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Milda R Saunders, Haena Lee, Marshall H Chin
BACKGROUND: We examined the association of dialysis facility characteristics with payment reductions and change in clinical performance measures during the first year of the United States Centers for Medicare & Medicaid Services (CMS) End Stage Renal Disease Quality Incentive Plan (ESRD QIP) to determine its potential impact on quality and disparities in dialysis care. METHODS: We linked the 2012 ESRD QIP Facility Performance File to the 2007-2011 American Community Survey by zip code and dichotomized the QIP total performance scores-derived from percent of patients with urea reduction rate > 65, hemoglobin < 10 g/dL, and hemoglobin > 12 g/dL-as 'any' versus 'no' payment reduction...
December 8, 2017: BMC Health Services Research
Kathrin Alber, Thomas Kuehlein, Angela Schedlbauer, Susann Schaffer
BACKGROUND: Medical overuse is a topic of growing interest in health care systems and especially in primary care. It comprises both over investigation and overtreatment. Quaternary prevention strategies aim at protecting patients from unnecessary or harmful medicine. The objective of this study was to gain a deeper understanding of relevant aspects of medical overuse in primary care from the perspective of German general practitioners (GPs). We focused on the scope, consequences and drivers of medical overuse and strategies to reduce it (=quaternary prevention)...
December 8, 2017: BMC Family Practice
Madeleine Macdonald, John H F Smith, John A Tidy, Julia E Palmer
There is no doubt that organised cervical screening programmes have significantly reduced the rates of cervical cancer by detection and treatment of high-grade cervical intraepithelial neoplasia (CIN2, CIN3). National UK guidelines do not differentiate between CIN2 and CIN3 as separate entities and recommend treatment for both, although a degree of uncertainty exists regarding the natural history of CIN2. This national survey of British Society for Colposcopy and Cervical Pathology members aimed to assess attitudes towards conservative management (CM) of CIN2 in the UK and identify potential selection criteria...
December 6, 2017: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Grégoire Arnoux, Marc Pusztaszeri
"Noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) is a recent reclassification of the encapsulated follicular variant of papillary thyroid carcinoma, which is supposed to reflect its indolent clinical behavior and to prevent overtreatment of patients with this neoplasm. The diagnosis of NIFTP can only be made histologically on the surgical specimen according to specific inclusion and exclusion criteria, which requires the examination of the whole nodule and its capsule. Spindle cell proliferations, especially of follicular cell origin, arising within thyroid follicular neoplasms are very rare and may cause diagnostic difficulties...
December 1, 2017: International Journal of Surgical Pathology
F Nahar, M A Hossain, S K Paul, M U Ahmed, S Khatun, N Akhter, G R Bhuiyan, S A Nasreen, S Roy, T K Barman, N Laskar, H Begum, S Abedin, N Haque, S Ahmed, N Kobayashi
Cervical cancer is a major world health problem for women. It is the fourth most leading cause of death in women around the world. High risk HPV DNA has been shown to be present in 99.7% of cervical cancers worldwide. Oncoprotein E6 and E7 play an important role in the development of cervical cancer which can be detected by OncoE6 cervical test. This Cross sectional observational study was performed to detect E6 Oncoprotein from cervical swab by OncoE6 cervical test. Following universal safety precautions a total of 47 endocervical swabs were collected from Colposcopy clinic of Obstetrics and Gynaecology department of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2015 to December 2015...
October 2017: Mymensingh Medical Journal: MMJ
Bin Xu, Nada Farhat, Justine A Barletta, Yin P Hung, Dario de Biase, Gian Piero Casadei, Ayse Mine Onenerk, R Michael Tuttle, Benjamin R Roman, Nora Katabi, Vania Nosé, Peter Sadow, Giovanni Tallini, William C Faquin, Ronald Ghossein
OBJECTIVE: In 2016, non-invasive, well-circumscribed and encapsulated, follicular variant of papillary thyroid carcinoma (NI-EFV PTC) was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in order to reduce overtreatment of this indolent tumor. However, the study cohort did not include subcentimeter tumors, i.e., papillary thyroid microcarcinoma (mPTC) with NI-EFV morphology, and such lesions are still regarded and staged by most pathologists as microcarcinomas...
December 4, 2017: Endocrine
Francesco Pisani, Elena Pavlidis
The role of EEG in neonatal seizure detection is well-established, being the multichannel video-EEG the gold standard. However, in the clinical practice often amplitude integrated EEG (aEEG) is used, in order to overcome the difficulties related to EEG use. Areas covered: An overview regarding neonatal seizures, current tools used to detect these (multichannel EEG versus aEEG) with respective strenghts and limitations, and some tools that can implement the use of multichannel EEG in the NICU. Expert commentary: Multichannel video-EEG is still a gold standard for seizure detection...
December 4, 2017: Expert Review of Neurotherapeutics
Ian Amber, Suyash Mohan
Acetabular labral tears represent a common finding on magnetic resonance imaging of the hip. Labral tears can arise from a multitude of underlying pathological processes or they may be an asymptomatic incidental finding. The prevalence of labral tears and their lack of specificity make this an area vulnerable to potential overdiagnosis. The overdiagnosis of labral tears leads to overtreatment by exposing patients to unnecessary surgeries as well as complications ranging from unsatisfying outcomes to deep venous thrombosis...
November 30, 2017: Academic Radiology
Benjamin Djulbegovic, Shira Elqayam, William Dale
In spite of substantial spending and resource utilization, today's health care remains characterized by poor outcomes, largely due to overuse (overtesting/overtreatment) or underuse (undertesting/undertreatment) of health services. To a significant extent, this is a consequence of low-quality decision making that appears to violate various rationality criteria. Such suboptimal decision making is considered a leading cause of death and is responsible for more than 80% of health expenses. In this paper, we address the issue of overuse or underuse of health care interventions from the perspective of rational choice theory...
December 1, 2017: Journal of Evaluation in Clinical Practice
E Hart Huberta, E Rutten Guy, N Bontje Kyra, C Vos Rimke
There are indications of overtreatment in older type 2 diabetes patients in both the US and Europe. We assessed the level of personalized diabetes treatment for older patients in primary care, focusing on overtreatment. Based on Dutch guidelines individuals ≥ 70 years were classified into three HbA1c treatment target groups: 7% (53 mmol/mol), 7.5% (58 mmol/mol) and 8% (64 mmol/mol). In our cohort of 1.002 patients (n=319 ≥ 70 yrs), the 165 patients with target above 7% had more micro- and macrovascular complications, used more often ≥ 5 medicines and were more often frail compared to those with an HbA1c target ≤ 7%...
November 30, 2017: Diabetes, Obesity & Metabolism
Sigve Andersen, Elin Richardsen, Mehrdad Rakaee, Helena Bertilsson, Roy Bremnes, Magne Børset, Lill-Tove Busund, Tobias Slørdahl
BACKGROUND: Prostate cancer (PC) stratification needs new prognostic tools to reduce overtreatment. Phosphatase of regenerating liver (PRL-3) is a phosphatase found at high levels in several cancer types, where its expression is associated with survival. A recent PC cell line study has shown it to be involved in PC growth and migration. METHODS: We used a monoclonal antibody to evaluate the expression of PRL-3 in PC tissue of patients in an unselected cohort of 535 prostatectomy patients...
2017: PloS One
Kirsten R Carlaw, Henry H Woo
Background: Approaches to prostate cancer (PCa) diagnosis and treatment have evolved significantly over past decades. There has been an increasing focus on minimizing overdiagnosis and overtreatment of clinically insignificant PCa. The objective of this study was to evaluate the changes in the diagnostic approach and initial treatment strategy that has evolved over time in an Australian urological private practice. Materials and methods: Men with newly diagnosed PCa were identified from the private practice electronic and paper medical records from 2005 to 2016 and data was consolidated into six groups of 2-year intervals...
December 2017: Prostate International
Kinan Mokbel, Umar Wazir, Hiba El Hage Chehade, Aisling Manson, Christina Choy, Victoria Moye, Kefah Mokbel
BACKGROUND: Computational algorithms, such as NHS PREDICT, have been developed using cancer registry data to guide decisions regarding adjuvant chemotherapy. They are limited by biases of the underlying data. Recent breakthroughs in molecular biology have aided the development of genomic assays which provide superior clinical information. In this study, we compared the performance in risk stratification of EndoPredict Clinical (EPClin, a composite of clinical data and EndoPredict) and PREDICT in a cohort of patients with breast cancer considered potential candidates for chemotherapy by the clinicians...
December 2017: Anticancer Research
Yngve Nordby, Elin Richardsen, Nora Ness, Tom Donnem, Hiten R H Patel, Lill-Tove Busund, Roy M Bremnes, Sigve Andersen
Due to insufficient prognostic tools, failure to predict aggressive prostate cancer (PC) has left patient selection for radical treatment an unsolved challenge. This has resulted in overtreatment with radical therapy. Better prognostic tools are urgently warranted. MicroRNAs (miRs) have emerged as important regulators of cellular pathways, resulting in altered gene expressions. miR-205 has previously been observed downregulated in PC, acting as tumor suppressor. Herein, the expression of miR-205 in prostate tissue was examined in a large, well-described cohort of 535 Norwegian prostatectomy patients...
November 24, 2017: Scientific Reports
Nathan Perlis, Thamir Al-Kasab, Ardalan Ahmad, Estee Goldberg, Kamel Fadak, Rashid Sayid, Antonio Finelli, Girish Kulkarni, Rob Hamilton, Alexandre Zlotta, Sangeet Ghai, Neil Fleshner
PURPOSE: Prostate Cancer (PCa) overdiagnosis and overtreatment is a concern for clinicians and policy makers. Multiparametric MRI (mpMRI) and the PCA3 urine test select for clinically significant cases. We explore how well the tests perform in combination for men with previous biopsies. MATERIALS AND METHODS: We collected clinicopathologic data from all patients with a PCA3 test from 2011 to June 2016 in accordance with ethics committee approval. This included patients on active surveillance (AS) for low-risk PCa and those without PCa with previous negative biopsies and suspicion of occult disease...
November 23, 2017: Journal of Urology
João Lobo, Ângelo Rodrigues, Luís Antunes, Inês Graça, João Ramalho-Carvalho, Filipa Quintela Vieira, Ana Teresa Martins, Jorge Oliveira, Carmen Jerónimo, Rui Henrique
INTRODUCTION: Overtreatment is a major concern in patients with prostate cancer (PCa). Prognostic biomarkers discriminating indolent from aggressive disease in prostate biopsy are urgently needed. We aimed to evaluate the prognostic value of Ki67, EZH2, LSD1, and SMYD3 immunoexpression in diagnostic biopsies from a cohort of PCa patients with long term follow-up. MATERIALS AND METHODS: A series of 189 consecutive prostate biopsies diagnosed with PCa (1997-2001) in a cancer center was included in the study, with follow-up last updated in November 2016...
November 22, 2017: Urologic Oncology
Jathin Bandari, Omar M Ayyash, Sherry L Emery, Charles B Wessel, Benjamin J Davies
CONTEXT: Testosterone replacement therapy (TRT) is currently approved by the Food and Drug Administration only for classic hypogonadism, although off-label indications have resulted in a dramatic expansion in prescriptions in the USA. Marketing may significantly affect prescriber behavior. OBJECTIVE: To systematically review all available evidence on marketing and TRT in the USA. EVIDENCE ACQUISITION: PubMed, Embase, and Scopus were searched up to July 2017 for all relevant publications reporting on assessments of the TRT market size, economic costs associated with hypogonadism, trends in TRT prescriptions, drug discontinuation rates, and advertising and sales efforts in the USA...
November 22, 2017: European Urology Focus
M G Wallis
Overdiagnosis is the inevitable flip side of early detection resulting in unnecessary labelling of well women with a diagnosis of cancer and possible unnecessary treatment. Overdiagnosis occurs because breast cancers have different rates of growth and slow-growing cancers are preferentially detected by screening. Some of these slow-growing screen-detected cancers may never have been clinically apparent during an individual's lifetime. Evaluating the benefits and risks of screening are complex, but this has been performed for the UK population by an independent review led by Professor Marmot...
November 22, 2017: Clinical Radiology
Noor Janjua, Volkert B Wreesmann
Differentiated thyroid cancer is characteristically associated with an innocuous clinical course, but a minority of cases may manifest surprisingly aggressive behaviour. Such aggressive DTC are directly responsible for the majority of thyroid cancer related deaths. Moreover, they contribute indirectly to increased DTC-related morbidity, because our inability to differentiate these tumours from innocuous DTC at an early stagefuels a significant degree of DTC overtreatment around the globe. In the present paper we describe how improved understanding of the clinicopathological thyroid tumour progression model and optimization of clinical staging systems continues to improve our ability to diagnose and treat aggressive DTC...
October 6, 2017: European Journal of Surgical Oncology
Z Požgain, D Kristek, I Lovrić, G Kondža, M Jelavić, J Kocur, M Danilović
INTRODUCTION: A pulmonary contusion is an entity defined as alveolar haemorrhage and pulmonary parenchymal destruction after blunt chest trauma. According to the literature, most pulmonary contusions can only be seen on a chest CT. The aim of this study was to evaluate the patients with pulmonary contusions, as well as their management, considering diagnostic and therapeutic options related to their outcomes, since we assumed, based on everyday clinical practice, that an 'overdiagnosing' and 'overtreatment' attitude towards this injury could be present...
November 22, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
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