[Exploration of screening scores for pediatric obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To evaluate the feasibility of screening for pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) according to OSA-18,physical examination and electronic nasopharyngoscopy. METHOD: Outpatients with snoring received questionnaire, physical examination and electronic nasopharyngoscopy in Pediatric Sleep Center of Beijing Children's Hospital from 2009.1 to 2009.12. All children were divided into OSAHS or non-OSAHS group based on the results of polysomnography (PSG). The material was compared between these two groups. RESULT: The differences of age,tonsil scores, adenoid scores,total OSA-18 sores, the loudness of snoring scores, sleep asthma or suffocation scores, worrying lack of oxygen scores were significant (P < 0.05). And then put them into the logistic equation Y and make ROC analysis, if Y is higher than 0. 735, these children were more likely with OSAHS. The sensitivity was 62.7% and the specificity was 79.4%. CONCLUSION: It is feasible to screen for pediatric OSAHS according to questionnaire, physical examination and electronic nasopharyngoscopy.

Implementation of a minimally invasive breast biopsy program in countries with limited resources.

Minimally invasive breast biopsy techniques, such as core needle biopsy (CNB) and fine-needle aspiration biopsy (FNAB), offer several advantages over surgical biopsy. Patients in whom minimally invasive biopsy techniques are used may undergo biopsy more quickly, are more likely to have only one surgery for treatment of the breast tumor and axillary staging, and are less likely to need reoperation after breast-conserving surgery because of positive margins. Knowledge of a diagnosis of cancer before surgery allows patients to participate in treatment decisions, and compared with surgical biopsy, minimally invasive biopsy has lower costs, produces less scarring, has nearly equivalent diagnostic accuracy, and does not require general anesthesia or sedation. Minimally invasive biopsy can permit accurate diagnosis and prompt intervention in a cost-effective manner, particularly in countries with limited resources, where patients often present with advanced-stage breast cancer. Several events characterize the implementation of a successful program in minimally invasive breast biopsy: public education about the less invasive nature of these techniques, which may encourage women to seek care at earlier stages; a change in the philosophy of medical personnel that favors involving patients in treatment decisions and acceptance of less extensive but accurate methods of diagnosis; education of medical personnel in the selection of patients for minimally invasive biopsy, performance of the biopsy, and interpretation of histologic and/or cytologic samples; quality assessment and use of the triple test (i.e., correlation of clinical, radiologic, and pathologic findings); and economical use of resources, which results from the lower costs of minimally invasive procedures and the avoidance of unnecessary surgery for benign conditions.

[Quality control for MHTS region and possibility of the standardization].

There is a final purpose of the standardization of the external quality control for the resolution of the difference between facilities. Two solutions are promoted in order to unify the evaluation level. They are that it unifies the reference value and common evaluation method used common display. However, it is the prior settlement that there is some a problem on both method and that absolute value is made to agree using standard substance.

Analise dos metodos dignosticos para infeccao urinaria / Analysis of the diagnostic methods for urinary tract infections

Os autores analisam os metodos diagnosticos para infeccao urinaria (IU) na crianca, suas vantagens e deficiencias relativas. Discutem as indicacoes dos metodos segundo tipo de paciente e recursos disponiveis.

Chronic strongyloidiasis in Tasmanian veterans--clinical diagnosis by the use of a screening index.

Chronic infection with Strongyloides stercoralis presents a diagnostic problem because of the low recovery of the organism from stools and the insensitivity of current serological tests. Of 150 former Far East POWs, 26 (17%) had S. stercoralis in stools. The clinical features in 18 stool-positive patients were compared to those in 24 stool-negative patients and showed that strongyloidiasis was associated with a higher frequency of alteration in bowel habit, upper abdominal discomfort, rash and eosinophilia. On the basis of these features, a screening index was devised which largely separated stool-positive and stool-negative patients and led to helpful therapy in three of four patients with compatible symptoms who lacked a definitive diagnosis. Treatment with thiabendazole appeared to be superior to treatment with mebendazole.

A discussion on the conventional estimator of sensitivity and specificity in multiple tests.

Both the variation of positive responses (negative responses) among individuals and the internal correlation among responses for the same individual affect the precision of the estimate of sensitivity (specificity). To estimate the sensitivity (specificity) of a medical diagnostic test, this paper proposes a Bayesian approach with a simple Markov model to evaluate the performance of the conventional estimator under different situations. On the basis of the assumed model, we derive a general formula for the variance of the conventional estimator regarding multiple tests and present a quantitative discussion on the limitations of this estimator.

Effect of laboratory error on the identification of persons with hypercholesterolemia in an employee health service.

Cholesterol is a major risk factor for coronary heart disease. Of 117 employees seen consecutively in the Tennessee State Employee Health Service voluntary screening program, 86 (74%) had cholesterol levels above the reference range reported by a commercial clinical laboratory. This was three times greater than the calculated expected number of 29 (25%, 17 at moderate risk, 12 at high risk for coronary disease). Age and sex adjustment using Lipid Research Clinic guidelines reduced the number with elevated cholesterol to 55 (47%, 24 at moderate risk, 31 at high risk). Split sample cholesterol assays run independently by the commercial laboratory and a university laboratory showed excellent correlation (r = 0.99, commercial laboratory = 1.0 (university laboratory) + 10.8), but a systematic difference of 12.4 mg/dL (SD = 6.4 mg/dL, paired-t = 9.63, p less than 0.00001) between the two laboratories. Further adjustment for this difference reduced the number with elevated cholesterol to 41 (36%, 26 at moderate risk, 15 at high risk). This experience illustrates how small systematic laboratory errors in cholesterol determination can greatly exaggerate the number of persons reported to have clinically important cholesterol elevations. Clinical laboratories should report age and sex adjusted cholesterol reference ranges and provide clients periodic quality assurance reports that their measurements of cholesterol levels are accurate.

Multiphasic Health Checkup Evaluation: a 16-year follow-up.

The Multiphasic Health Checkup Evaluation Study, a long-term clinical trial, has been completed. A study group of 5156 men and women age 35-54 at entry was urged to have annual multiphasic health checkups (MHCs) for 16 years. A control group of 5557 comparable subjects was not so urged but was followed up in a comparable fashion. The mean and median number of MHCs per person were 6.8 and 6, respectively, in the study group and 2.8 and 1, respectively, in the control group. During 16 years the study group experienced a 30% reduction (p less than 0.05) in deaths from pre-specified "potentially postponable" causes, largely associated with lower death rates from colorectal cancer and hypertension. This reduction was most pronounced in the early years of the study. The two groups did not differ to a statistically significant degree in mortality from all other causes (84% of total mortality) or in total mortality. There was no difference in self-reported disability in the overall groups. In the setting of our prepaid health care plan where MHCs were already available on a voluntary basis, a program of urging middle-aged persons to undergo regular MHCs brought about a substantial reduction in mortality from preselected diseases.

Vision screening requirements under 52 Early and Periodic Screening Diagnosis and Treatment (EPSDT) Programs.

A 1979 survey of vision screening requirements in 52 Early and Periodic Screening Diagnosis and Treatment (EPSDT) programs revealed that 17 percent of the programs had no requirements, and 17 percent required only distance visual acuity testing. An additional 25 percent required distance vision and ocular muscle-fusion tests only, and the remaining programs required various combinations of three or more tests. Fewer than two-thirds of the programs with requirements had referral criteria for the tests. The ages at which initial testing was required also varied among the programs. The differences in requirements were not related to the demographic, socioeconomic, and other variables analyzed in this study. Programs with specific referral criteria, however, had a higher percentage of referrals for vision screening than those without such criteria. Because of the variability in vision screening standards and referral criteria observed among the programs, the authors conclude that national standards are needed.