A multiphasic reading screening procedure.
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Screening for impaired visual acuity in middle age in general practice.
Screening for impaired distant visual acuity was one component of a controlled trial of multiphasic screening in middle age carried out in two general practices. The prevalence of impaired visual acuity (6/18 or worse in the better eye) at the initial screening in 1967 was 9.6% overall, ranging from 5.9% in people aged 40-49 years to 16.3% in those aged over 60. The question "Do you have difficulty seeing distant objects?" had a low sensitivity and high specificity, rendering it unsatisfactory for use in mass population screening for visual impairment. The prevalences of impaired visual acuity in the screening and control groups at the survey in 1972 showed no significant differences in any age group. Mass screening for defects of visual acuity in the course of a multiphasic examination is thus unlikely to reduce the prevalence of impaired distant visual acuity in the community.
Adult↗
[Clinical value of rectal digital examination in early diagnosis of colorectal cancer (author's transl)].
A prospective study was carried out on a series of 1500 patients of a gastro-enterological and surgical unit in order to evaluate critically the accuracy of rectal digital examination as a single tool in the early diagnosis of colorectal tumours. The patients in this study were explored independently by two investigators, first by rectal digital palpation and afterwards by means of the proctosigmoidoscope. Endoscopy confirmed the presence of 239 tumours, 96 of these being diagnosed histologically as carcinoma. Comparative analysis of the results of physical and endoscopic examination demonstrated that digital palpation provided a correct diagnosis in 58 out of 239 tumours, equivalent to an accuracy of 24.3% for tumours within the reach of the rectoscope, and 10% for all colorectal tumours. Hence, rectal examination should not be used as single diagnostic tool in screening for large bowel cancer. A multiphasic screening system, including investigations for occult blood, proctosigmoidoscopy, endoscopic polypectomy and determination of colon-embryonic-antigen levels is discussed to obtain better results in general health screening, early diagnosis and avoidance of incurable colorectal carcinomas and the early detection of recurrence.
Colonic Neoplasms↗
Computerized entry into medical care. Its impact on doctor-patient relationships.
A large proportion of cannery workers see a doctor only as a last resort, in time of crisis. The Cannery Workers Multiphasic Screening Program identified workers in need of physician evaluation, and referred each to a physician of his choice, for examination by appointment, while the worker was not acutely ill. In many instances the screening program generated the first encounters between patient and physician. It conducted a follow-up system for workers unaccustomed to methodical health care. The program financed pretesting education of the persons to be tested, multiphasic testing, physician evaluation of abnormal findings, and the follow-up reminder system. Each physician, in advance of the appointment for evaluation, was sent a computerized report calling attention to findings that exceeded limits considered normal. The report included a form facilitating the physician's report and billing. In counties having foundations for medical care, the foundations reviewed the form for adequacy of follow-up and appropriateness of charges. The effort to bridge the gap between findings, diagnosis and therapy, for a population group newly introduced to modern medical care delivery, was made possible by the use of the computer as a tool for the attainment of specific, preanalyzed components of the total objective.
Computers↗
Human bone and tissue allografts. Preparation and safety.
Currently, modern tissue banks routinely supply requested bone and soft-tissue allografts. These allografts are safe if tissue-bank personnel adhere to the existing methodology for excluding any donors with potential for disease transmission. The authors' discard rate after excision of tissues has been approximately 18%, reflecting their concern for allograft safety. The preparation of significant numbers of allografts is labor intensive and very expensive, as is multiphasic screening of donors. However, long-term success with a large number of bone or soft-tissue recipient patients has led physicians and patients to have confidence in the safety of allografts prepared as described.
Bone Transplantation↗
Utilization of an automated multiphasic health testing system for performing prehospitalization examinations.
Various impacts of performing prehospitalization examinations (of elective surgical patients) by utilizing automated multiphasic screening technology were evaluated. Compared to the conventional way of conducting such examinations (in the concerned health care organization) the automated system was found to be more efficient (results were available earlier, in a more complete and convenient format), saved considerable time to patients and resulted in a shorter average hospital (postoperative) stay, suggesting that the automated technology is also cost effective. Postoperative stay was reduced by 20 per cent (1.8 days) in the group of patients who undertook the automated multiphasic testing, as compared to a similar group of patients who performed the required tests in the conventional way. Possible explanations for this finding are discussed.
Adolescent↗
Who is the primary physician?
Several studies have concluded that specialists form a hidden system for primary-care delivery. However, these studies assume that a specialist who provides the majority of care is the primary-care physician. Using data for a one-year period from 2752 people enrolled in the Rand Health Insurance Experiment, we examined the validity of this conclusion. We compared the effects of three different definitions of a primary-care physician on identification of the primary-care provider: the physician who delivered the "majority of care" (34 per cent were specialists), the physician designated by the patient to receive the results of a multiphasic-screening examination (12 per cent were specialists), and the physician who treated common problems (9 per cent were specialists). Use of the "majority-of-care" criterion to define primary care overestimated by threefold the contribution specialists make to this activity. Definitions of a primary-care physician must be more specific and should include the tasks frequently associated with primary care, as well as patients' perceptions of the physician who provides their primary care.
Appointments and Schedules↗
Epidemiology of hyperuricemia in an ambulatory elderly population.
The relationship of serum uric acid concentration to age and sex was assessed in 1,701 participants in a geriatric multiphasic screening clinic. Included were 1,067 women and 634 men. The mean uric acid level for men was 6.35 mg/100 ml compared to 5.44 mg/100 ml for women. No statistically significant increases in serum uric acid between age groups were apparent, except for women over 84 years of age. The mean serum urate concentrations found in this geriatric study are higher than those reported for other population groups, suggesting a higher normal value for the elderly.
Age Factors↗
Iron deficiency in the elderly population in Finland.
In connection with a large multiphasic screening programme carried out in Finland the prevalence rate of anaemia and iron deficiency were studied. Hb was under 130 g/l in 7.9 per cent of the men aged 65 years or over and under 120 g/l in 3.8 per cent of the women in the same age range. Transferrin saturation was under 15 per cent in 6.4 per cent of the men and in 7.7 per cent of the women. Iron deficiency was especially common in the rural population. A dietary study showed that iron deficient persons consumed less meat products and more liquid milk products than the others. The dietary factors are significant in the etiology of iron deficiency.
Aged↗
The changing face of primary hyperparathyroidism.
The introduction of multiphasic screening and the development of sensitive parathormone assays have changed the demography and clinical symptomatology of patients presenting with primary hyperparathyroidism. This retrospective review includes 158 patients operated on for primary hyperparathyroidism at the Medical College of Georgia from 1973-1987. Compared to the 46 patients managed prior to 1973, the frequency of subclinical hyperparathyroidism has increased from 46% to 64%. The median patient age has increased from 50 to 59 years. Recognition of primary hyperparathyroidism in a more geriatric population modifies indications for surgical intervention in subclinical disease. Osteoporosis, myalgias, fatigue, arthralgias, memory loss, or constipation occurred in 50% of patients. These complaints are frequent in normocalcemic elderly people. They represent disease, not normal aging. Their exacerbation by hypercalcemia should not go uncorrected if neck exploration can be tolerated by the patient.
Female↗
Lowering triglyceride values in an occupational setting.
Within a multiphasic screening program it was possible to establish an effective industrial counseling program for individuals identified as potential cardiovascular risks by their serum triglyceride values. A significant reduction of serum triglyceride values was obtained even where minimal supervision was used to modify aspects of an employee's life style. A counseled group of 109 male employees, 40 years and older, with serum triglyceride levels of 200 mg. or higher per 100 ml., was matched by location and age with a control group of 135 noncounseled individuals with similarly elevated triglyceride levels. Individuals in both groups showing significant percentage reduction were those whose serum levels began above 250 mg. per 100 ml. The employees who lowered their triglyceride values most significantly were those that had dieted and were periodically counseled and checked by a physician.
Adult↗
Epidemiologic findings on the relationship of time of day and time since last meal to glucose tolerance.
Data from 10,559 men and women, age 30-64, participating in the morning and afternoon in a Chicago Health Department multiphasic screening project, were used to determine the effects of time of day and time since last meal on the values for plasma glucose one and two hours following oral challenge with 100 gm. of glucose. Mean plasma glucose values and rates of suspect glucose intolerance (based on several cutpoints) were sizeably higher in the afternoon than in the morning. In addition, plasma glucose values increased with time elapsed since the last meal, up to 10 hours postprandially. Thereafter, both one- and two-hour plasma glucose values tended to exhibit a decline. Analysis of covariance confirmed that fluctuations in glucose tolerance were related to time of day and time since last meal, but the effects of each parameter were exerted independently.
Adult↗
[An epidemiological study on the ossification of the anterior longitudinal ligament of the spine].
An epidemiological study was carried out in connection with the multiphasic screening examination of 1,057 people (442 men and 615 women) in the village of Yachiho. The purpose of this study was to define the etiology of OALL (ossification of the anterior longitudinal ligament) and disc narrowing. The prevalence of disc narrowing increased with age, but OALL was not correlated with aging. OALL was found more frequently in men, but disc narrowing showed no difference between each sexes. The body height and weight-height index were higher in the OALL cases. The body height shrinkage by aging was greater in the patients with disc narrowing cases. The index of thoracic kyphosis was higher in the OALL cases than in the patients with disc narrowing ones. OALL was associated with ossification of the other ligaments of the spine, but disc narrowing was not. This study suggests that despite some similarities, OALL is etiologically different from disc narrowing.
Aging↗
Assessing the likely effectiveness of screening older people for impaired vision in primary care.
Screening for visual impairment is frequently included in multiphasic screening assessments for older people, although evidence for the effectiveness of screening from randomized trials is lacking. This paper uses previously developed criteria for assessing the likely effectiveness of community screening programmes to review the non-trial evidence around visual screening. Unreported or undiagnosed visual impairment is common among older people and is associated with considerable morbidity. Testing for visual acuity is easy and quick, but may not accurately reflect the level of functional disability caused by the visual problem in everyday living. Effective therapeutic interventions exist for most symptomatic patients, but the effects of treating unreported visual impairment detected by screening have not been evaluated. Existing barriers to effective treatment for older people with symptomatic visual problems include financial costs to the patient, and an inability of ophthalmic services to meet demand. These same factors may be barriers to the uptake of treatment following screening. Further work is needed to assess the needs of older people with unreported visual problems, and to clarify barriers to effective screening.
Aged↗
Health testing in the elderly by the multiphasic method.
A multiphasic screening programme was carried out on a stratified sample of the elderly population of a small town in Israel. The purpose was to gain an assessment of the health profile of the subjects and to estimate what kind of community geriatric services might be required. The performance of the programme in 3 days on 89% of the 200 subjects who were available testified to the rapidity and yield of information by this 'conveyor-belt' system of examination. The technique is described, and some criticisms and suggestions are advanced. Evaluation of the efficacy of this method of screening was judged on four types of information accruing in a survey of the elderly. Demographic and epidemiological data, together with prevalence of symptoms or clinical signs and their correlations could be rapidly ascertained; so also could specific pathologic parameters be rapidly collected, which required medical follow-up, such as blood sugar values. The method appeared less successful in assessing an individual's functional or social difficulties which would require specific community services because of the multi-facetted type of examination by different members of the team. Similarly, a screening programme which depends on its subjects being transported may miss some of the more infirm people, as was subsequently found in this survey. It is concluded that for the elderly, the multiphasic method with the expense and organisation required is appropriate for preliminary screening of a section of a population, or for the screening of selective groups at risk.
Aged↗
Failure by a group of elderly men to use a preventive health service.
The perceptions of 25 white males (age range, 53-62) were studied in relation to use of multiphasic screening. Each of these men had been urged repeatedly to take advantage of this service but had failed to do so. The multiphasic examination itself was free, so cost was not an inhibiting feature. This report deals with the proffered reasons why these men did not take the screening examination. The factors could be classified as: 1) social influences, 2) health care setting, 3) beliefs about health, 4)use of alternative forms of care, 5) the time involved for testing, and 6) disinterest. A discussion of some individual responses is included. Recommendations are made for structuring more effective delivery of health care services for the elderly.
Attitude to Health↗
Screening in health fairs. A critical review of benefits, risks, and costs.
Health fairs provide multiphasic screening to more than 2 million Americans each year, and the number is growing rapidly. Nearly 40 different tests are in use, commonly including the measurement of up to 30 different blood chemistry levels. This report reviews the activities in a sample of 940 health fair sites and examines the experience regarding six specific screening procedures (blood pressure, anemia, blood chemistries, glaucoma, hearing, and fecal occult blood testing). Widespread use of these and other tests raises complex issues of cost, risk, and benefit. Rates of false alarm of healthy people and false reassurance of those at risk may be high for some tests, and the benefits of detecting new disease are easily overestimated. Detailed data collection and evaluation could help health fair sponsors to identify more rational screening strategies.
Anemia↗
Periodic health examination, 1994 update: 2. Screening strategies for colorectal cancer. Canadian Task Force on the Periodic Health Examination.
OBJECTIVE: To make recommendations on the effectiveness of screening for colorectal cancer in asymptomatic patients over 40 years of age. OPTIONS: Multiphase screening that begins with test for fecal occult blood, uniphase screening with sigmoidoscopy and uniphase screening with colonoscopy. Options included screening repeated at different intervals and different procedures for patients with selected risk factors. OUTCOMES: Rates of death, death from cancer and cancer detection; compliance, feasibility and accuracy of each manoeuvre. EVIDENCE: A MEDLINE search for articles published between January 1966 and June 1993 with the use of MeSH terms "screening" and "colorectal neoplasia," a check with the reference sections of review articles published before June 1993 and a survey of content experts. Articles were weighted according to the Canadian Task Force on the Periodic Health Examination levels of evidence. VALUES: The highest value was assigned to manoeuvres that lowered the rate of death from cancer and had a low rate of false-positive results and acceptable cost and compliance. Recommendations were determined by consensus of the authors, members of the task force and colorectal cancer experts. BENEFITS, HARMS AND COSTS: There is evidence that annual fecal occult blood testing with the use of the rehydrated Hemoccult test has a small but significant benefit in lowering the rate of death from cancer after more than 10 years of screening; however, the high rate of false-positive results (9.8%) and the poor sensitivity of annual (49%) and biennial (38%) screening make this a poor method for detecting colorectal cancer. There is fair evidence that screening with sigmoidoscopy may improve survival rates; however, this may be due to volunteer bias. The high cost of and poor compliance with colonoscopic screening make this an unfeasible strategy.
Adult↗