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At least 721 records · Page 40Linked to original sources
PubMed1997

Ultrasonographic screening before hospital discharge for deep venous thrombosis after arthroplasty: the post-arthroplasty screening study. A randomized, controlled trial.

BACKGROUND: The clinical significance of asymptomatic deep venous thrombosis that develops after joint arthroplasty and the value of screening tests to detect thrombi are uncertain. OBJECTIVES: To determine 1) the rate of symptomatic deep venous thrombosis or pulmonary embolism occurring after hospitalization for joint arthroplasty and 2) the value of screening compression ultrasonography. DESIGN: Double-blind, randomized, controlled trial. SETTING: Tertiary care hospital. PATIENTS: 1024 patients undergoing elective total hip or knee arthroplasty who received warfarin prophylaxis. INTERVENTION: Patients were randomly assigned to undergo either bilateral compression ultrasonography or a sham procedure before hospital discharge. Patients with a diagnosis of asymptomatic deep venous thrombosis were treated after discharge with standard anticoagulant therapy; other patients had warfarin therapy discontinued at discharge. All patients were followed for 90 days. RESULTS: In the screening group, asymptomatic proximal deep venous thrombosis was detected in 13 of 518 patients (2.5%). Another 4 patients subsequently developed symptomatic proximal deep venous thrombosis, and 1 patient treated for asymptomatic deep venous thrombosis developed major bleeding, for a total outcome event rate of 1.0% (5 of 518 patients). In the placebo group, 3 patients developed symptomatic proximal deep venous thrombosis and 2 had nonfatal pulmonary embolism, for a total event rate of 1.0% (5 of 506 patients) (difference, 0 percentage points [95% CI, -1.2 to 1.2 percentage points]). CONCLUSIONS: In patients undergoing total hip or knee arthroplasty, the use of warfarin prophylaxis during hospitalization results in a very low rate of symptomatic deep venous thrombosis or pulmonary embolism after hospital discharge. The use of screening compression ultrasonography at hospital discharge does not seem to be justified in this setting.

Algorithms↗
PubMed1991

A maternal serum screen for trisomy 18: an extension of maternal serum screening for Down syndrome.

The feasibility of extending second-trimester maternal blood screening for Down syndrome so as to include screening for trisomy 18 was examined using stored maternal serum samples collected for neural tube-defect screening. There were 12 samples from trisomy 18 pregnancies and 390 controls. The median maternal serum concentration of alpha-fetoprotein, free alpha-subunit human chorionic gonadotrophin, free beta-subunit human chorionic gonadotrophin, intact human chorionic gonadotrophin, total estriol, unconjugated estriol, estradiol, human placental lactogen, and progesterone were lowered in those pregnancies affected by trisomy 18 when compared with unaffected pregnancies matched for racial origin, maternal age, gestational age, and sample-storage duration. At an estimated odds risk of 1:400, 83.3% of affected pregnancies were detected using an algorithm which combines the maternal age-related risk with the maternal serum concentrations of unconjugated estriol, free alpha-subunit human chorionic gonadotrophin, free beta-subunit human chorionic gonadotrophin, estradiol, and human placental lactogen. The associated false-positive rate was 2.6%. At high risk odds of 1:10, the detection rate was 58.3%, with an associated false-positive rate of 0.3%. beta-Subunit human chorionic gonadotrophin and unconjugated estriol were the most powerful discriminators. It is possible to incorporate into existing Down syndrome screening programs an algorithm for detecting trisomy 18 with high sensitivity and specificity.

Adult↗
PubMed1990

[Tumor marker--screening for gynecological cancer; personal experience. Utility of tumor markers in screening of ovarian cancer].

PAP smears and biopsies are very effective in mass screening for uterine cancer. However, in this study, we tried to determine whether tumor markers could be useful for ovarian cancer screening. Eight tumor markers (CA125, TPA, CEA, ALP, amylase, LDH, CRP, IAP) were tested in serum samples from 3,540 women and the values were supplied to a CAMPAS (computer aided multivariate and pattern analysis system). Using this system, we managed to reduce the false positive rate to 0.68% but we couldn't prove the sensitivity of this system, because there were no ovarian cancer cases in this group. At this time, it is important to determine the high risk group of ovarian cancer for reducing the cost of mass screening. Finally, if tumor markers are to become more effective for ovarian cancer screening, it will be necessary to find ones that are more sensitive to ovarian cancer.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1990

[Early diagnosis of cystic fibrosis: to screen or not to screen?].

After an experimental neonatal screening program for cystic fibrosis (CF) had been carried out in the Netherlands during 1973-1979, a follow-up study to evaluate the effects of neonatal screening was started in 1980. The results of this study suggest that early diagnosis and appropriate treatment may prevent serious deterioration and death at a young age, and may reduce the extent of early irreversible lung damage in patients with CF. The short period between the birth of an affected child and the diagnosis and the timely information on the high recurrence risk, may lead to a significant reduction in subsequent births in the case of neonatal screening. However it is still doubtful whether general neonatal screening for CF should be recommended, as treatment directed against the harmful effects of the genetic defect is not yet available.

Child↗
PubMed2005

Cystic fibrosis newborn screening: a pilot study to maximize carrier screening.

Newborn screening for cystic fibrosis (CF) is expanding because early diagnosis has been shown to result in improved nutrition and growth. Most newborns identified by a mutation panel have a single detected mutation and require sweat testing to exclude an additional undetected mutation. The resulting identification of CF carrier newborns, although not the primary purpose of screening, has three potential benefits, (1) the detection of trait-trait couples, (2) presymptomatic testing of these couples' previously born children who may have undetected CF, and (3) a carrier parent alerting his/her extended family members to the chance of also being a CF carrier. Reaping each benefit requires genetic counseling of parents and their accepting carrier testing. The purpose of this study was to utilize the sweat testing visit to educate parents about the value of carrier testing for themselves and their blood relatives. We compared special care (genetic counseling after explaining the sweat test result and offering of parental DNA testing, all on the sweat test visit) versus standard care (sweat test result reported by phone to the parents the next day by the newborn's physician, ideally with the recommendation to arrange genetic counseling and parental carrier testing). In the first year of New York State CF screening, 64 newborns with one detected mutation were reported in the nine-county region that includes Rochester. Of these, parents of 39 agreed to participate in the study and to be randomized to special or standard care. Sixty-one parents completed both the initial and 1-year follow-up questionnaires (30 couples and one mother). Of the 61 parents, 23 had carrier testing after the birth of the baby. The frequency of such parental testing was significantly higher in the special care group (17/34 or 50%) than in the standard care group (6/27 or 22%) (p < 0.05). This is the first evidence from a randomized trial that genetic counseling and offering carrier testing to parents on the sweat test visit increases identification of carrier parents. Such identification detects trait-trait parents and facilitates carrier testing among relatives.

Cystic Fibrosis↗
PubMed1995

Breast and cervical cancer screening among underserved women. Baseline survey results from six states. The National Cancer Institute Cancer Screening Consortium for Underserved Women.

OBJECTIVE: To characterize breast and cervical cancer screening rates in selected underserved populations and to compare the rates with objectives for the year 2000. DESIGN: Six random-sample surveys were conducted in underserved populations between 1991 and 1993. Two of the surveys were random-digit-dial telephone surveys; four were conducted using in-person interviews. SETTINGS: The studies were conducted in the following target populations: (1) low-income and minority women residing in urban areas in Minnesota, Rhode Island, and North Carolina; (2) Hispanic women residing in urban communities in Texas; and (3) women residing in rural West Virginia and Wisconsin. PARTICIPANTS: A total of 6648 noninstitutionalized women aged 40 years or older were interviewed. MAIN OUTCOME MEASURES: Self-reported knowledge and practices related to mammograms and Papanicolaou smears. RESULTS: Between 35% and 79% of women had ever had a mammogram, and between 27% and 66% reported having a mammogram in the past 2 years. Between 82% and 95% of women had ever had a Papanicolaou smear, and between 55% and 74% reported having a Papanicolaou smear in the past 3 years. Women with low levels of education, below 200% of the poverty level, with no health insurance, 80 years or older, residing in Appalachian West Virginia, and Hispanic women residing in urban Texas have the farthest to go to reach the cancer screening objectives for the year 2000. CONCLUSIONS: Although access to health care is high among the women studied, screening rates are uneven. Objectives for the year 2000 clearly are attainable for some populations of underserved women, though much work needs to be done if objectives are to be met for all subgroups.

Adult↗
PubMed1990

Colon cancer screening. The dilemma of positive screening tests.

Despite doubts about the benefits of colon cancer screening, sigmoidoscopy and fecal occult blood tests are now often performed by clinicians who must then deal with positive test results. The purpose of this literature review is to examine potential strategies for dealing with positive screening test results. If positive results are obtained, current data support the use of colonoscopy as the single most effective diagnostic strategy. Exceptions include situations that reduce the predictive value of the screening test. Several important areas of controversy are highlighted that need to be assessed in subsequent studies.

Colonic Neoplasms↗
PubMed2002

Screening for symptoms of eating disorders: reliability of the SCOFF screening tool with written compared to oral delivery.

OBJECTIVE: The validity of the SCOFF delivered orally as a screening tool for eating disorders has previously been established, but clinical screening for eating disorders also occurs via written format, for example, in occupational health settings. The objective was to compare responses to the SCOFF between verbal and written administration. METHOD: In a volunteer group of nursing and midwifery students at a South London University SCOFF was delivered orally at interview and via written questionnaire. Order was allocated randomly with repeat administration interrupted by distraction questions. RESULTS: There were 185 students who participated, providing 178 fully completed responses. Twenty subjects were male. There was overall agreement in the scores of 157 subjects (88.2%), providing a kappa coefficient of 0.811, with agreement in prediction of eating disorder for 167 (93.8%) and a kappa value of 0.824 (both p < 0.001). For 82 subjects administered the SCOFF verbally first followed by the written version, the kappa statistic was 0.752 (p < 0.001). For 96 subjects with SCOFF administered in reverse order (written form first), kappa was 0.862 (p < 0.001). DISCUSSION: Results demonstrated overall good replicability of the SCOFF administered as a written questionnaire compared to oral interview. Two trends were noted. The first was towards higher scores with written versus oral delivery irrespective of order, possibly indicating enhanced disclosure via written format. The second was of less consistency where verbal preceded written responses. Altogether findings support use of the SCOFF where a concise, valid and reliable screening for eating disorders is required in written form.

Anorexia Nervosa↗
PubMed2004

Secondary prevention for eating disorders: the impact of education, screening, and referral in a college-based screening program.

OBJECTIVE: The first National Eating Disorders Screening Program (NEDSP), conducted on more than 400 college campuses in 1996, was an educational and two-stage screening program designed to detect potentially clinically significant disordered eating attitudes and behaviors and offer referrals for further evaluation when warranted. The current study assessed the impact of the NEDSP on participants. METHOD: A randomly selected subset of this sample (n = 289) was contacted approximately 2 years after the NEDSP to assess the impact of the program on knowledge and treatment-seeking behaviors for eating disorders. RESULTS: For greater than 80% of the participants, the program made participants aware of the danger of eating disorders and the availability of treatment. Of those who received a recommendation for further clinical evaluation of disordered eating (n = 109), nearly one half (47.7%) followed up on this recommendation and kept at least a first appointment and 39.4% actually sought treatment subsequent to the NEDSP. DISCUSSION: The results of the current study suggest that educational and screening programs may be a promising strategy for secondary prevention of eating disorders. They also suggest that awareness of the risks of disordered eating and available treatment may not be sufficient to motivate individuals to adhere to recommendations to seek treatment. Clinicians should, therefore, be vigilant for nonadherence to treatment recommendations and proactive in facilitating treatment.

Adolescent↗
PubMed1992

Breast cancer in Canada: to screen or not to screen?

Lomas (1988) and Sabatier (1987) have suggested models by which to examine the roles that values, scientific knowledge, institutions, and the learning process play in the formulation of both national and clinical health-care policies. Utilizing their frameworks, this article offers an explanation for the development of high-volume screening mammography policies in Canada, despite the suggested inefficacy of screening technologies for 'unavoidable' illnesses such as carcinoma in the breast. The preliminary results of Canada's National Breast Screening Study further complicate this tissue. Inappropriate framing of the 'problem' in the policy-making process, by actors highly influenced by societal values and scientific evidence, is identified as the reason for present and planned policies and practices contradicting the first principles of health-policy analysis.

Adult↗
PubMed1989

Immunoreactive trypsinogen screening for cystic fibrosis: characterization of infants with a false-positive screening test.

Blood immunoreactive trypsinogen (IRT) is elevated in newborns with cystic fibrosis (CF) and has been used as a neonatal screening test. However, not only is the benefit of early diagnosis unknown, but also the sensitivity, specificity, and time related decline of IRT values have yet to be comprehensively evaluated. This report describes the characteristics of infants with a false-positive IRT in our experience with CF screening of 87,000 infants. The IRT value was elevated in 92 newborns; 13 had a confirmed diagnosis of CF by quantitative pilocarpine iontophoresis sweat testing, and 79 infants did not have CF and were therefore classified as false positives by IRT screening. In order to test the hypothesis that perinatal stress factors are associated with high neonatal IRT values, we evaluated Apgar scores at 1 and 5 minutes. We found that the scores of false-positive infants were significantly lower (P = 0.0004 and P = 0.0102 at 1 and 5 minutes, respectively), compared with infants in the general population. While perinatal asphyxia as reflected by low Apgar scores is an associated factor accounting for an elevated IRT value, the majority of non-CF newborns with an elevated IRT have normal Apgar scores.

Apgar Score↗
PubMed2005

Identifying target populations for screening or not screening using logic regression.

Colorectal cancer remains a significant public health concern despite the fact that effective screening procedures exist and that the disease is treatable when detected at early stages. Numerous risk factors for colon cancer have been identified, but none are very predictive alone. We sought to determine whether there are certain combinations of risk factors that distinguish well between cases and controls, and that could be used to identify subjects at particularly high or low risk of the disease to target screening. Using data from the Seattle site of the Colorectal Cancer Family Registry, we fit logic regression models to combine risk factor information. Logic regression is a methodology that identifies subsets of the population, described by Boolean combinations of binary coded risk factors. This method is well suited to situations in which interactions between many variables result in differences in disease risk. We found that neither the logic regression models nor stepwise logistic regression models fit for comparison resulted in criteria that could be used to direct subjects to screening. However, we believe that our novel statistical approach could be useful in settings where risk factors do discriminate between cases and controls, and illustrate this with a simulated data set.

Adult↗
PubMed1985

Maternal serum alpha-fetoprotein screening for neural tube defects. Report of a combined study in Germany and short overview on screening in populations with low birth prevalence of neural tube defects.

The basis of maternal serum alpha-fetoprotein (AFP)-screening for neural tube defects is discussed. A report is given of a large scale screening study in the Federal Republic of Germany combining the experiences in Giessen and Hannover on over 50,000 pregnant women, about evenly distributed among both centers. Published and known forthcoming data from other low incidence populations, particularly of European countries, are reviewed briefly. The conclusion is reached that general screening could effectively be instituted and in the final result should also be cost-beneficial.

Amniotic Fluid↗
PubMed1984

Follow-up study of a nation-wide neonatal metabolic screening program in Japan. A collaborative study group of neonatal screening for inborn errors of metabolism in Japan.

A nationwide neonatal screening program for phenylketonuria (PKU), maple syrup urine disease (MSUD), homocystinuria, histidinemia and galactosemia was started in Japan in 1977. The total number of infants screened had reached 6,311,754 by March, 1982. A follow-up study revealed the incidence of the disease in Japan: 1/108,823 for PKU; 1/450,840 for hyperphenylalaninemia (HPA); 1/1,577,939 for biopterin deficiency; 1/525,980 for MSUD; 1/1,051,959 for homocystinuria; 1/8,371 for histidinemia, and 1/788,969 for galactosemia type 1. The incidences of PKU, HPA, homocystinuria, and galactosemia (type 1) were found to be markedly low in Japan as compared with those in Caucasian countries. There was no great difference in the incidence of MSUD between both. On the other hand, the incidence of histidinemia was higher in Japan. It was found that most of the patients with PKU, HPA, MSUD, homocystinuria, or galactosemia are developing normally due to the early initiation of dietary treatment. These results clearly indicate that the neonatal mass screening program plays a great role in preventing the occurrence of handicapped children.

Biopterins↗
PubMed1994

Screening for major depression in Vietnamese refugees: a validation and comparison of two instruments in a health screening population.

OBJECTIVES: 1) Using standard cutoffs, to determine the accuracy of two Vietnamese-language depression screening instruments for major depression in a nonpsychiatric setting, 2) to examine the utility of other cutoffs, and 3) to compare the instruments' overall accuracies. DESIGN: 1) A research assistant administered the Vietnamese Depression Scale (VDS) and the Indochinese Hopkins Symptom Checklist Depression Subscale (HSCL-D) to all subjects. 2) The "gold standard" was determined by a native Vietnamese-speaking psychiatrist using a written translation of a standard semistructured clinical interview. SETTING: A health screening clinic at a large public hospital. PATIENTS: A convenience sample of 206 newly arrived adult Vietnamese refugees undergoing routine, mandatory health screening. RESULTS: The psychiatrist diagnosed 7% of the refugees as having major depression. At standard cutoffs, the VDS had a 64% sensitivity, a 98% specificity, a 75% positive predictive value, and a 97% negative predictive value. Corresponding results for the HSCL-D were 86%, 93%, 48%, and 99%. More than half of the patients who had false-positive results had other clinical disorders. For each instrument, adjusting the cutoff improved sensitivity and positive predictive value. Receiver operating characteristic (ROC) curve analysis showed no difference in accuracy between the two instruments. Each instrument took approximately 5-10 minutes to administer. CONCLUSIONS: These instruments accurately identified Vietnamese refugees with major depression and should be of use to clinicians in primary care settings. Standard cutoffs may need to be adjusted in nonpsychiatric settings.

Adult↗
PubMed2005

Inadequate follow-up of abnormal screening mammograms: findings from the race differences in screening mammography process study (United States).

OBJECTIVE: Despite relatively high mammography screening rates, there are reports of inadequate follow-up of abnormal results. Our objective was to identify factors associated with inadequate follow-up, and specifically, to determine if this outcome differed by race/ethnicity. METHODS: We studied 176 subjects with abnormal or inconclusive mammograms identified from a prospective cohort study of African-American (n = 635) and White (n = 816) women who underwent screening in five hospital-based facilities in Connecticut, October 1996 through January 1998. Using multivariate logistic regression, we identified independent predictors of inadequate follow-up of an abnormal mammogram. RESULTS: Over 28% of women requiring immediate or short-term follow-up did not receive this care within three months of the recommended return date. African-American race/ethnicity, pain during the mammogram, and lack of a usual provider were significant independent predictors of inadequate follow-up. Although many factors were examined, the observed race difference was unexplained. CONCLUSIONS: While inadequate follow-up of abnormal exams undermines the potential benefits of mammography screening for all women, the observed race difference in this study may have implications for the persistent race difference in breast cancer stage at diagnosis and survival. More research is needed to identify factors that contribute to poor follow-up among African-American women.

Adult↗
PubMed1988

Abnormal glucose screening in pregnancy in patients with normal oral glucose tolerance tests as a screening test for fetal macrosomia.

Minor abnormalities of carbohydrate metabolism in pregnancy are a risk factor for delivery of a macrosomic infant. However, the 50-g 1-h oral glucose screen at 28 weeks is not a useful screening test for macrosomia in pregnant patients with normal glucose tolerance tests, because a positive screen does not raise the probability of delivering a macrosomic infant sufficiently to warrant intervention.

Cross-Sectional Studies↗