scholarly journals Strategic testing plan for Ambulatory Surgery Centers (ASCs) after the COVID-19 pandemic

2020 ◽  
pp. 1-20
Author(s):  
Ramana Naidu ◽  
Samir Sheth ◽  
Rahul Chaturvedi ◽  
Krishnan Chakravarthy
Keyword(s):  
Sensitivity And Specificity ◽  
Additional Data ◽  
Ambulatory Surgery ◽  
False Negative ◽  
Clinical Work ◽  
Local Public Health ◽  
Ambulatory Surgery Centers ◽  
Screening Questionnaires ◽  
Public Health Officials ◽  
Testing Plan

Abstract As the curve continues to flatten during the SARS-CoV-2 pandemic, and more physicians resume outpatient clinical work, the question arises of how to ensure the safety of the patients and staff while performing cases. Many institutions and health care offices have turned to screening questionnaires to determine the likelihood of COVID-19 positivity. However, screening questionnaires are woefully inadequate as studies have shown that roughly 6.4% to 50% of patients may spread this virus without any symptoms. In this paper, we have outlined a proposal to restart elective procedures after the curve has flattened in a certain locale, particularly for ambulatory surgery centers (ASCs). Until additional data are collected for specific sensitivity and specificity values for PCR testing, we recommend performing two consecutive PCR tests to minimize false negative rates. The algorithm described in this paper can help ASCs begin their practices and provide local public health officials with valuable data that can help establish true sensitivity and specificity rates for these tests.

432: The Association Between Stone Surgery Utilization and Surgeon Ownership of Ambulatory Surgery Centers

2007 ◽  
Vol 177 (4S) ◽  
pp. 144-145
Author(s):  
John M. Hollingsworth ◽  
Zaojun Ye ◽  
Sarah L. Krein ◽  
Alon Z. Weizer ◽  
Brent K. Hollenbeck
Keyword(s):  
Ambulatory Surgery ◽  
Ambulatory Surgery Centers

scholarly journals 144. Little evidence of same-day, oral antibiotic prescribing at ambulatory surgery centers

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S82-S83
Author(s):  
Laura M King ◽  
Lauri Hicks ◽  
Sarah Kabbani; Sharon Tsay ◽  
Katherine E Fleming-Dutra
Keyword(s):  
Surgical Procedures ◽  
Ambulatory Surgery ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Chi Square ◽  
Convenience Sample ◽  
Ambulatory Surgery Centers ◽  
National Public Health ◽  
Course Length

Abstract Background The objective of our study was to describe oral antibiotic prescriptions associated with procedures in ambulatory surgery centers (ASC) to evaluate if there are major national opportunities to improve antibiotic use in this setting. Methods We identified surgical procedures in ASCs and oral antibiotic prescriptions in the IBM® MarketScan® Commercial 2018 database, a large convenience sample of privately-insured individuals aged < 65 years. We excluded visits with same-day hospitalizations and those with infectious diagnoses that may warrant antibiotic treatment. We included only antibiotic prescriptions dispensed on the same day as an ASC visit. We calculated the number of visits and oral antibiotic prescriptions and the percent of visits with oral antibiotic prescriptions overall, and by patient age group (< 18 and 18–64 years), antibiotic class, and procedure type. We also calculated median antibiotic course length. Across-group comparisons were evaluated using chi-square tests. Results In 2018, 918,127 ASC visits with surgical procedure codes were captured, of which 37,032 (4.0%) were associated with same-day oral antibiotic prescriptions. The percent of visits with antibiotic prescriptions was significantly higher among children compared to adults (9.4% vs 3.8%; p< 0.01); however, adults accounted for 89% of prescriptions. Respiratory/nasal and urinary tract system procedures were most frequently associated with antibiotic prescriptions (Figure). Median course length was 5 (interquartile range 3–7) days. The most common antibiotic class was cephalosporins (49.6% of prescriptions), followed by penicillins (12.6%) and fluoroquinolones (10.9%). Figure. Percent of ambulatory surgery center visits with same-day antibiotic prescriptions by procedure category, IBM® MarketScan® Commercial Database, 2018 Conclusion Only 4% of ASC procedures were associated with same-day oral antibiotic prescriptions, suggesting antibiotics are not commonly prescribed in ASCs on the day of surgical procedures. Additionally, the observed 5-day median duration may suggest that some of these courses are intended for treatment rather than prophylaxis. Our estimates represent lower bounds for oral antibiotic prescriptions in this setting, as we only captured same-day prescriptions. However, our findings suggest that ASC facilities may not be high-impact targets for national, public health antibiotic stewardship efforts. Disclosures All Authors: No reported disclosures

scholarly journals Pretherapeutic Imaging for Axillary Staging in Breast Cancer: A Systematic Review and Meta-Analysis of Ultrasound, MRI and FDG PET

2021 ◽  
Vol 10 (7) ◽  
pp. 1543
Author(s):  
Morwenn Le Boulc’h ◽  
Julia Gilhodes ◽  
Zara Steinmeyer ◽  
Sébastien Molière ◽  
Carole Mathelin
Keyword(s):  
Systematic Review ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
False Negative ◽  
Significant Proportion ◽  
False Negative Rate ◽  
True Positive Rate ◽  
Axillary Staging ◽  
Positron Emission ◽  
Positive Rate

Background: This systematic review aimed at comparing performances of ultrasonography (US), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography (PET) for axillary staging, with a focus on micro- or micrometastases. Methods: A search for relevant studies published between January 2002 and March 2018 was conducted in MEDLINE database. Study quality was assessed using the QUality Assessment of Diagnostic Accuracy Studies checklist. Sensitivity and specificity were meta-analyzed using a bivariate random effects approach; Results: Across 62 studies (n = 10,374 patients), sensitivity and specificity to detect metastatic ALN were, respectively, 51% (95% CI: 43–59%) and 100% (95% CI: 99–100%) for US, 83% (95% CI: 72–91%) and 85% (95% CI: 72–92%) for MRI, and 49% (95% CI: 39–59%) and 94% (95% CI: 91–96%) for PET. Interestingly, US detects a significant proportion of macrometastases (false negative rate was 0.28 (0.22, 0.34) for more than 2 metastatic ALN and 0.96 (0.86, 0.99) for micrometastases). In contrast, PET tends to detect a significant proportion of micrometastases (true positive rate = 0.41 (0.29, 0.54)). Data are not available for MRI. Conclusions: In comparison with MRI and PET Fluorodeoxyglucose (FDG), US is an effective technique for axillary triage, especially to detect high metastatic burden without upstaging majority of micrometastases.

scholarly journals Diagnostic Performance of Ankle-Brachial Pressure Index in Lower Extremity Arterial Disease

2021 ◽  
Vol 07 (03) ◽  
pp. e132-e137
Author(s):  
Mohammed Alagha ◽  
Thomas M. Aherne ◽  
Ahmed Hassanin ◽  
Adeel S. Zafar ◽  
Doireann P. Joyce ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Sensitivity And Specificity ◽  
False Negative ◽  
Arterial Disease ◽  
Initial Assessment ◽  
Reference Standard ◽  
Lower Extremity Arterial Disease ◽  
Negative Results ◽  
Positive Results ◽  
Arterial Imaging

Abstract Introduction Ankle-brachial pressure indices (ABIs) continue to form the basis of diagnostics for lower extremity arterial disease (LEAD). However, there remains a paucity of data to support its accuracy. This study aims to evaluate its diagnostic sensitivity and specificity using established arterial-imaging modalities as a benchmark. Methods In this retrospective study, a regional, prospectively maintained, vascular laboratory database was interrogated to identify referred patients with arterial disease who underwent concomitant assessment with ABI and lower limb arterial duplex ultrasound (DUS). Duplex acted as the reference standard. Those who had peripheral computed tomography angiogram (CTA) within 3 months of initial assessment were included in a subgroup analysis to correlate ABI with CTA. The primary end point was the sensitivity and specificity of ABI compared with DUS as the reference standard. Results Concomitant assessment was performed in 438 limbs (250 patients) over a 27-month period. The ABI was normal (0.9 to 1.4) in 196 limbs (44.9%) and abnormal in the remaining 241 limbs (55.1%). False-positive results occurred in 83 out of 241 limbs (34.4%), and false-negative results occurred in 54 limbs out of 196 (27.5%). True-positive results were 158 out of 241 limbs (65.6%), whereas true-negative results were 142 out of 196 limbs (72.4%). ABI using DUS as a benchmark identified a sensitivity for peripheral artery disease of 72.3% and a specificity of 69.3%. Concomitant CTA imaging was available in 200 limbs. The sensitivity and specificity of ABI correlated with CTA were 65.5 and 68.8%, respectively. Conclusion ABIs have a moderate predictive value in the diagnosis of LEAD. Normal range outcomes cannot be taken to infer the absence of LEAD and, as such, further arterial imaging in the form of DUS or angiography should be strongly considered in those with suspected underlying disease requiring intervention. Further noninvasive tests such as exercise studies or pulse volume waveforms should be considered, if diagnostic uncertainty exists, in those requiring nonoperative intervention and risk factor control.

scholarly journals Evaluation of Recombinant Proteins of Burkholderia mallei for Serodiagnosis of Glanders

2012 ◽  
Vol 19 (8) ◽  
pp. 1193-1198 ◽  
Author(s):  
Vijai Pal ◽  
Subodh Kumar ◽  
Praveen Malik ◽  
Ganga Prasad Rai
Keyword(s):  
Sensitivity And Specificity ◽  
Recombinant Proteins ◽  
False Negative ◽  
Enzyme Linked Immunosorbent Assay ◽  
Burkholderia Mallei ◽  
Content Type ◽  
Whole Cells ◽  
Negative Results ◽  
Elisa Format ◽  
Low Sensitivity

ABSTRACTGlanders is a contagious disease caused by the Gram-negative bacillusBurkholderia mallei. The number of equine glanders outbreaks has increased steadily during the last decade. The disease must be reported to the Office International des Epizooties, Paris, France. Glanders serodiagnosis is hampered by the considerable number of false positives and negatives of the internationally prescribed tests. The major problem leading to the low sensitivity and specificity of the complement fixation test (CFT) and enzyme-linked immunosorbent assay (ELISA) has been linked to the test antigens currently used, i.e., crude preparations of whole cells. False-positive results obtained from other diagnostic tests utilizing crude antigens lead to financial losses to animal owners, and false-negative results can turn a risk into a possible threat. In this study, we report on the identification of diagnostic targets using bioinformatics tools for serodiagnosis of glanders. The identified gene sequences were cloned and expressed as recombinant proteins. The purified recombinant proteins ofB. malleiwere used in an indirect ELISA format for serodiagnosis of glanders. Two recombinant proteins, 0375H and 0375TH, exhibited 100% sensitivity and specificity for glanders diagnosis. The proteins also did not cross-react with sera from patients with the closely related disease melioidosis. The results of this investigation highlight the potential of recombinant 0375H and 0375TH proteins in specific and sensitive diagnosis of glanders.

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