Academic literature on the topic 'Diagnosis – Examinations – Study guides'

Benign Prostatic Hyperplasia (BPH) is a medical condition that is often found in men and its incidence is influenced by age. In autopsy studies, the histologic prevalence of BPH was 8% in the fourth decade of life, 50% in the sixth decade of life, and 80% in the ninth decade of life. In addition, Benign Prostatic Hyperplasia (BPH) is a disease that is progressive and causes a decrease in the quality of life in men. Therefore, knowledge about the diagnosis and good management of BPH needs to be understood by every clinician. The writing of this article focuses on discussing the diagnosis and management of BPH. The method used in writing this article is literature review relevant sources from various references include scientific journals, the latest clinical guides from IAUI, websites, and the latest and most trusted textbooks on the topic of Benign prostatic hyperplasia (BPH). Based on the literature search, the diagnosis of BPH was established based on anamnesis, physical examination, and appropriate supporting examinations. In the history it is important to explore the various complaints that are typical of BPH patients. BPH is a medical condition that is often found in men and its incidence is influenced by age. This disease is progressive and causes a significant reduction in quality of life. The diagnosis of BPH is based on anamnesis, physical examination, and appropriate investigations. Treatment options or management in BPH patients consist of conservative therapy (watchful waiting), medication, and surgery.

Abstract This article continues a discussion of the results of a nationwide study that reviewed 2100 impairment ratings and found a large number of errors (see the May/June issue of The Guides Newsletter). Spinal impairment ratings, for example, often are erroneous. Although the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides) clearly specifies use of the Diagnosis related estimates (DRE) method, evaluators sometimes incorrectly use the range-of-motion (ROM) method, which is fraught with potential error and typically results in higher impairment ratings. The most common problem associated with rating the lower extremities is combining multiple duplicative impairments. Multiple impairments typically are combined rather than added because the latter usually results in overrating impairments. A sidebar highlights red flags to erroneous AMA Guides ratings, and evaluators can take a number of steps to ensure accurate ratings. The first of these is to ensure an unbiased rating, preferably by a board-certified physician who, ideally, also has certification in the performance of independent medical and impairment examinations. The client requesting the evaluation should provide a cover letter describing the specifics of the evaluation, and the evaluator's report should comply with standards defined in the AMA Guides. All submitted reports should be reviewed by a physician experienced in the use of the AMA Guides; this cannot be accomplished by a nonphysician reviewer.

Introduction: Frozen section is a rapid intraoperative method of tissue sectioning with the help of cryostat to arrive at a diagnosis and guide the operative procedure. It is an important diagnostic tool in the intraoperative management of ovarian neoplasms. Aims and Objectives: 1) To evaluate clinically suspected ovarian neoplastic lesions by frozen section. 2) To analyze the factors associated with difficulty in diagnoses of borderline ovarian neoplasms. Materials and Methods: This is a cross-sectional study conducted in the Department of Pathology for a period of 2 years. 60 cases of ovarian neoplasms undergoing Frozen section and subsequent histopathological examination are included in the study. Results: The mean age of patient is 39.49 years (21-72). Of the 60 cases, 73.33% are benign, 8.33% borderline and 18.3% are malignant on histopathological diagnosis. The concordance rate of frozen section with histopathological diagnosis is 91.67%. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Frozen section in the diagnosis of Benign, Borderline and Malignant ovarian neoplasms are 95.45%, 92.73%, 97.67%, 88.24% and 88.64%; 100%, 92.16%, 55.56%, 100% and 55.56%; 72.73%, 100%, 100%, 94.23% and 72.73% respectively. Conclusion: Frozen section of ovarian neoplasms helps to arrive at a diagnosis of whether they are benign or malignant with a high level of accuracy. Diagnosis of a benign lesion in a young patient guides the surgeon to a fertility conserving surgery. Likewise, diagnosis of a malignant lesion on table guides the surgeon to execute an extensive surgery in a single setting, saving the patient of the physical, emotional, psychological and financial strain of a second look operation.

Aims The aims of this study were to determine the diagnostic yield of image-guided biopsy in providing a final diagnosis in patients with suspected infectious spondylodiscitis, to report the diagnostic accuracy of various microbiological tests and histological examinations in these patients, and to report the epidemiology of infectious spondylodiscitis from a country where tuberculosis (TB) is endemic, including the incidence of drug-resistant TB. Methods A total of 284 patients with clinically and radiologically suspected infectious spondylodiscitis were prospectively recruited into the study. Image-guided biopsy of the vertebral lesion was performed and specimens were sent for various microbiological tests and histological examinations. The final diagnosis was determined using a composite reference standard based on clinical, radiological, serological, microbiological, and histological findings. The overall diagnostic yield of the biopsy, and that for each test, was calculated in light of the final diagnosis. Results The final diagnosis was tuberculous spondylodiscitis in 250 patients (88%) and pyogenic spondylodiscitis in 22 (7.8%). Six (2.1%) had a noninfectious condition-mimicking infectious spondylodiscitis, and six (2.1%) had no definite diagnosis and improved without specific treatment. The diagnosis was made by image-guided biopsy in 152 patients (56%) with infectious spondylodiscitis. Biopsy was contributory in identifying 132/250 patients (53%) with tuberculous spondylodiscitis, and 20/22 patients (91%) with pyogenic spondylodiscitis. Histological examination was the most sensitive diagnostic modality, followed by Xpert MTB/RIF assay. Conclusion Image-guided biopsy has a reasonably high diagnostic yield in patients with suspected infectious spondylodiscitis. A combination of histological examination, Xpert MTB/RIF assay, bacterial culture, and sensitivity provides high diagnostic accuracy in a country in which TB is endemic. Cite this article: Bone Joint J 2022;104-B(1):120–126.

Background: This study was initiated to compare the diagnostic hypotheses of doctors in the emergency department, ultrasound results and operative reports of patients seen for acute abdominal and/or pelvic pain. Patients and method: This is a prospective descriptive study of 12 months from January to December 2022, involving 55 consenting patients, hospitalized at the Fertilia medical clinic in Bamako and having benefited from at least one imaging examination to abdominal and pelvic emergency. Ultrasounds were performed using General Electric Voluson E8, Logic9 and Vivid3 devices. The x-rays were taken by an Italian Mecall machine. Result: Our study involved a sample of 55 consenting patients with acute abdominal and/or pelvic pain. The average age was 25.5 years. The male sex was the most represented with a sex ratio of 1.5. The most common etiology mentioned was appendicitis, i.e. 38%. The diagnostic hypotheses formulated by the host doctors were confirmed by imaging in 87.2% of cases and those of imaging confirmed by surgery in 60% of cases. Conclusion: Abdominal emergencies are frequent in consultations and mainly affect young people. The approach to the management of emergency patients requires a well-performed clinical examination which guides the choice of the imaging examination which remains most often necessary not only to make the diagnosis but also to guide the therapeutic actions. Imaging helps to correct the clinical suspicion. Despite these good results, progress remains to be made, especially in terms of the prescription of radiological examinations, in this case that concerning information.

Introduction and Aim: Coronavirus disease (COVID-19) is a viral infection that can lead to severe respiratory disease. Radiological examinations mainly computed tomography (CT) and Chest x-ray (CXR) play a role in diagnosis, follow-up, and management of COVID-19 infection. The purpose of this study was to look into the extent of using chest imaging in COVID-19 infection, as well to see if chest imaging in COVID-19 infections is justified and guided by clinical recommendation in Mosul, Iraq. Materials and Methods: This cross-sectional study involved 245 people (93 males and 152 females), infected previously with COVID-19 infection in Mosul, Iraq. The participants were asked to self-complete an anonymous questionnaire. Data obtained was subjected to statistical analysis. Results: The 245 participants had an average age of 25.7 ±8.44 years. The study sample included 57 (23.2%) with low education and 188 (76.7%) with moderate to high education. Among the radiological examinations undergone by these participants, chest X-ray (CXR) was the most common followed by chest computed tomography scan (CT scan). The CXR and the CT scan were done during the patient's illness either for diagnosis or follow-up of the disease. Non-clinically recommended examinations were reported by 64% and 20% of patients who undertook CXR and CT scan respectively, during COVID-19 illness. Higher education status was associated with a tendency to do non-recommended CXR examination during COVID-19 infection. Conclusion: CXR and CT imaging are the most commonly used radiological examinations in the diagnosis and follow-up in COVID-19 infection. However, a non-clinically recommended utilization of these examinations was noted in Mosul, Iraq during the pandemic. Therefore, educating people of this region about the limitation of non-justified uses of imaging is essential for healthy maintenance of individuals, environment, and resources.

e15680 Background: Radiological examinations including computed tomography (CT) and endoscopic ultrasound sonography (EUS) are important for the diagnosis of pancreatic neuroendocrine tumors (PNETs). Pathological diagnosis is not needed with functional PNETs because the diagnosis is made by biochemical testing. Therefore, pathological diagnosis is essential for the non-functional PNETs (nf-PNETs). In this study, we examined the diagnostic yield of radiological examinations and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for nf-PNETs. Methods: From January 1997 to December 2007, consecutive 38 cases were pathologically diagnosed from as nf-PNETs at Aichi Cancer Center Hospital. Of these 33 patients was diagnosed with surgical specimen, 5 patients with EUS-FNA specimen. Of 33 patients, 16 patients underwent EUS-FNA preoperatively, and were examined further: their EUS-FNA specimens were submitted for additional immunohistochemical examination for CD 56, chromogranin A, synaptophysin, somatostatin receptor 2A (SSTR2A) and Ki-67 using cell block method. Staging of PNETs was performed according to WHO classification. Results: 16 patients (10 men and 6 women) who ranged in age from 23 to 81 years. The mean of tumor size was 2.2 cm and ranged from 0.7 to 4.4 cm. Diagnosis by CT and EUS was 12 (75.0%) PNETs, two pancreatic cancer, one solid papillary tumors and one malignant lymphoma. Accurate diagnosis by cytology and immunohistochemistry was 75.0% and 93.8%, respectively. The Ki-67 in specimens of malignancy tended to be higher than those of benign or uncertain behavior. If we assumed that a tumor with Ki-67 of more than 2% was malignancy, the diagnostic accuracy was 75.0%. Positive reaction to SSTR2A was up to 14 out of 16 nf-PNETs. Conclusions: The EUS-FNA is a useful tool for diagnosing nf-PNETs with immunohistochemical staining compared to cytology and radiological examinations. Ki-67 may be also effective to predict the degree of malignancy. No significant financial relationships to disclose.

Percutaneous ultrasound-guided cholecystocentesis was performed on 13 healthy beagle dogs to determine whether percutaneous ultrasound-guided cholecystocentesis in the dog was a feasible and safe procedure. Clinical, laboratory and ultrasonographic examinations were done at 0 and 10 minutes, in the 2nd and 16th hour, and on the 7th day. They included a detailed physical examination of the mucous membranes, cardiorespiratory system and abdominal organs. Laboratory examinations of the blood consisted of a complete blood count, determination of packed cell volume (PCV), haemoglobin (Hb), total plasma protein (TPP), parameters of haemostasis including prothrombin time (PT), activated partial thromboplastin time (APTT), and enzyme activities reflecting hepatobiliary function, i.e. aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT). Ultrasonographic findings of the gallbladder (size, shape, wall, content) and appearance of the biliary tract and the surrounding cranial intraabdominal organs were also evaluated. Percutaneous ultrasound-guided cholecystocentesis was performed easily during the study, and dogs tolerated well the procedure performed without anaesthesia. All laboratory parameters of the blood remained within normal limits throughout the study. However, some follow-up values, i.e. PCV, TPP, APTT and ALT, demonstrated statistically significant differences when compared to baseline measurements, which might reflect the effect of 24-hour fasting before the experiment, as well as day-to-day metabolic fluctuations due to feeding and water supply during the study. There were no visible signs of bleeding from the liver, bile leakage from the gallbladder or accumulation of free peritoneal fluid during repeated ultrasonographic examinations. Percutaneous ultrasound-guided cholecystocentesis seems to be an important diagnostic procedure in canine gallbladder diseases and can be used safely and easily to gain gallbladder bile for diagnosis of bacterial cholecystitis or for investigating hepatobiliary function in the dog.

AbstractA multitude of musculoskeletal disorders of the knee are commonly encountered in clinical practice. Ensuring an accurate diagnosis can be challenging. It is critical to establish a thoughtful and systematic approach to assessing the patient using history and physical exam followed by appropriate imaging studies. The physical exam may be complicated due to various test maneuvers designed to help make the diagnosis. It is also important to understand the limitations of each physical exam maneuver. When appropriate, imaging is obtained to help make the diagnosis and guide treatment. There are various imaging examinations to choose from when evaluating the knee, including X-rays, computed tomography, magnetic resonance imaging, and ultrasound. An algorithmic approach to choosing the best imaging study is often helpful to avoid unnecessary costs and burden to the patients. The combination of a thorough clinical assessment and appropriate imaging examinations will result in accurate diagnosis, which directs proper treatment.

Background: Rural general practitioners (GPs) have insufficient diagnostic information to deal with complex clinical scenarios due to the inequality in medical imaging resources in rural and remote communities. The objective of this study is to explore the value of a tele-mentored handheld ultrasound (tele-HHUS) system, allowing GPs to provide ultrasound (US) services in rural and remote communities. Methods: Overall, 708 patients underwent tele-HHUS examination between March and October 2021 and March and April 2022 across thirteen primary hospitals and two tertiary-care general hospitals. All US examinations were guided and supervised remotely in real time by US experts more than 300 km away using the tele-HHUS system. The following details were recorded: location of tele-HHUS scanning, primary complaints, clinical diagnosis, and US findings. The recommendations (referral or follow-up) based on clinical experience alone were compared with those based on clinical experience with tele-HHUS information. Results: Tele-HHUS examinations were performed both in hospital settings (90.6%, 642/708) and out of hospital settings (9.4%, 66/708). Leaving aside routine physical examinations, flank pain (14.2%, 91/642) was the most common complaint in inpatients, while chest distress (12.1%, 8/66) and flank discomfort (12.1%, 8/66) were the most common complaints in out-of-hospital settings. Additionally, the referral rate increased from 5.9% to 8.3% (kappa = 0.202; p = 0.000). Conclusions: The tele-HHUS system can help rural GPs perform HHUS successfully in remote and rural communities. This novel mobile telemedicine model is valuable in resource-limited areas.

Abstract Primary stabbing headache, previously referred to as “ice-pick headache,” is a headache condition that causes short-lived but excruciating pain in the extratrigeminal regions. It is diagnosed through careful patient examination as well as testing to rule out conditions with similar presentation: clinicians should not discredit the importance of a detailed patient history while caring for individuals suffering from headaches. When primary stabbing headache is suspected, clinicians must exclude giant cell arteritis, glaucoma, cluster headache, thunderclap headache, and reversible cerebral vasoconstriction syndrome. Once diagnosis of primary stabbing headache has been established, possible treatment options include long-acting NSAIDs, gabapentin, and botox injections. The aim of this case review is to guide the reader through a complex case study in which a clinician is faced with the challenge of navigating both patient history and diagnostic testing to establish the most appropriate headache diagnosis.

Brachial plexus injuries are semi-emergency conditions that require early intervention. Nerve transfers in adult brachial plexus injuries have become the standard treatment that gives reasonably good results if performed before the degeneration of muscle end plates. A clinical diagnosis based on clinical examinations supported by radiological and electrophysiological investigations is required that guides the specific procedures to be chosen. The surgeons must prioritize the objectives of reconstruction and keeping the different lifeboats for the use in future before choosing a specific nerve transfer. Also, it is important to be familiar with different nerve transfers so that one can select and perform a specific one based on pre-operative examinations and intraoperative findings of nerve stimulations. The author aims to describe the approach for exploring and dissecting the brachial plexus and different surgical techniques of nerve transfers used for different muscle reinnervations in different scenarios.

The project aims to present the results of an experimental research study conducted during the academic years 2015-2016, 2016-2017 at the University of Padova Language Centre (CLA). The objectives of this study are to examine the results of the proposal to integrate self-evaluation and entrance evaluation aimed at foreign incoming students enrolled at our University. In the first phase an initial review of the placement test results carried out at the CLA combined with an examination of language certificates presented by the students has raised some critical issues related to incongruous data among the various tests/certifications. Other situations have shown different results regarding language skills within the same test, which has reinforced the decision to also introduce a system of self-assessment to grant greater autonomy and responsibility to the students when choosing their class. To this end, in the second phase, two different self-assessment tools have been assigned to the students with the attempt to answer the questions whether students can be good “self-assessors” and if self-assessment tools based on Common European Framework of Reference (CEFR) “can do” descriptors and on the Syllabus adopted in our language Centre can be used as reliable diagnostic tools in an academic environment in which learners are expected to have some experience with self-rating. The results have shown that the self-assessment instruments we used may function as a placement tools, but that this is true especially in the case of learners who are familiar with self-assessment and with the teacher’s guidance. The third phase, described in detail in this contribution, is to overcome the previously emerging critical issues by providing an interactive guided syllabus, since it effectively integrates evaluation and self-assessment and actively engages the student in choosing the proper language level through online activities.

The outpatient department, often known as an outpatient clinic, is a distinct area within a hospital dedicated to the treatment of individuals, referred to as outpatients. These individuals seek diagnosis or treatment without the need for overnight or prolonged care. Modern outpatient departments provide a diverse array of diagnostic tests, treatment services, and minor surgical procedures. Consultant doctors in the outpatient department also attend to inpatients in the hospital wards. Many patients undergo examinations and initial treatments as outpatients before potential admission for further inpatient care. Furthermore, the outpatient department oversees follow-up treatments after a patient's discharge.

This chapter explores several steps of the thermal breast exams analysis process in detecting breast abnormality and evaluating the response of pre-surgical treatment. Topics concerning the process of acquiring, storing, and preprocessing these exams, including a novel segmentation proposal that uses collective intelligence techniques, will be discussed. In addition, various approaches to calculating statistical and geometric descriptors from thermal breast examinations are also considered of this chapter. These descriptors can be used at different stages of the analysis process of these exams. In this sense, two experiments will be presented. The first one explores the use of genetic algorithms in the feature selection process. The second conducts a preliminary study that intends to analyze some descriptors, already used in other works, in the process of evaluating preoperative treatment response. This evaluation is of fundamental importance since the response is directly associated with the prognosis of the disease.

Developing an effective computer-aided diagnosis (CAD) system for lung cancer is of great clinical importance and can increase the patient's chance of survival. For this reason, CAD systems for lung cancer have been investigated in a huge number of research studies. Several studies have shown the feasibility and robustness of automated matching of corresponding nodule pairs between follow up examinations. Different image pre-processing and segmentation techniques are used in various research sides to segment different tumors or ulcers from different images. This paper aims to make a review on the existing segmentation algorithms used for CT images of pulmonary nodules and presents a study of the existing methods on automated lung nodule detection. It provides a comparison of the performance of the existing approaches in regards to effective domain results.

Abstract The commonly held belief that there is decreased cognitive function (mental acuity) with age is justified, but there is great individual variation. Some mental processes do slow down with age, but many do not. Studies from several countries including the United States have reached this conclusion. Research into aging has been greatly advanced by the Study of Aging in America program sponsored for more than a decade by Chicago’s MacArthur Foundation. As part of this research, millions of dollars were provided to scientists and doctors around the country to support studies on aging within their particular areas of expertise. John Rowe and Robert Kahn present the results of the Aging in America Study in their book, Successful Aging. Fears of mental decline, loss of memory, and especially of Alzheimer’s disease are widespread among older people. According to the Aging in America study, about 10% of people over the age of 65 may have Alzheimer’s disease, and the proportion increases with age. Among the oldest, people from 85 to 100 years of age or more, as many as 50% may have some degree of Alzheimer’s. These are probably reliable statistics; specialists believe that cognitive tests and medical examinations now available enable them to make a diagnosis with 90% confidence.

The active spread of respiratory infections in pig farms raises the issue of differential pathomorphological diagnosis of diseases related to a single syndrome of respiratory pathologies. Pathological autopsy and histopathological examinations of organs from 72 carcasses of pigs during the fattening period were performed. Pathological autopsy of pigs was performed by complete evisceration. Histologically examined 360 lung samples with regional lymph nodes. The presence of bacterial and viral infections was confirmed by bacteriological and PCR studies. The aim of the study is to establish the characteristic differential features at the macro- and micro-level in the lungs of domestic pigs for viral and bacterial pathogens. The main tasks of the work are to determine the morphofunctional features and dynamics of pathomorphological changes in the parenchyma and immune formations of the lungs in respiratory pathology. As a result of complex pathomorphological studies of the lungs in respiratory infections of pigs found that structural and functional changes in the body have different localization, stage and nature of the pathological process, which depend on the direct action of the etiological factor. Acute catarrhal bronchopneumonia is registered in respiratory mycoplasmosis (enzootic pneumonia), which in a prolonged course turns into chronic catarrhal or catarrhal-purulent pneumonia. Hemorrhagic necrotizing pneumonia is a manifestation of actinobacillary pleuropneumonia. Interstitial (diffuse proliferative) pneumonia develops with viral pathogens - circovirus infection and reproductive and respiratory syndrome of pigs (PRRS). Serous fibrinous and fibrinous pleurisy develop in hemophilic polyserositis and actinobacillary pleuropneumonia. Pathomorphological changes of the lungs in the reproductive and respiratory syndrome of pigs are polymorphic and are manifested by the gradual progressive development of the inflammatory process from congestive hyperemia, acute catarrh to diffuse interstitial pneumonia. Pathomorphological changes of the lungs in mycoplasmosis (enzootic pleuropneumonia) of pigs are polymorphic and are manifested by the gradual progressive development of the inflammatory process, which is localized in the cranial, middle and peripheral parts of the diaphragmatic particles and is characterized by acute catarrhal bronchopneumonia. In actinobacillary pleuropneumonia pathohistological studies revealed a pronounced stage of morphological changes in the lungs and regional lymph nodes in actinobacillary pleuropneumonia. Depending on the form of the disease, serous-hemorrhagic exudation is exacerbated by fibrinogen exudation and increased migration of lymphocytes and mononuclear cells. In subacute and chronic forms of the disease, necrotic phenomena prevail in combination with areas of serous-fibrinous inflammation. In the future, further studies of immunohistochemical analysis to establish the tropism of the pathogen and the study of markers of lymphoid cells.

Introduction: The intrusive dislocation in primary teeth is when the tooth moves to the interior of the alveolar bone, and can harm the periodontal structure, the pulp tissue and the successor teeth through the destruction and rupture of the fibers of the periodontal ligament and the vascular supply. Objective: the objective of this study is, through a literature review, to analyze aspects related to intrusive dislocation such as epidemiological data, diagnosis, degrees of injury, radiographic examinations, sequelae in permanent teeth and forms of treatment. Literature review: Intrusive dislocation in children is the trauma that happens most frequently, knowledge of the techniques of manipulation of intrusive dislocation is essential to perform a good treatment. The importance of radiographic examination should be emphasized, because without it it is not possible to find out where the root of the tooth has moved. Most of the time as a form of treatment if the root of the intruded tooth has not reached the successor tooth is chosen to wait for the reeruption of the intruded tooth, but if there is any complication during the wait can opt for tooth extraction. Final considerations: Most of the time as a form of treatment it is chosen to wait for the reeruption of the primary teeth when there is no compromise of the permanent successor tooth and opt for extraction only if there is any complication during the wait, due to the proximity of the primary tooth with the permanent tooth it is common to have the occurrence of sequelae in the permanents, That is why it is necessary to have a follow-up until the reeruption of the primary tooth and an orientation to the country, it is also important to emphasize the importance of clinical and radiographic examination because when they are done correctly they can reduce the chances of sequelae in the primary and permanent teeth.

Introduction: Among the fibroepithelial lesions, there are fibroadenoma and phyllodes tumors (PTs) that are breast neoplasms. Both of them offer breast lumps. Fibroadenoma is the most common benign breast lesion in young adult women. It has limited growth and does not usually exceed 2 cm, and in some cases it can present itself as a giant. More commonly, it affects the upper lateral quadrant, and it can be located in any quadrant, multiple, unilateral or bilateral forms. PTs represent less than 1% of fibroepithelial tumors in the breast, being more common around the age of 40. It can be benign, borderline, or malignant. Methods: An analysis about the theme was carried out in scientific articles using the various academic means of electronic data, with an emphasis on SciELO, Google Academic, LILACS, RBGO, BVS, and CAPES. A comparative study of fibroadenoma and PT was performed from 2018 to 2022. Results: Fibroadenoma is usually slow growing and painless. The association of clinical and imaging findings makes the follow-up of these lesions quite reliable. In contrast, PT manifests as a faster growing nodule that can be repeated even after excision and/or metastasize. The differential diagnosis between the two tumors is of extreme importance, bearing in mind the prognosis and therapy to be used in each one. Imaging tests, such as mammography and ultrasound, do not show pathognomonic signs of PT; however, as a support in diagnosis, ultrasound is a reliable method in cases of large and well-defined tumors, due to the presence of cystic areas interspersed with the solid mass. As for fibroadenoma, cytology associated with the clinical and imaging is part of the triple diagnosis, in case of doubt, FNA is added, which has a specific cytological aspect. Conclusion: Fibroadenoma is usually slow growing and painless. The association of clinical and imaging findings makes the follow-up of these lesions quite reliable. In contrast, PT manifests as a faster growing nodule that can be repeated even after excision and/or metastasize. The differential diagnosis between the two tumors is of extreme importance, bearing in mind the prognosis and therapy to be used in each one. Imaging tests, such as mammography and ultrasound, do not show pathognomonic signs of PT; however, as a support in diagnosis, ultrasound is a reliable method in cases of large and well-defined tumors, due to the presence of cystic areas interspersed with the solid mass. As for fibroadenoma, cytology associated with clinical and imaging is part of the triple diagnosis, in case of doubt, FNA is added, which has a specific cytological aspect.

Objective: To develop a model for Quality Management in a Reference Center for breast diagnosis. Methodology: Crosssectional study of an interpretative nature of qualitative research based on research and management models. Results: A survey of the priority problems and the respective primary actions required was carried out with the construction of the Zero Base Goals matrix to analyze the three sources of losses for the Image sector. The Anomaly Report model was developed to identify nonconformities, their possible causes, as well as their analysis and action plans for standardization. Then, the standard operating procedures for the assignments of the monitoring and quality assurance groups of the images were built. The standard operating procedure of quality control for risk management with its possible failures and preventive actions was also prepared, as well as the form for monitoring the acquisition and processing of images, the form for monitoring and analyzing rejected images, and their respective failures. In a later stage, the technical quality standards were prepared for the phase of execution of mammographic examinations, following the quality standards determined by the regulatory agencies. For the execution phase, which comprises the stages of experimentation and development of action proposals for improvement or adaptation, some changes will be made to improve the process. Conclusion: The development of the Quality Management model in a Reference Center for breast diagnosis is in the phase of correction and adaptation for subsequent application, allowing for timely and relevant changes as the corresponding needs are evidenced.

Feline sporotrichosis is a zoonosis transmitted by Sporothrix brasiliensis that causes cutaneous and disseminated lesions. The study aimed to evaluate the efficiency of the clinical routine, diagnosis and treatment of feline sporotrichosis. 96 cases suggestive of sporotrichosis were analyzed, through clinical and laboratory examinations. A protocol defined by the Sporotrichosis Service of the Zoonosis Control area of ​​the City of Vitória – ES was recommended. The material was collected by Swabs or by the imprint method , from an exudative lesion, identified, packaged and examined in the laboratory. Of the 95 (100%) animals were diagnosed with sporotrichosis, 69 (73%) submitted to the proposed treatment (itraconazole or itraconazole + potassium iodide) were cured and 26 (27%) were unsuccessful in the treatment. Therefore, it is concluded that felines between 23 months and 35 weeks, classified in stages I and II of treatment, achieved satisfactory cure rates and demonstrated that the therapeutic protocol used was effective.

Introduction: Breast cancer is the most common neoplasm among women worldwide. The advent of genetic studies and DNA microarrays and their proteins had made it possible to correlate the patterns of gene expression of each type of cancer in different women, associate them with other prognostic factors, and verify the clinical evolution and therapeutic response. The immunohistochemistry (IHC) technique is based on the detection of protein cellular constituents — antigens — and based on the identification and classification of specific cells in the tissue sample. Immunohistochemical panels have been traced to determine breast cancer subtypes, to reproduce gene expression profiles, which have specific treatments. Different molecular subtypes have been established associated with differences in survival and treatment. The four main types in clinical practice are luminal A, luminal B, HER2 overexpression, and triple negative. Objective: The aim of this study was to trace the epidemiological profile of the molecular subtypes of breast cancer in women treated at the Hospital Regional da Asa Norte-Brasília, DF. Methods: Cross-sectional, longitudinal, and retrospective study through the analysis of 138 electronic medical records stored on the TrakCare® platform of cases of women diagnosed with breast cancer, with known histological type, and who underwent IHC examination to determine the molecular subtype. The study included women who attended between January 2015 and December 2020, in the Mastology Department of Hospital Regional da Asa Norte (HRAN). Results: The most common molecular subtype was luminal B, with 65 of the total cases, equivalent to 47.1%. Luminal A subtype was the subtype of 41 cases, equivalent to 29% and being the second most observed subtype. Triple negative was recorded in 21 of the cases, corresponding to 15.2%. The least observed subtype was HER2 overexpression, with 11 cases and 7.9% of the cases. Two participants had local recurrence within less than 2 years of diagnosis, changing from luminal A to luminal B, and luminal B to luminal A. The mean age of the women in the study at the time of diagnosis of breast cancer was 51.5 years, with age extremes of 17 and 86 years. Conclusion: The most prevalent molecular subtype in this sample studied was luminal B, corroborating other studies carried out in the Brazilian population and diverging from the international literature, in which it is the luminal A subtype. Epidemiological knowledge can guide the elaboration of public policies to improve the quality of care, such as drug planning and neoadjuvant and adjuvant treatments with the best results.

Clinical reasoning refers to the cognitive process that physicians employ in evaluating and managing patients. This process typically involves suggesting necessary examinations, diagnosing patients’ diseases, and selecting appropriate therapies, etc. Accurate clinical reasoning requires extensive medical knowledge and rich clinical experience, setting a high bar for physicians. This is particularly challenging in developing countries due to the overwhelming number of patients and limited physician resources, contributing significantly to global health inequity and necessitating automated clinical reasoning approaches. Recently, the emergence of large language models (LLMs) such as ChatGPT and GPT-4 have demonstrated their potential in clinical reasoning. However, these LLMs are prone to hallucination problems, and the reasoning process of LLMs may not align with the clinical decision pathways of physicians. In this study, we introduce a novel framework, In-Context Padding (ICP), to enhance LLMs reasoning with medical knowledge. Specifically, we infer critical clinical reasoning elements (referred to as knowledge seeds) and use these as anchors to guide the generation process of LLMs. Experiments on two clinical question datasets validate that ICP significantly improves the clinical reasoning ability of LLMs.

The occurrence of adverse events (AE) in healthcare represents a severe problem for the quality of care, due to unsafe or poor quality of healthcare service. Similar to many other healthcare environments, Dentistry entails inherent patient safety risks. Research on patient safety has been developed over the last decades, however, it is important to consider AE to improve patient safety in this care environment, as adequate reporting systems for this area of intervention are not known. Thus, the main aim of this study was to carry out a literature review to investigate AE exclusively related to dental care, and associated with the types of procedures that dentists perform and the tools used. Results will guide future studies, particularly related to their notification, as a way of promoting patient safety. The PubMed, Scopus and SciELO databases were used and the following keywords searched: “patient safety”, “adverse events”, “dental care”, “dental services” and “dentistry”, in English, Spanish and Portuguese. Observational studies, published in the last 10 years, were considered. Review studies, case reports and clinical trials were excluded. 56 articles were identified. The most common AE in dental care settings were: infections, delayed or failed diagnosis, allergies, errors in diagnosis and examination, errors in treatment planning or procedure, and accidental ingestion or inhalation of foreign objects, among others. Improving the knowledge on AE is important to encourage reporting, control and seek for tools that help manage care, and to promote improvements in care and patient safety. To conclude, the identification and recognition of AE, specific to this field of medical practice, is only the first step towards improving patient safety in dental care, through the development of specific notification systems. In future works, we intend to develop and validate an AE notification system adapted to the specificities of the dental field, using the clinical school of Dentistry at the University of Rio Verde as a study site.

Abstract Stenosis is abnormal narrowing of blood vessels that causes a shortage in blood supply and a blockage of an artery Diagnosis of its severity guides the physician to determine the most appropriate treatment plan. Fractional flow reserve (FFR) is currently the most accurate procedure in stenosis diagnosis. It is a guidewire based technique that uses a small sensor on the tip of the wire to measure proximal and distal pressure of the stenosis. The difficulty of using such method is placing the guidewire precisely in centerline of blood vessel. Therefore, the main objective of the current study is to investigate how the measured pressure varies with the guidewire position. Accordingly, three different positions from the blood vessel centerline along with three degrees of severity are considered. The governing equations for blood flow are obtained and numerically simulated. Numerical results are validated using the available experimental and numerical data. A good agreement between predicted and measured values are obtained. Based on the predicted results, pressure drop coefficient (CDP) and pressure recovery factor (η) are computed. The predicted results with and without the effect of existing guidewire at different location are analyzed and the certainty of fractional flow reserve is reported and discussed. The current method is very helpful to increase the accuracy of fractional flow reserve procedure in stenosis severity estimation.

Abstract. The aim of the study is to assess the informativeness of a number of clinical, functional, laboratory parameters as indicators of cardiovascular pathology in workers exposed to harmful industrial factors during mandatory periodic medical examinations, to identify some pathogenetic mechanisms of the formation of the risk of cardiovascular diseases (CVD). The experienced workers (n=310) of the metallurgical enterprise of the Nizhny Novgorod region were examined. The sphygmometry indicators, the content of endothelin-1, nitric oxide, lipid profile, ox-LDL, and the levels of IgG-class autoantibodies (aAT) to the antigens of the myocardial and vascular wall structures were evaluated in addition to regulated researches. The complex approach made it possible to more fully identify violations of the cardiovascular system, and elucidate some of the pathogenetic mechanisms of CVD development in workers in hazardous working conditions.

The lesions of uncertain malignant potential of the breast, classified as B3, besides increasing the relative risk for breast cancer, have very heterogeneous abnormalities and raise a big question when defining conduct. A good multidisciplinary evaluation is necessary, comparing biopsy and imaging examination results. This study reports the case of a 54-year-old patient, without other risk factors for breast cancer, who was referred to MAMARJ, a mastology clinic, from a gynecology service, in November 2019 for evaluation of category 4 mammography, due to alterations in the right breast: linear and heterogeneous calcifications in the upper outer quadrant (UOQ) and punctiform and grouped calcifications lower inner quadrant (LIQ). Mammotomies were indicated, and histopathological reports were compatible with columnar cell hyperplasia with a focus on planar atypia — in the UOQ — and adenomyoepithelioma and columnar cell hyperplasia without atypia — in the LIQ. She was taken to surgery to remove the lesion from the UOQ (histopathology without malignancy). In July 2020, she underwent a mammography with a category 2 (BIRADS) report due to parenchymal distortion from previous surgery, and a ultrasonography with sparse cysts and bilateral ductal ectasia (category 3). One year later, in July 2021, she presented mammography — amorphous calcifications in the upper quadrants and punctate calcifications in the LIQ, near the clip from previous mammotomy. A mammotomy of the calcifications in the upper quadrants was performed. The diagnosis of the vacuum-guided biopsy was columnar cell changes with minimal architectural atypia in the upper quadrants. Removal of the lesion from the upper quadrants and the LIQ (target of the previous mammotomy) was indicated. The histopathological diagnosis was ductal carcinoma in situ (LIQ), associated with an atypical ductal hyperplasia, microcalcifications, and flat epithelial atypia. Immunohistochemical panel: estrogen receptor (ER) was positive, progesterone receptor (PR) was positive, and human epidermal growth factor receptor type 2 (HER2) was negative. The upper quadrant lesion was compatible with a focus on intraductal proliferation with discrete atypia. A simple mastectomy was performed with immediate reconstruction in the right breast. The mastectomy was indicated mainly because it was the patient’s choice. As suggested, since the first diagnosis of B3 lesion and after that of ductal carcinoma in situ, the patient did not accept chemoprevention. It should be noted that risk-reducing mastectomy is cited only rarely for the prevention in cases of even recurrent and multicentric premalignant lesions, as in this case.

Objective: The aim of this study was to discover the percentage of patients who underwent surgery due to a biopsy with a diagnosis of papillary lesion and who had their diagnosis underestimated for cancer, analyzing the biopsy data and comparing it with the post-surgical results in the past 10 years. Methods: Anatomopathological examinations of percutaneous core-type or vacuum breast biopsy between 2010 and 2020 with a result of the papillary lesion were analyzed and compared with the anatomopathological result obtained surgically. Cases in which the biopsy already demonstrated malignancy were excluded. The data were from the CEDAP (Centro de Diagnósticos Anátomo-Patológicos) pathological anatomy laboratory database in Joinville, Santa Catarina. Results: In the reported period, 126 biopsies were recorded with a diagnosis of breast papillary lesion. Of these, 21 were excluded because they did not meet the established criteria. In the follow-up examinations of the papillary lesions after surgery, 76 (72.4%) corresponded to benign lesions, including 30 cases demonstrating atypia, and 29 (27.6%) to carcinomas, of which 14 corresponded to invasive lesions and 15 in situ carcinomas. Conclusion: Papillary breast lesions are a diagnostic challenge in a biopsy, requiring sequential surgical excision, even though this practice is being questioned nowadays, due to the high risk of underestimation.

Objective: Pancreatic ductal adenocarcinoma (PDAC) has the best survival when detected early with 5-year survival near 40% for small, resectable PDAC. We evaluate the undiagnosed PDAC imaging features on routine CT and their impact on resectability. Methods: 76 of the screened 134 CTs from 1/1/2012 to 12/31/2018 using our tumor registry were obtained prior to PDAC diagnosis for other indications at least one month before presentation. Each cross-sectional study was reviewed for features of early PDAC: pancreatic mass, pancreatic ductal dilatation, perivascular/peripancreatic soft-tissue infiltration, omental lesions/ascites, and lymphadenopathy. When such features were detectible by the reviewing radiologists, the original CT readings were classified as concordant/discrepant. Descriptive statistics are reported for discrepant reads, tumor resectability, and tumor size. Results: Of the 76 cases from 46 unique subjects (30 male/16 female), 25 CTs (33%) had undetected PDAC imaging features: masses (15/19 unreported), ductal dilatation (16/20 unreported), and peripancreatic/perivascular soft-tissue infiltration (20/36 unreported). 63% of early PDAC features were not identified initially. One year before clinical diagnosis, 75-80% of the PDAC cases were resectable; at < 6 months before clinical diagnosis, only 29% were resectable. Conclusion: Improving early detection of key PDAC features on routine CT examinations can potentially improve patient outcomes.

Introduction: The increasing prevalence of chronic kidney disease (CKD), coupled with advancements in the diagnosis and treatment of renal diseases and improvements in life expectancy, has led to a greater number of patients requiring hemodialysis. The preferred method of vascular access for hemodialysis is AV fistula formation; however, it is associated with a high rate of failure. In our prospective study, we focused on 40 CKD patients planned for initiation of maintenance hemodialysis. Methods: We employed preoperative ultrasound mapping to assess cephalic vein diameter, compressibility, and colour flow, as well as radial and brachial artery diameter, peak systolic velocity, and intimal wall calcification. Postoperatively, ultrasound examinations were conducted on day 7 and at 6 weeks to evaluate fistula blood volume and detect any complications. Results: A significant association between fistula failure and cephalic vein diameter, brachial artery diameter, intimal vessel wall calcification, and comorbid conditions like diabetes mellitus was observed. Furthermore, blood flow at day 7 was notably lower in the failure group compared to those with a functioning fistula and any fistula with blood flow <154 ml/min on day 7 may be predictive of early fistula failure. Conclusion: Preoperative vessel mapping and early postoperative ultrasonography is indispensable for patients who require AV fistula formation for hemodialysis and provide valuable information for selecting suitable vessels for successful fistula creation and enable early intervention to salvage a failing fistula after the surgery. By utilizing these, healthcare professionals can make informed decisions and take necessary steps to optimize the outcomes of AV fistula formation in patients undergoing hemodialysis.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.

Overview Skin cancer prevention is a component of the new Cancer Plan 2022–27, which guides the work of the Cancer Institute NSW. To lessen the impact of skin cancer on the community, the Cancer Institute NSW works closely with the NSW Skin Cancer Prevention Advisory Committee, comprising governmental and non-governmental organisation representatives, to develop and implement the NSW Skin Cancer Prevention Strategy. Primary Health Networks and primary care providers are seen as important stakeholders in this work. To guide improvements in skin cancer prevention and inform the development of the next NSW Skin Cancer Prevention Strategy, an up-to-date review of the evidence on the effectiveness and feasibility of skin cancer prevention activities in primary care is required. A research team led by the Daffodil Centre, a joint venture between the University of Sydney and Cancer Council NSW, was contracted to undertake an Evidence Check review to address the questions below. Evidence Check questions This Evidence Check aimed to address the following questions: Question 1: What skin cancer primary prevention activities can be effectively administered in primary care settings? As part of this, identify the key components of such messages, strategies, programs or initiatives that have been effectively implemented and their feasibility in the NSW/Australian context. Question 2: What are the main barriers and enablers for primary care providers in delivering skin cancer primary prevention activities within their setting? Summary of methods The research team conducted a detailed analysis of the published and grey literature, based on a comprehensive search. We developed the search strategy in consultation with a medical librarian at the University of Sydney and the Cancer Institute NSW team, and implemented it across the databases Embase, MEDLINE, PsycInfo, Scopus, Cochrane Central and CINAHL. Results were exported and uploaded to Covidence for screening and further selection. The search strategy was designed according to the SPIDER tool for Qualitative and Mixed-Methods Evidence Synthesis, which is a systematic strategy for searching qualitative and mixed-methods research studies. The SPIDER tool facilitates rigour in research by defining key elements of non-quantitative research questions. We included peer-reviewed and grey literature that included skin cancer primary prevention strategies/ interventions/ techniques/ programs within primary care settings, e.g. involving general practitioners and primary care nurses. The literature was limited to publications since 2014, and for studies or programs conducted in Australia, the UK, New Zealand, Canada, Ireland, Western Europe and Scandinavia. We also included relevant systematic reviews and evidence syntheses based on a range of international evidence where also relevant to the Australian context. To address Question 1, about the effectiveness of skin cancer prevention activities in primary care settings, we summarised findings from the Evidence Check according to different skin cancer prevention activities. To address Question 2, about the barriers and enablers of skin cancer prevention activities in primary care settings, we summarised findings according to the Consolidated Framework for Implementation Research (CFIR). The CFIR is a framework for identifying important implementation considerations for novel interventions in healthcare settings and provides a practical guide for systematically assessing potential barriers and facilitators in preparation for implementing a new activity or program. We assessed study quality using the National Health and Medical Research Council (NHMRC) levels of evidence. Key findings We identified 25 peer-reviewed journal articles that met the eligibility criteria and we included these in the Evidence Check. Eight of the studies were conducted in Australia, six in the UK, and the others elsewhere (mainly other European countries). In addition, the grey literature search identified four relevant guidelines, 12 education/training resources, two Cancer Care pathways, two position statements, three reports and five other resources that we included in the Evidence Check. Question 1 (related to effectiveness) We categorised the studies into different types of skin cancer prevention activities: behavioural counselling (n=3); risk assessment and delivering risk-tailored information (n=10); new technologies for early detection and accompanying prevention advice (n=4); and education and training programs for general practitioners (GPs) and primary care nurses regarding skin cancer prevention (n=3). There was good evidence that behavioural counselling interventions can result in a small improvement in sun protection behaviours among adults with fair skin types (defined as ivory or pale skin, light hair and eye colour, freckles, or those who sunburn easily), which would include the majority of Australians. It was found that clinicians play an important role in counselling patients about sun-protective behaviours, and recommended tailoring messages to the age and demographics of target groups (e.g. high-risk groups) to have maximal influence on behaviours. Several web-based melanoma risk prediction tools are now available in Australia, mainly designed for health professionals to identify patients’ risk of a new or subsequent primary melanoma and guide discussions with patients about primary prevention and early detection. Intervention studies have demonstrated that use of these melanoma risk prediction tools is feasible and acceptable to participants in primary care settings, and there is some evidence, including from Australian studies, that using these risk prediction tools to tailor primary prevention and early detection messages can improve sun-related behaviours. Some studies examined novel technologies, such as apps, to support early detection through skin examinations, including a very limited focus on the provision of preventive advice. These novel technologies are still largely in the research domain rather than recommended for routine use but provide a potential future opportunity to incorporate more primary prevention tailored advice. There are a number of online short courses available for primary healthcare professionals specifically focusing on skin cancer prevention. Most education and training programs for GPs and primary care nurses in the field of skin cancer focus on treatment and early detection, though some programs have specifically incorporated primary prevention education and training. A notable example is the Dermoscopy for Victorian General Practice Program, in which 93% of participating GPs reported that they had increased preventive information provided to high-risk patients and during skin examinations. Question 2 (related to barriers and enablers) Key enablers of performing skin cancer prevention activities in primary care settings included: • Easy access and availability of guidelines and point-of-care tools and resources • A fit with existing workflows and systems, so there is minimal disruption to flow of care • Easy-to-understand patient information • Using the waiting room for collection of risk assessment information on an electronic device such as an iPad/tablet where possible • Pairing with early detection activities • Sharing of successful programs across jurisdictions. Key barriers to performing skin cancer prevention activities in primary care settings included: • Unclear requirements and lack of confidence (self-efficacy) about prevention counselling • Limited availability of GP services especially in regional and remote areas • Competing demands, low priority, lack of time • Lack of incentives.