Hypothetical Screening Research Articles

Cost-effectiveness and cost utility of community screening for glaucoma in urban India

ObjectivesPopulation-based screening for glaucoma has been demonstrated to be cost-effective if targeted at high-risk groups such as older adults and those with a family history of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India. Study designA hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India. MethodsScreening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted. ResultsThe introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being ▪10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme. ConclusionsIn comparison with current practice (i.e. without a screening programme but with some opportunistic case finding), the introduction of a community screening programme for glaucoma for the 40–69 years age group is likely to be relatively cost-effective if implemented in the urban areas of India.

Testing whether barriers to a hypothetical screening test affect unrelated perceived benefits and vice versa: A randomised, experimental study

ObjectiveDetermine whether (fictitious) health screening test benefits affect perceptions of (unrelated) barriers, and barriers affect perceptions of benefits. MethodsUK adults were recruited via an online survey panel and randomised to receive a vignette describing a hypothetical screening test with either high or low benefits (higher vs. lower mortality reduction) and high or low barriers (severe vs. mild side-effects; a 2×2 factorial design). ANOVAs compared mean perceived benefits and barriers scores. Screening ‘intentions’ were compared using Pearson’s χ2 test. ResultsBenefits were rated less favourably when barriers were high (mean: 27.4, standard deviation: 5.3) than when they were low (M: 28.5, SD: 4.8; p=0.010, partial η2=0.031). Barriers were rated more negatively when benefits were low (M: 17.1, SD: 7.6) than when they were high (M: 15.7, SD: 7.3; p=0.023, partial η2=0.024). Most intended to have the test in all conditions (73–81%); except for the low benefit-high barrier condition (37%; p<0.0005; N=218). ConclusionsPerceptions of test attributes may be influenced by unrelated characteristics. Practice implicationsReducing screening test barriers alone may have suboptimal effects on perceptions of barriers if benefits remain low; increasing screening benefits may not improve perceptions of benefits if barriers remain high.

Comparing diagnostic tests on benefit-risk

ABSTRACTComparing diagnostic tests on accuracy alone can be inconclusive. For example, a test may have better sensitivity than another test yet worse specificity. Comparing tests on benefit risk may be more conclusive because clinical consequences of diagnostic error are considered. For benefit-risk evaluation, we propose diagnostic yield, the expected distribution of subjects with true positive, false positive, true negative, and false negative test results in a hypothetical population. We construct a table of diagnostic yield that includes the number of false positive subjects experiencing adverse consequences from unnecessary work-up. We then develop a decision theory for evaluating tests. The theory provides additional interpretation to quantities in the diagnostic yield table. It also indicates that the expected utility of a test relative to a perfect test is a weighted accuracy measure, the average of sensitivity and specificity weighted for prevalence and relative importance of false positive and false negative testing errors, also interpretable as the cost-benefit ratio of treating non-diseased and diseased subjects. We propose plots of diagnostic yield, weighted accuracy, and relative net benefit of tests as functions of prevalence or cost-benefit ratio. Concepts are illustrated with hypothetical screening tests for colorectal cancer with test positive subjects being referred to colonoscopy.

Adolescent Perceptions of Cholesterol Screening Results: “Young Invincibles” or Developing Adults?

PurposeGuidelines recommend cholesterol screening for all adolescents and young adults (AYAs) ages 17–21 years. Little is known about how screening results impact perceptions of AYA health. MethodsWe recruited 37 AYAs and 35 parents of AYAs with differing risk for abnormal cholesterol results: (1) familial hypercholesterolemia; (2) obesity; and (3) generally healthy. Participants completed quantitative health status ratings using visual analog scales (VASs) and semistructured interviews regarding three hypothetical cholesterol screening scenarios: (1) high likelihood of cardiovascular disease (CVD) before age 40 years (“high risk”); (2) some risk of CVD before age 70 years (“moderate risk”); and (3) low risk for CVD despite a strong family history of CVD (“low risk”). We analyzed VAS data with logistic regression and qualitative data with a priori and emergent coding using multiple coders. ResultsEach group perceived all three cholesterol screening scenarios as comparatively less than perfect health; the high-risk result fell furthest from perfect health. Although there was no significant difference between AYAs and parents in VAS ratings, qualitative analyses revealed AYAs were more likely than parents to discount the impact of moderate-risk results because of longer length of time before predicted CVD. ConclusionsAYAs' and parents' perceptions of the impact of cholesterol screening results on AYA health varied by presented scenario, ranging from mild to significant decreases in perceptions of AYA health. As universal cholesterol screening continues to be adopted in this age group, further studies of the real-life impact on AYA risk perceptions and subsequent behavior are warranted.

Immunochemical faecal occult blood testing to screen for colorectal cancer: can the screening interval be extended?

ObjectiveColorectal cancer (CRC) screening programmes based on faecal immunochemical testing for haemoglobin (FIT) typically use a screening interval of 2 years. We aimed to estimate how alternative FIT strategies that...

Cost-effectiveness analysis of hepatocellular carcinoma screening by combinations of ultrasound and alpha-fetoprotein among Alaska Native people, 1983–2012

BackgroundThe American Association for the Study of Liver Diseases (AASLD) recommends semi-annual hepatocellular carcinoma (HCC) screening using ultrasound (US) in persons with chronic hepatitis B (CHB) virus infection at high risk for HCC such as Asian males aged ≥40 years and Asian females aged ≥50 years.ObjectiveTo analyse the cost-effectiveness of 2 HCC screening methods in the Alaska Native (AN) health system: US-alone, or screening by alpha-fetoprotein (AFP) initially and switching to US for subsequent screenings if AFP >10 ng/mL (AFP→US).DesignA spreadsheet-based model was developed for accounting the costs of 2 hypothetical HCC screening methods. We used epidemiologic data from a cohort of 839 AN persons with CHB who were offered HCC screening by AFP/US semi-annually during 1983–2012. We assumed that compared with AFP→US, US-alone identifies 33% more tumours at an early stage (defined as a single tumour ≤5 cm or ≤3 tumours ≤3 cm in diameter). Years of life gained (YLG) attributed to screening was estimated by comparing additional years of survival among persons with early- compared with late-stage tumours. Screening costs were calculated using Medicare reimbursement rates in 2012. Future screening costs and YLG were projected over a 30-year time horizon using a 3% discount rate.ResultsThe total cost of screening for the cohort by AFP→US would have been approximately $357,000 ($36,000/early-stage tumour detected) compared to $814,000 ($59,000/early-stage tumour detected) by US-alone. The AFP→US method would have yielded an additional 27.8 YLG ($13,000/YLG) compared with 38.9 YLG ($21,000/YLG) for US-alone. Screening by US-alone would incur an additional $114,000 per extra early-tumour detected compared with AFP→US and $41,000 per extra YLG.ConclusionsAlthough US-alone HCC screening might have yielded more YLG than AFP→US, the reduced costs of the AFP→US method could expand access to HCC screening in resource constrained settings.

The costs of offering HPV-testing on self-taken samples to non-attendees of cervical screening in Finland.

BackgroundOffering self-sampling to non-attendees of cervical screening increases screening attendance.MethodsWe used observations from two Finnish studies on the use of self-sampling among the non-attendees to estimate in a hypothetical screening population of 100,000 women the possible costs per extra screened woman and costs per extra detected and treated CIN2+ with three intervention strategies; 1) a primary invitation and a reminder letter, 2) a primary invitation and a mailed self-sampling kit and 3) two invitation letters and a self-sampling kit. The program costs were derived from actual performance and costs in the original studies and a national estimate on management costs of HPV related diseases.ResultsThe price per extra participant and price per detected and treated CIN2+ lesion was lower with a reminder letter than by self-sampling as a first reminder. When self-sampling was used as a second reminder with a low sampler price and a triage Pap-smear as a follow-up test for HPV-positive women instead of direct colposcopy referral, the eradication of a CIN2+ lesion by self-sampling was not more expensive than in routine screening, and the addition of two reminders to the invitation protocol did not increase the price of an treated CIN2+ lesion in the entire screened population.ConclusionsAs a first reminder, a reminder letter is most likely a better choice. As second reminder, the higher costs of self-sampling might be compensated by the higher prevalence of CIN2+ in the originally non-attending population.

Practicing Evidence-Based Medicine

Today, a plethora of resources for evidence-based medicine (EBM) are available via alert services, compendia, and more. In theory, a clinician researching a topic or looking for information regarding a clinical decision should easily find the literature or synopses needed. However, the real challenge lies in recognizing which resources (out of hundreds or possibly thousands) present the best and most reliable evidence. As well, evidence from research is only part of the decision calculus, and the clinician, not the evidence, makes the final decisions. Medical decision analysis attempts to formalize the process and reduce it to algebra, but it is difficult or impossible to represent all the components of a decision mathematically and validly let alone do so in “real time” for individual patients. This review discusses these challenges and more, including how to ask answerable questions, understand the hierarchy for evidence-based information resources, critically appraise evidence, and apply research results to patient care. Figures show the total number of new articles in Medline from 1965 to 2012, a “4S” hierarchy of preappraised medicine, percentage of physician and medical student respondents with a correct or incorrect answer to a question about calculating the positive predictive value of a hypothetical screening test, a nomogram for Bayes’s rule, an example of nomogram use for pulmonary embolism, and a model for evidence-informed clinical decisions. Tables list selected barriers to the implementation of EBM; Patient, Intervention, Comparison, and Outcome (PICO) framework for formulating clinical questions; guides for assessing medical texts for evidence-based features; clinically useful measures of disease frequency and statistical significance and precision; definitions of clinically useful measures of diagnostic test performance and interpretation; definitions of clinically useful measures of treatment effects from clinical trials; summary of results and derived calculations from the North American Symptomatic Carotid Endarterectomy Trial (NASCET); and selected number needed to treat values for common therapies. This review contains 6 highly rendered figures, 9 tables, and 28 references.

Transformation of the Visual Afterimage Under Subject's Eye and Body Movements and the Visual Field Constancy Mechanisms.

Two types of positive afterimages differing in their structural complexity--called poor and rich--were used to investigate the visual field constancy mechanisms during eye and head movements. In the case of a poor afterimage, consistent with Emmert's law, every eye and head movement caused the afterimage to appear moving (in exactly the same way), unlike a real object, which appeared to remain stationary during those same eye and head movements (although its retinal image moved opposite to the eye movement). However, in the case of a rich afterimage, the afterimage appeared stationary during eye movements, while a small stationary test light in the real space appeared to move, violating Emmert's law. It is suggested that, in these two cases, the different apparent transformations reflected functioning of different constancy mechanisms. Both mechanisms implement projection of retinal images upon a hypothetical constant visual screen in strict accordance with the subject's movements but in two different ways. The experiments have indicated that, during binocular fusion, the visual afferent system is able to use information from the structural organization of the visual flow to implement the visual field stability and to calculate gaze direction independently of proprioceptive signals.

What women think: hypothetical notions of screening for intimate partner violence in Kenyan hospital settings

reproductive health and HIV clinic). Data were collected by two female interviewers who were not involved in the clinical management of the respondents. These data were generated in response to hypothetical questions posed to women to assess the extent to which IPV screening would be acceptable to, and useful for, them. The indepth interviews were hand-recorded verbatim and typed up in MS Word. Data were analyzed using content analysis techniques primarily, with codes developed and configured along lines of topical inquiry. Additional codes were developed based on emerging themes that seemed important for determining the utility of IPV screening. Dominant themes depicting women’s main thoughts about IPV screening are presented here. Results: what women think Qualitative analysis suggested that women’ so pinions about hypothetical IPV screening protocols in this Kenyan context are shaped by their concerns about confidentiality; the need to raise awareness around IPV and available care; gaps in the health care system that translate to unmet needs of survivors; and the need for clear-cut responses to IPV that do not promise more than can be realistically offered. While there is some overlap between these themes, each is presented separately, and verbatim quotes from respondents are labelled according to the location at which the respondent sought care. Provider distance could help facilitate screening The women in this study perceived that the involvement of health providers (particularly - but not solely - doctors) in the screening and referral process would serve to greatly enhance the chances of survivors complying with referrals for IPV care. Providers in hospital settings were seen by

Practicing Evidence-Based Medicine

Today, a plethora of resources for evidence-based medicine (EBM) are available via alert services, compendia, and more. In theory, a clinician researching a topic or looking for information regarding a clinical decision should easily find the literature or synopses needed. However, the real challenge lies in recognizing which resources (out of hundreds or possibly thousands) present the best and most reliable evidence. As well, evidence from research is only part of the decision calculus, and the clinician, not the evidence, makes the final decisions. Medical decision analysis attempts to formalize the process and reduce it to algebra, but it is difficult or impossible to represent all the components of a decision mathematically and validly let alone do so in “real time” for individual patients. This review discusses these challenges and more, including how to ask answerable questions, understand the hierarchy for evidence-based information resources, critically appraise evidence, and apply research results to patient care. Figures show the total number of new articles in Medline from 1965 to 2012, a “4S” hierarchy of preappraised medicine, percentage of physician and medical student respondents with a correct or incorrect answer to a question about calculating the positive predictive value of a hypothetical screening test, a nomogram for Bayes’s rule, an example of nomogram use for pulmonary embolism, and a model for evidence-informed clinical decisions. Tables list selected barriers to the implementation of EBM; Patient, Intervention, Comparison, and Outcome (PICO) framework for formulating clinical questions; guides for assessing medical texts for evidence-based features; clinically useful measures of disease frequency and statistical significance and precision; definitions of clinically useful measures of diagnostic test performance and interpretation; definitions of clinically useful measures of treatment effects from clinical trials; summary of results and derived calculations from the North American Symptomatic Carotid Endarterectomy Trial (NASCET); and selected number needed to treat values for common therapies. This review contains 6 highly rendered figures, 9 tables, and 28 references.

Practicing Evidence-Based Medicine

Today, a plethora of resources for evidence-based medicine (EBM) are available via alert services, compendia, and more. In theory, a clinician researching a topic or looking for information regarding a clinical decision should easily find the literature or synopses needed. However, the real challenge lies in recognizing which resources (out of hundreds or possibly thousands) present the best and most reliable evidence. As well, evidence from research is only part of the decision calculus, and the clinician, not the evidence, makes the final decisions. Medical decision analysis attempts to formalize the process and reduce it to algebra, but it is difficult or impossible to represent all the components of a decision mathematically and validly let alone do so in “real time” for individual patients. This review discusses these challenges and more, including how to ask answerable questions, understand the hierarchy for evidence-based information resources, critically appraise evidence, and apply research results to patient care. Figures show the total number of new articles in Medline from 1965 to 2012, a “4S” hierarchy of preappraised medicine, percentage of physician and medical student respondents with a correct or incorrect answer to a question about calculating the positive predictive value of a hypothetical screening test, a nomogram for Bayes’s rule, an example of nomogram use for pulmonary embolism, and a model for evidence-informed clinical decisions. Tables list selected barriers to the implementation of EBM; Patient, Intervention, Comparison, and Outcome (PICO) framework for formulating clinical questions; guides for assessing medical texts for evidence-based features; clinically useful measures of disease frequency and statistical significance and precision; definitions of clinically useful measures of diagnostic test performance and interpretation; definitions of clinically useful measures of treatment effects from clinical trials; summary of results and derived calculations from the North American Symptomatic Carotid Endarterectomy Trial (NASCET); and selected number needed to treat values for common therapies. This review contains 6 highly rendered figures, 9 tables, and 28 references.

Practicing Evidence-Based Medicine (SAGHE)

Today, a plethora of resources for evidence-based medicine (EBM) are available via alert services, compendia, and more. In theory, a clinician researching a topic or looking for information regarding a clinical decision should easily find the literature or synopses needed. However, the real challenge lies in recognizing which resources (out of hundreds or possibly thousands) present the best and most reliable evidence. As well, evidence from research is only part of the decision calculus, and the clinician, not the evidence, makes the final decisions. Medical decision analysis attempts to formalize the process and reduce it to algebra, but it is difficult or impossible to represent all the components of a decision mathematically and validly let alone do so in “real time” for individual patients. This review discusses these challenges and more, including how to ask answerable questions, understand the hierarchy for evidence-based information resources, critically appraise evidence, and apply research results to patient care. Figures show the total number of new articles in Medline from 1965 to 2012, a “4S” hierarchy of preappraised medicine, percentage of physician and medical student respondents with a correct or incorrect answer to a question about calculating the positive predictive value of a hypothetical screening test, a nomogram for Bayes’s rule, an example of nomogram use for pulmonary embolism, and a model for evidence-informed clinical decisions. Tables list selected barriers to the implementation of EBM; Patient, Intervention, Comparison, and Outcome (PICO) framework for formulating clinical questions; guides for assessing medical texts for evidence-based features; clinically useful measures of disease frequency and statistical significance and precision; definitions of clinically useful measures of diagnostic test performance and interpretation; definitions of clinically useful measures of treatment effects from clinical trials; summary of results and derived calculations from the North American Symptomatic Carotid Endarterectomy Trial (NASCET); and selected number needed to treat values for common therapies. This review contains 6 highly rendered figures, 9 tables, and 28 references.

Practicing Evidence-Based Medicine

Today, a plethora of resources for evidence-based medicine (EBM) are available via alert services, compendia, and more. In theory, a clinician researching a topic or looking for information regarding a clinical decision should easily find the literature or synopses needed. However, the real challenge lies in recognizing which resources (out of hundreds or possibly thousands) present the best and most reliable evidence. As well, evidence from research is only part of the decision calculus, and the clinician, not the evidence, makes the final decisions. Medical decision analysis attempts to formalize the process and reduce it to algebra, but it is difficult or impossible to represent all the components of a decision mathematically and validly let alone do so in “real time” for individual patients. This review discusses these challenges and more, including how to ask answerable questions, understand the hierarchy for evidence-based information resources, critically appraise evidence, and apply research results to patient care. Figures show the total number of new articles in Medline from 1965 to 2012, a “4S” hierarchy of preappraised medicine, percentage of physician and medical student respondents with a correct or incorrect answer to a question about calculating the positive predictive value of a hypothetical screening test, a nomogram for Bayes’s rule, an example of nomogram use for pulmonary embolism, and a model for evidence-informed clinical decisions. Tables list selected barriers to the implementation of EBM; Patient, Intervention, Comparison, and Outcome (PICO) framework for formulating clinical questions; guides for assessing medical texts for evidence-based features; clinically useful measures of disease frequency and statistical significance and precision; definitions of clinically useful measures of diagnostic test performance and interpretation; definitions of clinically useful measures of treatment effects from clinical trials; summary of results and derived calculations from the North American Symptomatic Carotid Endarterectomy Trial (NASCET); and selected number needed to treat values for common therapies. This review contains 6 highly rendered figures, 9 tables, and 28 references.

Don’t just do something, stand there

Imagine a (hypothetical) screening test which, done in a population of average risk, saves one person from dying from cancer out of every 10,000 people screened. Imagine as well that every one of those 10,000 pays a price in terms of time and money spent, as well as discomfort, and that some or even many of them will also have to deal with increased anxiety, repeat testing, biopsies, and in a few cases, surgery. Finally, a few will have serious adverse effects like infection or organ failure.

Modeling of Leaked Digital Video Signal and Information Recovery Rate as a Function of SNR

Substantial information leakage at PC monitors and TV systems arises in the form of unintentional emissions of high-speed digital video signals, such as DVI/HDMI. The information recovery rate from the emanated video signal varies depending on the SNR of the receiver system, which is placed a certain distance away. In this study, a situation in which the signal from a digital video system is intercepted is modeled using full-wave electromagnetic and circuit simulations. For a quantitative evaluation of the eavesdropping threat of display systems and the effect of its countermeasure, the readability of characters on a hypothetical screen as a function of the BER of the recovery signals is presented. It is clear that a decrease of the SNR of the received signal causes a deterioration of the digital video signal-recovery rate and consequently degrades the legibility of the characters on the intercepted screen. It is expected that these techniques can be useful for measurements and analyses of the effects of countermeasures, such as noise jamming or signal modulation, to prevent interceptions of digital video information.

Random blood glucose: a robust risk factor for type 2 diabetes.

Although random blood glucose (RBG) values are common in clinical practice, the role of elevated RBG values as a risk factor for type 2 diabetes is not well described. This study aimed to examine nondiagnostic, RBG values as a risk factor for type 2 diabetes This was a cross-sectional study of National Health and Nutrition Examination Surveys (NHANES) participants (2005-2010). Nonfasting NHANES participants (n = 13 792) without diagnosed diabetes were included. The primary outcome was glycemic status (normal glycemia, undiagnosed prediabetes, or undiagnosed diabetes) using hemoglobin HbA1C as the criterion standard. Multinomial logistic regression examined associations between diabetes risk factors and RBG values according to glycemic status. Associations between current U.S. screening strategies and a hypothetical RBG screening strategy with undiagnosed diabetes were examined. In unadjusted analyses, a single RBG ≥ 100 mg/dL (5.6 mmol/L) was more strongly associated with undiagnosed diabetes than any single risk factor (odds ratio [OR], 31.2; 95% confidence interval [CI], 21.3-45.5) and remained strongly associated with undiagnosed diabetes (OR, 20.4; 95% CI, 14.0-29.6) after adjustment for traditional diabetes risk factors. Using RBG < 100 mg/dL as a reference, the adjusted odds of undiagnosed diabetes increased significantly as RBG increased. RBG 100-119 mg/dL (OR 7.1; 95% CI 4.4-11.4); RBG 120-139 mg/dL (OR 30.3; 95% CI 20.0-46.0); RBG ≥ 140 mg/dL (OR 256; 95% CI 150.0-436.9). As a hypothetical screening strategy, an elevated RBG was more strongly associated with undiagnosed diabetes than current United States Preventative Services Task Force guidelines (hypertension alone; P < .0001) and similar to American Diabetes Association guidelines (P = .12). A single RBG ≥ 100 mg/dL is more strongly associated with undiagnosed diabetes than traditional risk factors. Abnormal RBG values are a risk factor for diabetes and should be considered in screening guidelines.

Targeted screening of individuals at high risk for pancreatic cancer: results of a simulation model.

To identify when, from the standpoint of relative risk, magnetic resonance (MR) imaging-based screening may be effective in patients with a known or suspected genetic predisposition to pancreatic cancer. The authors developed a Markov model of pancreatic ductal adenocarcinoma (PDAC). The model was calibrated to National Cancer Institute Surveillance, Epidemiology, and End Results registry data and informed by the literature. A hypothetical screening strategy was evaluated in which all population individuals underwent one-time MR imaging screening at age 50 years. Screening outcomes for individuals with an average risk for PDAC ("base case") were compared with those for individuals at an increased risk to assess for differential benefits in populations with a known or suspected genetic predisposition. Effects of varying key inputs, including MR imaging performance, surgical mortality, and screening age, were evaluated with a sensitivity analysis. RESULTS In the base case, screening resulted in a small number of cancer deaths averted (39 of 100 000 men, 38 of 100 000 women) and a net decrease in life expectancy (-3 days for men, -4 days for women), which was driven by unnecessary pancreatic surgeries associated with false-positive results. Life expectancy gains were achieved if an individual's risk for PDAC exceeded 2.4 (men) or 2.7 (women) times that of the general population. When relative risk increased further, for example to 30 times that of the general population, averted cancer deaths and life expectancy gains increased substantially (1219 of 100 000 men, life expectancy gain: 65 days; 1204 of 100 000 women, life expectancy gain: 71 days). In addition, results were sensitive to MR imaging specificity and the surgical mortality rate. Although PDAC screening with MR imaging for the entire population is not effective, individuals with even modestly increased risk may benefit.

Treating Taylor: Multidisciplinary Management of Eating Disorders

OPEN ACCESSOctober 30, 2014Treating Taylor: Multidisciplinary Management of Eating Disorders Kendrin Sonneville, ScD, RD, Melissa Freizinger, Sara Forman, Pamela Burke, Adrianne Goncalves, Sarah Pitts, Holly Gooding Kendrin Sonneville, ScD, RD Boston Children's Hospital Google Scholar More articles by this author , Melissa Freizinger Boston Children's Hospital, Division of Adolescent Medicine Google Scholar More articles by this author , Sara Forman Boston Children's Hospital, Division of Adolescent Medicine Google Scholar More articles by this author , Pamela Burke Boston Children's Hospital, Division of Adolescent Medicine Google Scholar More articles by this author , Adrianne Goncalves Boston Children's Hospital, Division of Adolescent Medicine Google Scholar More articles by this author , Sarah Pitts Boston Children's Hospital, Division of Adolescent Medicine Google Scholar More articles by this author , Holly Gooding Boston Children's Hospital, Division of Adolescent Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9938 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: Eating disorders (EDs) are a source of significant morbidity and mortality among youth in the United States. The lifetime prevalence rates of anorexia nervosa, bulimia nervosa, and binge eating disorder during adolescents are 0.3%, 0.9%, and 1.6%, respectively. Partial syndrome EDs affect up to 20% of the general adolescent population and many more adolescents engage in extreme weight control behaviors. EDs are associated with substantial psychiatric comorbidities and, because no organ system is spared the effects of EDs, the medical complications can be serious or even life-threatening. Treatment of such disorders requires a collaborative approach by a multidisciplinary team of mental health, nutrition, and medical specialists. This evolving case allows trainees to develop skills in the assessment, treatment, and management of EDs with an emphasis on the role of the multidisciplinary team. Methods: Students review, discuss, and ultimately develop a treatment plan for Taylor, a 13 year-old girl diagnosed with an ED. The students review the case over five sessions that cover ED assessment, diagnosis, and treatment modalities. During the final session students are encouraged to design a hypothetical eating disorder screening program. Results: This case has been used successful with a multidisciplinary group of postgraduate health care professionals training in adolescent health in 2 consecutive years. Learners reported on standard pre- and postcase 4-point Likert-type scales (4 = very confident) that the case experience improved their confidence in their ability to assess adolescents with eating disorders (pre = 3.0, post = 3.6), to diagnose eating disorders in adolescents (pre = 2.7, post = 3.4), to counsel adolescents with eating disorders (pre = 2.4, post = 3.1), and to devise a treatment plan for these youth (pre = 2.6, post = 3.3). Discussion: This case provides an opportunity for trainees to explore barriers and challenges common to the clinical management of EDs while also providing exposure to current trends and evidence in the prevention and treatment of EDs. The case introduces trainees to aspects of program development and allows trainees to identify opportunities for advocacy and leadership. Educational Objectives By the end of this session, learners will be able to: Assess a patient with an eating disorder (ED).Understand the differential diagnosis for weight loss in the adolescent.Compare diagnostic criteria of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).Set developmentally appropriate weight goals for an ED patient.Describe prevalence and correlates of AN, BN, and BED.Describe common misconceptions about eating disorders.Explain the tenets of family-based treatment for EDs.Compare common tools used in screening for EDs.Identify common comorbidities seen among individuals with an ED. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Treating Taylor Instructors Guide.doc Treating Taylor Case.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Related Treating Taylor: Multidisciplinary Management of Eating Disorders Transitioning Bryan: The Transition to Adulthood and the Medical Home Copyright & Permissions© 2014 Sonneville et al. This is an open-access article distributed under the terms of the Creative Commons Attribution license.KeywordsMedicineInterdisciplinaryNursingNutritionSocial WorkEating DisordersInterdisciplinary StudiesAdolescentPsychology Disclosures None to report. Funding/Support None to report. Loading ...

The Impact of Uncertainty in Barrett's Esophagus Progression Rates on Hypothetical Screening and Treatment Decisions.

Estimates for the annual progression rate from Barrett's esophagus (BE) to esophageal adenocarcinoma (EAC) vary widely. In this explorative study, we quantified how this uncertainty affects the estimates of effectiveness and efficiency of screening and treatment for EAC. We developed 3 versions of the University of Washington / Microsimulation Screening Analysis-EAC model. The models differed with respect to the annual progression rate from BE to EAC (0.12% or 0.42%) and the possibility of spontaneous regression of dysplasia (yes or no). All versions of the model were calibrated to the observed Surveillance, Epidemiology, and End Results esophageal cancer incidence rates from 1998 to 2009. To identify the impact of natural history, we estimated the incidence and deaths prevented as well as numbers needed to screen (NNS) and treat (NNT) of a one-time perfect screening at age 65 years that detected all prevalent BE cases, followed by a perfect treatment intervention. Assuming a perfect screening and treatment intervention for all patients with BE, the maximum EAC mortality reduction (64%-66%) and the NNS per death prevented (470-510) were similar across the 3 model versions. However, 3 times more people needed to be treated to prevent 1 death (24 v. 8) in the 0.12% regression model compared with the 0.42% progression model. Restricting treatment to those with dysplasia or only high-grade dysplasia resulted in smaller differences in NNT (2-3 to prevent one EAC case) but wider variation in effectiveness (mortality reduction of 15%-24%). The uncertainty in the natural history of the BE to EAC sequence influenced the estimates of effectiveness and efficiency of BE screening and treatment considerably. This uncertainty could seriously hamper decision making about implementing BE screening and treatment interventions.