Research Prospectus: Title –Compliance with the United States Preventive Services Task Force (USPSTF) AAA Screening (Abdominal Aortic aneurysms) Purpose/hypothesis Abdominal Aortic Aneurysms have been shown to account for the major mortality and morbidity rates in adults. The reason for this is because, for AAA, most of the symptoms lie dormant and rarely show until the disease gets to an advanced stage and there is a rupture of the Aorta. As such, regular screening is important since it allows for early detection of the disease allowing doctors to be able to manage the condition before rupture occurs. Men aged between 65-75 years which are past or present smokers are at a greater risk of developing an AAA. For this reason, this group of patients that would benefit greatly from early detection in the form of screening and reparative surgical treatment. The purpose of the proposed study was to determine the percentage of ever-smoking males 65-75 years of age who have undergone CT screening for Abdominal Aortic aneurysms (AAAs), as recommended by the United States Preventive Services Task Force (USPSTF), and the percentage of PCPs who recommend such screening as part of annual/interval physical examinations. The research thus hypothesizes that a low percentage of eligible males undergo such screening and a low percentage of physicians recommend such screening despite the high prevalence of AAA among members of these group. Background AAA is defined as a dilation that occurs on the abdominal aorta causing the aorta to expand to 50% of its normal size to diameters of 3 centimeters or more. Consequently, the epidemiology of AAA is acquired from scanning and screening at-risk populations and autopsy studies. As such, based on the studies conducted so far, epidemiology rates range from 4% to 8% in men, and about 1% of AAA cases have been reported in women. In addition, data collected by the Veterans Affairs Co-operative Study showed that 3.6% of the males screened had an aneurysm of 3cm while another 1.2% of the candidates had an aneurysm of 4cm or more (Zucker, & Prabhakar, 2018). Their study shows that the incidence of AAA ranges from 40.6-49.3 for every 100,000 men and 6.8-12 for every 100, 000 women in the US. (Zucker, & Prabhakar, 2018). To combat the above-increased rates of AAA rates among Americans, the Department of Health developed the USPSTF guidelines in 2005 which recommended AAA screening for males between the age of 65 and 75 who had smoked 100 cigarettes or more in their lifetime (Aggarwal, Qamar, Sharma & Sharma, 2011). The guidelines aim to ensure that most men who fit the above characteristics were screened in order to adopt preventive measures to combat the issue. However, for individuals who did not smoke, the agency did not make any recommendations and also advised against screening for women since their comorbidity rates were shown to be low. The rationale behind the guidelines was that screening would help to mitigate the d.

1. Research Prospectus:
Title –Compliance with the United States Preventive Services
Task Force (USPSTF) AAA Screening (Abdominal Aortic
aneurysms)
Purpose/hypothesis
Abdominal Aortic Aneurysms have been shown to account for
the major mortality and morbidity rates in adults. The reason for
this is because, for AAA, most of the symptoms lie dormant and
rarely show until the disease gets to an advanced stage and there
is a rupture of the Aorta. As such, regular screening is
important since it allows for early detection of the disease
allowing doctors to be able to manage the condition before
rupture occurs. Men aged between 65-75 years which are past or
present smokers are at a greater risk of developing an AAA. For
this reason, this group of patients that would benefit greatly
from early detection in the form of screening and reparative
surgical treatment.
The purpose of the proposed study was to determine the
percentage of ever-smoking males 65-75 years of age who have
undergone CT screening for Abdominal Aortic aneurysms
(AAAs), as recommended by the United States Preventive
Services Task Force (USPSTF), and the percentage of PCPs who
recommend such screening as part of annual/interval physical
examinations.
The research thus hypothesizes that a low percentage of eligible
males undergo such screening and a low percentage of
physicians recommend such screening despite the high
prevalence of AAA among members of these group.
Background
AAA is defined as a dilation that occurs on the abdominal aorta
causing the aorta to expand to 50% of its normal size to
diameters of 3 centimeters or more. Consequently, the
epidemiology of AAA is acquired from scanning and screening

2. at-risk populations and autopsy studies. As such, based on the
studies conducted so far, epidemiology rates range from 4% to
8% in men, and about 1% of AAA cases have been reported in
women. In addition, data collected by the Veterans Affairs Co-
operative Study showed that 3.6% of the males screened had an
aneurysm of 3cm while another 1.2% of the candidates had an
aneurysm of 4cm or more (Zucker, & Prabhakar, 2018). Their
study shows that the incidence of AAA ranges from 40.6-49.3
for every 100,000 men and 6.8-12 for every 100, 000 women in
the US. (Zucker, & Prabhakar, 2018).
To combat the above-increased rates of AAA rates among
Americans, the Department of Health developed the USPSTF
guidelines in 2005 which recommended AAA screening for
males between the age of 65 and 75 who had smoked 100
cigarettes or more in their lifetime (Aggarwal, Qamar, Sharma
& Sharma, 2011). The guidelines aim to ensure that most men
who fit the above characteristics were screened in order to
adopt preventive measures to combat the issue. However, for
individuals who did not smoke, the agency did not make any
recommendations and also advised against screening for women
since their comorbidity rates were shown to be low. The
rationale behind the guidelines was that screening would help to
mitigate the disease by identifying if individuals had AAA or
not.
In 2014, the USPSTFF updated the guidelines requiring one-
time sonography for all elderly male smokers. However, for
nonsmokers, the agency reported that screening could be
selectively offered to these individuals depending on patient
preference or professional opinion. With respect to these
guidelines, the organization expected that screening rates will
increase. However, a study conducted by (Aggarwal, Qamar,
Sharma & Sharma, 2011), shows that screening only increased
in the male ever smoker categories while no appreciable change
has been seen in other demographic groups. Consequently, in
respect to the hypothesis which shows that there have been low
screening rates, the USPSTFF has constantly updated their

3. recommendations to encourage screening as shown by the
updated guidelines as shown in the 2014 by-laws (Dahl,
Hasselgård & Myhre, 1999). In addition, the organization is
also providing new guidelines this year to demonstrate that
screening should be carried out among at-risk populations. As
such, it is important for clinical imagers to be aware of future
guidelines and revisions and also to be aware of associated
practices required of them and the implications of their actions.
Materials & Methods
Data will be collected from chart review of eligible patients
(ever-smoker males 65-75 years of age undergoing
annual/interval physical examinations without previous
screening or diagnosis of an AAA). This is a preliminary study
with a target sample size of 100 (10 charts/PCP). PCPs (FPs
and internists) with private offices in Washington DC,
Maryland, and Virginia, will be interviewed face-to-face to
determine whether or not they recommend CT screening of ever-
smoker males 65-75 years of age during annual/interval physical
examinations. The target sample size is 10.
Consequently, the data collection will be aimed at determining
how many times PCP’s have recommended screening for people
in this age bracket and how many times PCP’s have screened a
patient. As such, the questions that will be directed at people in
this subgroup will entail;
1. Are you aware of the current standards that instruct AAA
screening?
2. How many patients who are smoker males between 65-75
years of age have you screened for the presence of an AAA?
3. Have you recommended AAA screening for a patient as a
precautionary measure and if so when did the doctor recommend
that?
4. Do you think AAA screening for people this age is important
and if so why?
To maintain data validity and ensure that the data collected will
be within the stipulated guidelines of research, a waiver will be
requested from the Ethics Committee for the retrospective chart

4. review. Informed consent will be obtained from the interviewed
physicians and anonymity will be guaranteed. IRB approval
will be requested.
Statistical analysis
The triangulation model will be used for data sampling while
qualitative data analysis models will be utilized to evaluate the
results of the respondents. In addition, quantitative models of
data analysis will also be utilized in order to determine if the
results collected adhere to the hypothesis. The results will thus
be analyzed to determine whether they affirm the hypothesis or
have disproved it.
Budget
There will be no costs associated with the study.
Discussion
This study will provide data for clinicians with respect to the
prevalence of AAA and whether screening guidelines are
followed. This may encourage clinicians to be better aware of
the importance of early detection by screening, and thus may
result in increased screening rates in active male smokers aged
between 65-75 years of age in order to reduce comorbidity and
mortality rates. As such, my study will likely transform clinical
practices leading to the adoption of minimally invasive
technologies and imaging devices in order to facilitate increased
screening and better patient outcomes in the coming years. In
addition, the study will likely prompt clinicians to adopt
mandatory screening for patients who are smokers and even
recommend patients who are non-smokers to get screened for
AAA based on their medical and physiologic histories. As such,
the study will lead to improvement and optimization in
screening practices, better management of incidental findings
and regular follow-ups.

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