Introduction

The introduction reimagines the historical narrative of rivalry between increasingly specialized cultures of medicine and the arts in the Romantic period as instead a period of mutual exchange. This familiar history is belied by the historical movement of the terms “autopsy” and “verve,” which traveled in opposite directions between medical and literary fields during the height of the British Romantic period. The crossing of “autopsy” and “verve” between fields introduces the book’s principal concerns: how shared concepts and critical practices were exchanged between letters and medicine, how new structures of thought crossed between biological and textual concerns, and how tropes of organicity, disease, and treatment in Romantic texts reveal the diagnostic practices that bridged literary and medical cultures. Through a study of the great developments in the history of medicine in this period, and the “metapothecaries” like Samuel Taylor Coleridge who considered literature and medicine through a shared ontology, the chapter argues that Romantic literature develops the notion of protocols of diagnosis—the idea that the same protocols of critical interpretation can be used by doctors to diagnose disease, and by readers to understand works of fiction and poetry. Outlining four protocols of diagnosis that the rest of the book will elaborate, the chapter concludes by linking these four formulations to modern methodologies of critical reading, exploring the resonance of this history to contemporary reflections on the history of what has come to be called “symptomatic reading.”

Electrochemical nanobiosensors perspectives for COVID 19 pandemic

Early, rapid and ultrasensitive diagnosis of COVID-19 to facilitate high-throughput analysis without a high degree of technical expertise or sophisticated equipment is necessary to expand COVID-19 testing capability. Leveraging interdisciplinary proficiency in analytical chemistry, biomedical instrumentation, molecular biology, microfluidics, and nanotechnology, considerable advances have been made to develop a novel diagnostic tool that assures superior key performances for COVID-19 diagnosis. This review summarizes the nano-enabled systems such as electrochemical nanobiosensor for SARS-CoV-2 virus detection and emphasizes promising diagnostic techniques to extensively facilitate the diagnostic practices during the COVID-19 pandemic. Currently, three main diagnostic methods have been widely used in the COVID-19 pandemic: nucleic acid (NA)-based testing, computed tomography (CT), and serological testing. NA-based detection of SARS-CoV-2 such as Reverse transcription polymerase chain reaction has become the gold standard for COVID-19 diagnosis. This review congregates significant contributions in the electrochemical nanobiosensor research area, which is helpful for further nanobiosensor development. Although many efforts were taken to detect the SARS-CoV-2, the COVID 19 diagnosis still relies on expensive prolonged analysis. A rapid and reliable alternative is the utilization of a low-cost nanobiosensor for SARS-CoV-2 detection that can rapidly diagnose the disease even in asymptomatic conditions with high reliability and sensitivity.

742. Evaluation of Chagas Disease Diagnostic Testing Practices in Four Hospital Systems in California and Texas

Background Chagas disease (CD) is a neglected parasitic disease that affects >6 million people in the Americas, including >200,000 people in the United States (US). Medical provider knowledge of CD is key to decreasing morbidity and transmission; however, few studies have assessed diagnostic practices in US health systems serving at-risk patients. Our study aimed to describe existing provider approaches to diagnosing CD in California and Texas. Methods Site-based research teams at four hospital systems (the University of California [UC] San Francisco [UCSF], San Diego [UCSD], Irvine [UCI], and the Harris Health System [HHS] in Houston, TX) retrospectively identified patients ≥18 years old tested for CD between 2016-2019 and systematically extracted electronic medical record data using complementary electronic data entry forms. Specifically, eligible patients were identified using laboratory orders at UCSF and UCI, while the remaining sites employed SlicerDicer (Epic Systems). This study was approved by institutional review boards at each site. Results We identified 333 patients tested for CD, including 109 from UCSF, 88 from UCSD, 25 from UCI, and 111 from HHS. These patients had 125, 99, 31, and 181 tests sent to commercial laboratories, respectively. Test reactivity varied by system with the greatest percent reactivity among tests ordered at UCI (23%) followed by UCSD (16%), HHS (15%), and UCSF (10%). Among patients who screened positive for CD by commercial assays, confirmatory testing through the Centers for Disease Control and Prevention was sought for 100% at UCI; 59% at HHS, 55% at UCSF, and 40% at UCSD. The medical specialty that most often ordered CD testing was Cardiology at all UC sites (UCSF, 50%; UCSF, 55%; UCI, 35%) and Internal Medicine at HHS (46%; Cardiology ordered 13%). Only one recorded CD test was ordered by an Obstetrics/Gynecology service at any site. Conclusion These early results report positivity rates between our healthcare systems and demonstrate inconsistency in attaining recommended confirmatory testing, as well as a paucity of CD testing ordered through Obstetrics/Gynecology despite risk of congenital transmission. These findings suggest areas of opportunity to improve provider awareness and lay a foundation for standardizing CD diagnostic practices in the US. Disclosures Caryn Bern, MD, MPH, UpToDate (Wolters Kluwer) (Other Financial or Material Support, Author Royalties)

The impact of medical scribes on emergency physician diagnostic testing and diagnosis charting

Objectives Since the widespread adoption of electronic medical records (EMRs), medical scribes have been increasingly utilized in emergency department (ED) settings to offload the documentation burden of emergency physicians (EPs). Scribes have been shown to increase EP productivity and satisfaction; however, little is known about their effects on the EP’s diagnostic process. We aimed to assess what effect, if any, scribes have on EP diagnostic test ordering and their documentation of differential diagnoses. Methods We conducted a retrospective cohort study utilizing a chart review to compare diagnostic practices of EPs working both with and without scribes. We analyzed the number of laboratory and radiologic diagnostic studies ordered per encounter as well as characteristics of differential diagnosis documentation. Results Scribes did not affect laboratory studies ordered per encounter (mean 6.31 by scribes vs. 7.35 by EPs, difference −1.04; 95% confidence interval [CI] −2.34 to 0.26) or radiologic studies ordered per encounter (mean 1.49 by scribes vs. 1.39 by EPs, difference 0.10; 95% CI −0.15 to 0.35). Scribes did not affect the frequency of documenting a differential diagnosis or the number of diagnoses considered in each differential, but they were associated with higher word counts in EP differentials (mean 72.29 by scribes vs. 50.00 by EPs, mean difference 22.79; 95% CI 6.77 to 38.81). Conclusions Scribe use does not appear to affect EP diagnostic test ordering but may have a small effect on their documentation of differential diagnoses.

Cancer Diagnostic Practices Have Seen a Transformation in the Last Few Years- Explore the Scenario

Identifying cancer at the early stages does offer several chances for a cure. Cancer diagnostics can be defined as a process of detecting proteins, biomarkers, and certain marks that help in proper spotting of a malignant tumor in body. For quite a few malignant cases, studies and surveys reveal that screening tests have often proved to be highly beneficial for the detection. However, for other types, screening tests are suggested only for patients with bigger risk factors. There are several guidelines and procedures for cancer screening and they tend to vary from organization to organization. A doctor or a medical practitioner take recourse to different approaches to identify cancers and they take in biopsy, imaging tests (CT scans, colonoscopy, mammography etc.), lab tests, and physical exam. Lately, researchers have also come up with a more advanced procedure, namely molecular diagnostics that can spot explicit cancer-associated molecules that flow in bodily solutions such as urine and blood.

TBE Vaccination Breakthrough Cases—Does Age Matter?

Tick-borne encephalitis (TBE) vaccines are highly effective in preventing TBE and vaccine failures (VF) are rare events. In this study, we compared the age distribution of TBE cases and TBE VF in three endemic countries: Sweden, Southern Germany, and Latvia. While the age distribution of TBE cases was similar for those <50 years versus those ≥50 years in all three countries, in Sweden, a higher proportion of VF cases was ≥50 years, whereas most VF cases in Latvia were <50 years of age and more evenly distributed between those <50 years versus those ≥50 in Southern Germany. Here, theoretical explanations were provided, including differences in diagnostic practices, vaccine uptake between age groups, behavioral patterns and underlying medical conditions, as to why VF were generally older in Sweden than the other countries. There is no scientific rationale to give an extra priming dose of TBE vaccine to subjects ≥50 years of age.

Revealing Truth through Diagnostics: From Disclosure Laws to Clinical Research for Novel Drug Development

This article examines the changing role of ‘confessional technologies’ (Foucault 1990) over the history of the HIV pandemic, beginning when US public health departments first rolled out testing campaigns and continuing in the present day through the expansion of diagnostic practices to support the development and implementation of pharmaceutical technologies for HIV prevention. Across this decades-long history, diagnostic practices have been shaped by ethical principles, legal mandates, and research priorities, which have compelled the individual who is ‘at risk’ of acquiring HIV to speak about their sexual practices and thus reveal hidden truths about one’s self to an intimate Other (Whitacre 2018). Indeed, public health ethics have long focused on confession as a means for disciplining safe sex and managing pleasure (Race 2007) and relied on these techniques to secure resources for survival (Nguyen 2010). I argue that confessions have recently become a productive means by which to generate evidence about the efficacy of pharmaceuticals. Practices of revealing truth have contributed to clinical evidence for pharmaceutical interventions, including the use of antiretrovirals for oral HIV pre-exposure prophylaxis (PrEP). Considering the contemporary use of confessions in enabling the development of drug products and facilitating market growth, I contend that confessing should be understood as a form of labour.

Decline in overall pulmonary embolism-related mortality and increasing prevalence of cancer-associated events in the Veneto region (Italy), 2008-2019

Background. Despite evidence of ongoing epidemiological changes in deaths from venous thromboembolism in high-income countries, little recent information is available on the time trends in mortality related to PE as underlying or concomitant cause of death in Europe. Methods. We accessed the regional database of death certificates of Veneto Region (Northern Italy, population 4,900,000) from 2008 to 2019. We analysed the trends in crude and age-adjusted annual rates of mortality related to PE (reported either as underlying cause or in any position in the death certificate) using Joinpoint regression; in the contribution of PE to mortality (proportionate mortality); and, using logistic regression, in the association between PE and cancer at death. Results. Between 2008 and 2019, the age-standardized mortality rate related to PE in Veneto decreased from 20.7 to 12.6 annual deaths per 100,000 population for PE in any position of the death certificate, and from 4.6 to 2.2 annual deaths per 100,000 population for PE as underlying cause of death. PE-related proportionate mortality remained up to twice as high in women. The age- and sex-adjusted odds ratio for cancer in deaths with (vs. without) PE constantly increased from 1.01 (95% CI 0.88-1.16) in 2008 to 1.58 (95% CI 1.35-1.83) in 2019. Conclusions. The descending trend in PE-related mortality reported for Europe up to 2015 for both sexes continued thereafter in Northern Italy. However, sex differences in proportionate mortality persist, and the increasing association between PE and cancer at death may reflect changes in risk factor distribution or diagnostic practices.