Conclusions:In the UK National Health Service (NHS) abdominal aortic aneurysm (AAA) screening programs are effective in detecting AAA and lead to effectively treating men with AAA.Summary: Approximately 3000 to 4000 people die from ruptured AAA each year in England and Wales. Most of the deaths occur in men over 65 years of age. Population screening of men $65 years of age for AAA in the UK began in 2009 and was implemented in all of England by April 2013. The current study presented here reviews the results of the first 5 years of screening among 65 year old men who had attended an ultrasound screening and the first cohort of men referred for treatment of a large aneurysm over 5.47 cm. The goal was to check the systems and processes of the AAA screening program. In the program men aged 65 years were invited for a single abdominal ultrasound scan. Data were entered into a bespoke database (AAA SMaRT). This paper represents a planned analysis after the first 5 years of the program. Summation analysis involves the first 700,000 men screened and the first 1000 men with a large AAA referred for possible treatment. The prevalence of AAA defined as an aortic diameter larger than 2.9 cm in 65 year old men was 1.34%. The mean uptake was 78.1% and varied from 61.7 to 85.8% across the UK. Based on the index of multiple deprivation, uptake was 65.1% in the most deprived vs 84.1% in the least deprived areas. Of the first 1000 men referred for possible treatment of an AAA the false positive rate was 3.2%. 770 men underwent a planned AAA intervention (non-intervention rate 9.2%) with 7 deaths for a perioperative mortality rate of 0.8%.Comment: Use of the screening program varied among regions in the UK with those from less affluent areas and having to travel greater distances making less use of the screening program (Crilly M, et al Br J Surg 2015;102:916-23). Perhaps patients who place a less priority on their own health have an increased prevalence of AAA so the prevalence of AAA may be higher than indicated. False negative rates of screening are unknown. Nevertheless, at the moment it appears from this analysis, screening for AAA is effective both from a medical and cost effectiveness point of view.
to every 418 of the population. Massachusetts for a limited part of the service has one bed for every 375 of the population. The same report recommends the services of either a trained or untrained nurse for every 802 of the population. Massachusetts has one registered nurse for every 513 of the population. Most sickness surveys fail to record either alcoholics or venereal diseases. Feeble-mindedness, alcoholism and venereal disease must be seriously considered in any helpful campaign to eliminate poverty or sickness. The field worker for Dutchess County was able to report only one case of venereal disease out of 1600 cases of sickness. From data on venereal disease supplied by the hospitals, the report recommends one bed for these diseases for every 6615 of the population-7.1% of the whole required for Dutchess County. (See p. 100.) Applying the same ratio for Massachusetts, there would be needed 572 beds for venereal diseases, or 17 beds less than the entire complement of beds at the Massachusetts General Hospital. The same survey recommends one bed to every 3042 of the population for alcoholics. For Massachusetts that would take 1242 beds, and would fill both the Boston City Hospital and Carney Hospital, with only 24 beds vacant. For psychopathic patients, one bed to every 4643 of the population is recommended. This would require 815 beds,
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