Hospital-based Screening Program Research Articles

Newly diagnosed lung cancer in hospitalized patients during the COVID-19 pandemic: How well are LDCTs utilized?

10624 Background: Medicare covers the cost of lung cancer screening in individuals aged 50-77 years with a high-risk smoking history. The COVID-19 pandemic caused a decrease in outpatient visits and cancer screenings. The objective of this study was to provide a comparison between the multitude of lung cancer diagnoses upon presentation to the hospital predating and during the COVID-19 pandemic in patients with varying insurance types. Methods: We retrospectively reviewed fifteen hospitals in West Florida with newly diagnosed lung cancer during the pre-pandemic period from March 2019-August 2020 and the pandemic period from March 2020- August 2021. These patients were split into subcategories based on insurance type: private medical insurance; Medicare; Medicaid; no insurance; and other. The chi-square test was used for statistical analysis. Results: A total of 1409 inpatients, 676 during the pre-pandemic and 733 during the pandemic, were identified with a new diagnosis of lung cancer upon presentation to the hospital. 74% of the pandemic population and 77% of the pre-pandemic population were patients insured with Medicare. Hospitals without LDCT screening programs were found to have 317 lung cancer diagnoses during the pre-pandemic period and 292 during the pandemic period. Hospitals with LDCT screening programs were found to have 359 lung cancer diagnoses during the pre-pandemic period and 441 during the pandemic period. Chi-square tests comparing pre-pandemic to pandemic did not show a p-value of statistical significance. Conclusions: A substantial number of patients with Medicare were newly diagnosed with lung cancer during the pre-pandemic and pandemic periods compared to patients with other insurance types. Although Medicare provides LDCT screening for lung cancer in high-risk populations at no out-of-pocket cost, about 75% of West Florida’s patients were diagnosed with lung-cancer upon presentation to the hospital. Hospitals with LDCT screening programs had an increase in cancer diagnoses during the pandemic, consistent with prior research data. Instead, the pandemic did not seem to affect hospitals without LDCT screening programs. We need to address the barriers in implementation of LDCT hospital-based screening programs to increase early diagnoses and decrease hospitalization diagnoses, leading to improved lung cancer mortality. [Table: see text]

Active and latent TB screening in recently arrived persons from Afghanistan: feasibility and lessons learned

We describe an active and latent tuberculosis (TB) screening programme undertaken in Manchester, UK in response to the arrival of a cohort of refugees from Afghanistan. In total, 217 adults and 347 children were offered screening, which involved a symptom questionnaire, Mantoux test or interferon gamma release assay, blood-borne virus screening and a chest X-ray in participants over the age of 11. We found a latent TB infection (LTBI) rate of 15% in adults and 1.5% in children, which is lower than global LTBI estimates. One case of active TB was detected. Screening was undertaken in the hotels where participants were temporarily housed, leading to high participant engagement levels. Attendance rates were almost doubled compared with a previous hospital-based screening programme. Hotel-based screening for TB presented several challenges, including transfer of information and results to secondary care. Understanding these challenges and learning from the programme has helped us refine our screening protocol to optimise migrant TB screening in Manchester in the future.

CORRELATION OF PAP SMEAR AND COLPOSCOPIC FINDING WITH DIRECTED BIOPSY TO ASSESS THE ADVANTAGE OF CONCURRENT TESTING BY CYTOLOGY AND COLPOSCOPY IN THE DETECTION OF CERVICAL NEOPLASM

Background: Cervical cancer was the second most common cancer among women 15-44 years of age and in 2018 it was the fourth most frequent cancer and cause of cancer death among all women in the world
 Methods:Women (18-65 yrs) attending Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur were recruited for study. After applying inclusion and exclusion criteria written and informed consent were taken from all study participants
 Results: On histopathology report we found that 10% had normal inflammation followed by 9.33% had carcinoma in situ, 8% had CIN-2, 6.67% had CIN-1, 5.67% had CIN-3 and Squamous cell carcinoma each.
 Conclusion: Pap smear and colposcopy both the tests can be used to complement each other in a hospital based screening programme, where facilities for both modalities are available. Hence use of single visit approach in which cytology, colposcopy and guided biopsy all are done in single sitting, and treated accordingly in resource poor countries like ours will enable maximal utilization of scarce medical resources.
 Keywords: Pap smear, CIN, Cervical cancer

Evaluation of the VITEK 2 Advanced Expert System performance for predicting resistance mechanisms in Enterobacterales acquired from a hospital-based screening program.

There is limited literature examining the accuracy of the VITEK 2 Advanced Expert System (AES) in characterisation of β-lactamase resistance patterns. We present a prospective single centre study to better ascertain the performance characteristics of this program. The VITEK 2 AES interpretation was compared to established laboratory phenotypic methods. The overall sensitivity for detection of broad-spectrum β-lactamase by the AES was 95%, with a specificity of 78%. One or more discrepancies were noted in 36% of samples, with the majority of these (87/100) due to incorrect 'overcall' of a resistance mechanism. AES characterisation of AmpC resistance mechanisms was excellent. In contrast, the AES had poor specificity in classifying extended spectrum β-lactamases (ESBLs). As a screening aid, the AES can be a valuable tool. However, optimal use requires an adequate working knowledge of resistance mechanisms in order to correctly interpret and accept the result output.

Screening and linkage to care for hepatitis C among inpatients in Georgia's national hospital screening program

The country of Georgia initiated an ambitious national hepatitis C elimination program. To facilitate elimination, a national hospital hepatitis C screening program was launched in November 2016, offering all inpatients screening for HCV infection. This analysis assesses the effectiveness of the first year of the screening program to identify HCV-infected persons and link them to care. Data from Georgia's electronic Health Management Information System and ELIMINATION-C treatment database were analyzed for patients aged ≥18 years hospitalized from November 1, 2016 to October 31, 2017. We described patient characteristics and screening results and compared linked-to-care patients to those not linked to care, defined as having a test for viremia following an HCV antibody (anti-HCV) positive hospital screening. Of 291,975 adult inpatients, 252,848 (86.6%) were screened. Of them, 4.9% tested positive, with a high of 17.4% among males aged 40–49. Overall, 19.8% of anti-HCV+ patients were linked to care, which differed by sex (20.6% for males vs. 18.4% for females; p = .019), age (23.9% for age 50–59 years vs. 10.7% for age ≥ 70 years; p < .0001), and length of hospitalization (21.8% among patients hospitalized for 1 day vs. 16.1% for those hospitalized 11+ days; p = .023). Redundant screening is a challenge; 15.6% of patients were screened multiple times and 27.6% of anti-HCV+ patients had a prior viremia test. This evaluation demonstrates that hospital-based screening programs can identify large numbers of anti-HCV+ persons, supporting hepatitis C elimination. However, low linkage-to-care rates underscore the need for screening programs to be coupled with effective linkage strategies.

An early-detection programme for prostate cancer in Saudi men: A call from a tertiary-care centre in the Eastern province

ObjectiveTo review the mode of presentation and clinical course of patients with prostate cancer during a specified period, as the detection rate is tending to increase, with most patients presenting at an advanced stage, and yet the overall incidence and prevalence rates are low. Patients and methodsWe retrospectively reviewed all aspects of care for patients who were diagnosed between May 2006 and July 2010. ResultsIn all, 76 men had a histologically confirmed prostatic adenocarcinoma diagnosed between May 2006 and July 2010 (mean age 71.1years, SD 8). The median (range) prostate-specific antigen level at diagnosis was 52 (1.2–16,230) ng/mL. Of the patients, 74% had a Gleason grade of⩾7 on diagnosis, and 64% had extraprostatic disease on presentation. Active surveillance was adopted in four patients, and four others were maintained on watchful waiting. Six patients had a radical prostatectomy, in one of whom it was a salvage procedure. Six patients received external-beam radical radiotherapy, five of whom had neoadjuvant, concurrent and adjuvant hormonal therapy. All remaining patients were treated primarily with androgen-deprivation therapy (ADT). Of the patients on hormonal manipulation, in 56% the cancer became castrate-resistant within the mean (SD) follow-up of 17.2 (15) months. Of patients treated primarily with ADT, 34% died. The death rate among the whole group was 23%. Both percentages include both prostate cancer-specific and non-specific mortality. ConclusionAn advanced stage of disease at presentation mandates an early-detection, hospital-based screening programme. Further research should include many more patients and be based in several centres.

The Prevalence and Characterization of β-Thalassemia Trait by Using High-Performance Liquid Chromatography among the Rural Population in West Bengal, India

Hemoglobinopathies, common genetic disorders of hemoglobin, can be prevented by population screening and genetic counseling. Identification of these disorders is immensely important epidemiologically and aid in prevention of more serious hemoglobin disorders. Thalassemia is the commonest monogenic disorder in India, which belongs to the thalassemia belt of the world. The present study was undertaken to find out the characteristics of β-thalassemia trait and spectrum of this disorder among the rural population, screened under the hospital-based screening program in West Bengal, a state in eastern part of India. This study was carried out in school and college students, newly married couples and pregnant women after proper counseling in the rural areas of five southern districts of this state. Blood samples were tested by high-performance liquid chromatography. Total 1429 β-thalassemia traits were detected by random screening from this population. The mean value of HbA2 of the study population, having β-thalassemia trait is 4.9%. The prevalence (10.5%) of β-thalassemia trait in West Bengal is higher than other parts of the country. These data are likely to help us in future planning for screening programmes in rural areas of West Bengal, India.

Screening for thalassemia and other hemoglobinopathies in a tertiary care hospital of West Bengal: Implications for population screening

Hemoglobinopathies are common genetic disorders of hemoglobin, which can be prevented by population screening and offering genetic counseling. In absence of population-based screening for hemoglobinopathies, the hospital-based diagnosis register provide idea about the extent of problem in the community. The present study was undertaken to find out the burden of hemoglobinopathies and spectrum of this disorders among the population who were screened in the hospital-based screening program. A record-basedanalysis of subjects who underwent screening for hemoglobinopathies in Burdwan Medical College and Hospital over a period of 3 years and 4 months revealed that overall 29.3% of subjects were positive for hemoglobinopathies. Beta thalassemia heterozygous was the most commonhemoglobinopathy in this region closely followed by hemoglobin E heterozygous. In view of high prevalence of hemoglobinopathies in this region, a routine premarital screening program is needed for identification and prevention of high-risk marriages.

Screening for abdominal aortic aneurysms: An analysis of the private and indirect costs in a hospital-based screening program

The goal was to determine the private and indirect costs in a hospital based screening programme for abdominal aortic aneurysm (AAA) in five local hospitals in Viborg County, Denmark. As part of a prospective randomized screening program for AAA, all screened 65-year-old men in 1998 were asked to fill in a short questionnaire before leaving the screening location. Data were collected upon work, travelling and time spent. Total private costs were calculated and comparisons was made between the hospitals. All 389 screened patients answered the questionnaire. Only 76 (20%) of the men were still working, and 54 of them had been absent from work an average of 1.5 hours to attend screening, however none of them had suffered pay loss. On average all patients travelled 25 kilometers. The mean travel costs, excluding time spent driving, was 34 DKr per attender. 10% were accompanied to the hospital, but only 1% claimed it was necessary. The total mean time required for screening was 40 minutes, and the largest part of this time was spent at travelling (35 minutes). The total private and indirect costs including travelling and the estimated production loss were in average 76 DKr per attender. No correlations were found between the extent of private costs and attendance rates at the various screening locations. The private and indirect costs seem to be high compared to the direct cost per scan, and should be considered in the final costs-effectiveness analysis.

Cord Blood Thyroxine and Thyroid Stimulating Hormone Screening for Congenital Hypothyroidism: How Useful Are They?

To determine and compare the usefulness of cord blood screening for free thyroxine (FT4) and thyroid stimulating hormone (TSH). There is a vast amount of literature on capillary heel prick screening tests, but relatively little on cord blood testing particularly FT4. For a decade all infants born at Tawam Hospital had cord blood FT4 and at Oasis Hospital cord TSH measured through the hospital-based screening programme. On January 1st 1998, the national screening programme (NSP) for congenital hypothyroidism (CH) in the United Arab Emirates (UAE) started using capillary TSH measurement (Delfia method). Since then newborns in both hospitals have been screened both ways, i.e. cord blood and capillary blood screening. We reviewed retrospectively all infants born from January 1998 until the end of June 2004 with CH who had double screening: cord FT4 or TSH and 4th-5th day TSH screening. Thirteen infants (one in 1,778) had CH in Tawam Hospital. In six of these the cord blood FT4 was low (<9.1 pm/l) (0.73 ng/dl) and in seven the cord blood FT4 was normal, i.e., over half were missed. Eight infants (one in 1,198) had CH in the Oasis Hospital. Cord blood TSH was high in six of them (>13 IU/l) and two were normal. Cord FT4 detected the most severe cases, but missed most others. Cord TSH detected six out of eight cases, but there was a recall rate of one in 23. Cord FT4 identifies only infants with severe CH. Cord TSH is more sensitive than cord FT4 screening. Capillary TSH dried blood spot testing on the 3rd-5th day is the most sensitive method.

Age trends in pre‐cancerous and cancerous lesions of the uterine cervix in a cytology screening programme: what should be the target age group for a major thrust of screening in resource‐limited settings?

To identify the target age group where screening efforts may be concentrated in order to reduce the incidence of cervical cancer in resource-limited countries. The results of cyto-screening in a hospital-based screening programme for early detection of cervical cancer were analysed retrospectively. The frequency of epithelial cell abnormalities (ECAs) was computed in different age groups. A total of 5.6% ECAs were detected on cyto-screening. The peak age incidence for squamous intraepithelial lesions (SILs) was in the 30-39 age group while that for malignancies was age >60 years. The mean ages for LSIL, HSIL and cancer were 34.7, 37.7 and 51.8 years respectively. Around 43% LSILs and 48% HSILs presented in the fourth decade. If both fourth and fifth decade are covered by screening we could detect almost two-thirds of SILs. A distinct latent period of more than a decade between the onset of SIL and development of frank cancer provides us with ample opportunity to prevent cervical cancer through screening. Our data validate the WHO recommendation of once in a lifetime screening of women in their fourth decade, for low-resource settings. If resources permit, screening can be extended to include women in the fifth decade. This approach would enable us to pick up maximum SILs within the available resources and prevent their progression to cancer.

Spectrum of epithelial cell abnormalities of uterine cervix in a cervical cancer screening programme: Implications for resource limited settings

Objective (1) To compute the frequencies and peak age incidences of epithelial cell abnormalities (ECA) of uterine cervix in a cytology-based screening programme and (2) to analyze the comparative frequencies of squamous intraepithelial lesions (SIL) and malignancies in age groups <40 and ≥40 years, in order to assess the implications for screening protocol in resource limited settings. Study design Pap smears form 29,475 women were cytologically screened over a 4-year period as a part of hospital-based screening programme. The frequencies, peak age incidences and mean age of various ECA detected were computed. The data was further stratified in to age groups <40 (Gp 1) and ≥40 (Gp 2) and comparative profile of the lesions was analyzed. Results On cytologic screening of the smears 5.6% ECA were detected. Atypical squamous cells-undetermined significance (ASC-US) and low grade SILs (LSIL) were diagnosed more frequently in Gp 1 ( p < 0.001) while atypical glandular cells (AGC) and malignancies were more significantly more frequent in Gp 2 ( p < 0.001). The frequency of HSIL was similar in the two groups. The SILs predominated in the fourth decade while the malignant lesions were most frequent in age >50 years. The mean age for LSIL and HSIL was 34.7 and 37.7 years, respectively, while for malignancy it was 51.8 years thus corroborating the hypothesis that a prolonged latent phase exists between the precursor lesions and the onset of invasive cancer. Conclusions Since the goal of any screening programme should be to pick up majority of the precursor lesions and not frank cancers, it is desirable to initiate screening before 40 years of age. The WHO recommendation of once in a life time screening between 35 and 40 years of age seems appropriate for resource limited settings like ours.

Metabolic syndrome and chronic kidney disease in Okinawa, Japan

We assessed the prevalence of chronic kidney disease (CKD) in a hospital-based screening program in Okinawa, Japan. The significance of metabolic syndrome as a determinant of CKD was examined using multivariate logistic regression analysis. A total of 6980 participants, aged 30-79 years, participated in a screening program in Tomishiro Chuo Hospital. Metabolic syndrome was defined according to the criteria of the Adult Treatment Panel III (ATP III). Data were also analyzed according to the modified criteria of the National Cholesterol Education Program (NCEP) that defines abdominal obesity as a waist circumference of > oe =85 cm in men and > or =90 cm in women. CKD was defined as dipstick proteinuria (> or =1+) or a reduced glomerular filtration rate (GFR). GFR was estimated using the abbreviated Modification of Diet in Renal Disease (MDRD) formula. The prevalence of metabolic syndrome and CKD was 12.8 and 13.7%, respectively. Metabolic syndrome was a significant determinant of CKD (adjusted odds ratio (OR) 1.537 and 95% confidence interval (CI) 1.277-1.850, P<0.0001). The adjusted OR (95% CI) was 1.770 (1.215-2.579, P=0.0029) for those with four metabolic syndrome risk factors compared to those with no metabolic syndrome risk factors. Metabolic syndrome was a significant determinant for younger participants (<60 years; OR 1.686, 95% CI 1.348-2.107, P<0.0001), but not for older participants (> or =60 years; OR 1.254, 95% CI 0.906-1.735, NS). The relationship between the number of metabolic syndrome risk factors and the prevalence of CKD was linear using the modified criteria. The results suggest that metabolic syndrome is a significant determinant of CKD in men under 60 years of age, in Okinawa, Japan.

A hospital-based screening program for natural rubber latex allergy

Natural rubber latex (NRL) allergy has become an important occupational health problem for health care workers, of whom approximately 10% are reportedly sensitized. Some medical facilities have chosen to convert entirely to NRL-free gloves, but others have found this to be financially or logistically unfeasible. The goals of this study were 1) to devise a NRL allergy screening program that could identify sensitized (at-risk) employees for the purpose of providing them with a safe working environment; and 2) to develop a glove conversion plan that would lead to the removal of all NRL gloves from the institution. A multidisciplinary University of Maryland Medical System NRL risk team developed a mandatory NRL screening program for all newly hired employees and any existing employees transferring into or within patient care positions. Employees were screened with a clinical questionnaire and a serology for immunoglobulin (Ig)E anti-NRL. Some employees voluntarily received an experimental NRL skin test to evaluate their skin reactivity to NRL. Each employee reporting respiratory or systemic symptoms associated with NRL exposure was evaluated by an allergist. During the 15-month study period from April 1998 to July 1999, 1,795 employees were screened for NRL allergy. Of the whole group, 8% (144 of 1,795) were NRL-specific IgE antibody-positive by CAP radioallergosorbent test (Pharmacia-Upjohn Diagnostics, Kalamazoo, MI) and/or NRL skin test, 57.3% of whom reported symptoms with powdered NRL glove exposure. The NRL IgE-positive rates of nonpatient-care employees (who did not use NRL gloves on a regular basis) and direct patient-care employees was 5.9% and 8.6%, respectively. Most NRL-sensitized employees were successfully accommodated with the use of synthetic gloves and continued to work in the positions for which they were hired. The University of Maryland Medical System NRL screening program has been successful in identifying at-risk employees and ensuring them a safe working environment during a progressive conversion of the hospital to a NRL-safe environment.

Screening for Abdominal Aortic Aneurysms: An Analysis of the Private and Indirect Costs in a Hospital-based Screening Program

Screening for Abdominal Aortic Aneurysms: An Analysis of the Private and Indirect Costs in a Hospital-based Screening Program

Screening for abdominal aortic aneurysms: An analysis of the private and indirect costs in a hospital-based screening program

Screening for abdominal aortic aneurysms: An analysis of the private and indirect costs in a hospital-based screening program

Nuclear grooves in intermediate cells in cervical smears

One thousand cervical smears from women who took part in a hospital-based screening programme for early detection of cervical cancer were studied for the presence of nuclear grooves. Grooved nuclei were frequently detected in intermediate cells in all phases of the menstrual cycle, although their frequency of occurrence was slightly lower in the luteal and premenstrual phases. The mean number of nuclear grooves varied from 3.6 to 4.2 in different phases of the menstrual cycle. The differences, however, were not statistically significant. The presence of nuclear grooves in cervical cells appears to be a nonspecific finding at present.

Automated auditory brainstem response in neonatal hearing screening.

Severe congenital hearing impairment is an important handicap affecting 0.1% of apparently healthy liveborn infants and 1-2% of graduates of neonatal intensive care units. The prognosis for intellectual, emotional, language and speech development in the hearing-impaired child is improved when the diagnosis is made early and intervention is begun before the age of 6 mo. Universal screening is preferable, since about 50% of infants with hearing loss are not discovered if neonatal hearing screening is restricted to high-risk groups. The automated auditory brainstem response (AABR) screener is a dedicated hearing screening device which provides information not only about the outer/middle ear and cochlea but also about the auditory pathway up to the brainstem. AABR has an agreement with conventional auditory brainstem response up to 98%. It uses a 35 dB near hearing level click. No operator interpretation is needed and it can be used on the ward and during oxygen therapy without disturbance from ambient noise. Reported referral rates in a hospital-based screening programme at the time of discharge vary, with an average of 4%. AABR has also been used in a home-based setting, with the same results. The time necessary for screening varies with the setting, but ranges from 4 to 15 min. Initial costs range from $15 to $25 per test, which is similar to neonatal screening for metabolic diseases. In addition to individual healthcare savings, early diagnosis may lead to savings on costs of intensive speech-language intervention and educational facilities.

The quality of photographs produced by the non-mydriatic fundus camera in a screening programme for diabetic retinopathy: a 1 year prospective study.

A prospective study was performed on the quality of photographs produced by the non-mydriatic fundus camera used in a hospital-based screening programme for diabetic retinopathy. In 1 year 981 binocular patients were photographed. A photograph of acceptable quality was obtained from 90.5% of eyes and 84.4% of patients had an acceptable photograph of both eyes. The photograph of the second eye was more often unacceptable than that of the first. This tendency was significant in females (p = 0.0196) and when considering the sexes together (p = 0.0044), but not significant in males (p = 0.1042). Photographs of unacceptable quality were obtained significantly more often in patients aged over 55 years for both right and left eyes (p = 0.001). An overall improvement in photographic quality might be achieved by allowing full recovery of flash-induced pupil constriction before taking the second photograph and by dilating those aged over 55 years.