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PubMedDate not supplied

ECG boy: low-cost medical instrumentation using mass-produced, hand-held entertainment computers. A preliminary report.

A prototype low-cost, portable ECG monitor, the "ECG Boy," is described. A mass produced hand-held video game platform is the basis for a complete three-lead, driven right-leg electrocardiogram (ECG). The ECG circuitry is planned to fit in a standard modular cartridge that is inserted in a production Nintendo "Gameboy." The combination is slightly smaller than a paperback book and weighs less than 500 g. The unit contains essential safety features such as optical isolation and is powered by 9-V and AA batteries. Functionally, the ECG Boy permits viewing ECG recordings in real time on the integrated screen. The user can select both the lead displayed on the screen and the time scale used. A 1-mV reference allows for calibration. Other ECG enhancements such as data transmission via telephone can be easily and inexpensively added to this system. The ECG Boy is intended as a proof of concept for a new class of low-cost biomedical instruments. Rising health care costs coupled with tightened funding have created an acute demand for low-cost medical equipment that satisfies safety and quality standards. A mass-produced microprocessor-based platform designed for the entertainment market can keep costs low while providing a functional basis for a biomedical instrument.

Analog-Digital Conversion↗
PubMed2006

Colonoscopic withdrawal times and adenoma detection during screening colonoscopy.

BACKGROUND: Colonoscopy is commonly used to screen for neoplasia. To assess the performance of screening colonoscopy in everyday practice, we conducted a study of the rates of detection of adenomas and the amount of time taken to withdraw the colonoscope among endoscopists in a large community-based practice. METHODS: During a 15-month period, 12 experienced gastroenterologists performed 7882 colonoscopies, of which 2053 were screening examinations in subjects who had not previously undergone colonoscopy. We recorded the numbers, sizes, and histologic features of the neoplastic lesions detected during screening, as well as the duration of insertion and of withdrawal of the colonoscope during the procedure. We compared rates of detection of neoplastic lesions among gastroenterologists who had mean colonoscopic withdrawal times of less than 6 minutes with the rates of those who had mean withdrawal times of 6 minutes or more. According to experts, 6 minutes is the minimum length of time to allow adequate inspection during instrument withdrawal. RESULTS: Neoplastic lesions (mostly adenomatous polyps) were detected in 23.5% of screened subjects. There were large differences among gastroenterologists in the rates of detection of adenomas (range of the mean number of lesions per subject screened, 0.10 to 1.05; range of the percentage of subjects with adenomas, 9.4 to 32.7%) and in their times of withdrawal of the colonoscope from the cecum to the anus (range, 3.1 to 16.8 minutes for procedures during which no polyps were removed). As compared with colonoscopists with mean withdrawal times of less than 6 minutes, those with mean withdrawal times of 6 minutes or more had higher rates of detection of any neoplasia (28.3% vs. 11.8%, P<0.001) and of advanced neoplasia (6.4% vs. 2.6%, P=0.005). CONCLUSIONS: In this large community-based gastroenterology practice, we observed greater rates of detection of adenomas among endoscopists who had longer mean times for withdrawal of the colonoscope. The effect of variation in withdrawal times on lesion detection and the prevention of colorectal cancer in the context of widespread colonoscopic screening is not known. Ours was a preliminary study, so the generalizability and implications for clinical practice need to be determined by future studies.

Adenoma↗
PubMed2002

Modeling and optimization in early detection programs with a single exam.

The choice of timing of screening examinations is an important element in determining the efficacy of strategies for the early detection of occult disease. In this article, we describe a flexible decision-making framework for the design of early detection programs, and we investigate the choice of timing when each individual in the screening program is examined only once. We focus on the theoretical relation between the optimal examination time and the distributions of sojourn times in health-related states. Specifically, we derive closed-form solutions of the optimal age using two specifications of utility functions, discuss the effects of natural history and utility specifications on the optimal solution, and present an application to early detection of colorectal cancer by once-only sigmoidoscopy or colonoscopy.

Age Factors↗
PubMed2003

Erectile dysfunction risk factors in noninsulin dependent diabetic Saudi patients.

PURPOSE: We assessed the prevalence of and analyzed risk factors for erectile dysfunction in patients with noninsulin dependent diabetes in Makkah, Saudi Arabia. MATERIALS AND METHODS: A total of 562 male diabetic Saudi patients were enrolled in this study. Patients were screened for erectile dysfunction using the International Index of Erectile Function. At the time of screening patients were also interviewed for sociodemographic data, including age, education, occupation, marital status and smoking. Medical history included diabetes, diabetes related complications, risk factors for diabetes and erectile dysfunction, and current medication. RESULTS: Mean age of the study sample was 53.7 years (range 27 to 84). Of the patients 86.1% had various degrees of erectile dysfunction, including mild in 7.7%, moderate in 29.4% and severe in 49.1%. The prevalence of erectile dysfunction was 25% in patients younger than 50 years, which increased to 75% in those older than 50 years. Of those without erectile dysfunction 70% were younger and 30% were older than 50 years (p = 0.0001). Patients with a history of diabetes of greater than 10 years were 3 times as likely to report erectile dysfunction as those with a history of less than 5 years. Men with poor metabolic control were 12.2 times as likely to report erectile dysfunction as those with good metabolic control. Of diabetic patients with erectile dysfunction 53% had 1 or more diabetic related complications compared with 20.5% with no erectile dysfunction (p = 0.0001). CONCLUSIONS: Erectile dysfunction is common in diabetic Saudi men. This study provides a quantitative estimate of the prevalence of erectile dysfunction and its main risk factors in diabetic Saudi patients.

Adult↗
PubMed2006

Expanded HIV screening in the United States: effect on clinical outcomes, HIV transmission, and costs.

BACKGROUND: An extensive literature supports expanded HIV screening in the United States. However, the question of whom to test and how frequently remains controversial. OBJECTIVE: To inform the design of HIV screening programs by identifying combinations of screening frequency and HIV prevalence and incidence at which screening is cost-effective. DESIGN: Cost-effectiveness analysis linking simulation models of HIV screening to published reports of HIV transmission risk, with and without antiretroviral therapy. DATA SOURCES: Published randomized trials, observational cohorts, national cost and service utilization surveys, the Red Book, and previous modeling results. TARGET POPULATION: U.S. communities with low to moderate HIV prevalence (0.05% to 1.0%) and annual incidence (0.0084% to 0.12%). TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTIONS: One-time and increasingly frequent voluntary HIV screening of all adults using a same-day rapid test. OUTCOME MEASURES: HIV infections detected, secondary transmissions averted, quality-adjusted survival, lifetime medical costs, and societal cost-effectiveness, reported in discounted 2004 dollars per quality-adjusted life-year (QALY) gained. RESULTS OF BASE-CASE ANALYSIS: Under moderately favorable assumptions regarding the effect of HIV patient care on secondary transmission, routine HIV screening in a population with HIV prevalence of 1.0% and annual incidence of 0.12% had incremental cost-effectiveness ratios of 30,800 dollars/QALY (one-time screening), 32,300 dollars/QALY (screening every 5 years), and 55,500 dollars/QALY (screening every 3 years). In settings with HIV prevalence of 0.10% and annual incidence of 0.014%, one-time screening produced cost-effectiveness ratios of 60,700 dollars/QALY. RESULTS OF SENSITIVITY ANALYSIS: The cost-effectiveness of screening policies varied within a narrow range as assumptions about the effect of screening on secondary transmission varied from favorable to unfavorable. Assuming moderately favorable effects of antiretroviral therapy on transmission, cost-effectiveness ratios remained below 50,000 dollars/QALY in settings with HIV prevalence as low as 0.20% for routine HIV screening on a one-time basis and at prevalences as low as 0.45% and annual incidences as low as 0.0075% for screening every 5 years. LIMITATIONS: This analysis does not address the difficulty of determining the prevalence and incidence of undetected HIV infection in a given patient population. CONCLUSIONS: Routine, rapid HIV testing is recommended for all adults except in settings where there is evidence that the prevalence of undiagnosed HIV infection is below 0.2%.

Adult↗
PubMed1985

Macular recovery time recorded by nyctometry--a screening method for selection of patients who are at risk of developing proliferative diabetic retinopathy. Results of a 5-year follow-up.

A 5-year study on the predictive value of the macular recovery time, as recorded by nyctometry, in the development of proliferative diabetic retinopathy in insulin-dependent diabetes mellitus has been completed. Seventy-seven patients with a median age of 30,8 years and a median duration of the disease of 15,8 years participated. In the follow-up period, 16 out of 20 patients initially showing abnormally prolonged macular recovery time had developed proliferative diabetic retinopathy the median duration from the initial investigation to the diagnosis of retinal neovascularization being 34 months. Contrary to this finding, only 4 out of 57 patients initially showing normal macular recovery had advanced into proliferative retinopathy, and the median duration until diagnosis of this condition was 45 months. It is concluded that nyctometry can serve as an easily performed screening method in selecting those at risk of developing proliferative retinopathy within a few years.

Adolescent↗
PubMed2006

What motivates men age > or =50 years to participate in a screening program for melanoma?

BACKGROUND: The screening behavior and screening outcomes of men age > or =50 years was investigated within a randomized controlled trial of a community-based intervention of screening for melanoma, consisting of a community education program, an education program for medical practitioners, and the provision of dedicated skin-screening clinics. METHODS: Data from cross-sectional telephone surveys before (559 completed interviews), at the end (591 completed interview), and at 2 years after the intervention (445 completed interviews) were analyzed. In addition, the authors analyzed data from skin-screening clinics within the intervention program (3355 men age > or =50 years participated). RESULTS: During the intervention period men age > or =50 years increased both their screening behavior and intention to screen. Those men age > or =50 years who reported a past history of removal of a mole as well as other risk factors for skin cancer and positive attitudes toward screening were more likely to participate in skin screening across time. Men age > or =50 years accounted for 20.5% of all skin-screening clinic attendees, 31.3% of those referred for a suspicious lesion, 48.5% of melanomas, and 45% of all keratinocyte carcinomas diagnosed within the screening program, respectively. CONCLUSIONS: The intervention program successfully motivated men age > or =50 years to attend screening for skin cancer, resulting in the highest yield of skin cancer within this subgroup of the population. Messages addressing skin cancer risk factors and attitudes toward skin cancer and screening could be used to target a screening program for melanoma toward men age > or =50 years.

Attitude to Health↗
PubMed2005

Towards an inline reconstruction architecture for micro-CT systems.

Recent developments in micro-CT have revolutionized the ability to examine in vivo living experimental animal models such as mouse with a spatial resolution less than 50 microm. The main requirements of in vivo imaging for biological researchers are a good spatial resolution, a low dose induced to the animal during the full examination and a reduced acquisition and reconstruction time for screening purposes. We introduce inline acquisition and reconstruction architecture to obtain in real time the 3D attenuation map of the animal fulfilling the three previous requirements. The micro-CT system is based on commercially available x-ray detector and micro-focus x-ray source. The reconstruction architecture is based on a cluster of PCs where a dedicated communication scheme combining serial and parallel treatments is implemented. In order to obtain high performance transmission rate between the detector and the reconstruction architecture, a dedicated data acquisition system is also developed. With the proposed solution, the time required to filter and backproject a projection of 2048 x 2048 pixels inside a volume of 140 mega voxels using the Feldkamp algorithm is similar to 500 ms, the time needed to acquire the same projection.

Algorithms↗
PubMed2001

Does mammographic screening and a negative result affect attitudes towards future breast screening?

OBJECTIVES: To investigate the impact of an experience of a benign mammographic result on intention to seek medical help immediately in the case of breast abnormalities, and on intentions and thoughts about future participation in screening. SETTING: The Dutch Breast Cancer Screening Programme for women aged 50-69. METHODS: Subjects were women who were invited for an initial breast examination: 223 women filled out a questionnaire about 10 days before and about 6 weeks after their initial breast examination. To be able to control for possible test effects, another group of 293 women filled out a questionnaire only after mammography. Changes in thoughts and intentions were examined. RESULTS: Most women were very satisfied with the course of their initial breast examination, although pain or discomfort was often mentioned. No clues to suggest false reassurance were found: more than 99% of the women would consider the possibility of breast cancer if they felt a lump in one of their breasts. In such a situation, most women intended to seek medical help within a week. These variables were not influenced by the experience of mammography with a benign result. In general, women were very positive about (repeat) participation, both before and after screening. After screening, the average woman perceived fewer costs in participating, and perceived her own ability to engage in future screening as higher. However, the experience of pain and anxiety during the initial screening did lead to reverse effects. Women who were less satisfied about their treatment by the staff were more likely to change their intentions to reparticipate in a negative way. CONCLUSIONS: As, in general, women became more positive about regular participation after they had attended breast cancer screening, efforts to improve first round attendance must be continued. At the same time, the screening organisations must continue to prioritise the high level of client friendliness throughout the screening. No evidence for detrimental effects of screening through false reassurance among participants was found.

Aged↗
PubMed2002

Stephen L. Gans overseas lecture. Mass screening for neuroblastoma in Japan: lessons learned and future directions.

BACKGROUND/PURPOSE: Since 1985, a nationwide mass screening program (MS) for neuroblastoma has been conducted for 6-month-old infants throughout Japan, resulting in the detection of more than 1,900 cases of neuroblastoma. The outcome of these patients has been excellent: more than 97% of them are alive. Yet, several reports suggest that the number of advanced-stage neuroblastoma patients over 1 year of age has not changed substantially. The current report focuses on the 15-year experience with MS of the Kyushu Pediatric Oncology Study Group. METHODS: The clinical and biological features of neuroblastoms detected (n = 320) and not detected by MS (n = 245) were compared. Regional and national statistics for neuroblastoma before and after 1985 were analyzed using standard epidemiologic measures for the occurrence of disease. RESULTS: The majority of the MS-positive cases were biologically favorable and had an excellent outcome. In contrast, the majority of non-MS patients in whom neuroblastoma later developed had advanced-stage, unfavorable-prognosis tumors. The overall mortality rate of neuroblastoma in the Kyushu area was not improved by MS. CONCLUSIONS: The optimal time for screening is the point at which neuroblastomas regressing spontaneously can no longer be detected, but more aggressive disease can be found. A birth cohort study could determine the optimal timing for a second screening. Identification of other new prognostic factors may be required.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Inspection for gastric occult blood at regular intervals is the optimum program for the screening of esophageal-gastric cancer.

Gastric occult blood screening has been performed for 242296 persons from 1986 to 1993. 30227 persons had positive reactions to the occult blood reagent. Among them, 17915 persons were asked to accept gastroscopy exam, and 638 esophageal-gastric cancers were found. The cancer detection rates were 3.56%. 4774 persons were asked to accept screening twice and 203 persons were asked to accept screening three times. After follow-up, the cancer detection rates were 2.11% for occult blood positive group if the screening was conducted once a year. The missing case was 0.77% for negative group and it was 0.05% in the same group if the screening was performed twice. Lastly, the missing case would be decreased to 0% when the patients undergone the exam, for three times in continuity. Two thirds of patients still belonged to the early-middle stage of cancer. The 5-year survival rates were 95.2%. The missing case of cancer would be reduced to 0% if the screening was conducted for three years in continuity. The death rates were deducted as well. It is certified that this method is the most effective and reliable way for reducing the death rate of cancer and screening of the upper digestive tract cancer.

Adolescent↗
PubMed2006

Improved toxicogenomic screening for drug-induced phospholipidosis using a multiplexed quantitative gene expression ArrayPlate assay.

We previously showed that a toxicogenomics analysis of drug-induced phospholipidosis enabled the identification of 12 specific gene markers and the establishment of an in vitro real-time PCR screening assay for the assessment of the phospholipidosis-inducing potential of compounds. The purpose of this study was to transfer our PCR-based assay into a 96-well microplate-based multiple mRNAs measuring assay (ArrayPlate assay) in order to increase throughput. Specifically, we determined the expression of the 12 marker genes using real-time PCR and ArrayPlate in human hepatoma HepG2 cells that were treated for 24h with each of amiodarone and 80 proprietary compounds. The following three performance criteria were satisfied in the ArrayPlate analysis: 1. Sensitivity-the expression of mRNA for all target genes was detected at quantifiable levels. 2. Repeatability-signal intensities and fold change values of each marker gene were highly repeatable. 3. Correlation-fold change values and their average values, which were used as indices of phospholipidosis induction potential, showed apparent correlation between the ArrayPlate and real-time PCR assays. Thus, the in vitro screening assay for compound-induced phospholipidosis should be transferable from a PCR-based assay to the higher-throughput ArrayPlate-based method.

Cell Line, Tumor↗
PubMed2006

[The Dutch Child Health Care guideline 'early detection of congenital heart disease in the age group 0-19 years'].

The Dutch Child Health Care guideline on the early detection of congenital heart disease was developed according to the principles for evidence-based guideline development and contains recommendations for the conduct of the examination during routine check-ups and for referral criteria. Most congenital heart diseases can be detected in the first year of life if physicians and nurses work according to this guideline. Important early times for screening are the home visit to infants at the age of two weeks by the child health nurse and the routine check-up of infants at the age of four weeks by the child health care physician. A routine cardiac screening is carried out in every child by the nurse and the physician at times specified in the basic list of professional responsibilities. A more extensive examination is carried out when indicated. Routine cardiac check-ups are recommended until the age of four, after which they should be done only when indicated on medical grounds. A feasibility study showed that physicians and nurses can apply the guideline effectively, provided that they take part in prior specific training.

Adolescent↗
PubMed1980

Hypertension, levels of serum gamma glutamyl transpeptidase and degree of blood pressure control in middle-aged males.

Among the first screened 2439 males born in 1926 and 1927, aged 48-49 years at the time of screening and representing 76% of these age cohorts, uncontrolled or partly controlled hypertension was found in 7.5%. Of these individuals, 30% preferred to remain with their physicians, regardless of the degree of control they had achieved. Among those who were referred to the Hypertension Unit (5.2% of the screened population), elevated S-GT levels (greater than or equal to 1.10 mukat/l) were found in 38.3%, against 18.5% in the two cohorts. During 24 months of treatment and follow-up only two men among the entire group of hypertensives referred dropped out, both were heavy drinkers (greater than 80 g alcohol daily). The mean BP after treatment was significantly lower among men with normal than high S-GT values or in those who admitted to heavy drinking. Of the 99 males treated for more than two years, 82 (83%) were responders (supine DBP less than or equal to 95 mmHg). Of the non-responders, 70% were either heavy drinkers or had abnormal S-GT values. The possible role of alcohol in the pathogenesis of essential hypertension in middle-aged males is discussed.

Alcohol Drinking↗
PubMed2002

Pulmonary tuberculosis in the Taiwanese prison population.

BACKGROUND AND PURPOSE: Tuberculosis (TB) in prison is a serious public health problem that is fueled by overcrowding, poor nutrition and unsatisfactory medical services. To evaluate the magnitude of the TB epidemic in Taiwanese prisons, we analyzed the results of a screening program for TB among inmates. METHODS: A mass radiography screening was performed in 24 prisons and five jails from July 1998 through June 1999. The National TB Register was notified and treatment with a rifampin-based short-course anti-TB regimen was given for all cases identified in the screening. The outcome of treatment of TB inmates was determined from records of the National TB Register. RESULTS: A total of 51,496 inmates were screened. Pulmonary TB was diagnosed in 107 (258.7 per 100,000 population) inmates. Among them, 88 (82.2%) were newly diagnosed TB patients, 12 (11.2%) had a history of anti-TB treatment and were re-treated after screening, and seven (6.6%) had previously diagnosed TB and were receiving treatment at the time of screening. Of the 107 inmates with TB, 86 (80.4%) completed treatment, 17 (15.9%) were lost to follow-up due to release from prison, and four (3.7%) died (three of TB). During a mean of 26.2 +/- 4.4 months (range, 19.7-39.0 mo) post-registration follow-up, three patients who had completed treatment relapsed. CONCLUSIONS: The high prevalence of TB in prisons indicates that prison administrators and the national TB program in Taiwan need to strengthen their activity to control this disease. The establishment of a surveillance section of the national TB program to systematically collect data on TB in prisons may facilitate efforts to monitor and control TB both in prisons and the general population. Our findings also indicate that TB control in prisons should give top priority to improving mycobacteriology laboratory services to ensure the quality of sputum examinations.

Adolescent↗