Establish Screening Criteria Research Articles

Neuroendocrine challenges and clinical outcomes in men with chronic traumatic brain injury: a cross-sectional study.

Marked changes in the hypothalamic-pituitary axis have been documented in patients with traumatic brain injury (TBI). These enduring endocrine challenges could significantly influence the physical and psychological outcomes thereby impacting overall recovery. This study aimed to determine the prevalence and types of endocrine dysfunction in men with chronic TBI and to determine the association of endocrine dysfunction with clinical outcomes. A cross-sectional study that included male participants of 25-45 years (N = 66) with moderate to severe TBI within 6-24 months of injury. Serum Cortisol, Free T4, TSH, Luteinizing hormone, Testosterone, ACTH, Prolactin and IGF-1 were assessed. Glasgow Outcome Scale Extended (GOS-E) and Modified Barthel Index (MBI) scores were also assessed in them. The study cohort comprised male patients with a mean ± age of 32.8 ± 5.7 years. Low IGF-1 levels were most commonly encountered, followed by hypogonadism. Hypopituitarism was present in 56.1%. The proportion of hypogonadism was significantly higher in the group with moderate-total dependence (13/26) as compared to the functionally independent (8/40) group (50% vs. 20%; P = 0.011). Univariate and multivariate logistic regression analysis was used to determine the factors associated with hypopituitarism, revealing that severity of injury (OR = 2.6;) and GOS-E (OR = 3.1) were significant (P < 0.10) on univariate analysis. This study emphasizes the need to screen TBI patients for neuroendocrine dysfunction during the chronic phases and to establish screening criteria.

Effective methods for monitoring internal contamination among workers handling radioactive materials in various fields

This study aimed to develop effective methods for monitoring internal contamination among workers handling radioactive materials in various fields. A total of 160 workers from nuclear power plants, medical institutions, military units, and educational/research institutions were included in the study. The monitoring methods included urinalysis and whole-body counting (WBC) using a mobile radio bioassay laboratory (MRL). Gamma-emitting radionuclides were monitored using the MRL WBC system, and a separate pretreatment procedure was used for tritium measurement in urine samples. Gross beta-screening was performed using a liquid scintillation counting system. The results were evaluated on the basis of the established screening criteria and compared with the dose limits. Additionally, tritium concentrations in the bodies of workers in the vicinity of a heavy-water reactor was analysed to assess the association between tritium concentration and occupation. The results showed a wide distribution of tritium concentrations. Workers involved in fuel and maintenance tasks demonstrated the maximum exposure. Workers in medical facilities showed low levels of internal contamination, which was primarily related to tasks involving radioactive isotopes. Military personnel involved in equipment repair showed significant tritium contamination due to damage during repairs. Workers in educational and research institutions in general had low levels of internal contamination.

Hsp90 is a potential risk factor for ovarian cancer prognosis: an evidence of a Chinese clinical center

BackgroundThe potential treatment effects of heat shock protein 90 (Hsp90) inhibitors in ovarian cancer (OC) are controversial. This research aims to investigate the relationship between the level of Hsp90 in peripheral blood and the prognosis of OC patients, as well as the clinicopathological indicators.Materials and methodsWe retrospectively collected the clinicopathological indicators of OC patients who were admitted to the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Anhui Medical University from 2017 to 2022. Hsp90 level in patient blood was detected by enzyme-linked immunosorbent assay, and the correlation between Hsp90 level and OC prognosis was systematically investigated. Kaplan–Meier method was used to draw the survival curve, and the average survival time and survival rate were calculated. The log-rank test and Cox model were used for univariate survival analysis, and the Cox proportional hazards model was applied for multivariate survival analysis. Based on the TCGA dataset of OC obtained by cBioPortal, Pearson’s correlation coefficients between Hsp90 level values and other mRNA expression values were calculated to further conduct bioinformatics analysis. GSEA and GSVA analysis were also conducted for gene functional enrichment. The expression of Hsp90 in OC tissues were evaluated and compared by Immunohistochemical staining.ResultsAccording to the established screening criteria, 106 patients were selected. The enzyme-linked immunosorbent assay results showed that 50.94% OC patients with abnormal Hsp90 level. According to the outcome of Kaplan–Meier curves, the results revealed that the abnormal level of Hsp90 was suggested to poor prognosis (P = 0.001) of OC patients. Furthermore, the result of multivariate Cox proportional hazards regression model analysis also predicted that abnormal Hsp90 level (HR = 2.838, 95%CI = 1.139–7.069, P = 0.025) was linked to poor prognosis, which could be an independent prognostic factor for the prognosis of OC patients. Moreover, top 100 genes screened by Pearson’s value associated with Hsp90, indicating that Hsp90 participated in the regulation of ATF5 target genes, PRAGC1A target genes and BANP target genes and also enriched in the metabolic processes of cell response to DNA damage stimulus, response to heat and protein folding.ConclusionHsp90 level is positively associated with OC mortality and is a potential prognostic indicator of OC.

The role of surfactants in preserving the stability of amorphous solid dispersions: A review

In recent years among various formulation strategies, amorphous solid dispersions (ASDs) has gained tremendous recognition for improving the solubility of poorly soluble drug substances. Among various manufacturing strategies, hot melt extrusion (HME), spray drying, kinetisol, and electrospinning are the most widely employed for developing ASDs. Despite the improving solubility and bioavailability, the stability of ASDs is the major problem haunting the pharmaceutical industries. Various factors, such as miscibility, the solubility of the drug in polymer, drug-polymer interactions, glass transition temperature, hygroscopicity, and storage conditions, determine the stability of ASDs. The poor stability of amorphous drugs also limits the drug loading capacity, resulting in an increased volume of the dosage form affecting patient compliance. Apart from the physical stability of ASDs, solution-mediated recrystallization of the drug when present in a supersaturated state is another factor affecting the quality and performance of the formulations. In recent years incorporation of surfactants to hinder solution-mediated recrystallization of drugs, thereby improving the stability and performance of ASD formulations, is being most widely investigated. The incorporation of surfactant in the HME process will also act as a plasticizer, thereby allowing the process to be carried at lower temperatures. This review article mainly focuses on the role of surfactants in ASD systems and recent advancements. Still, research is warranted to understand the mechanism of surfactants and to establish screening criteria.

Hypoxic ischemic encephalopathy and perinatal asphyxia

Background: There is considerable variation in the clinical manifestations of neonatal encephalopathy. It has been associated to early-onset neurological abnormalities and preterm or late delivery (before or after 35 weeks of gestation, respectively). Convulsions, coma, respiratory distress, slowed or halted breathing, slowed or halted reflexes, and depressed tone are all possible outcomes. The goal of this study was to assess the prevalence of hypoxic ischemic encephalopathy (HIE) among tertiary care hospital patients with a diagnosis of perinatal asphyxia. Contents and techniques: In Sawabi, Pakistan, researchers from the GKMC/BKMC Hospital surveyed the local population. Investigators gathered data from July 1, 2021, through December 31, 2021. The study comprised 80 babies diagnosed with perinatal hypoxia. Each newborn was evaluated using established screening criteria for hypoxic ischemic encephalopathy. The average age was 2.5371.28 days for the participants in this research, which ranged in age from 1 to 10 days. The average duration of pregnancy was 37.6811.24 weeks, and the mean birth weight was 3.2750.35 kg. Seventy-five percent of all births were accomplished by vaginal delivery, while the remaining twenty-five percent were accomplished through caesarean section. Eight persons were diagnosed with hypoxic ischemic encephalopathy.

Impact of marital status at diagnosis on the survival of patients with anal canal squamous cell carcinoma: a propensity score-matched analysis.

Marital status has been shown to be an important psychosocial factor that plays an important role in the prognosis of various cancers. The effect of marital status on survival outcomes in anal canal squamous cell carcinoma has not been studied. The purpose of this study was to address this issue. According to the established screening criteria, we obtained 2429 patients with anal canal squamous cell carcinoma from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier analysis and multivariate Cox regression analysis were used to analyze the survival of anal canal squamous cell carcinoma patients with different marital status. 1:1 propensity score matching (PSM) was used to match 979 unmarried patients with 979 married patients to further demonstrate the effect of marital status on the survival of patients with anal canal squamous cell carcinoma. The 5-year overall survival (OS) rates of married, divorced/separated, single, and widowed patients with anal canal squamous cell carcinoma were 75.6%, 69.7%, 62.2%, and 51.3%, respectively and the corresponding 5-year cancer-specific survival (CSS) rates were 80.7%, 79.6%, 70.1%, and 68.9%, respectively. Multivariate Cox regression analysis showed that marital status, sex, race, SEER stage, tumor size, regional nodes positive, primary site surgery, chemotherapy, and radiotherapy were independent prognostic factors for OS and CSS, and also demonstrated that the widowed patients suffered the highest risk mortality. Furthermore, married patients were found to have better OS and CSS than unmarried patients both before and after propensity score matching. This study found that married patients with anal canal squamous cell carcinoma had better survival outcomes, while widowed patients had the worst OS and CSS.

EP01.06-007 The Impact of Modified Screening Eligibility Criteria on Race and Sex Disparities in Lung Cancer Screening

Low Dose CT screening (LDCT) redistributes lung cancer to earlier stage at diagnosis and reduces mortality. However, established screening criteria underestimate risk in women and racial minorities, inadvertently exacerbating access disparities. Using a cohort of patients enrolled into an incidental lung nodule program (LNP), we evaluated the impact of criteria modifications on rates of LDCT eligibility and lung cancer detection by race and sex.

Meta-Analysis of Safety and Efficacy of Different Radical Gastrectomy in the Treatment of Gastric Cancer

To investigate the safety and efficacy of different radical gastric cancer treatments in the management of gastric cancer. The literature published in the last 5 y was searched for recent outcomes of different radical gastric cancer procedures used in the treatment of gastric cancer. 14 papers were finally included according to the established screening criteria. The trial design, study population characteristics and findings of the included studies were abstracted using randomized independent trials and statistically analyzed using RevMan 5.0 software. The results of the meta-analysis showed that laparoscopic early distal gastric cancer surgery compared with conventional open surgery: The operative time was 49.85 min longer (p<0.05), but intraoperative bleeding was 145.50 ml less (p<0.05), the number of postoperative analgesic requests was 1.22 less (p=0.01) and the number of days to the first postoperative vent was 0.57 d shorter (p<0.05), the number of days to the first postoperative meal was shortened by 0.88 d (p<0.05); the number of postoperative hospital days was shortened by 4.76 d (p<0.05) and the incidence of postoperative complications was low, both differences were statistically significant (p<0.05). The recent efficacy of laparoscopy-assisted distal gastrectomy in treating gastric cancer was significantly better than that of conventional open distal gastrectomy.

Establishing screening criteria for field application of wettability alteration in gas-condensate reservoirs

The use of wettability alteration to improve production in a gas reservoir that has suffered decline in rates due to condensate banking has garnered tremendous success at the experimental level but has not translated well to field trials. In this paper, we present a study using the design and analysis of experiments approach to investigate the rock and fluid properties that influence the success of wettability alteration in the field. The results quantify the effect of reservoir and fluid properties on the performance of wettability alteration. The work highlights that the condensate yield of the reservoir fluid impacts the extent of the influence of these properties. One of the main findings is that permeability cannot be the sole parameter in judging the potential effectiveness of the approach. The interaction of various parameters need to be considered, namely the yield of the reservoir fluid and the well spacing of the field development plan. The conclusions highlight screening criteria that can be used towards further development of novel chemicals that target specific reservoir and fluid types.

Cervical seatbelt sign is not associated with blunt cerebrovascular injury in children: A review of the national trauma databank

BackgroundBlunt cerebrovascular injury (BCVI) is a rare consequence of blunt trauma. There appears to be benefit to an aggressive approach to screening for BCVI due to catastrophic sequelae of unrecognized injury. However, screening for BCVI carries extensive cost and oncologic risk to young patients. Foundational BCVI studies examined adults primarily, leaving question to the effectiveness of these criteria in children. We sought to evaluate BCVI screening criteria developed in primarily adult populations using a nationally representative pediatric dataset. MethodsWe queried the 2008–2014 National Trauma Data Bank for patients with BCVI. Patients were stratified by age (adults>18yrs, pediatric≤18yrs). Screening factors from the Modified Denver Criteria and Modified Memphis Criteria (GCS≤8, C1C3 cervical fracture, cervical subluxation, seatbelt sign, basilar skull fracture, mid-facial fracture, mandibular fracture, significant blood loss, coma, stroke, and hanging) were examined using univariate analysis and backwards-stepwise logistic regression to verify predictors of BCVI. ResultsBlunt injury occurred in 2,174,244 adults and 422,181 children; 5970 adults and 809 children sustained BCVI. In univariate analysis, all screening factors correlated with BCVI in both groups (p < 0.001). When comparing BCVI patients, children more commonly experienced GCS≤8, seatbelt sign, basilar skull fracture, mid-facial fracture, mandibular fracture, and coma (p < 0.05). In multivariable analysis, seatbelt sign was not associated with pediatric BCVI. ConclusionMany adult-associated BCVI risk factors apply to children. Although children more commonly experience seatbelt sign, it does not independently cause increased BCVI risk. Given the rarity of pediatric BCVI, prospective multi-institutional studies are warranted to establish screening criteria specific to children.

Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units

BackgroundTo evaluate the prevalence, risk factors and treatment of retinopathy of prematurity (ROP) in Turkey and to establish screening criteria for this condition.MethodsA prospective cohort study (TR-ROP) was performed between...

Evaluation of criteria of manual blood smear review following automated complete blood counts in a large university hospital.

BackgroundThere is great interest in reducing the number of automated complete blood counts requiring manual blood smear reviews without sacrificing the quality of patient care. This study was aimed at evaluating and establishing appropriate screening criteria for manual blood smear reviews to improve the performance in a hematology laboratory.MethodA total of 1977 consecutive samples from the daily workload were used to evaluate four sets of screening criteria for manual blood smear reviews to identify samples with positive smear findings. Three sets of screening criteria were arbitrarily proposed in this study: Group 1 (narrow ranges), Group 2 (intermediate ranges), and Group 3 (wide limits) and one set (Group 4) was adapted from the International Society for Laboratory Hematology. All samples were run on Sysmex hematology analyzers and were investigated using manual blood smear reviews. Diagnostic accuracy and agreement were performed for each set of screening criteria, including an investigation of microscopic review rate and efficiency.ResultsThe microscopic review rates for Groups 1, 2, 3 and 4 were 73.85%, 54.52%, 46.33% and 46.38%, respectively; the false-negative rates were 0.50%, 1.97%, 2.73% and 3.95%, respectively. The efficiency and negative predictive values of Group 3 were 73.04% and 4.91%, respectively.ConclusionsGroup 3 had the best relationship between safety (false-negative rate: ≤3%) and efficiency to estimate the limits of automation in performing complete blood counts. This study strengthens the importance of establishing screening criteria for manual blood smear reviews, which account for the different contexts in which hematological determinations are performed. Each laboratory should optimize the screening criteria for manual blood smear reviews in order to maximize their efficiency and safety.

Resident Candidate Interviews: Best Practices

Improving resident selection is of utmost importance. Reviewing the plastic surgery and medical education literature provided information on the types of candidates that we have, those that are most likely to be successful, and what candidates are looking for in a program. It also revealed that >30% of programs have had attrition and >60% placed a resident on probation in the last 10 years, despite a majority of surveyed program directors reporting satisfaction with their current process.1 A review of literature on human resources revealed 2 valuable lessons: screen for the necessary skill set and interview for cultural fit.2 Screening for skill set involves critically reviewing the application for objective data indicative of the skills needed to perform or learn the necessary tasks. For surgery residents, this translates to the ability to pass in-service examinations and boards, perform research, work well as a member of a team, educate subordinates, and exhibit good manual dexterity.3 Screening applications can be delegated to those uninvolved in the interview process to avoid biasing interviewers with the details of an application. The interview is for assessing an applicant’s suitability and fit into existing culture, defined as the values, habits, and beliefs of a society, people, or organization (ie, “the intangibles”). To interview for cultural fit, it is critical to honestly assess the traits valued in your most successful residents and what your program’s culture truly is. Not all programs put the same emphasis on research, interest in global health and international travel, or the ability to blend with the resident cohort. After establishing screening criteria and defining the program’s culture, the interview techniques can be addressed. There is a time and place for individual, panel, and group interviews. A panel interview of 2 to 3 interviewers to-1 interviewee is a high-yield format allowing applicants to meet more faculty and/or resident interviewers and for multiple interviewers to assess the same answers and responses from a candidate and compare reactions, impressions, and assessments. Within the interview, an unstructured, semi-structured, or structured approach may be taken. Semi-structured and structured interviews allow for direct comparison of applicants by an interviewer and provide applicants with a sense of uniformity, organization, and fairness about the process. Behavioral interviewing style questions, where applicants are asked questions about situations or traits and further required to give examples of how they dealt with a problem or achieved a goal or to define their role in a project or on a team, are the recommended means of obtaining information and assessing cultural fit. Once selection is complete, it is imperative to reflect and evaluate. External feedback should and can easily be obtained through surveys to be completed anonymously and placed in sealed envelopes at the completion of the interview day. Internal feedback with analysis of the process and its individual components (screening criteria and ease, flow of interview day, evaluation of the applicants, developing the rank list, and success of matching) should be scrutinized at the completion of each interview season, instead of repeating the same potential mistakes, resting on laurels, or settling for mediocrity.

Controversies in Screening and Diagnosis of Gestational Diabetes: Cuba's Position.

Gestational diabetes is the most common endocrine disorder affecting pregnant women and its prevalence is on the rise. Prevalence in Cuba is about 5.8%, and global prevalence ranges from 2% to 18% depending on the criteria applied. Gestational diabetes can lead to adverse gestational outcomes, such as fetal death, preterm delivery, dystocia, perinatal asphyxia and neonatal complications. Prompt, accurate diagnosis allowing early treatment can benefit both mother and child. The disease is asymptomatic, so clinical laboratory testing plays a key role in its screening and diagnosis. Cuba's approach to diabetes screening and diagnosis differs from some international practices. All pregnant women in Cuba are screened with a fasting plasma glucose test and diagnosed using modified WHO criteria. Some international recommendations are to skip the screening step and instead follow the diagnostic criteria of the Hyperglycemia and Adverse Pregnancy Outcomes study. In Cuba, gestational outcomes for women with diabetes (including gestational diabetes) are satisfactory (preeclampsia 5%; preterm delivery 12%; neonatal macrosomia 7.5%; congenital abnormalities 4.3% and perinatal deaths 4.8%). These data do not indicate a need to change established screening and diagnostic criteria. KEYWORDS Gestational diabetes, screening, diagnosis, early detection, early diagnosis, Cuba.

Screening for Symptoms of Postpartum Traumatic Stress in a Sample of Mothers with Preterm Infants

There are no established screening criteria to help identify mothers of premature infants who are at risk for symptoms of emotional distress. The current study, using data obtained from recruitment and screening in preparation for a randomized controlled trial, aimed to identify potential risk factors associated with symptoms of depression, anxiety and posttraumatic stress in a sample of mothers with premature infants hospitalized in a neonatal intensive care unit. One hundred, thirty-five mothers of preterm infants born at 26–34 weeks of gestation completed three self-report measures: the Stanford Acute Stress Reaction Questionnaire, the Beck Depression Inventory (2nd ed.), and the Beck Anxiety Inventory to determine their eligibility for inclusion in a treatment intervention study based on clinical cut-off scores for each measure. Maternal sociodemographic measures, including race, ethnicity, age, maternal pregnancy history, and measures of infant medical severity were not helpful in differentiating mothers who screened positive on one or more of the measures from those who screened negative. Programs to screen parents of premature infants for the presence of symptoms of posttraumatic stress, anxiety, and depression will need to adopt universal screening rather than profiling of potential high risk parents based on their sociodemographic characteristics or measures of their infant's medical severity.

Opportunistic detection of atrial fibrillation in subjects aged 65 years or older in primare care: a randomised clinical trial of efficacy. DOFA-AP study protocol

BackgroundClinical Practice Guidelines recommend using peripheral blood pulse measuring as a screening test for Atrial Fibrillation. However, there is no adequate evidence supporting the efficacy of such procedure in primary care clinical practice. This paper describes a study protocol designed to verify whether early opportunistic screening for Atrial Fibrillation by measuring blood pulse is more effective than regular practice in subjects aged 65 years attending primary care centers.Methods/designAn cluster-randomized controlled trial conducted in Primary Care Centers of the Spanish National Health Service. A total of 269 physicians and nurses will be allocated to one of the two arms of the trial by stratified randomization with a 3:2 ratio (three practitioners will be assigned to the Control Group for every two practitioners assigned to the Experimental Group). As many as 12 870 patients aged 65 years or older and meeting eligibility criteria will be recruited (8 580 will be allocated to the Experimental Group and 4 290 to the Control Group). Randomization and allocation to trial groups will be carried out by a central computer system. The Experimental Group practitioners will conduct an opportunistic case finding for patients with Atrial Fibrillation, while the Control Group practitioners will follow the regular guidelines. The first step will be finding new Atrial Fibrillation cases. A descriptive inferential analysis will be performed (bivariate and multivariate by multilevel logistic regression analysis).DiscussionIf our hypothesis is confirmed, we expect Primary Care professionals to take a more proactive approach and adopt a new protocol when a patient meeting the established screening criteria is identified. Finally, we expect this measure to be incorporated into Clinical Practice Guidelines.Trial registrationThe study is registered as NCT01291953 (ClinicalTrials.gob)

International eye health: a 20-year perspective

Clare Gilbert has worked as a clinical ophthalmologist for more than 10 years and has an MD in Surgical Retina. She is Professor of International Eye Health at the International Centre for Eye Health and has been a Medical Advisor to Sight Savers International since 1995. Since January 2006, Clare has been Co-Director of the International Centre for Eye Health. Clare is in overall charge of the research undertaken by the Centre and is a member of the School’s ethics committee. Over the last 10 years, the eye group has given technical support for national surveys in Bangladesh, Pakistan and Nigeria, and continues to support the implementation of effective eyecare worldwide. Clare’s recent projects include a national study of the prevalence and causes of blindness in children in Bangladesh, with an emphasis on childhood cataract, and a cohort and nested case–control study of retinopathy of prematurity in Rio de Janeiro, Brazil, to establish screening criteria and to explore risk factors. Ongoing projects include a study to explore the effectiveness of low-vision care for children in three countries in Asia and an intervention study to assess the impact of training neonatal nurses on the outcomes of neonatal care in Brazil, including retinopathy of prematurity.

Combined Assessment of Carotid Vulnerable Plaque, Renal Insufficiency, Eosinophilia, and hs-CRP for Predicting Risky Aortic Plaque of Cholesterol Crystal Embolism

Cholesterol crystal embolism (CCE) is a serious complication of vascular procedures and based on the clinical features of patients with CCE, the aim of the present study was to establish screening criteria for aortic complex plaques (ACP) at high-risk of CCE. For the first study, 10 patients diagnosed as having CCE were recruited. They had prior multiple atherosclerotic disease and a high proportion of complex plaques of the carotid artery and aorta. Elevated levels of high-sensitivity C-reactive protein (hs-CRP), eosinophilia, and renal insufficiency were already recognized before CCE diagnosis. The second study prospectively enrolled 102 patients. ACP is related to CCE and predictive criteria of ACP were established. Among 19 patients with ACP, 2 presented with CCE. Multivariate analysis revealed carotid complex plaque, eosinophilia and multiple atherosclerotic risk factors as independent predictors of ACP. The criteria including these factors (multiple atherosclerotic risk factors, carotid complex plaque, hs-CRP > or =0.2 mg/dl, eGFR < or =60 ml . min(-1) . 1.73 m(-2), eosinophil count > or =400 /microl) could detect patients with ACP with 95% sensitivity, 94% specificity, and 79% positive predictive value. Multiple atherosclerotic risk factors, elevated hs-CRP, renal insufficiency, eosinophilia before CCE diagnosis and carotid complex plaques were features of patients with CCE. Diagnostic criteria including these characteristics effectively predict ACP patients at high-risk of CCE. (Circ J 2010; 74: 51 - 58).

Screening for Constipation in Palliative Care Patients

The objective of this study was to establish screening criteria for constipation in palliative care and, subsequently, to determine data for diagnostic suspicion of constipation in a palliative care population. Also we investigate the incidence of fecal impaction in the same sample of palliative care patients. A descriptive, multicenter cross-sectional study was done. All patients in active care by a group of hospital and home palliative care teams were studied. A questionnaire on signs (frequency and consistency of stools) and symptoms (pain, discomfort, or a sensation of incomplete evacuation when having a bowel movement) of constipation in last weeks, and a verbal numerical scale (VNS) (0-10) on discomfort or difficulty with constipation was completed by the patients. The patients were asked about impaction in the last 3 months. One hundred twenty patients from 21 palliative care teams were included; the majority of patients received opiates (66%) and also laxatives (60%). Bowel movement rate less than three stools per week was found in 13% of patients, stools harder than normal were experienced in 24% patients, and 33% exhibited pain, discomfort, or sensation of incomplete evacuation. Of the patients studied 13% had some signs of habitual constipation but they did not complain of symptoms, others (17%) had some discomfort in spite of not having signs of constipation. As screening criteria for constipation in palliative care we elected to include indistinct presence of constipation symptoms or constipation signs in recent weeks. A diagnosis of suspicion of constipation was established in almost 1 of 2 patients (48%) of our palliative care population. VNS with cutoff point of 3 or more of 10, showed a sensitivity of 0.70 and a specificity of 0.74 and positive predictive value (PPV) of 73% positive and negative predictive value (NPV) of 70%. In addition to these findings a considerable number of our palliative care patients (20%) reported episodes of fecal impaction in the last 3 months. The screening for constipation in palliative care should be performed exploring subjective symptoms and other objective signs. A diagnosis of suspected constipation was found in almost half of the palliative care patients studied. A VNS of constipation did not produce good predictive values for the detection of constipation in our sample.

Modification of Screening Criteria for Retinopathy of Prematurity in India and Other Middle-Income Countries

To determine the gestational age and birth weight of premature babies who developed vision-threatening severe retinopathy of prematurity. Prospective observational study of babies at risk of blindness due to retinopathy of prematurity. Data pertaining to all babies who underwent laser treatment or surgery for acute retinopathy of prematurity and those who had cicatricial retinopathy of prematurity were prospectively collected. The gestational age and birth weight were evaluated to establish screening criteria. In 120 babies, the mean gestational age was 29.6 weeks (range 26 to 36 weeks). The birth weight of 115 babies ranged from 710 to 2000 g (mean 1254.5 g, SD 280.8). Birth weight was not available for five babies. Only one baby had a gestational age of >35 weeks. Ocular morbidity related to retinopathy of prematurity was seen in bigger and more mature babies. This study provides a scientific basis for establishing screening criteria for retinopathy of prematurity in South India and other middle-income countries.