Recommendations For Further Testing Research Articles

Back Pain: Clinical Updates in Women's Health Care Primary and Preventive Care Review.

Every age group experiences back pain, a common reason for activity limitation. Management of back pain in a woman is challenging because of physiologic and hormonal changes through the woman's life cycle. The treatment is dictated by etiology and a woman's stage of life or reproductive events, such as pregnancy, breastfeeding, and menopause. Most episodes of low back pain are temporary with minimal long-term sequelae, but recurrent and long-lasting episodes require more thorough clinical evaluation. This monograph describes the anatomy of the spine; illustrates a focused, thorough evaluation, including obtaining a medical history and performing a physical examination; discusses warning signs and symptoms of more serious etiologies; provides recommendations for further testing or referral; and offers case vignettes of common causes of low back pain as a woman progresses from young adulthood to advanced age.

Impact of a Multidisciplinary eBoard on the Management of Patients With Complex Inflammatory Bowel Disease

Abstract Background We aim to assess the impact of a multidisciplinary inflammatory bowel disease (IBD) conference on the management of patients with complex IBD. Methods Data were collected during each conference from February 2017 through October 2018 with chart review performed at 6 months to determine if conference recommendations were successfully implemented. Results Eighty-five patients were discussed. The presenting diagnosis was changed by 11.8%. Recommendations for further testing, medical therapy, and surgery were successfully implemented in 77.1%, 98.1%, and 88.4%, respectively. Conclusions This study supports the role of IBD multidisciplinary conferences in the management of patients with complex IBD.

A simple model for temperature response of single-zone passive buildings

This article presents a method for calculating interior air temperature as a function of ambient conditions for simple structures (single-zone passive buildings with low infiltration). Examples of such structures are unconditioned greenhouses, storage facilities, and wholly passive solar houses. The method was tested in a partially unoccupied apartment building for 8 days. A simple model was applied to the data in which interior air temperature was taken as an exponential step response to a change in exterior temperature. The time constant calculated from this relationship exhibited periodic fluctuations from day to day. A method is described for reconstructing the interior temperature record using these findings in the step change model. The average difference between the recorded and modeled data was −0.1°C for the period of monitoring. This was unexpected considering that insolation was not monitored or taken into account in the model. The simple step response model was thus sufficient to reconstruct the recorded interior temperature data at this test site. The paper concludes with recommendations for further testing of the method.

Abstract B75: Factors correlated with follow up after an abnormal mammogram: A population-based study

Abstract Introduction: There are a plethora of data regarding factors correlating with screening mammography, yet a relative paucity of data regarding factors correlated with following the recommendation for further testing after an abnormal mammogram. We hypothesized that socioeconomic status, race/ethnicity and insurance would be key drivers in patients' decision to follow the recommendation for further tests. Methods: The National Health Interview Survey is a face-to-face population-based study conducted annually by the CDC, and is the largest source of health information for Americans. Data from the 2010 Cancer Supplement, which included questions regarding follow-up after abnormal mammograms, were used for this analysis. Univariate and multivariate analyses were conducted using SAS-Callable SUDAAN software. Results: In 2010, there were 8518 women over the age of 30 who answered the question regarding the recommendation for further testing after their most recent mammogram, representing 65,226,785 women in the population. Of these, 10.6% were recommended to have further tests done. Women under the age of 65 were significantly more likely to be recommended to have further imaging than their older counterparts (p=0.0005). Recommendation for further testing did not vary by region (p=0.599), race/ethnicity (p=0.126), income (p=0.124), and education (p=0.771). Insurance status was also associated with recommendation for further testing on univariate analysis. On multivariate analysis, however, neither age nor insurance were predictive of recommendations for further testing. Of the 881 people (6,912,415 in the population) for whom additional testing was recommended, 82.4% followed this guidance. Factors correlating with following these recommendations included insurance status (p=0.008), education (p=0.010), and income (p<0.001). Age, region and race/ethnicity were not correlated with the decision to comply with follow-up recommendations. On multivariate analysis, controlling for education and income, insurance status remained the only predictor of the likelihood of a patient to follow recommendations for further testing after an abnormal mammogram (p=0.0128). Compared to the uninsured population, those with private insurance were 2.7 times more likely to follow recommendations for further testing (95% CI: 1.37-5.44, p=0.005). Conclusion: Nearly 11% of women undergoing mammography will be recommended to have further testing; however, nearly 20% will not follow these recommendations. Lack of insurance status was the only factor correlating with a significantly lower likelihood to comply with recommended further testing; race/ethnicity, income and education were not independent predictors on multivariate analysis. This finding highlights the importance of insurance as a means to secure access for early breast cancer detection. Citation Format: Taber C. Lightbourne, Anees B. Chagpar. Factors correlated with follow up after an abnormal mammogram: A population-based study. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B75.

Abstract NS24: Algorithm Development to Improve Transient Ischemic Attack Outcomes

Background and Purpose: Management of care for the patient experiencing a transient ischemic attack (TIA) is inconsistent and compromises patient outcomes. This is due to the absence of a clearly defined protocol for TIA aimed at expediting care to reduce delays in diagnosis and treatment. The purpose of this study was to establish an evidence-based method for early identification, assessment, and consistent treatment of TIA. Methods: A TIA algorithm was designed and implemented based on translation of current evidence. Effectiveness of the algorithm was determined by comparing two separate groups using secondary data analysis of patients presenting to emergency department triage diagnosed with TIA six months prior to implementation of the algorithm (n= 80) and six months following implementation (n= 67). Patients in the implementation group received the evaluation and treatment outlined in the algorithm as the new standard of care. Primary outcomes were analyzed using a Chi-Square test of independence to evaluate recurrent ischemic events post-index TIA and independent samples t -tests for measuring length of stay (LOS) and total direct costs of care. Results: Significant reductions in overall direct costs of care [ t (121) = 7.23, p = .001, d = 1.20] and LOS [ t (142) = 2.40, p = .018, d = 0.40] associated with consistency in diagnostic testing and patient disposition were found. Recurrent TIA [ X 2 (1, N = 147) = 1.52, p= .22, r 2 = 0.01] and stroke [ X 2 (1, N = 147) = 2.83, p= .093, r 2 = 0.02] events post-index TIA were noted within the implementation group. Although not significant in this sample size, the clinical importance of findings demonstrated a 7.2% difference in overall stroke events with no recurrence of TIA as evaluated at 2, 30, 60, and 90-day time intervals. Conclusions: Findings from this study demonstrated that the use of a TIA algorithm was successful in guiding the interdisciplinary team to impact outcomes for the patient at risk for stroke. Recommendations for further testing of the algorithm in a multi-site cohort study would allow for a larger sample to evaluate this disease specific care model.

THE DEVELOPMENT AND INITIAL VALIDATION OF A QUESTIONNAIRE TO MEASURE THE KEY ATTRIBUTES OF THE CLINICAL NURSE SPECIALIST IN PALLIATIVE CARE

BackgroundThe Scottish Government recognises the importance of quality, person-centred healthcare, and current worldwide events have forced an examination of the nursing contribution to this agenda. This increasing requirement to demonstrate...

Robustness evaluation using highly accelerated life testing

This paper presents experimental aspects and results of highly accelerated life testing in order to study the robustness of electronic boards subject to two main covariates: thermal and vibration stresses. Statistical analysis of test results and assessment of the product quality characteristics under different conditions (operating and destruction limits) are presented. Recommendations for further testing are also presented.

Impact of Oxcarbazepine Sulfate Metabolite on Incurred Sample Reanalysis and Quantification of Oxcarbazepine

Recently, incurred sample reanalysis (ISR) has become a requirement in bioanalysis. The general guidance recommends investigating ISR failure to evaluate the suitability of an analytical method. In the case of acceptable ISR evaluation, there were no precise recommendations for further testing when sporadic values were obtained. The ISR evaluation performed during a bioequivalence study for the anticonvulsant drug oxcarbazepine showed acceptable ISR results, but one particular chromatographic anomaly led to a thorough investigation. The finding of these tests showed that an oxcarbazepine phase II metabolite occasionally co-eluted with the drug and impacted oxcarbazepine's quantitation through in-source conversion. This paper demonstrates the necessity of rigorous interpretation of ISR results and close monitoring of all subject sample results.

Non-adherence to Recommendations for Further Testing after Outpatient CT and MRI

Background Nearly 1 in every 5 outpatient visits ends with a request for a diagnostic imaging test, and imaging reports often contain recommendations for further testing. Little is known about adherence to recommendations for further testing after outpatient computed tomography (CT) and magnetic resonance imaging (MRI). Methods We performed a retrospective cohort study linking provincial administrative data to a cross-sectional audit of 23,691 outpatient CT and MRI scans performed in 2005 in Ontario, Canada. After excluding patients who died (n = 1031), were hospitalized (n = 3030), or visited an emergency department (n = 3660) within 180 days of the index CT/MRI scan, 15,970 CT/MRI scans were included. The primary outcome was adherence to recommendations for further testing within 180 days of an index CT/MRI scan. Results Further testing was recommended in 2027 of 15,970 (12.7%) index CT/MRI scan reports and was recommended most frequently after CT chest scans (593 of 2276 [26.1%]). From the 2027 scans in which further testing was recommended, we identified 2102 individual recommendations for a specific type of follow-up test and found that just over one third (37.6%) of these recommendations were followed at 180 days. Adherence was lower (32.3%) when patients had a visit to the referring physician within 180 days of the index CT/MRI scan, compared with when they had no such visit (50.5%; P <.001). Conclusions Radiologists commonly recommend further testing after outpatient CT and MRI scanning. However, nearly two thirds of these recommendations are not followed. This suggests that substantial opportunities exist to improve the exchange of information between clinicians and radiologists and to advance the quality of outpatient care.

The Equivocally AmplifiedHER2FISH Result on Breast Core Biopsy

To our knowledge, there are no universally accepted, evidence-based guidelines for how to resolve the HER2 status of tumors demonstrating equivocal amplification. The present study was based on 17 breast core biopsy specimens demonstrating invasive carcinoma with equivocal HER2 amplification, defined as an HER2/chromosome 17 centromere ratio of 1.8 to 2.2. Each case had a corresponding resection specimen, on which HER2 immunohistochemical and repeated fluorescence in situ hybridization analyses were performed. A definitive change in HER2 status based on the resection specimen occurred in 10 (59%) of 17 cases, with 4 patients (24%) becoming eligible for trastuzumab therapy and 6 (35%) triaged as ineligible. These results suggest that genetic and protein expression heterogeneity exists in tumors that show low-level HER2 gene copy numbers. For the purposes of uniform clinical management, HER2 status should be evaluated on a larger tumor sample if the core biopsy specimen demonstrates an equivocal result. These results support the recent American Society of Clinical Oncology/College of American Pathologists recommendations for further testing in cases with equivocal HER2 results.

Spar Corner Radius Integrity for the A400M Wing

The paper focuses on the structural integrity of the corner radius of the carbon fibre composite, ‘C’-section spar for the Airbus A400M wing. The corner radius is subject to opening moments generated by internal wing box fuel pressures. The low inter-lamina strength of composites makes de-lamination of the corner of prime concern. The paper describes initial development of analytical techniques to calculate the through-thickness tensile stresses and inter-lamina shear stresses developed in a corner radius under applied bending moments and transverse shear forces. A test programme is also described, aimed at the determination of the failure moment of curved laminates under pure bending moments. Using the analytical expressions developed, a through-thickness failure stress is calculated from the failure moments. A variation of the failure stress with specimen thickness is indicated, showing that thicker specimens fail at higher inter-lamina stresses – a characteristic that must be exploited in the design of the spar. Using finite element analysis of the test configuration, in conjunction with virtual crack extension techniques, it is demonstrated that, at the failure load, a constant rate of strain energy release accompanies inter-lamina crack growth in the different test specimens. A critical energy release rate for uncontrolled crack growth is thus established, which is used, in conjunction with further finite element analysis, to predict the failure stress of specimens with different values of thickness and corner radius. It is concluded that this fracture mechanics approach to integrity can be applied to the A400M spar corner and to similar aircraft structures. Recommendations for further testing and correlation with analysis are proposed to strengthen the theoretical basis for such integrity assessments.

Application of CCME Procedures for Deriving Site-Specific Water Quality Guidelines for the CCME Water Quality Index

Abstract Since its development in 2001, the Canadian Council of Ministers of the Environment (CCME) Water Quality Index (WQI) has established itself as a valuable tool for communicating ambient water quality data. Due to the high natural background levels of particular parameters in water bodies throughout the country it is often necessary to use Site-Specific Water Quality Guidelines (SS-WQGs) as opposed to generic national Water Quality Guidelines (WQGs) or provincial Water Quality Objectives (WQOs) in the CCME WQI model to obtain truly representative rankings. SS-WQGs have only been developed for a limited number of ambient water quality sites and this has been a major hurdle to the widespread use and acceptance of the CCME WQI. This paper presents the adaptation and implementation of an existing CCME-approved SS-WQGs derivation method called the background concentration (BC) procedure into a Site-Specific Water Quality Index (SS-WQI) calculator and tool. It discusses the application of the SS-WQI calculator to compute water quality indices for five pristine ambient water quality sites in Newfoundland and Labrador. The effects of using five different BC-based SS-WQGs (mean; median; mean ± one standard deviation; mean ± two standard deviations; 90th and 10th percentile) are examined. The paper also discusses the challenges and benefits of using this methodology and provides recommendations for further testing.

Proximity of Clothing to Self Scale

This paper presents methods and results of Phases One and Two of a multi-phase research program whose long-term goals are to develop an instrument for scaling people on the multidimensional attribute proximity of clothing to self (PCS) and to verify content and construct validity and reliability of the instrument, including the individual dimensions that comprise the PCS concept. Phase One resulted in (a) revised definitions of six PCS dimensions and (b) 78 PCS Scale items with established content validity. Both definitions and items are grounded in people’s experience of clothing in everyday life across age and gender. Completion of three rounds of confirmatory factor analyses in Phase Two resulted in a 24-item PCS Scale that has demonstrated construct validity and reliability for adolescents in high school. The initially hypothesized 6-factor scale was not confirmed for adolescents; content from the six dimensions was integrated into a 4-factor scale for use with this age group. Recommendations for further testing of construct validity of the PCS Scale across the life span are made.

Interpretation of hepatitis B virus serology results by medical scientists

Medical laboratory scientists who had agreed to participate in an evaluation which required them to measure the level of anti-HBs in a panel of sera, were given a brief clinical scenario for seven of the results and asked to comment on the person's immune status. The interpretations of immune status were assessed against the matters considered by the authors to reflect the current state of knowledge about immunity to hepatitis B and recommendations from authorities. There were a number of common but not universal misconceptions in the interpretation of results and current guidelines, particularly regarding appropriate use of hepatitis B immune globulin (HBIG), equating the absence of anti-HBs in a previous seroconverter with no immunity or the need to institute a new course of vaccination, and inappropriate recommendations for further testing or retesting. Given that the cost of serology for anti-HBs now exceeds the cost of three doses of vaccine, more effective and rational testing of immune status to hepatitis B is required.