Mass screening

About: Mass screening is a research topic. Over the lifetime, 34508 publications have been published within this topic receiving 1365148 citations.

Predictors of Nonadherence to Screening Colonoscopy

Abstract: BACKGROUND: Colonoscopy has become a preferred colorectal cancer (CRC) screening modality. Little is known about why patients who are referred for colonoscopy do not complete the recommended procedures. Prior adherence studies have evaluated colonoscopy only in combination with flexible sigmoidoscopy, failed to differentiate between screening and diagnostic procedures, and have examined cancellations/no-shows, but not nonscheduling, as mechanisms of nonadherence. METHODS: Sociodemographic predictors of screening completion were assessed in a retrospective cohort of 647 patients referred for colonoscopy at a major university hospital. Then, using a qualitative study design, a convenience sample of patients who never completed screening after referral (n=52) was interviewed by telephone, and comparisons in reported reasons for nonadherence were made by gender. RESULTS: Half of all patients referred for colonoscopy failed to complete the procedure, overwhelmingly because of nonscheduling. In multivariable analysis, female sex, younger age, and insurance type predicted poorer adherence. Patient-reported barriers to screening completion included cognitive-emotional factors (e.g., lack of perceived risk for CRC, fear of pain, and concerns about modesty and the bowel preparation), logistic obstacles (e.g., cost, other health problems, and competing demands), and health system barriers (e.g., scheduling challenges, long waiting times). Women reported more concerns about modesty and other aspects of the procedure than men. Only 40% of patients were aware of alternative screening options. CONCLUSIONS: Adherence to screening colonoscopy referrals is suboptimal and may be improved by better communication with patients, counseling to help resolve logistic barriers, and improvements in colonoscopy referral and scheduling mechanisms.

2013 Update of the 2011 American College of Rheumatology Recommendations for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for the Medical Therapy of Children With Systemic Juvenile Idiopathic Arthritis and Tuberculosis Screening Among Children Receiving Biologic Medications

Abstract: Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for particular patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to these guidelines and recommendations to be voluntary, with the ultimate determination regarding their application to be made by the physician in light of each patient's individual circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Guidelines and recommendations developed or endorsed by the ACR are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice. The American College of Rheumatology is an independent, professional, medical and scientific society which does not guarantee, warrant, or endorse any commercial product or service.

The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess.

Abstract: Previous reports have recommended the use of a "classic triad" of fever, spine pain, and neurologic deficits to diagnose spinal epidural abscess (SEA); however, the prognosis for complete recovery is poor once these deficits are present. This retrospective case-control study investigates the impact of diagnostic delays on outcome and explores the use of risk factor screening for early identification of SEA in a population of ED patients. Inpatients with a discharge diagnosis of SEA and a related ED visit before the admission were identified over a 10-year time period. In addition, a pool of ED patients presenting with a chief complaint of spine pain was generated; controls were hand-matched 2:1 to each SEA patient based on age and gender. Data regarding demographics, presence of risk factors, physical examination findings, laboratory and radiographic results, and clinical outcome were abstracted from medical records and entered into a database for further analysis. Patients with SEA were compared to matched controls with regard to the prevalence of risk factors and the "classic triad." We also explored the impact on outcome of diagnostic delays, defined as either: 1) multiple ED visits before diagnosis, or 2) admission without a diagnosis of SEA and >24 h to a definitive study. A total of 63 SEA patients were hand-matched to 126 controls with spine pain. Diagnostic delays were present in 75% of SEA patients. Residual motor weakness was present in 45% of these patients vs. only 13% of patients without diagnostic delays (odds ratio 5.65, 95% C.I. 1.15-27.71, p < 0.05). The "classic triad" of spine pain, fever, and neurologic abnormalities was present in 13% of SEA patients and 1% of controls during the initial visit (p < 0.01); one or more risk factors were present in 98% of SEA patients and 21% of controls (p < 0.01). The erythrocyte sedimentation rate (ESR) was more sensitive and specific than total white blood cell (WBC) count as a screen for SEA. In conclusion, diagnostic delays are common in patients with SEA, often leading to irreversible neurologic deficits. The use of risk factor assessment is more sensitive than the use of the classic diagnostic triad to screen ED patients with spine pain for SEA. The ESR may be a useful screening test before magnetic resonance imaging in selected patients.

Abdominal aortic aneurysm in 4237 screened patients: Prevalence, development and management over 6 years

Abstract: An ultrasonography screening programme for detecting abdominal aortic aneurysm (AAA) in the community is described in which 7200 men and women aged between 65 and 80 years were contacted by letter. Of these, 4237 were screened; the aorta was visualized in 4122 and 179 AAAs of 3 cm or more in diameter were detected (4.3 per cent). Criteria for surgery are suggested and the results of their application prospectively over 6 years are discussed. Using these criteria, under 10 per cent of patients with ultrasonographically-detected AAA should require surgery for this condition provided ultrasonography follow-up is used.

The validity of the Beck Depression Inventory as a screening and diagnostic instrument for depression in patients with Parkinson's disease

Abstract: PURPOSE To evaluate the validity of the Beck Depression Inventory (BDI) as a screening and diagnostic scale for depression in Parkinson's disease (PD). PATIENTS AND METHODS Fifty-three nondemented patients with PD were diagnosed according to a standardized protocol consisting of the depression module of the Structured Clinical Interview for DSM axis I disorders (SCID) and the BDI. A “receiver operating characteristics” (ROC) curve was obtained and the sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) were calculated for different cut-off points of the BDI. RESULTS Maximum discrimination was obtained with a cut-off score of 13/14. High sensitivity and NPV were obtained with cut-off scores of 8/9 or lower; a high specificity and PPV were obtained with cut-off scores of 16/17 or higher. The area under the ROC curve was 85.67%. CONCLUSION A single cut-off score on the BDI to distinguish nondepressed from depressed patients with PD is not feasible. If one accepts the low specificity, then the BDI can be used as a valid screening instrument for depression in PD with a cut-off of 8/9. With a cut-off score of 16/17, it can be used as a diagnostic scale, at the cost of a low sensitivity. The use of diagnostic criteria for depression remains necessary.