Risultati per: Lo screening oncologico: come aumentare l’adesione

Objectives
Atrial fibrillation (AF) screening may increase early detection and reduce complications of AF. European, Australian and World Heart Federation guidelines recommend opportunistic screening, despite a current lack of clear evidence supporting a net benefit for systematic screening. Where screening is implemented, the most appropriate approaches are unknown. We explored the views of European stakeholders about opportunities and challenges of implementing four AF screening scenarios.

Design
Telephone-based semi-structured interviews with results reported using Consolidated criteria for Reporting Qualitative research guidelines. Data were thematically analysed using the framework approach.

Setting
AF screening stakeholders in 11 European countries.

Participants
Healthcare professionals and regulators (n=24) potentially involved in AF screening implementation.

Intervention
Four AF screening scenarios: single time point opportunistic, opportunistic prolonged, systematic single time point/prolonged and patient-led screening.

Primary outcome measures
Stakeholder views about the challenges and feasibility of implementing the screening scenarios in the respective national/regional healthcare system.

Results
Three themes developed. (1) Current screening approaches: there are no national AF screening programmes, with most AF detected in symptomatic patients. Patient-led screening exists via personal devices, creating screening inequity. (2) Feasibility of screening: single time point opportunistic screening in primary care using single-lead ECG devices was considered the most feasible. Software algorithms may aid identification of suitable patients and telehealth services have potential to support diagnosis. (3) Implementation requirements: sufficient evidence of benefit is required. National screening processes are required due to different payment mechanisms and health service regulations. Concerns about data security, and inclusivity for those without primary care access or personal devices must be addressed.

Conclusions
There is an overall awareness of AF screening. Opportunistic screening appears the most feasible across Europe. Challenges are health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit and a tailored approach adapted to national realities.

Objectives
A very small proportion of children with anxiety problems receive evidence-based treatment. Barriers to access include difficulties with problem identification, concerns about stigma and a lack of clarity about how to access specialist services and their limited availability. A school-based programme that integrates screening to identify those children who are most likely to be experiencing anxiety problems with the offer of intervention has the potential to overcome many of these barriers. This article is a process-based account of how we used codesign to develop a primary school-based screening and intervention programme for child anxiety problems.

Design
Codesign.

Setting
UK primary schools.

Participants
Data were collected from year 4 children (aged 8–9 years), parents, school staff and mental health practitioners.

Results
We report how the developed programme was experienced and perceived by a range of users, including parents, children, school staff and mental health practitioners, as well as how the programme was adapted following user feedback.

Conclusions
We reflect on the mitigation techniques we employed, the lessons learnt from the codesign process and give recommendations that may inform the development and implementation of future school-based screening and intervention programmes.

Objectives
We examined the efficacy of case management (CM) interventions to encourage participation in colorectal cancer screening for patients with schizophrenia. This study aimed to clarify patients’ acceptability of the intervention and the helpful components of the intervention. Simultaneously, the study aimed to determine the acceptability, appropriateness and feasibility of the intervention from the perspective of psychiatric care providers.

Study design and setting
This study was a secondary qualitative analysis of a mixed-method randomised controlled trial that evaluated the efficacy of the CM approach to encourage participation in cancer screening for people with schizophrenia. The intervention comprised education and patient navigation for colorectal cancer screening. Interviews were conducted with patients who received the intervention and staff from two psychiatric hospitals in Japan who delivered the intervention.

Participants
Of the 172 patients with schizophrenia who participated in the trial, 153 were included. In addition, three out of six providers were included.

Data collection and analysis
Using a structured interview, the case manager asked participants about patient acceptability and the helpful components of the intervention. Content analysis was conducted for the responses obtained, and the number of responses was tabulated by two researchers. For the interviews with the providers, opinions obtained from verbatim transcripts were extracted and summarised.

Results
Forty-three of the 56 patients perceived that the intervention was acceptable. For the intervention component, inperson counselling with an explanation of the screening process by psychiatric care providers was most frequently reported by the patients as helpful (48 of the 68 respondents). Psychiatric care providers evaluated the intervention as acceptable, appropriate and easy to understand and administer. However, providing the intervention to all patients simultaneously was considered difficult with the current human resources.

Conclusions
This study showed that the CM intervention was perceived as acceptable by patients and acceptable and appropriate by psychiatric care providers.

Trial registration number
UMIN000036017.

Objective
To estimate the budget impact of portable wide-field digital imaging incorporation on screening neonatal causes of childhood blindness and visual impairment in Rio de Janeiro, Brazil.

Design
Budget impact analysis.

Setting
Rio de Janeiro, Brazil.

Primary and secondary outcome measures
The primary outcome was the direct cost of indirect binocular ophthalmoscopy, red reflex test and portable wide-field digital image screening comprising all babies born in Rio de Janeiro’s government maternity wards. The secondary outcome was the budget impact of implementing portable wide-field digital image screening in Rio de Janeiro, Brazil.

Results
Considering 100% coverage of maternity wards, the total budget impact between 2020 and 2024 would be US$3 820 706.04, ranging from US$3 139 844.34 to US$6 099 510.35. The additional cost would be US$3 124 457.28, ranging from US$2 714 492.26 to US$4 880 608.63.

Conclusion
The cost of universal digital imaging screening corresponds to less than 1% of the government health budget of the city of Rio de Janeiro. The information provided in this study may help government decision-makers evaluate the feasibility of implementing this new strategy in the municipal setting. Further health economic evaluations should be performed to verify the affordability of the implementation of this screening strategy in the Brazilian scenario, taking into account scarce human resources.

Introduction
Point-of-care dual tests (POCTs) for simultaneously detecting antibodies to HIV and syphilis (dual HIV-syphilis POCTs) have been developed recently and show encouraging performance compared with the reference tests in laboratory-based studies. As community-based voluntary, counselling and testing (CBVCT) services are effective providers of HIV and syphilis testing and counselling with high acceptability among men who have sex with men (MSM), the evaluation of the utility of these dual tests in CBVCT services is a high priority. This prospective cross-sectional study will conduct a clinical utility evaluation of two dual POCTs in non-clinical settings for the screening of HIV and syphilis in MSM. This master protocol outlines the overall research approach that will be used in four countries.

Methods and analysis
MSM presenting at CBVCT services participating in the study for HIV/STI screening will be enrolled. The (WHO preapproved) dual POCTs to be evaluated will be SD Bioline HIV/Syphilis Duo (Abbot) and Dual Path Platform HIV-Syphilis Assay (Chembio). Trained staff will collect a capillary blood sample using finger prick blood to perform both POCTs according the manufacturers’ instructions. An analysis of the feasibility of introducing the dual POCT for the screening of HIV and syphilis in MSM at CBVCT services will be performed, by assessing its acceptability and usability at CBVCT service among MSM users and providers.

Ethics and dissemination
This core protocol was independently peer reviewed and approved by the Research Project Review Panel (RP2) of the WHO Department of Sexual and Reproductive Health and Research and by the WHO Ethics Review Committee (ERC). The protocol has been adapted to individual countries and approved by RP2, ERC and institutional review boards at each site. Results will be disseminated through peer-reviewed journals and relevant conferences.

Objective
To assess the effect of adding an oral glucose tolerance test (OGTT) to fasting plasma glucose (FPG) in terms of detection of type 2 diabetes (T2D) and impaired glucose tolerance (IGT).

Design
Retrospective analysis of serial cross-sectional screening study.

Setting
Population-based health examinations within primary care in Västerbotten County, Sweden.

Participants
Individuals aged 40- 50 and 60 years with participation from 1985 to 2017. Those with previously diagnosed diabetes and FPG≥7 mmol/L were excluded.

Primary and secondary outcome measures
Prevalence of hyperglycaemia on the OGTT (IGT and T2D defined as 2-hour postload capillary plasma glucose of 8.9–12.1 mmol/L and ≥12.2 mmol/L, respectively). Analyses were further stratified by age, sex and risk factor burden to identify groups at high or low risk of IGT and T2D on testing. The numbers needed to screen (NNS) to prevent one case of T2D through detection and treatment of IGT was estimated, combining prevalence numbers with average progression rates and intervention effects from previous meta-analyses.

Results
The prevalence of IGT ranged from 0.9% (95% CI 0.7% to 1.1%) to 29.6% (95% CI 27.4% to 31.7%), and the prevalence of T2D ranged from 0.06% (95% CI 0.02% to 0.11%) to 7.0% (95% CI 5.9% to 8.3%), depending strongly on age, sex and risk factor burden. The estimated NNS to prevent one case of T2D through detection and lifestyle treatment of IGT ranged from 1332 among 40-year-old men without risk factors, to 39 among 60-year-old women with all risk factors combined.

Conclusions
The prevalence of hyperglycaemia on OGTT is highly dependent on age, sex and risk factor burden; OGTT should be applied selectively to high-risk groups to avoid unnecessary testing in the general population.

We read with the great interest the randomized controlled trial on gastric cancer prevention by active eradication of Helicobacter pylori in a high-risk area of southern China since 1994.1 During the long-term observation, the active eradication of H pylori significantly reduced gastric cancer incidence (adjusted hazard ratio, 0.57; 95% confidence interval, 0.33–0.98), compared to placebo. This experience might support the massive screening and eradication of H pylori in China, which has persistently high incidence and mortality of gastric cancer.

La campagna di prevenzione promossa dall’Istituto nazionale per le ricerche cardiovascolari

Stroke, Volume 53, Issue 5, Page e218-e218, May 1, 2022.

Stroke, Volume 53, Issue Suppl_1, Page AWP116-AWP116, February 1, 2022. Background:Delirium occurs frequently in patients with stroke but is often underrecognized. We aimed to develop a novel delirium screening tool designed specifically for stroke patients, and to test its feasibility and accuracy in a pilot study.Methods:We designed an easy-to-use 5-point instrument called the Fluctuating Mental Status Evaluation (FMSE) and tested it in a cohort of patients with intracerebral hemorrhage (ICH) who had daily delirium assessments throughout their admission. Expert ratings were performed by an attending neurointensivist or behavioral neurologist each afternoon using DSM-5 criteria, and were derived from bedside assessments and clinical data from the preceding 24 hours. Paired FMSE assessments were performed by patients’ clinical nurses after brief training on the use of the tool. Nursing assessments were aggregated over 24-hour periods (including day and night shifts), and accuracy of the FMSE was analyzed on both a per-assessment day and per-patient basis.Results:Among the 40 enrolled patients (mean age 71.1±12.2, median initial NIHSS score 16.5 [IQR 12-20]), 34 experienced delirium during their hospitalization. There were 306 total coma-free days with paired assessments, of which 208 (68%) were rated as days with delirium. Compared to expert ratings, an FMSE score ≥1 had 86% sensitivity and 74% specificity on a per-day basis, while a score ≥2 had 68% sensitivity and 83% specificity. On a per-patient basis, a score ≥1 at any point during admission had 97% sensitivity and 67% specificity in identifying patients who experienced delirium, while a score ≥2 had 94% sensitivity and 67% specificity.Conclusion:The FMSE is a feasible delirium screening tool in ICH patients, with high real-world sensitivity and specificity. Based on these results, we plan to validate the tool in a larger, more diverse cohort of stroke patients, using score cutoffs of ≥1 as “possible” delirium and ≥2 as “probable” delirium.

Stroke, Volume 53, Issue Suppl_1, Page AWP66-AWP66, February 1, 2022. Introduction:As stroke survivors transition from acute to post-acute care, and finally to community settings, the Centers for Disease Control reports ~65% receive NO rehabilitation. Even more receive rehabilitation too late, after critical brain changes for recovery are complete. Stroke survivors with invisible disabilities of cognition and depression are especially vulnerable to experience poor recovery. We launched a dedicated process to identify invisible disabilities. Our long-term objective is to make acute and post-acute, evidence-based intervention accessible.Hypothesis: >50% of acute stroke patients have cognitive deficits, or depression.Methods:Our comprehensive stroke center completes bedside psychometric assessment with standardized instruments for aphasia (Language Screening Test, LAST), spatial neglect (Catherine Bergego Scale, CBS), memory/global cognition (Montreal Cognitive Assessment, MoCA), delirium (3-Minute Diagnostic Interview for the Confusion Assessment Method, 3D-CAM) and depression (Patient health questionnaire, PHQ-8). Patients unable to respond to questions are assessed for spatial neglect and delirium (standardized observations).Results:105 ischemic stroke survivors were assessed in the first quarter of program launch (April-July, 2021). Of that group, patients met screening criteria for spatial neglect (47%), aphasia (40%), delirium (19%) and depression (31%). Over 90% had memory / global cognitive impairment (MoCA

Stroke, Volume 53, Issue Suppl_1, Page A117-A117, February 1, 2022. Introduction:Right-to-left (RtL) intracardiac and intrapulmonary shunts are associated with embolic stroke. Although contrast-enhanced transcranial doppler ultrasonography (ceTCD) and transesophageal echocardiography (TEE) are used in embolic stroke work up, there are no standardized guidelines as to which test should be considered as ‘gold standard’. Our objective is to evaluate the sensitivity of contrast-enhanced TCD and TEE in detecting right-to-left shunt to determine respective utilities as screening tools.Methods:Electronic medical records of subjects presenting with acute neurological symptoms who had ceTCD and TEE were evaluated. Sensitivity and specificity were calculated. Based on the respective prevalence of intracardiac and intrapulmonary shunts, positive predictive value, negative predictive value, and test accuracy were determined for ceTCD and TEE. Social Science Statistics was used for data analysis.Results:From June 2016 to August 2021, of 7,498 ischemic stroke patients, 260 patients were suspected of having strokes related to right to left shunts and underwent ceTCD and TEE for detection of cardioembolic sources for stroke. A positive right-to-left shunt was detected in 83 subjects. Detection by ceTCD was confirmed by the operator for 81 patients while 2 were considered false positive results (delayed sporadic High Intensity Transient Signals (HITS)). Sensitivity of ceTCD was 97.65% (95% CI [91.76%, 99.71%]). No safety concerns were identified in patients undergoing ceTCD. Of those with positive ceTCD (68.57%, n=35) were detected by Valsalva, and all of those 35 patients had negative TEE. TEE had sensitivity of 70.34% (95% CI [61.23%, 78.39%]).Conclusion:Contrast-enhanced TCD has superior sensitivity, is cost-effective, practical, and a safe alternative to TEE in identifying intracardiac or intrapulmonary shunts. Screening superiority of ceTCD may lie in ability to elicit shunts during Valsalva maneuvers. To our knowledge this is the largest single center series confirming ceTCD as a gold standard tool for screening of right to left shunts.

Stroke, Volume 53, Issue Suppl_1, Page AWP228-AWP228, February 1, 2022. Background:Cardiac structure and function are important in determining ischemic stroke (IS) etiology, but whether there is an association with cognition post IS is unknown.Methods:IS patients admitted to Johns Hopkins Hospital (2017-2019) underwent transthoracic echocardiography. IS was classified (TOAST) by a masked reviewer. Parasternal short axis left atrial (LA) diameter was evaluated as a continuous variable with a spline at 4cm (normal ≤4cm versus enlarged >4cm); left ventricle ejection fraction (LVEF) was evaluated as a nonlinear continuous variable with two spline knots at 40% and 65%. Cognition was assessed by telephone using the Six Item Screener (SIS), which tests orientation (day, month, year) and recall (grass, paper, shoe) and was dichotomized into low (0-3, worse score) and high (4-6, better score), and conservatively imputing low category scores for non-answerers. Multivariable logistic regression determined the association of SIS category with LA or LVEF, each, adjusted for covariates.Results:Participants (N=119) were on average 60 (18-89) years, 60% male, and 59% Black. Mean LA diameter was 3.9cm (SD=0.8) and mean LVEF 61.4% (SD=10.5). For LA diameter ≤4cm, each 1cm increase was associated with 5.93 greater odds (95% CI=1.49-23.65) of scoring in the high SIS category, while for LA diameter >4cm each 1cm increase was associated with lower odds (OR=0.88, 95% CI=0.39-1.99) of scoring in the high SIS category (Figure 1). Decreased (OR=0.91, 95% CI=0.74-1.11), normal (OR=0.98, 95% CI=0.91-1.06) or hyperdynamic LVEF (OR=1.02, 95% CI=0.90-1.14) showed no relationship with SIS category.Conclusions:In this study, a 1cm change in LA diameter was significantly associated with a higher score on a telephone cognition screening test, if patients had a LA diameter within normal range, but without the same association with SIS if the LA diameter was >4cm. We cautiously suggest that LA function may be associated with cognition post-stroke.