Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations.

OBJECTIVES: To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. PARTICPANTS AND METHODS: Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. RESULTS: A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. CONCLUSION: This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening

Integrating community pharmacy testing for hepatitis c with specialist care

Background: Many patients with hepatitis C virus (HCV) infection lie undiagnosed and a significant proportion of patients that have been identified are disengaged from specialist services. The Isle of Wight (IOW) typifies this issue, with an estimated 200 undiagnosed patients with HCV infection and a small number of known cases engaged with specialist services. Aim: To reduce the burden of undiagnosed HCV on the IOW and link new diagnoses directly to specialist care. Service development, design and implementation: Dry blood spot tests were undertaken at community pharmacies for HCV, hepatitis B, HIV and syphilis. Individuals testing positive for HCV RNA or hepatitis B surface antigen were automatically referred to the mainland hepatology service and were seen at a pharmacy 'point-of-diagnosis' consultation with the testing pharmacist and hepatologist. Pharmacy testing activity was compared with the local drug support centre (island recovery integrated service [IRIS]). Service outcomes: Over a period of nine months (September 2014 to May 2015), a total of 88 tests were performed at community pharmacies. Of these, 39 of the individuals tested reported injecting drug use as their main risk factor; 17 of these were not engaged at IRIS and were significantly less likely to have had a previous test (77% vs. 41%, P =0.04). During the same period at the IRIS centre, 34 tests were performed. A greater proportion of individuals had a history of injecting drug use (85%, P &lt;0.01) and were more likely to have had a test in the past three years (56%P, =0.07). Overall, 7% of pharmacy tests and 9% of IRIS tests were positive for HCV RNA (P =0.7); all pharmacy cases were seen at a point-of-diagnosis consultation with a hepatologist Conclusion: Pharmacy-based testing has the potential to reach at-risk individuals who are not tested for HCV elsewhere. When combined with integrated specialist referral, it has the potential to reduce the burden of undiagnosed HCV and engage new diagnoses directly with specialist care.</p

Impact de la mise en place d’un réseau des soins pour la traumatologie grave dans la ville de Kinshasa, RD Congo : étude quasi-expérimentale

Contexte et objectif: Une part non négligeable de décès posttraumatiques semble évitable par une meilleure prise en charge. L’objectif de la présente étude était d’évaluer l’impact de la mise en place d’un réseau des soins sur la mortalité des patients traumatisés graves dans la ville de Kinshasa. Méthodes: C’était une étude multicentrique quasi-expérimentale avant/après portant sur les patients adultes hospitalisés en réanimation ousoins intensifs pour traumatisme grave, entre le 1er janvier 2009 et le 31 décembre 2014. L’intervention a consisté à la mise en place d’un réseau de soins entre les deux groupes. La mortalité hospitalière ajustée sur l’âge, le sexe et le score RTS étaient le critère de jugement principal. Résultats: Au total, 4 hôpitaux ont participé et ont inclus 195 patients consécutifs dans le groupe pré-interventionnel contre 9 hôpitaux et 210 patients dans le groupe post-interventionnel. Entre les deux groupes, le taux d’admission directe s’est amélioré (48,6 % vs 75,9 %) ainsi que le temps d’arrivée à l’hôpital (6,5 h vs 4,2 h). Il a été relevé une diminution des volumes de perfusion associée à une augmentation des taux d’utilisation des catécholamines (2% vs 6,6 %), de la transfusion sanguine (15,8 % vs 25,7 %) et de l’acide tranexamique (zéro % vs 77,6 %). Le taux d’intubationen cas de GCS &lt; 9 (13,2 % vs 37 %), d’administration de mannitol en présence d’une mydriase (58 % vs 72,4 %) et de réalisation du scanner cérébral chez les patients ayant un GCS ≤14 (10,6 % vs 54,6%) ont augmenté également. En revanche, le pourcentage de patients ayant bénéficié d’un&nbsp; drainage thoracique (0,5 % vs 1,4 %) et la fréquence d’actes de chirurgie (43 % vs 50 %) n’ont pas significativement varié. La mortalité, quant à elle,&nbsp; est significativement passée de 73,3 % à 54,7 %. Conclusion: Une amélioration des pratiques et une baisse de la mortalité ont été observées après&nbsp; la mise en place du réseau de soins. &nbsp; English title: Impact of the establishment of a severe trauma care network in the City of Kinshasa, Democratic Republic of the Congo: a quasi-experimental study Context and objective: Better management is mandatory for avoidable post-traumatic deaths. This study aimed to assess the impact of the&nbsp; implementation of a trauma network on the mortality of severe trauma patients in Kinshasa, DR Congo. Methods: The multicentric quasic-experimental before/after survey included adult patients admitted in intensive care unit for trauma in Kinshasa&nbsp; between January 2009 and December 2014. The relevance of the implementation of a trauma network was assessed. In-hospital mortality adjusted&nbsp; for age, gender and RTS score was the primary endpoint. Results: A total of 195 consecutive patients was concerned from 4 hospitals in the pre-intervention group vs 210 patients from 9 hospitals in the&nbsp; postintervention group. In the two groups, the direct admission rate improved (48.6 % vs 75.9 %) as well as the time of arrival at the hospital (4.2 h&nbsp; vs 6.5 h). There was a decrease in infusion volumes associated with an increase utilization rate of catecholamines 2 % vs. 6.6 %), blood transfusion (15.8 % vs. 25.7 %) and acid tranexamic (0 % vs 77.6 %). The rate of intubation in the event of GCS &lt; 9 (13.2 % vs 37 %), administration of mannitol in&nbsp; the presence of mydriasis (58 % vs 72.4 %) and realization of the brain scan in patients with a GCS ≤14 (10.6 % vs&nbsp; 4.6 %) also increased. However, the&nbsp; percentage of patients who received chest drainage (0.5 % vs&nbsp; 1.4 %) and the frequency of surgery (43 % vs 50 %) did not vary significantly. Mortality, meanwhile, fell from 73.3 % to 54.7 %. Conclusion: An improvement in practices and a reduction in mortality were observed after the&nbsp; implementation of the trauma network