scholarly journals Coinfection of cattle in Virginia with Theileria orientalis Ikeda genotype and Anaplasma marginale

2021 ◽  
pp. 104063872110576
Author(s):  
Vanessa J. Oakes ◽  
S. Michelle Todd ◽  
Amanda A. Carbonello ◽  
Pawel Michalak ◽  
Kevin K. Lahmers
Keyword(s):  
United States ◽  
Clinical Decision Making ◽  
Anaplasma Marginale ◽  
Clinical Decision ◽  
The United States ◽  
Diagnostic Information ◽  
Theileria Orientalis ◽  
Blood Samples ◽  
The Difference ◽  
Tick Vectors

Theileria orientalis Ikeda is a newly identified agent of bovine infectious anemia in the United States. Although T. orientalis Ikeda is transmitted by ticks other than the tick that transmits Anaplasma marginale—a bacterial etiology of bovine infectious anemia—the geographic distributions of these 2 infectious organisms overlap, with coinfection reported in some cattle. Only anaplasmosis has an approved effective treatment in the United States. To provide rapid diagnostic information for producers with anemic animals, we developed a duplex real-time PCR (rtPCR) for A. marginale and T. orientalis. With a cutoff of 38 cycles, the duplex assay has a sensitivity of 97.0% and a specificity of 100% for A. marginale; with a cutoff of 45 cycles, the duplex assay has a sensitivity and a specificity of 100% for T. orientalis, compared to existing tests. In addition to providing a tool for improved clinical decision-making for veterinarians and producers, our rtPCR facilitates the study of coinfection of cattle in Virginia. Of 1,359 blood samples analyzed, 174 were positive for T. orientalis, 125 were positive for A. marginale, and 12 samples were positive for both T. orientalis and A. marginale. Hence, coinfection by these 2 agents of bovine infectious anemia does occur within Virginia. It is likely that this pattern of infection will be seen in other regions where T. orientalis and A. marginale infections are endemic, despite the difference in tick vectors.

scholarly journals Co-Infection of cattle in Virginia with Theileria orientalis ikeda genotype and Anaplasma marginale

2021 ◽  
Author(s):  
Vanessa J. Oakes ◽  
S. Michelle Todd ◽  
Amanda A. Carbonello ◽  
Pawel Michalak ◽  
Kevin K. Lahmers
Keyword(s):  
United States ◽  
Clinical Decision Making ◽  
Anaplasma Marginale ◽  
Clinical Decision ◽  
The United States ◽  
Diagnostic Information ◽  
Theileria Orientalis ◽  
Blood Samples ◽  
The Difference ◽  
Tick Vectors

AbstractTheileria orientalis ikeda is a newly identified agent of bovine infectious anemia in the United States. Although it is transmitted by separate tick hosts than Anaplasma marginale – a bacterial etiology of bovine infectious anemia –the geographic distributions of these two infectious organisms overlap, with co-infection reported in some cattle. Only anaplasmosis has approved effective treatment in the United States. To provide rapid diagnostic information for producers with anemic animals, we developed a duplex qPCR for A. marginale and T. orientalis. With a cut-off of 38 cycles, the duplex assay has a sensitivity of 96.97% and a specificity of 100% for A. marginale; with a cut-off of 45 cycles, the duplex assay has a sensitivity and a specificity of 100% for T. orientalis. In addition to providing a tool for improved clinical decision-making for veterinarians and producers, this qPCR facilitates the study of co-infection rate of cattle in Virginia. Of 1,359 blood samples analyzed, 174 were positive for the presence of T. orientalis, 125 were positive for the presence of A. marginale, and 12 samples were positive for both T. orientalis and A. marginale. This indicated that co-infection of both of these etiologies of bovine infectious anemia does occur within the state of Virginia. It is likely that this pattern of infection will be seen in regions where T. orientalis and A. marginale are endemic, despite the difference in tick vectors.

Quality improvement strategies and tools: A comparative analysis between Italy and the United States

2018 ◽  
Vol 31 (4) ◽  
pp. 205-217 ◽  
Author(s):  
Stefano Villa ◽  
Joseph D Restuccia ◽  
Eugenio Anessi-Pessina ◽  
Marco Giovanni Rizzo ◽  
Alan B Cohen
Keyword(s):  
United States ◽  
Quality Improvement ◽  
Clinical Decision Making ◽  
Clinical Pathways ◽  
Clinical Decision ◽  
The United States ◽  
Quality Performance ◽  
Report Quality ◽  
Improvement Strategies ◽  
The Difference

Italian and American hospitals, in two different periods, have been urged by external circumstances to extensively redesign their quality improvement strategies. This paper, through the use of a survey administered to chief quality officers in both countries, aims to identify commonalities and differences between the two systems and to understand which approaches are effective in improving quality of care. In both countries chief quality officers report quality improvement has become a strategic priority, clinical governance approaches, and tools—such as disease-specific quality improvement projects and clinical pathways—are commonly used, and there is widespread awareness that clinical decision making must be supported by protocols and guidelines. Furthermore, the study clearly outlines the critical importance of adopting a system-wide approach to quality improvement. To this extent Italy seems lagging behind compared to US in fact: (i) responsibilities for different dimensions of quality are spread across different organizational units; (ii) quality improvement strategies do not typically involve administrative staff; and (iii) quality performance measures are not disseminated widely within the organization but are reported primarily to top management. On the other hand, in Italy chief quality officers perceive that the typical hospital organizational structure, which is based on clinical directories, allows better coordination between clinical specialties than in the United States. In both countries, the results of the study show that it is not the single methodology/model that makes the difference but how the different quality improvement strategies and tools interact to each other and how they are coherently embedded with the overall organizational strategy.

Breast Cancer Screening and Diagnosis Clinical Practice Guidelines

2006 ◽  
Vol 4 (5) ◽  
pp. 480 ◽  
Author(s):  
_ _
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Practice Guidelines ◽  
Clinical Decision Making ◽  
Cost Effective ◽  
Clinical Decision ◽  
The United States ◽  
Mammographic Screening ◽  
Effective Manner ◽  
Recent Version

The lifetime risk of a woman developing breast cancer has increased over the past 5 years in the United States: of every 7 women, 1 is at risk based on a life expectancy of 85 years. An estimated 214,640 new cases (212,920 women and 1,720 men) of breast cancer and 41,430 deaths (40,970 women and 460 men) from this disease will occur in the United States in 2006. However, mortality from breast cancer has decreased slightly, attributed partly to mammographic screening. Early detection and accurate diagnosis made in a cost-effective manner are critical to a continued reduction in mortality. These practice guidelines are designed to facilitate clinical decision making. For the most recent version of the guidelines, please visit NCCN.org

scholarly journals Influence of Prior Authorization Requirements on Provider Clinical Decision Making

2021 ◽  
Author(s):  
Stephen Salzbrenner ◽  
Maxwell Lydiatt ◽  
Brandon Heldin ◽  
Lawrence M. Scheier ◽  
Harrison Greene ◽  
...  
Keyword(s):  
United States ◽  
Decision Making ◽  
Health Plan ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The United States ◽  
Trial Registration ◽  
Prior Authorization ◽  
Step Therapy ◽  
Effective Use

Abstract Background: Prior authorization (PA) of medications is widely used by payers in the United States as a way to promote safe and effective use of medications and to control costs. However, PA-related tasks such as completing forms, submitting forms, researching medical history and submitting required documentation can all contribute to burden on healthcare providers. This study examines how such tasks and affect provider burden and treatment decisions. Methods: We developed and administered a nationwide, cross-sectional online survey of medical providers in the United States in 2020 based on a convenience sample of 100,000 providers (physicians, nurse practitioners, and physician assistants). Path analysis was used to test the associations between provider practice characteristics, step therapy and other health plan requirements, perceived burdens of PA, and communication issues with insurers on prescribing behaviors, which included prescribing a different medication, avoiding prescribing of newer medications, and modifying a diagnosis. Weighted analyses were also conducted to account for sample bias due to non-response. Results: A total of 1173 providers (1.2% response rate) provided 1147 usable surveys. The sample was 49.6% female, and a majority were MD/DO providers (85%). Step therapy requirements had the largest influence on prescribing a different medication than planned (b = .22, 95% CI = .160-.285) and avoiding prescribing a newer medication despite meeting evidence-based guidelines (b = .24, 95% CI = .181-.309). A unit-weighted index of perceived PA burden risk was associated with prescribing a different medication (b = .09, 95% CI = .012-.128) and modifying a diagnosis to obtain PA approval (b = .14, 95% CI = .065-.195). Communication issues were associated with prescribing a different medication (b = .11, 95% CI = .029-.186), while health plan requirements (e.g., clinical documentation) was significantly associated with all three prescribing outcomes. Weighted analyses showed that the study conclusions were unlikely to have been biased by nonresponse. Conclusions: Providers report altering prescribing and modifying diagnoses to avoid PA requirements and related burdens. Processes that reduce the administrative burden of PA through improved communication and transparency as well as standardized documentation may help ensure that PA more seamlessly achieves its goals of safe and effective use of medications. Trial Registration: NA Keywords: clinical decision making, health plan, prior authorization, provider burden, specialty types, workaroundsTrial Registration: NA

scholarly journals The United States Medical Licensing Examination Step 1 Is Changing—US Medical Curricula Should Too

10.2196/20182 ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e20182
Author(s):  
Benjamin Liu
Keyword(s):  
United States ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The United States ◽  
Medical Decision ◽  
Medical Licensing ◽  
Traditional Lectures ◽  
Usmle Step 1 ◽  
Licensing Examination ◽  
Usmle Step

In recent years, US medical students have been increasingly absent from medical school classrooms. They do so to maximize their competitiveness for a good residency program, by achieving high scores on the United States Medical Licensing Examination (USMLE) Step 1. As a US medical student, I know that most of these class-skipping students are utilizing external learning resources, which are perceived to be more efficient than traditional lectures. Now that the USMLE Step 1 is adopting a pass/fail grading system, it may be tempting to expect students to return to traditional basic science lectures. Unfortunately, my experiences tell me this will not happen. Instead, US medical schools must adapt their curricula. These new curricula should focus on clinical decision making, team-based learning, and new medical decision technologies, while leveraging the validated ability of these external resources to teach the basic sciences. In doing so, faculty will not only increase student engagement but also modernize the curricula to meet new standards on effective medical learning.

The knowledge and practices of urologists in the United States (US) about standardization of PSA assays.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 207-207
Author(s):  
A. Gupta ◽  
S. F. Shariat ◽  
J. A. Eastham ◽  
P. T. Scardino ◽  
A. J. Vickers ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Decision Making ◽  
Reference Range ◽  
Prostate Cancer Screening ◽  
Prostate Cancer Risk ◽  
Clinical Decision ◽  
The United States ◽  
Web Based ◽  
The Us ◽  
The Difference

207 Background: PSA assays can be calibrated to either the WHO or the Hybritech standard. Studies of PSA-based prostate cancer screening have used Hybritech-standardized assays and prostate cancer risk calculators are based on these studies. Testing of patient samples with a WHO calibrated assay gives values that are 22% lower than from those with Hybritech-calibrated assays. Up to 60% of the labs in the US use WHO calibrated assays. We evaluated whether US urologists are aware of the different calibrators and the differences in PSA values. Methods: A random sample of 1,742 US urologists were invited by email to participate in a web-based survey of their knowledge and practices regarding PSA assay standardization. No mention was made of assays or calibration in the invitation. 419 responses were received. Results: Many (56%) US urologists thought that different standards may lead to clinically relevant differences in PSA values. Although 62% reported awareness of the two PSA calibrators, 67% did not know the difference between the two. Only 17% correctly reported the difference between the two standards. Nationally almost 60% of the labs use WHO standardized assays, but in this survey only 5% of the urologists thought that the hospital where they practice used a WHO standardized assay. The rest reported either not knowing the standard (46%) or use of the Hybritech standard (49%). The majority of urologists did not look at the reference range (64%) or for the PSA standard (74%) in the lab reports. Only 25% reported considering the PSA-calibration in their clinical decisions about prostate biopsy, but only a third of them correctly knew the difference between the calibrators. Conclusions: Many US urologists are unaware of the difference caused by WHO versus Hybritech based PSA-assay calibration. Although 60% of clinical laboratories use WHO-calibrated assays, only 5% of urologists are aware of this use in their practice, and a majority of urologists could not correctly explain the difference between the different calibrators. A greater awareness is needed amongst US urologists about the different PSA calibrators, the calibrator in use at their practice, and means to account for different calibrators in clinical decision making. [Table: see text]

scholarly journals The United States Medical Licensing Examination Step 1 Is Changing—US Medical Curricula Should Too (Preprint)

2020 ◽  
Author(s):  
Benjamin Liu
Keyword(s):  
United States ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The United States ◽  
Medical Decision ◽  
Medical Licensing ◽  
Traditional Lectures ◽  
Usmle Step 1 ◽  
Licensing Examination ◽  
Usmle Step

UNSTRUCTURED In recent years, US medical students have been increasingly absent from medical school classrooms. They do so to maximize their competitiveness for a good residency program, by achieving high scores on the United States Medical Licensing Examination (USMLE) Step 1. As a US medical student, I know that most of these class-skipping students are utilizing external learning resources, which are perceived to be more efficient than traditional lectures. Now that the USMLE Step 1 is adopting a pass/fail grading system, it may be tempting to expect students to return to traditional basic science lectures. Unfortunately, my experiences tell me this will not happen. Instead, US medical schools must adapt their curricula. These new curricula should focus on clinical decision making, team-based learning, and new medical decision technologies, while leveraging the validated ability of these external resources to teach the basic sciences. In doing so, faculty will not only increase student engagement but also modernize the curricula to meet new standards on effective medical learning.

scholarly journals Symptoms of COVID-19 Outpatients in the United States

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Matthew F Pullen ◽  
Caleb P Skipper ◽  
Kathy H Hullsiek ◽  
Ananta S Bangdiwala ◽  
Katelyn A Pastick ◽  
...  
Keyword(s):  
United States ◽  
Clinical Decision Making ◽  
Diagnostic Testing ◽  
Clinical Decision ◽  
The United States ◽  
Early Infection ◽  
Late Infection ◽  
Symptom Profiles ◽  
Symptom Frequency ◽  
Time Point

Abstract Background Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel pathogen causing the current worldwide coronavirus disease 2019 (COVID-19) pandemic. Due to insufficient diagnostic testing in the United States, there is a need for clinical decision-making algorithms to guide testing prioritization. Methods We recruited participants nationwide for a randomized clinical trial. We categorized participants into 3 groups: (1) those with confirmed SARS-CoV-2 infection, (2) those with probable SARS-CoV-2 infection (pending test or not tested but with a confirmed COVID-19 contact), and (3) those with possible SARS-CoV-2 infection (pending test or not tested and with a contact for whom testing was pending or not performed). We compared the frequency of self-reported symptoms in each group and categorized those reporting symptoms in early infection (0–2 days), midinfection (3–5 days), and late infection (>5 days). Results Among 1252 symptomatic persons screened, 316 had confirmed, 393 had probable, and 543 had possible SARS-CoV-2 infection. In early infection, those with confirmed and probable SARS-CoV-2 infection shared similar symptom profiles, with fever most likely in confirmed cases (P = .002). Confirmed cases did not show any statistically significant differences compared with unconfirmed cases in symptom frequency at any time point. The most commonly reported symptoms in those with confirmed infection were cough (82%), fever (67%), fatigue (62%), and headache (60%), with only 52% reporting both fever and cough. Conclusions Symptomatic persons with probable SARS-CoV-2 infection present similarly to those with confirmed SARS-CoV-2 infection. There was no pattern of symptom frequency over time.

Mitigating Implicit Bias in Clinical Decision Making

2021 ◽  
Author(s):  
Keith Scally
Keyword(s):  
United States ◽  
Decision Making ◽  
Black Women ◽  
Clinical Decision Making ◽  
Implicit Bias ◽  
Clinical Decision ◽  
The United States ◽  
Healthcare Outcomes ◽  
Maternal Deaths ◽  
The Past

Background: Evidence supports that maternal deaths among Black women in the United States have substantially increased over the past three decades. While the cause of these deaths can be multifactorial, research reveals that implicit bias can be a contributing factor. Implicit bias can negatively influence clinical decision making abilities, and therefore, negatively impact healthcare outcomes. Purpose: To improve awareness of implicit bias and reduce its impact on clinical decision making.

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