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Clinical pathway diagnostic test

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https://www.readbyqxmd.com/read/28210553/impact-of-value-based-breast-cancer-care-pathway-implementation-on-pre-operative-breast-magnetic-resonance-imaging-utilization
#1
Devina K S McCray, Stephen R Grobmyer, Holly J Pederson
BACKGROUND: Bilateral breast magnetic resonance imaging (MRI) is commonly used in the diagnostic workup of breast cancer (BC) to assess extent of disease and identify occult foci of disease. However, evidence for routine use of pre-operative MRI is lacking. Breast MRI is costly and can lead to unnecessary tests and treatment delays. Clinical care pathways (care paths) are value-based guidelines, which define management recommendations derived by expert consensus and available evidence based data...
February 2017: Gland Surgery
https://www.readbyqxmd.com/read/28194756/chlorhexidine-allergy-in-4-specialist-allergy-centres-in-the-uk-2009-2013-clinical-features-and-diagnostic-tests
#2
William Egner, Matthew Helbert, Ravishankar Sargur, Kirsty Swallow, Nigel Harper, Tomaz Garcez, Sinisa Savic, Louise Savic, Eren Effren
We describe an observational survey of diagnostic pathways in 104 patients attending four specialist allergy clinics in the UK following perioperative hypersensitivity reactions to chlorhexidine reactions. The majority were life threatening. Men undergoing urological or cardiothoracic surgery predominated. Skin prick testing and sIgE testing were the most common tests used for diagnosis. Fifty-three % of diagnoses were made on the basis of a single positive test. Where multiple tests were performed the sensitivity of intradermal, basophil activation and skin prick testing was 68% (50-86%), 50% (10-90%) and 35% (17-55%) respectively...
February 14, 2017: Clinical and Experimental Immunology
https://www.readbyqxmd.com/read/28188237/first-identification-of-kr%C3%A3-ppel-like-factor-2-mutation-in-heritable-pulmonary-arterial-hypertension
#3
Christina A Eichstaedt, Jie Song, Rebecca Rodríguez Viales, Zixuan Pan, Nicola Benjamin, Christine Fischer, Marius Hoeper, Silvia Ulrich, Katrin Hinderhofer, Ekkehard Grünig
Heritable pulmonary arterial hypertension (HPAH) is an autosomal dominantly inherited disease caused by mutations in the bone morphogenic protein receptor 2 gene and/or genes of its signalling pathway in about 85% of patients. We clinically and genetically analysed a HPAH family without mutations in previously described PAH genes. Clinical assessment included electrocardiogram, lung function, blood gas analysis, chest X-ray, laboratory testing, echocardiography and right heart catheterisation in case of suspected disease...
February 10, 2017: Clinical Science (1979-)
https://www.readbyqxmd.com/read/28185757/molecular-biomarkers-for-the-evaluation-of-colorectal-cancer-guideline-from-the-american-society-for-clinical-pathology-college-of-american-pathologists-association-for-molecular-pathology-and-american-society-of-clinical-oncology
#4
REVIEW
Antonia R Sepulveda, Stanley R Hamilton, Carmen J Allegra, Wayne Grody, Allison M Cushman-Vokoun, William K Funkhouser, Scott E Kopetz, Christopher Lieu, Noralane M Lindor, Bruce D Minsky, Federico A Monzon, Daniel J Sargent, Veena M Singh, Joseph Willis, Jennifer Clark, Carol Colasacco, R Bryan Rumble, Robyn Temple-Smolkin, Christina B Ventura, Jan A Nowak
OBJECTIVES: To develop evidence-based guideline recommendations through a systematic review of the literature to establish standard molecular biomarker testing of colorectal cancer (CRC) tissues to guide epidermal growth factor receptor (EGFR) therapies and conventional chemotherapy regimens. METHODS: The American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and American Society of Clinical Oncology convened an expert panel to develop an evidence-based guideline to establish standard molecular biomarker testing and guide therapies for patients with CRC...
February 2, 2017: Journal of Molecular Diagnostics: JMD
https://www.readbyqxmd.com/read/28179200/laparoscopic-management-of-abdomininal-pregnancy
#5
Francesco Cosentino, Cristiano Rossitto, Luigi Carlo Turco, Salvatore Gueli Alletti, Carmine Vascone, Lavinia Di Meglio, Giovanni Scambia, Mario Malzoni
CASE REPORT OBJECTIVE: To show the surgical management in laparoscopy of a particular localization of an extra-uterine pregnancy misunderstood until 12 week of EG complicated by hemoperitoneum and abortion. BACKGROUND: The prevalence of ectopic pregnancy among women who go to an emergency department with first trimester bleeding, pain, or both ranges from 1 to 16 percent [1]. The most common localization of ectopic pregnancy are the Fallopian tubes while abdominal pregnancy represent at least 1 percent of extra-uterine pregnancies...
February 4, 2017: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/28164089/met-hgf-pathway-activation-as-a-paradigm-of-resistance-to-targeted-therapies
#6
REVIEW
Brian Ko, Tianfang He, Shirish Gadgeel, Balazs Halmos
Resistance to targeted therapeutics is a key issue limiting the long-term utility of these medications in the management of molecularly selected subsets of cancer patients, including patients with non-small cell lung cancer harboring oncogenic alterations affecting EGFR, ALK and other genes. Bypass resistance mediated by activation of MET kinase has emerged as a frequent, validated and pivotal resistance mechanism in multiple types of cancers. Biochemical understanding is accumulating to explain the unique role of MET in such bypass pathways, providing alternate downstream activation opportunities and intricate interactions during epithelial-mesenchymal transitions...
January 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28161015/-electrophysiological-testing-in-spinal-cord-tumors
#7
REVIEW
N André-Obadia, F Mauguière
Evoked potentials (EPs) are useful to evaluate the functional impairment of motor and somatosensory pathways in spinal cord tumors. Conduction through pyramidal tracts is evaluated by motor EPs (MEPs) elicited by transcranial stimulation, magnetic for awake patients or electric in the operating room. Somatosensory EPs (SEPs) and laser EPs (LEPs) are complementary procedures to explore conduction in dorsal columns and spinothalamic tracts, respectively. MEPs as well as SEPs show conduction abnormalities in about 60% of cases with a sensitivity that increases up to 70% when both procedures are carried out...
February 1, 2017: Neuro-Chirurgie
https://www.readbyqxmd.com/read/28160214/impairments-in-motor-neurons-interneurons-and-astrocytes-contribute-to-hyperexcitability-in-als-underlying-mechanisms-and-paths-to-therapy
#8
REVIEW
Dzung Do-Ha, Yossi Buskila, Lezanne Ooi
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterised by the loss of motor neurons leading to progressive paralysis and death. Using transcranial magnetic stimulation (TMS) and nerve excitability tests, several clinical studies have identified that cortical and peripheral hyperexcitability are among the earliest pathologies observed in ALS patients. The changes in the electrophysiological properties of motor neurons have been identified in both sporadic and familial ALS patients, despite the diverse etiology of the disease...
February 3, 2017: Molecular Neurobiology
https://www.readbyqxmd.com/read/28159916/impact-of-deploying-multiple-point-of-care-tests-with-a-sample-first-approach-on-a-sexual-health-clinical-care-pathway-a-service-evaluation
#9
Emma M Harding-Esch, Achyuta V Nori, Aseel Hegazi, Marcus J Pond, Olanike Okolo, Anthony Nardone, Catherine M Lowndes, Phillip Hay, S Tariq Sadiq
OBJECTIVES: To assess clinical service value of STI point-of-care test (POCT) use in a 'sample first' clinical pathway (patients providing samples on arrival at clinic, before clinician consultation). Specific outcomes were: patient acceptability; whether a rapid nucleic acid amplification test (NAAT) for Chlamydia trachomatis/Neisseria gonorrhoeae (CT/NG) could be used as a POCT in practice; feasibility of non-NAAT POCT implementation for Trichomonas vaginalis (TV) and bacterial vaginosis (BV); impact on patient diagnosis and treatment...
February 3, 2017: Sexually Transmitted Infections
https://www.readbyqxmd.com/read/28152963/kaiser-permanente-georgia-colon-cancer-care-through-the-science-of-performance-improvement
#10
(no author information available yet)
: 250 Background: While our patients reported high satisfaction with the care they received, Kaiser Permanente Georgia's baseline assessment found variation in the way our colon cancer patients were diagnosed and received care. This variation also effects the cycle time from diagnosis to initiation of treatment (surgery or first infusion). METHODS: Using Kaiser Permanente's Performance Improvement methodology and interdisciplinary cooperation, this project launched in January of 2014...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28144274/noonan-syndrome-a-new-survey
#11
Alireza Tafazoli, Peyman Eshraghi, Zahra Kamel Koleti, Mohammadreza Abbaszadegan
Noonan syndrome (NS) is an autosomal dominant disorder with vast heterogeneity in clinical and genetic features. Various symptoms have been reported for this abnormality such as short stature, unusual facial characteristics, congenital heart abnormalities, developmental complications, and an elevated tumor incidence rate. Noonan syndrome shares clinical features with other rare conditions, including LEOPARD syndrome, cardio-facio-cutaneous syndrome, Noonan-like syndrome with loose anagen hair, and Costello syndrome...
February 1, 2017: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/28125364/improving-oncology-quality-measurement-in-accountable-care-filling-gaps-with-cross-cutting-measures
#12
Tom Valuck, David Blaisdell, Donna P Dugan, Kimberly Westrich, Robert W Dubois, Robert S Miller, Mark McClellan
: Payment for health care services, including oncology services, is shifting from volume-based fee-for-service to value-based accountable care. The objective of accountable care is to support providers with flexibility and resources to reform care delivery, accompanied by accountability for maintaining or improving outcomes while lowering costs. These changes depend on health care payers, systems, physicians, and patients having meaningful measures to assess care delivery and outcomes and to balance financial incentives for lowering costs while providing greater value...
February 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28125081/prospective-comparison-of-the-cost-effectiveness-of-clinical-whole-exome-sequencing-with-that-of-usual-care-overwhelmingly-supports-early-use-and-reimbursement
#13
Zornitza Stark, Deborah Schofield, Khurshid Alam, William Wilson, Nessie Mupfeki, Ivan Macciocca, Rupendra Shrestha, Susan M White, Clara Gaff
PURPOSE: To undertake the first prospective cost-effectiveness study of whole-exome sequencing (WES) as an early, routine clinical test for infants with suspected monogenic disorders. METHODS: Cost data for diagnosis-related investigations and assessments were collected for a prospective, sequential clinical cohort of infants (N = 40) who underwent singleton WES in parallel to usual diagnostic care. We determined costs per patient, costs per diagnosis, and incremental costs per additional diagnosis for three alternative strategies for integrating WES into the diagnostic trajectory...
January 26, 2017: Genetics in Medicine: Official Journal of the American College of Medical Genetics
https://www.readbyqxmd.com/read/28124548/european-rules-to-bring-novel-radiopharmaceuticals-to-the-clinic
#14
Clemens Decristoforo, Ivan Penuelas, Marianne Patt, Sergio Todde
The development of novel radiopharmaceutical is very rapid and highly innovative both for diagnostic and therapeutic applications. The translation into the clinic, however, is hampered by the high regulatory demands in Europe. This article describes the main rules, guidelines and guidance documents in the European Union in relation to the pharmaceutical regulatory framework. Until today a great number of radiopharmaceuticals are introduced clinically using specific national pathways outside the clinical trial regulation and examples are provided...
January 26, 2017: Quarterly Journal of Nuclear Medicine and Molecular Imaging
https://www.readbyqxmd.com/read/28110982/diagnostic-accuracy-of-multi-parametric-mri-and-trus-biopsy-in-prostate-cancer-promis-a-paired-validating-confirmatory-study
#15
Hashim U Ahmed, Ahmed El-Shater Bosaily, Louise C Brown, Rhian Gabe, Richard Kaplan, Mahesh K Parmar, Yolanda Collaco-Moraes, Katie Ward, Richard G Hindley, Alex Freeman, Alex P Kirkham, Robert Oldroyd, Chris Parker, Mark Emberton
BACKGROUND: Men with high serum prostate specific antigen usually undergo transrectal ultrasound-guided prostate biopsy (TRUS-biopsy). TRUS-biopsy can cause side-effects including bleeding, pain, and infection. Multi-parametric magnetic resonance imaging (MP-MRI) used as a triage test might allow men to avoid unnecessary TRUS-biopsy and improve diagnostic accuracy. METHODS: We did this multicentre, paired-cohort, confirmatory study to test diagnostic accuracy of MP-MRI and TRUS-biopsy against a reference test (template prostate mapping biopsy [TPM-biopsy])...
January 19, 2017: Lancet
https://www.readbyqxmd.com/read/28108699/an-evaluation-study-of-the-becton-dickinson-probetec-qx-bdqx-trichomonas-vaginalis-trichomoniasis-molecular-diagnostic-test-in-two-large-urban-std-services
#16
Craig Tipple, Michael Rayment, Sundhiya Mandalia, Lisa Walton, Sinead O'Neill, John Murray, Alan O'Riordan, Monica Rebec, Laura Harrington, Rachael Jones, Dawn Wilkinson
OBJECTIVES: The BASHH guidelines recommend molecular tests to aid diagnosis of Trichomonas vaginalis (TV) infection; however many clinics continue to use relatively insensitive techniques (pH, wet-prep microscopy (WPM) and culture). Our objectives were to establish a laboratory pathway for TV testing with the Becton-Dickinson Qx (BDQx) molecular assay, to determine TV prevalence and to identify variables associated with TV detection. METHODS: A prospective study of 901 women attending two urban sexual health services for STI testing was conducted...
January 20, 2017: Sexually Transmitted Infections
https://www.readbyqxmd.com/read/28104680/evaluation-of-thyroseq-v2-performance-in-thyroid-nodules-with-indeterminate-cytology
#17
Pablo Valderrabano, Laila Khazai, Marino E Leon, Zachary J Thompson, Zhenjun Ma, Christine H Chung, Julie E Hallanger-Johnson, Kristen J Otto, Kara D Rogers, Barbara Centeno, Bryan McIver
ThyroSeq v2 claims high positive (PPV) and negative (NPV) predictive values in a wide range of pre-test risks of malignancy in indeterminate thyroid nodules (ITNs) (categories B-III and B-IV of the Bethesda system). We evaluated ThyroSeq v2 performance in a cohort of patients with ITNs seen at our Academic Cancer Center from September 2014 to April 2016, in light of the new diagnostic criteria for non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Our study included 182 patients (76% female) with 190 ITNs consecutively tested with ThyroSeq v2...
January 19, 2017: Endocrine-related Cancer
https://www.readbyqxmd.com/read/28101347/clinical-presentation-and-management-of-uveal-melanoma
#18
Abelardo Rodríguez, Alfonso Dueñas-Gonzalez, Sarai Delgado-Pelayo
Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. The majority of the patients are Caucasian (97.8%) and aged 50-80 years. Choroidal melanoma is the predominant type (86.3%). The clinical presentation may range from no symptoms over various types of visual disturbances to visual loss. Examination includes slit-lamp biomicroscopy, indirect ophthalmoscopy and diagnostic testing, such as B-scan ultrasonography. A number of patients with posterior UM are treated with plaque radiation therapy or enucleation...
December 2016: Molecular and Clinical Oncology
https://www.readbyqxmd.com/read/28096695/hysterosalpingo-foam-sonography-patient-selection-and-perspectives
#19
REVIEW
Hemashree Rajesh, Serene Liqing Lim, Su Ling Yu
We present an overview of the common types of tubal patency tests, with a focus on hysterosalpingo-foam sonography (HyFoSy). Current evidence suggests that HyFoSy is an accurate alternative to X-ray hysterosalpingography (HSG) for outpatient tubal evaluation in women who are at low risk for tubal disease. It may be superior to saline hysterosalpingo-contrast sonography (HyCoSy) in excluding tubal occlusion. A hyperechogenic medium may enhance contrast visualization and enable clearer delineation of tubal anatomy...
2017: International Journal of Women's Health
https://www.readbyqxmd.com/read/28092290/clinical-recommendations-of-cardiac-magnetic-resonance-part-ii-inflammatory-and-congenital-heart-disease-cardiomyopathies-and-cardiac-tumors-a-position-paper-of-the-working-group-applicazioni-della-risonanza-magnetica-of-the-italian-society-of-cardiology
#20
Gianluca Pontone, Gianluca Di Bella, Castelletti Silvia, Viviana Maestrini, Pierluigi Festa, Lamia Ait-Ali, Pier Giorgio Masci, Lorenzo Monti, Gabriella di Giovine, Manuel De Lazzari, Alberto Cipriani, Andrea I Guaricci, Santo Dellegrottaglie, Alessia Pepe, Martina Perazzolo Marra, Giovanni Donato Aquaro
The current document was developed by the working group on the 'application of cardiac magnetic resonance' of the Italian Society of Cardiology to provide a perspective on the current state of technical advances and clinical cardiac magnetic resonance applications and to inform cardiologists how to implement their clinical and diagnostic pathway with the introduction of this technique in the clinical practice. Appropriateness criteria were defined using a score system: score 1-3 = inappropriate (test is not generally acceptable and is not a reasonable approach for the indication), score 4-6 = uncertain (test may be generally acceptable and may be a reasonable approach for the indication but more research and/or patient information is needed to classify the indication definitively) and score 7-9 = appropriate (test is generally acceptable and is a reasonable approach for the indication)...
January 13, 2017: Journal of Cardiovascular Medicine
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