Risultati per: Indicazioni per gli screening oncologici

In Toscana e Veneto progetto pilota con 400mila test

In this issue of JAMA Internal Medicine, Lee and colleagues reported the results of a stepped-wedge cluster randomized implementation trial aimed at identifying and decreasing unhealthy alcohol use among primary care patients. The intervention by Lee et al significantly increased screening and brief counseling about unhealthy alcohol use in primary care patients but did not increase treatment of alcohol use disorder (AUD).

The US Preventive Services Task Force has reaffirmed its 2016 recommendation against population-based serologic genital herpes screening in asymptomatic adults and adolescents, including pregnant persons (D recommendation). With little new data identified in a focused evidence update (ie, no new eligible studies were included), the current 2023 recommendation reaffirmed with moderate certainty that the potential harms of serologic screening for genital herpes simplex virus (HSV)-2 infection in asymptomatic individuals outweigh potential benefits. This recommendation aligns with corresponding guidelines from the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists.

Ridotta del 30% incidenza e gravità grazie a prevenzione

Ridotta del 30% incidenza e gravità grazie a prevenzione

Researchers describe the performance of a brief instrument that requires no reading, writing, or drawing.

Objectives
The 2020–2022 research project ‘Colorectal Cancer Screening Intervention for Malaysia’ (CRC-SIM) evaluated the implementation of a home-based CRC screening pilot in Segamat District. This budget impact analysis (BIA) assessed the expected changes in health expenditure of the Malaysian Ministry of Health budget in the scenario where the pilot programme was implemented nationwide vs current opportunistic screening.

Design
Budget impact analysis. Assumptions and costs in the opportunistic and novel CRC screening scenarios were derived from a previous evaluation of opportunistic CRC screening in community health clinics across Malaysia and the CRC-SIM research project, respectively.

Setting
National level (with supplement analysis for district level). The BIA was conducted from the viewpoint of the federal government and estimated the annual financial impact over a period of 5 years.

Results
The total annual cost of the current practice of opportunistic screening was RM1 584 321 (~I$1 099 460) of which 80% (RM1 274 690 or ~I$884 587) was expended on the provision of opportunistic CRC to adults who availed of the service. Regarding the implementation of national CRC screening programme, the net budget impact in the first year was estimated to be RM107 631 959 (~I$74 692 546) and to reach RM148 485 812 (~I$103 043 589) in the fifth year based on an assumed increased uptake of 5% annually. The costs were calculated to be sensitive to the probability of adults who were contactable, eligible and agreeable to participating in the programme.

Conclusions
Results from the BIA provided direct and explicit estimates of the budget changes to when implementing a population-based national CRC screening programme to aid decision making by health services planners and commissioners in Malaysia about whether such programme is affordable within given their budget constraint. The study also illustrates the use and value of the BIA approach in low-income and middle-income countries and resource-constrained settings.

Circulation, Ahead of Print. BACKGROUND:Managing disease risk among first-degree relatives of probands diagnosed with a heritable disease is central to precision medicine. A critical component is often clinical screening, which is particularly important for conditions like dilated cardiomyopathy (DCM) that remain asymptomatic until severe disease develops. Nonetheless, probands are frequently ill-equipped to disseminate genetic risk information that motivates at-risk relatives to complete recommended clinical screening. An easily implemented remedy for this key issue has been elusive.METHODS:The DCM Precision Medicine Study developedFamily Heart Talk, a booklet designed to help probands with DCM communicate genetic risk and the need for cardiovascular screening to their relatives. The effectiveness of theFamily Heart Talkbooklet in increasing cardiovascular clinical screening uptake among first-degree relatives was assessed in a multicenter, open-label, cluster-randomized, controlled trial. The primary outcome measured in eligible first-degree relatives was completion of screening initiated within 12 months after proband enrollment. Because probands randomized to the intervention received the booklet at the enrollment visit, eligible first-degree relatives were limited to those who were alive and not enrolled on the same day as the proband.RESULTS:Between June 2016 and March 2020, 1241 probands were randomized (1:1) to receiveFamily Heart Talk(n=621) or not (n=620) within strata defined by site and self-identified race/ethnicity (non-Hispanic Black, non-Hispanic White, or Hispanic). Final analyses included 550 families (n=2230 eligible first-degree relatives) in theFamily Heart Talkarm and 561 (n=2416) in the control arm. A higher percentage of eligible first-degree relatives completed screening in theFamily Heart Talkarm (19.5% versus 16.0%), and the odds of screening completion among these first-degree relatives were higher in theFamily Heart Talkarm after adjustment for proband randomization stratum, sex, and age quartile (odds ratio, 1.30 [1-sided 95% CI, 1.08–∞]). A prespecified subgroup analysis did not find evidence of heterogeneity in the adjusted intervention odds ratio across race/ethnicity strata (P=0.90).CONCLUSIONS:Family Heart Talk,a booklet that can be provided to patients with DCM by clinicians with minimal additional time investment, was effective in increasing cardiovascular clinical screening among first-degree relatives of patients with DCM.REGISTRATION:URL:https://clinicaltrials.gov; Unique identifier: NCT03037632.

Colorectal cancer (CRC) screening guidelines include screening-colonoscopy and sequential high sensitivity fecal occult blood testing (HSgFOBT), with expectation of similar effectiveness based on the assumption of similar high adherence. However, adherence to screening-colonoscopy compared to sequential HSgFOBT has not been reported. In this randomized clinical trial, we assessed adherence and pathology findings for a single screening-colonoscopy versus sequential and non-sequential HSgFOBT.

Objectives
This field study evaluated a multiwave media campaign that aired in 2019 to promote participation in the Australian National Bowel Cancer Screening Program (NBCSP), which provides free biennial mailed-out immunochemical faecal occult blood test (iFOBT) kits to Australians aged 50–74 years.

Design
Adjusted negative binomial regression models determined rate ratios of iFOBT kits returned during and following three campaign waves compared with 2018 (baseline). Interaction terms determined whether effects differed by genderxage group, socioeconomic status (SES) and previous participation.

Setting
Australia.

Participants
All Australians eligible for the NBCSP (men and women aged 50–74 years) who returned an iFOBT kit between 1 January 2018 and 30 October 2019.

Interventions
A multiwave national integrated media campaign to promote participation in the NBCSP.

Main outcome measures
iFOBT kit return rate and number of iFOBT kits returned during and immediately following campaign activity overall and within historically lower screening groups (men, 50–59 years old; lower SES; never participants).

Results
The rate of iFOBT kits returned increased significantly during all three campaign waves, with evidence of carry-over effects of the second wave coinciding with a general practitioner mail-out strategy (all p

A 56-year-old man with no significant medical history has declined screening colonoscopy at previous physician visits but wants to undergo a less invasive test because his father died of colorectal cancer at age 80. What would you do next?

Objectives
Earlier research has evaluated the non-medical costs after lung cancer diagnosis. This study estimated the time costs and transportation costs associated with low-dose CT (LDCT) screening and diagnostic lung procedures in Taiwan.

Design
Cross-sectional study.

Setting
A tertiary referral medical centre.

Participants and interventions
The study participants were individuals aged 50–80 years who underwent LDCT screening or diagnostic lung procedures between 2021 and 2022. Participants completed a questionnaire including items on time spent on receiving care, time spent on travel and its cost and time taken off from work by the participant and any accompanying caregiver.

Outcome measures
Time costs were valued using the age- and sex-specific average daily wage for employed participants/caregivers. Costs of informal healthcare sector consisted of time cost of the participant, transportation cost and time cost of the caregiver.

Results
A total of 209 participants who underwent LDCT screening (n=84) or non-surgical (n=12) or surgical (n=113) diagnostic lung procedures for the first time were enrolled. Considering the purchasing power parity, the average costs of informal healthcare sector were US$126.4 (95% CI 101.6 to 151.2), US$290.7 (95% CI 106.9 to 474.5) and US$749.8 (95% CI 567.3 to 932.4), respectively, for LDCT screening, non-surgical procedures and surgical procedures.

Conclusions
This study estimated time and transportation costs associated with LDCT screening and diagnostic lung procedures, which could be used for future analysis of cost-effectiveness of lung cancer screening in Taiwan.

Objectives
The use of preoperative triage questionnaires is an innovative way to mitigate the shortage of anaesthesiologists and to identify and refer high-risk patients early for evaluation. This study evaluates the diagnostic accuracy of one such questionnaire in identifying high-risk patients in a Sub-Saharan population.

Design
Diagnostic accuracy study

Setting
The study was conducted in a preanaesthesia assessment clinic in a tertiary referral hospital in Sub-Saharan Africa.

Participants
The study had a sample size of 128, including all patients above the age of 18 scheduled for elective surgery under any modality of anaesthesia other than local anaesthesia presenting to the preanaesthesia clinic. Patients scheduled for cardiac and major non-cardiac surgery and those non-literate in English were excluded.

Outcome measures
The sensitivity of the preanaesthesia risk assessment tool (PRAT) was the primary outcome measure. Other outcome measures were specificity, positive predictive value and negative predictive value.

Results
Majority of patients were young and women with a mean age of 36 referred for obstetric and gynaecological procedures. The sensitivity of the PRAT in identifying high-risk patients was at 90.6% with 95% CI (76.9 to 98.2) in this current study while the specificity, negative predictive value (NPV) and positive predictive value (PPV) were 37.5% with 95% CI (24.0 to 43.7), 92.3% with 95% CI (77.7 to 97.0) and 32.6% with 95% CI (29.6 to 37.3) respectively.

Conclusion
The PRAT has a high sensitivity and may be used as a screening tool in identifying high risk patients to refer to the anaesthesiologist early before surgery. Adjusting the high risk criteria to fit the anaesthesiologists’ assessments may improve the specificity of the tool.

Annals of Internal Medicine, Ahead of Print.