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This Medical News article is an interview with Stanford University economist Susan Athey, PhD, about the clinical practice implications of her recent research on machine learning and causal vs predictive targeting for student financial aid renewal.
Oncologi, più test genetici per individuare chi ne ha beneficio
Objectives
The primary aim of this study was to optimise colorectal cancer (CRC) screening strategies and target populations in resource-limited areas through cost-effectiveness analysis, evaluating the best screening methods and appropriate screening ages.
Design
A prospective microsimulation model was used for cost-effectiveness analysis, calibrated with real-world data.
Setting
The study was conducted in Huzhou City, Zhejiang Province, China, focusing on primary and secondary healthcare levels. Data were obtained from the Huzhou Center for Disease Control and Prevention.
Participants
The study included 418 805 local residents who participated in the Huzhou screening programme between 2020 and 2022. Inclusion criteria were individuals aged 45–100 years and residing in the local area.
Interventions
Four initial screening methods were evaluated: single-sample immunochemical faecal occult blood test (iFOBT), double-sample iFOBT, single-sample iFOBT combined with a risk assessment questionnaire and double-sample iFOBT combined with a risk assessment questionnaire. Screening frequencies included annual and biennial intervals.
Primary outcome measures
The primary outcome measure was the cost per incremental quality-adjusted life year (QALY) for different screening strategies. Also, the impact on CRC incidence, related deaths, life years saved (LYS) and QALYs was considered.
Results
The primary data were sourced from the Huzhou screening programme, which included 418 805 individuals from 2020 to 2022. All screening strategies were found to be effective, with the cost per incremental QALY being less than $1036, which is below the minimum standard for middle-income countries. The most effective screening strategy was the annual combined two-sample iFOBT and risk evaluation questionnaires. This approach led to a reduction in CRC incidence and related deaths by 2435 and 1174 cases per 100 000 individuals, respectively, and an increase in LYS by 13 903 years and QALYs by 35 564 years. The recommended ages to begin and end screening were 48 and 72 years, respectively.
Conclusions
All CRC screening strategies demonstrated effectiveness compared with non-screening, with the annual combined two-sample iFOBT and risk evaluation questionnaires emerging as the optimal approach. For additional regions, the best screening strategy can be selected based on the health outcomes and costs we have provided.
Circulation, Volume 151, Issue 17, Page e964-e964, April 29, 2025.
Circulation, Volume 151, Issue 17, Page e962-e963, April 29, 2025.
Sodium-glucose transport protein 2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) were initially developed as glucose-lowering medications for people with type 2 diabetes (T2D), with additional benefits of weight loss and blood pressure reduction. These medications have since been shown by large randomized clinical trials (RCTs) to have clinical benefits beyond glycemic control, including for patients with heart failure and kidney disease, and sometimes even for patients without T2D.
This Guide to Statistics and Methods discusses target trial emulation, including why to use it, limitations of the method, and how to interpret target trial emulation findings.
Optimal treat-to-target strategies for Crohn’s disease (CD) are still being sought. We examined the value of video capsule endoscopy (VCE) to guide proactive treat-to-target optimization in CD.
Introduction
Due to inferior safety profile and higher risk of diversion than buprenorphine/naloxone, guidelines typically recommend stringent eligibility criteria such as daily witnessed ingestion of methadone for at least 12 weeks before considering take-home doses. Recent research has focused on whether or not to initiate take-home methadone doses, often using pandemic-era data when temporary prescribing changes provided a natural experiment on the impact of access to take-home doses. However, none of these studies adequately examined the optimal timing and criteria for safely starting take-home doses to enhance treatment outcomes. To determine the optimal timing for initiating methadone take-home doses, we will compare the effects of different initiation times on time to treatment discontinuation, all-cause mortality and acute-care visits among individuals who completed methadone induction in British Columbia, Canada, from 2010 to 2022.
Methods and analysis
We propose emulating a target trial using linked population-level health administrative data for all individuals aged 18 or older living in British Columbia, Canada, completing methadone induction between 1 January 2010 and 31 December 2022. The exposure strategies will include no take-home dosing and take-home dose initiation in ≤4, 5–12, 13–24 and 25–52 weeks since completed induction. The outcomes will include the time to treatment discontinuation, all-cause mortality and acute-care visits. We propose a per-protocol analysis with a clone-censor-weighting approach to address the immortal time bias implicit in the comparison of alternative take-home dose initiation times. Subgroup and sensitivity analyses, including cohort restrictions, study timeline variations, eligibility criteria modifications and outcome reclassifications, are proposed to assess the robustness of our results.
Ethics and dissemination
The protocol, cohort creation and analysis plan have been classified and approved as a quality improvement initiative by Providence Health Care Research Ethics Board and the Simon Fraser University Office of Research Ethics. Results will be disseminated to local advocacy groups and decision-makers, national and international clinical guideline developers, presented at international conferences and published in peer-reviewed journals.
Annals of Internal Medicine, Ahead of Print.
Annals of Internal Medicine, Ahead of Print.
Circulation, Volume 151, Issue 6, Page 400-415, February 11, 2025. Atherosclerotic cardiovascular disease is a major health concern worldwide and requires effective preventive measures. Lp(a) (lipoprotein [a]) has recently garnered attention as an independent risk factor for astherosclerotic cardiovascular disease, with proinflammatory and prothrombotic mechanisms contributing to its atherogenicity. On an equimolar basis, Lp(a) is ~5 to 6 times more atherogenic than particles that have been widely associated with adverse cardiovascular outcomes, such as LDL (low-density lipoprotein). Lp(a) can enter the vessel wall, leading to the accumulation of oxidized phospholipids in the arterial intima, which are crucial for initiating plaque inflammation and triggering vascular disease progression. In addition, Lp(a) may cause atherothrombosis through interactions between apoA (apolipoprotein A) and the platelet PAR-1 (protease-activated receptor 1) receptor, as well as competitive inhibition of plasminogen. Because Lp(a) is mostly determined on genetic bases, a 1-time assessment in a lifetime can suffice to identify patients with elevated levels. Mendelian randomization studies and post hoc analyses of randomized trials of LDL cholesterol–lowering drugs showed a causal link between Lp(a) concentrations and cardiovascular outcomes, with therapeutic reduction of Lp(a) expected to contribute to estimated cardiovascular risk mitigation. Many Lp(a)-lowering drugs, including monoclonal antibodies, small interfering ribonucleic acids, antisense oligonucleotides, small molecules, and gene editing compounds, are at different stages of clinical investigation and show promise for clinical use. In particular, increased Lp(a) testing and treatment are expected to have a substantial impact at the population level, enabling the identification of high-risk individuals and the subsequent prevention of a large number of cardiovascular events. Ongoing phase 3 trials will further elucidate the cardiovascular benefits of Lp(a) reduction over the long term, offering potential avenues for targeted interventions and improved cardiovascular outcomes.
Introduction
Energy management education (EME) is a manualised, evidence-based self-management education programme developed and delivered by occupational therapists for persons living with chronic disease-related fatigue. Studies have shown that EME can positively affect self-efficacy, fatigue impact and quality of life in persons with chronic conditions, while data on persons with long COVID are lacking.
The primary aim is to evaluate if adding EME to the standard care improves outcomes in persons with long COVID-related fatigue. The secondary aim is to explore the energy management behavioural strategies applied in daily routines and investigate the influencing factors of implementing behavioural changes. The third aim is to perform a cost-effectiveness analysis of EME.
Methods and analysis
Using observational data, we will emulate a prospective two-parallel arms target trial to assess whether adding EME to the standard care is associated with improved outcomes in patients with long COVID-related fatigue. The estimated sample size to detect a post-intervention difference of 1.5 points in self-efficacy to implement energy conservation strategies with 90% power (0.05 alpha) is 122 people (1:1 ratio).
Persons with long COVID-related fatigue who follow EME as part of their standard care will be recruited and included in the experimental group (EG), while potential participants for the control group (CG) will be recruited from a register and prospectively matched to a participant in the EG by applying the propensity score technique. The ‘standard of care’ of the CG will include any intervention, except occupational therapy-based EME in peer groups. The causal contrast of interest will be the per-protocol effect. Four self-reported questionnaires (fatigue impact, self-efficacy in performing energy management strategies, competency in performing daily activities, health-related quality of life) will be administered at baseline (T0; week 0), after lesson 7 (T1; week 6), post-intervention (T2; week 14) and follow-up (T3, week 24). Our main assessment will be at T2. Disease-related and productivity cost data will be collected, and a cost-effectiveness profile of the EME intervention will be compared with standard care.
Ethics and dissemination
Ethical approval has been obtained from the competent Swiss ethics commission.
Findings will be reported (1) to the study participants; (2) to patient organisations and hospitals supporting EMERGE; (3) to funding bodies; (4) to the national and international occupational therapy community and healthcare policy; (5) will be presented at local, national, and international conferences and (6) will be disseminated by peer-review publications.
