Systematic Screening Program Research Articles

Results of Second Round Lung Cancer Screening by Low-Dose CT scan - French Cohort Study (DEP-KP80)

IntroductionOver the last few years, lung cancer screening by low-dose CT scan has demonstrated a decrease in lung cancer mortality. While this method has been in use since 2013 in the United States of America, no European country has yet implemented a systematic screening program. We hereby report the results from the second round of screening from a French cohort study. Patients and MethodsDEP KP80 is a prospective study evaluating lung cancer screening by means of three low-dose computer tomography (CT) scans at 1-year intervals in 1,307 participants, aged 55 to 74 years old, all smokers or former smokers, having quit within the last 15 years, with over 30 pack years. The results of the first round demonstrated it was possible to conduct effective screening in real-life situations. ResultsParticipation was lower in this second round than in the first (35.3% vs. 73.1%, P < .001). The rate of negative results was significantly higher and that of undetermined results lower than those produced in the first round. Overall, 75% of cancers revealed were Stage 1 and 87.5% benefitted from surgical treatment. The incidence of cancer in the second round was 2.43%. ConclusionAs with the first round, the results of this second round confirm the feasibility and efficacy of lung cancer screening. The lower participation rate for this second round is proof of the need to improve awareness among participants and healthcare professionals of the relevance of committing to an annual screening program.

Implementation and Clinical Outcomes of a Large-scale Population-based Abdominal Aortic Aneurysm Screening Program: A Cohort Study

Since 2005, the United States (U.S.) Preventative Services Task Force has recommended one-time ultrasound screening for abdominal aortic aneurysm (AAA) in men ages 65 to 75 years who have ever smoked. However, AAA screening rates remain low in the U.S., and contemporary estimates of AAA disease prevalence are sparse. This study analyzes the processes, patient characteristics, and short-term clinical outcomes of a large-scale systematic AAA screening program targeting this high-risk population.

Screen-detected breast cancer is associated with better prognosis and survival compared to self-detected/symptomatic cases in a Chilean cohort of female patients.

The implementation of national breast cancer (BC) screening programs in Latin America has been rather inconsistent. Instead, most countries have opted for "opportunistic" mammogram screenings on the population at risk. Our study assessed and compared epidemiological, clinical factors, and survival rates associated with BC detected by screening (SDBC) or self-detected/symptomatic (non-SDBC) in Chilean female patients. Registry-based cohort study that included non-metastatic BC (stage I/II/III) patients diagnosed between 1993 and 2020, from a public hospital (PH) and a private university cancer center (PC). Epidemiological and clinical data were obtained from medical records. A total of 4559 patients were included. Most patients (55%; n = 2507) came from PH and were diagnosed by signs/symptoms (non-SDBC; n = 3132, 68.6%); these patients displayed poorer overall (OS) and invasive disease-free survival (iDFS) compared to SDBC. Importantly, the proportion of stage I and "luminal" BC (HR + /HER2-) were significantly higher in SDBC vs. non-SDBC. Finally, using a stage/subset-stratified age/insurance-adjusted model, we found that non-SDBC cases are at a higher risk of death (HR:1.75; p < 0.001). In contrast, patients with PC health insurance have a lower risk of death (HR: 0.60; p < 0.001). We confirm previous studies that report better prognosis/survival on SDBC patients. This is probably due to a higher proportion of stage I and luminal-A cases versus non-SDBC. In turn, the survival benefit observed in patients with PC health insurance might be attributed to a larger proportion of SDBC. Our data support the implementation of a systematic BC screening program in Chile to improve patient prognosis and survival rates.

Atrial Fibrillation (AF) and Ibrutinib, a Monocentric Experience: Should Cardiological Evaluation be a Guide in Clinical Practice?

IntroductionReported prevalence of AF in patients with chronic lymphocytic leukemia (CLL) on ibrutinib is approximately 5-10%. Management of AF in ibrutinib treated patients represents a multidisciplinary and challenging clinical need. Despite therapeutic advances, substantial morbidity and mortality still remain, and preventive or therapeutic strategies need to be implemented. Older age, male gender, arterial hypertension (AH) and valvular heart disease have recently been recognized as strong predictors of AF on ibrutinib. A clear relationship exists between an enlarged left atrium (LA), assessed by transthoracic echocardiography (TTE), and incidence of AF. LA dysfunction at ibrutinib start has been suggested as a predictor of AF: it helps identifying a selected cohort of patients who may benefit from strict follow-up and preventive strategies to reduce incidence of AF and associated complications. To date no prospective clinical trials have been conducted.AimTo analyse cardiovascular predictors and incidence of AF in a monocentric population of CLL patients on ibrutinib and in regular cardio-oncologic follow-up.MethodsFrom June 2014 to June 2017 we prospectively evaluated CLL patients requiring ibrutinib treatment at our Institution. Before starting therapy a full cardiovascular evaluation including accurate history, clinical examination and assessment of concomitant cardiovascular risk factors and cardioactive therapy were performed by an expert cardio-oncologist. All patients underwent non-invasive instrumental investigations performed by the same clinician: baseline electrocardiography (ECG) was used for rhythm documentation and TTE was focused on studying LA size and function. In a selected group of patients a 24 hours ECG monitoring was performed.ResultsFourty-three patients on ibrutinib were evaluated for a median of 12 months (range 1-37). Male/female ratio was 2.07 (M/F 29/14) and median age was 71 years (range 54-86). AF occurred in 7 patients (16.3%) after a median period of 6 months from the beginning of ibrutinib. Before starting therapy 30 patients (69.8%) had at least one cardiovascular risk factor, with 23 (53.5%) suffering from AH and 27 (62.8%) having more than one cardiovascular comorbidity. Twenty-three patients (53.5%) were regularly taking at least one cardioactive drug. We observed male gender and AH (p=0.009) to be significantly related to incidence of AF (p=0.04). One or more pre-existent cardiovascular comorbidity was found to be a strong predictive factor for AF (p=0.03). Concomitant cardioactive therapy and incidence of AF failed to show a significant correlation. Analysing TTE data, a strong predictive value of increased LA linear dimensions (p 0.02) and area (p 0.03) clearly emerged. Sixteen patients (37.2%) were evaluated through prolonged ECG-monitoring. We observed a trend to significance (p=0.07) of a higher maximal heart rate (HR) (109,5±0,7) reached in AF patients compared to those in stable sinus rhythm (73,35±30,6): higher HR, uncovering an increased sympathetic tone, is known to be a risk factor for AF. No significant correlation emerged between occurrence of AF and atrial conduction abnormalities recorded by baseline ECG.ConclusionsDue to the widespread use of ibrutinib in CLL population prompt recognition of AF high risk patients represents an emerging issue.As reported in literature, male sex and AH significantly correlate with AF development. LA enlargement represents a strong predictive factor for AF and TTE can reliably be used as a non-invasive exam to detect early signs of atrial dysfunction. In our cohort AF has occurred in a slightly higher percentage of patients treated with Ibrutinib than in literature. This finding, especially if validated in a larger CLL cohort, can suggest that silent, undetected AF is a common and a often underdiagnosed event in older patients with multiple risk factors. These initial results support a systematic cardiologic monitoring and AF screening program. Proper cardiological evaluation aims to identify patients at higher risk of AF. Educating patients to early recognize adverse events and behave accordingly to clinician's instructions allow to avoid unnecessary drug suspension. Comorbidity control and implementation of cardioactive therapy by an expert cardio-oncologist, preventing LA dilation and dysfunction, could be pursued as a means of reducing AF on ibrutinib. DisclosuresNo relevant conflicts of interest to declare.

Complex interventions to implement a diabetic retinopathy care pathway in the public health system in Kerala: the Nayanamritham study protocol

IntroductionUsing a type 2 hybrid effectiveness-implementation design, we aim to pilot a diabetic retinopathy (DR) care pathway in the public health system in Kerala to understand how it can be...

Multi-cancer detection and tissue of origin determination based on 5-hydroxymethylcytosine biomarkers in circulating cell-free DNA.

3123 Background: Early detection may reduce cancer mortality. Systematic screening programs are available only for a limited number of cancers (e.g., colorectal cancer). The majority of common cancers are detected after the onset of signs and symptoms, making treatment difficult or less effective. We describe here a multi-cancer epigenetic approach for simultaneous cancer detection of common cancers (̃70% of adult cancers) and determination of tissue of origin (TOO) using circulating cell-free DNA (cfDNA) from plasma. Methods: A total of 2241 cancer cases, including patients with newly diagnosed primary colorectal, gastric, esophageal, liver, lung, and breast cancer (stages I-III or equivalent) and 2289 non-cancer controls were recruited from participating hospitals in China. Study participants were randomly assigned into a training set (70%) and a testing set (30%), and patients were matched for cancer types and stages. Plasma samples were collected before radical treatment or surgery. The 5hmC-Seal, a highly sensitive chemical labeling technique, was used to profile genome-wide 5-hydroxymethylcytosines (5hmC) in cfDNA from ̃5mL of plasma per person, followed by the next-generation sequencing, data summarization at gene-level, and normalization. We applied the elastic net regularization to establish a predictive rule based on the multivariable logistic regression model for cancer detection in the training set as well as a multiclass classification model for determining TOO. The final solution for simultaneous cancer detection and TOO determination was established by integrating the 5hmC-based models and protein markers (e.g., AFP). Overall sensitivity and specificity were computed and reported in the testing set of 670 cancer cases and 686 non-cancer controls. Results: For the primary scenario (i.e., stages I-III or equivalent), at specificity of 95%, the overall sensitivity achieved 79.3% for detecting a cancer patient in all six cancer types in the testing set, except stage I lung cancer, for which the multi-cancer detection solution showed a sensitivity of 51%. Notably, for individuals with a negative result from conventional protein markers (e.g., AFP, CEA), the 5hmC-only models showed 67.6% sensitivity at 98.2% specificity in the testing set, representing significant improvement. In the testing set, among the 500 cancer patients who were detected from the multi-cancer detection solution, 435 patients were assigned a TOO; of those, 362 (83.2%) TOO were correctly determined. Conclusions: The 5hmC-Seal in cfDNA shows the potential as a non-invasive tool that could be integrated into a screening program for simultaneous detection of common cancers and TOO localization. This approach can be expanded to additional cancer types and is currently undergoing validation in prospectively recruited cohorts.

Histoire et organisation du programme français de dépistage néonatal systématique (1967-2020)

Au cours du dernier quart du xxe siècle s’est construit en France un ambitieux programme de santé publique. Il s’agissait du dépistage de maladies de l’enfant inapparentes à la naissance, mais dont le diagnostic et le traitement précoces allaient transformer l’état de santé des enfants porteurs de ces maladies. Ce programme très bien structuré est toujours en œuvre et a donné les fruits que nous espérions. Ce texte raconte l’histoire de cette action de santé et résume l’organisation et les objectifs du programme.

Distress experienced by lung cancer patients and their family caregivers in the first year of their cancer journey.

Diagnosis of cancer is emotionally threatening not only for patients but also for their family caregivers (FC) who witness and share much of the illness experience. This study compares distress experienced by lung cancer patients and their FC during the year following the diagnosis. A prospective cohort study of 206 patients recently diagnosed with inoperable lung cancer (participation rate 79.5%) and 131 FC (participation rate 63.6%) was conducted in an ambulatory oncology clinic in Quebec City (Canada). They completed validated questionnaires regarding their personal and psychological characteristics (Hospital and Anxiety Depression Scale-HADS), in the first months after the diagnosis of lung cancer and after 6 and 12 months. Univariate, bivariate, and linear mixed models were conducted to compare patient and FC distress. At baseline, 7.8% of patients reported distress (HADS total score >15) and their mean distress score was 7.0 ± 4.9 (range 0-42). In contrast, 33.6% of FC presented significant distress and their mean distress score was 12.0 ± 7.2 (P < 0.0001). Proportions of patients and FC with distress remained relatively stable at 6 and 12 months, and at every time point, FC reported higher levels of distress compared to their relative with cancer (P < 0.0001). Comparable trends were found when looking at the mean scores of distress, anxiety, and depression throughout the study. Being diagnosed with lung cancer and going through its different phases seems to affect more FC than patients. The psychological impact of such diagnosis appears early after the diagnosis and does not significantly change over time. These findings reinforce the importance for oncology teams, to include FC in their systematic distress screening program, in order to help them cope with their own feelings and be able to play their role in patient support and care throughout the cancer journey.

Chances and Challenges of New Genetic Screening Technologies (NIPT) in Prenatal Medicine from a Clinical Perspective: A Narrative Review.

In 1959, 63 years after the death of John Langdon Down, Jérôme Lejeune discovered trisomy 21 as the genetic reason for Down syndrome. Screening for Down syndrome has been applied since the 1960s by using maternal age as the risk parameter. Since then, several advances have been made. First trimester screening, combining maternal age, maternal serum parameters and ultrasound findings, emerged in the 1990s with a detection rate (DR) of around 90–95% and a false positive rate (FPR) of around 5%, also looking for trisomy 13 and 18. With the development of high-resolution ultrasound, around 50% of fetal anomalies are now detected in the first trimester. Non-invasive prenatal testing (NIPT) for trisomy 21, 13 and 18 is a highly efficient screening method and has been applied as a first-line or a contingent screening approach all over the world since 2012, in some countries without a systematic screening program. Concomitant with the rise in technology, the possibility of screening for other genetic conditions by analysis of cfDNA, such as sex chromosome anomalies (SCAs), rare autosomal anomalies (RATs) and microdeletions and duplications, is offered by different providers to an often not preselected population of pregnant women. Most of the research in the field is done by commercial providers, and some of the tests are on the market without validated data on test performance. This raises difficulties in the counseling process and makes it nearly impossible to obtain informed consent. In parallel with the advent of new screening technologies, an expansion of diagnostic methods has begun to be applied after invasive procedures. The karyotype has been the gold standard for decades. Chromosomal microarrays (CMAs) able to detect deletions and duplications on a submicroscopic level have replaced the conventional karyotyping in many countries. Sequencing methods such as whole exome sequencing (WES) and whole genome sequencing (WGS) tremendously amplify the diagnostic yield in fetuses with ultrasound anomalies.

BK virus nephropathy in non-renal solid organ transplant recipients: Are we looking hard enough?

We retrospectively examined the clinical characteristics, pathological features, and outcomes of BK viremia and nephropathy in a population of non-renal solid organ transplant patients (NRSOT) referred for outpatient nephrology consultation over a period of 5years. In the entire cohort of liver, heart, and lung transplant recipients referred to this clinic, 14% percent were found to have BK viremia with a median peak serum BK viral load of 35500 copies/ml (range 250 to 21100000 copies/ml). BK viremia resolved in six of the seventeen patients (35%). Four out of five patients biopsied showed BK virus (BKV) nephropathy. Eleven out of seventeen patients with BK viremia developed advanced (stage 4 or 5) chronic kidney disease. Four patients developed rejection of their solid organ transplant within the first year post detection of BK viremia after immunosuppression reduction. We conclude that a multi-center study is required to evaluate whether implementation of a systematic BK screening program would be effective in early detection and management of this problem in the NRSOT population.

Bridging the valley of death between research and implementing a systematic diabetic retinopathy screening program in low- and medium-income countries.

Translating research findings to routine clinical practice is fraught with obstacles. The gap between the end of a research project and the implementation of its results is often termed the “valley of death.” In this perspective, we highlight the barriers and potential solutions in translating research on diabetic retinopathy care pathways to implementation in the clinic. This gap analysis applies to all countries around the world, though it predominantly applies to low- and middle-income countries.

Application of the theory of regulatory fit to promote adherence to evidence-based breast cancer screening recommendations: experimental versus longitudinal evidence

ObjectivesTo reduce overtreatment caused by overuse of screening, it is advisable to reduce the demand for mammography screening outside the recommended guidelines among women who are not yet eligible for...

Latent Tuberculosis Therapy Outcomes in Dialysis Patients: A Retrospective Cohort

Maintenance dialysis patients are at an increased risk for active tuberculosis (TB). In 2012, British Columbia, Canada, began systematically screening maintenance dialysis patients for latent TB infection (LTBI) and treating people with evidence of LTBI when appropriate. We examined LTBI treatment outcomes and compared treatment outcomes before and after rollout of the systematic screening program. Retrospective cohort study. The study comprised 365 people in British Columbia, Canada, initiating at least 90 days of dialysis from January 1, 2001, to May 31, 2017, and starting LTBI therapy: 290 (79.5%) people in the recent cohort and 75 (20.5%) in the historical cohort. People starting LTBI therapy from January 1, 2012, onward were classified as the recent cohort, whereas people starting LTBI therapy before January 1, 2012, were classified as the historical cohort. Systematic LTBI screening and therapy. Proportion of people who experience grade 3 to 5 adverse events (AEs) or any grade rash and end-of-treatment outcomes. Outcomes were reported using descriptive statistics. 2-sample test of proportions using χ2 distribution was used to test for statistical significance between the recent and historical cohorts. 298 (81.6%) people successfully completed LTBI therapy. The proportion of people experiencing a grade 3 to 4 AE or any grade rash was 21.1%. Most AEs were related to gastrointestinal events, general malaise, or pruritus that resulted in regimen changes. 2 (0.5%) people were hospitalized for AEs related to LTBI therapy. No significant difference was found between the recent and historical cohorts in all outcomes of interest. No grade 5 AEs (deaths) were attributed to LTBI therapy. Retrospective data and generalizability outside low-TB-burden settings. Our findings suggest that a high proportion of people receiving maintenance dialysis can complete LTBI therapy. The rate of grade 3 to 4 AEs was high and associated with frequent medication changes during therapy. LTBI therapy in maintenance dialysis may be safe but requires close monitoring.

May Measurement Month 2018: an analysis of blood pressure screening results from Chile.

Hypertension is highly prevalent in Chile. The National Health Survey 2016–17 reported a 27.6% prevalence, 68.7% awareness, and 33.3% of hypertensives had controlled blood pressure (BP). May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. A cross-sectional survey of volunteers aged ≥18 years old was carried out in May 2018. Blood pressure measurement, the definition of hypertension, and statistical analysis followed the MMM protocol. Ninety-four sites participated, most of them from the Public Health System outpatient clinics distributed along the country. In addition, universities, clinical research sites, and private clinics participated. Hypertension was diagnosed as mean systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or receiving antihypertensive medication. Overall 9344 individuals were screened. After multiple imputation, hypertension prevalence was 29.2%, of which 64.0% were aware of their condition. Of those aware of their hypertension diagnosis, 87.7% were receiving antihypertensive medication and 56.1% of the total number of hypertensives were on antihypertensive medication. Moreover, 15.3% of the participants who were not receiving treatment were considered potential hypertensives identified in the MMM18. MMM18 was one of the largest BP screening campaigns performed in Chile. It demonstrated a high prevalence of hypertension with one-third of these individuals having controlled BP. The high percentage of persons untreated or with uncontrolled hypertension while on pharmacologic treatment suggests that systematic screening programmes may be a useful tool to improve hypertension control in Chile.

May Measurement Month 2018: an analysis of blood pressure screening results from Spain.

Elevated blood pressure (BP) is the single most important contributing risk factor to the global disease burden, leading to over 10 million deaths each year. In Spain, hypertension (HTN) affects around 20% of the adult population and remains the greatest attributable cause of cardiovascular mortality. May Measurement Month (MMM) is a worldwide initiative aimed at increasing awareness of HTN and to improve the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged 18 and over was carried out in May 2018. Blood pressure measurement, the definition of HTN and statistical analysis followed the standard MMM protocol. Anthropometric data and responses to questionnaires on demographic, lifestyle, and environmental factors were obtained as additional information. Screening sites mainly in community pharmacies, universities, primary care centres, HTN units, and cardiovascular departments in hospitals were set up across Spain as part of this initiative. In total, 7646 individuals (63.5% female) were screened during MMM18. After multiple imputation, 40.0% had HTN, of whom 74.4% were aware of their diagnosis and 69.6% were taking antihypertensive medication. Of individuals not receiving antihypertensive medication, 16.9% were hypertensive. Of individuals receiving antihypertensive medication, 36.4% had uncontrolled BP. MMM18 almost doubled the number of participants of MMM17 and was the largest BP screening campaign ever undertaken in Spain, showing that in the absence of systematic screening programmes for HTN, MMM can identify a great number of individuals at risk, increasing their awareness and attracting the interest of the healthcare system in Spain.

Strongyloidiasis in Southern Alicante (Spain): Comparative Retrospective Study of Autochthonous and Imported Cases.

Background: Strongyloidiasis is a parasitic disease with global prevalence. In Spain, autochthonous cases are concentrated in the Mediterranean basin. We aimed to analyze clinical and epidemiological characteristics of Strongyloides stercoralis infection in Vega Baja del Segura (Spain), comparing autochthonous versus imported cases. Methods: Observational retrospective study of all strongyloidiasis cases from January 2009 to January 2019. Cases were diagnosed by stool larvae visualization, positive culture, PCR, Strongyloides serology, and/or compatible histology. Results: We included 36 patients (21 men) with a mean age of 60.8 years ±17.6; 15 cases were autochthonous and 21 imported 80.9% from Latin America. Autochthonous cases were associated with older age (mean 71.3 vs. 53.3 years; p = 0.002), male sex (odds ratio (OR) 5.33; 95% confidence interval (CI) 1.15–24.68; p = 0.041), and agricultural activity (OR 13.5; 95% CI 2.4–73.7; p = 0.002). Fourteen were asymptomatic, three autochthonous cases presented with hyperinfection syndrome, and two patients died. There was no difference between autochthonous versus imported origin in eosinophilia at diagnosis (93.3% vs. 75%; p = 0.207), treatment received, or clinical response (85.7% vs. 88.9% cured; p = 1). Conclusion: In our region, imported strongyloidiasis coexists with autochthonous cases, which are mainly in older male farmers who are diagnosed at more advanced stages. Systematic screening programs are needed.

Perinatal and perioperative factors associated with mortality and an increased need for hospital care in infants with transposition of the great arteries: A nationwide 11-year population-based cohort.

Newborn infants with transposition of the great arteries (d-TGA) need immediate care for an optimal outcome. This study comprised a nationwide 11-year population-based cohort of d-TGA infants, and assessed whether the implementation of a nationwide systematic fetal screening program, or other perinatal, or perioperative factors, are associated with mortality or an increased need for hospital care. The national cohort consisted of all live-born infants with simple d-TGA (TGA±small ventricular septal defect, n=127) born in Finland during 2004-2014. Data were collected from six national registries. Prenatal diagnosis and perinatal and perioperative factors associated with mortality and length of hospitalization were evaluated. Preoperative mortality was 7.9%, and the total mortality was 8.7%. The prenatal detection rate increased after introducing systematic fetal anomaly screening from 5.0% to 37.7% during the study period (P<.0001), but the total mortality rate remained unchanged. All prenatally diagnosed infants (n=27) survived. Lower gestational age (odds ratio 0.68, P=.012) and higher maternal age at birth (odds ratio 1.16, P=.036) were associated with increased mortality in multivariable analysis. Older infant age at time of operation (P=.002), longer aortic clamp time (P<.001), and higher maternal body mass index (P=.027) were associated with longer initial hospital stay. An extended need for hospital care during the first year of life was multi-factorial. In our cohort, none of the prenatally diagnosed d-TGA infants died. As a result of the limited prenatal detection rates, however, the sample size was insufficient to reach statistical significance. The d-TGA infants born with lower gestational age and to older mothers had increased mortality.

Impact of organized colorectal cancer screening programs on screening uptake and screening inequalities: A study of systematic- and patient-reliant programs in Canada

BackgroundVarious provincial colorectal cancer screening programs have been implemented in Canada but have yet to be evaluated. ObjectiveWe examined the effects of patient-reliant and systematic organized colorectal screening programs on colorectal cancer screening uptake and on screening inequalities by income, education, rural residence, and access to a primary care physician. MethodsLifetime and recent (< 1, <2 years) stool-based screening uptake were assessed among Canadian Community Health Survey respondents (cycles 2003–2014), aged 50–75 years, with no personal or family history of colorectal cancer. We used a difference-in-differences approach to estimate the effects of two systematic provincial programs (where all eligible residents receive screening kits via mail), and one patient-reliant program (where residents receive screening kits via mail following their request to a physician, phone line or website). ResultsOverall, systematic and patient-reliant programs were associated with a 4- [95 % CI: 1%, 7%] and a 12-percentage point [95 % CI: 2%, 8%] increase in recent (<2 years) stool-based screening, respectively, with effect sizes converging after three years at approximately 10 %. The patient-reliant program was associated with an 11 % [95 % CI: 5%, 17 %] increase in uptake among those with a physician, but no effect among those without—leading to increased inequality in uptake according to physician access. InterpretationBoth program types increase colorectal screening overall. Reliance on patients’ request for screening may increase disparities according to physician access. Exploration of complementary targeted interventions in patient-reliant settings appears warranted.

Health Economic and Safety Considerations for Artificial Intelligence Applications in Diabetic Retinopathy Screening.

Systematic screening for diabetic retinopathy (DR) has been widely recommended for early detection in patients with diabetes to address preventable vision loss. However, substantial manpower and financial resources are required to deploy opportunistic screening and transition to systematic DR screening programs. The advent of artificial intelligence (AI) technologies may improve access and reduce the financial burden for DR screening while maintaining comparable or enhanced clinical effectiveness. To deploy an AI-based DR screening program in a real-world setting, it is imperative that health economic assessment (HEA) and patient safety analyses are conducted to guide appropriate allocation of resources and design safe, reliable systems. Few studies published to date include these considerations when integrating AI-based solutions into DR screening programs. In this article, we provide an overview of the current state-of-the-art of AI technology (focusing on deep learning systems), followed by an appraisal of existing literature on the applications of AI in ophthalmology. We also discuss practical considerations that drive the development of a successful DR screening program, such as the implications of false-positive or false-negative results and image gradeability. Finally, we examine different plausible methods for HEA and safety analyses that can be used to assess concerns regarding AI-based screening.

Long-term outcomes in major trauma patients and correlations with the acute phase

BackgroundMajor trauma patients experience a 20% mortality rate overall, and many survivors remain permanently disabled.In order to monitor the quality of trauma care in the Trauma System, outcomes assessment is essential. Quality indicators on outcome can be expressed as quality of life, functional outcome, and others.The trauma follow-up system was created within the Romagna Trauma System (Italy) in order to monitor the trauma network and assess its long-term outcomes.The aim of this paper is firstly to evaluate the existence of correlations between epidemiological data, severity of injury, and clinical assessment characterizing the acute phase and the long-term outcomes in trauma patients and secondly, to explore the association between outcome variables have been modified.MethodsWe conducted a cross-sectional study over a 10-year period, including patients with severe trauma who survived and were discharged from the intensive care unit. The outcome measures were assessed with the use of the Extended Glasgow Outcome Scale and the Euro Quality of Life scale 5 dimension.Demographic data and clinical severity descriptors versus functional outcome were tested in a binary logistic regression model.ResultsIn all, 428 major trauma patients participated in the study. At 1 year, 50.8% of trauma patients included had a good recovery and 49.2% had some degree of disability. The median value of quality of life was 0.725.At the multivariate analysis, variables showing significant impact on functional outcome were age (p = 0.052, OR 1.025), injury severity score (p = 0.001, OR 1.025), and Glasgow coma scale ≤ 8 (p = 0.001, OR 3.509)The Spearman’s Rank correlation coefficient showed a strong correlation between the global level of function variables and quality of life at one year (Spearman’s Rho Correlation Coefficient 0.760 (p < 0.0001)).ConclusionsIncreased age, increased injury severity score, and severe traumatic brain injury are predictors of long-term disability.Most of these trauma patients show impairments that affect not only the level of functional state but also the quality of life. The degree of functional independence has the greatest positive impact on quality of life.According to our results, after the recovery a prompt recognition of physical and psychological problems with systematic follow-up screening programs can help patients and doctors in defining specific therapeutic-rehabilitation pathways tailored to meet individual requirements.