Organized Program Research Articles

Use of loop diuretics in chronic heart failure: do we adhere to the Hippocratian principle 'do no harm'?

Use of loop diuretics in chronic heart failure: do we adhere to the Hippocratian principle 'do no harm'?

The present scenario of colorectal cancer in Southeastern Brazil.

e18782 Background: Cancer is the second leading cause of death in the world and in Brazil. Most of colorectal cancers (CRC) are sporadic and occur in individuals over the age of 50. Since almost all CRC originate from a polyp , the early detection and excision of an adenomatous polyp is essential to avoid the adenoma-carcinoma sequence that occurs over the years. Most colorectal polyps are asymptomatic and identified during screening colonoscopies or in patients with positive fecal occult blood test . There is evidence that detecting and removing these cancer precursor lesions can prevent many cases of cancer and reduce mortality. The CRC are public health problem in Brazil and fulfills criteria to merit the implementation of a structured screening program. and in this sense, several medical societies recommend screening through organized programs and not just opportunistic as done in Brazil. It is believed that this strategy is related to late diagnosis and has impact on high mortality. Most evidence on CRC screening interventions comes from high-income countries. The large disparities in CRC incidence and mortality rates between high-income and low-income countries are attribute to screening. The study will evaluate the stage of colorectal cancer at diagnosis at Southeastern Brazil. Methods: We collected retrospective data of patients with CRC registered in the Hospital Evangélico de Cachoeiro de Itapemirim (HECI) Health Information System - SISRHC from 2010 to 2017 to know the clinical characteristics (TNM) of the patients diagnosed during this period, age and sex. From January 1, 2010 to December 31, 2017, 6,962 newly diagnosed cases of cancer were identified. Of this total, 676 (9.7%) were new cases of colorectal cancer. When submitting to the inclusion and exclusion criteria of the present study 91 cases were excluded (1 case under the age of 18 years; 64 cases that started their first cancer treatment before the pathological result; 26 cases without information from the anatomopathological diagnosis). Data from the remaining 585 cases were analyzed. Results: Among 585 analyzed, the distribution of stage at diagnosis was : 0 (0,68%), I 45 (7,69%), II 109 (18,63%), III 225 (38,45%), IV 129 (22,05%) and 73 (12,48%) had this information missing. Mean age at diagnosis was 62 years, with 411(70,50%) between ages 51-80 years. Regarding sex we found 306 (52,49%) male and 277 (47,51%) female. Conclusions: The results found in the studied population are in agreement with the literature regarding age at diagnosis and sex. Unfortunately demonstrates that most of colorectal,cancer in southeastern region of Brazil are diagnosed in late stages. The lack of screening is an explanation to this fact. Only the implemention of national organized screening program can improve cancer detection and provide better chances of cancer survival.

Advancing health equity in cancer care: The lived experiences of poverty and access to lung cancer screening.

Individuals living with low income are more likely to smoke, have a higher risk of lung cancer, and are less likely to participate in preventative healthcare (i.e., low-dose computed tomography (LDCT) for lung cancer screening), leading to equity concerns. To inform the delivery of an organized pilot lung cancer screening program in Ontario, we sought to contextualize the lived experiences of poverty and the choice to participate in lung cancer screening. At three Toronto academic primary-care clinics, high-risk screen-eligible patients who chose or declined LDCT screening were consented; sociodemographic data was collected. Qualitative interviews were conducted. Theoretical thematic analysis was used to organize, describe and interpret the data using the morphogenetic approach as a guiding theoretical lens. Eight participants chose to undergo screening; ten did not. From interviews, we identified three themes: Pathways of disadvantage (social trajectories of events that influence lung-cancer risk and health-seeking behaviour), lung-cancer risk and early detection (upstream factors that shape smoking behaviour and lung-cancer screening choices), and safe spaces of care (care that is free of bias, conflict, criticism, or potentially threatening actions, ideas or conversations). We illuminate how 'choice' is contextual to the availability of material resources such as income and housing, and how 'choice' is influenced by having access to spaces of care that are free of judgement and personal bias. Underserved populations will require multiprong interventions that work at the individual, system and structural level to reduce inequities in lung-cancer risk and access to healthcare services such as cancer screening.

Cancer Screening Interventions in Indigenous Populations: A Rapid Review.

Cancer screening is an important component of a cancer control strategy. Indigenous people in Canada have higher incidence rates for many types of cancer, including those that can be detected early or prevented through organized screening programs. Increased participation and retention in cancer screening is critical to improved population health outcomes amongst Indigenous people. This rapid review evaluates cancer screening interventions published in the last six years. Included studies demonstrated increased participation in breast, colorectal, or cervical cancer screening programs in Indigenous populations or showed promise of increased participation based on the factors that influence people’s screening practices, such as knowledge, attitude, or intent to screen. The Preferred Reporting Items for Systematic Reviews guided the search strategy. The review identified 85 articles with 12 meeting the specified criteria: seven studies reported an increase in cancer screening participation and five studies reported improved knowledge, attitude, or intent to screen. The use of multiple culturally appropriate strategies in co-designed studies were the most effective. This review will be used to inform First Nations (FN) populations and Screening Programs in Alberta of potential strategies to address disparities identified through a recent data analysis comparing cancer screening and outcomes between FN and non-FN people.

Six years of colorectal cancer mortality surveillance in the screening population for a risk stratified screening program

ObjectiveTo evaluate the impact of a colorectal cancer (CRC) risk predicting system on CRC mortality rates. MethodAn organized population screening program targeted at all the subjects (n = 102,076) at age 40–74 in nine towns of Jiashan county, China was conducted from 2007 to 2012. All of the screening participants were first triaged into high-risk & low-risk groups by a questionnaire and two fecal immunuochemical tests, only the high-risk subjects were subject to colonocopy. The screening participants were surveyed death caused by CRC for a total of six years after the enrollment. The CRC mortality in subgroups of the screening population was analyzed. ResultsA total of 82,184 (80.51 % of the targeted population) screening participants were identified. CRC death were recorded for 142 subjects (28.819 per 105 person-years). The age-adjusted relative risk(RR) of CRC death in the high-risk subjects (n = 12862, 84.48 per 105 person-years) was 3.92 (95 % CI = 2.81–5.49) compared with the low-risk subjects (n = 69322, 18.52 per 105 person-years). In the high-risk group, the age-adjusted RR of CRC death for those accepted colonoscopies (51.44 per 105 person-years) compared with those refused colonoscopies (187.94 per 105 person-years, P < 0.0001) was 0.34 (95 % CI = 0.21−0.56). The first three years after screening has seen the largest difference of CRC death hazard in both comparing groups. ConclusionThe high-risk subjects triaged by the risk predicting system have a higher CRC mortality rate than the low-risk subjects, especially in the first three years after screening. Refusal of colonoscopy is risky behavior for the high-risk subject.

Breast cancer screening patterns in Jamaican women: review of the largest national mammography clinic

BackgroundBreast cancer is the leading cause of cancer and cancer related deaths in Jamaican women. In Jamaica, women often present with advanced stages of breast cancer, despite the availability of screening mammography for early detection. The utilization of screening mammography for early breast cancer diagnosis seems to be limited, and this study investigated the national patterns of mammographic screening and the impact of mammography on the diagnosis of breast cancer in Jamaica.MethodsA retrospective analysis of the records of the largest mammography clinic in Jamaica was done for the period January 2011 to December 2016. Descriptive statistics was performed on relevant patient characteristics with calculation of rates and proportions; cross-tabulations were utilized to assess relationship of covariates being studied on the outcomes of interest. Results are reported in aggregate form with no identifiable patient data.Results48,203 mammograms were performed during the study period. 574 women (1.2%) had mammograms suspicious for breast cancer with median age of 57 years (range 30–95 years); 35% were under the age of 50. 4 women with suspicious findings had undergone ‘screening mammography’, with the remaining having ‘diagnostic mammography’. 38% reported previous mammograms, with a mean interval of 8 years between previous normal mammogram and mammogram suspicious for breast cancer. Median age at first screening mammogram was 51 years (range 41–77).ConclusionBreast cancer screening mammography is underutilized in Jamaica. An organized national breast cancer screening programme is recommended to improve adherence to international breast cancer screening guidelines.

Continued Participation of Israeli Adolescents in Online Sports Programs during the COVID-19 Pandemic Is Associated with Higher Resilience.

Background: Coronavirus disease 2019 (COVID-19) has forced adolescents to adapt rapidly to a new reality of physical and social distancing, while introducing a range of new sources of stress and adversity. Our primary aim was to study the relationship between adolescents’ resilience and their participation in online sports programs during the COVID-19 pandemic lockdown period. Our secondary aims were to assess the associations between the organized sports programs’ determinants and resilience. Methods: Online surveys designed to examine resilience, lifestyle, psychosocial health and characteristics of the organized sports programs were administered to 473 adolescents who were enrolled in organized sports programs before the COVID-19 pandemic. Results: Adolescents who continued to participate in online structured programs during the lockdown period were significantly more resilient and physically active, had higher self-related health, satisfaction with life, and ability to cope during the pandemic, compared to those who did not participate. Relationships with the adult instructor and levels of physical activity were the most important factors of the programs that were associated with resilience. Conclusions: Participation of adolescents in sports programs is an important resource associated with higher levels of resilience. Youth programs should continue their activities during globally challenging times, such as the COVID-19 pandemic.

Adenoma detection by Endocuff-assisted versus standard colonoscopy in an organized screening program: the “ItaVision” randomized controlled trial

The Endocuff Vision device (Arc Medical Design Ltd., Leeds, UK) has been shown to increase mucosal exposure, and consequently adenoma detection rate (ADR), during colonoscopy. This nationwide multicenter study assessed possible benefits and harms of using Endocuff Vision in a fecal immunochemical test (FIT)-based screening program. Patients undergoing colonoscopy after a FIT-positive test were randomized 1:1 to undergo Endocuff-assisted colonoscopy or standard colonoscopy, stratified by sex, age, and screening history. Primary outcome was ADR. Secondary outcomes were ADR stratified by endoscopists' ADR, advanced ADR (AADR), adenomas per colonoscopy (APC), withdrawal time, and adverse events. 1866 patients were enrolled across 13 centers. After exclusions, 1813 (mean age 60.1 years; male 53.8 %) were randomized (908 Endocuff Vision, 905 standard colonoscopy). ADR was significantly higher in the Endocuff Vision arm (47.8 % vs. 40.8 %; relative risk [RR] 1.17, 95 % confidence interval [CI] 1.06-1.30), with no differences between arms regarding size or morphology. When stratifying for endoscopists' ADR, only low detectors (ADR < 33.3 %) showed a statistically significant ADR increase (Endocuff Vision 41.1 % [95 %CI 35.7-46.7] vs. standard colonoscopy 26.0 % [95 %CI 21.3-31.4]). AADR (24.8 % vs. 20.5 %, RR 1.21, 95 %CI 1.02-1.43) and APC (0.94 vs. 0.77; P = 0.001) were higher in the Endocuff Vision arm. Withdrawal time and adverse events were similar between arms. Endocuff Vision increased ADR in a FIT-based screening program by improving examination of the whole colonic mucosa. Utility was highest among endoscopists with a low ADR.

Organized Breast and Cervical Cancer Screening: Attendance and Determinants in Southern Italy.

Simple SummaryAlthough the effectiveness of screening in reducing the mortality of breast and cervical cancer in the EU is established, the impact of these cancers continues to be substantial among women. The aims of this study were to evaluate the attendance to breast and cervical cancer screening and the role of related determinants in an area of Southern Italy. Only 49.7% of the sample reported to have undergone mammography in the previous two years, 27.7% within an organized program and 22% as an opportunistic procedure. The attendance to cervical cancer screening interval of three years was reported by 56.1% of women, 16.1% within an organized program and 40% as an opportunistic procedure. A very low attendance was thus detected for both breast and cervical cancer organized screening programs. A strong commitment to the promotion of these programs is urgently needed, also to support their role in the reduction of inequalities of attendance of disadvantaged women.The aims of this study were to evaluate the attendance to breast and cervical cancer screening and the related determinants in a low attendance area. A cross-sectional study was conducted among mothers of students attending secondary schools and university courses in Campania region, Southern Italy. Only 49.7% of the eligible women reported to have undergone mammography in the previous two years. Unemployed women, unsatisfied about their health status, with a family history of breast cancer, and having visited a physician in the previous 12 months were significantly more likely to have undergone mammography in the previous two years within an organized screening program. The attendance to cervical cancer screening in the interval of three years was reported to be 56.1% of women. Having a lower than graduation degree, being smokers, and having visited a physician in the previous 12 months were significant predictors of having had a Pap-smear in the previous three years in an organized screening program. In this study a very low attendance was found to both breast and cervical cancer organized screening programs. A strong commitment to their promotion is urgently needed, also to reduce inequalities of attendance of disadvantaged women.

WILLINGNESS TO BODY DONATION AMONG THE POPULATION OF CORDOBA IN ARGENTINA

Corpses are an irreplaceable resource for teaching and research in Anatomy. Voluntary donation is the source of cadavers, but in the National University of Cordoba we are struggling with a critical shortage due to the lack of an organized donation program. The objective of this study was to know the attitude of general population of the city of Cordoba about this subject and the profile of potential donors to develop a program. A survey was randomly distributed among older than 18 years. The questionnaire included demographic, educational, laboral and religious aspects and specific ones related to the willingness to donate the own body and reasons to do it, knowledge about this possibility, interest in further information. Two thousand and thirty responses were obtained from a population so diverse that we considered it as representative of the city. Among the respondents, 80% should be willing to donate organs for transplantation and 41% the whole body; with 45% who said to know about donation and 54% interested in more information. Main motives to donate were related to support teaching, research and science; while the main reason not to donate was associated with insuficient information. The profile of potential donors was obtained from the analysis of all the variables and we compared with other studies demonstrating that not only cultural and religious aspects may determine the willingness to donate but also the level of public information and facilities to register as donors.

Screening is associated with lower mastectomy rates in eastern Switzerland beyond stage effects

BackgroundA recent study found an influence of organized mammography screening programmes (MSPs) on geographical and temporal variation of mastectomy rates. We aimed to quantify the effect on the example of one of the cantonal programmes in Switzerland.MethodsWe used incidence data for the years 2010–2017 from the cancer registry of Eastern Switzerland. We included women with invasive-non-metastatic breast cancer (BC) in the screening age group 50–69-year-olds in the canton of St.Gallen. We compared mastectomy rates among cancer patients detected through the organised screening programme (MSP) vs. otherwise detected by stage.ResultsMSP-detected patients in St.Gallen presented with lower stages. 95% of MSP-detected had stages I-II vs 76% of Non-MSP-detected. Within all non-metastatic stage, tumour size and nodal status groups, MSP-detected patients had lower mastectomy rates, overall 10% vs 24% in 50–69-year-old non-participants. Their odds of receiving a mastectomy are about half of the Non-MSP-detected (OR = 0.48, p = 0.002).ConclusionsOur study showed that MSPs have a positive effect on lowering mastectomy rates. Screening participants are significantly less likely to receive a mastectomy compared to non-participants, which must be attributed to additional factors than just lower stages. Lower mastectomy rates lead to a higher quality of life for many patients.

A63 REFINING THE CANADIAN ASSOCIATION OF GASTROENTEROLOGY GUIDELINE ON SCREENING IN PERSONS WITH A FAMILY HISTORY OF NONHEREDITARY COLORECTAL CANCER OR ADENOMA: A MODIFIED DELPHI PROCESS

Abstract Background In 2018, the Canadian Association of Gastroenterology (CAG) published an extensive systematic review and guideline on screening in persons with a family history (FHx) of nonhereditary colorectal cancer (CRC) and adenoma. While CAG’s recommendations were evidence-based, some recommendations lacked precision (e.g. ranges for some start ages &amp; intervals) and screening cessation age was not addressed, leading to implementation challenges for practitioners and CRC screening programs. Aims To review and update the evidence since the 2018 guideline and to formulate implementable recommendations in the Ontario context that are aligned with the CAG guideline. Methods ColonCancerCheck (Ontario’s organized CRC screening program) conducted a modified version of the literature search used by CAG (Jan 2017 - Sept 2019). A 19-member expert panel with Canadian and international representatives from endoscopy, primary care, epidemiology, organized CRC screening programs, Ontario’s cancer system and the general public refined the recommendations of the CAG guideline for the purposes of implementation in an organized CRC screening program using a modified Delphi process. This iterative process involved a series of webinars and anonymous survey rounds where the panel reviewed evidence materials and provided online feedback to develop, refine &amp; achieve consensus on screening recommendations in persons with a FHx of CRC/adenoma. Consensus was achieved if ≥75% of members agreed or strongly agreed with the statement. Results Six new systematic reviews and 2 new guidelines were identified. New evidence included data on the absolute risk (10 year &amp; lifetime risk) of CRC by type of FHx, as well as the performance of fecal immunochemical testing (FIT) and barriers to CRC screening in persons with a FHx of CRC. The expert panel participated in 3 webinars and 4 online surveys to arrive at consensus. Panel recommendations and level of consensus will be reported for the 6 statements (Table). Conclusions Building from the CAG guideline, we derived evidence-based and implementable recommendations for screening persons with a FHx of CRC or adenoma. Funding Agencies Ontario Health (Cancer Care Ontario)

Status of medical physics education and training in AFOMP region.

Medical physicists are health professionals recognized by the International Labour Organization (ILO) and hence medical physicists working in a clinical environment should have the required competency and undergo a structured training program and residency under an experienced medical physicist in a recognized institution. Furthermore, medical physics is a rapidly growing area needing a high degree of knowledge and professional competency due to the rise in complexity of treatment procedures, increasing access to medical technology, and the requirement of coordination between the disciplines of medicine, physics and biomedical engineering. The unprecedented surge in medical physics competency in the last 2-3 decades is due to the implementation of specialized physics intensive procedures such as particle therapy, image-guided & intra-operative radiotherapy, advanced imaging and nuclear medicine techniques. In this scenario to handle this new technology era the quantity of qualified medical physicists needs to be in consonance with the competency needed. There is a special requirement for education and training of medical physicists which led to the opening of numerous educational programs around the world. The Asia-Oceania Federation of Organizations for Medical Physics (AFOMP) was founded in 2000 and today 19 countries national medical physicist associations (NMPO) are member of AFOMP. The AFOMP region is populated by over 4.5 billion people and socioeconomically is very diverse with GDP per capita as high as around US $60,000 [Australia] to as low as around US $750 [Nepal]. We conducted a survey by sending questionnaires to AFOMP NMPOs to assess the status of medical physics education and training in the region. We have received responses from 20 countries in the AFOMP region to the questionnaire. It was observed that 16 [80%] countries from AFOMP have well organized master program in medical physics, however only 8 [50%] programs were accredited and in only 9 [45%] countries are medical physicists registered as health professionals.

Gaps between recommendations and their implementation: A register-based study of follow-up after abnormalities in cervical cancer screening

Follow-up after screen-detected abnormalities is crucial for the success of cervical cancer screening programs but is usually not closely monitored in official screening statistics. We determined how the follow-up deviated from the recommendations in the Danish organized program. Using Danish nationwide population-based registers, the follow-up pathways of 60,199 women aged 23–59 with non-negative screening samples from 2012 to 2014 were mapped until end of 2018. We studied the timeliness and appropriateness of follow-up tests after cervical cytology screening and the total resource use in accordance with the national recommendations. Regression analyses were used to determine variations in adherence according to age, provider type, region, and history of abnormalities. Among women referred for immediate colposcopy, 91.3% (95% CI: 90.9%–91.6%) attended within four months as recommended, whereas up to about half of the women with a recommendation for a repeat test received this test either too early or very late. Overall, only 43% (95% CI: 42.9%–43.7%) of women with non-negative screening tests received the recommended follow-up, whereas 18% (95% CI: 17.6%–18.2%) received more than was recommended, 35% (95% CI: 34.4%–35.1%) received some follow-up but less than recommended and 4% (95% CI: 3.9%–4.2%) were not followed up at all. These proportions varied by screening diagnosis, woman's age, type of health care provider, region, and history of abnormalities. On average, women underwent more tests of each type than recommended by the guidelines. Deviations from follow-up recommendations are very frequent even in organized cervical screening programs and should be routinely monitored by screening program statistics.

Risk Factor Associations of Breast Cancer Among Women Attending Out-Patients Department of the Hospital: A Case vs. Control Study

Breast cancer is the first most common cancer in Indian women. The main factors that influence risk of breast cancer include being a woman and getting older, sociodemographic factors, family history of cancer, OCP, etc. The aim of the study was to report the sociodemographic factors, habits, personal history, clinical presentation of women and analyze risk factors with breast cancer in comparison with without breast cancer. This study is based on data collection from women (N = 606) from out-patients department of a regional cancer hospital who attended the Centre during the study period. Data analysis for 606 women showed the overall mean age of the participants was 39.32 ± 9.79 (mean ± SD) years with most (46.6%) of them belonging to the age group of 40–49 years. Most of them (39.6%) complain about feeling lumps inside the breast. Age at menarche starts at the age below 13 years, early marriage, parity more than 4, taking oral contraceptive pills as a method of contraception, do not feed to their child, most of them are housewife’s and have a family history of breast cancer. Age at menarche starts at the age below 13 years, early marriage, parity more than 4, taking oral contraceptive pills as a method of contraception, do not feed to the child and family history were highlighted as significant risk factors for breast cancer in Indian women. Hence, effective methods with routine organized screening programs are recommended to detect early breast cancer.

The Performance of Colorectal Cancer Screening in Brazil: The First Two Years of the Implementation Program in Barretos Cancer Hospital.

Colorectal cancer is the second most common cancer in Brazil. Yet, a nationally organized colorectal screening program is not implemented. Barretos Cancer Hospital (BCH) is one of the largest Brazilian institution that cares for underserved patients. BCH developed a fecal immunochemical test (FIT)-based organized colorectal cancer screening program to improve colorectal cancer outcomes.This study aims to present the quality/performance measures of the first 2 years of the FIT-based colorectal cancer screening program and its impact on the colorectal cancer disease stage. Between 2015 and 2017, a total of 6,737 individuals attending the Outpatient Department of Prevention or the Mobile Unit of BCH, which visits 18 cities of Barretos county, ages 50 to 65 years, were personally invited by a health agent/nurse practitioner. Exclusion criteria were personal history of colorectal cancer, adenomatous polyps, inflammatory bowel disease, and colonoscopy, or flexible sigmoidoscopy performed in the past 5 years. European Union (EU) guidelines for colorectal cancer screening programs were evaluated. Overall, 92.8% returned the FIT, with an inadequate examination rate of 1.5%. Among the 6,253 adequately tested, 12.5% had a positive result. The colonoscopy compliance and completion rates were 84.6 and 98.2%, respectively. The PPVs were 60.0%, 16.5%, and 5.6% for adenoma, advanced adenoma, and cancer, respectively. Stage distribution of screen-detected cancers shows earlier stages than clinically diagnosed colorectal cancer cancers reported at BCH and Brazilian cancer registries. Our colorectal cancer screening program achieved desirable quality metrics, aligned with the EU guidelines. The observed shift toward earlier colorectal cancer stages suggests an exciting opportunity to improve colorectal cancer-related cancers in Brazil.

Feasibility of implementing a national lung cancer screening program: Interim results from the Korean Lung Cancer Screening Project (K-LUCAS).

BackgroundLung cancer screening conducted in high-risk group using low-dose computer tomography (LDCT) has been reported as an effective method to reduce lung cancer mortality in two large randomized-control trials. However, the effectiveness is uncertain when lung cancer screening is expanded to a nationwide population-based program.MethodsThe Korean Lung Cancer Screening Project (K-LUCAS) is a single-arm cohort study that was conducted from February 2017 to evaluate the feasibility of implementing an organized national lung cancer screening program in Korea. High-risk population aged 55–74 years with more than a 30-pack-year smoking history was recruited. Smoking history was obtained from administering questionnaires at national health screening programs or public smoking cessation programs which are already established programs in Korea. The screening results were reported using the Lung Imaging Reporting and Data System (Lung-RADS), suggested by the American College of Radiology. K-LUCAS was performed by a network-based diagnosis supporting system using a computer-aided detection (CAD) program to maintain screening quality. Current smokers were provided with mandatory smoking counseling.ResultsAmong 71,829 participants aged 50 years or older in the national health screening program, 5,975 (8.3%) were eligible for lung cancer screening. Among them, 1,062 (17.8%) refused to participate in K-LUCAS. Additionally, 779 participants were recruited in the smoking cessation program. Thus, a total of 5,692 eligible high-risk participants were recruited in this study. Among them, 865 (15.2%) had positive screening results, which requires a further examination; 529 (9.3%) had Lung-RADS category 3 (indeterminate), and 336 (5.9%) had category 4 (suspicious of lung cancer); 42 (0.7%) had confirmed lung cancer. Approximately 66.7% had early-stage lung cancer: 24 (57.1%), stage I and 4 (9.5%), stage II. Six (1.1%) patients developed complications at the time of diagnosis, including one death. The anxiety level related to cancer screening was low. Participation in screening encouraged motivation to quit smoking.ConclusionsK-LUCAS provided promising evidence supporting the implementation of a national lung cancer screening program to detect early stage lung cancer and promote smoking cessation for participants in Asian population.

The utility of the adjusted-OPTIMIZE-HF risk model for predicting in-hospital length of stay in the Chinese population.

Various risk scores exist for predicting in-hospital mortality in patients with heart failure (HF), including the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) risk model. However, the relations between these risk scores and length of in-hospital stay (LOS) in patients with acute decompensated heart failure (ADHF) has not received much attention. We aim to explore the relationship between the adjusted-OPTIMIZE-HF risk model and LOS in the Chinese population. This was a single-center, retrospective study that enrolled a total of 4,481 patients with ADHF. We investigated the relation between a wide range of patient variables present at hospital admission, including those that comprise the adjusted-OPTIMIZE-HF risk model and LOS (primary outcome). We divided patients into a short LOS (n=2,177, LOS <6 days) and a long LOS (n=2,304, LOS ≥6 days) group. We then explored the relations between the adjusted-OPTIMIZE-HF risk score and LOS using logistic regression, receiver operating characteristic (ROC) curves, and subgroup analyses. A total of 4,481 people [61.6% male, median age 71 years (interquartile range, 16 years)] were included in this study. In univariate regression analyses, numerous variables were significantly different between the long and short LOS groups. Multivariate logistic regression showed that the adjustedOPTIMIZE-HF risk score had a significant predictive ability for LOS (OR 1.248, 95% CI: 1.094-1.424), P=0.001). The results of the ROC curve analysis [area under the curve (AUC) 0.583, 95% CI: 0.567-0.600] demonstrated the potential value of the risk score for predicting LOS. Finally, subgroup analyses showed that the risk score was not only predictive of LOS in the overall population, but also in subgroups of patients defined by gender, history of smoking, history of drinking, presence of hypertension, and diabetes. The adjusted-OPTIMIZE-HF risk model performed well in predicting LOS greater than 6 days in the Chinese patients with ADHF. Moreover, the model proved to be stable across subgroup analyses.

Cost-effectiveness of colonoscopy in an organized screening program.

Colorectal cancer (CRC) is a serious health problem, and various screening programs to reduce CRC have been introduced worldwide. However, the cost‑effectiveness of a program based on once‑in‑a‑lifetime colonoscopy in Poland is unknown. The main aim of this study was to assess the cost‑effectiveness of Polish Colonoscopy Screening Platform (PCSP), the colonoscopy screening program in Poland. A Markov model was constructed to compare the strategy of colonoscopy screening as compared with no screening in 100 000 subjects. The model was based on data collected from the nationwide Polish CRC screening program whenever possible. The incremental cost‑effectiveness ratio (ICER) was calculated and compared with the willingness‑to‑pay thresholds. A sensitivity analysis was also performed using the Monte Carlo simulation. Colonoscopy screening within PCSP resulted in a 18.9% reduction in CRC incidence and 19.8% reduction in CRC mortality. The strategy allowed a gain of 2317 life‑years saved (1959 after discount‑ ing). The cost of colonoscopy screening per participant examined was estimated at 267.70 USD (95% CI, 263.08-272.32 USD). The ICER was less than 6500 USD, which was much lower than the accepted willingness‑to‑pay thresholds, indicating that the screening was cost‑effective. Colonoscopy screening within the PCSP is cost‑effective and may have a substantial impact on the Polish society due to life‑years saved. The results have good informative value not only for health policy makers and medical practitioners, but also for health technology assessment.

Association of gut-related metabolites with outcome in acute heart failure

Trimethylamine N-oxide (TMAO), a gut-related metabolite, is associated with heart failure (HF) outcomes. However, TMAO is the final product of a complex metabolic pathway (ie, choline/carnitine) that has never been entirely investigated in HF. The present study investigates a panel of metabolites involved in the TMAO-choline/carnitine metabolic pathway for their associations with outcome in acute HF patients. In total, 806 plasma samples from acute HF patients were analyzed for TMAO, trimethyllysine, L-carnitine, acetyl-L-carnitine, γ-butyrobetaine, crotonobetaine, trimethylamine, betaine aldehyde, choline, and betaine using a developed liquid chromatography-tandem mass spectrometry method. Associations with outcome of all-cause mortality (death) and a composite of all-cause mortality and/or rehospitalization caused by HF (death/HF) at 30 days and 1 year were investigated. TMAO, trimethyllysine, L-carnitine, acetyl-L-carnitine, and γ-butyrobetaine were associated with death and death/HF at 30 days (short term; hazard ratio 1.30-1.49, P≤ .021) and at 1 year (long term; hazard ratio 1.15-1.25, P≤ .026) when adjusted for cardiac risk factors. L-carnitine and acetyl-L-carnitine were superior for short-term outcomes whereas TMAO was the superior metabolite for association with long-term outcomes. Furthermore, acetyl-L-carnitine and L-carnitine were superior for in-hospital mortality and improved risk stratification when combined with current clinical risk scores (ie, Acute Decompensated HEart Failure National REgistry, Organized Program To Initiate Lifesaving Treatment In Hospitalized Patients With Heart Failure, and Get With The Guidelines-Heart Failure; odds ratio (OR) ≥ 1.52, P≤ .020). Carnitine-related metabolites show associations with adverse outcomes in acute HF, in particular L-carnitine and acetyl-L-carnitine for short-term outcomes, and TMAO for long-term outcomes. Further studies are warranted to investigate the role and implications of carnitine metabolites including intervention in the pathogenesis of HF.