Why we might not need to stress about ruling out inducible myocardial ischemia

Editorial on the high-sensitivity cardiac troponin (hs-cTn) tests

High value health care is low carbon health care

Culling low value care will cut health care carbon emission

I need an exact margin measurement for this basal cell carcinoma!

Pathology laboratories are required to determine or estimate the measurement uncertainty for all quantitative results, but there is no literature on the uncertainty in margin measurements for skin cancer excisions. Six pathologists measured 4–14 histological margins in each of 10 basal cell carcinoma

Analyses within risk strata overestimate gain in discrimination: the example of coronary artery calcium scores

Risk prediction models are potentially useful tools for health practitioners and policy makers. When new predictors are proposed to add to existing models, the improvement of discrimination is one of the main measures to assess any increment in performance. In assessing such predictors, we observed two paradoxes: 1) the discriminative ability within all individual risk strata was worse than for the overall population; 2) incremental discrimination after including a new predictor was greater within each individual risk strata than for the whole population. We show two examples of the paradoxes and analyse the possible causes. The key cause of bias is use of the same prediction model as for both stratifying the population, and as the base model to which the new predictor is adde

Including Information on Overdiagnosis in Shared Decision Making : A Review of Prostate Cancer Screening Decision Aids

Publisher Copyright: © The Author(s) 2022.Background. Overdiagnosis is an accepted harm of cancer screening, but studies of prostate cancer screening decision aids have not examined provision of information important in communicating the risk of overdiagnosis, including overdiagnosis frequency, competing mortality risk, and the high prevalence of indolent cancers in the population. Methods. We undertook a comprehensive review of all publicly available decision aids for prostate cancer screening, published in (or translated to) the English language, without date restrictions. We included all decision aids from a recent systematic review and screened excluded studies to identify further relevant decision aids. We used a Google search to identify further decision aids not published in peer reviewed medical literature. Two reviewers independently screened the decision aids and extracted information on communication of overdiagnosis. Disagreements were resolved through discussion or by consulting a third author. Results. Forty-one decision aids were included out of the 80 records identified through the search. Most decision aids (n = 32, 79%) did not use the term overdiagnosis but included a description of it (n = 38, 92%). Few (n = 7, 17%) reported the frequency of overdiagnosis. Little more than half presented the benefits of prostate cancer screening before the harms (n = 22, 54%) and only 16, (39%) presented information on competing risks of mortality. Only 2 (n = 2, 5%) reported the prevalence of undiagnosed prostate cancer in the general population. Conclusion. Most patient decision aids for prostate cancer screening lacked important information on overdiagnosis. Specific guidance is needed on how to communicate the risks of overdiagnosis in decision aids, including appropriate content, terminology and graphical display. Most patient decision aids for prostate cancer screening lacks important information on overdiagnosis. Specific guidance is needed on how to communicate the risks of overdiagnosis.Peer reviewe

Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance

Aims Human health is intrinsically linked with planetary health. But planetary resources are currently being degraded and this poses an existential threat to human health and the sustainability of our healthcare systems. The aims of this study were to (1) describe an approach to integrate environmental impacts in a cost analysis; and (2) demonstrate this approach by estimating select environmental impacts alongside traditional health system and other costs using the example of the pilot MEL-SELF randomised controlled trial of patient-led melanoma surveillance. Methods Economic costs were calculated alongside a randomised trial using standard cost analysis methodology from a societal perspective. Environmental impacts were calculated using a type of carbon footprinting methodology called process-based life cycle analysis. This method considers three scopes of carbon emissions: Scope 1, which occur directly from the intervention; Scope 2, which occur indirectly from the intervention’s energy use; and Scope 3, which occur indirectly because of the value chain of the intervention. In this study we only included emissions from patient transport to attend their melanoma clinic over the study period of 6 months. Results The environmental impact per participant across allocated groups for patient transport to their melanoma clinic was estimated to be 10 kg carbon dioxide equivalent. Economic costs across the allocated groups indicated substantial health system costs, out-of-pocket costs, and productivity losses associated with melanoma surveillance. The largest cost contributor was health system costs, and the most expensive category of health system cost was hospital admission

Breast Cancer Stage and Size Detected with Film versus Digital Mammography in New South Wales, Australia: A Population-Based Study Using Routinely Collected Data.

Digital mammography has replaced film mammography in breast-screening programs globally, including Australia. This led to an increase in the rate of detection, but whether there was increased detection of clinically important cancers is uncertain. We found increased detection of in situ cancer (3.36 per 10,000 screens), localized invasive, and smaller-sized breast cancers attributable to the change in mammography technology, whereas screen-detected intermediate-sized and metastatic breast cancers decreased. Rates of early-stage and intermediate-sized interval cancers increased, and late-stage (−1.62 per 10,000 screens) and large interval cancers decreased. In unscreened women, there were small increases in the temporal trends of cancers across all stages

Comparison of Readability Scores for Written Health Information Across Formulas Using Automated vs Manual Measures

Assessing the readability of written health information is a common way to evaluate whether patients are likely to understand it.1 Readability is an objective measure that estimates a text’s equivalent school-grade reading level and is increasingly recommended globally in health policies.2,3 Several formulas for calculating readability exist, and scores can vary substantially depending on the formula applied.4 There has also been a proliferation of automated online calculators that provide readability estimates within seconds. However, the accuracy and consistency of automated calculators have not been evaluated. The aims of this study were to assess (1) the variability of readability scores across automated calculators, (2) the association of text preparation with score variability, and (3) the level of agreement of automated readability scores with the reference standard (manually calculated scores) using the Simple Measure of Gobbledygook (SMOG) Index, the Flesch Kincaid Grade Level (FKGL), and the Automated Readability Index (ARI)

Considering potential benefits, as well as harms, from the COVID-19 disruption to cancer screening and other healthcare services.

Since 2020, hundreds of thousands of more deaths than expected have been observed across the globe. Amid the coronavirus 2019 (COVID-19) pandemic, current research priorities are to control the spread of infection and minimise loss of life. However, there may be future opportunities to learn from the pandemic to build a better healthcare system that delivers maximum health benefits with minimum harm. So far, much research has focused on foregone benefits of healthcare services such as cancer screening during the pandemic. A more balanced approach is to recognise that all healthcare services have potential harms as well as benefits. In this way, we may be able to use pandemic ‘natural experiments’ to identify cases where a reduction in a healthcare service has not been harmful to the population and some instances where this may have even been beneficial

Association of Attention-Deficit/Hyperactivity Disorder Diagnosis With Adolescent Quality of Life

Appropriate diagnosis of attention-deficit/hyperactivity disorder (ADHD) can improve some short-term outcomes in children and adolescents, but little is known about the association of a diagnosis with their quality of life (QOL). Objective To compare QOL in adolescents with and without an ADHD diagnosis. Design, Setting, and Participants This cohort study followed an emulated target trial design using prospective, observational data from the Longitudinal Study of Australian Children, a representative, population-based prospective cohort study with biennial data collection from 2006 to 2018 with 8 years of follow-up (ages 6-7 to 14-15 years). Propensity score matching was used to ensure children with and without ADHD diagnosis were well matched on a wide range of variables, including hyperactive/inattentive (H/I) behaviors. Eligible children were born in 1999 to 2000 or 2003 to 2004 and did not have a previous ADHD diagnosis. All incident ADHD cases were matched with controls. Data were analyzed from July 2021 to January 2022. Exposures Incident parent-reported ADHD diagnosis at age 6 to 7, 8 to 9, 10 to 11, 12 to 13, or 14 to 15. Main Outcomes and Measures Quality of life at age 14 to 15 was measured with Child Health Utility 9D (CHU9D) and 8 other prespecified, self-reported measures mapped to the World Health Organization’s QOL domains. Pooled regression models were fitted for each outcome, with 95% CIs and P values calculated using bootstrapping to account for matching and repeat observations