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Results for “Screening programs”

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PubMed1988

Optimal timing of colonoscopy to screen for cancer in ulcerative colitis.

Patients with ulcerative colitis have a high risk of colon cancer that increases with duration of disease. Annual colonoscopy with biopsies for 99 patients with pancolitis and a mean duration of disease at entry of 17 years was evaluated. The outcomes of mucosal dysplasia or cancer were analyzed to determine the annual risk (hazard rate) of high-grade dysplasia or colon cancer. The hazard rates were used to recommend screening intervals. The delay in the diagnosis of cancer is minimized for any given number of tests when the time between tests is inversely proportional to the square root of the hazard rate. Since the hazard rate for cancer increases with duration of disease, intervals for screening tests should not be uniform. For a range of reasonable marginal benefits from additional testing, the number of tests recommended is less than the number of tests done in fixed-interval screening programs. Scheduling screening tests using patient-specific hazard rates to minimize the delay in the diagnosis of cancer reduces the number of colonoscopies, associated cost, and morbidity.

Adolescent↗

PubMed1991

Financial analysis critical to physician alliances.

Although physician support programs have gained in popularity in recent years, organizations must be careful to select the most effective mix of physician relations programs. A healthcare financial manager can help create a productive physician alliance program by analyzing physicians as strategic business units, providing financial and analytical support for program assessment, screening programs for legal risks, and assessing an alliance program's risks in terms of antifraud and abuse legislation, tax laws, and private inurement issues.

Financial Management, Hospital↗

PubMedDate not supplied

Developing new anti-cancer drugs: novel targets and methodological problems.

The identification of molecular events relevant in the biology of cancer cells and the possibility of defining the molecular profile of cancer cell lines have radically changed the process of cancer-drug development. Cancer drug discovery relies now mainly on the National Cancer Institute cell line screening program; this screening system allows the selection of compounds with well-defined molecular mechanisms of action by screening them on cell lines characterised at the molecular level and by comparing their cytotoxicity through a computer-based analysis of the response profile. Biologically targeted drugs, which should hit specific molecular or biochemical targets, can be classified by a specific target, such as farnesyltransferase inhibitors, or by general mechanism of action. The clinical development of these new anti-cancer agents presents a significant challenge because clinical studies should comply with the molecular premises and be devised in order to provide the "proof of principle", that is the ability of the drug to interact with and activate or block the molecular target. After a summary of the main features and problems faced in the clinical development of biologically targeted anti-cancer therapies, the pre-clinical and clinical data available for some cell-cycle modulators, signal transduction inhibitors, drugs acting on the mitochondria and proteasome inhibitors will be reviewed.

Antineoplastic Agents↗

PubMed1992

Neonatal screening for hip joint instability. Its clinical and economic relevance.

Effort to determine the efficacy of neonatal hip examination began in 1967. During the subsequent 23 years, there have been three analyses of the study's data: (1) a retrospective review reported in 1981, (2) a prospective examination in 1989, and (3) an economic evaluation in 1990. The retrospective review concluded that a neonatal hip screening program effectively screens for acetabular dysplasia, and early treatment seems to alter the outcome of congenital dislocation of the hip. The prospective examination, involving 62 newborns diagnosed as having dislocated or dislocatable hips, established that such cases can be effectively treated from birth with flexion/abduction splints monitored by routine clinical and follow-up examinations. An economic evaluation of the data demonstrated an economic benefit of more than $15,000 Cdn per 1000 infants screened. This study, through these three analyses, presents a compelling argument in favor of a routine, standardized neonatal hip examination.

False Negative Reactions↗

PubMed1991

Family history of cancer in a female cohort population in Japan.

This study was aimed at examining the effect of familial predisposition on cancer incidence in a cohort population. Family history (FH) of cancer and reproductive history were obtained by a simple questionnaire from about 40,000 participants in a cervical cancer screening program visiting screening clinics in 1977. Number and age structure of family members were not known. About 40% of subjects reported positive FH which was not medically verified. Comparing the observed and expected numbers of pair-wise combination of various cancers observed among the family members, we found more intense cluster of cancers of the same than different sites. This population was followed until 1987 by using the population-based cancer registry and 638 cancer cases were detected. By matching residence and birth year, the same number of nonaffected controls was chosen from the original cohorts. Positive effect of FH was detected for large bowel and breast cancers, but not for stomach and cervical cancers. Older age at marriage and lower parity were noted for breast cancer cases.

Adult↗

PubMed1994

The Routine Antenatal Diagnostic Imaging with Ultrasound Study: another perspective.

The Routine Antenatal Diagnostic Imaging With Ultrasound Study (RADIUS) has reported that the adoption of routine screening in the United States would add considerably to health care costs, but stated that a potential benefit may be identification of fetal anomalies. To determine whether the cost per detected malformed fetus using data from the RADIUS study is cost-effective, a comparison is made with the California maternal serum alpha-fetoprotein (MSAFP) screening program. When screening ultrasound is performed by individuals who have a diagnostic rate similar to that reported for tertiary centers that participated in the RADIUS study (6.8 per 1000), the cost for identifying a malformed fetus is $10,805 less ($200 per ultrasound examination) than the cost using MSAFP screening ($40,338; $53 per test). However, when the screening examination is performed by individuals whose diagnostic rate is similar to that reported for non-tertiary centers (1.7 per 1000) that participated in the RADIUS study, the cost for identifying a malformed fetus ($115,575) is $75,237 higher than MSAFP screening. Using data from the RADIUS study, a proposal is suggested by which physicians are reimbursed for second-trimester ultrasound based upon their diagnostic skills. This approach maintains the cost per detected malformed fetus at less than $30,000, decreases the current cost of diagnostic ultrasound to third-party payers, and allows second-trimester ultrasound to be offered as a cost-effective screening test for low-risk patients for identification of malformed fetuses.

Congenital Abnormalities↗

PubMed1989

Significance tests for cancer screening trials.

The goal of a cancer screening program is to reduce cancer mortality by detecting tumors at earlier stages of their development. For some types of cancer, screening tests may allow the preclinical detection of benign precursors of a tumor, and thus a screening program could result in reductions in both cancer incidence and mortality. For other types of cancer, a screening program will not reduce cancer incidence, and thus the expected outcome in a randomized cancer screening trial would be equal cancer incidence rates in control and study groups, but reduced cancer mortality in the study group. For the latter situation, we employ a variety of Poisson models for cancer incidence and mortality to derive optimal tests for equality of cancer mortality rates in a cancer screening trial, and we compare the asymptotic relative efficiencies of the test statistics under various alternatives. We demonstrate that testing equality of case mortality rates using Fisher's exact test or its Pearson chi-square approximation is nearly optimal when cancer incidence rates are equal and is fully efficient when cancer incidence rates are unequal. When valid, this comparison of case mortality rates in the study and control groups can be considerably more powerful than the standard comparison of population mortality rates. We illustrate the results using data from a clinical trial of a breast cancer screening program.

Adult↗

PubMed1992

The use of epidemiology for screening and early detection of cancer: examples from Austria.

Reduction of mortality rates and the costs of screening programs have sometimes been discussed on basis of certain therapeutic nihilism especially concerning the treatment of some cancer localizations. Interest of an epidemiological institute should, however, concern specific regions with high cancer risk and in these areas, well defined by epidemiological investigations, screening projects should be performed. A screening program initiated in Oberpullendorf, a district in the federal country of Burgenland in Austria resulted in a rate of 53% Dukes A colorectal cancer stages (0% Dukes D) compared to 27% Dukes A stage (19% Dukes D) without screening. As regards the lung cancer screening programs, these are controversial, due to high costs and no evident influence on mortality rates. The mortality rate for Vienna is about 20% above the Austrian average. In women the discrepancy between the capital and the federal countries is especially high, as in Vienna 44% more women die on lung cancer as compared to the Austrian average. Some promising results in the treatment of lung cancer, especially in small cell carcinoma and combined treatment by chemo- and radiotherapy might justify a screening program for lung cancer. The highest increase of mortality in lung cancer is found in patients at the age of 75 and older. Those patients, however, suffer from other diseases too, therefore "screening programs for polymorbidity" should be discussed.

Adult↗

PubMedDate not supplied

Screening for cancer of the cervix uteri.

Cervical cancer is the second most common cancer in women worldwide. The majority of cervical cancers are squamous cell carcinomas. Pap smears for early detection of precursor lesions of cervical cancer have been available for 40 years. A clinical trial to evaluate Pap smears was never undertaken; however, evidence gradually accumulated from time trend analyses and from cohort and case-control studies showed the incidence and mortality of cervical cancer to be reduced by organized screening programs. The risk of cervical cancer following different screening histories was estimated in a recent study of the International Agency for Research on Cancer. Screening with 1-year and 3-year intervals was estimated to reduce the incidence of squamous cervical cancer by 94% and 91%, respectively. Cervical cancer is rare in young women, and little was estimated to be gained from including women below the age of 25 years in organized screening programs. The age distribution of cervical cancer has changed; a substantial proportion of cases now occur in the older generations of women, who have never been offered organized screening. Computerized pathology registration systems may serve as a tool for integration of the total smear-taking activity and, thus, ensure that a high percentage of women are screened regularly at minimized costs. The planning of a screening program should include both the smear-taking activity and the treatment.

Carcinoma, Squamous Cell↗

PubMed2003

Is large-scale community memory screening feasible? Experience from a regional memory-screening day.

OBJECTIVES: To investigate whether a large-scale memory-screening program for community-dwelling elders would be successful in identifying individuals with a high probability of dementia in need of further assessment that would result in the earlier diagnosis of dementia. DESIGN: A descriptive study of experience with a volunteer sample. SETTING: Ten sites (e.g., senior centers, churches, clinics) throughout New England on October 29, 1999. PARTICIPANTS: Trained volunteer clinicians evaluated 497 community-dwelling individuals on the screening day. An additional 162 subjects who could not be accommodated on that day were subsequently screened at local sites by appointment during the following month. MEASUREMENTS: Subjects participated in a standardized format consisting of an educational lecture, followed by individual screenings with the 7-minute screen (7MS) with locally trained staff. Subjects were informed immediately of test results and counseled regarding follow-up options. A survey was conducted with these subjects and their primary care physicians over the following year. RESULTS: Because the groups tested at different times were not statistically different in terms of demographics, they were combined in the analysis. One hundred ten (16.7% of all screened) individuals received high/retest scores on the 7MS. They were advised to seek diagnostic evaluation and encouraged to have results sent to their primary care physicians (PCPs). Of those followed up, 64% reported that they followed up the screening results with their PCP. More than one-third (38%) of participants with a high/retest score on the 7MS had inconclusive findings on follow-up or were awaiting further diagnostic evaluation. Of those for whom follow-up data were available, 10 (9%) were diagnosed with probable Alzheimer's disease (AD), and an additional nine (8%) who had previous diagnoses of AD were correctly identified by the 7MS. Anecdotally, feedback from participants indicated a high level of satisfaction with the process. Participants reported that the educational talk and the possibility of early detection were the most helpful components of the screening program. Moreover, most individuals surveyed in follow-up would recommend the program to a friend or family member. CONCLUSION: A follow-up survey of participants and their physicians supported the conclusion that a community memory-screening program might detect individuals who were previously unknown to have cognitive problems. Furthermore, such a program was highly acceptable to participants. The small number of individuals diagnosed with dementia as a result of the screening program indicates that this form of screening may be inefficient as performed. Multiple obstacles to seeking follow-up care were identified and would need to be addressed in larger-scale programs to make this a worthwhile endeavor. The experience gained in this memory screening program might aid in the planning of better programs, which will be essential if early diagnosis is to keep pace with the growth of treatments for dementia.

Aged↗

PubMed2003

Cost-efficient vision screening for astigmatism in native american preschool children.

PURPOSE: To design and test a cost-efficient, community-based vision screening program for a population of Native American preschool children in which there is a high prevalence of astigmatism. METHODS: Based on analysis of vision screening and eye examination data from a preschool population with a 33% prevalence of astigmatism, comparative costs to conduct a 1000-child screening program with a target sensitivity of 90% were estimated for photoscreening, noncycloplegic autorefraction, autokeratometry, and Lea symbols distance visual acuity testing. Results of the cost analysis and examination of sensitivity and specificity data from the preschool population led to development of a hybrid screening program of autokeratometry and visual acuity screening with referral thresholds of 2.25 D of corneal astigmatism or inability to read a 20/63 Lea symbols line on two separate attempts. The screening program was prospectively implemented in a community-based screening of a similar cohort of 167 children, and its efficiency was evaluated by comparison to results of cycloplegic refraction. RESULTS: The community-based screening showed 96.8% sensitivity and 79.2% specificity for detecting the presence of refractive astigmatism of 1.50 D or more. CONCLUSIONS: Referring children who have at least 2.25 D of corneal astigmatism or acuity worse than 20/63 on two attempts, provides the high sensitivity and specificity associated with automated keratometry while maintaining an acuity component that can detect other causes of reduced acuity in the absence of astigmatism.

Astigmatism↗

PubMed2001

Survey of pediatrician practices in retrieving statewide authorized newborn screening results.

OBJECTIVE: Mandated state newborn screening programs for the approximately 4 million infants born each year in the United States involves the following 5 components: 1) initial screening, 2) immediate follow-up testing of the screen-positive newborn, 3) diagnosis confirmation (true positive versus false positive), 4) immediate and long-term care, and 5) evaluation of all of the components of the system, including process and outcomes measures. Smooth functioning of this system requires pretest education of the parents as well as education and involvement of all health care providers who interact with the newborn screening system. Although extensive literature is available concerning public health aspects, technical standards/protocols, and discussion of the interfaces among the 5 components of the system, little information is available regarding physician awareness, involvement, and interactions with the system. The objective of this study was to determine, through a survey, primary care pediatricians' satisfaction with their state's newborn screening program. This was reflected in survey questions that asked how pediatricians were notified of the results of newborn screening tests that were performed on infants in their practice. METHODS: Two thousand questionnaires were sent to primary care pediatricians in all 50 states and the District of Columbia regarding their practices in retrieving statewide newborn screening results. Of the 2000 surveys, 574 (29%) responses from primary care pediatricians who care for at least 1 to 5 newborns each week form the basis of this report. Also reported are the commentaries of the physicians concerning their specific practices, overall assessment of the system, and ideas for improvement. RESULTS: Physicians reported their general satisfaction with the newborn screening system's ability to retrieve screen-positive infants for follow-up testing. However, communication and partnership with the primary care pediatrician regarding accessibility and timely retrieval of newborn screening test results was deemed less than optimal. Thirty-one percent of respondents indicated that notification for screen-positive test results was greater than 10 days, whereas 26% indicated that they do not receive the results of screen-negative tests and need to develop office procedures (contact birth hospital or state laboratory) to obtain results. Twenty-eight percent indicated that they do not actively seek results of newborn screening for their patients and presume that "no news is good news." Barriers to retrieving test results included that infants were born at hospitals where the physician does not have privileges, there were new transfers to the practice, infants were born in other states, personnel time was needed to track results, and there was a lack of a cohesive communication/reporting system that includes the primary care physician as an integral partner in the newborn screening communication process. Ninety-two percent of physicians would welcome an enhanced state system with direct communication to the primary care pediatrician as well as the birth hospital. CONCLUSION: Pediatricians recognize and endorse the benefits of newborn screening and believe that they play an important role in the efficient functioning of the system. An enhanced physician partnership with the newborn screening program will enable the timely follow-up of the screen-positive newborn for confirmatory testing. All test results need to be communicated to the pediatrician in a timely and efficient manner: 7 days for screen-positive results and 10 to 14 days for all results. Newborn screening test results of new patients who enter the practice should be available at the time of the first well-infant visit, ideally by 2 weeks of age. The majority of primary care pediatricians acknowledge the need to establish office protocols for the retrieval of newborn screening test results and would welcome an enhanced direct communication system with the state newborn screening program.

Attitude of Health Personnel↗

PubMed2002

Intimate partner violence from the emergency medicine perspective.

BACKGROUND: The incidence of acute cases of intimate partner violence (IPV) in the Emergency Department (ED) patients is between 2 and 7.2%. Ongoing IPV may be an immediate cause of presentation for medical care, or it may not be readily apparent. Over the last two decades efforts to improve identification of IPV in the ED have been successful. METHODS: A medline literature search from 1981-2001 was performed. A review of intimate partner violence from the emergency department provider perspective is performed. A discussion of the screening/detection of intimate partner violence and the barriers to improving detection rates is provided. RESULTS: The review of the current literature shows that IPV is a frequent cause of illness or injury in patients presenting in the ED. Screening programs for intimate partner violence have shown to increase the identification of patients experiencing acute episodes of abuse and seeking treatment. The difficulty has been in sustaining the programs and improving the screening of patients. Patient, provider and systems barriers prevent adequate recognition and management of the problem. CONCLUSION: Detection of IPV in patients presenting to the ED can be improved by providing educational programs and screening tools to health care providers. Sustaining the screening programs is more difficult and requires a health care system-wide effort.

Emergency Medicine↗

PubMed1997

Promotion of breast cancer screening in communities: a research agenda.

This paper used the National Cancer Institute of Canada (NCIC) cancer control framework to review research on participation in breast cancer screening programs and identify areas for further study. Cancer Lit, MEDLINE, CINAHL, Sociofile, Health and the Public Affairs Information Service databases were searched for literature published from 1990 to 1995. Information was also obtained from provincial breast cancer screening programs and Health Canada. Interventions designed to promote participation in screening programs have not been effective. Involvement of the target community, however, increased success and sustainability. Barriers to initial participation within screening programs include alternative sources of screening and the lack of funds to screen all eligible women. Studies show that participation decreases with successive screening rounds. The priorities for study are development of: a theoretical framework for recruitment strategies, a method to capture all Canadian screening results including those performed through provincial health insurance plans and a mechanism to deliver screening to all eligible Canadian women.

Academies and Institutes↗

PubMed2001

Complete diagnostic evaluation in colorectal cancer screening: research design and baseline findings.

BACKGROUND: While indicated by guidelines, complete diagnostic evaluation, or CDE (i.e., colonoscopy or combined flexible sigmoidoscopy plus barium enema X ray), is often not recommended and performed for persons with an abnormal screening fecal occult blood test (FOBT) result. We initiated a randomized trial to assess the impact of a physician-oriented intervention on CDE rates in primary care practices. METHODS: In 1998, we identified 1,184 primary care physicians (PCPs) in 584 practices whose patients received FOBTs that are mailed annually by a managed care organization screening program. A total of 470 PCPs in 318 practices completed a baseline survey. Practices were randomly assigned either to a Control Group (N = 198) or to an Intervention Group (N = 120). Control Group practices received the screening program. Intervention Group practices received the screening program and the intervention (i.e., CDE reminder-feedback plus educational outreach). Practice CDE recommendation and performance rates are the primary outcomes to be measured in the study. RESULTS: Baseline CDE recommendation and performance rates were low and were comparable in Control and Intervention Group practices (54 to 57% and 39 to 40%, respectively). PCPs in the practices tended to view FOBT screening and CDE favorably, but had concerns about screening efficacy, time involved in CDE, and patient discomfort and adherence. Control Group physicians were more likely than Intervention Group physicians to believe that a mail-out FOBT screening program helps in the practice of medicine. CONCLUSIONS: We were able to enroll a high proportion of targeted primary care practices, measure practice characteristics and CDE rates at baseline, and develop and implement the intervention. Study outcome analyses will take into account baseline differences in practice characteristics.

Analysis of Variance↗

PubMedDate not supplied

National registry of cervical cytologic diagnoses in The Netherlands.

The national cervical cytology registry being developed in the Netherlands is described. A large-scale screening program for cervical cancer has been in effect since 1975 in the region of the cities of Nijmegen, Utrecht and Rotterdam. At the start of the pilot projects, laboratories agreed upon a uniform protocol for reporting cytologic findings and recommendations for follow-up examinations in cases of abnormalities. Based on the results of the three pilot projects, in 1985 the Dutch government decided to organize a nationwide screening program for cervical cancer. All pathology laboratories involved in this national screening program are using the same screening protocol and the same coding system for cytologic and histologic diagnoses. By the end of 1989, all pathology laboratories will be linked to a central pathology diagnosis data base (PALGA). Linkage of screening results to previous and follow-up cytologic and histologic findings will enable epidemiologic studies on a regional or national level. Each physician who has submitted specimens will, next to the cytology reports, periodically receive reviews of the number of smears submitted, the cellular composition (quality) of those smears and the follow-up findings. The execution of requests for follow-up examination will be supervised by the participating pathology laboratories. The national cervical cytology registry will enable registration of all relevant cytologic and histologic diagnoses in a uniform way, but will also establish a unique high-quality national data bank, which will be of great value in the analysis of the effectiveness of the national screening program for cervical cancer. It will enable measurement of the impact of various screening protocols and give insight into the behavior of cervical cancer and the progressive or regressive character of its early stages. It will also offer the opportunity to initiate and evaluate quality control protocols.

Cervix Uteri↗

PubMed2005

[Cost-effectiveness of screening for amblyopia].

BACKGROUND: The effectiveness of a screening program for amblyopia has been discussed controversely for several years. While the medical profit is obvious, little is known on the cost-effectiveness of such a screening program. METHODS: By literature research all important variables were determined: incidence of amblyopia, sensitivity of different screening modalities, effectiveness of therapy, costs as well as the loss of utility and life quality by an existing amblyopia. Based on those data in a simple model the costs of a screening program for amblyopia were determined per quality adjusted life year (QALY). The result was analyzed for its stability by sensitivity analysis and compared to the costs of other therapies. RESULTS: Amblyopia occurs with an incidence of approximately 2 % (1.3 - 12 %). Most Screening programs reach a sensitivity of 60 - 90 % and cause costs of 900 - 1400 Euro per detected case. By appropriate therapy with mean costs of 2300 Euro approx. 60 % of the cases obtain useful vision of > 20/40. However, therapy results vary considerably. After discounting the incremental cost-effectiveness ratio (ICER) reaches 7684 Euro/QALY for a screening and treatment program for amblyopia. This is well comparable with other therapies and accepted to be cost-efficient. Sensitivity analysis yielded 24 700 Euro/QALY and 57,633 Euro/QAL with higher discounting for worst case scenarios. CONCLUSION: Screening for amblyopia meets the basic requirements of cost-effectiveness.

Amblyopia↗

PubMed1999

[Pilot study on early diagnosis of renal cell carcinoma by sonography].

UNLABELLED: The goal of this study was to investigate the practicability and effectiveness of a systematic screening for renal cell carcinoma by ultrasound in the course of the established German Health Ministry screening programs. METHODS: In two centers (Mainz and Wuppertal) a screening program for renal cell carcinoma for all citizens (age > 40 years) was established. The screening was divided into two phases (time period 1 year): (1) All citizens over 40 years could attend voluntarily a cost-free ultrasound investigation. (2) A follow-up investigation for the entire screening population was provided. RESULTS: Ten thousand volunteers attended the screening program. Mean age was 60 years. Thirteen renal cell carcinomas were detected. The incidence of other findings was 15%; none of those required further treatment. CONCLUSION: Systematic screening for renal cell carcinoma by ultrasound is cost-effective and showed high acceptance and practicability in a German population. The rate of detection of renal cell carcinoma was higher than initially statistically calculated.

Aged↗

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