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Yang W, Liu M, He Z, Ke Y. Reply to C. Xia et al. J Clin Oncol 2024; 42:3378-3379. [PMID: 38986043 DOI: 10.1200/jco.24.01033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 07/12/2024] Open
Affiliation(s)
- Wenlei Yang
- Wenlei Yang, PhD, and Mengfei Liu, PhD, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China; and Zhonghu He, PhD, and Yang Ke, MD, State Key Laboratory of Molecular Oncology, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Mengfei Liu
- Wenlei Yang, PhD, and Mengfei Liu, PhD, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China; and Zhonghu He, PhD, and Yang Ke, MD, State Key Laboratory of Molecular Oncology, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhonghu He
- Wenlei Yang, PhD, and Mengfei Liu, PhD, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China; and Zhonghu He, PhD, and Yang Ke, MD, State Key Laboratory of Molecular Oncology, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yang Ke
- Wenlei Yang, PhD, and Mengfei Liu, PhD, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China; and Zhonghu He, PhD, and Yang Ke, MD, State Key Laboratory of Molecular Oncology, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
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Obiora D, Orikogbo O, Davies BJ, Jacobs BL. Controversies in prostate cancer screening. Urol Oncol 2024:S1078-1439(24)00534-9. [PMID: 39127529 DOI: 10.1016/j.urolonc.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/10/2024] [Accepted: 06/17/2024] [Indexed: 08/12/2024]
Abstract
Prostate cancer is the second most diagnosed cancer and the fifth leading cause of cancer death among men worldwide. In the 1980s, the development and implementation of Prostate-Specific Antigen (PSA) testing for diagnosing prostate cancer led to a surge in the number of prostate cancer diagnoses. We explore the trends in recommendations and new innovations in adjunctive testing for prostate cancer screening.
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Affiliation(s)
- Daisy Obiora
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center
| | - Oluwaseun Orikogbo
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center
| | - Benjamin J Davies
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center
| | - Bruce L Jacobs
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center.
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Stewart C, Davenport MS, Miglioretti DL, Smith-Bindman R. Types of Evidence Needed to Assess the Clinical Value of Diagnostic Imaging. NEJM EVIDENCE 2024; 3:EVIDra2300252. [PMID: 38916414 DOI: 10.1056/evidra2300252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
AbstractThe evidence underlying the use of advanced diagnostic imaging is based mainly on diagnostic accuracy studies and not on well-designed trials demonstrating improved patient outcomes. This has led to an expansion of low-value and potentially harmful patient care and raises ethical issues around the widespread implementation of tests with incompletely known benefits and harms. Randomized clinical trials are needed to support the safety and effectiveness of imaging tests and should be required for clearance of most new technologies. Large, diverse cohort studies are needed to quantify disease risk associated with many imaging findings, especially incidental findings, to enable evidence-based management. The responsibility to minimize the use of tests with unknown or low value requires engagement of clinicians, medical societies, and the public.
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Affiliation(s)
- Carly Stewart
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Matthew S Davenport
- Department of Radiology, Michigan Medicine, Ann Arbor
- Department of Urology, Michigan Medicine, Ann Arbor
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, Davis
| | - Rebecca Smith-Bindman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco
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4
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Yoshida T, Inoue M, Kumon Y, Takamatsu N, Nozaki T, Albayda J, Izumi Y. Usefulness of skeletal muscle ultrasound as a screening test for sarcopenia in patients with rheumatoid arthritis. Int J Rheum Dis 2024; 27:e15257. [PMID: 39022913 DOI: 10.1111/1756-185x.15257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/10/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Takeshi Yoshida
- Department of Rheumatology, Chikamori Hospital, Kochi, Japan
- Department of Neurology, Tokushima University Hospital, Tokushima, Japan
| | - Masataka Inoue
- School of Nursing, Hyogo Medical University, Nishinomiya, Japan
| | - Yoshitaka Kumon
- Department of Rheumatology, Chikamori Hospital, Kochi, Japan
| | - Naoko Takamatsu
- Department of Neurology, Tokushima University Hospital, Tokushima, Japan
| | - Taiki Nozaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Jemima Albayda
- School of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yuishin Izumi
- Department of Neurology, Tokushima University Hospital, Tokushima, Japan
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Loizzi V, Cerbone M, Arezzo F, Silvestris E, Damiani GR, Cazzato G, Cicinelli E, Cormio G. Contraception as chemoprevention of ovarian cancer in BRCA1 and BRCA2 women. Hormones (Athens) 2024; 23:277-286. [PMID: 38112915 DOI: 10.1007/s42000-023-00519-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
Ovarian cancer is the seventh most common cancer in women in the world, with an estimated worldwide mortality of over 207'000 women every year. This cancer, due to the current lack of adequate screening techniques, is commonly diagnosed late and has a poor prognosis. The oral contraceptive pill is considered the most effective prevention strategy for ovarian cancer in the general population, being associated with a decreased incidence while also having a substantial positive impact on the mortality rate, which is reduced by up to 50%. BRCA1 and BRCA2 germline mutated women have an augmented risk of ovary and breast cancer: despite international guidelines that consider prophylactic surgery as the gold standard for ovarian cancer prevention, there are currently no effective non-invasive preventive methods. In BRCA1\2 mutated patients, clinicians should weigh the benefits of contraceptive pills against the risk of long-term thromboembolic side effects and hormonal malignancies such as breast and cervical cancer. A multidisciplinary team should counsel patients on the most appropriate risk-reduction strategy tailored to their needs and expectations, proposing the oral contraceptive pill to selected patients after balancing the risks of adverse effects and the benefits on both contraception and chemoprevention.
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Affiliation(s)
- Vera Loizzi
- S.S.D. Ginecologia Oncologica Clinicizzata, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
- Dipartimento Di Biomedicina Traslazionale E Neuroscienze (DiBraiN), University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Marco Cerbone
- Obstetrics and Gynecology Unit, University of Bari, Bari, Italy.
| | - Francesca Arezzo
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Erica Silvestris
- Oncology Unit IRCSS Istituto Tumori "Giovanni Paolo II", 70124, Bari, Italy
| | | | - Gerardo Cazzato
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Ettore Cicinelli
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Gennaro Cormio
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", 70124, Bari, Italy
- Oncology Unit IRCSS Istituto Tumori "Giovanni Paolo II", 70124, Bari, Italy
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Allahqoli L, Laganà AS, Mazidimoradi A, Salehiniya H, Günther V, Chiantera V, Karimi Goghari S, Ghiasvand MM, Rahmani A, Momenimovahed Z, Alkatout I. Diagnosis of Cervical Cancer and Pre-Cancerous Lesions by Artificial Intelligence: A Systematic Review. Diagnostics (Basel) 2022; 12:2771. [PMID: 36428831 PMCID: PMC9689914 DOI: 10.3390/diagnostics12112771] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The likelihood of timely treatment for cervical cancer increases with timely detection of abnormal cervical cells. Automated methods of detecting abnormal cervical cells were established because manual identification requires skilled pathologists and is time consuming and prone to error. The purpose of this systematic review is to evaluate the diagnostic performance of artificial intelligence (AI) technologies for the prediction, screening, and diagnosis of cervical cancer and pre-cancerous lesions. MATERIALS AND METHODS Comprehensive searches were performed on three databases: Medline, Web of Science Core Collection (Indexes = SCI-EXPANDED, SSCI, A & HCI Timespan) and Scopus to find papers published until July 2022. Articles that applied any AI technique for the prediction, screening, and diagnosis of cervical cancer were included in the review. No time restriction was applied. Articles were searched, screened, incorporated, and analyzed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS The primary search yielded 2538 articles. After screening and evaluation of eligibility, 117 studies were incorporated in the review. AI techniques were found to play a significant role in screening systems for pre-cancerous and cancerous cervical lesions. The accuracy of the algorithms in predicting cervical cancer varied from 70% to 100%. AI techniques make a distinction between cancerous and normal Pap smears with 80-100% accuracy. AI is expected to serve as a practical tool for doctors in making accurate clinical diagnoses. The reported sensitivity and specificity of AI in colposcopy for the detection of CIN2+ were 71.9-98.22% and 51.8-96.2%, respectively. CONCLUSION The present review highlights the acceptable performance of AI systems in the prediction, screening, or detection of cervical cancer and pre-cancerous lesions, especially when faced with a paucity of specialized centers or medical resources. In combination with human evaluation, AI could serve as a helpful tool in the interpretation of cervical smears or images.
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Affiliation(s)
- Leila Allahqoli
- Midwifery Department, Ministry of Health and Medical Education, Tehran 1467664961, Iran
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Afrooz Mazidimoradi
- Neyriz Public Health Clinic, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Veronika Günther
- University Hospitals Schleswig-Holstein, Campus Kiel, Kiel School of Gynaecological Endoscopy, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Shirin Karimi Goghari
- School of Industrial and Systems Engineering, Tarbiat Modares University (TMU), Tehran 1411713114, Iran
| | - Mohammad Matin Ghiasvand
- Department of Computer Engineering, Amirkabir University of Technology (AUT), Tehran 1591634311, Iran
| | - Azam Rahmani
- Nursing and Midwifery Care Research Centre, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran 141973317, Iran
| | - Zohre Momenimovahed
- Reproductive Health Department, Qom University of Medical Sciences, Qom 3716993456, Iran
| | - Ibrahim Alkatout
- University Hospitals Schleswig-Holstein, Campus Kiel, Kiel School of Gynaecological Endoscopy, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
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Calès P, Ravaioli F, Berger A, Farcau O, Festi D, Stefanescu H, Vitellius C, Nahon P, Bureau C, Ganne-Carriè N, Berzigotti A, de Ledinghen V, Petta S. Comparison of screening strategies with two new tests to score and diagnose varices needing treatment. Clin Res Hepatol Gastroenterol 2022; 46:101925. [PMID: 35470108 DOI: 10.1016/j.clinre.2022.101925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS We aimed to improve non-invasive screening of varices needing treatment (VNT) and compare different screening strategies. METHODS 2,290 patients with chronic liver disease were included in a retrospective study. Etiologies were: virus: 50.0%, NAFLD: 29.5%, alcohol: 20.5%, VNT: 14.9%. Test descriptors were performance (spared endoscopy) and safety (missed VNT). VNT tests were evaluated according to their safety levels either for individual screening (95% negative predictive value (NPV)), population screening (95% sensitivity) or undifferentiated screening (100% sensitivity/NPV) without missed VNT. The tests provided three categories: missed VNT <5%, VNT 100% specificity (new category), both sparing endoscopies, and intermediate (endoscopy required). RESULTS Independent VNT predictors (etiology, sex, age, platelets, prothrombin index, albumin, ALT, liver stiffness) were included in two tests: VNT virus alcohol NAFLD test (VANT) and varice risk score (VARS). We report results of the whole population. Considering population screening, performances were, Baveno VI criteria: 24.1%, Anticipate: 24.7%, VariScreen: 35.3%, VANT: 40.2% (p<0.001 vs other tests). VANT spared 58.0% more endoscopies in the whole population than Baveno criteria in compensated advanced chronic liver diseases. Considering individual screening, VARS performance was, in all patients: 62.0% vs 42.9% for the expanded Baveno VI criteria (p<0.001), and, in NAFLD: 72.8% vs 65.1% for the NAFLD cirrhosis criteria (p<0.001). Considering undifferentiated screening, VARS performance was 12%. The VARS score estimated VNT probability from 0 to 100% (AUROC: 0.826). CONCLUSION VANT and VARS spared from 12% (undifferentiated screening) to 40% (population screening) or 62% (individual screening) of endoscopies in main-etiology patients without ascites.
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Affiliation(s)
- Paul Calès
- Hepato-Gastroenterology Department, University Hospital, Angers, France; HIFIH laboratory, UPRES 3859, UNIV Angers, France.
| | - Federico Ravaioli
- Gastroenterology and Hepatology Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
| | - Arthur Berger
- Hepato-Gastroenterology Department, University Hospital, Angers, France; HIFIH laboratory, UPRES 3859, UNIV Angers, France.
| | - Oana Farcau
- Liver Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Davide Festi
- Gastroenterology and Hepatology Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
| | - Horia Stefanescu
- Liver Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Carole Vitellius
- Hepato-Gastroenterology Department, University Hospital, Angers, France; HIFIH laboratory, UPRES 3859, UNIV Angers, France.
| | - Pierre Nahon
- Hepatology Department, Avicenne Hospital, Bobigny, Paris hospitals, INSERM UMR-1162, Paris Sorbonne University, France.
| | - Christophe Bureau
- Hepato-Gastroenterology Department, Purpan University Hospital, Toulouse, France.
| | - Nathalie Ganne-Carriè
- Hepatology Department, Avicenne Hospital, Bobigny, Paris hospitals, INSERM UMR-1162, Paris Sorbonne University, France.
| | - Annalisa Berzigotti
- Hepatology, Swiss Liver Center, Visceral Surgery and Medicine Clinic (UVCM), Inselspital, University of Bern, Switzerland.
| | | | - Salvatore Petta
- Department of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italy.
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Nakamura J, Manabe N, Yamatsuji T, Fujiwara Y, Murao T, Ayaki M, Fujita M, Shiotani A, Ueno T, Monobe Y, Akiyama T, Haruma K, Naomoto Y, Hata J. Subjective factors affecting prognosis of 469 patients with esophageal squamous cell carcinoma: a retrospective cohort study of endoscopic screening. BMC Gastroenterol 2022; 22:319. [PMID: 35764928 PMCID: PMC9238142 DOI: 10.1186/s12876-022-02399-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background To date, no in-depth studies have focused on the impact of various clinical characteristics of esophageal squamous cell carcinoma (ESCC), including its association with subjective symptoms, on patient prognosis. We aimed to investigate the clinical factors that affect the prognosis of patients with ESCC and to clarify how subjective symptoms are related to prognosis. Methods We retrospectively evaluated the clinical records of 503 consecutive patients with ESCC from April 2011 to December 2019. Six established prognostic factors for ESCC (body mass index, alcohol drinking, cigarette smoking, sex, clinical stage, and age) and subjective symptoms were used to subgroup patients and analyze survival differences. Next, the patients were divided into two groups: a symptomatic group and an asymptomatic group. In the symptomatic group, differences in the incidence of subjective symptoms according to tumor size, tumor location, macroscopic tumor type, and clinical stage were examined. Finally, subjective symptoms were divided into swallowing-related symptoms and other symptoms, and their prognosis was compared. Results Multivariate Cox regression analysis identified sex [hazard ratio (HR) 1.778; 95% CI 1.004–3.149; p = 0.049], TNM classification (HR 6.591; 95% CI 3.438–12.63; p < 0.001), and subjective symptoms (HR 1.986; 95% CI 1.037–3.803; p = 0.0386) as independent risk factors for overall survival. In the symptomatic group, the mean time from symptom onset to diagnosis was 2.4 ± 4.3 months. The incidence of subjective symptoms differed by clinical stage, and the prognosis of patients with swallowing-related symptoms was significantly worse than that of patients with other symptoms. Conclusion The results of this study suggest that screening by upper gastrointestinal endoscopy, independent of subjective symptoms (especially swallowing-related symptoms), may play an important role in the early detection and improvement of prognosis of ESCC, although further validation in a large prospective study is needed.
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O'Donnell M, Eller AW, Waxman EL, Clancy CJ, Nguyen MH. Screening for ocular candidiasis among patients with candidemia: Is it time to change practice? Clin Infect Dis 2022; 75:1092-1096. [PMID: 35325089 DOI: 10.1093/cid/ciac233] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Indexed: 11/13/2022] Open
Abstract
Ocular candidiasis (OC) complicates ~10% of candidemia and carries potentially severe morbidity. There are conflicting recommendations about the need for routine funduscopic examinations of candidemic patients. Indirect funduscopy is accurate and safe in diagnosing OC, and positive findings change recommended treatment. However, conclusive evidence is lacking that treatment changes improve outcomes. Bringing perspectives as infectious diseases physicians and ophthalmologists, we review controversies about OC and endorse routine screening during candidemia. We acknowledge difficulties in obtaining inpatient ophthalmologic consults, and recommend studies evaluating digital fundus photography and tele-ophthalmology as an alternative to funduscopic examinations by ophthalmologists in asymptomatic patients.
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Affiliation(s)
- Matthew O'Donnell
- University of Pittsburgh Medical Center, Division of Infectious Diseases, Pittsburgh, PA, USA
| | | | | | - Cornelius J Clancy
- Department of Medicine and University of Pittsburgh, Pittsburgh, PA, USA
| | - M Hong Nguyen
- University of Pittsburgh Medical Center, Division of Infectious Diseases, Pittsburgh, PA, USA.,Department of Medicine and University of Pittsburgh, Pittsburgh, PA, USA
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Butler CR, Kasper KB, Huggins RA, Cropper TL, Frankel DN, Pawlak MT, Casey T, Casa DJ. Deaths Among U.S. Air Force Basic Military Trainees, 2008-2020. Mil Med 2022; 188:usab493. [PMID: 35043203 DOI: 10.1093/milmed/usab493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The U.S. Air Force (USAF) Basic Military Training (BMT), a rigorous training program for all enlisted members of the USAF, trains roughly 36,000 recruits annually. Transforming civilians into ready warrior airmen has inherent risks to trainee health, which has infrequently included death. While the average death rate at USAF BMT has decreased between 1956 and 2007 due to process improvement and preventive medicine efforts, further review is warranted to examine the deaths that have occurred since the last published period (1997-2007) and to determine the impact policy changes and updates have had on death rates since that time. Therefore, the purpose of this paper is to identify death rates and types from 2008 to 2020, explore policy implementation, and identify areas needing further improvement or modifications to the overall safety, fitness, and health of USAF BMT trainees. MATERIALS AND METHODS All deaths were examined and reviewed from 2008 through 2020 for trainees attending the USAF BMT using medical records and autopsy reports. Death rates were calculated using the total population of trainees in a given year as well as over the entire 13-year study period. RESULTS From 2008 to 2020, five deaths occurred among USAF BMT trainees (one cardiac, two exertional sickling due to sickle cell trait, one infection, and one suicide). This resulted in an overall average death rate of 1.08 per 100,000 trainees, as compared to 1.46 per 100,000 from 1997 to 2007. The last death in the study period occurred in 2016. CONCLUSION A modest downward trend of average death rate has continued since 2007, and no deaths from 2016 through 2020 represents the longest time frame without any deaths at USAF BMT over all times reported (dating back to 1956) which suggest that emergency best practice policies are/have improved. However, cardiac death rate and suicide rate have not changed since the last report. Policies and practices should be continuously reviewed and refined to reduce the risk of death at USAF BMT.
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Kanclerz P, Tuuminen R, Khoramnia R. Imaging Modalities Employed in Diabetic Retinopathy Screening: A Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:1802. [PMID: 34679501 PMCID: PMC8535170 DOI: 10.3390/diagnostics11101802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Urbanization has caused dramatic changes in lifestyle, and these rapid transitions have led to an increased risk of noncommunicable diseases, such as type 2 diabetes. In terms of cost-effectiveness, screening for diabetic retinopathy is a critical aspect in diabetes management. The aim of this study was to review the imaging modalities employed for retinal examination in diabetic retinopathy screening. METHODS The PubMed and Web of Science databases were the main sources used to investigate the medical literature. An extensive search was performed to identify relevant articles concerning "imaging", "diabetic retinopathy" and "screening" up to 1 June 2021. Imaging techniques were divided into the following: (i) mydriatic fundus photography, (ii) non-mydriatic fundus photography, (iii) smartphone-based imaging, and (iv) ultrawide-field imaging. A meta-analysis was performed to analyze the performance and technical failure rate of each method. RESULTS The technical failure rates for mydriatic and non-mydriatic digital fundus photography, smartphone-based and ultrawide-field imaging were 3.4% (95% CI: 2.3-4.6%), 12.1% (95% CI: 5.4-18.7%), 5.3% (95% CI: 1.5-9.0%) and 2.2% (95% CI: 0.3-4.0%), respectively. The rate was significantly different between all analyzed techniques (p < 0.001), and the overall failure rate was 6.6% (4.9-8.3%; I2 = 97.2%). The publication bias factor for smartphone-based imaging was significantly higher than for mydriatic digital fundus photography and non-mydriatic digital fundus photography (b = -8.61, b = -2.59 and b = -7.03, respectively; p < 0.001). Ultrawide-field imaging studies were excluded from the final sensitivity/specificity analysis, as the total number of patients included was too small. CONCLUSIONS Regardless of the type of the device used, retinal photographs should be taken on eyes with dilated pupils, unless contraindicated, as this setting decreases the rate of ungradable images. Smartphone-based and ultrawide-field imaging may become potential alternative methods for optimized DR screening; however, there is not yet enough evidence for these techniques to displace mydriatic fundus photography.
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Affiliation(s)
- Piotr Kanclerz
- Hygeia Clinic, 80-286 Gdańsk, Poland
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland;
| | - Raimo Tuuminen
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland;
- Eye Centre, Kymenlaakso Central Hospital, 48100 Kotka, Finland
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany;
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12
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Ahmed B, Konje JC. Screening for infections in pregnancy - An overview of where we are today. Eur J Obstet Gynecol Reprod Biol 2021; 263:85-93. [PMID: 34171635 DOI: 10.1016/j.ejogrb.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 12/09/2022]
Abstract
Although most infections in pregnancy have very little impact, some affect either the mother or fetus or both. Screening must target those infections with consequences and furthermore, must be cost-beneficial. The introduction of any screening test for infections should take into consideration the prevalence of the condition, its consequences (health impact), the accuracy of the test and whether there are remedial steps including primary and secondary prevention to take with a positive or negative test. For some of these infections (for example syphilis and rubella) universal screening of all pregnant women has been the norm world-wide but as the epidemiology of these infections continue to change, a review of this practice must evolve. Furthermore, emerging infections line severe acute respiratory syndrome coronavirus-2 pose greater public health challenges. This article provides an overview of screening for infections in pregnancy, critically appraising screening for the common infections and arguing for abandoning of universal screening for rubella but advocating for universal screening for GBS and selective screening for CMV and toxoplasmosis.
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Affiliation(s)
- Badredeen Ahmed
- Feto Maternal Centre, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; Qatar University, Qatar
| | - Justin C Konje
- Department of Health Sciences, University of Leicester, UK.
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Van Den Heede K, Tolley NS, Di Marco AN, Palazzo FF. Differentiated Thyroid Cancer: A Health Economic Review. Cancers (Basel) 2021; 13:cancers13092253. [PMID: 34067214 PMCID: PMC8125846 DOI: 10.3390/cancers13092253] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary This review reflects on health economic considerations associated with the increasing diagnosis and treatment of differentiated thyroid cancer. Analysis of different relevant health economic topics, such as overdiagnosis, overtreatment, surgical costs, and costs of follow-up are being addressed. Several unanswered research questions such as optimising molecular markers for diagnosis, active surveillance of primary tumours, and improved risk stratification and survivorship care all influence future healthcare expenditures. Abstract The incidence of differentiated thyroid cancer (DTC) is rising, mainly because of an increased detection of asymptomatic thyroid nodularity revealed by the liberal use of thyroid ultrasound. This review aims to reflect on the health economic considerations associated with the increasing diagnosis and treatment of DTC. Overdiagnosis and the resulting overtreatment have led to more surgical procedures, increasing health care and patients’ costs, and a large pool of community-dwelling thyroid cancer follow-up patients. Additionally, the cost of thyroid surgery seems to increase year on year even when inflation is taken into account. The increased healthcare costs and spending have placed significant pressure to identify potential factors associated with these increased costs. Some truly ground-breaking work in health economics has been undertaken, but more cost-effectiveness studies and micro-cost analyses are required to evaluate expenses and guide future solutions.
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Affiliation(s)
- Klaas Van Den Heede
- Department of Endocrine & Thyroid Surgery, Hammersmith Hospital, London W12 0HS, UK; (N.S.T.); (A.N.D.M.); (F.F.P.)
- Department of General and Endocrine Surgery, OLV Hospital, 9300 Aalst, Belgium
- Correspondence:
| | - Neil S. Tolley
- Department of Endocrine & Thyroid Surgery, Hammersmith Hospital, London W12 0HS, UK; (N.S.T.); (A.N.D.M.); (F.F.P.)
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK
| | - Aimee N. Di Marco
- Department of Endocrine & Thyroid Surgery, Hammersmith Hospital, London W12 0HS, UK; (N.S.T.); (A.N.D.M.); (F.F.P.)
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK
| | - Fausto F. Palazzo
- Department of Endocrine & Thyroid Surgery, Hammersmith Hospital, London W12 0HS, UK; (N.S.T.); (A.N.D.M.); (F.F.P.)
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK
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14
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Screening Women for Anal Cancers: Guidance for Health Care Professionals. Am J Gastroenterol 2021; 116:509-516. [PMID: 33606380 DOI: 10.14309/ajg.0000000000001186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/11/2021] [Indexed: 12/11/2022]
Abstract
Anal cancer is rare in the general population but is steadily increasing in incidence over the past decade especially in women. Identification and screening of women with high risk facilitates detection of anal precancer and early-stage cancer, improves survival, and potentially uses less invasive therapies compared with the conventional chemoradiation treatments used for advanced cancers. No recently published guidelines currently describe details about screening women for anal squamous cell cancer (ASCC). The available evidence supports the existence of groups of women with higher prevalence of ASCC (e.g., women with human immunodeficiency virus, immune suppression, or previous lower-genital high-grade lesion or cancer) who would likely benefit from screening with some combination of anal cytology and human papillomavirus testing. Additional research is needed to establish the cost-effectiveness and the influence of screening on ASCC mortality rates.
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15
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Vogel WH, Minhas A, Baumrucker S. Dihydropyrimidine Dehydrogenase Deficiency: To Screen or Not to Screen? J Adv Pract Oncol 2021; 11:68-73. [PMID: 33542850 PMCID: PMC7517765 DOI: 10.6004/jadpro.2020.11.1.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
5-fluorouracil (5-FU) and its prodrug capecitabine are frequently prescribed in oncology. While usually well tolerated, toxicity can be severe, and even life-threatening. A dihydropyrimidine dehydrogenase (DPD) deficiency can cause severe toxicity. Current testing for DPD deficiency does not meet the criteria for a routine screening test prior to 5-FU therapy. A case study of a fatality secondary to capecitabine toxicity is reviewed and literature is examined regarding general screening for DPD deficiency.
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Affiliation(s)
| | - Ahmed Minhas
- East Tennessee State University, Johnson City, Tennessee
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16
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Howie C, Potter C, Shannon C, Davidson G, Mulholland C. Screening for the at-risk mental state in educational settings: A systematic review. Early Interv Psychiatry 2020; 14:643-654. [PMID: 31883215 DOI: 10.1111/eip.12926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/10/2019] [Accepted: 12/14/2019] [Indexed: 12/20/2022]
Abstract
AIM The at-risk mental state (ARMS) allows clinicians to identify individuals who have an increased risk of developing psychosis. At present, most screening for psychosis-risk is carried out within help-seeking populations; however, screening within educational settings may allow clinicians to identify individuals at-risk earlier and to increase the rate of detection. This review aimed to examine screening for the ARMS in educational settings, with the key questions: what screening tools have been used in educational settings, can screening in educational settings detect individuals with ARMS, what threshold scores in screening tools indicate a positive screen in educational settings, are there comorbid mental health conditions associated with the ARMS in educational settings? METHODS Searches were carried out in PsycINFO, MEDLINE, EMBASE, Scopus and Web of Science and reference lists of included articles searched. Results were summarized using narrative synthesis. RESULTS Nine papers were included for narrative synthesis. A variety of screening tools have been used when screening for the ARMS in educational settings. The majority of studies have been conducted in schools. The prevalence of the ARMS reported in ranges from 1% to 8%. CONCLUSIONS The ARMS indicates the presence of distressing symptoms for which intervention may be beneficial. Screening programmes within educational settings may allow outreach for prodromal symptoms at an earlier stage than clinical settings currently provided for.
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Affiliation(s)
- Clare Howie
- School of Medicine, Queen's University Belfast, Belfast, UK
| | - Claire Potter
- School of Medicine, Queen's University Belfast, Belfast, UK
| | - Ciaran Shannon
- Holywell Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Gavin Davidson
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Ciaran Mulholland
- School of Medicine, Queen's University Belfast, Belfast, UK.,Holywell Hospital, Northern Health and Social Care Trust, Antrim, UK
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17
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Hodgson DC. Cardiac Screening for Childhood Cancer Survivors Can Be Improved With Existing Technology. J Clin Oncol 2020; 38:3827-3829. [PMID: 33026936 DOI: 10.1200/jco.20.02374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- David C Hodgson
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Pediatric Oncology Group of Ontario, Toronto, ON, Canada
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18
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Evaluation of 2011 AAP cervical spine screening guidelines for children with Down Syndrome. Childs Nerv Syst 2020; 36:2609-2614. [PMID: 32778937 DOI: 10.1007/s00381-020-04855-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Atlantoaxial instability (AAI) has a higher incidence rate among individuals with Down syndrome (DS) than the non-DS population. In 2011, the American Academy of Pediatrics (AAP) updated its AAI screening guidelines for children with DS from radiographic screening to radiographs only if there are clinical symptoms suggestive of cervical spine pathology. An assessment of whether this alteration has been associated with an increase in AAI-associated spinal cord injury has not been undertaken. METHODS We provide the first neurosurgical review of a large experience implementing the 2011 AAP guidelines. We reviewed the courses of patients with DS seen at the Sie Center for Down Syndrome at Children's Hospital Colorado who were evaluated for cervical spine disease and determined whether screening radiographic imaging could have led to earlier diagnosis or prevented development of neurological deficits. We also report an illustrative case of a 5-year-old female with Down syndrome who presented with instability after normal screening radiographs per the pre-2011 guidelines. RESULTS The clinical experience of the Sie Center demonstrates that even when limiting imaging to patients who show signs or symptoms of spine pathology, the vast majority of x-rays are negative. Our exemplary patient presented to the emergency department for neck pain without a history of significant trauma. She was diagnosed and treated for atlantoaxial subluxation associated with os odontoideum. CONCLUSION Routine radiographic screening may not be sufficiently predictive of DS individuals at risk to develop AAI. This experience supports the appositeness of the de-escalation of care asserted by the guidelines.
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19
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Hoy RF, Glass DC, Dimitriadis C, Hansen J, Hore-Lacy F, Sim MR. Identification of early-stage silicosis through health screening of stone benchtop industry workers in Victoria, Australia. Occup Environ Med 2020; 78:296-302. [PMID: 33115923 DOI: 10.1136/oemed-2020-106897] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/21/2020] [Accepted: 10/02/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The popularity of high silica content artificial stone has been associated with emergence of severe, progressive silicosis as a major health issue affecting workers in the stone benchtop industry. This population-based health assessment programme has been implemented with the aim of identifcation of silica-associated disease at a preclinical stage. METHODS All current and former workers from the stone benchtop industry in the State of Victoria are offered free health assessments. Primary evaluations include a standardised questionnaire, physical examination, spirometry and gas transfer assessment and International Labour Organisation-categorised chest X-ray. Secondary evaluations include high-resolution CT chest, blood tests and a respiratory physician evaluation. RESULTS At the end of the first 12 months, 86/239 (36%) workers who had completed secondary evaluation were diagnosed with silicosis (65 simple silicosis and 21 complicated silicosis). 22 had worked in the industry for less than 10 years at the time of diagnosis. Of those with simple silicosis, 80% of workers reported breathlessness only with strenuous exercise (modified Medical Research Council score of 0), and lung function was well preserved (prebronchodilator forced vital capacity mean 99.8% predicted (SD 13.6), diffusion capacity of the lung for carbon monoxide mean 96.2% predicted (SD 18.0)). Antinuclear antibodies were detected in 37% with silicosis and 24% without silicosis. CONCLUSION Early results from this comprehensive health assessment programme have indicated a high proportion of referred artificial stone benchtop workers have silicosis, including many with early-stage disease. The common finding of antinuclear antibodies suggest significant potential for autoimmune disease in this occupational group.
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Affiliation(s)
- Ryan F Hoy
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences. Monash University, Melbourne, Victoria, Australia
| | - Deborah C Glass
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences. Monash University, Melbourne, Victoria, Australia
| | - Christina Dimitriadis
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences. Monash University, Melbourne, Victoria, Australia
| | - Jessy Hansen
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences. Monash University, Melbourne, Victoria, Australia
| | - Fiona Hore-Lacy
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences. Monash University, Melbourne, Victoria, Australia
| | - Malcolm R Sim
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences. Monash University, Melbourne, Victoria, Australia
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20
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Abstract
Background The likelihoods of valvular heart disease ( VHD ) and conduction abnormalities in patients with ankylosing spondylitis ( AS p) are poorly defined. Knowing their lifetime risks of VHD and pacemaker use would help inform whether cardiac screening should be done. Methods and Results Patients with AS p and a comparison group without AS p were identified among US Medicare beneficiaries in 1999 to 2013. Frequencies of VHD and pacemaker use were compared in 4 age groups: 65 to 69 years, 70 to 74 years, 75 to 79 years, and 80 years or older, as were rates of valve surgeries, a measure of VHD severity, and new pacemaker insertions. Outcomes were compared between 42 327 patients with AS p and 19 211 703 patients without AS p. The prevalence of aortic valve disease in patients with AS p increased with age (2.6%, 6.7%, 10.9%, and 17.1%), as did the prevalence of mitral valve disease. Risks of VHD were slightly but significantly higher in patients with AS p (adjusted odds ratios 1.06-1.51). Rates of aortic valve replacement/repair were also higher in patients with AS p than in the comparison group (125 versus 93; 183 versus 149; 261 versus 208; 279 versus 191 per 100 000 patient-years in the 4 age groups). Rates of mitral valve surgery did not differ between groups. Among patients with AS p, pacemaker use ranged from 1.0% to 7.6% across age groups, and was slightly higher than in controls (odds ratio range 1.11-1.32). Conclusions Lifetime risks of VHD and pacemaker use in AS p increase markedly with age, but are only slightly higher than in elderly people without AS p.
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Affiliation(s)
- Michael M Ward
- 1 Intramural Research Program National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institutes of Health Bethesda MD
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21
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Czum JM. Simulated Lumbar Dual-Energy X-Ray Absorptiometry With Machine Learning Algorithms: Why Radiologists Who Interpret Abdominal CTs Should Care. J Am Coll Radiol 2019; 16:1471-1472. [DOI: 10.1016/j.jacr.2019.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 10/25/2022]
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22
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Mazzone PJ, Jett J. Principled Lung Cancer Screening Follows Screening Principles. Chest 2019; 154:1265-1266. [PMID: 30526961 DOI: 10.1016/j.chest.2018.08.1056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- Peter J Mazzone
- Department of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH.
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23
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Maselli F, Rossettini G, Viceconti A, Testa M. Importance of screening in physical therapy: vertebral fracture of thoracolumbar junction in a recreational runner. BMJ Case Rep 2019; 12:12/8/e229987. [PMID: 31471360 DOI: 10.1136/bcr-2019-229987] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Running is one of the most popular sports worldwide. Studies suggest that 11%-85% of recreational runners have at least one running-related injury (RRI) each year, resulting in a reduction or interruption in training. A high risk for running-related injuries (RRIs) represents an important inconvenience counterbalancing the beneficial effects of running. RRIs primarily affect the joints of the lower limb and lumbar spine. Noteworthy, in some cases, the clinical presentation of signs and symptoms is confusing and may hide serious conditions; thus, clinicians have to pay special attention when potential factors arise, such as the presence of red flags. As reported in this case report, patients can present with low back pain (LBP) as a primary problem, mimicking a red flag such as a fracture of the spine. The aim of this case report was to describe a case of a recreational runner presenting with LBP as the sole symptom of an underlying thoracolumbar fracture.
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Affiliation(s)
- Filippo Maselli
- DINOGMI - Universita degli Studi di Genova Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Genova, Italy.,Istituto Nazionale Assicurazione contro gli Infortuni sul Lavoro, Direzione Regionale Puglia INAIL, Bari, Italy
| | - Giacomo Rossettini
- DINOGMI - Universita degli Studi di Genova Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Genova, Italy
| | - Antonello Viceconti
- DINOGMI - Universita degli Studi di Genova Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Genova, Italy
| | - Marco Testa
- DINOGMI - Universita degli Studi di Genova Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Genova, Italy
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24
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Codipilly DC, Qin Y, Dawsey SM, Kisiel J, Topazian M, Ahlquist D, Iyer PG. Screening for esophageal squamous cell carcinoma: recent advances. Gastrointest Endosc 2018; 88:413-426. [PMID: 29709526 PMCID: PMC7493990 DOI: 10.1016/j.gie.2018.04.2352] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/20/2018] [Indexed: 02/08/2023]
Abstract
Esophageal squamous cell carcinoma (ESCC) is the most common type of esophageal cancer worldwide, with a high mortality due to advanced stage at diagnosis. Although most common in an area known as the Asian Esophageal Cancer Belt, which extends from the Caspian Sea to northern China, and in parts of Africa, high-risk populations also exist elsewhere in the world. Screening for ESCC has been practiced in a few geographic areas and high-risk populations, with varying levels of success. Esophageal squamous dysplasia is recognized as the precursor lesion for ESCC. Endoscopic screening for ESCC/esophageal squamous dysplasia is expensive and not sufficiently available in many high-risk regions. Recent advances in non-endoscopic screening enhanced by biomarker-based disease detection have raised the prospect of improved accuracy and availability of screening for esophageal squamous dysplasia and early stage ESCC. Development of a cost-effective, accurate, and well-tolerated screening test, if applied in endemic areas and high-risk populations, has the potential to reduce mortality from this deadly disease worldwide. In this review, we summarize recent developments in endoscopic and non-endoscopic screening modalities.
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Affiliation(s)
- DC Codipilly
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester
| | - Y Qin
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester
| | - Sanford M. Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute
| | - John Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester
| | - Mark Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester
| | - David Ahlquist
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester
| | - PG Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester
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Codipilly DC, Chandar AK, Singh S, Wani S, Shaheen NJ, Inadomi JM, Chak A, Iyer PG. The Effect of Endoscopic Surveillance in Patients With Barrett's Esophagus: A Systematic Review and Meta-analysis. Gastroenterology 2018; 154:2068-2086.e5. [PMID: 29458154 PMCID: PMC5985204 DOI: 10.1053/j.gastro.2018.02.022] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Guidelines recommend endoscopic surveillance of patients with Barrett's esophagus (BE) to identify those with dysplasia (a precursor of carcinoma) or early-stage esophageal adenocarcinoma (EAC) who can be treated endoscopically. However, it is unclear whether surveillance increases survival times of patients with BE. We performed a systematic review and meta-analysis to qualitatively and quantitatively examine evidence for the association of endoscopic surveillance in patients with BE with survival and other outcomes. METHODS We searched publication databases for studies reporting the effects of endoscopic surveillance on mortality and other EAC-related outcomes. We reviewed randomized controlled trials, case-control studies, studies comparing patients with BE who received regular surveillance with those who did not receive regular surveillance, and studies comparing outcomes of patients with surveillance-detected EAC vs symptom-detected EACs. We performed a meta-analysis of surveillance studies to generate summary estimates using a random effects model. The primary aim was to examine the association of BE surveillance on EAC-related mortality. Secondary aims were to examine the association of BE surveillance with all-cause mortality and EAC stage at time of diagnosis. RESULTS A single case-control study did not show any association between surveillance and EAC-related mortality. A meta-analysis of 4 cohort studies found that lower EAC-related and all-cause mortality were associated with regular surveillance (relative risk, 0.60; 95% CI, 0.50-0.71; hazard ratio, 0.75; 95% CI, 0.59-0.94). Meta-analysis of 12 cohort studies showed lower EAC-related and all-cause mortality among patients with surveillance-detected EAC vs symptom-detected EAC (relative risk, 0.73; 95% CI, 0.57-0.94; hazard ratio, 0.59; 95% CI, 0.45-0.76). Lead- and length-time bias adjustment substantially attenuated/eliminated the observed benefits. Surveillance was associated with detection of EAC at earlier stages. A randomized trial is underway to evaluate the effects of endoscopic surveillance on mortality in patients with BE. CONCLUSIONS In a systematic review and meta-analysis of the effects of surveillance in patients with BE, surveillance as currently performed was associated with detection of earlier-stage EAC and may provide a small survival benefit. However, the effects of confounding biases on these estimates are not fully defined and may completely or partially explain the observed differences between surveyed and unsurveyed patients.
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Affiliation(s)
| | - Apoorva Krishna Chandar
- Division of Gastroenterology and Liver Diseases, Case Western Reserve University, Cleveland, OH
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, San Diego, CA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nicholas J. Shaheen
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John M. Inadomi
- Division of Gastroenterology, University of Washington, Seattle, WA
| | - Amitabh Chak
- Division of Gastroenterology and Liver Diseases, Case Western Reserve University, Cleveland, OH
| | - Prasad G. Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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26
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Ristori D, Miele S, Rossettini G, Monaldi E, Arceri D, Testa M. Towards an integrated clinical framework for patient with shoulder pain. Arch Physiother 2018; 8:7. [PMID: 29862049 PMCID: PMC5975572 DOI: 10.1186/s40945-018-0050-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/23/2018] [Indexed: 01/03/2023] Open
Abstract
Background Shoulder pain (SP) represents a common musculoskeletal condition that requires physical therapy care. Along the years, the usual evaluation strategies based on clinical tests and diagnostic imaging has been challenged. Clinical tests appear unable to clearly identify the structures that generated pain and interpretation of diagnostic imaging is still controversial. The current patho-anatomical diagnostic categories have demonstrated poor reliability and seem inadequate for the SP treatment. Objectives The present paper aims to (1) describe the different proposals of clinical approach to SP currently available in the literature; to (2) integrate these proposals in a single framework in order to help the management of SP. Conclusion The proposed clinical framework, based on a bio-psychosocial vision of health, integrates symptoms characteristics, pain mechanisms and expectations, preferences and psychosocial factors of patients that may guide physiotherapist to make a diagnostic triage and to choose the right treatment for the individual patient.
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Affiliation(s)
- Diego Ristori
- Via Veneto, 6, Subbiano, Arezzo Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Simone Miele
- Via Paolo VI, Cologne, Brescia Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Giacomo Rossettini
- Via de Gaspari, 9, Montecchio Maggiore, Vicenza Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Erica Monaldi
- Via Italo Svevo, 2 Codogno, Lodi, Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Diego Arceri
- Via Eugenio Scalfaro, 17, Catanzaro, Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Marco Testa
- Via Magliotto, 2 17100, Savona, Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
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Rydzak CE, Armato SG, Avila RS, Mulshine JL, Yankelevitz DF, Gierada DS. Quality assurance and quantitative imaging biomarkers in low-dose CT lung cancer screening. Br J Radiol 2017; 91:20170401. [PMID: 28830225 DOI: 10.1259/bjr.20170401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
After years of assessment through controlled clinical trials, low-dose CT screening for lung cancer is becoming part of clinical practice. As with any cancer screening test, those undergoing lung cancer screening are not being evaluated for concerning signs or symptoms, but are generally in good health and proactively trying to prevent premature death. Given the resultant obligation to achieve the screening aim of early diagnosis while also minimizing the potential for morbidity from workup of indeterminate but ultimately benign screening abnormalities, careful implementation of screening with conformance to currently recognized best practices and a focus on quality assurance is essential. In this review, we address the importance of each component of the screening process to optimize the effectiveness of CT screening, discussing options for quality assurance at each step. We also discuss the potential added advantages, quality assurance requirements and current status of quantitative imaging biomarkers related to lung cancer screening. Finally, we highlight suggestions for improvements and needs for further evidence in evaluating the performance of CT screening as it transitions from the research trial setting into daily clinical practice.
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Affiliation(s)
- Chara E Rydzak
- 1 Mallinckrodt Institute of Radiology, Washington University School of Medicine , St. Louis, MO , USA
| | - Samuel G Armato
- 2 Department of Radiology, University of Chicago , Chicago, IL , USA
| | | | - James L Mulshine
- 4 Department of Internal Medicine, Rush University , Chicago, IL , USA
| | - David F Yankelevitz
- 5 Department of Radiology, Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - David S Gierada
- 1 Mallinckrodt Institute of Radiology, Washington University School of Medicine , St. Louis, MO , USA
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Lee JM, Ichikawa L, Valencia E, Miglioretti DL, Wernli K, Buist DSM, Kerlikowske K, Henderson LM, Sprague BL, Onega T, Rauscher GH, Lehman CD. Performance Benchmarks for Screening Breast MR Imaging in Community Practice. Radiology 2017; 285:44-52. [PMID: 28582633 PMCID: PMC5621720 DOI: 10.1148/radiol.2017162033] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To compare screening magnetic resonance (MR) imaging performance in the Breast Cancer Surveillance Consortium (BCSC) with Breast Imaging Reporting and Data System (BI-RADS) benchmarks. Materials and Methods This study was approved by the institutional review board and compliant with HIPAA and included BCSC screening MR examinations collected between 2005 and 2013 from 5343 women (8387 MR examinations) linked to regional Surveillance, Epidemiology, and End Results program registries, state tumor registries, and pathologic information databases that identified breast cancer cases and tumor characteristics. Clinical, demographic, and imaging characteristics were assessed. Performance measures were calculated according to BI-RADS fifth edition and included cancer detection rate (CDR), positive predictive value of biopsy recommendation (PPV2), sensitivity, and specificity. Results The median patient age was 52 years; 52% of MR examinations were performed in women with a first-degree family history of breast cancer, 46% in women with a personal history of breast cancer, and 15% in women with both risk factors. Screening MR imaging depicted 146 cancers, and 35 interval cancers were identified (181 total-54 in situ, 125 invasive, and two status unknown). The CDR was 17 per 1000 screening examinations (95% confidence interval [CI]: 15, 20 per 1000 screening examinations; BI-RADS benchmark, 20-30 per 1000 screening examinations). PPV2 was 19% (95% CI: 16%, 22%; benchmark, 15%). Sensitivity was 81% (95% CI: 75%, 86%; benchmark, >80%), and specificity was 83% (95% CI: 82%, 84%; benchmark, 85%-90%). The median tumor size of invasive cancers was 10 mm; 88% were node negative. Conclusion The interpretative performance of screening MR imaging in the BCSC meets most BI-RADS benchmarks and approaches benchmark levels for remaining measures. Clinical practice performance data can inform ongoing benchmark development and help identify areas for quality improvement. © RSNA, 2017.
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Affiliation(s)
- Janie M. Lee
- From the Department of Radiology, University of Washington, Seattle, Wash (J.M.L., E.V.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., D.L.M., K.W., D.S.M.B.); Department of Public Health Sciences, School of Medicine, University of California, Davis School of Medicine, Davis, Calif (D.L.M.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (L.M.H.); Department of Surgery, University of Vermont, Burlington, Vt (B.L.S.); Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O.); Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Ill (G.H.R.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.)
| | - Laura Ichikawa
- From the Department of Radiology, University of Washington, Seattle, Wash (J.M.L., E.V.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., D.L.M., K.W., D.S.M.B.); Department of Public Health Sciences, School of Medicine, University of California, Davis School of Medicine, Davis, Calif (D.L.M.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (L.M.H.); Department of Surgery, University of Vermont, Burlington, Vt (B.L.S.); Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O.); Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Ill (G.H.R.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.)
| | - Elizabeth Valencia
- From the Department of Radiology, University of Washington, Seattle, Wash (J.M.L., E.V.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., D.L.M., K.W., D.S.M.B.); Department of Public Health Sciences, School of Medicine, University of California, Davis School of Medicine, Davis, Calif (D.L.M.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (L.M.H.); Department of Surgery, University of Vermont, Burlington, Vt (B.L.S.); Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O.); Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Ill (G.H.R.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.)
| | - Diana L. Miglioretti
- From the Department of Radiology, University of Washington, Seattle, Wash (J.M.L., E.V.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., D.L.M., K.W., D.S.M.B.); Department of Public Health Sciences, School of Medicine, University of California, Davis School of Medicine, Davis, Calif (D.L.M.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (L.M.H.); Department of Surgery, University of Vermont, Burlington, Vt (B.L.S.); Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O.); Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Ill (G.H.R.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.)
| | - Karen Wernli
- From the Department of Radiology, University of Washington, Seattle, Wash (J.M.L., E.V.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., D.L.M., K.W., D.S.M.B.); Department of Public Health Sciences, School of Medicine, University of California, Davis School of Medicine, Davis, Calif (D.L.M.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (L.M.H.); Department of Surgery, University of Vermont, Burlington, Vt (B.L.S.); Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O.); Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Ill (G.H.R.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.)
| | - Diana S. M. Buist
- From the Department of Radiology, University of Washington, Seattle, Wash (J.M.L., E.V.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., D.L.M., K.W., D.S.M.B.); Department of Public Health Sciences, School of Medicine, University of California, Davis School of Medicine, Davis, Calif (D.L.M.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (L.M.H.); Department of Surgery, University of Vermont, Burlington, Vt (B.L.S.); Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O.); Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Ill (G.H.R.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.)
| | - Karla Kerlikowske
- From the Department of Radiology, University of Washington, Seattle, Wash (J.M.L., E.V.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., D.L.M., K.W., D.S.M.B.); Department of Public Health Sciences, School of Medicine, University of California, Davis School of Medicine, Davis, Calif (D.L.M.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (L.M.H.); Department of Surgery, University of Vermont, Burlington, Vt (B.L.S.); Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O.); Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Ill (G.H.R.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.)
| | - Louise M. Henderson
- From the Department of Radiology, University of Washington, Seattle, Wash (J.M.L., E.V.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., D.L.M., K.W., D.S.M.B.); Department of Public Health Sciences, School of Medicine, University of California, Davis School of Medicine, Davis, Calif (D.L.M.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (L.M.H.); Department of Surgery, University of Vermont, Burlington, Vt (B.L.S.); Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O.); Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Ill (G.H.R.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.)
| | - Brian L. Sprague
- From the Department of Radiology, University of Washington, Seattle, Wash (J.M.L., E.V.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., D.L.M., K.W., D.S.M.B.); Department of Public Health Sciences, School of Medicine, University of California, Davis School of Medicine, Davis, Calif (D.L.M.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (L.M.H.); Department of Surgery, University of Vermont, Burlington, Vt (B.L.S.); Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O.); Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Ill (G.H.R.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.)
| | - Tracy Onega
- From the Department of Radiology, University of Washington, Seattle, Wash (J.M.L., E.V.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., D.L.M., K.W., D.S.M.B.); Department of Public Health Sciences, School of Medicine, University of California, Davis School of Medicine, Davis, Calif (D.L.M.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (L.M.H.); Department of Surgery, University of Vermont, Burlington, Vt (B.L.S.); Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O.); Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Ill (G.H.R.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.)
| | - Garth H. Rauscher
- From the Department of Radiology, University of Washington, Seattle, Wash (J.M.L., E.V.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., D.L.M., K.W., D.S.M.B.); Department of Public Health Sciences, School of Medicine, University of California, Davis School of Medicine, Davis, Calif (D.L.M.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (L.M.H.); Department of Surgery, University of Vermont, Burlington, Vt (B.L.S.); Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O.); Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Ill (G.H.R.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.)
| | - Constance D. Lehman
- From the Department of Radiology, University of Washington, Seattle, Wash (J.M.L., E.V.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (L.I., D.L.M., K.W., D.S.M.B.); Department of Public Health Sciences, School of Medicine, University of California, Davis School of Medicine, Davis, Calif (D.L.M.); Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (L.M.H.); Department of Surgery, University of Vermont, Burlington, Vt (B.L.S.); Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O.); Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Ill (G.H.R.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.)
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29
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Abstract
Many economists and policy makers believe that United States healthcare costs are rising at an unsustainable rate. In response, newer payment systems such as bundled payments, accountable care organizations, and population health management have been proposed. These new paradigms all aim to encourage collaboration between health care providers to conserve costs and increase quality. To succeed in this evolving environment, radiologists should consider embracing change by working to standardize radiology practice, participating in radiology utilization management, working with vendors to increase storage of radiology imaging data to improve access and interconnectivity, and exploring targeted screening in high risk populations.
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30
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Lewiss RE, Chan W, Sheng AY, Soto J, Castro A, Meltzer AC, Cherney A, Kumaravel M, Cody D, Chen EH. Research Priorities in the Utilization and Interpretation of Diagnostic Imaging: Education, Assessment, and Competency. Acad Emerg Med 2015; 22:1447-54. [PMID: 26568277 DOI: 10.1111/acem.12833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 07/10/2015] [Accepted: 07/12/2015] [Indexed: 01/22/2023]
Abstract
The appropriate selection and accurate interpretation of diagnostic imaging is a crucial skill for emergency practitioners. To date, the majority of the published literature and research on competency assessment comes from the subspecialty of point-of-care ultrasound. A group of radiologists, physicists, and emergency physicians convened at the 2015 Academic Emergency Medicine consensus conference to discuss and prioritize a research agenda related to education, assessment, and competency in ordering and interpreting diagnostic imaging. A set of questions for the continued development of an educational curriculum on diagnostic imaging for trainees and competency assessment using specific assessment methods based on current best practices was delineated. The research priorities were developed through an iterative consensus-driven process using a modified nominal group technique that culminated in an in-person breakout session. The four recommendations are: 1) develop a diagnostic imaging curriculum for emergency medicine (EM) residency training; 2) develop, study, and validate tools to assess competency in diagnostic imaging interpretation; 3) evaluate the role of simulation in education, assessment, and competency measures for diagnostic imaging; 4) study is needed regarding the American College of Radiology Appropriateness Criteria, an evidence-based peer-reviewed resource in determining the use of diagnostic imaging, to maximize its value in EM. In this article, the authors review the supporting reliability and validity evidence and make specific recommendations for future research on the education, competency, and assessment of learning diagnostic imaging.
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Affiliation(s)
- Resa E. Lewiss
- Department of Emergency Medicine; University of Colorado Hospital; Aurora CO
| | - Wilma Chan
- Department of Emergency Medicine; Hospital of the University of Pennsylvania; Philadelphia PA
| | - Alexander Y. Sheng
- Department of Emergency Medicine; Boston University Medical Center; Boston MA
| | - Jorge Soto
- Department of Radiology; Boston University Medical Center; Boston MA
| | - Alexandra Castro
- Department of Emergency Medicine; University of Pittsburgh Medical Center; Pittsburgh PA
| | - Andrew C. Meltzer
- Department of Emergency Medicine; George Washington University School of Medicine; Washington DC
| | - Alan Cherney
- Department of Emergency Medicine; Lehigh Valley Health Network; Allentown PA
| | - Manickam Kumaravel
- Department Sports, Orthopedics, and Emergency Imaging; University of Texas Health Science Center at Houston; Houston TX
| | - Dianna Cody
- Department of Imaging Physics; Division of Diagnostic Imaging; The University of Texas MD Anderson Cancer Center; Houston TX
| | - Esther H. Chen
- Department of Emergency Medicine; University of California San Francisco/San Francisco General Hospital; San Francisco CA
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31
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George A, Ajwani S, Johnson M, Dahlen H, Blinkhorn A, Bhole S, Ellis S, Zheng C, Dawes W. Developing and Testing of an Oral Health Screening Tool for Midwives to Assess Pregnant Woman. Health Care Women Int 2014; 36:1160-74. [PMID: 25299615 DOI: 10.1080/07399332.2014.959170] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Maternal oral health is important, and midwives are encouraged to screen women for dental problems. We aimed to develop and test a midwifery oral health screening tool. A three-item tool was tested as part of a trial involving 300 women in Southwestern Sydney. A two-item combination showed better sensitivity (98%) and had a positive predictive value of 88%. Specificity was 40%, and negative predictive value was 80%. A two-item screening tool has been identified that is sensitive to identifying dental problems and facilitating referrals. Further validation using a larger sample is required to reassess the tool's specificity.
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Affiliation(s)
- Ajesh George
- a Centre for Applied Nursing Research, University of Western Sydney (UWS); South Western Sydney Local Health District, University of Sydney; and Ingham Institute of Applied Medical Research , Sydney , New South Wales , Australia
| | - Shilpi Ajwani
- b Sydney Local Health District Oral Health Services and Sydney Dental Hospital; and Faculty of Dentistry, University of Sydney , Sydney , New South Wales , Australia
| | - Maree Johnson
- c Faculty of Health Sciences, Australian Catholic University , Sydney, New South Wales, Australia
| | - Hannah Dahlen
- d School of Nursing & Midwifery, University of Western Sydney , Sydney , New South Wales , Australia
| | - Anthony Blinkhorn
- e Faculty of Dentistry, University of Sydney , Sydney , New South Wales , Australia
| | - Sameer Bhole
- b Sydney Local Health District Oral Health Services and Sydney Dental Hospital; and Faculty of Dentistry, University of Sydney , Sydney , New South Wales , Australia
| | - Sharon Ellis
- f Antenatal Services, Camden and Campbelltown Hospitals, South Western Sydney Local Health District , Sydney , New South Wales , Australia
| | - Catherine Zheng
- g Centre for Applied Nursing Research, University of Western Sydney; South Western Sydney Local Health District; and Ingham Institute of Applied Medical Research , Sydney , New South Wales , Australia
| | - William Dawes
- h Community Oral Health Clinics, Sydney Local Health District Oral Health Services; and Faculty of Dentistry, University of Sydney , Sydney , New South Wales , Australia
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32
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Relative impact of earlier diagnosis and improved treatment on survival for colorectal cancer: A US database study among elderly patients. Cancer Epidemiol 2014; 38:733-40. [DOI: 10.1016/j.canep.2014.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/06/2014] [Accepted: 10/12/2014] [Indexed: 01/26/2023]
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33
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Nolen BM, Lomakin A, Marrangoni A, Velikokhatnaya L, Prosser D, Lokshin AE. Urinary protein biomarkers in the early detection of lung cancer. Cancer Prev Res (Phila) 2014; 8:111-9. [PMID: 25416410 DOI: 10.1158/1940-6207.capr-14-0210] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The early detection of lung cancer has the potential to greatly impact disease burden through the timely identification and treatment of affected individuals at a manageable stage of development. The insufficient specificity demonstrated by currently used screening and diagnostic techniques has led to intense investigation into biomarkers as diagnostic tools. Urine may represent a noninvasive alternative matrix for diagnostic biomarker development. We performed an analysis of 242 biomarkers in urines obtained from 83 patients with non-small cell lung carcinomas (NSCLC), 74 patients diagnosed with benign pulmonary conditions, and 77 healthy donors. A large number of significant alterations were observed between the NSCLC and control groups. A multivariate analysis identified a three-biomarker panel consisting of IGFBP-1, sIL-1Ra, CEACAM-1, which discriminated NSCLC from healthy controls with a sensitivity/specificity of 84/95 in an initial training set and 72/100 in an independent validation set. This panel performed well among multiple subtypes of NSCLC and early-stage disease but demonstrated only limited efficacy for the discrimination of NSCLC from benign controls and limited specificity for patients with several other cancers and tuberculosis. These findings demonstrate that urine biomarkers may provide screening and diagnostic properties which exceed those reported for serum biomarkers and approach a level necessary for further clinical development.
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Affiliation(s)
- Brian M Nolen
- University of Pittsburgh Cancer Institute, Hillman Cancer Center, Pittsburgh, Pennsylvania. Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Aleksey Lomakin
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Adele Marrangoni
- University of Pittsburgh Cancer Institute, Hillman Cancer Center, Pittsburgh, Pennsylvania
| | | | - Denise Prosser
- University of Pittsburgh Cancer Institute, Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Anna E Lokshin
- University of Pittsburgh Cancer Institute, Hillman Cancer Center, Pittsburgh, Pennsylvania. Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Department of Ob/Gyn, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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34
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Kline E, Schiffman J. Psychosis risk screening: a systematic review. Schizophr Res 2014; 158:11-8. [PMID: 25034762 DOI: 10.1016/j.schres.2014.06.036] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/13/2014] [Accepted: 06/16/2014] [Indexed: 01/03/2023]
Abstract
Despite the wealth of evidence linking duration of untreated psychosis to critical illness outcomes, most clinicians do not utilize any formal evaluation tools to identify attenuated or emerging psychotic symptoms. Given the costs associated with training and administration, interview-based assessments such as the Structured Interview for Psychosis Risk Syndromes (SIPS) are not likely to be widely adopted for clinical use. The ability to identify high-risk individuals through low-cost, brief methods is essential to the success of scalable prevention efforts. The aim of this article is to present a comprehensive review of the use of self-report forms as psychosis risk "screeners." A literature search revealed 34 investigations in which authors used a self-report questionnaire as a first-step screener in a clinical high-risk assessment protocol. Information about each screener, including reported psychometric data, is presented within the review. Psychosis risk screeners have been used in diverse samples with the goals of validating assessments, screening populations for clinical referral, recruiting samples of interest for research participation, and estimating symptom prevalence and severity. Screeners focusing on attenuated psychotic experiences appear to measure a reliable construct with variable prevalence in help-seeking and general population samples. Administration of screeners to help-seeking populations can identify enriched samples with substantially elevated likelihood of meeting CHR criteria and transitioning to psychosis over time. More research is needed, however, to establish reliable norms and screening thresholds, as score elevations indicating a likely high-risk respondent appear to be unreliable across populations and settings.
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Affiliation(s)
- Emily Kline
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD 21250, United States
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD 21250, United States.
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35
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Debus ES. Commentary on 'carotid artery atherosclerosis among 65-year-old Swedish men: a population based screening study'. Eur J Vasc Endovasc Surg 2014; 48:11-2. [PMID: 24878233 DOI: 10.1016/j.ejvs.2014.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
- E S Debus
- Department for Vascular Medicine, Heart Center at University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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36
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Cheah CY, Seymour JF. Adding weight to a sinking ship: more reasons not to perform routine surveillance imaging in patients with diffuse large B-cell lymphoma in remission. Leuk Lymphoma 2014; 55:2223-5. [PMID: 24410590 DOI: 10.3109/10428194.2014.881483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Chan Y Cheah
- Department of Haematology, Peter MacCallum Cancer Centre , East Melbourne, Victoria , Australia and University of Melbourne , Parkville, Victoria , Australia
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37
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Mascaux C, Peled N, Garg K, Kato Y, Wynes MW, Hirsch FR. Early detection and screening of lung cancer. Expert Rev Mol Diagn 2014; 10:799-815. [PMID: 20843203 DOI: 10.1586/erm.10.60] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Celine Mascaux
- University of Colorado Denver, Anschutz Medical Campus, 12801 East 17th Avenue, Aurora, CO 80045, USA.
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38
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Emerging and Evolving Roles for CT in Screening for Coronary Heart Disease. J Am Coll Radiol 2013; 10:943-8. [DOI: 10.1016/j.jacr.2013.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 09/13/2013] [Indexed: 01/10/2023]
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39
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Seddik AF, Shawky DM. A low-cost screening method for the detection of the carotid artery diseases. Knowl Based Syst 2013. [DOI: 10.1016/j.knosys.2013.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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40
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Abstract
The focus of this report is to examine the process of validation of new screening tests designed to detect the problem gambler in research and practice settings. A hierarchical or phases of evaluation model is presented as a conceptual framework to describe the basic features of the validation process and its implications for application and interpretation of test results. The report describes a number of threats to validity in the form of sources of unintended bias that when unrecognized may lead to incorrect interpretations of study results and the drawing of incorrect conclusions about the usefulness of the new screening tests. Examples drawn from the gambling literature on problem gambling are used to illustrate some of the more important concepts including spectrum bias and clinical variation in test accuracy. The concept of zones of severity and the bias inherent in selecting criterion thresholds are reviewed. A definition of reference or study gold standard is provided. The use of 2-stage designs to establish validity by efficiently using reference standards to determine indices of accuracy and prevalence is recommended.
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Affiliation(s)
- Blase Gambino
- American Academy of Health Care Providers in the Addictive Disorders, 10 Ellet Street, Boston, MA 02122, USA.
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41
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Jeffers CD, Pandey T, Jambhekar K, Meek M. Effective Use of Low-Dose Computed Tomography Lung Cancer Screening. Curr Probl Diagn Radiol 2013; 42:220-30. [DOI: 10.1067/j.cpradiol.2013.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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42
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Robbins JB, Kim DH. Computed tomographic colonography: evidence and techniques for screening. Semin Roentgenol 2013; 48:264-72. [PMID: 23796377 DOI: 10.1053/j.ro.2013.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Jessica B Robbins
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53729, USA.
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43
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Is HLAB genotyping the future of gout pharmacogenomics? Nat Rev Rheumatol 2013; 9:200-2. [DOI: 10.1038/nrrheum.2013.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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44
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Rozenfeld MN, Ansari SA, Shaibani A, Russell EJ, Mohan P, Hurley MC. Should patients with autosomal dominant polycystic kidney disease be screened for cerebral aneurysms? AJNR Am J Neuroradiol 2013; 35:3-9. [PMID: 23292526 DOI: 10.3174/ajnr.a3437] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Autosomal dominant polycystic kidney disease is a genetic disorder affecting 1 in 1000 people worldwide and is associated with an increased risk of intracranial aneurysms. It remains unclear whether there is sufficient net benefit to screening this patient population for IA, considering recent developments in imaging and treatment and our evolving understanding of the natural history of unruptured aneurysms. There is currently no standardized screening protocol for IA in patients with ADPCKD. Our review of the literature focused on the above issues and presents our appraisal of the estimated value of screening for IA in the setting of ADPCKD.
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Affiliation(s)
- M N Rozenfeld
- Department of Radiology, St. Francis Hospital, Evanston, Illinois
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Ollendorf DA, Blackmore CC, Lee JM. Toward evidence-based decisions in diagnostic radiology: a research and rating process for multiple decision-makers. Acad Radiol 2012; 19:1049-54. [PMID: 22727624 DOI: 10.1016/j.acra.2012.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/02/2012] [Accepted: 04/03/2012] [Indexed: 11/29/2022]
Abstract
The use of diagnostic imaging tests and the development of evidence-based guidelines, reviews, and other materials have both undergone substantial growth in recent years. However, the proliferation of evidence-based information has not translated into the universal deployment of medical and coverage policy for diagnostic imaging that is similarly evidence-based. One possible reason is the failure of those institutions generating evidence-based information to format findings in an accessible manner for all relevant stakeholders. The Institute for Clinical and Economic Review has developed a simple and transparent method for rating evidence that is accessible to clinicians, patients, payers, and other policy makers. The authors describe this process in relation to three imaging-based examples (computed tomographic colonography, coronary computed tomographic angiography, and positron emission tomography for dementia neuropathology). The issues raised, controversies considered, and use of the ratings in setting policy are discussed in relation to each example.
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Affiliation(s)
- Daniel A Ollendorf
- Institute for Clinical and Economic Review, Massachusetts General Hospital, Boston, 02114, USA.
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Nolen BM, Langmead CJ, Choi S, Lomakin A, Marrangoni A, Bigbee WL, Weissfeld JL, Wilson DO, Dacic S, Siegfried JM, Lokshin AE. Serum biomarker profiles as diagnostic tools in lung cancer. Cancer Biomark 2012; 10:3-12. [PMID: 22297547 PMCID: PMC4556364 DOI: 10.3233/cbm-2012-0229] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Computed tomography (CT) scanning has emerged as an effective means of early detection for lung cancer. Despite marked improvement over earlier methodologies, the low level of specificity demonstrated by CT scanning has limited its clinical implementation as a screening tool. A minimally-invasive biomarker-based test that could further characterize CT-positive patients based on risk of malignancy would greatly enhance its clinical efficacy. METHODS We performed an analysis of 81 serum proteins in 92 patients diagnosed with lung cancer and 172 CT-screened control individuals. We utilize a series of bioinformatics algorithms including Metropolis-Monte Carlo, artificial neural networks, Naïve Bayes, and additive logistic regression to identify multimarker panels capable of discriminating cases from controls with high levels of sensitivity and specificity in distinct training and independent validation sets. RESULTS A three-biomarker panel comprised of MIF, prolactin, and thrombospondin identified using the Metropolis-Monte Carlo algorithm provided the best classification with a %Sensitivity/Specificity/Accuracy of 74/90/86 in the training set and 70/93/82 in the validation set. This panel was effective in the classification of control individuals demonstrating suspicious pulmonary nodules and stage I lung cancer patients. CONCLUSIONS The selected serum biomarker panel demonstrated a high diagnostic utility in the current study and performance characteristics which compare favorably with previous reports. Further advancements may lead to the development of a diagnostic tool useful as an adjunct to CT-scanning.
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Affiliation(s)
- Brian M Nolen
- University of Pittsburgh Cancer Institute, Hillman Cancer Center, Pittsburgh, PA 15213, USA
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Rothstein MA. Currents in contemporary bioethics. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2012; 40:682-689. [PMID: 23061594 DOI: 10.1111/j.1748-720x.2012.00699.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
From the earliest days of the Human Genome Project, the holy grail of genomics was the ability to perform whole-genome sequencing quickly, accurately, and relatively inexpensively so that the benefits of genomics would be widely available in clinical settings. Although the mythical $1,000 genome sequence seemed elusive for many years, next-generation sequencing technologies and other recent advances clearly indicate that inexpensive whole-genome sequencing is at hand.Whole-genome sequencing has demonstrable value in elucidating the genetic etiology of rare disorders, in identifying atypical variants in common diseases, in determining pharmacogenomically appropriate drugs and dosages, in performing tumor genome sequencing, and in aiding other clinical applications for the diagnosis and treatment of individuals who are symptomatic or whose family health history places them at substantial risk. Undoubtedly, the clinical applications of wholegenome sequencing will increase in the future.
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Affiliation(s)
- Mark A Rothstein
- Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine
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Hegedus EJ, Stern B. Beyond SpPIN and SnNOUT: Considerations with Dichotomous Tests During Assessment of Diagnostic Accuracy. J Man Manip Ther 2011; 17:E1-5. [PMID: 20046556 DOI: 10.1179/jmt.2009.17.1.1e] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Paramount to efficient and effective care is the determination of an accurate diagnosis that leads to the proper referral and/or intervention. In an effort to improve the clinical utility of diagnostic accuracy calculations, researchers have promoted the use of the mnemonics SpPIn (if specificity is high, a positive test rules in pathology) and SnNOut (if sensitivity is high, a negative test rules out pathology). Using examples from diagnostic accuracy studies and a review of pertinent literature, this clinimetrics corner outlines additional considerations for clinicians when consuming research in this area. The paper has three foci. First, sensitivity, specificity, and other estimates of the diagnostic accuracy of dichotomous physical examination tests should be viewed as estimates with confidence when those estimates are expressed as confidence intervals. Second, appropriate power must be considered when evaluating each study. Last, the quality of a diagnostic accuracy study can affect the generalizibility of the results to practice environments.
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Thilo C, Gebregziabher M, Mayer FB, Berghaus TM, Zwerner PL, Schoepf UJ. Can non-calcified coronary artery plaques be detected on non-contrast CT calcium scoring studies? Acad Radiol 2011; 18:858-65. [PMID: 21669351 DOI: 10.1016/j.acra.2011.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 02/07/2011] [Accepted: 02/14/2011] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES Coronary computed tomographic (CT) angiography has been shown to detect noncalcified coronary artery plaque. Depending on tissue composition, noncalcified plaque differs in CT attenuation from blood and epicardial fat. The aim of this study was to determine whether noncalcified plaque can be visually detected on non-contrast-enhanced CT calcium scoring studies. MATERIALS AND METHODS A total of 106 patients (40 women; mean age, 59 years) who underwent coronary calcium scoring, coronary CT angiography, and quantitative catheter angiography were prospectively investigated. Two blinded observers independently reviewed calcium scoring studies for positive vascular remodeling and hypoattenuation within the vessel wall, suggestive of noncalcified plaque. Findings on calcium scoring studies were compared with those on coronary CT angiography and quantitative catheter angiography. RESULTS The mean Agatston score was 515.8 ± 826.8. Overall interobserver agreement for the identification of noncalcified lesions was substantial (κ = 0.69). Observer 1 and observer 2 identified 21 and 17 patients, respectively, with 38 and 35 lesions suggestive of noncalcified plaque. Coronary CT angiography confirmed noncalcified plaque in 33 of 38 (86.8%; observer 1) and 31 of 35 (88.6%; observer 2) lesions. Thus, the overall positive predictive value for correct identification of noncalcified plaque on calcium scoring studies was 0.88, although overall sensitivity was low at 0.39. CONCLUSIONS Noncalcified plaque can be visually detected on calcium scoring studies. Review of calcium scoring studies for features of noncalcified plaque may enhance the identification of patients with more active disease and higher cardiovascular risk.
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Affiliation(s)
- Christian Thilo
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29401, USA.
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