Mass Screening Program Research Articles

4. 先天性代謝異常マススクリーニング'治療について : 先天性代謝異常マススクリーニングの展望

4. 先天性代謝異常マススクリーニング'治療について : 先天性代謝異常マススクリーニングの展望

A cytological study of leukoplakia in oral cavity at Patliputra Medical College and Hospital, Dhanbad

Objectives: To assess the role of cytology in leukoplakia and its etiology in patients attending outpatient department at Patliputra Medical College and Hospital (PMCH), Dhanbad, Jharkhand, India. Materials and Methods: The diagnosis of leukoplakia was based on clinical examination and cytological smear. Results: The total number of patients affected by leukoplakia in this time duration was 268. Of these, 238 (86%) were male, whereas 30 were female (14%). Greatest proportion of patients with leukoplakia had a habit of consuming khaini and tobacco in other forms. Mild form of leukoplakia was commonly seen. Conclusion: This study reveals that the incidence rate of leukoplakia in patients visiting PMCH, Dhanbad, was 1%. Males were more affected than females. Use of cytology in mass screening programs helped in identifying leukoplakias with parakeratotic patterns and leading to those cases, which need careful long-term follow-up.

Prevalence of prediabetes in apparently healthy population of Tehsil Kangra and adjoining areas

Background: More than 50% of the diabetes mellitus (DM) subjects in India remain unaware of their diabetic status. The aim of the study was to screen and identify apparently healthy individuals for impaired glucose tolerance in Tehsil Kangra and adjoining areas of Himachal Pradesh, India.Methods: Cross sectional study with 80 apparently healthy subjects in the age group of 30 to 70 years were taken. Anthropometric parameters viz. weight, height and waist circumference of subjects were measured. Whole blood sample was used for estimation of glycosylated hemoglobin (HbA1c) and serum sample for fasting blood sugar (FBS) and some lipid parameters.Results: The prevalence of prediabetes in apparently healthy population was found to be 25%. Additionally, a significant increase was observed in the FBS levels in prediabetics as compared to healthy subjects. However, no significant change was observed in the mean body mass index (BMI), mean body surface area (BSA), waist to height ratio (WHtR) and lipid parameters between prediabetics and healthy subjects.Conclusions: The burden of prediabetes in apparently healthy subjects of Tehsil Kangra and adjoining areas was found to be 25% and this urgently calls for mass awareness and screening programmes to identify and overcome DM.

Clinical Breast Examination Campaign: Experience From Thiruvananthapuram, South India

Background and context: Thiruvananthapuram has the highest breast cancer incidence in India and majority of cases are detected late pointing to the inefficiency of early detection programs. Primary health care providers do not advise regarding regular screening and most women never resort to any screening practices. Mammogram is not cost-effective and clinical breast examination (CBE) is not popular as a screening modality in our population. Aim: To describe the conduct, utilization and outcome of mass screening program conducted in Thiruvananthapuram. Strategy: A mass screening program with media publicity to motivate organizations and residential associations was planned. CBE was conducted by one of the five lady doctors who were trained by an expert breast surgeon at a tertiary care center to detect suspicious lumps. All suspicious cases referred to experts who would further evaluate the cases at a clinic outside the tertiary care center. Advocacy and expert service at accessible sites and availability of expert service outside the tertiary care center at convenient timings improved the acceptance of screening. Intersectoral coordination, community participation, accessible expert services and appropriate technology were followed. Program/Policy process: 9942 women had CBE along with breast awareness in 101 camps over 66 days and it was probably “the first ever marathon breast cancer screening campaign” in the world. Sociodemographic variables, details regarding previous screening, breast symptoms and known risk factors were collected. Anyone with suspicious findings was referred to experts. Outcomes: 868 (8.73%) women with suspicious findings were referred to experts who advised 258 mammograms and confirmed breast cancer in 16 women (1.61 per 1000 women). Mean age was 45.46 years. 82.5% had screening for the first time. Uniformity in examination, three levels of screening and minimum utilization of diagnostic procedures makes this campaign distinct from others. All participants are kept on follow-up through a free clinic maintained by a nonprofit NGO in Thiruvananthapuram. Effective planning and selfless service along with coordinated effort of an apex institution (Regional Cancer Centre, Thiruvananthapuram), a private medical college (Sree Gokulam Medical College, Thiruvananthapuram) and media partners were the key to success. What was learned: Early detection of breast cancer is possible by CBE, provided women can be motivated for regular screening and adequate expertise is available. CBE campaigns can improve screening behavior and breast awareness among women. Primary health care providers and mass media could educate women regarding the benefits of breast awareness and motivate them for regular screening. Proper referral system including certified intermediate referral centers should be in place to ensure the success of early detection by CBE.

Comparison of Measurement of Intraocular Pressure between Goldmann Applanation Tonometer and Non-Contact Air Puff Tonometer

Objective: To compare measurement of intraocular pressure between Goldmann Applanation Tonometer and Non-Contact Air Puff Tonometer. Study Design: Clinical Observational Study. Place and Duration of Study: This study was carried out at Out Patient Department of Ophthalmology, Khairpur Medical College Hospital, Khairpur Mir�s from January 2017 to March 2017. Methodology: In this Clinical Observational Study, intra ocular pressures of 400 eyes of 200 patients, Male 125 (250 eyes) and Female 75 (150 eyes) with age ranging from 20 to 70 years, were measured by Goldmann Applanation Tonometer (GAT) and Non-Contact Air Puff Tonometer (APT), results and differences were noted. Results: The mean IOP was 16mmHg (SD = 6 mmHg) measured by APT and 13mmHg (SD = 3 mmHg) measured by GAT. The calculated difference between APT and GAT was 3 � 2.5 mmHg. Pressure taken by APT was slight high (i.e. around 3 mmHg). Conclusion: Air Puff tonometry gives slightly higher results (about 3mmHg) but is safe and easy than Goldmann Applanation tonometer. There is no fear of spread of infection and can be used easily in mass screening programs. Key Words: Goldmann Applanation Tonometer, Air-Puff non-contact Tonometer, Intraocular pressure, Glaucoma.

Should sex differences be considered when applying mathematical indices and formulas for discriminating β- thalassemia minor from iron deficiency?

Backgroundβ-thalassemia minor (BTM) and iron deficiency (ID) are common disorders characterized by microcytosis and/or hypochromasia, leading to a challenge in their discrimination during mass-screening programs especially in developing countries where resources are limited. It has been shown with varying reliability that quick exclusion of either disorder could be achieved mathematically using RBC-based indices and formulas. However, none of these proposed indices and formulas considered the sex-based hematological differences. This comparative retrospective study examined the efficacy of using sex-based RBC indices in the mathematical discrimination BTM and ID in adult males and females. MethodsThe CBC of randomly selected eight hundred adults diagnosed with BTM or ID (200M & 200F BTM, and 200M & 200F ID) were used in the comparisons. The discrimination power, in terms of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and Youden index were calculated for all subjects and separately for males and females for 20 mathematical indices and formulas. ResultsData revealed significant differences in the RBC-based indices between males and females for both BTM and ID groups. Significant variation in reliability indicators for the different indices and formulas were discovered between males and females samples. ConclusionSex-based indices and formulas are necessary to improve the reliability in mathematically discriminating between BTM and ID in mass screening programs. We also advocate for a large–scale multicenter study to establish the parameters of such indices and formulas with sex and age.

A preliminary analysis of factors affecting the knowledge of parents on Neonatal Mass Screening programs

A preliminary analysis of factors affecting the knowledge of parents on Neonatal Mass Screening programs

Saudi lung cancer prevention and screening guidelines.

BACKGROUND:While lung cancer is the leading cancer cause of death, it is largely preventable. Furthermore, early diagnosis enhances the chance of cure. Therefore, we developed guidelines for lung cancer prevention and early detection.METHODS:A multidisciplinary team of experts in lung cancer representing different health-care sectors was assembled based on the National Cancer Center request and in coordination with the Saudi Lung Cancer Association of Saudi Thoracic Society. The team reviewed various reliable international guidelines and the data and experience in the Kingdom and formulated guidelines that address the primary and secondary prevention approaches in lung cancer, including tobacco control, early diagnosis, and lung cancer screening.RESULTS:The team developed guidelines to assist healthcare professionals in the Kingdom manage the different aspects of lung cancer prevention. Primary prevention through tobacco control: the recommendations encourage all healthcare professionals in all practice settings to screen their patients for smoking and to provide counseling and if needed referral to smoking cessation programs for current smokers. For early diagnosis of patients with symptoms suspicions of lung cancer, it is expected standard of care to investigate, work up, and refer the patients appropriately. Mass screening of patients at high risk for developing lung cancer: the recommendations listed the program requirements, eligible patients, and algorithm to manage findings. However, the team does not recommend that national screening program be mandated or implemented for lung cancer at this stage until more data and studies provide stronger evidence to justify adopting a national program.CONCLUSIONS:Physicians can play an important role in preventing lung cancer by tobacco control and also detect lung cancer at earlier presentation. However, national mass screening programs require further study.

Automated DR and prediction of various related diseases of retinal fundus images

An Automated DR system is developed and prediction of various related diseases are analyzed. Digital Retinal Fundus image is analyzed for the classification of various stages of Diabetic Retinopathy (DR). This imparts much importance, since many of systemic organs disease are related to the developmental stages of DR and those could be predicted well in advance, by analyzing the fundus image itself which is a cost effective technique. This kind of cost effective automated system is needed for mass screening programs in the developing nations. The system is tested on the database obtained from a private hospital in Tamilnadu, which consists of 196 images of different diagnoses. The system outputs are validated with the Expert ophthalmologist’s ground truth images. The proposed method involves three main phases. In the first phase is preprocessing steps are done followed by next phase of removal of normal features with extraction of abnormal features and its statistical values. The third phase is classification stages which includes mild, moderate to severe, severe PDR and neovascularization etc. using neural network. The proposed method has achieved a sensitivity, specificity and accuracy as 94.87%, 90% and 93.22%. The automated detection and classification method surely gives an important and promising data and information to the doctors for further progress in the treatment.

Patient navigation to reduce social inequalities in colorectal cancer screening participation: A cluster randomized controlled trial.

Despite free colorectal cancer screening in France, participation remains low and low socioeconomic status is associated with a low participation. Our aim was to assess the effect of a screening navigation program on participation and the reduction in social inequalities in a national-level organized mass screening program for colorectal cancer by fecal-occult blood test (FOBT). A multicenter (3 French departments) cluster randomized controlled trial was conducted over two years. The cluster was a small geographical unit stratified according to a deprivation index and the place of residence. A total of 14,556 subjects (72 clusters) were included in the control arm where the FOBT program involved the usual postal reminders, and 14,373 subjects (66 clusters) were included in the intervention arm. Intervention concerned only non-attended subjects with a phone number available defined as the navigable population. A screening navigator was added to the usual screening organization to identify and eliminate barriers to CRC screening with personalized contact. The participation rate by strata increased in the intervention arm. The increase was greater in affluent strata than in deprived ones. Multivariate analyses demonstrated that the intervention mainly with phone navigation increased individual participation (OR=1.19 [1.10, 1.29]) in the navigable population. For such interventions to reduce social inequalities in a country with a national level organized mass screening program, they should first be administered to deprived populations, in accordance with the principle of proportionate universalism. ClinicalTrials.gov Identifier: NCT01555450.

Prevalence of type 2 diabetes using Indian diabetes risk score and its risk factors in a rural area of Tamil Nadu, India

Background: Currently the number of cases of diabetes worldwide is estimated to be around 150 million. This number is predicted to double by 2025, with the greatest number of cases being expected in China and India. In countries like India, there is also a lack of awareness about the existing interventions for preventing diabetes and the management of complications. This underscores the need for mass awareness and screening programs to identify and overcome the burden due to diabetes in India. The aim and objectives of the study was to find out the people at risk of developing diabetes using a simple risk factor scoring in a rural area in Tamil NaduMethods: A community based cross-sectional study was carried out from June 2016 to August 2016 among 974 participants in the three rural blocks in Kancheepuram district of Tamil Nadu. A house to house visit was made and all population above 35 years of age, presenting on the day of survey were included in the study. Socio-demographic variables, risk factors were collected using a pre-tested structured questionnaire and High Risk Analysis for diabetes was done as per Indian Diabetes Risk Score (IDRS).Results: Out of 974 study subjects, 62 (6.34%) of them reported that they had diabetes. Based on the screening tool, 253 subjects were found to be in the high risk category (score >60). Proportion of subjects with high risk score in the self-reported diabetes group (58.07%) were high compared to apparently normal group (23.79%) and this difference was statistically significant (p<0.05) using Chi Square test.Conclusions: This study estimates the usefulness of simplified Indian diabetes risk score for identifying high risk diabetic subjects in the community. Use of the IDRS can make mass screening for diabetes in India more cost effective.

Worldwide Recall Rate in Newborn Screening Programs for Congenital Hypothyroidism.

ContextNeonatal mass screening program for congenital hypothyroidism provides the best tool for prevention of its devastating effects on mental development. Despite the overall success of the screening programs in detecting congenital hypothyroidism and eliminating its sequelae and new developments made in the program design, high recall rate and false positive results impose a great challenge worldwide. Lower recall rate and false positive results may properly organize project expenses by reducing the unnecessary repeated laboratory tests, increase physicians and parents’ assurance and cooperation, as well as reduce the psychological effects in families.Evidence AcquisitionIn this review, we assessed the recall rate in different programs and its risk factors worldwide.MethodsPublications reporting the results of the CH screening program from 1997 to 2016 focusing on the recall rate have been searched. ResultsRecall rates vary from 0.01% to 13.3% in different programs; this wide range may be due to different protocols of screening (use of T4 or TSH or both), different laboratory techniques, site of sample collection, recall cutoff, iodine status, human error, and even CH incidence as affected by social, cultural, and regional factors of the population.ConclusionsIt is suggested to implement suitable interventions to reduce the contributing factors by improving the quality of laboratory tests, selecting conservative cut off points, control iodine deficiency, use of iodine free antiseptic during delivery, and use of more specific markers or molecular tests. Applying an age dependent criteria for thyrotropin levels can be helpful in regions with a varied time of discharge after delivery or for preterm babies.

Age and gender-specific reference intervals for lysosomal enzymes in dried blood spot samples: A study in Indian population

ObjectivesThe study aimed to establish age and gender-specific reference values for the activities of lysosomal enzymes (acid α-galactosidase [GLA], acid β-glucocerebrosidase [GBA], acid α-glucosidase [GAA], acid sphingomyelinase [ASM] and galactocerebrosidase [GALC]) in dried blood spots (DBS) of Indian population. Design and methodsA total of 3797 healthy Indian subjects (1456 females and 2341 males) aged from 2days to 60years were selected for the study. Activities of 5 lysosomal enzymes were determined by tandem mass spectrometry, for newborns (<30days), infants (>1month–1year), children (>1–5years) and (>5–18years) and adults (>18years).Variations in enzyme activities based on age and gender were studied. The reference interval was defined as the central 95% range, and was determined based on age and gender. ResultsHighly significant differences in activities were observed for GAA (p=0.001), GLA (p<0.0001), GBA (p<0.0001), ASM (p<0.0001) and GALC (p<0.0001), between different age groups. Comparison of activities between genders showed significant difference for ASM in children aged 1–5years (p=0.03) with higher activity in females, and for GLA in children aged 5–18years (p=0.004) where the activity was higher in males. Reference intervals decreased with age for all enzymes, except GAA. The ranges of GLA and GALC were higher in females, whereas GBA was higher in males. ConclusionThe study establishes age and gender-specific reference values for the screening and identification of lysosomal storage disorders in Indian population. Our data may facilitate establishment of mass screening programs for these disorders in India.

Diagnosis of retinal health in digital fundus images using continuous wavelet transform (CWT) and entropies

Vision is paramount to humans to lead an active personal and professional life. The prevalence of ocular diseases is rising, and diseases such as glaucoma, Diabetic Retinopathy (DR) and Age-related Macular Degeneration (AMD) are the leading causes of blindness in developed countries. Identifying these diseases in mass screening programmes is time-consuming, labor-intensive and the diagnosis can be subjective. The use of an automated computer aided diagnosis system will reduce the time taken for analysis and will also reduce the inter-observer subjective variabilities in image interpretation. In this work, we propose one such system for the automatic classification of normal from abnormal (DR, AMD, glaucoma) images. We had a total of 404 normal and 1082 abnormal fundus images in our database. As the first step, 2D-Continuous Wavelet Transform (CWT) decomposition on the fundus images of two classes was performed. Subsequently, energy features and various entropies namely Yager, Renyi, Kapoor, Shannon, and Fuzzy were extracted from the decomposed images. Then, adaptive synthetic sampling approach was applied to balance the normal and abnormal datasets. Next, the extracted features were ranked according to the significances using Particle Swarm Optimization (PSO). Thereupon, the ranked and selected features were used to train the random forest classifier using stratified 10-fold cross validation. Overall, the proposed system presented a performance rate of 92.48%, and a sensitivity and specificity of 89.37% and 95.58% respectively using 15 features. This novel system shows promise in detecting abnormal fundus images, and hence, could be a valuable adjunct eye health screening tool that could be employed in polyclinics, and thereby reduce the workload of specialists at hospitals.

Past, present, and future of molecular oncology in India

&lt;span lang="en-US"&gt;Cancer has become an important public health issue in India as ICMR in its latest report on cancer status (summarized in Figure 1), has projected that the total number of new cases would be around 14.5 lakhs in 2016 and the figure is likely to reach 17.3 lakhs by the year 2020. &lt;/span&gt;&lt;span&gt;Molecular oncology, a &lt;/span&gt;&lt;span lang="en-US"&gt;multidisciplinary &lt;/span&gt;&lt;span&gt;specialty&lt;/span&gt;&lt;span lang="en-US"&gt; involving extensive use of genomics, computational biology&lt;/span&gt;&lt;span&gt;,&lt;/span&gt;&lt;span lang="en-US"&gt; and tumor imaging, is the “backbone technology” for the management of the disease. In the modern day India, the growing significance of molecular genetics and cytogenetics in diagnosis as well as management of various cancers has also led to expansion of genetic diagnostic and counseling services. However, skewed geographical distribution, lack of awareness about the disease, symptoms, and diagnostic practices further augments the challenge of treating cancers in India. Lack of adequate infrastructure and absence of mass screening programs are key barriers to timely and accurate diagnosis in India. Key themes that may help in effective management of cancer include cost&lt;/span&gt;&lt;span&gt;-&lt;/span&gt;&lt;span lang="en-US"&gt;effective, early diagnosis and screening; national planning based on robust and granular cancer registry; public-private partnerships to decentralize cancer care delivery and nurture cent&lt;/span&gt;&lt;span&gt;e&lt;/span&gt;&lt;span lang="en-US"&gt;rs of excellence.&lt;/span&gt;

Analysis of Neuroblastoma Mortality Rates before and after the Cessation of the Mass Screening Program According to Vital Statistics of Japan Data

Background: Although neuroblastoma (NB) is one of the most common neoplasms in children, the Ministry of Health, Labour, and Welfare opted to halt the mass screening program for NB at 6 months of age in 2004. It is important to determine the impact of this cessation on NB mortality. Methods: We conducted a retrospective survey of patients with neuroblastoma as descriptive epidemiology. Mortality rates of NB below 15 years of age were observed using vital statistics data in Japan, covering the period from 1999 through 2014. We observed deaths classified as C74.9, C38.1, C38.2, C38.3, and C48.0 in our analysis, because NB does not have a unique code according to the ICD-10th classification system. Results: A total of 631 deaths, an average of 45 per year, were recorded for children under 14 in the 16-year study period. This comprised 356 males and 275 females, giving a male to female ratio of 1.29. Both sexes showed a peak in deaths at age 4, after which mortality declined. The annual transition in mortality rate was not markedly different from the annual transition in number of deaths. We compared 2 birth cohort groups: one from 1999 to 2003, in which children had undergone mass screening, to one from 2004 to 2014, in which they had not, and found no marked difference between the two cohorts. Conclusions: Our results indicate no overall increase in the child neuroblastoma mortality rate in childhood as a result of cessation of the mass screening program.

Cytological Changes in Normal Oral Mucosa of Individuals with Tobacco Habits: A Cytomorphometric Study.

Oral cancer is one of the six most common cancers in the world, and globally more than 50% of head and neck cancers occur in Asia, remarkably in India. Overall, 200,000 cases of head and neck cancers occur each year in India, among which 80,000 are oral cancers. Epidemiological and clinical studies suggest a causative role of tobacco use in the evolution of oral potentially malignant and malignant disorders. The aim of the study is to evaluate independently and compare the cytological effects of smoking, tobacco chewing, and smoking in conjunction with tobacco chewing on oral mucosa by cytomorphometric analysis. The study included a total of 120 individuals subdivided into four groups, each group with 30 individuals. Group I was tobacco smokers, group II tobacco chewers, and group III both tobacco smokers and chewers. Group IV comprised 30 individuals without tobacco habit. Smears were prepared from buccal mucosa of both the study and control groups using a cytobrush and stained using Papanicolaou staining. The cells were quantified using image analysis software. The results of the study showed alterations in the nuclear and cellular parameters in the study groups when compared with control groups and were statistically significant (p < 0.05). The present study explains the significance of early identification of cellular changes in individuals with tobacco habits who require early intercession even without any visible oral mucosal changes. The study emphasizes that exfoliative cytology and cytomorphometry aid as a valuable tool to evaluate the effect of tobacco on oral mucosa. Simple noninvasive techniques like exfoliative cytology can be employed as a chairside technique and in mass screening programs for identification of cellular changes in oral mucosa of individuals with tobacco habits. Thereby, it can be used as an early diagnostic tool for identification of potentially cancerous and cancerous lesions.

Trends in net survival from colon cancer in six European Latin countries: results from the SUDCAN population-based study.

Colon cancer represents a major public health issue. The aim of the SUDCAN collaborative study was to compare the net survival from colon cancer between six European Latin countries (Belgium, France, Italy, Portugal, Spain, and Switzerland) and provide trends in net survival and dynamics of the excess mortality rates up to 5 years after diagnosis. The data were extracted from the EUROCARE-5 database. First, net survival was studied over the 2000-2004 period using the Pohar-Perme estimator. For trend analyses, the study period was specific to each country. Results were reported from 1992 to 2004 in France, Italy, Spain, and Switzerland and from 2000 to 2004 in Belgium and Portugal. These analyses were carried out using a flexible excess rate modeling strategy. There were few differences between countries in age-standardized net survivals (2000-2004). During the 2000-2004 period, the 5-year net survival ranged between 57 (Spain and Portugal) and 61% (Belgium and Switzerland). The age-standardized survival at 1 and 5 years after diagnosis increased between 1992 and 2004. This increase was observed at ages 60 and 70, but was less marked at 80. This increase was linked to a marked decrease in the excess mortality rate between 1992 and 2004 until 18 months after diagnosis. Beyond this period, the decrease in the excess mortality rates among countries was modest and nearly the same whatever the year of diagnosis. There were minor differences in survival after colon cancer between European Latin countries. A considerable improvement in the 5-year net survival was observed in all countries, but the gain was mainly limited to the first 18 months after diagnosis. Further improvements are expected through the implementation of mass screening programs.

Automatic CDR Estimation for Early Glaucoma Diagnosis.

Glaucoma is a degenerative disease that constitutes the second cause of blindness in developed countries. Although it cannot be cured, its progression can be prevented through early diagnosis. In this paper, we propose a new algorithm for automatic glaucoma diagnosis based on retinal colour images. We focus on capturing the inherent colour changes of optic disc (OD) and cup borders by computing several colour derivatives in CIE L∗a∗b∗ colour space with CIE94 colour distance. In addition, we consider spatial information retaining these colour derivatives and the original CIE L∗a∗b∗ values of the pixel and adding other characteristics such as its distance to the OD centre. The proposed strategy is robust due to a simple structure that does not need neither initial segmentation nor removal of the vascular tree or detection of vessel bends. The method has been extensively validated with two datasets (one public and one private), each one comprising 60 images of high variability of appearances. Achieved class-wise-averaged accuracy of 95.02% and 81.19% demonstrates that this automated approach could support physicians in the diagnosis of glaucoma in its early stage, and therefore, it could be seen as an opportunity for developing low-cost solutions for mass screening programs.

The Challenges Involved in Implementing a Community Screening Program to Detect Subclinical Atrial Fibrillation

Background: Atrial fibrillation (AF) is a leading cause of stroke in the elderly. Screening programs using portable ECG monitoring devices are cost effective. However, the practical aspects of implementing a program in elderly patients has not been studied. We implemented a pilot community AF screening program and explored some of the challenges that may be experienced with mass screening. Methods: 169 participants (mean age 70.1 ± 4.2yrs, males 53%) ≥65 years from the community (with 1 or more risk factors for AF) were followed up for incident AF. Patients were asked to use a portable ECG monitoring device (Remon) to perform 5 × 1 min recordings/day for 1 week. Patients were referred to their local doctor for anticoagulation if AF was diagnosed. We recorded compliance rates and technical issues. A questionnaire addressing the practical aspects of the device was sent to all participants. Results: AF was diagnosed in 21 participants (13%). 42% of participants completed less than 5 recordings/day. 17 (10%) contacted research staff due to technical issues with the device (4 reported that the device had stopped working). 77/169 questionnaires were completed (46%). 6 (8%) reported that the ECG device was difficult to use. 24 (31%) reported difficulty with holding the device to perform recordings and 24 (31%) had some degree of anxiety regarding the results. Conclusion: Although a mass screening program for AF is attractive and cost effective, there remains additional challenges in the elderly population which must be considered including manual dexterity, cognitive impairment, patient anxiety and use of technology.