scholarly journals Appraisal of the faecal haemoglobin, age and sex test (FAST) score in assessment of patients with lower bowel symptoms: an observational study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jayne Digby ◽  
Judith A. Strachan ◽  
Craig Mowat ◽  
Robert J. C. Steele ◽  
Callum G. Fraser
Keyword(s):  
Primary Care ◽  
Bowel Disease ◽  
Added Value ◽  
Advanced Adenoma ◽  
Individual Risk ◽  
First Year ◽  
Lower Bowel ◽  
Bowel Symptoms ◽  
Group A ◽  
Group B

Abstract Background Many patients present in primary care with lower bowel symptoms, but significant bowel disease (SBD), comprising colorectal cancer (CRC), advanced adenoma (AA), or inflammatory bowel disease (IBD), is uncommon. Quantitative faecal immunochemical tests for haemoglobin (FIT), which examine faecal haemoglobin concentrations (f-Hb), assist in deciding who would benefit from colonoscopy. Incorporation of additional variables in an individual risk-score might improve this approach. We investigated if the published f-Hb, age and sex test score (FAST score) added value. Methods Data from the first year of routine use of FIT in primary care in one NHS Board in Scotland were examined: f-Hb was estimated using one HM-JACKarc FIT system (Kyowa Medex Co., Ltd., Tokyo, Japan) with a cut-off for positivity ≥10 μg Hb/g faeces. 5660 specimens were received for analysis in the first year. 4072 patients were referred to secondary care: 2881 (70.6%) of these had returned a FIT specimen. Of those referred, 1447 had colonoscopy data as well as the f-Hb result (group A): 2521 patients, also with f-Hb, were not immediately referred (group B). The FAST score was assessed in both groups. Results 1196 (41.7%) of patients who returned a specimen for FIT analysis had f-Hb ≥10 μg Hb/g faeces. In group A, 252 of 296 (85.1%) with SBD had f-Hb > 10 μg Hb/g faeces, as did 528 of 1151 (45.8%) without SBD. Using a FAST score > 2.12, which gives high clinical sensitivity for CRC, only 1143 would have been referred for colonoscopy (21.0% reduction in demand): 286 of 296 (96.6%) with SBD had a positive FAST score, as did 857 of 1151 (74.5%) without SBD. However, one CRC, five AA and four IBD would have been missed. In group B, although 95.2% had f-Hb < 10 μg Hb/g faeces, 1371 (53.7%) had FAST score ≥ 2.12: clinical rationale led to only 122 of group B completing subsequent bowel investigations: a FAST score > 2.12 was found in 13 of 15 (86.7%) with SBD. Conclusions The performance characteristics of the FAST score did not seem to enhance the utility of f-Hb alone. Locally-derived formulae might confer desired benefits.

scholarly journals Do other variables add value to assessment of the risk of colorectal disease using faecal immunochemical tests for haemoglobin?

2019 ◽  
Vol 56 (4) ◽  
pp. 472-479 ◽  
Author(s):  
Jayne Digby ◽  
Robert JC Steele ◽  
Judith A Strachan ◽  
Craig Mowat ◽  
Annie S Anderson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Inflammatory Bowel Disease ◽  
Family History ◽  
Bowel Disease ◽  
Odds Ratios ◽  
Lower Bowel ◽  
Bowel Symptoms ◽  
History Of ◽  
Inflammatory Bowel

Background Faecal immunochemical tests for haemoglobin have been recommended to assist in assessment of patients presenting in primary care with lower bowel symptoms. The aim was to assess if, and which, additional variables might enhance this use of faecal immunochemical tests. Methods Faecal immunochemical test analysis has been a NHS Tayside investigation since December 2015. During the first year, 993 patients attending colonoscopy were invited to complete a detailed questionnaire on demographic background, symptoms, smoking status, alcohol use, dietary fibre, red and processed meat intake, physical activity, sitting time, dietary supplement use, family history of colorectal cancer, adenoma, inflammatory bowel disease and diabetes. Significant bowel disease was classified as colorectal cancer, advanced adenoma or inflammatory bowel disease. Results A total of 470 (47.3%) invitees agreed to complete the questionnaire and 408 (41.1%) did. Unadjusted odds ratios for the presence of significant bowel disease compared with undetectable faecal haemoglobin increased with increasing faecal haemoglobin and for faecal haemoglobin 10–49, 50–199, 200–399 and ⩾400 μg Hb/g faeces were 0.95 (95% CI: 0.16–5.63), 2.47 (0.55–1.03), 6.30 (1.08–36.65) and 18.90 (4.22–84.62), respectively. Rectal bleeding and family history of polyps were the only other variables with statistically significant ( P < 0.05) odds ratios greater than 1.00, being 1.88 (1.13–3.17) and 2.93 (1.23–6.95), respectively. Odds ratios adjusted for all other variables showed similar associations, but only faecal haemoglobin and family history of polyps had significant associations. Conclusions Faecal haemoglobin is the most important factor to be considered when deciding which patients presenting in primary care with lower bowel symptoms would benefit most from referral for colonoscopy.

scholarly journals Faecal haemoglobin and faecal calprotectin as indicators of bowel disease in patients presenting to primary care with bowel symptoms

Gut ◽  
2015 ◽  
Vol 65 (9) ◽  
pp. 1463-1469 ◽  
Author(s):  
Craig Mowat ◽  
Jayne Digby ◽  
Judith A Strachan ◽  
Robyn Wilson ◽  
Francis A Carey ◽  
...  
Keyword(s):  
Primary Care ◽  
Bowel Disease ◽  
Faecal Calprotectin ◽  
Bowel Symptoms

Immunity to Diphtheria, Pertussis, Tetanus, and Poliomyelitis in Children with Acute Lymphocytic Leukemia After Cessation of Chemotherapy

PEDIATRICS ◽  
1981 ◽  
Vol 67 (2) ◽  
pp. 222-229 ◽  
Author(s):  
A. van der Does-van den Berg ◽  
J. Hermans ◽  
J. Nagel ◽  
G. van Steenis
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
First Year ◽  
Healthy Children ◽  
Healthy Control ◽  
Antibody Titers ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Antibody Levels

Antibody titers to diphtheria, pertussis, tetanus, and poliomyelitis (types I to III) were measured in previously vaccinated children with acute lymphocytic leukemia in remission after cessation of therapy. The response to revaccination one year after therapy was stopped was also studied. The patients' antibody titers were compared with those of healthy children, matched for age and sex. Two groups of patients were studied: one group (group A, N = 30) was given two drugs (6-mercaptopurine, methotrexate); the other group (group B, N= 19) was given three drugs (6-mercaptopurine, methotrexate, and cyclophosphamide) for maintenance treatment. In general, the patients' antibody titers were lower than those of healthy children, but in most patients they were still at levels considered to be protective. No significant differences in antibody levels between the two patient groups were found. A spontaneous rise in antibody titers in the first year after termination of therapy was not observed. After revaccination the rise in antibody titers was correlated with preexisting antibody titers in the same way in patients as in healthy children, and the antibody titers in patients and in healthy control subjects were on roughly the same level.

scholarly journals Impact of introducing a faecal immunochemical test (FIT) for haemoglobin into primary care on the outcome of patients with new bowel symptoms: a prospective cohort study

2019 ◽  
Vol 6 (1) ◽  
pp. e000293 ◽  
Author(s):  
Craig Mowat ◽  
Jayne Digby ◽  
Judith A Strachan ◽  
Rebecca McCann ◽  
Christopher Hall ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Clinical Assessment ◽  
Bowel Disease ◽  
Record Linkage ◽  
Prospective Cohort ◽  
Faecal Immunochemical Test ◽  
Bowel Symptoms ◽  
Immunochemical Test

ObjectiveTo determine whether a faecal immunochemical test (FIT) for faecal haemoglobin concentration (f-Hb) can be safely implemented in primary care as a rule-out test for significant bowel disease (SBD) (colorectal cancer (CRC), higher risk adenoma (HRA) and inflammatory bowel disease (IBD)) when used as an adjunct to the clinical assessment of new bowel symptoms.DesignSingle-centre prospective cohort study of all patients who attended primary care and submitted a FIT in the first calendar year of the service beginning December 2015. f-Hb was estimated using HM-JACKarc (Kyowa Medex) with a clinical cut-off of ≥10 µg Hb/g faeces. Incident cases of CRC were verified via anonymised record linkage to the Scottish Cancer Registry.Results5422 patients submitted 5660 FIT specimens, of which 5372 were analysed (positivity: 21.9%). 2848 patients were referred immediately to secondary care and three with f-Hb <10 µg/g presented acutely within days with obstructing CRC. 1447 completed colonoscopy in whom overall prevalence of SBD was 20.5% (95 CRC (6.6%), 133 HRA (9.2%) and 68 IBD (4.7%)); 6.6% in patients with f-Hb <10 µg/g vs 32.3% in patients with f-Hb ≥10 µg/g. One CRC was detected at CT colonoscopy. 2521 patients were not immediately referred (95.3% had f-Hb <10 µg/g) of which four (0.2%) later developed CRC. Record linkage identified no additional CRC cases within a follow-up period of 23–35 months.ConclusionIn primary care, measurement of f-Hb, in conjunction with clinical assessment, can safely and objectively determine a patient’s risk of SBD.

scholarly journals A Simple Clinical Scale to Stratify Risk of Recurrent Falls in Community-Dwelling Adults Aged 65 Years and Older

2010 ◽  
Vol 90 (4) ◽  
pp. 550-560 ◽  
Author(s):  
Severine Buatois ◽  
Christine Perret-Guillaume ◽  
Rene Gueguen ◽  
Patrick Miget ◽  
Guy Vançon ◽  
...  
Keyword(s):  
Community Dwelling ◽  
Added Value ◽  
Clinical Scale ◽  
Moderate Risk ◽  
Stand Test ◽  
Sit To Stand ◽  
Balance Tests ◽  
Recurrent Falls ◽  
Group A ◽  
Group B

BackgroundCorrect identification of people at risk for recurrent falls facilitates the establishment of preventive and rehabilitative strategies in older adults.ObjectiveThe purposes of this study were: (1) to develop and validate a simple clinical scale to stratify risk for recurrent falls in community-dwelling elderly people based on easily obtained social and clinical items and (2) to evaluate the added value of 3 clinical balance tests in predicting this risk.DesignThis was a prospective measurement study.MethodsA population of 1,618 community-dwelling people over 65 years of age underwent a health checkup, including performance of 3 clinical balance tests: the One-Leg-Balance Test, the Timed “Up & Go” Test, and the Five-Times-Sit-to-Stand Test. Falls were recorded using a self-administered questionnaire that was completed a mean (SD) of 25±5 months after the visit. Participants were randomly divided into either group A (n=999), which was used to develop the scale, or group B (n=619), which was used to prospectively validate the scale.ResultsLogistic regression analysis identified 4 variables that independently predicted recurrent falls in group A: history of falls, living alone, taking ≥4 medications per day, and female sex. Thereafter, 3 risk categories of recurrent falls (low, moderate, and high) were determined. Predicted probability of recurrent falls increased from 4.1% to 30.1% between the first and third categories. This scale subsequently was validated with great accuracy in group B. Only the Five-Times-Sit-to-Stand Test provided added value in the estimation of risk for recurrent falls, especially for the participants who were at moderate risk, in whom failure on the test (duration of &gt;15 seconds) doubled the risk.LimitationsFalls were assessed only once, and length of follow-up was heterogeneous (18–36 months).ConclusionsClinicians could easily classify older patients in low-, moderate-, or high-risk groups of recurrent falls by using 4 easy-to-obtain items. The Five-Times-Sit-to-Stand Test provides added value to stratify risk for falls in people at moderate risk.

scholarly journals Proactive Infliximab Monitoring Following Reactive Testing is Associated With Better Clinical Outcomes Than Reactive Testing Alone in Patients With Inflammatory Bowel Disease

2018 ◽  
Vol 12 (7) ◽  
pp. 804-810 ◽  
Author(s):  
Konstantinos Papamichael ◽  
Ravy K Vajravelu ◽  
Byron P Vaughn ◽  
Mark T Osterman ◽  
Adam S Cheifetz
Keyword(s):  
Inflammatory Bowel Disease ◽  
Treatment Failure ◽  
Bowel Disease ◽  
Cox Regression ◽  
Drug Discontinuation ◽  
Cox Regression Analysis ◽  
Loss Of Response ◽  
Group A ◽  
Inflammatory Bowel ◽  
Group B

Abstract Background and Aims Reactive testing has emerged as the new standard of care for managing loss of response to infliximab in inflammatory bowel disease [IBD]. Recent data suggest that proactive infliximab monitoring is associated with better therapeutic outcomes in IBD. Nevertheless, there are no data regarding the clinical utility of proactive infliximab monitoring after first reactive testing. We aimed to evaluate long-term outcomes of proactive infliximab monitoring following reactive testing compared with reactive testing alone in patients with IBD. Methods This was a retrospective multicenter cohort study of consecutive IBD patients on infliximab maintenance therapy receiving a first reactive testing between September 2006 and January 2015. Patients were divided into two groups; Group A [proactive infliximab monitoring after reactive testing] and Group B [reactive testing alone]. Patients were followed through December 2015. Time-to-event analysis for treatment failure and IBD-related surgery and hospitalization was performed. Treatment failure was defined as drug discontinuation due to either loss of response or serious adverse event. Results The study population consisted of 102 [n = 70, 69% with CD] patients [Group A, n = 33 and Group B, n = 69] who were followed for (median, interquartile range [IQR]) 2.7 [1.4–3.8] years. Multiple Cox regression analysis identified proactive following reactive TDM as independently associated with less treatment failure (hazard ratio [HR] 0.15; 95% confidence interval [CI] 0.05–0.51; p = 0.002) and fewer IBD-related hospitalizations [HR: 0.18; 95% CI 0.05–0.99; p = 0.007]. Conclusions This study showed that proactive infliximab monitoring following reactive testing was associated with greater drug persistence and fewer IBD-related hospitalizations than reactive testing alone.

scholarly journals Red cell indexes made easy using an interactive animation: do students and their scores concur?

2018 ◽  
Vol 42 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Upasana Kachroo ◽  
Elizabeth Vinod ◽  
Sivakumar Balasubramanian ◽  
Jesi W. ◽  
Neetu Prince
Keyword(s):  
Student Performance ◽  
Clinical Aspects ◽  
Cell Physiology ◽  
First Year ◽  
Red Cell ◽  
Interactive Animation ◽  
Student Comprehension ◽  
Group A ◽  
Group B ◽  
Conventional Classroom

A good understanding of red cell indexes can aid medical students in a considerable manner, serving as a basis to unravel both concepts in red cell physiology and abnormalities associated with the same. In this study, we tried to assess whether an interactive animation was helpful in improving student comprehension and understanding of red cell indexes compared with conventional classroom teaching. Eighty-eight first-year MBBS students participated, of which 44 were assigned to group A and 44 were assigned to group B after randomization. After further creation of smaller groups, students were provided with 45 min to revise red cell indexes, after which they were required to complete a multimodal questionnaire. Group A subgroups used written material for revision, whereas group B subgroups had access to an interactive animation. After completion of the questionnaire, group A students also used the animation after which feedback was collected from all students. Efficacy of the animation to improve learning and retention was demonstrated, as group B students scored significantly higher than group A students on the questionnaire ( P = 0.0003). A clear majority of the students agreed/strongly agreed that the animation was easy to operate, conveyed important concepts efficiently, and improved their knowledge of related clinical aspects as well. From the results and feedback, we found that the animation was a simple, well-received model, which, by significantly improving student performance, corroborated our hypothesis that inclusion of interactive animation into student curriculum can advance their academic attainment, compared with didactic teaching alone.

scholarly journals INTEGRATING “ENGLISH PRONUNCIATION” APP INTO PRONUNCIATION TEACHING: HOW IT AFFECTS STUDENTS’ PARTICIPATION AND LEARNING

2020 ◽  
Vol 8 (2) ◽  
pp. 202
Author(s):  
Haryadi Haryadi, S ◽  
Aprianoto Aprianoto
Keyword(s):  
Independent Learning ◽  
First Year ◽  
English Pronunciation ◽  
Group A ◽  
Group Interviews ◽  
Group B ◽  
Teaching Pronunciation ◽  
Participant Observer ◽  
Self Learning

This study aimed to find out whether the integration of the English Pronunciation app in pronunciation class at Mandalika University of Education (UNDIKMA) can increase students’ participation and self-learning. This study made use of quasi-qualitative design. Forty-eight first-year English department students from two groups of learning involved in this research, aged between 19 to 21. Each group, group A and group B, comprised of 24 students. Both groups received instruction using the English pronunciation app. Data was collected using class observation and interviews. In conducting observation, the observer chose to take the role of participant-observer in that the researcher immersed with the students during the observation activities. One volunteer assistant was employed to work with the researcher. It was intended to increase the accuracy of the data collected. In regard to the interview process, the researcher used individual and group interviews where one interviewer/researcher interviews a group of students. The result of the study indicates that the integration of the English Pronunciation app in teaching pronunciation increased the students’ participation (engagement, attitude, and conduct). In addition, the app brought a positive effect to the establishment of independent learning to a significant number of students.

Is laparoscopic experience helpful in simulator based robotic training in general surgery?

2021 ◽  
Vol 71 (9) ◽  
Author(s):  
Shahriyar Ghazanfar ◽  
Sajida Qureshi ◽  
Muhammad Zubair ◽  
Yumnah Safdar ◽  
Aftab Ahmed Leghari ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Cross Sectional Study ◽  
First Year ◽  
Robotic Training ◽  
Laparoscopic Skills ◽  
Cross Sectional ◽  
Robotic Skills ◽  
Group A ◽  
Group B ◽  
The Individual

Objective: To evaluate whether or not prior laparoscopic training improves performance during robotic surgery utilising DaVinci robotic skills simulator. Methods: The cross-sectional study was conducted at the Civil Hospital, Karachi, from May 4 to November 11, 2018, and comprised first year residents in Group A with no laparoscopic skills and fourth year residents doing laparoscopic cholecystectomy independently and surgical faculty members in Group B who had laparoscopic skills. Both the groups had no previous exposure to robotic surgery and skills simulator. There were 4 exercises which were repeated three times by each participant. Scoring was done using the the DaVinci robotic skills simulator software. Data was analysed using SPSS 22. Results: Of the 30 surgeons, there were 15(50%) in Group A with a mean age of 26±0.56 years, and 15(50%) in Group B with a mean age of 32 years± 9.16 (p<0.001). The overall mean age was 32±9.16 years (range: 25-52 years). There were 19(63.3) females in the sample compared to 11(36.6%) males. Mean scores of Ring walk 2, Peg board 2, and Suture sponge 3 were better in Group A, while mean score of Matchboard 2 was better in Group although B (p>0.05). Group B fared better in the individual scoring of Suture sponge 2 (p>0.05). Conclusion: Laparoscopic skills apparently did not confer any benefit while performing exercises on the DaVinci skills simulator. Key Words: DaVinci Si, DaVinci skills simulator, dVSSS, Robotic surgery curriculum, Robotic surgery simulation. Continuous...

SPOSAB ABP 501 - A SICILIAN PROSPECTIVE OBSERVATIONAL STUDY OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE TREATED WITH ADALIMUMAB BIOSIMILAR ABP 501

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S59-S59
Author(s):  
Fabio Salvatore Macaluso ◽  
Maria Cappello ◽  
Anita Busacca ◽  
Walter Fries ◽  
Anna Viola ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Observational Study ◽  
Bowel Disease ◽  
Prospective Observational Study ◽  
Treatment Persistence ◽  
Group A ◽  
Inflammatory Bowel ◽  
Abp 501 ◽  
Group B

Abstract Background and Aims There are few clinical data on Adalimumab (ADA) biosimilars in inflammatory bowel disease. Methods SPOSAB ABP 501 is a multicenter, observational, prospective study performed among the cohort of the Sicilian Network for Inflammatory Bowel Disease. All consecutive patients treated with ADA biosimilar ABP 501 from the introduction of the drug in Sicily (February 2019) to February 2020 (12 months) were enrolled to assess its safety and effectiveness. Patients were divided into 3 groups: group A, naïve to ADA and naïve to anti-TNFs; group B, naïve to ADA, previously exposed to anti-TNFs; group C: switched from ADA originator to ABP 501. Results 559 patients (median age 39 years; CD 88.0%, UC 12.0%) were included, with a follow-up time of 403.4 patient-years. Thirty-six SAEs occurred in 36 patients [(6.4% - incidence rate (IR): 8.9 per 100 person-years (PY)]. The IR of SAEs was higher among patients in group A compared with group C (17.4 vs. 4.8 per 100 PY; IR ratio=3.61; p&lt;0.001) and among patients in group B compared with group C (16.4 vs. 4.8 per 100 PY; IR ratio=3.42; p=0.041). Among ADA-naïve patients (group A+B), 188 (85.8%) had a clinical response after 12 weeks, including 165 (75.3%) who achieved steroid-free remission. Higher treatment persistence estimates were reported for patients in group C compared with group A and B (log-rank p&lt;0.001). Conclusions Safety and effectiveness of ABP 501 seem to be overall similar to those reported for ADA originator. Switching from originator to ABP 501 was safe and effective.

Sign in / Sign up

Export Citation Format

Share Document