Cost-effectiveness of artificial intelligence for screening colonoscopy: a modelling study

Background: Artificial intelligence (AI) tools increase detection of precancerous polyps during colonoscopy and might contribute to long-term colorectal cancer prevention. The aim of the study was to investigate the incremental effect of the implementation of AI detection tools in screening colonoscopy on colorectal cancer incidence and mortality, and the cost-effectiveness of such tools. Methods: We conducted Markov model microsimulation of using colonoscopy with and without AI for colorectal cancer screening for individuals at average risk (no personal or family history of colorectal cancer, adenomas, inflammatory bowel disease, or hereditary colorectal cancer syndrome). We ran the microsimulation in a hypothetical cohort of 100 000 individuals in the USA aged 50-100 years. The primary analysis investigated screening colonoscopy with versus without AI every 10 years starting at age 50 years and finishing at age 80 years, with follow-up until age 100 years, assuming 60% screening population uptake. In secondary analyses, we modelled once-in-life screening colonoscopy at age 65 years in adults aged 50-79 years at average risk for colorectal cancer. Post-polypectomy surveillance followed the simplified current guideline. Costs of AI tools and cost for downstream treatment of screening detected disease were estimated with 3% annual discount rates. The main outcome measures included the incremental effect of AI-assisted colonoscopy versus standard (no-AI) colonoscopy on colorectal cancer incidence and mortality, and cost-effectiveness of screening projected for the average risk screening US population. Findings: In the primary analyses, compared with no screening, the relative reduction of colorectal cancer incidence with screening colonoscopy without AI tools was 44·2% and with screening colonoscopy with AI tools was 48·9% (4·8% incremental gain). Compared with no screening, the relative reduction in colorectal cancer mortality with screening colonoscopy with no AI was 48·7% and with screening colonoscopy with AI was 52·3% (3·6% incremental gain). AI detection tools decreased the discounted costs per screened individual from $3400 to$3343 (a saving of $57 per individual). Results were similar in the secondary analyses modelling once-in-life colonoscopy. At the US population level, the implementation of AI detection during screening colonoscopy resulted in yearly additional prevention of 7194 colorectal cancer cases and 2089 related deaths, and a yearly saving of US$290 million. Interpretation: Our findings suggest that implementation of AI detection tools in screening colonoscopy is a cost-saving strategy to further prevent colorectal cancer incidence and mortality

Performance of artificial intelligence for colonoscopy regarding adenoma and polyp detection: a meta-analysis

BACKGROUND AND AIMS One fourth of colorectal neoplasia is missed at screening colonoscopy, representing the main cause of interval colorectal cancer (CRC). Deep learning systems with real-time computer-aided polyp detection (CADe) showed high accuracy in artificial settings, and preliminary randomized clinical trials (RCT) reported favourable outcomes in clinical setting. Aim of this meta-analysis was to summarise available RCTs on the performance of CADe systems in colorectal neoplasia detection. METHODS We searched MEDLINE, EMBASE and Cochrane Central databases until March 2020 for RCTs reporting diagnostic accuracy of CADe systems in detection of colorectal neoplasia. Primary outcome was pooled adenoma detection rate (ADR), Secondary outcomes were adenoma per colonoscopy (APC) according to size, morphology and location, advanced APC (AAPC), as well as polyp detection rate (PDR), Polyp-per-colonoscopy (PPC), and sessile serrated lesion per colonoscopy (SPC). We calculated risk ratios (RR), performed subgroup, and sensitivity analysis, assessed heterogeneity, and publication bias. RESULTS Overall, 5 randomized controlled trials (4354 patients), were included in the final analysis. Pooled ADR was significantly higher in the CADe groups than in the control group (791/2163, 36.6% vs 558/2191, 25.2%; RR, 1.44; 95% CI, 1.27-1.62; p10 mm adenomas (RR, 1.46; 95% CI, 1.04-2.06), as well as for proximal (RR, 1.59; 95% CI, 1.34-1.88) and distal (RR, 1.68; 95% CI, 1.50-1.88), and for flat (RR: 1.78 95% CI 1.47-2.15) and polypoid morphology (RR, 1.54; 95% CI, 1.40-1.68). Regarding histology, CADe resulted in a higher SPC (RR, 1.52; 95% CI,1.14-2.02), whereas a nonsignificant trend for AADR was found (RR, 1.35; 95% CI, 0.74 – 2.47; p = 0.33; I 2:69%). Level of evidence for RCTs was graded moderate. CONCLUSIONS According to available evidence, the incorporation of Artificial Intelligence as aid for detection of colorectal neoplasia results in a significant increase of the detection of colorectal neoplasia, and such effect is independent from main adenoma characteristics

The role of statins on helicobacter pylori eradication : Results from the european registry on the management of h. pylori (hp-eureg)

Funding: This project was promoted and funded by the European Helicobacter and Microbiota Study Group (EHMSG), the Spanish Association of Gastroenterology (AEG), and the Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd).Peer reviewedPublisher PD

Procalcitonin in preterm rupture of membranes: a systematic review and meta-analysis

Purpose Early detection of infection is of supreme importance in obstetrics; however, during pregnancy it is not reliably predicted by standard laboratory tests. We aimed to determine if procalcitonin (PCT) is a reliable predictor of chorioamnionitis (CA) in women with premature rupture of membranes (PPROM). Methods An electronic search of Scopus, ISI, Medline, Embase, ClinicalTrials.gov and the Cochrane Library databases was performed using specifed key words. We examined all English and French reports on PCT measurement after admission for PPROM and considered: human studies published between 1990 and 2019; observational studies; and randomized controlled trials. A protocol was determined previously, registered at PROSPERO as CRD42019145464. The eligibility was independently assessed by two researchers and literature search yielded 590 studies; after revision of the titles and abstracts, 46 articles were identifed as potentially eligible; eight studies were included in the meta-analysis. Primary data synthesis was performed in Review Manager Version 5.3 and average sensitivity and specifcity was calculated using Midas, Stata. Results From the eight studies included, 335 participants with PPROM were enrolled. Our meta-analysis disclosed that PCT has a poor sensitivity (0.50; 95% CI 0.28–0.73) and a modest specifcity (0.72; 95% CI 0.51–0.87) in diagnosing CA. C-reactive protein (CRP) not only has better sensitivity (0.71; 95% CI 0.53–0.84), but also better specifcity (0.75; 95% CI 0.55–0.88), compared with the other infammatory parameters analyzed. Procalcitonin does not seems to be better than CRP in preterm rupture of membranes for chorioamnionitis diagnosis.F31D-D663-4EF2 | Anabela Mota Pintoinfo:eu-repo/semantics/publishedVersio

Implementação e desenvolvimento de um serviço de outsourcing para as unidades de alojamento turístico de Fátima

Enquadramento: Este projeto pretende analisar o recurso a outsourcing pelas unidades de alojamento em Fátima, perceber a importância da prestação de serviços de outsourcing para as unidades de alojamento em Fátima, identificar a que serviços os hoteleiros recorrem a empresas externas de outsourcing e quais os serviços de outsourcing mais necessários aos hoteleiros de Fátima. Objetivos: O primeiro objetivo deste trabalho assenta no estudo do outsourcing e na análise da sua importância para a hotelaria de Fátima. O segundo objetivo consiste num estudo de viabilidade económica, que permita identificar oportunidades para a criação de uma empresa que preste um serviço de outsourcing respondendo às necessidades da hotelaria de Fátima. Metodologia: Na primeira parte do projeto será realizada uma revisão da literatura no sentido de se compreender o conceito outsourcing. Será ainda desenvolvido e aplicado um questionário, cujos resultados permitirão a identificação da eventual necessidade de outsourcing para as unidades de alojamento turístico em Fátima. Identificada a dimensão da necessidade foi elaborado um de plano de negócio para estimar o potencial da viabilidade económico do presente projeto. Resultados e conclusões: Serão dados a conhecer os resultados decorrentes da investigação para a identificação das necessidades dos hoteleiros de Fátima e ainda a atratividade do outsourcing no mercado de alojamento turístico de Fátima. No final serão ainda comunicadas as limitações à investigação e futuras linhas de investigação

Earthquake strengthening of historic constructions' connections

Dissertação de mestrado integrado em Engenharia Civil (área de especialização em Perfil de Estruturas e Geotecnia)O trabalho de investigação realizado teve como principal objetivo o conhecimento do comportamento de elementos de alvenaria quando submetidos a forças perpendiculares ao seu plano (como forças provenientes da ação sísmica ou do vento), de forma a desenvolver uma técnica capaz de lhes garantir uma maior resistência à flexão para do seu plano. Cedo se percebeu que a técnica a ser desenvolvida teria dificuldade em competir com outro tipo de técnicas correntes utilizadas para reforçar este tipo de elementos, que garantem um incremento de resistência bastante elevado. A ideia foi desenvolvê-la de forma a poder ser aplicada em construções de alvenaria que se encontrem em estado de ruína, isto é, elementos remanescentes de construções históricas que se encontrem sem qualquer tipo de contraventamento horizontal. Nesse campo, a técnica apresenta muitas vantagens, visto que foi concebida de forma a não ficar visível, não alterando o valor estético, patrimonial e histórico do elemento a reforçar. Ao longo deste trabalho foram realizados alguns ensaios experimentais, com maior destaque para os ensaios de flexão para fora do plano de seis provetes de paredes de alvenaria, encontrando-se quatro deles reforçados com este sistema de reforço desenvolvido. Desses ensaios foi possível concluir que este sistema contribui para aumentar a rigidez, o limite elástico e a resistência à flexão dos elementos estruturais, assim como, para manter a integridade do elemento após a rotura. Porém, ainda terão que ser desenvolvidos alguns aspetos, nomeadamente a nível da trabalhabilidade, para conhecer a potencialidade do sistema.The research work developed had as the main objective the knowledge of the behavior of masonry elements when subjected to out-of-plain actions (as forces derived from seismic activity or the wind loads), in order to develop a strengthening technique to assure a higher flexural strength. Quickly became apparent that it will be hard for the technique to compete with other kind of currently used techniques that can guarantee a very high increase in bending strength. So, the idea turned to focus on the developing so it can be applied in masonry ruins, like remaining elements of historic constructions that have no horizontal bracing. With this concern, the technique has many advantages, because it was conceived to be invisible to avoid aesthetic changes, irreversible, and loss of heritage and historical values. During the development of this research work experimental tests were performed with greater emphasis on the bending tests of six specimens of masonry walls. Four of these six specimens were reinforced with the developed technique. From these tests it was concluded that this system contributes to the increase of the stiffness, the elastic limit, and the flexural strength of the structural elements, as well as to maintain the integrity of walls after cracking and large deformations. However, it’s still necessary to develop some aspects, particularly in terms of workability in order to be effective and to be able for practical applications