Upper Limit For Age Research Articles

Inter-Rater Reliability of Pain Provocation Tests for Painful Lumbar Facet Joints. A Pilot Study.

With a life-time prevalence of 39%, low back pain (LBP) is one of the most common musculoskeletal disorders. Correct diagnosis of underlying causes is commonly seen as a prerequisite for successful therapy of LBP. Currently, there is no useful, non-invasive clinical test to diagnose painful lumbar zygapophyseal joints. Clinical tests with high diagnostic accuracy are therefore desirable. Inter-rater reliability is commonly seen as a prerequisite of test validity. The objective of this pilot study was thus to evaluate inter-rater reliability of new clinical pain provocation tests for diagnosing painful lumbar zygapophyseal joints. If a clinically significant level of inter-rater reliability were to be determined, this study could constitute a first step towards establishing the clinical utility of this new set of tests in the structural diagnosis of low back disorders. Patients participating in this study were recruited in a specialist hospital throughout June 2015 until September 2016. Both female and male patients with current LBP, with or without buttock or lower extremity symptoms were screened for inclusion. Patients had preferably to be 50 years or older in order to be included in this study. The upper age limit was set at 90 years. They also had to be fluent in German to be able to follow verbal instructions. Exclusion criteria comprised the presence of red flags, surgical spinal fusion at any level of the lumbar spine, discectomy within the past 12 months, radiculopathy and/or radicular pain, interventional treatments for the IVD, SIJs or ZAJs within the past three months, psychiatric disorders, current litigation issues concerning back pain, and central nervous system diseases. Three certified manual therapy instructors tested patients independently. Fleiss' kappa values and percent agreements were calculated. Subjects included a sample of 48 patients (15 males and 33 females) with a mean age of 66.48 years (range 33 - 90) presenting at a specialist hospital with low back pain. The new pain provocation tests for lumbar zygapophyseal joints showed moderate reliability (Fleiss' κ = 0.46) and an overall percent agreement of 68.8%. Separate tests for the zygapophyseal joints of L5-S1 showed fair reliability (Fleiss' κ = 0.37) and an overall percent agreement of 64.6%. Unidimensional tests that were used in the study to exclude the intervertebral disc as a nociceptive generator showed fair reliability as well (average κ of 0.28 and 0.39, respectively). Neither drop outs nor adverse events occurred. The new pain provocation tests for lumbar zygapophyseal joints showed clinically significant levels of inter-rater reliability. Validation of these tests against fluoroscopy-guided medial branch blocks is warranted.

Efficacy of Internet-Delivered Mindfulness for Improving Depression in Caregivers of People With Spinal Cord Injuries and Chronic Neuropathic Pain: A Randomized Controlled Feasibility Trial

ObjectivesTo explore the feasibility and efficacy of web-based mindfulness training for carers of people with spinal cord injury (SCI). DesignRandomized controlled feasibility study with 3-month follow-up. SettingCommunity setting. ParticipantsSpouses or family caregivers (N=55) of people with SCI and chronic neuropathic pain were recruited via the direct care team and advertisements. Participants were older than 18 years (no upper age limit), with Internet access for the duration of the study. Participants were randomly allocated to an 8-week online mindfulness training intervention (n=28), or to receive 8 weeks of psychoeducational materials on SCI and chronic pain (n=27). InterventionsAn established web-based, mindfulness training course was delivered over 8 weeks. Participants completed 10 minutes of mindfulness practices, twice per day, 6 days per week, totaling 960 minutes. The control group received a weekly e-mail with psychoeducational materials (based on the established elements) on SCI and pain for 8 weeks. Main Outcome MeasureDepression severity. ResultsMindfulness reduced depression severity more than psychoeducation at T2 (mean difference= −.891; 95% confidence interval,−1.48 to −.30) and T3 (mean difference=−1.96; 95% confidence interval, −2.94 to −.97). Mindfulness training also reduced anxiety at T2 (mean difference=−.888; 95% confidence interval, −1.40 to −.38) and T3 (mean difference=−2.44; 95% confidence interval, −3.20 to −1.69). ConclusionsResults indicate that Internet-delivered mindfulness training offers unique benefits and is viable for caregivers of people with SCI and chronic neuropathic pain. Further work should explore the feasibility of combined education and mindfulness training incorporating both patient and caregiver, for optimum benefit.

Assessing the Cost-Effectiveness of Updated Breast Cancer Screening Guidelines for Average-Risk Women

BackgroundSeveral specialty societies have recently updated their breast cancer screening guidelines in late 2015/early 2016. ObjectivesTo evaluate the cost-effectiveness of US-based mammography screening guidelines. MethodsWe developed a microsimulation model to generate the natural history of invasive breast cancer and capture how screening and treatment modified the natural course of the disease. We used the model to assess the cost-effectiveness of screening strategies, including annual screening starting at the age of 40 years, biennial screening starting at the age of 50 years, and a hybrid strategy that begins screening at the age of 45 years and transitions to biennial screening at the age of 55 years, combined with three cessation ages: 75 years, 80 years, and no upper age limit. Findings were summarized as incremental cost-effectiveness ratio (cost per quality-adjusted life-year [QALY]) and cost-effectiveness acceptability frontier. ResultsThe screening strategy that starts annual mammography at the age of 45 years and switches to biennial screening between the ages of 55 and 75 years was the most cost-effective, yielding an incremental cost-effectiveness ratio of $40,135/QALY. Probabilistic analysis showed that the hybrid strategy had the highest probability of being optimal when the societal willingness to pay was between $44,000/QALY and $103,500/QALY. Within the range of commonly accepted societal willingness to pay, no optimal strategy involved screening with a cessation age of 80 years or older. ConclusionsThe screening strategy built on a hybrid design is the most cost-effective for average-risk women. By considering the balance between benefits and harms in forming its recommendations, this hybrid screening strategy has the potential to optimize the health care system’s investment in the early detection and treatment of breast cancer.

U-Pb geochronology and geochemistry from the northeastern New River belt, southern New Brunswick, Canada: significance of the Almond Road Group to the Ganderian platformal margin

The Almond Road Group in the northeastern New River belt comprises two formations: the basal Snider Mountain Formation contains orthoquartzite, feldspathic quartzite, and quartzite pebble conglomerate; the gradationally overlying Ketchum Brook Formation is composed of feldspathic sandstone, laminated dark siltstone and shale, overlain by mafic lithic tuffs and basaltic flows. The Almond Road Group overlies latest Ediacaran to earliest Cambrian (early Fortunian) pyroclastic, volcaniclastic, and epiclastic rocks of the Belleisle Bay Group. Based in part on this relationship, the Almond Road Group was thought to be Early Cambrian, although an upper age limit had never been determined. A U–Pb (zircon) age of 475 ± 2 Ma for the West Scotch Settlement porphyry, a small felsic hypabyssal intrusion emplaced into the Ketchum Brook Formation, demonstrates that the Almond Road Group is no younger than Early Ordovician (early Floian) age. Its age is further constrained by LA ICP-MS detrital zircon data from a basal quartzite in the Snider Mountain Formation. Results show a dominant peak in the Ediacaran (ca. 575 Ma), with the youngest coherent cluster of ages at ca. 530–520 Ma. Together these data support a Cambrian age for the quartz-rich Almond Road Group and its platformal relationship to Ganderia.

Upper Age Limit in Outpatient Anesthesia: Opportunities and Risks

Ambulatory surgery in elderly patients continues to increase - avoiding hospitalization and thus postoperative cognitive dysfunction in older patients being its major objectives. An upper age limit in outpatient anesthesia does not exist to date. However, functional rather than chronological age is crucial in patient selection. In consensus discussion, baseline functional status should be evaluated regularly - defined as everyday behaviors necessary to maintain daily life and encompassing areas of physical, cognitive, and social functioning. Moreover, frailty in elderly patients can be quantified objectively and is associated with increased perioperative morbidity in ambulatory general surgery. The decision for or against outpatient anesthesia therefore remains a case-by-case decision which should be discussed within a team.

35.2 PREVENTING PSYCHOSIS: WHAT, (IF ANYTHING) CAN WE LEARN FROM THE EU-GEI INCIDENCE STUDY?

BackgroundThe incidence of psychotic disorders varies across replicable social and environmental gradients at both an individual and a population level, such as higher rates of disorder in urban and migrant populations. However, the factors underpinning this are unclear. The EU-GEI study was established to investigate the incidence as well as the genetic and environmental determinants of first episode psychosis in a multi-national setting. The aim of the present study was to investigate the variance found in the incidence across the 17 catchment areas in the 6 countries (England, France, Italy, the Netherlands, Spain and Brazil) included in this study at both individual and population level, and identify putative predictors of psychosis risk.MethodsWe conducted a population-based study of the incidence of non-organic adult ICD-10 psychotic disorders (F20-F33). Demographic data (age, sex, ethnicity) and OPCRIT diagnoses were collected, and denominator data was estimated from government sources. Crude incidence rates were directly standardised to the 2011 England and Wales Census population to account for population differences in age, sex and ethnicity. Multilevel Poisson regression was carried out to investigate variance in incidence between catchment areas by latitude, population density, and percentage of unemployment, owner-occupied houses and single-person households as markers of catchment-area level social fragmentation, using official government statistics and data from the 2011 European Population and Housing Census.ResultsWe identified a total of 2,774 cases over 12.94 million person-years at risk, leading to a crude incidence of 21.4 per 100,000 person-years (95%CI: 19.4–23.4). The age pattern of incidence differed between men and women: crude incidence peaked in men aged 18–24 (61.0 per 100,000 person-years, 95%CI: 59.0–63.1) and declined sharply thereafter, for women rates also peaked in the youngest age group (27.0 per 100,000 person-years, 95%CI: 24.9–29.1) but decline was more gradual and there was a small but robust secondary peak after age 45. By age 35, 68% of male cases had presented to services, compared to 51% of female cases. Age-sex-ethnicity standardised incidence of all psychotic disorders varied 8-fold across settings. Poisson regression revealed higher rates in minority groups (IRR: 1.6, 95%CI: 1.5–1.7), and an association between greater catchment area-level owner-occupancy and lower incidence (IRR for a 10% increase: 0.8, 95%CI: 0.7–0.8). No relationship was found for other putative environmental risk factors, including latitude and population density. Results were similar for non-affective and affective disorders.DiscussionVariance in treated incidence was substantial and was only partially explained by standardisation for age, sex and ethnicity, and Poisson regression including catchment-area level risk factors. For the prevention of psychosis two main lessons can be learned: services focused on early intervention should not have an upper age limit as half of all female (and 32% of male) cases present after age 35, and future examinations of variance should focus on socioenvironmental and not geographical determinants.

Extracorporeal cellular therapy (ELAD) in severe alcoholic hepatitis: A multinational, prospective, controlled, randomized trial.

Severe alcoholic hepatitis (sAH) is associated with a poor prognosis. There is no proven effective treatment for sAH, which is why early transplantation has been increasingly discussed. Hepatoblastoma‐derived C3A cells express anti‐inflammatory proteins and growth factors and were tested in an extracorporeal cellular therapy (ELAD) study to establish their effect on survival for subjects with sAH. Adults with sAH, bilirubin ≥8 mg/dL, Maddrey's discriminant function ≥ 32, and Model for End‐Stage Liver Disease (MELD) score ≤ 35 were randomized to receive standard of care (SOC) only or 3‐5 days of continuous ELAD treatment plus SOC. After a minimum follow‐up of 91 days, overall survival (OS) was assessed by using a Kaplan‐Meier survival analysis. A total of 203 subjects were enrolled (96 ELAD and 107 SOC) at 40 sites worldwide. Comparison of baseline characteristics showed no significant differences between groups and within subgroups. There was no significant difference in serious adverse events between the 2 groups. In an analysis of the intent‐to‐treat population, there was no difference in OS (51.0% versus 49.5%). The study failed its primary and secondary end point in a population with sAH and with a MELD ranging from 18 to 35 and no upper age limit. In the prespecified analysis of subjects with MELD < 28 (n = 120), ELAD was associated with a trend toward higher OS at 91 days (68.6% versus 53.6%; P = .08). Regression analysis identified high creatinine and international normalized ratio, but not bilirubin, as the MELD components predicting negative outcomes with ELAD. A new trial investigating a potential benefit of ELAD in younger subjects with sufficient renal function and less severe coagulopathy has been initiated. Liver Transplantation 24 380–393 2018 AASLD.

Donor selection in the modern era.

The growing disparity between the supply of donor hearts for transplantation and the demand for such organs has led to liberalization of the criteria for donor heart acceptance over the past few decades. The upper age limit and size restrictions for donor heart acceptance continue to be revised and hearts are being routinely used from donors with left ventricular dysfunction, left ventricular hypertrophy (LVH), cocaine use, multiple medical co-morbidities and after cardiopulmonary resuscitation. This article reviews recent data for use of such "expanded criteria" donor hearts and suggests ways to further increase the donor pool, including use of hearts from donors with hepatitis C and after circulatory determination of death. Donor biomarkers and risk scores may eventually aid in heart acceptance decisions, while ethical issues surrounding information sharing with transplant recipients remain a topic of great debate.

Cohort profile: workers’ compensation in a changing Australian labour market: the return to work (RTW) study

PurposeWorkers’ compensation claims for older workers and workers who have suffered psychological injury are increasing as a proportion of total claims in many jurisdictions. In the Australian state of Victoria,...

MTE 04.02 General Principles of PCI in the Treatment of SCLC

The brain is a well-recognized sanctuary site for micrometastases in patients with small cell lung cancer (SCLC) treated with chemotherapy. The administration of prophylactic cranial irradiation (PCI) in patients responding to chemotherapy reduces the incidence of clinically detectable brain metastases in patients with both limited1 and extensive disease.2,3 In patients with limited disease, this translated into a survival benefit in a meta-analysis of 987 complete responders, but in patients with extensive disease, one trial of 286 responders to chemotherapy showed a survival benefit2, whilst in another of 224 patients it did not.3 The design of this latter trial suggested that regular surveillance with MRI and treatment at the time of metastasis detection might be an equally effective strategy. This could reduce the incidence of the most serious toxicity of PCI which is delayed neurotoxicity. Limiting the total dose is another possible means of reducing neurotoxicity. A randomized trial of three dose prescriptions restricted to patients with limited disease showed no difference in rate of brain metastases between 25 Gy in 10 fractions versus two higher dose schedules, but there was a higher mortality associated with the higher doses, due to an unexplained increase in disease progression.4 In spite of this high level evidence there are still numerous uncertainties facing the clinician when deciding whether to recommend PCI. 1. Is the classification limited versus extensive disease still appropriate when selecting patients? 2. Are there subgroups of patients with metastatic disease more likely to benefit from PCI than others because their overall prognosis is better?5 3. Should there be an upper age limit? 4. Are pre-existing neurologic conditions or paraneoplastic syndromes contraindications? 5. In patients with extensive disease, is pretreatment MRI required? 6. Is MRI surveillance cost effective? 7. Is there a role for hippocampal sparing techniques or neuroprotective agents? 8. Is there a place for lower dose/shorter fractionation schedules? 9. In patients with extensive disease having consolidative chest irradiation, is there any difference between giving PCI simultaneously versus sequentially? 10. What will be the role of PCI in the era of immunotherapy? Question 7 is currently the subject of an actively recruiting randomized trial (NRG-CC003), but for the other questions, physician and patient discretion will be required for the foreseeable future. 1. Auperin, A., et al., Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med, 1999. 341: 476-84. 2. Slotman, B., et al., Prophylactic Cranial Irradiation in Extensive Small-Cell Lung Cancer N Engl J Med, 2007. 357: 664-672. 3. Takahashi, T., et al., Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol, 2017. 18: 663-671. 4. Le Pechoux, C., et al., Standard-dose versus higher-dose prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer in complete remission after chemotherapy and thoracic radiotherapy (PCI 99-01, EORTC 22003-08004, RTOG 0212, and IFCT 99-01): a randomised clinical trial. Lancet Oncol, 2009. 10:467-74. 5. Eberhardt, W.E., et al., The IASLC Lung Cancer Staging Project: Proposals for the Revision of the M Descriptors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol, 2015. 10:1515-22. small cell lung cancer, prophylactic cranial irradiation

Nivolumab in non-small cell lung cancer: is there an upper age limit?

Introduction: Recent scientific evidence has led to extensive use of immunotherapy in the treatment of non-small cell lung cancer (NSCLC) patients (pts) pretreated with platinum-based chemotherapy regimens. The checkpoint inhibitor Nivolumab (Opdivo® BMS ™) has shown superior efficacy to standard 2nd-line chemotherapy with greater tolerability, which results in improved quality of life. Aging involves physiologic changes and immunosenescence, aging-related loss of immune function, may have a negative impact on clinical benefit and effectiveness of immunotherapy. The objective of our study was to evaluate disease treatment response, to estimate the incidence and diversity of immune-related adverse events (IrAEs) in pts receiving Nivolumab and to check the relationship with age-associated immune dysregulation. Material and methods: From May 2015 to April 2017, 92 NSCLC pts were treated with nivolumab as a single agent, after disease progression to one or more chemotherapy lines, at a dose of 3 mg/kg every two weeks. Clinical examination and evaluation of adverse reactions were performed every 2 weeks. CT scans was performed every 8-12 weeks to assess tumor treatment response. The study population was divided into two different age groups, under 70 years and over 70 years older. Two aspects of adverse event patterns were measured: incidence rate and different types of adverse events in each of the pts age groups. Results: Of 92 pts 41 were age <70 yrs (45%) and 51 were >70 yrs (55%). ORR in pts group <70 yrs was 43% (PR 23%, SD 20%), similar to that found in older pts group (PR 14%, SD 29%). The incidence of IrAEs was 36% in the first group, 32% in the second group. Most common irAEs among pts >70 were endocrinopathies (11%), colitis (7%) and rash (7%). Some adverse events, such as endocrinopathies and fatigue, appeared most frequently in the pts group <70 yrs (16% and 10% respectively). Conclusions: Immunotherapy represent a valid therapeutic option for NSCLC patients but currently there is little known about the safety of nivolumab in elderly patients that may still respond appropriately to checkpoint inhibitors. The obtained data suggest that nivolumab is well tolerated and there is no significant differences between the two age-groups in terms of efficacy and tolerability. The inclusion of greater number of elderly patients in registration clinical trials will provide helpful informations to clinicians on the safety of immunotherapy in patients aged 70 yrs and older.

PP.01.26] PROTOCOL OF THE SWISS LONGITUDINAL COHORT STUDY (SWICOS) IN RURAL Switzerland

Objective: Increased longevity and consequent major changes in demographics and population lifestyles necessitate new approaches to reduce the burden of aging-related diseases (including CVD) and maintain an optimal quality of life. This study aims to examine and longitudinally follow health status and disease risk factors in a Swiss rural cohort, evaluating all health related research and practice disciplines to assure development of new implementable and successful preventive strategies for healthy aging. Design and method: Small villages of rural regions in Switzerland with low migration rates have been selected for this longitudinal prospective study. All residents (age >=6 years, no upper age limit) are eligible. Target enrolment number per village is 300. Examinations and measurements encompass medical history, anthropometry, cardiac and vascular health, pulmonary function, physical performance, nutritional, mental and emotional status, biochemical and molecular analyses. Follow-up examinations (identical to baseline) will be performed after 5 and 10 years, and in 10-year intervals thereafter. Results: In the first participating village, more than 300 participants have been enrolled so far. Enrollment will start in a second participating village in 2017. Conclusions: This study will allow to: (1) identify “hidden” (asymptomatic and/or unrecognized) health problems which enhance risk for chronic diseases; (2) identify barriers to accessing health care and adapting health behaviours; (3) evaluate efficacy of present preventive strategies and recommendations; (4) evaluate knowledge and attitude towards ongoing health programs and public health recommendations; (5) monitor change and progress towards the national health objectives; (6) formulate new preventive strategies and recommendations based on the findings and knowledge base of the last 10 years; (7) formulate models for successful prevention of chronic diseases and for healthy aging.

Age Limit of Pediatrics.

Pediatrics is a multifaceted specialty that encompasses children's physical, psychosocial, developmental, and mental health. Pediatric care may begin periconceptionally and continues through gestation, infancy, childhood, adolescence, and young adulthood. Although adolescence and young adulthood are recognizable phases of life, an upper age limit is not easily demarcated and varies depending on the individual patient. The establishment of arbitrary age limits on pediatric care by health care providers should be discouraged. The decision to continue care with a pediatrician or pediatric medical or surgical subspecialist should be made solely by the patient (and family, when appropriate) and the physician and must take into account the physical and psychosocial needs of the patient and the abilities of the pediatric provider to meet these needs.

Associations between self-rated health and health behaviour among older adults in Estonia: a cross-sectional analysis

ObjectivesThe population of Estonia has one of the lowest life expectancies and health statuses in Europe. This is reflected in a lower perception of health among older adults. This study...

The Kasur Incident of Child Abuse: A Fact Funding Report; Analyzing State of Child Protection in Pakistan

An incident was surfaced in media nationally and internationally in 2015 where large number of children was sexually abused. Pakistan is a signatory to the Convention on the Rights of the Child and has also ratified Optional Protocol to the Convention on the Rights of the Child on the Sale of Children, Child Prostitution and Child Pornography. The reports finds that Pakistan lacks internationally accepted rights based child protection mechanism at national, provincial and local level. National and provincial laws and policies on child protection are inadequate. Child sexual abuse, Child Prostitution and Child Pornography are dealt indirectly in national and provincial laws. Denial and repression are also evident in the current state of legislation on child sexual abuse in Pakistan. The Prime Minister of Pakistan has taken serious notice of the report and directed federal and provincial governments to implement its recommendations which led to adoption of Criminal Law Amendment Act, 2015 aimed at protecting children from mental and physical abuse. Amongst major amendments, the act raises the minimum age of criminal responsibility from 7 to 10 years and the upper age limit from 12 to 14 years. Moreover, it protects children from cruel treatment and criminalizes child pornography.

Patient satisfaction with nurse-led chronic kidney disease clinics: A multicentre evaluation.

There is growing international evidence that nurse-led chronic kidney disease (CKD) clinics provide a comprehensive approach to achieving clinical targets effective in slowing the progression of CKD. Across Queensland, Australia, these clinics have been established in many renal outpatient departments although patient satisfaction with these clinics is unknown. To measure patient satisfaction levels with CKD nurse-led clinics. This was a cross-sectional study undertaken at five clinics located in metropolitan, regional and remote hospitals in Queensland. Participants were >18 years of age (no upper age limit) with CKD (non-dialysis) who attended CKD nurse-led clinics over a six month period (N = 873). They completed the Nurse Practitioner Patient Satisfaction questionnaire which was modified for CKD. The response rate was 64.3 % (n = 561); half of the respondents were male (55.5 %), there was a median age range of 71-80 years (43.5 %) and most respondents were pensioners or retired (84.2 %). While the majority reported that they were highly satisfied with the quality of care provided by the nurse (83.8 %), we detected differences in some aspects of satisfaction between genders, age groups and familiarity with the nurse. Overall, patients' comments were highly positive with a few improvements to the service being suggested; these related to car-parking, providing more practical support, and having accessible locations. In an era of person-centred care, it is important to measure patient satisfaction using appropriate and standardised questionnaires. Our results highlight that, to improve services, communication strategies should be optimised in nurse-led clinics.

Patients 60 years of age and older should have the same chance for heart transplantation or not?

Heart transplantation is considered the best treatment modality for advanced heart disease. While old age has conventionally been considered a contraindication for heart transplantation due to the reported adverse effect of advanced age, however donor hearts' shortage continues to stimulate the discussion about the recipient's upper age limit. Our study was based on a retrospective analysis for the results of 52 (18%) patients aged 60 years and older undergoing heart transplantation between May 2008 and December 2015, and these patients were compared with 236 (82%) adult recipients who were younger than 60 years at the time of transplantation and during the same period. In older group, 71% were males with the mean age of 63.38±3.55 years, and in younger group, 83.4% were males with a mean age of 43.72±11.41 years (P=0.27). Dilated cardiomyopathy was the most common indication for transplantation among patients in both groups (P=0.147). In older group, the 3-month survival rate was higher than that in younger group (P=0.587), however the 6-month survival rate showed no significant difference (P=0.225). Although the 1-year survival rate was higher in older group (P=0.56), yet the 3-year survival rate between the two groups showed no statistically significant difference (P=0.48). According to our experience among older heart transplant candidates who were 60 years and older, we believe that advanced age should not be an excluding criterion to cardiac transplantation.

National multicentre audit of pregnancy status in general surgery admissions in Scotland

BackgroundDocumentation of pregnancy status (PS) is an integral component of the assessment of women of reproductive age when admitted to hospital. Our aim was to determine how accurately PS was...

OP67 Cost-Effectiveness of Human Papillomavirus-based Primary Cervical Screening In Ireland

INTRODUCTION:The cost-effectiveness of Human papillomavirus (HPV)-based primary cervical screening in the Irish healthcare setting is assessed using a decision-analysis approach to inform a decision around changes to the national screening program. Current practices comprises primary screening with liquid-based cytology (LBC) followed by HPV triage, at 3-yearly intervals for ages 25 to 45 years and 5-yearly until age 60 years.METHODS:This study assessed changing the primary screening test from LBC to HPV testing, in both an unvaccinated and a vaccinated (against HPV 16/18) cohort. It considered extending the screening interval (to 5-yearly for all), the upper age limit (from 60 to 65 years) and different test sequences (four possible tests were included: HPV, LBC, partial genotyping for HPV16 or HPV 18 and the molecular biomarker p16INK4a/Ki67). A Markov-model for HPV-infection and cervical cancer was developed based on a German cervical screening model (1). The perspective of the healthcare system was adopted and a 5 percent discount rate used.RESULTS:Strategies using HPV as the primary screening test are more effective than LBC-based strategies. The optimal strategy, at a willingness-to-pay threshold of EUR45,000 per quality-adjusted life year (QALY), for the unvaccinated cohort was HPV-based primary screening with a LBC triage test, at five-yearly intervals from age 25 to 60 years. This strategy is cost saving compared with current practice and cost effective when compared to no screening, with an Incremental cost-effectiveness ratio (ICER) of EUR18,164 per QALY. The optimal strategy for the vaccinated cohort was also HPV primary screening with a LBC triage test, at five-yearly intervals from age 25 to 60 years. While more effective and cost saving compared with current practice, it would not be considered cost effective compared with no screening (ICER of EUR58,745/QALY).CONCLUSIONS:Based on our analyses, HPV-based cervical screening is more effective and cost saving compared with LBC-based screening for both vaccinated and unvaccinated cohorts in an Irish setting.

Upper Age Limit in Population-based Breast Cancer Screening

Upper Age Limit in Population-based Breast Cancer Screening