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Imaging Tests for the Diagnosis and Staging of Pancreatic Adenocarcinoma

September 29, 2014 Comments off

Imaging Tests for the Diagnosis and Staging of Pancreatic Adenocarcinoma (PDF)
Source: Agency for Healthcare Research and Quality

Objectives
Our objectives were to synthesize the available information on the diagnostic accuracy and clinical utility of commonly used imaging tests for the diagnosis and staging of pancreatic adenocarcinoma , as well as screening for pancreatic adenocarcinoma in high risk individuals .

Data sources
We searched Embase , MEDLINE, PubMed, and The Cochrane Library from 1980 through November 1, 2013 , for English – la nguage, full – length articles on the role of m ultidetector computed tomography ( MD CT), endoscopic ultrasound with fine – needle aspiration (EUS – FNA), magnetic resonance imaging (MRI), and positron emission tomography – computed tomography ( PET/CT ) in screening, diagnosis, and staging pancreatic adenocarcinoma. The searches identified 9, 776 citations; after screening against the inclusion criteria, we included 15 systematic reviews and 108 primary studies.

Methods
We extracted data from the included studies and constructed evidence tables. Comparative o utcomes of interest included diagnostic accuracy (sensitivity and specificity) , staging accuracy, screening accuracy, clinical management, quality of life, survival, and harms of imaging tests. For studies of a single imaging test, the key outcomes were accuracy and procedural harms. Where possible, we pooled the data using bivariate binomial regression models for comparative accuracy. For each pair of tests and each assessed aspect (e.g., determination of metastase s), we determined whether the evidence was sufficient to permit a conclusion of a difference, a conclusion of similar accuracy , or neither (i.e., insufficient ). We rated the risk of bias of individual studies using an internal validity instrument and grade d the overall strength of evidence of conclusions using Evidence – based Practic e Center methods . For dat a on single – test accuracy, procedural harms, patient tolerance, and screening accuracy, we tabulated the important information and summarized the evidenc e qualitatively.

Results
We included 15 systematic reviews and 108 primary studies. Regarding comparative accuracy, the evidence was sufficient to conclude that MDCT and EUS – FNA have similar accuracy in assess ing resectability in patients whose disease is unstaged , and that EUS – FNA has a slight advantage over MDCT with respect to T (tumor) staging (specifically, a lower chance of undersizing the tumor) . Further, we concluded that MDCT and MRI are similarly accurate with respect to both diagnos ing and asses s ing vessel involvement. For PET/CT , evidence was generally inconclusive, but we f ound low – strength evidence to conclude that PET/CT is more accurate than MDCT in assessing distant metastases (slight advantages in both sensitivity and specificity) . No ne of the included studies reported comparative data on clinical management, survival, quality, or the impact on comparative accuracy of patient characteristics , tumor characteristics , or operator experience. Many studies have reported procedural harms, but har ms are generally rare and are different for different imaging modalities. In the screening of people at high risk of developing pancreatic adenocarcinoma , a vailable studies do not correlate the results of a given imagin g test to subsequent diagnoses.

Conclusions.
Current evidence permits some tentative conclusions about the comparative assessment of imaging tests for diagnosing and staging pancreatic adenocarcinoma, but many gaps remain. The conclusions we did draw are as follows: MDCT and EUS – FNA have similar accuracy in assessing resectability in patients whose disease is unstaged ; EUS – FNA has a slight advantage over MDCT with respect to T (tumor) staging (specifically, a lower chance of undersizing the tumor) ; MDCT and MRI are similarly accurate with respect to both diagnos ing and assess ing vessel involvement ; and PET/CT is more accurate than MDCT in assessing distant metastases (slight advantages in both sensitivity and specificity). The prominent gaps include minimal information on MDCT angiography , impr ecis e data on other imaging techniques, a lack of comparative data on patient – oriented outco mes and factors that could influence comparative accuracy, and test – specific data on screening accuracy.

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CRS — Increased Department of Defense Role in U.S. Ebola Response, CRS Insights (September 17, 2014)

September 25, 2014 Comments off

Increased Department of Defense Role in U.S. Ebola Response, CRS Insights (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

On September 16, 2014, President Obama announced a major increase in the United States response to the current Ebola outbreak in West Africa. The Department of Defense (DOD) submitted requests to Congress to make excess Overseas Contingency Operations funds appropriated for FY2014 available to support this effort. The requested funds would be used to provide humanitarian assistance, including:

  • transportation of DOD and non-DOD personnel and supplies;
  • coordination delivery of supplies from both DOD and non-DOD sources such as isolation units, personnel protective equipment and medical supplies;
  • construction of 27 planned Ebola treatment units; and,
  • training and education in support of sanitation and mortuary affairs functions to limit the spread of the Ebola outbreak.

DOD officials have stated that DOD personnel will not provide direct medical care to Ebola victims, but that non-governmental organizations are submitting proposals to the World Health Organization and other entities to provide health care workers.

The European Union’s response to Ebola

September 24, 2014 Comments off

The European Union’s response to Ebola
Source: European Parliamentary Research Service

A number of West African countries are currently experiencing the worst Ebola epidemic in history. As the situation continues to deteriorate rapidly, the European Commission has stepped up its response since March 2014 and is now pledging more than €147 million in response to the devastating human, sanitary, economic and political effects of this crisis for the region. Since the beginning of the epidemic, the European Parliament has shown its concern as regards this critical situation.

Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections

September 24, 2014 Comments off

Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections
Source: New England Journal of Medicine

A total of 4507 confirmed and probable EVD cases were reported to the WHO between December 30, 2013, and September 14, 2014 — a 37-week period. A total of 718 confirmed and probable cases and 289 deaths were reported in the week of September 8 through September 14 alone. The numbers of confirmed and probable cases reported by each country over time are shown in Figure 1 and Figure 2. Detailed information was available on 3343 confirmed and 667 probable cases; these cases were used in all our analyses, with the exception of projections (results of analyses based on confirmed, probable, and suspected cases are provided in Supplementary Appendix 1). The median age of persons with EVD was 32 years (interquartile range, 21 to 44), and there were no significant differences in the age distribution of persons with EVD among countries. The majority of persons with EVD (60.8%) were between 15 and 44 years of age (this age group makes up only 44% of the population) (Table 1Table 1Demographic Characteristics and Signs and Symptoms in Confirmed and Probable Ebola Case Patients with a Definitive Clinical Outcome in Guinea, Liberia, Nigeria, and Sierra Leone.). There were also no significant differences among countries in the total numbers of male and female persons with EVD reported (49.9% of the total were male patients; within-country differences have not yet been fully investigated). EVD has taken a heavy toll among health care workers in Guinea, Liberia, and Sierra Leone. By September 14, a total of 318 cases, including 151 deaths, had been reported among health care workers.

CDC — 2014 Ebola Outbreak: Information and Updates

September 24, 2014 Comments off

2014 Ebola Outbreak: Information and Updates
Source: Centers for Disease Control and Prevention

The 2014 Ebola outbreak is the largest Ebola outbreak in history and the first Ebola outbreak in West Africa. This outbreak is the first Ebola epidemic the world has ever known — affecting multiple countries in West Africa. Although the risk of an Ebola outbreak in the United States is very low, CDC and partners are taking precautions to prevent this from happening.

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

September 23, 2014 Comments off

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Source: Morbidity and Mortality Weekly Report (CDC)

A single dose of PPSV23 is recommended for routine use in the United States among adults aged ≥65 years. Effectiveness of PPSV23 in preventing IPD in adults has been demonstrated, but the data on the effectiveness of this vaccine in preventing noninvasive pneumococcal pneumonia among adults aged ≥65 years have been inconsistent. PPSV23 contains 12 serotypes in common with PCV13 and 11 additional serotypes. In 2013, 38% of IPD among adults aged ≥65 years was caused by serotypes unique to PPSV23. Given the high proportion of IPD caused by serotypes unique to PPSV23, broader protection is expected to be provided through use of both PCV13 and PPSV23 in series. ACIP considered multiple factors when determining the optimal interval between a dose of PCV13 and PPSV23, including immune response, safety, the risk window for protection against disease caused by serotypes unique to PPSV23, as well as timing for the next visit to the vaccination provider.

FDA releases updated proposals to improve food safety and help prevent foodborne illness in response to public comments

September 23, 2014 Comments off

FDA releases updated proposals to improve food safety and help prevent foodborne illness in response to public comments
Source: U.S. Food and Drug Administration
<blockquote.
Based on extensive outreach and public comment, the U.S. Food and Drug Administration today proposed revisions to four proposed rules designed to help prevent food-borne illness. When finalized, the proposed rules will implement portions of the FDA Food Safety Modernization Act (FSMA), which aims to strengthen food safety by shifting the focus to preventing food safety problems rather than responding to problems after the fact.

Since FSMA was signed into law in January 2011, the FDA has proposed seven rules to implement FSMA. The four updated proposed rules include: produce-safety; preventive controls for human food; preventive controls for animal food; and the foreign supplier verification program.

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