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[PMID]:29309104
[Au] Autor:Bankovic Lazarevic D; Krivokapic Z; Barisic G; Jovanovic V; Ilic D; Veljkovic M
[Ti] Título:Organized colorectal cancer screening in Serbia - the first round within 2013-2014.
[So] Source:Vojnosanit Pregl;73(4):360-7, 2016 Apr.
[Is] ISSN:0042-8450
[Cp] País de publicação:Serbia
[La] Idioma:eng
[Ab] Resumo:Background/Aim: The National Organized Colorectal Cancer Screening Program was conducted in the Republic of Serbia during 2013-2014 covering the population of both genders, aged 50 to 74 years, in 28 municipalities out of 180, with the target population of 651,445 people. This organized colorectal cancer screening aims to reduce mortality from colorectal cancer in the target population. The aim of this study was to show the results of organized screening for colorectal cancer during the first biannual round in Serbia. Methods: General practitioners from the primary health centers, invited target population by letters and by phone to perform immunochemical fecal occult blood test. Persons with a positive test results were referred to the colonoscopy. The database of health insurance and other citizens of the target population was used for invitation for screening in primary health centers. Descriptive statistical analysis of the results in organized colorectal cancer screening in the first round was performed for the key screening indicators. Results: In the first round, a total of 99,592 persons were invited. The participation rate was 62.5%. Colonoscopy was performed in 1,554 persons. Adenomas were found in 586 persons (0.9% of all the tested), e.g. 37.7 % of all colonoscopied. In 129 persons colorectal cancer was diagnosed (0.2% of all the tested), e.g. 8.3% of all the colonoscopied. In the left half of the colon (rectum, sigmoid and descending colon) there were 70.4% diagnosed polyps and 77.3% carcinomas, while 29.6% of polyps and 22.7% carcinomas were found in the proximal parts of the colon. Conclusion: In the first round of the organized colorectal cancer screening in Serbia the participation rate of the targeted population was high and gave encouraging result. It was expected that in the forthcoming rounds even higher coverage of the target population would be accomplished. A positive predictive value of the completed colonoscopies showed that further work on observing the stages of diagnosed adenomas and carcinomas would reach the goals of the expected improvement in early detection of colorectal cancer in Serbia.
[Mh] Termos MeSH primário: Neoplasias Colorretais/diagnóstico
Detecção Precoce de Câncer/métodos
Programas de Rastreamento/métodos
[Mh] Termos MeSH secundário: Adenoma/diagnóstico
Idoso
Carcinoma/diagnóstico
Pólipos do Colo/diagnóstico
Colonoscopia
Seres Humanos
Masculino
Meia-Idade
Sangue Oculto
Sérvia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180109
[St] Status:MEDLINE
[do] DOI:10.2298/VSP150421113B


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[PMID]:29253458
[Au] Autor:Lew JB; St John DJB; Xu XM; Greuter MJE; Caruana M; Cenin DR; He E; Saville M; Grogan P; Coupé VMH; Canfell K
[Ad] Endereço:Cancer Research Division, Cancer Council NSW, NSW, Australia; Prince of Wales Clinical School, University of NSW, NSW, Australia. Electronic address: jiebin.lew@nswcc.org.au.
[Ti] Título:Long-term evaluation of benefits, harms, and cost-effectiveness of the National Bowel Cancer Screening Program in Australia: a modelling study.
[So] Source:Lancet Public Health;2(7):e331-e340, 2017 Jul.
[Is] ISSN:2468-2667
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: No assessment of the National Bowel Screening Program (NBCSP) in Australia, which considers all downstream benefits, costs, and harms, has been done. We aimed to use a comprehensive natural history model and the most recent information about cancer treatment costs to estimate long-term benefits, costs, and harms of the NBCSP (2 yearly immunochemical faecal occult blood testing screening at age 50-74 years) and evaluate the incremental effect of improved screening participation under different scenarios. METHODS: In this modelling study, a microsimulation model, Policy1-Bowel, which simulates the development of colorectal cancer via both the conventional adenoma-carcinoma and serrated pathways was used to simulate the NBCSP in 2006-40, taking into account the gradual rollout of NBCSP in 2006-20. The base-case scenario assumed 40% screening participation (currently observed behaviour) and two alternative scenarios assuming 50% and 60% participation by 2020 were modelled. Aggregate year-by-year screening, diagnosis, treatment and surveillance-related costs, resource utilisation (number of screening tests and colonoscopies), and health outcomes (incident colorectal cancer cases and colorectal cancer deaths) were estimated, as was the cost-effectiveness of the NBCSP. FINDINGS: With current levels of participation (40%), the NBCSP is expected to prevent 92 200 cancer cases and 59 000 deaths over the period 2015-40; an additional 24 300 and 37 300 cases and 16 800 and 24 800 deaths would be prevented if participation was increased to 50% and 60%, respectively. In 2020, an estimated 101 000 programme-related colonoscopies will be done, associated with about 270 adverse events; an additional 32 500 and 49 800 colonoscopies and 88 and 134 adverse events would occur if participation was increased to 50% and 60%, respectively. The overall number needed to screen (NNS) is 647-788 per death prevented, with 52-59 colonoscopies per death prevented. The programme is cost-effective due to the cancer treatment costs averted (cost-effectiveness ratio compared with no screening at current participation, AUS$3014 [95% uncertainty interval 1807-5583] per life-year saved) in the cost-effectiveness analysis. In the budget impact analysis, reduced annual expenditure on colorectal cancer control is expected by 2030, with expenditure reduced by a cumulative AUS$1·7 billion, AUS$2·0 billion, and AUS$2·1 billion (2015 prices) between 2030 and 2040, at participation rates of 40%, 50%, and 60%, respectively. INTERPRETATION: The NBCSP has potential to save 83 800 lives over the period 2015-40 if coverage rates can be increased to 60%. By contrast, the associated harms, although an important consideration, are at a smaller magnitude at the population level. The programme is highly cost-effective and within a decade of full roll-out, there will be reduced annual health systems expenditure on colorectal cancer control due to the impact of screening. FUNDING: Australia Postgraduate Award PhD Scholarship, Translational Cancer Research Network Top-up scholarship (supported by Cancer Institute NSW) and Cancer Council NSW.
[Mh] Termos MeSH primário: Neoplasias Colorretais/diagnóstico
Detecção Precoce de Câncer
[Mh] Termos MeSH secundário: Idoso
Austrália
Neoplasias Colorretais/economia
Análise Custo-Benefício
Detecção Precoce de Câncer/economia
Detecção Precoce de Câncer/estatística & dados numéricos
Fezes/química
Seres Humanos
Meia-Idade
Modelos Teóricos
Sangue Oculto
Avaliação de Programas e Projetos de Saúde
Medição de Risco
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE


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[PMID]:29241854
[Au] Autor:Lieberman D
[Ad] Endereço:Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA.
[Ti] Título:Is it safe to wait 10 years after a negative baseline screening colonoscopy result?
[So] Source:Gastrointest Endosc;87(1):260-261, 2018 01.
[Is] ISSN:1097-6779
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Colonoscopia
Sangue Oculto
[Mh] Termos MeSH secundário: Neoplasias Colorretais
Seres Humanos
Programas de Rastreamento
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE


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[PMID]:28463410
[Au] Autor:Bjerrum A; Andersen O; Fischer A; Lindebjerg J; Lynge E
[Ad] Endereço:Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
[Ti] Título:Long-term risk of colorectal cancer after negative colonoscopy in a Danish gFOBT screening cohort.
[So] Source:Int J Cancer;141(3):503-511, 2017 08 01.
[Is] ISSN:1097-0215
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Faecal occult blood test (FOBT) screening for colorectal cancer (CRC) is implemented in several countries. Approximately half of all screen positive persons have negative colonoscopy, but consensus is lacking on how these persons should be followed up. Health authorities in Denmark and The Netherlands recommend suspending screening for 8-10 years, while patients in UK are invited to screening after 2 years. In this cohort-study, we followed 166,277 individuals invited to FOBT-screening in 2005-2006 and a reference group comprising the remaining 1,240,348 Danes of the same age. We linked Danish population and health service registers to obtain information about colonoscopy outcome and incident CRC. We estimated CRC risk by colonoscopy outcome (adenoma, other colorectal pathology or negative colonoscopy) for the reference group, the screening group, and subgroups. Persons with positive screening FOBT followed by negative colonoscopy had the same long-term CRC risk as persons with adenoma detected due to a positive screening FOBT (aHR 1.33, 95% CI: 0.65-2.71). We found no difference in the long-term CRC risk between persons with negative colonoscopy after a positive FOBT screening test and the unscreened reference population (aHR 1.05, 95% CI: 0.62-1.78). Since FOBT screen positive persons in our study remained at average risk of CRC despite of a negative index colonoscopy, we question the safety of suspending FOBT screening for this group. It needs to be monitored whether recent efforts to improve colonoscopy quality have been successful in ensuring low CRC risk after negative colonoscopy also in FOBT positive persons.
[Mh] Termos MeSH primário: Adenoma/epidemiologia
Colonoscopia/métodos
Neoplasias Colorretais/epidemiologia
Detecção Precoce de Câncer
Sangue Oculto
Guias de Prática Clínica como Assunto/normas
[Mh] Termos MeSH secundário: Adenoma/diagnóstico
Idoso
Estudos de Coortes
Neoplasias Colorretais/diagnóstico
Dinamarca/epidemiologia
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Prognóstico
Medição de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1002/ijc.30756


  5 / 4803 MEDLINE  
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[PMID]:29202544
[Au] Autor:Sun YD; Zhao JL; Zhang P; Wang Q; Li MT
[Ad] Endereço:Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
[Ti] Título:[The 460th case: lower extremity edema, positive fecal occult blood].
[So] Source:Zhonghua Nei Ke Za Zhi;56(12):974-976, 2017 Dec 01.
[Is] ISSN:0578-1426
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:An 61-year-old woman presenting deep vein thrombosis and persistent positive anticardiolipin antibodies was diagnosed as antiphospholipid syndrome and treated with low molecular weight heparin. Before and after anticoagulant therapy, continuous positive fecal occult-blood was found asymptomatically. Colonoscopy confirmed rectal cancer. Antiphospholipid autoantibodies are non-specially positive in some malignances, especially in elder onset patients. Thus, routine screening of malignancies is strongly suggested.
[Mh] Termos MeSH primário: Anticorpos Antifosfolipídeos/sangue
Anticoagulantes/uso terapêutico
Síndrome Antifosfolipídica/tratamento farmacológico
Heparina de Baixo Peso Molecular/uso terapêutico
Extremidade Inferior/fisiopatologia
Sangue Oculto
Trombose Venosa/fisiopatologia
[Mh] Termos MeSH secundário: Anticorpos Anticardiolipina/sangue
Anticoagulantes/administração & dosagem
Síndrome Antifosfolipídica/diagnóstico
Edema/etiologia
Feminino
Heparina de Baixo Peso Molecular/administração & dosagem
Seres Humanos
Meia-Idade
Neoplasias Retais
Trombose Venosa/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Anticardiolipin); 0 (Antibodies, Antiphospholipid); 0 (Anticoagulants); 0 (Heparin, Low-Molecular-Weight)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0578-1426.2017.12.018


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[PMID]:27776358
[Au] Autor:Weinberg DS; Barkun A; Turner BJ
[Ad] Endereço:From Fox Chase Cancer Center, Philadelphia, Pennsylvania; McGill University, Montreal, Quebec, Canada; and University of Texas Health Science Center at San Antonio, San Antonio, Texas.
[Ti] Título:Colorectal Cancer Screening in the United States: What Is the Best FIT?
[So] Source:Ann Intern Med;166(4):297-298, 2017 Feb 21.
[Is] ISSN:1539-3704
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Neoplasias Colorretais/diagnóstico
Detecção Precoce de Câncer/métodos
Fezes/química
[Mh] Termos MeSH secundário: Colonoscopia
Consenso
Seres Humanos
Imunoquímica
Sangue Oculto
Sociedades Médicas
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.7326/M16-2341


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[PMID]:29049756
[Au] Autor:Selby K; Baumgartner C; Levin TR; Doubeni CA; Zauber AG; Schottinger J; Jensen CD; Lee JK; Corley DA
[Ad] Endereço:From Kaiser Permanente Division of Research, Oakland, California; University of Lausanne, Lausanne, Switzerland; University of California at San Francisco, San Francisco, California; Bern University Hospital, Bern, Switzerland; Kaiser Permanente Medical Center, Walnut Creek, California; University o
[Ti] Título:Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests: A Systematic Review.
[So] Source:Ann Intern Med;167(8):565-575, 2017 Oct 17.
[Is] ISSN:1539-3704
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: Fecal immunochemical testing is the most commonly used method for colorectal cancer screening worldwide. However, its effectiveness is frequently undermined by failure to obtain follow-up colonoscopy after positive test results. Purpose: To evaluate interventions to improve rates of follow-up colonoscopy for adults after a positive result on a fecal test (guaiac or immunochemical). Data Sources: English-language studies from the Cochrane Central Register of Controlled Trials, PubMed, and Embase from database inception through June 2017. Study Selection: Randomized and nonrandomized studies reporting an intervention for colonoscopy follow-up of asymptomatic adults with positive fecal test results. Data Extraction: Two reviewers independently extracted data and ranked study quality; 2 rated overall strength of evidence for each category of study type. Data Synthesis: Twenty-three studies were eligible for analysis, including 7 randomized and 16 nonrandomized studies. Three were at low risk of bias. Eleven studies described patient-level interventions (changes to invitation, provision of results or follow-up appointments, and patient navigators), 5 provider-level interventions (reminders or performance data), and 7 system-level interventions (automated referral, precolonoscopy telephone calls, patient registries, and quality improvement efforts). Moderate evidence supported patient navigators and provider reminders or performance data. Evidence for system-level interventions was low. Seventeen studies reported the proportion of test-positive patients who completed colonoscopy compared with a control population, with absolute differences of -7.4 percentage points (95% CI, -19 to 4.3 percentage points) to 25 percentage points (CI, 14 to 35 percentage points). Limitation: More than half of studies were at high or very high risk of bias; heterogeneous study designs and characteristics precluded meta-analysis. Conclusion: Patient navigators and giving providers reminders or performance data may help improve colonoscopy rates of asymptomatic adults with positive fecal blood test results. Current evidence about useful system-level interventions is scant and insufficient. Primary Funding Source: National Cancer Institute. (PROSPERO: CRD42016048286).
[Mh] Termos MeSH primário: Assistência ao Convalescente
Colonoscopia/utilização
Neoplasias Colorretais/diagnóstico
Sangue Oculto
[Mh] Termos MeSH secundário: Viés
Seres Humanos
Navegação de Pacientes
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.7326/M17-1361


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[PMID]:28973514
[Au] Autor:Greuter MJE; de Klerk CM; Meijer GA; Dekker E; Coupé VMH
[Ad] Endereço:From VU University Medical Center, Academic Medical Center, and Netherlands Cancer Institute, Amsterdam, the Netherlands.
[Ti] Título:Screening for Colorectal Cancer With Fecal Immunochemical Testing With and Without Postpolypectomy Surveillance Colonoscopy: A Cost-Effectiveness Analysis.
[So] Source:Ann Intern Med;167(8):544-554, 2017 Oct 17.
[Is] ISSN:1539-3704
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: Population-based screening to prevent colorectal cancer (CRC) death is effective, but the effectiveness of postpolypectomy surveillance is unclear. Objective: To evaluate the additional benefit in terms of cost-effectiveness of colonoscopy surveillance in a screening setting. Design: Microsimulation using the ASCCA (Adenoma and Serrated pathway to Colorectal CAncer) model. Data Sources: Dutch CRC screening program and published literature. Target Population: Asymptomatic persons aged 55 to 75 years without a prior CRC diagnosis. Time Horizon: Lifetime. Perspective: Health care payer. Intervention: Fecal immunochemical test (FIT) screening with colonoscopy surveillance performed according to the Dutch guideline was simulated. The comparator was no screening or surveillance. FIT screening without colonoscopy surveillance and the effect of extending surveillance intervals were also evaluated. Outcome Measures: CRC burden, colonoscopy demand, life-years, and costs. Results of Base-Case Analysis: FIT screening without surveillance reduced CRC mortality by 50.4% compared with no screening or surveillance. Adding surveillance to FIT screening reduced mortality by an additional 1.7% to 52.1% but increased lifetime colonoscopy demand by 62% (from 335 to 543 colonoscopies per 1000 persons) at an additional cost of €68 000, for an increase of 0.9 life-year. Extending the surveillance intervals to 5 years reduced CRC mortality by 51.8% and increased colonoscopy demand by 42.7% compared with FIT screening without surveillance. In an incremental analysis, incremental cost-effectiveness ratios (ICERs) for screening plus surveillance exceeded the Dutch willingness-to-pay threshold of €36 602 per life-year gained. Results of Sensitivity Analysis: When using a parameter set representing low colorectal lesion prevalence or when colonoscopy costs were halved or colorectal lesion incidence was doubled, screening plus surveillance became cost-effective compared with screening without surveillance. Limitation: Limited data on FIT performance and background CRC risk in the surveillance population. Conclusion: Adding surveillance to FIT screening is not cost-effective based on the Dutch ICER threshold and substantially increases colonoscopy demand. Extending surveillance intervals to 5 years would decrease colonoscopy demand without substantial loss of effectiveness. Primary Funding Source: Alpe d'HuZes, Dutch Cancer Society, and Stand Up To Cancer.
[Mh] Termos MeSH primário: Colonoscopia/economia
Neoplasias Colorretais/diagnóstico
Detecção Precoce de Câncer/economia
Fezes/química
Programas de Rastreamento/economia
Sangue Oculto
[Mh] Termos MeSH secundário: Idoso
Pólipos do Colo/diagnóstico
Pólipos do Colo/terapia
Análise Custo-Benefício
Detecção Precoce de Câncer/métodos
Feminino
Seres Humanos
Masculino
Programas de Rastreamento/métodos
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171004
[St] Status:MEDLINE
[do] DOI:10.7326/M16-2891


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[PMID]:28922370
[Au] Autor:Perry T; Laffin M; Fedorak RN; Thiesen A; Dicken B; Madsen KL
[Ad] Endereço:Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
[Ti] Título:Ileocolic resection is associated with increased susceptibility to injury in a murine model of colitis.
[So] Source:PLoS One;12(9):e0184660, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Ileocolic resection (ICR) is the most common intestinal resection performed for Crohn's disease, with recurrences commonly occurring at the site of the anastomosis. This study used an animal model of ICR in wild-type mice to examine immunologic changes that developed around the surgical anastomosis and how these changes impacted gut responses to minor acute injury. ICR was performed in adult 129S1/SvlmJ mice and results compared with mice receiving sham or no surgery. Dextran sodium sulfate was given either on post-operative day 9 or day 24 to evaluate immune responses in the intestine both immediately following surgery and after a period of healing. Fecal occult blood measurements and animal weights were taken daily. Cytokine levels were measured in ileal and colonic tissue. Bacterial load in the neo-terminal ileum was measured using qPCR. Immune cell populations in the intestinal tissue, mesenteric lymph nodes, and spleen were assessed using flow cytometry. Cytokine secretion in response to microbial products was measured in isolated mesenteric lymph nodes and spleen cells. ICR resulted in an initial elevation of inflammatory markers in the terminal ileum and colon followed by enhanced levels of bacterial growth in the neo-terminal ileum. Intestinal surgical resection resulted in the recruitment of innate immune cells into the colon that exhibited a non-responsiveness to microbial stimuli. DSS colitis phenotype was more severe in the ileocolic resection groups and this was associated with local and systemic immunosuppression as evidenced by a reduced cytokine responses to microbial stimuli. This study reveals the development of an immune non-responsiveness to microbial products following ileocolic resection that is associated with enhanced levels of bacterial growth in the neo-terminal ileum. These surgical-induced altered immune-microbial interactions in the intestine may contribute to disease recurrence at the surgical anastomosis site following ileocolic resections in patients with Crohn's disease.
[Mh] Termos MeSH primário: Colo
Doença de Crohn
Microbioma Gastrointestinal/imunologia
Íleo
[Mh] Termos MeSH secundário: Animais
Colo/imunologia
Colo/microbiologia
Colo/cirurgia
Doença de Crohn/induzido quimicamente
Doença de Crohn/imunologia
Doença de Crohn/microbiologia
Doença de Crohn/cirurgia
Sulfato de Dextrana/toxicidade
Modelos Animais de Doenças
Íleo/imunologia
Íleo/microbiologia
Íleo/cirurgia
Linfonodos/imunologia
Mesentério/imunologia
Camundongos
Camundongos Endogâmicos ICR
Sangue Oculto
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
9042-14-2 (Dextran Sulfate)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170919
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184660


  10 / 4803 MEDLINE  
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[PMID]:28873161
[Au] Autor:Singal AG; Gupta S; Skinner CS; Ahn C; Santini NO; Agrawal D; Mayorga CA; Murphy C; Tiro JA; McCallister K; Sanders JM; Bishop WP; Loewen AC; Halm EA
[Ad] Endereço:Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
[Ti] Título:Effect of Colonoscopy Outreach vs Fecal Immunochemical Test Outreach on Colorectal Cancer Screening Completion: A Randomized Clinical Trial.
[So] Source:JAMA;318(9):806-815, 2017 09 05.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Mailed fecal immunochemical test (FIT) outreach is more effective than colonoscopy outreach for increasing 1-time colorectal cancer (CRC) screening, but long-term effectiveness may need repeat testing and timely follow-up for abnormal results. Objective: Compare the effectiveness of FIT outreach and colonoscopy outreach to increase completion of the CRC screening process (screening initiation and follow-up) within 3 years. Design, Setting, and Participants: Pragmatic randomized clinical trial from March 2013 to July 2016 among 5999 participants aged 50 to 64 years who were receiving primary care in Parkland Health and Hospital System and were not up to date with CRC screenings. Interventions: Random assignment to mailed FIT outreach (n = 2400), mailed colonoscopy outreach (n = 2400), or usual care with clinic-based screening (n = 1199). Outreach included processes to promote repeat annual testing for individuals in the FIT outreach group with normal results and completion of diagnostic and screening colonoscopy for those with an abnormal FIT result or assigned to colonoscopy outreach. Main Outcomes and Measures: Primary outcome was screening process completion, defined as adherence to colonoscopy completion, annual testing for a normal FIT result, diagnostic colonoscopy for an abnormal FIT result, or treatment evaluation if CRC was detected. Secondary outcomes included detection of any adenoma or advanced neoplasia (including CRC) and screening-related harms (including bleeding or perforation). Results: All 5999 participants (median age, 56 years; women, 61.9%) were included in the intention-to-screen analyses. Screening process completion was 38.4% in the colonoscopy outreach group, 28.0% in the FIT outreach group, and 10.7% in the usual care group. Compared with the usual care group, between-group differences for completion were higher for both outreach groups (27.7% [95% CI, 25.1% to 30.4%] for the colonoscopy outreach group; 17.3% [95% CI, 14.8% to 19.8%] for FIT outreach group), and highest in the colonoscopy outreach group (10.4% [95% CI, 7.8% to 13.1%] for the colonoscopy outreach group vs FIT outreach group; P < .001 for all comparisons). Compared with usual care, the between-group differences in adenoma and advanced neoplasia detection rates were higher for both outreach groups (colonoscopy outreach group: 10.3% [95% CI, 9.5% to 12.1%] for adenoma and 3.1% [95% CI, 2.0% to 4.1%] for advanced neoplasia, P < .001 for both comparisons; FIT outreach group: 1.3% [95% CI, -0.1% to 2.8%] for adenoma and 0.7% [95% CI, -0.2% to 1.6%] for advanced neoplasia, P < .08 and P < .13, respectively), and highest in the colonoscopy outreach group (colonoscopy outreach group vs FIT outreach group: 9.0% [95% CI, 7.3% to 10.7%] for adenoma and 2.4% [95% CI, 1.3% to 3.3%] for advanced neoplasia, P < .001 for both comparisons). There were no screening-related harms in any groups. Conclusions and Relevance: Among persons aged 50 to 64 years receiving primary care at a safety-net institution, mailed outreach invitations offering FIT or colonoscopy compared with usual care increased the proportion completing CRC screening process within 3 years. The rate of screening process completion was higher with colonoscopy than FIT outreach. Trial Registration: clinicaltrials.gov Identifier: NCT01710215.
[Mh] Termos MeSH primário: Colonoscopia
Neoplasias Colorretais/diagnóstico
Detecção Precoce de Câncer/métodos
Promoção da Saúde/métodos
Sangue Oculto
[Mh] Termos MeSH secundário: Detecção Precoce de Câncer/utilização
Feminino
Seres Humanos
Masculino
Programas de Rastreamento/métodos
Meia-Idade
Provedores de Redes de Segurança
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; PRAGMATIC CLINICAL TRIAL; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171021
[Lr] Data última revisão:
171021
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170906
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.11389



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