Use Of Predictive Testing Research Articles

Perinatal optimisation and predictive testing of in utero transfers and their outcome: A regional study.

To review in utero transfers (IUT), their antenatal optimisation strategies including predictive testing and outcomes in a large region in the UK. All IUT requests received by regional transport service in the UK, over a 12-month period, were reviewed gathering information on gestation at referral, antenatal corticosteroid use, tocolysis, magnesium sulphate, predictive test use (and result if applicable) and delivery outcome at 48 h. The reason for transfer was also collated to determine capacity issues. Only 22.9% of women transferred delivered within 48 h of transfer, with only 76% of eligible women receiving antenatal steroids. The overall use of predictive testing was low, in 23.5% of all referrals. Approximately 19.8% of women presenting at 30 weeks gestation or more received predictive testing while only 26.5% of women at risk of extreme preterm delivery had a predictive test, and 40.7% of all IUT requests were for capacity reasons. More predictive testing with accurate approaches to predicting imminent preterm labour and delivery needs to be incorporated into clinical care to reduce the number of inappropriate IUTs. Appropriate antenatal optimisation to improve outcomes should be offered to women undergoing an IUT. Capacity remains problematic leading to a significant number of transfers.

P1177 Perceptions of patients with Inflammatory Bowel Disease and first degree relatives on prediction and prevention of disease

Abstract Background Significant advances have been made in understanding the preclinical stages of IBD, and in identifying risk factors and biomarkers to predict IBD onset. With the use of predictive testing to identify patients at risk of developing the disease, it would be possible to intervene and try to mitigate that risk. However, the feasibility of such strategy, would depend on whether individuals at risk of developing IBD would be willing to undergo predictive testing and preventive interventions. Methods A Redcap® electronic survey, available in five languages, was disseminated by clinicians and patient’s associations to patients with IBD, first-degree relatives (FDRs) of those with IBD, parents with IBD and healthy children at risk (based on family history), and healthy couples with multiple children including one with IBD. Participants were asked to express their concerns regarding their own or offspring’s risk of developing IBD and acceptable predictive testing and preventive interventions. Results 817 individuals (75% women, mean age of 41±12 years) living in 28 different countries participated. The majority were parents with IBD of healthy at-risk children (59%). Among individuals with IBD, 50% had Crohn's disease, 55% were on biologic treatment, 25% had undergone surgery, and 62% reported a significant impact on their quality of life. Overall 85% expressed willingness for predictive testing, favoring minimally-invasive methods. Half of participants would agree to cross-sectional imaging and 38% would accept a colonoscopy. The main benefits recognized with predictive testing were the possibility of starting preventive interventions to minimize the risk of developing IBD (74%) and obtaining an earlier diagnosis (63%). Anxiety from a positive result was a concern (57%). A total of 98% would accept preventive interventions. The most accepted were quitting smoking (64%), physical exercise (81%), dietary modification/supplementation (86%/71%) and probiotics (79%); with the optimal duration of the intervention to last up to one year (33%). Participants deemed a risk of minor adverse events up to 10% acceptable, with 33% tolerating a higher risk if disease risk was reduced by 75%. Half agreed that costs should be supported entirely or shared (39%) with the government. Conclusion In this international survey of patients with IBD or parents of children at-risk of developing IBD, minimally-invasive predictive testing would be well accepted as well as non-pharmacological and highly effective preventive interventions.

Comparison of different predictive tests for difficult airways in pediatrics

Objective: There are few studies regarding the use of predictive tests for difficult airways in pediatrics. The aim of this study was to investigate the effectiveness of the modified Mallampati test (MMT), the upper lip bite test (ULBT) and anthropometric measurements of the head and neck in the prediction of difficult airways in children. Methods: Forty-eight pediatric patients who underwent elective surgery under general anesthesia with endotracheal intubation were recruited for the study. During the preanesthetic evaluation, airway status was evaluated using three methods: MMT, ULBT and anthropometric measurements of the head and neck. Laryngoscopy was performed with a single blade of a videolaryngoscope and airway status was evaluated using the Cormack-Lehane classification. All patients were then classified into two groups: difficult airway or easy airway. Results: Ten (20.8%) patients were classified as the difficult airway group. In this group, 80% of the patients had MMT grade 3-4 (p=0.001) while 50% of the patients were classified as ULBT 3 (p=0.000). Interincisor distance (ID), hyomental distance (HMD), distance from ear tragus to the corner of the mouth (DTM) and distance from frontal plane to chin (DFC) were significantly different between the groups (p<0.05). In ROC curve analysis, ULBT had the largest area under the curve (AUC=0.880). Conclusion: ULBT, MMT, HMD and ID were the most consistent predictors of difficult airway status. ULBT was superior to other tests because of its larger AUC and higher sensitivity and specificity rates. However, difficulty in applicability in young children seemed to be the most important limitation of both ULBT and MMT.

Fixed Drug Eruption: Case Report

Drug allergy is characterized by hypersensitivity reactions to pharmacological agents, having an immune mechanism of development. In these reactions antibody and/or activated T cells are directed against medications or their metabolites. This problem is rather urgent for practical healthcare, as over 7% of people suffer from drug allergy. A 54-year old male presented at the emergency room Hospital Zainoel Abidin with redness and swelling of the bodies of a burning sensation, itching pain. In the detailed anamnesis taken from the patient, it was learned that 1 days previously he had consulted a nurse with the fever and 60 min after examination had been prescribed with acid mefenamic. Hypersensitivity immune reactions to medications, according to the present concepts, are divided into immediate reactions (within 1–6 h after starting the preparation manifesting with various forms—from mild to life-threatening symptoms of anaphylaxia), or delayed reactions (several hours to several days after the offending medication is started, manifesting clinically with exanthemas in the majority of cases). Drug allergy should be prevented.Steps to prevent allergic drug reactions include (1) a careful history to determine host risk factors, (2) avoidance of cross-reactive drugs, (3) use of predictive tests when available, (4) proper and prudent prescribing of drugs (especiallyantibiotics) that are frequently associated with adverse reactions,(5) use of oral drugs when possible, and (6) documentation of drug allergy in the patient’s medical record.

Classification of Chronic Obstructive Pulmonary Disease (COPD) using Gabor Filter With SVM Classifier

In the field of medical diagnosis, early detection of COPD symptoms is difficult. The use of predictive tests leads to the treatment of COPD and also helps to identify signs of COPD early. Therefore, we present in this paper a feature extraction method for the structural representation of COPD images using the Gabor Filter. In addition, we train and evaluate COPD extracted function or category with SVM classification. The results show that the proposed method can be more accurate, more flexible, and more reliable. This approach is well adapted for early diagnosis of COPD.

Overview of in vivo and ex vivo endpoints in murine food allergy models: Suitable for evaluation of the sensitizing capacity of novel proteins?

Significant efforts are necessary to introduce new dietary protein sources to feed a growing world population while maintaining food supply chain sustainability. Such a sustainable protein transition includes the use of highly modified proteins from side streams or the introduction of new protein sources that may lead to increased clinically relevant allergic sensitization. With food allergy being a major health problem of increasing concern, understanding the potential allergenicity of new or modified proteins is crucial to ensure public health protection. The best predictive risk assessment methods currently relied on are in vivo models, making the choice of endpoint parameters a key element in evaluating the sensitizing capacity of novel proteins. Here, we provide a comprehensive overview of the most frequently used in vivo and ex vivo endpoints in murine food allergy models, addressing their strengths and limitations for assessing sensitization risks. For optimal laboratory‐to‐laboratory reproducibility and reliable use of predictive tests for protein risk assessment, it is important that researchers maintain and apply the same relevant parameters and procedures. Thus, there is an urgent need for a consensus on key food allergy parameters to be applied in future food allergy research in synergy between both knowledge institutes and clinicians.

Perceptions of predictive testing for those at risk of developing a chronic inflammatory disease: a meta-synthesis of qualitative studies

Background: The availability of tests to predict the risk of developing chronic diseases is increasing. The identification of individuals at high risk of disease can trigger early intervention to reduce the risk of disease and its severity. In order for predictive tests to be accepted and used by those at risk, there is a need to understand people’s perceptions of predictive testing. Method: A meta-synthesis of qualitative research that explored patient and public perceptions of predictive testing for chronic inflammatory diseases was conducted. Studies were coded by researchers and patient research partners, and then organised into common themes associated with the acceptability or use of predictive testing. Results: Perceived barriers to predictive testing were identified, including a concern about a lack of confidentiality around the use of risk information; a lack of motivation for change; poor communication of information; and a possible impact on emotional well-being. In order to reduce these barriers, the literature shows that a patient-centred approach is required at each stage of the testing process. This includes the consideration of individual needs, such as accessibility and building motivation for change; readily available and easy to understand pre and post-test information; support for patients on how to deal with the implications of their results; and the development of condition specific lifestyle intervention programmes to facilitate sustainable lifestyle changes. Conclusion: Patients and members of the public had some concerns about predictive testing; however, a number of strategies to reduce barriers and increase acceptability are available. Further research is required to inform the development of a resource that supports the individual to make an informed decision about whether to engage in a predictive test, what test results mean, and how to access post-test support.

Médecine personnalisée en radiothérapie : perception des praticiens

This exploratory study was designed to investigate the representations of radiotherapists in relation to personalized medicine. On the basis of current?>' available radiotherapy predictive tests, we tried to understand how these tests could be used in routine radiotherapy practice and in what way this possible change of practices could affect the role of radiotherapists in treatment protocols. In the absence of any available data allowing the construction of a quantitative tool, qualitative data were recorded by individual interviews with radiotherapists. Based on textual data analysis, a second national quantitative phase was conducted using a self-administered questionnaire. Crossover analysis of the two datasets highlighted the interest of radiotherapists in personalized medicine and the use of predictive tests, while indicating certain limitations and concerns in relation to ethical issues related to personalized medicine in oncology and the physician's position.

Medical Transfer of Patients in Preterm Labor: Treatments and Tocolytics

Objective. To examine the epidemiology, effectiveness, and safety of tocolytics, and the variation in use of standard treatments and predictive testing for women in preterm labor (PTL) transported to tertiary care. Methods. This was a health record review of consecutive PTL patients (<38 weeks gestation) transported to a tertiary care facility by Ontario's air and land critical care transport service between January 1, 2006 and January 1, 2011. The primary outcome was the effectiveness of tocolytics in decreasing the frequency of contractions and incidence of delivery. Secondary outcomes included the type of tocolytics used, adverse events (defined a priori), use of standard treatments (corticosteroid, antibiotic), and use of predictive tests (cervical length measurement, fetal fibronectin). We report descriptive statistics and relative risk of contractions decreasing with tocolytics with 95% confidence intervals. Results. Of the 510 transports reviewed, 488 met all inclusion criteria with the following characteristics: mean age 26.1 years, mean gestational age 31.2 weeks, mean transport time 80 minutes, 61.0% multiparous, 13.3% twins, mean initial dilatation 1.8 cm, contraction <8 min apart 67.7%, and 66.8% from Northern Ontario. Tocolytics were used in 206 (42.2%), with nonsteroidal anti-inflammatory drugs and nitroglycerine being used most frequently. Eleven (2.3%) patients delivered during transport, 4 (36.4%) of which received tocolytics with relative risk (RR) 0.8 (95%CI 0–2.0), and number needed to treat (NNT) 165 (31.5–299.3). Among the 311 (63.7%) patients for which change in contractions was documented, 140 (45%) received tocolytics and of these patients, contractions decreased in 94 (67%), with an RR 0.6 (95%CI 0.3–0.9) and NNT 4.6 (3.1–6.2). Adverse events were documented in 67 (14%) patients (most commonly tachycardia 5.8%). Steroids were appropriately used in 268 (54.9%) patients and antibiotics were appropriately used in 286 (58.6%) patients. Predictive testing was performed in only 19 (3.9%) patients. Conclusions. Tocolytics were associated with decreased contraction frequency in more than two-thirds of those treated. However, nearly half those who did not receive the treatment also had decreased contractions, and the effect did not reach statistical significance. Variation in the type of tocolytic drug used suggests a need for clinical practice guidelines for tocolytic use during transport of PTL patients.

Cancer risk communication, predictive testing and management in France, Germany, the Netherlands and the UK: general practitioners' and breast surgeons' current practice and preferred practice responsibilities

Genetic testing has its greatest public health value when it identifies individuals who will benefit from specific interventions based upon their risk. This paradigm is the basis for the use of predictive tests, such as BRCA1/BRCA2 testing which has become part of clinical practice for more than a decade. Currently predictive BRCA1/BRCA2 testing is offered to women using low, moderate and high risk based upon family history as cut-off levels. Non-genetic health professionals such as general practitioners (GPs) and breast surgeons (BS) are seen as gatekeepers to manage demand and/or facilitate access to appropriate services for high-risk patients. Data about current practices are lacking. The paper presents data on the current practice of GPs' and BS' cancer risk assessment, referral practices and preferred practice responsibilities for women at risk for familial breast cancer in France, Germany, the Netherlands and the UK derived by a self-administered questionnaire send to a representative sample of GPs and BS in the four countries. One thousand one hundred ninety-seven GPs and 1,223 BS completed the questionnaire. Both GPs and BS reported that they are consulted by a considerable number of patients presenting with concerns about a family history of cancer. Both commonalities and striking differences could be observed between GPs and BS from the four participating countries. GPs from France and Germany reported significantly higher proportions taking a family history of cancer including the extended family than GPs from the Netherlands and the UK. Most GPs from France, Germany and the Netherlands stated their willingness for providing risk assessment for an unaffected (high-risk) woman with a family history of breast cancer and the vast majority of BS from all four countries reported that they themselves would provide risk assessment for an unaffected (high-risk) woman with a family history of breast cancer. However, a substantial number of both GPs and BS would not have taken an appropriate family history for their patient failing to take into account the paternal side of the family. GPs from Germany reported a significantly lower readiness to refer a patient with a family history of a BRCA1 mutation for specialist genetic counselling when compared to the GPs from the other countries. GPs and BS from France, Germany and the Netherlands significantly less often assigned practice responsibilities to a genetic specialist as compared to the participating GPs and BS from the UK. The outcome of the study confirms the need for capability building in genetics for non-genetic health professionals. Using genetic risk assessment tools without a full understanding could result in missed opportunities for cancer prevention and harm patients. In order to provide best possible services for high-risk patients presenting with cancer concerns, close collaboration with clinical geneticists should become routine part of mainstream medical practice.

Decision Making in Surgical Treatment of Chronic Low Back Pain: The performance of prognostic tests to select patients for lumbar spinal fusion

Decision Making in Surgical Treatment of Chronic Low Back Pain: The performance of prognostic tests to select patients for lumbar spinal fusion

Séquelles esthétiques de la radiothérapie adjuvante dans le traitement conservateur du cancer du sein localisé

Radiotherapy after breast-conserving therapy for early breast cancer is reported to adversely affect the cosmetic outcome. The incidence of radiation-induced fibroatrophy is around 10% at 5years. A better knowledge of its pathophysiology has revealed the essential role of activated fibroblasts and reactive oxygen species, mediated by TGF beta 1, allowing the development of antioxidant in the management of the established radiation-induced fibroatrophy. Cosmetic sequelae are evaluated with standardized scales, such as the LENT-SOMA and must be monitored during at least 5years. The main factors determining the occurrence of sequelae are a large breast volume, dose heterogeneity and the use of tumour bed boost after whole-breast radiation therapy. Intensity modulated radiotherapy and partial breast irradiation position themselves as a good alternatives to reduce the incidence of late skin side effects. The use of predictive tests of intrinsic radiosensitivity might fit into the therapeutic strategy.

Premotor Parkinson's disease: concepts and definitions.

Parkinson's disease (PD) has a prodromal phase during which nonmotor clinical features as well as physiological abnormalities may be present. These premotor markers could be used to screen for PD before motor abnormalities are present. The technology to identify PD before it reaches symptomatic Braak Stage 3 (substantia nigra compacta [SNc] involvement) already exists. The current challenge is to define the appropriate scope of use of predictive testing for PD. Imaging technologies such as dopamine transporter imaging currently offer the highest degree of accuracy for identifying premotor PD, but they are expensive as screening tools, and abnormalities on these studies would only be evident at Braak Stage 3 or higher. Efficiency is greatly enhanced by combining imaging with a prescreening test such as olfactory testing. This 2-step process has the potential to greatly reduce costs while retaining diagnostic accuracy. Alternatively, or in concert with this approach, evaluating high-risk populations (eg, patients with rapid eye movement behavior disorder or LRRK2 mutations) would enrich the sample for cases with underlying PD. Ultimately, the role of preclinical detection of PD will be determined by the ability of emerging therapies to influence clinical outcomes. As such, implementation of large-scale screening strategies awaits the arrival of clearly safe and effective therapies that address the underlying pathogenesis of PD. Future research will establish more definitive biomarkers capable of revealing the presence of disease in advance of SNc involvement with the promise of the potential for introducing disease-modifying therapy even before the development of evidence of dopamine deficiency.

Clinical decision making in spinal fusion for chronic low back pain. Results of a nationwide survey among spine surgeons

ObjectivesTo assess the use of prognostic patient factors and predictive tests in clinical decision making for spinal fusion in patients with chronic low back pain.Design and settingNationwide survey among spine...

Aspectos éticos dos testes preditivos em doenças de manifestação tardia

Discutem-se aqui, da perspectiva bioética, algumas das implicações da aplicação de testes pre-ditivos em doenças de manifestação tardia. São sugeridos questionamentos que podem ajudar a nortear a decisão sobre o uso dos testes preditivos e é feito um paralelo entre esses questionamentos e os princípios bioéticos de respeito à autonomia, justiça, beneficência e não maleficência. Observa-se, como resultado, a existência de uma preocupação com o resguardo de uma ética de vida em paralelo aos avanços tecnocientíficos no campo da Genética. Conclui-se pelo benefício de uma constante reflexão ética sobre a questão do diagnóstico prévio de doenças genéticas de início tardio.

Premotor Parkinson's disease: Clinical features and detection strategies

In many areas of medicine, the focus has shifted from treating existing disease to screening and prevention. The technology to screen for Parkinson's disease (PD) already exists. The current challenge is to define the appropriate use of predictive testing for PD. Imaging technologies currently offer the highest degree of accuracy for identifying premotor PD, but they are expensive as screening tools. Efficiency is greatly enhanced by combining imaging with a prescreening test, such as olfactory testing. This two-step process has the potential to greatly reduce costs while retaining diagnostic accuracy. Ultimately, the role of preclinical detection of PD will be determined by the ability of emerging therapies to influence clinical outcomes. As such, implementation of large-scale screening strategies awaits the arrival of clearly safe and effective therapies that address the underlying pathogenesis of PD. Current research to evaluate efficient screening methods and to understand the clinical and physiological features of "premotor" PD will lay the foundation for the screening and prevention strategies of the future.

Predictive tests for individualization of pharmacological cancer treatment

The selection of cancer drugs for an individual patient is still based mostly on cancer type and stage. Predictive tests are needed to make individualized and more efficient pharmacological cancer treatment possible. To provide an overview of available, possible future development and principles for development of predictive tests for individualized selection of cancer drugs. Overview of published data. Despite increased knowledge in cancer biology, only limited progress has been made in the development and use of predictive tests. However, rapid progress in this field will be possible using already available and emerging technologies, but requires a paradigm shift in principles for the development and use of cancer drugs. Assessment of drug activity in intact tumor cells and tumor cell gene expression signatures are considered to have greatest potential for the development of versatile predictive tests.

Psychosocial impact of predictive testing for myotonic dystrophy type 1

In the Saguenay-Lac-Saint-Jean region (Quebec, Canada), a predictive DNA-testing program for myotonic dystrophy type 1 (DM1) has been available as a clinical service since 1988. From 1 to 12 years (median, 5 years) after receiving predictive testing, a total of 308 participants (44 carriers and 264 non-carriers) answered a questionnaire to determine the psychosocial impact of this genetic testing. The main reasons for wanting to be tested were to learn if children are at risk for DM1 or for reproductive decision making (75%) and to relieve the uncertainty for themselves (17%). The majority of participants (96.1%) remembered correctly their test result. At the time of the survey, the perception of the general well-being, the psychological distress (Psychiatric Symptom Index), and the self-esteem (Rosenberg Self-Esteem Scale) were similar in carriers, in non-carriers, and in the reference (Quebec) population. When participants indicated a change in different aspects of their lives following predictive testing, it was perceived as a change for the better by non-carriers and as a change for the worse by carriers. Nevertheless, for a majority of carriers and of non-carriers, the test result did not bring changes in their lives. All respondents believed that predictive testing should be available for the at-risk population and the vast majority of carrier and of non-carriers would recommend the use of predictive testing to their family members. Predictive testing for individuals at-risk of DM1 can be offered safely within a well-organized clinical and genetic counseling program that includes careful pre-test counseling, pre-test clinical assessment, post-test psychological support, and follow-up for those identified as carriers.

Colorectal cancer chemotherapy

SummaryColorectal cancer is a leading cause of cancer death world‐wide. There have been important advances in the chemotherapeutic management of colorectal cancer as a result of a deliberate collaborative process of well‐designed clinical trials. From the earlier standard of 5‐fluorouracil‐based therapy alone, the recent availability of newer agents, including capecitabine, irinotecan and oxaliplatin, has significantly expanded the options available for the management of patients with advanced colorectal cancer, with consequent improvements in survival. For patients with resected, high‐risk, localized disease, adjuvant systemic chemotherapy improves survival. The identification of new chemotherapy regimens, the use of predictive testing and the integration of novel targeted therapies with cytotoxic chemotherapies are areas of active clinical investigation. A review of the chemotherapeutic management of colorectal cancer is presented.

Attitudes of patients with mild dementia and their carers towards disclosure of the diagnosis.

To determine the attitudes of patients with mild dementia and their carers towards the disclosure of diagnoses of cancer and dementia and whether there are differences between these groups. To determine whether any major adverse events occurred following disclosure of diagnosis of dementia. A prospective study followed by a retrospective case-note study after 1 year. Fifty patients with mild dementia and their carers were recruited from a memory clinic in Nottingham, UK, and an old-age psychiatrist, using a semistructured questionnaire, separately interviewed them. Questions related to whether patients and their carers wished to be told diagnoses of cancer and dementia; the reasons for this; whether they would want treatment and make use of predictive testing if available were included. At 1-year follow-up whether antidepressants had been prescribed and whether any catastrophic reaction had occurred following disclosure of diagnosis. An overwhelming majority of patients with mild dementia wished to be informed of their diagnosis (92%); even more (98%) of the same patient sample reported wanting disclosure of a hypothetical diagnosis of cancer. A higher proportion (98%) of carers would wish to be told if they were to develop either dementia or cancer. All patients and carers would like access to treatment for dementia. A total of 88% of patients and 86% of carers would make use of a predictive test of Alzheimer's disease. Before receiving a diagnosis of mild dementia, only 28% of patients had insight that they may have dementia. Only a quarter (26%) of carers did not want the doctor to disclose the diagnosis of dementia to the patient. After 1 year, 6% of the original sample had developed a depressive illness requiring antidepressant treatment and no major incidents had occurred following disclosure of diagnosis. There has been a growing debate on whether patients with dementia should be informed of their diagnosis. Until recently, little was known about the views of patients themselves. This study shows that the vast majority of patients with mild dementia wish to be fully informed. Despite increasing awareness, a quarter of carers still do not wish their relative to be informed, though wish to be informed if they themselves were to develop the illness. This is significantly lower, however, than previously reported, suggesting a shift in attitudes. This study adds support to the weight of evidence that disclosure of a diagnosis of dementia does not cause depression or any irreversible harm to the patient.