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Screening Programme (screening + programme)
Kinds of Screening Programme Selected AbstractsCervical screening policies 2008 and beyondCYTOPATHOLOGY, Issue 2007R. 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] Cervical screening in England and Wales: its effect has been underestimatedCYTOPATHOLOGY, Issue 6 2000A. Herbert Opinions about cervical screening in the UK tend to follow one of two negative lines of thought. The first is that cervical cancer is a rare disease, and too much time and effort are spent on screening. The second is that it has been relatively ineffective, since incidence of invasive carcinoma did not fall until the NHS Cervical Screening Programme (NHSCSP) was introduced in 1988, although it fell by 40% since then. This paper presents publicly available data to demonstrate that neither of these views is true. Registrations of invasive carcinoma of the uterine cervix and carcinoma in situ in England and Wales between 1971 and 1996 show that a substantially increased risk of disease in women born since 1940 has been reversed, almost certainly by greatly improved screening. Cervical carcinoma is now a rare disease because most cases are prevented before they become invasive, mostly by screening young women, aged 20,40, before the decade of life when symptomatic cervical carcinoma most frequently presents. [source] Cervical screening: how often should women be screened?CYTOPATHOLOGY, Issue 2 2000A. Herbert Introduction As a result of major improvements that have been made to cervical screening during the last 15 years, and implementation of call and recall to invite all women aged 20,64 for screening, the incidence of cervical carcinoma has fallen by 42% since 19901. Cervical cancer is now a rare disease, largely thanks to the widespread uptake of screening by the women at risk. Despite the manifest success of the NHS Cervical Screening Programme (NHSCSP), there is pressure on one hand to improve its sensitivity by the introduction of new technology, including human papillomavirus (HPV) testing2, and on the other hand to reduce the cost of the programme, which is more than £130m per year. The main method suggested to reduce costs is the restriction of routine screening to an interval of 5 years3,5. [source] Issues regarding quality assurance in the English National Screening Programme for Sight-threatening Diabetic Retinopathy: response to paper by C. Arun et al., ,Establishing ongoing quality assurance in a retinal screening programme'DIABETIC MEDICINE, Issue 6 2007L. Garvican No abstract is available for this article. [source] Accuracy of trisomy 18 screening using the second-trimester triple testPRENATAL DIAGNOSIS, Issue 6 2003Chris Meier Abstract Objective To assess the accuracy of the calculated risk for trisomy 18 assigned to individual women screened with the second-trimester triple test. Methods The study was based on 382 598 women screened in the Ontario Maternal Serum Screening Programme between October 1993 and September 2000. Of the women screened, 111 cases of trisomy 18 were identified. Originally, 92 874 women were screened using a risk cut-off level method. Estimated risks of trisomy 18 were calculated by applying published population parameters for the remaining women screened using a fixed analyte cut-off method. Women were ranked according to their individual risk for trisomy 18 syndrome in decreasing order and divided into 12 groups. The mean calculated risks of having an affected pregnancy at term for each group were compared with the birth prevalence of the corresponding group after allowing for spontaneous fetal losses. Results Agreement between the mean calculated risks and the observed prevalence was seen across the entire risk range, although women identified as having high-risk pregnancies had an actual prevalence that was somewhat lower than that estimated by the screen. Conclusion The calculated risk for trisomy 18 syndrome assigned to the individual woman on the basis of the risk cut-off method accurately reflects their risk of having a term trisomy 18 syndrome pregnancy. Copyright © 2003 John Wiley & Sons, Ltd. [source] Outcome of Newborn Hearing Screening Programme delivered by health visitorsCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 5 2008S. Basu Abstract Background The Newborn Hearing Screening Programme (NHSP) was introduced in England in 2001 to detect congenital hearing loss in the newborn. The screen is either hospital- or community-based. Objectives This is the first large-scale study of community-based NHSP published in the United Kingdom which aims to evaluate the performance of the community-based screen and compare it against national targets for NHSP and the outcome of national pilot projects. Method Hearing screening data recorded for 10 074 well babies between March 2004 and December 2005 were analysed. Babies who were admitted to the Special Care Baby Unit were excluded. The case notes of all children who failed the initial hearing screen, either unilateral or bilateral, were reviewed retrospectively. Specific performance measures include coverage rate, referral rate and yield. Reasons for failure to complete the screen were identified. Results The community programme met all the standards set by the NHSP and the results are comparable with the average of the pilot sites reported in 2004. Conclusion The data demonstrate that a community-based hearing screening programme conducted by Health Visitors meets all the current national standards and could be implemented across wider areas in this country. Its advantages include a low false positive rate and convenience for parents living in rural areas. The babies identified can be diagnosed and rehabilitated in a time which meets national standards. [source] Prevalence and risk factors of undetected proteinuria in an elderly South-East Asian populationNEPHROLOGY, Issue 4 2006VEENA D JOSHI SUMMARY: Background: Urinalysis is not a standard component of health screening in the elderly population. Objective: We investigated the prevalence and risk factors of undetected renal disease as defined by proteinuria (PR) in an elderly South-East Asian population. Method: There were 19 848 participants of age ,65 years in National Kidney Foundation's Nationwide Screening programme at Singapore. Mean age was 70.6 ± 5.3 years. After excluding the 1.1% who had pre-existing renal disease, 8.5% were identified to have previously undetected PR defined as ,1+ protein on urine dipstick analysis. Multivariate regression revealed that male gender (OR = 1.2, reference category (Ref): female), known diabetes (odds ratio (OR) = 2.28; P < 0.0001), hypertension (OR = 1.62; P = 0.0001), presence of elevated blood pressure (BP) (,120/90 mmHg) on screening (OR = 1.38, 1.89, 3.45 for mild, moderate and severe BP, respectively, all P < 0.0001), elevated body mass index (BMI) (OR = 1.3 for BMI ,23 vs BMI < 23 kg/m2), and smoking (OR = 1.2, ref: non-smokers) were significantly associated with PR. Finally, a progressive increase in OR for PR was observed with stepwise increase in age (years) (OR for 67,68.9: 1.2, P = 0.025; 69,72.9, 1.49, P = 0.49; ,73: 1.56, P < 0.0001, Ref: 65,66.9 years). Conclusion: We conclude that there is high prevalence of previously undetected proteinuria in elderly South-East Asians. Because proteinuria is a risk factor for cardiovascular disease, our findings support inclusion of urinalysis in routine health screening for this population. [source] A national survey of the current state of screening services for diabetic retinopathy: ABCD,Diabetes UK survey of specialist diabetes services 2006DIABETIC MEDICINE, Issue 12 2009D. K. Nagi Abstract The main aims were to ascertain the progress made in the implementation of retinal screening services and to explore any barriers or difficulties faced by the programmes. The survey focused on all the essential elements for retinal screening, including assessment and treatment of screen-positive cases. Eighty-five per cent of screening programmes have a coordinated screening service and 73% of these felt that they have made significant progress. Eighty-five per cent of screening units use ,call and recall' for appointments and 73.5% of programmes follow the National Screening Committee (NSC) guidance. Although many units worked closely with ophthalmology, further assessment and management of screen-positive patients was a cause for concern. The fast-track referral system, to ensure timely and appropriate care, has been difficult to engineer by several programmes. This is demonstrated by 48% of programmes having waiting lists for patients identified as needing further assessment and treatment for retinopathy. Ophthalmology service for people with diabetic retinopathy was provided by a dedicated ophthalmologist in 89.4% of the programmes. Sixty-six per cent of the programmes reported inadequate resources to sustain a high-quality service, while 26% highlighted the lack of infrastructure and 49% lacked information technology (IT) support. In conclusion, progress has been made towards establishing a national screening programme for diabetic retinopathy by individual screening units, with a number of programmes providing a structured retinal screening service. However, programmes face difficulties with resource allocation and compliance with Quality Assurance (QA) standards, especially those which apply to ophthalmology and IT support. Screening programmes need to be resourced adequately to ensure comprehensive coverage and compliance with QA. [source] Vision screening of older peopleOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 6 2007Zahra Jessa Abstract A recent systematic review found that between 20% and 50% of older people in the UK have undetected reduced vision and in most cases this is caused by refractive error or cataracts, and is correctable. Two approaches to improve the detection of these problems are to better publicise optometric services and to carry out community-based vision screening of older people. Screening programmes should pass the Wilson criteria and a consideration of these highlights three inter-related questions: ,Is vision screening effective at detecting correctable low vision in older people?'; ,Which tests should be included?' and ,Which venues are most appropriate?' We carried out a systematic review to investigate these questions. For the first question, only one study was found which met our selection criteria. The ,gold standard' eye examination in this study lacked several important components, and the vision screening method that was used was not found to be very effective. The review revealed other studies, which, although not meeting our selection criteria, included relevant information. The screening studies highlight the lack of agreement on the content of a gold standard eye examination and of the test(s) that should be used to screen vision. Visual function in older people is not adequately described by high contrast visual acuity (VA), nor by self-reports of visual difficulties. Other tests that may be relevant include visual field testing, low contrast VA, contrast sensitivity and stereo-acuity. The pinhole test has often been used in attempts to detect uncorrected refractive errors, but results from this test can be problematic and possible reasons for this are discussed. Appropriate venues for vision screening are contingent upon the format of the vision screening programme. There is still uncertainty over the battery of vision tests that are most appropriate. This, and optimum venues for screening, require further research before it can be fully determined whether vision screening of older people meets the Wilson criteria. If a vision screening programme using a battery of vision tests, perhaps computerised, can be established, then this should be tested to determine the sensitivity and specificity for detecting the target conditions. Ultimately, longitudinal studies are necessary to determine whether such a screening programme will lead to improved visual performance and quality of life in older people. [source] Screening programmes for the early detection and prevention of oral cancerAUSTRALIAN DENTAL JOURNAL, Issue 2 2009O Kujan Background:, Screening programmes for major cancers, such as breast and cervical cancer have effectively decreased the mortality rate and helped to reduce the incidence of these cancers. Although oral cancer is a global health problem with increasing incidence and mortality rates, no national population-based screening programmes for oral cancer have been implemented. To date there is debate on whether to employ screening methods for oral cancer in the daily routine work of health providers. Objectives:, To assess the effectiveness of current screening methods in decreasing oral cancer mortality. Search strategy:, Electronic databases (MEDLINE, CANCERLIT, EMBASE (1966 to July 2005) and CENTRAL (The Cochrane Library 2005, Issue 3), bibliographies, handsearching of specific journals and contact authors were used to identify published and unpublished data. Selection criteria:, Randomized controlled trials of screening for oral cancer or precursor oral lesions using visual examination, toluidine blue, fluorescence imaging or brush biopsy. Data collection and analysis:, The search found 112 citations and these have been reviewed. One randomized controlled trial of screening strategies for oral cancer was identified as meeting the review's inclusion criteria. Validity assessment, data extraction and statistics evaluation were undertaken by two independent review authors. Main results:, One 10-year randomized controlled trial has been included (n = 13 clusters: 191 873 participants). There was no difference in the age-standardized oral cancer mortality rates for the screened group (16.4/100 000 person-years) and the control group (20.7/100 000 person-years). Interestingly, a significant 34% reduction in mortality was recorded in high-risk subjects between the intervention cohort (29.9/100 000 person-years) and the control arm (45.4/100 000). However, this study has some methodological weaknesses. Additionally, the study did not provide any information related to costs, quality of life or even harms of screening from false-positive or false-negative findings. Authors' conclusions:, Given the limitation of evidence (only one included randomized controlled trial) and the potential methodological weakness of the included study, it is valid to say that there is insufficient evidence to support or refute the use of a visual examination as a method of screening for oral cancer using a visual examination in the general population. Furthermore, no robust evidence exists to suggest that other methods of screening, toluidine blue, fluorescence imaging or brush biopsy, are either beneficial or harmful. Future high quality studies to assess the efficacy, effectiveness and costs of screening are required for the best use of public health resources. In addition, studies to elucidate the natural history of oral cancer, prevention methods and the effectiveness of opportunistic screening in high risk groups are needed. Future studies on improved treatment modalities for oral cancer and precancer are also required. Plain language summary:, Screening programmes for the early detection and prevention of oral cancer. More evidence needed to find out whether screening programmes could detect oral cancer earlier and reduce the number of deaths from this disease. Cancer of the mouth and back of the throat (oral cancer) has a low survival rate, largely because the disease is often not diagnosed until it is advanced. Screening the general population for oral cancer might make it possible to detect cases of the disease earlier. The most common method is visual inspection by a clinician, but other techniques include the use of a special blue "dye" and an imaging technique. The review found that there is not enough evidence to decide whether screening by visual inspection reduces the death rate for oral cancer, and no evidence for other screening methods. [source] Cervical screening policies 2008 and beyondCYTOPATHOLOGY, Issue 2007R. 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] O-11 Proposal for extending the role Of ABMSPS in reporting cervical loopsCYTOPATHOLOGY, Issue 2007K. Ellis Introduction:, The advanced biomedical scientist practitioner (ABMSP) in Cervical Cytology was established in the NHS cervical screening programme (NHSCCSP) in 2001 and there are approximately 60 ABMSPs in post. The aim of this study was to explore the potential for further expansion of their role in the NHSCSP by reporting the histology of loop excision biopsies of the cervical transformation zone (LLETZ). Methods:, The initial study included LLETZ specimens from 55 sequential patients, which, according to standard local practice had the diagnosis of CIN confirmed by cervical punch biopsy prior to the procedure. All the cases were independently examined by an ABMSP and a consultant histopathologist and reports complying with the Royal College of pathologists (RCPath) minimum data sets were assembled. The cases were reviewed at the discussion microscope and ABMSP reports were compared to the final reports issued by the histopathologist. Results:, In the preliminary findings, total agreement between ABMSP and consultant histopathologist was reached on just under 90% of cases. Of those cases that did not reach total agreement, none varied by more than one grade. There was agreement on other parameters from the RCPath minimum data sets. Discussion:, Based on our preliminary findings, it appears there may be scope for extending the role of ABMSPs to report LLETZ samples under the supervision of a histopathologist. We plan to increase the number of cases both in our department and through collaboration with other UK centres and to present evidence to the RCPath, with a view to adoption of this role by ABMSPs and development of an appropriate training scheme. [source] Reasons for variation in coverage in the NHS cervical screening programmeCYTOPATHOLOGY, Issue 6 2001C. E. McGAHAN Reasons for variation in coverage in the NHS cervical screening programme In order to investigate reasons for variation in coverage of cervical screening, data from standard Department of Health returns were obtained for all Health Authorities for 1998/1999. Approximately 80% of the variation between health authorities is explained by differences in age distribution and area classification. Considerable differences between Health Authority and Office of National Statistics (ONS) population figures in City and Urban (London) areas for the age group 25,29 years and for City (London) for age group 30,34 years, suggest an effect of list inflation in these groups. Coverage as a performance indicator may be more accurately represented using the age range 35,64 years. Using this narrower age range, the percentage of health authorities meeting the 80% 5-year coverage target increases from 87% to 90%. [source] Invited editorial Managing incidents in the cervical screening programmeCYTOPATHOLOGY, Issue 5 2000M. J. Wilkinson No abstract is available for this article. [source] Screening for type 2 diabetes: an update of the evidenceDIABETES OBESITY & METABOLISM, Issue 10 2010R. K. Simmons A growing body of evidence on diabetes screening has been published during the last 10 years. Type 2 diabetes meets many but not all of the criteria for screening. Concerns about potential harms of screening have largely been resolved. Screening identifies a high-risk population with the potential to gain from widely available interventions. However, in spite of the findings of modelling studies, the size of the benefit of earlier initiation of treatment and the overall cost-effectiveness remains uncertain, in contrast to other screening programmes (such as for abdominal aortic aneurysms) that are yet to be fully implemented. There is also uncertainty about optimal specifications and implementation of a screening programme, and further work to complete concerning development and delivery of individual- and population-level preventive strategies. While there is growing evidence of the net benefit of earlier detection of individuals with prevalent but undiagnosed diabetes, there remains limited justification for a policy of universal population-based screening for type 2 diabetes at the present time. Data from ongoing studies should inform the key assumptions in existing modelling studies and further reduce uncertainty. [source] The prevalence of depressive symptoms in a white European and South Asian population with impaired glucose regulation and screen-detected Type 2 diabetes mellitus: a comparison of two screening toolsDIABETIC MEDICINE, Issue 8 2010N. Aujla Diabet. Med. 27, 896,905 (2010) Abstract Aims, To compare the identification of prevalent depressive symptoms by the World Health Organization-5 Wellbeing Index (WHO-5) and Centre for Epidemiological Studies Depression Scale (CES-D) for South Asian and white European people, male and female, attending a diabetes screening programme, and to explore the adequacy of the screening tools for this population. An additional aim was to further explore associations of depressive symptoms with impaired glucose regulation (IGR) and Type 2 diabetes mellitus (Type2 DM). Methods, Eight hundred and sixty-four white European (40,75 years old) and 290 South Asian people (25,75 years old) underwent an oral glucose tolerance test (OGTT), detailed history and anthropometric measurements and completed the WHO-5 and CES-D. Depressive symptoms were defined by a WHO-5 score , 13, and CES-D score , 16. Results, Unadjusted prevalence of depressive symptoms with the WHO-5, for people with Type2 DM was 42.3% (47.4% in white European; 28.6% in South Asian) and for IGR 30.7% (26% in white European; 45.8% in South Asian). With the CES-D, the prevalence in Type2 DM was 27.2% (25.4% in white European; 31.8% in South Asian) and for IGR 30.7% (27.8% in white European; 40.7% in South Asian). Statistically significant differences in the prevalence of depressive symptoms for sex or ethnicity were not identified. Odds ratios adjusted for age, sex and ethnicity showed no significant association of depression with Type2 DM or IGR, with either WHO-5 or CES-D. Agreement was moderate (, = 0.48, 95% confidence intervals 0.42,0.54), and reduced when identifying depressive symptoms in people with Type2 DM. For this group, a WHO-5 cut-point of , 10 was optimal. Conclusions, Depressive symptoms, identified by WHO-5 or CES-D, were not significantly more prevalent in people with Type2 DM or IGR. The WHO-5 and CES-D differed in their identification of depressive symptoms in people with Type2 DM, though discrepancies between sex and ethnicity were not identified. [source] A national survey of the current state of screening services for diabetic retinopathy: ABCD,Diabetes UK survey of specialist diabetes services 2006DIABETIC MEDICINE, Issue 12 2009D. K. Nagi Abstract The main aims were to ascertain the progress made in the implementation of retinal screening services and to explore any barriers or difficulties faced by the programmes. The survey focused on all the essential elements for retinal screening, including assessment and treatment of screen-positive cases. Eighty-five per cent of screening programmes have a coordinated screening service and 73% of these felt that they have made significant progress. Eighty-five per cent of screening units use ,call and recall' for appointments and 73.5% of programmes follow the National Screening Committee (NSC) guidance. Although many units worked closely with ophthalmology, further assessment and management of screen-positive patients was a cause for concern. The fast-track referral system, to ensure timely and appropriate care, has been difficult to engineer by several programmes. This is demonstrated by 48% of programmes having waiting lists for patients identified as needing further assessment and treatment for retinopathy. Ophthalmology service for people with diabetic retinopathy was provided by a dedicated ophthalmologist in 89.4% of the programmes. Sixty-six per cent of the programmes reported inadequate resources to sustain a high-quality service, while 26% highlighted the lack of infrastructure and 49% lacked information technology (IT) support. In conclusion, progress has been made towards establishing a national screening programme for diabetic retinopathy by individual screening units, with a number of programmes providing a structured retinal screening service. However, programmes face difficulties with resource allocation and compliance with Quality Assurance (QA) standards, especially those which apply to ophthalmology and IT support. Screening programmes need to be resourced adequately to ensure comprehensive coverage and compliance with QA. [source] Trends in yield and effects of screening intervals during 17 years of a large UK community-based diabetic retinopathy screening programmeDIABETIC MEDICINE, Issue 10 2009A. Misra Abstract Aims, To describe changes in risk profiles and yield in a screening programme and to investigate relationships between retinopathy prevalence, screening interval and risk factors. Methods, We analysed a population of predominantly Type 2 diabetic patients, managed in general practice, and screened between 1990 and 2006, with up to 17 years' follow-up and up to 14 screening episodes each. We investigated associations between referable or sight-threatening diabetic retinopathy (STDR), screening interval and frequency of repeated screening, whilst adjusting for age, duration and treatment of diabetes, hypertension treatment and period. Results, Of 63 622 screening episodes among 20 788 people, 16 094 (25%) identified any retinopathy, 3136 (4.9%) identified referable retinopathy and 384 (0.60%) identified STDR. The prevalence of screening-detected STDR decreased by 91%, from 1.7% in 1991,1993 to 0.16% in 2006. The prevalence of referable retinopathy increased from 2.0% in 1991,1993 to 6.7% in 1998,2001, then decreased to 4.7% in 2006. Compared with screening intervals of 12,18 months, screening intervals of 19,24 months were not associated with increased risk of referable retinopathy [adjusted odds ratio 0.93, 94% confidence interval (CI) 0.82,1.05], but screening intervals of more than 24 months were associated with increased risk (odds ratio 1.56, 95% CI 1.41,1.75). Screening intervals of < 12 months were associated with high risks of referable retinopathy and STDR. Conclusions, Over time the risk of late diagnosis of STDR decreased, possibly attributable to earlier diagnosis of less severe retinopathy, decreasing risk factors and systematic screening. Screening intervals of up to 24 months should be considered for lower risk patients. [source] Interobserver agreement between primary graders and an expert grader in the Bristol and Weston diabetic retinopathy screening programme: a quality assurance auditDIABETIC MEDICINE, Issue 8 2009S. Patra Abstract Aims, 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. Methods, 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. Results, 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. Conclusion, 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. [source] Socioeconomic factors related to attendance at a Type 2 diabetes screening programmeDIABETIC MEDICINE, Issue 5 2009E-M. Dalsgaard Abstract Aims, The prevalence of diabetes is increasing, and screening of high-risk populations is recommended. A low attendance rate has been observed in many Type 2 diabetes screening programmes, so that an analysis of factors related to attendance is therefore relevant. This paper analyses the association between socioeconomic factors and attendance for Type 2 diabetes screening. Methods, Persons aged 40,69 years (n = 4603) were invited to participate in a stepwise diabetes screening programme performed in general practitioners' offices in the county of Aarhus, Denmark in 2001. The study was population-based and cross-sectional with follow-up. The association between screening attendance in the high-risk population and socioeconomic factors was analysed by odds ratio. Results, Forty-four percent of the estimated high-risk population attended the screening programme. In those with known risk for Type 2 diabetes, attenders were more likely to be older, to be unemployed and to live in the countryside than non-attenders. The risk for Type 2 diabetes was unknown for 21% of the study population; this group was younger and less likely to be cohabitant, skilled, or employed and to have middle or high income than the study population with known risk score for diabetes. Conclusions, A low attendance rate was found in this screening programme for Type 2 diabetes. No substantial socioeconomic difference was found between attenders and non-attenders in the high-risk population. Further research is needed to uncover barriers to screening of Type 2 diabetes in socioeconomically deprived persons. [source] A national retinal screening programme for diabetes in ScotlandDIABETIC MEDICINE, Issue 12 2003G. P. Leese Abstract The Health Technology Board Scotland (HTBS) have issued recommendations for eye screening in patients with diabetes. These are based on evidence-based clinical studies. Evidence-based studies do not answer all the practical issues, and some conclusions have thus been extrapolated from the known evidence base. Other factors such as patient issues, organizational issues and cost effectiveness have also been incorporated into the recommendations. HTBS recommend single-field digital retinal photography. Retinal photography best addresses the issues of adequate sensitivity and accountable quality assurance. Non-mydriatic photography is recommended, followed by immediate use of dilating eye drops if it is unsuccessful, followed by slit-lamp examination if both of these approaches fail. An independent grading scheme has been established, which is similar to the ,Global', and compatible with the National Screening Committee (NSC) grading scheme. The rationale for these recommendations, and debate behind some of the decisions, is laid out in this article. [source] A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathyDIABETIC MEDICINE, Issue 7 2003J. A. Olson Abstract Aims To compare the respective performances of digital retinal imaging, fundus photography and slit-lamp biomicroscopy performed by trained optometrists, in screening for diabetic retinopathy. To assess the potential contribution of automated digital image analysis to a screening programme. Methods A group of 586 patients recruited from a diabetic clinic underwent three or four mydriatic screening methods for retinal examination. The respective performances of digital imaging (n = 586; graded manually), colour slides (n = 586; graded manually), and slit-lamp examination by specially trained optometrists (n = 485), were evaluated against a reference standard of slit-lamp biomicroscopy by ophthalmologists with a special interest in medical retina. The performance of automated grading of the digital images by computer was also assessed. Results Slit-lamp examination by optometrists for referable diabetic retinopathy achieved a sensitivity of 73% (52,88) and a specificity of 90% (87,93). Using two-field imaging, manual grading of red-free digital images achieved a sensitivity of 93% (82,98) and a specificity of 87% (84,90), and for colour slides, a sensitivity of 96% (87,100) and a specificity of 89% (86,91). Almost identical results were achieved for both methods with single macular field imaging. Digital imaging had a lower technical failure rate (4.4% of patients) than colour slide photography (11.9%). Applying an automated grading protocol to the digital images detected any retinopathy, with a sensitivity of 83% (77,89) and a specificity of 71% (66,75) and diabetic macular oedema with a sensitivity of 76% (53,92) and a specificity of 85% (82,88). Conclusions Both manual grading methods produced similar results whether using a one- or two-field protocol. Technical failures rates, and hence need for recall, were lower with digital imaging. One-field grading of fundus photographs appeared to be as effective as two-field. The optometrists achieved the lowest sensitivities but reported no technical failures. Automated grading of retinal images can improve efficiency of resource utilization in diabetic retinopathy screening. Diabet. Med. 20, 528,534 (2003) [source] Use of oral fluorescein angiography in the diagnosis of macular oedema within a diabetic retinopathy screening programmeDIABETIC MEDICINE, Issue 12 2001F. M. Razvi Abstract Aims To assess if oral fluorescein angiography (OFA) is a suitable screening method to detect macular oedema in diabetic retinopathy. Methods Eighty-four diabetic patients were included in the study. They were from a consecutive series of patients attending the diabetic eye-screening clinic, with retinopathy at the macula requiring ophthalmology assessment. All patients were subsequently examined in the eye hospital, by ophthalmologist slit lamp biomicroscopy assessment as the gold standard, followed by oral fluorescein angiography. Results This study indicates a sensitivity of 92% and specificity of 81%. Only 4.8% of patients developed a minor reaction to oral fluorescein; 84.5% of images were of good quality. Conclusions Oral fluorescein angiography is an efficient and highly sensitive tool for the detection of macular oedema. It can be used as an adjunct in the diabetic screening service to identify patients with oedema within a disc diameter of the macula. Ultimately it will ensure that only necessary and smaller numbers of patients are referred to ophthalmologists. Diabet. Med. 18, 1003,1006 (2001) [source] Opportunistic screening for Chlamydia in general practice: the experience of health professionalsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2003Elizabeth Perkins Abstract Chlamydia trachomatis is the most common curable bacterial sexually transmitted infection in the UK. The infection is asymptomatic in up to 70% of women, and if untreated, can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Chlamydial infection can be diagnosed using urine testing and is easily treated with antibiotics. In 1999, the UK Department of Health funded a pilot opportunistic Chlamydia screening programme in two health authorities. All sexually active women between the ages of 16 and 24 years attending general practices and other healthcare settings, such as family planning clinics, antenatal clinics and genito-urinary medicine services, were offered the opportunity to be screened for Chlamydia, regardless of the purpose of their visit. This evaluation was funded to assess the feasibility and acceptability of opportunistic screening. The evaluation was conducted using both qualitative and quantitative methods. The present paper describes findings from the qualitative evaluation study arising from the health professionals' experience of opportunistic screening in general practice. Receptionists were central to the opportunistic screening model in general practice and it was this aspect of the model that raised most concerns. Whilst general practitioners reported that the involvement of receptionists saved them time, the receptionists themselves were sometimes drawn into discussions for which they felt ill equipped and unsuitably located. This research suggests that a call,recall national screening programme would provide a better model to undertake Chlamydia screening in general practice. The advantages of this model are threefold. First, each individual within the target age range can receive information about Chlamydia through the post. Secondly, the test and more detailed information can be managed by a practice nurse in a private and confidential setting. Thirdly, individuals are not repeatedly offered the test when visiting the surgery. [source] Would general practitioners support a population-based colorectal cancer screening programme of faecal-occult blood testing?INTERNAL MEDICINE JOURNAL, Issue 9-10 2004S. Tong Abstract Background:, The success of a population-based screening for colorectal cancer (CRC) is determined to a large extent by general practitioner (GP) attitudes, beliefs and support. The extent to which GPs support population-based CRC screening remains unclear. Aims:, To assess the knowledge, attitudes and practices of GPs in relation to CRC screening, and to identify the determinants of GP support for population-based faecal-occult blood testing (FOBT). Methods:, A cross-sectional postal survey was conducted with a random sample of 692 GPs in Queensland, Australia. We assessed GP knowledge, attitudes and practices concerning CRC screening in relation to their stance on population-based FOBT screening. Results:, Although the response rate was low (41%), participants were representative of Queensland GPs in general. Of 284 participating GPs, 143 (50.5%) indicated that they would support a population-based FOBT screening programme, 42 (14.8%) would not and 98 (34.6%) were unsure. Belief in FOBT test efficacy (P < 0.001), possession of CRC guidelines (P < 0.05) and belief in earlier stage detection (P < 0.05) were major determinants of support for population-based FOBT screening. No significant association was observed for doctor's sex, location of practice, age, year completed medical training, membership of a Division of General Practice, number of weekly consultations, number of patients investigated for CRC per month, size of practice, own family history of CRC, interest in further information on CRC screening or treatment, and current use of FOBT with asymptomatic patients aged ,40 years. Conclusions:, GP support for FOBT population-based screening appears to have increased over recent years. The knowledge and attitudes/beliefs of GPs are key determinants of their support. (Intern Med J 2004; 34: 532,538) [source] Achieving long-term compliance with colonoscopic surveillance guidelines for patients at increased risk of colorectal cancer in AustraliaINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2007P. A. Bampton Summary We have previously demonstrated that we could improve colonoscopic surveillance practice for patients at increased risk of colorectal cancer by the adoption of guidelines, facilitated by a nurse co-ordinator. This study was to determine whether we could sustain this improvement over a longer period (4 years). All colonoscopic surveillance decisions made by the co-ordinated colorectal screening programme of our hospital between 2000 and April 2004 were reviewed. Reasons for variance were recorded, and surveillance decisions made in the last 4 months of the study time were compared with decisions made 4 years previously, both before and after the introduction of the co-ordinated programme. Between 2000 and 2004, 1794 surveillance decisions were made with variance occurring in 100. In the last 4 months of the period of study, 98% of decisions matched guidelines, suggesting that the improvement made following the adoption of the guidelines (45,96% p < 0.05) could be maintained. Reasons for variance from guidelines included a belief that the particular clinical scenario was not covered in the guidelines, disagreement with the guidelines or patient anxiety. Adherence to evidence based medicine guidelines for colonoscopy surveillance can be maintained over time at a high level. A number of clinical scenarios are not covered adequately by the existing guidelines and continue to generate disagreement amongst clinicians. [source] Prevalence and inheritance of canine elbow dysplasia in German RottweilerJOURNAL OF ANIMAL BREEDING AND GENETICS, Issue 6 2000R. Beuing Summary A total of 2114 scores of elbow arthrosis from the official screening programme of the German Rottweiler Breeding Association (ADRK) were analysed in respect of prevalence and genetic disposition. 45.8% showed no signs of arthritis, 40.6% were scored in Grade 1 with minor osteophytes and 13.6% were affected by arthritis of clinical relevance (Grade 2 and 3). REML estimates showed a heritability of 28% and a litter variance of 6.4%. The only significant environmental fixed effect was gender. 39.1% of the male and 51.5% of the female were free from ED which corresponds with 19.2% of the male and only 8.8% of the female in the critical ED classes of Grade 2 and 3. Differences between the years of examination could be explained by genetic gain. Month of birth as well as age at examination, in the range covered by this study, was not significant. It was stated that the effect of bodyweight should be tested before starting a breeding programme. Zusammenfassung 2114 Bewertungen der Ellbogenarthrose aus dem offiziellen Screening des Allgemeinen Deutschen Rottweiler Klub (ADRK) wurden in Hinblick auf Häufigkeit und genetische Praedisposition untersucht. 45,8% der Tiere hatten keine Anzeichen von Arthrose, 40,6% wurden mit Grad 1, geringgradige Osteophythenbildung, bewertet und 13,6% waren mit Arthrosen Grad 2 und 3 von klinischer Relevanz behaftet. REML-Schätzungen zeigten eine Heritabilität von 28% und eine wurfbedingte Varianz von 6.4%. Der einzige signifikante fixe Umwelteffekt war der Einfluß des Geschlechtes. 39,1% der Rüden und 51,5% der Hündinnen waren ED-frei. Das korrespondiert damit, daß 19,2% der Rüden und nur 8,8% der Hündinnen in die kritischen ED-Klassen 2 und 3 eingestuft wurden. Unterschiede zwischen den Untersuchungsjahren konnten als genetischer Trend erklärt werden. Der Geburtsmonat sowie das Alter beim Röntgen, zumindest in dem Altersbereich, den diese Studie umfasste, waren nicht signifikant. Es wurde als wichtig angesehen, den Einfluß des Körpergewichtes näher zu prüfen, bevor ein Zuchtprogramm begonnen wird. [source] The newly isolated lytic bacteriophages st104a and st104b are highly virulent against Salmonella entericaJOURNAL OF APPLIED MICROBIOLOGY, Issue 1 2006G. O'Flynn Abstract Aims:, To screen Irish faecal samples from a variety of sources with a view to isolating novel anti- Salmonella phages and to subsequently evaluate their lytic capability. Methods and Results:, Two novel anti- Salmonella phages st104a and st104b were isolated from a screening programme based on their lytic capability. The phages produced significantly larger plaques (2 mm) on the chosen indicator Salmonella enterica strain, DPC6046, when compared with the well-known control phage, Felix 01 (0·5 mm). Both phages st104a and st104b were found to have a broad host range within the Salm. enterica species. During in vitro trials, both phages (st104a and st104b) reduced Salm. enterica numbers more than 99% within 1 h. In vivo studies, involving the addition of the phage to porcine gastric juice (pH 2·5) demonstrated that phage st104a and phage Felix 01 were capable of surviving (10 and 30% survival respectively) the acidic conditions, unlike st104b, which was undetectable after 2 h exposure. Conclusions:, Two novel lytic anti- Salmonella phages were isolated and characterized. Significance and Impact of the Study:, With the exception of phage Felix 01, there has been relatively little phage therapy work performed using lytic Salmonella phage. In this study, the lytic phages st104a and st104b were isolated as a result of a faecal screening programme. Subsequently, phage st104a was found to have potential for biocontrol of Salm. enterica numbers if administered orally to pigs given their survival in porcine gastric juice, whereas, phage st104b may have potential in reducing cell numbers if applied by alternative approaches. [source] Exploring the perspective of midwives involved in offering serum screening for Down's syndrome in Northern IrelandJOURNAL OF CLINICAL NURSING, Issue 20 2009Jennifer 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] ,If it was osteoporosis, I would have really hurt myself.' Ambiguity about osteoporosis and osteoporosis care despite a screening programme to educate fragility fracture patientsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2010Joanna E. M. Sale PhD Abstract Rationale, aims and objectives, Behaviour change models suggest that people need clear information about their susceptibility to disease and knowledge of treatment recommendations in order to change their behaviour. The purpose of this qualitative study was to examine fracture patients' understanding of osteoporosis (OP) and OP care after being screened for, and educated about, OP in a fracture clinic. Methods, We conducted five focus groups with 24 patients (18 women, six men) aged 47,80 years old who were screened for OP through an urban fracture clinic. Participants were asked about their awareness of OP and their status of bone mineral density (BMD) testing and OP treatment. Results, Twenty participants vocalized at least one expression of ambiguity regarding OP and/or treatment recommendations conveyed by the screening programme staff. Participants were ambiguous about the cause of their fracture, the BMD test process and results, and the presentation of OP. They were also ambiguous about the amount and type of medication and supplements recommended. Conclusions, Despite a standardized screening programme in which OP was addressed in fragility fracture patients, ambiguity about diagnosis, testing and treatment were described. Efforts to clarify information relayed to fracture patients about their condition and recommended care need to extend beyond the fracture clinic so that health care providers can promote long-term adherence to these recommendations. [source] | |||||||||||||||||||||||||||||||||||||||||||