Use Of Screening Tools Research Articles

The Loneliness of Aging

Isolation and loneliness have become buzz words when discussing older adults during the coronavirus disease pandemic; yet, these are age-old problems. Both have been studied extensively, yet there currently is no rapid or succinct tool that can be used in the emergency department to screen for either, or a consensus of evidence-based ways to correct these issues. This is of concern because both loneliness and social isolation have been linked to poor health. Poor health, in turn, can lead to worse isolation and loneliness. These health problems may lead to the older adult seeking care in the emergency department where screening and initial treatment could be initiated. Suggestions for questions that emergency nurses can ask to identify an older adult who is lonely or suffers from social isolation, as well as steps to consider when encountering the older adult with complaints of loneliness and/or social isolation, are provided, with the realization that these are only the first steps of many that would need to be taken. The purpose of this article is to bring forward updated information that discusses loneliness and social isolation in older adults, a timely priority during the coronavirus disease pandemic and often listed as a factor in older adult deaths. A review of relevant screening tools for use in the emergency department are provided.

Evaluation of Ultra-Low-Dose Chest CT Images to Detect Lung Lesions

Background: The present study was conducted to examine the possibility of detecting different types of lung lesions, such as cancer, using ultra-low dose (ULD) chest CT images. Method: In this basic (experimental) study with computed tomography (CT images), 20 patients with different lung disease indications were scanned with ULD and routine dose chest CT protocols. ULD and routine dose CT images were reconstructed utilizing iDose and iterative model reconstruction. CT images were evaluated by two expert radiologists. Volume CT dose index (CTDIvol), dose length product, and effective dose were used for dose assessment in both protocols. Results: CTDIvol and dose length product for ULD protocol were 98% less compared to those for routine chest CT. The chest CT images for ULD and routine dose were diagnosed as normal in three patients with lung lesions, such as nodules, masses, plural effusion, fibrosis, diffuse ground glass opacities, bronchiectasis, and infiltration, in 17 patients. Patient dose of ULD chest CT (0.11mSv) is comparable to Poster-Anterior plus Lateral (0.1 mSv) chest radiograph while the effective dose due to routine chest CT is about 5.1 mSv. Conclusion: Diagnostic findings regarding ULD chest CT images with 98% of dose reduction were compared to those for routine dose. We concluded that it may be utilized as a very useful tool for screening and the follow-up of different lung diseases, malignancy for instance. ULD chest CT with 98% of dose reduction could be a suitable substitute for chest radiograph, with higher diagnostic values.

\u201cI\u2019ll tell you what\u2019s important to me\u2026\u201d: lessons for women\u2019s health screening

BackgroundProviders face increasing demands to screen for various health issues. Family medicine, primary care, and obstetric providers are encouraged to screen women universally for intimate partner violence, which could be challenging without comprehensive screening tools. The screening expectations and demands motivated providers and staff in south-central Appalachia (U.S.) to engage community members in streamlining women’s health screening tools, and integrating intimate partner violence screening questions, through a Human-Centered Design (HCD) process. The objective of this article is to present participants’ experiences with and perceptions of the HCD process for developing screening tools for women’s health.MethodsThis was a qualitative, phenomenological study conducted with community members (n = 4) and providers and staff (n = 7) who participated in the HCD process. Sampling was purposive and opportunistic. An experienced qualitative researcher conducted open-ended, semi-structured interviews with participants. Interviews were transcribed and coded for thematic analysis.ResultsCommunity members reported that in the HCD sessions they wanted clinicians to understand the importance of timing and trust in health screening. They focused on the importance of taking time to build trust before asking about intimate partner violence; not over-focusing on body weight as this can preclude trust and disclosure of other issues; and understanding the role of historical oppression and racial discrimination in contributing to healthcare mistrust. Providers and staff reported that they recognized the importance of these concerns during the HCD process.ConclusionsCommunity members provided critical feedback for designing appropriate tools for screening for women’s health. The findings suggest that co-designing screening tools for use in clinical settings can facilitate communication of core values. How, when, and how often screening questions are asked are as important as what is asked—especially as related to intimate partner violence and weight.

Development of the adult complexity tool for pharmaceutical care (ACTPC) in hospital: A modified Delphi study.

Hospital pharmacists play an essential role in patient care; however, a lack of resources means pharmacists are unable to review all patients daily. Consequently, there is a demand for reliable screening tools to allocate care to patients with urgent and/or complex pharmaceutical needs. Several tools have been developed, but no broad consensus exists on the design of a screening tool to be used in the adult hospital setting. To obtain expert consensus on the design of a pharmaceutical care complexity screening tool for use on admission to hospital. Two Delphi studies were conducted: the first sought to gain consensus from experts including pharmacists, academics and physicians on the components of a pharmaceutical complexity tool, the second to achieve consensus from UK chief pharmacists and clinical service pharmacy managers on the clinical appropriateness and practicality of the tool. Tool components and Delphi statements were identified and refined from our previous systematic review, UK survey and interview study of prioritisation tools. A valid definition for consensus was used. Over 300 components were extracted from the interview data and systematic review and then refined for inclusion in the first Delphi study. Thirty-three experts completed Delphi One and consensus was reached on 92 components. Components were grouped into demographic, clinical and medication components and condensed to 33 items, which were included in the first draft of the Adult Complexity Tool for Pharmaceutical Care (ACTPC). The tool stratified patients into highly, moderately or least complex. Forty expert panellists completed Delphi Two and consensus was reached on review frequency and experience of pharmacy practitioner at each level. These decisions were incorporated into the final version of the ACTPC. The ACTPC is the first systematically designed and internationally agreed tool for use on medical admission to hospital. It has potential to enable the delivery of targeted patient-centred pharmaceutical care.

Co-Toxicity Factor Analysis Reveals Numerous Plant Essential Oils Are Synergists of Natural Pyrethrins against Aedes aegypti Mosquitoes.

Simple SummaryWith insecticide-resistant mosquito populations becoming an ever-growing concern, new vector control technologies are needed. Plant essential oils represent new insecticides and repellents, which are generally safer to mammals and non-target organisms than conventional materials. A set of 20 plant essential oils was screened alone and in combination with a natural insecticide, pyrethrins, for their ability to produce immobilization (knockdown at 1 h) and mortality at 24 h against the yellow fever mosquito. Overall, only a few of the oils produced considerable mortality or knockdown when applied alone at the doses used in this study. However, a number of them synergized or antagonized the toxicity of natural pyrethrins when applied in mixtures. These findings highlight select plant essential oils that may offer important avenues for the development of future insecticide synergists. Moreover, synergism or antagonism was highly dependent on the amount of the oil applied, e.g., some oils were more effective at improving natural pyrethrins toxicity at low doses, whereas others were better at improving its toxicity at high doses.With insecticide-resistant mosquito populations becoming an ever-growing concern, new vector control technologies are needed. With the lack of new chemical classes of insecticides to control mosquito populations, the development of novel synergists may improve the performance of available insecticides. We screened a set of 20 plant essential oils alone and in combination with natural pyrethrins against Aedes aegypti (Orlando) female adult mosquitoes to assess their ability to synergize this natural insecticide. A co-toxicity factor analysis was used to identify whether plant oils modulated the toxicity of natural pyrethrins antagonistically, additively, or synergistically. Both knockdown at 1 h and mortality at 24 h were monitored. A majority of oils increased the toxicity of natural pyrethrins, either via an additive or synergistic profile. Many oils produced synergism at 2 µg/insect, whereas others were synergistic only at the higher dose of 10 µg/insect. Amyris, cardamom, cedarwood, and nutmeg East Indies (E.I.) oils were the most active oils for increasing the mortality of natural pyrethrins at 24 h with co-toxicity factors greater than 50 at either or both doses. A number of oils also synergized the 1 h knockdown of natural pyrethrins. Of these, fir needle oil and cypress oils were the most successful at improving the speed-of-action of natural pyrethrins at both doses, with co-toxicity factors of 130 and 62, respectively. To further assess the co-toxicity factor method, we applied selected plant essential oils with variable doses of natural pyrethrins to calculate synergism ratios. Only the oils that produced synergistic co-toxicity factors produced statistically significant synergism ratios. This analysis demonstrated that the degree of co-toxicity factor correlated well with the degree of synergism ratio observed (Pearson correlation coefficient r = 0.94 at 2 µg/insect; r = 0.64 at 10 µg/insect) and that the co-toxicity factor is a useful tool in screening for synergistic activity.

Diagnostic Accuracy and Acceptability of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Among US Veterans

Posttraumatic stress disorder (PTSD) is a serious mental health disorder that can be effectively treated with empirically based practices. PTSD screening is essential for identifying undetected cases and providing patients with appropriate care. To determine whether the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PC-PTSD-5) is a diagnostically accurate and acceptable measure for use in Veterans Affairs (VA) primary care clinics. This cross-sectional, diagnostic accuracy study enrolled participants from May 19, 2017, to September 26, 2018. Participants were recruited from primary care clinics across 2 VA Medical Centers. Session 1 was conducted in person, and session 2 was completed within 30 days via telephone. A consecutive sample of 1594 veterans, aged 18 years or older, who were scheduled for a primary care visit was recruited. Data analysis was performed from March 2019 to August 2020. In session 1, participants completed a battery of questionnaires. In session 2, a research assistant administered the PC-PTSD-5 to participants, and then a clinician assessor blind to PC-PTSD-5 results conducted a structured diagnostic interview for PTSD. The range of PC-PTSD-5 cut points overall and across gender was assessed, and diagnostic performance was evaluated by calculating weighted κ values. In total, 495 of 1594 veterans (31%) participated, and 396 completed all measures and were included in the analyses. Participants were demographically similar to the VA primary care population (mean [SD] age, 61.4 [15.5] years; age range, 21-93 years) and were predominantly male (333 participants [84.1%]) and White (296 of 394 participants [75.1%]). The PC-PTSD-5 had high levels of diagnostic accuracy for the overall sample (area under the receiver operating characteristic curve [AUC], 0.927; 95% CI, 0.896-0.959), men (AUC, 0.932; 95% CI, 0.894-0.969), and women (AUC, 0.899, 95% CI, 0.824-0.974). A cut point of 4 ideally balanced false negatives and false positives for the overall sample and for men. However, for women, this cut point resulted in high numbers of false negatives (6 veterans [33.3%]). A cut point of 3 fit better for women, despite increasing the number of false positives. Participants rated the PC-PTSD-5 as highly acceptable. The PC-PTSD-5 is an accurate and acceptable screening tool for use in VA primary care settings. Because performance parameters will change according to sample, clinicians should consider sample characteristics and screening purposes when selecting a cut point.

Meta-analysis of latent tuberculosis in healthcare workers in Iran: a retrospective review

Here we review the status of latent tuberculosis (LTB) in Iranian healthcare workers (HCWs). A literature search was conducted using keywords according to the Preferred Reporting Items for Systematic Review and Meta-Analyses instructions. Cross-sectional studies published from 1 January 2000 through 1 January 2019 were retrieved. Meta-analysis was performed using Comprehensive Meta-Analysis software using the random effects model, Cochran's Q and I2 tests. Publication bias was estimated by funnel plot and Egger's linear regression test. Among 774 articles retrieved in the primary literature search, 21 studies met the eligibility criteria. No publication bias was observed among the included studies (p=0.07). The prevalence of LTB ranged from 7% to 63% in Iranian HCWs from different geographical areas. The overall combined prevalence of LTB among Iranian HCWs was 30.9% (95% confidence interval 24.2 to 38.5). Also, 52.4% of the included studies showed a significant correlation between occupation and LTB incidence (p<0.05). The prevalence of LTB was high among Iranian HCWs. This requires developing comprehensive information databases and surveillance systems for detecting LTB among HCWs. It is also essential to periodically screen for LTB in HCWs to provide a timely diagnosis of the infection. It is recommended to perform a tuberculin skin test, a useful tool for screening and treatment of LTB, on an annual basis in HCWs.

Cysteamine assay for the evaluation of bioactive electrophiles

Covalent modifications of thiol and amine groups may control the function of proteins involved in the regulatory and signaling pathways of the cell. In this study, we developed a simple cysteamine assay which can be used to study the reactivity of electrophilic compounds towards primary amine and thiol groups in an aqueous environment. The detection principle is based on the electrochemical, photometrical and mass spectrometric analyses of cysteamine (2-aminoethanethiol) as the molecular probe. This technique is useful for studying the reaction kinetics of electrophiles with thiol (SH) and amino (NH2) groups. The decrease in analytical responses of cysteamine was monitored to evaluate the reactivity of three electrophilic activators of the Nrf2 pathway, which mediates the cellular stress response. The SH-reactivity under cell-free conditions of the tested electrophiles decreased in the following order: 4-hydroxy-2-nonenal ≥ nitro-oleic acid > sulforaphane. However, as shown in RAW264.7 cells, the tested compounds activated Nrf2-dependent gene expression in the opposite order: sulforaphane > nitro-oleic acid ≥ 4-hydroxy-2-nonenal. Although other factors in addition to chemical reactivity play a role in biological systems, we conclude that this cysteamine assay is a useful tool for screening potentially bioactive electrophiles and for studying their reactivity at a molecular level.

Prenatal stress induced chromatin remodeling and risk of psychopathology in adulthood.

New insights into the pathophysiology of psychiatric disorders suggest the existence of a complex interplay between genetics and environment. This notion is supported by evidence suggesting that exposure to stress during pregnancy exerts profound effects on the neurodevelopment and behavior of the offspring and predisposes them to psychiatric disorders later in life. Accumulated evidence suggests that vulnerability to psychiatric disorders may result from permanent negative effects of long-term changes in synaptic plasticity due to altered epigenetic mechanisms (histone modifications and DNA methylation) that lead to condensed chromatin architecture, thereby decreasing the expression of candidate genes during early brain development. In this chapter, we have summarized the literature of clinical studies on psychiatric disorders induced by maternal stress during pregnancy. We also discussed the epigenetic alterations of gene regulations induced by prenatal stress. Because the clinical manifestations of psychiatric disorders are complex, it is obvious that the biological progression of these diseases cannot be studied only in postmortem brains of patients and the use of animal models is required. Therefore, in this chapter, we have introduced a well-established mouse model of prenatal stress (PRS) generated in restrained pregnant dams. The behavioral phenotypes of the offspring (PRS mice) born to the stressed dam and underlying epigenetic changes in key molecules related to synaptic activity were described and highlighted. PRS mice may serve as a useful model for investigating the pathogenesis of psychiatric disorders and may be a useful tool for screening for the potential compounds that may normalize aberrant epigenetic mechanisms induced by prenatal stress.

Giving voice to people with communication disabilities during mental capacity assessments.

Healthcare professionals without specialist training in communication disorders may not know how to identify and support patients with communication disabilities during mental capacity assessments. To meet this need, a novel communication screening tool was developed and tested as part of a mental capacity assessment support toolkit. To provide an initial evaluation of the communication screening tool's usability, interrater reliability and criterion validity. A prototype communication screening tool was developed iteratively using co-production and user-centred design principles. A mixed-methods case series design was used to explore how multidisciplinary healthcare professionals used the tool to test patients in acute hospital and intermediate care settings. Usability data were collected in an electronic survey and from a documentary analysis. Screening test outcomes obtained by pairs of professionals were compared to measure the tool's interrater reliability. Outcomes obtained by professionals were compared with the outcomes of a speech and language therapist's communication assessment to measure criterion validity. Quantitative data were analysed using frequency counts and inferential statistics. Qualitative data were analysed using framework analysis. A total of 21 professionals, including physicians, nurses, occupational therapists, physiotherapists, and speech and language therapists, and 17 patients with diagnoses of stroke or cognitive impairment took part. Professionals reported they found the tool easy to use, useful and that its use increased their understanding of communication support methods and the speech and language therapist role in relation to mental capacity assessment. However, not all used it consistently or accurately. Professionals reported they chose not to use the tool when they perceived patients' communication to be intact. Four of eight patients with a diagnosis of dementia or memory impairment, who professionals elected not to screen, were found to have significant communication needs. Screening outcome data for nine patients suggest the tool's interrater reliability is currently moderate, whilst its criterion validity is poor. This study highlights that non-speech and language therapist health professionals have difficulty identifying and screening for communication difficulties. This confirms existing evidence that people with communication disabilities may not receive the decision-making support they require during mental capacity assessments when speech and language therapists are not involved. Greater understanding of health professionals' thought processes regarding communication is required to further develop this unique communication screening tool so that it can effectively enable healthcare professionals to identify and use communicative adaptations to support decision-making. What this paper adds What is already known on this subject Limited previous research suggests that assessing the mental capacity of people with communication disabilities is complex. Practice needs to be improved to ensure this group is adequately supported to make decisions, in line with legal requirements. What this paper adds to existing knowledge This paper describes the development and testing of a novel communication screening tool for use by healthcare professionals preparing to undertake mental capacity assessments. It increases our understanding of how healthcare professionals without specialist training understand communication disability and the role of the speech and language therapist in relation to mental capacity assessment. What are the potential or actual clinical implications of this work? Healthcare professionals without specialist training require support to understand and respond to the needs of people with communication disabilities during mental capacity assessments. With further development and testing, in response to initial evaluation, this novel communication screening tool may be able to provide this support.

PCV62 A Cost-Effectiveness Model about Atrial Fibrillation Screening from the Perspective of the German Statutory Health Insurance

Atrial fibrillation (AF) increases the risk of stroke by 4.2-fold to a comparable population without AF. This risk can decrease by up to 70% if AF is detected early enough and effective stroke preventive measures are taken as recommended by international guidelines. Long-term studies found large share of population with undiagnosed AF. “Preventicus Heartbeats" is a hands-on screening tool for use on smartphone to diagnose AF with high sensitivity and specificity. The aim of this study is to research the cost-effectiveness of systematic screening for AF with this smartphone application, given the cost-structure of German statutory health insurance. Employing a Markov model we analysed the cost-effectiveness of the screening-tool from the perspective of German statutory sick funds versus a scenario without screening. The course of the health state of both cohorts was modelled based on parameters from official statistics and publications about topics “stroke”, “atrial fibrillation and stroke” and “share of undetected atrial fibrillation”. Software: TreeAge Pro®, v2019.2.1 For a cohort of 10,000 insured 75-year-old the use of the diagnostic app could avoid 60 strokes in the remaining lifetime thereof 32 strokes in the next four years. Former models have applied similar cohorts. The same cohort showed an increase in quality-adjusted life years (QALY) in the remaining lifetime of 165 QALYs in the scenario with screening versus without screening and a decrease in discounted lifetime costs (including risk compensation effects) of €129 per participant (€148 for male, €114 for female participants). Sensitivity analyses showed that the model result is particularly dependent on the population-rate of undetected AF and the assumptions about costs of stroke. The modelling demonstrates the health benefits and economic effects of an implementation of a systematic screening on AF with atrial fibrillation screening, given the perspective of the German payer, the statutory health care system.

Validation of the Neuropsychological Assessment Battery Screening Module (NAB-SM) in patients with traumatic brain injury

This study cross-validates the screening module of the Neuropsychological Assessment Battery (NAB-SM) with a battery of well validated neuropsychological tests (Convergent Validity Test Battery: CVTB) in a Traumatic Brain Injury (TBI) population. Forty-four participants with “mild-complicated” to “severe” TBI were recruited from a cohort of patients attending an outpatient clinic at a UK major trauma center. The NAB-SM Total Index score and an abbreviated short-form, from which a TBI Index was derived, both showed good classification accuracy in predicting impairment as measured by the CVTB mean score. These indices also accurately identified impairment as defined by the base rate of low scores across individual CVTB indices measuring mental processing speed, working memory, memory and executive functioning. The NAB-SM and its derived TBI index therefore have significant utility as a cognitive screening tool for use in either inpatient (acute) or outpatient TBI populations.

Validation of the Toronto Psoriatic Arthritis Screen II (ToPAS II) questionnaire in a Brazilian population.

The Toronto Psoriatic Arthritis Screen II (ToPAS II) was developed as a tool to screen patients with probable psoriatic arthritis. We aimed to evaluate the validation of the ToPAS II questionnaire in a Brazilian population. The Portuguese translation of the ToPAS II was sent to us by the developer authors of the original index, and adapted to Brazilian Portuguese. Subjects were recruited from dermatology, general, and rheumatology outpatient clinics. After patients completed the questionnaire, they were assessed by a rheumatologist, according to standard protocol. Receiver operating characteristics (ROC) was used to obtain the sensitivity and specificity of the Brazilian Portuguese version of the ToPAS II questionnaire. One hundred and eighty-four subjects were recruited in the study. There were 70 subjects from the psoriasis group, 44 subjects from the psoriatic arthritis (PsA) group, 40 subjects from the rheumatology (non-PsA) group, and 45 healthy controls. Twenty-four patients (34.3%) in the psoriasis group had inflammatory pain and met the CASPAR classification criteria. The area under the ROC curve was 0.96, which indicates that an excellent predictor and optimum cutoff threshold to discriminate patients diagnosed with PsA used was eight as originally chosen. The overall sensitivity and specificity based on the cutoff threshold of eight were 91.3 and 90.9%, respectively. The Portuguese Brazilian version of the ToPAS II has good sensitivity and specificity and is a useful tool to screen for PsA. Key Points • Among these psoriasis patients, almost 35% in fact had psoriatic arthritis without correct diagnosis. Keeping alert of the need to disclose screening tool's use. • The TOPAS II can facilitate the screening of patients suggestive of inflammatory joint disease (with high probability of rheumatologic diagnosis) decreasing morbidity of these patients.

Prediction of Alzheimer's disease using multi-variants from a Chinese genome-wide association study

Previous genome-wide association studies have identified dozens of susceptibility loci for sporadic Alzheimer’s disease, but few of these loci have been validated in longitudinal cohorts. Establishing predictive models of Alzheimer’s disease based on these novel variants is clinically important for verifying whether they have pathological functions and provide a useful tool for screening of disease risk. In the current study, we performed a two-stage genome-wide association study of 3913 patients with Alzheimer’s disease and 7593 controls and identified four novel variants (rs3777215, rs6859823, rs234434, and rs2255835; Pcombined = 3.07 × 10−19, 2.49 × 10−23, 1.35 × 10−67, and 4.81 × 10−9, respectively) as well as nine variants in the apolipoprotein E region with genome-wide significance (P < 5.0 × 10−8). Literature mining suggested that these novel single nucleotide polymorphisms are related to amyloid precursor protein transport and metabolism, antioxidation, and neurogenesis. Based on their possible roles in the development of Alzheimer’s disease, we used different combinations of these variants and the apolipoprotein E status and successively built 11 predictive models. The predictive models include relatively few single nucleotide polymorphisms useful for clinical practice, in which the maximum number was 13 and the minimum was only four. These predictive models were all significant and their peak of area under the curve reached 0.73 both in the first and second stages. Finally, these models were validated using a separate longitudinal cohort of 5474 individuals. The results showed that individuals carrying risk variants included in the models had a shorter latency and higher incidence of Alzheimer’s disease, suggesting that our models can predict Alzheimer’s disease onset in a population with genetic susceptibility. The effectiveness of the models for predicting Alzheimer’s disease onset confirmed the contributions of these identified variants to disease pathogenesis. In conclusion, this is the first study to validate genome-wide association study-based predictive models for evaluating the risk of Alzheimer’s disease onset in a large Chinese population. The clinical application of these models will be beneficial for individuals harbouring these risk variants, and particularly for young individuals seeking genetic consultation.

Transitioning to digital first line intervention \u2013 validation of a brief online screener for early identification of a suspected eating disorder: study protocol

BackgroundOnly one in four people with eating disorders seeks treatment, and of those who do seek treatment, 20% go on to experience a chronic course. Early intervention has been associated with better prognosis, with those seeking specialised intervention in the early stages of their illness more than twice as likely to achieve remission. Current screening measures typically require expert administration and are rarely validated across a spectrum of DSM-5 eating disorder presentations or for online use. In light of COVID-19 and increasing reliance on telehealth technologies in the intervention and delivery of mental health services, online assessments suitable for self-referral are likely to be the first step to seeking care. InsideOut Institute has developed a 6-item online screening tool for the purposes of identifying eating disorder risk and symptomatology, aimed specifically at increasing help-seeking behaviour in subsyndromal and early presentations.MethodsThis study investigates the reliability and validity of the InsideOut Institute Screener (IOI-S), using a cross-sectional survey research design. Participants aged 14 and over will complete an extensive baseline survey battery for evaluation. 50% of participants will be randomly selected for one follow-up re-test of the IOI-S only, 2 weeks post initial testing. The IOI-S will be analysed for statistical reliability on two parameters: internal consistency and test re-test reliability, and for statistical validity on four parameters: concurrent validity, sensitivity and specificity, convergent and discriminant validity.DiscussionThe rapid and ongoing shift to digital intervention has highlighted gaps and opportunities in our pathways to care. Adequate screening for eating disorders is a major gap. This study aims to validate an online screening tool for use in telehealth early intervention, designed for users seeking information for a suspected eating disorder. The screener meets those at risk ‘where they are’ (i.e. online) and may improve timely referrals to relevant services. This is of particular salience as face-to-face healthcare and traditional frontline interventions are disrupted, and we are challenged to re-design our practices to deliver diagnostic and treatment services in highly adaptive digital contexts.

Prospective intimate partner violence screening tool for use in primary healthcare facilities

The study piloted an intimate partner violence (IPV) screening tool for use with female patients by professional nurses in primary health facilities. Utilising a one group, pre-test post-test design, one hundred and twenty-eight participants completed the pre-test measure (all females; age range = 40 to 50 years; with 15< years of work experience). As part of the study, they completed a brief 20-minute training session in IPV screening. Following the 20-minute training, the participants were provided with the IPV screening tool to use for a period of three-months. Sixty-three participants completed the post-test (all females; age range = 40 to 50 years; 11 to 15 years of work experience). At post-test, the nurses scored marginally higher on knowledge about IPV (n1 = 128, 8,17±8,83) as well as on practices (such as screening for IPV: n2 =63, 2,44±2,68). Although the training effect was indiscernible, nurses trained in IPV screening would provide better quality care to female patients at risk for IPV compared to those without training.

Diagnostic Value of Lung Ultrasound Versus Chest X-Ray in Surgical ICU Patients Alrefaey K Alrefaey, Ahmed S Marwa, Yassen M Amr, Zaghloul A Amgad

Introduction: Facing the recognized obstacles of chest computerized tomography (CT) and chest x-ray (CXR), lung ultrasound (LUS) is a promising alternative imaging tool gathering the benefits of real-time diagnosis with lower difficulties. This study aims to evaluate the effectiveness of LUS as a diagnostic modality in surgical critical care in contrast to chest x-ray. Patients and Methods: In this study, for each of the 92 included patients, when chest CT is indicated, CXR was requested and the BLUE protocol for LUS examination was initiated simultaneously. LUS data were recorded while analysis of CXR finding was performed by independent radiologist who was unaware of CT or LUS findings. Results: For each patient, 4 lung areas were examined with LUS and compared to CXR. LUS showed higher specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) of LUS in contrast to chest x-ray. A significantly lower time was required for LUS to reach the diagnosis compared to CXR (10.2± 4 minutes vs. 33±17 minutes respectively, p less than 0.01). Conclusion: LUS is a useful tool in screening and diagnosis detection of various pulmonary problems in surgical ICU; it can be used as daily bedside diagnostic tool for the critically ill patients adding the use of other chest imaging modalities.

Improvement Initiative to Develop and Implement a Tool for Detecting Drug-Drug Interactions During Oncology Clinical Trial Enrollment Eligibility Screening.

Screening subjects for drug-drug interactions (DDIs) before enrollment in oncology clinical trials is integral to ensuring safety, but standard procedures or tools are not readily available to screen DDI in this setting. Our objectives were to develop a DDI screening tool for use during oncology clinical trial enrollment and to test usability in single-center and multicenter pilot studies. A multistage approach was used for this quality improvement intervention. Semistructured interviews with individuals responsible for DDI screening were conducted to develop a prototype tool. The tool was used for screening DDI in subjects enrolling in National Clinical Trials Network trials of commercially available agents during a single-center 3-month pilot. Improvements were made, and a 3-month multicenter pilot was conducted at volunteer SWOG Cancer Research Network sites. Participants were surveyed to determine tool usability and efficiency. A tool was developed from semistructured interviews. A critical feature was reporting which medications had specific pharmacokinetic and pharmacodynamic characteristics including transporter and cytochrome P450 substrates, inhibitors, or inducers and QT prolongation. In the 12-site study, average (SD) DDI screening time for each patient decreased by 15.7 (10.2) minutes (range, 3-35 minutes; P < 0.001). Users reported the tool highly usable, with >90% agreeing with all positive usability characterizations and disagreeing with all negative complexity characterizations. A DDI screening tool for oncology clinical trial enrollment was created and its usability confirmed. Further testing with more diverse investigator sites and study drugs during eligibility screening is warranted to improve safety and data accuracy within clinical trials.

N-terminal pro-brain natriuretic peptide used for screening hemodynamically significant patent ductus arteriosus in very low birth weight infants: How and when?

N-terminal pro-B-type natriuretic peptide (NTproBNP) appears to be a useful tool for diagnosing hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. However, a consensus for its application has not been reached. The present study aims to evaluate the role of NTproBNP in predicting hsPDA in preterm infants, and explore the optimal cutoff value and testing-time. A prospective blind study of 120 preterm infants with birth weights of < 1,500 g was conducted at the NICU of Peking University Shenzhen Hospital. Blood samples were successively collected on the first three days after birth for NTproBNP analysis. Echocardiographies were performed on day three of life to confirm the status of the ductus arteriosus. A receiver operating characteristic curve (ROC) analysis was performed to determine the ability of NTproBNP to recognize hsPDA. NTproBNP was significantly higher in infants with hsPDA, than in infants in the control group, on both day two (P < 0.001) and day three (P < 0.001). On day two, a NTproBNP cutoff value of 3,689.0 pmol/L offered an optimal predictive value for hsPDA, while on day three, the optimal cut-off value for hsPDA was 2,331.5 pmol/L. The investigators proposes day three of life (48-72 hours) as the optimal testing time. The NTproBNP biomarker during the early neonatal period can be a useful tool for screening and assessing hsPDA in premature infants, especially on day three of life.

Clinical Validation and Performance Evaluation of the Automated Vitros Total Anti-SARS-CoV-2 Antibodies Assay for Screening of Serostatus in COVID-19.

ObjectivesEvaluation of serostatus against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as an important tool in identification of exposure to coronavirus disease 2019 (COVID-19). We report on the validation of the Vitros Anti–SARS-CoV-2 Total (CoV2T) assay for qualitative serologic testing of SARS-CoV-2 antibodies.MethodsWe performed validation studies according to Commission of Office Laboratories Accreditation guidelines, using samples previously tested for SARS-CoV-2 by reverse transcription–polymerase chain reaction (RT-PCR). We evaluated precision, analytical interferences, and cross-reactivity with other viral infections; evaluated concordance with molecular and other serologic testing; and evaluated seroconversion.ResultsThe Vitros CoV2T assay exhibited acceptable precision and did not exhibit cross-reactivity with other acute respiratory virus infections. The CoV2T assay exhibited 100% negative predictive agreement (56/56) and 71% positive predictive agreement (56/79) with RT-PCR across all patient samples and was concordant with other serologic assays. Concordance with RT-PCR was 97% more than 7 days after symptom onset. The CoV2T assay was robust to icterus and lipemia but had interference from significant hemolysis.ConclusionsThe Vitros CoV2T assay was successfully validated in our laboratory. We anticipate it will be a useful tool in screening for exposure to SARS-CoV-2; however, the use of the CoV2T and other serologic assays in the clinical management of patients with COVID-19 is unknown and must be evaluated in future studies.