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Systematic Screening (systematic + screening)
Selected AbstractsApplying the Systematic Screening and Assessment Method to childhood obesity preventionNEW DIRECTIONS FOR EVALUATION, Issue 125 2010Nicola Dawkins The authors describe application of the Systematic Screening and Assessment (SSA) Method to an initiative called the Early Assessment of Programs and Policies to Prevent Childhood Obesity. Over a 2-year period, a national network of practitioners, policy makers, and funders nominated programs and policies across five substantive areas: school district local wellness policies, school-based comprehensive physical activity programs, day care and after-school programs, access to healthy foods in low-income communities, and changes in the built environment to promote physical activity. The role of an expert panel in selecting innovations for evaluability assessment on the basis of the likelihood for a positive health impact is described. © Wiley Periodicals, Inc., and the American Evaluation Association. [source] Further validation of the Systematic Screening for Behavior Disorders in middle and junior high school,PSYCHOLOGY IN THE SCHOOLS, Issue 7 2009Michael J. Richardson The Systematic Screening for Behavior Disorders (SSBD), a screening system to identify elementary students at risk for emotional and behavioral disorders, was evaluated for use in middle and junior high schools. Teachers completed SSBD Stages One and Two on students in grades 6 to 8 who had characteristics of internalizing or externalizing disorders. Teacher, parent, and self-rating forms of the Achenbach System of Empirically Based Assessment (ASEBA) and the Social Skills Rating System (SSRS) were also completed on 66 students nominated via the SSBD as at risk for internalizing and externalizing problems. Office discipline referrals and grade point averages, for students nominated at SSBD Stage One, were compared with nonnominated students resulting in medium to large effect sizes. Small to moderate correlations were also found between SSBD Stage Two scores and ASEBA and SSRS scores, including several from the parent and student forms. © 2009 Wiley Periodicals, Inc. [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] Improving detection of first-episode psychosis by mental health-care services using a self-report questionnaireEARLY INTERVENTION IN PSYCHIATRY, Issue 4 2009Nynke Boonstra Abstract Objective: To examine the utility of the Community Assessment of Psychic Experiences (CAPE)-42, a self-report questionnaire, to improve detection of first-episode psychosis in new referrals to mental health services. Method: At first contact with mental health-care services patients were asked to complete the CAPE-42 and were then routinely diagnosed by a clinician. Standard diagnoses were obtained by means of the mini-Schedule for Clinical Assessment in Neuropsychiatry. Results: Of the 246 included patients, 26 (10.6%) were diagnosed with psychosis according to the mini-Schedule for Clinical Assessment in Neuropsychiatry. Only 10 of them were recognized by clinical routine, and 16 psychotic patients were not properly identified. Using an optimal cut-off of 50 on the frequency or distress dimension of the positive subscale of the CAPE-42 detected 14 of these misdiagnosed patients. The sensitivity of the CAPE-42 at this cut-off point was 77.5 and the specificity 70.5. Conclusion: Systematic screening of patients using a self-report questionnaire for psychotic symptoms improves routine detection of psychotic patients when they first come into contact with mental health services. [source] Screening for duct-dependent congenital heart disease with pulse oximetry: A critical evaluation of strategies to maximize sensitivityACTA PAEDIATRICA, Issue 11 2005ANNE DE-WAHL GRANELLI Abstract Aim: To evaluate the feasibility of detecting duct-dependent congenital heart disease before hospital discharge by using pulse oximetry. Design: Case-control study. Setting: A supra-regional referral centre for paediatric cardiac surgery in Sweden. Patients: 200 normal term newborns with echocardiographically normal hearts (median age 1.0 d) and 66 infants with critical congenital heart disease (CCHD; median age 3 d). Methods: Pulse oximetry was performed in the right hand and one foot using a new-generation pulse oximeter (NGoxi) and a conventional-technology oximeter (CToxi). Results: With the NGoxi, normal newborns showed a median postductal saturation of 99% (range 94,100%); intra-observer variability showed a mean difference of 0% (SD 1.3%), and inter-observer variability was 0% (SD 1.5%). The CToxi recorded a significantly greater proportion of postductal values below 95% (41% vs 1%) in the normal newborns compared with NGoxi (p < 0.0001). The CCHD group showed a median postductal saturation of 90% (45,99%) with the NGoxi. Analysis of distributions suggested a screening cut-off of < 95%; however, this still gave 7/66 false-negative patients, all with aortic arch obstruction. Best sensitivity was obtained by adding one further criterion: saturation of < 95% in both hand and foot or a difference of > ± 3% between hand and foot. These combined criteria gave a sensitivity of 98.5%, specificity of 96.0%, positive predictive value of 89.0% and negative predictive value of 99.5%. Conclusion: Systematic screening for CCHD with high accuracy requires a new-generation oximeter, and comparison of saturation values from the right hand and one foot substantially improves the detection of CCHD. [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] Preservation of sight in diabetes: developing a national risk reduction programmeDIABETIC MEDICINE, Issue 9 2000L. Garvican SUMMARY Background Early treatment for diabetic retinopathy is effective at saving sight, but dependent on pre-symptomatic detection. Although 60% of people with diabetes have their eyes examined annually, few UK health authorities have systematic programmes that meet the British Diabetic Association's standards for sensitivity (> 80%) and specificity (> 95%). Screening is generally performed by general practitioners and optometrists, with some camera-based schemes, operated by dedicated staff. The National Screening Committee commissioned a group to develop a model and cost estimates for a comprehensive national risk-reduction programme. Ophthalmoscopy Evidence indicates that direct ophthalmoscopy using a hand-held ophthalmoscope does not give adequate specificity and sensitivity, and should be abandoned as a systematic screening technique. Indirect ophthalmoscopy using a slit lamp is sensitive and specific enough to be viable, and widespread availability in high street optometrists is an advantage, but the method requires considerable skill. Photographic schemes The principal advantage of camera-based screening is the capturing of an image, for patient education, review of disease progression, and quality assurance. Digital cameras are becoming cheaper, and are now the preferred option. The image is satisfactory for screening and may be transmitted electronically. With appropriate training and equipment, different professional groups might participate in programme delivery, based on local decisions. Cost issues Considerable resources are already invested in ad hoc screening, with inevitable high referral rates incurring heavy outpatient costs. Treatment for advanced disease is expensive, but less likely to be effective. The costs of a new systematic screening and treatment programme appear similar to current expenditure, as a result of savings in treatment of late-presenting advanced retinopathy. Conclusion A systematic national programme based on digital photography is proposed. [source] Unraveling the Genetic Component of Multifactorial Diseases: Dream or RealityINTERNATIONAL STATISTICAL REVIEW, Issue 1 2000F. Clerget-Darpoux Summary The etiology of many human diseases is complex and very likely involves a combination of genetic and environmental risk factors. A popular strategy to detect genetic risk factors is to perform a systematic screening of the genome searching for linkage. The power of such and approach depends very much on the unknown characteristics of the genetic factors and the main difficulty is to establish a good trade-off between false positives and false negatives. Besides, a precise localisation of the risk factor will generally not be obtained. The set up of a candidate gene stratery is necessary to go further in genetic factor identification. It is likely that for multicfactorioal diseases the only genetic risk factors that can be detected are those with fairly strong effect. Even in that case, it is important to design strategies which increase the power of detection and provide for a better evaluation of the associated risks. Résumé La majorité des maladies humaines ont une étiologic complexe et résultent, de I'interaction de facteurs génétiques, etd' environnment. Une stratégic, populaire pour détecter; des cacteurs de risque est la recherche systématique, de liaison sur le génome. La puissance d' une telle approch dépend essentiellement des caractéristiques, inconnues des facteurs génétiques, et la difficultéprincipale est d'établir un bon cornpromis entre faux positifs et faux négatifs. PPar ailleurs, elle ne permet généralement pas de locatiser de facon préciseles facteurs génétiques, impliqués. La misc en place d'une stratégic, de géne candidat est nécessaire pour avancer vers I; identificatin d' un facteur de risque génétique. IIest vraisemblable que pour les maladies multifactorielles, seuls les facteurs ayant un effet immportant pourront étre, détecté. Méme, dans ce cas, il est important de mettre enpalce des stratégies, qui donnent une pussance maximum de détection, et permettent d' évaluer au mieux les risques associés. [source] Early recognition of delirium: review of the literatureJOURNAL OF CLINICAL NURSING, Issue 6 2001Marieke J. Schuurmans PhD ,,This review focuses on delirium and early recognition of symptoms by nurses. ,,Delirium is a transient organic mental syndrome characterized by disturbances in consciousness, thinking and memory. The incidence in older hospitalized patients is about 25%. ,,The causes of delirium are multi-factorial; risk factors include high age, cognitive impairment and severity of illness. ,,The consequences of delirium include high morbidity and mortality, lengthened hospital stay and nursing home placement. ,,Delirium develops in a short period and symptoms fluctuate, therefore nurses are in a key position to recognize symptoms. ,,Delirium is often overlooked or misdiagnosed due to lack of knowledge and awareness in nurses and doctors. To improve early recognition of delirium, emphasis should be given to terminology, vision and knowledge regarding health in ageing and delirium as a potential medical emergency, and to instruments for systematic screening of symptoms. [source] Uveitis caused by fastidious bacteriaACTA OPHTHALMOLOGICA, Issue 2009B BODAGHI Purpose The etiologic evaluation of uveitis is frequently unsuccessful if only noninvasive methods are used. We conducted a prospective study to evaluate systematic screening for pathogens of uveitis. Methods All patients with uveitis referred to the participating tertiary ophthalmology departments from January 2001 to September 2007 underwent intraocular and serum specimen collection. The standardized protocol for laboratory investigations included universal polymerase chain reaction (PCR)-based detection of any bacteria and mycoses, specific PCR-based detection of fastidious (difficult-to-grow) bacteria and herpes viruses, and culture of vitreous fluid. Sera were tested for fastidious bacteria. Results Among the 1321 included patients, infection was diagnosed in 147 (11.1%) patients: 78 (53%) were caused by fastidious bacteria that included spirochetes, Bartonella species, intracellular bacteria (Chlamydia species, Rickettsia species, Coxiella burnetii), and Tropheryma whipplei; 18 by herpes viruses; and 9 by fungi. Bartonella quintana, Coxiella burnetii, Paracoccus yeei, Aspergillus oryzae, and Cryptococcus albidus were found to be associated with uveitis for the first time, to our knowledge. Conclusion We recommend applying a 1-step diagnostic procedure that incorporates intraocular, specific microbial PCR with serum analyses in tertiary centers to determine the etiology of uveitis. [source] Screening for diabetic retinopathy in Denmark: the current statusACTA OPHTHALMOLOGICA, Issue 6 2004Anja Bech Hansen Abstract. Purpose:,To investigate the current status of screening for diabetic retinopathy in Denmark, focussing on organization, methods of screening and regional differences. Methods:,A questionnaire was sent out in 2002 to 14 departments of ophthalmology and one ophthalmology practice, covering all 15 counties in Denmark. Results:,Six counties reported having systematic screening, defined as organized screening, including a database; three reported having plans for systematic screening; two reported having undetermined plans for systematic screening and four reported having no plans for systematic screening. In counties with systematic screening, both the organization and the method of screening varied. Conclusion:,Approximately 43% of Danish patients with diabetes currently live in a county without systematic screening for diabetic retinopathy. Should all counties contemplating systematic screening implement their plans, this proportion will be reduced to approximately 17%. 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