Barrett-Screening: rationale, aktuelle Konzepte und Perspektiven

2020 ◽  
Vol 99 (04) ◽  
pp. 214-223
Author(s):  
Josef Weismüller ◽  
René Thieme ◽  
Albrecht Hoffmeister ◽  
Tobias Weismüller ◽  
Ines Gockel
Keyword(s):  
At Risk ◽  
Barrett Ösophagus ◽  
Kurative Therapie ◽  
Diagnostische Methoden ◽  
Ösophageales Adenokarzinom ◽  
Eine Verbesserte

ZusammenfassungDer Barrett-Ösophagus (BE) stellt den wichtigsten Risikofaktor für das ösophageale Adenokarzinom dar. Derzeit ist kein hinreichend effizientes Screening-Programm verfügbar, um in der Gesamtpopulation Patienten mit einem hohen Risiko für ein ösophageales Adenokarzinom auf dem Boden eines Barrett-Ösophagus zu identifizieren. Das aktuelle endoskopische Screening zielt auf symptomatische Refluxpatienten, aus denen sich aber nur ein Teil der Risikopatienten rekrutiert. Derzeit werden verschiedene neue Verfahren untersucht, die die Effektivität des Screenings deutlich erhöhen könnten.Selektive Literaturrecherche in MEDLINE/PubMed unter Berücksichtigung deutscher und internationaler Leitlinien.Alternative Screening-Verfahren könnten 2-stufig angelegt sein: Zunächst die Identifikation von Personen „at risk“ über eine Erfassung geeigneter biologischer Marker, dann deren gezielte endoskopisch-bioptische Abklärung, Risikostratifikation, Überwachung (Surveillance) und ggf. Therapie. Neue diagnostische Methoden wie der Cytosponge® in Kombination mit einer Auswertung von Markern für Barrett-Schleimhaut könnten einen wesentlichen Fortschritt darstellen.Barrett-Karzinome zeigen nach wie vor eine zunehmende Inzidenz und eine (trotz therapeutischer Fortschritte) ungünstige Prognose, wobei aber Patienten mit Barrett-Frühkarzinomen eine gute Prognose hinsichtlich Langzeitüberleben aufweisen. Eine verbesserte Früherkennung ist dringend wünschenswert, da bisher die meisten Patienten erst im fortgeschrittenen Stadium endoskopisch diagnostiziert werden, was eine kurative Therapie erschwert. Nur eine effiziente frühzeitige Identifizierung von Risikopatienten mit Barrett-Ösophagus durch ein praktikables Screening-Programm auf Populationsebene wird zur Verbesserung der Prognose beitragen können.

Barrett-Screening: Rationale, aktuelle Konzepte und Perspektiven

2019 ◽  
Vol 57 (03) ◽  
pp. 317-326 ◽  
Author(s):  
Josef Weismüller ◽  
René Thieme ◽  
Albrecht Hoffmeister ◽  
Tobias Weismüller ◽  
Ines Gockel
Keyword(s):  
At Risk ◽  
Barrett Ösophagus ◽  
Kurative Therapie ◽  
Diagnostische Methoden ◽  
Ösophageales Adenokarzinom ◽  
Eine Verbesserte

ZusammenfassungDer Barrett-Ösophagus (BE) stellt den wichtigsten Risikofaktor für das ösophageale Adenokarzinom dar. Derzeit ist kein hinreichend effizientes Screening-Programm verfügbar, um in der Gesamtpopulation Patienten mit einem hohen Risiko für ein ösophageales Adenokarzinom auf dem Boden eines Barrett-Ösophagus zu identifizieren. Das aktuelle endoskopische Screening zielt auf symptomatische Refluxpatienten, aus denen sich aber nur ein Teil der Risikopatienten rekrutiert. Derzeit werden verschiedene neue Verfahren untersucht, die die Effektivität des Screenings deutlich erhöhen könnten.Selektive Literaturrecherche in MEDLINE/PubMed unter Berücksichtigung deutscher und internationaler Leitlinien.Alternative Screening-Verfahren könnten zweistufig angelegt sein: Zunächst die Identifikation von Personen „at risk“ über eine Erfassung geeigneter biologischer Marker, dann deren gezielte endoskopisch-bioptische Abklärung, Risikostratifikation, Überwachung (Surveillance) und ggf. Therapie. Neue diagnostische Methoden wie der Cytosponge® in Kombination mit einer Auswertung von Markern für Barrett-Schleimhaut könnten einen wesentlichen Fortschritt darstellen.Barrett-Karzinome zeigen nach wie vor eine zunehmende Inzidenz und eine (trotz therapeutischer Fortschritte) ungünstige Prognose, wobei aber Patienten mit Barrett-Frühkarzinomen eine gute Prognose hinsichtlich Langzeitüberleben aufweisen. Eine verbesserte Früherkennung ist dringend wünschenswert, da bisher die meisten Patienten erst im fortgeschrittenen Stadium endoskopisch diagnostiziert werden, was eine kurative Therapie erschwert. Nur eine effiziente frühzeitige Identifizierung von Risikopatienten mit Barrett-Ösophagus durch ein praktikables Screening-Programm auf Populationsebene wird zur Verbesserung der Prognose beitragen können.

Gastroösophageale Refluxerkrankung und maligne Transformation – für Männer und Frauen ein gleich großes Risiko?

2016 ◽  
Vol 95 (12) ◽  
pp. 828-830
Author(s):  
O. Pech
Keyword(s):  
Maligne Transformation ◽  
Eine Hohe ◽  
Gastroösophageale Refluxerkrankung ◽  
Barrett Ösophagus ◽  
Ösophageales Adenokarzinom

ZusammenfassungDie gastroösophageale Refluxerkrankung (GERD) hat gerade in der westlichen Welt eine hohe Prävalenz. Patienten mit GERD haben ein etwa 10%-iges Risiko einen Barrett-Ösophagus zu entwickeln, der wiederum ein Risiko für die Entstehung eines ösophagealen Adenokarzinoms darstellt. Männer haben eine höhere Intensität der GERD in Hinblick auf den Grad der Entzündung und den Säurereflux. Aus diesem Grund ist das Risiko einen Barrett-Ösophagus zu entwickeln bei Männern etwa 2–3-fach erhöht und für ein ösophageales Adenokarzinom sogar 3–6-mal höher als bei Frauen.

Phonological Awareness Screening to Identify At-Risk Readers

1998 ◽  
Vol 29 (2) ◽  
pp. 109-116 ◽  
Author(s):  
Margie Gilbertson ◽  
Ronald K. Bramlett
Keyword(s):  
At Risk ◽  
Phonological Awareness ◽  
Reading Ability ◽  
At Risk Students ◽  
First Grade ◽  
Receptive Vocabulary ◽  
Standardized Assessments ◽  
Cutoff Score ◽  
Invented Spelling ◽  
Reading Measures

The purpose of this study was to investigate informal phonological awareness measures as predictors of first-grade broad reading ability. Subjects were 91 former Head Start students who were administered standardized assessments of cognitive ability and receptive vocabulary, and informal phonological awareness measures during kindergarten and early first grade. Regression analyses indicated that three phonological awareness tasks, Invented Spelling, Categorization, and Blending, were the most predictive of standardized reading measures obtained at the end of first grade. Discriminant analyses indicated that these three phonological awareness tasks correctly identified at-risk students with 92% accuracy. Clinical use of a cutoff score for these measures is suggested, along with general intervention guidelines for practicing clinicians.

Effects of a Supplemental Spanish Phonological Awareness Intervention on Latinx Preschoolers' Dual Language Emergent Literacy Skills

2020 ◽  
Vol 29 (3) ◽  
pp. 1283-1300
Author(s):  
Xigrid T. Soto ◽  
Andres Crucet-Choi ◽  
Howard Goldstein
Keyword(s):  
At Risk ◽  
Phonological Awareness ◽  
Emergent Literacy ◽  
Language Learners ◽  
Literacy Instruction ◽  
Dual Language ◽  
Literacy Skills ◽  
Dual Language Learners ◽  
Probe Design ◽  
Emergent Literacy Skills

Purpose Preschoolers' phonological awareness (PA) and alphabet knowledge (AK) skills are two of the strongest predictors of future reading. Despite evidence that providing at-risk preschoolers with timely emergent literacy interventions can prevent academic difficulties, there is a scarcity of research focusing on Latinx preschoolers who are dual language learners. Despite evidence of benefits of providing Latinxs with Spanish emergent literacy instruction, few studies include preschoolers. This study examined the effects of a supplemental Spanish PA and AK intervention on the dual emergent literacy skills of at-risk Latinx preschoolers. Method A multiple probe design across four units of instruction evaluated the effects of a Spanish supplemental emergent literacy intervention that explicitly facilitated generalizations to English. Four Latinx preschoolers with limited emergent literacy skills in Spanish and English participated in this study. Bilingual researchers delivered scripted lessons targeting PA and AK skills in individual or small groups for 12–17 weeks. Results Children made large gains as each PA skill was introduced into intervention and generalized the PA skills they learned from Spanish to English. They also improved their English initial sound identification skills, a phonemic awareness task, when instruction was delivered in Spanish but with English words. Children made small to moderate gains in their Spanish letter naming and letter–sound correspondence skills and in generalizing this knowledge to English. Conclusion These findings provide preliminary evidence Latinx preschoolers who are dual language learners benefit from emergent literacy instruction that promotes their bilingual and biliterate development.

Reading Risk in Children With Speech Sound Disorder: Prevalence, Persistence, and Predictors

2020 ◽  
Vol 63 (11) ◽  
pp. 3714-3726
Author(s):  
Sherine R. Tambyraja ◽  
Kelly Farquharson ◽  
Laura Justice
Keyword(s):  
At Risk ◽  
Sound Production ◽  
Speech Therapy ◽  
Speech Sound ◽  
Reading Difficulties ◽  
School Age Children ◽  
Speech Sound Disorder ◽  
Word Decoding ◽  
School Year ◽  
School Based

Purpose The purpose of this study was to determine the extent to which school-age children with speech sound disorder (SSD) exhibit concomitant reading difficulties and examine the extent to which phonological processing and speech production abilities are associated with increased likelihood of reading risks. Method Data were obtained from 120 kindergarten, first-grade, and second-grade children who were in receipt of school-based speech therapy services. Children were categorized as being “at risk” for reading difficulties if standardized scores on a word decoding measure were 1 SD or more from the mean. The selected predictors of reading risk included children's rapid automatized naming ability, phonological awareness (PA), and accuracy of speech sound production. Results Descriptive results indicated that just over 25% of children receiving school-based speech therapy for an SSD exhibited concomitant deficits in word decoding and that those exhibiting risk at the beginning of the school year were likely to continue to be at risk at the end of the school year. Results from a hierarchical logistic regression suggested that, after accounting for children's age, general language abilities, and socioeconomic status, both PA and speech sound production abilities were significantly associated with the likelihood of being classified as at risk. Conclusions School-age children with SSD are at increased risk for reading difficulties that are likely to persist throughout an academic year. The severity of phonological deficits, reflected by PA and speech output, may be important indicators of subsequent reading problems.

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

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