Blood-Based Versus Stool-Based Biomarker Accuracy in Detection of Colorectal Cancer and Impact of Non-Invasive Tests on Patient Participation

Colorectal cancer is a very treatable cancer when detected early, therefore patient adherence and colorectal cancer screening is key to decrease mortality. The purpose of this research and systematic literature review was to determine how the accuracy of blood-based and stool-based biomarkers compared in the detection of colorectal cancer and how noninvasive testing modalities influence patient participation in colorectal cancer screening. Only articles published within the past 10 years were included. A combination of keywords and MeSH phrases to include but not limited to “adherence,” “SEPT9,” “colonoscopy,” “multitarget stool,” and “colorectal cancer” were used to find relevant articles for each theme. Meta-analyses were excluded. Of note, several articles are used in multiple themes of this literature review. In terms of patient compliance and adherence, the studies comprehensively agree that non-invasive testing modality availability can increase patient participation in screening for colorectal cancer screening. While there was not significant data demonstrating the impact of participation when offering blood testing, various studies demonstrated that this modality is not well known by participants. Overall, MT-sDNA testing showed to be more accurate than SEPT9 in the detection of colorectal cancer and precancerous lesions based on the determined sensitivities and specificities. Of note, SEPT9 did show similar performance to FIT, which is a current FDA approved screening recommendation, in the detection of colorectal cancer and precancerous lesions. Combination testing showed trends that when SEPT9 and FIT were used in combination, sensitivity was increased, however, this in turn decreased specificity of the testing. There are not currently studies available comparing the performance of SEPT9 and MT-sDNA performance in combination, hence, further research is needed in this area to fully optimize available modalities

Blood-Based Versus Stool-Based Biomarker Accuracy in Detection of Colorectal Cancer and Impact of Non-Invasive Tests on Patient Participation

Colorectal cancer is a very treatable cancer when detected early, therefore patient adherence and colorectal cancer screening is key to decrease mortality. The purpose of this research and systematic literature review was to determine how the accuracy of blood-based and stool-based biomarkers compared in the detection of colorectal cancer and how noninvasive testing modalities influence patient participation in colorectal cancer screening. PubMed and Clinical Key were used as search engines. In terms of patient compliance and adherence, the studies comprehensively agree that non-invasive testing modality availability can increase patient participation in screening for colorectal cancer. While there was not significant data demonstrating the impact of participation when offering blood testing, various studies demonstrated that this modality is not well known by participants. Overall, MT-sDNA testing showed to be more accurate than SEPT9 in the detection of colorectal cancer and precancerous. Of note, SEPT9 did show similar performance to FIT, which is a current FDA approved screening recommendation, in the detection of colorectal cancer and precancerous lesions. Combination testing showed trends that when SEPT9 and FIT were used in combination, sensitivity was increased, however, this in turn decreased specificity of the testing. There were not currently studies available comparing the performance of SEPT9 and MT-sDNA performance alone versus in combination, hence, further research is needed in this area to fully optimize available modalities.https://commons.und.edu/pas-grad-posters/1283/thumbnail.jp

Coping Strategies Related to Obsessive-Compulsive, Social Anxiety, and Depressive Symptoms

The relationship between coping strategies and psychological symptoms has been studied for decades. The purpose of the current study was to examine how coping strategies relate to obsessive-compulsive, social anxiety, and depressive symptoms as well as how these three symptom domains influence chosen coping strategies. Participants were administered the COPE, Dimensional Obsessive-Compulsive Scale (DOCS), Social Phobia Scale (SPS), Social Interaction Anxiety Scale (SIAS), and Center for Epidemiologic Studies Depression Scale, Revised (CESD-R). Given the symptom comorbidity between these three symptom domains, regression analyses were conducted to control for comorbidity among both symptom domains and coping factors. This study found that increased use of coping strategies categorized under the avoidant coping factor were related to increased reporting of obsessive-compulsive, social anxiety, and depressive symptoms. Use of coping strategies categorized under the self-sufficient factor were found to have an inverse relationship with social anxiety symptoms. Additionally, this study found that while obsessive-compulsive and depressive symptoms are predictors of the avoidant coping factor, obsessive-compulsive and social anxiety symptoms are also predictors of the self-sufficient factor. Clinical implications of this study\u27s findings are twofold. First, assessing the coping strategies with these symptom domains in the same subject pool allows for a comparison of how the coping strategies used by individuals with obsessive-compulsive, social anxiety, and depressive symptoms while controlling for the other two domains. Second, data from this study could potentially be used to develop disorder-specific psychoeducation about coping strategies to better treat those with mental disorders

Coping Strategies Related to Obsessive-Compulsive, Social Anxiety, and Depressive Symptoms

The relationship between coping strategies and psychological symptoms has been studied for decades. The purpose of the current study was to examine how coping strategies relate to obsessive-compulsive, social anxiety, and depressive symptoms as well as how these three symptom domains influence chosen coping strategies. Participants were administered the COPE, Dimensional Obsessive-Compulsive Scale (DOCS), Social Phobia Scale (SPS), Social Interaction Anxiety Scale (SIAS), and Center for Epidemiologic Studies Depression Scale, Revised (CESD-R). Given the symptom comorbidity between these three symptom domains, regression analyses were conducted to control for comorbidity among both symptom domains and coping factors. This study found that increased use of coping strategies categorized under the avoidant coping factor were related to increased reporting of obsessive-compulsive, social anxiety, and depressive symptoms. Use of coping strategies categorized under the self-sufficient factor were found to have an inverse relationship with social anxiety symptoms. Additionally, this study found that while obsessive-compulsive and depressive symptoms are predictors of the avoidant coping factor, obsessive-compulsive and social anxiety symptoms are also predictors of the self-sufficient factor. Clinical implications of this study\u27s findings are twofold. First, assessing the coping strategies with these symptom domains in the same subject pool allows for a comparison of how the coping strategies used by individuals with obsessive-compulsive, social anxiety, and depressive symptoms while controlling for the other two domains. Second, data from this study could potentially be used to develop disorder-specific psychoeducation about coping strategies to better treat those with mental disorders

Presidential Decision Making: Comparing the Personality Profiles of Barack Obama and Franklin D. Roosevelt

This paper presents the results of indirect assessments of the personalities of U.S. presidents Franklin D. Roosevelt and Barack H. Obama, from the conceptual perspective of personologist Theodore Millon. Information concerning Roosevelt and Obama was collected from biographical sources and published reports and synthesized into personality profiles using the second edition of the Millon Inventory of Diagnostic Criteria (MIDC), which yields 34 normal and maladaptive personality classifications congruent with Axis II of DSM-IV. The personality profiles yielded by the MIDC were analyzed on the basis of interpretive guidelines provided in the MIDC manual. Roosevelt’s primary personality pattern was found to be Dominant/controlling, with secondary features of the Ambitious/self-serving and Conscientious/dutiful patterns. Obama’s primary personality pattern was found to be Ambitious/self-serving, with secondary features of the Conscientious/respectful and Retiring/reserved patterns. Roosevelt’s and Obama’s personalities are compared and contrasted and the influence of their personality patterns on presidential decision making discussed in the context of parallel political and economic challenges faced by these two presidents

Multi-drug resistance, inappropriate initial antibiotic therapy and mortality in Gram-negative severe sepsis and septic shock: A retrospective cohort study

INTRODUCTION: The impact of in vitro resistance on initially appropriate antibiotic therapy (IAAT) remains unclear. We elucidated the relationship between non-IAAT and mortality, and between IAAT and multi-drug resistance (MDR) in sepsis due to Gram-negative bacteremia (GNS). METHODS: We conducted a single-center retrospective cohort study of adult intensive care unit patients with bacteremia and severe sepsis/septic shock caused by a gram-negative (GN) organism. We identified the following MDR pathogens: MDR P. aeruginosa, extended spectrum beta-lactamase and carbapenemase-producing organisms. IAAT was defined as exposure within 24 hours of infection onset to antibiotics active against identified pathogens based on in vitro susceptibility testing. We derived logistic regression models to examine a) predictors of hospital mortality and b) impact of MDR on non-IAAT. Proportions are presented for categorical variables, and median values with interquartile ranges (IQR) for continuous. RESULTS: Out of 1,064 patients with GNS, 351 (29.2%) did not survive hospitalization. Non-survivors were older (66.5 (55, 73.5) versus 63 (53, 72) years, P = 0.036), sicker (Acute Physiology and Chronic Health Evaluation II (19 (15, 25) versus 16 (12, 19), P <0.001), and more likely to be on pressors (odds ratio (OR) 2.79, 95% confidence interval (CI) 2.12 to 3.68), mechanically ventilated (OR 3.06, 95% CI 2.29 to 4.10) have MDR (10.0% versus 4.0%, P <0.001) and receive non-IAAT (43.4% versus 14.6%, P <0.001). In a logistic regression model, non-IAAT was an independent predictor of hospital mortality (adjusted OR 3.87, 95% CI 2.77 to 5.41). In a separate model, MDR was strongly associated with the receipt of non-IAAT (adjusted OR 13.05, 95% CI 7.00 to 24.31). CONCLUSIONS: MDR, an important determinant of non-IAAT, is associated with a three-fold increase in the risk of hospital mortality. Given the paucity of therapies to cover GN MDRs, prevention and development of new agents are critical

Imipenem resistance of Pseudomonas in pneumonia: a systematic literature review

<p>Abstract</p> <p>Background</p> <p>Pneumonia, and particularly nosocomial (NP) and ventilator-associated pneumonias (VAP), results in high morbidity and costs. NPs in particular are likely to be caused by <it>Pseudomonas aeruginosa </it>(PA), ~20% of which in observational studies are resistant to imipenem. We sought to identify the burden of PA imipenem resistance in pneumonia.</p> <p>Methods</p> <p>We conducted a systematic literature review of randomized controlled trials (RCT) of imipenem treatment for pneumonia published in English between 1993 and 2008. We extracted study, population and treatment characteristics, and proportions caused by PA. Endpoints of interest were: PA resistance to initial antimicrobial treatment, clinical success, microbiologic eradication and on-treatment emergence of resistance of PA.</p> <p>Results</p> <p>Of the 46 studies identified, 20 (N = 4,310) included patients with pneumonia (imipenem 1,667, PA 251; comparator 1,661, PA 270). Seven were double blind, and 7 included US data. Comparator arms included a β-lactam (17, [penicillin 6, carbapenem 4, cephalosporin 7, monobactam 1]), aminoglycoside 2, vancomycin 1, and a fluoroquinolone 5; 5 employed double coverage. Thirteen focused exclusively on pneumonia and 7 included pneumonia and other diagnoses. Initial resistance was present in 14.6% (range 4.2-24.0%) of PA isolates in imipenem and 2.5% (range 0.0-7.4%) in comparator groups. Pooled clinical success rates for PA were 45.2% (range 0.0-72.0%) for imipenem and 74.9% (range 0.0-100.0%) for comparator regimens. Microbiologic eradication was achieved in 47.6% (range 0.0%-100.0%) of isolates in the imipenem and 52.8% (range 0.0%-100.0%) in the comparator groups. Resistance emerged in 38.7% (range 5.6-77.8%) PA isolates in imipenem and 21.9% (range 4.8-56.5%) in comparator groups.</p> <p>Conclusions</p> <p>In the 15 years of RCTs of imipenem for pneumonia, PA imipenem resistance rates are high, and PA clinical success and microbiologic eradication rates are directionally lower for imipenem than for comparators. Conversely, initial and treatment-emergent resistance is more likely with the imipenem than the comparator regimens.</p

The combination effects of trivalent gold ions and gold nanoparticles with different antibiotics against resistant Pseudomonas aeruginosa

Despite much success in drug design and development, Pseudomonas aeruginosa is still considered as one of the most problematic bacteria due to its ability to develop mutational resistance against a variety of antibiotics. In search for new strategies to enhance antibacterial activity of antibiotics, in this work, the combination effect of gold materials including trivalent gold ions (Au ) and gold nanoparticles (Au NPs) with 14 different antibiotics was investigated against the clinical isolates of P. aeruginosa, Staphylococcus aureus and Escherichia coli. Disk diffusion assay was carried out, and test strains were treated with the sub-inhibitory contents of gold nanomaterial. Results showed that Au NPs did not increase the antibacterial effect of antibiotics at tested concentration (40 μg/disc). However, the susceptibility of resistant P. aeruginosa increased in the presence of Au and methicillin, erythromycin, vancomycin, penicillin G, clindamycin and nalidixic acid, up to 147 %. As an individual experiment, the same group of antibiotics was tested for their activity against clinical isolates of S. aureus, E. coli and a different resistant strain of P. aeruginosa in the presence of sub-inhibitory contents of Au , where Au increased the susceptibility of test strains to methicillin, erythromycin, vancomycin, penicillin G, clindamycin and nalidixic acid. Our finding suggested that using the combination of sub-inhibitory concentrations of Au and methicillin, erythromycin, nalidixic acid or vancomycin may be a promising new strategy for the treatment of highly resistant P. aeruginosa infections