Standard Of Care For Screening Research Articles

The Psychiatrist's Role in Treating Perinatal Opioid Use Disorder and Reducing Maternal Mortality.

Drug overdose is a leading cause of maternal mortality. Psychiatrists can play a critical role in reducing these deaths by delivering effective evidence-based treatments for perinatal opioid use disorder (POUD), including the use of buprenorphine. Medications for POUD (i.e., buprenorphine, methadone) are life-saving treatments, but only half of those who are diagnosed as having POUD will receive this treatment, which can result in an increased risk for return to opioid use, overdose, and death. Psychiatrists are well positioned to prescribe buprenorphine given the Drug Enforcement Administration's (DEA) removal of the requirement to submit a Notice of Intent to prescribe buprenorphine for the treatment of opioid use disorders. Psychiatrists who have a current DEA registration that includes Schedule III authority may now prescribe buprenorphine for opioid use disorders; the training requirements to do so are outlined herein. This article reviews the standard of care for screening, diagnosis, and treatment of POUD, and prescribing buprenorphine for POUD, as well as shared decision-making for medication selection, induction, and maintenance of buprenorphine during pregnancy, labor and delivery, and the postpartum year.

Rapid magneto-enzyme-linked immunosorbent assay for ultrasensitive protein detection

Protein-based diagnostics are the standard of care for screening and diagnosing a broad range of diseases and medical conditions. The current gold standard method for quantifying proteins in clinical specimens is the enzyme-linked immunosorbent assay (ELISA), which offers high analytical sensitivity, can process many samples at once, and is widely available in many diagnostic laboratories worldwide. However, running an ELISA is cumbersome, requiring multiple liquid handling and washing steps, and time-intensive (∼2 − 4 h per test). Here, we demonstrate a unique magneto-ELISA that utilizes dually labeled magnetic nanoparticles (DMPs) coated with horseradish peroxidase (HRP) and an HRP-conjugated detection antibody, enabling rapid immunomagnetic enrichment and signal amplification. For proof of concept, this assay was used to detect Plasmodium falciparum histidine-rich protein 2 (PfHRP2), a malaria parasite biomarker, which exhibited a lower limit of detection of 2 pg mL−1 (33 fM) in human serum. Measurements of PfHRP2 in clinical blood samples from individuals with and without P. falciparum infection revealed that this magneto-ELISA offers a superior diagnostic accuracy compared to a commercial PfHRP2 ELISA kit. We also demonstrate the versatility of this platform by adapting it for the detection of SARS-CoV-2 nucleocapsid protein, which could be detected at concentrations as low as 8 pg mL−1 (174 fM) in human serum. In addition to its high analytical performance, this assay can be completed in 30 min, requires no specialized equipment, and is compatible with standard microplate readers and ELISA protocols, allowing it to integrate readily into current clinical practice.

Guideline No. 405: Screening and Counselling for Alcohol Consumption During Pregnancy.

To establish national standards of care for screening and counselling pregnant women and women of child-bearing age about alcohol consumption and possible alcohol use disorder based on current best evidence. Health care providers who care for pregnant women and women of child-bearing age. Pregnant women and women of child-bearing age and their families. Medline, EMBASE, and CENTRAL databases were searched for "alcohol use and pregnancy." The results were filtered for a publication date between 2010 and September 2018. The search terms were developed using Medical Subject Headings terms and keywords, including pre-pregnancy, pregnant, breastfeeding, lactation, female, women, preconception care, prenatal care, fetal alcohol spectrum disorder, prenatal alcohol exposure, drinking behavior, alcohol abstinence, alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol consumption, alcohol abuse, benzodiazepines, disulfiram, naltrexane, acamprosate, ondansetron, topiramate, cyanamide, calcium carbimide, alcohol deterrents, disease management, detoxification, Alcoholics Anonymous, alcohol counselling, harm reduction, pre-pregnancy care, prenatal care, incidence, prevalence, epidemiological monitoring, and brief intervention. Evidence was included from clinical trials, observational studies, reviews, systematic reviews and meta-analyses, guidelines, and conference consensus. The content and recommendations in this guideline were drafted and agreed upon by the authors. The Board of Directors of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework. Implementation of the recommendations in these guidelines using validated screening tools and brief intervention approaches may increase obstetrical care provider recognition of alcohol consumption and problematic alcohol use among women of child-bearing age and those who are pregnant. It is anticipated that health care providers will become confident and competent in managing and supporting these women so they can achieve optimal health and pregnancy outcomes. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).

Outcomes and costs of single-step hepatitisC testing in primary care, Birmingham, UnitedKingdom.

In UK laboratories, the diagnostic algorithm for chronic hepatitis C (HCV) infection commonly requires two serological assays to confirm anti-HCV-antibody positivity in a serum sample followed by HCV RNA detection in a second whole-blood sample (two-step testing algorithm). A single-step algorithm (both anti-HCV antibodies and RNA tested on an initial serum specimen) has been advocated to reduce attrition rates from the care pathway. To investigate the feasibility, clinical impact and relative costs of switching from a two-step to single-step testing algorithm in the laboratory, a pilot study on unselected primary care requests was undertaken. All primary care patients tested for HCV infection from December 2013 to April 2016 were included. The single-step testing algorithm was introduced in March 2015. Before this, the two-step algorithm was used. Patients were followed up until August 2016. RNA quantitation in plasma was within one log of serum values for 21 paired samples. Although all patients in the single-step algorithm received an RNA test, only 70% completed the two-step testing algorithm; differences in referral rates to specialist care was due to 30% of HCV antibody-positive patients in the two-step algorithm not having follow-up whole-blood sampling for HCV RNA testing. Costs per new diagnosis and new diagnosis referred to specialist care were lower in single-step testing by £94.32 and £144.25, respectively. This study provides further evidence that a single-step testing algorithm, as recommended in the UK Standards for Microbiology Investigation, works in practice and should be the standard of care for screening for chronic HCV.

Combined Endoscopic Laparoscopic Surgery Procedures for Colorectal Surgery

Colonoscopy is the standard of care for screening and surveillance of colorectal cancers. Removal of adenomatous polyps prevents the transformation of adenomas to potential adenocarcinoma. While most polyps are amenable to simple endoscopic polypectomy, difficult polyps that are large, broad-based, or located in haustral folds or in tortuous colon segments can present a challenge for endoscopists. Traditionally, patients with endoscopically unresectable polyps have been referred for oncologic surgical resection due to the underlying risk of malignancy within the polyp; however, the majority of these polyps are benign on final pathology. Combined endoscopic laparoscopic surgery can help facilitate endoscopic removal of difficult lesions, or allow the surgeon to select the correct laparoscopic approach for polyp excision. Current literature suggests that these procedures are safe and effective and can potentially save patients from the morbidity of laparotomy and segmental colectomy.

Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position.

Background:Recent reports of increased intracranial pressure (ICP) due to steep Trendelenburg (ST) position causing neurological deterioration, decreased regional cerebral oxygen saturation and postoperative visual loss after robotic urological and gynecological surgeries led us to consider a simple technique of ICP monitoring. Ours is one of the first instances reported of quantitative noninvasive measurement of increase in ICP with ST position by serial measurement of binocular optic nerve sheath diameter (ONSD) in patients undergoing robot assisted urological and gynecological oncosurgery. We tested whether ONSD values rose to above the upper limits of normal and for what length of time they remained elevated.Materials and Methods:Prospective, randomized, interventional, parallel group, active control study conducted on 252 American Society of Anesthesiologists I and II patients. ONSD was measured using 7.5 MHz linear ultrasound probe in supine and Trendelenburg positions.Statistics:Student's t-test to compare the inter-group mean ONSD and the repetitive t-test for intra-group analysis.Result:Comparison of the mean ONSD values of both groups yielded a 2-tailed significance P <0.01 at all compared time points intra- and post-operatively. In Group-O (open surgery; supine position), the baseline mean bilateral ONSD was 4.36 mm, which did not show any statistically significant change throughout open surgery and postoperative period. On de-docking the robot, 6.2 mm was the mean ONSD value in Group-R (robotic group) while 4.3 mm was the corresponding value in control Group-O.Conclusion:ONSD evaluation is a simple, quick, safe, readily available, reliable, cost effective, noninvasive, potential standard of care for screening and monitoring of patients undergoing robotic surgery in ST position.

Bedside ultrasound in the diagnosis of nonalcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the United States. While the American Association for the Study of Liver Diseases guidelines define NAFLD as hepatic steatosis detected either on histology or imaging without a secondary cause of abnormal hepatic fat accumulation, no imaging modality is recommended as standard of care for screening or diagnosis. Bedside ultrasound has been evaluated as a non-invasive method of diagnosing NAFLD with the presence of characteristic sonographic findings. Prior studies suggest characteristic sonographic findings for NAFLD include bright hepatic echoes, increased hepatorenal echogenicity, vascular blurring of portal or hepatic vein and subcutaneous tissue thickness. These sonographic characteristics have not been shown to aid bedside clinicians easily identify potential cases of NAFLD. While sonographic findings such as attenuation of image, diffuse echogenicity, uniform heterogeneous liver, thick subcutaneous depth, and enlarged liver filling of the entire field could be identified by clinicians from bedside ultrasound. The accessibility, ease of use, and low-side effect profile of ultrasound make bedside ultrasound an appealing imaging modality in the detection of hepatic steatosis. When used with appropriate clinical risk factors and steatosis involves greater than 33% of the liver, ultrasound can reliably diagnose NAFLD. Despite the ability of ultrasound in detecting moderate hepatic steatosis, it cannot replace liver biopsy in staging the degree of fibrosis. The purpose of this review is to examine the diagnostic accuracy, utility, and limitations of ultrasound in the diagnosis of NAFLD and its potential use by clinicians in routine practices.

Sudden cardiac death screening in adolescent athletes: an evaluation of compliance with national guidelines

ObjectiveIn the USA, the preparticipation physical evaluation (PPE) is the standard of care for screening eight million high-school athletes for their risk of sudden cardiac death (SCD). Our aim was...

Use of A1C for Screening and Diagnosis of Type 2 Diabetes in Three Rural Health Care Systems

T he prevalence of type 2 diabetes continues to escalate in the United States. An estimated 26 million people have been diagnosed with type 2 diabetes; an additional 79 million have prediabetes and are at risk for developing the disease.1 Lifestyle interventions to reduce the risk of type 2 diabetes in at-risk individuals may be beneficial.2–5 Effective screening for type 2 diabetes in the primary care population may improve outcomes.5,6 Traditionally, fasting plasma glucose (FPG) measurement, casual (random) plasma glucose testing, and oral glucose tolerance tests (OGTTs) have been the standard of care for screening and diagnosis of diabetes.7 A1C has not been recommended as a diabetes screening or diagnostic test. Rather, this measure, which reflects average blood glucose during an approximately 3-month time span, has been used to monitor diabetes treatment and as a predictor of potential diabetes complications.7 Following the recommendation of an international expert committee and based on data from the National Health and Nutrition Examination Survey and other sources,8 the American Diabetes Association (ADA) added A1C to its criteria for screening for and diagnosing diabetes in January 2010.7 This study evaluated trends in A1C testing used to screen for and diagnose type 2 diabetes in three rural health care systems in the upper Midwest after the 2010 change in ADA guidelines. Additionally, it surveyed health care providers to assess their knowledge and attitudes pertaining to screening for and diagnosing type 2 diabetes. A1C test results used for analysis in this retrospective review of electronic medical record (EMR) charts were obtained from individuals receiving an A1C test in 2009 and 2010 (before and after, respectively, the 2010 change in the ADA recommendations) in three health care systems in the Red River Valley of North Dakota and …

Optical frequency domain imaging system and catheters for volumetric imaging of the human esophagus.

Barrett's esophagus (BE) is a metaplastic disorder that can undergo dysplastic progression, leading to esophageal adenocarcinoma. Upper endoscopy is the standard of care for screening for BE, but this technique has a relatively low diagnostic accuracy and high cost due to the requirement of conscious sedation. Optical frequency domain imaging (OFDI) is a high-speed imaging modality that generates cross-sectional images of tissues with a resolution of approximately 10μm that is sufficient for detecting microscopic tissue architecture. In combination with a balloon-centering catheter, this method enables BE diagnosis over the entire distal esophagus.

The “Coming of Age” of Nonmammographic Screening for Breast Cancer

THE STUDY BY BERG AND COLLEAUGES 1 PUBLISHED IN this issue of JAMA addresses important clinical questions: What is the additional cancer diagnosis yield of screening ultrasound in women at increased risk of breast cancer, and what are the “costs” of such strategies in terms of false-positive diagnoses. The design of this American College of Radiology Imaging Network (ACRIN) trial, from the multi-institutional setting to source documentation and independent data analysis, is excellent from every aspect. This study and several other previously published trials demonstrate how important it is to have institutions like ACRIN sponsor and help organize prospective clinical trials that follow good clinical practice in the world of diagnostic imaging, which, unlike clinical research in the therapeutic sector, has to proceed without the financial support and scientific infrastructure usually provided by the pharmaceutical and medical device industries. The results of this study are impressive. Ultrasound was associated with a 55% increase in diagnosing breast cancer compared with mammography alone: a 7.6 per 1000 to 11.8 per 1000. The sensitivity with which breast cancer was detected was 77.5% (32 of 41) for the combined use of ultrasound and mammography vs 49% (20 of 41) for mammography alone. Given that mammography is the standard of care, one could argue that a main finding of this study is the apparently limited sensitivity of screening mammography. However, this finding is in keeping with recent results of several mammographic screening studies. Depending on the composition of the screening cohort, the sensitivity can be as low as 25% for BRCA1 mutation carriers, but even in women at average risk, for instance in almost 50 000 women who participated in theDigitalMammographic ImagingScreening trial, theoverall sensitivity of screening mammography was only 55%. It is well established that mammography and ultrasound are complementary for diagnosing breast cancer. Ultrasound performs best in cases for which mammography performs weakest, ie, in breast areas with of dense fibroglandular tissue. Yet, breast ultrasound is seldom used for screening in the United States, and to date, none of the worldwide screening programs offers ultrasound. Reservations against the use of ultrasound include costs, frequency of falsepositive findings, and lack of evidence from randomized trials on mortality end points. The results from this study by Berg and colleagues confirm that the positive predictive value of screening ultrasound is indeed low. Of 233 women for whom biopsy was recommended based on a suspicious ultrasound finding, only 20 (8.6%) were diagnosed with breast cancer. Stated otherwise, 91.4% of all suspicious ultrasound findings identified by expert breast radiologists were due to benign changes. Although this seems to be a key argument against the use of breast ultrasound, one should consider that mammography, the accepted standard of care for screening, had a positive predictive value of 14.7% (20 of 136) in the same cohort. In the cohort of 2712 women, the number of falsepositive diagnoses increased from 116 (for mammography alone) to 275 (for the combined use of mammography and ultrasound). This might be considered far too many. But this has to be weighted against the benefit of the additional cancer diagnosis yield of ultrasound. Twelve cancers, ie, 29% of the total 41 cancers, were only detected by ultrasound. Whether this is sufficient to justify the many false-positive ultrasound diagnoses is something every individual woman may have to decide for herself. Of note, comparing only numbers of false-positive diagnoses may not be fair because a suspicious finding made by mammography usually requires stereotactic, mostly vacuumassisted biopsy, an expensive and time-consuming procedure. In comparison, a positive ultrasound finding can be investigated by ultrasound-guided core biopsy (or even fineneedle aspiration), a simple, fast, and inexpensive procedure that often may be performed immediately. Accordingly, the average false-positive ultrasound may not have the same implications as the average false-positive mammographic diagnosis. This statement should not downplay the problem. Falsepositive diagnoses should be avoided not only because they add to the overall costs of a screening program but also because they may stimulate unnecessary anxieties. However, a recent study on the psychological impact of false-positive screening diagnoses concluded that “women who are re-

Breast Cancers Detected with Imaging Screening in theBRCAPopulation: Emphasis on MR Imaging with Histopathologic Correlation

The benefit of screening with breast magnetic resonance (MR) imaging for certain patient populations at high risk for breast cancer, most notably patients with a genetic mutation in the BRCA1 or BRCA2 gene, has been established in numerous studies and is now becoming part of routine clinical practice. Despite the lower sensitivity of mammography compared with that of MR imaging, the former remains the standard of care for screening any patient population. In the BRCA1 and BRCA2 populations, the inferior sensitivity and specificity of ultrasonography (US) limit its role as a screening tool, but US remains a vital diagnostic tool because of its ability to provide guidance for biopsy of many suspicious lesions detected with MR imaging. Important features of a screening program with breast MR imaging include the following: optimization of the MR imaging technique, an awareness of the imaging features of invasive and noninvasive breast cancers detected with MR imaging, an understanding of the limitations of the various imaging modalities in both the initial screening and subsequent diagnostic work-up evaluations, and the requirement for MR imaging-guided biopsy.

Refeeding Syndrome in Hospitalized Pediatric Patients

Refeeding syndrome has been well documented over the years, primarily through case reports and literature reviews. Awareness of refeeding syndrome is crucial in preventing the occurrence of, and the metabolic and physiologic complications associated with, aggressive nutrition support in malnourished populations. Once compromised patients have been identified to be at risk of refeeding syndrome, nutrition rehabilitation should be cautiously initiated. We have found a lack of clinical validation for instituting nutrition support in high-risk pediatric patients who may develop refeeding syndrome. The purposes of our investigation were to determine the incidence of refeeding syndrome in pediatric hospitalized patients beginning on parenteral nutrition and to determine how consistently the Department of Clinical Nutrition standards of care for screening and prevention were followed at our institution.