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Jahn LS, Kengonzi A, Kabwama SN, Rubaihayo J, Theuring S. Preventing HIV Infection in Pregnant Women in Western Uganda Through a Comprehensive Antenatal Care-Based Intervention: An Implementation Study. Arch Sex Behav 2024; 53:745-756. [PMID: 37943471 PMCID: PMC10844405 DOI: 10.1007/s10508-023-02726-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
We implemented and assessed a comprehensive, antenatal care (ANC)-embedded strategy to prevent HIV seroconversions during pregnancy in Uganda. HIV-negative first-time ANC clients were administered an HIV risk assessment tool and received individual risk counseling. Those attending ANC without partners obtained formal partner invitation letters. After three months, repeat HIV testing was carried out; non-attending women were reminded via phone. We analyzed uptake and acceptance, HIV incidence rate, and risk behavior engagement. Among 1081 participants, 116 (10.7%) reported risk behavior engagement at first visit; 148 (13.7%) were accompanied by partners. At the repeat visit (n = 848), 42 (5%, p < 0.001) reported risk behavior engagement; 248 (29.4%, p < 0.001) women came with partners. Seroconversion occurred in two women. Increased odds for risk behavior engagement were found in rural clients (aOR 3.96; 95% CI 1.53-10.26), women with positive or unknown partner HIV-status (2.86; 1.18-6.91), and women whose partners abused alcohol (2.68; 1.15-6.26). Overall, the assessed HIV prevention strategy for pregnant women seemed highly feasible and effective. Risk behavior during pregnancy was reduced by half and partner participation rates in ANC doubled. The observed HIV incidence rate was almost four times lower compared to a pre-intervention cohort in the same study setting.
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Affiliation(s)
- Lisa S Jahn
- Institute of International Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Agnes Kengonzi
- School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda
| | | | - John Rubaihayo
- School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda
| | - Stefanie Theuring
- Institute of International Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Abstract
This article presents an overview of methods developed for the modeling and control of local coronavirus outbreaks. The article reviews early transmission dynamics featuring exponential growth in infections, and links this to a renewal epidemic model where the current incidence of infection depends upon the expected value of incidence randomly lagged into the past. This leads directly to simple formulas for the fraction of the population infected in an unmitigated outbreak, and reveals herd immunity as the solution to an optimization problem. The model also leads to direct and easy-to-understand formulas for aligning observable epidemic indicators such as cases, hospitalizations and deaths with the unobservable incidence of infection, and as a byproduct leads to a simple first-order approach for estimating the effective reproduction number R t . The model also leads naturally to direct assessments of the effectiveness of isolation in preventing the spread of infection. This is illustrated with application to repeat asymptomatic screening programs of the sort utilized by universities, sports teams and businesses to prevent the spread of infection.
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Affiliation(s)
- Joseph T Chang
- Department of Statistics and Data Science, Yale University, 24 Hillhouse Avenue, New Haven, CT 06511, USA
| | - Edward H Kaplan
- Yale School of Management, 165 Whitney Avenue, New Haven, CT 06511, USA
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Hambridge HL, Kahn R, Onnela JP. Examining SARS-CoV-2 Interventions in Residential Colleges Using an Empirical Network. Int J Infect Dis 2021; 113:325-330. [PMID: 34624516 PMCID: PMC8492892 DOI: 10.1016/j.ijid.2021.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/17/2021] [Accepted: 10/02/2021] [Indexed: 01/11/2023] Open
Abstract
Objectives Universities have turned to SARS-CoV-2 models to examine campus reopening strategies. While these studies have explored a variety of modeling techniques, none have used empirical data. Methods In this study, we use an empirical proximity network of college freshmen obtained using smartphone Bluetooth to simulate the spread of the virus. We investigate the role of immunization, testing, isolation, mask wearing, and social distancing in the presence of implementation challenges and imperfect compliance. Results We show that frequent testing could drastically reduce the spread of the virus if levels of immunity are low, but its effects are limited if immunity is more ubiquitous. Furthermore, moderate levels of mask wearing and social distancing could lead to additional reductions in cumulative incidence, but their benefit decreases rapidly as immunity and testing frequency increase. However, if immunity from vaccination is imperfect or declines over time, scenarios not studied here, frequent testing and other interventions may play more central roles. Conclusions Our findings suggest that although regular testing and isolation are powerful tools, they have limited benefit if immunity is high or other interventions are widely adopted. If universities can attain even moderate levels of vaccination, masking, and social distancing, they may be able to relax the frequency of testing to once every four weeks.
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Affiliation(s)
- Hali L Hambridge
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Rebecca Kahn
- Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
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Abstract
Universities have turned to SARS-CoV-2 models to examine campus reopening strategies1-9. While these studies have explored a variety of modeling techniques, all have relied on simulated data. Here, we use an empirical proximity network of college freshmen10, ascertained using smartphone Bluetooth, to simulate the spread of the virus. We investigate the role of testing, isolation, mask wearing, and social distancing in the presence of implementation challenges and imperfect compliance. Here we show that while frequent testing can drastically reduce spread if mask wearing and social distancing are not widely adopted, testing has limited impact if they are ubiquitous. Furthermore, even moderate levels of immunity can significantly reduce new infections, especially when combined with other interventions. Our findings suggest that while testing and isolation are powerful tools, they have limited benefit if other interventions are widely adopted. If universities can attain high levels of masking and social distancing, they may be able to relax testing frequency to once every two to four weeks.
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Affiliation(s)
- Hali L Hambridge
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rebecca Kahn
- Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
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Abstract
Residential colleges are considering re-opening under uncertain futures regarding the COVID-19 pandemic. We consider repeat SARS-CoV-2 testing models for the purpose of containing outbreaks in the residential campus community. The goal of repeat testing is to detect and isolate new infections rapidly to block transmission that would otherwise occur both on and off campus. The models allow for specification of aspects including scheduled on-campus resident screening at a given frequency, test sensitivity that can depend on the time since infection, imported infections from off campus throughout the school term, and a lag from testing until student isolation due to laboratory turnaround and student relocation delay. For early- (late-) transmission of SARS-CoV-2 by age of infection, we find that weekly screening cannot reliably contain outbreaks with reproductive numbers above 1.4 (1.6) if more than one imported exposure per 10,000 students occurs daily. Screening every three days can contain outbreaks providing the reproductive number remains below 1.75 (2.3) if transmission happens earlier (later) with time from infection, but at the cost of increased false positive rates requiring more isolation quarters for students testing positive. Testing frequently while minimizing the delay from testing until isolation for those found positive are the most controllable levers for preventing large residential college outbreaks. A web app that implements model calculations is available to facilitate exploration and consideration of a variety of scenarios.
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Affiliation(s)
- Joseph T. Chang
- Department of Statistics and Data Science, Yale University, 24 Hillhouse Avenue, New Haven, CT 06511-6814 USA
| | - Forrest W. Crawford
- Department of Biostatistics, Department of Ecology and Evolutionary Biology, Yale School of Management, Department of Statistics and Data Science, Yale School of Public Health, PO Box 208034, New Haven, CT 06510 USA
| | - Edward H. Kaplan
- Yale School of Management, Yale School of Public Health, Yale School of Engineering and Applied Science, 165 Whitney Avenue, New Haven, CT 06511 USA
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Shaw JL, McCudden CR, Colantonio DA, Booth RA, Lin DC, Blasutig IM, Moran T, Trofimczuk D, Carriere C, Gharra A, Portelance C, Tremblay C, Dupaul D, Breton N, Angelkovski M, Jariwala C, Embleton M, Campbell C, Groulx K, Larmour K. Effective interventions to improve the quality of critically high point-of-care glucose meter results. Pract Lab Med 2020; 22:e00184. [PMID: 33145388 PMCID: PMC7596339 DOI: 10.1016/j.plabm.2020.e00184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/16/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives Point-of-care testing (POCT) is testing performed outside the traditional laboratory, often at the patient bedside. In hospital settings, blood glucose is the most common POCT. Staff performing POCT are not usually laboratory trained; they are clinical staff with a primary focus on treating patients. Clinical staff find POCT quality assurance (QA) practices burdensome and are often non-compliant. In hospitals within EORLA (Eastern Ontario Regional Laboratories Association), all critically high POCT glucose results must be repeated prior to acting, according to policy. Compliance with this policy is audited regularly. Design and methods: All POCT glucose tests performed in participating sites between January and June 2018 and June and December 2019 were audited for compliance with the critical repeat policy. The discordant repeat rate was also determined for each audit period. Between January and May 2019, there were interventions aimed at improving compliance with the repeat policy. Results Compliance with the critical repeat policy increased from 30 to 57% in 2019 compared to 2018, following nursing education and implementation of notifications on the glucose meters themselves. The rate of discordant repeat results (>20% different from initial) also improved at most sites in 2019 compared to 2018. Nurses cited insufficient cleaning of patient hands prior to initial testing as the primary reason for discordant repeats. Conclusions Operator compliance with POCT QA policies is an ongoing challenge requiring continual audit, feedback and education. A strong POCT multi-disciplinary committee with supports from senior and clinical leadership in an organization are key to improving compliance. Compliance with the policy requiring repeat of all critically high POCT glucose results is audited as a quality indicator. Audits demonstrated a high rate of non-compliance with the critical repeat policy by clinical staff performing POCT. Approximately 25% of critically high glucose results repeated were discordant (>20% different from the initial result) Implementation of meter notifications and nursing education led to significant improvements in compliance at most sites.
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Affiliation(s)
- Julie Lv Shaw
- Eastern Ontario Regional Laboratories Association, Canada.,Division of Biochemistry, The Ottawa Hospital, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Canada
| | - Christopher R McCudden
- Eastern Ontario Regional Laboratories Association, Canada.,Division of Biochemistry, The Ottawa Hospital, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Canada
| | - David A Colantonio
- Eastern Ontario Regional Laboratories Association, Canada.,Division of Biochemistry, The Ottawa Hospital, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Canada
| | - Ronald A Booth
- Eastern Ontario Regional Laboratories Association, Canada.,Division of Biochemistry, The Ottawa Hospital, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Canada
| | - Danny C Lin
- Eastern Ontario Regional Laboratories Association, Canada.,Division of Biochemistry, The Ottawa Hospital, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Canada
| | - Ivan M Blasutig
- Eastern Ontario Regional Laboratories Association, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Canada.,Division of Biochemistry, Children's Hospital of Eastern Ontario, Canada
| | - Thomas Moran
- Eastern Ontario Regional Laboratories Association, Canada
| | | | | | - Anas Gharra
- Eastern Ontario Regional Laboratories Association, Canada
| | | | | | - Dianne Dupaul
- Eastern Ontario Regional Laboratories Association, Canada
| | | | | | | | | | | | | | - Karen Larmour
- Eastern Ontario Regional Laboratories Association, Canada
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Bannink Mbazzi F, Namukwaya Z, Amone A, Ojok F, Etima J, Byamugisha J, Katabira E, Fowler MG, Homsy J, King R. "[Repeat] testing and counseling is one of the key [services] that the government should continue providing": participants' perceptions on extended repeat HIV testing and enhanced counseling (ERHTEC) for primary HIV prevention in pregnant and lactating women in the PRIMAL study, Uganda. BMC Public Health 2020; 20:694. [PMID: 32414405 PMCID: PMC7227345 DOI: 10.1186/s12889-020-08738-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 04/20/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The 'Primary HIV Prevention among Pregnant and Lactating Ugandan Women' (PRIMAL) randomized controlled trial aimed to assess an enhanced counseling strategy linked to extended postpartum repeat HIV testing and enhanced counseling among 820 HIV-negative pregnant and lactating women aged 18-49 years and 410 of their male partners to address the first pillar of the WHO Global Strategy for the Prevention of Mother-to-Child HIV transmission (PMTCT). This paper presents findings of qualitative studies aimed at evaluating participants' and service providers' perceptions on the acceptability and feasibility of the intervention and at understanding the effects of the intervention on risk reduction, couple communication, and emotional support from women's partners. METHODS PRIMAL Study participants were enrolled from two antenatal care clinics and randomized 1:1 to an intervention or control arm. Both arms received repeat sexually transmitted infections (STI) and HIV testing at enrolment, labor and delivery, and at 3, 6, 12, 18 and 24 months postpartum. The intervention consisted of enhanced quarterly counseling on HIV risk reduction, couple communication, family planning and nutrition delivered by study counselors through up to 24 months post-partum. Control participants received repeat standard post-test counseling. Qualitative data were collected from intervention women participants, counsellors and midwives at baseline, midline and end of the study through 18 focus group discussions and 44 key informant interviews. Data analysis followed a thematic approach using framework analysis and a matrix-based system for organizing, reducing, and synthesizing data. RESULTS At baseline, FGD participants mentioned multiple sexual partners and lack of condom use as the main risks for pregnant and lactating women to acquire HIV. The main reasons for having multiple sexual partners were 1) the cultural practice not to have sex in the late pre-natal and early post-natal period; 2) increased sexual desire during pregnancy; 3) alcohol abuse; 4) poverty; and 5) conflict in couples. Consistent condom use at baseline was limited due to lack of knowledge and low acceptance of condom use in couples. The majority of intervention participants enrolled as couples felt enhanced counselling improved understanding, faithfulness, mutual support and appreciation within their couple. Another benefit mentioned by participants was improvement of couple communication and negotiation, as well as daily decision-making around sexual needs, family planning and condom use. Participants stressed the importance of providing counselling services to all couples. CONCLUSION This study shows that enhanced individual and couple counselling linked to extended repeat HIV and STI testing and focusing on HIV prevention, couple communication, family planning and nutrition is a feasible and acceptable intervention that could enhance risk reduction programs among pregnant and lactating women. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT01882998, date of registration 21st June 2013.
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Affiliation(s)
- Femke Bannink Mbazzi
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.
- Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.
| | - Zikulah Namukwaya
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Alexander Amone
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Juliane Etima
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University School of Medicine, Kampala, Uganda
| | - Elly Katabira
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
- College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
| | - Mary Glenn Fowler
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jaco Homsy
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Rachel King
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
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Saffar H, Abdollahi A, Hosseini AS, Torabi Farsani M, Hajinasrollah G, Mohaghegh P. Necessity of Routine Repeat Testing of Critical Values in Various Working Shifts. Iran J Pathol 2020; 15:161-166. [PMID: 32754210 PMCID: PMC7354071 DOI: 10.30699/ijp.2020.99403.1980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 12/26/2019] [Indexed: 12/02/2022]
Abstract
Background & Objective: Accurate and timely reporting of critical values is an important issue. There is some doubt whether repeat testing of critical values would offer any advantage over single testing or not. The aim of this study was evaluation of utility of routine repeat testing of critical values in our referral center and to compare probable variations in different working shifts. Methods: Clinical results of serum Potassium, Calcium, Blood Hemoglobin and Prothrombin Time (INR: International Normalized Ratio) were evaluated for three months. Results: Totally, 178, 96, 67 and 107 consecutive critical values for Potassium, Calcium, Hemoglobin and INR were reported, respectively. In potassium and Hemoglobin 5.05% and 1.17% of retest runs exceeded the accep1 tolerance limit. All of the calcium retest results were within the acceptable limit. For INR, 21/107 retest results did not meet the acceptable tolerance limit, nine still were critical. Afternoon working run performance was significantly better than the two others. Conclusion: Our observation suggests that routine repeat of hematology and chemistry critical test result is not necessary and may adversely affect patient safety measure. However, attention should be paid to results greater than analytical measurement range and all such results should be repeated before reporting.
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Affiliation(s)
- Hiva Saffar
- Department of Pathology and Laboratory Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Abdollahi
- Department of Pathology and Laboratory Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefe Sadat Hosseini
- Department of Pathology and Laboratory Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojgan Torabi Farsani
- Department of Pathology and Laboratory Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazal Hajinasrollah
- Department of Community Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Mohaghegh
- Department of Community and Preventive Medicine, Arak University of Medical Sciences, Arak, Iran
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Ma I, Guo M, Lau CK, Kandalam V, Naugler C. Dataset of test volume and tests repeated for complete blood count and electrolyte panels from hospitals in a Canadian province in 2018. Data Brief 2020; 29:105144. [PMID: 32021889 PMCID: PMC6994501 DOI: 10.1016/j.dib.2020.105144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/10/2020] [Indexed: 11/19/2022] Open
Abstract
All laboratory tests performed within the province of Alberta in Canada are captured by three Laboratory Information Systems (LIS; Millennium, Sunquest and Meditech), which comprise the provincial Consolidated Laboratory Data Repository (CLDR). The following secondary laboratory data for electrolyte panel (EP) and complete blood count (CBC) test panels performed in emergency room (ER) and inpatient settings were collected from January 1 – December 31, 2018: total test panel volume, total number of test panels repeated, number of test panels repeated within the 24 hour period, test result, date of testing, time of test, and patient Provincial Health Number (PHN). Patient PHN were used as a linking variable to match subsequent tests performed on the same patient. The first time a test was recorded per patient was defined as the “index test”. If the same test panel was performed within a 24-h period following the index test for the patient, data for the repeated test panel was also collected. The index test was defined as “normal” or “abnormal” according to established laboratory normal values and laboratory test reference ranges. For CBCs, we considered the panel to be abnormal if any of the hematocrit (Hct), hemoglobin (Hgb), mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), platelet (PLT), red blood cell (RBC), red cell distribution width (RDW) or white blood cell (WBC) values were outside the normal laboratory reference range. For electrolyte panels, we considered the panel to be abnormal if any of the chloride (Cl), potassium (K), and sodium (Na) were outside of the normal laboratory reference range. All EP results were from clinical chemistry analyzers only. The reuse potential of this dataset can allow other jurisdictions in Canada to compare their redundant repeat testing in their hospital settings with this dataset as a benchmark. This article was submitted via another Elsevier journal as a co-submission (“Inappropriate repeat testing of complete blood count (CBC) and electrolytes in inpatients from Alberta, Canada” [1]), and readers should refer to the co-submission article for interpretation of the results.
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Affiliation(s)
- Irene Ma
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Maggie Guo
- Alberta Public Laboratories (formerly Calgary Laboratory Services), Canada
| | - Cheryl K. Lau
- Alberta Public Laboratories (formerly Calgary Laboratory Services), Canada
| | - Vijay Kandalam
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Canada
- Alberta Public Laboratories (formerly Calgary Laboratory Services), Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Canada
- Corresponding author. Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Canada.
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Kandalam V, Lau CK, Guo M, Ma I, Naugler C. Inappropriate repeat testing of complete blood count (CBC) and electrolyte panels in inpatients from Alberta, Canada. Clin Biochem 2019; 77:32-35. [PMID: 31891680 DOI: 10.1016/j.clinbiochem.2019.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/19/2019] [Accepted: 12/21/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The avoidance of repeat chemistry testing such as Complete Blood Count (CBC) and Electrolyte Panel (EP) on clinically stable patients was identified as important utilization goals by Choosing Wisely Canada. The purpose of this study was to assess the volume of overutilization of CBC and EP in an inpatient setting in Alberta, Canada, and provide an estimated cost assessment of unnecessary testing. METHODS The total laboratory testing volumes of two common test panels were collected retrospectively for one-year from January to December 2018. Data was collected on test panels performed in an emergency room (ER) and inpatient setting from three separate Laboratory Information Systems covering the provincial population in Alberta, Canada. Total initial test panel instances, total repeated panels, repeated panels that were previously normal or abnormal, and estimated costs were examined. Cost assessment was completed based on Reference Median Cost (RMC) analysis for each of these two common test panels. RESULTS During the study period, 2,020,467 (CBC) and 1,455,983 (EP) initial test panel instances were recorded, of which 67.7% and 73.5% were repeated for the CBC and EP, respectively. There was a higher proportion of EP repeated inappropriately (previously normal; 35.6%) compared to CBCs (5.4%). The cost to the province for inappropriately repeating CBC and EP were estimated to be RMC $0.52 million and RMC $1.90 million CAD, respectively. CONCLUSION Results from this study can assist policy makers in implementing utilization management initiatives and update clinical practice guidelines to reduce costs to healthcare without compromising patient care.
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Affiliation(s)
- Vijay Kandalam
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl K Lau
- Alberta Public Laboratories (formerly Calgary Laboratory Services), Calgary, Alberta, Canada
| | - Maggie Guo
- Alberta Public Laboratories (formerly Calgary Laboratory Services), Calgary, Alberta, Canada
| | - Irene Ma
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Public Laboratories (formerly Calgary Laboratory Services), Calgary, Alberta, Canada.
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Elman JA, Jak AJ, Panizzon MS, Tu XM, Chen T, Reynolds CA, Gustavson DE, Franz CE, Hatton SN, Jacobson KC, Toomey R, McKenzie R, Xian H, Lyons MJ, Kremen WS. Underdiagnosis of mild cognitive impairment: A consequence of ignoring practice effects. Alzheimers Dement (Amst) 2018; 10:372-381. [PMID: 30003138 PMCID: PMC6039708 DOI: 10.1016/j.dadm.2018.04.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Longitudinal testing is necessary to accurately measure cognitive change. However, repeated testing is susceptible to practice effects, which may obscure true cognitive decline and delay detection of mild cognitive impairment (MCI). METHODS We retested 995 late-middle-aged men in a ∼6-year follow-up of the Vietnam Era Twin Study of Aging. In addition, 170 age-matched replacements were tested for the first time at study wave 2. Group differences were used to calculate practice effects after controlling for attrition effects. MCI diagnoses were generated from practice-adjusted scores. RESULTS There were significant practice effects on most cognitive domains. Conversion to MCI doubled after correcting for practice effects, from 4.5% to 9%. Importantly, practice effects were present although there were declines in uncorrected scores. DISCUSSION Accounting for practice effects is critical to early detection of MCI. Declines, when lower than expected, can still indicate practice effects. Replacement participants are needed for accurately assessing disease progression.
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Affiliation(s)
- Jeremy A. Elman
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, CA, USA
| | - Amy J. Jak
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, La Jolla, CA, USA
| | - Matthew S. Panizzon
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, CA, USA
| | - Xin M. Tu
- Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Tian Chen
- Department of Mathematics and Statistics, University of Toledo, Toledo, OH, USA
| | - Chandra A. Reynolds
- Department of Psychology, University of California Riverside, Riverside, CA, USA
| | - Daniel E. Gustavson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, CA, USA
| | - Carol E. Franz
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, CA, USA
| | - Sean N. Hatton
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, CA, USA
| | - Kristen C. Jacobson
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Rosemary Toomey
- Department of Psychology, Boston University, Boston, MA, USA
| | - Ruth McKenzie
- Department of Psychology, Boston University, Boston, MA, USA
| | - Hong Xian
- Department of Statistics, St Louis University, St Louis, MO, USA
- Research Service, VA St Louis Healthcare System, St Louis, MO, USA
| | | | - William S. Kremen
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, CA, USA
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Bellodi E, Vagnoni E, Bonvento B, Lamma E. Economic and organizational impact of a clinical decision support system on laboratory test ordering. BMC Med Inform Decis Mak 2017; 17:179. [PMID: 29273037 PMCID: PMC5741908 DOI: 10.1186/s12911-017-0574-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 12/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We studied the impact of a clinical decision support system (CDSS) implemented in a few wards of two Italian health care organizations on the ordering of redundant laboratory tests under different perspectives: (1) analysis of the volume of tests, (2) cost analysis, (3) end-user satisfaction before and after the installation of the CDSS. METHODS (1) and (2) were performed by comparing the ordering of laboratory tests between an intervention group of wards where a CDSS was in use and a second (control) group where a CDSS was not in use; data were compared during a 3-month period before (2014) and a 3-month period after (2015) CDSS installation. To measure end-user satisfaction (3), a questionnaire based on POESUS was administered to the medical staff. RESULTS After the introduction of the CDSS, the number of laboratory tests requested decreased by 16.44% and costs decreased by 16.53% in the intervention group, versus an increase in the number of tests (+3.75%) and of costs (+1.78%) in the control group. Feedback from practice showed that the medical staff was generally satisfied with the CDSS and perceived its benefits, but they were less satisfied with its technical performance in terms of slow response time. CONCLUSIONS The implementation of CDSSs can have a positive impact on both the efficiency of care provision and health care costs. The experience of using a CDSS can also result in good practice to be implemented by other health care organizations, considering the positive result from the first attempt to gather the point of view of end-users in Italy.
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Affiliation(s)
- Elena Bellodi
- Department of Engineering, University of Ferrara, Via Saragat 1, Ferrara, Italy
| | - Emidia Vagnoni
- Department of Economics and Management and CRISAL, University of Ferrara, Via Voltapaletto 11, Ferrara, Italy
| | - Barbara Bonvento
- Research Centre for the Health Care Economics and Management (CRISAL), University of Ferrara, Via Voltapaletto 11, Ferrara, Italy
| | - Evelina Lamma
- Department of Engineering, University of Ferrara, Via Saragat 1, Ferrara, Italy
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Visser M, van Aar F, Koedijk FDH, Kampman CJG, Heijne JCM. Repeat Chlamydia trachomatis testing among heterosexual STI outpatient clinic visitors in the Netherlands: a longitudinal study. BMC Infect Dis 2017; 17:782. [PMID: 29262776 PMCID: PMC5738891 DOI: 10.1186/s12879-017-2871-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/30/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chlamydia infections are common in both men and women, are often asymptomatic and can cause serious complications. Repeat testing in high-risk groups is therefore indicated. In the Netherlands, guidelines on repeat chlamydia testing differ between testing facilities, and knowledge on repeat testing behaviour is limited. Here, we analyse the current repeat testing behaviour of heterosexual STI clinic visitors, and aim to identify groups for which repeat testing advice could be advantageous. METHODS Longitudinal surveillance data from all Dutch STI outpatient clinics were used, which included all STI clinic consultations carried out among heterosexual men and women between June 2014 and December 2015. Repeat testing was defined as returning to the same STI clinic between 35 days and 12 months after initial consultation. We calculated chlamydia positivity at repeat test stratified by initial test result and time between consultations. Logistic regression analyses were used to identify predictors of repeat testing, and predictors of having a chlamydia positive repeat test. RESULTS In total, 140,486 consultations in 75,487 women and 46,286 men were available for analyses. Overall, 15.4% of women and 11.1% of men returned to the STI clinic within the study period. Highest chlamydia positivity at repeat test was seen 3-5 months after initial positive test. Among both women and men, repeat testing was associated with non-Western ethnicity, having had more than two sex partners in the past 6 months, reporting STI symptoms, having a history of STI, and having a chlamydia positive initial test. Among repeat testers, chlamydia positive repeat test was most strongly associated with younger age, followed by a chlamydia positive initial test. CONCLUSIONS Repeat testing most often resulted in a positive test result among young heterosexuals (<25) and heterosexuals of any age with a chlamydia infection at the initial consultation. Further efforts are needed to determine optimal repeat testing strategies.
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Affiliation(s)
- Maartje Visser
- National Institute for Public Health and the Environment, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands.
| | - Fleur van Aar
- National Institute for Public Health and the Environment, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands
| | - Femke D H Koedijk
- Public Health Service Twente, postbus 1400, 7500, BK, Enschede, the Netherlands
| | | | - Janneke C M Heijne
- National Institute for Public Health and the Environment, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands
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Nielsen A, De Costa A, Danielsson KG, Salazar M. Repeat testing for chlamydia trachomatis, a "safe approach" to unsafe sex? a qualitative exploration among youth in Stockholm. BMC Health Serv Res 2017; 17:730. [PMID: 29141635 PMCID: PMC5688721 DOI: 10.1186/s12913-017-2681-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Chlamydia trachomatis testing is offered to youth in Sweden, through a network of Youth Health Clinics, free at the point of care, in an attempt to bring down the prevalence and incidence of the infection. Nevertheless, infections rates have continued to rise during the past two decades and re-testing rates among youth for Chlamydia trachomatis has been reported to be high in Stockholm County. A few literature reports suggest that testing for sexually transmitted infections and the test result itself can have an undesirable impact on the sexual behaviour for the individual, i.e. increase sexual risk-taking. Methods This qualitative study aimed to explore the motives for repeated testing for Chlamydia trachomatis among youth using the services of the Youth Health Clinics in Stockholm, and how testing affects their subsequent risk-taking. We interviewed 15 repeat testers aging 18–22 years. Results Our main findings were that the fear of social stigma related to infecting a peer was a major driver of the re-testing process. The repetitive testing process, the test result, and the encounter with personnel did not decrease sexual risk-taking among this group. Conclusions While testing and treatment services are an important part of Chlamydia trachomatis prevention it must not take the focus away from primary prevention strategies. Testing should be encouraged, but not to the exclusion of risk reduction measures. The testing services must be complemented with stronger emphasis on safe sex, especially for those who attend the clinics repeatedly, otherwise the easy accessible testing services risk counteracting its own purpose. Future research should focus on developing and evaluating youth appropriate interventions to increase condom use, taking into consideration factors which youth perceive as important to drive this behaviour change. Electronic supplementary material The online version of this article (10.1186/s12913-017-2681-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Nielsen
- Department of Women's and Children's Health K6, Karolinska University Hospital Solna, 17176, Stockholm, Sweden.
| | - Ayesha De Costa
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women's and Children's Health K6, Karolinska University Hospital Solna, 17176, Stockholm, Sweden
| | - Mariano Salazar
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
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Xian Z, Quinones AK, Tozbikian G, Zynger DL. Breast cancer biomarkers before and after neoadjuvant chemotherapy: does repeat testing impact therapeutic management? Hum Pathol 2017; 62:215-21. [PMID: 28041972 DOI: 10.1016/j.humpath.2016.12.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/07/2016] [Accepted: 12/15/2016] [Indexed: 01/10/2023]
Abstract
In patients treated with neoadjuvant chemotherapy (NAC), there is no consensus on retesting biomarkers within the excision specimen. Our aim was to investigate the clinical relevance of biomarker changes post-NAC at a large tertiary medical center. A retrospective search was performed to identify cases from 2012 to 2015 with needle biopsy-confirmed invasive breast carcinoma treated with NAC and subsequent excision containing residual invasive tumor. Biomarkers (estrogen receptor [ER], progesterone receptor [PR], and HER2/neu [HER2]) were performed on all pre-NAC biopsies. One hundred fifty-four NAC-treated cases were identified in which 83 (54%) had repeat testing of at least 1 biomarker on the surgical specimen. Twenty-five (30%) of 83 repeated cases demonstrated changes in pre-NAC biopsy versus post-NAC resection biomarker status. There was no impact of age or grade on biomarker status changes. Tumors that were triple negative at biopsy were more likely to remain triple negative. Clinically relevant changes were identified including the following: (1) ER negative to ER positive, 2 (3%) of 75; (2) PR negative to PR positive with ER negative both pre- and post-NAC, 2 (3%) of 73; and (3) HER2 negative to positive, 1 (1%) of 77. Four of 5 of the changes led to modifications of the adjuvant treatment regimen, including the addition of adjuvant tamoxifen, anastrazole, or trastuzumab. In summary, post-NAC biomarker repeat testing in patients with breast cancer impacts therapeutic management in a small subset of patients and therefore, repeat testing may be considered for patients that are hormone receptor and/or HER2 negative before NAC.
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