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Radiology Jun 2023Radiologic tests often contain rich imaging data not relevant to the clinical indication. Opportunistic screening refers to the practice of systematically leveraging... (Review)
Review
Radiologic tests often contain rich imaging data not relevant to the clinical indication. Opportunistic screening refers to the practice of systematically leveraging these incidental imaging findings. Although opportunistic screening can apply to imaging modalities such as conventional radiography, US, and MRI, most attention to date has focused on body CT by using artificial intelligence (AI)-assisted methods. Body CT represents an ideal high-volume modality whereby a quantitative assessment of tissue composition (eg, bone, muscle, fat, and vascular calcium) can provide valuable risk stratification and help detect unsuspected presymptomatic disease. The emergence of "explainable" AI algorithms that fully automate these measurements could eventually lead to their routine clinical use. Potential barriers to widespread implementation of opportunistic CT screening include the need for buy-in from radiologists, referring providers, and patients. Standardization of acquiring and reporting measures is needed, in addition to expanded normative data according to age, sex, and race and ethnicity. Regulatory and reimbursement hurdles are not insurmountable but pose substantial challenges to commercialization and clinical use. Through demonstration of improved population health outcomes and cost-effectiveness, these opportunistic CT-based measures should be attractive to both payers and health care systems as value-based reimbursement models mature. If highly successful, opportunistic screening could eventually justify a practice of standalone "intended" CT screening.
Topics: Humans; Artificial Intelligence; Algorithms; Radiologists; Mass Screening; Radiology
PubMed: 37219444
DOI: 10.1148/radiol.222044 -
Hepatology Communications Mar 2021New therapies offer hope for a cure to millions of persons living with hepatitis C virus (HCV) infection. HCV elimination is a global goal that will be difficult to... (Review)
Review
New therapies offer hope for a cure to millions of persons living with hepatitis C virus (HCV) infection. HCV elimination is a global goal that will be difficult to achieve using the traditional paradigms of diagnosis and care. The current standard has evolved toward universal HCV screening and treatment, to achieve elimination goals. There are several steps between HCV diagnosis and cure with major barriers along the way. Innovative models of care can address barriers to better serve hardly reached populations and scale national efforts in the United States and abroad. Herein, we highlight innovative models of HCV care that aid in our progress toward HCV elimination.
Topics: Antiviral Agents; Disease Eradication; Health Services Accessibility; Hepacivirus; Hepatitis C; Humans; Mass Screening; Organizational Innovation
PubMed: 33681673
DOI: 10.1002/hep4.1646 -
Annals of the Academy of Medicine,... Dec 2020
Topics: Congenital Hypothyroidism; Humans; Infant, Newborn; Mass Screening; Neonatal Screening
PubMed: 33463650
DOI: 10.47102/annals-acadmedsg.2020618 -
Deutsches Arzteblatt International Feb 2023
Topics: Humans; Infant, Newborn; Neonatal Screening; Hearing; Mass Screening
PubMed: 37005719
DOI: 10.3238/arztebl.m2022.0269 -
PloS One 2021Bayes' Theorem imposes inevitable limitations on the accuracy of screening tests by tying the test's predictive value to the disease prevalence. The aforementioned...
Bayes' Theorem imposes inevitable limitations on the accuracy of screening tests by tying the test's predictive value to the disease prevalence. The aforementioned limitation is independent of the adequacy and make-up of the test and thus implies inherent Bayesian limitations to the screening process itself. As per the WHO's Wilson - Jungner criteria, one of the prerequisite steps before undertaking screening is to ensure that a treatment for the condition screened for exists. However, when applying screening programs in closed systems, a paradox, henceforth termed the "screening paradox", ensues. If a disease process is screened for and subsequently treated, its prevalence would drop in the population, which as per Bayes' theorem, would make the tests' predictive value drop in return. Put another way, a very powerful screening test would, by performing and succeeding at the very task it was developed to do, paradoxically reduce its ability to correctly identify individuals with the disease it screens for in the future-over some time t. In this manuscript, we explore the mathematical model which formalizes said screening paradox and explore its implications for population level screening programs. In particular, we define the number of positive test iterations (PTI) needed to reverse the effects of the paradox. Given their theoretical nature, clinical application of the concepts herein reported need validation prior to implementation. Meanwhile, an understanding of how the dynamics of prevalence can affect the PPV over time can help inform clinicians as to the reliability of a screening test's results.
Topics: Bayes Theorem; Humans; Mass Screening; Models, Statistical; Predictive Value of Tests; Reproducibility of Results
PubMed: 34469479
DOI: 10.1371/journal.pone.0256645 -
Acta Obstetricia Et Gynecologica... Apr 2020It is well established that correct antenatal identification of small-for-gestational-age (SGA) fetuses reduces their risk of adverse perinatal outcome with long-term...
INTRODUCTION
It is well established that correct antenatal identification of small-for-gestational-age (SGA) fetuses reduces their risk of adverse perinatal outcome with long-term consequences. Ultrasound estimates of fetal weight (EFW ) are the ultimate tool for this identification. It can be conducted as a "universal screening", that is, all pregnant women at a specific gestational age. However, in Denmark it is conducted as "selective screening", that is, only on clinical indication. The aim of this study was to assess the performance of the Danish national SGA screening program and the consequences of false-positive and false-negative SGA cases.
MATERIAL AND METHODS
In this retrospective cohort study, we included 2928 women with singleton pregnancies with due dates in 2015. We defined "risk of SGA" by an EFW ≤ -15% of expected for the gestational age and "SGA" as birthweight ≤-22% of expected for gestational age.
RESULTS
At birth, the prevalence of SGA was 3.3%. The overall sensitivity of the Danish screening program was 62% at a false-positive rate of 5.6%. Within the entire cohort, 63% had an EFW compared with 79% of the SGA cases. The sensitivity was 79% for those born before 37 weeks of gestation but only 40% for those born after 40 weeks of gestation. The sensitivity was also associated with birthweight deviation; 73% among extreme SGA cases (birthweight deviation ≤-33%) and 55% among mild SGA (birthweight deviation between -22% and -27%). False diagnosis of SGA was associated with an increased rate of induction of labor (OR = 2.51, 95% CI 1.70-3.71) and cesarean section (OR = 1.44, 95% CI 0.96-2.18).
CONCLUSIONS
The performance of the Danish national screening program for SGA based on selective EFW on clinical indication has improved considerably over the last 20 years. Limitations of the program are the large proportion of women referred to ultrasound scan and the low performance post-term.
Topics: Birth Weight; Cesarean Section; Denmark; False Negative Reactions; False Positive Reactions; Female; Fetal Growth Retardation; Fetal Weight; Gestational Age; Humans; Infant, Newborn; Infant, Small for Gestational Age; Labor, Induced; Mass Screening; Pregnancy; Program Evaluation; Retrospective Studies; Sensitivity and Specificity; Ultrasonography, Prenatal
PubMed: 31670396
DOI: 10.1111/aogs.13764 -
Pediatrics Jul 2021Advances in new technologies, when incorporated into routine health screening, have tremendous promise to benefit children. The number of health screening tests, many of... (Review)
Review
Advances in new technologies, when incorporated into routine health screening, have tremendous promise to benefit children. The number of health screening tests, many of which have been developed with machine learning or genomics, has exploded. To assess efficacy of health screening, ideally, randomized trials of screening in youth would be conducted; however, these can take years to conduct and may not be feasible. Thus, innovative methods to evaluate the long-term outcomes of screening are needed to help clinicians and policymakers make informed decisions. These methods include using longitudinal and linked-data systems to evaluate screening in clinical and community settings, school data, simulation modeling approaches, and methods that take advantage of data available in the digital and genomic age. Future research is needed to evaluate how longitudinal and linked-data systems drawing on community and clinical settings can enable robust evaluations of the effects of screening on changes in health status. Additionally, future studies are needed to benchmark participating individuals and communities against similar counterparts and to link big data with natural experiments related to variation in screening policies. These novel approaches have great potential for identifying and addressing differences in access to screening and effectiveness of screening across population groups and communities.
Topics: Adolescent; Artificial Intelligence; Child; Computer Simulation; Creativity; Education; Genomics; Humans; Longitudinal Studies; Mass Screening; Population Health; Time Factors; Treatment Outcome
PubMed: 34210844
DOI: 10.1542/peds.2021-050693F -
Zhongguo Fei Ai Za Zhi = Chinese... Nov 2020Lung cancer is the most common malignant tumor in the world. The five-year survival rate is 19.7%, which seriously threatens human health. Lung cancer screening is an... (Review)
Review
Lung cancer is the most common malignant tumor in the world. The five-year survival rate is 19.7%, which seriously threatens human health. Lung cancer screening is an effective measure to reduce lung cancer mortality. Existing studies have shown that screening with low-dose computed tomography (LDCT) can reduce lung cancer deaths by 20%. Currently, lung cancer screening is recommended internationally and nationally. Studying the development status of lung cancer screening helps us to identify the high-risk groups of lung cancer, explore reasonable screening programs, improve the cost-effectiveness of screening and reduce the economic burden. Therefore, this article summarizes the current status of lung cancer screening, the cost-effectiveness of lung cancer screening and the existing problems as follows. .
Topics: Cost-Benefit Analysis; Humans; Lung Neoplasms; Mass Screening; Risk Factors; Tomography, X-Ray Computed
PubMed: 32819054
DOI: 10.3779/j.issn.1009-3419.2020.101.37 -
Missouri Medicine 2024The incidence of diabetes and hyperlipidemia are increasing at rapid rates in children. These conditions are associated with increased risk of macrovascular and... (Review)
Review
The incidence of diabetes and hyperlipidemia are increasing at rapid rates in children. These conditions are associated with increased risk of macrovascular and microvascular complications causing major morbidity and mortality later in life. Early diagnosis and treatment can reduce the lifelong risk of complications from these diseases, exemplifying the importance of screening in the pediatric population. The following article presents a summary of the current guidelines for diabetes and hyperlipidemia screening in pediatric patients.
Topics: Humans; Child; Dyslipidemias; Mass Screening; Practice Guidelines as Topic; Diabetes Mellitus; Pediatrics; Hyperlipidemias; Adolescent
PubMed: 38854609
DOI: No ID Found -
World Journal of Gastroenterology Aug 2019Since its original application, gastrointestinal (GI) endoscopy has undergone many innovative transformations aimed at expanding the scope, safety, accuracy,... (Review)
Review
Since its original application, gastrointestinal (GI) endoscopy has undergone many innovative transformations aimed at expanding the scope, safety, accuracy, acceptability and cost-effectiveness of this area of clinical practice. One method of achieving this has been to reduce the caliber of endoscopic devices. We propose the collective term "Miniature GI Endoscopy". In this Opinion Review, the innovations in this field are explored and discussed. The progress and clinical use of the three main areas of miniature GI endoscopy (ultrathin endoscopy, wireless endoscopy and scanning fiber endoscopy) are described. The opportunities presented by these technologies are set out in a clinical context, as are their current limitations. Many of the positive aspects of miniature endoscopy are clear, in that smaller devices provide access to potentially all of the alimentary canal, while conferring high patient acceptability. This must be balanced with the costs of new technologies and recognition of device specific challenges. Perspectives on future application are also considered and the efforts being made to bring new innovations to a clinical platform are outlined. Current devices demonstrate that miniature GI endoscopy has a valuable place in investigation of symptoms, therapeutic intervention and screening. Newer technologies give promise that the potential for enhancing the investigation and management of GI complaints is significant.
Topics: Biomedical Technology; Endoscopy, Gastrointestinal; Equipment Design; Gastrointestinal Diseases; Humans; Inventions; Mass Screening; Miniaturization
PubMed: 31435163
DOI: 10.3748/wjg.v25.i30.4051