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Journal of Rehabilitation Medicine Mar 2015To systematically review the psychometric properties and clinical utility of cognitive screening tools post-stroke. (Review)
Review
OBJECTIVE
To systematically review the psychometric properties and clinical utility of cognitive screening tools post-stroke.
DATA SOURCES
EMBASE, CINAHL, MEDLINE, PsychInfo.
STUDY SELECTION
Studies testing the accuracy of screening tools for cognitive impairment after stroke.
DATA EXTRACTION
Data regarding the participants, selection criteria, criterion/reference measure, cut-off score, sensitivity, specificity and positive and negative predicted values for the selected tools were extracted. Tools with sensitivity ≥ 80% and specificity ≥ 60% were selected. Clinical utility was assessed using a previously validated tool and those scoring <6 were excluded.
DATA SYNTHESIS
Twenty-one papers regarding 12 screening tools were selected. Only the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE) met all psychometric and clinical utility criteria for any levels of cognitive impairment. However, the MMSE is most accurate to screen for dementia (cut-off score 23/24) and should only be used for this purpose. In addition, the following can be used to detect: • Any impairment: Addenbrooke's Cognitive Examination-Revised (ACE-R), Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and Cognistat. • Multiple-domain impairments: ACE-R, Telephone-MoCA or modified Telephone Interview for Cognitive Status (TICS). • Dementia: TICS; Cambridge Cognitive Examination; Rotterdam-Cambridge Cognitive Examination; Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) and short-IQCODE. The IQCODE and short-IQCODE are useful when the patient is unable to respond and an informant's view is required.
CONCLUSION
The MoCA is the most valid and clinically feasible screening tool to identify stroke survivors with a wide range of cognitive impairments who warrant further assessment.
Topics: Aged; Aged, 80 and over; Cognition Disorders; Dementia; Female; Humans; Male; Mass Screening; Neuropsychological Tests; Patient Selection; Psychometrics; Sensitivity and Specificity; Stroke; Surveys and Questionnaires
PubMed: 25590458
DOI: 10.2340/16501977-1930 -
BMC Health Services Research Sep 2011Interferon-γ release assays (IGRAs) for TB have the potential to replace the tuberculin skin test (TST) in screening for latent tuberculosis infection (LTBI). The... (Comparative Study)
Comparative Study Review
BACKGROUND
Interferon-γ release assays (IGRAs) for TB have the potential to replace the tuberculin skin test (TST) in screening for latent tuberculosis infection (LTBI). The higher per-test cost of IGRAs may be compensated for by lower post-screening costs (medical attention, chest x-rays and chemoprevention), given the higher specificity of the new tests as compared to that of the conventional TST. We conducted a systematic review of all publications that have addressed the cost or cost-effectiveness of IGRAs. The objective of this report was to undertake a structured review and critical appraisal of the methods used for the model-based cost-effectiveness analysis of TB screening programmes.
METHODS
Using Medline and Embase, 75 publications that contained the terms "IGRA", "tuberculosis" and "cost" were identified. Of these, 13 were original studies on the costs or cost-effectiveness of IGRAs.
RESULTS
The 13 relevant studies come from five low-to-medium TB-incidence countries. Five studies took only the costs of screening into consideration, while eight studies analysed the cost-effectiveness of different screening strategies. Screening was performed in high-risk groups: close contacts, immigrants from high-incidence countries and healthcare workers. Two studies used the T-SPOT.TB as an IGRA and the other studies used the QuantiFERON-TB Gold and/or Gold In-Tube test. All 13 studies observed a decrease in costs when the IGRAs were used. Six studies compared the use of an IGRA as a test to confirm a positive TST (TST/IGRA strategy) to the use of an IGRA-only strategy. In four of these studies, the two-step strategy and in two the IGRA-only strategy was more cost-effective. Assumptions about TST specificity and progression risk after a positive test had the greatest influence on determining which IGRA strategy was more cost-effective.
CONCLUSION
The available studies on cost-effectiveness provide strong evidence in support of the use of IGRAs in screening risk groups such as HCWs, immigrants from high-incidence countries and close contacts. So far, only two studies provide evidence that the IGRA-only screening strategy is more cost-effective.
Topics: Contact Tracing; Cost-Benefit Analysis; Female; Germany; Health Care Costs; Humans; Interferon-gamma Release Tests; Male; Mass Screening; Tuberculin Test; Tuberculosis, Pulmonary
PubMed: 21961888
DOI: 10.1186/1472-6963-11-247 -
BMC Public Health Mar 2018Chronic hepatitis B infection is a significant cause of morbidity and mortality worldwide; low- and middle-income countries (LMICs) are disproportionately affected.... (Review)
Review
BACKGROUND
Chronic hepatitis B infection is a significant cause of morbidity and mortality worldwide; low- and middle-income countries (LMICs) are disproportionately affected. Economic evaluations are a useful decision tool to assess costs versus benefits of hepatitis B virus (HBV) screening. No published study reviewing economic evaluations of HBV screening in LMICs has been undertaken to date.
METHODS
The following databases were searched from inception to 21 April 2017: MEDLINE, PubMed, EMBASE, CINAHL Plus, the Cochrane Library, Global Health and the Cost-effectiveness Analysis Registry. English-language studies were included if they assessed the costs against the benefits of HBV screening in LMICs. PROSPERO registration: CRD42015024391, 20 July 2015.
RESULTS
Nine studies fulfilled the eligibility criteria. One study from Thailand indicated that adding hepatitis B immunoglobulin (HBIG) to HBV vaccination for newborns following screening of pregnant women might be cost-effective for some LMICs, though inadequate total funding and health infrastructure were likely to limit feasibility. A similar study from China indicated a benefit to cost ratio of 2.7 from selective HBIG administration to newborns, if benefits were considered from a societal perspective. Of the two studies assessing screening amongst the general adult population, a single cost-benefit analysis from China found a benefit to cost ratio (BCR) of 1.73 with vaccination guided by HBV screening of adults aged 21-39, compared to 1.42 with vaccination with no screening, both from a societal perspective. Community-based screening of adults in The Gambia with linkage to treatment yielded an incremental cost per disability-adjusted life year averted of $566 (in 2017 USD), less than two-times gross domestic product per capita for that country.
CONCLUSIONS
Screening with 'catch-up' vaccination for younger adults yielded benefits above costs, and screening linked with treatment has shown cost-effectiveness that may be affordable for some LMICs. However, interpretation needs to account for total cost implications and further research in LMICs is warranted as there were only nine included studies and evidence from high-income countries is not always directly applicable.
Topics: Cost-Benefit Analysis; Developing Countries; Hepatitis B; Humans; Mass Screening
PubMed: 29558894
DOI: 10.1186/s12889-018-5261-8 -
Clinical Nutrition ESPEN Dec 2022The Norwegian Directorate of Health has identified a need to harmonize and standardize the malnutrition screening practice in Norwegian hospitals and primary health care...
BACKGROUND & AIMS
The Norwegian Directorate of Health has identified a need to harmonize and standardize the malnutrition screening practice in Norwegian hospitals and primary health care settings, in order to provide a seamless communication of malnutrition screening along the patient pathway. Our aim was to perform a systematic review of the validity and reliability of screening tools used to identify risk of malnutrition across health care settings, diagnoses or conditions and adult age groups, as a first step towards a national recommendation of one screening tool.
METHODS
A systematic literature search for articles evaluating validity, agreement, and reliability of malnutrition screening tools, published up to August 2020, was conducted in: MEDLINE, Embase, APA PsycInfo, Cinahl, Cochrane Databases, Web of Science, Epistemonikos, SveMed+, and Norart. The systematic review was registered in PROSPERO (CRD42022300558). For critical appraisal of each included article, the Quality Criteria Checklist by The Academy of Nutrition and Dietetics was used.
RESULTS
The review identified 105 articles that fulfilled the inclusion and exclusion criteria. The most frequently validated tools were Mini Nutritional Assessment short form (MNA), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and Nutritional Risk Screening 2002 (NRS-2002). MNA, MST and NRS-2002 displayed overall moderate validity, and MUST low validity. All four tools displayed low agreement. MST and MUST were validated across health care settings and age groups. In general, data on reliability was limited.
CONCLUSIONS
The screening tools MST and NRS-2002 displayed moderate validity for the identification of malnutrition in adults, of which MST is validated across health care settings. In addition, MNA has moderate validity for the identification of malnutrition in adults 65 years or older.
Topics: Adult; Humans; Reproducibility of Results; Nutrition Assessment; Malnutrition; Mass Screening; Reference Standards
PubMed: 36513471
DOI: 10.1016/j.clnesp.2022.09.028 -
Canadian Journal of Gastroenterology &... 2016Introduction. The objectives of this systematic review were to evaluate the evidence for different CRC screening tests and to determine the most appropriate ages of... (Meta-Analysis)
Meta-Analysis Review
Introduction. The objectives of this systematic review were to evaluate the evidence for different CRC screening tests and to determine the most appropriate ages of initiation and cessation for CRC screening and the most appropriate screening intervals for selected CRC screening tests in people at average risk for CRC. Methods. Electronic databases were searched for studies that addressed the research objectives. Meta-analyses were conducted with clinically homogenous trials. A working group reviewed the evidence to develop conclusions. Results. Thirty RCTs and 29 observational studies were included. Flexible sigmoidoscopy (FS) prevented CRC and led to the largest reduction in CRC mortality with a smaller but significant reduction in CRC mortality with the use of guaiac fecal occult blood tests (gFOBTs). There was insufficient or low quality evidence to support the use of other screening tests, including colonoscopy, as well as changing the ages of initiation and cessation for CRC screening with gFOBTs in Ontario. Either annual or biennial screening using gFOBT reduces CRC-related mortality. Conclusion. The evidentiary base supports the use of FS or FOBT (either annual or biennial) to screen patients at average risk for CRC. This work will guide the development of the provincial CRC screening program.
Topics: Age Factors; Aged; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Male; Mass Screening; Middle Aged; Observational Studies as Topic; Occult Blood; Ontario; Patient Selection; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Risk Factors; Sigmoidoscopy; Time Factors
PubMed: 27597935
DOI: 10.1155/2016/2878149 -
Value in Health : the Journal of the... May 2021Many economic evaluations of hepatocellular carcinoma (HCC) screenings have been conducted; however, these vary substantially with regards to screening strategies,...
OBJECTIVES
Many economic evaluations of hepatocellular carcinoma (HCC) screenings have been conducted; however, these vary substantially with regards to screening strategies, patient group, and setting. This review aims to report the current knowledge of the cost-effectiveness of screening and describe the published data.
METHODS
We conducted a search of biomedical and health economic databases up to July 2020. We included full and partial health economic studies if they evaluated the costs or outcomes of HCC screening strategies.
RESULTS
The review included 43 studies. Due to significant heterogeneity in key aspects across the studies, a narrative synthesis was conducted. Most studies reported using ultrasound or alpha fetoprotein as screening strategies. Screening intervals were mostly annual or biannual. Incidence, diagnostic performance, and health state utility values were the most critical parameters affecting the cost-effectiveness of screening. The majority of studies reported HCC screening to be cost-effective, with the biannual ultrasound + alpha fetoprotein standing out as the most cost-effective strategy. However, few studies considered the utilization rate, and none considered the diagnostic performance of ultrasound in the context of central adiposity. Computed tomography and magnetic resonance imaging were also evaluated, but its cost-effectiveness was still controversial.
CONCLUSIONS
Although many studies suggested HCC screening was cost-effective, substantial limitations of the quality of these studies means the results should be interpreted with caution. Future modeling studies should consider the impact of central adiposity on the precision of ultrasound, real-world utilization rates and projections of increased HCC incidence.
Topics: Carcinoma, Hepatocellular; Cost-Benefit Analysis; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Mass Screening; Quality-Adjusted Life Years; Tomography, X-Ray Computed; Ultrasonography; alpha-Fetoproteins
PubMed: 33933243
DOI: 10.1016/j.jval.2020.11.014 -
Preventing Chronic Disease Aug 2021Unmet health-related social needs contribute to high patient morbidity and poor population health. A potential solution to improve population health includes the...
INTRODUCTION
Unmet health-related social needs contribute to high patient morbidity and poor population health. A potential solution to improve population health includes the adoption of care delivery models that alleviate unmet needs through screening, referral, and tracking of patients in health care settings, yet the overall impact of such models has remained unexplored. This review addresses an existing gap in the literature regarding the effectiveness of these models and assesses their overall impact on outcomes related to experience of care, population health, and costs.
METHODS
In March 2020, we searched for peer-reviewed articles published in PubMed over the past 10 years. Studies were included if they 1) used a screening tool for identifying unmet health-related social needs in a health care setting, 2) referred patients with positive screens to appropriate resources for addressing identified unmet health-related social needs, and 3) reported any outcomes related to patient experience of care, population health, or cost.
RESULTS
Of 1,821 articles identified, 35 met the inclusion criteria. All but 1 study demonstrated a tendency toward high risk of bias. Improved outcomes related to experience of care (eg, change in social needs, patient satisfaction, n = 34), population health (eg, diet quality, blood cholesterol levels, n = 7), and cost (eg, program costs, cost-effectiveness, n = 3) were reported. In some studies (n = 5), improved outcomes were found among participants who received direct referrals or additional assistance with indirect referrals compared with those who received indirect referrals only.
CONCLUSION
Effective collaborations between health care organizations and community-based organizations are essential to facilitate necessary patient connection to resources for addressing their unmet needs. Although evidence indicated a positive influence of screening and referral programs on outcomes related to experience of care and population health, no definitive conclusions can be made on overall impact because of the potentially high risk of bias in the included studies.
Topics: Delivery of Health Care; Humans; Mass Screening; Referral and Consultation
PubMed: 34387188
DOI: 10.5888/pcd18.200569 -
Journal of Vascular Surgery Dec 2016This report was produced for the Canadian Task Force on Preventive Health Care to provide guidelines on screening for abdominal aortic aneurysm (AAA) with ultrasound... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This report was produced for the Canadian Task Force on Preventive Health Care to provide guidelines on screening for abdominal aortic aneurysm (AAA) with ultrasound scan.
PURPOSE
The aim of this systematic review is to examine the evidence on benefits and harms of AAA screening.
SEARCH STRATEGY
This systematic review considered studies from the most recent United States Preventive Services Task Force review on AAA screening and passed through the screening process with citations identified in our search up to April 2015 (PROSPERO Registration #CRD42015019047).
RESULTS
For benefits of one-time AAA screening in men compared with controls, pooled analyses from four randomized controlled trials with moderate quality evidence showed significant reductions in AAA-related mortality and AAA rupture rate up to 13 to 15 years of follow-up with 42% reduction (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.39-0.88; number needed to screen = 212) and 38% reduction (RR, 0.62; 95% CI, 0.45-0.86; number needed to screen = 200), respectively. The effect of on all-cause mortality was marginally significant for longer follow-up. The Chichester trial examined the benefits of one-time AAA screening in women and found no significant differences between screening and control arms for up to 10 years of follow-up (RR, 0.88; 95% CI, 0.72-1.07). For consequences of one-time AAA screening in men compared with controls, there was a significant increase in the total number of AAA-related procedures over a follow-up of 13 to 15 years (2.16 times more likely) compared with controls. For harms of one-time AAA screening, no significant differences were observed in 30-day postoperative mortality for elective and emergency operations with compared control groups. Evidence from the Multicenter Aneurysm Screening Study trial using 13-year follow-up data showed that one-time AAA screening with ultrasound scan was potentially associated with an overdiagnosis of 45% (95% CI, 42%-47%) among screen-detected men.
CONCLUSIONS
Population-based screening for AAA with ultrasound scan in asymptomatic men aged 65 years and older showed statistically significant reductions in AAA-related mortality and rupture and, hence, avoids unnecessary AAA-related deaths. The current evidence showed no benefit of one-time AAA screening in woman. Limited evidence is available on the benefits of repeat AAA screening and targeted screening approaches based on risk factors for AAA. Future research should explore the differential benefits of AAA screening based on risk factors that increase risk for developing AAA.
Topics: Age Factors; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Asymptomatic Diseases; Evidence-Based Medicine; Female; Humans; Male; Mass Screening; Middle Aged; Odds Ratio; Patient Selection; Predictive Value of Tests; Prognosis; Risk Factors; Sex Factors; Time Factors; Ultrasonography; Unnecessary Procedures
PubMed: 27871502
DOI: 10.1016/j.jvs.2016.05.101 -
Preventive Medicine Feb 2022The effectiveness of a cancer screening program relies on its adherence rate. Health literacy (HL) has been investigated among the factors that could influence such... (Meta-Analysis)
Meta-Analysis Review
The effectiveness of a cancer screening program relies on its adherence rate. Health literacy (HL) has been investigated among the factors that could influence such participation, but the findings are not always consistent. The aim of this meta-analysis was to summarize the evidence between having an adequate level of HL (AHL) and adherence to cancer screening programs. PubMed, Scopus, and Web of Science were searched. Cross-sectional studies, conducted in any country, that provided raw data, unadjusted or adjusted odds ratio (OR) on the associations of interest were included. The quality of the studies was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled ORs and their associated confidence interval (CI) stratified by time interval (e.g., undergoing screening in the last period, or at least once during lifetime) for each cancer type, considering unadjusted and adjusted estimates separately. A sensitivity analysis was performed for those studies providing more estimates. Overall, 15 articles of average-to-good quality were pooled. We found a significant association between AHL and higher screening participation for breast, cervical and colorectal cancer, independently of other factors, both overall (N = 7, aOR = 1.73; 95% CI: 1.27-2.36; N = 3, aOR = 1.64; 95% CI: 1.30-2.09; and N = 5, aOR = 1.25, 95% CI: 1.12-1.39, respectively) and in most time-stratified analyses. The sensitivity analyses confirmed these results. Health literacy seems to be critical for an effective cancer prevention. Given the high prevalence of illiterate people across the world, a long-term action plan is needed.
Topics: Cross-Sectional Studies; Early Detection of Cancer; Health Literacy; Humans; Mass Screening; Neoplasms; Prevalence
PubMed: 34954244
DOI: 10.1016/j.ypmed.2021.106927 -
World Journal of Gastroenterology Jul 2019Malnutrition is prevalent in inflammatory bowel disease (IBD). Multiple nutrition screening (NST) and assessment tools (NAT) have been developed for general populations,...
BACKGROUND
Malnutrition is prevalent in inflammatory bowel disease (IBD). Multiple nutrition screening (NST) and assessment tools (NAT) have been developed for general populations, but the evidence in patients with IBD remains unclear.
AIM
To systematically review the prevalence of abnormalities on NSTs and NATs, whether NSTs are associated with NATs, and whether they predict clinical outcomes in patients with IBD.
METHODS
Comprehensive searches performed in Medline, CINAHL Plus and PubMed. Included: English language studies correlating NSTs with NATs or NSTs/NATs with clinical outcomes in IBD. Excluded: Review articles/case studies; use of body mass index/laboratory values as sole NST/NAT; age < 16.
RESULTS
Of 16 studies and 1618 patients were included, 72% Crohn's disease and 28% ulcerative colitis. Four NSTs (the Malnutrition Universal Screening Tool, Malnutrition Inflammation Risk Tool (MIRT), Saskatchewan Inflammatory Bowel Disease Nutrition Risk Tool (SaskIBD-NRT) and Nutrition Risk Screening 2002 (NRS-2002) were significantly associated with nutritional assessment measures of sarcopenia and the Subjective Global Assessment (SGA). Three NSTs (MIRT, NRS-2002 and Nutritional Risk Index) were associated with clinical outcomes including hospitalizations, need for surgery, disease flares, and length of stay (LOS). Sarcopenia was the most commonly evaluated NAT associated with outcomes including the need for surgery and post-operative complications. The SGA was not associated with clinical outcomes aside from LOS.
CONCLUSION
There is limited evidence correlating NSTs, NATs and clinical outcomes in IBD. Although studies support the association of NSTs/NATs with relevant outcomes, the heterogeneity calls for further studies before an optimal tool can be recommended. The NRS-2002, measures of sarcopenia and developments of novel NSTs/NATs, such as the MIRT, represent key, clinically-relevant areas for future exploration.
Topics: Humans; Inflammatory Bowel Diseases; Malnutrition; Mass Screening; Nutrition Surveys; Prevalence; Risk Assessment; Risk Factors; Sarcopenia
PubMed: 31391776
DOI: 10.3748/wjg.v25.i28.3823