Best practice & research. Clinical anaesthesiology

Publisher: Thomson Gale (Firm); ScienceDirect (Online service), Elsevier


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    Expanded Academic ASAP., ScienceDirect Freedom Collection., Best practice & research., Best practice and research., Clinical anaesthesiology
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    • Publisher last contacted on 18/10/2013
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of colorectal cancer (CRC) has been increasing during the past decades, and the lifetime risk for CRC in industrialised countries is about 5%. CRC is a good candidate for screening, because it is a disease with high prevalence, has recognised precursors, and early treatment is beneficial. This paper outlines the evidence for efficacy from randomised trials for the most commonly used CRC screening tests to reduce CRC incidence and mortality in the average-risk population. Four randomised trials have investigated the effect of guaiac-based fecal occult blood screening on CRC mortality, with a combined CRC mortality risk reduction of 15-17% in an intention-to-screen analysis, and 25% for those people who attended screening. Flexible sigmoidoscopy screening has been evaluated in three randomised trials. The observed reduction in CRC incidence varied between 23 and 80%, and between 27 and 67% for CRC mortality, respectively (intention-to-screen analyses) in the trials with long follow-up time. No randomised trials exist in other CRC screening tools, included colonoscopy screening. FOBT and flexible sigmoidoscopy are the two CRC screening methods which have been tested in randomised trials and shown to reduce CRC mortality. These tests can be recommended for CRC screening.
    Best practice & research. Clinical anaesthesiology 08/2010; 24(4):417-25.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Stool testing is a widely accepted, non-invasive, technique for colorectal cancer (CRC) screening. Guaiac-based faecal occult blood test (gFOBT) screening has been proven to decrease CRC-related mortality; however gFOBT is hampered by a low sensitivity. Faecal immunochemical tests (FITs) have several advantages over gFOBT. First of all, FIT has a better sensitivityand higher uptake. Furthermore, the quantitative variant of the FIT allows choices on cut-off level for test-positivity according to colonoscopy resources available, personal risk profile, and/or intended detection rate in the screened population. Stool-based DNA (sDNA) tests aiming at the detection of specific DNA alterations may improve detection of CRC and adenomas compared to gFOBT screening, but large-scale population based studies are lacking. This review focuses on factors influencing test performance of those three stool based screening tests.
    Best practice & research. Clinical anaesthesiology 08/2010; 24(4):479-92.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Colorectal Cancer (CRC) screening delivery is a multidisciplinary undertaking, aiming at reducing mortality from and incidence of CRC without adversely affecting the health status of participants. The adoption of a public health perspective involves commitment to ensure equity of access and sustainability of the program over time. We reviewed available evidence concerning predictors of CRC screening uptake and the impact of interventions to improve adoption of screening using conceptual frameworks defining the role of determinants of preventive behaviours and the reach and target of interventions. The results of this review indicate that policy measures aimed at supporting screening delivery, as well as organisational changes, influencing the operational features of preventive services, need to be implemented, in order to allow individual's motivation to be eventually realised. To ensure coverage and equity of access and to maximise the impact of the intervention, policies aimed at implementing organised programs should be adopted, ensuring that participation in screening and any follow-up assessment should not be limited by financial barriers. Participants and providers beliefs may determine the response to different screening modalities. To achieve the desired health impact, an active follow-up of people with screening abnormalities should be implemented, supported by the introduction of infrastructural changes and multidisciplinary team work, which can ensure sustainability over time of effective interventions. Continuous monitoring as well as the adoption of plans to evaluate for program effectiveness represent crucial steps in the implementation of a successful program. introduction of infrastructural changes and multidisciplinary team work, which can ensure sustainability over time of effective interventions. Continuous monitoring as well as the adoption of plans to evaluate for program effectiveness represent crucial steps in the implementation of a successful program.
    Best practice & research. Clinical anaesthesiology 08/2010; 24(4):509-20.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Simulation modelling is increasingly used to inform decision-making on screening, including colorectal cancer screening strategies. The strength of simulation is its ability to handle complexity and to identify the implications of uncertainty in a formal, documented, reproducible and consistent way. Important specific uncertainties concerning colorectal cancer screening are the dwell time of adenomas and the associated sensitivity of the various tests. Concerning these issues, for distal colorectal neoplasia, knowledge has been greatly increased by the recent availability of the once only sigmoidoscopy randomised trial results. Other uncertainties concern the quality of life effects of screening, diagnostic and surveillance colonoscopies, and the true total costs of the various screening modalities in a routine high throughput efficient setting. A limitation of simulation of screening is that complexity leads to lack of insight and understanding into the models used, and therefore a lack of sound criticism, acceptance and use amongst decision makers. Modellers are currently focussing on ways to make models and the implications of assumptions more transparent. Thus it is important to further develop the quality and acceptability of simulation, especially that for colorectal cancer screening.
    Best practice & research. Clinical anaesthesiology 08/2010; 24(4):427-37.
  • [Show abstract] [Hide abstract]
    ABSTRACT: There are several modalities available for a colorectal cancer (CRC) screening program. When determining which CRC screening program to implement, the costs of such programs should be considered in comparison to the health benefits they are expected to provide. Cost-effectiveness analysis provides a tool to do this. In this paper we review the evidence on the cost-effectiveness of CRC screening. Published studies universally indicate that when compared with no CRC screening, all screening modalities provide additional years of life at a cost that is deemed acceptable by most industrialized nations. Many recent studies even find CRC screening to be cost-saving. However, when the alternative CRC screening strategies are compared against each other in an incremental cost-effectiveness analysis, no single optimal strategy emerges across the studies. There is consensus that the new technologies of stool DNA testing, computed tomographic colonography and capsule endoscopy are not yet cost-effective compared with the established CRC screening tests.
    Best practice & research. Clinical anaesthesiology 08/2010; 24(4):439-49.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cervical and breast cancer screening programmes have been introduced in times when both the professional requirements for evidence based medicine and public demand for quantification of benefits may have been less explicit. The World Health Organisation has recommended cancer screening only for cervix, breast and colorectal cancer (CRC)--the latter leaving health authorities with a choice between a multitude of screening methods of which the efficacy has been proven only for fecal occult blood testing (FOBT). Although we are far from seeing the perfect screening method and screening programme, cost effectiveness for CRC screening has been estimated at least as cost-effective as established programmes for cervix and breast cancer screening. Established and imminent screening programmes should be considered as natural platforms for randomised trial with commitment and responsibility to continuously improve the quality and effectiveness of the screening service provided.
    Best practice & research. Clinical anaesthesiology 08/2010; 24(4):521-7.
  • Best practice & research. Clinical anaesthesiology 08/2010; 24(4):379-80.
  • [Show abstract] [Hide abstract]
    ABSTRACT: This chapter explores the concept of quality assurance of colorectal cancer screening. It argues that effective quality assurance is critical to ensure that the benefits of screening outweigh the harms. The three key steps of quality assurance, definition of standards, measurement of standards and enforcement of standards, are explained. Quality is viewed from the perspective of the patient and illustrated by following the path of patients accessing endoscopy within screening services. The chapter discusses the pros and cons of programmatic versus non-programmatic screening and argues that quality assurance of screening can and should benefit symptomatic services. Finally, the chapter emphasises the importance of a culture of excellence underpinned by continuous quality improvement and effective service leadership.
    Best practice & research. Clinical anaesthesiology 08/2010; 24(4):451-64.
  • [Show abstract] [Hide abstract]
    ABSTRACT: AIP is now considered an IgG4-related systemic disease. Maintain a high clinical suspicion for AIP. IgG4+ tissue aggressively sought. Diagnose the disease before surgery! Steroid therapy is effective. Close follow-up for misdiagnosis and relapse. Long term immunomodulatory therapy likely in at least 30%. Pancreatic cancer may be an evolving long term risk of patients with AIP.
    Best practice & research. Clinical anaesthesiology 08/2010; 24(4):361-78.
  • [Show abstract] [Hide abstract]
    ABSTRACT: It is well known that adenomas represent the morphologically categorised precursor of the vast majority of colorectal cancers. Only few adenomas actually develop invasive cancer (progressive adenomas), although every adenoma has the capacity of malignant evolution. Most adenomas stabilise their progression or even regress. Easily identifiable but widely ranged pathological features (size, architectural growth, type, grade and gross organisation of dysplasia) are predictive of their natural history in terms of potential of cancerisation and duration of the adenoma-carcinoma sequence. Knowledge of the biological machineries sustaining the progression rates and times could be crucial to refine the natural history assumptions in screening modelling.
    Best practice & research. Clinical anaesthesiology 08/2010; 24(4):397-406.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Endoscopic and radiologic tests appear to be more accurate than stool-tests in detecting advanced neoplasia because of direct visualisation of colorectal mucosa. Further technological advances are expected to improve the performance and acceptability of these tests. Several attempts at increasing the adenoma detection rate of colonoscopy have been tested, and in vivo histologic differentiation between neoplastic and hyperplastic polyps may lead to substantial saving in economic and medical resources. Low-volume and non-cathartic bowel preparations may improve CT colonography acceptability, whilst computer-aided detection and low-dose protocols may result in a higher accuracy and safety of this procedure. Despite the lack of ionising radiation, significant drawbacks will likely to limit the role of MR colonography in screening programs. Colon capsule endoscopy appears to be a safe and technically feasible procedure. The suboptimal accuracy of the first generation seems to be substantially improved by the second generation of this device.
    Best practice & research. Clinical anaesthesiology 08/2010; 24(4):493-507.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Currently colorectal cancer (CRC) screening guidelines are based on age and to some extent on family history of screenees only. Potentially CRC screening could be also customised according to gender, race, ethnicity, smoking habits, presence of obesity, diabetes and metabolic syndrome. The factors that could be individually modified are: choice of screening test, age of initiation of screening and screening intervals. Gender is probably the easiest factor to be included. One of the professional societies has already included the race into guidelines in order to lower the age of starting screening in African-Americans. Targeting persons at higher than average-risk aims at optimising the use of available resources. However, an important drawback of such approach exists; it is the risk of making guidelines too complex and incomprehensible for both eligible screenees and physicians.
    Best practice & research. Clinical anaesthesiology 08/2010; 24(4):407-16.