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PubMed2004

Coping and anxiety in women recalled for additional diagnostic procedures following an abnormal screening mammogram.

This study characterized women's concurrent and subsequent levels of emotional distress associated with a questionable mammogram screening and relationships between women's coping and psychosocial adjustment. State anxiety was assessed in 98 women 1 day after receiving a mammogram screening (Time 1), after notification of a questionable screening result that necessitated additional testing (Time 2), and after being informed of their breast-cancer-free status (Time 3). Key findings include (a) women reported a significant increase in anxiety following notification of the need to return for follow-up testing; (b) significant and positive associations were found between anxiety and behavioral approach, behavioral avoidance, cognitive approach, and cognitive avoidance coping in cross-sectional analyses; and (c) cognitive avoidance coping was a strong predictor of final levels of state anxiety in women. Findings suggest that cognitive avoidance coping plays an important role in reducing anxiety in women recalled to clarify an initially ambiguous screening procedure.

Adaptation, Psychological↗

PubMed1993

[Integration of Doppler ultrasound into the obstetric department of a gynecologic clinic].

This study was performed to evaluate the time interval for Doppler ultrasound and sonographic diagnostic measurement at 267 patients during antenatal risk screening. Time for biometry, screening of malformation, Doppler ultrasound, documentation and discussion with the patients were measured. Although experienced colleagues used an standardized inquiry a mean time interval of 52 minutes were needed under optimal conditions. It is interesting to note that outstanding disturbance factors extend the examination time considerable. Many data must be calculated and recorded by the obstetrician. Several proposals are drawn up and discussed in this paper on the basis of this results. This study shows that high special knowledge and a large time expense is necessary to establish Doppler technology in the routine antenatal screening.

Appointments and Schedules↗

PubMed1998

A school-based Chlamydia control program using DNA amplification technology.

OBJECTIVES: Chlamydia trachomatis is the most prevalent bacterial sexually transmitted disease (STD) in the United States, with the highest rates reported among adolescents. Chlamydia has severe consequences including pelvic inflammatory disease and infertility, and is believed to be a cofactor in human immunodeficiency virus transmission. Given that chlamydia is predominantly asymptomatic, most cases are identified through routine screening in health care settings. Over time, screening and treatment appear to be associated with a decrease in the prevalence of disease in areas with consistent chlamydia control programs. The new availability of sensitive and specific urine tests for chlamydia (polymerase chain reaction [PCR] and ligase chain reaction [LCR]) provides the opportunity to screen large numbers of at-risk youth in a noninvasive manner. We used PCR/LCR testing to investigate the feasibility of a school-based chlamydia control program and to determine the prevalence of chlamydia infection among junior and senior high school students. DESIGN: At three junior/senior high schools, all students, regardless of symptoms or sexual history, were given the opportunity to be tested for chlamydia using urine-based PCR or LCR testing. Only students with parental consent were eligible. Parents could not obtain test results, except if their children told them. During the five 3-week testing periods, throughout the day, classes were escorted to the testing area and each student was individually counseled regarding the opportunity to participate in the testing. SETTING: Three urban public schools in Louisiana. PARTICIPANTS: A total of 1933 students in grades 7 through 12, including 861 girls and 1072 boys. INTERVENTION: All students were informed about the test and taught about chlamydia during the homeroom period. Students were asked to provide a first-void urine specimen of not more than 30 mL. Specimens were refrigerated and delivered to the laboratory on the same day. Infected students were counseled and offered treatment with azithromycin, 1 g orally. They were also referred for or offered additional STD and human immunodeficiency virus testing. Infected students were asked to refer their sex partners to the city STD clinic for treatment. MAIN OUTCOME MEASURE: Prevalence of C trachomatis infection by grade and gender. RESULTS: Parental consent was obtained for 2849 (86.9%) of the 3278 matriculated students in grades 7 through 12. Fifty-one parents (1.6%) returned consent forms refusing permission for their child to participate in this screening and treatment program. The remaining 378 (11.5%) could not be reached by mail or telephone. Among all students with consent, 1933 (67.8% of those consented and 59.0% of those matriculated) were tested. Girls were less likely to be tested than boys (861/1363 [63. 2%] vs 1072/1465 [73.2%]). The overall prevalence of C trachomatis was 6.5%, with rates among girls more than twice that of boys (9.7% vs 4.0%). Generally, rates of infection increased with age. The prevalence rates among boys were for 7th grade, 2/208 (1%); 8th grade, 2/196 (2%); 9th grade, 10/236 (4.2%); 10th grade, 12/185 (6. 5%); 11th grade, 8/146 (5.5%); and 12th grade, 9/101 (8.9%). For boys 15 to 19 year old, the prevalence of chlamydia was 5.7%. Among girls, the prevalence rates were 7th grade, 0/105 (0%); 8th grade, 11/166 (6.6%); 9th grade, 23/218 (10.6%); 10th grade 23/146 (15.8%); 11th grade, 13/118 (11%); and 12th grade, 13/107 (12.1%). Among girls 15 to 19 years old, 12.7% were infected. Of 126 infected students, treatment was provided to 111 (88%). For this project, the laboratory cost of LCR testing was $17.76 per test. Without considering clinical staff time to collect the specimens, the average laboratory cost per infected student identified was $272. For students 15 to 19 years of age, of whom 104 (8.9%) of 1170 were infected, the laboratory cost was $200 per case identified. CONCLUSION: (ABSTRACT TRUNCATED)

Adolescent↗

PubMed2006

Percutaneous iliosacral screw fixation of unstable pelvic injuries by conventional fluoroscopy.

OBJECTIVE: Closed reduction and retention of translatory unstable pelvic injuries (type C injuries), in order to restore the form and function of the posterior pelvis by percutaneous iliosacral screw osteosynthesis, using conventional fluoroscopy. INDICATIONS: Definitive treatment of the posterior pelvis in type C injuries (AO classification) with complete sacral fracture, sacroiliac joint (SI joint) dislocation, transiliac or transsacral dislocation fracture of the SI joint with insignificant small fragment and sacroiliac avulsion injuries which can be reduced almost anatomically in closed technique. CONTRAINDICATIONS: Poor general health, local soft-tissue damage, rotationally unstable type B pelvic injuries as well as type C injuries which cannot be reduced satisfactorily in closed technique. SURGICAL TECHNIQUE: Closed reduction, stab incision and percutaneous stabilization of the posterior pelvis by transiliosacral screw osteosynthesis, guided by fluoroscopy. POSTOPERATIVE MANAGEMENT: Partial loading of the injured side with 15 kg for 8-12 weeks with two underarm crutches. Implant removal 6-12 months after injury. RESULTS: 20 patients with a transforaminal sacral fracture consistent with a type C pelvic injury underwent screw fixation with fluoroscopy with 7.3-mm cannulated screws, placed in a transiliosacral position in the vertebral body of S1. The average preoperative displacement of 3.8 mm was decreased by closed reduction to 1.6 mm postoperatively. The average operating time was 55 min, the average screening time 2.22 min. Incorrect screw position with no consequences was observed in three patients; iatrogenic nerve damage was not found. All fractures healed within 3 months.

Adolescent↗

PubMed2004

Randomized controlled trial of screening for hepatocellular carcinoma.

PURPOSE: Screening for hepatocellular carcinoma (HCC) has been conducted for over 20 years, but there is no conclusive evidence that screening may reduce HCC mortality. The aim of this study was to assess the effect of screening on HCC mortality in people at increased risk. METHODS: This study included 18,816 people, aged 35-59 years with hepatitis B virus infection or a history of chronic hepatitis in urban Shanghai, China. Participants were randomly allocated to a screening (9,373) or control (9,443) group. Controls received no screening and continued to use health-care facilities. Screening group participants were invited to have an AFP test and ultrasonography examination every 6 months. Screening was stopped in December 1997; by that time screening group participants had been offered five to ten times. All participants were followed up until December 1998. The primary outcome measure was HCC mortality. RESULTS: The screened group completed 58.2 percent of the screening offered. When the screening group was compared to the control group, the number of HCC was 86 versus 67; subclinical HCC being 52 (60.5%) versus 0; small HCC 39 (45.3%) versus 0; resection achieved 40 (46.5%) versus 5 (7.5%); 1-, 3,-, and 5-year survival rate 65.9%, 52.6%, 46.4% versus 31.2%, 7.2%, 0, respectively. Thirty-two people died from HCC in the screened group versus 54 in the control group, and the HCC mortality rate was significantly lower in the screened group than in controls, being 83.2/100,000 and 131.5/100,000, respectively, with a mortality rate ratio of 0.63 (95%CI 0.41-0.98). CONCLUSIONS: Our finding indicated that biannual screening reduced HCC mortality by 37%.

Adult↗

PubMed1993

Bolus chasing: a new technique in peripheral arteriography.

Recent advances in digital angiographic equipment design have enabled a new technique of peripheral arteriography involving digital bolus chasing to be developed. This technique permits real-time visualization of the contrast bolus so that it can be followed peripherally with digital images being acquired at a suitable frame rate. We give the first description of this technique using the Philips Integris C2000 and compare it to conventional stepped arteriography. Sixty-one patients undergoing peripheral arteriography using the conventional stepped technique were compared with 55 patients using bolus chasing. The parameters assessed were the procedure time, the number of runs and screening time per investigation, the consumables used, the patient and radiologist radiation dose and the image quality. A reduction in the procedure time and the patient and radiologist radiation dose, and improvement in image quality are demonstrated with the bolus chasing technique. Bolus chasing represents an important advance in peripheral arteriography.

Angiography↗

PubMed2006

Liquid-based cytology and conventional smears compared over two 12-month periods.

BACKGROUND AND OBJECTIVE: Liquid based cytology (LBC) was introduced across the Scottish Cervical Screening Programme in 2003-2004. The objective of this study was to compare in a large cytopathology laboratory the results of cervical samples over two twelve-month periods, 2001-2002, when the great majority of smears were conventional, with 2003-2004, when all were LBC. METHODS: The results of smears in both periods were analysed to give overall reporting profiles, and correlated with results of cervical biopsies. The numbers of patients referred for colposcopy were compared. RESULTS: The percentage of unsatisfactory smears fell from 13.6% to 1.9%. Colposcopic referrals for repeated unsatisfactory smears fell from almost 25% to 0.5%. There was a decrease in overall smear numbers, but despite this there was an increase in the number of smears reported as showing dyskaryosis of any grade. There was an increase in positive predictive value for moderate dyskaryosis and above, from 79.5% to 86.1%. The outcome of biopsies from patients referred with mild dyskaryosis showed no decrease in accuracy of predicting a low grade histological lesion. Workload in the laboratory decreased, due to fewer smears received overall, more rapid primary screening times and fewer multi-slide cases. Primary screening backlogs all but disappeared, and reporting times greatly improved. CONCLUSIONS: Introduction of liquid based cytology led to improvements in unsatisfactory smear rates, with significant benefits to colposcopic referrals and laboratory turnaround times. Pick-up rates of dyskaryosis were maintained, and the positive predictive value of a dyskaryotic smear report was improved.

Colposcopy↗

PubMedDate not supplied

Conventional cervical cytologic smears vs. ThinPrep smears. A paired comparison study on cervical cytology.

OBJECTIVE: To compare the time required for evaluation, the diagnostic accuracy and quality of conventional glass slide smears vs. ThinPrep smears in 365 women. STUDY DESIGN: Both smears were obtained at the same time using the Accellon Combi cervical biosampler. Histology served as the diagnostic "gold standard." RESULTS: The average screening time was 1 minute, 23 seconds, shorter per smear with the ThinPrep method as compared to the conventional glass slide (P < .001). Direct diagnostic agreement between the two smear methods was obtained in 311 of 364 evaluable smears (85.4%, kappa = .63). Despite the relatively high rate of "adequate but limited by absence of transformation zone components" observed with the ThinPrep method, the sensitivity and specificity of the ThinPrep method was slightly greater but not statistically significantly different than the conventional technique, irrespective of the disease categories (low and high grade squamous intraepithelial lesion and invasive cancer). CONCLUSION: The shorter time required to screen ThinPrep smears compared to conventional smears in this study was not sufficiently important to offset the current unit price for preparing ThinPrep smears.

Adenocarcinoma↗

PubMed2003

Depression screening: a practical strategy.

A 2-stage strategy, combining an assessment of severity with depression criteria, can help a physician focus on the most severe cases without missing less severe ones that still need treatment. Because of its brevity, relatively high positive predictive value, and ability to inform the clinician on both depression severity and diagnostic criteria, the PRIME-MD Patient Health Questionnaire (PHQ-9) is the best available depression screening tool for primary care. One-time screening is cost-effective; physicians may elect to screen more often based on risk factors.

Depression↗

PubMed2002

Prostate cancer mortality reduction by screening: power and time frame with complete enrollment in the European Randomised Screening for Prostate Cancer (ERSPC) trial.

From 1992-2001, 7 countries in Europe gradually recruited men for the European Randomised Screening for Prostate Cancer (ERSPC) trial. Centres recruit different age groups and have different designs for recruiting and countries have different underlying risks for prostate cancer. Recruitment has reached 163,126 men aged 55-69 at entry now. Our purpose was to calculate the power of the trial and at what point in time can statistically significant differences in prostate cancer mortality be expected. Recruitment data were collected from the screening centres. We calculated the expected number of prostate cancer deaths in each follow-up year, based on national statistics and expected rate in trial entrants. The power was calculated using different assumptions on intervention effect and contamination rate and also if the ERSPC trial would cooperate with other trials. With an assumed 25% intervention effect in men actually screened and a 20% contamination rate, the trial will reach a power of 0.86 in 2008. With an assumed intervention effect of 40%, the power reaches 0.90 in 2003-2004. Pooling data with those of the Prostate, Lung, Colorectal and Ovary (PLCO) trial early is expected to improve the power to 79% (20% intervention effect) to 92% (40% intervention effect PLCO). Adding more centres with compliance rates lower than 45% decreases the power of the trial. The ERSPC trial has sufficient power to detect a significant difference in prostate cancer mortality between the 2 arms if the true reduction in mortality by screening is 25% or more or if contamination remains limited to 10% if the true effect is 20% or more. If early detection and treatment turns out to have a stronger effect as may be suggested by observational data, the ERSPC trial is likely to conclusively show that within the next 5 years.

Aged↗

PubMed1998

Cost-effectiveness of screening for asymptomatic carotid stenosis.

PURPOSE: The benefit of carotid endarterectomy for patients who are asymptomatic with > 60% carotid stenosis has been established by the Asymptomatic Carotid Atherosclerosis Study (ACAS). Which screening strategy is most appropriate is still unclear. This study assessed the cost-effectiveness of ultrasound screening for asymptomatic carotid stenosis. METHODS: Cost-effectiveness analysis was performed with a Markov model and with data from ACAS and other studies. RESULTS: For 60-year-old patients with a 5% prevalence of 60% to 99% asymptomatic stenosis, duplex ultrasound screening increased average quality-adjusted life years (QALY; 11.485 vs 11.473) and lifetime cost of care ($5500 vs $5012) under base-case assumptions. The incremental cost per QALY gained (cost-effectiveness ratio) was $39,495. Screening was cost-effective with the following conditions: disease prevalence was 4.5% or more, the specificity of the screening test (ultrasound) was 91% or more, the stroke rate of patients who were medically treated was 3.3% or more, the relative risk reduction of surgery was 37% or more, the stroke rate associated with surgery was 160% or less than that of the North American Symptomatic Carotid Endarterectomy Trial or ACAS perioperative complication rates, and the cost of ultrasound screening was $300 or less. A one-time screening, compared with a screening every 5 years, had more QALY (11.485 vs 11.482) and lower cost ($5500 vs $5790). Screening without arteriography, compared with screening with arteriographic verification, provided few additional QALYs (11.486 vs 11.485) at additional cost ($6896 vs $5500). The cost-effectiveness ratio was sensitive to assumptions about the stroke rate of patients who were asymptomatic and other variables. CONCLUSIONS: Screening for asymptomatic carotid stenosis can be cost-effective when both screening and carotid endarterectomy are performed in centers of excellence.

Carotid Stenosis↗

PubMed2001

Reliability of tissue Doppler wall motion monitoring after heart transplantation for replacement of invasive routine screenings by optimally timed cardiac biopsies and catheterizations.

BACKGROUND: Invasive screenings at predefined time intervals for acute rejection and transplant coronary artery disease (TxCAD) are standard procedures. However, cardiac biopsies and catheterizations are distressing and risky for the patients and are also costly. We assessed the reliability of pulsed-wave tissue Doppler imaging (PW-TDI) for the timing of invasive examinations in heart recipients in an attempt to avoid unnecessary endomyocardial biopsies (EMBs) and catheterizations. METHODS AND RESULTS: PW-TDI obtained at the basal left ventricular posterior wall before 408 EMBs and 293 catheterizations was tested for its diagnostic value regarding rejection and TxCAD with the use of International Society of Heart and Lung Transplantation biopsy grading, coronary angiography, and intravascular ultrasound as standards. Early diastolic peak wall motion velocity and relaxation time showed high sensitivities for clinically relevant rejection diagnosis (90.0% and 93.3%, respectively). The negative and positive predictive values for rejection of diastolic parameter changes appeared high enough (up to 96% and 92%, respectively) to allow a reliable noninvasive PW-TDI monitoring with efficiently timed, instead of routinely scheduled, EMBs. At definite cutoff values for systolic parameters, the probability for TxCAD reached 92% to 97%. The Fisher classification functions allowed TxCAD exclusion with 80% probability. CONCLUSIONS: Without diastolic parameter changes, acute rejection can be practically excluded, and serial PW-TDI can save patients from routine EMBs. The high specificity and negative predictive value for TxCAD of reduced systolic peak velocities and extended systolic time allow optimized timed catheterizations. Peak systolic velocity and systolic time allow diagnostic classifications that enable patients without known TxCAD but with high risk for catheterization to be spared routine angiographies.

Adult↗

PubMed2006

What women want: convenient appointment times for cervical screening tests.

Little is known about women's preferred appointment times for cervical screening tests. Data from a postal questionnaire survey were used to compare preferred appointment times with those given. Although 33.4%[95% confidence intervals (CI) 31.8%-35.0%] of respondents received appointments between 10h00 and 11h55, only 17.0% (95% CI 15.3%-18.7%) wanted an appointment at that time. Nineteen per cent (95% CI 17.4%-21.0%) of respondents wanted appointments between 18h00 and 20h00, but only 4.4% (95% CI 3.7%-5.1%) received them. Saturday appointments for cervical screening are not given; however, overall approximately 13% of those surveyed would have preferred a Saturday appointment. Preferred times also varied significantly with age and deprivation category. Further research is required to determine whether appointment times for cervical screening can be tailored to meet these expressed needs, and the impact this has on service provision and uptake.

Adult↗

PubMedDate not supplied

AutoCyte SCREEN interactive automated primary cytology screening system. A preliminary evaluation.

OBJECTIVE: To perform a preliminary evaluation of the relative sensitivity of a new interactive automated cytology screening system (AutoCyte SCREEN, AutoCyte, Inc., Elon College, North Carolina, U.S.A.) designed as a primary screening system for AutoCyte PREP monolayer slides (AutoCyte). STUDY DESIGN: Monolayer slides were prepared and evaluated in a masked review both manually and using the automated system. Human and machine performance was monitored and measured. RESULTS: Five hundred eighty-three monolayer preparations, including 56 clearly abnormal cases, were evaluated. The dual and combined computer and cytologist image evaluation resulted in a relatively low false positive rate, 20.8%, and 1.8% false negative rate. Use of the system was efficient, significantly reducing cytotechnologist screening time. CONCLUSION: The integrated AutoCyte cell preparation and automated screening approach seems to hold significant promise for primary cytology screening applications.

Adenocarcinoma↗

PubMed2004

Completion of colorectal cancer screening in women attending screening mammography.

RATIONALE AND OBJECTIVES: The American Cancer Society (ACS) and the United States Preventive Services Task Force (USPSTF) recommend colorectal cancer (CRC) screening to begin at age 50 in individuals at average risk for CRC. To estimate rate at which women eligible for CRC screening at the time of screening mammography attendance later completed in CRC screening, we retrospectively evaluated CRC screening utilization in women who underwent screening mammography at our institution. MATERIALS AND METHODS: We retrospectively identified 3357 women between the ages of 50 to 75 who received screening mammography in 1998 at a single academic medical center using the institution's Radiology Information System (RIS). Additional information collected from the institution's Health System Data Warehouse and the Radiology department's mammography quality assurance data included mammography results, Breast Imaging Reporting and Database System (BI-RADS) classification of mammography findings, recommendation for screening mammography follow-up, insurance status, and CRC screening utilization after screening mammography. After excluding women who were current with CRC screening at the time of mammography, we determined the proportion of eligible women who completed CRC screening after mammography. Age, insurance type, BI-RADS code, and recommendation code were evaluated as potential predictors of CRC screening completion in eligible women. RESULTS: Of the 3357 women between the ages of 50 and 75 who received screening mammography in 1998, only 414 (12.3%) were current with CRC screening at the time of screening mammography. Of the remaining 2943 women who were eligible for CRC screening at the time of screening mammography, 142 (4.8%) subsequently completed CRC screening. Average time to completion of CRC screening after screening mammography is 35.4 months (range, 0.27-64.9). Managed care insurance was the only significant predictor of CRC screening completion after screening mammography in eligible women after adjusting for other variables (adjusted OR 1.73, 95% CI 1.21-2.47, P < .0001). Neither BI-RADS classification nor postmammography recommendations were significantly associated with CRC screening completion. CONCLUSIONS: Prevalence studies have demonstrated that women who were compliant with screening mammography were more compliant with CRC screening. Our data suggest that despite this increased compliance, overall incidence of CRC screening is low in the screening mammography population.

Aged↗

PubMed2002

An investigation into the effect of extending routine mammographic screening to older women in the United Kingdom on the time it takes to screen.

OBJECTIVE: To compare the time it takes to screen women aged 65-69 with women age 50-64. SETTING: Screening centres participating in the Department of Health funded demonstration study of extending breast screening to women aged 65-69. METHODS: Consecutive women of all ages were timed during November 1999 to February 2000, until about 50 women aged 65-69 had been screened at each of the sites. For each woman screened, her age, whether she had been screened before, the times when she checked in, started to get undressed, started screening, finished screening, and when she left the screening unit were recorded. The radiographers also recorded any difficulties associated with screening any of the women in the survey. RESULTS: The total mean time spent at the centres and the time being screened was not significantly different between the two age groups overall or within each of the demonstration sites (p>0.05). The distribution of screen time was similar between the age groups within each of the sites. The proportion of screens reported as difficult by the radiographers differed between sites, with two out of the three sites reporting more problems screening older women. CONCLUSIONS: Despite some radiographers reporting more difficulties associated with screening older women, screening a woman aged 65-69 was found, on average, to take no longer than screening a women aged 50-64 years. Thus, when the NHS breast screening programme is extended to include older women, the same time interval for an appointment can be scheduled regardless of the woman's age.

Aged↗

PubMedDate not supplied

When should children have their eyes checked?

Timely screening for the early detection of eye and vision problems in children is vital to avoid lifelong visual impairment. Early detection provides the best opportunity for effective treatment. Organizations devoted to the health and well-being of children have issued recommendations or policy statements regarding the timing of eye screenings and examinations. The American Academy of Pediatrics (AAP), American Association of Pediatric Ophthalmology and Strabismus (AAPOS), American Academy of Ophthalmology (AAO), American Association of Certified Orthoptists (AACO), and the American Academy of Family Physicians (AAFP) recommend screening at birth and all well-child visits. The American Optometric Association (AOA) recommends that vision examinations begin at 6 months of age. All children found to have an ocular abnormality or who fail vision assessment should be referred to an eye care specialist trained to treat pediatric patients.

Age Factors↗

PubMed1998

Dose-area product readings for fluoroscopic and plain film examinations, including an analysis of the source of variation for barium enema examinations.

This paper contains the results of an investigation undertaken between 1994 and 1996 using dose-area product (DAP) meters for monitoring radiation doses from six types of simple examinations and seven types of complex examinations. Mean hospital DAP levels have been compared with National Reference Levels (NRL), with most departments producing levels lower than NRLs. DAP readings have allowed the proposal of provisional Reference Levels (RL) to be set for simple and complex examinations. The results were also compared with recently published data from the National Radiological Protection Board (NRPB), highlighting those hospitals which need to make changes in radiographic technique. The study of DAP reference doses also confirms that dose levels for complex investigations are clearly related to technique, in terms of screening time and number of films. Although the use of increased screening tube kilovoltage may be relevant, the overall effect is small. The results suggest that there is still a need to optimize the protocols for these examinations. The use of digital equipment has been shown to have a complex effect on dose, particularly in the case of investigations involving both films and fluoroscopy.

Barium↗