Uncertainty following an inconclusive result from the BRCA1/2 genetic test:A review about psychological outcomes

BACKGROUND An inconclusive result from BRCA1/2 genetic testing indicates that a genetic variant of uncertain significance is detected.This case constitutes the majority of genetic test results,but studies specifically addressing the psychological adjustment of people with inconclusive results are scarce.AIM To examine psychological outcomes of receiving an uninformative BRCA1/2 test result.METHODS PubMed,PsychInfo,and Cochrane Central Register of Controlled Trials were screened for studies focusing on distress,anxiety,and depression levels in individuals with inconclusive genetic test results.This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method.RESULTS Studies on psychological outcomes of inconclusive BRCA1/2 focused on general and specific distress,anxiety,and depression.Overall,they produced mixed results.These inconsistent findings are probably due to the uncertainty caused by this type of result,that may also influence the decisions of individuals about surveillance and prophylactic options,reducing their compliance.In addition,this review highlights specific risk and protective factors that affect psychological adjustment in individuals with an inconclusive genetic testing result.CONCLUSION Individuals with inconclusive genetic test results need specific educational programs and support to better understand the meaning of their results in order to be able to make decisions about surveillance and prophylactic options.

ROSE: Alternative for Cancelled and Inconclusive Cytopathologic Examinations, as Well as Professional Training at the UNESP-Botucatu Veterinary Hospital

ROSE is a method for fast sample evaluation that does not compromise sensitivity and specificity in the hospital environment when establishing the diagnosis and the therapeutic protocol. The technique is already well-established in human medicine as it operates within the standard operational procedure, reducing the rates of inconclusive results and cancelled cytopathology assays in the hospital environment. However, its application is scarce in Veterinary Medicine, including in hospitals where intensive care is available. This study aims at conducting a case-by-case assessment of inconclusive and cancelled examinations in the Cytopathology Outpatient Clinic at UNESP (HV), Botucatu, Brazil, from 2012 to 2016 and ascertains the causes. For this purpose, a retrospective study was conducted for 9587 examinations in canines, of which 4.1% and 10.44% were inconclusive and cancelled, respectively. These results are not in line with ROSE, which foresees a total rate of 5% for these occurrences. The reasons for these high rates in the outpatient clinic were the lack of a Standard Operating Procedure (SOP) and the relative inexperience of the residents in a university hospital. Therefore, with the adoption of the ROSE protocol for veterinary cytopathological examinations, together with adequate training for the outpatient professionals responsible for the examinations, the goals set forth by the ROSE protocol would be met and the rates of inconclusive and cancelled examinations would decrease considerably. Lastly, this study hopes to contribute towards the diagnosis and therapeutic protocols of the main diseases affecting dogs.

Single-arm phase II three-outcome designs with handling of over-running/under-running

Phase II clinical trials are commonly conducted as pilot studies to evaluate the efficacy and safety of the investigational drug in the targeted patient population with the disease or condition to be treated or prevented.When designing such a trial considering efficacy conclusions,people natu-rally think as follows:if efficacy evidence is very strong,a go decision should be made;if efficacy evidence is very weak,a no-go decision should be made;if the efficacy evidence is neither strong nor weak,no decision can be made(inconclusive).The designs presented in this paper match this natural thinking process with go/no-go/inconclusive outcomes.Both two-/three-stage designs are developed with three outcomes.Additionally,a general approach based on conditional error function is implemented such that new decision boundaries can be calculated to handle mid-course sample size change which results in either‘over-running’or‘under-running’and ensure the control of overall type I error.A free open-source R package tsdf that calculates the proposed two-/three-stage designs is available on CRAN.