			Home About us Contact

Screening Policies (screening + policy)

Distribution by Scientific Domains

Medical Sciences	57%
Life Sciences	28%

Selected Abstracts

Cervical screening policies 2008 and beyond

CYTOPATHOLOGY, Issue 2007
R. Winder
There are many developments in cytology and in the NHS that will impact on the NHS Cervical Screening Programme over the next few years. In the short term HPV is a major issue, whether triage, primary screening or vaccination with further evidence coming forward from NHS early implementers and from research trials. Cytology automation is also already being trialled for the UK. So far as NHS developments go, we already have the two Carter reports, one on pathology modernisation and one on commissioning are both likely to impact on our service, as is the forthcoming Cancer Reform Strategy which should be out in a few months time. This will set out a blue print for cancer services in 2012, by which time the cervical screening programme could have a very different shape. [source]

Contingent screening for Down syndrome,results from the FaSTER trial

PRENATAL DIAGNOSIS, Issue 2 2008
Howard S. Cuckle
Abstract Objective Comparison of contingent, step-wise and integrated screening policies. Methods Mid-trimester Down syndrome risks were retrospectively calculated from FaSTER trial data. For contingent screening, initial risk was calculated from ultrasound measurement of nuchal translucency (NT), maternal serum pregnancy-associated plasma protein (PAPP)-A and free ,-human chorionic gonadotrophin (hCG) at 11,13 weeks, and classified positive (>1 in 30), borderline (1 in 30,1500) or negative. Borderline risks were recalculated using ,-fetoprotein, hCG, unconjugated estriol (uE3) and inhibin at 15,18 weeks, and reclassified as positive (>1 in 270) or negative. For step-wise screening, initial negative risks were also recalculated. For integrated screening, a single risk was calculated from NT, PAPP-A and the second trimester markers. Results There were 86 Down syndrome and 32 269 unaffected pregancies. The detection rate for contingent screening was 91% and false-positive rate was 4.5%; initial detection rate was 60%, initial false-positive rate was 1.2% and borderline risk was 23%. Step-wise screening had 92% detection rate and 5.1% false-positive rate; integrated screening had 88% and 4.9% respectively. Conclusion As predicted by modelling, the contingent screening detection rate for a fixed false-positive rate is comparable with step-wise and integrated screening, but substantially reduces the number needing to return for second trimester testing. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Nuchal translucency measurement at different crown-rump lengths along the 10- to 14-week period for Down syndrome screening

PRENATAL DIAGNOSIS, Issue 5 2005
Maria A. Zoppi
Abstract Objectives To evaluate the screening accuracy for Down syndrome of nuchal translucency (NT) measurement at different crown-rump length (CRL) subgroups along the 10- to 14-week period. Methods NT was classified ,enlarged' if greater than or equal to 1.5 and 2.0 multiples of the regressed median. Accuracies for Down syndrome (formula = [(TP + TN)/(TP + TN + FP + FN)] × 100, where TP: true positive, TN: true negative, FP: false positive, FN: false negative) were evaluated in four classes of CRL: 38,44 mm, 45,54 mm, 55,70 mm, and 71,84 mm, and compared. Results Of 20 743 fetuses, 20 611 were with no chromosomal abnormalities and 132 were with Down syndrome. Down syndrome fetuses with enlarged NT were 99 (greater than or equal to 1.5 MoM) and 86 (greater than or equal to 2.0 MoM). Sensitivity decreased with gestation, while specificity increased, resulting in increasing likelihood ratios with gestation for each of the CRL groups (8.1, 14.1, 16.3, 17.1 with the use of the 1.5 MoM cut-off, and 13.2, 27.1, 50.1, 84.1 for the 2.0 MoM cut-off). The accuracy increased with gestation (89%, 95%, 95%, 96% with the use of the 1.5 MoM cut-off, and 94%, 97%, 98%, 99% for the 2.0 MoM cut-off, for each of the CRL groups), differences being statistically significant between periods in half of the comparisons. Conclusions Although sensitivity of NT assessment for Down syndrome screening decreased as gestation advanced from the 10th to the 14th week, accuracy showed a remarkable increase. These changes should be taken into account in defining and improving the Down syndrome screening policies. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Evaluation of prenatal diagnosis of associated congenital heart diseases by fetal ultrasonographic examination in Europe

PRENATAL DIAGNOSIS, Issue 4 2001
C. Stoll
Abstract Ultrasound scans in the mid trimester of pregnancy are now a routine part of antenatal care in most European countries. With the assistance of Registries of Congenital Anomalies a study was undertaken in Europe. The objective of the study was to evaluate prenatal detection of congenital heart defects (CHD) by routine ultrasonographic examination of the fetus. All congenital malformations suspected prenatally and all congenital malformations, including chromosome anomalies, confirmed at birth were identified from the Congenital Malformation Registers, including 20 registers from the following European countries: Austria, Croatia, Denmark, France, Germany, Italy, Lithuania, Spain, Switzerland, The Netherlands, UK and Ukrainia. These registries follow the same methodology. The study period was 1996,1998, 709,030 births were covered, and 8126 cases with congenital malformations were registered. If more than one cardiac malformation was present the case was coded as complex cardiac malformation. CHD were subdivided into ,isolated' when only a cardiac malformation was present and ,associated' when at least one other major extra cardiac malformation was present. The associated CHD were subdivided into chromosomal, syndromic non-chromosomal and multiple. The study comprised 761 associated CHD including 282 cases with multiple malformations, 375 cases with chromosomal anomalies and 104 cases with non-chromosomal syndromes. The proportion of prenatal diagnosis of associated CHD varied in relation to the ultrasound screening policies from 17.9% in countries without routine screening (The Netherlands and Denmark) to 46.0% in countries with only one routine fetal scan and 55.6% in countries with two or three routine fetal scans. The prenatal detection rate of chromosomal anomalies was 40.3% (151/375 cases). This rate for recognized syndromes and multiply malformed with CHD was 51.9% (54/104 cases) and 48.6% (137/282 cases), respectively; 150/229 Down syndrome (65.8%) were livebirths. Concerning the syndromic cases, the detection rate of deletion 22q11, situs anomalies and VATER association was 44.4%, 64.7% and 46.6%, respectively. In conclusion, the present study shows large regional variations in the prenatal detection rate of CHD with the highest rates in European regions with three screening scans. Prenatal diagnosis of CHD is significantly higher if associated malformations are present. Cardiac defects affecting the size of the ventricles have the highest detection rate. Mean gestational age at discovery was 20,24 weeks for the majority of associated cardiac defects. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Analysis of Revenue Maximization Under Two Movie-Screening Policies

PRODUCTION AND OPERATIONS MANAGEMENT, Issue 1 2010
Milind Dawande
A few weeks before the start of a major season, movie distributors arrange a private screening of the movies to be released during that season for exhibitors and, subsequently, solicit bids for these movies (from exhibitors). Since the number of such solicitations far exceeds the number of movies that can be feasibly screened at a multiplex (i.e., a theater with multiple screens), the problem of interest for an exhibitor is that of choosing a subset of movies for which to submit bids to the distributors. We consider the problem of the selection and screening of movies for a multiplex to maximize the exhibitor's cumulative revenue over a fixed planning horizon. The release times of the movies that can potentially be selected during the planning horizon are known a priori. If selected for screening, a movie must be scheduled through its obligatory period, after which its run may or may not be extended. The problem involves two primary decisions: (i) the selection of a subset of movies for screening from those that can potentially be screened during the planning horizon and (ii) the determination of the duration of screening for the selected movies. We investigate two basic and popular screening policies: preempt-resume and non-preempt. In the preempt-resume policy, the screening of a movie can be preempted and resumed in its post-obligatory period. In the non-preempt policy, a movie is screened continuously from its release time until the time it is permanently withdrawn from the multiplex. We show that optimizing under the preempt-resume policy is strongly NP-hard while the problem under the non-preempt policy is polynomially solvable. We develop efficient algorithms for the problem under both screening policies and show that the revenue obtained from the preempt-resume policy can be significantly higher as compared with that from the non-preempt policy. Our work provides managers of multiplexes with valuable insights into the selection and screening of movies and offers an easy-to-use computational tool to compare the revenues obtainable from adopting these popular policies. [source]

The contribution of founder mutations to early-onset breast cancer in French-Canadian women

CLINICAL GENETICS, Issue 5 2009
P Ghadirian
In an ethnically-homogeneous population, it is valuable to identify founder mutations in cancer-predisposing genes. Founder mutations have been found in four breast-cancer-predisposing genes in French-Canadian breast cancer families. The frequencies of the mutant alleles have been measured neither in a large series of unselected breast cancer patients from Quebec, nor in healthy controls. These estimates are necessary to measure their contribution to the hereditary burden of breast cancer in Quebec and to help develop genetic screening policies which are appropriate for the province. We studied 564 French-Canadian women with early-onset invasive breast cancer who were treated at a single Montreal hospital. Patients had been diagnosed at age 50 or less, and were ascertained between 2004 and 2008. We screened all 564 patients for nine founder mutations: four in BRCA1, three in BRCA2 and one each in PALB2 and CHEK2. We also studied 6433 DNA samples from newborn infants from the Quebec City area to estimate the frequency of the nine variant alleles in the French-Canadian population. We identified a mutation in 36 of the 564 breast cancer cases (6.4%) and in 35 of 6443 controls (0.5%). In the breast cancer patients, the majority of mutations were in BRCA2 (54%). However, in the general population (newborn infants), the majority of mutations were in CHEK2 (54%). The odds ratio for breast cancer to age 50, given a BRCA1 mutation, was 10.1 (95% CI: 3.7,28) and given a BRCA2 mutation was 29.5 (95% CI: 12.9,67). The odds ratio for breast cancer to age 50, given a CHEK2 mutation, was 3.6 (95% CI: 1.4,9.1). One-half of the women with a mutation had a first- or second-degree relative diagnosed with breast or ovarian cancer. Thus, it can be concluded that a predisposing mutation in BRCA1, BRCA2, CHEK2 or PALB2 is present in approximately 6% of French-Canadian women with early-onset breast cancer. It is reasonable to offer screening for founder mutations to all French-Canadian women with breast cancer before age 50. The frequency of these mutations in the general population (0.5%) is too low to advocate population-based screening. [source]

Chlamydia trachomatis: time for screening?

CLINICAL MICROBIOLOGY AND INFECTION, Issue 9 2005
A. Spiliopoulou
Abstract Genital Chlamydia trachomatis infection is the leading cause of bacterial sexually transmitted disease in industrialised countries, particularly among young people. The consequences of chlamydial infection may involve urethritis, cervicitis, pelvic inflammatory disease, ectopic pregnancy, tubal factor infertility, epididymitis and prostatitis. In addition, chlamydial infection increases the risk of acquisition of human immunodeficiency virus and has been associated with cervical cancer. Although screening programmes exist in a number of countries, the continuously increasing prevalence of chlamydial infections demonstrates the necessity for health authorities to establish effective screening policies, and the importance of defining a comprehensive European screening policy is emerging. [source]

Reversibility of hepatic fibrosis in treated genetic hemochromatosis: A study of 36 cases,

HEPATOLOGY, Issue 2 2006
Ludivine Falize
The current study was undertaken to assess whether fibrosis could regress under venesection therapy in patients with C282Y homozygous genetic hemochromatosis. The 36 patients studied were recruited from a subfile of our database consisting of 125 C282Y homozygotes with either severe fibrosis or cirrhosis (F3 or F4 fibrosis stage, respectively, according to the METAVIR grading system). The second liver biopsy was performed for management of liver cancer, extrahepatic surgery, or assessment of liver fibrosis. All paired biopsies were reviewed by two pathologists without knowledge of clinical data. Among the 13 patients who had F3 fibrosis on their initial liver biopsy, 3 had F0, 6 had F1, and 2 had F2 on their second liver biopsy. Among the 23 patients with cirrhosis on their initial liver biopsy, 1 had F0, 4 had F1, 3 had F2, and 2 had F3 on their second liver biopsy. When defining regression of fibrosis as a decrease of at least 2 METAVIR units, fibrosis regressed in 9 of 13 (69%) F3 and in 8 of 23 (35%) F4. When the ratio of gammaglobulins (g/L) to (platelets [n/mm3] × prothrombin activity [%]) was greater than 7.5, fibrosis never regressed. In conclusion, these data extend the concept of regression of fibrosis to patients with treated genetic hemochromatosis and suggest that some simple biochemical tests would be predictive of further regression of fibrosis as a result of venesection therapy. If confirmed on larger series, this could modify the ultrasound screening policy of hepatocellular carcinoma in genetic hemochromatosis. (HEPATOLOGY 2006;44:472,477.) [source]

Regional audit: Perioperative management of MRSA orthopaedic patients in the Oxford region

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2004
N. Aslam
Summary Aim:, Methicillin resistant staphylococcus aureus (MRSA) colonisation or infection is of particular importance in patients undergoing operations involving implanteable materials, such as in orthopaedic surgery. An audit of the perioperative management of orthopaedic patients in the Oxford region was carried out to assess the level of clinician awareness and the uniformity of current guidelines between hospitals. Methods:, A postal questionnaire was designed for asking information on various aspects of perioperative management of MRSA patients and was sent to each hospital. Results:, Responses were obtained from nine of 10 hospitals in the region. The average response rate for each hospital was 75%, and the overall individual response rate was 67.5% (27/40). Seventy-eight per cent of respondents knew that there was a pre-admission screening policy. Fifteen per cent were unaware of any MRSA policy. Forty-four per cent indicated that teicoplanin was used for prophylaxis in implant surgery whilst 44% used vancomycin. Eighteen per cent believed that cefuroxime was used for prophylaxis. Forty-eight per cent of hospitals had an MRSA-free zone for orthopaedic patients. Conclusion:, This study indicates a lack of uniformity in the perioperative management of MRSA-positive patients in the region and a lack of awareness of both MRSA guidelines and their implementation. Uniformity of MRSA guidelines is necessary to allow better clinician awareness and compliance, especially in surgical trainees who are travelling between different training hospitals in the region. Implementation of such a policy with re-audit of subsequent awareness and compliance is proposed. [source]

Exploring the perspective of midwives involved in offering serum screening for Down's syndrome in Northern Ireland

JOURNAL OF CLINICAL NURSING, Issue 20 2009
Jennifer McNeill
Aims., To explore the perspective of midwives offering serum screening for Down's syndrome. Background., Previous literature has indicated that the offer and discussion of prenatal serum screening tests with women is complex, and health professionals may influence women's decisions to accept or decline screening. Midwives are usually the key professional to offer serum screening for Down's syndrome in the UK but their perspective is relatively neglected in the literature. Design., An explorative qualitative interview study with 15 midwives employed in a maternity unit in Northern Ireland involved in offering prenatal screening to pregnant women. Data were collected from 1 July 2005,31 October 2005. Methods., A focused ethnographic approach was used to explore the perspective of midwives. Results., Midwives reported difficulty in explaining the test to women and felt unable to provide the necessary information to adequately inform women within their appointment time. The test offered (the triple test) and potential pathway of subsequent care, were identified as sources of professional and personal conflict by midwives. The expectation that midwives would provide a universal offer of Down's syndrome serum screening but be unable to support women regarding termination of pregnancy also created dissonance. Conclusions., The feasibility of proceeding with a universal serum screening programme for Down's syndrome is questionable in countries which legally or culturally oppose termination of pregnancy. Professionals practising within environments such as this experience conflict in their role, which affects communication with women when discussing screening tests. Relevance to clinical practice., As midwives are often, the primary health professional providing information to women, it is important that midwives are key participants in ongoing planning and discussions about screening policy to ensure programmes are implemented successfully. [source]

The hidden mortality of transposition of the great arteries and survival advantage provided by prenatal diagnosis

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2008
M Blyth
Objective, To describe the sensitivity of fetal anomaly scanning at detecting transposition of the great arteries (TGA) and to investigate whether prenatal detection improves survival. Design, Retrospective review of survival by comparing those who had an antenatal diagnosis with those who did not. Setting, Population-based study in Wessex region over 13 years. Population, Babies with isolated TGA and an intact ventricular septum. Methods, Review of outcomes by comparing those who had an antenatal diagnosis with those who did not. Main outcome measures, Mortality rates in each group. Results, TGA occurred more commonly in boys than in girls. Using the existing national screening policy, the antenatal detection rate of TGA was only 6.9% over the study period, improving to 25% in the last 4 years. This contrasts with a 40% detection rate when TGA was associated with a ventricular septal defect (VSD). All the babies who had TGA diagnosed antenatally survived through surgery. Of those who were not diagnosed antenatally, two were stillborn, five died before the diagnosis was made and four died after surgery. Although the difference in survival rates between those who were antenatally diagnosed and those who were not is not statistically significant (,2= 3.9; P = 0.11), some of these deaths could have been prevented if a prenatal diagnosis had been made. Conclusions, Improved antenatal diagnosis could lead to a significant reduction in the mortality associated with TGA. The current low detection rate of TGA in the UK could be improved by the inclusion of outflow tract views in routine fetal anomaly scans, and we believe that the extra workload is justified. [source]

Community-based multiple screening model,,§¶

CANCER, Issue 8 2004
387 participants Taiwan community-based integrated screening group, Design, analysis of 4, implementation
Abstract BACKGROUND Multiple disease screening may have several advantages over single disease screening because of the economics of scale, with the high yield of detecting asymptomatic diseases, the identification of multiple diseases or risk factors simultaneously, the enhancement of the attendance rate, and the efficiency of follow-up. METHODS An integrated model of community-based multiple screening was designed and conducted between 1999 and 2001 in Keelung, Taiwan. The authors used a Papanicolaou (Pap) smear screening program as a base to integrate other screening regimens encompassing four other neoplastic diseases and three nonneoplastic chronic diseases. Screening methods, the interscreening interval, and the follow-up for each screening regimen were designed based on evidence-based literature and current national screening policy. RESULTS A total of 42,387 subjects participated in the screening activities. A 25% increase in the attendance rate for Pap smear screening was demonstrated after the introduction of multiple disease screening programs. At the first screen, this program yielded a total of 677 asymptomatic neoplasms (16.0 per 1000), including a large proportion of precancerous lesions and small presymptomatic tumors without lymph node involvement. The association between the occurrence of neoplasm and the presence of comorbid nonneoplastic chronic disease was found to be statistically significant (odds ratio, 1.64; 95% confidence interval, 1.38,1.94 [P < 0.05]). The authors also identified 5314 subjects with metabolic syndrome who were at a greater risk for colorectal and oral neoplasias. CONCLUSIONS The results of the current study demonstrate that an outreach and community-based multiple screening program not only enhances attendance rates but also has a high yield of early cases of various diseases simultaneously, and provides a natural opportunity to elucidate the correlation between neoplastic disease and nonneoplastic chronic disease. Cancer 2004. © 2004 American Cancer Society. [source]