Screening Test Results Research Articles

P-2121. A prospective observational study of usefulness of interferon-gamma release assay for latent tuberculosis infection in pediatric hematopoietic stem cell transplant recipients

Abstract Background Pediatric hematopoietic stem cell transplantation (HSCT) recipients are one of the high-risk groups concerning tuberculosis and screening for latent tuberculosis infection (LTBI) prior to HSCT is important and accurate diagnostic tests for predicting LTBI in these high-risk children are on demand. However, there are concerns for Interferon-gamma release assay(IGRA) being less sensitive in the children group for screening LTBI. This study was aimed to evaluate the predictive value of Quantiferon-TB Gold test (QFT-G) using the enzyme-linked immunosorbent spot assay (T-SPOT.TB) in immunocompromised Korean children. Methods In this prospective observational study, children under age 20 who were scheduled for allogeneic HSCT at Asan Medical Center Children`s Hospital were enrolled during March 2017 and May 2018. QFT-G test and T-SPOT.TB were done prior to HSCT. Concordance rates were calculated among each group. Electronic Medical Records was reviewed for clinical and demographic data of the enrolled patients. Results Among the 62 patients who were planned to receive allogenic HSCT during March 2017 and May 2018, 11 patients were excluded and a total of 51 patients were enrolled. Median age was 10 years and the underlying disease leading to HSCT was mostly aplastic anemia (31.4%). Others were acute myeloid leukemia (23.5%), acute lymphoblastic leukemia (15.7%), myelodysplastic syndrome (7.8%), and other benign disease (17.6%). About 52% of the patients were applied immunosuppressive drugs in the recent 3-month period prior to testing. 4 patients were considered LTBI based on screening test results. At 2 year follow up period, 1 patient was confirmed pulmonary TB. Overall concordance rate was 82.4% (42/51). The age-based concordance rate was 93.8% (14/15) for children younger than 5-years old and 77.8% (28/36) for 5 or above. Concordance rate between negative test results and not TB diagnosis was further checked; QFT-GIT 97.8% (44/45), T-SPOT. TB 97.9% (46/47), and TST 100% (10/10). Conclusion This study shows that the GFT-GIT well matched with the T-SPOT.TB for screening LTBI and children under age 5 showed to have higher concordance rates compared to the older age group. This could provide evidence to testing younger children with IGRA assays. Disclosures All Authors: No reported disclosures

627. Outcomes of Military Blood Donors Screening Positive for Trypanosoma cruzi

Abstract Background First time blood donors at the Armed Service Blood Bank-San Antonio are screened for Trypanosoma cruzi infection with a chemiluminescent microparticle immunoassay (CMIA) followed by a confirmatory enzyme strip assay (ESA). In military populations, T. cruzi positivity on a screening test accounts for the fourth most common reason for post-donation deferral. With concerns for low positive predictive value in a low prevalence disease, this study evaluated the clinical outcomes and diagnostic work-up of blood donors who screened positive on T. cruzi CMIA testing.Table 1:Workup of 49 blood donors who screened positive for Trypanosoma cruzi infection Methods All blood donors from 2017-2022 were screened for T. cruzi antibodies with CMIA and deferred indefinitely if screening was positive, regardless of ESA result. All donors that initially screened positive for T. cruzi infection were evaluated to determine diagnostic work-up, further testing, specialty appointments seen, and final diagnosis of each case following their initial positive blood donation screen.Table 2:Clinical outcomes of 4 blood donors with positive T. cruzi screening test and confirmatory test Results Of 89,459 blood donors during the study period, 49 (57.3 per 100k donors) screened positive for Chagas disease on initial blood donation. Of those individuals, 4 (8%) had positive, 18 (36%) had indeterminate, and 30 (61%) had negative confirmatory tests. The evaluation varied significantly depending on the results of ESA testing, however there were no blood donors who met criteria for Chagas disease (Table 1). Evaluation of four donors with positive CMIA and ESA showed only one with repeat positivity on one assay, but all were ultimately deemed negative (Table 2). Conclusion While positive T. cruzi antibodies were a common reason for post-donation deferral in this cohort, there were no confirmed cases of Chagas disease, despite most patients receiving an extensive work-up. Patients with positive or indeterminate ESA received more specialty care and more confirmatory testing than those with a negative confirmatory test. This study demonstrates the need for higher specificity screening and confirmatory tests for T. cruzi in blood donors in low prevalence settings. Disclosures All Authors: No reported disclosures

Hypopituitarism Screening in Patients with Traumatic Brain Injury in the Primary Care Setting at the Minneapolis Veterans Affairs Health Care System.

Traumatic brain injury (TBI) is a significant health issue among veterans and poses a substantial risk for pituitary injury. Consensus guidelines recommend that patients who have sustained a TBI should undergo a baseline pituitary hormonal evaluation after the primary brain insult. Patients with abnormal screening test results or with symptoms of hypopituitarism should be referred to endocrinology for a full assessment. Currently, there are no reported data on the screening rates of hypopituitarism in veterans with TBI. This pilot study was conducted to determine the frequency of screening for hypopituitarism in veterans with TBI in a primary care clinic setting. We conducted a single-center retrospective cohort study of patients with a diagnosis of TBI who were seen by their primary care physicians at the Minneapolis Veteran Affairs Health Care System over a 1-year period. A random sample was generated using computerized random generator software of patient data, including demographics, TBI-related information, and pituitary hormone levels, which were collected from the panel of primary care providers. We used 2 sets of screening criteria, one by Ghigo etal. published in 2005, and the second by Tan etal. published in 2017, to define hypopituitarism screening adequacy in our cohort of TBI patients. Institutional Review Board approval was obtained. None of the 50 patients who met the criteria for screening based on the 2005 recommendations were screened for hypopituitarism. Only 2 of the 26 patients who met the criteria for screening based on the more recent 2017 recommendations were screened for hypopituitarism. We report that the screening rate for hypopituitarism in TBI patients is exceedingly low in the primary care setting, even with the less rigorous newer screening recommendations. Measures should be taken to improve screening of hypopituitarism to decrease morbidity and improve the quality of life in patients with a history of TBI.

Medical Students' Observations of High Value and Potentially Wasteful Care Behaviors Modeled During Clinical Rotations.

Medical student exposure to role-modeling of high-value care (HVC) behaviors may shape professional identity formation and future HVC practices. To investigate the frequency and characteristics of HVC role-modeling witnessed by medical students during core clinical rotations. Cross-sectional survey study. Medical students on clinical rotations at 11 US medical schools. A validated 13-item survey was used to assess medical student perception of cost-conscious role-modeling behaviors or potentially wasteful role-modeling behaviors and modified to include whom demonstrated the behavior (attending vs resident/fellow) and during which clinical rotation the modeling occurred. Cost-conscious role-modeling behaviors were observed by medical students sometimes/often 52.9-70.5% (353/667-452/641) of the time across all clinical rotations, except for praising a student for ordering a cost-effective diagnostic work-up which was seen only 25.7% (143/556) of the time. Potentially wasteful role-modeling behaviors were observed sometimes/often 5-14.3% (26/537-87/609) of the time, except simultaneously ordering numerous tests before seeing results of initial screening tests 45.1% (273/605) and repeating tests rather than attempting to obtain recently performed test results 32.2% (194/602). HVC modeling was most often demonstrated by internal medicine attendings 67.7% (65/96) and least frequently by general surgery attendings 47.3% (17/36). Attendings were overall more likely to model HVC compared to residents/fellows. HVC role-modeling, as observed by medical students, is not consistently demonstrated across clinical rotations. Attendings generally model more HVC than residents and general surgery models less HVC compared to other specialties. Future studies should strive to identify factors which promote or inhibit HVC modeling.

Optimising data sharing whilst protecting participant privacy: a data note describing processed data from a qualitative study of healthcare professionals’ experiences of caring for women with false positive screening test results

ABSTRACT Introduction The present article describes the processed data generated in a qualitative interview study and template analysis. Many women find the experience of being recalled and receiving a false-positive breast screening test result to be distressing. The interview study aimed to understand breast screening healthcare professionals’ (HCPs) experiences of providing care during the recall process and when receiving false-positive screening test results, including their communication with women around false-positive screening test results. Methods Twelve HCPs from a single screening unit in the English National Health Service Breast Screening Programme participated in semi-structured interviews in 2020. All participants were female. A range of HCPs roles were recruited, including advanced radiographer practitioners, breast radiographers, breast radiologists, clinical nurse specialists, and radiology healthcare assistants. The data were analysed thematically using template analysis from a limited realist perspective. Results A total of 20 data files are described, reflecting the iterative nature of template analysis. The files report various versions of codes, subthemes, themes, and every template produced during analysis. The files are publicly available on the Open Science Framework and UK Data Service (ReShare). Discussion This data note outlines our approach to conducting a template analysis of qualitative data while protecting highly identifiable data, which is stored in a non-public archive and only available to the study team. It offers a practical, worked example of the template analysis process, thereby providing a detailed illustration beyond the concise summaries typically found in published reports, and complementing methodological papers of template analysis.

Exploiting the Electrostatic Binding of Ruthenium Hexamine Molecular Redox Nanowires onto DNA/OGCN Biohybrid Electrodes toward the Electrochemical Detection of COVID-19.

The Coronavirus Disease 2019 (COVID-19) recently emerged as a life-threatening global pandemic that has ravaged millions of lives. The affected patients are known to frequently register numerous comorbidities induced by COVID-19 such as diabetes, asthma, cardiac arrest, hypertension, and neurodegenerative diseases, to name a few. The expensiveness and probability of false negative results of conventional screening tests often delay timely diagnosis and treatment. In such cases, the deployment of a suitable biosensing platform can readily expedite the rapid diagnosis process for enhanced patient outcomes. We report the development of an electrochemical genosensor based on DNA/OGCN (DNA/oxygenated graphitic carbon nitride) nanohybrids for the quantification of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) DNA─the key biomarker for COVID-19. This is achieved by exploiting the molecular nanowire-formation capability of the [Ru(NH3)6]2+/3+ redox probe onto the DNA phosphate backbone via electrostatic interactions. The microstructural characterization of OGCN was performed using scanning electron microscopy (SEM) coupled with an energy-dispersive X-ray (EDX) module, X-ray diffraction (XRD), and Fourier transform infrared spectroscopy. The electrochemical analyses were performed using cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS), while the analytical performance of the sensor was evaluated using square wave voltammetry (SWV). The developed sensor exhibited a wide linear detection range within 10 fM-10 μM, with a limit of detection (LoD) of ∼7.23 fM with a high degree of selectivity toward SARS-CoV-2 target DNA, thereby indicating its potential to be employed in a point-of-care scenario toward providing affordable healthcare to the global populace.

Epidemiology analysis of carbapenemase-producing Escherichia coli in a hospital in Henan Province from 2021 to 2023

Objective: To analyze the epidemiological characteristics of drug resistance genes of carbapenemase-producing Escherichia coli (CPECO) in Henan Province Hospital of Traditional Chinese Medicine from 2021 to 2023, providing data support and theoretical basis for controlling nosocomial infections of CPECO. Methods: Using a cross-sectional study, 30 carbapenem-resistant Escherichia coli (CRECO) strains confirmed by VITEK-2 Compact identification and drug sensitivity test in the Clinical Microbiology Laboratory of Henan Province Hospital of Traditional Chinese Medicine from 2021 to 2023 were tested, using carbapenemase inhibitor enhancement test to conduct preliminary screening of carbapenemases, and colloidal gold immunochromatography and polymerase chain reaction (PCR) were used to determine the phenotypes and genotypes of common carbapenemases (blaKPC, blaNDM, blaVIM, blaIMP, blaOXA) respectively, and the genotypes (blaSHV, blaTEM, blaCTX) of common extended Spectrum beta-lactamases (ESBL) were confirmed using PCR. The PCR amplification products of carbapenemase and ESBL positive strains were Sanger-sequenced, and the sequencing products were compared on the Blast website to determine the exact carbapenemase and ESBL genotypes. Sequence typing (ST) was performed on CPECO using the Achtman multi-locus sequence typing scheme to determine the cloning relationship between different strains. Results: A total of 21 CPECO strains were screened. Drug sensitivity test results showed that CPECO strains showed widespread drug resistance, with the resistance rate to monocyclic (aztreonam) and trimethoprim/sulfamethoxazole being over 60%(16/21, 14/21), and the resistance rate to other antibacterial drugs being 100%. Only the sensitivity to aminoglycosides and fosfomycin remained relatively high, and no strains resistant to tigecycline and colistin were found. Colloidal gold immunochromatography detected 18 blaNDM types, 2 blaKPC types, and 1 blaIMP type. Sequencing of drug resistance gene PCR products classified 17 blaNDM-5 strains, 1 blaNDM-4 strain, 2 blaKPC-2 strain, and 1 blaIMP-4 strain, which were completely consistent with the results of screening test and colloidal gold immunochromatography. ESBL resistance gene testing showed that the detection rate of blaTEM was 42.9%(9/21), blaCTX-M was 33.3%(7/21), and blaSHV was 4.8%(1/21). The rate of blaNDM producing CPECO carrying both ESBL resistance genes was 27.8%(5/18). The MLST typing results revealed 11 sequence types (STs), including one ST155 clonal complex and nine singleton STs. Among these, there were seven strains of ST167, five strains of ST410, and one strain each of ST58, ST68, ST69, ST93, ST131, ST155, ST648, ST1114, and ST3268. Conclusion: The main resistance mechanism identified in this study for CPECO was the production of blaNDM-5 carbapenemase, with a high proportion of strains also carrying blaTEM-1D and/or blaCTX-M-15 ESBLs. MLST typing found that the epidemic strain of CPECO showed certain polymorphism, but there were clonal transmission of multiple clonal complexes between ST167 and ST410.

The Role of Preoperative Inflammatory Markers in Cervical Cerclage Success.

To compare the inflammatory markers between therapeutic and emergency cerclage and assess the predictive role of inflammatory markers for the latency period. Descriptive study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Bursa Yuksek Ihtisas Training and Research Hospital, Turkiye, from January 2016 to September 2022. The therapeutic cerclage group (n = 64) included patients with a history of cervical insufficiency, normal prenatal screening test results, and who underwent cerclage based on history indications. The emergency cerclage group (n = 14) included patients with painless cervical dilation in the second trimester or a history of preterm and a short cervix on ultrasonography. Exclusion criteria composed of multiple pregnancies, active uterine contractions, vaginal bleeding, chorioamnionitis, membrane rupture, foetal anomalies, history of conization or abdominal cerclage, and having inflammatory diseases. Sociodemographic features, perinatal outcomes, and inflammatory markers such as neutrophil-to-lymphocyte ratio, C-reactive protein, and systemic immune-inflammation index were compared. Systemic immune-inflammation index was calculated by formulating the multiplication value of the neutrophil and platelet count divided by the lymphocyte count. The latency period was shorter (5.5 (0-29) vs. 20 (1-31) weeks, p <0.001) in the emergency cerclage group. Neutrophil-to- lymphocyte ratio and systemic immune-inflammation index, which are representatives of increased inflammatory state, were significantly higher in the emergency cerclage group (p = 0.007 for both). Systemic immune-inflammation index was correlated with cerclage to delivery interval for all patients (r = -0.307, p = 0.006). Also, it predicted neonatal mortality with a cut-off value of 1078.08, 90% sensitivity and 70.59% specificity (AUC = 0.776, p <0.001) and low Apgar scores with 57.1% sensitivity and 74% specificity (AUC = 0.641, p = 0.038). Systemic immune-inflammation index, correlated with cerclage to delivery interval, could be a marker for predicting neonatal mortality and morbidity in cerclage patients. Cervical cerclage, Inflammatory markers, Perinatal outcomes, Systemic immune-inflammation index.

Diagnostic accuracy of screening tests for eating disorders in adolescents and adults in primary health care: protocol for systematic review and meta-analysis

IntroductionEating disorders can be irreversible and, in many cases, fatal. However, the symptoms full recovery is possible, and early diagnosis is one, of many, important factors for the success of...

Confronting Various Quality Perspectives of Paper Straws—Case Study with Generation Z

This article provides answers to the question of how Generation Z perceives various quality characteristics in connection with paper straws. The aim of this study was to analyze the advantages and disadvantages of paper straws from three perspectives: intrinsic quality characteristics, sensory perception, and physical characteristics. A total of 215 young adults and 65 students aged up to 27 years took part in the field study and sensory analysis, respectively. The field survey revealed that Serbian Gen Z prefers and expects paper straws do not contribute to the flavor of the drink, have a rounded and dull edge, and not change their shape when dipped into the drink. The sensory panel was formed by selecting students based on the results of several sensory screening tests conducted in the initial phase. Sensory testing for the difference showed that the impact of paper straws of different diameters on flavor was limited, although it was confirmed that artificial saliva could easily coat the surfaces and penetrate the layers of the paper straws, resulting in a significant loss of firmness and a greater potential to adhere to the lips. No effects were found on the sweetness, sourness, pungency, and overall flavor of the soft drink. Viscosity was the only attribute that was affected. The soft drink was perceived as more viscous when using the narrower straw than when using the larger diameter straws. Artificial saliva and water were the liquids that had the greatest influence on the loss of firmness of the soaked straws. After 20 min of exposure to most of the liquids tested, the paper straws were found to lose over 75% of their firmness. Paper straws are more sustainable and have the potential to completely replace plastic straws. However, their physical properties, especially firmness, need to be further improved, considering that they can be soaked in liquids for more than 20 min when consuming various beverages.

RhD-negative red blood cells can be saved during liver transplantation in RhD-negative patients due to low risk of alloimmunization against RhD.

Transfusion demand is high in liver transplantation (LT), and thus RhD-positive (RhD+) red blood cell concentrates (RBCs) are sometimes given to RhD-negative (RhD-) patients. Due to immunosuppression, these patients rarely produce anti-D. We investigated the rate of anti-D formation in RhD- patients undergoing LT who were transfused with RhD+ RBCs as well as the number of transfused RhD- and RhD+ RBCs. RhD-type and transfusion history of all patients undergoing LT between 2010 and 2023 were reviewed retrospectively. In RhD- patients, who received RhD+ RBCs, the results of antibody screening test (indirect antiglobulin test and with papain-treated test cells) and direct antiglobulin test were evaluated. Five hundred and twenty-seven patients underwent 576 LT. Eighty-seven patients were RhD-, of whom 42 were transfused with RhD+ RBCs. In 34 of them, an antibody screening test result was available more than two weeks after the last RhD+ RBCs transfusion. In two of them, a transient, weak anti-D antibody was detectable, which disappeared in the further course. Overall, 1352 RBCs were transfused to the 87 RhD- patients, 543 of those were RhD+. Most RhD+ RBCs were provided to men and elder women. Transient weak anti-D occurred in two RhD- male patients during LT after transfusion of RhD+ RBCs without evidence for a hemolytic transfusion reaction. To save stocks of RhD- RBCs, early transfusion of RhD+ RBCs to RhD- men and women beyond the childbearing age should be considered during LT.

The Importance of Hearing Screening and Central Auditory Processing in School-Aged Children.

The aim of the study was to evaluate the prevalence of undiagnosed hearing impairment or central auditory processing disorders in children from I and VIII grades of primary schools in Warsaw. The participants in the study were 15,659 pupils from classes I and VIII attending primary schools in Warsaw. As part of the study, the hearing threshold for air conduction at frequencies of 0.5-8 kHz was determined, and a test assessing central auditory processing was performed: FPT (Frequency Pattern Test), DDT (Dichotic Digit Test), the Auditory Behaviour Scale (SAB), and an interview questionnaire developed for the program. Abnormal test results were found in 1946 children, of which abnormal hearing screening test results were found in 678 children tested, while reduced central auditory processing results were found in 1268 children. The program implemented draws attention to the fact that tests of central auditory processing are included in the testing protocol. As has been shown, peripheral hearing testing alone is not sufficient to exclude abnormalities concerning the sense of hearing.

Evaluation of Maternal Factors Affecting Postpartum Insulin Resistance Markers in Mothers with Gestational Diabetes-A Case-Control Study.

Gestational diabetes mellitus (GDM) is defined by an insufficient insulin response to counteract the insulin resistance (IR) that arises from the physiological adaptations associated with pregnancy. However, the pathophysiology of IR is complex and unclear, as it encompasses elements such as epigenetics, environmental factors, modifiable lifestyle factors, and psychosocial factors. The objective of this study was to evaluate the influence of GDM and other maternal factors on IR markers in comparison to mothers with normal glucose tolerance during pregnancy in the first week postpartum. The study population comprised 70 participants, including mothers with gestational diabetes who were treated with a diet and physical activity (GDM G1), with insulin (GDM G2), and a control group of healthy mothers without gestational diabetes (non-GDM). A series of statistical techniques were employed to facilitate the comparison of data between the study groups, with the objective of identifying potential associations with maternal factors. A taxonomic analysis was conducted using the following factors: classification by study group, a history of hypothyroidism in the maternal medical interview, and maternal gestational weight gain, which were identified as the best-fitting predictors. The analysis resulted in the identification of four clusters of patients. Comparison of the insulin resistance markers between mothers assigned to the abovementioned clusters showed differences in the incidence of excessive weight loss and in the results of glucose screening tests during pregnancy. Also, differences concerning fasting glucose levels in the first and second/third trimesters of pregnancy and glucose levels at 1 h post-OGTT were found. For the clusters, the results of the HOMA-IR and the QUICKI did not show any differences in the first week after delivery (p > 0.05). HbA1c results varied significantly. Degree of glucose metabolism disorders, hypothyroidism, and weight gain in pregnancy influence maternal insulin resistance markers in the first week postpartum. Additionally, gestational weight fluctuation has a significant influence on the outcome of pregnancy, particularly with regard to fetal growth and, consequently, the infant's birth weight and adipose tissue accumulation.

Therapeutic drug monitoring of tenofovir disoproxil and emtricitabine in oral HIV pre-exposure prophylaxis (PrEP) users who have undergone gastrointestinal surgery.

Oral HIV pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV, but its efficacy depends on adequate absorption of drug, which may decrease following gastrointestinal surgery. Clinicians across eight Genito-urinary Medicine clinics in the United Kingdom submitted data on PrEP users with history of gastrointestinal surgery who were referred to a national complex PrEP multi-disciplinary team between June 2021 and April 2023. Anonymised data were submitted on demographics, surgical history, PrEP regimen, and results of therapeutic drug monitoring (TDM) and HIV screening tests. Descriptive analyses were performed in SPSS version 29. Nine cases described cis-gender men-who-have-sex-with-men (MSM) with median age of 47.4 years (IQR = 43 - 56.5) taking tenofovir disoproxil (TDF)/emtricitabine (FTC) daily (n = 8) or event-based (n = 1) as PrEP. Median time between PrEP initiation and TDM was 53 days (IQR = 8.5-1705). The mean (±SD) trough concentration of tenofovir (TFV) and FTC were 90.2 ± 27.7ng/mL and 76.0 ± 45.9ng/mL, respectively. All patients had a negative HIV test at follow-up. Plasma trough concentrations of TFV observed in our cohort taking TDF/FTC were above the expected concentrations associated with PrEP efficacy as previously described in the literature, suggesting that PrEP can be safely given in this population, with TDM used for reassurance.

A Review of Drug Abuse, Misuse, and Related Laboratory Challenges.

Various definitions can be considered for drugs and substance abuse. According to the National Institute on Abuse, the use of an over-the-counter drug in a different way than that prescribed to experience or arouse emotion is a simple form of drug abuse. The World Health Organization (WHO) also defines drug abuse as the persistent or sporadic use of drugs that are incompatible or unrelated to acceptable medical practice. With the increasing non-therapeutic use of prescription drugs, serious related consequences have also increased. Therefore, there is a need to know more precisely about the types of substances and drug abuse, which is the most important part of diagnosis and recognizing the tests that cause false positive and negative results. The purpose of this review article is to collect and summarize the most important and more common types of drugs of abuse and review the drugs that cause false results in screening tests. In addition, the most common detection methods of the drug will be reviewed and the advantages and drawbacks of each method will be discussed. In this article, we aimed to point out all the facts about the emerging problems in drug abuse, the methods of screening, and the possible false results in addition to troubleshooting strategies.

Patient Perceptions on the Follow-Up of Abnormal Cancer Screening Test Results.

Timely follow-up after an abnormal cancer screening test result is needed to maximize the benefits of screening, but is frequently not achieved. Little is known about patient experiences with the process of following up abnormal screening results. Assess patient experiences and perceptions regarding the process of a diagnostic workup following abnormal breast, cervical, or colorectal cancer screening results. Survey of participating patients between April 2021 and June 2022 after reaching the primary outcome time point in a randomized controlled trial to improve follow-up of overdue abnormal screening results. Patients from 44 participating practices in three primary care practice networks. Self-reported ease of scheduling follow-up, perceived barriers or concerns, provider trust, and satisfaction with communication and care received for the follow-up of abnormal screening results. Overall, 241 (25.0%) patients completed the survey including 66 (32.8%) with breast, 79 (25.3%) with cervical, and 96 (21.3%) with colorectal screening test; median age 55years, 79.7% women, 80.5% non-Hispanic white, and 51.0% did not complete recommended follow-up. Most patients were worried that the test would find cancer (63.1%), but fewer worried about discomfort or side effects (34.4%), and neither were associated with completing follow-up. However, 17% of patients did not think they needed follow-up tests or appointments and were less likely to complete follow-up (10.5% vs. 24.0%, respectively, p-value 0.009). Most patients were very satisfied with their overall care (71.0%), but only 50.2% strongly agreed that they trusted their provider to put their medical needs above all else when making recommendations. Patients with overdue abnormal breast, cervical, and colorectal cancer screening test results reported important deficiencies in the management of recommended follow-up. Addressing patient concerns about fear of cancer and effectively communicating the need for follow-up procedures may improve timely follow-up after an abnormal cancer screening result. ClinicalTrials.gov NCT03979495.

Uji Potensi Antituberkulosis Ekstrak N-Heksan dan Ekstrak Etanol Daun Jeruk Nipis (Citrus Aurantiifolia) secara in Vitro

Tuberculosis is a disease caused by Mycobacterium tuberculosis which is widely suffered and causes death. Currently, antituberculosis treatment using synthetic chemicals has been widely resistant. The purpose of this study was to test the potential of lime extract to inhibit the growth of tuberculosis bacteria. This research method uses a quantitative approach and is experimental. The results of the study showed that the results of the phytochemical screening test showed the same group of chemical compounds in fresh leaves, simplex and ethanol extract of lime leaves, namely alkaloids, flavonoids, tannins, saponins, steroids and glycosides. While the n-hexane extract only contains steroids and glycosides. Then the effectiveness of antituberculosis can be seen from the ethanol extract being stronger than the n-hexane extract, namely in the 1st week there was inhibition while the n-hexane extract from the 1st week to the 4th week had bacterial growth.

Predictors of Early Intervention Referral after a Positive Developmental Screen in Community Primary Care Clinics

BackgroundPrimary care physicians (PCPs) may rely upon factors other than screening test scores in making referral decisions to developmental services. This study investigated which patient, provider, and screening test factors predict a PCP’s IDEA Part C Early Intervention (EI) referral after a positive screening test result. MethodsChild demographics, developmental screening test results and EI referral decisions were collected via medical record review of 2,756 15-, 18-, 24- and 30-month well-child checks conducted at 7 community primary care clinics in 4 Oregon counties, in 2020-2021. A provider survey collected PCP demographic and professional characteristics. We tested the association of receipt of EI referral with screening test (Ages & Stages-3 [ASQ-3] and Modified Checklist for Autism in Toddlers – Revised [MCHAT-R]) scores, provider demographic information, child demographic data (sex, language, race/ ethnicity), using multivariable logistic regression. Results54.1% of children with positive MCHAT-R screens, and 42% of children with positive ASQ-3 screens received EI referrals. Multivariable analyses showed that MCHAT-R score, ASQ-3 Communication and Gross Motor scores were associated with referral after a positive screen. Child sex, race, ethnicity, and language, and provider demographics had no multivariable association with referral. Referral rates varied substantially by site and individual provider. ConclusionThe majority of toddlers with positive developmental screens were not receiving EI referrals from their PCP during the COVID-19 pandemic. Screening test thresholds and clinical thresholds for EI referral differ substantially, and some portions of the ASQ-3 do not seem to impact provider referral decisions. These findings may help inform physician training on developmental screening in primary care, specifically during times of unprecedented healthcare challenges.

High-value care modeling: Evaluating cost conscious and potentially wasteful behaviors.

42 Background: Value-based care is key to decreasing waste, addressing increasing healthcare costs, and minimizing patient financial toxicity - especially in the treatment of high-cost diagnoses such as cancer. Medical student exposure to role-modeling of high-value care (HVC) behaviors may help shape professional identity formation and have long-term effects on future practices. Our study aimed to investigate the frequency and characteristics of faculty role-modeling of HVC in medical student core clinical rotations. Methods: A cross-sectional survey study was performed with third- and fourth-year medical students on clinical rotations at 11 U.S. medical schools. The survey assessed thirteen variables associated with cost conscious role-modeling behaviors or potentially wasteful role-modeling behaviors, as well as questions characterizing the rotation such behaviors were observed on, demographic information, and organizational culture around HVC. Results: Cost-conscious role-modeling behaviors were observed “sometimes” or “often” between 52.9-70.5% of the time across all clinical rotations, with the exception of observing a student or resident being praised for ordering a cost-effective diagnostic work-up (seen only 25.7% of the time). Potentially wasteful role modeling behaviors were observed “sometimes” or “often” 5%-14.3% of the time, except simultaneously ordering numerous tests before seeing results of initial screening tests (45.1%) and repeating tests rather than attempting to obtain recently performed test results (42.9%). HVC was most often observed on internal medicine rotations (58.3%) and least frequently on surgery rotations (34.5%). Attendings were significantly more likely to model HVC compared to residents/fellows in 5/7 domains. Organizational culture correlated with frequency of HVC behavior observed. Conclusions: HVC role-modeling behaviors, as observed by medical students, are variable across clinical rotations. HVC practices are essential not only within oncology, but across all medical specialties; future studies should strive to identify factors which promote or inhibit HVC modeling and understand differences between HVC education in undergraduate medical curriculum.

Frequency of Blood Components Wastages and Related Factors in Fars Blood Transfusion Centers, Iran

Introduction: Blood component waste is an important issue in all blood transfusion centers. Therefore, reducing and managing these wastages are a major concern in blood transfusion centers. The present study examined the causes and frequency of blood product wastage in blood transfusion centers of Fars Province from 2015 to 2020. Materials and Methods: This is a descriptive and retrospective study, and the cause and frequency of red blood cell, platelet, plasma and cryoprecipitate wastage from 2015 to 2020 were evaluated. The data related to the blood product wastage were extracted from the comprehensive software of the Blood Transfusion Organization (Negareh). Then, it was analyzed using SPSS software version 25. Results: The total amount of waste was equal to 164981 units. The highest percentage of wastage of products was in 2015 (8.12%), 2016 (7.15 %) and 2017 (6.75 %), respectively. The most discarded products were whole blood, cryoprecipitate and platelet, respectively. Also, the leading causes of waste included positive screening test results, expiration date, contamination, blood group incompatibility, and abnormal and bloody color, respectively. Conclusion: The authors concluded that blood component wastage has a dropping pattern in this period. Proper management and continuous training of technical staff are important in reducing blood product wastage.