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A comparison of two emergency medical dispatch protocols with respect to accuracy.

https://arctichealth.org/en/permalink/ahliterature294553
Source
Scand J Trauma Resusc Emerg Med. 2017 Dec 29; 25(1):122
Publication Type
Comparative Study
Journal Article
Randomized Controlled Trial
Date
Dec-29-2017
Author
Klara Torlén
Lisa Kurland
Maaret Castrén
Knut Olanders
Katarina Bohm
Author Affiliation
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, SE 118 83, Stockholm, Sweden. klara.torlen@ki.se.
Source
Scand J Trauma Resusc Emerg Med. 2017 Dec 29; 25(1):122
Date
Dec-29-2017
Language
English
Publication Type
Comparative Study
Journal Article
Randomized Controlled Trial
Keywords
Clinical Protocols
Emergency Medical Dispatch - organization & administration
Emergency Medical Service Communication Systems
Female
Humans
Male
Sensitivity and specificity
Sweden
Triage - methods
Abstract
Emergency medical dispatching should be as accurate as possible in order to ensure patient safety and optimize the use of ambulance resources. This study aimed to compare the accuracy, measured as priority level, between two Swedish dispatch protocols - the three-graded priority protocol Medical Index and a newly developed prototype, the four-graded priority protocol, RETTS-A.
A simulation study was carried out at the Emergency Medical Communication Centre (EMCC) in Stockholm, Sweden, between October and March 2016. Fifty-three voluntary telecommunicators working at SOS Alarm were recruited nationally. Each telecommunicator handled 26 emergency medical calls, simulated by experienced standard patients. Manuscripts for the scenarios were based on recorded real-life calls, representing the six most common complaints. A cross-over design with 13?+?13 calls was used. Priority level and medical condition for each scenario was set through expert consensus and used as gold standard in the study.
A total of 1293 calls were included in the analysis. For priority level, n?=?349 (54.0%) of the calls were assessed correctly with Medical Index and n?=?309 (48.0%) with RETTS-A (p?=?0.012). Sensitivity for the highest priority level was 82.6% (95% confidence interval: 76.6-87.3%) in the Medical Index and 54.0% (44.3-63.4%) in RETTS-A. Overtriage was 37.9% (34.2-41.7%) in the Medical Index and 28.6% (25.2-32.2%) in RETTS-A. The corresponding proportion of undertriage was 6.3% (4.7-8.5%) and 23.4% (20.3-26.9%) respectively.
In this simulation study we demonstrate that Medical Index had a higher accuracy for priority level and less undertriage than the new prototype RETTS-A. The overall accuracy of both protocols is to be considered as low. Overtriage challenges resource utilization while undertriage threatens patient safety. The results suggest that in order to improve patient safety both protocols need revisions in order to guarantee safe emergency medical dispatching.
Notes
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PubMed ID
29284542 View in PubMed
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A multicenter clinical trial validating the performance of HE4, CA125, risk of ovarian malignancy algorithm and risk of malignancy index.

https://arctichealth.org/en/permalink/ahliterature295822
Source
Gynecol Oncol. 2018 10; 151(1):159-165
Publication Type
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Validation Studies
Date
10-2018
Author
Maria Lycke
Björg Kristjansdottir
Karin Sundfeldt
Author Affiliation
Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Sweden. Electronic address: maria.lycke@vgregion.se.
Source
Gynecol Oncol. 2018 10; 151(1):159-165
Date
10-2018
Language
English
Publication Type
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Validation Studies
Keywords
Adult
Aged
Algorithms
CA-125 Antigen - blood
Diagnosis, Differential
Female
Humans
Incidence
Membrane Proteins - blood
Middle Aged
Neoplasms, Glandular and Epithelial - blood - diagnosis - epidemiology - pathology
Ovarian Cysts - blood - diagnosis - pathology - surgery
Ovarian Neoplasms - blood - diagnosis - epidemiology - pathology
Ovary - pathology - surgery
Pelvic Neoplasms - blood - diagnosis - pathology - surgery
Proteins - analysis
Risk assessment
Sensitivity and specificity
Sweden - epidemiology
Abstract
To validate, in a multicenter clinical trial, the performance of biomarkers and algorithms for differential diagnosis in a population of women diagnosed with an unknown ovarian cyst or pelvic tumor.
Six hospitals in Western Sweden consecutively enrolled 638 women from September 2013 to February 2016. Serum, transvaginal ultrasound data, and basic patient characteristics were collected preoperatively. Biomarker levels, risk of malignancy algorithm (ROMA), and risk of malignancy index (RMI) were calculated and compared with the final pathology report.
Our sample of 638 patients had 445 benign, 31 borderline, and 162 malignant tumors recorded, and the overall incidence of epithelial ovarian cancer was 21%. In postmenopausal women, RMI (>200), ROMA (=29.9), CA125 (>35?U/mL), and HE4 (>140?pmol/L) showed sensitivity at 89%, 91%, 92%, and 72%, respectively, and specificity at 80%, 77%, 80%, and 92%. In premenopausal women, sensitivity of RMI, ROMA (=11.6), CA125, and HE4 (>70?pmol/L) was 87%, 87%, 96%, and 83%, respectively, and specificity was 90%, 81%, 60%, 91%. Diagnostic accuracy (ROC AUC) of RMI and ROMA in postmenopausal women was 0.85 and 0.84, and in premenopausal women, 0.90 and 0.81.
Our results suggest that CA125 is superior to HE4 as a biomarker to identify women with ovarian cancer. HE4 more correctly identifies benign lesions, which may help in differential diagnoses to guide the level of care and decrease overtreatment. This study confirms prior results from single-center studies and suggests the implementation of HE4 measurement in daily practice.
PubMed ID
30149898 View in PubMed
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Predicting the effectiveness of the Finnish population-based colorectal cancer screening programme.

https://arctichealth.org/en/permalink/ahliterature291767
Source
J Med Screen. 2017 Dec; 24(4):182-188
Publication Type
Journal Article
Randomized Controlled Trial
Date
Dec-2017
Author
Sherry Yueh-Hsia Chiu
Nea Malila
Amy Ming-Fang Yen
Sam Li-Sheng Chen
Jean Ching-Yuan Fann
Matti Hakama
Author Affiliation
1 Department of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan.
Source
J Med Screen. 2017 Dec; 24(4):182-188
Date
Dec-2017
Language
English
Publication Type
Journal Article
Randomized Controlled Trial
Keywords
Aged
Cohort Studies
Colorectal Neoplasms - diagnosis - epidemiology - prevention & control
Early Detection of Cancer - methods - standards
Finland - epidemiology
Humans
Incidence
Male
Mass Screening - methods - standards
Middle Aged
Occult Blood
Sensitivity and specificity
Abstract
Objective Because colorectal cancer (CRC) has a long natural history, estimating the effectiveness of CRC screening programmes requires long-term follow-up. As an alternative, we here demonstrate the use of a temporal multi-state natural history model to predict the effectiveness of CRC screening. Methods In the Finnish population-based biennial CRC screening programme using faecal occult blood tests (FOBT), which was conducted in a randomised health services study, we estimated the pre-clinical incidence, the mean sojourn time (MST), and the sensitivity of FOBT using a Markov model to analyse data from 2004 to 2007. These estimates were applied to predict, through simulation, the effects of five rounds of screening on the relative rate of reducing advanced CRC with 6 years of follow-up, and on the reduction in mortality with 10 years of follow-up, in a cohort of 500,000 subjects aged 60 to 69. Results For localised and non-localised CRC, respectively, the MST was 2.06 and 1.36 years and the sensitivity estimates were 65.12% and 73.70%. The predicted relative risk of non-localised CRC and death from CRC in the screened compared with the control population was 0.86 (95% CI: 0.79-0.98) and 0.91 (95% CI: 0.85-1.02), respectively. Conclusion Based on the preliminary results of the Finnish CRC screening programme, our model predicted a 9% reduction in CRC mortality and a 14% reduction in advanced CRC.
PubMed ID
28084889 View in PubMed
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Randomised study of HPV prevalence and detection of CIN2+ in vaginal self-sampling compared to cervical specimens collected by medical personnel.

https://arctichealth.org/en/permalink/ahliterature299493
Source
Int J Cancer. 2019 01 01; 144(1):89-97
Publication Type
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Date
01-01-2019
Author
Inger Gustavsson
Riina Aarnio
Malin Berggrund
Julia Hedlund-Lindberg
Karin Sanner
Ingrid Wikström
Stefan Enroth
Matts Olovsson
Ulf Gyllensten
Author Affiliation
Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden.
Source
Int J Cancer. 2019 01 01; 144(1):89-97
Date
01-01-2019
Language
English
Publication Type
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Keywords
Cervical Intraepithelial Neoplasia - diagnosis - epidemiology - virology
Diagnostic Tests, Routine - methods
Early Detection of Cancer - methods
Female
Health Personnel
Humans
Middle Aged
Papanicolaou Test - methods
Papillomaviridae - classification - physiology
Papillomavirus Infections - diagnosis - epidemiology - virology
Prevalence
Sensitivity and specificity
Specimen Handling - methods
Sweden - epidemiology
Uterine Cervical Neoplasms - diagnosis - epidemiology - virology
Vaginal Smears - methods
Abstract
We conducted a randomised study to compare vaginal self-sampling with assisted sampling by medical personnel on the cervix for HPV testing in primary screening. The first aim was to determine if the HPV prevalence is independent of sampling location (vagina versus cervix) and the person performing the sampling. The second aim was to evaluate if the two sampling strategies differed in the detection rate of CIN2+. In total, 19,523 women were randomised into two groups, with 9926 invited to perform self-sampling (SS arm) using the Rover VIBA-brush and 9597 offered assisted sampling using the cytobrush (AS arm). All samples were applied to the indicating FTA elute card and analysed for high-risk HPV using the hpVIR real-time PCR assay. The outcome for the first aim was HPV prevalence and for the second aim the number of CIN2+ based on histology. In the SS arm, 52.7% of invited women participated in the study, as compared to 34.2% in the AS arm. All samples contained sufficient amount of nuclear DNA for a valid HPV result, with vaginal samples having a higher DNA amount than cervical samples (p
PubMed ID
29943822 View in PubMed
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