scholarly journals Health Screening Program to Enhance Enrollment of Women and Minorities in CREST-2

Stroke ◽  
2022 ◽  
Author(s):  
Brajesh K. Lal ◽  
James F. Meschia ◽  
Michael Jones ◽  
Herbert D. Aronow ◽  
Angelica Lackey ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Stroke Prevention ◽  
Screening Program ◽  
The United States ◽  
Health Screening ◽  
High Grade ◽  
Carotid Ultrasound ◽  
Substantial Impact ◽  
Carotid Revascularization ◽  
Prevention Trials

Background and Purpose: The CREST-2 (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial) consists of 2 parallel randomized stroke prevention trials in patients with asymptomatic high-grade stenosis of the cervical carotid artery. The purpose of this report is to detail the outcomes of a health screening effort to increase trial enrollment of women and minorities. Methods: Life Line screening (LLS) conducts nationwide screening for vascular disease. Screenings within a 50-mile radius of each CREST-2 center were identified for participation in a joint CREST-LLS program over the course of one year (November 2018 to October 2019) whereby patients with an abnormal carotid ultrasound were referred to the local CREST-2 center for further workup, management, and potential consideration for trial enrollment. Results: LLS completed the screening of 588 198 individuals in 29 732 zip codes across the United States. Of those, 230 021 individuals were screened at events occurring near a CREST-2 clinical center and 646 (0.3%) were found to have abnormal carotid ultrasound findings. Each of the 646 individuals was contacted by CREST-LLS program staff for permission to be referred to their local CREST-2 center; 200 (31%) consented to be contacted by CREST-2. Of those, 39 (19.5%) agreed to be, and were, evaluated at their local CREST-2 center. High-grade stenosis was confirmed in 27 patients. A total of 3 patients were eligible for the trial and were enrolled, one woman but no racial/ethnic minorities. Conclusions: The LLS program appears to identify community-living individuals with high-grade carotid stenosis through ultrasonography. However, the prevalence of abnormal carotid findings was low. In addition, screening and offering participation into the CREST-2 trial had no substantial impact on the proportion of women and minorities enrolled in the trial. Additional innovative strategies are needed to promote enrollment of diverse patients with carotid stenosis into stroke prevention trials.

scholarly journals The CREST-2 experience with the evolving challenges of COVID-19

Neurology ◽  
2020 ◽  
Vol 95 (1) ◽  
pp. 29-36 ◽  
Author(s):  
James F. Meschia ◽  
Kevin M. Barrett ◽  
Robert D. Brown ◽  
Tanya N. Turan ◽  
Virginia J. Howard ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Medical Management ◽  
Neurological Disorders ◽  
Stroke Prevention ◽  
Prevention Trial ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Ethical Obligation ◽  
Carotid Revascularization

The coronavirus disease 2019 pandemic has disrupted the lives of whole communities and nations. The multinational multicenter National Institute of Neurological Disorders and Stroke Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial stroke prevention trial rapidly experienced the effects of the pandemic and had to temporarily suspend new enrollments and shift patient follow-up activities from in-person clinic visits to telephone contacts. There is an ethical obligation to the patients to protect their health while taking every feasible step to ensure that the goals of the trial are successfully met. Here, we describe the effects of the pandemic on the trial and steps that are being taken to mitigate the effects of the pandemic so that trial objectives can be met.

scholarly journals Variation in Ultrasound Diagnostic Thresholds for Carotid Stenosis in the United States

Circulation ◽  
2020 ◽  
Vol 141 (12) ◽  
pp. 946-953 ◽  
Author(s):  
Jesse A. Columbo ◽  
Robert M. Zwolak ◽  
Edward J. Arous ◽  
Philip P. Goodney ◽  
Michael P. Lilly ◽  
...  
Keyword(s):  
United States ◽  
Carotid Stenosis ◽  
Disease Severity ◽  
Peak Systolic Velocity ◽  
The United States ◽  
Population Based ◽  
Cardiovascular Health Study ◽  
Carotid Ultrasound ◽  
Diagnostic Thresholds ◽  
Potential Impact

Background: Individuals with carotid stenosis enter surveillance or are considered for surgery on the basis of disease severity assessed by ultrasound. However, there is variation in the ultrasound diagnostic thresholds used to determine disease severity. Our objective was to describe this variation and its potential impact on patients. Methods: To describe the variation in carotid ultrasound diagnostic thresholds, we examined testing protocols from 338 accredited vascular testing centers in the United States. To determine the potential impact of this variation, we applied the range of thresholds to carotid ultrasound parameters from 2 groups: a population-based sample ≥65 years of age in the Cardiovascular Health Study (n=4791), and a cohort of patients who underwent surgery for asymptomatic carotid stenosis in the Vascular Quality Initiative registry (n=28 483). Results: Internal carotid artery peak systolic velocity was used by all centers to assess disease severity, with 60 distinct thresholds in use. The peak systolic velocity threshold for moderate (≥50%) stenosis ranged from 110 to 245 cm/s (median, 125; 5th and 95th percentile, 125 and 150), and the threshold for severe (≥70%) stenosis ranged from 175 to 340 cm/s (median, 230; 5th and 95th percentile, 230 and 275). In the population-based sample, the 5th percentile threshold would assign a diagnosis of moderate carotid stenosis to twice as many individuals as the 95th percentile threshold (7.9% versus 3.9%; relative risk, 2.01 [CI, 1.70–2.38]). In the surgical cohort, 1 in 10 (9.8%) patients had peak systolic velocity values that warranted the diagnosis of severe carotid stenosis at centers in the 5th percentile, but not in the 95th. Conclusions: The diagnostic threshold for carotid stenosis varies considerably. Whether or not a person is said to have moderate stenosis and enters surveillance, and whether or not they have severe stenosis and are candidates for surgery, can depend on which center performs their ultrasound.

scholarly journals Carotid Intervention for High Grade Asymptomatic Carotid Stenosis does not Confer Stroke Prevention over Best Medical Therapy

2013 ◽  
Vol 58 (5) ◽  
pp. 1429-1430
Author(s):  
Maria Mora Pinzon ◽  
Daniel Zindrick ◽  
Johanna Erstad ◽  
Taeyoung Park ◽  
Pegge Halandras ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Medical Therapy ◽  
Stroke Prevention ◽  
High Grade ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Best Medical Therapy

scholarly journals Race Differences in High-Grade Carotid Artery Stenosis

Stroke ◽  
2021 ◽  
Author(s):  
Brajesh K. Lal ◽  
James F. Meschia ◽  
Thomas G. Brott ◽  
Michael Jones ◽  
Herbert D. Aronow ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Native Americans ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
The United States ◽  
Artery Stenosis ◽  
High Grade ◽  
Lower Prevalence ◽  
Prevalence Estimates

Background and Purpose: Despite a higher incidence of stroke and a more adverse cardiovascular risk factor profile in Blacks and Hispanics compared with Whites, carotid artery revascularization is performed less frequently among these subpopulations. We assessed racial differences in high-grade (≥70% diameter-reducing) carotid stenosis. Methods: Consecutive clients in a Nationwide Life Line for-Profit Service to screen for vascular disease, 2005 to 2019 were evaluated in a cross-sectional study. The prevalence of high-grade stenosis, defined by a carotid ultrasound peak systolic velocity of ≥230 cm/s, was assessed. Participants self-identified as White, Black, Hispanic, Asian, Native American, or other. Race/ethnic differences were assessed using Poisson regression. The number of individuals in the United States with high-grade stenosis was estimated by applying prevalence estimates to 2015 US Census population estimates. Results: The prevalence of high-grade carotid stenosis was estimated in 6 130 481 individuals. The prevalence of high-grade stenosis was higher with increasing age in all race-sex strata. Generally, Blacks and Hispanics had a lower prevalence of high-grade stenosis compared with Whites, while Native Americans had a higher prevalence. For example, for men aged 55 to 65, the relative risk of stenosis compared with Whites was 0.40 (95% CI, 0.29–0.55) and 0.61 (95% CI, 0.46–0.81) for Blacks and Hispanics, respectively; and 1.53 (95% CI, 1.12–2.10) for Native Americans. When these prevalence estimates were applied to the Census estimates of the US population, an estimated 327 721 individuals have high-grade stenosis, of whom 7% are Black, 7% Hispanic, and 43% women. Conclusions: Despite their having a more adverse cardiovascular risk profile, there was a lower prevalence of high-grade carotid artery stenosis for both the Black and Hispanic relative to the White clients. This lower prevalence of high-grade stenosis is a potential contributor to the lower use of carotid revascularization procedures in these minority populations.

scholarly journals COVID-19 and the Ophthalmology Residency Match: Data from Applicants' Perspectives

2021 ◽  
Vol 13 (01) ◽  
pp. e73-e77
Author(s):  
Benjamin Steren ◽  
Ankur Parikh ◽  
Bilal Ahmed ◽  
Benjamin Young ◽  
Jayanth Sridhar ◽  
...  
Keyword(s):  
Interest Groups ◽  
The United States ◽  
Application Process ◽  
Substantial Impact ◽  
Clinical Exposure ◽  
Residency Programs ◽  
Informed Decisions ◽  
Rank List ◽  
Perceived Impacts ◽  
Residency Application

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on medical education, particularly for those applying to residency programs in 2020 to 2021. This study describes the challenges for potential ophthalmology residency applicants so that residency leadership can make informed decisions about changes to the process. Methods A survey was distributed electronically via social media and medical school ophthalmology interest groups from June 18, 2020 to July 2, 2020 to individuals interested in applying to ophthalmology residency in the United States. Survey questions included demographics and perceived impacts of COVID-19 on ability, confidence, intention to apply, and perceptions toward changes in the application process for the 2020 to 2021 ophthalmology residency application cycle. Results One-hundred sixteen total responses were received. Eighty-six responses (74%) were from individuals intending to apply in the 2020 to 2021 application cycle. Most respondents (86%) felt that their application would be affected by COVID-19 with 51% feeling less confident. Only four (5%) felt that they could adequately compile a rank list following a video interview, and over half (51%) anticipated applying to more programs than they originally intended. Academic plans of seven (8%) respondents were significantly altered via deferral of application or cancellation of a research year. Thirty-nine (45%) students reported delayed ophthalmology electives, with less than half (41%) feeling that they had adequate clinical exposure to be prepared for residency. Conclusion The COVID-19 pandemic has had a substantial impact on the 2020 to 2021 ophthalmology residency application cycle. As stakeholders begin to approach this cycle, these findings will help them make effective and informed decisions to create the best overall experience for all involved.

scholarly journals Cost effectiveness analysis of implementing tuberculosis screening among applicants for non-immigrant U.S. work visas

Pneumonia ◽  
2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Bisma Ali Sayed ◽  
Drew L. Posey ◽  
Brian Maskery ◽  
La’Marcus T. Wingate ◽  
Martin S. Cetron
Keyword(s):  
United States ◽  
Home Country ◽  
Screening Program ◽  
Cost Savings ◽  
The United States ◽  
Active Tuberculosis ◽  
Multiple Perspectives ◽  
Tuberculosis Screening ◽  
Hospitalization Costs ◽  
The U.S

Abstract Background While persons who receive immigrant and refugee visas are screened for active tuberculosis before admission into the United States, nonimmigrant visa applicants (NIVs) are not routinely screened and may enter the United States with infectious tuberculosis. Objectives We evaluated the costs and benefits of expanding pre-departure tuberculosis screening requirements to a subset of NIVs who arrive from a moderate (Mexico) or high (India) incidence tuberculosis country with temporary work visas. Methods We developed a decision tree model to evaluate the program costs and estimate the numbers of active tuberculosis cases that may be diagnosed in the United States in two scenarios: 1) “Screening”: screening and treatment for tuberculosis among NIVs in their home country with recommended U.S. follow-up for NIVs at elevated risk of active tuberculosis; and, 2) “No Screening” in their home country so that cases would be diagnosed passively and treatment occurs after entry into the United States. Costs were assessed from multiple perspectives, including multinational and U.S.-only perspectives. Results Under “Screening” versus “No Screening”, an estimated 179 active tuberculosis cases and 119 hospitalizations would be averted in the United States annually via predeparture treatment. From the U.S.-only perspective, this program would result in annual net cost savings of about $3.75 million. However, rom the multinational perspective, the screening program would cost $151,388 per U.S. case averted for Indian NIVs and $221,088 per U.S. case averted for Mexican NIVs. Conclusion From the U.S.-only perspective, the screening program would result in substantial cost savings in the form of reduced treatment and hospitalization costs. NIVs would incur increased pre-departure screening and treatment costs.

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