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Preventing overdiagnosis

Gonzalo Bearman, Michelle Doll, Kaila Cooper, Michael P Stevens
PURPOSE OF REVIEW: To summarize the extent to which hospital-acquired infections (HAIs) are preventable and to assess expectations, challenges, and barriers to improve patient outcomes. RECENT FINDINGS: HAIs cause significant morbidity and mortality. Getting to zero HAIs is a commonly stated goal yet leads to unrealistic expectations. The extent to which all HAIs can be prevented remains debatable and is subject to multiple considerations and barriers. Current infection prevention science is inexact and evolving...
February 2, 2019: Current Infectious Disease Reports
M Wohlmannstetter
BACKGROUND: In recent years "overtreatment" and "overdiagnosis" have become well discussed problems in medicine. OBJECTIVES: Similar to medicine, could some nursing interventions be classified as "overtreatment in nursing"? METHODS: The available literature was evaluated and the different kinds of "overtreatment in nursing" are described. Ritualised nursing interventions are critically reflected upon...
January 31, 2019: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Holli A Loomans-Kropp, Asad Umar
A primary mode of cancer prevention and early detection in the United States is the widespread practice of screening. Although many strategies for early detection and prevention are available, adverse outcomes, such as overdiagnosis and overtreatment, are prevalent among those utilizing these approaches. Broad use of mammography and prostate cancer screening are key examples illustrating the potential harms stemming from the detection of indolent lesions and the subsequent overtreatment. Furthermore, there are several cancers for which prevention strategies do not currently exist...
2019: NPJ Precision Oncology
Francesco Attena
BACKGROUND: The role of medicine in society appears to be focused on two views, which may be summarized as follows: "Doing more means doing better" (paradigm A) and "Doing more does not mean doing better" (paradigm B). MAIN BODY: I compared paradigms A and B both in terms of a single clinical condition and in the general context of a medical system. For a single clinical condition, I analyzed breast cancer screening. There are at least seven interconnected issues that influence the conflict between paradigms A and B in the debate on breast cancer screening: disconnection between research and practice; scarcity of information given to women; how "political correctness" can influence the choice of a health policy; professional interests; doubts about effectiveness; incommensurability between harms and benefits; and the difficulty in making dichotomous decisions with discrete variables...
January 22, 2019: BMC Public Health
Candyce Hamel, Eddy Lang, Kate Morissette, Andrew Beck, Adrienne Stevens, Becky Skidmore, Heather Colquhoun, John LeBlanc, Ainsley Moore, John J Riva, Brett D Thombs, Ian Colman, Sophie Grigoriadis, Stuart Gordon Nicholls, Beth K Potter, Kerri Ritchie, Julie Robert, Priya Vasa, Bianca Lauria-Horner, Scott Patten, Simone N Vigod, Brian Hutton, Beverley J Shea, Shamila Shanmugasegaram, Julian Little, David Moher
BACKGROUND: In 2018, the World Health Organization reported that depression is the most common cause of disability worldwide, with over 300 million people currently living with depression. Depression affects an individual's physical health and well-being, impacts psychosocial functioning, and has specific negative short- and long-term effects on maternal health, child health, developmental trajectories, and family health. The aim of these reviews is to identify evidence on the benefits and harms of screening for depression in the general adult population and in pregnant and postpartum women...
January 19, 2019: Systematic Reviews
Jennifer J Koplin, Kirsten P Perrett, Hugh A Sampson
Diagnosis of peanut allergy presents a significant clinical challenge. Accurate diagnosis is critical for patient management and prevention of allergic reactions, whereas overdiagnosis or failure to diagnose tolerance in a previously allergic patient can lead to unnecessary dietary restrictions and impaired quality of life. Oral food challenges, the criterion standard for diagnosis, pose a risk of potentially severe allergic reactions, and are time- and resource- intensive. In this article, we review other currently available tests for peanut allergy and present the strengths and weaknesses of each to assist the clinician in determining which test might be appropriate for their patients, as well as highlighting emerging tests currently in development...
December 20, 2018: Journal of Allergy and Clinical Immunology in Practice
Henriëtte E van der Horst
Most people claim that health is an important prerequisite for a happy life. Our society puts much effort into promoting a healthy lifestyle, prevention and timely risk detection. After all, prevention is better than cure. The increased attention to health and the strong focus on prevention, risk reduction and risk avoidance have their downsides, as Ivan Illich already pointed out in the nineteen-seventies. Overdiagnosis, overtreatment and the transformation of many everyday complaints and phenomena into abnormalities lead to medicalisation...
December 5, 2018: Nederlands Tijdschrift Voor Geneeskunde
Elena Cardona Corrochano, Ana Pereira Iglesias, David Fraile Navarro, Alberto López García Franco
In 1994, the World Health Organisation established osteoporosis criteria based on bone mineral density (in terms of T-Score), granting a risk factor the category of disease. Given that it has a low positive predictive value of fractures when applied to low-risk populations, its use as a screening test is controversial because it favours overdiagnosis due to the false labelling of the disease it produces. In the coming years, the indication of densitometry will be made based on the absolute risk of fracture...
November 2018: Atencion Primaria
G Layer
Screening is a special issue in medical questions concerning disease prevention. Preconditions for screening are clearly defined by the World Health Organization. High prevalence, effectiveness of therapy, availability of accepted test procedure and consensus concerning the economic concerns are necessary for successful implementation of a screening program. Preventive diagnostic studies can only be understood if one is familiar with the statistical terms sensitivity, specificity, prevalence, incidence and bias (especially overdiagnosis and lead time bias)...
December 14, 2018: Der Radiologe
Joseph Hartge, Patricia Toledo
BACKGROUND: Attention-deficit/hyper-activity disorder's (ADHD) prevalence rate has been increasing during the last decade. Evidence from different studies suggests that the effect of ADHD on earnings and employment could be more detrimental than other disorders such as depression or anxiety. Although it is widely known that these mental disorders can coexist with ADHD, none of these studies has considered the joint evaluation of ADHD and its comorbidities. OBJECTIVE: In this paper, we evaluate whether ADHD is a more severe disorder than three other comorbid mental disorders -- learning disabilities, depression, and anxiety -- regarding their effects on earnings and employment...
September 1, 2018: Journal of Mental Health Policy and Economics
F Benoît, K Segers, C Sergeant, J Robberecht, J M Meyts, R Karmali, M Surquin
Over-medicalization is a broad concept, which also concerns the elderly patient. It encompasses both over-diagnosis and over-treatment. An increasing awareness of this issue has emerged since 2013, with the first " Preventing Overdiagnosis " conference. Currently, Evidence-Based Medicine does not prevent over-diagnosis. Indeed, the presence of geriatric characteristics such as multiple comorbidities, polypharmacy and frailty can lead to misdiagnosis and to potentially deleterious treatment. Subclinical hypothyroidism and Alzheimer's disease are two examples of pitfalls in the interpretation of biological and para-clinical data that may lead to the administration of useless treatment...
2018: Revue Médicale de Bruxelles
Karen M Meagher, Jonathan S Berg
No abstract text is available yet for this article.
September 27, 2018: Personalized Medicine
Alfredo Cerisola, Eugenia Chaibún, Melania Rosas, Lucía Cibils
A febrile seizure occurs in association with fever in a child aged 6 to 60 months, without central nervous system infection or other known cause of acute seizures in a child without a prior history of afebrile seizures. Febrile seizures occur in about 2-5% of children. Central nervous system infections should be considered in patients with febrile seizures, even though the frequency of this possibility is low, especially when patients do not return to baseline. Simple febrile seizures are considered benign events and there are clear guidelines about evaluation and management, but the evaluation of complex febrile seizures is controversial...
2018: Medicina
Yasue Uchida, Saiko Sugiura, Yukiko Nishita, Naoki Saji, Michihiko Sone, Hiromi Ueda
The amount of attention to age-related hearing loss (ARHL) has been growing, not only from the perspective of being one of the most common health conditions affecting older adults, but also from the perspective of its relation to cognition. Results from a number of epidemiological and laboratory studies have demonstrated a significant link between ARHL and cognitive decline. The Lancet International Commission on Dementia, Prevention, Intervention, and Care has estimated that mid-life hearing loss, if eliminated, might decrease the risk of dementia by nine percent, since hearing loss is a modifiable age-associated condition linked to dementia...
August 31, 2018: Auris, Nasus, Larynx
Samantha Barratt Ross, Christopher Semsarian
No abstract text is available yet for this article.
November 1, 2018: JAMA Cardiology
Minal S Kale, Deborah Korenstein
Overdiagnosis, is defined as the diagnosis of a condition that, if unrecognized, would not cause symptoms or harm a patient during his or her lifetime, and it is increasingly acknowledged as a consequence of screening for cancer and other conditions. Because preventive care is a crucial component of primary care, which is delivered to the broad population, overdiagnosis in primary care is an important problem from a public health perspective and has far reaching implications. The scope of overdiagnosis as a result of services delivered in primary care is unclear, though overdiagnosis of indolent breast, prostate, thyroid, and lung cancers is well described and overdiagnosis of chronic kidney disease, depression, and attention-deficit/hyperactivity disorder is also recognized...
August 14, 2018: BMJ: British Medical Journal
Alison T Brenner, Teri L Malo, Marjorie Margolis, Jennifer Elston Lafata, Shynah James, Maihan B Vu, Daniel S Reuland
Importance: The US Preventive Services Task Force recommends that shared decision making (SDM) involving a thorough discussion of benefits and harms should occur between clinicians and patients before initiating lung cancer screening (LCS) with low-dose computed tomography. The Centers for Medicare & Medicaid Services require an SDM visit using a decision aid as a prerequisite for LCS coverage. However, little is known about how SDM about LCS occurs in practice. Objective: To assess the quality of SDM about the initiation of LCS in clinical practice...
October 1, 2018: JAMA Internal Medicine
Michael J Sweeting, Katya L Masconi, Edmund Jones, Pinar Ulug, Matthew J Glover, Jonathan A Michaels, Matthew J Bown, Janet T Powell, Simon G Thompson
BACKGROUND: A third of deaths in the UK from ruptured abdominal aortic aneurysm (AAA) are in women. In men, national screening programmes reduce deaths from AAA and are cost-effective. The benefits, harms, and cost-effectiveness in offering a similar programme to women have not been formally assessed, and this was the aim of this study. METHODS: We developed a decision model to assess predefined outcomes of death caused by AAA, life years, quality-adjusted life years, costs, and the incremental cost-effectiveness ratio for a population of women invited to AAA screening versus a population who were not invited to screening...
August 11, 2018: Lancet
Susan J Curry, Alex H Krist, Douglas K Owens, Michael J Barry, Aaron B Caughey, Karina W Davidson, Chyke A Doubeni, John W Epling, Alex R Kemper, Martha Kubik, C Seth Landefeld, Carol M Mangione, Michael Silverstein, Melissa A Simon, Chien-Wen Tseng, John B Wong
Importance: Peripheral artery disease (PAD) is a manifestation of atherosclerosis in the lower limbs. It can impair walking and, in severe cases, can lead to tissue loss, infection, and amputation. In addition to morbidity directly caused by PAD, patients with PAD are at increased risk for cardiovascular disease (CVD) events, because atherosclerosis is a systemic disease that also causes coronary and cerebrovascular events. Objective: To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on screening for PAD and CVD risk with the ankle-brachial index (ABI)...
July 10, 2018: JAMA: the Journal of the American Medical Association
Lisa Parker, Lisa Bero, Donna Gillies, Melissa Raven, Barbara Mintzes, Jon Jureidini, Quinn Grundy
PURPOSE: Many who seek primary health care advice about mental health may be using mobile applications (apps) claiming to improve well-being or relieve symptoms. We aimed to identify how prominent mental health apps frame mental health, including who has problems and how they should be managed. METHODS: We conducted a qualitative content analysis of advertising material for mental health apps found online in the United States, the United Kingdom, Canada, and Australia during late 2016...
July 2018: Annals of Family Medicine
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