Breast cancer screening controversies: who, when, why, and how?

PubMed

Chetlen, Alison; Mack, Julie; Chan, Tiffany

2016-01-01

Mammographic screening is effective in reducing mortality from breast cancer. The issue is not whether mammography is effective, but whether the false positive rate and false negative rates can be reduced. This review will discuss controversies including the reduction in breast cancer mortality, overdiagnosis, the ideal screening candidate, and the optimal imaging modality for breast cancer screening. The article will compare and contrast screening mammography, tomosynthesis, whole-breast screening ultrasound, magnetic resonance imaging, and molecular breast imaging. Though supplemental imaging modalities are being utilized to improve breast cancer diagnosis, mammography still remains the gold standard for breast cancer screening. Copyright © 2015 Elsevier Inc. All rights reserved.

Screening for Breast Cancer.

PubMed

Niell, Bethany L; Freer, Phoebe E; Weinfurtner, Robert Jared; Arleo, Elizabeth Kagan; Drukteinis, Jennifer S

2017-11-01

The goal of screening is to detect breast cancers when still curable to decrease breast cancer-specific mortality. Breast cancer screening in the United States is routinely performed with mammography, supplemental digital breast tomosynthesis, ultrasound, and/or MR imaging. This article aims to review the most commonly used breast imaging modalities for screening, discuss how often and when to begin screening with specific imaging modalities, and examine the pros and cons of screening. By the article's end, the reader will be better equipped to have informed discussions with patients and medical professionals regarding the benefits and disadvantages of breast cancer screening. Copyright © 2017 Elsevier Inc. All rights reserved.

Occult Primary Neuroendocrine Tumor Metastasis to the Breast Detected on Screening Mammogram.

PubMed

Policeni, Fabiana; Pakalniskis, Brittany; Yang, Limin

2016-01-01

Metastatic tumors are rare in the breast. Well-differentiated neuroendocrine tumors (WDNETs) are slow-growing neoplasms that arise from neuroendocrine cells, particularly in the gastrointestinal tract and bronchial tree. Metastatic WDNET to the breast is a rare entity. We present a case report of ileal WDNET metastatic to the breast which was initially identified as a small mass in the patient's left breast on screening mammography. Targeted ultrasound identified a suspicious mass, and ultrasound-guided percutaneous core biopsy was performed. Pathology revealed metastatic WDNET. Breast magnetic resonance imaging (MRI) was then performed and demonstrated left axillary Level 2 lymphadenopathy, and liver lesions were suspicious for metastasis. The patient underwent abdominal computed tomography (CT) to evaluate for distant metastatic disease. A spiculated mass was found near the ileocecal valve, suggestive of primary ileal WDNET. In addition, CT identified multiple liver lesions, most compatible with metastasis. Indium 111 OctreoScan confirmed radiotracer uptake in the ileum consistent with primary neuroendocrine tumor. In this report, we review the imaging characteristics of metastatic WDNET to the breast by different imaging modalities including mammogram, ultrasound, and breast MRI.

Comparative Effectiveness Study to Assess Two Examination Modalities Used to Detect Dental Caries in Preschool Urban Children

PubMed Central

Billings, Ronald J.

2013-01-01

Abstract Background: Dental caries affecting the primary dentition of U.S. children continues to be the most prevalent chronic childhood disease. Preventive screening for dental caries in toddlers by dental professionals is labor-intensive and costly. Studies are warranted to examine innovative screening modalities that reduce cost, are less labor-intensive, and have the potential to identify caries in high-risk children. Subjects and Methods: Two hundred ninety-one children were randomized into two groups: Group 1 received a traditional, visual tactile examination initially and follow up-examinations at 6 and 12 months, and Group 2 received a teledentistry examination initially and follow-up examinations at 6 and 12 months. The mean primary tooth decayed and filled surfaces (dfs) scores were calculated for all children at baseline and 6 and 12 months. Results: At baseline, the mean dfs score for children examined by means of teledentistry was 2.19, and for the children examined by means of the traditional method, the mean was 1.27; the means were not significantly different. At the 12-month examination, the mean dfs score for the children examined by means of teledentistry was 3.02, and for the children examined by means of the clinical method, the mean dfs was 1.70; the means were not significantly different. At 12 months the mean fillings score for the children examined by means of teledentistry was 1.43 and for the children examined by means of the clinical method was 0.51; the means were statistically significantly different (p<0.001). Conclusions: These results suggest that the teledentistry examinations were comparable to clinical examinations when screening for early childhood caries in preschool children. The data further showed that color printouts of teeth with cavities provided to parents of children who received teledentistry screenings promoted oral healthcare utilization, as children from the teledentistry study group received more dental care than children from the clinical study group. PMID:24053114

The Role of Preoperative Magnetic Resonance Imaging (MRI) in the Workup and Surgical Treatment of Interval and Screen-Detected Breast Cancer in Older Women

PubMed Central

Goodrich, Martha E.; Weiss, Julie; Onega, Tracy; Balch, Steve L.; Buist, Diana S.M.; Kerlikowske, Karla; Henderson, Louise M.; Hubbard, Rebecca A.

2016-01-01

Goals We describe the relationship between preoperative Magnetic Resonance Imaging (MRI) and the utilization of additional imaging, biopsy, and primary surgical treatment for subgroups of women with interval versus screen-detected breast cancer. We determined the proportion of women receiving additional breast imaging or biopsy and type of primary surgical treatment, stratified by use of preoperative MRI, separately for both groups. Methods Using Breast Cancer Surveillance Consortium (BCSC) data, we identified a cohort of women age 66 and older with an interval or screen-detected breast cancer diagnosis between 2005–2010. Using logistic regression, we explored associations between primary surgical treatment type and preoperative MRI use for interval and screen-detected cancers. Results There were 204 women with an interval cancer and 1254 with a screen-detected cancer. The interval cancer group was more likely to receive preoperative MRI (21% vs. 13%). In both groups, women receiving MRI were more likely to receive additional imaging and/or biopsy. Receipt of MRI was not associated with increased odds of mastectomy (OR =0.99, 95% CI: 0.67–1.50), while interval cancer diagnosis was associated with significantly higher odds of mastectomy (OR=1.64, 95% CI: 1.11–2.42). Conclusion Older women with interval cancer were more likely than women with a screen-detected cancer to have preoperative MRI, however, those with an interval cancer had 64% higher odds of mastectomy regardless of receipt of MRI. Given women with interval cancer are reported to have a worse prognosis, more research is needed to understand effectiveness of imaging modalities and treatment consequences within this group. PMID:27550072

Population-based mammography screening: comparison of screen-film and full-field digital mammography with soft-copy reading--Oslo I study.

PubMed

Skaane, Per; Young, Kari; Skjennald, Arnulf

2003-12-01

To compare screen-film and full-field digital mammography with soft-copy reading in a population-based screening program. Full-field digital and screen-film mammography were performed in 3,683 women aged 50-69 years. Two standard views of each breast were acquired with each modality. Images underwent independent double reading with use of a five-point rating scale for probability of cancer. Recall rates and positive predictive values were calculated. Cancer detection rates determined with both modalities were compared by using the McNemar test for paired proportions. Retrospective side-by-side analysis for conspicuity of cancers was performed by an external independent radiologist group with experience in both modalities. In 3,683 cases, 31 cancers were detected. Screen-film mammography depicted 28 (0.76%) malignancies, and full-field digital mammography depicted 23 (0.62%) malignancies. The difference between cancer detection rates was not significant (P =.23). The recall rate for full-field digital mammography (4.6%; 168 of 3,683 cases) was slightly higher than that for screen-film mammography (3.5%; 128 of 3,683 cases). The positive predictive value based on needle biopsy results was 46% for screen-film mammography and 39% for full-field digital mammography. Side-by-side image comparison for cancer conspicuity led to classification of 19 cancers as equal for probability of malignancy, six cancers as slightly better demonstrated at screen-film mammography, and six cancers as slightly better demonstrated at full-field digital mammography. There was no statistically significant difference in cancer detection rate between screen-film and full-field digital mammography. Cancer conspicuity was equal with both modalities. Full-field digital mammography with soft-copy reading is comparable to screen-film mammography in population-based screening.

Down syndrome screening in assisted conception twins: an iatrogenic medical challenge.

PubMed

Ben-Ami, Ido; Maymon, Ron; Svirsky, Ran; Cuckle, Howard; Jauniaux, Eric

2013-11-01

The objective of this study was to provide a critical analysis of the impact of assisted conception on prenatal screening for Down syndrome (DS) in twin pregnancies and the value of various screening modalities for early detection of anomalies. The literature was searched using PubMed and the Cochrane Library focusing on prenatal screening and antenatal care of assisted-conception twin pregnancies. Serum screening alone is of limited value in detecting aneuploid twins, because the unaffected cotwin can "mask" the abnormal serum results of an affected one. In addition, this test can designate the pregnancy as at high risk but not identify the affected fetus. Nuchal translucency (NT) screening is the best available modality and a highly effective screening method for twin pregnancies. Among twins, NT alone has a 69% DS detection rate, first-trimester combined NT and serum biochemistry has a 72% DS detection rate, and an integrated screen will have an 80% DS detection rate at a 5% FPR. The data in the literature concerning the effect of assisted conception on maternal serum screening markers in twin pregnancies are scarce. Down syndrome screening in assisted-conception twins presents clinical and technical challenges. Therefore, assisted-conception twins need close monitoring from conception to delivery, by a practitioner familiar with the available screening modalities and their relative accuracy.

The utility of chest X-ray as a screening tool for blunt thoracic aortic injury.

PubMed

Gutierrez, Adam; Inaba, Kenji; Siboni, Stefano; Effron, Zachary; Haltmeier, Tobias; Jaffray, Paul; Reddy, Sravanthi; Lofthus, Alexander; Benjamin, Elizabeth; Dubose, Joseph; Demetriades, Demetrios

2016-01-01

The early and accurate identification of patients with blunt thoracic aortic injury (BTAI) remains a challenge. Traditionally, a portable AP chest X-ray (CXR) is utilized as the initial screening modality for BTAI, however, there is controversy surrounding its sensitivity. The purpose of this study was to assess the sensitivity of CXR as a screening modality for BTAI. After IRB approval, all adult (≥18 yo) blunt trauma patients admitted to LAC+USC (01/2011-12/2013) who underwent CXR and chest CT were retrospectively reviewed. Final radiology attending CXR readings were reviewed for mediastinal abnormalities (widened mediastinum, mediastinal to chest width ratio greater than 0.25, irregular aortic arch, blurred aortic contour, opacification of the aortopulmonary window, and apical pleural haematoma) suggestive of aortic injury. Chest CT final attending radiologist readings were utilized as the gold standard for diagnosis of BTAI. The primary outcome analyzed was CXR sensitivity. A total of 3728 patients were included in the study. The majority of patients were male (72.6%); mean age was 43 (SD 20). Median ISS was 9 (IQR 4-17) and median GCS was 15 (IQR 14-15). The most common mechanism of injury was MVC (48.0%), followed by fall (20.6%), and AVP (16.9%). The total number of CXRs demonstrating a mediastinal abnormality was 200 (5.4%). Widened mediastinum was present on 191 (5.1%) of CXRs, blurred aortic contour on 10 (0.3%), and irregular aortic arch on 4 (0.1%). An acute aortic injury confirmed by chest CT was present in 17 (0.5%) patients. Only 7 of these with CT-confirmed BTAI had a mediastinal abnormality identified on CXR, for a sensitivity of 41% (95% CI: 19-67%). The results from this study suggest that CXR alone is not a reliable screening modality for BTAI. A combination of screening CXR and careful consideration of other factors, such as mechanism of injury, will be required to effectively discriminate between those who should and should not undergo chest CT. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Multi-Modality CMOS Sensor Array for Cell-Based Assay and Drug Screening.

PubMed

Chi, Taiyun; Park, Jong Seok; Butts, Jessica C; Hookway, Tracy A; Su, Amy; Zhu, Chengjie; Styczynski, Mark P; McDevitt, Todd C; Wang, Hua

2015-12-01

In this paper, we present a fully integrated multi-modality CMOS cellular sensor array with four sensing modalities to characterize different cell physiological responses, including extracellular voltage recording, cellular impedance mapping, optical detection with shadow imaging and bioluminescence sensing, and thermal monitoring. The sensor array consists of nine parallel pixel groups and nine corresponding signal conditioning blocks. Each pixel group comprises one temperature sensor and 16 tri-modality sensor pixels, while each tri-modality sensor pixel can be independently configured for extracellular voltage recording, cellular impedance measurement (voltage excitation/current sensing), and optical detection. This sensor array supports multi-modality cellular sensing at the pixel level, which enables holistic cell characterization and joint-modality physiological monitoring on the same cellular sample with a pixel resolution of 80 μm × 100 μm. Comprehensive biological experiments with different living cell samples demonstrate the functionality and benefit of the proposed multi-modality sensing in cell-based assay and drug screening.

[Current Status of Endoscopic Resection of Early Gastric Cancer in Korea].

PubMed

Jung, Hwoon Yong

2017-09-25

Endoscopic resection (Endoscopic mucosal resection [EMR] and endoscopic submucosal dissection [ESD]) is already established as a first-line treatment modality for selected early gastric cancer (EGC). In Korea, the number of endoscopic resection of EGC was explosively increased because of a National Cancer Screening Program and development of devices and techniques. There were many reports on the short-term and long-term outcomes after endoscopic resection in patients with EGC. Long-term outcome in terms of recurrence and death is excellent in both absolute and selected expanded criteria. Furthermore, endoscopic resection might be positioned as primary treatment modality replacing surgical gastrectomy. To obtain these results, selection of patients, perfect en bloc procedure, thorough pathological examination of resected specimen, accurate interpretation of whole process of endoscopic resection, and rational strategy for follow-up is necessary.

Usefulness of esophagogastroduodenoscopy and 18F-fluorodeoxyglucose positron-emission tomography in detecting synchronous multiple primary cancers with oral cancer.

PubMed

Ishibashi-Kanno, Naomi; Yamagata, Kenji; Uchida, Fumihiko; Hasegawa, Shogo; Yanagawa, Toru; Bukawa, Hiroki

2017-12-01

The purpose of this study is to compare the value of screening for synchronous multiple primary cancers in other organs by esophagogastroduodenoscopy (EGD) or 18 F-fluorodeoxyglucose positron-emission tomography (PET-CT) in patients newly diagnosed with oral cancer. We retrospectively examined consecutive Japanese patients who were diagnosed with oral squamous cell carcinoma (OSCC) and were screened for synchronous multiple primary cancers in other organs by EGD and/or PET-CT between January 2010 and December 2015 at our institution. The study included 190 patients (106 males and 84 females) from 36 to 93 years of age (median age 68.8 years). The patients were screened by EGD, PET-CT, or both before beginning treatment for OSCC. Of 190 Japanese patients with OSCC, 15 had multiple primary cancers: 13 patients had double cancer and two had triple cancers. The sites of the 17 multiple primary cancers were gastric (6), esophageal (4), and lung (3), and ovarian, colon, liver, and thyroid (1 each). All of the gastric and esophageal cancers were found by EGD and were not detected by PET-CT. For three patients, the detection of multiple cancers affected the treatment modality or order of treatment selected for the OSCC. In two cases, the oral cancer and multiple primary cancer(s) in another organ were resected simultaneously by joint surgical teams. PET-CT for oral cancer patients is an effective supporting diagnostic tool. However, the ability of PET-CT has some limitations. Especially for early detection of the upper gastrointestinal cancers, it is necessary to be supplemented by EGD.

[Cost-effectiveness of multiple screening modalities on breast cancer in Chinese women from Shanghai].

PubMed

Wu, F; Mo, M; Qin, X X; Fang, H; Zhao, G M; Liu, G Y; Chen, Y Y; Cao, Z G; Yan, Y J; Lyu, L L; Xu, W H; Shao, Z M

2017-12-10

Objective: To determine the most cost-effective modality for breast cancer screening in women living in Shanghai. Methods: A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district, Shanghai, during 2008 to 2012. Parameters of the model were derived from literatures. General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years. Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality. Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness. Results: The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one. The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved, which were within the threshold of 2-3 times of local per capita Gross Domestic Product. Results from sensitivity analysis showed that, due to higher incidence rate of breast cancer in Shanghai, the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China. Conclusion: Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai, and thus be widely promoted in this population elsewhere.

Cargo identification algorithms facilitating unmanned/unattended inspection at high throughput portals

NASA Astrophysics Data System (ADS)

Chalmers, Alex

2007-10-01

A simple model is presented of a possible inspection regimen applied to each leg of a cargo containers' journey between its point of origin and destination. Several candidate modalities are proposed to be used at multiple remote locations to act as a pre-screen inspection as the target approaches a perimeter and as the primary inspection modality at the portal. Information from multiple data sets are fused to optimize the costs and performance of a network of such inspection systems. A series of image processing algorithms are presented that automatically process X-ray images of containerized cargo. The goal of this processing is to locate the container in a real time stream of traffic traversing a portal without impeding the flow of commerce. Such processing may facilitate the inclusion of unmanned/unattended inspection systems in such a network. Several samples of the processing applied to data collected from deployed systems are included. Simulated data from a notional cargo inspection system with multiple sensor modalities and advanced data fusion algorithms are also included to show the potential increased detection and throughput performance of such a configuration.

Medical auditing of whole-breast screening ultrasonography

PubMed Central

2017-01-01

Since breast ultrasonography (US) has been used as an adjunctive screening modality in women with dense breasts, the need has arisen to evaluate and monitor its possible harm and benefits in comparison with other screening modalities such as mammography. Recently, the fifth edition of the Breast Imaging Reporting and Data System published by the American College of Radiology has suggested auditing methods for screening breast US. However, the method proposed therein is slightly different from how diagnostic performance was calculated in previous studies on screening breast US. In this article, the background and core aspects of medical audits of breast cancer screening will be reviewed to provide an introduction to the medical auditing of screening breast US, with the goal of helping radiologists to understand and identify potential ways to improve outcomes. PMID:28322034

Medical auditing of whole-breast screening ultrasonography.

PubMed

Kim, Min Jung

2017-07-01

Since breast ultrasonography (US) has been used as an adjunctive screening modality in women with dense breasts, the need has arisen to evaluate and monitor its possible harm and benefits in comparison with other screening modalities such as mammography. Recently, the fifth edition of the Breast Imaging Reporting and Data System published by the American College of Radiology has suggested auditing methods for screening breast US. However, the method proposed therein is slightly different from how diagnostic performance was calculated in previous studies on screening breast US. In this article, the background and core aspects of medical audits of breast cancer screening will be reviewed to provide an introduction to the medical auditing of screening breast US, with the goal of helping radiologists to understand and identify potential ways to improve outcomes.

Seeing touch is correlated with content-specific activity in primary somatosensory cortex.

PubMed

Meyer, Kaspar; Kaplan, Jonas T; Essex, Ryan; Damasio, Hanna; Damasio, Antonio

2011-09-01

There is increasing evidence to suggest that primary sensory cortices can become active in the absence of external stimulation in their respective modalities. This occurs, for example, when stimuli processed via one sensory modality imply features characteristic of a different modality; for instance, visual stimuli that imply touch have been observed to activate the primary somatosensory cortex (SI). In the present study, we addressed the question of whether such cross-modal activations are content specific. To this end, we investigated neural activity in the primary somatosensory cortex of subjects who observed human hands engaged in the haptic exploration of different everyday objects. Using multivariate pattern analysis of functional magnetic resonance imaging data, we were able to predict, based exclusively on the activity pattern in SI, which of several objects a subject saw being explored. Along with previous studies that found similar evidence for other modalities, our results suggest that primary sensory cortices represent information relevant for their modality even when this information enters the brain via a different sensory system.

Liver (Hepatocellular) Cancer Screening (PDQ®)—Health Professional Version

Cancer.gov

Liver (hepatocellular) cancer screening, even in high risk individuals, has not been shown to be beneficial. Get detailed information about liver cancer screening, potential screening modalities, and research directions in this summary for clinicians.

Storytelling for promoting colorectal cancer prevention and early detection among Latinos.

PubMed

Larkey, Linda K; Gonzalez, Julie

2007-08-01

Health promotion efforts directed at Latinos may be more effective when culturally adapted methods are used. Our study was designed to test a novel communication modality for promoting colorectal cancer (CRC) prevention and screening messages among Latinos. We compared a culturally aligned, brief storytelling educational intervention (ST) to a numeric risk tool intervention (NR) based on the Harvard Cancer Risk Index. Both interventions included risk factor information and recommendations for primary prevention and screening for CRC. Sixty-four Latinos (mean age 46.8, 86% female) were randomized and completed pre- and post-tests. Participants in ST indicated intent to add significantly more servings of vegetables (p=.030) and more minutes of exercise (p=.018) to daily routines than those in NR. Most respondents (ST and NR) reported intentions to recommend CRC screening to friends and relatives. These data provide support for storytelling's potential to promote health behavior change with cultural relevance for Latinos. Storytelling shows promise as an effective method for reaching one of the historically underserved ethnic groups with cancer prevention and screening information.

Virtual colonoscopy, optical colonoscopy, or fecal occult blood testing for colorectal cancer screening: results of a pilot randomized controlled trial.

PubMed

You, John J; Liu, Yudong; Kirby, John; Vora, Parag; Moayyedi, Paul

2015-07-09

No head-to-head randomized controlled trials have demonstrated the superiority of one colorectal screening modality over another in reducing colorectal cancer mortality. We conducted a pilot randomized controlled trial of fecal occult blood testing (FOBT), optical colonoscopy (OC), and virtual colonoscopy (VC), to inform the planning of a larger evaluative trial. Eligible patients (aged 50 to 70) were recruited from five primary care practices in Hamilton, ON, Canada, between March 23, 2010 and August 11, 2010, and randomized 1:1:1 in a parallel design using an automated, centralized telephone service to either FOBT, OC, or VC. To reflect conventional practice, patients received no additional reminders to complete their allocated screening test beyond those received in usual practice. The primary outcome was completion of the assigned screening procedure. Results of the index test and any follow-up investigations were ascertained at 6 months. Participants, caregivers, and outcome assessors were not blinded to group assignment. The trial was stopped early due to lack of ongoing funding. A total of 198 participants were enrolled, of whom 67 were allocated to FOBT, 66 to OC, and 65 to VC. The allocated screening procedure was completed by 43 (64%) subjects allocated to FOBT (95% confidence interval [CI], 52-75%), 53 (80%) subjects allocated to OC (95% CI, 69-88%), and 50 (77%) subjects allocated to VC (95% CI, 65-85%); because the trial stopped early, we had insufficient statistical power to detect clinically relevant differences in completion rates. During 6 months follow-up, colorectal adenomas were detected in 0 (0%) subjects allocated to FOBT, 12 (18%) subjects allocated to OC, and 2 (3%) subjects allocated to VC. One subject in the OC arm had histological evidence of high-grade dysplasia. No subjects were diagnosed with colorectal cancer. In this pilot randomized controlled trial of colorectal cancer screening in a primary care setting, 64-80% of subjects completed their allocated screening test. These findings may be of value to investigators planning clinical trials to evaluate the effectiveness of colorectal cancer screening. ClinicalTrials.gov NCT00865527. https://clinicaltrials.gov/ct2/show/NCT00865527.

Major depression in primary care: making the diagnosis

PubMed Central

Ng, Chung Wai Mark; How, Choon How; Ng, Yin Ping

2016-01-01

Major depression is a common condition seen in the primary care setting, often presenting with somatic symptoms. It is potentially a chronic illness with considerable morbidity, and a high rate of relapse and recurrence. Major depression has a bidirectional relationship with chronic diseases, and a strong association with increased age and coexisting mental illnesses (e.g. anxiety disorders). Screening can be performed using clinical tools for major depression, such as the Patient Health Questionaire-2, Patient Health Questionaire-9 and Beck Depression Inventory, so that timely treatment can be initiated. An accurate diagnosis of major depression and its severity is essential for prompt treatment to reduce morbidity and mortality. This is the first of a series of articles that illustrates the approach to the management of major depression in primary care. Our next articles will cover suicide risk assessment in a depressed patient and outline the basic principles of management and treatment modalities. PMID:27872937

Long-term survival of heart transplant recipients with lung cancer: the role of chest computed tomography screening.

PubMed

Mohammadi, S; Bonnet, N; Leprince, P; Charbonneau, E; Berberian, G; Aslani, M; Silvaggio, G; Dorent, R; Pavie, A; Gandjbakhch, I

2007-10-01

We sought to evaluate the screening modality and outcome of lung cancer occurring in heart transplant recipients (HTR) during a 21-year period. We conducted a retrospective review to investigate the incidence, risk factors, screening modality, treatment, and outcomes in HTR with lung cancer. We compared them with a case-matched HTR control group. Out of 829 recipients of heart transplants, 19 cases of bronchogenic carcinoma were found either by routine chest X-ray (n = 10), chest computed tomographic (CT) scanning (n = 4), or by assessment of clinical symptoms (n = 5). The mean time from transplantation to bronchogenic carcinoma diagnosis was 68.8 +/- 42.4 months. A history of smoking was the only risk factor in HTR with bronchogenic carcinoma compared to their case-matched HTR control group ( P < 0.05). Of 18 patients with non-small cell lung cancer (NSCLC), 13 underwent surgery and 5 with advanced cancer underwent chemotherapy and/or radiotherapy. NSCLC was diagnosed by chest X-ray (n = 10), and 6 of these patients died after an average of 43.7 +/- 62.2 months following cancer detection. NSCLC was also diagnosed on the basis of clinical symptoms (n = 4), and 2 of these patients died after a mean follow-up of 9 +/- 4.2 months after cancer diagnosis. All 4 patients in whom cancer was detected by CT scan were alive at an average of 53.5 +/- 36.7 months following cancer detection. The survival rates did not differ between the study and control groups ( P = 0.5). Optimal outcomes of treatment for primary lung cancer after heart transplantation seem to be related to early detection. A high proportion of deaths from NSCLC may be prevented by chest CT scan screening.

Colorectal Cancer Screening (PDQ®)—Health Professional Version

Cancer.gov

Colorectal cancer (CRC) screening reduces CRC mortality; some screening modalities also reduce CRC incidence. Get detailed information about CRC screening tests (e.g., fecal occult blood test, sigmoidoscopy, colonoscopy, stool DNA) including potential benefits and harms in this clinician summary.

Ultrasonography of Various Thyroid Diseases in Children and Adolescents: A Pictorial Essay

PubMed Central

Lee, Eun Hye; Jeong, Sun Hye; Park, Jisang; Lee, Heon

2015-01-01

Thyroid imaging is indicated to evaluate congenital hypothyroidism during newborn screening or in cases of a palpable thyroid mass in children and adolescents. This pictorial essay reviews the ultrasonography (US) of thyroid diseases in children and adolescents, including normal thyroid gland development, imaging features of congenital thyroid disorders (dysgenesis, [aplasia, ectopy, hypoplasia], dyshormonogenesis, transient hypothyroidism, thyroglossal duct cyst), diffuse thyroid disease (Grave's disease, Hashimoto's thyroiditis, and suppurative thyroiditis), and thyroid nodules. The primary imaging modalities for evaluating thyroid diseases are US and radionuclide scintigraphy. Additionally, US can be used to guide aspiration of detected nodules. PMID:25741204

The relative importance of patient-reported barriers to colorectal cancer screening.

PubMed

Jones, Resa M; Woolf, Steven H; Cunningham, Tina D; Johnson, Robert E; Krist, Alex H; Rothemich, Stephen F; Vernon, Sally W

2010-05-01

Colorectal cancer (CRC) screening rates are suboptimal. The most important barriers identified by patients are poorly understood. A comprehensive assessment of barriers to all recommended modalities is needed. In 2007, a questionnaire was mailed to 6100 patients, aged 50-75 years, from 12 family medicine practices in the Virginia Ambulatory Care Outcomes Research Network. People aged 65-75 years and African Americans were oversampled. Patients were asked to rate 19-21 barriers to each of four recommended tests. In 2008, responses were coded on a 5-point scale; higher scores reflected stronger barrier endorsement. The response rate was 55% (n=3357). Approximately 40% of respondents were aged >/=65 years, 30% were African-American, and 73% were adherent to screening. A clinician's failure to suggest screening and not knowing testing was necessary received the highest mean scores as barriers. Financial concerns and misconceptions were also cited. Barrier scores differed depending on whether respondents were never screened, overdue for screening, or adherent to guidelines. The top five barriers for each modality included test-specific barriers (e.g., handling stool, bowel preparation), which often outranked generic barriers to screening. Not knowing testing was necessary was a top barrier for all tests but colonoscopy. Although physician advice and awareness of the need for screening are important, barriers to screening are not homogenous across tests, and test-specific barriers warrant consideration in designing strategies to improve screening rates. Barrier scores differ by screening status, highlighting the need to address prior screening experience. Evidence that patients are more familiar with colonoscopy than with other modalities suggests an opportunity to improve screening rates by educating patients about alternative tests. 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Impact of screening colonoscopy on outcomes in colorectal cancer.

PubMed

Matsuda, Takahisa; Ono, Akiko; Kakugawa, Yasuo; Matsumoto, Minori; Saito, Yutaka

2015-10-01

Colorectal cancer is one of the most common cancers in both men and women worldwide and a good candidate for screening programs. There are two modalities of colorectal cancer screening: (i) population-based screening and (ii) opportunistic screening. The first one is based on organized, well-coordinated, monitored and established programs with a systematic invitation covering the entire target population. In contrast, opportunistic screening tests are offered to people who are being examined for other reasons. Recently, a variety of colorectal cancer screening tests have become available; each country should make a choice, based on national demographics and resources, on the screening method to be used. Fecal occult blood test, especially the fecal immunochemical test, would be the best modality for decreasing colorectal cancer mortality through population-based screening. In contrast, if the aim includes the early detection of colorectal cancer and adenomas, endoscopic methods are more appropriate. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Health-related quality-of-life effects of radical prostatectomy and primary radiotherapy for screen-detected or clinically diagnosed localized prostate cancer.

PubMed

Madalinska, J B; Essink-Bot, M L; de Koning, H J; Kirkels, W J; van der Maas, P J; Schröder, F H

2001-03-15

The current study was undertaken within the framework of a screening trial to compare the health-related quality-of-life (HRQOL) outcomes of two primary treatment modalities for localized prostate cancer: radical prostatectomy and external-beam radiotherapy. We conducted a prospective longitudinal cohort study among 278 patients with early screen-detected (59%) or clinically diagnosed (41%) prostate cancer using both generic and disease-specific HRQOL measures (SF-36, UCLA Prostate Cancer Index [urinary and bowel modules] and items relating to sexual functioning) at three points in time: t1 (baseline), t2 (6 months later), and t3 (12 months after t1). Questionnaires were completed by 88% to 93% of all initially enrolled patients. Patients referred for primary radiotherapy were significantly older than prostatectomy patients (63 v 68 years, P <.01). Analyses (adjusted for age and pretreatment level of functioning) revealed poorer levels of generic HRQOL after radiotherapy. Prostatectomy patients reported significantly higher (P <.01) posttreatment incidences of urinary incontinence (39% to 49%) and erectile dysfunction (80% to 91%) than radiotherapy patients (respectively, 6% to 7% and 41% to 55%). Bowel problems (urgency) affected 30% to 35% of the radiotherapy group versus 6% to 7% of the prostatectomy group (P <.01). Patients with screen-detected and clinically diagnosed cancer reported similar posttreatment HRQOL. Prostatectomy and radiotherapy differed in the type of HRQOL impairment. Because the HRQOL effects may be valued differently at the individual level, patients should be made fully aware of the potential benefits and adverse consequences of therapies for early prostate cancer. Differences in posttreatment HRQOL were not related to the method of cancer detection.

Evaluation of Promotional Materials To Promote Low-Dose Computed Tomography (LDCT) Screening to High-Risk Consumers and Health Care Providers.

PubMed

Hudson, Janella N; Quinn, Gwendolyn P; Wilson, Lauren E; Simmons, Vani N

2017-03-11

Low-dose computed tomography (LDCT) screening is a promising screening modality for increasing the detection rate of early stage lung cancers among high-risk individuals. Despite being recommended by the US Preventative Services Task Force, uptake of LDCT remains low. The objective of the current study was to gather feedback from high-risk consumers and health care providers on LDCT promotional materials. Focus group discussions were conducted with high-risk individuals (8 focus groups; N = 38) and primary care providers (9 focus groups; N = 23). Participants reviewed existing LDCT promotional materials to assess their perceptions of media materials created to publicize LDCT. Data were analyzed using the constant comparative method. Several key themes emerged from focus groups that can be used to inform development of future LDCT promotional materials. High-risk (HR) participants expressed greater receptivity for promotional materials that did not further stigmatize lung cancer and/or smoking and expressed preferences for materials that clearly outlined the risks/benefits of screening. Primary care providers (PCPs) offered suggestions to facilitate the referral process such as diagnostic codes and requested a design that clearly outlined eligibility criteria. A clear and thorough explanation of LDCT eligibility, cost, harms, and benefits was of chief importance for both PCP and HR audiences. Given that PCPs and HR audiences are not well informed on the specifics of LDCT screening eligibility and insurance coverage, creating provider and patient education opportunities will aid in shared decision-making opportunities. Promotional materials that meet the needs of the target audience are needed to facilitate discussions of risks/benefits of screening with HR individuals.

Imaging Management of Breast Density, a Controversial Risk Factor for Breast Cancer.

PubMed

Falcon, Shannon; Williams, Angela; Weinfurtner, Jared; Drukteinis, Jennifer S

2017-04-01

Breast density is well recognized as an independent risk factor for the development of breast cancer. However, the magnitude of risk is controversial. As the public becomes increasingly aware of breast density as a risk factor, legislation and notification laws in relation to breast density have become common throughout the United States. Awareness of breast density as a risk factor for breast cancer presents new challenges for the clinician in the approach to the management and screening of women with dense breasts. The evidence and controversy surrounding breast density as a risk factor for the development of breast cancer are discussed. Common supplemental screening modalities for breast cancer are also discussed, including tomosynthesis, ultrasonography, and magnetic resonance imaging. A management strategy for screening women with dense breasts is also presented. The American College of Radiology recognizes breast density as a controversial risk factor for breast cancer, whereas the American Congress of Obstetricians and Gynecologists recognizes breast density as a modest risk factor. Neither organization recommends the routine use of supplemental screening in women with dense breasts without considering additional patient-related risk factors. Breast density is a poorly understood and controversial risk factor for the development of breast cancer. Mammography is a screening modality proven to reduce breast cancer-related mortality rates and is the single most appropriate tool for population-based screening. Use of supplemental screening modalities should be tailored to individual risk assessment.

Development of an Automated Modality-Independent Elastographic Image Analysis System for Tumor Screening

DTIC Science & Technology

2006-02-01

further develop modality-independent elastography as a system that is able to reproducibly detect regions of increased stiffness within the breast based...tested on a tissue-like polymer phantom. elastography , breast cancer screening, image processing 16. SECURITY CLASSIFICATION OF: 17. LIMITATION...is a map of the breast (or other tissue of interest) that reflects material inhomogeneity, such as in the case of a tumor mass that disrupts the

Multilevel predictors of colorectal cancer testing modality among publicly and privately insured people turning 50.

PubMed

Wheeler, Stephanie B; Kuo, Tzy-Mey; Meyer, Anne Marie; Martens, Christa E; Hassmiller Lich, Kristen M; Tangka, Florence K L; Richardson, Lisa C; Hall, Ingrid J; Smith, Judith Lee; Mayorga, Maria E; Brown, Paul; Crutchfield, Trisha M; Pignone, Michael P

2017-06-01

Understanding multilevel predictors of colorectal cancer (CRC) screening test modality can help inform screening program design and implementation. We used North Carolina Medicare, Medicaid, and private, commercially available, health plan insurance claims data from 2003 to 2008 to ascertain CRC test modality among people who received CRC screening around their 50th birthday, when guidelines recommend that screening should commence for normal risk individuals. We ascertained receipt of colonoscopy, fecal occult blood test (FOBT) and fecal immunochemical test (FIT) from billing codes. Person-level and county-level contextual variables were included in multilevel random intercepts models to understand predictors of CRC test modality, stratified by insurance type. Of 12,570 publicly-insured persons turning 50 during the study period who received CRC testing, 57% received colonoscopy, whereas 43% received FOBT/FIT, with significant regional variation. In multivariable models, females with public insurance had lower odds of colonoscopy than males (odds ratio [OR] = 0.68; p < 0.05). Of 56,151 privately-insured persons turning 50 years old who received CRC testing, 42% received colonoscopy, whereas 58% received FOBT/FIT, with significant regional variation. In multivariable models, females with private insurance had lower odds of colonoscopy than males (OR = 0.43; p < 0.05). People living 10-15 miles away from endoscopy facilities also had lower odds of colonoscopy than those living within 5 miles (OR = 0.91; p < 0.05). Both colonoscopy and FOBT/FIT are widely used in North Carolina among insured persons newly age-eligible for screening. The high level of FOBT/FIT use among privately insured persons and women suggests that renewed emphasis on FOBT/FIT as a viable screening alternative to colonoscopy may be important.

Development of a fluorescence-based assay to screen antiviral drugs against Kaposi's sarcoma– associated herpesvirus

PubMed Central

Nun, Tamara K.; Kroll, David J.; Oberlies, Nicholas H.; Soejarto, Djaja D.; Case, Ryan J.; Piskaut, Pius; Matainaho, Teatulohi; Hilscher, Chelsey; Wang, Ling; Dittmer, Dirk P.; Gao, Shou-Jiang; Damania, Blossom

2013-01-01

Tumors associated with Kaposi's sarcoma–associated herpesvirus infection include Kaposi's sarcoma, primary effusion lymphoma, and multicentric Castleman's disease. Virtually all of the tumor cells in these cancers are latently infected and dependent on the virus for survival. Latent viral proteins maintain the viral genome and are required for tumorigenesis. Current prevention and treatment strategies are limited because they fail to specifically target the latent form of the virus, which can persist for the lifetime of the host. Thus, targeting latent viral proteins may prove to be an important therapeutic modality for existing tumors as well as in tumor prevention by reducing latent virus load. Here, we describe a novel fluorescence-based screening assay to monitor the maintenance of the Kaposi's sarcoma–associated herpesvirus genome in B lymphocyte cell lines and to identify compounds that induce its loss, resulting in tumor cell death. PMID:17699731

Effects of Text Modality in Multimedia Presentations on Written and Oral Performance

ERIC Educational Resources Information Center

Broek, G. S. E.; Segers, E.; Verhoeven, L.

2014-01-01

A common assumption in multimedia design is that audio-visual materials with pictures and spoken narrations lead to better learning outcomes than visual-only materials with pictures and on-screen text. The present study questions the generalizability of this modality effect. We explored how modality effects change over time, taking into account…

The Image Data Resource: A Bioimage Data Integration and Publication Platform.

PubMed

Williams, Eleanor; Moore, Josh; Li, Simon W; Rustici, Gabriella; Tarkowska, Aleksandra; Chessel, Anatole; Leo, Simone; Antal, Bálint; Ferguson, Richard K; Sarkans, Ugis; Brazma, Alvis; Salas, Rafael E Carazo; Swedlow, Jason R

2017-08-01

Access to primary research data is vital for the advancement of science. To extend the data types supported by community repositories, we built a prototype Image Data Resource (IDR) that collects and integrates imaging data acquired across many different imaging modalities. IDR links data from several imaging modalities, including high-content screening, super-resolution and time-lapse microscopy, digital pathology, public genetic or chemical databases, and cell and tissue phenotypes expressed using controlled ontologies. Using this integration, IDR facilitates the analysis of gene networks and reveals functional interactions that are inaccessible to individual studies. To enable re-analysis, we also established a computational resource based on Jupyter notebooks that allows remote access to the entire IDR. IDR is also an open source platform that others can use to publish their own image data. Thus IDR provides both a novel on-line resource and a software infrastructure that promotes and extends publication and re-analysis of scientific image data.

New technologies in cervical cancer precursor detection.

PubMed

Soler, M E; Blumenthal, P D

2000-09-01

The current literature reflects three routes toward improving cervical cancer screening. The first is to improve the test qualities of cytology-based screening. The use of liquid-based cytology and computerized analysis of Papanicolaou tests are examples of attempts at this approach. Secondly, through various combinations of parallel or sequential tests, either the sensitivity or the specificity of a given test could be improved depending on the tests chosen and the order in which they were performed (eg, Papanicolaou test followed by human papillomavirus [HPV] or vice versa). Several excellent studies have been published this year on the use of HPV DNA testing as a primary screening modality and as an adjunct to the triage of mildly abnormal cytologic findings. The recent literature also reflects increasing interest in visual inspection of the cervix and self-collected samples for HPV testing as an equally effective and viable alternative to cytology in low-resource settings. A third possibility is to make use of advances in digital and spectroscopic techniques. In these cost-conscious times, a significant number of articles address the cost-effectiveness of these technologies and the real value of cervical cancer screening. This article reviews the current literature concerning both the advent of new cervical cancer screening technologies and the rediscovery of old ones.

Breast Cancer Screening and Social Media: a Content Analysis of Evidence Use and Guideline Opinions on Twitter.

PubMed

Nastasi, Anthony; Bryant, Tyler; Canner, Joseph K; Dredze, Mark; Camp, Melissa S; Nagarajan, Neeraja

2018-06-01

There is ongoing debate regarding the best mammography screening practices. Twitter has become a powerful tool for disseminating medical news and fostering healthcare conversations; however, little work has been done examining these conversations in the context of how users are sharing evidence and discussing current guidelines for breast cancer screening. To characterize the Twitter conversation on mammography and assess the quality of evidence used as well as opinions regarding current screening guidelines, individual tweets using mammography-related hashtags were prospectively pulled from Twitter from 5 November 2015 to 11 December 2015. Content analysis was performed on the tweets by abstracting data related to user demographics, content, evidence use, and guideline opinions. Standard descriptive statistics were used to summarize the results. Comparisons were made by demographics, tweet type (testable claim, advice, personal experience, etc.), and user type (non-healthcare, physician, cancer specialist, etc.). The primary outcomes were how users are tweeting about breast cancer screening, the quality of evidence they are using, and their opinions regarding guidelines. The most frequent user type of the 1345 tweets was "non-healthcare" with 323 tweets (32.5%). Physicians had 1.87 times higher odds (95% CI, 0.69-5.07) of providing explicit support with a reference and 11.70 times higher odds (95% CI, 3.41-40.13) of posting a tweet likely to be supported by the scientific community compared to non-healthcare users. Only 2.9% of guideline tweets approved of the guidelines while 14.6% claimed to be confused by them. Non-healthcare users comprise a significant proportion of participants in mammography conversations, with tweets often containing claims that are false, not explicitly backed by scientific evidence, and in favor of alternative "natural" breast cancer prevention and treatment. Furthermore, users appear to have low approval and confusion regarding screening guidelines. These findings suggest that more efforts are needed to educate and disseminate accurate information to the general public regarding breast cancer prevention modalities, emphasizing the safety of mammography and the harms of replacing conventional prevention and treatment modalities with unsubstantiated alternatives.

Cost-effectiveness of Different Diabetic Retinopathy Screening Modalities

PubMed Central

Pasquel, Francisco J.; Hendrick, Andrew M.; Ryan, Martha; Cason, Emily; Ali, Mohammed K.; Narayan, K. M. Venkat

2015-01-01

Current screening strategies aimed at detection of diabetic retinopathy (DR) historically have poor compliance, but advancements in technology can enable improved access to care. Nearly 80% of all persons with diabetes live in low- and middle-income countries (LMICs), highlighting the importance of a cost effective screening program. Establishing mechanisms to reach populations with geographic and financial barriers to access is essential to prevent visual disability. Teleretinal programs leverage technology to improve access and reduce cost. The quality of currently employed screening modalities depends on many variables including the instrument used, use of pupillary mydriasis, number of photographic fields, and the qualifications of the photographer and image interpreter. Recent telemedicine and newer technological approaches have been introduced, but data for these technologies is yet limited. We present results of a systematic review of studies evaluating cost-effectiveness of DR screening, and discuss potential relevance for LMICs. PMID:26719134

Contrast-enhanced [18F] fluorodeoxyglucose-positron emission tomography-computed tomography as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin.

PubMed

Jain, Avani; Srivastava, Madhur Kumar; Pawaskar, Alok Suresh; Shelley, Simon; Elangovan, Indirani; Jain, Hasmukh; Pandey, Somnath; Kalal, Shilpa; Amalachandran, Jaykanth

2015-01-01

To evaluate the advantages of contrast enhanced F-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-contrast enhanced CT [CECT]) when used as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin (MUO). A total of 243 patients with fine needle aspiration cytology/biopsy proven MUO were included in this prospective study. Patients who were thoroughly evaluated for primary or primary tumor was detected by any other investigation were excluded from the analysis. Totally, 163 patients with pathological diagnosis of malignancy but no apparent sites of the primary tumor were finally selected for analysis. The site of probable primary malignancy suggested by PET-CECT was confirmed by biopsy/follow-up. PET-CECT suggested probable site of primary in 128/163 (78.52%) patients. In 30/35 remaining patients, primary tumor was not detected even after extensive work-up. In 5 patients, where PET-CECT was negative, primary was found on further extensive investigations or follow-up. The sensitivity, specificity, positive predictive value and negative predictive value of the study were 95.76%, 66.67%, 88.28% and 85.71% respectively. F-18 FDG PET-CECT aptly serves the purpose of initial imaging modality owing to high sensitivity, negative and positive predictive value. PET-CECT not only surveys the whole body for the primary malignancy but also stages the disease accurately. Use of contrast improves the diagnostic utility of modality as well as help in staging of the primary tumor. Although benefits of using PET-CECT as initial diagnostic modality are obvious from this study, there is a need for a larger study comparing conventional methods for diagnosing primary in patients with MUO versus PET-CECT.

Silent music reading: auditory imagery and visuotonal modality transfer in singers and non-singers.

PubMed

Hoppe, Christian; Splittstößer, Christoph; Fliessbach, Klaus; Trautner, Peter; Elger, Christian E; Weber, Bernd

2014-11-01

In daily life, responses are often facilitated by anticipatory imagery of expected targets which are announced by associated stimuli from different sensory modalities. Silent music reading represents an intriguing case of visuotonal modality transfer in working memory as it induces highly defined auditory imagery on the basis of presented visuospatial information (i.e. musical notes). Using functional MRI and a delayed sequence matching-to-sample paradigm, we compared brain activations during retention intervals (10s) of visual (VV) or tonal (TT) unimodal maintenance versus visuospatial-to-tonal modality transfer (VT) tasks. Visual or tonal sequences were comprised of six elements, white squares or tones, which were low, middle, or high regarding vertical screen position or pitch, respectively (presentation duration: 1.5s). For the cross-modal condition (VT, session 3), the visuospatial elements from condition VV (session 1) were re-defined as low, middle or high "notes" indicating low, middle or high tones from condition TT (session 2), respectively, and subjects had to match tonal sequences (probe) to previously presented note sequences. Tasks alternately had low or high cognitive load. To evaluate possible effects of music reading expertise, 15 singers and 15 non-musicians were included. Scanner task performance was excellent in both groups. Despite identity of applied visuospatial stimuli, visuotonal modality transfer versus visual maintenance (VT>VV) induced "inhibition" of visual brain areas and activation of primary and higher auditory brain areas which exceeded auditory activation elicited by tonal stimulation (VT>TT). This transfer-related visual-to-auditory activation shift occurred in both groups but was more pronounced in experts. Frontoparietal areas were activated by higher cognitive load but not by modality transfer. The auditory brain showed a potential to anticipate expected auditory target stimuli on the basis of non-auditory information and sensory brain activation rather mirrored expectation than stimulation. Silent music reading probably relies on these basic neurocognitive mechanisms. Copyright © 2014 Elsevier Inc. All rights reserved.

Screening CT Colonography: Multicenter Survey of Patient Experience, Preference, and Potential Impact on Adherence

PubMed Central

Pooler, B. Dustin; Baumel, Mark J.; Cash, Brooks D.; Moawad, Fouad J.; Riddle, Mark S.; Patrick, Amy M.; Damiano, Mark; Lee, Matthew H.; Kim, David H.; del Rio, Alejandro Muñoz; Pickhardt, Perry J.

2013-01-01

OBJECTIVE Prior research indicates CT colonography (CTC) would be a cost-effective colorectal cancer (CRC) screening test if widespread availability were to increase overall CRC screening adherence rates. The primary aims of this multicenter study were to evaluate patient experience and satisfaction with CTC screening and compare preference against screening colonoscopy. MATERIALS AND METHODS A 12-question survey instrument measuring pretest choice, experience, and satisfaction was given to a consecutive cohort of adults undergoing CTC screening in three disparate screening settings: university academic center, military medical center, and community practice. The study cohort was composed of individuals voluntarily participating in clinical CTC screening programs. RESULTS A total of 1417 patients responded to the survey. The top reasons for choosing CTC for screening included “noninvasiveness” (68.0%), “avoidance of sedation/anesthesia” (63.1%), “ability to drive after the test” (49.2%), “avoidance of optical colonoscopy risks” (46.9%), and “identifying abnormalities outside the colon” (43.3%). Only 7.2% of patients reported pain during the CTC examination and only 2.5% reported greater than moderate discomfort. Of 441 patients who had experienced both CTC and optical colonoscopy, 77.1% preferred CTC and 13.8% preferred optical colonoscopy. Of all patients, 29.6% indicated that they may not have undergone optical colonoscopy screening if CTC were not available. Of all patients, 92.9% labeled their overall experience with CTC as “excellent” or “good,” and 93.0% indicated they would choose CTC for their next screening. CONCLUSION Respondents reported a very high satisfaction level with CTC, and those who had experienced both modalities indicated a preference for CTC over optical colonoscopy. These results suggest that CTC has the potential to increase adherence to CRC screening guidelines if widely available. PMID:22623549

Multi-modality image registration for effective thermographic fever screening

NASA Astrophysics Data System (ADS)

Dwith, C. Y. N.; Ghassemi, Pejhman; Pfefer, Joshua; Casamento, Jon; Wang, Quanzeng

2017-02-01

Fever screening based on infrared thermographs (IRTs) is a viable mass screening approach during infectious disease pandemics, such as Ebola and Severe Acute Respiratory Syndrome (SARS), for temperature monitoring in public places like hospitals and airports. IRTs have been found to be powerful, quick and non-invasive methods for detecting elevated temperatures. Moreover, regions medially adjacent to the inner canthi (called the canthi regions in this paper) are preferred sites for fever screening. Accurate localization of the canthi regions can be achieved through multi-modality registration of infrared (IR) and white-light images. Here we propose a registration method through a coarse-fine registration strategy using different registration models based on landmarks and edge detection on eye contours. We have evaluated the registration accuracy to be within +/- 2.7 mm, which enables accurate localization of the canthi regions.

Which technology to select for primary focal treatment of prostate cancer?-European Section of Urotechnology (ESUT) position statement.

PubMed

Ganzer, Roman; Arthanareeswaran, Vinodh Kumar Adithyaa; Ahmed, Hashim U; Cestari, Andrea; Rischmann, Pascal; Salomon, Georg; Teber, Dogu; Liatsikos, Evangelos; Stolzenburg, Jens-Uwe; Barret, Eric

2018-05-09

With growing interest in focal therapy (FT) of prostate cancer (PCa) there is an increasing armamentarium of treatment modalities including high-intensity focused ultrasound (HIFU), cryotherapy, focal laser ablation (FLA), irreversible electroporation (IRE), vascular targeted photodynamic therapy (VTP), focal brachytherapy (FBT) and stereotactic ablative radiotherapy (SABR). Currently there are no clear recommendations as to which of these technologies are appropriate for individual patient characteristics. Our intention was to review the literature for special aspects of the different technologies that might be of advantage depending on individual patient and tumour characteristics. The current literature on FT was screened for the following factors: morbidity, repeatability, tumour risk category, tumour location, tumour size and prostate volume and anatomical issues. The ESUT expert panel arrived at consensus regarding a position statement on a structured pathway for available FT technologies based on a combination of the literature and expert opinion. Side effects were low across different studies and FT modalities with urinary continence rates of 90-100% and erectile dysfunction between 5 and 52%. Short to medium cancer control based on post-treatment biopsies were variable between ablative modalities. Expert consensus suggested that posterior lesions are better amenable to FT using HIFU. Cryotherapy provides best possible outcomes for anterior tumours. Apical lesions, when treated with FBT, may yield the least urethral morbidity. Further prospective trials are required to assess medium to long term disease control of different ablative modalities for FT. Amongst different available FT modalities our ESUT expert consensus suggests that some may be better for diffe`rent tumour locations. Tumour risk, tumour size, tumour location, and prostate volume are all important factors to consider and might aid in designing future FT trials.

Diagnostic Accuracy of B-mode USG and Doppler Scan for Ovarian Lesions

PubMed Central

Agarwal, Vinish Kumar

2016-01-01

Introduction Ultrasonography (USG) is considered as the primary imaging modality for confirmation of ovarian mass and to differentiate them in to benign or malignant. Aim The present study was conducted with the aim to evaluate accuracy of B- mode USG and Doppler scan (Colour Doppler + Spectral Doppler) for ovarian lesions. Materials and Methods The patients included in the study were from those referred with either palpable adnexal mass or incidentally detected adnexal masses. Total 250 women were evaluated by USG, Doppler scan. Only fifty patients who had true ovarian mass intraoperatively and on histopathology were included in study, rest masses were excluded. Study parameters were morphological indexing on B- Mode USG, flow study, vessel arrangement, and vessel morphology and vessel location in Colour Doppler and resistive index and pulsatility index in spectral Doppler. Results Total 50 women were included in present study. Out of these 46% were pre-menopausal while 54% were menopaused women, 66.7% of post-menopausal women had malignant ovarian masses compared to 8.7% of premenopausal. Sensitivity, specificity, positive predictive value and negative predictive value of B-Mode USG for ovarian masses were 94.44%, 48.15%, 54.84% and 92.86% respectively, with p-value = 0.007, while sensitivity, specificity, positive predictive value and negative predictive value of Doppler scan were 85%, 90%, 85% and 90% respectively, with p-value = 0.0001. Conclusion USG and its different techniques are accepted as the primary imaging modality for early stage diagnosis of an ovarian malignancy. Statistical analysis suggests that Doppler Scan (Colour + Spectral) was more accurate (88%) than B-Mode USG (67%), but author is in view that both of these modalities should be used in conjunction to screen the ovarian lesions. PMID:27790544

Identification and treatment of depression in minority populations.

PubMed

DeJesus, Stania A; Diaz, Vanessa A; Gonsalves, Wanda C; Carek, Peter J

2011-01-01

Depression is a common condition, representing close to 6% of visits to primary care providers. Although minorities are more likely to have chronic depression, they are more likely to be incorrectly diagnosed and less likely to receive treatment when compared to the mainstream population. Screening and appropriate treatment within primary care is recommended in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow-up. This recommendation is especially relevant for treatment of minority populations, as they are more likely to seek care for mental health problems from primary care providers rather than specialists. A number of self-report screening tools that simplify screening are available. Treatment modalities that are supported by evidence are psychotherapy, prescription medications, and electroconvulsive therapy for severe depression. Selective serotonin reuptake inhibitors (SSRIs) have become the cornerstone of therapy for depression since the Food and Drug Administration (FDA) approval of fluoxetine in 1987. No substantial differences in efficacy of SSRIs have been found, although data suggest differences with respect to onset of action and adverse effects that may be relevant in the choice of one medicine over another. Common side effects of serotonin reuptake inhibitors include nausea, diarrhea, insomnia, somnolence and dizziness, akathisia, and sexual dysfunction. While most of these symptoms tend to subside within several weeks of use, sexual dysfunction appears to be a long-term side effect that typically reverses within a few days after discontinuation of the causative medication. Selective norepinephrine reuptake inhibitors (SNRIs), bupropion, mirtazapine, and tricyclic antidepressants (TCAs) are other commonly used medications. Complementary and alternative treatments, such as St. John's wort (Hypericum perforatum), exercise, acupuncture, music therapy, and relaxation, have limited data supporting their efficacy.

Colorectal cancer among Koreans living in South Korea versus California: incidence, mortality, and screening rates.

PubMed

Ryu, So Yeon; Crespi, Catherine M; Maxwell, Annette E

2014-08-01

This study compared trends in colorectal cancer (CRC) incidence and mortality rates among Koreans in South Korea and Korean Americans and non-Hispanic whites in California between 1999 and 2009, and examined CRC screening rates and socio-demographic correlates of CRC screening in the two Korean populations. Age-standardized CRC incidence and mortality rates of Koreans in South Korea and Korean Americans and non-Hispanic whites in California for the years 1999-2009 were obtained from annual reports of cancer statistics and modeled using joinpoint regression. Using 2009 data from the Korean National Health and Nutrition Examination Survey and the California Health Interview Survey, we estimated and compared CRC screening rates and test modalities. We used multiple logistic regression to examine socio-demographic correlates of completion of CRC screening according to the guidelines among the two Korean populations. CRC incidence and mortality rates among South Koreans increased during 1999-2009 but more slowly during the late 2000s. In California, CRC incidence increased among Korean American females but decreased among non-Hispanic whites. About 37% of South Koreans and 60% of Korean Americans reported completion of CRC screening according to guidelines in 2009. Among South Koreans, married status, higher income, and private health insurance were associated with CRC screening, adjusting for other factors. Among Korean Americans, having health insurance was associated with CRC screening. Despite almost identical CRC screening guidelines in South Korea and the USA and substantially higher screening rates among Korean Americans as compared to South Koreans, disparities remain in both populations with respect to CRC statistics. Thus, efforts to promote primary and secondary prevention of CRC in both Korean populations are critically important in both countries.

Associative learning changes cross-modal representations in the gustatory cortex

PubMed Central

Vincis, Roberto; Fontanini, Alfredo

2016-01-01

A growing body of literature has demonstrated that primary sensory cortices are not exclusively unimodal, but can respond to stimuli of different sensory modalities. However, several questions concerning the neural representation of cross-modal stimuli remain open. Indeed, it is poorly understood if cross-modal stimuli evoke unique or overlapping representations in a primary sensory cortex and whether learning can modulate these representations. Here we recorded single unit responses to auditory, visual, somatosensory, and olfactory stimuli in the gustatory cortex (GC) of alert rats before and after associative learning. We found that, in untrained rats, the majority of GC neurons were modulated by a single modality. Upon learning, both prevalence of cross-modal responsive neurons and their breadth of tuning increased, leading to a greater overlap of representations. Altogether, our results show that the gustatory cortex represents cross-modal stimuli according to their sensory identity, and that learning changes the overlap of cross-modal representations. DOI: http://dx.doi.org/10.7554/eLife.16420.001 PMID:27572258

Contrast-enhanced [18F] fluorodeoxyglucose-positron emission tomography-computed tomography as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin

PubMed Central

Jain, Avani; Srivastava, Madhur Kumar; Pawaskar, Alok Suresh; Shelley, Simon; Elangovan, Indirani; Jain, Hasmukh; Pandey, Somnath; Kalal, Shilpa; Amalachandran, Jaykanth

2015-01-01

Background: To evaluate the advantages of contrast enhanced F-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-contrast enhanced CT [CECT]) when used as an initial imaging modality in patients presenting with metastatic malignancy of undefined primary origin (MUO). Materials and Methods: A total of 243 patients with fine needle aspiration cytology/biopsy proven MUO were included in this prospective study. Patients who were thoroughly evaluated for primary or primary tumor was detected by any other investigation were excluded from the analysis. Totally, 163 patients with pathological diagnosis of malignancy but no apparent sites of the primary tumor were finally selected for analysis. The site of probable primary malignancy suggested by PET-CECT was confirmed by biopsy/follow-up. Results: PET-CECT suggested probable site of primary in 128/163 (78.52%) patients. In 30/35 remaining patients, primary tumor was not detected even after extensive work-up. In 5 patients, where PET-CECT was negative, primary was found on further extensive investigations or follow-up. The sensitivity, specificity, positive predictive value and negative predictive value of the study were 95.76%, 66.67%, 88.28% and 85.71% respectively. Conclusions: F-18 FDG PET-CECT aptly serves the purpose of initial imaging modality owing to high sensitivity, negative and positive predictive value. PET-CECT not only surveys the whole body for the primary malignancy but also stages the disease accurately. Use of contrast improves the diagnostic utility of modality as well as help in staging of the primary tumor. Although benefits of using PET-CECT as initial diagnostic modality are obvious from this study, there is a need for a larger study comparing conventional methods for diagnosing primary in patients with MUO versus PET-CECT. PMID:26170563

The Novel Language-Systematic Aphasia Screening SAPS: Screening-Based Therapy in Combination with Computerised Home Training

ERIC Educational Resources Information Center

Krzok, Franziska; Rieger, Verena; Niemann, Katharina; Nobis-Bosch, Ruth; Radermacher, Irmgard; Huber, Walter; Willmes, Klaus; Abel, Stefanie

2018-01-01

Background: SAPS--'Sprachsystematisches Aphasiescreening'--is a novel language-systematic aphasia screening developed for the German language, which already had been positively evaluated. It offers a fast assessment of modality-specific psycholinguistic components at different levels of complexity and the derivation of impairment-based treatment…

["Local" or "mobile" screening for diabetic retinopathy in general practice by non-mydriatic digital cameras? about the Diabetes Midi-Pyrénées network activity between 2005 and 2010].

PubMed

Bismuth, Pierre; Bismuth, Michel; Dupouy, Julie; Rougé-Bugat, Marie-Eve; Poutrain, Jean-Christophe; Escourrou, Brigitte; Hanaire, Hélène; Oustric, Stéphane

2012-12-01

Fundus photographs using non-mydriatic digital cameras for diabetic retinopathy screening have been studied in France during the past 10 years. Nevertheless, the different screening modalities have not been compared. The main goal of this study was to compare patient recruitment with two different screening modalities, and secondarily to compare diagnostic effectiveness and cost. A retrospective study analyzed data from the Diabetes Midi Pyrenees Network in 2005 and between 2006 and 2010. In 2005, a vehicle with digital camera traveled through a rural department in order to screen diabetic patients whose last fundus examination was performed greater than 1 year previously. Between 2006 and 2010, general practitioners sent their diabetic patients whose last fundus examination was performed greater than 1 year previously to a "local" screening site. In the two cases, fundus photographs were made by trained operator at screening site and analyzed by an ophthalmologist. The "mobile" screening recruited 698 patients, and the "local" screening 345 patients. Patients recruited by "mobile" screening were older than those recruited by "local" screening. They were preferentially men and suffered from diabetes from far longer The diagnostic performance of "local" screening was 26.8%, and it was 28.6% for "mobile" screening (p = 0.47). The cost of screening was higher for "mobile" screening: 116 Euro against 61 Euro for "local" screening. "Mobile" screening could allow more patient recruitment than "local" screening when geographic and demographic constraints are more important.

Sequential roles of primary somatosensory cortex and posterior parietal cortex in tactile-visual cross-modal working memory: a single-pulse transcranial magnetic stimulation (spTMS) study.

PubMed

Ku, Yixuan; Zhao, Di; Hao, Ning; Hu, Yi; Bodner, Mark; Zhou, Yong-Di

2015-01-01

Both monkey neurophysiological and human EEG studies have shown that association cortices, as well as primary sensory cortical areas, play an essential role in sequential neural processes underlying cross-modal working memory. The present study aims to further examine causal and sequential roles of the primary sensory cortex and association cortex in cross-modal working memory. Individual MRI-based single-pulse transcranial magnetic stimulation (spTMS) was applied to bilateral primary somatosensory cortices (SI) and the contralateral posterior parietal cortex (PPC), while participants were performing a tactile-visual cross-modal delayed matching-to-sample task. Time points of spTMS were 300 ms, 600 ms, 900 ms after the onset of the tactile sample stimulus in the task. The accuracy of task performance and reaction time were significantly impaired when spTMS was applied to the contralateral SI at 300 ms. Significant impairment on performance accuracy was also observed when the contralateral PPC was stimulated at 600 ms. SI and PPC play sequential and distinct roles in neural processes of cross-modal associations and working memory. Copyright © 2015 Elsevier Inc. All rights reserved.

Recruitment strategies for an osteoporosis clinical trial: analysis of effectiveness.

PubMed

Heard, Allison; March, Rachel; Maguire, Patricia; Reilly, Penny; Helmore, Joy; Cameron, Sheryl; Frampton, Christopher; Nicholls, Gary; Gilchrist, Nigel

2012-09-01

To examine the effectiveness of a planned rapid recruitment strategy in an osteoporosis clinical trial. Multiple recruitment methods were explored, including media advertising, searching bone density scan and X-ray results in specialist and primary practice databases, community initiatives, and generation of research centre and study-specific pamphlets. Of 246 women screened, 41 consenting to the study, only 14 were randomised. Thus, 232 (94%) volunteers were screen failures, ineligible or declined to participate. With regard to the cost-effectiveness of all recruitment strategies, searching the research centre database was the most successful, with four women randomised at a cost of approximately NZ$302 per volunteer. Other strategies were less cost-effective. Obtaining a specific study cohort can be achieved by a comprehensive, targeted, rapid recruitment program. A research centre database search was the most successful and cost-effective recruitment modality in this small study. © 2012 Canterbury Geriatric Medical Research Trust. Australasian Journal on Ageing © 2012 ACOTA.

Explorations in High-Risk Stimulation: Two Modalities in Mothering.

ERIC Educational Resources Information Center

Gochman, Eva R. Grubler; Aisenstein, Clara

An exploratory study of high-risk mothers' interactions with their infants studied modalities of stimulation; vestibular and auditory. It was hypothesized that stimulation would be lower for non-paranoid than for paranoid types, and than for control mothers. Mothers recruited from inner city gynecological clinics were screened for probable…

Test, episode, and programme sensitivities of screening for colorectal cancer as a public health policy in Finland: experimental design.

PubMed

Malila, Nea; Oivanen, Tiina; Malminiemi, Outi; Hakama, Matti

2008-11-20

To report the sensitivities of the faecal occult blood test, screening episode, and screening programme for colorectal cancer and the benefits of applying a randomised design at the implementation phase of a new public health policy. Experimental design incorporated in public health evaluation using randomisation at individual level in the target population. 161 of the 431 Finnish municipalities in 2004-6. 106 000 adults randomised to screening or control arms. In total, 52 998 adults aged 60-64 in the screening arm received faecal occult blood test kits. Test, episode, and programme sensitivities estimated by the incidence method and corrected for selective attendance and overdiagnosis. The response for screening was high overall (70.8%), and significantly better in women (78.1%) than in men (63.3%). The incidence of cancer in the controls was somewhat higher in men than in women (103 v 93 per 100 000 person years), which was not true for interval cancers (42 v 49 per 100 000 person years). The sensitivity of the faecal occult blood test was 54.6%. Only a few interval cancers were detected among those with positive test results, hence the episode sensitivity of 51.3% was close to the test sensitivity. At the population level the sensitivity of the programme was 37.5%. Although relatively low, the sensitivity of screening for colorectal cancer with the faecal occult blood test in Finland was adequate. An experimental design is a prerequisite for evaluation of such a screening programme because the effectiveness of preventing deaths is likely to be small and results may otherwise remain inconclusive. Thus, screening for colorectal cancer using any primary test modality should be launched in a public health programme with randomisation of the target population at the implementation phase.

Developments in Screening Tests and Strategies for Colorectal Cancer

PubMed Central

Sovich, Justin L.; Sartor, Zachary

2015-01-01

Background. Worldwide, colorectal cancer (CRC) is the third most common cancer in men and second most common in women. It is the fourth most common cause of cancer mortality. In the United States, CRC is the third most common cause of cancer and second most common cause of cancer mortality. Incidence and mortality rates have steadily fallen, primarily due to widespread screening. Methods. We conducted keyword searches on PubMed in four categories of CRC screening: stool, endoscopic, radiologic, and serum, as well as news searches in Medscape and Google News. Results. Colonoscopy is the gold standard for CRC screening and the most common method in the United States. Technological improvements continue to be made, including the promising “third-eye retroscope.” Fecal occult blood remains widely used, particularly outside the United States. The first at-home screen, a fecal DNA screen, has also recently been approved. Radiological methods are effective but seldom used due to cost and other factors. Serum tests are largely experimental, although at least one is moving closer to market. Conclusions. Colonoscopy is likely to remain the most popular screening modality for the immediate future, although its shortcomings will continue to spur innovation in a variety of modalities. PMID:26504799

Potential impact of legislation mandating breast density notification: benefits, harms, and cost effectiveness of supplemental ultrasound screening

PubMed Central

Sprague, Brian L.; Stout, Natasha K.; Schechter, Clyde; van Ravesteyn, Nicolien T.; Cevik, Mucahit; Alagoz, Oguzhan; Lee, Christoph I.; van den Broek, Jeroen J.; Miglioretti, Diana L.; Mandelblatt, Jeanne S.; de Koning, Harry J.; Kerlikowske, Karla; Lehman, Constance D.; Tosteson, Anna N. A.

2014-01-01

Background At least nineteen states have laws that require telling women with dense breasts and a negative screening mammogram to consider supplemental screening. The most readily available supplemental screening modality is ultrasound, yet little is known about its effectiveness. Objective To evaluate the benefits, harms, and cost-effectiveness of supplemental ultrasound screening for women with dense breasts. Design Comparative modeling with 3 validated simulation models. Data Sources Surveillance, Epidemiology, and End Results Program; Breast Cancer Surveillance Consortium; the medical literature. Target Population A contemporary cohort of women eligible for routine screening. Time Horizon Lifetime. Perspective Payer. Interventions Supplemental ultrasound screening for women with dense breasts following a negative screening mammogram. Outcome Measures Breast cancer deaths averted, quality-adjusted life years (QALYs) gained, false positive ultrasound biopsy recommendations, costs, costs per QALY gained. Results of Base-Case Analysis Supplemental ultrasound screening after a negative mammogram for women aged 50–74 with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models: 0.14–0.75), gained 1.7 QALYs (0.9–4.7), and resulted in 354 false-positive ultrasound biopsy recommendations (345–421) per 1000 women with dense breasts compared with biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained ($112,000-$766,000). Restricting supplemental ultrasound screening to women with extremely dense breasts cost $246,000 per QALY gained ($74,000-$535,000). Results of Sensitivity Analysis The conclusions were not sensitive to ultrasound performance characteristics, screening frequency, or starting age. Limitations Provider costs for coordinating supplemental ultrasound were not considered. Conclusions Supplemental ultrasound screening for women with dense breasts undergoing screening mammography would substantially increase costs while producing relatively small benefits in breast cancer deaths averted and QALYs gained. Primary Funding Source National Institutes of Health PMID:25486550

Optimizing the Use of the AUDIT for Alcohol Screening in College Students

ERIC Educational Resources Information Center

DeMartini, Kelly S.; Carey, Kate B.

2012-01-01

The screening and brief intervention modality of treatment for at-risk college drinking is becoming increasingly popular. A key to effective implementation is use of validated screening tools. Although the Alcohol Use Disorders Identification Test (AUDIT) has been validated in adult samples and is often used with college students, research has not…

The Impact of Multimedia Effect on Science Learning: Evidence from Eye Movements

ERIC Educational Resources Information Center

She, Hsiao-Ching; Chen, Yi-Zen

2009-01-01

This study examined how middle school students constructed their understanding of the mitosis and meiosis processes at a molecular level through multimedia learning materials presented in different interaction and sensory modality modes. A two (interaction modes: animation/simulation) by two (sensory modality modes: narration/on-screen text)…

Eye closure helps memory by reducing cognitive load and enhancing visualisation.

PubMed

Vredeveldt, Annelies; Hitch, Graham J; Baddeley, Alan D

2011-10-01

Closing the eyes helps memory. We investigated the mechanisms underlying the eyeclosure effect by exposing 80 eyewitnesses to different types of distraction during the witness interview: blank screen (control), eyes closed, visual distraction, and auditory distraction. We examined the cognitive load hypothesis by comparing any type of distraction (visual or auditory) with minimal distraction (blank screen or eyes closed). We found recall to be significantly better when distraction was minimal, providing evidence that eyeclosure reduces cognitive load. We examined the modality-specific interference hypothesis by comparing the effects of visual and auditory distraction on recall of visual and auditory information. Visual and auditory distraction selectively impaired memory for information presented in the same modality, supporting the role of visualisation in the eyeclosure effect. Analysis of recall in terms of grain size revealed that recall of basic information about the event was robust, whereas recall of specific details was prone to both general and modality-specific disruptions.

Barriers and incentives for choosing to specialise in mammography: Qualitative analysis.

PubMed

Warren-Forward, H M; Taylor, J

2017-02-01

There is a projected shortage of radiographers working in breast screening and this study aimed to examine comments from open response questions from a mixed methods survey of current diagnostic radiography students on their perceptions of working in mammography. The survey asked three open ended questions: Justification of choice of modality in which they would want to specialise, why they believed there was a shortage of radiographers working in breast screening and any other comment about mammography. Reasons given for specialising in any modality was interest, feature of a modality, amount of clinical exposure during the degree program, personal issues and career prospects. Few current diagnostic radiography students indicated that they would be interested in specialising in breast imaging. They considered there to be a shortage of radiographers as breast imaging was seen to be repetitive, high pressure, intimate and gender biased. Lack of education, clinical exposure, limited career prospects and low pay were also discussed. Increasing education to the modality during the degree, allowing males to be involved in breast imaging and promoting part-time work in mammography while also working in other modalities may alter the perception that mammography offers a limited career pathway. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Biomarkers for CNS involvement in pediatric lupus

PubMed Central

Rubinstein, Tamar B; Putterman, Chaim; Goilav, Beatrice

2015-01-01

CNS disease, or central neuropsychiatric lupus erythematosus (cNPSLE), occurs frequently in pediatric lupus, leading to significant morbidity and poor long-term outcomes. Diagnosing cNPSLE is especially difficult in pediatrics; many current diagnostic tools are invasive and/or costly, and there are no current accepted screening mechanisms. The most complicated aspect of diagnosis is differentiating primary disease from other etiologies; research to discover new biomarkers is attempting to address this dilemma. With many mechanisms involved in the pathogenesis of cNPSLE, biomarker profiles across several modalities (molecular, psychometric and neuroimaging) will need to be used. For the care of children with lupus, the challenge will be to develop biomarkers that are accessible by noninvasive measures and reliable in a pediatric population. PMID:26079959

Variation in Cardiac Screening and Management of Carcinoid Heart Disease in the UK and Republic of Ireland.

PubMed

Dobson, R; Valle, J W; Burgess, M I; Poston, G J; Cuthbertson, D J

2015-12-01

Screening for carcinoid heart disease is an important, yet frequently neglected aspect of the management of patients with neuroendocrine tumours (NETs). Screening is advocated in international guidelines, although recommendations on the modality and frequency are poorly defined. We mapped current practice for the screening and management of carcinoid heart disease in specialist NET centres throughout the UK and Republic of Ireland. Thirty-five NET centres were invited to complete an online questionnaire outlining the size of NET service, patient selection criteria for carcinoid heart disease screening and the modality and frequency of screening. Twenty-eight centres responded (80%), representing over 5500 patients. Eleven per cent of centres screen all patients with any NET, 14% screen only patients with midgut NETs, 32% screen all patients with liver metastases and/or carcinoid syndrome and 43% screen all patients with evidence of syndrome or raised urinary/serum/plasma 5-hydroxyindoleacetic acid (5HIAA). The mode of screening included clinical examination, echocardiography and biomarker measurement: 89% of centres carry out echocardiography, ranging from at initial presentation only (24%), periodically without clearly defined intervals (28%), annually (36%) or less than annually (12%); three centres use a scoring system to report their echocardiograms. Fifty per cent of centres utilise biomarkers for screening (chromogranins, plasma/urinary 5HIAA or most commonly N-terminal pro-brain natriuretic peptide) at varying time intervals. There is considerable heterogeneity across the UK and Ireland in multiple aspects of screening and management of carcinoid heart disease. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Canadian women's attitudes toward noninvasive prenatal testing of fetal DNA in maternal plasma (.).

PubMed

Pariente, Gali; Hasan, Lara; Gadot, Yifat; De Souza, Leanne R; Lebovic, Gerald; Berger, Howard

2016-12-01

To determine the perceptions and attitudes of Canadian women to Noninvasive Prenatal Testing of fetal DNA. A designed questionnaire was administered to women attending the outpatient antenatal clinic at a tertiary urban hospital. Attitudes to current and new prenatal screening modalities were assessed using a five-point Likert scale. Bowker's test of symmetry was used to compare individual responses regarding the two screening modalities. Changes in women's responses pre- and post-delivery were also compared. One hundred and twenty-nine women were enrolled in this study. 88% of women state that they would perform prenatal screening via fetal DNA in the maternal plasma if available. When compared to conventional screening, significantly less women believe that the NIPT should be available upon request for non-medical traits (36.4% versus 60.4%, p < 0.001). When compared to their answer before delivery, more women agreed that screening with fetal DNA in maternal plasma could be used in a negative way to select for desired non-medical traits such as gender. The use of fetal DNA in the maternal plasma is widely accepted in our Canadian population as a future method of noninvasive prenatal screening despite recognition of certain ethical concerns. This information can be used when implementing new genetic screening programs.

Working women identify influences and obstacles to breast health practices.

PubMed

Stamler, L L; Thomas, B; Lafreniere, K

2000-06-01

To identify factors contributing to participation in breast screening in working women to drive health education planning and implementation. Survey. Automotive plants in southern Canada. Union and nonunion women working in the plants. Survey using "Health Care Practices: A Worksite Survey," modified for Canadian population. Age, education, breast health practices, influences on decision to participate in breast screening, and physician gender. Differences were noted among three age groups (under 30 years, 30-49 years, 50 years or older) in terms of influences and perceived barriers to the different modalities of breast screening. For clinical breast exams, women preferred an expert in breast health, regardless of whether the professional was a physician or a nurse. In all groups, the physician was noted as being very influential; however, perceptions of encouragement from the physician varied across the age groups. Perceptions of barriers to breast screening differed among the age groups and between women with male physicians and those with female physicians. Coworkers were identified as being a strong influence in the older group, whereas friends and family were identified as being more influential in the younger groups. Health promotion and education strategies may need to be stratified for different age groups. Breast health education may need to be seen as an ongoing educational process, with the target groups being both the women and the primary healthcare professionals. The worksite has strong potential as a setting for health promotion activities.

Evidence for modality-independent order coding in working memory.

PubMed

Depoorter, Ann; Vandierendonck, André

2009-03-01

The aim of the present study was to investigate the representation of serial order in working memory, more specifically whether serial order is coded by means of a modality-dependent or a modality-independent order code. This was investigated by means of a series of four experiments based on a dual-task methodology in which one short-term memory task was embedded between the presentation and recall of another short-term memory task. Two aspects were varied in these memory tasks--namely, the modality of the stimulus materials (verbal or visuo-spatial) and the presence of an order component in the task (an order or an item memory task). The results of this study showed impaired primary-task recognition performance when both the primary and the embedded task included an order component, irrespective of the modality of the stimulus materials. If one or both of the tasks did not contain an order component, less interference was found. The results of this study support the existence of a modality-independent order code.

Re Viewing Listening: "Clip Culture" and Cross-Modal Learning in the Music Classroom

ERIC Educational Resources Information Center

Webb, Michael

2010-01-01

This article envisions a new, cross-modal approach to classroom music listening, one that takes advantage of students' rising screen literacy and the ever-expanding archive of music-related visual material available on DVD and on video sharing sites such as YouTube. It is grounded in current literature on music performance studies, embodied music…

Multicolor Scanning Laser Imaging in Diabetic Retinopathy.

PubMed

Ahmad, Mohammad S Z; Carrim, Zia Iqbal

2017-11-01

Diabetic retinopathy is a common cause of blindness in individuals younger than 60 years. Screening for retinopathy is undertaken using conventional color fundus photography and relies on the identification of hemorrhages, vascular abnormalities, exudates, and cotton-wool spots. These can sometimes be difficult to identify. Multicolor scanning laser imaging, a new imaging modality, may have a role in improving screening outcomes, as well as facilitating treatment decisions. Observational case series comprising two patients with known diabetes who were referred for further examination after color fundus photography revealed abnormal findings. Multicolor scanning laser imaging was undertaken. Features of retinal disease from each modality were compared. Multicolor scanning laser imaging provides superior visualization of retinal anatomy and pathology, thereby facilitating risk stratification and treatment decisions. Multicolor scanning laser imaging is a novel imaging technique offering the potential for improving the reliability of screening for diabetic retinopathy. Validation studies are warranted.

Decision Support and the Effectiveness of Web-based Delivery and Information Tailoring for Bowel Cancer Screening: An Exploratory Study

PubMed Central

Wilson, Carlene J; Zajac, Ian T; Hart, Elizabeth; McGillivray, Jane A

2012-01-01

Background Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females throughout the developed world. Population screening using fecal occult blood tests (FOBTs) facilitates early detection and greater chance of survival, but participation rates are low. We developed a Web-based decision tool to provide information tailored to an individual’s decision stage for CRC screening and attitude toward screening utilizing the Preventive Health Model (PHM) and Precaution Adoption Process Model (PAPM) as theoretical frameworks for screening behavior. We describe the practical steps employed in the tool’s design and the subsequent conduct of an exploratory study. Objective To design a decision tool for CRC screening and conduct an exploratory study among average-risk men and women to (1) test the impact of message type (tailored vs non-tailored) and message delivery modality (Web-based vs paper-based) on attitudes toward screening and screening uptake, and (2) investigate the acceptability of the decision tool and relevance of materials. Methods Participants (n = 100), recruited from a population sample of men and women aged 50-76 residing in urban Adelaide, Australia, were randomly assigned to a control group or one of 4 interventions: (1) Web-based and tailored information, (2) paper-based and tailored information, (3) Web-based and non-tailored (generic) information, or (4) paper-based and non-tailored information. Participation was augmented by snowball recruitment (n = 19). Questionnaires based on PHM variables were administered pre- and post-intervention. Participants were given the opportunity to request an FOBT. Following the intervention, participants discussed the acceptability of the tool. Results Full data were available for 87.4% (104/119) of participants. Post-intervention, perceived susceptibility scores for individuals receiving tailored information increased from mean 10.6 (SD 2.1) to mean 11.8 (SD 2.2). Scores on self-efficacy increased in the tailored group from mean 11.7 (SD 2.0) to mean 12.6 (SD 1.8). There were significant time x modality x message effects for social influence and salience and coherence, reflecting an increase in these scores for tailored Web-based participants only; social influence scores increased from mean 11.7 (SD 2.6) to mean 14.9 (SD 2.3), and salience and coherence scores increased from mean 16.0 (SD 2.2) to mean 17.7 (SD 2.1). There was no greater influence of modality or message type on movement toward a decision to screen or screening uptake, indicating that neither tailored messages nor a Web modality had superior effect. Overall, participants regarded tailored messages positively, but thought that the Web tool lacked “media richness.” Conclusions This exploratory study confirms that tailoring on PHM predictors of CRC screening has the potential to positively address attitudes toward screening. However, tailoring on these variables did not result in significantly increased screening uptake. Future research should consider other possible psychosocial influences. Mode of delivery did not affect outcomes, but as a delivery medium, the Web has economic and logistical advantages over paper. PMID:23611950

A Reconstruction Algorithm for Breast Cancer Imaging With Electrical Impedance Tomography in Mammography Geometry

PubMed Central

Kao, Tzu-Jen; Isaacson, David; Saulnier, Gary J.; Newell, Jonathan C.

2009-01-01

The conductivity and permittivity of breast tumors are known to differ significantly from those of normal breast tissues, and electrical impedance tomography (EIT) is being studied as a modality for breast cancer imaging to exploit these differences. At present, X-ray mammography is the primary standard imaging modality used for breast cancer screening in clinical practice, so it is desirable to study EIT in the geometry of mammography. This paper presents a forward model of a simplified mammography geometry and a reconstruction algorithm for breast tumor imaging using EIT techniques. The mammography geometry is modeled as a rectangular box with electrode arrays on the top and bottom planes. A forward model for the electrical impedance imaging problem is derived for a homogeneous conductivity distribution and is validated by experiment using a phantom tank. A reconstruction algorithm for breast tumor imaging based on a linearization approach and the proposed forward model is presented. It is found that the proposed reconstruction algorithm performs well in the phantom experiment, and that the locations of a 5-mm-cube metal target and a 6-mm-cube agar target could be recovered at a target depth of 15 mm using a 32 electrode system. PMID:17405377

Performance characteristics of digital vs film screen mammography in community practice.

PubMed

Dabbous, Firas; Dolecek, Therese A; Friedewald, Sarah M; Tossas-Milligan, Katherine Y; Macarol, Tere; Summerfelt, Wm Thomas; Rauscher, Garth H

2018-05-01

We compared the performance characteristics of 297 629 full field digital (FFDM) and 416 791 screen film mammograms (SFM). Sensitivity increased with age, decreased with breast density, and was lower for more aggressive and lobular tumors. While sensitivity did not differ significantly by modality, specificity was generally 1%-2% points higher for FFDM than for SFM across age and breast density categories. The lower recall rate for FFDM vs SFM in our study may partially explain performance differences by modality. In this large health care organization, modest gains in performance were achieved with the introduction of FFDM as a replacement for SFM. © 2017 Wiley Periodicals, Inc.

The intelligent, painless, "germ-free" colonoscopy: A Columbus' egg for increasing population adherence to colorectal cancer screening?

PubMed

Perri, Francesco; Iacobellis, Angelo; Gentile, Marco; Tumino, Emanuele; Andriulli, Angelo

2010-12-01

Colorectal cancer (CRC) represents a major cause of morbidity and mortality. Although it is widely accepted that CRC screening in average risk populations lowers CRC incidence and mortality, a disappointedly low adherence rate to both faecal occult blood testing and colonoscopy-based screening programs has been observed in Italy and in other European countries. Main reasons for the low acceptance of colonoscopy-based CRC screening has been ascribed to lack of recommendations given by general practitioners, fear of discomfort or complications, embarrassment, and avoidance of unpleasant preparation. New advances in endoscopic technology such as colon capsule and robotic colonoscopy might represent the ideal tool for CRC screening since they reduce or eliminate procedure-related pain and discomfort. Moreover, no disinfection between procedures is required. Motion of the new probes along the gastrointestinal tract is achieved either in passive modality by utilizing the gut peristalsis (colon capsule) or in active "intelligent" modality by means of computer-assisted propulsion (robotic colonoscopy). In this review, the preliminary clinical results obtained with the new devices are summarized. It is expected that the new instruments will be soon available in clinical practice with the hope of increasing adherence to CRC screening programs. Copyright © 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Verna Wright Lecture: Psoriatic Arthritis: The Need for Early Intervention.

PubMed

McHugh, Neil J

2015-11-01

About 30% of individuals with skin psoriasis will develop an inflammatory disease of the peripheral or axial skeleton involving synovial and/or entheseal tissue termed psoriatic arthritis (PsA). In most cases psoriasis will precede PsA by several years. Hence skin psoriasis provides an opportune model to investigate genetic and environmental factors that interact and contribute to the development of a common form of inflammatory arthritis. Further, the preexisting presence of psoriasis represents a unique opportunity for the early detection of arthritis and the potential for more effective intervention. However, despite the presence of psoriasis, there may be delay in the diagnosis of PsA that is associated with adverse longterm outcome. Undiagnosed disease is not uncommon, as demonstrated by studies applying screening questionnaires to primary care and dermatology clinic populations. Other potential risk factors, such as obesity and smoking, the presence of certain genetic and biomarker profiles, combined with accurate imaging modalities, offer the potential for more targeted screening. So in future it should be possible to detect PsA at a much earlier stage and prevent significant joint damage and associated disability before it happens.

Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review

PubMed Central

Pereira, Amanda; Farrenkopf, Brooke A; Labrique, Alain B; Pariyo, George W; Hyder, Adnan A

2017-01-01

Background National and subnational level surveys are important for monitoring disease burden, prioritizing resource allocation, and evaluating public health policies. As mobile phone access and ownership become more common globally, mobile phone surveys (MPSs) offer an opportunity to supplement traditional public health household surveys. Objective The objective of this study was to systematically review the current landscape of MPSs to collect population-level estimates in low- and middle-income countries (LMICs). Methods Primary and gray literature from 7 online databases were systematically searched for studies that deployed MPSs to collect population-level estimates. Titles and abstracts were screened on primary inclusion and exclusion criteria by two research assistants. Articles that met primary screening requirements were read in full and screened for secondary eligibility criteria. Articles included in review were grouped into the following three categories by their survey modality: (1) interactive voice response (IVR), (2) short message service (SMS), and (3) human operator or computer-assisted telephone interviews (CATI). Data were abstracted by two research assistants. The conduct and reporting of the review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results A total of 6625 articles were identified through the literature review. Overall, 11 articles were identified that contained 19 MPS (CATI, IVR, or SMS) surveys to collect population-level estimates across a range of topics. MPSs were used in Latin America (n=8), the Middle East (n=1), South Asia (n=2), and sub-Saharan Africa (n=8). Nine articles presented results for 10 CATI surveys (10/19, 53%). Two articles discussed the findings of 6 IVR surveys (6/19, 32%). Three SMS surveys were identified from 2 articles (3/19, 16%). Approximately 63% (12/19) of MPS were delivered to mobile phone numbers collected from previously administered household surveys. The majority of MPS (11/19, 58%) were panel surveys where a cohort of participants, who often were provided a mobile phone upon a face-to-face enrollment, were surveyed multiple times. Conclusions Very few reports of population-level MPS were identified. Of the MPS that were identified, the majority of surveys were conducted using CATI. Due to the limited number of identified IVR and SMS surveys, the relative advantages and disadvantages among the three survey modalities cannot be adequately assessed. The majority of MPS were sent to mobile phone numbers that were collected from a previously administered household survey. There is limited evidence on whether a random digit dialing (RDD) approach or a simple random sample of mobile network provided list of numbers can produce a population representative survey. PMID:28476725

Building the Evidence Base for Remote Data Collection in Low- and Middle-Income Countries: Comparing Reliability and Accuracy Across Survey Modalities

PubMed Central

Gibson, Dustin G; Khattar, Christelle; Labrique, Alain B; Pariyo, George W

2017-01-01

Background Given the growing interest in mobile data collection due to the proliferation of mobile phone ownership and network coverage in low- and middle-income countries (LMICs), we synthesized the evidence comparing estimates of health outcomes from multiple modes of data collection. In particular, we reviewed studies that compared a mode of remote data collection with at least one other mode of data collection to identify mode effects and areas for further research. Objective The study systematically reviewed and summarized the findings from articles and reports that compare a mode of remote data collection to at least one other mode. The aim of this synthesis was to assess the reliability and accuracy of results. Methods Seven online databases were systematically searched for primary and grey literature pertaining to remote data collection in LMICs. Remote data collection included interactive voice response (IVR), computer-assisted telephone interviews (CATI), short message service (SMS), self-administered questionnaires (SAQ), and Web surveys. Two authors of this study reviewed the abstracts to identify articles which met the primary inclusion criteria. These criteria required that the survey collected the data from the respondent via mobile phone or landline. Articles that met the primary screening criteria were read in full and were screened using secondary inclusion criteria. The four secondary inclusion criteria were that two or more modes of data collection were compared, at least one mode of data collection in the study was a mobile phone survey, the study had to be conducted in a LMIC, and finally, the study should include a health component. Results Of the 11,568 articles screened, 10 articles were included in this study. Seven distinct modes of remote data collection were identified: CATI, SMS (singular sitting and modular design), IVR, SAQ, and Web surveys (mobile phone and personal computer). CATI was the most frequent remote mode (n=5 articles). Of the three in-person modes (face-to-face [FTF], in-person SAQ, and in-person IVR), FTF was the most common (n=11) mode. The 10 articles made 25 mode comparisons, of which 12 comparisons were from a single article. Six of the 10 articles included sensitive questions. Conclusions This literature review summarizes the existing research about remote data collection in LMICs. Due to both heterogeneity of outcomes and the limited number of comparisons, this literature review is best positioned to present the current evidence and knowledge gaps rather than attempt to draw conclusions. In order to advance the field of remote data collection, studies that employ standardized sampling methodologies and study designs are necessary to evaluate the potential for differences by survey modality. PMID:28476728

Primary prevention of cannabis use: a systematic review of randomized controlled trials.

PubMed

Norberg, Melissa M; Kezelman, Sarah; Lim-Howe, Nicholas

2013-01-01

A systematic review of primary prevention was conducted for cannabis use outcomes in youth and young adults. The aim of the review was to develop a comprehensive understanding of prevention programming by assessing universal, targeted, uni-modal, and multi-modal approaches as well as individual program characteristics. Twenty-eight articles, representing 25 unique studies, identified from eight electronic databases (EMBASE, MEDLINE, CINAHL, ERIC, PsycINFO, DRUG, EBM Reviews, and Project CORK), were eligible for inclusion. Results indicated that primary prevention programs can be effective in reducing cannabis use in youth populations, with statistically significant effect sizes ranging from trivial (0.07) to extremely large (5.26), with the majority of significant effect sizes being trivial to small. Given that the preponderance of significant effect sizes were trivial to small and that percentages of statistically significant and non-statistically significant findings were often equivalent across program type and individual components, the effectiveness of primary prevention for cannabis use should be interpreted with caution. Universal multi-modal programs appeared to outperform other program types (i.e, universal uni-modal, targeted multi-modal, targeted unimodal). Specifically, universal multi-modal programs that targeted early adolescents (10-13 year olds), utilised non-teacher or multiple facilitators, were short in duration (10 sessions or less), and implemented boosters sessions were associated with large median effect sizes. While there were studies in these areas that contradicted these results, the results highlight the importance of assessing the interdependent relationship of program components and program types. Finally, results indicated that the overall quality of included studies was poor, with an average quality rating of 4.64 out of 9. Thus, further quality research and reporting and the development of new innovative programs are required.

Primary Prevention of Cannabis Use: A Systematic Review of Randomized Controlled Trials

PubMed Central

Norberg, Melissa M.; Kezelman, Sarah; Lim-Howe, Nicholas

2013-01-01

A systematic review of primary prevention was conducted for cannabis use outcomes in youth and young adults. The aim of the review was to develop a comprehensive understanding of prevention programming by assessing universal, targeted, uni-modal, and multi-modal approaches as well as individual program characteristics. Twenty-eight articles, representing 25 unique studies, identified from eight electronic databases (EMBASE, MEDLINE, CINAHL, ERIC, PsycINFO, DRUG, EBM Reviews, and Project CORK), were eligible for inclusion. Results indicated that primary prevention programs can be effective in reducing cannabis use in youth populations, with statistically significant effect sizes ranging from trivial (0.07) to extremely large (5.26), with the majority of significant effect sizes being trivial to small. Given that the preponderance of significant effect sizes were trivial to small and that percentages of statistically significant and non-statistically significant findings were often equivalent across program type and individual components, the effectiveness of primary prevention for cannabis use should be interpreted with caution. Universal multi-modal programs appeared to outperform other program types (i.e, universal uni-modal, targeted multi-modal, targeted unimodal). Specifically, universal multi-modal programs that targeted early adolescents (10–13 year olds), utilised non-teacher or multiple facilitators, were short in duration (10 sessions or less), and implemented boosters sessions were associated with large median effect sizes. While there were studies in these areas that contradicted these results, the results highlight the importance of assessing the interdependent relationship of program components and program types. Finally, results indicated that the overall quality of included studies was poor, with an average quality rating of 4.64 out of 9. Thus, further quality research and reporting and the development of new innovative programs are required. PMID:23326396

Computational challenges and human factors influencing the design and use of clinical research participant eligibility pre-screening tools

PubMed Central

2012-01-01

Background Clinical trials are the primary mechanism for advancing clinical care and evidenced-based practice, yet challenges with the recruitment of participants for such trials are widely recognized as a major barrier to these types of studies. Data warehouses (DW) store large amounts of heterogenous clinical data that can be used to enhance recruitment practices, but multiple challenges exist when using a data warehouse for such activities, due to the manner of collection, management, integration, analysis, and dissemination of the data. A critical step in leveraging the DW for recruitment purposes is being able to match trial eligibility criteria to discrete and semi-structured data types in the data warehouse, though trial eligibility criteria tend to be written without concern for their computability. We present the multi-modal evaluation of a web-based tool that can be used for pre-screening patients for clinical trial eligibility and assess the ability of this tool to be practically used for clinical research pre-screening and recruitment. Methods The study used a validation study, usability testing, and a heuristic evaluation to evaluate and characterize the operational characteristics of the software as well as human factors affecting its use. Results Clinical trials from the Division of Cardiology and the Department of Family Medicine were used for this multi-modal evaluation, which included a validation study, usability study, and a heuristic evaluation. From the results of the validation study, the software demonstrated a positive predictive value (PPV) of 54.12% and 0.7%, respectively, and a negative predictive value (NPV) of 73.3% and 87.5%, respectively, for two types of clinical trials. Heuristic principles concerning error prevention and documentation were characterized as the major usability issues during the heuristic evaluation. Conclusions This software is intended to provide an initial list of eligible patients to a clinical study coordinators, which provides a starting point for further eligibility screening by the coordinator. Because this software has a high “rule in” ability, meaning that it is able to remove patients who are not eligible for the study, the use of an automated tool built to leverage an existing enterprise DW can be beneficial to determining eligibility and facilitating clinical trial recruitment through pre-screening. While the results of this study are promising, further refinement and study of this and related approaches to automated eligibility screening, including comparison to other approaches and stakeholder perceptions, are needed and future studies are planned to address these needs. PMID:22646313

Computational challenges and human factors influencing the design and use of clinical research participant eligibility pre-screening tools.

PubMed

Pressler, Taylor R; Yen, Po-Yin; Ding, Jing; Liu, Jianhua; Embi, Peter J; Payne, Philip R O

2012-05-30

Clinical trials are the primary mechanism for advancing clinical care and evidenced-based practice, yet challenges with the recruitment of participants for such trials are widely recognized as a major barrier to these types of studies. Data warehouses (DW) store large amounts of heterogenous clinical data that can be used to enhance recruitment practices, but multiple challenges exist when using a data warehouse for such activities, due to the manner of collection, management, integration, analysis, and dissemination of the data. A critical step in leveraging the DW for recruitment purposes is being able to match trial eligibility criteria to discrete and semi-structured data types in the data warehouse, though trial eligibility criteria tend to be written without concern for their computability. We present the multi-modal evaluation of a web-based tool that can be used for pre-screening patients for clinical trial eligibility and assess the ability of this tool to be practically used for clinical research pre-screening and recruitment. The study used a validation study, usability testing, and a heuristic evaluation to evaluate and characterize the operational characteristics of the software as well as human factors affecting its use. Clinical trials from the Division of Cardiology and the Department of Family Medicine were used for this multi-modal evaluation, which included a validation study, usability study, and a heuristic evaluation. From the results of the validation study, the software demonstrated a positive predictive value (PPV) of 54.12% and 0.7%, respectively, and a negative predictive value (NPV) of 73.3% and 87.5%, respectively, for two types of clinical trials. Heuristic principles concerning error prevention and documentation were characterized as the major usability issues during the heuristic evaluation. This software is intended to provide an initial list of eligible patients to a clinical study coordinators, which provides a starting point for further eligibility screening by the coordinator. Because this software has a high "rule in" ability, meaning that it is able to remove patients who are not eligible for the study, the use of an automated tool built to leverage an existing enterprise DW can be beneficial to determining eligibility and facilitating clinical trial recruitment through pre-screening. While the results of this study are promising, further refinement and study of this and related approaches to automated eligibility screening, including comparison to other approaches and stakeholder perceptions, are needed and future studies are planned to address these needs.

From randomized trials to the clinic: is it time to implement individual lung-cancer screening in clinical practice? A multidisciplinary statement from French experts on behalf of the french intergroup (IFCT) and the groupe d'Oncologie de langue française (GOLF)

PubMed Central

Couraud, S.; Cortot, A. B.; Greillier, L.; Gounant, V.; Mennecier, B.; Girard, N.; Besse, B.; Brouchet, L.; Castelnau, O.; Frappé, P.; Ferretti, G. R.; Guittet, L.; Khalil, A.; Lefebure, P.; Laurent, F.; Liebart, S.; Molinier, O.; Quoix, E.; Revel, M.-P.; Stach, B.; Souquet, P.-J.; Thomas, P.; Trédaniel, J.; Lemarié, E.; Zalcman, G.; Barlési, F.; Milleron, B.

2013-01-01

Background Despite advances in cancer therapy, mortality is still high except in early-stage tumors, and screening remains a challenge. The randomized National Lung Screening Trial (NLST), comparing annual low-dose computed tomography (LDCT) and chest X-rays, revealed a 20% decrease in lung-cancer-specific mortality. These results raised numerous questions. The French intergroup for thoracic oncology and the French-speaking oncology group convened an expert group to provide a coherent outlook on screening modalities in France. Methods A literature review was carried out and transmitted to the expert group, which was divided into three workshops to tackle specific questions, with responses presented in a plenary session. A writing committee drafted this article. Results The multidisciplinary group favored individual screening in France, when carried out as outlined in this article and after informing subjects of the benefits and risks. The target population involves subjects aged 55–74 years, who are smokers or have a 30 pack-year smoking history. Subjects should be informed about the benefits of quitting. Screening should involve LDCT scanning with specific modalities. Criteria for CT positivity and management algorithms for positive examinations are given. Conclusions Individual screening requires rigorous assessment and precise research in order to potentially develop a lung-cancer screening policy. PMID:23136229

Screening and Identification in Pediatric Primary Care

ERIC Educational Resources Information Center

Simonian, Susan J.

2006-01-01

This article reviews issues related to behavioral screening in pediatric primary care settings. Structural-organizational issues affecting the use of pediatric primary care screening are discussed. This study also reviewed selected screening instruments that have utility for use in the primary care setting. Clinical and research issues related to…

Understanding breast cancer screening practices in Taiwan: a country with universal health care.

PubMed

Wu, Tsu-Yin; Chung, Scott; Yeh, Ming-Chen; Chang, Shu-Chen; Hsieh, Hsing-Fang; Ha, Soo Ji

2012-01-01

While the incidence of breast cancer (BC) has been relatively low in Asian countries, it has been rising rapidly in Taiwan. Within the last decade, it has replaced cervical cancer as the most diagnosed cancer site for women. Nevertheless, there is a paucity of studies reporting the attitudes and practices of breast cancer screening among Chinese women. The aim of this study is to assess Taiwanese women's knowledge of and attitudes toward BC screening and to identify potential factors that may influence screening behavior. The study population consisted of a sample of 434 Taiwanese women aged 40 and older. Despite access to universal health care for Taiwanese women and the fact that a majority of the women had heard of the breast cancer screening (mammogram, clinical breast exams, etc.), the actual utilization of these screening modalities was relatively low. In the current study, the majority of women had never had mammograms or ultrasound in the past 5 years. The number one most reported barriers were "no time, " "forgetfulness, " "too cumbersome, " and "laziness, " followed by the perception of no need to get screened. In addition, the results revealed several areas of misconceptions or incorrect information perceived by study participants. Based on the results from the regression analysis, significant predictors of obtaining repeated screening modalities included age, coverage for screening, barriers, self-efficacy, intention, family/friends diagnosed with breast cancer. The findings from the current study provide the potential to build evidence-based programs to effectively plan and implement policies in order to raise awareness in breast cancer and promote BC screening in order to optimize health outcomes for women affected by this disease.

Influence of Primary Care Use on Population Delivery of Colorectal Cancer Screening

PubMed Central

Fenton, Joshua J.; Reid, Robert J.; Baldwin, Laura-Mae; Elmore, Joann G.; Buist, Diana S.M.; Franks, Peter

2009-01-01

Objective Colorectal cancer (CRC) screening is commonly initiated during primary care visits. Thus, at the population level, limited primary care attendance may constitute a substantial barrier to CRC screening uptake. Within a defined population, we quantified the percent of CRC screening underuse that is potentially explained by low use of primary care visits. Methods Among 48,712 adults aged 50-78 years eligible for CRC screening within a Washington state health plan, we estimated the degree to which a lack of CRC screening in 2002-2003 (fecal occult blood testing, sigmoidoscopy, or colonoscopy) was attributable to low primary care use, expressed as the population attributable risk percent (PAR%) associated with 0 to 3 primary care visits during the two-year period. Results In analyses adjusted for age, comorbidity, non-primary care visit use, and prior preventive service use, low primary care use in 2002-2003 was strongly associated with a lack of CRC screening among both women and men. However, a majority of unscreened women and men had >=4 primary care visits. Thus, whether low primary care use was defined as 0, 0 to 1, 0 to 2, or 0 to 3 primary care visits, the PAR% associated with low primary care use was large in neither women (range: 3.0-6.8%) nor men (range: 5.6-11.5%). Conclusions Health plan outreach efforts to encourage primary care attendance would be unlikely to substantially increase population uptake of CRC screening. In similar settings, resources might be more fruitfully devoted to the optimization of screening delivery during primary care visits that patients already attend. PMID:19190140

Comparison of Cardiovascular Risk Screening Methods and Mortality Data among Hungarian Primary Care Population: Preliminary Results of the First Government-Financed Managed Care Program.

PubMed

Móczár, Csaba; Rurik, Imre

2015-09-01

Besides participation in the primary prevention, screening as secondary prevention is an important requirement for primary care services. The effect of this work is influenced by the characteristics of individual primary care practices and doctors' screening habits, as well as by the regulation of screening processes and available financial resources. Between 1999 and 2009, a managed care program was introduced and carried out in Hungary, financed by the government. This financial support and motivation gave the opportunity to increase the number of screenings. 4,462 patients of 40 primary care practices were screened on the basis of SCORE risk assessment. The results of the screening were compared on the basis of two groups of patients, namely: those who had been pre-screened (pre-screening method) for known risk factors in their medical history (smoking, BMI, age, family cardiovascular history), and those randomly screened. The authors also compared the mortality data of participating primary care practices with the regional and national data. The average score was significantly higher in the pre-screened group of patients, regardless of whether the risk factors were considered one by one or in combination. Mortality was significantly lower in the participating primary practices than had been expected on the basis of the national mortality data. This government-financed program was a big step forward to establish a proper screening method within Hungarian primary care. Performing cardiovascular screening of a selected target group is presumably more appropriate than screening within a randomly selected population. Both methods resulted in a visible improvement in regional mortality data, though it is very likely that with pre-screening a more cost-effective selection for screening may be obtained.

A tumor specific antibody to aid breast cancer screening in women with dense breast tissue

PubMed Central

Roy, Lopamudra Das; Dillon, Lloye M.; Zhou, Ru; Moore, Laura J.; Livasy, Chad; El-Khoury, Joe M.; Puri, Rahul; Mukherjee, Pinku

2017-01-01

Screening for breast cancer has predominantly been done using mammography. Unfortunately, mammograms miss 50% cancers in women with dense breast tissue. Multi-modal screenings offer the best chance of enhancing breast cancer screening effectiveness. We evaluated the use of TAB004, an antibody that recognizes the tumor form of the glycoprotein MUC1 (tMUC1), to aid early detection of breast cancer. Our experimental approach was to follow tMUC1 from the tissue into circulation. We found that 95% of human breast cancer tissues across all subtypes stained positive for TAB004. In breast cancer cell lines, we showed that the amount of tMUC1 released from tumor cells is proportional to the cell's tMUC1 expression level. Finally, we showed that TAB004 can be used to assess circulating tMUC1 levels, which when monitored in the context of cancer immunoediting, can aid earlier diagnosis of breast cancer regardless of breast tissue density. In a blinded pilot study with banked serial samples, tMUC1 levels increased significantly up to 2 years before diagnosis. Inclusion of tMUC1 monitoring as part of a multi-modal screening strategy may lead to earlier stage diagnosis of women whose cancers are missed by mammography. PMID:28680538

Dispersion of Sound in Marine Sediments

DTIC Science & Technology

2015-09-30

primary objective of this work is to investigate the approach to use the information in the extracted mode amplitudes to invert for sound attenuation...marine sediment. APPROACH Previous work carried out on the use of modal amplitude information for estimating sound attenuation in the sediments...investigate the intrinsic modal interference. Estimation of sound attenuation in marine sediments from modal amplitudes requires knowledge of the

Portfolio of prospective clinical trials including brachytherapy: an analysis of the ClinicalTrials.gov database.

PubMed

Cihoric, Nikola; Tsikkinis, Alexandros; Miguelez, Cristina Gutierrez; Strnad, Vratislav; Soldatovic, Ivan; Ghadjar, Pirus; Jeremic, Branislav; Dal Pra, Alan; Aebersold, Daniel M; Lössl, Kristina

2016-03-22

To evaluate the current status of prospective interventional clinical trials that includes brachytherapy (BT) procedures. The records of 175,538 (100 %) clinical trials registered at ClinicalTrials.gov were downloaded on September 2014 and a database was established. Trials using BT as an intervention were identified for further analyses. The selected trials were manually categorized according to indication(s), BT source, applied dose rate, primary sponsor type, location, protocol initiator and funding source. We analyzed trials across 8 available trial protocol elements registered within the database. In total 245 clinical trials were identified, 147 with BT as primary investigated treatment modality and 98 that included BT as an optional treatment component or as part of the standard treatment. Academic centers were the most frequent protocol initiators in trials where BT was the primary investigational treatment modality (p < 0.01). High dose rate (HDR) BT was the most frequently investigated type of BT dose rate (46.3 %) followed by low dose rate (LDR) (42.0 %). Prostate was the most frequently investigated tumor entity in trials with BT as the primary treatment modality (40.1 %) followed by breast cancer (17.0 %). BT was rarely the primary investigated treatment modality for cervical cancer (6.8 %). Most clinical trials using BT are predominantly in early phases, investigator-initiated and with low accrual numbers. Current investigational activities that include BT mainly focus on prostate and breast cancers. Important questions concerning the optimal usage of BT will not be answered in the near future.

Comparative Effectiveness of Digital Versus Film-Screen Mammography in Community Practice in the United States

PubMed Central

Kerlikowske, Karla; Hubbard, Rebecca A.; Miglioretti, Diana L.; Geller, Berta M.; Yankaskas, Bonnie C.; Lehman, Constance D.; Taplin, Stephen H.; Sickles, Edward A.

2013-01-01

Background Few studies have examined the comparative effectiveness of digital versus film-screen mammography in U.S. community practice. Objective To determine whether the interpretive performance of digital and film-screen mammography differs. Design Prospective cohort study. Setting Mammography facilities in the Breast Cancer Surveillance Consortium. Participants 329 261 women aged 40 to 79 years underwent 869 286 mammograms (231 034 digital; 638 252 film-screen). Measurements Invasive cancer or ductal carcinoma in situ diagnosed within 12 months of a digital or film-screen examination and calculation of mammography sensitivity, specificity, cancer detection rates, and tumor outcomes. Results Overall, cancer detection rates and tumor characteristics were similar for digital and film-screen mammography, but the sensitivity and specificity of each modality varied by age, tumor characteristics, breast density, and menopausal status. Compared with film-screen mammography, the sensitivity of digital mammography was significantly higher for women aged 60 to 69 years (89.9% vs. 83.0%; P = 0.014) and those with estrogen receptor-negative cancer (78.5% vs. 65.8%; P = 0.016); borderline significantly higher for women aged 40 to 49 years (82.4% vs. 75.6%; P = 0.071), those with extremely dense breasts (83.6% vs. 68.1%; P= 0.051), and pre- or perimenopausal women (87.1% vs. 81.7%; P = 0.057); and borderline significantly lower for women aged 50 to 59 years (80.5% vs. 85.1%; P = 0.097). The specificity of digital and film-screen mammography was similar by decade of age, except for women aged 40 to 49 years (88.0% vs. 89.7%; P< 0.001). Limitation Statistical power for subgroup analyses was limited. Conclusion Overall, cancer detection with digital or film-screen mammography is similar in U.S. women aged 50 to 79 years undergoing screening mammography. Women aged 40 to 49 years are more likely to have extremely dense breasts and estrogen receptor-negative tumors; if they are offered mammography screening, they may choose to undergo digital mammography to optimize cancer detection. Primary Funding Source National Cancer Institute. PMID:22007043

Tele-cytology: An innovative approach for cervical cancer screening in resource-poor settings.

PubMed

Singh, Sandeep; Badaya, Sorabh

2016-01-01

Carcinoma cervix remains a leading cause of cancer mortality among women in countries lacking any screening program. The existing screening policy and approach via conventional cytology centered mainly in Tertiary Care Center, is totally unaffordable to Indian women, especially in the remote areas. This suggests the need of depolarizing the resources via generating the near real time modalities which could be used at the door step of the needy ones. For any screening modality to be effective it should be adequately sensitive, specific, reproducible, cheap, simple, affordable, and the most important is should be real time to ensure wide coverage and curtail loss to follow-up. Incorporating telecytology as a screening tool could make the dream come true. Telecytology is the interpretation of cytology material at a distance using digital images. Use of mobile telecytology unit housed in a van carrying satellite equipment and the automated image capturing systems is the central theme behind this idea. The imaging equipment would be carrying out the imaging of Papanicolaou smears prepared at the screening site and sending the images to the central laboratories situated at some tertiary care level. This concept could overcome the hindrance of trained cytology infrastructure in the resource poor settings and could provide an efficient and economical way of screening patients. There is possibility that the designed approach may not detect the entire women positive for the disease but if the desired objective was to diagnose as many cases as possible in resource poor setting, then this process offers an advantage over no screening at all.

Effects of Modality and Redundancy Principles on the Learning and Attitude of a Computer-Based Music Theory Lesson among Jordanian Primary Pupils

ERIC Educational Resources Information Center

Aldalalah, Osamah Ahmad; Fong, Soon Fook

2010-01-01

The purpose of this study was to investigate the effects of modality and redundancy principles on the attitude and learning of music theory among primary pupils of different aptitudes in Jordan. The lesson of music theory was developed in three different modes, audio and image (AI), text with image (TI) and audio with image and text (AIT). The…

Contrast-enhanced spectral mammography (CESM) versus MRI in the high-risk screening setting: patient preferences and attitudes.

PubMed

Phillips, Jordana; Miller, Matthew M; Mehta, Tejas S; Fein-Zachary, Valerie; Nathanson, Audrey; Hori, Wendy; Monahan-Earley, Rita; Slanetz, Priscilla J

Our study evaluates patient preferences toward screening CESM versus MRI. As part of a prospective study, high-risk patients had breast MRI and CESM. Patients completed an anonymous survey to evaluate preferences regarding the two modalities. 88% of participants completed the survey. 79% preferred CESM over MRI if the exams had equal sensitivity. 89% would be comfortable receiving contrast as part of an annual screening test. High-risk populations may accept CESM as a screening exam and may prefer it over screening MRI if ongoing trials demonstrate screening CESM to be clinically non-inferior MRI. Copyright © 2016 Elsevier Inc. All rights reserved.

Magnetic resonance imaging of breast implants.

PubMed

Shah, Mala; Tanna, Neil; Margolies, Laurie

2014-12-01

Silicone breast implants have significantly evolved since their introduction half a century ago, yet implant rupture remains a common and expected complication, especially in patients with earlier-generation implants. Magnetic resonance imaging is the primary modality for assessing the integrity of silicone implants and has excellent sensitivity and specificity, and the Food and Drug Administration currently recommends periodic magnetic resonance imaging screening for silent silicone breast implant rupture. Familiarity with the types of silicone implants and potential complications is essential for the radiologist. Signs of intracapsular rupture include the noose, droplet, subcapsular line, and linguine signs. Signs of extracapsular rupture include herniation of silicone with a capsular defect and extruded silicone material. Specific sequences including water and silicone suppression are essential for distinguishing rupture from other pathologies and artifacts. Magnetic resonance imaging provides valuable information about the integrity of silicone implants and associated complications.

Comparison of breast density measurements made using ultrasound tomography and mammography

NASA Astrophysics Data System (ADS)

Sak, Mark; Duric, Neb; Littrup, Peter; Bey-Knight, Lisa; Krycia, Mark; Sherman, Mark E.; Boyd, Norman; Gierach, Gretchen L.

2015-03-01

Women with elevated mammographic percent density, defined as the ratio of fibroglandular tissue area to total breast area on a mammogram are at an increased risk of developing breast cancer. Ultrasound tomography (UST) is an imaging modality that can create tomographic sound speed images of a patient's breast, which can then be used to measure breast density. These sound speed images are useful because physical tissue density is directly proportional to sound speed. The work presented here updates previous results that compared mammographic breast density measurements with UST breast density measurements within an ongoing study. The current analysis has been expanded to include 158 women with negative digital mammographic screens who then underwent a breast UST scan. Breast density was measured for both imaging modalities and preliminary analysis demonstrated strong and positive correlations (Spearman correlation coefficient rs = 0.703). Additional mammographic and UST related imaging characteristics were also analyzed and used to compare the behavior of both imaging modalities. Results suggest that UST can be used among women with negative mammographic screens as a quantitative marker of breast density that may avert shortcomings of mammography.

Abbreviated MRI Protocols: Wave of the Future for Breast Cancer Screening.

PubMed

Chhor, Chloe M; Mercado, Cecilia L

2017-02-01

The purpose of this article is to describe the use of abbreviated breast MRI protocols for improving access to screening for women at intermediate risk. Breast MRI is not a cost-effective modality for screening women at intermediate risk, including those with dense breast tissue as the only risk. Abbreviated breast MRI protocols have been proposed as a way of achieving efficiency and rapid throughput. Use of these abbreviated protocols may increase availability and provide women with greater access to breast MRI.

Modal cost analysis for simple continua

NASA Technical Reports Server (NTRS)

Hu, A.; Skelton, R. E.; Yang, T. Y.

1988-01-01

The most popular finite element codes are based upon appealing theories of convergence of modal frequencies. For example, the popularity of cubic elements for beam-like structures is due to the rapid convergence of modal frequencies and stiffness properties. However, for those problems in which the primary consideration is the accuracy of response of the structure at specified locations, it is more important to obtain accuracy in the modal costs than in the modal frequencies. The modal cost represents the contribution of a mode in the norm of the response vector. This paper provides a complete modal cost analysis for simple continua such as beam-like structures. Upper bounds are developed for mode truncation errors in the model reduction process and modal cost analysis dictates which modes to retain in order to reduce the model for control design purposes.

Non-collinear interaction of guided elastic waves in an isotropic plate

NASA Astrophysics Data System (ADS)

Ishii, Yosuke; Biwa, Shiro; Adachi, Tadaharu

2018-04-01

The nonlinear wave propagation in a homogeneous and isotropic elastic plate is analyzed theoretically to investigate the non-collinear interaction of plate wave modes. In the presence of two primary plate waves (Rayleigh-Lamb or shear horizontal modes) propagating in arbitrary directions, an explicit expression for the modal amplitude of nonlinearly generated wave fields with the sum or difference frequency of the primary modes is derived by using the perturbation analysis. The modal amplitude is shown to grow in proportion with the propagation distance when the resonance condition is satisfied, i.e., when the wavevector of secondary wave coincides with the sum or difference of those of primary modes. Furthermore, the non-collinear interaction of two symmetric or two antisymmetric modes is shown to produce the secondary wave fields consisting only of the symmetric modes, while a pair of symmetric and antisymmetric primary modes is shown to produce only the antisymmetric modes. The influence of the intersection angle, the primary frequencies, and the mode combinations on the modal amplitude of secondary wave is examined for a low-frequency range where the lowest-order symmetric and antisymmetric Rayleigh-Lamb waves and the lowest-order symmetric shear horizontal wave are the only propagating modes.

The Integrated Taxonomy of Health Care: Classifying Both Complementary and Biomedical Practices Using a Uniform Classification Protocol

PubMed Central

Porcino, Antony; MacDougall, Colleen

2009-01-01

Background: Since the late 1980s, several taxonomies have been developed to help map and describe the interrelationships of complementary and alternative medicine (CAM) modalities. In these taxonomies, several issues are often incompletely addressed: A simple categorization process that clearly isolates a modality to a single conceptual categoryClear delineation of verticality—that is, a differentiation of scale being observed from individually applied techniques, through modalities (therapies), to whole medical systemsRecognition of CAM as part of the general field of health care Methods: Development of the Integrated Taxonomy of Health Care (ITHC) involved three stages: Development of a precise, uniform health glossaryAnalysis of the extant taxonomiesUse of an iterative process of classifying modalities and medical systems into categories until a failure to singularly classify a modality occurred, requiring a return to the glossary and adjustment of the classifying protocol Results: A full vertical taxonomy was developed that includes and clearly differentiates between techniques, modalities, domains (clusters of similar modalities), systems of health care (coordinated care system involving multiple modalities), and integrative health care. Domains are the classical primary focus of taxonomies. The ITHC has eleven domains: chemical/substance-based work, device-based work, soft tissue–focused manipulation, skeletal manipulation, fitness/movement instruction, mind–body integration/classical somatics work, mental/emotional–based work, bio-energy work based on physical manipulation, bio-energy modulation, spiritual-based work, unique assessments. Modalities are assigned to the domains based on the primary mode of interaction with the client, according the literature of the practitioners. Conclusions: The ITHC has several strengths: little interpretation is used while successfully assigning modalities to single domains; the issue of taxonomic verticality is fully resolved; and the design fully integrates the complementary health care fields of biomedicine and CAM. PMID:21589735

Magnetic resonance imaging. Application to family practice.

PubMed

Goh, R H; Somers, S; Jurriaans, E; Yu, J

1999-09-01

To review indications, contraindications, and risks of using magnetic resonance imaging (MRI) in order to help primary care physicians refer patients appropriately for MRI, screen for contraindications to using MRI, and educate patients about MRI. Recommendations are based on classic textbooks, the policies of our MRI group, and a literature search using MEDLINE with the MeSH headings magnetic resonance imaging, brain, musculoskeletal, and spine. The search was limited to human, English-language, and review articles. Evidence in favour of using MRI for imaging the head, spine, and joints is well established. For cardiac, abdominal, and pelvic conditions, MRI has been shown useful for certain indications, usually to complement other modalities. For demonstrating soft tissue conditions, MRI is better than computed tomography (CT), but CT shows bone and acute bleeding better. Therefore, patients with trauma or suspected intracranial bleeding should have CT. Tumours, congenital abnormalities, vascular structures, and the cervical or thoracic spine show better on MRI. Either modality can be used for lower back pain. Cardiac, abdominal, and pelvic abnormalities should be imaged with ultrasound or CT before MRI. Contraindications for MRI are mainly metallic implants or shrapnel, severe claustrophobia, or obesity. With the increasing availability of MRI scanners in Canada, better understanding of the indications, contraindications, and risks will be helpful for family physicians and their patients.

Noninvasive imaging of hepatocellular carcinoma: From diagnosis to prognosis

PubMed Central

Jiang, Han-Yu; Chen, Jie; Xia, Chun-Chao; Cao, Li-Kun; Duan, Ting; Song, Bin

2018-01-01

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a major public health problem worldwide. Hepatocarcinogenesis is a complex multistep process at molecular, cellular, and histologic levels with key alterations that can be revealed by noninvasive imaging modalities. Therefore, imaging techniques play pivotal roles in the detection, characterization, staging, surveillance, and prognosis evaluation of HCC. Currently, ultrasound is the first-line imaging modality for screening and surveillance purposes. While based on conclusive enhancement patterns comprising arterial phase hyperenhancement and portal venous and/or delayed phase wash-out, contrast enhanced dynamic computed tomography and magnetic resonance imaging (MRI) are the diagnostic tools for HCC without requirements for histopathologic confirmation. Functional MRI techniques, including diffusion-weighted imaging, MRI with hepatobiliary contrast agents, perfusion imaging, and magnetic resonance elastography, show promise in providing further important information regarding tumor biological behaviors. In addition, evaluation of tumor imaging characteristics, including nodule size, margin, number, vascular invasion, and growth patterns, allows preoperative prediction of tumor microvascular invasion and patient prognosis. Therefore, the aim of this article is to review the current state-of-the-art and recent advances in the comprehensive noninvasive imaging evaluation of HCC. We also provide the basic key concepts of HCC development and an overview of the current practice guidelines. PMID:29904242

Towards early detection of cervical cancer: Fractal dimension of AFM images of human cervical epithelial cells at different stages of progression to cancer.

PubMed

Guz, Nataliia V; Dokukin, Maxim E; Woodworth, Craig D; Cardin, Andrew; Sokolov, Igor

2015-10-01

We used AFM HarmoniX modality to analyse the surface of individual human cervical epithelial cells at three stages of progression to cancer, normal, immortal (pre-malignant) and carcinoma cells. Primary cells from 6 normal strains, 6 cancer, and 6 immortalized lines (derived by plasmid DNA-HPV-16 transfection of cells from 6 healthy individuals) were tested. This cell model allowed for good control of the cell phenotype down to the single cell level, which is impractical to attain in clinical screening tests (ex-vivo). AFM maps of physical (nonspecific) adhesion are collected on fixed dried cells. We show that a surface parameter called fractal dimension can be used to segregate normal from both immortal pre-malignant and malignant cells with sensitivity and specificity of more than 99%. The reported method of analysis can be directly applied to cells collected in liquid cytology screening tests and identified as abnormal with regular optical methods to increase sensitivity. Despite cervical smear screening, sometimes it is very difficult to differentiate cancers cells from pre-malignant cells. By using AFM to analyze the surface properties of human cervical epithelial cells, the authors were able to accurately identify normal from abnormal cells. This method could augment existing protocols to increase diagnostic accuracy. Copyright © 2015. Published by Elsevier Inc.

A snapshot of current gestational diabetes management practices from 26 low-income and lower-middle-income countries.

PubMed

Utz, Bettina; Kolsteren, Patrick; De Brouwere, Vincent

2016-08-01

To identify screening and management practices for gestational diabetes mellitus (GDM) in low-income and lower-middle-income countries. A cross-sectional survey was conducted between November 12, 2014 and May 11, 2015. Questionnaires were distributed to gynecologists, endocrinologists, and medical doctors who were representatives of national professional societies or were involved in providing care to patients with GDM in low-income or lower-middle-income countries in Africa, South Asia, and Latin America. The data were descriptively analyzed. Questionnaires were sent to 182 individuals and 77 healthcare providers from 26 countries completed the survey. The results demonstrated high diversity in screening and management practices. Only 52 (68%) participants reported that any guidelines were available in their setting. Management of GDM was found to take place mainly at the tertiary level and reported practices, including the frequency of post-diagnosis follow-up, modalities of glucose surveillance, and treatment and practices surrounding delivery, varied and did not always reflect the most recent evidence. Attempts to ensure greater adherence to latest consensus guidelines are required, and should be accompanied by systemic changes to improve the detection and management of GDM at primary- and secondary-level healthcare facilities to facilitate patient access to GDM screening and treatment. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Neonatal Restriction of Tactile Inputs Leads to Long-Lasting Impairments of Cross-Modal Processing

PubMed Central

Röder, Brigitte; Hanganu-Opatz, Ileana L.

2015-01-01

Optimal behavior relies on the combination of inputs from multiple senses through complex interactions within neocortical networks. The ontogeny of this multisensory interplay is still unknown. Here, we identify critical factors that control the development of visual-tactile processing by combining in vivo electrophysiology with anatomical/functional assessment of cortico-cortical communication and behavioral investigation of pigmented rats. We demonstrate that the transient reduction of unimodal (tactile) inputs during a short period of neonatal development prior to the first cross-modal experience affects feed-forward subcortico-cortical interactions by attenuating the cross-modal enhancement of evoked responses in the adult primary somatosensory cortex. Moreover, the neonatal manipulation alters cortico-cortical interactions by decreasing the cross-modal synchrony and directionality in line with the sparsification of direct projections between primary somatosensory and visual cortices. At the behavioral level, these functional and structural deficits resulted in lower cross-modal matching abilities. Thus, neonatal unimodal experience during defined developmental stages is necessary for setting up the neuronal networks of multisensory processing. PMID:26600123

Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement.

PubMed

2009-11-17

Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for breast cancer in the general population. The USPSTF examined the evidence on the efficacy of 5 screening modalities in reducing mortality from breast cancer: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging in order to update the 2002 recommendation. To accomplish this update, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review of 6 selected questions relating to benefits and harms of screening, and 2) a decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals. The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms. (Grade C recommendation) The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. (I statement) The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation) The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer. (I statement).

Modeling and control of beam-like structures

NASA Technical Reports Server (NTRS)

Hu, A.; Skelton, R. E.; Yang, T. Y.

1987-01-01

The most popular finite element codes are based upon appealing theories of convergence of modal frequencies. For example, the popularity of cubic elements for beam-like structures is due to the rapid convergence of modal frequencies and stiffness properties. However, for those problems in which the primary consideration is the accuracy of response of the structure at specified locations it is more important to obtain accuracy in the modal costs than in the modal frequencies. The modal cost represents the contribution of a mode in the norm of the response vector. This paper provides a complete modal cost analysis for beam-like continua. Upper bounds are developed for mode truncation errors in the model reduction process and modal cost analysis dictates which modes to retain in order to reduce the model for control design purposes.

fMRI-based Multivariate Pattern Analyses Reveal Imagery Modality and Imagery Content Specific Representations in Primary Somatosensory, Motor and Auditory Cortices.

PubMed

de Borst, Aline W; de Gelder, Beatrice

2017-08-01

Previous studies have shown that the early visual cortex contains content-specific representations of stimuli during visual imagery, and that these representational patterns of imagery content have a perceptual basis. To date, there is little evidence for the presence of a similar organization in the auditory and tactile domains. Using fMRI-based multivariate pattern analyses we showed that primary somatosensory, auditory, motor, and visual cortices are discriminative for imagery of touch versus sound. In the somatosensory, motor and visual cortices the imagery modality discriminative patterns were similar to perception modality discriminative patterns, suggesting that top-down modulations in these regions rely on similar neural representations as bottom-up perceptual processes. Moreover, we found evidence for content-specific representations of the stimuli during auditory imagery in the primary somatosensory and primary motor cortices. Both the imagined emotions and the imagined identities of the auditory stimuli could be successfully classified in these regions. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Role of radiology in the management of primary aldosteronism.

PubMed

Patel, Shilpan M; Lingam, Ravi K; Beaconsfield, Tina I; Tran, Tan L; Brown, Beata

2007-01-01

The diagnosis of primary aldosteronism, the most common form of secondary hypertension, is based on clinical and biochemical features. Although radiology plays no role in the initial diagnosis, it has an important role in differentiating between the two main causes of primary aldosteronism: aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH). This distinction is important because APAs are generally managed surgically and BAH medically. Adrenal venous sampling is considered the standard of reference for determining the cause of primary aldosteronism but is technically demanding, operator dependent, costly, and time consuming, with a low but significant complication rate. Other imaging modalities, including computed tomography, magnetic resonance imaging, and adrenal scintigraphy, have also been used to determine the cause of primary aldosteronism. Cross-sectional imaging has traditionally focused on establishing the diagnosis of an APA, with that of BAH being one of exclusion. A high specificity for detecting an APA is desirable, since it will avert unnecessary surgery in patients with BAH. However, an overreliance on cross-sectional imaging can lead to the incorrect treatment of affected patients, mainly due to the wide variation in the reported diagnostic performance of these modalities. A combination of modalities is usually required to confidently determine the cause of primary aldosteronism. The quest for optimal radiologic management of primary aldosteronism continues just over a half century since this disease entity was first described. RSNA, 2007

Building the Evidence Base for Remote Data Collection in Low- and Middle-Income Countries: Comparing Reliability and Accuracy Across Survey Modalities.

PubMed

Greenleaf, Abigail R; Gibson, Dustin G; Khattar, Christelle; Labrique, Alain B; Pariyo, George W

2017-05-05

Given the growing interest in mobile data collection due to the proliferation of mobile phone ownership and network coverage in low- and middle-income countries (LMICs), we synthesized the evidence comparing estimates of health outcomes from multiple modes of data collection. In particular, we reviewed studies that compared a mode of remote data collection with at least one other mode of data collection to identify mode effects and areas for further research. The study systematically reviewed and summarized the findings from articles and reports that compare a mode of remote data collection to at least one other mode. The aim of this synthesis was to assess the reliability and accuracy of results. Seven online databases were systematically searched for primary and grey literature pertaining to remote data collection in LMICs. Remote data collection included interactive voice response (IVR), computer-assisted telephone interviews (CATI), short message service (SMS), self-administered questionnaires (SAQ), and Web surveys. Two authors of this study reviewed the abstracts to identify articles which met the primary inclusion criteria. These criteria required that the survey collected the data from the respondent via mobile phone or landline. Articles that met the primary screening criteria were read in full and were screened using secondary inclusion criteria. The four secondary inclusion criteria were that two or more modes of data collection were compared, at least one mode of data collection in the study was a mobile phone survey, the study had to be conducted in a LMIC, and finally, the study should include a health component. Of the 11,568 articles screened, 10 articles were included in this study. Seven distinct modes of remote data collection were identified: CATI, SMS (singular sitting and modular design), IVR, SAQ, and Web surveys (mobile phone and personal computer). CATI was the most frequent remote mode (n=5 articles). Of the three in-person modes (face-to-face [FTF], in-person SAQ, and in-person IVR), FTF was the most common (n=11) mode. The 10 articles made 25 mode comparisons, of which 12 comparisons were from a single article. Six of the 10 articles included sensitive questions. This literature review summarizes the existing research about remote data collection in LMICs. Due to both heterogeneity of outcomes and the limited number of comparisons, this literature review is best positioned to present the current evidence and knowledge gaps rather than attempt to draw conclusions. In order to advance the field of remote data collection, studies that employ standardized sampling methodologies and study designs are necessary to evaluate the potential for differences by survey modality. ©Abigail R Greenleaf, Dustin G Gibson, Christelle Khattar, Alain B Labrique, George W Pariyo. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.05.2017.

Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review.

PubMed

Gibson, Dustin G; Pereira, Amanda; Farrenkopf, Brooke A; Labrique, Alain B; Pariyo, George W; Hyder, Adnan A

2017-05-05

National and subnational level surveys are important for monitoring disease burden, prioritizing resource allocation, and evaluating public health policies. As mobile phone access and ownership become more common globally, mobile phone surveys (MPSs) offer an opportunity to supplement traditional public health household surveys. The objective of this study was to systematically review the current landscape of MPSs to collect population-level estimates in low- and middle-income countries (LMICs). Primary and gray literature from 7 online databases were systematically searched for studies that deployed MPSs to collect population-level estimates. Titles and abstracts were screened on primary inclusion and exclusion criteria by two research assistants. Articles that met primary screening requirements were read in full and screened for secondary eligibility criteria. Articles included in review were grouped into the following three categories by their survey modality: (1) interactive voice response (IVR), (2) short message service (SMS), and (3) human operator or computer-assisted telephone interviews (CATI). Data were abstracted by two research assistants. The conduct and reporting of the review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A total of 6625 articles were identified through the literature review. Overall, 11 articles were identified that contained 19 MPS (CATI, IVR, or SMS) surveys to collect population-level estimates across a range of topics. MPSs were used in Latin America (n=8), the Middle East (n=1), South Asia (n=2), and sub-Saharan Africa (n=8). Nine articles presented results for 10 CATI surveys (10/19, 53%). Two articles discussed the findings of 6 IVR surveys (6/19, 32%). Three SMS surveys were identified from 2 articles (3/19, 16%). Approximately 63% (12/19) of MPS were delivered to mobile phone numbers collected from previously administered household surveys. The majority of MPS (11/19, 58%) were panel surveys where a cohort of participants, who often were provided a mobile phone upon a face-to-face enrollment, were surveyed multiple times. Very few reports of population-level MPS were identified. Of the MPS that were identified, the majority of surveys were conducted using CATI. Due to the limited number of identified IVR and SMS surveys, the relative advantages and disadvantages among the three survey modalities cannot be adequately assessed. The majority of MPS were sent to mobile phone numbers that were collected from a previously administered household survey. There is limited evidence on whether a random digit dialing (RDD) approach or a simple random sample of mobile network provided list of numbers can produce a population representative survey. ©Dustin G Gibson, Amanda Pereira, Brooke A Farrenkopf, Alain B Labrique, George W Pariyo, Adnan A Hyder. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.05.2017.

Cost effectiveness of fecal DNA screening for colorectal cancer: a systematic review and quality appraisal of the literature.

PubMed

Skally, Mairead; Hanly, Paul; Sharp, Linda

2013-06-01

Fecal DNA (fDNA) testing is a noninvasive potential alternative to current colorectal cancer screening tests. We conducted a systematic review and quality assessment of studies of cost-effectiveness of fDNA as a colorectal cancer screening tool (compared with no screening and other screening modalities), and identified key variables that impinged on cost-effectiveness. We searched MEDLINE, Embase, and the Centre for Reviews and Dissemination for cost-effectiveness studies of fDNA-based screening, published in English by September 2011. Studies that undertook an economic evaluation of fDNA, using either a cost-effectiveness or cost-utility analysis, compared with other relevant screening modalities and/or no screening were included. Additional inclusion criteria related to the presentation of data pertaining to model variables including time horizon, costs, fDNA performance characteristics, screening uptake, and comparators. A total of 369 articles were initially identified for review. After removing duplicates and applying inclusion and exclusion criteria, seven articles were included in the final review. Data was abstracted on key descriptor variables including screening scenarios, time horizon, costs, test performance characteristics, screening uptake, comparators, and incremental cost-effectiveness ratios. Quality assessment was undertaken using a standard checklist for economic evaluations. Studies cited by cost-effectiveness articles as the source of data on fDNA test performance characteristics were also reviewed. Seven cost-effectiveness studies were included, from the USA (4), Canada (1), Israel (1), and Taiwan (1). Markov models (5), a partially observable Markov decision process model (1) and MISCAN and SimCRC (1) microsimulation models were used. All studies took a third-party payer perspective and one included, in addition, a societal perspective. Comparator screening tests, screening intervals, and specific fDNA tests varied between studies. fDNA sensitivity and specificity parameters were derived from 12 research studies and one meta-analysis. Outcomes assessed were life-years gained and quality-adjusted life-years gained. fDNA was cost-effective when compared with no screening in six studies. Compared with other screening modalities, fDNA was not considered cost-effective in any of the base-case analyses: in five studies it was dominated by all alternatives considered. Sensitivity analyses identified cost, compliance, and test parameters as key influential parameters. In general, poor presentation of "study design" and "data collection" details lowered the quality of included articles. Although the literature searches were designed for high sensitivity, the possibility cannot be excluded that some eligible studies may have been missed. Reports (such as Health Technology Assessments produced by government agencies) and other forms of grey literature were excluded because they are difficult to identify systematically and/or may not report methods and results in sufficient detail for assessment. On the basis of the available (albeit limited) evidence, while fDNA is cost-effective when compared with no screening, it is currently dominated by most of the other available screening options. Cost and test performance appear to be the main influences on cost-effectiveness.

Free-free and fixed base modal survey tests of the Space Station Common Module Prototype

NASA Technical Reports Server (NTRS)

Driskill, T. C.; Anderson, J. B.; Coleman, A. D.

1992-01-01

This paper describes the testing aspects and the problems encountered during the free-free and fixed base modal surveys completed on the original Space Station Common Module Prototype (CMP). The CMP is a 40-ft long by 14.5-ft diameter 'waffle-grid' cylinder built by the Boeing Company and housed at the Marshall Space Flight Center (MSFC) near Huntsville, AL. The CMP modal survey tests were conducted at MSFC by the Dynamics Test Branch. The free-free modal survey tests (June '90 to Sept. '90) included interface verification tests (IFVT), often referred to as impedance measurements, mass-additive testing and linearity studies. The fixed base modal survey tests (Feb. '91 to April '91), including linearity studies, were conducted in a fixture designed to constrain the CMP in 7 total degrees-of-freedom at five trunnion interfaces (two primary, two secondary, and the keel). The fixture also incorporated an airbag off-load system designed to alleviate the non-linear effects of friction in the primary and secondary trunnion interfaces. Numerous test configurations were performed with the objective of providing a modal data base for evaluating the various testing methodologies to verify dynamic finite element models used for input to coupled load analysis.

The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: Microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline.

PubMed

Peterse, Elisabeth F P; Meester, Reinier G S; Siegel, Rebecca L; Chen, Jennifer C; Dwyer, Andrea; Ahnen, Dennis J; Smith, Robert A; Zauber, Ann G; Lansdorp-Vogelaar, Iris

2018-05-30

In 2016, the Microsimulation Screening Analysis-Colon (MISCAN-Colon) model was used to inform the US Preventive Services Task Force colorectal cancer (CRC) screening guidelines. In this study, 1 of 2 microsimulation analyses to inform the update of the American Cancer Society CRC screening guideline, the authors re-evaluated the optimal screening strategies in light of the increase in CRC diagnosed in young adults. The authors adjusted the MISCAN-Colon model to reflect the higher CRC incidence in young adults, who were assumed to carry forward escalated disease risk as they age. Life-years gained (LYG; benefit), the number of colonoscopies (COL; burden) and the ratios of incremental burden to benefit (efficiency ratio [ER] = ΔCOL/ΔLYG) were projected for different screening strategies. Strategies differed with respect to test modality, ages to start (40 years, 45 years, and 50 years) and ages to stop (75 years, 80 years, and 85 years) screening, and screening intervals (depending on screening modality). The authors then determined the model-recommended strategies in a similar way as was done for the US Preventive Services Task Force, using ER thresholds in accordance with the previously accepted ER of 39. Because of the higher CRC incidence, model-predicted LYG from screening increased compared with the previous analyses. Consequently, the balance of burden to benefit of screening improved and now 10-yearly colonoscopy screening starting at age 45 years resulted in an ER of 32. Other recommended strategies included fecal immunochemical testing annually, flexible sigmoidoscopy screening every 5 years, and computed tomographic colonography every 5 years. This decision-analysis suggests that in light of the increase in CRC incidence among young adults, screening may be offered earlier than has previously been recommended. Cancer 2018. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Applications of chemogenomic library screening in drug discovery.

PubMed

Jones, Lyn H; Bunnage, Mark E

2017-04-01

The allure of phenotypic screening, combined with the industry preference for target-based approaches, has prompted the development of innovative chemical biology technologies that facilitate the identification of new therapeutic targets for accelerated drug discovery. A chemogenomic library is a collection of selective small-molecule pharmacological agents, and a hit from such a set in a phenotypic screen suggests that the annotated target or targets of that pharmacological agent may be involved in perturbing the observable phenotype. In this Review, we describe opportunities for chemogenomic screening to considerably expedite the conversion of phenotypic screening projects into target-based drug discovery approaches. Other applications are explored, including drug repositioning, predictive toxicology and the discovery of novel pharmacological modalities.

Integration of geriatric mental health screening into a primary care practice: a patient satisfaction survey.

PubMed

Samuels, S; Abrams, R; Shengelia, R; Reid, M C; Goralewicz, R; Breckman, R; Anderson, M A; Snow, C E; Woods, E C; Stern, A; Eimicke, J P; Adelman, R D

2015-05-01

Colocation of mental health screening, assessment, and treatment in primary care reduces stigma, improves access, and increases coordination of care between mental health and primary care providers. However, little information exists regarding older adults' attitudes about screening for mental health problems in primary care. The objective of this study was to evaluate older primary care patients' acceptance of and satisfaction with screening for depression and anxiety. The study was conducted at an urban, academically affiliated primary care practice serving older adults. Study patients (N = 107) were screened for depression/anxiety and underwent a post-screening survey/interview to assess their reactions to the screening experience. Most patients (88.6%) found the length of the screening to be "just right." A majority found the screening questions somewhat or very acceptable (73.4%) and not at all difficult (81.9%). Most participants did not find the questions stressful (84.9%) or intrusive (91.5%); and a majority were not at all embarrassed (93.4%), upset (93.4%), or uncomfortable (88.8%) during the screening process. When asked about frequency of screening, most patients (72.4%) desired screening for depression/anxiety yearly or more. Of the 79 patients who had spoken with their physicians about mental health during the visit, 89.8% reported that it was easy or very easy to talk with their physicians about depression/anxiety. Multivariate results showed that patients with higher anxiety had a lower positive reaction to the screen when controlling for gender, age, and patient-physician communication. These results demonstrate strong patient support for depression and anxiety screening in primary care. Copyright © 2014 John Wiley & Sons, Ltd.

Human factors evaluation of the effectiveness of multi-modality displays in advanced traveler information systems

DOT National Transportation Integrated Search

1999-12-01

To achieve the goals for Advanced Traveler Information Systems (ATIS), significant information will necessarily be provided to the driver. A primary ATIS design issue is the display modality (i.e., visual, auditory, or the combination) selected for p...

Progress in Operational Analysis of Launch Vehicles in Nonstationary Flight

NASA Technical Reports Server (NTRS)

James, George; Kaouk, Mo; Cao, Timothy

2013-01-01

This paper presents recent results in an ongoing effort to understand and develop techniques to process launch vehicle data, which is extremely challenging for modal parameter identification. The primary source of difficulty is due to the nonstationary nature of the situation. The system is changing, the environment is not steady, and there is an active control system operating. Hence, the primary tool for producing clean operational results (significant data lengths and data averaging) is not available to the user. This work reported herein uses a correlation-based two step operational modal analysis approach to process the relevant data sets for understanding and development of processes. A significant drawback for such processing of short time histories is a series of beating phenomena due to the inability to average out random modal excitations. A recursive correlation process coupled to a new convergence metric (designed to mitigate the beating phenomena) is the object of this study. It has been found in limited studies that this process creates clean modal frequency estimates but numerically alters the damping.

Strategies for early detection of resectable pancreatic cancer

PubMed Central

Okano, Keiichi; Suzuki, Yasuyuki

2014-01-01

Pancreatic cancer is difficult to diagnose at an early stage and generally has a poor prognosis. Surgical resection is the only potentially curative treatment for pancreatic carcinoma. To improve the prognosis of this disease, it is essential to detect tumors at early stages, when they are resectable. The optimal approach to screening for early pancreatic neoplasia has not been established. The International Cancer of the Pancreas Screening Consortium has recently finalized several recommendations regarding the management of patients who are at an increased risk of familial pancreatic cancer. In addition, there have been notable advances in research on serum markers, tissue markers, gene signatures, and genomic targets of pancreatic cancer. To date, however, no biomarkers have been established in the clinical setting. Advancements in imaging modalities touch all aspects of the clinical management of pancreatic diseases, including the early detection of pancreatic masses, their characterization, and evaluations of tumor resectability. This article reviews strategies for screening high-risk groups, biomarkers, and current advances in imaging modalities for the early detection of resectable pancreatic cancer. PMID:25170207

Computed Tomography

NASA Astrophysics Data System (ADS)

Castellano, Isabel; Geleijns, Jacob

After its clinical introduction in 1973, computed tomography developed from an x-ray modality for axial imaging in neuroradiology into a versatile three dimensional imaging modality for a wide range of applications in for example oncology, vascular radiology, cardiology, traumatology and even in interventional radiology. Computed tomography is applied for diagnosis, follow-up studies and screening of healthy subpopulations with specific risk factors. This chapter provides a general introduction in computed tomography, covering a short history of computed tomography, technology, image quality, dosimetry, room shielding, quality control and quality criteria.

Subject-level differences in reported locations of cutaneous tactile and nociceptive stimuli

PubMed Central

Steenbergen, Peter; Buitenweg, Jan R.; Trojan, Jörg; Klaassen, Bart; Veltink, Peter H.

2012-01-01

Recent theoretical advances on the topic of body representations have raised the question whether spatial perception of touch and nociception involve the same representations. Various authors have established that subjective localizations of touch and nociception are displaced in a systematic manner. The relation between veridical stimulus locations and localizations can be described in the form of a perceptual map; these maps differ between subjects. Recently, evidence was found for a common set of body representations to underlie spatial perception of touch and slow and fast pain, which receive information from modality specific primary representations. There are neurophysiological clues that the various cutaneous senses may not share the same primary representation. If this is the case, then differences in primary representations between touch and nociception may cause subject-dependent differences in perceptual maps of these modalities. We studied localization of tactile and nociceptive sensations on the forearm using electrocutaneous stimulation. The perceptual maps of these modalities differed at the group level. When assessed for individual subjects, the differences localization varied in nature between subjects. The agreement of perceptual maps of the two modalities was moderate. These findings are consistent with a common internal body representation underlying spatial perception of touch and nociception. The subject level differences suggest that in addition to these representations other aspects, possibly differences in primary representation and/or the influence of stimulus parameters, lead to differences in perceptual maps in individuals. PMID:23226126

Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors

PubMed Central

Shah, Priya; Wyatt, Jeremy C; Makubate, Boikanyo; Cross, Frank W

2011-01-01

Objective Expert authorities recommend clinical decision support systems to reduce prescribing error rates, yet large numbers of insignificant on-screen alerts presented in modal dialog boxes persistently interrupt clinicians, limiting the effectiveness of these systems. This study compared the impact of modal and non-modal electronic (e-) prescribing alerts on prescribing error rates, to help inform the design of clinical decision support systems. Design A randomized study of 24 junior doctors each performing 30 simulated prescribing tasks in random order with a prototype e-prescribing system. Using a within-participant design, doctors were randomized to be shown one of three types of e-prescribing alert (modal, non-modal, no alert) during each prescribing task. Measurements The main outcome measure was prescribing error rate. Structured interviews were performed to elicit participants' preferences for the prescribing alerts and their views on clinical decision support systems. Results Participants exposed to modal alerts were 11.6 times less likely to make a prescribing error than those not shown an alert (OR 11.56, 95% CI 6.00 to 22.26). Those shown a non-modal alert were 3.2 times less likely to make a prescribing error (OR 3.18, 95% CI 1.91 to 5.30) than those not shown an alert. The error rate with non-modal alerts was 3.6 times higher than with modal alerts (95% CI 1.88 to 7.04). Conclusions Both kinds of e-prescribing alerts significantly reduced prescribing error rates, but modal alerts were over three times more effective than non-modal alerts. This study provides new evidence about the relative effects of modal and non-modal alerts on prescribing outcomes. PMID:21836158

New Ways to Detect Pediatric Sickle Cell Retinopathy: A Comprehensive Review.

PubMed

Pahl, Daniel A; Green, Nancy S; Bhatia, Monica; Chen, Royce W S

2017-11-01

Sickle retinopathy reflects disease-related vascular injury of the eye, which can potentially result in visual loss from vitreous hemorrhage or retinal detachment. Here we review sickle retinopathy among children with sickle cell disease, describe the epidemiology, pediatric risk factors, pathophysiology, ocular findings, and treatment. Newer, more sensitive ophthalmological imaging modalities are available for retinal imaging, including ultra-widefield fluorescein angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography. Optical coherence tomography angiography provides a noninvasive view of retinal vascular layers that could previously not be imaged and can be quantified for comparative or prospective analyses. Ultra-widefield fluorescein angiography provides a more comprehensive view of the peripheral retina than traditional imaging techniques. Screening for retinopathy by standard fundoscopic imaging modalities detects a prevalence of approximately 10%. In contrast, these more sensitive methods allow for more sensitive examination that includes the retina perimeter where sickle retinopathy is often first detectable. Use of these new imaging modalities may detect a higher prevalence of early sickle pathology among children than has previously been reported. Earlier detection may help in better understanding the pathogenesis of sickle retinopathy and guide future screening and treatment paradigms.

Cost-effectiveness of secondary screening modalities for hypertension.

PubMed

Wang, Y Claire; Koval, Alisa M; Nakamura, Miyabi; Newman, Jonathan D; Schwartz, Joseph E; Stone, Patricia W

2013-02-01

Clinic-based blood pressure (CBP) has been the default approach for the diagnosis of hypertension, but patients may be misclassified because of masked hypertension (false negative) or 'white coat' hypertension (false positive). The incorporation of other diagnostic modalities, such as home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), holds promise to improve diagnostic accuracy and subsequent treatment decisions. We reviewed the literature on the costs and cost-effectiveness of adding HBPM and ABPM to routine blood pressure screening in adults. We excluded letters, editorials, and studies of pregnant and/or pre-eclamptic patients, children, and patients with specific conditions (e.g. diabetes). We identified 14 original, English language studies that included cost outcomes and compared two or more modalities. ABPM was found to be cost saving for diagnostic confirmation following an elevated CBP in six studies. Three of four studies found that adding HBPM to an elevated CBP was also cost-effective. Existing evidence supports the cost-effectiveness of incorporating HBPM or ABPM after an initial CBP-based diagnosis of hypertension. Future research should focus on their implementation in clinical practice, long-term economic values, and potential roles in identifying masked hypertension.

Older users, multimodal reminders and assisted living technology.

PubMed

Warnock, David; McGee-Lennon, Marilyn; Brewster, Stephen

2012-09-01

The primary users of assisted living technology are older people who are likely to have one or more sensory impairments. Multimodal technology allows users to interact via non-impaired senses and provides alternative ways to interact if primary interaction methods fail. An empirical user study was carried out with older participants which evaluated the performance, disruptiveness and subjective workload of visual, audio, tactile and olfactory notifications then compared the results with earlier findings in younger participants. It was found that disruption and subjective workload were not affected by modality, although some modalities were more effective at delivering information accurately. It is concluded that although further studies need to be carried out in a real-world settings, the findings support the argument for multiple modalities in assisted living technology.

From Roentgen to magnetic resonance imaging: the history of medical imaging.

PubMed

Scatliff, James H; Morris, Peter J

2014-01-01

Medical imaging has advanced in remarkable ways since the discovery of x-rays 120 years ago. Today's radiologists can image the human body in intricate detail using computed tomography, magnetic resonance imaging, positron emission tomography, ultrasound, and various other modalities. Such technology allows for improved screening, diagnosis, and monitoring of disease, but it also comes with risks. Many imaging modalities expose patients to ionizing radiation, which potentially increases their risk of developing cancer in the future, and imaging may also be associated with possible allergic reactions or risks related to the use of intravenous contrast agents. In addition, the financial costs of imaging are taxing our health care system, and incidental findings can trigger anxiety and further testing. This issue of the NCMJ addresses the pros and cons of medical imaging and discusses in detail the following uses of medical imaging: screening for breast cancer with mammography, screening for osteoporosis and monitoring of bone mineral density with dual-energy x-ray absorptiometry, screening for congenital hip dysplasia in infants with ultrasound, and evaluation of various heart conditions with cardiac imaging. Together, these articles show the challenges that must be met as we seek to harness the power of today's imaging technologies, as well as the potential benefits that can be achieved when these hurdles are overcome.

Separate modal analysis for tumor detection with a digital image elasto tomography (DIET) breast cancer screening system.

PubMed

Kashif, Amer S; Lotz, Thomas F; Heeren, Adrianus M W; Chase, James G

2013-11-01

It is estimated that every year, 1 × 10(6) women are diagnosed with breast cancer, and more than 410,000 die annually worldwide. Digital Image Elasto Tomography (DIET) is a new noninvasive breast cancer screening modality that induces mechanical vibrations in the breast and images its surface motion with digital cameras to detect changes in stiffness. This research develops a new automated approach for diagnosing breast cancer using DIET based on a modal analysis model. The first and second natural frequency of silicone phantom breasts is analyzed. Separate modal analysis is performed for each region of the phantom to estimate the modal parameters using imaged motion data over several input frequencies. Statistical methods are used to assess the likelihood of a frequency shift, which can indicate tumor location. Phantoms with 5, 10, and 20 mm stiff inclusions are tested, as well as a homogeneous (healthy) phantom. Inclusions are located at four locations with different depth. The second natural frequency proves to be a reliable metric with the potential to clearly distinguish lesion like inclusions of different stiffness, as well as providing an approximate location for the tumor like inclusions. The 10 and 20 mm inclusions are always detected regardless of depth. The 5 mm inclusions are only detected near the surface. The homogeneous phantom always yields a negative result, as expected. Detection is based on a statistical likelihood analysis to determine the presence of significantly different frequency response over the phantom, which is a novel approach to this problem. The overall results show promise and justify proof of concept trials with human subjects.

[Comparison of screening performance between primary high-risk HPV screening and high-risk HPV screening plus liquid-based cytology cotesting in diagnosis of cervical precancerous or cancerous lesions].

PubMed

Zhao, X L; Remila, Rezhake; Hu, S Y; Zhang, L; Xu, X Q; Chen, F; Pan, Q J; Zhang, X; Zhao, F H

2018-05-06

Objective: To evaluate and compare the screening performance of primary high-risk HPV(HR-HPV) screening and HR-HPV screening plus liquid-based cytology (LBC) cotesting in diagnosis of cervical cancer and precancerous lesions (CIN2+). Methods: We pooled 17 population-based cross-sectional studies which were conducted across China from 1999 to 2008. After obtaining informed consent, all women received liquid-based cytology(LBC)testing, HR-HPV DNA testing. Totally 28 777 women with complete LBC, HPV and biopsy results were included in the final analysis. Screening performance of primary HR-HPV DNA screening and HPV screening plus LBC co-testing in diagnosis of CIN2+ were calculated and compared among different age groups. Results: Among the whole population, the detection rates of primary HR-HPV screening and HR-HPV screening plus LBC co-testing are 3.05% (879 CIN2+) and 3.13%(900 CIN2+), respectively. The sensitivity were 96.4% and 98.7% (χ(2)=19.00, P< 0.001), and the specificity were 86.2% and 78.8% (χ(2)=2 067.00, P< 0.001), respectively. Areas under the receiver operating characteristic (ROC) curve (AUC) showed that the primary HR-HPV screening performed better than co-testing (AUC were 0.913 and 0.888; Z= 6.16, P< 0.001). Compared with primary HR-HPV screening, co-testing showed significantly higher colposcopy referral rates (16.5% and 23.6%, respectively, χ(2)=132.00, P< 0.001) and the number of colposcopy examination for detecting per CIN2+ (5.4 and 7.6, respectively).In the group aged 25-29, the colposcopy referral rates was 8.7 (10.9%(199 cases) vs 1.3%(23 cases)) times as much as the detection rate of primary HR-HPV screening in diagnosis of CIN2+, and was 12.5 (15.7%(288 cases) vs 1.3%(23 cases)) times as much as the detection rate of HR-HPV screening plus cytology contesting. Conclusion: Compared with primary HR-HPV screening, HR-HPV screening plus cytology co-testing does not show better results in the screening performance for CIN2+ detection, and the cost-effectiveness is not good enough, especially in younger age group.

A systematic review of recommendations and guidelines for the management of osteoarthritis: The chronic osteoarthritis management initiative of the U.S. bone and joint initiative.

PubMed

Nelson, Amanda E; Allen, Kelli D; Golightly, Yvonne M; Goode, Adam P; Jordan, Joanne M

2014-06-01

Although a number of osteoarthritis (OA) management guidelines exist, uptake has been suboptimal. Our aim was to review and critically evaluate existing OA management guidelines to better understand potential issues and barriers. A systematic review of the literature in MEDLINE published from January 1, 2000 to April 1, 2013 was performed and supplemented by bibliographic reviews, following PRISMA guidelines and a written protocol. Following initial title and abstract screening, 2 authors independently reviewed full-text articles; a third settled disagreements. Two independent reviewers extracted data into a standardized form. Two authors independently assessed guideline quality using the AGREE II instrument; three generated summary recommendations based on the extracted guideline data. Overall, 16 articles were included in the final review. There was broad agreement on recommendations by the various organizations. For non-pharmacologic modalities, education/self-management, exercise, weight loss if overweight, walking aids as indicated, and thermal modalities were widely recommended. For appropriate patients, joint replacement was recommended; arthroscopy with debridement was not recommended for symptomatic knee OA. Pharmacologic modalities most recommended included acetaminophen/paracetamol (first line) and NSAIDs (topical or oral, second line). Intra-articular corticosteroids were generally recommended for hip and knee OA. Controversy remains about the use of acupuncture, knee braces, heel wedges, intra-articular hyaluronans, and glucosamine/chondroitin. The relative agreement on many OA management recommendations across organizations indicates a problem with dissemination and implementation rather than a lack of quality guidelines. Future efforts should focus on optimizing implementation in primary care settings, where the majority of OA care occurs. Copyright © 2014 Elsevier Inc. All rights reserved.

The increased use of computed tomography angiography and magnetic resonance angiography as the sole imaging modalities prior to infrainguinal bypass has had no effect on outcomes.

PubMed

Shue, Bing; Damle, Rachelle N; Flahive, Julie; Kalish, Jeffrey A; Stone, David H; Patel, Virendra I; Schanzer, Andres; Baril, Donald T

2015-08-01

Angiography remains the gold standard imaging modality before infrainguinal bypass. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have emerged as noninvasive alternatives for preoperative imaging. We sought to examine contemporary trends in the utilization of CTA and MRA as isolated imaging modalities before infrainguinal bypass and to compare outcomes following infrainguinal bypass in patients who underwent CTA or MRA versus those who underwent conventional arteriography. Patients undergoing infrainguinal bypass within the Vascular Study Group of New England were identified (2003-2012). Patients were stratified by preoperative imaging modality: CTA/MRA alone or conventional angiography. Trends in utilization of these modalities were examined and demographics of these groups were compared. Primary end points included primary patency, secondary patency, and major adverse limb events (MALE) at 1 year as determined by Kaplan-Meier analysis. Multivariable Cox proportional hazards models were constructed to evaluate the effect of imaging modality on primary patency, secondary patency, and MALE after adjusting for confounders. In 3123 infrainguinal bypasses, CTA/MRA alone was used in 462 cases (15%) and angiography was used in 2661 cases (85%). Use of CTA/MRA alone increased over time, with 52 (11%) bypasses performed between 2003 and 2005, 189 (41%) bypasses performed between 2006 and 2009, and 221 (48%) bypasses performed between 2010 and 2012 (P < 0.001). Patients with CTA/MRA alone, compared with patients with angiography, more frequently underwent bypass for claudication (33% vs. 26%, P = 0.001) or acute limb ischemia (13% vs. 5%, P < 0.0001), more frequently had prosthetic conduits (39% vs. 30%, P = 0.001), and less frequently had tibial/pedal targets (32% vs. 40%, P = 0.002). After adjusting for these and other confounders, multivariable analysis demonstrated that the use of CTA/MRA alone was not associated with a significant difference in 1 year primary patency (hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.78-1.16), secondary patency (HR 1.30, 95% CI 0.99-1.72), or MALE (HR 1.08, 95% CI 0.89-1.32). CTA and MRA are being increasingly used as the sole preoperative imaging modality before infrainguinal bypass. This shift in practice patterns appears to have no measurable effect on outcomes at 1 year. Copyright © 2015 Elsevier Inc. All rights reserved.

Use of Digital Rectal Examination as an Adjunct to Prostate Specific Antigen in the Detection of Clinically Significant Prostate Cancer.

PubMed

Halpern, Joshua A; Oromendia, Clara; Shoag, Jonathan E; Mittal, Sameer; Cosiano, Michael F; Ballman, Karla V; Vickers, Andrew J; Hu, Jim C

2018-04-01

Guidelines from the NCCN ® (National Comprehensive Cancer Network®) advocate digital rectal examination screening only in men with elevated prostate specific antigen. We investigated the effect of prostate specific antigen on the association of digital rectal examination and clinically significant prostate cancer in a large American cohort. We evaluated the records of the 35,350 men who underwent digital rectal examination in the screening arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial for the development of clinically significant prostate cancer (Gleason 7 or greater). Followup was 343,273 person-years. The primary outcome was the rate of clinically significant prostate cancer among men with vs without suspicious digital rectal examination. We performed competing risks regression to evaluate the interaction between time varying suspicious digital rectal examination and prostate specific antigen. A total of 1,713 clinically significant prostate cancers were detected with a 10-year cumulative incidence of 5.9% (95% CI 5.6-6.2). Higher risk was seen for suspicious vs nonsuspicious digital rectal examination. Increases in absolute risk were small and clinically irrelevant for normal (less than 2 ng/ml) prostate specific antigen (1.5% vs 0.7% risk of clinically significant prostate cancer at 10 years), clinically relevant for elevated (3 ng/ml or greater) prostate specific antigen (23.0% vs 13.7%) and modestly clinically relevant for equivocal (2 to 3 ng/ml) prostate specific antigen (6.5% vs 3.5%). Digital rectal examination demonstrated prognostic usefulness when prostate specific antigen was greater than 3 ng/ml, limited usefulness for less than 2 ng/ml and marginal usefulness for 2 to 3 ng/ml. These findings support the restriction of digital rectal examination to men with higher prostate specific antigen as a reflex test to improve specificity. It should not be used as a primary screening modality to improve sensitivity. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Racial/Ethnic Differences in the Use of Primary Care Providers and Preventive Health Services at a Midwestern University.

PubMed

Focella, Elizabeth S; Shaffer, Victoria A; Dannecker, Erin A; Clark, Mary J; Schopp, Laura H

2016-06-01

Many universities seek to improve the health and wellbeing of their faculty and staff through employer wellness programs but racial/ethnic disparities in health care use may still persist. The purpose of this research was to identify racial/ethnic disparities in the use of preventive health services at a Midwestern university. A record review was conducted of self-reported health data from University employees, examining the use of primary care and common screening procedures collected in a Personal Health Assessment conducted by the University's wellness program. Results show that there were significant racial/ethnic differences in the use of primary care and participation in screening. Notably, Asian employees in this sample were less likely to have a primary care provider and participate in routine cancer screenings. The observed racial/ethnic differences in screening behavior were mediated by the use of primary care. Together, these data show that despite equal access to care, racial and ethnic disparities in screening persist and that having a primary care provider is an important predictor of screening behavior. Results suggest that health communications designed to increase screening among specific racial/ethnic minority groups should target primary care use.

Effects of Secondary Task Modality and Processing Code on Automation Trust and Utilization During Simulated Airline Luggage Screening

NASA Technical Reports Server (NTRS)

Phillips, Rachel; Madhavan, Poornima

2010-01-01

The purpose of this research was to examine the impact of environmental distractions on human trust and utilization of automation during the process of visual search. Participants performed a computer-simulated airline luggage screening task with the assistance of a 70% reliable automated decision aid (called DETECTOR) both with and without environmental distractions. The distraction was implemented as a secondary task in either a competing modality (visual) or non-competing modality (auditory). The secondary task processing code either competed with the luggage screening task (spatial code) or with the automation's textual directives (verbal code). We measured participants' system trust, perceived reliability of the system (when a target weapon was present and absent), compliance, reliance, and confidence when agreeing and disagreeing with the system under both distracted and undistracted conditions. Results revealed that system trust was lower in the visual-spatial and auditory-verbal conditions than in the visual-verbal and auditory-spatial conditions. Perceived reliability of the system (when the target was present) was significantly higher when the secondary task was visual rather than auditory. Compliance with the aid increased in all conditions except for the auditory-verbal condition, where it decreased. Similar to the pattern for trust, reliance on the automation was lower in the visual-spatial and auditory-verbal conditions than in the visual-verbal and auditory-spatial conditions. Confidence when agreeing with the system decreased with the addition of any kind of distraction; however, confidence when disagreeing increased with the addition of an auditory secondary task but decreased with the addition of a visual task. A model was developed to represent the research findings and demonstrate the relationship between secondary task modality, processing code, and automation use. Results suggest that the nature of environmental distractions influence interaction with automation via significant effects on trust and system utilization. These findings have implications for both automation design and operator training.

Scrutinizing screening: a critical interpretive review of primary care provider perspectives on mammography decision-making with average-risk women.

PubMed

Siedlikowski, Sophia; Ells, Carolyn; Bartlett, Gillian

2018-01-01

A decision to undertake screening for breast cancer often takes place within the primary care setting, but current controversies such as overdiagnosis and inconsistent screening recommendations based on evolving evidence render this a challenging process, particularly for average-risk women. Given the responsibility of primary care providers in counseling women in this decision-making process, it is important to understand their thoughts on these controversies and how they manage uncertainty in their practice. To review the perspectives and approaches of primary care providers regarding mammography decision-making with average-risk women. This study is a critical interpretive review of peer-review literature that reports primary care provider perspectives on mammography screening decision-making. Ovid MEDLINE®, Ovid PsycInfo, and Scopus databases were searched with dates from 2002 to 2017 using search terms related to mammography screening, uncertainty, counseling, decision-making, and primary health care providers. Nine articles were included following a review process involving the three authors. Using an inductive and iterative approach, data were grouped into four thematic categories: (1) perceptions on the effectiveness of screening, screening initiation age, and screening frequency; (2) factors guiding primary care providers in the screening decision-making process, including both provider and patient-related factors, (3) uncertainty faced by primary care providers regarding guidelines and screening discussions with their patients; and (4) informed decision-making with average-risk women, including factors that facilitate and hinder this process. The discussion of results addresses several factors about the diversity of perspectives and practices of physicians counseling average-risk women regarding breast cancer screening. This has implications for the challenge of understanding and explaining evidence, what should be shared with average-risk women considering screening, the forms of knowledge that physicians value to guide screening decision-making, and the consent process for population-based screening initiatives. Within the data, there was little attention placed on how physicians coped with uncertainty in practice. Given the dual responsibility of physicians in caring for both individuals and the larger population, further research should probe more deeply into how they balance their duties to individual patients with those to the larger population they serve.

Cell-free fetal DNA screening in the USA: a cost analysis of screening strategies.

PubMed

Evans, M I; Sonek, J D; Hallahan, T W; Krantz, D A

2015-01-01

To determine whether implementation of primary cell-free fetal DNA (cffDNA) screening would be cost-effective in the USA and to evaluate potential lower-cost alternatives. Three strategies to screen for trisomy 21 were evaluated using decision tree analysis: 1) a primary strategy in which cffDNA screening was offered to all patients, 2) a contingent strategy in which cffDNA screening was offered only to patients who were high risk on traditional first-trimester screening and 3) a hybrid strategy in which cffDNA screening was offered to all patients ≥ 35 years of age and only to patients < 35 years who were high risk after first-trimester screening. Four traditional screening protocols were evaluated, each assessing nuchal translucency (NT) and pregnancy-associated plasma protein-A (PAPP-A) along with either free or total beta-human chorionic gonadotropin (β-hCG), with or without nasal bone (NB) assessment. Utilizing a primary cffDNA screening strategy, the cost per patient was 1017 US$. With a traditional screening protocol using free β-hCG, PAPP-A and NT assessment as part of a hybrid screening strategy, a contingent strategy with a 1/300 cut-off and a contingent strategy with a 1/1000 cut-off, the cost per patient was 474, 430 and 409 US$, respectively. Findings were similar using the other traditional screening protocols. Marginal cost per viable case detected for the primary screening strategy as compared to the other strategies was 3-16 times greater than the cost of care for a missed case. Primary cffDNA screening is not currently a cost-effective strategy. The contingent strategy was the lowest-cost alternative, especially with a risk cut-off of 1/1000. The hybrid strategy, although less costly than primary cffDNA screening, was more costly than the contingent strategy. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Effect of perceptual load on semantic access by speech in children

PubMed Central

Jerger, Susan; Damian, Markus F.; Mills, Candice; Bartlett, James; Tye-Murray, Nancy; Abdi, Hervè

2013-01-01

Purpose To examine whether semantic access by speech requires attention in children. Method Children (N=200) named pictures and ignored distractors on a cross-modal (distractors: auditory-no face) or multi-modal (distractors: auditory-static face and audiovisual-dynamic face) picture word task. The cross-modal had a low load, and the multi-modal had a high load [i.e., respectively naming pictures displayed 1) on a blank screen vs 2) below the talker’s face on his T-shirt]. Semantic content of distractors was manipulated to be related vs unrelated to picture (e.g., picture dog with distractors bear vs cheese). Lavie's (2005) perceptual load model proposes that semantic access is independent of capacity limited attentional resources if irrelevant semantic-content manipulation influences naming times on both tasks despite variations in loads but dependent on attentional resources exhausted by higher load task if irrelevant content influences naming only on cross-modal (low load). Results Irrelevant semantic content affected performance for both tasks in 6- to 9-year-olds, but only on cross-modal in 4–5-year-olds. The addition of visual speech did not influence results on the multi-modal task. Conclusion Younger and older children differ in dependence on attentional resources for semantic access by speech. PMID:22896045

Can ultrasound be used as the primary imaging in children with suspected Crohn disease?

PubMed

Tsai, Timothy L; Marine, Megan B; Wanner, Matthew R; Cooper, Matthew L; Steiner, Steven J; Ouyang, Fangqian; Gregory Jennings, S; Karmazyn, Boaz

2017-07-01

There is growing literature on the use of ultrasound (US) for evaluation of Crohn disease in adults, but few studies have been conducted on children. Several studies demonstrated high accuracy of US in the diagnosis of Crohn disease. Using US as the primary screening imaging modality for Crohn disease can reduce health care costs, the need for sedation and ionizing radiation exposure. The aim of our study is to determine if US can be used for screening evaluation of pediatric Crohn disease. A prospective cohort study of pediatric patients undergoing MR enterography (MRE) for suspected or known history of Crohn disease was performed, with gray-scale and Doppler US of the terminal ileum done immediately before or after MRE. US images were interpreted by two radiologists (Reader 1 and Reader 2) not involved in image acquisition, in blinded and randomized fashion. US findings of Crohn disease including bowel wall thickening, wall stratification, increased vascularity on Doppler, lymphadenopathy, fat infiltration and extraintestinal complications were evaluated. MRE findings of terminal ileitis were considered the reference standard. Demographic data, body mass index (BMI), symptoms, and laboratory, endoscopic and histopathological data were obtained from electronic medical records. Forty-one patients (mean age: 13.7 years: 4.6-18.9 years) were evaluated. Mean BMI was 21.2 (range: 13-40.2); 10 patients (24.3%) were either overweight or obese. Final diagnoses were Crohn disease (n=24), ulcerative colitis (n=4) and normal/non-inflammatory bowel disease-related diagnoses (n=13). US demonstrated sensitivity of 67% and 78% and specificity of 78% and 83%, by Reader 1 and Reader 2, respectively. MRE sensitivity and specificity were 75% and 100%, respectively, compared to final clinicopathological diagnosis. Interobserver agreement between Reader 1 and Reader 2 was good (0.6< kappa <0.8). In screening for Crohn disease in children, US has limited sensitivity for detecting terminal ileitis.

Introduction of molecular HPV testing as the primary technology in cervical cancer screening: Acting on evidence to change the current paradigm.

PubMed

Tota, Joseph E; Bentley, James; Blake, Jennifer; Coutlée, François; Duggan, Máire A; Ferenczy, Alex; Franco, Eduardo L; Fung-Kee-Fung, Michael; Gotlieb, Walter; Mayrand, Marie-Hélène; McLachlin, Meg; Murphy, Joan; Ogilvie, Gina; Ratnam, Sam

2017-05-01

Since being introduced in the 1940s, cervical cytology - despite its limitations - has had unequivocal success in reducing cervical cancer burden in many countries. However, we now know that infection with human papillomavirus (HPV) is a necessary cause of cervical cancer and there is overwhelming evidence from large-scale clinical trials, feasibility studies and real-world experience that supports the introduction of molecular testing for HPV as the primary technology in cervical cancer screening (i.e., "HPV primary screening"). While questions remain about the most appropriate age groups for screening, screening interval and triage approach, these should not be considered barriers to implementation. Many countries are in various stages of adopting HPV primary screening, whereas others have not taken any major steps towards introduction of this approach. As a group of clinical experts and researchers in cervical cancer prevention from across Canada, we have jointly authored this comprehensive examination of the evidence to implement HPV primary screening. Our intention is to create a common understanding among policy makers, agencies, clinicians, researchers and other stakeholders about the evidence concerning HPV primary screening to catalyze the adoption of this improved approach to cervical cancer prevention. With the first cohort of vaccinated girls now turning 21, the age when routine screening typically begins, there is increased urgency to introduce HPV primary screening, whose performance may be less adversely affected compared with cervical cytology as a consequence of reduced lesion prevalence post-vaccination. Published by Elsevier Inc.

Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening.

PubMed

Kistler, Christine E; Vu, Maihan; Sutkowi-Hemstreet, Anne; Gizlice, Ziya; Harris, Russell P; Brewer, Noel T; Lewis, Carmen L; Dolor, Rowena J; Barclay, Colleen; Sheridan, Stacey L

2018-01-01

Primary-care providers may contribute to the use of low-value cancer screening. We sought to examine circumstances under which primary-care providers would discuss and recommend two types of cancer screening services across a spectrum of net benefit and other factors known to influence screening. This was a cross sectional survey of 126 primary-care providers in 24 primary-care clinics in the US. Participants completed surveys with two hypothetical screening scenarios for prostate or colorectal cancer (CRC). Patients in the scenarios varied by age and screening-request status. For each scenario, providers indicated whether they would discuss and recommend screening. Providers also reported on their screening attitudes and the influence of other factors known to affect screening (short patient visits, worry about lawsuits, clinical reminders/performance measures, and screening guidelines). We examined associations between providers' attitudes and their screening recommendations for hypothetical 90-year-olds (the lowest-value screening). Providers reported they would discuss cancer screening more often than they would recommend it ( P <0.001). More providers would discuss and recommend screening for CRC than prostate cancer ( P <0.001), for younger than older patients ( P <0.001), and when the patient requested it than when not ( P <0.001). For a 90-year-old patient, every point increase in cancer-specific screening attitude increased the likelihood of a screening recommendation (30% for prostate cancer and 30% for CRC). While most providers' reported practice patterns aligned with net benefit, some providers would discuss and recommend low-value cancer screening, particularly when faced with a patient request. More work appears to be needed to help providers to discuss and recommend screening that aligns with value.

Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening

PubMed Central

Kistler, Christine E; Vu, Maihan; Sutkowi-Hemstreet, Anne; Gizlice, Ziya; Harris, Russell P; Brewer, Noel T; Lewis, Carmen L; Dolor, Rowena J; Barclay, Colleen; Sheridan, Stacey L

2018-01-01

Background Primary-care providers may contribute to the use of low-value cancer screening. Objective We sought to examine circumstances under which primary-care providers would discuss and recommend two types of cancer screening services across a spectrum of net benefit and other factors known to influence screening. Patients and methods This was a cross sectional survey of 126 primary-care providers in 24 primary-care clinics in the US. Participants completed surveys with two hypothetical screening scenarios for prostate or colorectal cancer (CRC). Patients in the scenarios varied by age and screening-request status. For each scenario, providers indicated whether they would discuss and recommend screening. Providers also reported on their screening attitudes and the influence of other factors known to affect screening (short patient visits, worry about lawsuits, clinical reminders/performance measures, and screening guidelines). We examined associations between providers’ attitudes and their screening recommendations for hypothetical 90-year-olds (the lowest-value screening). Results Providers reported they would discuss cancer screening more often than they would recommend it (P<0.001). More providers would discuss and recommend screening for CRC than prostate cancer (P<0.001), for younger than older patients (P<0.001), and when the patient requested it than when not (P<0.001). For a 90-year-old patient, every point increase in cancer-specific screening attitude increased the likelihood of a screening recommendation (30% for prostate cancer and 30% for CRC). Discussion While most providers’ reported practice patterns aligned with net benefit, some providers would discuss and recommend low-value cancer screening, particularly when faced with a patient request. Conclusion More work appears to be needed to help providers to discuss and recommend screening that aligns with value. PMID:29844698

Salvage therapy for locally recurrent prostate cancer after radiation.

PubMed

Marcus, David M; Canter, Daniel J; Jani, Ashesh B; Dobbs, Ryan W; Schuster, David M; Carthon, Bradley C; Rossi, Peter J

2012-12-01

External beam radiotherapy (EBRT) is widely utilized as primary therapy for clinically localized prostate cancer. For patients who develop locally recurrent disease after EBRT, local salvage therapy may be indicated. The primary modalities for local salvage treatment in this setting include radical prostatectomy, cryotherapy, and brachytherapy. To date, there is little data describing outcomes and toxicity associated with each of these salvage modalities. A review of the literature was performed to identify studies of local salvage therapy for patients who had failed primary EBRT for localized prostate cancer. We focused on prospective trials and multi-institutional retrospective series in order to identify the highest level of evidence describing these therapies. The majority of reports describing the use of local salvage treatment for recurrent prostate cancer after EBRT are single-institution, retrospective reports, although small prospective studies are available for salvage cryotherapy and salvage brachytherapy. Clinical outcomes and toxicity for each modality vary widely across studies, which is likely due to the heterogeneity of patient populations, treatment techniques, and definitions of failure. In general, most studies demonstrate that local salvage therapy after EBRT may provide long-term local control in appropriately selected patients, although toxicity is often significant. As there are no randomized trials comparing salvage treatment modalities for localized prostate cancer recurrence after EBRT, the selection of a local treatment modality should be made on a patient-by-patient basis, with careful consideration of each patient's disease characteristics and tolerance for the risks of treatment. Additional data, ideally from prospective randomized trials, is needed to guide decision making for patients with local recurrence after EBRT failure.

Detecting Parkinson's disease from sustained phonation and speech signals.

PubMed

Vaiciukynas, Evaldas; Verikas, Antanas; Gelzinis, Adas; Bacauskiene, Marija

2017-01-01

This study investigates signals from sustained phonation and text-dependent speech modalities for Parkinson's disease screening. Phonation corresponds to the vowel /a/ voicing task and speech to the pronunciation of a short sentence in Lithuanian language. Signals were recorded through two channels simultaneously, namely, acoustic cardioid (AC) and smart phone (SP) microphones. Additional modalities were obtained by splitting speech recording into voiced and unvoiced parts. Information in each modality is summarized by 18 well-known audio feature sets. Random forest (RF) is used as a machine learning algorithm, both for individual feature sets and for decision-level fusion. Detection performance is measured by the out-of-bag equal error rate (EER) and the cost of log-likelihood-ratio. Essentia audio feature set was the best using the AC speech modality and YAAFE audio feature set was the best using the SP unvoiced modality, achieving EER of 20.30% and 25.57%, respectively. Fusion of all feature sets and modalities resulted in EER of 19.27% for the AC and 23.00% for the SP channel. Non-linear projection of a RF-based proximity matrix into the 2D space enriched medical decision support by visualization.

Breast cancer screening and problem solving using mammography, ultrasound, and magnetic resonance imaging.

PubMed

Hooley, Regina J; Andrejeva, Liva; Scoutt, Leslie M

2011-03-01

Although mammography is the mainstay of early breast cancer detection, it has known limitations, particularly in women with dense breasts. As a result, additional imaging modalities, including ultrasound and contrast-enhanced magnetic resonance imaging, are also being used to supplement mammography in the early detection of occult breast cancer. This article reviews the indications and efficacy of mammography, ultrasound, and magnetic resonance imaging as both screening and diagnostic tools.

A comparison of oncological outcomes between transoral surgical and non-surgical treatment protocols in the management of oropharyngeal squamous cell carcinoma.

PubMed

Kao, S S; Micklem, J; Ofo, E; Edwards, S; Dhatrak, D; Foreman, A; Krishnan, S; Hodge, J-C

2018-04-01

The incidence of oropharyngeal squamous cell carcinoma in the Western world is increasing, with the human papillomavirus epidemic implicated in this observed trend. The optimal treatment modality is yet undetermined regarding oncological outcomes. This study comprised 98 patients with oropharyngeal squamous cell carcinoma, treated with either primary transoral surgery with adjuvant therapy or primary chemoradiotherapy with curative intent, between 2008 and 2012. Clinicopathological characteristics including tumour-node-metastasis stage, human papillomavirus status, treatment modality, recurrence and overall survival were collated. Five per cent of primary surgical patients had locoregional recurrences compared with 25 per cent of primary chemoradiotherapy patients. A lower rate of locoregional recurrence was observed in the human papillomavirus positive group. This paper reports higher rates of overall survival and local control for oropharyngeal squamous cell carcinoma treated with primary surgery compared with primary chemoradiotherapy. This reflects overall lower tumour stage and higher human papillomavirus status in this group.

Limited data tomographic image reconstruction via dual formulation of total variation minimization

NASA Astrophysics Data System (ADS)

Jang, Kwang Eun; Sung, Younghun; Lee, Kangeui; Lee, Jongha; Cho, Seungryong

2011-03-01

The X-ray mammography is the primary imaging modality for breast cancer screening. For the dense breast, however, the mammogram is usually difficult to read due to tissue overlap problem caused by the superposition of normal tissues. The digital breast tomosynthesis (DBT) that measures several low dose projections over a limited angle range may be an alternative modality for breast imaging, since it allows the visualization of the cross-sectional information of breast. The DBT, however, may suffer from the aliasing artifact and the severe noise corruption. To overcome these problems, a total variation (TV) regularized statistical reconstruction algorithm is presented. Inspired by the dual formulation of TV minimization in denoising and deblurring problems, we derived a gradient-type algorithm based on statistical model of X-ray tomography. The objective function is comprised of a data fidelity term derived from the statistical model and a TV regularization term. The gradient of the objective function can be easily calculated using simple operations in terms of auxiliary variables. After a descending step, the data fidelity term is renewed in each iteration. Since the proposed algorithm can be implemented without sophisticated operations such as matrix inverse, it provides an efficient way to include the TV regularization in the statistical reconstruction method, which results in a fast and robust estimation for low dose projections over the limited angle range. Initial tests with an experimental DBT system confirmed our finding.

Just-in-Time Compound Pooling Increases Primary Screening Capacity without Compromising Screening Quality.

PubMed

Elkin, L L; Harden, D G; Saldanha, S; Ferguson, H; Cheney, D L; Pieniazek, S N; Maloney, D P; Zewinski, J; O'Connell, J; Banks, M

2015-06-01

Compound pooling, or multiplexing more than one compound per well during primary high-throughput screening (HTS), is a controversial approach with a long history of limited success. Many issues with this approach likely arise from long-term storage of library plates containing complex mixtures of compounds at high concentrations. Due to the historical difficulties with using multiplexed library plates, primary HTS often uses a one-compound-one-well approach. However, as compound collections grow, innovative strategies are required to increase the capacity of primary screening campaigns. Toward this goal, we have developed a novel compound pooling method that increases screening capacity without compromising data quality. This method circumvents issues related to the long-term storage of complex compound mixtures by using acoustic dispensing to enable "just-in-time" compound pooling directly in the assay well immediately prior to assay. Using this method, we can pool two compounds per well, effectively doubling the capacity of a primary screen. Here, we present data from pilot studies using just-in-time pooling, as well as data from a large >2-million-compound screen using this approach. These data suggest that, for many targets, this method can be used to vastly increase screening capacity without significant reduction in the ability to detect screening hits. © 2015 Society for Laboratory Automation and Screening.

Cross-modal versus within-modal recall: differences in behavioral and brain responses.

PubMed

Butler, Andrew J; James, Karin H

2011-10-31

Although human experience is multisensory in nature, previous research has focused predominantly on memory for unisensory as opposed to multisensory information. In this work, we sought to investigate behavioral and neural differences between the cued recall of cross-modal audiovisual associations versus within-modal visual or auditory associations. Participants were presented with cue-target associations comprised of pairs of nonsense objects, pairs of nonsense sounds, objects paired with sounds, and sounds paired with objects. Subsequently, they were required to recall the modality of the target given the cue while behavioral accuracy, reaction time, and blood oxygenation level dependent (BOLD) activation were measured. Successful within-modal recall was associated with modality-specific reactivation in primary perceptual regions, and was more accurate than cross-modal retrieval. When auditory targets were correctly or incorrectly recalled using a cross-modal visual cue, there was re-activation in auditory association cortex, and recall of information from cross-modal associations activated the hippocampus to a greater degree than within-modal associations. Findings support theories that propose an overlap between regions active during perception and memory, and show that behavioral and neural differences exist between within- and cross-modal associations. Overall the current study highlights the importance of the role of multisensory information in memory. Copyright © 2011 Elsevier B.V. All rights reserved.

Cost-effectiveness of cervical cancer screening with primary human papillomavirus testing in Norway.

PubMed

Burger, E A; Ortendahl, J D; Sy, S; Kristiansen, I S; Kim, J J

2012-04-24

New screening technologies and vaccination against human papillomavirus (HPV), the necessary cause of cervical cancer, may impact optimal approaches to prevent cervical cancer. We evaluated the cost-effectiveness of alternative screening strategies to inform cervical cancer prevention guidelines in Norway. We leveraged the primary epidemiologic and economic data from Norway to contextualise a simulation model of HPV-induced cervical cancer. The current cytology-only screening was compared with strategies involving cytology at younger ages and primary HPV-based screening at older ages (31/34+ years), an option being actively deliberated by the Norwegian government. We varied the switch-age, screening interval, and triage strategies for women with HPV-positive results. Uncertainty was evaluated in sensitivity analysis. Current cytology-only screening was less effective and more costly than strategies that involve switching to primary HPV testing in older ages. For unvaccinated women, switching at age 34 years to primary HPV testing every 4 years was optimal given the Norwegian cost-effectiveness threshold ($83,000 per year of life saved). For vaccinated women, a 6-year screening interval was cost-effective. When we considered a wider range of strategies, we found that an earlier switch to HPV testing (at age 31 years) may be preferred. Strategies involving a switch to HPV testing for primary screening in older women is expected to be cost-effective compared with current recommendations in Norway.

Diagnostic accuracy of high-risk HPV genotyping in women with high-grade cervical lesions: evidence for improving the cervical cancer screening strategy in China.

PubMed

Xu, Huihui; Lin, Aifen; Shao, Xiujuan; Shi, Weiwu; Zhang, Yang; Yan, Weihua

2016-12-13

Currently, clinical data for primary HPV screening alone are lacking in China. Here, we evaluate cervical cancer screening with primary HPV genotyping, as well as possible future screening strategy. Overall, high-risk HPV (hrHPV) prevalence was 18.2% among hospital-based population in Taizhou area. For cervical intraepithelial neoplasia 2 or worse (CIN2+), the sensitivity of primary hrHPV genotyping strategy and current cervical cancer screening strategy were 93.5%, and 71.1%, respectively; whereas the specificity was 17.5%, and 62.4%, respectively. Current cervical screening strategy had slightly higher positive predictive values (28.4%) for CIN2+ than hrHPV genotyping strategy (21.9%), whereas primary hrHPV genotyping strategy demonstrated higher negative predictive values (94.7%) than current cervical screening strategy (91.1%). Compared to HPV35/39/45/51/56/59/66/68 genotypes, the odds ratios (OR) for CIN2+ in HPV16/18/31/33/52/58 infection women were 3.2 (95% confidence interval [CI] 2.3-4.1). Primary hrHPV genotyping strategy provides a better predictive value than HPV16/18 genotyping alone in guiding the clinical management of the current cervical cancer screening. HPV testing without adjunctive cytology may be sufficiently sensitive for primary cervical cancer screening.

Using entertainment-education to promote cervical cancer screening in Thai women.

PubMed

Love, Gail D; Tanjasiri, Sora Park

2012-06-01

Southeast Asian women in California have high cervical cancer incidence and mortality rates, but low levels of Pap screening. No published reports have addressed screening among Thai women. Entertainment-education (EE) is a useful strategy for low-literacy, culturally diverse populations. This quasi-experimental study determined whether a soap-opera-themed, Thai-language EE video was superior to a print handout for increasing knowledge, attitudes, and behavioral intention toward Pap testing. No uniform differences were found between the intervention group (video) and the control group (brochure). Both educational modalities appeared to result in selected increases in knowledge and attitudes.

Risk factors & screening modalities for oral cancer.

PubMed

Chau, Steven

2008-01-01

Dentists are at the forefront for screening oral cancer. In addition to the well known carcinogenic potential of tobacco and alcohol, betel nut chewing and human papilloma virus are important risk factors in the development of oral cancer. To aid in screening and decreasing morbidity and mortality from oral cancer, a variety of techniques have been developed. These techniques show promise but they require additional investigations to determine their usefulness in oral cancer detection. Dentists need to be well educated and vigilant when dealing with all patients they encounter. Early detection, diagnosis and treatment are critical for the effective management of oral cancers.

Primary care practice and facility quality orientation: influence on breast and cervical cancer screening rates.

PubMed

Goldzweig, Caroline Lubick; Parkerton, Patricia H; Washington, Donna L; Lanto, Andrew B; Yano, Elizabeth M

2004-04-01

Despite the importance of early cancer detection, variation in screening rates among physicians is high. Insights into factors influencing variation can guide efforts to decrease variation and increase screening rates. To explore the association of primary care practice features and a facility's quality orientation with breast and cervical cancer screening rates. Cross-sectional study of screening rates among 144 Department of Veterans Affairs (VA) medical centers and for a national sample of women. We linked practice structure and quality improvement characteristics of individual VA medical centers from 2 national surveys (1 to primary care directors and 1 to a stratified random sample of employees) to breast and cervical cancer screening rates determined from a review of random medical records. We conducted bivariate analyses and multivariate logistic regression of primary care practice and facility features on cancer screening rates, above and below the median. While the national screening rates were high for breast (87%) and cervical cancer (90%), higher screening rates were more likely when primary care providers were consistently notified of specialty visits and when staff perceived a greater organizational commitment to quality and anticipated rewards and recognition for better performance. Organization and quality orientation of the primary care practice and its facility can enhance breast and cervical cancer screening rates. Internal recognition of quality performance and an overall commitment to quality improvement may foster improved prevention performance, with impact varying by clinical service.

Colorectal cancer screening practices of primary care providers: results of a national survey in Malaysia.

PubMed

Norwati, Daud; Harmy, Mohamed Yusoff; Norhayati, Mohd Noor; Amry, Abdul Rahim

2014-01-01

The incidence of colorectal cancer has been increasing in many Asian countries including Malaysia during the past few decades. A physician recommendation has been shown to be a major factor that motivates patients to undergo screening. The present study objectives were to describe the practice of colorectal cancer screening by primary care providers in Malaysia and to determine the barriers for not following recommendations. In this cross sectional study involving 132 primary care providers from 44 Primary Care clinics in West Malaysia, self-administered questionnaires which consisted of demographic data, qualification, background on the primary care clinic, practices on colorectal cancer screening and barriers to colorectal cancer screening were distributed. A total of 116 primary care providers responded making a response rate of 87.9%. About 21% recommended faecal occult blood test (FOBT) in more than 50% of their patients who were eligible. The most common barrier was "unavailability of the test". The two most common patient factors are "patient in a hurry" and "poor patient awareness". This study indicates that colorectal cancer preventive activities among primary care providers are still poor in Malaysia. This may be related to the low availability of the test in the primary care setting and poor awareness and understanding of the importance of colorectal cancer screening among patients. More awareness programmes are required for the public. In addition, primary care providers should be kept abreast with the latest recommendations and policy makers need to improve colorectal cancer screening services in health clinics.

Motivation Conditions in a Foreign Language Reading Comprehension Course Offering Both a Web-Based Modality and a Face-to-Face Modality (Las condiciones de motivación en un curso de comprensión de lectura en lengua extranjera (LE) ofrecido tanto en la modalidad presencial como en la modalidad a distancia en la web)

ERIC Educational Resources Information Center

Lopera Medina, Sergio

2014-01-01

Motivation plays an important in role in education. Based on the ten macro-strategies proposed by Dörnyei and Csizér (1998), this article analyzes the motivation conditions in a foreign language reading comprehension course using both a web-based modality and a face-to-face modality. A case study was implemented as the primary research method, and…

Breast cancer screening utilization among women from Muslim majority countries in Ontario, Canada.

PubMed

Vahabi, Mandana; Lofters, Aisha; Kim, Eliane; Wong, Josephine Pui-Hing; Ellison, Lisa; Graves, Erin; Glazier, Richard H

2017-12-01

Breast cancer screening disparities continue to prevail with immigrant women being at the forefront of the under screened population. There is a paucity of knowledge about the role of religious affiliation or cultural orientation on immigrant women's cancer screening uptake. This study examined differences in uptake of breast cancer screening among women from Muslim and non- Muslim majority countries in Ontario, Canada. A cohort of 1,851,834 screening-eligible women living in Ontario during April 1, 2013 to March 31, 2015 was created using linked health and social administrative databases. The study found that being born in a Muslim majority country was associated with lower breast cancer screening uptake after adjusting for region of origin, neighbourhood income, and primary care-related factors. However, screening uptake in Muslim majority countries varied by world region with the greatest differences found in Sub-Saharan Africa and South Asia. Screening uptake was lower for women who had no primary care provider, were in a traditional fee-for service model of primary care, had a male physician, had an internationally trained physician, resided in a low income neighbourhood, and entered Canada under the family class of immigration. Religion may play a role in screening uptake, however, the variation in rates by regions of origin, immigration class, and access to primary care providers alludes to confluence of socio-demographic, cultural beliefs and practices, immigration trajectories and system level factors. Facilitating access for immigrant women to regular primary care providers, particularly female providers and enrollment in primary care models could enhance screening uptake. Copyright © 2017 Elsevier Inc. All rights reserved.

CE: Original Research: Primary Care Providers and Screening for Military Service and PTSD.

PubMed

Mohler, Kristin Michelle; Sankey-Deemer, Cydnee

2017-11-01

: Background: Most veterans have the option of receiving their health care from the Veterans Health Administration or through primary care providers in the private sector. However, there is some evidence that fewer than half of community-based, private sector primary care and mental health providers screen their patients for military service, particularly in rural areas, leaving these veterans less likely to be screened for posttraumatic stress disorder (PTSD) and other military service-related conditions. To determine whether primary care providers in the private sector are screening patients for military service and subsequent PTSD. We designed and piloted a survey to determine whether primary care providers in a rural Pennsylvania region routinely screen for military service and service-related PTSD. We distributed the survey to a convenience sample of more than 250 primary care providers in central and western Pennsylvania through the U.S. Postal Service, via Facebook, and via work e-mails for those who worked in a local health system. Among 50 eligible respondents, only four (8%) said they screen all their patients for military service, and 20 (40%) reported screening none; only two respondents (4%) screened all their patients who have served in the military for PTSD, and 30 (60%) screened none. Veterans who rely on private sector providers may not receive evidence-based care for military service-related health problems, including PTSD. To improve care for these patients, providers in the private sector should be educated on why all patients should be screened for military service, how to conduct such screening properly, and veterans' general health concerns.

Comparison of glass slides and various digital-slide modalities for cytopathology screening and interpretation.

PubMed

Hanna, Matthew G; Monaco, Sara E; Cuda, Jacqueline; Xing, Juan; Ahmed, Ishtiaque; Pantanowitz, Liron

2017-09-01

Whole-slide imaging in cytology is limited when glass slides are digitized without z-stacks for focusing. Different vendors have started to provide z-stacking solutions to overcome this limitation. The Panoptiq imaging system allows users to create digital files combining low-magnification panoramic images with regions of interest (ROIs) that are imaged with high-magnification z-stacks. The aim of this study was to compare such panoramic images with conventional whole-slide images and glass slides for the tasks of screening and interpretation in cytopathology. Thirty glass slides, including 10 ThinPrep Papanicolaou tests and 20 nongynecologic cytology cases, were digitized with an Olympus BX45 integrated microscope with an attached Prosilica GT camera. ViewsIQ software was used for image acquisition and viewing. These glass slides were also scanned on an Aperio ScanScope XT at ×40 (0.25 μm/pixel) with 1 z-plane and were viewed with ImageScope software. Digital and glass sides were screened and dotted/annotated by a cytotechnologist and were subsequently reviewed by 3 cytopathologists. For panoramic images, the cytotechnologist manually created digital maps and selected representative ROIs to generate z-stacks at a higher magnification. After 3-week washout periods, panoramic images were compared with Aperio digital slides and glass slides. The Panoptiq system permitted fine focusing of thick smears and cell clusters. In comparison with glass slides, the average screening times were 5.5 and 1.8 times longer with Panoptiq and Aperio images, respectively, but this improved with user experience. There was no statistical difference in diagnostic concordance between all 3 modalities. Users' diagnostic confidence was also similar for all modalities. The Aperio whole-slide scanner with 1 z-plane scanning and the Panoptiq imaging system with z-stacking are both suitable for cytopathology screening and interpretation. However, ROI z-stacks do offer a superior mechanism for overcoming focusing problems commonly encountered with digital cytology slides. Unlike whole-slide imaging, the acquisition of representative z-stack images with the Panoptiq system requires a trained cytologist to create digital files. Cancer Cytopathol 2017;125:701-9. © 2017 American Cancer Society. © 2017 American Cancer Society.

Modal phase measuring deflectometry

DOE PAGES

Huang, Lei; Xue, Junpeng; Gao, Bo; ...

2016-10-14

Here in this work, a model based method is applied to phase measuring deflectometry, which is named as modal phase measuring deflectometry. The height and slopes of the surface under test are represented by mathematical models and updated by optimizing the model coefficients to minimize the discrepancy between the reprojection in ray tracing and the actual measurement. The pose of the screen relative to the camera is pre-calibrated and further optimized together with the shape coefficients of the surface under test. Simulations and experiments are conducted to demonstrate the feasibility of the proposed approach.

Cross-modality Sharpening of Visual Cortical Processing through Layer 1-Mediated Inhibition and Disinhibition

PubMed Central

Ibrahim, Leena A.; Mesik, Lukas; Ji, Xu-ying; Fang, Qi; Li, Hai-fu; Li, Ya-tang; Zingg, Brian; Zhang, Li I.; Tao, Huizhong Whit

2016-01-01

Summary Cross-modality interaction in sensory perception is advantageous for animals’ survival. How cortical sensory processing is cross-modally modulated and what are the underlying neural circuits remain poorly understood. In mouse primary visual cortex (V1), we discovered that orientation selectivity of layer (L)2/3 but not L4 excitatory neurons was sharpened in the presence of sound or optogenetic activation of projections from primary auditory cortex (A1) to V1. The effect was manifested by decreased average visual responses yet increased responses at the preferred orientation. It was more pronounced at lower visual contrast, and was diminished by suppressing L1 activity. L1 neurons were strongly innervated by A1-V1 axons and excited by sound, while visual responses of L2/3 vasoactive intestinal peptide (VIP) neurons were suppressed by sound, both preferentially at the cell's preferred orientation. These results suggest that the cross-modality modulation is achieved primarily through L1 neuron and L2/3 VIP-cell mediated inhibitory and disinhibitory circuits. PMID:26898778

Electroconvulsive therapy: Promoting awareness among primary care physicians.

PubMed

Sicher, Sarah; Gedzior, Joanna

2016-04-01

This article aims to promote awareness among primary care providers and support electroconvulsive therapy as a generally well-tolerated, effective therapeutic modality to treat specific psychiatric conditions in appropriately selected patients. There seem to be several potential barriers to treatment with electroconvulsive therapy including stigma, lack of providers who preform it, and lack of awareness among providers referring patients who may be appropriate candidates. The article provides a brief overview of electroconvulsive therapy principles and topics and includes a case report to illustrate clinical utility. The article proposes the concept that a potential way to overcome barriers to treatment with electroconvulsive therapy may be to promote education and awareness of it as a viable treatment modality among primary care providers. © The Author(s) 2016.

Alerts in electronic medical records to promote a colorectal cancer screening programme: a cluster randomised controlled trial in primary care.

PubMed

Guiriguet, Carolina; Muñoz-Ortiz, Laura; Burón, Andrea; Rivero, Irene; Grau, Jaume; Vela-Vallespín, Carmen; Vilarrubí, Mercedes; Torres, Miquel; Hernández, Cristina; Méndez-Boo, Leonardo; Toràn, Pere; Caballeria, Llorenç; Macià, Francesc; Castells, Antoni

2016-07-01

Participation rates in colorectal cancer screening are below recommended European targets. To evaluate the effectiveness of an alert in primary care electronic medical records (EMRs) to increase individuals' participation in an organised, population-based colorectal cancer screening programme when compared with usual care. Cluster randomised controlled trial in primary care centres of Barcelona, Spain. Participants were males and females aged 50-69 years, who were invited to the first round of a screening programme based on the faecal immunochemical test (FIT) (n = 41 042), and their primary care professional. The randomisation unit was the physician cluster (n = 130) and patients were blinded to the study group. The control group followed usual care as per the colorectal cancer screening programme. In the intervention group, as well as usual care, an alert to health professionals (cluster level) to promote screening was introduced in the individual's primary care EMR for 1 year. The main outcome was colorectal cancer screening participation at individual participant level. In total, 67 physicians and 21 619 patients (intervention group) and 63 physicians and 19 423 patients (control group) were randomised. In the intention-to-treat analysis screening participation was 44.1% and 42.2% respectively (odds ratio 1.08, 95% confidence interval [CI] = 0.97 to 1.20, P = 0.146). However, in the per-protocol analysis screening uptake in the intervention group showed a statistically significant increase, after adjusting for potential confounders (OR, 1.11; 95% CI = 1.02 to 1.22; P = 0.018). The use of an alert in an individual's primary care EMR is associated with a statistically significant increased uptake of an organised, FIT-based colorectal cancer screening programme in patients attending primary care centres. © British Journal of General Practice 2016.

IMPLEMENTATION OF GASTRIC CANCER SCREENING – THE GLOBAL EXPERIENCE

PubMed Central

Leja, Mārcis; You, Weicheng; Camargo, M. Constanza; Saito, Hiroshi

2018-01-01

Gastric cancer (GC) is still an important global healthcare problem, and in absolute figures it is going to remain at the present level in foreseeable future. In general, survival of patients with GC is poor mainly due to advanced-stage diagnosis. Early-stage GC can be cured by endoscopic resection or less invasive surgical treatment. Unfortunately, there is no appropriate screening strategy available for global application. This article provides a description of established national and regional GC screening programs and the screening modalities used. This review also summarizes current approaches to develop cancer-screening biomarkers. Although candidates with initial promising results have been suggested, moving discovery into clinical practice is still a major challenge. Well-designed biomarker studies, with systematic validation steps, are needed to decrease the burden of this fatal disease. PMID:25439074

Streamlining the Evaluation of Low Back Pain in Children

PubMed Central

Auerbach, Joshua D.; Ahn, Jaimo; Zgonis, Miltiadis H.; Reddy, Sudheer C.; Ecker, Malcolm L.

2008-01-01

The workup of low back pain in children often results in overimaging so as not to miss organic back pain. The primary goal of this study was to identify which combination of imaging modalities provides the most sensitive and specific screening protocol for children with low back pain. Medical records from 100 consecutive patients between 2 and 18 years of age presenting with low back pain, without night pain or constitutional symptoms, were evaluated. A hyperextension test combined with a radiograph showed a negative predictive value of 0.81 and sensitivity of 0.90. The addition of a bone scan was highly effective in achieving good negative predictive value and sensitivity. Bone scans had perfect negative predictive value and sensitivity when symptom duration was less than 6 weeks. We identified a set of factors that is highly predictive for distinguishing organic back pain from mechanical back pain. Painless hyperextension combined with negative anteroposterior, lateral, and oblique lumbar radiographs and magnetic resonance images predicts mechanical back pain. For patients with nonneurologic back pain of less than 6 weeks duration, bone scan is the most useful screening test because it is accurate, accessible, inexpensive, and unlikely to require sedation. Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18553213

Prostate Cancer Detection and Diagnosis: The Role of MR and its Comparison to other Diagnostic Modalities – A Radiologist's Perspective

PubMed Central

Penzkofer, Tobias; Tempany-Afdhal, Clare M.

2013-01-01

It is now universally recognized that many prostate cancers are over-diagnosed and over-treated. The European Randomized Study of Screening for Prostate Cancer (ERSPC) from 2009 evidenced that, to save one man from death of prostate cancer, over 1,400 men had to be screened, and 48 had to undergo treatment. Detection of prostate cancer is traditionally based upon digital rectal examination (DRE) and measuring serum prostate specific antigen (PSA), followed by ultrasound guided biopsy. The primary role of imaging for the detection and diagnosis of prostate cancer has been transrectal ultrasound (TRUS) guidance during biopsy. MRI has traditionally been used primarily for staging disease in men with biopsy proven cancer. It is has a well-established role in detecting T3 disease, planning radiation therapy, especially 3D conformal or intensity modulated external beam radiation therapy (IMRT), and planning and guiding interstitial seed implant or brachytherapy. New advances have now established prostate MRI can accurately characterize focal lesions within the gland, an ability that has led to new opportunities for improved cancer detection and guidance for biopsy. There are two new approaches to prostate biopsy are under investigation both use pre-biopsy MRI to define potential targets for sampling and then the biopsy is performed either with direct real-time MR guidance (in-bore) or MR fusion/registration with TRUS images (out-of-bore). In-bore or out-of-bore MRI-guided prostate biopsies have the advantage of using the MR target definition for accurate localization and sampling of targets or suspicious lesions. The out-of-bore method uses combined MRI/TRUS with fusion software that provided target localization and increases the sampling accuracy for TRUS-guided biopsies by integrating prostate MRI information with TRUS. Newer parameters for each imaging modality such as sonoelastography or shear wave elastography (SWE), contrast enhanced US (CEUS) and MRI-elastography, show promise to further enrich data sets. PMID:24000133

Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Screening (PDQ®)—Health Professional Version

Cancer.gov

Ovarian, fallopian tube, and primary peritoneal cancer screening is not currently recommended as part of routine cancer screening. Get detailed information about the potential benefits and harms of screening tests used in these cancers in this summary for clinicians.

Dynamic Testing of a Pre-stretched Flexible Tube for Identifying the Factors Affecting Modal Parameter Estimation

NASA Astrophysics Data System (ADS)

Unnikrishnan, Madhusudanan; Rajan, Akash; Basanthvihar Raghunathan, Binulal; Kochupillai, Jayaraj

2017-08-01

Experimental modal analysis is the primary tool for obtaining the fundamental dynamic characteristics like natural frequency, mode shape and modal damping ratio that determine the behaviour of any structure under dynamic loading conditions. This paper discusses about a carefully designed experimental method for calculating the dynamic characteristics of a pre-stretched horizontal flexible tube made of polyurethane material. The factors that affect the modal parameter estimation like the application time of shaker excitation, pause time between successive excitation cycles, averaging and windowing of measured signal, as well as the precautions to be taken during the experiment are explained in detail. The modal parameter estimation is done using MEscopeVESTM software. A finite element based pre-stressed modal analysis of the flexible tube is also done using ANSYS ver.14.0 software. The experimental and analytical results agreed well. The proposed experimental methodology may be extended for carrying out the modal analysis of many flexible structures like inflatables, tires and membranes.

Evidence-based development and first usability testing of a social serious game based multi-modal system for early screening for atypical socio-cognitive development.

PubMed

Gyori, Miklos; Borsos, Zsófia; Stefanik, Krisztina

2015-01-01

At current, screening for, and diagnosis of, autism spectrum disorders (ASD) are based on purely behavioral data; established screening tools rely on human observation and ratings of relevant behaviors. The research and development project in the focus of this paper is aimed at designing, creating and evaluating a social serious game based multi-modal, interactive software system for screening for high functioning cases of ASD at kindergarten age. The aims of this paper are (1) to summarize the evidence-based design process and (2) to present results from the first usability test of the system. Game topic, candidate responses, and candidate game contents were identified via an iterative literature review. On this basis, the 1^st partial prototype of the fully playable game has been created, with complete data recording functionality but without the decision making component. A first usability test was carried out on this prototype (n=13). Overall results were unambiguously promising. Although sporadic difficulties in, and slightly negative attitudes towards, using the game occasionally arose, these were confined to non-target-group children only. The next steps of development include (1) completing the game design; (2) carrying out first large-n field test; (3) creating the first prototype of the decision making component.

Clinical Nononcologic Applications of PET/CT and PET/MRI in Musculoskeletal, Orthopedic, and Rheumatologic Imaging.

PubMed

Gholamrezanezhad, Ali; Basques, Kyle; Batouli, Ali; Matcuk, George; Alavi, Abass; Jadvar, Hossein

2018-06-01

With improvements in PET/CT and PET/MRI over the last decade, as well as increased understanding of the pathophysiology of musculoskeletal diseases, there is an emerging potential for PET as a primary or complementary modality in the management of rheumatologic and orthopedic conditions. We discuss the role of PET/CT and PET/MRI in nononcologic musculoskeletal disorders, including inflammatory and infectious conditions and postoperative complications. There is great potential for an increased role for PET to serve as a primary or complementary modality in the management of orthopedic and rheumatologic disorders.

Review of current therapies for secondary hypertrophic pulmonary osteoarthropathy.

PubMed

Nguyen, Sheila; Hojjati, Mehrnaz

2011-01-01

Hypertrophic osteoarthropathy (HOA) is a disabling condition that may occur secondarily to primary lung cancer. It is characterized by digital clubbing, arthralgia/arthritis, and periostosis of the tubular bones. The pain associated with HOA can be disabling and often refractory to conventional analgesics. We performed a comprehensive review of the literature using the PubMed database on treatment modalities available for HOA. We found 52 relevant articles-40 case reports, six case series, two review papers, and four combined case series and review papers. There were no randomized controlled trials reported. We then classified treatments used for HOA into two categories: (1) treatment of primary cause (i.e., resection of tumor, chemotherapy, radiotherapy, treatment of infection, etc.) and (2) symptomatic treatments (i.e., bisphosphonates, octreotide, NSAIDs, vagotomy, etc.). Subsequently, we summarized the main findings for each treatment. Although the clinical diagnosis of HOA has existed for over 100 years, the pathogenesis mechanism has not yet been elucidated, and treatment options for this condition remain experimental. Primary treatment is the most widely reported modality to be efficacious. In cases which primary therapy is not possible, several symptomatic treatment modalities are suggested, with various degree of success. Further research is needed to clarify the pathophysiological mechanism of HOA as to appropriately direct therapy.

The role of primary auditory and visual cortices in temporal processing: A tDCS approach.

PubMed

Mioni, G; Grondin, S; Forgione, M; Fracasso, V; Mapelli, D; Stablum, F

2016-10-15

Many studies showed that visual stimuli are frequently experienced as shorter than equivalent auditory stimuli. These findings suggest that timing is distributed across many brain areas and that "different clocks" might be involved in temporal processing. The aim of this study is to investigate, with the application of tDCS over V1 and A1, the specific role of primary sensory cortices (either visual or auditory) in temporal processing. Forty-eight University students were included in the study. Twenty-four participants were stimulated over A1 and 24 participants were stimulated over V1. Participants performed time bisection tasks, in the visual and the auditory modalities, involving standard durations lasting 300ms (short) and 900ms (long). When tDCS was delivered over A1, no effect of stimulation was observed on perceived duration but we observed higher temporal variability under anodic stimulation compared to sham and higher variability in the visual compared to the auditory modality. When tDCS was delivered over V1, an under-estimation of perceived duration and higher variability was observed in the visual compared to the auditory modality. Our results showed more variability of visual temporal processing under tDCS stimulation. These results suggest a modality independent role of A1 in temporal processing and a modality specific role of V1 in the processing of temporal intervals in the visual modality. Copyright © 2016 Elsevier B.V. All rights reserved.

HPV primary cervical screening in England: Women's awareness and attitudes.

PubMed

Patel, Hersha; Moss, Esther L; Sherman, Susan M

2018-03-09

Primary human papillomavirus (HPV) cervical screening is due to be implemented in England within the next 2 years; however, the acceptability of HPV testing as the primary screening test is unclear. This study explores women's awareness and attitudes toward HPV testing/screening. Qualitative interviews (semistructured and focus group) were conducted with 46 women (aged 25-65 years) from community and secondary care settings. Data were analyzed by using the inductive-framework method. Women were unaware that cervical screening currently includes HPV testing and lacked HPV-related knowledge. Emotions of shock, fear, and anxiety were reported upon receiving a positive HPV result. For women in long-term relationships, the realization that HPV is a sexually transmitted infection was seen as a barrier to primary HPV testing. Knowledge that HPV testing is a screening test to prevent cervical cancer did not change their attitudes. Women debated the need for continued screening following a negative result. Women feared judgment by the community if they participated with primary HPV screening because they were being tested for a sexually transmitted infection, with the possible attendant perception that they had adopted a high-risk lifestyle in comparison to nonattenders. The acceptability of HPV testing may be a limiting factor in encouraging participation with screening in the future. Copyright © 2018 John Wiley & Sons, Ltd.

Adolescent Risk Screening Instruments for Primary Care: An Integrative Review Utilizing the Donabedian Framework.

PubMed

Hiott, Deanna B; Phillips, Shannon; Amella, Elaine

2017-07-31

Adolescent risk-taking behavior choices can affect future health outcomes. The purpose of this integrative literature review is to evaluate adolescent risk screening instruments available to primary care providers in the United States using the Donabedian Framework of structure, process, and outcome. To examine the literature concerning multidimensional adolescent risk screening instruments available in the United States for use in the primary care setting, library searches, ancestry searches, and Internet searches were conducted. Library searches included a systematic search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier, Health Source Nursing Academic Ed, Medline, PsycINFO, the Psychology and Behavioral Sciences Collection, and PubMed databases with CINAHL headings using the following Boolean search terms: "primary care" and screening and pediatric. Criteria for inclusion consisted of studies conducted in the United States that involved broad multidimensional adolescent risk screening instruments for use in the pediatric primary care setting. Instruments that focused solely on one unhealthy behavior were excluded, as were developmental screens and screens not validated or designed for all ages of adolescents. In all 25 manuscripts reviewed, 16 screens met the inclusion criteria and were included in the study. These 16 screens were examined for factors associated with the Donabedian structure-process-outcome model. This review revealed that many screens contain structural issues related to cost and length that inhibit provider implementation in the primary care setting. Process limitations regarding the report method and administration format were also identified. The Pediatric Symptom Checklist was identified as a free, short tool that is valid and reliable.

Cost-effectiveness of cervical cancer screening with primary human papillomavirus testing in Norway

PubMed Central

Burger, E A; Ortendahl, J D; Sy, S; Kristiansen, I S; Kim, J J

2012-01-01

Background: New screening technologies and vaccination against human papillomavirus (HPV), the necessary cause of cervical cancer, may impact optimal approaches to prevent cervical cancer. We evaluated the cost-effectiveness of alternative screening strategies to inform cervical cancer prevention guidelines in Norway. Methods: We leveraged the primary epidemiologic and economic data from Norway to contextualise a simulation model of HPV-induced cervical cancer. The current cytology-only screening was compared with strategies involving cytology at younger ages and primary HPV-based screening at older ages (31/34+ years), an option being actively deliberated by the Norwegian government. We varied the switch-age, screening interval, and triage strategies for women with HPV-positive results. Uncertainty was evaluated in sensitivity analysis. Results: Current cytology-only screening was less effective and more costly than strategies that involve switching to primary HPV testing in older ages. For unvaccinated women, switching at age 34 years to primary HPV testing every 4 years was optimal given the Norwegian cost-effectiveness threshold ($83 000 per year of life saved). For vaccinated women, a 6-year screening interval was cost-effective. When we considered a wider range of strategies, we found that an earlier switch to HPV testing (at age 31 years) may be preferred. Conclusions: Strategies involving a switch to HPV testing for primary screening in older women is expected to be cost-effective compared with current recommendations in Norway. PMID:22441643

Development of Modal Aerosol Module in CAM5 for Biogeochemical Cycles

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Xiaohong

2017-11-18

This project aims at developing new capabilities for the Modal Aerosol Module in the DOE’s E3SM model with the applications to the global biogeochemical cycle. The impacts of the new developments on model simulations of clouds and climate will be examined. There are thee objectives for this project study: Implementing primary marine organic aerosols into the modal aerosol module (MAM) and investigate effects of primary marine organic aerosols on climate in E3SM; Implementing dust speciation in MAM and investigate the effect of dust species on mixed-phase clouds through indirect effects in E3SM; Writing papers documenting the new MAM developments (e.g.,more » MAM4 documentation paper, marine organic aerosol paper, dust speciation); These objectives will be accomplished in collaborations with Drs. Phil Rasch, Steve Ghan, and Susannah Burrows at Pacific Northwest National Laboratory.« less

More comprehensive discussion of CRC screening associated with higher screening.

PubMed

Mosen, David M; Feldstein, Adrianne C; Perrin, Nancy A; Rosales, A Gabriella; Smith, David H; Liles, Elizabeth G; Schneider, Jennifer L; Meyers, Ronald E; Elston-Lafata, Jennifer

2013-04-01

Examine association of comprehensiveness of colorectal cancer (CRC) screening discussion by primary care physicians (PCPs) with completion of CRC screening. Observational study in Kaiser Permanente Northwest, a group-model health maintenance organization. A total of 883 participants overdue for CRC screening received an automated telephone call (ATC) between April and June 2009 encouraging CRC screening. Between January and March 2010, participants completed a survey on PCPs' discussion of CRC screening and patient beliefs regarding screening. receipt of CRC screening (assessed by electronic medical record [EMR], 9 months after ATC). Primary independent variable: comprehensiveness of CRC screening discussion by PCPs (7-item scale). Secondary independent variables: perceived benefits of screening (4-item scale assessing respondents' agreement with benefits of timely screening) and primary care utilization (EMR; 9 months after ATC). The independent association of variables with CRC screening was assessed with logistic regression. Average scores for comprehensiveness of CRC discussion and perceived benefits were 0.4 (range 0-1) and 4.0 (range 1-5), respectively. A total of 28.2% (n = 249) completed screening, 84% of whom had survey assessments after their screening date. Of screeners, 95.2% completed the fecal immunochemical test. More comprehensive discussion of CRC screening was associated with increased screening (odds ratio [OR] = 1.51, 95% confidence interval [CI] = 1.03-2.21). Higher perceived benefits (OR = 1.46, 95% CI = 1.13-1.90) and 1 or more PCP visits (OR = 5.82, 95% CI = 3.87-8.74) were also associated with increased screening. More comprehensive discussion of CRC screening was independently associated with increased CRC screening. Primary care utilization was even more strongly associated with CRC screening, irrespective of discussion of CRC screening.

Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Screening (PDQ®)—Patient Version

Cancer.gov

Ovarian, fallopian tube, or primary peritoneal cancer screening has not been shown to reduce the chance of dying from these cancers. Not all screening tests are helpful, and many have risks. Learn more the potential benefits and harms of screening in this expert-reviewed summary.

An analysis of hearing screening test results in 2291 premature infants of Chinese population.

PubMed

Huang, Lili; Xiong, Fei; Li, Jinrong; Yang, Fan

2017-04-01

The aim of this study was to analyze the hearing screening program among preterm infants as well as to identify risk factors associated with failing primary newborn hearing screening. The retrospectively selected population included all preterm infants who had primary hearing screening in a neonatal ward from January 1st, 2013 to December 31st, 2015 at West China Second University Hospital, Sichuan University. The newborn hearing screening (NHS) procedure was performed in all preterm infants by automated auditory brainstem response (AABR). Infants who failed the primary hearing screening received a second screening at 42 days after birth. Infants who failed both tests were referred to a tertiary audiology center for diagnostic confirmation and management before 6 months of age. The final diagnosis for referred infants was obtained by telephone follow-up. The risk factors associated with failure to pass the primary hearing screen were evaluated and analyzed for preterm infants. Among 2291 preterm infants recruited, 155 infants (6.8%) failed the primary hearing screening with an abnormal AABR. Of these 155 infants, 113 (72.9%) passed the secondary screening. At the end of the follow-up, 1 infant (0.04%) was diagnosed with hearing loss, 3 infants had delayed language development, and 40 infants were lost to follow up. Multivariate regression analysis revealed that gestational age ≤32 weeks (Odds ratio [OR] = 2.093, 95% confidence interval [CI] 1.370-3.196), super hyperbilirubinemia (≥25 mg/dl) (OR = 3.560, 95% CI 1.009-12.560), and respiratory failure (OR = 1.971, 95% CI 1.188-3.265) were associated with failure to pass newborn hearing screening. The prevalence of failure to pass primary hearing screening among preterm infants was 6.8% in our study, and we found a relatively low prevalence of hearing loss (0.04%). Super hyperbilirubinemia, gestational age ≤32weeks, and respiratory failure were risk factors associated with failure of preterm infants to pass the primary hearing screening. Our results suggest that preterm infants with hyperbilirubinemia, gestational age ≤32 weeks, and respiratory failure should be closely followed. Copyright © 2017 Elsevier B.V. All rights reserved.

SCREENING FOR PTSD AMONG INCARCERATED MEN

PubMed Central

WOLFF, NANCY; GREGORY CHUGO, M; SHI, JING; HUENING, JESSICA; FRUEH, B. CHRISTOPHER

2014-01-01

Trauma exposure is overrepresented in incarcerated male populations and is linked to psychiatric morbidity, particularly posttraumatic stress disorder (PTSD). This study tests the feasibility, reliability, and validity of using computer-administered interviewing (CAI) versus orally administered interviewing (OAI) to screen for PTSD among incarcerated men. A 2 × 2 factorial design was used to randomly assign 592 incarcerated men to screening modality. Findings indicate that computer screening was feasible. Compared with OAI, CAI produced equally reliable screening information on PTSD symptoms, with test–retest intraclass correlations for the PTSD Checklist (PCL) total score ranging from .774 to .817, and the Clinician-Administered PTSD scale and PCL scores were significantly correlated for OAI and CAI. These findings indicate that data on PTSD symptoms can be reliably and validly obtained from CAI technology, increasing the efficiency by which incarcerated populations can be screened for PTSD, and those at risk can be identified for treatment. PMID:25673900

Novel minimally invasive multi-modality monitoring modalities in neurocritical care.

PubMed

Al-Mufti, Fawaz; Smith, Brendan; Lander, Megan; Damodara, Nitesh; Nuoman, Rolla; El-Ghanem, Mohammad; Kamal, Naveed; Al-Marsoummi, Sarmad; Alzubaidi, Basim; Nuoaman, Halla; Foreman, Brandon; Amuluru, Krishna; Gandhi, Chirag D

2018-07-15

Elevated intracranial pressure (ICP) following brain injury contributes to poor outcomes for patients, primarily by reducing the caliber of cerebral vasculature, and thereby reducing cerebral blood flow. Careful monitoring of ICP is critical in these patients in order to determine prognosis, implement treatment when ICP becomes elevated, and to judge responsiveness to treatment. Currently, the gold standard for monitoring is invasive pressure transducers, usually an intraventricular monitor, which presents significant risk of infection and hemorrhage. These risks made discovering non-invasive methods for monitoring ICP and cerebral perfusion a priority for researchers. Herein we sought to review recent publications on novel minimally invasive multi-modality monitoring techniques that provide surrogate data on ICP, cerebral oxygenation, metabolism and blood flow. While limitations in various forms preclude them from supplanting the use of invasive monitors, these modalities represent useful screening tools within our armamentarium that may be invaluable when the risks of invasive monitoring outweigh the associated benefits. Copyright © 2018 Elsevier B.V. All rights reserved.

Potential usefulness of apolipoprotein A2 isoforms for screening and risk stratification of pancreatic cancer

PubMed Central

Honda, Kazufumi; Srivastava, Sudhir

2016-01-01

Given the low incidence of pancreatic cancer in the general population, screening of pancreatic cancer in the general population using invasive modalities is not feasible. Combination of invasive screening with noninvasive biomarkers for pancreatic cancer and its precancerous lesions has the potential to reduce mortality due to pancreatic cancer. In this review, we focus on biomarkers found in the blood that can indicate early-stage pancreatic cancer, and we discuss current strategies for screening for pancreatic cancer. We recently identified a unique alteration in apolipoprotein A2 isoforms in pancreatic cancer and its precancerous lesions, and we describe its clinical usefulness as a potential biomarker for the early detection and risk stratification of pancreatic cancer. PMID:27673558

Tracking Organs Composed of One or Multiple Regions Using Geodesic Active Region Models

NASA Astrophysics Data System (ADS)

Martínez, A.; Jiménez, J. J.

In radiotherapy treatment it is very important to find out the target organs on the medical image sequence in order to determine and apply the proper dose. The techniques to achieve this goal can be classified into extrinsic and intrinsic. Intrinsic techniques only use image processing with medical images associated to the radiotherapy Radiotherapy treatment, as we deal in this chapter. To accurately perform this organ tracking it is necessary to find out segmentation and tracking models that were able to be applied to several image modalities involved on a radiotherapy session (CT CT See Modality , MRI Magnetic resoance imaging , etc.). The movements of the organs are mainly affected by two factors: breathing and involuntary movements associated with the internal organs or patient positioning. Among the several alternatives to track the organs of interest, a model based on geodesic active regions is proposed. This model has been tested over CT Computed tomography images from the pelvic, cardiac, and thoracic area. A new model for the segmentation of organs composed by more than one region is proposed.

Assessing the Future.

ERIC Educational Resources Information Center

Berger, Allen

A review of the past, the present, and the future offers an enlightening view of literacy in America. A 1967 issue of the "Illinois Journal of Education" has articles on phonics, linguistics, spelling, modalities of learning, disadvantaged children, vision screening and vision training, readiness, Montessori, partnerships between…

Primary care practice organization influences colorectal cancer screening performance.

PubMed

Yano, Elizabeth M; Soban, Lynn M; Parkerton, Patricia H; Etzioni, David A

2007-06-01

To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors. Primary care director survey (1999-2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001). Practices were characterized by degrees of centralization (e.g., authority over operations, staffing, outside-practice influence); resources (e.g., sufficiency of nonphysician staffing, space, clinical support arrangements); and complexity (e.g., facility size, academic status, managed care penetration), adjusting for patient-level covariates and contextual factors. Chart-based evidence of CRC screening through direct colonoscopy, sigmoidoscopy, or consecutive fecal occult blood tests, eliminating cases with documented histories of CRC, polyps, or inflammatory bowel disease. After adjusting for sociodemographic characteristics and health care utilization, patients were significantly more likely to be screened for CRC if their primary care practices had greater autonomy over the internal structure of care delivery (p<.04), more clinical support arrangements (p<.03), and smaller size (p<.001). Deficits in primary care clinical support arrangements and local autonomy over operational management and referral procedures are associated with significantly lower CRC screening performance. Competition with hospital resource demands may impinge on the degree of internal organization of their affiliated primary care practices.

Using Entertainment-Education to Promote Cervical Cancer Screening in Thai Women

PubMed Central

Love, Gail D.; Tanjasiri, Sora Park

2015-01-01

Southeast Asian women in California have high cervical cancer incidence and mortality rates, but low levels of Pap screening. No published reports have addressed screening among Thai women. Entertainment-education (EE) is a useful strategy for low-literacy, culturally diverse populations. This quasi-experimental study determined whether a soap-opera-themed, Thai-language EE video was superior to a print handout for increasing knowledge, attitudes, and behavioral intention toward Pap testing. No uniform differences were found between the intervention group (video) and the control group (brochure). Both educational modalities appeared to result in selected increases in knowledge and attitudes. PMID:22581487

Screening and Biosensor-Based Approaches for Lung Cancer Detection

PubMed Central

Wang, Lulu

2017-01-01

Early diagnosis of lung cancer helps to reduce the cancer death rate significantly. Over the years, investigators worldwide have extensively investigated many screening modalities for lung cancer detection, including computerized tomography, chest X-ray, positron emission tomography, sputum cytology, magnetic resonance imaging and biopsy. However, these techniques are not suitable for patients with other pathologies. Developing a rapid and sensitive technique for early diagnosis of lung cancer is urgently needed. Biosensor-based techniques have been recently recommended as a rapid and cost-effective tool for early diagnosis of lung tumor markers. This paper reviews the recent development in screening and biosensor-based techniques for early lung cancer detection. PMID:29065541

Use of complementary and alternative medicine by a sample of Turkish primary headache patients.

PubMed

Karakurum Göksel, Başak; Coşkun, Özlem; Ucler, Serap; Karatas, Mehmet; Ozge, Aynur; Ozkan, Secil

2014-01-01

Complementary and alternative medicine (CAM) is increasingly being used as adjunctive treatment in primary headache syndromes in many countries. In the Turkish population, no epidemiologic data have been reported about awareness and usage of these treatments in patients with headache. One hundred and ten primary headache patients attending three headache clinics completed a questionnaire regarding their headaches, the known modalities and the use and effect of CAM procedures for their headaches. The mean age of the patients was 34.7±9.6 years (32.8-36.5). Almost two-thirds of patients had completed high school and university, and one-third of patients were housewives. Migraine without aura (45.5%) was the most frequently diagnosed type of headache followed by migraine with aura (19.1%) and tension-type headache (18.2%). In 43.6% of the patients, headache frequency was 5-10 per month. The most frequently known CAM modalities were massage (74.5%), acupuncture (44.5%), yoga (31.8%), exercise (28.2%), psychotherapy (25.5%), and rosemary (23.6%). The most frequently used CAM treatments were massage (51%) and exercise (11%). Only massage was reported to be beneficial in one-third of the primary headache patients; the other modalities were not. Our findings suggest that the subgroup of primary headache patients in Turkey seek and use alternative treatments, frequently in combination with standard treatments. Neurologists should become more knowledgeable regarding CAM therapies; further randomized and controlled clinical researches with large sample sizes are needed.

Prevalence of high-risk human papillomavirus among women in two English-speaking Caribbean countries.

PubMed

Andall-Brereton, Glennis; Brown, Eulynis; Slater, Sherian; Holder, Yvette; Luciani, Silvana; Lewis, Merle; Irons, Beryl

2017-06-08

To characterize high-risk human papillomavirus (HPV) infections in a sample of women in two small English-speaking Caribbean countries: Saint Kitts and Nevis and Saint Vincent and the Grenadines. Sexually active women ≥ 30 years old attending primary care health facilities participated in the study. Each participant had a gynecological examination, and two cervical specimens were collected: (1) a specimen for a Papanicolaou (Pap) test and (2) a sample of exfoliated cervical cells for HPV DNA testing, using the HPV High Risk Screen Real-TM (Sacace). High-risk HPV genotypes were assessed in 404 women in Saint Kitts and Nevis and 368 women in Saint Vincent and the Grenadines. High-risk HPV was detected in 102 of 404 (25.2%) in Saint Kitts and Nevis and in 109 of 368 (29.6%) in Saint Vincent and the Grenadines. High-risk HPV genotypes 52, 35, 51, 45, and 31 were the most common high-risk types in Saint Kitts and Nevis. In Saint Vincent and the Grenadines, the most common high-risk HPV genotypes were 45, 35, 31, 18, and 51. Current age was found to be significantly associated with high-risk HPV infection in both countries. In addition, in Saint Vincent and the Grenadines, high parity (> 3 pregnancies) and having had an abnormal Pap smear were found to be independent risk factors for high-risk HPV. These results contribute to the evidence on HPV prevalence for small island states of the Caribbean and support the accelerated introduction of the 9-valent HPV vaccine in the two countries and elsewhere in the English-speaking Caribbean. Use of the study's results to guide the development of policy regarding implementation of HPV testing as the primary screening modality for older women is recommended.

Alerts in electronic medical records to promote a colorectal cancer screening programme: a cluster randomised controlled trial in primary care

PubMed Central

Guiriguet, Carolina; Muñoz-Ortiz, Laura; Burón, Andrea; Rivero, Irene; Grau, Jaume; Vela-Vallespín, Carmen; Vilarrubí, Mercedes; Torres, Miquel; Hernández, Cristina; Méndez-Boo, Leonardo; Toràn, Pere; Caballeria, Llorenç; Macià, Francesc; Castells, Antoni

2016-01-01

Background Participation rates in colorectal cancer screening are below recommended European targets. Aim To evaluate the effectiveness of an alert in primary care electronic medical records (EMRs) to increase individuals’ participation in an organised, population-based colorectal cancer screening programme when compared with usual care. Design and setting Cluster randomised controlled trial in primary care centres of Barcelona, Spain. Method Participants were males and females aged 50–69 years, who were invited to the first round of a screening programme based on the faecal immunochemical test (FIT) (n = 41 042), and their primary care professional. The randomisation unit was the physician cluster (n = 130) and patients were blinded to the study group. The control group followed usual care as per the colorectal cancer screening programme. In the intervention group, as well as usual care, an alert to health professionals (cluster level) to promote screening was introduced in the individual’s primary care EMR for 1 year. The main outcome was colorectal cancer screening participation at individual participant level. Results In total, 67 physicians and 21 619 patients (intervention group) and 63 physicians and 19 423 patients (control group) were randomised. In the intention-to-treat analysis screening participation was 44.1% and 42.2% respectively (odds ratio 1.08, 95% confidence interval [CI] = 0.97 to 1.20, P = 0.146). However, in the per-protocol analysis screening uptake in the intervention group showed a statistically significant increase, after adjusting for potential confounders (OR, 1.11; 95% CI = 1.02 to 1.22; P = 0.018). Conclusion The use of an alert in an individual’s primary care EMR is associated with a statistically significant increased uptake of an organised, FIT-based colorectal cancer screening programme in patients attending primary care centres. PMID:27266861

Postpartum two- and three-dimensional ultrasound evaluation of anal sphincter complex in women with obstetric anal sphincter injury.

PubMed

Ros, C; Martínez-Franco, E; Wozniak, M M; Cassado, J; Santoro, G A; Elías, N; López, M; Palacio, M; Wieczorek, A P; Espuña-Pons, M

2017-04-01

To compare the sensitivity and specificity of two- (2D) and three- (3D) dimensional transperineal ultrasound (TPUS) and 3D endovaginal ultrasound (EVUS) with the gold standard 3D endoanal ultrasound (EAUS) in detecting residual defects after primary repair of obstetric anal sphincter injuries (OASIS). External (EAS) and internal (IAS) anal sphincters were evaluated by the four ultrasound modalities in women with repaired OASIS. 2D-TPUS was evaluated in real-time, whereas 3D-TPUS, 3D-EVUS and 3D-EAUS volumes were evaluated offline by six blinded readers. The presence/absence of any tear in EAS or IAS was recorded and defects were scored according to the Starck system. Sensitivity, specificity and predictive values were calculated, using 3D-EAUS as reference standard. Inter- and intraobserver analyses were performed for all 3D imaging modalities. Association between patients' symptoms (Wexner score) and ultrasound findings (Starck score) was calculated. Images from 55 patients were analyzed. Compared with findings on 3D-EAUS, the agreement for EAS evaluation was poor for 3D-EVUS (κ = 0.01), fair for 2D-TPUS (κ = 0.30) and good for 3D-TPUS (κ = 0.73). The agreement for IAS evaluation was moderate for both 3D-EVUS (κ = 0.41) and 2D-TPUS (κ = 0.52) and good for 3D-TPUS (κ = 0.66). Good intraobserver (3D-EAUS, κ = 0.73; 3D-TPUS, κ = 0.78) and interobserver (3D-EAUS, κ = 0.68; 3D-TPUS, κ = 0.60) agreement was reported. Significant association between Starck and Wexner scores was found only for 3D-EAUS (Spearman's rho = 0.277, P = 0.04). 2D-TPUS and 3D-EVUS are not accurate modalities for the assessment of anal sphincters after repair of OASIS. 3D-TPUS shows good agreement with the gold standard 3D-EAUS and a high sensitivity in detecting residual defects. It, thus, has potential as a screening tool after primary repair of OASIS. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance.

PubMed

Huh, Warner K; Ault, Kevin A; Chelmow, David; Davey, Diane D; Goulart, Robert A; Garcia, Francisco A R; Kinney, Walter K; Massad, L Stewart; Mayeaux, Edward J; Saslow, Debbie; Schiffman, Mark; Wentzensen, Nicolas; Lawson, Herschel W; Einstein, Mark H

2015-02-01

In 2011, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology updated screening guidelines for the early detection of cervical cancer and its precursors. Recommended screening strategies were cytology and cotesting (cytology in combination with hrHPV testing). These guidelines also addressed the use of hrHPV testing alone as a primary screening approach, which was not recommended for use at that time. There is now a growing body of evidence for screening with primary hrHPV testing, including a prospective US-based registration study. Thirteen experts including representatives from the Society of Gynecologic Oncology, American Society for Colposcopy and Cervical Pathology, American College of Obstetricians and Gynecologists, American Cancer Society, American Society of Cytopathology, College of American Pathologists, and the American Society for Clinical Pathology, convened to provide interim guidance for primary hrHPV screening. This guidance panel was specifically triggered by an application to the FDA for a currently marketed HPV test to be labeled for the additional indication of primary cervical cancer screening. Guidance was based on literature review and review of data from the FDA registration study, supplemented by expert opinion. This document aims to provide information for healthcare providers who are interested in primary hrHPV testing and an overview of the potential advantages and disadvantages of this strategy for screening as well as to highlight areas in need of further investigation. Copyright © 2015 Elsevier Inc. All rights reserved.

About CIB | Division of Cancer Prevention

Cancer.gov

The Consortium was created to improve cancer screening, early detection of aggressive cancer, assessment of cancer risk and cancer diagnosis aimed at integrating multi-modality imaging strategies and multiplexed biomarker methodologies into a singular complementary approach. Investigator perform collaborative studies, exchange information, share knowledge and leverage common

Sacral root neuromodulation in the treatment of various voiding and storage problems.

PubMed

Shaker, H; Hassouna, M M

1999-01-01

This paper reviews the use of sacral neuromodulation as a treatment modality for patients with bladder dysfunction. The dual functions of the urinary bladder are to act as a reservoir and to evacuate under voluntary control. Bladder dysfunction is a descriptive term describing the loss or the impairment of one or both of these functions. In the first part of the manuscript we describe the different components of sacral neuromodulation: the screening test known as percutaneous nerve evaluation (PNE), which involves screening patients who could potentially benefit from the therapy. Those who show a satisfactory response will have a permanent neuroprosthesis implanted. The technical aspects of both components of neuromodulation are described in detail, as well as the technical difficulties encountered. In the second part we present our long-term results in patients with sacral neuromodulation. Sacral neuromodulation is a safe and efficient therapeutic modality that helps patients with refractory voiding dysfunction restore their bladder function.

Online advertising by three commercial breast imaging services: message takeout and effectiveness.

PubMed

Johnson, Rebecca; Jalleh, Geoffrey; Pratt, Iain S; Donovan, Robert J; Lin, Chad; Saunders, Christobel; Slevin, Terry

2013-10-01

Mammography is widely acknowledged to be the most cost-effective technique for population screening for breast cancer. Recently in Australia, imaging modalities other than mammography, including thermography, electrical impedance, and computerised breast imaging, have been increasingly promoted as alternative methods of breast cancer screening. This study assessed the impact of three commercial breast imaging companies' promotional material upon consumers' beliefs about the effectiveness of the companies' technology in detecting breast cancer, and consumers' intentions to seek more information or consider having their breasts imaged by these modalities. Results showed 90% of respondents agreed that the companies' promotional material promoted the message that the advertised breast imaging method was effective in detecting breast cancer, and 80% agreed that the material promoted the message that the imaging method was equally or more effective than a mammogram. These findings have implications for women's preference for and uptake of alternative breast imaging services over mammography. Copyright © 2013 Elsevier Ltd. All rights reserved.

Combining in Vitro Diagnostics with in Vivo Imaging for Earlier Detection of Pancreatic Ductal Adenocarcinoma: Challenges and Solutions

PubMed Central

Laeseke, Paul F.; Chen, Ru; Jeffrey, R. Brooke; Brentnall, Teresa A.

2015-01-01

Pancreatic ductal adenocarcinoma (PDAC) is the fourth-leading cause of cancer-related death in the United States and is associated with a dismal prognosis, particularly when diagnosed at an advanced stage. Overall survival is significantly improved if PDAC is detected at an early stage prior to the onset of symptoms. At present, there is no suitable screening strategy for the general population. Available diagnostic serum markers are not sensitive or specific enough, and clinically available imaging modalities are inadequate for visualizing early-stage lesions. In this article, the role of currently available blood biomarkers and imaging tests for the early detection of PDAC will be reviewed. Also, the emerging biomarkers and molecularly targeted imaging agents being developed to improve the specificity of current imaging modalities for PDAC will be discussed. A strategy incorporating blood biomarkers and molecularly targeted imaging agents could lead to improved screening and earlier detection of PDAC in the future. © RSNA, 2015 PMID:26599925

Kiosk versus In-person Screening for Alcohol and Drug Use in the Emergency Department: Patient Preferences and Disclosure

PubMed Central

Hankin, Abigail; Haley, Leon; Baugher, Amy; Colbert, Kia; Houry, Debra

2015-01-01

Introduction Annually eight million emergency department (ED) visits are attributable to alcohol use. Screening ED patients for at-risk alcohol and substance use is an integral component of screening, brief intervention, and referral to treatment programs, shown to be effective at reducing substance use. The objective is to evaluate ED patients’ acceptance of and willingness to disclose alcohol/substance use via a computer kiosk versus an in-person interview. Methods This was a cross-sectional, survey-based study. Eligible participants included those who presented to walk-in triage, were English-speaking, ≥18 years, were clinically stable and able to consent. Patients had the opportunity to access the kiosk in the ED waiting room, and were approached for an in-person survey by a research assistant (9am–5pm weekdays). Both surveys used validated assessment tools to assess drug and alcohol use. Disclosure statistics and preferences were calculated using chi-square tests and McNemar’s test. Results A total of 1,207 patients were screened: 229 in person only, 824 by kiosk, and 154 by both in person and kiosk. Single-modality participants were more likely to disclose hazardous drinking (p=0.003) and high-risk drug use (OR=22.3 [12.3–42.2]; p<0.0001) via kiosk. Participants who had participated in screening via both modalities were more likely to reveal high-risk drug use on the kiosk (p=0.003). When asked about screening preferences, 73.6% reported a preference for an in-person survey, which patients rated higher on privacy and comfort. Conclusion ED patients were significantly more likely to disclose at-risk alcohol and substance use to a computer kiosk than an interviewer. Paradoxically patients stated a preference for in-person screening, despite reduced disclosure to a human screener. PMID:25834660

Increasing the Elective Endovascular to Open Repair Ratio of Popliteal Artery Aneurysm.

PubMed

Wrede, Axel; Wiberg, Frans; Acosta, Stefan

2018-02-01

Open repair (OR) for popliteal artery aneurysm (PAA) has recently been challenged by endovascular repair (ER) as the primary choice of treatment. The aim of the present study was to evaluate time trends in treatment modality and compare outcomes between OR and ER among electively operated patients after start of screening in 2010 for abdominal aortic aneurysm (AAA), a disease highly associated with PAA. Between January 1, 2009, and April 30, 2017, 102 procedures and 36 acute and 66 elective repairs for PAA were identified. Over time, a trend ( P = .089) for an increasing elective to acute repair ratio of PAA and an increase in elective ER to OR ratio ( P = .003) was found. Among electively repaired PAAs, the ER group was older ( P = .047) and had a higher ankle-brachial index (ABI; P = .044). The ER group had fewer wound infections ( P = .003), fewer major bleeding complications ( P = .046), and shorter in-hospital stay ( P < .001). After 1 year of follow-up, the ER group had a higher rate of major amputations ( P = .037). Amputation-free survival at the end of follow-up did not differ between groups ( P = .68). Among the 17 patients with PAA eligible for AAA screening, 4 (24%) were diagnosed with PAA through the screening program of AAA. The epidemiology of elective repair of PAA has changed toward increased ER, although ER showed a higher rate of major amputations at 1 year. Confounding was considerable and a randomized trial is needed for evaluation of the best therapeutic option.

When Do Pictures Help Learning from Expository Text? Multimedia and Modality Effects in Primary Schools

ERIC Educational Resources Information Center

Herrlinger, Simone; Höffler, Tim N.; Opfermann, Maria; Leutner, Detlev

2017-01-01

Adding pictures to a text is very common in today's education and might be especially beneficial for elementary school children, whose abilities to read and understand pure text have not yet been fully developed. Our study examined whether adding pictures supports learning of a biology text in fourth grade and whether the text modality (spoken or…

Multi-Modal Surrogates for Retrieving and Making Sense of Videos: Is Synchronization between the Multiple Modalities Optimal?

ERIC Educational Resources Information Center

Song, Yaxiao

2010-01-01

Video surrogates can help people quickly make sense of the content of a video before downloading or seeking more detailed information. Visual and audio features of a video are primary information carriers and might become important components of video retrieval and video sense-making. In the past decades, most research and development efforts on…

Contemporary Management of Primary Distal Urethral Cancer.

PubMed

Traboulsi, Samer L; Witjes, Johannes Alfred; Kassouf, Wassim

2016-11-01

Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function. Copyright © 2016 Elsevier Inc. All rights reserved.

Audiovisual Modulation in Mouse Primary Visual Cortex Depends on Cross-Modal Stimulus Configuration and Congruency.

PubMed

Meijer, Guido T; Montijn, Jorrit S; Pennartz, Cyriel M A; Lansink, Carien S

2017-09-06

The sensory neocortex is a highly connected associative network that integrates information from multiple senses, even at the level of the primary sensory areas. Although a growing body of empirical evidence supports this view, the neural mechanisms of cross-modal integration in primary sensory areas, such as the primary visual cortex (V1), are still largely unknown. Using two-photon calcium imaging in awake mice, we show that the encoding of audiovisual stimuli in V1 neuronal populations is highly dependent on the features of the stimulus constituents. When the visual and auditory stimulus features were modulated at the same rate (i.e., temporally congruent), neurons responded with either an enhancement or suppression compared with unisensory visual stimuli, and their prevalence was balanced. Temporally incongruent tones or white-noise bursts included in audiovisual stimulus pairs resulted in predominant response suppression across the neuronal population. Visual contrast did not influence multisensory processing when the audiovisual stimulus pairs were congruent; however, when white-noise bursts were used, neurons generally showed response suppression when the visual stimulus contrast was high whereas this effect was absent when the visual contrast was low. Furthermore, a small fraction of V1 neurons, predominantly those located near the lateral border of V1, responded to sound alone. These results show that V1 is involved in the encoding of cross-modal interactions in a more versatile way than previously thought. SIGNIFICANCE STATEMENT The neural substrate of cross-modal integration is not limited to specialized cortical association areas but extends to primary sensory areas. Using two-photon imaging of large groups of neurons, we show that multisensory modulation of V1 populations is strongly determined by the individual and shared features of cross-modal stimulus constituents, such as contrast, frequency, congruency, and temporal structure. Congruent audiovisual stimulation resulted in a balanced pattern of response enhancement and suppression compared with unisensory visual stimuli, whereas incongruent or dissimilar stimuli at full contrast gave rise to a population dominated by response-suppressing neurons. Our results indicate that V1 dynamically integrates nonvisual sources of information while still attributing most of its resources to coding visual information. Copyright © 2017 the authors 0270-6474/17/378783-14$15.00/0.

Changes of the directional brain networks related with brain plasticity in patients with long-term unilateral sensorineural hearing loss.

PubMed

Zhang, G-Y; Yang, M; Liu, B; Huang, Z-C; Li, J; Chen, J-Y; Chen, H; Zhang, P-P; Liu, L-J; Wang, J; Teng, G-J

2016-01-28

Previous studies often report that early auditory deprivation or congenital deafness contributes to cross-modal reorganization in the auditory-deprived cortex, and this cross-modal reorganization limits clinical benefit from cochlear prosthetics. However, there are inconsistencies among study results on cortical reorganization in those subjects with long-term unilateral sensorineural hearing loss (USNHL). It is also unclear whether there exists a similar cross-modal plasticity of the auditory cortex for acquired monaural deafness and early or congenital deafness. To address this issue, we constructed the directional brain functional networks based on entropy connectivity of resting-state functional MRI and researched changes of the networks. Thirty-four long-term USNHL individuals and seventeen normally hearing individuals participated in the test, and all USNHL patients had acquired deafness. We found that certain brain regions of the sensorimotor and visual networks presented enhanced synchronous output entropy connectivity with the left primary auditory cortex in the left long-term USNHL individuals as compared with normally hearing individuals. Especially, the left USNHL showed more significant changes of entropy connectivity than the right USNHL. No significant plastic changes were observed in the right USNHL. Our results indicate that the left primary auditory cortex (non-auditory-deprived cortex) in patients with left USNHL has been reorganized by visual and sensorimotor modalities through cross-modal plasticity. Furthermore, the cross-modal reorganization also alters the directional brain functional networks. The auditory deprivation from the left or right side generates different influences on the human brain. Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.

Alignment of breast cancer screening guidelines, accountability metrics, and practice patterns.

PubMed

Onega, Tracy; Haas, Jennifer S; Bitton, Asaf; Brackett, Charles; Weiss, Julie; Goodrich, Martha; Harris, Kimberly; Pyle, Steve; Tosteson, Anna N A

2017-01-01

Breast cancer screening guidelines and metrics are inconsistent with each other and may differ from breast screening practice patterns in primary care. This study measured breast cancer screening practice patterns in relation to common evidence-based guidelines and accountability metrics. Cohort study using primary data collected from a regional breast cancer screening research network between 2011 and 2014. Using information on women aged 30 to 89 years within 21 primary care practices of 2 large integrated health systems in New England, we measured the proportion of women screened overall and by age using 2 screening definition categories: any mammogram and screening mammogram. Of the 81,352 women in our cohort, 54,903 (67.5%) had at least 1 mammogram during the time period, 48,314 (59.4%) had a screening mammogram. Women aged 50 to 69 years were the highest proportion screened (82.4% any mammogram, 75% screening indication); 72.6% of women at age 40 had a screening mammogram with a median of 70% (range = 54.3%-84.8%) among the practices. Of women aged at least 75 years, 63.3% had a screening mammogram, with the median of 63.9% (range = 37.2%-78.3%) among the practices. Of women who had 2 or more mammograms, 79.5% were screened annually. Primary care practice patterns for breast cancer screening are not well aligned with some evidence-based guidelines and accountability metrics. Metrics and incentives should be designed with more uniformity and should also include shared decision making when the evidence does not clearly support one single conclusion.

[Screening for bipolar disorder in primary care patients with psychological symptoms].

PubMed

Aragonès, Enric; López-Rodríguez, Juan A; Escobar-Rabadán, Francisco; Téllez-Lapeira, Juan; Mínguez, José; Párraga, Ignacio; Suárez-Hernández, Tatiana; Piñero, María José; Guzón, Marta-Magdalena

2015-03-01

To estimate the proportion of positive results in the screening of bipolar disorder (BD) among primary care patients presenting with psychological symptoms, and to analyze their characteristics. Multicenter cross-sectional study. Nineteen Primary Care clinics in different Spanish regions. A total of 360 consecutive primary care patients aged 18 to 70, presenting with psychological symptoms. Screening for BP was performed by means of the Mood Disorders Questionnaire. Data on quality of life (EuroQol-5D) and functional impairment (Sheehan Disability Inventory) were obtained. Data on psychiatric comorbidity and data on the use of psychotropic medication were acquired by review of medical records. Of the patients screened, 11.9% were positive (95%CI: 8.8%-15.7%). Only two patients had a diagnosis of BP in their clinical records and, although more than half received treatment with antidepressants, only two received treatment with mood stabilizers. Positive screening is associated with work, social and family dysfunction, greater perceived stress and poor quality of life. BD screening in primary care patients with psychological problems leads to a striking proportion of positive results, indicating that there may be a significant prevalence of BP patients, most of them undiagnosed and untreated. Further research is needed to determine the role that Primary Care can or should assume in the screening, diagnosis and management of this disorder. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Anal cancer and intraepithelial neoplasia screening: A review

PubMed Central

Leeds, Ira L; Fang, Sandy H

2016-01-01

This review focuses on the early diagnosis of anal cancer and its precursor lesions through routine screening. A number of risk-stratification strategies as well as screening techniques have been suggested, and currently little consensus exists among national societies. Much of the current clinical rationale for the prevention of anal cancer derives from the similar tumor biology of cervical cancer and the successful use of routine screening to identify cervical cancer and its precursors early in the disease process. It is thought that such a strategy of identifying early anal intraepithelial neoplasia will reduce the incidence of invasive anal cancer. The low prevalence of anal cancer in the general population prevents the use of routine screening. However, routine screening of selected populations has been shown to be a more promising strategy. Potential screening modalities include digital anorectal exam, anal Papanicolaou testing, human papilloma virus co-testing, and high-resolution anoscopy. Additional research associating high-grade dysplasia treatment with anal cancer prevention as well as direct comparisons of screening regimens is necessary to develop further anal cancer screening recommendations. PMID:26843912

Orbitofacial Metastatic Basal Cell Carcinoma: Report of 10 Cases.

PubMed

Branson, Sara V; McClintic, Elysa; Ozgur, Omar; Esmaeli, Bita; Yeatts, R Patrick

To explore the clinical features, management, and prognosis of metastatic basal cell carcinoma originating in the orbitofacial region. Ten cases of orbitofacial metastatic basal cell carcinoma were identified by searching databases at 2 institutions from 1995 to 2015. A retrospective chart review was performed. Main outcome measures included patient demographics, lesion size, location of metastases, histologic subtype, recurrence rate, time between primary tumor diagnosis and metastasis, perineural invasion, treatment modalities, and survival from time of metastasis. The median tumor size at largest dimension was 3.3 cm (range, 1.9-11.5 cm), and 6 of 10 patients had at least 1 local recurrence before metastasis (range, 0-2 recurrences). The most common sites of metastasis included the ipsilateral parotid gland (n = 6) and cervical lymph nodes (n = 5). Histologic subtypes included infiltrative (n = 5), basosquamous (n = 2), nodular (n = 1), and mixed (n = 1). The median time from primary tumor diagnosis to metastasis was 7.5 years (range, 0-13). The median survival time from diagnosis of metastasis to last documented encounter or death was 5.3 years (range, 7 months-22.8 years). Treatment regimens included surgical excision, radiotherapy, and hedgehog inhibitors. Based on our findings, the following features may be markers of high risk orbitofacial basal cell carcinoma: 1) increasing tumor size, 2) local recurrence of the primary tumor, 3) aggressive histologic subtype, and 4) perineural invasion. Screening should include close observation of the primary site and tissues in the distribution of regional lymphatics, particularly the parotid gland and cervical lymph nodes.

Radiology of colorectal cancer.

PubMed

Pijl, M E J; Chaoui, A S; Wahl, R L; van Oostayen, J A

2002-05-01

In the past 20 years, the radiology of colorectal cancer has evolved from the barium enema to advanced imaging modalities like phased array magnetic resonance imaging (MRI), virtual colonoscopy and positron emission tomography (PET). Nowadays, primary rectal cancers are preferably imaged with transrectal ultrasound or MRI, while barium enema is still the most often used technique for imaging of colonic cancers. Virtual colonoscopy is rapidly evolving and might considerably change the imaging of colorectal cancer in the near future. The use of virtual colonoscopy for screening purposes and imaging of the colon in occlusive cancer or incomplete colonoscopies is currently under evaluation. The main role of PET is in detecting tumour recurrences, both locally and distantly. Techniques to fuse cross-sectional anatomical (computer tomography (CT) and MRI) and functional (PET) images are being developed. Apart from diagnostic imaging, the radiologists has added image-guided minimally invasive treatments of colorectal liver metastases to their arsenal. The radio-frequency ablation technique is now widely available, and can be used during laparotomy or percutaneously in selected cases.

ADMultiImg: a novel missing modality transfer learning based CAD system for diagnosis of MCI due to AD using incomplete multi-modality imaging data

NASA Astrophysics Data System (ADS)

Liu, Xiaonan; Chen, Kewei; Wu, Teresa; Weidman, David; Lure, Fleming; Li, Jing

2018-02-01

Alzheimer's Disease (AD) is the most common cause of dementia and currently has no cure. Treatments targeting early stages of AD such as Mild Cognitive Impairment (MCI) may be most effective to deaccelerate AD, thus attracting increasing attention. However, MCI has substantial heterogeneity in that it can be caused by various underlying conditions, not only AD. To detect MCI due to AD, NIA-AA published updated consensus criteria in 2011, in which the use of multi-modality images was highlighted as one of the most promising methods. It is of great interest to develop a CAD system based on automatic, quantitative analysis of multi-modality images and machine learning algorithms to help physicians more adequately diagnose MCI due to AD. The challenge, however, is that multi-modality images are not universally available for many patients due to cost, access, safety, and lack of consent. We developed a novel Missing Modality Transfer Learning (MMTL) algorithm capable of utilizing whatever imaging modalities are available for an MCI patient to diagnose the patient's likelihood of MCI due to AD. Furthermore, we integrated MMTL with radiomics steps including image processing, feature extraction, and feature screening, and a post-processing for uncertainty quantification (UQ), and developed a CAD system called "ADMultiImg" to assist clinical diagnosis of MCI due to AD using multi-modality images together with patient demographic and genetic information. Tested on ADNI date, our system can generate a diagnosis with high accuracy even for patients with only partially available image modalities (AUC=0.94), and therefore may have broad clinical utility.

Effectiveness Modelling and Economic Evaluation of Primary HPV Screening for Cervical Cancer Prevention in New Zealand

PubMed Central

Lew, Jie-Bin; Simms, Kate; Smith, Megan; Lewis, Hazel; Neal, Harold; Canfell, Karen

2016-01-01

Background New Zealand (NZ) is considering transitioning from 3-yearly cervical cytology screening in women 20–69 years (current practice) to primary HPV screening. We evaluated HPV-based screening in both HPV-unvaccinated women and cohorts offered HPV vaccination in New Zealand (vaccination coverage ~50%). Methods A complex model of HPV transmission, vaccination, cervical screening, and invasive cervical cancer was extensively validated against national population-based datasets. Sixteen potential strategies for HPV screening were considered. Results Most primary HPV strategies were more effective than current practice, for both unvaccinated women and cohorts offered vaccination. The optimal strategy for both groups was 5-yearly HPV screening in women aged 25–69 years with partial genotyping for HPV 16/18 and referral to colposcopy, and cytological triage of other oncogenic types. This is predicted to reduce cervical cancer incidence and mortality by a further 12–16% and to save 4–13% annually in program costs (excluding overheads). The findings are sensitive to assumptions about future adherence to initiating screening at 25 years. Conclusion Primary HPV screening with partial genotyping would be more effective and less costly than the current cytology-based screening program, in both unvaccinated women and cohorts offered vaccination. These findings have been considered in a review of cervical screening in NZ. PMID:27187495

Rapid lead discovery through iterative screening of one bead one compound libraries.

PubMed

Gao, Yu; Amar, Sabrina; Pahwa, Sonia; Fields, Gregg; Kodadek, Thomas

2015-01-12

Primary hits that arise from screening one bead one compound (OBOC) libraries against a target of interest rarely have high potency. However, there has been little work focused on the development of an efficient workflow for primary hit improvement. In this study, we show that by characterizing the binding constants for all of the hits that arise from a screen, structure-activity relationship (SAR) data can be obtained to inform the design of "derivative libraries" of a primary hit that can then be screened under more demanding conditions to obtain improved compounds. Here, we demonstrate the rapid improvement of a primary hit against matrix metalloproteinase-14 using this approach.

A nurse-facilitated depression screening program in an Army primary care clinic: an evidence-based project.

PubMed

Yackel, Edward E; McKennan, Madelyn S; Fox-Deise, Adrianna

2010-01-01

Depression, sometimes with suicidal manifestations, is a medical condition commonly seen in primary care clinics. Routine screening for depression and suicidal ideation is recommended of all adult patients in the primary care setting because it offers depressed patients a greater chance of recovery and response to treatment, yet such screening often is overlooked or omitted. The purpose of this study was to develop, to implement, and to test the efficacy of a systematic depression screening process to increase the identification of depression in family members of active duty soldiers older than 18 years at a military family practice clinic located on an Army infantry post in the Pacific. The Iowa Model of Evidence-Based Practice to Promote Quality Care was used to develop a practice guideline incorporating a decision algorithm for nurses to screen for depression. A pilot project to institute this change in practice was conducted, and outcomes were measured. Before implementation, approximately 100 patients were diagnosed with depression in each of the 3 months preceding the practice change. Approximately 130 patients a month were assigned a 311.0 Code 3 months after the practice change, and 140 patients per month received screenings and were assigned the correct International Classification of Diseases, Ninth Revision Code 311.0 at 1 year. The improved screening and coding for depression and suicidality added approximately 3 minutes to the patient screening process. The education of staff in the process of screening for depression and correct coding coupled with monitoring and staff feedback improved compliance with the identification and the documentation of patients with depression. Nurses were more likely than primary care providers to agree strongly that screening for depression enhances quality of care. Data gathered during this project support the integration of military and civilian nurse-facilitated screening for depression in the military primary care setting. The decision algorithm should be adapted and tested in other primary care environments.

The cost-effectiveness of screening for gestational diabetes mellitus in primary and secondary care in the Republic of Ireland.

PubMed

Danyliv, Andriy; Gillespie, Paddy; O'Neill, Ciaran; Tierney, Marie; O'Dea, Angela; McGuire, Brian E; Glynn, Liam G; Dunne, Fidelma P

2016-03-01

The aim of the study was to assess the cost-effectiveness of screening for gestational diabetes mellitus (GDM) in primary and secondary care settings, compared with a no-screening option, in the Republic of Ireland. The analysis was based on a decision-tree model of alternative screening strategies in primary and secondary care settings. It synthesised data generated from a randomised controlled trial (screening uptake) and from the literature. Costs included those relating to GDM screening and treatment, and the care of adverse outcomes. Effects were assessed in terms of quality-adjusted life years (QALYs). The impact of the parameter uncertainty was assessed in a range of sensitivity analyses. Screening in either setting was found to be superior to no screening, i.e. it provided for QALY gains and cost savings. Screening in secondary care was found to be superior to screening in primary care, providing for modest QALY gains of 0.0006 and a saving of €21.43 per screened case. The conclusion held with high certainty across the range of ceiling ratios from zero to €100,000 per QALY and across a plausible range of input parameters. The results of this study demonstrate that implementation of universal screening is cost-effective. This is an argument in favour of introducing a properly designed and funded national programme of screening for GDM, although affordability remains to be assessed. In the current environment, screening for GDM in secondary care settings appears to be the better solution in consideration of cost-effectiveness.

Screening for cognitive impairment in the elderly.

PubMed Central

Bush, C.; Kozak, J.; Elmslie, T.

1997-01-01

OBJECTIVE: To evaluate the extent and type of screening for cognitive impairment primary care physicians use for their elderly patients, to identify perceived barriers to screening, and to explore whether physicians would be willing to use the clock drawing test as a cognitive screening tool. DESIGN: Mailed questionnaire. SETTING: Primary care practices in the Ottawa-Carleton region. PARTICIPANTS: Family physicians and general practitioners culled from the Yellow Pages and Canadian Medical Directory; 368 of 568 questionnaires were returned for a response rate of 70%. Six respondents had fewer than 30 patients weekly and two responded too late to be included in the analysis; 360 cases were included in the analysis. MAIN OUTCOME MEASURES: Responses to 10 questions on cognitive screening and five on demographics and the nature of respondents' practices. RESULTS: About 80% of respondents reported doing at least one mental status examination during the past year. Only 24% routinely screened patients, although 82% believed screening was needed. Major barriers to cognitive screening were lack of time, risk of offending patients, and possible negative consequences of follow up. Clock drawing was perceived as an acceptable method of screening, if it were proven effective. CONCLUSIONS: Most primary care physicians believe cognitive screening is needed, but few routinely screen their elderly patients. Lack of time is the most important perceived barrier to screening. Primary care physicians are receptive to using the clock drawing test, and, because it is not time-consuming, are less likely to consider lack of time a barrier to testing. The clock test might help bridge the gap between perceived need for screening and actual screening. PMID:9356757

Reducing the health consequences of opioid addiction in primary care.

PubMed

Bowman, Sarah; Eiserman, Julie; Beletsky, Leo; Stancliff, Sharon; Bruce, R Douglas

2013-07-01

Addiction to prescription opioids is prevalent in primary care settings. Increasing prescription opioid use is largely responsible for a parallel increase in overdose nationally. Many patients most at risk for addiction and overdose come into regular contact with primary care providers. Lack of routine addiction screening results in missed treatment opportunities in this setting. We reviewed the literature on screening and brief interventions for addictive disorders in primary care settings, focusing on opioid addiction. Screening and brief interventions can improve health outcomes for chronic illnesses including diabetes, hypertension, and asthma. Similarly, through the use of screening and brief interventions, patients with addiction can achieve improved health outcome. A spectrum of low-threshold care options can reduce the negative health consequences among individuals with opioid addiction. Screening in primary care coupled with short interventions, including motivational interviewing, syringe distribution, naloxone prescription for overdose prevention, and buprenorphine treatment are effective ways to manage addiction and its associated risks and improve health outcomes for individuals with opioid addiction. Copyright © 2013 Elsevier Inc. All rights reserved.

Assessing the accuracy and feasibility of a refractive error screening program conducted by school teachers in pre-primary and primary schools in Thailand.

PubMed

Teerawattananon, Kanlaya; Myint, Chaw-Yin; Wongkittirux, Kwanjai; Teerawattananon, Yot; Chinkulkitnivat, Bunyong; Orprayoon, Surapong; Kusakul, Suwat; Tengtrisorn, Supaporn; Jenchitr, Watanee

2014-01-01

As part of the development of a system for the screening of refractive error in Thai children, this study describes the accuracy and feasibility of establishing a program conducted by teachers. To assess the accuracy and feasibility of screening by teachers. A cross-sectional descriptive and analytical study was conducted in 17 schools in four provinces representing four geographic regions in Thailand. A two-staged cluster sampling was employed to compare the detection rate of refractive error among eligible students between trained teachers and health professionals. Serial focus group discussions were held for teachers and parents in order to understand their attitude towards refractive error screening at schools and the potential success factors and barriers. The detection rate of refractive error screening by teachers among pre-primary school children is relatively low (21%) for mild visual impairment but higher for moderate visual impairment (44%). The detection rate for primary school children is high for both levels of visual impairment (52% for mild and 74% for moderate). The focus group discussions reveal that both teachers and parents would benefit from further education regarding refractive errors and that the vast majority of teachers are willing to conduct a school-based screening program. Refractive error screening by health professionals in pre-primary and primary school children is not currently implemented in Thailand due to resource limitations. However, evidence suggests that a refractive error screening program conducted in schools by teachers in the country is reasonable and feasible because the detection and treatment of refractive error in very young generations is important and the screening program can be implemented and conducted with relatively low costs.

Do physicians understand cancer screening statistics? A national survey of primary care physicians in the United States.

PubMed

Wegwarth, Odette; Schwartz, Lisa M; Woloshin, Steven; Gaissmaier, Wolfgang; Gigerenzer, Gerd

2012-03-06

Unlike reduced mortality rates, improved survival rates and increased early detection do not prove that cancer screening tests save lives. Nevertheless, these 2 statistics are often used to promote screening. To learn whether primary care physicians understand which statistics provide evidence about whether screening saves lives. Parallel-group, randomized trial (randomization controlled for order effect only), conducted by Internet survey. (ClinicalTrials.gov registration number: NCT00981019) National sample of U.S. primary care physicians from a research panel maintained by Harris Interactive (79% cooperation rate). 297 physicians who practiced both inpatient and outpatient medicine were surveyed in 2010, and 115 physicians who practiced exclusively outpatient medicine were surveyed in 2011. Physicians received scenarios about the effect of 2 hypothetical screening tests: The effect was described as improved 5-year survival and increased early detection in one scenario and as decreased cancer mortality and increased incidence in the other. Physicians' recommendation of screening and perception of its benefit in the scenarios and general knowledge of screening statistics. Primary care physicians were more enthusiastic about the screening test supported by irrelevant evidence (5-year survival increased from 68% to 99%) than about the test supported by relevant evidence (cancer mortality reduced from 2 to 1.6 in 1000 persons). When presented with irrelevant evidence, 69% of physicians recommended the test, compared with 23% when presented with relevant evidence (P < 0.001). When asked general knowledge questions about screening statistics, many physicians did not distinguish between irrelevant and relevant screening evidence; 76% versus 81%, respectively, stated that each of these statistics proves that screening saves lives (P = 0.39). About one half (47%) of the physicians incorrectly said that finding more cases of cancer in screened as opposed to unscreened populations "proves that screening saves lives." Physicians' recommendations for screening were based on hypothetical scenarios, not actual practice. Most primary care physicians mistakenly interpreted improved survival and increased detection with screening as evidence that screening saves lives. Few correctly recognized that only reduced mortality in a randomized trial constitutes evidence of the benefit of screening. Harding Center for Risk Literacy, Max Planck Institute for Human Development.

Global report on primary immunodeficiencies: 2018 update from the Jeffrey Modell Centers Network on disease classification, regional trends, treatment modalities, and physician reported outcomes.

PubMed

Modell, Vicki; Orange, Jordan S; Quinn, Jessica; Modell, Fred

2018-05-09

Primary immunodeficiencies (PI) are genetic defects of the immune system that result in chronic, serious, and often life-threatening infections, if not diagnosed and treated. Many patients with PI are undiagnosed, underdiagnosed, or misdiagnosed. In fact, recent studies have shown that PI may be more common than previously estimated and that as many as 1% of the population may be affected with a PI when all types and varieties are considered. In order to raise awareness of PI with the overall goal of reducing associated morbidity and mortality, the Jeffrey Modell Foundation (JMF) established a network of specialized centers that could better identify, diagnose, treat, and follow patients with PI disorders. Over the past decade, the Jeffrey Modell Centers Network (JMCN) has provided the infrastructure to accept referrals, provide diagnosis, and offer treatments. Currently, the network consists of 792 Expert Physicians at 358 institutions, in 277 cities, and 86 countries spanning 6 continents. JMF developed an annual survey for physician experts within the JMCN, using the categories and gene defects identified by the International Union of Immunological Societies Expert Committee for the Classification of PI, to report on the number of patients identified with PI; treatment modalities, including immunoglobulins, transplantation, and gene therapy; and data on gender and age. Center Directors also provided physician-reported outcomes and differentials pre- and post-diagnosis. The current physician-reported data reflect an increase in diagnosed patients, as well as those receiving treatment. Suspected patients are being identified and referred so that they can receive early and appropriate diagnosis and treatment. The significant increase in patients identified with a PI is due, in part, to expanding education and awareness initiatives, newborn screening, and the expansion of molecular diagnosis and sequencing. To our knowledge, this is the most extensive single physician report on patients with PI around the world.

NON-SPECIFIC SYMPTOMS AND SCREENING OF NON-PSYCHOTIC MORBIDITY IN PRIMARY CARE1

PubMed Central

Srinivasan, T.N.; Suresh, T.R.

1990-01-01

SUMMARY Much of the non-psychotic mental morbidity in primary care goes undetected by the primary care health personnel. This is often because of the non-specific somatic nature of the presenting complaints of these patients and the difficulty on the part of the primary care physician to elicit specific emotional symptoms to screen psychiatric problems. This paper describes the development of the 7-item Primary care Psychiatric Questionnaire (PPQ.) which, by requiring to elicit only the non-specific symptoms, could overcome this practical difficulty. This new screening method has been standardised against the Self Report Questionaaire—20-item version which is commonly used in primary care. PMID:21927432

Providing Telehealth Services to a Public Primary Care Network: The Experience of RedeNUTES in Pernambuco, Brazil.

PubMed

Diniz, Paula Rejane Beserra; Ribeiro Sales, Fernando José; de Araújo Novaes, Magdala

2016-08-01

Information technologies have been applied in primary care domains to improve the delivery of health services. This article reports the telehealth network experience in Pernambuco, Brazil. Five different data sets were used, one by each service and the structural aspects of the network, collected from 2008 until August 2015. The data include solicited themes for educational activities, users' evaluation of services, numbers of sites, municipalities participating, participants in tele-education activities, teleconsultations, telediagnosis, and remote screenings. The analysis was done in absolute and percentage values using Microsoft Excel (version 2007). The indicators show high utilization of tele-education resources, followed by the teleconsultation service. The synchronous modality was the most used and the general clinical question was the most frequent type of question. Nurses are the professional category that most used the teleconsultation services (36%). Telediagnosis of electrocardiography has growth utilization, overcoming teleconsulting more recently. The satisfaction rate was 89%, and 68.5% of professionals changed their planning to patients' referrals to specialists. Telehealth has been considered effective since it avoids inappropriate referrals of the patient and provides continuous actualization to health professionals. Our results provide evidence of the feasibility and importance of using telehealth as a tool to ensure the universality, equality, and completeness in the health system.

Computer-aided detection (CAD) of breast cancer on full field digital and screening film mammograms

NASA Astrophysics Data System (ADS)

Sun, Xuejun; Qian, Wei; Song, Xiaoshan; Qian, Yuyan; Song, Dansheng; Clark, Robert A.

2003-05-01

Full-field digital mammography (FFDM) as a new breast imaging modality has potential to detect more breast cancers or to detect them at smaller sizes and earlier stages compared with screening film mammography (SFM). However, its performance needs verification, and it would pose new problems for the development of CAD methods for breast cancer detection and diagnosis. Performance evaluation of CAD systems on FFDM and SFM has been conducted in this study, respectively. First, an adaptive CAD system employing a series of advanced modules has been developed on FFDM. Second, a standardization approach has been developed to make the CAD system independent of characteristics of digitizer or imaging modalities for mammography. CAD systems developed previously for SFM and developed in this study for FFDM have been evaluated on FFDM and SFM images without and with standardization, respectively, to examine the performance improvement of the CAD system developed in this study. Computerized free-response receiver operating characteristic (FROC) analysis has been adopted as performance evaluation method. Compared with previous one, the CAD system developed in this study demonstrated significantly performance improvements. However, the comparison results have shown that the performances of final CAD system in this study are not significantly different on FFDM and on SFM after standardization. It needs further study on the assessment of CAD system performance on FFDM and SFM modalities.

Primary care validation of a single-question alcohol screening test.

PubMed

Smith, Peter C; Schmidt, Susan M; Allensworth-Davies, Donald; Saitz, Richard

2009-07-01

Unhealthy alcohol use is prevalent but under-diagnosed in primary care settings. To validate, in primary care, a single-item screening test for unhealthy alcohol use recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Cross-sectional study. Adult English-speaking patients recruited from primary care waiting rooms. Participants were asked the single screening question, “How many times in the past year have you had X or more drinks in a day?”, where X is 5 for men and 4 for women, and a response of 1 or greater [corrected] is considered positive. Unhealthy alcohol use was defined as the presence of an alcohol use disorder, as determined by a standardized diagnostic interview, or risky consumption, as determined using a validated 30-day calendar method. Of 394 eligible primary care patients, 286 (73%) completed the interview. The single-question screen was 81.8% sensitive (95% confidence interval (CI) 72.5% to 88.5%) and 79.3% specific (95% CI 73.1% to 84.4%) for the detection of unhealthy alcohol use. It was slightly more sensitive (87.9%, 95% CI 72.7% to 95.2%) but was less specific (66.8%, 95% CI 60.8% to 72.3%) for the detection of a current alcohol use disorder. Test characteristics were similar to that of a commonly used three-item screen, and were affected very little by subject demographic characteristics. The single screening question recommended by the NIAAA accurately identified unhealthy alcohol use in this sample of primary care patients. These findings support the use of this brief screen in primary care.

A single-question screening test for drug use in primary care.

PubMed

Smith, Peter C; Schmidt, Susan M; Allensworth-Davies, Donald; Saitz, Richard

2010-07-12

Drug use (illicit drug use and nonmedical use of prescription drugs) is common but underrecognized in primary care settings. We validated a single-question screening test for drug use and drug use disorders in primary care. Adult patients recruited from primary care waiting rooms were asked the single screening question, "How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?" A response of at least 1 time was considered positive for drug use. They were also asked the 10-item Drug Abuse Screening Test (DAST-10). The reference standard was the presence or absence of current (past year) drug use or a drug use disorder (abuse or dependence) as determined by a standardized diagnostic interview. Drug use was also determined by oral fluid testing for common drugs of abuse. Of 394 eligible primary care patients, 286 (73%) completed the interview. The single screening question was 100% sensitive (95% confidence interval [CI], 90.6%-100%) and 73.5% specific (95% CI, 67.7%-78.6%) for the detection of a drug use disorder. It was less sensitive for the detection of self-reported current drug use (92.9%; 95% CI, 86.1%-96.5%) and drug use detected by oral fluid testing or self-report (81.8%; 95% CI, 72.5%-88.5%). Test characteristics were similar to those of the DAST-10 and were affected very little by participant demographic characteristics. The single screening question accurately identified drug use in this sample of primary care patients, supporting the usefulness of this brief screen in primary care.

75 FR 47310 - Solicitation for Nominations for New Clinical Preventive Health Topics To Be Considered for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-05

... preventive services include screening, counseling and preventive medications associated with primary care... secondary prevention topic (screening, counseling or preventive medication). b. Primary care relevance... basis of populations, types of services (screening, counseling, preventive medications) and disease...

Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance.

PubMed

Huh, Warner K; Ault, Kevin A; Chelmow, David; Davey, Diane D; Goulart, Robert A; Garcia, Francisco A R; Kinney, Walter K; Massad, L Stewart; Mayeaux, Edward J; Saslow, Debbie; Schiffman, Mark; Wentzensen, Nicolas; Lawson, Herschel W; Einstein, Mark H

2015-02-01

In 2011, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology updated screening guidelines for the early detection of cervical cancer and its precursors. Recommended screening strategies were cytology or cotesting (cytology in combination with high-risk human papillomavirus [hrHPV] testing). These guidelines also addressed the use of hrHPV testing alone as a primary screening approach, which was not recommended for use at that time. There is now a growing body of evidence for screening with primary hrHPV testing, including a prospective U.S.-based registration study. Thirteen experts, including representatives from the Society of Gynecologic Oncology, the American Society for Colposcopy and Cervical Pathology, the American College of Obstetricians and Gynecologists, the American Cancer Society, the American Society of Cytopathology, the College of American Pathologists, and the American Society for Clinical Pathology, convened to provide interim guidance for primary hrHPV screening. This guidance panel was specifically triggered by an application to the U.S. Food and Drug Administration (FDA) for a currently marketed HPV test to be labeled for the additional indication of primary cervical cancer screening. Guidance was based on literature review and review of data from the FDA registration study, supplemented by expert opinion. This document aims to provide information for health care providers who are interested in primary hrHPV testing and an overview of the potential advantages and disadvantages of this strategy for screening as well as to highlight areas in need of further investigation.

Impact of an electronic health record alert in primary care on increasing hepatitis c screening and curative treatment for baby boomers.

PubMed

Konerman, Monica A; Thomson, Mary; Gray, Kristen; Moore, Meghan; Choxi, Hetal; Seif, Elizabeth; Lok, Anna S F

2017-12-01

Despite effective treatment for chronic hepatitis C, deficiencies in diagnosis and access to care preclude disease elimination. Screening of baby boomers remains low. The aims of this study were to assess the impact of an electronic health record-based prompt on hepatitis C virus (HCV) screening rates in baby boomers in primary care and access to specialty care and treatment among those newly diagnosed. We implemented an electronic health record-based "best practice advisory" (BPA) that prompted primary care providers to perform HCV screening for patients seen in primary care clinic (1) born between 1945 and 1965, (2) who lacked a prior diagnosis of HCV infection, and (3) who lacked prior documented anti-HCV testing. The BPA had associated educational materials, order set, and streamlined access to specialty care for newly diagnosed patients. Pre-BPA and post-BPA screening rates were compared, and care of newly diagnosed patients was analyzed. In the 3 years prior to BPA implementation, 52,660 baby boomers were seen in primary care clinics and 28% were screened. HCV screening increased from 7.6% for patients with a primary care provider visit in the 6 months prior to BPA to 72% over the 1 year post-BPA. Of 53 newly diagnosed patients, all were referred for specialty care, 11 had advanced fibrosis or cirrhosis, 20 started treatment, and 9 achieved sustained virologic response thus far. Implementation of an electronic health record-based prompt increased HCV screening rates among baby boomers in primary care by 5-fold due to efficiency in determining needs for HCV screening and workflow design. Streamlined access to specialty care enabled patients with previously undiagnosed advanced disease to be cured. This intervention can be easily integrated into electronic health record systems to increase HCV diagnosis and linkage to care. (Hepatology 2017;66:1805-1813). © 2017 by the American Association for the Study of Liver Diseases.

The Clinical and Economic Benefits of Co-Testing Versus Primary HPV Testing for Cervical Cancer Screening: A Modeling Analysis.

PubMed

Felix, Juan C; Lacey, Michael J; Miller, Jeffrey D; Lenhart, Gregory M; Spitzer, Mark; Kulkarni, Rucha

2016-06-01

Consensus United States cervical cancer screening guidelines recommend use of combination Pap plus human papillomavirus (HPV) testing for women aged 30 to 65 years. An HPV test was approved by the Food and Drug Administration in 2014 for primary cervical cancer screening in women age 25 years and older. Here, we present the results of clinical-economic comparisons of Pap plus HPV mRNA testing including genotyping for HPV 16/18 (co-testing) versus DNA-based primary HPV testing with HPV 16/18 genotyping and reflex cytology (HPV primary) for cervical cancer screening. A health state transition (Markov) model with 1-year cycling was developed using epidemiologic, clinical, and economic data from healthcare databases and published literature. A hypothetical cohort of one million women receiving triennial cervical cancer screening was simulated from ages 30 to 70 years. Screening strategies compared HPV primary to co-testing. Outcomes included total and incremental differences in costs, invasive cervical cancer (ICC) cases, ICC deaths, number of colposcopies, and quality-adjusted life years for cost-effectiveness calculations. Comprehensive sensitivity analyses were performed. In a simulation cohort of one million 30-year-old women modeled up to age 70 years, the model predicted that screening with HPV primary testing instead of co-testing could lead to as many as 2,141 more ICC cases and 2,041 more ICC deaths. In the simulation, co-testing demonstrated a greater number of lifetime quality-adjusted life years (22,334) and yielded $39.0 million in savings compared with HPV primary, thereby conferring greater effectiveness at lower cost. Model results demonstrate that co-testing has the potential to provide improved clinical and economic outcomes when compared with HPV primary. While actual cost and outcome data are evaluated, these findings are relevant to U.S. healthcare payers and women's health policy advocates seeking cost-effective cervical cancer screening technologies.

Products of cells from gliomas: VIII. Multiple-well immunoperoxidase assay of immunoreactivity of primary hybridoma supernatants with human glioma and brain tissue and cultured glioma cells.

PubMed

McKeever, P E; Wahl, R L; Shakui, P; Jackson, G A; Letica, L H; Liebert, M; Taren, J A; Beierwaltes, W H; Hoff, J T

1990-06-01

To test the feasibility of primary screening of hybridoma supernatants against human glioma tissue, over 5000 combinations of hybridoma supernatants with glioma tissue, cultured glioma cells, and normal central neural tissue were screened with a new multiple-well (M-well) screening system. This is an immunoperoxidase assay system with visual endpoints for screening 20-30 hybridoma supernatants per single microscope slide. There were extensive differences between specificities to tissue and to cultured glioma cells when both were screened with M-wells and when cultured cells were screened with standard semi-automated fluorescence. Primary M-well screening with glioma tissue detected seven hybridoma supernatants that specifically identified parenchymal cells of glioma tissue and that were not detected with cultured cells. Immunoreactivities of individual supernatants for vascular components (nine supernatants), necrosis (five supernatants), and nuclei (three supernatants) were detected. Other supernatants bound multiple sites on glioma tissue and/or subpopulations of neurons and glia of normal tissue. The results show that primary screening with glioma tissue detects a number of different specificities of hybridoma supernatants to gliomas not detected by conventional screening with cultured cells. These are potentially applicable to diagnosis and therapy.

Psychological trauma symptoms and Type 2 diabetes prevalence, glucose control, and treatment modality among American Indians in the Strong Heart Family Study

PubMed Central

Jacob, Michelle M.; Gonzales, Kelly L.; Calhoun, Darren; Beals, Janette; Muller, Clemma Jacobsen; Goldberg, Jack; Nelson, Lonnie; Welty, Thomas K.; Howard, Barbara V.

2013-01-01

Aims The aims of this paper are to examine the relationship between psychological trauma symptoms and Type 2 diabetes prevalence, glucose control, and treatment modality among 3,776 American Indians in Phase V of the Strong Heart Family Study. Methods This cross-sectional analysis measured psychological trauma symptoms using the National Anxiety Disorder Screening Day instrument, diabetes by American Diabetes Association criteria, and treatment modality by four categories: no medication, oral medication only, insulin only, or both oral medication and insulin. We used binary logistic regression to evaluate the association between psychological trauma symptoms and diabetes prevalence. We used ordinary least squares regression to evaluate the association between psychological trauma symptoms and glucose control. We used binary logistic regression to model the association of psychological trauma symptoms with treatment modality. Results Neither diabetes prevalence (22-31%; p = 0.19) nor control (8.0-8.6; p = 0.25) varied significantly by psychological trauma symptoms categories. However, diabetes treatment modality was associated with psychological trauma symptoms categories, as people with greater burden used either no medication, or both oral and insulin medications (odds ratio = 3.1, p < 0.001). Conclusions The positive relationship between treatment modality and psychological trauma symptoms suggests future research investigate patient and provider treatment decision making. PMID:24051029

Large Subpectoral Lipoma on Screening Mammography

PubMed Central

Su, Andres; Margolies, Laurie

2017-01-01

A 61 year-old woman presenting for bilateral screening mammogram was found to have an oval fat-density mass in the posterior right breast, partially visualized, with anterior displacement and thinning of the pectoralis major muscle. This mass was found on CT and MRI correlation to represent a large fat-containing mass, likely a lipoma, deep to the pectoralis major. On subsequent screening mammograms, the visualized portion of the mass remained stable. Subpectoral lipomas and intramuscular lipomas within the pectoralis major are rare, and their appearance on mammography may not be familiar to most radiologists. A review of the literature and a discussion of their appearance on multiple imaging modalities is provided. PMID:29299106

Tri-modal confocal margin screening for the presence of residual squamous cell carcinoma in Mohs surgical excisions

NASA Astrophysics Data System (ADS)

Bar, Anna; Snavely, Nicholas; Chen, Nathaniel; Jacques, Steven; Gareau, Daniel S.

2012-03-01

Screening cancer in excision margins may be done with confocal microscopy to save time and cost over the gold standard histopathology (H&E). However, diagnostic accuracy requires sufficient contrast. Reflectance mode enables detection of large (>500um) nodular tumors. Enhanced nuclear contrast with acridine orange fluorescence mode additionally enables detection of tiny (<50um) basal cell carcinomas. Here, we present a novel combination of three modes to detect squamous cell carcinoma (SCC). Accurate screening of SCC requires eosin fluorescence, reflectance and acridine orange fluorescence to enable contrast for cytoplasm, collagen and nuclei respectively. Combining these signals replicates H&E for rapid clinical translation.

Treatment and prognostic factors of radiation-associated angiosarcoma (RAAS) after primary breast cancer: a systematic review.

PubMed

Depla, A L; Scharloo-Karels, C H; de Jong, M A A; Oldenborg, S; Kolff, M W; Oei, S B; van Coevorden, F; van Rhoon, G C; Baartman, E A; Scholten, R J; Crezee, J; van Tienhoven, G

2014-07-01

Radiation-associated angiosarcoma (RAAS) of the breast is a rare, aggressive disease. The incidence is increasing with the prolonged survival of women irradiated for primary breast cancer. Surgery is the current treatment of choice. Prognosis is poor. This review aims to evaluate all publications on primary treatment of RAAS to identify prognostic factors and evaluate treatment modalities. Databases were searched for articles with published individual patient data on prognostic factors, treatment and follow-up of patients with RAAS. A regression analysis was performed to test the prognostic values of age, interval between primary treatment and RAAS, tumour size and grade on the local recurrence-free interval (LRFI) and overall survival (OS). The effects of treatment modalities surgery, radiation (with or without hyperthermia) and chemotherapy or combinations were evaluated. 74 articles were included, representing data on 222 patients. In these patients, the 5-year OS was 43% and 5-year LRFI was 32%. Tumour size and age were significant prognostic factors on LRFI and OS. Of all patients, 68% received surgery alone, 17% surgery and reirradiation and 6% surgery with chemotherapy. The remaining 9% received primary treatments without surgery. Surgery with radiotherapy had a better 5-year LRFI of 57% compared to 34% for surgery alone (p=0.008). The value of other treatment modalities could not be assessed. This systematic review confirms the poor prognosis of RAAS. Tumour size and age were of prognostic value. The addition of reirradiation to surgery in the treatment of RAAS appears to enhance local control. Copyright © 2014 Elsevier Ltd. All rights reserved.

Cost-Effectiveness of Primary HPV Testing, Cytology and Co-testing as Cervical Cancer Screening for Women Above Age 30 Years.

PubMed

Jin, Xian Wen; Lipold, Laura; Foucher, Julie; Sikon, Andrea; Brainard, Jennifer; Belinson, Jerome; Schramm, Sarah; Nottingham, Kelly; Hu, Bo; Rothberg, Michael B

2016-11-01

Cervical cancer screening guidelines for women aged ≥30 years allow for co-testing or primary cytology testing. Our objective was to determine the test characteristics and costs associated with Cytology, HPV and Co-testing screening strategies. Retrospective cohort study of women undergoing cervical cancer screening with both cytology and HPV (Hybrid Capture 2) testing from 2004 to 2010 in an integrated health system. The electronic health record was used to identify women aged ≥30 years who had co-testing. Unsatisfactory or unavailable test results and incorrectly ordered tests were excluded. The main outcome was biopsy-proven cervical intraepithelial neoplasia grade 3 or higher (CIN3+). The final cohort consisted of 99,549 women. Subjects were mostly white (78.4 %), married (70.7 %), never smokers (61.3 %) and with private insurance (86.1 %). Overall, 5121 (5.1 %) tested positive for HPV and 6115 (6.1 %) had cytology ≥ ASCUS; 1681 had both and underwent colposcopy and 310 (0.3 %) had CIN3+. Sensitivity for CIN3+ was 91.9 % for Primary Cytology, 99.4 % for Co-testing, and 94.8 % for Primary HPV; specificity was 97.3 % for Co-testing and Primary Cytology and 97.9 % for Primary HPV. Over a 3-year screening interval, Primary HPV detected more cases of CIN3+ and was less expensive than Primary Cytology. Co-testing detected 14 more cases of CIN3+ than Primary HPV, but required an additional 100,277 cytology tests and 566 colposcopies at an added cost of $2.38 million, or $170,096 per additional case detected. Primary HPV was more effective and less expensive than Primary Cytology. Primary HPV screening appears to represent a cost-effective alternative to Co-testing.

Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test.

PubMed

Wright, Thomas C; Stoler, Mark H; Behrens, Catherine M; Sharma, Abha; Zhang, Guili; Wright, Teresa L

2015-02-01

ATHENA evaluated the cobas HPV Test as the primary screen for cervical cancer in women ≥25years. This reports the 3-year end-of-study results comparing the performance of HPV primary screening to different screening and triage combinations. 42,209 women ≥25years were enrolled and had cytology and hrHPV testing. Women with abnormal cytology (≥atypical squamous cells of undetermined significance) and those HPV positive were referred to colposcopy. Women not reaching the study endpoint of CIN2+ entered the 3-year follow-up phase. 3-year CIR of CIN3+ in cytology-negative women was 0.8% (95% CI; 0.5-1.1%), 0.3% (95% CI 0.1-0.7%) in HPV-negative women, and 0.3% (95% CI; 0.1-0.6%) in cytology and HPV negative women. The sensitivity for CIN3+ of cytology was 47.8% (95% CI; 41.6-54.1%) compared to 61.7% (95% CI; 56.0-67.5%) for the hybrid strategy (cytology if 25-29years and cotesting with cytology and HPV if ≥30years) and 76.1% (95% CI; 70.3-81.8%) for HPV primary. The specificity for CIN3+ was 97.1% (95% CI; 96.9-97.2%), 94.6% (95% CI; 94.4-94.8%), and 93.5% (95% CI; 93.3-93.8%) for cytology, hybrid strategy, and HPV primary, respectively. Although HPV primary detects significantly more cases of CIN3+ in women ≥25years than either cytology or hybrid strategy, it requires significantly more colposcopies. However, the number of colposcopies required to detect a single CIN3+ is the same as for the hybrid strategy. HPV primary screening in women ≥25years is as effective as a hybrid screening strategy that uses cytology if 25-29years and cotesting if ≥30years. However, HPV primary screening requires less screening tests. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Improving Universal Suicide Prevention Screening in Primary Care by Reducing False Negatives

DTIC Science & Technology

2016-09-01

AWARD NUMBER: W81XWH-14-1-0272 TITLE: Improving universal suicide prevention screening in primary care by reducing false negatives PRINCIPAL...COVERED 9/1/2015-8/31/2016 4. TITLE AND SUBTITLE Improving universal suicide prevention screening in primary care by 5a. CONTRACT NUMBER reducing...proposed project is to develop a shortened version of the Suicide Cognitions Scale (SCS) and to evaluate its efficacy as a universal suicide prevention

Boundaries Instead of Walls: The Rehabilitation of Prisoner Drug Addicts.

ERIC Educational Resources Information Center

Teichman, Meir; Kadmon, Anna

1998-01-01

Describes an experimental rehabilitation program for drug addict prisoners which is based on Winnicott's propositions on "object relationships" and was carried out in a hostel in Israel. The program applies a variety of therapeutic modalities, from education to individual, group to family therapy, and evaluates and screens potential…

Fetal Implications of Diagnostic Radiation Exposure During Pregnancy: Evidence-based Recommendations.

PubMed

Rimawi, Bassam H; Green, Victoria; Lindsay, Michael

2016-06-01

The purpose of this article is to review the fetal and long-term implications of diagnostic radiation exposure during pregnancy. Evidence-based recommendations for radiologic imaging modalities utilizing exposure of diagnostic radiation during pregnancy, including conventional screen-film mammography, digital mammography, tomosynthesis, and contrast-enhanced mammography are described.

Multisensory Modalities for Blending and Segmenting among Early Readers

ERIC Educational Resources Information Center

Lee, Lay Wah

2016-01-01

With the advent of touch-screen interfaces on the tablet computer, multisensory elements in reading instruction have taken on a new dimension. This computer assisted language learning research aimed to determine whether specific technology features of a tablet computer can add to the functionality of multisensory instruction in early reading…

Marathon Group Therapy: Potential for University Counseling Centers and Beyond

ERIC Educational Resources Information Center

Stanger, Thomas; Harris, Rafael S., Jr.

2005-01-01

A descriptive analysis of marathon group therapy was conducted, specifying issues of set-up, screening, preparation, start-up, introduction to group process, facilitating therapeutic moments throughout the weekend, termination, and follow-up. Factors and dynamics unique to this modality are outlined for marathon groups in university counseling…

Gender differences in attitudes impeding colorectal cancer screening

PubMed Central

2013-01-01

Background Colorectal cancer screening (CRCS) is the only type of cancer screening where both genders reduce risks by similar proportions with identical procedures. It is an important context for examining gender differences in disease-prevention, as CRCS significantly reduces mortality via early detection and prevention. In efforts to increase screening adherence, there is increasing acknowledgment that obstructive attitudes prevent CRCS uptake. Precise identification of the gender differences in obstructive attitudes is necessary to improve uptake promotion. This study randomly sampled unscreened, screening - eligible individuals in Ontario, employing semi-structured interviews to elicit key differences in attitudinal obstructions towards colorectal cancer screening with the aim of deriving informative differences useful in planning promotions of screening uptake. Methods N = 81 participants (49 females, 32 males), 50 years and above, with no prior CRCS, were contacted via random-digit telephone dialing, and consented via phone-mail contact. Altogether, N = 4,459 calls were made to yield N = 85 participants (1.9% response rate) of which N = 4 participants did not complete interviews. All subjects were eligible for free-of-charge CRCS in Ontario, and each was classified, via standard interview by CRCS screening decision-stage. Telephone-based, semi-structured interviews (SSIs) were employed to investigate gender differences in CRCS attitudes, using questions focused on 5 attitudinal domains: 1) Screening experience at the time of interview; 2) Barriers to adherence; 3) Predictors of Adherence; 4) Pain-anxiety experiences related to CRCS; 5) Gender-specific experiences re: CRCS, addressing all three modalities accessible through Ontario’s program: a) fecal occult blood testing; b) flexible sigmoidoscopy; c) colonoscopy. Results Interview transcript analyses indicated divergent themes related to CRCS for each gender: 1) bodily intrusion, 2) perforation anxiety, and 3) embarrassment for females and; 1) avoidant procrastination with underlying fatalism, 2) unnecessary health care and 3) uncomfortable vulnerability for males. Respondents adopted similar attitudes towards fecal occult blood testing, flexible sigmoidoscopy and colonoscopy, and were comparable in decision stage across tests. Gender differences were neither closely tied to screening stage nor modality. Women had more consistent physician relationships, were more screening-knowledgeable and better able to articulate views on screening. Men reported less consistent physician relationships, were less knowledgeable and kept decision-making processes vague and emotionally distanced (i.e. at ‘arm’s length’). Conclusions Marked differences were observed in obstructive CRCS attitudes per gender. Females articulated reservations about CRCS-associated distress and males suppressed negative views while ambiguously procrastinating about the task of completing screening. Future interventions could seek to reduce CRCS-related stress (females) and address the need to overcome procrastination (males). PMID:23706029

Gender differences in attitudes impeding colorectal cancer screening.

PubMed

Ritvo, Paul; Myers, Ronald E; Paszat, Lawrence; Serenity, Mardie; Perez, Daniel F; Rabeneck, Linda

2013-05-24

Colorectal cancer screening (CRCS) is the only type of cancer screening where both genders reduce risks by similar proportions with identical procedures. It is an important context for examining gender differences in disease-prevention, as CRCS significantly reduces mortality via early detection and prevention. In efforts to increase screening adherence, there is increasing acknowledgment that obstructive attitudes prevent CRCS uptake. Precise identification of the gender differences in obstructive attitudes is necessary to improve uptake promotion. This study randomly sampled unscreened, screening - eligible individuals in Ontario, employing semi-structured interviews to elicit key differences in attitudinal obstructions towards colorectal cancer screening with the aim of deriving informative differences useful in planning promotions of screening uptake. N = 81 participants (49 females, 32 males), 50 years and above, with no prior CRCS, were contacted via random-digit telephone dialing, and consented via phone-mail contact. Altogether, N = 4,459 calls were made to yield N = 85 participants (1.9% response rate) of which N = 4 participants did not complete interviews. All subjects were eligible for free-of-charge CRCS in Ontario, and each was classified, via standard interview by CRCS screening decision-stage. Telephone-based, semi-structured interviews (SSIs) were employed to investigate gender differences in CRCS attitudes, using questions focused on 5 attitudinal domains: 1) Screening experience at the time of interview; 2) Barriers to adherence; 3) Predictors of Adherence; 4) Pain-anxiety experiences related to CRCS; 5) Gender-specific experiences re: CRCS, addressing all three modalities accessible through Ontario's program: a) fecal occult blood testing; b) flexible sigmoidoscopy; c) colonoscopy. Interview transcript analyses indicated divergent themes related to CRCS for each gender: 1) bodily intrusion, 2) perforation anxiety, and 3) embarrassment for females and; 1) avoidant procrastination with underlying fatalism, 2) unnecessary health care and 3) uncomfortable vulnerability for males. Respondents adopted similar attitudes towards fecal occult blood testing, flexible sigmoidoscopy and colonoscopy, and were comparable in decision stage across tests. Gender differences were neither closely tied to screening stage nor modality. Women had more consistent physician relationships, were more screening-knowledgeable and better able to articulate views on screening. Men reported less consistent physician relationships, were less knowledgeable and kept decision-making processes vague and emotionally distanced (i.e. at 'arm's length'). Marked differences were observed in obstructive CRCS attitudes per gender. Females articulated reservations about CRCS-associated distress and males suppressed negative views while ambiguously procrastinating about the task of completing screening. Future interventions could seek to reduce CRCS-related stress (females) and address the need to overcome procrastination (males).

Cervical and breast cancer screening uptake among women with serious mental illness: a data linkage study.

PubMed

Woodhead, Charlotte; Cunningham, Ruth; Ashworth, Mark; Barley, Elizabeth; Stewart, Robert J; Henderson, Max J

2016-10-21

Breast and cancer screening uptake has been found to be lower among women with serious mental illness (SMI). This study aims to corroborate these findings in the UK and to identify variation in screening uptake by illness/treatment factors, and primary care consultation frequency. Linked population-based primary and secondary care data from the London borough of Lambeth (UK) were used to compare breast and cervical screening receipt among linked eligible SMI patients (n = 625 and n = 1393), to those without SMI known only to primary care (n = 106,554 and n = 25,385) using logistic regression models adjusted first for socio-demographic factors and second, additionally for primary care consultation frequency. Eligible SMI patients were less likely to have received breast (adjusted odds ratio (OR) 0.69, 95 % confidence interval (CI), 0.57 - 0.84, p < 0.001) or cervical screening (adjusted OR 0.72, CI: 0.60 - 0.85, p < 0.001). Schizophrenia diagnosis, depot injectable antipsychotic prescription, and illness severity and risk were associated with the lowest odds of uptake of breast (adjusted ORs 0.46 to 0.59, all p < 0.001) and cervical screening (adjusted ORs 0.48 - 0.65, all p < 0.001). Adjustments for consultation frequency further reduced effect sizes for all subgroups of SMI patient, in particular for cervical screening. Women with SMI are less likely to receive breast and cervical cancer screening than comparable women without SMI. Higher primary care consultation rates among SMI patients is likely a mediating factor between SMI status and uptake, particularly for cervical screening - a service organised in primary care. To tackle health disparities linked to SMI, efforts at increasing screening uptake are key and should be targeted at women with other markers of illness severity or risk, beyond SMI status alone.

A response surface methodology based damage identification technique

NASA Astrophysics Data System (ADS)

Fang, S. E.; Perera, R.

2009-06-01

Response surface methodology (RSM) is a combination of statistical and mathematical techniques to represent the relationship between the inputs and outputs of a physical system by explicit functions. This methodology has been widely employed in many applications such as design optimization, response prediction and model validation. But so far the literature related to its application in structural damage identification (SDI) is scarce. Therefore this study attempts to present a systematic SDI procedure comprising four sequential steps of feature selection, parameter screening, primary response surface (RS) modeling and updating, and reference-state RS modeling with SDI realization using the factorial design (FD) and the central composite design (CCD). The last two steps imply the implementation of inverse problems by model updating in which the RS models substitute the FE models. The proposed method was verified against a numerical beam, a tested reinforced concrete (RC) frame and an experimental full-scale bridge with the modal frequency being the output responses. It was found that the proposed RSM-based method performs well in predicting the damage of both numerical and experimental structures having single and multiple damage scenarios. The screening capacity of the FD can provide quantitative estimation of the significance levels of updating parameters. Meanwhile, the second-order polynomial model established by the CCD provides adequate accuracy in expressing the dynamic behavior of a physical system.

Establishment and characterization of a novel head and neck squamous cell carcinoma cell line USC-HN1.

PubMed

Liebertz, Daniel J; Lechner, Melissa G; Masood, Rizwan; Sinha, Uttam K; Han, Jing; Puri, Raj K; Correa, Adrian J; Epstein, Alan L

2010-02-22

Head and neck squamous cell carcinoma (HNSCC) is an aggressive and lethal malignancy. Publically available cell lines are mostly of lingual origin, or have not been carefully characterized. Detailed characterization of novel HNSCC cell lines is needed in order to provide researchers a concrete keystone on which to build their investigations. The USC-HN1 cell line was established from a primary maxillary HNSCC biopsy explant in tissue culture. The immortalized cells were then further characterized by heterotransplantation in Nude mice; immunohistochemical staining for relevant HNSCC biomarkers; flow cytometry for surface markers; cytogenetic karyotypic analysis; human papillomavirus and Epstein-Barr virus screening; qRT-PCR for oncogene and cytokine analysis; investigation of activated, cleaved Notch1 levels; and detailed 35,000 gene microarray analysis. Characterization experiments confirmed the human HNSCC origin of USC-HN1, including a phenotype similar to the original tumor. Viral screening revealed no HPV or EBV infection, while western blotting displayed significant upregulation of activated, cleaved Notch1. USC-HN1, a novel immortalized cell line has been derived from a maxillary HNSCC. Characterization studies have shown that the cell line is of HNSCC origin and displays many of the same markers previously reported in the literature. USC-HN1 is available for public research and will further the investigation of HNSCC and the development of new therapeutic modalities.

Evaluation of the effect of an audit and feedback reporting tool on screening participation: The Primary Care Screening Activity Report (PCSAR).

PubMed

Jonah, Leigh; Pefoyo, Anna Kone; Lee, Alex; Hader, Joanne; Strasberg, Suzanne; Kupets, Rachel; Chiarelli, Anna M; Tinmouth, Jill

2017-03-01

Participation in cancer screening is critical to its effectiveness in reducing the burden of cancer. The Primary Care Screening Activity Report (PCSAR), an electronic report, was developed as an innovative audit and feedback tool to increase screening participation in Ontario's cancer screening programs. This study aims to assess its impact on patient screening participation. This study used a retrospective cohort design to evaluate the effectiveness of the 2014 PCSAR on screening participation in Ontario's three screening programs (breast, cervix and colorectal). The 3 cohorts comprised all participants eligible for each of the programs enrolled with a primary care physician in Ontario. Two exposures were evaluated for each cohort: enrollment with a physician who was registered to receive the PCSAR and enrollment with a registered physician who also logged into the PCSAR. Logistic regression modelling was used to assess the magnitude of the effect of PCSAR on participation, adjusting for participant and physician characteristics. Across all three screening programs, 63% of eligible physicians registered to receive the PCSAR and 38% of those registered logged-in to view it. Patients of physicians who registered were significantly more likely to participate in screening, with odds ratios ranging from 1.06 [1.04;1.09] to 1.15 [1.12;1.19]. The adjusted odds ratios associated with PCSAR log-in were 1.07 [1.03;1.12] to 1.18 [1.14;1.22] across all screening programs. Implementation of the PCSAR was associated with a small increase in screening participation. The PCSAR appears to be modestly effective in assisting primary care physicians in optimizing cancer screening participation among their patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Danish method study on cervical screening in women offered HPV vaccination as girls (Trial23): a study protocol.

PubMed

Thamsborg, Lise Holst; Andersen, Berit; Larsen, Lise Grupe; Christensen, Jette; Johansen, Tonje; Hariri, Jalil; Christiansen, Sanne; Rygaard, Carsten; Lynge, Elsebeth

2018-05-26

The first birth cohorts of women offered human papillomavirus (HPV) vaccination as girls are now entering cervical screening. However, there is no international consensus on how to screen HPV vaccinated women. These women are better protected against cervical cancer and could therefore be offered less intensive screening. Primary HPV testing is more sensitive than cytology, allowing for a longer screening interval. The aim of Trial23 is to investigate if primary HPV testing with cytology triage of HPV positive samples is a reasonable screening scheme for women offered HPV vaccination as girls. Trial23 is a method study embedded in the existing cervical screening programme in four out of five Danish regions. Without affecting the screening programme, women born in 1994 are randomised to present screening with liquid-based cytology every third year (present programme arm) or present screening plus an HPV test (HPV arm). The study started 1 February 2017 and will run over three screening rounds corresponding to 7-8 years. The primary endpoint is cervical intraepithelial neoplasia grade 3 or above. The trial is undertaken as a non-inferiority study including intention-to-treat and per-protocol analyses. The potential effect of primary HPV screening with a 6-year interval will be calculated from the observed data. The study protocol has been submitted to the ethical committee and deemed a method study. All women are screened according to routine guidelines. The study will contribute new evidence on the future screening of HPV vaccinated birth cohorts of women. All results will be published in open-access journal. NCT03049553; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Impact of a Generalizable Reminder System on Colorectal Cancer Screening in Diverse Primary Care Practices

PubMed Central

Nease, Donald E.; Ruffin, Mack T.; Klinkman, Michael S.; Jimbo, Masahito; Braun, Thomas M.; Underwood, Jennifer M.

2015-01-01

Background Computerized reminder systems (CRS) show promise for increasing preventive services such as colorectal cancer (CRC) screening. However, prior research has not evaluated a generalizable CRS across diverse, community primary care practices. We evaluated whether a generalizable CRS, ClinfoTracker, could improve screening rates for CRC in diverse primary care practices. Methods The study was a prospective trial to evaluate ClinfoTracker using historical control data in 12 Great Lakes Research In Practice Network community-based, primary care practices distributed from Southeast to Upper Peninsula Michigan. Our outcome measures were pre- and post-study practice-level CRC screening rates among patients seen during the 9-month study period. Ability to maintain the CRS was measured by days of reminder printing. Field notes were used to examine each practice’s cohesion and technology capabilities. Results All but one practice increased their CRC screening rates, ranging from 3.3% to 16.8% improvement. t tests adjusted for within practice correlation showed improvement in screening rates across all 12 practices, from 41.7% to 50.9%, P = 0.002. Technology capabilities impacted printing days (74% for high technology vs. 45% for low technology practices, P = 0.01), and cohesion demonstrated an impact trend for screening (15.3% rate change for high cohesion vs. 7.9% for low cohesion practices). Conclusions Implementing a generalizable CRS in diverse primary care practices yielded significant improvements in CRC screening rates. Technology capabilities are important in maintaining the system, but practice cohesion may have a greater influence on screening rates. This work has important implications for practices implementing reminder systems. PMID:18725836

Comprehension of Navigation Directions

NASA Technical Reports Server (NTRS)

Schneider, Vivian I.; Healy, Alice F.

2000-01-01

In an experiment simulating communication between air traffic controllers and pilots, subjects were given navigation instructions varying in length telling them to move in a space represented by grids on a computer screen. The subjects followed the instructions by clicking on the grids in the locations specified. Half of the subjects read the instructions, and half heard them. Half of the subjects in each modality condition repeated back the instructions before following them,and half did not. Performance was worse for the visual than for the auditory modality on the longer messages. Repetition of the instructions generally depressed performance, especially with the longer messages, which required more output than did the shorter messages, and especially with the visual modality, in which phonological recoding from the visual input to the spoken output was necessary. These results are explained in terms of the degrading effects of output interference on memory for instructions.

A prospective clinical trial to compare the performance of dried blood spots prenatal screening for Down's syndrome with conventional non-invasive testing technology.

PubMed

Hu, Huiying; Jiang, Yulin; Zhang, Minghui; Liu, Shanying; Hao, Na; Zhou, Jing; Liu, Juntao; Zhang, Xiaojin; Ma, Liangkun

2017-03-01

To evaluate, side by side, the efficiency of dried blood spots (DBSs) against serum screening for Down's syndrome, and then, to construct a two-tier strategy by topping up the fetal cell-free DNA (cfDNA) secondary screening over the high-risk women marked by the primary blood testing to build a practical screening tactic to identify fetal Down's syndrome. One thousand eight hundred and thirty-seven low-risk Chinese women, with singleton pregnancy, were enrolled for the study. Alpha-fetoprotein and free beta human chorionic gonadotropin were measured for the serum as well as for the parallel DBS samples. Partial high-risk pregnant women identified by primary blood testing (n = 38) were also subject to the secondary cfDNA screening. Diagnostic amniocentesis was utilized to confirm the screening results. The true positive rate for Down's syndrome detection was 100% for both blood screening methods; however, the false-positive rate was 3.0% for DBS and 4.0% for serum screening, respectively. DBS correlated well with serum screening on Down's syndrome detection. Three out of 38 primary high-risk women displayed chromosomal abnormalities by cfDNA analysis, which were confirmed by amniocentesis. Either the true detection rate or the false-positive rate for Down's syndrome between DBS and the serum test is comparable. In addition, blood primary screening aligned with secondary cfDNA analysis, a "before and after" two-tier screening strategy, can massively decrease the false-positive rate, which, then, dramatically reduces the demand for invasive diagnostic operation. Impact statement Children born with Down's syndrome display a wide range of mental and physical disability. Currently, there is no effective treatment to ease the burden and anxiety of the Down's syndrome family and the surrounding society. This study is to evaluate the efficiency of dried blood spots against serum screening for Down's syndrome and to construct a two-tier strategy by topping up the fetal cell-free DNA (cfDNA) secondary screening over the high-risk women marked by the primary blood testing to build a practical screening tactic to identify fetal Down's syndrome. Results demonstrate that fetal cfDNA can significantly reduce false-positive rate close to none while distinguishing all true positives. Thus, we recommend that fetal cfDNA analysis to be utilized as a secondary screening tool atop of the primary blood protein screening to further minimize the capacity of undesirable invasive diagnostic operations.

Interobserver agreement between primary graders and an expert grader in the Bristol and Weston diabetic retinopathy screening programme: a quality assurance audit.

PubMed

Patra, S; Gomm, E M W; Macipe, M; Bailey, C

2009-08-01

To assess the quality and accuracy of primary grading in the Bristol and Weston diabetic retinopathy screening programme and to set standards for future interobserver agreement reports. A prospective audit of 213 image sets from six fully trained primary graders in the Bristol and Weston diabetic retinopathy screening programme was carried out over a 4-week period. All the images graded by the primary graders were regraded by an expert grader blinded to the primary grading results and the identity of the primary grader. The interobserver agreement between primary graders and the blinded expert grader and the corresponding Kappa coefficient was determined for overall grading, referable, non-referable and ungradable disease. The audit standard was set at 80% for interobserver agreement with a Kappa coefficient of 0.7. The interobserver agreement bettered the audit standard of 80% in all the categories. The Kappa coefficient was substantial (0.7) for the overall grading results and ranged from moderate to substantial (0.59-0.65) for referable, non-referable and ungradable disease categories. The main recommendation of the audit was to provide refresher training for the primary graders with focus on ungradable disease. The audit demonstrated an acceptable level of quality and accuracy of primary grading in the Bristol and Weston diabetic retinopathy screening programme and provided a standard against which future interobserver agreement can be measured for quality assurance within a screening programme. Diabet. Med. 26, 820-823 (2009).

Histopathology reveals correlative and unique phenotypes in a high-throughput mouse phenotyping screen

PubMed Central

Adissu, Hibret A.; Estabel, Jeanne; Sunter, David; Tuck, Elizabeth; Hooks, Yvette; Carragher, Damian M.; Clarke, Kay; Karp, Natasha A.; Project, Sanger Mouse Genetics; Newbigging, Susan; Jones, Nora; Morikawa, Lily; White, Jacqueline K.; McKerlie, Colin

2014-01-01

The Mouse Genetics Project (MGP) at the Wellcome Trust Sanger Institute aims to generate and phenotype over 800 genetically modified mouse lines over the next 5 years to gain a better understanding of mammalian gene function and provide an invaluable resource to the scientific community for follow-up studies. Phenotyping includes the generation of a standardized biobank of paraffin-embedded tissues for each mouse line, but histopathology is not routinely performed. In collaboration with the Pathology Core of the Centre for Modeling Human Disease (CMHD) we report the utility of histopathology in a high-throughput primary phenotyping screen. Histopathology was assessed in an unbiased selection of 50 mouse lines with (n=30) or without (n=20) clinical phenotypes detected by the standard MGP primary phenotyping screen. Our findings revealed that histopathology added correlating morphological data in 19 of 30 lines (63.3%) in which the primary screen detected a phenotype. In addition, seven of the 50 lines (14%) presented significant histopathology findings that were not associated with or predicted by the standard primary screen. Three of these seven lines had no clinical phenotype detected by the standard primary screen. Incidental and strain-associated background lesions were present in all mutant lines with good concordance to wild-type controls. These findings demonstrate the complementary and unique contribution of histopathology to high-throughput primary phenotyping of mutant mice. PMID:24652767

Modal Testing of Seven Shuttle Cargo Elements for Space Station

NASA Technical Reports Server (NTRS)

Kappus, Kathy O.; Driskill, Timothy C.; Parks, Russel A.; Patterson, Alan (Technical Monitor)

2001-01-01

From December 1996 to May 2001, the Modal and Control Dynamics Team at NASA's Marshall Space Flight Center (MSFC) conducted modal tests on seven large elements of the International Space Station. Each of these elements has been or will be launched as a Space Shuttle payload for transport to the International Space Station (ISS). Like other Shuttle payloads, modal testing of these elements was required for verification of the finite element models used in coupled loads analyses for launch and landing. The seven modal tests included three modules - Node, Laboratory, and Airlock, and four truss segments - P6, P3/P4, S1/P1, and P5. Each element was installed and tested in the Shuttle Payload Modal Test Bed at MSFC. This unique facility can accommodate any Shuttle cargo element for modal test qualification. Flexure assemblies were utilized at each Shuttle-to-payload interface to simulate a constrained boundary in the load carrying degrees of freedom. For each element, multiple-input, multiple-output burst random modal testing was the primary approach with controlled input sine sweeps for linearity assessments. The accelerometer channel counts ranged from 252 channels to 1251 channels. An overview of these tests, as well as some lessons learned, will be provided in this paper.

Alcohol Screening among Opioid Agonist Patients in a Primary Care Clinic and an Opioid Treatment Program.

PubMed

Klimas, Jan; Muench, John; Wiest, Katharina; Croff, Raina; Rieckman, Traci; McCarty, Dennis

2015-01-01

Problem alcohol use is associated with adverse health and economic outcomes, especially among people in opioid agonist treatment. Screening, brief intervention, and referral to treatment (SBIRT) are effective in reducing alcohol use; however, issues involved in SBIRT implementation among opioid agonist patients are unknown. To assess identification and treatment of alcohol use disorders, we reviewed clinical records of opioid agonist patients screened for an alcohol use disorder in a primary care clinic (n = 208) and in an opioid treatment program (n = 204) over a two-year period. In the primary care clinic, 193 (93%) buprenorphine patients completed an annual alcohol screening and six (3%) had elevated AUDIT scores. In the opioid treatment program, an alcohol abuse or dependence diagnosis was recorded for 54 (27%) methadone patients. Practitioner focus groups were completed in the primary care (n = 4 physicians) and the opioid treatment program (n = 11 counselors) to assess experience with and attitudes towards screening opioid agonist patients for alcohol use disorders. Focus groups suggested that organizational, structural, provider, patient, and community variables hindered or fostered alcohol screening. Alcohol screening is feasible among opioid agonist patients. Effective implementation, however, requires physician training and systematic changes in workflow.

Spatiotemporal frequency tuning of BOLD and gamma band MEG responses compared in primary visual cortex.

PubMed

Muthukumaraswamy, Suresh D; Singh, Krish D

2008-05-01

In this study, the spatial and temporal frequency tuning characteristics of the MEG gamma (40-60 Hz) rhythm and the BOLD response in primary visual cortex were measured and compared. In an identical MEG/fMRI paradigm, 10 participants viewed reversing square wave gratings at 2 spatial frequencies [0.5 and 3 cycles per degree (cpd)] reversing at 5 temporal frequencies (0, 1 6, 10, 15 Hz). Three-dimensional images of MEG source power were generated with synthetic aperture magnetometry (SAM) and showed a high degree of spatial correspondence with BOLD responses in primary visual cortex with a mean spatial separation of 6.5 mm, but the two modalities showed different tuning characteristics. The gamma rhythm showed a clear increase in induced power for the high spatial frequency stimulus while BOLD showed no difference in activity for the two spatial frequencies used. Both imaging modalities showed a general increase of activity with temporal frequency, however, BOLD plateaued around 6-10 Hz while the MEG generally increased with a dip exhibited at 6 Hz. These results demonstrate that the two modalities may show activation in similar spatial locations but that the functional pattern of these activations may differ in a complex manner, suggesting that they may be tuned to different aspects of neuronal activity.

Screening uptake rates and the clinical and cost effectiveness of screening for gestational diabetes mellitus in primary versus secondary care: study protocol for a randomised controlled trial

PubMed Central

2014-01-01

Background The risks associated with gestational diabetes mellitus (GDM) are well recognized, and there is increasing evidence to support treatment of the condition. However, clear guidance on the ideal approach to screening for GDM is lacking. Professional groups continue to debate whether selective screening (based on risk factors) or universal screening is the most appropriate approach. Additionally, there is ongoing debate about what levels of glucose abnormalities during pregnancy respond best to treatment and which maternal and neonatal outcomes benefit most from treatment. Furthermore, the implications of possible screening options on health care costs are not well established. In response to this uncertainty there have been repeated calls for well-designed, randomised trials to determine the efficacy of screening, diagnosis, and management plans for GDM. We describe a randomised controlled trial to investigate screening uptake rates and the clinical and cost effectiveness of screening in primary versus secondary care settings. Methods/Design This will be an unblinded, two-group, parallel randomised controlled trial (RCT). The target population includes 784 women presenting for their first antenatal visit at 12 to 18 weeks gestation at two hospitals in the west of Ireland: Galway University Hospital and Mayo General Hospital. Participants will be offered universal screening for GDM at 24 to 28 weeks gestation in either primary care (n = 392) or secondary care (n = 392) locations. The primary outcome variable is the uptake rate of screening. Secondary outcomes include indicators of clinical effectiveness of screening at each screening site (primary and secondary) including gestational week at time of screening, time to access antenatal diabetes services for women diagnosed with GDM, and pregnancy and neonatal outcomes for women with GDM. In addition, parallel economic and qualitative evaluations will be conducted. The trial will cover the period from the woman’s first hospital antenatal visit at 12 to 18 weeks gestation, until the completion of the pregnancy. Trial registration Current Controlled Trials: ISRCTN02232125 PMID:24438478

Improving Universal Suicide Prevention Screening in Primary Care by Reducing False Negatives

DTIC Science & Technology

2017-09-01

develop a shortened version of the Suicide Cognitions Scale (SCS) and to evaluate its efficacy as a universal suicide prevention screen for use in... Cognitions Scale (SCS) and to evaluate its efficacy as a universal suicide prevention screen for use in military primary care clinics. We propose to

The impact of different cross-training modalities on performance and injury-related variables in high school cross country runners.

PubMed

Paquette, Max R; Peel, Shelby A; Smith, Ross E; Temme, Mark; Dwyer, Jeffrey N

2017-11-29

There are many different types of aerobic cross-training modalities currently available. It is important to consider the effects that these different modalities have on running performance and injury risks. The purpose of this study was to compare movement quality, running economy and performance, injury-related biomechanical variables and, hip muscle strength before and after training with different cross-training modalities in high school runners. Thirty-one high school male runners trained for four weeks in one of three cross-training modalities, in addition to a running-only (RUN, n=9) group, for which training sessions replaced two easy runs per week: cycling (CYCLE; n=6), indoor elliptical (ELLIP; n=7) and, outdoor elliptical bike (EBIKE; n=9). Functional movement screen (FMS), running economy (RE), 3,000m performance, hip kinematics, hip muscle strength were assessed. Paired t-tests and Cohen's d effect sizes were used to assess mean differences for each variable before and after training within each group. EBIKE training was the only modality that improved FMS scores (d = 1.36) and RE before and after training (d = 0.48). All groups showed improvements in 3,000m performance but large effects were only found for the CYCLE (d = 1.50) and EBIKE (d = 1.41) groups. RUN (d = 1.25), CYCLE (d = 1.17) and, EBIKE (d = 0.82) groups showed improvements in maximal hip extensor strength. Outdoor cycling and elliptical bike cross-training may be the most effective cross-training modalities to incorporate in early season training to improve running performance in high school runners.

New bone post-processing tools in forensic imaging: a multi-reader feasibility study to evaluate detection time and diagnostic accuracy in rib fracture assessment.

PubMed

Glemser, Philip A; Pfleiderer, Michael; Heger, Anna; Tremper, Jan; Krauskopf, Astrid; Schlemmer, Heinz-Peter; Yen, Kathrin; Simons, David

2017-03-01

The aim of this multi-reader feasibility study was to evaluate new post-processing CT imaging tools in rib fracture assessment of forensic cases by analyzing detection time and diagnostic accuracy. Thirty autopsy cases (20 with and 10 without rib fractures in autopsy) were randomly selected and included in this study. All cases received a native whole body CT scan prior to the autopsy procedure, which included dissection and careful evaluation of each rib. In addition to standard transverse sections (modality A), CT images were subjected to a reconstruction algorithm to compute axial labelling of the ribs (modality B) as well as "unfolding" visualizations of the rib cage (modality C, "eagle tool"). Three radiologists with different clinical and forensic experience who were blinded to autopsy results evaluated all cases in a random manner of modality and case. Rib fracture assessment of each reader was evaluated compared to autopsy and a CT consensus read as radiologic reference. A detailed evaluation of relevant test parameters revealed a better accordance to the CT consensus read as to the autopsy. Modality C was the significantly quickest rib fracture detection modality despite slightly reduced statistic test parameters compared to modalities A and B. Modern CT post-processing software is able to shorten reading time and to increase sensitivity and specificity compared to standard autopsy alone. The eagle tool as an easy to use tool is suited for an initial rib fracture screening prior to autopsy and can therefore be beneficial for forensic pathologists.

Lung Cancer Screening with Low-Dose Computed Tomography for Primary Care Providers

PubMed Central

Richards, Thomas B.; White, Mary C.; Caraballo, Ralph S.

2015-01-01

This review provides an update on lung cancer screening with low-dose computed tomography (LDCT) and its implications for primary care providers. One of the unique features of lung cancer screening is the potential complexity in patient management if an LDCT scan reveals a small pulmonary nodule. Additional tests, consultation with multiple specialists, and follow-up evaluations may be needed to evaluate whether lung cancer is present. Primary care providers should know the resources available in their communities for lung cancer screening with LDCT and smoking cessation, and the key points to be addressed in informed and shared decision-making discussions with patients. PMID:24830610

Impact of a Brief Training on Medical Resident Screening for Alcohol Misuse and Illicit Drug Use

PubMed Central

Gunderson, Erik W.; Levin, Frances R.; Owen, Patricia

2011-01-01

Educational initiatives are needed to improve primary care substance use screening. This study assesses the impact on 24 medical residents of a 2.5-day curriculum combining experiential and manual-based training on screening for alcohol misuse and illicit drug use. A retrospective chart review of new primary care outpatients demonstrated that nearly all were asked about current alcohol use before and after curriculum participation. Adherence to national screening guidelines on quantification of alcohol consumption modestly improved (p < .05), as did inquiry about current illicit drug use (p < .05). Continued efforts are needed to enhance educational initiatives for primary care physicians. PMID:18393059

Impact of a brief training on medical resident screening for alcohol misuse and illicit drug use.

PubMed

Gunderson, Erik W; Levin, Frances R; Owen, Patricia

2008-01-01

Educational initiatives are needed to improve primary care substance use screening. This study assesses the impact on 24 medical residents of a 2.5-day curriculum combining experiential and manual-based training on screening for alcohol misuse and illicit drug use. A retrospective chart review of new primary care outpatients demonstrated that nearly all were asked about current alcohol use before and after curriculum participation. Adherence to national screening guidelines on quantification of alcohol consumption modestly improved (p < .05), as did inquiry about current illicit drug use (p < .05). Continued efforts are needed to enhance educational initiatives for primary care physicians.

Gender Differences in the Primary Representational System according to Neurolinguistic Programming.

ERIC Educational Resources Information Center

Cassiere, M. F.; And Others

Neurolinguistic Programming (NLP) is a currently popular therapeutic modality in which individuals organize information through three basic sensory systems, one of which is the Primary Representational System (PRS). This study was designed to investigate gender differences in PRS according to the predicate preference method. It was expected that…

Primary HPV testing versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program.

PubMed

Lew, Jie-Bin; Simms, Kate T; Smith, Megan A; Hall, Michaela; Kang, Yoon-Jung; Xu, Xiang Ming; Caruana, Michael; Velentzis, Louiza Sofia; Bessell, Tracey; Saville, Marion; Hammond, Ian; Canfell, Karen

2017-02-01

Australia's National Cervical Screening Program currently recommends cytological screening every 2 years for women aged 18-69 years. Human papillomavirus (HPV) vaccination was implemented in 2007 with high population coverage, and falls in high-grade lesions in young women have been reported extensively. This decline prompted a major review of the National Cervical Screening Program and new clinical management guidelines, for which we undertook this analysis. We did effectiveness modelling and an economic assessment of potential new screening strategies, using a model of HPV transmission, vaccination, natural history, and cervical screening. First, we evaluated 132 screening strategies, including those based on cytology and primary HPV testing. Second, after a recommendation was made to adopt primary HPV screening with partial genotyping and direct referral to colposcopy of women positive for HPV16/18, we evaluated the final effect of HPV screening after incorporating new clinical guidelines for women positive for HPV. Both evaluations considered both unvaccinated and vaccinated cohorts. Strategies entailing HPV testing every 5 years and either partial genotyping for HPV16/18 or cytological co-testing were the most effective. One of the most effective and cost-effective strategies comprised primary HPV screening with referral of women positive for oncogenic HPV16/18 direct to colposcopy, with reflex cytological triage for women with other oncogenic types and direct referral for those in this group with high-grade cytological findings. After incorporating detailed clinical guidelines recommendations, this strategy is predicted to reduce cervical cancer incidence and mortality by 31% and 36%, respectively, in unvaccinated cohorts, and by 24% and 29%, respectively, in cohorts offered vaccination. Furthermore, this strategy is predicted to reduce costs by up to 19% for unvaccinated cohorts and 26% for cohorts offered vaccination, compared with the current programme. Primary HPV screening every 5 years with partial genotyping is predicted to be substantially more effective and potentially cost-saving compared with the current cytology-based screening programme undertaken every 2 years. These findings underpin the decision to transition to primary HPV screening with partial genotyping in the Australian National Cervical Screening Program, which will occur in May, 2017. Department of Health, Australia. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license. Published by Elsevier Ltd.. All rights reserved.

Colorectal cancer screening: An updated review of the available options.

PubMed

Issa, Iyad A; Noureddine, Malak

2017-07-28

Colorectal cancer (CRC) is a significant cause of morbidity and mortality worldwide. However, colon cancer incidence and mortality is declining over the past decade owing to adoption of effective screening programs. Nevertheless, in some parts of the world, CRC incidence and mortality remain on the rise, likely due to factors including "westernized" diet, lifestyle, and lack of health-care infrastructure and resources. Participation and adherence to different national screening programs remain obstacles limiting the achievement of screening goals. Different modalities are available ranging from stool based tests to radiology and endoscopy with varying sensitivity and specificity. However, the availability of these tests is limited to areas with high economic resources. Recently, FDA approved a blood-based test (Epi procolon ® ) for CRC screening. This blood based test may serve to increase the participation and adherence rates. Hence, leading to increase in colon cancer detection and prevention. This article will discuss various CRC screening tests with a particular focus on the data regarding the new approved blood test. Finally, we will propose an algorithm for a simple cost-effective CRC screening program.

Impacts of household income and economic recession on participation in colorectal cancer screening in Korea.

PubMed

Myong, Jun-Pyo; Kim, Hyoung-Ryoul

2012-01-01

To assess the impact of household income and economic recession on participation in CRC screening, we estimated annual participating proportions from 2007 to 2009 for different CRC screening modalities according to household income levels. A total of 8,042 subjects were derived from the fourth Korean National Health and Nutrition Examination Survey (KNHANES IV). Multivariate logistic regression analysis was used to estimate odds ratios and 95% confidence intervals for CRC screening with household income quartiles by gender in each year. People were less likely to attend a high-cost CRC screening such as a sigmoidoscopy or colonoscopy independent of the income quartile during the economic recession. Income disparities for participating in opportunistic cancer screening appear to have existed among both males and females during the three years (2007-2009), but were most distinctive in 2009. An increase in mortality of CRC can therefore be expected due to late detection in periods of economic crisis. Accordingly, the government should expand the coverage of CRC screening to prevent excess deaths by reducing related direct and indirect costs during the economic recession.

Colorectal cancer screening: An updated review of the available options

PubMed Central

Issa, Iyad A; Noureddine, Malak

2017-01-01

Colorectal cancer (CRC) is a significant cause of morbidity and mortality worldwide. However, colon cancer incidence and mortality is declining over the past decade owing to adoption of effective screening programs. Nevertheless, in some parts of the world, CRC incidence and mortality remain on the rise, likely due to factors including “westernized” diet, lifestyle, and lack of health-care infrastructure and resources. Participation and adherence to different national screening programs remain obstacles limiting the achievement of screening goals. Different modalities are available ranging from stool based tests to radiology and endoscopy with varying sensitivity and specificity. However, the availability of these tests is limited to areas with high economic resources. Recently, FDA approved a blood-based test (Epi procolon®) for CRC screening. This blood based test may serve to increase the participation and adherence rates. Hence, leading to increase in colon cancer detection and prevention. This article will discuss various CRC screening tests with a particular focus on the data regarding the new approved blood test. Finally, we will propose an algorithm for a simple cost-effective CRC screening program. PMID:28811705

Patterns of cancer screening in primary care from 2005 to 2010.

PubMed

Martires, Kathryn J; Kurlander, David E; Minwell, Gregory J; Dahms, Eric B; Bordeaux, Jeremy S

2014-01-15

Cancer screening recommendations vary widely, especially for breast, prostate, and skin cancer screening. Guidelines are provided by the American Cancer Society, the US Preventive Services Task Force, and various professional organizations. The recommendations often differ with regard to age and frequency of screening. The objective of this study was to determine actual rates of screening in the primary care setting. Data from the National Ambulatory Medical Care Survey were used. Only adult visits to non-federally employed, office-based physicians for preventive care from 2005 through 2010 were examined. Prevalence rates for breast, pelvic, and rectal examinations were calculated, along with the rates for mammograms, Papanicolaou smears, and prostate-specific antigen tests. Factors associated with screening, including age, race, smoking status, and insurance type, were examined using t tests and chi-square tests. In total, 8521 visits were examined. The rates of most screening examinations and tests were stable over time. Clinical breast examinations took place significantly more than mammography was ordered (54.8% vs 34.6%; P<.001). White patients received more mammography (P=.031), skin examinations (P<.010), digital rectal examinations (P<.010), and prostate-specific antigen tests (P=.003) than patients of other races. Patients who paid with Medicare or private insurance received more screening than patients who had Medicaid or no insurance (P<.010). Current cancer screening practices in primary care vary significantly. Cancer screening may not follow evidence-based practices and may not be targeting patients considered most at risk. Racial and socioeconomic disparities are present in cancer screening in primary care. © 2013 American Cancer Society.

A population management system for improving colorectal cancer screening in a primary care setting.

PubMed

Wu, Charlotte A; Mulder, Amara L; Zai, Adrian H; Hu, Yuanshan; Costa, Manuela; Tishler, Lori Wiviott; Saltzman, John R; Ellner, Andrew L; Bitton, Asaf

2016-06-01

Provision of colorectal cancer (CRC) screening in primary care is suboptimal; failure to observe screening guidelines poses unnecessary risks to patients and doctors. Implement a population management system for CRC screening; evaluate impact on compliance with evidence-based guidelines. A quasi-experimental, prospective quality improvement study design using pre-post-analyses with concurrent controls. Six suites within an academic primary care practice. 5320 adults eligible for CRC screening treated by 70 doctors. In three intervention suites, doctors reviewed real-time rosters of patients due for CRC screening and chose practice delegate outreach or default reminder letter. Delegates tracked overdue patients, made outreach calls, facilitated test ordering, obtained records and documented patient deferral, exclusion or decline. In three control suites, doctors followed usual preventive care practices. CRC screening compliance (including documented decline, deferral or exclusion) and CRC screening completion rates over 5 months. At baseline, there was no significant difference in CRC screening compliance (I: 80.4% and C: 79.6%, P = 0.439) and CRC screening completion rates (I: 78.3% and C: 77.3%, P = 0.398) between intervention and control groups. Post-intervention, compliance rates (I: 88.1% and C: 80.5%, P < 0.01) and completion rates (I: 81.0% and C: 78.1%, P < 0.05) were significantly higher in the intervention group. A population management system using closed-loop communication may improve CRC screening compliance and completion rates within academic primary care practices. Team-based care using well-designed IT systems can enable sharing of patient care responsibilities and improve patient outcomes. © 2015 John Wiley & Sons, Ltd.

A qualitative study of primary care professionals’ views of case finding for depression in patients with diabetes or coronary heart disease in the UK

PubMed Central

2013-01-01

Background Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness. Methods Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland. Results We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis. Conclusion The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening. PMID:23557512

A qualitative study of primary care professionals' views of case finding for depression in patients with diabetes or coronary heart disease in the UK.

PubMed

Maxwell, Margaret; Harris, Fiona; Hibberd, Carina; Donaghy, Eddie; Pratt, Rebekah; Williams, Chris; Morrison, Jill; Gibb, Jennifer; Watson, Philip; Burton, Chris

2013-04-04

Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness. Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland. We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis. The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.

Comprehensive Screening for Suicide Risk in Primary Care.

PubMed

Diamond, Guy S; Herres, Joanna L; Krauthamer Ewing, E Stephanie; Atte, Tita O; Scott, Syreeta W; Wintersteen, Matt B; Gallop, Robert J

2017-07-01

Suicide is a major public health problem and a complex clinical challenge. Assessment and early identification could be enhanced with screening tools that look beyond depression. The purpose of this study was to identify profiles of risk behaviors and social stress associated with suicidal ideation and behavior using the Behavioral Health Screen. The study used screening data from 2,513 primary care patients (aged 14-24 years). Data were collected between 2008 and 2012, and were analyzed in 2016. Latent class analysis identified a high and low risk profile. Domains of primary influence included substance use, sexual assault, same-sex behavior, and unsafe sex. The high-risk group was 11 times more likely to have made a suicide attempt, five times more likely to report a history of suicidal ideation and behavior, and three times more likely to report recent suicidal ideation and behavior. Risk behaviors and social stress contribute to the risk for suicide above and beyond depression and should be assessed during routine primary care visits with adolescents. The Behavioral Health Screen can screen all these domains and thus assist primary care providers in assessing for both psychiatric and social stress factors associated with youth suicide. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

The Sector-Wide Approach in Bangladesh Primary Education: A Critical View. CREATE Pathways to Access. Research Monograph No. 57

ERIC Educational Resources Information Center

Ahmed, Manzoor

2011-01-01

This monograph, in the CREATE Pathways to Access series, is about the modality of cooperation and programme management in primary education in Bangladesh, based specifically on the experience of the Second Primary Education Development Programme (PEDP II). It is not intended to be an assessment of PEDP II accomplishments, but key information and a…

Utilization of cervical cancer screening services and its associated factors among primary school teachers in Ilala Municipality, Dar es Salaam, Tanzania.

PubMed

Kileo, Neema Minja; Michael, Denna; Neke, Nyasule Majura; Moshiro, Candida

2015-12-15

Worldwide cervical cancer is one of the more common forms of carcinoma among women, causing high morbidity and high mortality. Despite being a major health problem in Tanzania, screening services for cervical cancer are very limited, and uptake of those services is low. We therefore conducted a study to investigate utilization of cancer screening services, and its associated factors among female primary school teachers in Ilala Municipality, Dar es Salaam. We conducted a cross-sectional study between May - August 2011 which involved 110 primary schools in Ilala Municipality in Dar es Salaam. Five hundred and twelve female primary school teachers were sampled using a two-stage cluster sampling procedure. Data on utilization of cervical cancer and risk factors were collected using a self-administered questionnaire. Proportional utilization of cervical cancer screening services was identified through a self report. Risk factors for services utilization were assessed using logistic regression analyses. Out of 512 female primary school teachers, only 108 (21 %) reported to ever been screened for cervical cancer. Utilization of cervical cancer screening services was 28 % among those aged 20-29, 22 % among married and 24 % among those with higher level of education. Women were more likely to utilize the cancer-screening service if they were multiparous (age-adjusted OR = 3.05, 95 % CI 1.15-8.06, P value 0.025), or reported more than one lifetime sexual partner (age-adjusted OR 2.17, 95 % CI 1.04-4.54, P value 0.038), or did not involve their spouse in making health decisions (adjusted OR 3.56, 95 % CI 2.05-6.18, P value <0.001). The study has demonstrated low level of utilization of cervical cancer screening service among female primary school teachers in Ilala munipality. Female primary school teachers with more than one previous pregnancy and those with more than one life-time sex partners were more likely to report utilization of the service. Spouse or partners support was an important factor in the utilization of cervical cancer screening service amongst the study population.

CMHC practices related to tardive dyskinesia screening and informed consent for neuroleptic drugs.

PubMed

Benjamin, S; Munetz, M R

1994-04-01

The authors conducted a national survey of community mental health centers to determine their policies and practices about screening patients for tardive dyskinesia and obtaining informed consent for use of neuroleptic drugs. Clinical directors of 235 centers in the United States, selected by geographic region and population, were surveyed through a nine-item questionnaire. Although nearly all the 160 respondents reported that they screened patients for tardive dyskinesia, only about two-fifths had formal screening policies, and about two-fifths had screening programs. The Abnormal Involuntary Movement Scale examination was used by almost two-thirds of respondents who screened patients, and about one-fifth relied on unstructured observation. Slightly more than half of respondents specified a frequency for screening examinations, at a modal interval of six months. Seventy percent used nonpsychiatric clinicians for screening. Almost three-quarters of the respondents had informed consent policies for use of neuroleptics. Urban centers tended to be more aware than rural centers of the American Psychiatric Association's tardive dyskinesia screening guidelines. They also used fewer nonmedical practitioners for screening and were more likely to obtain informed consent for neuroleptics. Despite the existence of APA guidelines and state policies and regulations about tardive dyskinesia screening, a national effort to educate clinicians about prevention of tardive dyskinesia is still needed.

Screening tools for the identification of dementia for adults with age-related acquired hearing or vision impairment: a scoping review.

PubMed

Pye, Annie; Charalambous, Anna Pavlina; Leroi, Iracema; Thodi, Chrysoulla; Dawes, Piers

2017-11-01

Cognitive screening tests frequently rely on items being correctly heard or seen. We aimed to identify, describe, and evaluate the adaptation, validity, and availability of cognitive screening and assessment tools for dementia which have been developed or adapted for adults with acquired hearing and/or vision impairment. Electronic databases were searched using subject terms "hearing disorders" OR "vision disorders" AND "cognitive assessment," supplemented by exploring reference lists of included papers and via consultation with health professionals to identify additional literature. 1,551 papers were identified, of which 13 met inclusion criteria. Four papers related to tests adapted for hearing impairment; 11 papers related to tests adapted for vision impairment. Frequently adapted tests were the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MOCA). Adaptations for hearing impairment involved deleting or creating written versions for hearing-dependent items. Adaptations for vision impairment involved deleting vision-dependent items or spoken/tactile versions of visual tasks. No study reported validity of the test in relation to detection of dementia in people with hearing/vision impairment. Item deletion had a negative impact on the psychometric properties of the test. While attempts have been made to adapt cognitive tests for people with acquired hearing and/or vision impairment, the primary limitation of these adaptations is that their validity in accurately detecting dementia among those with acquired hearing or vision impairment is yet to be established. It is likely that the sensitivity and specificity of the adapted versions are poorer than the original, especially if the adaptation involved item deletion. One solution would involve item substitution in an alternative sensory modality followed by re-validation of the adapted test.

Estimating the cost of cervical cancer screening in five developing countries

PubMed Central

Goldhaber-Fiebert, Jeremy D; Goldie, Sue J

2006-01-01

Background Cost-effectiveness analyses (CEAs) can provide useful information to policymakers concerned with the broad allocation of resources as well as to local decision makers choosing between different options for reducing the burden from a single disease. For the latter, it is important to use country-specific data when possible and to represent cost differences between countries that might make one strategy more or less attractive than another strategy locally. As part of a CEA of cervical cancer screening in five developing countries, we supplemented limited primary cost data by developing other estimation techniques for direct medical and non-medical costs associated with alternative screening approaches using one of three initial screening tests: simple visual screening, HPV DNA testing, and cervical cytology. Here, we report estimation methods and results for three cost areas in which data were lacking. Methods To supplement direct medical costs, including staff, supplies, and equipment depreciation using country-specific data, we used alternative techniques to quantify cervical cytology and HPV DNA laboratory sample processing costs. We used a detailed quantity and price approach whose face validity was compared to an adaptation of a US laboratory estimation methodology. This methodology was also used to project annual sample processing capacities for each laboratory type. The cost of sample transport from the clinic to the laboratory was estimated using spatial models. A plausible range of the cost of patient time spent seeking and receiving screening was estimated using only formal sector employment and wages as well as using both formal and informal sector participation and country-specific minimum wages. Data sources included primary data from country-specific studies, international databases, international prices, and expert opinion. Costs were standardized to year 2000 international dollars using inflation adjustment and purchasing power parity. Results Cervical cytology laboratory processing costs were I$1.57–3.37 using the quantity and price method compared to I$1.58–3.02 from the face validation method. HPV DNA processing costs were I$6.07–6.59. Rural laboratory transport costs for cytology were I$0.12–0.64 and I$0.14–0.74 for HPV DNA laboratories. Under assumptions of lower resource efficiency, these estimates increased to I$0.42–0.83 and I$0.54–1.06. Estimates of the value of an hour of patient time using only formal sector participation were I$0.07–4.16, increasing to I$0.30–4.80 when informal and unpaid labor was also included. The value of patient time for traveling, waiting, and attending a screening visit was I$0.68–17.74. With the total cost of screening for cytology and HPV DNA testing ranging from I$4.85–40.54 and I$11.30–48.77 respectively, the cost of the laboratory transport, processing, and patient time accounted for 26–66% and 33–65% of the total costs. From a payer perspective, laboratory transport and processing accounted for 18–48% and 25–60% of total direct medical costs of I$4.11–19.96 and I$10.57–28.18 respectively. Conclusion Cost estimates of laboratory processing, sample transport, and patient time account for a significant proportion of total cervical cancer screening costs in five developing countries and provide important inputs for CEAs of alternative screening modalities. PMID:16887041

Deaf College Students' Representation of Image and Verbal Information.

ERIC Educational Resources Information Center

Epstein, Kenneth; And Others

This paper discusses the results of a study of 27 college students with deafness that investigated whether cognitive processes are modality dependent in individuals with deafness. The experiment included two separate parts, one composed of shape trials and the other composed of word trials. An initial stimulus was shown on a computer screen for…

Multimodality, "Reading", and "Writing" for the 21st Century

ERIC Educational Resources Information Center

Jewitt, Carey

2005-01-01

As words fly onto the computer screen, revolve, and dissolve, image, sound, and movement enter school classrooms in "new" and significant ways, ways that reconfigure the relationship of image and word. In this paper I discuss these "new" modal configurations and explore how they impact on students' text production and reading…

Surface Enhanced Raman Spectroscopy (SERS) and multivariate analysis as a screening tool for detecting Sudan I dye in culinary spices

NASA Astrophysics Data System (ADS)

Di Anibal, Carolina V.; Marsal, Lluís F.; Callao, M. Pilar; Ruisánchez, Itziar

2012-02-01

Raman spectroscopy combined with multivariate analysis was evaluated as a tool for detecting Sudan I dye in culinary spices. Three Raman modalities were studied: normal Raman, FT-Raman and SERS. The results show that SERS is the most appropriate modality capable of providing a proper Raman signal when a complex matrix is analyzed. To get rid of the spectral noise and background, Savitzky-Golay smoothing with polynomial baseline correction and wavelet transform were applied. Finally, to check whether unadulterated samples can be differentiated from samples adulterated with Sudan I dye, an exploratory analysis such as principal component analysis (PCA) was applied to raw data and data processed with the two mentioned strategies. The results obtained by PCA show that Raman spectra need to be properly treated if useful information is to be obtained and both spectra treatments are appropriate for processing the Raman signal. The proposed methodology shows that SERS combined with appropriate spectra treatment can be used as a practical screening tool to distinguish samples suspicious to be adulterated with Sudan I dye.

EDRN Breast and Ovary Cancer CVC, Study 3: Phase 3 Validation of screening decision rules in preclinical UKCTOCS serial samples — EDRN Public Portal

Cancer.gov

We will collaborate with investigators from University College London to test a screening decision rule in preclinical serial samples from the U.K. Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) to learn if the panel can do better than CA125 alone. The UKCTOCS is an ideal setting for retrospective validation of an early detection marker panel and decision rule because it offers serial samples collected annually and use of imaging in women with rising CA125. Multi-modal strategies using serum markers HE4, MSLN, MMP7, and CA125 will be compared to strategies relying exclusively on CA125 and transvaginal sonography (TVS).

Does working memory capacity predict cross-modally induced failures of awareness?

PubMed

Kreitz, Carina; Furley, Philip; Simons, Daniel J; Memmert, Daniel

2016-01-01

People often fail to notice unexpected stimuli when they are focusing attention on another task. Most studies of this phenomenon address visual failures induced by visual attention tasks (inattentional blindness). Yet, such failures also occur within audition (inattentional deafness), and people can even miss unexpected events in one sensory modality when focusing attention on tasks in another modality. Such cross-modal failures are revealing because they suggest the existence of a common, central resource limitation. And, such central limits might be predicted from individual differences in cognitive capacity. We replicated earlier evidence, establishing substantial rates of inattentional deafness during a visual task and inattentional blindness during an auditory task. However, neither individual working memory capacity nor the ability to perform the primary task predicted noticing in either modality. Thus, individual differences in cognitive capacity did not predict failures of awareness even though the failures presumably resulted from central resource limitations. Copyright © 2015 Elsevier Inc. All rights reserved.

Cost-Effectiveness Comparison of Breast Cancer Screening and Vascular Event Primary Prevention with Aspirin in Wales

ERIC Educational Resources Information Center

Morgan, Gareth

2011-01-01

Aim: For the first time, this article presents a cost-effectiveness comparison of a breast cancer screening programme with a possible health education programme with aspirin for vascular event primary prevention. Background: Breast cancer screening is a well established part of cancer control programmes yet recent evidence on this intervention has…

Accuracy of digital arm and wrist manometers: clinical implications for the dental hygienist.

PubMed

Furgeson, Danielle; Mickels-Foster, Nancy

2013-10-01

Utilization of digital manometers chairside is fast becoming a standard of care in dental hygiene education. It is imperative to ensure accurate blood pressure measurements regardless of modality to avoid medical emergencies in the dental chair. This study sought to determine the accuracy of the automated digital arm and wrist cuffs utilized by students in the University of Maine at Augusta, Bangor Campus Dental Health Programs' dental hygiene clinic. After institutional review board approval, 121 subjects were recruited, with 21 excluded for a total of 100 subjects. Subjects were randomly assigned to different test modalities upon check-in. Initial blood pressure measurements were taken with a calibrated aneroid control device by a principal investigator. A second measurement was taken with the randomized arm or wrist manometer 5 minutes later. Investigators were blinded to the modality of test manometer and measurements obtained from the second reading. All readings were taken according to manufacturers' instructions to ensure technique consistency. Data indicated lower readings for each modality from the control for both systolic and diastolic measurements. The differences in the systolic and diastolic readings for the wrist modality were significantly lower than the control with (p= 0.000) and (p=0.000), respectively. Automated digital manometers should be used with caution as a screening tool in the dental setting, particularly when administration of pharmacological agents such as local anesthesia may be used during the course of treatment. These automated modalities should not be used for patients with cardiac or hypertensive conditions.

FEATURES, EVENTS, AND PROCESSES: SYSTEM-LEVEL AND CRITICALITY

DOE Office of Scientific and Technical Information (OSTI.GOV)

D.L. McGregor

The primary purpose of this Analysis/Model Report (AMR) is to identify and document the screening analyses for the features, events, and processes (FEPs) that do not easily fit into the existing Process Model Report (PMR) structure. These FEPs include the 3 1 FEPs designated as System-Level Primary FEPs and the 22 FEPs designated as Criticality Primary FEPs. A list of these FEPs is provided in Section 1.1. This AMR (AN-WIS-MD-000019) documents the Screening Decision and Regulatory Basis, Screening Argument, and Total System Performance Assessment (TSPA) Disposition for each of the subject Primary FEPs. This AMR provides screening information and decisionsmore » for the TSPA-SR report and provides the same information for incorporation into a project-specific FEPs database. This AMR may also assist reviewers during the licensing-review process.« less

Evidence-Based Practice in Liposuction.

PubMed

Collins, Patrick S; Moyer, Kurtis E

2018-06-01

The goal of this study is to examine the existing peer reviewed literature comparing modern adjunctive techniques in liposuction including laser-assisted liposuction (LAL) and ultrasound-assisted liposuction (UAL) to standard suction-assisted liposuction (SAL). We intend to interpret these findings into a literature-based clinical application to influence practice patterns. A literature review was conducted using a keyword search in PubMed. Keyword search items included liposuction, lipoplasty, suction assisted liposuction, ultrasound assisted liposuction, laser assisted liposuction, tumescent, liposuction comparison, liposuction review, and combinations therein. Exclusion criteria included articles with a primary focus on histologic effects of energy devices, primary animal models, primary opinion papers with no reference to available data, and industry-sponsored publications. Inclusion criteria included articles with direct comparison of liposuction modalities, randomized or blinded studies, and studies with objective outcomes. Twenty-five articles that met the inclusion criteria comparing SAL to UAL or LAL out of 9972 articles identified were obtained. The selected literature was assigned into 3 categories: evidence demonstrating an advantage of 1 modality (SAL, UAL, or LAL) over another, evidence that showed no benefit of 1 modality over another, and evidence that demonstrated risks of complications of 1 modality over another. The benefits of UAL and LAL over SAL include the following: (1) UAL over SAL in the treatment of gynecomastia, (2) LAL and UAL over SAL with decreased hemoglobin/hematocrit in high-volume lipoaspirates, and (3) LAL over SAL with skin tightening in select areas specifically the submental area. Otherwise, the literature demonstrates equivocal results among the described techniques with no clear benefit to set one apart from the other. There appears to be no demonstrable added benefit to the addition of either UAL or LAL that would urge a change in practice patterns outside the exceptions listed.

Visual Information Present in Infragranular Layers of Mouse Auditory Cortex.

PubMed

Morrill, Ryan J; Hasenstaub, Andrea R

2018-03-14

The cerebral cortex is a major hub for the convergence and integration of signals from across the sensory modalities; sensory cortices, including primary regions, are no exception. Here we show that visual stimuli influence neural firing in the auditory cortex of awake male and female mice, using multisite probes to sample single units across multiple cortical layers. We demonstrate that visual stimuli influence firing in both primary and secondary auditory cortex. We then determine the laminar location of recording sites through electrode track tracing with fluorescent dye and optogenetic identification using layer-specific markers. Spiking responses to visual stimulation occur deep in auditory cortex and are particularly prominent in layer 6. Visual modulation of firing rate occurs more frequently at areas with secondary-like auditory responses than those with primary-like responses. Auditory cortical responses to drifting visual gratings are not orientation-tuned, unlike visual cortex responses. The deepest cortical layers thus appear to be an important locus for cross-modal integration in auditory cortex. SIGNIFICANCE STATEMENT The deepest layers of the auditory cortex are often considered its most enigmatic, possessing a wide range of cell morphologies and atypical sensory responses. Here we show that, in mouse auditory cortex, these layers represent a locus of cross-modal convergence, containing many units responsive to visual stimuli. Our results suggest that this visual signal conveys the presence and timing of a stimulus rather than specifics about that stimulus, such as its orientation. These results shed light on both how and what types of cross-modal information is integrated at the earliest stages of sensory cortical processing. Copyright © 2018 the authors 0270-6474/18/382854-09$15.00/0.

Resources Required for Cervical Cancer Prevention in Low- and Middle-Income Countries.

PubMed

Campos, Nicole G; Sharma, Monisha; Clark, Andrew; Kim, Jane J; Resch, Stephen C

2016-01-01

Cervical cancer is the fourth leading cause of cancer death in women, with 85% of cases and deaths occurring in developing countries. While organized screening programs have reduced cervical cancer incidence in high-income countries through detection and treatment of precancerous lesions, the implementation of organized screening has not been effective in low-resource settings due to lack of infrastructure and limited budgets. Our objective was to estimate the cost of comprehensive primary and secondary cervical cancer prevention in low- and middle-income countries. We performed a modeling analysis to estimate 1) for girls aged 10 years, the cost of 2-dose human papillomavirus (HPV) vaccination; and 2) for women aged 30 to 49 years, the cost of cervical cancer screening (with visual inspection with acetic acid (VIA), HPV testing, or cytology) and preventive treatment in 102 low- and middle-income countries from 2015 to 2024. We used an Excel-based costing and service utilization model to estimate financial costs (2013 US$) based on prevalence of HPV, prevalence of precancerous lesions, and screening test performance. Where epidemiologic data were unavailable, we extrapolated from settings with data using an individual-based microsimulation model of cervical carcinogenesis (calibrated to 20 settings) and multivariate regression. Total HPV vaccination costs ranged from US$8.6 billion to US$24.2 billion for all scenarios considered (immediate, 5-year, or 10-year roll-out; price per dose US$4.55-US$70 by country income level). The total cost of screening and preventive treatment ranged from US$5.1 billion (10-year roll-out, screening once at age 35 years) to US$42.3 billion (immediate roll-out, high intensity screening). Limitations of this analysis include the assumption of standardized protocols by country income level that did not account for the potential presence of multiple screening modalities or management strategies within a country, and extrapolation of cost and epidemiologic data to settings where data were limited. The estimated cost of comprehensive cervical cancer prevention with 2-dose HPV vaccination of 10-year-old girls and screening of women aged 30 to 49 years ranges from US$13.7 billion to US$66.5 billion, depending on speed of roll-out, vaccine price per dose, and screening test and frequency. Findings demonstrate the substantial impact of vaccine price in middle-income countries that are not eligible for assistance from Gavi, the Vaccine Alliance. Replacing routine cytology with HPV-based screening may reduce total costs. Data on the health impact and relative cost-effectiveness of strategies are needed to determine the best value for public health dollars.

Resources Required for Cervical Cancer Prevention in Low- and Middle-Income Countries

PubMed Central

Campos, Nicole G.; Sharma, Monisha; Clark, Andrew; Kim, Jane J.; Resch, Stephen C.

2016-01-01

Background Cervical cancer is the fourth leading cause of cancer death in women, with 85% of cases and deaths occurring in developing countries. While organized screening programs have reduced cervical cancer incidence in high-income countries through detection and treatment of precancerous lesions, the implementation of organized screening has not been effective in low-resource settings due to lack of infrastructure and limited budgets. Our objective was to estimate the cost of comprehensive primary and secondary cervical cancer prevention in low- and middle-income countries. Methods and Findings We performed a modeling analysis to estimate 1) for girls aged 10 years, the cost of 2-dose human papillomavirus (HPV) vaccination; and 2) for women aged 30 to 49 years, the cost of cervical cancer screening (with visual inspection with acetic acid (VIA), HPV testing, or cytology) and preventive treatment in 102 low- and middle-income countries from 2015 to 2024. We used an Excel-based costing and service utilization model to estimate financial costs (2013 US$) based on prevalence of HPV, prevalence of precancerous lesions, and screening test performance. Where epidemiologic data were unavailable, we extrapolated from settings with data using an individual-based microsimulation model of cervical carcinogenesis (calibrated to 20 settings) and multivariate regression. Total HPV vaccination costs ranged from US$8.6 billion to US$24.2 billion for all scenarios considered (immediate, 5-year, or 10-year roll-out; price per dose US$4.55-US$70 by country income level). The total cost of screening and preventive treatment ranged from US$5.1 billion (10-year roll-out, screening once at age 35 years) to US$42.3 billion (immediate roll-out, high intensity screening). Limitations of this analysis include the assumption of standardized protocols by country income level that did not account for the potential presence of multiple screening modalities or management strategies within a country, and extrapolation of cost and epidemiologic data to settings where data were limited. Conclusions The estimated cost of comprehensive cervical cancer prevention with 2-dose HPV vaccination of 10-year-old girls and screening of women aged 30 to 49 years ranges from US$13.7 billion to US$66.5 billion, depending on speed of roll-out, vaccine price per dose, and screening test and frequency. Findings demonstrate the substantial impact of vaccine price in middle-income countries that are not eligible for assistance from Gavi, the Vaccine Alliance. Replacing routine cytology with HPV-based screening may reduce total costs. Data on the health impact and relative cost-effectiveness of strategies are needed to determine the best value for public health dollars. PMID:27711124

Primary Care Screening of Depression and Treatment Engagement in a University Health Center: A Retrospective Analysis

ERIC Educational Resources Information Center

Klein, Michael C.; Ciotoli, Carlo; Chung, Henry

2011-01-01

Objectives: This retrospective study analyzed a primary care depression screening initiative in a large urban university health center. Depression detection, treatment status, and engagement data are presented. Participants: Participants were 3,713 graduate and undergraduate students who presented consecutively for primary care services between…

Projected future impact of HPV vaccination and primary HPV screening on cervical cancer rates from 2017-2035: Example from Australia.

PubMed

Hall, Michaela T; Simms, Kate T; Lew, Jie-Bin; Smith, Megan A; Saville, Marion; Canfell, Karen

2018-01-01

Many countries are transitioning from cytology-based to longer-interval HPV screening. Trials comparing HPV-based screening to cytology report an increase in CIN2/3 detection at the first screen, and longer-term reductions in CIN3+; however, population level year-to-year transitional impacts are poorly understood. We undertook a comprehensive evaluation of switching to longer-interval primary HPV screening in the context of HPV vaccination. We used Australia as an example setting, since Australia will make this transition in December 2017. Using a model of HPV vaccination, transmission, natural history and cervical screening, Policy1-Cervix, we simulated the planned transition from recommending cytology every two years for sexually-active women aged 18-20 to 69, to recommending HPV screening every five years for women aged 25-74 years. We estimated rates of CIN2/3, cervical cancer incidence, and mortality for each year from 2005 to 2035, considering ranges for HPV test accuracy and screening compliance in the context of HPV vaccination (current coverage ~82% in females; ~76% in males). Transient increases are predicted to occur in rates of CIN2/3 detection and invasive cervical cancer in the first two to three years following the screening transition (of 16-24% and 11-14% in respectively, compared to 2017 rates). However, by 2035, CIN2/3 and invasive cervical cancer rates are predicted to fall by 40-44% and 42-51%, respectively, compared to 2017 rates. Cervical cancer mortality rates are predicted to remain unchanged until ~2020, then decline by 34-45% by 2035. Over the period 2018-2035, switching to primary HPV screening in Australia is expected to avert 2,006 cases of invasive cervical cancer and save 587 lives. Transient increases in detected CIN2/3 and invasive cancer, which may be detectable at the population level, are predicted following a change to primary HPV screening. This is due to improved test sensitivity bringing forward diagnoses, resulting in longer term reductions in both cervical cancer incidence and mortality. Fluctuations in health outcomes due to the transition to a longer screening interval are predicted to occur for 10-15 years, but cervical cancer rates will be significantly reduced thereafter due to the impact of HPV vaccination and HPV screening. In order to maintain confidence in primary HPV screening through the transitional phase, it is important to widely communicate that an initial increase in CIN2/3 and perhaps even invasive cervical cancer is expected after a national transition to primary HPV screening, that this phenomenon is due to increased prevalent disease detection, and that this effect represents a marker of screening success.

Variation in Screening Abnormality Rates and Follow-Up of Breast, Cervical and Colorectal Cancer Screening within the PROSPR Consortium.

PubMed

Tosteson, Anna N A; Beaber, Elisabeth F; Tiro, Jasmin; Kim, Jane; McCarthy, Anne Marie; Quinn, Virginia P; Doria-Rose, V Paul; Wheeler, Cosette M; Barlow, William E; Bronson, Mackenzie; Garcia, Michael; Corley, Douglas A; Haas, Jennifer S; Halm, Ethan A; Kamineni, Aruna; Rutter, Carolyn M; Tosteson, Tor D; Trentham-Dietz, Amy; Weaver, Donald L

2016-04-01

Primary care providers and health systems have prominent roles in guiding effective cancer screening. To characterize variation in screening abnormality rates and timely initial follow-up for common cancer screening tests. Population-based cohort undergoing screening in 2011, 2012, or 2013 at seven research centers comprising the National Cancer Institute-sponsored Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. Adults undergoing mammography with or without digital breast tomosynthesis (n = 97,683 ages 40-75 years), fecal occult blood or fecal immunochemical tests (n = 759,553 ages 50-75 years), or Papanicolaou with or without human papillomavirus tests (n = 167,330 ages 21-65 years). Breast, colorectal, or cervical cancer screening. Abnormality rates per 1000 screens; percentage with timely initial follow-up (within 90 days, except 9-month window for BI-RADS 3). Primary care clinic-level variation in percentage with screening abnormality and percentage with timely initial follow-up. There were 10,248/97,683 (104.9 per 1000) abnormal breast cancer screens, 35,847/759,553 (47.2 per 1000) FOBT/FIT-positive colorectal cancer screens, and 13,266/167,330 (79.3 per 1000) abnormal cervical cancer screens. The percentage with timely follow-up was 93.2 to 96.7 % for breast centers, 46.8 to 68.7  % for colorectal centers, and 46.6 % for the cervical cancer screening center (low-grade squamous intraepithelial lesions or higher). The primary care clinic variation (25th to 75th percentile) was smaller for the percentage with an abnormal screen (breast, 8.5-10.3 %; colorectal, 3.0-4.8 %; cervical, 6.3-9.9 %) than for the percentage with follow-up within 90 days (breast, 90.2-95.8 %; colorectal, 43.4-52.0 %; cervical, 29.6-61.4 %). Variation in both the rate of screening abnormalities and their initial follow-up was evident across organ sites and primary care clinics. This highlights an opportunity for improving the delivery of cancer screening through focused study of patient, provider, clinic, and health system characteristics associated with timely follow-up of screening abnormalities.

Validity of the AUDIT-C screen for at-risk drinking among students utilizing university primary care.

PubMed

Campbell, Clare E; Maisto, Stephen A

2018-03-22

Research is needed to establish the psychometric properties of brief screens in university primary care settings. This study aimed to assess the construct validity of one such screen, the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), for detecting at-risk drinking among students who have utilized on-campus primary care. 389 students recently seen in university primary care completed a confidential online survey in December 2014. Bivariate correlations between the AUDIT-C and measures of alcohol consumption and negative drinking consequences provided concurrent evidence for construct validity. Receiver Operating Characteristic curve analyses determined optimal cut-off scores for at-risk drinking. The AUDIT-C significantly correlated with measures of alcohol consumption and negative drinking consequences (p < .001). Analyses support optimal AUDIT-C cut-off scores of 5 for females and 7 for males. The AUDIT-C is a valid screen for at-risk drinking among students who utilize university primary care.

Predictors of skin cancer screening practice and attitudes in primary care.

PubMed

Rodriguez, Georgette L; Ma, Fangchao; Federman, Daniel G; Rouhani, Panta; Chimento, Stacy; Multach, Mark; Kirsner, Robert S

2007-11-01

Physician visits provide invaluable opportunities to screen patients for skin cancer, yielding earlier detection and improved survival. We sought to assess frequency of skin cancer screening by full body skin examinations (FBSE) by primary care physicians, patient attitudes toward FBSE, and risk factors for cutaneous malignancy. Questionnaires were distributed to patients at primary care and dermatology clinics. A total of 426 participants were surveyed. Overall, 20% of patients reported having undergone regular FBSE by their primary care physician. Sex, race, personal skin cancer history, and Fitzpatrick skin type were predictive of whether a FBSE was performed by a patient's primary care physician. Men were more likely to report having undergone a FBSE (22% vs 19%; P < .01); women were more likely to report feeling embarrassed by a FBSE (15% vs 4%; P < .01). This study was conducted at a single site academic center. Although low rates of skin cancer screening are reported by patients, those at higher risk are being screened more frequently. Sex disparity exists, and as both male and female patients have a strong preference to undergo FBSE, unmet opportunities for skin cancer prevention should be maximized.

Biological characterization of preclinical Bioluminescent Osteosarcoma Orthotopic Mouse (BOOM) model: A multi-modality approach

PubMed Central

Garimella, Rama; Eskew, Jeff; Bhamidi, Priyanka; Vielhauer, George; Hong, Yan; Anderson, H. Clarke; Tawfik, Ossama; Rowe, Peter

2013-01-01

Osteosarcoma (OS) is a bone malignancy that affects children and adolescents. It is a highly aggressive tumor and typically metastasizes to lungs. Despite aggressive chemotherapy and surgical treatments, the current 5 year survival rate is 60–70%. Clinically relevant models are needed to understand OS pathobiology, metastatic progression from bones to lungs, and ultimately, to develop more efficacious treatment strategies and improve survival rates in OS patients with metastasis. The main goal of this study was to develop and characterize an in vivo OS model that will allow non-invasive tracking of tumor progression in real time, and aid in studying OS pathobiology, and screening of potential therapeutic agents against OS. In this study, we have used a multi-modality approach using bioluminescent imaging, electron microscopy, micro-computed tomography, and histopathology to develop and characterize a preclinical Bioluminescent Osteosarcoma Orthotopic Mouse (BOOM) model, using 143B human OS cell line. The results of this study clearly demonstrate that the BOOM model represents the clinical disease as evidenced by a spectrum of changes associated with tumor establishment, progression and metastasis, and detection of known OS biomarkers in the primary and metastatic tumor tissue. Key novel findings of this study include: (a) multimodality approach for extensive characterization of the BOOM model using 143B human OS cell line; (b) evidence of renal metastasis in OS orthotopic model using 143B cells; (c) evidence of Runx2 expression in the metastatic lung tissue; and (d) evidence of the presence of extracellular membrane vesicles and myofibroblasts in the BOOM model. PMID:25688332

Multi-modal two-step floating catchment area analysis of primary health care accessibility.

PubMed

Langford, Mitchel; Higgs, Gary; Fry, Richard

2016-03-01

Two-step floating catchment area (2SFCA) techniques are popular for measuring potential geographical accessibility to health care services. This paper proposes methodological enhancements to increase the sophistication of the 2SFCA methodology by incorporating both public and private transport modes using dedicated network datasets. The proposed model yields separate accessibility scores for each modal group at each demand point to better reflect the differential accessibility levels experienced by each cohort. An empirical study of primary health care facilities in South Wales, UK, is used to illustrate the approach. Outcomes suggest the bus-riding cohort of each census tract experience much lower accessibility levels than those estimated by an undifferentiated (car-only) model. Car drivers' accessibility may also be misrepresented in an undifferentiated model because they potentially profit from the lower demand placed upon service provision points by bus riders. The ability to specify independent catchment sizes for each cohort in the multi-modal model allows aspects of preparedness to travel to be investigated. Copyright © 2016. Published by Elsevier Ltd.

A postgraduation follow-up of social work students trained in "SBIRT": Rates of usage and perceptions of effectiveness.

PubMed

Senreich, Evan; Ogden, Lydia P; Greenberg, Joy Pastan

2017-01-01

Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based modality that can help social workers work with substance-using clients as part of an integrated health care approach. This study reports the findings of a post-graduation one-year follow-up survey of 193 master's and bachelor's social work students trained in SBIRT in practice courses at a Northeast urban college. Forty-three percent of the trainees who were practicing social work after graduation were using SBIRT. A content analysis of participants' comments found that the vast majority found SBIRT to be a valuable practice modality, with barriers to utilization of SBIRT identified.

Visual Speech-Training Aid for the Deaf

NASA Technical Reports Server (NTRS)

Miller, Robert J.

1987-01-01

Teaching deaf to speak aided by electronic system provides striking colored, pictorial representation of sound; energy at different frequencies as function of time. Other modalities, such as nasality, intra-oral pressure, and lip-muscle contraction, pictorialized simultaneously. Use of standard components, including personal microcomputer, helps reduce cost below prior voice-training systems. Speech-training system, microphone output separated by filters into narrow frequency bands, changed into digital signals, formatted by computer, and displayed on television screen. Output from other sensors displayed simultaneously or screen split to allow sound produced by student to be compared with that of teacher.

Early Psoriatic Arthritis.

PubMed

McHugh, Neil John

2015-11-01

Skin psoriasis is a major risk factor for the development of psoriatic arthritis. Recent studies have shown that delayed diagnosis is associated with long-term adverse outcomes. Screening questionnaires have revealed a potential burden of undiagnosed disease. Lifestyle factors and genetic and soluble biomarkers have come under scrutiny as risk factors. Imaging modalities may have an important role in detecting early change. With more effective treatments, it may be possible to prevent significant joint damage and associated disability. However, the precise nature of accurate and cost-effective screening strategies remains to be determined. Copyright © 2015 Elsevier Inc. All rights reserved.

The Relationship Between Colorectal Cancer Screening Adherence and Knowledge Among Vulnerable Rural Residents of Appalachian Kentucky

PubMed Central

Bardach, Shoshana H.; Schoenberg, Nancy E.; Fleming, Steven T.; Hatcher, Jennifer

2011-01-01

Background Colorectal cancer (CRC) is one of the leading causes of cancer related deaths among residents of rural Appalachia. Rates of guideline-consistent CRC screening in Appalachian Kentucky are suboptimal. Objective This study sought to determine the relationship between colorectal cancer screening knowledge, specifically regarding recommended screening intervals, and receipt of screening among residents of rural Appalachian Kentucky. Methods Residents of Appalachian Kentucky (n=1096) between the ages of 50 and 76 completed a telephone survey including questions on demographics, health history, and knowledge about colorectal cancer screening between November 20, 2009 and April 22, 2010. Results While 67% of respondents indicated receiving screenings according to guidelines, respondents also demonstrated significant knowledge deficiencies about screening recommendations. Nearly half of respondents were unable to identify the recommended screening frequency for any of the colorectal cancer screening modalities. Accuracy about the recommended frequency of screening was positively associated with screening adherence. Conclusions Enhanced educational approaches have the potential to increase colorectal cancer screening adherence in this population and reduce cancer mortality in this underserved region. Implications for practice Nurses play a critical role in patient education, which ultimately may increase screening rates. To fulfill this role, nurses should incorporate current recommendation about CRC screening into educational sessions. Advanced practices nurses in rural settings should also be aware of the increased vulnerability of their patient population and develop strategies to enhance awareness about CRC and the accompanying screening tests. PMID:21946905

Validating the Primary Care Posttraumatic Stress Disorder Screen and the Posttraumatic Stress Disorder Checklist with Soldiers Returning from Combat

ERIC Educational Resources Information Center

Bliese, Paul D.; Wright, Kathleen M.; Adler, Amy B.; Cabrera, Oscar; Castro, Carl A.; Hoge, Charles W.

2008-01-01

The purpose of the research was to assess the diagnostic efficiency of the Primary Care Posttraumatic Stress Disorder Screen (PC-PTSD) and the Posttraumatic Stress Disorder Checklist (PCL) as clinical screening tools for active duty soldiers recently returned from a combat deployment. A secondary goal was to examine the item-level characteristics…

Effectively Communicating Colorectal Cancer Screening Information to Primary Care Providers: Application for State, Tribe or Territory Comprehensive Cancer Control Coalitions

ERIC Educational Resources Information Center

Redmond, Jennifer; Vanderpool, Robin; McClung, Rebecca

2012-01-01

Background: Patients are more likely to be screened for colorectal cancer if it is recommended by a health care provider. Therefore, it is imperative that providers have access to the latest screening guidelines. Purpose: This practice-based project sought to identify Kentucky primary care providers' preferred sources and methods of receiving…

Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five-country cluster randomized factorial trial.

PubMed

Anderson, Peter; Bendtsen, Preben; Spak, Fredrik; Reynolds, Jillian; Drummond, Colin; Segura, Lidia; Keurhorst, Myrna N; Palacio-Vieira, Jorge; Wojnar, Marcin; Parkinson, Kathryn; Colom, Joan; Kłoda, Karolina; Deluca, Paolo; Baena, Begoña; Newbury-Birch, Dorothy; Wallace, Paul; Heinen, Maud; Wolstenholme, Amy; van Steenkiste, Ben; Mierzecki, Artur; Okulicz-Kozaryn, Katarzyna; Ronda, Gaby; Kaner, Eileen; Laurant, Miranda G H; Coulton, Simon; Gual, Toni

2016-11-01

To test if training and support, financial reimbursement and option of referring screen-positive patients to an internet-based method of giving advice (eBI) can increase primary health-care providers' delivery of Alcohol Use Disorders Identification Test (AUDIT)-C-based screening and advice to heavy drinkers. Cluster randomized factorial trial with 12-week implementation and measurement period. Primary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden. A total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden. PHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR) and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI. The primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen-positive patients advised; and proportion of consulting adult patients given an intervention (screening and advice to screen-positives) during the same 12-week implementation period. During a 4-week baseline measurement period, the proportion of consulting adult patients who were screened for their alcohol consumption was 0.059 per PHCU (95% CI 0.034 to 0.084). Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CI = 1.13-1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was 2.00 (95% CI = 1.56-2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was 2.34 (95% CI = 1.77-3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CI = 1.11-2.53). Providing primary health-care units with training, support and financial reimbursement for delivering Alcohol Use Disorders Identification Test-C-based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health-care units with the option of referring screen-positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption. © 2016 Society for the Study of Addiction.

Patient acceptability of tear collection in the primary healthcare setting.

PubMed

Quah, Joanne Hui Min; Tong, Louis; Barbier, Sylvaine

2014-04-01

The primary healthcare setting is well placed for health screening. Tear fluid composition gives valuable information about the eye and systemic health, and there is now significant interest in the potential application of tears as a tool for health screening; however, the acceptability of tear collection in the primary healthcare setting as compared with other methods of human sample collection has not been previously addressed. The objective of this study was to evaluate the patient acceptability of tear collection in a primary healthcare setting. This was a cross-sectional study on 383 adult patients seeking primary healthcare, who were not diabetic and were not attending for an eye-related complaint. Tear collection was done using Schirmer strips, and an interviewer-administered questionnaire was conducted to collate information on the pain score (0-10) of the Schirmer tear collection, as well as to score the pain associated with their previous experience of antecubital venous puncture and finger prick test. The pain score for Schirmer tear collection was significantly lower (p < 0.001) than antecubital venous puncture but higher (p < 0.001) than finger prick. The pain scores for all three procedures were significantly higher in participants of younger age, female gender, and higher education level. Among the participants, 70% did not mind their tears being collected to screen for eye problems, whereas only 38% did not mind this procedure being performed for general health screening. Nevertheless, 69% of the participants preferred tear to urine collection, and 74% of participants preferred tear to blood collection. Tear collection using Schirmer strips is a highly acceptable form of investigation that has the potential for use in health screening in the primary healthcare setting. This study has implications on using tear collection as a method of ocular and systemic health screening in the primary healthcare setting.

Seeing cilia: imaging modalities for ciliary motion and clinical connections.

PubMed

Peabody, Jacelyn E; Shei, Ren-Jay; Bermingham, Brent M; Phillips, Scott E; Turner, Brett; Rowe, Steven M; Solomon, George M

2018-06-01

The respiratory tract is lined with multiciliated epithelial cells that function to move mucus and trapped particles via the mucociliary transport apparatus. Genetic and acquired ciliopathies result in diminished mucociliary clearance, contributing to disease pathogenesis. Recent innovations in imaging technology have advanced our understanding of ciliary motion in health and disease states. Application of imaging modalities including transmission electron microscopy, high-speed video microscopy, and micron-optical coherence tomography could improve diagnostics and be applied for precision medicine. In this review, we provide an overview of ciliary motion, imaging modalities, and ciliopathic diseases of the respiratory system including primary ciliary dyskinesia, cystic fibrosis, chronic obstructive pulmonary disease, and idiopathic pulmonary fibrosis.

Psychological Impact of Primary Screening (PIPS) for HPV: a protocol for a cross-sectional evaluation within the NHS cervical screening programme.

PubMed

McBride, Emily; Marlow, Laura; Forster, Alice S; Moss, Sue; Myles, Jonathan; Kitchener, Henry; Patnick, Julietta; Waller, Jo

2016-12-23

The NHS Cervical Screening Programme is now using human papillomavirus (HPV) testing as the primary test in six sentinel sites in England, with the intention of rolling this out across the whole of England. Previous research evaluating HPV testing in the cervical screening context suggests that an HPV-positive result may increase anxiety beyond that associated with abnormal cytology, but this has not been explored in the context of primary HPV testing. The main aim of this study is to explore the impact of the HPV primary screening programme on anxiety and distress. A cross-sectional between-groups design (total N ∼ 673) will be employed to assess the psychological impact of different HPV and cytology results at three time points: shortly after receiving the results, and 6 and 12 months later. Women will fall into one of six groups based on their screening results. The primary outcomes will be anxiety and general distress. Secondary outcomes will include understanding of screening results, perceived risk of cervical cancer, psychosexual functioning, intention to attend future screening and knowledge of HPV. General linear modelling will be used to test for differences between groups and changes over the three time points. Health Research Authority approval was received on 26 September 2016. Ethical approval was received from London- Surrey Borders NHS Research Ethics Committee on 30 August 2016. Section 251 approval was received from the Confidentiality Advisory Group on 24 August 2016. Results will be disseminated via peer-reviewed publication and presentation at national and international conferences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Feasibility and Acceptability of a Colocated Homeless-Tailored Primary Care Clinic and Emergency Department.

PubMed

Gabrielian, Sonya; Chen, Jennifer C; Minhaj, Beena P; Manchanda, Rishi; Altman, Lisa; Koosis, Ella; Gelberg, Lillian

2017-10-01

Homeless adults have low primary care engagement and high emergency department (ED) utilization. Homeless-tailored, patient-centered medical homes (PCMH) decrease this population's acute care use. We studied the feasibility (focused on patient recruitment) and acceptability (conceptualized as clinicians' attitudes/beliefs) of a pilot initiative to colocate a homeless-tailored PCMH with an ED. After ED triage, low-acuity patients appropriate for outpatient care were screened for homelessness; homeless patients chose between a colocated PCMH or ED visit. To study feasibility, we captured (from May to September 2012) the number of patients screened for homelessness, positive screens, unique patients seen, and primary care visits. We focused on acceptability to ED clinicians (physicians, nurses, social workers); we sent a 32-item survey to ED clinicians (n = 57) who worked during clinic hours. Questions derived from an instrument measuring clinician attitudes toward homeless persons; acceptability of homelessness screening and the clinic itself were also explored. Over the 5 months of interest, 281 patients were screened; 172 (61.2%) screened positive for homelessness; 112 (65.1%) of these positive screens were seen over 215 visits. Acceptability data were obtained from 56% (n = 32) of surveyed clinicians. Attitudes toward homeless patients were similar to prior studies of primary care physicians. Most (54.6%) clinicians agreed with the homelessness screening procedures. Nearly all (90.3%) clinicians supported expansion of the homeless-tailored clinic; a minority (42.0%) agreed that ED colocation worked well. Our data suggest the feasibility of recruiting patients to a homeless-tailored primary care clinic colocated with the ED; however, the clinic's acceptability was mixed. Future quality improvement work should focus on tailoring the clinic to increase its acceptability among ED clinicians, while assessing its impact on health, housing, and costs.

Prevalence of Bipolar Disorder symptoms in Primary Care (ProBiD-PC)

PubMed Central

Chiu, John F.; Chokka, Pratap R.

2011-01-01

Abstract Objective To describe the prevalence of patients who screen positive for symptoms of bipolar disorder in primary care practice using the validated Mood Disorders Questionnaire (MDQ). Design Prevalence survey. Setting Fifty-four primary care practices across Canada. Participants Adult patients presenting to their primary care practitioners for any cause and reporting, during the course of their visits, current or previous symptoms of depression, anxiety, substance use disorders, or attention deficit hyperactivity disorder. Main outcome measures Subjects were screened for symptoms suggestive of bipolar disorder using the MDQ. Health-related quality of life, functional impairment, and work productivity were evaluated using the 12-Item Short-Form Health Survey and Sheehan Disability Scale. Results A total of 1416 patients were approached to participate in this study, and 1304 completed the survey. Of these, 27.9% screened positive for symptoms of bipolar disorder. All 13 items of the MDQ were significantly associated with screening positive for bipolar disorder (P < .05). Patients screening positive were significantly more likely to report depression, anxiety, substance use, attention deficit hyperactivity disorder, family history of bipolar disorder, or suicide attempts than patients screening negative were (P < .001). Health-related quality of life, work or school productivity, and social and family functioning were all significantly worse in patients who screened positive (P < .001). Conclusion This prevalence survey suggests that more than a quarter of patients presenting to primary care with past or current psychiatric indices are at risk of bipolar disorder. Patients exhibiting a cluster of these symptoms should be further questioned on family history of bipolar disorder and suicide attempts, and selectively screened for symptoms suggestive of bipolar disorder using the quick and high-yielding MDQ. PMID:21642707

Feasibility and Acceptability of a Colocated Homeless-Tailored Primary Care Clinic and Emergency Department

PubMed Central

Gabrielian, Sonya; Chen, Jennifer C.; Minhaj, Beena P.; Manchanda, Rishi; Altman, Lisa; Koosis, Ella; Gelberg, Lillian

2017-01-01

Objectives: Homeless adults have low primary care engagement and high emergency department (ED) utilization. Homeless-tailored, patient-centered medical homes (PCMH) decrease this population’s acute care use. We studied the feasibility (focused on patient recruitment) and acceptability (conceptualized as clinicians’ attitudes/beliefs) of a pilot initiative to colocate a homeless-tailored PCMH with an ED. After ED triage, low-acuity patients appropriate for outpatient care were screened for homelessness; homeless patients chose between a colocated PCMH or ED visit. Methods: To study feasibility, we captured (from May to September 2012) the number of patients screened for homelessness, positive screens, unique patients seen, and primary care visits. We focused on acceptability to ED clinicians (physicians, nurses, social workers); we sent a 32-item survey to ED clinicians (n = 57) who worked during clinic hours. Questions derived from an instrument measuring clinician attitudes toward homeless persons; acceptability of homelessness screening and the clinic itself were also explored. Results: Over the 5 months of interest, 281 patients were screened; 172 (61.2%) screened positive for homelessness; 112 (65.1%) of these positive screens were seen over 215 visits. Acceptability data were obtained from 56% (n = 32) of surveyed clinicians. Attitudes toward homeless patients were similar to prior studies of primary care physicians. Most (54.6%) clinicians agreed with the homelessness screening procedures. Nearly all (90.3%) clinicians supported expansion of the homeless-tailored clinic; a minority (42.0%) agreed that ED colocation worked well. Conclusion: Our data suggest the feasibility of recruiting patients to a homeless-tailored primary care clinic colocated with the ED; however, the clinic’s acceptability was mixed. Future quality improvement work should focus on tailoring the clinic to increase its acceptability among ED clinicians, while assessing its impact on health, housing, and costs. PMID:28367682

Preventing diabetes blindness: cost effectiveness of a screening programme using digital non-mydriatic fundus photography for diabetic retinopathy in a primary health care setting in South Africa.

PubMed

Khan, Taskeen; Bertram, Melanie Y; Jina, Ruxana; Mash, Bob; Levitt, Naomi; Hofman, Karen

2013-08-01

South Africa like many other developing countries is experiencing an epidemiologic transition with a marked increase in the non-communicable disease (NCD) burden. Diabetic retinopathy is the most common cause of incidental blindness in adults. A screening programme using a mobile fundal camera in a primary care setting has been shown to be effective in the country. Information on affordability and cost is essential for policymakers to consider its adoption. Economic evaluation is the comparative analysis of competing alternative interventions in terms of costs and consequences. A cost effectiveness analysis was done using actual costs from the primary care screening programme. A total of 14,541 patients were screened in three primary healthcare facilities in the Western Cape. Photographs were taken by a trained technician with supervision by an ophthalmic nurse. The photographs were then read by a medical officer with ophthalmic experience. A cost effective ratio of $1206 per blindness case averted was obtained. This included costs for screening and treating an individual. The cost just to screen a patient for retinopathy was $22. The costs of screening and treating all incident cases of blindness due to diabetes in South Africa would be 168,000,000 ZAR ($19,310,344) per annum. Non mydriatic digital fundoscopy is a cost effective measure in the screening and diagnosis of diabetic retinopathy in a primary care setting in South Africa. The major savings in the long term are a result of avoiding government disability grant for people who suffer loss of vision. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Evaluation of control laws and actuator locations for control systems applicable to deformable astronomical telescope mirrors

NASA Technical Reports Server (NTRS)

Ostroff, A. J.

1973-01-01

Some of the major difficulties associated with large orbiting astronomical telescopes are the cost of manufacturing the primary mirror to precise tolerances and the maintaining of diffraction-limited tolerances while in orbit. One successfully demonstrated approach for minimizing these problem areas is the technique of actively deforming the primary mirror by applying discrete forces to the rear of the mirror. A modal control technique, as applied to active optics, has previously been developed and analyzed. The modal control technique represents the plant to be controlled in terms of its eigenvalues and eigenfunctions which are estimated via numerical approximation techniques. The report includes an extension of previous work using the modal control technique and also describes an optimal feedback controller. The equations for both control laws are developed in state-space differential form and include such considerations as stability, controllability, and observability. These equations are general and allow the incorporation of various mode-analyzer designs; two design approaches are presented. The report also includes a technique for placing actuator and sensor locations at points on the mirror based upon the flexibility matrix of the uncontrolled or unobserved modes of the structure. The locations selected by this technique are used in the computer runs which are described. The results are based upon three different initial error distributions, two mode-analyzer designs, and both the modal and optimal control laws.

Human papillomavirus reduces the prognostic value of nodal involvement in tonsillar squamous cell carcinomas.

PubMed

Straetmans, Jos M J A A; Olthof, Nadine; Mooren, Jeroen J; de Jong, Jos; Speel, Ernst-Jan M; Kremer, Bernd

2009-10-01

Assessment of the prognostic value of nodal status in relation to human papillomavirus (HPV) status and the various treatment modalities in tonsillar squamous cell carcinomas (TSCC). Retrospective 5-year survival analysis. A 5-year follow-up of disease-free, disease-specific, and overall survival in a group of 81 patients with TSCC was conducted. The nodal status and integration of HPV-DNA in the genome (detected with fluorescence in situ hybridization) as prognostic indicators were examined while correcting for other clinical parameters (smoking habits, alcohol consumption, treatment modality, differentiation, TNM classification). Of TSCCs, 41% were positive for HPV type 16. In these TSCCs, the primary tumor was significantly smaller when compared to HVP-negative TSCCs (P = .04), whereas the percentage of cases with cervical metastases was identical. In the total population, it was not nodal involvement, but rather HPV manifestation, which was related to patient prognosis. Within the treatment modalities (surgery combined with radiotherapy and radiotherapy alone), neither nodal status nor HPV were prognostic indicators. Since a substantial percentage of TSCCs are HPV-positive and metastasizes to cervical lymph nodes in less advanced primary tumors, the N status is an unreliable prognostic indicator in TSCCs. HPV is only prognostically relevant in the total tumor population, but loses its value within patient groups receiving a single treatment modality. The value of HPV for prognosis of patients with TSCC requires further study.

Preschool vision screening frequency after an office-based training session for primary care staff.

PubMed

Hered, Robert W; Rothstein, Marjorie

2003-07-01

Although vision screening for preschool children is recommended for detecting amblyopia, many pediatric and family medicine practices do not screen preschool-aged children. The aim of this study was to determine the effect of a training program for primary care clinical staff on vision screening behavior and attitudes. All local pediatric and family medicine practices were mailed invitations for free training sessions in preliterate eye chart vision screening. The clinical support staff at each participating practice location received a single training session. The lead ancillary medical employee of each practice location was surveyed immediately before and after training, and again 4 to 6 months later, to determine the effect of a single training session on screening behavior and attitudes. Twenty-nine (26%) of 110 practice locations received training in vision screening. Four to 6 months after training, reported screening frequency of 3-year-olds increased, but not of other ages. The reported comfort level with screening 3-year-olds and 4-year-olds was improved 4 to 6 months after training. Most practices responded that the training was beneficial and worthwhile, but lasting impact on practice behavior for the cohort was modest. Direct, practical training in preliterate eye chart vision screening may increase the number of 3-year-old children screened and improve clinical support staff comfort with screening preschool children. A single training session is not sufficient in itself, however, to achieve the goal of universal preschool vision screening in the primary care setting.

Developmental Surveillance and Screening Practices by Pediatric Primary Care Providers: Implications for Early Intervention Professionals

ERIC Educational Resources Information Center

Porter, Sallie; Qureshi, Rubab; Caldwell, Barbara Ann; Echevarria, Mercedes; Dubbs, William B.; Sullivan, Margaret W.

2016-01-01

This study used a survey approach to investigate current developmental surveillance and developmental screening practices by pediatric primary care providers in a diverse New Jersey county. A total of 217 providers were contacted with a final sample size of 57 pediatric primary care respondents from 13 different municipalities. Most providers…

A proposal for cervical screening information systems in developing countries.

PubMed

Marrett, Loraine D; Robles, Sylvia; Ashbury, Fredrick D; Green, Bo; Goel, Vivek; Luciani, Silvana

2002-11-20

The effective and efficient delivery of cervical screening programs requires information for planning, management, delivery and evaluation. Specially designed systems are generally required to meet these needs. In many developing countries, lack of information systems constitutes an important barrier to development of comprehensive screening programs and the effective control of cervical cancer. Our report outlines a framework for creating such systems in developing countries and describes a conceptual model for a cervical screening information system. The proposed system is modular, recognizing that there will be considerable between-region heterogeneity in current status and priorities. The proposed system is centered on modules that would allow for the assembly and computerization of data on Pap tests, since these represent the main screening modality at the present time. Additional modules would process data and create and maintain a screening database (e.g., standardize, edit, link and update modules) and allow for the integration of other types of data, such as cervical histopathology results. An open systems development model is proposed, since it is most compatible with the goals of local stakeholder involvement and capacity-building. Copyright 2002 Wiley-Liss, Inc.

Estimated number of infants detected and missed by critical congenital heart defect screening.

PubMed

Ailes, Elizabeth C; Gilboa, Suzanne M; Honein, Margaret A; Oster, Matthew E

2015-06-01

In 2011, the US Secretary of Health and Human Services recommended universal screening of newborns for critical congenital heart defects (CCHDs), yet few estimates of the number of infants with CCHDs likely to be detected through universal screening exist. Our objective was to estimate the number of infants with nonsyndromic CCHDs in the United States likely to be detected (true positives) and missed (false negatives) through universal newborn CCHD screening. We developed a simulation model based on estimates of birth prevalence, prenatal diagnosis, late detection, and sensitivity of newborn CCHD screening through pulse oximetry to estimate the number of true-positive and false-negative nonsyndromic cases of the 7 primary and 5 secondary CCHD screening targets identified through screening. We estimated that 875 (95% uncertainty interval [UI]: 705-1060) US infants with nonsyndromic CCHDs, including 470 (95% UI: 360-585) infants with primary CCHD screening targets, will be detected annually through newborn CCHD screening. An additional 880 (UI: 700-1080) false-negative screenings, including 280 (95% UI: 195-385) among primary screening targets, are expected. We estimated that similar numbers of CCHDs would be detected under scenarios comparing "lower" (∼19%) and "higher" (∼41%) than current prenatal detection prevalences. A substantial number of nonsyndromic CCHD cases are likely to be detected through universal CCHD screening; however, an equal number of false-negative screenings, primarily among secondary targets of screening, are likely to occur. Future efforts should document the true impact of CCHD screening in practice. Copyright © 2015 by the American Academy of Pediatrics.

The Geography of Primary Hepatic Neoplasms Treatments in Canada: Changes in Latitudes and Changes in Attitudes

PubMed Central

Cwinn, Matthew; Rahman, Sheikh Hasibur

2017-01-01

Background Studies on treatment modalities for primary hepatic neoplasms (PHN) in Canada are lacking. Our primary aim was to analyze the age-standardized incidence of hepatic resection, ablation, transplantation, and embolization for PHN between 2002 and 2013. Secondary aim was to evaluate temporal trends for these treatment modalities. Study Design National Canadian Cancer Registries were accessed for relevant epidemiological data. Age-standardized incidence of treatment ratios (SIRs) was calculated and comparisons were performed for Atlantic Canada, Ontario, the Prairies, and British Columbia. Results British Columbia recorded the highest SIRs for ablation (1.9; 95% CI 1.8–2.0), hepatic resection (1.2; 95% CI 1.1–1.3), and transarterial locoregional therapies (2.8; 95% CI 2.4–3.2). For hepatic resection, the lowest SIR was found in Atlantic Canada (0.7; 95% CI 0.6–0.9), while the Prairies recorded the lowest estimate for transarterial therapies (0.2; 95% CI 0.1–0.4). Liver transplantation had the highest SIR in Ontario (1.5; 95% CI 1.3–1.6) and the lowest SIR in British Columbia. No significant temporal changes in SIRs were observed for any of the treatments except for transarterial therapies. Conclusions Treatment of PHN in Canada differs by geography. Variations might be due to differences in expertise or access to therapeutic modalities. PMID:28815170

Adult depression screening in Saudi primary care: prevalence, instrument and cost

PubMed Central

2014-01-01

Background By the year 2020 depression would be the second major cause of disability adjusted life years lost, as reported by the World Health Organization. Depression is a mental illness which causes persistent low mood, a sense of despair, and has multiple risk factors. Its prevalence in primary care varies between 15.3-22%, with global prevalence up to 13% and between 17-46% in Saudi Arabia. Despite several studies that have shown benefit of early diagnosis and cost-savings of up to 80%, physicians in primary care setting continue to miss out on 30-50% of depressed patients in their practices. Methods A cross sectional study was conducted at three large primary care centers in Riyadh, Saudi Arabia aiming at estimating point prevalence of depression and screening cost among primary care adult patients, and comparing Patient Health Questionnaires PHQ-2 with PHQ-9. Adult individuals were screened using Arabic version of PHQ-2 and PHQ-9. PHQ-2 scores were correlated with PHQ-9 scores using linear regression. A limited cost-analysis and cost saving estimates of depression screening was done using the Human Capital approach. Results Patients included in the survey analysis were 477, of whom 66.2% were females, 77.4% were married, and nearly 20% were illiterate. Patients exhibiting depressive symptoms on the basis of PHQ9 were 49.9%, of which 31% were mild, 13.4% moderate, 4.4% moderate-severe and 1.0% severe cases. Depression scores were significantly associated with female gender (p-value 0.049), and higher educational level (p-value 0.002). Regression analysis showed that PHQ-2 & PHQ-9 were strongly correlated R = 0.79, and R2 = 0.62. The cost-analysis showed savings of up to 500 SAR ($133) per adult patient screened once a year. Conclusion The point prevalence of screened depression is high in primary care visitors in Saudi Arabia. Gender and higher level of education were found to be significantly associated with screened depression. Majority of cases were mild to moderate, PHQ-2 was equivocal to PHQ 9 in utility and that screening for depression in primary care setting is cost saving. PMID:24992932

Perceived Barriers and Facilitators of Using a Web-Based Interactive Decision Aid for Colorectal Cancer Screening in Community Practice Settings: Findings From Focus Groups With Primary Care Clinicians and Medical Office Staff

PubMed Central

2013-01-01

Background Information is lacking about the capacity of those working in community practice settings to utilize health information technology for colorectal cancer screening. Objective To address this gap we asked those working in community practice settings to share their perspectives about how the implementation of a Web-based patient-led decision aid might affect patient-clinician conversations about colorectal cancer screening and the day-to-day clinical workflow. Methods Five focus groups in five community practice settings were conducted with 8 physicians, 1 physician assistant, and 18 clinic staff. Focus groups were organized using a semistructured discussion guide designed to identify factors that mediate and impede the use of a Web-based decision aid intended to clarify patient preferences for colorectal cancer screening and to trigger shared decision making during the clinical encounter. Results All physicians, the physician assistant, and 8 of the 18 clinic staff were active participants in the focus groups. Clinician and staff participants from each setting reported a belief that the Web-based patient-led decision aid could be an informative and educational tool; in all but one setting participants reported a readiness to recommend the tool to patients. The exception related to clinicians from one clinic who described a preference for patients having fewer screening choices, noting that a colonoscopy was the preferred screening modality for patients in their clinic. Perceived barriers to utilizing the Web-based decision aid included patients’ lack of Internet access or low computer literacy, and potential impediments to the clinics’ daily workflow. Expanding patients’ use of an online decision aid that is both easy to access and understand and that is utilized by patients outside of the office visit was described as a potentially efficient means for soliciting patients’ screening preferences. Participants described that a system to link the online decision aid to a computerized reminder system could promote a better understanding of patients’ screening preferences, though some expressed concern that such a system could be difficult to keep up and running. Conclusions Community practice clinicians and staff perceived the Web-based decision aid technology as promising but raised questions as to how the technology and resultant information would be integrated into their daily practice workflow. Additional research investigating how to best implement online decision aids should be conducted prior to the widespread adoption of such technology so as to maximize the benefits of the technology while minimizing workflow disruptions. PMID:24351420

Results from a Multi-Modal Program Evaluation of a Four Year Statewide Juvenile Sex Offender Treatment and Reentry Program

ERIC Educational Resources Information Center

Underwood, Lee A.; Dailey, Frances L. L.; Merino, Carrie; Crump, Yolanda

2015-01-01

The results of the Program Evaluation show the OJJ Statewide Sex Offender Treatment program is exceptionally productive in meeting over 90% of its established performance markers. These markers included successful screening and assessment of risk and psychosocial needs, completion of initial and master treatment plans, establishment of sex…

Screening Maritime Shipping Containers for Weapons of Mass Destruction

DTIC Science & Technology

2010-01-01

for dangerous chemical, biological, radiological, nuclear , and explosives (CBRNE) materials to prevent their unlawful transpOitation into the United...techniques, and various sensor modalities within their respective size, weight, and power constraints. Shipping containers are natural repositories ...isolators. The environmental enclosure has sufficient volume to allow for multiple sensors as well as a truth collection station (Summa canisters

Involving Teachers in Reducing Children's Media Risks

ERIC Educational Resources Information Center

Stiller, Anja; Schwendemann, Hanna; Bleckmann, Paula; Bitzer, Eva-Maria; Mößle, Thomas

2018-01-01

Purpose: The purpose of this paper is twofold: first, to introduce MEDIA PROTECT, a multi-modal intervention for parents and teachers with six components preventing problematic, and in the long run addictive, use of screen media by children; second, to present results of a formative evaluation of the teacher training, an important component of the…

Protective effect of the edible brown alga Ecklonia stolonifera on doxorubicin-induced hepatotoxicity in primary rat hepatocytes.

PubMed

Jung, Hyun Ah; Kim, Jae-I; Choung, Se Young; Choi, Jae Sue

2014-08-01

As part of our efforts to isolate anti-hepatotoxic agents from marine natural products, we screened the ability of 14 edible varieties of Korean seaweed to protect against doxorubicin-induced hepatotoxicity in primary rat hepatocytes. Among the crude extracts of two Chlorophyta (Codium fragile and Capsosiphon fulvescens), seven Phaeophyta (Undaria pinnatifida, Sargassum thunbergii, Pelvetia siliquosa, Ishige okamurae, Ecklonia cava, Ecklonia stolonifera and Eisenia bicyclis), five Rhodophyta (Chondrus ocellatus, Gelidium amansii, Gracilaria verrucosa, Symphycladia latiuscula and Porphyra tenera), and the extracts of Ecklonia stolonifera, Ecklonia cava, Eisenia bicyclis and Pelvetia siliquosa exhibited significant protective effects on doxorubicin-induced hepatotoxicity, with half maximal effective concentration (EC50) values of 2.0, 2.5, 3.0 and 15.0 μg/ml, respectively. Since Ecklonia stolonifera exhibits a significant protective potential and is frequently used as foodstuff, we isolated six phlorotannins, including phloroglucinol (1), dioxinodehydroeckol (2), eckol (3), phlorofucofuroeckol A (4), dieckol (5) and triphloroethol-A (6). Phlorotannins 2 ∼ 6 exhibited potential protective effects on doxorubicin-induced hepatotoxicity, with corresponding EC50 values of 3.4, 8.3, 4.4, 5.5 and 11.5 μg/ml, respectively. The results clearly demonstrated that the anti-hepatotoxic effects of Ecklonia stolonifera and its isolated phlorotannins are useful for further exploration and development of therapeutic modalities for treatment of hepatotoxicity. © 2014 Royal Pharmaceutical Society.

[Recommendations for Diagnosis and Treatment of Fractures of the Ring of Axis].

PubMed

Scholz, Matti; Schleicher, Philipp; Kandziora, Frank; Badke, Andreas; Dreimann, Marc; Gebhard, Harry; Gercek, Erol; Gonschorek, Oliver; Hartensuer, René; Jarvers, Jan-Sven Gilbert; Katscher, Sebastian; Kobbe, Philipp; Koepp, Holger; Korge, Andreas; Matschke, Stefan; Mörk, Sven; Müller, Christian W; Osterhoff, Georg; Pécsi, Ferenc; Pishnamaz, Miguel; Reinhold, Maximilian; Schmeiser, Gregor; Schnake, Klaus John; Schneider, Kristian; Spiegl, Ulrich Josef Albert; Ullrich, Bernhard

2018-06-22

In a consensus process with four sessions in 2017, the working group "upper cervical spine" of the German Society for Orthopaedics and Trauma Surgery (DGOU) formulated "Therapeutic Recommendations for the Diagnosis and Treatment of Upper Cervical Fractures", taking their own experience and the current literature into consideration. The following article describes the recommendations for axis ring fractures (traumatic spondylolysis C2). About 19 to 49% of all cervical spine injuries include the axis vertebra. Traumatic spondylolysis of C2 may include potential discoligamentous instability C2/3. The primary aim of the diagnostic process is to detect the injury and to determine potential disco-ligamentous instability C2/3. For classification purposes, the Josten classification or the modified Effendi classification may be used. The Canadian C-spine rule is recommended for clinical screening for C-spine injuries. CT is the preferred imaging modality and an MRI is needed to determine the integrity of the discoligamentous complex C2/3. Conservative treatment is appropriate in case of stable fractures with intact C2/3 motion segment (Josten type 2 and 2). Patients should be closely monitored, in order to detect secondary dislocation as early as possible. Surgical treatment is recommended in cases of primary severe fracture dislocation or discoligamentous instability C2/3 (Josten 3 and 4) and/or secondary fracture dislocation. Anterior cervical decompression and fusion (ACDF) C2/3 is the treatment of choice. However, in case of facet joint luxation C2/3 with looked facet (Josten 4), a primary posterior approach may be necessary. Georg Thieme Verlag KG Stuttgart · New York.

The clinical implementation of primary HPV screening.

PubMed

Mariani, Luciano; Igidbashian, Sarah; Sandri, Maria Teresa; Vici, Patrizia; Landoni, Fabio

2017-03-01

To evaluate, from a gynecology perspective, the transition from cytology-based HPV screening to primary HPV screening. Studies examining switching from cytology-based screening to primary HPV-DNA testing with triaging of patients with positive test results were retrieved and reviewed, with a particular focus on screening in an Italian setting. The increased complexity of patient-management decisions when implementing HPV-based screening was a critical issue discussed in the literature. The change in strategy represents a paradigm shift in moving from a medical perspective of identifying the disease in individual patients, to a public-healthcare perspective of excluding HPV from the healthy population and identifying a small sub-group of individuals at increased risk of HPV. With knowledge about HPV screening evolving rapidly, new programs and related algorithms need to be sufficiently flexible to be adjusted according to ongoing research and the validation of new assays. The establishment of a national working group (including epidemiologists, gynecologists, pathologists, and healthcare providers) will be necessary to properly implement and govern this important technical and cultural transition. © 2016 International Federation of Gynecology and Obstetrics.

Unified-planning, graded-administration, and centralized-controlling: a management modality for treating acquired immune deficiency syndrome with Chinese medicine in Henan Province of China.

PubMed

Xu, Li-Ran; Guo, Hui-jun; Liu, Zhi-bin; Li, Qiang; Yang, Ji-ping; He, Ying

2015-04-01

Henan Province in China has a major epidemic of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Chinese medicine (CM) has been used throughout the last decade, and a management modality was developed, which can be described by unified-planning, graded-administration, and centralized-controlling (UGC). The UGC modality has one primary concept (patient-centered medicine from CM theory), four basic foundations (classifying administrative region, characteristics of CM on disease treatment, health resource conditions, and distribution of patients living with HIV), six important relationships (the "three uniformities and three combinations," and the six relationships therein guide the treatment of AIDS with CM), and four key sections (management, operation, records, and evaluation). In this article, the authors introduce the UGC modality, which could be beneficial to developing countries or resource-limited areas for the management of chronic infectious disease.

The clinical effectiveness and cost-effectiveness of primary human papillomavirus cervical screening in England: extended follow-up of the ARTISTIC randomised trial cohort through three screening rounds.

PubMed

C Kitchener, Henry; Canfell, Karen; Gilham, Clare; Sargent, Alexandra; Roberts, Chris; Desai, Mina; Peto, Julian

2014-04-01

The ARTISTIC (A Randomised Trial In Screening To Improve Cytology) trial originally reported after two rounds of primary cervical screening with human papillomavirus (HPV). Extended follow-up of the randomised trial cohort through a third round could provide valuable insight into the duration of protection of a negative HPV test, which could allow extended screening intervals. If HPV primary screening is to be considered in the national programme, then determining its cost-effectiveness is key, and a detailed economic analysis using ARTISTIC data is needed. (1) To determine the round 3 and cumulative rates of cervical intraepithelial neoplasia (CIN) grade 2 or worse (2+) and CIN grade 3 or worse (CIN3+) between the revealed and concealed arms of ARTISTIC after three screening rounds over 6 years. (2) To compare the cumulative incidence of CIN2+ over three screening rounds following negative screening cytology with that following negative baseline HPV. (3) To determine whether or not HPV screening could safely extend the screening interval from 3 to 6 years. (4) To study the potential clinical utility of an increased cut-off of 2 relative light unit/mean control (RLU/Co) for Hybrid Capture 2 (HC2) and HPV genotyping in primary cervical screening. (5) To determine the potential impact of HPV vaccination with Cervarix™ in terms of preventing abnormal cytology and CIN2+. (6) To determine the cost-effectiveness of HPV primary screening compared with current practice using cervical cytology in England. The ARTISTIC study cohort was recalled for a third round of screening 3 years after round 2 and 6 years following their enrolment to the study. Both arms of the original trial used a single protocol during round 3. ARTISTIC study cohort undergoing cervical screening in primary care in Greater Manchester, UK. Between July 2007 and September 2009, 8873 women participated in round 3; 6337 had been screened in round 2 and 2536 had not been screened since round 1. All women underwent liquid-based cytology and HPV testing and genotyping. Colposcopy was offered to women with moderate dyskaryosis or worse and with HPV-positive mild dyskaryosis/borderline changes. Women with negative cytology or HPV-negative mild dyskaryosis/borderline changes were returned to routine recall. Principal outcomes were cumulative rates of CIN2+ over three screening rounds by cytology and HPV status at entry; HPV type specific rates of CIN2+; effect of age on outcomes correlated with cytology and HPV status; comparison of HC2 cut-off RLU/Co of both 1 and 2; and cost-effectiveness of HPV primary screening. The median duration of follow-up was 72.7 months in round 3. Over the three screening rounds, there was no significant difference in CIN2+ [odds ratio (OR): 1.06, 95% confidence interval (CI) 0.89 to 1.26, p = 0.5)] or CIN3+ (OR: 0.90, 95% CI 0.72 to 1.14, p = 0.4) rates between the trial arms (revealed vs. concealed). Overall, 16% of women were HC2 positive at entry, decreasing from 40% in women aged 20-24 years to around 7% in women aged over 50 years. Abnormal cytology rates at entry were 13% for borderline+ and 2% for moderate+ cytology. Following positive cytology at entry, the cumulative rate of CIN2+ was 20.5%, and was 20.1% following a HPV-positive result at baseline. The cumulative CIN2+ rate for women who were HPV negative at baseline was only 0.87% (95% CI 0.70% to 1.06%) after three rounds of screening, significantly lower than that for women with negative cytology, which was 1.41% (95% CI 1.19% to 1.65%). Women who were HPV negative at baseline had similar protection from CIN2+ after 6 years as women who were cytology negative at baseline after 3 years. Women who were HPV positive/cytology negative at baseline had a cumulative CIN2+ rate at 6 years of 7.7%, significantly higher than that for women who were cytology positive/HPV negative (3.2%). Women who were HPV type 16 positive at baseline had a cumulative CIN2+ rate over three rounds of 43.6% compared with 20.1% for any HPV-positive test. Using a HC2 cut-off of RLU/Co ≥ 2 would maintain acceptable sensitivity and result in 16% fewer HPV-positive results. Typing data suggested that around 55-60% of high-grade cytology and CIN2+, but less than 25% of low-grade cytology, would be prevented by HPV vaccine given current rates of coverage in the UK national programme. For the cost-effectiveness analysis, most of the primary HPV strategies examined where HPV was used as the sole primary test were cost saving in both unvaccinated and vaccinated cohorts under baseline cost assumptions, with a 7-18% reduction in annual screening-associated costs in unvaccinated cohorts and a 9-22% reduction for vaccinated cohorts. Utilising partial genotyping at the primary screening stage to identify women with HPV 16/18 and referring them to colposcopy was the most effective strategy (barring co-testing, which is significantly more costly than any other strategies considered), resulting in 83 additional life-years per 100,000 women for unvaccinated women when compared with current practice, and similar life-years saved compared with current practice for vaccinated women. In unvaccinated cohorts, however, this genotyping strategy is predicted to result in a 20% increase in the number of colposcopies performed in England, although in vaccinated cohorts the number of colposcopy referrals was predicted to be lower than in current practice. For all strategies in which HPV is used as the sole primary screening test, decreasing the follow-up interval for intermediate-risk women from 24 to 12 months increased the overall effectiveness of primary HPV screening. In exploratory analysis, strategies for which cytology screening was retained until either age 30 or 35 years, and for which HPV testing was used at older ages, were predicted to be of higher costs and intermediate effectiveness than those associated with full implementation of primary HPV screening from age 25 years. However, this finding should be interpreted with caution as it depends on assumptions made about screening behaviour and compliance with recommendations at the 'switch over' point. HPV testing as an initial screen was significantly more protective over three rounds (6 years) than the current practice of cytology and the use of primary HPV screening could allow a safe lengthening of the screening interval. A substantial decrease in high-grade cytology and CIN2+ can be expected as a consequence of the HPV vaccination programme. A HC2 cut-off of 2RLU/Co instead of the manufacturer's recommended cut-off of 1 would be clinically beneficial in terms of an optimal balance between sensitivity and specificity. Modelled analysis predicts that primary HPV screening would be both more effective and cost saving compared with current practice with cervical cytology for a number of potential strategies in both unvaccinated and vaccinated cohorts. Compliance with surveillance and optimal management of HPV-positive/cytology-negative women after primary HPV screening is of key importance. Limitations of the economic investigation included the need to make assumptions around compliance with screening attendance and follow-up for longer screening intervals in the future, assumptions regarding maintenance of current uptake vaccination in the future, and assumptions regarding the stability of cost of HPV and cytology tests in the future. Detailed sensitivity analysis across a range of possible assumptions was conducted to address these issues. This study and the economic evaluation lend support to convert from cytology to HPV-based screening. Future work should include researching (i) the attitudes of women who test HPV positive/cytology negative, (ii) the value of complementary biomarkers and (iii) activities relevant to primary HPV screening in unvaccinated and vaccinated populations from the point of view of QALY assessment. Current Controlled Trials ISRCTN25417821.

Emergency Management of Hypertension in Children

PubMed Central

Singh, Dinesh; Akingbola, Olugbenga; Yosypiv, Ihor; El-Dahr, Samir

2012-01-01

Systemic arterial hypertension in children has traditionally been thought to be secondary in origin. Increased incidence of risk factors like obesity, sedentary life-styles, and faulty dietary habits has led to increased prevalence of the primary arterial hypertension (PAH), particularly in adolescent age children. PAH has become a global epidemic worldwide imposing huge economic constraint on health care. Sudden acute increase in systolic and diastolic blood pressure can lead to hypertensive crisis. While it generally pertains to secondary hypertension, occurrence of hypertensive crisis in PAH is however rare in children. Hypertensive crisis has been further subclassified depending on presence or absence of end-organ damage into hypertensive emergency or urgency. Both hypertensive emergencies and urgencies are known to cause significant morbidity and mortality. Increasing awareness among the physicians, targeted at investigation of the pathophysiology of hypertension and its complications, better screening methods, generation, and implementation of novel treatment modalities will impact overall outcomes. In this paper, we discuss the etiology, pathogenesis, and management of hypertensive crisis in children. An extensive database search using keywords was done to obtain the information. PMID:22577545

Depression screening optimization in an academic rural setting.

PubMed

Aleem, Sohaib; Torrey, William C; Duncan, Mathew S; Hort, Shoshana J; Mecchella, John N

2015-01-01

Primary care plays a critical role in screening and management of depression. The purpose of this paper is to focus on leveraging the electronic health record (EHR) as well as work flow redesign to improve the efficiency and reliability of the process of depression screening in two adult primary care clinics of a rural academic institution in USA. The authors utilized various process improvement tools from lean six sigma methodology including project charter, swim lane process maps, critical to quality tree, process control charts, fishbone diagrams, frequency impact matrix, mistake proofing and monitoring plan in Define-Measure-Analyze-Improve-Control format. Interventions included change in depression screening tool, optimization of data entry in EHR. EHR data entry optimization; follow up of positive screen, staff training and EHR redesign. Depression screening rate for office-based primary care visits improved from 17.0 percent at baseline to 75.9 percent in the post-intervention control phase (p<0.001). Follow up of positive depression screen with Patient History Questionnaire-9 data collection remained above 90 percent. Duplication of depression screening increased from 0.6 percent initially to 11.7 percent and then decreased to 4.7 percent after optimization of data entry by patients and flow staff. Impact of interventions on clinical outcomes could not be evaluated. Successful implementation, sustainability and revision of a process improvement initiative to facilitate screening, follow up and management of depression in primary care requires accounting for voice of the process (performance metrics), system limitations and voice of the customer (staff and patients) to overcome various system, customer and human resource constraints.

[Opinion from physicians on the need for dyslipidemia screening in cardiovascular risk. Similarities and differences between primary care and other specialties. The DIANA study].

PubMed

Serrano, Adalberto; Pascual, Vicente

2017-10-01

The clinical inertia in the screening and treatment of patients at high or very high cardiovascular risk leads to the failure to achieve LDLc targets in this population. The aim of the DIANA study was to determine the opinion of doctors about the screening for dyslipidaemia, the usual practice, and the differences between Primary Care physicians and other specialties. A questionnaire, using the modified Delphi method, included four blocks on dyslipidemic patients with impaired glucose metabolism. Of the 497 participating experts, 58% were Primary Care physicians. There was agreement on the need for dyslipidemia screening in patients with diabetes, ischaemic heart disease or hypertension, although to a lesser extent among Primary Care physicians. Greater significant differences were found in situations such as pre-diabetes or family history of premature cardiovascular disease (86.2% and 88.6% in Primary Care physicians versus 96.1% and 97.6% in other specialties, respectively). There was no agreement on the need for screening in the presence of xanthomas, xanthelasmas or corneal arcus in people under the age of 45 years, with statistically significant differences in the latter. Dyslipidaemia screening is mainly performed on patients with cardiovascular disease or any major cardiovascular risk factor, and cutaneous lesions of familial hypercholesterolaemia are underestimated. The need for accurate screening and treatment of dyslipidemia in subjects at high cardiovascular risk must be stressed. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Mental Health Screening in Primary Care: A Comparison of 3 Brief Measures of Psychological Distress

PubMed Central

Cano, Annmarie; Sprafkin, Robert P.; Scaturo, Douglas J.; Lantinga, Larry J.; Fiese, Barbara H.; Brand, Frank

2001-01-01

Background: The current study compared 3 brief mental health screening measures in a sample of older patients in a primary care outpatient setting. Previous mental health screening research has been conducted primarily with younger patients, often with only 1 screening measure, thereby limiting the generalizability of findings. In addition, measures have not yet been compared in terms of their ability to discriminate between cases and noncases of psychiatric disorder. Method: One hundred thirty-four male patients attending their appointments at a primary care clinic in a Department of Veterans Affairs Medical Center participated in this study. Participants completed the General Health Questionnaire-12 (GHQ-12), the Symptom Checklist-10 (SCL-10), and the Primary Care Evaluation of Mental Disorders screening questionnaire and interview. Results: Receiver operating characteristic analysis yielded the optimum cutoff scores on each brief mental health screening measure and showed that all 3 measures discriminated well between cases and noncases of psychiatric disorders. The 3 measures performed slightly better in terms of discriminating between cases and noncases of mood or anxiety disorders than between cases and noncases of any psychiatric disorder. There were no significant differences between the measures' abilities to accurately identify cases and noncases of disorder. Conclusion: Primary care physicians are encouraged to use brief mental health screening measures with their patients, since many report symptoms of psychological distress and disorder. It is recommended that the SCL-10 and GHQ-12 be used to detect mood or anxiety disorders in patients such as these because of the accuracy and brevity of these measures. PMID:15014574

Optimal Methods to Screen Men and Women for Intimate Partner Violence: Results from an Internal Medicine Residency Continuity Clinic

ERIC Educational Resources Information Center

Kapur, Nitin A.; Windish, Donna M.

2011-01-01

Contradictory data exist regarding optimal methods and instruments for intimate partner violence (IPV) screening in primary care settings. The purpose of this study was to determine the optimal method and screening instrument for IPV among men and women in a primary-care resident clinic. We conducted a cross-sectional study at an urban, academic,…

Perception and Experience of Primary Care Physicians on Pap Smear Screening for Women with Intellectual Disabilities: A Preliminary Finding

ERIC Educational Resources Information Center

Lin, Jin-Ding; Sung, Chang-Lin; Lin, Lan-Ping; Liu, Ta-Wen; Lin, Pei-Ying; Chen, Li-Mei; Chu, Cordia M.; Wu, Jia-Ling

2010-01-01

This study aims to establish evidence-based data to explore the perceptions and experience of primary care physicians in the Pap smear screening provision for women with intellectual disabilities (ID), and to analyze the associated factors in the delivery of screening services to women with ID in Taiwan. Data obtained by a cross-sectional survey…

Screening for adolescents' internalizing symptoms in primary care: item response theory analysis of the behavior health screen depression, anxiety, and suicidal risk scales.

PubMed

Bevans, Katherine B; Diamond, Guy; Levy, Suzanne

2012-05-01

To apply a modern psychometric approach to validate the Behavioral Health Screen (BHS) Depression, Anxiety, and Suicidal Risk Scales among adolescents in primary care. Psychometric analyses were conducted using data collected from 426 adolescents aged 12 to 21 years (mean = 15.8, SD = 2.2). Rasch-Masters partial credit models were fit to the data to determine whether items supported the comprehensive measurement of internalizing symptoms with minimal gaps and redundancies. Scales were reduced to ensure that they measured singular dimensions of generalized anxiety, depressed affect, and suicidal risk both comprehensively and efficiently. Although gender bias was observed for some depression and anxiety items, differential item functioning did not impact overall subscale scores. Future revisions to the BHS should include additional items that assess low-level internalizing symptoms. The BHS is an accurate and efficient tool for identifying adolescents with internalizing symptoms in primary care settings. Access to psychometrically sound and cost-effective behavioral health screening tools is essential for meeting the increasing demands for adolescent behavioral health screening in primary/ambulatory care.

A multi-image approach to CADx of breast cancer with integration into PACS

NASA Astrophysics Data System (ADS)

Elter, Matthias; Wittenberg, Thomas; Schulz-Wendtland, Rüdiger; Deserno, Thomas M.

2009-02-01

While screening mammography is accepted as the most adequate technique for the early detection of breast cancer, its low positive predictive value leads to many breast biopsies performed on benign lesions. Therefore, we have previously developed a knowledge-based system for computer-aided diagnosis (CADx) of mammographic lesions. It supports the radiologist in the discrimination of benign and malignant lesions. So far, our approach operates on the lesion level and employs the paradigm of content-based image retrieval (CBIR). Similar lesions with known diagnosis are retrieved automatically from a library of references. However, radiologists base their diagnostic decisions on additional resources, such as related mammographic projections, other modalities (e.g. ultrasound, MRI), and clinical data. Nonetheless, most CADx systems disregard the relation between the craniocaudal (CC) and mediolateral-oblique (MLO) views of conventional mammography. Therefore, we extend our approach to the full case level: (i) Multi-frame features are developed that jointly describe a lesion in different views of mammography. Taking into account the geometric relation between different images, these features can also be extracted from multi-modal data; (ii) the CADx system architecture is extended appropriately; (iii) the CADx system is integrated into the radiology information system (RIS) and the picture archiving and communication system (PACS). Here, the framework for image retrieval in medical applications (IRMA) is used to support access to the patient's health care record. Of particular interest is the application of the proposed CADx system to digital breast tomosynthesis (DBT), which has the potential to succeed digital mammography as the standard technique for breast cancer screening. The proposed system is a natural extension of CADx approaches that integrate only two modalities. However, we are still collecting a large enough database of breast lesions with images from multiple modalities to evaluate the benefits of the proposed approach on.

What is the most cost-effective strategy to screen for left ventricular systolic dysfunction: natriuretic peptides, the electrocardiogram, hand-held echocardiography, traditional echocardiography, or their combination?

PubMed

Galasko, Gavin I W; Barnes, Sophie C; Collinson, Paul; Lahiri, Avijit; Senior, Roxy

2006-01-01

To assess the screening characteristics and cost-effectiveness of screening for left ventricular systolic dysfunction (LVSD) in community subjects. A total of 1392 members of the general public and 928 higher risk subjects were randomly selected from seven community practices. Attending subjects underwent an ECG, N-terminal pro-brain natriuretic peptide (NTproBNP) serum levels, and traditional echocardiography (TE). A total of 533 consecutive subjects underwent hand-held echocardiography (HE). The screening characteristics and cost-effectiveness (cost per case of LVSD diagnosed) of eight strategies to predict LVSD (LVSD <45% on TE) were compared. A total of 1205 subjects attended. Ninety six per cent of subjects with LVSD in the general population had identifiable risk factors. All screening strategies gave excellent negative predictive value. Screening high-risk subjects was most cost-effective, screening low-risk subjects least cost-effective. TE screening was the least cost-effective strategy. NTproBNP screening gave similar cost savings to ECG screening; HE screening greater cost-savings, and HE screening following NTproBNP or ECG pre-screening the greatest cost-savings, costing approximately 650 Euros per case of LVSD diagnosed in high-risk subjects (63% cost-savings vs.TE). Thus several different modalities allow cost-effective community-based screening for LVSD, especially in high-risk subjects. Such programmes would be cost-effective and miss few cases of LVSD in the community.

Missed connections: Unintended consequences of updated cervical cancer screening guidelines on screening rates for sexually transmitted infections.

PubMed

Bogler, Tali; Farber, Allison; Stall, Nathan; Wijayasinghe, Sheila; Slater, Morgan; Guiang, Charlie; Glazier, Richard H

2015-10-01

To examine the effects of the updated 2012 cervical cancer screening guidelines on the rates of sexually transmitted infection (STI) screening in primary care. Retrospective chart review. Five academic family practice units at St Michael's Hospital in Toronto, Ont. Female patients, aged 19 to 25, who had at least 1 visit with a physician at 1 of the 5 academic family practice units during a 12-month period before (May 1, 2011, to April 30, 2012) or after (November 1, 2012, to October 31, 2013) the release of the updated guidelines. Number of women who received Papanicolaou tests or underwent STI screening; rates of STI screening performed during a Pap test or a periodic health examination; screening rates for HIV, syphilis, and hepatitis C; and the methods used for STI screening before and after the release of the updated guidelines. Results Before the release of the 2012 guidelines, 42 of 100 women had Pap tests and 40 of 100 women underwent STI screening. After the release of the guidelines, 17 of 100 women had Pap tests and 20 of 100 women received STI screening. Female patients were less likely to undergo STI screening under the 2012 guidelines compared with the 2005 guidelines (odds ratio 0.38, 95% CI 0.19 to 0.74; P = .003). Implementation of the 2012 cervical cancer screening guidelines was associated with lower rates of STI screening in the primary care setting. Primary care physicians should screen at-risk women for STIs at any clinically appropriate encounter and consider using noninvasive self-sampling methods.

Small median tumor diameter at cure threshold (<20 mm) among aggressive non-small cell lung cancers in male smokers predicts both chest X-ray and CT screening outcomes in a novel simulation framework.

PubMed

Goldwasser, Deborah L; Kimmel, Marek

2013-01-01

The effectiveness of population-wide lung cancer screening strategies depends on the underlying natural course of lung cancer. We evaluate the expected stage distribution in the Mayo CT screening study under an existing simulation model of non-small cell lung cancer (NSCLC) progression calibrated to the Mayo lung project (MLP). Within a likelihood framework, we evaluate whether the probability of 5-year NSCLC survival conditional on tumor diameter at detection depends significantly on screening detection modality, namely chest X-ray and computed tomography. We describe a novel simulation framework in which tumor progression depends on cellular proliferation and mutation within a stem cell compartment of the tumor. We fit this model to randomized trial data from the MLP and produce estimates of the median radiologic size at the cure threshold. We examine the goodness of model fit with respect to radiologic tumor size and 5-year NSCLC survival among incident cancers in both the MLP and Mayo CT studies. An existing model of NSCLC progression under-predicts the number of advanced-stage incident NSCLCs among males in the Mayo CT study (p-value = 0.004). The probability of 5-year NSCLC survival conditional on tumor diameter depends significantly on detection modality (p-value = 0.0312). In our new model, selected solution sets having a median tumor diameter of 16.2-22.1 mm at cure threshold among aggressive NSCLCs predict both MLP and Mayo CT outcomes. We conclude that the median lung tumor diameter at cure threshold among aggressive NSCLCs in male smokers may be small (<20 mm). Copyright © 2012 UICC.

Primary breast lymphomas--a retrospective analysis of twelve cases.

PubMed

Barişta, I; Baltali, E; Tekuzman, G; Kars, A; Ruacan, S; Ozişik, Y; Güler, N; Güllü, I H; Atahan, I L; Firat, D

2000-01-01

This study was undertaken to define the natural history and treatment results of patients with primary breast non-Hodgkin's lymphoma (NHL). Twelve female patients who had been followed at Hacettepe University Hospital between 1973 and 1997 were retrospectively evaluated. All patients presented with breast masses (6 in the right breast and 6 in the left) that had recently enlarged. The most common histologic subtype was diffuse, small cleaved-cell lymphoma. Chemotherapy regimens were employed in 9 patients. Radiotherapy was delivered to the breast and its lymphatics in 8 patients. Lumpectomy, simple or modified radical mastectomy was performed in 5 cases. An objective response was attained with surgery, chemotherapy, or radiotherapy alone in 2, 1, and 1 cases, respectively. Combined modality treatment including either two or three modalities was successful in 7 cases. The median progression-free and overall survival times were 49 and 56 months, respectively. Although primary NHL of the breast is a rare disease compared to carcinoma, it should be considered in the differential diagnosis of breast masses.

Evaluation of diabetic foot screening in Primary Care.

PubMed

Alonso-Fernández, Margarita; Mediavilla-Bravo, José Javier; López-Simarro, Flora; Comas-Samper, José Manuel; Carramiñana-Barrera, Francisco; Mancera-Romero, José; de Santiago Nocito, Ana

2014-01-01

To ascertain whether patients with type 2 diabetes are screened for diabetic foot, and to analyze the factors related to patients and centers associated to performance of such screening. A multicenter, epidemiological, cross-sectional study was conducted. The clinical records of 443 patients with type 2 diabetes monitored at Primary Care for at least 12 months were reviewed. Demographic and healthcare variables and characteristics of the primary care center were recorded. In the previous year, 51.2% of patients had been trained on foot self-care, 56.4% had undergone foot inspection, 39.5% had been examined with a monofilament, and palpation of peripheral pulses and measurement of the ankle-brachial index were performed in 45.8 and 10.1% of patients, respectively. Diabetic foot screening (inspection, monofilament testing, and palpation of peripheral pulses) was performed in 37% of study patients. Ulcer risk stratification was done in 12.4% of patients. A significant association was found between diabetic foot screening and presence of foot deformities (P<.001), history of neuropathy (P=.005), and history of peripheral artery disease (P<.05). Screening was also associated to some characteristics of the center, such as reception of information about goal achievement (P<.001) and economic incentives for goal attainment (P<.001). Compliance with diabetic foot screening and ulcer risk stratification in patients with type 2 diabetes in Primary Care was poor. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

[Impact of an informative intervention on the colorectal cancer screening program in primary care professionals].

PubMed

Benito-Aracil, Llúcia; Binefa-Rodriguez, Gemma; Milà-Diaz, Núria; Lluch-Canut, M Teresa; Puig-Llobet, Montse; Garcia-Martinez, Montse

2015-01-01

To evaluate the impact of an intervention in primary care professionals on their current knowledge about colorectal cancer screening, subsequent surveillance recommendations and referral strategies. Cluster randomized controlled trial. Primary Care Centers in L'Hospitalet de Llobregat (Barcelona). Primary Care Professionals (doctors and nurses). Training session in six of the 12 centers (randomly selected) about the colorrectal cancer screening program, and three emails with key messages. Professionals and centers characteristics and two contextual variables; involvement of professionals in the screening program; information about colorectal cancer knowledge, risk factors, screening procedures, surveillance recommendations and referral strategies. The total score mean on the first questionnaire was 8.07 (1.38) and the second 8.31 (1.39). No statistically significant differences between the intervention and control groups were found, however, in 9 out of 11 questions the percentage of correct responses was increased in the intervention group, mostly related to the surveillance after the diagnostic examination. The intervention improves the percentage of correct answers, especially in those in which worst score obtained in the first questionnaire. This study shows that professionals are familiar with colorectal cancer screening, but there's a need to maintain frequent communication in order to keep up to date the information related to the colorectal cancer screening. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Families at risk of poor parenting: a model for service delivery, assessment, and intervention.

PubMed

Ayoub, C; Jacewitz, M M

1982-01-01

The At Risk Parent Child Program is a multidisciplinary network agency designed for the secondary prevention of poor parenting and the extremes of child abuse and neglect. This model system of service delivery emphasizes (1) the coordination of existing community resources to access a target population of families at risk of parenting problems, (2) the provision of multiple special services in a neutral location (ambulatory pediatric clinic), and (3) the importance of intensive individual contact with a clinical professional who serves as primary therapist, social advocate and service coordinator for client families. Identification and assessment of families is best done during prenatal and perinatal periods. Both formal and informal procedures for screening for risk factors are described, and a simple set of at risk criteria for use by hospital nursing staff is provided. Preventive intervention strategies include special medical, psychological, social and developmental services, offered in an inpatient; outpatient, or in-home setting. Matching family needs to modality and setting of treatment is a major program concern. All direct services to at risk families are supplied by professionals employed within existing local agencies (hospital, public health department, state guidance center, and medical school pediatric clinic). Multiple agency involvement allows a broad-based screening capacity which allows thousands of families routine access to program services. The administrative center of the network stands as an independent, community-funded core which coordinates and monitors direct clinical services, and provides local political advocacy for families at risk of parenting problems.

Radiofrequency ablation in primary non-small cell lung cancer: What a radiologist needs to know

PubMed Central

Bhatia, Shivank; Pereira, Keith; Mohan, Prasoon; Narayanan, Govindarajan; Wangpaichitr, Medhi; Savaraj, Niramol

2016-01-01

Lung cancer continues to be one of the leading causes of death worldwide. In advanced cases of lung cancer, a multimodality approach is often applied, however with poor local control rates. In early non-small cell lung cancer (NSCLC), surgery is the standard of care. Only 15-30% of patients are eligible for surgical resection. Improvements in imaging and treatment delivery systems have provided new tools to better target these tumors. Stereotactic body radiation therapy (SBRT) has evolved as the next best option. The role of radiofrequency ablation (RFA) is also growing. Currently, it is a third-line option in stage 1 NSCLC, when SBRT cannot be performed. More recent studies have demonstrated usefulness in recurrent tumors and some authors have also suggested combination of RFA with other modalities in larger tumors. Following the National Lung Screening Trial (NLST), screening by low-dose computed tomography (CT) has demonstrated high rates of early-stage lung cancer detection in high-risk populations. Hence, even considering the current role of RFA as a third-line option, in view of increasing numbers of occurrences detected, the number of potential RFA candidates may see a steep uptrend. In view of all this, it is imperative that interventional radiologists be familiar with the techniques of lung ablation. The aim of this article is to discuss the procedural technique of RFA in the lung and review the current evidence regarding RFA for NSCLC. PMID:27081229

Projected future impact of HPV vaccination and primary HPV screening on cervical cancer rates from 2017–2035: Example from Australia

PubMed Central

Smith, Megan A.; Saville, Marion; Canfell, Karen

2018-01-01

Background Many countries are transitioning from cytology-based to longer-interval HPV screening. Trials comparing HPV-based screening to cytology report an increase in CIN2/3 detection at the first screen, and longer-term reductions in CIN3+; however, population level year-to-year transitional impacts are poorly understood. We undertook a comprehensive evaluation of switching to longer-interval primary HPV screening in the context of HPV vaccination. We used Australia as an example setting, since Australia will make this transition in December 2017. Methods Using a model of HPV vaccination, transmission, natural history and cervical screening, Policy1-Cervix, we simulated the planned transition from recommending cytology every two years for sexually-active women aged 18–20 to 69, to recommending HPV screening every five years for women aged 25–74 years. We estimated rates of CIN2/3, cervical cancer incidence, and mortality for each year from 2005 to 2035, considering ranges for HPV test accuracy and screening compliance in the context of HPV vaccination (current coverage ~82% in females; ~76% in males). Findings Transient increases are predicted to occur in rates of CIN2/3 detection and invasive cervical cancer in the first two to three years following the screening transition (of 16–24% and 11–14% in respectively, compared to 2017 rates). However, by 2035, CIN2/3 and invasive cervical cancer rates are predicted to fall by 40–44% and 42–51%, respectively, compared to 2017 rates. Cervical cancer mortality rates are predicted to remain unchanged until ~2020, then decline by 34–45% by 2035. Over the period 2018–2035, switching to primary HPV screening in Australia is expected to avert 2,006 cases of invasive cervical cancer and save 587 lives. Conclusions Transient increases in detected CIN2/3 and invasive cancer, which may be detectable at the population level, are predicted following a change to primary HPV screening. This is due to improved test sensitivity bringing forward diagnoses, resulting in longer term reductions in both cervical cancer incidence and mortality. Fluctuations in health outcomes due to the transition to a longer screening interval are predicted to occur for 10–15 years, but cervical cancer rates will be significantly reduced thereafter due to the impact of HPV vaccination and HPV screening. In order to maintain confidence in primary HPV screening through the transitional phase, it is important to widely communicate that an initial increase in CIN2/3 and perhaps even invasive cervical cancer is expected after a national transition to primary HPV screening, that this phenomenon is due to increased prevalent disease detection, and that this effect represents a marker of screening success. PMID:29444073

What is lacking in current decision aids on cancer screening?

PubMed Central

Jimbo, Masahito; Rana, Gurpreet K.; Hawley, Sarah; Holmes-Rovner, Margaret; Kelly-Blake, Karen; Nease, Donald E.; Ruffin, Mack T.

2013-01-01

Recent guidelines on cancer screening have given not only more screening options but also conflicting recommendations. Thus, patients, with their clinicians’ support, must decide whether to get screened or not, which modality to use, and how often to get screened. Decision aids could potentially lead to better shared decision making regarding screening between the patient and the clinician. We reviewed 73 decision aids on screening for breast, cervical, colorectal, and prostate cancers. The goal of this review was to assess the effectiveness of such decision aids, examine areas in need for more research, and determine how the decision aids can be currently applied in the real world setting. Most studies used sound study design. Significant variation existed in setting, theoretical framework, and measured outcomes. Just over a third of the decision aids included an explicit values clarification. Other than knowledge, little consistency was noted in which patient attributes were measured as outcomes. Few studies actually measured shared decision making. Little information was available on the feasibility and outcomes of integrating decision aids into practice. We discuss the implications for future research, as well as what the clinicians can do now to incorporate decision aids into their practice. PMID:23504675

Tumor treating fields - an emerging cancer treatment modality.

PubMed

Davis, Mary Elizabeth

2013-08-01

Tumor treating fields (TTFs) are an evolving new anticancer modality. The U.S. Food and Drug Administration has approved the first device, the NovoTTF-100A™, that uses this technology and is indicated for use in progressive glioblastoma multiforme after standard therapies have failed. Promising clinical trial results will likely lead to expanded uses in primary brain tumors and other cancer types. This article will review the concept of TTFs and their mechanism of action, and overview the TTF device and its approved usage.

RF Modal Quantity Gaging

NASA Technical Reports Server (NTRS)

Vanleuven, K.

1989-01-01

The primary objective is to provide a concept of a radio frequency (RF) modal resonance technique which is being investigated as a method for gaging the quantities of subcritical cryogenic propellants in metallic tanks. Of special interest are the potential applications of the technique to microgravity propellant gaging situations. The results of concept testing using cryogenic oxygen, hydrogen, and nitrogen, as well as paraffin simulations of microgravity fluid orientations, are reported. These test results were positive and showed that the gaging concept was viable.

Fluids and Combustion Facility: Fluids Integrated Rack Modal Model Correlation

NASA Technical Reports Server (NTRS)

McNelis, Mark E.; Suarez, Vicente J.; Sullivan, Timothy L.; Otten, Kim D.; Akers, James C.

2005-01-01

The Fluids Integrated Rack (FIR) is one of two racks in the Fluids and Combustion Facility on the International Space Station. The FIR is dedicated to the scientific investigation of space system fluids management supporting NASA s Exploration of Space Initiative. The FIR hardware was modal tested and FIR finite element model updated to satisfy the International Space Station model correlation criteria. The final cross-orthogonality results between the correlated model and test mode shapes was greater than 90 percent for all primary target modes.

Diagnostic imaging of the lower genitourinary tract

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rifkin, M.D.

1985-01-01

Dr. Rifkin analyzes the relative merits of ultrasound, computed tomography, magnetic resonance imaging, nuclear medicine, and radiography. He correlates ultrasound findings with those of computed tomography, radiography, and nuclear medicine and assesses the potential benefits of magnetic resonance imaging as compared with ultrasound and other imaging modalities. Each imaging modality is discussed in terms of its role as the primary, secondary, or complementary study for diagnoses involving the urinary bladder and perivesical spaces, the prostate and seminal vesicles, the urethra and penis, and the scrotal sac.

Primary treatments for clinically localized prostate cancer: a comprehensive lifetime cost-utility analysis

PubMed Central

Cooperberg, Matthew R.; Ramakrishna, Naren R.; Duff, Steven B.; Hughes, Kathleen E.; Sadownik, Sara; Smith, Joseph A.; Tewari, Ashutosh K.

2012-01-01

Objectives To characterize the costs and outcomes associated with radical prostatectomy (open, laparoscopic, or robot-assisted) and radiation therapy (dose-escalated 3-dimensional conformal radiation, intensity-modulated radiation, brachytherapy, or combination), using a comprehensive, lifetime decision analytic model. Patients and Methods A Markov model was constructed to follow hypothetical men with low-, intermediate-, and high-risk prostate cancer over their lifetimes following primary treatment; probabilities of outcomes were based on an exhaustive literature search yielding 232 unique publications. Patients could experience remission, recurrence, salvage treatment, metastasis, death from prostate cancer, and death from other causes. Utilities for each health state were determined, and disutilities were applied for complications and toxicities of treatment. Costs were determined from the U.S. payer perspective, with incorporation of patient costs in a sensitivity analysis. Results Differences in quality-adjusted life years across modalities were modest, ranging from 10.3 to 11.3 for low-risk patients, 9.6 to 10.5 for intermediate-risk patients, and 7.8 to 9.3 for high-risk patients. There were no statistically significant differences among surgical modalities, which tended to be more effective than radiation modalities, with the exception of combination external beam + brachytherapy for high-risk disease. Radiation modalities were consistently more expensive than surgical modalities; costs ranged from $19,901 (robot-assisted prostatectomy for low-risk disease) to $50,276 (combination radiation for high-risk disease). These findings were robust to an extensive set of sensitivity analyses. Conclusions Our analysis found small differences in outcomes and substantial differences in payer and patient costs across treatment alternatives. These findings may inform future policy discussions regarding strategies to improve efficiency of treatment selection for localized prostate cancer. PMID:23279038

Increasing Working Memory Load Reduces Processing of Cross-Modal Task-Irrelevant Stimuli Even after Controlling for Task Difficulty and Executive Capacity

PubMed Central

Simon, Sharon S.; Tusch, Erich S.; Holcomb, Phillip J.; Daffner, Kirk R.

2016-01-01

The classic account of the load theory (LT) of attention suggests that increasing cognitive load leads to greater processing of task-irrelevant stimuli due to competition for limited executive resource that reduces the ability to actively maintain current processing priorities. Studies testing this hypothesis have yielded widely divergent outcomes. The inconsistent results may, in part, be related to variability in executive capacity (EC) and task difficulty across subjects in different studies. Here, we used a cross-modal paradigm to investigate whether augmented working memory (WM) load leads to increased early distracter processing, and controlled for the potential confounders of EC and task difficulty. Twenty-three young subjects were engaged in a primary visual WM task, under high and low load conditions, while instructed to ignore irrelevant auditory stimuli. Demands of the high load condition were individually titrated to make task difficulty comparable across subjects with differing EC. Event-related potentials (ERPs) were used to measure neural activity in response to stimuli presented in both the task relevant modality (visual) and task-irrelevant modality (auditory). Behavioral results indicate that the load manipulation and titration procedure of the primary visual task were successful. ERPs demonstrated that in response to visual target stimuli, there was a load-related increase in the posterior slow wave, an index of sustained attention and effort. Importantly, under high load, there was a decrease of the auditory N1 in response to distracters, a marker of early auditory processing. These results suggest that increased WM load is associated with enhanced attentional engagement and protection from distraction in a cross-modal setting, even after controlling for task difficulty and EC. Our findings challenge the classic LT and offer support for alternative models. PMID:27536226

Increasing Working Memory Load Reduces Processing of Cross-Modal Task-Irrelevant Stimuli Even after Controlling for Task Difficulty and Executive Capacity.

PubMed

Simon, Sharon S; Tusch, Erich S; Holcomb, Phillip J; Daffner, Kirk R

2016-01-01

The classic account of the load theory (LT) of attention suggests that increasing cognitive load leads to greater processing of task-irrelevant stimuli due to competition for limited executive resource that reduces the ability to actively maintain current processing priorities. Studies testing this hypothesis have yielded widely divergent outcomes. The inconsistent results may, in part, be related to variability in executive capacity (EC) and task difficulty across subjects in different studies. Here, we used a cross-modal paradigm to investigate whether augmented working memory (WM) load leads to increased early distracter processing, and controlled for the potential confounders of EC and task difficulty. Twenty-three young subjects were engaged in a primary visual WM task, under high and low load conditions, while instructed to ignore irrelevant auditory stimuli. Demands of the high load condition were individually titrated to make task difficulty comparable across subjects with differing EC. Event-related potentials (ERPs) were used to measure neural activity in response to stimuli presented in both the task relevant modality (visual) and task-irrelevant modality (auditory). Behavioral results indicate that the load manipulation and titration procedure of the primary visual task were successful. ERPs demonstrated that in response to visual target stimuli, there was a load-related increase in the posterior slow wave, an index of sustained attention and effort. Importantly, under high load, there was a decrease of the auditory N1 in response to distracters, a marker of early auditory processing. These results suggest that increased WM load is associated with enhanced attentional engagement and protection from distraction in a cross-modal setting, even after controlling for task difficulty and EC. Our findings challenge the classic LT and offer support for alternative models.

Obesity Prevention and Screening.

PubMed

Mackey, Eleanor R; Olson, Alexandra; DiFazio, Marc; Cassidy, Omni

2016-03-01

Obesity is widespread, associated with several physical and psychosocial comorbidities, and is difficult to treat. Prevention of obesity across the lifespan is critical to improving the health of individuals and society. Screening and prevention efforts in primary care are an important step in addressing the obesity epidemic. Each period of human development is associated with unique risks, challenges, and opportunities for prevention and intervention. Screening tools for overweight/obesity, although imperfect, are quick and easy to administer. Screening should be conducted at every primary care visit and tracked longitudinally. Screening tools and cutoffs for overweight and obesity vary by age group. Copyright © 2016 Elsevier Inc. All rights reserved.

Screening and brief interventions for hazardous and harmful alcohol use in primary care: a cluster randomised controlled trial protocol

PubMed Central

Kaner, Eileen; Bland, Martin; Cassidy, Paul; Coulton, Simon; Deluca, Paolo; Drummond, Colin; Gilvarry, Eilish; Godfrey, Christine; Heather, Nick; Myles, Judy; Newbury-Birch, Dorothy; Oyefeso, Adenekan; Parrott, Steve; Perryman, Katherine; Phillips, Tom; Shenker, Don; Shepherd, Jonathan

2009-01-01

Background There have been many randomized controlled trials of screening and brief alcohol intervention in primary care. Most trials have reported positive effects of brief intervention, in terms of reduced alcohol consumption in excessive drinkers. Despite this considerable evidence-base, key questions remain unanswered including: the applicability of the evidence to routine practice; the most efficient strategy for screening patients; and the required intensity of brief intervention in primary care. This pragmatic factorial trial, with cluster randomization of practices, will evaluate the effectiveness and cost-effectiveness of different models of screening to identify hazardous and harmful drinkers in primary care and different intensities of brief intervention to reduce excessive drinking in primary care patients. Methods and design GPs and nurses from 24 practices across the North East (n = 12), London and South East (n = 12) of England will be recruited. Practices will be randomly allocated to one of three intervention conditions: a leaflet-only control group (n = 8); brief structured advice (n = 8); and brief lifestyle counselling (n = 8). To test the relative effectiveness of different screening methods all practices will also be randomised to either a universal or targeted screening approach and to use either a modified single item (M-SASQ) or FAST screening tool. Screening randomisation will incorporate stratification by geographical area and intervention condition. During the intervention stage of the trial, practices in each of the three arms will recruit at least 31 hazardous or harmful drinkers who will receive a short baseline assessment followed by brief intervention. Thus there will be a minimum of 744 patients recruited into the trial. Discussion The trial will evaluate the impact of screening and brief alcohol intervention in routine practice; thus its findings will be highly relevant to clinicians working in primary care in the UK. There will be an intention to treat analysis of study outcomes at 6 and 12 months after intervention. Analyses will include patient measures (screening result, weekly alcohol consumption, alcohol-related problems, public service use and quality of life) and implementation measures from practice staff (the acceptability and feasibility of different models of brief intervention.) We will also examine organisational factors associated with successful implementation. Trial registration Current Controlled Trials ISRCTN06145674. PMID:19664255

Preparing patients for biologic medications for dermatologic and rheumatic diseases.

PubMed

Smith, Benjamin J; Nuccio, Brigitta C; Graves, Katelyn Y; McMillan, Victor M

2018-06-01

Psoriasis, psoriatic arthritis, and rheumatoid arthritis are prevalent conditions that often require a team of primary care and specialist healthcare professionals for the most optimum patient outcomes. Primary care providers can facilitate referrals to dermatology and rheumatology specialists by obtaining the needed screening workup for patients who need treatment with immunosuppressive therapies. This article reviews tuberculosis screening, hepatitis screening, and vaccinations to be administered before patients begin biologic medications.

Attitudes and Beliefs of Primary Care Providers in New Mexico About Lung Cancer Screening Using Low-Dose Computed Tomography

PubMed Central

Hoffman, Richard M.; Sussman, Andrew L.; Getrich, Christina M.; Rhyne, Robert L.; Crowell, Richard E.; Taylor, Kathryn L.; Reifler, Ellen J.; Wescott, Pamela H.; Murrietta, Ambroshia M.; Saeed, Ali I.

2015-01-01

Introduction On the basis of results from the National Lung Screening Trial (NLST), national guidelines now recommend using low-dose computed tomography (LDCT) to screen high-risk smokers for lung cancer. Our study objective was to characterize the knowledge, attitudes, and beliefs of primary care providers about implementing LDCT screening. Methods We conducted semistructured interviews with primary care providers practicing in New Mexico clinics for underserved minority populations. The interviews, conducted from February through September 2014, focused on providers’ tobacco cessation efforts, lung cancer screening practices, perceptions of NLST and screening guidelines, and attitudes about informed decision making for cancer screening. Investigators iteratively reviewed transcripts to create a coding structure. Results We reached thematic saturation after interviewing 10 providers practicing in 6 urban and 4 rural settings; 8 practiced at federally qualified health centers. All 10 providers promoted smoking cessation, some screened with chest x-rays, and none screened with LDCT. Not all were aware of NLST results or current guideline recommendations. Providers viewed study results skeptically, particularly the 95% false-positive rate, the need to screen 320 patients to prevent 1 lung cancer death, and the small proportion of minority participants. Providers were uncertain whether New Mexico had the necessary infrastructure to support high-quality screening, and worried about access barriers and financial burdens for rural, underinsured populations. Providers noted the complexity of discussing benefits and harms of screening and surveillance with their patient population. Conclusion Providers have several concerns about the feasibility and appropriateness of implementing LDCT screening. Effective lung cancer screening programs will need to educate providers and patients to support informed decision making and to ensure that high-quality screening can be efficiently delivered in community practice. PMID:26160294

Financial Incentives and Cervical Cancer Screening Participation in Ontario's Primary Care Practice Models.

PubMed

Pendrith, Ciara; Thind, Amardeep; Zaric, Gregory S; Sarma, Sisira

2016-08-01

The primary objective of this paper is to compare cervical cancer screening rates of family physicians in Ontario's two dominant reformed practice models, Family Health Group (FHG) and Family Health Organization (FHO), and traditional fee-for-service (FFS) model. Both reformed models formally enrol patients and offer extensive pay-for-performance incentives; however, they differ by remuneration for core services (FHG is FFS; FHO is capitated). The secondary objective is to estimate the average and marginal costs of screening in each model. Using administrative data on 7,298 family physicians and their 2,083,633 female patients aged 35-69 eligible for cervical cancer screening in 2011, we assessed screening rates after adjusting for patient and physician characteristics. Predicted screening rates, fees and bonus payments were used to estimate the average and marginal costs of cervical cancer screening. Adjusted screening rates were highest in the FHG (81.9%), followed by the FHO (79.6%), and then the traditional FFS model (74.2%). The cost of a cervical cancer screening was $18.30 in the FFS model. The estimated average cost of screening in the FHGs and FHOs were $29.71 and $35.02, respectively, while the corresponding marginal costs were $33.05 and $39.06. We found significant differences in cervical cancer screening rates across Ontario's primary care practice models. Cervical screening rates were significantly higher in practice models eligible for incentives (FHGs and FHOs) than the traditional FFS model. However, the average and marginal cost of screening were lowest in the traditional FFS model and highest in the FHOs. Copyright © 2016 Longwoods Publishing.

Comparing solutions to the expectancy-value muddle in the theory of planned behaviour.

PubMed

O' Sullivan, B; McGee, H; Keegan, O

2008-11-01

The authors of the Theories of Reasoned Action (TRA) and Planned Behaviour (TPB) recommended a method for statistically analysing the relationship between the indirect belief-based measures and the direct measures of attitude, subjective norm, and perceived behavioural control (PBC). However, there is a growing awareness that this yields statistically uninterpretable results. This study's objective was to compare two solutions to what has been called the 'expectancy-value muddle'. These solutions were (i) optimal scoring of modal beliefs and (ii) individual beliefs without multiplicative composites. Cross-sectional data were collected by telephone interview. Participants were 110 first-degree relatives (FDRs) of patients diagnosed with colorectal cancer (CRC), who were offered CRC screening in the study hospital (83% response rate). Participants were asked to rate the TPB constructs in relation to attending for CRC screening. There was no significant difference in the correlation between behavioural beliefs and attitude for rescaled modal and individual beliefs. This was also the case for control beliefs and PBC. By contrast, there was a large correlation between rescaled modal normative beliefs and subjective norm, whereas individual normative beliefs did not correlate with subjective norm. Using individual beliefs without multiplicative composites allows for a fairly unproblematic interpretation of the relationship between the indirect and direct TPB constructs (French & Hankins, 2003). Therefore, it is recommended that future studies consider using individual measures of behavioural and control beliefs without multiplicative composites and examine a different way of measuring individual normative beliefs without multiplicative composites to that used in this study.

Screening for colorectal cancer.

PubMed

He, Jin; Efron, Jonathan E

2011-01-01

March is national colorectal cancer awareness month. It is estimated that as many as 60% of colorectal cancer deaths could be prevented if all men and women aged 50 years or older were screened routinely. In 2000, Katie Couric's televised colonoscopy led to a 20% increase in screening colonoscopies across America, a stunning rise called the "Katie Couric Effect". This event demonstrated how celebrity endorsement affects health behavior. Currently, discussion is ongoing about the optimal strategy for CRC screening, particularly the costs of screening colonoscopy. The current CRC screening guidelines are summarized in Table 2. Debates over the optimum CRC screening test continue in the face of evidence that 22 million Americans aged 50 to 75 years are not screened for CRC by any modality and 25,000 of those lives may have been saved if they had been screened for CRC. It is clear that improving screening rates and reducing disparities in underscreened communities and population subgroups could further reduce colorectal cancer morbidity and mortality. National Institutes of Health consensus identified the following priority areas to enhance the use and quality of colorectal cancer screening: Eliminate financial barriers to colorectal cancer screening and appropriate follow-up of positive results of colorectal cancer screening. Develop systems to ensure the high quality of colorectal cancer screening programs. Conduct studies to determine the comparative effectiveness of the various colorectal cancer screening methods in usual practice settings. Encouraging population adherence to screening tests and allowing patients to select the tests they prefer may do more good (as long as they choose something) than whatever procedure is chosen by the medical profession as the preferred test.

Mutual information-based template matching scheme for detection of breast masses: from mammography to digital breast tomosynthesis

PubMed Central

Mazurowski, Maciej A; Lo, Joseph Y; Harrawood, Brian P; Tourassi, Georgia D

2011-01-01

Development of a computational decision aid for a new medical imaging modality typically is a long and complicated process. It consists of collecting data in the form of images and annotations, development of image processing and pattern recognition algorithms for analysis of the new images and finally testing of the resulting system. Since new imaging modalities are developed more rapidly than ever before, any effort for decreasing the time and cost of this development process could result in maximizing the benefit of the new imaging modality to patients by making the computer aids quickly available to radiologists that interpret the images. In this paper, we make a step in this direction and investigate the possibility of translating the knowledge about the detection problem from one imaging modality to another. Specifically, we present a computer-aided detection (CAD) system for mammographic masses that uses a mutual information-based template matching scheme with intelligently selected templates. We presented principles of template matching with mutual information for mammography before. In this paper, we present an implementation of those principles in a complete computer-aided detection system. The proposed system, through an automatic optimization process, chooses the most useful templates (mammographic regions of interest) using a large database of previously collected and annotated mammograms. Through this process, the knowledge about the task of detecting masses in mammograms is incorporated in the system. Then we evaluate whether our system developed for screen-film mammograms can be successfully applied not only to other mammograms but also to digital breast tomosynthesis (DBT) reconstructed slices without adding any DBT cases for training. Our rationale is that since mutual information is known to be a robust intermodality image similarity measure, it has high potential of transferring knowledge between modalities in the context of the mass detection task. Experimental evaluation of the system on mammograms showed competitive performance compared to other mammography CAD systems recently published in the literature. When the system was applied “as-is” to DBT, its performance was notably worse than that for mammograms. However, with a simple additional preprocessing step, the performance of the system reached levels similar to that obtained for mammograms. In conclusion, the presented CAD system not only performed competitively on screen-film mammograms but it also performed robustly on DBT showing that direct transfer of knowledge across breast imaging modalities for mass detection is in fact possible. PMID:21554985

Modal analysis and dynamic stresses for acoustically excited shuttle insulation tiles

NASA Technical Reports Server (NTRS)

Ojalvo, I. U.; Ogilvie, P. L.

1975-01-01

Improvements and extensions to the RESIST computer program developed for determining the normalized modal stress response of shuttle insulation tiles are described. The new version of RESIST can accommodate primary structure panels with closed-cell stringers, in addition to the capability for treating open-cell stringers. In addition, the present version of RESIST numerically solves vibration problems several times faster than its predecessor. A new digital computer program, titled ARREST (Acoustic Response of Reusable Shuttle Tiles) is also described. Starting with modal information contained on output tapes from RESIST computer runs, ARREST determines RMS stresses, deflections and accelerations of shuttle panels with reusable surface insulation tiles. Both programs are applicable to stringer stiffened structural panels with or without reusable surface insulation titles.

Robust energy-absorbing compensators for the ACTEX II test article

NASA Astrophysics Data System (ADS)

Blaurock, Carl A.; Miller, David W.; Nye, Ted

1995-05-01

The paper addresses the problem of satellite solar panel vibration. A multi-layer vibration control scheme is investigated using a flight test article. Key issues in the active control portion are presented in the paper. The paper discusses the primary control design drivers, which are the time variations in modal frequencies due to configuration and thermal changes. A local control design approach is investigated, but found to be unworkable due to sensor/actuator non-collocation. An alternate design process uses linear robust control techniques, by describing the modal shifts as uncertainties. Multiple modal design, alpha- shifted multiple model, and a feedthrough compensation scheme are examined. Ground and simulation tests demonstrate that the resulting controllers provide significant vibration reduction in the presence of expected system variations.

SSF loads and controllability during assembly

NASA Technical Reports Server (NTRS)

Larson, Charles R.; Ghofranian, S.; Fujii, E.

1993-01-01

The Orbiter Primary Reaction Control System (PRCS) pulse width and firing frequency is restricted to prevent excessive loads in the Space Station Freedom (SSF). The feasibility of using the SSF Control Moment Gyros (CMG) as a secondary controller for load relief is evaluated. The studies revealed the CMG not only reduced loads but were useful for other SSF functions: vibration suppression and modal excitation. Vibration suppression lowers the g level for the SSF micro-g experiments and damps the low frequency oscillations that cause crew sickness. Modal excitation could be used for the modal identification experiment and health monitoring. The CMG's reduced the peak loads and damped the vibrations. They were found to be an effective multi-purpose ancillary device for SSF operation.

Primary care providers’ perspectives on discontinuing prostate cancer screening

PubMed Central

Pollack, Craig E.; Platz, Elizabeth A.; Bhavsar, Nrupen A.; Noronha, Gary; Green, Gene E.; Chen, Sean; Carter, H. Ballentine

2012-01-01

Background Clinical guidelines recommend against routine prostate specific antigen (PSA) screening in older men and those with lower life expectancies. We examined providers’ decision-making regarding discontinuing PSA screening. Methods We administered a survey of primary providers from a large, university-affiliated primary care practice. Providers were asked about their current screening practices, factors that influence their decision to discontinue screening, and barriers to discontinuing screening. Bivariate and multivariable logistic regression analyses were used to examine whether taking age and/or life expectancy into account and barriers to discontinuing were associated with clinician characteristics and practice styles. Results 88.7% of providers participated in the survey (125 out of 141). Over half (59.3%) took both age and life expectancy into account whereas 12.2% did not consider either in their decisions to discontinue PSA screening. Providers varied with the age they typically stop screening and majority (66.4%) report difficulty in assessing life expectancy. Taking patient age and life expectancy into account was not associated with provider characteristics or practice styles. The most frequently cited barriers to discontinuing PSA screening were patient expectation (74.4%) and time constraints (66.4%). Black providers were significantly less likely than non-black providers to endorse barriers related to time constraints and clinical uncertainty, though these results are limited by the small sample size of black providers. Conclusion Though age and life expectancy often figure prominently in decisions to employ screening, providers face multiple barriers to discontinue PSA routine screening, PMID:22517310

Improving substance abuse screening and intervention in a primary care clinic.

PubMed

Neushotz, Lori A; Fitzpatrick, Joyce J

2008-04-01

Despite recent efforts to educate primary care providers in the identification and management of patients presenting with substance abuse problems, many opportunities to identify and intervene with these patients are overlooked. This project was designed to identify factors that interfere with rates of screening and brief intervention (SBI) of substance abuse problems in a primary care clinic in a major academic medical center in New York City. Six informants representing the disciplines of medicine, nursing, and social work in the primary care clinic provided information regarding SBI. Analysis was focused on substantiation of the need for enhanced diffusion of knowledge related to screening for substance abuse problems to improve rates of SBI in primary care. Recommendations for improvement included continued promotion of SBI by influential role models and opinion leaders, improvement in primary care providers' perceptions of the perceived characteristics of SBI to improve rates of adoption, implementation of interdisciplinary educational initiatives toward the goal of improving rates of SBI in the primary care clinic, and initiation of translational research at the clinic supporting SBI in primary care.

Comparison of the PSC-17 and Alternative Mental Health Screens in an At-Risk Primary Care Sample

ERIC Educational Resources Information Center

Gardner, William; Lucas, Amanda; Kolko, David J.; Campo, John V.

2007-01-01

Objective: To validate the 17-item version of the Pediatric Symptom Checklist (PSC-17) as a screen for common pediatric mental disorders in primary care. Method: Patients were 269 children and adolescents (8-15 years old) whose parents completed the PSC-17 in primary care waiting rooms. Children were later assessed using the Schedule for Affective…

Preliminary Validation of a Screening Tool for Adolescent Panic Disorder in Pediatric Primary Care Clinics

ERIC Educational Resources Information Center

Queen, Alexander H.; Ehrenreich-May, Jill; Hershorin, Eugene R.

2012-01-01

This study examines the validity of a brief screening tool for adolescent panic disorder (PD) in a primary care setting. A total of 165 participants (ages 12-17 years) seen in two pediatric primary care clinics completed the Autonomic Nervous System Questionnaire (ANS; Stein et al. in Psychosomatic Med 61:359-364, 40). A subset of those screening…

[Breast cancer diagnosis among women aged 75 and over: study on information delivered by organized breast cancer screening agencies to women reaching the limit age].

PubMed

Ecomard, Louis-Marie; Malingret, Nathalie; Asad-Syed, Maryam; Dilhuydy, Marie-Hélène; Madranges, Nicolas; Payet, Catherine; Debled, Marc

2013-01-01

Breast cancer among older women is a major and increasing public health issue. No clear recommendation has been established in France after 74 years, the age limit for state-organised screening program. A survey was performed among all regional agencies in charge of the breast screening to analyse which information is delivered to women reaching the age of 75 years. A postal survey sent to 91 French organised cancer screening agencies. Among the 89 agencies that answered, only 22 deliver a systematic written information. Twelve suggest that mammographic screening should be continued, and five mention clinical examination. Twenty agencies dispatch the screening to general practitioners or gynaecologists. Two information letters insist on the ongoing risk of breast cancer. Most of the written information is given with the last mammography report. No impact study has ever been performed. In our study, only 25% of the screening agencies give systematic information to women. The modalities and the substance of this information are heterogeneous. A better information seems to be a key-point for earlier clinical breast cancer diagnosis among older women, for whom there is little direct evidence of the benefit of systematic mammographic screening.

Small-area variation in screening for cancer, glucose and cholesterol in Ontario: a cross-sectional study.

PubMed

Fernandes, Kimberly A; Sutradhar, Rinku; Borkhoff, Cornelia M; Baxter, Nancy; Lofters, Aisha; Rabeneck, Linda; Tinmouth, Jill; Paszat, Lawrence

2015-01-01

Screening for cervical, breast and colon cancers, and elevations of cholesterol and glucose, reduces premature cause-specific mortality from these cancers and circulatory diseases. Despite primary care reforms and incentives, and promotion of cancer-screening programs among individuals, participation is suboptimal. We aimed to examine participation as of Dec. 31, 2011, by factors of deprivation, demographics and primary care at the small-area level. From health care administrative databases, we identified people eligible for each screening test, and their participation, in each dissemination area (referred to as small areas, n = 18 950) in Ontario. We calculated rates for each test among small areas (overall and stratified by demographic, socioeconomic and primary care descriptors) and stratified by sex for all tests combined. We loaded all data into a geographic information system. Funnel plots were generated showing the percentage of eligible people who completed screening for all tests by small area, stratified by sex. Overall and stratified screening prevalence ratios were calculated among small areas. Among small areas, the mean and SD for participation in all tests combined was 31.6% (SD 11.0%) for women and 41.2% (SD 12.0%) for men. Screening prevalence among small areas, for each test and for all tests combined, overall and stratified by sex, declined with decreasing percentage with high school completion, decreasing socioeconomic quintile, and decreasing percentage with an identifiable primary care physician. Our results show that the rate of participation in all eligible screening tests among small areas is much lower than the rate of participation in any one particular test. This finding has implications for the design and implementation of strategies to improve rates of screening.

Exploring Dreamspace through Video Art with At-Risk Youth

ERIC Educational Resources Information Center

Ehinger, Jon

2009-01-01

This thesis is an art-based research video demonstration of an alternate medium for art therapy. It postulates the value and validity of media arts as a therapeutic modality by way of adopting the major motion picture green screening technique for therapy with an at-risk youth population. Four male participants, raging from 16 to 19 years of age,…

[Current treatment of bacterial vaginosis].

PubMed

Borisov, I

1999-01-01

Therapeutic options for the treatment of accurately diagnosed bacterial vaginosis are reviewed on the basis of current concepts for treatment of bacterial vaginosis. The importance for screening for bacterial vaginosis is pointed out especially before intrauterine procedures and in pregnant women at risk for premature deliveries. Treatment regimens for pregnant women are discussed as well. Emphasis is given to treatment modalities for recurrent bacterial vaginosis.

On the Screen or Printed: A Case of EFL Learners' Online and Offline Reading the Press

ERIC Educational Resources Information Center

Rahimi, Ali; Behjat, Fatemeh

2011-01-01

A growing body of investigations on second language teaching and learning is now being devoted to the international use of network information and communication technology known as e-learning. Individualized self-paced e-learning offline and online are two of the common e-learning modalities used by language teachers and learners (Romiszowski…

Segmentation and Quantification for Angle-Closure Glaucoma Assessment in Anterior Segment OCT.

PubMed

Fu, Huazhu; Xu, Yanwu; Lin, Stephen; Zhang, Xiaoqin; Wong, Damon Wing Kee; Liu, Jiang; Frangi, Alejandro F; Baskaran, Mani; Aung, Tin

2017-09-01

Angle-closure glaucoma is a major cause of irreversible visual impairment and can be identified by measuring the anterior chamber angle (ACA) of the eye. The ACA can be viewed clearly through anterior segment optical coherence tomography (AS-OCT), but the imaging characteristics and the shapes and locations of major ocular structures can vary significantly among different AS-OCT modalities, thus complicating image analysis. To address this problem, we propose a data-driven approach for automatic AS-OCT structure segmentation, measurement, and screening. Our technique first estimates initial markers in the eye through label transfer from a hand-labeled exemplar data set, whose images are collected over different patients and AS-OCT modalities. These initial markers are then refined by using a graph-based smoothing method that is guided by AS-OCT structural information. These markers facilitate segmentation of major clinical structures, which are used to recover standard clinical parameters. These parameters can be used not only to support clinicians in making anatomical assessments, but also to serve as features for detecting anterior angle closure in automatic glaucoma screening algorithms. Experiments on Visante AS-OCT and Cirrus high-definition-OCT data sets demonstrate the effectiveness of our approach.

Pulmonary nodule characterization, including computer analysis and quantitative features.

PubMed

Bartholmai, Brian J; Koo, Chi Wan; Johnson, Geoffrey B; White, Darin B; Raghunath, Sushravya M; Rajagopalan, Srinivasan; Moynagh, Michael R; Lindell, Rebecca M; Hartman, Thomas E

2015-03-01

Pulmonary nodules are commonly detected in computed tomography (CT) chest screening of a high-risk population. The specific visual or quantitative features on CT or other modalities can be used to characterize the likelihood that a nodule is benign or malignant. Visual features on CT such as size, attenuation, location, morphology, edge characteristics, and other distinctive "signs" can be highly suggestive of a specific diagnosis and, in general, be used to determine the probability that a specific nodule is benign or malignant. Change in size, attenuation, and morphology on serial follow-up CT, or features on other modalities such as nuclear medicine studies or MRI, can also contribute to the characterization of lung nodules. Imaging analytics can objectively and reproducibly quantify nodule features on CT, nuclear medicine, and magnetic resonance imaging. Some quantitative techniques show great promise in helping to differentiate benign from malignant lesions or to stratify the risk of aggressive versus indolent neoplasm. In this article, we (1) summarize the visual characteristics, descriptors, and signs that may be helpful in management of nodules identified on screening CT, (2) discuss current quantitative and multimodality techniques that aid in the differentiation of nodules, and (3) highlight the power, pitfalls, and limitations of these various techniques.

Subject-friendly entire gastrointestinal screening with a single capsule endoscope by magnetic navigation and the Internet.

PubMed

Ohta, Hidetoshi; Katsuki, Shinichi

2014-01-01

Ever since capsule endoscopy (CE) was introduced into clinical practice, we gastroenterologists have been dreaming of using this less invasive modality to explore the entire gastrointestinal (GI) tract. To realize this dream, we have developed a magnetic navigation system which includes real-time internet streaming of endoscopic video and some useful gadgets (position detection by means of magnetic impedance (MI) sensors and a modified capsule that is "weightless" in water). The design of the weightless capsule made it possible with 0.5T (Tesla) extracorporeal magnets to control the capsule beyond 20cm. A pair of MI sensors on the body surface could detect subtle magnetic flux generated by an intra-capsular magnet in the GI tract by utilizing the space diversity effect which eliminated the interference of terrestrial magnetism. Subjects underwent CE, during which they were free from confinement in the hospital, except for 1 hour when the capsule was manipulated in the stomach and colon. This study had a completion rate of 97.5%. The high completion rate indicates that our system (single capsule endoscopy-SCE) with further improvements could become a viable modality for screening of the entire GI tract.

Is an opportunistic primary care-based intervention for non-responders to bowel screening feasible and acceptable? A mixed-methods feasibility study in Scotland

PubMed Central

Calanzani, Natalia; Cavers, Debbie; Vojt, Gabriele; Orbell, Sheina; Steele, Robert J C; Brownlee, Linda; Smith, Steve; Patnick, Julietta; Weller, David; Campbell, Christine

2017-01-01

Objectives We aimed to test whether a brief, opportunistic intervention in general practice was a feasible and acceptable way to engage with bowel screening non-responders. Design This was a feasibility study testing an intervention which comprised a brief conversation during routine consultation, provision of a patient leaflet and instructions to request a replacement faecal occult blood test kit. A mixed-methods approach to evaluation was adopted. Data were collected from proformas completed after each intervention, from the Bowel Screening Centre database and from questionnaires. Semi-structured interviews were carried out. We used descriptive statistics, content and framework analysis to determine intervention feasibility and acceptability. Participants Bowel screening non-responders (as defined by the Scottish Bowel Screening Centre) and primary care professionals working in five general practices in Lothian, Scotland. Primary and secondary outcome measures Several predefined feasibility parameters were assessed, including numbers of patients engaging in conversation, requesting a replacement kit and returning it, and willingness of primary care professionals to deliver the intervention. Results The intervention was offered to 258 patients in five general practices: 220 (87.0%) engaged with the intervention, 60 (23.3%) requested a new kit, 22 (8.5%) kits were completed and returned. Interviews and questionnaires suggest that the intervention was feasible, acceptable and consistent with an existing health prevention agenda. Reported challenges referred to work-related pressures, time constraints and practice priorities. Conclusions This intervention was acceptable and resulted in a modest increase in non-responders participating in bowel screening, although outlined challenges may affect sustained implementation. The strategy is also aligned with the increasing role of primary care in promoting bowel screening. PMID:29025829

Fecal occult blood testing beliefs and practices of U.S. primary care physicians: serious deviations from evidence-based recommendations.

PubMed

Nadel, Marion R; Berkowitz, Zahava; Klabunde, Carrie N; Smith, Robert A; Coughlin, Steven S; White, Mary C

2010-08-01

Fecal occult blood testing (FOBT) is an important option for colorectal cancer screening that should be available in order to achieve high population screening coverage. However, results from a national survey of clinical practice in 1999-2000 indicated that many primary care physicians used inadequate methods to implement FOBT screening and follow-up. To determine whether methods to screen for fecal occult blood have improved, including the use of newer more sensitive stool tests. Cross-sectional national survey of primary care physicians. Participants consisted of 1,134 primary care physicians who reported ordering or performing FOBT in the 2006-2007 National Survey of Primary Care Physicians' Recommendations and Practices for Cancer Screening. Self-reported data on details of FOBT implementation and follow-up of positive results. Most physicians report using standard guaiac tests; higher sensitivity guaiac tests and immunochemical tests were reported by only 22.0% and 8.9%, respectively. In-office testing, that is, testing of a single specimen collected during a digital rectal examination in the office, is still widely used although inappropriate for screening: 24.9% of physicians report using only in-office tests and another 52.9% report using both in-office and home tests. Recommendations improved for follow-up after a positive test: fewer physicians recommend repeating the FOBT (17.8%) or using tests other than colonoscopy for the diagnostic work-up (6.6%). Only 44.3% of physicians who use home tests have reminder systems to ensure test completion and return. Many physicians continue to use inappropriate methods to screen for fecal occult blood. Intensified efforts to inform physicians of recommended technique and promote the use of tracking systems are needed.

Crossmodal Connections of Primary Sensory Cortices Largely Vanish During Normal Aging

PubMed Central

Henschke, Julia U.; Ohl, Frank W.; Budinger, Eike

2018-01-01

During aging, human response times (RTs) to unisensory and crossmodal stimuli decrease. However, the elderly benefit more from crossmodal stimulus representations than younger people. The underlying short-latency multisensory integration process is mediated by direct crossmodal connections at the level of primary sensory cortices. We investigate the age-related changes of these connections using a rodent model (Mongolian gerbil), retrograde tracer injections into the primary auditory (A1), somatosensory (S1), and visual cortex (V1), and immunohistochemistry for markers of apoptosis (Caspase-3), axonal plasticity (Growth associated protein 43, GAP 43), and a calcium-binding protein (Parvalbumin, PV). In adult animals, primary sensory cortices receive a substantial number of direct thalamic inputs from nuclei of their matched, but also from nuclei of non-matched sensory modalities. There are also direct intracortical connections among primary sensory cortices and connections with secondary sensory cortices of other modalities. In very old animals, the crossmodal connections strongly decrease in number or vanish entirely. This is likely due to a retraction of the projection neuron axonal branches rather than ongoing programmed cell death. The loss of crossmodal connections is also accompanied by changes in anatomical correlates of inhibition and excitation in the sensory thalamus and cortex. Together, the loss and restructuring of crossmodal connections during aging suggest a shift of multisensory processing from primary cortices towards other sensory brain areas in elderly individuals. PMID:29551970

Crossmodal Connections of Primary Sensory Cortices Largely Vanish During Normal Aging.

PubMed

Henschke, Julia U; Ohl, Frank W; Budinger, Eike

2018-01-01

During aging, human response times (RTs) to unisensory and crossmodal stimuli decrease. However, the elderly benefit more from crossmodal stimulus representations than younger people. The underlying short-latency multisensory integration process is mediated by direct crossmodal connections at the level of primary sensory cortices. We investigate the age-related changes of these connections using a rodent model (Mongolian gerbil), retrograde tracer injections into the primary auditory (A1), somatosensory (S1), and visual cortex (V1), and immunohistochemistry for markers of apoptosis (Caspase-3), axonal plasticity (Growth associated protein 43, GAP 43), and a calcium-binding protein (Parvalbumin, PV). In adult animals, primary sensory cortices receive a substantial number of direct thalamic inputs from nuclei of their matched, but also from nuclei of non-matched sensory modalities. There are also direct intracortical connections among primary sensory cortices and connections with secondary sensory cortices of other modalities. In very old animals, the crossmodal connections strongly decrease in number or vanish entirely. This is likely due to a retraction of the projection neuron axonal branches rather than ongoing programmed cell death. The loss of crossmodal connections is also accompanied by changes in anatomical correlates of inhibition and excitation in the sensory thalamus and cortex. Together, the loss and restructuring of crossmodal connections during aging suggest a shift of multisensory processing from primary cortices towards other sensory brain areas in elderly individuals.

Optimizing bowel preparation for colonoscopy: a guide to enhance quality of visualization

PubMed Central

Bechtold, Matthew L.; Mir, Fazia; Puli, Srinivas R.; Nguyen, Douglas L.

2016-01-01

Colonoscopy is an important screening and therapeutic modality for colorectal cancer. Unlike other screening tests, colonoscopy is dependent on pre-procedure bowel preparation. If the bowel preparation is poor, significant pathology may be missed. Many factors are known to improve bowel preparation. This review will highlight those factors that may optimize the bowel preparation, including choice of bowel preparation, grading or scoring of the bowel preparation, special factors that influence preparation, and diet prior to colonoscopy that affects bowel preparation. The aim of the review is to offer suggestions and guide endoscopists on how to optimize the bowel preparation for the patients undergoing colonoscopy. PMID:27065725

Laboratory Assays in Evaluation of Lynch Syndrome in Patients with Endometrial Carcinoma.

PubMed

Djordjevic, Bojana; Broaddus, Russell R

2016-06-01

This article reviews the main tissue testing modalities for Lynch Syndrome in the pathology laboratory, such as immunohistochemistry and PCR based analyses, and discusses their routine application, interpretation pitfalls, and troubleshooting of common technical performance issues. Discrepancies between laboratory and genetic testing may arise, and are examined in the context of the complexity of molecular abnormalities associated with Lynch Syndrome. The merits of targeted versus universal screening in a changing healthcare climate are addressed. In the absence of comprehensive screening programs, specific tumor topography and histological features that may prompt pathologist-initiated molecular tumor testing are outlined. Copyright © 2016 Elsevier Inc. All rights reserved.

RNAi Screening with Self-Delivering, Synthetic siRNAs for Identification of Genes That Regulate Primary Human T Cell Migration.

PubMed

Freeley, Michael; Derrick, Emily; Dempsey, Eugene; Hoff, Antje; Davies, Anthony; Leake, Devin; Vermeulen, Annaleen; Kelleher, Dermot; Long, Aideen

2015-09-01

Screening of RNA interference (RNAi) libraries in primary T cells is labor-intensive and technically challenging because these cells are hard to transfect. Chemically modified, self-delivering small interfering RNAs (siRNAs) offer a solution to this problem, because they enter hard-to-transfect cell types without needing a delivery reagent and are available in library format for RNAi screening. In this study, we have screened a library of chemically modified, self-delivering siRNAs targeting the expression of 72 distinct genes in conjunction with an image-based high-content-analysis platform as a proof-of-principle strategy to identify genes involved in lymphocyte function-associated antigen-1 (LFA-1)-mediated migration in primary human T cells. Our library-screening strategy identified the small GTPase RhoA as being crucial for T cell polarization and migration in response to LFA-1 stimulation and other migratory ligands. We also demonstrate that multiple downstream assays can be performed within an individual RNAi screen and have used the remainder of the cells for additional assays, including cell viability and adhesion to ICAM-1 (the physiological ligand for LFA-1) in the absence or presence of the chemokine SDF-1α. This study therefore demonstrates the ease and benefits of conducting siRNA library screens in primary human T cells using self-delivering, chemically modified siRNAs, and it emphasizes the feasibility and potential of this approach for elucidating the signaling pathways that regulate T cell function. © 2015 Society for Laboratory Automation and Screening.

Pediatrician identification of Latino children at risk for autism spectrum disorder.

PubMed

Zuckerman, Katharine E; Mattox, Kimber; Donelan, Karen; Batbayar, Oyundari; Baghaee, Anita; Bethell, Christina

2013-09-01

Latino-white disparities in age at autism spectrum disorder (ASD) diagnosis may be modified by primary care pediatrician (PCP) practices and beliefs. The objectives of this study were to assess ASD and developmental screening practices, attitudes toward ASD identification in Latino children, and barriers to ASD identification for Latino children, in a sample of 267 California PCPs. In mail-based PCP survey, we assessed rates of bilingual general developmental and ASD screening, perceptions of parent ASD knowledge in Latino and white families, reports of difficulty assessing for ASDs in Latino and white children, and perceptions of barriers to early ASD identification for Latinos. Although 81% of PCPs offered some form of developmental screening, 29% of PCPs offered Spanish ASD screening per American Academy of Pediatrics guidelines, and only 10% offered both Spanish general developmental and Spanish ASD screening per American Academy of Pediatrics guidelines. Most PCPs thought that Latino (English and Spanish primary family language) parents were less knowledgeable about ASDs than white parents. PCPs had more difficulty assessing ASD risk for Latino children with Spanish primary family language than for white children, even when the PCP conducted recommended ASD screening or had >25% Latino patients. The most frequent barrier to ASD identification in Latinos was access to developmental specialists. Multiple factors in the primary care setting may contribute to delayed ASD identification for Latinos. Promoting language-appropriate screening, disseminating culturally appropriate ASD materials to Latino families, improving the specialist workforce, and providing PCP support in screening and referral of Latino children may be important ways to reduce racial and ethnic differences in care.

Public Health Surveillance via Template Management in Electronic Health Records: Tri-Service Workflow's Rapid Response to an Infectious Disease Crisis.

PubMed

Berkley, Holly; Barnes, Matthew; Carnahan, David; Hayhurst, Janet; Bockhorst, Archie; Neville, James

2017-03-01

To describe the use of template-based screening for risk of infectious disease exposure of patients presenting to primary care medical facilities during the 2014 West African Ebola virus outbreak. The Military Health System implemented an Ebola risk-screening tool in primary care settings in order to create early notifications and early responses to potentially infected persons. Three time-sensitive, evidence-based screening questions were developed and posted to Tri-Service Workflow (TSWF) AHLTA templates in conjunction with appropriate training. Data were collected in January 2015, to assess the adoption of the TSWF-based Ebola risk-screening tool. Among encounters documented using TSWF templates, 41% of all encounters showed use of the TSWF-based Ebola risk-screening questions by the fourth day. The screening rate increased over the next 3 weeks, and reached a plateau at approximately 50%. This report demonstrates the MHS capability to deploy a standardized, globally applicable decision support aid that could be seen the same day by all primary care clinics across the military health direct care system, potentially improving rapid compliance with screening directives. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. preventive services task force recommendation statement.

PubMed

Moyer, Virginia A

2013-08-06

Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening and behavioral counseling interventions in primary care to reduce alcohol misuse. The USPSTF reviewed new evidence on the effectiveness of screening for alcohol misuse for improving health outcomes, the accuracy of various screening approaches, the effectiveness of various behavioral counseling interventions for improving intermediate or long-term health outcomes, the harms of screening and behavioral counseling interventions, and influences from the health care system that promote or detract from effective screening and counseling interventions for alcohol misuse. These recommendations apply to adolescents aged 12 to 17 years and adults aged 18 years or older. These recommendations do not apply to persons who are actively seeking evaluation or treatment of alcohol misuse. The USPSTF recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse. (Grade B recommendation)The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse in adolescents. (I statement)

Use of a brief standardized screening instrument in a primary care setting to enhance detection of social-emotional problems among youth in foster care.

PubMed

Jee, Sandra H; Halterman, Jill S; Szilagyi, Moira; Conn, Anne-Marie; Alpert-Gillis, Linda; Szilagyi, Peter G

2011-01-01

To determine whether systematic use of a validated social-emotional screening instrument in a primary care setting is feasible and improves detection of social-emotional problems among youth in foster care. Before-and-after study design, following a practice intervention to screen all youth in foster care for psychosocial problems using the Strengths and Difficulties Questionnaire (SDQ), a validated instrument with 5 subdomains. After implementation of systematic screening, youth aged 11 to 17 years and their foster parents completed the SDQ at routine health maintenance visits. We assessed feasibility of screening by measuring the completion rates of SDQ by youth and foster parents. We compared the detection of psychosocial problems during a 2-year period before systematic screening to the detection after implementation of systematic screening with the SDQ. We used chart reviews to assess detection at baseline and after implementing systematic screening. Altogether, 92% of 212 youth with routine visits that occurred after initiation of screening had a completed SDQ in the medical record, demonstrating high feasibility of systematic screening. Detection of a potential mental health problem was higher in the screening period than baseline period for the entire population (54% vs 27%, P < .001). More than one-fourth of youth had 2 or more significant social-emotional problem domains on the SDQ. Systematic screening for potential social-emotional problems among youth in foster care was feasible within a primary care setting and doubled the detection rate of potential psychosocial problems. Copyright © 2011 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Barriers to Alcohol Screening Among Hypertensive Patients and the Role of Stigma: Lessons for the Implementation of Screening and Brief Interventions in European Primary Care Settings.

PubMed

Hanschmidt, Franz; Manthey, Jakob; Kraus, Ludwig; Scafato, Emanuele; Gual, Antoni; Grimm, Carsten; Rehm, Jürgen

2017-09-01

1. To quantify barriers to alcohol screening among hypertensive patients reported by primary healthcare professionals. 2. To examine whether education and screening frequency measures are associated with stigma-related barriers. A web survey was conducted among 3081 primary healthcare professionals from France, Germany, Italy, Spain and the UK. Participants were asked about perceived barriers to alcohol screening as free-text response. The replies were independently categorized by two raters. Stigma-related barriers were predicted by logistic regressions with education, knowledge on alcohol as risk factor and frequency of alcohol screening. In France and Italy, almost half of the reported barriers were stigma-related, whereas time constraints were cited most commonly in Spain and the UK. In Germany, nearly half of respondents rated the importance of alcohol screening for hypertension as low. Perception that regular screening is inappropriate or associated with too much effort, beliefs that screening is unnecessary, and insufficient knowledge of screening tools were cited as further barriers. Professional education on alcohol use was consistently rated to be poorer than the equivalent education on hypertension, and only a minority of respondents perceived alcohol as important risk factor for hypertension. Stigma-related barriers could not be significantly predicted by education, knowledge or screening frequency in most models. Overall, regular alcohol screening among hypertensive patients seems to be widely accepted, but further education (Germany) and structural support (Spain, UK) could contribute to increase screening rates. In France and Italy, screening uptake could be improved by addressing stigma. Alcohol screening among hypertensive patients was largely accepted among general practitioners from five different European countries. Reported screening barriers varied between countries and included time constraints, stigma and underrated importance of alcohol. Results did not indicate a positive impact of education and screening frequency on perception of stigma as barrier to screening. © The Author 2017. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Theoretical Models of Comprehension Skills Tested through a Comprehension Assessment Battery for Primary School Children

ERIC Educational Resources Information Center

Tobia, Valentina; Ciancaleoni, Matteo; Bonifacci, Paola

2017-01-01

In this study, two alternative theoretical models were compared, in order to analyze which of them best explains primary school children's text comprehension skills. The first one was based on the distinction between two types of answers requested by the comprehension test: local or global. The second model involved texts' input modality: written…

Melorheostosis of the Foot: A Case Report of A rare entity with a Review of Multimodality Imaging Emphasizing the Importance of Conventional Radiography in Diagnosis.

PubMed

Ashish, Gulia; Shashikant, Juvekar; Ajay, Puri; Subhash, Desai

2016-01-01

Melorheostosis is a benign bone dysplasia affecting predominantly the appendicular skeleton and adjoining soft tissues. The diagnosis can be established on plain radiographs alone and advanced imaging modalities can be avoided. We hereby report a rare case of melorheostosis affecting the foot with a review of the role of various imaging modalities in diagnosis of this rare bone dysplasia. We present the case of a 29 years old man who was diagnosed with melorheostosis affecting his left foot. The patient presented to the outpatient department of our tertiary care referral hospital with complains of pain in the left ankle and foot with imaging and evaluation done at a primary center. The radiograph revealed an irregular, longitudinal extraosseous hyperostosis along the body of the calcaneum and the metacarpals which was consistent with the classical radiological description of melorheostosis. The CT, MRI and bone scan findings corroborated our primary diagnosis. The purpose of this case report is to review the features of this rare disorder affecting the foot, on multiple imaging modalities and emphasizing the role of conventional radiology in its diagnosis.

Melorheostosis of the Foot: A Case Report of A rare entity with a Review of Multimodality Imaging Emphasizing the Importance of Conventional Radiography in Diagnosis

PubMed Central

Ashish, Gulia; Shashikant, Juvekar; Ajay, Puri; Subhash, Desai

2016-01-01

Introduction: Melorheostosis is a benign bone dysplasia affecting predominantly the appendicular skeleton and adjoining soft tissues. The diagnosis can be established on plain radiographs alone and advanced imaging modalities can be avoided. We hereby report a rare case of melorheostosis affecting the foot with a review of the role of various imaging modalities in diagnosis of this rare bone dysplasia. Case Report: We present the case of a 29 years old man who was diagnosed with melorheostosis affecting his left foot. The patient presented to the outpatient department of our tertiary care referral hospital with complains of pain in the left ankle and foot with imaging and evaluation done at a primary center. The radiograph revealed an irregular, longitudinal extraosseous hyperostosis along the body of the calcaneum and the metacarpals which was consistent with the classical radiological description of melorheostosis. The CT, MRI and bone scan findings corroborated our primary diagnosis. Conclusion: The purpose of this case report is to review the features of this rare disorder affecting the foot, on multiple imaging modalities and emphasizing the role of conventional radiology in its diagnosis. PMID:27299136

Percutaneous Tumor Ablation Tools: Microwave, Radiofrequency, or Cryoablation—What Should You Use and Why?

PubMed Central

Lubner, Meghan G.; Ziemlewicz, Timothy J.; Lee, Fred T.; Brace, Christopher L.

2014-01-01

Image-guided thermal ablation is an evolving and growing treatment option for patients with malignant disease of multiple organ systems. Treatment indications have been expanding to include benign tumors as well. Specifically, the most prevalent indications to date have been in the liver (primary and metastatic disease, as well as benign tumors such as hemangiomas and adenomas), kidney (primarily renal cell carcinoma, but also benign tumors such as angiomyolipomas and oncocytomas), lung (primary and metastatic disease), and soft tissue and/or bone (primarily metastatic disease and osteoid osteomas). Each organ system has different underlying tissue characteristics, which can have profound effects on the resulting thermal changes and ablation zone. Understanding these issues is important for optimizing clinical results. In addition, thermal ablation technology has evolved rapidly during the past several decades, with substantial technical and procedural improvements that can help improve clinical outcomes and safety profiles. Staying up to date on these developments is challenging but critical because the physical properties underlying the different ablation modalities and the appropriate use of adjuncts will have a tremendous effect on treatment results. Ultimately, combining an understanding of the physical properties of the ablation modalities with an understanding of the thermal kinetics in tissue and using the most appropriate ablation modality for each patient are key to optimizing clinical outcomes. Suggested algorithms are described that will help physicians choose among the various ablation modalities for individual patients. ©RSNA, 2014 PMID:25208284

Screening for diabetic retinopathy in primary care with a mobile fundal camera--evaluation of a South African pilot project.

PubMed

Mash, Bob; Powell, Di; du Plessis, Felicity; van Vuuren, Unita; Michalowska, Margaret; Levitt, Naomi

2007-12-01

In South Africa diabetes makes a significant contribution to the burden of disease. Diabetic retinopathy is a leading cause of adult blindness, and screening can reduce the incidence. This project aimed to implement and evaluate a new service for retinal screening that uses a non-mydriatic mobile fundal camera in primary care. This is the first time such a service has been evaluated in an African primary care context. The service was implemented as an operational research study at three community health centres and data were collected to evaluate the operational issues, screening, reporting and referral of patients. Out of 400 patients screened 84% had a significantly reduced visual acuity, 63% had retinopathy (22% severe nonproliferative, 6% proliferative and 15% maculopathy), 2% of eyes could not be screened and 14% of patients required dilatation. Referral was necessary in 27% of cases for cataracts, in 7% for laser treatment and in 4% for other specialist services. Repeat photography was needed in 8% and urgent follow-up in 12%. A SWOT analysis of the pilot project was completed and recommendations were made on how to integrate it into the district health system. Screening with a fundal camera improved the quality of care for diabetic patients and is feasible in the South African public sector, primary care setting. A single technician should be able to photograph almost 10,000 patients a year.

Integrating GDM management in primary care: Gulf Cooperation Council (GCC) perspective.

PubMed

Anjum, Qudsia; Mumtaz, Shadma

2016-09-01

Diabetes is prevailing universally and Gulf Cooperation Council (GCC) is no exception. Pregnancies associated with gestational diabetes place women at high risk of natal complications. Statistics from GCC gives variable figures for GDM. Family Physicians are the first level health care providers and their role in management of GDM can be promising. This has been evident from a focused group study where patients prefer screening for GDM in primary care settings. Strengthening of primary care is important universally. Government should have mandatory primary care registration to be referred to secondary level for obstetric follow up and management. An important issue needing attention is presence of multiple criteria for diagnosing and screening GDM. There is need for a single guideline globally to avoid confusion for primary care providers.10 Primary care centers can better be utilized to screen for GDM at early stages. This will decrease the load on secondary and tertiary care centers and can also maintain continuity of care.

A magnetoencephalography study of multi-modal processing of pain anticipation in primary sensory cortices.

PubMed

Gopalakrishnan, R; Burgess, R C; Plow, E B; Floden, D P; Machado, A G

2015-09-24

Pain anticipation plays a critical role in pain chronification and results in disability due to pain avoidance. It is important to understand how different sensory modalities (auditory, visual or tactile) may influence pain anticipation as different strategies could be applied to mitigate anticipatory phenomena and chronification. In this study, using a countdown paradigm, we evaluated with magnetoencephalography the neural networks associated with pain anticipation elicited by different sensory modalities in normal volunteers. When encountered with well-established cues that signaled pain, visual and somatosensory cortices engaged the pain neuromatrix areas early during the countdown process, whereas the auditory cortex displayed delayed processing. In addition, during pain anticipation, the visual cortex displayed independent processing capabilities after learning the contextual meaning of cues from associative and limbic areas. Interestingly, cross-modal activation was also evident and strong when visual and tactile cues signaled upcoming pain. Dorsolateral prefrontal cortex and mid-cingulate cortex showed significant activity during pain anticipation regardless of modality. Our results show pain anticipation is processed with great time efficiency by a highly specialized and hierarchical network. The highest degree of higher-order processing is modulated by context (pain) rather than content (modality) and rests within the associative limbic regions, corroborating their intrinsic role in chronification. Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.

Adherence of Low-income Women to Cancer Screening Recommendations

PubMed Central

O'Malley, Ann S; Forrest, Christopher B; Mandelblatt, Jeanne

2002-01-01

BACKGROUND African-American and low-income women have lower rates of cancer screening and higher rates of late-stage disease than do their counterparts. OBJECTIVE To examine the effects of primary care, health insurance, and HMO participation on adherence to regular breast, cervical, and colorectal cancer screening. DESIGN Random-digit-dial and targeted household telephone survey of a population-based sample. SETTING Washington, D.C. census tracts with ≥30% of households below 200% of federal poverty threshold. PARTICIPANTS Included in the survey were 1,205 women over age 40, 82% of whom were African American. MAIN OUTCOME MEASURES Adherence was defined as reported receipt of the last 2 screening tests within recommended intervals for age. RESULTS The survey completion rate was 85%. Overall, 75% of respondents were adherent to regular Pap smears, 66% to clinical breast exams, 65% to mammography, and 29% to fecal occult blood test recommendations. Continuity with a single primary care practitioner, comprehensive service delivery, and higher patient satisfaction with the relationships with primary care practitioners were associated with higher adherence across the 4 screening tests, after considering other factors. Coordination of care also was associated with screening adherence for women age 65 and over, but not for the younger women. Compared with counterparts in non-HMO plans, women enrolled in health maintenance organizations were also more likely to be adherent to regular screening (e.g., Pap, odds ratio [OR] 1.89, 95% confidence interval [CI] 1.11 to 3.17; clinical breast exam, OR 2.04, 95% CI 1.21 to 3.44; mammogram, OR 1.95, 95% CI 1.15 to 3.31; fecal occult blood test, OR 1.70, 95% CI 1.01 to 2.83.) CONCLUSIONS Organizing healthcare services to promote continuity with a specific primary care clinician, a comprehensive array of services available at the primary care delivery site, coordination among providers, and better patient-practitioner relationships are likely to improve inner-city, low-income women's adherence to cancer screening recommendations. PMID:11841530

Assessment of primary care services and perceived barriers to care in persons with disabilities.

PubMed

Harrington, Amanda L; Hirsch, Mark A; Hammond, Flora M; Norton, H James; Bockenek, William L

2009-10-01

To determine what percentage of persons with disabilities have a primary care provider, participate in routine screening and health maintenance examinations, and identify perceived physical or physician barriers to receiving care. A total of 344 surveys, consisting of 66 questions, were collected from adults with disabilities receiving care at an outpatient rehabilitation clinic. A total of 89.5% (95% CI 86.3%-92.8%) of participants reported having a primary care physician. Younger persons (P < 0.0001), men (P < 0.02), persons with brain injury (P < 0.05), or persons with amputations (P < 0.05) were less likely to have a primary care physician. Participant report of screening for alcohol, nonprescription drug use, and safety with relationships at home ranged from 26.6% to 37.5% compared with screening for depression, diet, exercise, and smoking (64.5%-70%). Completion rates of age- and gender-appropriate health maintenance examinations ranged from 42.4% to 90%. A total of 2.67% of participants reported problems with physical access at their physician's office, and 36.4% (95% CI 30.8%-42.1%) of participants reported having to teach their primary care physician about their disability. Most persons with disabilities have a primary care physician. In general, completion rates for routine screening and health maintenance examinations were high. Perceived deficits in primary care physicians' knowledge of disability issues seem more prevalent than physical barriers to care.

Understanding Transgender Men's Experiences with and Preferences for Cervical Cancer Screening: A Rapid Assessment Survey.

PubMed

Seay, Julia; Ranck, Atticus; Weiss, Roy; Salgado, Christopher; Fein, Lydia; Kobetz, Erin

2017-08-01

Transgender men are less likely than cisgender women to receive cervical cancer screening. The purpose of the current study was to understand experiences with and preferences for cervical cancer screening among transgender men. Ninety-one transgender men ages 21-63 completed the survey. The survey evaluated experiences with and preferences for screening, including opinions regarding human papillomavirus (HPV) self-sampling as a primary cervical cancer screening. Half (50.5%) of participants did not have Pap smear screening within the past 3 years. The majority (57.1%) of participants preferred HPV self-sampling over provider-collected Pap smear screening. Participants who reported discrimination were more likely to prefer HPV self-sampling (odds ratio = 3.29, 95% confidence interval 1.38-7.84, P = 0.007). Primary HPV testing via HPV self-sampling may improve cervical cancer screening uptake among transgender men. Future work should pilot this innovative cervical cancer screening method within this population.

Promoting Colorectal Cancer Screening Discussion

PubMed Central

Christy, Shannon M.; Perkins, Susan M.; Tong, Yan; Krier, Connie; Champion, Victoria L.; Skinner, Celette Sugg; Springston, Jeffrey K.; Imperiale, Thomas F.; Rawl, Susan M.

2013-01-01

Background Provider recommendation is a predictor of colorectal cancer (CRC) screening. Purpose To compare the effects of two clinic-based interventions on patient–provider discussions about CRC screening. Design Two-group RCT with data collected at baseline and 1 week post-intervention. Participants/setting African-American patients that were non-adherent to CRC screening recommendations (n=693) with a primary care visit between 2008 and 2010 in one of 11 urban primary care clinics. Intervention Participants received either a computer-delivered tailored CRC screening intervention or a nontailored informational brochure about CRC screening immediately prior to their primary care visit. Main outcome measures Between-group differences in odds of having had a CRC screening discussion about a colon test, with and without adjusting for demographic, clinic, health literacy, health belief, and social support variables, were examined as predictors of a CRC screening discussion using logistic regression. Intervention effects on CRC screening test order by PCPs were examined using logistic regression. Analyses were conducted in 2011 and 2012. Results Compared to the brochure group, a greater proportions of those in the computer-delivered tailored intervention group reported having had a discussion with their provider about CRC screening (63% vs 48%, OR=1.81, p<0.001). Predictors of a discussion about CRC screening included computer group participation, younger age, reason for visit, being unmarried, colonoscopy self-efficacy, and family member/friend recommendation (all p-values <0.05). Conclusions The computer-delivered tailored intervention was more effective than a nontailored brochure at stimulating patient–provider discussions about CRC screening. Those who received the computer-delivered intervention also were more likely to have a CRC screening test (fecal occult blood test or colonoscopy) ordered by their PCP. Trial registration This study is registered at www.clinicaltrials.gov NCT00672828. PMID:23498096

The cost-effectiveness of screening for oral cancer in primary care.

PubMed

Speight, P M; Palmer, S; Moles, D R; Downer, M C; Smith, D H; Henriksson, M; Augustovski, F

2006-04-01

To use a decision-analytic model to determine the incremental costs and outcomes of alternative oral cancer screening programmes conducted in a primary care environment. The cost-effectiveness of oral cancer screening programmes in a number of primary care environments was simulated using a decision analysis model. Primary data on actual resource use and costs were collected by case note review in two hospitals. Additional data needed to inform the model were obtained from published costs, from systematic reviews and by expert opinion using the Trial Roulette approach. The value of future research was determined using expected value of perfect information (EVPI) for the decision to screen and for each of the model inputs. Hypothetical screening programmes conducted in a number of primary care settings. Eight strategies were compared: (A) no screen; (B) invitational screen--general medical practice; (C) invitational screen--general dental practice; (D) opportunistic screen--general medical practice; (E) opportunistic screen--general dental practice; (F) opportunistic high-risk screen--general medical practice; (G) opportunistic high-risk screen--general dental practice; and (H) invitational screen--specialist. A hypothetical population over the age of 40 years was studied. The main measures were mean lifetime costs and quality-adjusted life-years (QALYs) of each alternative screening scenario and incremental cost-effectiveness ratios (ICERs) to determine the additional costs and benefits of each strategy over another. No screening (strategy A) was always the cheapest option. Strategies B, C, E and H were never cost-effective and were ruled out by dominance or extended dominance. Of the remaining strategies, the ICER for the whole population (age 49-79 years) ranged from pound 15,790 to pound 25,961 per QALY. Modelling a 20% reduction in disease progression always gave the lowest ICERs. Cost-effectiveness acceptability curves showed that there is considerable uncertainty in the optimal decision identified by the ICER, depending on both the maximum amount that the NHS may be prepared to pay and the impact that treatment has on the annual malignancy transformation rate. Overall, however, high-risk opportunistic screening by a general dental or medical practitioner (strategies F and G) may be cost-effective. EVPIs were high for all parameters with population values ranging from pound 8 million to pound 462 million. However, the values were significantly higher in males than females but also varied depending on malignant transformation rate, effects of treatment and willingness to pay. Partial EVPIs showed the highest values for malignant transformation rate, disease progression, self-referral and costs of cancer treatment. Opportunistic high-risk screening, particularly in general dental practice, may be cost-effective. This screening may more effectively be targeted to younger age groups, particularly 40-60 year olds. However, there is considerable uncertainty in the parameters used in the model, particularly malignant transformation rate, disease progression, patterns of self-referral and costs. Further study is needed on malignant transformation rates of oral potentially malignant lesions and to determine the outcome of treatment of oral potentially malignant lesions. Evidence has been published to suggest that intervention has no greater benefit than 'watch and wait'. Hence a properly planned randomised controlled trial may be justified. Research is also needed into the rates of progression of oral cancer and on referral pathways from primary to secondary care and their effects on delay and stage of presentation.

Defined, serum/feeder-free conditions for expansion and drug screening of primary B-acute lymphoblastic leukemia.

PubMed

Jiang, Zhiwu; Wu, Di; Ye, Wei; Weng, Jianyu; Lai, Peilong; Shi, Pengcheng; Guo, Xutao; Huang, Guohua; Deng, Qiuhua; Tang, Yanlai; Zhao, Hongyu; Cui, Shuzhong; Lin, Simiao; Wang, Suna; Li, Baiheng; Wu, Qiting; Li, Yangqiu; Liu, Pentao; Pei, Duanqing; Du, Xin; Yao, Yao; Li, Peng

2017-12-05

Functional screening for compounds represents a major hurdle in the development of rational therapeutics for B-acute lymphoblastic leukemia (B-ALL). In addition, using cell lines as valid models for evaluating responses to novel drug therapies raises serious concerns, as cell lines are prone to genotypic/phenotypic drift and loss of heterogeneity in vitro . Here, we reported that OP9 cells, not OP9-derived adipocytes (OP9TA), support the growth of primary B-ALL cells in vitro . To identify the factors from OP9 cells that support the growth of primary B-ALL cells, we performed RNA-Seq to analyze the gene expression profiles of OP9 and OP9TA cells. We thus developed a defined, serum/feeder-free condition (FI76V) that can support the expansion of a range of clinically distinct primary B-ALL cells that still maintain their leukemia-initiating ability. We demonstrated the suitability of high-throughput drug screening based on our B-ALL cultured conditions. Upon screening 378 kinase inhibitors, we identified a cluster of 17 kinase inhibitors that can efficiently kill B-ALL cells in vitro . Importantly, we demonstrated the synergistic cytotoxicity of dinaciclib/BTG226 to B-ALL cells. Taken together, we developed a defined condition for the ex vivo expansion of primary B-ALL cells that is suitable for high-throughput screening of novel compounds.

A Little Effort Can Withstand the Hardship: Fielding an Internet-Based Intervention to Prevent Depression among Urban Racial/Ethnic Minority Adolescents in a Primary Care Setting.

PubMed

Bansa, Melishia; Brown, Darryl; DeFrino, Daniela; Mahoney, Nicholas; Saulsberry, Alexandria; Marko-Holguin, Monika; Fogel, Joshua; Gladstone, Tracy R G; Van Voorhees, Benjamin W

2018-04-01

This study explored the implementation of Chicago Urban Resiliency Building (CURB), a randomized clinical trial designed as an Internet-based primary care depression prevention intervention for urban African American and Latino adolescents. We utilized a mixed methods analysis to explore four aims. First, we estimated the percent of at-risk adolescents that were successfully screened. Second, we examined clinic site factors and performance. Third, primary care providers (n = 10) and clinic staff (n = 18) were surveyed to assess their knowledge and attitudes about the intervention. Fourth, clinic staff (nursing and medical assistant) interviews were analyzed using thematic analysis to gather perspectives of the implementation process. We found that the estimated percent of at-risk adolescents who were successfully screened in each clinic varied widely between clinics with a mean of 14.48%. Daily clinic communication was suggestive of greater successful screening. Feasibility of screening was high for both primary care providers and clinic staff. Clinic staff exit interviews indicated the presence of community barriers that inhibited successful implementation of the intervention. This study shares the challenges and successes for depression screening and implementing Internet-based mental health interventions for urban racial/ethnic minority adolescents in primary care settings. Published by Elsevier Inc.

Experience with a Talker Can Transfer Across Modalities to Facilitate Lipreading

PubMed Central

Sanchez, Kauyumari; Dias, James W.; Rosenblum, Lawrence D.

2013-01-01

Rosenblum, Miller, and Sanchez (2007) found that participants first trained to lipread a particular talker were then better able to perceive the auditory speech of that same talker, compared to that of a novel talker. This suggests that the talker experience a perceiver gains in one sensory modality can be transferred to another modality to make that speech easier to perceive. An experiment was conducted to examine whether this cross-sensory transfer of talker experience could occur: 1) from auditory to lipread speech; 2) with subjects not screened for adequate lipreading skill; 3) when both a familiar and unfamiliar talker are presented during lipreading; and 4) for both old (presentation set) and new words. Subjects were first asked to identify a set of words from a talker. They were then asked to perform a lipreading task from two faces, one of which was of the same talker they heard in the first phase of the experiment. Results revealed that subjects who lipread from the same talker they had heard performed better than those who lipead a different talker, regardless of whether the words were old or new. These results add further evidence that learning of amodal talker information can facilitate speech perception across modalities and also suggest that this information is not restricted to previously heard words. PMID:23955059

Dual-modality NIRF-MRI cubosomes and hexosomes: High throughput formulation and in vivo biodistribution.

PubMed

Tran, Nhiem; Bye, Nicole; Moffat, Bradford A; Wright, David K; Cuddihy, Andrew; Hinton, Tracey M; Hawley, Adrian M; Reynolds, Nicholas P; Waddington, Lynne J; Mulet, Xavier; Turnley, Ann M; Morganti-Kossmann, M Cristina; Muir, Benjamin W

2017-02-01

Engineered nanoparticles with multiple complementary imaging modalities are of great benefit to the rapid treatment and diagnosis of disease in various organs. Herein, we report the formulation of cubosomes and hexosomes that carry multiple amphiphilic imaging contrast agents in their self-assembled lipid bilayers. This is the first report of the use of both near infrared fluorescent (NIRF) imaging and gadolinium lipid based magnetic resonance (MR) imaging modalities in cubosomes and hexosomes. High-throughput screening was used to rapidly optimize formulations with desirable nano-architectures and low in vitro cytotoxicity. The dual-modal imaging nanoparticles in vivo biodistribution and organ specific contrast enhancement were then studied. The NIRF in vivo imaging results indicated accumulation of both cubosomes and hexosomes in the liver and spleen of mice up to 20h post-injection. Remarkably, the biodistribution of the nanoparticle formulations was affected by the mesophase (i.e. cubic or hexagonal), a finding of significant importance for the future use of these compounds, with hexosomes showing higher accumulation in the spleen than the liver compared to cubosomes. Furthermore, in vivo MRI data of animals injected with either type of lyotropic liquid crystal nanoparticle displayed enhanced contrast in the liver and spleen. Copyright © 2016 Elsevier B.V. All rights reserved.

Effect of perceptual load on semantic access by speech in children.

PubMed

Jerger, Susan; Damian, Markus F; Mills, Candice; Bartlett, James; Tye-Murray, Nancy; Abdi, Hervé

2013-04-01

To examine whether semantic access by speech requires attention in children. Children (N = 200) named pictures and ignored distractors on a cross-modal (distractors: auditory-no face) or multimodal (distractors: auditory-static face and audiovisual-dynamic face) picture word task. The cross-modal task had a low load, and the multimodal task had a high load (i.e., respectively naming pictures displayed on a blank screen vs. below the talker's face on his T-shirt). Semantic content of distractors was manipulated to be related vs. unrelated to the picture (e.g., picture "dog" with distractors "bear" vs. "cheese"). If irrelevant semantic content manipulation influences naming times on both tasks despite variations in loads, Lavie's (2005) perceptual load model proposes that semantic access is independent of capacity-limited attentional resources; if, however, irrelevant content influences naming only on the cross-modal task (low load), the perceptual load model proposes that semantic access is dependent on attentional resources exhausted by the higher load task. Irrelevant semantic content affected performance for both tasks in 6- to 9-year-olds but only on the cross-modal task in 4- to 5-year-olds. The addition of visual speech did not influence results on the multimodal task. Younger and older children differ in dependence on attentional resources for semantic access by speech.

Hydroxychloroquine screening practice patterns within a large multispecialty ophthalmic practice.

PubMed

Au, Adrian; Parikh, Vishal; Modi, Yasha S; Ehlers, Justis P; Schachat, Andrew P; Singh, Rishi P

2015-09-01

To determine provider compliance with hydroxychloroquine screening following the revised recommendations published in 2011 by the American Academy of Ophthalmology. Evaluation of adherence to a screening protocol. Subjects were identified with hydroxychloroquine as a medication by electronic query at a large multispecialty ophthalmic practice. Patients were excluded if patients: (1) were screened by an outside physician; (2) lacked recorded height, weight, start date, or dosing; or (3) took hydroxychloroquine for malaria prophylaxis. Screening tests were stratified by ophthalmic subspecialty. Guidelines define proper screening as 1 subjective test-Humphrey visual field (HVF), and 1 objective test-spectral-domain optical coherence tomography (SD OCT), fundus autofluorescence (FAF), or multifocal electroretinography (mfERG). Adherence to guidelines was determined by categorizing practices as: (1) "appropriate"-consistent with guidelines; (2) "underscreened"-insufficient testing; or (3) "inappropriate"-no testing. The study comprised 756 patients with a mean age of 56 years undergoing 1294 screening visits. Twenty-one patients received initial screenings outside the institution. Most common screening tests employed included SD OCT (56.6%), 10-2 HVF (55.0%), and Amsler grid (40.0%). Of the 735 initial screenings, 341 (46.4%) were appropriately screened, 204 (27.8%) underscreened, and 190 (25.9%) inappropriately screened. Of those who presented solely for screening (560), 307 (54.8%) were appropriately screened, 144 (25.7%) underscreened, and 109 (19.5%) inappropriately screened. Of patients presenting for hydroxychloroquine screening, 54.8% of patients received appropriate evaluation, indicating lack of adherence to guidelines. Overall, SD OCT and 10-2 HVF were the preferred screening modalities, with FAF and mfERG less frequently ordered. Copyright © 2015 Elsevier Inc. All rights reserved.

Establishing high resolution melting analysis: method validation and evaluation for c-RET proto-oncogene mutation screening.

PubMed

Benej, Martin; Bendlova, Bela; Vaclavikova, Eliska; Poturnajova, Martina

2011-10-06

Reliable and effective primary screening of mutation carriers is the key condition for common diagnostic use. The objective of this study is to validate the method high resolution melting (HRM) analysis for routine primary mutation screening and accomplish its optimization, evaluation and validation. Due to their heterozygous nature, germline point mutations of c-RET proto-oncogene, associated to multiple endocrine neoplasia type 2 (MEN2), are suitable for HRM analysis. Early identification of mutation carriers has a major impact on patients' survival due to early onset of medullary thyroid carcinoma (MTC) and resistance to conventional therapy. The authors performed a series of validation assays according to International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) guidelines for validation of analytical procedures, along with appropriate design and optimization experiments. After validated evaluation of HRM, the method was utilized for primary screening of 28 pathogenic c-RET mutations distributed among nine exons of c-RET gene. Validation experiments confirm the repeatability, robustness, accuracy and reproducibility of HRM. All c-RET gene pathogenic variants were detected with no occurrence of false-positive/false-negative results. The data provide basic information about design, establishment and validation of HRM for primary screening of genetic variants in order to distinguish heterozygous point mutation carriers among the wild-type sequence carriers. HRM analysis is a powerful and reliable tool for rapid and cost-effective primary screening, e.g., of c-RET gene germline and/or sporadic mutations and can be used as a first line potential diagnostic tool.

Vibroacoustics of the piano soundboard: (Non)linearity and modal properties in the low- and mid-frequency ranges

NASA Astrophysics Data System (ADS)

Ege, Kerem; Boutillon, Xavier; Rébillat, Marc

2013-03-01

The piano soundboard transforms the string vibration into sound and therefore, its vibrations are of primary importance for the sound characteristics of the instrument. An original vibro-acoustical method is presented to isolate the soundboard nonlinearity from that of the exciting device (here: a loudspeaker) and to measure it. The nonlinear part of the soundboard response to an external excitation is quantitatively estimated for the first time, at ≈-40 dB below the linear part at the ff nuance. Given this essentially linear response, a modal identification is performed up to 3 kHz by means of a novel high resolution modal analysis technique [K. Ege, X. Boutillon, B. David, High-resolution modal analysis, Journal of Sound and Vibration 325 (4-5) (2009) 852-869]. Modal dampings (which, so far, were unknown for the piano in this frequency range) are determined in the mid-frequency domain where FFT-based methods fail to evaluate them with an acceptable precision. They turn out to be close to those imposed by wood. A finite-element modelling of the soundboard is also presented. The low-order modal shapes and the comparison between the corresponding experimental and numerical modal frequencies suggest that the boundary conditions can be considered as blocked, except at very low frequencies. The frequency-dependency of the estimated modal densities and the observation of modal shapes reveal two well-separated regimes. Below ≈1 kHz, the soundboard vibrates more or less like a homogeneous plate. Above that limit, the structural waves are confined by ribs, as already noticed by several authors, and localised in restricted areas (one or a few inter-rib spaces), presumably due to a slightly irregular spacing of the ribs across the soundboard.

Treatment Needs of Driving While Intoxicated Offenders: The Need for a Multi-modal Approach to Treatment

PubMed Central

Mullen, Jillian; Ryan, Stacy R.; Mathias, Charles W.; Dougherty, Donald M.

2015-01-01

Objective This study aimed to characterize and compare the treatment needs of adults with driving while intoxicated (DWI) offenses recruited from a correctional residential treatment facility and the community to provide recommendations for treatment development. Method A total of 119 adults (59 Residential, 60 Community) with at least one DWI offense were administered clinical diagnostic interviews to assess substance use disorders and completed a battery of questionnaires assessing demographic characteristics, legal history, psychiatric diagnoses, medical diagnoses, and health care utilization. Results Almost all (96.6%) DWI offenders met clinical diagnostic criteria for an alcohol use disorder, approximately half of the sample also met diagnostic criteria for co-morbid substance use disorders and a substantial proportion also reported psychiatric and medical co-morbidities. However, a high percentage were not receiving treatment for these issues, most likely as a result of having limited access to care as the majority of participants had no current health insurance (64.45%) or primary care physician (74.0%). The residential sample had more extensive criminal histories compared to the community sample but was generally representative of the community in terms of their clinical characteristics. For instance, the groups did not differ in rates of substance use, psychiatric and medical health diagnoses or in the treatment of such issues, with the exception of alcohol abuse treatment. Conclusions DWI offenders represent a clinical population with high levels of complex and competing treatment needs which are not currently being met. Our findings demonstrate the need for standardized screening of DWI offenders and call for the development of a multi-modal treatment approach in efforts to reduce recidivism. PMID:25664371

A review on EEG-based methods for screening and diagnosing alcohol use disorder.

PubMed

Mumtaz, Wajid; Vuong, Pham Lam; Malik, Aamir Saeed; Rashid, Rusdi Bin Abd

2018-04-01

The screening test for alcohol use disorder (AUD) patients has been of subjective nature and could be misleading in particular cases such as a misreporting the actual quantity of alcohol intake. Although the neuroimaging modality such as electroencephalography (EEG) has shown promising research results in achieving objectivity during the screening and diagnosis of AUD patients. However, the translation of these findings for clinical applications has been largely understudied and hence less clear. This study advocates the use of EEG as a diagnostic and screening tool for AUD patients that may help the clinicians during clinical decision making. In this context, a comprehensive review on EEG-based methods is provided including related electrophysiological techniques reported in the literature. More specifically, the EEG abnormalities associated with the conditions of AUD patients are summarized. The aim is to explore the potentials of objective techniques involving quantities/features derived from resting EEG, event-related potentials or event-related oscillations data.

Pre- and post-test genetic counseling for chromosomal and Mendelian disorders.

PubMed

Fonda Allen, Jill; Stoll, Katie; Bernhardt, Barbara A

2016-02-01

Genetic carrier screening, prenatal screening for aneuploidy, and prenatal diagnostic testing have expanded dramatically over the past 2 decades. Driven in part by powerful market forces, new complex testing modalities have become available after limited clinical research. The responsibility for offering these tests lies primarily on the obstetrical care provider and has become more burdensome as the number of testing options expands. Genetic testing in pregnancy is optional, and decisions about undergoing tests, as well as follow-up testing, should be informed and based on individual patients' values and needs. Careful pre- and post-test counseling is central to supporting informed decision-making. This article explores three areas of technical expansion in genetic testing: expanded carrier screening, non-invasive prenatal screening for fetal aneuploidies using cell-free DNA, and diagnostic testing using fetal chromosomal microarray testing, and provides insights aimed at enabling the obstetrical practitioner to better support patients considering these tests. Copyright © 2016 Elsevier Inc. All rights reserved.

Breast cancer screening initiation after turning 40 years of age within the PROSPR consortium.

PubMed

Beaber, Elisabeth F; Tosteson, Anna N A; Haas, Jennifer S; Onega, Tracy; Sprague, Brian L; Weaver, Donald L; McCarthy, Anne Marie; Doubeni, Chyke A; Quinn, Virginia P; Skinner, Celette Sugg; Zauber, Ann G; Barlow, William E

2016-11-01

Although United States clinical guidelines differ, the earliest recommended age for average risk breast cancer screening is 40 years. Little is known about factors influencing screening initiation. We conducted a cohort study within the National Cancer Institute-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We identified 3413 women on their 40th birthday in primary care networks at Geisel School of Medicine at Dartmouth (DH) and Brigham and Women's Hospital (BWH) during 2011-2013 with no prior breast imaging or breast cancer. Cumulative incidence curves and Cox modeling were used to determine time from the 40th birthday to first breast cancer screening, cohort exit, or 42nd birthday. We calculated hazards ratios and 95 % confidence intervals from multivariable Cox proportional hazards models. Breast cancer screening cumulative incidence by the 42nd birthday was 62.9 % (BWH) and 39.8 % (DH). Factors associated with screening initiation were: a primary care visit within a year (HR 4.99, 95 % CI 4.23-5.89), an increasing number of primary care visits within a year (p for trend <0.0001), ZIP code of residence annual median household income ≤$52,000 (HR 0.79, 95 % CI 0.68-0.92), and health insurance type (Medicaid HR 0.72, 95 % CI 0.58-0.88; Medicare HR 0.55, 95 % CI 0.39-0.77; uninsured HR 0.37, 95 % CI 0.25-0.57). Breast cancer screening uptake after the 40th birthday varies by health system, primary care visits, median household income, and health insurance type, suggesting the need for further exploration. Future research should evaluate screening performance metrics after initiation and consider cumulative benefits and risks associated with breast cancer screening over time.

Screening for Pancreatic Adenocarcinoma in BRCA2 Mutation Carriers: Results of a Disease Simulation Model.

PubMed

Pandharipande, Pari V; Jeon, Alvin; Heberle, Curtis R; Dowling, Emily C; Kong, Chung Yin; Chung, Daniel C; Brugge, William R; Hur, Chin

2015-12-01

BRCA2 mutation carriers are at increased risk for multiple cancers including pancreatic adenocarcinoma (PAC). Our goal was to compare the effectiveness of different PAC screening strategies in BRCA2 mutation carriers, from the standpoint of life expectancy. A previously published Markov model of PAC was updated and extended to incorporate key aspects of BRCA2 mutation carrier status, including competing risks of breast- and ovarian-cancer specific mortality. BRCA2 mutation carriers were modeled and analyzed as the primary cohort for the analysis. Additional higher risk BRCA2 cohorts that were stratified according to the number of first-degree relatives (FDRs) with PAC were also analyzed. For each cohort, one-time screening and annual screening were evaluated, with screening starting at age 50 in both strategies. The primary outcome was net gain in life expectancy (LE) compared to no screening. Sensitivity analysis was performed on key model parameters, including surgical mortality and MRI test performance. One-time screening at age 50 resulted in a LE gain of 3.9 days for the primary BRCA2 cohort, and a gain of 5.8 days for those with BRCA2 and one FDR. Annual screening resulted in LE loss of 12.9 days for the primary cohort and 1.3 days for BRCA2 carriers with 1 FDR, but resulted in 20.6 days gained for carriers with 2 FDRs and 260 days gained for those with 3 FDRs. For patients with ≥ 3 FDRs, annual screening starting at an earlier age (i.e. 35-40) was optimal. Among BRCA2 mutation carriers, aggressive screening regimens may be ineffective unless additional indicators of elevated risk (e.g., 2 or more FDRs) are present. More clinical studies are needed to confirm these findings. American Cancer Society - New England Division - Ellison Foundation Research Scholar Grant (RSG-15-129-01-CPHPS).

A Learning Collaborative Approach to Improve Primary Care STI Screening.

PubMed

McKee, M Diane; Alderman, Elizabeth; York, Deborah V; Blank, Arthur E; Briggs, Rahil D; Hoidal, Kelsey E S; Kus, Christopher; Lechuga, Claudia; Mann, Marie; Meissner, Paul; Patel, Nisha; Racine, Andrew D

2017-10-01

The Bronx Ongoing Pediatric Screening (BOPS) project sought to improve screening for sexual activity and sexually transmitted infections (gonorrhea and chlamydia [GCC] and HIV) in a primary care network, employing a modified learning collaborative, real-time clinical data feedback to practices, improvement coaching, and a pay-for-quality monetary incentive. Outcomes are compared for 11 BOPS-participating sites and 10 non-participating sites. The quarterly median rate for documenting sexual activity status increased from 55% to 88% (BOPS sites) and from 13% to 74% (non-BOPS sites). GCC screening of sexually active youth increased at BOPS and non-BOPS sites. Screening at non-health care maintenance visits improved more at BOPS than non-BOPS sites. Data from nonparticipating sites suggests that introduction of an adolescent EMR template or other factors improved screening rates regardless of BOPS participation; BOPS activities appear to promote additional improvement of screening during non-health maintenance visits.

Use of specialty OB consults during high-risk pregnancies in a Medicaid-covered population: initial impact of the Arkansas ANGELS intervention.

PubMed

Bronstein, Janet M; Ounpraseuth, Songthip; Jonkman, Jeffrey; Fletcher, David; Nugent, Richard R; McGhee, Judith; Lowery, Curtis L

2012-12-01

This study examines the impact of a Medicaid-supported intervention (Antenatal and Neonatal Guidelines, Education and Learning System) to expand a high-risk obstetrics consulting service on the use of specialty consults between 2001 and 2006. Using a Medicaid claims-birth certificate data set, we find a decline over time in use of specialty consults for lower risk diagnoses and a shift to remote modalities for contact. Local physician participation in grand rounds via teleconference was associated both with specialty contact and use of remote modalities. Local physician use of a Call Center service was also associated with patient specialty contact. Expansion of telemedicine remote sites did not increase the likelihood of contact but was associated with the shift toward remote modalities. Specialty consult use and modality were influenced by the care context of the patient, particularly level of pregnancy risk, the specialty of the primary prenatal care provider, the timing of her prenatal care, and her ethnicity and education level.

Patient education for colon cancer screening: a randomized trial of a video mailed before a physical examination.

PubMed

Zapka, Jane G; Lemon, Stephenie C; Puleo, Elaine; Estabrook, Barbara; Luckmann, Roger; Erban, Stephen

2004-11-02

Colorectal cancer screening is underused, and primary care clinicians are challenged to provide patient education within the constraints of busy practices. To test the effect of an educational video, mailed to patients' homes before a physical examination, on performance of colorectal cancer screening, particularly sigmoidoscopy. Randomized, controlled trial. 5 primary care practices in central Massachusetts. 938 patients age 50 to 74 years who were scheduled for an upcoming physical examination, had no personal history of colorectal cancer, and were eligible for lower-endoscopy screening according to current guidelines. Participants were randomly assigned to receive usual care (n = 488) or a video about colorectal cancer, the importance of early detection, and screening options (n = 450). Baseline and 6-month follow-up telephone assessments were conducted. A dependent variable classified screening since baseline as 1) sigmoidoscopy with or without other tests, 2) another test or test combination, or 3) no tests. Overall screening rates were the same in the intervention and control groups (55%). In regression modeling, intervention participants were nonsignificantly more likely to complete sigmoidoscopy alone or in combination with another test (odds ratio, 1.22 [95% CI, 0.88 to 1.70]). Intervention dose (viewing at least half of the video) was significantly related to receiving sigmoidoscopy with or without another test (odds ratio, 2.81 [CI, 1.85 to 4.26]). Recruitment records showed that at least 23% of people coming for periodic health assessments were currently screened by a lower-endoscopy procedure and therefore were not eligible. The primary care sample studied consisted primarily of middle-class white persons who had high screening rates at baseline. The results may not be generalizable to other populations. The trial was conducted during a period of increased health insurance coverage for lower-endoscopy procedures and public media attention to colon cancer screening. A mailed video had no effect on the overall rate of colorectal cancer screening and only modestly improved sigmoidoscopy screening rates among patients in primary care practices.

Point-Counterpoint: Cervical Cancer Screening Should Be Done by Primary Human Papillomavirus Testing with Genotyping and Reflex Cytology for Women over the Age of 25 Years

PubMed Central

Zhao, Chengquan

2015-01-01

Screening for cervical cancer with cytology testing has been very effective in reducing cervical cancer in the United States. For decades, the approach was an annual Pap test. In 2000, the Hybrid Capture 2 human papillomavirus (HPV) test was approved by the U.S. Food and Drug Administration (FDA) for screening women who have atypical squamous cells of underdetermined significance (ASCUS) detected by Pap test to determine the need for colposcopy. In 2003, the FDA approved expanding the use of the test to include screening performed in conjunction with a Pap test for women over the age of 30 years, referred to as “cotesting.” Cotesting allows women to extend the testing interval to 3 years if both tests have negative results. In April of 2014, the FDA approved the use of an HPV test (the cobas HPV test) for primary cervical cancer screening for women over the age of 25 years, without the need for a concomitant Pap test. The approval recommended either colposcopy or a Pap test for patients with specific high-risk HPV types detected by the HPV test. This was based on the results of the ATHENA trial, which included more than 40,000 women. Reaction to this decision has been mixed. Supporters point to the fact that the primary-screening algorithm found more disease (cervical intraepithelial neoplasia 3 or worse [CIN3+]) and also found it earlier than did cytology or cotesting. Moreover, the positive predictive value and positive-likelihood ratio of the primary-screening algorithm were higher than those of cytology. Opponents of the decision prefer cotesting, as this approach detects more disease than the HPV test alone. In addition, the performance of this new algorithm has not been assessed in routine clinical use. Professional organizations will need to develop guidelines that incorporate this testing algorithm. In this Point-Counterpoint, Dr. Stoler explains why he favors the primary-screening algorithm, while Drs. Austin and Zhao explain why they prefer the cotesting approach to screening for cervical cancer. PMID:25948606

Chest Computed Tomographic Image Screening for Cystic Lung Diseases in Patients with Spontaneous Pneumothorax Is Cost Effective

PubMed Central

Langenderfer, Dale; McCormack, Francis X.; Schauer, Daniel P.; Eckman, Mark H.

2017-01-01

Rationale: Patients without a known history of lung disease presenting with a spontaneous pneumothorax are generally diagnosed as having primary spontaneous pneumothorax. However, occult diffuse cystic lung diseases such as Birt-Hogg-Dubé syndrome (BHD), lymphangioleiomyomatosis (LAM), and pulmonary Langerhans cell histiocytosis (PLCH) can also first present with a spontaneous pneumothorax, and their early identification by high-resolution computed tomographic (HRCT) chest imaging has implications for subsequent management. Objectives: The objective of our study was to evaluate the cost-effectiveness of HRCT chest imaging to facilitate early diagnosis of LAM, BHD, and PLCH. Methods: We constructed a Markov state-transition model to assess the cost-effectiveness of screening HRCT to facilitate early diagnosis of diffuse cystic lung diseases in patients presenting with an apparent primary spontaneous pneumothorax. Baseline data for prevalence of BHD, LAM, and PLCH and rates of recurrent pneumothoraces in each of these diseases were derived from the literature. Costs were extracted from 2014 Medicare data. We compared a strategy of HRCT screening followed by pleurodesis in patients with LAM, BHD, or PLCH versus conventional management with no HRCT screening. Measurements and Main Results: In our base case analysis, screening for the presence of BHD, LAM, or PLCH in patients presenting with a spontaneous pneumothorax was cost effective, with a marginal cost-effectiveness ratio of $1,427 per quality-adjusted life-year gained. Sensitivity analysis showed that screening HRCT remained cost effective for diffuse cystic lung diseases prevalence as low as 0.01%. Conclusions: HRCT image screening for BHD, LAM, and PLCH in patients with apparent primary spontaneous pneumothorax is cost effective. Clinicians should consider performing a screening HRCT in patients presenting with apparent primary spontaneous pneumothorax. PMID:27737563

Chest Computed Tomographic Image Screening for Cystic Lung Diseases in Patients with Spontaneous Pneumothorax Is Cost Effective.

PubMed

Gupta, Nishant; Langenderfer, Dale; McCormack, Francis X; Schauer, Daniel P; Eckman, Mark H

2017-01-01

Patients without a known history of lung disease presenting with a spontaneous pneumothorax are generally diagnosed as having primary spontaneous pneumothorax. However, occult diffuse cystic lung diseases such as Birt-Hogg-Dubé syndrome (BHD), lymphangioleiomyomatosis (LAM), and pulmonary Langerhans cell histiocytosis (PLCH) can also first present with a spontaneous pneumothorax, and their early identification by high-resolution computed tomographic (HRCT) chest imaging has implications for subsequent management. The objective of our study was to evaluate the cost-effectiveness of HRCT chest imaging to facilitate early diagnosis of LAM, BHD, and PLCH. We constructed a Markov state-transition model to assess the cost-effectiveness of screening HRCT to facilitate early diagnosis of diffuse cystic lung diseases in patients presenting with an apparent primary spontaneous pneumothorax. Baseline data for prevalence of BHD, LAM, and PLCH and rates of recurrent pneumothoraces in each of these diseases were derived from the literature. Costs were extracted from 2014 Medicare data. We compared a strategy of HRCT screening followed by pleurodesis in patients with LAM, BHD, or PLCH versus conventional management with no HRCT screening. In our base case analysis, screening for the presence of BHD, LAM, or PLCH in patients presenting with a spontaneous pneumothorax was cost effective, with a marginal cost-effectiveness ratio of $1,427 per quality-adjusted life-year gained. Sensitivity analysis showed that screening HRCT remained cost effective for diffuse cystic lung diseases prevalence as low as 0.01%. HRCT image screening for BHD, LAM, and PLCH in patients with apparent primary spontaneous pneumothorax is cost effective. Clinicians should consider performing a screening HRCT in patients presenting with apparent primary spontaneous pneumothorax.

Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease

PubMed Central

Schwimmer, J B; Newton, K P; Awai, H I; Choi, L J; Garcia, M A; Ellis, L L; Vanderwall, K; Fontanesi, J

2013-01-01

Background Screening overweight and obese children for non-alcoholic fatty liver disease (NAFLD) is recommended by paediatric and endocrinology societies. However, gastroenterology societies have called for more data before making a formal recommendation. Aim To determine whether the detection of suspected NAFLD in overweight and obese children through screening in primary care and referral to paediatric gastroenterology resulted in a correct diagnosis of NAFLD. Methods Information generated in the clinical evaluation of 347 children identified with suspected NAFLD through screening in primary care and referral to paediatric gastroenterology was captured prospectively. Diagnostic outcomes were reported. The diagnostic performance of two times the upper limit of normal (ULN) for alanine aminotransferase (ALT) was assessed. Results Non-alcoholic fatty liver disease was diagnosed in 55% of children identified by screening and referral. Liver disease other than NAFLD was present in 18% of those referred. Autoimmune hepatitis was the most common alternative diagnosis. Children with NAFLD had significantly (P < 0.05) higher screening ALT (98 ± 95) than children with liver disease other than NAFLD (86 ± 74). Advanced fibrosis was present in 11% of children. For the diagnosis of NAFLD, screening ALT two times the clinical ULN had a sensitivity of 57% and a specificity of 71%. Conclusions Screening of overweight and obese children in primary care for NAFLD with referral to paediatric gastroenterology has the potential to identify clinically relevant liver pathology. Consensus is needed on how to value the risk and rewards of screening and referral, to identify children with liver disease in the most appropriate manner. PMID:24117728

Cardiopulmonary events during primary colonoscopy screening in an average risk population.

PubMed

Khalid-de Bakker, C A; Jonkers, D M; Hameeteman, W; de Ridder, R J; Masclee, A A; Stockbrügger, R W

2011-04-01

Large colorectal cancer screening studies using primary colonoscopy have reported a low risk of major complications. Studies on diagnostic and therapeutic colonoscopy have pointed to a frequent occurrence of(minor) cardiopulmonary events, and with the steady increase of colonoscopy screening, it is important to investigate their occurrence in colonoscopy screening. This study describes the frequency of bradycardia(pulse rate <60 min-1), hypotension (systolic blood pressure(SB P) <90 mmHg), hypoxaemia (blood oxygenation, SaO2<90%) and ECG changes during colonoscopy screening in an average-risk population (hospital personnel, n=214,mean age 54.0±3.8, 39.3% male), without significant comorbidity) and aims at identifying subject-related and/or endoscopic factors associated with their occurrence. All data were collected prospectively. During 214 consecutive primary screening colonoscopies under conscious sedation(midazolam and pethidine), on top of pulse rate and SaO2,blood pressure and a three-channel ECG were recorded every five minutes. No major complications or relevant ECG changes occurred. Hypoxaemia occurred in 119 (55.6%),hypotension in 19 (8.9%) and bradycardia in 12 subjects(5.6%). In multivariate analysis, the sedation level 3 increased the risk of hypoxaemia (OR 4.8, CI 1.7-13.7), and incomplete colonoscopy (OR 5.3, CI 1.6-18.1) was associated with hypotension. Subjects with bradycardia had a longer mean procedure time (38±12 vs. 29±12 min, p<0.05), which did not turn out as a risk factor in a multivariate analysis. Mainly procedure-related and not subject-related factors were found to be associated with the occurrence of cardiopulmonary events in primary colonoscopy screening in this relatively healthy screening population.

Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease.

PubMed

Schwimmer, J B; Newton, K P; Awai, H I; Choi, L J; Garcia, M A; Ellis, L L; Vanderwall, K; Fontanesi, J

2013-11-01

Screening overweight and obese children for non-alcoholic fatty liver disease (NAFLD) is recommended by paediatric and endocrinology societies. However, gastroenterology societies have called for more data before making a formal recommendation. To determine whether the detection of suspected NAFLD in overweight and obese children through screening in primary care and referral to paediatric gastroenterology resulted in a correct diagnosis of NAFLD. Information generated in the clinical evaluation of 347 children identified with suspected NAFLD through screening in primary care and referral to paediatric gastroenterology was captured prospectively. Diagnostic outcomes were reported. The diagnostic performance of two times the upper limit of normal (ULN) for alanine aminotransferase (ALT) was assessed. Non-alcoholic fatty liver disease was diagnosed in 55% of children identified by screening and referral. Liver disease other than NAFLD was present in 18% of those referred. Autoimmune hepatitis was the most common alternative diagnosis. Children with NAFLD had significantly (P < 0.05) higher screening ALT (98 ± 95) than children with liver disease other than NAFLD (86 ± 74). Advanced fibrosis was present in 11% of children. For the diagnosis of NAFLD, screening ALT two times the clinical ULN had a sensitivity of 57% and a specificity of 71%. Screening of overweight and obese children in primary care for NAFLD with referral to paediatric gastroenterology has the potential to identify clinically relevant liver pathology. Consensus is needed on how to value the risk and rewards of screening and referral, to identify children with liver disease in the most appropriate manner. © 2013 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.

Fully Scalable Porous Metal Electrospray Propulsion

DTIC Science & Technology

2012-03-20

particular emphasis on the variation of specific impulse for multi-modal propulsion is currently carried out by MIT and the Busek Company under an...Beam profile distributions in the negative (left) and positive (center) modes as visualized directly thorough a multi-channel plate and phosphor...screen. These profiles are parabolic (right) indicating the non-thermal character of these type of ion beams. Microscopic Image of pattern imprinted on Si

A model to evaluate the costs and clinical effectiveness of human papilloma virus screening compared with annual papanicolaou cytology in Germany.

PubMed

Petry, Karl Ulrich; Barth, Cordula; Wasem, Jürgen; Neumann, Anja

2017-05-01

We modelled human papilloma virus (HPV) primary screening scenarios compared with Pap cytology to evaluate clinical effectiveness and projected annual costs in Germany. A Markov cohort model was built to compare the budget impact of annual Pap cytology with different 5-yearly HPV screening scenarios: (1) a positive HPV test followed by Pap cytology; (2) a positive HPV test followed by p16/Ki-67 dual-stained cytology; (3) a positive HPV test followed by colposcopy if HPV-16/18-positive or p16/Ki-67 dual-stained cytology if positive for other subtypes; (4) co-testing with HPV and Pap. Screening scenarios were based on a 10-year horizon. All HPV screening scenarios in the model were associated with fewer deaths from missed diagnosis of cervical cancer compared with Pap screening; 10-year totals n=172-344 (1.5-3 per 100,000) versus n=477 (4.1 per 100,000), respectively. Total annual costs were lower with HPV screening than Pap cytology. The projected average annual cost for HPV screening ranged from €117 million to €136 million compared with €177 million for Pap screening, representing annual savings of €41-60 million. The greatest clinical impact was achieved with primary HPV screening (with genotyping) followed by colposcopy for HPV 16/18-positive women or p16/Ki-67 dual-stained cytology for women positive for other HPV subtypes. Screening strategies including primary HPV testing for high-risk subtypes (HPV-16/18) in conjunction with p16/Ki-67 dual-stained cytology can improve the detection of cervical cancer at a lower total annual cost than conventional Pap cytology screening. Copyright © 2017. Published by Elsevier B.V.

Primary care physicians' reported use of pre-screening discussions for prostate cancer screening: a cross-sectional survey.

PubMed

Linder, Suzanne K; Hawley, Sarah T; Cooper, Crystale P; Scholl, Lawrence E; Jibaja-Weiss, Maria; Volk, Robert J

2009-03-18

Professional medical organizations recommend individualized patient decision making about prostate cancer screening. Little is known about primary care physicians' use of pre-screening discussions to promote informed decision making for prostate cancer screening. The aim of this study is to explore physicians' use of pre-screening discussions and reasons why physicians would or would not try to persuade patients to be screened if they initially refuse testing. Primary care physicians completed a self-administered survey about prostate cancer screening practices for informed decision making. Sixty-six physicians (75.9%) completed the survey, and 63 were used in the analysis. Thirteen physicians (20.6%) reported not using prescreening discussions, 45 (71.4%) reported the use of prescreening discussions, and 3 (4.8%) reported neither ordering the PSA test nor discussing it with patients. Sixty-nine percent of physicians who reported not having discussions indicated they were more likely to screen African American patients for prostate cancer, compared to 50% of physicians who reported the use of discussions (Chi-square(1) = 1.62, p = .20). Similarly, 91% of physicians who reported not having discussions indicated they are more likely to screen patients with a family history of prostate cancer, compared to 46% of those who reported the use of discussion (Chi-square(1) = 13.27, p < .001). Beliefs about the scientific evidence and efficacy of screening, ethical concerns regarding patient autonomy, and concerns about time constraints differed between physicians who would and would not try to persuade a patient to be tested. Although guidelines recommend discussing the risks and benefits of prostate cancer screening, physicians report varying practice styles. Future research needs to consider the nature of discussions and the degree to which informed decision making is being achieved in clinical practice.

HPV vaccination impact on a cervical cancer screening program: methods of the FASTER-Tlalpan Study in Mexico.

PubMed

Salmerón, Jorge; Torres-Ibarra, Leticia; Bosch, F Xavier; Cuzick, Jack; Lörincz, Attila; Wheeler, Cosette M; Castle, Philip E; Robles, Claudia; Lazcano-Ponce, Eduardo

2016-04-01

To outline the design of a clinical trial to evaluate the impact of HPV vaccination as part of a hrHPV-based primary screening program to extend screening intervals. A total of 18,000 women aged 25-45 years, attending the regular cervical cancer-screening program in primary health care services in Tlalpan, Mexico City, will be invited to the study. Eligible participants will be assigned to one of three comparison groups: 1) HPV16/18 vaccine and hrHPV-based screening; 2) HPV6/11/16/18 vaccine and hrHPV-based screening; 3) Control group who will receive only hrHPV-based screening. Strict surveillance of hrHPV persistent infection and occurrence of precancerous lesions will be conducted to estimate safety profiles at different screening intervals; participants will undergo diagnosis confirmation and treatment as necessary. The FASTER-Tlalpan Study will provide insights into new approaches of cervical cancer prevention programs. It will offer valuable information on potential benefits of combining HPV vaccination and hrHPV-based screening to safety extend screening intervals.

[Screening for risk of child abuse and neglect. A practicable method?].

PubMed

Kindler, H

2010-10-01

Selective primary prevention programs for child abuse and neglect depend on risk screening instruments that have the goal of systematically identifying families who can profit most from early help. Based on a systematic review of longitudinal studies, a set of established risk factors for early child abuse and neglect is presented. Nearly half of the items included in screening instruments can be seen as validated. Available studies indicate a high sensitivity of risk screening instruments. Positive predictive values, however, are low. Overall, the use of risk screening instruments in the area of primary prevention for families at risk represents a feasible method, as long as stigmatizing effects can be avoided and participating families also benefit beyond preventing endangerment.

High-Content, High-Throughput Screening for the Identification of Cytotoxic Compounds Based on Cell Morphology and Cell Proliferation Markers

PubMed Central

Martin, Heather L.; Adams, Matthew; Higgins, Julie; Bond, Jacquelyn; Morrison, Ewan E.; Bell, Sandra M.; Warriner, Stuart; Nelson, Adam; Tomlinson, Darren C.

2014-01-01

Toxicity is a major cause of failure in drug discovery and development, and whilst robust toxicological testing occurs, efficiency could be improved if compounds with cytotoxic characteristics were identified during primary compound screening. The use of high-content imaging in primary screening is becoming more widespread, and by utilising phenotypic approaches it should be possible to incorporate cytotoxicity counter-screens into primary screens. Here we present a novel phenotypic assay that can be used as a counter-screen to identify compounds with adverse cellular effects. This assay has been developed using U2OS cells, the PerkinElmer Operetta high-content/high-throughput imaging system and Columbus image analysis software. In Columbus, algorithms were devised to identify changes in nuclear morphology, cell shape and proliferation using DAPI, TOTO-3 and phosphohistone H3 staining, respectively. The algorithms were developed and tested on cells treated with doxorubicin, taxol and nocodazole. The assay was then used to screen a novel, chemical library, rich in natural product-like molecules of over 300 compounds, 13.6% of which were identified as having adverse cellular effects. This assay provides a relatively cheap and rapid approach for identifying compounds with adverse cellular effects during screening assays, potentially reducing compound rejection due to toxicity in subsequent in vitro and in vivo assays. PMID:24505478

A qualitative study of the acceptability of routine screening of postnatal women using the Edinburgh Postnatal Depression Scale.

PubMed Central

Shakespeare, Judy; Blake, Fiona; Garcia, Jo

2003-01-01

BACKGROUND: Screening for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS) has been widely recommended and implemented in primary care, although little is known about how acceptable it is to women. AIM: To explore the acceptability to women of postnatal screening by health visitors with the EPDS. DESIGN OF STUDY: Qualitative interview study. SETTING: Postnatal patients from 22 general practices within the area of Oxford City Primary Care Group. METHOD: Thirty-nine postnatal women from a purposive sample were interviewed, chosen on the basis of different general practices, EPDS results at eight weeks and eight months postnatal, and whether 'listening visits' were received. The interviews were analysed using the constant comparative method. RESULTS: Just over half of the women interviewed found screening with the EPDS less than acceptable, whatever their postnatal emotional health. The main themes identified were problems with the process of screening and, in particular, the venue, the personal intrusion of screening and stigma. The women interviewed had a clear preference for talking about how they felt, rather than filling out a questionnaire. CONCLUSION: For this sample, routine screening with the EPDS was less than acceptable for the majority of women. This is of concern, as universal screening with the EPDS for the detection of postnatal depression is already recommended and widespread in primary care. PMID:14601337

The sweet spot: FDG and other 2-carbon glucose analogs for multi-modal metabolic imaging of tumor metabolism

PubMed Central

Cox, Benjamin L; Mackie, Thomas R; Eliceiri, Kevin W

2015-01-01

Multi-modal imaging approaches of tumor metabolism that provide improved specificity, physiological relevance and spatial resolution would improve diagnosing of tumors and evaluation of tumor progression. Currently, the molecular probe FDG, glucose fluorinated with 18F at the 2-carbon, is the primary metabolic approach for clinical diagnostics with PET imaging. However, PET lacks the resolution necessary to yield intratumoral distributions of deoxyglucose, on the cellular level. Multi-modal imaging could elucidate this problem, but requires the development of new glucose analogs that are better suited for other imaging modalities. Several such analogs have been created and are reviewed here. Also reviewed are several multi-modal imaging studies that have been performed that attempt to shed light on the cellular distribution of glucose analogs within tumors. Some of these studies are performed in vitro, while others are performed in vivo, in an animal model. The results from these studies introduce a visualization gap between the in vitro and in vivo studies that, if solved, could enable the early detection of tumors, the high resolution monitoring of tumors during treatment, and the greater accuracy in assessment of different imaging agents. PMID:25625022

Multi-Modality Imaging in the Evaluation and Treatment of Mitral Regurgitation.

PubMed

Bouchard, Marc-André; Côté-Laroche, Claudia; Beaudoin, Jonathan

2017-10-13

Mitral regurgitation (MR) is frequent and associated with increased mortality and morbidity when severe. It may be caused by intrinsic valvular disease (primary MR) or ventricular deformation (secondary MR). Imaging has a critical role to document the severity, mechanism, and impact of MR on heart function as selected patients with MR may benefit from surgery whereas other will not. In patients planned for a surgical intervention, imaging is also important to select candidates for mitral valve (MV) repair over replacement and to predict surgical success. Although standard transthoracic echocardiography is the first-line modality to evaluate MR, newer imaging modalities like three-dimensional (3D) transesophageal echocardiography, stress echocardiography, cardiac magnetic resonance (CMR), and computed tomography (CT) are emerging and complementary tools for MR assessment. While some of these modalities can provide insight into MR severity, others will help to determine its mechanism. Understanding the advantages and limitations of each imaging modality is important to appreciate their respective role for MR assessment and help to resolve eventual discrepancies between different diagnostic methods. With the increasing use of transcatheter mitral procedures (repair or replacement) for high-surgical-risk patients, multimodality imaging has now become even more important to determine eligibility, preinterventional planning, and periprocedural guidance.

Understanding type 2 diabetes mellitus screening practices among primary care physicians: a qualitative chart-stimulated recall study.

PubMed

Hafez, Dina; Nelson, Daniel B; Martin, Evan G; Cohen, Alicia J; Northway, Rebecca; Kullgren, Jeffrey T

2017-04-04

Early diagnosis and treatment of prediabetes and type 2 diabetes mellitus (T2DM) can prevent future health problems, yet many individuals with these conditions are undiagnosed. This could be due, in part, to primary care physicians' (PCP) screening practices, about which little is known. The objectives of this study were to identify factors that influence PCPs' decisions to screen patients for T2DM and to characterize their interpretation and communication of screening test results to patients. We conducted semi-structured chart-stimulated recall interviews with 20 University of Michigan Health System (UMHS) primary care physicians. PCPs were asked about their recent decisions to screen or not screen 134 purposively sampled non-diabetic patients who met American Diabetes Association criteria for screening for T2DM. Interviews were audio-recorded, transcribed, and analyzed using qualitative directed content analysis. Data on patient demographic characteristics and comorbidities were abstracted from the electronic health record. The most common reasons PCPs gave for not screening 63 patients for T2DM were knowledge of a previously normal screening test (49%) and a visit for reasons other than a health maintenance examination (48%). The most common reasons PCPs gave for screening 71 patients for T2DM were knowledge of a previously abnormal screening test (49%), and patients' weight (42%) and age (38%). PCPs correctly interpreted 89% of screening test results and communicated 95% of test results to patients. Among 24 patients found to have prediabetes, PCPs usually (58%) recommended weight loss and increased physical activity but never recommended participation in a Diabetes Prevention Program or use of metformin. Previous screening test results, visit types, and patients' weight and age influenced PCPs' decisions to screen for T2DM. When patients were screened, test results were generally correctly interpreted and consistently communicated. Recommendations to patients with prediabetes could better reflect evidence-based strategies to prevent T2DM.

An image based vibration sensor for soft tissue modal analysis in a Digital Image Elasto Tomography (DIET) system.

PubMed

Feng, Sheng; Lotz, Thomas; Chase, J Geoffrey; Hann, Christopher E

2010-01-01

Digital Image Elasto Tomography (DIET) is a non-invasive elastographic breast cancer screening technology, based on image-based measurement of surface vibrations induced on a breast by mechanical actuation. Knowledge of frequency response characteristics of a breast prior to imaging is critical to maximize the imaging signal and diagnostic capability of the system. A feasibility analysis for a non-invasive image based modal analysis system is presented that is able to robustly and rapidly identify resonant frequencies in soft tissue. Three images per oscillation cycle are enough to capture the behavior at a given frequency. Thus, a sweep over critical frequency ranges can be performed prior to imaging to determine critical imaging settings of the DIET system to optimize its tumor detection performance.

Isolated colorectal cancer screening or integrated cancer prevention? A provocative suggestion!

PubMed

Stockbrugger, Reinhold

2012-01-01

Colorectal cancer (CRC) screening is still not fully established in the European Union. Recently, the United European Gastroenterology Federation (UEGF) supported CRC screening with the publication of quality guidelines and a written declaration in the European Parliament in favor of European-wide monitored CRC screening and primary prevention of CRC, the latter particularly in young citizens. In this article, the need for population-based CRC screening is once again stressed. In addition, the value of opportunistic CRC screening is pointed out, either as a regional or nation-wide alternative (such as in the USA and Germany) or as a 'forerunner' activity in view of subsequent population-based CRC screening. With regard to other parallel organ-related screening activities in Europe (breast, uterus) and the increasing need for primary prevention of malignant and benign diseases, the question is raised as to whether preventive activities should not be recognized as an integrated and logical part of a 'healthcare chain' offered to all European citizens. Copyright © 2012 S. Karger AG, Basel.

Integrating Oral and General Health Screening at Senior Centers for Minority Elders

PubMed Central

Cheng, Bin; Northridge, Mary E.; Kunzel, Carol; Huang, Catherine; Lamster, Ira B.

2013-01-01

Racial/ethnic and socioeconomic disparities regarding untreated oral disease exist for older adults, and poor oral health diminishes quality of life. The ElderSmile program integrated screening for diabetes and hypertension into its community-based oral health activities at senior centers in northern Manhattan. The program found a willingness among minority seniors (aged ≥ 50 years) to be screened for primary care sensitive conditions by dental professionals and a high level of unrecognized disease (7.8% and 24.6% of ElderSmile participants had positive screening results for previously undiagnosed diabetes and hypertension, respectively). Dental professionals may screen for primary care–sensitive conditions and refer patients to health care providers for definitive diagnosis and treatment. The ElderSmile program is a replicable model for community-based oral and general health screening. PMID:23597378

Screening for Impaired Visual Acuity in Older Adults: US Preventive Services Task Force Recommendation Statement.

PubMed

Siu, Albert L; Bibbins-Domingo, Kirsten; Grossman, David C; Baumann, Linda Ciofu; Davidson, Karina W; Ebell, Mark; García, Francisco A R; Gillman, Matthew; Herzstein, Jessica; Kemper, Alex R; Krist, Alex H; Kurth, Ann E; Owens, Douglas K; Phillips, William R; Phipps, Maureen G; Pignone, Michael P

2016-03-01

Update of the US Preventive Services Task Force (USPSTF) recommendation on screening for impaired visual acuity in older adults. The USPSTF reviewed the evidence on screening for visual acuity impairment associated with uncorrected refractive error, cataracts, and age-related macular degeneration among adults 65 years or older in the primary care setting; the benefits and harms of screening; the accuracy of screening; and the benefits and harms of treatment of early vision impairment due to uncorrected refractive error, cataracts, and age-related macular degeneration. This recommendation applies to asymptomatic adults 65 years or older who do not present to their primary care clinician with vision problems. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in older adults. (I statement).

Screening for increased cardiometabolic risk in primary care: a systematic review

PubMed Central

den Engelsen, Corine; Koekkoek, Paula S; Godefrooij, Merijn B; Spigt, Mark G; Rutten, Guy E

2014-01-01

Background Many programmes to detect and prevent cardiovascular disease (CVD) have been performed, but the optimal strategy is not yet clear. Aim To present a systematic review of cardiometabolic screening programmes performed among apparently healthy people (not yet known to have CVD, diabetes, or cardiometabolic risk factors) and mixed populations (apparently healthy people and people diagnosed with risk factor or disease) to define the optimal screening strategy. Design and setting Systematic review of studies performed in primary care in Western countries. Method MEDLINE, Embase, and CINAHL databases were searched for studies screening for increased cardiometabolic risk. Exclusion criteria were studies designed to assess prevalence of risk factors without follow-up or treatment; without involving a GP; when fewer than two risk factors were considered as the primary outcome; and studies constrained to ethnic minorities. Results The search strategy yielded 11 445 hits; 26 met the inclusion criteria. Five studies (1995–2012) were conducted in apparently healthy populations: three used a stepwise method. Response rates varied from 24% to 79%. Twenty-one studies (1967–2012) were performed in mixed populations; one used a stepwise method. Response rates varied from 50% to 75%. Prevalence rates could not be compared because of heterogeneity of used thresholds and eligible populations. Observed time trends were a shift from mixed to apparently healthy populations, increasing use of risk scores, and increasing use of stepwise screening methods. Conclusion The optimal screening strategy in primary care is likely stepwise, in apparently healthy people, with the use of risk scores. Increasing public awareness and actively involving GPs might facilitate screening efficiency and uptake. PMID:25267047

Increasingly strong reduction in breast cancer mortality due to screening

PubMed Central

van Schoor, G; Moss, S M; Otten, J D M; Donders, R; Paap, E; den Heeten, G J; Holland, R; Broeders, M J M; Verbeek, A L M

2011-01-01

Background: Favourable outcomes of breast cancer screening trials in the 1970s and 1980s resulted in the launch of population-based service screening programmes in many Western countries. We investigated whether improvements in mammography and treatment modalities have had an influence on the effectiveness of breast cancer screening from 1975 to 2008. Methods: In Nijmegen, the Netherlands, 55 529 women received an invitation for screening between 1975 and 2008. We designed a case–referent study to evaluate the impact of mammographic screening on breast cancer mortality over time from 1975 to 2008. A total number of 282 breast cancer deaths were identified, and 1410 referents aged 50–69 were sampled from the population invited for screening. We estimated the effectiveness by calculating the odds ratio (OR) indicating the breast cancer death rate for screened vs unscreened women. Results: The breast cancer death rate in the screened group over the complete period was 35% lower than in the unscreened group (OR=0.65; 95% CI=0.49–0.87). Analysis by calendar year showed an increasing effectiveness from a 28% reduction in breast cancer mortality in the period 1975–1991 (OR=0.72; 95% CI=0.47–1.09) to 65% in the period 1992–2008 (OR=0.35; 95% CI=0.19–0.64). Conclusion: Our results show an increasingly strong reduction in breast cancer mortality over time because of mammographic screening. PMID:21343930

Differential diagnosis between benign and malignant soft tissue tumors utilizing ultrasound parameters.

PubMed

Morii, Takeshi; Kishino, Tomonori; Shimamori, Naoko; Motohashi, Mitsue; Ohnishi, Hiroaki; Honya, Keita; Aoyagi, Takayuki; Tajima, Takashi; Ichimura, Shoichi

2018-01-01

Preoperative discrimination between benign and malignant soft tissue tumors is critical for the prevention of excess application of magnetic resonance imaging and biopsy as well as unplanned resection. Although ultrasound, including power Doppler imaging, is an easy, noninvasive, and cost-effective modality for screening soft tissue tumors, few studies have investigated reliable discrimination between benign and malignant soft tissue tumors. To establish a modality for discrimination between benign and malignant soft tissue tumors using ultrasound, we extracted the significant risk factors for malignancy based on ultrasound information from 40 malignant and 56 benign pathologically diagnosed soft tissue tumors and established a scoring system based on these risk factors. The maximum size, tumor margin, and vascularity evaluated using ultrasound were extracted as significant risk factors. Using the odds ratio from a multivariate regression model, a scoring system was established. Receiver operating characteristic analyses revealed a high area under the curve value (0.85), confirming the accuracy of the scoring system. Ultrasound is a useful modality for establishing the differential diagnosis between benign and malignant soft tissue tumors.

Depression screening and management among adolescents in primary care: factors associated with best practice.

PubMed

Taliaferro, Lindsay A; Hetler, Joel; Edwall, Glenace; Wright, Catherine; Edwards, Anne R; Borowsky, Iris W

2013-06-01

To compare depression identification and management perceptions and practices between professions and disciplines in primary care and examine factors that increase the likelihood of administering a standardized depression screening instrument, asking about patients' depressive symptoms, and using best practice when managing depressed adolescents. Data came from an online survey of clinicians in Minnesota (20% response rate). Analyses involved bivariate tests and linear regressions. The analytic sample comprised 260 family medicine physicians, 127 pediatricians, 96 family nurse practitioners, and 54 pediatric nurse practitioners. Overall, few differences emerged between physicians and nurse practitioners or family and pediatric clinicians regarding addressing depression among adolescents. Two factors associated with administering a standardized instrument included having clear protocols for follow-up after depression screening and feeling better prepared to address depression among adolescents. Enhancing clinicians' competence to address depression and developing postscreening protocols could help providers implement universal screening in primary care.

Efficient hit-finding approaches for histone methyltransferases: the key parameters.

PubMed

Ahrens, Thomas; Bergner, Andreas; Sheppard, David; Hafenbradl, Doris

2012-01-01

For many novel epigenetics targets the chemical ligand space and structural information were limited until recently and are still largely unknown for some targets. Hit-finding campaigns are therefore dependent on large and chemically diverse libraries. In the specific case of the histone methyltransferase G9a, the authors have been able to apply an efficient process of intelligent selection of compounds for primary screening, rather than screening the full diverse deck of 900 000 compounds to identify hit compounds. A number of different virtual screening methods have been applied for the compound selection, and the results have been analyzed in the context of their individual success rates. For the primary screening of 2112 compounds, a FlashPlate assay format and full-length histone H3.1 substrate were employed. Validation of hit compounds was performed using the orthogonal fluorescence lifetime technology. Rated by purity and IC(50) value, 18 compounds (0.9% of compound screening deck) were finally considered validated primary G9a hits. The hit-finding approach has led to novel chemotypes being identified, which can facilitate hit-to-lead projects. This study demonstrates the power of virtual screening technologies for novel, therapeutically relevant epigenetics protein targets.

Drug screening of cancer cell lines and human primary tumors using droplet microfluidics.

PubMed

Wong, Ada Hang-Heng; Li, Haoran; Jia, Yanwei; Mak, Pui-In; Martins, Rui Paulo da Silva; Liu, Yan; Vong, Chi Man; Wong, Hang Cheong; Wong, Pak Kin; Wang, Haitao; Sun, Heng; Deng, Chu-Xia

2017-08-22

Precision Medicine in Oncology requires tailoring of therapeutic strategies to individual cancer patients. Due to the limited quantity of tumor samples, this proves to be difficult, especially for early stage cancer patients whose tumors are small. In this study, we exploited a 2.4 × 2.4 centimeters polydimethylsiloxane (PDMS) based microfluidic chip which employed droplet microfluidics to conduct drug screens against suspended and adherent cancer cell lines, as well as cells dissociated from primary tumor of human patients. Single cells were dispersed in aqueous droplets and imaged within 24 hours of drug treatment to assess cell viability by ethidium homodimer 1 staining. Our results showed that 5 conditions could be screened for every 80,000 cells in one channel on our chip under current circumstances. Additionally, screening conditions have been adapted to both suspended and adherent cancer cells, giving versatility to potentially all types of cancers. Hence, this study provides a powerful tool for rapid, low-input drug screening of primary cancers within 24 hours after tumor resection from cancer patients. This paves the way for further technological advancement to cutting down sample size and increasing drug screening throughput in advent to personalized cancer therapy.

HIV primary care by the infectious disease physician in the United States - extending the continuum of care.

PubMed

Lakshmi, Seetha; Beekmann, Susan E; Polgreen, Philip M; Rodriguez, Allan; Alcaide, Maria L

2018-05-01

Models of care for people living with HIV (PLWH) have varied over time due to long term survival, development of HIV-associated non-AIDS conditions, and HIV specific primary care guidelines that differ from those of the general population. The objectives of this study are to assess how often infectious disease (ID) physicians provide primary care for PLWH, assess their practice patterns and barriers in the provision of primary care. We used a 6-item survey electronically distributed to ID physician members of Emerging Infections Network (EIN). Of the 1248 active EIN members, 644 (52%) responded to the survey. Among the 644 respondents, 431 (67%) treated PLWH. Of these 431 responders, 326 (75%) acted as their primary care physicians. Responders who reported always/mostly performing a screening assessment as recommended per guidelines were: (1) Screening specific to HIV (tuberculosis 95%, genital chlamydia/gonorrhoea 77%, hepatitis C 67%, extra genital chlamydia/gonorrhoea 47%, baseline anal PAP smear for women 36% and men 34%); (2) Primary care related screening (fasting lipids 95%, colonoscopy 95%, mammogram 90%, cervical PAP smears 88%, depression 57%, osteoporosis in postmenopausal women 55% and men >50 yrs 33%). Respondents who worked in university hospitals, had <5 years of ID experience, and those who cared for more PLWH were most likely to provide primary care to all or most of their patients. Common barriers reported include: refusal by patient (72%), non-adherence to HIV medications (43%), other health priorities (44%), time constraints during clinic visit (43%) and financial/insurance limitations (40%). Most ID physicians act as primary care providers for their HIV infected patients especially if they are recent ID graduates and work in university hospitals. Current screening rates are suboptimal. Interventions to increase screening practices and to decrease barriers are urgently needed to address the needs of the aging HIV population in the United States.

The Inclusion of Pseudowords within the Year One Phonics "Screening Check" in English Primary Schools

ERIC Educational Resources Information Center

Gibson, Howard; England, Jennifer

2016-01-01

The paper highlights problems surrounding the Year 1 Phonics Screening Check that has accompanied the legislative framework for synthetic phonics in English primary schools. It investigates the inclusion of pseudowords and raises questions regarding their generation and categorization, the rationale for their inclusion and the assumption that the…

Increasing the Screening and Counseling of Adolescents for Risky Health Behaviors: A Primary Care Intervention

ERIC Educational Resources Information Center

Ozer, Elizabeth M.; Adams, Sally H.; Lustig, Julie L.; Gee, Scott; Garber, Andrea K.; Gardner, Linda Rieder; Rehbein, Michael; Addison, Louise; Irwin, Charles E., Jr.

2005-01-01

Objective: To determine whether a systems intervention for primary care providers resulted in increased preventive screening and counseling of adolescent patients, compared with the usual standard of care. Methods: The intervention was conducted in 2 out-patient pediatric clinics; 2 other pediatric clinics in the same health maintenance…

Aldosterone to Renin Ratio as a Screening Instrument for Primary Aldosteronism in a Middle-Aged Population with Atrial Fibrillation.

PubMed

Mourtzinis, Georgios; Ebrahimi, Ahmad; Gustafsson, Helena; Johannsson, Gudmundur; Manhem, Karin

2017-11-01

Atrial fibrillation seems to be overrepresented among patients with primary aldosteronism. The aim of this study was to determine the usefulness of aldosterone to renin ratio as a screening instrument for primary aldosteronism in an atrial fibrillation population with relatively low cardiovascular risk profile. A total of 149 patients <65 years and with history of AF were screened for primary aldosteronism using aldosterone to renin ratio. Pathologically increased aldosterone to renin ratio (>65 pmol/mIU) was found in 15 participants (10.1%). Further investigation of the positive screened participants and confirmatory saline infusion test resulted in a diagnosis of primary aldosteronism in four individuals out of 149 (2.6%). Three out of the four individuals with primary aldosteronism had previously been diagnosed with hypertension, but only one out of the four had uncontrolled blood pressure, that is, >140/90 mmHg. All participants had normal potassium levels. Individuals with increased aldosterone to renin ratio had significantly higher mean systolic and diastolic blood pressure in comparison to participants with normal aldosterone to renin ratio (136 vs. 126 mmHg, p=0.02 and 84 vs. 78 mmHg, p=0.02). These findings suggest that assessment of aldosterone to renin ratio can be useful for identification of underlying primary aldosteronism in patients with diagnosed atrial fibrillation and hypertension in spite of well controlled blood pressure and normokalemia. © Georg Thieme Verlag KG Stuttgart · New York.

Realization and testing of a deployable space telescope based on tape springs

NASA Astrophysics Data System (ADS)

Lei, Wang; Li, Chuang; Zhong, Peifeng; Chong, Yaqin; Jing, Nan

2017-08-01

For its compact size and light weight, space telescope with deployable support structure for its secondary mirror is very suitable as an optical payload for a nanosatellite or a cubesat. Firstly the realization of a prototype deployable space telescope based on tape springs is introduced in this paper. The deployable telescope is composed of primary mirror assembly, secondary mirror assembly, 6 foldable tape springs to support the secondary mirror assembly, deployable baffle, aft optic components, and a set of lock-released devices based on shape memory alloy, etc. Then the deployment errors of the secondary mirror are measured with three-coordinate measuring machine to examine the alignment accuracy between the primary mirror and the deployed secondary mirror. Finally modal identification is completed for the telescope in deployment state to investigate its dynamic behavior with impact hammer testing. The results of the experimental modal identification agree with those from finite element analysis well.

PARO robot affects diverse interaction modalities in group sensory therapy for older adults with dementia.

PubMed

Šabanović, Selma; Bennett, Casey C; Chang, Wan-Ling; Huber, Lesa

2013-06-01

We evaluated the seal-like robot PARO in the context of multi-sensory behavioral therapy in a local nursing home. Participants were 10 elderly nursing home residents with varying levels of dementia. We report three principle findings from our observations of interactions between the residents, PARO, and a therapist during seven weekly therapy sessions. Firstly, we show PARO provides indirect benefits for users by increasing their activity in particular modalities of social interaction, including visual, verbal, and physical interaction, which vary between primary and non-primary interactors. Secondly, PARO's positive effects on older adults' activity levels show steady growth over the duration of our study, suggesting they are not due to short-term "novelty effects." Finally, we show a variety of ways in which individual participants interacted with PARO and relate this to the "interpretive flexibility" of its design.

Sensory Prioritization in Rats: Behavioral Performance and Neuronal Correlates.

PubMed

Lee, Conrad C Y; Diamond, Mathew E; Arabzadeh, Ehsan

2016-03-16

Operating with some finite quantity of processing resources, an animal would benefit from prioritizing the sensory modality expected to provide key information in a particular context. The present study investigated whether rats dedicate attentional resources to the sensory modality in which a near-threshold event is more likely to occur. We manipulated attention by controlling the likelihood with which a stimulus was presented from one of two modalities. In a whisker session, 80% of trials contained a brief vibration stimulus applied to whiskers and the remaining 20% of trials contained a brief change of luminance. These likelihoods were reversed in a visual session. When a stimulus was presented in the high-likelihood context, detection performance increased and was faster compared with the same stimulus presented in the low-likelihood context. Sensory prioritization was also reflected in neuronal activity in the vibrissal area of primary somatosensory cortex: single units responded differentially to the whisker vibration stimulus when presented with higher probability compared with lower probability. Neuronal activity in the vibrissal cortex displayed signatures of multiplicative gain control and enhanced response to vibration stimuli during the whisker session. In conclusion, rats allocate priority to the more likely stimulus modality and the primary sensory cortex may participate in the redistribution of resources. Detection of low-amplitude events is critical to survival; for example, to warn prey of predators. To formulate a response, decision-making systems must extract minute neuronal signals from the sensory modality that provides key information. Here, we identify the behavioral and neuronal correlates of sensory prioritization in rats. Rats were trained to detect whisker vibrations or visual flickers. Stimuli were embedded in two contexts in which either visual or whisker modality was more likely to occur. When a stimulus was presented in the high-likelihood context, detection was faster and more reliable. Neuronal recording from the vibrissal cortex revealed enhanced representation of vibrations in the prioritized context. These results establish the rat as an alternative model organism to primates for studying attention. Copyright © 2016 the authors 0270-6474/16/363243-11$15.00/0.

Primary goals, information-giving and men’s understanding: a qualitative study of Australian and UK doctors’ varied communication about PSA screening

PubMed Central

Pickles, Kristen; Rychetnik, Lucie; McCaffery, Kirsten; Entwistle, Vikki A

2018-01-01

Objectives (1) To characterise variation in general practitioners’ (GPs’) accounts of communicating with men about prostate cancer screening using the prostate-specific antigen (PSA) test, (2) to characterise GPs’ reasons for communicating as they do and (3) to explain why and under what conditions GP communication approaches vary. Study design and setting A grounded theory study. We interviewed 69 GPs consulting in primary care practices in Australia (n=40) and the UK (n=29). Results GPs explained their communication practices in relation to their primary goals. In Australia, three different communication goals were reported: to encourage asymptomatic men to either have a PSA test, or not test, or alternatively, to support men to make their own decision. As well as having different primary goals, GPs aimed to provide different information (from comprehensive to strongly filtered) and to support men to develop different kinds of understanding, from population-level to ‘gist’ understanding. Taking into account these three dimensions (goals, information, understanding) and building on Entwistle et al’s Consider an Offer framework, we derived four overarching approaches to communication: Be screened, Do not be screened, Analyse and choose, and As you wish. We also describe ways in which situational and relational factors influenced GPs’ preferred communication approach. Conclusion GPs’ reported approach to communicating about prostate cancer screening varies according to three dimensions—their primary goal, information provision preference and understanding sought—and in response to specific practice situations. If GP communication about PSA screening is to become more standardised in Australia, it is likely that each of these dimensions will require attention in policy and practice support interventions. PMID:29362252

Integration and sustainability of alcohol screening, brief intervention, and pharmacotherapy in primary care settings.

PubMed

Ornstein, Steven M; Miller, Peter M; Wessell, Andrea M; Jenkins, Ruth G; Nemeth, Lynne S; Nietert, Paul J

2013-07-01

At-risk drinking and alcohol use disorders are common in primary care and may adversely affect the treatment of patients with diabetes and/or hypertension. The purpose of this article is to report the impact of dissemination of a practice-based quality improvement approach (Practice Partner Research Network-Translating Research into Practice [PPRNet-TRIP]) on alcohol screening, brief intervention for at-risk drinking and alcohol use disorders, and medications for alcohol use disorders in primary care practices. Nineteen primary care practices from 15 states representing 26,005 patients with diabetes and/or hypertension participated in a group-randomized trial (early intervention vs. delayed intervention). The 12-month intervention consisted of practice site visits for academic detailing and participatory planning and network meetings for "best practice" dissemination. At the end of Phase 1, eligible patients in early-intervention practices were significantly more likely than patients in delayed-intervention practices to have been screened (odds ratio [OR] = 3.30, 95% CI [1.15, 9.50]) and more likely to have been provided a brief intervention (OR = 6.58, 95% CI [1.69, 25.7]. At the end of Phase 2, patients in delayed-intervention practices were more likely than at the end of Phase 1 to have been screened (OR = 5.18, 95% CI [4.65, 5.76]) and provided a brief intervention (OR = 1.80, 95% CI [1.31, 2.47]). Early-intervention practices maintained their screening and brief intervention performance during Phase 2. Medication for alcohol use disorders was prescribed infrequently. PPRNet-TRIP is effective in improving and maintaining improvement in alcohol screening and brief intervention for patients with diabetes and/or hypertension in primary care settings.

Primary goals, information-giving and men's understanding: a qualitative study of Australian and UK doctors' varied communication about PSA screening.

PubMed

Pickles, Kristen; Carter, Stacy M; Rychetnik, Lucie; McCaffery, Kirsten; Entwistle, Vikki A

2018-01-23

(1) To characterise variation in general practitioners' (GPs') accounts of communicating with men about prostate cancer screening using the prostate-specific antigen (PSA) test, (2) to characterise GPs' reasons for communicating as they do and (3) to explain why and under what conditions GP communication approaches vary. A grounded theory study. We interviewed 69 GPs consulting in primary care practices in Australia (n=40) and the UK (n=29). GPs explained their communication practices in relation to their primary goals. In Australia, three different communication goals were reported: to encourage asymptomatic men to either have a PSA test, or not test, or alternatively, to support men to make their own decision. As well as having different primary goals, GPs aimed to provide different information (from comprehensive to strongly filtered) and to support men to develop different kinds of understanding, from population-level to 'gist' understanding. Taking into account these three dimensions (goals, information, understanding) and building on Entwistle et al' s Consider an Offer framework, we derived four overarching approaches to communication: Be screened , Do not be screened , Analyse and choose , and As you wish . We also describe ways in which situational and relational factors influenced GPs' preferred communication approach. GPs' reported approach to communicating about prostate cancer screening varies according to three dimensions-their primary goal, information provision preference and understanding sought-and in response to specific practice situations. If GP communication about PSA screening is to become more standardised in Australia, it is likely that each of these dimensions will require attention in policy and practice support interventions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PET/CT versus bone marrow biopsy in the initial evaluation of bone marrow infiltration in various pediatric malignancies.

PubMed

Zapata, Claudia P; Cuglievan, Branko; Zapata, Catalina M; Olavarrieta, Raquel; Raskin, Scott; Desai, Kavita; De Angulo, Guillermo

2018-02-01

Accurate staging is essential in the prognosis and management of pediatric malignancies. Current protocols require screening for marrow infiltration with bone marrow biopsy (BMB) as the gold standard. Positron emission tomography-computed tomography (PET-CT) is commonly used to complete the staging process and can also be used to evaluate marrow infiltration. To compare PET-CT and BMB in the initial evaluation of bone marrow infiltration in pediatric cancers. We retrospectively reviewed new cases of EWS, rhabdomyosarcoma, neuroblastoma, and lymphoma diagnosed between January 2009 and October 2014. Each case had undergone both PET-CT and BMB within 4 weeks without treatment in the interval between screening modalities. We reviewed 69 cases. Bone marrow infiltration was demonstrated in 34 cases by PET-CT and in 18 cases by BMB. The sensitivity and negative predictive value of PET-CT were both 100%. Interestingly, the cases in which infiltration was not detected on BMB had an abnormal marrow signal on PET-CT focal or distant to iliac crest. PET-CT has a high sensitivity when assessing marrow infiltration in pediatric malignancies. Advances in radiologic modalities may obviate the use of invasive, painful, and costly procedures like BMB. Furthermore, biopsy results are limited by insufficient tissue or the degree of marrow infiltration (diffuse vs. focal disease). PET-CT can improve the precision of biopsy when used as a guiding tool. This study proposes the use of PET-CT as first-line screening for bone marrow infiltration to improve the accuracy of staging in new diagnoses. © 2017 Wiley Periodicals, Inc.

Cross multivariate correlation coefficients as screening tool for analysis of concurrent EEG-fMRI recordings.

PubMed

Ji, Hong; Petro, Nathan M; Chen, Badong; Yuan, Zejian; Wang, Jianji; Zheng, Nanning; Keil, Andreas

2018-02-06

Over the past decade, the simultaneous recording of electroencephalogram (EEG) and functional magnetic resonance imaging (fMRI) data has garnered growing interest because it may provide an avenue towards combining the strengths of both imaging modalities. Given their pronounced differences in temporal and spatial statistics, the combination of EEG and fMRI data is however methodologically challenging. Here, we propose a novel screening approach that relies on a Cross Multivariate Correlation Coefficient (xMCC) framework. This approach accomplishes three tasks: (1) It provides a measure for testing multivariate correlation and multivariate uncorrelation of the two modalities; (2) it provides criterion for the selection of EEG features; (3) it performs a screening of relevant EEG information by grouping the EEG channels into clusters to improve efficiency and to reduce computational load when searching for the best predictors of the BOLD signal. The present report applies this approach to a data set with concurrent recordings of steady-state-visual evoked potentials (ssVEPs) and fMRI, recorded while observers viewed phase-reversing Gabor patches. We test the hypothesis that fluctuations in visuo-cortical mass potentials systematically covary with BOLD fluctuations not only in visual cortical, but also in anterior temporal and prefrontal areas. Results supported the hypothesis and showed that the xMCC-based analysis provides straightforward identification of neurophysiological plausible brain regions with EEG-fMRI covariance. Furthermore xMCC converged with other extant methods for EEG-fMRI analysis. © 2018 The Authors Journal of Neuroscience Research Published by Wiley Periodicals, Inc.

The Cost-Effectiveness of Birth-Cohort Screening for Hepatitis C Antibody in U.S. Primary Care Settings

PubMed Central

Rein, David B.; Smith, Bryce D.; Wittenborn, John S.; Lesesne, Sarah B.; Wagner, Laura D.; Roblin, Douglas W.; Patel, Nita; Ward, John W.; Weinbaum, Cindy M.

2017-01-01

Background In the United States, hepatitis C virus (HCV) infection is most prevalent among adults born from 1945 through 1965, and approximately 50% to 75% of infected adults are unaware of their infection. Objective To estimate the cost-effectiveness of birth-cohort screening. Design Cost-effectiveness simulation. Data Sources National Health and Nutrition Examination Survey, U.S. Census, Medicare reimbursement schedule, and published sources. Target Population Adults born from 1945 through 1965 with 1 or more visits to a primary care provider annually. Time Horizon Lifetime. Perspective Societal, health care. Intervention One-time antibody test of 1945–1965 birth cohort. Outcome Measures Numbers of cases that were identified and treated and that achieved a sustained viral response; liver disease and death from HCV; medical and productivity costs; quality-adjusted life-years (QALYs); incremental cost-effectiveness ratio (ICER). Results of Base-Case Analysis Compared with the status quo, birth-cohort screening identified 808 580 additional cases of chronic HCV infection at a screening cost of $2874 per case identified. Assuming that birth-cohort screening was followed by pegylated interferon and ribavirin (PEG-IFN + R) for treated patients, screening increased QALYs by 348 800 and costs by $5.5 billion, for an ICER of $15 700 per QALY gained. Assuming that birth-cohort screening was followed by direct-acting antiviral plus PEG-IFN + R treatment for treated patients, screening increased QALYs by 532 200 and costs by $19.0 billion, for an ICER of $35 700 per QALY saved. Results of Sensitivity Analysis The ICER of birth-cohort screening was most sensitive to sustained viral response of antiviral therapy, the cost of therapy, the discount rate, and the QALY losses assigned to disease states. Limitation Empirical data on screening and direct-acting antiviral treatment in real-world clinical settings are scarce. Conclusion Birth-cohort screening for HCV in primary care settings was cost-effective. Primary Funding Source Division of Viral Hepatitis, Centers for Disease Control and Prevention. PMID:22056542

Enhanced HTS hit selection via a local hit rate analysis.

PubMed

Posner, Bruce A; Xi, Hualin; Mills, James E J

2009-10-01

The postprocessing of high-throughput screening (HTS) results is complicated by the occurrence of false positives (inactive compounds misidentified as active by the primary screen) and false negatives (active compounds misidentified as inactive by the primary screen). An activity cutoff is frequently used to select "active" compounds from HTS data; however, this approach is insensitive to both false positives and false negatives. An alternative method that can minimize the occurrence of these artifacts will increase the efficiency of hit selection and therefore lead discovery. In this work, rather than merely using the activity of a given compound, we look at the presence and absence of activity among all compounds in its "chemical space neighborhood" to give a degree of confidence in its activity. We demonstrate that this local hit rate (LHR) analysis method outperforms hit selection based on ranking by primary screen activity values across ten diverse high throughput screens, spanning both cell-based and biochemical assay formats of varying biology and robustness. On average, the local hit rate analysis method was approximately 2.3-fold and approximately 1.3-fold more effective in identifying active compounds and active chemical series, respectively, than selection based on primary activity alone. Moreover, when applied to finding false negatives, this method was 2.3-fold better than ranking by primary activity alone. In most cases, novel hit series were identified that would have otherwise been missed. Additional uses of and observations regarding this HTS analysis approach are also discussed.

A randomized, controlled trial of disability prevention in frail older patients screened in primary care: the FRASI study. Design and baseline evaluation.

PubMed

Bandinelli, Stefania; Lauretani, Fulvio; Boscherini, Vittorio; Gandi, Francesca; Pozzi, Martina; Corsi, Anna Maria; Bartali, Benedetta; Lova, Raffaello Molino; Guralnik, Jack M; Ferrucci, Luigi

2006-10-01

We describe the enrollment and intervention phases of FRASI (FRAilty, Screening and Intervention), a randomized controlled trial aimed at preventing ADL disability in frail older persons screened in primary care. Patients, 70-85 years old, non-disabled and noncognitively impaired, were screened for frailty (score < or = 9 on the Short Physical Performance Battery, SPPB) during primary care visits. Of 447 eligible persons, 410 came to the study clinic and 251 were randomized into treatment (n=126) and control groups (n=125). The active group received an intensive medical intervention, and sixteen 90-minute supervised exercise sessions over 8 weeks. The primary outcome was time to ADL disability onset or death in the 12-month period after study enrollment. The two study arms were similar for demographics, cognitive function, physical function and health status. Compared with a population-based sample selected according to FRASI inclusion criteria except SPPB score, FRASI participants had significantly worse health and functional status. Restricting the comparison to persons with SPPB < or = 9, all differences disappeared. The 99 participants (78.6% of 126) who completed the intervention participated in a mean of 15.3+/-1.6 exercise sessions. Screening in primary care for non-disabled, older persons with SPPB < or = 9 yields individuals with substantial morbidity, impairments and functional limitations that can be successfully involved in an intensive medical and exercise intervention. Whether such an intervention effectively prevents new disability remains to be confirmed.

Delivery of Brief Interventions for Heavy Drinking in Primary Care: Outcomes of the ODHIN 5-Country Cluster Randomized Trial

PubMed Central

Anderson, Peter; Coulton, Simon; Kaner, Eileen; Bendtsen, Preben; Kłoda, Karolina; Reynolds, Jillian; Segura, Lidia; Wojnar, Marcin; Mierzecki, Artur; Deluca, Paolo; Newbury-Birch, Dorothy; Parkinson, Kathryn; Okulicz-Kozaryn, Katarzyna; Drummond, Colin; Gual, Antoni

2017-01-01

PURPOSE We aimed to test whether 3 strategies—training and support, financial reimbursement, and an option to direct screen-positive patients to an Internet-based method of giving brief advice—have a longer-term effect on primary care clinicians’ delivery of screening and advice to heavy drinkers operationalized with the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) tool. METHODS We undertook a cluster randomized factorial trial with a 12-week implementation period in 120 primary health care units throughout Catalonia, England, Netherlands, Poland, and Sweden. Units were randomized to 8 groups: care as usual (control); training and support alone; financial reimbursement alone; electronic brief advice alone; paired combinations of these conditions; and all 3 combined. The primary outcome was the proportion of consulting adult patients (aged 18 years and older) receiving intervention—screening and, if screen-positive, advice—at 9 months. RESULTS Based on the factorial design, the ratio of the log of the proportion of patients given intervention at the 9-month follow-up was 1.39 (95% CI, 1.03–1.88) in units that received training and support as compared with units that did not. Neither financial reimbursement nor directing screen-positive patients to electronic brief advice led to a higher proportion of patients receiving intervention. CONCLUSIONS Training and support of primary health care units has a lasting, albeit small, impact on the proportion of adult patients given an alcohol intervention at 9 months. PMID:28694269

Integrated economic and experimental framework for screening of primary recovery technologies for high cell density CHO cultures

PubMed Central

Popova, Daria; Stonier, Adam; Pain, David; Titchener‐Hooker, Nigel J.

2016-01-01

Abstract Increases in mammalian cell culture titres and densities have placed significant demands on primary recovery operation performance. This article presents a methodology which aims to screen rapidly and evaluate primary recovery technologies for their scope for technically feasible and cost‐effective operation in the context of high cell density mammalian cell cultures. It was applied to assess the performance of current (centrifugation and depth filtration options) and alternative (tangential flow filtration (TFF)) primary recovery strategies. Cell culture test materials (CCTM) were generated to simulate the most demanding cell culture conditions selected as a screening challenge for the technologies. The performance of these technology options was assessed using lab scale and ultra scale‐down (USD) mimics requiring 25–110mL volumes for centrifugation and depth filtration and TFF screening experiments respectively. A centrifugation and depth filtration combination as well as both of the alternative technologies met the performance selection criteria. A detailed process economics evaluation was carried out at three scales of manufacturing (2,000L, 10,000L, 20,000L), where alternative primary recovery options were shown to potentially provide a more cost‐effective primary recovery process in the future. This assessment process and the study results can aid technology selection to identify the most effective option for a specific scenario. PMID:27067803

Cost-Effectiveness of a Community Pharmacist-Led Sleep Apnea Screening Program - A Markov Model.

PubMed

Perraudin, Clémence; Le Vaillant, Marc; Pelletier-Fleury, Nathalie

2013-01-01

Despite the high prevalence and major public health ramifications, obstructive sleep apnea syndrome (OSAS) remains underdiagnosed. In many developed countries, because community pharmacists (CP) are easily accessible, they have been developing additional clinical services that integrate the services of and collaborate with other healthcare providers (general practitioners (GPs), nurses, etc.). Alternative strategies for primary care screening programs for OSAS involving the CP are discussed. To estimate the quality of life, costs, and cost-effectiveness of three screening strategies among patients who are at risk of having moderate to severe OSAS in primary care. Markov decision model. Published data. Hypothetical cohort of 50-year-old male patients with symptoms highly evocative of OSAS. The 5 years after initial evaluation for OSAS. Societal. Screening strategy with CP (CP-GP collaboration), screening strategy without CP (GP alone) and no screening. Quality of life, survival and costs for each screening strategy. Under almost all modeled conditions, the involvement of CPs in OSAS screening was cost effective. The maximal incremental cost for "screening strategy with CP" was about 455€ per QALY gained. Our results were robust but primarily sensitive to the treatment costs by continuous positive airway pressure, and the costs of untreated OSAS. The probabilistic sensitivity analysis showed that the "screening strategy with CP" was dominant in 80% of cases. It was more effective and less costly in 47% of cases, and within the cost-effective range (maximum incremental cost effectiveness ratio at €6186.67/QALY) in 33% of cases. CP involvement in OSAS screening is a cost-effective strategy. This proposal is consistent with the trend in Europe and the United States to extend the practices and responsibilities of the pharmacist in primary care.

Standardised alcohol screening in primary health care services targeting Aboriginal and Torres Strait Islander peoples in Australia.

PubMed

Islam, M Mofizul; Oni, Helen T; Lee, K S Kylie; Hayman, Noel; Wilson, Scott; Harrison, Kristie; Hummerston, Beth; Ivers, Rowena; Conigrave, Katherine M

2018-03-29

Aboriginal and Torres Strait Islander Community Controlled Health Services (ACCHSs) around Australia have been asked to standardise screening for unhealthy drinking. Accordingly, screening with the 3-item AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) tool has become a national key performance indicator. Here we provide an overview of suitability of AUDIT-C and other brief alcohol screening tools for use in ACCHSs. All peer-reviewed literature providing original data on validity, acceptability or feasibility of alcohol screening tools among Indigenous Australians was reviewed. Narrative synthesis was used to identify themes and integrate results. Three screening tools-full AUDIT, AUDIT-3 (third question of AUDIT) and CAGE (Cut-down, Annoyed, Guilty and Eye-opener) have been validated against other consumption measures, and found to correspond well. Short forms of AUDIT have also been found to compare well with full AUDIT, and were preferred by primary care staff. Help was often required with converting consumption into standard drinks. Researchers commented that AUDIT and its short forms prompted reflection on drinking. Another tool, the Indigenous Risk Impact Screen (IRIS), jointly screens for alcohol, drug and mental health risk, but is relatively long (13 items). IRIS has been validated against dependence scales. AUDIT, IRIS and CAGE have a greater focus on dependence than on hazardous or harmful consumption. Detection of unhealthy drinking before harms occur is a goal of screening, so AUDIT-C offers advantages over tools like IRIS or CAGE which focus on dependence. AUDIT-C's brevity suits integration with general health screening. Further research is needed on facilitating implementation of systematic alcohol screening into Indigenous primary healthcare.

Colorectal Cancer Screening Initiation After Age 50 Years in an Organized Program.

PubMed

Fedewa, Stacey A; Corley, Douglas A; Jensen, Christopher D; Zhao, Wei; Goodman, Michael; Jemal, Ahmedin; Ward, Kevin C; Levin, Theodore R; Doubeni, Chyke A

2017-09-01

Recent studies report racial disparities among individuals in organized colorectal cancer (CRC) programs; however, there is a paucity of information on CRC screening utilization by race/ethnicity among newly age-eligible adults in such programs. This was a retrospective cohort study among Kaiser Permanente Northern California enrollees who turned age 50 years between 2007 and 2012 (N=138,799) and were served by a systemwide outreach and facilitated in-reach screening program based primarily on mailed fecal immunochemical tests to screening-eligible people. Kaplan-Meier and Cox model analyses were used to estimate differences in receipt of CRC screening in 2015-2016. Cumulative probabilities of CRC screening within 1 and 2 years of subjects' 50th birthday were 51% and 73%, respectively. Relative to non-Hispanic whites, the likelihood of completing any CRC screening was similar in blacks (hazard ratio, 0.98; 95% CI=0.96, 1.00); 5% lower in Hispanics (hazard ratio, 0.95; 95% CI=0.93, 0.96); and 13% higher in Asians (hazard ratio, 1.13; 95% CI=1.11, 1.15) in adjusted analyses. Fecal immunochemical testing was the most common screening modality, representing 86% of all screening initiations. Blacks and Hispanics had lower receipt of fecal immunochemical testing in adjusted analyses. CRC screening uptake was high among newly screening-eligible adults in an organized CRC screening program, but Hispanics were less likely to initiate screening near age 50 years than non-Hispanic whites, suggesting that cultural and other individual-level barriers not addressed within the program likely contribute. Future studies examining the influences of culturally appropriate and targeted efforts for screening initiation are needed. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Breast Cancer Screening in the Precision Medicine Era: Risk-Based Screening in a Population-Based Trial.

PubMed

Shieh, Yiwey; Eklund, Martin; Madlensky, Lisa; Sawyer, Sarah D; Thompson, Carlie K; Stover Fiscalini, Allison; Ziv, Elad; Van't Veer, Laura J; Esserman, Laura J; Tice, Jeffrey A

2017-01-01

Ongoing controversy over the optimal approach to breast cancer screening has led to discordant professional society recommendations, particularly in women age 40 to 49 years. One potential solution is risk-based screening, where decisions around the starting age, stopping age, frequency, and modality of screening are based on individual risk to maximize the early detection of aggressive cancers and minimize the harms of screening through optimal resource utilization. We present a novel approach to risk-based screening that integrates clinical risk factors, breast density, a polygenic risk score representing the cumulative effects of genetic variants, and sequencing for moderate- and high-penetrance germline mutations. We demonstrate how thresholds of absolute risk estimates generated by our prediction tools can be used to stratify women into different screening strategies (biennial mammography, annual mammography, annual mammography with adjunctive magnetic resonance imaging, defer screening at this time) while informing the starting age of screening for women age 40 to 49 years. Our risk thresholds and corresponding screening strategies are based on current evidence but need to be tested in clinical trials. The Women Informed to Screen Depending On Measures of risk (WISDOM) Study, a pragmatic, preference-tolerant randomized controlled trial of annual vs personalized screening, will study our proposed approach. WISDOM will evaluate the efficacy, safety, and acceptability of risk-based screening beginning in the fall of 2016. The adaptive design of this trial allows continued refinement of our risk thresholds as the trial progresses, and we discuss areas where we anticipate emerging evidence will impact our approach. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Primary care physicians and disparities in colorectal cancer screening in the elderly.

PubMed

Singal, Ashwani K; Lin, Yu-Li; Kuo, Yong-Fang; Riall, Taylor; Goodwin, James S

2013-02-01

To examine whether having a primary care physician (PCP) is associated with reduced ethnic disparities for colorectal cancer (CRC) screening and whether clustering of minorities within PCPs contributes to the disparities. Retrospective cohort study of Medicare beneficiaries age 66-75 in 2009 in Texas. The percentage of beneficiaries up to date in CRC screening in 2009 was stratified by race/ethnicity. Multilevel models were used to study the effect of having a PCP and PCP characteristics on the racial and ethnic disparities on CRC screening. Medicare data from 2000 to 2009 were used to assess prior CRC screening. Odds of undergoing CRC screening were more than twice as high in patients with a PCP (OR = 2.05, 95 percent CI 2.03-2.07). After accounting for clustering and PCP characteristics, the black-white disparity in CRC screening rates almost disappears and the Hispanic-white disparity decreases substantially. Ethnic disparities in CRC screening in the elderly are mostly explained by decreased access to PCPs and by clustering of minorities within PCPs less likely to screen any of their patients. © Health Research and Educational Trust.

Estimation of non-solid lung nodule volume with low-dose CT protocols: effect of reconstruction algorithm and measurement method

NASA Astrophysics Data System (ADS)

Gavrielides, Marios A.; DeFilippo, Gino; Berman, Benjamin P.; Li, Qin; Petrick, Nicholas; Schultz, Kurt; Siegelman, Jenifer

2017-03-01

Computed tomography is primarily the modality of choice to assess stability of nonsolid pulmonary nodules (sometimes referred to as ground-glass opacity) for three or more years, with change in size being the primary factor to monitor. Since volume extracted from CT is being examined as a quantitative biomarker of lung nodule size, it is important to examine factors affecting the performance of volumetric CT for this task. More specifically, the effect of reconstruction algorithms and measurement method in the context of low-dose CT protocols has been an under-examined area of research. In this phantom study we assessed volumetric CT with two different measurement methods (model-based and segmentation-based) for nodules with radiodensities of both nonsolid (-800HU and -630HU) and solid (-10HU) nodules, sizes of 5mm and 10mm, and two different shapes (spherical and spiculated). Imaging protocols included CTDIvol typical of screening (1.7mGy) and sub-screening (0.6mGy) scans and different types of reconstruction algorithms across three scanners. Results showed that radio-density was the factor contributing most to overall error based on ANOVA. The choice of reconstruction algorithm or measurement method did not affect substantially the accuracy of measurements; however, measurement method affected repeatability with repeatability coefficients ranging from around 3-5% for the model-based estimator to around 20-30% across reconstruction algorithms for the segmentation-based method. The findings of the study can be valuable toward developing standardized protocols and performance claims for nonsolid nodules.

High-definition colonoscopy increases adenoma detection rate.

PubMed

Jrebi, Nezar Y; Hefty, Matthew; Jalouta, Tarek; Ogilvie, James; Davis, Alan T; Asgeirsson, Theodor; Luchtefeld, Martin

2017-01-01

The adenoma detection rate (ADR) is a quality indicator for colonoscopy. High-definition (HD) imaging has been reported to increase polyp detection rates. The primary objective of this study was to compare polyp detection rate (PDR) and adenoma detection rate (ADR) before and after the implementation of HD colonoscopy. A retrospective chart review was performed on patients aged 48-55 years old, who underwent first-time screening colonoscopy. The first group underwent standard-definition (SD) colonoscopy in the first 6 months of 2011. The second group underwent screening with HD colonoscopy during the first 6 months of 2012. We compared age, gender, PDR, ADR, and average sizes of adenomatous polyps between gastroenterologist and colorectal surgeon and among physicians themselves. Statistical analysis was performed with Fischer's exact test and Pearson Chi-square. A total of 1268 patients were involved in the study (634 in each group). PDR (35.6 vs. 48.2 %, p < 0.001) and ADR (22.2 vs. 30.4 %, p = 0.02) were higher in the HD group. The average size of an adenomatous polyp was the same in the two groups (0.58 vs. 0.57, p = 0.69). However, this difference was not seen among colorectal surgeons PDR (35.7 vs. 37 %, p = 0.789), ADR (22.9 vs. 24.5 % p = 0.513), but clearly seen among gastroenterologist, PDR (35.6 vs. 53.1 % p < 0.001) and ADR (21.9 vs. 32.9 % p < 0.001). When polyps were categorized into size groups, there was no difference in ADR between the two timeframes (<5 mm in size (41.5 vs. 35.4 %), 5-10 mm (49.3 vs. 60.1 %) and >10 mm (9.2 vs. 4.5 %), p = 0.07). Polyps were most commonly seen in the sigmoid colon (26.1 vs. 24.7 %). There was no difference in the rate of synchronous polyp detection between modalities (25.6 vs. 29 %, p = 0.51). Withdrawal time was the same in both procedure (9.2 vs. 8.5 min, p = 0.10). Screening colonoscopy with high-definition technology significantly improved both PDR and ADR. In addition, high-definition colonoscopy may be particularly useful and advantageous among less experienced endoscopists in various community settings. However, there needs to be application to specific patient populations in future studies to assess for any statistical differences between standard- and high-definition modalities to determine clinical utility.

Use of the blue cotton screen method with endoscopy to detect occult esophageal foreign bodies

PubMed Central

Xia, Yan; Zhang, Fan; Xu, Weiran

2017-01-01

More than 20,000 cases of upper gastrointestinal foreign bodies (FBs) have been reported in the last 5 years in China. Early detection and treatment is vital in these patients. Differential diagnosis of esophageal injury and occult esophageal foreign bodies is challenging, particularly in the case of non-radio-opaque foreign bodies. A diagnostic technique with high accuracy and low risk is needed for clinical practice. We describe successful use of the “blue cotton screen method” to detect esophageal foreign bodies in 2 patients. The advantages and disadvantages of various diagnostic modalities in the management of patients with foreign body ingestion are presented. This technique is safer and more effective than traditional methods for foreign body impaction in the esophageal cavity. It could be applied for screening and in the differential diagnosis of esophageal injury and FBs in the esophageal lumen. PMID:29362659

Parkinsonian Balance Deficits Quantified Using a Game Industry Board and a Specific Battery of Four Paradigms.

PubMed

Darbin, Olivier; Gubler, Coral; Naritoku, Dean; Dees, Daniel; Martino, Anthony; Adams, Elizabeth

2016-01-01

This study describes a cost-effective screening protocol for parkinsonism based on combined objective and subjective monitoring of balance function. Objective evaluation of balance function was performed using a game industry balance board and an automated analyses of the dynamic of the center of pressure in time, frequency, and non-linear domains collected during short series of stand up tests with different modalities and severity of sensorial deprivation. The subjective measurement of balance function was performed using the Dizziness Handicap Inventory questionnaire. Principal component analyses on both objective and subjective measurements of balance function allowed to obtained a specificity and selectivity for parkinsonian patients (vs. healthy subjects) of 0.67 and 0.71 respectively. The findings are discussed regarding the relevance of cost-effective balance-based screening system as strategy to meet the needs of broader and earlier screening for parkinsonism in communities with limited access to healthcare.

[Computerised monitoring of integrated cervical screening. Indicators of diagnostic performance].

PubMed

Bucchi, L; Pierri, C; Amadori, A; Folicaldi, S; Ghidoni, D; Nannini, R; Bondi, A

2003-12-01

In a previous issue of this journal, we presented the background, rationale, general methods, and indicators of participation of a computerised system for the monitoring of integrated cervical screening, i.e. the integration of spontaneous Pap smear practice into organised screening. We also reported the results of the application of those indicators in the general database of the Pathology Department of Imola Health District in northern Italy. In the current paper, we present the rationale and definitions of indicators of diagnostic performance (total Pap smears and rate of unsatisfactory Pap smears, distribution by cytology class reported, rate of patients without timely follow-up, detection rate, positive predictive value, distribution of cytology classes reported by histology diagnosis, and distribution of cases of CIN and carcinoma registered by detection modality) as well as the results of their application in the same database as above.

Effects of Promotional Materials on Attitudes and Fear towards Colorectal Cancer Screening among Chinese Older Adults: An Experimental Study.

PubMed

Leung, Doris Y P; Chen, Joanne M T; Lou, Vivian W Q; Wong, Eliza M L; Chan, Aileen W K; So, Winnie K W; Chan, Carmen W H

2017-07-13

Colorectal cancer (CRC) screening is a cost-effective prevention and control strategy. However, the promotion of CRC screening for older adults may be difficult because reading CRC prevention information may evoke embarrassment, fear, and anxiety towards the screening procedure and cancer diagnosis. This study aims to (1) examine the effects of three promotional materials for CRC screening on the attitudes toward CRC screening tests (screening interest, screening effectiveness, and trust in the screening results) and cancer fear, and (2) to explore the interaction effect of cancer fear with screening effectiveness and trust in the screening results on screening interest of the three screening tests (fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy) among Chinese older adults. A total of 114 community-dwelling older adults were asked to look at the corresponding promotional materials (pamphlet, cartoon, and video) of one of the three study groups. The pamphlet and video represent convention strategies and the cartoon represents an innovative strategy. No significant difference was observed in the screening interest and cancer fear across groups. FOBT was the most preferred screening modality. The video group has a large proportion agreed screening effectiveness of flexible sigmoidoscopy than pamphlet and cartoon groups and trusted in the screening results for FOBT and flexible sigmoidoscopy than the pamphlet group. Logistic regression results showed that the effect of trust in the screening results on screening interest for colonoscopy was greater among participants with higher cancer fear than those with lower cancer fear level. In conclusion, the three promotional groups had produced similar results in their attitudes toward CRC screening and cancer fear. The use of cartoons may be a comparable approach with conventional methods in the promotion of CRC screening. Additional components that can arouse fear and boost response efficacy simultaneously might also be useful for the effective promotion of colonoscopy among Chinese older adults.

Effects of Promotional Materials on Attitudes and Fear towards Colorectal Cancer Screening among Chinese Older Adults: An Experimental Study

PubMed Central

Leung, Doris Y. P.; Chen, Joanne M. T.; Lou, Vivian W. Q.; Wong, Eliza M. L.; So, Winnie K. W.; Chan, Carmen W. H.

2017-01-01

Colorectal cancer (CRC) screening is a cost-effective prevention and control strategy. However, the promotion of CRC screening for older adults may be difficult because reading CRC prevention information may evoke embarrassment, fear, and anxiety towards the screening procedure and cancer diagnosis. This study aims to (1) examine the effects of three promotional materials for CRC screening on the attitudes toward CRC screening tests (screening interest, screening effectiveness, and trust in the screening results) and cancer fear, and (2) to explore the interaction effect of cancer fear with screening effectiveness and trust in the screening results on screening interest of the three screening tests (fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy) among Chinese older adults. A total of 114 community-dwelling older adults were asked to look at the corresponding promotional materials (pamphlet, cartoon, and video) of one of the three study groups. The pamphlet and video represent convention strategies and the cartoon represents an innovative strategy. No significant difference was observed in the screening interest and cancer fear across groups. FOBT was the most preferred screening modality. The video group has a large proportion agreed screening effectiveness of flexible sigmoidoscopy than pamphlet and cartoon groups and trusted in the screening results for FOBT and flexible sigmoidoscopy than the pamphlet group. Logistic regression results showed that the effect of trust in the screening results on screening interest for colonoscopy was greater among participants with higher cancer fear than those with lower cancer fear level. In conclusion, the three promotional groups had produced similar results in their attitudes toward CRC screening and cancer fear. The use of cartoons may be a comparable approach with conventional methods in the promotion of CRC screening. Additional components that can arouse fear and boost response efficacy simultaneously might also be useful for the effective promotion of colonoscopy among Chinese older adults. PMID:28703752

Conducting Universal Complete Mental Health Screening via Student Self-Report

ERIC Educational Resources Information Center

Moore, Stephanie A.; Widales-Benitez, Oscar; Carnazzo, Katherine W.; Kim, Eui Kyung; Moffa, Kathryn; Dowdy, Erin

2015-01-01

Universal screening is increasingly becoming part of prevention and early intervention best practice in schools. Although the number of schools engaging in universal screening has increased over the past decade, emotional and behavioral problems are often their primary focus. Problem-focused screening, however, does not address positive…

The Clinical Aspects of Newborn Screening: Importance of Newborn Screening Follow-Up

ERIC Educational Resources Information Center

James, Philip M.; Levy, Harvey L.

2006-01-01

The aim of newborn screening is to identify presymptomatic healthy infants that will develop significant metabolic or endocrine derangements if left undiagnosed and untreated. The goal of ultimately reducing or eliminating irreversible sequelae is reached by maximizing test sensitivity of the primary newborn screening that measures specific…

Are we able to reduce the mortality and morbidity of oral cancer; Some considerations

PubMed Central

2013-01-01

Oral cancer makes up 1%-2% of all cancers that may arise in the body. The majority of oral cancers consists of squamous cell carcinomas. Oral cancer carries a considerable mortality rate, being mainly dependent on the stage of the disease at admission. Worldwide some 50% of the patients with oral cancer present with advanced disease. There are several ways of trying to diagnose oral cancer in a lower tumor stage, being 1) mass screening or screening in selected patients, 2) reduction of patients’ delay, and 3) reduction of doctors’ delay. Oral cancer population-based screening (“mass screening”) programs do not meet the guidelines for a successful outcome. There may be some benefit when focusing on high-risk groups, such as heavy smokers and heavy drinkers. Reported reasons for patients’ delay range from fear of a diagnosis of cancer, limited accessibility of primary health care, to unawareness of the possibility of malignant oral diseases. Apparently, information campaigns in news programs and TV have little effect on patients’ delay. Mouth self-examination may have some value in reducing patients’ delay. Doctors’ delay includes dentists’ delay and diagnostic delay caused by other medical and dental health care professionals. Doctors’ delay may vary from almost zero days up to more than six months. Usually, morbidity of cancer treatment is measured by quality of life (QoL) questionnaires. In the past decades this topic has drawn a lot of attention worldwide. It is a challenge to decrease the morbidity that is associated with the various treatment modalities that are used in oral cancer without substantially compromising the survival rate. Smoking cessation contributes to reducing the risk of oral cancers, with a 50% reduction in risk within five years. Indeed, risk factor reduction seems to be the most effective tool in an attempt to decrease the morbidity and mortality of oral cancer. Key words:Oral cancer, early diagnosis, quality of life. PMID:23229266

Cortico-Cortical Connections of Primary Sensory Areas and Associated Symptoms in Migraine.

PubMed

Hodkinson, Duncan J; Veggeberg, Rosanna; Kucyi, Aaron; van Dijk, Koene R A; Wilcox, Sophie L; Scrivani, Steven J; Burstein, Rami; Becerra, Lino; Borsook, David

2016-01-01

Migraine is a recurring, episodic neurological disorder characterized by headache, nausea, vomiting, and sensory disturbances. These events are thought to arise from the activation and sensitization of neurons along the trigemino-vascular pathway. From animal studies, it is known that thalamocortical projections play an important role in the transmission of nociceptive signals from the meninges to the cortex. However, little is currently known about the potential involvement of cortico-cortical feedback projections from higher-order multisensory areas and/or feedforward projections from principle primary sensory areas or subcortical structures. In a large cohort of human migraine patients ( N = 40) and matched healthy control subjects ( N = 40), we used resting-state intrinsic functional connectivity to examine the cortical networks associated with the three main sensory perceptual modalities of vision, audition, and somatosensation. Specifically, we sought to explore the complexity of the sensory networks as they converge and become functionally coupled in multimodal systems. We also compared self-reported retrospective migraine symptoms in the same patients, examining the prevalence of sensory symptoms across the different phases of the migraine cycle. Our results show widespread and persistent disturbances in the perceptions of multiple sensory modalities. Consistent with this observation, we discovered that primary sensory areas maintain local functional connectivity but express impaired long-range connections to higher-order association areas (including regions of the default mode and salience network). We speculate that cortico-cortical interactions are necessary for the integration of information within and across the sensory modalities and, thus, could play an important role in the initiation of migraine and/or the development of its associated symptoms.

Treatment options for Primary CNS Lymphoma.

PubMed

Laghari, Altaf Ali; Ahmed, Syed Ijlal; Jabbar, Adnan; Shamim, Muhammad Shahzad

2018-03-01

Primary CNS lymphoma (PCNSL) is a rare and aggressive brain tumour that is uniformly fatal. The rarity of the disease and the poor response to treatment makes it difficult to reach a consensus with regards to treatment options. In this review, the authors have discussed different treatment modalities used in the management of PCNSL including chemotherapy, surgery and radiation, as well as the results of recent clinical trials on treatment options for PCNSL.

Imaging Surveillance After Primary Breast Cancer Treatment

PubMed Central

Lam, Diana L.; Houssami, Nehmat; Lee, Janie M.

2017-01-01

OBJECTIVE Current clinical guidelines are consistent in supporting annual mammography for women after treatment of primary breast cancer. Surveillance imaging beyond standard digital mammography, including digital breast tomosynthesis (DBT), breast ultrasound, and MRI, may improve outcomes. This article reviews the evidence on the performance and effectiveness of breast imaging modalities available for surveillance after treatment of sporadic unilateral primary breast cancer and identifies additional factors to be considered when selecting an imaging surveillance regimen. CONCLUSION Evidence review supports the use of mammography for surveillance after primary breast cancer treatment. Variability exists in guideline recommendations for surveillance initiation, interval, and cessation. DBT offers the most promise as a potential modality to replace standard digital mammography as a front-line surveillance test; a single published study to date has shown a significant decrease in recall rates compared with standard digital mammography alone. Most guidelines do not support the use of whole-breast ultrasound in breast cancer surveillance, and further studies are needed to define the characteristics of women who may benefit from MRI surveillance. The emerging evidence about surveillance imaging outcomes suggests that additional factors, including patient and imaging characteristics, tumor biology and gene expression profile, and choice of treatment, warrant consideration in selecting personalized posttreatment imaging surveillance regimens. PMID:28075622

Rationale and Study Protocol for a Multi-component Health Information Technology (HIT) Screening Tool for Depression and Post-traumatic Stress Disorder in the Primary Care Setting

PubMed Central

Biegler, Kelly; Mollica, Richard; Sim, Susan Elliott; Nicholas, Elisa; Chandler, Maria; Ngo-Metzger, Quyen; Paigne, Kittya; Paigne, Sompia; Nguyen, Danh V.; Sorkin, Dara H.

2016-01-01

The prevalence rate of depression in primary care is high. Primary care providers serve as the initial point of contact for the majority of patients with depression, yet, approximately 50% of cases remain unrecognized. The under-diagnosis of depression may be further exacerbated in limited English-language proficient (LEP) populations. Language barriers may result in less discussion of patients’ mental health needs and fewer referrals to mental health services, particularly given competing priorities of other medical conditions and providers’ time pressures. Recent advances in Health Information Technology (HIT) may facilitate novel ways to screen for depression in LEP populations. The purpose of this paper is to describe the rationale and protocol of a clustered-randomized controlled trial that will test the effectiveness of an HIT intervention that provides a multi-component approach to delivering culturally competent, mental health care in the primary care setting. The HIT intervention has four components: 1) web-based provider training, 2) multimedia electronic screening of depression and PTSD in the patients’ primary language, 3) Computer generated risk assessment scores delivered directly to the provider, and 4) clinical decision support. The outcomes of the study include assessing the potential of the HIT intervention to improve screening rates, clinical detection, provider initiation of treatment, and patient outcomes for depression and PTSD among LEP Cambodian refugees who experienced war atrocities and trauma during the Khmer Rouge. This technology has the potential to be adapted to any LEP population in order to facilitate mental health screening and treatment in the primary care setting. PMID:27394385

Rationale and study protocol for a multi-component Health Information Technology (HIT) screening tool for depression and post-traumatic stress disorder in the primary care setting.

PubMed

Biegler, Kelly; Mollica, Richard; Sim, Susan Elliott; Nicholas, Elisa; Chandler, Maria; Ngo-Metzger, Quyen; Paigne, Kittya; Paigne, Sompia; Nguyen, Danh V; Sorkin, Dara H

2016-09-01

The prevalence rate of depression in primary care is high. Primary care providers serve as the initial point of contact for the majority of patients with depression, yet, approximately 50% of cases remain unrecognized. The under-diagnosis of depression may be further exacerbated in limited English-language proficient (LEP) populations. Language barriers may result in less discussion of patients' mental health needs and fewer referrals to mental health services, particularly given competing priorities of other medical conditions and providers' time pressures. Recent advances in Health Information Technology (HIT) may facilitate novel ways to screen for depression and other mental health disorders in LEP populations. The purpose of this paper is to describe the rationale and protocol of a clustered randomized controlled trial that will test the effectiveness of an HIT intervention that provides a multi-component approach to delivering culturally competent, mental health care in the primary care setting. The HIT intervention has four components: 1) web-based provider training, 2) multimedia electronic screening of depression and PTSD in the patients' primary language, 3) Computer generated risk assessment scores delivered directly to the provider, and 4) clinical decision support. The outcomes of the study include assessing the potential of the HIT intervention to improve screening rates, clinical detection, provider initiation of treatment, and patient outcomes for depression and post-traumatic stress disorder (PTSD) among LEP Cambodian refugees who experienced war atrocities and trauma during the Khmer Rouge. This technology has the potential to be adapted to any LEP population in order to facilitate mental health screening and treatment in the primary care setting. Copyright © 2016 Elsevier Inc. All rights reserved.

[Drug using risks screening in primary care patients using the ASSIST test: Cross sectional study].

PubMed

López-Rodríguez, Juan A; Rigabert, Alina; Gómez Llano, M Nieves; Rubio, Gabriel

2018-03-15

The aim of this study is to estimate risky-drug use patterns of consumption of primary care patients. Multicentric descriptive cross-sectional study. five primary health care centers of the South of Madrid. all patients between 16-100 year-old consulting with their family physician. Spanish-validated World Health Organization ASSIST test was use to screen risky drug use in primary care. Total points scored at the test were obtained. A sum of 441 screening test were collected. Mean age was 51,3 years and 51.6% of patients presented a moderate-severe risky drug use out of the nine drugs tested. The more frequent drug use screened were tobacco (41.7%) followed by alcohol (15.4%), hypnotics (13.7%) and cannabis (5.7%). Differences were found between genders in the patterns: men had higher risky drug uses compared to women regarding alcohol and cannabis. Women had higher sedatives/hypnotics consumption prevalence. A 16% of patients presented with polyconsumption drug use patterns. There is risk derived from drug misuse in primary care for tobacco, alcohol, hypnotics and cannabis as detected by the ASSIST test. There is a higher rate of hypnotics than expected. Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

The use of electrocautery as the primary ablation modality for malignant and benign airway obstruction.

PubMed

Wahidi, Momen M; Unroe, Mark A; Adlakha, Natasha; Beyea, Mathew; Shofer, Scott L

2011-09-01

Laser has been the main ablative modality in the airways, but a growing experience with endobronchial electrocautery suggests a comparable efficacy and safety profile. To evaluate the efficacy and safety of electrocautery as the primary heat therapy for malignant and benign airway obstruction. A retrospective review of all patients undergoing endobronchial electrocautery, alone or in combination with other airway tools, at Duke University Medical Center between April 2004 and November 2009. Data on efficacy (luminal patency, symptomatic, radiographic, or physiologic improvement) and safety (complication rate) were collected. Ninety-four patients underwent 117 procedures with endobronchial electrocautery for endobronchial malignant and nonmalignant disease. Endoscopic improvement was seen in 94% of cases. Seventy-one percent of patients reported symptomatic improvement. Radiographic studies demonstrated luminal improvement in 78% of patients on chest computed tomography, improved aeration on chest computed tomography and chest x-ray in 63% and 43% of patients, respectively. The rate of major complications was 0.8%, whereas minor complications occurred in 6.8% of cases. There was no perioperative mortality. Endobronchial electrocautery is effective and safe when used as an ablative modality in malignant and benign airway obstruction and has a comparable profile to laser with the advantage of lower cost.

Relativity Screens for Misvalued Medical Services: Impact on Noninvasive Diagnostic Radiology.

PubMed

Rosenkrantz, Andrew B; Silva, Ezequiel; Hawkins, C Matthew

2017-11-01

In 2006, the AMA/Specialty Society Relative Value Scale Update Committee (RUC) introduced ongoing relativity screens to identify potentially misvalued medical services for payment adjustments. We assess the impact of these screens upon the valuation of noninvasive diagnostic radiology services. Data regarding relativity screens and relative value unit (RVU) changes were obtained from the 2016 AMA Relativity Assessment Status Report. All global codes in the 2016 Medicare Physician Fee Schedule with associated work RVUs were classified as noninvasive diagnostic radiology services versus remaining services. The frequency of having ever undergone a screen was compared between the two groups. Screened radiology codes were further evaluated regarding the RVU impact of subsequent revaluation. Of noninvasive diagnostic radiology codes, 46.0% (201 of 437) were screened versus 22.2% (1,460 of 6,575) of remaining codes (P < .001). Most common screens for which radiology codes were identified as potentially misvalued were (1) high expenditures (27.5%) and (2) high utilization (25.6%). The modality and body region most likely to be identified in a screen were CT (82.1%) and breast (90.9%), respectively. Among screened radiology codes, work RVUs, practice expense RVUs, and nonfacility total RVUs decreased in 20.3%, 65.9%, and 75.3%, respectively. All screened CT, MRI, brain, and spine codes exhibited decreased total RVUs. Policymakers' ongoing search for potentially misvalued medical services has disproportionately impacted noninvasive diagnostic radiology services, risking the introduction of unintended or artificial shifts in physician practice. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Listen to them draw: screening children in primary care through the use of human figure drawings.

PubMed

Tielsch, Anna H; Allen, Patricia Jackson

2005-01-01

This literature review focuses on the Human Figure Drawing (HFD) methods put forth by Elizabeth Koppitz as a screening instrument. Children's drawings have potential as a mental health screening aide for health care practitioners in the primary care setting. This paper focuses on self-portrait drawings as a screening technique for emotional well-being, anxiety, and depression in school-aged children (6-12 years old). Using Koppitz's emotional indicators checklist for mental health, practitioners can use the child's HFD as a quick screening tool. Although the HFD is not diagnostic and can not be used as the sole indicator for anxiety or depression, two or more emotional indicators may signal to the clinician that further psychiatric assessment and referral is needed.

Android Based Behavioral Biometric Authentication via Multi-Modal Fusion

DTIC Science & Technology

2014-06-12

such as the way he or she uses the mouse, or interacts with the Graphical User Interface (GUI) [9]. Described simply, standard biometrics is determined...as a login screen on a standard computer. Active authentication is authentication that occurs dynamically throughout interaction with the device. A...because they are higher level constructs in themselves. The Android framework was specifically used for capturing the multitouch gestures: pinch and zoom

E-mental health preferences of Veterans with and without probable posttraumatic stress disorder.

PubMed

Whealin, Julia M; Seibert-Hatalsky, L Alana; Howell, Jennifer Willett; Tsai, Jack

2015-01-01

Mental health care practices supported by electronic communication, referred to as e-mental health, offer ways to increase access to mental health resources. In recent years, e-mental health interventions using clinical video teleconferencing, Internet-based interventions, social networking sites, and telephones have emerged as viable, cost-effective methods to augment traditional service delivery. Whereas some research evaluates attitudes about e-mental health, few studies have assessed interest in using these approaches in a contemporary sample of U.S. Veterans. This study sought to understand willingness to use e-mental health in a diverse group of Veterans residing in Hawaii. Mailed surveys were completed by 600 Operation Iraqi Freedom/Operation Enduring Freedom Veterans and National Guard members. Results suggest that overall willingness to use e-mental health ranged from 32.2% to 56.7% depending on modality type. Importantly, Veterans who screened positive for posttraumatic stress disorder (PTSD) were significantly less likely to report willingness to use each e-mental health modality than their peers without PTSD, despite their greater desire for mental health services. These results suggest that despite solutions to logistical barriers afforded via e-mental health services, certain barriers to mental health care may persist, especially among Veterans who screen positive for PTSD.

Longitudinal analysis of domain-level breast cancer literacy among African-American women.

PubMed

Mabiso, Athur; Williams, Karen Patricia; Todem, David; Templin, Thomas N

2010-02-01

Functional breast cancer literacy was assessed among African-American women and measured at the domain level over time. We used the Kin Keeper(SM) Cancer Prevention Intervention to educate 161 African-American women on three domains of breast cancer literacy: (i) cancer awareness, (ii) knowledge of breast cancer screening modalities and (iii) cancer prevention and control. A breast cancer literacy assessment was administered pre- and post-educational intervention at two time points followed by another assessment 12 months after the second intervention. Generalized estimating equations were specified to predict the probability of correctly answering questions in each domain over time. Domain-level literacy differentials exist; at baseline, women had higher test scores in the breast cancer prevention and control domain than the cancer awareness domain (odds ratio = 1.67, 95% confidence interval 1.19-2.34). After Kin Keeper(SM) Cancer Prevention Intervention, African-American women consistently improved their breast cancer literacy in all domains over the five time stages (P < 0.001) though at different rates for each domain. Differences in domain-level breast cancer literacy highlight the importance of assessing literacy at the domain level. Interventions to improve African-American women's breast cancer literacy should focus on knowledge of breast cancer screening modalities and cancer awareness domains.

Image-guided percutaneous removal of ballistic foreign bodies secondary to air gun injuries.

PubMed

Rothermund, Jacob L; Rabe, Andrew J; Zumberge, Nicholas A; Murakami, James W; Warren, Patrick S; Hogan, Mark J

2018-01-01

Ballistic injuries with retained foreign bodies from air guns is a relatively common problem, particularly in children and adolescents. If not removed in a timely fashion, the foreign bodies can result in complications, including pain and infection. Diagnostic methods to identify the presence of the foreign body run the entire gamut of radiology, particularly radiography, ultrasound (US) and computed tomography (CT). Removal of the foreign bodies can be performed by primary care, emergency, surgical, and radiologic clinicians, with or without imaging guidance. To evaluate the modalities of radiologic detection and the experience of image-guided ballistic foreign body removal related to air gun injuries within the interventional radiology department of a large pediatric hospital. A database of more than 1,000 foreign bodies that were removed with imaging guidance by the interventional radiologists at our institution was searched for ballistic foreign bodies from air guns. The location, dimensions, diagnostic modality, duration, complications and imaging modality used for removal were recorded. In addition, the use of sedation and anesthesia required for the procedures was also recorded. Sixty-one patients with ballistic foreign bodies were identified. All foreign bodies were metallic BBs or pellets. The age of the patients ranged from 5 to 20 years. The initial diagnostic modality to detect the foreign bodies was primarily radiography. The primary modality to assist in removal was US, closely followed by fluoroscopy. For the procedure, 32.7% of the patients required some level of sedation. Only two patients had an active infection at the time of the removal. The foreign bodies were primarily in the soft tissues; however, successful removal was also performed from intraosseous, intraglandular and intratendinous locations. All cases resulted in successful removal without complications. Image-guided removal of ballistic foreign bodies secondary to air guns is a very effective procedure that can obviate the need for open surgical procedures in children.

Gold standards and expert panels: a pulmonary nodule case study with challenges and solutions

NASA Astrophysics Data System (ADS)

Miller, Dave P.; O'Shaughnessy, Kathryn F.; Wood, Susan A.; Castellino, Ronald A.

2004-05-01

Comparative evaluations of reader performance using different modalities, e.g. CT with computer-aided detection (CAD) vs. CT without CAD, generally require a "truth" definition based on a gold standard. There are many situations in which a true invariant gold standard is impractical or impossible to obtain. For instance, small pulmonary nodules are generally not assessed by biopsy or resection. In such cases, it is common to use a unanimous consensus or majority agreement from an expert panel as a reference standard for actionability in lieu of the unknown gold standard for disease. Nonetheless, there are three major concerns about expert panel reference standards: (1) actionability is not synonymous with disease (2) it may be possible to obtain different conclusions about which modality is better using different rules (e.g. majority vs. unanimous consensus), and (3) the variability associated with the panelists is not formally captured in the p-values or confidence intervals that are generally produced for estimating the extent to which one modality is superior to the other. A multi-reader-multi-case (MRMC) receiver operating characteristic (ROC) study was performed using 90 cases, 15 readers, and a reference truth based on 3 experienced panelists. The primary analyses were conducted using a reference truth of unanimous consensus regarding actionability (3 out of 3 panelists). To assess the three concerns noted above: (1) additional data from the original radiology reports were compared to the panel (2) the complete analysis was repeated using different definitions of truth, and (3) bootstrap analyses were conducted in which new truth panels were constructed by picking 1, 2, or 3 panelists at random. The definition of the reference truth affected the results for each modality (CT with CAD and CT without CAD) considered by itself, but the effects were similar, so the primary analysis comparing the modalities was robust to the choice of the reference truth.

Improvements in BTS estimation of ton-miles

DOT National Transportation Integrated Search

2004-08-01

Ton-miles (one ton of freight shipped one mile) is the primary physical measure of freight transportation output. This paper describes improved measurements of ton-miles for air, truck, rail, water, and pipeline modes. Each modal measure contains a d...

Colon Cancer Treatment (PDQ®)—Health Professional Version

Cancer.gov

Colon cancer treatment often involves open surgical resection as the primary treatment for localized disease. Other modalities include chemotherapy, targeted therapy, radiation therapy, and local ablation. Get detailed information about colon cancer treatment in this summary for clinicians.