Complete Screening Research Articles

Rapid survey assessment: Barriers and facilitators to mammogram completion in English and Spanish-speaking patients in a federally qualified health center (FQHC) setting.

1587 Background: Mammography has decreased breast cancer mortality in the US by 40% since the 1980s; yet disparities in screening and outcomes persist in underserved populations. Many studies note language as a barrier to screening with lower mammogram completion amongst Spanish-speaking patients versus those with English language proficiency. At our health center, Spanish-speaking patients were more likely to complete screening mammography compared to patients with English proficiency (53% vs 31% in 2022). To understand this pattern and barriers and facilitators to breast cancer screening, we conducted a mixed methods rapid assessment survey as part of a quality improvement initiative. Methods: We developed a patient bilingual survey measuring knowledge, attitudes, and behaviors about breast cancer prevention and screening. We identified consecutive female patients (age 40-75 years) and extracted baseline demographic data from the electronic medical record. Surveys were distributed via our health center’s patient messaging service and responses stored on a secure platform. Data analysis included descriptive statistics, chi-squared testing between groups and qualitative analysis to identify common themes from free-text answers. Results: The overall response rate was 14% (N=732/5,332) in 30 days. Of the surveys completed, 37% were in Spanish. Spanish-speaking patients more strongly regarded mammography as safe and effective compared to English-speaking patients (p<0.001). Spanish-speaking patients were more likely to view getting a mammogram as a priority (79% vs 65% p<0.001) and noted speaking about breast cancer prevention in their communities more often (p<0.006) as an important factor. Spanish-speaking patients primarily cited cost, scheduling, and language (p<0.05) as barriers to mammogram completion, while English-speaking patients cited time constraints, transportation, and discomfort (p<0.05) more frequently. Spanish-speaking patients were more likely to prefer speaking with a trusted community member or attending health fairs than English-speaking patients (P<0.05). Conclusions: Our study demonstrates differences in attitudes, behaviors, and perceived barriers to mammography in English vs Spanish-speaking patients. The increased mammogram completion rate in Spanish-speaking patients may reflect more positive attitudes about screening and more discussion in the community amongst Spanish-speaking patients queried. Reported barriers to screening differed and will guide targeted QI interventions. We demonstrated feasibility and patient engagement in a diverse population using a message system built into our EHR in an FQHC setting. This survey study allows us to elevate patient voices, better understand gaps and preferences, and better tailor future interventions for cancer screening.

A prospective study comparing AI-based clinical trial eligibility screening with traditional EMR-based screening.

e13636 Background: For clinical trials of novel oncology therapies, screening patients for eligibility relies on research staff manually abstracting complex eligibility criteria, which is time-consuming and subject to inconsistent interpretations. AI algorithms based on structured data fields may facilitate automated eligibility criteria extraction, assure more complete screening for the benefit of all patients, improve workflow for research staff, and assure no bias in who is reviewed. AI algorithms can support abstraction and imputation approaches to assure the greatest number of clinical records get reviewed. Prospective validation of such algorithms and approaches for sponsored registrational clinical trials is lacking from literature. Methods: We conducted a prospective controlled observational study of an AI model to prioritize potentially eligible patients, as part of a phase 3, randomized, multi-site therapeutic trial for Relapsed or Refractory Multiple Myeloma. In this observational study, we studied eligibility criteria focused on measurable disease and prior anti-myeloma treatments. The AI eligibility model extracted structured eligibility criteria to predict likelihood of meeting study eligibility. A single CRC (Clinical Research Coordinator) allocated 40 hours to screening in both control and intervention phases of the study. In the control phase, the CRC screened myeloma patients’ electronic health records in alphabetical order by last name. In the intervention phase, the CRC screened a different set of patients ranked by the eligibility likelihood model. Descriptive statistics were used to compare primary outcomes of efficiency (percentage of patients watch-listed) and speed (average time to screen a patient) between control and intervention phase. Patients marked as watch-listed meet eligibility criteria but need additional testing or disease progression before becoming eligible for the study. Results: The AI Eligibility method captured the same share (19%1) of screened patients as the EMR method, with a 3.3x (12.5 versus 41 minutes) improvement per screened patient. Conclusions: The AI eligibility method allows research staff to screen three times more patients with similar outcomes as compared to routine CRC EMR screening. Future work can leverage AI to identify and predict patient progression, further enhancing screening efficiency. [Table: see text]

Avelumab first-line maintenance in advanced urothelial carcinoma: Complete screening for prognostic and predictive factors using machine learning in the JAVELIN Bladder 100 phase 3 trial.

Avelumab first-line (1 L) maintenance is a standard of care for advanced urothelial carcinoma (aUC) based on the JAVELIN Bladder 100 phase 3 trial, which showed that avelumab 1 L maintenance + best supportive care (BSC) significantly prolonged overall survival (OS) and progression-free survival (PFS) vs BSC alone in patients who were progression free after receiving 1 L platinum-containing chemotherapy. Here, we comprehensively screened JAVELIN Bladder 100 trial datasets to identify prognostic factors that define subpopulations of patients with longer or shorter OS irrespective of treatment, and predictive factors that select patients who could obtain a greater OS benefit from avelumab 1 L maintenance treatment. We performed machine learning analyses to screen a large set of baseline covariates, including patient demographics, disease characteristics, laboratory values, molecular biomarkers, and patient-reported outcomes. Covariates were identified from previously reported analyses and established prognostic and predictive markers. Variables selected from random survival forest models were processed further in univariate Cox models with treatment interaction and visually inspected using correlation analysis and Kaplan-Meier curves. Results were summarized in a multivariable Cox model. Prognostic baseline covariates associated with OS included in the final model were assignment to avelumab 1 L maintenance treatment, Eastern Cooperative Oncology Group performance status, site of metastasis, sum of longest target lesion diameters, levels of C-reactive protein and alkaline phosphatase in blood, lymphocyte proportion in intratumoral stroma, tumor mutational burden, and tumor CD8+ T-cell infiltration. Potential predictive factors included site of metastasis, tumor mutation burden, and tumor CD8+ T-cell infiltration. An analysis in patients with PD-L1+ tumors had similar findings to those in the overall population. Machine learning analyses of data from the JAVELIN Bladder 100 trial identified potential prognostic and predictive factors for avelumab 1 L maintenance treatment in patients with aUC, which warrant further evaluation in other clinical datasets.

Establishing reliability and construct validity for the revised Emotional Social Screening Tool for School Readiness (E3SR-R)

School readiness assessments in South Africa still predominantly focus on the assessment of cognitive skills. The Emotional Social Screening Tool for School Readiness (E3SR) was developed to bridge the perceived gap in assessing emotional-social skills as a domain of school readiness. An emerging body of research reports exists on the psychometric properties and factor structure of the E3SR. An initial validation study recommended a 6-factor solution instead of the theoretical 9-factor model that was proposed in the development of the E3SR. The E3SR (Revised) was also reduced in length. We report here on a pilot study of which the aim was to establish the reliability and construct validity of the E3SR (Revised). A cross-sectional survey design was used to gather data from 9 pre-schools in Cape Town, South Africa. Pre-school teachers (n = 24) constituted the respondent group who completed the E3SR (Revised) screening questionnaires on Grade R learners (n = 394). Analysis was conducted on 321 completed screening questionnaires. With the data analysis we aimed to: a) summarise sample characteristics of teachers and children; b) establish reliability estimates; and c) establish construct validity and confirming the factor structure. Ethics clearance was given by the Humanities and Social Science Research Ethics Committee (HSSREC) of the University of the Western Cape. The study adhered to stipulated ethics requirements. Data failed to show multivariate normality; however, this violation of normality was expected and was theoretically supported. The sample size (n = 321) was sufficient for factor analysis of a 36-item scale. All subscales showed excellent reliability: Cronbach’s alphas ranged between .939 and .971. CFA results demonstrated a good model fit. The E3SR (Revised) was found to be reliable and valid for use. The use of a rigorous methodological process including the decision-making matrix represent good research practice that can be used in instrument development across cultures.

Evaluating a New Digital App-Based Program for Heart Health: Feasibility and Acceptability Pilot Study.

Cardiovascular disease (CVD) is the leading cause of death in the United States, affecting a significant proportion of adults. Digital health lifestyle change programs have emerged as a promising method of CVD prevention, offering benefits such as on-demand support, lower cost, and increased scalability. Prior research has shown the effectiveness of digital health interventions in reducing negative CVD outcomes. This pilot study focuses on the Lark Heart Health program, a fully digital artificial intelligence (AI)-powered smartphone app, providing synchronous CVD risk counseling, educational content, and personalized coaching. This pilot study evaluated the feasibility and acceptability of a fully digital AI-powered lifestyle change program called Lark Heart Health. Primary analyses assessed (1) participant satisfaction, (2) engagement with the program, and (3) the submission of health screeners. Secondary analyses were conducted to evaluate weight loss outcomes, given that a major focus of the Heart Health program is weight management. This study enrolled 509 participants in the 90-day real-world single-arm pilot study of the Heart Health app. Participants engaged with the app by participating in coaching conversations, logging meals, tracking weight, and completing educational lessons. The study outcomes included participant satisfaction, app engagement, the completion of screeners, and weight loss. On average, Heart Health study participants were aged 60.9 (SD 10.3; range 40-75) years, with average BMI indicating class I obesity. Of the 509 participants, 489 (96.1%) stayed enrolled until the end of the study (dropout rate: 3.9%). Study retention, based on providing a weight measurement during month 3, was 80% (407/509; 95% CI 76.2%-83.4%). Participant satisfaction scores indicated high satisfaction with the overall app experience, with an average score of ≥4 out of 5 for all satisfaction indicators. Participants also showed high engagement with the app, with 83.4% (408/489; 95% CI 80.1%-86.7%) of the sample engaging in ≥5 coaching conversations in month 3. The results indicated that participants were successfully able to submit health screeners within the app, with 90% (440/489; 95% CI 87%-92.5%) submitting all 3 screeners measured in the study. Finally, secondary analyses showed that participants lost weight during the program, with analyses showing an average weight nadir of 3.8% (SD 2.9%; 95% CI 3.5%-4.1%). The study results indicate that participants in this study were satisfied with their experience using the Heart Health app, highly engaged with the app features, and willing and able to complete health screening surveys in the app. These acceptability and feasibility results provide a key first step in the process of evidence generation for a new AI-powered digital program for heart health. Future work can expand these results to test outcomes with a commercial version of the Heart Health app in a diverse real-world sample.

Predicting first time depression onset in pregnancy: applying machine learning methods to patient-reported data.

To develop a machine learning algorithm, using patient-reported data from early pregnancy, to predict later onset of first time moderate-to-severe depression. A sample of 944 U.S. patient participants from a larger longitudinal observational cohortused a prenatal support mobile app from September 2019 to April 2022. Participants self-reported clinical and social risk factors during first trimester initiation of app use and completed voluntary depression screenings in each trimester. Several machine learning algorithms were applied to self-reported data, including a novel algorithm for causal discovery. Training and test datasets were built from a randomized 80/20 data split. Models were evaluated on their predictive accuracy and their simplicity (i.e., fewest variables required for prediction). Among participants, 78% identified as white with an average age of 30 [IQR 26-34]; 61% had income ≥ $50,000; 70% had a college degree or higher; and 49% were nulliparous. All models accurately predicted first time moderate-severe depression using first trimester baseline data (AUC 0.74-0.89, sensitivity 0.35-0.81, specificity 0.78-0.95). Several predictors were common across models, including anxiety history, partnered status, psychosocial factors, and pregnancy-specific stressors. The optimal model used only 14 (26%) of the possible variables and had excellent accuracy (AUC = 0.89, sensitivity = 0.81, specificity = 0.83). When food insecurity reports were included among a subset of participants, demographics, including race and income, dropped out and the model became more accurate (AUC = 0.93) and simpler (9 variables). A relatively small amount of self-report data produced a highly predictive model of first time depression among pregnant individuals.

Association of systemic inflammatory response index with bone mineral density, osteoporosis, and future fracture risk in elderly hypertensive patients

ABSTRACT Objectives This study sought to investigate the relationship between the systemic inflammatory response index (SIRI) and bone mineral density (BMD), osteoporosis, and future fracture risk in elderly hypertensive patients. Methods Elderly hypertensive patients (age ≥60 years) who attended our hospital between January 2021 and December 2023 and completed BMD screening were included in the study. Analyses were performed with multivariate logistic and linear regression. Results The multiple linear regression indicated that SIRI levels were significantly negatively correlated with lumbar 1 BMD (β = -0.15, 95% CI: −0.24, −0.05), lumbar 2 BMD (β = -0.15, 95% CI: −0.24, −0.05), lumbar 3 BMD (β = -1.35, 95% CI: −0.23, −0.02), lumbar 4 BMD (β = -0.11, 95% CI: −0.30, −0.10), femur neck BMD (β = -0.11, 95% CI: −0.18, −0.05) and Ward’s triangle BMD (β = -0.12, 95% CI: −0.20, −0.05) among elderly hypertensive patients, after fully adjusting for confounders. Furthermore, we observed that SIRI was positively associated with future fracture risk in elderly hypertensive patients. Specifically, SIRI was associated with an increased risk of major osteoporotic fractures (β = 0.33) and hip fractures (β = 0.25). The logistic regression analysis indicated that there is an association between the SIRI level and an increased risk of osteoporosis (OR = 1.60, 95% CI = 1.37, 1.87), after fully adjusting for confounders. Conclusions Our findings indicate a potential association between SIRI and BMD, osteoporosis, and the risk of future fractures in elderly hypertensive patients. However, further studies are warranted to confirm these findings.

Abstract A009: Integrative drug screening and multi-omic characterization of patient-derived bladder cancer organoids reveals novel molecular correlates of chemotherapy response

Abstract Introduction: Predicting response to therapy for each patient’s tumor is critical to improving long-term outcomes for muscle-invasive bladder cancer (MIBC). Our objective is to establish ex vivo bladder cancer patient-derived organoid (PDO) models that are representative of patients’ tumors and determine potential efficacy of standard-of-care and curated experimental therapies. Methods: Tumor material was prospectively collected from consented patients with bladder cancer to generate short-term PDO models, which were screened against a panel of clinically relevant drugs in ex vivo 3D culture. Drugs were tested at the maximum plasma concentration (Cmax) in human trials, so as to provide physiologic relevance. When material was sufficient, cells were additionally tested using full dose response. The number of drugs screened was dependent upon amount of tissue available, with up to 34 drugs screened at Cmax and 9 drugs screened in dose response format. Multiomic profiling was utilized to validate the PDO models, establish the molecular characteristics of each tumor, assess gene expression (GEX) patterns between paired primary tissue and PDOs, and identify potential biomarkers of drug response using Pearson correlation coefficients and Kruskal-Wallis tests with Dunn’s post-hoc pairwise comparison testing. Results: 106 tumors were collected from 97 patients, with 65 samples yielding sufficient material for complete multiomic molecular characterization and PDO screening with 6 to 32 drugs/combinations. RNA sequencing and GSEA enriched pathways across organoids were compared to other published datasets, noting high levels of correlation between our organoid models and in particular the Cancer Cell Line Encyclopedia urethral lines. Moreover, analysis of subtype and mutation/copy number data further indicate that our organoid dataset is representative of the full spectrum of disease. RNA sequencing and subtyping of cultured organoids compared to patient tissue indicate that organoid models are representative of patient tissue and do not undergo subtype shifts in our short-term 3D cultures. Our drug screening results highlight the large spectrum of response to chemotherapies that in fact, clinically benefit only a small proportion of patients in the neoadjuvant setting. Utilizing an integrative approach, novel correlations between ex vivo drug responses and genomic alterations, GEX, and protein expression were identified, including a multiomic signature of gemcitabine response. Conclusions: Rapid organoid development, characterization, and drug screening allows for the prediction of therapeutic response in ~10 days following sample collection. Use of this technique on tissue provided during disease work-up may further guide selection of effective therapeutic agents in patients with bladder cancer, beyond the typical unranked lists derived from genomic analyses. This work would help maximize the overall benefits of standard of care therapies and could be used to identify alternative therapeutics for patients who progress on standard therapies. Citation Format: Nathan M. Merrill, Samuel D. Kaffenberger, Liwei Bao, Nathalie Vandecan, Laura E. Goo, Athena Apfel, Xu Cheng, Zhaoping Qin, Chia-Jen Liu, Armand Bankhead, Yin Wang, Varun Kathawate, Lila Tudrick, Habib Serhan, Zackariah Farah, Chad Ellimoottil, Khaled S. Hafez, Lindsey A. Herrel, Jeffrey S. Montgomery, Todd M. Morgan, Simpa S. Salami, Alon Z. Weizer, Peter J. Ulintz, Mark L. Day, Matthew B. Soellner, Phillip L. Palmbos, Sofia D. Merajver, Aaron M. Udager. Integrative drug screening and multi-omic characterization of patient-derived bladder cancer organoids reveals novel molecular correlates of chemotherapy response [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2024 May 17-20; Charlotte, NC. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(10_Suppl):Abstract nr A009.

Effectiveness of Midwifery Care for Family Planning (KB) Acceptors with IUD (Intrauterine Device): Study in Kayu Kul Village, Pegasing, Central Aceh, Indonesia

Family planning (KB) is one of the Indonesian government's priority programs to control the rate of population growth. IUD (Intrauterine Device) is an effective and popular family planning method in Indonesia. Quality midwifery care is important to ensure successful IUD use and increase acceptor satisfaction. This study aims to analyze the effectiveness of midwifery care for family planning acceptors with IUDs in Kayu Kul Village, Pegasing, Central Aceh, Indonesia. This study used a cross-sectional observational design involving family planning acceptors with IUDs in Kayu Kul Village, Pegasing, Central Aceh, Indonesia. Data was collected through structured interviews and observations of midwifery care provided to acceptors. Data were analyzed using univariate and bivariate analysis with the Chi-square test. The results showed that the majority of family planning acceptors with IUDs (80%) received effective midwifery care. Effective midwifery care includes: complete health screening, comprehensive education about IUD use, counseling about IUD side effects and complications, and regular monitoring of IUD use. Acceptors who received effective midwifery care had a higher level of satisfaction (90%) compared to acceptors who did not receive effective midwifery care (60%). Effective midwifery care has been proven to increase family planning acceptor satisfaction with the IUD. Therefore, it is important to improve the quality of midwifery care at Health Centers to ensure successful use of IUDs and increase acceptor satisfaction.

Living with rare genetic disease during the COVID-19 pandemic: A qualitative study of adolescents and young adults with Li-Fraumeni syndrome

BackgroundThe COVID-19 pandemic caused large-scale shifts in healthcare access and delivery that impacted the availability of routine care, such as cancer screening. Vulnerable populations, including those with rare cancer-prone genetic disease, faced considerable difficulties in managing their cancer risk. Studies characterizing the specific impacts of the pandemic on physical, mental, and emotional well-being for individuals with rare cancer-prone syndromes are emerging. This study used a patient-centered perspective to characterize how young adults with Li-Fraumeni syndrome (LFS), an inherited cancer predisposition syndrome with nearly 100 % lifetime risk of cancer, managed their physical and mental health during the first year of the COVID-19 pandemic. MethodsThis exploratory, qualitative cohort study was conducted between March and July of 2021 as part of the National Cancer Institute's Li-Fraumeni Study. Thirty adolescents and young adults (22 female, 8 male, median age 31 years, range 18–41) with a confirmed pathogenic TP53 variant completed a semi-structured qualitative interview. An interdisciplinary team conducted Thematic Content Analysis on verbatim transcribed data. ResultsMost participants (22/30, 77 %) completed cancer screening during the first year of the pandemic, with a median perceived delay of 5 months (range 2–12 months) and with financial COVID-19-related burden (55 %). While participants reported satisfaction with telehealth-based services, they also reported challenges establishing new clinical relationships and a clear preference for in-person clinical care. Most participants reported negative or mixed impacts of COVID-19 on mental health (21/30, 70 %). Social network changes were reported by 22 (73 %), and almost all participants experienced negative or mixed emotions such as loss, grief, and isolation, to adaptations necessitated by COVID-19 in their social structure. ConclusionsThe COVID-19 pandemic had detrimental effects on the physical, emotional, and social health in young adults with Li-Fraumeni, including disruptions in care. These data highlight the need for integrative strategies to be in place prior to future pandemics to prioritize and support vulnerable populations, such as those with rare disease, and to manage unforeseen large-scale shifts in healthcare access and social structure.

Addressing cervical cancer prevention in Bhutan: A study on the use of loop electrosurgical excision procedures at the primary health care level

AbstractBackgroundCervical cancer is the top and fourth leading cause of death among women in Bhutan and worldwide, respectively. The cervical cancer elimination flagship program initiated by the Ministry of Health aims to achieve the 90–70–90 goals by 2030. To achieve this, detection and treatment of pre‐cancerous lesions of the cervix through colposcopy and loop electrosurgical excision procedure (LEEP) are being carried out through the outreach health camps.MethodsThis descriptive study aimed to assess the safety and tolerability of LEEP under local anesthesia and assess the margin status of high‐grade lesion (HGL). We analyzed 193 records of clients who underwent LEEP at Wangdue Phodrang Hospital from 26 September to 5 October 2022. The sociodemographic profile, intraoperative pain, complications, and histopathological reports were described using structured pro forma.ResultsThe mean age of clients was 40.9 ± 8.5 years (range 25–66 years). There were 3.1% who had intraoperative and 2.6% who had postoperative bleeding. There were 18.6% who had foul‐smelling vaginal discharge, and 8.3% had moderate‐to‐severe intraoperative pain. Histopathological assessment revealed 29.5% with chronic cervicitis, 34.2% with HGL, and 1.6% with microinvasive cervical carcinoma. The margin positivity for HGL was 36.4%.ConclusionGiven the safety profile of LEEP under local anesthesia in our setting, the scope of providing a complete cervical cancer screening and treatment package at the primary health care level looks promising. Based on the higher rate of overtreatment and margin positivity, we recommend the practical implementation of standard colposcopy guidelines.

A Randomized Trial of Choice Architecture and Mailed Colorectal Cancer Screening Outreach in a Community Health Setting

Mailed outreach for colorectal cancer (CRC) screening increases uptake but it is unclear how to offer the choice of testing. We evaluated if the active choice between colonoscopy and fecal immunochemical test (FIT), or FIT alone, increased response compared with colonoscopy alone. This pragmatic, randomized, controlled trial at a community health center included patients between ages 50 and 74 who were not up to date with CRC screening. Patients were randomized 1:1:1 to the following: (1) colonoscopy only, (2) active choice of colonoscopy or FIT, or (3) FIT only. Patients received an outreach letter with instructions for testing (colonoscopy referral and/or an enclosed FIT kit), a reminder letter at 2 months, and another reminder at 3 to 5 months via text message or automated voice recording. The primary outcome was CRC screening completion within 6 months. Among 738 patients in the final analysis, the mean age was 58.7 years (SD, 6.2 y); 48.6% were insured by Medicaid and 24.3% were insured by Medicare; and 71.7% were White, 16.9% were Black, and 7.3% were Hispanic/Latino. At 6 months, 5.6% (95% CI, 2.8-8.5) completed screening in the colonoscopy-only arm, 12.8% (95% CI, 8.6-17.0) in the active-choice arm, and 11.3% (95% CI, 7.4-15.3) in the FIT-only arm. Compared with colonoscopy only, there was a significant increase in screening in active choice (absolute difference, 7.1%; 95% CI, 2.0-12.2; P= .006) and FIT only (absolute difference, 5.7%; 95% CI, 0.8-10.6; P= .02). Both choice of testing and FIT alone increased response and may align with patient preferences. clinicaltrials.gov NCT04711473.

E002 The Psoriasis Epidemiology Screening Tool (PEST) as a mechanism for diagnosing psoriatic arthritis in dermatology practice: 5 year follow-up data from a quality improvement project

Abstract Background/Aims We carried out a QIP in 2018 as a collaboration between dermatology and rheumatology. 280 patients with psoriasis attending outpatient appointments in dermatology completed Psoriasis Epidemiology Screening Tool (PEST) forms between January and April 2018; results were recorded on the patient record. 110 patients (39%) had a positive PEST score, indicating a possible diagnosis of PsA. Of these, 48/110 were not already known to rheumatology services. Patients with a positive PEST were informed of the results and their GP was advised to refer to rheumatology if they had not previously been assessed. The pathway aimed to avoid duplication of assessments, and acknowledged that patients with psoriasis may have had a rheumatology assessment at another hospital, or even be under their ongoing care. Methods We reviewed the hospital electronic and regional patient records of the 48 patients in January 2023 in order to identify which of these had been referred for a rheumatology review and/or had a new diagnosis of psoriatic arthritis. Results One patient was excluded due to lack of access to local records. Of the remaining 47 patients, 31 had a PEST score of 3, 15 patients scored 4, and 1 patient scored 5. 5/47 (10%) patients were referred for a rheumatology opinion following a positive PEST score. 3/5 of these patients went on to be diagnosed with psoriatic arthritis. 7/47 (15%) patients had a diagnosis of psoriatic arthritis on GP records with no secondary care input. None of these patients were on treatment for PsA. 7/31 patients with PEST score of 3 were diagnosed with PsA, 2/15 patients with PEST score of 4 and the only patient with a score of 5 were diagnosed with PsA. Overall 10/47 (21%) patients were diagnosed with PsA. Conclusion A letter from dermatology to request review of joint disease and consideration of a rheumatology referral in response to a positive PEST score appears to have resulted in a low response in terms of rheumatology review. Others seemingly acquired a diagnosis of PsA without rheumatology review, potentially through the PEST score alone, which is concerning, and not how the PEST score should be used. Screening for PsA in psoriasis populations remains problematic. PEST score is recommended by dermatology guidelines, but lacks specificity and can result in high numbers of referrals, with potential duplication of work if referred repeatedly. It is important to recognise PsA in patients with psoriasis, but equally important that this is done efficiently and accurately, so patients are not inadvertently treated or inaccurately labelled with this diagnosis. Rheumatologists should work with dermatology and primary care colleagues to improve understanding of PsA and the PEST questionnaire, and consider the optimum pathways to ensure that PsA is recognised and treated promptly. Disclosure S. Ahmed: None. M. Babiker: None. M. Osama: None. M. Ahmed: None. K. Jobling: None. P. Hampton: None. B. Thompson: None.

Geographic Accessibility and Completion of Initial Low-Dose CT-Based Lung Cancer Screening in an Urban Safety-Net Population.

Recent modifications to low-dose CT (LDCT)-based lung cancer screening guidelines increase the number of eligible individuals, particularly among racial and ethnic minorities. Because these populations disproportionately live in metropolitan areas, we analyzed the association between travel time and initial LDCT completion within an integrated, urban safety-net health care system. Using Esri's StreetMap Premium, OpenStreetMap, and the r5r package in R, we determined projected private vehicle and public transportation travel times between patient residence and the screening facility for LDCT ordered in March 2017 through December 2022 at Parkland Memorial Hospital in Dallas, Texas. We characterized associations between travel time and LDCT completion in univariable and multivariable analyses. We tested these associations in a simulation of 10,000 permutations of private vehicle and public transportation distribution. A total of 2,287 patients were included in the analysis, of whom 1,553 (68%) completed the initial ordered LDCT. Mean age was 63 years, and 73% were underrepresented minorities. Median travel time from patient residence to the LDCT screening facility was 17 minutes by private vehicle and 67 minutes by public transportation. There was a small difference in travel time to the LDCT screening facility by public transportation for patients who completed LDCT versus those who did not (67 vs 66 min, respectively; P=.04) but no difference in travel time by private vehicle for these patients (17 min for both; P=.67). In multivariable analysis, LDCT completion was not associated with projected travel time to the LDCT facility by private vehicle (odds ratio, 1.01; 95% CI, 0.82-1.25) or public transportation (odds ratio, 1.14; 95% CI, 0.89-1.44). Similar results were noted across travel-type permutations. Black individuals were 29% less likely to complete LDCT screening compared with White individuals. In an urban population comprising predominantly underrepresented minorities, projected travel time is not associated with initial LDCT completion in an integrated health care system. Other reasons for differences in LDCT completion warrant investigation.

Evaluation of a new two-step frailty assessment of head and neck patients in a prospective cohort

PurposeAssessing frailty, in head and neck cancer (HNC) patients is key when choosing appropriate treatment. Optimal screening is challenging, as it should be feasible and should avoid over-referral for comprehensive geriatric assessment (CGA) This study aims to evaluate the association between geriatric assessment using a new two-step care pathway, referral to geriatrician and adverse outcomes.MethodsThis institutional retrospective analysis on a prospective cohort analysed the multimodal geriatric assessment (GA) of newly diagnosed HNC patients. Uni- and multivariable logistic regression was performed to study the association between the screening tests, and referral to the geriatrician for complete geriatric screening, and adverse outcomes.ResultsThis study included 539 patients, of whom 276 were screened. Patients who underwent the GA, were significantly older and more often had advanced tumour stages compared to non-screened patients. Referral to the geriatrician was done for 30.8% of patients. Of the 130 patients who underwent surgery, 26/130 (20%) experienced clinically relevant postoperative complications. Of the 184 patients who underwent (radio)chemotherapy, 50/184 (27.2%) had clinically relevant treatment-related toxicity. Age, treatment intensity, polypharmacy and cognitive deficits, were independently associated with referral to geriatrician. A medium to high risk of malnutrition was independently associated with acute radiation induced toxicity and adverse outcomes in general.ConclusionThe current study showed a 30.8% referral rate for CGA by a geriatrician. Age, treatment intensity, cognitive deficits and polypharmacy were associated with higher rates of referral. Furthermore, nutritional status was found to be an important negative factor for adverse treatment outcomes, that requires attention.

Effect of anti-thyroid antibodies on recurrent miscarriage: A meta-analysis.

Previous studies addressed the association between anti-thyroid antibodies and recurrent miscarriage (RM), however, the role of anti-thyroid antibodies in RM patients is debatable. Therefore, we conducted this meta-analysis and the aim of this current study was to assess whether anti-thyroid peroxidase (anti-TPO) and/or anti-thyroglobulin (anti-TG) antibody positivity was associated with RM. A meta-analysis was conducted. Recurrent miscarriage patients. STATA 12.0 software were applied to compute odds ratios (ORs)/relative risks (RRs) and 95% CIs regarding association between anti-TPO and anti-TG antibodies and the prevalence of RM. N = 28 studies (8875 participants) explored effect of anti-thyroid antibodies on RM. Analysis of the 28 studies revealed significant association between anti-TPO, anti-TG antibodies and the prevalence of RM with a random effects model (OR/RR = 2.02; 95% CI: 1.63-2.51, p < 0.001; I2 = 44.3%, p value for Q test = 0.004). Analysis of the 20 studies revealed significant association between anti-TPO antibodies and the prevalence of RM with a random effects model (OR/RR = 1.59; 95% CI: 1.25-2.03, p < 0.001; I2 = 43.1%, p value for Q test = 0.022). Analysis of the 14 studies revealed significant association between anti-TG antibodies and the prevalence of RM with a random effects model (OR/RR = 2.25; 95% CI: 1.56-3.23, p < 0.001; I2 = 49.2%, p value for Q test = 0.019). Based on the currently available analysis, our findings suggest that women with anti-TPO and/or anti-TG antibodies have a higher risk of RM than that in negative antibody women. Further investigation is needed to better clarify the exact role of the anti-thyroid antibodies in RM and whether treatment is of benefit. First, differences from various detection methods and reagents used in different studies may affect the diagnostic interpretation of anti-thyroid antibodies, which might influence the accuracy of this meta-analysis. Second, positive anti-thyroid antibodies seem likely to be part of a more general disorder of maternal immune system, due to restrictions of funding and condition, a complete autoantibody screening investigation is hardly to conduct in all participants, and this could be a possible limitation of all included studies. Third, there is no mention of thyroxine therapy on RM, making the meta-analysis even more limited.

Implementation and Evaluation of a Large Community-Based Colorectal Cancer Screening Program.

Colorectal cancer (CRC) screening can significantly reduce incidence and mortality; however, screening rates are suboptimal. The lowest rates are among those with no usual source of care and the uninsured. We describe the implementation and evaluation of a community-based CRC screening program from 2012 to 2015 designed to increase screening within a predominantly Hispanic US-Mexico border population. The multicomponent, evidence-based program provided in-person, bilingual, culturally tailored health education facilitated by community health workers, no-cost primarily stool-based testing and diagnostic colonoscopy, and navigation. We recruited uninsured individuals due for CRC screening from clinics and community sites. An extensive qualitative and quantitative program process and outcome evaluation was conducted. In total, 20 118 individuals were approached, 8361 were eligible for screening; 74.8% completed screening and 74.6% completed diagnostic testing; 14 cancers were diagnosed. The mean age of participants was 56.8 years, and the majority were Hispanic, female, and of low socioeconomic status. The process evaluation gathered information that enabled effective program implementation and demonstrated effective staff training, compliance with processes, and high patient satisfaction. This program used a population-based approach focusing on uninsured individuals and proved successful at achieving high fecal immunochemical test kit return rates and colonoscopy completion rates. Key factors related to its success included tailoring the intervention to our priority population, strong partnerships with community-based sites and clinics, expertise in clinical CRC screening, and an active community advisory board. This program can serve as a model for similar populations along the border to increase CRC screening rates among the underserved.

Association Between Liver Fibrosis Score and Diabetic Kidney Disease: A Retrospective Cross-Sectional Study of Hospitalized Patients.

To investigate the association between liver fibrosis score and diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM). A total of 897 hospitalized patients with T2DM were included in this study. Each patient completed DKD screening. Logistic regression analysis was used to assess the predictive value of non-alcoholic fatty liver disease fibrosis score (NAFLD-FS) and fibrosis-4 (FIB-4) for the occurrence of DKD and risk for DKD progression, respectively. The prevalence of DKD and risk for its progression significantly increased with increasing NAFLD-FS risk category. DKD prevalence also increased with increasing FIB-4 risk category. Multivariate logistic regression analysis showed that the "high-risk" NAFLD-FS had a significantly higher risk of DKD (odds ratio [OR]: 1.89, 95% confidence interval [CI]: 1.16-3.08) and risk for DKD progression (OR: 2.88, 95% CI: 1.23-6.78), and the "intermediate-risk" FIB-4 had a significantly higher risk of DKD (OR: 1.41, 95% CI: 1.00-1.98). Subgroup analysis showed that the association between NAFLD-FS and FIB-4 and DKD was significant in the female subgroup, whereas the association between the "high-risk" NAFLD-FS and risk for DKD progression was significant in the male subgroup. NAFLD-FS and FIB-4 are strongly associated with DKD and risk for DKD progression in patients with T2DM. Additionally, sexual dimorphism exists in this association.

Screening for Colorectal Cancer.

Colorectal cancer (CRC) is the second leading cause of cancer death. Screening has been proven to reduce both cancer incidence and cancer-related mortality. Various screening tests are available, each with their own advantages and disadvantages and varying levels of evidence to support their use. Clinicians should offer CRC screening to average-risk persons aged 50 to 75 years; starting screening at age 45 years remains controversial. Screening may be beneficial in select persons aged 76 to 85 years, based on their overall health and screening history. Offering a choice of screening tests or sequentially offering an alternate test for those who do not complete screening can significantly increase participation.

The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: Asystematic review and network analysis.

To assess the comparative effectiveness and safety of parenteral agents for pain reduction in patients with acute migraine. Parenteral agents have been shown to be effective in treating acute migraine pain; however, the comparative effectiveness of different approaches is unclear. Nine electronic databases and gray literature sources were searched to identify randomized clinical trials assessing parenteral agents to treat acute migraine pain in emergency settings. Two independent reviewers completed study screening, data extraction, and Cochrane risk-of-bias assessment, with differences being resolved by adjudication. The protocol of the review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100096). A total of 97 unique studies were included, with most studies reporting a high or unclear risk of bias. Monotherapy, as well as combination therapy, successfully reduced pain scores prior to discharge. They also increased the proportion of patients reporting pain relief and being pain free. Across the pain outcomes assessed, combination therapy was one of the higher ranked approaches and provided robust improvements in pain outcomes, including lowering pain scores (mean difference -3.36, 95% confidence interval [CI] -4.64 to -2.08) and increasing the proportion of patients reporting pain relief (risk ratio [RR] 2.83, 95% CI 1.74-4.61). Neuroleptics and metoclopramide also ranked high in terms of the proportion of patients reporting pain relief (neuroleptics RR 2.76, 95% CI 2.12-3.60; metoclopramide RR 2.58, 95% CI 1.90-3.49) and being pain free before emergency department discharge (neuroleptics RR 4.8, 95% CI 3.61-6.49; metoclopramide RR 4.1, 95% CI 3.02-5.44). Most parenteral agents were associated with increased adverse events, particularly combination therapy and neuroleptics. Various parenteral agents were found to provide effective pain relief. Considering the consistent improvements across various outcomes, combination therapy, as well as monotherapy of either metoclopramide or neuroleptics are recommended as first-line options for managing acute migraine pain. There are risks of adverse events, especially akathisia, following treatment with these agents. We recommend that a shared decision-making model be considered to effectively identify the best treatment option based on the patient's needs.