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Portable Medical Orders and End of Life Measures in Acute Myeloid Leukemia and Myelodysplastic Syndromes.

Blood Adv 2021 Sep 15. Epub 2021 Sep 15.

University of Rochester Medical Center, Rochester, New York, United States.

Patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) experience high rates of hospitalization, intensive care unit (ICU) admissions, and in-hospital deaths at end of life (EOL). Early goals-of-care (GOC) discussions might reduce intensity of care at EOL. Portable Medical Order (POLST) forms, known as Medical Orders for Life Sustaining Treatment (MOLST) forms in New York State, allow patients to translate GOC discussions into specific medical orders that communicate their wishes during a medical emergency. Read More

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September 2021

Establishing Benchmarks for Antimicrobial Use in Canadian Children's Hospitals: Results From 2 National Point Prevalence Surveys.

Pediatr Infect Dis J 2021 Oct;40(10):899-905

Division of Infectious Diseases, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.

Background: Point prevalence surveys (PPS) are potentially useful to measure antimicrobial use across institutions. The objectives of the study were to describe and compare antimicrobial use between pediatric hospitals in Canada.

Methods: Fifteen pediatric hospitals all with pediatric infectious diseases service participated in 2 single-day PPS in 2018/19. Read More

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October 2021

Occupational Competence and Activities of Daily Living Performance in Bronchial Asthma : Compétence professionnelle et activités de la vie quotidienne Performance dans l'asthme bronchique.

Can J Occup Ther 2021 Sep 15:84174211022883. Epub 2021 Sep 15.

Activity restriction is one of the most common symptoms reported by people living with bronchial asthma. The study aimed to determine occupational competence and values in people living with bronchial asthma and compare with the occupational competence and activities of daily living (ADL) of healthy controls. Twenty individuals with asthma and 20 healthy controls were enrolled. Read More

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September 2021

Sirolimus (Rapamycin) for Slow-Flow Malformations in Children: The Observational-Phase Randomized Clinical PERFORMUS Trial.

JAMA Dermatol 2021 Sep 15. Epub 2021 Sep 15.

University of Tours, Centre Hospitalier Régional Universitaire Tours, Department of Pediatric Radiology, Tours, France.

Importance: Sirolimus is increasingly being used to treat various vascular anomalies, although evidence of its efficacy is lacking.

Objective: To assess the efficacy and safety of sirolimus for children with slow-flow vascular malformations to better delineate the indications for treatment.

Design, Setting And Participants: This multicenter, open-label, observational-phase randomized clinical trial included 59 children aged 6 to 18 years with a slow-flow vascular malformation who were recruited between September 28, 2015, and March 22, 2018, in 11 French tertiary hospital centers. Read More

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September 2021

Do-not-resuscitate order in COVID-19 times: bioethics and professional ethics.

Rev Gaucha Enferm 2021 13;42(spe):e20200172. Epub 2021 Sep 13.

Universidade Federal do Rio de Janeiro (UFRJ), Escola de Enfermagem Anna Nery, Programa de Pós-Graduação Stricto Sensu. Rio de Janeiro, Rio de Janeiro, Brasil.

Objective: To reflect about the do-not-resuscitation order at COVID-19 in Brazil, under bioethical focus and medical and nursing professional ethics.

Method: Reflection study based on the principlist bioethics of Beauchamps and Childress and in professional ethics, problematizing actions, and decisions of non-resuscitation in the pandemic.

Results: It is important to consider the patient's clinic, appropriation of treatment goals for people with comorbidities, elderly people, with less chance of surviving to resuscitation, or less quality of life, with the palliative care team, to avoid dysthanasia, use of scarce resources and greater exposure of professionals to contamination. Read More

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September 2021

Real-world Performance of the MiniMed™ 780G System: First Report of Outcomes from 4'120 Users.

Diabetes Technol Ther 2021 Sep 15. Epub 2021 Sep 15.

Medtronic International Trading Sàrl, Toluchenaz, Tolochenaz, Switzerland, 46733;

Background: The MiniMed™ 780G system includes an Advanced Hybrid Closed Loop (AHCL) algorithm which provides for both automated basal and correction bolus insulin delivery. The preliminary performance of the system in real-world settings was evaluated.

Methods: Data uploaded from August 2020 to March 2021 by individuals living in Belgium, Finland, Italy, the Netherlands, Qatar, South Africa, Sweden, Switzerland and the United Kingdom were aggregated and retrospectively analyzed to determine the mean Glucose Management Indicator (GMI), percentage of time spent within (TIR), below (TBR) and above (TAR) glycemic ranges, system use and insulin consumption in users having ≥10 days of sensor glucose (SG) data after initiating AHCL. Read More

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September 2021

The patient-driven payment model: A missed opportunity for patient-centered cancer care.

J Am Geriatr Soc 2021 Sep 14. Epub 2021 Sep 14.

Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.

Hospitalized older patients with advanced cancer who were discharged to a skilled nursing facility (SNF) for rehabilitation are unlikely to receive future cancer treatment, have high 30-day readmission rates, and high mortality yet minimal hospice use. The Medicare SNF benefit was designed to be a bridge and provide short-term nursing and rehabilitation care for patients after a hospitalization. However, advanced cancer patients churn through the health system cycling between the hospital, post-acute care facilities, and home in the last months of life. Read More

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September 2021

The Importance of Understanding Parental Perception When Treating Primary Nocturnal Enuresis: A Topic Review and an Institutional Experience.

Res Rep Urol 2021 7;13:679-690. Epub 2021 Sep 7.

Department of Surgery, Erlin Christian Hospital, Changhua, Taiwan.

Primary nocturnal enuresis (PNE) is a common childhood disorder that adversely affects a child's mental well-being and social life. Our clinical experience showed parents and their child often have significantly different perspective of enuresis, and these differences can affect family dynamics, treatment approaches, and treatment success. Parents' perception of PNE also influences the likelihood of seeking medical treatment, and we found parents of children with enuresis have markedly different beliefs regarding bedwetting than those of physicians. Read More

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September 2021

Toward Evaluation of the Subjective Experience of a General Class of User-Controlled, Robot-Mediated Rehabilitation Technologies for Children with Neuromotor Disability.

Informatics (MDPI) 2020 ;7(4):45-50

Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.

Technological advances in game-mediated robotics provide an opportunity to engage children with cerebral palsy (CP) and other neuromotor disabilities in more frequent and intensive therapy by making personalized, programmed interventions available 24/7 in children's homes. Though shown to be clinically effective and feasible to produce, little is known of the subjective factors impacting acceptance of what we term assistive/rehabilitative (A/R) gamebots by their target populations. This research describes the conceptualization phase of an effort to develop a valid and reliable instrument to guide the design of A/R gamebots. Read More

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January 2020

Front-loading of anatomy content has no effect on long-term anatomy knowledge retention among physical therapy students: a prospective cohort study.

BMC Med Educ 2021 Sep 14;21(1):491. Epub 2021 Sep 14.

St. Luke's University Health Network, Bethlehem, PA, USA.

Background: Information learned over a longer period of time has been shown to result in better long-term knowledge retention than information learned over a shorter period of time. In order to address multiple curricular goals, the timing and spacing of anatomy content within the Doctor of Physical Therapy (DPT) program at our institution recently changed from a very spaced to a very compressed format. The purpose of the present study was to assess differences in anatomy knowledge retention that might have been impacted by this change. Read More

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September 2021

Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study.

BMC Health Serv Res 2021 Sep 14;21(1):964. Epub 2021 Sep 14.

Rovaniemi Health Center, Koskikatu 25, 96200, Rovaniemi, Finland.

Background: Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. Read More

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September 2021

Mitigating phosphorus pollution from detergents in the surface waters of China.

Sci Total Environ 2021 Sep 4;804:150125. Epub 2021 Sep 4.

Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, College of Resources and Environment, Southwest University, Tiansheng Road 02, Chongqing 400715, China. Electronic address:

Phosphorus (P) from detergents contributes to water pollution and eutrophication. Understanding the impacts of detergent use on P inputs to surface waters and their main drivers is vital for supporting Sustainable Development Goals on clean water. This study aims to quantify past and future trends in P inputs to surface waters from detergent use in China. Read More

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September 2021

In-Hospital Morbidity and Mortality with Delays to Femoral Shaft Fracture Fixation.

J Orthop Trauma 2021 Sep 14. Epub 2021 Sep 14.

Department of Orthopaedic Surgery, Washington University, St. Louis, MO Center for Administrative Data Research, Washington University, St. Louis, MO Department of Orthopaedic Surgery, UC-Davis, Sacramento, CA.

Objectives: The goals of this study were to investigate trends in the timing to femur fracture fixation in trauma centers in the United States, identify predictors for delayed treatment, and analyze the association of timing to fixation with in-hospital morbidity and mortality using data from the National Trauma Data Bank (NTDB).

Methods: Patients with femoral shaft fractures treated from 2007-2015 were identified from the NTDB, and grouped by timing of femur fixation: <24 hours, 24-48 hours, and >48 hours after hospital presentation. The primary outcome measure was in-hospital postoperative mortality rate. Read More

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September 2021

Embedding a Behavior Change Program Designed to Reduce Sedentary Time Within a Pulmonary Rehabilitation Program Is Feasible in People With COPD.

J Cardiopulm Rehabil Prev 2021 Sep 13. Epub 2021 Sep 13.

Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada (Drs Wshah, Selzler, Brooks, and Goldstein); Rehabilitation Sciences Institute (Drs Wshah, Brooks, and Goldstein) and Department of Medicine (Drs Brooks and Goldstein), University of Toronto, Toronto, Ontario, Canada; Department of Physical and Occupational Therapy, Hashemite University, Zarqa, Jordan (Dr Wshah); School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia (Dr Hill); and School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada (Dr Brooks).

Purpose: This study examined the feasibility of embedding a 4-wk intervention, which sought to reduce sedentary time (SED), into a pulmonary rehabilitation program (PRP) in people with chronic obstructive pulmonary disease.

Methods: This was an intervention study that comprised one face-to-face session and three follow-up visits. Primary outcomes related to feasibility and included adherence to data completion undertaken before and during the intervention period, participant satisfaction with the intervention (out of 100%), and participant achievement of intervention goals. Read More

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September 2021

High-Frequency, High-Throughput Quantification of SARS-CoV-2 RNA in Wastewater Settled Solids at Eight Publicly Owned Treatment Works in Northern California Shows Strong Association with COVID-19 Incidence.

mSystems 2021 Sep 14:e0082921. Epub 2021 Sep 14.

Department of Civil & Environmental Engineering, Stanford Universitygrid.168010.e, Stanford, California, USA.

A number of recent retrospective studies have demonstrated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentrations in wastewater are associated with coronavirus disease 2019 (COVID-19) cases in the corresponding sewersheds. Implementing high-resolution, prospective efforts across multiple plants depends on sensitive measurements that are representative of COVID-19 cases, scalable for high-throughput analysis, and comparable across laboratories. We conducted a prospective study across eight publicly owned treatment works (POTWs). Read More

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September 2021

Caring for Patients With Dementia at End of Life.

Am J Hosp Palliat Care 2021 Sep 14:10499091211046247. Epub 2021 Sep 14.

Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.

Care of the dementia patient continues to be challenging. It is a terminal condition that many times goes undiagnosed leading to improper evidence-based interventions. Healthcare professionals (HCPs) should initiate goals of care conversations early with patients and their families in order to align treatment preferences. Read More

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September 2021

[Study of the factors contributing to poor quality of life in chronic heart failure with reduced ejection fraction].

Ann Cardiol Angeiol (Paris) 2021 Sep 10. Epub 2021 Sep 10.

Service de cardiologie Hôpital Habib Thameur, 03 Rue Salman el Fersi Rades 2040.

Background: The increasing prevalence and poor prognosis associated with chronic heart failure (CHF) have made the improvement of quality of life (QoL) one of the main goals in the treatment of CHF patients. Since little is known about the QoL in Tunisian patients with heart failure (HF), the current study was performed to assess QoL in a sample of Tunisian patients hospitalized with HF and to identify factors related to QoL.

Methods: In this prospective study, we evaluated patients with CHF attending the cardiology department of Habib Thameur University Hospital in a four-month period. Read More

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September 2021

A pilot study investigating the efficacy of brief, phone-based, behavioral interventions for burnout in graduate students.

J Clin Psychol 2021 Sep 13. Epub 2021 Sep 13.

Department of Psychiatry and Behavioral Sciences, Cognitive-Behavioral Research and Therapy Program, Duke University Medical Center, Durham, North Carolina, USA.

Objective: This pilot study tested the efficacy of two brief, phone-administered, behavioral interventions derived from behavioral activation in reducing burnout among doctoral students.

Methods: Sixty-six doctoral students demonstrating current high burnout were randomly assigned to one of three intervention conditions: (1) Reward: increasing pleasant, rewarding behaviors, (2) Approach: approaching important goals that they have been avoiding, or (3) Control: monitoring only.

Results: Results indicated that doctoral students treated with the approach intervention reported significantly lower burnout compared to participants in the control condition immediately after the intervention and at a 1-week follow-up. Read More

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September 2021

Fecal Microbiota Transplantation and Medical Therapy for Clostridium difficile Infection: Meta-analysis of Randomized Controlled Trials.

J Clin Gastroenterol 2021 Sep 9. Epub 2021 Sep 9.

Departments of Medicine Gastroenterology and Hepatology Library Services, Cleveland Clinic Foundation Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH Department of Medicine, UPMC, Pittsburgh, PA Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL Department of Medicine, Asante Rogue Regional Medical Center, Medford, OR Baba Farid University of Health Sciences, Faridkot, Punjab, India.

Goals: The aim was to assess the effectiveness of fecal microbiota transplantation (FMT) against medical therapy (MT).

Background: FMT has shown good outcomes in the treatment of Clostridium difficile infection (CDI). We aimed to conduct a systematic review and meta-analysis to compare the effectiveness of FMT versus MT for CDI. Read More

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September 2021

Identification of resiliency processes in dual-trauma couples: An exploration of self-reported relational strengths and weaknesses.

Psychol Trauma 2021 Sep 13. Epub 2021 Sep 13.

Department of Family Social Science.

Objective: Empirical knowledge about "dual-trauma couples" (DTC), characterized by both partners with a history of trauma exposure and presentation of trauma-related symptoms, is especially deficient. We analyzed DTC partners' qualitative data culled from the Relationship Evaluation Questionnaire (Busby et al., 2001) to ascertain dyadic resiliency processes within dual-trauma couples. Read More

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September 2021

Measuring treatment effect on psoriatic arthritis-related domains: insights from the SPIRIT-H2H study at weeks 24 and 52.

Clin Rheumatol 2021 Sep 13. Epub 2021 Sep 13.

Sorbonne Université, INSERM, Institut Pierre Louis D'Epidémiologie Et de Santé Publique, Paris, France.

Introduction: Improvements in both musculoskeletal and non-musculoskeletal manifestations are important treatment goals in psoriatic arthritis (PsA).

Objective: These post hoc analyses determined whether additional benefits related to various PsA domains are observed in patients simultaneously achieving 50% improvement in American College of Rheumatology criteria (ACR50) and 100% improvement in Psoriasis Area Severity Index (PASI100), the primary endpoint of the SPIRIT-H2H study.

Methods: Patients with active PsA and psoriasis in SPIRIT-H2H (N = 566) were categorised into two sets of four response groups irrespective of treatment allocation (approved dosages of ixekizumab or adalimumab): patients who simultaneously achieved ACR50 and PASI100 response, achieved ACR50 response only, achieved PASI100 response only, or did not achieve ACR50 or PASI100 response after 24 and 52 weeks of treatment. Read More

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September 2021

Innovative radiation oncology Together - Precise, Personalized, Human : Vision 2030 for radiotherapy & radiation oncology in Germany.

Strahlenther Onkol 2021 Sep 13. Epub 2021 Sep 13.

Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.

Purpose: Scientific and clinical achievements in radiation, medical, and surgical oncology are changing the landscape of interdisciplinary oncology. The German Society for Radiation Oncology (DEGRO) working group of young clinicians and scientists (yDEGRO) and the DEGRO representation of associate and full professors (AKRO) are aware of the essential role of radiation oncology in multidisciplinary treatment approaches. Together, yDEGRO and AKRO endorsed developing a German radiotherapy & radiation oncology vision 2030 to address future challenges in patient care, research, and education. Read More

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September 2021

Treatment of Iron Deficiency Anemia in CKD and End-Stage Kidney Disease.

Kidney Int Rep 2021 Sep 5;6(9):2261-2269. Epub 2021 Jun 5.

Division of Nephrology, Department of Medicine and Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Iron deficiency is common in individuals with chronic kidney disease and plays a major role in the development of anemia. Oral and intravenous iron agents are both available to replete iron in patients with chronic kidney disease diagnosed with iron deficiency. The choice of which agent to use is most often dictated by goals of therapy, tolerability, convenience, and response to prior therapy. Read More

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September 2021

The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction.

Res Rep Urol 2021 2;13:647-657. Epub 2021 Sep 2.

Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.

Neurogenic bladder dysfunction is a major source of urologic morbidity in children, especially in those with spina bifida (SB). Complications from progression of bladder dysfunction can include urinary tract infections (UTIs), urinary incontinence, upper tract deterioration, and renal dysfunction or failure. In these children, there has been a recent trend toward proactive rather than expectant management of neurogenic bladder. Read More

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September 2021

The Cost of Gait Slowness: Can Persons with Parkinson's Disease Save Energy by Walking Faster?

J Parkinsons Dis 2021 Sep 7. Epub 2021 Sep 7.

Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD, USA.

Background: Gait slowing is a common feature of Parkinson's disease (PD). Many therapies aim to improve gait speed in persons with PD, but goals are often imprecise. How fast should each patient walk? And how do persons with PD benefit from walking faster? There is an important need to understand how walking speed affects fundamental aspects of gait-including energy cost and stability-that could guide individualized therapy decisions in persons with PD. Read More

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September 2021

Automation of oxygen titration in preterm infants: Current evidence and future challenges.

Early Hum Dev 2021 Sep 4:105462. Epub 2021 Sep 4.

School of Engineering, University of Tasmania, Hobart, Tasmania, Australia.

For the preterm infant with respiratory insufficiency requiring supplemental oxygen, tight control of oxygen saturation (SpO) is advocated, but difficult to achieve in practice. Automated control of oxygen delivery has emerged as a potential solution, with six control algorithms currently embedded in commercially-available respiratory support devices. To date, most clinical evaluations of these algorithms have been short-lived crossover studies, in which a benefit of automated over manual control of oxygen titration has been uniformly noted, along with a reduction in severe SpO deviations and need for manual FiO adjustments. Read More

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September 2021

Patient activation and treatment decision-making in the context of cancer: examining the contribution of informal caregivers' involvement.

J Cancer Surviv 2021 Sep 12. Epub 2021 Sep 12.

Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Room 333, Houston, TX, 77204-4013, USA.

Purpose: The present work investigated the relationship between patient activation, treatment decision-making, and adherence to the prescribed treatment regimen. Given the role of informal caregivers in patient-reported outcomes, it was additionally assessed whether caregiver involvement acted as a moderator of this relationship.

Methods: Survey data collected from 504 cancer survivors were utilized. Read More

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September 2021

Practical guidance for the management of adults receiving adjunctive cenobamate for the treatment of focal epilepsy-expert opinion.

Epilepsy Behav 2021 Sep 8;123:108270. Epub 2021 Sep 8.

Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Clinical trial results have demonstrated that adjunctive cenobamate (CNB) substantially decreases seizure frequency in adults with uncontrolled focal onset seizures with an acceptable and well-identified safety profile. This manuscript summarizes an expert panel's recommendations regarding optimized CNB treatment of epilepsies with focal onset seizures. Cenobamate, when slowly titrated to the target maintenance dose, represents an effective new antiseizure medication (ASM) with a comparatively high rate of seizure freedom relative to existing treatment options. Read More

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September 2021

Hypertonic Saline for Hyponatremia: Meeting Goals and Avoiding Harm.

Am J Kidney Dis 2021 Sep 8. Epub 2021 Sep 8.

Rochester General Hospital and University of Rochester School of Medicine and Dentistry, Rochester, New York. Electronic address:

Hypertonic saline has been used for the treatment of hyponatremia for nearly a century. There is now general consensus that hypertonic saline should be used in patients with hyponatremia associated with moderate or severe symptoms to prevent neurological complications. However, much less agreement exists among experts regarding other aspects of its use. Read More

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September 2021

Accuracy of combined molecular and morphology-based triage for HPV-positive women in routine cervical cancer screening services from Colombia.

Prev Med 2021 Sep 8:106801. Epub 2021 Sep 8.

Subdirección de Investigación - Instituto Nacional de Cancerología, Bogotá, Colombia. Electronic address:

WHO cervical cancer elimination goals comprise 70% of highly-sensitive screening coverage and 90% treatment of precancerous lesions. Triage for HPV-positive women may challenge sensitivity of screening algorithms and women's follow-up, particularly in low- and middle-income countries (LMIC) where screening quality and protocol adherence are frequently deficient. We aimed to determine the accuracy of triage for HPV positive women in routine screening services from Colombia by a prospective cross-sectional study. Read More

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September 2021