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Wimmer MR, Griffin M, Peterson-Weber A, Schulz LT, Hamel AG, Schwei RJ, Fong K, Burgess DR, Brett M, Hale CM, Holubar M, Jain R, Larry R, Spivak ES, Newland H, Njoku J, Postelnick M, Walraven C, Pulia MS. Diagnostic testing and antibiotic utilization among inpatients evaluated for coronavirus disease 2019 (COVID-19) pneumonia. Infect Control Hosp Epidemiol 2024; 45:667-669. [PMID: 38151334 DOI: 10.1017/ice.2023.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
We evaluated diagnostic test and antibiotic utilization among 252 patients from 11 US hospitals who were evaluated for coronavirus disease 2019 (COVID-19) pneumonia during the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant pandemic wave. In our cohort, antibiotic use remained high (62%) among SARS-CoV-2-positive patients and even higher among those who underwent procalcitonin testing (68%).
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Affiliation(s)
- Megan R Wimmer
- Department of Pharmacy, University of Wisconsin Health, Madison, Wisconsin
| | - Meggie Griffin
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Lucas T Schulz
- Department of Pharmacy, University of Wisconsin Health, Madison, Wisconsin
| | - Ashlee G Hamel
- Department of Pharmacy, Sentara Health, Norfolk, Virginia
| | - Rebecca J Schwei
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Karen Fong
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah
| | | | - Meghan Brett
- University of New Mexico Hospital, Albuquerque, New Mexico
| | - Cory M Hale
- Department of Pharmacy, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Marisa Holubar
- Stanford University School of Medicine, Stanford California
| | - Rupali Jain
- University of Washington, Seattle, Washington
| | - Rachel Larry
- Department of Pharmacy, Infirmary Health, Mobile, Alabama
| | | | | | | | - Michael Postelnick
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois
| | - Carla Walraven
- University of New Mexico Hospital, Albuquerque, New Mexico
| | - Michael S Pulia
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin
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2
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Healy JM, Ray L, Tack DM, Eikmeier D, Tobin-D'Angelo M, Wilson E, Hurd S, Lathrop S, McGuire SM, Bruce BB. Modelling counterfactual incidence during the transition towards culture-independent diagnostic testing. Int J Epidemiol 2024; 53:dyad133. [PMID: 37820050 DOI: 10.1093/ije/dyad133] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 09/20/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Culture-independent diagnostic testing (CIDT) provides rapid results to clinicians and is quickly displacing traditional detection methods. Increased CIDT use and sensitivity likely result in higher case detection but might also obscure infection trends. Severe illness outcomes, such as hospitalization and death, are likely less affected by changes in testing practices and can be used as indicators of the expected case incidence trend had testing methods not changed. METHODS Using US Foodborne Diseases Active Surveillance Network data during 1996-2019 and mixed effects quasi-Poisson regression, we estimated the expected yearly incidence for nine enteric pathogens. RESULTS Removing the effect of CIDT use, CIDT panel testing and culture-confirmation of CIDT testing, the modelled incidence in all but three pathogens (Salmonella, Shigella, STEC O157) was significantly lower than the observed and the upward trend in Campylobacter was reversed from an observed 2.8% yearly increase to a modelled -2.8% yearly decrease (95% credible interval: -4.0, -1.4). CONCLUSIONS Severe outcomes may be useful indicators in evaluating trends in surveillance systems that have undergone a marked change.
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Affiliation(s)
- Jessica M Healy
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Logan Ray
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Danielle M Tack
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Elisha Wilson
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Sharon Hurd
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - Sarah Lathrop
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Beau B Bruce
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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3
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Kang HM, Yoo IH, Jeong DC. The role of rapid syndromic diagnostic testing of gastrointestinal pathogens as a clinical decision support tool in a pediatric emergency department. Ann Clin Microbiol Antimicrob 2024; 23:3. [PMID: 38183046 PMCID: PMC10770992 DOI: 10.1186/s12941-023-00662-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/16/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE This study aimed to investigate the role of rapid syndromic diagnostic testing of gastrointestinal pathogens as a clinical decision support tool in a pediatric emergency department (ED) by comparing clinical decision and patient outcome parameters pre- and post-implementation. METHODS This was a big data analytical study of children < 18 years old without any underlying diseases, that visited the ED with acute moderate to severe diarrhea during a 34-month period from 2018 to 2022 using Seoul St. Mary's hospital's healthcare corporate data warehouse to retrieve demographic, clinical, and laboratory parameters. Outcome measures pre- and post-implementation of a rapid syndromic multiplex gastrointestinal panel (GI panel) were compared. RESULTS A total of 4,184 patients' data were included in the analyses. Broad spectrum antibiotics were prescribed at a significantly lower rate to patients presenting with acute infectious diarrhea at discharge from the ED (9.9% vs 15.8%, P < 0.001) as well as upon admission (52.2% vs 66.0%, P < 0.001) during the post-implementation period compared to the pre-implementation period. Although the duration of ED stay was found to be significantly longer (6.5 vs 5.5 h, P < 0.0001), the rate of ED revisit due to persistent or aggravated symptoms was significantly lower (Δ in intercept, β = -0.027; SE = 0.013; P = 0.041), and the admission rate at follow up after being discharged from the ED shown to be significantly lower during the post-implementation period compared to the pre-implementation period (0.8% vs. 2.1%, P = 0.001, respectively). No significant difference in disease progression was observed (P = 1.000). CONCLUSION Using the GI panel in the ED was shown to decrease broad spectrum antibiotic prescribing practices and reduce revisits or admission at follow up by aiding clinical decisions and improving patient outcome.
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Affiliation(s)
- Hyun Mi Kang
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- College of Medicine, Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Korea
| | - In Hyuk Yoo
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Dae Chul Jeong
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Androudi S, Apivatthakakul A, Arevalo FJ, Berkenstock MK, Carreño E, Chee SP, Choovuthayakorn J, Cimino L, Cornish EE, Farrall AL, Gehl Z, Gentile P, Gerges TK, Gozzi F, Hernández-Pons A, Issa S, Kim HM, Kim M, Knickelbein JE, Kunavisarut P, Lee SM, Lim LL, Lin ML, Llorenç V, López-Sierra S, Martínez-Costa L, McCluskey P, Mochizuki M, O'Day RF, Pai AS, Palestine AG, Pathanapitoon K, Radford MH, Silpa-Archa S, Smith JR, Terada Y, Waduthantri S, Weaver TR, Williams KL, Woo SJ, Younan C. Presentation, Diagnostic Testing and Initial Treatment of Vitreoretinal Lymphoma. Ophthalmol Retina 2024; 8:72-80. [PMID: 37648063 DOI: 10.1016/j.oret.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Vitreoretinal lymphoma is a malignancy with high mortality. Incidence is rare, and there is a lack of medical evidence to direct management. This work describes presentation, diagnostic testing, and first treatment approaches in a recently diagnosed and treated patient cohort. DESIGN Clinical registry-based observational study. SUBJECTS Forty-eight women and 32 men (age range, 32-91 years; median age, 64 years) diagnosed with vitreoretinal lymphoma. METHODS An international network of ophthalmologists reported clinical features and management of patients presenting with vitreoretinal lymphoma between January 1, 2020 and December 31, 2022 via an electronic platform. MAIN OUTCOME MEASURES Visual acuity at presentation (logarithm of the minimum angle of resolution [logMAR]); basis for diagnosis; first treatment. RESULTS Vitreoretinal lymphoma was bilateral at presentation in 65% of patients (n = 52) and an initial site of lymphoma in 78% (n = 62). Of 127 eyes with lymphoma at presentation, vitreous was involved in 89% (n = 113) and was the only involved eye tissue in 40% (n = 51), and retina was involved in 46% (n = 59) and was the only involved eye tissue in 9% (n = 11). Median logMAR visual acuity of the worse-seeing eye was 0.50. The lymphoma was diagnosed from ocular specimens in 80% of patients (64/80), usually vitreous (57/64 patients [89%]), and on other clinical information in 20% of patients (16/80). Cellular studies were performed on ocular specimens from 59 of 64 patients (92%), most often cytology. Tumor gene analysis was used in 21 of 64 patients (33%), and cytokine assays were used in 13 of 64 patients (20%). For 76 patients (95%), treatment was initiated within 6 months of diagnosis and included ocular (38/76 [48%]), extraocular (17/76 [21%]), and ocular plus extraocular (21/76 [26%]) approaches. Intravitreal methotrexate was the most common ocular treatment (83/87 eyes [95%]). CONCLUSIONS Using data collected from 80 patients diagnosed with vitreoretinal lymphoma since 2020, we show that visual impairment is common, and that management often involves diagnosis by cellular tests and treatment with intravitreal chemotherapy. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Green BB, Anderson ML, McClure JB, Ehrlich K, Hall YN, Hansell L, Hsu C, Margolis KL, Munson SA, Thompson MJ. Is Hypertension Diagnostic Testing and Diagnosis Associated With Psychological Distress? Am J Hypertens 2024; 37:69-76. [PMID: 37688515 DOI: 10.1093/ajh/hpad083] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Psychological impacts of hypertension diagnostic testing and new hypertension diagnoses are unclear. METHODS BP-CHECK was a randomized diagnostic study conducted in 2017-2019 in an integrated healthcare system. Participants with no hypertension diagnosis or medications and elevated blood pressure (BP) were randomized to one of three diagnostic regimens: (i) Clinic, (ii) Home, or (iii) Kiosk. Participants completed questionnaires at baseline, after completion of the diagnostic regimens, and at 6 months. Outcomes included changes from baseline in health-related quality of life (HRQOL), BP-related worry, and thoughts about having a stroke or heart attack. RESULTS Participants (n = 482) were mostly over age 50 (77.0%), and White race (80.3%). HRQOL did not significantly change from baseline to 3 weeks or 6 months. Among all participants, BP-related worry and concerns about having a heart attack or stroke increased significantly from baseline to 3 weeks, with heart attack and stroke concerns significantly higher in the Kiosk compared Clinic and Home groups. At 6 months, thoughts about having a heart attack or stroke returned to baseline overall and in the Kiosk group, however BP-related worry was significantly higher among those with, compared to those without, a new hypertension diagnosis. CONCLUSIONS The hypertension diagnostic process did not lead to short-term or intermediate-term changes in self-reported HRQOL. However, BP-related worry increased short-term and persisted at 6 months among individuals with a new hypertension diagnosis. Results warrant validation in more representative populations and additional exploration of the impacts of this worry on psychological well-being and hypertension control. CLINICALTRIALS.GOV IDENTIFIER NCT03130257.
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Affiliation(s)
- B B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Washington Permanente Medical Group, Seattle, Washington, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - M L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - J B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - K Ehrlich
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Y N Hall
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - L Hansell
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - C Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - K L Margolis
- HealthPartners Institute, Minneapolis, Minnesota, USA
| | - S A Munson
- Department of Human Centered Design and Engineering, University of Washington, Seattle, Washington, USA
| | - M J Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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Hazan G, Goldstein Y, Greenberg D, Khalde F, Mahajna R, Keren-Naos A, Hershkovitz E, Faingelernt Y, Givon-Lavi N, Danino D. Comparing single versus multiple virus detection in pediatric acute gastroenteritis postimplementation of routine multiplex RT-PCR diagnostic testing. J Med Virol 2024; 96:e29344. [PMID: 38149453 DOI: 10.1002/jmv.29344] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
Utilizing multiplex real time polymerase chain reaction (RT-PCR) for rapid diagnosis of gastroenteritis, enables simultaneous detection of multiple pathogens. A comparative analysis of disease characteristics was conducted between cases with single and multiple viruses. Rotavirus vaccine was introduced in 2010, reaching a 70% coverage in 2 years. All rectal swabs collected from diarrheic children (<5 years) between December 2017 and March 2022 were included. Detection of the same viruses within 2 months was considered a single episode. Episodes with positive stool bacterial PCR were excluded. A total of 5879 samples were collected, revealing 86.9% (1509) with single virus detection and 13.1% (227) with multiple viruses. The most frequent combination was rotavirus and norovirus (27.8%), these infections followed a winter-spring seasonality akin to rotavirus. Children with multivirus infections exhibited higher immunodeficiency (OR 2.06) rates, but lower food allergy (OR 0.45) and prematurity rates (OR 0.55) compared to single infections. Greater disease severity, evaluated by the Vesikari score, was observed in multivirus episodes (p < 0.001, OR 1.12). Multivirus infections accounted for 13.1% of symptomatic cases in hospitalized young children. Despite vaccination efforts, rotavirus remained prominent, frequently in co-infections with norovirus. Overall, multivirus infections were linked to more severe diseases than single virus cases.
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Affiliation(s)
- Guy Hazan
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Yoav Goldstein
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - David Greenberg
- Pediatric Infectious Diseases Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Firas Khalde
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Rofaida Mahajna
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Ayelet Keren-Naos
- Clinical Virology Laboratory, Soroka University Medical Center, Beer Sheva, Israel
| | - Eli Hershkovitz
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Yaniv Faingelernt
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
- Pediatric Gastroenterology Hepatology and Nutrition Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Noga Givon-Lavi
- Pediatric Infectious Diseases Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Dana Danino
- Pediatric Department D., Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
- Pediatric Infectious Diseases Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
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Särnholm J, Kronish IM. Psychological Distress and Hypertension Diagnostic Testing: Is There Anything to Worry About? Am J Hypertens 2024; 37:18-20. [PMID: 37798140 PMCID: PMC10724523 DOI: 10.1093/ajh/hpad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/07/2023] Open
Affiliation(s)
- Josefin Särnholm
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Ian M Kronish
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA
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Crone AS, Wright LM, Cheknis A, Johnson S, Pacheco SM, Skinner AM. Characteristics and outcomes of Clostridioides difficile infection after a change in the diagnostic testing algorithm. Infect Control Hosp Epidemiol 2024; 45:57-62. [PMID: 37462099 DOI: 10.1017/ice.2023.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND Polymerase chain reaction (PCR) testing for the detection of C. difficile is a highly sensitive test. Some clinical laboratories have included a 2-step testing algorithm utilizing PCR plus toxin enzyme immunoassays (EIAs) to increase specificity. OBJECTIVE To determine the risk factors and outcomes of C. difficile PCR-positive/toxin-positive encounters compared to PCR-positive/toxin-negative encounters. DESIGN Retrospective study. SETTING A Veterans' Affairs hospital. METHODS A retrospective case-control study of patient encounters with a positive C. difficile test by PCR and either a toxin EIA-positive assay (ie, cases) or toxin EIA-negative assay (ie, controls). Clinically relevant exposures and risk factors were determined to assess CDI recurrence at 30 days. Available encounter stool specimens were cultured for C. difficile and were subjected to restriction endonuclease analysis (REA) strain typing. RESULTS Among 130 C. difficile PCR-positive patient encounters, 80 (61.5%) were toxin EIA negative and 50 (38.5%) were toxin EIA positive. Encounters that were toxin positive were more frequently treated (96.0%) compared to toxin-negative encounters (71.3%; P < .01). A multivariable logistic regression model revealed that toxin-negative encounters were less likely to suffer a recurrent CDI episode within 30 days (odds ratio [OR], 0.20, 95% confidence interval [CI], 0.05-0.83). Additionally, a higher C. difficile PCR cycle threshold predicted a lower risk of CDI recurrence at 30 days. (OR, 0.82; 95% CI, 0.68-0.98). During the study period, the REA group Y strain accounted for most toxin-negative encounters (32.5%; P = .05), whereas REA group BI strain accounted for most toxin-positive encounters (24.3%; P = .02). CONCLUSIONS A testing strategy of PCR plus toxin EIA helped predict recurrent CDI.
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Affiliation(s)
- Andrew S Crone
- Research Service and Infectious Diseases Section, Edward Hines, Jr. VA Hospital, Hines, Illinois
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Lorinda M Wright
- Research Service and Infectious Diseases Section, Edward Hines, Jr. VA Hospital, Hines, Illinois
| | - Adam Cheknis
- Research Service and Infectious Diseases Section, Edward Hines, Jr. VA Hospital, Hines, Illinois
| | - Stuart Johnson
- Research Service and Infectious Diseases Section, Edward Hines, Jr. VA Hospital, Hines, Illinois
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Susan M Pacheco
- Research Service and Infectious Diseases Section, Edward Hines, Jr. VA Hospital, Hines, Illinois
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Andrew M Skinner
- Research Service and Infectious Diseases Section, Edward Hines, Jr. VA Hospital, Hines, Illinois
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois
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Miller MR, Braun E, Ip HS, Tyson GH. Domestic and wild animal samples and diagnostic testing for SARS-CoV-2. Vet Q 2023; 43:1-11. [PMID: 37779468 PMCID: PMC10614713 DOI: 10.1080/01652176.2023.2263864] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023] Open
Abstract
From the first cases in 2019, COVID-19 infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have resulted in over 6 million human deaths in a worldwide pandemic. SARS-CoV-2 is commonly spread from human to human through close contact and is capable of infecting both humans and animals. Worldwide, there have been over 675 animal outbreaks reported that resulted in over 2000 animal infections including domestic and wild animals. As the role of animal infections in the transmission, pathogenesis, and evolution of SARS-CoV-2 is still unfolding, accurate and reliable animal diagnostic tests are critical to aid in managing both human and animal health. This review highlights key animal samples and the three main diagnostic approaches used for animal testing: PCR, serology, and Next Generation Sequencing. Diagnostic results help inform (often difficult) clinical decision-making, but also possible ways to mitigate spread among pets, food supplies, or wildlife. A One Health approach has been key to monitoring the SARS-CoV-2 pandemic, as consistent human-animal interactions can lead to novel variants. Having multiple animal diagnostic tests for SARS-CoV-2 available is critical to ensure human, animal, and environmental health.
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Affiliation(s)
- Megan R. Miller
- Center for Veterinary Medicine, U.S. Food and Drug Administration, Laurel, MD, USA
| | - Elias Braun
- Center for Veterinary Medicine, U.S. Food and Drug Administration, Laurel, MD, USA
- School of Veterinary Medicine, University of PA, Philadelphia, PA, USA
| | - Hon S. Ip
- National Wildlife Health Center, U.S. Geological Survey, Madison, WI, USA
| | - Gregory H. Tyson
- Center for Veterinary Medicine, U.S. Food and Drug Administration, Laurel, MD, USA
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Ropers FG, Rietveld S, Rings EHHM, Bossuyt PMM, van Bodegom-Vos L, Hillen MA. Diagnostic testing in children: A qualitative study of pediatricians' considerations. J Eval Clin Pract 2023; 29:1326-1337. [PMID: 37221991 DOI: 10.1111/jep.13867] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/25/2023]
Abstract
AIMS AND OBJECTIVES Studies in adult medicine have shown that physicians base testing decisions on the patient's clinical condition but also consider other factors, including local practice or patient expectations. In pediatrics, physicians and parents jointly decide on behalf of a (young) child. This might demand more explicit and more complex deliberations, with sometimes conflicting interests. We explored pediatricians' considerations in diagnostic test ordering and the factors that influence their deliberation. METHOD We performed in-depth, semistructured interviews with a purposively selected heterogeneous sample of 20 Dutch pediatricians. We analyzed transcribed interviews inductively using a constant comparative approach, and clustered data across interviews to derive common themes. RESULTS Pediatricians perceived test-related burden in children higher compared with adults, and reported that avoiding an unjustified burden causes them to be more restrictive and deliberate in test ordering. They felt conflicted when parents desired testing or when guidelines recommended diagnostic tests pediatricians perceived as unnecessary. When parents demanded testing, they would explore parental concern, educate parents about harms and alternative explanations of symptoms, and advocate watchful waiting. Yet they reported sometimes performing tests to appease parents or to comply with guidelines, because of feared personal consequences in the case of adverse outcomes. CONCLUSION We obtained an overview of the considerations that are weighed in pediatric test decisions. The comparatively strong focus on prevention of harm motivates pediatricians to critically appraise the added value of testing and drivers of low-value testing. Pediatricians' relatively restrictive approach to testing could provide an example for other disciplines. Improved guidelines and physician and patient education could help to withstand the perceived pressure to test.
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Affiliation(s)
- Fabienne G Ropers
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Sophie Rietveld
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Edmond H H M Rings
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Patrick M M Bossuyt
- Amsterdam University Medical Centers, University of Amsterdam, Epidemiology & Data Science, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Leti van Bodegom-Vos
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Marij A Hillen
- Amsterdam University Medical Centers, location AMC, Amsterdam Public Health, Medical Psychology, Amsterdam, The Netherlands
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11
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Mordaunt DA, Stark Z, Santos Gonzalez F, Dalziel K, Goranitis I. Development of a microcosting protocol to determine the economic cost of diagnostic genomic testing for rare diseases in Australia. BMJ Open 2023; 13:e069441. [PMID: 38030253 PMCID: PMC10689401 DOI: 10.1136/bmjopen-2022-069441] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Genomic testing is a relatively new, disruptive and complex health technology with multiple clinical applications in rare diseases, cancer and infection control. Genomic testing is increasingly being implemented into clinical practice, following regulatory approval, funding and adoption in models of care, particularly in the area of rare disease diagnosis. A significant barrier to the adoption and implementation of genomic testing is funding. What remains unclear is what the cost of genomic testing is, what the underlying drivers of cost are and whether policy differences contribute to cost variance in different jurisdictions, such as the requirement to have staff with a medical license involved in testing. This costing study will be useful in future economic evaluations and health technology assessments to inform optimal levels of reimbursement and to support comprehensive and comparable assessment of healthcare resource utilisation in the delivery of genomic testing globally. METHODS A framework is presented that focuses on uncovering the process of genomic testing for any given laboratory, evaluating its utilisation and unit costs, and modelling the cost drivers and overall expenses associated with delivering genomic testing. The goal is to aid in refining and implementing policies regarding both the regulation and funding of genomic testing. A process-focused (activity-based) methodology is outlined, which encompasses resources, assesses individual cost components through a combination of bottom-up and top-down microcosting techniques and allows disaggregation of resource type and process step. ETHICS AND DISSEMINATION The outputs of the study will be reported at relevant regional genetics and health economics conferences, as well as submitted to a peer-reviewed journal focusing on genomics. Human research ethics committee approval is not required for this microcosting study. This study does not involve research on human subjects, and all data used in the analysis are either publicly available.
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Affiliation(s)
- Dylan A Mordaunt
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Women's and Children's Division, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Zornitza Stark
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Australian Genomics Health Alliance, Australian Genomics Health Alliance, Australia, UK
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Francisco Santos Gonzalez
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ilias Goranitis
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Onwuchekwa C, Atwell J, Moreo LM, Menon S, Machado B, Siapka M, Agarwal N, Rubbrecht M, Aponte-Torres Z, Rozenbaum M, Curcio D, Nair H, Kalina WV, Vroling H, Gessner B, Begier E. Pediatric Respiratory Syncytial Virus Diagnostic Testing Performance: A Systematic Review and Meta-analysis. J Infect Dis 2023; 228:1516-1527. [PMID: 37285396 PMCID: PMC10681870 DOI: 10.1093/infdis/jiad185] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/11/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Adding additional specimen types (eg, serology or sputum) to nasopharyngeal swab (NPS) reverse transcription polymerase chain reaction (RT-PCR) increases respiratory syncytial virus (RSV) detection among adults. We assessed if a similar increase occurs in children and quantified underascertainment associated with diagnostic testing. METHODS We searched databases for studies involving RSV detection in persons <18 years using ≥2 specimen types or tests. We assessed study quality using a validated checklist. We pooled detection rates by specimen and diagnostic tests and quantified performance. RESULTS We included 157 studies. Added testing of additional specimens to NP aspirate (NPA), NPS, and/or nasal swab (NS) RT-PCR resulted in statistically nonsignificant increases in RSV detection. Adding paired serology testing increased RSV detection by 10%, NS by 8%, oropharyngeal swabs by 5%, and NPS by 1%. Compared to RT-PCR, direct fluorescence antibody tests, viral culture, and rapid antigen tests were 87%, 76%, and 74% sensitive, respectively (pooled specificities all ≥98%). Pooled sensitivity of multiplex versus singleplex RT-PCR was 96%. CONCLUSIONS RT-PCR was the most sensitive pediatric RSV diagnostic test. Adding multiple specimens did not substantially increase RSV detection, but even small proportional increases could result in meaningful changes in burden estimates. The synergistic effect of adding multiple specimens should be evaluated.
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Affiliation(s)
| | | | | | - Sonia Menon
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Belen Machado
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Mariana Siapka
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
- Impact Epilysis, Thessaloniki, Greece
| | - Neha Agarwal
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | | | | | - Harish Nair
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Hilde Vroling
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
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13
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van Maurik IS, Bakker ED, van Unnik AAJM, Broulikova HM, Zwan MD, van de Giessen E, Berkhof J, Bouwman FH, Bosmans JE, van der Flier WM. How healthy participants value additional diagnostic testing with amyloid-PET in patients diagnosed with mild cognitive impairment - a bidding game experiment. Alzheimers Res Ther 2023; 15:208. [PMID: 38017549 PMCID: PMC10683285 DOI: 10.1186/s13195-023-01346-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 10/25/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND To estimate the perceived value of additional testing with amyloid-PET in Euros in healthy participants acting as analogue patients with mild cognitive impairment (MCI). METHODS One thousand four hundred thirty-one healthy participants acting as analogue MCI patients (mean age 65 ± 8, 929 (75%) female) were recruited via the Dutch Brain Research Registry. Participants were asked to identify with a presented case (video vignette) of an MCI patient and asked whether they would prefer additional diagnostic testing with amyloid PET in this situation. If yes, respondents were asked how much they would be willing to pay for additional diagnostic testing. Monetary value was elicited via a bidding game in which participants were randomized over three conditions: (A) additional testing results in better patient management, (B) Same as condition A and a delay in institutionalization of 3 months, and (C) same as A and a delay in institutionalization of 6 months. Participants who were not willing to take a test were compared with participants who were willing to take a test using logit models. The highest monetary value per condition was analyzed using random-parameter mixed models. RESULTS The vast majority of participants acting as analogue MCI patients (87% (n = 1238)) preferred additional testing with amyloid PET. Participants who were not interested were more often female (OR = 1.61 95% CI [1.09-2.40]) and expressed fewer worries to get AD (OR = 0.64 [0.47-0.87]). The median "a priori" (i.e., before randomization) monetary value of additional diagnostic testing was €1500 (IQR 500-1500). If an additional amyloid PET resulted in better patient management (not further specified; condition A), participants were willing to pay a median price of €2000 (IQR = 1000-3500). Participants were willing to pay significantly more than condition A (better patient management) if amyloid-PET testing additionally resulted in a delay in institutionalization of 3 months (€530 [255-805] on top of €2000, condition B) or 6 months (€596 [187-1005] on top of €2000, condition C). CONCLUSIONS Members of the general population acting as MCI patients are willing to pay a substantial amount of money for amyloid-PET and this increases when diagnostic testing leads to better patient management and the prospect to live longer at home.
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Affiliation(s)
- I S van Maurik
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands.
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands.
| | - E D Bakker
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - A A J M van Unnik
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - H M Broulikova
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - M D Zwan
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - E van de Giessen
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, the Netherlands
| | - J Berkhof
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - F H Bouwman
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - J E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - W M van der Flier
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
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14
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Filkins LM. A tool for stewarding the use of 16S rRNA gene amplification and sequencing in diagnostic testing. Am J Clin Pathol 2023; 160:438-440. [PMID: 37458094 DOI: 10.1093/ajcp/aqad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Affiliation(s)
- Laura M Filkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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15
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Dunleavy KA, Cross RK, Raffals LE. Causes, Diagnostic Testing, and Treatment of Residual Symptoms in Patients With IBD With Quiescent Disease. Am J Gastroenterol 2023; 118:1909-1914. [PMID: 36988311 DOI: 10.14309/ajg.0000000000002267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Katie A Dunleavy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland, USA
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland, USA
| | - Laura E Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland, USA
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Pham HN, Pham L, Sato K. Bioinformatic analysis identified novel candidate genes with the potentials for diagnostic blood testing of primary biliary cholangitis. PLoS One 2023; 18:e0292998. [PMID: 37844121 PMCID: PMC10578581 DOI: 10.1371/journal.pone.0292998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
Primary biliary cholangitis (PBC) is an autoimmune disorder characterized by intrahepatic bile duct destruction and cholestatic liver injury. Diagnosis of PBC is generally based on the existence of anti-mitochondrial antibody (AMA) in blood samples; however, some PBC patients are negative for serum AMA tests, and invasive liver histological testing is required in rare PBC cases. The current study seeks novel candidate genes that are associated with PBC status and have potentials for blood diagnostic testing. Human transcriptomic profiling data of liver and blood samples were obtained from Gene Expression Omnibus (GEO). Three GEO data series (GSE79850, GSE159676, and GSE119600) were downloaded, and bioinformatic analyses were performed. Various differentially expressed genes were identified in three data series by comparing PBC patients and control individuals. Twelve candidate genes were identified, which were upregulated in both liver tissues and blood samples of PBC patients in all three data series. The enrichment analysis demonstrated that 8 out of 12 candidate genes were associated with biological functions, which were closely related to autoimmune diseases including PBC. Candidate genes, especially ITGAL showed good potentials to distinguish PBC with other diseases. These candidate genes could be useful for diagnostic blood testing of PBC, although further clinical studies are required to evaluate their potentials as diagnostic biomarkers.
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Affiliation(s)
- Hoang Nam Pham
- Department of Life Sciences, University of Science and Technology of Hanoi, Hanoi, Vietnam
| | - Linh Pham
- Department of Science and Mathematics, Texas A&M University–Central Texas, Killeen, Texas, United States of America
| | - Keisaku Sato
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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Ghosh P, Chowdhury R, Rahat MA, Hossain F, Arpha NE, Kristan M, Higgins M, El Wahed AA, Goto Y, Islam MMT, Campino S, Cameron M, Duthie MS, Haque R, Mondal D. Dried Blood Spots (DBS): A suitable alternative to using whole blood samples for diagnostic testing of visceral leishmaniasis in the post-elimination era. PLoS Negl Trop Dis 2023; 17:e0011680. [PMID: 37862287 PMCID: PMC10588855 DOI: 10.1371/journal.pntd.0011680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Serum or whole blood collection, processing, transport and storage still present significant challenges in low resource settings where mass surveillance is required to sustain disease elimination. Therefore, in this study, we explored the diagnostic efficacy of dried blood spots (DBS) as a minimally invasive and potentially cost-effective alternative sampling technique to whole blood sampling procedures for subsequent detection of Leishmania donovani antibodies or DNA. METHODOLOGY AND PRINCIPAL FINDINGS Archived serum, DNA samples from whole blood of visceral leishmaniasis (VL) cases and healthy controls, and DBS from corresponding cases and controls, were used. Both molecular and serological assays were optimized to detect L. donovani antibodies or DNA in DBS elute and results were compared against those obtained with whole blood. Serological assays (both rK28 ELISA and rK39 ELISA) of DBS samples showed sensitivity and specificity of 100% and had excellent agreement with results from whole blood samples (kappa value ranged from 0.98-1). Bland-Altman analysis of OD values from rK28-ELISA with DBS elute and patients' serum showed an excellent agreement (ICC = 0.9) whereas a good agreement (ICC = 0.8) was observed in the case of rK39-ELISA. However, qPCR and RPA of DBS samples had a diminished sensitivity of 76% and 68%, respectively, and poor agreement was observed with the whole blood samples. CONCLUSION Our results demonstrate that DBS offer excellent diagnostic efficiency for serological assays and represent a viable alternative to whole blood sampling procedures.
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Affiliation(s)
- Prakash Ghosh
- Nutirition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Banladesh, Dhaka, Bangladesh
| | - Rajashree Chowdhury
- Nutirition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Banladesh, Dhaka, Bangladesh
| | - Md. Abu Rahat
- Nutirition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Banladesh, Dhaka, Bangladesh
| | - Faria Hossain
- Nutirition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Banladesh, Dhaka, Bangladesh
| | - Nur E Arpha
- Genetic Engineering and Biotechnology, BRAC University, Dhaka, Bangladesh
| | - Mojca Kristan
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Matthew Higgins
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Ahmed Abd El Wahed
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, Leipzig, Germany
| | - Yasuyuki Goto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - M. M. Towhidul Islam
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | - Susana Campino
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Mary Cameron
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | | | - Rashidul Haque
- Emerging Infections and Parasitology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Dinesh Mondal
- Nutirition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Banladesh, Dhaka, Bangladesh
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Ireland J, McGowan C. Deciphering reference intervals and clinical decision limits in equine endocrine diagnostic testing. Vet J 2023; 300-302:106037. [PMID: 37832629 DOI: 10.1016/j.tvjl.2023.106037] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
Reference intervals (RIs) and clinical decision limits (CDLs) are frequently established to facilitate interpretation of values of endocrine biomarkers in the diagnosis of disease. Despite their commonplace use in clinical decision-making, these concepts can be confused. Comparing a test result with a RI provides an estimation as to whether or not the individual is healthy, whereas comparison with a CDL facilitates identification of individuals with a particular disease state or at greater risk of adverse clinical outcomes. In practice, there will also be a range of results for which the discriminative ability of the test is insufficient to inform a specific diagnostic decision. Including a range of uncertain test results, or 'grey zone', between positive and negative avoids the constraint of a binary decision in classifying an individual with a test value above (or below) a single cut-off value as diseased. This review will detail the application of both RIs and CDLs, including defining the range of uncertain test results, in the context of equine endocrinology.
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Affiliation(s)
- Joanne Ireland
- Department of Equine Clinical Science, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst, CH64 7TE Cheshire, UK.
| | - Catherine McGowan
- Department of Equine Clinical Science, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst, CH64 7TE Cheshire, UK
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Zhang X, Huang X, Xing L. ADSP: An adaptive sample pooling strategy for diagnostic testing. J Biomed Inform 2023; 146:104501. [PMID: 37742781 DOI: 10.1016/j.jbi.2023.104501] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/30/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND We often must conduct diagnostic tests on a massive volume of samples within a limited time during outbreaks of infectious diseases (e.g., COVID-19,screening) or repeat many times routinely (e.g., regular and massive screening for plant virus infections in farms). These tests aim to obtain the diagnostic result of all samples within a limited time. In such scenarios, the limitation of testing resources and human labor drives the need to pool individual samples and test them together to improve testing efficiency. When a pool is positive, further testing is required to identify the affected individuals; whereas when a pool is negative, we conclude all individuals in the pool are negative. How one splits the samples into pools is a critical factor affecting testing efficiency. OBJECTIVE We aim to find the optimal strategy that adaptively guides users on optimally splitting the sample cohort into test-pools. METHODS We developed an algorithm that minimizes the expected number of tests needed to obtain the diagnostic results of all samples. Our algorithm dynamically updates the critical information according to the result of the most recent test and calculates the optimal pool size for the next test. We implemented our novel adaptive sample pooling strategy into a web-based application, ADSP (https://ADSP.uvic.ca). ADSP interactively guides users on how many samples to be pooled for the current test, asks users to report the test result back and uses it to update the best strategy on how many samples to be pooled for the next test. RESULTS We compared ADSP with other popular pooling methods in simulation studies, and found that ADSP requires fewer tests to diagnose a cohort and is more robust to the inaccurate initial estimate of the test cohort's disease prevalence. CONCLUSION Our web-based application can help researchers decide how to pool their samples for grouped diagnostic tests. It improves test efficiency when grouped tests are conducted.
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Affiliation(s)
- Xuekui Zhang
- Department of Mathematics and Statistics, University of Victoria, Victoria, BC, Canada.
| | - Xiaolin Huang
- Department of Mathematics and Statistics, University of Victoria, Victoria, BC, Canada
| | - Li Xing
- Department of Mathematics and Statistics, University of Saskatchewan, Saskatoon, SK, Canada
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20
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Ochmann S, von Polenz I, Marcus ME, Theilmann M, Flood D, Agoudavi K, Aryal KK, Bahendeka S, Bicaba B, Bovet P, Campos Caldeira Brant L, Carvalho Malta D, Damasceno A, Farzadfar F, Gathecha G, Ghanbari A, Gurung M, Guwatudde D, Houehanou C, Houinato D, Hwalla N, Jorgensen JA, Karki KB, Lunet N, Martins J, Mayige M, Moghaddam SS, Mwalim O, Mwangi KJ, Norov B, Quesnel-Crooks S, Rezaei N, Sibai AM, Sturua L, Tsabedze L, Wong-McClure R, Davies J, Geldsetzer P, Bärnighausen T, Atun R, Manne-Goehler J, Vollmer S. Diagnostic testing for hypertension, diabetes, and hypercholesterolaemia in low-income and middle-income countries: a cross-sectional study of data for 994 185 individuals from 57 nationally representative surveys. Lancet Glob Health 2023; 11:e1363-e1371. [PMID: 37591584 PMCID: PMC10480389 DOI: 10.1016/s2214-109x(23)00280-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Testing for the risk factors of cardiovascular disease, which include hypertension, diabetes, and hypercholesterolaemia, is important for timely and effective risk management. Yet few studies have quantified and analysed testing of cardiovascular risk factors in low-income and middle-income countries (LMICs) with respect to sociodemographic inequalities. We aimed to address this knowledge gap. METHODS In this cross-sectional analysis, we pooled individual-level data for non-pregnant adults aged 18 years or older from nationally representative surveys done between Jan 1, 2010, and Dec 31, 2019 in LMICs that included a question about whether respondents had ever had their blood pressure, glucose, or cholesterol measured. We analysed diagnostic testing performance by quantifying the overall proportion of people who had ever been tested for these cardiovascular risk factors and the proportion of individuals who met the diagnostic testing criteria in the WHO package of essential noncommunicable disease interventions for primary care (PEN) guidelines (ie, a BMI >30 kg/m2 or a BMI >25 kg/m2 among people aged 40 years or older). We disaggregated and compared diagnostic testing performance by sex, wealth quintile, and education using two-sided t tests and multivariable logistic regression models. FINDINGS Our sample included data for 994 185 people from 57 surveys. 19·1% (95% CI 18·5-19·8) of the 943 259 people in the hypertension sample met the WHO PEN criteria for diagnostic testing, of whom 78·6% (77·8-79·2) were tested. 23·8% (23·4-24·3) of the 225 707 people in the diabetes sample met the WHO PEN criteria for diagnostic testing, of whom 44·9% (43·7-46·2) were tested. Finally, 27·4% (26·3-28·6) of the 250 573 people in the hypercholesterolaemia sample met the WHO PEN criteria for diagnostic testing, of whom 39·7% (37·1-2·4) were tested. Women were more likely than men to be tested for hypertension and diabetes, and people in higher wealth quintiles compared with those in the lowest wealth quintile were more likely to be tested for all three risk factors, as were people with at least secondary education compared with those with less than primary education. INTERPRETATION Our study shows opportunities for health systems in LMICs to improve the targeting of diagnostic testing for cardiovascular risk factors and adherence to diagnostic testing guidelines. Risk-factor-based testing recommendations rather than sociodemographic characteristics should determine which individuals are tested. FUNDING Harvard McLennan Family Fund, the Alexander von Humboldt Foundation, and the National Heart, Lung, and Blood Institute of the US National Institutes of Health.
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Affiliation(s)
- Sophie Ochmann
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany
| | | | - Maja-Emilia Marcus
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine, and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | | | - Krishna Kumar Aryal
- Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Silver Bahendeka
- Saint Francis Hospital Nsambya, Uganda Martyrs University, Kampala, Uganda
| | - Brice Bicaba
- Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Pascal Bovet
- Ministry of Health, Victoria, Seychelles; University Center for General Medicine and Public Health (Unisanté), Lausanne, Switzerland
| | - Luisa Campos Caldeira Brant
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Deborah Carvalho Malta
- Postgraduate Program in Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gladwell Gathecha
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Ali Ghanbari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mongal Gurung
- Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Nahla Hwalla
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Jutta Adelin Jorgensen
- Global Health Section, Dept of Public Health, University of Copenhagen, Cophenhagen, Denmark
| | - Khem B Karki
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
| | - Joao Martins
- Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Dili, Timor-Leste
| | - Mary Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Kiel Institute for the World Economy, Kiel, Germany
| | - Omar Mwalim
- Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway; Ministry of Health, Zanzibar City, Tanzania
| | - Kibachio Joseph Mwangi
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bolormaa Norov
- Nutrition Division, National Center for Public Health, Ulaanbaatar, Mongolia
| | | | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abla M Sibai
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Roy Wong-McClure
- Office of Epidemiology and Surveillance, Caja Costarricense de Seguro Social, San José, Costa Rica
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA; Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine, and University Hospital, Heidelberg University, Heidelberg, Germany; Harvard Center for Population and Development Studies, Cambridge, MA, USA; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Rifat Atun
- Department of Global Health and Social Medicine, Boston, MA, USA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany.
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21
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Kopylova KV, Kasparov EW, Marchenko IV, Smolnikova MV. [Digital PCR as a Highly Sensitive Diagnostic Tool: A Review]. Mol Biol (Mosk) 2023; 57:771-781. [PMID: 37752642 DOI: 10.31857/s0026898423050051, edn: xwwkds] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/29/2023] [Indexed: 09/28/2023]
Abstract
Digital PCR (dPCR) is a nucleic acid quantification method that is widely used in genetic analysis. One of the most significant advantages of dPCR over other methods is the possibility of absolute quantitative determination of genetic material without construction of calibration curves, which allows one to detect even single molecules of nucleic acids, and, hence, provides early diagnosis of diseases. One specific characteristic of dPCR is the detection of the analyzed biological object in each microreaction, followed by the presentation of the analysis results in a binary system, thereby giving the method its name. The key aspects of developing the dPCR method, i.e., from the first devices based on microfluidic chip technology to modern systems capable of measuring a target at a concentration of up to 1 in 100000 copies are shown in the current work. We analyzed the data on the detection of various pathogens using dPCR, as well as summarizing various study results demonstrating the innovativeness of this method. Both the possibilities of multiplex dPCR analysis and its potential in clinical practice are presented. This review also addresses the issue of the role of dPCR in the development of noninvasive methods for analysis of oncological diseases. Possible ways of developing dPCR technology were emphasized, including its use as a "point-of-care" system.
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Affiliation(s)
- K V Kopylova
- Scientific Research Institute of Medical Problems of the North, Krasnoyarsk, 660022 Russia
| | - Ed W Kasparov
- Scientific Research Institute of Medical Problems of the North, Krasnoyarsk, 660022 Russia
| | - I V Marchenko
- Scientific Research Institute of Medical Problems of the North, Krasnoyarsk, 660022 Russia
| | - M V Smolnikova
- Scientific Research Institute of Medical Problems of the North, Krasnoyarsk, 660022 Russia
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22
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Jarman AF, Mumma BE, White R, Dooley E, Yang NT, Taylor SL, Newgard C, Morris C, Cloutier J, Maughan BC. Sex differences in guideline-consistent diagnostic testing for acute pulmonary embolism among adult emergency department patients aged 18-49. Acad Emerg Med 2023; 30:896-905. [PMID: 36911917 PMCID: PMC10497718 DOI: 10.1111/acem.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Pulmonary embolism (PE) is a frequent diagnostic consideration in emergency department (ED) patients, yet diagnosis is challenging because symptoms of PE are nonspecific. Guidelines recommend the use of clinical decision tools to increase efficiency and avoid harms from overtesting, including D-dimer screening in patients not at high risk for PE. Women undergo testing for PE more often than men yet have a lower yield from testing. Our study objective was to determine whether patient sex influenced the odds of received guideline-consistent care. METHODS We performed a retrospective cohort study at two large U.S. academic EDs from January 1, 2016, to December 31, 2018. Nonpregnant patients aged 18-49 years were included if they presented with chest pain, shortness of breath, hemoptysis, or syncope and underwent testing for PE with D-dimer or imaging. Demographic and clinical data were exported from the electronic medical record (EMR). Pretest risk scores were calculated using manually abstracted EMR data. Diagnostic testing was then compared with recommended testing based on pretest risk. The primary outcome was receipt of guideline-consistent care, which required an elevated screening D-dimer prior to imaging in all non-high-risk patients. RESULTS We studied 1991 discrete patient encounters; 37% (735) of patients were male and 63% (1256) were female. Baseline characteristics, including revised Geneva scores, were similar between sexes. Female patients were more likely to receive guideline-consistent care (70% [874/1256] female vs. 63% [463/735] male, p < 0.01) and less likely to be diagnosed with PE (3.1% [39/1256] female vs. 5.3% [39/735] male, p < 0.05). The most common guideline deviation in both sexes was obtaining imaging without a screening D-dimer in a non-high-risk patient (75% [287/382] female vs. 75% [205/272] male). CONCLUSIONS In this cohort, females were more likely than males to receive care consistent with current guidelines and less likely to be diagnosed with PE.
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Affiliation(s)
- Angela F Jarman
- Department of Emergency Medicine, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Bryn E Mumma
- Department of Emergency Medicine, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Richard White
- Department of Internal Medicine, Division of Rheumatology, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Emily Dooley
- University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Nuen Tsang Yang
- Department of Public Health Sciences, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Sandra L. Taylor
- Department of Public Health Sciences, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Craig Newgard
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Cynthia Morris
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
| | - Jared Cloutier
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Brandon C Maughan
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
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23
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Rieder M, Zweier C, Odening KE. Novel Insights Into the Prevalence of TNNI3K-Mediated Dilated Cardiomyopathy and Putative Disease Mechanisms. Circ Genom Precis Med 2023; 16:337-339. [PMID: 37325914 DOI: 10.1161/circgen.123.004207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Marina Rieder
- Translational Cardiology, Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland (M.R., K.E.O)
| | - Christiane Zweier
- Department of Human Genetics, Inselspital, University Hospital Bern, Bern, Switzerland (C.Z.)
| | - Katja E Odening
- Translational Cardiology, Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland (M.R., K.E.O)
- Department of Physiology, University of Bern, Bern, Switzerland (K.O.)
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24
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Parwani P, Patel AR. Diagnostic testing in cardiac sarcoidosis: what comes first? J Nucl Cardiol 2023; 30:1588-1591. [PMID: 37101019 DOI: 10.1007/s12350-023-03257-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, Loma Linda University Health, Loma Linda, CA, USA.
| | - Amit R Patel
- Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville, VA, USA
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25
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Onwuchekwa C, Moreo LM, Menon S, Machado B, Curcio D, Kalina W, Atwell JE, Gessner BD, Siapka M, Agarwal N, Rubbrecht M, Nair H, Rozenbaum M, Aponte-Torres Z, Vroling H, Begier E. Underascertainment of Respiratory Syncytial Virus Infection in Adults Due to Diagnostic Testing Limitations: A Systematic Literature Review and Meta-analysis. J Infect Dis 2023; 228:173-184. [PMID: 36661222 PMCID: PMC10345483 DOI: 10.1093/infdis/jiad012] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Most observational population-based studies identify respiratory syncytial virus (RSV) by nasal/nasopharyngeal swab reverse transcriptase real-time PCR (RT-PCR) only. We conducted a systematic review and meta-analyses to quantify specimen and diagnostic testing-based underascertainment of adult RSV infection. METHODS EMBASE, PubMed, and Web of Science were searched (January 2000-December 2021) for studies including adults using/comparing >1 RSV testing approach. We quantified test performance and RSV detection increase associated with using multiple specimen types. RESULTS Among 8066 references identified, 154 met inclusion. Compared to RT-PCR, other methods were less sensitive: rapid antigen detection test (RADT; pooled sensitivity, 64%), direct fluorescent antibody (DFA; 83%), and viral culture (86%). Compared to singleplex PCR, multiplex PCR's sensitivity was lower (93%). Compared to nasal/nasopharyngeal swab RT-PCR alone, adding another specimen type increased detection: sputum RT-PCR, 52%; 4-fold rise in paired serology, 44%; and oropharyngeal swab RT-PCR, 28%. Sensitivity was lower in estimates limited to only adults (for RADT, DFA, and viral culture), and detection rate increases were largely comparable. CONCLUSIONS RT-PCR, particularly singleplex testing, is the most sensitive RSV diagnostic test in adults. Adding additional specimen types to nasopharyngeal swab RT-PCR testing increased RSV detection. Synergistic effects of using ≥3 specimen types should be assessed, as this approach may improve the accuracy of adult RSV burden estimates.
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Affiliation(s)
| | | | - Sonia Menon
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Belen Machado
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | | | | | - Mariana Siapka
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
- Impact Epilysis, Thessaloniki, Greece
| | - Neha Agarwal
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | - Harish Nair
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Hilde Vroling
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
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26
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Stamm BD, Tamerius J, Reddy S, Barlow S, Hamer C, Kempken A, Goss M, He C, Bell C, Arnold M, Checovich M, Temte E, Norton D, Chen G, Baltus J, Gurley ES, Temte JL. The Influence of Rapid Influenza Diagnostic Testing on Clinician Decision-Making for Patients With Acute Respiratory Infection in Urgent Care. Clin Infect Dis 2023; 76:1942-1948. [PMID: 36723863 PMCID: PMC10249985 DOI: 10.1093/cid/ciad038] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/06/2023] [Accepted: 01/20/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The potential benefits of using rapid influenza diagnostic tests (RIDTs) in urgent care facilities for clinical care and prescribing practices are understudied. We compared antiviral and antibiotic prescribing, imaging, and laboratory ordering in clinical encounters with and without RIDT results. METHODS We compared patients with acute respiratory infection (ARI) symptoms who received an RIDT and patients who did not at 2 urgent care facilities. Primary analysis using 1-to-1 exact matching resulted in 1145 matched pairs to which McNemar 2 × 2 tests were used to assess the association between the likelihood of prescribing, imaging/laboratory ordering, and RIDT use. Secondary analysis compared the same outcomes using logistic regression among the RIDT-tested population between participants who tested negative (RIDT(-)) and positive (RIDT(+)). RESULTS Primary analysis revealed that compared to the non-RIDT-tested population, RIDT(+) patients were more likely to be prescribed antivirals (OR, 10.23; 95% CI, 5.78-19.72) and less likely to be prescribed antibiotics (OR, 0.15; 95% CI, .08-.27). Comparing RIDT-tested to non-RIDT-tested participants, RIDT use increased antiviral prescribing odds (OR, 3.07; 95% CI, 2.25-4.26) and reduced antibiotic prescribing odds (OR, 0.52; 95% CI, .43-.63). Secondary analysis identified increased odds of prescribing antivirals (OR, 28.21; 95% CI, 18.15-43.86) and decreased odds of prescribing antibiotics (OR, 0.20; 95% CI, .13-.30) for RIDT(+) participants compared with RIDT(-). CONCLUSIONS Use of RIDTs in patients presenting with ARI symptoms influences clinician diagnostic and treatment decision-making, which could lead to improved patient outcomes, population-level reductions in influenza burden, and a decreased threat of antibiotic resistance.
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Affiliation(s)
- Brian D Stamm
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | | | | | - Shari Barlow
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Caroline Hamer
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Ashley Kempken
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Maureen Goss
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Cecilia He
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Cristalyne Bell
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Mitchell Arnold
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Mary Checovich
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Emily Temte
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Derek Norton
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Guanhua Chen
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Jeffrey Baltus
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Emily S Gurley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan L Temte
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
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27
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Maas SM, Krzyzewska IM, Lombardi MPR, Mannens MMA, Vos N, Bliek J. Should testing for mosaic genome-wide paternal uniparental disomy in Beckwith-Wiedemann spectrum (BWSp) be implemented in diagnostic testing? Eur J Hum Genet 2023; 31:615-616. [PMID: 37012326 PMCID: PMC10250354 DOI: 10.1038/s41431-023-01354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Affiliation(s)
- Saskia M Maas
- Department of Human Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- European Reference Network for Rare Craniofacial Anomalies and ENT Disorders (ERN CRANIO), Amsterdam, The Netherlands
| | - Izabela M Krzyzewska
- Department of Human Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria P R Lombardi
- Department of Human Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel M A Mannens
- Department of Human Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Niels Vos
- Department of Human Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jet Bliek
- Department of Human Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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28
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Castilho VAR, Komiyama CM, Burbarelli MFC, Fernandes AM, Garcia RG, Seno LO, Barbosa DK, Przybulinski BB, Serpa FC. Precision technologies for predictive diagnosis and study of the allometric growth of broiler chickens with breast myopathies. Br Poult Sci 2023; 64:204-213. [PMID: 36169617 DOI: 10.1080/00071668.2022.2128989] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/29/2022] [Indexed: 01/10/2023]
Abstract
1. An experiment was carried out to validate techniques as predictive diagnostic tools for breast myopathies and to study the allometric growth of distinct parts of the body and meat quality of broilers.2. Infrared thermography was performed at 35 d of age. The surface temperatures of breasts of 300 birds were recorded, followed by ultrasound imaging.3. The birds were slaughtered and the cuts were made to weigh the body parts. Then, the breasts were evaluated as for the presence and severity of myopathies, from which nine treatments were established represented by the associated degrees of the myopathies white striping and wooden breast and breasts classified as normal.4. There was no difference in surface temperatures and echogenicity values between normal breasts and breasts affected by myopathies. At 35 d of age few fillets classified as normal were found.5. The breast showed late growth in relation to the body, regardless of characteristic lesions of myopathies. The most severe score of wooden breast affected meat quality variables.
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Affiliation(s)
- V A R Castilho
- Faculty of Animal Science, Federal University of Grande Dourados (UFGD), Dourados, Brazil
| | - C M Komiyama
- Faculty of Animal Science, Federal University of Grande Dourados (UFGD), Dourados, Brazil
| | - M F C Burbarelli
- Faculty of Animal Science, Federal University of Grande Dourados (UFGD), Dourados, Brazil
| | - A M Fernandes
- Faculty of Animal Science, Federal University of Grande Dourados (UFGD), Dourados, Brazil
| | - R G Garcia
- Faculty of Animal Science, Federal University of Grande Dourados (UFGD), Dourados, Brazil
| | - L O Seno
- Faculty of Animal Science, Federal University of Grande Dourados (UFGD), Dourados, Brazil
| | - D K Barbosa
- Faculty of Animal Science, Federal University of Grande Dourados (UFGD), Dourados, Brazil
| | - B B Przybulinski
- Faculty of Animal Science, Federal University of Grande Dourados (UFGD), Dourados, Brazil
| | - F C Serpa
- Faculty of Animal Science, Federal University of Grande Dourados (UFGD), Dourados, Brazil
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29
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Drain PK, Dalmat RR, Hao L, Bemer MJ, Budiawan E, Morton JF, Ireton RC, Hsiang TY, Marfatia Z, Prabhu R, Woosley C, Gichamo A, Rechkina E, Hamilton D, Montaño M, Cantera JL, Ball AS, Golez I, Smith E, Greninger AL, McElrath MJ, Thompson M, Grant BD, Meisner A, Gottlieb GS, Gale M. Duration of viral infectiousness and correlation with symptoms and diagnostic testing in non-hospitalized adults during acute SARS-CoV-2 infection: A longitudinal cohort study. J Clin Virol 2023; 161:105420. [PMID: 36913789 PMCID: PMC9981266 DOI: 10.1016/j.jcv.2023.105420] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Guidelines for SARS-CoV-2 have relied on limited data on duration of viral infectiousness and correlation with COVID-19 symptoms and diagnostic testing. METHODS We enrolled ambulatory adults with acute SARS-CoV-2 infection and performed serial measurements of COVID-19 symptoms, nasal swab viral RNA, nucleocapsid (N) and spike (S) antigens, and replication-competent SARS-CoV-2 by viral growth in culture. We determined average time from symptom onset to a first negative test result and estimated risk of infectiousness, as defined by positive viral growth in culture. RESULTS Among 95 adults, median [interquartile range] time from symptom onset to first negative test result was 9 [5] days, 13 [6] days, 11 [4] days, and >19 days for S antigen, N antigen, culture growth, and viral RNA by RT-PCR, respectively. Beyond two weeks, virus growth and N antigen titers were rarely positive, while viral RNA remained detectable among half (26/51) of participants tested 21-30 days after symptom onset. Between 6-10 days from symptom onset, N antigen was strongly associated with culture positivity (relative risk=7.61, 95% CI: 3.01-19.22), whereas neither viral RNA nor symptoms were associated with culture positivity. During the 14 days following symptom onset, the presence of N antigen remained strongly associated (adjusted relative risk=7.66, 95% CI: 3.96-14.82) with culture positivity, regardless of COVID-19 symptoms. CONCLUSIONS Most adults have replication-competent SARS-CoV-2 for 10-14 after symptom onset. N antigen testing is a strong predictor of viral infectiousness and may be a more suitable biomarker, rather than absence of symptoms or viral RNA, to discontinue isolation within two weeks from symptom onset.
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Affiliation(s)
- Paul K Drain
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States; Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA, United States.
| | - Ronit R Dalmat
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
| | - Linhui Hao
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Meagan J Bemer
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Elvira Budiawan
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Jennifer F Morton
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Renee C Ireton
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Tien-Ying Hsiang
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Zarna Marfatia
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Roshni Prabhu
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Claire Woosley
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Adanech Gichamo
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Elena Rechkina
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Daphne Hamilton
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | - Michalina Montaño
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States
| | | | | | - Inah Golez
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Elise Smith
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - M Juliana McElrath
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA, United States; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Matthew Thompson
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, United States
| | | | - Allison Meisner
- International Clinical Research Center, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Geoffrey S Gottlieb
- Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States; Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA, United States; Environmental Health & Safety Department, University of Washington, Seattle, WA, United States
| | - Michael Gale
- Department of Immunology, Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, United States; Center for Emerging & Re-emerging Infectious Diseases, University of Washington, Seattle, WA, United States
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Leslie M. White House budget includes push to eliminate hepatitis C. Science 2023; 379:1077. [PMID: 36926977 DOI: 10.1126/science.adh7975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
$11.3 billion would go to treatment, testing, and education.
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Abstract
Skin-interfaced microfluidic systems help assess health status and chemical exposure.
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Affiliation(s)
- Da Som Yang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Roozbeh Ghaffari
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
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Rahman MM, Islam MR, Dhar PS. Leptospirosis's abrupt resurgence: types, bacteriology, molecular genetics, etiology, diagnostic testing, transmission, symptoms, and medications. Int J Surg 2023; 109:120-122. [PMID: 36799822 PMCID: PMC10389422 DOI: 10.1097/js9.0000000000000031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/20/2022] [Indexed: 02/18/2023]
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Aghi A, Salvagnini D, Berton G, Cecconi M, Della Valle E, Spera R, Mambelli M, Palermi S, Neunhaeuserer D, Vecchiato M. Selective Functional Movement Assessment (SFMA) Reliability and Proposal of Its Use in Sports. Int J Environ Res Public Health 2023; 20:2032. [PMID: 36767405 PMCID: PMC9915240 DOI: 10.3390/ijerph20032032] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The Selective Functional Movement Assessment (SFMA) is a functional movement assessment method to observe movement restrictions in individuals with known musculoskeletal disorders, although it has also been used to evaluate healthy athletes of different sports. AIM The present paper aimed to evaluate the applicability of SFMA in a clinical setting and to verify whether a student can correctly perform it. METHODS An introductory and explanatory email was sent to the subjects, containing the instructions needed to produce a video with SFMA evaluation movements. SFMA methodology was then used to analyze the received videos. The results between interobserver and intraobserver agreement were compared to the literature, considered the gold standard methods. RESULTS Twenty-eight subjects (17.71 ± 1.96 years aged) were rated. The functional non-painful scenario (FN) has been assigned more frequently by all raters. The student's intra-rater reliability proved to be moderate (Kappa coefficient 0.49). Results for inter-rater reliability showed that the reliability degree between the senior physiotherapist and student before and after their educational path is good (Kappa coefficient 0.60 and 0.62, respectively). CONCLUSIONS The results of this study showed SFMA intra-rater reliability to be moderate, while inter-rater reliability can be considered good. These characteristics make it a valuable tool for sport's needs, even when used by students.
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Affiliation(s)
- Andrea Aghi
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy
- Rehabilitation Center “Fisioterapia Raimondi di Giovanni e Daniele”, 35030 Selvazzano Dentro-Padova, Italy
| | | | - Giovanni Berton
- Rehabilitation Center “Fisioterapia Raimondi di Giovanni e Daniele”, 35030 Selvazzano Dentro-Padova, Italy
| | - Mattia Cecconi
- Rehabilitation Center “Fisiomedic”, Oriago, 30034 Venice, Italy
| | | | - Rocco Spera
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Maria Mambelli
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
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Luke RA, Kearsley AJ, Pisanic N, Manabe YC, Thomas DL, Heaney CD, Patrone PN. Modeling in higher dimensions to improve diagnostic testing accuracy: Theory and examples for multiplex saliva-based SARS-CoV-2 antibody assays. PLoS One 2023; 18:e0280823. [PMID: 36913381 PMCID: PMC10010503 DOI: 10.1371/journal.pone.0280823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/05/2023] [Indexed: 03/14/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has emphasized the importance and challenges of correctly interpreting antibody test results. Identification of positive and negative samples requires a classification strategy with low error rates, which is hard to achieve when the corresponding measurement values overlap. Additional uncertainty arises when classification schemes fail to account for complicated structure in data. We address these problems through a mathematical framework that combines high dimensional data modeling and optimal decision theory. Specifically, we show that appropriately increasing the dimension of data better separates positive and negative populations and reveals nuanced structure that can be described in terms of mathematical models. We combine these models with optimal decision theory to yield a classification scheme that better separates positive and negative samples relative to traditional methods such as confidence intervals (CIs) and receiver operating characteristics. We validate the usefulness of this approach in the context of a multiplex salivary SARS-CoV-2 immunoglobulin G assay dataset. This example illustrates how our analysis: (i) improves the assay accuracy, (e.g. lowers classification errors by up to 42% compared to CI methods); (ii) reduces the number of indeterminate samples when an inconclusive class is permissible, (e.g. by 40% compared to the original analysis of the example multiplex dataset) and (iii) decreases the number of antigens needed to classify samples. Our work showcases the power of mathematical modeling in diagnostic classification and highlights a method that can be adopted broadly in public health and clinical settings.
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Affiliation(s)
- Rayanne A. Luke
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, United States of America
- Applied and Computational Mathematics Division, National Institute of Standards and Technology, Gaithersburg, MD, United States of America
- * E-mail:
| | - Anthony J. Kearsley
- Applied and Computational Mathematics Division, National Institute of Standards and Technology, Gaithersburg, MD, United States of America
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Yukari C. Manabe
- Department of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - David L. Thomas
- Department of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Christopher D. Heaney
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, United States of America
- Department of Internal Health, Johns Hopkins University, Baltimore, MD, United States of America
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States of America
| | - Paul N. Patrone
- Applied and Computational Mathematics Division, National Institute of Standards and Technology, Gaithersburg, MD, United States of America
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Djulbegovic B, Hozo I. Using Decision Curve Analysis to Evaluate Testing and/or Predictive Modeling. Cancer Treat Res 2023; 189:77-84. [PMID: 37789162 DOI: 10.1007/978-3-031-37993-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
In this chapter, we extend the threshold model to evaluate the value of diagnostic tests or predictive models over a range of all possible thresholds by using decision curve analysis (DCA). DCA has been developed within the expected utility theory (EUT) and expected regret theory (ERT) framework.
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Affiliation(s)
- Benjamin Djulbegovic
- Hematology Stewardship Program, Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Iztok Hozo
- Department of Mathematics, Indiana University Northwest, Gary, IN, USA
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Djulbegovic B, Hozo I. Making Decisions When No Further Diagnostic Testing is Available. Cancer Treat Res 2023; 189:25-37. [PMID: 37789158 DOI: 10.1007/978-3-031-37993-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
In this chapter, we illustrate how evidence about treatments' benefits and harms can be integrated to enable rational decision-making even under considerable clinical uncertainty.
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Affiliation(s)
- Benjamin Djulbegovic
- Hematology Stewardship Program, Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Iztok Hozo
- Department of Mathematics, Indiana University Northwest, Gary, IN, USA
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Doswell A, Anderst J, Tieder JS, Herman BE, Hall M, Wilkins V, Knochel ML, Kaplan R, Cohen A, DeLaroche AM, Harper B, Mittal MK, Shastri N, Prusakowski M, Puls HT. Diagnostic testing for and detection of physical abuse in infants with brief resolved unexplained events. Child Abuse Negl 2023; 135:105952. [PMID: 36423537 DOI: 10.1016/j.chiabu.2022.105952] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND A Brief Resolved Unexplained Event (BRUE) can be a sign of occult physical abuse. OBJECTIVES To identify rates of diagnostic testing able to detect physical abuse (head imaging, skeletal survey, and liver transaminases) at BRUE presentation. The secondary objective was to estimate the rate of physical abuse diagnosed at initial BRUE presentation through 1 year of age. PARTICIPANTS AND SETTING Infants who presented with a BRUE at one of 15 academic or community hospitals were followed from initial BRUE presentation until 1 year of age for BRUE recurrence or revisits. METHODS This study was part of the BRUE Research and Quality Improvement Network, a multicenter retrospective cohort examining infants with BRUE. Generalized estimating equations assessed associations with performance of diagnostic testing (adjusted odds ratio (aOR)). RESULTS Of the 2036 infants presenting with a BRUE, 6.2 % underwent head imaging, 7.0 % skeletal survey, and 12.1 % liver transaminases. Infants were more likely to undergo skeletal survey if there were physical examination findings concerning for trauma (aOR 8.23, 95 % CI [1.92, 35.24], p < 0.005) or concerning social history (aOR 1.89, 95 % CI [1.13, 3.16], p = 0.015). There were 7 (0.3 %) infants diagnosed with physical abuse: one at BRUE presentation, one <3 days after BRUE presentation, and five >30 days after BRUE presentation. CONCLUSION There were low rates of diagnostic testing and physical abuse identified in infants presenting with BRUE. Further study including standardized testing protocols is warranted to identify physical abuse in infants presenting with a BRUE.
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Affiliation(s)
- Angela Doswell
- Division of Child Abuse and Neglect, Department of Pediatrics, Connecticut Children's Medical Center and University of Connecticut School of Medicine, 282 Washington Street, Hartford, CT 06106, United States of America.
| | - James Anderst
- Division of Child Adversity and Resilience, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri and University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States of America
| | - Joel S Tieder
- Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital and School of Medicine, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, United States of America
| | - Bruce E Herman
- Division of Pediatric Emergency Medicine, Primary Children's Hospital and University of Utah, 100 North Mario Capecchi Drive, Salt Lake City, UT 84113, United States of America
| | - Matt Hall
- Children's Hospital Association, 16011 College Boulevard, Lenexa, KS 66219, United States of America
| | - Victoria Wilkins
- Division of Pediatric Hospital Medicine, Primary Children's Hospital and University of Utah, 100 North Mario Capecchi Drive, Salt Lake City, UT 84113, United States of America
| | - Miguel L Knochel
- Division of Pediatric Hospital Medicine, Primary Children's Hospital and University of Utah, 100 North Mario Capecchi Drive, Salt Lake City, UT 84113, United States of America
| | - Ron Kaplan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, United States of America
| | - Adam Cohen
- Division of Hospital Medicine, Department of Pediatrics and Department of Education, Innovation and Technology, Baylor College of Medicine and Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, United States of America
| | - Amy M DeLaroche
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, United States of America
| | - Beth Harper
- Division of Hospital Medicine, Department of Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States of America
| | - Manoj K Mittal
- Division of Emergency Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States of America
| | - Nirav Shastri
- Division of Emergency Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri and University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States of America
| | - Melanie Prusakowski
- Department of Emergency Medicine, Carilion Children's Hospital, 1906 Belleview Avenue SE, Roanoke, VA 24014, United States of America
| | - Henry T Puls
- Division of Hospital Medicine, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri and University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States of America
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Djulbegovic B, Hozo I. Decision-Making When Diagnostic Testing is Available. Cancer Treat Res 2023; 189:53-65. [PMID: 37789160 DOI: 10.1007/978-3-031-37993-2_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
When a decision-maker has the option of diagnostic testing, they face a typical dilemma: (1) do not administer treatment and do not test, (2) test and decide to administer treatment based on the test result, and (3) administer treatment without testing. In this chapter, we will discuss the theory behind threshold modeling when diagnostic testing is available; we will illustrate the approach by presenting a case vignette.
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Affiliation(s)
- Benjamin Djulbegovic
- Hematology Stewardship Program, Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Iztok Hozo
- Department of Mathematics, Indiana University Northwest, Gary, IN, USA
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Djulbegovic B, Hozo I. Making Decisions When no Further Diagnostic Testing is Available (Expected Regret Theory Threshold Model). Cancer Treat Res 2023; 189:39-52. [PMID: 37789159 DOI: 10.1007/978-3-031-37993-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
In Chap. 2 , we illustrated the application of the expected utility theory (EUT) to rational decision-making when no further diagnostic testing is available. In this chapter, we apply regret theory to the decision problems discussed in Chap. 2 .
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Affiliation(s)
- Benjamin Djulbegovic
- Hematology Stewardship Program, Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Iztok Hozo
- Department of Mathematics, Indiana University Northwest, Gary, IN, USA
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Kraft A, Ciaccio CE. Diagnostic Testing Procedures and Challenges for Primary Immunodeficiencies. Pediatr Ann 2022; 51:e480-e484. [PMID: 36476200 DOI: 10.3928/19382359-20221006-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary immunodeficiencies are rare but are often on the differential diagnosis list when patients present with recurrent or atypical infections. Patients with primary immunodeficiencies can present with a variety of symptoms and can present providers with diagnostic challenges given this variability, and the severe implications of immunodeficiencies can sometimes lead providers to pursue broad workups that may not be necessary. However, there are certain symptom patterns providers can look out for and diagnostic steps that can be taken to triage these presentations. We have used the practice modeled in the "Five Fingers of the Immune Workup" to outline common laboratory tests for clinicians to order when they are concerned for immunodeficiencies while remembering that these diagnoses are often rare, and true concern for this pathology would warrant referral to a specialist. [Pediatr Ann. 2022;51(12):e480-e484.].
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Wang ET, Chiang S, Cleboski S, Rao VR, Vannucci M, Haneef Z. Seizure count forecasting to aid diagnostic testing in epilepsy. Epilepsia 2022; 63:3156-3167. [PMID: 36149301 PMCID: PMC11025604 DOI: 10.1111/epi.17415] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Epilepsy monitoring unit (EMU) admissions are critical for presurgical evaluation of drug-resistant epilepsy but may be nondiagnostic if an insufficient number of seizures are recorded. Seizure forecasting algorithms have shown promise for estimating the likelihood of seizures as a binary event in individual patients, but methods to predict how many seizures will occur remain elusive. Such methods could increase the diagnostic yield of EMU admissions and help patients mitigate seizure-related morbidity. Here, we evaluated the performance of a state-space method that uses prior seizure count data to predict future counts. METHODS A Bayesian negative-binomial dynamic linear model (DLM) was developed to forecast daily electrographic seizure counts in 19 patients implanted with a responsive neurostimulation (RNS) device. Holdout validation was used to evaluate performance in predicting the number of electrographic seizures for forecast horizons ranging 1-7 days ahead. RESULTS One-day-ahead prediction of the number of electrographic seizures using a negative-binomial DLM resulted in improvement over chance in 73.1% of time segments compared to a random chance forecaster and remained >50% for forecast horizons of up to 7 days. Superior performance (mean error = .99) was obtained in predicting the number of electrographic seizures in the next day compared to three traditional methods for count forecasting (integer-valued generalized autoregressive conditional heteroskedasticity model or INGARCH, 1.10; Croston, 1.06; generalized linear autoregressive moving average model or GLARMA, 2.00). Number of electrographic seizures in the preceding day and laterality of electrographic pattern detections had highest predictive value, with greater number of electrographic seizures and RNS magnet swipes in the preceding day associated with a higher number of electrographic seizures the next day. SIGNIFICANCE This study demonstrates that DLMs can predict the number of electrographic seizures a patient will experience days in advance with above chance accuracy. This study represents an important step toward the translation of seizure forecasting methods into the optimization of EMU admissions.
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Affiliation(s)
- Emily T. Wang
- Department of Statistics, Rice University, Houston, Texas, USA
| | - Sharon Chiang
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Vikram R. Rao
- Department of Statistics, Rice University, Houston, Texas, USA
| | - Marina Vannucci
- Department of Statistics, Rice University, Houston, Texas, USA
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
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Cohen JM, Damsky W, Girardi M. Comment on "Diagnostic testing of eczematous dermatitis with incomplete response to dupilumab". J Am Acad Dermatol 2022; 87:e241-e242. [PMID: 35933070 DOI: 10.1016/j.jaad.2022.05.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut; Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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Michels MAHM, Volokhina EB, van de Kar NCAJ, van den Heuvel LPJ. Challenges in diagnostic testing of nephritic factors. Front Immunol 2022; 13:1036136. [PMID: 36451820 PMCID: PMC9702996 DOI: 10.3389/fimmu.2022.1036136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/12/2022] [Indexed: 09/27/2023] Open
Abstract
Nephritic factors (NeFs) are autoantibodies promoting the activity of the central enzymes of the complement cascade, an important first line of defense of our innate immune system. NeFs stabilize the complement convertase complexes and prevent their natural and regulator-mediated decay. They are mostly associated with rare complement-mediated kidney disorders, in particular with C3 glomerulopathy and related diseases. Although these autoantibodies were already described more than 50 years ago, measuring NeFs for diagnostic purposes remains difficult, and this also complicates our understanding of their clinical associations. In this review, we address the multifactorial challenges of NeF diagnostics. We describe the diseases NeFs are associated with, the heterogenic mechanisms of action of different NeF types, the different methods available in laboratories used for their detection, and efforts for standardization. Finally, we discuss the importance of proper NeF diagnostics for understanding the clinical impact of these autoantibodies in disease pathophysiology and for considering future complement-directed therapy.
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Affiliation(s)
- Marloes A. H. M. Michels
- Department of Pediatric Nephrology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Elena B. Volokhina
- Department of Pediatric Nephrology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
- Innatoss Laboratories, Oss, Netherlands
| | - Nicole C. A. J. van de Kar
- Department of Pediatric Nephrology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lambertus P.W. J. van den Heuvel
- Department of Pediatric Nephrology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Pediatrics/Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
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Krey I, Platzer K, Esterhuizen A, Berkovic SF, Helbig I, Hildebrand MS, Lerche H, Lowenstein D, Møller RS, Poduri A, Sadleir L, Sisodiya SM, Weckhuysen S, Wilmshurst JM, Weber Y, Lemke JR. Current practice in diagnostic genetic testing of the epilepsies. Epileptic Disord 2022; 24:765-786. [PMID: 35830287 PMCID: PMC10752379 DOI: 10.1684/epd.2022.1448] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/10/2022] [Indexed: 01/19/2023]
Abstract
Epilepsy genetics is a rapidly developing field, in which novel disease-associated genes, novel mechanisms associated with epilepsy, and precision medicine approaches are continuously being identified. In the past decade, advances in genomic knowledge and analysis platforms have begun to make clinical genetic testing accessible for, in principle, people of all ages with epilepsy. For this reason, the Genetics Commission of the International League Against Epilepsy (ILAE) presents this update on clinical genetic testing practice, including current techniques, indications, yield of genetic testing, recommendations for pre- and post-test counseling, and follow-up after genetic testing is completed. We acknowledge that the resources vary across different settings but highlight that genetic diagnostic testing for epilepsy should be prioritized when the likelihood of an informative finding is high. Results of genetic testing, in particular the identification of causative genetic variants, are likely to improve individual care. We emphasize the importance of genetic testing for individuals with epilepsy as we enter the era of precision therapy.
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Affiliation(s)
- Ilona Krey
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Alina Esterhuizen
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Samuel F. Berkovic
- Epilepsy Research Centre, Department of Medicine, University of Melbourne (Austin Health), Heidelberg, VIC, Australia
| | - Ingo Helbig
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Building C, Arnold-Heller-Straße 3, 24105 Kiel, Germany
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, 19104 USA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104 USA
| | - Michael S. Hildebrand
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg and Murdoch Children’s Research Institute, Royal Children’s Hospital, Victoria, Australia
| | - Holger Lerche
- Department of Epileptology and Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Daniel Lowenstein
- Department of Neurology, University of California, San Francisco, USA
| | - Rikke S. Møller
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Annapurna Poduri
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Lynette Sadleir
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology London, UK and Chalfont Centre for Epilepsy, Buckinghamshire, UK
| | - Sarah Weckhuysen
- Center for Molecular Neurology, VIB-University of Antwerp, VIB, Antwerp, Belgium; Department of Neurology, University Hospital Antwerp, Antwerp, Belgium
| | - Jo M. Wilmshurst
- Department of Paediatric Neurology, Paediatric and Child Health, Red Cross War Memorial Children’s Hospital, Neuroscience Institute, University of Cape Town, South Africa
| | - Yvonne Weber
- Department of Epileptology and Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
- Department of Epileptology and Neurology, University of Aachen, Germany
| | - Johannes R. Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
- Center for Rare Diseases, University of Leipzig Medical Center, Leipzig, Germany
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Zhu YX, Li Y, Wu ST, Liu WD, Song RR, Li W, Wang Y. [Application of ROC and PR curves in the evaluation of clinical diagnostic testing]. Zhonghua Yu Fang Yi Xue Za Zhi 2022; 56:1341-1347. [PMID: 36207901 DOI: 10.3760/cma.j.cn112150-20220104-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This study reviewed the concepts and properties of the receiver operating characteristic (ROC) curve and precision recall (PR) curve, and made suggestions on the application of two curves based on the prevalence in combination with the results of simulation data. This study demonstrated that the ROC curve and PR curve had different properties, which could reflect the performance of diagnostic methods from various aspects. These two curves should be selected with a consideration of prevalence and clinical scenarios. When the prevalence was less than 20%, especially less than 5%, the PR curve could be adopted.
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Affiliation(s)
- Y X Zhu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Y Li
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - S T Wu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - W D Liu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - R R Song
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - W Li
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Y Wang
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Weir-McCall JR, Williams MC, Wood A. One step closer to quantifying 'clinical likelihood' in pre-test probability. European Heart Journal - Quality of Care and Clinical Outcomes 2022; 8:597-599. [PMID: 35776955 PMCID: PMC9442847 DOI: 10.1093/ehjqcco/qcac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Jonathan R Weir-McCall
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
- Department of Radiology, Royal Papworth Hospital, Cambridge CB20QQ Cambridge, UK
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH8 9YL, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Angela Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0QQ, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB2 0QQ, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge CB2 0QQ, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, UK
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Mathis D, Croft J, Chrastina P, Fowler B, Vianey‐Saban C, Ruijter GJG. The role of ERNDIM diagnostic proficiency schemes in improving the quality of diagnostic testing for inherited metabolic diseases. J Inherit Metab Dis 2022; 45:926-936. [PMID: 35560233 PMCID: PMC9540881 DOI: 10.1002/jimd.12523] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 11/22/2022]
Abstract
External quality assurance (EQA) is crucial to monitor and improve the quality of biochemical genetic testing. ERNDIM (www.erndim.org), established in 1994, aims at reliable and standardized procedures for diagnosis, treatment and monitoring of inherited metabolic disease (IMD) by providing EQA schemes and educational activities. Currently, ERNDIM provides 16 different EQA schemes including quantitative schemes for various metabolite groups, and interpretive schemes such as diagnostic proficiency testing (DPT). DPT schemes focus on the ability of laboratories to correctly identify and interpret abnormalities in authentic urine samples across a wide range of IMDs. In the DPT schemes, six samples each year are distributed together with clinical information. Laboratories choose and perform the tests needed to reach a diagnosis. Data were collected on 345 samples, distributed to up to 105 laboratories worldwide. Diagnostic proficiency (the % of total points possible for all participating laboratories within a scheme for analysis and interpretation) ranged widely: amino acid disorders (n = 20), range 33%-100%, mean 84%; organic acid disorders (n = 35), range 14%-100%, mean 84%; lysosomal storage disorders (n = 13), range 20%-97%, mean 73%; purine/pyrimidine disorders (n = 9), range 37%-100%, mean 70%; miscellaneous disorders (n = 8), range 17%-100%, mean 65%; no IMD, range 65%-95%, mean 85%. When a sample with the same disorder was distributed in a subsequent survey, performance improved in 75 cases with no improvement seen in 32, suggesting overall improvement of performance. ERNDIM diagnostic proficiency testing is a valuable activity which can help to assess laboratory performance, identify methodological/technical challenges, be informative during quality audits and contribute to a better clinical appreciation of diagnostic uncertainty.
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Affiliation(s)
- Déborah Mathis
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Joanne Croft
- Department of Clinical Chemistry and Newborn ScreeningSheffield Children's NHS Foundation TrustSheffieldUK
| | - Petr Chrastina
- Department of Pediatrics and Inherited Metabolic Disorders, General University Hospital in Prague and First Faculty of MedicineCharles University in PraguePragueCzech Republic
| | - Brian Fowler
- University Children's Hospital Basel, University Children's Hospitals ZürichBasel and ZürichSwitzerland
| | - Christine Vianey‐Saban
- Division of Inborn Errors of Metabolism, Department of Biochemistry and Molecular BiologyCHU de LyonLyonFrance
| | - George J. G. Ruijter
- Department of Clinical Genetics, Center for Lysosomal and Metabolic DiseasesErasmus University Medical CenterRotterdamThe Netherlands
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Aden TA, Blevins P, York SW, Rager S, Balachandran D, Hutson CL, Lowe D, Mangal CN, Wolford T, Matheny A, Davidson W, Wilkins K, Cook R, Roulo RM, White MK, Berman L, Murray J, Laurance J, Francis D, Green NM, Berumen RA, Gonzalez A, Evans S, Hudziec M, Noel D, Adjei M, Hovan G, Lee P, Tate L, Gose RB, Voermans R, Crew J, Adam PR, Haydel D, Lukula S, Matluk N, Shah S, Featherston J, Ware D, Pettit D, McCutchen E, Acheampong E, Buttery E, Gorzalski A, Perry M, Fowler R, Lee RB, Nickla R, Huard R, Moore A, Jones K, Johnson R, Swaney E, Jaramillo J, Reinoso Webb C, Guin B, Yost J, Atkinson A, Griffin-Thomas L, Chenette J, Gant J, Sterkel A, Ghuman HK, Lute J, Smole SC, Arora V, Demontigny CK, Bielby M, Geeter E, Newman KAM, Glazier M, Lutkemeier W, Nelson M, Martinez R, Chaitram J, Honein MA, Villanueva JM. Rapid Diagnostic Testing for Response to the Monkeypox Outbreak - Laboratory Response Network, United States, May 17-June 30, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:904-907. [PMID: 35834423 PMCID: PMC9290387 DOI: 10.15585/mmwr.mm7128e1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
As part of public health preparedness for infectious disease threats, CDC collaborates with other U.S. public health officials to ensure that the Laboratory Response Network (LRN) has diagnostic tools to detect Orthopoxviruses, the genus that includes Variola virus, the causative agent of smallpox. LRN is a network of state and local public health, federal, U.S. Department of Defense (DOD), veterinary, food, and environmental testing laboratories. CDC developed, and the Food and Drug Administration (FDA) granted 510(k) clearance* for the Non-variola Orthopoxvirus Real-time PCR Primer and Probe Set (non-variola Orthopoxvirus [NVO] assay), a polymerase chain reaction (PCR) diagnostic test to detect NVO. On May 17, 2022, CDC was contacted by the Massachusetts Department of Public Health (DPH) regarding a suspected case of monkeypox, a disease caused by the Orthopoxvirus Monkeypox virus. Specimens were collected and tested by the Massachusetts DPH public health laboratory with LRN testing capability using the NVO assay. Nationwide, 68 LRN laboratories had capacity to test approximately 8,000 NVO tests per week during June. During May 17-June 30, LRN laboratories tested 2,009 specimens from suspected monkeypox cases. Among those, 730 (36.3%) specimens from 395 patients were positive for NVO. NVO-positive specimens from 159 persons were confirmed by CDC to be monkeypox; final characterization is pending for 236. Prompt identification of persons with infection allowed rapid response to the outbreak, including isolation and treatment of patients, administration of vaccines, and other public health action. To further facilitate access to testing and increase convenience for providers and patients by using existing provider-laboratory relationships, CDC and LRN are supporting five large commercial laboratories with a national footprint (Aegis Science, LabCorp, Mayo Clinic Laboratories, Quest Diagnostics, and Sonic Healthcare) to establish NVO testing capacity of 10,000 specimens per week per laboratory. On July 6, 2022, the first commercial laboratory began accepting specimens for NVO testing based on clinician orders.
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