scholarly journals A population approach using cholesterol imputation to identify adults with high cardiovascular risk: a report from AHRQ’s EvidenceNow initiative

2018 ◽  
Vol 26 (2) ◽  
pp. 155-158
Author(s):  
Samuel Cykert ◽  
Darren A DeWalt ◽  
Bryan J Weiner ◽  
Michael Pignone ◽  
Jason Fine ◽  
...  
Keyword(s):  
High Risk ◽  
False Positive Rate ◽  
Hdl Cholesterol ◽  
Risk Scores ◽  
Risk Equation ◽  
Positive Rate ◽  
Small Primary ◽  
Ascvd Risk ◽  
Conservative Estimation ◽  
Primary Care Practices

Abstract Objective: Large practice networks have access to EHR data that can be used to drive important improvements in population health. However, missing data often limit improvement efforts. Our goal was to determine the proportion of patients in a cohort of small primary care practices who lacked cholesterol data to calculate ASCVD risk scores and then gauge the extent that imputation can accurately identify individuals already at high risk. 219 practices enrolled. Patients between the ages of 40 and 79 years qualified for risk calculation. For patients who lacked cholesterol data, we measured the effect of employing a conservative estimation strategy using a total cholesterol of 170 mg/dl and HDL-cholesterol of 50 mg/dl in the ASCVD risk equation to identify patients with ≥ 10%, 10-year ASCVD risk who were eligible for risk reduction interventions then compared this to a rigorous formal imputation methodology. 345 440 patients, average age 58 years, qualified for risk scores. 108 515 patients were missing cholesterol information. Using the “good value” estimation methodology, 40 565 had risk scores ≥ 10% compared to 43 205 using formal imputation. However, the latter strategy yielded a lower specificity and higher false positive rate. Estimates using either strategy achieved ASCVD risk stratification quickly and accurately identified high risk patients who could benefit from intervention.

scholarly journals Performance of Fetal Medicine Foundation Software for Pre-Eclampsia Prediction Upon Marker Customization: Cross-Sectional Study (Preprint)

2019 ◽  
Author(s):  
Karina Bilda De Castro Rezende ◽  
Antonio José Ledo Alves Cunha ◽  
Joffre Amim Jr ◽  
Wescule De Moraes Oliveira ◽  
Maria Eduarda Belloti Leão ◽  
...  
Keyword(s):  
High Risk ◽  
False Positive ◽  
False Positive Rate ◽  
Area Under The Curve ◽  
Screening Tests ◽  
Risk Scores ◽  
Cross Sectional ◽  
Fetal Medicine ◽  
Maternal Characteristics ◽  
Positive Rate

BACKGROUND FMF2012 is an algorithm developed by the Fetal Medicine Foundation (FMF) to predict pre-eclampsia on the basis of maternal characteristics combined with biophysical and biochemical markers. Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian setting. OBJECTIVE This study aimed to analyze the performance of pre-eclampsia prediction software by customization of maternal ethnicity. METHODS This was a cross-sectional observational study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers, and they were presented as the risk for early pre-eclampsia (PE34) and preterm pre-eclampsia (PE37). The following steps were followed: (1) identification of women characterized as black ethnicity; (2) calculation of early and preterm pre-eclampsia risk, reclassifying them as white, which generated a new score; (3) comparison of the proportions of women categorized as high risk between the original and new scores; (4) construction of the receiver operator characteristic curve; (5) calculation of the area under the curve, sensitivity, and false positive rate; and (6) comparison of the area under the curve, sensitivity, and false positive rate of the original with the new risk by chi-square test. RESULTS A total of 1531 cases were included in the final sample, with 219 out of 1531 cases (14.30; 95% CI 12.5-16.0) and 182 out of 1531 cases (11.88%; 95% CI 10.3-13.5) classified as high risk for pre-eclampsia development, originally and after recalculating the new risk, respectively. The comparison of FMF2012 predictive model performance between the originally estimated risks and the estimated new risks showed that the difference was not significant for sensitivity and area under the curve, but it was significant for false positive rate. CONCLUSIONS We conclude that black ethnicity classification of Brazilian pregnant women by the FMF2012 algorithm increases the false positive rate. Suppressing ethnicity effect did not improve the test sensitivity. By modifying demographic characteristics, it is possible to improve some performance aspects of clinical prediction tests.

scholarly journals Performance of Fetal Medicine Foundation Software for Pre-Eclampsia Prediction Upon Marker Customization: Cross-Sectional Study

10.2196/14738 ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. e14738 ◽  
Author(s):  
Karina Bilda De Castro Rezende ◽  
Antonio José Ledo Alves Cunha ◽  
Joffre Amim Jr ◽  
Wescule De Moraes Oliveira ◽  
Maria Eduarda Belloti Leão ◽  
...  
Keyword(s):  
High Risk ◽  
False Positive ◽  
False Positive Rate ◽  
Area Under The Curve ◽  
Screening Tests ◽  
Risk Scores ◽  
Cross Sectional ◽  
Fetal Medicine ◽  
Maternal Characteristics ◽  
Positive Rate

Background FMF2012 is an algorithm developed by the Fetal Medicine Foundation (FMF) to predict pre-eclampsia on the basis of maternal characteristics combined with biophysical and biochemical markers. Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian setting. Objective This study aimed to analyze the performance of pre-eclampsia prediction software by customization of maternal ethnicity. Methods This was a cross-sectional observational study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers, and they were presented as the risk for early pre-eclampsia (PE34) and preterm pre-eclampsia (PE37). The following steps were followed: (1) identification of women characterized as black ethnicity; (2) calculation of early and preterm pre-eclampsia risk, reclassifying them as white, which generated a new score; (3) comparison of the proportions of women categorized as high risk between the original and new scores; (4) construction of the receiver operator characteristic curve; (5) calculation of the area under the curve, sensitivity, and false positive rate; and (6) comparison of the area under the curve, sensitivity, and false positive rate of the original with the new risk by chi-square test. Results A total of 1531 cases were included in the final sample, with 219 out of 1531 cases (14.30; 95% CI 12.5-16.0) and 182 out of 1531 cases (11.88%; 95% CI 10.3-13.5) classified as high risk for pre-eclampsia development, originally and after recalculating the new risk, respectively. The comparison of FMF2012 predictive model performance between the originally estimated risks and the estimated new risks showed that the difference was not significant for sensitivity and area under the curve, but it was significant for false positive rate. Conclusions We conclude that black ethnicity classification of Brazilian pregnant women by the FMF2012 algorithm increases the false positive rate. Suppressing ethnicity effect did not improve the test sensitivity. By modifying demographic characteristics, it is possible to improve some performance aspects of clinical prediction tests.

scholarly journals A prospective clinical trial to compare the performance of dried blood spots prenatal screening for Down’s syndrome with conventional non-invasive testing technology

2017 ◽  
Vol 242 (5) ◽  
pp. 547-553
Author(s):  
Huiying Hu ◽  
Yulin Jiang ◽  
Minghui Zhang ◽  
Shanying Liu ◽  
Na Hao ◽  
...  
Keyword(s):  
High Risk ◽  
False Positive ◽  
False Positive Rate ◽  
Down's Syndrome ◽  
Down’S Syndrome ◽  
Dried Blood Spots ◽  
High Risk Women ◽  
Secondary Screening ◽  
Serum Screening ◽  
Positive Rate

To evaluate, side by side, the efficiency of dried blood spots (DBSs) against serum screening for Down’s syndrome, and then, to construct a two-tier strategy by topping up the fetal cell-free DNA (cfDNA) secondary screening over the high-risk women marked by the primary blood testing to build a practical screening tactic to identify fetal Down’s syndrome. One thousand eight hundred and thirty-seven low-risk Chinese women, with singleton pregnancy, were enrolled for the study. Alpha-fetoprotein and free beta human chorionic gonadotropin were measured for the serum as well as for the parallel DBS samples. Partial high-risk pregnant women identified by primary blood testing (n = 38) were also subject to the secondary cfDNA screening. Diagnostic amniocentesis was utilized to confirm the screening results. The true positive rate for Down’s syndrome detection was 100% for both blood screening methods; however, the false-positive rate was 3.0% for DBS and 4.0% for serum screening, respectively. DBS correlated well with serum screening on Down’s syndrome detection. Three out of 38 primary high-risk women displayed chromosomal abnormalities by cfDNA analysis, which were confirmed by amniocentesis. Either the true detection rate or the false-positive rate for Down’s syndrome between DBS and the serum test is comparable. In addition, blood primary screening aligned with secondary cfDNA analysis, a “before and after” two-tier screening strategy, can massively decrease the false-positive rate, which, then, dramatically reduces the demand for invasive diagnostic operation. Impact statement Children born with Down’s syndrome display a wide range of mental and physical disability. Currently, there is no effective treatment to ease the burden and anxiety of the Down’s syndrome family and the surrounding society. This study is to evaluate the efficiency of dried blood spots against serum screening for Down’s syndrome and to construct a two-tier strategy by topping up the fetal cell-free DNA (cfDNA) secondary screening over the high-risk women marked by the primary blood testing to build a practical screening tactic to identify fetal Down’s syndrome. Results demonstrate that fetal cfDNA can significantly reduce false-positive rate close to none while distinguishing all true positives. Thus, we recommend that fetal cfDNA analysis to be utilized as a secondary screening tool atop of the primary blood protein screening to further minimize the capacity of undesirable invasive diagnostic operations.

Abstract 024: Effects Of Diet On 10-year Atherosclerotic Cardiovascular Disease Risk Using The Pooled Cohort Equations Risk Calculator: Results From The Dash Trial

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Sun Young Jeong ◽  
Lara Kovell ◽  
Timothy B Plante ◽  
Christina C Wee ◽  
Edgar R Miller ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Disease Risk ◽  
Control Diet ◽  
Cardiovascular Disease Risk ◽  
Hdl Cholesterol ◽  
Risk Scores ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
Dash Diet ◽  
Ascvd Risk

Background: The Dietary Approaches to Stop Hypertension (DASH) diet is known to reduce cardiovascular disease (CVD) risk factors, but its effects on 10-year CVD risk based on the pooled cohort estimating equation has not been reported. Objective: To determine the effects of adopting the DASH diet on 10-year atherosclerotic cardiovascular disease (ASCVD) risk compared to a typical American (control) diet or a diet rich fruit and vegetables (F/V), but otherwise similar to control. Methods: The DASH trial was a 3-arm, parallel-group, randomized controlled feeding trial of 459 adults aged 22 to 75 years without CVD and not taking anti-hypertensive or diabetes medications. These participants were randomized to a control diet, a F/V diet, or the DASH diet for 8 weeks. Weight was kept constant. Blood pressure (BP) and lipids were measured at baseline and at 8-weeks to compare 10-year ASCVD risk scores across dietary assignments. Comparisons were performed via linear regression adjusted for baseline ASCVD risk score. Results: The mean age of participants was 45 years; 49% were women, 60% were black, and 10% were current smokers. Mean systolic BP was 131.3±10.8 mm Hg, mean LDL cholesterol was 121±32 mg/dL, and mean HDL cholesterol was 48±14 mg/dL. Both DASH and F/V diets shifted the distribution of ASCVD risk scores downward compared to the control diet ( Figure, Panel A ). Compared to the control diet, the DASH and F/V diets reduced 10-year ASCVD risk by 10.0% (95% CI: -17.7, -1.5; P = 0.02) and 11.7% (95% CI: -19.3, -3.3; P = 0.007) respectively ( Figure, Panel B ). There was no difference between the DASH and F/V diets (-1.9%; 95% CI: -10.3, 7.4; P = 0.68). Conclusions: Compared to the control diet, the DASH and F/V diets reduced 10-year ASCVD risk, while the DASH and F/V had similar effects.

scholarly journals LDCT lung cancer screening in populations at different risk for lung cancer

2020 ◽  
Vol 7 (1) ◽  
pp. e000455
Author(s):  
Gustavo Borges da Silva Teles ◽  
Ana Carolina Sandoval Macedo ◽  
Rodrigo Caruso Chate ◽  
Viviane Arevalo Tabone Valente ◽  
Marcelo Buarque de Gusmao Funari ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Lung Cancer Risk ◽  
Risk Group ◽  
False Positive Rate ◽  
Lung Cancer Screening ◽  
Low Risk ◽  
Positive Rate ◽  
Risk Patients

IntroductionThe improvement of low-dose CT (LDCT) lung cancer screening selection criteria could help to include more individuals who have lung cancer, or in whom lung cancer will develop, while avoiding significant cost increase. We evaluated baseline results of LDCT lung cancer screening in a population with a heterogeneous risk profile for lung cancer.MethodsLDCT lung cancer screening was implemented alongside a preventive health programme in a private hospital in Brazil. Individuals older than 45 years, smokers and former smokers, regardless of tobacco exposure, were included. Patients were classified according to the National Lung Screening Trial (NLST) eligibility criteria and to PLCOm2012 6-year lung cancer risk. Patient characteristics, CT positivity rate, detection rate of lung cancer and false-positive rate were assessed.ResultsLDCT scans of 472 patients were evaluated and three lung adenocarcinomas were diagnosed. CT positivity rate (Lung-RADS 3/4) was significantly higher (p=0.019) in the NLST group (10.1% (95% CI, 5.9% to 16.9%)) than in the non-NLST group (3.6% (95% CI, 2.62% to 4.83%)) and in the PLCOm2012 high-risk group (14.3% (95% CI, 6.8% to 27.7%)) than in the PLCOm2012 low-risk group (3.7% (95% CI, 2.9% to 4.8%)) (p=0.016). Detection rate of lung cancer was also significantly higher (p=0.018) among PLCOm2012 high-risk patients (5.7% (95% CI, 2.5% to 12.6%)) than in the PLCOm2012 low-risk individuals (0.2% (95% CI, 0.1% to 1.1%)). The false-positive rate for NLST criteria (16.4% (95% CI, 13.2% to 20.1%)) was higher (p<0.001) than for PLCOm2012 criteria (7.6 (95% CI, 5.3% to 10.5%)).DiscussionOur study indicates a lower performance when screening low-risk individuals in comparison to screening patients meeting NLST criteria and PLCOm2012 high-risk patients. Also, incorporating PLCOm2012 6-year lung cancer risk ≥0.0151 as an eligibility criterion seems to increase lung cancer screening effectiveness.

scholarly journals 615. Overlooking those at Intermediate Risk? ASCVD Prevention Measures among People Living with HIV at an Urban Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S367-S368
Author(s):  
Mark Liotta ◽  
Peter Cangialosi ◽  
Jeanne Ho ◽  
Diana Finkel ◽  
Shobha Swaminathan ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Score ◽  
Guideline Adherence ◽  
Risk Group ◽  
Risk Scores ◽  
Adherence Rate ◽  
People Living With Hiv ◽  
Intermediate Risk ◽  
Ascvd Risk ◽  
Living With Hiv

Abstract Background The American College of Cardiology (ACC) recognizes HIV as a risk factor for atherosclerotic cardiovascular disease (ASCVD). However, 2019 guidelines do not address people living with HIV (PLWH), aside from stating that their Risk Estimator Plus tool, which is used to calculate a 10-year risk for ASCVD and advise management, likely underestimates CVD risk in PLWH. This quality assessment project examines rates of ACC guideline adherence for ASCVD prevention for PLWH who have calculated risk scores in the low (&lt; 7.5%), intermediate (&gt; 7.5% & &lt; 20%), and high-risk (&gt; 20%) ranges. Patients analyzed are from an HIV registry of University Hospital Infectious Disease Outpatient clinic in Newark, NJ. The clinic’s 2451 total patients are 40% female, 63% non-Hispanic black, 23% Hispanic, and 64% &gt; 45 years old. Methods This project was approved by the Rutgers IRB. Patients (40-79 years) with a clinic visit from 2/1/2019 to 1/31/2020 were reviewed. ASCVD risk scores were calculated using the Risk Estimator Plus for all patients when data was available. Guideline adherence rate was defined as following 2019 ACC guidelines for appropriate statin therapy, while considering medication interactions. Results Of the 1127 patients who met criteria, 744 ASCVD risk scores were calculated. Lipid values outside the calculator range (229) or no documented lipids (154) resulted in non-calculatable scores. Guideline adherence rate for the intermediate-risk group was significantly less than the high-risk and low-risk groups (P&lt; 0.05): low-risk 92.8% (95% CI 90.0-95.1, n=346), intermediate-risk 35.2% (95% CI 29.7-41.1, n=270), and high-risk 52.3% (95% CI 43.8-60.8, n=128). Adherence rates within the intermediate-risk group for patients with hypertension (HTN) and smokers were significantly less than those with CVD (P&lt; 0.05). Table 1: Patients with Calculated ASCVD Risk Score &gt; 20 for PLWH from 2/1/2019 – 1/31/2020 Table 2: Patients with Calculated ASCVD Risk Score &gt; 7.5 & &lt; 20 for PLWH from 2/1/2019 – 1/31/2020 Table 3: Patients with Calculated ASCVD Risk Score &lt; 7.5 for PLWH from 2/1/2019 – 1/31/2020 Conclusion Lower overall guideline adherence rates within the intermediate risk group, and particularly among those with a history of HTN and smoking, highlights the need for targeted care. Provider education on the calculation and application of ASCVD risk scores, as well as increased awareness of the risk-enhancing nature of HIV infection in coexistence with the traditional risk factors of CVD history, diabetes, HTN, and smoking are important steps to increase adherence rates. Disclosures All Authors: No reported disclosures

scholarly journals Primary care practices’ ability to predict future risk of expenditures and hospitalization using risk stratification and segmentation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
David A. Dorr ◽  
Rachel L. Ross ◽  
Deborah Cohen ◽  
Devan Kansagara ◽  
Katrina Ramsey ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Score ◽  
Adverse Outcomes ◽  
Risk Scores ◽  
Ed Visits ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background Patients with complex health care needs may suffer adverse outcomes from fragmented and delayed care, reducing well-being and increasing health care costs. Health reform efforts, especially those in primary care, attempt to mitigate risk of adverse outcomes by better targeting resources to those most in need. However, predicting who is susceptible to adverse outcomes, such as unplanned hospitalizations, ED visits, or other potentially avoidable expenditures, can be difficult, and providing intensive levels of resources to all patients is neither wanted nor efficient. Our objective was to understand if primary care teams can predict patient risk better than standard risk scores. Methods Six primary care practices risk stratified their entire patient population over a 2-year period, and worked to mitigate risk for those at high risk through care management and coordination. Individual patient risk scores created by the practices were collected and compared to a common risk score (Hierarchical Condition Categories) in their ability to predict future expenditures, ED visits, and hospitalizations. Accuracy of predictions, sensitivity, positive predictive values (PPV), and c-statistics were calculated for each risk scoring type. Analyses were stratified by whether the practice used intuition alone, an algorithm alone, or adjudicated an algorithmic risk score. Results In all, 40,342 patients were risk stratified. Practice scores had 38.6% agreement with HCC scores on identification of high-risk patients. For the 3,381 patients with reliable outcomes data, accuracy was high (0.71–0.88) but sensitivity and PPV were low (0.16–0.40). Practice-created scores had 0.02–0.14 lower sensitivity, specificity and PPV compared to HCC in prediction of outcomes. Practices using adjudication had, on average, .16 higher sensitivity. Conclusions Practices using simple risk stratification techniques had slightly worse accuracy in predicting common outcomes than HCC, but adjudication improved prediction.

scholarly journals ASSESSMENT OF 10-YEAR RISK OF DEVELOPING A MAJOR CARDIOVASCULAR EVENT IN PATIENTS ATTENDING A HOSPITAL FOR THE TREATMENT OF OTHER DISORDERS

2020 ◽  
pp. 74-78
Author(s):  
M. MAHIMA SWAROOPA ◽  
REDDY PRAVEEN ◽  
S. K. LAL SAHEB ◽  
S. K. SAI RINNISHA ◽  
P. SARANYA ◽  
...  
Keyword(s):  
High Risk ◽  
Low Risk ◽  
Risk Scores ◽  
Intermediate Risk ◽  
Total Risk ◽  
Cvd Risk ◽  
Framingham Risk ◽  
Risk Scoring ◽  
Ascvd Risk ◽  
Risk Estimator

Objective: To assess the individual’s predicted risk of developing a CVD event in 10 y using risk scores among persons with other disorders/diseases. Methods: This is a cross-sectional observational study conducted for a period of 6 mo among 283 subjects. Total risk was estimated individually by using Framingham Risk Scoring Algorithm and ASCVD risk estimator. Results: According to Framingham Risk score the prevalence of low risk (<10%) identified as 67.84% (192), followed by intermediate risk (10%-19%), 19.08% (54), and high risk (≥20%) 13.07% (37). By using ASCVD Risk estimator, risk has reported in our study population was low risk (<5%) is 48.76% (138), borderline risk (5-7.4%) is 13.07% (37), intermediate risk (7.5-19.9%) is about 25.09% (71), high risk (>20%) is about 13.07% (37). Conclusion: In this study burden of CVD risk was relatively low, which was estimated by both the Framingham scale and ASCVD Risk estimator. Risk scoring of individuals helps us to identify the patients at high risk of CV diseases and also helps in providing management strategies.

scholarly journals Quantitative faecal immunochemical test for patients with high risk bowel symptoms: a prospective cohort study

2020 ◽  
Author(s):  
Helga E Laszlo ◽  
Edward Seward ◽  
Ruth Ayling ◽  
Jenny Lake ◽  
Aman Malhi ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Limit Of Detection ◽  
False Positive Rate ◽  
Detection Sensitivity ◽  
National Guidelines ◽  
Urgent Referral ◽  
Positive Rate

Objectives: To evaluate whether quantitative measurement of faecal haemoglobin (f-Hb) using faecal immunochemical testing (FIT) can be used to rule out colorectal cancer (CRC) for patients who present to primary care with high risk symptoms defined by national guidelines for urgent referral for suspected cancer (NICE NG12). Design: Prospective cohort study carried out between April 2017 and March 2019. Setting: 59 GP practices in London and 24 hospitals in England. Participants: Symptomatic patients in England referred to the urgent CRC pathway who provided a faecal sample for FIT in addition to standard investigations for cancer. Main outcome measures: CRC was confirmed by established clinical and histopathology procedures. f-Hb (microgr per gram of stool) was measured in a central laboratory blinded to cancer outcome. We calculated sensitivity (percentage of patients with CRC who have f-Hb exceeding specified cut-offs); false-positive rate [FPR] (percentage of patients without CRC whose f-Hb exceeds the same cut-offs); and positive predictive value [PPV] (percentage of all patients with f-Hb above the cut-offs who have CRC). Results: 4676 patients were recruited of whom 3596 patients were included (had a valid FIT test and a known definitive diagnosis). Among the 3596, median age was 67 years, 53% were female and 78% had colonoscopy. 90 patients were diagnosed with CRC, 7 with other cancers, and 3499 with no cancer found. f-Hb did not correlate with age, sex or ethnicity. Using f-Hb greater than or equal to 4 microgr/g (lowest limit of detection), sensitivity, FPR and PPV were 87.8%, 27.0% and 7.7% respectively. Using f-Hb greater than or equal to 10 microgr/g, the corresponding measures were 83.3%, 19.9% and 9.7%. 15 patients with CRC had f-Hb below 10 microgr/g. If FIT had been used at thresholds of 10 microg/gr or 4 microgr/g, 1 in 6 or 1 in 8 patients with cancer respectively would have been missed. If the absence of anaemia or abdominal pain is used alongside f-Hb 10 microgr/g, only 1 in 18 cancers would be missed but 56% of people without CRC could potentially avoid further investigations including colonoscopies. Conclusions: In our study, if FIT alone had been used to determine urgent referral for patients with high risk symptoms for definitive cancer investigation, some patients with bowel cancer would not have been diagnosed. If used in conjunction with clinical features, particularly in the absence of anaemia, the efficacy of FIT is significantly improved. With appropriate safety netting, FIT could be used to focus secondary care diagnostic capacity on patients most at risk of CRC.

scholarly journals Ultrasound-Guided Invasive Procedures in Genetic Prenatal Diagnostics

2011 ◽  
Vol 5 (2) ◽  
pp. 137-139
Author(s):  
Miroslaw Wielgos ◽  
Piotr Wegrzyn
Keyword(s):  
High Risk ◽  
False Positive Rate ◽  
Chorionic Villus ◽  
High Risk Group ◽  
Screening Methods ◽  
Chorionic Villus Sampling ◽  
Invasive Procedures ◽  
Fetal Blood Sampling ◽  
Wide Range ◽  
Positive Rate

ABSTRACT There is a wide range of noninvasive screening methods that aim to identify the subgroup of fetuses that are in a high risk of chromosomal defects. Invasive procedures should be offered to women in the high-risk group identified with the highest possible detection rate and the lowest false-positive rate. The method of choice at 11 + 0 - 13 + 6 weeks is chorionic villus sampling. An early amniocentesis is much more dangerous and should be abandoned. CVS should be performed not earlier than at 11 + 0 weeks of pregnancy. Amniocentesis should be performed no earlier that at 15 + 0 weeks. Earlier procedure is associated with significantly higher rate of talipes equinovarius, amniotic fluid leakage and miscarriage. The umbilical cord insertion is a preferable site for fetal blood sampling. Care must be taken to distinguish between the vein and the artery, and the vein must be sampled, not the artery. The operator's experience is very important issue. It has been postulated that to achieve a reasonable experience one should perform a minimum of 100 chorionic villus samplings, and a reasonable number of invasive procedures should be performed yearly.

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