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1.
Swiss Med Wkly ; 151: w20471, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33580705

RESUMO

OBJECTIVES: To develop and validate a screening tool designed to identify detained people at increased risk for COVID-19 mortality, the COVID-19 Inmate Risk Appraisal (CIRA). DESIGN: Cross-sectional study with a representative sample (development) and a case-control sample (validation). SETTING: The two largest Swiss prisons. PARTICIPANTS: (1) Development sample: all male persons detained in Pöschwies, Zurich (n = 365); (2) Validation sample: case-control sample of male persons detained in Champ-Dollon, Geneva (n = 192, matching 1:3 for participants at risk for severe course of COVID-19 and participants without risk factors). MAIN OUTCOME MEASURES: The CIRA combined seven risk factors identified by the World Health Organization and the Swiss Federal Office of Public Health as predictive of severe COVID-19 to derive an absolute risk increase in mortality rate: Age ≥60 years, cardiovascular disease, diabetes, hypertension, chronic respiratory disease, immunodeficiency and cancer. RESULTS: Based on the development sample, we proposed a three-level classification: average (<3.7), elevated (3.7-5.7) and high (>5.7) risk. In the validation sample, the CIRA identified all individuals identified as vulnerable by national recommendations (having at least one risk factor). The category “elevated risk” maximised sensitivity (1) and specificity (0.97). The CIRA had even higher capacity in discriminating individuals vulnerable according to clinical evaluation (a four-level risk categorisation based on a consensus of medical staff). The category “elevated risk” maximised sensitivity and specificity (both 1). When considering the individuals classified as extremely high risk by medical staff, the category “high risk” had a high discriminatory capacity (sensitivity =0.89, specificity =0.97). CONCLUSIONS: The CIRA scores have a high discriminative ability and will be important in custodial settings to support decisions and prioritise actions using a standardised valid assessment method. However, as knowledge on risk factors for COVID-19 mortality is still limited, the CIRA may be considered preliminary. Underlying data will be updated regularly on the website (http://www.prison-research.com), where the CIRA algorithm is freely available.


Assuntos
/etiologia , Técnicas de Apoio para a Decisão , Programas de Rastreamento/normas , Prisioneiros/estatística & dados numéricos , Medição de Risco/normas , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Prisões , Reprodutibilidade dos Testes , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Suíça
3.
J Urol ; 205(1): 250-256, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32716680

RESUMO

PURPOSE: Given the increasing prevalence of chronic kidney disease in people with spina bifida, we sought to determine if this is associated with an increase in end stage kidney disease. We examined population based data to measure the frequency of procedures to establish renal replacement therapy-a marker for end stage kidney disease-among patients with spina bifida. MATERIALS AND METHODS: We used the Healthcare Cost and Utilization Project State Inpatient Database and State Ambulatory Surgery and Services Database from Florida, Kentucky, Maryland and New York (2000 to 2014), which include encounter level data. With a diagnosis code based algorithm we identified all procedural encounters made by patients with spina bifida. We determined the percentage of these encounters that were for facilitating renal replacement therapy (ie arteriovenous anastomosis, renal transplantation). We assessed for changes over time in this percentage with the Cochran-Armitage trend test. Bivariate analysis was performed using chi-square test. RESULTS: Of all procedures performed on patients with spina bifida over this time the proportion of procedures performed to establish renal replacement therapy significantly decreased in both the inpatient and outpatient settings (p=0.042 and p <0.001, respectively). People with spina bifida undergoing procedures to establish renal replacement therapy were, on average, young adults (mean age 34.5 and 36.0 years) with a high prevalence hypertension (75.8% of inpatients, 68.6% of outpatients). CONCLUSIONS: The frequency of surgeries to initiate renal replacement therapy among people with spina bifida undergoing procedures is low and is not increasing. This highlights the importance of consistent care throughout adolescence and young adulthood, and hypertension screening.


Assuntos
Hipertensão/epidemiologia , Falência Renal Crônica/terapia , Terapia de Substituição Renal/tendências , Disrafismo Espinal/complicações , Adolescente , Adulto , Fatores Etários , Criança , Estudos de Coortes , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipertensão/prevenção & controle , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , Masculino , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Terapia de Substituição Renal/estatística & dados numéricos , Fatores de Risco , Disrafismo Espinal/terapia , Estados Unidos/epidemiologia , Adulto Jovem
4.
J Med Internet Res ; 23(1): e23897, 2021 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-33320825

RESUMO

BACKGROUND: Confirmed COVID-19 cases have been registered in more than 200 countries, and as of July 28, 2020, over 16 million cases have been reported to the World Health Organization. This study was conducted during the epidemic peak of COVID-19 in Italy. The early identification of individuals with suspected COVID-19 is critical in immediately quarantining such individuals. Although surveys are widely used for identifying COVID-19 cases, outcomes, and associated risks, no validated epidemiological tool exists for surveying SARS-CoV-2 infection in the general population. OBJECTIVE: We evaluated the capability of self-reported symptoms in discriminating COVID-19 to identify individuals who need to undergo instrumental measurements. We defined and validated a method for identifying a cutoff score. METHODS: Our study is phase II of the EPICOVID19 Italian national survey, which launched in April 2020 and included a convenience sample of 201,121 adults who completed the EPICOVID19 questionnaire. The Phase II questionnaire, which focused on the results of nasopharyngeal swab (NPS) and serological tests, was mailed to all subjects who previously underwent NPS tests. RESULTS: Of 2703 subjects who completed the Phase II questionnaire, 694 (25.7%) were NPS positive. Of the 472 subjects who underwent the immunoglobulin G (IgG) test and 421 who underwent the immunoglobulin M test, 22.9% (108/472) and 11.6% (49/421) tested positive, respectively. Compared to NPS-negative subjects, NPS-positive subjects had a higher incidence of fever (421/694, 60.7% vs 391/2009, 19.5%; P<.001), loss of taste and smell (365/694, 52.6% vs 239/2009, 11.9%; P<.001), and cough (352/694, 50.7% vs 580/2009, 28.9%; P<.001). With regard to subjects who underwent serological tests, IgG-positive subjects had a higher incidence of fever (65/108, 60.2% vs 43/364, 11.8%; P<.001) and pain in muscles/bones/joints (73/108, 67.6% vs 71/364, 19.5%; P<.001) than IgG-negative subjects. An analysis of self-reported COVID-19 symptom items revealed a 1-factor solution, the EPICOVID19 diagnostic scale. The following optimal scores were identified: 1.03 for respiratory problems, 1.07 for chest pain, 0.97 for loss of taste and smell 0.97, and 1.05 for tachycardia (ie, heart palpitations). These were the most important symptoms. For adults aged 18-84 years, the cutoff score was 2.56 (sensitivity: 76.56%; specificity: 68.24%) for NPS-positive subjects and 2.59 (sensitivity: 80.37%; specificity: 80.17%) for IgG-positive subjects. For subjects aged ≥60 years, the cutoff score was 1.28, and accuracy based on the presence of IgG antibodies improved (sensitivity: 88.00%; specificity: 89.58%). CONCLUSIONS: We developed a short diagnostic scale to detect subjects with symptoms that were potentially associated with COVID-19 from a wide population. Our results support the potential of self-reported symptoms in identifying individuals who require immediate clinical evaluations. Although these results come from the Italian pandemic period, this short diagnostic scale could be optimized and tested as a screening tool for future similar pandemics.


Assuntos
/diagnóstico , Inquéritos Epidemiológicos , Programas de Rastreamento/normas , Psicometria , Autorrelato , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , /fisiopatologia , Feminino , Febre/epidemiologia , Humanos , Imunoglobulina G/análise , Imunoglobulina M/análise , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Reprodutibilidade dos Testes , Adulto Jovem
6.
Radiol Clin North Am ; 59(1): 41-55, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33222999

RESUMO

Screening mammography aims to identify small, node-negative breast cancers when they are still curable while maintaining an acceptable range of false-positive recalls and biopsies. The mammography audit is a powerful tool to help radiologists understand their performance with respect to that goal. This article defines audit terms and describes how to use collected and derived data to perform a mammography audit. Accepted benchmarks are discussed as well as their applicability to radiologists and breast imaging practices in the United States. Special considerations regarding volumes and radiologist characteristics are explored, because these factors may affect audit results.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamografia/normas , Auditoria Médica/métodos , Controle de Qualidade , Detecção Precoce de Câncer/normas , Feminino , Humanos , Programas de Rastreamento/normas , Estados Unidos , United States Food and Drug Administration
7.
J Fam Pract ; 69(10): 514-517, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33348347

RESUMO

The new draft recommendations from the US Preventive Services Task Force make a significant change to the previous colorectal cancer screening recommendations. This month, Dr. Campos-Outcalt describes that change and provides a look at the financial implications (as stipulated by the Affordable Care Act) of the screening method chosen.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , Medicina de Família e Comunidade/normas , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto , Serviços Preventivos de Saúde/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
9.
JAMA ; 324(23): 2423-2436, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320229

RESUMO

Importance: A 2014 review for the US Preventive Services Task Force (USPSTF) found antiviral therapy for hepatitis B virus (HBV) infection associated with improved intermediate outcomes, although evidence on clinical outcomes was limited. Objective: To update the 2014 HBV screening review in nonpregnant adolescents and adults to inform the USPSTF. Data Sources: Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Ovid MEDLINE (2014 to August 2019); with surveillance through July 24, 2020. Study Selection: Randomized clinical trials (RCTs) on screening and antiviral therapy; cohort studies on screening, antiviral therapy clinical outcomes, and the association between achieving intermediate outcomes after antiviral therapy and clinical outcomes. Data Extraction and Synthesis: One investigator abstracted data; a second investigator checked accuracy. Two investigators independently assessed study quality. Random-effects profile likelihood meta-analysis was performed. Results: Thirty trials and 20 cohort studies, with a total of 94 168 participants, were included. No study directly evaluated the effects of screening for HBV infection vs no screening on clinical outcomes such as mortality, hepatocellular carcinoma, or cirrhosis. Screening strategies that focused on risk factors such as ever having immigrated from high-prevalence countries and demographic and behavioral risk factors would identify nearly all HBV infection cases. In 1 study (n = 21 008), only screening immigrants from high-prevalence countries would miss approximately two-thirds of infected persons. Based on 18 trials (n = 2972), antiviral therapy compared with placebo or no treatment was associated with greater likelihood of achieving intermediate outcomes, such as virologic suppression and hepatitis B e-antigen (HBeAg) or hepatitis B surface antigen loss or seroconversion; the numbers needed to treat ranged from 2.6 for virologic suppression to 17 for HBeAg seroconversion. Based on 12 trials (n = 4127), first-line antiviral therapies were at least as likely as nonpreferred therapies to achieve intermediate outcomes. Based on 16 trials (n = 4809), antiviral therapy might be associated with improved clinical outcomes, but data were sparse and imprecise. Nine cohort studies (n = 3893) indicated an association between achieving an intermediate outcome following antiviral therapy and improved clinical outcomes but were heterogeneous (hazard ratios ranged from 0.07 to 0.87). Antiviral therapy was associated with higher risk of withdrawal due to adverse events vs placebo or no antiviral therapy. Conclusions and Relevance: There was no direct evidence for the clinical benefits and harms of HBV screening vs no screening. Antiviral therapy for HBV infection was associated with improved intermediate outcomes and may improve clinical outcomes.


Assuntos
Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B , Hepatite B Crônica/diagnóstico , Programas de Rastreamento/normas , Adolescente , Adulto , Antivirais/uso terapêutico , Emigrantes e Imigrantes , Vírus da Hepatite B/imunologia , Hepatite B Crônica/tratamento farmacológico , Humanos , Programas de Rastreamento/efeitos adversos , Guias de Prática Clínica como Assunto , Fatores de Risco
10.
JAMA ; 324(23): 2415-2422, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320230

RESUMO

Importance: An estimated 862 000 persons in the US are living with chronic infection with hepatitis B virus (HBV). Persons born in regions with a prevalence of HBV infection of 2% or greater, such as countries in Africa and Asia, the Pacific Islands, and parts of South America, often become infected at birth and account for up to 95% of newly reported chronic infections in the US. Other high-prevalence populations include persons who inject drugs; men who have sex with men; persons with HIV infection; and sex partners, needle-sharing contacts, and household contacts of persons with chronic HBV infection. Up to 60% of HBV-infected persons are unaware of their infection, and many remain asymptomatic until onset of cirrhosis or end-stage liver disease. Objective: To update its 2014 recommendation, the USPSTF commissioned a review of new randomized clinical trials and cohort studies published from 2014 to August 2019 that evaluated the benefits and harms of screening and antiviral therapy for preventing intermediate outcomes or health outcomes and the association between improvements in intermediate outcomes and health outcomes. New key questions focused on the yield of alternative HBV screening strategies and the accuracy of tools to identify persons at increased risk. Population: This recommendation statement applies to asymptomatic, nonpregnant adolescents and adults at increased risk for HBV infection, including those who were vaccinated before being screened for HBV infection. Evidence Assessment: The USPSTF concludes with moderate certainty that screening for HBV infection in adolescents and adults at increased risk for infection has moderate net benefit. Recommendation: The USPSTF recommends screening for HBV infection in adolescents and adults at increased risk for infection. (B recommendation).


Assuntos
Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B , Hepatite B Crônica/diagnóstico , Programas de Rastreamento/normas , Adolescente , Adulto , Emigrantes e Imigrantes , Vacinas contra Hepatite B , Vírus da Hepatite B/imunologia , Humanos , Programas de Rastreamento/efeitos adversos , Fatores de Risco , Estados Unidos
11.
Medicine (Baltimore) ; 99(50): e23681, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327357

RESUMO

The article presents a systematic review protocol. The aim of the study is an assessment of current studies regarding the application of artificial intelligence and neural networks in the screening for adverse perinatal outcomes. We intend to compare the reported efficacy of these methods to improve pregnancy care and outcomes. There are more and more studies that describe the role of machine learning in facilitating the diagnosis of adverse perinatal outcomes, like gestational diabetes or pregnancy hypertension. A systematic review of available literature seems to be crucial to compare the known efficacy and application. Publication of a systematic review in this category would improve the value of future studies. The studies reporting on artificial intelligence application will have a major impact on future prenatal practice.


Assuntos
Inteligência Artificial/estatística & dados numéricos , Programas de Rastreamento/métodos , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Inteligência Artificial/normas , Glicemia , Pressão Sanguínea , Feminino , Humanos , Testes de Função Hepática , Programas de Rastreamento/normas , Gravidez , Projetos de Pesquisa , Medição de Risco , Ultrassonografia Pré-Natal/métodos
12.
Medicine (Baltimore) ; 99(46): e23161, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181689

RESUMO

BACKGROUND: To investigate the accuracy of screening tests for gestational diabetes mellitus (GDM) in Southeast Asian pregnant women. METHODS: We searched PubMed (MEDLINE), Web of Science, Cochrane Library, ClinicalTrials.gov, Google Scholar, and Google for relevant articles published in English up to November 2018 using search terms related to GDM, screening tests for GDM and diagnostic performance. The studies were independently screened and selected by both authors. The methodological quality of the included studies was independently assessed by quality assessment of diagnostic accuracy studies 2. A hierarchical summary receiver operating characteristic (HSROC) model was created to estimate the HSROC curve. The summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated in a meta-analysis using bivariate random-effects model. RESULTS: A total of 19 studies were included in which the 100 g oral glucose tolerance test (OGTT) and 75 g OGTT were the two common reference standards for diagnosis of GDM. Most points of diagnostic performance in the HSROC 50 g GCT curve compared with the 100 g OGTT reference standard were clustered in the upper left-hand quadrant. The pooled sensitivity and specificity of the 50 g GCT were 79% (95% confidence interval [CI] 64%-89%) and 74% (95% CI 59%-85%), respectively. For the 75 g OGTT reference standard, the non-fasting 2-hour plasma glucose showed quite similar sensitivity the 50 g GCT compared with the 100 g OGTT reference standard. The pooled sensitivities and specificities of the fasting plasma glucose and hemoglobin A1c were 81% (95% CI 76%-86%) and 70% (95% CI 67%-72%), and 80% (95% CI 66%-90%) and 69% (95% CI 58%-78%), respectively. CONCLUSION: Our findings indicate that the 50 g GCT using the threshold of 140 mg/dL is a good screening test for identifying GDM at 24 to 28 weeks' gestational age for both high-risk and universal screening strategies in Southeast Asian countries. The non-fasting 2-hour PG, fasting plasma glucose or hemoglobin A1c are alternative choices for screening.


Assuntos
Diabetes Gestacional , Teste de Tolerância a Glucose/métodos , Programas de Rastreamento , Ásia Sudeste/epidemiologia , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Precisão da Medição Dimensional , Feminino , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Gravidez
13.
Medicine (Baltimore) ; 99(46): e23251, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181717

RESUMO

BACKGROUND: In pediatric tumors, immunotherapy exhibits less toxicity than chemotherapy and radiation. The current study aims to identify potential immune targets in immune-related genes of C-C motif chemokine ligand genes (CCLs) and C-C motif chemokine receptors (CCRs) in childhood osteosarcoma (OS) and to explore the underlying molecular mechanisms of childhood OS. METHODS: Firstly, we identified immune-related genes in CCLs and CCRs, these genes were used for functional annotation and interaction analysis. Then, the prognostic value of these genes was evaluated using Kaplan-Meier analysis and multivariate COX regression model. And the potential relationship between risk score and immune infiltrating cells was identified. Finally, gene set enrichment analysis was used to determine the underlying molecular mechanism of OS. Immune-related genes in CCLs and CCRs are inextricably linked. RESULTS: The results of survival analysis of these genes show that CCL5, CCL8, CCR4, and CCR5 are significantly associated with the prognosis of childhood OS. The combined effect survival analysis shows that the co-high expression of these 4 genes has a good prognosis for childhood OS. A prognostic signature model was constructed based on the 4 genes mentioned above, and the result of time-dependent receiver operating characteristic curves showed that this model was a good predictor of childhood OS 3- and 5-year prognosis. In addition, the risk score of the constructed prognostic signature model was closely related to immune infiltration. We also found that CCL5, CCL8, and CCR5 may affect the prognosis of OS through complex regulation among Toll-like receptor signaling pathway, mitogen-activated protein kinase (MAPK) family signaling cascade, and nuclear factor-kappaB pathway, whereas CCR4 affects the prognosis of OS by regulating eukaryotic translation. CONCLUSION: CCL5, CCL8, CCR4, and CCR5 are potential prognostic markers for the prognosis of childhood OS, and the underlying molecular mechanisms of childhood OS have been identified.


Assuntos
Biomarcadores Tumorais/análise , Osteossarcoma/diagnóstico , Prognóstico , Biomarcadores Tumorais/genética , Criança , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Perfilação da Expressão Gênica/métodos , Regulação Neoplásica da Expressão Gênica/genética , Regulação Neoplásica da Expressão Gênica/imunologia , Humanos , Imunoterapia/métodos , Estimativa de Kaplan-Meier , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Osteossarcoma/genética , Pediatria/métodos , Pediatria/tendências , Estudos Prospectivos , Análise de Sobrevida
14.
Sci Rep ; 10(1): 19012, 2020 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-33149198

RESUMO

To combat the pandemic of the coronavirus disease 2019 (COVID-19), numerous governments have established phone hotlines to prescreen potential cases. These hotlines have struggled with the volume of callers, leading to wait times of hours or, even, an inability to contact health authorities. Symptoma is a symptom-to-disease digital health assistant that can differentiate more than 20,000 diseases with an accuracy of more than 90%. We tested the accuracy of Symptoma to identify COVID-19 using a set of diverse clinical cases combined with case reports of COVID-19. We showed that Symptoma can accurately distinguish COVID-19 in 96.32% of clinical cases. When considering only COVID-19 symptoms and risk factors, Symptoma identified 100% of those infected when presented with only three signs. Lastly, we showed that Symptoma's accuracy far exceeds that of simple "yes-no" questionnaires widely available online. In summary, Symptoma provides unparalleled accuracy in systematically identifying cases of COVID-19 while also considering over 20,000 other diseases. Furthermore, Symptoma allows free text input, furthered with disease-specific follow up questions, in 36 languages. Combined, these results and accessibility give Symptoma the potential to be a key tool in the global fight against COVID-19. The Symptoma predictor is freely available online at https://www.symptoma.com .


Assuntos
Inteligência Artificial , Infecções por Coronavirus/diagnóstico , Programas de Rastreamento/métodos , Pneumonia Viral/diagnóstico , Software , Telemedicina/métodos , Infecções por Coronavirus/epidemiologia , Humanos , Programas de Rastreamento/normas , Pandemias , Pneumonia Viral/epidemiologia , Telemedicina/normas
15.
Sci Rep ; 10(1): 18899, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33144632

RESUMO

Severe acute respiratory coronavirus 2 (SARS-CoV-2) testing reagents are expected to become scarce worldwide. However, little is known regarding whether pooling of samples accurately detects SARS-CoV-2. To validate the feasibility of pooling samples, serial dilution analysis and spike-in experiments were conducted using synthetic DNA and nucleic acids extracted from SARS-CoV-2-positive and -negative patients. Furthermore, we studied 1000 individuals, 667 of whom were "healthy" individuals (195 healthcare workers and 472 hospitalized patients with disorders other than COVID-19 infection), and 333 infection-suspected patients with cough and fever. Serial dilution analysis showed a limit of detection of around 10-100 viral genome copies according to the protocol of the National Institute of Infectious Diseases, Japan. Spike-in experiments demonstrated that RT-qPCR detected positive signals in pooled samples with SARS-CoV-2-negative and -positive patients at 5-, 10-, 20-fold dilutions. By screening with this pooling strategy, by the end of April 2020 there were 12 SARS-CoV-2-positive patients in 333 infection-suspected patients (3.6%) and zero in 667 "healthy" controls. We obtained these results with a total of 538 runs using the pooling strategy, compared with 1000 standard runs. In a prospective study, we successfully detected SARS-CoV-2 using 10- to 20-fold diluted samples of nasopharyngeal swabs from eighteen COVID-19 patients with wide ranges of viral load. Pooling sample is feasible for conserving test reagents and detecting SARS-CoV-2 in clinical settings. This strategy will help us to research the prevalence infected individuals and provide infected-status information to prevent the spread of the virus and nosocomial transmission.


Assuntos
Técnicas de Laboratório Clínico/métodos , Programas de Rastreamento/métodos , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Limite de Detecção , Programas de Rastreamento/normas , Reprodutibilidade dos Testes , Mucosa Respiratória/virologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa/normas
16.
J Glob Health ; 10(2): 020507, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33110590

RESUMO

Background: In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide. Methods: During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100). Results: A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries. Conclusions: This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions. Study registration: Registered in ClinicalTrials.gov: NCT04344197.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/normas , Betacoronavirus , Infecções por Coronavirus/transmissão , Infecção Hospitalar/virologia , Estudos Transversais , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Controle de Infecções/normas , Programas de Rastreamento/normas , Pneumonia Viral/transmissão , Políticas , Padrões de Prática Médica/normas , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Inquéritos e Questionários
17.
Arch Osteoporos ; 15(1): 162, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33067691

RESUMO

We examine whether new government criteria designed to reduce overuse of vitamin D testing changed testing rates in Australian women. Although testing initially declined, the reduction was not sustained. Women who had more doctor visits and who had been tested previously were more likely to have vitamin D testing. PURPOSE: Vitamin D testing increased substantially in the 2000s in many countries, particularly in women. Because of concerns about potential over-testing, in 2014, the Australian criteria for subsidised testing were restricted to those at high risk of vitamin D deficiency. We aimed to describe vitamin D testing trends in Australian women (1996 to 2019) and investigate sociodemographic and health factors associated with testing under the new criteria. METHODS: We used joinpoint regression to assess changes in national testing trends in Australian women (aged 15+ years) using universal health insurance system data. Additionally, we investigated the factors associated with vitamin D testing through Poisson regression with robust error variance using survey and linked insurance system data from participants born 1946-51 in the Australian Longitudinal Study on Women's Health (ALSWH). RESULTS: Between 1996 and 2013, vitamin D testing rates increased in all age groups. Rates declined between 2013 and 2016, but increased again between 2016 and 2019. In the ALSWH cohort, a higher likelihood of testing under the new criteria was associated with 12 or more doctor visits per year compared to two or fewer visits per year (relative risk (RR) 1.85; 95% CI 1.61-2.12), and women who had two or more vitamin D tests between 2012 and 2014 compared to no test (RR 1.55; 95% CI 1.48-1.62). CONCLUSION: The introduction of new criteria has not led to sustained declines in testing. High testing rates and repeated testing suggest that over-testing for vitamin D deficiency in Australian women is still occurring.


Assuntos
Guias como Assunto , Programas de Rastreamento , Deficiência de Vitamina D/diagnóstico , Vitamina D , Adolescente , Austrália/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Programas de Rastreamento/normas , Programas de Rastreamento/tendências , Padrões de Prática Médica/estatística & dados numéricos , Gravidez , Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/etiologia , Vitaminas
18.
PLoS One ; 15(10): e0240779, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33057446

RESUMO

The practicability of a prototype capillary whole-blood IgG-IgM COVID-19 self-test (Exacto® COVID-19 self-test, Biosynex Swiss SA, Freiburg, Switzerland) as a serological screening tool for SARS-CoV-2 infection adapted to the general public was evaluated in a cross-sectional, general adult population study performed between April and May 2020 in Strasbourg, France, consisting of face-to-face, paper-based, semi-structured, and self-administrated questionnaires. Practicability was defined as the correct use of the self-test and the correct interpretation of the result. The correct use of self-test was conditioned by the presence of the control band after 15-min of migration. The correct interpretation of the tests was defined by the percent agreement between the tests results read and interpret by the participants compared to the expected results coded by the numbers and verified by trained observers. A total of 167 participants (52.7% female; median age, 35.8 years; 82% with post-graduate level) were enrolled, including 83 and 84 for usability and test results interpretation substudies, respectively. All participants (100%; 95% CI: 95.6-100) correctly used the self-test. However, 12 (14.5%; 95% CI: 8.5-23.6) asked for verbal help. The percent agreement between the tests results read and interpret by the participants compared to the expected results was 98.5% (95% CI: 96.5-99.4). However, misinterpretation occurred in only 2.3% of positive and 1.2% of invalid test results. Finally, all (100%) participants found that performing the COVID-19 self-test was easy; and 98.8% found the interpretation of the self-test results easy. Taken together, these pilot observations demonstrated for the first-time, high practicability and satisfaction of COVID-19 self-testing for serological IgG and IgM immune status, indicating its potential for use by the general public to complete the arsenal of available SARS-CoV-2 serological assays in the urgent context of the COVID-19 epidemic.


Assuntos
Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Kit de Reagentes para Diagnóstico/normas , Adulto , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/sangue , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pandemias , Pneumonia Viral/sangue , Testes Imediatos , Autoadministração , Sensibilidade e Especificidade
19.
Spine (Phila Pa 1976) ; 45(21): E1431-E1438, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33035046

RESUMO

STUDY DESIGN: The study is a cross-sectional, diagnostic validity study. OBJECTIVE: The aim of this study was to examine the performance characteristics and validity of an existing lumbar instability questionnaire as a screening tool for lumbar instability among chronic low back pain (CLBP) patients. SUMMARY OF BACKGROUND DATA: Lumbar instability is an initial stage of more severe spinal pathology. Early screening for this condition should help prevent more structural damage. To meet this need, the present study developed numerical cutoff scores for the lumbar instability screening tool. METHODS: Lumbar instability screening tool responses and x-ray assessments were reviewed from a sample of 110 patients with CLBP (aged 20-59 years). Receiver operator curves were constructed to optimize sensitivity and specificity of the tool. RESULTS: Fourteen (12.73%) patients had radiological lumbar instability. These patients reported a higher mean lumbar instability questionnaire score than those without radiological lumbar instability. A questionnaire score of at least 7 had a sensitivity of 100% (95% CI, 100-100) and a specificity of 26.04% (95% CI = 17.84-34.24) for detecting lumbar instability when compared with x-ray examination. Receiver operator curve analysis revealed the lumbar instability screening had an area under the curve of 0.62 (95% CI, 0.47-0.77). CONCLUSION: A lumbar instability screening tool total score of at least 7 was ruled out lumbar instability in CLBP patients. This cutoff score may be used as a marker of conservative treatment response. The sample size of patients with lumbar instability in this study was small, which may hinder the reliability of the data. Further studies are needed. LEVEL OF EVIDENCE: 4.


Assuntos
Instabilidade Articular/diagnóstico , Programas de Rastreamento/normas , Doenças da Coluna Vertebral/diagnóstico , Inquéritos e Questionários/normas , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Instabilidade Articular/epidemiologia , Dor Lombar , Masculino , Pessoa de Meia-Idade , Radiografia , Reprodutibilidade dos Testes , Tamanho da Amostra , Sensibilidade e Especificidade , Doenças da Coluna Vertebral/epidemiologia , Tailândia , Adulto Jovem
20.
PLoS One ; 15(9): e0239474, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32960917

RESUMO

Worldwide, testing capacity for SARS-CoV-2 is limited and bottlenecks in the scale up of polymerase chain reaction (PCR-based testing exist. Our aim was to develop and evaluate a machine learning algorithm to diagnose COVID-19 in the inpatient setting. The algorithm was based on basic demographic and laboratory features to serve as a screening tool at hospitals where testing is scarce or unavailable. We used retrospectively collected data from the UCLA Health System in Los Angeles, California. We included all emergency room or inpatient cases receiving SARS-CoV-2 PCR testing who also had a set of ancillary laboratory features (n = 1,455) between 1 March 2020 and 24 May 2020. We tested seven machine learning models and used a combination of those models for the final diagnostic classification. In the test set (n = 392), our combined model had an area under the receiver operator curve of 0.91 (95% confidence interval 0.87-0.96). The model achieved a sensitivity of 0.93 (95% CI 0.85-0.98), specificity of 0.64 (95% CI 0.58-0.69). We found that our machine learning algorithm had excellent diagnostic metrics compared to SARS-CoV-2 PCR. This ensemble machine learning algorithm to diagnose COVID-19 has the potential to be used as a screening tool in hospital settings where PCR testing is scarce or unavailable.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Pacientes Internados , Aprendizado de Máquina , Pneumonia Viral/diagnóstico , Adulto , Idoso , Área Sob a Curva , Técnicas de Laboratório Clínico/normas , Humanos , Los Angeles , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Pandemias , Reação em Cadeia da Polimerase , Estudos Retrospectivos
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