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Nitzan I, Philips R, White RD. Screening Recommendations and Treatments for Postpartum Depression. JAMA 2024; 331:1153-1154. [PMID: 38563841 DOI: 10.1001/jama.2024.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Itamar Nitzan
- Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Raylene Philips
- Loma Linda University Children's Hospital, Loma Linda University School of Medicine, Loma Linda, California
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Moore Simas TA, Whelan A, Byatt N. Screening Recommendations and Treatments for Postpartum Depression-Reply. JAMA 2024; 331:1154. [PMID: 38563838 DOI: 10.1001/jama.2024.1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester
| | - Anna Whelan
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester
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3
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Moore Simas TA, Whelan A, Byatt N. Postpartum Depression-New Screening Recommendations and Treatments. JAMA 2023; 330:2295-2296. [PMID: 38010647 DOI: 10.1001/jama.2023.21311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
This Insights in the Women’s Health series describes perinatal depression (occurring prepregnancy through postpartum periods) and new recommendations and treatment guidelines for this condition.
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Affiliation(s)
- Tiffany A Moore Simas
- University of Massachusetts Chan Medical School, Worcester
- UMass Memorial Health, Worcester, Massachusetts
| | - Anna Whelan
- University of Massachusetts Chan Medical School, Worcester
- UMass Memorial Health, Worcester, Massachusetts
| | - Nancy Byatt
- University of Massachusetts Chan Medical School, Worcester
- UMass Memorial Health, Worcester, Massachusetts
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Wilemon K, Knowles JW, Baum SJ. USPSTF Recommendation on Screening for Lipid Disorders in Children and Adolescents. JAMA 2023; 330:2024. [PMID: 38015224 DOI: 10.1001/jama.2023.20446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
| | - Joshua W Knowles
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford, California
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Santos RD, Libby P, Watts GF. USPSTF Recommendation on Screening for Lipid Disorders in Children and Adolescents. JAMA 2023; 330:2022-2023. [PMID: 38015223 DOI: 10.1001/jama.2023.20449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Raul D Santos
- Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | - Peter Libby
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Gerald F Watts
- Royal Perth Hospital School of Medicine, University of Western Australia, Perth, Australia
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6
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Barry MJ, Li L. USPSTF Recommendation on Screening for Lipid Disorders in Children and Adolescents-Reply. JAMA 2023; 330:2024-2025. [PMID: 38015221 DOI: 10.1001/jama.2023.20452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
| | - Li Li
- University of Virginia, Charlottesville
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McGowan MP, Cuchel M, Lee PC. USPSTF Recommendation on Screening for Lipid Disorders in Children and Adolescents. JAMA 2023; 330:2023-2024. [PMID: 38015225 DOI: 10.1001/jama.2023.20443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Mary P McGowan
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Paul C Lee
- Washington University in St Louis, St Louis, Missouri
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Vajravelu ME, Okah E, Bensignor M, Karbeah J. A Call to Replace Race- and Ethnicity-Based Screening with Health-Related Social Needs Evaluation When Assessing Risk of Type 2 Diabetes in Youth. J Adolesc Health 2023; 73:620-621. [PMID: 37542507 PMCID: PMC10926327 DOI: 10.1016/j.jadohealth.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Mary Ellen Vajravelu
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Ebiere Okah
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Megan Bensignor
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Division of Pediatric Endocrinology and Diabetes, University of Minnesota Medical School, Minneapolis, Minnesota
| | - J'Mag Karbeah
- Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota; Center for Antiracism Research for Health Equity, University of Minnesota, Minneapolis, Minnesota
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Mangione CM, Barry MJ, Nicholson WK, Cabana M, Chelmow D, Coker TR, Davidson KW, Davis EM, Donahue KE, Jaén CR, Kubik M, Li L, Ogedegbe G, Pbert L, Ruiz JM, Silverstein M, Stevermer J, Wong JB. Screening for Depression and Suicide Risk in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA 2022; 328:1534-1542. [PMID: 36219440 DOI: 10.1001/jama.2022.16946] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Depression is a leading cause of disability in the US. Children and adolescents with depression typically have functional impairments in their performance at school or work as well as in their interactions with their families and peers. Depression can also negatively affect the developmental trajectories of affected youth. Major depressive disorder (MDD) in children and adolescents is strongly associated with recurrent depression in adulthood; other mental disorders; and increased risk for suicidal ideation, suicide attempts, and suicide completion. Suicide is the second-leading cause of death among youth aged 10 to 19 years. Psychiatric disorders and previous suicide attempts increase suicide risk. Objective To update its 2014 and 2016 recommendations, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening, accuracy of screening, and benefits and harms of treatment of MDD and suicide risk in children and adolescents that would be applicable to primary care settings. Population Children and adolescents who do not have a diagnosed mental health condition or are not showing recognized signs or symptoms of depression or suicide risk. Evidence Assessment The USPSTF concludes with moderate certainty that screening for MDD in adolescents aged 12 to 18 years has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on screening for MDD in children 11 years or younger. The USPSTF concludes that the evidence is insufficient on the benefit and harms of screening for suicide risk in children and adolescents owing to a lack of evidence. Recommendation The USPSTF recommends screening for MDD in adolescents aged 12 to 18 years. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for MDD in children 11 years or younger. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in children and adolescents. (I statement).
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Affiliation(s)
| | | | | | | | | | | | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Chan Medical School, Worcester
| | | | | | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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11
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Tuddenham S, Ghanem KG. The Critical Need to Modernize Syphilis Screening. JAMA 2022; 328:1209-1211. [PMID: 36166050 DOI: 10.1001/jama.2022.15227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Susan Tuddenham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Khalil G Ghanem
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Sarma EA, Walter FM, Kobrin SC. Achieving Diagnostic Excellence for Cancer: Symptom Detection as a Partner to Screening. JAMA 2022; 328:525-526. [PMID: 35849403 DOI: 10.1001/jama.2022.11744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Elizabeth A Sarma
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Fiona M Walter
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Sarah C Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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Fang M, Wang D, Echouffo-Tcheugui JB, Selvin E. Prediabetes and Diabetes Screening Eligibility and Detection in US Adults After Changes to US Preventive Services Task Force and American Diabetes Association Recommendations. JAMA 2022; 327:1924-1925. [PMID: 35579650 PMCID: PMC9115610 DOI: 10.1001/jama.2022.5185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This cross-sectional study using NHANES data assesses the proportion of asymptomatic US adults eligible for screening based on new vs current US Preventive Services Task Force and American Diabetes Association screening guidelines, overall and among those with prediabetes or undiagnosed diabetes.
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Affiliation(s)
- Michael Fang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dan Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Leung TI, Cifu AS, Lee WW. Screening for Anxiety in Adolescent and Adult Women. JAMA 2022; 327:976-977. [PMID: 35258542 DOI: 10.1001/jama.2022.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tiffany I Leung
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, the Netherlands
| | - Adam S Cifu
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Wei Wei Lee
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
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Adjobimey M, Ade S, Wachinou P, Esse M, Yaha L, Bekou W, Campbell JR, Toundoh N, Adjibode O, Attikpa G, Agodokpessi G, Affolabi D, Merle CS. Prevalence, acceptability, and cost of routine screening for pulmonary tuberculosis among pregnant women in Cotonou, Benin. PLoS One 2022; 17:e0264206. [PMID: 35192665 PMCID: PMC8863221 DOI: 10.1371/journal.pone.0264206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We sought to evaluate the yield, cost, feasibility, and acceptability of routine tuberculosis (TB) screening of pregnant women in Cotonou, Benin. DESIGN Mixed-methods, cross-sectional study with a cost assessment. SETTING Eight participating health facilities in Cotonou, Benin. PARTICIPANTS Consecutive pregnant women presenting for antenatal care at any participating site who were not in labor or currently being treated for TB from April 2017 to April 2018. INTERVENTIONS Screening for the presence of TB symptoms by midwives and Xpert MTB/RIF for those with cough for at least two weeks. Semi-structured interviews with 14 midwives and 16 pregnant women about experiences with TB screening. PRIMARY AND SECONDARY OUTCOME MEASURES Proportion of pregnant women with cough of at least two weeks and/or microbiologically confirmed TB. The cost per pregnant woman screened and per TB case diagnosed in 2019 USD from the health system perspective. RESULTS Out of 4,070 pregnant women enrolled in the study, 94 (2.3%) had a cough for at least two weeks at the time of screening. The average (standard deviation) age of symptomatic women was 26 ± 5 years and 5 (5.3%) had HIV. Among the 94 symptomatic women, 2 (2.3%) had microbiologically confirmed TB for a TB prevalence of 49 per 100,000 (95% CI: 6 to 177 per 100,000) among pregnant women enrolled in the study. The average cost to screen one pregnant woman for TB was $1.12 USD and the cost per TB case diagnosed was $2271 USD. Thematic analysis suggested knowledge of TB complications in pregnancy was low, but that routine TB screening was acceptable to both midwives and pregnant women. CONCLUSION Enhanced screening for TB among pregnant women is feasible, acceptable, and inexpensive per woman screened, however in this setting has suboptimal yield even if it can contribute to enhance TB case finding.
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Affiliation(s)
- Mênonli Adjobimey
- National Tuberculosis Program, Cotonou, Benin
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
- * E-mail:
| | - Serge Ade
- National Tuberculosis Program, Cotonou, Benin
- Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Prudence Wachinou
- National Tuberculosis Program, Cotonou, Benin
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Marius Esse
- National Tuberculosis Program, Cotonou, Benin
| | - Lydia Yaha
- National Tuberculosis Program, Cotonou, Benin
| | | | - Jonathon R. Campbell
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | | | - Geoffroy Attikpa
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Gildas Agodokpessi
- National Tuberculosis Program, Cotonou, Benin
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Dissou Affolabi
- National Tuberculosis Program, Cotonou, Benin
- Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Corinne S. Merle
- Special Programme for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
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Saboo K, Petrakov NV, Shamsaddini A, Fagan A, Gavis EA, Sikaroodi M, McGeorge S, Gillevet PM, Iyer RK, Bajaj JS. Stool microbiota are superior to saliva in distinguishing cirrhosis and hepatic encephalopathy using machine learning. J Hepatol 2022; 76:600-607. [PMID: 34793867 PMCID: PMC8858861 DOI: 10.1016/j.jhep.2021.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Saliva and stool microbiota are altered in cirrhosis. Since stool is logistically difficult to collect compared to saliva, it is important to determine their relative diagnostic and prognostic capabilities. We aimed to determine the ability of stool vs. saliva microbiota to differentiate between groups based on disease severity using machine learning (ML). METHODS Controls and outpatients with cirrhosis underwent saliva and stool microbiome analysis. Controls vs. cirrhosis and within cirrhosis (based on hepatic encephalopathy [HE], proton pump inhibitor [PPI] and rifaximin use) were classified using 4 ML techniques (random forest [RF], support vector machine, logistic regression, and gradient boosting) with AUC comparisons for stool, saliva or both sample types. Individual microbial contributions were computed using feature importance of RF and Shapley additive explanations. Finally, thresholds for including microbiota were varied between 2.5% and 10%, and core microbiome (DESeq2) analysis was performed. RESULTS Two hundred and sixty-nine participants, including 87 controls and 182 patients with cirrhosis, of whom 57 had HE, 78 were on PPIs and 29 on rifaximin were included. Regardless of the ML model, stool microbiota had a significantly higher AUC in differentiating groups vs. saliva. Regarding individual microbiota: autochthonous taxa drove the difference between controls vs. patients with cirrhosis, oral-origin microbiota the difference between PPI users/non-users, and pathobionts and autochthonous taxa the difference between rifaximin users/non-users and patients with/without HE. These were consistent with the core microbiome analysis results. CONCLUSIONS On ML analysis, stool microbiota composition is significantly more informative in differentiating between controls and patients with cirrhosis, and those with varying cirrhosis severity, compared to saliva. Despite logistic challenges, stool should be preferred over saliva for microbiome analysis. LAY SUMMARY Since it is harder to collect stool than saliva, we wanted to test whether microbes from saliva were better than stool in differentiating between healthy people and those with cirrhosis and, among those with cirrhosis, those with more severe disease. Using machine learning, we found that microbes in stool were more accurate than saliva alone or in combination, therefore, stool should be preferred for analysis and collection wherever possible.
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Affiliation(s)
- Krishnakant Saboo
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Nikita V Petrakov
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Andrew Fagan
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA
| | - Edith A Gavis
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA
| | | | - Sara McGeorge
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA
| | | | - Ravishankar K Iyer
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA.
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Kaur H, Mukhopadhyay L, Gupta N, Aggarwal N, Sangal L, Potdar V, Inbanathan FY, Narayan J, Gupta S, Rana S, Vijay N, Singh H, Kaur J, Kumar V, Kaundal N, Abraham P, Ravi V. External quality assessment of COVID-19 real time reverse transcription PCR laboratories in India. PLoS One 2022; 17:e0263736. [PMID: 35134089 PMCID: PMC8824319 DOI: 10.1371/journal.pone.0263736] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/25/2022] [Indexed: 11/18/2022] Open
Abstract
Sudden emergence and rapid spread of COVID-19 created an inevitable need for expansion of the COVID-19 laboratory testing network across the world. The strategy to test-track-treat was advocated for quick detection and containment of the disease. Being the second most populous country in the world, India was challenged to make COVID-19 testing available and accessible in all parts of the country. The molecular laboratory testing network was augmented expeditiously, and number of laboratories was increased from one in January 2020 to 2951 till mid-September, 2021. This rapid expansion warranted the need to have inbuilt systems of quality control/ quality assurance. In addition to the ongoing inter-laboratory quality control (ILQC), India implemented an External Quality Assurance Program (EQAP) with assistance from World Health Organization (WHO) and Royal College of Pathologists, Australasia. Out of the 953 open system rRTPCR laboratories in both public and private sector who participated in the first round of EQAP, 891(93.4%) laboratories obtained a passing score of > = 80%. The satisfactory performance of Indian COVID-19 testing laboratories has boosted the confidence of the public and policy makers in the quality of testing. ILQC and EQAP need to continue to ensure adherence of the testing laboratories to the desired quality standards.
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Affiliation(s)
- Harmanmeet Kaur
- Virology Unit, Indian Council of Medical Research, DHR, MoHFW, New Delhi, Delhi, India
| | - Labanya Mukhopadhyay
- Virology Unit, Indian Council of Medical Research, DHR, MoHFW, New Delhi, Delhi, India
| | - Nivedita Gupta
- Virology Unit, Indian Council of Medical Research, DHR, MoHFW, New Delhi, Delhi, India
- * E-mail:
| | - Neeraj Aggarwal
- Virology Unit, Indian Council of Medical Research, DHR, MoHFW, New Delhi, Delhi, India
| | - Lucky Sangal
- WHO South-East Asia Regional Office, New Delhi, Delhi, India
| | - Varsha Potdar
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | | | - Jitendra Narayan
- Virology Unit, Indian Council of Medical Research, DHR, MoHFW, New Delhi, Delhi, India
| | - Swati Gupta
- Virology Unit, Indian Council of Medical Research, DHR, MoHFW, New Delhi, Delhi, India
| | - Salaj Rana
- Virology Unit, Indian Council of Medical Research, DHR, MoHFW, New Delhi, Delhi, India
| | - Neetu Vijay
- Virology Unit, Indian Council of Medical Research, DHR, MoHFW, New Delhi, Delhi, India
| | - Harpreet Singh
- Division of Biomedical Informatics, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Jasmine Kaur
- Division of Biomedical Informatics, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Vinit Kumar
- Division of Biomedical Informatics, Indian Council of Medical Research, New Delhi, Delhi, India
| | | | - Priya Abraham
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Vasanthapuram Ravi
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Kahwati LC, Asher GN, Kadro ZO, Keen S, Ali R, Coker-Schwimmer E, Jonas DE. Screening for Atrial Fibrillation: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 327:368-383. [PMID: 35076660 DOI: 10.1001/jama.2021.21811] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Atrial fibrillation (AF), the most common arrhythmia, increases the risk of stroke. OBJECTIVE To review the evidence on screening for AF in adults without prior stroke to inform the US Preventive Services Task Force. DATA SOURCES PubMed, Cochrane Library, and trial registries through October 5, 2020; references, experts, and literature surveillance through October 31, 2021. STUDY SELECTION Randomized clinical trials (RCTs) of screening among asymptomatic persons without known AF or prior stroke; test accuracy studies; RCTs of anticoagulation among persons with AF; systematic reviews; and observational studies reporting harms. DATA EXTRACTION AND SYNTHESIS Two reviewers assessed titles/abstracts, full-text articles, and study quality and extracted data; when at least 3 similar studies were available, meta-analyses were conducted. MAIN OUTCOMES AND MEASURES Detection of undiagnosed AF, test accuracy, mortality, stroke, stroke-related morbidity, and harms. RESULTS Twenty-six studies (N = 113 784) were included. In 1 RCT (n = 28 768) of twice-daily electrocardiography (ECG) screening for 2 weeks, the likelihood of a composite end point (ischemic stroke, hemorrhagic stroke, systemic embolism, all-cause mortality, and hospitalization for bleeding) was lower in the screened group over 6.9 years (hazard ratio, 0.96 [95% CI, 0.92-1.00]; P = .045), but that study had numerous limitations. In 4 RCTs (n = 32 491), significantly more AF was detected with intermittent and continuous ECG screening compared with no screening (risk difference range, 1.0%-4.8%). Treatment with warfarin over a mean of 1.5 years in populations with clinical, mostly persistent AF was associated with fewer ischemic strokes (pooled risk ratio [RR], 0.32 [95% CI, 0.20-0.51]; 5 RCTs; n = 2415) and lower all-cause mortality (pooled RR, 0.68 [95% CI, 0.50-0.93]) compared with placebo. Treatment with direct oral anticoagulants was also associated with lower incidence of stroke (adjusted odds ratios range, 0.32-0.44) in indirect comparisons with placebo. The pooled RR for major bleeding for warfarin compared with placebo was 1.8 (95% CI, 0.85-3.7; 5 RCTs; n = 2415), and the adjusted odds ratio for major bleeding for direct oral anticoagulants compared with placebo or no treatment ranged from 1.38 to 2.21, but CIs did not exclude a null effect. CONCLUSIONS AND RELEVANCE Although screening can detect more cases of unknown AF, evidence regarding effects on health outcomes is limited. Anticoagulation was associated with lower risk of first stroke and mortality but with increased risk of major bleeding, although estimates for this harm are imprecise; no trials assessed benefits and harms of anticoagulation among screen-detected populations.
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Affiliation(s)
- Leila C Kahwati
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Gary N Asher
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Zachary O Kadro
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill
| | - Susan Keen
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Rania Ali
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Emmanuel Coker-Schwimmer
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Daniel E Jonas
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
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Moreno-Contreras J, Espinoza MA, Sandoval-Jaime C, Cantú-Cuevas MA, Madrid-González DA, Barón-Olivares H, Ortiz-Orozco OD, Muñoz-Rangel AV, Guzmán-Rodríguez C, Hernández-de la Cruz M, Eroza-Osorio CM, Arias CF, López S. Pooling saliva samples as an excellent option to increase the surveillance for SARS-CoV-2 when re-opening community settings. PLoS One 2022; 17:e0263114. [PMID: 35077513 PMCID: PMC8789121 DOI: 10.1371/journal.pone.0263114] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/13/2022] [Indexed: 12/15/2022] Open
Abstract
In many countries a second wave of infections caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has occurred, triggering a shortage of reagents needed for diagnosis and compromising the capacity of laboratory testing. There is an urgent need to develop methods to accelerate the diagnostic procedures. Pooling samples represents a strategy to overcome the shortage of reagents, since several samples can be tested using one reaction, significantly increasing the number and speed with which tests can be carried out. We have reported the feasibility to use a direct lysis procedure of saliva as source for RNA to SARS-CoV-2 genome detection by reverse transcription quantitative-PCR (RT-qPCR). Here, we show that the direct lysis of saliva pools, of either five or ten samples, does not compromise the detection of viral RNA. In addition, it is a sensitive, fast, and inexpensive method that can be used for massive screening, especially considering the proximity of the reincorporation of activities in universities, offices, and schools.
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Affiliation(s)
- Joaquín Moreno-Contreras
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología UNAM, Cuernavaca, Morelos, México
| | - Marco A. Espinoza
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología UNAM, Cuernavaca, Morelos, México
| | - Carlos Sandoval-Jaime
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología UNAM, Cuernavaca, Morelos, México
| | | | | | | | | | | | | | | | | | - Carlos F. Arias
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología UNAM, Cuernavaca, Morelos, México
| | - Susana López
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología UNAM, Cuernavaca, Morelos, México
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Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Epling JW, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Screening for Atrial Fibrillation: US Preventive Services Task Force Recommendation Statement. JAMA 2022; 327:360-367. [PMID: 35076659 DOI: 10.1001/jama.2021.23732] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Atrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence of AF increases with age, from less than 0.2% in adults younger than 55 years to about 10% in those 85 years or older, with a higher prevalence in men than in women. It is uncertain whether the prevalence of AF differs by race and ethnicity. Atrial fibrillation is a major risk factor for ischemic stroke and is associated with a substantial increase in the risk of stroke. Approximately 20% of patients who have a stroke associated with AF are first diagnosed with AF at the time of the stroke or shortly thereafter. OBJECTIVE To update its 2018 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the benefits and harms of screening for AF in older adults, the accuracy of screening tests, the effectiveness of screening tests to detect previously undiagnosed AF compared with usual care, and the benefits and harms of anticoagulant therapy for the treatment of screen-detected AF in older adults. POPULATION Adults 50 years or older without a diagnosis or symptoms of AF and without a history of transient ischemic attack or stroke. EVIDENCE ASSESSMENT The USPSTF concludes that evidence is lacking, and the balance of benefits and harms of screening for AF in asymptomatic adults cannot be determined. RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AF. (I statement).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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22
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Greenland P. Screening for Atrial Fibrillation-More Data Still Needed. JAMA 2022; 327:329-330. [PMID: 35076684 DOI: 10.1001/jama.2021.23727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Philip Greenland
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Senior Editor, JAMA
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23
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Affiliation(s)
- Daniel M Horn
- From the Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Jennifer S Haas
- From the Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
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24
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Abstract
Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of developing hepatocellular carcinoma (HCC), especially among those who have cirrhosis or advanced fibrosis, but 20-30% of cases of NAFLD-related HCC occur in the absence of advanced fibrosis. The prevalence of NAFLD-related HCC is increasing in most countries worldwide. There are few direct data to support or refute the efficacy or effectiveness of HCC surveillance in NAFLD or to guide its application. We use evidence on surveillance in other conditions and studies on the clinical course of patients with NAFLD to arrive at recommendations for rational approaches to HCC surveillance in this growing cohort of patients. We also outline gaps in research and practice, including opportunities to advance the field.
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Affiliation(s)
- Amit G Singal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Hashem B El-Serag
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA.
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25
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Abstract
BACKGROUND Annual lung cancer screening via low-dose computed tomography can reduce lung cancer mortality among high-risk adults by 20%; however, screening take-up remains low. Inadequate insurance coverage or access to care may be a barrier to screening. OBJECTIVE The objective of this study was to estimate the effect of nearly universal access to Medicare coverage on annual lung cancer screening. RESEARCH DESIGN A regression discontinuity design was used to estimate the causal effect of nearly universal access to Medicare at age 65. Data come from the 2017 to 2019 Behavioral Risk Factor Surveillance System in 28 states that adopted the optional module on lung cancer screening and lung cancer risk. SUBJECTS A total of 11,163 individuals at high risk for lung cancer just above and below age 65. MEASURE Self-reported use of low-dose computed tomography to screen for lung cancer in the past 12 months. RESULTS A total of 10,951 people at high lung cancer risk (45.7% women, response rate=98.1%) reported lung cancer screening information. Nearly universal access to Medicare increased lung cancer screening by 16.2 percentage points among men (95% confidence interval: 2.4%-30.0%, P=0.02), compared with a baseline screening rate of 11.1% just younger than age 65. Women had a baseline screening rate of 18.2% and experienced no statistically significant change in screening (1.6 percentage point increase, 95% confidence interval: -19.8% to 23.0%, P=0.88). CONCLUSIONS Gaining Medicare coverage at age 65 increased lung cancer screening take-up among men at high lung cancer risk. Lack of insurance or inadequate access to care hinders screening.
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Affiliation(s)
- Jiren Sun
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Marcelo Coca Perraillon
- Department of Health, Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca Myerson
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
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26
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Hortlund M, Mühr LSA, Lagheden C, Hjerpe A, Dillner J. Audit of laboratory sensitivity of human papillomavirus and cytology testing in a cervical screening program. Int J Cancer 2021; 149:2083-2090. [PMID: 34418082 DOI: 10.1002/ijc.33769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/07/2022]
Abstract
The globally recommended public health policy for cervical screening is primary human papillomavirus (HPV) screening with cytology triaging of positives. To ensure optimal quality of laboratory services we have conducted regular audits of cervical smears taken before cervical cancer or cancer in situ (CIN3+) within an HPV-based screening program. The central cervical screening laboratory of Stockholm, Sweden, identified cases of CIN3+ who had had a previous cervical screening test up to 3 years before and randomly selected 300 cervical liquid-based cytology (LBC) samples for auditing. HPV testing with Roche Cobas was performed either at screening or with biobanked samples. HPV negative samples and subsequent biopsies were retrieved and tested with modified general primer HPV PCR and, if still HPV-negative, the LBCs and biopsies were whole genome sequenced. The Cobas 4800 detected HPV in 1020/1052 (97.0%) LBC samples taken before CIN3+. Further analyses found HPV in 28 samples, with nine of those containing HPV types not targeted by the Cobas 4800 test. There were 4 specimens (4/1052, 0.4%) where no HPV was detected. By comparison, the proportion of CIN3+ cases that were positive in a previous cytology were 91.6%. We find that the routine HPV screening test had a sensitivity in the real-life screening program of 97.0%. Regular laboratory audits of cervical samples taken before CIN3+ can be readily performed within a real-life screening program and provide assurance that the laboratory of the real-life program has the expected performance.
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Affiliation(s)
- Maria Hortlund
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Camilla Lagheden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hjerpe
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Cervical Cancer Prevention, Department of Pathology & Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden
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27
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Sohni D. Thermal Screening in COVID-19: Why Is It Commonplace? Mayo Clin Proc 2021; 96:3180. [PMID: 34863403 PMCID: PMC8486674 DOI: 10.1016/j.mayocp.2021.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
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Mirza KL, Wickham CJ, Noren ER, Shin J, Cologne KG, Lee SW. Full-Thickness Laparoendoscopic Excision for Management of Complex Colon Polyps. Dis Colon Rectum 2021; 64:1559-1563. [PMID: 34596631 DOI: 10.1097/dcr.0000000000002112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Benign colon polyps are increasingly being detected because of improved colonoscopic screening and early detection of masses on the adenoma-to-carcinoma pathway. Full-thickness laparoendoscopic excision is a colon-preserving technique for endoscopically unresectable polyps consisting of endoscopically guided nonanatomic wedge colectomy. OBJECTIVE This study aimed to evaluate the safety and success of full-thickness laparoendoscopic excision compared to segmental colectomy for complex polyps not amenable to endoscopic resection. DESIGN This is a retrospective case-control study. SETTINGS This study was conducted at a tertiary academic center. PATIENTS A prospectively maintained institutional database identified 22 patients with benign complex polyps managed with full-thickness laparoendoscopic excision from 2015 to 2020. These patients were compared with 22 propensity score-matched controls from the same database that underwent laparoscopic segmental colectomy. MAIN OUTCOME MEASURES Primary outcome was inpatient length of stay. Secondary outcomes included operative details and postoperative morbidities. RESULTS Full-thickness laparoendoscopic excision was successful in all patients. Patients had a median age of 64 years (41-85), and 82% were men. Final pathology revealed complete excision of benign lesions in 20 of 22 patients and adenocarcinoma in 2 of 22. For the adenocarcinomas, 1 patient underwent subsequent elective colectomy without complications, and 1 patient declined surgery. Propensity score matching was successful for age, sex, BMI, ASA score, colon location, and prior abdominal surgery. Compared with controls, cases had significantly shorter operative time (89.5 minutes (46-290) vs 122 minutes (85-200), p = 0.009), length of stay (1 day (0-17) vs 3 days (1-8), p < 0.001), and reduced blood loss (5 mL (2-15) vs 25 mL (10-150), p < 0.001). Thirty-day morbidity (9.1% vs 27.3%, p = 0.240) was not significantly different. An unplanned 30-day reoperation was performed in 1 patient for suspected small-bowel obstruction. There was 1 mortality due to decompensated cirrhosis in the treatment group. LIMITATIONS This study was limited by its single-institution retrospective design. CONCLUSIONS Full-thickness laparoendoscopic excision is safe and successful compared with corresponding segmental colectomy for complex polyps. Favorable postoperative outcomes, including decreased operative time, length of stay, and blood loss, make it a useful approach for managing complex polyps throughout the colon.
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Affiliation(s)
- Kasim L Mirza
- Department of Surgery, Division of Colorectal Surgery, University of Southern California, Los Angeles, California
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29
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Dagan M, Dinh DT, Stehli J, Zaman S, Brennan A, Tan C, Liew D, Reid CM, Stub D, Kaye DM, Lefkovits J, Duffy SJ. Impact of Age and Sex on Treatment and Outcomes Following Myocardial Infarction. J Am Coll Cardiol 2021; 78:1934-1936. [PMID: 34736569 DOI: 10.1016/j.jacc.2021.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
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30
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Katureebe C, Ashburn K, Machekano R, Gill MM, Gross J, Kazooba P, Kiyonga A, Taasi G, Adler M, Nazziwa E, Rivadeneira ED, Kekitiinwa A, Magongo E, Matovu JB, Nantume S, Bitarakwate E. Developing and Validating an Effective Pediatric and Adolescent HIV Testing Eligibility Screening Tool for High-Volume Entry Points in Uganda. J Acquir Immune Defic Syndr 2021; 88:290-298. [PMID: 34651604 PMCID: PMC10203979 DOI: 10.1097/qai.0000000000002775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Because of low pediatric HIV prevalence, more tests are needed to find 1 HIV-positive child compared with adults. In Uganda, the number needed to test (NNT) to find 1 new HIV-positive child was 64 in outpatient departments (OPDs) and 31 through index testing. We aimed to develop and validate a pediatric (1.5-14 years) screening tool to optimize testing approaches. METHODS Phase 1 evaluated the performance of 10 screening questions in 14 OPDs using a variable selection algorithm to evaluate combinations of screening questions. Using logistic regression, we identified the number of screening questions with the best predictive accuracy using the receiver operation characteristic curve. Phase 2 validated the proposed tool in 15 OPDs and 7 orphan and vulnerable children programs. We estimated sensitivity, specificity, and NNT accounting for intercluster correlations. RESULTS A total of 3482 children were enrolled. The optimal model included reported HIV-positive maternal status or 2/5 symptoms (sickly in the last 3 months, recurring skin problems, weight loss, not growing well, and history of tuberculosis). The proposed tool had sensitivity of 83.6% [95% confidence interval (CI): 68.1 to 92.4] and specificity of 62.5% (95% CI: 55.0 to 69.4). The tool was validated in a sample of 11,342 children; sensitivity was 87.8% (95% CI: 80.9 to 92.5) and specificity 62.6% (95% CI: 54.8 to 69.7) across OPDs and community sites. In OPDs, sensitivity was 88.1% (95% CI: 80.8 to 92.8) and specificity 69.0% (95% CI: 61.9 to 75.3). The NNT was 43 (95% CI: 28 to 67) across settings and 28 (95% CI: 20 to 38) for OPD. CONCLUSIONS This HIV screening tool has high sensitivity and reasonable specificity, increasing testing efficiency and yield for children and adolescents.
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Affiliation(s)
| | - Kim Ashburn
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, D.C., U.S.A
| | | | - Michelle M. Gill
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, D.C., U.S.A
| | - Jessica Gross
- Maternal and Child Health Branch, Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, U.S.A
| | | | | | | | - Michelle Adler
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Esther Nazziwa
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Emilia D. Rivadeneira
- Maternal and Child Health Branch, Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, U.S.A
| | | | | | | | - Sophie Nantume
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
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Deiteren A, Coenen E, Lenders S, Verwilst P, Mannaert E, Rasschaert F. Data driven evaluation of healthy volunteer characteristics at screening for phase I clinical trials to inform on study design and optimize screening processes. Clin Transl Sci 2021; 14:2450-2460. [PMID: 34378856 PMCID: PMC8604224 DOI: 10.1111/cts.13113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
Protocols for clinical trials describe inclusion and exclusion criteria based on general and compound-specific considerations to ensure subject safety and data quality. In phase I clinical trials, healthy volunteers (HVs) are screened against these criteria that often specify predefined eligibility ranges for vital signs, electrocardiogram, and laboratory tests. HVs are excluded if baseline parameters deviate from these ranges even though this may not indicate underlying pathology, which could delay trial execution. Data from 3365 HVs participating in 9670 screening visits for 94 phase I HV trials, conducted between December 2008 and May 2019 at the Janssen Clinical Pharmacology Unit, were retrospectively analyzed. Commonly predefined protocol ranges were overlaid with HV data to estimate predicted screen failure rates (SFRs). Of the overall population, 91% was White and 64% were men with mean age of 42.8 ± 12.5 years. High predicted SFRs are related to cardiovascular/metabolic (body mass index, heart rate [HR], blood pressure [BP], and corrected QT Fridericia's formula [QTcF]), renal (estimated glomerular filtration rate [eGFR]), liver (alanine aminotransferase [ALT], and total bilirubin), and coagulation (prothrombin time [PT]) parameters. Predicted SFRs increased with age for high systolic and diastolic BP, QTcF interval, and eGFR. In contrast, lower SFRs in the older age groups were seen for low diastolic BP, liver function test, ALT, PT, and total bilirubin. This analysis can be used to inform on study design, protocol inclusion and exclusion criteria, and to optimize the screening process. Data-driven critical appraisal of proposed inclusion and exclusion criteria using a risk-based approach may significantly reduce screen failure rates without compromising subjects' safety.
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Affiliation(s)
| | - Erwin Coenen
- Janssen Clinical Pharmacology UnitMerksemBelgium
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32
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Muñoz Fernandez SS, Garcez FB, Alencar JCGD, Cederholm T, Aprahamian I, Morley JE, de Souza HP, Avelino da Silva TJ, Ribeiro SML. Applicability of the GLIM criteria for the diagnosis of malnutrition in older adults in the emergency ward: A pilot validation study. Clin Nutr 2021; 40:5447-5456. [PMID: 34653825 DOI: 10.1016/j.clnu.2021.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Acutely ill older adults are at higher risk of malnutrition. This study aimed to explore the applicability and accuracy of the GLIM criteria to diagnose malnutrition in acutely ill older adults in the emergency ward (EW). METHODS We performed a retrospective secondary analysis, of an ongoing cohort study, in 165 participants over 65 years of age admitted to the EW of a Brazilian university hospital. Nutrition assessment included anthropometry, the Simplified Nutritional Assessment Questionnaire (SNAQ), the Malnutrition Screening Tool (MST), and the Mini-Nutritional Assessment (MNA). We diagnosed malnutrition using GLIM criteria, defined by the parallel presence of at least one phenotypic [nonvolitional weight loss (WL), low BMI, low muscle mass (MM)] and one etiologic criterion [reduced food intake or assimilation (RFI), disease burden/inflammation]. We used the receiver operating characteristic (ROC) curves and Cox and logistic regression for data analyses. RESULTS GLIM criteria, following the MNA-SF screening, classified 50.3% of participants as malnourished, 29.1% of them in a severe stage. Validation of the diagnosis using MNA-FF as a reference showed good accuracy (AUC = 0.84), and moderate sensitivity (76%) and specificity (75.1%). All phenotypic criteria combined with RFI showed the best metrics. Malnutrition showed a trend for an increased risk of transference to intensive care unit (OR = 2.08, 95% CI 0.99, 4.35), and severe malnutrition for in-hospital mortality (HR = 4.23, 95% CI 1.2, 14.9). CONCLUSION GLIM criteria, following MNA-SF screening, appear to be a feasible approach to diagnose malnutrition in acutely ill older adults in the EW. Nonvolitional WL combined with RFI or acute inflammation were the best components identified and are easily accessible, allowing their potential use in clinical practice.
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Affiliation(s)
| | - Flavia Barreto Garcez
- Geriatrics Division, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Julio César García de Alencar
- Disciplina de Emergencias Clínicas, Departamento de Clínica Médica, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Karolinska University Hospital, Stockholm, Sweden
| | - Ivan Aprahamian
- Geriatrics Division, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - John Edward Morley
- Division of Geriatric Medicine, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Heraldo Possolo de Souza
- Disciplina de Emergencias Clínicas, Departamento de Clínica Médica, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | | | - Sandra Maria Lima Ribeiro
- Nutrition Department, School of Public Health, University of Sao Paulo, São Paulo, Brazil; School of Arts, Science, and Humanity, University of Sao Paulo, São Paulo, Brazil
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Schuttner L, Haraldsson B, Maynard C, Helfrich CD, Reddy A, Parikh T, Nelson KM, Wong E. Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration. JAMA Netw Open 2021; 4:e2130581. [PMID: 34677595 PMCID: PMC8536952 DOI: 10.1001/jamanetworkopen.2021.30581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Most clinical practice guidelines recommend stopping cancer screenings when risks exceed benefits, yet low-value screenings persist. The Veterans Health Administration focuses on improving the value and quality of care, using a patient-centered medical home model that may affect cancer screening behavior. OBJECTIVE To understand rates and factors associated with outpatient low-value cancer screenings. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed the receipt of low-value cancer screening and associated factors among 5 993 010 veterans. Four measures of low-value cancer screening defined by validated recommendations of practices to avoid were constructed using administrative data. Patients with cancer screenings in 2017 at Veterans Health Administration primary care clinics were included. Excluded patients had recent symptoms or historic high-risk diagnoses that may affect test appropriateness (eg, melena preceding colonoscopy). Data were analyzed from December 23, 2019, to June 21, 2021. EXPOSURES Receipt of cancer screening test. MAIN OUTCOMES AND MEASURES Low-value screenings were defined as occurring for average-risk patients outside of guideline-recommended ages or if the 1-year mortality risk estimated using a previously validated score was at least 50%. Factors evaluated in multivariable regression models included patient, clinician, and clinic characteristics and patient-centered medical home domain performance for team-based care, access, and continuity previously developed from administrative and survey data. RESULTS Of 5 993 010 veterans (mean [SD] age, 63.1 [16.8] years; 5 496 976 men [91.7%]; 1 027 836 non-Hispanic Black [17.2%] and 4 539 341 non-Hispanic White [75.7%] race and ethnicity) enrolled in primary care, 903 612 of 4 647 479 men of average risk (19.4%) underwent prostate cancer screening; 299 765 of 5 770 622 patients of average risk (5.2%) underwent colorectal cancer screening; 21 930 of 469 045 women of average risk (4.7%) underwent breast cancer screening; and 65 511 of 458 086 women of average risk (14.3%) underwent cervical cancer screening. Of patients screened, low-value testing was rare for 3 cancers, with receipt of a low-value test in 633 of 21 930 of women screened for breast cancer (2.9%), 630 of 65 511 of women screened for cervical cancer (1.0%), and 6790 of 299 765 of patients screened for colorectal cancer (2.3%). However, 350 705 of 4 647 479 of screened men (7.5%) received a low-value prostate cancer test. Patient race and ethnicity, sociodemographic factors, and illness burden were significantly associated with likelihood of receipt of low-value tests among screened patients. No single patient-, clinician-, or clinic-level factor explained the receipt of a low-value test across cancer screening cohorts. CONCLUSIONS AND RELEVANCE This large cohort study found that low-value breast, cervical, and colorectal cancer screenings were rare in the Veterans Health Administration, but more than one-third of patients screened for prostate cancer were tested outside of clinical practice guidelines. Guideline-discordant care has quality implications and is not consistently explained by associated multilevel factors.
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Affiliation(s)
- Linnaea Schuttner
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | | | - Charles Maynard
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Christian D. Helfrich
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Ashok Reddy
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - Toral Parikh
- Department of Medicine, University of Washington, Seattle
- Geriatrics and Extended Care, VA Puget Sound Healthcare System
| | - Karin M. Nelson
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - Edwin Wong
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
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Bonnet E, Daures JP, Landais P. Determination of thresholds of risk in women at average risk of breast cancer to personalize the organized screening program. Sci Rep 2021; 11:19104. [PMID: 34580360 PMCID: PMC8476568 DOI: 10.1038/s41598-021-98604-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/06/2021] [Indexed: 11/08/2022] Open
Abstract
In France, more than 10 million women at "average" risk of breast cancer (BC), are included in the organized BC screening. Existing predictive models of BC risk are not adapted to the French population. Thus, we set up a new score in the French Hérault region and looked for subgroups at a graded level of risk in women at "average" risk. We recruited a retrospective cohort of women, aged 50 to 60, who underwent the organized BC screening, and included 2241 non-cancer women and 527 who developed a BC during a 12-year follow-up period (2006-2018). The risk factors identified were high breast density (ACR BI-RADS grading)(B vs A: HR = 1.41, 95%CI [1.05; 1.9], p = 0.023; C vs A: HR = 1.65 [1.2; 2.27], p = 0.02 ; D vs A: HR = 2.11 [1.25;3.58], p = 0.006), a history of maternal breast cancer (HR = 1.61 [1.24; 2.09], p < 0.001), and socioeconomic difficulties (HR 1.23 [1.09; 1.55], p = 0.003). While early menopause (HR = 0.36 [0.13; 0.99], p = 0.003) and an age at menarche after 12 years (HR = 0.77 [0.63; 0.95], p = 0.047) were protective factors. We identified 3 groups at risk: lower, average, and higher, respectively. A low threshold was characterized at 1.9% of 12-year risk and a high threshold at 4.5% 12-year risk. Mean 12-year risks in the 3 groups of risk were 1.37%, 2.68%, and 5.84%, respectively. Thus, 12% of women presented a level of risk different from the average risk group, corresponding to 600,000 women involved in the French organized BC screening, enabling to propose a new strategy to personalize the national BC screening. On one hand, for women at lower risk, we proposed to reduce the frequency of mammograms and on the other hand, for women at higher risk, we suggested intensifying surveillance.
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Affiliation(s)
- Emmanuel Bonnet
- Montpellier University, EA2415, Institut Universitaire de recherche clinique, 34093, Montpellier Cedex 5, France.
- Languedoc Mutualité, Nouvelles Technologies, AESIO, Montpellier, France.
| | - Jean-Pierre Daures
- Montpellier University, EA2415, Institut Universitaire de recherche clinique, 34093, Montpellier Cedex 5, France
- Languedoc Mutualité, Nouvelles Technologies, AESIO, Montpellier, France
| | - Paul Landais
- Montpellier University, EA2415, Institut Universitaire de recherche clinique, 34093, Montpellier Cedex 5, France
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Ropers FG, Barratt A, Wilt TJ, Nicholls SG, Taylor-Phillips S, Kramer BS, Esserman LJ, Norris SL, Gibson LM, Harris RP, Carter SM, Jacklyn G, Jørgensen KJ. Health screening needs independent regular re-evaluation. BMJ 2021; 374:n2049. [PMID: 34580059 DOI: 10.1136/bmj.n2049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Fabienne G Ropers
- Department of General Paediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Alexandra Barratt
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales
| | - Timothy J Wilt
- Minneapolis VA Center for Care Delivery and Outcomes Research and the University of Minnesota, Minneapolis, MN, USA
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Barnett S Kramer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Laura J Esserman
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | | | - Lorna M Gibson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Russell P Harris
- School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, NSW, Australia
| | - Gemma Jacklyn
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Kue J, Szalacha LA, Rechenberg K, Nolan TS, Menon U. Communication Among Southeast Asian Mothers and Daughters About Cervical Cancer Prevention. Nurs Res 2021; 70:S73-S83. [PMID: 34173374 PMCID: PMC8527390 DOI: 10.1097/nnr.0000000000000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Southeast Asian women have high rates of cervical cancer and yet are among the least likely to be screened. There is sparse literature on communication patterns among Southeast Asian women, specifically related to cervical cancer and Pap test uptake. Little is known about the influence of Southeast Asian mothers and daughters on each other's cervical cancer beliefs and screening behaviors. OBJECTIVES We examined the perceptions of and barriers to cervical cancer screening among Cambodian and Lao mothers and daughters and explored how they converse about women's health issues, specifically cervical cancer and Pap testing. METHODS We conducted in-depth interviews with Cambodian and Lao mother-daughter dyads, aged 18 years and older, living in a large Midwestern city between February and September of 2015. Descriptive statistics were calculated to summarize the sample demographic characteristics. Bivariate tests (contingency table analyses, independent t-tests, and Pearson correlations) were conducted to test for differences between the mothers and daughters in demographic characteristics and measures of health status and beliefs. Qualitative data were analyzed using content analysis. RESULTS In-depth interviews were conducted with three Cambodian and eight Lao mother-daughter dyads. The daughters were significantly more acculturated to English, had greater education, and were mostly employed full time. The mothers and daughters evaluated their health status much the same, their medical mistrust equally, and all of the mothers and nine of the daughters were Buddhist. Themes in mother-daughter communication included what mothers and daughters do and do not talk about with regard to sexual health, refugee experiences, what hinders mother-daughter communication, and relationship dynamics. The mothers were embarrassed and uncomfortable discussing cervical cancer, Pap testing, and other women's health issues with their daughters. Although mothers did not influence women's health promotion or cervical cancer prevention with their daughters, daughters did influence their mothers' health and healthcare decisions. Daughters were critical in navigating healthcare systems, engaging with providers, and making medical decisions on behalf of their mothers. DISCUSSION By leveraging the unique and dynamic intergenerational bond that mothers and daughters who identify as Southeast Asian have, we can develop strategies to influence the cultural dialogue related to cervical cancer and early detection.
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Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Krist AH, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Simon MA, Stevermer J, Tseng CW, Wong JB. Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 326:949-956. [PMID: 34519796 DOI: 10.1001/jama.2021.14081] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Chlamydia and gonorrhea are among the most common sexually transmitted infections in the US. Infection rates are highest among adolescents and young adults of both sexes. Chlamydial and gonococcal infections in women are usually asymptomatic and may lead to pelvic inflammatory disease and its associated complications. Newborns of pregnant persons with untreated infection may develop neonatal chlamydial pneumonia or gonococcal or chlamydial ophthalmia. Infection in men may lead to urethritis and epididymitis. Both types of infection can increase risk of acquiring or transmitting HIV. OBJECTIVE To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for chlamydia and gonorrhea in sexually active adolescents and adults, including pregnant persons. POPULATION Asymptomatic, sexually active adolescents and adults, including pregnant persons. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection has moderate net benefit. The USPSTF concludes with moderate certainty that screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection has moderate net benefit. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men. RECOMMENDATION The USPSTF recommends screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (B recommendation) The USPSTF recommends screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men. (I statement).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Cantor A, Dana T, Griffin JC, Nelson HD, Weeks C, Winthrop KL, Chou R. Screening for Chlamydial and Gonococcal Infections: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 326:957-966. [PMID: 34519797 DOI: 10.1001/jama.2021.10577] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE The 2014 US Preventive Services Task Force (USPSTF) recommendation statement supported the effectiveness of screening for chlamydia and gonorrhea in asymptomatic, sexually active women 24 years or younger and in older women at increased risk for infection, although evidence for screening in men was insufficient. OBJECTIVE To update the 2014 USPSTF review on screening for chlamydial and gonococcal infection in adults and adolescents, including those who are pregnant. DATA SOURCES Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Ovid MEDLINE (January 1, 2014, through May 28, 2020) with surveillance through May 21, 2021. STUDY SELECTION Randomized clinical trials and observational studies of screening effectiveness, accuracy of risk stratification and alternative screening methods, accuracy of tests, and screening harms. DATA EXTRACTION AND SYNTHESIS One investigator abstracted data; a second checked accuracy. Two investigators independently assessed study quality. MAIN OUTCOMES AND MEASURES Complications of infection; infection transmission or acquisition; diagnostic accuracy of anatomical site-specific testing and collection methods; screening harms. RESULTS Twenty-seven studies were included (N = 179 515). Chlamydia screening compared with no screening was significantly associated with reduced risk of pelvic inflammatory disease (PID) in 2 of 4 trials and with reduced hospital-diagnosed PID (0.24% vs 0.38%); relative risk, 0.6 [95% CI, 0.4-1.0]), but not clinic-diagnosed PID or epididymitis, in the largest trial. In studies of risk prediction instruments in asymptomatic women, age younger than 22 years demonstrated comparable accuracy to extensive criteria. Sensitivity of chlamydial testing was similar at endocervical (89%-100%) and self- and clinician-collected vaginal (90%-100%) sites for women and at meatal (100%), urethral (99%), and rectal (92%) sites for men but lower at pharyngeal sites (69.2%) for men who have sex with men. Sensitivity of gonococcal testing was 89% or greater for all anatomical samples. False-positive and false-negative testing rates were low across anatomical sites and collection methods. CONCLUSIONS AND RELEVANCE Screening for chlamydial infection was significantly associated with a lower risk of PID in young women. Risk prediction criteria demonstrated limited accuracy beyond age. Testing for asymptomatic chlamydial and gonococcal infections was highly accurate at most anatomical sites, including urine and self-collected specimens. Effectiveness of screening in men and during pregnancy, optimal screening intervals, and adverse effects of screening require further evaluation.
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Affiliation(s)
- Amy Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- Department of Family Medicine, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Jessica C Griffin
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Heidi D Nelson
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Chandler Weeks
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Kevin L Winthrop
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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Sultan S, Siddique SM, Singh S, Altayar O, Caliendo AM, Davitkov P, Feuerstein JD, Kaul V, Lim JK, Mustafa RA, Falck-Ytter Y, Inadomi JM. AGA Rapid Review and Guideline for SARS-CoV2 Testing and Endoscopy Post-Vaccination: 2021 Update. Gastroenterology 2021; 161:1011-1029.e11. [PMID: 34029569 PMCID: PMC8139430 DOI: 10.1053/j.gastro.2021.05.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This guideline provides updated recommendations on the role of preprocedure testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in individuals undergoing endoscopy in the post-vaccination period and replaces the prior guideline from the American Gastroenterological Association (AGA) (released July 29, 2020). Since the start of the pandemic, our increased understanding of transmission has facilitated the implementation of practices to promote patient and health care worker (HCW) safety. Simultaneously, there has been increasing recognition of the potential harm associated with delays in patient care, as well as inefficiency of endoscopy units. With widespread vaccination of HCWs and the general population, a re-evaluation of AGA's prior recommendations was warranted. In order to update the role of preprocedure testing for SARS-CoV2, the AGA guideline panel reviewed the evidence on prevalence of asymptomatic SARS-CoV2 infections in individuals undergoing endoscopy; patient and HCW risk of infections that may be acquired immediately before, during, or after endoscopy; effectiveness of COVID-19 vaccine in reducing risk of infections and transmission; patient and HCW anxiety; patient delays in care and potential impact on cancer burden; and endoscopy volumes. The panel considered the certainty of the evidence, weighed the benefits and harms of routine preprocedure testing, and considered burden, equity, and cost using the Grading of Recommendations Assessment, Development and Evaluation framework. Based on very low certainty evidence, the panel made a conditional recommendation against routine preprocedure testing for SARS-CoV2 in patients scheduled to undergo endoscopy. The panel placed a high value on minimizing additional delays in patient care, acknowledging the reduced endoscopy volumes, downstream impact on delayed cancer diagnoses, and burden of testing on patients.
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Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota.
| | - Shazia M Siddique
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Osama Altayar
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Angela M Caliendo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Perica Davitkov
- Division of Gastroenterology, Northeast Ohio Veterans Affairs Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joseph D Feuerstein
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Vivek Kaul
- Division of Gastroenterology and Hepatology at the University of Rochester Medical Center, Rochester, New York
| | - Joseph K Lim
- Yale Liver Center and Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Yngve Falck-Ytter
- Division of Gastroenterology, Northeast Ohio Veterans Affairs Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - John M Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Orchard JJ, Orchard JW, Toresdahl B, Asif IM, Hughes D, La Gerche A, Semsarian C. Cardiovascular Screening of Elite Athletes by Sporting Organizations in Australia: A Survey of Chief Medical Officers. Clin J Sport Med 2021; 31:401-406. [PMID: 32073477 DOI: 10.1097/jsm.0000000000000798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/27/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare cardiovascular screening policies of Australian elite sporting organizations. DESIGN Online survey. SETTING Elite/professional sports in Australia. PARTICIPANTS Chief medical officers (CMOs) of elite/professional sports in Australia, including rugby union and league, cricket, tennis, Australian football, and cycling. ASSESSMENT OF VARIABLES Survey questions about each sport's cardiac screening policy: which screening components were included [eg, history and physical (H&P), resting 12-lead electrocardiogram (ECG)], whether screening was mandatory, whether the policy applied to elite junior and/or adult players, and which criteria were used to interpret ECGs. MAIN OUTCOME MEASURES Which sports had a formal cardiac screening policy, which athletes the policy applied to, components of screening, ECG interpretation criteria used. RESULTS Chief medical officers for 22/31 (71%) sports responded, representing >5000 athletes. Of these, 19/22 (86%) perform regular screening (100% H&P; 89% included ECG) with international cyclists also having routine echocardiograms and stress testing. Thirty-three percent of CMOs used the 2017 International Criteria for athlete ECG interpretation. Screening was mandatory with enforcement (26%), mandatory without enforcement (48%), and opt-out (26%). All screened adult elite athletes, and 68% screened junior elite athletes. Forty-two percent indicated athletes were required to pay for screening tests, and 63% required athletes to pay for follow-up tests. Almost all (94%) sports with a sports physician as the CMO screened athletes. CONCLUSIONS Most sports have a screening policy, with reasonable uniformity of components. All included H&P, and almost all included ECG. Only one sport included an echocardiogram and stress test as a standard (international players only). Promoting the latest ECG interpretation criteria may reduce false-positives and cost. Future work should explore cardiac emergency plans, screening infrastructure, cost, and long-term follow-up.
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Affiliation(s)
- Jessica J Orchard
- Heart Research Institute, Charles Perkins Centre, Sydney, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - John W Orchard
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | | | - Irfan M Asif
- University of Alabama Birmingham, Birmingham, Alabama
| | - David Hughes
- Australian Institute of Sport, Canberra, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Australia ; and
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
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Freeman K, Geppert J, Stinton C, Todkill D, Johnson S, Clarke A, Taylor-Phillips S. Use of artificial intelligence for image analysis in breast cancer screening programmes: systematic review of test accuracy. BMJ 2021; 374:n1872. [PMID: 34470740 PMCID: PMC8409323 DOI: 10.1136/bmj.n1872] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the accuracy of artificial intelligence (AI) for the detection of breast cancer in mammography screening practice. DESIGN Systematic review of test accuracy studies. DATA SOURCES Medline, Embase, Web of Science, and Cochrane Database of Systematic Reviews from 1 January 2010 to 17 May 2021. ELIGIBILITY CRITERIA Studies reporting test accuracy of AI algorithms, alone or in combination with radiologists, to detect cancer in women's digital mammograms in screening practice, or in test sets. Reference standard was biopsy with histology or follow-up (for screen negative women). Outcomes included test accuracy and cancer type detected. STUDY SELECTION AND SYNTHESIS Two reviewers independently assessed articles for inclusion and assessed the methodological quality of included studies using the QUality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. A single reviewer extracted data, which were checked by a second reviewer. Narrative data synthesis was performed. RESULTS Twelve studies totalling 131 822 screened women were included. No prospective studies measuring test accuracy of AI in screening practice were found. Studies were of poor methodological quality. Three retrospective studies compared AI systems with the clinical decisions of the original radiologist, including 79 910 women, of whom 1878 had screen detected cancer or interval cancer within 12 months of screening. Thirty four (94%) of 36 AI systems evaluated in these studies were less accurate than a single radiologist, and all were less accurate than consensus of two or more radiologists. Five smaller studies (1086 women, 520 cancers) at high risk of bias and low generalisability to the clinical context reported that all five evaluated AI systems (as standalone to replace radiologist or as a reader aid) were more accurate than a single radiologist reading a test set in the laboratory. In three studies, AI used for triage screened out 53%, 45%, and 50% of women at low risk but also 10%, 4%, and 0% of cancers detected by radiologists. CONCLUSIONS Current evidence for AI does not yet allow judgement of its accuracy in breast cancer screening programmes, and it is unclear where on the clinical pathway AI might be of most benefit. AI systems are not sufficiently specific to replace radiologist double reading in screening programmes. Promising results in smaller studies are not replicated in larger studies. Prospective studies are required to measure the effect of AI in clinical practice. Such studies will require clear stopping rules to ensure that AI does not reduce programme specificity. STUDY REGISTRATION Protocol registered as PROSPERO CRD42020213590.
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Affiliation(s)
- Karoline Freeman
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Julia Geppert
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Chris Stinton
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Daniel Todkill
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Samantha Johnson
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Aileen Clarke
- Division of Health Sciences, University of Warwick, Coventry, UK
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Deshields TL, Wells-Di Gregorio S, Flowers SR, Irwin KE, Nipp R, Padgett L, Zebrack B. Addressing distress management challenges: Recommendations from the consensus panel of the American Psychosocial Oncology Society and the Association of Oncology Social Work. CA Cancer J Clin 2021; 71:407-436. [PMID: 34028809 DOI: 10.3322/caac.21672] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Distress management (DM) (screening and response) is an essential component of cancer care across the treatment trajectory. Effective DM has many benefits, including improving patients' quality of life; reducing distress, anxiety, and depression; contributing to medical cost offsets; and reducing emergency department visits and hospitalizations. Unfortunately, many distressed patients do not receive needed services. There are several multilevel barriers that represent key challenges to DM and affect its implementation. The Consolidated Framework for Implementation Research was used as an organizational structure to outline the barriers and facilitators to implementation of DM, including: 1) individual characteristics (individual patient characteristics with a focus on groups who may face unique barriers to distress screening and linkage to services), 2) intervention (unique aspects of DM intervention, including specific challenges in screening and psychosocial intervention, with recommendations for resolving these challenges), 3) processes for implementation of DM (modality and timing of screening, the challenge of triage for urgent needs, and incorporation of patient-reported outcomes and quality measures), 4) organization-inner setting (the context of the clinic, hospital, or health care system); and 5) organization-outer setting (including reimbursement strategies and health-care policy). Specific recommendations for evidence-based strategies and interventions for each of the domains of the Consolidated Framework for Implementation Research are also included to address barriers and challenges.
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Affiliation(s)
- Teresa L Deshields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Sharla Wells-Di Gregorio
- Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University Wexner Medical Center, James Cancer Hospital, Columbus, Ohio
| | - Stacy R Flowers
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan Nipp
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lynne Padgett
- Department of Psychology, Veterans Affairs Medical Center, Washington, District of Columbia
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan
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Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Krist AH, Kubik M, Li L, Ogedegbe G, Owens DK, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Screening for Prediabetes and Type 2 Diabetes: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 326:736-743. [PMID: 34427594 DOI: 10.1001/jama.2021.12531] [Citation(s) in RCA: 172] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE An estimated 13% of all US adults (18 years or older) have diabetes, and 34.5% meet criteria for prediabetes. The prevalences of prediabetes and diabetes are higher in older adults. Estimates of the risk of progression from prediabetes to diabetes vary widely, perhaps because of differences in the definition of prediabetes or the heterogeneity of prediabetes. Diabetes is the leading cause of kidney failure and new cases of blindness among adults in the US. It is also associated with increased risks of cardiovascular disease, nonalcoholic fatty liver disease, and nonalcoholic steatohepatitis and was estimated to be the seventh leading cause of death in the US in 2017. Screening asymptomatic adults for prediabetes and type 2 diabetes may allow earlier detection, diagnosis, and treatment, with the ultimate goal of improving health outcomes. OBJECTIVE To update its 2015 recommendation, the USPSTF commissioned a systematic review to evaluate screening for prediabetes and type 2 diabetes in asymptomatic, nonpregnant adults and preventive interventions for those with prediabetes. POPULATION Nonpregnant adults aged 35 to 70 years seen in primary care settings who have overweight or obesity (defined as a body mass index ≥25 and ≥30, respectively) and no symptoms of diabetes. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that screening for prediabetes and type 2 diabetes and offering or referring patients with prediabetes to effective preventive interventions has a moderate net benefit. CONCLUSIONS AND RECOMMENDATION The USPSTF recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 years who have overweight or obesity. Clinicians should offer or refer patients with prediabetes to effective preventive interventions. (B recommendation).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | - Li Li
- University of Virginia, Charlottesville
| | | | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Screening for Gestational Diabetes: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 326:531-538. [PMID: 34374716 DOI: 10.1001/jama.2021.11922] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Gestational diabetes is diabetes that develops during pregnancy. Prevalence of gestational diabetes in the US has been estimated at 5.8% to 9.2%, based on traditional diagnostic criteria, although it may be higher if more inclusive criteria are used. Pregnant persons with gestational diabetes are at increased risk for maternal and fetal complications, including preeclampsia, fetal macrosomia (which can cause shoulder dystocia and birth injury), and neonatal hypoglycemia. Gestational diabetes has also been associated with an increased risk of several long-term health outcomes in pregnant persons and intermediate outcomes in their offspring. OBJECTIVE The USPSTF commissioned a systematic review to evaluate the accuracy, benefits, and harms of screening for gestational diabetes and the benefits and harms of treatment for the pregnant person and infant. POPULATION Pregnant persons who have not been previously diagnosed with type 1 or type 2 diabetes. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that there is a moderate net benefit to screening for gestational diabetes at 24 weeks of gestation or after to improve maternal and fetal outcomes. The USPSTF concludes that the evidence on screening for gestational diabetes before 24 weeks of gestation is insufficient, and the balance of benefits and harms of screening cannot be determined. RECOMMENDATION The USPSTF recommends screening for gestational diabetes in asymptomatic pregnant persons at 24 weeks of gestation or after. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for gestational diabetes in asymptomatic pregnant persons before 24 weeks of gestation. (I statement).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Cheng CH, Chow CL, Chow WK. A discussion on the minimum required number of tests in two common pooling test methods for SARS-CoV-2. Epidemiol Infect 2021; 149:e179. [PMID: 34340721 PMCID: PMC8365137 DOI: 10.1017/s0950268821001667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/17/2021] [Accepted: 07/09/2021] [Indexed: 12/02/2022] Open
Abstract
Pooling of samples in detecting the presence of virus is an effective and efficient strategy in screening carriers in a large population with low infection rate, leading to reduction in cost and time. There are a number of pooling test methods, some being simple and others being complicated. In such pooling tests, the most important parameter to decide is the pool or group size, which can be optimised mathematically. Two pooling methods are relatively simple. The minimum numbers required in these two tests for a population with known infection rate are discussed and compared. Results are useful for identifying asymptomatic carriers in a short time and in implementing health codes systems.
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Affiliation(s)
- C. H. Cheng
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong, China
| | - C. L. Chow
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong, China
| | - W. K. Chow
- Department of Building Services Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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Abstract
Despite considerable improvement in human immunodeficiency virus (HIV) knowledge and treatment in the last 3 decades, the overall number of people living with HIV (PLHIV) is still rising with up to one quarter being unaware of their HIV status. Early HIV diagnosis and treatment prolongs life, reduces transmission, improves quality of life, and is a cost-effective public health intervention. The emergency department (ED) sees a large number of patients from marginalized and traditionally underserved populations in whom HIV is known to be more prevalent and who may not attend traditional services because of either cultural reasons or because of a chaotic lifestyle. This article discusses the two main approaches to screening; 'Opt-out' screening offers testing routinely in all clinical settings, and 'Targeted' screening offers testing to individuals presenting with indicator conditions. There are many studies of 'Opt-out' ED HIV screening in urban areas of high-HIV prevalence. However, little is known about the effectiveness of 'targeted' HIV screening, especially in areas of low prevalence. This review discusses the background to HIV screening in the ED and reviews the evidence around 'targeted' HIV screening in adult EDs in different HIV prevalence settings, concluding that targeted HIV screening at the ED can be impactful, cost-effective, and well accepted in the ED population, but its long-term implementation requires extra funding and increased staffing resource limiting its application in low resource setting. Despite most evidence being from areas of high-HIV prevalence, targeted screening might also be appropriate in low-HIV prevalence areas.
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Affiliation(s)
- Ornella Spagnolello
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
- Usher Institute, University of Edinburgh, NINE, 9 Little France Road, Edinburgh BioQuarter, Edinburgh, EH16 4UX, UK.
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Karastogiannidou C, Giannoulaki P, Samaras I, Kotzakioulafi E, Didangelos T, Bocsan IC, Vassilopoulou E. The Diabetes Eating Problem Survey-Revised (DEPS-R) in a Greek Adult Population with Type 1 Diabetes Mellitus: Model Comparison Supporting a Single Factor Structure. Nutrients 2021; 13:nu13072375. [PMID: 34371885 PMCID: PMC8308548 DOI: 10.3390/nu13072375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/27/2021] [Accepted: 07/09/2021] [Indexed: 11/21/2022] Open
Abstract
Type 1 diabetes mellitus (T1DM) patients occasionally develop disordered eating behaviors, leading to insulin manipulation without medical consultation, targeting to achieve weight control. In clinical practice, the Diabetes Eating Problem Survey-Revised Version (DEPS-R) questionnaire has been used to evaluate eating disorders in T1DM patients. This study was conducted to validate the factor structure of the Greek version of DEPS-R using Confirmatory Factor Analysis (CFA), to investigate its reliability and convergent validity in Greek T1DM adults and to compare a single factor DEPS-R model with multiple factor models. Participants were 103 T1DM adults receiving insulin, who responded to DEPS-R. Their anthropometric, biochemical and clinical history data were evaluated. The sample presented good glycemic control and 30.1% scored above the established DEPS-R cut-off score for disturbed eating behavior. CFA results revealed that the data fit well to the factor models. The DEPS-R scale had good reliability and was positively linked to BMI, HbA1c, total daily dose and time in range. Model comparison supported the superiority of the 1-factor model, implying that Greek clinicians and practitioners might not have to consider individualized treatment based on various scores across different subscales but they can adopt a single DEPS-R score for an easy and efficient screening for disordered eating.
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Affiliation(s)
- Calliope Karastogiannidou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (C.K.); (I.S.); (E.V.)
| | - Parthena Giannoulaki
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (P.G.); (E.K.); (T.D.)
| | - Ioannis Samaras
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (C.K.); (I.S.); (E.V.)
| | - Evangelia Kotzakioulafi
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (P.G.); (E.K.); (T.D.)
| | - Triantafyllos Didangelos
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (P.G.); (E.K.); (T.D.)
| | - Ioana Corina Bocsan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400337 Cluj Napoca, Romania
- Correspondence:
| | - Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (C.K.); (I.S.); (E.V.)
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Tamura N, Watanabe E, Shirakawa R, Nakatani E, Yamada K, Hatakeyama H, Torii-Hanakita M, Kyo C, Kosugi R, Ogawa T, Kotani M, Usui T, Inoue T. Comparisons of plasma aldosterone and renin data between an automated chemiluminescent immunoanalyzer and conventional radioimmunoassays in the screening and diagnosis of primary aldosteronism. PLoS One 2021; 16:e0253807. [PMID: 34242264 PMCID: PMC8270132 DOI: 10.1371/journal.pone.0253807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/13/2021] [Indexed: 11/18/2022] Open
Abstract
Determining values of plasma renin activity (PRA) or plasma active renin concentration (ARC), plasma aldosterone concentration (PAC), and aldosterone-to-renin ratio (ARR) is essential to diagnose primary aldosteronism (PA), but it takes several days with conventional radioimmunoassays (RIAs). Chemiluminescent enzyme immunoassays for PAC and ARC using the Accuraseed® immunoanalyzer facilitated the determination, but relations between Accuraseed® immunoanalyzer-based and RIA-based values in samples of PA confirmatory tests and adrenal venous sampling remained to be elucidated. We addressed this issue in the present study. This is a prospective, cross-sectional study. ARC and PAC values were measured by the Accuraseed® immunoanalyzer in samples, in which PRA and PAC values had been measured by the PRA-FR® RIA and SPAC®-S Aldosterone kits, respectively. The relations between Accuraseed® immunoanalyzer-based and RIA-based values were investigated with regression analyses. The optimal cutoff of Accuraseed® immunoanalyzer-based ARR for PA screening was determined by the receiver operating characteristic analysis. After log-log transformations, linear relations with high coefficients of determination were observed between Accuraseed® immunoanalyzer-based and RIA-based data of renin and aldosterone. Following the PA guidelines of Japan Endocrine Society, Accuraseed® immunoanalyzer-based cutoffs were calculated from the regression equations: the basal PAC for PA screening >12 ng/dL, PAC for the saline infusion test >8.2 ng/dL, ARC for the furosemide-upright test <15 pg/mL, and ARR for the captopril challenge test >3.09 ng/dL per pg/mL. The optimal cutoff of Accuraseed® immunoanalyzer-based ARR for PA screening was >2.43 ng/dL over pg/mL not to overlook bilateral PA patients. The present study provided conversion formulas between Accuraseed® immunoanalyzer-based and RIA-based values of renin, aldosterone, and ARR, not only in basal samples but also in samples of PA confirmatory tests and adrenal venous sampling. Although validation studies are awaited, the present study will become priming water of harmonization of renin and aldosterone immunoassays.
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Affiliation(s)
- Naohisa Tamura
- Research Support Center, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- * E-mail:
| | - Erika Watanabe
- Department of Clinical Laboratory Medicine, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Rumi Shirakawa
- Department of Clinical Laboratory Medicine, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Eiji Nakatani
- Research Support Center, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Kanako Yamada
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Hiroshi Hatakeyama
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Mizuki Torii-Hanakita
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Chika Kyo
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Rieko Kosugi
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- Department of Medical Genetics, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Tatsuo Ogawa
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Masato Kotani
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Takeshi Usui
- Research Support Center, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- Department of Medical Genetics, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Tatsuhide Inoue
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
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