Diagnostic performance evaluation of urine HIV-1 antibody rapid test kits in a real-life routine care setting in China

Objectives
To evaluate the diagnostic performance of urine HIV antibody rapid test kits in screening diverse populations and to analyse subjects’ willingness regarding reagent types, purchase channels, acceptable prices, and self-testing.

Designs
Diagnostic accuracy studies

Participants
A total of 2606 valid and eligible samples were collected in the study, including 202 samples from female sex workers (FSWs), 304 persons with injection drug use (IDU), 1000 pregnant women (PW), 100 subjects undergoing voluntary HIV counselling and testing (VCT) and 1000 students in higher education schools or colleges (STUs). Subjects should simultaneously meet the following inclusion criteria: (1) being at least 18 years old and in full civil capacity, (2) signing an informed consent form and (3) providing truthful identifying information to ensure that the subjects and their samples are unique.

Results
The sensitivity, specificity and area under the curve (AUC) of the urine HIV-1 antibody rapid test kits were 92.16%, 99.92% and 0.960 (95% CI: 0.952 to 0.968, p

Leggi
Febbraio 2024

Colonoscopy vs. the Fecal Immunochemical Test: Which is Best?

While there is no debate around the effectiveness of colorectal cancer (CRC) screening in reducing disease burden, there remains a question regarding the most effective and cost-effective screening modality. Current United States guidelines present a panel of options that include the two most commonly used modalities, colonoscopy and stool testing with the fecal immunochemical test (FIT). Large-scale comparative effectiveness trials comparing colonoscopy and FIT for CRC outcomes are underway, but results not yet available.

Leggi
Febbraio 2024

Measurement properties of the incremental step test for people with chronic obstructive pulmonary disease: a cross-sectional study

Objectives
The new incremental step test (IST) is a field test that was developed for people with chronic obstructive pulmonary disease (COPD), based on the characteristics of the incremental shuttle walk test (ISWT); however, its measurement properties still need to be determined. We aimed, first, to assess the construct validity (through the comparison with the ISWT), within-day reliability and measurement error of the IST in people with COPD; and, second, to identify whether the participants have a learning effect in the IST.

Design
Cross-sectional study, conducted according to COnsensus-based Standards for the selection of health status Measurement INstruments guidelines.

Setting
A family health unit in Portugal, April 2022 to June 2023.

Participants and analysis
63 participants (67.5±10.5 years) attended two sessions to perform two IST and two ISWT, separately. Spearman’s correlations were used to compare the best performances between the IST and the ISWT. Intraclass correlation coefficient (ICC2,1) was used for reliability, and the SE of measurement (SEM), minimal detectable change at 95% CI (MDC95) and Bland and Altman 95% limits of agreement (LoA) were used for measurement error. The learning effect was explored with the Wilcoxon signed-rank test.

Results
The IST was significant and strongly correlated with the ISWT (0.72

Leggi
Febbraio 2024

Abstract TP25: Model-Free Dynamic Contrast-Enhanced MRI in Cerebral Small Vessel Disease: Test-Retest Reliability and Association With WMH Lesion Burden

Stroke, Volume 55, Issue Suppl_1, Page ATP25-ATP25, February 1, 2024. Introduction:Dynamic contrast enhanced (DCE)-MRI has been used to study blood-brain barrier (BBB) disruption in cerebral small vessel disease (CSVD), but complex kinetic modeling of DCE MRI is sensitive to noise and is not robust in detecting subtle BBB impairments. In contrast, model-free DCE is simple and does not require arterial input function and complex computation. In this study, we aimed to evaluate the test-retest repeatability of model-free DCE and its association with white matter hyperintensity (WMH) burden.Methods:Patients with CSVD were recruited. DCE-MRI, FLAIR, and T1 MPRage scans were acquired. A subgroup of patients had two repeated DCE MRI scans with an average interval of 41 days. WMH segmentation was performed to obtain the relative volume of WMH (rVwmh). Ten subjects had DCE-MRI data in two sessions for test-retest repeatability analysis. DCE-MRI were acquired using a Siemens volumetric interpolated breath-hold examination (VIBE) gradient echo sequence with a temporal resolution of 49 seconds and an acquisition time of ~20 minutes. The wash-out slope (WOS), which indicates the rate of contrast agent leaving the tissue, was computed.Results:64 patients (mean (SD) age = 68.6 (8.51), 37 females) with CSVD were studied. WOS demonstrated good test-retest repeatability for WM and GM with an intra-class correlation coefficient (ICC) of 0.626 and 0.671 in cerebrum WM and GM, respectively. WMH WOS has a significant negative correlation with rVwmh (r=-0.31; p

Leggi
Febbraio 2024

Effect of an algorithm for automatic placing of standardised test order sets on low-value appointments and attendance rates at four Spanish teaching hospitals: an interrupted time series analysis

Objective
Reducing backlogs for elective care is a priority for healthcare systems. We conducted an interrupted time series analysis demonstrating the effect of an algorithm for placing automatic test order sets prior to first specialist appointment on avoidable follow-up appointments and attendance rates.

Design
Interrupted time series analysis.

Setting
4 academic hospitals from Madrid, Spain.

Participants
Patients referred from primary care attending 10 033 470 outpatient appointments from 16 clinical specialties during a 6-year period (1 January 2018 to 30 June 2023).

Intervention
An algorithm using natural language processing was launched in May 2021. Test order sets developed for 257 presenting complaints from 16 clinical specialties were placed automatically before first specialist appointments to increase rates of diagnosis and initiation of treatment with discharge back to primary care.

Primary and secondary outcome measures
Primary outcomes included rate of diagnosis and discharge to primary care and follow-up to first appointment index. The secondary outcome was trend in ‘did not attend’ rates.

Results
Since May 2021, a total of 1 175 814 automatic test orders have been placed. Significant changes in trend of diagnosis and discharge to primary care at first appointment (p=0.005, 95% CI 0.5 to 2.9) and ‘did not attend’ rates (p=0.006, 95% CI –0.1 to –0.8) and an estimated attributable reduction of 11 306 avoidable follow-up appointments per month were observed.

Conclusion
An algorithm for placing automatic standardised test order sets can reduce low-value follow-up appointments by allowing specialists to confirm diagnoses and initiate treatment at first appointment, also leading to early discharge to primary care and a reduction in ‘did not attend’ rates. This initiative points to an improved process for outpatient diagnosis and treatment, delivering healthcare more effectively and efficiently.

Leggi
Gennaio 2024