Risultati per: Linee guida sulla diagnosi e screening del dolore neuropatico

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This randomized clinical trial evaluates the effects of Helicobacter pylori stool antigen assessment plus fecal immunochemical testing (FIT), vs FIT alone, on gastric cancer incidence and mortality among adults in Taiwan.

To the Editor We read with interest the recent study that compared the fecal immunochemical test (FIT) positivity threshold vs multitarget stool RNA (mt-sRNA) testing for colorectal cancer screening. However, we have concerns regarding the study methodology and the capability of FIT to fully replace the mt-sRNA panel.

In Reply Our study adjusted the FIT cutoff to yield the same overall positivity rate as reported for the mt-sRNA test (17%) to enhance comparability of diagnostic performance of both tests. Below we address each of the 3 points made by Drs Yang and Ma.

Circulation, Volume 150, Issue 21, Page 1656-1658, November 19, 2024.

Circulation, Volume 150, Issue 21, Page 1741-1744, November 19, 2024.

Cherubini (Siedp) “evitabili in oltre 450 bimbi ogni anno”

Background
Hepatocellular carcinoma (HCC) is plagued by failures across the cancer care continuum, leading to frequent late-stage diagnoses and high mortality. We evaluated the effectiveness of mailed outreach invitations plus patient navigation to promote HCC screening process completion in patients with cirrhosis.

Methods
Between April 2018 and September 2021, we conducted a multicentre pragmatic randomised clinical trial comparing mailed outreach plus patient navigation for HCC screening (n=1436) versus usual care with visit-based screening (n=1436) among patients with cirrhosis at three US health systems. Our primary outcome was screening process completion over a 36-month period, and our secondary outcome was the proportion of time covered (PTC) by screening. All patients were included in intention-to-screen analyses.

Results
All 2872 participants (median age 61.3 years; 32.3% women) were included in intention-to-screen analyses. Screening process completion was observed in 6.6% (95% CI: 5.3% to 7.9%) of patients randomised to outreach and 3.3% (95% CI: 2.4% to 4.3%) of those randomised to usual care (OR 2.05, 95% CI: 1.44 to 2.92). The intervention increased HCC screening process completion across most subgroups including age, sex, race and ethnicity, Child-Turcotte-Pugh class and health system. PTC was also significantly higher in the outreach arm than usual care (mean 37.5% vs 28.2%; RR 1.33, 95% CI: 1.31 to 1.35). Despite screening underuse, most HCC in both arms were detected at an early stage.

Conclusion
Mailed outreach plus navigation significantly increased HCC screening process completion versus usual care in patients with cirrhosis, with a consistent effect across most examined subgroups. However, screening completion remained suboptimal in both arms, underscoring a need for more intensive interventions.

Trial registration number
NCT02582918.