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Tidsskrift For Den Norske Laegeforening... Sep 2013Young athletes are at an increased risk of sudden cardiac death compared to others. Cardiac screening has been proposed to prevent deaths. We wished to review the... (Review)
Review
BACKGROUND
Young athletes are at an increased risk of sudden cardiac death compared to others. Cardiac screening has been proposed to prevent deaths. We wished to review the evidence for cardiac screening of young athletes.
METHOD
We have conducted a literature search in PubMed on sudden cardiac death in young athletes, using a combination of search terms related to screening, incidence, cost efficiency and recommendations, supplemented by secondary references and articles from our own archive.
RESULTS
Published studies utilise a variety of definitions of athlete and sudden death, and some studies also include cardiac arrest with subsequent successful resuscitation. Retrospective studies, often based on media searches, remain the most common form. The cause of death is not invariably determined by an autopsy. Recommendations in favour of screening are based on studies of limited quality and on the personal, often regional, experiences of experts.
INTERPRETATION
The differences in study methods result in uncertain incidence figures. The estimates of cost efficiency are therefore questionable. To improve the quality of knowledge, standardised methods need to be devised, ideally also including a register of cardiac arrest in children and young people. To date, we have insufficient knowledge to recommend mandatory cardiac screening with ECG in Norway. Should this be introduced, it should be differentiated according to gender, type of sport and competition level. Cost efficiency could probably be improved with the aid of standardised questionnaires and a standardised interpretation of ECG among athletes.
Topics: Adolescent; Adult; Athletes; Child; Cost-Benefit Analysis; Death, Sudden, Cardiac; Electrocardiography; Female; Humans; Male; Mass Screening; Medical History Taking; Physical Examination; Physical Exertion; Sports; Young Adult
PubMed: 24005709
DOI: 10.4045/tidsskr.13.0016 -
PloS One 2019Disutility allows to identify how much population values intervention-related harms contributing to knowledge on the benefits/harms ratio of cancer screening programs....
OBJECTIVES
Disutility allows to identify how much population values intervention-related harms contributing to knowledge on the benefits/harms ratio of cancer screening programs. This systematic review evaluates disutility related to cancer screening applying a utility theory framework.
METHODS
Using a predefined protocol, Embase, Medline Ovid, Web of Science, Cochrane, Google scholar and supplementary sources were systematically searched. The framework grouped disutilities associated with breast, cervical, lung, colorectal, and prostate cancer screening programs into the screening, diagnostic work up, and treatment phases. We assessed the quality of included studies according to the relevance to target population, risk of bias, appropriateness of measure and the time frame.
RESULTS
Out of 2840 hits, we included 38 studies, of which 27 measured (and others estimated) disutilities. Around 70% of studies had medium to high-level quality. Measured disutilities and Quality Adjusted Life Years loss were 0-0.03 and 0-0.0013 respectively in screening phases. Both disutilities and Quality Adjusted Life Years loss had similar ranges in diagnostic work up (0-0.26), and treatment (0.09-0.27) phases. We found no measured disutilities available for lung cancer screening and-little evidence for disutilities in treatment phase. Almost 40% of the estimated disutility values were above the range of measured ones.
CONCLUSIONS
Cancer screening programs led to low disutities related to screening phase, and low to moderate disutilities related to diagnostic work up and treatment phases. These disutility values varied by the measurement instrument applied, and were higher in studies with lower quality. The estimated disutility values comparing to the measured ones tended to overestimate the harms.
Topics: Attitude to Health; Early Detection of Cancer; False Positive Reactions; Humans; Mass Screening; Neoplasms; Patient Harm; Predictive Value of Tests; Quality of Life; Quality-Adjusted Life Years; Risk Assessment
PubMed: 31339958
DOI: 10.1371/journal.pone.0220148 -
Annals of Clinical Biochemistry Jul 2002Colorectal cancer (CRC) causes 20 000 deaths per annum in the UK alone. Screening has been shown to reduce mortality but debate exists as to which approach to use....
Colorectal cancer (CRC) causes 20 000 deaths per annum in the UK alone. Screening has been shown to reduce mortality but debate exists as to which approach to use. Direct visualization of the colorectum has the advantage that it detects lesions most effectively and is required at less frequent intervals, but the procedure is invasive and at present too costly for screening purposes. Faecal occult blood measurement, despite its limitations, is currently the recommended screening method, with follow-up of positive tests by colonoscopy or other visualization techniques. This strategy has been shown to reduce mortality from CRC by about 20% and screening trials directed towards individuals in the over 50 years age group are underway in the UK and elsewhere. Future developments in CRC screening include colorectal visualization by computed colonography -- a less-invasive alternative to colonoscopy. Developments in stool analysis are also occurring. Examination of faecal samples for cellular products derived from neoplasms (e.g. calprotectin) may prove more sensitive and specific than faecal occult blood measurements. In addition, detection of altered DNA in faeces is being investigated by molecular biology techniques. Using a multi-target assay panel to detect point mutations and other neoplasia-associated DNA abnormalities may be an effective strategy for CRC screening in the future.
Topics: Biomarkers, Tumor; Clinical Trials as Topic; Colonoscopy; Colorectal Neoplasms; DNA, Neoplasm; Diet; Genetic Predisposition to Disease; Genetic Testing; Humans; Mass Screening; Middle Aged; Occult Blood; Patient Compliance; Pilot Projects; Practice Guidelines as Topic; Risk Factors; Sensitivity and Specificity; United Kingdom
PubMed: 12117439
DOI: 10.1258/000456302760042470 -
PloS One 2021There is considerable heterogeneity in individuals' risk of disease and thus the absolute benefits and harms of population-wide screening programmes. Using colorectal...
The impact of information about different absolute benefits and harms on intention to participate in colorectal cancer screening: A think-aloud study and online randomised experiment.
BACKGROUND
There is considerable heterogeneity in individuals' risk of disease and thus the absolute benefits and harms of population-wide screening programmes. Using colorectal cancer (CRC) screening as an exemplar, we explored how people make decisions about screening when presented with information about absolute benefits and harms, and how those preferences vary with baseline risk, between screening tests and between individuals.
METHOD
We conducted two linked studies with members of the public: a think-aloud study exploring decision making in-depth and an online randomised experiment quantifying preferences. In both, participants completed a web-based survey including information about three screening tests (colonoscopy, sigmoidoscopy, and faecal immunochemical testing) and then up to nine scenarios comparing screening to no screening for three levels of baseline risk (1%, 3% and 5% over 15 years) and the three screening tests. Participants reported, after each scenario, whether they would opt for screening (yes/no).
RESULTS
Of the 20 participants in the think-aloud study 13 did not consider absolute benefits or harms when making decisions concerning CRC screening. In the online experiment (n = 978), 60% expressed intention to attend at 1% risk of CRC, 70% at 3% and 77% at 5%, with no differences between screening tests. At an individual level, 535 (54.7%) would attend at all three risk levels and 178 (18.2%) at none. The 27% whose intention varied by baseline risk were more likely to be younger, without a family history of CRC, and without a prior history of screening.
CONCLUSIONS
Most people in our population were not influenced by the range of absolute benefits and harms associated with CRC screening presented. For an appreciable minority, however, magnitude of benefit was important.
Topics: Colorectal Neoplasms; Cost-Benefit Analysis; Decision Making; Female; Humans; Intention; Internet; Male; Mass Screening; Middle Aged; Surveys and Questionnaires
PubMed: 33592037
DOI: 10.1371/journal.pone.0246991 -
Revista Espanola de Enfermedades... Aug 2014
Topics: Colorectal Neoplasms; Cost-Benefit Analysis; Early Detection of Cancer; Humans; Mass Screening; Spain
PubMed: 25490161
DOI: No ID Found -
BMJ Open Quality Apr 2024The failed or partial implementation of clinical practices negatively impacts patient safety and increases systemic inefficiencies. Implementation of sepsis screening... (Review)
Review
INTRODUCTION
The failed or partial implementation of clinical practices negatively impacts patient safety and increases systemic inefficiencies. Implementation of sepsis screening guidelines has been undertaken in many settings with mixed results. Without a theoretical understanding of what leads to successful implementation, improving implementation will continue to be ad hoc or intuitive. This study proposes a programme theory for how and why the successful implementation of sepsis screening guidelines can occur.
METHODS
A rapid realist review was conducted to develop a focused programme theory for the implementation of sepsis screening guidelines. An independent two-reviewer approach was used to iteratively extract and synthesise context and mechanism data. Theoretical context-mechanism-outcome propositions were refined and validated by clinicians using a focus group and individual realist interviews. Implementation resources and clinical reasoning were differentiated in articulating mechanisms.
RESULTS
Eighteen articles were included in the rapid review. The theoretical domains framework was identified as the salient substantive theory informing the programme theory. The theory consisted of five main middle-range propositions. Three promoting mechanisms included positive belief about the benefits of the protocol, belief in the legitimacy of using the protocol and trust within the clinical team. Two inhibiting mechanisms included pessimism about the protocol being beneficial and pessimism about the team. Successful implementation was defined as achieving fidelity and sustained use of the intervention. Two intermediate outcomes, acceptability and feasibility of the intervention, and adoption, were necessary to achieve before successful implementation.
CONCLUSION
This rapid realist review synthesised key information from the literature and clinician feedback to develop a theory-based approach to clinical implementation of sepsis screening. The programme theory presents knowledge users with an outline of how and why clinical interventions lead to successful implementation and could be applied in other clinical areas to improve quality and safety.
Topics: Humans; Sepsis; Mass Screening
PubMed: 38684345
DOI: 10.1136/bmjoq-2023-002593 -
The American Journal of Emergency... Oct 2020The COVID19 crisis has provided a portal to revisit and understand qualities of screening tests and the importance of Bayes' theorem in understanding how to interpret...
The COVID19 crisis has provided a portal to revisit and understand qualities of screening tests and the importance of Bayes' theorem in understanding how to interpret results and implications of next actions.
Topics: Bayes Theorem; COVID-19; Humans; Mass Screening; Pandemics; Real-Time Polymerase Chain Reaction
PubMed: 33142166
DOI: 10.1016/j.ajem.2020.06.054 -
The Oncologist Jul 2017Cervical cancer screening is one of the most effective cancer prevention strategies, but most women in Africa have never been screened. In 2007, the Cameroon Baptist...
BACKGROUND
Cervical cancer screening is one of the most effective cancer prevention strategies, but most women in Africa have never been screened. In 2007, the Cameroon Baptist Convention Health Services, a large faith-based health care system in Cameroon, initiated the Women's Health Program (WHP) to address this disparity. The WHP provides fee-for-service cervical cancer screening using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC), prioritizing care for women living with HIV/AIDS. They also provide clinical breast examination, family planning (FP) services, and treatment for reproductive tract infection (RTI). Here, we document the strengths and challenges of the WHP screening program and the unique aspects of the WHP model, including a fee-for-service payment system and the provision of other women's health services.
METHODS
We retrospectively reviewed WHP medical records from women who presented for cervical cancer screening from 2007-2014.
RESULTS
In 8 years, WHP nurses screened 44,979 women for cervical cancer. The number of women screened increased nearly every year. The WHP is sustained primarily on fees-for-service, with external funding totaling about $20,000 annually. In 2014, of 12,191 women screened for cervical cancer, 99% received clinical breast exams, 19% received FP services, and 4.7% received treatment for RTIs. We document successes, challenges, solutions implemented, and recommendations for optimizing this screening model.
CONCLUSION
The WHP's experience using a fee-for-service model for cervical cancer screening demonstrates that in Cameroon VIA-DC is acceptable, feasible, and scalable and can be nearly self-sustaining. Integrating other women's health services enabled women to address additional health care needs.
IMPLICATION FOR PRACTICE
The Cameroon Baptist Convention Health Services Women's Health Program successfully implemented a nurse-led, fee-for-service cervical cancer screening program using visual inspection with acetic acid-enhanced by digital cervicography in the setting of a large faith-based health care system in Cameroon. It is potentially replicable in many African countries, where faith-based organizations provide a large portion of health care. The cost-recovery model and concept of offering multiple services in a single clinic rather than stand-alone "silo" cervical cancer screening could provide a model for other low-and-middle-income countries planning to roll out a new, or make an existing, cervical cancer screening services accessible, comprehensive, and sustainable.
Topics: Cameroon; Colposcopy; Community Health Services; Fee-for-Service Plans; Female; HIV Seropositivity; Humans; Mass Screening; Uterine Cervical Neoplasms
PubMed: 28536303
DOI: 10.1634/theoncologist.2016-0383 -
BMC Cancer Oct 2021Low- and middle-income countries (LMICs) experienced increasing rates of colorectal cancer (CRC) incidence in the last decade and lower 5-year survival rates compared to...
BACKGROUND
Low- and middle-income countries (LMICs) experienced increasing rates of colorectal cancer (CRC) incidence in the last decade and lower 5-year survival rates compared to high-income countries (HICs) where the implementation of screening and treatment services have advanced. This review scoped and mapped the literature regarding the content, implementation and uptake of CRC screening interventions as well as opportunities and challenges for the implementation of CRC screening interventions in LMICs.
METHODS
We systematically followed a five-step scoping review framework to identify and review relevant literature about CRC screening in LMICs, written in the English language before February 2020. We searched Medline, Embase, Web of Science and Google Scholar for studies targeting the general, asymptomatic, at-risk adult population. The TIDieR tool and an implementation checklist were used to extract data from empirical studies; and we extracted data-informed insights from policy reviews and commentaries.
RESULTS
CRC screening interventions (n = 24 studies) were implemented in nine middle-income countries. Population-based screening programmes (n = 11) as well as small-scale screening interventions (n = 13) utilised various recruitment strategies. Interventions that recruited participants face-to-face (alone or in combination with other recruitment strategies) (10/15), opportunistic clinic-based screening interventions (5/6) and educational interventions combined with screening (3/4), seemed to be the strategies that consistently achieved an uptake of > 65% in LMICs. FOBT/FIT and colonoscopy uptake ranged between 14 and 100%. The most commonly reported implementation indicator was 'uptake/reach'. There was an absence of detail regarding implementation indicators and there is a need to improve reporting practice in order to disseminate learning about how to implement programmes.
CONCLUSION
Opportunities and challenges for the implementation of CRC screening programmes were related to the reporting of CRC cases and screening, cost-effective screening methods, knowledge about CRC and screening, staff resources and training, infrastructure of the health care system, financial resources, public health campaigns, policy commitment from governments, patient navigation, planning of screening programmes and quality assurance.
Topics: Adult; Asymptomatic Diseases; Colorectal Neoplasms; Developing Countries; Female; Health Resources; Humans; Male; Mass Screening; Middle Aged; Patient Education as Topic; Program Development
PubMed: 34666704
DOI: 10.1186/s12885-021-08809-1 -
PloS One 2016A wide range of screening tools are available to detect common mental disorders (CMDs), but few have been specifically developed for populations in low and middle income... (Review)
Review
BACKGROUND
A wide range of screening tools are available to detect common mental disorders (CMDs), but few have been specifically developed for populations in low and middle income countries (LMIC). Cross-cultural application of a screening tool requires that its validity be assessed against a gold standard diagnostic interview. Validation studies of brief CMD screening tools have been conducted in several LMIC, but until now there has been no review of screening tools for all CMDs across all LMIC populations.
METHODS
A systematic review with broad inclusion criteria was conducted, producing a comprehensive summary of brief CMD screening tools validated for use in LMIC populations. For each validation, the diagnostic odds ratio (DOR) was calculated as an easily comparable measure of screening tool validity. Average DOR results weighted by sample size were calculated for each screening tool, enabling us to make broad recommendations about best performing screening tools.
RESULTS
153 studies fulfilled our inclusion criteria. Because many studies validated two or more screening tools, this corresponded to 273 separate validations against gold standard diagnostic criteria. We found that the validity of every screening tool tested in multiple settings and populations varied between studies, highlighting the importance of local validation. Many of the best performing tools were purposely developed for a specific population; however, as these tools have only been validated in one study, it is not possible to draw broader conclusions about their applicability in other contexts.
CONCLUSIONS
Of the tools that have been validated in multiple settings, the authors broadly recommend using the SRQ-20 to screen for general CMDs, the GHQ-12 for CMDs in populations with physical illness, the HADS-D for depressive disorders, the PHQ-9 for depressive disorders in populations with good literacy levels, the EPDS for perinatal depressive disorders, and the HADS-A for anxiety disorders. We recommend that, wherever possible, a chosen screening tool should be validated against a gold standard diagnostic assessment in the specific context in which it will be employed.
Topics: Adolescent; Adult; Developing Countries; Female; Humans; Male; Mass Screening; Mental Disorders; Middle Aged; Odds Ratio; Pregnancy; Psychiatric Status Rating Scales; Psychometrics; Validation Studies as Topic
PubMed: 27310297
DOI: 10.1371/journal.pone.0156939