Publications

@article{pmid38607627,

title = {Semaglutide vs Endoscopic Sleeve Gastroplasty for Weight Loss},

author = {Muhammad Haseeb and Jagpreet Chhatwal and Jade Xiao and Pichamol Jirapinyo and Christopher C Thompson},

doi = {10.1001/jamanetworkopen.2024.6221},

issn = {2574-3805},

year  = {2024},

date = {2024-04-01},

journal = {JAMA Netw Open},

volume = {7},

number = {4},

pages = {e246221},

abstract = {IMPORTANCE: Obesity is a disease with a large socioeconomic burden. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic bariatric procedure with wide global adoption. More recently, new weight-loss medications, such as glucagon-like peptide-1 receptor agonists (eg, semaglutide), have attracted increased attention due to their efficacy. However, their cost-effectiveness over an extended period compared with ESG is a critical gap that needs to be better explored for informed health care decision-making.nnOBJECTIVE: To assess the cost-effectiveness of semaglutide compared with ESG over 5 years for individuals with class II obesity.nnDESIGN, SETTING, AND PARTICIPANTS: This economic evaluation study, conducted from September 1, 2022, to May 31, 2023, used a Markov cohort model to compare ESG and semaglutide, with a no-treatment baseline strategy. The study comprised adult patients in the US health care system with class II obesity (body mass index [BMI] of 35-39.9). The base case was a 45-year-old patient with class II obesity (BMI of 37). Patients undergoing ESG were subjected to risks of perioperative mortality and adverse events with resultant costs and decrement in quality of life.nnINTERVENTIONS: Strategies included treatment with semaglutide and ESG.nnMAIN OUTCOMES AND MEASURES: Costs (2022 US dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) with a willingness-to-pay threshold of $100 000/QALY. A 5-year time horizon with a cycle length of 1 month with a 3% discount rate was used. Probabilities, costs, and quality-of-life estimates of the model were derived from published literature. One-way, 2-way, and probabilistic sensitivity analyses were also performed.nnRESULTS: The model found that ESG was more cost-effective than semaglutide over a 5-year time horizon, with an ICER of -$595 532/QALY. Endoscopic sleeve gastroplasty added 0.06 QALYs and reduced total cost by $33 583 relative to semaglutide. The results remained robust on 1-way and probabilistic sensitivity analyses. Endoscopic sleeve gastroplasty sustained greater weight loss over 5 years vs semaglutide (BMI of 31.7 vs 33.0). To achieve nondominance, the annual price of semaglutide, currently $13 618, would need to be $3591.nnCONCLUSIONS AND RELEVANCE: This study suggests that ESG is cost saving compared with semaglutide in the treatment of class II obesity. On price threshold analyses, a 3-fold decrease in the price of semaglutide is needed to achieve nondominance.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38336533,

title = {The assessment of quality of care of patients with type 2 diabetes mellitus in a population-based cohort in the District of Landeck in Austria},

author = {Mag Veronika Haslwanter and Ursula Rochau and L\'{a}ra R Hallsson and Uwe Siebert and Hans-Robert Sch\"{o}nherr and Monika Lechleitner and Willi Oberaigner},

doi = {10.1016/j.pcd.2024.01.011},

issn = {1878-0210},

year  = {2024},

date = {2024-04-01},

urldate = {2024-02-01},

journal = {Prim Care Diabetes},

volume = {18},

number = {2},

pages = {163-168},

abstract = {INTRODUCTION: Structured diabetes care based on evidence-based guidelines is one of the main strategies to improve glycemic control and to reduce long-term complications in diabetes mellitus.nnMETHODS: This study is based on the "Diabetes-Landeck Cohort", a population-based cohort of patients with diabetes mellitus type 2 (T2DM). We assessed the quality of diabetes care and compared it between three groups of care units, that is, general practitioners (GP), diabetes specialists in private practice (DSPP), and hospitals (HOSP).nnRESULTS: The total study population comprised 1616 patients with T2DM, including 378 patients of GP, 281 of DSPP, and 957 from HOSP. We identified statistically significant differences: DSPP showed the highest percentage of structured training, sufficient training, eye examinations and foot examinations. The group HOSP showed the highest proportion for increased HbA1c≥ 7.5 and almost all long-term complications surveyed, that is, nephropathy (23.2%), neuropathy (14.4%), diabetic foot (5.1%), and cerebrovascular diseases (10.9%).nnCONCLUSION: This population-based cohort study on patients with T2DM in Austria showed significant differences in important quality-of-care process and outcome parameters across different groups of care units. Future research should also include prediction modeling for early warning and monitoring systems as well as adjustment for patient characteristics and duration and severity of disease.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38552671,

title = {Effectiveness and Cost-Effectiveness of Colorectal Cancer Screening With a Blood Test That Meets the Centers for Medicare \& Medicaid Services Coverage Decision},

author = {Rosita van den Puttelaar and Pedro Nascimento de Lima and Amy B Knudsen and Carolyn M Rutter and Karen M Kuntz and Lucie de Jonge and Fernando Alarid Escudero and David Lieberman and Ann G Zauber and Anne I Hahn and John M Inadomi and Iris Lansdorp-Vogelaar},

doi = {10.1053/j.gastro.2024.02.012},

issn = {1528-0012},

year  = {2024},

date = {2024-03-01},

journal = {Gastroenterology},

abstract = {BACKGROUND \& AIMS: A blood-based colorectal cancer (CRC) screening test may increase screening participation. However, blood tests may be less effective than current guideline-endorsed options. The Centers for Medicare \& Medicaid Services (CMS) covers blood tests with sensitivity of at least 74% for detection of CRC and specificity of at least 90%. In this study, we investigate whether a blood test that meets these criteria is cost-effective.nnMETHODS: Three microsimulation models for CRC (MISCAN-Colon, CRC-SPIN, and SimCRC) were used to estimate the effectiveness and cost-effectiveness of triennial blood-based screening (from ages 45 to 75 years) compared to no screening, annual fecal immunochemical testing (FIT), triennial stool DNA testing combined with an FIT assay, and colonoscopy screening every 10 years. The CMS coverage criteria were used as performance characteristics of the hypothetical blood test. We varied screening ages, test performance characteristics, and screening uptake in a sensitivity analysis.nnRESULTS: Without screening, the models predicted 77-88 CRC cases and 32-36 CRC deaths per 1000 individuals, costing $5.3-$5.8 million. Compared to no screening, blood-based screening was cost-effective, with an additional cost of $25,600-$43,700 per quality-adjusted life-year gained (QALYG). However, compared to FIT, triennial stool DNA testing combined with FIT, and colonoscopy, blood-based screening was not cost-effective, with both a decrease in QALYG and an increase in costs. FIT remained more effective (+5-24 QALYG) and less costly (-$3.2 to -$3.5 million) than blood-based screening even when uptake of blood-based screening was 20 percentage points higher than uptake of FIT.nnCONCLUSION: Even with higher screening uptake, triennial blood-based screening, with the CMS-specified minimum performance sensitivity of 74% and specificity of 90%, was not projected to be cost-effective compared with established strategies for colorectal cancer screening.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38537159,

title = {Pack-Year Smoking History: An Inadequate and Biased Measure to Determine Lung Cancer Screening Eligibility},

author = {Alexandra L Potter and Nuo N Xu and Priyanka Senthil and Deepti Srinivasan and Hang Lee and G Scott Gazelle and Lydia Chelala and Wei Zheng and Florian J Fintelmann and Lecia V Sequist and Jessica Donington and Julie R Palmer and Chi-Fu Jeffrey Yang},

doi = {10.1200/JCO.23.01780},

issn = {1527-7755},

year  = {2024},

date = {2024-03-01},

journal = {J Clin Oncol},

pages = {JCO2301780},

abstract = {PURPOSE: Pack-year smoking history is an imperfect and biased measure of cumulative tobacco exposure. The use of pack-year smoking history to determine lung cancer screening eligibility in the current US Preventive Services Task Force (USPSTF) guideline may unintentionally exclude many high-risk individuals, especially those from racial and ethnic minority groups. It is unclear whether using a smoking duration cutoff instead of a smoking pack-year cutoff would improve the selection of individuals for screening.nnMETHODS: We analyzed 49,703 individuals with a smoking history from the Southern Community Cohort Study (SCCS) and 22,126 individuals with a smoking history from the Black Women's Health Study (BWHS) to assess eligibility for screening under the USPSTF guideline versus a proposed guideline that replaces the ≥20-pack-year criterion with a ≥20-year smoking duration criterion.nnRESULTS: Under the USPSTF guideline, only 57.6% of Black patients with lung cancer in the SCCS would have qualified for screening, whereas a significantly higher percentage of White patients with lung cancer (74.0%) would have qualified ( < .001). Under the proposed guideline, the percentage of Black and White patients with lung cancer who would have qualified for screening increased to 85.3% and 82.0%, respectively, eradicating the disparity in screening eligibility between the groups. In the BWHS, using a 20-year smoking duration cutoff instead of a 20-pack-year cutoff increased the percentage of Black women with lung cancer who would have qualified for screening from 42.5% to 63.8%.nnCONCLUSION: Use of a 20-year smoking duration cutoff instead of a 20-pack-year cutoff greatly increases the proportion of patients with lung cancer who would qualify for screening and eliminates the racial disparity in screening eligibility between Black versus White individuals; smoking duration has the added benefit of being easier to calculate and being a more precise assessment of smoking exposure compared with pack-year smoking history.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38199940b,

title = {Implementation of a comprehensive clinical risk management system in a university hospital},

author = {Wolfgang Buchberger and Marten Schmied and Michael Schomaker and Anca Del Rio and Uwe Siebert},

doi = {10.1016/j.zefq.2023.11.008},

issn = {2212-0289},

year  = {2024},

date = {2024-03-01},

journal = {Z Evid Fortbild Qual Gesundhwes},

volume = {184},

pages = {18--25},

abstract = {BACKGROUND: Adverse events during hospital treatment are common and can lead to serious harm. This study reports the implementation of a comprehensive clinical risk management system in a university hospital and assesses the impact of clinical risk management on patient harms.nnMETHODS: The clinical risk management system was rolled out over a period of eight years and consisted of a training of interdisciplinary risk management teams, external and internal risk audits, and the implementation of a critical incident reporting system (CIRS). The risks identified during the audits were analyzed according to the type, severity, and implementation of preventive measures. Other key figures of the risk management system were obtained from the annual risk reports. The number of liability cases was used as primary outcome measurement.nnRESULTS: Of the 1,104 risks identified during the risk audits, 56.2% were related to organization, 21.3% to documentation, 15.3% to treatment, and 7.2% to patient information and consent. The highest proportion of serious risks was found in the category organization (22.7%), the lowest in the category documentation (13.6%). Critical incident reporting identified between 241 and 370 critical incidents per year, for which in 79.5% to 83% preventive measures were implemented within twelve months. The frequency of incident reports per department correlated with the number of active risk managers and risk team meetings. Compared with the years prior to the introduction of the clinical risk management system, an average annual reduction of harms by 60.1% (95% CI: 57.1; 63.1) was observed two years after the implementation was completed. On average, the rate of harms dropped by 5% per year for each 10% increase in roll-out of the clinical risk management system (incidence rate ratio: 0.95; 95% CI: 0.93; 0.97) .nnCONCLUSION: The results of this project demonstrate the effectiveness of clinical risk management in detecting treatment-related risks and in reducing harm to patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38492923,

title = {Hepatitis C Elimination in Rwanda: Progress, Feasibility, and Economic Evaluation},

author = {Huaiyang Zhong and Alec Aaron and Lindsey Hiebert and Janvier Serumondo and Yueran Zhuo and Madeline Adee and Gallican N Rwibasira and John W Ward and Jagpreet Chhatwal},

doi = {10.1016/j.jval.2024.03.005},

issn = {1524-4733},

year  = {2024},

date = {2024-03-01},

journal = {Value Health},

abstract = {OBJECTIVE: In 2018, Rwanda launched a national program to eliminate the hepatitis C virus (HCV). We aim to assess the impact of the program to date and identify strategies to achieve the World Health Organization's HCV elimination goals by 2030.nnMETHODS: We developed a microsimulation model to simulate Rwanda's HCV epidemic from 2015 through 2050 and evaluated temporal trends in HCV infection, prevalence, mortality, and the total cost of care for scenarios that could achieve HCV elimination by 2030.nnRESULTS: Between 2018 and 2022, over 7 million people were screened for HCV, and 60,000 were treated. The study projected that Rwanda could achieve HCV elimination as early as 2027. A feasible strategy of an annual screening rate of 15% and a treatment rate of 100% would achieve all WHO elimination goals by 2028, requiring screening an additional 4 million people and treating 23,900 patients by 2030. The elimination strategy costs $25 million for screening and diagnosis and $21 million for treatment from 2015 to 2050. The national program would avert 4,900 hepatocellular carcinoma cases and 6,700 HCV-related deaths and save the health system $25.33 million from 2015 to 2050.nnCONCLUSIONS: Rwanda is poised to become one of the first countries in the world to eliminate HCV. Rwanda's program serves as a blueprint for other countries in the African region. By rapid screening and treatment scale-up (e.g., by leveraging HIV platforms) and by drug price negotiations, HCV elimination is not only feasible but can be cost-saving in low-income settings.},

keywords = {},

pubstate = {published},

tppubtype = {article}

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@article{pmid38470046,

title = {The Need to Revise the Model for Face Validity},

author = {Elliot B Tapper and Jagpreet Chhatwal},

doi = {10.14309/ajg.0000000000002696},

issn = {1572-0241},

year  = {2024},

date = {2024-03-01},

journal = {Am J Gastroenterol},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38290142,

title = {Comparative Analysis of Instrumental Variables on the Assignment of Buprenorphine/Naloxone or Methadone for the Treatment of Opioid Use Disorder},

author = {Fahmida Homayra and Benjamin Enns and Jeong Eun Min and Megan Kurz and Paxton Bach and Julie Bruneau and Sander Greenland and Paul Gustafson and Mohammad Ehsanul Karim and P Todd Korthuis and Thomas Loughin and Malcolm MacLure and Lawrence McCandless and Robert William Platt and Kevin Schnepel and Hitoshi Shigeoka and Uwe Siebert and Eugenia Socias and Evan Wood and Bohdan Nosyk},

doi = {10.1097/EDE.0000000000001697},

issn = {1531-5487},

year  = {2024},

date = {2024-03-01},

journal = {Epidemiology},

volume = {35},

number = {2},

pages = {218--231},

abstract = {BACKGROUND: Instrumental variable (IV) analysis provides an alternative set of identification assumptions in the presence of uncontrolled confounding when attempting to estimate causal effects. Our objective was to evaluate the suitability of measures of prescriber preference and calendar time as potential IVs to evaluate the comparative effectiveness of buprenorphine/naloxone versus methadone for treatment of opioid use disorder (OUD).nnMETHODS: Using linked population-level health administrative data, we constructed five IVs: prescribing preference at the individual, facility, and region levels (continuous and categorical variables), calendar time, and a binary prescriber's preference IV in analyzing the treatment assignment-treatment discontinuation association using both incident-user and prevalent-new-user designs. Using published guidelines, we assessed and compared each IV according to the four assumptions for IVs, employing both empirical assessment and content expertise. We evaluated the robustness of results using sensitivity analyses.nnRESULTS: The study sample included 35,904 incident users (43.3% on buprenorphine/naloxone) initiated on opioid agonist treatment by 1585 prescribers during the study period. While all candidate IVs were strong (A1) according to conventional criteria, by expert opinion, we found no evidence against assumptions of exclusion (A2), independence (A3), monotonicity (A4a), and homogeneity (A4b) for prescribing preference-based IV. Some criteria were violated for the calendar time-based IV. We determined that preference in provider-level prescribing, measured on a continuous scale, was the most suitable IV for comparative effectiveness of buprenorphine/naloxone and methadone for the treatment of OUD.nnCONCLUSIONS: Our results suggest that prescriber's preference measures are suitable IVs in comparative effectiveness studies of treatment for OUD.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37991182,

title = {Unspoken Truths: Mental Health Among Academic Surgeons},

author = {Reagan A Collins and Tianna Herman and Rebecca A Snyder and Krista L Haines and Anne Stey and Tania K Arora and Sunil K Geevarghese and Joseph D Phillips and Diego Vicente and Cornelia L Griggs and Imani E McElroy and Anji E Wall and Tasha M Hughes and Srijan Sen and Jaber Valinejad and Andres Alban and J Shannon Swan and Nathaniel Mercaldo and Mohammad S Jalali and Jagpreet Chhatwal and G Scott Gazelle and Erika Rangel and Chi-Fu Jeffrey Yang and Karen Donelan and Jessica A Gold and Colin P West and Carrie Cunningham},

doi = {10.1097/SLA.0000000000006159},

issn = {1528-1140},

year  = {2024},

date = {2024-03-01},

urldate = {2024-03-01},

journal = {Ann Surg},

volume = {279},

issue = {3},

pages = {429-436},

abstract = {OBJECTIVE: To characterize the current state of mental health within the surgical workforce in the United States (US).nnSUMMARY BACKGROUND DATA: Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown.nnMETHODS: Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed.nnRESULTS: Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P\<0.001), anxiety (31.6% vs. 16.2%, P=0.001), PTSD (12.8% vs. 5.6%, P=0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P=0.022). 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past two weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P=0.033), and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P\<0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P=0.002) were associated with increased odds of suicidal ideation over the past 12 months.nnCONCLUSIONS: Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the US.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37814499,

title = {Intracranial arteriosclerosis and the risk of dementia: A population-based cohort study},

author = {Tim C van den Beukel and Frank J Wolters and Uwe Siebert and Wilko Spiering and M Arfan Ikram and Meike W Vernooij and Pim A de Jong and Daniel Bos},

doi = {10.1002/alz.13496},

issn = {1552-5279},

year  = {2024},

date = {2024-02-20},

urldate = {2023-10-01},

journal = {Alzheimers Dement},

volume = {20},

issue = {2},

pages = {869-879},

abstract = {BACKGROUND: The impact of intracranial arteriosclerosis on dementia remains largely unclear.nnMETHODS: In 2339 stroke-free and dementia-free participants (52.2% women, mean age 69.5 years) from the general population, we assessed intracranial carotid artery calcification (ICAC) and vertebrobasilar artery calcification (VBAC) as proxy for arteriosclerosis. Associations with dementia were assessed using Cox models. In addition, indirect effects through cerebral small vessel disease (cSVD) and subcortical brain structure volumes were assessed using causal mediation analyses.nnRESULTS: During a median of 13.4 years (25th-75th percentiles 9.9-14.5) of follow-up, 282 participants developed dementia. Both ICAC presence (hazard ratio [HR]: 1.53, 95% confidence interval [CI]: 1.00-2.32]) and volume (HR per standard deviation: 1.19, 95% CI: 1.01-1.40) increased dementia risk. For VBAC, severe calcifications increased dementia risk (HR for third vs first volume tertile: 1.89, 95% CI: 1.00-3.59). These effects were mediated partly through increased cSVD (percentage mediated for ICAC: 13% and VBAC: 24%).nnDISCUSSION: Intracranial arteriosclerosis increases the risk of dementia.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38369282,

title = {Acceptability of using Real-World Data to Estimate Relative Treatment Effects in Health Technology Assessments: Barriers and Future Steps},

author = {Manuel Gomes and Alex J Turner and Cormac Sammon and Dalia Dawoud and Sreeram Ramagopalan and Alex Simpson and Uwe Siebert},

doi = {10.1016/j.jval.2024.01.020},

issn = {1524-4733},

year  = {2024},

date = {2024-02-16},

urldate = {2024-02-01},

journal = {Value Health},

abstract = {OBJECTIVES: Evidence about the comparative effects of new treatments is typically collected in randomized controlled trials (RCTs). In some instances, RCTs are not possible, or their value is limited by an inability to capture treatment effects over the longer-term or in all relevant population subgroups. In these cases, non-randomized studies (NRS) using real-world data (RWD) are increasingly used to complement trial evidence on treatment effects for health technology assessment (HTA). However, there have been concerns over a lack of acceptability of this evidence by HTA agencies. This paper aims to identify barriers to the acceptance of NRS and steps that may facilitate increases in the acceptability of NRS in the future.nnMETHODS: Opinions of the authorship team based on their experience in real-world evidence research in academic, HTA, and industry settings, supported by a critical assessment of existing studies.nnRESULTS: Barriers were identified that are applicable to key stakeholder groups including HTA agencies (e.g., the lack of comprehensive methodological guidelines for using RWD), evidence-generators (e.g., avoidable deviations from best practices), and external stakeholders (e.g., data controllers providing timely access to high-quality RWD). Future steps that may facilitate future acceptability of NRS include improvements in the quality, integration, and accessibility of RWD, wider use of demonstration projects to highlight the value and applicability of non-randomized designs, living and more detailed HTA guidelines, and improvements in HTA infrastructure relating to RWD.nnCONCLUSION: NRS can represent a crucial source of evidence on treatment effects for use in HTA when RCT evidence is limited.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38353683,

title = {Cost-effectiveness of a multidimensional post-discharge disease management program for heart failure patients-economic evaluation along a one-year observation period},

author = {T Egelseer-Bruendl and B Jahn and M Arvandi and S Puntscher and J Santamaria and L Brunelli and K Weissenegger and B Pfeifer and S Neururer and C Rissbacher and A Huber and B Fetz and C Kleinheinz and R Modre-Osprian and K Kreiner and U Siebert and G Poelzl},

doi = {10.1007/s00392-024-02395-5},

issn = {1861-0692},

year  = {2024},

date = {2024-02-14},

urldate = {2024-02-14},

journal = {Clin Res Cardiol},

abstract = {OBJECTIVE: This study aimed to assess the cost-effectiveness of the telemedically assisted post-discharge management program (DMP) HerzMobil Tirol (HMT) for heart failure (HF) patients in clinical practice in Austria.nnMETHODS: We conducted a cost-effectiveness analysis along a retrospective cohort study (2016-2019) of HMT with a propensity score matched cohort of 251 individuals in the HMT and 257 in the usual care (UC) group and a 1-year follow-up. We calculated the effectiveness (hospital-free survival, hospital-free life-years gained, and number of avoided rehospitalizations), costs (HMT, rehospitalizations), and the incremental cost-effectiveness ratio (ICER). We performed a nonparametric sensitivity analysis with bootstrap sampling and sensitivity analyses on costs of HF rehospitalizations and on costs per disease-related diagnosis (DRG) score for rehospitalizations.nnRESULTS: Base-case analysis showed that HMT resulted in an average of 42 additional hospital-free days, 40 additional days alive, and 0.12 avoided hospitalizations per patient-year compared with UC during follow-up. The average HMT costs were EUR 1916 per person. Mean rehospitalization costs were EUR 5551 in HMT and EUR 6943 in UC. The ICER of HMT compared to UC was EUR 4773 per life-year gained outside the hospital. In a sensitivity analysis, HMT was cost-saving when "non-HF related costs" related to the DMP were replaced with average costs.nnCONCLUSIONS: The economic evaluation along the cohort study showed that the HerzMobil Tirol is very cost-effective compared to UC and cost-saving in a sensitivity analysis correcting for "non-HF related costs." These findings promote a widespread adoption of telemedicine-assisted DMP for HF.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37463414,

title = {The Rising Costs of Alcohol-associated Liver Disease in the United States},

author = {Jovan Julien and Turgay Ayer and Elliot B Tapper and Jagpreet Chhatwal},

doi = {10.14309/ajg.0000000000002405},

issn = {1572-0241},

year  = {2024},

date = {2024-02-05},

urldate = {2023-07-01},

journal = {Am J Gastroenterol},

volume = {119},

issue = {2},

pages = {270-277},

abstract = {INTRODUCTION: Alcohol-associated liver disease (ALD) is rising in the United States because of an increase in high-risk drinking, but population-level ALD cost is unknown. Our aim was to project the direct and indirect costs associated with ALD in the US population through 2040.nnMETHODS: We utilized a previously validated microsimulation model of alcohol consumption and ALD with model parameters estimated from publicly available data sources, including the National Epidemiologic Survey Alcohol and Related Conditions-III, the Center for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research, the Bureau of Labor Statistics, and published studies informing the impact of alcohol consumption on ALD severity in the United States resident population. The simulated scenario included current and projected ALD-associated costs.nnRESULTS: From 2022-2040, the ALD is projected to cost $880 billion; $355 billion in direct healthcare- related costs and $525 billion in lost labor and economic consumption. The annual cost of ALD is projected to increase from $31 billion in 2022 to $66 billion (118% increase) in 2040. While the female population makes up 29% of these costs in 2022, by 2040 on a per annum basis, female costs would be 43% of the total annual expenditure.nnDISCUSSION: Increased consumption of alcohol in the US population, especially in females, will cause a steep rise in the economic burden of alcohol-associated liver disease in the United States. These findings highlight the need for planners and policymakers to plan for the increased impact of liver disease in the United States.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38353447,

title = {Society of Radiologists in Ultrasound Consensus Conference Recommendations for Incidental Gallbladder Polyp Management: Interreader Agreement Among Ten Radiologists},

author = {Mark A Anderson and Sarah Mercaldo and Jinjin Cao and Nayla Mroueh and Felipe S Furtado and Rory L Cochran and Ryan Chung and Reece J Goiffon and Madeleine Sertic and Theodore T Pierce and Aoife Kilcoyne and Amirkasra Mojtahed and Anuradha S Shenoy-Bhangle and Onofrio A Catalano and Avinash Kambadakone},

doi = {10.2214/AJR.23.30720},

issn = {1546-3141},

year  = {2024},

date = {2024-02-01},

journal = {AJR Am J Roentgenol},

abstract = { The 2022 Society of Radiologists in Ultrasound (SRU) consensus conference recommendations support less-aggressive management of small gallbladder polyps on ultrasound versus earlier approaches and may help standardize polyp evaluation by radiologists.  To assess radiologists' interreader agreement in applying the SRU recommendations for management of incidental gallbladder polyps on ultrasound.  This retrospective study included 105 patients (median age, 52 years; 75 women, 27 men) with a gallbladder polyp on ultrasound (without features highly suspicious for invasive or malignant tumor) who underwent cholecystectomy between January 1, 2003 and January 1, 2021. Ten abdominal radiologists independently reviewed ultrasound examinations and, using SRU recommendations, assessed one polyp per patient for risk category (extremely low-risk, low-risk, or indeterminate risk) and possible recommendation for surgical consultation. Five radiologists were considered less-experienced (<5 years), and five more-experienced (≥5 years). Interreader agreement was evaluated. Polyps were classified pathologically as nonneoplastic or neoplastic.  For risk category assignments, interreader agreement was substantial among all readers (k=0.710), less-experienced readers (k=0.705), and more-experienced readers (k=0.692). For surgical consultation recommendations, interreader agreement was substantial among all readers (k=0.795) and more-experienced readers (kappa=0.740), and almost perfect among less-experienced readers (k=0.811). Of ten readers, a median of 5 (IQR, 2-8), 4 (IQR, 2-7), and 0 (IQR, 0-0) classified polyps as extremely low risk, low risk, and indeterminate risk, respectively. Across readers, the fraction of polyps classified as extremely low risk ranged from 32-72%, as low risk from 24-65%, and as indeterminate risk from 0-8%. Of ten readers, a median of 0 (IQR, 0-1) recommended surgical consultation; the fraction of polyps receiving a surgical consultation recommendation ranged from 4-22%. A total of 102/105 polyps were nonneoplastic; 3/105 were neoplastic (all benign). Based on readers' most-common assessments for the nonneoplastic polyps, the risk category was extremely low risk in 53, low risk in 48, and indeterminate risk in 1; surgical consultation was recommended in 16.  Ten abdominal radiologists showed substantial agreement for polyp risk categorizations and surgical consultation recommendations, although areas of reader variability were identified.  The findings support overall reproducibility of the SRU recommendations, while indicating opportunity for improvement.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38086003,

title = {Cost-Effectiveness Analysis of Screening for Pancreatic Cancer Among High-Risk Populations},

author = {Mary Linton B Peters and Andrew Eckel and Claudia L Seguin and Barak Davidi and David H Howard and Amy B Knudsen and Pari V Pandharipande},

doi = {10.1200/OP.23.00495},

issn = {2688-1535},

year  = {2024},

date = {2024-02-01},

urldate = {2024-02-01},

journal = {JCO Oncol Pract},

volume = {20},

issue = {2},

pages = {278-290},

abstract = {PURPOSE: We evaluated the potential cost-effectiveness of combined magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) screening for pancreatic ductal adenocarcinoma (PDAC) among populations at high risk for the disease.nnMETHODS: We used a microsimulation model of the natural history of PDAC to estimate the lifetime health benefits, costs, and cost-effectiveness of PDAC screening among populations with specific genetic risk factors for PDAC, including  and , , , Lynch syndrome, , , and . For each high-risk population, we simulated 29 screening strategies, defined by starting age and frequency. Screening included MRI with follow-up EUS in a subset of patients. Costs of tests were based on Medicare reimbursement for MRI, EUS, fine-needle aspiration biopsy, and pancreatectomy. Cancer-related cost by stage of disease and phase of treatment was based on the literature. For each high-risk population, we performed an incremental cost-effectiveness analysis, assuming a willingness-to-pay (WTP) threshold of $100,000 US dollars (USD) per quality-adjusted life year (QALY) gained.nnRESULTS: For men with relative risk (RR) 12.33 () and RR 28 (), annual screening was cost-effective, starting at age 55 and 40 years, respectively. For women, screening was only cost-effective for those with RR 28 (), with annual screening starting at age 45 years.nnCONCLUSION: Combined MRI/EUS screening may be a cost-effective approach for the highest-risk populations (among mutations considered, those with RR \>12). However, for those with moderate risk (RR, 5-12), screening would only be cost-effective at higher WTP thresholds (eg, $200K USD/QALY) or with once-only screening.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38191430,

title = {Planning, implementing and governing systems-based co-creation: the DISCOVER framework},

author = {Niamh Smith and Michail Georgiou and Mohammad S Jalali and Sebastien Chastin},

doi = {10.1186/s12961-023-01076-5},

issn = {1478-4505},

year  = {2024},

date = {2024-01-08},

urldate = {2024-01-01},

journal = {Health Res Policy Syst},

volume = {22},

number = {1},

pages = {6},

abstract = {BACKGROUND: Increasingly, public health faces challenges requiring complex, multifaceted and multi-sectoral responses. This calls for systems-based approaches that facilitate the kind of collective and collaborative thinking and working required to address complexity. While the literature on systems thinking, system dynamics and the associated methodologies is extensive, there remains little clear guidance on how to plan, govern and implement participatory systems approaches within a co-creation process.nnMETHODS: We used a three-step process to develop DISCOVER, a framework for implementing, and governing systems-based co-creation: Stage 1: We conducted a literature analysis of key texts to identify well-documented methods and phases for co-creation using a systems approach, as well as areas where gaps existed. Stage 2: We looked for the most appropriate methods and approaches to fill the gaps in the knowledge production chain. Stage 3: We developed the framework, identifying how the different tools and approaches fit together end-to-end, from sampling and recruiting participants all the way through to responding with an action plan.nnRESULTS: We devised DISCOVER to help guide researchers and stakeholders to collectively respond to complex social, health and wider problems. DISCOVER is a strategic research planning and governance framework that provides an actionable, systematic way to conceptualise complex problems and move from evidence to action, using systems approaches and co-creation. In this article, we introduce the eight-step framework and provide an illustrative case study showcasing its potential. The framework integrates complementary approaches and methods from social network analysis, systems thinking and co-creation literature. The eight steps are followed sequentially but can overlap.nnCONCLUSIONS: DISCOVER increases rigour and transparency in system approaches to tackling complex issues going from planning to action. It is being piloted in environmental health research but may be suitable to address other complex challenges and could be incorporated into research proposals and protocols for future projects.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37722825b,

title = {Aetiology, ejection fraction and mortality in chronic heart failure: a mediation analysis},

author = {Josef Fritz and Katrin Belovari and Hanno Ulmer and Marc-Michael Zaruba and Moritz Messner and Maria Ungericht and Uwe Siebert and Frank Ruschitzka and Axel Bauer and Gerhard Poelzl},

doi = {10.1136/heartjnl-2023-322803},

issn = {1468-201X},

year  = {2024},

date = {2024-01-01},

journal = {Heart},

volume = {110},

number = {4},

pages = {290--298},

abstract = {OBJECTIVE: Clinical decision making in chronic heart failure (CHF) is based primarily on left ventricular ejection fraction (LVEF), and only secondarily on aetiology of the underlying disease. Our aim was to investigate the mediating role of LVEF in the relationship between aetiology and mortality.nnMETHODS: Using data of 2056 Austrian patients with CHF (mean age 57.2 years; mean follow-up 8.8 years), effects of aetiology on LVEF and overall mortality were estimated using multivariable-adjusted linear and Cox regression models. In causal mediation analyses, we decomposed the total effect of aetiology on mortality into direct and indirect (mediated through LVEF) effects.nnRESULTS: For the analysed aetiologies (dilated (DCM, n=1009) and hypertrophic (HCM, n=89) cardiomyopathy; ischaemic (IHD, n=529) and hypertensive (HHD, n=320) heart disease; cardiac amyloidosis (CA, n=109)), the effect of LVEF on mortality was similar (HR=1.07, 95% CI 1.04 to 1.10; p=0.718). HCM and CA were associated with significantly higher, and IHD and DCM with significantly lower LVEF compared with other aetiologies. Compared with respective other aetiologies, the corresponding total effect HRs for mortality were 0.77 (95% CI 0.67 to 0.89), 0.47 (95% CI 0.25 to 0.88), 1.40 (95% CI 1.21 to 1.62), 0.79 (95% CI 0.67 to 0.95) and 2.36 (95% CI 1.81 to 3.08) for DCM, HCM, IHD, HHD and CA, respectively. CA had the highest mortality despite a HR of 0.74 (95% CI 0.65 to 0.83). For all other aetiologies, <20% of the total mortality effects were mediated through LVEF.nnCONCLUSIONS: The direct effect of aetiology on mortality dominates the indirect effect through LVEF. Therefore, clarification of aetiology is as important as measurement of LVEF.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38218784,

title = {Nature-based social interventions to address loneliness among vulnerable populations: a common study protocol for three related randomized controlled trials in Barcelona, Helsinki, and Prague within the RECETAS European project},

author = {Laura Coll-Planas and Aina Carb\'{o}-Carde\~{n}a and Anu Jansson and Vladimira Dost\'{a}lov\'{a} and Alzbeta Bartova and Laura Rautiainen and Annika Kolster and Montse Mas\'{o}-Aguado and Laia Briones-Buixassa and Sergi Blancafort-Alias and Marta Roqu\'{e}-Figuls and Ashby Lavelle Sachs and Cristina Casajuana and Uwe Siebert and Ursula Rochau and Sibylle Puntscher and Iva Holmerov\'{a} and Kaisu H Pitkala and Jill S Litt},

doi = {10.1186/s12889-023-17547-x},

issn = {1471-2458},

year  = {2024},

date = {2024-01-01},

journal = {BMC Public Health},

volume = {24},

number = {1},

pages = {172},

abstract = {BACKGROUND: The negative effects of loneliness on population health and wellbeing requires interventions that transcend the medical system and leverage social, cultural, and public health system resources. Group-based social interventions are a potential method to alleviate loneliness. Moreover, nature, as part of our social and health infrastructure, may be an important part of the solutions that are needed to address loneliness. The RECETAS European project H2020 (Re-imagining Environments for Connection and Engagement: Testing Actions for Social Prescribing in Natural Spaces) is an international research project aiming to develop and test the effectiveness of nature-based social interventions to reduce loneliness and increase health-related quality of life.nnMETHODS: This article describes the three related randomized controlled trials (RCTs) that will be implemented: the RECETAS-BCN Trial in Barcelona (Spain) is targeting people 18+ from low socio-economic urban areas; the RECETAS-PRG Trial in Prague (Czech Republic) is addressing community-dwelling older adults over 60 years of age, and the RECETAS-HLSNK trial is reaching older people in assisted living facilities. Each trial will recruit 316 adults suffering from loneliness at least sometimes and randomize them to nature-based social interventions called "Friends in Nature" or to the control group. "Friends in Nature" uses modifications of the "Circle of Friends" methodology based on group processes of peer support and empowerment but including activities in nature. Participants will be assessed at baseline, at post-intervention (3 months), and at 6- and 12-month follow-up after baseline. Primary outcomes are the health-related quality-of-life according to 15D measure and The De Jong Gierveld 11-item loneliness scale. Secondary outcomes are health and psychosocial variables tailored to the specific target population. Nature exposure will be collected throughout the intervention period. Process evaluation will explore context, implementation, and mechanism of impact. Additionally, health economic evaluations will be performed.nnDISCUSSION: The three RECETAS trials will explore the effectiveness of nature-based social interventions among lonely people from various ages, social, economic, and cultural backgrounds. RECETAS meets the growing need of solid evidence for programs addressing loneliness by harnessing the beneficial impact of nature on enhancing wellbeing and social connections.nnTRIAL REGISTRATION: Barcelona (Spain) trial: ClinicalTrials.gov, ID: NCT05488496. Registered 29 July 2022. Prague (Czech Republic) trial: ClinicalTrials.gov, ID: NCT05522140. Registered August 25, 2022. Helsinki (Finland) trial: ClinicalTrials.gov, ID: NCT05507684. Registered August 12, 2022.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38199940,

title = {Implementation of a comprehensive clinical risk management system in a university hospital},

author = {Wolfgang Buchberger and Marten Schmied and Michael Schomaker and Anca Del Rio and Uwe Siebert},

doi = {10.1016/j.zefq.2023.11.008},

issn = {2212-0289},

year  = {2024},

date = {2024-01-01},

journal = {Z Evid Fortbild Qual Gesundhwes},

abstract = {BACKGROUND: Adverse events during hospital treatment are common and can lead to serious harm. This study reports the implementation of a comprehensive clinical risk management system in a university hospital and assesses the impact of clinical risk management on patient harms.nnMETHODS: The clinical risk management system was rolled out over a period of eight years and consisted of a training of interdisciplinary risk management teams, external and internal risk audits, and the implementation of a critical incident reporting system (CIRS). The risks identified during the audits were analyzed according to the type, severity, and implementation of preventive measures. Other key figures of the risk management system were obtained from the annual risk reports. The number of liability cases was used as primary outcome measurement.nnRESULTS: Of the 1,104 risks identified during the risk audits, 56.2% were related to organization, 21.3% to documentation, 15.3% to treatment, and 7.2% to patient information and consent. The highest proportion of serious risks was found in the category organization (22.7%), the lowest in the category documentation (13.6%). Critical incident reporting identified between 241 and 370 critical incidents per year, for which in 79.5% to 83% preventive measures were implemented within twelve months. The frequency of incident reports per department correlated with the number of active risk managers and risk team meetings. Compared with the years prior to the introduction of the clinical risk management system, an average annual reduction of harms by 60.1% (95% CI: 57.1; 63.1) was observed two years after the implementation was completed. On average, the rate of harms dropped by 5% per year for each 10% increase in roll-out of the clinical risk management system (incidence rate ratio: 0.95; 95% CI: 0.93; 0.97) .nnCONCLUSION: The results of this project demonstrate the effectiveness of clinical risk management in detecting treatment-related risks and in reducing harm to patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37925258,

title = {Association of patient-practitioner sex concordance with specialist referral in primary hyperparathyroidism},

author = {Jordan M Broekhuis and Maria P Cote and Reagan A Collins and Jorge L Gomez-Mayorga and Natalia Chaves and Benjamin C James},

doi = {10.1016/j.surg.2023.08.048},

issn = {1532-7361},

year  = {2024},

date = {2024-01-01},

urldate = {2023-11-01},

journal = {Surgery},

volume = {175},

issue = {1},

pages = {19-24},

abstract = {BACKGROUND: Prior research has demonstrated barriers to the workup and management of primary hyperparathyroidism. As recent data have suggested that patient and practitioner sex concordance is associated with lower surgical complications, we sought to evaluate the effect of sex concordance on referral for primary hyperparathyroidism.nnMETHODS: We queried an institutional database for patients with first-incident hypercalcemia and subsequent biochemical evidence of primary hyperparathyroidism between 2010 and 2018. Primary care practitioner and endocrinologist sex, laboratory values, and complications of primary hyperparathyroidism were collected. Sex concordance (male patient/male practitioner or female patient/female practitioner) was evaluated as a binary predictor of specialist evaluation using logistic regression and Cox proportional hazards modeling.nnRESULTS: Among 1,100 patients, mean age was 62.5 (standard deviation 13.6), and 74% were female sex. Primary care practitioner sex was 52% female, and 63% of patients had sex concordance with their primary care practitioner. Endocrinologist sex was 59% female, and 45% of patients had sex concordance with their endocrinologist. Patients with sex concordance with their primary care practitioner (70 vs 80%, P = .001) and endocrinologist (71 vs 82%, P \< .001) were less likely to be female sex compared to those with discordance. After adjusting for demographics and clinical covariates, those patients with primary care practitioner sex concordance had 32% higher odds of endocrinologist evaluation (odds ratio 1.32, 95% confidence interval 1.003-1.734, P = .047). Similarly, those patients with endocrinologist sex concordance had a 48% higher rate of surgeon evaluation (hazard ratio 1.48, confidence interval 1.1-2.0, P = .009). Stratified analysis revealed that sex discordance reduced the rate of surgeon referral for female patients (hazard ratio 0.63, confidence interval 0.44-0.89, P = .008) but not male patients (hazard ratio 1.06, CI 0.58-1.93, P = .861).nnCONCLUSION: Sex discordance between patients and their health care professionals may contribute to under-referral in primary hyperparathyroidism. Further evaluation of the effect of patient and practitioner identities on communication and decision-making in surgery are needed.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37872045,

title = {The impact of social determinants of health on thyroid cancer mortality and time to treatment},

author = {Reagan A Collins and Catherine McManus and Eric J Kuo and Rachel Liou and James A Lee and Jennifer H Kuo},

doi = {10.1016/j.surg.2023.04.062},

issn = {1532-7361},

year  = {2024},

date = {2024-01-01},

urldate = {2023-10-01},

journal = {Surgery},

volume = {175},

issue = {1},

pages = {57-64},

abstract = {BACKGROUND: Whereas racial disparities in thyroid cancer care are well established, the role of social determinants of health is less clear. We aimed to assess the individual and cumulative impact of social determinants of health on mortality and time to treatment among patients with thyroid cancer.nnMETHODS: We collected social determinants of health data from thyroid cancer patients registered in the National Cancer Database from 2004 to 2017. We created a count variable for patients in the lowest quartile of each social determinant of health (ie, low income, low education, and no insurance). We assessed the association of social determinants of health with mortality and time to treatment and the association between cumulative social determinants of health count and time to treatment using Cox regression.nnRESULTS: Of the 142,024 patients we identified, patients with longer time to treatment had greater mortality compared to patients treated within 90 days (90-180 days, adjusted hazard ratio 1.21 (95% confidence interval 1.13-1.29, P \< .001); \>180 days, adjusted hazard ratio 1.57 (95% confidence interval 1.41-1.76, (P \< .001). Compared to patients with no adverse social determinants of health, patients with 1, 2, or 3 adverse social determinants of health had a 10%, 12%, and 34%, respectively, higher likelihood of longer time to treatment (1 social determinant of health, hazard ratio 0.90, 95% confidence interval 0.89-0.92, P \< .001; 2 social determinants of health, hazard ratio 0.88, 95% confidence interval 0.87-0.90, P \< .001; 3 social determinants of health, hazard ratio 0.66, 95% confidence interval 0.62-0.71, P \< .001 for all). On subgroup analysis by race, each adverse social determinant of health was associated with an increased likelihood of a longer time to treatment for Black and Hispanic patients (P \< .05).nnCONCLUSION: A greater number of adverse social determinants of health leads to a higher likelihood of a longer time to treatment for patients with thyroid cancer, which, in turn, is associated with an increased risk for mortality.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37792380,

title = {Depression and Suicide Among American Surgeons-A Grave Threat to the Surgeon Workforce},

author = {Tasha M Hughes and Reagan A Collins and Carrie E Cunningham},

doi = {10.1001/jamasurg.2023.4658},

issn = {2168-6262},

year  = {2024},

date = {2024-01-01},

urldate = {2023-10-01},

journal = {JAMA Surg},

volume = {159},

issue = {1},

pages = {7-8},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37302445,

title = {Hepatocellular Carcinoma Incidence Threshold for Surveillance in Virologically Cured Hepatitis C Individuals},

author = {Jagpreet Chhatwal and Ali Hajjar and Peter P Mueller and Gizem Nemutlu and Neeti Kulkarni and Mary Linton B Peters and Fasiha Kanwal},

doi = {10.1016/j.cgh.2023.05.024},

issn = {1542-7714},

year  = {2024},

date = {2024-01-01},

urldate = {2024-01-01},

journal = {Clin Gastroenterol Hepatol},

volume = {22},

issue = {1},

pages = {91-101},

abstract = {BACKGROUND \& AIMS: Guidelines recommend biannual surveillance for hepatocellular carcinoma (HCC) in hepatitis C individuals with cirrhosis if the HCC incidence rate is above 1.5 per 100 person-years (PY). However, the incidence threshold for surveillance in individuals who achieve a virologic cure is unknown. We estimated the HCC incidence rate above which routine HCC surveillance is cost-effective in this growing population of virologically cured hepatitis C individuals with cirrhosis or advanced fibrosis.nnMETHODS: We developed a Markov-based microsimulation model of the natural history of HCC in individuals with hepatitis C who achieved virologic cure with oral direct-acting antivirals. We used published data on the natural history of hepatitis C, competing risk post virologic cure, HCC tumor progression, real-world HCC surveillance adherence, contemporary HCC treatment options and associated costs, and utilities of different health states. We estimated the HCC incidence above which biannual HCC surveillance using ultrasound and alpha-fetoprotein would be cost-effective.nnRESULTS: In virologically cured hepatitis C individuals with cirrhosis or advanced fibrosis, HCC surveillance is cost-effective if HCC incidence exceeds 0.7 per 100 PY using $100,000 per quality-adjusted life year willingness-to-pay. At this HCC incidence, routine HCC surveillance would result in 2650 and 5700 additional life years per 100,000 cirrhosis and advanced fibrosis persons, respectively, compared with no surveillance. At $150,000 willingness-to-pay, surveillance is cost-effective if HCC incidence exceeds 0.4 per 100 PY. Sensitivity analysis showed that the threshold mostly remained below 1.5 per 100 PY.nnCONCLUSIONS: The contemporary HCC incidence threshold is much lower than the previous 1.5% incidence value used to guide HCC surveillance decisions. Updating clinical guidelines could improve the early diagnosis of HCC.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35778898,

title = {Equitable Policies Need Equitable Practices: Alcohol- and Substance-Exposed Pregnancy as a Case Study},

author = {Arielle R Deutsch and Mohammad S Jalali and Sarah Stout and Leah Frerichs},

doi = {10.1177/15248399221107605},

issn = {1524-8399},

year  = {2024},

date = {2024-01-01},

urldate = {2022-07-01},

journal = {Health Promot Pract},

volume = {25},

issue = {1},

pages = {17-21},

abstract = {There is clear need for more effective public health policies. Coupled with calls for more effective policies, increasing demand to address public health disparities experienced by systemically marginalized and historically oppressed groups emphasizes the long-standing need for policies that improve public health equity. Such need is highlighted when examining public health issues such as alcohol- and substance-exposed pregnancy (ASEP): Current policies are ineffective at reducing ASEP, and marginalized groups experience disproportionately lower benefits and higher negative consequences as a result of such policies. Powerful strategies to develop more effective policies that can account for the complexity of such issues, such as systems science methods (SSMs), are becoming popular. However, current best practices for such methods often do not emphasize the additional efforts that will be required to develop equitable, not just effective policies. Using ASEP as an example of a crucial complex issue requiring new policy, we suggest additional steps to include in SSM projects for developing more effective policies that will also help stakeholders determine high-equity policies to reduce health disparities. These steps include modeling structural differences experienced by marginalized groups via systemic racism and oppression, incorporating existing cultural and community sources of strength and resilience as key areas for policy development, and evaluating the sustainability of policies as a dimension of efficacy. We also discuss using community-based participatory approaches as a framework for all SSM processes to ensure that policy development itself is grounded in equitable shared decision-making for marginalized individuals.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38048504,

title = {Why Similar Policies Resulted In Different COVID-19 Outcomes: How Responsiveness And Culture Influenced Mortality Rates},

author = {Tse Yang Lim and Ran Xu and Nick Ruktanonchai and Omar Saucedo and Lauren M Childs and Mohammad S Jalali and Hazhir Rahmandad and Navid Ghaffarzadegan},

doi = {10.1377/hlthaff.2023.00713},

issn = {1544-5208},

year  = {2023},

date = {2023-12-01},

journal = {Health Aff (Millwood)},

volume = {42},

number = {12},

pages = {1637--1646},

abstract = {In the first two years of the COVID-19 pandemic, per capita mortality varied by more than a hundredfold across countries, despite most implementing similar nonpharmaceutical interventions. Factors such as policy stringency, gross domestic product, and age distribution explain only a small fraction of mortality variation. To address this puzzle, we built on a previously validated pandemic model in which perceived risk altered societal responses affecting SARS-CoV-2 transmission. Using data from more than 100 countries, we found that a key factor explaining heterogeneous death rates was not the policy responses themselves but rather variation in responsiveness. Responsiveness measures how sensitive communities are to evolving mortality risks and how readily they adopt nonpharmaceutical interventions in response, to curb transmission. We further found that responsiveness correlated with two cultural constructs across countries: uncertainty avoidance and power distance. Our findings show that more responsive adoption of similar policies saves many lives, with important implications for the design and implementation of responses to future outbreaks.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37500964,

title = {Consensus report from the 10th Global Forum for Liver Magnetic Resonance Imaging: developments in HCC management},

author = {Bachir Taouli and Ahmed Ba-Ssalamah and Julius Chapiro and Jagpreet Chhatwal and Kathryn Fowler and Tae Wook Kang and Gesine Knobloch and Dow-Mu Koh and Masatoshi Kudo and Jeong Min Lee and Takamichi Murakami and David J Pinato and Kristina I Ringe and Bin Song and Parissa Tabrizian and Jin Wang and Jeong Hee Yoon and Mengsu Zeng and Jian Zhou and Val\'{e}rie Vilgrain},

doi = {10.1007/s00330-023-09928-y},

issn = {1432-1084},

year  = {2023},

date = {2023-12-01},

urldate = {2023-07-01},

journal = {Eur Radiol},

volume = {33},

number = {12},

pages = {9152-9166},

abstract = {The 10th Global Forum for Liver Magnetic Resonance Imaging (MRI) was held as a virtual 2-day meeting in October 2021, attended by delegates from North and South America, Asia, Australia, and Europe. Most delegates were radiologists with experience in liver MRI, with representation also from specialists in liver surgery, oncology, and hepatology. Presentations, discussions, and working groups at the Forum focused on the following themes: • Gadoxetic acid in clinical practice: Eastern and Western perspectives on current uses and challenges in hepatocellular carcinoma (HCC) screening/surveillance, diagnosis, and management • Economics and outcomes of HCC imaging • Radiomics, artificial intelligence (AI) and deep learning (DL) applications of MRI in HCC. These themes are the subject of the current manuscript. A second manuscript discusses multidisciplinary tumor board perspectives: how to approach early-, mid-, and late-stage HCC management from the perspectives of a liver surgeon, interventional radiologist, and oncologist (Taouli et al, 2023). Delegates voted on consensus statements that were developed by working groups on these meeting themes. A consensus was considered to be reached if at least 80% of the voting delegates agreed on the statements. CLINICAL RELEVANCE STATEMENT: This review highlights the clinical applications of gadoxetic acid-enhanced MRI for liver cancer screening and diagnosis, as well as its cost-effectiveness and the applications of radiomics and AI in patients with liver cancer. KEY POINTS: • Interpretation of gadoxetic acid-enhanced MRI differs slightly between Eastern and Western guidelines, reflecting different regional requirements for sensitivity vs specificity. • Emerging data are encouraging for the cost-effectiveness of gadoxetic acid-enhanced MRI in HCC screening and diagnosis, but more studies are required. • Radiomics and artificial intelligence are likely, in the future, to contribute to the detection, staging, assessment of treatment response and prediction of prognosis of HCC-reducing the burden on radiologists and other specialists and supporting timely and targeted treatment for patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37439935,

title = {Consensus report from the 10th global forum for liver magnetic resonance imaging: multidisciplinary team discussion},

author = {Bachir Taouli and Ahmed Ba-Ssalamah and Julius Chapiro and Jagpreet Chhatwal and Kathryn Fowler and Tae Wook Kang and Gesine Knobloch and Dow-Mu Koh and Masatoshi Kudo and Jeong Min Lee and Takamichi Murakami and David J Pinato and Kristina I Ringe and Bin Song and Parissa Tabrizian and Jin Wang and Jeong Hee Yoon and Mengsu Zeng and Jian Zhou and Val\'{e}rie Vilgrain},

doi = {10.1007/s00330-023-09919-z},

issn = {1432-1084},

year  = {2023},

date = {2023-12-01},

urldate = {2023-07-01},

journal = {Eur Radiol},

volume = {33},

number = {12},

pages = {9167-9181},

abstract = {The 10th Global Forum for Liver Magnetic Resonance Imaging was held in October 2021. The themes of the presentations and discussions at this Forum are described in detail in the review by Taouli et al (2023). The focus of this second manuscript developed from the Forum is on multidisciplinary tumor board perspectives in hepatocellular carcinoma (HCC) management: how to approach early-, mid-, and late-stage management from the perspectives of a liver surgeon, an interventional radiologist, and an oncologist. The manuscript also includes a panel discussion by multidisciplinary experts on three selected cases that explore challenging aspects of HCC management. CLINICAL RELEVANCE STATEMENT: This review highlights the importance of a multidisciplinary team approach in liver cancer patients and includes the perspectives of a liver surgeon, an interventional radiologist, and an oncologist, including illustrative case studies. KEY POINTS: • A liver surgeon, interventional radiologist, and oncologist presented their perspectives on the treatment of early-, mid-, and late-stage HCC. • Different perspectives on HCC management between specialties emphasize the importance of multidisciplinary tumor boards. • A multidisciplinary faculty discussed challenging aspects of HCC management, as highlighted by three case studies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36959868,

title = {Effective contact tracing for COVID-19: A systematic review},

author = {Carl-Etienne Juneau and Anne-Sara Briand and Pablo Collazzo and Uwe Siebert and Tomas Pueyo},

doi = {10.1016/j.gloepi.2023.100103},

issn = {2590-1133},

year  = {2023},

date = {2023-12-01},

journal = {Glob Epidemiol},

volume = {5},

pages = {100103},

abstract = {Contact tracing is commonly recommended to control outbreaks of COVID-19, but its effectiveness is unclear. Following PRISMA guidelines, we searched four databases using a range of terms related to contact tracing effectiveness for COVID-19. We found 343 papers; 32 were included. All were observational or modelling studies. Observational studies ( = 14) provided consistent, very-low certainty evidence that contact tracing (alone or in combination with other interventions) was associated with better control of COVID-19 (e.g. in Hong Kong, only 1084 cases and four deaths were recorded in the first 4.5 months of the pandemic). Modelling studies ( = 18) provided consistent, high-certainty evidence that under assumptions of prompt and thorough tracing with effective quarantines, contact tracing could stop the spread of COVID-19 (e.g. by reducing the reproduction number from 2.2 to 0.57). A cautious interpretation indicates that to stop the spread of COVID-19, public health practitioners have 2-3 days from the time a new case develops symptoms to isolate the case and quarantine at least 80% of its contacts.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37991759,

title = {Estimated US Cancer Deaths Prevented With Increased Use of Lung, Colorectal, Breast, and Cervical Cancer Screening},

author = {Amy B Knudsen and Amy Trentham-Dietz and Jane J Kim and Jeanne S Mandelblatt and Rafael Meza and Ann G Zauber and Philip E Castle and Eric J Feuer},

doi = {10.1001/jamanetworkopen.2023.44698},

issn = {2574-3805},

year  = {2023},

date = {2023-11-01},

journal = {JAMA Netw Open},

volume = {6},

number = {11},

pages = {e2344698},

abstract = {IMPORTANCE: Increased use of recommended screening could help achieve the Cancer Moonshot goal of reducing US cancer deaths.nnOBJECTIVE: To estimate the number of cancer deaths that could be prevented with a 10-percentage point increase in the use of US Preventive Services Task Force (USPSTF)-recommended screening.nnDESIGN, SETTING, AND PARTICIPANTS: This decision analytical model study is an extension of previous studies conducted for the USPSTF from 2018 to 2023. This study simulated contemporary cohorts of US adults eligible for lung, colorectal, breast, and cervical cancer screening.nnEXPOSURES: Annual low-dose computed lung tomography among eligible adults aged 50 to 80 years; colonoscopy every 10 years among adults aged 45 to 75 years; biennial mammography among female adults aged 40 to 74 years; and triennial cervical cytology screening among female adults aged 21 to 29 years, followed by human papillomavirus testing every 5 years from ages 30 to 65 years.nnMAIN OUTCOMES AND MEASURES: Estimated number of cancer deaths prevented with a 10-percentage point increase in screening use, assuming screening commences at the USPSTF-recommended starting age and continues throughout the lifetime. Outcomes were presented 2 ways: (1) per 100 000 and (2) among US adults in 2021; and they were expressed among the target population at the age of screening initiation. For lung cancer, estimates were among those who will also meet the smoking eligibility criteria during their lifetime. Harms from increased uptake were also reported.nnRESULTS: A 10-percentage point increase in screening use at the age that USPSTF recommended screening commences was estimated to prevent 226 lung cancer deaths (range across models within the cancer site, 133-332 deaths), 283 (range, 263-313) colorectal cancer deaths, 82 (range, 61-106) breast cancer deaths, and 81 (1 model; no range available) cervical cancer deaths over the lifetimes of 100 000 persons eligible for screening. These rates corresponded with an estimated 1010 (range, 590-1480) lung cancer deaths prevented, 11 070 (range, 10 280-12 250) colorectal cancer deaths prevented, 1790 (range, 1330-2310) breast cancer deaths prevented, and 1710 (no range available) cervical cancer deaths prevented over the lifetimes of eligible US residents at the recommended age to initiate screening in 2021. Increased uptake was also estimated to generate harms, including 100 000 (range, 45 000-159 000) false-positive lung scans, 6000 (range, 6000-7000) colonoscopy complications, 300 000 (range, 295 000-302 000) false-positive mammograms, and 348 000 (no range available) colposcopies over the lifetime.nnCONCLUSIONS AND RELEVANCE: In this decision analytical model study, a 10-percentage point increase in uptake of USPSTF-recommended lung, colorectal, breast, and cervical cancer screening at the recommended starting age was estimated to yield important reductions in cancer deaths. Achieving these reductions is predicated on ensuring equitable access to screening.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37925262,

title = {Social vulnerability and time to surgeon evaluation for primary hyperparathyroidism in a Massachusetts cohort},

author = {Reagan A Collins and Jordan M Broekhuis and Maria P Cote and Jorge L Gomez-Mayorga and Natalia Chaves and Benjamin C James},

doi = {10.1016/j.surg.2023.04.067},

issn = {1532-7361},

year  = {2023},

date = {2023-11-01},

urldate = {2023-11-01},

journal = {Surgery},

volume = {175},

issue = {1},

pages = {25-31},

abstract = {BACKGROUND: Identifying patients at risk for under-evaluation of primary hyperparathyroidism is essential to minimizing long-term sequelae, including osteoporosis, nephrolithiasis, and cardiovascular disease. This study assessed the impact of social vulnerability on time-to-surgery evaluation among patients with primary hyperparathyroidism in a Massachusetts cohort.nnMETHODS: This is a retrospective review of patients from an institutional database with the first incident of hypercalcemia between 2010 and 2018 and subsequent biochemical diagnosis of primary hyperparathyroidism. The overall social vulnerability index and social vulnerability index subthemes were merged with the institutional data via patient ZIP code. Patients were stratified into social vulnerability index quartiles, where quartile 4 represented the highest vulnerability. Baseline sociodemographic and clinical characteristics were compared, and Cox regression was used to assess the association between social vulnerability index and time to surgeon evaluation.nnRESULTS: Of 1,082 patients included, those with a higher social vulnerability index were less likely to be evaluated by a surgeon (quartile 1 social vulnerability index: 31.1% vs. quartile 2 social vulnerability index: 31.41% vs. quartile 3 social vulnerability index: 25.93% vs. quartile 4 social vulnerability index: 21.92%, P = .03). On adjusted analysis, patients with the highest vulnerability had a 33% lower estimated rate of surgeon evaluation and were seen 67 days later compared with patients with the lowest vulnerability (hazard ratio: 0.67, confidence interval 0.47-0.97, P = .032). Differential rates of surgical evaluation by vulnerability persisted for the social vulnerability index subthemes for socioeconomic status, minority status and language, and housing type and transportation.nnCONCLUSION: Among a Massachusetts cohort, highly vulnerable populations with primary hyperparathyroidism are at greater risk for under-evaluation by a surgeon, which may contribute to the development of long-term sequelae of their disease.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37921772,

title = {Factors Associated With Abrupt Discontinuation of Long-Term High-Dose Opioid Treatment},

author = {Carolina Vivas-Valencia and Huiru Dong and Erin J Stringfellow and W Alton Russell and Jake R Morgan and Mina Tadrous and Mohammad S Jalali},

doi = {10.1001/jamanetworkopen.2023.41416},

issn = {2574-3805},

year  = {2023},

date = {2023-11-01},

journal = {JAMA Netw Open},

volume = {6},

number = {11},

pages = {e2341416},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37434347b,

title = {The association between longitudinal trends in receipt of buprenorphine for opioid use disorder and buprenorphine-waivered providers in the United States},

author = {Erin J Stringfellow and Tse Yang Lim and Huiru Dong and Ziyuan Zhang and Mohammad S Jalali},

doi = {10.1111/add.16291},

issn = {1360-0443},

year  = {2023},

date = {2023-11-01},

urldate = {2023-07-01},

journal = {Addiction},

volume = {118},

number = {11},

pages = {2215-2219},

abstract = {AIMS, DESIGN AND SETTING: We sought to describe longitudinal trends in buprenorphine receipt and buprenorphine-waivered providers in the United States from 2003 to 2021 and measure whether the relationship between the two differed after capacity-building strategies were enacted nationally in 2017. This was a retrospective study of two separate cohorts covering the years 2003-21, testing whether the association between two trends in these cohorts changed comparing 2003 to 2016 and from 2017 to 2021, among buprenorphine providers in the United States, regardless of treatment setting. Patients receiving dispensed buprenorphine at retail pharmacies.nnPARTICIPANTS: All providers who have obtained a waiver to prescribe buprenorphine in the United States, and an estimate of the annual number of patients who had buprenorphine for opioid use disorder (OUD) dispensed to them at a retail pharmacy.nnMEASUREMENTS: We synthesized and summarized data from multiple sources to assess the cumulative number of buprenorphine-waivered providers over time. We used national-level prescription data from IQVIA to estimate annual buprenorphine receipt for OUD.nnFINDINGS: From 2003 to 2021, the number of buprenorphine-waivered providers in the United States increased from fewer than 5000 in the first 2 years of Food and Drug Administration (FDA) approval to more than 114 000 in 2021, while patients receiving buprenorphine products for OUD increased from approximately 19 000 to more than 1.4 million. The strength of association between waivered providers and patients is significantly different before and after 2017 (P \< 0.001). From 2003 to 2016, for each additional provider, there was an average increase of 32.1 [95% confidence interval (CI) = 28.7-35.6] patients, but an increase of only 4.6 (95% CI= 3.5-5.7) patients for each additional provider, beginning in 2017.nnCONCLUSIONS: In the United States, the relationship between the rates of growth in buprenorphine providers and patients became weaker after 2017. While efforts to increase buprenorphine-waivered providers were successful, there was less success in translating that into significant increases in buprenorphine receipt.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37437883,

title = {Early Detection of Lung Cancer using small RNAs},

author = {Tobias Sikosek and Rastislav Horos and Franziska Trudzinski and Julia Jehn and Maurice Frank and Timothy Rajakumar and Laura V Klotz and Nathaniel Mercaldo and Mustafa Kahraman and Marco Heuvelman and Yasser Taha and Jennifer Gerwing and Jasmin Skottke and Alberto Daniel-Moreno and Marta Sanchez-Delgado and Sophie Bender and Christina Rudolf and Franziska Hinkfoth and Kaja Tikk and Judith Schenz and Markus A Weigand and Peter Feindt and Christian Schumann and Petros Christopoulos and Hauke Winter and Michael Kreuter and Marc A Schneider and Thomas Muley and Stephan Walterspacher and Martin Schuler and Kaid Darwiche and Christian Taube and Balazs Hegedus and Klaus F Rabe and Kimberly Rieger-Christ and Francine L Jacobsen and Clemens Aigner and Martin Reck and Alexander A Bankier and Amita Sharma and Bruno R Steinkraus},

doi = {10.1016/j.jtho.2023.07.005},

issn = {1556-1380},

year  = {2023},

date = {2023-11-01},

urldate = {2023-07-01},

journal = {J Thorac Oncol},

volume = {18},

number = {11},

pages = {1504-1523},

abstract = {BACKGROUND: Lung cancer remains the deadliest cancer in the world and survival is heavily dependent on tumor stage at the time of detection. Low-dose computed tomography (LDCT) screening can significantly reduce mortality, however, annual screening is limited by low adherence in the USA and still not broadly implemented in Europe. As a result, \<10% of lung cancers are detected through existing programs. Thus, there is great need for additional screening tests, such as a blood test that could be deployed in the primary care setting.nnMETHODS: We prospectively recruited 1,384 individuals meeting the NLST demographic eligibility criteria for lung cancer and collected stabilized whole blood to enable the pipetting-free collection of material, thus minimizing pre-analytical noise. Ultra-deep small RNA sequencing (20 million reads/sample) was performed with the addition of a method to remove highly abundant erythroid RNAs, and thus open bandwidth for the detection of less abundant species originating from plasma or the immune cellular compartment. We utilized 100 random data splits to train and evaluate an ensemble of logistic regression classifiers using small RNA expression of 943 individuals, discovered an 18-small RNA feature consensus signature (miLung), and validated this signature in an independent cohort (441 individuals). Blood cell sorting and tumor tissue sequencing were performed to deconvolve small RNAs into their source of origin.nnRESULTS: We generated diagnostic models and report a median ROC AUC of 0.86 (95% CI 0.84-0.86) in the discovery cohort, and generalized performance of 0.83 in the validation cohort. Diagnostic performance increased in a stage-dependent manner ranging from 0.73 (95% CI 0.71-0.76) for Stage I to 0.90 (95% CI 0.89-0.90) for Stage IV in the discovery cohort, and from 0.76 to 0.86 in the validation cohort. We identified a tumor-shed, plasma-bound ribosomal RNA fragment of the L1 stalk as a dominant predictor of lung cancer. The fragment is decreased following surgery with curative intent. In additional experiments, dried blood spot collection and sequencing demonstrated that small RNA analysis could potentially be conducted via home-sampling.nnCONCLUSION: These data suggest the potential of a small RNA-based blood test as a viable alternative to LDCT screening for early detection of smoking-associated lung cancer.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37344967,

title = {Social vulnerability predictors of drug poisoning mortality: A machine learning analysis in the United States},

author = {Moosa Tatar and Mohammad R Faraji and Katherine Keyes and Fernando A Wilson and Mohammad S Jalali},

doi = {10.1111/ajad.13445},

issn = {1521-0391},

year  = {2023},

date = {2023-11-01},

urldate = {2023-06-21},

journal = {Am J Addict},

volume = {32},

number = {6},

pages = {539-546},

abstract = {BACKGROUND AND OBJECTIVES: Drug poisoning is a leading cause of unintentional deaths in the United States. Despite the growing literature, there are a few recent analyses of a wide range of community-level social vulnerability features contributing to drug poisoning mortality. Current studies on this topic face three limitations: often studying a limited subset of vulnerability features, focusing on small sample sizes, or solely including local data. To address this gap, we conducted a national-level analysis to study the impacts of several social vulnerability features in predicting drug mortality rates in the United States.nnMETHODS: We used machine learning to investigate the role of 16 social vulnerability features in predicting drug mortality rates for US counties in 2014, 2016, and 2018-the most recent available data. We estimated each vulnerability feature\'s gain relative contribution in predicting drug poisoning mortality.nnRESULTS: Among all social vulnerability features, the percentage of noninstitutionalized persons with a disability is the most influential predictor, with a gain relative contribution of 18.6%, followed by population density and the percentage of minority residents (13.3% and 13%, respectively). Percentages of households with no available vehicles, mobile homes, and persons without a high school diploma are the following features with gain relative contributions of 6.3%, 5.8%, and 5.1%, respectively.nnCONCLUSION AND SCIENTIFIC SIGNIFICANCE: We identified social vulnerability features that are most predictive of drug poisoning mortality. Public health interventions and policies targeting vulnerable communities may increase the resilience of these communities and mitigate the overdose death and drug misuse crisis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37406750c,

title = {Ultrasound Surveillance of Small, Incidentally Detected Gallbladder Polyps: Projected Benefits by Sex, Age, and Comorbidity Level},

author = {Claudia L Seguin and Barak Davidi and Mary Linton B Peters and Andrew Eckel and Mukesh G Harisinghani and Reece J Goiffon and Amy B Knudsen and Pari V Pandharipande},

doi = {10.1016/j.jacr.2023.05.015},

issn = {1558-349X},

year  = {2023},

date = {2023-10-01},

urldate = {2023-10-01},

journal = {J Am Coll Radiol},

volume = {20},

number = {10},

pages = {1031-1041},

abstract = {OBJECTIVE: Incidentally detected gallbladder polyps are commonly encountered when performing upper abdominal ultrasound. Our purpose was to estimate the life expectancy (LE) benefit of ultrasound-based gallbladder surveillance in patients with small (6-7 to \<10 mm), incidentally detected gallbladder polyps, accounting for patient sex, age, and comorbidity level.nnMETHODS: We developed a decision-analytic Markov model to evaluate hypothetical cohorts of women and men with small gallbladder polyps, with varying age (66-80 years) and comorbidity level (none, mild, moderate, severe). Drawing from current evidence, in the base case, we assumed no increased risk of gallbladder cancer in patients with small gallbladder polyps. To estimate maximal possible LE gains from surveillance, we assumed perfect cancer control consequent to 5 years of surveillance. We varied key assumptions including cancer risk and test performance characteristics in sensitivity analysis.nnRESULTS: Projected LE gains from surveillance were \<3 days across most cohorts and scenarios evaluated. For 66- and 80-year-olds with no comorbidities, LE gains were 1.46 and 1.45 days, respectively, for women, and 0.67 and 0.75 days for men. With 10 years of surveillance, LE gains increased to 2.94 days for 66-year-old women with no comorbidities (men: 1.35 days). If we assumed a 10% increase in gallbladder cancer risk among individuals with polyps, LE gains increased slightly to 1.60 days for 66-year-old women with no comorbidities (men: 0.74 days). Results were sensitive to test performance and surgical mortality.nnDISCUSSION: Even under unrealistic, optimistic assumptions of cancer control, ultrasound surveillance of incidentally detected small gallbladder polyps provided limited benefit.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37454978b,

title = {NordICC Trial Results in Line With Expected Colorectal Cancer Mortality Reduction After Colonoscopy: A Modeling Study},

author = {Danica M N van den Berg and Pedro Nascimento de Lima and Amy B Knudsen and Carolyn M Rutter and David Weinberg and Iris Lansdorp-Vogelaar and },

doi = {10.1053/j.gastro.2023.06.035},

issn = {1528-0012},

year  = {2023},

date = {2023-10-01},

journal = {Gastroenterology},

volume = {165},

number = {4},

pages = {1077--1079.e2},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37795630,

title = {Long-term benefits and harms of early colorectal cancer screening in German individuals with familial cancer risk},

author = {Gaby Sroczynski and L\'{a}ra R Hallsson and Nikolai M\"{u}hlberger and Beate Jahn and Raphael Rehms and Sabine Hoffmann and Alexander Crispin and Doris Lindoerfer and Ulrich Mansmann and Uwe Siebert},

doi = {10.1002/ijc.34747},

issn = {1097-0215},

year  = {2023},

date = {2023-10-01},

urldate = {2023-10-01},

journal = {Int J Cancer},

volume = {154},

issue = {3},

pages = {516-529},

abstract = {Individuals with a family history of colorectal cancer (CRC) may benefit from early screening with colonoscopy or immunologic fecal occult blood testing (iFOBT). We systematically evaluated the benefit-harm trade-offs of various screening strategies differing by screening test (colonoscopy or iFOBT), interval (iFOBT: annual/biennial; colonoscopy: 10-yearly) and age at start (30, 35, 40, 45, 50 and 55 years) and end of screening (65, 70 and 75 years) offered to individuals identified with familial CRC risk in Germany. A Markov-state-transition model was developed and used to estimate health benefits (CRC-related deaths avoided, life-years gained [LYG]), potential harms (eg, associated with additional colonoscopies) and incremental harm-benefit ratios (IHBR) for each strategy. Both benefits and harms increased with earlier start and shorter intervals of screening. When screening started before age 50, 32-36 CRC-related deaths per 1000 persons were avoided with colonoscopy and 29-34 with iFOBT screening, compared to 29-31 (colonoscopy) and 28-30 (iFOBT) CRC-related deaths per 1000 persons when starting age 50 or older, respectively. For iFOBT screening, the IHBRs expressed as additional colonoscopies per LYG were one (biennial, age 45-65 vs no screening), four (biennial, age 35-65), six (biennial, age 30-70) and 34 (annual, age 30-54; biennial, age 55-75). Corresponding IHBRs for 10-yearly colonoscopy were four (age 55-65), 10 (age 45-65), 15 (age 35-65) and 29 (age 30-70). Offering screening with colonoscopy or iFOBT to individuals with familial CRC risk before age 50 is expected to be beneficial. Depending on the accepted IHBR threshold, 10-yearly colonoscopy or alternatively biennial iFOBT from age 30 to 70 should be recommended for this target group.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37782860,

title = {How Funding Policy Maintains Structural Inequity Within Indigenous Community-Based Organizations},

author = {Arielle R Deutsch and Leah Frerichs and Zeynep Hasgul and Foster Murphey and Addie K Coleman and Annie Y Bachand and Arlana Bettelyoun and Paul Forney and Gene Tyon and Mohammad S Jalali},

doi = {10.1377/hlthaff.2023.00483},

issn = {1544-5208},

year  = {2023},

date = {2023-10-01},

journal = {Health Aff (Millwood)},

volume = {42},

number = {10},

pages = {1411--1419},

abstract = {Despite efforts to increase investment in Indigenous health and well-being in the United States, disparities remain. The way in which health-promoting organizations are funded is one key mechanism driving the systemic, long-term health disparities experienced by Indigenous people in the US. Using Indigenous-led community-based organizations (ICBOs) that provide psychosocial care as a case study, we highlight multiple ways in which policies that regulate the external funding that ICBOs depend on must change to promote equity and allow the organizations to flourish and address unmet psychosocial needs for Indigenous community members. We use a system dynamics approach to discuss how "capability traps" arise from a misfit between external funding regulations and organizations' needs for sustainability and effective care provision. We provide suggestions for reforming funding policies that focus on improving ICBO sustainability.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}