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[PMID]:28463870
[Au] Autor:Pines JM; Zocchi MS; Buchanan ME; Shah MN; Travers D
[Ad] Endereço:Center for Healthcare Innovation and Policy Research (Dr Pines and Mr Zocchi), Department of Emergency Medicine (Dr Pines), and School of Medicine and Health Sciences (Ms Buchanan), The George Washington University, Washington, District of Columbia; Department of Emergency Medicine, The University of Wisconsin-Madison (Dr Shah); and School of Nursing (Dr Travers) and Department of Emergency Medicine (Dr Travers), The University of North Carolina at Chapel Hill.
[Ti] Título:The Utility of Point-of-Care Testing at Emergency Department Triage by Nurses in Simulated Scenarios.
[So] Source:Adv Emerg Nurs J;39(2):152-158, 2017 Apr/Jun.
[Is] ISSN:1931-4493
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We developed and tested simulated patient scenarios to assess how normal or abnormal point-of-care (POC) test results at triage change prioritization decisions. This was a cross-sectional study where our team developed simulated scenarios and presented them to triage nurses from 3 academic medical centers. Twenty-four scenarios were constructed on the basis of 12 clinical indications from a protocol previously developed by our team. In each scenario, nurses were presented with 2 patients with the same Emergency Severity Index Version 4 (ESI v.4; Agency for Healthcare Research and Quality, Rockville, MD) triage level (Level 2 or Level 3). One of the patients met the inclusion criteria for POC testing under the protocol (cases), whereas the other patient did not (controls). Nurses were asked which of the 2 patients to prioritize first in 3 separate rounds: first without any POC test results, once with abnormal POC test results for case patients, and once with normal POC test results for case patients. Prioritization decisions that changed on the basis of abnormal POC results were defined as "up-triage" and prioritization decisions that changed on the basis of normal results were defined as "down-triage." A total of 39 nurses completed 468 scenarios. In scenarios without any POC test results, 42.3% of case patients were prioritized first. When POC test results were abnormal, 71.6% of cases were prioritized first. When POC test results were normal, 32.7% of case patients were prioritized first. An abnormal POC test resulted in up-triage in 32.5% of the scenarios. When POC test results were normal, there was down-triage in 18.6% of the scenarios. Up- and down-triage rates varied considerably by scenario and clinical indication. Point-of-care testing at emergency department triage results in reasonably high rates of up- and down-triage in simulated scenarios; however, POC tests for specific indications appear to be more useful than others.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência/organização & administração
Recursos Humanos de Enfermagem no Hospital
Testes Imediatos
Triagem
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1097/TME.0000000000000140


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[PMID]:28463867
[Au] Autor:McMahon B; Hudson J; Prewitt J; Carman MJ; Engleson M
[Ad] Endereço:Duke University Health System, Durham, North Carolina (Ms McMahon and Drs Hudson, Prewitt, and Carman); and Duke University Health System, Raleigh, North Carolina (Ms Engleson).
[Ti] Título:Measuring Fatigue in Triage: A Pilot Study.
[So] Source:Adv Emerg Nurs J;39(2):114-122, 2017 Apr/Jun.
[Is] ISSN:1931-4493
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:: Given the critical nature of triage in facilitating emergency department (ED) functions, an understanding of the factors that impact triage nurses' ability to accurately assign triage scores and the ways in which these factors may affect various patient outcomes is extremely important; yet, there exists a paucity of such research in the literature. To further develop this knowledge base, an investigation of triage nurse fatigue and the role it may play in the ability to accurately assign triage scores was developed. The purpose of this pilot study was to determine how the length of a triage shift affects perceived fatigue levels among triage nurses. This pilot study was conducted using a prospective, descriptive cohort design with 28 registered nurses at a university-affiliated community hospital in the southeastern United States. Fatigue data were collected every 2 hr while the subject was in triage over the course of eighteen 24-hr periods between November 2015 and April 2016. Fatigue was measured using a self-reported fatigue questionnaire that included 2 validated fatigue scales: Karolinska Sleepiness Scale and Samn-Perelli Seven-Point Fatigue Scale. Data were analyzed using SPSS and Microsoft Excel. Results indicate a strong correlation between the amount of time spent in triage and fatigue scores, with average fatigue scores increasing by 64.4%-75.2% over the course of a 12-hr shift. Findings suggest that there was a positive correlation between the length of a triage shift and perceived fatigue levels among triage nurses in the ED. The biggest percent increase in fatigue scores is between hours 4 and 8. Further studies are needed to determine optimal triage shift length as well as the effect of nursing fatigue on triage accuracy.
[Mh] Termos MeSH primário: Fadiga
Triagem
[Mh] Termos MeSH secundário: Seres Humanos
Projetos Piloto
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1097/TME.0000000000000143


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Texto completo SciELO Brasil
[PMID]:29340526
[Au] Autor:Yousefi M; Yousefi M; Fogliatto FS; Ferreira RPM; Kim JH
[Ad] Endereço:Departamento de Engenharia de Produção e Transportes, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
[Ti] Título:Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based framework.
[So] Source:Braz J Med Biol Res;51(3):e6961, 2018 Jan 11.
[Is] ISSN:1414-431X
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:The objective of this study was to develop an agent based modeling (ABM) framework to simulate the behavior of patients who leave a public hospital emergency department (ED) without being seen (LWBS). In doing so, the study complements computer modeling and cellular automata (CA) techniques to simulate the behavior of patients in an ED. After verifying and validating the model by comparing it with data from a real case study, the significance of four preventive policies including increasing number of triage nurses, fast-track treatment, increasing the waiting room capacity and reducing treatment time were investigated by utilizing ordinary least squares regression. After applying the preventing policies in ED, an average of 42.14% reduction in the number of patients who leave without being seen and 6.05% reduction in the average length of stay (LOS) of patients was reported. This study is the first to apply CA in an ED simulation. Comparing the average LOS before and after applying CA with actual times from emergency department information system showed an 11% improvement. The simulation results indicated that the most effective approach to reduce the rate of LWBS is applying fast-track treatment. The ABM approach represents a flexible tool that can be constructed to reflect any given environment. It is also a support system for decision-makers to assess the relative impact of control strategies.
[Mh] Termos MeSH primário: Comportamento
Serviço Hospitalar de Emergência/organização & administração
Pacientes Desistentes do Tratamento/estatística & dados numéricos
Triagem/estatística & dados numéricos
[Mh] Termos MeSH secundário: Brasil
Simulação por Computador
Aglomeração
Tomada de Decisões
Técnicas de Apoio para a Decisão
Serviço Hospitalar de Emergência/estatística & dados numéricos
Hospitais Públicos
Seres Humanos
Tempo de Internação
Modelos Teóricos
Pacientes Desistentes do Tratamento/psicologia
Modelagem Computacional Específica para o Paciente
Treinamento por Simulação
Listas de Espera
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180118
[St] Status:MEDLINE


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[PMID]:29259005
[Au] Autor:Chen N; Zhang C; Hu S
[Ad] Endereço:Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai,200233, China.
[Ti] Título:Strengthening trauma care in China.
[So] Source:BMJ;359:j5545, 2017 12 19.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Acidentes de Trânsito/mortalidade
Assistência à Saúde/normas
Centros de Traumatologia/estatística & dados numéricos
Ferimentos e Lesões/mortalidade
[Mh] Termos MeSH secundário: Acidentes de Trânsito/prevenção & controle
China/epidemiologia
Assistência à Saúde/organização & administração
Socorristas/educação
Custos de Cuidados de Saúde/estatística & dados numéricos
Necessidades e Demandas de Serviços de Saúde
Seres Humanos
Incidência
Centros de Traumatologia/organização & administração
Centros de Traumatologia/normas
Triagem/normas
Ferimentos e Lesões/economia
Ferimentos e Lesões/epidemiologia
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171221
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5545


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Registro de Ensaios Clínicos
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[PMID]:29233854
[Au] Autor:Mohan D; Farris C; Fischhoff B; Rosengart MR; Angus DC; Yealy DM; Wallace DJ; Barnato AE
[Ad] Endereço:Scaife Hall, 3550 Terrace St, University of Pittsburgh, Pittsburgh, PA 15261, USA.
[Ti] Título:Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial.
[So] Source:BMJ;359:j5416, 2017 12 12.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine whether a behavioral intervention delivered through a video game can improve the appropriateness of trauma triage decisions in the emergency department of non-trauma centers. DESIGN: Randomized clinical trial. SETTING: Online intervention in national sample of emergency medicine physicians who make triage decisions at US hospitals. PARTICIPANTS: 368 emergency medicine physicians primarily working at non-trauma centers. A random sample (n=200) of those with primary outcome data was reassessed at six months. INTERVENTIONS: Physicians were randomized in a 1:1 ratio to one hour of exposure to an adventure video game (Night Shift) or apps based on traditional didactic education (myATLS and Trauma Life Support MCQ Review), both on iPads. Night Shift was developed to recalibrate the process of using pattern recognition to recognize moderate-severe injuries (representativeness heuristics) through the use of stories to promote behavior change (narrative engagement). Physicians were randomized with a 2×2 factorial design to intervention (game traditional education apps) and then to the experimental condition under which they completed the outcome assessment tool (low high cognitive load). Blinding could not be maintained after allocation but group assignment was masked during the analysis phase. MAIN OUTCOME MEASURES: Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries. Participants completed the simulation within four weeks of their intervention. Decisions to admit, discharge, or transfer were measured. The proportion of patients under-triaged (patients with severe injuries not transferred to a trauma center) was calculated then (primary outcome) and again six months later, with a different set of cases (primary outcome of follow-up study). The secondary outcome was effect of cognitive load on under-triage. RESULTS: 149 (81%) physicians in the game arm and 148 (80%) in the traditional education arm completed the trial. Of these, 64/100 (64%) and 58/100 (58%), respectively, completed reassessment at six months. The mean age was 40 (SD 8.9), 283 (96%) were trained in emergency medicine, and 207 (70%) were ATLS (advanced trauma life support) certified. Physicians exposed to the game under-triaged fewer severely injured patients than those exposed to didactic education (316/596 (0.53) 377/592 (0.64), estimated difference 0.11, 95% confidence interval 0.05 to 0.16; P<0.001). Cognitive load did not influence under-triage (161/308 (0.53) 155/288 (0.54) in the game arm; 197/300 (0.66) 180/292 (0.62) in the traditional educational apps arm; P=0.66). At six months, physicians exposed to the game remained less likely to under-triage patients (146/256 (0.57) 172/232 (0.74), estimated difference 0.17, 0.09 to 0.25; P<0.001). No physician reported side effects. The sample might not reflect all emergency medicine physicians, and a small set of cases was used to assess performance. CONCLUSIONS: Compared with apps based on traditional didactic education, exposure of physicians to a theoretically grounded video game improved triage decision making in a validated virtual simulation. Though the observed effect was large, the wide confidence intervals include the possibility of a small benefit, and the real world efficacy of this intervention remains uncertain. TRIAL REGISTRATION: clinicaltrials.gov; NCT02857348 (initial study)/NCT03138304 (follow-up).
[Mh] Termos MeSH primário: Aplicativos Móveis/utilização
Médicos/estatística & dados numéricos
Triagem/métodos
Jogos de Vídeo/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Tomada de Decisões
Tomada de Decisões Assistida por Computador
Medicina de Emergência/normas
Serviço Hospitalar de Emergência/normas
Feminino
Heurística
Seres Humanos
Masculino
Meia-Idade
Aplicativos Móveis/estatística & dados numéricos
Avaliação de Resultados (Cuidados de Saúde)
Centros de Traumatologia/normas
[Pt] Tipo de publicação:CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171214
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5416


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[PMID]:29384856
[Au] Autor:Atas Berksoy E; Bag Ö; Yazici S; Çelik T
[Ad] Endereço:University of Health Sciences, Tepecik Education and Research Hospital, Pediatric Emergency Clinic, Izmir.
[Ti] Título:Use of noncontact infrared thermography to measure temperature in children in a triage room.
[So] Source:Medicine (Baltimore);97(5):e9737, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We compared the accuracy and utility of 3 infrared (IFR) thermographs fitted with axillary digital thermometers used to measure temperature in febrile and afebrile children admitted to an emergency triage room.A total of 184 febrile and 135 afebrile children presenting to a triage room were consecutively evaluated. Axillary temperature was recorded using a digital electronic thermometer. Simultaneously, IFR skin scans were performed on the forehead, the neck (over the carotid artery), and the nape by the same nurse. Fever was defined as an axillary temperature ≥37.5°C. The temperature readings at the 4 sites were compared.For all subjects, the median axillary temperature was 37.7 ±â€Š1.5°C, the IFR forehead temperature was 37 ±â€Š1.1°C, the IFR neck temperature was 37.6 ±â€Š1.5°C, and the IFR nape temperature was 37 ±â€Š1.2°C. A Bland-Altman plot of the differences suggested that all agreements between IFR and axillary measures were poor (the latter measure was considered the standard). The forehead measurements had a sensitivity of 88.6% and a specificity of 60% in patients with temperatures ≥36.75°C. The sensitivities of the neck measurement at cut-offs of ≥37.35°C and ≥36.95 were 95.5% and 78.8% for those aged 2 to 6 years. Thus, 11.4% of febrile subjects were missed when forehead measurements were performed.An IFR scan over the lateral side of neck is a reliable, comfortable, rapid, and noninvasive method for fever screening, particularly in children aged 2 to 6 years, in busy settings such as pediatric triage rooms.
[Mh] Termos MeSH primário: Termografia
Triagem
[Mh] Termos MeSH secundário: Adolescente
Temperatura Corporal
Criança
Pré-Escolar
Feminino
Febre/diagnóstico
Febre/fisiopatologia
Testa
Seres Humanos
Lactente
Raios Infravermelhos
Masculino
Pescoço
Enfermeiras e Enfermeiros
Estudos Prospectivos
Reprodutibilidade dos Testes
Sensibilidade e Especificidade
Pele/fisiopatologia
Termômetros
Triagem/métodos
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009737


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[PMID]:29304160
[Au] Autor:Chong SL; Ong GY; Chin WYW; Chua JM; Nair P; Ong ASZ; Ng KC; Maconochie I
[Ad] Endereço:Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
[Ti] Título:A retrospective review of vital signs and clinical outcomes of febrile infants younger than 3 months old presenting to the emergency department.
[So] Source:PLoS One;13(1):e0190649, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Febrile infants younger than 3 months old present a diagnostic dilemma to the emergency physician. We aim to describe a large population of febrile infants less than 3 months old presenting to a pediatric emergency department (ED) and to assess the performance of current heart rate guidelines in the prediction of serious infections (SI). MATERIALS AND METHODS: We performed a retrospective review of febrile infants younger than 3 months old, between March 2015 and Feb 2016, in a large tertiary pediatric ED. We documented the primary outcome of SI for each infant, as well as the clinical findings, vital signs, and Severity Index Score (SIS). We assessed the performance of the Paediatric Canadian Triage and Acuity Scale (PaedCTAS), Advanced Pediatric Life Support (APLS) guidelines and Fleming normal reference values, using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operating characteristics curve (AUC). RESULTS: 1057 infants were analyzed, with 326 (30.6%) infants diagnosed with SI. High temperature, tachycardia, and low SIS score were significantly associated with SI. Item analysis showed that the SIS performance was driven by the presence of mottling (p = 0.003) and high temperature (p<0.001). The APLS guideline had the highest sensitivity (66.0%, 95% CI 60.5-71.1%), NPV (73.3%, 95% CI 69.7-76.5%) and AUC (0.538), while the PaedCTAS (2 standard deviation from normal) had the highest specificity (98.5%, 95% CI 97.3-99.3%) and PPV (55.2%, 95% CI 32.7-71.0%). CONCLUSIONS: Current guidelines on infantile heart rates have a variable performance. In our study, the APLS heart rate guidelines performed with the highest sensitivity, but no individual guideline predicted for SIs satisfactorily.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência/utilização
Febre/fisiopatologia
Avaliação de Resultados (Cuidados de Saúde)
Sinais Vitais
[Mh] Termos MeSH secundário: Seres Humanos
Lactente
Recém-Nascido
Masculino
Estudos Retrospectivos
Singapura
Triagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190649


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[PMID]:29391099
[Au] Autor:Kozyr S; Ponce S; Feramisco H; Pakula A; Skinner R
[Ad] Endereço:Department of Surgery, Trauma Division, Kern Medical, Bakersfield, California, USA.
[Ti] Título:High-Risk Prehospital Mechanisms in Tier II Trauma Codes: An Analysis of Under-Triage at a Level II Trauma Center.
[So] Source:Am Surg;83(10):1080-1084, 2017 Oct 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Under-triage is used as a surrogate for trauma quality. We sought to analyze factors that may impact under-triage at our institution by a detailed analysis of prehospital mechanisms and patient factors that were associated with the need for invasive intervention, intensive care unit monitoring, or death. Patients admitted to our Level II trauma center who met the criteria for under-triage using the Cribari method were studied, n = 160, and prominent mechanisms were motor vehicle collisions (MVCs). Patient demographics, detailed mechanism characteristics, ED vital signs, operative intervention, and outcomes were studied. The age of the study group and injury severity score were 42 ± 20 and 22 ± 6, respectively. Alcohol or drug use was common as were high-speed frontal collisions. Overall, 38 per cent of patients required surgery, and a monitored bed was required in 60 per cent of patients. Logistic regression identified drug use as predictive of mortality and MVC speeds ≥40 mph as predictive of intensive care unit admission. Patients requiring surgery had a high incidence of frontal collisions, 40 per cent. MVCs were predominant in under-triaged trauma patients. Operative intervention, intensive care unit monitoring, and deaths were associated with frontal impacts, high speeds, and drug use. Further study is warranted to assess the incorporation of high-risk injury patterns in triage algorithms aimed at enhancing trauma quality.
[Mh] Termos MeSH primário: Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos
Centros de Traumatologia
Triagem/métodos
Ferimentos e Lesões/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Algoritmos
Serviços Médicos de Emergência/métodos
Serviços Médicos de Emergência/normas
Serviços Médicos de Emergência/estatística & dados numéricos
Feminino
Seres Humanos
Escala de Gravidade do Ferimento
Modelos Logísticos
Masculino
Meia-Idade
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Triagem/normas
Triagem/estatística & dados numéricos
Ferimentos e Lesões/etiologia
Ferimentos e Lesões/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE


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[PMID]:29189454
[Au] Autor:Coyle AL
[Ad] Endereço:Amanda L. Coyle is an assistant professor at the Johns Hopkins School of Nursing in Baltimore, Md.
[Ti] Título:Dealing with patient self-triage.
[So] Source:Nursing;47(12):17-18, 2017 Dec.
[Is] ISSN:1538-8689
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Autoavaliação Diagnóstica
Enfermagem em Emergência
Relações Enfermeiro-Paciente
Triagem
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1097/01.NURSE.0000526907.77132.72


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[PMID]:28470689
[Au] Autor:Agorastos T; Chatzistamatiou K; Moysiadis T; Kaufmann AM; Skenderi A; Lekka I; Koch I; Soutschek E; Boecher O; Kilintzis V; Angelidou S; Katsiki E; Hagemann I; Boschetti Gruetzmacher E; Tsertanidou A; Angelis L; Maglaveras N; Jansen-Duerr P
[Ad] Endereço:4th Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece.
[Ti] Título:Human papillomavirus E7 protein detection as a method of triage to colposcopy of HPV positive women, in comparison to genotyping and cytology. Final results of the PIPAVIR study.
[So] Source:Int J Cancer;141(3):519-530, 2017 08 01.
[Is] ISSN:1097-0215
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The objective of the presented cross-sectional-evaluation-screening study is the clinical evaluation of high-risk(hr)HPVE7-protein detection as a triage method to colposcopy for hrHPV-positive women, using a newly developed sandwich-ELISA-assay. Between 2013-2015, 2424 women, 30-60 years old, were recruited at the Hippokratio Hospital, Thessaloniki/Greece and the Im Mare Klinikum, Kiel/Germany, and provided a cervical sample used for Liquid Based Cytology, HPV DNA genotyping, and E7 detection using five different E7-assays: "recomWell HPV16/18/45KJhigh", "recomWell HPV16/18/45KJlow", "recomWell HPV39/51/56/59", "recomWell HPV16/31/33/35/52/58" and "recomWell HPVHRscreen" (for 16,18,31,33,35,39,45,51,52,56,58,59 E7), corresponding to different combinations of hrHPVE7-proteins. Among 1473 women with eligible samples, those positive for cytology (ASCUS+ 7.2%), and/or hrHPV DNA (19.1%) were referred for colposcopy. Cervical Intraepithelial Neoplasia grade 2 or worse (CIN2+) was detected in 27 women (1.8%). For HPV16/18-positive women with no triage, sensitivity, positive predictive value (PPV) and the number of colposcopies needed to detect one case of CIN2+ were 100.0%, 11.11% and 9.0 respectively. The respective values for E7-testing as a triage method to colposcopy ranged from 75.0-100.0%, 16.86-26.08% and 3.83-5.93. Sensitivity and PPV for cytology as triage for hrHPV(non16/18)-positive women were 45.45% and 27.77%; for E7 test the respective values ranged from 72.72-100.0% and 16.32-25.0%. Triage of HPV 16/18-positive women to colposcopy with the E7 test presents better performance than no triage, decreasing the number of colposcopies needed to detect one CIN2+. In addition, triage of hrHPV(non16/18)-positive women with E7 test presents better sensitivity and slightly worse PPV than cytology, a fact that advocates for a full molecular screening approach.
[Mh] Termos MeSH primário: Neoplasia Intraepitelial Cervical/diagnóstico
Colposcopia/métodos
Papillomaviridae/genética
Proteínas E7 de Papillomavirus/metabolismo
Infecções por Papillomavirus/complicações
Triagem/métodos
Neoplasias do Colo do Útero/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Neoplasia Intraepitelial Cervical/virologia
Ensaio de Imunoadsorção Enzimática
Feminino
Genótipo
Seres Humanos
Meia-Idade
Estadiamento de Neoplasias
Papillomaviridae/isolamento & purificação
Infecções por Papillomavirus/virologia
Prognóstico
Neoplasias do Colo do Útero/virologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Papillomavirus E7 Proteins)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1002/ijc.30761



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