Browsing by Subject "Testing"
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Item Attitudes and Experiences of Frontline Nursing Home Staff Towards Coronavirus Testing(Elsevier, 2020-11-05) Hofschulte-Beck, Spencer L.; Hickman, Susan E.; Blackburn, Justin L.; Mack, Laramie M.; Unroe, Kathleen T.; Medicine, School of MedicineThe Indiana State Department of Health tested nursing home staff for COVID-19 in June 2020. A survey of staff found many felt physical discomfort, some questioned testing the asymptomatic, but a majority agreed testing is important.Item Bayesian Modeling of COVID-19 Positivity Rate -- the Indiana experience(arXiv, 2020-07-09) Boukai, Ben; Wang, Jiayue; Mathematical Sciences, School of ScienceIn this short technical report we model, within the Bayesian framework, the rate of positive tests reported by the the State of Indiana, accounting also for the substantial variability (and overdispeartion) in the daily count of the tests performed. The approach we take, results with a simple procedure for prediction, a posteriori, of this rate of ’positivity’ and allows for an easy and a straightforward adaptation by any agency tracking daily results of COVID-19 tests. The numerical results provided herein were obtained via an updatable R Markdown document.Item Clinician Perceptions of a Computerized Decision Support System for Pediatric Type 2 Diabetes Screening(Thieme, 2020-03) El Mikati, Hala K.; Yazel-Smith, Lisa; Grout, Randall W.; Downs, Stephen M.; Carroll, Aaron E.; Hannon, Tamara S.; Pediatrics, School of MedicineObjective: With the increasing prevalence of type 2 diabetes (T2D) in youth, primary care providers must identify patients at high risk and implement evidence-based screening promptly. Clinical decision support systems (CDSSs) provide clinicians with personalized reminders according to best evidence. One example is the Child Health Improvement through Computer Automation (CHICA) system, which, as we have previously shown, significantly improves screening for T2D. Given that the long-term success of any CDSS depends on its acceptability and its users' perceptions, we examined what clinicians think of the CHICA diabetes module. Methods: CHICA users completed an annual quality improvement and satisfaction questionnaire. Between May and August of 2015 and 2016, the survey included two statements related to the T2D-module: (1) "CHICA improves my ability to identify patients who might benefit from screening for T2D" and (2) "CHICA makes it easier to get the lab tests necessary to identify patients who have diabetes or prediabetes." Answers were scored using a 5-point Likert scale and were later converted to a 2-point scale: agree and disagree. The Pearson chi-square test was used to assess the relationship between responses and the respondents. Answers per cohort were compared using the Mann-Whitney U-test. Results: The majority of respondents (N = 60) agreed that CHICA improved their ability to identify patients who might benefit from screening but disagreed as to whether it helped them get the necessary laboratories. Scores were comparable across both years. Conclusion: CHICA was endorsed as being effective for T2D screening. Research is needed to improve satisfaction for getting laboratories with CHICA.Item Community COVID-19 activity level and nursing home staff testing for active SARS-CoV-2 infection in Indiana(Elsevier, 2020) Blackburn, Justin; Weaver, Lindsay; Cohen, Liza; Menachemi, Nir; Rusyniak, Dan; Unroe, Kathleen T.; Health Policy and Management, School of Public HealthObjectives: To assess whether using coronavirus disease 2019 (COVID-19) community activity level can accurately inform strategies for routine testing of facility staff for active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design: Cross-sectional study. Setting and Participants: In total, 59,930 nursing home staff tested for active SARS-CoV-2 infection in Indiana. Measures: Receiver operator characteristic curves and the area under the curve to compare the sensitivity and specificity of identifying positive cases of staff within facilities based on community COVID-19 activity level including county positivity rate and county cases per 10,000. Results: The detection of any infected staff within a facility using county cases per 10,000 population or county positivity rate resulted in an area under the curve of 0.648 (95% confidence interval 0.601‒0.696) and 0.649 (95% confidence interval 0.601‒0.696), respectively. Of staff tested, 28.0% were certified nursing assistants, yet accounted for 36.9% of all staff testing positive. Similarly, licensed practical nurses were 1.4% of staff, but 4.7% of positive cases. Conclusions and Implications: We failed to observe a meaningful threshold of community COVID-19 activity for the purpose of predicting nursing homes with any positive staff. Guidance issued by the Centers for Medicare and Medicaid Services in August 2020 sets the minimum frequency of routine testing for nursing home staff based on county positivity rates. Using the recommended 5% county positivity rate to require weekly testing may miss asymptomatic infections among nursing home staff. Further data on results of all-staff testing efforts, particularly with the implementation of new widespread strategies such as point-of-care testing, is needed to guide policy to protect high-risk nursing home residents and staff. If the goal is to identify all asymptomatic SARS-Cov-2 infected nursing home staff, comprehensive repeat testing may be needed regardless of community level activity.Item COVID-19 and saliva: A primer for dental health care professionals(Wiley, 2020-08-23) Srinivasan, Mythily; Thyvalikakath, Thankam P.; Cook, Blaine N.; Zero, Domenick T.; Oral Pathology, Medicine and Radiology, School of DentistryTo contain the COVID‐19 pandemic, it is essential to find methods that can be used by a wide range of health care professionals to identify the virus. The less potential contagious nature of the collection process, the ease of collection and the convenience of frequent collection for real‐time monitoring makes saliva an excellent specimen for home‐based collection for epidemiological investigations. With respect to COVID‐19, the use of saliva offers the added advantages of greater sensitivity and potential for detection at an early stage of infection. However, the advantages from a diagnostic perspective also reflect the potential risk to dental professionals from saliva from infected patients. Although not validated in COVID‐19 patients, but by extension from studies of SARS‐CoV‐1 studies, it is suggested that using antimicrobial mouthrinses such as chlorhexidine, hydrogen peroxide or sodium hypochlorite solutions could reduce the viral load in saliva droplets and reduce the risk of direct transmission. Because large saliva droplets could deposit on inanimate surfaces, changing the personal protective equipment including the clinical gown, gloves, masks, protective eye wear and face shield between patients, as well as decontamination of the work surfaces in the clinic, could reduce the risk of indirect contact transmission.Item Development of Patient Resource for Lecanemab APOE Genetic Testing(Wiley, 2025-01-09) Klee, Victoria; Dratch, Laynie; Fong, Jamie C.; Freeman, Abigail A.; Rumbaugh, Malia C.; Medical and Molecular Genetics, School of MedicineCurrent joint practice guidelines (PG) on genetic counseling and testing for Alzheimer’s disease (AD), published in 2011 by the National Society of Genetic Counselors (NSGC) and American College of Medical Genetics), recommend against clinical APOE genetic testing. These recommendations were largely followed, as seen in a survey of AD Research Centers in 2019 where only 7% of centers reported disclosure of APOE to research participants. However, because the risk of amyloid related imaging abnormalities (ARIA) associated with anti‐amyloid therapy is increased for those with one or two copies of APOE e4, the FDA now endorses APOE testing for those considering this treatment. The current PG states that APOE testing should only occur within the context of genetic counseling. Because AD is a common disease, it is not feasible for genetic counselors to see every patient with MCI or early‐stage AD considering anti‐amyloid therapy. APOE testing is complex, with implications not only for the patient, but for their family members. This has created a need for patient‐facing educational materials and revised clinical guidelines, including when to refer for genetic counseling. The NSGC Dementia Workgroup has received approval to formally update the current PG. Meanwhile, we recognize the urgent need for patient‐facing materials. We therefore developed a factsheet on APOE testing for lecanemab to be used by any provider prescribing the therapy. It has been reviewed by stakeholder and professional groups to optimize utility. Additional multimedia resources are in development. Although there is a spotlight on APOE given the advances in anti‐amyloid therapeutics, the genetic landscape of AD is much more complicated and evolving. The future of genetic testing for AD includes broader dementia panel testing, exome and genome sequencing, proteomic testing for APOE and polygenic risk scores. Furthermore, APOE testing will likely expand to asymptomatic individuals for risk stratification and research participation. These new directions will increase the need for patient education and additional updates to the PG, as well as appropriate triage to maximize benefits from limited genetic counseling resources.Item ESL student perspectives on university classroom testing practices(Indiana University's Faculty Academy on Excellence in Teaching (FACET), 2010-11) Teemant, AnnelaESL students struggle to represent accurately on tests what they know. Understanding what constitutes equitable testing practices in university settings for ESL students poses a significant challenge to educators. This study reports on the content analysis of semi-structured interview data obtained from 13 university-level ESL students on their opinions, concerns, strategies, and preferences in testing. ESL students provide evidence that language proficiency, test anxiety, and preferences for particular test formats, such as multiple-choice over essay questions, affect their ability to demonstrate content knowledge. Students describe context, culture, and seven language-related problems in testing, and show awareness of various test-taking strategies. The results suggest practical implications for making testing outcomes more equitable for ESL students.Item Intermittent viral shedding in respiratory samples of patients with SARS-CoV-2: observational analysis with infection control implications(Elsevier, 2020-09-10) AlJishi, J.M.; Al-Tawfiq, Jaffar A.; Medicine, School of MedicineSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a global health concern since December 2019. It was feared that intermittent positive cases may indicate a reinfection as there were a number of patients who had positive reverse-transcriptase–polymerase-chain-reaction (RT-PCR) after an initial negative test. Here, we describe the occurrence of intermittent positive PCR and the duration of viral PCR positivity in patients with SARS-CoV-2 infection in patients admitted to Qatif Central Hospital, Saudi Arabia.Item Malignant effusions secondary to metastatic thyroid carcinomas: A review of 15 cases(Wiley, 2023) Mustafa, Mohamed Amin; Malenie, Renuka; Mir, Fatima; Hamadeh, Fatima; Policarpio‐Nicolas, Maria Luisa; Pathology and Laboratory Medicine, School of MedicineBackground: Malignant effusions secondary to thyroid carcinomas are rare, and publications on this topic are limited. This study presents a large cohort of thyroid carcinomas involving effusion cytology. Methods: A 20-year computerized search for fluid cytology diagnosed with thyroid malignancy was performed. The following data were collected: patients' demographics, clinical findings, and histologic diagnoses. The cytology slides and ancillary tests were reviewed. Results: Among 47,593 specimens, 15 thyroid carcinomas involving the pleural fluid from 11 patients were found. There were six males and five females with a mean age of 72 years. Ten patients with available follow-up died of their disease. Papillary thyroid carcinoma (PTC) was the only histologic type. Ten cytology cases were available for review. The cytologic findings common to all cases were nonspecific (clusters/three-dimensional architecture, enlarged irregular nuclei, and scant to abundant to vacuolated cytoplasm). The classic PTC features were not present in all cases (fine/powdery chromatin [80%], micronucleoli [70%], nuclear grooves [50%], papillary-like architecture [40%], psammoma bodies [40%], and pseudo-nuclear inclusions [20%; present on the cell block only]). In 11 of the 15 cases, the diagnosis was rendered with immunohistochemical stains performed on the cell block (paired box 8, thyroid transcription factor 1, and thyroglobulin). In four of the 15 cases, the cytologic diagnosis was made after a comparison with prior surgical pathology or fluid cytology. Conclusions: PTC is the most common histologic type of thyroid malignancy involving pleural effusion. Because the cytologic findings are nonspecific and classic PTC features are not always present, the clinical history in conjunction with immunohistochemical stains is helpful in arriving at the correct diagnosis.Item Multicenter registry of United States emergency department patients tested for SARS-CoV-2(Wiley, 2020-11-12) Kline, Jeffrey A.; Pettit, Katherine L.; Kabrhel, Christopher; Courtney, D. Mark; Nordenholz, Kristen E.; Camargo, Carlos A.; Emergency Medicine, School of MedicineThis paper summarizes the methodology for the registry of suspected COVID‐19 in emergency care (RECOVER), a large clinical registry of patients from 155 United States (US) emergency departments (EDs) in 27 states tested for SARS‐CoV‐2 from March–September 2020. The initial goals are to derive and test: (1) a pretest probability instrument for prediction of SARS‐CoV‐2 test results, and from this instrument, a set of simple criteria to exclude COVID‐19 (the COVID‐19 Rule‐Out Criteria—the CORC rule), and (2) a prognostic instrument for those with COVID‐19. Patient eligibility included any ED patient tested for SARS‐CoV‐2 with a nasal or oropharyngeal swab. Abstracted clinical data included 204 variables representing the earliest manifestation of infection, including week of testing, demographics, symptoms, exposure risk, past medical history, test results, admission status, and outcomes 30 days later. In addition to the primary goals, the registry will provide a vital platform for characterizing the course, epidemiology, clinical features, and prognosis of patients tested for COVID‐19 in the ED setting.