Abstract:RESUMO Objetivo Identificar estudos que realizaram rastreio para hepatite C e que também avaliaram a prevalência do vírus em usuários de unidades de urgência e emergência. Método Revisão sistemática realizada nas bases de dados LILACS, MEDLINE via PubMed, SciELO e Biblioteca Virtual em Saúde. Resultados Após criteriosa busca e análise, fizeram parte dos resultados 19 publicações, essas em conformidades com os critérios pré-definidos. As datas de publicação se concentraram entre 1992 e 2018. A principal revi… Show more
Background
Emergency department patients are disproportionately non-adherent with the United States Preventive Services Task Force cancer screening recommendations, making the emergency department a target-rich environment for interventions aimed at increasing the uptake of cancer screening. Promotion of cancer screening in the emergency department has the potential to address health disparities and to reach patients that experience significant barriers to accessing preventive care.
Topics of review
This narrative review presents concise summaries of the four types of cancer screenings with grade A or B recommendations from the United States Preventive Services Task Force (breast, cervical, colorectal, and lung) and presents the potential enabling factors and challenges of utilizing the emergency department setting to increase cancer screening uptake. Past and ongoing efforts to promote cancer screening among emergency department patients are discussed, and critical knowledge gaps and research opportunities are highlighted.
Conclusion
Although there has been a paucity of research evaluating interventions that have the potential to increase cancer screening uptake among emergency department patients, the emergency department setting is uniquely positioned to address disparities in cancer screening uptake and contribute to progress towards national cancer screening goals. To be effective, interventions that aim to achieve this purpose must identify patients with screening needs, engage with patients regarding their knowledge and beliefs about screening, and provide an effective method to conduct or connect patients with screening procedures and subsequent follow-up.
Background
Emergency department patients are disproportionately non-adherent with the United States Preventive Services Task Force cancer screening recommendations, making the emergency department a target-rich environment for interventions aimed at increasing the uptake of cancer screening. Promotion of cancer screening in the emergency department has the potential to address health disparities and to reach patients that experience significant barriers to accessing preventive care.
Topics of review
This narrative review presents concise summaries of the four types of cancer screenings with grade A or B recommendations from the United States Preventive Services Task Force (breast, cervical, colorectal, and lung) and presents the potential enabling factors and challenges of utilizing the emergency department setting to increase cancer screening uptake. Past and ongoing efforts to promote cancer screening among emergency department patients are discussed, and critical knowledge gaps and research opportunities are highlighted.
Conclusion
Although there has been a paucity of research evaluating interventions that have the potential to increase cancer screening uptake among emergency department patients, the emergency department setting is uniquely positioned to address disparities in cancer screening uptake and contribute to progress towards national cancer screening goals. To be effective, interventions that aim to achieve this purpose must identify patients with screening needs, engage with patients regarding their knowledge and beliefs about screening, and provide an effective method to conduct or connect patients with screening procedures and subsequent follow-up.
Testing for hepatitis C virus (HCV) is currently targeted towards those at high-risk in France. While universal screening was recently rejected, a growing body of research from other high-income countries suggests that HCV testing in emergency departments (ED) can be effective and cost-effective. In the absence of any studies on the effectiveness of HCV testing in ED attendees in France, this study aimed to perform an early economic evaluation of ED-based HCV testing. A Markov model was developed to simulate HCV testing in the ED versus no ED testing. The model captured costs from a French health service perspective, presented in 2020 euros, and outcomes, presented as quality-adjusted life years (QALYs), over a lifetime horizon. Incremental cost-effectiveness ratios (ICER) were calculated as costs per QALYs gained and compared to willingness-to-pay thresholds of €18,592 and €33,817 per QALY. Value of information analyses were also performed. ED testing for HCV was cost-effective at both thresholds when assuming ED prevalence of 1.1%, yielding an ICER of €3,800 per QALY. Testing remained cost-effective when the HCV prevalence amongst ED attendees remained higher than in the general population (0.3%). The maximum value of future research ranged from €10 to €79 million, depending on time horizons and willingness-to-pay thresholds. Our analysis suggests ED-based HCV testing may be cost-effective in France, although there is uncertainty due to the lack of empirical studies available. Further research is of high value, suggesting seroprevalence surveys and pilot studies in French ED settings are warranted.
Aim: To investigate the parameters of the functional state of the pancreas in chronic pancreatitis in the background of chronic viral hepatitis C, as well as their dynamics under the influence of complex therapy with the inclusion of complex bioregulatory drugs.
Materials and Methods: 106 patients were examined: patients with CP in remission, patients with CP in remission in combination with HCV in remission, and after antiviral therapy. Patients with CP and concomitant HCV were divided into two groups according to correction programs. Group I (36 patients) received only conventional treatment: antispasmodics and/or prokinetics, enzyme preparations, proton pump inhibitors, hepatoprotectors in the mode “on-demand”. Group II (36 patients), in addition to conventional treatment, received additional complex bioregulatory drugs.
Results: After treatment, there was an improvement in coprogram results and an increase in fecal elastase-1 levels. Positive dynamics was observed in both groups, but in patients of group I it was statistically insignificant (p>0.05), while in the group of patients who additionally received complex of bioregulatory drugs, the changes were more pronounced: in group II the level of fecal elastase-1 increased by 52.79% (p<0.05).
Conclusions: This indicates a statistically significant effect of treatment using a complex bioregulatory corrector of exocrine insufficiency (Momordica Compositum: 1 ampoule 2.2 ml intramuscularly 3 times a week №10) and a complex bioregulatory hepatotropic drug (Hepeel: 1 tab. sublingually 3 times a day 15-20 minutes before meals or 1 hour after meals for 1 month).
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