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PubMed1978

[Biological method of identifying antibiotic substances at an early screening stage].

A biological method was used in addition to the chemical methods of identification in the screening programme of new antibiotics. The method consists of evaluation of the effect of the crude antibiotic preparations on microbial forms resistant to various antibiotics. The efficiency of the biological method is shown. It provides more complete and rapid characterization of the properties of the new antibiotics and their rough identification at early screening stages.

Anti-Bacterial Agents↗

PubMed1991

Early screening and treatment of "silent" patent ductus arteriosus in prematures with RDS.

From January 1987 to December 1989, prematures with RDS weighing 1750 g or less admitted to the Neonatal Intensive Care Unite (NICU) were submitted from the third postnatal day to serial two-dimensional and pulsed Doppler (ATL MK 600) echocardiographic evaluation for "silent" patent ductus arteriosus (PDA). PDA was diagnosed in 36/175 prematures with RDS (20.5%). Thirty patients had indomethacin treatment and the PDA closed completely in 27 (90%); five needed a second course of indomethacin, that was effective in two (40%). Four RDS patients (4/36-11%) already weaned from the respirator, needed supplemental oxygen. The three non-responders and six other prematures with counterindications to the drug underwent surgical ligation (25%). As historical control, we retrospectively evaluated the population of preterm infants with RDS weighing less than or equal to 1750 g treated for hemodynamically significant PDA during three previous years before the screening protocol; in this group the echocardiographic and Doppler evaluations were done when congestive heart failure and pulmonary edema were clinically evident. In comparison, we found a reduced incidence of prematures with RDS treated for PDA, 7/120 (5.8%) a higher age at medical treatment (9 +/- 1.4 vs 4.4 - 2.3 days) and a larger prevalence of patients underwent ductal ligation (71.4%). These data show that early screening and treatment of "silent" PDA may result advantageous to improve the efficacy (90%) of indomethacin, in a critical time for the recovery of RDS, and furthermore decreasing the need of surgical ligation.

Birth Weight↗

PubMed1982

Real-time ultrasonography for determination of ovarian morphology and volume. A possible early screening test for ovarian cancer?

The accuracy with which ovarian morphology and size can be determined by a real-time, ultrasound mechanical sector scanner was assessed. Both ovaries of 11 climacteric women appeared morphologically normal by ultrasonography and these findings were confirmed at laparotomy the following day. The correlation coefficient between ovarian volumes determined by sonar and those obtained by direct measurement at operation was 0.97. In a series of 31 postmenopausal women in whom clinical examination was unremarkable, both ovaries were identified by sonar in 26 subjects (84%) and a cystic ovary was diagnosed in 1 patient. Ovarian morphology in the other 25 subjects appeared normal and the range of volumes was from 1.47 to 10.43 cm3 with an arithmetic mean of 4.33 cm2 +/- 1.91 (SD). The mean difference between the volumes of the right and left ovaries was 1.48 cm3 +/- 1.19 and the percentage mean difference was 42.88% +/- 32.05. An ovary with a volume more than twice the size of its fellow should be regarded with some suspicion because ovarian volumes within individuals are clearly related (correlation coefficient = 0.82). The potential of the technique as a screening test for the early detection of ovarian cancer warrants further evaluation.

Climacteric↗

PubMed1999

Screening early renal failure: cut-off values for serum creatinine as an indicator of renal impairment.

BACKGROUND: The aim of this study was to define cut-off values for serum creatinine as an indicator of several levels of renal impairment. METHODS: To identify the suitable values, receiver operating characteristic curves were constructed based on the data of 984 laboratory assessments of renal function. The glomerular filtration rate was measured with inulin clearance. Three levels of renal impairment were analyzed. An index that gave the same weight to false positive and false negative results was used to determine the thresholds. Robustness of the results was tested using a "bootstrap" technique. RESULTS: Considering an inulin clearance of less than 80 ml/min/1.73 m2, the cut-off value for serum creatinine was 11.5 mumol/liter for men and 90 mumol/liter for women. The cut-off value for a clearance of less than 60 ml/min/1.73 m2 was 137 mumol/liter for men and 104 mumol/liter for women. For a clearance of less than 30 ml/min/1.73 m2, the cut-off value was 177 mumol/liter for men and 146 mumol/liter for women. CONCLUSION: This method is useful to determine a cut-off value for serum creatinine in epidemiological studies concerning early chronic renal failure screening. The value of the glomerular filtration rate of reference and the weight of false positive and false negative results have to be adapted to the aim of the individual study design.

Adult↗

PubMed1995

Screening, Early Detection, and Early Intervention Strategies for Lung Cancer.

Screening for lung cancer has been utilized for several decades without demonstrating overall survival benefit. However, recent advances in treatment of lung cancer, improvements in our biologic understanding of lung cancer development, and an increasing population of healthy ex-smokers provide cause for optimism. Several chemoprevention trials suggest that it may be possible to intervene in the oncologic process prior to the development of invasive malignancy, resulting in a delay or reversal of these changes.

Journal Article↗

PubMed2000

Early screening for fetal cardiac anomalies by transvaginal echocardiography in an unselected population: the role of operator experience.

OBJECTIVES: To examine the accuracy of early transvaginal fetal echocardiography performed in an unselected population by operators with different levels of experience and to compare the results with those obtained from a referral population. DESIGN: Prospective study. METHODS: A series of 4785 unselected fetuses and 221 referred fetuses were screened at 13-15 weeks' gestational age by transvaginal echocardiography. For each fetus, visualization of the four-chamber view plus the origin of the great arteries was attempted. Color Doppler imaging was only performed in cases of cardiac malformations already identified by two-dimensional echocardiography. The scans were performed by seven operators with different levels of experience. Reliability was assessed by conventional transabdominal echocardiography at 20-22 weeks, by postnatal follow-up in the first 3 months of life, and/or by autopsy in all cases of termination or fetal death. RESULTS: The rate of complete visualization (four-chamber view plus great arteries) was 47.5% in the unselected population, and 76.9% in the referral population. There were four (0.08%) true positives among the unselected fetuses, and five (2.3%) among referrals, mostly with enlarged nuchal translucency or other malformations. Among the unselected fetuses, nine false negatives were detected by transabdominal echocardiography. Improvement in the operators' ability to recognize cardiac anomalies in unselected population was disappointing and was influenced more by individual approach than by the number of examinations performed. CONCLUSIONS: Early screening for cardiac anomalies among unselected fetuses is ill-advisable. The usefulness of an early approach is confirmed in high risk fetuses or in the presence of enlarged nuchal translucency when performed by expert operators.

Adult↗

PubMed2005

Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients.

BACKGROUND: About 25-40% of hospital patients are malnourished. With current clinical practices, only 50% of malnourished patients are identified by the medical and nursing staff. OBJECTIVE: The objective of this study was to report the cost and effectiveness of early recognition and treatment of malnourished hospital patients with the use of the Short Nutritional Assessment Questionnaire (SNAQ). DESIGN: The intervention group consisted of 297 patients who were admitted to 2 mixed medical and surgical wards and who received both malnutrition screening at admission and standardized nutritional care. The control group consisted of a comparable group of 291 patients who received the usual hospital clinical care. Outcome measures were weight change, use of supplemental drinks, use of tube feeding, use of parenteral nutrition and in-between meals, number of consultations by the hospital dietitian, and length of hospital stay. RESULTS: The recognition of malnutrition improved from 50% to 80% with the use of the SNAQ malnutrition screening tool during admission to the hospital. The standardized nutritional care protocol added approximately 600 kcal and 12 g protein to the daily intake of malnourished patients. Early screening and treatment of malnourished patients reduced the length of hospital stay in malnourished patients with low handgrip strength (ie, frail patients). To shorten the mean length of hospital stay by 1 d for all malnourished patients, a mean investment of 76 euros (91 US dollars) in nutritional screening and treatment was needed. The incremental costs were comparably low in the whole group and in the subgroup of malnourished patients with low handgrip strength. CONCLUSIONS: Screening with the SNAQ and early standardized nutritional care improves the recognition of malnourished patients and provides the opportunity to start treatment at an early stage of hospitalization. The additional costs of early nutritional care are low, especially in frail malnourished patients.

Body Mass Index↗

PubMed1999

Screening, early identification, and office-based intervention with children and youth living in substance-abusing families.

All health care professionals with clinical responsibility for the care of children and adolescents must be able to recognize, as early as possible, associated health problems or concerns in children of substance-abusing parents, and to be able to assist these children and families in seeking treatment and promoting health. Health care providers can have a tremendous influence on families of substance-abusing parents because of their understanding of family dynamics and their close long-standing relationship with the family. Information about family alcohol and other drug use should be obtained as part of routine history-taking and when there are indications of family dysfunction, child behavior or emotional problems, school difficulties, and recurring episodes of apparent accidental trauma, and in the setting of recurrent or multiple vague somatic complaints by the child or adolescent. In many instances, family problems with alcohol or drug use are not blatant; rather, their identification requires a deliberate and skilled screening effort. Combining the principles of anticipatory guidance, screening, and early identification, with the acknowledgment that families should be included in the process, leads to a clear conclusion that screening for children affected by parental substance abuse must occur at all ages across infancy, childhood, and adolescence. Health care providers need to be trained in the identification and management of children and youth exposed to parental addiction. Such training must begin during undergraduate education in the health professions and be reinforced by role-modeling among health professions faculty as well as practicing providers.

Adolescent↗

PubMed2005

Beyond newborn screening: early diagnosis and management of hearing loss in infants.

As a result of the 1993 National Institutes of Health Consensus Statement recommending hearing screening for all infants before discharge from the newborn nursery, there are an increasing number of newborns identified with hearing impairment requiring follow-up services. Research has shown that hearing-impaired infants who receive intervention by the time they are 6 months adjusted gestational age are likely to develop language that is equal to their normal-hearing peers. Newborn hearing screening will not attain its goal of early intervention for hearing loss unless a comprehensive follow-up program is in place. The neonatal nurse plays an important role in the follow-up program by providing information to parents and stressing the importance of follow-up. Follow-up for infants identified through the screening process includes rescreening within 4 to 6 weeks of discharge and a full diagnostic evaluation for infants who fail the rescreening. The diagnostic evaluation includes Auditory Brainstem Response (ABR), Otoacoustic Emissions (OAE), and middle ear assessment. The course of treatment or therapy and the type of amplification chosen for hearing-impaired infants depends on the type and degree of hearing loss as well as the communication mode chosen by the family. The ultimate goal of early audiological diagnosis of hearing loss is to begin treatment as soon as possible to minimize delays in speech/language and academic development. This article focuses on what needs to happen after newborn hearing screening to ensure early and optimal intervention for hearing-impaired infants.

Hearing Loss↗

PubMed2002

[Measurement of evoked acoustic otoemissions: an early screening test of neonatal deafness].

Every child born with deafness displays a pathological language development. An early and specific approach is mandatory, hence requiring an universal hearing screening. Available evidence indicate that performing acoustic otoemissions prior to six months of age is the most reliable method. The recording of the AOE is performed successfully from the 30th week of conceptual age. To obtain AOE in the newborn, one needs to wait until the 3rd day post delivery in 98% of cases. The reliability of the test, the socio-economical cost, the consequences of the screening and the role of the family have to be discussed.

Deafness↗

PubMed2006

Early screening for autism spectrum disorders: update on the modified checklist for autism in toddlers and other measures.

Early intervention for autism spectrum disorders necessitates early detection. This need has led to widespread agreement across disciplines that screening is critical in very young children. Two screening issues are highlighted in this review. Level of screening refers to the type of sample: Level I is defined as an unselected sample, and Level II consists of selected children already identified as being at risk for a developmental disorder. Breadth or scope of screening refers to the range of difficulties the screening tool attempts to identify: broad screening instruments identify multiple range of developmental difficulties, whereas disorder-specific tools focus on a single disorder or class of disorders. Broad developmental instruments reviewed include the Parents' Evaluation of Developmental Status and the Ages and Stages Questionnaires; autism-specific tools reviewed include the Checklist for Autism in Toddlers, the Modified Checklist for Autism in Toddlers (M-CHAT), the Pervasive Developmental Disorders Screening Test, Second Edition, and the Screening Tool for Autism in Two-year-olds. The development of the M-CHAT, a Level I and Level II screening instrument, is described, and current research and clinical use of the M-CHAT are reviewed, including description of the structured follow-up interview which reduces the false-positive rate of the parent-report M-CHAT.

Autistic Disorder↗

PubMed1976

Ultrasound and human-placental-lactogen screening early detection of twin pregnancies.

In the past five years gradual introduction of ultrasonic screening of pregnant women increased the ante-partum detection of multiple pregnancy from 60% in 1971 to 95% in the first half of 1975. At the same time the average gestational age for dection of multiple pregnancies diminished from thirty-three to twenty-five weeks. The corresponding figures for 1963 were 32% and thirty-six weeks. Plasma human-placental-lactogen concentrations were assessed for their value in selecting a smaller target group for subsequent ultrasonic screening. All but 2 of 39 twin pregnancies examined by single H.P.L. determinations had H.P.L. values more than 1 S.D. above the mean of the normal distribution. The use of plasma-H.P.L. screening might lower the proportion of patients requiring ultrasonography for antepartum diagnosis of multiple pregnancies to 16% of the total pregnant population.

Evaluation Studies as Topic↗

PubMed1992

Early screening for orthodontic treatment. Differences in assessments made by a consultant orthodontist and three public health dentists.

The aim of the present study was to compare the differences in the assessments of occlusal and functional features, the need for and timing of orthodontic treatment and the complexity of treatment made by a consultant orthodontist and three public health dentists. The data comprised the examinations of 260 children aged 7-8 yr (87% of total age group of the community) attending the first grade of primary school in a medium-sized town in eastern Finland. The examinations were carried out according to agreed criteria. The main indications for treatment were Class II malocclusion, lateral crossbite and crowding. When assessing treatment need, agreement between the orthodontist and the three dentists was fairly good (agreement in 69%, Kappa statistic 0.51), sensitivity for each dentist ranged from 0.86 to 0.97 and specificity from 0.72 to 0.92. The agreement on the timing of treatment was poor (agreement in 49%, Kappa statistic 0.18). In most cases of disagreement, the dentists would begin the treatment earlier than the orthodontist. The agreement on the complexity of treatment was rather poor (agreement in 61%, Kappa statistic 0.22). In most cases of disagreement, the treatment was regarded as more complex by the orthodontist than by the dentists. When dentists work with a consultant orthodontist, it seems justified to have the dentist screen the children at the age of 7-8 yr for early orthodontic treatment, but the orthodontist should assess the timing and complexity of treatment.

Child↗

PubMed2004

Current status of PSA screening. Early detection of prostate cancer.

OBJECTIVE: To update current evidence for prostate-specific antigen (PSA) screening for prostate cancer and to give readers some practical information to discuss with patients. QUALITY OF EVIDENCE A MEDLINE: search revealed only three randomized studies, two of which are incomplete. Several controlled non-randomized studies were found. MAIN MESSAGE: Two ongoing studies have not yet reported survival data, but have added to evidence for screening intervals. One Canadian randomized study has been criticized for its design and conclusions. Non-randomized studies suggest that screening effectively identifies serious cancers and leads to earlier diagnosis. Mortality from prostate cancer has been falling in most western countries since 1992. This cannot be explained by PSA screening, which would probably not produce survival benefit until at least 10 years after its unofficial introduction in about 1990. CONCLUSION: Indirect evidence suggests that all men older than 45 with at least a 10-year life expectancy should be informed of the potential benefits and drawbacks of PSA screening so they can make an informed decision on whether to have the test.

Aged↗

PubMed1991

Congenital heart disease in Down's syndrome: two year prospective early screening study.

OBJECTIVE: To determine the effectiveness of clinical examination, chest radiography, and electrocardiography compared with echocardiography in detecting congenital heart disease early in the life of children with Down's syndrome. DESIGN: Prospective two year screening survey. SETTING: Regional paediatric cardiology service, Northern Ireland. PATIENTS: 81 newborn infants with Down's syndrome born in Northern Ireland between November 1987 and November 1989. INTERVENTIONS: Clinical examination, chest radiography, and electrocardiography soon after birth followed by cross sectional Doppler echocardiography. MAIN OUTCOME MEASURES: Diagnostic ability of clinical examination, radiography, and electrocardiography compared with echocardiographic findings. RESULTS: 34 babies had congenital heart disease detected by echocardiography (13 had atrioventricular septal defects, seven secundum atrial septal defects, six a solitary patent ductus arteriosus, five isolated ventricular septal defects, and three combinations of heart defects). Individual examination methods were insensitive (the sensitivity of clinical examination was 0.53, of radiography 0.44, and of electrocardiography 0.41) but highly specific (the specificity of clinical examination was 0.94, of radiography 0.98, and of electrocardiography 1.0), although sensitivity improved when the three techniques were combined (the sensitivity was 0.71, the specificity 0.91). CONCLUSION: Echocardiography performed early in life can detect congenital heart disease that might otherwise be missed. Early detection may help prevent complications such as pulmonary vascular disease that may adversely affect the outcome of cardiac surgery.

Down Syndrome↗

PubMed1987

[Early screening of cancer of the stomach in Japan].

Gastric cancer is the most frequent malignant tumor reported in Japan, and increasing effort is being directed towards its early diagnosis. Radiographic imaging is considered to be the main exploratory investigation for screening of this cancer, fibroscopy being reserved for cases with suspected lesions on radiology. In the series studied, 40% of cases of gastric cancer were diagnosed at an early stage, a non-negligible result when one considers that the 5-year survival rate is better than 95% at this stage.

Adult↗

PubMed2005

Can teachers' behavior ratings be used to screen early adolescent boys for psychiatric diagnoses?

The present study examined if a short, 22-item teacher rating questionnaire could be used to screen young adolescent boys for psychiatric diagnoses. Subjects were 239 12-year-old boys from a community sample of low socioeconomic status families. Child and parent versions of the Diagnostic Interview Schedule for Children were used to provide DSM-III-R diagnoses. Results show a low to moderate screening value for the Short Social Behavior Questionnaire (S-SBQ) scales, with best results for externalizing disorders. The method used to establish the diagnoses had an impact on the screening efficacy of the S-SBQ, higher prevalence rates resulting in a lower proportion of false-positives for the same cutoff point. Additional research is needed to assess the screening efficacy of the S-SBQ across ages and gender, but results suggest that teacher ratings with the S-SBQ could be used to screen boys with externalizing disorders at the end of elementary school.

Child↗

PubMed1995

Screening, early detection, and treatment of prostate cancer: a European view.

Powerful tests are now available for the detection of prostate cancer, both more frequently and at an earlier and usually more curable stage. In some countries of the world, mainly the United States and some European countries, serum prostate-specific antigen (PSA) and rectal examination-based screening is routinely applied to men at risk. In other countries, particularly in Northern Europe, routine application of screening procedures for prostate cancer is not accepted for a number of reasons: knowledge about the natural history of early lesions suggests that indiscriminate use of these tests will lead to overdiagnosis and overtreatment, information on the effectiveness of treatment from randomized trials is unavailable, and no evidence exists that early diagnosis and treatment will lead to an improvement of disease-related and overall mortality. In this article a number of critical and controversial issues of screening for prostate cancer are reviewed. This includes the risk of prostate cancer to patients, the efficacy and acceptability of the screening tests, the issue of overdiagnosis in relation to the natural history, evidence concerning the effectiveness of treatment, and the chances that early treatment may lead to an improvement of prostate cancer mortality. In relation to these points it is concluded that prostate cancer is a frequent cause of death in men and that at present the possibility of early diagnosis and treatment represents the only possibility of cure. The question whether cure is necessary in every identified case or in identifiable subgroups remains unanswered at this time. Although the individual positive predictive value of the screening tests is low, a combination offers higher positive predictive values that are in the range of 70-80%. With proper streamlining of the screening tests, it may be possible in the future to detect one cancer in 2.5-3.0 biopsies. The most efficient use of the screening tests in the general population still remains to be determined. Estimates related to the amount of overdiagnosis are made. Depending on the definition used, overdiagnosis with one round of screening for prostate cancer is probably in the range two- to threefold. The effectiveness of available treatment modalities compared with delayed management has not been studied in a prospective randomized manner. There is, however, indirect evidence, especially relating to the long-term survival of grade 3 patients and to the long-term normalization of serum PSA values after radical prostatectomy, that at least this treatment is effective.(ABSTRACT TRUNCATED AT 400 WORDS)

Europe↗