Surveillance Plan Research Articles

Prevalence, Risk Factors, and Disease Associations of Overweight and Obesity in Dogs that Visited the Veterinary Medical Teaching Hospital at the University of California, Davis from January 2006 to December 2015

Overweight and obesity contribute to a variety of disease processes and negatively affect quality of life in dogs. A considerable number of epidemiological studies performed in a variety of canine communities revealed varied prevalence, and identified associated risk factors, including neutering. Associations between excessive body weight and certain diseases, including orthopedic diseases, were also reported. However, risk factors and disease associations of overweight and obesity in a larger population of dogs seen in recent years at a single referral veterinary hospital remains undefined. The present study utilized descriptive statistics and logistic regression models to characterize prevalence, risk factors, and disease associations of excessive body weight (both overweight and obesity) in 40,038 dogs that visited the Veterinary Medical Teaching Hospital at the University of California, Davis from January 2006 to December 2015.The overall prevalence of overweight and obesity in 40,038 dogs were 21.1% (n = 8461) and 20.2% (n = 8089) respectively. Dogs that were neutered, female, and considered middle-aged or senior were at increased risk of overweight and obesity. Certain breed types, including Retriever and Spaniel, and certain disease processes, including orthopedic diseases, were also at increased risk of overweight and obesity.Overweight and obesity are prevalent problems, which can benefit from continual education to raise awareness of the scale of the problem to both the veterinary community and the general public. Structured disease surveillance plans monitoring these associated factors also help to guide further research and to better prevent overweight and obesity.

Diversity and Distribution of Theileria Species and Their Vectors in Ruminants from India, Pakistan and Bangladesh

Tropical theileriosis, caused by the apicomplexan hemoparasite of the genus Theileria, is a major constraint to livestock production in various parts of world, including South Asia. Several studies have been carried out over the last five decades; however, comprehensive information in this region regarding the diversity and distribution of Theileria is lacking. Therefore, keeping in mind the economic importance of theileriosis, we have systematically reviewed the current knowledge about Theileria spp. diversity and distribution affecting cattle, water buffaloes, goats and sheep in three countries included India, Pakistan and Bangladesh of the Indian sub-continent. The data collected indicated that the microscopic method is the widely used method for evaluating Theileria species in the three countries from 1970 to 2021. This is the first study in this region to compile a comprehensive knowledge about the diversity and distribution of Theileria. Our study revealed the existence of 11 different species of Theileria, including Theileria spp. Theleria annulata, T. orientalis, T. mutans, T. velifera circulating in cattle and buffalo while T. annulata, T. lestoquardi, T. luwenshuniT. ovis, Theileria spp. and T. lestoquardi-like spp., were infecting goats and sheep from various regions of India, Pakistan and Bangladesh. We find that T. annulata can be found in both small and large ruminants and is widely distributed in the different regions of India, Pakistan and Bangladesh. In addition, our analysis revealed that the existence of possible tick vectors of the genera Hyalomma, Haemophysalis, Rhipicephalus and Amblyomma may be responsible for the diverse and wide distribution of different Theileria species. However, the competence of these tick vectors for different Theileria species still need to be explored. Therefore, further studies are needed to bridge this gap and to improve the health and production of livestock and reduce economic losses due to theileriosis in India, Pakistan and Bangladesh. Furthermore, we selected representative 18S rRNA sequences for T. annulata from the different regions to infer phylogenetic relationship. Phylogenetic analysis of the selected isolates clustered in different clades which might be due to the variation in a hypervariable region of 18S rRNA. The outcome of this analysis is expected to provide a coherent and integrated framework about the different Theileria species prevailing in these countries and contribute to improving the surveillance and control plans of various Theileria species in the region.

A Coordinated, Risk-Based, National Forest Biosecurity Surveillance Program for Australian Forests

Australia has a comprehensive plant biosecurity system, with the Australian Government responsible for pre-border (e.g., off-shore compliance) and border (e.g., import inspections) activities, while state governments undertake a variety of post-border activities (e.g., post-border surveillance, management of pest incursions, and regulation of pests) designed to reduce alien pest and pathogen arrival and establishment. Once an alien pest or pathogen has established and spread, its management becomes the responsibility of the land manager. There has been a growing understanding among plant industries of the need to be more engaged in post-border biosecurity activities, including resourcing and undertaking early detection surveillance and contingency planning. Here we summarize Australia’s broader plant biosecurity system along with current forest-specific biosecurity surveillance activities. We describe the development of a proposed forest biosecurity partnership between the Australian Government, state governments and the forest sector to establish a post-border, risk-based National Forest Pest Surveillance Program. We outline why there is a recognized need for such a program, how it would improve biosecurity outcomes in relation to forests, its component activities, and key stakeholders and beneficiaries.

Situational diagnosis of plans for the surveillance, prevention and control of COVID-19 at work in the hydrocarbon sector.

Introduction:During the COVID-19 pandemic in Peru, economic activities were restricted to limit the risk of contagion, and companies were required to prepare and register the plan for COVID-19 surveillance, prevention and control in the workplace prior to resuming activities.Objective:To describe the status of plan registration in the hydrocarbon sector during the first half of 2020, as well as the characteristics of health professionals and occupational health and safety supervisors or committees.Methods:Cross-sectional study with secondary analysis of databases obtained from the Integrated System for COVID-19 of Companies (Sistema Integrado para COVID-19 de Empresas, SISCOVID Empresas) and government public data on the mining sector.Results:We reviewed 2,566 plans and identified 54 198 hydrocarbon companies in the 2020 period. Regarding the plans registered, 5.9% of companies did not have an occupational safety and health supervisor or committee, and 63% do not have a health professional.Conclusions:There is evidence of non-compliance with plan registration requirements among hydrocarbon companies. There is also non-compliance with the requirement of having a health professional, occupational safety and health committee or supervisor. The findings show serious deficiencies in plan registration, which could lead to inadequate management of the activities to monitor, prevent and control COVID-19 in the workplace. Companies are advised to develop, register, and implement their plans to protect the health of their employees.

Measles surveillance in Kashmir: A mixed methods study.

Measles surveillance serves as the means of monitoring program success. The quintessential purpose of measles surveillance is to identify gaps and garner effective public health responses to achieve measles elimination. There were two key objectives: (i) to conduct an in-depth review of the existing measles surveillance system in Kashmir and highlight its strengths and weaknesses and (ii) to assess the pattern of measles-containing vaccine (MCV1) coverage and MCV2 coverage among under-5 years children and describe the health-seeking patterns of suspected cases of measles. The mixed methods study was conducted in the Kashmir valley from March 2018 to March 2019. An explorative qualitative design was followed using individual face-to-face interviews with thirty-two (n = 32) different stakeholders from the state, district, medical block, and primary health center (PHC) levels. To complement the qualitative study, a quantitative survey was done in two districts, Srinagar and Ganderbal, which consist of 5 and 4 medical blocks, respectively. Among the suspected cases of measles, 52% had visited PHCs. Sixty-four suspected cases of measles (64) were immunized with two doses of MCV. None of the clinically suspected cases of measles were further investigated. In the qualitative analysis, five themes were generated viz, "measles surveillance description of Kashmir valley;" "factors affecting measles surveillance, perceptions, and experiences of stakeholders;" "barriers to measles surveillance;" "measles surveillance activities need to be intensified;" and "respondent recommendations for building an effective and sensitive measles surveillance system." The current measles surveillance system in Kashmir was not effectively functioning; case-based measles surveillance is not being done as per the WHO guidelines. There is a lack of planning, advocacy, awareness, and communication of measles surveillance among the stakeholders. The visible barriers in measles surveillance included lack of training, logistics, incentives, and monitoring by internal and external agencies.

Illegal Wildlife Trade: Trade Flows of Wildlife Products and Facilitation Methods in the Ruaha Landscape, Tanzania

Tanzania’s Ruaha landscape is prominent for its potential wildlife resources, which play a key role in sustaining the economy and livelihoods of the people. However, most of these resources are illegally obtained and traded in different places within and outside the Ruaha landscape. Due to its illegal nature, most of the important information regarding the trade is poorly documented. Therefore, the current study aimed first, to explore the origin and destination of wildlife products; second, to assess the relationship between hunters and buyers or customers; third, to assess the means used to transport wildlife products; and lastly, to assess who influences people to engage in illegal hunting and trade activities. In addition, we assess the materials used in the exchange of wildlife products. Semi-structured questionnaires and face-to-face interviews were used to collect information from 123 respondents. Social network analysis was used to indicate the origin and destination of wildlife products. The findings show that 70% of wildlife products originate from the Ruaha National Park and MBOMIPA wildlife management areas, with the remaining 30% originating from villages. The majority of respondents (65%) reported transporting wildlife products by foot and bicycle as the primary modes of transportation. Suppliers of wildlife products are reported to have close and long-term relationships with their customers and traders, with most of whom being friends and relatives. We found most poachers to be influenced by their friends and relatives in terms making decision to engage in illegal wildlife trade. In addition, crops like maize and rice were the most popular products used to exchange with wildlife products in the Ruaha landscape. Therefore, in order to combat illegal trade in wildlife products at the local level, alternative income-generating activities need to be promoted accompanied by not only well-funded anti-poaching programmes but also more effective surveillance plans. These should entail the use of advanced techniques and skills, such as wildlife forensics.

Generative planning for construction safety surveillance camera installation in 4D BIM environment

Surveillance cameras have become increasingly significant in the field of construction safety monitoring. With visual information, these cameras support safety managers to identify the potential hazards and deliver prompt feedback. However, developing the surveillance camera plan remains challenging in considering the workspace of working at height activities and the dynamic nature of the construction site. This study proposes a camera installation plan considering different site layouts with time during the optimization to resolve this problem. An approach for Generating Planning for Construction Safety Surveillance Camera Installation in 4D BIM Environment, called SCI4D. The SCI4D comprises three modules: The site profile module (SPM), which extracts the spatial and temporal information from a 4D BIM; Parametric modeling module (PMM), which simulate cameras and calculate the performance of surveillance systems, Installation planning module (IPM) suggests the appropriate solutions that meet the requirement. The efficiency of the SCI4D approach is validated through the test of a building project of 3000 square meters. SCI4D determined 45 solutions with optimal coverage within budget, $2500. The contribution of the proposed approach is to proactively aid project teams in preparing surveillance plan that ultimately supports construction safety monitoring using vision intelligence.

Prevalence, risk factors, and disease associations of overweight and obesity in cats that visited the Veterinary Medical Teaching Hospital at the University of California, Davis from January 2006 to December 2015

Overweight and obesity are commonly diagnosed in domestic cats, and undermine cats’ quality of life directly or indirectly via various disease processes known to be associated with overweight and obesity. Epidemiological studies have reported varied overall prevalence among different feline populations, and commonly identified risk factors such as neutering. However, disease associations were not consistently reported. The status of feline overweight and obesity in a referral veterinary teaching hospital in the United States remains undefined as well. The present study used descriptive statistics and logistic regression models to analyze feline medical records obtained at the Veterinary Medical Teaching Hospital at the University of California, Davis from January 2006 to December 2015 and to characterize the prevalence of overweight and obesity, risk factors, and disease associations. In 9,062 feline records analyzed, the overall prevalence of overweight (17.2%; n = 1,560) and obesity (23.8%; n = 2,160) was 41.0%. Neutered, male, and crossbred cats that were in age groups between 3.0 and 14.9 years old and presented with disease processes in orthopedic, dentistry, and urinary categories were positively associated with overweight and obesity. Overweight and obesity are prevalent problems, which can benefit from continual veterinary education emphasizing its importance. Structured disease surveillance plans monitoring these associated factors also help guide further research and ideally can contribute to development of better prevention strategies for overweight and obesity.

P-BN31 Surveillance for Gallbladder polyps at a NHS District General Hospital – a retrospective analysis

Abstract Background Gallbladder polyps are encountered in 5% of ultrasound scans and continue to remain a dilemma in terms of management. Very few polyps progress to cancer. However, most cancerous polyps are usually found at an advanced stage. It is therefore important to identify the premalignant polyps. There is a lack of national consensus in UK for surveillance of gallbladder polyps. Many trusts in the UK either adopt the European guidelines or formulate local protocols. We aim to present our findings based on our local surveillance policy existent during the study period with a view to recommending new local guidelines. Methods A search from our radiology database being coded to gallbladder polyp identified patients. We identified 431 patients from 2017 – 2019 who had a total of 1014 scans. The data was collected from local hospital IT databases in terms of variables such as number of scans, polyp size, number of polyps, progression to surgery or discharge from surveillance and histology. The data was analysed on excel platform. Results Patient demographics revealed an incidence of 54% in females (males 46%) with an average age of 59.7 years. Pain was the dominant symptom prompting the first scan (48%). An average of 2.3 scans were performed per patient. 45% of the polyps were less than 5mm. Overall, 22% polyps demonstrated interval growth. Only 15% of polyps less than 5mm demonstrated interval growth and none required cholecystectomy. 6% patients proceeded to surgery mainly for symptoms (46%) compared to polyp progression (1.5%). No malignancy was identified in this study. 43% of patients with polyp diagnosis in primary care had no identified surveillance plan. Conclusions Our study demonstrates a low incidence of polyp progression. We would recommend stopping annual surveillance after 2 years from the index scan for multiple small (<5mm) polyps with little or no progression but continue with annual surveillance for polyps greater than 5mm. We would recommend reserving cholecystectomy for symptomatic polyps and polyps greater than 10mm. There is wide variation in surveillance practice particularly in primary care. We would recommend sharing the guideline widely with primary care for optimal surveillance.

Adherence to discharge protocols and prostate‐specific antigen surveillance plans in men without a prostate cancer diagnosis

AbstractProstate‐specific antigen (PSA) surveillance testing is a valuable tool in the ongoing care of men who have undergone investigations into potential prostate cancer, with a benign outcome. A literature review was conducted to assess the published evidence into discharge protocols for men who have undergone investigations into prostate cancer with benign outcomes, and compliance with, and attrition from, these protocols in this patient group. When insufficient literature was retrieved, the search was broadened to include men with low‐grade prostate cancer on active surveillance pathways. There is little evidence in the published literature surrounding the issue of compliance with discharge plans in the target group. Concordance with active surveillance plans is better documented, but evidence remains relatively scarce. Evidence from research into men with low‐grade prostate cancer shows that compliance with discharge plans is a complex issue with many factors affecting outcomes. The attitudes of physicians, along with those of patients, are a major component, as is the availability of consistent and accessible guidelines. The literature surrounding men who have had benign outcomes from investigations into potential prostate cancer tends to make little reference to the issues surrounding concordance, and it is clear that this is not a well‐researched area. Concerns were raised surrounding the finding that up to 50% of men who have not adhered to their PSA surveillance plans have had other routine bloods drawn by their general practitioners (GPs) raising the issue of GP non‐compliance. The issue of compliance with PSA surveillance plans in men without a prostate cancer diagnosis is clearly a complex one which is compounded by the lack of nationally standardized discharge protocols. Further research is required to design a standardized discharge protocol to improve compliance with surveillance pathways, thereby improving early detection of developing cancers.

Whole-Genome Sequencing of Gram-Negative Bacteria Isolated From Bovine Mastitis and Raw Milk: The First Emergence of Colistin mcr-10 and Fosfomycin fosA5 Resistance Genes in Klebsiella pneumoniae in Middle East.

Antimicrobial resistance is a major concern in the dairy industry. This study investigated the prevalence, antimicrobial resistance phenotypes, and genome sequencing of Gram-negative bacteria isolated from clinical (n = 350) and subclinical (n = 95) bovine mastitis, and raw unpasteurized milk (n = 125). Klebsiella pneumoniae, Aeromonas hydrophila, Enterobacter cloacae (100% each), Escherichia coli (87.78%), and Proteus mirabilis (69.7%) were the most prevalent multidrug-resistant (MDR) species. Extensive drug-resistance (XDR) phenotype was found in P. mirabilis (30.30%) and E. coli (3.33%) isolates. Ten isolates (four E. coli, three Klebsiella species and three P. mirabilis) that displayed the highest multiple antibiotic resistance (MAR) indices (0.54–0.83), were exposed to whole-genome sequencing (WGS). Two multilocus sequence types (MLST): ST2165 and ST7624 were identified among the sequenced E. coli isolates. Three E. coli isolates (two from clinical mastitis and one from raw milk) belonging to ST2165 showed similar profile of plasmid replicon types: IncFIA, IncFIB, IncFII, and IncQ1 with an exception to an isolate that contained IncR, whereas E. coli ST7624 showed a different plasmid profile including IncHI2, IncHI2A, IncI1α, and IncFII replicon types. ResFinder findings revealed the presence of plasmid-mediated colistin mcr-10 and fosfomycin fosA5 resistance genes in a K. pneumoniae (K1) isolate from bovine milk. Sequence analysis of the reconstructed mcr-10 plasmid from WGS of K1 isolate, showed that mcr-10 gene was bracketed by xerC and insertion sequence IS26 on an IncFIB plasmid. Phylogenetic analysis revealed that K1 isolate existed in a clade including mcr-10-harboring isolates from human and environment with different STs and countries [United Kingdom (ST788), Australia (ST323), Malawi (ST2144), Myanmar (ST705), and Laos (ST2355)]. This study reports the first emergence of K. pneumoniae co-harboring mcr-10 and fosA5 genes from bovine milk in the Middle East, which constitutes a public health threat and heralds the penetration of the last-resort antibiotics. Hence, prudent use of antibiotics in both humans and animals and antimicrobial surveillance plans are urgently required.

Prevalence of Anisakis Larvae in Different Fish Species in Southern Albania: Five-Year Monitoring (2016–2020)

Anisakidae are nematodes that commonly parasitize in the coelomic cavity and viscera of several fish species. They can be found in flesh, which is why they have an important economic and public health impact. The aim of the current work was to assess the presence and prevalence of Anisakis larvae in fish species caught in the coastal area of the Karaburun Peninsula in Vlora Bay (Albania). A total of 856 of wild teleosts and 219 specimens of farmed fish were collected over a 5-year period (from 2016 to 2020). The results showed that out of a total of 1075 analyzed samples, 361 (33.58%) were parasitized with L3 larvae. In particular, only Solea vulgaris returned negative results, while Sparus aurata, Dicentrarchus labrax, and Sardinella aurita showed the lowest prevalence (4.55%, 9.17%, and 10.53%, respectively) and mean abundance (0.84, 1.19, and 0.92, respectively). Conversely, Scomber japonicus and Scomber scombrus showed the highest prevalence (74.07% and 68.00%, respectively) and mean abundance (188.24 and 249.82, respectively). The data suggest that the coastal area of the Karaburun Peninsula (southern Albania) may be a high-risk area for zoonotic diseases, and the consumption of raw or undercooked fish caught in the Vlora district could result in the acquisition of human anisakiasis. For these reasons, it is necessary to improve the surveillance plan.

Personalized individual semantics based consensus reaching process for large-scale group decision making with probabilistic linguistic preference relations and application to COVID-19 surveillance

This paper develops a new personalized individual semantic (PIS) based consensus reaching process (CRP) for large-scale group decision making (LSGDM) with probabilistic linguistic preference relations (PLPRs) and applies to the selection of COVID-19 surveillance plans. Firstly, considering that a linguistic term means different things to different decision makers (DMs), a new definition of distance between probabilistic linguistic term sets (PLTSs) is defined considering the PIS of a DM. Then, a consistency-driven optimization model is built to determine the PIS of linguistic terms in a PLPR of a DM by maximizing the consistency of a PLPR. DMs’ weights can be acquired through a programming model by minimizing the distance between the individual semantic and the collective semantic. Besides, a clustering algorithm based on PIS is devised for dividing DMs into several subgroups with similar semantic. Based on the obtained subgroups, the corresponding moderators can be identified by DMs with unacceptable consensus level (CL). Several minimum preference adjustment models are constructed to obtain the adjusted PLPRs. These models not only can sufficiently consider the willingness of DMs to modify their preferences but also can improve their CLs in CRP. Finally, an illustration example of selection of college COVID-19 surveillance plans is offered to demonstrate the proposed method and to verify the effectiveness of the proposed model.

Screening of diesters of ortho‐phthalic acid in printed baby bibs in the European market

AbstractA screening exercise targeting ortho‐phthalates in 22 plastic baby bibs collected in the European market was performed. A GC–MS method was used with a limit of detection ranging from 0.1 to 0.6 mg kg−1 bib. The most frequently detected phthalates were di‐n‐butyl phthalate (DBP) and diisobutyl phthalate (DIBP) in nearly all samples. DIBP was detected at concentrations suggesting its intended use. Overall, the highest levels were detected for benzyl butyl phthalate (BBP), with six samples presenting concentration from 13 to 47 mg kg−1 and one sample with the highest value of 65 mg kg−1. Results indicate that several non‐authorised phthalates are intentionally used either in the plastic or in the printing inks. Worst case migration calculations indicate that diethyl phthalate (DEP), DAP and DIBP exceed the limit of 0.01 mg kg−1. Therefore, determination of experimental migration is needed to conclude on compliance of baby bibs with the European and Swiss legislation. Bibs are articles that fall in the scope of the definition of FCMs accordingly to European legislation. Therefore, they should comply with the applicable rules, restrictions and limits. These articles should be included in surveillance plans, focusing on monitoring bib composition, migration and the application of good manufacturing practices by industry.

The community care model (CCM) for multi-drug resistant of tuberculosis (MDR-TB) patient with social engagement: A case study province located at lower northeastern part, Thailand

This research was aimed to develop the community care model for Multi-Drug Resistant of Tuberculosis (MDR-TB) patient and to evaluate the community care for MDR-TB patient model. Four steps of method were (1) identify the problem, (2) performance enhancement, (3) model development, and (4) implementation. The 36 sub-districts from 12 districts where found MDR-TB patient was the study areas. Target groups were consisted of MDR-TB patient, TB Clinic people from district and sub-district hospital, care giver who care on drug observe therapy (Dot) to MDR-TB patient, and community leader. Research tools were questionnaires, interview guide, and venue of participation of the stake holders. The data analysis was used descriptive statistics for quantitative data and content analysis for qualitative data. The model of Multi-drug Resistance Tuberculosis (MDR-TB) Patient Care, “Srisaket Model” was 4 phrases; (1) Early access, “Prepare the readiness of care team”, 2-7 day before registered to treatment. Care team at sub-district level was provided MDR-TB case report and communicated to care team, patient assessment, stop taking any drug in case of TB old case, and prepare the readiness for MDR-TB treatment. (2) In-hospital care, “Start treatment and care as MDR-TB patient”, 14-28 day in the hospital. The essential activities were case management; prepare team and community to care of the patient, disease investigation and screening TB contact case. (3) Intensive care, “Dot by heart”, 3-6 months, the core activities was Dot, drug injection, quality drug assurance and averse drug management (ADM), and prepare area zone for care of MDR-TB patient followed the Infectious control guideline for TB/MDR-TB. And (4) Continuum care, “Cooperation to cope the disease”, Dot care continuously, surveillance to ADM, discharge plan and continuously 5 years plan for TB contact cases surveillance by Chest X-ray and for relapse of TB/MDR-TB patient.

Evaluation of an Artificial Intelligence–Augmented Digital System for Histologic Classification of Colorectal Polyps

Colorectal polyps are common, and their histopathologic classification is used in the planning of follow-up surveillance. Substantial variation has been observed in pathologists' classification of colorectal polyps, and improved assessment by pathologists may be associated with reduced subsequent underuse and overuse of colonoscopy. To compare standard microscopic assessment with an artificial intelligence (AI)-augmented digital system that annotates regions of interest within digitized polyp tissue and predicts polyp type using a deep learning model to assist pathologists in colorectal polyp classification. In this diagnostic study conducted at a tertiary academic medical center and a community hospital in New Hampshire, 100 slides with colorectal polyp samples were read by 15 pathologists using a microscope and an AI-augmented digital system, with a washout period of at least 12 weeks between use of each modality. The study was conducted from February 10 to July 10, 2020. Accuracy and time of evaluation were used to compare pathologists' performance when a microscope was used with their performance when the AI-augmented digital system was used. Outcomes were compared using paired t tests and mixed-effects models. In assessments of 100 slides with colorectal polyp specimens, use of the AI-augmented digital system significantly improved pathologists' classification accuracy compared with microscopic assessment from 73.9% (95% CI, 71.7%-76.2%) to 80.8% (95% CI, 78.8%-82.8%) (P < .001). The overall difference in the evaluation time per slide between the digital system (mean, 21.7 seconds; 95% CI, 20.8-22.7 seconds) and microscopic examination (mean, 13.0 seconds; 95% CI, 12.4-13.5 seconds) was -8.8 seconds (95% CI, -9.8 to -7.7 seconds), but this difference decreased as pathologists became more familiar and experienced with the digital system; the difference between the time of evaluation on the last set of 20 slides for all pathologists when using the microscope and the digital system was 4.8 seconds (95% CI, 3.0-6.5 seconds). In this diagnostic study, an AI-augmented digital system significantly improved the accuracy of pathologic interpretation of colorectal polyps compared with microscopic assessment. If applied broadly to clinical practice, this tool may be associated with decreases in subsequent overuse and underuse of colonoscopy and thus with improved patient outcomes and reduced health care costs.

The challenge of quantifying screening colonoscopy quality: Development and psychometric properties of the Colonoscopy Quality Score instrument

Introduction and aimsColonoscopy quality is measured by the degree in which the examination increases the likelihood of obtaining adequate results on health. Our aim was to develop an instrument for evaluating the quality of screening colonoscopies, taking into account the performance of endoscopists and endoscopy units. Materials and methodsMixed methodology was employed. The first stage (qualitative) consisted of a Medline search, from which a group of experts developed the quality score items. The second stage (quantitative) utilized a modified Delphi technique to reach consensus (3 rounds). We evaluated the psychometric properties of the instrument (reliability and construct validity) in elective screening colonoscopies (in patients ≥ 50 years of age), performed within the January–April 2017 time frame. ResultsA final instrument with 8 items was produced: (1) the Boston Bowel Preparation Scale score; (2) cecal intubation rate; (3) colonoscopy withdrawal time; (4) image documentation; (5) adenoma detection rate; (6) endoscopic surveillance planning; (7) perforation rate, and (8) continuous improvement programs. The instrument was evaluated in 323 colonoscopies performed by 31 endoscopists and found to be one-dimensional and reliable (Cronbach’s alpha 0.76). Performance was compared between endoscopists (center 1) and an expert endoscopist from another center (center 2): Boston Bowel Preparation Scale score 8.3 vs. 7.36 (P < .001), cecal intubation rate 93.5 vs. 96%, colonoscopy withdrawal time 14.8 vs. 8.4 min (P < .001), and adenoma detection rate 34 vs. 52.2% (P < .001), respectively. ConclusionThe Colonoscopy Quality Score is a reliable and valid instrument for evaluating screening colonoscopy quality. Its results could be adapted to the usual endoscopic report to adjust monitorization frequency post-colonoscopy.

Enzootic Bovine Leukosis in Italy: Epidemiological Issues after Free Status Recognition and Measures Applied to Tackle the Last Persistent Clusters.

Enzootic Bovine Leukosis (EBL), caused by the bovine leukemia virus (BLV), has been eradicated in over 20 countries, most of which are in Western Europe. The European Commission, in 2017, declared Italy to be an officially EBL-free country by means of Commission Implementing Decision (EU) 2017/1910, despite the presence of some infection clusters located in four regions of Central-Southern Italy. As a consequence of persisting infection, the Italian Ministry of Health established specific eradication measures in these areas. In collaboration with the National Reference Laboratory for the Study of Ruminant Retroviral Infectious Diseases, the Ministry of Health employed data from the veterinary information system digital platform, combined with a gap analysis exercise, to monitor and verify the progress of control activities within infection clusters during the period 2018–2021. Our aim was to identify any remaining gaps and, consequently, specific measures to eliminate the factors favouring EBL persistence, on the basis of a description and analysis of the current data regarding epidemiological trends in Italian clusters. The final goal is to achieve the implementation of a less expensive surveillance plan in these areas, as well. The results of comprehensive analysis showed that the eradication activities had been effectively implemented by official local veterinary services, resulting in a drastic reduction of EBL outbreaks in most territories during the period 2018–2021.

Feasibility of a truncated surveillance schedule for patients following curative intent treatment for carcinoma of the oral cavity

The purpose of this study was to determine whether a regular follow-up schedule with examination by clinicians results in a better detection rate of disease recurrence and eventual better clinical outcomes when compared to patients who present with symptoms to the clinic and are subsequently detected to have a recurrence of oral squamous cell carcinoma. Retrospective data from 642 patients who underwent treatment for oral squamous cell carcinoma at a tertiary level cancer centre were analysed. Of the 642 patients, 197 had recurrences of which 108 were detected on regular follow-up and 87 were detected in patients presenting out of schedule with symptoms; two patients were detected to have recurrence at another centre, but their mode of detection could not be ascertained. There was no difference in the loco-regional recurrence-free survival or disease-free survival between the two groups. A strict follow-up schedule in the first year followed by a more flexible symptom-based schedule in the subsequent years, with supplementation of imaging if clinically indicated, should be an adequate surveillance plan for oral cancer patients.

Management recommendations for pancreatic manifestations of von Hippel-Lindau disease.

Von Hippel-Lindau disease (VHL) is a multineoplasm inherited disease manifesting with hemangioblastoma of the central nervous system and retina, adrenal pheochromocytoma, renal cell carcinoma, pancreatic neuroendocrine tumors and cysts, and neoplasms/cysts of the ear, broad ligament, and testicles. During 2018-2020, the VHL Alliance gathered several committees of experts in the various clinical manifestations of VHL to review the literature, gather the available evidence on VHL, and develop recommendations for patient management. The current report details the results of the discussion of a group of experts in the pancreatic manifestations of VHL along with their proposed recommendations for the clinical surveillance and management of patients with VHL. The recommendations subcommittee performed a comprehensive systematic review of the literature and conducted panel discussions to reach the current recommendations. The level of evidence was defined according to the Shekelle variation of the Grading of Recommendations, Assessment, Development, and Evaluation grading system. The National Comprehensive Cancer Network Categories of Evidence and Consensus defined the committee members' interpretation of the evidence and degree of consensus. The recommendations encompass the main aspects of VHL-related pancreatic manifestations and their clinical management. They are presented in a clinical orientation, including general planning of screening and surveillance for pancreatic neuroendocrine tumors, utility of biochemical biomarkers, the optimal choice for imaging modality, indirect risk stratification, indications for tissue sampling of VHL-related pancreatic neuroendocrine tumors, and interventions. These recommendations are designed to serve as the reference for all aspects of the screening, surveillance, and management of VHL-related pancreatic manifestations.