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Talli I, Padoan A, Cosma C, Furlan G, Zaninotto M, Marchioro L, Galozzi P, Basso D, Plebani M. Evaluation of the Comparability of Wantai Wan200+ Instrument with Routine Laboratory Assays for 21 Different Analytes. J Clin Med 2024; 13:2246. [PMID: 38673517 PMCID: PMC11051161 DOI: 10.3390/jcm13082246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: We compared the performance of 21 different assays performed by the Wantai Wan200+ (Wantai BioPharm, Beijing, China) with respect to other methods in use at the University Hospital of Padova (AOPD), Italy. Methods: The plasma (P) or serum (S) of 5027 leftover samples, collected from May to Sept 2023, was either analyzed or frozen at -20 °C. Beckman DXI800 (DXI), Roche Cobas 8000 e801 (RC), Snibe Maglumi 4000 plus (SM), DiaSorin Liaison XL (DL) and Binding Site Optilite (BS) equipment were used at the AOPD. P-procalcitonin (PCT), DXI; P-Troponin I (TnI), DXI; S-CA125, DXI; S-free PSA (f-PSA), DXI; S-total PSA (t-PSA), DXI; S-IL6, SM; P-Troponin T (TnT), RC; P-NT-proBNP, RC; P-Neuron-Specific Enolase (NSE), RC; S-CA15-3, DL; S-CA19-9, DL; S-AFP, DL; and S-CEA, DL were tested in fresh samples. P-Myoglobin (Myo), DXI; P-Cyfra21-1, RC; S-β2 microglobulin (B2MIC), BS; S-HE4, SM; S-PGI, SM; S-PGII, SM; S-CA72-4, SM; and S-CA50, SM were analyzed in frozen and thawed samples. Bland-Altman (BA), Passing-Bablok (PB) and Cohen's Kappa (CKa) metrics were used as statistics. Results: An excellent comparability profile was found for 11 analytes. For example, the t-PSA CKa was 0.94 (95%CI: 0.90 to 0.98), and the PB slope and intercept were 1.02 (95%CI: 0.99 to 1.03) and 0.02 (95%CI: 0.01 to 0.03), respectively; the BA bias was 2.25 (95%CI: -0.43 to 4.93). Ten tested measurands demonstrated a suboptimal comparability profile. Biological variation in EFLM (EuBIVAS) performance specifications was evaluated to assess the clinical relevance of measured biases. Conclusions: Evaluation of the Wantai Wan200+'s performance suggests that between-method differences did not exceed the calculated bias. Metrological traceability may influence the comparisons obtained for some measurands.
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Affiliation(s)
- Ilaria Talli
- Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (I.T.); (A.P.); (C.C.); (P.G.); (D.B.)
- Laboratory Medicine Unit, University Hospital of Padova, 35128 Padova, Italy
| | - Andrea Padoan
- Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (I.T.); (A.P.); (C.C.); (P.G.); (D.B.)
- Laboratory Medicine Unit, University Hospital of Padova, 35128 Padova, Italy
- QI.LAB.MED, Spin-Off of the University of Padova, 35011 Campodarsego, Italy; (G.F.); (M.Z.); (L.M.)
| | - Chiara Cosma
- Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (I.T.); (A.P.); (C.C.); (P.G.); (D.B.)
- QI.LAB.MED, Spin-Off of the University of Padova, 35011 Campodarsego, Italy; (G.F.); (M.Z.); (L.M.)
| | - Giulia Furlan
- QI.LAB.MED, Spin-Off of the University of Padova, 35011 Campodarsego, Italy; (G.F.); (M.Z.); (L.M.)
| | - Martina Zaninotto
- QI.LAB.MED, Spin-Off of the University of Padova, 35011 Campodarsego, Italy; (G.F.); (M.Z.); (L.M.)
| | - Lucio Marchioro
- QI.LAB.MED, Spin-Off of the University of Padova, 35011 Campodarsego, Italy; (G.F.); (M.Z.); (L.M.)
| | - Paola Galozzi
- Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (I.T.); (A.P.); (C.C.); (P.G.); (D.B.)
- Laboratory Medicine Unit, University Hospital of Padova, 35128 Padova, Italy
| | - Daniela Basso
- Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (I.T.); (A.P.); (C.C.); (P.G.); (D.B.)
- Laboratory Medicine Unit, University Hospital of Padova, 35128 Padova, Italy
- QI.LAB.MED, Spin-Off of the University of Padova, 35011 Campodarsego, Italy; (G.F.); (M.Z.); (L.M.)
| | - Mario Plebani
- Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (I.T.); (A.P.); (C.C.); (P.G.); (D.B.)
- QI.LAB.MED, Spin-Off of the University of Padova, 35011 Campodarsego, Italy; (G.F.); (M.Z.); (L.M.)
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152
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Gano D, Pardo AC, Glenn OA, Sherr E. Diverse childhood neurologic disorders and outcomes following fetal neurologic consultation. Semin Fetal Neonatal Med 2024:101524. [PMID: 38609800 DOI: 10.1016/j.siny.2024.101524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Fetal neurology encompasses the full spectrum of neonatal and child neurology presentations, with complex additional layers of diagnostic and prognostic challenges unique to the specific prenatal consultation. Diverse genetic and acquired etiologies with a range of potential outcomes may be encountered. Three clinical case presentations are discussed that highlight how postnatal phenotyping and longitudinal follow-up are essential to address the uncertainties that arise in utero, after birth, and in childhood, as well as to provide continuity of care.
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Affiliation(s)
- Dawn Gano
- Departments of Neurology & Pediatrics, UCSF School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Andrea C Pardo
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Orit A Glenn
- Department of Radiology & Biomedical Imaging, UCSF School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Elliott Sherr
- Departments of Neurology & Pediatrics, UCSF School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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153
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Santhosh L. Reckoning with uncertainty to repair trust. J Hosp Med 2024. [PMID: 38590047 DOI: 10.1002/jhm.13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/10/2024]
Affiliation(s)
- Lekshmi Santhosh
- Department of Medicine, Divisions of Pulmonary/Critical Care Medicine and Hospital Medicine, University of California San Francisco, San Francisco, California, USA
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154
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Mohr NM, Young T, Vakkalanka JP, Carter KD, Shane DM, Ullrich F, Schuette AR, Mack LJ, DeJong K, Bell A, Pals M, Camargo CA, Zachrison KS, Boggs KM, Skibbe A, Ward MM. Provider-to-provider telehealth for sepsis patients in a cohort of rural emergency departments. Acad Emerg Med 2024; 31:326-338. [PMID: 38112033 DOI: 10.1111/acem.14857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Telehealth has been proposed as one strategy to improve the quality of time-sensitive sepsis care in rural emergency departments (EDs). The purpose of this study was to measure the association between telehealth-supplemented ED (tele-ED) care, health care costs, and clinical outcomes among patients with sepsis in rural EDs. METHODS Cohort study using Medicare fee-for-service claims data for beneficiaries treated for sepsis in rural EDs between February 1, 2017, and September 30, 2019. Our primary hospital-level analysis used multivariable generalized estimating equations to measure the association between treatment in a tele-ED-capable hospital and 30-day total costs of care. In our supporting secondary analysis, we conducted a propensity-matched analysis of patients who used tele-ED with matched controls from non-tele-ED-capable hospitals. Our primary outcome was total health care payments among index hospitalized patients between the index ED visit and 30 days after hospital discharge, and our secondary outcomes included hospital mortality, hospital length of stay, 90-day mortality, 28-day hospital-free days, and 30-day inpatient readmissions. RESULTS In our primary analysis, sepsis patients in tele-ED-capable hospitals had 6.7% higher (95% confidence interval [CI] 2.1%-11.5%) total health care costs compared to those in non-tele-ED-capable hospitals. In our propensity-matched patient-level analysis, total health care costs were 23% higher (95% CI 16.5%-30.4%) in tele-ED cases than matched non-tele-ED controls. Clinical outcomes were similar. CONCLUSIONS Tele-ED capability in a mature rural tele-ED network was not associated with decreased health care costs or improved clinical outcomes. Future work is needed to reduce rural-urban sepsis care disparities and formalize systems of regionalized care.
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Affiliation(s)
- Nicholas M Mohr
- Departments of Emergency Medicine, Anesthesia, and Epidemiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Tracy Young
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - J Priyanka Vakkalanka
- Departments of Emergency Medicine and Epidemiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Knute D Carter
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Dan M Shane
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Fred Ullrich
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | | | - Luke J Mack
- Department of Family Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
- Avel eCARE, Sioux Falls, South Dakota, USA
| | | | | | - Mark Pals
- Avel eCARE, Sioux Falls, South Dakota, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Krislyn M Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Adam Skibbe
- Department of Geography, University of Iowa College of Liberal Arts and Sciences, Iowa City, Iowa, USA
| | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA
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155
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de Almeida SM, Tresoldi Neto J, Rocha A, Medeiros A, Gonçalves D, Guimarães F. Cerebrospinal Fluid Biomarkers of Symptomatic Neurosyphilis in People With HIV Compared with Uninfected Individuals. J Neurovirol 2024; 30:146-164. [PMID: 38472642 DOI: 10.1007/s13365-024-01199-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
We evaluated the diagnostic clinical performance characteristics (DCPC) of cerebrospinal fluid (CSF) total protein (TP), white blood cell count (WBC), and lactate (LA) with different cutoff points as adjunct biomarkers of confirmed or presumptive symptomatic neurosyphilis (NS) and the impact of HIV infection. From 5,640 participants who underwent lumbar punctures, 236 participants were included, and classified as either people with HIV (PWH) or people without HIV (PWoH) according to the CDC criteria for confirmed NS (n = 42), presumptive NS (n = 74), systemic syphilis (SS) (n = 38), serological diagnosis of syphilis (n = 18), PWH without SS and NS (n = 10), and negative control (n = 72). In PWoH, for presumptive NS, the combination of CSF TP > 45 mg/dL and/or WBC > 5.0 cells/mm3 is valuable for screening, whereas in PWH, it is not recommended for either screening or case-finding NS, however the DCPC were better in the suppressed group. In PWoH, the value of CSF TP > 45 mg/dL is adequate for both screening and confirmation of presumptive NS, subject to prevalence. For WBC count > 20 cell/mm3, the positive predictive value (PPV) of the test is almost perfect, suggesting a confirmatory test. In PWH, CSF TP is an inadequate marker of NS. The WBC count, with cutoffs of > 10 or > 20 cells/mm3, was moderately applicable for screening.As conclusions: CSF WBC count and TP showed distinct DCPC in confirmed or presumptive NS, better in the former. These biomarkers could be included for presumptive NS diagnosis. DCPC of these biomarkers for the diagnosis of NS is greatly affected by HIV co-infection.
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Affiliation(s)
- Sérgio Monteiro de Almeida
- Virology Section, Hospital de Clínicas, Universidade Federal Do Paraná, Setor Análises Clínicas Rua Padre Camargo, Curitiba, PR, 80060-240, Brazil.
- Neuroinfection Outclinic, Hospital de Clínicas, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil.
| | - José Tresoldi Neto
- Virology Section, Hospital de Clínicas, Universidade Federal Do Paraná, Setor Análises Clínicas Rua Padre Camargo, Curitiba, PR, 80060-240, Brazil
- Neuroinfection Outclinic, Hospital de Clínicas, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil
| | - Amanda Rocha
- Virology Section, Hospital de Clínicas, Universidade Federal Do Paraná, Setor Análises Clínicas Rua Padre Camargo, Curitiba, PR, 80060-240, Brazil
- Neuroinfection Outclinic, Hospital de Clínicas, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil
| | - Ana Medeiros
- Virology Section, Hospital de Clínicas, Universidade Federal Do Paraná, Setor Análises Clínicas Rua Padre Camargo, Curitiba, PR, 80060-240, Brazil
- Neuroinfection Outclinic, Hospital de Clínicas, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil
| | - Debora Gonçalves
- Virology Section, Hospital de Clínicas, Universidade Federal Do Paraná, Setor Análises Clínicas Rua Padre Camargo, Curitiba, PR, 80060-240, Brazil
- Neuroinfection Outclinic, Hospital de Clínicas, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil
| | - Fausto Guimarães
- Virology Section, Hospital de Clínicas, Universidade Federal Do Paraná, Setor Análises Clínicas Rua Padre Camargo, Curitiba, PR, 80060-240, Brazil
- Neuroinfection Outclinic, Hospital de Clínicas, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil
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156
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Penner JC, Schuwirth L, Durning SJ. From Noise to Music: Reframing the Role of Context in Clinical Reasoning. J Gen Intern Med 2024; 39:851-857. [PMID: 38243110 PMCID: PMC11043232 DOI: 10.1007/s11606-024-08612-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Affiliation(s)
- John C Penner
- Department of Medicine, University of California, San Francisco, CA, USA.
- Medical Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Lambert Schuwirth
- Prideaux Discipline of Clinical Education, Flinders University, Adelaide, SA, Australia
| | - Steven J Durning
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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157
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Zhou C, Cai Z, Jin B, Lin H, Xu L, Jin Z. Saliva-based detection of SARS-CoV-2: a bibliometric analysis of global research. Mol Cell Biochem 2024; 479:761-777. [PMID: 37178376 PMCID: PMC10182745 DOI: 10.1007/s11010-023-04760-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
Saliva has emerged as a promising noninvasive biofluid for the diagnosis of oral and systemic diseases, including viral infections. During the coronavirus disease 2019 (COVID-19) pandemic, a growing number of studies focused on saliva-based detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Taking advantage of the WoS core collection (WoSCC) and CiteSpace, we retrieved 1021 articles related to saliva-based detection of SARS-CoV-2 and conducted a comprehensive bibliometric analysis. We analyzed countries, institutions, authors, cited authors, and cited journals to summarize their contribution and influence and analyzed keywords to explore research hotspots and trends. From 2020 to 2021, research focused on viral transmission via saliva and verification of saliva as a reliable specimen, whereas from 2021 to the present, the focus of research has switched to saliva-based biosensors for SARS-CoV-2 detection. By far, saliva has been verified as a reliable specimen for SARS-CoV-2 detection, although a standardized procedure for saliva sampling and processing is needed. Studies on saliva-based detection of SARS-CoV-2 will promote the development of saliva-based diagnostics and biosensors for viral detection. Collectively, our findings could provide valuable information to help scientists perceive the basic knowledge landscapes on saliva-based detection of SARS-CoV-2, the past and current research hotspots, and future opportunities.
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Affiliation(s)
- Chun Zhou
- Jinhua People's Hospital Joint Center for Biomedical Research, Zhejiang Normal University, Jinhua, 321000, Zhejiang, China
- Department of Science and Education, the Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, 321000, Zhejiang, China
| | - Zhaopin Cai
- College of Life Sciences, Zhejiang Normal University, 688 Yingbin Road, Jinhua, 321000, Zhejiang, China
| | - Boxing Jin
- College of Life Sciences, Zhejiang Normal University, 688 Yingbin Road, Jinhua, 321000, Zhejiang, China
| | - Huisong Lin
- Zhejiang Institute of Medical Device Testing, Hangzhou, Zhejiang, China
| | - Lingling Xu
- College of Life Sciences, Zhejiang Normal University, 688 Yingbin Road, Jinhua, 321000, Zhejiang, China
| | - Zhigang Jin
- Jinhua People's Hospital Joint Center for Biomedical Research, Zhejiang Normal University, Jinhua, 321000, Zhejiang, China.
- College of Life Sciences, Zhejiang Normal University, 688 Yingbin Road, Jinhua, 321000, Zhejiang, China.
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158
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Teixeira da Silva JA, Scelles N. An artificial intelligence tool misclassifies sport science journals as predatory. J Sci Med Sport 2024; 27:266-269. [PMID: 38158321 DOI: 10.1016/j.jsams.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/01/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES The choice of a scholarly journal, as opposed to a predatory journal, might impact a sport scientist's career negatively if the wrong choice is made, especially at an early stage of their research and publishing careers. Artificial intelligence (AI) is increasingly impacting sport science and academia. In this study, we tested the accuracy and sensitivity of an AI-driven tool, applied specifically to sport science. DESIGN Our research relies on the use of a new and free online AI-driven tool, the AJPC System, which claims the ability to distinguish "normal" (scholarly) from "suspected predatory" (unscholarly) journals. METHODS The AJPC System was used to assess (1 December 2023) the classification of all ranked sport journals (n = 124), namely those in all four quartiles (Q1-Q4) of SCImago Journal Rank (SJR), in the "Sports Science" category. RESULTS The AJPC System considered 47/124 journals to be "suspected predatory", mostly in Q4 journals (54.8 % of total), casting a negative image on their academic standing. CONCLUSIONS Sport scientists are likely to consider SJR Q1-Q4 journals to be relatively safe to publish in, reliable and reputable, and might be confused with the "suspected predatory" label assigned to 37.9 % of those journals. The AJPC System is thus misleading sport scientists.
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Affiliation(s)
| | - Nicolas Scelles
- Sport Policy Unit, Faculty of Business and Law, Manchester Metropolitan University, UK.
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159
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Hojat LS, Wilson BM, Satlin MJ, Perez F, Mojica MF, Singer ME, Bonomo RA, Epstein LH. 14-Year Epidemiologic study of Pseudomonas aeruginosa bloodstream infection incidence and resistance in the Veterans Health Administration system, 2009-2022. JAC Antimicrob Resist 2024; 6:dlae031. [PMID: 38449517 PMCID: PMC10914452 DOI: 10.1093/jacamr/dlae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Background Multidrug resistant Pseudomonas aeruginosa (PA) represents a serious threat to hospitalized patients. Characterizing the incidence of PA infection and degree of resistance can inform empiric treatment and preventative measures. Objectives We sought to describe trends in incidence and resistance characteristics of PA bloodstream infections (BSI) observed within the Veterans Health Administration (VHA) system and identify factors contributing to higher observed mortality within this population. Methods We characterized demographic and clinical features of unique patients among the VHA population presenting with their first episode of PA-BSI between 2009 and 2022 and summarized trends related to mortality and resistance phenotype based on year and geographical location. We additionally used logistic regression analysis to identify predictors of 30-day mortality among this cohort. Results We identified 8039 PA-BSIs during the study period, 32.7% of which were hospital onset. Annual PA-BSI cases decreased by 35.8%, and resistance among all antimicrobial classes decreased during the study period, while the proportion of patients receiving early active treatment based on susceptibility testing results increased. Average 30-day mortality rate was 23.3%. Higher Charlson Comorbidity Index, higher mAPACHE score, VHA facility complexity 1b and hospital-onset cases were associated with higher mortality, and early active treatment was associated with lower mortality. Conclusions PA-BSI resistance decreased across the VHA system during the study period. Further investigation of antimicrobial stewardship measures possibly contributing to the observed decreased resistance in this cohort and identification of measures to improve on the high mortality associated with PA-BSI in the VHA population is warranted.
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Affiliation(s)
- Leila S Hojat
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Case Western Reserve University, 11100 Euclid Avenue, 44106, Cleveland, OH, USA
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Brigid M Wilson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Case Western Reserve University, 11100 Euclid Avenue, 44106, Cleveland, OH, USA
- Geriatric Research Education and Clinical Center (GRECC), The VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Michael J Satlin
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Federico Perez
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Case Western Reserve University, 11100 Euclid Avenue, 44106, Cleveland, OH, USA
- Geriatric Research Education and Clinical Center (GRECC), The VA Northeast Ohio Healthcare System, Cleveland, OH, USA
- Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Case Western Reserve University, Cleveland, OH, USA
| | - Maria F Mojica
- Research Service, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
- Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
| | - Mendel E Singer
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Robert A Bonomo
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Case Western Reserve University, 11100 Euclid Avenue, 44106, Cleveland, OH, USA
- Geriatric Research Education and Clinical Center (GRECC), The VA Northeast Ohio Healthcare System, Cleveland, OH, USA
- Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Case Western Reserve University, Cleveland, OH, USA
- Research Service, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Lauren H Epstein
- US Department of Veterans Affairs Medical Center, Emory University, Atlanta, Georgia, USA
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160
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Horgan D, Van den Bulcke M, Malapelle U, Normanno N, Capoluongo ED, Prelaj A, Rizzari C, Stathopoulou A, Singh J, Kozaric M, Dube F, Ottaviano M, Boccia S, Pravettoni G, Cattaneo I, Malats N, Buettner R, Lekadir K, de Lorenzo F, Alix-Panabieres C, Badreh S, Solary E, De Maria R, Hofman P. Demographic Analysis of Cancer Research Priorities and Treatment Correlations. Curr Oncol 2024; 31:1839-1864. [PMID: 38668042 PMCID: PMC11048756 DOI: 10.3390/curroncol31040139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/07/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Understanding the diversity in cancer research priorities and the correlations among different treatment modalities is essential to address the evolving landscape of oncology. This study, conducted in collaboration with the European Cancer Patient Coalition (ECPC) and Childhood Cancer International-Europe (CCI-E) as part of the "UNCAN.eu" initiative, analyzed data from a comprehensive survey to explore the complex interplay of demographics, time since cancer diagnosis, and types of treatments received. Demographic analysis revealed intriguing trends, highlighting the importance of tailoring cancer research efforts to specific age groups and genders. Individuals aged 45-69 exhibited highly aligned research priorities, emphasizing the need to address the unique concerns of middle-aged and older populations. In contrast, patients over 70 years demonstrated a divergence in research priorities, underscoring the importance of recognising the distinct needs of older individuals in cancer research. The analysis of correlations among different types of cancer treatments underscored the multidisciplinary approach to cancer care, with surgery, radiotherapy, chemotherapy, precision therapy, and biological therapies playing integral roles. These findings support the need for personalized and combined treatment strategies to achieve optimal outcomes. In conclusion, this study provides valuable insights into the complexity of cancer research priorities and treatment correlations in a European context. It emphasizes the importance of a multifaceted, patient-centred approach to cancer research and treatment, highlighting the need for ongoing support, adaptation, and collaboration to address the ever-changing landscape of oncology.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium; (J.S.); (M.K.)
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Faculty of Engineering and Technology, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India
| | | | - Umberto Malapelle
- Department of Public Health, University Federico II of Naples, 80138 Naples, Italy;
| | - Nicola Normanno
- Istituto Nazionale Tumori “Fondazione G. Pascale”—IRCCS, 80131 Naples, Italy;
| | - Ettore D. Capoluongo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80138 Naples, Italy;
- Department of Clinical Pathology, Azienda Ospedaliera San Giovanni Addolorata, Via Amba Aradam 8, 00184 Rome, Italy
| | - Arsela Prelaj
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| | - Carmelo Rizzari
- Unità di Ematologia Pediatrica, Fondazione MBBM, Università di Milano-Bicocca, 20126 Monza, Italy;
| | - Aliki Stathopoulou
- European Cancer Patient Coalition, 1000 Brussels, Belgium; (A.S.); (F.d.L.)
| | - Jaya Singh
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium; (J.S.); (M.K.)
| | - Marta Kozaric
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium; (J.S.); (M.K.)
| | - France Dube
- Astra Zeneca, Concord Pike, Wilmington, DE 19803, USA;
| | - Manuel Ottaviano
- Departamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, 28040 Madrid, Spain;
| | - Stefania Boccia
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
- Departments of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO) IRCCS, 20139 Milan, Italy
| | | | - Núria Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), 28029 Madrid, Spain;
| | - Reinhard Buettner
- Lung Cancer Group Cologne, Institute of Pathology, Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, 50937 Cologne, Germany;
| | - Karim Lekadir
- Artificial Intelligence in Medicine Lab (BCN-AIM), Universitat de Barcelona, 08007 Barcelona, Spain;
| | | | - Catherine Alix-Panabieres
- Laboratory of Rare Human Circulating Cells, University Medical Center of Montpellier, 34093 Montpellier, France;
| | - Sara Badreh
- Cancer Childhood International, 1200 Vienna, Austria;
| | - Eric Solary
- INSERM U1287, Gustave Roussy Cancer Campus, 94805 Paris, France;
- Faculty of Medicine, Université Paris-Sud, 91405 Le Kremlin-Bicêtre, Île-de-France, France
- Department of Hematology, Gustave Roussy Cancer Campus, 94805 Paris, France
| | - Ruggero De Maria
- Institute of General Pathology, Catholic University of the Sacred Heart, 20123 Rome, Italy;
| | - Paul Hofman
- IHU RespirERA, FHU OncoAge, Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Université Côte d’Azur, 06000 Nice, France;
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Al Hossain F, Tonmoy MTH, Nuvvula S, Chapman BP, Gupta RK, Lover AA, Dinglasan RR, Carreiro S, Rahman T. Syndromic surveillance of population-level COVID-19 burden with cough monitoring in a hospital emergency waiting room. Front Public Health 2024; 12:1279392. [PMID: 38605877 PMCID: PMC11007176 DOI: 10.3389/fpubh.2024.1279392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
Syndromic surveillance is an effective tool for enabling the timely detection of infectious disease outbreaks and facilitating the implementation of effective mitigation strategies by public health authorities. While various information sources are currently utilized to collect syndromic signal data for analysis, the aggregated measurement of cough, an important symptom for many illnesses, is not widely employed as a syndromic signal. With recent advancements in ubiquitous sensing technologies, it becomes feasible to continuously measure population-level cough incidence in a contactless, unobtrusive, and automated manner. In this work, we demonstrate the utility of monitoring aggregated cough count as a syndromic indicator to estimate COVID-19 cases. In our study, we deployed a sensor-based platform (Syndromic Logger) in the emergency room of a large hospital. The platform captured syndromic signals from audio, thermal imaging, and radar, while the ground truth data were collected from the hospital's electronic health record. Our analysis revealed a significant correlation between the aggregated cough count and positive COVID-19 cases in the hospital (Pearson correlation of 0.40, p-value < 0.001). Notably, this correlation was higher than that observed with the number of individuals presenting with fever (ρ = 0.22, p = 0.04), a widely used syndromic signal and screening tool for such diseases. Furthermore, we demonstrate how the data obtained from our Syndromic Logger platform could be leveraged to estimate various COVID-19-related statistics using multiple modeling approaches. Aggregated cough counts and other data, such as people density collected from our platform, can be utilized to predict COVID-19 patient visits related metrics in a hospital waiting room, and SHAP and Gini feature importance-based metrics showed cough count as the important feature for these prediction models. Furthermore, we have shown that predictions based on cough counting outperform models based on fever detection (e.g., temperatures over 39°C), which require more intrusive engagement with the population. Our findings highlight that incorporating cough-counting based signals into syndromic surveillance systems can significantly enhance overall resilience against future public health challenges, such as emerging disease outbreaks or pandemics.
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Affiliation(s)
- Forsad Al Hossain
- Manning College of Information and Computer Sciences, University of Massachusetts-Amherst, Amherst, MA, United States
| | - M. Tanjid Hasan Tonmoy
- Halıcıoǧlu Data Science Institute, University of California, San Diego, San Diego, CA, United States
| | - Sri Nuvvula
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Brittany P. Chapman
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Rajesh K. Gupta
- Halıcıoǧlu Data Science Institute, University of California, San Diego, San Diego, CA, United States
| | - Andrew A. Lover
- School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Rhoel R. Dinglasan
- Infectious Diseases and Immunology, University of Florida, Gainesville, FL, United States
| | - Stephanie Carreiro
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Tauhidur Rahman
- Halıcıoǧlu Data Science Institute, University of California, San Diego, San Diego, CA, United States
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162
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Brooman-White R, Blakeman T, McNab D, Deaton C. Informing understanding of coordination of care for patients with heart failure with preserved ejection fraction: a secondary qualitative analysis. BMJ Qual Saf 2024; 33:232-245. [PMID: 37802647 DOI: 10.1136/bmjqs-2023-016583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/15/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Patients with heart failure with preserved ejection fraction (HFpEF) are a complex and underserved group. They are commonly older patients with multiple comorbidities, who rely on multiple healthcare services. Regional variation in services and resourcing has been highlighted as a problem in heart failure care, with few teams bridging the interface between the community and secondary care. These reports conflict with policy goals to improve coordination of care and dissolve boundaries between specialist services and the community. AIM To explore how care is coordinated for patients with HFpEF, with a focus on the interface between primary care and specialist services in England. METHODS We applied systems thinking methodology to examine the relationship between work-as-imagined and work-as-done for coordination of care for patients with HFpEF. We analysed clinical guidelines in conjunction with a secondary applied thematic analysis of semistructured interviews with healthcare professionals caring for patients with HFpEF including general practitioners, specialist nurses and cardiologists and patients with HFpEF themselves (n=41). Systems Thinking for Everyday Work principles provided a sensitising theoretical framework to facilitate a deeper understanding of how these data illustrate a complex health system and where opportunities for improvement interventions may lie. RESULTS Three themes (working with complexity, information transfer and working relationships) were identified to explain variability between work-as-imagined and work-as-done. Participants raised educational needs, challenging work conditions, issues with information transfer systems and organisational structures poorly aligned with patient needs. CONCLUSIONS There are multiple challenges that affect coordination of care for patients with HFpEF. Findings from this study illuminate the complexity in coordination of care practices and have implications for future interventional work.
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Affiliation(s)
- Rosalie Brooman-White
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Blakeman
- Centre for Primary Care, University of Manchester Faculty of Medical and Human Sciences, Manchester, UK
| | - Duncan McNab
- Medical Directorate, NHS Education for Scotland, Glasgow, UK
| | - Christi Deaton
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
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163
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Plebani M. Value-based laboratory medicine: the time is now. Clin Chem Lab Med 2024; 62:579-580. [PMID: 37800197 DOI: 10.1515/cclm-2023-1095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Mario Plebani
- Honorary Professor of Clinical Biochemistry and Clinical Molecular Biology, University of Padova, Padova, Italy
- Adjunct Professor, Department of Pathology, University of Texas-Medical Branch, Galveston, TX, USA
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164
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Harada Y, Kawamura R, Yokose M, Shimizu T, Singh H. Definitions and Measurements for Atypical Presentations at Risk for Diagnostic Errors in Internal Medicine: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e56933. [PMID: 38526541 PMCID: PMC11002735 DOI: 10.2196/56933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Atypical presentations have been increasingly recognized as a significant contributing factor to diagnostic errors in internal medicine. However, research to address associations between atypical presentations and diagnostic errors has not been evaluated due to the lack of widely applicable definitions and criteria for what is considered an atypical presentation. OBJECTIVE The aim of the study is to describe how atypical presentations are defined and measured in studies of diagnostic errors in internal medicine and use this new information to develop new criteria to identify atypical presentations at high risk for diagnostic errors. METHODS This study will follow an established framework for conducting scoping reviews. Inclusion criteria are developed according to the participants, concept, and context framework. This review will consider studies that fulfill all of the following criteria: include adult patients (participants); explore the association between atypical presentations and diagnostic errors using any definition, criteria, or measurement to identify atypical presentations and diagnostic errors (concept); and focus on internal medicine (context). Regarding the type of sources, this scoping review will consider quantitative, qualitative, and mixed methods study designs; systematic reviews; and opinion papers for inclusion. Case reports, case series, and conference abstracts will be excluded. The data will be extracted through MEDLINE, Web of Science, CINAHL, Embase, Cochrane Library, and Google Scholar searches. No limits will be applied to language, and papers indexed from database inception to December 31, 2023, will be included. Two independent reviewers (YH and RK) will conduct study selection and data extraction. The data extracted will include specific details about the patient characteristics (eg, age, sex, and disease), the definitions and measuring methods for atypical presentations and diagnostic errors, clinical settings (eg, department and outpatient or inpatient), type of evidence source, and the association between atypical presentations and diagnostic errors relevant to the review question. The extracted data will be presented in tabular format with descriptive statistics, allowing us to identify the key components or types of atypical presentations and develop new criteria to identify atypical presentations for future studies of diagnostic errors. Developing the new criteria will follow guidance for a basic qualitative content analysis with an inductive approach. RESULTS As of January 2024, a literature search through multiple databases is ongoing. We will complete this study by December 2024. CONCLUSIONS This scoping review aims to provide rigorous evidence to develop new criteria to identify atypical presentations at high risk for diagnostic errors in internal medicine. Such criteria could facilitate the development of a comprehensive conceptual model to understand the associations between atypical presentations and diagnostic errors in internal medicine. TRIAL REGISTRATION Open Science Framework; www.osf.io/27d5m. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56933.
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Affiliation(s)
- Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Japan
| | - Ren Kawamura
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Japan
| | - Masashi Yokose
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, Japan
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
- Health Services Research Section, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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165
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Eslamifar Z, Behzadifard M, Zare E. Investigation of homocysteine, D-dimer and platelet count levels as potential predictors of thrombosis risk in COVID-19 patients. Mol Cell Biochem 2024:10.1007/s11010-024-04967-5. [PMID: 38502382 DOI: 10.1007/s11010-024-04967-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 02/13/2024] [Indexed: 03/21/2024]
Abstract
Thrombosis plays an important role in induction of Coronavirus disease 19 (COVID-19) complications including heart attack and stroke. Reliable biomarkers are needed to predict thrombosis risk for better management and improve patient outcomes. This study aimed to investigate the relationship between homocysteine, a thrombosis-related biomarker, and other thrombosis-related parameters, such as D-dimer and platelet count with disease outcome in COVID-19 patients. This case-control study including 50 intensive care unit hospitalized patients with Covid-19 with a positive RT-PCR test for SARS-CoV-2 infection and 50 healthy individuals as a control group was conducted. Both groups were matched for age and body mass index (BMI) and had no history of underlying diseases such as cardiovascular, liver, kidney or smoking. Blood samples were collected from both groups to measure serum homocysteine, platelet count and D-dimer levels. Data were analyzed using GraphPad Prism version 8.3 software. The study found no statistically significant difference in homocysteine levels between COVID-19 patients and the control group. However, D-dimer levels were significantly higher in the patient group. Platelet count analysis revealed a significant difference between patients who died and those who were discharged from the hospital (P < 0.05). Despite previous studies suggesting a link between homocysteine and thrombosis, this study found no significant difference in homocysteine levels between COVID-19 patients and the control group. The significantly elevated D-dimer levels in the death group patient suggest that D-dimer and thrombocytopenia may be more reliable predictors of thrombosis and worse outcome in COVID-19 patients without underlying diseases.
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Affiliation(s)
- Zahra Eslamifar
- Department of Medical Laboratory Sciences, School of Paramedical Sciences, Dezful University of Medical Sciences, Dezful, Iran
| | - Mahin Behzadifard
- Department of Medical Laboratory Sciences, School of Paramedical Sciences, Dezful University of Medical Sciences, Dezful, Iran.
| | - Ehsan Zare
- Student Research Committee, Dezful University of Medical Sciences, Dezful, Iran
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166
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Manrique P, Montero I, Fernandez-Gosende M, Martinez N, Cantabrana CH, Rios-Covian D. Past, present, and future of microbiome-based therapies. MICROBIOME RESEARCH REPORTS 2024; 3:23. [PMID: 38841413 PMCID: PMC11149097 DOI: 10.20517/mrr.2023.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 06/07/2024]
Abstract
Technological advances in studying the human microbiome in depth have enabled the identification of microbial signatures associated with health and disease. This confirms the crucial role of microbiota in maintaining homeostasis and the host health status. Nowadays, there are several ways to modulate the microbiota composition to effectively improve host health; therefore, the development of therapeutic treatments based on the gut microbiota is experiencing rapid growth. In this review, we summarize the influence of the gut microbiota on the development of infectious disease and cancer, which are two of the main targets of microbiome-based therapies currently being developed. We analyze the two-way interaction between the gut microbiota and traditional drugs in order to emphasize the influence of gut microbial composition on drug effectivity and treatment response. We explore the different strategies currently available for modulating this ecosystem to our benefit, ranging from 1st generation intervention strategies to more complex 2nd generation microbiome-based therapies and their regulatory framework. Lastly, we finish with a quick overview of what we believe is the future of these strategies, that is 3rd generation microbiome-based therapies developed with the use of artificial intelligence (AI) algorithms.
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167
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Schwarz KM, Nienhaus A, Diel R. Risk of SARS-CoV-2 infection in dental healthcare workers - a systematic review and meta-analysis. GMS HYGIENE AND INFECTION CONTROL 2024; 19:Doc09. [PMID: 38655123 PMCID: PMC11035909 DOI: 10.3205/dgkh000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background Mounting evidence supports an association between the use of personal protective equipment (PPE) and the risk of infection from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in dental healthcare workers (DCW). However, the prevalence and incidence of SARS-CoV-2 infections in the setting of dental care remains poorly characterized. Methods A systematic review and meta-analysis of studies published prior to Mai 2023 providing epidemiological data for the occurrence of SARS-CoV-2 in DCW was performed. A random-effects model was used to calculate pooled estimates and odds ratios (ORs) with corresponding 95% confidence intervals (CIs). The associated factors were narratively evaluated. Risk of bias was assessed using the Joanna Briggs Institute tool for prevalence studies. Results Twenty-nine eligible studies were identified including a total of 85,274 DCW at risk; 27 studies met the criteria for the meta-analysis. Among the included DCW, the overall prevalence of SARS-CoV-2 was 11.8% (13,155/85,274; 95%CI, 7.5%-17%), whereby the degree of heterogeneity between the studies was considerable (I2=99.7%). The pooled prevalence rate for dentists and dental hygienists alone was 12.7% (1943/20,860; 95%CI, 8.0%-18.0%), showing significantly increased odds of contracting a SARS-CoV-2 infection compared to dental assistant personnel, the prevalence rate for which was less than half, at 5.2% (613/15,066; OR=2.42; 95% CI, 2.2-2.7). In the subgroup of 17 studies from countries with high income there was a significantly lower prevalence rate of 7.3% (95% CI, 5%-10%) in DCW compared to the prevalence rate in low- and middle-income countries, which came to 20.8% (95% CI, 14%-29%; p<0.001). In 19 out of the 29 studies (65.5%), specific information on the use of and adherence to PPE was absent while in the reports with concrete figures the wearing of N95 (or at least surgical masks) by DCW appeared to be associated with lower SARS-CoV-2 prevalence rates. Conclusions DCW were, depending in each case on their proximity to patients, at particular risk of SARS-CoV-2 infection during the COVID-19 pandemic. Until a significant level of vaccination protection against newer SARS-CoV-2 variants can be built up in the population, dental healthcare facilities should further maintain their focus on using PPE according to current guidelines.
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Affiliation(s)
- Kira Marie Schwarz
- Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Albert Nienhaus
- Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
| | - Roland Diel
- Institute for Epidemiology, University Medical Hospital, Schleswig-Holstein, Kiel, Germany
- LungClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
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168
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Elamragy A, Samir A, Maher A, Rizk H, Meshaal M. Infective endocarditis presentations during the COVID-19 pandemic: have they paid an untold toll? Glob Cardiol Sci Pract 2024; 2024:e202411. [PMID: 38746068 PMCID: PMC11090171 DOI: 10.21542/gcsp.2024.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/14/2024] [Indexed: 05/16/2024] Open
Abstract
Background: COVID-19 caused restrictions and re-allocation of medical resources among all healthcare services. During the peak of the pandemic, several unrelated-yet critical-conditions had silently taken their toll. Infective endocarditis (IE), owing to its non-specific clinical presentation, may have been largely mislabeled as COVID-19 in a number of cases. Results: This retrospective observational study reviewed all IE presentations at an IE unit in a university hospital during the peak of COVID-19. Patient characteristics, courses, and outcomes were compared with historical controls from our IE database published before the COVID era. We identified 30 IE cases [Group A] during the COVID-19 peak in our region (June 2021 to June 2022), with a 25% decrease compared to the usual annual rate. This is in contrast to the expected surge during the pandemic. Compared with group B (398 published IE cases from our database), group A had significantly longer symptoms-to-presentation intervals (60 [31-92] vs. 28 [14-72] days, p = 0.01). Male sex dominated both groups, but group A had significantly less pre-existing structural heart disease. Despite the more liberal use of empirical antibiotics in the COVID-era, group-A had lower rates of culture-negative IE. Compared to group B, group A demonstrated a better response to medical therapy, fewer arterial embolizations, fewer indications for surgery, and fewer overall complications, except for increased acute kidney injury. This can be explained by the abundant use of non-steroidal anti-inflammatory drugs. The data analysis strongly suggests that there might have been a natural selection or selection bias of IE patients with favorable profiles to survive the pandemic to the appropriate diagnosis. Conclusions: The diagnosis of IE and commencing the appropriate workup were significantly undermined during the COVID-19 pandemic. The inexplicable decline in IE referral rate and the favorable outcomes witnessed during the pandemic strongly suggest a referral bias and natural selection of those who survived the pandemic to the appropriate IE diagnosis.
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Affiliation(s)
- Ahmed Elamragy
- Kasralainy Medical School, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmad Samir
- Kasralainy Medical School, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Maher
- Kasralainy Medical School, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hussein Rizk
- Kasralainy Medical School, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa Meshaal
- Kasralainy Medical School, Faculty of Medicine, Cairo University, Cairo, Egypt
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169
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Jeong S, Choi YJ. Investigating the Influence of Heavy Metals and Environmental Factors on Metabolic Syndrome Risk Based on Nutrient Intake: Machine Learning Analysis of Data from the Eighth Korea National Health and Nutrition Examination Survey (KNHANES). Nutrients 2024; 16:724. [PMID: 38474852 DOI: 10.3390/nu16050724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
This study delves into the complex interrelations among nutrient intake, environmental exposures (particularly to heavy metals), and metabolic syndrome. Utilizing data from the Korea National Health and Nutrition Examination Survey (KNHANES), machine learning techniques were applied to analyze associations in a cohort of 5719 participants, categorized into four distinct nutrient intake phenotypes. Our findings reveal that different nutrient intake patterns are associated with varying levels of heavy metal exposure and metabolic health outcomes. Key findings include significant variations in metal levels (Pb, Hg, Cd, Ni) across the clusters, with certain clusters showing heightened levels of specific metals. These variations were associated with distinct metabolic health profiles, including differences in obesity, diabetes prevalence, hypertension, and cholesterol levels. Notably, Cluster 3, characterized by high-energy and nutrient-rich diets, showed the highest levels of Pb and Hg exposure and had the most concerning metabolic health indicators. Moreover, the study highlights the significant impact of lifestyle habits, such as smoking and eating out, on nutrient intake phenotypes and associated health risks. Physical activity emerged as a critical factor, with its absence linked to imbalanced nutrient intake in certain clusters. In conclusion, our research underscores the intricate connections among diet, environmental factors, and metabolic health. The findings emphasize the need for tailored health interventions and policies that consider these complex interplays, potentially informing future strategies to combat metabolic syndrome and related health issues.
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Affiliation(s)
- Seungpil Jeong
- Department of Medical Informatics, College of Medicine, Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yean-Jung Choi
- Department of Food and Nutrition, Sahmyook University, Seoul 01795, Republic of Korea
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170
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Yamashita S, Tago M, Tokushima M, Tokushima Y, Hirakawa Y, Aihara H, Katsuki NE, Fujiwara M, Oda Y. Effects of a 60-Minute Lecture About Diagnostic Errors for Medical Students: A Single-Center Interventional Study. Cureus 2024; 16:e56117. [PMID: 38618404 PMCID: PMC11014750 DOI: 10.7759/cureus.56117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION The danger of diagnostic errors exists in daily medical practice, and doctors are required to avoid such errors as much as possible. Although various factors, including cognitive, system-related, and patient-related factors, are involved in the occurrence of diagnostic errors, the percentage of doctors with insufficient medical knowledge among those factors is extremely low. Therefore, lectures on diagnostic errors might also be useful for medical students without experience working as doctors. This study investigated whether a 60-minute lecture on diagnostic errors would enable Japanese medical students to consider the factors involved in diagnostic errors and how their perceptions of diagnostic errors change. METHODS AND MATERIALS This single-center interventional study was conducted in October 2022 among fourth-year medical students at the Faculty of Medicine, Saga University. A questionnaire survey was conducted before and immediately after the lecture to investigate changes in the perceptions of medical students regarding diagnostic errors. One mock case question was given on an exam the day after the lecture, and the number of responses to cognitive biases and system-related and patient-related factors involved in diagnostic errors were calculated. RESULTS A total of 83 students were analyzed. After the lecture, medical students were significantly more aware of the existence of the concept of diagnostic error, the importance of learning about it, their willingness to continue learning about it, and their perception that learning about diagnostic errors improves their clinical skills. They were also significantly less likely to feel blame or shame over diagnostic errors. The mean numbers of responses per student for cognitive bias, system-related factors, and patient-related factors were 1.9, 3.4, and 0.9, respectively. The mean number of responses per student for all factors was 5.6. CONCLUSION A 60-minute lecture on diagnostic errors among medical students is beneficial because it significantly changes their perception of diagnostic errors. The results of the present study also suggest that lectures may enable Japanese medical students to consider the factors involved in diagnostic errors.
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Affiliation(s)
- Shun Yamashita
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga, JPN
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, JPN
| | - Midori Tokushima
- Saga Medical Career Support Center, Saga University Hospital, Saga, JPN
| | | | - Yuka Hirakawa
- Department of General Medicine, Saga University Hospital, Saga, JPN
| | - Hidetoshi Aihara
- Department of General Medicine, Saga University Hospital, Saga, JPN
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga, JPN
| | - Motoshi Fujiwara
- Department of General Medicine, Saga University Hospital, Saga, JPN
| | - Yasutomo Oda
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga, JPN
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171
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Festekjian A, Hall JE, Zipkin R, Schiff J, Pham PK, Mesropyan L, Araradian C, Nager AL, Chang TP. A checklist intervention for pediatric emergency department transfer of care sign-outs. Am J Emerg Med 2024; 77:215-219. [PMID: 38216365 DOI: 10.1016/j.ajem.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/01/2024] [Accepted: 01/01/2024] [Indexed: 01/14/2024] Open
Affiliation(s)
- Ara Festekjian
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 113, Los Angeles, CA 90027, United States of America; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.
| | - Jeanine E Hall
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 113, Los Angeles, CA 90027, United States of America; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.
| | - Ronen Zipkin
- Department of Pediatrics, Division of Hospital Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 94, Los Angeles, CA 90027, United States of America; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.
| | - Jared Schiff
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 113, Los Angeles, CA 90027, United States of America; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.
| | - Phung K Pham
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 113, Los Angeles, CA 90027, United States of America
| | - Levon Mesropyan
- University of California Los Angeles, Burbank Pediatrics, 2625 W. Alameda, Suite 300, Burbank, CA 9150, United States of America.
| | - Cynthia Araradian
- Oregon Health Sciences University*, 3181 S.W. Jackson Park Road, Portland, OR 97239, United States of America.
| | - Alan L Nager
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 113, Los Angeles, CA 90027, United States of America; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.
| | - Todd P Chang
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 113, Los Angeles, CA 90027, United States of America; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.
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172
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Vettori M, Carpenè G, Salvagno GL, Gelati M, Dima F, Celegon G, Favaloro EJ, Lippi G. Effects of Recombinant SARS-CoV-2 Spike Protein Variants on Platelet Morphology and Activation. Semin Thromb Hemost 2024; 50:275-283. [PMID: 37327884 DOI: 10.1055/s-0043-1769939] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Platelets are central elements of hemostasis and also play a pivotal role in the pathogenesis of thrombosis in coronavirus disease 2019. This study was planned to investigate the effects of different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) recombinant spike protein variants on platelet morphology and activation. Citrated whole blood collected from ostensibly healthy subjects was challenged with saline (control sample) and with 2 and 20 ng/mL final concentration of SARS-CoV-2 recombinant spike protein of Ancestral, Alpha, Delta, and Omicron variants. Platelet count was found to be decreased with all SARS-CoV-2 recombinant spike protein variants and concentrations tested, achieving the lowest values with 20 ng/mL Delta recombinant spike protein. The mean platelet volume increased in all samples irrespective of SARS-CoV-2 recombinant spike protein variants and concentrations tested, but especially using Delta and Alpha recombinant spike proteins. The values of both platelet function analyzer-200 collagen-adenosine diphosphate and collagen-epinephrine increased in all samples irrespective of SARS-CoV-2 recombinant spike protein variants and concentrations tested, and thus reflecting platelet exhaustion, and displaying again higher increases with Delta and Alpha recombinant spike proteins. Most samples where SARS-CoV-2 recombinant spike proteins were added were flagged as containing platelet clumps. Morphological analysis revealed the presence of a considerable number of activated platelets, platelet clumps, platelet-monocyte, and platelet-neutrophils aggregates, especially in samples spiked with Alpha and Delta recombinant spike proteins at 20 ng/mL. These results provide support to the evidence that SARS-CoV-2 is capable of activating platelets through its spike protein, though such effect varies depending on different spike protein variants.
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Affiliation(s)
- Marco Vettori
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Giovanni Carpenè
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Gian Luca Salvagno
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Matteo Gelati
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Francesco Dima
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Giovanni Celegon
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Emmanuel J Favaloro
- Department of Haematology, Sydney Centers for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
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173
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Howard MC. Reinvestigating the Perceptions of Annual Skin Cancer Screening Scale: a suitable measure for older adults. Eur J Cancer Prev 2024; 33:177-180. [PMID: 37807954 DOI: 10.1097/cej.0000000000000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVES The Perceptions of Annual Skin Cancer Screening Scale (PASCSS) explains significant variance in whether people undergo annual clinical skin cancer screening beyond other relevant predictors. When developing the PASCSS, the author only tested its psychometric properties and validity with participants representative of the general USA population, despite the particular relevance of annual clinical skin cancer screenings to at-risk populations, namely, older adults. We reanalyze the PASCSS using a sample of older adults. METHODS We conducted a three-wave survey study (n = 237) with each wave separated by one week. Demographic information was recorded at Time 1. The PASCSS was administered at Time 2. Outcomes were measured at Time 3. RESULTS The model fit of our confirmatory factor analysis met or closely approached traditional cutoffs, and each item loaded very strongly onto its respective latent factor. These PASCSS's dimensions together explained an additional 38% of variance in dermatologist screening and 37% of variance in any medical professional screening beyond our control variables (both P < 0.01). The dimension of Unknowledgeable was statistically significant in predicting dermatologist screening ( P = 0.03), whereas the three dimensions of Forget, Recommended, and Unknowledgeable were statistically significant in predicting any medical professional screening (all P < 0.05). CONCLUSION Our results supported the psychometric properties and validity of the PASCSS, and we showed that the dimensions significantly relate to whether participants received a clinical skin cancer screening in the past year. The current investigation supports that the PASCSS is appropriate to administer to older adults.
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Affiliation(s)
- Matt C Howard
- Mitchell College of Business, University of South Alabama, Alabama, USA
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174
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Al-Moghrabi D, Abu Arqub S, Maroulakos MP, Pandis N, Fleming PS. Can ChatGPT identify predatory biomedical and dental journals? A cross-sectional content analysis. J Dent 2024; 142:104840. [PMID: 38219888 DOI: 10.1016/j.jdent.2024.104840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVES To assess whether ChatGPT can help to identify predatory biomedical and dental journals, analyze the content of its responses and compare the frequency of positive and negative indicators provided by ChatGPT concerning predatory and legitimate journals. METHODS Four-hundred predatory and legitimate biomedical and dental journals were selected from four sources: Beall's list, unsolicited emails, the Web of Science (WOS) journal list and the Directory of Open Access Journals (DOAJ). ChatGPT was asked to determine journal legitimacy. Journals were classified into legitimate or predatory. Pearson's Chi-squared test and logistic regression were conducted. Two machine learning algorithms determined the most influential criteria on the correct classification of journals. RESULTS The data were categorized under 10 criteria with the most frequently coded criteria being the transparency of processes and policies. ChatGPT correctly classified predatory and legitimate journals in 92.5 % and 71 % of the sample, respectively. The accuracy of ChatGPT responses was 0.82. ChatGPT also demonstrated a high level of sensitivity (0.93). Additionally, the model exhibited a specificity of 0.71, accurately identifying true negatives. A highly significant association between ChatGPT verdicts and the classification based on known sources was observed (P <0.001). ChatGPT was 30.2 times more likely to correctly classify a predatory journal (95 % confidence interval: 16.9-57.43, p-value: <0.001). CONCLUSIONS ChatGPT can accurately distinguish predatory and legitimate journals with a high level of accuracy. While some false positive (29 %) and false negative (7.5 %) results were observed, it may be reasonable to harness ChatGPT to assist with the identification of predatory journals. CLINICAL SIGNIFICANCE STATEMENT ChatGPT may effectively distinguish between predatory and legitimate journals, with accuracy rates of 92.5 % and 71 %, respectively. The potential utility of large-scale language models in exposing predatory publications is worthy of further consideration.
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Affiliation(s)
- Dalya Al-Moghrabi
- Department of Preventive Dental Sciences, College of Dentistry, Princess Nourah bint Abdulrahman University, P.O. Box: 84428 Airport Road, Riyadh 11671, Saudi Arabia.
| | - Sarah Abu Arqub
- Department of Orthodontics, University of Florida, Gainesville, FL, USA
| | - Michael P Maroulakos
- Division of Public and Child Dental Health, Dublin Dental School and Hospital, Dublin, Ireland
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Medical Faculty, Dental School, University of Bern, Bern, Switzerland
| | - Padhraig S Fleming
- Division of Public and Child Dental Health, Dublin Dental School and Hospital, Dublin, Ireland
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175
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Si J. Validating the Korean shorter Diagnostic Thinking Inventory in medical education: a pilot study. KOREAN JOURNAL OF MEDICAL EDUCATION 2024; 36:17-26. [PMID: 38462239 PMCID: PMC10925811 DOI: 10.3946/kjme.2024.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/11/2024] [Accepted: 01/31/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE Developing clinical reasoning across the medical curriculum requires valid, reliable, and feasible assessment tools. However, few validated tools are available for the convenient and efficient quantification of clinical reasoning. Thus, this study aimed to create a shorter version of the Diagnostic Thinking Inventory (DTI) and validate it in the Korean medical education context (DTI-SK). METHODS The DTI-SK was constructed using content validity and a translation and back-translation process. It comprises two subcategories and 14 items. Its validity and reliability were explored using exploratory and confirmatory factor analyses, mean comparisons of four medical student groups (med 1 to med 4), and internal consistency using Cronbach's α. Two hundred medical students were invited to participate through email, and the survey was administered for 2 weeks. RESULTS Data from 136 students were analyzed. Exploratory factor analysis revealed two factors with eigenvalues greater than 1.0 and they together explained 54.65% of the variance. Confirmatory factor analysis demonstrated that the model had acceptable level of fit and convergent validity. Discriminant validity was confirmed using heterotrait-monotrait criterion. Group comparisons demonstrated that the med 4 students showed significantly higher scores than the med 1 and 2 students. The inventory exhibited strong internal consistency for all items (Cronbach's α=0.906). CONCLUSION The findings indicated that the DTI-SK is a reliable and valid tool for measuring medical students' clinical reasoning in the context of Korean medical education.
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Affiliation(s)
- Jihyun Si
- Department of Medical Education, Dong-A University College of Medicine, Busan, Korea
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176
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Nagy ÈS, Westaway M, Danieletto S, Afrin LB. Breast Implant Illness May Be Rooted in Mast Cell Activation: A Case-Controlled Retrospective Analysis. ANNALS OF SURGERY OPEN 2024; 5:e398. [PMID: 38883946 PMCID: PMC11175949 DOI: 10.1097/as9.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/12/2024] [Indexed: 06/18/2024] Open
Abstract
Objective To investigate the possible association between breast implant illness (BII) and mast cell activation syndrome (MCAS), which often manifests increased mast cells (MCs) in assorted tissues and may explain BII symptoms. Background Mechanisms by which implants cause BII symptoms remain unclear, but BII and MCAS symptom profiles heavily overlap, warranting investigation of potential linkage. Methods We retrospectively analyzed 20 implant patients who underwent explantation and total capsulectomy; 15 self-reported preoperatively they had BII (subject group); 5 felt they did not [control group 1 (CG1)]. Five prophylactic mastectomy patients constituted control group 2 (CG2). Subjects and CG1 patients completed BII symptom questionnaires preoperatively and multiple points postoperatively. With CD117 staining, average and maximum mast cell counts (MCCs) in resected tissues were determined. Results Mean BII symptom score 2 weeks postexplantation was reduced by 77% (P < 0.0001), and 85% by 9 months. Analysis suggested BII in CG1 patients, too, who improved similarly. Among CG2 patients, healthy breast tissue showed mean and maximum MCCs of 5.0/hpf and 6.9/hpf. Mean and maximum MCCs in capsules in BII patients were 11.7/hpf and 16.3/hpf, and 7.6/hpf and 13.3/hpf in CG1 patients. All intergroup comparisons were significantly different (P < 0.0001). Conclusions MCCs in peri-implant capsules in BII patients are increased; some implanted patients appear to have unrecognized BII. Given that neoantigenic/xenobiotic exposures commonly trigger dysfunctional MCs in MCAS to heighten aberrant mediator expression driving inflammatory and other issues, further investigation of whether BII represents an implant-driven escalation of preexisting MCAS and whether an MCAS diagnosis flags risk for BII seems warranted.
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Affiliation(s)
- Èva S Nagy
- From the Sydney Oncoplastic Surgery, North Shore Health Hub, St Leonards, NSW, Australia
| | | | - Suzanne Danieletto
- Douglas Hanly Moir, Macquarie University Hospital, Macquarie Park, NSW, Australia
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177
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Akin C. Dilemma of Mast Cell Activation Syndrome: Overdiagnosed or Underdiagnosed? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:762-763. [PMID: 38458701 DOI: 10.1016/j.jaip.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 03/10/2024]
Affiliation(s)
- Cem Akin
- Department of Medicine, Division of Allergy and Immunology, University of Michigan, Ann Arbor, Mich.
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178
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Zaghmout T, Maclachlan L, Bedi N, Gülen T. Low Prevalence of Idiopathic Mast Cell Activation Syndrome Among 703 Patients With Suspected Mast Cell Disorders. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:753-761. [PMID: 38056692 DOI: 10.1016/j.jaip.2023.11.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/03/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Idiopathic mast cell activation syndrome (iMCAS) is characterized by severe, episodic systemic mast cell (MC) activation and mediator-related symptoms, an event-related increase in serum tryptase levels, and response to MC-targeted therapies in the absence of underlying IgE-mediated allergy or clonal MC disorder. Studies indicating its prevalence using evidence-based diagnostic criteria are lacking. OBJECTIVE To assess the prevalence and clinical and laboratory features of patients with iMCAS. METHODS We conducted a retrospective evaluation of data from 703 consecutive patients (aged ≥18 years) referred to our center based on suspicion of having MC disorders. Patients underwent a thorough clinical workup including patient history, allergy tests, KIT D816V mutation analysis, and/or bone marrow investigation. Disease activity was prospectively assessed during follow-up visits. RESULTS We identified 31 patients with confirmed iMCAS. Furthermore, hereditary α-tryptasemia was detected in three patients with baseline tryptase levels greater than 8 ng/mL. The most common clinical presentation during MCAS episodes was mucocutaneous symptoms in patients with iMCAS, especially urticaria or angioedema. However, these symptoms were less prevalent in patients with clonal MCAS (P = .015). The duration of diagnostic delay was significantly longer in patients with iMCAS compared to those with clonal MCAS (P = .02). CONCLUSIONS The overall prevalence of iMCAS was 4.4% in the entire cohort, which indicates that iMCAS is an uncommon condition. To accurately diagnose iMCAS, it is crucial to evaluate suspected patients using the three diagnostic MCAS criteria. This involves performing a comprehensive allergy work-up including laboratory tests and ultrasensitive mutation analysis of KIT D816V. Subsequently, recommended diagnostic algorithms should be applied.
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Affiliation(s)
- Taleb Zaghmout
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Solna, Division of Clinical Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
| | - Laura Maclachlan
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nawfal Bedi
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Theo Gülen
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine Solna, Division of Clinical Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Mastocytosis Center Karolinska, Karolinska University Hospital, Stockholm, Sweden.
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179
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Padoan A, Talli I, Cosma C, Moz S, Furlan G, Navaglia F, Marchioro L, Zaninotto M, Basso D, Plebani M. Analytical and clinical evaluations of SNIBE Maglumi chemiluminescent immunoassay for the detection of SARS-CoV-2 antigen in salivary samples. Clin Chem Lab Med 2024; 62:572-577. [PMID: 37787733 DOI: 10.1515/cclm-2023-0947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES In this study, we describe the analytical and clinical performances of the SNIBE Maglumi SARS-CoV-2 antigen fully-automated chemiluminescent immunoassay (MAG-CLIA) on salivary samples. METHODS Limit of detection (LOD), linearity and precision were tested for values close to or below the declared LOD. Clinical performance of MAG-CLIA was evaluated on leftover salivary samples from the healthcare workers (HCW) surveillance program, at the University-Hospital of Padova. Salivary samples were analyzed by Lumipulse G SARS-CoV-2 Ag, and in case where the values exceeded 0.41 ng/L, further testing was conducted using TaqPathTM COVID-19 RT-PCR (Applied Biosystems, Thermo Fisher Scientific). RESULTS The estimated MAG-CLIA LOD was 3 ng/L, with repeatability of 7.5 %. Good linearity was demonstrated by diluting two samples at 52.7 ng/L and 211.4 ng/L. Of the 228 HCW samples, 59/228 (25.9 %) were positive, 169/228 (74.1 %) were negative. MAG-CLIA SARS-CoV-2 sAg median level (and interquartile range [IQR]) was 5.03 ng/L (<0.001-35.8 ng/L) for positive and <0.001 ng/L (<0.001 ng/L) for negative samples. MAG-CLIA AUC was 0.795 (95 % CI: 0.720-0.871). Using the best cut-off, 3.5 ng/L, sensitivity and specificity were 57.1 % (95 % CI: 42.2-71.2 %) and 97.0 % (95 % CI: 93.2-99.0 %), respectively. The agreement with the molecular assay was 88.1 % (Cohen's kappa 0.606 [SE=0.066, p<0.001]). CONCLUSIONS The analytical performances of MAG-CLIA are satisfactory, also when values below LOD were tested. In saliva samples, although specificity was elevated, clinical performance was not comparable with that on nasopharyngeal swabs (NPS).
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Affiliation(s)
- Andrea Padoan
- Department of Medicine (DIMED), University of Padova, Padova, Italy
- Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
- QI.LAB.MED., Spin-off of the University of Padova, Padova, Italy
| | - Ilaria Talli
- Department of Medicine (DIMED), University of Padova, Padova, Italy
- Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
| | - Chiara Cosma
- Department of Medicine (DIMED), University of Padova, Padova, Italy
- Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
- QI.LAB.MED., Spin-off of the University of Padova, Padova, Italy
| | - Stefania Moz
- Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
| | - Giulia Furlan
- QI.LAB.MED., Spin-off of the University of Padova, Padova, Italy
| | - Filippo Navaglia
- Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
| | - Lucio Marchioro
- Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
- QI.LAB.MED., Spin-off of the University of Padova, Padova, Italy
| | - Martina Zaninotto
- Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
- QI.LAB.MED., Spin-off of the University of Padova, Padova, Italy
| | - Daniela Basso
- Department of Medicine (DIMED), University of Padova, Padova, Italy
- Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
- QI.LAB.MED., Spin-off of the University of Padova, Padova, Italy
| | - Mario Plebani
- Department of Medicine (DIMED), University of Padova, Padova, Italy
- Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
- QI.LAB.MED., Spin-off of the University of Padova, Padova, Italy
- Clinical Biochemistry and Clinical Molecular Biology, School of Medicine, University of Padova, Padova, Italy
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180
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Elvén M, Prenkert M, Holmström IK, Edelbring S. Reasoning about reasoning - using recall to unveil clinical reasoning in stroke rehabilitation teams. Disabil Rehabil 2024:1-10. [PMID: 38392962 DOI: 10.1080/09638288.2024.2320263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE The study objective was to investigate how health care providers in stroke teams reason about their clinical reasoning process in collaboration with the patient and next of kin. MATERIALS AND METHODS An explorative qualitative design using stimulated recall was employed. Audio-recordings from three rehabilitation dialogs were used as prompts in interviews with the involved staff about their clinical reasoning. A thematic analysis approach was employed. RESULTS A main finding was the apparent friction between profession-centered and person-centered clinical reasoning, which was salient in the data. Five themes were identified: the importance of different perspectives for a rich picture and well-informed decisions; shared understanding in analysis and decision-making - good intentions but difficult to achieve; the health care providers' expertise directs the dialog; the context's impact on the rehabilitation dialog; and insights about missed opportunities to grasp the patient perspective and arrive at decisions. CONCLUSIONS Interprofessional stroke teams consider clinical reasoning as a process valuing patient and next of kin perspectives; however, their professional expertise risks preventing individual needs from surfacing. There is a discrepancy between professionals' intentions for person-centeredness and how clinical reasoning plays out. Stimulated recall can unveil person-centered practice and enhance professionals' awareness of their clinical reasoning.
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Affiliation(s)
- Maria Elvén
- School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Malin Prenkert
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Inger K Holmström
- School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Samuel Edelbring
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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181
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Nicola S, Mazzola M, Lo Sardo L, Montabone E, Badiu I, Corradi F, Azzolina MCR, Dall’Acqua MG, Rolla G, Ridolfi I, Quinternetto A, Brussino L. Safety and Tolerability of COVID-19 Vaccine in Mast Cell Disorders Real-Life Data from a Single Centre in Italy. Vaccines (Basel) 2024; 12:202. [PMID: 38400185 PMCID: PMC10893122 DOI: 10.3390/vaccines12020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Background In the past three years, COVID-19 has had a significant impact on the healthcare systems and people's safety worldwide. Mass vaccinations dramatically improved the health and economic damage caused by SARS-CoV-2. However, the safety of COVID-19 vaccines in patients at high risk of allergic reactions still has many unmet needs that should be clarified. Material and methods A retrospective, single-centre study was performed by collecting demographic and clinical data of patients with Mast Cell Disorders (MCDs) to evaluate the safety and tolerability of COVID-19 vaccinations. Moreover, any changes in the natural history of the underlying disease following the vaccine have been evaluated. Results This study included 66 patients affected with MCDs. Out of them, 52 (78.8%) received a COVID-19 vaccination and 41 (78.8%) completed the vaccination course. Premedication came first in 86.6% of our patients. A total of seven (4.5%) patients complained about an immediate reaction and two (1.3%) had a late reaction. Worsening of MCD history was observed in a single patient. Conclusions Despite the overall high risk of allergic reactions, our study did not reveal any increased risk for SARS-CoV-2 allergic reactions in MCD patients, thus supporting the recommendation in favour of the SARS-CoV-2 vaccination. However, due to the potentially increased rate of anaphylactic reactions, MCD patients should receive vaccine premedication and should be treated in a hospital setting after an allergological specialistic evaluation.
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Affiliation(s)
- Stefania Nicola
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
| | - Marina Mazzola
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
| | - Luca Lo Sardo
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
| | - Erika Montabone
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
| | - Iuliana Badiu
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
| | - Federica Corradi
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
| | - Maria Carmen Rita Azzolina
- Health Direction, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (M.C.R.A.)
| | | | - Giovanni Rolla
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
| | - Irene Ridolfi
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
| | - Anna Quinternetto
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
| | - Luisa Brussino
- SCDU Immunologia e Allergologia, A.O. Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy; (S.N.); (M.M.); (L.L.S.); (E.M.); (I.B.); (F.C.); (A.Q.); (L.B.)
- Department of Medical Sciences, University of Torino, C.so AM Dogliotti, 14, 10126 Torino, Italy;
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182
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Adler BL, Chung T, Rowe PC, Aucott J. Dysautonomia following Lyme disease: a key component of post-treatment Lyme disease syndrome? Front Neurol 2024; 15:1344862. [PMID: 38390594 PMCID: PMC10883079 DOI: 10.3389/fneur.2024.1344862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Dysautonomia, or dysfunction of the autonomic nervous system (ANS), may occur following an infectious insult and can result in a variety of debilitating, widespread, and often poorly recognized symptoms. Dysautonomia is now widely accepted as a complication of COVID-19 and is an important component of Post-Acute Sequelae of COVID-19 (PASC or long COVID). PASC shares many overlapping clinical features with other infection-associated chronic illnesses including Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Post-Treatment Lyme Disease Syndrome (PTLDS), suggesting that they may share common underlying mechanisms including autonomic dysfunction. Despite the recognition of this complication of Lyme disease in the care of patients with PTLD, there has been a scarcity of research in this field and dysautonomia has not yet been established as a complication of Lyme disease in the medical literature. In this review, we discuss the evidence implicating Borrelia burgdorferi as a cause of dysautonomia and the related symptoms, propose potential pathogenic mechanisms given our knowledge of Lyme disease and mechanisms of PASC and ME/CFS, and discuss the diagnostic evaluation and treatments of dysautonomia. We also outline gaps in the literature and priorities for future research.
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Affiliation(s)
- Brittany L Adler
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
| | - Tae Chung
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - Peter C Rowe
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, United States
| | - John Aucott
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
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183
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Lippi G, Salvagno GL. Cardiac troponin T (cTnT) assessment using incompletely filled K2EDTA blood tubes is reliable. EINSTEIN-SAO PAULO 2024; 22:eCE0613. [PMID: 38324845 PMCID: PMC10948097 DOI: 10.31744/einstein_journal/2024ce0613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/11/2023] [Indexed: 02/09/2024] Open
Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine , University of Verona , Verona , Italy
| | - Gian Luca Salvagno
- Section of Clinical Biochemistry and School of Medicine , University of Verona , Verona , Italy
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184
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Scher MS, Agarwal S, Venkatesen C. Clinical decisions in fetal-neonatal neurology II: Gene-environment expression over the first 1000 days presenting as "four great neurological syndromes". Semin Fetal Neonatal Med 2024; 29:101522. [PMID: 38637242 DOI: 10.1016/j.siny.2024.101522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Interdisciplinary fetal-neonatal neurology (FNN) training considers a woman's reproductive and pregnancy health histories when assessing the "four great neonatal neurological syndromes". This maternal-child dyad exemplifies the symptomatic neonatal minority, compared with the silent majority of healthy children who experience preclinical diseases with variable expressions over the first 1000 days. Healthy maternal reports with reassuring fetal surveillance testing preceded signs of fetal distress during parturition. An encephalopathic neonate with seizures later exhibited childhood autistic spectrum behaviors and intractable epilepsy correlated with identified genetic biomarkers. A systems biology approach to etiopathogenesis guides the diagnostic process to interpret phenotypic form and function. Evolving gene-environment interactions expressed by changing phenotypes reflect a dynamic neural exposome influenced by reproductive and pregnancy health. This strategy considers critical/sensitive periods of neuroplasticity beyond two years of life to encompass childhood and adolescence. Career-long FNN experiences reenforce earlier training to strengthen the cognitive process and minimize cognitive biases when assessing children or adults. Prioritizing social determinants of healthcare for persons with neurologic disorders will help mitigate the global burden of brain diseases for all women and children.
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Affiliation(s)
- Mark S Scher
- Pediatrics and Neurology, Rainbow Babies and Children's Hospital Case Western Reserve University School of Medicine, USA.
| | - Sonika Agarwal
- Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, USA.
| | - Charu Venkatesen
- Neurology and Pediatrics, Cincinnati Children's Hospital, Cincinnati School of Medicine, USA.
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185
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Cosby K, Yang D, Fineberg HV. Assessing Diagnostic Performance. NEJM EVIDENCE 2024; 3:EVIDra2300232. [PMID: 38320492 DOI: 10.1056/evidra2300232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Assessing Diagnostic PerformanceDiagnosis is an action and a goal in medicine. This article is the introduction to a series of review articles on varying facets of diagnosis. Clinical diagnosis is an exercise in classification; that is, placing the patient's condition in the correct diagnostic category. However, consideration must also be given to the performance objective, whether it is technical performance of a test, acquiring diagnostic information with respect to clinical management for an individual or a population's health outcomes, or cost-effectiveness and equity of care.
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Affiliation(s)
- Karen Cosby
- Gordon and Betty Moore Foundation, Palo Alto, CA
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186
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Hofman P, Berezowska S, Kazdal D, Mograbi B, Ilié M, Stenzinger A, Hofman V. Current challenges and practical aspects of molecular pathology for non-small cell lung cancers. Virchows Arch 2024; 484:233-246. [PMID: 37801103 PMCID: PMC10948551 DOI: 10.1007/s00428-023-03651-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Abstract
The continuing evolution of treatment options in thoracic oncology requires the pathologist to regularly update diagnostic algorithms for management of tumor samples. It is essential to decide on the best way to use tissue biopsies, cytological samples, as well as liquid biopsies to identify the different mandatory predictive biomarkers of lung cancers in a short turnaround time. However, biological resources and laboratory member workforce are limited and may be not sufficient for the increased complexity of molecular pathological analyses and for complementary translational research development. In this context, the surgical pathologist is the only one who makes the decisions whether or not to send specimens to immunohistochemical and molecular pathology platforms. Moreover, the pathologist can rapidly contact the oncologist to obtain a new tissue biopsy and/or a liquid biopsy if he/she considers that the biological material is not sufficient in quantity or quality for assessment of predictive biomarkers. Inadequate control of algorithms and sampling workflow may lead to false negative, inconclusive, and incomplete findings, resulting in inappropriate choice of therapeutic strategy and potentially poor outcome for patients. International guidelines for lung cancer treatment are based on the results of the expression of different proteins and on genomic alterations. These guidelines have been established taking into consideration the best practices to be set up in clinical and molecular pathology laboratories. This review addresses the current predictive biomarkers and algorithms for use in thoracic oncology molecular pathology as well as the central role of the pathologist, notably in the molecular tumor board and her/his participation in the treatment decision-making. The perspectives in this setting will be discussed.
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Affiliation(s)
- Paul Hofman
- Côte d'Azur University, FHU OncoAge, IHU RespirERA, Laboratory of Clinical and Experimental Pathology, BB-0033-00025, Louis Pasteur Hospital, 30 avenue de la voie romaine, BP69, 06001, Nice cedex 01, France.
- Côte d'Azur University, IRCAN, Inserm, CNRS 7284, U1081, Nice, France.
| | - Sabina Berezowska
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Daniel Kazdal
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Centers for Personalized Medicine (ZPM), Heidelberg, Germany
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Baharia Mograbi
- Côte d'Azur University, FHU OncoAge, IHU RespirERA, Laboratory of Clinical and Experimental Pathology, BB-0033-00025, Louis Pasteur Hospital, 30 avenue de la voie romaine, BP69, 06001, Nice cedex 01, France
- Côte d'Azur University, IRCAN, Inserm, CNRS 7284, U1081, Nice, France
| | - Marius Ilié
- Côte d'Azur University, FHU OncoAge, IHU RespirERA, Laboratory of Clinical and Experimental Pathology, BB-0033-00025, Louis Pasteur Hospital, 30 avenue de la voie romaine, BP69, 06001, Nice cedex 01, France
- Côte d'Azur University, IRCAN, Inserm, CNRS 7284, U1081, Nice, France
| | - Albrecht Stenzinger
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Centers for Personalized Medicine (ZPM), Heidelberg, Germany
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Véronique Hofman
- Côte d'Azur University, FHU OncoAge, IHU RespirERA, Laboratory of Clinical and Experimental Pathology, BB-0033-00025, Louis Pasteur Hospital, 30 avenue de la voie romaine, BP69, 06001, Nice cedex 01, France
- Côte d'Azur University, IRCAN, Inserm, CNRS 7284, U1081, Nice, France
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187
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Lippi G, Pighi L, Tosi M, Vettori M, Celegon G, Favaloro EJ, Salvagno GL. Effect of syringe underfilling on the quality of venous blood gas analysis. Diagnosis (Berl) 2024; 11:91-96. [PMID: 37665244 DOI: 10.1515/dx-2023-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/13/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES There is limited information on the influence of collecting small amounts of blood on the quality of blood gas analysis. Therefore, the purpose of this study was to investigate the effects of different degrees of underfilling of syringes on test results of venous blood gas analysis. METHODS Venous blood was collected by venipuncture from 19 healthcare workers in three 1.0 mL syringes for blood gas analysis, by manually aspirating different volumes of blood (i.e., 1.0, 0.5 and 0.25 mL). Routine blood gas analysis was then immediately performed with GEM Premier 5,000. The results of the two underfilled syringes were compared with those of the reference syringe filled with appropriate blood volume. RESULTS The values of most assayed parameters did not differ significantly in the two underfilled syringes. Statistically significant variations were found for lactate, hematocrit and total hemoglobin, the values of which gradually increased as the fill volume diminished, as well as for sodium concentration, which decreased in both insufficiently filled blood gas syringes. The bias was clinically meaningful for lactate in syringe filled with 0.25 mL of blood, and for hematocrit, total hemoglobin and sodium in both syringes containing 0.5 and 0.25 mL of blood. CONCLUSIONS Collection of smaller volumes of venous blood than the specified filling volume in blood gas syringes may have an effect on the quality of some test results, namely lactate, hematocrit, total hemoglobin and sodium. Specific indications must be given for standardizing the volume of blood to be collected within these syringes.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Laura Pighi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Marco Tosi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Marco Vettori
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Giovanni Celegon
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Emmanuel J Favaloro
- Department of Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, NSW, Australia
- Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Gian Luca Salvagno
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
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188
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Kotwal S, Singh A, Tackett S, Bery AK, Omron R, Gold D, Newman-Toker DE, Wright SM. Assessing clinical reasoning skills following a virtual patient dizziness curriculum. Diagnosis (Berl) 2024; 11:73-81. [PMID: 38079609 DOI: 10.1515/dx-2023-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/09/2023] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Dizziness is a common medical symptom that is frequently misdiagnosed. While virtual patient (VP) education has been shown to improve diagnostic accuracy for dizziness as assessed by VPs, trainee performance has not been assessed on human subjects. The study aimed to assess whether internal medicine (IM) interns after training on a VP-based dizziness curriculum using a deliberate practice framework would demonstrate improved clinical reasoning when assessed in an objective structured clinical examination (OSCE). METHODS All available interns volunteered and were randomized 2:1 to intervention (VP education) vs. control (standard clinical teaching) groups. This quasi-experimental study was conducted at one academic medical center from January to May 2021. Both groups completed pre-posttest VP case assessments (scored as correct diagnosis across six VP cases) and participated in an OSCE done 6 weeks later. The OSCEs were recorded and assessed using a rubric that was systematically developed and validated. RESULTS Out of 21 available interns, 20 participated. Between intervention (n=13) and control (n=7), mean pretest VP diagnostic accuracy scores did not differ; the posttest VP scores improved for the intervention group (3.5 [SD 1.3] vs. 1.6 [SD 0.8], p=0.007). On the OSCE, the means scores were higher in the intervention (n=11) compared to control group (n=4) for physical exam (8.4 [SD 4.6] vs. 3.9 [SD 4.0], p=0.003) and total rubric score (43.4 [SD 12.2] vs. 32.6 [SD 11.3], p=0.04). CONCLUSIONS The VP-based dizziness curriculum resulted in improved diagnostic accuracy among IM interns with enhanced physical exam skills retained at 6 weeks post-intervention.
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Affiliation(s)
- Susrutha Kotwal
- Department of Medicine, Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amteshwar Singh
- Department of Medicine, Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sean Tackett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anand K Bery
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa, Canada
| | - Rodney Omron
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Gold
- Department of Neurology, Division of Neuro-Visual & Vestibular Disorders, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David E Newman-Toker
- Department of Neurology, Division of Neuro-Visual & Vestibular Disorders, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott M Wright
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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189
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Dalal AK, Schnipper JL, Raffel K, Ranji S, Lee T, Auerbach A. Identifying and classifying diagnostic errors in acute care across hospitals: Early lessons from the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study. J Hosp Med 2024; 19:140-145. [PMID: 37211760 DOI: 10.1002/jhm.13136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 04/20/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Anuj K Dalal
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeffrey L Schnipper
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Katie Raffel
- Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Sumant Ranji
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Andrew Auerbach
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
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190
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Harada Y, Otaka Y, Katsukura S, Shimizu T. Prevalence of atypical presentations among outpatients and associations with diagnostic error. Diagnosis (Berl) 2024; 11:40-48. [PMID: 38059495 DOI: 10.1515/dx-2023-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES This study aimed to assess the prevalence of atypical presentations and their association with diagnostic errors in various diseases. METHODS This retrospective observational study was conducted using cohort data between January 1 and December 31, 2019. Consecutive outpatients consulted by physicians from the Department of Diagnostic and Generalist Medicine at a university hospital in Japan were included. Patients for whom the final diagnosis was not confirmed were excluded. Primary outcomes were the prevalence of atypical presentations, and the prevalence of diagnostic errors in groups with typical and atypical presentations. Diagnostic errors and atypical presentations were assessed using the Revised Safer Dx Instrument. We performed primary analyses using a criterion; the average score of less than five to item 12 of two independent reviewers was an atypical presentation (liberal criterion). We also performed additional analyses using another criterion; the average score of three or less to item 12 was an atypical presentation (conservative criterion). RESULTS A total of 930 patients were included out of a total of 2022 eligible. The prevalence of atypical presentation was 21.7 and 6.7 % when using liberal and conservative criteria for atypical presentation, respectively. Diagnostic errors (2.8 %) were most commonly observed in the cases with slight to moderate atypical presentation. Atypical presentation was associated with diagnostic errors with the liberal criterion for atypical presentation; however, this diminished with the conservative criterion. CONCLUSIONS An atypical presentation was observed in up to 20 % of outpatients with a confirmed diagnosis, and slight to moderate atypical presentation may be the highest risk population for diagnostic errors.
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Affiliation(s)
- Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Shimotsugagun, Tochigi, Japan
| | - Yumi Otaka
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Shimotsugagun, Tochigi, Japan
| | - Shinichi Katsukura
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Shimotsugagun, Tochigi, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Shimotsugagun, Tochigi, Japan
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191
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Ocal S, Schiller E, Alpert JB, Stavrakis C, Fefferman NR, Hoffmann JC. Design, Implementation, and Initial Impact of a Longitudinal Radiology Curriculum in a Primary Care-Focused Medical School. J Am Coll Radiol 2024; 21:346-349. [PMID: 36893997 DOI: 10.1016/j.jacr.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Selin Ocal
- Medical Student MS3, NYU Long Island School of Medicine, Mineola, New York; ACR Member, ACR Medical Student Subcommittee Member.
| | - Emily Schiller
- Medical Student MS2, NYU Long Island School of Medicine, Mineola, New York; ACR Member
| | - Jeffrey B Alpert
- Associate Professor, Department of Radiology at NYU Grossman School of Medicine; Department of Thoracic Radiology and Department of Radiology, NYU Langone Health, New York, New York
| | - Costas Stavrakis
- Clinical Assistant Professor, Department of Radiology at NYU Long Island School of Medicine, Mineola, New York; and Department of Musculoskeletal Radiology, NYU Langone Health, New York, New York; and ACR Member
| | - Nancy R Fefferman
- Vice Chair for Education; Section Chief Pediatric Radiology; Associate Professor, Department of Radiology at NYU Grossman School of Medicine, Department of Radiology, NYU Langone Health, New York, New York
| | - Jason C Hoffmann
- Director, Diagnostic Radiology Residency Program, NYU Langone Hospital-Long Island, Mineola, New York, and Associate Professor, Department of Radiology at NYU Long Island School of Medicine, New York, New York; President of the NYU Long Island School of Medicine Faculty Council; ACR Member
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192
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Kobayashi T, Ono Y. Medical history-taking by highlighting the time course: PODCAST approach. Diagnosis (Berl) 2024; 11:109-111. [PMID: 37677070 DOI: 10.1515/dx-2023-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Takahiro Kobayashi
- Department of General Medicine, National Defense Medical College, Saitama, Japan
| | - Yosuke Ono
- Department of General Medicine, National Defense Medical College, Saitama, Japan
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193
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Auerbach AD, Lee TM, Hubbard CC, Ranji SR, Raffel K, Valdes G, Boscardin J, Dalal AK, Harris A, Flynn E, Schnipper JL. Diagnostic Errors in Hospitalized Adults Who Died or Were Transferred to Intensive Care. JAMA Intern Med 2024; 184:164-173. [PMID: 38190122 PMCID: PMC10775080 DOI: 10.1001/jamainternmed.2023.7347] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/07/2023] [Indexed: 01/09/2024]
Abstract
Importance Diagnostic errors contribute to patient harm, though few data exist to describe their prevalence or underlying causes among medical inpatients. Objective To determine the prevalence, underlying cause, and harms of diagnostic errors among hospitalized adults transferred to an intensive care unit (ICU) or who died. Design, Setting, and Participants Retrospective cohort study conducted at 29 academic medical centers in the US in a random sample of adults hospitalized with general medical conditions and who were transferred to an ICU, died, or both from January 1 to December 31, 2019. Each record was reviewed by 2 trained clinicians to determine whether a diagnostic error occurred (ie, missed or delayed diagnosis), identify diagnostic process faults, and classify harms. Multivariable models estimated association between process faults and diagnostic error. Opportunity for diagnostic error reduction associated with each fault was estimated using the adjusted proportion attributable fraction (aPAF). Data analysis was performed from April through September 2023. Main Outcomes and Measures Whether or not a diagnostic error took place, the frequency of underlying causes of errors, and harms associated with those errors. Results Of 2428 patient records at 29 hospitals that underwent review (mean [SD] patient age, 63.9 [17.0] years; 1107 [45.6%] female and 1321 male individuals [54.4%]), 550 patients (23.0%; 95% CI, 20.9%-25.3%) had experienced a diagnostic error. Errors were judged to have contributed to temporary harm, permanent harm, or death in 436 patients (17.8%; 95% CI, 15.9%-19.8%); among the 1863 patients who died, diagnostic error was judged to have contributed to death in 121 (6.6%; 95% CI, 5.3%-8.2%). In multivariable models examining process faults associated with any diagnostic error, patient assessment problems (aPAF, 21.4%; 95% CI, 16.4%-26.4%) and problems with test ordering and interpretation (aPAF, 19.9%; 95% CI, 14.7%-25.1%) had the highest opportunity to reduce diagnostic errors; similar ranking was seen in multivariable models examining harmful diagnostic errors. Conclusions and Relevance In this cohort study, diagnostic errors in hospitalized adults who died or were transferred to the ICU were common and associated with patient harm. Problems with choosing and interpreting tests and the processes involved with clinician assessment are high-priority areas for improvement efforts.
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Affiliation(s)
- Andrew D. Auerbach
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco
| | - Tiffany M. Lee
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco
| | - Colin C. Hubbard
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco
| | - Sumant R. Ranji
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Katie Raffel
- Department of Medicine, University of Colorado School of Medicine, Denver
| | - Gilmer Valdes
- Department of Radiation Oncology, University of California San Francisco
| | - John Boscardin
- Division of Geriatrics, Department of Medicine, University of California San Francisco
| | - Anuj K. Dalal
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
| | | | | | - Jeffrey L. Schnipper
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
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194
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Fernández Reina A, López Abellán MD, Attaibi Hadri S, Puche Candel Á, Díaz López MI, Fernández EP, Orgaz Morales MT, García de Guadiana-Romualdo L. Reliability of a point of care testing blood gas analyzer for measurement of lactate levels in cerebrospinal fluid. Scand J Clin Lab Invest 2024; 84:76-78. [PMID: 38376201 DOI: 10.1080/00365513.2024.2318619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024]
Abstract
Analysis of cerebrospinal fluid (CSF), including lactate, is key for diagnosis of acute meningitis. Since blood gas analyzers (BGA) enable rapid and safe blood-lactate measurements, we evaluated the reliability of RAPIDPoint 500 BGA to provide a fast and accurate measure of CSF lactate. In this study, CSF lactate levels were measured by a reference assay and on RAPIDPoint 500 BGA. Comparability was evaluated through difference analysis, using Bland Altman test, and linear regression analysis, using the Passing Bablok test. Agreement rate according to CSF lactate (≥3.5 and <3.5 mmol/L) was calculated using kappa (κ) statistic. Population study included 98 CSF samples. Concerning difference analysis, according to Bland-Altman test, bias was 0.13 mmol/L (CI 95%: -0.26 to 0.52 mmol/L. In regression analysis, according to Passing-Bablok equation a systematic difference between both assays was found. In concordance analysis, the interrate realibility was very high (κ: 0.964). According to our resuls, although a systematic difference was detected when lactate levels were measured on RAPIDPoint 500 BGA, the results from Bland-Altman test and the high agreement rate support that this POCT analyzer could be useful for a early and safe detection of patients with high probability of increased CSF lactate level.
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Affiliation(s)
| | | | - Samir Attaibi Hadri
- Laboratory Medicine Department, Hospital Universitario Santa Lucía, Cartagena, Spain
| | - Ángela Puche Candel
- Laboratory Medicine Department, Hospital Universitario Santa Lucía, Cartagena, Spain
| | | | - Eva Pérez Fernández
- Laboratory Medicine Department, Hospital Universitario Santa Lucía, Cartagena, Spain
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Kulkarni SA, Wachter RM. The Hospitalist Movement 25 Years Later. Annu Rev Med 2024; 75:381-390. [PMID: 37802086 DOI: 10.1146/annurev-med-051022-043301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Hospitalists are generalists who specialize in the care of hospitalized patients. In the 25 years since the term hospitalist was coined, the field of hospital medicine has grown exponentially and established a substantial footprint in the medical community. There are now more hospitalists than practicing physicians in any other internal medicine subspecialty. Several key forces catalyzed the growth in the field of hospital medicine, including the quality, safety, and value movements; residency duty hour restrictions; the emergence of electronic health records; and the COVID-19 pandemic. Looking ahead, we see new opportunities in the realms of technology and telemedicine, and challenges persist in regard to balancing financial considerations with increasing workload and burnout. Hospitalists must remain nimble and seize emerging opportunities to continue supporting the field's prominence and growth.
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Affiliation(s)
- Shradha A Kulkarni
- Department of Medicine, University of California, San Francisco, California, USA; ,
| | - Robert M Wachter
- Department of Medicine, University of California, San Francisco, California, USA; ,
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196
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V Carvalho AS, Broekema B, Brito Fernandes Ó, Klazinga N, Kringos D. Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review. BMC Emerg Med 2024; 24:19. [PMID: 38273229 PMCID: PMC10811879 DOI: 10.1186/s12873-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic severely impacted care for non-COVID patients. Performance indicators to monitor acute care, timely reported and internationally accepted, lacked during the pandemic in OECD countries. This study aims to summarize the performance indicators available in the literature to monitor changes in the quality of acute care in OECD countries during the first year and a half of the pandemic (2020-July 2021) and to assess their trends. METHODS Scoping review. Search in Embase and MEDLINE (07-07-2022). Acute care performance indicators and indicators related to acute general surgery were collected and collated following a care pathway approach. Indicators assessing identical clinical measures were grouped under a common indicator title. The trends from each group of indicators were collated (increase/decrease/stable). RESULTS A total of 152 studies were included. 2354 indicators regarding general acute care and 301 indicators related to acute general surgery were included. Indicators focusing on pre-hospital services reported a decreasing trend in the volume of patients: from 225 indicators, 110 (49%) reported a decrease. An increasing trend in pre-hospital treatment times was reported by most of the indicators (n = 41;70%) and a decreasing trend in survival rates of out-of-hospital cardiac arrest (n = 61;75%). Concerning care provided in the emergency department, most of the indicators (n = 752;71%) showed a decreasing trend in admissions across all levels of urgency. Concerning the mortality rate after admission, most of the indicators (n = 23;53%) reported an increasing trend. The subset of indicators assessing acute general surgery showed a decreasing trend in the volume of patients (n = 50;49%), stability in clinical severity at admission (n = 36;53%), and in the volume of surgeries (n = 14;47%). Most of the indicators (n = 28;65%) reported no change in treatment approach and stable mortality rate (n = 11,69%). CONCLUSION This review signals relevant disruptions across the acute care pathway. A subset of general surgery performance indicators showed stability in most of the phases of the care pathway. These results highlight the relevance of assessing this care pathway more regularly and systematically across different clinical entities to monitor disruptions and to improve the resilience of emergency services during a crisis.
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Affiliation(s)
- Ana Sofia V Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Bente Broekema
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Pediatrics, Dijklander Hospital, Location Hoorn, Maelsonstraat 3, Hoorn, 1624 NP, The Netherlands
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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197
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Lippi G, Mattiuzzi C, Favaloro EJ. Artificial intelligence in the pre-analytical phase: State-of-the art and future perspectives. J Med Biochem 2024; 43:1-10. [PMID: 38496022 PMCID: PMC10943465 DOI: 10.5937/jomb0-45936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 03/19/2024] Open
Abstract
The use of artificial intelligence (AI) has become widespread in many areas of science and medicine, including laboratory medicine. Although it seems obvious that the analytical and post-analytical phases could be the most important fields of application in laboratory medicine, a kaleidoscope of new opportunities has emerged to extend the benefits of AI to many manual labor-intensive activities belonging to the pre-analytical phase, which are inherently characterized by enhanced vulnerability and higher risk of errors. These potential applications involve increasing the appropriateness of test prescription (with computerized physician order entry or demand management tools), improved specimen collection (using active patient recognition, automated specimen labeling, vein recognition and blood collection assistance, along with automated blood drawing), more efficient sample transportation (facilitated by the use of pneumatic transport systems or drones, and monitored with smart blood tubes or data loggers), systematic evaluation of sample quality (by measuring serum indices, fill volume or for detecting sample clotting), as well as error detection and analysis. Therefore, this opinion paper aims to discuss the state-of-the-art and some future possibilities of AI in the preanalytical phase.
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Affiliation(s)
- Giuseppe Lippi
- University of Verona, Section of Clinical Biochemistry and School of Medicine, Verona, Italy
| | - Camilla Mattiuzzi
- Hospital of Rovereto, Provincial Agency for Social and Sanitary Services (APSS), Medical Direction, Trento, Italy
| | - Emmanuel J. Favaloro
- Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, Department of Haematology, NSW Health Pathology, Westmead Hospital, Westmead, NSW Australia
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198
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Mazer BL. Mergers and afflictions: can wellness soothe the healthcare beast? J Clin Pathol 2024; 77:96-97. [PMID: 38053277 DOI: 10.1136/jcp-2023-209211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Benjamin L Mazer
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
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199
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de C Williams AC, McGrigor H. A thematic synthesis of qualitative studies and surveys of the psychological experience of painful endometriosis. BMC Womens Health 2024; 24:50. [PMID: 38238741 PMCID: PMC10795225 DOI: 10.1186/s12905-023-02874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/28/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Endometriosis is a widespread problem in women of reproductive age, causing cyclical and non-cyclical pain in the pelvis and elsewhere, and associated with fatigue, fertility problems, and other symptoms. As a chronic pain problem, psychological variables are important in adjustment and quality of life, but have not been systematically studied. METHODS A systematic search of multiple databases was conducted to obtain surveys and qualitative studies of women's experience of pain from endometriosis. Surveys were combined narratively; qualitative studies were combined by thematic synthesis, and the latter rated for methodological quality. RESULTS Over 2000 records were screened on title and abstract, and provided 22 surveys and 33 qualitative studies from which accounts could be extracted of the psychological components of pain in endometriosis. Surveys mostly addressed quality of life in endometriosis, with poorer quality of life associated with higher levels of pain and of distress, but few referred to coherent psychological models. Qualitative studies focused rather on women's experience of living with endometriosis, including trajectories of diagnosis and treatment, with a few addressing meaning and identity. Thematic synthesis provided 10 themes, under the groupings of internal experience of endometriosis (impact on body, emotions, and life); interface with the external world (through self-regulation and social regulation); effects on interpersonal and social life, and encounters with medical care. CONCLUSIONS The psychological components of pain from endometriosis only partly corresponded with standard psychological models of pain, derived from musculoskeletal pain studies, with fewer fears about physical integrity and more about difficulties of managing pain and other symptoms in social settings, including work. Better understanding of the particular psychological threats of endometriosis, and integration of this understanding into medical care with opportunities for psychologically-based pain management, would substantially improve the experience and quality of life of women with painful endometriosis.
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Affiliation(s)
- Amanda C de C Williams
- Research Dept of Clinical, Educational & Health Psychology, University College London, Gower St, London, WC1E 6BT, UK.
| | - Honor McGrigor
- Research Dept of Clinical, Educational & Health Psychology, University College London, Gower St, London, WC1E 6BT, UK
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200
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Devis L, Catry E, Honore PM, Mansour A, Lippi G, Mullier F, Closset M. Interventions to improve appropriateness of laboratory testing in the intensive care unit: a narrative review. Ann Intensive Care 2024; 14:9. [PMID: 38224401 PMCID: PMC10789714 DOI: 10.1186/s13613-024-01244-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024] Open
Abstract
Healthcare expenses are increasing, as is the utilization of laboratory resources. Despite this, between 20% and 40% of requested tests are deemed inappropriate. Improper use of laboratory resources leads to unwanted consequences such as hospital-acquired anemia, infections, increased costs, staff workload and patient stress and discomfort. The most unfavorable consequences result from unnecessary follow-up tests and treatments (overuse) and missed or delayed diagnoses (underuse). In this context, several interventions have been carried out to improve the appropriateness of laboratory testing. To date, there have been few published assessments of interventions specific to the intensive care unit. We reviewed the literature for interventions implemented in the ICU to improve the appropriateness of laboratory testing. We searched literature from 2008 to 2023 in PubMed, Embase, Scopus, and Google Scholar databases between April and June 2023. Five intervention categories were identified: education and guidance (E&G), audit and feedback, gatekeeping, computerized physician order entry (including reshaping of ordering panels), and multifaceted interventions (MFI). We included a sixth category exploring the potential role of artificial intelligence and machine learning (AI/ML)-based assisting tools in such interventions. E&G-based interventions and MFI are the most frequently used approaches. MFI is the most effective type of intervention, and shows the strongest persistence of effect over time. AI/ML-based tools may offer valuable assistance to the improvement of appropriate laboratory testing in the near future. Patient safety outcomes are not impaired by interventions to reduce inappropriate testing. The literature focuses mainly on reducing overuse of laboratory tests, with only one intervention mentioning underuse. We highlight an overall poor quality of methodological design and reporting and argue for standardization of intervention methods. Collaboration between clinicians and laboratory staff is key to improve appropriate laboratory utilization. This article offers practical guidance for optimizing the effectiveness of an intervention protocol designed to limit inappropriate use of laboratory resources.
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Affiliation(s)
- Luigi Devis
- Department of Laboratory Medicine, Biochemistry, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Emilie Catry
- Department of Laboratory Medicine, Biochemistry, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
- Institute for Experimental and Clinical Research (IREC), Pôle Mont Godinne (MONT), UCLouvain, Yvoir, Belgium
| | - Patrick M Honore
- Department of Intensive Care, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Alexandre Mansour
- Department of Anesthesia and Critical Care, Pontchaillou University Hospital of Rennes, Rennes, France
- IRSET-INSERM-1085, Univ Rennes, Rennes, France
| | - Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University Hospital of Verona, Verona, Italy
| | - François Mullier
- Department of Laboratory Medicine, Hematology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
- Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Namur, Belgium
- Institute for Experimental and Clinical Research (IREC), Pôle Mont Godinne (MONT), UCLouvain, Yvoir, Belgium
| | - Mélanie Closset
- Department of Laboratory Medicine, Biochemistry, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium.
- Institute for Experimental and Clinical Research (IREC), Pôle Mont Godinne (MONT), UCLouvain, Yvoir, Belgium.
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