Effectiveness of a targeted screening program in identifying infants with positive urine toxicology screening results in a regular neonatal nursery

BACKGROUND: Targeted spirometry screening for chronic obstructive pulmonary disease (COPD) has been studied in primary care and community settings. Limitations regarding availability and quality of testing remain. A targeted spirometry screening program was implemented within a presurgical screening (PSS) clinic to detect undiagnosed airways disease and identify patients with COPD/asthma in need of treatment optimization.OBJECTIVE: The present quality assurance study evaluated airflow obstruction detection rates and examined characteristics of patients identified through the targeted screening program.METHODS: The targeted spirometry screening program was implemented within the PSS clinic of a tertiary care university hospital. Current or ex-smokers with respiratory symptoms and patients with a history of COPD or asthma underwent prebronchodilator spirometry. History of airways disease and smoking status were obtained during the PSS assessment and confirmed through chart reviews.RESULTS: After exclusions, the study sample included 449 current or ex-smokers. Abnormal spirometry results were found in 184 (41%) patients: 73 (16%) had mild, 93 (21%) had moderate and 18 (4%) had severe or very severe airflow obstruction. One hundred eighteen (26%) new cases of airflow obstruction suggestive of COPD were detected. One-half of these new cases had moderate or severe airflow obstruction. Only 34% of patients with abnormal spirometry results had reported a previous diagnosis of COPD. More than one-half of patients with abnormal spirometry results were current smokers.CONCLUSIONS: Undiagnosed airflow obstruction was detected in a significant number of smokers and ex-smokers through a targeted screening program within a PSS clinic. These patients can be referred for early intervention and secondary preventive strategies.

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Cholesterol, Children, and Heart Disease: An Analysis of Alternatives

PEDIATRICS ◽

10.1542/peds.68.5.721 ◽

1981 ◽

Vol 68 (5) ◽

pp. 721-730

Author(s):

Donald M. Berwick ◽

Shan Cretin ◽

Emmett Keeler

Keyword(s):

Screening Program ◽

Rank Order ◽

Improve Efficiency ◽

Control Programs ◽

Policy Choices ◽

Targeted Screening ◽

Analysis Of Alternatives ◽

Cholesterol Control ◽

The Cost ◽

High Risk Children

Cost-effectiveness analysis is used to compare proposed cholesterol control programs. The analysis employs estimates of such biologic variables as effect of diet on cholesterol level, stability of level, and change in morbidity with level. Sensitivity analysis identifies the biologic and behavioral uncertainties that most critically affect policy choices. At a discount rate of 5%, a cholesterol-screening program for all 10-year-old children would cost about $10,000 per year of life saved. Rescreening would not improve efficiency. Targeted screening of high-risk children could improve efficiency by 25%, but would benefit only one sixth as many people. Community-wide interventions without screening may be more efficient by a factor of 3. The cost per year of life saved is most affected by the rate of discount and the dollar cost of changing behavior, but is insensitive to stability of cholesterol rank order and to the cost of screening.

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Are Intoxicated Trauma Patients at an Increased Risk for Intraoperative Anesthetic Complications? A Retrospective Study

Anesthesiology Research and Practice ◽

10.1155/2020/2157295 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Brian D. Wolf ◽

Swapna Munnangi ◽

Raymond Pesso ◽

Charles McCahery ◽

Madhu Oad

Keyword(s):

Intraoperative Complications ◽

Final Analysis ◽

Trauma Patients ◽

Urine Toxicology ◽

Physical Status Classification ◽

Increased Risk ◽

Toxicology Screening ◽

Anesthetic Complications ◽

American Society ◽

American Society Of Anesthesiologists

Background. The purpose of this study was to correlate intraoperative anesthetic complications of trauma patients with their respective urine toxicology results. Methods. This retrospective, single-center cohort study at a Level 1 trauma center included patients with the following criteria: (1) trauma admission between January 1, 2010, and December 31, 2016, (2) required surgical intervention, (3) are age 18 and older, and (4) urine toxicology screening was completed. Anesthetic records were evaluated for intraoperative complications. Results. The final analysis included 847 patients. The mean anesthesia time, American Society of Anesthesiologists physical status classification scores, change in body temperature, anesthetic complication rate, and mortality were not significantly different between urine toxicology positive and negative patients. Of note, a significantly lower proportion of the urine toxicology positive patients were extubated postoperatively in comparison to urine toxicology negative patients (57.32% vs 63.83%). Conclusions. Trauma patients who presented with a positive urine toxicology screening are not at an increased risk for intraoperative anesthetic complications compared to those with a negative urine toxicology screening. However, our results indicated that the need for postoperative mechanical ventilation increased in the acutely intoxicated trauma patients when compared to those without preinjury intoxication.

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Utility of Bedside Urine Toxicology Screening Test in Emergency Department: A Retrospective Study

Cyprus Journal of Medical Sciences ◽

10.5152/cjms.2018.588 ◽

2018 ◽

pp. 98-102 ◽

Cited By ~ 1

Author(s):

Gul Pamukcu Gunaydin ◽

◽

Gulhan Kurtoglu Celik ◽

Teoman Ersen ◽

Alp Sener ◽

...

Keyword(s):

Emergency Department ◽

Retrospective Study ◽

Screening Test ◽

Urine Toxicology ◽

Toxicology Screening

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Screening of BRCA2 mutated men for detection of prostate cancer: Preliminary results from a national high volume cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16567 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16567-e16567

Author(s):

Monica Zuradelli ◽

Nicolo' Buffi ◽

Paolo Bianchi ◽

Carla Barbara Ripamonti ◽

Monica Barile ◽

...

Keyword(s):

Prostate Cancer ◽

Ovarian Cancer ◽

Screening Program ◽

Brca2 Mutation ◽

Specific Antigen ◽

Digital Rectal Examination ◽

Brca2 Gene ◽

Pathogenic Mutation ◽

Genealogical Trees ◽

Targeted Screening

e16567 Background: Up to 10% of cases of Prostate Cancer (PCa) are hereditary. Germline pathogenic mutations in BRCA2 gene confer the highest risk (2.5 to 8.6 fold in men ≤ 65 yr). Beyond periodic Prostate Specific Antigen (PSA) dosage and digital rectal examination (DRE), a targeted screening for carriers is still undefined. Prostate Health Index (PHI), a combination of the tPSA, fPSA and proPSA tests, may be a more accurate biomarker than PSA only to detect PCa. We evaluated how to better screen BRCA2 mutated men for PCa. Methods: We reviewed the genealogical trees of all women tested positive for germline BRCA2 pathogenic mutation at our clinic. We offered targeted BRCA2 mutational analysis to all first/second degree relative men between 40 and 69 yr. A targeted screening program (annual PSA and PHI dosages and DRE) was proposed to all men tested positive. In case of PSA and/or PHI values out of range ( > 4ng/ml and > 20, respectively) we proceeded with a multiparametric Magnetic Resonance Imaging (mpMRI) and fusion biopsy of suspected lesions. Results: From June 2008 to October 2018 610 breast/ovarian cancer patients had BRCA test: 35 (5.7%) tested positive for BRCA1 pathogenic mutation, 32 (5.2%) for BRCA2 pathogenic mutation. From October 2017 90 relatives were checked for the familial mutation and 24 (27%) (12 women, 12 men) tested positive for BRCA2 mutation. All the 12 men (median age 48 yr, IQR 44 to 60) accepted to join our screening program. During the first year all men had negative DRE. Median PSA was 0.70 (IQR 0.43 to 1.02), median PHI was 17.56 (IQR 11.85 to 24.06). One patient with out of range PHI value already had mpMRI resulted negative. During the second year 4 men underwent screening so far: they had negative DRE. Median PSA was 0.57 (IQR 0.38-0.77), median PHI was 16.88 (IQR 11.87-21.90). Two men had PHI out of range and will undergo mpMRI. Conclusions: An accurate review of the genealogical trees of breast/ovarian cancer BRCA2 mutated patients allows to identify male relatives potentially carriers of the same mutation. These men have a high lifetime risk of PCa and require an appropriate screening, currently absent. Our approach may be leveraged as proof of concept of selection and screening program in carriers of BRCA2 mutations.

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Urine toxicology screening in Austrian trauma patients: a prospective study

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-009-0995-5 ◽

2009 ◽

Vol 130 (7) ◽

pp. 883-887 ◽

Cited By ~ 6

Author(s):

Markus Figl ◽

Linda E. Pelinka ◽

Patrick Weninger ◽

Christoph Walchetseder ◽

Walter Mauritz ◽

...

Keyword(s):

Prospective Study ◽

Trauma Patients ◽

Urine Toxicology ◽

Toxicology Screening ◽

A Prospective Study

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Implementation of Targeted Screening for Poverty in a Large Primary Care Team in Toronto, Canada: a feasibility study

10.21203/rs.3.rs-206360/v2 ◽

2021 ◽

Author(s):

Kimberly Wintemute ◽

Meh Noor ◽

Aashka Bhatt ◽

Gary Bloch ◽

Suja Arackal ◽

...

Keyword(s):

Primary Care ◽

Screening Program ◽

Office Visit ◽

Care Team ◽

Primary Care Team ◽

Community Based ◽

Implementation Evaluation ◽

Number Of Patients ◽

Targeted Screening ◽

Deprived Areas

Abstract Background Poverty has a significant influence on health. Efforts to optimize income and reduce poverty could make a difference to the lives of patients and their families. Routine screening for poverty in primary care is an important first step but rarely occurs in Canada. We aimed to implement a targeted screening and referral process in a large, distributed primary care team in Toronto, Ontario, Canada.Methods This implementation evaluation was conducted with a large community-based primary care team in north Toronto. The primary care team serves relatively wealthy neighborhoods that contain pockets of poverty. Physicians were invited to participate. We implemented targeted screening by combining census information on neighborhood-level deprivation with postal codes in patient records. For physicians agreeing to participate, we added prompts to screen for poverty to the charts of adult patients living in the most deprived areas. Standardized electronic medical record templates recommended a referral to a team case worker for income optimization, for those patients screening positive. We recorded the number and percentages of participants at each stage, from screening to receiving advice on income optimization. Results The primary care team included 86 physicians distributed across 19 clinical locations. Thirty-four physicians (39%) participated. Their practices provided care for 27,290 patients aged 18 or older; 852 patients (3%) were found to be living in the most deprived neighborhoods. 509 (60%) had at least one office visit over the 6 months of follow up, and 128 (25%) of those seen were screened. Only 25 (20%) of these patients screened positive for poverty, and 13 (52%) were referred. Eight patients (62% of those referred) were ultimately seen by a caseworker for income optimization.Discussion & Conclusions We implemented a targeted poverty screening program combined with resources to optimize income for patients in a large, distributed community-based primary care team. However, only a small number of patients were identified and linked to the intervention Further efforts to scale and spread screening and mitigation of poverty are warranted; these should include broadening the targeted population beyond those living in the most deprived areas.

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