Relevant bibliographies by topics / Health screening clinics

Academic literature on the topic 'Health screening clinics'

Author: Grafiati
Published: 10 December 2022
Last updated: 19 February 2023

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Journal articles on the topic "Health screening clinics"

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Buchanan, C., T. Manion, and R. Jayasinghe. "Heart Health Screening Clinics." Heart, Lung and Circulation 18 (2009): S195. http://dx.doi.org/10.1016/j.hlc.2009.05.442.

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Lock, Loren J., Roomasa Channa, Meghan B. Brennan, Ying Cao, and Yao Liu. "Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening." BMJ Open Diabetes Research & Care 10, no. 6 (December 2022): e003174. http://dx.doi.org/10.1136/bmjdrc-2022-003174.

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IntroductionRural versus urban disparities have been observed in diabetic eye screening, but whether the level of disadvantage in rural versus urban areas is related to these disparities is unclear. Our goal was to determine the role of level of disadvantage in explaining the effect of health systems on rural and urban disparities in diabetic eye screening.Research design and methodsThis is a retrospective cohort study using an all-payer, state-wide claims database covering over 75% of Wisconsin residents. We included adults with diabetes (18–75 years old) who had claims billed throughout the baseline (2012–2013) and measurement (2013–2014) years. We performed multivariable regressions to assess factors associated with receipt of diabetic eye screening. The primary exposure was the primary care clinic’s combined level of rurality and disadvantage. We adjusted for the health system as well as patient-level variables related to demographics and comorbidities. Health system was defined as an associated group of physicians and/or clinics.ResultsA total of 118 707 adults with diabetes from 698 primary care clinics in 143 health systems met the inclusion criteria. Patients from urban underserved clinics were less likely to receive screening than those from rural underserved clinics before adjusting for health system in the model. After adjusting for health system fixed effects, however, the directionality of the relationship between clinic rurality and screening reversed: patients from urban underserved clinics were more likely to receive screening than those from rural underserved clinics. Similar findings were observed for both Medicare and non-Medicare subgroups.ConclusionsThe effect of health system on receipt of diabetic eye screening in rural versus urban areas is most pronounced in underserved areas. Health systems, particularly those providing care to urban underserved populations, have an opportunity to increase screening rates by leveraging health system-level interventions to support patients in overcoming barriers from social determinants of health.
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Bloom, Joan R., Susan L. Stewart, Jocelyn Koo, and Robert A. Hiatt. "Cancer Screening in Public Health Clinics." Medical Care 39, no. 12 (December 2001): 1345–51. http://dx.doi.org/10.1097/00005650-200112000-00010.

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Buchanan, Christine. "Indigenous Heart Health Outreach Screening Clinics." Heart, Lung and Circulation 20 (January 2011): S4. http://dx.doi.org/10.1016/j.hlc.2011.04.016.

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Buchanan, Christine. "Indigenous Heart Health Outreach Screening Clinics." Heart, Lung and Circulation 21, no. 10 (October 2012): 651. http://dx.doi.org/10.1016/j.hlc.2012.07.029.

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de Vos, L., E. Mazinyo, D. Bezuidenhout, N. Ngcelwane, D. S. Mandell, S. H. Schriger, J. Daniels, and A. Medina-Marino. "Reasons for missed opportunities to screen and test for TB in healthcare facilities." Public Health Action 12, no. 4 (December 21, 2022): 171–73. http://dx.doi.org/10.5588/pha.22.0042.

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Missed opportunities for TB screening and/or passive testing in clinics continues to contribute to the number of missed cases. To understand reasons for these missed opportunities, we conducted focus group discussions with clinic-based nurses. Nurses described low indices of suspicion, prioritization of seemingly more urgent ailments and clinic operational challenges as barriers to TB screening and testing. To improve TB screening and testing in clinics, standard patients should be used to identify real-time factors that impact nurses’ clinical decision-making and engage in real-time feedback and discussion with nurses to help optimize opportunities for TB screening and testing.
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Stepien, Cathie J., Marilyn A. Bowbeer, and Roland G. Hiss. "Screening for Diabetic Retinopathy in Communities." Diabetes Educator 18, no. 2 (April 1992): 115–20. http://dx.doi.org/10.1177/014572179201800205.

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Twelve retinopathy screening clinics serving 489 diabetic patients were conducted in three Michigan communities as part of the outreach effort of the Michigan Diabetes Research and Training Center. Screening activities were initiated by local diabetes educators who conducted a program designed to promote detection of diabetic eye disease and increase patient and health care provider awareness of accepted ophthalmic evaluation guidelines. This experience suggests that retinopathy screening clinics can be successfully conducted if health care professionals in the community consider diabetic retinopathy to be a serious problem, one individual is willing to oversee the organizational aspects of the clinic, and an ophthalmologist with laser treatment capability is present or nearby. These clinics are effective in detecting diabetic eye disease and facilitating subsequent patient visits to an ophthalmologist for evaluation in accordance with national recommendations.
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Edwards, Joellen Beckett, and Fred Tudiver. "Women's Preventive Screening in Rural Health Clinics." Women's Health Issues 18, no. 3 (May 2008): 155–66. http://dx.doi.org/10.1016/j.whi.2008.01.005.

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Walker, Timothy J., Betsy Risendal, Michelle C. Kegler, Daniela B. Friedman, Bryan J. Weiner, Rebecca S. Williams, Shin-Ping Tu, and Maria E. Fernandez. "Assessing Levels and Correlates of Implementation of Evidence-Based Approaches for Colorectal Cancer Screening: A Cross-Sectional Study With Federally Qualified Health Centers." Health Education & Behavior 45, no. 6 (July 10, 2018): 1008–15. http://dx.doi.org/10.1177/1090198118778333.

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Multiple evidence-based approaches (EBAs) exist to improve colorectal cancer screening in health clinics. The success of these approaches is tied to effective implementation. Therefore, the purpose of this study was to assess the implementation of EBAs for colorectal cancer screening and clinic-level correlates of implementation in federally qualified health centers (FQHCs). We conducted descriptive and cross-sectional analyses using data collected from FQHC clinics across seven states ( n = 51). A clinic representative completed electronic surveys about clinic characteristics (e.g., size, patient characteristics, and medical record system characteristics) and the implementation of Community Guide recommended EBAs (e.g., client reminders, small media, and provider assessment and feedback). We used bivariate Spearman correlations to assess clinic-level correlates with implementation outcomes. Most clinics were planning to implement, in the early implementation stages, or inconsistently implementing EBAs. No EBA was fully implemented by more than nine (17.6%) clinics. Clinic size variables were inversely related to implementation levels of one-on-one education; medical record variables were directly related to implementation levels of client and provider reminders as well as provider assessment and feedback; and rapid and timely feedback from clinic leaders was directly associated with implementation levels of four out of six EBAs. Given the varying levels of implementation, clinics need to assess current use of implementation strategies and improve effective program delivery to increase colorectal cancer screening among their patients. In addition, clinics should also consider how their characteristics may support or serve as a barrier to implementation in their respective settings.
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MacDonald, Madeline, Abu-Sayeef Mirza, Rahul Mhaskar, Aldenise Ewing, Liwei Chen, Katherine Robinson, Yuanyuan Lu, et al. "Preventative Cancer Screening Rates Among Uninsured Patients in Free Clinics: A Retrospective Cohort Study of Cancer Survivors and Non-cancer Survivors." Cancer Control 29 (January 2022): 107327482110729. http://dx.doi.org/10.1177/10732748211072983.

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Background There is limited research on screening rates among uninsured cancer survivors. Uninsured cancer survivors are at higher risk of poorer health outcomes than the insured due to limited access to preventative screening for secondary cancers. This study examines the rates of surveillance and screening of uninsured cancer survivors and compares to uninsured patients without a cancer history seen in free clinics. Methods Data were collected retrospectively from electronic medical records and paper charts of patients from 10 free clinics between January 2016 and December 2018 in the Tampa Bay area. The prevalence of socioeconomic characteristics, cancer diagnoses, and screening practices were compared for cancer survivors and free clinic patients without a history of cancer. Study participants were determined to be eligible for cancer screenings based on the United States Preventive Services Task Force guidelines. Results Out of 13 982 uninsured patients frequenting free clinics between 2016 and 2018, 402 (2.9%) had a documented history of cancer. Out of the 285 eligible cancer survivors, 44 (15.4%) had completed age-appropriate colon cancer screening. Among the 170 female cancer survivors, 75 (44.1%) had completed breast cancer screenings, and only 5.9% (59/246) had completed cervical cancer screenings. After adjusting for age, gender, race, salary, employment status, and household size, cancer survivors were more likely to undergo colorectal cancer screening (OR: 3.59, 95% CI: 2.10–6.15) and breast cancer screening (OR: 2.13, 95% CI: 1.30–3.84) than patients without a cancer history. This difference was not seen for cervical cancer screening (OR: 0.99, 95% CI: .62–1.58). Conclusions Uninsured cancer survivors frequenting free clinics represent a unique population that is underrepresented in the medical literature. Our results suggest that uninsured survivors use screening services at higher rates when compared to uninsured patients without a reported cancer diagnosis. However, these rates are suboptimal when compared to national screening rates of insured cancer survivors.
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Dissertations / Theses on the topic "Health screening clinics"

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Clark, Rebecca Teresa, Christine Michelle Mullins, and Jean Croce Hemphill. "Monitoring Prediabetes Screening in Two Primary Care Clinics in Rural Appalachia: A Quality Improvement Project." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/12.

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Introduction: Prediabetes is major risk factor for the development of Type 2 Diabetes Mellitus (T2DM). One-third of the population in the United States has prediabetes, but 90% remain undiagnosed because healthcare providers are not performing screenings, making this a public health challenge. The purpose of this process improvement project was to implement prediabetes screening, prediabetes identification, and a referral process to a nutritionist to prevent or delay the onset of T2DM in patients in two Federally Qualified Health Centers. Methods: This was a quality improvement project conducted over a six-week period after receiving exemption from the University’s Internal Review Board. The Knowledge to Action framework was used to guide implementation of screening, prediabetes identification, management, and referral process. The outcomes were to measure the number and percent of screenings performed after provider education on prediabetes screening, those at risk for prediabetes, and the evidence-based interventions providers chose for management. The prediabetes risk assessment tool (PRAT) was the “Are you at risk for Type 2 Diabetes?” It was administered in both English and Spanish to adults who were not pregnant and had no previous diagnosis of Type 1 Diabetes Mellitus or T2DM. The preferred interventions included referral to a nutritionist, encourage 5%-7% total body weight loss, and/or 150 minutes of exercise per week. The PRAT and interventions data were coded, extracted into SPSS Version 25, and analyzed. Descriptive statistics were used to report patient characteristics, quantity of screenings performed, evidence-based recommendations offered, and patient risk factors for prediabetes. Results: In both clinics, 41% (n=269) of patients screened were found to be at risk for prediabetes. The most self-reported risk factor for prediabetes was family history of T2DM. Healthcare providers mostly provided education on weight loss and exercise, and recommended/referred less than 20% (n=49) of patients for nutritional education. The screening rates in the clinics were 52% (n=92) at site A and 72% (n=177) in site B, falling below the goal of 100%. Conclusions: There remains a gap in provider knowledge and use of evidence-based recommendations to decrease patients’ risk for prediabetes. The authors project that implementation of the PRAT and evidence-based interventions in the electronic health record would positively impact future screening results. This project set the benchmark for future efforts to educate, encourage, and measure providers successes.
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Swanepoel, Daniël Christiaan De Wet. "Infant hearing screening at maternal and child health clinics in a developing South African community." Pretoria : [s.n.], 2004. http://upetd.up.ac.za/thesis/available/etd-08242005-093303.

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Kiley, Elizabeth Ann. "Identification of Malnutrition in the Gastroenterology, Hepatology, and Nutrition Outpatient Clinics Using the Malnutrition Screening Tool." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1461158932.

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Palm, Anna. "Studies on routine inquiry about violence victimization and alcohol consumption in youth clinics." Doctoral thesis, Uppsala universitet, Obstetrik & gynekologi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-307393.

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Objectives: Violence victimization is common in youth, and the association between victimization and ill-health is well established. Youth is also the period when alcohol risk drinking is most prevalent. At youth clinics in Västernorrland, Sweden, a randomized controlled intervention was conducted examining health outcomes and risk drinking after implementing routine inquiry about violence victimization and alcohol consumption. Methods: Participants in the intervention group underwent routine inquiry about violence victimization and alcohol consumption. Victimized participants received empowering strategies and were offered further counseling. Risk drinkers received motivational interviewing (MI). All participants answered questionnaires about sociodemography and health at baseline, at 3 months and at 12 months. Of 1,445 eligible young women, 1,051 (73%) participated, with 54% of them completing the 12-month follow-up. Males were excluded from the quantitative analysis owing to the low number of male participants. Fifteen research interviews examining the experience of routine inquiry were conducted. Results: Violence-victimized young women reported more ill health than non-victimized women did. This was especially evident for those who had been multiply victimized. There were no differences in health outcomes between the baseline and the 12-month follow-up for the intervention group and for the control group. Of the victimized women in the intervention group, 14% wanted and received further counseling. There was a significant decrease in risk drinking from baseline to follow-up, but no differences between the MI group and the controls. There was a large intra-individual mobility in the young women’s drinking behavior. In interviews, the participants described how questions about violence had helped them to process prior victimization. For some, this initiated changes such as leaving a destructive relationship or starting therapy. The participants considered risk drinking in terms of consequences and did not find unit-based guidelines useful. Conclusion: Violence victimization, especially multiple victimization, was strongly associated with ill health in young women. Routine inquiry about violence and subsequent follow-up led to a high degree of disclosure but did not improve self-reported health. However, victimized participants described talking about prior victimization as very helpful. Participants viewed risk drinking in terms of consequences rather than in quantity or frequency of alcohol, which may render unit-based drinking guidelines less useful when addressing risk drinking in youth.
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Ray, Robyn T. "Utilization of a Clinical Reminder System to Increase the Incidence of HIV Screening in a Primary Care Clinic." Thesis, University of Louisiana at Lafayette, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3712863.

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HIV infection is a leading cause of morbidity and mortality in our country today with nearly 1.2 million Americans living with HIV infection. Early recognition of infection is imperative for appropriate initiation of treatment to prevent comorbidities. Additionally, identification of infection can serve as a primary preventative measure to reduce spread of the disease. National organizations have supported the initiation of routine screening policies for HIV in health care settings. Primary care providers are uniquely positioned to be able to offer HIV screenings and identify infected persons very early in the course of the disease. Despite support for routine testing in the literature and by national evidence-based guidelines, testing is still not offered routinely in the primary care setting. The purpose of this project was to explore if a clinical reminder improves the frequency of HIV screening offered in a rural primary care clinic (PCC) located in Central Louisiana. Results of the project did show a statistically significant increase in the frequency of HIV screening offered following implementation of the clinical reminder system.

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Bennett, Jennifer Gay. "Implementing Lipid Screening Guidelines for Children in a Rural Health Clinic." Thesis, University of Louisiana at Lafayette, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10163291.

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During the past three decades, there has been an abundance of research regarding cardiovascular disease and the pathology responsible for it. The incidence of childhood obesity and dyslipidemia are at the highest in history. Evidence exists demonstrating that arterial changes leading to cardiovascular disease begin in childhood. The National Heart, Lung, and Blood Institute (NHLBI), along with the American Academy of Pediatrics (AAP), issued guidelines in 2011 advocating for the screening of all children for dyslipidemia in order to identify children at-risk for development of cardiovascular disease and to implement interventions. The purpose of this synthesis project was to implement an evidence-based quality improvement project to screen lipids in children at the Start Community Clinic (SCC), a rural health clinic in Northeast Louisiana. Statistical Process Control (SPC) was used to evaluate both processes and outcomes. Outcomes measured include the number of children eligible to be screened compared to the number of children screened. Control charts were used to determine the stability and success of the improvement effort in implementing the evidence-based guideline. The guideline implementation using quality management techniques was successful and resulted in lipid screening of 60% of eligible children within the project time frame.

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Toth-Pal, Eva. "Computer decision support systems for opportunistic health screening and for chronic heart failure management in primary health care /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-435-8/.

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Back, Jenny. "Private Health Practitioners' experience of and attitude screening for Postnatal Depression." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10149.

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Ten to fifteen per cent of women from affluent countries, utilising private health care services are diagnosed with Postnatal Depression (PND) annually. Despite the high prevalence and the negative consequences for mother, child and partner, PND remains largely undiagnosed. Thus, this study explored health practitioners' experience of and attitude towards screening for postnatal depression to explore the barriers to screening as well as potential mechanisms to improve the rate of detection.
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Hunley, Alacyn Johnson. "Optimizing Prediabetes Screening in a Rural Primary Care Clinic." Thesis, University of Louisiana at Lafayette, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=10981632.

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Purpose: Implement and evaluate a formal evidence-based risk screening protocol in a rural clinic setting to optimize early identification of prediabetes and T2DM in asymptomatic, non-pregnant adults age 18–44.

Significance: Absence of an evidence-based risk screening protocol contributed to under/overutilization in laboratory test referral and inconsistency in prescribed treatments among clinic providers. Early identification of prediabetes and initiation of appropriate treatment plans may assist in preventing T2DM and its associated complications.

Methodology: Quality improvement project utilizing a retrospective, randomized representative sample of charts, n = 30 and a convenience sample of participants, n = 40. The American Diabetes Association Diabetes Risk Test (ADA DRT) served as a prediabetes risk screening tool. Provider adherence to ADA DRT risk screening and laboratory test referral, type of laboratory test ordered, the relationship between demographic characteristics and the ADA DRT score, participant follow-up, and treatment ordered based on risk screening and laboratory results were analyzed using group data.

Results: Thirteen (35.7%) participants had laboratory values in the prediabetes or T2DM range and 100% of treatment ordered are substantiated by ADA guidelines. Using the ADA DRT tool, risk screening was completed in 100% of eligible participants; accordingly, appropriate utilization of laboratory test referral improved by 33.33%.

Recommendation: Incorporation of best-practices for risk screening and laboratory test referral for early identification of prediabetes is needed. APRNs are instrumental in promoting efficacious screening strategies and preventative treatment aimed at improving health outcomes. The benefits of using the ADA DRT as a prediabetes risk screening protocol in primary care should be elucidated in a prospective study.

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Johanson, Kirsten S. "Increasing Colorectal Cancer Screening Rates in a Rural Health Clinic through Practice Change." Otterbein University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1460902876.

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Books on the topic "Health screening clinics"

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Vermont. Dept. of Health. Mobile screening clinics: Report to the Legislature on Act 27 - 10. Burlington, Vt: Vermont Dept. of Health, 2007.

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Clinical Standards Board for Scotland. Diabetic retinopathy screening: Clinical standards - March 2004. Edinburgh: Clinical Standards Board for Scotland, 2004.

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Law, J. Screening for speech and language delay: A systematic review of the literature. Alton (GB): Core Research, 1998.

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Bartu, Anne. Evaluation of a preventative intervention strategy in a non-clinical setting using computerised screening. [Perth, W.A.]: Western Australian Alcohol & Drug Authority, 1991.

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Medical Tests Sourcebook: Basic Consumer Health Information about Medical Tests, Including Age-Specific Health Tests, Important Health Screenings and Exams, ... Reference Series) (Health Reference Series). 2nd ed. Detroit, Mich.: Omnigraphics, Inc., 2004.

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Offit, Kenneth. Clinical cancer genetics: Risk counseling and management. New York: Wiley-Liss, 1998.

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United States. Congress. Senate. Committee on Health, Education, Labor, and Pensions. Severe acute respiratory syndrome threat (SARS): Hearing before the Committee on Health, Education, Labor, and Pensions, United States Senate, One Hundred Eighth Congress, first session on examining the severe acute respiratory syndrome threat, focusing on the issues of vaccine development, drug screening, and clinical research, April 7, 2003. Washington: U.S. G.P.O., 2003.

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Adsul, Prajakta, and Purnima Madhivanan. Assessing the Community Context When Implementing Cervical Cancer Screening Programs. Edited by David A. Chambers, Wynne E. Norton, and Cynthia A. Vinson. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190647421.003.0032.

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This case study demonstrates the use of qualitative, community-based, participatory research to understand the context in which cervical cancer screening programs are implemented in rural India, thereby enabling not just successful implementation but also future sustainability of the program in the community. A series of studies were undertaken to understand the cervical cancer screening program in its current state and provide information for the implementation of future programs. These studies included (1) qualitative interviews with physicians delivering cervical cancer care in the private and public sector, (2) focus group discussions with health workers in primary health care clinics, and (3) photovoice study with women residing in the communities. Study findings helped identify elements of the social and cultural context of rural communities, thereby providing a rich understanding of factors influencing of cervical cancer screening that can be integrated into pre-intervention capacity development in the future.
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How to Integrate Pharmacotherapy for Substance Use Disorders at Your Mental Health Clinic: A Step-By-Step Guide for Screening and Treating Adults with Co-Occurring Mental Illness and Alcohol and/or Opioid Use Disorders with Pharmacotherapy in Mental Health Clinics. RAND Corporation, 2021. http://dx.doi.org/10.7249/tl-a928-1.

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Maloney, Michael P., Joel Dvoskin, and Jeffrey L. Metzner. Mental health screening and brief assessments. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0011.

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Screening and assessment are a core component of psychiatric care in any setting. In jails and prisons, the process, structure, content and timing of screenings and assessments are vital parts of the healthcare system. While the number of incarcerated persons is clear, the actual number of incarcerated prisoners who suffer from a mental disorder or independent psychiatric symptoms is difficult to determine because of methodological issues (e.g., different definitions of mental illness, different thresholds of severity, etc.) as well as wide variation in the nature (e.g. prison, jail, police lockup), size, and mental health service delivery systems of various settings. However, despite differences in methodology, geographic area, and other issues (e.g., types of facility, when studies were conducted, etc.), virtually every relevant study has concluded that a significant number of prisoners have serious mental illnesses and that the numbers of mentally ill prisoners are increasing. Because people with mental illnesses are at risk of suicide and exacerbations of their mental illnesses, correctional institutions need to identify such persons in a timely manner and provide appropriate clinical interventions. This chapter addresses the initial mental health screening of persons entering prisons and jails, with a special emphasis on suicide risk screening and follow-up clinical assessments of prisoners whose receiving or intake screening results suggest the likelihood that treatment or suicide prevention efforts will be necessary.
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Book chapters on the topic "Health screening clinics"

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Zenner, Dominik. "Approaches to New Entrant Screening and Occupational Health Screening." In Tuberculosis in Clinical Practice, 349–66. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-75509-6_19.

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Goodman, Melody S. "Diagnostic testing/screening." In Biostatistics for Clinical and Public Health Research, 89–106. Milton Park, Abingdon, Oxon ; New York, NY : Routledge, 2018.: Routledge, 2017. http://dx.doi.org/10.4324/9781315155661-5.

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Lee, Sherman A., and Robert A. Neimeyer. "Pandemic Grief Scale (PGS): A Clinical Screening Tool." In International Handbook of Behavioral Health Assessment, 1–13. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-89738-3_11-1.

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Lee, Sherman A., and Robert A. Neimeyer. "Pandemic Grief Scale (PGS): A Clinical Screening Tool." In International Handbook of Behavioral Health Assessment, 1–13. Cham: Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-030-89738-3_11-2.

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Hurley, Brian, Kenny Lin, Suni Niranjan Jani, and Kevin Kapila. "Screening and Assessment of Trauma in Clinical Populations." In Trauma, Resilience, and Health Promotion in LGBT Patients, 183–90. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-54509-7_15.

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Dvorsky, Melissa R., Erin Girio-Herrera, and Julie Sarno Owens. "School-Based Screening for Mental Health in Early Childhood." In Issues in Clinical Child Psychology, 297–310. Boston, MA: Springer US, 2013. http://dx.doi.org/10.1007/978-1-4614-7624-5_22.

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Siefert, Caleb J. "Screening for Personality Disorders in Psychiatric Settings: Four Recently Developed Screening Measures." In Handbook of Clinical Rating Scales and Assessment in Psychiatry and Mental Health, 125–44. Totowa, NJ: Humana Press, 2009. http://dx.doi.org/10.1007/978-1-59745-387-5_6.

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Tarren-Sweeney, Michael. "Clinical interventions and support services for children in alternative care (and their carers)." In Mental Health Screening and Monitoring for Children in Care, 56–86. Milton Park, Abingdon, Oxon ; New York, NY : Routledge, 2018.: Routledge, 2018. http://dx.doi.org/10.4324/9781315102078-2.

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Marcus, Pamela M. "Foundations." In Assessment of Cancer Screening, 1–13. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-94577-0_1.

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AbstractThe ability to understand cancer screening data does not require an extensive background in biostatistics, biology, or oncology. Rather, it requires clear thinking, an open mind, and knowledge of a small set of foundational concepts, which are presented in this chapter. Cancer screening, the routine, periodic testing for signs of cancer among individuals who have no symptoms, is explained and its goals, at both an individual and population level, are discussed. Reasons that have driven the decision to screen for certain cancers in the US are presented, as are reasons that have driven the choice of who to screen. The clinical activities that come before and after application of the screening test, including invitation to be screened, diagnostic evaluation of a positive test, and cancer diagnosis, as well as the need to consider them when evaluating cancer screening, are discussed. Organized screening programs and opportunistic screening are compared and their strengths and weaknesses are noted. The most frequently used metrics of benefit of cancer screening are presented along with arguments for and against their use. The reason why efficacy, the ability of cancer screening to lead to a benefit in an experimental setting, does not guarantee effectiveness, the ability to lead to a benefit in a community setting, is discussed. The chapter closes with discussion of a central issue in cancer screening: the practice turns some healthy individuals into cancer patients, perhaps with no gain.
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Hastings, Debra Pilling, and Glenda Kaufman Kantor. "Screening for family violence with perioperative patients." In Health consequences of abuse in the family: A clinical guide for evidence-based practice., 33–44. Washington: American Psychological Association, 2004. http://dx.doi.org/10.1037/10674-002.

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Conference papers on the topic "Health screening clinics"

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John, Sheila, Sangeetha Srinivasan, Keerthi Ram, and Mohanasankar Sivaprakasam. "Effectiveness of a computer-assisted algorithm for onsite screening of diabetic retinopathy from retinal photographs at diabetic outpatient clinics." In The 18th international symposium on health information management research. Linnaeus University Press, 2022. http://dx.doi.org/10.15626/ishimr.2020.03.

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Purpose: To examine the effectiveness of a computer-assisted algorithm for onsite screening for diabetic retinopathy (DR) at diabetic outpatient clinics. Methods: 1263 patients were examined over two years. Undilated fundus photographs were acquired at the clinic. Photographs were independently assessed by an ophthalmologist and optometrist in a darkened room in a masked fashion and also processed through the algorithm. DR was defined per the International Clinical Diabetic Retinopathy Disease Severity Scale and severity of diabetic retinopathy. Results: 2526 eyes of 1263 patients were assessed. The algorithm successfully graded 2153 (85%) images with 63.04% sensitivity and 79.63% specificity compared to an ophthalmologist; in comparison to an optometrist, sensitivity and specificity were 60.87% and 79.05%, respectively. The agreement between ophthalmologist and optometrist was kappa=0.835 for presence of DR, 0.835 for severity of DR. Conclusion: This algorithm may be a utilized in a diabetic clinic for a quick screening with only the retinal photographs.
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Perera, SJ, A. Shrivastava, F. Borg, and V. Geh. "G308 Combined rheumatology and orthoptic-led screening clinics for juvenile idiopathic arthritis." In Royal College of Paediatrics and Child Health, Abstracts of the RCPCH Conference–Online, 25 September 2020–13 November 2020. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health, 2020. http://dx.doi.org/10.1136/archdischild-2020-rcpch.268.

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Morton, Rentonia, Megan Cotter, Kara Riehman, Lily Shuting Liang, Michelle Kegler, Emily Phillips, Derrick Beasley, April Hermstad, and Jeremy Martinez. "Abstract B79: Addressing patient barriers to cancer screening in safety net clinics." In Abstracts: Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; November 13-16, 2015; Atlanta, Georgia. American Association for Cancer Research, 2016. http://dx.doi.org/10.1158/1538-7755.disp15-b79.

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Arnold, Connie L., Terry C. Davis, James Morris, Peggy Murphy, and Glenn Mills. "Abstract PR12: CRC screening in rural community clinics using the fecal immunochemical test (FIT): Issues with repeat screening." In Abstracts: Eleventh AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; November 2-5, 2018; New Orleans, LA. American Association for Cancer Research, 2020. http://dx.doi.org/10.1158/1538-7755.disp18-pr12.

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Arnold, Connie L., Terry C. Davis, Alfred W. Rademaker, James Morris, and Glenn Mills. "Abstract 770: Colorectal cancer screening in rural community health clinics using the fecal immunochemical test (FIT)." In Proceedings: AACR Annual Meeting 2017; April 1-5, 2017; Washington, DC. American Association for Cancer Research, 2017. http://dx.doi.org/10.1158/1538-7445.am2017-770.

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Arnold, Connie L., Terry C. Davis, Alfred Rademaker, James Morris, and Glenn Mills. "Abstract B11: Sustaining annual colorectal cancer screening in rural community health clinics using the fecal immunochemical test (FIT)." In Abstracts: Tenth AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; September 25-28, 2017; Atlanta, GA. American Association for Cancer Research, 2018. http://dx.doi.org/10.1158/1538-7755.disp17-b11.

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Jamison, Kelly, Preeti Pathela, Susan Blank, and Julia Schillinger. "O06.5 Do treatment rates suffer in a low-touch screening model? new york city sexual health clinics, 2017–2018." In Abstracts for the STI & HIV World Congress (Joint Meeting of the 23rd ISSTDR and 20th IUSTI), July 14–17, 2019, Vancouver, Canada. BMJ Publishing Group Ltd, 2019. http://dx.doi.org/10.1136/sextrans-2019-sti.138.

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MacDonald, Madeline, Justin Swanson, Shreni Shah, Jhulianna Vivar, Ethan Song, Tanzila Ahsan, Rahul Mhaskar, and Abu-Sayeef Mirza. "Abstract PO-248: Breast cancer risk factors, prevalence, and screening rates in uninsured women seen at free clinics." In Abstracts: AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; October 2-4, 2020. American Association for Cancer Research, 2020. http://dx.doi.org/10.1158/1538-7755.disp20-po-248.

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Welch, A. C., C. L. Wilshire, C. Gilbert, and J. A. Gorden. "Distance Between Indian Health Affiliated Clinics and Lung Cancer Screening Sites Suggest Structural Barriers in Access to Lung Cancer Screening in American Indian and Alaska Native Communities in Washington State." In American Thoracic Society 2021 International Conference, May 14-19, 2021 - San Diego, CA. American Thoracic Society, 2021. http://dx.doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1741.

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Saputri, Eviana Maya. "Urgency of Violence Screening in Pregnant Women: A Scoping Review." In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.03.61.

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ABSTRACT Background: Partner violence during pregnancy might contribute to the clinical conditions of pregnant women. Early assessment and supportive response are required to improve clinical diagnosis and subsequent care. This scoping review aimed to identify the partner violence screening practices of community-based health care providers in pregnant women. Subjects and Method: A scoping review method was conducted in eight stages including (1) Identification of study problems; (2) Determining priority problem and study question; (3) Determining framework; (4) Literature searching; (5) Article selec­tion; (6) Critical appraisal; (7) Data extraction; and (8) Mapping. The search included PubMed, Science Direct, EBSCO, Wiley Online Library, and ProQuest databases. The inclusion criteria were English-language and full-text articles published between 2010 and 2020. A total of 580 articles were obtained by the searched database. After the review process, eight articles were eligible for this review. The critical appraisal for searched articles were measured by Mix Methods Appraisal Tools (MMAT). The data were reported by the PRISMA flow chart. Results: Two articles from developing countries (Zimbabwe and Kenya) and six articles from developed countries (Australia, Norway, Italy, and Sweden) met the inclusion criteria with a mixed-method, qualitative, and quantitative (cross-sectional) studies. The existing studies revealed that violence screening in pregnant women was effective to increase awareness of violence by their partners. Screening practice had an empowering effect on women to disclose the violence experienced. Barriers to the health care providers performing partner violence screening included: lack of knowledge, experience and training, confidence in undertaking the screening, taboo cultural practices, and absence of domestic violence screening policies. Conclusion: Partner violence screening practice should be strongly considered at antenatal care visits. Further insights of community-based health care providers are required to perform effective screening. Keywords: partner violence screening, pregnant women, health care providers Correspondence: Eviana Maya Saputri. Universitas ‘Aisyiyah Yogyakarta. Jl. Siliwangi No. 63, Nogotirto, Gamping, Sleman, Yogyakarta, 55292. Email: evianamaya34@gmail.com. Mobile: +6281367470323. DOI: https://doi.org/10.26911/the7thicph.03.61
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Reports on the topic "Health screening clinics"

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Barclay, Colleen, Meera Viswanathan, Shana Ratner, Julia Tompkins, and Daniel E. Jonas. Implementing Evidence-Based Screening and Counseling for Unhealthy Alcohol Use With Epic-Based Electronic Health Record Tools. A Guide for Clinics and Health Systems, Developed as Part of a Pilot Dissemination Project. Agency for Healthcare Research and Quality (AHRQ), September 2018. http://dx.doi.org/10.23970/ahrqepcmethengagealcoholguide.

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Schnabel, Filipina, and Danielle Aldridge. Effectiveness of EHR-Depression Screening Among Adult Diabetics in an Urban Primary Care Clinic. University of Tennessee Health Science Center, April 2021. http://dx.doi.org/10.21007/con.dnp.2021.0003.

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Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR). Methods We conducted a retrospective chart review on patients aged 18 years and above with a diagnosis of DM2 and no initial diagnosis of depression or other mental illnesses. Chart reviews included those from 2018 or prior for before integration data and 2020 to present for after integration. Sixty subjects were randomly selected from a pool of 33,695 patients in the clinic with DM2 from the year 2013-2021. Thirty of the patients were prior to the integration of depression screening tools PHQ2 and PHQ9 into the EHR, while the other half were post-integration. The study population ranged from 18-83 years old. Results All subjects (100%) were screened using PHQ2 before integration and after integration. Twenty percent of patients screened had a positive PHQ2 among subjects before integration, while 10% had a positive PHQ2 after integration. Twenty percent of patients were screened with a PHQ9 pre-integration which accounted for 100% of those subjects with a positive PHQ2. However, of the 10% of patients with a positive PHQ2 post-integration, only 6.7 % of subjects were screened, which means not all patients with a positive PHQ2 were adequately screened post-integration. Interestingly, 10% of patients were treated with antidepressants before integration, while none were treated with medications in the post-integration group. There were no referrals made to the behavior team in either group. Conclusion There is no difference between the prevalence of depression screening before or after integration of depression screening tools in the EHR. The study noted that there is a decrease in the treatment using antidepressants after integration. However, other undetermined conditions could have influenced this. Furthermore, not all patients with positive PHQ2 in the after-integration group were screened with PHQ9. The authors are unsure if the integration of the depression screens influenced this change. In both groups, there is no difference between referrals to the behavior team. Implications to Nursing Practice This quality improvement study shows that providers are good at screening their DM2 patients for depression whether the screening tools were incorporated in the EHR or not. However, future studies regarding providers, support staff, and patient convenience relating to accessibility and availability of the tool should be made. Additional issues to consider are documentation reliability, hours of work to scan documents in the chart, risk of documentation getting lost, and the use of paper that requires shredding to comply with privacy.
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Hajarizadeh, Behzad, Jennifer MacLachlan, Benjamin Cowie, and Gregory J. Dore. Population-level interventions to improve the health outcomes of people living with hepatitis B: an Evidence Check brokered by the Sax Institute for the NSW Ministry of Health, 2022. The Sax Institute, August 2022. http://dx.doi.org/10.57022/pxwj3682.

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Background An estimated 292 million people are living with chronic hepatitis B virus (HBV) infection globally, including 223,000 people in Australia. HBV diagnosis and linkage of people living with HBV to clinical care is suboptimal in Australia, with 27% of people living with HBV undiagnosed and 77% not receiving regular HBV clinical care. This systematic review aimed to characterize population-level interventions implemented to enhance all components of HBV care cascade and analyse the effectiveness of interventions. Review questions Question 1: What population-level interventions, programs or policy approaches have been shown to be effective in reducing the incidence of hepatitis B; and that may not yet be fully rolled out or evaluated in Australia demonstrate early effectiveness, or promise, in reducing the incidence of hepatitis B? Question 2: What population-level interventions and/or programs are effective at reducing disease burden for people in the community with hepatitis B? Methods Four bibliographic databases and 21 grey literature sources were searched. Studies were eligible for inclusion if the study population included people with or at risk of chronic HBV, and the study conducted a population-level interventions to decrease HBV incidence or disease burden or to enhance any components of HBV care cascade (i.e., diagnosis, linkage to care, treatment initiation, adherence to clinical care), or HBV vaccination coverage. Studies published in the past 10 years (since January 2012), with or without comparison groups were eligible for inclusion. Studies conducting an HBV screening intervention were eligible if they reported proportion of people participating in screening, proportion of newly diagnosed HBV (participant was unaware of their HBV status), proportion of people received HBV vaccination following screening, or proportion of participants diagnosed with chronic HBV infection who were linked to HBV clinical care. Studies were excluded if study population was less than 20 participants, intervention included a pharmaceutical intervention or a hospital-based intervention, or study was implemented in limited clinical services. The records were initially screened by title and abstract. The full texts of potentially eligible records were reviewed, and eligible studies were selected for inclusion. For each study included in analysis, the study outcome and corresponding 95% confidence intervals (95%CIs) were calculated. For studies including a comparison group, odds ratio (OR) and corresponding 95%CIs were calculated. Random effect meta-analysis models were used to calculate the pooled study outcome estimates. Stratified analyses were conducted by study setting, study population, and intervention-specific characteristics. Key findings A total of 61 studies were included in the analysis. A large majority of studies (study n=48, 79%) included single-arm studies with no concurrent control, with seven (12%) randomised controlled trials, and six (10%) non-randomised controlled studies. A total of 109 interventions were evaluated in 61 included studies. On-site or outreach HBV screening and linkage to HBV clinical care coordination were the most frequent interventions, conducted in 27 and 26 studies, respectively. Question 1 We found no studies reporting HBV incidence as the study outcome. One study conducted in remote area demonstrated that an intervention including education of pregnant women and training village health volunteers enhanced coverage of HBV birth dose vaccination (93% post-intervention, vs. 81% pre-intervention), but no data of HBV incidence among infants were reported. Question 2 Study outcomes most relevant to the HBV burden for people in the community with HBV included, HBV diagnosis, linkage to HBV care, and HBV vaccination coverage. Among randomised controlled trials aimed at enhancing HBV screening, a meta-analysis was conducted including three studies which implemented an intervention including community face-to-face education focused on HBV and/or liver cancer among migrants from high HBV prevalence areas. This analysis demonstrated a significantly higher HBV testing uptake in intervention groups with the likelihood of HBV testing 3.6 times higher among those participating in education programs compared to the control groups (OR: 3.62, 95% CI 2.72, 4.88). In another analysis, including 25 studies evaluating an intervention to enhance HBV screening, a pooled estimate of 66% of participants received HBV testing following the study intervention (95%CI: 58-75%), with high heterogeneity across studies (range: 17-98%; I-square: 99.9%). A stratified analysis by HBV screening strategy demonstrated that in the studies providing participants with on-site HBV testing, the proportion receiving HBV testing (80%, 95%CI: 72-87%) was significantly higher compared to the studies referring participants to an external site for HBV testing (54%, 95%CI: 37-71%). In the studies implementing an intervention to enhance linkage of people diagnosed with HBV infection to clinical care, the interventions included different components and varied across studies. The most common component was post-test counselling followed by assistance with scheduling clinical appointments, conducted in 52% and 38% of the studies, respectively. In meta-analysis, a pooled estimate of 73% of people with HBV infection were linked to HBV clinical care (95%CI: 64-81%), with high heterogeneity across studies (range: 28-100%; I-square: 99.2%). A stratified analysis by study population demonstrated that in the studies among general population in high prevalence countries, 94% of people (95%CI: 88-100%) who received the study intervention were linked to care, significantly higher than 72% (95%CI: 61-83%) in studies among migrants from high prevalence area living in a country with low prevalence. In 19 studies, HBV vaccination uptake was assessed after an intervention, among which one study assessed birth dose vaccination among infants, one study assessed vaccination in elementary school children and 17 studies assessed vaccination in adults. Among studies assessing adult vaccination, a pooled estimate of 38% (95%CI: 21-56%) of people initiated vaccination, with high heterogeneity across studies (range: 0.5-93%; I square: 99.9%). A stratified analysis by HBV vaccination strategy demonstrated that in the studies providing on-site vaccination, the uptake was 78% (95%CI: 62-94%), significantly higher compared to 27% (95%CI: 13-42%) in studies referring participants to an external site for vaccination. Conclusion This systematic review identified a wide variety of interventions, mostly multi-component interventions, to enhance HBV screening, linkage to HBV clinical care, and HBV vaccination coverage. High heterogeneity was observed in effectiveness of interventions in all three domains of screening, linkage to care, and vaccination. Strategies identified to boost the effectiveness of interventions included providing on-site HBV testing and vaccination (versus referral for testing and vaccination) and including community education focussed on HBV or liver cancer in an HBV screening program. Further studies are needed to evaluate the effectiveness of more novel interventions (e.g., point of care testing) and interventions specifically including Indigenous populations, people who inject drugs, men who have sex with men, and people incarcerated.
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Cuesta, Ana, Lucia Delgado, Sebastián Gallegos, Benjamin Roseth, and Mario Sánchez. Increasing the Take-up of Public Health Services: An Experiment on Nudges and Digital Tools in Uruguay. Inter-American Development Bank, July 2021. http://dx.doi.org/10.18235/0003397.

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In this paper, we test whether promoting digital government tools increases the take-up of an important public health prevention service: cervical cancer screening. We implemented an at-scale field experiment in Uruguay, randomly encouraging women to make medical appointments with a digital application or reminding them to do it as usual at their local clinic. Using administrative records, we found that the digital application nearly doubled attendance of a screening appointment compared to reminders and tripled the rate compared to a pure control group (3.2 percentage point increase over a base of 1.9 percent). Survey data suggests that the impacts of the intervention were mostly mediated by reduced transaction costs. Our results highlight the potential of investing in digital government to improve the take-up of public services.
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Wallace, Ina F. Universal Screening of Young Children for Developmental Disorders: Unpacking the Controversies. RTI Press, February 2018. http://dx.doi.org/10.3768/rtipress.2018.op.0048.1802.

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In the past decade, American and Canadian pediatric societies have recommended that pediatric care clinicians follow a schedule of routine surveillance and screening for young children to detect conditions such as developmental delay, speech and language delays and disorders, and autism spectrum disorder. The goal of these recommendations is to ensure that children with these developmental issues receive appropriate referrals for evaluation and intervention. However, in 2015 and 2016, the US Preventive Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care issued recommendations that did not support universal screening for these conditions. This occasional paper is designed to help make sense of the discrepancy between Task Force recommendations and those of the pediatric community in light of research and practice. To clarify the issues, this paper reviews the distinction between screening and surveillance; the benefits of screening and early identification; how the USPSTF makes its recommendations; and what the implications of not supporting screening are for research, clinical practice, and families.
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Cook, R., S. Adams, J. Beauchamp, M. Bevelhimer, B. Blaylock, C. Brandt, C. Ford, et al. Phase 1 data summary report for the Clinch River Remedial Investigation: Health risk and ecological risk screening assessment. Office of Scientific and Technical Information (OSTI), December 1992. http://dx.doi.org/10.2172/6621390.

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Cook, Robert, Susan K. Holladay, Marshall Adams, Leslie A. Hook, John Beauchamp, Daniel Levine, Mark Bevelhimer, et al. Phase 1 Data Summary Report for the Clinch River Remedial Investigation: Health Risk and Ecological Risk Screening Assessment. Office of Scientific and Technical Information (OSTI), December 1992. http://dx.doi.org/10.2172/814569.

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Cook, R., S. Adams, J. Beauchamp, M. Bevelhimer, B. Blaylock, C. Brandt, C. Ford, et al. Phase 1 data summary report for the Clinch River Remedial Investigation: Health risk and ecological risk screening assessment. Environmental Restoration Program. Office of Scientific and Technical Information (OSTI), December 1992. http://dx.doi.org/10.2172/10117530.

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Rankin, Nicole, Deborah McGregor, Candice Donnelly, Bethany Van Dort, Richard De Abreu Lourenco, Anne Cust, and Emily Stone. Lung cancer screening using low-dose computed tomography for high risk populations: Investigating effectiveness and screening program implementation considerations: An Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Cancer Institute NSW. The Sax Institute, October 2019. http://dx.doi.org/10.57022/clzt5093.

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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.
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Tipton, Kelley, Brian F. Leas, Nikhil K. Mull, Shazia M. Siddique, S. Ryan Greysen, Meghan B. Lane-Fall, and Amy Y. Tsou. Interventions To Decrease Hospital Length of Stay. Agency for Healthcare Research and Quality (AHRQ), September 2021. http://dx.doi.org/10.23970/ahrqepctb40.

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Background. Timely discharge of hospitalized patients can prevent patient harm, improve patient satisfaction and quality of life, and reduce costs. Numerous strategies have been tested to improve the efficiency and safety of patient recovery and discharge, but hospitals continue to face challenges. Purpose. This Technical Brief aimed to identify and synthesize current knowledge and emerging concepts regarding systematic strategies that hospitals and health systems can implement to reduce length of stay (LOS), with emphasis on medically complex or vulnerable patients at high risk for prolonged LOS due to clinical, social, or economic barriers to timely discharge. Methods. We conducted a structured search for published and unpublished studies and conducted interviews with Key Informants representing vulnerable patients, hospitals, health systems, and clinicians. The interviews provided guidance on our research protocol, search strategy, and analysis. Due to the large and diverse evidence base, we limited our evaluation to systematic reviews of interventions to decrease hospital LOS for patients at potentially higher risk for delayed discharge; primary research studies were not included, and searches were restricted to reviews published since 2010. We cataloged the characteristics of relevant interventions and assessed evidence of their effectiveness. Findings. Our searches yielded 4,364 potential studies. After screening, we included 19 systematic reviews reported in 20 articles. The reviews described eight strategies for reducing LOS: discharge planning; geriatric assessment or consultation; medication management; clinical pathways; inter- or multidisciplinary care; case management; hospitalist services; and telehealth. All reviews included adult patients, and two reviews also included children. Interventions were frequently designed for older (often frail) patients or patients with chronic illness. One review included pregnant women at high risk for premature delivery. No reviews focused on factors linking patient vulnerability with social determinants of health. The reviews reported few details about hospital setting, context, or resources associated with the interventions studied. Evidence for effectiveness of interventions was generally not robust and often inconsistent—for example, we identified six reviews of discharge planning; three found no effect on LOS, two found LOS decreased, and one reported an increase. Many reviews also reported patient readmission rates and mortality but with similarly inconsistent results. Conclusions. A broad range of strategies have been employed to reduce LOS, but rigorous systematic reviews have not consistently demonstrated effectiveness within medically complex, high-risk, and vulnerable populations. Health system leaders, researchers, and policymakers must collaborate to address these needs.
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