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PubMed1994

Screening for glaucoma: the time taken by primary examiners to conduct visual field tests in practice.

A panel of 101 primary examiners (optometrists or their ancillary staff) in England and Wales prospectively recorded the time taken to examine the central visual fields of each of 10 (or more) of their patients. The results indicate that the time depended not only on the test procedure but on how frequently the examiner conducted such a test. A basic test with semi-automated field screening equipment, applied routinely by 30 examiners on 547 patients, took an average 3.7 min per patient; (lower quartile 2.8 min). For such examiners, a standard extended test took 4.9 min. Similar times applied whether tests were conducted by an optometrist or an assistant. It was concluded that visual field screening in a normal population could reasonably be assumed to take an average 4 min per patient.

Adult↗
PubMed1983

Occult spinal dysraphism in infants: screening with high-resolution real-time ultrasound.

Spinal dysraphism refers to incomplete embryologic development of the dorsal midline. Frequently it is not clinically obvious, and lack of treatment can lead to progressive neurological damage. Early diagnosis of occult defects can allow appropriate surgical intervention and prevent neurological deficits. The authors have used high-resolution real-time ultrasound to screen infants with various cutaneous lumbosacral markers, all of whom were at risk of occult spinal dysraphism. Preliminary results suggest that ultrasound is a reliable screening procedure and could obviate the need for more costly and invasive tests.

Humans↗
PubMed1993

[Spectral analysis of sounds produced by musical instruments and other sounding bodies for hearing screening of children].

Some time ago audiological screening in infants was mostly performed using musical instruments or equivalents. The use of acoustic evoked potentials and oto-acoustic emissions changed the strategies of hearing assessment in newborns and infants, however, musical instruments are still in use. An adequate interpretation of screening results obtained with musical instruments necessitates a profound knowledge of frequencies and intensities derived from these instruments. In this study spectral analyses of sounds from these instruments were performed. The results may be of value for those using musical instruments as a tool for audiological screening. In addition, the results show that with some instruments intensities able to cause inner ear damage can be generated.

Child↗
PubMed1988

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

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

Adolescent↗
PubMed2004

Feasibility of implementing a universal neonatal hearing screening programme using distortion product otoacoustic emission detection at a university hospital in Hong Kong.

OBJECTIVE: To assess the feasibility of implementing a universal neonatal hearing screening programme using distortion product otoacoustic emission detection at a major teaching hospital in Hong Kong. DESIGN: Descriptive study and questionnaire. SETTING. Teaching hospital, Hong Kong. METHODS: A total of 1064 infants, together with their mothers, were successfully recruited for the study. The participation rate was 99.3%. A three-stage hearing screening protocol using distortion product otoacoustic emission detection was adopted. Each of the participating infants was screened on three separate occasions (day 1-4, day 5-14, and day 21-30 after birth), irrespective of the test results. A questionnaire was administered to 364 randomly selected mothers to determine whether as consumers of the hearing screening service, mothers would find screening desirable. RESULTS: Results of the screening demonstrated an incidence of permanent bilateral hearing loss (>or=40 dB in the better ear) of 0.28%. The results also showed that 3.5% of the screened infants were referred for subsequent diagnostic audiological assessment, including those suspected with unilateral as well as bilateral hearing loss. Data obtained were comparable to other reported results obtained using multi-stage screening protocols. Taking both the false positive rate and the default rate into consideration, the most appropriate time for screening in this hospital setting appeared to be around day 5 to 14 when infants returned to the hospital's day centre as out-patients for routine medical follow-up. Since this day centre service is not generally provided by all maternity hospitals in Hong Kong, an alternative time for screening would be around day 21 to 30 when infants could return as out-patients solely for the hearing test. The results of the questionnaire suggested that most mothers thought a neonatal hearing screening would be desirable (91.35%). The majority (81.70%) indicated a preference for screening either within a few days of birth at the maternity ward prior to discharge from the hospital, or between 5 and 30 days when returning to the hospital as an out-patient. CONCLUSION: It was concluded that a universal neonatal hearing screening programme could be readily implemented in a maternity hospital setting in Hong Kong.

Clinical Protocols↗
PubMed2007

Trends in time to completion of mammographic screening and follow-up services.

OBJECTIVE: The popular press has raised questions about mammographic capacity in the United States, but mammographic utilization data have not been used to inform these concerns. We used data for the period 1995-2002 from the New Mexico Mammography Project to assess trends in time to completion of mammographic screening and follow-up services. CONCLUSION: The median time to return mammographic screening changed little over time, but trends in the time required to complete recommended follow-up services varied by type of service and urban or rural residence. Further monitoring of time required to complete screening and follow-up services in other regions can inform debates on mammographic capacity.

Breast Neoplasms↗
PubMed2005

Current realities of delivering mammography services in the community: do challenges with staffing and scheduling exist?

PURPOSE: To evaluate the current (2001-2002) capacity of community-based mammography facilities to deliver screening and diagnostic services in the United States. MATERIALS AND METHODS: Institutional review board approvals and patient consent were obtained. A mailed survey was sent to 53 eligible mammography facilities in three states (Washington, New Hampshire, and Colorado). Survey questions assessed equipment and staffing availability, as well as appointment waiting times for screening and diagnostic mammography services. Criterion-related content and construct validity were obtained first by means of a national advisory committee of academic, scientific, and clinical colleagues in mammography that reviewed literature on existing surveys and second by pilot testing a series of draft surveys among community mammography facilities not inclusive of the study facilities. The final survey results were independently double entered into a relational database with programmed data checks. The data were sent encrypted by means of file transfer protocol to a central analytical center at Group Health Cooperative. A two-sided P value with alpha = .05 was considered to show statistical significance in all analyses. RESULTS: Forty-five of 53 eligible mammography facilities (85%) returned the survey. Shortages of radiologists relative to the mammographic volume were found in 44% of mammography facilities overall, with shortages of radiologists higher in not-for-profit versus for-profit facilities (60% vs 28% reported). Shortages of Mammography Quality Standards Act-qualified technologists were reported by 20% of facilities, with 46% reporting some level of difficulty in maintaining qualified technologists. Waiting times for diagnostic mammography ranged from less than 1 week to 4 weeks, with 85% performed within 1 week. Waiting times for screening mammography ranged from less than 1 week to 8 weeks, with 59% performed between 1 week and 4 weeks. Waiting times for both diagnostic and screening services were two to three times higher in high-volume compared with low-volume facilities. CONCLUSION: Survey results show shortages of radiologists and certified mammography technologists.

Breast Neoplasms↗
PubMed1991

Intermediate determinants of mortality in the evaluation of screening.

The long time needed to carry out experimental studies of screening for chronic diseases limits their usefulness. This paper describes a method of using prognostic factors, such as the stage of cancer, determined at the time of treatment in screened and unscreened groups to predict the subsequent population mortality rate in each group. The method of prediction makes use of available data on the relation of case fatality to the prognostic factors. Such predictions could be made several years in advance of the time that mortality would be observed directly. The method is illustrated by use of data from the Health Insurance Plan (HIP) study of screening for breast cancer. A reduction of mortality in screened compared to unscreened women was predicted, but it was substantially less than the reduction that was observed. Potential sources of error in the predictions are discussed.

Breast Neoplasms↗
PubMed2005

The role of anxiety in prostate carcinoma: a structured review of the literature.

Although the impact of anxiety on patients with some types of cancer is well recognized, to the authors knowledge its impact on patients with prostate carcinoma has not been studied as thoroughly. The authors conducted a systematic review of the medical literature for high-quality articles that quantified anxiety levels in men with prostate carcinoma and identified 29 articles. Using the clinical timeline of prostate carcinoma to organize the articles, cross-sectional studies that reflected anxiety prevalence in populations and longitudinal studies that reflected changes in anxiety over time were identified. Anxiety appeared to fluctuate over the clinical timeline in response to stressors and uncertainty (such as at the time of screening and/or biopsy), rising before these times and falling afterward. Although anxiety levels in men age > 55 years who were at risk for prostate carcinoma were modest (10-15%), multiple studies found that these levels were substantially higher in men who presented for screening (> 50%), and "seeking peace of mind" was the motivation cited most frequently for pursuing screening. Most studies demonstrated a significant decrease in anxiety levels after a normal screening or biopsy result, although the proportion of men who remained anxious afterward did not fall to baseline levels (20-36%). Men who presented for prostate-specific antigen monitoring after treatment had elevated anxiety levels at the time of testing (23-33%). Many years after therapy for localized disease, anxiety levels were lower after prostatectomy (23%) compared with the levels after watchful waiting (31%).

Anxiety↗
PubMed1998

Bleeding symptoms and subsequent risk of gynecological and other cancers.

BACKGROUND: The purpose of our study was to find out whether bleeding symptoms are predictive factors of subsequent gynecological or urinary cancers among women screened negative. METHODS: The data stemmed from the Finnish Mass Screening Registry, and were linked to the National Cancer Registry: 37,596 screening negative women in the nationwide population-based mass screening program for cervical cancer were classified by their bleeding symptom (bloody discharge, coital bleeding, irregular bleeding, postmenopausal bleeding) at the time of screening (1985-1990) and followed up (1985-1994) in order to assess the subsequent risk of cancer. RESULTS: Bleeding symptoms with prevalence of 5.9% were more likely to be signs of preinvasive than invasive cervical cancer with the exception of coital bleeding, nevertheless relative risk of cervical cancer (SIR 1.1, 95% CI 0.8-1.4) was not significantly increased during the total follow-up of maximum 10 years. Women with any bleeding symptom had increased risk of cancer of the corpus uteri (SIR 2.1, 95% CI 1.6-2.6), postmenopausal bleeding was the strongest symptom (RR 3.6, 95% CI 2.0-6.0). None of the bleeding symptoms increased subsequent risk of ovarian, vaginal or vulvar carcinoma. The risk of kidney cancer was increased (SIR 1.7, 95% CI 1.0-2.6). CONCLUSIONS: The prevalence of bleeding symptoms was small and relative risks for cancers were low for them to be suitable as predictive factors of cancer neither in clinical practice nor for public health purposes, e.g. in developing selective screening based on this high risk group. Only 34 gynecological cancers during 220,000 person-years in women with bleeding symptoms were attributable to bleeding. Relative risks remained increased only for a short time after screening. Therefore, short term surveillance is important, but due to the fact that relative risks approached unity during the follow-up, reassurance of a woman that she is cancer-free should be emphasized more in the long term after the bleeding symptoms.

Adolescent↗
PubMed1999

Screening for breast cancer: time, travel, and out-of-pocket expenses.

BACKGROUND: We estimated the personal costs to women found to have a breast problem (either breast cancer or benign breast disease) in terms of time spent, miles traveled, and cash payments made for detection, diagnosis, initial treatment, and follow-up. METHODS: We analyzed data from personal interviews with 465 women from four communities in Florida. These women were randomly selected from those with a recent breast biopsy (within 6-8 months) that indicated either breast cancer (208 women) or benign breast disease (257 women). One community was the site of a multifaceted intervention to promote breast screening, and the other three communities were comparison sites for evaluation of that intervention. All P values are two-sided. RESULTS: In comparison with time spent and travel distance for women with benign breast disease (13 hours away from home and 56 miles traveled), time spent and travel distance were statistically significantly higher (P<.001) for treatment and follow-up of women with breast cancer (89 hours and 369 miles). Personal financial costs for treatment of women with breast cancer were also statistically significantly higher (breast cancer = $604; benign breast disease = $76; P < .001) but were statistically significantly lower for detection and diagnosis (breast cancer = $170; benign breast disease = $310; P < .001). Among women with breast cancer, time spent for treatment was statistically significantly lower (P = .013) when their breast cancer was detected by screening (68.9 hours) than when it was detected because of symptoms (84.2 hours). Personal cash payments for detection, diagnosis, and treatment were statistically significantly lower among women whose breast problems were detected by screening than among women whose breast problems were detected because of symptoms (screening detected = $453; symptom detected = $749; P = .045). CONCLUSION: There are substantial personal costs for women who are found to have a breast problem, whether the costs are associated with problems identified through screening or because of symptoms.

Aged↗
PubMedDate not supplied

Fast method development and rapid analysis using a screening approach for enantiomeric separations in capillary electrophoresis.

In order to speed up the trial-and-error process during enantioselective capillary electrophoresis methods development, a systemized approach is proposed to develop methods by applying several screening methods in the search for an initial separation. Screening methods combine high selectivity with broad applicability and are applied to find an initial enantiomeric separation during early pharmaceutical development (pre-Phase 1 to Phase 1). The goal is to achieve enantiomeric separation rapidly in order to characterize the chiral purity of pharmaceutical products. Dedicated, highly efficient screening methods are suggested for basic, neutral, and acidic compounds. In these screening methods, multiple chiral selectors are applied in mixtures at different buffer pH values. For the compounds studied, the technique allows fast method development. Furthermore, it is potentially applicable to a wide range of low-molecular-weight compounds and permits rapid analysis at low cost, since runs are performed in inexpensive, bare silica capillaries using ordinary buffer systems with only typical cyclodextrins as the selector. Along with simplicity and robustness, the approach results in sufficient efficacy (i.e., it is easy, straightforward, and reproducible, with a high success rate). Typical pharmaceutical applications are described. The major advantage of the screening approach to methods development is the decrease in development cycle time. The total screening time for one compound was about 5.3 hr on one CE instrument.

Complex Mixtures↗