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Objectives: Reverse-transcription PCR (RT-PCR) is considered the most sensitive method for the detection of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). However, this method is relatively resource- and time-consuming. This study was performed to compare SARS-CoV-2 nucleocapsid antigen (N-Ag) testing using an enzyme-linked immunosorbent assay (ELISA) with SARS-CoV-2 RNA detection. Methods: Parallel SARS-CoV-2 RT-PCR and quantitative N-Ag ELISA analysis was executed on nasopharyngeal specimens obtained during SARS-CoV-2 screening in a cohort of pre-hospitalization patients. Results: In total, 277 specimens were examined, including 182 (65.7%) RT-PCR-positive specimens, which demonstrated a median cycle threshold (Ct) value of 27 (interquartile range (IQR) 23–35). The SARS-CoV-2 N-Ag was detected in 164 of the 182 RT-PCR-positive specimens (overall sensitivity 90.1%). Among the 95 RT-PCR-negative specimens, 72 were N-Ag-negative (specificity 75.8%). SARS-CoV-2 RT-PCR and N-Ag ELISA results demonstrated a strong agreement (Cramer’s V = 0.668; P

OBJECTIVES To discuss potential benefits, challenges, and opportunities of integrating patient-reported outcome measures in geriatric oncology, with the goal being to advance patient screening for 'functional fitness for treatment.' DATA SOURCES This is narrative review of the relevant literature using PubMed. CONCLUSION Patient screening in geriatric cancer care can be driven by patient self-reports. Most of the research on patient-reported outcome measures in cancer care to date has involved, in different proportions and to different extents, older patients with cancer (≥70 years of age). However, reports specifically targeting implementation of patient-reported outcome measures in geriatric cancer care are surprisingly fewer. The International Society of Geriatric Oncology Priorities Initiative calls for more research into the use of patient-reported outcome measures for older adults with cancer. More feasibility studies will be required to evaluate patient-reported outcome measures as fit-for-purpose, reporting frequency, patient burden, integration and display of patient-reported information, and workflow impact. Developing, adapting, and validating patient-reported outcome measures for use in geriatric oncology will be key to ensure adequacy of measurement. Groundwork involving consultation of all potential end users of patient-reported information is paramount because there is no one size fits all. When the ground is ready for implementation adequate preparation, training, resources, and ongoing support will be needed. IMPLICATIONS FOR NURSING PRACTICE Working within the multidisciplinary team, nurses can promote patient screening that is led by the patient. Nursing roles can be developed, supported, expanded, or repurposed to involve greater use of patient-reported outcome measures for several key patient outcomes in geriatric cancer care.

Noninvasive detection of nonalcoholic steatohepatitis (NASH), the progressive form of nonalcoholic fatty liver disease, promises to improve patient screening, accelerate drug trials, and reduce health care costs. On the basis of protease dysregulation of the biological pathways of fibrotic NASH, we developed the Glympse Bio Test System (GBTS) for multiplexed quantification of liver protease activity. GBTS-NASH comprises a mixture of 19 mass-barcoded PEGylated peptides that is administered intravenously and senses liver protease activity by releasing mass-barcoded reporters into urine for analysis by mass spectrometry. To identify a protease signature of NASH, transcriptomic analysis of 355 human liver biopsies identified a 13-protease panel that discriminated clinically relevant NASH ≥F2 fibrosis from F0-F1 with high classification accuracy across two independent patient datasets. We screened 159 candidate substrates to identify a panel of 19 peptides that exhibited high activity for our 13-protease panel. In the choline-deficient, L-amino acid-defined, high-fat diet (CDAHFD) mouse model, binary classifiers trained on urine samples discriminated fibrotic NASH from simple steatosis and healthy controls across a range of nondisease conditions and indicated disease regression upon diet change [area under receiver operating characteristics (AUROCs)0.97]. Using a hepatoprotective triple combination treatment (FXR agonist, ACC and ASK1 inhibitors) in a rat model of NASH, urinary classification distinguished F0-F1 from ≥F2 animals and indicated therapeutic response as early as 1 week on treatment (AUROCs0.91). Our results support GBTS-NASH to diagnose fibrotic NASH via an infusion of peptides, monitor changes in disease severity, and indicate early treatment response.

This article provides the reader with a thoughtful example of an emergency nurse-led intervention to improve emergency department patient screening for domestic violence. Background information is provided along with the development of educational tools. Example ID badge cards and posters are also provided. Finally, helpful takeaways fare provided to aid in the implementation of similar projects in other emergency departments.

The crisis of the coronavirus disease (COVID-19) is causing damage to the social and medical community. However, extreme emergency neuro-interventions such as mechanical thrombectomy still require the healthcare workers to offer the appropriate treatment while preventing further spread of the infection. This article outlines the necessary steps in managing a possible COVID-19 patient starting from patient screening to personnel infection and environmental contamination measures.

Objective To describe the implementation of a statewide pharmacy program called ONE Rx (Opioid and Naloxone Education) within community pharmacies. Setting Thirty community pharmacies. Practice description Community pharmacies throughout the state of North Dakota were invited to participate. Pharmacists in North Dakota can legally prescribe and dispense naloxone. Practice innovation ONE Rx is a statewide program that provides pharmacists with the education and tools to screen every patient who was prescribed an opioid medication for the risk of opioid misuse and accidental overdose. The goal of ONE Rx is to prevent opioid misuse and accidental overdose through patient screening and individualized education and intervention within the community pharmacy. Evaluation Outcomes to measure the implementation of ONE Rx included the number of pharmacists and technicians who participated in the training, the number of pharmacies who chose to implement ONE Rx, and the number of patients screened for the risk of opioid misuse and accidental overdose. Results The ONE Rx training was completed by 240 pharmacists and 41 registered pharmacy technicians. Thirty community pharmacies implemented the program between October 2018 and May 2019, and more than 1700 patients were screened for the risk of opioid misuse and accidental overdose. Conclusion A statewide program to screen for opioid misuse and accidental overdose was successfully implemented.

Patients with immunodeficiency-associated vaccine-derived poliovirus (iVDPV) are potential poliovirus reservoirs in the posteradication era that might reintroduce polioviruses into the community. We update the iVDPV registry in Iran by reporting 9 new patients. In addition to national acute flaccid paralysis surveillance, cases were identified by screening nonparalyzed primary immunodeficiency (PID) patients. Overall, 23 iVDPV patients have been identified since 1995. Seven patients (30%) never had paralysis. Poliovirus screening accelerated the iVDPV detection rate in Iran after 2014.The iVDPV infection rate among nonparalyzed patients with adaptive PID was 3.1% (7/224), several folds higher than previous estimates. Severe combined immunodeficiency patients had the highest risk for asymptomatic infection (28.6%) compared with other PIDs. iVDPV2 emergence has decreased after the switch from trivalent to bivalent oral poliovirus vaccine in 2016. However, emergence of iVDPV1 and iVDPV3 continued. Poliovirus screening in PID patients is an essential step in the endgame of polio eradication.

Aim. To estimate mechanical function of the right heart chambers after the pulmonary denervation in comparison with the sham procedure using right heart catheterization (RHC) and echocardiography.Methods. Twelve patients with different clinical types of pulmonary hypertension were included in the study. All patients were randomized into two groups: Group I patients (n = 6) underwent the pulmonary denervation, Group II patients (n = 6) had sham procedure. All the patients had functional class 3 pulmonary hypertension. The patient screening was performed using echocardiography findings, and the final decision was made after RHC. After including in the study the RHC was done three times: before the procedure, immediately after it, and on the 12th months of the follow-up. Echocardiographic measurement of the right heart parameters was performed four times: a day before the procedure, immediately after it, on the 5th day and on the 12th months of the follow-up.Results. No complications during the procedure and the follow-up were registered. There were no statistically significant differences in any of the RHC parameters between groups at the second and the third control points. The same findings were determined after echocardiographic analysis.Conclusion. Pulmonary denervation does not have statistically significant effect on the mechanical function of the right heart chambers within the 12-months follow-up.

Background The widespread adoption of electronic health records (EHRs) has facilitated the secondary use of EHR data for clinical research. However, screening eligible patients from EHRs is a challenging task. The concepts in eligibility criteria are not completely matched with EHRs, especially derived concepts. The lack of high-level expression of Structured Query Language (SQL) makes it difficult and time consuming to express them. The openEHR Expression Language (EL) as a domain-specific language based on clinical information models shows promise to represent complex eligibility criteria. Objective The study aims to develop a patient-screening tool based on EHRs for clinical research using openEHR to solve concept mismatch and improve query performance. Methods A patient-screening tool based on EHRs using openEHR was proposed. It uses the advantages of information models and EL in openEHR to provide high-level expressions and improve query performance. First, openEHR archetypes and templates were chosen to define concepts called simple concepts directly from EHRs. Second, openEHR EL was used to generate derived concepts by combining simple concepts and constraints. Third, a hierarchical index corresponding to archetypes in Elasticsearch (ES) was generated to improve query performance for subqueries and join queries related to the derived concepts. Finally, we realized a patient-screening tool for clinical research. Results In total, 500 sentences randomly selected from 4691 eligibility criteria in 389 clinical trials on stroke from the Chinese Clinical Trial Registry (ChiCTR) were evaluated. An openEHR-based clinical data repository (CDR) in a grade A tertiary hospital in China was considered as an experimental environment. Based on these, 589 medical concepts were found in the 500 sentences. Of them, 513 (87.1%) concepts could be represented, while the others could not be, because of a lack of information models and coarse-grained requirements. In addition, our case study on 6 queries demonstrated that our tool shows better query performance among 4 cases (66.67%). Conclusions We developed a patient-screening tool using openEHR. It not only helps solve concept mismatch but also improves query performance to reduce the burden on researchers. In addition, we demonstrated a promising solution for secondary use of EHR data using openEHR, which can be referenced by other researchers.

Introduction The National Cancer Institute defines financial toxicity as “problems a patient has related to costs of cancer care.” Financial toxicity is a critical problem in cancer treatment and one that remains conventionally outside of clinical discussion and treatment decision-making. Methods This is a feasibility pilot study of the implementation of a medical oncology fellow-led financial toxicity screening intervention program at the Helen Diller Family Comprehensive Cancer Center (HDFCCC) at the University of California San Francisco. Fellows were asked to conduct and document financial toxicity screening of patients seen in medical oncology outpatient clinics from August 2017 to March 2018 in the electronic medical record. Results At baseline, no fellows documented financial toxicity screening. Screening rates peaked at 49%, however at the end of the intervention the screening rate decreased to 11% among participants. Discussion The results of the pilot feasibility study revealed that a fellow-led financial toxicity screening program in medical oncology clinics rendered low adherence to patient screening. Future research will need to develop mechanisms for identifying patients who may experience high levels of financial distress in medical oncology practice.

Summary:. Physicians attempted to continue providing patient care through the SARS-CoV2 (COVID-19) pandemic. Surgeons embraced telemedicine as patient evaluation transitioned from physical encounters to virtual appointments. However, there is a paucity in the literature on the utility of telemedicine within plastic surgery or how it can meet patients’ needs. A survey study was created to assess surgeons’ involvement and experience with telemedicine. Subjective experience was assessed on a five-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). This survey was distributed to the members of the American Society of Plastic Surgeons. Data were collected and analyzed via RedCap. Of the total 177 plastic surgeons who responded, 139 (78.5%) surgeons reported the implementation of telemedicine during the pandemic. Plastic surgeons felt that they were able to establish rapport (3.9 ± 0.9), meet the goals of the encounter (3.6 ± 1.0), and efficiently evaluate patients (3.5 ± 1.2). Plastic surgeons reported their overall experience was between helpful and neutral (3.2 ± 1.3). Most plastic surgeons have implemented telemedicine in their practice. The majority of telemedicine use was for breast, cosmetic, and reconstructive patient care. Telemedicine was most frequently used for initial patient screening and routine postoperative visits. Surgeons plan to continue using telemedicine when appropriate for patient screening and routine or unexpected postoperative visits in the future. Many have found utility of telemedicine in providing patient care and it is likely that telemedicine will be a part of routine practice moving forward.

Ultrasensitive molecular diagnostics are lowering the limit of detection for malaria parasites in the blood and providing insights not captured by conventional tools such as microscopy and rapid antigen tests. Low-level malaria infections identified by molecular tools may influence clinical outcomes, transmission events, and elimination efforts. While many ultrasensitive molecular methods require well-equipped laboratories, technologies such as loop-mediated isothermal amplification and recombinase polymerase amplification provide more portable and analytically sensitive solutions. These tools may benefit asymptomatic patient screening, antenatal care, and elimination campaigns. We review the recent evidence, offer our perspective on the impact of these new tests, and identify future research priorities.

ObjectivesTo design and evaluate a novel automated glaucoma classifier from retinal fundus images.MethodsWe designed a novel Artificial Intelligence (AI) automated tool to detect glaucoma from retinal fundus images. We then downloaded publicly available retinal fundus image datasets containing healthy patients and images with verified glaucoma labels. Two thirds of the images were used to train the classifier. The remaining third of the images was used to create several cross-validation evaluation sets with a realistic glaucoma prevalence, to evaluate the classifier’s performance in a screening scenario.Results10,658 retinal fundus images from seven different sources were found and downloaded. They were randomly divided into 7,106 for training and 3,551 for validation. Glaucoma prevalence was 24%. Using the validation set, we created 50 random sets of 1,000 images with a 5% glaucoma prevalence. On these sets, the classifier reached a detection rate of 84.1% (CI 95=+-1.1%) and 95.8% (CI 95=+-0.2%) specificity.ConclusionsA novel glaucoma classifier from retinal fundus images showed promising results as screening tool on a large cohort of patients. A large clinical study is needed to confirm these results.

To examine the effectiveness of an empiric protection protocol during oral surgical treatments in a COVID-19 pandemic area and to evaluate the potential effect of postponed dental procedures on the frequency of facial infections during a lockdown period. We performed a retrospective analysis of a case series of a broad-spectrum of oral surgeries in a COVID-19 pandemic area. Data collection included patient age, type of procedure performed, and COVID-19 status of staff and patients. Data were analyzed using descriptive statistics. Between February 21 and April 23, 2020, 1471 patients were treated in the outpatient clinic (n=1404) and under general anesthesia (n=67). All procedures were carried out under a strict empiric protective protocol that included patient screening, personal protective equipment allocation protocol, frequent staff testing, and patient testing before general anesthesia. Treatments included emergency and urgent elective procedures. Only one staff member was confirmed positive for COVID-19 during routine weekly testing, and an independent epidemiologic investigation suggested he was likely infected outside of hospital facilities. Our empiric protective protocol was found to be effective in preventing staff cross-infection with COVID-19 in an oral and maxillofacial surgery setting. To the best of our knowledge, this is the first report that provides data regarding oral surgical activity in a COVID-19 pandemic area. Our suggested protective protocol may assist oral surgeons in continuing dental services in a safe manner.

Background Aerosol and droplet production is inherent to dentistry. Potential for COVID-19 spread through aerosols and droplets characterizes dentistry as having a high risk of experiencing viral transmission, with necessity for aerosol and droplet mitigation. Methods Simulations of restorative treatment were completed on a dental manikin with a high-speed handpiece and high-volume evacuation suction. Variable experimental conditions with use of an extraoral vacuum suction at different distances from the simulated patient's mouth and different vacuum settings were tested to evaluate extraoral suction ability for droplet reduction. Results Using the extraoral suction unit during dental procedure simulations reduced droplet spatter at the dentist’s eye level, as well as the level of the simulated patient's mouth. When the extraoral suction unit was used at level 10 and 4 inches from the simulated patient's mouth, less spatter was detected. Conclusions Extraoral suction units are an effective method of reducing droplet spatter during operative dental procedures and can be useful in helping reduce risk of experiencing COVID-19 spread during dental procedures. Practical Implications During the pandemic, dentistry and its aerosol-generating procedures were placed on hold. The process to getting back to patient care is multifactorial, including personal protective equipment, patient screening, and mitigating aerosol spread.

Aim: In osteoarthritis (OA) there is a need for automated screening systems for early detection of structural progressors. We built a comprehensive machine learning (ML) model that bridges major OA risk factors and serum levels of adipokines/related inflammatory factors at baseline for early prediction of at-risk knee OA patient structural progressors over time. Methods: The patient- and gender-based model development used baseline serum levels of six adipokines, three related inflammatory factors and their ratios (36), as well as major OA risk factors [age and bone mass index (BMI)]. Subjects (677) were selected from the Osteoarthritis Initiative (OAI) progression subcohort. The probability values of being structural progressors (PVBSP) were generated using our previously published prediction model, including five baseline structural features of the knee, i.e. two X-rays and three magnetic resonance imaging variables. To identify the most important variables amongst the 47 studied in relation to PVBSP, we employed the ML feature classification methodology. Among five supervised ML algorithms, the support vector machine (SVM) demonstrated the best accuracy and use for gender-based classifiers development. Performance and sensitivity of the models were assessed. A reproducibility analysis was performed with clinical trial OA patients. Results: Feature selections revealed that the combination of age, BMI, and the ratios CRP/MCP-1 and leptin/CRP are the most important variables in predicting OA structural progressors in both genders. Classification accuracies for both genders in the testing stage (OAI) were >80%, with the highest sensitivity of CRP/MCP-1. Reproducibility analysis showed an accuracy ⩾92%; the ratio CRP/MCP-1 demonstrated the highest sensitivity in women and leptin/CRP in men. Conclusion: This is the first time that such a framework was built for predicting knee OA structural progressors. Using this automated ML patient- and gender-based model, early prediction of knee structural OA progression can be performed with high accuracy using only three baseline serum biomarkers and two risk factors. Plain language summary Machine learning model for early knee osteoarthritis structural progression Knee osteoarthritis is a well-known debilitating disease leading to reduced mobility and quality of life – the main causes of chronic invalidity. Disease evolution can be slow and span many years; however, for some individuals, the progression/evolution can be fast. Current treatments are only symptomatic and conventional diagnosis of osteoarthritis is not very effective in early identification of patients who will progress rapidly. To improve therapeutic approaches, we need a robust prediction model to stratify osteoarthritis patients at an early stage according to risk of joint structure disease progression. We hypothesize that a prediction model using a machine learning system would enable such an early identification of individuals for whom osteoarthritis knee structure will degrade rapidly. Data were from the Osteoarthritis Initiative, a National Institute of Health (United States) databank, and the robustness and generalizability of the developed model was further evaluated using osteoarthritis patients from an external cohort. Using the supervised machine learning system (support vector machine), we developed an automated patient- and gender-based model enabling an early clinical prognosis for individuals at high risk of structural progressive osteoarthritis. In brief, this model employed at baseline (when the subject sees a physician) easily obtained features consisting of the two main osteoarthritis risk factors, age and bone mass index (BMI), in addition to the serum levels of three molecules. Two of these molecules belong to a family of factors names adipokines and one to a related inflammatory factor. In brief, the model comprising a combination of age, BMI, and the ratios CRP/MCP-1 and leptin/CRP were found very robust for both genders, and the high accuracy persists when tested with an external cohort conferring the gender-based model generalizability. This study offers a new automated system for identifying early knee osteoarthritis structural progressors, which will significantly improve clinical prognosis with real time patient monitoring.

Since the beginning of the pandemic we have recorded a total of 3,355 healthcare workers (HCW) screened at Emergency & Trauma Department (ETD) of Sabah Women and Childrens Hospital (HWKSS). This amounted to 8,823 swabs taken for HCWs from a total of 21,367 swabs taken in ETD during the same period. The average swab per HCW was 2.62 swab/person. Data for patient screening are not included in this paper. From the 8,823 swabs taken, 46 HCWs were detected positive for Covid-19.

Objective Restriction in healthcare services during the COVID-19 pandemic caused delays in the diagnosis and treatment of several diseases. To overcome the risk of missed diagnosis of head and neck cancers, before deleting the scheduled appointments, we have introduced a selection of the patients by examining the clinical presenting issue and previous medical history. The aim of this study is to show the effects of the abovementioned strategy on the diagnosis and management of laryngeal cancer. Methods Data were extracted from the Hospital software regarding the new diagnosis of laryngeal SCC in the periods from March 2020 to December 2020 during the pandemic (study group) and from March 2019 to December 2019 (control group) were collected. Data were compared regarding: TNM stage, time from first medical examination to histological diagnosis (Time-1), and time form histological diagnosis to beginning of treatments (Time-2). Results The final study group was composed by 19 laryngeal cancers, the control group by 25 cases. No significant differences were found in the tumour stage between the groups. In the study group, Time-1 was shorter (24 days versus 43 days, p = 0.012), while Time-2 in surgically-treated patients was longer (20 days versus 9 days, p = 0.012). Conclusion During the pandemic, there was a dramatic lack of medical and nurse staff needed for surgical procedures. As consequence, the time between the diagnosis of malignancy and surgical treatment increased. In our unit, an efficient patient selection strategy to reschedule medical appointments avoided a dangerous shift toward higher laryngeal cancer stages.

Several rapid antigen tests (RATs) for the detection of SARS-CoV-2 were evaluated recently. However, reliable performance data for laboratory-based, high-throughput antigen tests are lacking. Therefore and in response to a short-term shortage of PCR reagents, we evaluated DiaSorin's LIAISON SARS-CoV-2 antigen test in comparison to RT-qPCR, and concerning the application of screening non-COVID-19 patients on hospital admission. Applying the manufacturer-recommended cut-off of 200 arbitrary units (AU/mL) the specificity of the LIAISON Test was 100%, the overall analytical sensitivity 40.2%. Lowering the cut-off to 100 AU/mL increased the sensitivity to 49.7% and decreased the specificity to 98.3%. Confining the analysis to samples with an RT-qPCR result

Recently, the role of AI in the development of eHealth is becoming increasingly ambitious since AI is allowing the development of whole new healthcare areas. In many cases, AI offers the possibility to support patient screening and monitoring through low-cost, non-invasive tests. One of the most relevant sectors in which a great contribution from AI is expected is that of neurodegenerative diseases, which represent one of the most important pathologies in Western countries with very serious follow up not only clinical, but also social and economic.

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Article Title and Bibliographic Information Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19). Nishiura H, Kobayashi T, Miyama T, et al. Int J Infect Dis 2020;94:154-155. https://doi.org/10.1016/j.ijid.2020.03.020 . Source of Funding Self-funded. Type of Study/Design Cross-sectional population study.

Objetivo: avaliar a execução do serviço de triagem de pacientes realizada na Clínica da Família de Nova Colina – Brasília, Brasil. Metodologia: Trata-se de um relato de experiência produzido a partir da vivência de discentes do curso de Medicina na elaboração e execução de uma simulação realística com os servidores da Estratégia de Saúde da Família Nova Colina/ DF com base nas demandas de dúvidas dos funcionários da Clínica da Família sobre a triagem dos pacientes. Aplicaram-se questionários previamente à simulação para levantamento das demandas e posteriormente para avaliação do conhecimento. Após, houve distribuição de material de apoio. Conclusão: verificou-se que há deficiências técnicas e teóricas dos profissionais da Clínica da Família quanto ao atendimento de triagem preconizado pelo Ministério da Saúde.

Background: The delivery of systemic anticancer therapy during the COVID-19 pandemic is extremely challenging Increased hospital visits and active anticancer therapy have been described as risk factors for developing more severe infection In order to balance the benefits of continuing anticancer therapy with these risks, we undertook a series of system changes in the delivery of cancer care We examined the rate of COVID-19 infection in patients attending for systemic anticancer treatments and the impact of COVID-19 on therapy delivered at our oncology dayward Methods: Patients who attended our dayward over a 4 month period were included Data were obtained from electronic patient records and chemotherapy prescribing records Patients were screened for symptoms of COVID-19 infection at two separate timepoints: the day prior to their visit via telephone, and using a symptom questionnaire given in a preassessment area on arrival at the hospital This area was established so that patients didn't have to transit through the main hospital If patients displayed COVID-19 symptoms, they were isolated and a viral swab was arranged Results: A total of 456 patients attended from January 1st to April 30th During this time there were 2369 patient visits to the oncology dayward and 1953 intravenous therapies administered 416 (18%) visits did not lead to treatments, 114 (27%) of which were scheduled non-treatment visits 194 (47%) treatments were held due to disease-related illness and 108 (26%) treatments were held due to treatment-related complications 19 patients were identified as having COVID-19 symptoms via telephone screening 34 patients were symptomatic on arrival at our pre-assessment area and referred for swabs, of which 4 were positive Those with a negative swab were rescheduled for chemotherapy the following week Overall, 53 treatments were held due to the screening process Conclusions: With the introduction of a new patient screening pathway, there have been few treatment disruptions due to the COVID-19 pandemic The overall rate of symptomatic COVID-19 infection appears low in those who continue on active treatments with regular hospital visits With careful systematic changes, it is feasible to continue to safely deliver systemic anticancer therapy during the COVID-19 pandemic Legal entity responsible for the study: The authors Funding: Has not received any funding Disclosure: All authors have declared no conflicts of interest

IntroductionAn amphibious assault ship was deployed on 22 March in Corsica to carry out medical evacuation of 12 critical patients infected with COVID-19. The ship has on-board hospital capacity and is the first time that an amphibious assault ship is engaged in this particular condition. The aim is to evaluate the feasibility and safety of prolonged medical evacuation of critical patients with COVID-19.MethodsWe included 12 patients with confirmed COVID-19 infection: six ventilated patients with acute respiratory distress syndrome and six non-ventilated patients with hypoxaemia. Transfer on an amphibious assault ship lasted 20 hours. We collected patients’ medical records: age, comorbidities, COVID-19 history and diagnosis, ventilation supply and ventilator settings, and blood gas results. We calculated oxygen consumption (OC).ResultsAll patients had a medical history. The median delay from onset of symptoms to hospitalisation was 8 (7–10) days. The median Sequential Organ Failure Assessment score on admission was 3 (2–5). There was no significant increase in oxygen during ship transport and no major respiratory complication. There was no significant increase in arterial oxygen pressure to fractional inspired oxygen ratio among ventilated patients during ship transport. Among ventilated patients, the median calculated OC was 255 L (222–281) by hours and 5270 L (4908–5616) during all ship transport. Among non-ventilated patients, the median calculated OC was 120 L (120–480) by hours and 2400 L (2400–9600) during all ship transport.ConclusionThe present work contributes to assessing the feasibility and safety condition of critical COVID-19 evacuation on an amphibious assault ship during an extended transport. The ship needs to prepare a plan and a specialised intensive team and conduct patient screening for prolonged interhospital transfers.

Article Summary In the context of the COVID-19 pandemic this study showed feasibility and efficacy of systematic preoperative screening for SARS-CoV-2 by chest CT and RT-PCR on nasopharyngeal swabs. This screening strategy allowed performing safely the majority of scheduled oncological interventions., Highlights TOC Statement- 20200658 In the context of the COVID-19 pandemic, this report shows feasibility and efficacy of systematic, preoperative screening for SARS-CoV-2 by chest computed tomography and real-time reverse transcriptase polymerase chain reaction on nasopharyngeal swabs. This screening strategy allowed performing the majority of scheduled oncologic interventions safely for both the patients and the staff.

Highlights •Digital survey applications can be used to create highly infectious disease screening tools•Digital screening tools simplify patient screening for non-clinical staff at facility entrances•Digital screening tools can be monitored remotely to assist with complianceQuick identification and isolation of patients with highly infectious diseases is extremely important in healthcare settings today. This study focused on the creation of a digital screening tool using a free and publicly available digital survey application to screen patients during a measles outbreak in New York City. The results indicate that digital tools are an effective alternative to paper tools due to their ease of use and remote compliance monitoring capabilities.

Coronavirus Disease 2019 (COVID-19) is currently a global pandemic, and early screening is one of the key factors for COVID-19 control and treatment. Here, we developed and validated chest CT-based imaging biomarkers for COVID-19 patient screening from two independent hospitals with 419 patients. We identified the vasculature-like signals from CT images and found that, compared to healthy and community acquired pneumonia (CAP) patients, COVID-19 patients display a significantly higher abundance of these signals. Furthermore, unsupervised feature learning led to the discovery of clinical-relevant imaging biomarkers from the vasculature-like signals for accurate and sensitive COVID-19 screening that have been double-blindly validated in an independent hospital (sensitivity: 0.941, specificity: 0.920, AUC: 0.971, accuracy 0.931, F1 score: 0.929). Our findings could open a new avenue to assist screening of COVID-19 patients.

There is a constantly evolving knowledgebase regarding the safety of MRI in pregnant patients, as well as the safety of gadolinium administration, given potential fetal risks. This review provides an overview of national and international recommendations for patient screening and safety by trimester, evaluates the most recent literature regarding administration of gadolinium in pregnant patients, and discusses technical requirements when imaging pregnant patients. A protocol for imaging pregnant patients is provided, and multiple common indications for MRI in pregnancy are discussed. Level of Evidence 5. Technical Efficacy Stage 5. J. Magn. Reson. Imaging 2019;49:621-631.

In clinical practice, doctors are using bedside tests to assist in the diagnosis of paraparesis. The disadvantage is that it depends on the doctor's clinical experience and the supervisor's judgment. Therefore, there is an urgent need for an objective and efficient diagnostic equipment. With the rapid development of wireless technology, ubiquitous RF signals become a promising sensing technology. In this study, we propose a non-contact wireless sensing method based on RF signals to detect paraparesis. Our system can reduce the burden on doctors and improve work efficiency. Outlier filters and wavelet hard threshold decomposition are used to filter the wireless signal. A 1D-CNN model is designed to automatically extract valid features and classifications. The results analyze in two bedside tests, our system perform efficiently and accurately patient screening with suspected paraparesis. This provide more effective guidance and assistance for further treatment. The proposed method has an average accuracy of 99.4% and 98.5% in the Barre test and Mingazzini test respectively.

Worldwide Coronavirus Disease 2019 (COVID‐19) epidemic makes the management of acute myocardial infarction (AMI) more complicated, effective treatment without further dissemination is thus quite challenging. Recently, we successfully treated three representative AMI cases, by sharing these detailed procedures, we summarized some important issues including patient screening, reperfusion strategy selecting, personnel/catheter lab protection principle, as well as operation tactics, which may lend precious experience on AMI treating during the ongoing COVID‐19 pandemic situation.

A large number of patient visits to the Emergency Department (ED) will influence the outcome of the services provided. The triage scale is one method designed to manage patient screening for quality service improvement. Several triage scales are employed internationally in the EDs including the Australasian Triage Scale (ATS), the Manchester Triage System (MTS), the Canadian Triage and Accuracy Scale (CTAS), and the Emergency Severity Index (ESI). Several studies have a concern to identify the reliability of the triage scale, but only a few of them identified the accuracy of the triage scale. The purpose of this literature review was to identify the best reliability and accuracy among ATS, MTS, CTAS, and ESI based on the literature. The literature search was conducted on electronic databases EBSCO and PubMed with keywords including (triage OR emergency department triage) AND reliability AND ((the Canadian Triage and Accuracy Scale OR CTAS) AND (the Australasian Triage Scale OR ATS) AND (the Manchester Triage System OR MTS) AND the Emergency Severity Index OR ESI)). Assessment of articles was composed based on the PRISMA format with criteria including primary research articles containing the reliability and accuracy of the triage scale in English and published between 2009 – 2019. A total of 271 publications were identified and only 10 studies were included in this literature review. The results reveal that ATS has a moderate level of reliability (k = 04 – 0.57) with an accuracy of 46.2% – 58.3%, CTAS has a good level reliability (k = 0.770) with accuracy of 49%, MTS have good to excellent level of reliability (k = 0.61 – 0.95) with accuracy of 49%, and ESI have moderate to excellent level reliability (k = 0.45 – 0.94) with accuracy of 59.6 % – 72.5%. Based on this review, MTS and ESI are the triage scale with the highest reliability and accuracy. Therefore, MTS and ESI are highly recommended in the ED. However, each EDs need to pay attention to the characteristics, culture, and available resources before choosing and implementing an appropriate triage scale.

Transcatheter aortic valve implantation (TAVI) has emerged as the gold standard technique for all patients with symptomatic severe aortic stenosis at elevated surgical risk. Much progress has been made to reduce procedural complications and improve patient outcomes. The impressive results of contemporary TAVI can be attributed to a variety of factors, including improving operator experience, pre-operative patient screening, and developments in transcatheter heart valve and delivery system technology. Despite these advances, serious procedural complications continue to occur and there remain some anatomical subsets and patient groups to whom TAVI technology has not been expanded. Herein we discuss these unmet needs in TAVI.

Apolipoprotein E (apoE) is a 34 kDa glycoprotein involved in lipid metabolism. The human APOE gene encodes for three different apoE protein isoforms: E2, E3 and E4. The interest in apoE isoforms is high for epidemiological research, patient stratification and identification of those at increased risk for clinical trials and prevention. The isoform apoE4 is associated with increased risk for coronary heart and Alzheimer's diseases. This paper describes a method for specifically detecting the apoE4 isoform from biological fluids by taking advantage of the capacity of apoE to bind "specifically" to polystyrene surfaces as capture and a specific anti-apoE4 monoclonal antibody as reporter. Our results indicate that the apoE-polystyrene binding interaction is highly stable, resistant to detergents and acid and basic washes. The methodology here described is accurate, easily implementable, fast and cost-effective. Although at present, our technique is unable to discriminate homozygous APOE ε4/ε4 from APOE ε3/ε4 and ε2/ε4 heterozygous, it opens new avenues for the development of inexpensive, yet effective, tests for the detection of apoE4 for patients' stratification. Preliminary results indicated that this methodology is also adaptable into turbidimetric platforms, which make it a good candidate for clinical implementation through its translation to the clinical analysis routine. The authors thank all the patients, hospitals, and institutions that made this study possible. We thank Pablo Cabello and Carlo Zanotti for their decisive role throughout the course of this project, and Elisenda Rodón, Almudena Pérez and Sergi Gassó from Pragmatic Diagnostics (Barcelona, Spain) for their work on the adaptation of the method to immunoturbidimetry. We also thank Montserrat Puntes (MD.) and Maria Teresa Garrido (MSc.) from the Centre for Drug Research (CIM) of the Hospital de la Santa Creu i Sant Pau for their collaboration on the project entitled “Study for the development of a non-genetic test in blood for the identification of carriers of the ε4 alelle of the APOE gene (APOE ε4)” (Code: BCR-2017-01). Sí

Objetivo: relatar a experiência de enfermeiros na gerência do cuidado ao paciente no serviço de métodos endoscópicos gástricos. Método: trata-se de um relato de experiência da vivência profissional de um grupo de enfermeiros no Serviço de Métodos Endoscópicos Gástricos, em um hospital do Rio de Janeiro, em março 2020-21. Resultados: a vivência profissional no período de pandemia possibilitou a reflexão sobre a prática do enfermeiro na gerência das ações de cuidados havendo, nas ações diretas, a implementação de protocolos, como o de triagem do paciente, e ajustes em outros, como, o de recuperação pós-procedimento; e nas ações indiretas, cálculos sobre previsão e provisão de materiais e equipamentos, modificações nos fluxos de trabalho, fixação de sinalizações e reforços teórico-práticos nas rotinas de desinfecção e limpeza. Considerações finais: a experiência permitiu o desenvolvimento de um olhar crítico e reflexivo acerca das ações gerenciais e das medidas de biossegurança, em vigência de pandemia, favorecendo o raciocínio clínico e o aprimoramento das ações diretas e indiretas contemplando paciente, família/acompanhante, profissionais e instituição.

Subcutaneous Implantable Cardioverter-Defibrillators (S-ICDs) are used for prevention of sudden cardiac death triggered by ventricular arrhythmias. T Wave Over Sensing (TWOS) is an inherent risk with S-ICDs which can lead to inappropriate shocks. A major predictor of TWOS is a high T:R ratio (the ratio between the amplitudes of the T and R waves). Currently patients' Electrocardiograms (ECGs) are screened over 10 seconds to measure the T:R ratio, determining the patients' eligibility for S-ICD implantation. Due to temporal variations in the T:R ratio, 10 seconds is not long enough to reliably determine the normal values of a patient's T:R ratio. In this paper, we develop a convolutional neural network (CNN) based model utilising phase space reconstruction matrices to predict T:R ratios from 10-second ECG segments without explicitly locating the R or T waves, thus avoiding the issue of TWOS. This tool can be used to automatically screen patients over a much longer period and provide an in-depth description of the behaviour of the T:R ratio over that period. The tool can also enable much more reliable and descriptive screenings to better assess patients' eligibility for S-ICD implantation.

Assessment of elbow flexion strength is an important component of upper limb neurological examination and is necessary for patient screening, planning of surgical interventions and rehabilitation. Medical Research Council (MRC) Scale is the most widely used method for grading muscle strength. The major drawback of MRC grading is that it is observer dependent and imprecise. A quantitative measure of elbow flexion strength is an objective measure that eliminates such bias. Several instruments have been developed for quantifying the elbow flexion power. However, availability, quality and measuring standards vary widely between these instruments most being cumbersome and expensive. We report the design of an instrument that is simple and cost effective for quantifying elbow flexion strength objectively. The validity of elbow flexion strength obtained from normal participants using this in-house instrument supports its clinical use in patients with brachial plexus injury.

Background/Aims: A potential use of biomarkers is to assist in prognostic enrichment of clinical trials, where only patients at relatively higher risk for an outcome of interest are eligible for the trial. We investigated methods for evaluating biomarkers for prognostic enrichment. Methods: We identified five key considerations when considering a biomarker and a screening threshold for prognostic enrichment: (1) clinical trial sample size, (2) calendar time to enroll the trial, (3) total patient screening costs and the total per-patient trial costs, (4) generalizability of trial results, and (5) ethical evaluation of trial eligibility criteria. Items (1)–(3) are amenable to quantitative analysis. We developed the Biomarker Prognostic Enrichment Tool for evaluating biomarkers for prognostic enrichment at varying levels of screening stringency. Results: We demonstrate that both modestly prognostic and strongly prognostic biomarkers can improve trial metrics using Biomarker Prognostic Enrichment Tool. Biomarker Prognostic Enrichment Tool is available as a webtool at http://prognosticenrichment.com and as a package for the R statistical computing platform. Conclusion: In some clinical settings, even biomarkers with modest prognostic performance can be useful for prognostic enrichment. In addition to the quantitative analysis provided by Biomarker Prognostic Enrichment Tool, investigators must consider the generalizability of trial results and evaluate the ethics of trial eligibility criteria.