Incomplete Tests Research Articles

Disparities in Health Screening Completion Status forAdults with Severe Disabilities Compared to Adults With NoDisabilities in Korea: A Retrospective Study ofElectronic Health Records.

Health screening is crucial for individuals with disabilities because they are likely to experience preventable health challenges, leading to poor health outcomes. However, there is limited insight into barriers to health screening for them after arriving at a healthcare facility. Thus, this study aimed to explore the association between disability status/type and health screening test completion and the reasons for incomplete tests after arriving at a healthcare facility. We reviewed 767 electronic health records of individuals who underwent health screening in a healthcare facility over one year. Chi-square or Fisher's exact tests were used to explore differences in test completion. Levesque's access to care framework was used to categorize the reasons for incomplete tests into provider- and patient-related domains. The findings showed associations between disability status and health screening completion. Both provider- and patient-related barriers were recorded as the reasons for incomplete tests for cases with disabilities. The associations found suggest potential disparities individuals with disabilities experience upon arrival at healthcare facilities. Further prospective studies are needed to test and validate the healthcare utilization disparities in disability.

A mixed-method analysis of provider adherence to integrated antenatal care guideline in BEmONC and Non BEmONC primary health center: An Indonesian case.

Provider adherence to the integrated antenatal care (ANC) procedure is an important indicator of high-quality ANC. The procedure is intended to avoid missed opportunities to detect the risk of abnormalities in pregnancy. This study aims to assess the provider's adherence to integrated ANC in Basic Emergency Obstetric and Newborn Care (BEmONC) and non-BEmONC Primary Health Center (PHC). This study employed an explanatory sequential mixed-method design. The quantitative phase reviewed 149 medical records of pregnant women in the four PHCs in Semarang from January until February 2020. The findings were used to describe the provider's adherence to the integrated ANC and lead to the contributing factors which should be explored in the qualitative phase. The study involved four in-depth interviews with midwife coordinators in four PHCs. The Mann-Whitney and Chi-square test was employed to analyse the quantitative data, while the thematic analysis was undertaken on the qualitative data. The provider's adherence to the guideline did not differ between BEmONC and non-BEmONC PHC. The general physical examination of the patients (18.81%) and dentist visits (84.6%) were not done in either BEmONC or non-BEmONC PHC. Incomplete laboratory tests were haemoglobin (28.2%) and urine protein (38.9%). The barriers to adherence to the integrated ANC guideline were related to an imbalance of resources, role and responsibility issues among doctors and midwives, and policy issues. This study found low BEmONC nor non-BEmONC PHC adherence to the integrated ANC guideline. A Periodic evaluation of the implementation of integrated ANC to ensure its high-quality implementation in Indonesia is needed.

Barriers to referral and evaluation and corresponding navigation services for toddlers screening positive for autism spectrum disorder.

Children from disadvantaged populations receive referrals, diagnoses, and services for autism spectrum disorder (ASD) late or not at all. We describe barriers to referral for and receipt of evaluation for ASD among young children from disadvantaged families and activities by autism family navigators (AFNs) to address these barriers. Trained AFNs offered navigation to families of children aged 16-30 months with positive ASD screens from community health center clinics in 2015-2018. AFNs interviewed families to identify perceived barriers to care and documented system barriers and navigation activities. We coded, categorized, and described barriers and AFN activities. Case studies illustrate barriers and navigation activities. Of 22 participating mothers, 82% were Latinx and 64% were native Spanish-speaking; 71% had household incomes <$30,000/year and 57% had no high school diploma. Half of the families experienced five or more barriers to ASD evaluation, most commonly pragmatic barriers. Information barriers/needs were 5 times more common among Spanish-speaking than English-speaking mothers. One-fifth of families identified negative experiences or expectations of care. System barriers included incomplete screening tests, inadequate referrals, and waiting lists. AFNs implemented navigation activities, most frequently categorized as care coordination (95%), education (68%), social/emotional support (36%), family advocacy (27%), and self-advocacy coaching (23%). AFNs also trained providers and staff to improve screening and referral implementation. In this largely Latinx sample, families experienced numerous barriers to obtaining ASD evaluations for their screen-positive children, likely reflecting the complexity of negotiating both healthcare and educational systems. Trained AFNs can assist parents to overcome barriers to timely diagnosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Preventing lost-to-follow up diagnostic imaging in ambulatory care: evaluation of an electronic notification tool

ObjectiveMissed or cancelled imaging tests may be invisible to the ordering clinician and result in diagnostic delay. We developed an outpatient results notification tool (ORNT) to alert physicians of patients’...

Inappropriate Multi-Target Stool DNA Use for Colorectal Cancer Screening: Risks, Compliance, and Outcomes.

Background Inappropriate or "off-label" use of multi-target stool DNA (mt-sDNA) tests refers to their use in patients for whom colonoscopy or no testing at all is warranted. Examples include a positive family history of colorectal cancer, a history of inflammatory bowel disease, or medical issues necessitating diagnostic colonoscopy, among others. Current understanding of off-label mt-sDNA use for colorectal cancer screening, its associated risks, and outcomes is lacking. We examined off-label mt-sDNA prescription and compliance with testing in an outpatient setting in southeast Michigan. Aims The primary aims of the study were determining the extent of off-label mt-sDNA testing and compliance, and results of all testing, as well as demographic factors associated with off-label prescriptions. The secondary aims were to examine explanations for incomplete testing and factors contributing to successful completion. Methods Using a retrospective design, we identified mt-sDNA orders from outpatient internal medicine clinics between January 1, 2018, to July 31, 2019, to evaluate the proportion of off-label mt-sDNA, results of testing, and follow-up colonoscopies up to one year after order placement. Patients were categorized as "off-label" if any inappropriate criteria were met. Statistical analysis was performed for primary and secondary outcomes. Results From 679 mt-sDNA orders within the study period, 81 (12.1%) had at least one off-label criterion for testing. In total, 404/679 (59.5%) patients completed testing. Lack of follow-up comprised the majority of incompletions (216/275; 78.6%). Only 52 (70.3%) out of 74 positive results were followed by diagnostic colonoscopy. Retired employment status (OR = 1.87; 95%CI, 1.17-2.98; P = 0.008) and age of 76 years or older (OR = 2.28; 95%CI, 0.99-5.21; P = 0.044) were significantly associated with increased risk of off-label mt-sDNA prescription. Increasing age range was associated with higher test completion (χ2 (5) = 12.085, p = 0.034). Multinomial logistic regression revealed an increasing age range (OR = 1.29; 95% CI, 1.09-1.54; P = 0.004), predictive of a positive mt-sDNA result for both groups. There was no significant difference between off-label or on-label groups in the mean number of resected polyps or pathology scores on follow-up colonoscopy. Conclusions Off-label mt-sDNA use remains a concern in the outpatient setting. Compliance for test completion and follow-up colonoscopy for positive results require further improvement. Our findings shed new light on the factors associated with off-label testing while reiterating its burden. We also describe common reasons for incomplete tests in an attempt to augment future colorectal cancer (CRC) screening initiatives.

A282 RISK FACTORS ASSOCIATED WITH UNSUCCESSFUL HIGH-RESOLUTION MANOMETRY: FAILURE IS COMMON BUT WHAT CAN WE CHANGE

Abstract Background High-resolution manometry (HRM) is a diagnostic tool used to evaluate esophageal motor function and diagnose motility disorders. A standardized protocol is used to make an accurate diagnosis based on the Chicago Classification. Some existing literature suggests that incomplete or imperfect manometry tests are common, however; there remains a paucity of data to evaluate risk factors for failure to help clinicians determine when a study may be difficult to perform. Purpose Our goal was to quantify how often failed tests occurred and determine specific factors that may be associated with failed HRM. Method We retrospectively evaluated records for HRM tests performed over 1 year at our academic centre. Based on clinical experience, we identified several factors that may be associated with the success of HRM testing including the following: indications and symptoms leading to testing, patient’s age and biological sex, previous esophageal manometry history, previous esophageal/gastric surgery, previous septal repair/deviated septum, history of significant nausea/vomiting, history of anxiety/depression, history of irritable bowel syndrome, and medication use (opioids, proton pump inhibitors, calcium channel blockers, nitrates). We then compared patients with successful HRM vs. unsuccessful HRM with regard to our pre-specified risk factors. Result(s) 29 HRM tests were unsuccessful from a total of 152 that were performed (19% failure rate). Reasons for failure included the inability to pass the probe through LES (55%) and the inability to tolerate the manometry probe for a minimum of 10 saline swallows (45%). After separating the failed cases from successful tests, both groups had a similar distribution of age and sex. Specific symptoms and indications did not have a significant association with unsuccessful tests. A previous history of failed manometry was associated with unsuccessful HRM (OR: 15, 95% CI 1.88 to 183.8, p=0.0156). Conversely, PPI usage was associated with fewer failed HRM tests (OR: 0.37, 95% CI 0.16 to 0.90, p=0.0343). Other medical history or medication use was not found to be associated with testing failure in our study. Conclusion(s) HRM is useful for diagnosing esophageal motility disorders, but incomplete tests are common. Although this study did not identify any factors in a patient’s medical history that could be used to predict failure in patients who have never had testing, further investigations may identify if PPI therapy can make HRM testing more tolerable. Additionally, the association between previous failed HRM and repeat failures suggests that endoscopic probe placement techniques should be considered instead of retrying conventional probe placement. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Open pleural decortication in a 12-day-old neonate with empyema thoracis

Introduction. Empyema thoracis, defined as the accumulation of pus in the pleural space, is rare in the neonatal population. Limited data are reported in the medical literature, and still, no treatment guidelines are available for this age. Case report. We present a term 12-day-old neonate (born healthy) who developed sepsis caused by methicillin-resistant Staphylococcus aureus (MRSA) and pneumonia associated with advanced-stage empyema. The child was admitted to our hospital with a few-hours history of difficulty breathing and lethargy. On admission, the child was cyanotic with desaturation and in severe respiratory distress; therefore, the child was intubated, and mechanical ventilation was started. Imaging tests were performed in an emergency, hence chest computed tomography (CT) scan was done without contrast. Suspected congenital pulmonary airway malformation with trapped air collections, significant mediastinal shift on CT scan, and deterioration of the patient?s condition indicated urgent surgery. Intraoperatively, the diagnosis of stage II empyema was established, and decortication of thickened parietal and visceral pleura was performed. Afterward, the baby showed quick and progressive clinical improvement. Conclusion. The diagnosis and management of empyema in neonates may be challenging, especially in the case of unremarkable history, fulminant progression of the disease, and incomplete imaging tests.

S936 Factors Associated With Fecal Calprotectin Sample Collection Compliance: An IBD Center Quality Improvement Project

Introduction: Regular assessment of objective markers of inflammatory bowel disease (IBD) activity is recommended. Fecal calprotectin (Fcal) is a non-invasive and inexpensive biomarker of disease activity, however, patient compliance with this test is variable and incompletely described. We assessed compliance rates with Fcal tests and identified factors associated with non-compliance. Methods: As a quality improvement project, we conducted a retrospective chart review of IBD patients who had a Fcal test ordered by us between August 2021 and December 2021. Demographic, clinical, disease-related, and test-related (location of lab relative to the patient’s visit in clinic or at home) information were recorded to determine predictors for non-compliance. Simple statistical analysis and multivariable logistic regression was performed. Results: Of 303 patients, 165 (54.4%) had an order for Fcal. Of the Fcal tests ordered, 55 (33.3%) were not completed. Between those with complete versus incomplete tests, IBD remission status (67.8% vs. 83.7%, p = 0.033), history of prior Fcal order completion (93.2% vs. 68.4%, p = 0.001), and test ordered to an external site (62.7% vs. 85.5%, p = 0.004) were significantly different. A multivariable logistic regression with these factors as well as age, gender, telehealth vs. in-person consultation, and patient residence revealed that history of a prior completed Fcal test is independently associated with subsequent test completion (odds ratio (OR) = 8.3, 95% CI 1.9-35.5, p = 0.004). Fcal testing location (institutional or third-party) was marginally significant (OR = 0.27, 95% CI 0.7-1.0, p = 0.051). A multivariable linear regression for days between test order and completion found that tests ordered for external locations are associated with delayed completion (95% CI 5.2-20.6, p = 0.002). Conclusion: In this single center analysis with Fcal testing in patients with IBD, we found that a history of incomplete testing is associated with subsequent non-compliance, and distant location of the lab is associated with delayed completion of the test. These findings suggest that ordering providers should identify additional methods to educate on the importance of disease monitoring with Fcal and when possible, simplify the lab used for testing. Future availability of at home Fcal tests may be helpful in this regard. Table 1. - Linear Regressions for Predictors of Fecal Calprotectin Compliance Logistic Regression for Test Compliance Regression for Delayed Testing Completion Estimate Effect Size (B) Standard Error P - Value 95% Confidence Interval Estimate Effect Size (B) Standard Error P - Value 95% Confidence Interval Age 0.017 0.015 0.248 0.998-1.048 0.148 0.104 0.163 -31.309-7.575 Gender -0.441 0.543 0.417 0.222-1.866 0.877 3.635 0.810 0.062-0.357 IBD Remission -0.949 0.624 0.128 0.114-1.316 -0.331 3.895 0.933 -6.421-8.176 Consultation Type -.0523 0.528 0.322 0.210-1.570 0.102 3.992 0.980 -8.151-7.490 History of Fecal Calprotectin Completion 2.116 0.741 0.004 1.942-35.493 6.628 2.625 0.357 -7.699-20.956 Fecal Calprotectin Testing Location -1.304 0.668 0.51 0.073-1.005 12.875 3.843 0.002 5.160-20.591

Step VEP visual acuity in a pediatric neuro-ophthalmological cohort

Steady-state VEPs, have been used to estimate visual acuity since the 1970s and allow responses to a range of stimulus sizes to be collected rapidly- with particular utility in infants. However, the assessment of children with cortical visual impairment is a bigger challenge that lead to the development of the Step VEP. Its initial evaluation revealed that accuracy and precision were poorer for pediatric patients than for optically degraded normal adults and that it was not necessarily successful in every child. Statistical models generated the equations: VAO = 0.56 VAStep (r2 = 0.75, F = 60.93, p = 0.000) and VAPL = 0.45 VAStep (r2 = 0.82, F = 156.85, p = 0.000), supported by a recent a systematic review of VA comparisons showing that recognition VA (optotypes) agrees more closely than discrimination VA (PL) with VEP VA. In combination, Step VEPS and subjective tests allowed complete assessment in 96% of patients, with incomplete Step VEPS much more likely to be partially successful than not, and more likely to be partially successful than incomplete subjective tests. This supports the rationale that Step VEPs maintain attention by limiting the time spent stimulating away from an individual’s threshold of spatial resolution. For the small number of patients in whom VA cannot be estimated, alternative stimuli and methods of presentation are proposed.

FUTURE PHILOLOGISTS’ LANGUAGE COMPETENCE FORMATION ON THE BASIS OF ASPECT INTEGRATION

The article deals with possibilities of future foreign language teachers’ language competence formation at the universities of Foreign Languages.&#x0D; The importance of highly qualified new generation specialists, who are able to adapt quickly to a new polycultural information society, ready for fruitful beneficial cooperation with the representatives of other countries is stressed. Particular attention is paid to Common European Framework of References for Languages, requirements of Bologna Convention and new Ukrainian educational strategies for future teachers’ and philologists’ professional training.&#x0D; Different approaches to students’ professional training at the university have been analyzed. The advantages of integrated language competence formation as a means of students’ independent general and linguistic horizon’s development and future self-education have been highlighted.&#x0D; The authors of the article claim that integrated language competence formation enables the learners to move away from learning the same linguistic notions in different subjects, to combine language knowledge in terms of students’ future profession thus showing them the importance and value of it. The peculiarities of the first-year students’ language competence formation are presented.&#x0D; The necessity of designing an integrated language module as a complex of teaching aids and teaching materials for each topic studied is considered.&#x0D; The characteristics of the 4 C’s components (content, communication, cognition, culture) of the integrated language module on the topic "Meals" and the integrated skills for each of them are described.&#x0D; The effectiveness and expediency of integrated language competence formation both for university teachers and students were experimentally proved. The results of interviewing and incomplete tests presented in the article speak about the qualitative growth of students’ language knowledge, habits and skills.

Incomplete Tests of Conditional Association for the Assessment of Model Assumptions

Many of the models that have been proposed for response data share the assumptions that define the monotone homogeneity (MH) model. Observable properties that are implied by the MH model allow for these assumptions to be tested. For binary response data, the most restrictive of these properties is called conditional association (CA). All the other properties considered can be considered incomplete tests of CA that alleviate the practical limitations encountered when assessing the MH model assumptions using CA. It is found that the assessment of the MH model assumptions with an incomplete test of CA, rather than CA, is generally associated with a substantial loss of information. We also look at the sensitivity of the observable properties to model violation and discuss the implications of the results. It is argued that more research is required about the extent to which the assumptions and the model specifications influence the inferences made from response data.

MedGCN: Medication recommendation and lab test imputation via graph convolutional networks

Laboratory testing and medication prescription are two of the most important routines in daily clinical practice. Developing an artificial intelligence system that can automatically make lab test imputations and medication recommendations can save costs on potentially redundant lab tests and inform physicians of a more effective prescription. We present an intelligent medical system (named MedGCN) that can automatically recommend the patients’ medications based on their incomplete lab tests, and can even accurately estimate the lab values that have not been taken. In our system, we integrate the complex relations between multiple types of medical entities with their inherent features in a heterogeneous graph. Then we model the graph to learn a distributed representation for each entity in the graph based on graph convolutional networks (GCN). By the propagation of graph convolutional networks, the entity representations can incorporate multiple types of medical information that can benefit multiple medical tasks. Moreover, we introduce a cross regularization strategy to reduce overfitting for multi-task training by the interaction between the multiple tasks. In this study, we construct a graph to associate 4 types of medical entities, i.e., patients, encounters, lab tests, and medications, and applied a graph neural network to learn node embeddings for medication recommendation and lab test imputation. we validate our MedGCN model on two real-world datasets: NMEDW and MIMIC-III. The experimental results on both datasets demonstrate that our model can outperform the state-of-the-art in both tasks. We believe that our innovative system can provide a promising and reliable way to assist physicians to make medication prescriptions and to save costs on potentially redundant lab tests.

Evolution of hysteresis characteristic of shape memory alloys at incomplete phase transformation cyclic loading

The phase transformation ratchetting of shape memory alloys (SMAs) at incomplete phase transformation cyclic loading is experimentally and theoretically investigated. To this end, two different kinds of incomplete phase transformation cyclic loading tests on NiTi wires are performed, i.e. incomplete transformation cyclic loads are respectively applied at the stages of forward martensitic transformation and reverse martensitic transformation. When the cyclic load of incomplete transformation is applied in the forward martensitic transformation stage, a novel phenomenon is discovered: although there is no greater stress to drive the anstenite turn to martensite, the SMAs can still gradually undergo martensitic transformation and accumulation until martensite reaches saturation. The hysteretic behavior finally reaches a shakedown state where the strain–stress curve no longer changes with the number of cycles. When the cyclic load of incomplete transformation is applied in the reverse martensitic transformation stage, a similar phenomenon is obtained. According to the analysis of the temperature evolution during the deformation process of the SMAs, combined with the relationship between the phase transformation yield stress and the temperature of SMAs, the experimental results are reasonably explained. This research is of great significance for a more comprehensive grasp of the mechanical behavior of SMAs.

141 New Guidelines to Reduce Unnecessary Blood Tests, Delayed Discharge and Costs Following Robot Assisted Radical Prostatectomy

Abstract Objectives Routine postoperative blood tests (POBT) following robot assisted radical prostatectomy (RARP) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT. Method The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed to form new guidelines. The new guidelines were prospectively validated in a sample of 300 patients. Results Derivation Dataset: 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 day due to delayed or incomplete blood tests. Validation Dataset: No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. Number of POBT requested reduced by 73% (p &amp;lt; 0.001). The new guidelines improved POBT sensitivity for complications from 98% to 100% and specificity from 0% to 74%. Discharge delays reduced from 6% to 0% (p = 0.008). Cost savings were £178 per patient. Conclusions Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.

O50 New guidelines to reduce unnecessary blood tests, delayed discharge and costs following robot assisted radical prostatectomy

Abstract Introduction Routine postoperative blood tests (POBT) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT. Method The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed, and new guidelines were designed. The guidelines were prospectively validated in a cohort of 300 patients. Result Derivation Dataset 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 days due to delayed or incomplete blood tests. Validation Dataset No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. New guidelines improved sensitivity for complications from 98% to 100% and specificity from 0% to 74%. The number of blood tests requested reduced by 73% (P &amp;lt; 0.001). Discharge delays reduced from 6% to 0% (P = 0.008). Cost savings were £178 per patient. Conclusion Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care. Take-home Message Routine postoperative blood tests following robot assisted radical prostatectomy are often unnecessary. A guideline-based approach can reduce costs and optimise patient care.

Streamlining the genetics pipeline to increase testing for patients at risk for hereditary prostate cancer.

66 Background: At UCSF, ~850 men with metastatic prostate cancer are seen annually, all of whom should receive germline genetic testing. Prior to our study, the GU medical oncology program offered a self-pay, take-home genetic testing kit (30-gene panel) to patients with metastatic prostate cancer. Patients with positive test results were referred for genetic counseling. For this study, the UCSF Cancer Genetics and Prevention program partnered with the GU medical oncology program, adapting a Genetic Testing Station (GTS) to expand access and accommodate testing needs. At Prostate GTS, a genetic counselor assistant (GCA) facilitates cancer genetics education by video, enrolls patient in a research registry, collects a family history and saliva sample sent for an 87-gene panel. Our study evaluates the effectiveness of the GTS by comparing prospective performance metrics and testing outcomes of Prostate GTS with retrospective data obtained from the take-home method (“Before GTS”). Methods: Men were ascertained by their treating oncologist and referred for GTS. Indications for genetic testing include: all metastatic prostate cancer, or under age 50 at diagnosis, or with family history, or at clinician discretion. GTS metrics were prospectively collected by clinical staff. “Before GTS” metrics were retrospectively collected through data reporting from commercial lab analysis (test orders dated 01/2017 to 09/2019) and patient chart review. Results: In the first 6 months of Prostate GTS (10/2019-3/2020), 139 patients received testing at the GTS and 91% (127) had received results at censoring. GTS results were distributed as follows: 10% (13) positives, 33% (42) negative no VUS, and 57% (72) negative w/VUS. In the 33 months, “Before GTS”, 218 genetic testing orders had been placed, with 78% (196) reported at censoring, distributed as 11% (22) positive, 68% (134) negative no VUS, and 20% (40) negative w/VUS. The rate of incomplete tests decreased significantly with the GTS, (22% down to 9%, p = 0.0008). "Before GTS", of patients with a positive result, 15/22 (68%) were referred for genetic counseling, of which 8 completed a visit (36% of all positives). In the GTS model, all patients with positive results were seen by a genetic counselor for results disclosure and counseling. Comparing result rates across similar timeframes, 127 results were reported from GTS compared to 40 results from “Before GTS” in the same calendar months the year prior, representing a 218% increase in returned results. Median turnaround time decreased from 16 days to 9 days with GTS. Conclusions: GTS efficiently increased access to genetic testing and counseling for patients with prostate cancer. By leveraging GCAs and video education, this model involves cancer genetics at each step of the process, decreases turnaround time, and increases rates of returned results that can be used by patients to inform treatment and prevention strategies.

Estimating Classification Decisions for Incomplete Tests

AbstractUnforeseen complications during the administration of large‐scale testing programs are inevitable and can prevent examinees from accessing all test material. For classification tests in which the primary purpose is to yield a decision, such as a pass/fail result, the current study investigated a model‐based standard error approach, Bayesian Inference, Binomial Distribution, and Lord–Wingersky Recursion methods to estimate the consistency of making these classification decisions on an incomplete test. Using operational data from a high‐stakes licensure examination, where items are presented in random order, results indicated that all methods were successful in eliminating misclassification when at least half the test was completed. Results from both Binomial and Recursion methods were nearly indistinguishable, yet differences emerged when item sequence was manipulated into difficulty order. Bayesian Inference was the most flexible, relatively unaffected by whether or not the items were randomly presented; however, representative prior data were required, which limits its practical utility. Implications for use in practice, relevant policy decisions, and feasibility for operational implementation are discussed.

Incidence of Huntington disease in a northeastern Spanish region: a 13-year retrospective study at tertiary care centre

BackgroundDespite the progress in the knowledge of Huntington disease (HD) in recent years, the epidemiology continues uncertain, so the study of incidence becomes relevant. This is important since various factors (type of population, diagnostic criteria, disease-modifying factors, etc.) make these data highly variable. Therefore, the genetic diagnosis of these patients is important, since it unequivocally allows the detection of new cases.MethodsDescriptive retrospective study with 179 individuals. Incidence of HD was calculated from the ratio of number of symptomatic cases newly diagnosed per 100,000 inhabitants per year during the period 2007–2019 in Aragon (Spain).Results50 (27.9%) incident cases of HD (CAG repeat length ≥ 36) were identified from a total of 179 persons studied. The remaining 129/179 (72.1%) were HD negative (CAG repeat length < 36). 29 (58.0%) females and 21 (42.0%) males were confirmed as HD cases. The overall incidence was 0.648 per 100,000 patient-years. 11/50 positive HD cases (22.0%) were identified by performing a predictive test, without clinical symptoms. The minimum number of CAG repeats found was 9 and the most common CAG length among HD negative individuals was 16.ConclusionsOur incidence lied within the range reported for other Caucasian populations. Implementation of new techniques has allowed to determine the exact number of CAG repeats, which is especially important in patients with triplet expansions in an HD intermediate and/or incomplete penetrance allele, both in diagnostic, predictive and prenatal tests.

METHOD FOR CALCULATING THE RELIABILITY OF QUARTZ RESONATORS

In the process of developing a thermocompensated quartz generator, it was necessary to calculate the reliability indicators of such an important element of the circuit as a quartz resonator for a failure-free period of 15 000 hours. The main parameter that can be used to evaluate the reliability of the quartz resonator is the stability of the nominal oscillation frequency. It is the stability of the nominal frequency of the resonator that formed the basis of the new developed technique. The method includes rules for constructing a probabilistic and statistical model of the dependence of the resonator frequency change on the test time. The article describes the work done on the accelerated evaluation of the reliability of piezoelectric resonators RK563 on the basis of probabilistic and statistical modeling of the behavior of the frequency from the test time. The method of mathematical modeling is based on the results of incomplete tests for a period of 30…50 % of the set value of the minimum operating time.

Hypo–High-Density Lipoproteinemia Is Associated With Preoperative Tear Size and With Postoperative Retear in Large to Massive Rotator Cuff Tears

To evaluate any association of specific subtypes of dyslipidemia with increments of preoperative tear size and with structural integrity after arthroscopic rotator cuff repair (ARCR). One surgeon's consecutive patients who underwent ARCR from January 2011 to June 2018 were reviewed. The inclusion criteria were minimum 1-year follow-up ultrasonography, blood tests, physical examination, and provision of informed consent. The exclusion criteria were incomplete laboratory tests, history of acute trauma, previous shoulder surgery, isolated subscapularis tendon tear, inappropriate radiographs, no 1-year follow-up ultrasonography, and medication with lipid-lowering drugs. Associated preoperative factors for the increments of tear size and for retear after ARCR were determined using logistic regression analysis. Statistical significance was set at P < .05. Of the 502 ARCR patients from the study period, 195 patients (195 shoulders), with a mean age of 60.5 ± 7.5 years, met the inclusion and exclusion criteria. Age (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.1-1.3), diabetes (OR, 3.6; 95% CI, 1.7-7.5), and hypo-high-density lipoproteinemia (hypo-HDLemia) (OR, 2.9; 95% CI, 1.5-5.6) were significantly associated with increments of preoperative tear size (P ≤ .01). Diabetes (OR, 3.0; 95% CI, 1.3-6.6), critical shoulder angle (OR, 2.0; 95% CI, 1.4-3.0), and tear size (OR, 2.1; 95% CI, 1.3-3.4) were significantly associated with retear after ARCR in overall study subjects (P= .01). Diabetes (OR, 3.8; 95% CI, 1.3-11.4), hypo-HDLemia (OR, 3.0; 95% CI, 1.1-8.8), and critical shoulder angle (OR, 1.5; 95% CI, 1.1-2.3) had significant associations with retear after ARCR in patients with a large to massive preoperative tear size (P ≤ .04). Preoperative hypo-HDLemia (high-density lipoprotein level < 40 mg/dL in male patients and < 50 mg/dL in female patients) has a significant association with the increments of preoperative tear size and with retear after ARCR in large- to massive-sized rotator cuff tears. Level IV, case series.