Economic evaluation of screening for open angle glaucoma

Objectives: The aim of this study was to assess the cost-effectiveness of screening for open-angle glaucoma (OAG) in the United Kingdom, given that OAG is an important cause of blindness worldwide. Methods: A Markov model was developed to estimate lifetime costs and benefits of a cohort of patients facing, alternatively, screening or current opportunistic case finding strategies. Strategies, varying in how screening would be organized (e.g., invitation for assessment by a glaucoma-trained optometrist [GO] or for simple test assessment by a technician) were developed, and allowed for the progression of OAG and treatment effects. Data inputs were obtained from systematic reviews. Deterministic and probabilistic sensitivity analyses were performed. Results: Screening was more likely to be cost-effective as prevalence increased, for 40 year olds compared with 60 or 75 year olds, when the re-screening interval was greater (10 years), and for the technician strategy compared with the GO strategy. For each age cohort and at prevalence levels of ≤1 percent, the likelihood that either screening strategy would be more cost-effective than current practice was small. For those 40 years of age, “technician screening” compared with current practice has an incremental cost-effectiveness ratio (ICER) that society might be willing to pay when prevalence is 6 percent to 10 percent and at over 10 percent for 60 year olds. In the United Kingdom, the age specific prevalence of OAG is much lower. Screening by GO, at any age or prevalence level, was not associated with an ICER < £30,000. Conclusions: Population screening for OAG is unlikely to be cost-effective but could be for specific subgroups at higher risk.This study was developed from a health technology assessment on the clinical and cost-effectiveness of screening for open-angle glaucoma (OAG), funded by the National Institute for Health Research Health Technology Assessment Programme (project no. 04/08/02).Peer reviewedAuthor versio

A clinical assessment tool for midwives undertaking the Newborn Infant Physical Examination

The role of midwives has evolved over the last two decades, and in the United Kingdom midwives and advanced neonatal nurse practitioners undertake roles that traditionally were undertaken by junior doctors. The Newborn Infant Physical Examination (NIPE) is performed within the first 72 hours of birth (Lanlehin, 2011), and enables midwives to provide a holistic assessment of neonates and their mothers, as well as confirming normality, identifying abnormalities, and providing early intervention for at risk neonates. The aim of this paper is to discuss the usefulness of the Newborn and Infant Assessment Tool (NIAT) which was originally used as an oral assessment tool for a health professional undertaking the NIPE course. However, it became clear over the course of 10 years that not only is this a framework for assessing students' application of theoretical knowledge to practice scenarios, it is also an assessment tool that can be used by trained midwives, medical staff, and student nurses to enhance clinical decision-making when faced with an unwell baby

Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis

Researchers increasingly use meta-analysis to synthesize the results of several studies in order to estimate a common effect. When the outcome variable is continuous, standard meta-analytic approaches assume that the primary studies report the sample mean and standard deviation of the outcome. However, when the outcome is skewed, authors sometimes summarize the data by reporting the sample median and one or both of (i) the minimum and maximum values and (ii) the first and third quartiles, but do not report the mean or standard deviation. To include these studies in meta-analysis, several methods have been developed to estimate the sample mean and standard deviation from the reported summary data. A major limitation of these widely used methods is that they assume that the outcome distribution is normal, which is unlikely to be tenable for studies reporting medians. We propose two novel approaches to estimate the sample mean and standard deviation when data are suspected to be non-normal. Our simulation results and empirical assessments show that the proposed methods often perform better than the existing methods when applied to non-normal data

Accuracy of the Patient Health Questionnaire-9 for screening to detect major depression : updated systematic review and individual participant data meta-analysis

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVE: To update a previous individual participant data meta-analysis and determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9), the most commonly used depression screening tool in general practice, for detecting major depression overall and by study or participant subgroups. DESIGN: Systematic review and individual participant data meta-analysis. DATA SOURCES: Medline, Medline In-Process, and Other Non-Indexed Citations via Ovid, PsycINFO, Web of Science searched through 9 May 2018. REVIEW METHODS: Eligible studies administered the PHQ-9 and classified current major depression status using a validated semistructured diagnostic interview (designed for clinician administration), fully structured interview (designed for lay administration), or the Mini International Neuropsychiatric Interview (MINI; a brief interview designed for lay administration). A bivariate random effects meta-analytic model was used to obtain point and interval estimates of pooled PHQ-9 sensitivity and specificity at cut-off values 5-15, separately, among studies that used semistructured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual), fully structured interviews (eg, Composite International Diagnostic Interview), and the MINI. Meta-regression was used to investigate whether PHQ-9 accuracy correlated with reference standard categories and participant characteristics. RESULTS: Data from 44 503 total participants (27 146 additional from the update) were obtained from 100 of 127 eligible studies (42 additional studies; 79% eligible studies; 86% eligible participants). Among studies with a semistructured interview reference standard, pooled PHQ-9 sensitivity and specificity (95% confidence interval) at the standard cut-off value of ≥10, which maximised combined sensitivity and specificity, were 0.85 (0.79 to 0.89) and 0.85 (0.82 to 0.87), respectively. Specificity was similar across reference standards, but sensitivity in studies with semistructured interviews was 7-24% (median 21%) higher than with fully structured reference standards and 2-14% (median 11%) higher than with the MINI across cut-off values. Across reference standards and cut-off values, specificity was 0-10% (median 3%) higher for men and 0-12 (median 5%) higher for people aged 60 or older. CONCLUSIONS: Researchers and clinicians could use results to determine outcomes, such as total number of positive screens and false positive screens, at different PHQ-9 cut-off values for different clinical settings using the knowledge translation tool at www.depressionscreening100.com/phq. STUDY REGISTRATION: PROSPERO CRD42014010673.publishersversionPeer reviewe

Probability of Major Depression Classification Based on the SCID, CIDI, and MINI Diagnostic Interviews : A Synthesis of Three Individual Participant Data Meta-Analyses

Funding Information: This study was funded by the Canadian Institutes of Health Research (KRS-134297, PCG-155468, PJT-162206, KRS-140994, KRS-144045). Drs. Wu and Levis were supported by Fonds de recherche du Québec – Santé (FRQS) Postdoctoral Training Fellowships. Dr. Benedetti was supported by a FRQS researcher salary award. Publisher Copyright: © 2020 Lippincott Williams and Wilkins. All rights reserved. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.INTRODUCTION: Three previous individual participant data meta-analyses (IPDMAs) reported that, compared to the Structured Clinical Interview for the DSM (SCID), alternative reference standards, primarily the Composite International Diagnostic Interview (CIDI) and the Mini International Neuropsychiatric Interview (MINI), tended to misclassify major depression status, when controlling for depression symptom severity. However, there was an important lack of precision in the results. OBJECTIVE: To compare the odds of the major depression classification based on the SCID, CIDI, and MINI. METHODS: We included and standardized data from 3 IPDMA databases. For each IPDMA, separately, we fitted binomial generalized linear mixed models to compare the adjusted odds ratios (aORs) of major depression classification, controlling for symptom severity and characteristics of participants, and the interaction between interview and symptom severity. Next, we synthesized results using a DerSimonian-Laird random-effects meta-analysis. RESULTS: In total, 69,405 participants (7,574 [11%] with major depression) from 212 studies were included. Controlling for symptom severity and participant characteristics, the MINI (74 studies; 25,749 participants) classified major depression more often than the SCID (108 studies; 21,953 participants; aOR 1.46; 95% confidence interval [CI] 1.11-1.92]). Classification odds for the CIDI (30 studies; 21,703 participants) and the SCID did not differ overall (aOR 1.19; 95% CI 0.79-1.75); however, as screening scores increased, the aOR increased less for the CIDI than the SCID (interaction aOR 0.64; 95% CI 0.52-0.80). CONCLUSIONS: Compared to the SCID, the MINI classified major depression more often. The odds of the depression classification with the CIDI increased less as symptom levels increased. Interpretation of research that uses diagnostic interviews to classify depression should consider the interview characteristics.publishersversionPeer reviewe

Developing Statutes for Competence to Stand Trial in Juvenile Delinquency Proceedings: A Guide for Lawmakers

The National Youth Screening and Assessment Project, part of the John D. and Catherine T. MacArthur Foundation’s Models for Change Initiative recently released a guide for policymakers who are considering creating juvenile competence to stand trial legislation. Authored by Kimberly Larson, J.D., Ph.D. and Thomas Grisso, Ph.D., the guide outlines the sixteen most important points lawmakers must consider in the creation of such legislation. Statutory language examples are provided throughout the guide on each of the sixteen key issues. This guide provides a comprehensive look at juveniles’ competence to stand trial. It will be of use not only to those considering drafting legislation in this area or currently creating juvenile competence to stand trial laws in their state, but also to judges who are addressing the issue of competence within their courts. Attorneys and mental health professionals can also use it to learn more about the application of competence to juveniles

Resident macrophages and their potential in cardiac tissue engineering

Many facets of tissue engineered models aim to understand cellular mechanisms to recapitulate in vivo behavior, study and mimic diseases for drug interventions and to provide better understanding towards improving regenerative medicine. Recent and rapid advances in stem cell biology, material science and engineering, have made the generation of complex engineered tissues much more attainable. One such tissue, human myocardium; is extremely intricate, with a number of different cell types. Recent studies have unraveled cardiac resident macrophages as a critical mediator for normal cardiac function. Macrophages within the heart exert phagocytosis and efferocytosis, facilitate electrical conduction, promote regeneration and remove cardiac exophers to maintain homeostasis. These findings underpin the rationale of introducing macrophages to engineered heart tissue, to more aptly capitulate in vivo physiology. Despite the lack of studies using cardiac macrophages in vitro, there is enough evidence to believe that they will be useful in making engineered heart tissues more physiologically relevant. In this review, we explore the rationale and feasibility of using macrophage as an additional cell source in engineered cardiac tissues

Tyrol Prostate Cancer Demonstration Project : early detection, treatment, outcome, incidence and mortality

This study aimed to evaluate the effectiveness of a well-controlled programme of early detection and treatment of prostate cancer in the population of Tyrol, Austria, where such a programme of early detection and treatment was initiated in 1988 and where prostate-specific antigen (PSA) testing was offered for free to all men aged 45-75 years from 1993. Comparison of prostate cancer mortality rates in Tyrol and the rest of Austria was accomplished through a generalized additive model. A piecewise linear change-point Poisson regression model was used to compare mortality rates in Tyrol and the rest of Austria. Standardized mortality ratios were calculated with reference to the mortality rates in 1986-1990. In all, 86.6% of eligible men have been tested at least once since 1993. Cancer deaths in Tyrol in 2005 were 54% (95% confidence interval [CI] 34-69%) lower than expected compared with 29% (95% CI 22-35%) in the rest of Austria. The decreasing trend in prostate cancer mortality was significantly greater in Tyrol compared with the rest of Austria (P = 0.001). A significant migration to lower stage disease occurred and radical prostatectomy was associated with low morbidity. In the Tyrol region where treatment is freely available to all patients, where widespread PSA testing and treatment with curative intent occurs, there was a reduction in prostate cancer mortality rates which was significantly greater than the reduction in the rest of Austria. This reduction in prostate cancer mortality is most probably due to early detection, consequent down-staging and effective treatment of prostate cancer

Técnicas visuales en la tamización del cáncer de cuello uterino

Introducción. La inspección visual directa para la tamización delcáncer cervical sigue siendo controversial, mientras que la colposcopia y la biopsia siguen considerándose como métodos de referencia para diagnosticar lesiones cervicales precancerosas.Objetivo. Determinar las tasas de detección deneoplasia intraepitelial cervical de grado 2y de los falsos positivos en la colposcopia y la inspección visual directa.Materiales y métodos. Se seleccionaron mujeres de 25 a 59 años sometidas a citología convencional, inspección visual directa con ácido acético y disolución de Lugol y colposcopia. Se practicó biopsia en todas las pruebas positivas. Utilizando la histología como el medio de verificación de referencia, se compararon las tasas de detección y de falsos positivos de cada prueba. Se estimaron las razones de sensibilidad y de falsos positivos con los correspondientes intervalos de confianza.Resultados. Se incluyeron 5.011 mujeres. Las colposcopias positivas de alto y bajo grado correspondieron a 1,6 y 10,8 %, respectivamente. La inspección visual directa con ácido acético y solución yodada de Lugol fue positiva en 7,4 y 9,9 %, respectivamente. La inspección visual directa con ácido acético tuvo tasas de detección y falsos positivos significativamente menores que la coloscopia con umbral de bajo grado (razón de sensibilidad: 0,72; IC95% 0,57-0,91; razón de falsos positivos: 0,70; CI95% 0,65-0,76); no hubo diferencias entre la inspección visual directa con solución yodada de Lugol y la colposcopia con dicho umbral. Las tasas de detección y de falsos positivos de los dos tipos de inspección visual fueron significativamente más altas que las de la colposcopia con el umbral de alto grado. Las tasas de detección de la inspección visual disminuyeron con la edad y las de falsos positivos aumentaron.Conclusiones: Las tasas de detección similares para la inspección visual directa con ácido acético o con solución yodada de Lugol y la colposcopia con umbral de bajo grado representan una oportunidad para reducir la mortalidad por cáncer de cuello uterino cuando el acceso a los servicios de salud es limitado. Las tasas de detecciónmás bajas para la colposcopia con umbral de alto grado sugieren la necesidad de revisar dicho umbral en ciertos entornos.Q465Biomédica 2019;39:65-74Visual techniques for cervical cancer screeningVisual techniques for cervical cancer screening in ColombiaÓscar Gamboa1, Mauricio González2, Jairo Bonilla3, Joaquín Luna4, Raúl Murillo1, INC Cervical Cancer Screening Study Group 1 Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia2 Grupo de Investigación Clínica, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia3 Departamento de Ginecología, Fundación Universitaria Ciencias de la Salud, Bogotá, D.C., Colombia4 Grupo de Ginecología, Organización Sanitas, Bogotá, D.C., ColombiaIntroduction: Direct visual inspection for cervical cancer screening remains controversial, whereas colposcopy-biopsy is considered the gold standard for diagnosis of preneoplastic cervical lesions.Objectives: To determinethe rates of cervical intraepithelial neoplasia grade 2 or more and of false positives for colposcopy and direct visual inspection.Materials and methods: Women aged 25-59 underwent direct visual inspection with acetic acid (VIA), Lugol’s iodine (VIA-VILI), and colposcopy. Punch biopsies were obtained for all positive tests. Using histology as the gold standard, detection and false positive rates were compared for VIA, VIA-VILI, and colposcopy (two thresholds). Sensitivity and false positive ratios with the corresponding 95% confidence intervals were estimated.Results: We included 5,011 women in the analysis and we obtained 602 biopsies. Positivity rates for colposcopy high-grade and low-grade diagnosis were 1.6% and 10.8%. Positivity rates for VIA and VIA-VILI were 7.4% and 9.9%. VIA showed a significantly lower detection rate than colposcopy with low-grade diagnosis as the threshold (SR=0.72; 95% CI 0.57-0.91), and significantly lower false positive rate (FPR=0.70; 95% CI 0.65-0.76). No differences between VIA-VILI and colposcopy low-grade threshold were observed. VIA and VIA-VILI showed significantly higher detection and false positive rates than colposcopy high-grade threshold. Sensitivity rates for visual inspection decreased with age and false positive rates increased. For all age groups, false positive rates for VIA and VIA-VILI were significantly higher than colposcopy.https://orcid.org/0000-0001-9612-8479https://orcid.org/0000-0001-7187-9946Revista Nacional - Indexad