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PubMed2004

Endoscopy in inflammatory bowel diseases.

A correct diagnosis, adequate assessment of disease activity, avoidance of surgery by endoscopic interventions, and effective cancer surveillance make endoscopy crucial in the management of inflammatory bowel diseases (IBDs). Impressive technical developments of several endoscopic techniques over the past few decades have allowed a detailed visual impression of the affected gut and enable tissue sampling and various therapeutic interventions. Here we propose guidelines for endoscopy in inflammatory bowel disease, and review all currently available endoscopic techniques relevant to the proper treatment of IBD patients.

Catheterization↗

PubMed1998

In vivo detection of coronary artery anomalies in asymptomatic athletes by echocardiographic screening.

BACKGROUND: Anomalous origin of coronary arteries (AOCA) is a rare congenital disease. Although it may have a benign course, it has been identified as a frequent cause of sports-related sudden death. Unfortunately, in vivo detection of AOCA is not easy, as individuals with this anomaly often are asymptomatic and show no signs of myocardial ischemia. Presently, transthoracic two-dimensional echocardiography (TTE) is the only noninvasive, widely available tool to visualize the ostia and first tracts of coronary arteries. OBJECTIVE: To assess the efficacy of TTE in the screening of AOCA in a large athletic population. STUDY DESIGN: In a prospective study, we assessed the ostia and first tracts of coronary arteries in 3,650 subjects (mean age, 30+/-12 years) practicing different sports at various competitive levels. Subjects underwent a TTE examination in our laboratory for scientific or diagnostic purposes. RESULTS: Technically satisfactory echocardiograms were obtained in 3,504 subjects (96%); a clear visualization of the ostia and first tracts of both coronary arteries was obtained in 3,150 cases (90%). Three asymptomatic athletes (0.09%) were suspected to have an AOCA; two with a right coronary artery origin from the left sinus, and one with a left coronary artery origin from the right sinus. Diagnosis was confirmed by coronary angiography. CONCLUSIONS: Our study indicated that AOCA is rare in asymptomatic athletes. Systematic and accurate exploration of coronary anatomy in athletes referred for a diagnostic TTE examination may be useful in identifying those with AOCA.

Adolescent↗

PubMed2005

Adolescent health screening questionnaire.

Adolescent screening questionnaire is a set of questions made on determinants of adolescent health and used to screen adolescents exposed to health risk environment to offer preventive and promotional health care . Most evidence based questionnaire (GAPS) was developed by American Medical Association. Subsequently American Academy of Pediatrics (AAP) and Bright Future (BF) developed questionnaire. All of them were developed to serve American and Western society needs. Format of Adolescent Preventive Services (FAPS) questionnaire was prepared by Adolescent Health Clinic of Calcutta Medical College to suit Indian adolescents, having a different cultural background, with technical support from WHO. National consultations on this questionnaire was supported by WHO and GOI. It was field tested and its validity and reliability were assessed among adolescents of six school students. Use of this tool helps identification of adolescents exposed to high-risk environments and use of necessary early intervention to prevent morbidity and mortality in adolescents. The available software version of FAPS can be used in the computer class to screen all school adolescents regularly.

Adolescent↗

PubMed1999

Strategy for evaluation and prevention of risk due to work in thermal environments.

A strategy in four successive stages is described and justified for the prevention and control of thermal problems in the workplace. This should allow these problems to be approached and solved progressively in small as well as large companies by relying successively, when necessary, on the complementary competencies of the workers themselves, their technical assistance, the occupational health specialists and the experts. The criteria to fulfil at each stage are described and discussed. Appendix 1 describes in detail the methods to be used at stages 2, "Observation" by the workers and their assistance; at stage 3, "Analysis" with the help of specialists; and outlines the stage 4, "Expertise".

Algorithms↗

PubMed1999

A case study of the effectiveness of nurse-led screening programmes for cervical cancer among Hong Kong Chinese women.

Cervical cancer remains a cause of morbidity and mortality among women despite the efficacy of Pap smear screening. Uptake rates for Papanicolaou (Pap) smears among Hong Kong Chinese women remain low and evidence suggests that both intrinsic and extrinsic factors influence women's attendance for Pap smear screening, particularly the practitioner taking the smear. This study examined the experiences and perceptions of Hong Kong Chinese women of having a Pap smear taken by a female doctor or a female nurse using a case study design. A convenience sample of 50 women was selected from the two case study settings. Data collection involved a confidential structured interview, followed by focus group interviews with a sample of women participating in the structured interview. The findings relating to the technical quality and outcome of care provide the focus for this paper. Although women were highly satisfied with the care provided by both practitioners, women were more satisfied with the information given about the procedure by the nurse (P = 0.0130) and had more confidence in the nurse (P = 0.024). One of the five criteria used to assess the quality of smears demonstrated the doctor achieved a statistically significant higher number of smears containing the required percentage of endocervical cells (P = 0. 0180). Nevertheless, none of the smears taken by the nurse required repeating due to an inadequate specimen. These findings suggest, despite the need for audit of Pap smears, that appropriately qualified nurses can make an important contribution to the uptake of Pap smears among this population.

Adult↗

PubMed1999

Comparison of Papnet-assisted and manual screening of cervical smears.

We compared the performance of Papnet to manual screening with respect to detection of dysplastic/atypical epithelial cells, endocervical cells, and inflammatory changes/infectious agents. One thousand consecutive manually screened smears were retrieved from the cytological files and subjected to Papnet analysis. Five slides had to be excluded for technical reasons. Of the remaining 995 cases, manual and Papnet diagnosis showed agreement in 986 cases, 950 benign or within normal limits, and 36 with epithelial abnormalities. Papnet detected 4 cases missed by manual screening, but failed to detect 5 manually diagnosed cases. In 293/749 smears, existing endocervical cells were not selected by Papnet (40%) and inflammatory changes/infectious agents were diagnosed in 49 cases, compared to 87 cases by manual screening (56%). Papnet equaled manual screening for dysplasias and epithelial atypias, but its poor performance regarding endocervical cells and inflammation would be a drawback in primary screening. Diagn. Cytopathol. 1999;21:296-299.

Diagnosis, Computer-Assisted↗

PubMed1996

Health screening, development, and equity.

Given the worldwide epidemiologic transition and the lure of technology aggressively promoted by those profiting from it, policy-makers in developing as well as industrialized countries now frequently face decisions on the introduction of screening into routine health services. Concerns regarding development and equity raise issues that may not arise within the scientific, technical, or individually-focused ethical frameworks used in prior work on screening policy. Screening can divert attention from primary prevention of a society's most important threats to health, especially when primary prevention faces political challenges and screening costs are viewed in isolation from the overall strategy required to make it useful. For secondary prevention of diseases with easily recognizable symptoms, public education promoting timely self-referral to accessible medical services is preferable to "screening" unselected populations. In any country, but perhaps especially in developing countries, screening may waste scarce resources: it could also lead to widened inequities.

Decision Making, Organizational↗

PubMed2000

[Mammography screening in Rogaland--the first round].

BACKGROUND: Screening with mammography is a proven method of detecting breast cancer at an early stage. In 1994, the Norwegian Ministry of Health and Social Services decided to initiate a trial with mammography screening in four counties before deciding whether to launch a national breast screening programme. Four counties were selected: Akershus, Oslo, Hordaland and Rogaland. MATERIAL AND METHODS: A detailed plan along with important determinants to evaluate the quality of the trial were agreed upon. The main-purpose was to find practical and administrative screening approaches which would result in a 30% reduction in mortality. Rogaland was the first county to start, in November 1995. The first screening round was completed in December 1997. We present the results from Rogaland and compare our results with the preset targets, and also with the results from the other three counties. A total number of 31,069 women aged 50-69 years were invited to participate. RESULTS: The attendance rate was 88.6%. A total of 6.7% were referred for additional examinations; 4.9% were reexamined due to mammographic findings, the remaining 1.8% for technical or clinical reasons. The detection rate in our study was 8.4 cancers per 1,000 screened women. Of these, 6.1 were invasive cancer and 2.3 in situ cancer. 70.0% of the tumours were < or = 15 mm in diameter. In 82.1% there was no histologic evidence of axillary metastases. INTEPRETATION: We conclude that our diagnostic results from the first round of mammographic screening meet the quality target and are noticeably higher than those obtained by the other three counties. Based upon these results, we conclude that a reduction in mortality of 30% should be attainable.

Aged↗

PubMed1993

Partnership programs in Poland.

Sponsored by the U.S. Agency for International Development (AID), Albany Medical College and the Marie Skłodowska-Curie Memorial Cancer Center and Institute of Oncology formed a Partnership in 1992 aimed at enhancing cancer control and care in Poland by providing technical assistance and education to foster existing programs and develop new oncologic programs. The initial focus of the partnership is on breast cancer. Three demonstration screening/early disease programs are being developed, as well as a clinical and clinical research program and a Polish Breast Cancer Trials Group. A program to foster accreditation of oncologic facilities and programs throughout Poland is being considered.

Breast Neoplasms↗

PubMed1999

[Early diagnosis of bronchial carcinoma. Technical endoscopic progress--a step toward new screening concepts?].

Lung cancer is the most common neoplasm of our days. Its mortality has remained invariably high over the last decades and the search for effective preventive and therapeutic strategies is as imperative as ever. Carcinogenesis is a process requiring years until invasive malignancy has developed and hence offers a sufficient period for early detection of (pre-)malignant lesions. Now, tools seem available to achieve this goal: technical refinements advocate a reappraisal of screening methods for lung cancer. Also, apart from conventional diagnostic procedures, which are reviewed in this article, photodynamic and autofluorescence bronchoscopy deserve particular attention. Recent data, showing sensitivity for detection of premalignant lesions increased by factor 1.9 to 2.7 as compared to white light bronchoscopy, suggest markedly improved diagnostic options. With these new instruments, especially when combined with screening programs of high-risk groups, earliest possible diagnosis and successful therapeutic intervention seem a promising concept of reduction of lung cancer mortality.

Bronchoscopes↗

PubMed2007

Measuring the psychosocial consequences of screening.

The last three decades have seen a dramatic rise in the implementation of screening programmes for cancer in industrialised countries. However, in contrast to screening for infectious diseases, most cancer screening programmes only have the potential to reduce mortality; they cannot lower the incidence of cancer in a population. In fact, most cancer screening programmes have been shown to increase the incidence of the disease as a consequence of over-diagnosis. A further dilemma of cancer screening programmes is that they do not distinguish between healthy people and those with disease. Rather, they identify a continuum of disease severity. Consequently, many healthy people who have abnormal screening tests are wrongly diagnosed. Indeed, studies have demonstrated that for each screening-prevented death from cancer, at least 200 false-positive results are given. Therefore, screening has the potential to be harmful as well as beneficial. The psychosocial consequences of false-positive screening results cannot be determined by diagnostic tests or by other technical means. Instead, patient reported outcome measures must be employed. To measure the outcomes of screening accurately and comprehensively patient reported outcome measures have to capture; the nature and extent of the psychosocial consequences and how these change over time. The outcome measures used must have high content validity and their psychometric properties should be determined prior to their use in the specific population. In particular it is important to establish unidimensionality, additivity and item ordering through the application of Item Response Theory.

Diagnostic Errors↗

PubMed1986

[Early diagnosis of colorectal cancer: technical problems and acceptability].

There has been little change in the survival rate of colorectal cancer over the last 20 years. Earlier diagnosis probably offers the best hope for improving this survival. At the present time, the only practical method of population screening is by the detection of occult blood in the faeces. Almost all published screening trials are uncontrolled. Although cancer detected by occult blood screening tends to be at a relatively early stage, only controlled trials can answer the critical question of whether screening decreases mortality from bowel cancer. High risk patients (prior adenoma or colorectal cancer, extensive colitis of more than 10 years duration, family history of polyposis) should have colonoscopy at regular intervals.

Adult↗

PubMed1984

Nontuberculous mycobacterial infections: comparison of the fluorescent auramine-O and Ziehl-Neelsen techniques in tissue diagnosis.

Nontuberculous (i.e., atypical) mycobacterial infections are increasing among pediatric and immunosuppressed patients, who commonly present with subcutaneous inflammatory masses or adenitis, which is often surgically excised. Since the most frequently isolated species also grow slowly in culture, early diagnosis may depend on histologic detection of a mycobacterial organism in the biopsy specimen. However, the histologic methods used for this purpose are of uncertain value in the diagnosis of these infections. Biopsy specimens from 22 patients with clinical histories highly consistent with nontuberculous mycobacteriosis in which part of the tissue was cultured were selected for study. Coded tissue blocks and control specimens were stained by the Ziehl-Neelsen (ZN) or auramine-O (A0) fluorescent technique and examined blindly for the presence of characteristic organisms. Results of these studies were compared with the culture results, and predictive values were calculated. This experience showed that the AO technique is technically simpler, allowing faster screening at lower power and showing greater sensitivity and predictive value of a negative result although less specificity than the ZN technique. The lower specificity of AO may be factitious and due to the detection in the tissue of organisms that did not grow in culture. Previous observations that nontuberculous mycobacterial infections may elicit tissue reactions that simulate cat-scratch disease, sarcoidosis, and nonspecific chronic inflammation were also confirmed.

Adult↗

PubMed1976

Erythrocyte porphyrin analysis in the detection of lead poisoning in children: evaluation of four micromethods.

We evaluated four procedures for determination of erythrocyte porphyrin: double extraction with ethyl acetate/acetic acid-HCl, single extraction with ethanol, single extraction with acetone, and direct solubilization with detergent-buffer. The ethyl acetate procedure, when used with two portions of HCl, apparently gives complete recovery of porphyrin and is suitable for reference as a comparison method. The ethanol procedure gives a high and consistent recovery and is technically simpler. The acetone procedure gives low and variable recovery of porphyrin, and the detergent-buffer method is subject to serious hemoglobin interference; neither of these two procedures offers any technical advantage. Stability of samples and methods for standardization were explored. A procedure for expressing results in terms of erythrocyte Zn-protoporphyrin content is given. Because of its stability, coproporphyrin is useful as a daily working standard. The ethyl acetate and ethanol methods are about equally efficient for detecting lead intoxication. Because of its simplicity, the ethanol method seems to be the best for use in screening.

Acetates↗

PubMed2005

The role of computed tomography in screening for cancer.

Recent technical developments have revolutionized computed tomographic (CT) capabilities, and therefore its clinical applications. Multidetector CT (MDCT) allows scanning of the entire body within a few minutes. Over 60 million CT examinations were performed last year in the United States and Western Europe. Many emergency room physicians use it as a virtual physical examination. Its applications to early cancer detection have been controversial. Targeted CT screening for widely prevalent cancers, namely lung and colon, has been advocated in the literature. Combining the two, a whole-body screening CT scan might be offered to appropriately selected, high-risk populations.

Colorectal Neoplasms↗

PubMed1994

Management of clinically occult (nonpalpable) breast lesions.

In the past generation, mammography has become a major, if not the best available, diagnostic tool for the earlier detection of breast cancer. We have certainly come far from hard-to-imagine anecdotes of the early 1970s that "if I can't feel it, it's not there!" Although current controversy questions the earliest age at which screening mammography truly lowers the death rate from breast cancer, that mammography does detect breast cancer years before it might be discovered as a mass in the breast cannot be challenged. Mammographic techniques have improved so that smaller and smaller areas of suspicion may be identified, and mammographers have gained greater judgment in the interpretation of these minute radiographic abnormalities. This has inevitably led to an increase in procedures designed to explain them. The incurred costs, both emotional and economic, of positive mammographic "calls" are considerable. Whether practicing medicine as patients' advocates or, as unfortunately currently seems to be of equal importance, exercising politically correct and cost-effective mandates, the management of nonpalpable breast lesions certainly bears witness to the correlation of cognitive and procedural skills and cooperation between physicians, as well as the technical achievements of contemporary medicine.

Biopsy↗

PubMed2003

Screening and management of tuberculosis in immigrants: the challenge beyond professional competence.

SETTING: Right of entry may sometimes be denied to immigrants because of the threat of tuberculosis. During 1990-2000 some 1050000 immigrants, mostly from countries highly endemic for TB, arrived in Israel, a low prevalence country. Nevertheless, TB rates in Israel have remained low. OBJECTIVE: To emphasise the challenge beyond technical competence for TB control for immigrants from the perspective of Israel's National Tuberculosis Programme (NTP). MATERIALS AND METHODS: We defined criteria for an NTP geared to immigration, and analysed our implementation of the European Task Force recommendations on international migration and TB control. We interviewed immigrants and health care workers to identify barriers to diagnosis, prevention and treatment of TB among immigrants. We used classical epidemiology to evaluate the impact of immigration on TB rates in the host population. RESULTS: Until now there has been no evidence of significant spread of TB from immigrants to the host population. Successful outcome of treatment has been noted in over 75%, although a sub-population of immigrant substance abusers is proving more difficult to treat. CONCLUSIONS: The risk of TB for the host country is very low and it seems possible to enhance TB control in immigrants with measures designed to address their cultural needs.

Emigration and Immigration↗

PubMed2006

A novel design for estimating relative accuracy of screening tests when complete disease verification is not feasible.

The accuracy (sensitivity and specificity) of a new screening test can be compared with that of a standard test by applying both tests to a group of subjects in which disease status can be determined by a gold standard (GS) test. However, it is not always feasible to administer a GS test to all study subjects. For example, a study is planned to determine whether a new screening test for cervical cancer ("ThinPrep") is better than the standard test ("Pap"), and in this setting it is not feasible (or ethical) to determine disease status by biopsy in order to identify women with and without disease for participation in a study. When determination of disease status is not possible for all study subjects, the relative accuracy of two screening tests can still be estimated by using a paired screen-positive (PSP) design in which all subjects receive both screening tests, but only have the GS test if one of the screening tests is positive. Unfortunately in the cervical cancer example, the PSP design is also infeasible because it is not technically possible to administer both the ThinPrep and Pap at the same time. In this article, we describe a randomized paired screen-positive (RPSP) design in which subjects are randomized to receive one of the two screening tests initially, and only receive the other screening test and GS if the first screening test is positive. We derive maximum likelihood estimators and confidence intervals for the relative accuracy of the two screening tests, and assess the small sample behavior of these estimators using simulation studies. Sample size formulae are derived and applied to the cervical cancer screening trial example, and the efficiency of the RPSP design is compared with other designs.

Biometry↗