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Journal of Hospital Medicine May 2016National guidelines for the management of community-acquired pneumonia (CAP) in children were published in 2011. These guidelines discourage most diagnostic testing for... (Review)
Review
BACKGROUND
National guidelines for the management of community-acquired pneumonia (CAP) in children were published in 2011. These guidelines discourage most diagnostic testing for outpatients, as well as repeat testing for hospitalized patients who are improving. We sought to evaluate the temporal trends in diagnostic testing associated with guideline implementation among children with CAP.
METHODS
Children 1 to 18 years old who were discharged with pneumonia after emergency department (ED) evaluation or hospitalization from January 1, 2008 to June 30, 2014 at any of 32 children's hospitals participating in the Pediatric Health Information System were included. We excluded children with complex chronic conditions and those requiring intensive care or who underwent early pleural drainage. We compared use of diagnostic testing (blood culture, complete blood count [CBC], C-reactive protein [CRP], and chest radiography [CXR]) before and after release of the guidelines, and assessed for temporal trends using interrupted time series analysis. We also calculated the cost impact of these changes on diagnostic utilization and evaluated the variability of the guideline's impact across hospitals.
RESULTS
Overall, 220,539 patients were included; 53% were male and the median age was 4 years (interquartile range, 2-7). For patients discharged from the ED with CAP, diagnostic utilization rates for blood culture, CBC, CRP, and CXR were higher after guideline publication compared with expected utilization rates without guidelines. In contrast, initial testing and repeat testing among patients hospitalized with CAP was lower after guideline publication. There were modest reductions in estimated costs associated with these changes. However, wide variability was observed in the impact of the guidelines across hospitals.
CONCLUSIONS
Publication of national pneumonia guidelines in 2011 was associated with modest changes in diagnostic testing for children with CAP. However, the changes varied across hospitals, and the financial impact was modest. Local implementation efforts are warranted to ensure widespread guideline adherence. Journal of Hospital Medicine 2016;11:317-323. © 2016 Society of Hospital Medicine.
Topics: Adolescent; Child; Child, Preschool; Community-Acquired Infections; Diagnostic Tests, Routine; Female; Guideline Adherence; Hospitals, Pediatric; Humans; Infant; Male; Pneumonia; Retrospective Studies
PubMed: 26762571
DOI: 10.1002/jhm.2534 -
Bulletin of the World Health... Dec 2015Maintaining quality, competitiveness and innovation in global health technology is a constant challenge for manufacturers, while affordability, access and equity are...
Maintaining quality, competitiveness and innovation in global health technology is a constant challenge for manufacturers, while affordability, access and equity are challenges for governments and international agencies. In this paper we discuss these issues with reference to rapid diagnostic tests for malaria. Strategies to control and eliminate malaria depend on early and accurate diagnosis. Rapid diagnostic tests for malaria require little training and equipment and can be performed by non-specialists in remote settings. Use of these tests has expanded significantly over the last few years, following recommendations to test all suspected malaria cases before treatment and the implementation of an evaluation programme to assess the performance of the malaria rapid diagnostic tests. Despite these gains, challenges exist that, if not addressed, could jeopardize the progress made to date. We discuss recent developments in rapid diagnostic tests for malaria, highlight some of the challenges and provide suggestions to address them.
Topics: Diagnostic Tests, Routine; Humans; Malaria; Plasmodium falciparum; Plasmodium vivax; Quality of Health Care; Sensitivity and Specificity; World Health Organization
PubMed: 26668438
DOI: 10.2471/BLT.14.151167 -
BMC Medical Research Methodology Jan 2016To describe approaches used in systematic reviews of diagnostic test accuracy studies for assessing variability in estimates of accuracy between studies and to provide... (Review)
Review
BACKGROUND
To describe approaches used in systematic reviews of diagnostic test accuracy studies for assessing variability in estimates of accuracy between studies and to provide guidance in this area.
METHODS
Meta-analyses of diagnostic test accuracy studies published between May and September 2012 were systematically identified. Information on how the variability in results was investigated was extracted.
RESULTS
Of the 53 meta-analyses included in the review, most (n=48; 91%) presented variability in diagnostic accuracy estimates visually either through forest plots or ROC plots and the majority (n=40; 75%) presented a test or statistical measure for the variability. Twenty-eight reviews (53%) tested for variability beyond chance using Cochran's Q test and 31 (58%) reviews quantified it with I(2). 7 reviews (13%) presented between-study variance estimates (τ(2)) from random effects models and 3 of these presented a prediction interval or ellipse to facilitate interpretation. Half of all the meta-analyses specified what was considered a significant amount of variability (n=24; 49%).
CONCLUSIONS
Approaches to assessing variability in estimates of accuracy varied widely between diagnostic test accuracy reviews and there is room for improvement. We provide initial guidance, complemented by an overview of the currently available approaches.
Topics: Analysis of Variance; Diagnostic Tests, Routine; Humans; Meta-Analysis as Topic; Publications; ROC Curve; Reproducibility of Results; Review Literature as Topic
PubMed: 26772804
DOI: 10.1186/s12874-016-0108-4 -
Journal of Biomedical Science Jan 2020Imaging live cells in a three-dimensional (3D) culture system yields more accurate information and spatial visualization of the interplay of cells and the surrounding... (Review)
Review
Imaging live cells in a three-dimensional (3D) culture system yields more accurate information and spatial visualization of the interplay of cells and the surrounding matrix components compared to using a two-dimensional (2D) cell culture system. However, the thickness of 3D cultures results in a high degree of scattering that makes it difficult for the light to penetrate deeply to allow clear optical imaging. Photoacoustic (PA) imaging is a powerful imaging modality that relies on a PA effect generated when light is absorbed by exogenous contrast agents or endogenous molecules in a medium. It combines a high optical contrast with a high acoustic spatiotemporal resolution, allowing the noninvasive visualization of 3D cellular scaffolds at considerable depths with a high resolution and no image distortion. Moreover, advances in targeted contrast agents have also made PA imaging capable of molecular and cellular characterization for use in preclinical personalized diagnostics or PA imaging-guided therapeutics. Here we review the applications and challenges of PA imaging in a 3D cellular microenvironment. Potential future developments of PA imaging in preclinical applications are also discussed.
Topics: Contrast Media; Diagnostic Tests, Routine; Optical Imaging; Photoacoustic Techniques; Tumor Cells, Cultured
PubMed: 31948442
DOI: 10.1186/s12929-019-0594-x -
APMIS : Acta Pathologica,... Jul 2018The placenta is a fetal organ, composed of fetal DNA and as such reflects the fetal phenotype. The placenta consists of an umbilical cord, fetal membranes (amnion and... (Review)
Review
The placenta is a fetal organ, composed of fetal DNA and as such reflects the fetal phenotype. The placenta consists of an umbilical cord, fetal membranes (amnion and chorion), and the placental disc which in turn is comprised of villous tissue. Both maternal and fetal disorders have placental sequelae and placental abnormalities can affect both maternal and fetal well-being. As such, placentas are often helpful in future maternal and neonatal healthcare. Thus, examination of the placenta is important for both mother and infant. On this basis, a list of indications for placental examinations has been created by a multidisciplinary group of pathologists, maternal-fetal-medicine specialists, and neonatologists that, if followed, will ensure that the vast majority of placentas that ultimately show any significant pathology will be examined (Arch Pathol Lab Med, 121, 1997, 449-76). This list include fetal, maternal, and placental indications. This chapter will discuss those indications as well as give a brief overview of macroscopic placental examination and procedure.
Topics: Diagnostic Tests, Routine; Female; Humans; Pathology; Placenta Diseases; Pregnancy
PubMed: 30129124
DOI: 10.1111/apm.12830 -
Chest Jul 2020Medical tests are procedures intended to detect, diagnose, characterize, or monitor a specific medical condition. Understanding the accuracy of a medical test is a... (Review)
Review
Medical tests are procedures intended to detect, diagnose, characterize, or monitor a specific medical condition. Understanding the accuracy of a medical test is a critical part of informed decision-making in patient management, as it allows clinicians to appreciate the types of errors a medical test might be prone to making and how often it makes them. Designing a study to assess the performance of a medical test, however, presents unique challenges, from acquiring a reference standard to dealing with the complexities that arise when the test involves an interpretation by a human reader. This article provides an overview of design considerations in this context, including common biases and how to avoid them, statistical considerations, and reporting guidelines. A short list of questions is also provided, which can serve as a quick reference for anyone designing, implementing, or reviewing a study that intends to assess the performance of a medical test.
Topics: Diagnostic Tests, Routine; Guidelines as Topic; Humans; Research Design
PubMed: 32658645
DOI: 10.1016/j.chest.2020.03.006 -
The Veterinary Clinics of North... Aug 2019Despite there being only 2 common endocrine diseases in horses, pituitary pars intermedia dysfunction (PPID) and equine metabolic syndrome (EMS), diagnosis is still... (Review)
Review
Despite there being only 2 common endocrine diseases in horses, pituitary pars intermedia dysfunction (PPID) and equine metabolic syndrome (EMS), diagnosis is still confusing. Failing to consider horse factors and treating based on laboratory results only have caused many animals to receive lifelong drug treatment unnecessarily. Increased plasma ACTH, baseline or TRH stimulated, supports a diagnosis of PPID; however, breed, age, thriftiness, illness, coat color, geography, diet, and season also affect ACTH concentration. Insulin dysregulation, the hallmark of EMS, can result from insulin resistance or excessive postprandial insulin release. Each requires a different diagnostic test to reach a diagnosis.
Topics: Animals; Diagnostic Tests, Routine; Endocrine System Diseases; Horse Diseases; Horses
PubMed: 31076223
DOI: 10.1016/j.cveq.2019.03.005 -
Biochemia Medica 2016Reliable and accurate reference intervals (RIs) for laboratory analyses are an integral part of the process of correct interpretation of clinical laboratory test... (Review)
Review
Reliable and accurate reference intervals (RIs) for laboratory analyses are an integral part of the process of correct interpretation of clinical laboratory test results. RIs given in laboratory reports have an important role in aiding the clinician in interpreting test results in reference to values for healthy populations. Since the 1980s, the International Federation of Clinical Chemistry (IFCC) has been proactive in establishing recommendations to clarify the true significance of the term 'RIs, to select the appropriate reference population and statistically analyse the data. The C28-A3 guideline published by the Clinical and Laboratory Standards Institute (CLSI) and IFCC is still the most widely-used source of reference in this area. In recent years, protocols additional to the Guideline have been published by the IFCC, Committee on Reference Intervals and Decision Limits (C-RIDL), including all details of multicenter studies on RIs to meet the requirements in this area. Multicentric RIs studies are the most important development in the area of RIs. Recently, the C-RIDL has performed many multicentric studies to obtain common RIs. Confusion of RIs and clinical decision limits (CDLs) remains an issue and pediatric and geriatric age groups are a significant problem. For future studies of RIs, the genetic effect would seem to be the most challenging area. The aim of the review is to present the current theory and practice of RIs, with special emphasis given to multicenter RIs studies, RIs studies for pediatric and geriatric age groups, clinical decision limits and partitioning by genetic effects on RIs.
Topics: Aged; Chemistry, Clinical; Child; Clinical Laboratory Techniques; Diagnostic Tests, Routine; Geriatrics; Guidelines as Topic; Humans; Pediatrics; Reference Values
PubMed: 26981015
DOI: 10.11613/BM.2016.001 -
BMC Health Services Research Dec 2017Dengue fever is rapidly expanding geographically, with about half of the world's population now at risk. Among the various diagnostic options, rapid diagnostic tests... (Review)
Review
BACKGROUND
Dengue fever is rapidly expanding geographically, with about half of the world's population now at risk. Among the various diagnostic options, rapid diagnostic tests (RDTs) are convenient and prompt, but limited in terms of accuracy and availability.
METHODS
A systematic review was conducted of published data on the use of RDTs for dengue with respect to their economic impact. The search was conducted with combinations of key search terms, including "((Dengue[Title]) AND cost/economic)" and "rapid diagnostic test/assay (or point-of-care)". Articles with insufficient report on cost/economic aspect of dengue RDTs, usually on comparison of different RDTs or assessment of novel rapid diagnostic tools, were excluded. This review has been registered in the PROSPERO International prospective register of systematic reviews (registry #: CRD42015017775).
RESULTS
Eleven articles were found through advanced search on Pubmed. From Embase and Web of Science, two and 14 articles were obtained, respectively. After removal of duplicate items, title screening was done on 21 published works and 12 titles, including 2 meeting abstracts, were selected for abstract review. For full-text review, by two independent reviewers, 5 articles and 1 meeting abstract were selected. Among these, the abstract was referring to the same study results as one of the articles. After full text review, two studies (two articles and one abstract) were found to report on cost-wise or economic benefits of dengue RDTs and were selected for data extraction. One study found satisfactory performance of IgM-based Panbio RDT, concluding that it would be cost-effective in endemic settings. The second study was a modeling analysis and showed that a dengue RDT would not be advantageous in terms of cost and effectiveness compared to current practice of antibiotics prescription for acute febrile illness.
CONCLUSIONS
Despite growing use of RDTs in research and clinical settings, there were limited data to demonstrate an economic impact. The available two studies reached different conclusions on the cost-effectiveness of dengue RDTs, although only one of the two studies reported outcomes from cost-effectiveness analysis of dengue and the other was considering febrile illness more generally. Evidence of such an impact would require further quantitative economic studies.
Topics: Anti-Bacterial Agents; Cost-Benefit Analysis; Dengue; Diagnostic Tests, Routine; Fever; Humans; Point-of-Care Systems; Prospective Studies
PubMed: 29284474
DOI: 10.1186/s12913-017-2789-8 -
Critical Reviews in Clinical Laboratory... Dec 2020The quest to use patient results as quality control for routine clinical chemistry testing has long been driven by issues of the unavailability and cost of suitable...
The quest to use patient results as quality control for routine clinical chemistry testing has long been driven by issues of the unavailability and cost of suitable quality control material and the matrix effects of synthetic material. Hematology laboratories were early adopters of average of normals techniques, primarily because of the difficulty in acquiring appropriate, stable quality control material, while in the chemistry laboratories, the perceived advantages and availability of synthetic material outweighed the disadvantages. However, the increasing volume of testing in clinical chemistry plus the capability of computer systems to deal with large and complex calculations has now made the use of patient-based quality control algorithms feasible. The desire to use patient-based quality control is also driven by increasing awareness that common quality control rules and frequency of analysis may fail to detect clinically significant assay biases. The non-commutability of quality control material has also become a problem as laboratories seek to harmonize results across regions and indeed globally. This review describes the history of patient-based quality control in clinical chemistry, summarizes the various approaches that can be implemented by laboratory professionals, and discusses how patient-based quality control can be integrated with traditional quality control techniques.
Topics: Algorithms; Clinical Chemistry Tests; Diagnostic Tests, Routine; Humans; Laboratories; Patients; Quality Control
PubMed: 32486872
DOI: 10.1080/10408363.2020.1765731