Risultati per: Raccomandazioni sullo screening del diabete per gli adulti

Annals of Internal Medicine, Volume 177, Issue 9, Page 1293-1294, September 2024.

This systematic review to support a 2024 US Preventive Services Task Force Recommendation Statement summarizes published evidence on the benefits and harms of iron supplementation, and screening for iron deficiency and iron deficiency anemia, during pregnancy.

This JAMA Patient Page discusses the pros and cons of screening for iron deficiency and iron deficiency anemia during pregnancy.

Annals of Internal Medicine, Volume 177, Issue 9, Page 1292, September 2024.

Stroke, Ahead of Print. Right-to-left shunt, mainly due to patent foramen ovale (PFO), is likely responsible for ≈5% of all ischemic strokes and 10% of those occurring in young and middle-aged adults. Randomized clinical trials demonstrated that, in selected young and middle-aged patients with otherwise cryptogenic acute ischemic stroke and high-risk PFO, percutaneous PFO closure is more effective than antiplatelet therapy alone in preventing recurrence. However, PFO is generally a benign finding and is present in about one-quarter of the population. Therefore, in clinical practice, identifying PFOs that are likely to be pathogenetic is crucial for selecting suitable patients for PFO closure to prevent recurrent stroke and to avoid potentially harmful and costly overtreatment. Contrast transthoracic echocardiography has a relatively low sensitivity in detecting PFO, whereas transesophageal echocardiography is currently considered the gold standard for PFO detection. However, it is a relatively invasive procedure and may not always be easily feasible in the subacute setting. Contrast transcranial Doppler is a noninvasive, inexpensive, accurate tool for the detection of right-to-left shunt. We conducted a literature review on the use of contrast transcranial Doppler to detect and grade right-to-left shunt after an acute ischemic stroke and present a clinical workflow proposal for young and middle-aged patients.

No. Test performance is quite variable.

Introduction
Given the increasing rates of antipsychotic use in multiple psychiatric conditions, greater attention to the assessment, monitoring and documentation of their side effects is warranted. While a significant degree of attention has been provided to metabolic side effect monitoring, comparatively little is known about how clinicians screen for, document and monitor the motor side effects of antipsychotics (ie, parkinsonism, akathisia, dystonia and dyskinesias, collectively ‘extrapyramidal side effects’, EPS). This review aims to systematically assess the literature for insights into current trends in EPS monitoring practices within various mental health settings globally.

Methods and analysis
An electronic search will be performed using the OVID Medline, PubMed, Embase, CINAHL and APA PsycINFO databases for studies published in the last quarter century (1998 to present day). Two independent reviewers will conduct the initial title and abstract screenings, using predetermined criteria for inclusion and exclusion. A third reviewer will resolve disagreements if consensus cannot be reached. If selected for inclusion, full-text data extraction will then be conducted using a pilot-tested data extraction form. Quality assessment will be conducted for all included studies using a modified version of the Quality Improvement Minimum Quality Criteria Set. A narrative synthesis and summary of the data will be provided. All stages of the review process will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Ethics and dissemination
Ethical approval is not required. Findings will be peer reviewed, published and shared verbally, electronically and in print with interested clinicians and will also be presented as posters or talks at relevant medical conferences and meetings.

PROSPERO registration number
CRD42023482372.

Introduction
When mental disorders go undetected until later stages, they can result in poorer health outcomes for patients. Primary healthcare (PHC) stands as a strategic setting for the early identification and management of these mental disorders, given its role as the primary care environment for health service users. This scoping review has the objective of mapping and assessing screening instruments validated for mental disorders that are applicable in PHC, particularly regarding their measurement properties.

Methods and analysis
This scoping review will include studies that have developed and validated screening instruments for mental disorders in the PHC context, irrespective of the age group. Searches will be conducted in MEDLINE, EMBASE, LILACS, CINAHL and PsycInfo without imposing restrictions on publication status, publication year or language. Additionally, we will scrutinise the references cited in the selected studies. Our inclusion criteria encompass studies examining any measurement property recommended by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) taxonomy. The selection process, data extraction and quality assessment of studies will be performed independently by pairs of reviewers. To evaluate the risk of bias within the selected studies, we will employ the COSMIN Risk of Bias 2 tools. The collected data will undergo analysis using descriptive statistics and will be presented in an evidence gap map format for each specific mental disorder.

Ethics and dissemination
The findings from this review will be discussed through deliberative dialogue with stakeholders and disseminated through peer-reviewed publications and conference presentations. The project was approved by the Ethics Committee for Research at the University of Sorocaba (number: 66993323.9.0000.5500).

Trial registration number
Open Science Framework – 10.17605/OSF.IO/Z6T5M.

In provincia di Ancona già eseguiti più di 15mila prelievi

In Reply We thank Dr D’Amico for his Letter, in which he states that nonattendance and contamination may have led the CAP study to underestimate the benefit of an invitation to a single PSA screening test for reducing prostate cancer mortality over a median 15-year follow-up (intention-to-treat estimate rate ratio, 0.92 [95% CI, 0.85-0.99]; P = .03). This finding corresponded to a reduction of 1 fewer prostate cancer death per 1000 men invited to screening compared with the control group over a median follow-up of 15 years (8 prostate cancer deaths per 1000 men in the control group vs 7 prostate cancer deaths per 1000 men invited to PSA screening). D’Amico states that the difference in PSA testing between the 2 randomized groups was approximately 30%, whereas, ideally, there should be a 100% difference between groups.

To the Editor In a secondary analysis of the Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP), the secondary end point of prostate cancer–specific mortality was significantly reduced, with a rate ratio of 0.92 (95% CI, 0.85-0.99; P = .03) after a median follow-up of 15 years. I agree with the authors that this result is modest, yet it is important to note that both nonattendance (ie, individuals randomized to the intervention group who did not have a prostate-specific antigen [PSA] test) and contamination (ie, individuals randomized to the standard group who had at least 1 PSA test) can affect the magnitude of the rate ratio for prostate cancer–specific mortality. Specifically, as the authors noted in their CAP article from 2018, the contamination rate was estimated at 10% to 15%, meaning at least 10% of participants in the standard group received at least 1 PSA test. In the current article, the authors noted that the nonattendance rate in the intervention group was 60% and an additional 6% of participants did not have a valid PSA test result. Therefore, in the best-case scenario, the difference in the PSA testing between the 2 randomized groups would be 30% (40% minus 10%). Specifically, 40% in the intervention group was derived from the 60% nonattendance rate and 10% in the standard group was due to contamination. Ideally, to assess the value of a single PSA test on prostate cancer–specific mortality, the difference in PSA testing between the 2 randomized groups should be 100%. As a result, the effect of a single PSA screen on the end point of prostate cancer–specific mortality is likely to be greater than the reported 8% reduction, as reflected in the rate ratio of 0.92. Therefore, it is important to recognize that the results of the CAP study may have underestimated the true effect of a single PSA screen on prostate cancer–specific mortality.

To the Editor Secondary analysis of the CAP study reported 15-year mortality rates among men who received an invitation for a PSA screening test followed by further diagnostic evaluation if the PSA was 3.0 ng/mL or greater compared with a control group who did not undergo PSA screening. Although there was increased detection of low-grade and localized prostate cancer among men in the PSA screening and intervention group, there was minimal absolute reduction in prostate cancer mortality (0.09%) and no reduction in all-cause mortality compared with the control group. This begs the question: Can prostate biopsies trigger the spread of prostate cancer in some men, thereby diminishing any potential benefit from early detection and treatment?

Objectives
Despite global research on early detection of age-related macular degeneration (AMD), not enough is being done for large-scale screening. Automated analysis of retinal images captured via smartphone presents a potential solution; however, to our knowledge, such an artificial intelligence (AI) system has not been evaluated. The study aimed to assess the performance of an AI algorithm in detecting referable AMD on images captured on a portable fundus camera.

Design, setting
A retrospective image database from the Age-Related Eye Disease Study (AREDS) and target device was used.

Participants
The algorithm was trained on two distinct data sets with macula-centric images: initially on 108,251 images (55% referable AMD) from AREDS and then fine-tuned on 1108 images (33% referable AMD) captured on Asian eyes using the target device. The model was designed to indicate the presence of referable AMD (intermediate and advanced AMD). Following the first training step, the test set consisted of 909 images (49% referable AMD). For the fine-tuning step, the test set consisted of 238 (34% referable AMD) images. The reference standard for the AREDS data set was fundus image grading by the central reading centre, and for the target device, it was consensus image grading by specialists.

Outcome measures
Area under receiver operating curve (AUC), sensitivity and specificity of algorithm.

Results
Before fine-tuning, the deep learning (DL) algorithm exhibited a test set (from AREDS) sensitivity of 93.48% (95% CI: 90.8% to 95.6%), specificity of 82.33% (95% CI: 78.6% to 85.7%) and AUC of 0.965 (95% CI:0.95 to 0.98). After fine-tuning, the DL algorithm displayed a test set (from the target device) sensitivity of 91.25% (95% CI: 82.8% to 96.4%), specificity of 84.18% (95% CI: 77.5% to 89.5%) and AUC 0.947 (95% CI: 0.911 to 0.982).

Conclusion
The DL algorithm shows promising results in detecting referable AMD from a portable smartphone-based imaging system. This approach can potentially bring effective and affordable AMD screening to underserved areas.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Circulation, Ahead of Print. Background:Guidelines have suggested screening for atrial fibrillation to enable early treatment and avoid downstream negative clinical events. We aimed to determine if atrial fibrillation screening potentially enhanced by NT-proBNP would reduce stroke or systemic embolism incidence as compared to in a control group and to determine if it was safe for those with low NT-proBNP concentrations to forfeit prolonged screening.Methods:In this randomized controlled trial all 75/76-year-old individuals in Stockholm Region, Sweden were randomized 1:1 to be invited to screening or serve as a control group. NT-proBNP concentration were measured and a single-lead-ECG registered only once if NT-proBNP