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Brown RE. Commentary: Morphoproteomics and Data Mining of the Medical Literature Define the Pathobiology of COVID-19 Pneumonitis in Humans and Provide Adjuvant Therapeutic Options. Ann Clin Lab Sci 2021; 51:890-893. [PMID: 34921044] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Due to the resurgence of COVID-19, understanding the biology of SARS-CoV-2 is an opportunity to develop adjuvant therapies that could target its pathobiology and lessen the severity of the COVID-19 infection so that our patients could survive. This commentary serves to accomplish this by using published morphoproteomic findings with data mining of the medical literature to define the pathobiology of COVID-19 pneumonitis and provide combinatorial and relatively non-toxic adjuvant therapies that have been successful against this viral infection.
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Affiliation(s)
- Robert E Brown
- Department of Pathology and Laboratory Medicine, the University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
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Haouari W, Dubail J, Poüs C, Cormier-Daire V, Bruneel A. Inherited Proteoglycan Biosynthesis Defects-Current Laboratory Tools and Bikunin as a Promising Blood Biomarker. Genes (Basel) 2021; 12:genes12111654. [PMID: 34828260 PMCID: PMC8625474 DOI: 10.3390/genes12111654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/11/2021] [Accepted: 10/17/2021] [Indexed: 12/15/2022] Open
Abstract
Proteoglycans consist of proteins linked to sulfated glycosaminoglycan chains. They constitute a family of macromolecules mainly involved in the architecture of organs and tissues as major components of extracellular matrices. Some proteoglycans also act as signaling molecules involved in inflammatory response as well as cell proliferation, adhesion, and differentiation. Inborn errors of proteoglycan metabolism are a group of orphan diseases with severe and irreversible skeletal abnormalities associated with multiorgan impairments. Identifying the gene variants that cause these pathologies proves to be difficult because of unspecific clinical symptoms, hardly accessible functional laboratory tests, and a lack of convenient blood biomarkers. In this review, we summarize the molecular pathways of proteoglycan biosynthesis, the associated inherited syndromes, and the related biochemical screening techniques, and we focus especially on a circulating proteoglycan called bikunin and on its potential as a new biomarker of these diseases.
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Affiliation(s)
- Walid Haouari
- INSERM UMR1193, Paris-Saclay University, Faculté de Pharmacie, 5 rue Jean-Baptiste Clément, 92220 Châtenay-Malabry, France; (W.H.); (C.P.)
| | - Johanne Dubail
- INSERM UMR1163, French Reference Center for Skeletal Dysplasia, Imagine Institute, Paris University, 24 Boulevard du Montparnasse, 75015 Paris, France; (J.D.); (V.C.-D.)
- AP-HP, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - Christian Poüs
- INSERM UMR1193, Paris-Saclay University, Faculté de Pharmacie, 5 rue Jean-Baptiste Clément, 92220 Châtenay-Malabry, France; (W.H.); (C.P.)
| | - Valérie Cormier-Daire
- INSERM UMR1163, French Reference Center for Skeletal Dysplasia, Imagine Institute, Paris University, 24 Boulevard du Montparnasse, 75015 Paris, France; (J.D.); (V.C.-D.)
- AP-HP, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - Arnaud Bruneel
- INSERM UMR1193, Paris-Saclay University, Faculté de Pharmacie, 5 rue Jean-Baptiste Clément, 92220 Châtenay-Malabry, France; (W.H.); (C.P.)
- AP-HP, Biochimie Métabolique et Cellulaire, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
- Correspondence:
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Sounderajah V, Ashrafian H, Rose S, Shah NH, Ghassemi M, Golub R, Kahn CE, Esteva A, Karthikesalingam A, Mateen B, Webster D, Milea D, Ting D, Treanor D, Cushnan D, King D, McPherson D, Glocker B, Greaves F, Harling L, Ordish J, Cohen JF, Deeks J, Leeflang M, Diamond M, McInnes MDF, McCradden M, Abràmoff MD, Normahani P, Markar SR, Chang S, Liu X, Mallett S, Shetty S, Denniston A, Collins GS, Moher D, Whiting P, Bossuyt PM, Darzi A. A quality assessment tool for artificial intelligence-centered diagnostic test accuracy studies: QUADAS-AI. Nat Med 2021; 27:1663-1665. [PMID: 34635854 DOI: 10.1038/s41591-021-01517-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sherri Rose
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Nigam H Shah
- Center for Biomedical Informatics Research, Stanford University, Stanford, CA, USA
| | - Marzyeh Ghassemi
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Robert Golub
- Journal of the American Medical Association (JAMA), Chicago, IL, USA
| | - Charles E Kahn
- University of Pennsylvania, Philadelphia, Pennsylvania, PA, USA
| | | | | | | | | | - Dan Milea
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Daniel Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Darren Treanor
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
- Department of Clinical Pathology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | - Dominic King
- Institute of Global Health Innovation, Imperial College London, London, UK
- Optum, London, UK
| | | | - Ben Glocker
- Faculty of Engineering, Department of Computing, Imperial College London, London, UK
| | - Felix Greaves
- National Institute for Health and Care Excellence, London, UK
| | - Leanne Harling
- Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Johan Ordish
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Jérémie F Cohen
- Department of Pediatrics, Centre of Research in Epidemiology and Statistics, Inserm UMR 1153, Necker- Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jon Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mariska Leeflang
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Matthew D F McInnes
- Departments of Radiology and Epidemiology, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Melissa McCradden
- Department of Bioethics, The Hospital for Sick Kids, Toronto, Ontario, Canada
| | - Michael D Abràmoff
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Pasha Normahani
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Chang
- Annals of Internal Medicine, American College of Physicians, Philadelphia, PA, USA
| | - Xiaoxuan Liu
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Health Data Research UK, London, UK
| | - Susan Mallett
- Centre for Medical Imaging, University College London, London, UK
| | | | - Alastair Denniston
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Health Data Research UK, London, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Moher
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Penny Whiting
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Koehler D, Ozga AK, Molwitz I, May P, Görich HM, Keller S, Adam G, Yamamura J. Time series analysis of the demand for COVID-19 related chest imaging during the first wave of the SARS-CoV-2 pandemic: An explorative study. PLoS One 2021. [PMID: 33657140 DOI: 10.1371/journal.pone.02476867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate possible patterns of demand for chest imaging during the first wave of the SARS-CoV-2 pandemic and derive a decision aid for the allocation of resources in future pandemic challenges. MATERIALS AND METHODS Time data of requests for patients with suspected or confirmed coronavirus disease 2019 (COVID-19) lung disease were analyzed between February 27th and May 27th 2020. A multinomial logistic regression model was used to evaluate differences in the number of requests between 3 time intervals (I1: 6am - 2pm, I2: 2pm - 10pm, I3: 10pm - 6am). A cosinor model was applied to investigate the demand per hour. Requests per day were compared to the number of regional COVID-19 cases. RESULTS 551 COVID-19 related chest imagings (32.8% outpatients, 67.2% in-patients) of 243 patients were conducted (33.3% female, 66.7% male, mean age 60 ± 17 years). Most exams for outpatients were required during I2 (I1 vs. I2: odds ratio (OR) = 0.73, 95% confidence interval (CI) 0.62-0.86, p = 0.01; I2 vs. I3: OR = 1.24, 95% CI 1.04-1.48, p = 0.03) with an acrophase at 7:29 pm. Requests for in-patients decreased from I1 to I3 (I1 vs. I2: OR = 1.24, 95% CI 1.09-1.41, p = 0.01; I2 vs. I3: OR = 1.16, 95% CI 1.05-1.28, p = 0.01) with an acrophase at 12:51 pm. The number of requests per day for outpatients developed similarly to regional cases while demand for in-patients increased later and persisted longer. CONCLUSIONS The demand for COVID-19 related chest imaging displayed distinct distribution patterns depending on the sector of patient care and point of time during the SARS-CoV-2 pandemic. These patterns should be considered in the allocation of resources in future pandemic challenges with similar disease characteristics.
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Affiliation(s)
- Daniel Koehler
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Ozga
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp May
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Maria Görich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Keller
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Koehler D, Ozga AK, Molwitz I, May P, Görich HM, Keller S, Adam G, Yamamura J. Time series analysis of the demand for COVID-19 related chest imaging during the first wave of the SARS-CoV-2 pandemic: An explorative study. PLoS One 2021; 16:e0247686. [PMID: 33657140 PMCID: PMC7928469 DOI: 10.1371/journal.pone.0247686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/10/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives The aim of this study was to investigate possible patterns of demand for chest imaging during the first wave of the SARS-CoV-2 pandemic and derive a decision aid for the allocation of resources in future pandemic challenges. Materials and methods Time data of requests for patients with suspected or confirmed coronavirus disease 2019 (COVID-19) lung disease were analyzed between February 27th and May 27th 2020. A multinomial logistic regression model was used to evaluate differences in the number of requests between 3 time intervals (I1: 6am - 2pm, I2: 2pm - 10pm, I3: 10pm - 6am). A cosinor model was applied to investigate the demand per hour. Requests per day were compared to the number of regional COVID-19 cases. Results 551 COVID-19 related chest imagings (32.8% outpatients, 67.2% in-patients) of 243 patients were conducted (33.3% female, 66.7% male, mean age 60 ± 17 years). Most exams for outpatients were required during I2 (I1 vs. I2: odds ratio (OR) = 0.73, 95% confidence interval (CI) 0.62–0.86, p = 0.01; I2 vs. I3: OR = 1.24, 95% CI 1.04–1.48, p = 0.03) with an acrophase at 7:29 pm. Requests for in-patients decreased from I1 to I3 (I1 vs. I2: OR = 1.24, 95% CI 1.09–1.41, p = 0.01; I2 vs. I3: OR = 1.16, 95% CI 1.05–1.28, p = 0.01) with an acrophase at 12:51 pm. The number of requests per day for outpatients developed similarly to regional cases while demand for in-patients increased later and persisted longer. Conclusions The demand for COVID-19 related chest imaging displayed distinct distribution patterns depending on the sector of patient care and point of time during the SARS-CoV-2 pandemic. These patterns should be considered in the allocation of resources in future pandemic challenges with similar disease characteristics.
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Affiliation(s)
- Daniel Koehler
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Ann-Kathrin Ozga
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp May
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Maria Görich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Keller
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Cernera G, Minno AD, Elce A, Liguori R, Bruzzese D, Lullo AMD, Castaldo G, Amato F, Zarrilli F, Comegna M. Letter to the Editor: Is there an Indication for Testing the Methylenetetrahydrofolate reductase A1298C Variant in Routine Clinical Settings? Ann Clin Lab Sci 2021; 51:277-279. [PMID: 33941571] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Gustavo Cernera
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II"
- CEINGE - Advanced Biotechnologies
| | - Alessandro Di Minno
- CEINGE - Advanced Biotechnologies
- Department of Pharmacy, University of Naples "Federico II"
| | - Ausilia Elce
- CEINGE - Advanced Biotechnologies
- Telematic University "Pegaso"
| | - Renato Liguori
- CEINGE - Advanced Biotechnologies
- Department of Sciences and Technologies, University of Naples "Parthenope"
| | - Dario Bruzzese
- Department of Public Health, University of Naples "Federico II", and Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II,"Naples, Italy
| | - Antonella Miriam Di Lullo
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II,"Naples, Italy
| | - Giuseppe Castaldo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II"
- CEINGE - Advanced Biotechnologies
| | - Felice Amato
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II"
- CEINGE - Advanced Biotechnologies
| | - Federica Zarrilli
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II"
- CEINGE - Advanced Biotechnologies
| | - Marika Comegna
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II"
- CEINGE - Advanced Biotechnologies
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Mafi JN, Reid RO, Baseman LH, Hickey S, Totten M, Agniel D, Fendrick AM, Sarkisian C, Damberg CL. Trends in Low-Value Health Service Use and Spending in the US Medicare Fee-for-Service Program, 2014-2018. JAMA Netw Open 2021; 4:e2037328. [PMID: 33591365 PMCID: PMC7887655 DOI: 10.1001/jamanetworkopen.2020.37328] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Low-value care, defined as care offering no net benefit in specific clinical scenarios, is associated with harmful outcomes in patients and wasteful spending. Despite a national education campaign and increasing attention on reducing health care waste, recent trends in low-value care delivery remain unknown. OBJECTIVE To assess national trends in low-value care use and spending. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, analyses of low-value care use and spending from 2014 to 2018 were conducted using 100% Medicare fee-for-service enrollment and claims data. Included individuals were aged 65 years or older and continuously enrolled in Medicare parts A, B, and D during each measurement year and the previous year. Data were analyzed from September 2019 through December 2020. EXPOSURE Being enrolled in fee-for-service Medicare for a period of time, in years. MAIN OUTCOMES AND MEASURES The Milliman MedInsight Health Waste Calculator was used to assess 32 claims-based measures of low-value care associated with Choosing Wisely recommendations and other professional guidelines. The calculator designates services as wasteful, likely wasteful, or not wasteful based on an absence of indication of appropriate use in the claims history; calculator-designated wasteful services were defined as low-value care. Spending was calculated as claim-line level (ie, spending on the low-value service) and claim level (ie, spending on the low-value service plus associated services), adjusting for inflation. RESULTS Among 21 045 759 individuals with fee-for-service Medicare (mean [SD] age, 77.4 [7.9] years; 12 515 915 [59.5%] women), the percentage receiving any of 32 low-value services decreased from 36.3% (95% CI, 36.3%-36.4%) to 33.6% (95% CI, 33.6%-33.6%) from 2014 to 2018. Uses of low-value services per 1000 individuals decreased from 677.8 (95% CI, 676.2-679.5) to 632.7 (95% CI, 632.6-632.8) from 2014 to 2018. Three services comprised approximately two-thirds of uses among 32 low-value services per 1000 individuals: preoperative laboratory testing decreased from 213.8 (95% CI, 213.4-214.2) to 166.2 (95% CI, 166.2-166.2), while opioids for back pain increased from 154.4 (95% CI, 153.6-155.2) to 182.1 (95% CI, 182.1-182.1) and antibiotics for upper respiratory infections increased from 75.0 (95% CI, 75.0-75.1) to 82 (95% CI, 82.0-82.0). Spending per 1000 individuals on low-value care also decreased, from $52 765.5 (95% CI, $51 952.3-$53 578.6) to $46 921.7 (95% CI, $46 593.7-$47 249.7) at the claim-line level and from $160 070.4 (95% CI, $158 999.8-$161 141.0) to $144 741.1 (95% CI, $144 287.5-$145 194.7) at the claim level. CONCLUSIONS AND RELEVANCE This cross-sectional study found that among individuals with fee-for-service Medicare receiving any of 32 measured services, low-value care use and spending decreased marginally from 2014 to 2018, despite a national education campaign in collaboration with clinician specialty societies and increased attention on low-value care. While most use of low-value care came from 3 services, 1 of these was opioid prescriptions, which increased over time despite the harms associated with their use. These findings may represent several opportunities to prevent patient harm and lower spending.
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Affiliation(s)
- John N. Mafi
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles
- RAND Health Care, RAND Corporation, Santa Monica, California
| | - Rachel O. Reid
- RAND Health Care, RAND Corporation, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Scot Hickey
- RAND Health Care, RAND Corporation, Santa Monica, California
| | - Mark Totten
- RAND Health Care, RAND Corporation, Santa Monica, California
| | - Denis Agniel
- RAND Health Care, RAND Corporation, Santa Monica, California
| | - A. Mark Fendrick
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Value-Based Insurance Design, University of Michigan, Ann Arbor
| | - Catherine Sarkisian
- Division of Geriatrics, David Geffen School of Medicine at the University of California, Los Angeles
- Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
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Li Y, Zhao H, Guo Y, Duan Y, Guo Y, Ding X. Association of Preadmission Metformin Use and Prognosis in Patients With Sepsis and Diabetes Mellitus: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:811776. [PMID: 35002982 PMCID: PMC8735596 DOI: 10.3389/fendo.2021.811776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/09/2021] [Accepted: 12/03/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND AIM A growing body of evidence suggests that preadmission metformin use could decrease the mortality of septic patients with diabetes mellitus (DM); however, the findings remain controversial. Therefore, this meta-analysis was conducted on available studies to confirm the relationship between preadmission metformin use and mortality in patients with sepsis and DM. METHODS A comprehensive search of the PubMed, Embase, and Cochrane Library databases was performed for studies published before August 8, 2021. Observational studies assessing the correlation between metformin use and mortality in patients with sepsis and DM were considered eligible studies. We used the Newcastle-Ottawa Scale (NOS) to assess the outcome quality of each included article. Furthermore, the odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed using the inverse variance method with random effects modeling. RESULTS Eleven articles including 8195 patients were analyzed in this meta-analysis. All the included articles were scored as low risk of bias. Our results showed that preadmission metformin use had a lower mortality rate (OR, 0.74; 95% CIs, 0.62-0.88, P < 0.01) in patients with sepsis and DM. Surprisingly, there was no statistically significant difference in the levels of serum creatinine (weighted mean difference (WMD), 0.36; 95% CIs, -0.03-0.75; P = 0.84) and lactic acid (WMD, -0.16; 95% CIs, -0.49-0.18; P = 0.07) between preadmission metformin use and non-metformin use. CONCLUSIONS This study is the most comprehensive meta-analysis at present, which shows that preadmission metformin use may reduce mortality and not increase the levels of serum creatinine and lactic acid in adult patients with sepsis and DM. Therefore, these data suggest that the potential efficacy of metformin could be assessed in future clinical studies. SYSTEMATIC REVIEW REGISTRATION https://inplasy.com/?s=INPLASY2021100113, identifier INPLASY2021100113.
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Affiliation(s)
- Yuanzhe Li
- Department of Pediatrics, Children’s Hospital Affiliated of Zhengzhou University, Zhengzhou, China
| | - Huayan Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yalin Guo
- Department of Pediatrics, Children’s Hospital Affiliated of Zhengzhou University, Zhengzhou, China
| | - Yongtao Duan
- Department of Pediatrics, Children’s Hospital Affiliated of Zhengzhou University, Zhengzhou, China
| | - Yanjun Guo
- Department of Pediatrics, Children’s Hospital Affiliated of Zhengzhou University, Zhengzhou, China
- *Correspondence: Xianfei Ding, ; Yanjun Guo,
| | - Xianfei Ding
- General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Xianfei Ding, ; Yanjun Guo,
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Abstract
Fast and widespread diagnosis is crucial to fighting against the outbreak of COVID-19. This work surveys the landscape of available and emerging biosensor technologies for COVID-19 testing. Molecular diagnostic assays based on quantitative reverse transcription polymerase chain reaction are used in most clinical laboratories. However, the COVID-19 pandemic has overwhelmed testing capacity and motivated the development of fast point-of-care tests and the adoption of isothermal DNA amplification. Antigenic and serological rapid tests based on lateral-flow immunoassays suffer from low sensitivity. Advanced digital systems enhance performance at the expense of speed and the need for large equipment. Emerging technologies, including CRISPR gene-editing tools, benefit from high sensitivity and specificity of molecular diagnostics and the easy use of lateral-flow assays. DNA sequencing and sample pooling strategies are highlighted to bring out the full capacity of the available biosensor technologies and accelerate mass testing.
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Affiliation(s)
- Ibon Santiago
- Physics DepartmentTechnical University of MunichAm Coulombwall 4a/II85748Garching b. MünchenGermany
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10
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Stresman G, Whittaker C, Slater HC, Bousema T, Cook J. Quantifying Plasmodium falciparum infections clustering within households to inform household-based intervention strategies for malaria control programs: An observational study and meta-analysis from 41 malaria-endemic countries. PLoS Med 2020; 17:e1003370. [PMID: 33119589 PMCID: PMC7595326 DOI: 10.1371/journal.pmed.1003370] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/11/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Reactive malaria strategies are predicated on the assumption that individuals infected with malaria are clustered within households or neighbourhoods. Despite the widespread programmatic implementation of reactive strategies, little empirical evidence exists as to whether such strategies are appropriate and, if so, how they should be most effectively implemented. METHODS AND FINDINGS We collated 2 different datasets to assess clustering of malaria infections within households: (i) demographic health survey (DHS) data, integrating household information and patent malaria infection, recent fever, and recent treatment status in children; and (ii) data from cross-sectional and reactive detection studies containing information on the household and malaria infection status (patent and subpatent) of all-aged individuals. Both datasets were used to assess the odds of infections clustering within index households, where index households were defined based on whether they contained infections detectable through one of 3 programmatic strategies: (a) Reactive Case Detection (RACD) classifed by confirmed clinical cases, (b) Mass Screen and Treat (MSAT) classifed by febrile, symptomatic infections, and (c) Mass Test and Treat (MTAT) classifed by infections detectable using routine diagnostics. Data included 59,050 infections in 208,140 children under 7 years old (median age = 2 years, minimum = 2, maximum = 7) by microscopy/rapid diagnostic test (RDT) from 57 DHSs conducted between November 2006 and December 2018 from 23 African countries. Data representing 11,349 infections across all ages (median age = 22 years, minimum = 0.5, maximum = 100) detected by molecular tools in 132,590 individuals in 43 studies published between April 2006 and May 2019 in 20 African, American, Asian, and Middle Eastern countries were obtained from the published literature. Extensive clustering was observed-overall, there was a 20.40 greater (95% credible interval [CrI] 0.35-20.45; P < 0.001) odds of patent infections (according to the DHS data) and 5.13 greater odds (95% CI 3.85-6.84; P < 0.001) of molecularly detected infections (from the published literature) detected within households in which a programmatically detectable infection resides. The strongest degree of clustering identified by polymerase chain reaction (PCR)/ loop mediated isothermal amplification (LAMP) was observed using the MTAT strategy (odds ratio [OR] = 6.79, 95% CI 4.42-10.43) but was not significantly different when compared to MSAT (OR = 5.2, 95% CI 3.22-8.37; P-difference = 0.883) and RACD (OR = 4.08, 95% CI 2.55-6.53; P-difference = 0.29). Across both datasets, clustering became more prominent when transmission was low. However, limitations to our analysis include not accounting for any malaria control interventions in place, malaria seasonality, or the likely heterogeneity of transmission within study sites. Clustering may thus have been underestimated. CONCLUSIONS In areas where malaria transmission is peri-domestic, there are programmatic options for identifying households where residual infections are likely to be found. Combining these detection strategies with presumptively treating residents of index households over a sustained time period could contribute to malaria elimination efforts.
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Affiliation(s)
- Gillian Stresman
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Charlie Whittaker
- Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research and MRC Centre for Outbreak Analysis and Modelling, Imperial College London, London, United Kingdom
| | - Hannah C. Slater
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- PATH, Seattle, Washington, United States of America
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jackie Cook
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
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11
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Nau JY. [Not Available]. Rev Med Suisse 2019; 15:1526-1527. [PMID: 31496179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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12
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Kendall EA, Kamoga C, Kitonsa PJ, Nalutaaya A, Salvatore PP, Robsky K, Nakasolya O, Mukiibi J, Isooba D, Cattamanchi A, Kato-Maeda M, Katamba A, Dowdy DW. Empiric treatment of pulmonary TB in the Xpert era: Correspondence of sputum culture, Xpert MTB/RIF, and clinical diagnoses. PLoS One 2019; 14:e0220251. [PMID: 31339935 PMCID: PMC6655770 DOI: 10.1371/journal.pone.0220251] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/11/2019] [Indexed: 11/19/2022] Open
Abstract
Background Clinical tuberculosis diagnosis and empiric treatment have traditionally been common among patients with negative bacteriologic test results. Increasing availability of rapid molecular diagnostic tests, including Xpert MTB/RIF and the new Xpert Ultra cartridge, may alter the role of empiric treatment. Methods We prospectively enrolled outpatients age > = 15 who were evaluated for pulmonary tuberculosis at three health facilities in Kampala, Uganda. Using sputum mycobacterial culture, interviews, and clinical record abstraction, we estimated the accuracy of clinical diagnosis relative to Xpert and sputum culture and assessed the contribution of clinical diagnosis to case detection. Results Over a period of 9 months, 99 patients were diagnosed with pulmonary tuberculosis and subsequently completed sputum culture; they were matched to 196 patients receiving negative tuberculosis evaluations in the same facilities. Xpert was included in the evaluation of 291 (99%) patients. Compared to culture, Xpert had a sensitivity of 92% (95% confidence interval 83–97%) and specificity of 95% (92–98%). Twenty patients with negative Xpert were clinically diagnosed with tuberculosis and subsequently had their culture status determined; two (10%) were culture-positive. Considering all treated patients regardless of Xpert and culture data completeness, and considering treatment initiations before a positive Xpert (N = 4) to be empiric, 26/101 (26%) tuberculosis treatment courses were started empirically. Compared to sputum smear- or Xpert-positive patients with positive cultures, empirically-treated, Xpert-negative patients with negative cultures had higher prevalence of HIV (67% versus 37%), shorter duration of cough (median 4 versus 8 weeks), and lower inflammatory markers (median CRP 7 versus 101 mg/L). Conclusion Judged against sputum culture in a routine care setting of high HIV prevalence, the accuracy of Xpert was high. Clinical judgment identified a small number of additional culture-positive cases, but with poor specificity. Although clinicians should continue to prescribe tuberculosis treatment for Xpert-negative patients whose clinical presentations strongly suggest pulmonary tuberculosis, they should also carefully consider alternative diagnoses.
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MESH Headings
- Adult
- Antibiotics, Antitubercular/classification
- Antibiotics, Antitubercular/therapeutic use
- Case-Control Studies
- Diagnostic Tests, Routine/methods
- Diagnostic Tests, Routine/trends
- Drug Resistance, Bacterial/genetics
- Female
- Humans
- Male
- Microbiological Techniques/methods
- Molecular Diagnostic Techniques/methods
- Mycobacterium tuberculosis/genetics
- Mycobacterium tuberculosis/isolation & purification
- Polymerase Chain Reaction/methods
- Polymerase Chain Reaction/trends
- Reproducibility of Results
- Sensitivity and Specificity
- Sputum/microbiology
- Time-to-Treatment/statistics & numerical data
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/genetics
- Tuberculosis, Multidrug-Resistant/prevention & control
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/microbiology
- Uganda/epidemiology
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Affiliation(s)
- Emily A. Kendall
- Division of Infectious Diseases and Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States America
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- * E-mail:
| | - Caleb Kamoga
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Peter J. Kitonsa
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Annet Nalutaaya
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Phillip P. Salvatore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States America
| | - Katherine Robsky
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States America
| | - Olga Nakasolya
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - James Mukiibi
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - David Isooba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Adithya Cattamanchi
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States America
| | - Midori Kato-Maeda
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States America
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David W. Dowdy
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States America
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Storey HL, Agarwal N, Cantera J, Golden A, Gallo K, Herrick T, Belizario V, Kihara J, Mwandawiro C, Cadwallader B, de los Santos T. Formative research to inform development of a new diagnostic for soil-transmitted helminths: Going beyond the laboratory to ensure access to a needed product. PLoS Negl Trop Dis 2019; 13:e0007372. [PMID: 31150389 PMCID: PMC6561600 DOI: 10.1371/journal.pntd.0007372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/12/2019] [Accepted: 04/09/2019] [Indexed: 12/11/2022] Open
Abstract
Soil-transmitted helminths (STHs) affect more than 1.5 billion people. The global strategy to control STH infections requires periodic mass drug administration (MDA) based on prevalence among populations at risk determined by diagnostic testing. Widely used copromicroscopy methods to detect infection, however, have low sensitivity as the prevalence and intensity of STH infections decline with repeated MDA. More sensitive diagnostic tools are needed to inform program decision-making. Using an integrated product development process, PATH conducted qualitative and quantitative formative research to inform the design and development of a more sensitive test for STH infections. The research, grounded in a conceptual framework for ensuring access to health products, involved stakeholder analysis, key opinion leader interviews, observational site visits of ongoing STH surveillance programs, and market research including market sizing, costing and willingness-to-pay analyses. Stakeholder analysis identified key groups and proposed strategic engagement of stakeholders during product development. Interviews highlighted features, motivations and concerns that are important for guiding design and implementation of new STH diagnostics. Process mapping outlined current STH surveillance workflows in Kenya and the Philippines. Market sizing in 2016 was estimated around half a million tests for lower STH burden countries, and 1-2 million tests for higher STH burden countries. The cost of commodities per patient for a molecular STH diagnostic may be around $10, 3-4 times higher than copromicroscopy methods, though savings may be possible in time and staffing requirements. The market is highly price sensitive as even at $5 per test, only 27% of respondents thought the test would be used by surveillance programs. A largely subsidized STH control strategy and a semi-functional Kato-Katz test may have created few incentives for manufacturers to innovate in STH diagnostics. Diverse partnerships, as well as balancing needs and expectations for new STH diagnostics are necessary to ensure access to needed products.
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Affiliation(s)
- Helen L. Storey
- PATH, Seattle, Washington, United States of America
- * E-mail:
| | - Neha Agarwal
- PATH, Seattle, Washington, United States of America
| | | | | | - Kerry Gallo
- PATH, Seattle, Washington, United States of America
| | - Tara Herrick
- PATH, Seattle, Washington, United States of America
| | | | - Jimmy Kihara
- Kenya Medical Research Institute, Nairobi, Kenya
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14
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Li S, Zou Q, Xing R, Govindaraju T, Fakhrullin R, Yan X. Peptide-modulated self-assembly as a versatile strategy for tumor supramolecular nanotheranostics. Theranostics 2019; 9:3249-3261. [PMID: 31244952 PMCID: PMC6567973 DOI: 10.7150/thno.31814] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/09/2019] [Indexed: 12/21/2022] Open
Abstract
Advances in supramolecular self-assembly have promoted the development of theranostics, the combination of both therapeutic and diagnostic functions in a single nanoplatform, which is closely associated with antitumor applications and has shown promising potential in personalized medicine. Peptide-modulated self-assembly serves as a versatile strategy for tumor supramolecular nanotheranostics possessing controllability, programmability, functionality and biosafety, thus promoting the translation of nanotheranostics from bench to bedside. In this review, we will focus on the self-assembly of peptide-photosensitizers and peptide-drugs as well as multicomponent cooperative self-assembly for the fabrication of nanotheranostics that integrate diagnosis and therapeutics for antitumor applications. Emphasis will be placed on building block design, interaction strategies and the potential relationships between their structures and properties, aiming to increase understanding of the critical role of peptide-modulated self-assembly in advancing antitumor supramolecular nanotheranostics.
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Affiliation(s)
- Shukun Li
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences Beijing 100049, P. R. China
| | - Qianli Zou
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, P. R. China
| | - Ruirui Xing
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, P. R. China
| | - Thimmaiah Govindaraju
- Bioorganic Chemistry Laboratory, New Chemistry Unit, Jawaharlal Nehru Centre for Advanced Scientific Research, Jakkur P.O., Bengaluru 560064, Karnataka, India
| | - Rawil Fakhrullin
- Bionanotechnology Lab, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Republic of Tatarstan, Russia
| | - Xuehai Yan
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, P. R. China
- Center for Mesoscience, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences Beijing 100049, P. R. China
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15
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Nagy B, Bhattoa Harjit P, Kappelmayer J. [Routine laboratory diagnostics of prostate cancer: Past, present and the future]. Magy Onkol 2019; 63:16-25. [PMID: 30889617] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/13/2019] [Indexed: 06/09/2023]
Abstract
Prostate cancer is one of the most frequently occurring malignancies in men. It is increasingly recognized in patients above 40 years of age. The discovery of prostate-specific antigen (PSA) nearly 50 years ago and the subsequent capability to measure it on automated immunoassay platforms have led to a widespread use in laboratory diagnostics. However, the plethora of the elevated PSA values resulted in premature invasive treatments in several cases, so the term 'overdiagnosis of prostate cancer' has been created. Beside the classical total PSA test, several new methods have emerged in the past years that considerably enhanced the specificity of PSA-based diagnostics and this paved the way for more adequate clinical decisions. Some of these new and complex laboratory tests are not yet financed in Hungary, but the techniques are already available. In addition to the measurement of various proteins by immunoassays, large attention is devoted to molecular tests that not only help to establish the underlying pathophysiological process, but may also aid in determining the proper prognostic subgroup.
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Affiliation(s)
- Béla Nagy
- Általános Orvostudományi Kar, Debreceni Egyetem, Laboratóriumi Medicina Intézet, Debrecen, Hungary.
| | - Pal Bhattoa Harjit
- Általános Orvostudományi Kar, Debreceni Egyetem, Laboratóriumi Medicina Intézet, Debrecen, Hungary.
| | - János Kappelmayer
- Általános Orvostudományi Kar, Debreceni Egyetem, Laboratóriumi Medicina Intézet, Debrecen, Hungary.
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16
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Zhang Y, Mi X, Tan X, Xiang R. Recent Progress on Liquid Biopsy Analysis using Surface-Enhanced Raman Spectroscopy. Theranostics 2019; 9:491-525. [PMID: 30809289 PMCID: PMC6376192 DOI: 10.7150/thno.29875] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [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] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/30/2018] [Indexed: 12/12/2022] Open
Abstract
Traditional tissue biopsy is limited in understanding heterogeneity and dynamic evolution of tumors. Instead, analyzing circulating cancer markers in various body fluids, commonly referred to as "liquid biopsy", has recently attracted remarkable interest for their great potential to be applied in non-invasive early cancer screening, tumor progression monitoring and therapy response assessment. Among the various approaches developed for liquid biopsy analysis, surface-enhanced Raman spectroscopy (SERS) has emerged as one of the most powerful techniques based on its high sensitivity, specificity, tremendous spectral multiplexing capacity for simultaneous target detection, as well as its unique capability for obtaining intrinsic fingerprint spectra of biomolecules. In this review, we will first briefly explain the mechanism of SERS, and then introduce recently reported SERS-based techniques for detection of circulating cancer markers including circulating tumor cells, exosomes, circulating tumor DNAs, microRNAs and cancer-related proteins. Cancer diagnosis based on SERS analysis of bulk body fluids will also be included. In the end, we will summarize the "state of the art" technologies of SERS-based platforms and discuss the challenges of translating them into clinical settings.
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Affiliation(s)
- Yuying Zhang
- School of Medicine, State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials for Ministry of Education, Nankai University, 300071 Tianjin, China
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17
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Schulson L, Novack V, Smulowitz PB, Dechen T, Landon BE. Emergency Department Care for Patients with Limited English Proficiency: a Retrospective Cohort Study. J Gen Intern Med 2018; 33:2113-2119. [PMID: 30187374 PMCID: PMC6258635 DOI: 10.1007/s11606-018-4493-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 02/05/2018] [Revised: 03/30/2018] [Accepted: 05/11/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited English proficiency (LEP) patients may be particularly vulnerable in the high acuity and fast-paced setting of the emergency department (ED). OBJECTIVE To compare the care processes of LEP patients in the ED. DESIGN Retrospective cohort study. SETTING ED in a large tertiary care academic medical center. PATIENTS Adult LEP and English Proficient (EP) patients during their index presentation to the ED from September 1, 2013, to August 31, 2015. LEP patients were identified as those who selected a preferred language other than English when registering for care. MAIN MEASURES Rates of diagnostic studies, admission, and return visits for those originally discharged from the ED. KEY RESULTS We studied 57,435 visits of which 5241 (9.1%) were for patients with LEP. In adjusted analyses, LEP patients were more likely to receive an X-ray/ultrasound (OR 1.11, CI 1.03-1.19) and be admitted to the hospital (OR 1.09, CI 1.01-1.19). There was no difference in 72-h return visits (OR 0.98, CI 0.73-1.33). LEP patients presenting with complaints related to the cardiovascular system were more likely to receive a stress test (OR 1.51, CI 1.22-1.86), and those with gastrointestinal diagnoses were more likely to have an X-ray/ultrasound (OR 1.31, CI 1.02-1.68). In stratified analyses, Spanish speakers were less likely to be admitted (OR 0.8, CI 0.70-0.91), but those preferring "other" languages, which were all languages with < 500 patients, had a statistically significant higher adjusted rate of admission (OR 1.35, CI 1.17-1.57). CONCLUSIONS ED patients with LEP experienced both increased rates of diagnostic testing and of hospital admission. Research is needed to examine why these differences occurred and if they represent inefficiencies in care.
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Affiliation(s)
- Lucy Schulson
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Victor Novack
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Clinical Research Center, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Peter B Smulowitz
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tenzin Dechen
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Bruce E Landon
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
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18
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Mitsakakis K, Kaman WE, Elshout G, Specht M, Hays JP. Challenges in identifying antibiotic resistance targets for point-of-care diagnostics in general practice. Future Microbiol 2018; 13:1157-1164. [PMID: 30113214 PMCID: PMC6190172 DOI: 10.2217/fmb-2018-0084] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/10/2018] [Indexed: 12/20/2022] Open
Abstract
General practitioners stand at the front line of healthcare provision and have a pivotal role in the fight against increasing antibiotic resistance. In this respect, targeted antibiotic prescribing by general practitioners would help reduce the unnecessary use of antibiotics, leading to reduced treatment failures, fewer side-effects for patients and a reduction in the (global) spread of antibiotic resistances. Current 'gold standard' antibiotic resistance detection strategies tend to be slow, taking up to 48 h to obtain a result, although the implementation of point-of-care testing by general practitioners could help achieve the goal of targeted antibiotic prescribing practices. However, deciding on which antibiotic resistances to include in a point-of-care diagnostic is not a trivial task, as outlined in this publication.
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Affiliation(s)
- Konstantinos Mitsakakis
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK – Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Wendy E Kaman
- Department of Medical Microbiology & Infectious Diseases, Erasmus University Medical Centre Rotterdam (Erasmus MC), Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Gijs Elshout
- Department of General Practice, Erasmus University Medical Centre Rotterdam (Erasmus MC), Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Mara Specht
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - John P Hays
- Department of Medical Microbiology & Infectious Diseases, Erasmus University Medical Centre Rotterdam (Erasmus MC), Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
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Weppelmann TA, Stephenson CJ, Musih E, Dame JB, Remy MY, Nicolas R, von Fricken ME. Elimination or more accurate estimation? Investigation of trends in malaria diagnoses in the Ouest Department of Haiti from 2008 to 2017. PLoS One 2018; 13:e0198070. [PMID: 29879170 PMCID: PMC5991735 DOI: 10.1371/journal.pone.0198070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/13/2018] [Indexed: 11/19/2022] Open
Abstract
Background According to the 2016 World Malaria Report, the malaria incidence in Haiti declined by > 40% between 2010 and 2015. Though elimination efforts have likely contributed, this time period also corresponded to a national change in diagnostic methods. Methods Monthly reports of aggregated patient data were acquired from five clinics in the Ouest Department of Haiti. Generalized linear models were used to compare the number of febrile patients tested, the number of positive tests, and the proportion of tests that were positive (TRP) before and after the national adoption of rapid diagnostic tests (RDTs). Results Prior to the earthquake when microcopy was used for diagnosis, a total of 1,727 patients with 557 (32.3%) positive; post-earthquake testing was reduced and the TPR was variable; during the post recovery period when RDTs were used exclusivly, a total of 5,132 patients were tested using RDTs, only 83 (1.62%) were positive. Compared to the pre-earthquake period, there was a 69% increase in the number of patients tested (IRR: 1.69; 95% CI IRR 1.59, 2.79), and a 97.0% decrease in the proportion of patients with a positive test result (IRR: 0.03; 95% CI IRR 0.02, 0.04) in the post-recovery period. Conclusions While the decline in malaria indicators between 2010 and 2015 has been cited as evidence of progress towards elimination, these reports derived estimates of the malaria burden in Haiti using two different diagnostic tests. Thus, comparison of these periods in the context of malaria elimination should be made with caution.
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Affiliation(s)
- Thomas A. Weppelmann
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States of America
| | - Caroline J. Stephenson
- Department of Global and Community Health, George Mason University, Fairfax, VA, United States of America
| | - Elisha Musih
- Department of Global and Community Health, George Mason University, Fairfax, VA, United States of America
| | - John B. Dame
- College of Veterinary Medicine, University of Florida, Gainesville, FL, United States of America
| | - Marie Y. Remy
- African Methodist Episcopal Church Service and Development Agency, Inc., Washington, DC, United States of America
| | - Robert Nicolas
- African Methodist Episcopal Church Service and Development Agency, Inc., Washington, DC, United States of America
| | - Michael E. von Fricken
- Department of Global and Community Health, George Mason University, Fairfax, VA, United States of America
- * E-mail:
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Momčilović S, Cantacessi C, Arsić-Arsenijević V, Otranto D, Tasić-Otašević S. Rapid diagnosis of parasitic diseases: current scenario and future needs. Clin Microbiol Infect 2018; 25:290-309. [PMID: 29730224 DOI: 10.1016/j.cmi.2018.04.028] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [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: 03/12/2018] [Revised: 04/22/2018] [Accepted: 04/24/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Parasitic diseases are one of the world's most devastating and prevalent infections, causing millions of morbidities and mortalities annually. In the past, many of these infections have been linked predominantly to tropical or subtropical areas. Nowadays, however, climatic and vector ecology changes, a significant increase in international travel, armed conflicts, and migration of humans and animals have influenced the transmission of some parasitic diseases from 'book pages' to reality in developed countries. It has also been noted that many patients who have never travelled to endemic areas suffer from blood-borne infections caused by protozoa. In the light of existing knowledge, this new trend can be explained by the fact that in the process of migration a large number of asymptomatic carriers become a part of the blood bank donor and transplant donor populations. Accurate and rapid diagnosis represents the crucial weapon in the fight against parasitic infections. AIMS To review old and new approaches for rapid diagnosis of parasitic infections. SOURCES Data for this review were obtained through searches of PubMed using combinations of the following terms: parasitological diagnostics, microscopy, lateral flow assays, immunochromatographic assays, multiplex-PCR, and transplantation. CONTENT In this review, we provide a brief account of the advantages and limitations of rapid methods for diagnosis of parasitic diseases and focus our attention on current and future research in this area. The approximate costs associated with the use of different techniques and their applicability in endemic and non-endemic areas are also discussed. IMPLICATIONS Microscopy remains the cornerstone of parasitological diagnostics, especially in the field and low-resource settings, and provides epidemiological assessment of parasite burden. However, increased use and availability of point-of-care tests and molecular assays in modern era allow more rapid and accurate diagnoses and increased sensitivity in the identification of parasitic infections.
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Affiliation(s)
- S Momčilović
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Serbia.
| | - C Cantacessi
- Department of Veterinary Medicine, University of Cambridge, UK
| | - V Arsić-Arsenijević
- Department for Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Serbia
| | - D Otranto
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Italy
| | - S Tasić-Otašević
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Serbia; Center of Microbiology and Parasitology, Public Health Institute Niš, Serbia
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Affiliation(s)
- Mark D Gonzalez
- Department of Pathology, Children's Healthcare of Atlanta, 1405 Clifton Road, Northeast, Atlanta, GA 30322, USA
| | - Erin McElvania
- Department of Pathology, NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL 60201, USA.
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Bogaty C, Lévesque S, Garenc C, Frenette C, Bolduc D, Galarneau LA, Lalancette C, Loo V, Tremblay C, Trudeau M, Vachon J, Dionne M, Villeneuve J, Longtin J, Longtin Y. Trends in the use of laboratory tests for the diagnosis of Clostridium difficile infection and association with incidence rates in Quebec, Canada, 2010-2014. Am J Infect Control 2017; 45:964-968. [PMID: 28549882 DOI: 10.1016/j.ajic.2017.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 02/08/2017] [Revised: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Several Clostridium difficile infection (CDI) surveillance programs do not specify laboratory strategies to use. We investigated the evolution in testing strategies used across Quebec, Canada, and its association with incidence rates. METHODS Cross-sectional study of 95 hospitals by surveys conducted in 2010 and in 2013-2014. The association between testing strategies and institutional CDI incidence rates was analyzed via multivariate Poisson regressions. RESULTS The most common assays in 2014 were toxin A/B enzyme immunoassays (EIAs) (61 institutions, 64%), glutamate dehydrogenase (GDH) EIAs (51 institutions, 53.7%), and nucleic acid amplification tests (NAATs) (34 institutions, 35.8%). The most frequent algorithm was a single-step NAAT (20 institutions, 21%). Between 2010 and 2014, 35 institutions (37%) modified their algorithm. Institutions detecting toxigenic C difficile instead of C difficile toxin increased from 14 to 37 (P < .001). Institutions detecting toxigenic C difficile had higher CDI rates (7.9 vs 6.6 per 10,000 patient days; P = .01). Institutions using single-step NAATs, GDH plus toxigenic cultures, and GDH plus cytotoxicity assays had higher CDI rates than those using an EIA-based algorithm (P < .05). CONCLUSIONS Laboratory detection of CDI has changed since 2010. There is an association between diagnostic algorithms and CDI incidence. Mitigation strategies are warranted.
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Affiliation(s)
- C Bogaty
- McGill University Faculty of Medicine, Montréal, QC, Canada
| | - S Lévesque
- Laboratoire de Santé Publique du Québec, Institute National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec (QC), Canada
| | - C Garenc
- Institut National de Santé Publique du Québec, Quebec City, QC, Canada; Centre Hospitalier Universitaire de Québec, Québec City, QC, Canada
| | - C Frenette
- McGill University Faculty of Medicine, Montréal, QC, Canada; McGill University Health Centre, Montréal, QC, Canada
| | - D Bolduc
- Centre intégré de santé et de services sociaux du Bas-Saint-Laurent, Rimouski, Quebec (QC), Canada
| | - L-A Galarneau
- Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Quebec (QC), Canada
| | - C Lalancette
- Laboratoire de Santé Publique du Québec, Institute National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec (QC), Canada
| | - V Loo
- McGill University Faculty of Medicine, Montréal, QC, Canada; McGill University Health Centre, Montréal, QC, Canada
| | - C Tremblay
- Centre Hospitalier Universitaire de Québec, Québec City, QC, Canada; Laval University Faculty of Medicine, Quebec City, QC, Canada
| | - M Trudeau
- Laboratoire de Santé Publique du Québec, Institute National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec (QC), Canada
| | - J Vachon
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Thetford Mines, Quebec (QC), Canada
| | - M Dionne
- Institut National de Santé Publique du Québec, Quebec City, QC, Canada
| | - J Villeneuve
- Institut National de Santé Publique du Québec, Quebec City, QC, Canada
| | - J Longtin
- Laboratoire de Santé Publique du Québec, Institute National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec (QC), Canada; Laval University Faculty of Medicine, Quebec City, QC, Canada.
| | - Y Longtin
- McGill University Faculty of Medicine, Montréal, QC, Canada
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Affiliation(s)
- Bjørn Hofmann
- Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology, and Centre for Medical Ethics at the University of Oslo, PO Box 1130, Blindern, N-0318 Oslo, Norway
| | - H Gilbert Welch
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Lesuis N, den Broeder N, Boers N, Piek E, Teerenstra S, Hulscher M, van Vollenhoven R, den Broeder AA. The effects of an educational meeting and subsequent computer reminders on the ordering of laboratory tests by rheumatologists: an interrupted time series analysis. Clin Exp Rheumatol 2017; 35:379-383. [PMID: 28339354] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 07/04/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To examine the effects of an educational meeting and subsequent computer reminders on the number of ordered laboratory tests. METHODS Using interrupted time series analysis we assessed whether trends in the number of laboratory tests ordered by rheumatologists between September 2012 and September 2015 at the Sint Maartenskliniek (the Netherlands) changed following an educational meeting (September 2013) and the introduction of computer reminders into the Computerised Physician Order Entry System (July 2014). The analyses were done for the set of tests on which both interventions had focussed (intervention tests; complement, cryoglobulins, immunoglobins, myeloma protein) and a set of control tests unrelated to the interventions (alanine transferase, anti-cyclic citrullinated peptide, C-reactive protein, creatine, haemoglobin, leukocytes, mean corpuscular volume, rheumatoid factor and thrombocytes). RESULTS At the start of the study, 101 intervention tests and 7660 control tests were ordered per month by the rheumatologists. After the educational meeting, both the level and trend of ordered intervention and control tests did not change significantly. After implementation of the reminders, the level of ordered intervention tests decreased by 85.0 tests (95%-CI -133.3 to -36.8, p<0.01), the level of control tests did not change following the introduction of reminders. CONCLUSIONS In summary, an educational meeting alone was not effective in decreasing the number of ordered intervention tests, but the combination with computer reminders did result in a large decrease of those tests. Therefore, we recommend using computer reminders in addition to education if reduction of inappropriate test use is aimed for.
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Affiliation(s)
- Nienke Lesuis
- Department of Rheumatology and Laboratory, Sint Maartenskliniek, Nijmegen, the Netherlands.
| | - Nathan den Broeder
- Department of Rheumatology and Laboratory, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Nadine Boers
- Department of Rheumatology and Laboratory, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Ester Piek
- Department of Rheumatology and Laboratory, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Steven Teerenstra
- Department for Health Evidence, Biostatistics Section, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marlies Hulscher
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Ronald van Vollenhoven
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Stockholm, Sweden
| | - Alfons A den Broeder
- Department of Rheumatology and Laboratory, Sint Maartenskliniek, Nijmegen, the Netherlands
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What's the buzz in automation? MLO Med Lab Obs 2017; 49:40. [PMID: 29924575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
PURPOSE OF REVIEW Tuberculosis (TB) incidence has declined ∼1.5% annually since 2000, but continued to affect 10.4 million individuals in 2015, with 1/3 remaining undiagnosed or underreported. The diagnosis of TB among those co-infected with HIV is challenging as TB remains the leading cause of death in such individuals. Accurate and rapid diagnosis of active TB will avert mortality in both adults and children, reduce transmission, and assist in timeous decisions for antiretroviral therapy initiation. This review describes advances in diagnosing TB, especially among HIV co-infected individuals, highlights national program's uptake, and impact on patient care. RECENT FINDINGS The TB diagnostic landscape has been transformed over the last 5 years. Molecular diagnostics such as Xpert MTB/RIF, which simultaneously detects Mycobacterium tuberculosis (MTB) resistance to rifampicin, has revolutionized TB control programs. WHO endorsed the use of Xpert MTB/RIF in 2010 for use in HIV/TB co-infected patients, and later in 2013 for use as the initial diagnostic test for all adults and children with signs and symptoms of pulmonary TB. Line probe assays (LPAs) are recommended for the detection of rifampicin and isoniazid resistance in sputum smear-positive specimens and mycobacterial cultures. A second-line line probe assay has been recommended for the diagnosis of extensively drug-resistant (XDR)-TB Assays such as the urine lateral flow (LF)-lipoarabinomannan (LAM), can be used at the point of care (POC) and have a niche role to supplement the diagnosis of TB in seriously ill HIV-infected, hospitalized patients with low CD4 cell counts of less than 100 cells/μl. Polyvalent platforms such as the m2000 (Abbott Molecular) and GeneXpert (Cepheid) offer potential for integration of HIV and TB testing services. While the Research and Development (R&D) pipeline appears to be rich at first glance, there are actually few leads for true POC tests that would allow for earlier TB diagnosis or rapid, comprehensive drug susceptibility testing, especially when considering the very high attrition rates observed between biomarker discovery and product market entry. SUMMARY In this review, we describe diagnostic strategies specifically for HIV and TB co-infected individuals. Molecular diagnostics in particular within the past 5 years have revolutionized and 'disrupted' this field. They lend themselves to integration of services with platforms capable of polyvalent testing. Impact on patient care is, however, still debatable. What has been highlighted is the need for health system strengthening and for true POC testing that can be used in active case finding.
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Affiliation(s)
- Lesley Scott
- aDepartment of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa bNational Priority Programs, National Health Laboratory Service, Johannesburg, Gauteng, South Africa cFoundation for Innovative New Diagnostics, Geneva dGlobal TB Program, WHO, Geneva, Switzerland
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Hawkins KR, Cantera JL, Storey HL, Leader BT, de los Santos T. Diagnostic Tests to Support Late-Stage Control Programs for Schistosomiasis and Soil-Transmitted Helminthiases. PLoS Negl Trop Dis 2016; 10:e0004985. [PMID: 28005900 PMCID: PMC5179049 DOI: 10.1371/journal.pntd.0004985] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Global efforts to address schistosomiasis and soil-transmitted helminthiases (STH) include deworming programs for school-aged children that are made possible by large-scale drug donations. Decisions on these mass drug administration (MDA) programs currently rely on microscopic examination of clinical specimens to determine the presence of parasite eggs. However, microscopy-based methods are not sensitive to the low-intensity infections that characterize populations that have undergone MDA. Thus, there has been increasing recognition within the schistosomiasis and STH communities of the need for improved diagnostic tools to support late-stage control program decisions, such as when to stop or reduce MDA. Failure to adequately address the need for new diagnostics could jeopardize achievement of the 2020 London Declaration goals. In this report, we assess diagnostic needs and landscape potential solutions and determine appropriate strategies to improve diagnostic testing to support control and elimination programs. Based upon literature reviews and previous input from experts in the schistosomiasis and STH communities, we prioritized two diagnostic use cases for further exploration: to inform MDA-stopping decisions and post-MDA surveillance. To this end, PATH has refined target product profiles (TPPs) for schistosomiasis and STH diagnostics that are applicable to these use cases. We evaluated the limitations of current diagnostic methods with regards to these use cases and identified candidate biomarkers and diagnostics with potential application as new tools. Based on this analysis, there is a need to develop antigen-detecting rapid diagnostic tests (RDTs) with simplified, field-deployable sample preparation for schistosomiasis. Additionally, there is a need for diagnostic tests that are more sensitive than the current methods for STH, which may include either a field-deployable molecular test or a simple, low-cost, rapid antigen-detecting test.
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Affiliation(s)
- Kenneth R. Hawkins
- Diagnostics Program, PATH, Seattle, Washington, United States of America
- * E-mail:
| | - Jason L. Cantera
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Helen L. Storey
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Brandon T. Leader
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Tala de los Santos
- Diagnostics Program, PATH, Seattle, Washington, United States of America
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Kainerstorfer J, Chowdhry F, Gandjbakhche A, Tromberg B, Gannot I. Special Section Guest Editorial: Optical Diagnostic and Biophotonic Methods from Bench to Bedside. J Biomed Opt 2016; 21:101401. [PMID: 27367052 DOI: 10.1117/1.jbo.21.10.101401] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Abstract
Laboratory diagnosis of Ebola virus disease plays a critical role in outbreak response efforts; however, establishing safe and expeditious testing strategies for this high-biosafety-level pathogen in resource-poor environments remains extremely challenging. Since the discovery of Ebola virus in 1976 via traditional viral culture techniques and electron microscopy, diagnostic methodologies have trended toward faster, more accurate molecular assays. Importantly, technological advances have been paired with increasing efforts to support decentralized diagnostic testing capacity that can be deployed at or near the point of patient care. The unprecedented scope of the 2014-2015 West Africa Ebola epidemic spurred tremendous innovation in this arena, and a variety of new diagnostic platforms that have the potential both to immediately improve ongoing surveillance efforts in West Africa and to transform future outbreak responses have reached the field. In this review, we describe the evolution of Ebola virus disease diagnostic testing and efforts to deploy field diagnostic laboratories in prior outbreaks. We then explore the diagnostic challenges pervading the 2014-2015 epidemic and provide a comprehensive examination of novel diagnostic tests that are likely to address some of these challenges moving forward.
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Affiliation(s)
- M Jana Broadhurst
- Department of Pathology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Tim J G Brooks
- Public Health England, Porton Down, Salisbury, United Kingdom
| | - Nira R Pollock
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Abstract
BACKGROUNG & AIMS The objective of this review is to identify common areas in gastroenterology practice where studies performed provide an opportunity for enhancing value or lowering costs. METHODS We provide examples of topics in gastroenterology where clinicians could enhance value by either using less invasive testing, choosing a single best test, or by using patient symptoms to guide additional testing. RESULTS The topics selected for review are selected in esophageal, pancreatic, and colorectal cancer; functional gastrointestinal diseases (irritable bowel syndrome, bacterial overgrowth, constipation); immune-mediated gastrointestinal diseases; and pancreaticobiliary pathology. We propose guidance to alter practice based on current evidence. CONCLUSIONS These studies support the need to review current practice and to continue performing research to further validate the proposed guidance to enhance value of care in gastroenterology and hepatology.
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Affiliation(s)
- Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
| | - David A Katzka
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Lussiana C. Towards subsidized malaria rapid diagnostic tests. Lessons learned from programmes to subsidise artemisinin-based combination therapies in the private sector: a review. Health Policy Plan 2016; 31:928-39. [PMID: 25862732 PMCID: PMC4977424 DOI: 10.1093/heapol/czv028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Subscribe] [Scholar Register] [Accepted: 03/07/2015] [Indexed: 11/14/2022] Open
Abstract
The idea of a private sector subsidy programme of artemisinin-based combination therapies (ACTs) was first proposed in 2004. Since then, several countries around the world have hosted pilot projects or programmes on subsidized ACTs and/or the Affordable Medicines Facility-malaria programme (AMFm). Overall the private sector subsidy programmes of ACTs have been effective in increasing availability of ACTs in the private sector and driving down average prices but struggled to crowd out antimalarial monotherapies. The results obtained from this ambitious strategy should inform policy makers in the designing of future interventions aimed to control malaria morbidity and mortality. Among the interventions recently proposed, a subsidy of rapid diagnostic tests (RDTs) in the private sector has been recommended by governments and international donors to cope with over-treatment with ACTs and to delay the emergence of resistance to artemisinin. In order to improve the cost-effectiveness of co-paid RDTs, we should build on the lessons we learned from almost 10 years of private sector subsidy programmes of ACTs in malaria-endemic countries.
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Langley G, Besser J, Iwamoto M, Lessa FC, Cronquist A, Skoff TH, Chaves S, Boxrud D, Pinner RW, Harrison LH. Effect of Culture-Independent Diagnostic Tests on Future Emerging Infections Program Surveillance. Emerg Infect Dis 2016; 21:1582-8. [PMID: 26291736 PMCID: PMC4550165 DOI: 10.3201/eid2109.150570] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The Centers for Disease Control and Prevention Emerging Infections Program (EIP) network conducts population-based surveillance for pathogens of public health importance. Central to obtaining estimates of disease burden and tracking microbiological characteristics of these infections is accurate laboratory detection of pathogens. The use of culture-independent diagnostic tests (CIDTs) in clinical settings presents both opportunities and challenges to EIP surveillance. Because CIDTs offer better sensitivity than culture and are relatively easy to perform, their use could potentially improve estimates of disease burden. However, changes in clinical testing practices, use of tests with different sensitivities and specificities, and changes to case definitions make it challenging to monitor trends. Isolates are still needed for performing strain typing, antimicrobial resistance testing, and identifying other molecular characteristics of organisms. In this article, we outline current and future EIP activities to address issues associated with adoption of CIDTs, which may apply to other public health surveillance.
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Abstract
A concern during the early AIDS epidemic was the lack of a test to identify individuals who carried the virus. The first HIV antibody test, developed in 1985, was designed to screen blood products, not to diagnose AIDS. The first-generation assays detected IgG antibody and became positive 6 to 12 weeks postinfection. False-positive results occurred; thus, a two-test algorithm was developed using a Western blot or immunofluorescence test as a confirmatory procedure. The second-generation HIV test added recombinant antigens, and the third-generation HIV tests included IgM detection, reducing the test-negative window to approximately 3 weeks postinfection. Fourth- and fifth-generation HIV assays added p24 antigen detection to the screening assay, reducing the test-negative window to 11 to 14 days. A new algorithm addressed the fourth-generation assay's ability to detect both antibody and antigen and yet not differentiate between them. The fifth-generation HIV assay provides separate antigen and antibody results and will require yet another algorithm. HIV infection may now be detected approximately 2 weeks postexposure, with a reduced number of false-positive results.
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Affiliation(s)
- Thomas S Alexander
- Summa Health, Department of Pathology and Laboratory Medicine, Akron, Ohio, USA, and Northeast Ohio Medical University, Rootstown, Ohio, USA
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Lima GFMDC, Lucchi NW, Silva-Flannery L, Macedo- de- Oliveira A, Hristov AD, Inoue J, Costa-Nascimento MDJ, Udhayakumar V, Di Santi SM. Still Searching for a Suitable Molecular Test to Detect Hidden Plasmodium Infection: A Proposal for Blood Donor Screening in Brazil. PLoS One 2016; 11:e0150391. [PMID: 26959994 PMCID: PMC4784969 DOI: 10.1371/journal.pone.0150391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/12/2016] [Indexed: 11/18/2022] Open
Abstract
Background Efforts have been made to establish sensitive diagnostic tools for malaria screening in blood banks in order to detect malaria asymptomatic carriers. Microscopy, the malaria reference test in Brazil, is time consuming and its sensitivity depends on microscopist experience. Although molecular tools are available, some aspects need to be considered for large-scale screening: accuracy and robustness for detecting low parasitemia, affordability for application to large number of samples and flexibility to perform on individual or pooled samples. Methodology In this retrospective study, we evaluated four molecular assays for detection of malaria parasites in a set of 56 samples previously evaluated by expert microscopy. In addition, we evaluated the effect of pooling samples on the sensitivity and specificity of the molecular assays. A well-characterized cultured sample with 1 parasite/μL was included in all the tests evaluated. DNA was extracted with QIAamp DNA Blood Mini Kit and eluted in 50 μL to concentrate the DNA. Pools were assembled with 10 samples each. Molecular protocols targeting 18S rRNA, included one qPCR genus specific (Lima-genus), one duplex qPCR genus/Pf (PET-genus, PET-Pf) and one duplex qPCR specie-specific (Rougemont: Roug-Pf/Pv and Roug-Pm/Po). Additionally a nested PCR protocol specie-specific was used (Snou-Pf, Snou-Pv, Snou-Pm and Snou-Po). Results The limit of detection was 3.5 p/μL and 0.35p/μl for the PET-genus and Lima-genus assays, respectively. Considering the positive (n = 13) and negative (n = 39) unpooled individual samples according to microscopy, the sensitivity of the two genus qPCR assays was 76.9% (Lima-genus) and 72.7% (PET-genus). The Lima-genus and PET-genus showed both sensitivity of 86.7% in the pooled samples. The genus protocols yielded similar results (Kappa value of 1.000) in both individual and pooled samples. Conclusions Efforts should be made to improve performance of molecular tests to enable the detection of low-density parasitemia if these tests are to be utilized for blood transfusion screening.
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Affiliation(s)
| | - Naomi W. Lucchi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Luciana Silva-Flannery
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Atlanta Research and Education Foundation, Decatur-GA, Atlanta, Georgia, United States of America
| | - Alexandre Macedo- de- Oliveira
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Angelica D Hristov
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Juliana Inoue
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Maria de Jesus Costa-Nascimento
- Núcleo de Estudos em Malária, Superintendência de Controle de Endemias, Secretaria de Estado da Saúde de São Paulo /Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Venkatachalam Udhayakumar
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Silvia M Di Santi
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Núcleo de Estudos em Malária, Superintendência de Controle de Endemias, Secretaria de Estado da Saúde de São Paulo /Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
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Seifert B, Vojtíšková J, Vitásek Z. [Trends in indication of selected laboratory methods by general practitioners]. Cas Lek Cesk 2016; 155:6-10. [PMID: 27256141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED The indication of laboratory methods in general practice is significantly influenced by practical guidelines and protocols for preventive care. The financial regulation pushes on rationalisation of the use of laboratory methods. Point of care testing is more and more important in prevention, diagnostics and follow up in primary care settings.Based on the data available from Škoda Insurance Company authors aimed to describe trends in induction and cost of laboratory methods, the most frequent methods used in primary care and trends in the use of POCT methods within general practice.The expenditures for laboratory methods in general practice are stable for a long term and suggest a rational behaviour of general practitioners. The most frequently indicated methods in general practice are glycaemia, ALT and AST. From expensive methods the most frequent are PSA, troponin and tumormarkers. The number of general practices performing POCT methods and also the number of POCT examinations increase. More than one half of INR examinations and nearly half of all CRP examinations are performed in POCT regime. KEY WORDS laboratory methods, clinical biochemistry, general practitioner, primary care, POCT.
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Sitaru C, Bauer J. [Modern laboratory diagnostic workup in dermatology]. Hautarzt 2015; 67:4-5. [PMID: 26612471 DOI: 10.1007/s00105-015-3729-3] [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: 11/26/2022]
Affiliation(s)
- C Sitaru
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Hauptstraße 7, 79104, Freiburg, Deutschland.
- MVZ Labor Clotten, Merzhauserstr. 112A, 79100, Freiburg, Deutschland.
| | - J Bauer
- Universitäts-Hautklinik Tübingen, Liebermeisterstraße 25, 72076, Tübingen, Deutschland.
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Abstract
In 2015, tuberculosis remains a major global health problem, and drug-resistant tuberculosis is a growing threat. Although tuberculosis diagnosis in many countries is still reliant on older tools, new diagnostics are changing the landscape. Stimulated, in part, by the success and roll out of Xpert MTB/RIF, there is now considerable interest in new technologies. The landscape looks promising, with a robust pipeline of new tools, particularly molecular diagnostics, and well over 50 companies actively engaged in product development. However, new diagnostics are yet to reach scale, and there needs to be greater convergence between diagnostics development and development of shorter-duration tuberculosis drug regimens. Another concern is the relative absence of non-sputum-based diagnostics in the pipeline for children and of biomarker tests for triage, cure, and progression of latent Mycobacterium tuberculosis infection. Several initiatives, described in this supplement, have been launched to further stimulate product development and policy, including assessment of needs and priorities, development of target product profiles, compilation of data on resistance-associated mutations, and assessment of market size and potential for new diagnostics. Advocacy is needed to increase funding for tuberculosis research and development, and governments in high-burden countries must invest more in tuberculosis control to meet post-2015 targets for care, control, and prevention.
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Affiliation(s)
- Madhukar Pai
- McGill International TB Centre
- McGill Global Health Programs, McGill University, Montreal, Canada
| | - Marco Schito
- Division of AIDS, Henry M. Jackson Foundation for the Advancement of Military Medicine, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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Klausner JD, Baghdadi J. An update on diagnostics for hepatitis C. MLO Med Lab Obs 2015; 47:34-36. [PMID: 26281095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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40
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Eccleston ME. Prostate cancer diagnostic options: Past, present, and future. MLO Med Lab Obs 2015; 47:30-31. [PMID: 26281110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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41
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Straube A, Dengler R. [Peripheral neurology: not a fringe area in routine clinical treatment!]. Nervenarzt 2015; 86:131-132. [PMID: 25631119 DOI: 10.1007/s00115-014-4077-8] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- A Straube
- Neurologische Klinik und Poliklinik & Deutsches Schwindel- und Gleichgewichtszentrum IFB, Ludwig-Maximilians-Universität München, Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland,
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Abstract
BACKGROUND the oldest old (85+) pose complex medical challenges. Both underdiagnosis and overdiagnosis are claimed in this group. OBJECTIVE to estimate diagnosis, prescribing and hospital admission prevalence from 2003/4 to 2011/12, to monitor trends in medicalisation. DESIGN AND SETTING observational study of Clinical Practice Research Datalink (CPRD) electronic medical records from general practice populations (eligible; n = 27,109) with oversampling of the oldest old. METHODS we identified 18 common diseases and five geriatric syndromes (dizziness, incontinence, skin ulcers, falls and fractures) from Read codes. We counted medications prescribed ≥1 time in all quarters of studied years. RESULTS there were major increases in recorded prevalence of most conditions in the 85+ group, especially chronic kidney disease (stages 3-5: prevalence <1% rising to 36.4%). The proportions of the 85+ group with ≥3 conditions rose from 32.2 to 55.1% (27.1 to 35.1% in the 65-84 year group). Geriatric syndrome trends were less marked. In the 85+ age group the proportion receiving no chronically prescribed medications fell from 29.6 to 13.6%, while the proportion on ≥3 rose from 44.6 to 66.2%. The proportion of 85+ year olds with ≥1 hospital admissions per year rose from 27.6 to 35.4%. CONCLUSIONS there has been a dramatic increase in the medicalisation of the oldest old, evident in increased diagnosis (likely partly due to better record keeping) but also increased prescribing and hospitalisation. Diagnostic trends especially for chronic kidney disease may raise concerns about overdiagnosis. These findings provide new urgency to questions about the appropriateness of multiple diagnostic labelling.
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Affiliation(s)
- David Melzer
- Epidemiology and Public Health, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
| | - Behrooz Tavakoly
- Epidemiology and Public Health, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
| | - Rachel E Winder
- Epidemiology and Public Health, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter EX1 2LU, UK
| | - Jane A H Masoli
- Epidemiology and Public Health, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
| | - William E Henley
- Health Statistics Group, University of Exeter Medical School, St Luke's Campus, Exeter EX1 2LU, UK
| | - Alessandro Ble
- Epidemiology and Public Health, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
| | - Suzanne H Richards
- Primary Care Research Group, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter EX1 2LU, UK
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Abstract
The diagnosis of Wilson disease has evolved from the original description of a neurological syndrome by Wilson and other contemporaries at the turn of the 20th century to where we recognize that there is a spectrum of clinical liver and neuropsychiatric disease diagnosed by a combination of clinical and biochemical tests and more recently by molecular genetic analysis. The history of the evolution of the findings that help us establish a diagnosis of Wilson disease are presented in the following brief summary of a century of progress toward this end.
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Affiliation(s)
- Michael L Schilsky
- Yale University School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT 06520, United States.
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Tazawa Y. [Current issues regarding companion diagnostics and future prospects]. Rinsho Byori 2014; 62:381-389. [PMID: 25022068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
On July 1st, 2013, about two years after the FDA's drafting of the guidance for companion diagnostics (CoDx), the Ministry of Health, Labour, and Welfare in Japan issued an official notification regarding the co-development of CoDx with a drug which requires dedicated diagnostic tests or medical devices to predict the efficacy of or adverse reactions to the drug. Both recommend to co-develop CoDx and drugs as well as indicate the approved tests and devices on the package insert of the drug. However, since many useful predictive biomarkers may be discovered after the commercial launch of a drug, the more effective use of laboratory developed tests (LDT) should be considered in order to avoid a biomarker test lag. Due to an increase of clinical needs for multiple biomarker assays using sequence and/or microarray technologies, on November 19th, 2013, the FDA approved 510K clearance for the next-generation sequencer and its universal kit. This strategically new regulatory framework may allow clinical laboratories certified under the CLIA Act to more easily perform LDT for genetic markers. Unfortunately, no act like the CLIA exits in Japan to promote LDT well validated for clinical practice, and it may be necessary to reform the regulatory classification and requirements and also quality management system for in-vitro diagnostics tests and devices for reimbursement in the future.
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Gupta S, Sukhal S, Agarwal R, Das K. Quick diagnosis units--an effective alternative to hospitalization for diagnostic workup: a systematic review. J Hosp Med 2014; 9:54-9. [PMID: 24323789 DOI: 10.1002/jhm.2129] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 10/03/2013] [Accepted: 10/21/2013] [Indexed: 11/06/2022]
Abstract
INTRODUCTION This era of healthcare reform emphasizes improving value of care. Inpatient admissions for diagnostic evaluation put economic pressure on an already strained healthcare system. We conducted a systematic review of effectiveness of quick diagnosis units (QDUs), an established outpatient model for early diagnostic workups in Europe. METHODS We searched MEDLINE and Embase for studies that focused on implementation of quick/rapid diagnosis units, with relevant Medical Subject Headings terms and keywords. Of 2047 studies, we selected 13 for full-text screening and bibliography review. Of these, 5 studies included at least 2 primary outcomes of interest and were included in our review. These units functioned as outpatient clinics, staffed by internists, nurses, and clerical staff, with expedited scheduling of outpatient diagnostic tests. Our primary outcome measures were final diagnosis, the mean time to final diagnosis, inpatient bed-days saved per patient, and costs saved per patient. We also studied discharge disposition, care preferences, and safety data. RESULTS About 18% to 30% of patients were diagnosed with malignancy, with an average time to diagnosis of 6 to 11 days. Inpatient bed-days saved per patient ranged from 4.5 to 7. Savings from fixed costs of hospitalization ranged from $2336(€1764) to $3304(€2514) for each patient enrolled in the protocol. The QDU model was preferred by 88% of patients, and patient satisfaction rates were 95% to 97%. CONCLUSIONS QDUs seem an effective and cost-saving alternative to inpatient hospitalization, and appear to be a safe approach for diagnostic workup of potentially severe diseases in select patient populations, although there are limited safety data available.
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Affiliation(s)
- Shweta Gupta
- Department of Hematology-Oncology, John H. Stroger Hospital of Cook County, Chicago, Illinois
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46
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Casados RM. The road to IQCP. MLO Med Lab Obs 2014; 46:30. [PMID: 24527527] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Rabies, an acute progressive, fatal encephalomyelitis, transmitted most commonly through the bite of a rabid animal, is responsible for an estimated 61,000 human deaths worldwide. The true disease burden and public health impact due to rabies remain underestimated due to lack of sensitive laboratory diagnostic methods. Rapid diagnosis of rabies can help initiate prompt infection control and public health measures, obviate the need for unnecessary treatment/medical tests, and assist in timely administration of pre- or postexposure prophylactic vaccination to family members and medical staff. Antemortem diagnosis of human rabies provides an impetus for clinicians to attempt experimental therapeutic approaches in some patients, especially after the reported survival of a few cases of human rabies. Traditional methods for antemortem and postmortem rabies diagnosis have several limitations. Recent advances in technology have led to the improvement or development of several diagnostic assays which include methods for rabies viral antigen and antibody detection and assays for viral nucleic acid detection and identification of specific biomarkers. These assays which complement traditional methods have the potential to revolutionize rabies diagnosis in future.
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Affiliation(s)
- Reeta Subramaniam Mani
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research on Rabies, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Shampur Narayan Madhusudana
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research on Rabies, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
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48
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Cosgrove DM. A conversation with Delos M.'Toby' Cosgrove, MD. Provider-side economics. Interview by John Marcille. Manag Care 2013; 22:36-40. [PMID: 24344526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
MESH Headings
- Chief Executive Officers, Hospital/economics
- Chief Executive Officers, Hospital/standards
- Cost Control/methods
- Cost Control/standards
- Diagnostic Tests, Routine/economics
- Diagnostic Tests, Routine/standards
- Diagnostic Tests, Routine/trends
- Equipment and Supplies, Hospital/economics
- Equipment and Supplies, Hospital/standards
- Hospital-Physician Joint Ventures/economics
- Hospital-Physician Joint Ventures/organization & administration
- Hospitals, Voluntary/economics
- Hospitals, Voluntary/organization & administration
- Hospitals, Voluntary/standards
- Humans
- Insurance, Health/economics
- Insurance, Health/organization & administration
- Insurance, Health/trends
- Interinstitutional Relations
- Medical Informatics/economics
- Medical Informatics/trends
- Models, Organizational
- Multi-Institutional Systems/economics
- Multi-Institutional Systems/organization & administration
- Personnel Downsizing/economics
- Personnel Downsizing/ethics
- Personnel Downsizing/trends
- Personnel Turnover/economics
- Personnel Turnover/statistics & numerical data
- Reimbursement Mechanisms/standards
- Reimbursement Mechanisms/trends
- Risk Management
- Salaries and Fringe Benefits
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49
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Bates DW. Ambulatory test result follow-up represents a serious problem and solutions are needed. Evid Based Med 2013; 18:197-198. [PMID: 23355645 DOI: 10.1136/eb-2012-101119] [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: 06/01/2023]
Affiliation(s)
- David W Bates
- Division of General Internal Medicine, Brigham and Women's Hospital, , Boston, Massachusetts, USA
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50
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Qi N, Zhang ZY, Xiang YH. [Application of terahertz technology in medical testing and diagnosis]. Guang Pu Xue Yu Guang Pu Fen Xi 2013; 33:2064-2070. [PMID: 24159847] [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: 06/02/2023]
Abstract
Terahertz science and technology is increasingly emphasized in science and industry, and has progressed significantly in recent years. There is an important aspect of attention in the application of terahertz technology to medicine. The overview of the terahertz characters, terahertz spectroscopy and terahertz imaging technology is introduced. This paper focuses on reviewing the use of and research progress in terahertz spectroscopy and terahertz imaging technology in medical testing and diagnosis. Furthermore, the problems to be solved and development directions of terahertz spectroscopy and terahertz imaging technology are discussed.
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Affiliation(s)
- Na Qi
- Department of Chemistry, Capital Normal University, Beijing 100048, China.
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