Insights Into Breast Cancer Screening: A Computer Simulation of Two Contemporary Screening Strategies.
Female; Humans; *Computer Simulation; *Practice Guidelines as Topic; American Cancer Society; Biopsy/economics/statistics & numerical data; breast cancer; Breast Neoplasms/*diagnostic imaging; Cost-Benefit Analysis; cost-effectiveness acceptability curves; Early Detection of Cancer/economics/methods; False Positive Reactions; mammography screening; Mammography/economics/*statistics & numerical data; Mass Screening/*methods; Medical Overuse/economics; mixed interval screening; Monte Carlo method; Monte Carlo Method; Unnecessary Procedures/economics
OBJECTIVE: The debate over the value of screening mammography is rekindled with each new published study or guideline. Central to the discussion are the uncertainties about screening benefits and harms and the criteria used to assess them. Today, the magnitude of benefits for a population is less certain, and the evolving concept of harm has come to encompass false-positives (FPs), unnecessary biopsies, overdiagnosis, and overtreatment. This study uses a Monte Carlo computer simulation to study the balance of benefits and harms of mammographic breast cancer screening for average-risk women. MATERIALS AND METHODS: This investigation compares the American Cancer Society's 2015 mixed annual-biennial guideline with the U.S. Preventive Services Task Force's 2016 fixed biennial guideline. Screening strategies are compared using cost-effectiveness acceptability curves, an economic analysis describing uncertainty in evaluating costs and health outcomes. Strategy preference is examined under changing assumptions of willingness to pay for a quality-adjusted life-year. Additionally, comparative effectiveness analysis is performed using FP screens and unnecessary biopsies per life-year gained. Alternative scenarios are compared assuming a reduced mortality benefit of screening. RESULTS: In general, results using both cost-effectiveness and clinical measures indicate that American Cancer Society's 2015 mixed annual-biennial guideline is preferred. Assuming decreases in the mortality benefit of mammography, no screening may be reasonable. CONCLUSION: The use of a mixed annual-biennial strategy for population screening takes advantage of the nonuniformity of occurrence of mammography benefits and harms over the duration of screening. This approach represents a step toward improving guidelines by exploiting age dependencies at which benefits and harms accrue.
Carter Kimbroe J; Castro Frank; Morcos Roy N
AJR. American journal of roentgenology
2018
2018-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2214/AJR.17.18484" target="_blank" rel="noreferrer noopener">10.2214/AJR.17.18484</a>
Development of a Nutrition Screening Tool for an Outpatient Wound Center.
*Nutrition Assessment; Adult; Ambulatory Care Facilities; Ambulatory Care/*methods; Bivariate Statistics; Convenience Sample; Descriptive Statistics; Human; Humans; Logistic Regression; Malnutrition – Risk Factors; Malnutrition/*diagnosis/etiology; Mass Screening/*methods; Nutrition; Nutritional Status; Ohio; Outcome Assessment (Health Care); Outpatients/*statistics & numerical data; Pilot Projects; Pilot Studies; Prospective Studies; Reliability and Validity; Wound Care; Wounds and Injuries/complications
OBJECTIVE: To construct a quickly and easily administered nutrition screening tool using variables believed to be predictive of malnutrition risk in the wound patient population. DESIGN: A prospective pilot study assessed patients on a list of suspected variables, as well as the Scored Patient-Generated Subjective Global Assessment (PG-SGA), chosen as the criterion standard. Variables were analyzed to select the most appropriate items for inclusion on a new nutrition screening tool using preliminary bivariate correlations and chi tests of association. Items significantly associated with malnutrition were dichotomized, and binary logistic regression analyses were performed to arrive at a final model. A sum score was computed, and receiver operating characteristic analysis was used to determine designation of risk. SETTING: An outpatient wound center in Northeast Ohio. PARTICIPANTS: The pilot study included a convenience sample of 105 outpatients with at least 1 active wound. MAIN OUTCOME MEASURES: Malnutrition as assessed by the Scored PG-SGA. MAIN RESULTS: The final nutrition screening tool, the MEAL Scale, is composed of 4 dichotomous elements: multiple wounds (number of wounds), eats less than 3 meals per day, appetite decrease (eats less than usual), and level of activity. These variables predicted 83.7% of the malnutrition cases assessed by the Scored PG-SGA. The receiver operating characteristic analysis showed an acceptable area under the curve (0.8581), and a cutoff score of 2 or greater was selected to indicate risk (median sensitivity = 91.4%, median specificity = 60.9%). CONCLUSIONS: Although further studies of validity and reliability are necessary to establish the tool before widespread use, the MEAL Scale is a needed step toward nutrition screening in a wound patient population.
Fulton Judith; Evans Brad; Miller Stephannie; Blasiole Kimberly N; Leone Raymond; Beinlich Nancy; Meehan Anita; Loose Claire
Advances in Skin & Wound Care
2016
2016-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/01.ASW.0000479803.09658.cb" target="_blank" rel="noreferrer noopener">10.1097/01.ASW.0000479803.09658.cb</a>