CT screening: a trade-off of risks, benefits, and costs.
Ontology highlight
ABSTRACT:
SUBMITTER: Hunink MG
PROVIDER: S-EPMC156117 | biostudies-literature | 2003 Jun
REPOSITORIES: biostudies-literature
Publications
CT screening: a trade-off of risks, benefits, and costs.
Hunink M G Myriam MG Gazelle G Scott GS
The Journal of clinical investigation 20030601 11
Similar Datasets
Project description:Few studies have examined the risk of computed tomography angiography (CTA) during the acute phase of spontaneous intracerebral hemorrhage (ICH), while the benefits of CTA in ICH have been well-documented. The present study investigated both the benefits of identifying spot signs, which are supposed to indicate hematoma enlargement after admission, and risks of CTA performed during the acute phase of ICH.We retrospectively assessed 323 consecutive patients with spontaneous ICHs admitted to our hospital between April 2009 and March 2012 and who underwent CTA on admission.In 80 patients (24.7 %), spot signs were demonstrated on CTA source images. Multivariate analysis revealed two independent factors correlated with presence of the spot sign: age and hematoma volume (p?<?0.05 each). The presence of spot sign was associated with unfavorable outcomes at discharge and hematoma growth after admission (p?<?0.05 each). Adverse events related to CTA occurred in 17 patients (5.2 %), including transient renal dysfunction in 16 patients and allergy to contrast medium in one patient. All adverse events completely resolved within 1 week.Presence of the spot sign indicated the possibility of hematoma growth and unfavorable outcomes. A small number of adverse events occurred in association with CTA, but without any permanent deficits. Given the potential benefits and risks, we believe that CTA performed at admission in all patients with ICH is beneficial to improve the outcomes.
| S-EPMC3988523 | biostudies-other
Project description:The presence of, and interactions with tourists can be both risky and beneficial for wild animals. In wildlife tourism settings, animals often experience elevated rates of aggression from conspecifics, and they may also be threatened or physically aggressed by the tourists themselves. However, tourist provisioning of wild animals provides them with highly desirable foods. In situations of conflicting motivations such as this, animals would be expected to respond using behavioural coping mechanisms. In the present study, we investigated how animals respond to tourist pressure, using wild adult Barbary macaques in the Middle Atlas Mountains, Morocco, as a case study. We found evidence that these animals use a range of different behavioural coping mechanisms-physical avoidance, social support, affiliative, aggressive and displacement behaviours-to cope with the stress associated with tourists. The pattern of use of such behaviours appears to depend on a trade-off between perceived risks and potential benefits. We propose a framework to describe how animals respond to conflicting motivational situations, such as the presence of tourists, that present simultaneously risks and benefits.
| S-EPMC5032226 | biostudies-literature
Project description:Identifying strategies to maintain seafood supply is central to global food supply. China is the world's largest producer of seafood and has used a variety of production methods in the ocean including domestic capture fisheries, aquaculture (both freshwater and marine), stock enhancement, artificial reef building, and distant water fisheries. Here we survey the outcomes of China's marine seafood production strategies, with particular attention paid to the associated costs, benefits, and risks. Benefits identified include high production, low management costs, and high employment, but significant costs and risks were also identified. For example, a majority of fish in China's catches are one year-old, ecosystem and catch composition has changed relative to the past, wild and farmed stocks can interact both negatively and positively, distant water fisheries are a potential source of conflict, and disease has caused crashes in mariculture farms. Reforming China's wild capture fisheries management toward strategies used by developed nations would continue to shift the burden of production to aquaculture and could have negative social impacts due to differences in fishing fleet size and behavior, ecosystem structure, and markets. Consequently, China may need to develop novel management methods in reform efforts, rather than rely on examples from other large seafood producing countries. Improved accounting of production from fisheries and aquaculture, harmonization and centralization of historical data sets and systematic scientific surveys would improve the knowledge base for planning and evaluating future reform.
| S-EPMC6968841 | biostudies-literature
Project description:BackgroundNewborn genetic screening (NBGS) based on next-generation sequencing offers enhanced disease detection and better detection rates than traditional newborn screening. However, challenges remain, especially around reporting the NBGS carrier results. Therefore, we aimed to investigate the NBGS carrier parents' views on NBGS and NBGS reports in China.MethodsWe distributed a survey querying demographic information, knowledge and perceptions of NBGS, the impact of NBGS on a total of 2930 parents, and their decision-making to parents of newborns reported as carriers in NBGS in Nanjing, China in 2022.ResultsThe average age of the survey respondents was 30.7 years (standard deviation = 3.6). Most (68.38%) felt informed about NBGS, especially women, the highly educated, and high earners. Nearly all (98.74%) saw NBGS as crucial for early disease detection, with 73.18% believing it positively impacts their future. However, 19.16% felt it might cause anxiety, especially among the less educated. Concerns included potential discrimination due to exposed genetic data and strained family ties. Many suggested NBGS coverage by medical insurance to ease financial burdens.ConclusionsThrough our study, we gained insights into parents' perspectives and concerns regarding the NBGS carrier result reporting, thus providing relevant information for further refinement and clinical promotion of the NBGS project.
| S-EPMC10884785 | biostudies-literature
Project description:ObjectivesCancer screening guidelines differ in their recommendations for or against screening. To be able to provide explicit recommendations, guidelines need to specify thresholds for the magnitude of benefits of screening, given its harms and burdens. We evaluated how current cancer screening guidelines address the relative importance of benefits versus harms and burdens of screening.Data sourceWe searched the Guidelines International Network, International Guideline Library, ECRI Institute and Medline. Two pairs of reviewers independently performed guideline selection and data abstraction.Eligibility criteriaWe included all cancer screening guidelines published in English between January 2014 and April 2019.ResultsOf 68 eligible guidelines, 25 included a statement regarding the trade-off between screening benefits versus harms and burdens (14 guidelines), or a statement of direction of the net effect (defined as benefits minus harms or burdens) (13 guidelines). None of these 25 guidelines defined how large a screening benefit should be to recommend screening, given its harms and burdens. 11 guidelines performed an economic evaluation of screening. Of these, six identified a key benefit outcome; two specified a cost-effectiveness threshold for recommending a screening option. Eight guidelines commented on people's values and preferences regarding the trade-off between benefits versus harms and burdens.ConclusionsCurrent cancer screening guidelines fail to specify the values and preferences underlying their recommendations. No guidelines provide a threshold at which they believe the benefits of screening outweigh its harms and burdens.Prospero registration numberCRD42019138590.
| S-EPMC7713181 | biostudies-literature
Project description:Optimal nest site selection is crucial in animals whose offspring are completely dependent on the shelter of a nest. Parental decisions influencing nest thermal conditions are particularly important because temperature strongly influences juvenile activity, metabolism, growth, developmental rate, survival, and adult body size. In small ectotherms such as bees, maternal decisions to nest in sun-exposed or shady sites can lead to marked differences in thermal microenvironments inside nests. Small carpenter bees (Ceratina calcarata) strongly prefer to nest in sun but also prefer nesting substrates more frequently found in shade, suggesting that nest site selection is based on a trade-off between costs and benefits of warmer versus cooler nest sites. We investigated the consequences of sun and shade nesting for mothers and their offspring using a field experiment in which mothers and newly founded nests were placed in sunny or shady habitats. Maternal costs and benefits in each treatment were quantified by comparing maternal foraging effort, nest size, number of brood provisioned, and number and size of live offspring. These demographic measures allowed us to estimate fitness for mothers nesting in sun versus shade. For juvenile bees from sun and shade nests, we quantified two thermal traits, high-temperature tolerance (CTmax) and metabolic rate. Mothers in sun nests had significantly higher nesting success, with 59% of all nests producing brood, while mothers in shade nests experienced only 32% success. Successful sun nests actually contained fewer live brood (5.2 ± 3.0, mean ± SD) than shade nests (6.9 ± 3.3), but their higher success rates meant that maternal fitness was higher in sun than in shade. However, sun nesting entailed clear costs to brood, which were significantly smaller, less likely to survive to adulthood, and had significantly elevated CTmax, suggesting that thermal stress during development necessitated them to shunt resources from growth to thermoprotection. The maternal preferences for sun nesting optimize maternal fitness despite the evident costs to juveniles developing in sun-exposed nests.
| S-EPMC11755220 | biostudies-literature
Project description:BackgroundStrategies for screening and intervening to reduce the risk of cardiovascular disease (CVD) in primary care settings need to be assessed in terms of both their costs and long-term health effects. We undertook a literature review to investigate the methodologies used.MethodsIn a framework of developing a new health-economic model for evaluating different screening strategies for primary prevention of CVD in Europe (EPIC-CVD project), we identified seven key modeling issues and reviewed papers published between 2000 and 2013 to assess how they were addressed.ResultsWe found 13 relevant health-economic modeling studies of screening to prevent CVD in primary care. The models varied in their degree of complexity, with between two and 33 health states. Programmes that screen the whole population by a fixed cut-off (e.g., predicted 10-year CVD risk >20 %) identify predominantly elderly people, who may not be those most likely to benefit from long-term treatment. Uncertainty and model validation were generally poorly addressed. Few studies considered the disutility of taking drugs in otherwise healthy individuals or the budget impact of the programme.ConclusionsModel validation, incorporation of parameter uncertainty, and sensitivity analyses for assumptions made are all important components of model building and reporting, and deserve more attention. Complex models may not necessarily give more accurate predictions. Availability of a large enough source dataset to reliably estimate all relevant input parameters is crucial for achieving credible results. Decision criteria should consider budget impact and the medicalization of the population as well as cost-effectiveness thresholds.
| S-EPMC5047941 | biostudies-literature
Project description:Recent dramatic reductions in the timeframe in which genomic sequencing can deliver results means its application in time-sensitive screening programs such as newborn screening (NBS) is becoming a reality. As genomic NBS (gNBS) programs are developed around the world, there is an increasing need to address the ethical and social issues that such initiatives raise. This study therefore aimed to explore the Australian public's perspectives and values regarding key gNBS characteristics and preferences for service delivery. We recruited English-speaking members of the Australian public over 18 years of age via social media; 75 people aged 23-72 participated in 1 of 15 focus groups. Participants were generally supportive of introducing genomic sequencing into newborn screening, with several stating that the adoption of such revolutionary and beneficial technology was a moral obligation. Participants consistently highlighted receiving an early diagnosis as the leading benefit, which was frequently linked to the potential for early treatment and intervention, or access to other forms of assistance, such as peer support. Informing parents about the test during pregnancy was considered important. This study provides insights into the Australian public's views and preferences to inform the delivery of a gNBS program in the Australian context.
| S-EPMC10801595 | biostudies-literature
Project description:ContextLung cancer is the leading cause of cancer death. Most patients are diagnosed with advanced disease, resulting in a very low 5-year survival. Screening may reduce the risk of death from lung cancer.ObjectiveTo conduct a systematic review of the evidence regarding the benefits and harms of lung cancer screening using low-dose computed tomography (LDCT). A multisociety collaborative initiative (involving the American Cancer Society, American College of Chest Physicians, American Society of Clinical Oncology, and National Comprehensive Cancer Network) was undertaken to create the foundation for development of an evidence-based clinical guideline.Data sourcesMEDLINE (Ovid: January 1996 to April 2012), EMBASE (Ovid: January 1996 to April 2012), and the Cochrane Library (April 2012).Study selectionOf 591 citations identified and reviewed, 8 randomized trials and 13 cohort studies of LDCT screening met criteria for inclusion. Primary outcomes were lung cancer mortality and all-cause mortality, and secondary outcomes included nodule detection, invasive procedures, follow-up tests, and smoking cessation.Data extractionCritical appraisal using predefined criteria was conducted on individual studies and the overall body of evidence. Differences in data extracted by reviewers were adjudicated by consensus.ResultsThree randomized studies provided evidence on the effect of LDCT screening on lung cancer mortality, of which the National Lung Screening Trial was the most informative, demonstrating that among 53,454 participants enrolled, screening resulted in significantly fewer lung cancer deaths (356 vs 443 deaths; lung cancer−specific mortality, 274 vs 309 events per 100,000 person-years for LDCT and control groups, respectively; relative risk, 0.80; 95% CI, 0.73-0.93; absolute risk reduction, 0.33%; P = .004). The other 2 smaller studies showed no such benefit. In terms of potential harms of LDCT screening, across all trials and cohorts, approximately 20% of individuals in each round of screening had positive results requiring some degree of follow-up, while approximately 1% had lung cancer. There was marked heterogeneity in this finding and in the frequency of follow-up investigations, biopsies, and percentage of surgical procedures performed in patients with benign lesions. Major complications in those with benign conditions were rare.ConclusionLow-dose computed tomography screening may benefit individuals at an increased risk for lung cancer, but uncertainty exists about the potential harms of screening and the generalizability of results.
| S-EPMC3709596 | biostudies-literature
Project description:Low-dose CT screening for lung cancer provides images of the entire chest and upper abdomen. While the focus of screening is on finding early lung cancer, radiology leadership has embraced the fact that the information contained in the images presents a new challenge to the radiology profession. Other findings in the chest and upper abdomen were not the reason for obtaining the screening CT scan, nor symptom-prompted, but still need to be reported. Reporting these findings and making recommendations for further workup requires careful consideration to avoid unnecessary workup or interventions while still maximizing the benefit that early identification of these other diseases provided. Other potential findings, such as cardiovascular disease and chronic pulmonary obstructive diseases actually cause more deaths than lung cancer. Existing recommendations for workup of abnormal CT findings are based on symptom-prompted indications for imaging. These recommendations may be different when the abnormalities are identified in asymptomatic people undergoing CT screening for lung cancer. I-ELCAP, a large prospectively collected multi-institutional and multi-national database of screenings, was used to analyze CT findings identified in screening for lung cancer. These analyses and recommendations were made by radiologists in collaboration with clinicians in different medical specialties.
| S-EPMC7947380 | biostudies-literature