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Preventive health is a broad term encompassing screening tests (e.g., for cancer, cardiovascular risk, or geriatric syndromes), healthy lifestyle counseling (e.g., nutrition and physical activity), immunizations, and safety considerations (e.g., falls, driving). These discussions become more important with age as a clinician considers an individual patient's goals and values, prognosis and life expectancy, and whether a patient is likely to benefit. The 4Ms (what Matters, Medications, Mentation, and Mobility) provide a useful framework for thinking about how to frame discussions with older adults in the primary care setting, and the Medicare Annual Wellness Visit provides an opportunity to review screening and prevention with an older adult and to update goals and preferences. The overarching goal should be to follow evidence-based practice, cause no harm to our patients, and align with what matters most to the patient.
This study aims to (i) develop a screening tool for determining distress and supportive care needs of adolescent and young adult cancer patients (AYAs) based on the NCCN's Distress Thermometer and Problem List (DTPL), (ii) evaluate its feasibility, discriminant validity, and test–retest reliability in clinical settings, and (iii) report prevalence of distress and unmet needs.
In the development phase, after translation of the Japanese version of the DTPL (DTPL-J) from English into Japanese and back translation, cognitive debriefing was performed. Items in the problem list were modified to better reflect AYAs’ concerns after interviews. The modified items were reviewed and accepted unanimously by healthcare professionals. In the feasibility phase, the DTPL-J for AYAs was used in a clinical setting for 3 months. Descriptive statistics of participants’ demographics, selected items, and DT scores were calculated to report prevalence of distress and unmet needs. Response and referral rates to experts were assessed to evaluate feasibility. Some items were compared with patient demographics to assess discriminant validity. Among the patients who responded at least twice, correlations between two consecutive screenings were assessed to evaluate test–retest reliability.
The DTPL-J consisted of 49 items in five categories. Of 251 patients, 232 (92.4%) were provided the DTPL-J and 230 (91.6%) responded. Based on the DT cutoff of ≥4, 69 of 230 patients (30%) had high distress. Anxiety (n = 85, 36.6%) was the most commonly selected item. Primary nurses referred 45 (21.7%) patients to an attending physician or another expert. Referral rates after DTPL-J use were higher than rates before use, but the difference was not statistically significant (p = 0.06). The items compared were consistent with their social background. A positive correlation was observed between two responses for some items.
Significance of results
The feasibility, discriminant validity, and test–retest reliability of the tool were suggested.
Mental disorders are overrepresented in the criminal justice system, and this applies equally to police custody. These environments are complex and often pressured, and the acuity of the situation, combined with underlying mental disorders, comorbid medical problems and substance misuse, can lead to behavioural disturbance and increased psychiatric risk. Police custody may also present an opportunity to identify and signpost people with mental disorders and vulnerabilities who are ordinarily hard to reach by standard health services. This article considers the purposes of mental health screening of detainees in police custody. It gives an overview of research into screening for a range of psychiatric disorders and vulnerabilities (including substance misuse and traumatic brain injury) and summarises data on deaths in and immediately following release from custody. Given the inadequacy of statutory screening procedures in some jurisdictions, the authors offer a pragmatic evidence-based protocol to guide screening for mental disorders in custody detainees.
In this cohort study of UK healthcare workers, we evaluated the use of fortnightly polymerase chain reaction (PCR) screening to facilitate the safe resumption of elective surgery in a low-prevalence setting. We found that adherence to serial testing was poor, and the resource required to identify 1 asymptomatic case was substantial.
Longstanding biases have fostered the erroneous notion that only those of higher socioeconomic status (SES) experience eating disorders (EDs); however, EDs present across all SES strata. Considering the dearth of ED research among those of lower SES, this study examined (1) the overall association between SES and ED prevalence, and (2) ED prevalence in the context of four relevant social identities (i.e. SES, gender identity, sexual orientation, and race/ethnicity) from an intersectional perspective, as unique combinations of multiple social identities may differentially influence risk.
A sample of 120 891 undergraduate/graduate students from the Healthy Minds Study self-reported family SES with a single-item question, gender identity, sexual orientation, and race/ethnicity, and were screened for ED risk.
Participants of lower SES had 1.27 (95% CI 1.25–1.30) times greater prevalence of a positive ED screen than those of higher SES. Substantial heterogeneity was observed across the four social identities beyond the association with SES. For example, positive ED screens were particularly common among lower SES, Latinx, sexual minority cisgender men and women, with 52% of bisexual men and 52% of lesbian women of Latinx ethnicity and lower SES screening positive.
Although positive ED screens were more common among undergraduate/graduate students of lower SES, the particularly high ED risk reported by certain groups of lower SES with multiple minority identities reinforces the importance of investigating multi-layered constructs of identity when identifying groups at disproportionate risk.
The hand examination does not follow the pattern of the other joints such as look, feel, move. This is because there are varied pathologies in the hand and each is examined differently. The process described is to first perform a screening test that will allow the examiner to identify the pathology present and then to subsequently tailor the rest of the clinical examination. For example, if a lump is found, it will be examined differently to Dupuytren’s disease being found or to a tendon injury.
In addition, examination findings of various pathologies seen in the hand are described such as rheumatoid disease, first carpometacarpal joint arthritis and flexor tendon injuries.
Mathematical models may be used to optimize the decision of when to screen for cancer and how invasive a test to use, for example a biopsy or a biomarker. Partially observable Markov decision process (POMDP) models may be used to optimize screening decisions based on a patient's belief state, which is calculated using Bayesian updating and comprises a patient's complete history of biomarker test results. POMDPs can be used to determine how, if at all, biomarkers should be used for cancer screening in order to maximize quality-adjusted life years, a population health measure of disease burden that incorporates both the quality and quantity of life.
Depression is a widespread comorbidity associated with a number of neurological disorders. Untreated depression has negative impacts on patients with neurological disorders, including intensification of pain, increase in symptomatology, impaired quality of life, and nonadherence to treatment. Nonadherence can lead to disease progression, resulting in poor outcomes. Early detection of depression and prompt intervention can substantially impact the mortality, morbidity, and disease burden of this at-risk population. The American Academy of Neurology recommends screening for neurological disease-specific depression comorbidities, while the United States Preventive Services Task Force recommends routine depression screening for the general adult population. However, fewer than 5% of adults are screened in primary care, and as many as 50% of patients remain undiagnosed without a standardized program. Specialty neurology clinic visits could be a point of screening for high-risk neurology patients to positively affect outcomes. A review of the literature supports using a validated tool such as the Patient Health Questionnaire (PHQ-9) to screen for depression in outpatient settings. This quality improvement project was implemented at a private neurology practice that currently has no formalized protocol to identify depressive symptomatology. The PHQ-9 was integrated into the review of systems for patients meeting inclusion criteria with the aim of screening 90% of patients and referring 90% of those who screen positive to mental health services. Descriptive data were used to evaluate current practice status and indications for change. A total of 476 patients were seen during the time frame for this quality improvement inquiry. There were 100 patients excluded related to cognitive impairment for a sample total of n = 376. Over a period of 30 days, the goal was to screen 90% of patients. Despite challenges related to the impact of COVID-19 on the practice’s delivery of care, 83.2% of patients received screening, which was 92% of our goal. Of those screened and diagnosed with depression, 100% were referred to a mental health provider, thereby exceeding the goal. An unanticipated outcome was that 46.3% of patients diagnosed with depression declined a referral to mental health.
There is a tremendous need for disease-modifying treatments for Alzheimer’s disease (AD). The pharmaceutical sector has expended considerable resources on AD drug discovery, yet to date have obtained regulatory approval for only one agent that slows AD progression. This has led to increased interest in identifying new AD drug targets and disease mechanisms. Academic laboratories can play a meaningful role in the validation of AD drug targets and the identification of molecular probes that modulate these targets. We discuss here how academic researchers can contribute to the AD drug discovery process. This includes examples of assays that have been used for AD small molecule screens within academic laboratories, and discussions on assay optimization for compound screening, the selection of molecular libraries, and the iterative process of compound optimization to identify molecules suitable for advancement to in vivo pharmacokinetic, safety, and efficacy testing. Finally, we outline how academic researchers might work with pharmaceutical partners in AD drug discovery, and note the pros and cons of such collaborations.
Carbapenemase-producing Enterobacterales (CPE) are important globally. In 2017, Ireland declared a national public health emergency to address CPE in acute hospitals. A National Public Health Emergency Team and an expert advisory group (EAG) were established. The EAG has identified key learnings to inform future strategies. First, there is still an opportunity to prevent CPE becoming endemic. Second, damp environmental reservoirs in hospitals are inadequately controlled. Third, antibiotic stewardship remains important in control. Finally, there is no current requirement to extend screening to detect CPE outside of acute hospitals. These conclusions and their implications may also be relevant in other countries.
In latent Wolff–Parkinson–White syndrome, ventricular pre-excitation is inapparent during sinus rhythm but carries the same possibility of sudden cardiac death and palpitations as overt Wolff–Parkinson–White syndrome. It is difficult to diagnose latent Wolff–Parkinson–White syndrome when a patient does not have syncope or palpitations. We report the case of an asymptomatic patient with latent Wolff–Parkinson–White syndrome detected on school heart screening using subtle electrocardiography findings.
Scientists often propose hypotheses based on patterns seen in data. However, if a scientist tests a hypothesis using the same data that suggested the hypothesis, then that scientist has violated a rule of science. The rule is: test hypotheses with independent data. This rule may sound so obvious as to be hardly worth mentioning. In fact, this mistake occurs frequently, especially when analyzing large data sets. Among the many pitfalls in statistics, screening is particularly serious. Screening is the process of evaluating a property for a large number of samples and then selecting samples in which that property is extreme. Screening is closely related to data fishing, data dredging, or data snooping. After a sample has been selected through screening, classical hypothesis tests exhibit selection bias. Quantifying the effect of screening often reveals that it creates biases that are substantially larger than one might guess. This chapter explains the concept of screening and illustrates it through examples from selecting predictors, interpreting correlation maps, and identifying change points.
Defines protocol, policy, and process and their importance in creating the Geriatric ED. Presents nearly 30 different processes that you can adopt or adapt to move towards geriatric-focussed ED care. Screening; enhanced assessments; workflow changes; transitions of care; physical comfort. Encourages EDs to consider which are going to be both easiest to implement and which are going be highest impact.
In this research communication we propose a new approach by portable digital microscopy with a 200× objective to improve the visualization of microparticles of pasteurized milk submitted to the alcohol test. Not only did the method reduce the subjectivity of the readings, but also generated high resolution images of the microparticles, which allows the creation of a specific image pattern for each type of final product. In comparison to a control pasteurized milk treatment, the results confirmed the effect and the specificity of added salts (sodium citrate, disodium phosphate or their combination) on the stability of the milk to the alcohol test. Finally, the mixture of stabilizing salts of citrate/phosphate provided the highest degree of stability to pasteurized milk among the treatments studied.
The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) found that there was no statistical difference in cardiovascular events with an initial invasive strategy as compared with an initial conservative strategy of guideline-directed medical therapy for patients with moderate to severe ischemia on noninvasive testing. In this study, we describe the reasons that potentially eligible patients who were screened for participation in the ISCHEMIA trial did not advance to enrollment, the step prior to randomization. Of those who preliminarily met clinical inclusion criteria on screening logs submitted during the enrollment period, over half did not participate due to physician or patient refusal, a potentially modifiable barrier. This analysis highlights the importance of physician equipoise when advising patients about participation in randomized controlled trials.
It is important to be able to name the plants and animals in one’s environment, but knowing the names does not in and of itself advance the study of ecology. Frank Rigler argued that the species-oriented approach to studying ecology is intractable simply because of the time it would take to obtain enough information on each species to generalize to the community scale. Life on Earth can be named (or classified) in two complementary ways, using phylogeny and functional traits. Trait matrices provide the raw material for trait-based ecology. Compilations and screening are two distinct sources of data for trait matrices. Compilation of traits across studies is an important way of generating data for global-scale synthesis. Screening traits of local communities in the field or under standard conditions is the most effective way of generating quality data for local communities.
The aim of gynaecological cancer screening is to prevent the development of cancer by identifying and treating pre-cancerous disease or achieve early diagnosis, which is likely to improve patient outcomes, including survival. For ovarian cancer, screening approaches have broadly focused on validated morphological scores and/or detecting increased CA-125 levels or trends. Population-based screening has been ineffective, but new approaches for early diagnosis and prevention that leverage molecular genomics are in development. For cervical cancer screening, European countries will continue with centralized national screening programmes, which will increasingly adopt HPV screening alone or in the form of co-testing and implement triage protocols and evidence based referral pathways. The individual population cervical cancer risk and the cost and patient inconvenience and attitude towards screening and potential unnecessary treatment is considered. Unlike cervical cancer, systematic testing for endometrial carcinoma is not recommended as there is no standard or routine screening test.
Rates of suicide in older adults may be higher than reported due to poor understandings of presentation of suicide ideation in this group. The objectives of this paper were to (i) review current measurement tools designed for older adults to detect suicide ideation and (ii) assess their psychometric properties.
We used a systematic review approach to identify measurement tools developed specifically for older adults without cognitive decline or impairment.
Ten articles that reported on a total of seven different measurement tools were identified. These included tools that focused on resiliency to suicide and those that measured risk of suicide behavior. There was wide variation across the articles: some were adaptations of existing scales to suit older populations, others were developed by authors; they varied in length from four to 69 items; a range of settings was used, and there was a mix of self-report and clinician-administered measures. Most displayed good psychometric properties, with both approaches showing similar quality. Limitations in terms of samples, settings, and measurement design are discussed.
The case for specific measures for older adults is clear from this review. There appear to be unique factors that should be considered in understanding suicide ideation and behavior among older adults that may not be directly assessed in non-specific measurements. However, there is a need to expand the diversity of individuals included in measurement development to ensure they are appropriate across gender, culture and minority status, and for the views of professionals to be considered.