Test Requests Research Articles

Psychological health associated with prenatal screening in low‐risk pregnancy for chromosomal aneuploidy

The aim of this study was to assess the psychological health associated with prenatal screening in low-risk pregnancy for chromosomal aneuploidy. This longitudinal study was performed on 310 low-risk pregnancies for chromosomal aneuploidies. Using the standard DASS-21 questionnaire, levels of stress, anxiety, and depression were assessed-prior to the recommended time for the first-trimester screening test (T1), after the first-trimester tests on the second referral (T2) concurrently with the request for the second-trimester tests (T3)-and compared between women undergoing the prenatal screening and in women refusing it. The results showed that the mean of stress, anxiety, and depression levels were not different between groups at T1; but the level of the stress, depression, and anxiety were higher in the screening group than the non-screening group. The effect of group on changes in the stress, depression, and anxiety levels was significant. The results revealed that the prenatal screening program in low-risk pregnancies for chromosomal aneuploidy can be followed by rising psychological symptoms and this psychological burden should be conceded on prenatal screening tests for pregnant women.

Mutations in viral nucleocapsid protein and endoRNase are discovered to associate with COVID19 hospitalization risk

SARS-CoV-2 is spreading worldwide with continuously evolving variants, some of which occur in the Spike protein and appear to increase viral transmissibility. However, variants that cause severe COVID-19 or lead to other breakthroughs have not been well characterized. To discover such viral variants, we assembled a cohort of 683 COVID-19 patients; 388 inpatients (“cases”) and 295 outpatients (“controls”) from April to August 2020 using electronically captured COVID test request forms and sequenced their viral genomes. To improve the analytical power, we accessed 7137 viral sequences in Washington State to filter out viral single nucleotide variants (SNVs) that did not have significant expansions over the collection period. Applying this filter led to the identification of 53 SNVs that were statistically significant, of which 13 SNVs each had 3 or more variant copies in the discovery cohort. Correlating these selected SNVs with case/control status, eight SNVs were found to significantly associate with inpatient status (q-values < 0.01). Using temporal synchrony, we identified a four SNV-haplotype (t19839-g28881-g28882-g28883) that was significantly associated with case/control status (Fisher’s exact p = 2.84 × 10–11). This haplotype appeared in April 2020, peaked in June, and persisted into January 2021. The association was replicated (OR = 5.46, p-value = 4.71 × 10−12) in an independent cohort of 964 COVID-19 patients (June 1, 2020 to March 31, 2021). The haplotype included a synonymous change N73N in endoRNase, and three non-synonymous changes coding residues R203K, R203S and G204R in the nucleocapsid protein. This discovery points to the potential functional role of the nucleocapsid protein in triggering “cytokine storms” and severe COVID-19 that led to hospitalization. The study further emphasizes a need for tracking and analyzing viral sequences in correlations with clinical status.

P219 Impact of COVID-19 pandemic in patients with a first consultation for suspected inflammatory bowel disease

BackgroundDuring the COVID-19 pandemic, outpatient activity and the performance of complementary tests have been limited in order to optimize health care resources in patients with SARS-CoV2 infection according to the incidence of cases in each time period. The aim of this study was to determine the impact of the measures implemented by the COVID-19 pandemic on the diagnosis, initiation of treatment, and follow-up of patients referred for suspected inflammatory bowel disease (IBD) at different times during the pandemic.MethodsRetrospective multicenter study comparing three cohorts of patients who were referred for evaluation in IBD consultation during three time periods: pre-pandemic “pre-COVID19” (pC), from March to May 2019; during health alert “alert-COVID19” (aC), from March to May 2020; and during a recent post-pandemic alert period “post-COVID19 alert” (p-aC), from January 2021 to March 2021. All patients referred with suspected IBD (“first time” consultation) were included. Epidemiological and clinical variables were recorded from the onset of digestive symptoms and up to a follow-up of 6 months after consultation.ResultsA total of 114 first-time consultations were recorded: 47 in pC (age 45.3, SD 2.6 years; 63.83% female), 24 in aC (age 48.3, SD 3.3; male 54.2%) and 43 in p-aC (age 44.5, SD 2.4; male 53.4%). Significant differences were determined in terms of the reason for consultation between the periods (recent diagnosis of IBD: 25.5% pC vs 41.7% cD vs 53.5% a-pC; p= 0.03 and suspicion of IBD: 74.5% pC vs 58.3% aC vs 46.5% in p-aC; p = 0.03). The diagnosis of IBD was confirmed in 44.6% of patients in the pC period, 66.6% in aC and 67.4% in p-aC, (p=0.06). There were no significant differences between the three periods in terms of time from suspicion of the disease to evaluation at the first visit and time to completion of complementary tests. However, there were significant differences in the time between diagnosis and initiation of treatment among the pC group (mean 1.7, SD 1.05 months), in contrast to 4.36 months (SD 2.03) in aC and 3.82 months (SD 1.3) in p-aC (p= 0.05). There were also no differences in the management (treatment and request for complementary tests) of the sucessive consultation, except for the number of hospital admissions in the six months following the first consultation (5 cases in pC vs. no admissions in aC and p-aC,p=0.03).ConclusionDuring the COVID19 pandemic,the ability to diagnose patients with IBD has been maintained with no delays in the performance of complementary tests at participating centers. However, a delay in the initiation of treatment that could negatively impact the health of IBD patients is currently being maintained.

Evolution of the quality of prenatal care in the primary network of Brazil from 2012 to 2018: What can (and should) improve?

The article describes the temporal evolution of prenatal quality indicators in the primary health care network in Brazil and investigates regional differences. This study used data from the external evaluation of Brazil's National Program for Improving Primary Care Access and Quality (PMAQ) with health teams participating in Cycles I, II and III of the Program, carried out respectively in 2012, 2013/14 and 2017/18. The number of visits, physical examination procedures, guidelines and request for laboratory tests were investigated. There was a positive evolution for tests-HIV, syphilis, blood glucose and ultrasound, and for all tests, guidance on feeding and weight gain of the baby and examination of the oral cavity. The indicators that performed the worst were: performance of tetanus vaccine, six or more visits, receiving guidance on exclusive breastfeeding and care for the newborn, and the procedures-all, measurement of uterine height, gynecological exam and cervix cancer prevention. These changes had a varied behavior between the regions of the country.

US EPA turns down requests for more PFAS toxicity testing

The US Environmental Protection Agency has deferred or turned aside advocacy groups’ requests to require Chemours to conduct toxicity tests on dozens of fluorochemicals found in North Carolina drinking-water supplies. The agency has already required or will require testing of 9 of the 54 compounds. Per- and polyfluoroalkyl substances (PFAS) traced to a Chemours plant outside Fayetteville taint the Cape Fear River and wells that supply water for hundreds of thousands of people. Several of these compounds have been found in the blood of people who have drunk that water. But the health effects of this exposure remain unclear because of a lack of toxicity data for the substances. On Dec. 28, the EPA announced that it was granting a petition from six North Carolina advocacy groups that sought testing of 54 fluorochemicals associated with Chemours’s Fayetteville operation. But the actions the agency indicated it will take in response fail

US EPA turns down requests for more PFAS toxicity testing

US EPA turns down requests for more PFAS toxicity testing

Digital Health Technology for Remote Care in Primary Care During the COVID-19 Pandemic: Experience from Dubai

Introduction: We aimed to provide an insight on the feasibility and impact of telemedicine use among primary health care (PHC) providers and on nonurgent health care delivery during the coronavirus disease 2019 (COVID-19) outbreak in the United Arab Emirates (UAE). Methods: This observational study was conducted using telemedicine data from Dubai Health Authority from January 2020 to July 2021. Results: Of 123,944 individuals who booked an appointment for the telemedicine service, 106,408 (86%) showed up. Most patients were 19-59 years old, UAE nationals, female, and having government insurance. The telemedicine care volume grew from 188 visits in January 2020 to 11,757 in April 2020. The most common diagnosis was general health consultation (55,672; 52%), followed by COVID-19-related consultation (18,523; 17%) and laboratory test requests (11,064; 10%). Around 4,997 (5%) telemedicine consultations were for a medication refill. A multiple linear regression model predicting the types of diagnosis-related telemedicine needs by age and the interaction of gender and nationality was statistically significant for dermatology (p = 0.0000), respiratory (p = 0.0000), and cardiovascular (p = 0.0000) diseases. Conclusions: Virtual care services in PHC clinics have been highly successful in meeting the needs of patients during the COVID-19 pandemic. Telemedicine has enabled clinicians to continue providing care to patients while maintaining the necessary public health measures adopted in the fight against COVID-19. However, will the switch to telemedicine be sustainable in the long term and what will be the level and degree of telemedicine adoption beyond COVID-19? This requires more studies to explore how the PHC organizations will provide further support and guidance on the suitability of telemedicine in various circumstances and clinical conditions.

Pandemic Response in the Clinical Laboratory: The Utility of Interactive Dashboards

The ability to access and analyze data is critical to manage a laboratory and respond and adapt to changes, particularly during a pandemic. Data analytic tools can not only improve laboratory operations, but also increase the visibility of the laboratory in the healthcare system and demonstrate the positive impact of the laboratory on patient care. In this article, we describe the creation and utility of laboratory dashboards. Several dashboards were designed to assist with pandemic response. For each dashboard, a stored procedure was created that performed a SQL query of our laboratory information system mirror database. We utilized the business analytics platform, Tableau, for data visualization. Users could modify the data by selecting a specific date range, time window, work shift, institution(s), specific test(s), and/or testing platform(s). Access was controlled by OKTA integration to the host server over the web, behind the hospital firewall. During the April 2020 surge, we saw an increase in blood gas testing and corresponding decrease in non-critical testing such as Vitamin D. At our institution, SARS-CoV-2 molecular testing was performed using four primary platforms, four in-house and one send-out. Weekly and hourly testing volumes as well as turnaround times fluctuated based on reagent availability, new testing requests, staffing, and operational changes. Productivity dashboards indicated that coagulation testing volumes were highest on the third shift and that all three analyzers may not be necessary. Further, specimen volumes and productivity of accessioning staff varied throughout the day. Phlebotomy venipuncture volumes and patient wait times also varied throughout the pandemic. A decrease in ambulatory draws was seen during the surge but after reopening draw volumes, particularly at offsite locations, surpassed prepandemic volumes. We demonstrate that data analytics and interactive dashboards are powerful tools, are helpful in response to a pandemic and lead to improved TAT, supply utilization, staffing and workflows. Furthermore, dashboards provide objective data to review with hospital leadership and promote collaboration.

Characteristics of patients aged 50&#x2013;74 years with a request for an immunochemical faecal occult blood test in the Australian general practice setting.

Objective To support improving participation in the National Bowel Cancer Screening Program (NBCSP), we aimed to identify Medicare-subsidised test requests for immunochemical faecal occult blood tests (FOBT) in Australian general practice for patients aged 50-74 years, eligible for the NBCSP, and describe sociodemographics, risk factors, indications and outcomes. Methods A cross-sectional study was conducted using de-identified data from 441 Australian general practice sites in the MedicineInsight database, recorded from 1 January 2018 to 31 December 2019. Results Of the 683 625 eligible patients, 45 771 (6.7%) had a record of a general practitioner (GP)-requested FOBT, either to aid diagnosis in symptomatic patients, or for screening; 144 986 (21.2%) patients had only an NBCSP FOBT. A diagnosis of polyps, gastrointestinal inflammatory condition or haemorrhoids, or a referral to a gastroenterologist or general surgeon, was more commonly recorded in the 6 months after a GP-requested FOBT than after an NBCSP FOBT. Uptake of NBCSP FOBTs was lower among those with obesity, high alcohol consumption and current smokers, who are at higher risk of bowel cancer. Conclusions This study describes the patient characteristics, reasons and outcomes associated with GP-requested FOBTs, identifies under-screened population sub-groups, and suggests involvement of GPs to improve participation in the NBCSP.

Reasons that clinicians in Australia offer cervical screening outside guidelines for frequency, age and co-testing.

Australian clinicians involved in cervical screening and treating women with cervical abnormalities were invited to complete a cross-sectional online survey between September 2019 and February 2020. We measured self-reported adherence to cervical screening guidelines for three common scenarios and analysed free-text reasons for offering tests contrary to guidelines using content analysis. A total of 607 clinicians (283 general practitioners [GPs], and 324 obstetricians and gynaecologists [O&Gs]) were eligible and participated. Of these, 37.8% of GPs and 43.8% of O&Gs would provide testing more frequently than indicated by guidelines, but recognised the need for patients to be aware of the additional cost and for guidelines to be explained; 13.9% of GPs and 10.2% of O&Gs would screen women at a younger age than indicated due to patient request, patient/family history and the need for patient reassurance; and 11.4% of GPs and 23.6% of O&Gs would perform a HPV and cytology co-test when not indicated, mainly as a result of a mistake or lack of familiarity with guidelines, patient/family history and patient reassurance. Patient request for testing was a reason for testing outside the guidelines with regard to frequency of testing, age of testing and co-testing. These data suggest that it is likely cervical screening outside guidelines is occurring in Australia. As patients often request these tests, strategies to reduce screening outside the guidelines should include ensuring that women are aware of the financial implications and the reasons for the updated guidelines.

OpenEHR modelling applied to Complementary Diagnostics Requests

Complementary Diagnostic Requests (CDRs) are required for disease identification, monitoring, and prognosis. Diagnostic tests misuse, on the other hand, can lead to negative health outcomes as well as additional costs. Inappropriate diagnostic test requests are primarily the result of a lack of interoperability between Healthcare Information Systems (HIS). On one hand, clinicians can be mislead into which test is the best option for each clinical case, on the other hand missing previous results, leads to duplication or unnecessary tests. HIS is increasingly relying on standards based on dual architecture to promote interoperability as well as the structuring and consistency of clinical and demographic data. The OpenEHR standard's duo-based architecture allows for concise modelling of archetypes and templates for a given clinical case, which was used in this study. As a result, the purpose of this research was to build an openEHR template for the CDR registration as well as the architecture of a Data Warehouse (DW) system capable of storing all of the information needed for the diagnostic test request process. Afterwards, Business Intelligence (BI) indicators was developed in order to answers the needs for test registration and execution.

INPUT PROCES ANALYSIS FOR TESTING CAR ENGINES

The topic covered in this paper is a study conducted in the automotive testing department of Renault Technologie Roumanie.The contains of this study is: an analysis of the testing process from receiving a test request to the generation of results and sending them for interpretation to the customer, the analysis of the types of mechanical engine tests performed at Renault Romania and the economical analysis of implementing a hybrid engine test bench, the first of its kind in Romania, with project analysis and SWOT analysis. What is being pursued by this process is the correct delimitation of the test stages, the succession and the way to become competitive on a market with tradition and which offers opportunities for progressive development along the evolution of vehicles towards hybrid and full-electric.

Effects of the COVID-19 Pandemic on Prostate Cancer Screening and Diagnosis

Background: COVID-19 pandemic clearly demonstrates that not only is it causing unprecedented morbidity and death worldwide, its almost unstoppable spread is affecting the diagnosis and treatment of many other acute and chronic diseases. These changes created by the COVID-19 pandemic have had a direct negative impact on cancer screening and new cancer diagnosis. Methods: We aimed to compare prostate specific antigen (PSA) requested, TRUS guided biopsy (TRUS-Bx) and new prostate cancer (PCa) diagnoses from 1 January 2019 to the end of 31 December 2021 both on an annual basis and as a monthly change, and evaluate the percentage change. Patients’ age, prostate volume, PSA values, pathology results of biopsies were analyzed as basic demographic information. Results: From January 2019 through December 2021, there were 18618 PSA testing and 141 TRUS-Bx results from men in the hospital database. When we look at the distribution of PSA test requests by years, we see that 8473 in 2019, 4763 with a decrease of 44% in 2020 and a 12% increase in 2021 compared to 2020, but still 36.5% less in 2019. When we look at the number of TRUS-Bx, we see that we performed a total of 141 TRUS-Bx between January 2019 and December 2021. While we performed 65 TRUS-Bx in 2019 before the pandemic, this figure decreased to 40 with a 38.5% decrease in 2020, while we observed that the similar situation continued with 36 cases in 2021. Conclusions: As a result, our findings show that a significant number of PCa screening opportunities and cancer diagnoses are missed. Delays in cancer diagnosis will cause adverse clinical outcomes in the coming years. Considering that PCa does not pause due to the COVID-19 pandemic, it may cause patients to progress to more advanced disease stage at the time of diagnosis, require more aggressive treatment and even succumb to cancer due to the delays that occur. Further work is required to analyze the assessment of the clinical prognostic impact of cancer diagnosis delays.

Community pharmacies fulfil 17 million lateral flow test requests, official data show

Pharmacy contractors in England claimed nearly 17 million transactions in the first eight months of the ‘Community pharmacy COVID-19 lateral flow device distribution service’, official data show. The service — publicly known as ‘Pharmacy Collect’ — enables members of the public to collect boxes of seven lateral flow COVID-19 tests free of charge from participating […]

Utilization of genetic testing: Analysis of 4,499 prior authorization requests for molecular genetic tests at four US regional health plans.

Continuous advances in genetic testing methodologies and an increased understanding of the genetic mechanisms of diseases have fueled genetic testing utilization across health care specialties. To our knowledge, national trends in the ordering of genetic testing have not been studied broadly across clinical indications, testing methodologies, and ordering provider specialties. We performed a retrospective analysis of 4,499 complete prior authorization requests for molecular genetic testing submitted to four regional health plans' commercial lines of business between May 1, 2019 and May 31, 2019. Ordering providers were characterized by their certification(s) and specialty of practice. Among 4,499 genetic testing requests, 92% were ordered by non-genetics providers. Obstetrician/gynecology (OBGYN) (63%), oncology (15%), and genetics (8%) providers ordered genetic testing most frequently. Reproductive, hereditary cancer, and tumor testing were the most frequently ordered genetic tests. Seventy-nine percent of all prior authorization requests were approved. When analyzing complex genetic testing requests, we found that testing ordered by genetics providers was more likely to be approved based on health plan policy than testing ordered by non-genetics providers. Our results suggest that health care providers across multiple medical specialties may benefit from involvement of genetics specialists in decision-making regarding molecular tests.

Implementasi OLAP pada Data Kerja Praktik dan Tugas Akhir Menggunakan Framework Modular Cube JS

&#x0D; &#x0D; &#x0D; The government's role in the implementation of higher education in Indonesia is to provide a university database. It is hoped that the government and the public can participate in assessing and conducting surveillance with the database. Every tertiary institution must report everything related to the implementation of education, starting from lecturer data, student data, and lecture data. In its performance, a Dikti Feeder application has been prepared that can transmit data. Each university will adjust the data entry following the Dikti standards. As one of the higher education providers, STMIK STIKOM Indonesia has been able to report data well, but specifically for final assignments and work practices, it has not been maximized due to the development of a separate system from the academic system. For this reason, a suitable system will be developed to accommodate Thesis and Internship data related to reporting on the Dikti Feeder by applying the Online Analytical Processing (OLAP) method using the Cube JS modular framework. Some of the tests carried out are schema file testing, frontend and backend testing, cube client testing, querying testing and load request testing showing the data can be displayed correctly and the process is successful.&#x0D; &#x0D; &#x0D;

SARS-CoV-2 detection in nasopharyngeal swabs: Performance characteristics of a real-time RT-qPCR and a droplet digital RT-PCR assay based on the exonuclease region (ORF1b, nsp 14)

The emergence and spread of SARS-CoV-2 has led to a compelling request for accurate diagnostic tests. The aim of this study was assessing the performance of a real-time RT-qPCR (rt RT-qPCR) assay and of a droplet digital RT-PCR (dd RT-PCR) targeting the nsp14 genome region for the detection of SARS-CoV-2 in nasopharyngeal swabs.A total of 258 nasopharyngeal swabs were analyzed with the nsp14 assays and, for comparison, with a reference assay targeting the RdRp and E genes. Conflicting results were further investigated by two additional protocols, the Centers for Disease Control and Prevention (CDC) real-time targeting N1/N2, and a nested RT-PCR for the spike region.Agreement of results was achieved on 226 samples (156 positive and 70 negative), 8 samples were positive in the reference assay and in the nsp14 rt RT-qPCR but negative with the dd RT-PCR, and 24 samples provided different combinations of results with the three assays. Sensitivity, specificity and accuracy (95 %C.I.) of the nsp14 assays were: 100.0 % (97.4–100.0), 98.7 % (92.1–100.0), and 99.6 % (97.5–100.0) for the rt RT-qPCR; 92.4 % (87.4–95.6), 100.0 % (94.2–100.0), and 94.7 % (91.1–97.0) for the dd RT-PCR.The results of the study support the use of the nsp14 real-time RT-qPCR and ddPCR for the detection of SARS-CoV-2 in nasopharyngeal swabs.

Do antimicrobial stewardship programs improve the quality of care in ICU patients diagnosed with infectious diseases following consultation? Experience in a tertiary care hospital

One of the most important public health concerns is the ever-growing problem of antibiotic resistance. Importantly, the rate of introduction of new molecules into clinical practice has slowed down considerably. Moreover, the rapid emergence of resistance shortens the effective 'lifespan' of these molecules. The quality of care before and after active intervention and feedback was evaluated in patients diagnosed with sepsis/septic shock or ventilator-associated pneumonia (VAP) in the ICUs of Hacettepe University Adult and Oncology Hospitals. There was a significant increase in total scores. Significant improvements were achieved in the management of these patients in terms of requests for necessary diagnostic tests, and the prolonged infusion of beta-lactam agents. Implementation of an ASP in centers where antimicrobial management of ICU patients is largely controlled by infectious diseases specialists remains a feasible strategy that leads to better patient care.

Online pathology request platform at the Semmelweis University

The 1st Department of Pathology and Experimental Cancer Research, Semmelweis University (Budapest, Hungary) has a broad network of clinical partners, many of which are non-university hospitals. A separate hospital information system and a local laboratory workflow management system is used at the Department. University clinics use the hospital information system for electronic requesting of tests. Non-university partners have no access to the systems, requesting tests is paper-based, registration of the requests at the pathology lab is manual and laborious. Our main objective was to improve the efficiency of the sample registration step of the pathology workflow. Applying the Plan-Do-Check-Act procedure, a quality improvement project has been carried out and an online, subspecialty-based requesting application tool, interfaced with the current laboratory information system, was developed. The average sample registration time improved with 65% among the early user partners. The past years have shown smaller, inefficient pathology labs decreasing in number and integrated into larger regional diagnostic centers. Both issues of efficiency and quality assurance and problems rooted in human resources are drivers of further centralisation. The numbers of test requests and samples from non in-house partners are expected to be increased in the pathology labs in the future. Efficient and safe sample tracking has to start at the site of sample acquisition. State of the art laboratory information systems should support this expansion of competence. Orv Hetil. 2021; 162(49): 1962-1967.

A survey study of endometrial receptivity tests and immunological treatments in in vitro fertilisation (IVF).

Suboptimal endometrial receptivity is a key factor behind in vitro fertilisation (IVF) implantation failure. Direct clinical tests of the endometrium of natural killer (NK) cells and endometrial receptivity analysis (ERA) are controversial. To examine the current practice of endometrial receptivity tests (NK cells and ERA) and immunological treatments (corticosteroids, anticoagulants, antiplatelets, intravenous immunoglobulin, Intralipid, other) among fertility specialists in Australia and New Zealand. A prospective 23-item web-based survey was distributed by email via the Fertility Society of Australia and New Zealand, between August and October 2020. Data were collected and analysed using Qualtrics. Of 238 fertility specialists, 90 completed the survey (response rate 37.8%). ERA (48/90, 53.3%) was most commonly ordered, followed by uterine NK (uNK) (36/90, 40.0%) and peripheral blood NK (pNK) (12/90, 13.3%). For all tests, the most common indication was recurrent implantation failure (RIF) (41/48, 22/36, 6/12; 85.4%, 61.1%, and 50.0%, respectively for ERA, uNK and pNK). Of those that did not offer these tests, the main reason cited was insufficient evidence (30/42, 47/54, 68/78; 71.4%, 87.0%, and 87.0%). A third of specialists offered empirical immunological treatment for RIF (30/90, 33.3%): anticoagulants (28/30, 93.3%), antiplatelets (27/30, 90.0%), and corticosteroids (25/30; 83.3%). The majority of specialists (56/90, 62.2%) stated they had refused a patient request for endometrial testing or treatment. Tests for presumed endometrial receptivity pathology are often used in Australia and New Zealand. Immunological treatments for RIF are commonly employed empirically, without strong evidence of their effectiveness or safety. Further studies should focus on education and clinical adherence to evidence-based guidelines.