1. Clinical scoring system suggests possibility of more precise colon cancer screening
Free abstract: Derivation and Validation of a Scoring System to Stratify Risk for Advanced Colorectal Neoplasia in Asymptomatic Adults: A Cross-sectional Study ONLINE FIRST Ann Intern Med. Published online 11 August 2015 doi:10.7326/M14-1720
Editorial: Precision Screening for Colorectal Cancer: Promise and Challenges ONLINE FIRST Ann Intern Med. Published online 11 August 2015 doi:10.7326/M15-1677
A clinical scoring system for colon cancer risk could help physicians identify which average-risk patients could potentially skip a colonoscopy and instead be screened with a less-invasive method. The researchers suggest that this approach could increase the uptake and efficiency of colorectal cancer (CRC) screening. The cross-sectional study is published in Annals of Internal Medicine.
Several screening tests are proven effective and are recommended for detecting colorectal cancer, yet screening is still underused, costly, and inefficient. Not all average-risk patients have the same risk for colorectal cancer. Risk stratification could potentially enable physicians to tailor screening based on a patient's risk for colorectal cancer.
Researchers studied a convenience sample of 4,460 patients scheduled to undergo their first screening colonoscopy in the Midwest. A clinical score was given based on the patient's complete health data and presence of the five most common risk factors for CRC - age, sex, waist circumference, cigarette smoking, and family history. The data showed that patients classified as low-risk did, in fact, have far fewer advanced adenomas compared with patients classified as high-risk. The authors suggest that patients at lower risk for cancer would be able to have a less invasive test (sigmoidoscopy, occult blood tests), while higher-risk patients would need a colonoscopy.
The author of an accompanying editorial cautions that the score should not be used for choosing the type of screening test an average-risk person should have. However, a sensitive algorithm may have a role in choosing appropriate follow up for a patient with a negative screening result.
2. Adding corticosteroids improves outcomes in patients with community-acquired pneumonia
Free abstract: Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Meta-analysis Ann Intern Med. Published online 11 August 2015 doi:10.7326/M15-0715
For hospitalized adults with community acquired pneumonia (CAP), evidence suggests that adjunctive corticosteroid therapy may reduce mortality and need for mechanical ventilation, while shortening hospital stay. The research is published in Annals of Internal Medicine.
CAP is common and often severe. Researchers reviewed published studies on randomized trials of systemic corticosteroids in hospitalized adults with CAP to determine the impact of adjunctive corticosteroid therapy on mortality, morbidity, and duration of hospitalization. They found that corticosteroids reduced mortality by approximately 3 percent and need for mechanical ventilation by approximately 5 percent, while shortening hospital stay by approximately one day. Benefits were more pronounced in patients with severe illness. Based on their findings, the researchers conclude that clinicians should seriously consider using corticosteroids in hospitalized patients with CAP, especially in the most severe cases.
3. Evidence suggests wide variations in hospital cleaning practices
Free content: Cleaning Hospital Room Surfaces to Prevent Health Care-Associated Infections: A Technical Brief Ann Intern Med. Published online 11 August 2015 doi:10.7326/M15-1192
Editorial: Intensifying the Focus on the Contribution of the Inanimate Environment to Health Care-Associated Infections ONLINE FIRST Ann Intern Med. Published online 11 August 2015 doi:10.7326/M15-1798
A systematic overview published in Annals of Internal Medicine finds important gaps in the evidence for the bestmethods for cleaning hospital rooms to prevent healthcare-associated Infections, and recommends additional research to help lower risk for patients.
The cleaning of hard surfaces in hospital rooms is critical for reducing healthcare-associated infections. Environmental cleaning is a complex, multifaceted process, and involves the physical action of cleaning surfaces and also the application of disinfectant. Monitoring strategies must also be employed to ensure that cleaning and disinfecting is done properly.
Researchers reviewed published research to summarize the modalities currently used for cleaning, disinfecting, and monitoring cleanliness of patient rooms as well as contextual factors that may impact the implementation and effectiveness of the cleaning process. Studies focused on three key healthcare-associated pathogens - MRSA, VRE, and c. diff. The researchers suggest that evaluating the clinical effectiveness of cleaning and disinfection modalities is challenging and there are several unanswered questions about practices. The authors of an accompanying editorial say that unlike handwashing, there is yet to be a consensus on the importance of cleaning the inanimate health care environment as a way to prevent the spread of infection. The authors suggest that in addition to more studies, effective communication and education are needed to ensure consistent practices.
The study was funded by the Agency for Healthcare Research and Quality and conducted by researchers at the ECRI Institute-Penn Medicine Evidence-Based Practice Center.