Common Screening Tests Research Articles

HITUNG CD4 TIDAK BERKORELASI DENGAN ATENSI DAN INTERNATIONAL HIV DEMENTIA SCALE (IHDS) PADA PENDERITA HIV

Background. Despite it is common neurocognitive domain that affected in patient with Human Immunodeficiency Virus (HIV) infection, attention domain is not assessed using International HIV Dementia Scale (IHDS), a common screening test to diagnose HIV-associated cognitive disorder. Detection of attention deficit in HIV patient is important as it can maintain the capacity to adherence to antiretroviral therapy and essential to activity daily living. CD4 is one of the markers for severity of HIV infection. Objective. We aims to correlate between CD4 with IHDS and CD4 with attention performance test, such as forward digit span test (FWD), backward digit span test (BWD), and trail making test A test (TMA). Methods. This is an analytic study using cross sectional design. 20 respondents are collected for the study using purposive sampling. Data is collected using instrument IHDS, FWD, BWD, and TMA. Results. Using the correlation of Eta, Eta 2 of CD4 and IHDS, CD4 and FWD, CD4 and BWD, also CD4 and TMA are 0.025, 0.022, 0.022 and 0.011. Conclusion. We concluded that CD4 have no correlation with test for attention domain and IHDS.

An Overview of Celiac Disease in Childhood Type 1 Diabetes.

ContextCeliac disease (CD) is a common phenomenon in children with Type 1 diabetes (T1D). In the present review, we have discussed the pathogenesis, diagnostic biomarkers, risk factors, and prognosis of CD in the context of pediatric T1D.Evidence AcquisitionLiterature published in Web of Science, PubMed, Scopus, Google Scholar, and Cochrane Library were scrutinized up to the end of 2017. The keywords of celiac disease, Type 1 diabetes, children, and pediatric were used in different combinations.ResultsImmune cytotoxic reactions along with dampen immune regulatory functions contribute to CD in the context of pediatric T1D. Many children with simultaneous CD and T1D do not represent with the clinical signs of the enteropathy rendering a diagnostic challenge. The most common screening tests in these children are routine serological tests of CD, anti - endomysial, anti - transglutaminase, and anti - deamidated gliadin peptide antibodies. Typing for human leukocyte antigens of DQ - 2 and DQ - 8 may assist in the diagnosis of silent CD in children with T1D. The most significant shared non - HLA genetic loci of CD and T1D comprise CTLA - 4, TAGAP, IL - 18RAP, PTPN2, RGS1, SH2B3, CCR5. Interactions between these loci can be important in susceptibility to CD in T1D. Some new biomarkers have been suggested for diagnosis of CD including ischemia-modified albumin (IMA), soluble syndecan-1 (SSDC-1), regenerating gene Iα (REG-Iα), Neurotensin, and Zonulin, which can be useful for diagnosis and screening of CD in childhood T1D.ConclusionsOverall, active seropositive CD seems to be of clinical importance in T1D with significant impacts on the quality of life and predisposition to diabetes associated complications. It is important to detect CD in the context of T1D to prevent potential risks contributing to morbidities and mortalities associated with either CD or T1D.

Population Screening for Hemoglobinopathies.

Hemoglobinopathies are the most common single-gene disorders in the world. Their prevalence is predicted to increase in the future, and low-income hemoglobinopathy-endemic regions need to manage most of the world's affected persons. International organizations, governments, and other stakeholders have initiated national or regional prevention programs in both endemic and nonendemic countries by performing population screening for α- and β-thalassemia, HbE disease, and sickle cell disease in neonates, adolescents, reproductive-age adults (preconceptionally or in the early antenatal period), and family members of diagnosed cases. The main aim of screening is to reduce the number of affected births and, in the case of sickle cell disease, reduce childhood morbidity and mortality. Screening strategies vary depending on the population group, but a few common screening test methods are universally used. We discuss the salient features of population-screening programs around the globe as well as current and proposed screening test methodologies.

Cognitive function, disease burden and the structural connectome in systemic lupus erythematosus.

Objective To investigate brain structural connectivity in relation to cognitive abilities and systemic damage in systemic lupus erythematosus (SLE). Methods Structural and diffusion MRI data were acquired from 47 patients with SLE. Brains were segmented into 85 cortical and subcortical regions and combined with whole brain tractography to generate structural connectomes using graph theory. Global cognitive abilities were assessed using a composite variable g, derived from the first principal component of three common clinical screening tests of neurological function. SLE damage ( LD) was measured using a composite of a validated SLE damage score and disease duration. Relationships between network connectivity metrics, cognitive ability and systemic damage were investigated. Hub nodes were identified. Multiple linear regression, adjusting for covariates, was employed to model the outcomes g and LD as a function of network metrics. Results The network measures of density (standardised ß = 0.266, p = 0.025) and strength (standardised ß = 0.317, p = 0.022) were independently related to cognitive abilities. Strength (standardised ß = -0.330, p = 0.048), mean shortest path length (standardised ß = 0.401, p = 0.020), global efficiency (standardised ß = -0.355, p = 0.041) and clustering coefficient (standardised ß = -0.378, p = 0.030) were independently related to systemic damage. Network metrics were not related to current disease activity. Conclusion Better cognitive abilities and more SLE damage are related to brain topological network properties in this sample of SLE patients, even those without neuropsychiatric involvement and after correcting for important covariates. These data show that connectomics might be useful for understanding and monitoring cognitive function and white matter damage in SLE.

Screening and management of gestational diabetes in Mexico: results from a survey of multilocation, multi-health care institution practitioners

PurposeTo identify the most common practices implemented for the screening and treatment of gestational diabetes mellitus (GDM) and to estimate the GDM clinician-reported proportion as a proxy of the incidence in Mexico.Materials and methodsThree hundred fifty-seven physicians in four major cities were asked about their practices regarding GDM screening, treatment, clinical exams, and health care staff involved in case of GDM diagnosis, as well as the percentage of women with GDM they care for. Data management and statistical analyses were done with Stata 13.ResultsThe overall GDM clinician-reported proportion was 23.7%. Regional differences were expected and consistent with the data on the epidemiology of the obesity in the country. The most common screening test was the oral glucose tolerance test 75 g one step (46.6% of total cases). Diet and exercise were sufficient to treat GDM in 40.6% of cases; the rest of the sample relied on some form of medication, especially oral hypoglycemic agents (63.0% of cases), insulin (22.0%), or a combination of these (13.0%). To educate women on how to measure glycemia and eventually take medications, an average of 2–3 hours were necessary. The three most common prenatal screening tests were the “no stress”, the “Doppler ultrasound”, and the “biophysical profile”, respectively, taken at least once by 70%, 60%, and 45% of women. Among women who were prescribed insulin, only 37% managed to keep the initial prescribed dose during the whole pregnancy.ConclusionThe survey confirmed the expected incidence and gave interesting results on the treatment of GDM. The current Mexican guidelines seem to have been partially implemented in practice, and a coherent national strategy for GDM is still missing. More studies are encouraged to investigate this topic, with the aim to better understand the importance of the monetary cost of GDM, which is currently underestimated.

Physical basis of the \u2018magnification rule\u2019 for standardized Immunohistochemical scoring of HER2 in breast and gastric cancer

BackgroundDetection of HER2/neu receptor overexpression and/or amplification is a prerequisite for efficient anti-HER2 treatment of breast and gastric carcinomas. Immunohistochemistry (IHC) of the HER2 protein is the most common screening test, thus precise and reproducible IHC-scoring is of utmost importance. Interobserver variance still is a problem; in particular in gastric carcinomas the reliable differentiation of IHC scores 2+ and 1+ is challenging.Herein we describe the physical basis of what we called the ‘magnification rule’: Different microscope objectives are employed to reproducibly subdivide the continuous spectrum of IHC staining intensities into distinct categories (1+, 2+, 3+).MethodsHER2-IHC was performed on 120 breast cancer biopsy specimens (n = 40 per category). Width and color-intensity of membranous DAB chromogen precipitates were measured by whole-slide scanning and digital morphometry. Image-analysis data were related to semi-quantitative manual scoring according to the magnification rule and to the optical properties of the employed microscope objectives.ResultsThe semi-quantitative manual HER2-IHC scores are correlated to color-intensity measured by image-analysis and to the width of DAB-precipitates. The mean widths ±standard deviations of precipitates were: IHC-score 1+, 0.64 ± 0.1 μm; score 2+, 1.0 ± 0.23 μm; score 3+, 2.14 ± 0.4 μm. The width of precipitates per category matched the optical resolution of the employed microscope objective lenses: Approximately 0.4 μm (40×), 1.0 μm (10×) and 2.0 μm (5×).ConclusionsPerceived intensity, width of the DAB chromogen precipitate, and absolute color-intensity determined by image-analysis are linked. These interrelations form the physical basis of the ‘magnification rule’: 2+ precipitates are too narrow to be observed with 5× microscope objectives, 1+ precipitates are too narrow for 10× objectives. Thus, the rule uses the optical resolution windows of standard diagnostic microscope objectives to derive the width of the DAB-precipitates. The width is in turn correlated with color-intensity. Hereby, the more or less subjective estimation of IHC scores based only on the staining-intensity is replaced by a quasi-morphometric measurement. The principle seems universally applicable to immunohistochemical stainings of membrane-bound biomarkers that require an intensity-dependent scoring.

Making Sense of Dementia Screening

Making Sense of Dementia Screening

Performance of the Pentagon Drawing test for the screening of older adults with Alzheimer's dementia.

ABSTRACT The Pentagon Drawing Test (PDT) is a common cognitive screening test.Objective: The aim of this study was to evaluate performance properties of a specific PDT scoring scale in older adults with Alzheimer's disease (AD) and healthy controls.Methods: A cross-sectional study of 390 elderly patients, aged 60 years or older with at least two years of education was conducted. All participants completed clinical and neuropsychological evaluations, including the Cambridge Cognitive Examination, the Mini-Mental State Examination (MMSE), and the Clock Drawing Test. All PDT were blindly scored with the scale of Bourke et al.Results: PDT analyses of the binary score on the MMSE (0 or 1 point) did not discriminate AD from controls (p = 0.839). However, when PDT was analyzed using the Bourke et al. scale, the two groups could be distinguished (p <0.001). PDT was not affected by education, showed sensitivity of 85.5% and specificity of 66.9%, discriminated different clinical stages of dementia, and correlated with the other cognitive tests (p <0.001). A 1-point difference on the Bourke et al. scale was associated with an odds ratio of 3.46 for AD.Conclusion: PDT can be used as a cognitive screen for suspected cases of dementia, especially AD, irrespective of educational level.

VALIDITY OF FUNCTIONAL SCREENING TESTS TO PREDICT LOST-TIME LOWER QUARTER INJURY IN A COHORT OF FEMALE COLLEGIATE ATHLETES

Lower quarter injuries account for more than 50% of all injuries in collegiate athletics. Neuromuscular screening tests could potentially identify athletes who are at risk for sustaining an injury. While previous research has studied individual tests, the authors of this paper are unaware of any study that has compared diagnostic accuracy of multiple neuromuscular screening tests within one study cohort. The purpose of this study was to examine the accuracy of three common neuromuscular screening tests to predict the occurrence of a lower quarter injury in female collegiate volleyball and basketball players. Prospective Cohort. Thirty-five subjects underwent a pre-season screening by performing the Y-balance test, the Functional Movement ScreenTM, and Single Leg Hop test. Data were collected on lower quarter injury incidence, lost practice time, and lost competition time among subjects throughout the course of one season. Receiver operating characteristics curves were plotted and area under the curve was calculated to assess the relationship between lower extremity injury incidence and the scores of the functional tests. Lost-time injuries occurred in 11 athletes (31.4%), of whom, six athletes (17.1%) lost 50 hours or greater. There were no significant relationships between occurrence of a lost-time lower extremity injury and scores on any of the three tests. Positive and negative likelihood ratios all included the value of 1.0. Although reliable, the screening tests under study did not appear to retain adequate validity to predict lower quarter injury risk within these female collegiate athletes. Level 2b.

Prediction of difficulties during laparoscopic cholecystectomy by preoperative clinical examination and ultrasonography

Background: Cholelithiasis (gall stone disease) is a well-known disease worldwide. Ultrasonography is the most common screening test for cholecystitis and cholelithiasis. Laparoscopic Cholecystectomy is considered the treatment of choice for symptomatic gall stone disease. It is important to know the different clinical, radiological parameter and specific predictor that give some prediction of difficult LC. The aim of this study was to predict the difficulty of LC and the possibility of conversion to OC before surgery using the clinical and ultrasonographic criteria in our set up.Methods: The present study was carried out in the Department of surgery, Sarojini Naidu Medical College Agra, from November 2014 to October 2016. A total of 210 patients were enrolled for the laparoscopic cholecystectomy. All patients who were included in the study were undergone detailed history and clinical examination. A number of clinical and ultrasonographical parameters were noted.Results: Amongst the 210 patients admitted for laparoscopic cholecystectomy, 21 (10%) were male and 189 (90%) female, with age ranging from 12–60 years. The conversion rate in our study was 4.5% (9 of 210). In our study significant pre-operative factors which increased the conversion rate to open cholecystectomy includes male gender, obesity, abdominal scar of previous surgery, contracted and thickened gall bladder and patients having stone impacted at the neck of gall bladder.Conclusions: From this study, we conclude that preoperative ultrasonography is a good predictor of difficult laparoscopic cholecystectomy in the majority of cases and should be used as a screening procedure.

Association of American Medical Colleges Core Entrustable Professional Activities for Entering Residency: Resident and Attending Physician Perceived Supervisory Needs of New Interns

Purpose: Interns enter internship needing to perform many duties expected of a physician. The Association of American Medical Colleges (AAMC) has outlined these expectations in the form of core entrustable professional activities (EPAs) that all graduating medical students should be expected to be able to perform on day one of residency without direct supervision.1 However, it is unclear how much supervision new interns actually need when performing these EPAs. Furthermore, attending physicians and residents may have different perceptions about interns’ need for supervision. Therefore, the purpose of this study was to examine how much supervision residents and attending physicians perceive new interns to need at the beginning of intern year when performing the EPAs, and to examine whether attending physicians and residents have different perceptions of how much supervision new interns need when performing these EPAs. Method: Four months into the 2014–2015 academic year, an anonymous and voluntary electronic survey was administered to attending physicians at Boston Children’s Hospital and Boston Medical Center, who supervise Boston Combined Residency Program (BCRP) pediatric interns on inpatient general pediatric services, asking them to rate the amount of supervision they perceive new interns to need when performing 11 of the AAMC EPAs. Answer options included “(1) Has knowledge; (2) May act under full supervision; (3) May act under moderate supervision; (4) May act independently; or (5) May act as a supervisor and instructor.” At the same time, a similar survey was administered to all BCRP residents asking them to rate how much supervision they felt they themselves needed at the beginning of their intern year when performing the same EPAs, with a similar response scale. For each EPA, the number and percentage of attending physicians and residents who selected one of the top three options, best correlating with the ability to perform the EPA without direct supervision, was calculated. Differences in these percentages between residents and attending physicians were also tested. Results: There were only five EPAs that the majority of attending physicians thought new interns could perform without direct supervision. For five of the EPAs, residents’ perceptions of their own abilities to perform the EPA independently as interns were significantly greater than the attending physician’s perceptions of interns’ abilities. For example, 90.8% of residents thought they were able to recommend and interpret common diagnostic and screening tests when they were interns without direct supervision, compared with only 29.6% of attending physicians (P < .001). Conclusions: Attending physicians and residents in a pediatric residency training program reported that new interns were not consistently able to perform the core EPAs that the AAMC has established as a goal for all new residents without direct supervision. Furthermore, residents perceived that new interns need less supervision than attending physicians.

Low DHEAS: A Sensitive and Specific Test for the Detection of Subclinical Hypercortisolism in Adrenal Incidentalomas.

Subclinical hypercortisolism (SH) occurs in 5% to 30% of adrenal incidentalomas (AIs). Common screening tests for adrenocorticotropin-independent hypercortisolism have substantial false-positive rates, mandating further time and resource-intensive investigations. To determine whether low basal dehydroepiandrosterone sulfate (DHEAS) is a sensitive and specific screening test for SH in AI. In total, 185 patients with AI were screened for adrenal medullary (plasma metanephrines) and cortical [1 mg overnight dexamethasone suppression test (ONDST), 24-hour urinary free cortisol (UFC), serum DHEAS, plasma renin, and aldosterone] hyperfunction. Positive ONDST [≥1.8 mcg/dL (≥50 nmol/L)] and/or UFC (more than the upper limit of reference range) results were further investigated. We diagnosed SH when at least 2 of the following were met: raised UFC, raised midnight serum cortisol, 48-hour dexamethasone suppression test (DST) cortisol ≥1.8 mcg/dL (≥50 nmol/L). 29 patients (16%) were diagnosed with SH. Adrenocorticotropin was <10 pg/mL (<2.2 pmol/L) in all patients with SH. We calculated age- and sex-specific DHEAS ratios (derived by dividing the DHEAS by the lower limit of the respective reference range) for all patients. Receiver operating characteristic curve analyses demonstrated that a ratio of 1.12 was sensitive (>99%) and specific (91.9%) for the diagnosis of SH. Cortisol following 1 mg ONDST of 1.9 mcg/dL (53 nmol/L) was a sensitive (>99%) screening test for SH but had lower specificity (82.9%). The 24-hour UFC lacked sensitivity (69%) and specificity (72%). A single basal measurement of DHEAS offers comparable sensitivity and greater specificity to the existing gold-standard 1 mg DST for the detection of SH in patients with AIs.

TF7 A Novel Integrated Learning Approach for Pre-Clinical Medical Students Through Early Procedural Exposure and Simulation

Much of existing pre-clinical basic science curriculum consists of lecture, reading, and standardized tests. Outside of the anatomy lab, many first- and second-year medical students (MS-1s, MS-2s) lack hands-on experiential learning. For visual and kinesthetic learners who thrive in a student-centered learning environment, new curricula must be offered to accommodate adult learners. The goal of this project is to offer MS-1s and MS-2s a novel integrated learning approach to medical curricula in their pre-clinical years through early procedural and simulation exposure. Four separate workshops occur over the course of a year to encourage diagnostic reasoning and procedural intervention. Through practical application of theoretical knowledge, students will dynamically engage with real-world medical cases and diagnostic dilemmas. During this series of workshops, the learner will be expected to (1) recall existing pre-clinical knowledge, (2) build knowledge though videos, online, and in-person curricula, (3) synthesize basic science knowledge with real-world application, (4) propose differential diagnoses and formulate treatment plans, and (5) perform hands-on procedures and practice clinical skills. In relation to entrustable professional activities (EPAs) medical students will: 1- Gather a history and perform a physical exam, 2- Prioritize a differential diagnosis, 3- Recommend and interpret common diagnostic and screening tests, 4- Form clinical questions and retrieve evidence to advance patient care, 5- Recognize a patient requiring urgent or emergent care and initiate evaluation and management, 6- Obtain informed consent for tests and/or procedures, and 7- Perform general procedures. The instruction will occur in a series of four workshops offered over 12 months (4 quarterly four-hour sessions), which is independent of, but complementary to, the pre-clinical curriculum. Each workshop has a pre-test and content overview including videos and interactive online materials. The in-person workshop consists of integrating diagnostic reasoning and procedural skills through case simulations. Students will rely on their classroom-based knowledge and underlying understanding of systems-based disease processes to work through the patient cases. Through scenarios such as headache with altered mental status (lumbar puncture), sepsis (central line), trauma (laceration repair/splinting), and vision loss (slit lamp exam, tonometry) students will perform procedures firsthand. The curriculum will guide the learners through independent study, group collaboration, critical reasoning, hands-on skills practice, and reflection. Students complete a post-test immediately following the workshop and at 3 months to gauge retention of the material covered. The curriculum was successfully piloted for MS-1s and MS-2s. 100% felt the curriculum was successful. Using a Likert scale of 1 (poor) to 5 (excellent), the average score was 4.8. In the future, the curriculum will be expanded in breadth of content and variety of teaching modalities. Further curriculum evaluation is needed to justify adding the proposed workshop-based curriculum to pre-clinical medical education and continued in perpetuity.

Serum Alanine Aminotransferase (ALT) Activity among Diabetic Patients

Serum Alanine aminotransferase (ALT) activity is the most common screening test as a part of routine assessment of liver damage. Due to its low activity in extra hepatic tissues an increase in serum ALT is more specific for liver disease. The liver pathology among diabetics is similar to that of alcoholic liver disease, including fatty liver, steatohepatitis, fibrosis, and cirrhosis. Thus, elevated serum ALT activity which is a common sign of liver disease is also observed more frequently in diabetics. This study has been designed with the aim to determine the association of serum ALT activity with diabetes mellitus. The study included 208 subjects attending Nepal police hospital during the time frame 6th October 2009 to 4th January 2010.The ALT activity in serum was determined by kit method, fasting and post prandial sugar was tested by GOD-POD method.Among the total diabetic subjects 43.26% were found to have elevated serum ALT activity (&gt;40IU/L). Diabetic status was found to be significantly associated with ALT activity (p=0.04). In addition to diabetic status body mass index (BMI) was also significantly associated with ALT activity (p=0.02) and higher BMI increases the likelihood of elevated ALT. The association of ALT activity was found to be inverse and significant with age of the patient(r=-0.217, p=0.005). Physical activity was also found to be inversely associated with ALT activity(r=-0.149, p=0.03). Int J Appl Sci Biotechnol, Vol 4(3): 386-390

Estimation of Upper Limit of Normal for Serum Alanine Transaminase in Healthy South Indian Population.

Alanine aminotransferase (ALT) is the most common and cost effective screening test for asymptomatic liver disease. There is paucity of data on normal ALT among healthy individuals in India. An observational cross sectional study was conducted from January to July 2013 to estimate the upper limit of normal for ALT in healthy south Indian population. Adults undergoing voluntary or pre-employment health screening were included. Those with current and past alcoholism or smoking, acute illness or hospitalization during preceding 12months, non-steroidal anti-inflammatory or over the counter medication use within a month, current or past intake of herbal medications, any chronic medical illness, abnormal body mass index (BMI), fatty liver in ultrasound, abnormality in haemoglobin, platelet count, blood sugar, creatinine, lipid profile and thyroid function test and positive serology (Hepatitis B, C or HIV) were excluded. A total of 2600 subjects were screened. 344 were included for analysis. Mean age was 35years in men and 34.83years in women, with a mean BMI of 22.2kg/m2 in men and 21.8kg/m2 in women. The mean ALT in men and women were 21.87±2.9 (97.5th percentile 28U/L) and 19.35±3.3 (97.5th percentile 24U/L) respectively. In conclusion, mean and upper limit of ALT (97.5th percentile) in south Indian men was 21.87 and 28IU/L and women were 19.35 and 24IU/L respectively. There is a need to re-consider ALT levels in our population for better detection of individuals at risk for liver disease.

Comparative analysis of commercially available methods for proteinuria assessment from the medical decision point of view – what do we keep forgetting about

Introduction: In assessing the kidney function Proteinuria still appears to be the most common screening test. Although recommendations focus on albuminuria, also in association with urine creatinine level, tradition, habits and economical reasons determine wide use of dipstick tests the tool for determining urine protein during routine urinalysis. Aim: The aim of this study was to compare 3 methodologically different tests used for assessing proteinuria, from medical point of view: the qualitative Sorenson method and 2 quantitative methods: the traditional Exton method and the method with pyrogallol red. Material and Methods: In this study we analyzed 395 urine samples from patients aged 3-101 years old, 45% (n=182) men, ordered from 18 entities. In all the samples we determined protein concentration with use of: Combur Test M dipstic tests, cobas u411, Roche; The Exton Reagent, Specol 11, Aqua-Med; Urinary/CSF protein, AU640, Beckman Coulter. Additionally we performed microscopic examination of urinary sediment and assessed if any physical or morphological parameters or the patients’ condition influence differences in obtained protein levels. Results: Analyzing the results we noticed the Sorenson method had tendency to generate ambiguous and inflated results in comparison to quantitative methods. The automatic method with pyrogallol red was characterized with the smallest imprecision across all its analytical linearity. Both quantitative methods was characterized with very good correlation coefficient (R=0.97) of results. The color of the urine, presence of bacteria and casts as well as serum C-reactive protein and creatinine level, and GFR were associated with statistically relevant differences in protein levels obtained with use of analytical methods in question. Conclusions: Only quantitative methods appear to ensure obtaining reliable proteinuria assessment. Laboratories should consider providing automatic quantitative methods for determining the concentration of the urine protein in routine urinalysis.

Cancer Screening in Older Adults.

When screening for cancer in older adults, it is important to consider the risks of screening, how long it takes to benefit from screening, and the patient's comorbidities and life expectancy. Delivering high-value care requires the consideration of evidence-based screening guidelines and careful selection of patients. This article considers the impact of cancer. It explores perspectives on the costs of common cancer screening tests, illustrates how using life expectancy can help clinicians determine who will benefit most from screening, and provides tools to help clinicians discuss with their older patients when it may be appropriate to stop screening for cancer.

Providers' advice concerning smoking cessation: Evidence from the Medical Expenditures Panel Survey

Importance and objectiveWe estimate how often adult smokers are advised to quit using a nationally representative sample of adults in the United States. Design and participantsData are from the 2012–2013 household component of the United States (US) Medical Expenditures Panel Survey (MEPS). Main outcome measureCurrent smoking and advice to quit offered by providers. ResultsSmoking was reported by 18.26% (CI 17.13%–19.38%) of 2012 MEPS respondents. Less than half of adult smokers (47.24%, CI 44.30%–50.19%) were advised to quit by their physicians although 17.57% (CI 15.37%–19.76%) had not seen a doctor in the last 12months. Advice to quit was given significantly less often to respondents classified as: aged 18–44 (40.29%), men (40.20%), less educated (42.26%), lower family income (43.51%), Hispanic (33.82%), never married (39.55%), and living outside the northeast. Smoking status at year 2 for patients who had received advice to quit was similar (85.13%: SE 1.62%) to those who had seen a physician but were not advised to quit (81.95%: SE 2.05%). Advice to quit smoking was less common than the use of common medical screening tests. Conclusions and relevanceSmoking cessation advice is given to less than half of current cigarette smokers and it is least likely to be given to the most vulnerable populations. Efforts to reduce smoking are deployed less often than other preventive practices. The rate of advice to quit has not changed over the last decade. Health care providers are missing an important opportunity to affect health behaviors and outcomes.

Reproducibility of measurements using the IMEA ADR III critical flicker-fusion frequency measuring device

Measurement of central critical flicker-fusion frequency is a common screening test for eye diseases and additionally it can serve as a useful diagnostic test in numerous neurological and internal diseases. The test might also be used for monitoring purposes. The aim of the authors was to evaluate a digital central critical flicker-fusion frequency measuring device (IMEA ADR III) in 30 young, healthy Hungarian subjects. After a general ophthalmological screening examination, monocular central critical flicker-fusion frequency was measured with four colours. Measurements were carried out on two separate days in three sessions under standardized conditions. Intrasession, intersession and intervisit variabilities, differences in central critical flicker-fusion frequency using the four colours and the effect of certain other influencing factors were determined. There were no statistically significant differences between sessions in the mean and standard deviation of the measurement sets. The central critical flicker-fusion frequency threshold for red colour was significantly lower than for other colours, and the threshold for blue colour was significantly lower than for green. There were no significant differences regarding sex, age, iris colour, and smoking indicating that these factors did not influence the central critical flicker-fusion frequency threshold in these subjects. Measurement results with the device are reliable and reproducible in healthy, young population in separate sessions.

Comparison of trends in colorectal cancer screening in the US end-stage renal disease population and the US Medicare population.

BackgroundAlthough patients treated with maintenance hemodialysis are at an increased risk of colorectal cancer compared with the general population, national practices for colorectal cancer screening have not been reported in this population. We assessed the performance of colorectal cancer screening in the US end-stage renal disease program in comparison with the US Medicare population.MethodsWe studied the United States Renal Data System for US prevalent hemodialysis patients between 2002 and 2011 who had Medicare as their primary insurer. We assessed procedure codes for performance of common colorectal cancer screening tests, including fecal occult blood testing, sigmoidoscopy and colonoscopy. We assessed screening sigmoidoscopy and screening colonoscopy only and excluded patients who had preexisting colon cancer or gastrointestinal hemorrhage. Because colorectal cancer screening recommendations are established for hemodialysis patients who have been listed for kidney transplantation, but no general recommendations exist for patients who are not wait-listed, we assessed colorectal cancer screening separately for the two groups.ResultsWe found that 1-year performance of colonoscopy in wait-listed hemodialysis patients was similar to or higher than that in general Medicare patients of the same age, while performance of colonoscopy in non-wait-listed patients was significantly lower than among general Medicare patients of the same age.ConclusionsGiven improved survival among hemodialysis patients in the last decade, the utility of colorectal cancer screening even among non-wait-listed hemodialysis patients should be reassessed.