scholarly journals Automated STI/HIV risk assessments: Testing an online clinical algorithm in Ottawa, Canada

2021 ◽  
pp. 095646242110313
Author(s):  
Patrick O’Byrne ◽  
Alexandra Musten ◽  
Lauren Orser ◽  
Scott Buckingham
Keyword(s):  
Hiv Transmission ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Quadratic Equation ◽  
Hiv Care ◽  
Sexually Transmitted ◽  
Sti Testing ◽  
Test Kit ◽  
Two Measures ◽  
Stis And Hiv

Despite the ongoing transmission of sexually transmitted infections (STIs) and HIV, many people became unable to access testing due to COVID-19. To address this, we created a mail-out HIV self-test kit, which could be delivered without restrictions in our region. The uptake and feedback from this project made us realize that comprehensive STI testing was being sought. To ensure testing occurred correctly—that is, it would be targeted at the persons most affected by STIs/HIV—we automated clinical decision-making. We built this model based on a 2-by-2 matrix that plots the risk of STI/HIV transmission and risk of STI/HIV exposure. The intercept of these two measures classifies a person as low, medium, or high risk. After automating this logic, 16 expert clinicians in STI/HIV care tested this system with over 400 test patient cases and refined the algorithm until it yielded the exact outcomes that these clinicians would offer patients based on guidelines. Findings of interest are that the scale of the y-axis is exponential, in that risk factors for exposure do not climb cumulatively but do so according to a quadratic equation. This helps ensure that testing services are targeted at those who are most inequitably burdened by these infections.

Diagnostic performance of the noninvasive prenatal FetoGnost RhD assay for the prediction of the fetal RhD blood group status

2021 ◽  
Author(s):  
Tobias J. Legler ◽  
Sandra Lührig ◽  
Irina Korschineck ◽  
Dieter Schwartz
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Performance ◽  
Clinical Decision Making ◽  
False Negative ◽  
Clinical Decision ◽  
Multiple Pregnancies ◽  
Group Status ◽  
Test Kit ◽  
Existing Data

Abstract Purpose: To evaluate the diagnostic accuracy of a commercially available test kit for noninvasive prenatal determination of the fetal RhD status (NIPT-RhD) with a focus on early gestation and multiple pregnancies. Methods: The FetoGnost RhD assay (Ingenetix, Vienna, Austria) is routinely applied for clinical decision making either in woman with anti-D alloimmunization or in order to target the application of routine antenatal anti-D prophylaxis (RAADP) to women with a RhD positive fetus. Based on existing data in the laboratory information system the newborn’s serological RhD status was compared with NIPT RhD results. Results: Since 2009 NIPT RhD was performed in 2,968 pregnant women between week 5+6 and 40+0 of gestation (median 12+6) and conclusive results were obtained in 2,888 (97.30%) cases. Diagnostic accuracy was calculated from those 2244 (77.70%) cases with the newborn’s serological RhD status reported. The sensitivity of the FetoGnost RhD assay was 99.93% (95% CI 99.61% - 99.99%) and the specificity was 99.61% (95% CI 98.86% - 99.87%). No false positive or false negative NIPT RhD result was observed in 203 multiple pregnancies. Conclusion: NIPT RhD results are reliable when obtained with FetoGnost RhD assay. Targeted routine anti-D-prophylaxis can start as early as 11+0 weeks of gestation in singleton and multiple pregnancies.

“Mini Dial-A-Nurses” and “Good Brands“: What Are the Desirable Features of Online HIV/STI Risk Calculators?

2020 ◽  
Vol 32 (6) ◽  
pp. 528-542
Author(s):  
Oralia Gómez-Ramírez ◽  
Kim Thomson ◽  
Travis Salway ◽  
Devon Haag ◽  
Titilola Falasinnu ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Thematic Analysis ◽  
Sexual Behaviors ◽  
Clinical Decision Making ◽  
Service Providers ◽  
Clinical Decision ◽  
End Users ◽  
Risk Assessments ◽  
Sexually Transmitted ◽  
Personalized Risk

A wide variety of risk calculators estimate individuals’ risk for HIV/sexually transmitted infections (STI) online. These tools can help target HIV/STI screening and optimize clinical decision-making. Yet, little evidence exists on suitable features for these tools to be acceptable to end-users. We investigated the desirable characteristics of risk calculators among STI clinic clients and testing service providers. Participants interacted with online HIV/STI risk calculators featuring varied target audiences, completion lengths, and message outputs. Thematic analysis of focus groups identified six qualities that would make risk calculators more appealing for online client use: providing personalized risk assessments based on users’ specific sexual behaviors and HIV/STI-related concerns; incorporating nuanced risk assessment and tailored educational information; supplying quantifiable risk estimates; using non-stigmatizing and inclusive framing; including explanations and next steps; and developing effective and appropriate branding. Incorporating these features in the design of online HIV/STI risk calculators may improve their acceptability among end-users.

scholarly journals Diagnostic performance of the noninvasive prenatal FetoGnost RhD assay for the prediction of the fetal RhD blood group status

2021 ◽  
Author(s):  
Tobias J. Legler ◽  
Sandra Lührig ◽  
Irina Korschineck ◽  
Dieter Schwartz
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Performance ◽  
Clinical Decision Making ◽  
False Negative ◽  
Clinical Decision ◽  
Multiple Pregnancies ◽  
Group Status ◽  
Test Kit ◽  
Existing Data

Abstract Purpose To evaluate the diagnostic accuracy of a commercially available test kit for noninvasive prenatal determination of the fetal RhD status (NIPT-RhD) with a focus on early gestation and multiple pregnancies. Methods The FetoGnost RhD assay (Ingenetix, Vienna, Austria) is routinely applied for clinical decision making either in woman with anti-D alloimmunization or to target the application of routine antenatal anti-D prophylaxis (RAADP) to women with a RhD positive fetus. Based on existing data in the laboratory information system the newborn’s serological RhD status was compared with NIPT RhD results. Results Since 2009 NIPT RhD was performed in 2968 pregnant women between weeks 5 + 6 and 40 + 0 of gestation (median 12 + 6) and conclusive results were obtained in 2888 (97.30%) cases. Diagnostic accuracy was calculated from those 2244 (77.70%) cases with the newborn’s serological RhD status reported. The sensitivity of the FetoGnost RhD assay was 99.93% (95% CI 99.61–99.99%) and the specificity was 99.61% (95% CI 98.86–99.87%). No false-positive or false-negative NIPT RhD result was observed in 203 multiple pregnancies. Conclusion NIPT RhD results are reliable when obtained with FetoGnost RhD assay. Targeted routine anti-D-prophylaxis can start as early as 11 + 0 weeks of gestation in singleton and multiple pregnancies.

“I’ve got HIV and I want to have a baby”

HIV ◽  
2020 ◽  
pp. 67-78
Author(s):  
Thana Khawcharoenporn ◽  
Beverly E. Sha
Keyword(s):  
Hiv Transmission ◽  
Opportunistic Infections ◽  
Perinatal Transmission ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Sexually Transmitted ◽  
Comprehensive Management ◽  
Art Initiation ◽  
Effective Combination ◽  
Intrapartum Management

Perinatal transmission is one of the important routes of HIV transmission that is preventable in the era of effective combination antiretroviral therapy (ART). This chapter presents the case of a known HIV-infected, ART-naïve pregnant woman who establishes antenatal and HIV care late, at 32 weeks’ gestational age. Her presentation raises concerns about the potential risk of HIV transmission to her baby given limited time to achieve HIV virologic suppression. The appropriate management is discussed, which includes first-encounter screening, management of opportunistic infections and sexually transmitted infections, risk behavior modification and counseling, ART initiation and treatment monitoring, intrapartum management, infant prophylaxis, and postpartum HIV care. The case presentation and discussion highlight the importance of comprehensive management of HIV infection in pregnant women to minimize the risk of mother-to-infant HIV transmission and optimize HIV control in the mothers.

Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

2015 ◽  
Vol 25 (1) ◽  
pp. 50-60
Author(s):  
Anu Subramanian
Keyword(s):  
Graduate Students ◽  
Clinical Education ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Added Value ◽  
Therapeutic Outcomes ◽  
Specific Feedback ◽  
Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

Clinical Decision-Making for Stroke and Aphasia in the Older Adult

2009 ◽  
Vol 14 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Jacqueline Hinckley
Keyword(s):  
Executive Function ◽  
Cerebrovascular Disease ◽  
Cognitive Abilities ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cognitive Profile ◽  
Focal Lesion ◽  
Cognitive Profiles ◽  
Supportive Communication ◽  
Spaced Retrieval

Abstract A patient with aphasia that is uncomplicated by other cognitive abilities will usually show a primary impairment of language. The frequency of additional cognitive impairments associated with cerebrovascular disease, multiple (silent or diagnosed) infarcts, or dementia increases with age and can complicate a single focal lesion that produces aphasia. The typical cognitive profiles of vascular dementia or dementia due to cerebrovascular disease may differ from the cognitive profile of patients with Alzheimer's dementia. In order to complete effective treatment selection, clinicians must know the cognitive profile of the patient and choose treatments accordingly. When attention, memory, and executive function are relatively preserved, strategy-based and conversation-based interventions provide the best choices to target personally relevant communication abilities. Examples of treatments in this category include PACE and Response Elaboration Training. When patients with aphasia have co-occurring episodic memory or executive function impairments, treatments that rely less on these abilities should be selected. Examples of treatments that fit these selection criteria include spaced retrieval and errorless learning. Finally, training caregivers in the use of supportive communication strategies is helpful to patients with aphasia, with or without additional cognitive complications.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

Sign in / Sign up

Export Citation Format

Share Document