scholarly journals Problems associated with mass border testing of COVID-19

2021 ◽  
pp. 140349482110236
Author(s):  
Mathias Grunér ◽  
Marika Nordberg ◽  
Knut Lönnroth
Keyword(s):  
Predictive Values ◽  
Relevant Case ◽  
Entry Requirements ◽  
Very High ◽  
Epidemiological Situation

We evaluated the yield of exit screening for SARS-Cov-2 performed in order for travellers to meet entry requirements to Sweden. Among 472 people screened, no infectious case of COVID-19 was detected, while two previously known cases were redetected after having already completed isolation. Our data suggest that depending on the epidemiological situation in the area of departure, border screening can lead to very low positive predictive values and very high costs per relevant case detected.

Administrative Data Fail to Accurately Identify Cases of Healthcare-Associated Infection

2006 ◽  
Vol 27 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Eileen R. Sherman ◽  
Kateri H. Heydon ◽  
Keith H. St. John ◽  
Eva Teszner ◽  
Susan L. Rettig ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Administrative Data ◽  
Active Surveillance ◽  
Predictive Value ◽  
Healthcare Associated Infection ◽  
Cross Sectional ◽  
Policy Makers ◽  
Predictive Values ◽  
Healthcare Associated ◽  
Very High

Objective.Some policy makers have embraced public reporting of healthcare-associated infections (HAIs) as a strategy for improving patient safety and reducing healthcare costs. We compared the accuracy of 2 methods of identifying cases of HAI: review of administrative data and targeted active surveillance.Design, Setting, and Participants.A cross-sectional prospective study was performed during a 9-month period in 2004 at the Children's Hospital of Philadelphia, a 418-bed academic pediatric hospital. “True HAI” cases were defined as those that met the definitions of the National Nosocomial Infections Surveillance System and that were detected by a trained infection control professional on review of the medical record. We examined the sensitivity and the positive and negative predictive values of identifying HAI cases by review of administrative data and by targeted active surveillance.Results.We found similar sensitivities for identification of HAI cases by review of administrative data (61%) and by targeted active surveillance (76%). However, the positive predictive value of identifying HAI cases by review of administrative data was poor (20%), whereas that of targeted active surveillance was 100%.Conclusions.The positive predictive value of identifying HAI cases by targeted active surveillance is very high. Additional investigation is needed to define the optimal detection method for institutions that provide HAI data for comparative analysis.

Use of Intraoperative Negative Margins Reduces Inverted Papilloma Recurrence

2018 ◽  
Vol 32 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Amar Miglani ◽  
Joseph M. Hoxworth ◽  
Matthew A. Zarka ◽  
Devyani Lal
Keyword(s):  
Frozen Section ◽  
Standard Of Care ◽  
Inverted Papilloma ◽  
Inclusion Criteria ◽  
Recurrence Rates ◽  
Predictive Values ◽  
Endoscopic Techniques ◽  
Time Of Presentation ◽  
Very High

Background Recurrence of inverted papilloma (IP) is a problem in 12–17% of tumors. Controversy exists regarding benefits of intraoperative frozen section histopathology (IFSH) for IP resection; however, to our knowledge, no study has specifically investigated this. IFSH for IP resection is the standard of care in our practice. We, therefore, reviewed our outcomes of using IFSH for IP resection. A secondary goal was to assess the reliability of IFSH. Methods Patients with IP who underwent surgical resection (2010–2016) with minimum 9–month follow-up were included. Results Twenty-two adults with IP met inclusion criteria. All underwent surgery via endoscopic techniques, supplemented by external ports in five patients. At the time of presentation, 36% IPs were recurrent tumors; 68% were graded as Krouse stage 3. Resection was conducted until “clear” (negative) mucosal margins were achieved on IFSH. In 6 (27%), a “positive” IFSH result dictated additional resection to clear margins. Final negative margins were achieved in all the patients. Both positive and negative predictive values for IFSH were 100% (concordance with final pathology results). Surveillance was performed every 1–6 months with nasal endoscopy by using imaging when necessary. No recurrences were noted (0%) at mean follow-up of 40 months (range, 10 -73 months). Conclusions Positive IFSH results led to increased resection in 27% of the patients, with a 0% recurrence rate in this cohort. The reliability of IFSH for IP is very high. No recurrence of IP was noted in any patient at a mean follow-up of 3.3 years. IFSH may help reduce recurrence rates of IP, but additional studies with longer follow-up are warranted.

scholarly journals Features of the Epidemiological Situation on Siberian Tick Typhus and other Tick-Borne Ricketsioses in the Russian Federation, Prognosis for 2019

2019 ◽  
pp. 89-97 ◽  
Author(s):  
N. V. Rudakov ◽  
S. N. Shpynov ◽  
D. V. Trankvilevsky ◽  
N. D. Pakskina ◽  
D. A. Savel’ev ◽  
...  
Keyword(s):  
Russian Federation ◽  
Far East ◽  
Laboratory Diagnostics ◽  
The Far East ◽  
Natural Foci ◽  
Causative Agents ◽  
Risk Areas ◽  
The Russian Federation ◽  
Very High ◽  
Epidemiological Situation

The review presents an analysis of the epidemic situation on infections of rickettsial etiology, the causative agents of which are transmitted by Ixodidae ticks in the territory of the Russian Federation. The data obtained through molecular-biological verification allow to unite under the name of “tick-borne ricketsioses” a group of infections caused by R. sibirica subsp. sibirica, R. conorii, R. heilongjiangensis and other species of rickettsiae circulating in natural foci of various regions of Russia. Cases of tick-borne rickettsioses in Siberia and the Far East, caused by various species of rickettsiae, are registered under the name of “Siberian tick-borne typhus” due to the lack of available methods of differential laboratory diagnostics. The paper presents the assessment of the incidence of Siberian tick-borne typhus, indicating not only the varying degrees of epidemic hazard of endemic regions, but also changes in the distribution of risk areas, including the identification of new, epidemically significant foci. In accordance with the risk-oriented approach to prophylaxis, forecasting of epidemic situation on tick-borne rickettsioses was given and differentiation of the endemic territories of the Russian Federation as regards Siberian tick-borne typhus was carried out with distinguishing of epidemiological zones of low, medium, above average, high and very high risk of population infection.

Some features of the epidemic spread of the new coronavirus infection (COVID-19) in the Rostov Region

2020 ◽  
Vol 11 (4) ◽  
pp. 99-106
Author(s):  
E. V. Kovalev ◽  
S. S. Slis ◽  
E. G. Yanovich ◽  
N. L. Pichurina ◽  
S. V. Volovikova ◽  
...  
Keyword(s):  
Process Intensification ◽  
Human Welfare ◽  
Epidemic Process ◽  
Regional Features ◽  
Rostov Region ◽  
Number Of Patients ◽  
Coronavirus Infection ◽  
Spread Of Infection ◽  
Very High ◽  
Epidemiological Situation

Purpose: to analyze the epidemiological situation for a new coronavirus infection (COVID-19), to identify some regional features of the Rostov region that contribute to spread of infection.Materials and methods: when assessing the epidemiological situation for a new coronavirus infection in the Rostov region, we used information provided by the Department of the Federal service for supervision of consumer protection and human welfare in the Rostov region. Processing of statistical data was performed by means of generally accepted method.Results: the spreading of a new coronavirus infection in the Rostov region is uneven in nature. When differentiating the territories of the region we identified groups of municipalities with a very high, medium and low number of patients. The administrative territories division of the Rostov region into the “Rostov urban agglomeration” and cluster of municipalities in which pronounced factors and conditions determining the “pendulum” migration of the population are absent, allow analyzing the specific features of the region and identification of territory with the highest risk of epidemic process intensification of a new coronavirus infection.Conclusions: the carried out differentiation of municipalities made it possible to identify and analyze some territorial features of the Rostov region, contributing to the spread of a new coronavirus infection. The obtained results could be used for development of measures aimed at reducing intensification of the epidemic process COVID-19 in condition infection. 

Screening Adolescents for Depression and Parent-Teenager Conflict in an Ambulatory Medical Setting: A Preliminary Investigation

PEDIATRICS ◽  
1990 ◽  
Vol 85 (5) ◽  
pp. 813-818
Author(s):  
Howard Schubiner ◽  
Arthur Robin
Keyword(s):  
Predictive Value ◽  
Preliminary Investigation ◽  
Conflict Behavior ◽  
Medical Setting ◽  
Predictive Values ◽  
Screening Questionnaire ◽  
Receiver Operating Characteristic Curves ◽  
Sensitivity Specificity ◽  
Very High ◽  
Simple Screening

Because more than 60% of adolescent visits to physicians last less than 10 minutes, simple screening devices to identify persons at risk for social morbidity are needed. The result of a pilot screening instrument for depression and parent-teenager conflict is described. A seven-item questionnaire (three items for depression and four items for parent-teenager conflict), the Beck Depression Inventory (BDI), and the Conflict Behavior Questionnaire (CBQ), were administered to 226 adolescents at a high-risk adolescent health center. After the visit, the provider rated each patient on a five-point Likert scale for level of depression and parent-teenager conflict. The screening questionnaire and the provider ratings were compared with the BDI and CBQ for sensitivity, specificity, and predictive value. A majority of the subjects (61% for depression and 63% for parent-teenager conflict) had no positive screening responses and, of these, less than 3% were classified as being depressed or having parent-teenager conflict by the BDI or CBQ. There were three or four positive screening responses (three responses for the depression questions and 20 responses for the parent-teenager conflict questions) among 23 adolescents and all of these scored in the abnormal range on the BDI or CBQ. Approximately one third of the subjects had intermediate responses. With one positive response, the predictive value for depression and parent-teenager conflict was 17% and 24%, respectively, whereas with two positive responses the predictive values were 56% and 26%. It was shown by receiver operating characteristic curves that the combined sensitivity and specificity of the screening questionnaire was superior to that of the physician ratings. In this study it was demonstrated that a simple seven-item instrument for depression and parent-teenager conflict can quickly and accurately classify the two thirds of patients with very high or very low scores and provide likelihoods of these problems for the remaining one third of patients who score in the intermediate ranges. This instrument can aid providers in efficient assessment of social morbidity factors in their adolescent patients.

Clinical Predictors of Acute Bacterial Diarrhea in Young Children

PEDIATRICS ◽  
1985 ◽  
Vol 76 (4) ◽  
pp. 551-556
Author(s):  
Thomas G. DeWitt ◽  
Kim F. Humphrey ◽  
Paul McCarthy
Keyword(s):  
High Probability ◽  
Bacterial Pathogen ◽  
Abrupt Onset ◽  
Stool Culture ◽  
Outpatient Setting ◽  
Polymorphonuclear Cells ◽  
Clinical Predictors ◽  
Predictive Values ◽  
Culture Positive ◽  
Very High

This prospective study assessed the value of presenting history, physical examination, and screening laboratory tests in predicting whether diarrhea in a young child is associated with a stool culture positive for a bacterial pathogen. Acutely ill children less than 4 years old were studied in a hospital outpatient setting. Two hundred patients were seen in a 9½-month period, which encompassed the seasons of summer, fall, and winter. One hundred ninety-five patients had cultures completed and twenty-nine (15%) had a bacterial pathogen isolated. The best predictive variable for a stool culture positive for a bacterial pathogen was the presence of polymorphonuclear cells in the stool, with a sensitivity of 85%, a specificity of 88%, and positive and negative predictive values of 59% and 97%, respectively. A cluster of three historical variables—abrupt onset of diarrhea, greater than four stools per day, and no vomiting before the onset of diarrhea—was identified that delineated a subpopulation of patients with an increased probability of having a stool culture positive for a bacterial pathogen (27% v 4% if any of the three variables was absent). It is suggested that these findings can be combined in a stepwise manner using the historical cluster as an initial screening, followed by examination for stool polymorphonuclear cells in the high probability subgroup, to identify those patients with a very high probability of having a bacterial pathogen isolated in their stool.

Screening for Low Prevalence Disorders

2000 ◽  
Vol 34 (1_suppl) ◽  
pp. A39-A46 ◽  
Author(s):  
Brian I. O'Toole
Keyword(s):  
Primary And Secondary Prevention ◽  
Prodromal Symptoms ◽  
Predictive Values ◽  
Australian General Practice ◽  
Time Periods ◽  
Low Prevalence ◽  
Eventual Outcome ◽  
Disease Free ◽  
Very High ◽  
False Positives And Negatives

Objective To examine the epidemiologic theory of screening as it applies to low prevalence disorders, such as schizophrenia, in order to identify the tasks required for primary and secondary prevention. Method Review of principles of screening, computation of prevented fraction for varying sensitivities, specificities and prevalences of disease, and review of prevalence of schizophrenia in Australian general practice. Results There is no currently available efficient method of screening for schizophrenia or for prodromal symptoms. From the genesis of disease to eventual outcome, the milestones that are passed in the case of schizophrenia are uncertain in their nature and the intervening time periods are of uncertain and possibly varying duration. The extent of false positives and negatives in low prevalence disorders is high unless the specificity is very high. Conclusion It may be feasible to screen for behaviours that are precursors to schizophrenia; however, screening depends upon the existence of a reliable screening instrument that can be shown to discriminate accurately between diseased and disease-free individuals. Development of a method for screening requires comparison against formal clinical assessment of both screen positives and screen negatives. For low prevalence disorders the predictive values may be low unless specificity is high.

scholarly journals A Rational Adoption of the High Sensitive Assay for Cardiac Troponin I in Diagnostic Routine

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Antonio Croce ◽  
Pietro Brunati ◽  
Carlo Colzani ◽  
Riccardo Terramocci ◽  
Stefano Favero ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Troponin I ◽  
Sensitive Assay ◽  
Roc Curve Analysis ◽  
Predictive Values ◽  
Coronary Syndrome ◽  
Gender Specific ◽  
Very High ◽  
High Sensitive Troponin ◽  
Made In

We describe the adoption of high sensitive troponin I (hsTnI) in clinical practice in two hospital settings in Italy. Samples from 426 consecutive patients (mean age 68.8 ± 17.0) admitted to the Emergency Department with a suspected acute coronary syndrome (ACS) have been tested at admittance and after 3 and 6 hours by contemporary TnI and hsTnI. Results have been compared to the final clinical diagnosis. Troponin was detectable in 68.6% by TnI and 89.9% by hsTnI. Since hsTnI has a lower threshold for females, 38/41 patients with positive values only by hsTnI were women. The correlation between the assays was very high (r=0.92). A diagnosis of acute myocardial infarction (AMI) was made in 45 cases (10.5%). The negative and positive predictive values for a 50% troponin variation at 3 hours were 95.8% and 66.7% for hsTnI and 95.0% and 52.6% for TnI and at 6 hours 90.3% and 100% for hsTnI and 88.9% and 78.9% for TnI, respectively. Receiver operating characteristic (ROC) curve analysis demonstrated a greater efficiency by hsTnI at 3 hours versus 6 hours (AUC = 0.91 versus 0.72). The main benefits of hsTnI are the adoption of gender-specific 99th percentile and the shortening of time to decision.

Abstract 15336: Real-world Diagnostic Performance of Single-lead Handheld Electrocardiograms for Atrial Fibrillation Screening: The Vital-af Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shaan Khurshid ◽  
Yuchiao Chang ◽  
Wyliena Guan ◽  
Ana Lipsanopoulos ◽  
Leila H Borowsky ◽  
...  
Keyword(s):  
Primary Care ◽  
Diagnostic Performance ◽  
Cluster Randomized Trial ◽  
Population Based ◽  
Predictive Values ◽  
Medical Assistants ◽  
Primary Care Population ◽  
Cluster Randomized ◽  
Very High

Introduction: AF screening can detect undiagnosed AF, but concerns exist regarding false positives and downstream consequences. AF screening using single-lead handheld electrocardiograms (1L ECGs) is feasible, but diagnostic performance in a pragmatic screening setting is not well-understood. Methods: VITAL-AF is a cluster-randomized trial (NCT035115057) of population-based AF screening with 30-second 1L ECGs. Individuals aged ≥65 years receiving primary care in a study practice were eligible, with practices randomized to screening (n=8) or usual care (n=8). Screening was performed with the AliveCor Kardia 1L ECG (AliveCor US) administered by medical assistants. In addition to the AliveCor interpretation, all 1L ECGs were overread by cardiologists. We assessed the distribution of automated interpretations and predictive values using cardiologist 1L ECG overread as the gold standard. Results: Screening generated 38,190 tracings representing 16,496 individuals read by 13 cardiologists (median time to read: 10h, quartile 1: 5, quartile 3: 19). We removed 1,554 tracings overread as uninterpretable, resulting in 36,636 tracings in the analysis. A total of 27,251 (74.4%) tracings had an AliveCor interpretation of normal, 6,223 (17.0%) unclassified, 2,420 (6.6%) possible AF, and 742 (2.0%) no interpretation. The positive predictive value (PPV) of possible AF by AliveCor was 76.2% (95% CI 74.5-77.9, Figure ). The negative predictive values (NPVs) were 99.7% (95% CI 99.6-99.8) for normal, 92.3% (95% CI 91.6-92.9) for unclassified, and 87.1% (95% CI 84.4-89.4) for no interpretation. Of 2,502 tracings overread as AF, 482 (19.3%) were unclassified by AliveCor. Conclusions: In an elderly primary care population, the PPV of possible AF by AliveCor algorithm was modest, whereas the NPV of a normal interpretation was very high. Unclassified tracings were common and enriched for AF. Abnormal findings, including unclassified 1L ECG tracings, merit follow-up testing.

scholarly journals The diagnostic accuracy of the mobile phone teledermatoscopy

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Hamza Yildiz ◽  
Memet Ersan Bilgili ◽  
Hasan Aktug Simsek
Keyword(s):  
Mobile Phone ◽  
Cost Effective ◽  
Skin Lesions ◽  
Predictive Values ◽  
Malignant Lesions ◽  
The Mean ◽  
Smart Mobile Phone ◽  
Smart Mobile ◽  
Very High ◽  
Mobile Phone Camera

The positive predictive value (PPV) of smart mobile phone teledermatoscopy is not known. The main purpose of the present study was to investigate the sensitivity and positive predictive values (PPVs) of smart mobile phone teledermatoscopy. Over a period of 6 months, up to three clinical and dermatoscopic images were obtained of 67 skin lesions from 67 patients using a mobile phone camera and standard pocket dermatoscopy device. Out of the 67 patients, 44 were men (65.67%) and 23 were women (34.32%). The mean age of the patients was 39.56 ± 22.19 years (ranging from 18 to 92). The majority of the lesions (71.64%; n=48) were benign, while 11.94% (n=8) of the biopsies were premalignant and 16.41% (n=11) of the lesions were malignant. The sensitivity for the diagnosis of benign, premalignant, and malignant lesions were 93.8%, 100%, and 100%, respectively. PPVs for the diagnosis of benign, premalignant, and malignant lesions were 93.8%, 100%, and 100%, respectively. The sensitivity and PPVs of all lesions were 95.9% and 95.7%. The accuracy of the teledermatoscopic consultation with a mobile phone is very high. We therefore think that it can be a cost effective and useful method in the consultation at distance.

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