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Screening Strategy (screening + strategy)
Selected AbstractsScreening Strategies for Group B Streptococcus in the Third Trimester of PregnancyJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 12 2002APRN-BC, FAANP, Lorna Schumann PhD Purpose To identify the best screening protocol to prevent neonatal group B streptococcal (GBS) sepsis through literature review. Data Sources Selected research articles, texts, and Internet sources. Conclusions Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and American College of Nurse Midwives (ACNM) have issued guidelines describing methods to identify pregnant women at risk of intrapartum transmission of GBS to their babies. Studies have been conducted to discover the superiority of one prevention method over the other but no consensus has been reached. Implications for Practice Before widely used prevention methods, approximately 8,000 babies each year became infected with GBS; of those, 400 died and many survivors suffered life-long sequelae. Adoption of an appropriate protocol can prevent transmission of GBS from a colonized mother to her infant. Clinicians should implement either universal culture-based or risk factor-based screening guidelines for prenatal diagnosis and intrapartum prophylaxis of GBS disease. [source] Prevalence of metabolic markers of insulin resistance in offspring of gestational diabetes pregnanciesPEDIATRIC DIABETES, Issue 1 2008Erin J Keely In utero hyperglycemia has been associated with insulin resistance (IR) in children; however, there are limited data in low-risk populations. The purpose of this study was to describe the prevalence of metabolic markers of IR in a primarily Caucasian cohort of gestational diabetes mellitus (GDM) offspring aged 7,11 yr (mean 9.1) and to correlate offspring with maternal indexes. Sixty-eight children were recruited through a follow-up study of women who participated in a randomized controlled trial of minimal intervention vs. tight glycemic control for GDM. All participants had a fasting plasma glucose (FPG), insulin, total cholesterol, high-density lipoprotein cholesterol (HDL-chol), triglyceride (TG) level, and a 2-h oral glucose tolerance test. We calculated homeostasis model assessment (HOMA) and recorded body mass index and waist circumference (WC). Criteria for metabolic syndrome for children included: FPG > 6.0 mmol/L, HDL-chol < 1.03 mmol/L, TG > 1.24 mmol/L, WC > 90% for age and gender, and 2-h glucose > 7.8 mmol/L. Among these children, 45 (66%), 17 (25%), 5 (7%), and 1 (1.5%) had zero, one, two, or three metabolic markers of IR, respectively. Hypertriglyceridemia (21%) was most prevalent, with no child having an elevated FPG. WC (p = 0.018) and TG (p = 0.005) were strong predictors of IR in the offspring after adjustment for age, gender, birthweight, family history, and maternal IR. Maternal and offspring HDL-chol, TG, WC, and HOMA but not fasting or 2-h glucose levels were significantly correlated. We conclude that metabolic markers of IR in children exposed to GDM may be present in the absence of abnormal fasting or 2-h glucose values. Screening strategies that focus on glucose levels may need to be reconsidered to institute early intervention with lifestyle changes for children at risk. [source] Screening strategies for familial paragangliomasCLINICAL OTOLARYNGOLOGY, Issue 4 2007S. Verma No abstract is available for this article. [source] Screening strategy for the rapid detection of in vitro generated glutathione conjugates using high-performance liquid chromatography and low-resolution mass spectrometry in combination with LightSight® software for data processingRAPID COMMUNICATIONS IN MASS SPECTROMETRY, Issue 22 2009César Ramírez-Molina The knowledge of drug metabolism in the early phases of the drug discovery process is vital for minimising compound failure at later stages. As chemically reactive metabolites may cause adverse drug reactions, it is generally accepted that avoiding formation of reactive metabolites increases the chances of success of a molecule. In order to generate this important information, a screening strategy for the rapid detection of invitro generated reactive metabolites trapped by glutathione has been developed. The bioassay incorporated the use of native glutathione and its close analogue the glutathione ethyl ester. The generic conditions for detecting glutathione conjugates that undergo constant neutral loss of 129 Da were optimised using a glutathione-based test mix of four compounds. The final liquid chromatography/tandem mass spectrometry constant neutral loss method used low-resolution settings and a scanning window of 200 amu. Data mining was rapidly and efficiently performed using LightSight® software. Unambiguous identification of the glutathione conjugates was significantly facilitated by the analytical characteristics of the conjugate pairs formed with glutathione and glutathione ethyl ester, i.e. by chromatographic retention time and mass differences. The reliability and robustness of the screening strategy was tested using a number of compounds known to form reactive metabolites. Overall, the developed screening strategy provided comprehensive and reliable identification of glutathione conjugates and is well suited for rapid routine detection of trapped reactive metabolites. This new approach allowed the identification of a previously unreported diclofenac glutathione conjugate. Copyright © 2009 John Wiley & Sons, Ltd. [source] Screening for Asymptomatic Left Ventricular Dysfunction Using B-Type Natriuretic PeptideCONGESTIVE HEART FAILURE, Issue 2008Theresa A. McDonagh MD Asymptomatic left ventricular dysfunction (ASLVD), a known precursor phase of heart failure, fulfills the essential criteria that should be met before screening for a disease. It is common and associated with reduced longevity and quality of life. Left untreated, it progresses to heart failure, which incurs a mortality greater than most cancers as well as significant morbidity rates. In addition, we now have several population-based studies that demonstrate that both B-type natriuretic peptide (BNP) and N-terminal prohormone brain natriuretic peptide (NTproBNP) can accurately exclude left ventricular systolic dysfunction. More recent work shows that this can be done cost-effectively. There is also a wealth of evidence from randomized controlled trials indicating that the treatment of ASLVD can reduce both morbidity and mortality and slow progression to the heart failure state. The main stumbling block to implementation of screening, in addition to the perceived cost, may well be the lack of a randomized study showing that screening the population for ASLVD really does alter the natural history of the condition, something that other screening strategies have so far failed to do. Congest Heart Fail. 2008;14(4 suppl 1):5,8. ©2008 Le Jacq [source] Diabetic retinopathy screening: a systematic review of the economic evidenceDIABETIC MEDICINE, Issue 3 2010S. Jones Diabet. Med. 27, 249,256 (2010) Abstract This paper systematically reviews the published literature on the economic evidence of diabetic retinopathy screening. Twenty-nine electronic databases were searched for studies published between 1998 and 2008. Internet searches were carried out and reference lists of key studies were hand searched for relevant articles. The key search terms used were ,diabetic retinopathy', ,screening', ,economic' and ,cost'. The search identified 416 papers of which 21 fulfilled the inclusion criteria, comprising nine cost-effectiveness studies, one cost analysis, one cost-minimization analysis, four cost,utility analyses and six reviews. Eleven of the included studies used economic modelling techniques and/or computer simulation to assess screening strategies. To date, the economic evaluation literature on diabetic retinopathy screening has focused on four key questions: the overall cost-effectiveness of ophthalmic care; the cost-effectiveness of systematic vs. opportunistic screening; how screening should be organized and delivered; and how often people should be screened. Systematic screening for diabetic retinopathy is cost-effective in terms of sight years preserved compared with no screening. Digital photography with telemedicine links has the potential to deliver cost-effective, accessible screening to rural, remote and hard-to-reach populations. Variation in compliance rates, age of onset of diabetes, glycaemic control and screening sensitivities influence the cost-effectiveness of screening programmes and are important sources of uncertainty in relation to the issue of optimal screening intervals. There is controversy in relation to the economic evidence on optimal screening intervals. Further research is needed to address the issue of optimal screening interval, the opportunities for targeted screening to reflect relative risk and the effect of different screening intervals on attendance or compliance by patients. [source] Screening for fetal alcohol syndrome: is it feasible and necessary?ADDICTION BIOLOGY, Issue 2 2000Larry Burd The potential to utilize screening strategies to improve the identification and outcome of persons with fetal alcohol syndrome (FAS) is reviewed. FAS is a condition where screening and surveillance activities would be appropriate. Development of FAS screening and surveillance programs is encouraged because the disorder is expensive. People with FAS have poor outcomes as adults with less than 10% living independently. Several useful tools and models are available. Screening would improve ascertainment and prevalence estimates. Early identification could improve access to services and long term outcome, secondary disabilities and, by extension, excess disability in affected children could be decreased. Lastly, mothers who are at the highest risk to have additional children with FAS could be identified and offered treatment. While both screening and surveillance activities are discussed, the principle focus of this article is a review of the screening process. Two screening tools and several screening methodologies for FAS are available. Since no test will be appropriate in all settings, screening tests need to be selected depending on the setting and population of interest. Screening for FAS should be conducted in a variety of settings and in populations of both high and moderate risk. The results would also provide important data to influence public policy development and resource allocation. Appropriate evaluation of the efficacy, efficiency and effectiveness of FAS screening tools and methodologies would be important before utilization in screening programs. [source] At what costs will screening with CT colonography be competitive?INTERNATIONAL JOURNAL OF CANCER, Issue 5 2009A cost-effectiveness approach Abstract The costs of computed tomographic colonography (CTC) are not yet established for screening use. In our study, we estimated the threshold costs for which CTC screening would be a cost-effective alternative to colonoscopy for colorectal cancer (CRC) screening in the general population. We used the MISCAN-colon microsimulation model to estimate the costs and life-years gained of screening persons aged 50,80 years for 4 screening strategies: (i) optical colonoscopy; and CTC with referral to optical colonoscopy of (ii) any suspected polyp; (iii) a suspected polyp ,6 mm and (iv) a suspected polyp ,10 mm. For each of the 4 strategies, screen intervals of 5, 10, 15 and 20 years were considered. Subsequently, for each CTC strategy and interval, the threshold costs of CTC were calculated. We performed a sensitivity analysis to assess the effect of uncertain model parameters on the threshold costs. With equal costs ($662), optical colonoscopy dominated CTC screening. For CTC to gain similar life-years as colonoscopy screening every 10 years, it should be offered every 5 years with referral of polyps ,6 mm. For this strategy to be as cost-effective as colonoscopy screening, the costs must not exceed $285 or 43% of colonoscopy costs (range in sensitivity analysis: 39,47%). With 25% higher adherence than colonoscopy, CTC threshold costs could be 71% of colonoscopy costs. Our estimate of 43% is considerably lower than previous estimates in literature, because previous studies only compared CTC screening to 10-yearly colonoscopy, where we compared to different intervals of colonoscopy screening. © 2008 Wiley-Liss, Inc. [source] Cost-effectiveness of primary cytology and HPV DNA cervical screeningINTERNATIONAL JOURNAL OF CANCER, Issue 2 2008Peter Bistoletti Abstract Because cost-effectiveness of different cervical cytology screening strategies with and without human papillomavirus (HPV) DNA testing is unclear, we used a Markov model to estimate life expectancy and health care cost per woman during the remaining lifetime for 4 screening strategies: (i) cervical cytology screening at age 32, 35, 38, 41, 44, 47, 50, 55 and 60, (ii) same strategy with addition of testing for HPV DNA persistence at age 32, (iii) screening with combined cytology and testing for HPV DNA persistence at age 32, 41 and 50, iv) no screening. Input data were derived from population-based screening registries, health-service costs and from a population-based HPV screening trial. Impact of parameter uncertainty was addressed using probabilistic multivariate sensitivity analysis. Cytology screening between 32 and 60 years of age in 3,5 year intervals increased life expectancy and life-time costs were reduced from 533 to 248 US Dollars per woman compared to no screening. Addition of HPV DNA testing, at age 32 increased costs from 248 to 284 US Dollars without benefit on life expectancy. Screening with both cytology and HPV DNA testing, at ages 32, 41 and 50 reduced costs from 248 to 210 US Dollars with slightly increased life expectancy. In conclusion, population-based, organized cervical cytology screening between ages 32 to 60 is highly cost-efficient for cervical cancer prevention. If screening intervals are increased to at least 9 years, combined cytology and HPV DNA screening appeared to be still more effective and less costly. © 2007 Wiley-Liss, Inc. [source] Fabry Disease: Treatment and diagnosisIUBMB LIFE, Issue 11 2009Paula A. Rozenfeld Abstract Fabry disease is an X-linked lysosomal disorder that results from a deficiency of the lysosomal enzyme ,-galactosidase A leading to accumulation of glycolipids, mainly globotriaosylceramide in the cells from different tissues. Classical Fabry disease affects various organs. Clinical manifestations start at early age and include angiokeratoma, acroparesthesia, hypohydrosis, heat/exercise intolerance, gastrointestinal pain, diarrhea, and fever. The main complications of Fabry disease are more prominent after the age of 30 when kidney, heart, and/or cerebrovascular disorders appear. Most of the heterozygous females are symptomatic. Enzyme replacement therapy (ERT) is the only specific treatment for Fabry disease. The beneficial effect of ERT on different organs/systems has been extensively evaluated. Quality of life of patients receiving ERT is improved. Enzyme replacement stabilizes or slows the decline in renal function and reduces left ventricular hypertrophy. Fabry disease may be underdiagnosed because of nonspecific and multiorgan symptoms. Different screening strategies have been carried out in different at-risk populations in order to detect undiagnosed Fabry patients. An increasing knowledge about Fabry disease within the medical community increases the chances of patients to receive a timely diagnosis and, consequently, to access the appropriate therapy. © 2009 IUBMB IUBMB Life, 61(11): 1043,1050, 2009 [source] Long-Term Effectiveness of Screening for Hearing Loss: The Screening for Auditory Impairment,Which Hearing Assessment Test (SAI-WHAT) Randomized TrialJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2010Bevan Yueh MD OBJECTIVES: To evaluate the effect of hearing screening on long-term hearing outcomes in a general population of older veterans. DESIGN: Hearing loss in the elderly is underdetected and undertreated. Routine hearing screening has been proposed, but it is not clear whether screening identifies patients who are sufficiently motivated to adhere to treatment. A four-arm randomized clinical trial was conducted to compare three screening strategies with no screening in 2,305 older veterans seeking general medical care. SETTING: Veterans Affairs Puget Sound Health Care System. INTERVENTIONS: The screening strategies were a tone-emitting otoscope, a widely used questionnaire about hearing handicap, and a combination of both tools. MEASUREMENTS: Hearing aid use 1 year after screening. RESULTS: Of participants who underwent screening with the tone-emitting otoscope, questionnaire, and combined testing, 18.6%, 59.2%, and 63.6%, respectively, screened positive for hearing loss (P<.01 for test of equality across three arms). Patients proceeded to formal audiology evaluation 14.7%, 23.0%, and 26.6% of the time in the same screening arms, compared with 10.8% in the control arm (P<.01 for test of equality across four arms). Hearing aid use 1 year after screening was 6.3%, 4.1%, and 7.4% in the same arms, compared with 3.3% in the control arm (P<.01). Hearing aid users experienced significant improvements in hearing-related function and communication ability. CONCLUSION: In older veterans, screening for hearing loss led to significantly more hearing aid use. Screening with the tone-emitting otoscope was more efficient. The results are most applicable to older populations with few cost barriers to hearing aids. [source] Role of the Clinical Breast Examination in Breast Cancer ScreeningJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2001Does This Patient Have Breast Cancer? QUESTION: The authors, in an article for the JAMA section on the rational clinical examination, consider the evidence on whether and how to use clinical breast examination as a cancer screening technique. BACKGROUND: Breast cancer is a common disease, particularly in older women. The authors note that by age 70 the annual incidence of breast cancer is one in 200 women. Breast cancer survival is strongly influenced by the stage of the disease at the time of diagnosis. As a result, it is important to consider how best to screen for this disease. In recent years there has been considerable attention in the clinical literature and in the popular media paid to the screening strategies of breast self-examination and of screening mammography, but somewhat less to the potential role of the breast examination by the healthcare provider. In actual clinical practice, the same woman may be the recipient of any, none, or all of these screening modalities. The best way to combine these screening strategies, particularly in the case of the older woman, remains a subject of some uncertainty and controversy. DATA SOURCES: Data were obtained from a MEDLINE search of the English-language literature for 1966 through 1997 and additional articles as identified by the authors. STUDY SELECTION CRITERIA: In their evaluation of the effectiveness of clinical breast examination, the authors included both controlled trials and case-controlled studies in which clinical breast examination was used as a component of the screening. Study of breast examination technique considered both clinical studies and studies using silicone breast models. DATA EXTRACTION: The combined data from the trials included information on approximately 200,000 women who received a breast cancer screening intervention (mammography and/or clinical breast examination). However, none of the studies made the direct comparison of a group receiving clinical breast examination as a sole intervention with a control group that did not receive any screening. Data on the utility of clinical breast examination were partially derived from studies where that screening modality was used in combination with mammography. MAIN RESULTS: A number of trials of cancer screening have demonstrated a reduction in mortality from the use of mammography and clinical breast examination as combined screening strategies compared with no screening, with the inference that the reduction in mortality comes from the earlier detection of breast cancer. The percentage of the detected cancers that are detected in the trials by clinical breast examination despite having been missed on mammography varies across the trials from a low of 3% of the detected cancers to a high of 45%. It is speculative whether the marginal contribution of clinical breast examination to the mortality reduction in these screening trials corresponds to the percentage of cancers detected by clinical breast examination alone. In most of the clinical trials, the technique of breast examination reportedly was not well described. It is unclear therefore how much the technique of breast examination used varied within and among the clinical trials. Data from studies using examinations of breast models made of silicone demonstrated that test performance accuracy correlated with a lengthier breast examination, better breast examination technique, and perhaps with examiner experience. The report includes data from six comparator studies and from two demonstration projects. Of the six comparator studies, four compared a screened population with an unscreened population and two compared different intensities of screening strategies. None of the eight clinical trials was directed to a geriatric population and in fact older women were excluded by upper age entry criteria from the six comparator studies. (The upper age limit for study entry in the six comparator studies varied from 49 to 64.) CONCLUSION: The authors drew on the pooled results of these eight studies to conclude that clinical breast examination has a sensitivity of 54% (95% confidence interval, 48.3,59.8) and a specificity of 94% (95% confidence interval, 90.2,96.9). The authors conclude that screening clinical breast examination should be done for women age older than 40. [source] The adrenal cortex and steroidogenesis as cellular and molecular targets for toxicity: critical omissions from regulatory endocrine disrupter screening strategies for human health?JOURNAL OF APPLIED TOXICOLOGY, Issue 2 2003Philip W. Harvey Abstract Current testing strategies to assess the endocrine disrupting properties of chemicals have omitted examination of the adrenal gland and do not adequately cover the process of steroidogenesis. Steroidogenesis is critical for adrenocortical function as well as that of the testes and ovaries, and presents multiple molecular targets for toxicity, ranging from general effects on all steroidogenic tissues (e.g. via StAR protein or CYP11A1 cholesterol side-chain cleavage) through to speci,c targets affecting only adrenocortical function (e.g. CYP11,/18 and glucocorticoid synthesis). Numerous chemicals of environmental relevance are now being shown to affect adrenocortical function both in vivo in aquatic species and in vitro in human cell lines, and given the vital role of the adrenal gland to human health and development, there is a strong case for including dedicated assessment techniques in screening batteries for endocrine-disrupting chemicals, not least to assist in general data interpretation (e.g. whether adrenal hypertrophy is due to stress or to a more sinister adrenocortical insuf,ciency). Cell lines such as H295R (derived from a human adrenocortical adenocarcinoma) currently exist that will allow assessment of cortisol production and most of the major enzymes and functional proteins in the steroidogenic pathway (e.g. StAR; CYP11A1/scc; CYP11,/18; CYP17; CYP19; CYP21; 3, -hydroxysteroid dehydrogenase). Adequate assessment of adrenocortical function, as with any component of the integrated endocrine system, probably also will require the development of speci,c in vivo methodology to include effects on hypothalamo-pituitary function. Finally, although there is currently no direct evidence that environmental exposure to endocrine-disrupting (oestrogenic) chemicals has actually caused adverse human health effects, lessons have been learned on their potential from the diethylstilboestrol case. Similar evidence exists from aminoglutethimide and etomidate on the lethal impact of unpredicted chemically induced adrenal insuf,ciency in sensitive human subgroups, and it would seem prudent to incorporate relevant tests for adrenal function and steroidogenesis into current regulatory validation programmes. Published in 2003 by John Wiley & Sons, Ltd. [source] Comparative study of four candidate strategies to detect cervical cancer in different health care settingsJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2007Meherbano 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] WS10 Development of CALUX bioassay-based systems as instruments to detect hormones and contaminantsJOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 2006A. BROUWER Objective Tremendous progress has been made in the ability to measure particular contaminants or veterinary drugs at very low concentrations. However, rare or previously unknown compounds, metabolites and mixtures are still presenting considerable analytical challenges, while this category in particular might be relevant in terms of food safety. In addition, the need for higher throughput screening strategies at lower costs also demands for methods in addition to chemical analysis. There is considerable development in methodology based on the interaction with bio-macromolecules or living cells or on a biological response in the exposed animal. The aim of this workshop is to provide an up-o-date and practical overview of the various analytical and biological strategies that are available to screen or detect (prior) exposure to drugs, contaminants and pollutants. [source] WS11 Comprehensive investigation of the transcriptomeJOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 2006T. PINEAU Objective Tremendous progress has been made in the ability to measure particular contaminants or veterinary drugs at very low concentrations. However, rare or previously unknown compounds, metabolites and mixtures are still presenting considerable analytical challenges, while this category in particular might be relevant in terms of food safety. In addition, the need for higher throughput screening strategies at lower costs also demands for methods in addition to chemical analysis. There is considerable development in methodology based on the interaction with bio-macromolecules or living cells or on a biological response in the exposed animal. The aim of this workshop is to provide an up-o-date and practical overview of the various analytical and biological strategies that are available to screen or detect (prior) exposure to drugs, contaminants and pollutants. [source] Targeted screening for hereditary haemochromatosis in high-risk groupsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2004S. DuBois Summary Patients with hereditary haemochromatosis are at risk for significant morbidity from iron overload as well as reduced life-expectancy once cirrhosis is established. Although inexpensive, sensitive screening tests and effective therapy are available, there is continued debate regarding the utility of screening for this condition because of recent data suggesting that the homozygous haemochromatosis mutation (C282Y) is associated with low penetrance and mild expressivity when identified in population screening studies. In this review, we examine the published data related to general population screening for haemochromatosis, as well as the evidence for screening selected ,high-risk' populations. We also suggest possible screening strategies based on the available evidence. [source] Detection and treatment of coronary artery disease in liver transplant candidatesLIVER TRANSPLANTATION, Issue 9 2001Brian G. Keeffe Patients with end-stage liver disease and coronary artery disease (CAD) being considered for orthotopic liver transplantation (OLT) present a difficult dilemma. The availability of multiple screening tests and newer treatment options for CAD prompted this review. Recent data suggest that the prevalence of CAD in patients with cirrhosis is much greater than previously believed and likely mirrors or exceeds the prevalence rate in the healthy population. The morbidity and mortality of patients with CAD who undergo OLT without treatment are unacceptably high, making identification of patients with CAD before OLT an important consideration. Patients with documented CAD or major clinical predictors of CAD should undergo cardiac catheterization before OLT. Those with advanced CAD not amenable to interventional therapy or with poor cardiac function are not candidates for OLT. Dobutamine stress echocardiogram appears to be an excellent means of screening patients with intermediate or minor clinical predictors of CAD before OLT. Patients found to have mild or moderate CAD should be aggressively treated medically and, if necessary and feasible based on hepatic reserve, by percutaneous or, less likely, surgical intervention pre-OLT to correct obstructive coronary lesions. Prospective studies regarding optimal screening strategies for the presence of CAD and the indications, timing, and outcomes of interventional therapy in patients with advanced cirrhosis are lacking and much needed. [source] Premotor Parkinson's disease: Clinical features and detection strategies,MOVEMENT DISORDERS, Issue S2 2009Randolph Stephenson MD Abstract In many areas of medicine, the focus has shifted from treating existing disease to screening and prevention. The technology to screen for Parkinson's disease (PD) already exists. The current challenge is to define the appropriate use of predictive testing for PD. Imaging technologies currently offer the highest degree of accuracy for identifying premotor PD, but they are expensive as screening tools. Efficiency is greatly enhanced by combining imaging with a prescreening test, such as olfactory testing. This two-step process has the potential to greatly reduce costs while retaining diagnostic accuracy. Ultimately, the role of preclinical detection of PD will be determined by the ability of emerging therapies to influence clinical outcomes. As such, implementation of large-scale screening strategies awaits the arrival of clearly safe and effective therapies that address the underlying pathogenesis of PD. Current research to evaluate efficient screening methods and to understand the clinical and physiological features of "premotor" PD will lay the foundation for the screening and prevention strategies of the future. © 2008 Movement Disorder Society [source] The cost-effectiveness of cervical screening in Australia: what is the impact of screening at different intervals or over a different age range?AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2008Rob Anderson Abstract Objective: To estimate the cost-effectiveness of altering the currently recommended interval and age range for cervical screening of Australian women. Methods: The cost and effectiveness estimates of alternative screening strategies were generated using an established decision model. This model incorporated a Markov model (of the natural history of cervical cancer and pre-cancerous lesions) and decision trees which: ,mapped' the various pathways to cervical cancer screening; the follow-up of abnormal Pap test results; and the management of confirmed lesions. The model simulated a hypothetical large cohort of Australian women from age 15 to age 85 and calculated the accumulated costs and life-years under each screening strategy. Results: Our model estimated that moving from the current two-yearly screening strategy to annual screening (over the same age range) would cost $379,300 per additional life-year saved. Moving from the current strategy to three-yearly screening would yield $117,100 of savings per life-year lost (costs and effects both discounted at 5% per year), with a relatively modest (<5%) reduction in the total number of life-years saved by the program. Conclusions: Although moving to annual screening would save some additional lives, it is not a cost-effective strategy. Consideration should be given to increasing the recommended interval for cervical screening. However, the net value of any such shift to less effective (e.g. less frequent) and less costly screening strategies will require better evidence about the cost-effectiveness of strategies that encourage non-screeners or irregular screeners to have a Pap test more regularly. [source] Discovery and Syntheses of "Superbug Challengers",Platensimycin and PlatencinCHEMISTRY - AN ASIAN JOURNAL, Issue 4 2010Kalanidhi Palanichamy Abstract Bacteria have developed resistance to almost all existing antibiotics known today and this has been a major issue over the last few decades. The search for a new class of antibiotics with a new mode of action to fight these multiply-drug-resistant strains, or "superbugs", allowed a team of scientists at Merck to discover two novel antibiotics, platensimycin and platencin using advanced screening strategies, as inhibitors of bacterial fatty acid biosynthesis, which is essential for the survival of bacteria. Though both these antibiotics are structurally related, they work by slightly different mechanisms and target different enzymes conserved in the bacterial fatty acid biosynthesis. This Focus Review summarizes the synthetic and biological aspects of these natural products and their analogues and congeners. [source] Phaeochromocytoma, new genes and screening strategiesCLINICAL ENDOCRINOLOGY, Issue 6 2006Anne-Paule Gimenez-Roqueplo Summary Following recent advances in the genetics of phaeochromocytomas and paragangliomas, the members of the European Network for the Study of Adrenal Tumours (ENS@T) Phaeochromocytoma Working Group have decided to share their genotyping data and to propose European recommendations for phaeochromocytoma/functional paraganglioma (PH/FPGL) genetic testing. Germline DNA from 642 patients was analysed by ENS@T teams. In 166 patients (25·9%) the disease was familial and caused by germline mutations in VHL (56), SDHB (34), SDHD (31), RET (31) or NF1 (14), causing von Hippel-Lindau disease, SDHB- or SDHD-PH/FPGL syndromes, multiple endocrine neoplasia type 2 (MEN 2) and type 1 neurofibromatosis (NF1), respectively. In almost 60% of inherited cases it was possible to formulate a probable genetic diagnosis based on family history and/or typical syndromic presentation. Genetic testing revealed mutations in 12·7% of cases with an apparently sporadic presentation. Several clinical characteristics, such as young age at onset, the presence of bilateral, extra-adrenal or multiple tumours or a malignant tumour, should be seen as indications for genetic testing. The ENS@T Phaeochromocytoma Working Group recommends the genetic testing of all patients with PH and FPGL and suggests a practice algorithm for the management of their exploration. [source] Ethical investment and the incentives for corporate environmental protection and social responsibilityCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 4 2003Iulie Aslaksen This paper addresses some interrelated questions regarding ethical investments: does ethical screening provide any incentives for improved social responsibility within firms? Are ethical screened portfolios competitive compared with conventional funds with respect to risk-adjusted return? Does the risk-adjusted return of a screened portfolio depend on the screening strategy applied? Considering ethical screening as a kind of segmentation of the equity market, it is shown that screening might create incentives for changes in firms' behaviour. The strength of this incentive depends on the relative share of screened portfolios, which in turn partially depends on the financial performance of the screened portfolios. While some theoretical arguments suggest that screening imposes a handicap compared with conventional portfolios, the empirical evidence does not suggest that screened portfolios systematically under-perform conventional portfolios. Copyright © 2003 John Wiley & Sons, Ltd and ERP Environment. [source] Cover Picture: Electrophoresis 21'2008ELECTROPHORESIS, Issue 21 2008Article first published online: 14 NOV 200 This issue has an emphasis on "Proteomics and Related Topics". It comprises 11 research articles including the "Fast Track" article on the topic of proteomics, glycoproteomics, proteins and peptides. The "Fast Track" article describes a CE-LIF detection-based assay for the simultaneous measurements of the electrophoretic mobility, catalytic activity and the variation of activity over time of the individual enzymes molecules of Escherichia coli beta-galactosidase. The remaining 10 research articles of the Emphasis deal with the development of sensitive fluorescent staining for proteomic analysis, depletion of high abundance proteins form human serum, lectin affinity chromatography in the identification of rat urinary glycoproteome, lab-on-chip screening strategy of mouse serum samples prior to proteomics analysis, identification of proteins from membrane preparations, capillary coating for CE of proteins, characterization of rabbit liver apothioneins by CE-ESI-MS, quantitative analysis of recombinant protein charge heterogeneity by imaging CIEF, dye staining and immunodetection of proteins on a PVDF membrane, and separation of multiphosphorylated peptide isomers by CZE. [source] ATM mutations on distinct SNP and STR haplotypes in ataxia-telangiectasia patients of differing ethnicities reveal ancestral founder effects,HUMAN MUTATION, Issue 1 2003Catarina Campbell Abstract Due to the large size (150 kb) of the ataxia-telangiectasia mutated (ATM) gene and the existence of over 400 mutations, identifying mutations in patients with ataxia-telangiectasia (A-T) is labor intensive. We compared the SNP and STR haplotypes of A-T patients from varying ethnicities who were carrying common ATM mutations. We used SSCP to determine SNP haplotypes. To our surprise, all of the most common ATM mutations in our large multiethnic cohort were associated with specific SNP haplotypes, whereas the STR haplotypes varied, suggesting that ATM mutations predated STR haplotypes but not SNP haplotypes. We conclude that these frequently observed ATM mutations are not hot spots, but have occurred only once and spread with time to different ethnic populations. More generally, a combination of SNP and STR haplotyping could be used as a screening strategy for identifying mutations in other large genes by first determining the ancestral SNP and STR haplotypes in order to identify specific founder mutations. We estimate this approach will identify approximately 30% of mutations in A-T patients across all ethnic groups. Hum Mutat 21:80,85, 2002. © 2002 Wiley-Liss, Inc. [source] Separation of haemoglobin HbE and HbA2 by the fully automated, high-pressure liquid chromatography Tosoh HLC-723 G7 analyzerINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 5 2008G. LIPPI Summary High-pressure liquid chromatography instruments specifically devised for separating haemoglobin (Hb) fractions have been increasingly employed by the hospital laboratories over the recent years since they allow easy and fast screening for several Hb variants. Although such instruments may be proposed as sensitive, specific and reliable alternatives to the classic electrophoretic techniques, a major drawback of this screening strategy is the almost identical retention time of several Hb variants. In particular, at least 18 Hb variants have been reported in the same retention window as HbA2, including HbE, the second most common ,-chain variant in humans after sickle cell trait. Recently, we evaluated the performance characteristics of an improved buffer formulation originally conceived for Hb variants separation procedures on the fully automated high-pressure liquid chromatography instrument Tosoh G7. At variance with other fully automated high-pressure liquid chromatography analyzers, the elution pattern on the G7 in subjects heterozygous for HbE is characterized by the presence of four suggestive peaks (HbF, HbA, HbA2 and HbE), confirming the effective separation of HbE from HbA2. Because of its potential value in the diagnosis of the thalassaemia syndromes, the effective separation of HbA2 from HbE can provide clinical laboratories with a valuable information for the diagnostic reasoning. [source] Influence of epidemiological factors on blood transfusionISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue 1 2007S. Laperche The prevalence, incidence and risk factors of infectious diseases observed in the general population have been described to directly influence transfusion medicine, especially the blood selection. The objective is to ensure the blood safety. The characterization of modes of transmission influences the donor selection: the risk factors of the main blood-borne infections have permitted to adapt the pre-donation questionnaire in order to exclude at-risk donors. The prevalence of infections also has an impact on the blood screening strategy. For example, anti-HBc antibody (Ab) screening is currently performed only in countries where the HBV prevalence is compatible with a reasonable number of donor exclusions. HTLV Ab screening is implemented in countries in which the rate of donors originating from endemic areas could represent a risk for blood components. Measurement of incidence which contributes to the residual risk has led to the introduction of nucleic acid testing (NAT) for HIV, HCV and in some cases for HBV in viral screening strategy in many countries worldwide. The observed NAT yield differs according to the incidence of the infection and according to the country. Finally, the putative blood transmission of new and emerging pathogens has led to implement specific and non-specific measures in order to enhance blood safety. Conversely, although the blood donor population is selected, the data observed in this population have also contributed to better understand epidemiology and pathogenesis of infection. Moreover, owing to the recent progress in developing modelling approaches for estimating risk, we are able to anticipate a transfusion transmission threat by introducing, when necessary, specific measures intended for reduce this risk. [source] ,-thalassaemia carrier detection by ELISA: A simple screening strategy for developing countriesJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 1 2005M. Shyla Ravindran Abstract The frequency of ,-thalassaemia in India ranges from 3.5% to 15% in the general population and of the 100,000 children born with thalassaemia major in the world, 10,000 are in India alone. Affected children do not die immediately, but treatment by regular transfusion is costly and leads to iron overload and death. Therefore, health services in lower-economic countries can sustain patients only if the numbers can be limited. Detecting carrier couples by simple blood test can prevent thalassaemia and at-risk couples can be identified and informed of their genetic risk before having children. A prevention programme including population screening, counselling, and prenatal diagnosis will markedly reduce the birth prevalence of affected individuals. Hemoglobin A2 (HbA2) measurement in human hemolysates has great significance, since its level can indicate ,-thalassaemia carrier status in otherwise healthy individuals. We have developed a rapid, simple, and inexpensive enzyme linked immunosorbent assay (ELISA) for the quantitation of HbA2, which can be used in carrier screening programmes in developing countries like India. In a limited trial for ,-thalassaemia carrier screening, the results obtained with ELISAs were compared with those obtained with the microcolumn chromatography method (r=0.89). J. Clin. Lab. Anal. 19:22,25, 2005. © 2005 Wiley-Liss, Inc. [source] Genetic testing for HFE hemochromatosis in Australia: The value of testing relatives of simple heterozygotesJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7 2002JULEEN A CAVANAUGH AbstractBackground : It is unclear whether screening of relatives of C282Y and H63D heterozygotes (other than compound heterozygotes) for hemochromatosis will detect sufficient numbers of cases to justify introduction of this screening strategy. Methods : Conditional probabilities were determined using published Australian allele frequencies and penetrance data to determine the detection rate of hemochromatosis by testing the siblings and offspring of heterozygotes (subjects with only one HFE mutation). Results : The number of individuals who are at risk of developing increased body iron stores because of HFE mutations is substantially higher (1 in 80) than previously estimated. In addition, 33% of the Australian population are heterozygous for either C282Y or H63D. Based on population estimates, the relative risk to the offspring of C282Y and H63D heterozygotes of developing increased iron stores is 4.1 and 1.5, respectively, while the relative risk to each sibling is 2.3 and 1, respectively. The risk of developing clinical features of hemochromatosis or hepatic fibrosis is likely to be substantially lower. Conclusions : Although the detection rate from testing the families of unaffected heterozygotes is low, this can be justified as a clinically useful screening strategy. At the present time this strategy should be restricted to first-degree relatives of heterozygotes. Further studies are recommended to determine if cascade genetic screening is a cost-effective alternative to general population screening. © 2002 Blackwell Publishing Asia Pty Ltd [source] Fecal occult blood and flexible sigmoidoscopy screening for colorectal cancer: Modeling the impact on colonoscopy requirements and cancer detection ratesJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 4 2001John K Olynyk Abstract Aim: The aim of this study was to estimate the colonoscopy requirements and the likely impact of fecal occult blood and flexible sigmoidoscopy screening on the detection of colorectal cancer by using previously published data. Methods: Fecal occult blood and flexible sigmoidoscopy screening programs were applied to the 2.04 million subjects aged 50,65 years, at a participation rate of 40%. The following strategies were evaluated: Fecal occult blood testing with colonoscopy follow up of all positive tests; flexible sigmoidoscopy with colonoscopy follow up of all adenomatous polyps; and flexible sigmoidoscopy with colonoscopy follow up of all adenomatous polyps > 10 mm in size. Results: The fecal occult blood program detected 5.6% of all colorectal cancer cases at a rate of 2914 colonoscopies/percentage of detection of colorectal cancer. The flexible sigmoidoscopy program detected 14% of all colorectal cancer cases at a rate of 8160 colonoscopies/percentage of detection of colorectal cancer. The flexible sigmoidoscopy program with follow up of adenomatous polyps > 10 mm in size detected 13% of all colorectal cancer cases at a rate of 1230 colonoscopies/percentage of detection of colorectal cancer. Conclusions: Flexible sigmoidoscopy screening followed by colonoscopic follow up of adenomatous polyps > 10 mm in size is the most efficient screening strategy in terms of colonoscopies generated and cases of colorectal cancer detected. [source] | ||||||||||||||||||||||||||||||||||