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PubMedDate not supplied

[Has the role of radiology changed in the fight against pulmonary tuberculosis?].

Tuberculosis is on the increase in Italy as in other industrial countries. The key to tuberculosis control is case finding and radiology plays a major role in both active and passive tuberculosis diagnosis. Have recent advances in radiologic techniques increased the value of conventional radiology? Has the role of chest radiography changed in tuberculosis screening? To answer these questions we examined a population referred to our hospital for both screening and diagnostic purposes over a 12-month period. In a population of 31,730 inhabitants, 1,461 chest radiographs were performed, 226 (15.4%) for passive and the others for active case finding. As for active case finding, high-risk patients were screened (21 immigrants and 296 aging people), together with the general population believed to be at risk according to current national recommendations (918 chest films). While screening allowed the diagnosis of only one tuberculosis case in the high-risk group, 3 cases were found in the symptomatic group with the passive protocol. In our experience, new radiologic techniques have not made the diagnosis of tuberculosis easier. Unlike in cancers, CT was not particularly useful in identifying symptomatic tuberculosis cases. In our experience, screening yielded poor results: in fact, this attempt at preventing tuberculosis caused an unreasonable waste of time and money because when screening low-risk groups many films are needed to diagnose a single case. Thus, the reason for this failure was not a technical one. It proved to be a problem of selecting the population to be screened. Our results suggest that no major change has taken place in the role of conventional radiology in passive tuberculosis case finding and that radiology must be used differently in passive case finding, that is, for screening purposes in high-risk groups only.

Adult↗

PubMed1996

[Quality and homogeneity monitoring of radiologists in the Turin mammographic screening. Comparison of the pilot phase results].

The Turin mammographic screening program was designed to be carried out in several independent screening centers because of the large proportion of population involved (76,000 women aged 50 to 59 years). The first center began working in 1992 and the second center was opened in 1995. The latter center carried out an early pilot study in which 1024 women were examined to assess the homogeneity and the quality of the results. The results were then compared with European quality standards and with the results of both the pilot and the active screening periods in the first center. The results from the second center were very good as far as detection rate is concerned (7.8/1000-2.9/1000 in carcinoma < or = 1 cm). This rate is higher than the so-called "desirable" European standard. Recall rate and benign/malignant biopsy ratio were higher than the so-called "fair" European standard (recall rate: 7.1%; B/M biopsy ratio: 0.62). These results are slightly superior to those of the pilot period in the first center and slightly inferior to the results of active screening in the same center. The improvement relative to the pilot period in the first center (1991) is probably related to technical progress, such as the introduction of the double mammographic projection. The difference relative to the results from the active screening period in the first center (1992-1994) reflects different specific experience. Even though pilot periods have no statistical significance, they can be used for comparison, and in our experience they have proved, with positive results, the quality of the mammographic screening program provided to the Turin population.

Female↗

PubMed2001

Application of microcolumn liquid chromatography and capillary electrophoresis with flame photometric detection for the screening of degradation products of chemical warfare agents in water and soil.

Microcolumn liquid chromatography (microLC) and capillary electrophoresis (CE) coupled on-line with flame photometric detection (FPD) have been used for the screening of polar breakdown products of chemical warfare agents in water and soil samples, provided during Official Proficiency Tests organized by the Technical Secretariat of the Organization for the Prohibition of Chemical Weapons. CE-FPD is shown to be a powerful and rapid method for the determination of alkylphosphonic acids, which are the breakdown products of organophosphorus nerve agents. Gradient elution microLC-FPD is more sensitive and robust but less rapid in the determination of these compounds. In addition, microLC-FPD can be applied to screen for hydrolysis products of sulfur mustard and its analogues. Both methods can be applied without prior derivatization and are extremely selective. In order to unambiguously identify the relevant compounds, electrospray ionization (tandem) mass spectrometry, gas chromatography-mass spectrometry and nuclear magnetic resonance spectrometry were applied.

Chemical Warfare Agents↗

PubMed1976

Mapping of several abnormal hemoglobins by horizontal polyacrylamide gel isoelectric focusing.

The relative mobilities of serveral human hemoglobin variants were studied by use of an isoelectric focusing method in a thin-layer horizontal polyacrylamide gel. The technic is described in detail and a preliminary mapping of these variants is presented. It appears that thin-layer gel isoelectric focusing is a method that is rapid, highly reproducible and easily applicable in laboratories concerned with the study of hemoglobinopathies.

Amino Acid Sequence↗

PubMed2001

Effectiveness of optometrist screening for diabetic retinopathy using slit-lamp biomicroscopy.

PURPOSE: To assess the effectiveness of optometrists as screeners for diabetic retinopathy using slit-lamp binocular indirect ophthalmoscopy through dilated pupils. METHODS: Prospective study of a screening scheme. Screening was performed by 27 locally accredited optometrists in their practice. The referral protocol used a new simple grading system of retinopathy, especially designed for use in an optometrist screening programme. All positive referrals and 10% of negative referrals were reexamined by an ophthalmologist. Sensitivity, specificity, likelihood ratios and technical failure rates were calculated. RESULTS: The optometrists screened 4904 people with diabetes in 18 months. 'Subthreshold' (screen negative) reports accounted for 4438 (90.5% of 4904); 429 (9.67%) of these were re-examined at secondary screening. There was disagreement regarding grading in 13 patients, of whom 5 (1.16% of 429) had sight-threatening retinopathy (STDR); this extrapolates to 52 patients if all the 4438 test-negatives had been examined. Of the 371 'threshold' patients, 112 (30.18%) were false positives; the commonest cause for false positive referral was drusen in patients with background diabetic retinopathy. The sensitivity for identification of STDR was 76% (95% CI 70% to 81%) and specificity 95% (95% CI 95% to 96%). The likelihood ratio of a positive test indicating STDR was 16.54 (95% CI 14.17 to 19.23) and that of a negative test 0.25 (95% CI 0.20 to 0.32). The technical failure rate was 0.2%. CONCLUSIONS: Suitably trained and accredited community optometrists performed well when screening for diabetic retinopathy using slit-lamp biomicroscopy through a dilated pupil. This was facilitated by the use of simple grading and referral criteria. The sensitivity, positive likelihood ratio and specificity were high.

Accreditation↗

PubMed1996

The reliability of the community version of the MRC Needs for Care Assessment.

One hundred and nine adults were screened in the community using the abridged version of the CIDI (CIDIS). The subjects comprised DSM-III-R current cases (N = 48), lifetime cases (N = 31) and non-cases (N = 30). The interviews with the 109 subjects were conducted by one of two pairs of clinicians and videotaped. Each interviewer-pair included a psychiatrist and a clinical psychologist. They rated the community version of the Needs for Care (NFCAS-C) by consensus. The other pair of judges then viewed the video and rated the NFCAS-C independently. The agreement on overall needs was excellent (kappa = 0.75), and very good for four of the seven specific sections (from kappa = 0.61 to 0.81). One section could not be rated because of low prevalence, and agreement was less good for the remaining two sections. Agreement was good on specific interventions (medication, kappa = 0.60; specific psychotherapy, kappa = 0.55), but poor on non-specific interventions. The majority of disagreements were due to differences in clinical judgement rather than to technical errors. A new instruction manual has been produced and should help training as well as stabilizing reliability. In devising reliable and valid instruments based on clinical judgement, a balance must be achieved between enhancing reliability with more precise rules and constraining clinical judgement so tightly that validity is lost.

Adult↗

PubMed1990

A simplified screening test for the diagnosis of allergy.

The Quidel allergy screen is a relatively rapid (less than 2 hours) multiallergen dipstick method for detecting specific immunoglobin E antibodies in serum. It was developed to answer the need of primary physician nonspecialists in allergy for a convenient in-office screening test for diagnosing allergy. The new test was evaluated against the benchmark diagnostic skin tests and the radioallergosorbent serologic tests for sensitivity, specificity, accuracy, and technical feasibility in an office setting. It was found that while the Quidel allergy screen lacks the specificity of the standard tests, its overall sensitivity, as defined by the percentage of patients with positive skin reactions who also tested positive with the Quidel screen (68%), its ease of use, and its rapidity warrant its consideration as a screening tool for confirming a possible case of allergy.

Humans↗

PubMed1984

Screening for occult faecal blood loss in a community by means of Hemoccult II slides and a tetramethylbenzidine test.

A total of 754 persons statistically selected from the age group 54-64 years were asked by letter to provide faecal samples for screening of occult blood during dietary restrictions. A total of 413 persons (55%) returned an average of 5.8 (range, 1-6) faecal samples each. All the faecal specimens were analysed with Hemoccult II slides and the 3,3',5,5'-tetramethylbenzidine (TMB) test 0.10%. For technical reasons, however, the Hemoccult test could not be evaluated. The TMB test showed faecal blood in 50 persons. A case history was obtained in 49 persons, of whom 47 agreed to further clinical, radiological, and endoscopic investigations. The most important findings in these examinations were resectable colonic carcinoma (Dukes's stage B) in 1 subject, a gastric ulcer in 1, haemorrhagic gastritis in 1, duodenal ulcers in 2, and colorectal polyps in 11 persons. The cost of the study was estimated to be NOK 114,000 (about USD 16,000).

Benzidines↗

PubMed2000

Organizational approaches to the HIV/AIDS crisis.

The Centers for Disease Control and Prevention (CDC) has played a major role in controlling the HIV/AIDS epidemic in the United States. After implementation of perinatal zidovudine therapy in 1994, the efforts of the CDC and others produced a dramatic decline in perinatal HIV transmission. However, in recent years, approximately 300 perinatally infected infants have been born annually in the United States. To further reduce this number, the CDC has identified four prevention goals: improve prenatal care, recommend HIV testing, ensure treatment for HIV-infected pregnant women, and ensure follow-up care. To address these goals, the CDC launched a prevention plan consisting of surveillance, research, outreach strategies, grant programs, evaluation efforts, and policy development. Globally, the CDC tailors this plan to meet the needs of developing countries. The CDC provides technical assistance to international organizations to help develop, implement, and evaluate global prevention programs. Specific international sites are targeted for new research and programs to reduce perinatal HIV transmission.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Evidence for clinical smoking cessation for adolescents.

OBJECTIVE: This report reviews the evidence that informs the role of health and mental health care providers in addressing youth smoking cessation. DESIGN: Qualitative literature review. RESULTS: Physicians do not consistently screen adolescents for tobacco use and fail to provide recommended cessation advice. Challenges to addressing smoking cessation include the need for procedures to ensure confidentiality and the existence of competing demands to provide other services. Few published studies have specifically addressed the effectiveness of clinical interventions. Interventions that require return visits or follow-up phone contacts are technically difficult to implement in this population. Successful interventions may require resources not available in nonresearch settings. Most studies have used brief clinical intervention as a control condition, making it impossible to evaluate its effectiveness. CONCLUSION: There is little evidence that supports current clinical smoking cessation guidelines for adolescents. More research is needed to develop inexpensive, efficient clinical interventions that can provide youths access to smoking cessation help. Future challenges include reorganizing clinical systems to offer greater counseling by support staff or in electronic formats and to provide effective booster messages and follow-up care in a population that is difficult to track.

Adolescent↗

PubMed1994

Treatment of early stage prostate cancer: radiotherapy.

PATIENTS with T1/T2 prostate cancer are well served by external beam radiation. 1. T1/T2, N0, M0 PATIENTS: The 10-year outcome of N0 patients is equal to that obtained by radical prostatectomy in similar patients without the operative mortality or incontinence that accompanies the latter procedure. Ten-year cure has been confirmed by PSA studies in irradiated patients, while this has not yet been demonstrated in surgical patients. 2. T1, NX, M0 PATIENTS: After radiation therapy these patients show no excess mortality as long as 15 years after treatment, an outcome confirming a strict criteria of cure. 3. T2, NX PATIENTS: After radiation therapy, these patients show continuing excess mortality to 15 years, but most 15-year survivors are NED, again supporting the concept of long-term cure. 4. T1/T2 N+, M0 PATIENTS: We must have clinical trials in these patients that study the roles of radiation, androgen deprivation, and surgery. 5. Conformal treatment technology is improving the technical delivery and dose administered by radiation therapy and decreasing both the acute and late side effects of treatment. It remains to be proved whether the increased dose and accuracy will improve local control and cure as hoped.

Adult↗

PubMed2006

Analysis of class 1 residual solvents in pharmaceuticals using headspace-programmed temperature vaporization-fast gas chromatography-mass spectrometry.

A sensitive method is presented for the fast screening and determination of residual class 1 solvents (1,1-dichloroethene, 1,2-dichloroethane, 1,1,1-trichloroethane, carbon tetrachloride and benzene) in pharmaceutical products. The applicability of a headspace (HS) autosampler in combination with GC equipped with a programmed temperature vaporizer (PTV) and a MS detector is explored. Different injection techniques were compared. The benefits of using solvent vent injection instead of split or splitless-hot injection for the measurement of volatile compounds are shown: better peak shapes, better signal-to-noise ratios, and hence better detection limits. The proposed method is extremely sensitive. The limits of detection ranged from 4.9 ppt (benzene) to 7.9 ppt (1,2-dichloroethane) and precision (measured as the relative standard deviation) was equal to or lower than 12% in all cases. The method was applied to the determination of residual solvents in nine different pharmaceutical products. The analytical performance of the method shows that it is appropriate for the determination of residual class 1 solvents and has much lower detection limits than the concentration limits proposed by the International Conference on Harmonization (ICH) of Technical Requirements for the Registration of Pharmaceuticals for Human Use. The proposed method achieves a clear improvement in sensitivity with respect to conventional headspace methods due to the use of the PTV.

Confidence Intervals↗

PubMed1994

[The epidemiologic significance of varicella].

A total of 552 persons working in the university hospital of Freiburg, Germany (nurses, pediatric nurses, administration--and technical personnel) was screened for antibodies to varicella zoster virus. Prevalence of antibodies to VZV among men was higher than among women. While the degree of immunity of nurses and administration/technical personnel was comparable, pediatric nurses had a significantly higher seroprevalence (< 20 years 89.3%, -30 years 95.7%, > 30 years 98.6%). Therefore, pediatric nurses should be screened and susceptible persons should be vaccinated.

Adult↗

PubMedDate not supplied

[Mass prophylactic examinations of the population and scientific and technical progress].

To ensure an early recognition and subsequent active dynamic observation and treatment of patients a further improvement of the forms and methods of prophylactic medical examinations of the population is necessary. One of the forms of organizing such examinations is construction and application in the medical practice of automated systems for mass examination of the population, in which efficient diagnostic methods are used.

Delivery of Health Care↗

PubMed2001

Personal view. Is it reality or an illusion that liquid-based cytology is better than conventional cervical smears?

Liquid-based cytology (LBC) has been heralded as the way forward for cervical screening, and as the answer to many of its problems. It is already used as a sole method of cell preparation in many private clinics in the UK. It is being used for colposcopy smears in many NHS clinics and is now being piloted for primary screening in three screening centres in England, as well as one in Scotland and one in Wales. LBC has been welcomed as a new technology because it deals with the problem of specimen adequacy at source, removing responsibility for slide preparation and fixation from the clinician or nurse. It provides uniformly well-fixed preparations that are free of inflammatory exudate and blood, and seem easier to screen than conventional smears. There are many articles in the world literature suggesting that LBC is more accurate than conventional screening, and it is thought likely to reduce the number of false negative tests. The main reasons for piloting LBC in the NHS Cervical Screening Programme (NHSCSP) lie in its potential for reducing screening times and for reducing the numbers of repeats for inadequate tests. LBC is expensive in terms of equipment, capital costs, maintenance, consumables, training, technical preparation time, transportation and disposal of liquid media. Its costs could be justified if they were offset by the money saved from reduced screening time and repeat tests, but only if its accuracy in terms of sensitivity and specificity were proven to be equal to or better than conventional cytology. Although that is generally held to be true by the public and medical profession alike, there is very little hard evidence to support it.

Female↗

PubMed2001

Is variation in quality of mammographic services race linked?

The purpose of this investigation was to (1) determine whether there was variability in the quality of services offered in mammography facilities across Connecticut and (2) determine whether African American women were more likely than white women to receive mammograms in facilities that offered substandard services. Since most facilities do not routinely record information on race, this investigation represents a unique opportunity to address the question of race-linked variation in the quality of screening mammography. Information on equipment, personnel, and record keeping in mammography facilities was used to construct indices that represented separate domains of quality: technical attributes, educational practices, and tracking of clients. While some variation in the quality of mammography services was found, there were no significant differences between the two race categories in the mean scores for each of three quality indices. Thus, variation in quality of screening mammographic services does not appear to be race linked.

Accreditation↗

PubMed1983

Comparison of five methods of cytomegalovirus antibody screening of blood donors.

A group of 120 sera from blood donors was screened by complement fixation and commercially available immunofluorescence, solid-phase fluorescence immunoassay, enzyme-linked immunosorbent assay, and indirect hemagglutination tests. Twenty-four of the sera were positive by three or more of the five tests and judged to be true positives; 89 were negative by three or more of the tests and considered to be true negatives. The tests were ranked for accuracy, sensitivity, specificity, false-positive rate, and false-negative rate. The indirect hemagglutination test scored best, followed by enzyme-linked immunosorbent assay, solid-phase fluorescence immunoassay, complement fixation, and immunofluorescence, in that order. When the tests were ranked on the basis of technical demands, turnaround time, requirement for special equipment, and subjectivity in reading, the indirect hemagglutination test again scored best, followed by solid-phase fluorescence immunoassay, enzyme-linked immunosorbent assay, immunofluorescence, and complement fixation in that order. Our findings suggest that the indirect hemagglutination test is the most reliable and effective commercially available test for the identification of those donors who are very unlikely to transmit cytomegalovirus to recipients.

Antibodies, Viral↗

PubMed2003

Screening for multiple hereditary hypercoagulability factors using the amplification refractory mutation system.

Many hereditary factors have been implicated in the development of arterial and/or venous thromboembolic diseases. A number of these risk factors can be identified by the amplification refractory mutation system (ARMS). However, the underlying technical conditions for performing ARMS are highly variable, and depend on which risk factors are being analyzed. We have now developed a novel ARMS-based system to simultaneously screen for multiple hypercoagulability factors under identical PCR conditions. This can greatly simplify the process of screening for hereditary hypercoagulability.

Base Sequence↗