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PubMed1996

Acquired Von Willebrand disease in children with a Wilms' tumor.

The association between acquired von Willebrand disease and Wilms' tumor has been reported in eight cases: four cases reports and one prospective study of Coppes et al. (J. Clin Oncol 10:422-427, 1992) who found this in four out of 50 patients. We retrospectively studied 73 children who were diagnosed with a Wilms' tumor between 1970 and 1993. All patients were treated according to the running international SIOP protocol. According to our local diagnostic workup protocol, blood samples for screening coagulation tests were obtained at diagnosis and during preoperative chemotherapy. Since 1984, factor VIII analysis was added. In four patients, no coagulation screen was done. Bleeding time and screening tests apart from APTT were normal in all 69 children tested before or within 2 days after starting therapy. In 47 out of 73 patients, an APTT was performed before starting therapy. In 19 patients (40%), it was prolonged (>33 sec). In 8 of them (17%), the prolongation was severe (> or = 40 sec). In 11 out of the 19 patients, factor VIIIc, factor VIIIag, and factor VIII RcoF determinations were done. In two children, all three factors were decreased suggestive for von Willebrand disease. One of the 19 patients with a prolonged APTT had hematuria. The others had no increased bleeding tendency or signs of bleeding in the tumor. In all patients, the prolonged APTT normalised during preoperative chemotherapy within 6 weeks. Frequent blood samples were obtained of the two children with acquired von Willebrand disease and showed normalisation of the coagulation disorder after 1 and 2 weeks, respectively. No specific therapy to correct the coagulation abnormalities was given to any patient.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2004

Examination of population-wide trends in barriers to cancer screening from a diffusion of innovation perspective (1987-2000).

BACKGROUND: Barriers to cancer screening may change over time as screening becomes more widespread. METHODS: Using 1987, 1992, and 2000 National Health Interview Survey data, we examined population-wide trends in barriers to Pap, mammography, and colorectal screening (n =66,452). RESULTS: Lack of awareness was the most common barrier for all screening tests; it decreased by 13.5 percentage points for mammography and by 4.6 percentage points for colorectal screening, but increased by 3.0 percentage points for Pap test from 1987 to 2000. Decreases in not recommended by a doctor were observed for mammography (from 20.5% to 3.7%) and colorectal screening (from 22.3% to 14.2%). Examination of trends in barriers among sociodemographic and health care access subgroups revealed disparities for each screening test. CONCLUSIONS: Although population-wide progress has been made in reducing barriers to screening, lack of awareness, and not recommended by a doctor remain important barriers, especially among traditionally underserved populations.

Adult↗
PubMed1988

Detection of and screening for endometrial cancer.

Endometrial cancer occurs more than twice as frequently as cervical cancer. The main risk factors are age, estrogen use, and obesity. Increasing life expectancy and more liberal use of estrogen to prevent postmenopausal bone loss will probably increase the magnitude of the problem. Endometrial cancer is a heterogeneous disease. Good prognosis is associated with obesity and estrogen use and with carcinomas preceded by precancerous hyperplasia. A bad prognosis may be found in women without major risk factors and is associated with a normal or atrophic endometrium. Because of a high prevalence of asymptomatic disease (6.9 per 1,000) and because the group with a poor prognosis is usually asymptomatic, all postmenopausal women should be screened at least one time. For screening, the use of one of the cytologic instruments is recommended; these instruments are safe, easy to handle, and can be used in the office setting without anesthesia. Yields are comparable to dilation and curettage. Family physicians are encouraged to familiarize themselves with cytologic instruments and to use them for screening postmenopausal women in their office.

Cytological Techniques↗
PubMed1987

Trends in mortality from cervical cancer in the Nordic countries: association with organised screening programmes.

Time trends in mortality from cervical cancer in Denmark, Finland, Iceland, Norway, and Sweden since the early 1950s were investigated in relation to the extent and intensity of organised screening programmes in these countries. In all five countries the cumulative mortality rates (0-74 years) fell between 1965 and 1982. In Iceland, where the nationwide programme has the widest target age range, the fall in mortality was greatest (80%). Finland and Sweden have nationwide programmes also; the mortality fell by 50% and 34%, respectively. In Denmark, where about 40% of the population are covered by organised programmes, the overall mortality fell by 25%, but in Norway, with only 5% of the population covered by organised screening, the mortality fell by only 10%. The results support the conclusion that organised screening programmes have had a major impact on the reduction in mortality from cervical cancer in the Nordic countries.

Adult↗
PubMed2003

Health authority cervical screening recall policies and time since last smear: a retrospective cohort analysis in the north west England.

OBJECTIVES: To evaluate the impact of health authority cervical screening programmes upon the the actual screening interval for women attending as a result of routine recall and to assess the impact of general practice recall policies on attendance for smears. SETTING: Nine health authorities constituting the Lancashire and Greater Manchester zones of the North West region on the National Health Service. METHODS: Information was obtained on the invitation and recall policies of each health authority. A retrospective analysis of information held on cervical screening databases ("Exeter" computer systems was performed. The proportions of smears, classified by a screening interval of "unscheduled", "on-time" or "overdue", in the different health authority recall programmes were compared. General practices in one health authority (operating five-yearly recall) were contacted to determine their current practice screening policy. RESULTS: Women who were invited as part of a three-yearly recall programme were more likely to attend for smears at intervals of 3-5 years than those on a five-yearly recall programme (68% vs 47%). Those health authorities operating three-yearly recall that issued recall invitations to women more than four weeks before the date the smear was due had higher rates of "unscheduled" smears. In the one health authority (operating a five-yearly recall programme) in which we determined general practice screening policy, 62% of the general practitioners (GPs) were operating their own three-yearly recall policy; these GPs had a higher proportion of the women who attended for smears "on-time" (51%) than did those who relied on the health authority five-yearly recall procedure (44%). CONCLUSIONS: Despite the cervical screening programme being a national programme, there is scope at a local level for considerable variation in the interpretation of national guidance. This variation effects the extent to which programmes comply with the requirement to screen all women at an interval of 3-5 years.

Adult↗
PubMed1999

Completeness of and duration of time before treatment after screening women for Chlamydia trachomatis infections.

OBJECTIVE: To assess the proportion of women with verified treatment after positive screening tests for C. trachomatis infection and to evaluate the duration of time until treatment. DESIGN: Retrospective cohort analysis linking the date of a positive genital C. trachomatis test with the documented date of treatment. SETTING: Family planning, sexually transmitted disease, obstetrical/gynecologic, adolescent, and walk-in clinics in Philadelphia from March 1, 1994 through December 31, 1995. PARTICIPANTS: Included 4,158 women with screening tests positive for C. trachomatis. MAIN OUTCOME MEASURES: Documented treatment of chlamydia-infected women and duration of time between initial clinic visit and therapy. RESULTS: Over a 21-month period, 4,158 women had endocervical screening tests positive for C. trachomatis. Twenty-four percent of these women were treated presumptively (on the day of specimen collection), with sexually transmitted disease clinics yielding the highest percentage (70.9%) of presumptively treated patients. Of the 3,143 chlamydia-positive women not treated presumptively, treatment was subsequently verified in 96.2%. The median interval between screening and treatment was 21 days. Private adolescent clinics had the lowest median interval of 14 days between screening and treatment, whereas public family planning clinics showed the largest median screening to treatment interval of 26 days. CONCLUSIONS: Large-scale screening programs in public health settings can bring nearly all C. trachomatis-infected patients to treatment. However, new strategies are needed to shorten the duration of time before treatment of selected subsets of women who screen positive for C. trachomatis.

Adult↗
PubMed1995

Evaluation of a hospital based cytology screening programme for reduction in life time risk of cervical cancer.

Hospital based cytology screening is one of the suggested alternative strategies for the developing countries. The present communication attempts to estimate the reduction in lifetime risk of cervical cancer initiated through a hospital based single lifetime screening programme. The percent reduction in cumulative incidence of cervical cancer during lifetime in different age groups of women was calculated after estimating the number of incident cases in the absence as well as presence of screening. Our analysis revealed that by introducing the single life time cytology screening in the group of hospital attending population, an overall reduction in the cumulative incidence of cervical cancer during lifetime was found to be 10.2%. It was further estimated that the reduction was much less in the early age groups (2.4-10.2% in 20-34 years) as compared to later age groups (11.2-55.6% in 35+ years).

Adult↗
PubMed2005

First-trimester Down syndrome screening: component analytes and timing for optimal performance.

The most effective first-trimester Down syndrome screening protocol in current use employs three independent markers: maternal serum levels of PAPP-A and free beta hCG, and measurement of fetal nuchal translucency (NT). Eleven weeks appears to be the optimum gestational age for performing first trimester DS risk assessment. Although the discrimination of free beta hCG improves with increasing gestational age and is greatest at 13 weeks, PAPP-A and NT perform optimally at 10 and 11 weeks, respectively. In addition to accurate pregnancy dating, first trimester screening performance is improved by using a consistent NT measurement technique, NT cut-offs adjusted for gestational age or crown-rump length, and possibly center- or operator-specific NT medians. Whether or not absence or presence of the nasal bone adds to screening accuracy is a matter of some debate. Finally, because enlarged NT has been associated with cardiac defects and other structural anomalies, even in euploid fetuses, its presence should prompt a targeted second trimester ultrasound examination.

Down Syndrome↗
PubMed1997

Screening dipstick urinalysis: a time to change.

OBJECTIVE: This study attempted to determine the minimal cost of screening dipstick urinalyses in a hypothetical cohort of 2000 asymptomatic pediatric patients in a primary care setting. METHODOLOGY: The minimal cost utilizing a private practitioner in an urban or suburban group pediatric setting was calculated. Costs were determined by using current charges for supplies ordered to perform tests in the office, charges for tests performed by a commercial laboratory, and the cost of an initial evaluation by a pediatric nephrologist. Data from published studies were also utilized. RESULTS: Nine percent (179/2000) of patients were calculated to have an initial abnormal urinalysis. Upon retesting only 1.5% (29/2000) of patients were calculated to have a persistent abnormality. The calculated rate of a false positive/transient abnormality for all patients in the hypothetical cohort of 2000 asymptomatic pediatric patients was 84% (150/179). The calculated minimal cost for the outpatient evaluation of 2000 asymptomatic pediatric patients by dipstick urinalyses ranged between $5022 to $6475. The range depends on whether 50% versus 100% of patients with a repeat abnormal dipstick urinalysis were referred to a pediatric nephrologist for further evaluation. The calculated cost was $1290 to initially screen all 2000 patients with a dipstick urinalysis or 65 cents per patient. The calculated cost to evaluate the 29 patients with any persistent abnormality on repeat dipstick urinalysis was $3732 to $5185 or $129 to $179 per patient. This is the calculated cost for a single screening of 2000 asymptomatic pediatric patients. The calculated cost for four multiple screening urinalyses as currently recommended is $20 088 to $25 900. Additionally, these are only minimal initial calculated costs. Costs of any renal imagining or function studies ordered by the pediatric nephrologist or the pediatrician pursuing a further evaluation on his/her own were not included. CONCLUSION: Multiple screening dipstick urinalyses in asymptomatic pediatric patients are costly and should be discontinued. In their place, we propose that a single screening dipstick urinalysis be obtained at school entry age, between 5 and 6 years old, in all asymptomatic children. The sample should be a first morning void.

Child↗
PubMed2004

Empirical bayes gene screening tool for time-course or dose-response microarray data.

An efficient method to reduce the dimensionality of microarray gene expression data from thousands or tens of thousands of cDNA clones down to a subset of the most differentially expressed cDNA clones is essential in order to simplify the massive amount of data generated from microarray experiments. An extension to the methods of Efron et al. [Efron, B., Tibshirani, R., Storey, J., Tusher, V. (2001). Empirical Bayes analysis of a microarray experiment. J. Am. Statist. Assoc. 96:1151-1160] is applied to a differential time-course experiment to determine a subset of cDNAs that have the largest probability of being differentially expressed with respect to treatment conditions across a set of unequally spaced time points. The proposed extension, which is advocated to be a screening tool, allows for inference across a continuous variable in addition to incorporating a more complex experimental design and allowing for multiple design replications. With the current data the focus is on a time-course experiment; however, the proposed methods can easily be implemented on a dose-response experiment, or any other microarray experiment that contains a continuous variable of interest. The proposed empirical Bayes gene-screening tool is compared with the Efron et al. (2001) method in addition to an adjusted model-based t-value using a time-course data set where the toxicological effect of a specific mixture of chemicals is being studied.

1-Methyl-3-isobutylxanthine↗
PubMedDate not supplied

Frequency and timing of symptoms in infants screened for sepsis: effectiveness of a sepsis-screening pathway.

To determine the frequency and timing of symptoms and to evaluate the effectiveness of a sepsis-screening pathway in term and near-term infants, data were collected prospectively for a period of 1 year from December 1, 2000, to November 30, 2001. Results confirmed that a sepsis-screening pathway using a combination of at least 2 serial complete blood cell count and C-reactive protein measurements in both symptomatic and asymptomatic infants is a safe, simple strategy that prevents unnecessary treatment of infants with risk factors with antibiotics. However, most infants with presumed or suspected early-onset sepsis are symptomatic. Routine treatment of asymptomatic infants with risk factors or prior treatment with intrapartum antibiotics is unnecessary. A combined approach of screening in the presence of risk factors and /or symptoms of sepsis and adequate follow-up for infants discharged at less than 72 hours of age may help reduce unnecessary treatment of infants with antibiotics.

Bacteremia↗
PubMed1993

Modified recalcification time: a global coagulation screening test.

Hypercoagulability with resultant thrombosis as a leading cause of death remains unproven due to the lack of a global screening coagulation test documenting antecedent hypercoagulability. To fill this need a modified recalcification time (MRT) test that incorporates the contribution of all the circulating cellular and chemical mediators, including the important but neglected tissue factor, to coagulation is described. Aliquots of blood are incubated with saline and with endotoxin, and the MRT is instrumentally determined. Values outside the normal ranges of 5.3 to 8.5 minutes (saline) and 4.5 to 7.5 minutes (endotoxin) in the coagulation spectrum of 0 to 10 minutes to infinity are abnormal. Shorter values are inversely related to the degree of hypercoagulability. To assess MRT in detecting hypercoagulability, MRT values in conditions with known thrombotic risk that were reported individually are presented by indicating the percentages of each in the abnormal ranges. The conditions, all with statistically significant hypercoagulability, included early breast cancer, diabetes, head, neck, and colon cancer, peripheral vascular disease, and pregnancy. Modified recalcification time meets the criteria of a global coagulation screening test because of: 1) age-related prevalence of asymptomatic cancer and thrombotic cardiovascular disease, 2) specificity and sensitivity, and 3) expected lower morbidity and mortality with early intervention.

Arterial Occlusive Diseases↗
PubMed1992

Interval carcinomas in the Malmö Mammographic Screening Trial: radiographic appearance and prognostic considerations.

OBJECTIVE: Interval carcinoma is the term used to describe malignant breast tumors that are detected in the intervals between mammographic screenings. These tumors are important because they contribute significantly to breast cancer mortality in the screened population. MATERIALS AND METHODS: Two radiologists retrospectively reviewed the mammograms of the 96 interval carcinomas (17% of all malignant neoplasms in the screened group) that were detected during the 10-year Malmö Mammographic Screening Trial in Malmö, Sweden (average time between screenings, 21 months), including one sarcoma, 75 invasive carcinomas, and 20 noninvasive carcinomas. We recorded the interval between screening and detection, and noted the tumor's appearance on the prior screening mammogram and at the time of diagnosis; these data were correlated with histologic tumor type and the patients' mortality. The doubling time for tumor volume of the invasive carcinomas was estimated. RESULTS: Excluding the sarcoma, 72 carcinomas (75%) were detected within 18 months of screening. Retrospective review of the available preceding screening mammograms (94 cases) indicated that 10 tumors were missed (observer's error), 63 studies showed no tumor (true interval carcinomas), and 21 studies showed subtle signs of malignancy, mostly nonspecific densities or asymmetries (unrecognized sign). Of 66 invasive carcinomas in which doubling times for tumor volume could be calculated, 27 (41%) had doubling times of less than 100 days. At the end of the study, 20 of the 96 patients had died of breast cancer. CONCLUSION: Interval carcinomas in this series were dominated by comedo, medullary, and mucinous carcinomas that often had a nonspecific appearance (when present) on prior screening mammograms. The interval carcinomas also contained a subset of rapidly growing tumors with a grave prognosis.

Aged↗
PubMed2005

Preoperative screening for coagulopathy using prothrombin time and partial thromboplastin time in patients requiring primary cranial vault remodeling.

BACKGROUND: The aim of this study was to investigate the prevalence of abnormal preoperative screening prothrombin time and partial thromboplastin time in patients listed for primary cranial vault remodeling that required hematologic workup and their diagnoses and subsequent management. METHODS: This retrospective analysis was performed from January of 2000 to December of 2003 at the International Craniofacial Institute, Dallas, Texas, on a total of 168 patients. RESULTS: All patients had a normal prothrombin time. Abnormally raised partial thromboplastin time was found in six patients (prevalence of 3.57 percent), one who had factor XI deficiency, one who had a borderline factor XI deficiency and circulating inhibitor, one who had an intermittent factor XI deficiency and circulating inhibitor, one who had a borderline von Willebrand's disease with low factor XII, and the remaining two who had a circulating inhibitor of coagulation. Of these six patients, the perioperative management was altered in four of five patients, and one patient declined surgery out of fear of surgical morbidity. The surgery of one patient was aborted intraoperatively because of abnormal bleeding without clot formation after the calvarial burr holes had been drilled. The mean blood loss was 183 ml for the four patients with completed surgery and 100 ml for one patient. CONCLUSIONS: The authors conclude that even though the prevalence of abnormal screening partial thromboplastin time in these patients was low (3.57 percent), detection of an abnormal result required preoperative correction of coagulopathy in 80 percent of cases.

Blood Coagulation Disorders↗
PubMed1996

Life expectancy in men who have never smoked and those who have smoked continuously: 15 year follow up of large cohort of middle aged British men.

OBJECTIVE: To estimate the life expectancy in a representative sample of men who have never smoked and of those who have smoked all their adult lives. DESIGN: 15 year follow up of a large representative cohort of British men in the British regional heart study and use of national mortality statistics for 1992. SUBJECTS: 7735 middle aged British men aged 40-59 at the time of screening (between 1978 and 1980). MAIN OUTCOME MEASURES: Mortality from all causes and from smoking related causes. RESULTS: 1624 men had never smoked at the time of screening and did not take up smoking during the study. 127 of them died during follow up. 3151 men began smoking before they were 30 and were still smoking at the time of screening. Of these, 751 had stopped smoking five years after screening; they were excluded from the analysis five years after the date they had stopped. 560 of the lifelong smokers died during follow up. When study estimates were combined with those from national mortality statistics for men aged 20-40, only an estimated 42% (95% confidence interval 36% to 50%) of lifelong smokers alive at the age of 20 would be alive at 73, compared with 78% (74% to 82%) of lifelong non-smokers. CONCLUSION: These estimates present the effects of smoking on mortality in a way that is easily communicated to patients and the general public in health promotion initiatives.

Adult↗
PubMed1996

[The "activated coagulation time (ACT)": two simple screening methods for evaluating coagulation disorders in dogs].

The use of the activated coagulation time (ACT) for testing the intrinsic coagulation is well established among veterinary practitioners in the USA. The advantage of the ACT compared to other coagulation tests is its ease to be performed under practice conditions. The ACT may be measured manually or instrumentally. The reference range of our instrumental measurement is between 90 and 120 seconds (median 105 seconds), of the manual measurement at room temperature between 115 and 145 seconds (median 125 seconds). Advantages of the instrumental method are the smaller amount of blood (0.4 ml versus 2.0 ml) necessary to perform the test, and the smaller potential for errors by unexperienced examiners. The spread is comparable between the two methods. The most important cause of false results is poor venipuncture technique: traumatic venipuncture will trigger the coagulation cascade already during venipuncture causing an artificially shortened ACT.

Animals↗
PubMed2007

Visual screening for malignant melanoma: a cost-effectiveness analysis.

OBJECTIVE: To evaluate the cost-effectiveness of various melanoma screening strategies proposed in the United States. DESIGN: We developed a computer simulation Markov model to evaluate alternative melanoma screening strategies. PARTICIPANTS: Hypothetical cohort of the general population and siblings of patients with melanoma. Intervention We considered the following 4 strategies: background screening only, and screening 1 time, every 2 years, and annually, all beginning at age 50 years. Prevalence, incidence, and mortality data were taken from the Surveillance, Epidemiology, and End Results Program. Sibling risk, recurrence rates, and treatment costs were taken from the literature. MAIN OUTCOME MEASURES: Outcomes included life expectancy, quality-adjusted life expectancy, and lifetime costs. Cost-effectiveness ratios were in dollars per quality-adjusted life year (US dollars/QALY) gained. RESULTS: In the general population, screening 1 time, every 2 years, and annually saved 1.6, 4.4, and 5.2 QALYs per 1000 persons screened, with incremental cost-effectiveness ratios of US dollars 10,100/QALY, US dollars 80,700/QALY, and US dollars 586,800/QALY, respectively. In siblings of patients with melanoma (relative risk, 2.24 compared with the general population), 1-time, every-2-years, and annual screenings saved 3.6, 9.8, and 11.4 QALYs per 1000 persons screened, with incremental cost-effectiveness ratios of US dollars 4000/QALY, US dollars 35,500/QALY, and US dollars 257,800/QALY, respectively. In higher risk siblings of patients with melanoma (relative risk, 5.56), screening was more cost-effective. Results were most sensitive to screening cost, melanoma progression rate, and specificity of visual screening. CONCLUSIONS: One-time melanoma screening of the general population older than 50 years is very cost-effective compared with other cancer screening programs in the United States. Screening every 2 years in siblings of patients with melanoma is also cost-effective.

Boston↗