Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Mandatory Testing”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 757 records · Page 42Linked to original sources
PubMed1994

Endocrine surgical diseases of elderly patients.

The causes, evaluation, and preoperative and postoperative care of primary hyperparathyroidism and thyroid nodules in the elderly patient population have been described. Primary hyperparathyroidism is easily diagnosed and is almost always curable by surgery. Elderly patients with asymptomatic disease are candidates for nonoperative, expectant management. If they become symptomatic, surgery should be performed. Postoperative care of the elderly patient who has undergone parathyroid exploration is potentially complicated by the patient's other medical problems, including cardiac and pulmonary difficulties, variable severity of symptoms of hypocalcemia, and sensitivity to medications. Thyroid nodules in the elderly may present later than in younger patients and are more likely to contain malignant tissue. Tissue diagnosis preoperatively, usually by FNA testing, is mandatory. Anaplastic thyroid carcinoma and thyroid lymphoma are both treated nonoperatively. Thyroid surgery in the elderly is usually well tolerated, although other medical conditions, as mentioned above, may complicate postoperative care. Thyroid carcinoma in the elderly carries a worse prognosis than in younger patients and should always be treated with postoperative adjuvant (radioablative) therapy. Although this does not affect survival (from the thyroid cancer), it does extend the disease-free interval. As the number of elderly patients increases, the frequency with which these disorders are encountered will also rise. It is important to realize that almost all elderly patients can both tolerate and benefit from surgical correction of these two disorders, if appropriate preoperative evaluation is coupled with excellent intraoperative and postoperative care.

Aged↗
PubMed1997

Pregnancy and addiction: translating research into practice.

In some areas of the United States pregnant women are incarcerated if they are addicted to illegal substances, particularly crack cocaine. However, incarceration does not happen to all pregnant addicts, but instead reflects racial/ethnic and socioeconomic categories of prejudice. In the following article, the authors suggest that analysis of this pattern of incarceration is clarified by the use of critical medical anthropology perspective with its explicit historical, political and economic foci. In addition, the authors introduce a program for addicted women that incorporates into practice the findings of the initial research and demonstrates how research can be translated into practice.

Adult↗
PubMed1994

Importance of pre-operative recognition of the nonrecurrent laryngeal nerve.

The nonrecurrent laryngeal nerve is vulnerable during thyroid surgery. Pre-operative recognition of this nerve allows surgeons to avoid injuring the nerve. This anomaly depends upon the aortic arch anomaly and, therefore, in some cases, surgeons are able to predict the presence of this nerve pre-operatively by chest X-ray or barium swallow. Two patients with nonrecurrent laryngeal nerve are reported, one of whom, a 48-year-old man, had an abnormal shadow of the aortic arch, which led to confirmation of a right aberrant subclavian artery. Barium swallow plays a decisive role in the diagnosis of nonrecurrent laryngeal nerve, and this test is mandatory in patients who complain of difficulty in swallowing.

Abnormalities, Multiple↗
PubMed2001

The seroepidemiology of varicella in Italy.

We conducted a seroepidemiological study to evaluate the potential impact of mass varicella vaccination on the transmission of varicella-zoster virus (VZV) in Italy, where vaccination is not mandatory. We tested 3179 serum samples, collected from September 1996 to October 1997, for specific anti-VZV antibodies using a commercially available ELISA. The results confirmed that varicella typically involves children (82.1% seroprevalence among 10- to 14-year-olds) and that the mean age of acquiring the infection seems to be increasing. The results also revealed that southern Italy, compared to the rest of the country, has a greater circulation of VZV and an earlier age of acquisition. The potential impact of mass vaccination among 12- to 18-month-old children on the epidemiological trend of the infection must be carefully considered, in that failure to reach high levels of coverage could lead to an increase in the mean age of acquisition, which is already occurring in Italy.

Adolescent↗
PubMed2005

Diagnosis of antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent vascular thrombosis and pregnancy losses. Laboratory diagnosis of APS relies on the demonstration of a positive anticardiolipin antibody test by an in-house or commercially available enzyme-linked immunosorbent assay, or on the presence of lupus anticoagulant by a coagulation-based test. Persistence of the positive results must be demonstrated, and other causes and underlying factors considered. Although it is universally recognized that the routine screening tests (anticardiolipin antibody or lupus anticoagulant) might miss some cases of APS, careful differential diagnosis and repeat testing are mandatory before the diagnosis of 'seronegative APS' can be made. Correct identification of patients with APS is important because prophylactic anticoagulant therapy can prevent thrombosis from recurring and treatment of affected women during pregnancy can improve fetal and maternal outcome.

Animals↗
PubMed2004

Prevalence of adverse reactions to food in Germany - a population study.

OBJECTIVE: A population study was performed to identify the prevalence of all kinds of adverse reactions to food. METHODS: In a representative cross-sectional survey performed in 1999 and 2000 in Berlin, 13 300 inhabitants of all ages were addressed by questionnaire. This questionnaire was answered by 4093 persons. All respondents mentioning any sign of food intolerance or the existence of allergic diseases (n = 2298) were followed up by telephone and, in case food intolerance could not be ruled out by patient history, were invited to attend to the clinic for personal investigation including double-blind, placebo-controlled food challenge tests (DBPCFC). RESULTS: The self-reported lifetime prevalence of any adverse reaction to food in the Berlin population (mean age 41 years) was 34.9%. Eight hundred and fourteen individuals were personally investigated according to the guidelines. The point prevalence of adverse reactions to food confirmed by DBPCFC tests in the Berlin population as a mean of all age groups was 3.6% (95% confidence interval [3.0-4.2%]) and 3.7% in the adult population (18-79 years, 95% confidence interval [3.1-4.4.%]). Two and a half percent were IgE-mediated and 1.1% non-IgE-mediated, females were more frequently affected (60.6%). Based on a statistical comparison with available data of adults from the nationwide German Health Survey from 1998, adverse reactions to food in the adult population of Germany (age 18-79) were calculated with 2.6% [2.1-3.2%]). CONCLUSIONS: The study gives for the first time information about the point prevalence of both immunological and nonimmunological adverse reactions to food and underlines the relevance of this issue in public health. The data also show that an individualized stepwise approach including provocation tests is mandatory to confirm the diagnosis.

Adolescent↗
PubMed1997

Does anti-HBc reactivity reflect 'lifestyle' risk in north London blood donors?

BACKGROUND AND OBJECTIVES: To determine whether antibody to hepatitis B core (anti-HBc) reactivity, as a marker of hepatitis B virus infection, reflects a 'lifestyle' risk in donors in North London, we have obtained detailed histories from donors with various manifestations of HBV infection. MATERIALS AND METHODS: Interviews based on a standardised questionnaire were conducted with 70 donors confirmed to be anti-HBc reactive. RESULTS: Comparison with controls (known to be anti-HBc-negative) and donors reactive for anti-hepatitis-C virus showed that current donor strategies are effective; in our area, reactivity for anti-HBc is not associated with a lifestyle risk for those donors who are unreactive in current mandatory screening tests. CONCLUSIONS: Blood from donors positive for both anti-HBc and anti-HBs should be considered suitable for transfusion purposes. This is consistent with the practice of accepting blood from naturally immune donors for preparation of hepatitis B immunoglobulin.

Antibodies, Viral↗
PubMed2001

Idiopathic normal-pressure hydrocephalus: evaluation and findings in a multidisciplinary memory clinic.

The diagnostic evaluation of patients with possible idiopathic normal-pressure hydrocephalus (INPH) is traditionally performed in the settings of either neurological, neurosurgical or psychiatric departments. The diagnostic procedure and findings in 71 consecutive patients referred with a clinical and radiological suspicion of INPH to our out-patient multidisciplinary memory clinic are evaluated. Primary diagnoses and potential concomitant disorders considered of secondary importance for the symptomatologies were established. Abnormal hydrodynamics, demonstrated by intraventricular pressure monitoring and infusion test were mandatory for the diagnosis of INPH. Mean age was 68 years and mean Mini-Mental State Examination (MMSE) score was 22. DSM IV criteria of dementia were fulfilled in 42%. In half of the referred patients (n=36), the suspicion of INPH was already disproved subsequently to the evaluation programme performed in the outpatient clinic. The main primary diagnosis was cerebrovascular disease (CVD) comprising 27% (n=19) of the referrals, whereas INPH was diagnosed in only 20% (n=14). Shunt improvement rate was 72%. The remaining patients were diagnosed as having one of 26 different conditions. A multiplicity of disorders mimics the INPH syndrome, with CVD being the primary differential diagnosis. Evaluating patients with possible INPH in an outpatient multidisciplinary memory clinic is an effective and rational diagnostic approach.

Adult↗
PubMed1999

Newborn screening for human immunodeficiency virus infection in the Bronx, NY, and evolving public health policy.

New advances in the diagnosis and treatment of HIV infection continue to propel changes in public understanding of HIV infection and the administration of public health law. Over the past decade, New York State has moved from a policy of blind newborn screening for seroprevalence data to mandatory HIV testing as part of the statewide Newborn Screening (NBS) Program. A new statewide program of expedited HIV testing (48-hr turnaround results) of pregnant women and newborns (whose HIV status is unknown at the time of delivery) began in the summer of 1999. To better understand the impact this program might have on the patients who receive health care at Lincoln Medical and Mental Health Center (Lincoln Hospital), we evaluated our experience with the current NBS program prior to inauguration of the new expedited testing program. We evaluated the NBS program from February 1, 1997, to January 31, 1999, including total number of HIV-exposed/infected infants born, mother's HIV status (if known) at the time of delivery, amount of time between blood sampling and return of the test results to the Hospital, and medical follow-up of infants with positive newborn screening test results. This was a retrospective study of the NBS registry and the medical records of patients who receive primary health care from the Pediatric Immunology Service of the Department of Pediatrics at Lincoln Hospital. One hundred and four newborns were identified with positive-HIV antibody (HIV-Ab-positive), and 13 (12.5%) were confirmed to be HIV-infected by positive polymerase chain reaction (PCR) test of viral DNA. Sixty-five (62.5%) of the newborns with positive NBS screening test results were born to mothers who were known to be HIV-infected prior to delivery; 39 (37.5%) were unanticipated. Four (30%) of the 13 HIV-infected babies were born to mothers who were known to be HIV-infected prior to delivery, and 9 (70%) were born to mothers whose HIV status was unknown at the time of delivery. Eighty percent (80%) of HIV-Ab-positive infants continued to receive follow-up care at Lincoln Hospital. Relocation to other health-care facilities occurred as a result of parental choice or due to foster care placement. No babies were "lost" from the NBS program. The average time between sampling and receipt of results for all blood tests was 16 days (range 10 to 141). Nearly 40% of newborns who acquired HIV infection from their mothers were unanticipated because the mother's HIV status was unknown at the time of delivery. These unanticipated HIV-infected infants represent missed opportunities for prevention of maternal-to-child transmission of HIV infection and early therapeutic intervention for HIV-infected infants. The new expedited HIV-testing program for New York State will facilitate early diagnosis, prevention and treatment of the HIV-exposed/infected infant for whom maternal HIV status is unknown at the time of delivery.

Female↗
PubMed2001

Diagnosis of recurrent deep vein thrombosis.

Long-term follow-up studies demonstrated that venous thromboembolism is a chronic disease, as the rate of recurrent deep vein thrombosis (DVT) continuously increases after the primitive thrombotic episode. Objective testing is mandatory to confirm or refute the presence of recurrent DVT, as only 30% of patients with suspected recurrence have a new documented thrombotic episode. There is no consensus on the preferred diagnostic procedure; furthermore, both invasive and noninvasive methods are limited in this context. Venography, the established gold standard, is invasive, costly, inconvenient and requires high technical skills. Among noninvasive techniques, serial impedance plethysmography, alone or in combination with leg scanning and venography, and serial compression ultrasound (CUS), were adequately investigated. At present, the recommended approach is represented by a quantitative CUS method that possesses an excellent reproducibility and accuracy. The safety of withholding anticoagulants from patients with a normal quantitative CUS work-up has been recently demonstrated in a prospective management study.

Anticoagulants↗
PubMed2001

Upper extremity deep vein thrombosis: risk factors, diagnosis, and management.

Upper extremity deep vein thrombosis (UEDVT) should no longer be regarded as an uncommon and benign disease, as previously reported. It is usually associated with risk factors, as central venous lines, malignancy, and coagulation defects; however, up to 20% of UEDVTs are apparently spontaneous. The clinical picture is characterized by swelling, pain, and functional impairment, albeit UEDVT may be completely asymptomatic. Objective testing is mandatory prior to instituting anticoagulation because the prevalence of UEDVT is less than 50% in symptomatic subjects, and compression ultrasound or color Doppler represents the preferred diagnostic methods. Up to 36% of the patients develop pulmonary embolism, which may be fatal; postthrombotic sequelae and recurrent thromboembolism are also frequent complications. Unfractionated or low-molecular-weight heparin followed by oral anticoagulation should be regarded as the treatment of choice; thrombolysis and surgery may be indicated in selected cases. Prophylaxis with low-dose heparin or low-dose warfarin is necessary whenever central venous catheters are positioned.

Anticoagulants↗
PubMedDate not supplied

[Manifestation of intolerance to cow's milk protein in mucoviscidosis with the symptom triad of hypoproteinemia, edema and anemia].

The symptom complex--hypoproteinemia, edema and anemia--occurs in approximately 5 percent of CF-patients during the first 6 months of life. Since milk is the only nutritional source in this age group, a hypocaloric nutrition respectively marginaly low protein intake may contribute to these symptoms in case of an exocrine pancreatic insufficiency. Even if breast milk and soy bean formulas can advance the disease it must be mentioned that relapses of the symptom triad had never occurred under pancreatic enzyme supplementation independently of the source of milk being fed. A cow's milk protein intolerance and coincidental exocrine pancreatic insufficiency lead to the symptom complex in an infant in spite of an adequate caloric and protein intake. This case revealed again that sweat electrolyte tests are unreliable during the acute period of disease, sweat tests were positive when the presenting symptoms were resolved. The case demonstrates that repeated sweat chloride tests are mandatory during an asymptomatic phase of disease besides the exclusion of a renal or cardiac origin of the symptom complex. An early postnatal diagnosis of CF and immediate initiation of pancreatic enzyme and fat soluble vitamin supplementation could prevent such courses of disease.

Anemia↗
PubMed2000

Immediate reexploration for the perioperative neurologic event after carotid endarterectomy: is it worthwhile?

PURPOSE: When managing a new neurologic deficit after carotid endarterectomy (CEA), the surgeon is often preoccupied with determining the cause of the problem, requesting diagnostics tests, and deciding whether the patient should be surgically reexplored. The goal of this study was to analyze a series of perioperative neurologic events and to determine if careful analysis of their timing and mechanisms can predict which cases are likely to improve with reoperation. METHODS: A review of 2024 CEAs performed from 1985 to 1997 revealed 38 patients who manifested a neurologic deficit in the perioperative period (1.9%). These cases form the focus of this analysis. RESULTS: The causes of the events included intraoperative clamping ischemia in 5 patients (13.2%); thromboembolic events in 24 (63.2%); intracerebral hemorrhage in 5 (13.2%); and deficits unrelated to the operated artery in 4 (10.5%). Neurologic events manifesting in the first 24 hours after surgery were significantly more likely to be caused by thromboembolic events than by other causes of stroke (88.0% vs. 12.0%, P<.002); deficits manifesting after the first 24 hours were significantly more likely to be related to other causes. Of 25 deficits manifesting in the first 24 hours after surgery, 18 underwent immediate surgical reexploration. Intraluminal thrombus was noted in 15 of the 18 reexplorations (83. 3%); any technical defects were corrected. After the 18 reexplorations, in 12 cases there was either complete resolution of or significant improvement in the neurologic deficit that had been present (66.7%). CONCLUSIONS: Careful analysis of the timing and presentation of perioperative neurologic events after CEA can predict which cases are likely to improve with reoperation. Neurologic deficits that present during the first 24 hours after CEA are likely to be related to intraluminal thrombus formation and embolization. Unless another etiology for stroke has clearly been established, we think immediate reexploration of the artery without other confirmatory tests is mandatory to remove the embolic source and correct any technical problems. This will likely improve the neurologic outcome in these patients, because an uncorrected situation would lead to continued embolization and compromise.

Aged↗
PubMed1996

Prevalence of malaria parasitaemia in transfused donor blood in Benin City, Nigeria.

In view of the problem of transfusional malaria, the prevalence of malaria parasitaemia in transfused donor blood was assessed. Blood film examination for malaria parasites on Giemsa-stained donor blood which was used for transfusion to neonates in Benin City, Nigeria was carried out over a 6-month period. Blood group O was the dominant blood type (17%). A high malarial parasite prevalence rate of 40% was noted in the transfused donor blood and Plasmodium falciparum was the dominant infecting species. All blood groups and rhesus factor types were infected with malarial parasites. There was no significantly increased malarial infection rate in any particular blood group type. The neonate, who is known to be immunologically naive, is at high risk of symptomatic malaria acquired through blood transfusion. All neonates who require blood transfusion should be given chloroquine sulphate soon after transfusion, at a dose of 5 mg/kg/day for 3 days, when the parasites are chloroquine-sensitive. In cases of chloroquine resistance, quinine sulphate or halofantrine hydrochloride is an acceptable alternative. Where feasible, donor blood screening for malaria should be carried out before transfusion to any neonate.

Animals↗