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Hendrick RE, Monticciolo DL. Mammography Screening Should Begin at Age 40 Years. J Breast Imaging 2024; 6:116-123. [PMID: 38280219 DOI: 10.1093/jbi/wbad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Indexed: 01/29/2024]
Abstract
The 2023 U.S. Preventive Services Task Force draft recommendation statement on screening for breast cancer recommends lowering the starting age for biennial screening with mammography to age 40 years from 50 years, the age of screening initiation that the Task Force had previously recommended since 2009. A recent Perspective article in the New England Journal of Medicine by Woloshin et al contends that this change will provide no additional benefit and is unjustified. This article reviews the main ideas presented by Woloshin et al and provides substantial evidence not considered by those authors in support of screening mammography in U.S. women starting at age 40 years.
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Affiliation(s)
- R Edward Hendrick
- Department of Radiology, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Debra L Monticciolo
- Dartmouth Geisel School of Medicine, Lebanon, NH, USA
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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2
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Iyer N, Hussein S, Singareddy S, Sn VP, Jaramillo AP, Yasir M, Nath TS. Sotagliflozin vs Dapagliflozin: A Systematic Review Comparing Cardiovascular Mortality. Cureus 2023; 15:e45525. [PMID: 37868384 PMCID: PMC10585602 DOI: 10.7759/cureus.45525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
After the debut of the results of the effect of Sotagliflozin on Cardiovascular Events in Patients with Type 2 Diabetes Post Worsening Heart Failure (SOLOIST-WHF) and Sotagliflozin in Patients With Chronic Kidney Disease and Type 2 Diabetes (SCORED) trials at the American Heart Association's 2020 Scientific session, sotagliflozin became the first drug and the third sodium glucose co-transporter-2 (SGLT-2) inhibitor to be approved for heart failure (HF) across the spectrum of ejection fraction (EF). In light of this recent major U.S. Food and Drug Administration (FDA) approval of sotagliflozin, we conducted a systematic review to compare the cardiovascular mortality rates between sotagliflozin and dapagliflozin in patients with HF. To find relevant articles, we extensively searched major research literature databases and search engines such as PubMed, MEDLINE, PubMed Central, Google Scholar, Embase, and Cochrane Library. We compared the results of significant trials involving sotagliflozin with the trials studying dapagliflozin to provide comprehensive mortality results of both drugs. The results showed that the timely initiation of sotagliflozin in HF cases significantly reduces cardiovascular mortality, hospitalizations, and urgent HF visits. Comparative trials with dapagliflozin indicate enhanced mortality reduction associated with greater initial symptom burden. The results of these major trials cannot be overlooked due to the large size of the combined trials, the randomized design, and the high standards with which they were conducted. The pathophysiology behind the cardioprotection offered by these agents is complex and multifactorial, but it is believed that due to the diuretic-like function, SGLT-2 inhibitors reduce glycemic-related toxicity, promote ketogenesis, and exert antihypertrophic, antifibrotic, and anti-remodeling properties. The benefits of dapagliflozin on cardiovascular death and worsening HF in patients with mildly reduced or preserved EF appeared especially pronounced in those with a greater degree of symptomatic impairment at baseline. Sotagliflozin led to a rise in the count of days patients were alive and not hospitalized (DAOH), which offers an extra patient-centered measure to assess the impact of the disease burden. The data in our article will help future researchers conduct large-scale trials with sotagliflozin to identify and implement it in the treatment of patients with HF as a mortality-reducing drug and to improve the quality of life for patients with HF.
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Affiliation(s)
- Nandhini Iyer
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sally Hussein
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sanjana Singareddy
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vijay Prabhu Sn
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Arturo P Jaramillo
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohamed Yasir
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tuheen Sankar Nath
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Amicizia D, Piazza MF, Marchini F, Astengo M, Grammatico F, Battaglini A, Schenone I, Sticchi C, Lavieri R, Di Silverio B, Andreoli GB, Ansaldi F. Systematic Review of Lung Cancer Screening: Advancements and Strategies for Implementation. Healthcare (Basel) 2023; 11:2085. [PMID: 37510525 PMCID: PMC10379173 DOI: 10.3390/healthcare11142085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths in Europe, with low survival rates primarily due to late-stage diagnosis. Early detection can significantly improve survival rates, but lung cancer screening is not currently implemented in Italy. Many countries have implemented lung cancer screening programs for high-risk populations, with studies showing a reduction in mortality. This review aimed to identify key areas for establishing a lung cancer screening program in Italy. A literature search was conducted in October 2022, using the PubMed and Scopus databases. Items of interest included updated evidence, approaches used in other countries, enrollment and eligibility criteria, models, cost-effectiveness studies, and smoking cessation programs. A literature search yielded 61 scientific papers, highlighting the effectiveness of low-dose computed tomography (LDCT) screening in reducing mortality among high-risk populations. The National Lung Screening Trial (NLST) in the United States demonstrated a 20% reduction in lung cancer mortality with LDCT, and other trials confirmed its potential to reduce mortality by up to 39% and detect early-stage cancers. However, false-positive results and associated harm were concerns. Economic evaluations generally supported the cost-effectiveness of LDCT screening, especially when combined with smoking cessation interventions for individuals aged 55 to 75 with a significant smoking history. Implementing a screening program in Italy requires the careful consideration of optimal strategies, population selection, result management, and the integration of smoking cessation. Resource limitations and tailored interventions for subpopulations with low-risk perception and non-adherence rates should be addressed with multidisciplinary expertise.
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Affiliation(s)
- Daniela Amicizia
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
| | - Maria Francesca Piazza
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Francesca Marchini
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Matteo Astengo
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Federico Grammatico
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
| | - Alberto Battaglini
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Irene Schenone
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Camilla Sticchi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Rosa Lavieri
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Bruno Di Silverio
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Giovanni Battista Andreoli
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Filippo Ansaldi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
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Zheng S, Schrijvers JJA, Greuter MJW, Kats-Ugurlu G, Lu W, de Bock GH. Effectiveness of Colorectal Cancer (CRC) Screening on All-Cause and CRC-Specific Mortality Reduction: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15071948. [PMID: 37046609 PMCID: PMC10093633 DOI: 10.3390/cancers15071948] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: The aim of this study was to pool and compare all-cause and colorectal cancer (CRC) specific mortality reduction of CRC screening in randomized control trials (RCTs) and simulation models, and to determine factors that influence screening effectiveness. (2) Methods: PubMed, Embase, Web of Science and Cochrane library were searched for eligible studies. Multi-use simulation models or RCTs that compared the mortality of CRC screening with no screening in general population were included. CRC-specific and all-cause mortality rate ratios and 95% confidence intervals were calculated by a bivariate random model. (3) Results: 10 RCTs and 47 model studies were retrieved. The pooled CRC-specific mortality rate ratios in RCTs were 0.88 (0.80, 0.96) and 0.76 (0.68, 0.84) for guaiac-based fecal occult blood tests (gFOBT) and single flexible sigmoidoscopy (FS) screening, respectively. For the model studies, the rate ratios were 0.45 (0.39, 0.51) for biennial fecal immunochemical tests (FIT), 0.31 (0.28, 0.34) for biennial gFOBT, 0.61 (0.53, 0.72) for single FS, 0.27 (0.21, 0.35) for 10-yearly colonoscopy, and 0.35 (0.29, 0.42) for 5-yearly FS. The CRC-specific mortality reduction of gFOBT increased with higher adherence in both studies (RCT: 0.78 (0.68, 0.89) vs. 0.92 (0.87, 0.98), model: 0.30 (0.28, 0.33) vs. 0.92 (0.51, 1.63)). Model studies showed a 0.62-1.1% all-cause mortality reduction with single FS screening. (4) Conclusions: Based on RCTs and model studies, biennial FIT/gFOBT, single and 5-yearly FS, and 10-yearly colonoscopy screening significantly reduces CRC-specific mortality. The model estimates are much higher than in RCTs, because the simulated biennial gFOBT assumes higher adherence. The effectiveness of screening increases at younger screening initiation ages and higher adherences.
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Affiliation(s)
- Senshuang Zheng
- Medical Center Groningen, Department of Epidemiology, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Jelle J A Schrijvers
- Medical Center Groningen, Department of Epidemiology, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Marcel J W Greuter
- Medical Center Groningen, Department of Radiology, University of Groningen, 9700 RB Groningen, The Netherlands
- Robotics and Mechatronics (RaM) Group, Technical Medical Centre, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, 7522 NH Enschede, The Netherlands
| | - Gürsah Kats-Ugurlu
- Medical Center Groningen, Department of Pathology, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin 300070, China
| | - Geertruida H de Bock
- Medical Center Groningen, Department of Epidemiology, University of Groningen, 9700 RB Groningen, The Netherlands
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Sertakova OV, Dudin MN, Krekova MM. [IMPROVING THE QUALITY OF WORK OF MEDICAL WORKERS AND THE LEVEL OF ASSISTANCE TO THE POPULATION AS A NECESSARY CONDITION FOR MINIMIZING DEATHS IN THE COVID-19 PANDEMIC]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2021; 29:652-657. [PMID: 34327939 DOI: 10.32687/0869-866x-2021-29-s1-652-657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/21/2021] [Indexed: 11/06/2022]
Abstract
The article considers the key factors that negatively affect the quality of work of medical workers and the quality of medical care to the population in the context of the COVID-19 pandemic, which in practice leads to additional deaths from a new coronavirus infection. There are two key reasons that can have a negative impact on the quality of work of medical workers and lead to an increase in the death rate of the population: 1) lack of relevant scientific support; 2) lack of qualified psychological support. The first reason does not allow to increase the professional competence of medical workers, the second reason leads to their professional deformation and emotional burnout. To solve the problem, it is proposed to use modern information and communication technologies: 1) creation of a rapidly updated database and an online system for sharing experience in COVID-19 treatment, centrally accessible to all Russian health workers; 2) creation of a remote psychological support service, also centrally accessible to all Russian health workers.
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Affiliation(s)
- O V Sertakova
- Ministry of Health of the Moscow Region, 143407, Krasnogorsk, Russia
| | - M N Dudin
- Institute of Market Problems of the Russian Academy of Sciences, 117418, Moscow, Russia,
| | - M M Krekova
- Moscow Polytechnic University, 107023, Moscow, Russia
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Chandran A, Xu C, Gross J, Leifheit KM, Phelan-Emrick D, Helleringer S, Althoff KN. A Web-Based Tool for Quantification of Potential Gains in Life Expectancy by Preventing Cause-Specific Mortality. Front Public Health 2021; 9:663825. [PMID: 34277538 PMCID: PMC8280746 DOI: 10.3389/fpubh.2021.663825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Local health departments are currently limited in their ability to use life expectancy (LE) as a benchmark for improving community health. In collaboration with the Baltimore City Health Department, our aim was to develop a web-based tool to estimate the potential lives saved and gains in LE in specific neighborhoods following interventions targeting achievable reductions in preventable deaths. Methods: The PROLONGER (ImPROved LONGEvity through Reductions in Cause-Specific Deaths) tool utilizes a novel Lives Saved Simulation model to estimate neighborhood-level potential change in LE after specified reduction in cause-specific mortality. This analysis uses 2012-2016 deaths in Baltimore City residents; a 20% reduction in heart disease mortality is shown as a case study. Results: According to PROLONGER, if heart disease deaths could be reduced by 20% in a given neighborhood in Baltimore City, there could be up to a 2.3-year increase in neighborhood LE. The neighborhoods with highest expected LE increase are not the same as those with highest heart disease mortality burden or lowest overall life expectancies. Discussion: PROLONGER is a practical resource for local health officials in prioritizing scarce resources to improve health outcomes. Focusing programs based on potential LE impact at the neighborhood level could lend new information for targeting of place-based public health interventions.
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Affiliation(s)
- Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Churong Xu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jonathan Gross
- Baltimore City Health Department, Baltimore, MD, United States
| | - Kathryn M. Leifheit
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Health Policy and Management, Fielding School of Public Health, Los Angeles, CA, United States
| | - Darcy Phelan-Emrick
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Baltimore City Health Department, Baltimore, MD, United States
| | - Stephane Helleringer
- Department of Social Research and Public Policy, New York University, New York, NY, United States
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Loertscher L, Wang L, Sanders SS. The impact of an accountable care unit on mortality: an observational study. J Community Hosp Intern Med Perspect 2021; 11:554-557. [PMID: 34211668 PMCID: PMC8221162 DOI: 10.1080/20009666.2021.1918945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Despite enthusiasm for inpatient ward redesign, coordinated models require high effort with uncertain return on investment. Objective: We aimed to reduce mortality and achieve a benchmark of zero preventable deaths by committing to an interprofessional model, including partnered nurse-physician unit leadership, geographic localization, and structured interdisciplinary bedside rounds (SIBR). Methods: An observational pre-post design with 5-year follow-up studied the transition of a medical unit to an Accountable Care Unit (ACU). This geographic model enables partnered nurse-physician leadership and patient-centered workflows, including daily interdisciplinary bedside rounds. Potentially additive or confounding hospital-wide safety initiatives were tracked. Yearly mortality was compared using multivariable logistic regression and reported as odds ratio (OR). For the pre-specified goal of no preventable deaths, we report unexpected deaths, defined as those occurring without documentation of comfort as the goal of care. Results: 12,158 inpatients (55.1% female, mean [sd] age 62.2 [19.7]) were observed over 6 years. Reduction in the risk-adjusted mortality was observed following ACU implementation, with Year 2 significantly lower than the pre-implementation year (adjusted odds ratio [aOR] = 0.58 [0.35–0.94]). Risk-adjusted mortality was similar in Year 3 (aOR = 0.64 [0.39–1.0]) but returned to baseline for Years 4 and 5. Unexpected deaths reached zero in Year 3 and plateaued in Years 4 and 5 at a rate below pre-implementation year (~0.1% vs. 0.38%). Conclusions: A geographic ACU with nurse-physician partnered leadership and daily structured interdisciplinary bedside rounds can reduce total and unexpected mortality. However, maintenance requires constant effort and, in the real world, multiple confounders complicate study.
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Affiliation(s)
- Laura Loertscher
- Clinical Faculty, Department of Medicine, Providence St. Vincent Medical Center Internal Medicine Residency, Portland, Oregon, USA
| | - Lian Wang
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Medical Data Research Center (MDRC, Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon, USA
| | - Shelley Schoepflin Sanders
- Clinical Faculty, Department of Medicine, Providence St. Vincent Medical Center Internal Medicine Residency, Portland, Oregon, USA
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Heijnsdijk EAM, Csanádi M, Gini A, Ten Haaf K, Bendes R, Anttila A, Senore C, de Koning HJ. All-cause mortality versus cancer-specific mortality as outcome in cancer screening trials: A review and modeling study. Cancer Med 2019; 8:6127-6138. [PMID: 31422585 PMCID: PMC6792501 DOI: 10.1002/cam4.2476] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/04/2019] [Accepted: 07/25/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND All-cause mortality has been suggested as an end-point in cancer screening trials in order to avoid biases in attributing the cause of death. The aim of this study was to investigate which sample size and follow-up is needed to find a significant reduction in all-cause mortality. METHODS A literature review was conducted to identify previous studies that modeled the effect of screening on all-cause mortality. Microsimulation modeling was used to simulate breast cancer, lung cancer, and colorectal cancer screening trials. Model outputs were: cancer-specific deaths, all-cause deaths, and life-years gained per year of follow-up. RESULTS There were large differences between the evaluated cancers. For lung cancer, when 40 000 high-risk people are randomized to each arm, a significant reduction in all-cause mortality could be expected between 11 and 13 years of follow-up. For breast cancer, a significant reduction could be found between 16 and 26 years of follow-up for a sample size of over 300 000 women in each arm. For colorectal cancer, 600 000 persons in each arm were required to be followed for 15-20 years. Our systematic literature review identified seven papers, which showed highly similar results to our estimates. CONCLUSION Cancer screening trials are able to demonstrate a significant reduction in all-cause mortality due to screening, but require very large sample sizes. Depending on the cancer, 40 000-600 000 participants per arm are needed to demonstrate a significant reduction. The reduction in all-cause mortality can only be detected between specific years of follow-up, more limited than the timeframe to detect a reduction in cancer-specific mortality.
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Affiliation(s)
- Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Andrea Gini
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kevin Ten Haaf
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rita Bendes
- Syreon Research Institute, Budapest, Hungary
| | | | - Carlo Senore
- SC Epidemiology, Screening, Cancer Registry, Città della Salute e della Scienza University Hospital, CPO, Turin, Italy
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Afriyie SO, Kong Y, Danso PO, Ibn Musah AA, Akomeah MO. Do corporate governance mechanisms and internal control systems matter in reducing mortality rates? Int J Health Plann Manage 2019; 34:744-760. [PMID: 30657198 DOI: 10.1002/hpm.2732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 01/26/2023] Open
Abstract
Internal controls are critical to guarding an institution against fraud, error, and devastation. They are effective tools for preventing losses and achieving organizational goals. However, internal control mechanisms need to be relevant, because the organization cannot comprehend the effectiveness of the system if they are out-of-touch with the operation. Health care control practices are not exceptionally different from what pertains in other industries. The health care organizations require effective corporate governance mechanisms to uphold their operations and performances. These practices assist health care organizations to exhume cynical practices that generate unproductive results and also factors militating against the hospital's goals or objectives. This study revealed that practices such as enhanced Board diligence, Health Professionals on board, financial prudence, and effective communication have the tendency of reducing mortality, if well executed.
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Affiliation(s)
| | - Yusheng Kong
- School of Finance and Economics, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Patrick Obeng Danso
- School of Finance and Economics, Jiangsu University, Zhenjiang, Jiangsu, China
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10
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de Koning HJ, Gulati R, Moss SM, Hugosson J, Pinsky PF, Berg CD, Auvinen A, Andriole GL, Roobol MJ, Crawford ED, Nelen V, Kwiatkowski M, Zappa M, Luján M, Villers A, de Carvalho TM, Feuer EJ, Tsodikov A, Mariotto AB, Heijnsdijk EAM, Etzioni R. The efficacy of prostate-specific antigen screening: Impact of key components in the ERSPC and PLCO trials. Cancer 2017; 124:1197-1206. [PMID: 29211316 DOI: 10.1002/cncr.31178] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND The European Randomized Study of Screening for Prostate Cancer (ERSPC) demonstrated that prostate-specific antigen (PSA) screening significantly reduced prostate cancer mortality (rate ratio, 0.79; 95% confidence interval, 0.69-0.91). The US Prostate, Lung, Colorectal, and Ovarian (PLCO) trial indicated no such reduction but had a wide 95% CI (rate ratio for prostate cancer mortality, 1.09; 95% CI, 0.87-1.36). Standard meta-analyses are unable to account for key differences between the trials that can impact the estimated effects of screening and the trials' point estimates. METHODS The authors calibrated 2 microsimulation models to individual-level incidence and mortality data from 238,936 men participating in the ERSPC and PLCO trials. A cure parameter for the underlying efficacy of screening was estimated by the models separately for each trial. The authors changed step-by-step major known differences in trial settings, including enrollment and attendance patterns, screening intervals, PSA thresholds, biopsy receipt, control arm contamination, and primary treatment, to reflect a more ideal protocol situation and differences between the trials. RESULTS Using the cure parameter estimated for the ERSPC, the models projected 19% to 21% and 6% to 8%, respectively, prostate cancer mortality reductions in the ERSPC and PLCO settings. Using this cure parameter, the models projected a reduction of 37% to 43% under annual screening with 100% attendance and biopsy compliance and no contamination. The cure parameter estimated for the PLCO trial was 0. CONCLUSIONS The observed cancer mortality reduction in screening trials appears to be highly sensitive to trial protocol and practice settings. Accounting for these differences, the efficacy of PSA screening in the PLCO setting is not necessarily inconsistent with ERSPC results. Cancer 2018;124:1197-206. © 2017 American Cancer Society.
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Affiliation(s)
- Harry J de Koning
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Institute, Seattle, Washington
| | - Sue M Moss
- Wolfson Institute, Queen Mary University of London, London, United Kingdom
| | - Jonas Hugosson
- Department of Urology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Christine D Berg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, Maryland
| | - Anssi Auvinen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Gerald L Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Monique J Roobol
- Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Vera Nelen
- Provinciaal Instituut voor Hygiene, Antwerp, Belgium
| | | | - Marco Zappa
- Unit of Epidemiology, Institute for Cancer Prevention, Florence, Italy
| | - Marcos Luján
- Urology Service, Infanta Cristina University Hospital, Complutense University of Madrid, Parla, Madrid, Spain
| | - Arnauld Villers
- Department of Urology, Regional University Hospital Center, Lille, France
| | - Tiago M de Carvalho
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eric J Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Alex Tsodikov
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Institute, Seattle, Washington
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11
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van Luijt PA, Heijnsdijk EAM, de Koning HJ. Cost-effectiveness of the Norwegian breast cancer screening program. Int J Cancer 2016; 140:833-840. [PMID: 27861849 DOI: 10.1002/ijc.30513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 11/08/2022]
Abstract
The Norwegian Breast Cancer Screening Programme (NBCSP) has a nation-wide coverage since 2005. All women aged 50-69 years are invited biennially for mammography screening. We evaluated breast cancer mortality reduction and performed a cost-effectiveness analysis, using our microsimulation model, calibrated to most recent data. The microsimulation model allows for the comparison of mortality and costs between a (hypothetical) situation without screening and a situation with screening. Breast cancer incidence in Norway had a steep increase in the early 1990s. We calibrated the model to simulate this increase and included recent costs for screening, diagnosis and treatment of breast cancer and travel and productivity loss. We estimate a 16% breast cancer mortality reduction for a cohort of women, invited to screening, followed over their complete lifetime. Cost-effectiveness is estimated at NOK 112,162 per QALY gained, when taking only direct medical costs into account (the cost of the buses, examinations, and invitations). We used a 3.5% annual discount rate. Cost-effectiveness estimates are substantially below the threshold of NOK 1,926,366 as recommended by the WHO guidelines. For the Norwegian population, which has been gradually exposed to screening, breast cancer mortality reduction for women exposed to screening is increasing and is estimated to rise to ∼30% in 2020 for women aged 55-80 years. The NBCSP is a highly cost-effective measure to reduce breast cancer specific mortality. We estimate a breast cancer specific mortality reduction of 16-30%, at the cost of 112,162 NOK per QALY gained.
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Affiliation(s)
- P A van Luijt
- Department of Public Health, Erasmus MC, CA Rotterdam, 3000, Netherlands
| | - E A M Heijnsdijk
- Department of Public Health, Erasmus MC, CA Rotterdam, 3000, Netherlands
| | - H J de Koning
- Department of Public Health, Erasmus MC, CA Rotterdam, 3000, Netherlands
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12
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Pavlik EJ. Ovarian cancer screening effectiveness: A realization from the UK Collaborative Trial of Ovarian Cancer Screening. ACTA ACUST UNITED AC 2016; 12:475-479. [PMID: 27595999 DOI: 10.1177/1745505716666096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 12/15/2022]
Abstract
Effects on survival in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) was reported in The Lancet, and demonstrate that reductions in disease-specific mortality in this randomized control trial (RCT) indicate that ovarian cancer screening works. The UKCTOCS was large enough for sufficient accrual and follow-up, using two intervention arms: MMS (a multimodal strategy using the biomarker Ca125 combined with ultrasound as a secondary test) and USS (ultrasound alone) compared against a no-screen control group. MMS and USS performed similarly, showing a statistically significant reduction in mortality that increased with follow-up surveillance (8% reduction in years 0-7 vs 28% in years 7-14). The data led to the estimate that 641 screens are needed to prevent one ovarian cancer death.
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Affiliation(s)
- Edward J Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and the Markey Cancer Center, Lexington, KY, USA
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13
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Koleva-Kolarova RG, Zhan Z, Greuter MJW, Feenstra TL, De Bock GH. To screen or not to screen for breast cancer? How do modelling studies answer the question? ACTA ACUST UNITED AC 2015; 22:e380-2. [PMID: 26628880 DOI: 10.3747/co.22.2889] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Breast cancer screening is a topic of hot debate, and currently no general consensus has been reached on starting and ending ages and screening intervals, in part because of a lack of precise estimations of the benefit-harm ratio. Simulation models are often applied to account for the expected benefits and harms of regular screening; however, the degree to which the model outcomes are reliable is not clear. In a recent systematic review, we therefore aimed to assess the quality of published simulation models for breast cancer screening of the general population. The models were scored according to a framework for qualitative assessment. We distinguished seven original models that utilized a common model type, modelling approach, and input parameters. The models predicted the benefit of regular screening in terms of mortality reduction; and overall, their estimates compared well to estimates of mortality reduction from randomized controlled trials. However, the models did not report on the expected harms associated with regular screening. We found that current simulation models for population breast cancer screening are prone to many pitfalls; their outcomes bear a high overall risk of bias, mainly because of a lack of systematic evaluation of evidence to calibrate the input parameters and a lack of external validation. Our recommendations concerning future modelling are therefore to use systematically evaluated data for the calibration of input parameters, to perform external validation of model outcomes, and to account for both the expected benefits and the expected harms so as to provide a clear balance and cost-effectiveness estimation and to adequately inform decision-makers.
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Affiliation(s)
- R G Koleva-Kolarova
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Z Zhan
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - M J W Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - T L Feenstra
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; ; rivm , Bilthoven, Netherlands
| | - G H De Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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14
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Hamashima C, Shabana M, Okada K, Okamoto M, Osaki Y. Mortality reduction from gastric cancer by endoscopic and radiographic screening. Cancer Sci 2015; 106:1744-9. [PMID: 26432528 PMCID: PMC4714659 DOI: 10.1111/cas.12829] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/24/2015] [Accepted: 09/26/2015] [Indexed: 12/17/2022] Open
Abstract
To evaluate mortality reduction from gastric cancer by endoscopic screening, we undertook a population‐based cohort study in which both radiographic and endoscopic screenings for gastric cancer have been carried out. The subjects were selected from the participants of gastric cancer screening in two cities in Japan, Tottori and Yonago, from 2007 to 2008. The subjects were defined as participants aged 40–79 years who had no gastric cancer screening in the previous year. Follow‐up of mortality was continued from the date of the first screening to the date of death or up to December 31, 2013. A Cox proportional hazards model was used to estimate the relative risk (RR) of gastric cancer incidence, gastric cancer death, all cancer deaths except gastric cancer death, and all‐causes death except gastric cancer death. The number of subjects selected for endoscopic screening was 9950 and that for radiographic screening was 4324. The subjects screened by endoscopy showed a 67% reduction of gastric cancer compared with the subjects screened by radiography (adjusted RR by sex, age group, and resident city = 0.327; 95% confidence interval [CI], 0.118–0.908). The adjusted RR of endoscopic screening was 0.968 (95%CI, 0.675–1.387) for all cancer deaths except gastric cancer death, and 0.929 (95%CI, 0.740–1.168) for all‐causes death except gastric cancer death. This study indicates that endoscopic screening can reduce gastric cancer mortality by 67% compared with radiographic screening. This is consistent with previous studies showing that endoscopic screening reduces gastric cancer mortality.
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Affiliation(s)
- Chisato Hamashima
- Cancer Screening Assessment and Management Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Michiko Shabana
- Department of Internal Medicine, San-in Rosai Hospital, Yonago, Japan
| | - Katsuo Okada
- Tottori Prefecture Health Promoting Council, Tottori, Japan
| | - Mikizo Okamoto
- Cancer Center, Tottori University Hospital, Yonago, Japan
| | - Yoneatsu Osaki
- Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
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15
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Chiu HM, Chen SLS, Yen AMF, Chiu SYH, Fann JCY, Lee YC, Pan SL, Wu MS, Liao CS, Chen HH, Koong SL, Chiou ST. Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the One Million Taiwanese Screening Program. Cancer 2015; 121:3221-9. [PMID: 25995082 PMCID: PMC4676309 DOI: 10.1002/cncr.29462] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/25/2014] [Accepted: 12/17/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The effectiveness of fecal immunochemical testing (FIT) in reducing colorectal cancer (CRC) mortality has not yet been fully assessed in a large, population-based service screening program. METHODS A prospective cohort study of the follow-up of approximately 5 million Taiwanese from 2004 to 2009 was conducted to compare CRC mortality for an exposed (screened) group and an unexposed (unscreened) group in a population-based CRC screening service targeting community residents of Taiwan who were 50 to 69 years old. Given clinical capacity, this nationwide screening program was first rolled out in 2004. In all, 1,160,895 eligible subjects who were 50 to 69 years old (ie, 21.4% of the 5,417,699 subjects of the underlying population) participated in the biennial nationwide screening program by 2009. RESULTS The actual effectiveness in reducing CRC mortality attributed to the FIT screening was 62% (relative rate for the screened group vs the unscreened group, 0.38; 95% confidence interval, 0.35-0.42) with a maximum follow-up of 6 years. The 21.4% coverage of the population receiving FIT led to a significant 10% reduction in CRC mortality (relative rate, 0.90; 95% confidence interval, 0.84-0.95) after adjustments for a self-selection bias. CONCLUSIONS This large, prospective Taiwanese cohort undergoing population-based FIT screening for CRC had the statistical power to demonstrate a significant CRC mortality reduction, although the follow-up time was short. Although such findings are informative for health decision makers, continued follow-up of this large cohort will be required to estimate the long-term impact of FIT screening if the covered population is expanded. Cancer 2015;121:3221–3229. © 2015 American Cancer Society. A significant reduction in colorectal cancer mortality resulting from fecal immunochemical testing is demonstrated by a large, population-based, nationwide service screening program with a maximum follow-up of 6 years. Although long-term follow-up of this nationwide service screening program is required, these findings are useful for convincing health decision makers that the continuous promotion of such a nationwide screening program is worthwhile.
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Affiliation(s)
- Han-Mo Chiu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan
| | - Jean Ching-Yuan Fann
- Department of Health Industry Management, School of Healthcare Management, Kainan University, Tao-Yuan, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shin-Liang Pan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Sheng Liao
- Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shin-Lan Koong
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Shu-Ti Chiou
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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Welte I. A physician led approach to telehealth-enabled care coordination: innovation in reimbursement and delivery system models to support physician engagement. Int J Integr Care 2012. [PMCID: PMC3571181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The U.S. study, entitled, ‘Integrated Telehealth and Care Management Program for Medicare Beneficiaries with Chronic Disease Linked to Savings’ (Health Affairs, September 2011), explored the economic impact of using content-based remote patient monitoring combined with physician led patient-centred care management for high cost patients with congestive heart failure, chronic obstructive pulmonary disease and/or diabetes mellitus. Researchers conducted an analysis evaluating changes in healthcare spending resulting from physician led patient-centred care management supported by remote patient monitoring (n=1767) and demonstrated spending reductions of 7.7–13.3% (£197.17–£342.52) per intervention patient in acute hospital cost per quarter over the two-year period studied. In addition, significant mortality differences between the treatment and control groups were noted, which suggest that the intervention may have produced noticeable Improvements/changes in health outcomes. Aim and objectives the presentation will outline the:
Findings from the analysis of the two-year study that could guide the design of future innovative physician led telehealth-enabled care coordination projects in the UK. Parallels between the proposed UK local health system model as described by the Health and social care bill and the Medicare system in the US in the context of an innovative community-based physician led telehealth enabled integrated system of care. Design and deployment of a system of care utilizing content-based telehealth technology to enable physician led integrated care coordination.
Results In an intent-to-treat population of 1725 patients, a reduction in critical aspects in utilization including hospitalization and A and E resulted in improved quality, satisfaction and cost outcomes for the patients and providers in the local region. Conclusion Innovative reimbursement models drove physician led telehealth enabled care coordination that generated reductions in key utilization and cost while optimizing health status. The intervention also generated substantive efficiency improvements that led to substantive cost savings.
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Abstract
Screening for colorectal cancer using the conventional Hemoccult test has been shown to reduce mortality associated with cancer by 33% through a randomized controlled trial. However, the magnitude of effectiveness is small in terms of cost-effectiveness. The recently developed immunochemical fecal occult blood test (IFOBT) provides a potential replacement for the Hemoccult test as a screening test, due to its superior performance characteristics such as higher sensitivity shown in preliminary studies and the fact that it does not require any dietary restriction. The IFOBT method is reviewed, especially in relation to its specificity. In known colorectal cancer subjects, IFOBTs have shown both higher sensitivity and specificity than the Hemoccult test. Similarly, IFOBT has demonstrated a higher sensitivity than Hemoccult for colorectal cancer in an asymptomatic population. A nationwide screening program in Japan has demonstrated the feasibility of this approach for large population screening. However, the positivity rate varied according to the conditions at each screening facility. Therefore, technical factors that influence the positivity rate of IFOBTs in the screening program are discussed. Case-control studies have strongly suggested that screening using IFOBT would reduce mortality from colorectal cancer by 60% or more. Several observational studies have provided support for this estimate. The feasibility and effectiveness of population-based screening by IFOBT are discussed.
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Affiliation(s)
- H Saito
- First Department of Internal Medicine, Hirosaki University School of Medicine, Japan
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