Risultati per: Screening del cancro ai polmoni

Oncologi,ma meno del 50% cittadini riceve consigli su stili vita

In the US, cancer prevention and screening have saved more lives from 5 types of cancer combined than treatment advances over the past 45 years, according to a modeling study published in JAMA Oncology. An estimated 5.9 million breast, cervical, colorectal, lung, and prostate cancer deaths were avoided from 1975 to 2020 due to prevention, screening, and treatment efforts, but prevention and screening alone were responsible for averting about 4.8 million—4 out of 5—of those deaths.

Introduction
Only 30%–50% of people referred to clinics during community-based eye screening are able to access care in Botswana, India, Kenya and Nepal. The access rate is even lower for certain population groups. This platform trial aims to test multiple, iterative, low-risk public health interventions and simple service modifications with a series of individual randomised controlled trials (RCT) conducted in each country, with the aim of increasing the proportion of people attending.

Methods and analysis
We will set up a platform trial in each country to govern the running of a series of pragmatic, adaptive, embedded, parallel, multiarm, superiority RCTs to test a series of service modifications suggested by intended service users. The aim is to identify serial marginal gains that cumulatively result in large improvements to equity and access. The primary outcome will be the probability of accessing treatment among the population group with the worst access at baseline. We will calculate Bayesian posterior probabilities of clinic attendance in each arm every 72 hours. Each RCT will continually recruit participants until the following default stopping rules have been met: >95% probability that one arm is best; >95% probability that the difference between the best arm and the arms remaining in the trial is

This Viewpoint proposes applying a systematic curriculum for early management of traumatically injured patients as a framework for suicide risk screening after overdose.

This model-based study using population-level cancer mortality data evaluates the association of prevention, screening, and treatment interventions with cumulative number of cancer deaths averted from 1975 to 2020 for breast, cervical, colorectal, lung, and prostate cancers.

This Teachable Moment describes a man in his 30s who presented with a right diabetic foot ulcer and hyperglycemia and was assumed to have type 2 diabetes and was subsequently diagnosed with latent autoimmune diabetes in adults.

Objective
To evaluate the knowledge, attitude and practice (KAP) regarding screening and managing diabetic microvascular complications, encompassing diabetic retinopathy (DR), diabetic kidney disease (DKD) and diabetic neuropathy (DN), among general practitioners (GPs).

Design
Cross-sectional study.

Setting
The online questionnaire survey was conducted between April and July 2023.

Participants
GPs from community health centres (CHCs) in all 16 districts of Shanghai were recruited.

Primary and secondary outcome measures
The data of sociodemographic characteristics, KAP scales, training experience and screening instruments for community screening and managing diabetic microvascular complications were collected. Multiple stepwise linear regression was used to explore the influencing factors of KAP. Restricted cubic spline curves with four knots (5%, 35%, 65%, 95%) were used to determine the association between KAP score and duration of general practice.

Results
A total of 1243 questionnaires were included in the analysis. The total KAP score was 66.6±8.8/100, and the knowledge, attitude and practice scores were 64.7±8.7, 83.5±10.5 and 51.6+17.8, respectively. Male (β=–2.419, p=0.012), shorter practice duration (β=–1.033, p=0.031), practice in rural area (β=3.230, p=0.001), not attending training in diabetic microvascular complications (β=–6.346, p

Stroke, Volume 56, Issue Suppl_1, Page ATMP36-ATMP36, February 1, 2025. This study compares the accuracy of manual stroke scale calculations against electronically calculated scores using the Ultimate Stroke Scale (USS), a new software designed to automate large vessel occlusion (LVO) screening scales from a modified National Institute of Health Stroke Scale (NIHSS). The USS has the potential to streamline LVO screening with enhanced accuracy using multiple validated stroke scales simultaneously.We prospectively applied eight stroke screening scales (NIHSS, BE-FAST, VAN, LAMS, FAST-ED, EMS RACE, 3-ISS, and PASS) to 199 stroke activations between January 2021 to December 2023. These values were recalculated with the USS calculator which incorporates inputs from a modified NIHSS score, including up to two additional points for hand grip strength. A Bland-Altman analysis was conducted to assess agreement between manual and USS-calculated scores.The NIHSS showed a percentage error of -8.24% and a mean difference of -0.97 (LoA: -3.88 to 1.93). The BE-FAST scale exhibited a percentage error of -14.72% and a mean difference of -0.12 (LoA: -0.85 to 0.60). The VAN scale had a percentage error of -21.76% and a mean difference of -0.11 (LoA: -0.83 to 0.62). The LAMS scale had a percentage error of 6.59% and a mean difference of 0.15 (LoA: -1.20 to 1.50). The FAST-ED scale had a percentage error of -4.82% and a mean difference of -0.15 (LoA: -2.10 to 1.80). The EMS-RACE scale had a percentage error of -9.99% and a mean difference of -0.39 (LoA: -3.20 to 2.42). The 3-ISS scale exhibited the highest percentage error of -29.36% and a mean difference of -0.54 (LoA: -2.47 to 1.39). The PASS scale had the lowest percentage error at -2.86% and a mean difference of -0.04 (LoA: -0.66 to 0.58). The combined percentage error for all scales was -8.44%, increasing slightly to -8.61% when excluding the NIHSS score. Excluding both NIHSS and 3-ISS reduced the combined error to -5.44%.Our findings demonstrate a general agreement between the manual and USS-calculated scores, with the strongest concordance observed in PASS, FAST-ED, and LAMS. Although some scales exhibited larger discrepancies, the moderate overall combined percentage error suggests that USS-calculated scores are generally consistent with manual calculations. These findings support the potential of the USS software to streamline LVO stroke screening, although further validation is necessary.

Stroke, Volume 56, Issue Suppl_1, Page A60-A60, February 1, 2025. Introduction:Over 70% of patients experience post-stroke cognitive impairment (PSCI), which can lead to functional decline. Outpatient stroke clinics often lack a consistent and validated cognitive assessment protocol for follow-ups. This increases the risk of missed diagnosis of PSCI, which is often determined based on the subjective assessment of cognitive functioning by patients or caregivers. Our goal was to assess the practice of unstructured PSCI screening at our stroke clinic and test if a cognitive screening protocol would improve PSCI detection in follow-up patients.Methods:We led a quality improvement project to identify root causes of the problem and plan interventions for introducing a feasible cognitive screening protocol. We performed a baseline chart review on 79 stroke patients seen at the clinic to assess documentation of discussion of cognitive symptoms during visits. We developed a pre-screening survey to assess educational level, post-stroke rehabilitation participation, and vascular risk factors. We enrolled 30 follow-up patients with either an ischemic or hemorrhagic stroke. An examiner conducted a short-form MoCA (MoCA-sf) test and a CLCE-24 questionnaire for subjective cognitive complaints (SCC) on each patient. We collected data from the electronic record on discharge mRS and NIHSS scores and measured time spent on screening to assess feasibility.Results:In baseline chart review, 65% of 79 patients did not have any discussion of cognitive symptoms documented during their visit before our intervention. In our initial screening results, 53% of patients screened positive for cognitive impairment (

Stroke, Volume 56, Issue Suppl_1, Page A152-A152, February 1, 2025. Cognitive and speech impairments are common after stroke, contributing to greater functional dependence and a diminished quality of life. Despite this, during acute stroke hospitalization, screening for these impairments using validated tools is rarely conducted beyond routine bedside examinations by medical providers.This quality improvement project aimed to enhance the early detection of speech and cognitive impairments in stroke patients. We hypothesized that there would be low concordance between provider perceptions of cognitive impairments and objective measures and that the referral rate for outpatient speech therapy would increase following the intervention.From 07/01/24 to 08/31/24, stroke patients were screened for cognitive and language function using Saint Louis University Mental Status (SLUMS) and Quick Aphasia Battery (QAB), respectively. Providers were also surveyed on their perceptions of the patients’ cognitive and language impairments and their intent to refer them for outpatient rehabilitation.Analysis revealed a significant association between QAB score and providers’ beliefs, χ2(2, N = 19) = 6.97, p = 0.031, suggesting that providers are more likely to recognize impairments as severity increases. Linear regression comparing provider scores and SLUMS scores showed R2= 0.13, indicating that provider ratings were unreliable. A significant difference was found in referral rates before and after the intervention compared to the same period in 2023, χ2(1, N = 77) = 4.52, p = 0.034.These findings indicate that mild and moderate cognitive impairments are frequently overlooked in acute stroke care. The discrepancy between provider assessments and standardized screening highlights the inadequacy of current bedside evaluations. Moreover, the significant increase in referrals following the implementation of validated screenings supports the effectiveness of this approach in promoting timely intervention for stroke survivors.

Stroke, Volume 56, Issue Suppl_1, Page AWP30-AWP30, February 1, 2025. Introduction:Brain arteriovenous malformations (bAVMs) are vascular anomalies resulting from defective morphogenesis of blood vessels in the brain. Kirsten rat sarcoma virus (KRAS)somatic activating gene mutations have been identified in the majority of bAVMs using digital droplet PCR-based assays (ddPCR). Currently, bAVM somatic mutation genetic characterization requires sequencing surgically excised lesion DNA, but recent advancements have overcome some conventional biopsy limitations through sequencing cell-free DNA (cfDNA) which is directly released into the blood circulation from cell breakdown and turnover at the site of the lesion. Therefore, cfDNA released from the mutated bAVM tissue cells may be detectable in a peripheral blood sample, providing a non-invasive approach for somatic mutation screening.Hypothesis:We hypothesize that somaticKRAS G12Dmutations in bAVM patients can be detected using non-invasive cfDNA screening.Methods:We selected six bAVM patients whose surgically-resected bAVM lesions screened positive for somaticKRAS G12Dmutation using ddPCR and had contributed a peripheral blood sample for research within 2 months prior to surgery. For each patient, cfDNA was isolated from 1.0 mL of banked plasma using the Circulating cfDNA/RNA Isolation Kit (Qiagen). We used the ddPCRKRAS G12Dassay (Bio-Rad) to screen cfDNA samples for presence of the mutation. Samples were screened in duplicate using 8 uL and 4 uL of cfDNA eluate and assays included both positive controls (syntheticKRAS G12Doligo sequence (Integrated DNA Technologies)) and negative controls (no template and water). The variant allele frequency was estimated for each sample as the (target concentration)/(target + reference concentration).Results:Of the six bAVM cases, five screened positive forKRAS G12Dmutation in the cfDNA sample. TheKRAS G12DcfDNA variant allele frequency ranged from 0.20 – 0.54% for the five positive samples.Conclusions:We detected somaticKRAS G12Dmutations in bAVM patients using non-invasive cfDNA screening. While further studies are needed to validate these findings, these exciting results suggest that we may be able to perform non-invasiveKRASsomatic mutation screening using cfDNA in a greater number of bAVM cases (e.g., not just those undergoing surgery), which may be useful to clinically stratify bAVM patients and provide targeted therapies based on specific genetic defect.

Stroke, Volume 56, Issue Suppl_1, Page ANS1-ANS1, February 1, 2025. Background:The 2023 American Heart Association/American Stroke Association’sGuideline for Management of Patients with Aneurysmal Subarachnoid Hemorrhage(SAH) support use of the Ottawa Rule to screen individuals at risk. Data showed SAH patients who presented to the Emergency Department (ED) with headache (HA) and hypertension frequently had long wait times before evaluation by a provider. The ED lacked a formal triage process for identification of SAH resulting in delayed treatment. This gap could lead to suboptimal patient outcomes.Purpose:The goal of this project is to create a nurse-led screening tool for identifying patients at risk for SAH and aid in the decision for computed tomography (CT). Earlier identification, along with order set initiation, supports best practice.Method:Patients presenting with nontraumatic HA are assessed by an ED RN to determine if HA reached maximum intensity within one hour of initial onset. If criterion is met, a best practice alert (BPA) triggers within the electronic medical record. The Ottawa Rule displays in the BPA to provide guidelines to determine next steps. If the patient age is 40 or older, or meets criteria of the Ottawa Rule, the ED RN initiates a stat head CT per protocol. Patients with identified SAH are immediately roomed and seen by an ED physician, who consults the stroke team. Guideline-based cares, including blood pressure management are initiated.Results:Use of the Ottawa Rule screening tool on patient arrival to the ED leads to earlier identification of patients with SAH, reduction of door to seen by provider time and door to diagnostic times, plus allows for expediated initiation of blood pressure management. A total of nine direct arriving patients were reviewed over a one-year period. The six patients treated before the practice change had a median door to CT of 90 minutes and a median door to stroke provider time of 134 minutes. Following implementation, the door to stroke provider median time was 33 minutes and door to provider time decreased to 52 minutes. This reflects a decrease of 63% of median arrival time to CT and a 61% decrease of median arrival time to stroke provider. Since implementation, 100% of patients with SAH were immediately identified and treatment initiated.Conclusion:Nurse driven screening tool utilizing the Ottawa Rule expedited care for ED patients diagnosed with SAH. Faster time to diagnosis allows for targeted BP management and adherence to standard of care.

Stroke, Volume 56, Issue Suppl_1, Page ATP270-ATP270, February 1, 2025. Introduction:Syphilis is associated with increased risk of cerebrovascular disease and acute stroke; stroke may even be the initial clinical manifestation of syphilis (Images 1 and 2). In the United States, syphilis rates have been increasing at an alarming rate since 2000, and between 2018-2022 cases increased by nearly 80%. Knowing the infectious status of a patient changes acute and secondary stroke management strategies, and widespread screening is imperative toward national eradication efforts. This study aims to explore syphilis laboratory screening trends in hospitalized stroke patients, whether rates of screening have risen with increases in national cases, and which demographic factors predict screening.Hypothesis:We hypothesized that 1) overall screening for syphilis in acute stroke is low, especially in comparison to screening for diabetes and hyperlipidemia, 2) screening rates increase annually from 2016-2020, and 3) screening for syphilis occurs more often in younger and minority patients.Methods:We reviewed all stroke admissions from a US comprehensive stroke center between 2016-2020 and collected syphilis laboratory data and patient demographics. Of patients without known history of syphilis, we evaluated screening rates of syphilis and compared to that of Hemoglobin A1c (HbA1c) or Low-Density Lipoprotein (LDL) for this period with Student’s t-test. We used logistic regression to determine the relationship between screening rates of syphilis and patient age and race.Results:Between 2016-2020, there were 5,653 stroke admissions without established infection. The average annual screening rate of syphilis (1.19%) was significantly lower than that of HbA1c (58%; p=0.002) and LDL (69.0%; p

Stroke, Volume 56, Issue Suppl_1, Page ATP28-ATP28, February 1, 2025. Cognitive impairment following acute stroke significantly impacts patient outcomes and rehabilitation. Early detection is crucial, yet comprehensive assessments are often impractical in acute settings. Digital clock drawing and recall (DCR) offers a rapid 5-minute cognitive screening by assessing clock drawing and three-word recall. While previously shown effective in early Alzheimer’s detection, its utility in stroke patients has been underexplored. This study investigates the feasibility and validity of DCR compared to the Montreal Cognitive Assessment (MoCA) in stroke patients.The study involved 80 acute ischemic stroke patients who completed both DCR and MoCA during hospitalization. DCR was implemented on the Linus Health platform. DCR data included DCR scores, battery duration, demographic variables, and recorded NIH Stroke Scale scores. Cognitive impairment was defined using a MoCA threshold of ≤24. Leave-One-Out Cross-Validation and XGBoost were used for analysis. Optuna-optimized hyperparameters and model performance were evaluated via AUC, accuracy, F1-score, sensitivity, and specificity. SHAP analysis provided insights into feature importance.The median time from stroke to cognitive screening was 3 days [1.0, 2.0]. The impaired group (MoCA ≤ 24) was older (mean 63.2 vs. 53.2 years, p = 0.271), had lower education levels (mean 13.4 vs. 15.8 years, p = 0.005), longer battery durations (median 288.0 vs. 232.0 seconds, p = 0.017), and lower DCR scores (median 1.0 vs. 3.0, p < 0.001). NIHSS scores were higher but not statistically significant (median 4.0 vs. 2.0, p = 1.). Gender, race, and ethnicity were insignificant predictors excluded from the final model.The XGBoost model demonstrated strong predictive performance, with an AUC of 0.8114, an F1-score of 0.8916, and an accuracy of 0.9. At the threshold of 0.5656 (Youden’s J statistic), the model achieved high sensitivity 0.9841 and moderate specificity 0.5882. SHAP analysis identified DCR score, education level, and battery duration as the most important features.DCR screening proves to be an effective, rapid cognitive screening tool in acute ischemic stroke care. It demonstrates high sensitivity in detecting subtle cognitive impairments and correlates well with MoCA scores. While further validation is needed, this tool offers a rapid and reliable method for cognitive assessment in acute settings, potentially enhancing personalized treatment approaches and improving patient outcomes in stroke care.

Stroke, Volume 56, Issue Suppl_1, Page ATP59-ATP59, February 1, 2025. Background:Baptist Health System [BHS] is a five-hospital system operating under one Provider Number with one combined Medical Staff. During a recent stroke certification survey, the BHS Comprehensive Stroke Center was recognized for consistent compliance with Dysphagia Screening [DS] that was well above the national benchmark. This was also true of all the hospitals within the BHS.Purpose:Share best practices for achieving and maintaining high compliance with DS within a system of hospitals.Method:Customized physician stroke orders [CSO] were developed for the Emergency Department [ED] and Inpatient [IP] units and utilization mandated across BHS to ensure completion of DS prior to first oral intake [FOI]. Both the ED and IP Registered Nurse [RN] were required to complete DS. ED CSO included 1] NPO until DS by RN passed; 2] Stat DS by RN prior to FOI, including medication and ice chips [Meds/Ice]. A “Reasons for Dysphagia Screening” job aid was developed and posted in the ED to prompt DS by RN for all stroke alert patients, all ED patients with brain imaging ordered and all patients with conditions/symptoms that may be associated with a high suspicion of aspiration risk. A “Dysphagia Screening Pathway” job aid was developed to ensure appropriate actions taken if passed or failed. IP CSO included 1] DS upon admission by RN prior to FOI, including Meds/Ice; 2] NPO until DS by RN passed, or if failed, then Speech Language Pathologist [SLP] swallow assessment completed; 3] SLP consultation for Evaluation&Treatment Dysphagia/Bedside swallow evaluation within 24 hours of admission. For NPO patients the route for medication administration was updated appropriately. DS metric compliance is shared with ED and IP RNs monthly. A written performance improvement plan using the Plan-Do-Study-Act model is implemented when the goal is not met for 3 consecutive months.Results:BHS DS compliance has remained between 91% – 95% for 10 consecutive years 2014-2023. National benchmarks range between 83-85% annually for the same period.Conclusion:Standardized processes, monthly data review, staff feedback, and written performance improvement plans led to a higher level of DS compliance within BHS.