Risultati per: Indicazioni per gli screening oncologici

Objective
To examine and synthesise the literature on adverse childhood experience (ACE) screening in clinical and healthcare settings servicing children (0–11) and young people (12–25).

Design
A systematic review of literature was undertaken.

Data source
PsycInfo, Web of Science, Embase, PubMed and CINAHL were searched through June 2021. Additional searches were also undertaken.

Eligibility criteria
English language studies were included if they reported results of an ACE tool being used in a clinical or healthcare setting, participants were aged between 0 and 25 years and the ACE tool was completed by children/young people or by parents/caregivers/clinicians on behalf of the child/young person. Studies assessing clinicians’ views on ACE screening in children/young people attending health settings were also included.

Data extraction and synthesis
Two independent reviewers extracted data and assessed for risk of bias using the Mixed Methods Appraisal Tool. Results were synthesised qualitatively.

Results
Initial searches identified 5231 articles, of which 36 were included in the final review. Findings showed that the most commonly used tool for assessing ACE was the ACE questionnaire; administering ACE tools was found to be feasible and acceptable; there were limited studies looking at the utility, feasibility and acceptability of assessing for ACE in First Nations people; and while four studies provided information on actions taken following ACE screening, no follow-up data were collected to determine whether participants accessed services and/or the impact of accessing services.

Conclusion
As the evidence stands, widespread ACE screening is not recommended for routine clinical use. More research is needed on how and what specific ACE to screen for and the impact of screening on well-being.

PROSPERO registration number
University of York Centre for Reviews and Dissemination (CRD42021260420).

Stroke, Volume 53, Issue 9, Page e424-e425, September 1, 2022.

Colorectal cancer (CRC) screening between ages 50 and 75 years is a US Preventive Services Task Force Grade A recommendation.1 The coronavirus disease 2019 (COVID-19) pandemic initially decreased CRC screening participation by as much as 82%,2 and new variants continue to disrupt preventive care. Screening colonoscopy is more vulnerable to pandemic-related delays than the fecal immunochemical test (FIT).2 We estimated the potential clinical impact of pandemic-related interruptions in CRC screening on the US population.

Introduction
The increasing prevalence of developmental disorders in early childhood poses a significant global health burden. Early detection of developmental problems is vital to ensure timely access to early intervention, and universal developmental surveillance is recommended best practice for identifying issues. Despite this, there is currently considerable variation in developmental surveillance and screening between Australian states and territories and low rates of developmental screening uptake by parents. This study aims to evaluate an innovative web-based developmental surveillance programme and a sustainable approach to referral and care pathways, linking primary care general practice (GP) services that fall under federal policy responsibility and state government-funded child health services.

Methods and analysis
The proposed study describes a longitudinal cluster randomised controlled trial (c-RCT) comparing a ‘Watch Me Grow Integrated’ (WMG-I) approach for developmental screening, to Surveillance as Usual (SaU) in GPs. Forty practices will be recruited across New South Wales and Queensland, and randomly allocated into either the (1) WMG-I or (2) SaU group. A cohort of 2000 children will be recruited during their 18-month vaccination visit or opportunistic visit to GP. At the end of the c-RCT, a qualitative study using focus groups/interviews will evaluate parent and practitioner views of the WMG-I programme and inform national and state policy recommendations.

Ethics and dissemination
The South Western Sydney Local Health District (2020/ETH01625), UNSW Sydney (2020/ETH01625) and University of Queensland (2021/HE000667) Human Research Ethics Committees independently reviewed and approved this study. Findings will be reported to the funding bodies, study institutes and partners; families and peer-reviewed conferences/publications.

Trial registration number
ANZCTR12621000680864.

Introduction
Indigenous peoples’ world views are intricately interrelated and interconnected with those of their communities and the environments where they live. Consequently, Indigenous peoples have a holistic view of their health, which contrasts with the dominant Western biomedical paradigm. However, the mental well-being of Indigenous peoples is predominately screened using tools developed using the Western paradigm that may not be culturally appropriate. The objective of this systematic mixed studies review (SMSR) is to assess the extent of the literature related to approaches used to develop new tools to screen the mental well-being of Indigenous adults.

Methods and analysis
This SMSR will be conducted in accordance with the method proposed by Pluye et al. It will include studies that describe the development of any type of tool or approach to screen for mental well-being in Indigenous adults, globally. Searches will be limited to the English language and literature published since January 2000. Databases to be searched include: CINAHL, Medline, PsycINFO, PubMed and Scopus. Only published studies will be included in the SMSR. Data that answers the research questions will be extracted from the literature and recorded on the associated data charting form. A sequential synthesis method will be used to analyse data from qualitative, quantitative and mixed-method studies. Data will be presented graphically, diagrammatically or in tabular form depending on what approach best conveys its meaning.

Ethics and dissemination
The SMSR will describe the approach to developing new tools for screening the mental well-being of Indigenous peoples across the globe. It will support researchers, clinicians and practitioners to consider both their approach to new tool development or, if they are using a previously developed tool, how reliable and valid it is for the population that they intend to use it with. Peer-reviewed publications will be used to disseminate SMSR findings.

Annals of Internal Medicine, Volume 175, Issue 10, Page 1491-1492, October 2022.

Objectives
To determine the diagnostic yield of screening patients for SARS-CoV-2 who were admitted with a diagnosis unrelated to COVID-19 and to identify risk factors for positive tests.

Design
Cohort from the Canadian COVID-19 Emergency Department Rapid Response Network registry.

Setting
30 acute care hospitals across Canada.

Participants
Patients hospitalised for non-COVID-19-related diagnoses who were tested for SARS-CoV-2 between 1 March and 29 December 2020.

Main outcome
Positive nucleic acid amplification test for SARS-CoV-2.

Outcome measure
Diagnostic yield.

Results
We enrolled 15 690 consecutive eligible adults who were admitted to hospital without clinically suspected COVID-19. Among these patients, 122 tested positive for COVID-19, resulting in a diagnostic yield of 0.8% (95% CI 0.64% to 0.92%). Factors associated with a positive test included presence of fever, being a healthcare worker, having a positive household contact or institutional exposure, and living in an area with higher 7-day average incident COVID-19 cases.

Conclusions
Universal screening of hospitalised patients for COVID-19 across two pandemic waves had a low diagnostic yield and should be informed by individual-level risk assessment in addition to regional COVID-19 prevalence.

Trial registration number
NCT04702945.

Introduction
Cryptococcal meningitis is a common fungal opportunistic infection and a leading cause of death among people with advanced HIV disease in sub-Saharan Africa. The WHO recommends cryptococcal antigen (CrAg) screening followed by pre-emptive therapy to prevent cryptococcal meningitis and death in this population. In 2016, South Africa was the first country to implement reflexive laboratory CrAg screening nationally. The Cryptococcal Antigen Screen-and-Treat National Evaluation Team (CAST-NET) aims to evaluate the effectiveness of this national screening programme to optimise health outcomes.

Methods and analysis
The CAST-NET study consists of two integrated parts: a retrospective cohort study and a cluster-randomised trial (CRT). The retrospective cohort study will determine 6-month cryptococcal meningitis-free survival among CrAg-positive patients. Secondary outcomes include the proportion of CrAg-positive results noted for action in the CrAg-positive patient chart, the proportion of CrAg-positive patients offered and accept/decline a lumbar puncture, the proportion of CrAg-positive patients prescribed antifungal therapy and the proportion of CrAg-positive patients who have antiretroviral therapy initiated or reinitiated at an appropriate time according to South African national guidelines. Cohort data will be analysed by the type of facility (ie, hospital vs primary health clinic) at which the patient was diagnosed with antigenaemia. The CRT will determine if the appointment and mentoring of a healthcare worker, or ‘crypto champion’, at intervention facilities is associated with a higher proportion of CrAg-positive persons initiating pre-emptive fluconazole therapy. Secondary outcomes will include 6-month cryptococcal meningitis-free survival and the proportion prescribed fluconazole maintenance treatment.

Ethics and dissemination
Ethics approvals were received from the University of the Witwatersrand Human Research Ethics Committee (Medical), the University of KwaZulu-Natal Biomedical Research Ethics Committee and the University of Pretoria Faculty of Health Sciences Research Ethics Committee. Study results will be disseminated to the South African Department of Health and participating facilities through peer-reviewed publications and reports.

Introduction
Approximately 1 in 7 pregnant women in the USA report past-month alcohol use. Strong evidence connects prenatal alcohol exposure with a range of adverse perinatal outcomes, including the spectrum of conditions known as fetal alcohol spectrum disorders. Screening and Brief Intervention (SBI) has been recommended for pregnant women but has proven difficult to implement. This study will test the efficacy of single-session technology-delivered SBI (electronic SBI) for alcohol use in pregnancy, while simultaneously evaluating the possible additional benefit of tailored text messages and/or booster sessions in a 3×2 factorial trial.

Method and analysis
This full factorial trial will use online advertising and clinic-based flyers to recruit pregnant women meeting criteria for unhealthy alcohol use, and randomly assign them to one of six conditions crossing three levels of brief intervention (none, single 120-minute session and single session plus two 5-minute boosters) with two levels of tailored text messaging (none vs twice weekly messages). The primary analysis will test for dose–response effects of the brief intervention on alcohol abstinence, defined as no self-report of alcohol use in the 90 days prior to 34 weeks’ gestation, and negative results for ethyl glucuronide analysis of fingernail samples. Secondary analyses will examine main and interaction effects of tailored text messaging as well as intervention effects on birth outcomes.

Ethics and dissemination
Ethical approval was provided by the Michigan State University Biomedical and Health Institutional Review Board (STUDY00005298). Results will be presented at conferences and community forums, in addition to being published in a peer-reviewed journal. Intervention content demonstrating sufficient efficacy and safety will be made publicly available.

Trial registration number
ClinicalTrials.gov Registry (NCT04332172).

Objective
To determine the test–retest reliability of the Brain Injury Screening Tool (BIST), which was designed to support the initial assessment of mild traumatic brain injury (mTBI) across a variety of contexts, including primary and secondary care.

Design
Test–retest design over a 2-week period.

Setting
Community based.

Participants
Sixty-eight adults (aged 18–58 years) who had not experienced an mTBI within the last 5 years and completed the BIST on two different occasions.

Measures
Participants were invited to complete the 15-item BIST symptom scale and the Depression, Anxiety and Stress Scale (DASS-21) online at two time-points (baseline and 2 weeks later). To account for large variations in mood affecting symptom reporting, change scores on the subscales of the DASS-21 were calculated, and outliers were removed from the analysis.

Results
The BIST total symptom score and subscale scores (physical-emotional, cognitive and vestibular) demonstrated moderate to good test–retest reliability with intraclass correlation coefficients ranging between 0.51 and 0.83. There were no meaningful differences between symptom reporting on the total scale or subscales of the BIST between time1 and time2 at the p

This cohort study evaluates individual-, neighborhood, and health care–level factors associated with differences in time from abnormal screening to biopsy among racial and ethnic groups.

Objective
We investigated the association between women’s healthcare decision making and cervical cancer screening uptake in sub-Saharan Africa.

Design
Secondary data from the Demographic and Health Surveys of six countries in sub-Saharan Africa were used. We employed multilevel binary logistic regression modelling.

Setting
Sub-Saharan Africa.

Participants
Women aged 15–49 years in Benin (n=5282), Côte d’Ivoire (n=1925), Cameroon (n=7558), Kenya (n=6696), Namibia (n=1990) and Zimbabwe (n=5006).

Primary outcome measures
Cervical cancer screening uptake.

Results
The overall prevalence of cervical cancer screening across the six sub-Saharan African countries was 13.4%. Compared with women whose healthcare decisions were made solely by husbands/partners/someone else, the likelihood of cervical cancer screening uptake was significantly higher among women who took healthcare decisions in consultation with their husbands/partners (aOR=1.38; 95% CI 1.19 to 1.59), but highest among those who made healthcare decisions alone (aOR=1.66; 95% CI 1.44 to 1.91). Women aged between 40 and 45 years (aOR=5.18; 95% CI 3.15 to 8.52), those with higher education (aOR=2.13; 95% CI 1.57 to 2.88), those who had ever heard of cervical cancer (aOR=32.74; 95% CI 20.02 to 53.55), read newspaper or magazine at least once a week (aOR=2.11; 95% CI 1.83 to 2.44), listened to the radio at least once a week (aOR=1.35; 95% CI1.18 to 1.52) and those in households with richest wealth index (aOR=1.55; 95% CI 1.20 to 2.00) had significantly higher odds of screening for cervical cancer compared to their counterparts.

Conclusion
Women who are able to make autonomous healthcare decisions and those who practice shared decision making are more likely to uptake cervical cancer screening. Therefore, policy interventions should focus on empowering women to be able to take autonomous healthcare decisions or shared decision making while targeting subpopulations (ie, multiparous and rural-dwelling women, as well as those in other religious affiliations aside from Christianity) that are less likely to uptake cervical cancer screening. Also, the radio and print media could be leveraged in raising awareness about cervical cancer screening to accelerate cervical cancer screening uptake in sub-Saharan Africa.

Introduction
Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord impairment. Unfortunately, the condition remains poorly recognised and underdiagnosed. To better identify patients, screening tests that target individuals at high risk would be helpful. One group in particular known to have a high prevalence of DCM consists of patients with lumbar degenerative disease (LDD), with the combined presentation referred to as tandem stenosis. Given that LDD is one of the most common presentations in neurosurgical practice and primary care, it is the objective of the proposed study to administer a screening test to these patients as well as those with risk factors or symptoms which raise the suspicion of underlying DCM.

Methods and analysis
A screening test based on clinical signs/symptoms and known risk factors of DCM was designed. Screening will be performed in neurosurgical consultations for patients with LDD or those with any suspicion of myelopathy. Points are attributed based on the presence of signs/symptoms of DCM (eg, Hoffmann sign, hyper-reflexia) and for comorbidities that predispose or are frequently associated with cervical myelopathy (eg, rheumatoid arthritis, carpal tunnel syndrome). Patients with ≥3 points undergo cervical MRI examination. Patients with positive MRIs will be consulted and receive assessment via modified Japanese Orthopedic Association and Neck Disability Index scores, and subsequent clinical management will be based on practice guidelines. An exploratory multivariate analysis of the effectiveness and efficiency of this proposed screening test will be evaluated after positively screening 50 patients for DCM.

Ethics and dissemination
This study has received research ethics approval from the Swiss Association of Research Ethics Committees (ID: 2020-02785). The results of this study will be disseminated in a journal targeting physicians commonly encountering patients with LDD.

Introduction
Current international guidelines recommend ECG monitoring after an ischaemic stroke to detect atrial fibrillation (AF) in order to prevent stroke recurrence. However, optimal strategies to detect AF and the downstream management to prevent stroke recurrence remain to be established. The objective of the study was to explore the use of long-term home-based ECG monitoring for AF detection and stroke prevention in patients with a history of stroke.

Methods and analysis
This prospective, randomised, open-label trial with blinded endpoint adjudication aimed to evaluate the efficacy of long-term home-based ECG monitoring for AF detection and stroke prevention in a 24-month period. Patients aged >18 years with a history of ischaemic stroke will be stratified according to the time from the index ischaemic stroke: 3 years and then randomised in 1:1 to (1) home-based AF screening and (2) control. The home-based AF screening system comprises (1) a handheld single-lead ECG recorder (Comfit Healthcare Devices, Hong Kong SAR, China) and (2) a patient-facing smartphone application specially designed for the study. Patients randomised to the home-based AF group will record a 30 s single-lead ECG using a specially designed handheld ECG device every morning or when symptomatic. All remotely obtained data will be automatically transmitted in real-time through the study smartphone application to a secured cloud hosting and analysed using an artificial intelligence-based diagnostic system. When a diagnosis of AF is made with the system, the patients will be called back for a formal cardiology consultation within 1 week. The primary endpoint is the time to first detection of AF at 24 months of follow-up. Secondary endpoints include recurrent stroke or transient ischaemic attack, initiation of long-term anticoagulation therapy, hospitalisation for heart failure, cardiovascular death and all-cause death.

Ethics and dissemination
The study protocol has been approved by the institutional review board of The University of Hong Kong, and Hong Kong West Cluster, Hospital Authority, Hong Kong SAR, China. Results will be published in peer-reviewed journals.

Trial registration number
NCT04523649.

Question: A healthy 66-year-old woman underwent screening colonoscopy for positive fecal immunochemical test. She reported intermittent per rectal bleeding for a few years without anemia and had never had a colonoscopy or appendicectomy. She took thyroxine for hypothyroidism and there was no family history of gastrointestinal malignancy. Colonoscopy showed a 2-cm tubular lesion with normal overlying mucosa, arising at the expected appendiceal orifice location (Figure A and B), which was not biopsied due to clinical suspicion of an inverted appendix.