Screening Guidelines Research Articles

Investigation of Iranian Family Physicians’ Knowledge Toward Colorectal Cancer Screening, Risk Factors, and Sings and Symptoms

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths with high mortality rates worldwide. Accessible screening methods have facilitated its early diagnosis. In Iran, as in many Asian countries, an important barrier to CRC screening is the insufficient knowledge of healthcare providers, including physicians, and the lack of advice from them. Available data on this subject are insufficient, and more surveys are needed in this country. Objectives: This study aimed to investigate Iranian physicians' knowledge about CRC signs and symptoms, risk factors, and screening. Additionally, the association between their knowledge and their characteristics was assessed to provide more data for further interventions. Methods: This cross-sectional study was conducted on 150 family physicians selected by convenience sampling from rural areas in Hamadan province, Iran, from June to September 2017. A self-administered, semi-structured questionnaire was used. Data were analyzed using SPSS 21, with a significance level set at P < 0.05. Results: The mean total knowledge score about CRC was 25.11 ± 4.64 (64.3%) out of 38 questions. The average scores for knowledge about CRC signs and symptoms, risk factors, and the screening program were 7.1 ± 0.81 (out of 8), 10.29 ± 1.83 (out of 13), and 7.77 ± 3.43 (out of 18), respectively. Family physicians had the highest accuracy in answering questions about CRC signs and symptoms (88.7%) and the lowest accuracy in answering questions about the screening program (43%). Since the Kolmogorov-Smirnov test rejected the normal distribution of the data, nonparametric tests were used to compare physicians' knowledge scores according to different variables. The study revealed a statistically significant reverse correlation between physicians’ knowledge of CRC and their age (r = -0.342, P < 0.001), years since graduation (r = -0.228, P = 0.005), and work experience (r = -0.247, P = 0.002). However, after multiple regression analysis, only higher age significantly predicted lower total knowledge scores (P = 0.002). No significant relationship was found between participants' knowledge scores and their gender (P = 0.929) or place of employment (P = 0.399). Conclusions: Family doctors had insufficient knowledge regarding CRC screening programs. To address this issue, health education programs should be designed to enhance their knowledge of CRC screening guidelines.

Polygenic Risk Score Informed Clinical Model for Improving Abdominal Aortic Aneurysm Screening

Abdominal aortic aneurysm (AAA) is a complex disease with environmental and genetic risk factors. Polygenic risk scores (PRSs) based on disease-specific risk-associated single nucleotide variants (SNVs) have demonstrated effectiveness in stratifying individual-level disease risk for cardiovascular diseases. This prospective cohort study assessed associations of PRS of AAA (PRSAAA) with risk of incident AAA, analyzed the effectiveness of a combined clinical-genetic risk model, and explored the clinical utility of the model in identifying high-risk individuals for AAA screening. PRSAAA was calculated using 911,440 SNVs and PRS of coronary artery disease was calculated using 2,324,683 SNVs derived from mixed ancestry genome-wide association studies. The UK Biobank was used as the study cohort. All individuals with complete genetic data available and no diagnosis of AAA at the time of recruitment were included in the analysis and followed prospectively to assess for incident AAA. A PRS-informed clinical model, Prob-AAA, was developed using clinically significant variables and PRSAAA. Four hundred eighty-one thousand one hundred 5 individuals were included in the analysis with 2,668 incident AAA cases. Incident AAA increased from 0.30 to 0.93% between the lowest and highest decile of PRSAAA; similarly, severe AAA, requiring surgery and/or presenting with rupture, increased from 23 to 39% of incident AAA cases across deciles. PRSAAA was a predictor of incident AAA diagnosis (hazard ratio 2.06 [1.70-2.48]) independent of other clinical risk factors including male sex, older age, and smoking history. Prob-AAA was an independent predictor of incident AAA (hazard ratio 1.92 [1.69-2.20]), and identified 9.6% of cases of incident AAA compared to only 4.2% by PRSAAA. Current screening guidelines captured 5.7% of the overall cohort, with an incident AAA rate of approximately 3.2%. Among males not included by current guidelines, Prob-AAA identified an additional cohort, approximately 2% of the overall cohort, with a similar rate of incident AAA. Prob-AAA, a PRS-informed clinical model for AAA, improved upon the predictive power of current, clinical risk factor-informed, screening guidelines for AAA.

Group B Streptococcus colonization status and antibiotic use during labour - a single-centre observational study.

Group B streptococcus (GBS) colonization among pregnant women is the leading cause of neonatal infection. Intrapartum antibiotic prophylaxis (IAP) is the most effective method to reduce the incidents of neonatal sepsis. We describe compliance with GBS management and the implementation of IAP in the context of the long-term effect of antibiotics. The study was conducted among 249 childbearing women hospitalized between January 2022 and February 2022 at University Clinical Center in Gdansk, Poland. The data were obtained from the questionnaire and medical records. We analyzed maternal colonization with GBS, compliance with GBS screening and treatment guidelines, risk factors contributing to GBS colonization, IAP administration, and neonatal congenital infection occurrence. Of all patients, 240 (96.4%) were screened for GBS, 215 (89.6%) between 35-37 weeks of gestation. Fifty (20%) were GBS-positive, 184 (74%) negative, 15 (6%) had unknown GBS status. There were no significant differences between the GBS-positive and GBS-negative groups in maternal age, mode of delivery, gestational age at birth, maternal comorbidities, parity, GBS status in previous pregnancies, and the development of infection among infants of both groups, regardless of IAP administration. Of all the studied women, 158 (63.5%) received antibiotics, 91 (36.5%) did not. The study showed the low positive and the high negative predictive value of the antenatal GBS screening test. We found that compliance with the universal GBS screening is widespread. The management of women with absent or only partial screening test requires assessing the risk factors before administering IAP.

High-Throughput Screening and Design Guidelines for Single-Phase Refractory High Entropy Alloys from the Nb-Ti-Zr System

High-Throughput Screening and Design Guidelines for Single-Phase Refractory High Entropy Alloys from the Nb-Ti-Zr System

Drug exposure and risk factors of maculopathy in tamoxifen users

Tamoxifen, a pivotal therapy for hormone receptor-positive breast cancer, is known for its efficacy in reducing breast cancer recurrence and mortality. However, concerns about potential ocular complications, particularly maculopathy, have emerged. This study aims to investigate the risk and associated factors of diverse macular conditions in tamoxifen users, considering drug exposure, demographics, and systemic diseases. A nationwide cohort of tamoxifen users, comprised of 14,267 tamoxifen users, was analyzed using the health insurance review and assessment database in South Korea. Demographic and clinical characteristics were examined, and the cumulative incidence of macular diseases was stratified by age and cumulative tamoxifen dosage. We conducted logistic regression analysis to identify potential risk factors among clinical variables such as age, sex, indications for tamoxifen use, and systemic diseases associated with various macular conditions. Additionally, Cox proportional hazard models were used to determine the baseline clinical characteristics predictive of these macular conditions, with subsequent calculation of hazard ratios. Cumulative incidences of overall macular diseases, other maculopathy excluding common macular diseases, and macular edema were 26.4, 11.4, and 6.5%, respectively. The incidence of various macular conditions increased with age and the cumulative tamoxifen dose. Age, cumulative dose group, and liver diseases demonstrated significant associations with overall macular diseases and maculopathy excluding common macular diseases in multivariate logistic regression analyses (all P < 0.05). Furthermore, age emerged as significant predictive factors of maculopathy in Cox proportional hazard models. Tamoxifen-induced maculopathy poses a concern for prescribing physicians and ophthalmologists, and this study provides valuable insights into its risk and risk factors. This study may contribute to evidence-based guidelines for tamoxifen maculopathy screening, emphasizing the importance of considering age, cumulative dose, and liver diseases for recommendation on screening timing and frequency.

Elderly men are underscreened for primary aldosteronism even in Hypertension Excellence Centre

Purpose The Endocrine Society (ES) guidelines recommend screening for primary aldosteronism (PA) in high risk hypertensive patients presenting with at least one of seven criteria (resistant HTN, hypokalaemia, adrenal nodule, etc.) Although guidelines are clear and screening is simple, compliance rates among clinicians are extremely low. This results in underdiagnosis of early disease, leading to cadiovasculaer complications and the extra-burden of advanced chronic kidney disease. We aimed to evaluate the screening rates in our Nephrology and Hypertension clinics, as an example of a dedicated Hypertension Excellence Centre. Materials and methods Data on adult hypertensive patients was retrieved from January 2018 to December 2020. Included in the study were hypertensive patients who had at least one of the ES criteria for PA screening. Of all suitable patients, we compared those who were screened for PA to patients who were not screened. Univariate and multivariate cox regression analyses were used for comparison between groups. Results Of 661 patients with HTN, 218 patients (33%) met the ES guidelines for PA screening. Forty-six of them (21.1%) were referred for screening. Advanced age and male gender were associated with lower screening referral rates. Odds ratio for age was 0.945 for every year (95% CI 0.915 − 0.975). There was a trend towards decreased referral rate in advanced kidney disease. Conclusions A 21% screening rate, suggests that many cases of PA are likely missed, more often in older patients. We therefore advocate for PA screening of all hypertensive patients, especially elderly patients with CKD, in whom clinicians’ awareness is low but the absolute risk is high.

Metformin-Induced Vitamin B12 Deficiency in Patients with Type 2 Diabetes: A Narrative Review with a Practical Approach for Screening, Diagnosing, and Managing Vitamin B12 Deficiency.

Metformin is the most widely used antihyperglycemic drug in patients with type 2 diabetes (T2D). Over the past 2 decades, several studies have highlighted a substantial increase in the risk of vitamin B12 deficiency in patients with T2D on metformin therapy. This can lead to several complications and induce or exacerbate peripheral neuropathy. Despite these data, there are no definite guidelines for screening, diagnosing, and treating vitamin B12 deficiency in patients with T2D on metformin therapy. Therefore, in this narrative review, we aimed to suggest a practical diagnostic and therapeutic strategy to address vitamin B12 deficiency in patients with T2D receiving metformin treatment. Clinical evidence supporting an increased risk of vitamin B12 deficiency in patients with T2D on metformin therapy and its risk factors and potential complications are also discussed.

Long-term effects of once-only flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: 21-year follow-up of the UK Flexible Sigmoidoscopy Screening randomised controlled trial

Flexible sigmoidoscopy screening reduces colorectal cancer incidence and mortality; however, uncertainty exists about the duration of protection and differences by sex and age. We assessed effects of once-only flexible sigmoidoscopy screening after 21 years' follow-up. The UK Flexible Sigmoidoscopy Screening Trial is a multicentre randomised controlled trial that recruited men and women aged 55-64 years from general practices serving 14 hospitals. Among participants indicating that they would attend flexible sigmoidoscopy screening if invited, randomisation (2:1) to the control (no further contact) or intervention (invited to once-only flexible sigmoidoscopy screening) group was performed centrally in blocks of 12, stratified by centre, general practice, and household type. Masking of intervention was infeasible. Primary outcomes were colorectal cancer incidence and mortality. The Kaplan-Meier method estimated cumulative incidence. Primary analyses estimated intention-to-treat hazard ratios (HRs) and risk differences, overall and stratified by subsite, sex, and age. The trial is registered with ISRCTN, number 28352761. Among participants recruited between Nov 14, 1994, and March 30, 1999, 170 432 were eligible and 113 195 were randomly assigned to the control group and 57 237 were randomly assigned to the intervention group. 406 participants were excluded from analyses (268 in the control group and 138 in the intervention group), leaving 112 927 participants in the control group (55 336 [49%] men and 57 591 [51%] women) and 57 099 in the intervention group (27 966 [49%] men and 29 103 [51%] women). Of participants who were invited to be screened, 40 624 (71%) attended screening. Median follow-up was 21·3 years (IQR 18·0-22·2). In the invited-to-screening group, colorectal cancer incidence was reduced compared with the control group (1631 vs 4201 cases; cumulative incidence at 21 years was 3·18% [95% CI 3·03 to 3·34] vs 4·16% [4·04 to 4·29]; HR 0·76 [95% CI 0·72 to 0·81]) with 47 fewer cases per 100 000 person-years (95% CI -56 to -37). Colorectal cancer mortality was also reduced in the invited-to-screening group compared with the control group (502 vs 1329 deaths; cumulative incidence at 21 years was 0·97% [0·88 to 1·06] vs 1·33% [1·26 to 1·40]; HR 0·75 [0·67 to 0·83]) with 16 fewer deaths per 100 000 person-years (-21 to -11). Effects were particularly evident in the distal colorectum (726 incident cancer cases in the invited-to-screening group vs 2434 cases in the control group; HR 0·59 [0·54 to 0·64]; 47 fewer cases per 100 000 person-years [-54 to -41]; 196 cancer deaths in the invited-to-screening group vs 708 deaths in the control group; HR 0·55 [0·47 to 0·64]; 15 fewer deaths per 100 000 person-years [-19 to -12]) and not the proximal colon (871 incident cancer cases in the invited-to-screening group vs 1749 cases in the control group; HR 0·98 [0·91 to 1·07]; one fewer case per 100 000 person-years [-8 to 5]; 277 cancer deaths in the invited-to-screening group vs 547 deaths in the control group; HR 1·00 [0·86 to 1·15]; zero fewer deaths per 100 000 person-years [-4 to 4]). The HR for colorectal cancer incidence was lower in men (0·70 [0·65-0·76]) than women (0·86 [0·79 to 0·93]; pinteraction=0·0007) but there was no difference by age. We show that once-only flexible sigmoidoscopy screening reduces colorectal cancer incidence and mortality for two decades and provide important data to inform colorectal cancer screening guidelines. National Institute for Health and Care Research Health Technology Assessment Programme and the Medical Research Council.

What Is the Epidemiology of Cervical and Thoracic Spine Fractures?

Vertebral fractures are associated with enduring back pain, diminished quality of life, as well as increased morbidity and mortality. Existing epidemiological data for cervical and thoracic vertebral fractures are limited by insufficiently powered studies and a failure to evaluate the mechanism of injury. What are the temporal trends in incidence, patient characteristics, and injury mechanisms of cervical and thoracic vertebral fractures in the United States from 2003 to 2021? The United States National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) database collects data on all nonfatal injuries treated in US hospital emergency departments and is well suited to capture epidemiological trends in vertebral fractures. As such, the NEISS-AIP was queried from 2003 to 2021 for cervical and thoracic fractures. The initial search by upper trunk fractures yielded 156,669 injuries; 6% (9900) of injuries, with a weighted frequency of 638,999 patients, met the inclusion criteria. The mean age was 62 ± 25 years and 52% (334,746 of 638,999) of patients were females. Descriptive statistics were obtained. Segmented regression analysis, accounting for the year before or after 2019 when the NEISS sampling methodology was changed, was performed to assess yearly injury trends. Multivariable logistic regression models with age and sex as covariates were performed to predict injury location, mechanism, and disposition. The incidence of cervical and thoracic fractures increased from 2.0 (95% CI 1.4 to 2.7) and 3.6 (95% CI 2.4 to 4.7) per 10,000 person-years in 2003 to 14.5 (95% CI 10.9 to 18.2) and 19.9 (95% CI 14.5 to 25.3) in 2021, respectively. Incidence rates of cervical and thoracic fractures increased for all age groups from 2003 to 2021, with peak incidence and the highest rate of change in individuals 80 years or older. Most injuries occurred at home (median 69%), which were more likely to impact older individuals (median [range] age 75 [2 to 106] years) and females (median 61% of home injuries); injuries at recreation/sports facilities impacted younger individuals (median 32 [3 to 96] years) and male patients (median 76% of sports facility injuries). Falls were the most common injury mechanism across all years, with females more likely to be impacted than males. The proportion of admissions increased from 33% in 2003 to 50% in 2021, while the proportion of treated and released patients decreased from 53% to 35% in the same period. This epidemiological study identified a disproportionate increase in cervical and thoracic fracture incidence rates in patients older than 50 years from 2003 to 2021. Furthermore, high hospital admission rates were also noted resulting from these fractures. These findings indicate that current osteoporosis screening guidelines may be insufficient to capture the true population at risk of osteoporotic fractures, and they highlight the need to initiate screening at an earlier age. Level III, prognostic study.

Analysis of the Application of Professional Society Screening Guidelines for Colorectal Polyposis Syndromes at a Single Institution

Several professional society guidelines suggest germline genetic testing for colorectal polyposis syndromes in patients with ≥10 lifetime adenomatous polyps. This study evaluated the factors associated with genetic testing decisions and outcomes when germline testing was recommended per guidelines. Surgical archives revealed 145 patients with a recommendation for germline genetic polyposis testing based on guidelines. Demographic data and medical history were collected to examine their association with testing decisions and results. Germline genetic testing was ordered in 90 out of 145 patients and was ordered in younger patients with more lifetime adenomas. Pathogenic alterations were detected in 12 out of 53 patients who completed testing. Younger ages and higher numbers of lifetime adenomas were not associated with the detection of germline genetic alterations. In fact, patients with a pathogenic germline alteration had higher median ages and fewer lifetime adenomas than those without an alteration. Half of the 12 patients with a pathogenic germline mutation were not White non-Hispanic, although White non-Hispanic patients comprised 75.5% of those tested. This study supports the 10 adenomatous polyp threshold for recommending germline genetic polyposis testing, as an alteration was detected in a sizable proportion (>20%) of patients tested. Although a younger age and a higher number of lifetime adenomas were associated with an increased likelihood of ordered tests, no evidence was found to support these additional factors in testing decisions.

Epidemiology of Colorectal Cancer in Saudi Arabia: A Review.

Colorectal cancer (CRC) is the second leading cause of cancer death in the world, originating from the glandular epithelial cells of the large intestine and the rectum. This article aims to review the epidemiology of CRC in Saudi Arabia, focusing on prevalence, incidence, risk factors, preventive measures, and outcomes. This narrative review utilized the PubMed database for data extraction, including freely accessible studies published in the last 15 years. Sixteen articles from different study designs were included, while awareness and non-English language studies were excluded. In 2020, the incidence and mortality rate of CRC in Saudi Arabia were 14.6% and 1.48% among all cancers, respectively. From 2006 to 2016, the number of colon cancer and rectal cancer cases increased by 8% and 7%, respectively. Risk factors for CRC in Saudi Arabia include low education level, unemployment, physical inactivity, excess weight, poor knowledge of foods rich in fiber, cigarette smoking, reduced serum vitamin D and calcium levels, and certain gene mutations. National guidelines in Saudi Arabia recommend CRC screening for all individuals above 45 years using colonoscopy, flexible sigmoidoscopy, or fecal occult blood test. The 10-year survival rate for CRC in Saudi Arabia is 44.6%. The overall 5-year survival rate for the Ministry of National Guard-Health Affairs is 52.0%. To lower the incidence and mortality of CRC, primary, secondary, and tertiary prevention are all very important. The most crucial aspect is to concentrate on primary prevention, which may involve raising public awareness of CRC risk factors and strategies for reducing or eliminating them.

To neutrally offer or strongly recommend? General practitioners’ perspectives on screening for gestational diabetes according to the national guideline in Norway

Objective To explore general practitioners’ experiences and reflections on how the current Norwegian guideline for screening for gestational diabetes affects their clinical practice. Design A qualitive study in which data were collected through semi-structured focus group interviews and analyzed thematically. Setting and subjects Five focus groups conducted in 2020 among GPs in Norway; three interviews took place face-to-face and two were held digitally. The total number of participants was 31. Results GPs acknowledged the potential benefits of more extensive screening, but had concerns about the medicalization of pregnancy, stating that some women experienced considerable anxiety. The GPs expressed doubts about the guideline’s evidence base but differed in how they interpreted what the guideline was asking them to do. Some offered eligible women the opportunity to be screened, while other set up a screening appointment without consulting the women first. For some, fear of incrimination made them recommend screening without being convinced that it was the right thing for the patient. Conclusions It is unclear whether the guideline for gestational diabetes requires GPs to recommend screening to pregnant women or if they should provide neutral information about the availability of screening. This ambiguity should be addressed, and the guideline evaluated against the core principles of general practice.

Assessment of Knowledge, Attitude, and Practice Regarding Colorectal Carcinoma Screening Among Healthcare Personnel.

Colorectal carcinoma (CRC) is a rising issue worldwide, with high morbidity and mortality rates. It is the third most common cause of death globally. Early diagnosis can lead to prevention and treatment, making it crucial for healthcare professionals to have proper knowledge about CRC screening. This study aimed to assess the level of awareness, identify knowledge gaps, and update the knowledge of healthcare workers. This descriptive cross-sectional study was conductedfrom May to October 2023, in multiple tertiary care hospitals of Khyber Pakhtunkhwa, Pakistan. Responses were collected manually through a designed proforma of questionnaires. A total of 164 participants (137 male and 27 female) took part in our study. Among the participants, 92.1% (n = 151) were aware that colonoscopy is used for CRC screening. Other screening methods known to them included a fecal occult blood test(FOBT)(65.9%, n = 108), flexible sigmoidoscopy (48.2%, n = 79), stool DNA test (31.1%, n = 51), and virtual colonoscopy (34.1%, n = 56). Only 6.1% (n = 10) routinely recommended CRC screening for all patients, 22.6% (n = 37) recommended it occasionally, and 71.3% (n = 117) rarely or never recommended it. Regarding factors influencing the recommendation of CRC screening, 83.5% (n = 137) cited family history of CRC as the major factor, followed by patient age (68.3%, n = 112), availability of screening facilities (46.3%, n = 76), patient's overall health status (37.2%, n = 61), and patient's preference (20.7%, n = 34). This study concluded that only a small proportion of healthcare personnel regularly recommend CRC screening. In addition, a small proportion are familiar with CRC screening guidelines, although most are well-informed about the various investigations used for screening.

Fetal alcohol spectrum disorder resources for health professionals: a scoping review

ObjectivesThis scoping review aimed to identify and critically appraise resources for health professionals to identify, diagnose, refer, and support individuals with fetal alcohol spectrum disorder (FASD)—including the extent to which...

Cost-effectiveness of approaches to cervical cancer screening in Malawi: comparison of frequencies, lesion treatment techniques, and risk-stratified approaches

BackgroundRecently-updated global guidelines for cervical cancer screening incorporated new technologies—most significantly, the inclusion of HPV DNA detection as a primary screening test—but leave many implementation decisions at countries’ discretion. We sought to develop recommendations for Malawi as a test case since it has the second-highest cervical cancer burden globally and high HIV prevalence. We incorporated updated epidemiologic data, the full range of ablation methods recommended, and a more nuanced representation of how HIV status intersects with cervical cancer risk and exposure to screening to model outcomes of different approaches to screening.MethodsUsing a Markov model, we estimate the relative health outcomes and costs of different approaches to cervical cancer screening among Malawian women. The model was parameterized using published data, and focused on comparing “triage” approaches—i.e., lesion treatment (cryotherapy or thermocoagulation) at differing frequencies and varying by HIV status. Health outcomes were quality-adjusted life years (QALYs) and deaths averted. The model was built using TreeAge Pro software.ResultsThermocoagulation was more cost-effective than cryotherapy at all screening frequencies. Screening women once per decade would avert substantially more deaths than screening only once per lifetime, at relatively little additional cost. Moreover, at this frequency, it would be advisable to ensure that all women who screen positive receive treatment (rather than investing in further increases in screening frequency): for a similar gain in QALYs, it would cost more than four times as much to implement once-per-5 years screening with only 50% of women treated versus once-per-decade screening with 100% of women treated. Stratified screening schedules by HIV status was found to be an optimal approach.ConclusionsThese results add new evidence about cost-effective approaches to cervical cancer screening in low-income countries. At relatively infrequent screening intervals, if resources are limited, it would be more cost-effective to invest in scaling up thermocoagulation for treatment before increasing the recommended screening frequency. In Malawi or countries in a similar stage of the HIV epidemic, a stratified approach that prioritizes more frequent screening for women living with HIV may be more cost-effective than population-wide recommendations that are HIV status neutral.

Late to the Game: Cancer Screening Guidelines and Nodule Surveillance in Idiopathic Interstitial Pneumonias.

Late to the Game: Cancer Screening Guidelines and Nodule Surveillance in Idiopathic Interstitial Pneumonias.

Assessing Patient Values and Preferences to Inform the 2023 American College of Rheumatology/American College of Chest Physicians Interstitial Lung Disease Guidelines.

Patient engagement is critical to clinical practice guideline (CPG) development. This work presents our approach to ascertaining patients' values and preferences to inform the American College of Rheumatology guidelines for screening, monitoring, and treatment of interstitial lung disease (ILD) in people with systemic autoimmune rheumatic diseases (SARDs). We conducted a cross-sectional qualitative study of a purposefully sampled Patient Panel using a modified content analytic approach. The study team reviewed text transcripts from the Patient Panel discussion to identify themes and develop a clustered thematic schema. Twenty-one patients (75% women) participated, with a mean age of 53 years (range 33-73). Patients had one or more SARDs: systemic sclerosis (38%), Sjögren disease (38%), idiopathic inflammatory myopathy (33%), rheumatoid arthritis (24%), and mixed connective tissue disease (10%). We identified 10 themes in 4 thematic clusters: communication, screening and monitoring, treatment goals, and treatment adverse effects. Patients prioritized recognizing ILD symptoms, importance of ILD screening and close monitoring, goals of survival and improving quality of life, and willingness to accept treatment risks provided that there is close communication with providers. Patient representatives shared patients' priorities and insight at the Voting Panel meeting, influencing multiple guideline recommendations. Patient engagement fosters a holistic approach to CPG development, leading to recommendations aiming for the best clinical outcomes while prioritizing outcomes important for patients. The patient-identified themes played a critical role in ILD guideline development and provide core elements for shared decision-making as clinicians make management and therapeutic decisions with patients with SARD-associated ILD.

Changing colon cancer screening guidelines to age 45: Has it made a difference?

BackgroundA concerning increase in early-onset colorectal cancer led to guideline changes in 2018 by the American Cancer Society to lower the age for initial colorectal cancer screening from 50 to 45 years of age. Although this would be expected to result in increased screening rates and subsequent earlier detection of colorectal cancer, the effect of this guideline change at a national level is not yet fully understood. MethodsUsing the National Cancer Database, we identified patients newly targeted for screening (age 45–49 years) diagnosed with colon cancer in either 2017 (early cohort) or 2019 (late cohort). The relationship between time period and stage of disease at presentation was examined by univariate analysis and in a multivariable logistic regression model. ResultsIn total, 5,479 patients met inclusion criteria. The median age at diagnosis did not differ between patients in the late and early cohorts (47 years for both cohorts, P = .41). Patients in the late and early cohorts had equal odds of having stage III-IV disease (odds ratio for late cohort to early cohort, 1.05, 95% confidence interval, 0.94–1.17), and patients in the late cohort showed slightly increased odds of having higher T-stage (pT3 or pT4) disease (odds ratio, 1.20, 95% confidence interval, 1.05–1.35). ConclusionDespite recommendations of earlier initial colorectal cancer screening, a clinically meaningful earlier shift in colon cancer stage was not observed in patients newly targeted for screening. Further studies will be needed to assess uptake of these recommendations by providers and patients and identify areas of improvement.

Improving Documentation of and Access to Diabetic Retinopathy Screening at a Student-Run Free Clinic

Background: Diabetic retinopathy (DR) affects approximately 9.6 million people in the United States (US) and is the leading cause of vision loss in working-age adults. However, less than 50% of people with diabetes in the US undergo the recommended screening. We aimed to assess need for DR screening (DRS) at the University of Michigan Student-Run Free Clinic (UMSRFC) and examine current DRS documentation practices to inform quality improvement initiatives at the clinic. Methods: We conducted a needs-assessment survey of 67 patients to examine access to eye and vision care among patients seen at the UMSRFC between January and April 2023. Descriptive analysis of survey data was performed. A retrospective chart review of all patients seen at the clinic between March 2021 and March 2023 was conducted to evaluate documentation of DRS in the medical record. These results informed the development of a DRS initiative at the clinic. Results: Of the 67 patients surveyed, 17 had a diagnosis of diabetes. Twenty-six patients reported an eye problem, of which 16 (62.0%) reported blurry vision, 9 (35.0%) reported floaters, and 1 (4.0%) reported dark/empty areas in their vision. Chart review yielded 404 patients, of which 70 had a diagnosis of type 2 diabetes. Twenty-eight (40.0%) had any mention of a diabetic eye exam in their chart, and 12 of these were up to date with the American Diabetes Association (ADA) screening guidelines. Twenty-three (33.0%) patients had any mention of a referral to an optometrist or ophthalmologist in their chart. On the DRS day, three patients were screened for DR. No cases of DR were identified. Conclusion: Survey and chart review data indicated a need for increased DRS and improved documentation practices of DRS at the UMSRFC. A DRS initiative was successfully implemented at the UMSRFC under the oversight of an ophthalmologist.

Assessing osteoporosis screening compliance in total joint surgery: a retrospective chart review.

Osteoporosis is a prevalent concern, particularly among aging populations, leading to increased risk of fractures, including those related to hip and knee arthroplasty procedures. Screening for osteoporosis, especially with dual X-ray absorptiometry (DXA) scans, is crucial for early detection and management. This study aimed to assess adherence to osteoporosis screening guidelines among patients aged 65 and older undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) within a single health network. Factors influencing screening adherence were also explored. A retrospective chart review of 2,160 patients undergoing elective THA or TKA between January 2019 and January 2023 was conducted. Demographic data, osteoporosis screening status, and occurrence of periprosthetic fractures were analyzed. Statistical analysis included descriptive statistics and chi-square tests. Only 24.1 % of eligible patients underwent a DXA scan prior to surgery. Females were more likely to undergo screening than males, and race was also associated with screening status. A total of 45 periprosthetic fractures were identified, with no significant correlation between osteoporosis status, DXA screening, and fracture occurrence. Adherence to osteoporosis screening guidelines among geriatric patients undergoing elective total joint arthroplasty remains low within the studied health network. Despite the lack of correlation between screening and fracture occurrence in this study, the importance of screening and potential optimization in high-risk patients is emphasized. Further research is needed to assess outcomes associated with different care pathways in bone health screening and management for elective geriatric total joint patients.