Screening Events Research Articles

The COVID-19 pandemic has highlighted the need to invest in care home research infrastructure

The COVID-19 pandemic resulted in catastrophic levels of morbidity and mortality for care home residents. Despite this, research platforms for COVID-19 in care homes arrived late in the pandemic compared with other care settings. The Prophylactic Therapy in Care Homes Trial (PROTECT-CH) was established to provide a platform to deliver multi-centre cluster-randomized clinical trials of investigational medicinal products for COVID-19 prophylaxis in UK care homes. Commencing set-up in January 2021, this involved the design and development of novel infrastructure for contracting and recruitment, remote consent, staff training, research insurance, eligibility screening, prescribing, dispensing, and adverse event reporting; such infrastructure being previously absent. By the time this infrastructure was in place, the widespread uptake of vaccination in care homes had changed the epidemiology of COVID-19 rendering the trial unfeasible. Whilst some of the resources developed through PROTECT-CH will enable the future establishment of care home platform research, the near absence of care home trial infrastructure and nationally-linked databases involving the care home sector will continue to significantly hamper progress. These issues are replicated in most other countries. Beyond COVID-19, there are many other research questions that require addressing to provide better care to people living in care homes. PROTECT-CH has exposed a clear need for research funders to invest in, and legislate for, an effective care home research infrastructure as part of national pandemic preparedness planning. Doing so would also invigorate care home research in the interim, leading to improved healthcare delivery specific to those living in this sector.

The impact of breast density notification on rescreening rates within a population-based mammographic screening program

BackgroundHigh participation in mammographic screening is essential for its effectiveness to detect breast cancers early and thereby, improve breast cancer outcomes. Breast density is a strong predictor of breast cancer risk and significantly reduces the sensitivity of mammography to detect the disease. There are increasing mandates for routine breast density notification within mammographic screening programs. It is unknown if breast density notification impacts the likelihood of women returning to screening when next due (i.e. rescreening rates). This study investigates the association between breast density notification and rescreening rates using individual-level data from BreastScreen Western Australia (WA), a population-based mammographic screening program.MethodsWe examined 981,705 screening events from 311,656 women aged 40+ who attended BreastScreen WA between 2008 and 2017. Mixed effect logistic regression was used to investigate the association between rescreening and breast density notification status.ResultsResults were stratified by age (younger, targeted, older) and screening round (first, second, third+). Targeted women screening for the first time were more likely to return to screening if notified as having dense breasts (Percentunadjusted notified vs. not-notified: 57.8% vs. 56.1%; Padjusted = 0.016). Younger women were less likely to rescreen if notified, regardless of screening round (all P < 0.001). There was no association between notification and rescreening in older women (all P > 0.72).ConclusionsBreast density notification does not deter women in the targeted age range from rescreening but could potentially deter younger women from rescreening. These results suggest that all breast density notification messaging should include information regarding the importance of regular mammographic screening to manage breast cancer risk, particularly for younger women. These results will directly inform BreastScreen programs in Australia as well as other population-based screening providers outside Australia who notify women about breast density or are considering implementing breast density notification.

A Pilot Interdisciplinary Falls Screening and Educational Event: Perceptions of Community-Dwelling Older Adults

Introduction: Falls are the leading cause of death and disability among people 65 years of age and older. Likewise, falls have psychological consequences which often lead to avoidance of activities, fear of falling, and further disabilities. Even though the impact of falls on one’s daily life and independence are substantial, evidence suggests that falls can be prevented by multi-factorial assessments and client-specific interventions. Objective: The purpose of this study was to determine (a) perceived knowledge of falls, (b) reported confidence in fall prevention, (c) perceived likelihood of implementing falls screening recommendations, (d) reported fear of falling, and (e) perceived value and satisfaction among community-dwelling older adults who attended an interdisciplinary falls screening and education event. Methods: An interdisciplinary group of professionals from behavioral sciences, family medicine, occupational therapy, optometry, pharmacy, and physical therapy screened 33 community dwelling older adult participants (66-84 years of age) using multi-factorial assessments and discipline-specific screening tools. Individualized recommendations were provided to each participant in verbal and written formats. Participants then completed a questionnaire at the conclusion of the event regarding their perceptions of knowledge gained about falls, confidence in preventing falls, perceived likelihood of implementing fall screening recommendations, fear of falling, and overall feedback regarding the event. Results: The majority of the participants indicated increased perceived knowledge of falls, confidence in preventing falls, and perceived high likelihood of implementing recommendations, along with decreased fear of falling. The majority of the participants also found the event to be valuable (85%), enjoyable (94%), and easy to understand (100%). Conclusion: The results of this study suggest that participants found this falls screening event to be valuable and improved their knowledge regarding falls, as well as their confidence in being able to prevent falls. This study highlights the potential value of an interdisciplinary team approach to increase knowledge, enhance prevention, and decrease fear of falling in community dwelling older adults.

Healthcare costs of colorectal cancer screening and events following colonoscopy among commercially insured average-risk adults in the United States

Objective To examine the healthcare costs associated with colorectal cancer (CRC) screening and the frequency and costs of events potentially related to colonoscopy among average-risk adults. Methods In this cohort study, adults (ages 50–75 years) with CRC screening between 1/1/2014 and 6/30/2019 (index = earliest test) were selected from the IBM MarketScan Research databases. Individuals at above-average risk for CRC or with prior CRC screening were excluded. Frequency of utilization was reported by screening type: colonoscopy, fecal immunochemical test (FIT), fecal occult blood test (FOBT), multi-target stool DNA (mt-sDNA). For colonoscopy, frequency and costs of potential events were reported overall, by event type, and by an individual event in the 30 days after colonoscopy. Results Among the 333,306 average-risk adults, colonoscopy was the most common CRC screening modality (70.6%), followed by FIT (17.7%), FOBT (8.1%), and mt-sDNA (3.2%). The mean cost of a colonoscopy procedure was $2,125 and the mean out-of-pocket costs were $79. Serious gastrointestinal (GI) events were observed in 1.3% of individuals with colonoscopy, 1.9% had other GI events, and 1.2% had an incident cardiovascular event. Mean event-related costs were $2,631 among individuals with a serious GI event, $1,774 among individuals with any other GI event, and $4,234 among individuals with a cardiovascular event. Conclusions This study provides updated and more detailed information regarding the costs of CRC screening and potential colonoscopy events based on a comprehensive review of a robust claims dataset.

The Dartmouth Falls Prevention Training Program: Primary Care and Community-Based Organization Collaboration

Falls are a leading cause of fatal and non-fatal injuries in older adults. Older adult participation in community-based falls prevention programs can significantly reduce falls risk, however, identifying and referring individuals to appropriate programs can be challenging. Through Administration for Community Living (ACL) funding, we have developed a comprehensive Dartmouth Falls Prevention Training Program for healthcare and community based organizations that includes (1) Falls screening in primary care; (2) “Balance Days”, a community-based education and balance screening event encompassing falls risk stratification and coaching into programs; (3) Instructor Training for Tai Ji Quan: Moving for Better Balance®, a highly effective falls prevention program; and (4) Implementation Training, a research informed workshop shown to enhance community-based program sustainability through participant retention. We will share strategies for sustainable collaborations between primary care and CBOs to reach at-risk individuals and improve lives and decrease costs associated with falls.

Providing vouchers and value information for already free eye exams increases uptake among a low-income minority population: A randomized trial.

We study whether vouchers without and with value information encourage attendance of already free follow-up appointments among low-income minority individuals referred for evaluation of possible eye disease. Between May 2017 and September 2018, 821 individuals referred from 114 screening events across Baltimore City were offered (1) standard referral for a free follow-up appointment and prescription glasses, (2) a paper voucher described as redeemable for free follow-up and prescription glasses, or (3) an otherwise identical paper voucher which also indicated the monetary value of the appointment ($250). Under all three conditions, all referred individuals received the same patient education, counseling, and appointment reminders. We find that vouchers without and with value information increase follow-up by 12.5 and 20.3 percentage points, respectively, corresponding to a 36% and 58% increase compared to the standard referral for free follow-up (i.e., without a voucher). We conclude that using vouchers is a promising, low-cost approach to increase uptake of already free health services, particularly when the vouchers also provide value information.

Immersion and Socio-Emotional Experiences During a Movie - Polish Adaptation of the Movie Consumption Questionnaires.

The aim of the article is to present a description of the psychometric properties of the Polish adaptation of the Movie Consumption Questionnaires (MCQ) - Immersion and MCQ - Experience. The instrument, created by Fornerino, Helme-Guizon and Gotteland (2008) allows measuring movie consumption in terms of immersion, the intensity of emotions and the intensity of social interactions during the screening. The Polish adaptation of the tool involved two stages, whose participants were movie-goers attending screening events at a cinema (N=577). The factor structure of the adapted instrument strongly resembles that obtained in the original study (RMSEA<0.08, CFI>0.95, SRNR<0.08) and has demonstrated very good internal consistency (α>0.8, ω>0.8). Criterion validity was also verified through the use of questionnaires that examine the following: affect - PANAS-X (Fajkowska & Marszał-Wiśniewska, 2009), emotionality - HEXACO (Szarota et al., 2007) and mindfulness - Mindful Attention Awareness Scale (Skala Świadomej Obecności; Radoń, 2014). Results of the analyses suggest that the adapted scales may be used as satisfactory tools for measuring movie consumption. By the same token, they may be useful in further psychological exploration of the movie screening phenomenon, with particular regard to immersion, emotional reactions and social interactions of the viewer.

Relief, Development, Empowerment Part Three: Looking at the Larger Picture Amidst a Global Pandemic

Relief, Development, Empowerment Part Three: Looking at the Larger Picture Amidst a Global Pandemic

Abstract 13454: Cardiac Abnormalities in a Large Student Athletes Screening Cohort in Central Texas

Introduction: Sudden cardiac death (SCD) in the young is a rare but devastating event. Pre-participation evaluation is required prior to competitive sports. The Texas Adolescent Athlete Heart Screening Registry (TAAHSR) performs screening events including history, ECG and limited echocardiogram (ECHO). Hypothesis: Cardiac abnormalities are identified in athlete screening and challenges exist in long-term follow up. Methods: The TAAHSR database of 4309 participants between 2013-2020 was analyzed and follow up data obtained from phone and electronic medical records. Screening results were classified as: I - no abnormality (abnl) identified, II - abnl identified and further evaluation but no activity restriction recommended, level III - abnl identified and further evaluation with activity restriction recommended if concern for SCD. Results: Of 4309 participants, 218 (5%) screened positive on either ECG, ECHO, or both. ECG abnl were seen in 117/4309 (2.7%) level II and 23/4309 level III (0.5%). ECHO abnl were seen in 73/4309 (1.7%) level II and 13/4307 (0.3%) level III. The most frequent abnl in 218 positive screenings included: ECG - right ventricular hypertrophy (27, 12%), right bundle branch block (26, 12%), T-wave abnormalities (23, 10%), left ventricular hypertrophy (22, 10%), left axis deviation (17, 8%), Wolff-Parkinson-White (8, 4%); ECHO - bicuspid aortic valve (15, 7%), mitral valve prolapse (9, 4%), increased left ventricular trabeculations (9, 4%). The most frequent positive history in the cohort (218) was family history of heart disease (56, 25%), racing or skipped beats (30, 14%), chest pain after exercise (28, 13%), family history of SCD before age 50 (21, 10%). Follow up data was obtained, to date, in 130/218 (60%) positive screening participants and 72/130 (55%) had the suspected diagnosis confirmed. Of 130, 42 (32%) were reached and are alive at median follow up of 5.3 years. Conclusions: Our data shows 3.2% ECG and 2% ECHO positive screening for suspected cardiovascular abnl. Screening results may improve with better utilization of ECG criteria in athletes and lower referral based on ECHO findings that may represent normal pattern in certain populations. Follow up remains a challenge to determine long term outcomes of athlete screening.

Service Learning is Action Learning: A Novel Way to Increase Classroom Learning Retention

Abstract Introduction/Objective As educators, how do we ignite students to become effective and engaging ambassadors for the medical laboratory profession while making learning difficult concepts fun? This case study explores the use of service learning as an effective tool in nurturing advocacy for issues affecting the health and longevity of minority populations within the community, while learning hematological and blood banking concepts. Methods/Case Report Four MLT student cohorts comprised of twelve to sixteen students each participated in a ten- week, service-learning assignment as part of their Medical Laboratory Technician Curriculum. Assignment objectives were to: (1) understand racial /cultural history that preclude individuals from participating in hematopoietic stem cell donation and transplant; and, (2) develop and implement a strategy to recruit donors for the screening event. Students actively recruited across their college campus and surrounding communities to enroll one hundred new stem cell donors, with over fifty percent of these donors identifying as people of color. This activity represented ten percent of their course grade. Examples of assignments students were required to complete included: creating and implementation a donor recruitment strategy; reflection journal entries; host an in-person /virtual stem cell donor drive; and submission of an outcome assessment summarizing goal achievement along with lessons learned. Results (if a Case Study enter NA) N/A Conclusion As a result, students enrolled over 300 new stem cell donors into Be The Match™ - National Marrow Donor Program® resulting in seven successful transplants. Students learned how to effectively inform their community of the importance of clinical laboratory scientists, raising awareness of the need for clinical laboratory professionals and the need of genetically diverse individuals to volunteer as donors to provide the life-saving therapies.

Disruptions in cancer screening and diagnoses during the COVID-19 pandemic in 2020.

315 Background: The pandemic resulted in reductions in cancer screenings, potentially compromising the ability to detect cancers early. We add new data to this growing research, and report screening and cancer diagnosis (Dxs) rates for four cancer types: breast (BC), cervical (CC), colorectal (CRC), and lung (LC). To learn whether home-based cancer screening options for colorectal cancer exhibited similar patterns, we examined screening rates for fecal occult blood (FOBT), fecal immunochemical (FIT), and Cologuard (CG) tests. Methods: We conducted retrospective analyses using de-identified medical claims data (2018-2020) from a national US health insurer. To assess screening rates, no indication of cancer Dxs prior to screening event were included. BC screenings (BCS), LC screenings (LCS), and CRC screenings (CRCS) were identified from CPT and HCPCS codes for digital mammography, low dose CT-scans (LDCT), colonoscopies, and home-based CRC tests. CPT, HCPCS, and ICD-10 codes defined CC screenings (CCS). Cancer Dxs were defined if individuals had ≥1 claim with an ICD-10 cancer code and no prior cancer dx within 24 months of continuous eligibility. Advanced cancer Dxs (ADxs) were defined if a malignancy code on a claim with a date of service (DOS) within 60 days of diagnosis DOS was present. Screening and Dxs changes were compared circa mid-March (5 weeks prior and 5 weeks after). Adjustments were made for changes in enrollment. Results: The table summarizes screening changes. Dxs decreased circa shutdown in LC, BC, CS, and CRC by -40%, -61%, -55%, -55%, respectively. Compared to 2019, DXs decreased in LC, BC, CS, and CRC -19%, -16%, -6%, -18%, respectively. Compared to 2019, ADxs in LC, BC, and CRC were -14%, -9%, -8%, respectively. CS exhibited an increase in ADxs by 2%. Conclusions: The pandemic impacted cancer care for multiple cancer types. Dxs and ADxs decreased during the pandemic except advanced CS. While cancer screenings increased after the shutdown, only LCS and Cologuard returned to pre-pandemic levels by the end of 2020, though these had low utilization even in the periods prior to the pandemic. Limitations include that administrative programs supporting home-based tests (e.g. FIT and FOBT) may not generate claims, and procedures received may have been incorrectly coded. Future studies will assess the clinical impact of missed care and whether certain groups were disproportionately impacted.[Table: see text]

Cinema audience immersion in story worlds through "ouen-jouei"

In Japan, ouen-jouei (cheer screening) events permit novel forms of audience participation, with screened events allowing cheering, glowstick waving, and cosplaying. Fans immerse themselves in story worlds by physically performing at such ouen-jouei events. Ouen-jouei audience members become immersed in the film's story world through a process of negotiation between their physical state as a spectator and their imagined self as a story world character, as is demonstrated by ouen-jouei events associated with the 2016 Japanese animated film King of Prism. Theories associated with audience studies, media studies, and fan tourism are deployed to analyze this novel form of cinema audience immersion. It is impossible to physically integrate audience members and a film's story world, so fans' inner experiences become the primary concern.

Assessing Data Adequacy for High Blood Pressure Clinical Decision Support: A Quantitative Analysis.

This study examines guideline-based high blood pressure (HBP) and hypertension recommendations and evaluates the suitability and adequacy of the data and logic required for a Fast Healthcare Interoperable Resources (FHIR)-based, patient-facing clinical decision support (CDS) HBP application. HBP is a major predictor of adverse health events, including stroke, myocardial infarction, and kidney disease. Multiple guidelines recommend interventions to lower blood pressure, but implementation requires patient-centered approaches, including patient-facing CDS tools. We defined concept sets needed to measure adherence to 71 recommendations drawn from eight HBP guidelines. We measured data quality for these concepts for two cohorts (HBP screening and HBP diagnosed) from electronic health record (EHR) data, including four use cases (screening, nonpharmacologic interventions, pharmacologic interventions, and adverse events) for CDS. We identified 102,443 people with diagnosed and 58,990 with undiagnosed HBP. We found that 21/35 (60%) of required concept sets were unused or inaccurate, with only 259 (25.3%) of 1,101 codes used. Use cases showed high inclusion (0.9-11.2%), low exclusion (0-0.1%), and missing patient-specific context (up to 65.6%), leading to data in 2/4 use cases being insufficient for accurate alerting. Data quality from the EHR required to implement recommendations for HBP is highly inconsistent, reflecting a fragmented health care system and incomplete implementation of standard terminologies and workflows. Although imperfect, data were deemed adequate for two test use cases. Current data quality allows for further development of patient-facing FHIR HBP tools, but extensive validation and testing is required to assure precision and avoid unintended consequences.

Remote Patient Monitoring Identifies the Need for Triage in Patients with Acute COVID-19 Infection.

Introduction: Telehealth was frequently used in the provision of care and remote patient monitoring (RPM) during the COVID-19 pandemic. The Precision Recovery Program (PRP) remotely monitored and supported patients with COVID-19 in their home environment. Materials and Methods: This was a single-center retrospective cohort study reviewing data acquired from the PRP clinical initiative. Results: Of the 679 patients enrolled in the PRP, 156 patients were screened by a clinician following a deterioration in symptoms and vital signs on a total of 240 occasions, and included in the analyses. Of these 240 occasions, 162 (67%) were escalated to the PRP physician. Thirty-six patients were referred to emergency department, with 12 (7%) admitted to the hospital. The most common risk factors coinciding with hospital admissions were cardiac (67%), age >65 (42%), obesity (25%), and pulmonary (17%). The most common symptoms reported that triggered a screening event were dyspnea/tachypnea (27%), chest pain (14%), and gastrointestinal issues (8%). Vital signs that commonly triggered a screening event were pulse oximetry (15%), heart rate (11%), and temperature (9%). Discussion: Common factors (risk factors, vital signs, and symptoms) among patients requiring screening, triage, and hospitalization were identified, providing clinicians with further information to support decision making when utilizing RPM in this cohort. Conclusion: A clinician-led RPM program for patients with acute COVID-19 infection provided supportive care and screening for deterioration. Similar models should be considered for implementation in COVID-19 cohorts and other conditions at risk of rapid clinical deterioration in the home setting.

UtoPia: an early history of Pia and its role in Japan’s ‘self-made’ film culture

In 1972, the Japanese entertainment listings magazine Pia was established, providing information on film screenings, theatre and concert events happening in Tokyo each month. It quickly cultivated an engaged readership of teenagers and young adults. Among this readership were participants of a burgeoning nationwide phenomenon of do-it-yourself film production, referred to in Japanese as jishu seisaku eiga (meaning ‘self-made films’), which typically saw young, aspiring filmmakers produce short and feature-length narrative works using 8 mm (and sometimes 16 mm) film cameras. This article contextualises the emergence of Pia magazine and its role in centralising and providing opportunities to Japan’s growing ‘self-made’ filmmaking community throughout the 1970s, 1980s and beyond. This can be viewed on two fronts: firstly, from within the pages of the magazine itself and its strategies to stimulate reader-to-cinema engagement; and, secondly, through the magazine’s organisation of an annual self-made film screening event in the late 1970s that would come to be known as the Pia Film Festival (PFF). PFF remains an essential national showcase for new Japanese filmmakers to this day, but, more importantly, it would herald its own system of independent film production in the form of the PFF Scholarship. This article concludes with a discussion about the PFF Scholarship, and its importance at a time when early career filmmakers were struggling within the Japanese film industry.

Hospital complications among older adults: Better processes could reduce the risk of delirium

Using observational data and variation in hospital admissions across days of the week, we examined the association between ED boarding time and development of delirium within 72 hours of admission among patients aged 65+ years admitted to an inpatient neurology ward. We exploited a natural experiment created by potentially exogenous variation in boarding time across days of the week because of competition for the neurology floor beds. Using proportional hazard models adjusting for socio-demographic and clinical characteristics in a propensity score, we examined the time to delirium onset among 858 patients: 2/3 were admitted for stroke, with the remaining admitted for another acute neurologic event. Among all patients, 81.2% had at least one delirium risk factor in addition to age. All eligible patients received delirium prevention protocols upon admission to the floor and received at least one delirium screening event. While the clinical and social-demographic characteristics of admitted patients were comparable across days of the week, patients with ED arrival on Sunday or Tuesday were more likely to have had delayed floor admission (waiting time greater than 13 hours) and delirium (adjusted HR = 1.54, 95%CI:1.37-1.75). Delayed initiation of delirium prevention protocol appeared to be associated with greater risk of delirium within the initial 72 hours of a hospital admission.

Exploring local environmental change through filmmaking: The Lentes en Cambio Climático program

How can youth become leaders in their communities’ resilience efforts? The Lentes en Cambio Climático (LECC) filmmaking program aimed to empower students to investigate how a changing climate affects their lives and use their own findings to inspire local resilience. Secondary students in LECC created films that explore the experiences of community members and document local knowledge around climate topics relevant to their lives. A mixed-methods study measured the program impacts on students. Results from summer implementations in 2018 and 2019 suggest that participation in LECC increased students’ awareness, confidence, and engagement around climate topics and their interest in contributing to community resilience efforts. Additionally, by leading community discussions during film screening events, students gained confidence in their leadership roles, and ability to share their expertise with parents and community members. These conversations appeared to both empower students and amplify their voices as advocates for change in their communities. Supplemental data for this article is available online at https://doi.org/10.1080/00958964.2021.1949570 .

Challenges and Opportunities to Bolster the Effectiveness of Childhood Screening.

Challenges and Opportunities to Bolster the Effectiveness of Childhood Screening.

First experience in clinical application of hyperspectral endoscopy for evaluation of colonic polyps.

Early detection and resection of adenomatous polyps prevents their progression to colorectal cancer (CRC), significantly improving patient outcomes. Polyps are typically identified and removed during white-light colonoscopy. Unfortunately, the rate of interval cancers that arise between CRC screening events remains high, linked to poor visualization of polyps during screening and incomplete polyp removal. Here, we sought to evaluate the potential of a hyperspectral endoscope (HySE) to enhance polyp discrimination for detection and resection. We designed, built and tested a new compact HySE in a proof-of-concept clinical study. We successfully collected spectra from three tissue types in seven patients undergoing routine colonoscopy screening. The acquired spectral data from normal tissue and polyps, both pre- and post- resection, were subjected to quantitative analysis using spectral angle mapping and machine learning, which discriminated the data by tissue type, meriting further investigation of HySE as a clinical tool.

A minute with …

A minute with …