This critical review of the literature assembles and compares available data on breast cancer clinical stage, time intervals to care, and access barriers in different countries. It provides evidence that while more th...This critical review of the literature assembles and compares available data on breast cancer clinical stage, time intervals to care, and access barriers in different countries. It provides evidence that while more than 70% of breast cancer patients in most high-income countries are diagnosed in stages Ⅰ and Ⅱ, only 20%-50% patients in the majority of low- and middleincome countries are diagnosed in these earlier stages. Most studies in the developed world show an association between an advanced clinical stage of breast cancer and delays greater than three months between symptom discovery and treatment start. The evidence assembled in this review shows that the median of this interval is 30-48 d in high-income countries but 3-8 mo in low- and middle-income countries. The longest delays occur between the first medical consultation and the beginning of treatment, known as the provider interval. The little available evidence suggests that access barriers and quality deficiencies in cancer care are determinants of provider delay in low- and middle-income countries. Research on specific access barriers and deficiencies in quality of care for the early diagnosis and treatment of breast cancer is practically non-existentin these countries, where it is the most needed for the design of cost-effective public policies that strengthen health systems to tackle this expensive and deadly disease.展开更多
Background:Gastric cancer is one of the most common malignant tumors in the digestive system in China.Few comprehensive practice guidelines for early gastric cancer in China are currently available.Therefore,we create...Background:Gastric cancer is one of the most common malignant tumors in the digestive system in China.Few comprehensive practice guidelines for early gastric cancer in China are currently available.Therefore,we created the Chinese national clinical practice guideline for the prevention,diagnosis,and treatment of early gastric cancer.Methods:This clinical practice guideline(CPG)was developed in accordance with the World Health Organization’s recommended process and with the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)in assessing evidence quality.We used the Evidence to Decision framework to formulate clinical recommendations to minimize bias and increase transparency in the CPG development process.We used the Reporting Items for practice Guidelines in HealThcare(RIGHT)statement and the Appraisal of Guidelines for Research and Evaluation II(AGREE II)as reporting and conduct guidelines to ensure completeness and transparency of the CPG.Results:This CPG contains 40 recommendations regarding the prevention,screening,diagnosis,treatment,and follow-up of early gastric cancer based on available clinical studies and guidelines.We provide recommendations for the timing of Helicobacter pylori eradication,screening populations for early gastric cancer,indications for endoscopic resection and surgical gastrectomy,follow-up interval after treatment,and other recommendations.Conclusions:This CPG can lead to optimum care for patients and populations by providing up-to-date medical information.We intend this CPG for widespread adoption to increase the standard of prevention,screening,diagnosis,treatment,and follow-up of early gastric cancer;thereby,contributing to improving national health care and patient quality of life.展开更多
目的分析高频彩色多普勒超声与乳腺钼靶断层融合技术在早期乳腺癌患者中的诊断价值,为患者进行早期临床检查提供更准确的依据。方法选取2022年6月—2023年3月徐州市妇幼保健院收治的64疑似早期乳腺癌患者为研究对象,将病理检查作为金标...目的分析高频彩色多普勒超声与乳腺钼靶断层融合技术在早期乳腺癌患者中的诊断价值,为患者进行早期临床检查提供更准确的依据。方法选取2022年6月—2023年3月徐州市妇幼保健院收治的64疑似早期乳腺癌患者为研究对象,将病理检查作为金标准。患者均依次接受高频彩色多普勒超声与乳腺钼靶断层融合技术检查,对比两种检验方式的诊断效能,并进行受试者工作特征(receiver operating characteristic,ROC)曲线分析。结果高频彩色多普勒超声的检验结果中,阳性28例,阴性36例,灵敏度为78.13%,特异度为90.63%,阳性预测值为89.29%,阴性预测值为80.56%;乳腺钼靶断层融合技术的检验结果中,阳性29例,阴性35例,灵敏度为84.38%,特异度为93.75%,阳性预测值为93.10%,阴性预测值为85.71%;两者联合检验结果中,阳性31例,阴性为33例,灵敏度为93.75%,特异度为96.88%,阳性预测值为96.77%,阴性预测值为93.94%。高频彩色多普勒超声检验的曲线下面积(area under curve,AUC)值为0.906,95%CI(0.823~0.989);乳腺钼靶断层融合技术检验的AUC值为0.938,95%CI(0.868~0.992);两者联合检验的AUC值为0.969,95%CI(0.919~0.999)。结论采用高频彩色多普勒超声联合乳腺钼靶断层融合技术诊断早期乳腺癌患者的效果显著,较单独检验更具临床价值。展开更多
文摘This critical review of the literature assembles and compares available data on breast cancer clinical stage, time intervals to care, and access barriers in different countries. It provides evidence that while more than 70% of breast cancer patients in most high-income countries are diagnosed in stages Ⅰ and Ⅱ, only 20%-50% patients in the majority of low- and middleincome countries are diagnosed in these earlier stages. Most studies in the developed world show an association between an advanced clinical stage of breast cancer and delays greater than three months between symptom discovery and treatment start. The evidence assembled in this review shows that the median of this interval is 30-48 d in high-income countries but 3-8 mo in low- and middle-income countries. The longest delays occur between the first medical consultation and the beginning of treatment, known as the provider interval. The little available evidence suggests that access barriers and quality deficiencies in cancer care are determinants of provider delay in low- and middle-income countries. Research on specific access barriers and deficiencies in quality of care for the early diagnosis and treatment of breast cancer is practically non-existentin these countries, where it is the most needed for the design of cost-effective public policies that strengthen health systems to tackle this expensive and deadly disease.
文摘Background:Gastric cancer is one of the most common malignant tumors in the digestive system in China.Few comprehensive practice guidelines for early gastric cancer in China are currently available.Therefore,we created the Chinese national clinical practice guideline for the prevention,diagnosis,and treatment of early gastric cancer.Methods:This clinical practice guideline(CPG)was developed in accordance with the World Health Organization’s recommended process and with the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)in assessing evidence quality.We used the Evidence to Decision framework to formulate clinical recommendations to minimize bias and increase transparency in the CPG development process.We used the Reporting Items for practice Guidelines in HealThcare(RIGHT)statement and the Appraisal of Guidelines for Research and Evaluation II(AGREE II)as reporting and conduct guidelines to ensure completeness and transparency of the CPG.Results:This CPG contains 40 recommendations regarding the prevention,screening,diagnosis,treatment,and follow-up of early gastric cancer based on available clinical studies and guidelines.We provide recommendations for the timing of Helicobacter pylori eradication,screening populations for early gastric cancer,indications for endoscopic resection and surgical gastrectomy,follow-up interval after treatment,and other recommendations.Conclusions:This CPG can lead to optimum care for patients and populations by providing up-to-date medical information.We intend this CPG for widespread adoption to increase the standard of prevention,screening,diagnosis,treatment,and follow-up of early gastric cancer;thereby,contributing to improving national health care and patient quality of life.
文摘目的分析高频彩色多普勒超声与乳腺钼靶断层融合技术在早期乳腺癌患者中的诊断价值,为患者进行早期临床检查提供更准确的依据。方法选取2022年6月—2023年3月徐州市妇幼保健院收治的64疑似早期乳腺癌患者为研究对象,将病理检查作为金标准。患者均依次接受高频彩色多普勒超声与乳腺钼靶断层融合技术检查,对比两种检验方式的诊断效能,并进行受试者工作特征(receiver operating characteristic,ROC)曲线分析。结果高频彩色多普勒超声的检验结果中,阳性28例,阴性36例,灵敏度为78.13%,特异度为90.63%,阳性预测值为89.29%,阴性预测值为80.56%;乳腺钼靶断层融合技术的检验结果中,阳性29例,阴性35例,灵敏度为84.38%,特异度为93.75%,阳性预测值为93.10%,阴性预测值为85.71%;两者联合检验结果中,阳性31例,阴性为33例,灵敏度为93.75%,特异度为96.88%,阳性预测值为96.77%,阴性预测值为93.94%。高频彩色多普勒超声检验的曲线下面积(area under curve,AUC)值为0.906,95%CI(0.823~0.989);乳腺钼靶断层融合技术检验的AUC值为0.938,95%CI(0.868~0.992);两者联合检验的AUC值为0.969,95%CI(0.919~0.999)。结论采用高频彩色多普勒超声联合乳腺钼靶断层融合技术诊断早期乳腺癌患者的效果显著,较单独检验更具临床价值。
