Number Of Diagnostic Tests Research Articles

P114: Barriers and facilitators affecting implementation of a decision aid for the diagnosis of acute aortic syndrome: a qualitative study

Introduction: Acute aortic syndrome (AAS) is an uncommon, life-threatening emergency that is frequently misdiagnosed. The Canadian clinical practice guidelines for the diagnosis of AAS were developed in order to reduce the frequency of misdiagnoses and number of diagnostic tests. As part of the guidelines, a clinical decision aid was developed in order to facilitate clinician decision-making based on practice recommendations. The objective of this study was to identify barriers and facilitators among physicians to implementation of the decision aid. Methods: We conducted semi-structured interviews with emergency room physicians working at 5 sites distributed between urban academic and rural settings. We used purposive sampling, contacting ED physicians until data saturation was reached. Interview questions were designed to understand potential barriers and facilitators affecting the probability of decision aid uptake and accurate application of the tool. Two independent raters coded interview transcripts using an integrative approach to theme identification, combining an inductive approach to identification of themes within an organizing framework (Theoretical Domains Framework), discrepancies in coding were resolved through discussion until consensus was reached. Results: A majority of interviewees anticipated that the decision aid would support clinical decision making and risk stratification while reducing resource use and missed diagnoses. Facilitators identified included validation and publication of the guidelines as well as adoption by peers. Barriers to implementation and application of the tool included the fact that the use of D-dimer and knowledge of the rationale for its use in the investigation of AAS were not widespread. Furthermore, scoring components were, at times, out of alignment with clinician practices and understanding of risk factors. The complexity of the decision aid was also identified as a potential barrier to accurate use. Conclusion: Physicians were amenable to using the AAS decision aid to support clinical decision-making and to reduce resource use, particularly within rural contexts. Key barriers identified included the complexity of scoring and inclusion criteria, and the variable acceptance of D-dimer among clinicians. These barriers should be addressed prior to implementation of the decision aid during validation studies of the clinical practice guidelines.

SARS-CoV-2 infection in pediatric population.

In December 2019, in Wuhan (Hubei, China), the first COVID-19 cases due to SARS-COV-2 had been reported. On July 1st 2020, more than 10.268.839 million people had developed the disease, with at least 506.064 deaths. At present, Italy is the third country considering the number of cases (n=240.760), after Spain, and the second for the cumulative number of deaths (n=249.271), after the United States. As regard pediatric COVID-19 cases, more than 4000 cases (have been reported; however, these figures are likely to be underestimated since they are influenced by the number of diagnostic tests carried out. Three pediatric deaths have been reported in Italy to date. We aimed to review the peculiar aspects of SARS-COV-2 infection in the pediatric population. (www.actabiomedica.it)

Interactive whiteboard use in clinical reasoning sessions to teach diagnostic test ordering and interpretation to undergraduate medical students

BackgroundOver-testing of patients is a significant problem in clinical medicine that can be tackled by education. Clinical reasoning learning (CRL) is a potentially relevant method for teaching test ordering and interpretation. The feasibility might be improved by using an interactive whiteboard (IWB) during the CRL sessions to enhance student perceptions and behaviours around diagnostic tests. Overall, IWB/CRL could improve their skills.MethodsThird-year undergraduate medical students enrolled in a vertically integrated curriculum were randomized into two groups before clinical placement in either a respiratory disease or respiratory physiology unit: IWB-based CRL plus clinical mentoring (IWB/CRL + CM: n = 40) or clinical mentoring only (CM-only: n = 40). Feasibility and learning outcomes were assessed. In addition, feedback via questionnaire of the IWB students and their classmates (n = 233) was compared.ResultsAnalyses of the IWB/CRL sessions (n = 40, 27 paperboards) revealed that they met validated learning objectives. Students perceived IWB as useful and easy to use. After the IWB/CRL + CM sessions, students mentioned more hypothesis-based indications in a test ordering file (p < 0.001) and looked for more nonclinical signs directly on raw data tests (p < 0.01) compared with students in the CM-only group. Last, among students who attended pre- and post-assessments (n = 23), the number of diagnostic tests ordered did not change in the IWB/CRL + CM group (+ 7%; p = N.S), whereas it increased among CM-only students (+ 30%; p < 0.001). Test interpretability increased significantly in the IWB/CRL + CM group (from 4.7 to 37.2%; p < 0.01) but not significantly in the CM-only group (from 2.4 to 9.8%; p = 0.36).ConclusionsIntegrating IWB into CRL sessions is feasible to teach test ordering and interpretation to undergraduate students. Moreover, student feedback and prospective assessment suggested a positive impact of IWB/CRL sessions on students’ learning.

Increased Testing and Health Care Costs for Pediatric Cannabis Exposures.

This study aimed to evaluate the process of identifying marijuana exposure in a children's hospital emergency department and compare the cost of diagnostic testing and procedures. A retrospective chart review was performed on patients 31 days to 20 years old with a positive marijuana toxicology screen result between November 2009 and December 2014. Primary outcomes included time to provider recognition of marijuana exposure, number of diagnostic tests and procedures performed, and length of hospital stay. Patients were analyzed based on time of exposure recognition (forthcoming compared with not forthcoming of marijuana exposure) and age (children <12 years compared with adolescents >12 years). There were 37 children and 38 adolescents included. Mean time to exposure recognition was 2.3 ± 4.3 hours in children compared with 0.4 ± 0.9 hours in adolescents (P = 0.02). Patients who were not forthcoming of marijuana exposure experienced more than twice as many diagnostic tests or procedures compared with children who were forthcoming of marijuana exposure (mean, 8.91 vs 4 tests, P < 0.0001) and more than a 4-fold higher cost of potentially avoidable diagnostic tests/procedures. Length of hospital stay was significantly longer in children (18.34 ± 2.39 hours) compared with adolescents (4.22 ± 0.52 hours; P ≤ 0.0001). Few parents or guardians were able to disclose characteristics of the marijuana product. Delay in recognition of marijuana exposure is associated with high resource utilization, unnecessary medical costs, and prolonged length of stay.

Achieving Inclusive Growth in Nigeria through Exports: An Empirical Investigation

The study investigated the effectiveness of export in the attainment of inclusive growth in Nigeria. The study functionally expressed inclusive growth as a function of oil export, non oil export, investment and foreign direct investment. In order to achieve the objectives of the study, a number of literature were reviewed, however, there were empirical regularities in the literature embracing inclusive growth as critical determinant of sustainable growth. Within the context of secondary data which spanned the period 1970-2016, the study utilized econometric technique to analyze inclusive growth model. In the model, real per capita income (proxy inclusive growth) is expressed as a function of oil exports, non oil export, investment and foreign direct investment. In particular, a number of diagnostic tests were carried out on the data before estimation in order to prevent spurious results. These include the unit root test, co-integration test and vector error correction tests. The stationarity test indicated that the data were stationary at first difference, while the co-integration test suggested long run co movement among the variables. In addition, the vector error correction model indicated the relationships among the inclusive growth fundamentals. Findings from the results indicated that in the long run, the coefficients of oil and non oil exports have negative effect on inclusive growth (proxied by real GDP per capita) while investment and foreign direct investment impacted positively on inclusive growth, while in the short run, oil exports and non oil export positively and significantly influenced inclusive growth in Nigeria. This study further suggested that government should intensify policy towards stimulating oil export and promote foreign investment inflows. More so, policy thrust should also embrace diversification of the economic base from monolithic base structure to agriculture.

An Optimised Fracture Liaison Service Model: Maintained Diagnostic Sensitivity Despite Reduced Number of Diagnostic Tests Performed.

Patients suffering a low-energy fracture are at high risk of subsequent fractures. Investigation of all fragility fracture patients above the age of 50years is recommended in order to prevent further fractures. The aim of this study was to investigate alternative strategies including known risk factors (age, sex, and body weight) for selecting fracture patients for osteoporosis assessment and investigate how these strategies would affect the proportion of patients with osteoporosis identified and the number of patients referred for Dual X-ray Absorptiometry (DXA) compared with the original FLS strategy. From OFELIA; a cohort study comprising 794 fragility fracture patients we included 622 patients aged 18 + years (mean age 56 ± 17) with fragility fractures. We investigated the predictive value of clinical risk factors using ROC curves and AUC analyses. The revised strategies were compared by analyzing sensitivity and specificity of different strategies based on sex, age, BMI, and bodyweight. For patients 50 + years, a strategy investigating men and women with body weight ≤ 85kg resulted in sensitivity and specificity of 94% and 25%, respectively, reducing the number of DXAs by 21%. For patients < 50 years, the prevalence of osteoporosis was low and it was, therefore, difficult to develop an acceptable strategy. We found that the original FLS strategy can be modified to include substantially fewer patients and still only miss the osteoporosis diagnosis in a very few patients. A modified strategy would potentially save costs and concerns in many patients.

Geriatric urinary tract infections: The value of laboratory parameters in estimating the need for bacteremia and Intensive Care Unit.

Objective:We investigated the geriatric patients diagnosed as urinary tract infection and evaluated the effects of white blood cell (WBC), neutrophil count, platelet, mean platelet volume (MPV), red cell distribution width (RDW), total bilirubin, direct bilirubin, creatine, albumin, erythrocyte sedimentation rate, C-reactive protein, and neutrophil/lymphocyte ratio parameters on estimating the need for bacteremia and intensive care (IC) for the patients with pyelonephritisMethods:Between 2016-2017, a total number of 188 patients aged 65 years and above were retrospectively evaluated at the infectious diseases clinic.Results:The 124 (66%) of the patients were male and 64 (34%) were female. The laboratory values of the patients with pyelonephritis and urosepsis were found to be significantly lower in only RDW bacteremic patients (p=0.047). The laboratory values during the application of third-step IC unit patients, who were treated and discharged, were compared. Albumin was significantly lower, while direct bilirubin, AST and ALT were significantly higher (p<0.05).Conclusions:Patients, whose biochemical parameters have changed, especially during admission or follow-up, should be evaluated carefully in terms of urosepsis, multiple organ failure and IC need. A number of diagnostic tests have been described to predict the need for sepsis and IC. However, many of them cannot be performed in emergency conditions. It is a great advantage that the parameters we use in our work are easily accessible and can be performed in emergency conditions.

Theraputic and Identifecation Study of Tinea Capitis Infection in Basra City

The current study included isolation and identifecation of some types of dermatophytic fungi that causes Tinea capitis in the province of Basrah from the patients of the Basra General Hospital and a private clinic in the province. The results showed that the number of positive samples of the culture was 110 samples and 61.11% as cases of Tinea capitis, as the number of male infected 78 samples and 70.90%, while the number of female infected was 32 and 29.09%, and found that the age group 6 - 10 years is Were more infection to develop tinea capitis and 47.27%,.The dermatophytes that causing tinea capitis were diagnosed using a number of diagnostic tests. Microsporumcanis was found to be more frequent by percentage 49.09%, The other side of the study was to test the inhibitory activity ofcloves extracts and peel of pomegranate in M.canis, using Agar Well Diffusion Method by using several different types of polar solvents .The results of the study showed that the Hexane extract of the clove plant had the highest effect in M.canis,, A comparison of Griseofulvin was found to be the most effective fungal antifungal against M.canis,.GC-MS has been used to diagnose fatty acids for the hexane extract of cloves..

Quantitative Effect of Emergency Department Case Management on Visits, Diagnostics, and Cost

Background and Hypothesis: &#x0D; In 2012, Parkview Health initiated a case management (CM) program with the hypothesis that it would reduce emergency department (ED) visits, radiation exposure, and costs for patients who had visited a Parkview ED 5 or more times within 6 months. &#x0D; Experimental Design or Project Methods: &#x0D; This retrospective case series involved examining medical records of 460 CM patients from 2011 to 2018, recording the amount of Parkview ED visits, diagnostic tests, and affected cost accumulated in the year prior to CM enrollment compared to each of the next 2 years. Demographics, chief complaints, diagnoses, psychiatric and drug use history, and whether the patients had insurance and a primary care provider were also recorded. Patient data was excluded if the patient was younger than 18 at the time of CM enrollment, had not yet completed 2 years in the CM program, or if medical records were not available. ANOVA and 1-sided, paired t-testing were performed to evaluate significance of the results. &#x0D; Results: &#x0D; Comparing the year before enrollment to the 2nd year after, ED visits were reduced from 5,264 to 2,012 for 378 patients (63%, p&lt;0.01), the affected cost was reduced from $551,734.45 to $246,248.34 for 299 patients (55%, p&lt;0.01), and the number of diagnostic tests was reduced from 6,040 to 1,883 for 104 patients (69%, p&lt;0.01). &#x0D; Conclusion and Potential Impact: &#x0D; Patients enrolled in Parkview’s CM program showed statistically significant reductions in ED visits, radiologic exposures, and affected costs over 2 years, with implicit improved health outcomes. Projected 10-year affected cost savings range from $3.7 million to $9.1 million.

A systematic diagnostic evaluation combined with an internet-based self-management support system for patients with asthma or COPD.

IntroductionAn (inter)national systematic approach for patients with asthma COPD referred to secondary care is lacking. Therefore, a novel systematic approach was designed and tested in clinical practice.MethodsThis was a retrospective observational study of data from the electronic record system of the Leiden University Medical Center. Asthma and COPD patients were included if they were evaluated with a novel systematic approach or if they had a new record for asthma or COPD and received usual care. The novel systematic approach consisted of a predefined diagnostic evaluation combined with an optional internet-based self-management support system. Diagnostic tests, final diagnosis, lifestyle advices, symptoms and individual care plans in the electronic records, number of patients referred back to primary care, and time to referral back to primary care were compared between the systematic approach and usual care groups using t-tests and chi-squared tests.ResultsA total of 125 patients were included, of which 22 (21.4%) were evaluated with the systematic approach. Mean (±SD) age was 48.8 (±18.4) years and 59.2% were women. Mean (±SD) number of diagnostic tests was higher in the systematic approach group compared with the usual care group (7.6±1.0 vs 5.5±1.8, P<0.001). Similarly, in the systematic approach group, more lifestyle advices (81.8% vs 29.1%), symptom scores (95.5% vs 21.4%), and individual care plans (50.0% vs 7.8%) were electronically recorded (P<0.001), and more patients were referred back to primary care (81.8% vs 56.3%, P=0.03). There were no differences in the final diagnoses and time to referral back.ConclusionOur study suggested that not all tests that were included in the systematic approach are regularly needed in the diagnostic work-up. In addition, a designated systematic approach stimulates physicians to record lifestyle advices, symptoms, and individual care plans. Thus, this approach could increase the number of patients referred back to primary care.

An Overview of Our Current Understanding of Diabetic Macular Ischemia (DMI).

Diabetic macular ischemia (DMI) is a troublesome complication of diabetes mellitus. The pathogenesis, progression, consequences, and treatment options for this disease are still poorly understood. However, it is believed that this complication is associated with several risk factors like poor glycemic control and high blood pressure. Two factors have been identified in the pathogenesis of the disease that play pivotal roles in disease development and progression. One of these factors includes extensive damage to the microvasculature of the retina. This includes narrowing of the vascular lumen and extensive damage to the endothelial cells, pericytes and the extracellular matrix. The second factor includes extensive damage to the neurosensory layer of the retina. DMI is always associated with other complications of diabetic retinopathy like retinal edema, so it is very difficult to find an isolated case of DMI. Moreover, the condition is also very rare making it very difficult to study and diagnose. However, a number of diagnostic tests like optical coherence tomography (OCT), fluorescence angiography (FA), and perimetry can be used as tools for the early detection of DMI. Since this disease damages the retina, loss of vision is an inevitable consequence that can progressively worsen over time. Also, DMI has been implicated as a risk factor for retinal edema and progressive diabetic retinopathy. Until now, no defined treatment protocol has been devised. The only available treatments focus on the management of risk factors (hyperglycemia and hypertension). Still, many aspects of DMI remain poorly studied and understood. This review paper aims to add to our current understanding of diabetic macular ischemia (DMI).

Syndrome Evaluation System for Simultaneous Detection Pathogens Causing Acute Encephalitic Syndrome in India, Part-1: Development and Standardization of the Assay.

A large number of organisms are known to cause acute encephalitic syndrome (AES). A number of diagnostic tests have to be performed in order to arrive at a probable pathogen causing AES thus making it a very time consuming, laborious and expensive. The problem is further compounded by the lack of availability of sufficient volume of Cerebrospinal fluid (CSF). Thus, there is an urgent need of a diagnostic tool for the simultaneous detection of all probable pathogens responsible for causing AES. Here we report the development of a novel diagnostic method, Syndrome Evaluation System (SES) for the simultaneous detection of 22 pathogens including RNA and DNA Viruses, bacteria, fungi, and parasite all endemic to India and Southeast Asia in a single sample using a novel multiplexing strategy. Syndrome Evaluation System (SES) involves isolation of nucleic acid, multiplex amplification of the DNA, and cDNA followed by identification of the amplified product by sequence specific hybridization on SES platform with the final read out being a visually recordable colored signal. The total time required to carry out this diagnostic procedure is 7 h. The SES was standardized using the commercially available vaccines, panels and cell culture grown quantified viruses/bacteria/fungi. The limit of detection (LOD) of SES ranged between 0.1 and 50 viral particles per ml of CSF and 100 to 200 bacterial cells or 5 parasites per ml of CSF, along with 100% specificity. Precision studies carried out as per the Clinical Laboratory Improvement Amendments (CLIA) guidelines, using two concentrations of each pathogen one the LOD and the other double the LOD, clearly demonstrated, that inter/intra assay variability was within the limits prescribed by the guidelines. SES is a rapid molecular diagnostic tool for simultaneous identification of 22 etiological agents of AES encountered both in sporadic and outbreak settings.

A panel of DNA methylation markers for the detection of prostate cancer from FV and DRE urine DNA

BackgroundEarly screening for prostate cancer (PCA) remains controversial because of overdiagnosis and overtreatment of clinically insignificant cancers. Even though a number of diagnostic tests have been developed to improve on PSA testing, there remains a need for a more informative non-invasive test for PCA. The objective of this study is to identify a panel of DNA methylation markers suitable for a non-invasive diagnostic test from urine DNA collected following a digital rectal exam (DRE) and/or from first morning void (FV). A secondary objective is to determine if the cumulative methylation is indicative of biopsy findings.MethodsDRE and FV urine samples were prospectively collected from 94 patients and analyzed using 24 methylation-specific quantitative PCR assays derived from 19 CpG islands. The methylation of individual markers and various combinations of markers was compared to biopsy results. A methylation threshold for cancer classification was determined using a target specificity of 70%. The average methylation and the number of positive markers were also compared to the result of the biopsy, and the area under the receiver operating characteristic curves (AUCs) were calculated.ResultsMethylation of all 19 markers was detected in FV and DRE DNAs. Combining the methylation of two or more markers improved on individual marker results. Using 6of19 methylated markers as the threshold for cancer classification yielded a specificity of 71% (95% CI, 0.57–0.86) from both DRE and FV and a sensitivity of 89% (95% CI, 0.79–0.97) from DRE and 94% (95% CI, 0.84–1.0) from FV. The negative predictive value at the 6of19 threshold was ≥ 90 for both DNA types.ConclusionsPCA-specific methylation was detected in both FV and DRE DNA. There was no significant difference in diagnostic accuracy at the 6of19 threshold between DRE and FV urine DNA. The results support the development of a non-invasive diagnostic test to reduce unnecessary biopsies in men with elevated PSA. The test can also provide patients with personalized recommendations based on their own methylation profile.

Use of a Pediatric Syncope Unit Improves Diagnosis and Lowers Costs: A Hospital-Based Experience

To assess the effect of a dedicated pediatric syncope unit on the diagnostic and therapeutic management of children with suspected syncope. We also evaluated the effectiveness of the pediatric syncope unit model in decreasing unnecessary tests and hospitalizations, minimizing social costs, and improving diagnostic yield. This single-center cohort observational, prospective study enrolled 2278 consecutive children referred to Bambino Gesù Children's Hospital from 2012 to 2017. Characteristics of the study population, number and type of admission examinations, and diagnostic findings before the pediatric syncope unit was implemented (2012-2013) and after the pediatric syncope unit was implemented (2014-2015 and 2016-2017) were compared. The proportion of undefined syncope, number of unnecessary diagnostic tests performed, and number of hospital stay days decreased significantly (P < .0001), with an overall decrease in costs. A multivariable logistic regression analysis, adjusted for confounding variables (age, sex, number of diagnostic tests), the period after pediatric syncope unit (2016-2017) resulted as the best independent predictor of effectiveness for a defined diagnosis of syncope (P < .0001). Pediatric syncope unit organization with fast-tracking access more appropriate diagnostic tests is effective in terms of accuracy of diagnostic yield and reduction of costs.

What is new in ISO standards, recommendations and legal regulations in Polish POCT?

The number of diagnostic tests performed as a point of care testing (POCT) is constantly growing. High quality of the results obtained in this way requires obligatory implementation of appropriate quality-oriented procedures. Such a procedures should come from legal issues like acts and executive regulations. In Poland, there is currently no comprehensive legal framework for POCT. The recommendations of the National Chamber of Medical Laboratory Specialists and the ISO Standard EN-PN 22870 provide guidance on the organization and management of the “bedside” testing system, as well as the pre-analytic, analytical and post-analytic phases of these &lt;i&gt;in vitro&lt;/i&gt; tests. However, both documents are not obligatory and compliance with them is voluntary. Taking into account the patient’s safety, legal acts should be created that will allow to ensure the appropriate quality of tests performed “near patient” and will be the basis for the cooperation of laboratories and clinical departments in this field.

MODELING AN EFFECTIVE SYSTEM FOR DIAGNOSING A TRACTION MOTOR WITH ACCOUNTING FOR SELECTION OF ITS ELEMENTS ASSEMBLY OPTIONS

Purpose. The purpose of study is the simulation the parameters of the locomotive traction motor diagnosis system to ensure a given level of reliability. Methodology. The research was carried out on the basis of the multi-criteria optimization procedure, methods of the reliability theory and the recovery theory. Results. The procedure of multicriteria optimization for the traction motor diagnostics system was presented that accounts for the following quality indicators: the number of diagnostic moments, and the mean time to failure. A method for constructing the moments of diagnosing components of a traction motor have been presented with the further determination of rational volumes of diagnosis and determination of corresponding resulting moments of diagnosing the engine as a single system. The diagnosis moments are selected so that the failure probability of the components does not fall below the pre-set value. Novelty. A new method for constructing a rational system for diagnosing a traction motor has been proposed by the definition of the Pareto criteria: the number of diagnostic tests, the mean time between failures. Practical value. The Research was carried out with the State Program for the Strategic Development of Railways of Ukraine prepared by the State Research Center for Railway Transport of Ukraine in conjunction with the specialists of Ukrzaliznytsia, and Renovation Program of the Traction Rolling-Stock of Railways to the 2020 year. The necessary quality of the diagnostic system should be determined according to the diagnosed object, taking into account the requirements imposed on the latter. The system of diagnosing of a technical object depends on the production technology and the technology of renovation of the components used, which makes it possible to choose the performer of the repair work or the manufacturer of the components of the technical object.

Probabilistic Modeling Approach to Reducing Healthcare Costs With Reflex Testing.

Statistical methods can be utilized to optimize the order for reflex diagnostic testing to attenuate patient and hospital costs without affecting quality of care. Our objective is to demonstrate the method of developing an order for testing and to apply this method to an illustrative example. An algorithm was developed for minimizing costs for any given number of diagnostic tests, and it was retrospectively applied to a sample. The actual scenario of using both tests on all patients was compared to 2 other hypothetical reflex testing approaches: all patients are given 1 test, and those patients who tested negative were then given the second test. The 2 scenarios would have saved 37.1% and 17.4% in testing costs, respectively. These calculations could be applied to numerous situations to reduce costs for patients and hospitals. We propose that this methodology would be best used in conjunction with any existing quality improvement initiatives.

Визначення системи діагностування ТЕД з урахуванням вибору бажаних елементів зі змінною інтенсивністю відмов

The purpose of study is the simulation the parameters of the locomotive traction motor diagnosis sys-tem to ensure a given level of reliability. The research was carried out on the basis of the multi-criteria optimization procedure, methods of the reliability theory and the recovery theory. The procedure of multicriteria optimization for the traction motor diagnostics system was presented that accounts for the following quality indicators: the number of diagnostic moments, and the mean time to failure. A method for constructing the moments of diagnosing components of a traction motor have been presented with the further determination of ra-tional volumes of diagnosis and determination of corresponding resulting moments of diagnosing the engine as a single system. The diagnosis moments are selected so that the failure probability of the components does not fall below the pre-set value. A new method for constructing a rational system for diagnosing a traction motor has been proposed by the definition of the Pareto criteria: the number of diagnostic tests, the mean time between failures. The Research was carried out with the State Program for the Strategic Development of Railways of Ukraine prepared by the State Research Center for Railway Transport of Ukraine in conjunction with the specialists of Ukrzaliznytsia, and Renovation Program of the Traction Rolling-Stock of Railways to the 2020 year. The necessary quality of the diagnostic system should be determined according to the diagnosed object, taking into account the requirements imposed on the latter. The system of diagnosing of a technical object depends on the production technology and the technology of renovation of the components used, which makes it possible to choose the performer of the repair work or the manufacturer of the components of the technical object

Relationship between diagnostic interval and pancreatic ductal adenocarcinoma (PDAC) resectability: A single-center retrospective analysis.

e15738 Background: PDAC often presents with nonspecific symptoms and the workup for suspected PDAC is not standardized. While surgery remains the only curative therapy, only 20% of PDAC is resectable due to local extension or metastasis. We examined the relationship between diagnostic interval of PDAC and surgical resectability. Methods: We performed a retrospective chart review of patients evaluated for PDAC at the Center for Pancreas Cancer at Johns Hopkins in 2014. Data were collected on the patient, diagnostic, and treatment time intervals (defined as days between first symptoms to medical presentation, presentation to diagnosis, and diagnosis to treatment), diagnostic tests performed, and the type of initial treatment. Asymptomatic patients diagnosed incidentally, or those for whom initial medical presentation was unclear, were excluded from our analysis. Results: Of 453 charts reviewed, 116 patients met our inclusion criteria. The median patient interval was 14 days (IQR 6-30), the median diagnostic interval was 22 days (IQR 8-46), and the median treatment interval was 26 days (IQR 15-35). The median number of diagnostic tests performed was 8 (IQR 6-11). At the time of diagnosis, 7 patients (6%) had stage 1, 53 (46%) had stage 2, 24 (21%) had stage 3, and 32 (28%) had stage 4 disease. A total of 38 patients (33%) received upfront surgery for treatment of PDAC and 78 (67%) received nonsurgical treatment. Non-white individuals had lower odds of receiving surgery (Adjusted Odds Ratio [aOR]: 0.09, 95% Confidence Interval [CI]: 0.01, 0.74, p = 0.024). After adjusting for age, sex, race and diagnostic clinic, the odds of receiving surgery significantly increased for individuals with a patient interval of 1 month or less (aOR: 3.47, 95% CI: 1.003, 12.0, p = 0.010) and with a diagnostic interval of 2 months or less (aOR: 15.3, 95% CI: 1.90, 122, p = 0.019). Conclusions: A patient interval of less than 1 month and a diagnostic interval less than 2 months for symptomatic PDAC were associated with an increased probability of upfront surgical treatment. These data indicate that extended intervals prior to PDAC diagnosis may reduce the odds of obtaining a potentially curative treatment.

Impact on Morbidity, Mortality, and Length of Stay of Hospital-Acquired Infections by Resistant Microorganisms.

Infections by multidrug-resistant organisms (MDROs) are a global threat and are particularly common in hospitals. This study was performed to assess the impact of hospital-acquired infections caused by MDROs on morbidity, mortality, and length of hospital stay. This was a retrospective cohort study. A sample of adults aged ≥18 years with a respiratory, urinary, bloodstream, or surgical site infection caused by a multidrug-resistant (cases) or -sensitive (controls) microorganism was selected. Measurements included hospital mortality from all causes (total and 30 days after infection), length of stay (LOS), and 5 indicators of morbidity: intensive care or surgery admissions, number of diagnostic tests after infection, and hospital readmissions or visits to the emergency department within 30 days of discharge. The sample was composed of 324 cases and 676 control patients. Risk of hospital mortality from all causes (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.25-2.32) and 30 day-mortality after infection (HR, 1.77; 95% CI, 1.29-2.44) were higher in patients with an MDRO infection. Probability of readmission was also higher (odds ratio [OR], 2.17; 95% CI, 1.36-3.46) in the case group. Emergency department visits were only significantly higher in methicillin-resistant Staphylococcus aureus (OR, 2.80; 95% CI, 1.65-4.74) and in Escherichia coli-resistant infections (OR, 2.28; 95% CI, 1.32-3.96). Infections by MDRO were not associated with any other outcome. Hospital infections caused by MDROs increase mortality, readmissions, and in some cases, visits to the emergency department compared with those produced by susceptible strains. They do not appear to influence LOS nor the need for hospital admission, intensive care, surgery, or diagnostic tests.