Screening for hepatitis C virus (HCV) infection in individuals at increased risk is currently recommended by most, but not all, health authorities. This study identifies outcomes of individuals diagnosed through a screening program targeting high-risk patients.
Veterans presenting for care in VA facilities are assessed for HCV risk factors by a questionnaire. Those with a risk factor are offered anti-HCV testing. Between October 1998 and May 2004, 25,701 patients were assessed and 8,471 patients had a risk factor for HCV. Patients diagnosed through the screening program were assessed per study protocol.
The prevalence of a positive HCV antibody in veterans who identified a risk factor was 7.3% (95% CI 6.6-8.0%). Among those diagnosed through the screening program (N = 260), 47% had chronic hepatitis C. Among patients with chronic HCV, 18% had evidence of advanced liver disease (stage III/IV on biopsy or clinical cirrhosis) while 34% had persistently normal alanine aminotransferase (ALT). Two-thirds of individuals who underwent liver biopsy had minimal or no fibrosis. About half (47%) of the screen-detected patients with chronic HCV were treatment candidates. Forty-four percent were not immediate candidates secondary to medical or psychiatric comorbidities or active substance abuse. Twenty-two patients (8%) had died after a median follow-up of 911 days. Two were liver-related deaths.
Screening for hepatitis C in persons at high risk can lead to early identification of individuals at risk for progressive liver disease who may benefit from antiviral therapy and counseling to reduce HCV-related liver injury.
"Also, early detection through screening population at high risk for HCV (those lacking access to healthcare and/or addicted to alcohol or injected drugs) can lead to counselling about antiviral therapy. Counselling can promote cessation or modification of activities known to contribute to HCV-related hepatic damage and can lead to recommendations to medically monitor antiviral therapy that assists in the reduction of the progression of liver disease (Mallette et al., 2008). Trepka et al. (2007) state, " Decreasing alcohol consumption may be one of the most important potential intermediate benefits of screening and counseling " , but caution that the empirical data are sometimes conflicting, depending on the type of population under study. "
[Show abstract][Hide abstract] ABSTRACT: This paper states that traditional facilities (i.e., hospitals, remote physician offices or referral care) may not be the best choice for chronic diseases that require long-term care. The increased need for specialised managed care for the growing numbers in the USA who require such care suggests that a disease management organisation (DMO) approach can best diagnose, treat and use health informatics to create treatment protocols for that specific population. Chronic viral hepatitis in Central Florida is presented to illustrate the need for DMOs that have a centralised structure, provide a platform for data acquisition through patient evaluation and diagnosis and provide both immediate treatment recommendations and long-term health monitoring. Unless surgery or an emergency requires acute care, this paper suggests building local capacity in terms of DMOs for managing chronic illness versus hospital management, on the premise that separate facilities can provide more cost-effective and defined treatment for the compounding aspects of chronic disease, to achieve the best outcomes for patients.
International Journal of Public Policy 01/2010; 6(3):260-277. DOI:10.1504/IJPP.2010.035129
[Show abstract][Hide abstract] ABSTRACT: Integrated spread spectrum modem and digital voice processor designs can achieve processing gain adaptation without communication interruption. Only those adaptations that hold constant PN chip and/or FH hop rate to avoid modem resynchronization, are considered useful. Sync outages can render modem processing gain advantages ineffective. Variable chip embedding, data redundancy, and header insertion signaling techniques can modify modem processing gain without disturbing operation of the interfacing digital voice processor.
Military Communications Conference, 1985. MILCOM 1985. IEEE; 11/1985
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