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Yu R, Xu Z, Lu Y, Zhu Y, Chen L. Attitudes and health behaviors of middle-aged and older adults with elevated tumor markers in China. Front Psychol 2024; 15:1265648. [PMID: 38379627 PMCID: PMC10878324 DOI: 10.3389/fpsyg.2024.1265648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
Objectives To understand the attitudes and health behaviors of middle-aged and older adults in China after receiving elevated results of tumor markers (TMs) test in the annual health examinations (AHEs) and explore the influencing factors. Methods A three-section online questionnaire survey was conducted from March 1 to April 30, 2020 in Hangzhou, China, to people who were aged 45 and older and had at least one elevated result of TMs test. Clinical information was collected from the online survey and medical records. Descriptive statistics were carried out followed by regression analyses. Results Of 380 participants, 76.1% were unwilling to quit the TMs test in AHEs, whereas 75.3% would take the doctor's advice and quit unnecessary TMs test; 67.4% felt stressed about their TMs. Among participants with elevated TMs, 76.8% changed lifestyle to keep healthy, 74.2% sought health information, 58.9% requested a TMs retest, and 50.3% did further tests to confirm a diagnosis. Family history of cancer was associated with lifestyle changing; education level, area of residence and health insurance were associated with health information seeking; comorbidity were associated with retests and sequential confirming tests. Conclusion The application of the TMs test in AHEs among Chinese people may lead to positive and negative behavioral consequences and psychological distress. Doctors have a significant impact on patients' health behaviors. Accurate indications and adequate communication with patients before and after the TMs test are in great need.
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Affiliation(s)
- Renke Yu
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhijie Xu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiting Lu
- Department of General Practice, Zhongdai Community Healthcare Center, Huzhou, China
| | - Yue Zhu
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liying Chen
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Gion M, De Gobbi R, Zorzi M, Carretta G, Leonardi L, Guzzinati S, Trevisiol C, Cancian M, Cardinali G, Michieletto F, Dittadi R, Fabricio ASC, Rugge M, Russo F. Overordering of tumor marker for outpatients revealed by performance indicators and the impact of a health policy intervention: An observational study using administrative records. Int J Biol Markers 2023; 38:61-71. [PMID: 36855811 DOI: 10.1177/03936155231154663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
PURPOSE The overuse of laboratory tests contributes to impair health systems effectiveness, tumor markers (TMs) being a paradigmatic example. In the present study we applied indicators of TMs appropriateness developed from administrative datasets to appraise regionwide overordering in the clinical practice. PATIENTS AND METHODS TMs ordered to outpatients in the Veneto Region over 6 years were obtained from the eletronic Outpatients' Records of Diagnostic and Therapeutic Procedures. TMs orders were examined as aggregated data or stratified according to disease codes, gender, age, and requests per patient. TMs recommended only for specific malignancies were examined using epidemiological data obtained from Veneto Tumor Registry. RESULTS A total of 5,821,251 TMs were ordered in 4,382,159 patients over 6 years. Overall, 3,252,389 (55.9%) TMs were ordered without appropriate disease codes (ranging from 77.0% for PSA to 17.5% for CA15.3). TM orders declined over 6 years (-13.4%), with a noticeable reduction of orders without appropriate disease codes (-21.3%). Orders decreased sharply from 2015 to 2016, after the enactment of a national Decree-Law aimed at improving appropriateness, and remained stable thereafter. However, the rate of inappropriate TMs requests still remained elevated (44.4%) in the last year of observation, with orders of TMs being much higher than expected on the basis of prevalence and incidence figures of specific malignancies. CONCLUSIONS Indicators developed from administrative datasets were effective in assessing the overordering of TMs and the impact of interventions to improve appropriateness. The developed indicators could be considered for other diagnostic tests.
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Affiliation(s)
- Massimo Gion
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Roberto De Gobbi
- UOC Analisi Attività Assistenziali Sanitarie e Socio Sanitarie, Azienda Zero - Veneto Region, Padua, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero - Veneto Region, Padua, Italy
| | | | - Luca Leonardi
- Engineering Ingegneria Informatica spa, Padua, Italy
| | | | | | | | - Giulia Cardinali
- Management Control Unit, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Federica Michieletto
- Regional Directorate of Prevention, Food Safety, Veterinary, Veneto Region, Venice, Italy
| | - Ruggero Dittadi
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
| | | | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero - Veneto Region, Padua, Italy
| | - Francesca Russo
- Regional Directorate of Prevention, Food Safety, Veterinary, Veneto Region, Venice, Italy
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Panteghini M, Dolci A, Birindelli S, Szoke D, Aloisio E, Caruso S. Pursuing appropriateness of laboratory tests: a 15-year experience in an academic medical institution. Clin Chem Lab Med 2022; 60:1706-1718. [PMID: 35998662 DOI: 10.1515/cclm-2022-0683] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/08/2022] [Indexed: 02/04/2023]
Abstract
Appropriateness in Laboratory Medicine has been the object of various types of interventions. From published experiences, it is now clear that to effectively manage the laboratory test demand it is recommended to activate evidence-based preventative strategies stopping inappropriate requests before they can reach the laboratory. To guarantee appropriate laboratory test utilization, healthcare institutions should implement and optimize a computerized provider order entry (CPOE), exploiting the potential of electronic requesting as "enabling factor" for reinforcing appropriateness and sustaining its effects over time. In our academic institution, over the last 15 years, our medical laboratory has enforced various interventions to improve test appropriateness, all directly or indirectly based on CPOE use. The following types of intervention were implemented: (1) applying specific recommendations supported by monitoring by CPOE as well as a continuous consultation with clinicians (tumour markers); (2) removing outdated tests and avoiding redundant duplications (cardiac markers, pancreatic enzymes); (3) order restraints to selected wards and gating policy (procalcitonin, B-type natriuretic peptide, homocysteine); (4) reflex testing (bilirubin fractions, free prostate-specific antigen, aminotransferases, magnesium in hypocalcemia); and (5) minimum retesting interval (D-Dimer, vitamin B12, C-reactive protein, γ-glutamyltranspeptidase). In this paper, we reviewed these interventions and summarized their outcomes primarily related to the changes in total test volumes and cost savings, without neglecting patient safety. Our experience confirmed that laboratory professionals have an irreplaceable role as "stewards" in designing, implementing, evaluating, and maintaining interventions focused to improving test appropriateness.
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Affiliation(s)
- Mauro Panteghini
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy.,Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi, Milan, Italy
| | - Alberto Dolci
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy.,Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi, Milan, Italy
| | - Sarah Birindelli
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Dominika Szoke
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elena Aloisio
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Simone Caruso
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy
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Gion M, Cardinali G, Guzzinati S, Morandi P, Trevisiol C, Fabricio ASC, Rugge M, Zorzi M. Use of Routine Health Datasets to Assess the Appropriateness of Diagnostic Tests in the Follow-Up of Breast Cancer Patients: A Population-Based Study on 3930 Patients. Risk Manag Healthc Policy 2022; 15:1087-1100. [PMID: 35615584 PMCID: PMC9126654 DOI: 10.2147/rmhp.s342072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/05/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Clinical practice guidelines (CPGs) recommend against intensive follow-up in asymptomatic women with breast cancer (BC). The present study assessed the adherence to CPGs of diagnostic tests ordering during BC follow-up by exploring routinely collected health data through an algorithm developed to distinguish patients according to their status at follow-up. Patients and Methods A retrospective population-based cohort study was performed monitoring the diagnostic tests ordered during 5 years of follow-up in all BC cases incident in 2013 in the Veneto Region, Italy. Data were extracted from the Veneto Tumour Registry, the Hospital Discharge Records and the Outpatients’ Records of Diagnostic and Therapeutic Procedures. The algorithm was developed using information on infusion of anticancer agents, imaging exams ordered, and death. Results The algorithm classified patients by status at follow-up in four groups: (i) probably no-evidence-of-disease (NED), (ii) suspicious signs of relapse not confirmed, (iii) increased risk of relapse and (iv) advanced disease at presentation or progressive disease. A total of 3930 consecutive incident cases were followed-up for 5 years, corresponding to 17,184 person-years, 15,345 of which pertaining to NED cases. In NED cases, 32,900 tumour markers and 15,858 imaging exams were ordered. Liver ultrasonography and chest radiography were most frequently ordered. Conclusion In contrast with recommendations of CPGs, a substantial overordering of tumour markers and imaging exams occurred in NED BC patients. The developed algorithm can be repeatedly applied to routine health datasets for regular monitoring of the adherence to CPGs and of the impact of interventions to improve appropriateness.
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Affiliation(s)
- Massimo Gion
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
- Correspondence: Massimo Gion, Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Ospedale SS. Giovanni e Paolo – Castello, Venezia, 6777 – 30122, Italy, Tel +39 041 5294260, Fax +39 041 5295603, Email
| | - Giulia Cardinali
- Management Control Unit, Azienda ULSS 3 Serenissima, Venice, Italy
| | | | - Paolo Morandi
- Medical Oncology Unit, Azienda ULSS 3 Serenissima, Venice, Italy
| | | | | | - Massimo Rugge
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
- University of Padova, Department of Medicine DIMED, Padua, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
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Nascimento-Júnior VP, Camargos EF. Inappropriate requests for tumor markers in patients aged 50 years and older: lessons not learned. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.5327/z2447-212320212000113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To investigate, within a private health insurance, the ordering frequency and the costs related to inappropriate TM test orders. METHODS: This study analyzed data regarding TM requests within a private health insurance between 2010 and 2017. Patients included in this analysis were ≥ 50 years old, had available medical records, and had at least 1 TM tested within the study period. Tests were considered inappropriate when TMs were used in screening for neoplasms, ie, when there was no previous diagnosis. We evaluated data regarding age, sex, the ordering physician’s medical specialty, and test costs. RESULTS: Between 2010 and 2017, 1,112 TM tests were performed and increased from 52 to 262 per year. Our sample consisted mostly of women (69.50%) with a mean age of 59.40 (SD, 8.20) years. Most orders were inappropriate (87.80%) and represented 79.40% of all expenses with TM tests. Cardiology professionals were the medical specialty that requested the most TM tests (23.90%), followed by internal medicine specialists (22.70%) and gynecologists (19.20%). CONCLUSIONS: We observed a high percentage of inappropriate test orders in the study period, resulting in elevated costs. Studies of this nature deserve the attention of health care managers, and interventions should be performed in order to reduce the inappropriate use of TM tests in clinical practice.
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Complementary Use of Carbohydrate Antigens Lewis a, Lewis b, and Sialyl-Lewis a (CA19.9 Epitope) in Gastrointestinal Cancers: Biological Rationale Towards A Personalized Clinical Application. Cancers (Basel) 2020; 12:cancers12061509. [PMID: 32527016 PMCID: PMC7352550 DOI: 10.3390/cancers12061509] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 12/14/2022] Open
Abstract
Carbohydrate antigen 19.9 (CA19.9) is used as a tumor marker for clinical and research purposes assuming that it is abundantly produced by gastrointestinal cancer cells due to a cancer-associated aberrant glycosylation favoring its synthesis. Recent data has instead suggested a different picture, where immunodetection on tissue sections matches biochemical and molecular data. In addition to CA19.9, structurally related carbohydrate antigens Lewis a and Lewis b are, in fact, undetectable in colon cancer, due to the down-regulation of a galactosyltransferase necessary for their synthesis. In the pancreas, no differential expression of CA19.9 or cognate glycosyltransferases occurs in cancer. Ductal cells only express such Lewis antigens in a pattern affected by the relative levels of each glycosyltransferase, which are genetically and epigenetically determined. The elevation of circulating antigens seems to depend on the obstruction of neoplastic ducts and loss of polarity occurring in malignant ductal cells. Circulating Lewis a and Lewis b are indeed promising candidates for monitoring pancreatic cancer patients that are negative for CA19.9, but not for improving the low diagnostic performance of such an antigen. Insufficient biological data are available for gastric and bile duct cancer. Studying each patient in a personalized manner determining all Lewis antigens in the surgical specimens and in the blood, together with the status of the tissue-specific glycosylation machinery, promises fruitful advances in translational research and clinical practice.
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8
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Su YY, Sun L, Guo ZR, Li JC, Bai TT, Cai XX, Li WH, Zhu YF. Upregulated expression of serum exosomal miR-375 and miR-1307 enhance the diagnostic power of CA125 for ovarian cancer. J Ovarian Res 2019; 12:6. [PMID: 30670062 PMCID: PMC6341583 DOI: 10.1186/s13048-018-0477-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 12/14/2018] [Indexed: 12/13/2022] Open
Abstract
Background Ovarian cancer (OC) is associated with high mortality in gynecological oncology; this is mainly due to the low diagnosis rate. Exosomal miRNA has demonstrated potential as a tumor biomarker. We aimed to explore the diagnostic potential of serum exosomal miR-1307 and miR-375 for OC. Methods The first six candidate miRNAs were selected from the previous literature. The relative quantification of qRT-PCR was used to screen for the stability of exosomal miRNAs, followed by validation of the cohort. ROC analysis was employed to analyze the specificity and sensitivity of exosomal miRNA. Results MiR-1307 and miR-375 were confirmed stably existing in serum exosomes of OC. Moreover, miR-1307 and miR-375 were both significantly up-regulated in serum exosomes of OC compared to ovarian benign and healthy groups. The overexpressed miRNAs showed independent diagnostic power and enhanced the diagnostic accuracy of traditional biomarkers when combined with CA-125 and HE4. MiR-1307 was associated with tumor staging, and miR-375 was associated with lymph node metastasis of OC. Conclusion Our results suggest that serum exosomal miR-1307 and miR-375 could serve as potential tumor biomarkers to improve diagnostic efficiency for OC.
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Affiliation(s)
- Ying Ying Su
- The Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Li Sun
- The Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Zhi Rui Guo
- The Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Jin Chang Li
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Ting Ting Bai
- The Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Xiao Xiao Cai
- The Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Wen Han Li
- The Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Ye Fei Zhu
- The Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China.
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Epidemiology-based assessment of tumor marker overordering in breast cancer: an algorithm to examine different disease conditions. Int J Biol Markers 2017; 32:e471-e473. [PMID: 28561878 DOI: 10.5301/ijbm.5000274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 11/20/2022]
Abstract
Laboratory tests are frequently overused and have elevated inappropriateness rates. We previously developed a model to investigate the rate of utilization of tumor markers (TMs) in outpatients as an indirect indicator of inappropriateness. The model was based on the comparison between the number of actually ordered and expected tests, with the latter estimated on the basis of both epidemiological data and recommendations of available clinical practice guidelines.In this paper we propose an algorithm to distinguish prevalent cases without evidence of disease from those with metastatic spread, on the basis of both epidemiological and clinical information. The algorithm allows for a more precise prediction of the expected TM requests per year, to be compared with the actual number of requested TMs in order to assess possibly inappropriate overordering rates. Moreover, the implementation of the algorithm renders the epidemiologically based model more flexible to develop accurate indicators for appropriateness in the use of TMs in different stages of disease and for different clinical questions. A practical application with CA15.3 requests in breast cancer is presented.
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Zhang S, Pang H, Sun M, Li H. Timosaponin AIII inhibits the growth of human leukaemia cells HL-60 by down-regulation of PI3K/AKT and Wnt/β-catenin pathways. BIOTECHNOL BIOTEC EQ 2017. [DOI: 10.1080/13102818.2017.1389304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Sai Zhang
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, P. R. China
| | - Haifeng Pang
- Department of Pediatrics, First Hospital of Jilin University, Changchun, P. R. China
| | - Meihua Sun
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, P. R. China
| | - Haibo Li
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, P. R. China
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Gion M, Cardinali G, Trevisiol C, Zappa M, Rainato G, Fabricio ASC. Indicators of inappropriate tumour marker use through the mining of electronic health records. J Eval Clin Pract 2017; 23:895-902. [PMID: 28503788 DOI: 10.1111/jep.12754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 12/12/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Although the issue of monitoring appropriateness of tumour markers (TMs) request in outpatients remains crucial, proper indicators are still demanding. The present study developed and explored indicators of inappropriate TM ordering in outpatients through the data mining of electronic health records (EHRs). METHODS Carcinoembryonic antigen (CEA), alfa-fetoprotein (AFP), carbohydrate antigen (CA)125, CA15.3, CA19.9, and prostate-specific antigen (PSA) ordered in outpatients during a year were examined by mining EHRs of a Local Health Authority in Italy. Evidence-based criteria were used to develop performance indicators. Demographic and clinical information associated with TM orders were examined. RESULTS A total of 80 813 TMs were ordered in 52 536 outpatients (1.54 markers/patient). Indicators related to disease codes, gender, age, and TM repetitions were developed, and their application showed that (1) CA15.3 and CEA are prevalently requested in patients with cancer (79.2% and 65.6%) whereas the other TMs are largely requested also in patients without cancer; (2) requests of PSA in women and of CA125 or CA15.3 in men are negligible; (3) although requests in people older than 80 years are relevant (16.4% of total), the highest rate of request of all markers occurs in patients aged 40 to 79 years; (4) CA15.3 and CEA are mainly requested in cancer cases between 50 and 79 years and AFP, CA19.9, and CA125 in those between 60 and 69 years; (5) <50% of PSA orders are associated with cancer code for all age intervals; and (6) multiple repetitions of AFP, CA125, CA15.3, CA19.9, and CEA are prevalent in cancer patients or benign diseases to which TMs are appropriate, whereas PSA repetitions occur mainly in patients without cancer. CONCLUSIONS The developed indicators resulted suitable to monitor TM overordering in outpatients through the mining of EHRs. The present study is a first approach towards the use of big-data mining for TM appropriateness evaluation purposes.
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Affiliation(s)
- Massimo Gion
- Centro Regionale Specializzato e Programma Regionale Biomarcatori, AULSS 3 Serenissima, Venice, Italy
| | | | | | - Marco Zappa
- Clinical and Descriptive Epidemiology Unit, ISPO Cancer Research and Prevention Institute, Florence, Italy
| | | | - Aline S C Fabricio
- Centro Regionale Specializzato e Programma Regionale Biomarcatori, AULSS 3 Serenissima, Venice, Italy
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Gion M, Trevisiol C, Fabricio ASC. Appropriateness of tumor marker request: a case of study. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:274. [PMID: 28758100 DOI: 10.21037/atm.2017.06.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Appropriateness is crucial to provide efficient and high-quality health services at affordable costs. Laboratory medicine is a sector of special interest for the investigation of inappropriateness, due to the high rate of technological innovation and its pivotal role in many diseases and clinical settings. Some subjective aspects related to either the patient or physician seem to have a major role on inappropriateness rates. Given the psychological impact of cancer on both patients and physicians, tumor markers represent a case of study for appropriateness. The assessment of inappropriateness of laboratory tests has been focused mainly on ordering patterns. Appropriateness can barely be appraised by matching the requested test with the clinical problem because clinical information on the test requisition form is usually inadequate. Monitoring inappropriateness through individual clinical information may be feasible in inpatient (clinical data are available), while an indirect approach should be used for outpatients. To estimate inappropriateness in outpatients our group developed innovative models based on comparison between the actually ordered and expected requests of tumor marker, calculated according to recommendations of clinical practice guidelines (CPGs) applied to figures of cancer prevalence. The implementation of the model at national scale in Italy led to recognize a very high rate of overordering of tumor markers. The model was further focused by a dedicated algorithm to be adapted to different clinical conditions or organizational settings by applying performance indicators to cohort-wide structured information in electronic health records (EHRs). With this novel approach, we showed that inappropriateness is multifaceted even within the specific category of tumour markers. The model was effective in identifying both over- and underordering. Implementation of evidence based information and monitoring their impact on the clinical practice are parts of the same, multistage, process aimed at the progressive improvement of health care.
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Affiliation(s)
- Massimo Gion
- Regional Center for Biomarkers, Department of Clinical Pathology and Transfusion Medicine, Azienda ULSS3 Serenissima, Venice, Italy
| | | | - Aline S C Fabricio
- Regional Center for Biomarkers, Department of Clinical Pathology and Transfusion Medicine, Azienda ULSS3 Serenissima, Venice, Italy
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Selectin Ligands Sialyl-Lewis a and Sialyl-Lewis x in Gastrointestinal Cancers. BIOLOGY 2017; 6:biology6010016. [PMID: 28241499 PMCID: PMC5372009 DOI: 10.3390/biology6010016] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 12/20/2022]
Abstract
The tetrasaccharide structures Siaα2,3Galβ1,3(Fucα1,4)GlcNAc and Siaα2,3Galβ1,4(Fucα1,3)GlcNAc constitute the epitopes of the carbohydrate antigens sialyl-Lewis a (sLea) and sialyl-Lewis x (sLex), respectively, and are the minimal requirement for selectin binding to their counter-receptors. Interaction of sLex expressed on the cell surface of leucocytes with E-selectin on endothelial cells allows their arrest and promotes their extravasation. Similarly, the rolling of cancer cells ectopically expressing the selectin ligands on endothelial cells is potentially a crucial step favoring the metastatic process. In this review, we focus on the biosynthetic steps giving rise to selectin ligand expression in cell lines and native tissues of gastrointestinal origin, trying to understand whether and how they are deregulated in cancer. We also discuss the use of such molecules in the diagnosis of gastrointestinal cancers, particularly in light of recent data questioning the ability of colon cancers to express sLea and the possible use of circulating sLex in the early detection of pancreatic cancer. Finally, we reviewed the data dealing with the mechanisms that link selectin ligand expression in gastrointestinal cells to cancer malignancy. This promising research field seems to require additional data on native patient tissues to reach more definitive conclusions.
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Lippi G, Bovo C, Ciaccio M. Inappropriateness in laboratory medicine: an elephant in the room? ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:82. [PMID: 28275627 DOI: 10.21037/atm.2017.02.04] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Appropriateness of diagnostic testing can be conventionally described as prescription of the right test, using the right method, at the right time, to the right patient, with the right costs and for producing the right outcome. There is ongoing debate about the real burden of inappropriateness in laboratory diagnostics. The media coverage of this issue has also recently led to either over- or under-emphasizing the clinical, organizational and economic consequences. This is quite problematic, inasmuch as some reliable data are available in the current scientific literature, showing that inappropriateness of laboratory testing can be as high as 70%. This is especially evident for, though not limited to, cancer biomarkers testing, in which the practice of avoidable tests ordering is dramatically magnified. The reasons beyond inappropriateness are many and multifaceted, entailing wrong habits, resistance to changes, poor culture, insufficient education and healthcare inefficiencies. There are many unfavorable consequences attributable to avoidable testing, including unjustified incremental costs, derangement of laboratory efficiency and potential patient safety issues. The tentative solutions to this important problem necessitate that policymakers, local hospital administrators, laboratory professionals, clinicians, patients' associations and diagnostic companies join the efforts and embark in the same landmark effort for disseminating a better culture of appropriateness.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Chiara Bovo
- Medical Direction, University Hospital of Verona, Verona, Italy
| | - Marcello Ciaccio
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biopathology and Medical Biotechnology, University of Palermo, Italy
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Need for Knowledge Translation to Improve Tumor Marker Application. Int J Biol Markers 2016; 31:e331. [DOI: 10.5301/jbm.5000250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 11/20/2022]
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Circulating tumor markers: a guide to their appropriate clinical use | Comparative summary of recommendations from clinical practice guidelines (PART 1). Int J Biol Markers 2016; 31:e332-e367. [PMID: 28025819 DOI: 10.5301/jbm.5000251] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/20/2022]
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