Screening In Clinical Settings Research Articles

Frequency of Hepatitis C in patients presented with isolated thrombocytopenia.

Objective: HCV-related thrombocytopenia poses challenges in infection and treatment. This study emphasizes screening for early thrombocytopenia as it signals hematological abnormalities, indicating bleeding tendencies and complications. Study Design: Cross-sectional Investigation. Setting: Pathology Department of Allama Iqbal Medical College and Jinnah Hospital. Period: November 2019 to November 2020. Methods: Included 180 participants with platelet counts <100,000/µl, normal hemoglobin, and WBC counts. Exclusions: anemia, leucopenia, prior Hepatitis C treatment, and platelet clumps. Data on age, gender, socioeconomic status, and family history were collected. Platelet counts and HCV detection utilized peripheral smears and venous blood samples, analyzed with SPSS version 25.0. Results: In a study of 180 thrombocytopenic patients of all ages were included with mean age 32. Among 34 HCV-positive cases, 102 had a family history, with age-wise distribution: 18, 14, 2. Gender: 20 males, 14 females. HCV-positive households: 21 positive, 13 negative. Significant p-values for age groups (p=0.000), non-significant for gender (p=0.281), socioeconomic status (p=0.083), and household HCV status (p=0.505). Conclusion: A significant association exists between decreased platelet count and Hepatitis C virus, providing valuable insights for screening in clinical settings.

Screening for social determinants of health among populations at risk for MASLD: a scoping review.

Social determinants of health (SDoH) have been associated with disparate outcomes among those with metabolic dysfunction-associated steatotic liver disease (MASLD) and its risk factors. To address SDoH among this population, real-time SDoH screening in clinical settings is required, yet optimal screening methods are unclear. We performed a scoping review to describe the current literature on SDoH screening conducted in the clinical setting among individuals with MASLD and MASLD risk factors. Through a systematic literature search of MEDLINE, Embase, and CINAHL Complete databases through 7/2023, we identified studies with clinic-based SDoH screening among individuals with or at risk for MASLD that reported pertinent clinical outcomes including change in MASLD risk factors like diabetes and hypertension. Ten studies (8 manuscripts, 2 abstracts) met inclusion criteria involving 148,151 patients: 89,408 with diabetes and 25,539 with hypertension. Screening was primarily completed in primary care clinics, and a variety of screening tools were used. The most commonly collected SDoH were financial stability, healthcare access, food insecurity and transportation. Associations between clinical outcomes and SDoH varied; overall, higher SDoH burden was associated with poorer outcomes including elevated blood pressure and hemoglobin A1c. Despite numerous epidemiologic studies showing associations between clinical outcomes and SDoH, and guidelines recommending SDoH screening, few studies describe in-clinic SDoH screening among individuals with MASLD risk factors and none among patients with MASLD. Future research should prioritize real-time, comprehensive assessments of SDoH, particularly among patients at risk for and with MASLD, to mitigate disease progression and reduce MASLD health disparities.

Development of a self-report screening instrument for emotional dysregulation: the Reactivity, Intensity, Polarity and Stability questionnaire, screening version (RIPoSt-SV)

BackgroundEmotional dysregulation (ED) refers to the inability to manage emotional experiences or expressions hindering goal-oriented behavior. Moderate impairment on at least two domains among temper control, affective lability, and emotional over-reactivity has been proposed to identify ED in adults with attention-deficit/hyperactivity disorder (ADHD). No screening measure designed for use in diverse psychiatric samples exists. We aimed to develop a self-report screening tool for ED based on the 40-item version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-40). Methods150 adult outpatients with non-psychotic conditions were enrolled between February and July 2023 at the Second Psychiatry Unit of Pisa University Hospital. Clinically significant ED (CSED) was defined based on the previously suggested approach for ADHD. Differences between patients with and without CSED were tested. To develop our screening instrument, a decision tree algorithm was trained by hyperparameter tuning through 5-fold cross-validation in 120 subjects and tested on the remaining 30. Results75 subjects met criteria for CSED (50 %). CSED was associated with lower age and higher prevalence of psychiatric conditions, including minor mood disorders, ADHD, cannabis use disorders, and eating disorders. We identified a decision tree consisting of six items from RIPoSt-40 that effectively detected CSED, with accuracy, sensitivity, specificity, positive and negative predictive values of 80 % or higher in both the training and testing sets. LimitationsTertiary-level; no consensus on criteria; sample size. ConclusionThe screening version of the Reactivity, Intensity, Polarity, and Stability questionnaire (RIPoSt-SV) demonstrates promise as a valuable tool for ED screening in clinical settings.

Mitochondrial DNA Haplogroups and SNPs: Risk Factors in Multiple Cancers Based on a Cross-Tumor Analysis in Chinese Population.

Mitochondrial DNA's (mtDNA) haplogroups and SNPs were associated with the risk of different cancer. However, there is no evidence that the same haplogroup or mitochondrial SNP (mtSNP) exhibits the pleiotropic effect on multiple cancers. We recruited 2,489 participants, including patients with colorectal, hepatocellular, lung, ovarian, bladder, breast, pancreatic, and renal cell carcinoma. In addition, 715 healthy individuals from Northern China served as controls. Next, cross-tumor analysis was performed to determine whether mtDNA variation is associated with multiple cancers. Our results revealed a significant decrease in the occurrence risk of multiple cancers among individuals belonging to haplogroup A [OR = 0.553, 95% confidence interval (CI) = 0.375-0.815, P = 0.003]. Furthermore, we identified 11 mtSNPs associated with multiple cancers and divided the population into high-risk and low-risk groups. Low-risk groups showed a significantly reduced risk of occurrence compared with high-risk groups (OR = 0.614, 95% CI = 0.507-0.744, P < 0.001). Furthermore, using interaction analysis, we identified a special group of individuals belonging to haplogroup A/M7 and the low-risk population, who exhibit a lower risk of multiple cancers compared with other populations (OR = 0.195, 95% CI = 0.106-0.359, P < 0.001). Finally, gene set enrichment analysis confirmed that haplogroup A/M7 patients had lower expression levels of cancer-related pathway genes compared with haplogroup D patients. We found that specific mtDNA haplogroups and mtSNPs may play a role in predicting multiple cancer predisposition in Chinese populations. This may provide a potential tool for early screening in clinical settings for individuals in the Chinese population.

A psychometric evaluation of the Life Attitudes Schedule-Short Form

The Life Attitudes Schedule-Short Form (LAS-SF) is a measure of suicide proneness featuring various conceptual models. We tested four competing LAS-SF factor structures, as well as construct validity with mental health and suicide metrics. Community dwelling adults (N = 488) completed an online cross-sectional survey. Results supported a four factor (i.e., death-related, health-related, injury-related, and self-related subscales) LAS-SF structure with one higher order factor. Death-related, injury-related, and self-related subscales demonstrated moderate positive associations with mental health and suicidal ideation. Death-related and self-related subscales showed links with suicidal ideation, as well as suicide and depression risk (controlling for other factors). This study is important in highlighting suicide proneness theory may need to be refined. LAS-SF uses include possible risk screening in clinical settings and future focus on the psychological death aspects of the LAS-SF in prospective research. Study limitations include lack of sample diversity and cross-sectional design.

A Qualitative Analysis of Barriers to Accessing HIV Prevention Services During an HIV Outbreak among Persons who Inject Drugs in West Virginia.

In response to an increase in HIV diagnoses among persons who inject drugs (PWID) in Kanawha County, West Virginia, West Virginia Bureau for Public Health and CDC conducted a qualitative assessment in Kanawha County to inform HIV outbreak response activities. Interviews with 26 PWID and 45 community partners were completed. Transcribed interviews were analyzed to identify barriers to accessing HIV prevention services among PWID using the risk environment framework. Participants identified numerous political, physical, social, and economic community-level barriers that influenced access to HIV prevention services among PWID. Political factors included low community support for syringe services programs (SSPs); physical factors included low SSP coverage, low coverage of HIV testing outreach events, low HIV preexposure prophylaxis availability, and homelessness; social factors included stigma and discrimination; economic factors included community beliefs that SSPs negatively affect economic investments and limited resources for HIV screening in clinical settings. Individual-level barriers included co-occurring acute medical conditions and mental illness. Community-level interventions, such as low-barrier one-stop shop models, are needed to increase access to sterile syringes through comprehensive harm reduction services.

Magnetic Bacteriophage‐Engineered Janus Micromotors for Selective Bacteria Capture and Detection

AbstractHerein, T4‐bacteriophage‐funcionalizated magnetic Janus micromotors are used for the first time for highly selective Escherichia coli (E. coli) recognition and detection. The micromotors propel at speeds of up to 40 µm s−1 in complex biological samples for on‐the‐fly capture of E. coli “strain B”‐thiolated T4 bacteriophage complex. Detection is achieved by a simplified colorimetric readout in connection with gold nanoparticles. The detection limit meets the cut‐off for the fast diagnosis of urinary tract infections. The bacteriophage‐engineered micromotors are tested on bacteria isolated from urine samples and in serum isolated from negative blood cultures from hospital patients with excellent selectivity and reliability. The new strategy described here holds considerable promise for the multiplexed detection of a myriad of bacteria strains using tailored bacteriophages. Technically, this is the first microplate‐reader integrated micromotor approach, crossing another bridge from the research lab to the practical use of micromotors. Specifically, these results represent a qualitative step forward in the use of micromotor technology with sophisticated functionalization for fast bacteria screening in clinical settings.

Predicting of β‐amyloid Positivity Using Integer‐based Risk Scores with Blood‐based Biomarkers

AbstractBackgroundβ‐amyloid (Aβ), a pathologic hallmark of Alzheimer’s disease (AD) is the target of recently FDA‐approved drugs. In trials and in practice, identifying individuals likely to be β‐amyloid positive (Aβ+) with accessible and affordable tests will be increasingly important. Blood‐based biomarkers (BBMs) have shown early promise in determining amyloid status. We aimed to develop machine learning‐based integer risk scores using BBMs and other accessible measures to predict Aβ positivity by PET in older, non‐demented (cognitively unimpaired or mild cognitive impairment) adults.MethodsWe used data from 722 individuals (72.1 ± 7.0 years old) from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) to develop integer risk scores for predicting Aβ positivity. The sample was divided into training (75%) and test (25%) sets. Variables were categorized as demographics (D: age, sex, and education), genetic information (G: APOE4 status), cognitive measures (C: ADAS‐Cog‐13 and MMSE), and plasma biomarkers of p‐Tau181(T) and neurofilament light (N: NfL). Feature‐sets were formed as hierarchically constructed combinations of these categorized variables (see Figure 1). Using the AutoScore algorithm, variables were ordered according to their Random Forest Gini Index and were iteratively included in the construction of logistic regression‐derived risk score models. Variables were included based on increases in Area Under the ROC Curves (AUCs).ResultsFour models were developed based on four feature‐sets. All models utilized age and APOE4 status and, when considered, all models retained ADAS‐Cog‐13, p‐Tau, and NfL. The best performing model corresponded to the DGCTN feature‐set with performance on the dedicated test set of AUC = 0.810 (C.I.: 0.745‐0.876). Using the DGCTN model on the test set, 97% of individuals with scores in the top quartile of possible risk score points were correctly identified as Aβ+.ConclusionsWe developed risk score models utilizing accessible and affordable measures to predict Aβ positivity. Plasma biomarkers improve performance of risk scores indicating their value. Applications include screening in clinical settings for therapeutic care and enrichment of clinical trials. These data can be used to optimize the efficient use of PET in determining eligibility for clinical trials and amyloid targeted therapies in practice.

Machine-learning assisted swallowing assessment: a deep learning-based quality improvement tool to screen for post-stroke dysphagia.

Post-stroke dysphagia is common and associated with significant morbidity and mortality, rendering bedside screening of significant clinical importance. Using voice as a biomarker coupled with deep learning has the potential to improve patient access to screening and mitigate the subjectivity associated with detecting voice change, a component of several validated screening protocols. In this single-center study, we developed a proof-of-concept model for automated dysphagia screening and evaluated the performance of this model on training and testing cohorts. Patients were admitted to a comprehensive stroke center, where primary English speakers could follow commands without significant aphasia and participated on a rolling basis. The primary outcome was classification either as a pass or fail equivalent using a dysphagia screening test as a label. Voice data was recorded from patients who spoke a standardized set of vowels, words, and sentences from the National Institute of Health Stroke Scale. Seventy patients were recruited and 68 were included in the analysis, with 40 in training and 28 in testing cohorts, respectively. Speech from patients was segmented into 1,579 audio clips, from which 6,655 Mel-spectrogram images were computed and used as inputs for deep-learning models (DenseNet and ConvNext, separately and together). Clip-level and participant-level swallowing status predictions were obtained through a voting method. The models demonstrated clip-level dysphagia screening sensitivity of 71% and specificity of 77% (F1 = 0.73, AUC = 0.80 [95% CI: 0.78-0.82]). At the participant level, the sensitivity and specificity were 89 and 79%, respectively (F1 = 0.81, AUC = 0.91 [95% CI: 0.77-1.05]). This study is the first to demonstrate the feasibility of applying deep learning to classify vocalizations to detect post-stroke dysphagia. Our findings suggest potential for enhancing dysphagia screening in clinical settings. https://github.com/UofTNeurology/masa-open-source.

Words matter: How clinical encounters can be unknowingly stigmatizing to some patient communities.

356 Background: Lack of patient engagement around the content and approach to care conversations related to social determinants of health (SDOH) can negatively impact healthcare experiences and exacerbate disparities in outcomes. Lived environment, financial/logistical challenges, general access barriers and patient mistrust must be addressed on a systemic and individual level. Assumptions based on socioeconomic status, age, race, gender, and medical conditions can undermine communication and/or invalidate a patient's feelings and lived experiences. Accelerating the requirement of SDOH screenings without addressing the patient-centeredness of these conversations will likely contribute to health inequities and yield substandard patient experiences and outcomes. Methods: To better understand patient perspectives about language commonly used in SDOH screenings, we gathered views on terminology used towards patients through surveys, focus groups, and virtual workshops. Participants were recruited from a diverse pool of insured patients served by Patient Advocate Foundation representing various medical diagnoses, were lower income (&lt;$48,000), racially/ethnically reflective of the US, and experienced healthcare access and/or affordability challenges. Results: Patients had both positive and negative perspectives on SDOH screening in clinical settings, specifically focused on communication, bias, and privacy. Survey/focus group results revealed the discomfort of financial and non-medical information (SDOH) being included in their electronic medical record (EMR). “It’s important to find words that are less stigmatizing because it affects how we see ourselves and others.” Only 21% reported being extremely comfortable with SDOH information being recorded in their EMR and subsequently being available to multiple members of their healthcare team. Judgement, embarrassment, shame, and lack of action (i.e., linkage to resources) were often cited as reasons for not wanting to have uncomfortable conversations. Patients also felt that disclosing this information could (or would) influence the treatment options offered, creating bias solely regarding their perceived ability to manage their medical and non-medical financial obligations. Conclusions: We uncovered how, without patient engagement, language and processes the healthcare system uses can feel biased and stigmatizing to those it is designed to help. Stigmatizing conversations can perpetuate discriminatory attitudes, influence clinicians' decision-making when treating a patient, and affect patient trust and disclosure within care settings. This cycle impacts quality of care and contributes to health disparities. By listening to patient perspectives, researchers and health care professionals can become more culturally aware and reduce stigmatizing language, while making care more patient-centric and inclusive.

Applying the R = MC2 implementation science heuristic to assess the impact of readiness on reach and implementation of a population-wide genomic screening program.

Population-wide genomic screening for genes that have high penetrance and clinical actionability enhances the opportunity to identify individuals at risk for developing hereditary conditions. Organizational readiness has been shown to influence the likelihood of successful implementation of complex initiatives such as the integration of population-wide genomic screening in clinical settings. We use the organizational readiness heuristic R = MC2 to better understand three factors that influence readiness for implementation of In Our DNA SC, a population-wide genomic screening program: motivation to implement, general capacity of an organization, and innovation-specific capacities. We then assessed the influence of these readiness factors on implementation outcomes of reach (measured through enrollment rate) and implementation (measured through the number of DNA samples collected). Data were collected pre-implementation and captured during the three-month pilot phase of the In Our DNA SC program. We collected administrative data from the electronic health record and quantitatively captured elements of readiness through surveys distributed to provider champions and clinical administrative champions at the 10 sites implementing the population-wide genomic screening program. We facilitated innovation-specific capacity through training offered at each site, as well as technical assistance through weekly meetings with other implementing sites, and resources available to all staff. Forty percent of provider champions attended training and 80% of administrative champions attended training. An average of 3.7 additional staff were trained at each implementing site. Satisfaction with training positively influenced reach (β = 0.0121, p = 0.0271) but did not impact implementation. Provider engagement (innovation capabilities) was associated with reach (β = 0.0020, p = 0.0251) and clinical administrator engagement was associated with sample collection rate (β = 0.2599, β = 0.038). Readiness to change is considered one of the most important factors in understanding the potential opportunity for implementation. We found that motivation to adopt a population-wide genomic screening program positively impacted the program's reach. The type of champion influenced discrete outcomes, with provider champions positively impacting reach and administrative champions influencing implementation (assessed through sample collection rate). As genomics continues to be integrated into clinical practice, it will be important to understand the contextual factors that influence readiness for implementation and design support throughout the life-course of implementation to ensure the success of large-scale, complex initiatives.

Diagnostic Performance of Deep Learning in Screened Mammogram: Systematic Review.

The usage of artificial intelligence in medical image analysis has significantly surpassed that of earlier related technologies. This paper aimed to investigate the diagnostic accuracy of Artificial Intelligence (AI) based-deep learning models for breast cancer detection. We used the PICO (Patient/Population/Problem, Intervention, Comparison, Outcome) scheme to formulate the research question and construct our search terms. Studies were systematically examined from the available literature using the constructed search terms from PubMed, and ScienceDirect according to the PRISMA guidelines. The quality of the included studies was assessed using the QUADAS-2 checklist. The characteristics of each included study such as the study design, population, index test, and reference standard, were extracted. The sensitivity, specificity, and AUC for each study were also reported. In this systematic review, 14 studies were analyzed. Eight studies showed that AI was more accurate than radiologists in evaluating mammographic images, while one comprehensive study found AI to be less precise. Studies that reported sensitivity and specificity without radiologist intervention showed performance scores ranging from 16.0% to 89.71%. With radiologist intervention, sensitivity was between 62% to 86%. Only three studies reported a specificity of 73.5% to 79%. The AUC of the studies was between 0.79 and 0.95. Thirteen studies were retrospective, and one was prospective. There's inadequate evidence on the effectiveness of AI-based deep learning for breast cancer screening in clinical settings. More research is needed, including studies evaluating accuracy, RCTs, and large-scale cohort studies. This systematic review found that AI-based deep learning improves radiologists' accuracy, especially for novice radiologists. Younger, tech-savvy clinicians may be more accepting of AI. Although it can't replace radiologists, the encouraging results suggest it will play a significant role in identifying breast cancer in the future.

A Study of Validity and Satisfaction of Tele-assessment

Objectives: This study aims to examine the validity of two types of remote language screening tests (indirect questionnaire type vs direct observational type), and differences in performance of children as well as satisfaction of their mothers between these two types of remote language screening test. Methods: In total 40 children without any language deficits aged 3 to 6 and their mothers participated in this study. For statistical analysis, a Pearson correlation was conducted between the remote language screening tests (indirect questionnaire type and direct observation type); a PRES (Preschool Receptive-Expressive Language Scale) to find out the concurrent validity, and a paired t-test was conducted to find out if there are significant differences in the performance of the children and satisfaction of their mothers between the two types of screening tests. Additionally as a qualitative analysis, mothers’ preference among two types of the test was asked using an open ended survey. Results: The two types of tests (indirect, direct) showed strong positive correlation with one another. Regarding concurrent validity, both test types showed strong positive correlation with a standardized language test as well. There was no significant difference between the two types in both the performance of the children and the satisfaction of mothers as well. However, 85% percent of mothers preferred the direct observation type citing better accuracy as their reasoning. Conclusion: It is hoped that remote language screening tests can contribute to the implementation of non-face-to-face screening in clinical settings since it is highly validated. Furthermore both two types of tests can be used and complement each other.

Nationwide patterns of hydroxychloroquine dosing and monitoring of retinal toxicity in patients with systemic lupus erythematosus

This study identified trends in hydroxychloroquine (HCQ) prescription and retinopathy screening in patients with systemic lupus erythematosus (SLE) according to clinical practice guidelines to minimise the risk of HCQ retinopathy. We used data from patients diagnosed with SLE between 2004 and 2019 from the National Health Insurance Service in Korea. To assess trends of daily dose per actual body weight (ABW), we performed an interrupted time-series analysis and identified effects after revision of guidelines. Among 38,973 patients with SLE, 28,415 (72.9%) were prescribed HCQ from 2004 to 2019. The proportion of patients using HCQ among SLE patients was 63% in 2004 and increased to 76% in 2019. The median daily dose per ABW for HCQ users decreased from 5.88 mg/kg in 2004 to 3.98 mg/kg in 2019, and from 5.45 mg/kg in 2005 to 4.17 mg/kg in 2019 for HCQ new users. The annual implementation rate of screening tests among HCQ new users increased from 3.5% in 2006 to 22.5% in 2019. Study results indicated that HCQ dosing management was adequate based on the revised guidelines. Although the implementation rate of retinal screening has increased, it is necessary to enhance awareness of retinal screening in clinical settings.

Predictive Value of Symptom Index for Early Detection of Ovarian Cancer

Objective: Although symptom-based screening has a positive role in identifying women at risk, it’s yet to be validated as screening tool. The present study aimed to validate the ovarian cancer symptom index in Pakistani population. Methods: From June 2019-December 2020, presenting symptoms were prospectively recorded in patients with ovarian cancer (n=70) and benign ovarian tumor (n=140) using Goff’s questionnaire. Results: Symptoms such as unable to eat normally, feeling full quickly, weight loss, increased abdomen size and postmenopausal bleeding were reported more frequently among the cancer group (p&lt;0.05). Symptoms including feeling full quickly, increased abdominal size and patients' age were independent predictors of cancer. The sensitivity, specificity, positive and negative predictive value, of symptom index were found to be 31.43%, 79.29%, 43.13%, and 69.81%, respectively. Conclusion: This study confirms that specific symptoms were useful in diagnosing women with ovarian cancer. Low sensitivity and specificity of the symptom index limit its use as an independent screening method. Nonetheless, with further validation it can be included for screening in clinical settings. Keywords: ovarian cancer, symptom index, diagnosis, predictive value

Stakeholder perspectives on social screening in US healthcare settings

BackgroundEvidence on the health impacts of social conditions has led US healthcare systems to consider identifying and addressing social adversity—e.g. food, housing, and transportation insecurity—in care delivery settings. Social screening is one strategy being used to gather patient information about social circumstances at the point of care. While several recent studies describe the rapid proliferation of social screening activities, little work has explored either why or how to implement social screening in clinical settings. Our study objectives were to assess diverse healthcare stakeholder perspectives on both the rationale for social screening and evidence needed to inform practice and policy-relevant implementation decisions.MethodsWe convened five focus groups with US experts representing different stakeholder groups: patient advocates, community-based organizations, healthcare professionals, payers, and policymakers. In total, 39 experts participated in approximately 90-minute long focus groups conducted between January-March 2021. A inductive thematic analysis approach was used to analyze discussions.ResultsThree themes emerged from focus groups, each reflecting the tension between the national enthusiasm for screening and existing evidence on the effectiveness and implementation of screening in clinical settings: (1) ambiguity about the rationale for social screening; (2) concerns about the relavence of screening tools and approaches, particularly for historically marginalized populations; (3) lack of clarity around the resources needed for implementation and scaling.ConclusionWhile participants across groups described potential benefits of social screening, they also highlighted knowledge gaps that interfered with realizing these benefits. Efforts to minimize and ideally resolve these knowledge gaps will advance future social screening practice and policy.

Financing Benefits and Barriers to Routine HIV Screening in Clinical Settings in the United States: A Scoping Review.

The Centers for Disease Control and Prevention recommends everyone between 13-64 years be tested for HIV at least once as a routine procedure. Routine HIV screening is reimbursable by Medicare, Medicaid, expanded Medicaid, and most commercial insurance plans. Yet, scaling-up HIV routine screening remains a challenge. We conducted a scoping review for studies on financial benefits and barriers associated with HIV screening in clinical settings in the U.S. to inform an evidence-based strategy to scale-up routine HIV screening. We searched Ovid MEDLINE®, Cochrane, and Scopus for studies published between 2006-2020 in English. The search identified 383 Citations; we screened 220 and excluded 163 (outside the time limit, irrelevant, or outside the U.S.). Of the 220 screened articles, we included 35 and disqualified 155 (did not meet the eligibility criteria). We organized eligible articles under two themes: financial benefits/barriers of routine HIV screening in healthcare settings (9 articles); and Cost-effectiveness of routine screening in healthcare settings (26 articles). The review concluded drawing recommendations in three areas: (1) Finance: Incentivize healthcare providers/systems for implementing HIV routine screening and/or separate its reimbursement from bundle payments; (2) Personnel: Encourage nurse-initiated HIV screening programs in primary care settings and educate providers on CDC recommendations; and (3) Approach: Use opt-out approach.

Magyar Afázia Szűrőteszt: új szűrőeljárás a poststroke aphasia gyors felismerésére

Although aphasia screening tools are widely used internationally, in Hungarian, to date, there have been no aphasia screening tests with reported psychometric properties available. (1) To provide an overview of the international practice and the tools of post-stroke aphasia screening. (2) To present a recently developed aphasia screening test in Hungarian. The Hungarian Aphasia Screening Test comprises five tasks assessing speech comprehension and production, and takes 5-10 minutes to complete. The test is easy to score and needs little equipment, therefore it can be useful in any clinical setting that allows for quick test administration and diagnostics. Based on results of two studies, we evaluate the psychometric properties and the diagnostic accuracy of the test, and determine three impairment severity ranks (mild, moderate, severe aphasia) for the test. The severity ranks were defined based on results of 70 people with post-stroke aphasia (35 women; average age: 61.4 years; average postonset: 12.6 months). The test has high diagnostic accuracy, a sensitivity of 92.5% and a specificity of 88.5%. It shows acceptable structural and concurrent (MR = 0.68) validity as well as good internal consistency (Mα = 0.74). The cut-off score for diagnosing aphasia is 17. The test can differentiate stroke patients with and without aphasia. With the use of the test, patients' aphasia can be rated as mild (score 14-17), moderate (score 9-13), or severe (score 0-8). Our results suggest that it is a reliable and valid screening tool. The test can detect the presence and quantify the severity of aphasia. We discuss the importance of aphasia screening in clinical settings and of the use of the Hungarian Aphasia Screening Test in the context of the international practices. Orv Hetil. 2022; 163(50): 2000-2008.

Diagnostic accuracy of the Stricker Learning Span and Mayo Test Drive Composite for amnestic Mild Cognitive Impairment.

AbstractBackgroundRemote assessment tools offer significant promise for aiding early detection of cognitive impairment. Mayo Test Drive (MTD): Test Development through Rapid Iteration, Validation and Expansion, is a web‐based platform for remote self‐administered assessment that includes a computer adaptive word list memory test (Stricker Learning Span; SLS) and a measure of processing speed (Symbols Test). We examined the diagnostic accuracy of the SLS and a MTD composite (SLS max span, SLS trials 1–5 total correct, SLS delay correct, [Symbols correct item response time*‐1]) for amnestic mild cognitive impairment (aMCI). We also explored diagnostic accuracy for a broader group that included individuals with possible MCI (pMCI; see Figure 1).MethodsParticipants were recruited from the Mayo Clinic Study of Aging for this ancillary remote study. 226 were cognitively unimpaired (CU; concordant CU diagnosis by 3 independent raters). Fifty‐six participants had possible MCI (at least 1 of 3 raters indicated MCI) and 16 had a consensus diagnosis of aMCI. Primary outcome variables were SLS sum of trials, AVLT sum of trials, Symbols correct items response time, and MTD composite. Mean difference analyses used linear model ANOVAs (alpha = .05). Receiver operating characteristic (ROC) curves were applied; we derived optimal cutoff scores based on the Youden index method.ResultsBoth aMCI and possible MCI groups showed significantly lower performance than the CU group on SLS (Hedge’s g aMCI = ‐1.72, pMCI = ‐1.04), Symbols (Hedge’s g aMCI = 1.38, pMCI = 0.64), and MTD composite (Hedge’s g aMCI = ‐1.89, pMCI = ‐1.09); see Tables 1 and 2 (all p‘s&lt;.01 even when additionally covarying age, education, sex). Total area under the curve was high for differentiating of CU vs. aMCI (MTD Composite = 0.91, SLS = 0.91) and acceptable for CU vs. pMCI (MTD Composite = 0.77, SLS = 0.77); see Table 2. Consistent with our flexible platform, a variety of device types were used to complete remote testing (32% smartphone, 12% tablet, 56% PC).ConclusionsMTD and the SLS show high diagnostic accuracy for aMCI. MTD is a flexible, brief, and easy‐to‐use remote cognitive assessment tool with great potential for scalable use in future studies seeking to maximize inclusion of individuals with aMCI in clinical trials or for cognitive screening in clinical settings.

Developmental Screening Tools Used with First Nations Populations: A Systematic Review

Developmental surveillance and screening is recommended for all children under five years of age, especially for those from at-risk populations such as First Nations children. No review to date has, however, evaluated the use of developmental screening tools with First Nations children. This review aimed to examine and synthesise the literature on developmental screening tools developed for, or used with, First Nations populations children aged five years or younger. A PRISMA-compliant systematic review was performed in the PsychInfo, PubMed, and Embase databases. Additional searches were also undertaken. In total 444 articles were identified and 13 were included in the final review. Findings indicated that several developmental screening tools have been administered with First Nations children. Most tools, however, have only been evaluated in one study. Results also found that no studies evaluated actions taken following positive screening results. More research evaluating the accuracy, acceptability, and feasibility of using developmental screeners with First Nations children is required before widespread implementation of developmental screening in clinical settings with First Nations children is recommended.