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Screening Performance (screening + performance)

Distribution by Scientific Domains

Medical Sciences	53%

Selected Abstracts

Comparative study of four candidate strategies to detect cervical cancer in different health care settings

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2007
Meherbano M. Kamal
Abstract Aim:, Considering the differing but potentially supplementary properties of visual inspection of the cervix with acetic acid (VIA) and the cytological examination (CYTO) of cervical smears for the screening of cervical cancers, we examined the performance of these two tests and their combinations for the screening of cervical cancer in different health care settings. Methods:, In this cross-sectional diagnostic test performance evaluation study of 4235 female subjects in the reproductive age group, we assessed the screening performance of four strategies: VIA alone, CYTO alone, VIA and CYTO combined in a parallel fashion, and VIA and CYTO combined in tandem. Subjects were recruited from three settings: Hospital, Urban Community and Rural Community. Colposcopy was used as the reference standard. Screening performance was assessed using sensitivity, specificity, post-test probabilities and likelihood ratios (LR), diagnostic odds, area under receiver operating characteristic curve and LR ,2. Results:, Both VIA and CYTO when used alone had a low sensitivity but high specificity, especially in the Rural Community setting. A combination of the results of VIA and CYTO improved the diagnostic accuracy but the strategy using a parallel combination of VIA and CYTO was the most accurate. In general, all screening strategies using VIA and CYTO showed a modest screening performance. Conclusions:, In the settings of varying levels of health care and low resources, caution is needed for a generalized use of VIA for cervical cancer screening. Further evaluation of the cost-effective ways of combining VIA and CYTO is needed in these circumstances. [source]

The proform of eosinophil major basic protein: a new maternal serum marker for adverse pregnancy outcome

PRENATAL DIAGNOSIS, Issue 11 2009
Kasper Pihl
Abstract Objective To establish the first trimester serum levels of the proform of eosinophil major basic protein (proMBP) in pregnancies with adverse outcome. Furthermore, to determine the screening performance using proMBP alone and in combination with other first trimester markers. Methods A case-control study was conducted in a primary hospital setting. The proMBP concentration was measured in cases with small-for-gestational age (SGA) (n = 150), spontaneous preterm delivery (n = 88), preeclampsia (n = 40), gestational hypertension (n = 10) and in controls (n = 500). Concentrations were converted to multiples of the median (MoM) in controls and groups were compared using Mann,Whitney U -test. Logistic regression analysis was used to determine significant factors for predicting adverse pregnancy outcome. Screening performance was assessed using receiver operating characteristic curves. Results The proMBP median was significantly reduced in pregnancies with SGA (0.81 MoM), spontaneous preterm delivery (0.83 MoM), preeclampsia (0.88 MoM) and gestational hypertension (0.60 MoM). The best screening performance was found for preeclampsia including the covariates proMBP and nulliparity yielding an area under the curve equal to 0.737 (p < 0.0005) and a 75% detection rate for a 30% false positive rate. Conclusion The proMBP is a novel first trimester serum marker for adverse pregnancy outcome. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Comparing clock tests for dementia screening: naïve judgments vs formal systems,what is optimal?

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2002
James M. Scanlan
Abstract Background Clock drawing tests (CDTs) vary in format, scoring, and complexity. Herein, we compared the dementia screening performance of seven CDT scoring systems and the judgements of untrained raters. Methods 80 clock drawings by subjects of known dementia status were selected, 20 from each of four categories (Consortium to Establish a Registry for Alzheimer's disease [CERAD] defined normal, mild, moderate, and severe abnormality). An expert rater scored all clocks using published criteria for seven systems. Additionally, 20 naïve raters judged clocks as either normal or abnormal, without formal instructions. Clocks were then classified by drawers' dementia status for comparison of dementia detection across systems. Results Naïve and formal CDT systems showed 90,100% agreement in CERAD normal, moderate and severe categories, but poor agreement (mean,=,39%) for mildly impaired clocks. When CDT systems were compared for accurate dementia classification, the Mendez and CERAD systems correctly identified the greatest proportion of subjects (84,85%), and Wolf-Klein the smallest (58%). The better systems correctly identified>,70% of mildly demented individuals (CDR,=,1). In contrast, medical records from patients' personal physicians correctly identified only 24% of the mildly demented. Strikingly, naïve raters' CDT judgements were as effective as five of the seven CDT systems in dementia identification. Conclusions While the Mendez system was the most accurate overall, it was not significantly better than CERAD, which had simpler scoring rules. Untrained raters discriminated normal from abnormal clocks with acceptable accuracy for community screening purposes. Results suggest that, if used, most CDT systems would improve personal physicians' dementia recognition in difficult to detect mildly demented subjects. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Screening for mental disorders in cancer patients , discriminant validity of HADS and GHQ-12 assessed by standardized clinical interview

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2001
Katrin Reuter
Abstract The detection and classification of comorbid mental disorders has major implications in cancer care. Valid screening instruments for different diagnostic specifications are therefore needed. This study investigated the discriminant validity of the German versions of the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire (GHQ-12). A total of 188 cancer patients participated in the examination, consisting first of the assessment of psychological distress and, second, of the diagnosis of mental disorders according to DSM-IV by clinical standardized interview (CIDI). Discriminant validity of the two instruments regarding the diagnosis of any mental disorder, anxiety, depression and multiple mental disorders was compared using ROC analysis. Overall, the total HADS scale shows a better screening performance than the GHQ-12, especially for the detection of depressive and anxiety disorders. Best results are achieved for depressive disorders with an area under the curve (AUC) of 0.80, a sensitivity of 79% and a specificity of 76% (cut-off point = 17). For the ability of the instruments to detect patients with mental disorders in general, the GHQ-12 (AUC: 0.68) shows a similar overall accuracy to the HADS (AUC: 0.70). The screening performance of both scales for comorbid mental disorders is comparable. The HADS is a valid screening instrument for depressive and anxiety disorders in cancer care. The GHQ-12 can be considered as an alternative to the HADS when diagnostic specifications are less detailed and the goal of screening procedures is to detect patients with single or multiple mental disorders in general. Limitations of conventional screening instruments are given through the differing methodological approaches of screening tests (dimensional approach) and diagnosis according to DSM-IV (categorical approach). Copyright © 2001 Whurr Publishers Ltd. [source]

Comparative study of four candidate strategies to detect cervical cancer in different health care settings

A Comparison of Two Single-Item Screeners for Hazardous Drinking and Alcohol Use Disorder

ALCOHOLISM, Issue 2 2010
Deborah A. Dawson
Background:, There is increasing interest in and physician support for the use of single-item screeners for problem drinking. Methods:, In a representative sample of U.S. adults (n = 43,093) and within selected subgroups, past-year frequency of drinking 5+/4+ drinks and maximum drinks consumed on any day were evaluated as screeners for past-year alcohol dependence, any alcohol use disorder (AUD), and any AUD or hazardous drinking, using standard measures of screening performance. AUDs were defined according to DSM-IV criteria. Hazardous drinking was defined as consuming >14 drinks/wk or 5+ drinks on any day for men and >7 drinks/wk or 4+ drinks on any day for women. Results:, Optimal cutpoints for both screeners varied across population subgroups, and these variations should be taken into account in order to maximize screening performance. At the optimal cutpoints for the total population, the sensitivity and specificity of maximum drinks were 89% and 82% for dependence at ,5 drinks, 90% and 79% for any AUD at ,4 drinks, and 90% and 96% for any AUD or hazardous drinking at ,4 drinks. Comparable values of sensitivity and specificity for 5+/4+ frequency were 90% and 83% at ,3 times a year, 87% and 82% at ,once a year, and 88% and 100% at ,once a year, respectively. Specificity was lower when only past-year drinkers were considered. The 5+/4+ frequency screener yielded fairly low sensitivity in predicting alcohol problems among the elderly and among Blacks. Results supported a past-year reference period for frequency of 5+/4+ drinks and substantiated gender- and age-specific thresholds for defining risk drinking. Conclusions:, Both of the single-item screeners performed nearly on a par with the AUDIT-C and have potential for use in primary and emergency care settings. [source]

Free leptin index and PAPP-A: a first trimester maternal serum screening test for pre-eclampsia

PRENATAL DIAGNOSIS, Issue 2 2010
Paula L. Hedley
Abstract Background Prophylaxis with low-dose aspirin may reduce the risk of pre-eclampsia (PE) if introduced in first trimester. The performance of first trimester maternal serum screening for PE using free leptin index (fLI) and PAPP-A, where fLI = leptin/leptin soluble receptor was studied. Methods First trimester serum samples from 126 PE pregnancies and 289 control pregnancies were studied. fLI and PAPP-A were converted into gestational age and maternal weight independent log MoM values of PAPP-A and fLI. The screening performance of markers was studied by receiver-operator-characteristics curves. The performance of population screening was estimated by Monte Carlo simulation. Results fLI was significantly (p < 0.001) elevated [mean log MoM 0.2165 (SD: 0.2604)] compared to controls [mean log MoM ,0.0368 (SD: 0.3132)] and PAPP-A was significantly (p < 0.001) reduced [mean log MoM ,0.0133 (SD: 0.2661)] compared to controls [mean log MoM 0.0474 (SD: 0.2521)] in PE pregnancies. There was no correlation between fLI and PAPP-A in control or PE pregnancies. Combined fLI and PAPP-A screening for PE had estimated population detection rates of 22% and 35% for false positives rates of 6% and 12%, respectively. Conclusion Combining PAPP-A and fLI improves screening performance for PE compared to single marker screening. Copyright © 2009 John Wiley & Sons, Ltd. [source]

The proform of eosinophil major basic protein: a new maternal serum marker for adverse pregnancy outcome

Prenatal screening for serious congenital heart defects using nuchal translucency: a meta-analysis

PRENATAL DIAGNOSIS, Issue 12 2008
Nicholas J. Wald
Abstract Objectives To assess the performance of nuchal translucency (NT) measurements in screening for congenital heart defects (CHD) which would benefit from prenatal detection. Methods A literature search was conducted of studies published prior to August 2007 of CHD and NT measurements in fetuses without chromosome defects. From this, data on 159 pregnancies were obtained. Fetuses with CHD that would benefit from prenatal detection were identified and their NT measurements were compared with NT measurements in 29 776 unaffected fetuses without Down syndrome from the Serum Urine and Ultrasound Screening Study (SURUSS) trial to determine the screening performance of NT measurements. Results In all 67 fetuses with CHD were identified as potentially likely to benefit from prenatal detection. Using NT measurements, the estimated detection rate (DR) for a 5% false-positive rate (FPR) was 52% (95% CI: 42,71). Conclusion Prenatal screening for CHD using NT measurements is likely to be effective, and given that NT measurement is already in place as part of prenatal screening for Down syndrome; this is an ideal time to set up demonstration projects to validate these results. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Sequential and contingent prenatal screening for Down syndrome

PRENATAL DIAGNOSIS, Issue 9 2006
Nicholas J Wald
Abstract Objective To compare the Integrated test in three policies for prenatal Down syndrome screening: Integrated screening for all women, sequential screening (first-trimester tests allowing early completion of screening for high-risk pregnancies), and Contingent screening (early completion of screening for high- and low-risk pregnancies). Design and Methods Estimation of detection rates (DRs) and false-positive rates (FPRs) using Monte Carlo simulation and cost effectiveness for each method. Setting and Population Down syndrome affected and unaffected pregnancies studied in the Serum Urine and Ultrasound Screening Study (SURUSS). Results and Main Outcomes Integrated screening has the best screening performance. The performance of the other two policies approached that of Integrated screening as the first-trimester test FPR decreased. If the first-trimester FPR is set to 0.5% (risk , 1 in 30) with an overall DR of 90%, sequential and contingent screening yield overall FPRs of 2.25% and 2.42%, respectively, and 66% of the affected pregnancies are detected by the first-trimester test. The Integrated test on all women yields an FPR of 2.15%. With sequential screening, 99.5% of women would proceed to an Integrated test, or 30% with contingent screening if those with first-trimester test risks of ,1 in 2000 are classified screen-negative and receive no further testing. About 20% of affected pregnancies identified in the first trimester using sequential or contingent screening would have unnecessary terminations (they would miscarry before the early second trimester). Contingent screening is the most cost-effective if there is no alphafetoprotein screening for neural tube defects, otherwise Integrated screening is more cost-effective. Conclusions Integrated screening for all women is the simplest, most effective, and the safest policy. Contingent screening is the most complex with the lowest screening performance. Making an earlier diagnosis with sequential and contingent screening has adverse consequences that are sufficient to discourage their use. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Maternal serum,integrated screening for trisomy 18 using both first- and second-trimester markers

PRENATAL DIAGNOSIS, Issue 3 2003
Glenn E. Palomaki
Abstract Objectives To estimate the prenatal screening performance of an integrated serum test for detecting trisomy 18, which combines measurements of first- and second-trimester markers with maternal age to assign patient-specific risks. Methods Published and new observations of maternal serum marker levels in trisomy 18 and unaffected pregnancies are used to derive population parameters. These parameters are then combined in a multivariate Gaussian model to assign patient-specific risks for trisomy 18. Results The best combination of serum markers includes pregnancy-associated plasma protein-A in the first trimester and alpha-fetoprotein, unconjugated estriol and human chorionic gonadotropin in the second trimester. At a second-trimester risk cutoff of 1 : 100, these 4 markers, in combination with maternal age, detect 90% of trisomy 18 pregnancies at a false-positive rate of 0.1%. The odds of a trisomy 18 pregnancy among screen-positive women are 1 : 4. Without the first-trimester marker, detection is reduced to 67% at about the same false-positive rate. Conclusion The algorithm described here is highly efficient for detecting trisomy 18 and should be considered by programs that offer serum-integrated screening for Down syndrome. Copyright © 2003 John Wiley & Sons, Ltd. [source]

The performance of the Japanese version of the K6 and K10 in the World Mental Health Survey Japan

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2008
Toshi A. Furukawa
Abstract Two new screening scales for psychological distress, the K6 and K10, have been developed using the item response theory and shown to outperform existing screeners in English. We developed their Japanese versions using the standard backtranslaton method and included them in the World Mental Health Survey Japan (WMH-J), which is a psychiatric epidemiologic study conducted in seven communities across Japan with 2436 participants. The WMH-J used the WMH Survey Initiative version of the Composite International Diagnostic Interview (CIDI) to assess the 30-day Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition (DSM-IV). Performance of the two screening scales in detecting DSM-IV mood and anxiety disorders, as assessed by the areas under receiver operating characteristic curves (AUCs), was excellent, with values as high as 0.94 (95% confidence interval = 0.88 to 0.99) for K6 and 0.94 (0.88 to 0.995) for K10. Stratum-specific likelihood ratios (SSLRs), which express screening test characteristics and can be used to produce individual-level predicted probabilities of being a case from screening scale scores and pretest probabilities in other samples, were strikingly similar between the Japanese and the original versions. The Japanese versions of the K6 and K10 thus demonstrated screening performances essentially equivalent to those of the original English versions. Copyright © 2008 John Wiley & Sons, Ltd. [source]