scholarly journals 1301. Graphical Analysis of HIV Guidelines Adherence Finds System-Wide Anomalies in Diagnostic Testing

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S469-S470
Author(s):  
Ronald George Hauser ◽  
Ankur Bhargava ◽  
Maggie Chartier ◽  
Marissa Maier
Keyword(s):  
Clinical Practice ◽  
Hiv Testing ◽  
Directed Graph ◽  
Diagnostic Tests ◽  
Case Reports ◽  
Diagnostic Testing ◽  
Screening Tests ◽  
Medical Database ◽  
The Impact ◽  
Resistance Tests

Abstract Background The misuse of HIV diagnostic tests can delay HIV diagnosis, contribute to HIV transmission, incur unnecessary costs, and pose legal risks. Prompted by case reports of misused HIV diagnostic tests, we developed a method to systematically evaluate HIV diagnostic testing that utilized an observational medical database, evaluated performance at different levels (e.g., system, facility, clinician), adjudicated clinical practice patterns as adherent or nonadherent to guidelines, quantified the impact of clinical practice deviations, and identified targets for intervention. Methods We used graph theory to assess patterns of HIV testing in a national healthcare system. We obtained all HIV screening tests, viral loads, and resistance tests performed January 1, 2015–January 31, 2019, excluding HIV-positive and deceased individuals (Figure 1). We modeled the CDC’s HIV diagnostic testing guidelines as a directed graph (Figure 2A). Each node in the graph represented a test, and the edges pointed from one test to the next in chronological order. We then graphed each patient’s HIV testing. This set of patient-level graphs was aggregated into a single graph. Finally, we compared the two graphs, the first representing the CDC’s recommended approach to HIV diagnostic testing and the second representing the observed patterns of HIV testing, to assess for clinical practice deviations. Results The HIV diagnostic testing of 1.643 million patients from 130 facilities provided 8.790 million HIV diagnostic test results for analysis (Figure 1). Significant deviations from recommended practice were found including the use of HIV resistance tests (n = 3,007) and HIV nucleic acid tests (n = 16,567) instead of the recommended HIV screen (Figure 2B). The estimated costs of nonadherent testing totaled $2.427 million in 2018 dollars. Conclusion We developed a method that modeled a complex medical scenario as a directed graph. When applied to HIV diagnostic testing, we identified deviations in clinical practice from guideline recommendations. The model enabled the identification of intervention targets and prompted systemwide policy changes to reduce nonadherent orders and enhance HIV detection (Figure 3). This approach could be applied to diverse medical scenarios. Disclosures All authors: No reported disclosures.

Fluorescence in situ hybridization for identification and visualization of microorganisms in infected heart valve tissue as addition to standard diagnostic tests improves diagnosis of endocarditis

2019 ◽  
Vol 29 (5) ◽  
pp. 678-684
Author(s):  
Simone Eichinger ◽  
Judith Kikhney ◽  
Annette Moter ◽  
Alexandra Wießner ◽  
Walter B Eichinger
Keyword(s):  
In Situ Hybridization ◽  
Fluorescence In Situ Hybridization ◽  
Diagnostic Tests ◽  
Diagnostic Testing ◽  
Bacterial Biofilm ◽  
Causative Organism ◽  
Histopathological Diagnosis ◽  
Duke Criteria ◽  
The Impact

Abstract OBJECTIVES In infective endocarditis (IE), identification of the causative organism and consecutive treatment are crucial for patient survival. Although the macroscopic aspect resembles infected tissue, standard diagnostic tests often fail to allow one to identify bacteria. Fluorescence in situ hybridization (FISH) is a molecular, culture-independent technique that allows one to identify and visualize microorganisms within tissue and to recognize their morphology, number and activity. We analysed the diagnostic benefit of FISH/polymerase chain reaction (PCR) by comparing its results to those of standard diagnostic tests. METHODS From September 2015 to April 2018, 128 patients underwent first-time or redo valve surgery to treat IE. Patients were designated according to the modified Duke criteria as definite (n = 61), possible (n = 34) or rejected (n = 33) IE. Tissue specimens obtained intraoperatively were analysed using FISH/PCR in addition to undergoing standard diagnostic testing and PCR alone. RESULTS We used blood cultures to detect microorganisms in 67/128 patients; valve cultures, in 34/128; PCR, in 67/128; histopathological diagnosis showed IE in 72/128 cases. We were able to detect microorganisms in 103/128 cases using FISH/PCR, with 55/61 in definite IE. Furthermore, we were able to identify 26 cases of bacterial biofilm using FISH/PCR, despite antibiotic treatment of 61 in the definite, 13 in the possible and 1 in the rejected group, including 8/33 patients in the rejected group with active bacteria. In all cases, the patient’s therapy was altered. CONCLUSIONS FISH/PCR was used to identify microorganisms in cases in which standard diagnostic tests failed to provide sufficient results for various reasons. Furthermore, FISH/PCR enabled us to identify bacterial biofilms and to differentiate between active versus degraded bacteria, thus indicating the impact of treatment. Therefore, we suggest FISH/PCR as an additional diagnostic tool in IE alongside standard diagnostic tests.

scholarly journals The impact of prenatal screening tests on prenatal diagnosis in Taiwan from 2006 to 2019: a regional cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Ching Hua Hsiao ◽  
Ching Hsuan Chen ◽  
Po Jen Cheng ◽  
Steven W. Shaw ◽  
Woei Chyn Chu ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Prenatal Screening ◽  
Diagnostic Testing ◽  
First Trimester ◽  
Screening Tests ◽  
Screening Methods ◽  
Second Trimester ◽  
Invasive Procedures ◽  
Trimester Screening ◽  
The Impact

Abstract Background The purpose of this study is to evaluate the impact of prenatal screening tests on prenatal diagnosis in Taiwan’s 14 years from 2006 to 2019. Methods The prenatal screening methods evolved from the second-trimester serum screening to combined first-trimester screening (cFTS) and then followed by the non-invasive cell-free DNA prenatal test (NIPT). The data used by the Department of Statistics, the Ministry of Health and Welfare and Department of Household Registration, Ministry of the Interior public website. Results This regional registry-based cohort retrospective study examined a total of 2,775,792 births from January 2006 to December 2019. The proportion of advanced maternal age (AMA) pregnancies increased from 11.63% in 2006 to 30.94% in 2019. Overall, invasive diagnostic testing was used in 87.22% of AMA pregnancies. The prenatal detection rate of trisomy 21 and 18 increased from 74.1% and 83.3% in 2006 to 96.9% and 98.8% in 2019, respectively. Conclusion During the second-trimester and cFTS periods, the percentage of AMA pregnancies increased every year and the number of invasive procedures also accompany with increased percentage of AMA. However, during the period that NIPT were implemented, the percentage of invasive procedures decreased.

Transforming Healthcare Means Zero Harm: Laboratory Testing Matters

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S110-S111
Author(s):  
A Mina
Keyword(s):  
Clinical Practice ◽  
Secondary Prevention ◽  
Role Model ◽  
Clinical Laboratory ◽  
Diagnostic Testing ◽  
High Sensitivity ◽  
Care Patient ◽  
Screening Tests ◽  
High Risk Population ◽  
Extensive Experience

Abstract Introduction/Objective My role model when I was a medical technologist intern was a chief pathologist who taught me to speak up when something is unsafe and to serve willingly, do what is right, be fair and excellent in work. His character impacted my whole life and career. Every moment matters; life is precious and something to protect. The patient and their care teams depend upon accurate, safe and high-quality clinical laboratory tests result to achieve positive patient outcomes. Methods/Case Report Clinical Practice Results (if a Case Study enter NA) We can do better. Everybody can be surveyors with greater understanding of pathophysiologic processes in disease, extensive experience working in laboratories and in-depth knowledge about complaince, quality, mistake-proofing care, patient-focused and laboratory management. Diagnostic testing would be the method to screen for disease, confirm disease, and monitor disease in hopes of secondary prevention - to identify latent disease to “catch it early.” The screening tests could be anything from newborn screening for inborn metabolism errors, adult screening tests (like mammograms, pap smears, and colonoscopies), to high-risk population screenings to detect HIV, RPR, and gonorrhea. The disease must have a high prevalence to justify the expense of therapy and should be detectable before symptoms arise. The test must not have many false positives but extremely high sensitivity. The results of these tests could lead to the three different methods of prevention. Primary prevention would reduce the risk of developing cardiovascular disease or stroke. Secondary prevention would detect the disease early to prevent progression of the disease. Tertiary prevention would reduce disabilty and promotion of rehabilitation from the disease like strokes or rehab programs. Conclusion In conclusion, this information provides clinicians with a laboratory test menu guidelines to improve clinical practice. We can all learn well to focus on what really matters. Together, we can make healthcare better, more patient-centered, less costly, and safer.

scholarly journals Rational use of diagnostic tests for clinical decision making

2019 ◽  
Vol 65 (3) ◽  
pp. 452-459 ◽  
Author(s):  
Anna Maria Buehler ◽  
Bruna de Oliveira Ascef ◽  
Haliton Alves de Oliveira Júnior ◽  
Cleusa Pinheiro Ferri ◽  
Jefferson Gomes Fernandes
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Diagnostic Accuracy ◽  
Diagnostic Tests ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Cross Sectional ◽  
Rational Use ◽  
Cross Sectional Design ◽  
The Impact

SUMMARY OBJECTIVE: To assist clinicians to make adequate interpretation of scientific evidence from studies that evaluate diagnostic tests in order to allow their rational use in clinical practice. METHODS: This is a narrative review focused on the main concepts, study designs, the adequate interpretation of the diagnostic accuracy data, and making inferences about the impact of diagnostic testing in clinical practice. RESULTS: Most of the literature that evaluates the performance of diagnostic tests uses cross-sectional design. Randomized clinical trials, in which diagnostic strategies are compared, are scarce. Cross-sectional studies measure diagnostic accuracy outcomes that are considered indirect and insufficient to define the real benefit for patients. Among the accuracy outcomes, the positive and negative likelihood ratios are the most useful for clinical management. Variations in the study's cross-sectional design, which may add bias to the results, as well as other domains that contribute to decreasing the reliability of the findings, are discussed, as well as how to extrapolate such accuracy findings on impact and consequences considered important for the patient. Aspects of costs, time to obtain results, patients’ preferences and values should preferably be considered in decision making. CONCLUSION: Knowing the methodology of diagnostic accuracy studies is fundamental, but not sufficient, for the rational use of diagnostic tests. There is a need to balance the desirable and undesirable consequences of tests results for the patients in order to favor a rational decision-making approach about which tests should be recommended in clinical practice.

scholarly journals COVID-19 in pregnancy: What do we really know?

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 362
Author(s):  
Jerome Bouaziz ◽  
Marc Even ◽  
Frederique Isnard-Bogillot ◽  
Eli Vesale ◽  
Mariam Nikpayam ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Pregnant Women ◽  
Current Knowledge ◽  
Case Reports ◽  
Case Series ◽  
Adverse Outcomes ◽  
Health Concern ◽  
Case Control Studies ◽  
Increased Risk ◽  
The Impact

Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to escalate worldwide and has become a pressing global health concern. This article comprehensively reviews the current knowledge on the impact of COVID-19 over pregnant women and neonates, as well as current recommendations for their management. We also analyse previous evidences from viral respiratory diseases such as SARS, Middle East respiratory syndrome, and influenza that may help to guide clinical practice during the current pandemic. We collected 23 case reports, case series, and case-control studies (18 from China) comprising 174 pregnant women with COVID-19. The majority of mothers showed a clinical presentation of the disease similar to that of non-infected adults. Preliminary evidences point towards a potentially increased risk of pregnancy adverse outcomes in women with COVID-19, with preterm delivery the most frequently observed (16.7%) followed by fetal distress (9.77%). The most commonly reported adverse neonatal outcomes included respiratory symptoms (7.95%) and low birth weight (6.81%). A few studies reported other maternal comorbidities that can influence these outcomes. Mothers with other comorbidities may be at higher risk of infection. Mother-to-child transmission of SARS-CoV-2 appears unlikely, with no study observing intrauterine transmission, and a few cases of neonatal infection reported a few hours after birth. Although the WHO and other health authorities have published interim recommendations for care and management of pregnant women and infants during COVID-19 pandemic, many questions remain open. Pregnant women should be considered in prevention and control efforts, including the development of drugs and vaccines against SARS-CoV-2. Further research is needed to confirm the exact impact of COVID-19 infection during pregnancy. To fully quantify this impact, we urgently need to integrate the current knowledge about viral characteristics, epidemiology, disease immunopathology, and potential therapeutic strategies with data from the clinical practice.

scholarly journals Bronchiolitis clinical practice guidelines implementation: surveillance study of hospitalized children in Jordan

2020 ◽  
Vol 15 ◽  
Author(s):  
Samah Awad ◽  
Rawan Hatim ◽  
Yousef Khader ◽  
Mohammad Alyahya ◽  
Nada Harik ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Diagnostic Tests ◽  
Hospital Admissions ◽  
Diagnostic Testing ◽  
University Hospital ◽  
Evidence Based ◽  
Diagnosis And Management ◽  
Syncytial Virus

Background: Bronchiolitis is a leading cause of hospital admissions and death in young children. Clinical practice guidelines (CPG) to diagnose and manage bronchiolitis have helped healthcare providers to avoid unnecessary investigations and interventions and to provide evidence-based treatment. Aim of this study is to determine the effect of implementing CPG for the diagnosis and management of bronchiolitis in a tertiary hospital in Jordan. Methods: The study compared children (age <24 months) diagnosed with bronchiolitis and who required admission to King Abdullah University Hospital in Irbid during the winter of 2017 (after CPG implementation) and age-matched children admitted in the winter of 2016. The proportion of patients receiving diagnostic tests and treatments in the two groups were compared.Results: Eighty-eight and 91 patients were diagnosed with bronchiolitis before and after CPG implementation, respectively. Respiratory syncytial virus rapid antigen detection testing decreased after CPG implementation [n=64 (72.7%) vs n=46 (50.5%), p=0.002]. However, there was no significant change in terms of other diagnostic tests. The use of nebulized salbutamol [n=44 (50%) vs n=29 (31.9%), p=0.01], hypertonic saline [n=39 (44.3%) vs n=8 (8.8%), p<0.001], and inappropriate antibiotics [n=31 (35.2%) vs n=15 (16.5%), p=0.004] decreased after CPG implementation. There was no difference in mean LOS (standard deviation; SD) between the pre- and post-CPG groups [3.5 (2) vs 4 (3.4) days, p=0.19]. The mean cost of stay (SD) was 449.4 (329.1) US dollars for pre-CPG compared to 507.3 (286.1) US dollars for the post-CPG group (p=0.24).Conclusion: We observed that the implementation of CPG for bronchiolitis diagnosis and management helped change physicians’ behavior toward evidence-based practices. However, adherence to guidelines must be emphasized to improve practices in developing countries, focusing on the rational use of diagnostic testing, and avoiding use of unnecessary medications when managing children with a diagnosis of bronchiolitis.

scholarly journals How COVID-19 pandemic is changing the practice of prenatal screening and diagnosis?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Hakan Golbasi ◽  
Ibrahim Omeroglu ◽  
Burak Bayraktar ◽  
Ceren Golbasi ◽  
Duygu Adıyaman ◽  
...  
Keyword(s):  
Diagnostic Tests ◽  
Prenatal Screening ◽  
Screening Tests ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Outpatient Visits ◽  
Prenatal Diagnostic ◽  
The Impact ◽  
Fetal Screening ◽  
Screening And Diagnosis

Abstract Objectives To evaluate the impact of the COVID-19 pandemic on prenatal screening and diagnostic tests. Methods We conducted a retrospective study with pregnant women attending to the perinatology department of a tertiary referral center. The pre-COVID-19 period between 11 March 2019 and 10 March 2020 and COVID-19 period between 11 March 2020 and 10 March 2021 were evaluated. Both periods were compared in terms of outpatient visits, ultrasound examinations, prenatal screening and diagnostic tests. The correlation of deaths related to COVID-19 pandemic on these parameters was also assessed. Results A total of 38,918 patients were examined and 28,452 ultrasound examinations, 26,672 prenatal screening tests and 1,471 prenatal diagnostic tests were performed over two years. During COVID-19 pandemic, number of outpatient visits decreased by 25.2%, ultrasound examinations decreased by 44.2%, prenatal screening tests decreased by 36.2% and prenatal diagnostic tests decreased by 30.7%. Statistically significant correlation was not observed between deaths related to COVID-19 and outpatient visits (p=0.210), ultrasound examinations (p=0.265), prenatal screening (p=0.781) and diagnostic tests (p=0.158). Among indications of prenatal diagnostic tests, maternal anxiety was significantly higher in COVID-19 period (p=0.023). There was significant decrease in the detection of fetuses with trisomy 21 (p=0.047) and a significant increase in the detection of fetuses with Turner syndrome (p=0.017) during COVID-19 period. Conclusions The COVID-19 pandemic has severely impacted antenatal care. Prenatal fetal screening and diagnosis was adversely affected by the pandemic in terms of detecting genetic and structural anomalies.

scholarly journals Influence of Inflammation on Cytochromes P450 Activity in Adults: A Systematic Review of the Literature

2021 ◽  
Vol 12 ◽  
Author(s):  
Camille Lenoir ◽  
Victoria Rollason ◽  
Jules A. Desmeules ◽  
Caroline F. Samer
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Case Reports ◽  
Cytochromes P450 ◽  
Convincing Evidence ◽  
Pharmacokinetic Parameters ◽  
Published Data ◽  
Resolution Of Inflammation ◽  
The Impact

Background: Available in-vitro and animal studies indicate that inflammation impacts cytochromes P450 (CYP) activity via multiple and complex transcriptional and post-transcriptional mechanisms, depending on the specific CYP isoforms and the nature of inflammation mediators. It is essential to review the current published data on the impact of inflammation on CYP activities in adults to support drug individualization based on comorbidities and diseases in clinical practice.Methods: This systematic review was conducted in PubMed through 7th January 2021 looking for articles that investigated the consequences of inflammation on CYP activities in adults. Information on the source of inflammation, victim drugs (and CYPs involved), effect of disease-drug interaction, number of subjects, and study design were extracted.Results: The search strategy identified 218 studies and case reports that met our inclusion criteria. These articles were divided into fourteen different sources of inflammation (such as infection, autoimmune diseases, cancer, therapies with immunomodulator…). The impact of inflammation on CYP activities appeared to be isoform-specific and dependent on the nature and severity of the underlying disease causing the inflammation. Some of these drug-disease interactions had a significant influence on drug pharmacokinetic parameters and on clinical management. For example, clozapine levels doubled with signs of toxicity during infections and the concentration ratio between clopidogrel’s active metabolite and clopidogrel is 48-fold lower in critically ill patients. Infection and CYP3A were the most cited perpetrator of inflammation and the most studied CYP, respectively. Moreover, some data suggest that resolution of inflammation results in a return to baseline CYP activities.Conclusion: Convincing evidence shows that inflammation is a major factor to be taken into account in drug development and in clinical practice to avoid any efficacy or safety issues because inflammation modulates CYP activities and thus drug pharmacokinetics. The impact is different depending on the CYP isoform and the inflammatory disease considered. Moreover, resolution of inflammation appears to result in a normalization of CYP activity. However, some results are still equivocal and further investigations are thus needed.

Molecular diagnostic testing patterns in patients (pts) with myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) in the Connect MDS/AML Registry.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7553-7553
Author(s):  
Tracy George ◽  
Jay L. Patel ◽  
Mehrdad Abedi ◽  
Christopher R. Cogle ◽  
Harry Paul Erba ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Diagnostic Testing ◽  
Gene Mutations ◽  
Integrated Approach ◽  
Geographic Region ◽  
Molecular Diagnostic ◽  
Molecular Testing ◽  
Factors Associated ◽  
The Impact ◽  
Testing Patterns

7553 Background: MDS and AML diagnosis requires an integrated approach including morphologic, cytogenetic and molecular testing. The WHO classification criteria for MDS and AML diagnosis were updated in 2016; however, the impact on clinical practice is unclear. We investigated molecular testing patterns for pts with MDS or AML treated in academic (AC) or community/government (CO/GOV)-based centers in the Connect MDS/AML Registry. Methods: The Connect MDS/AML Disease Registry (NCT01688011) is a large ongoing, US, multicenter, prospective observational cohort study of pts with MDS (aged ≥ 18 yrs) or AML (aged ≥ 55 yrs). Patient data were collected for this analysis upon enrollment from 12 Dec 2013 to 13 Dec 2019, the analysis cut-off. Differences in molecular testing between MDS and AML pts were evaluated and logistic regression used to assess factors associated with increased molecular testing. Results: As of 13 Dec 2019, 800 MDS pts and 626 AML pts were enrolled; median age was 74 vs 71 yrs, 66.3% vs 61.5% were male, and 73.5% vs 60.2% were insured by Medicare/Medicaid. A greater proportion of AML pts (77.5%) had molecular testing vs MDS pts (29.1%). Of 380 MDS pts enrolled before 2017 (< 2017), 16.8% had molecular testing, increasing to 40.2% in 420 MDS pts enrolled from 2017 onward (≥ 2017). Of 289 AML pts enrolled < 2017, 68.9% had molecular testing, increasing to 84.9% in 337 AML pts enrolled ≥ 2017. Mean number of mutations tested increased between < 2017 and ≥ 2017 from 6.9 to 12.7 in MDS pts and from 6.1 to 10.4 in AML pts. Of the 11 mutations most frequently tested ≥ 2017 in MDS and AML pts, 0% and 36%, respectively, have FDA-approved targeted therapies. Gene mutations tested differed between MDS and AML pts; ASXL1 was most frequently tested in MDS pts (68.2%) and FLT3-ITD in AML pts (89.7%). Testing rates increased between < 2017 and ≥ 2017 for ASXL1 from 48.4% to 75.7% in MDS pts and for FLT3-ITD from 84.4% to 93.4% in AML pts. Factors associated with increased testing were age < 75 (vs ≥ 75) yrs, ELN score ≥ 2 (vs 1) and enrollment at AC site (vs CO/GOV) (all P < 0.01) in AML pts and age < 80 (vs ≥ 80 yrs; P < 0.01), AC site (vs CO/GOV; P < 0.01), and geographic region outside the Midwest ( P = 0.015) in MDS pts. Conclusions: While molecular testing rates have increased since the publication of the WHO 2016 criteria, molecular testing rates for MDS pts remain lower than those for AML pts in real-world clinical practice. Elderly pts and pts enrolled in CO/GOV sites were found to have lower rates of molecular testing in both MDS and AML patient cohorts.

Translating Principles of Speech Science to Clinical Practice: Current and Future Trends in Craniofacial Disorders

2008 ◽  
Vol 18 (1) ◽  
pp. 31-40 ◽  
Author(s):  
David J. Zajac
Keyword(s):  
Clinical Practice ◽  
Speech Intelligibility ◽  
Current Practice ◽  
Computer Assisted ◽  
Behavioral Management ◽  
Single Word ◽  
Future Directions ◽  
Speech Science ◽  
The Impact ◽  
Opinion Article

Abstract The purpose of this opinion article is to review the impact of the principles and technology of speech science on clinical practice in the area of craniofacial disorders. Current practice relative to (a) speech aerodynamic assessment, (b) computer-assisted single-word speech intelligibility testing, and (c) behavioral management of hypernasal resonance are reviewed. Future directions and/or refinement of each area are also identified. It is suggested that both challenging and rewarding times are in store for clinical researchers in craniofacial disorders.

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