107 research outputs found

    Overdetection, overtreatment and costs in prostate-specific antigen screening for prostate cancer

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    Background:Prostate cancer screening with prostate-specific antigen (PSA) has shown to reduce prostate cancer mortality in the European Randomised study of Screening for Prostate Cancer (ERSPC) trial. Overdetection and overtreatment are substantial unfavourable side effects with consequent healthcare costs. In this study the effects of introducing widespread PSA screening is evaluated.Methods:The MISCAN model was used to simulate prostate cancer growth and detection in a simulated cohort of 100 000 men (European standard population) over 25 years. PSA screening from age 55 to 70 or 75, with 1, 2 and 4-year-intervals is simulated. Number of diagnoses, PSA tests, biopsies, treatments, deaths and corresponding costs for 100 000 men and for United Kingdom and United States are compared.Results:Without screening 2378 men per 100 000 were predicted to be diagnosed with prostate cancer compared with 4956 men after screening at 4-year intervals. By introducing screening, the costs would increase with 100% to \[euro]60 695 000. Overdetection is related to 39% of total costs (\[euro]23 669 000). Screening until age 75 is relatively most expensive because of the costs of overtreatment.Conclusion:Introduction of PSA screening will increase total healthcare costs for prostate cancer substantially, of which the actual screening costs will be a small part

    An exploration of the family resilience needs of a rural community in South Africa: a sequential explanatory mixed methodological study design

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    The aim of the study is to identify and explore family resilience needs in a rural community in the West Coast region of South Africa. An explanatory mixed methodological sequential design was implemented. Firstly, Sixbey’s (2005) Family Resilience Assessment Scale, was employed to conduct the quantitative assessment via a door-to-door sample of convenience identified with the assistance of a local nongovernmental organisation. Of the 656 participants, 39.8% were male and 60.2% were female, with an average age of 37.90 years (standard deviation 13.92). Secondly, four focus groups involving 27 community participants provided qualitative data. Results from the quantitative assessment show that family connectedness and utilising social and economic resources were the lowest scoring, and belief systems the highest scoring, dimensions in family resilience. Based on the quantitative findings and the discussions, three thematic categories emerged: community and family challenges; community belief systems; and current family functioning and organisational patterns. A number of families and groups within the community were able to provide feedback, recommendations and work collaboratively in this study. This contributed to the argument we make for the transformative mixed methods paradigm that is discussed. This study provides further insight into the theory of family resilience.ISI & Scopu

    A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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