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This systematic review to support the 2022 US Preventive Services Task Force Recommendation Statement on screening for obstructive sleep apnea (OSA) in adults summarizes published evidence on the benefits and harms of screening for OSA in asymptomatic adults and use of positive airway pressure and mandibular advancement devices for treatment of OSA.
An association of extreme obesity with hypersomnolence was recognized in antiquity and described in the early 19th century in both medical texts and, most famously, in Dickens’ Posthumous Papers of the Pickwick Club. However, not until the first polysomnographic recordings of sleep and respiration were made in the 1960s was it recognized that apneas resulting from intermittent obstruction of the upper airway during sleep, causing hypoxemia and cortical arousal, contributed to the excessive sleepiness in these so-called “Pickwickian” patients. The term “obstructive sleep apnea syndrome” was coined the following decade, and it was soon recognized that intermittent partial airway obstruction during sleep, resulting in reduced airflow (hypopnea) without apnea, could result in an identical clinical syndrome.
Aortic aneurysms grow silently, most commonly without signs or symptoms. Rupture leads to death unless the aortic aneurysm is discovered and repaired, leaving the individual and their loved ones to wonder what might have happened if the aneurysm had remained undiscovered. A desire to screen for aortic aneurysms is a natural response by physicians, patients, and families to the help avoid death from rupture because screening could potentially identify aortic aneurysms and allow repair for individuals in whom the risk of rupture exceeds their risk of operative repair. Identification of simple risk factors such as age and smoking status has helped the US Preventive Services Task Force (USPSTF) endorse screening ultrasound imaging for abdominal aortic aneurysm, focusing on male patients aged 65 to 75 years who have ever smoked, yet several studies have found this recommendation to be of moderate net benefit. The value of screening programs elsewhere in the aorta, however, are much less clear.
Objective
To explore general practitioners’ (GPs) perspectives on the barriers and facilitators to cervical cancer screening (CCS) for women from culturally and linguistically diverse (CALD) backgrounds.
Design
Qualitative descriptive study involving semi-structured interviews, with interview guide informed by the Theoretical Domains Framework.
Setting
Adelaide, South Australia.
Participants
Twelve GPs with experience in providing CCS to women from CALD backgrounds participated.
Results
Four main themes emerged: ‘importance of clinician–patient relationship’, ‘patients’ cultural understanding regarding health care and CCS’, ‘communication and language’ and ‘health system related’. Each theme had several subthemes. GPs’ professional relationship with their patients and repeated advice from other clinicians, together with the provision of opportunistic CCS, were described as facilitators, and encompassed the theme of ‘importance of clinician–patient relationship’. This theme also raised the possibility of self-collection human papilloma virus tests. Lack of awareness and knowledge, lower priority for cancer screening and patients’ individual circumstances contributed to the theme of ‘patients’ cultural understanding regarding health care and CCS’, and often acted as barriers to CCS. ‘Communication and language’ consisted of language difficulties, interpreter use and use of appropriate resources. Language difficulties were a barrier to the provision of CCS, and GPs used interpreters and written handouts to help overcome this. The theme of ‘health system related’ involved the increased time needed for CCS consults for CALD women, access to appointments, funding, health promotion and effective use of practice management software.
Conclusions
This study highlights that multiple, inter-related barriers and facilitators influence CALD women’s engagement with CCS, and that GPs needed to manage all of these factors in order to encourage CCS participation. More efforts are needed to address the barriers to ensure that GPs have access to appropriate resources, and CALD patients have access to GPs they trust.
Attesa a breve decisione Commissione Europea
Peggio del nostro Paese solo Cipro e Grecia; obeso più del 15%
Objective
To analyse women’s stated preferences for establishing the relative importance of each attribute of shared decision-making (SDM) and their willingness to pay (WTP) for more participatory care in breast cancer screening programmes (BCSP).
Design
A discrete choice experiment was designed with 12 questions (choice tasks). It included three attributes: ‘How the information is obtained’, regarding benefits and harms; whether there is a ‘Dialogue for scheduled mammography’ between the healthcare professional and the woman; and, ‘Who makes the decision’, regarding participation in BCSP. Data were obtained using a survey that included 12 choice tasks, 1 question on WTP and 7 socioeconomic-related questions. The analysis was performed using conditional mixed-effect logit regression and stratification according to WTP.
Setting
Data collection related to BCSP was conducted between June and November 2021 in Catalonia, Spain.
Participants
Sixty-five women aged between 50 and 60.
Main outcome measures
Women’s perceived utility of each attribute, trade-off on these attributes and WTP for SDM in BCSP.
Result
The only significant attribute was ‘Who makes the decision’. The decision made alone (coefficient=2.879; 95% CI=2.297 to 3.461) and the decision made together with a healthcare professional (2.375; 95% CI=1.573 to 3.177) were the options preferred by women. The former contributes 21% more utility than the latter. Moreover, 52.3% of the women stated a WTP of 10 or more for SDM. Women’s preferences regarding attributes did not influence their WTP.
Conclusions
The participant women refused a current paternalistic model and preferred either SDM or informed decision-making in BCSP.
Objectives
Our objective was to compare prostate cancer detection rates between patients undergoing serum prostate-specific antigen (PSA) vs magnetic resonance imaging (MRI) for prostate cancer screening.
Design
Phase III open-label randomised controlled trial.
Setting
Single tertiary cancer centre in Toronto, Canada.
Participants
Men 50 years of age and older with no history of PSA screening for ≥3 years, a negative digital rectal exam and no prior prostate biopsy.
Interventions
Patients were recommended to undergo a prostate biopsy if their PSA was ≥2.6 ng/mL (PSA arm) or if they had a PIRADS score of 4 or 5 (MRI arm). Patients underwent an end-of-study PSA in the MRI arm.
Primary and secondary outcome measures
Adenocarcinoma on prostate biopsy. Prostate biopsy rates and the presence of clinically significant prostate cancer were also compared.
Results
A total of 525 patients were randomised, with 266 in the PSA arm and 248 in the MRI arm. Due to challenges with accrual and study execution during the COVID-19 pandemic, the study was terminated early. In the PSA arm, 48 patients had an abnormal PSA and 28 (58%) agreed to undergo a prostate biopsy. In the MRI arm, 25 patients had a PIRADS score of 4 or 5 and 24 (96%) agreed to undergo a biopsy. The relative risk for MRI to recommend a prostate biopsy was 0.52 (95% CI 0.33 to 0.82, p=0.005), compared with PSA. The cancer detection rate for patients in the PSA arm was 29% (8 of 28) vs 63% (15 of 24, p=0.019) in the MRI arm, with a higher proportion of clinically significant cancer detected in the MRI arm (73% vs 50%). The relative risk for detecting cancer and clinically significant with MRI compared with PSA was 1.89 (95% CI 0.82 to 4.38, p=0.14) and 2.77 (95% CI 0.89 to 8.59, p=0.07), respectively.
Conclusions
Prostate MRI as a stand-alone screening test reduced the rate of prostate biopsy. The number of clinically significant cancers detected was higher in the MRI arm, but this did not reach statistical significance. Due to early termination, the study was underpowered. More patients were willing to follow recommendations for prostate biopsy based on MRI results.
Trial registration number
NCT02799303.
Studio RoboKId valuterà esiti, coinvolgerà 20 piccoli pazienti
Studio RoboKId valuterà esiti, coinvolgerà 20 piccoli pazienti
Circulation, Volume 146, Issue 19, Page 1461-1474, November 8, 2022. The technological evolution and widespread availability of wearables and handheld ECG devices capable of screening for atrial fibrillation (AF), and their promotion directly to consumers, has focused attention of health care professionals and patient organizations on consumer-led AF screening. In this Frontiers review, members of the AF-SCREEN International Collaboration provide a critical appraisal of this rapidly evolving field to increase awareness of the complexities and uncertainties surrounding consumer-led AF screening. Although there are numerous commercially available devices directly marketed to consumers for AF monitoring and identification of unrecognized AF, health care professional–led randomized controlled studies using multiple ECG recordings or continuous ECG monitoring to detect AF have failed to demonstrate a significant reduction in stroke. Although it remains uncertain if consumer-led AF screening reduces stroke, it could increase early diagnosis of AF and facilitate an integrated approach, including appropriate anticoagulation, rate or rhythm management, and risk factor modification to reduce complications. Companies marketing AF screening devices should report the accuracy and performance of their products in high- and low-risk populations and avoid claims about clinical outcomes unless improvement is demonstrated in randomized clinical trials. Generally, the diagnostic yield of AF screening increases with the number, duration, and temporal dispersion of screening sessions, but the prognostic importance may be less than for AF detected by single–time point screening, which is largely permanent, persistent, or high-burden paroxysmal AF. Consumer-initiated ECG recordings suggesting possible AF always require confirmation by a health care professional experienced in ECG reading, whereas suspicion of AF on the basis of photoplethysmography must be confirmed with an ECG. Consumer-led AF screening is unlikely to be cost-effective for stroke prevention in the predominantly young, early adopters of this technology. Studies in older people at higher stroke risk are required to demonstrate both effectiveness and cost-effectiveness. The direct interaction between companies and consumers creates new regulatory gaps in relation to data privacy and the registration of consumer apps and devices. Although several barriers for optimal use of consumer-led screening exist, results of large, ongoing trials, powered to detect clinical outcomes, are required before health care professionals should support widespread adoption of consumer-led AF screening.
Circulation, Ahead of Print. Background: Coronary artery calcium (CAC) can be identified on non-gated chest CTs, but this finding is not consistently incorporated into care. A deep learning algorithm enables opportunistic CAC screening of non-gated chest CTs. Our objective was to evaluate the impact of notifying clinicians and patients of incidental CAC on statin initiation.Methods: NOTIFY-1 was a randomized quality improvement project in the Stanford healthcare system. Patients without known atherosclerotic cardiovascular disease (ASCVD) or prior statin prescription were screened for CAC on a prior non-gated chest CT from 2014-2019 using a validated deep learning algorithm with radiologist confirmation. Patients with incidental CAC were randomized to notification of the primary care clinician and patient versus usual care. Notification included a patient-specific image of CAC and guideline recommendations regarding statin use. The primary outcome was statin prescription within 6 months.Results: Among 2,113 patients who met initial clinical inclusion criteria, CAC was identified by the algorithm in 424 patients. After additional exclusions following chart review, a radiologist confirmed CAC among 173 of 194 patients (89.2%) who were randomized to notification or usual care. At 6 months, the statin prescription rate was 51.2% (44/86) in the notification arm versus 6.9% (6/87) with usual care (p
Al via progetto Tech-toys coordinato da Stella Maris
In Reply I thank Elwood et al for highlighting their previous efforts to develop more robust evidence to guide melanoma screening efforts. However, their work found similar findings as Matsumoto et al, with increased thin melanoma ascertainment in patients who had undergone screening skin examinations. While they modeled possible associations with mortality based on thickness data, their work did not look at actual mortality, either all cause or melanoma related.
Since its modern-day nadir of 5979 cases per year, or 2.1 cases per 100 000 population, in 2001, primary and secondary (PS) syphilis incidence has rapidly increased. In 2019, 38 992 cases, or 11.9 cases per 100 000, were reported, more than a 5-fold increase. The United States Preventive Services Task Force (USPSTF) currently “recommends screening for syphilis infection in persons who are at increased risk for infection (A recommendation).” The recommendation applies to asymptomatic, nonpregnant adolescents and adults who have ever been sexually active and is based on findings that the benefits of screening outweigh the harms. Because dermatologists are among the frontline health care professionals in the fight against syphilis, the USPSTF recommendation, supported by an updated evidence report and systematic review, presents an opportunity to update the dermatology community regarding recent trends in syphilis epidemiology, clinical presentation, testing, and treatment.
