COVID-19 disruption to cervical cancer screening in England

INTRODUCTION: In England, routine invitations for cervical screening were reduced between April 2020 and June 2020 due to the COVID-19 pandemic. We quantify the impact of COVID-19 disruptions on attendance and excess diagnoses of cervical cancer (CC). METHODS: Using Public Health England CC screening data on laboratory samples received in 2018 as a baseline we quantify the reduction in screening attendances due to the COVID-19 pandemic between April 2020 and March 2021 for women aged 25–64. We model the impact on excess CC diagnoses assuming once invitations resume 87.5% of women attend within 12 months and 12.5% delay screening for 3 or 5 years (depending on age). RESULTS: The number of samples received at laboratories was 91% lower than expected during April, 85% during May and 43% during June 2020 compared to the same period in 2018. Although on average laboratories received 12.6% more samples between August 2020 and April 2021 than over the same months in 2018, by April 2021 there was a short fall of 200,949 samples (6.4% fewer than in 2018). An excess of 41 CC (4.0 per 100,000 women with a maximum screening delay of 12 months) are predicted to occur among the estimated 1,024,794 women attending this screening round with a delay. An excess of 60 CC (41.0 per 100,000 women) are predicted to occur among the estimated 146,391 women who do not attend this screening round. CONCLUSION: Prompt restoration of cervical screening services limited the impact on excess CC diagnoses. However, in 2020 a 6.4% shortfall of screening samples was observed. Every effort should be made to reassure these women that services are open and safe to attend

Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome (GETSET): Protocol for a Randomized Controlled Trial and Interview Study

Background: Chronic fatigue syndrome, also known as myalgic encephalomyelitis (CFS/ME), is characterized by chronic disabling fatigue and other symptoms, which are not explained by an alternative diagnosis. Previous trials have suggested that graded exercise therapy (GET) is an effective and safe treatment. GET itself is therapist-intensive with limited availability. Objective: While guided self-help based on cognitive behavior therapy appears helpful to patients, Guided graded Exercise Self-help (GES) is yet to be tested. Methods: This pragmatic randomized controlled trial is set within 2 specialist CFS/ME services in the South of England. Adults attending secondary care clinics with National Institute for Health and Clinical Excellence (NICE)-defined CFS/ME (N=218) will be randomly allocated to specialist medical care (SMC) or SMC plus GES while on a waiting list for therapist-delivered rehabilitation. GES will consist of a structured booklet describing a 6-step graded exercise program, supported by up to 4 face-to-face/telephone/Skype™ consultations with a GES-trained physiotherapist (no more than 90 minutes in total) over 8 weeks. The primary outcomes at 12-weeks after randomization will be physical function (SF-36 physical functioning subscale) and fatigue (Chalder Fatigue Questionnaire). Secondary outcomes will include healthcare costs, adverse outcomes, and self-rated global impression change scores. We will follow up all participants until 1 year after randomization. We will also undertake qualitative interviews of a sample of participants who received GES, looking at perceptions and experiences of those who improved and worsened. Results: The project was funded in 2011 and enrolment was completed in December 2014, with follow-up completed in March 2016. Data analysis is currently underway and the first results are expected to be submitted soon. Conclusions: This study will indicate whether adding GES to SMC will benefit patients who often spend many months waiting for rehabilitative therapy with little or no improvement being made during that time. The study will indicate whether this type of guided self-management is cost-effective and safe. If this trial shows GES to be acceptable, safe, and comparatively effective, the GES booklet could be made available on the Internet as a practitioner and therapist resource for clinics to recommend, with the caveat that patients also be supported with guidance from a trained physiotherapist. The pragmatic approach in this trial means that GES findings will be generalizable to usual National Health Service (NHS) practice

Accounting for test reliability in student progression: the reliable change index

Context Developed by Jacobson and Truax, the reliable change index (RCI) provides a measure of whether the change in an individual's score over time is within or beyond that which might be accounted for by measurement variability. In combination with measures of whether an individual's final score is closer to those of one population or another, this provides useful individual-level information that can be used to supplement traditional analyses. Objectives This article aims to highlight the potential of the RCI for use within medical education, particularly as a novel means of monitoring progress at the student level across successive test occasions or academic years. Methods We provide an example of how the RCI can be applied informatively to assessment evaluation, and discuss its wider usage. Conclusions The RCI approach can be used to identify and support failing students, as well as to determine best teaching and learning practices by identifying high-performing students. Furthermore, the individual-level nature of the RCI makes it well suited for educational research with small cohorts, as well as for tracking individual profiles within a larger cohort or addressing questions about individual performance that may be unanswerable at group level

Sviluppo di modelli innovativi per il monitoraggio multiscala degli indicatori di servizi ecosistemici nelle foreste Mediterranee (Progetto MIMOSE).

Gli ecosistemi, attraverso le loro funzioni, forniscono un ampio range di beni e servizi, che risultano fondamentali per il benessere dell’uomo. Questi vengono complessivamente definiti Servizi Ecosistemici (SE). I SE possono essere intesi come un flusso di valori verso la società, quale risultato dello stato e della quantità del capitale naturale disponibile. Il mantenimento degli stocks del capitale naturale può permettere di prevedere i flussi futuri dei SE, assicurando quindi il benessere dell’uomo per le generazioni future. Il progetto FIRB 2012 MIMOSE è finalizzato allo sviluppo di un approccio multiscala innovativo e all’implementazione di strumenti previsionali volti al monitoraggio dei SE in habitat forestali Mediterranei. Un set di indicatori viene considerato per stimare i SE forniti dalle foreste, sviluppando strumenti integrati per il loro monitoraggio multiscala. Le attività di ricerca vertono allo sviluppo di un metodo statistico innovativo per la stima spaziale degli indicatori di SE, sulla base di dati disponibili a diversi livelli di scala spaziale. Sono realizzate mappe wall-to-wall per la fornitura dei SE, derivate da diversi domini spaziali, dal livello di scala locale sino ad aree forestali di grande estensione. I dati sugli indicatori dei SE sono forniti nel contesto di attività di campionamento già stabilite (raccolta dati a livello di aree di saggio e di popolamento), per poi applicare tecniche di spazializzazione per aggregare i dati raccolti su scala locale a livelli di scala più ampia (paesaggio, scala regionale); l’approccio utilizzato viene valutato attraverso l’applicazione di strumenti di monitoraggio in un set di aree test. Si procede quindi alla valutazione dei cambiamenti spazio-temporali nella previsione dei SE, considerando indicatori sensibili alla gestione forestale, ovvero capaci di evidenziare cambiamenti nella previsione di fornitura di beni e servizi ad opera dei sistemi forestali, in relazione a differenti scenari gestionali, con l’obiettivo di fornire indicazioni ai gestori forestali ed alle comunità locali per l’applicazione di pratiche di gestione che possano mantenere o incrementare la fornitura dei SE in un preciso contesto territoriale. Questo progetto permette di realizzare un’attenta analisi dei gaps esistenti negli attuali schemi di inventariazione in relazione alla fornitura dei SE, con l’obiettivo di dare indicazioni utili all’implementazione ed integrazione degli stessi mediante individuazione di nuovi indicatori, nell’ottica di una gestione forestale sostenibile. Le attività di ricerca in corso possono concretamente contribuire all’incorporazione dei SE nei processi decisionali connessi alla gestione dei paesaggi forestali, fornendo un’opportunità per comprendere la congruenza tra i diversi SE negli ambienti forestali

Predictive score using clinical and blood biomarkers in advanced non-small cell lung cancer (aNSCLC) patients treated with immunotherapy

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Recovery practice in community mental health teams: national survey

Background There is consensus about the importance of ‘recovery’ in mental health services, but the link between recovery orientation of mental health teams and personal recovery of individuals has been underresearched. Aims To investigate differences in team leader, clinician and service user perspectives of recovery orientation of community adult mental health teams in England. Method In six English mental health National Health Service (NHS) trusts, randomly chosen community adult mental health teams were surveyed. A random sample of ten patients, one team leader and a convenience sample of five clinicians were surveyed from each team. All respondents rated the recovery orientation of their team using parallel versions of the Recovery Self Assessment (RSA). In addition, service users also rated their own personal recovery using the Questionnaire about Processes of Recovery (QPR). Results Team leaders (n = 22) rated recovery orientation higher than clinicians (n = 109) or patients (n = 120) (Wald(2) = 7.0, P = 0.03), and both NHS trust and team type influenced RSA ratings. Patient-rated recovery orientation was a predictor of personal recovery (b = 0.58, 95% CI 0.31–0.85, P50.001). Team leaders and clinicians with experience of mental illness (39%) or supporting a family member or friend with mental illness (76%) did not differ in their RSA ratings from other team leaders or clinicians. Conclusions Compared with team leaders, frontline clinicians and service users have less positive views on recovery orientation. Increasing recovery orientation may support personal recovery

Efficacy of Electronic Cigarettes vs Varenicline and Nicotine Chewing Gum as an Aid to Stop Smoking: A Randomized Clinical Trial.

IMPORTANCE: Electronic cigarettes (ECs) are often used by smokers as an aid to stopping smoking, but evidence is limited regarding their efficacy compared with nicotine replacement therapy (NRT), and no evidence is available on how their efficacy compares with that of varenicline. OBJECTIVE: To evaluate whether ECs are superior to NRT and noninferior to varenicline in helping smokers quit. DESIGN, SETTING, AND PARTICIPANTS: This was a randomized clinical trial conducted at 7 sites in China and including participants who were smoking at least 10 cigarettes per day and motivated to quit, not using stop-smoking medications or EC, and willing to use any of the study products. Participants were first recruited in May 2021, and data analysis was conducted in December 2022. INTERVENTIONS: A cartridge-based EC (30 mg/mL nicotine salt for 2 weeks and 50 mg/mL after that), varenicline (0.5 mg, once a day for 3 days; 0.5 mg, twice a day for 4 days; and 1 mg, twice a day, after that), and 2 mg (for smokers of ≤20 cigarettes per day) or 4 mg (>20 cigarettes per day) nicotine chewing gum, all provided for 12 weeks and accompanied by minimal behavioral support (an invitation to join a self-help internet forum). MAIN OUTCOMES AND MEASURES: The primary outcome was sustained abstinence from smoking at 6 months as validated by an expired-air carbon monoxide reading (<8 parts per million). Participants lost to follow-up were included as nonabstainers. RESULTS: Of 1068 participants, 357 (33.5%) were female, and the mean (SD) age was 33.9 (3.1) years. A total of 409 (38.3%), 409 (38.3%), and 250 (23.4%) participants were randomized to the EC, varenicline, and NRT arms, respectively. The 6-month biochemically validated abstinence rates were 15.7% (n = 64), 14.2% (n = 58), and 8.8% (n = 22) in the EC, varenicline, and NRT study arms, respectively. The quit rate in the EC arm was noninferior to the varenicline arm (absolute risk reduction, 1.47%; 95% CI, -1.41% to 4.34%) and higher than in the NRT arm (odds ratio, 1.92; 95% CI, 1.15-3.21). Treatment adherence was similar in all study arms during the initial 3 months, but 257 participants (62.8%) in the EC arm were still using ECs at 6 months, with no further use in the 2 other study arms. The most common adverse reactions were throat irritation (32 [7.8%]) and mouth irritation (28 [6.9%]) in the EC arm, nausea (36 [8.8%]) in the varenicline arm, and throat irritation (20 [8.0%]) and mouth irritation (22 [8.8%]) in the NRT arm. No serious adverse events were recorded. CONCLUSIONS AND RELEVANCE: The results of this randomized clinical trial found that when all treatments were provided with minimal behavior support, the efficacy of EC was noninferior to varenicline and superior to nicotine chewing gum. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2100048156

Peripheral blood biomarkers as prognostic factors for immunotherapy in advanced non-small cell lung cancer (aNSCLC) patients

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Design of smart garments for sports and rehabilitation

Physical exercise has proved benefits for general health [1] and can reduce the number of sports injuries to one third [2]. However, an athlete that has been injured during sports practice may omit this out of fear of discrimination, and worsen the injury in the weight room, during strength training [5]. Monitoring physiological status of an athlete or rehabilitation patients during training may thus help the person to get an earlier intervention, preventing injuries from getting worse. With this in mind, we propose a set of compression garments – shirt and leggings – with textile sensors to continually monitor heart and muscle activity, breathing rate and temperature. This paper reports the design of the garments and production of the shirt, which comprised a 3-lead ECG system, sEMG (Surface Electromiography) electrodes and a breathing sensor. The ECG (Electrocardiography) system was tested and presented some good results, in particular for very even movements, but the system still needs to be improved, in order to get a better signal, when it comes to movements with a considerable amplitude.This work is financed by Project “Deus ex Machina”, NORTE-01-0145-FEDER-000026, funded by CCDRN, through Sistema de Apoio à Investigação Cientifica e Tecnológica (Projetos Estruturados I&D&I) of Programa Operacional Regional do Norte, from Portugal 2020 and by FEDER funds through the Competitivity Factors Operational Programme - COMPETE and by national funds through FCT – Foundation for Science and Technology within the scope of the project POCI-01-0145-FEDER-007136.info:eu-repo/semantics/publishedVersio