Screening, Surveillance and Case-Finding
Tom Arie in Health Care of the Elderly, 1981
I should like to suggest that instead of using the term ‘screening’, we ought now to be referring to ‘case-finding’. In the document Prevention and Health11 it is stated: ‘Screening differs from ordinary clinical practice in that it involves seeking out people with no overt symptoms of disease and asking them to undergo examination and tests to see whether the condition to be identified is present.’ It may therefore be seen that measures directed at the detection of unreported illness or established disability are not included within this definition of screening since the latter is concerned only with those ‘with no overt symptoms of disease’. It may be argued, of course, that patients’ awareness of their disabilities and their willingness to report them is the criterion by which they may be judged ‘overt’ or not. The argument now becomes rather circular and sterile, but the pragmatist ought to have little difficulty in deciding what is overt and what is not and thus in distinguishing true screening from what ought more correctly to be described as case-finding. Put in another way, screening is a form of secondary prevention, i.e. the search for precursors of disease in those who do not have the symptoms of the disease and who believe themselves to be free from it. Case-finding, on the other hand is a form of tertiary prevention in which established disease and resultant disability are sought in order to achieve earlier diagnosis and thus create better prospects for care (or alleviation) and rehabilitation.
Screening in Urology
Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George in The Scientific Basis of Urology, 2010
Case finding is widely interpreted as “screening” by both the general public and the medical profession. In essence, case finding is no more than sporadic attempts by interested doctors and patients to detect disease or establish that disease is not present. As will be described below, chronic urological disease does not, in general, attain criteria sufficient to support full public-health screening programs. In the absence of such programs— often interpreted by critics as a “lack of interest” by the Department of Health—case finding becomes the predominant mode of preclinical disease identification, usually widely, and often inaccurately, reported by both the lay and medical press. Case finding is, however, a genuine and valid attempt by concerned doctors and patients to solve a medical dilemma, but the process should not be confused with scientifically designed and validated mass-screening programs.
Prevalence and Genetic Epidemiology of Developmental Disabilities
Merlin G. Butler, F. John Meaney in Genetics of Developmental Disabilities, 2019
The methodology used in prevalence studies of autism has generally involved a process of case finding followed by one of case confirmation (49,50). There have been a number of methods of case finding. The most comprehensive involves total population screening using the schools or pediatric well-child care visits as the vehicles for screening. The advantage of this methodology is that children who have not yet been diagnosed will come to the examiner’s attention. However, the process is labor intensive and has been done only in relatively small populations, which has limited the number of children identified with autism (43). Other methods used in case finding have targeted at-risk populations by focusing on programs and clinics specifically for children with DDs. Sources targeted have included special education programs, specialty diagnostic clinics, and other service programs for children with DDs. Methods used to identify children at such sources have varied from asking providers to identify children with possible autism to a comprehensive review of all service provider records. An advantage of the at-risk approach is that large populations can be targeted, but its success is dependent on the quality and comprehensiveness of diagnostic and treatment services in the community, as well as the extent of detail that is recorded in the individual records.
Association of the modified creatinine index with muscle strength and mortality in patients undergoing hemodialysis
Published in Renal Failure, 2022
Rongrong Tian, Liyang Chang, Dan Liu, Fenxia Luo, Ying Zhang, Linghong Cheng, Hongmei Zhang
The objective of case finding is to identify persons at a high risk of adverse clinical outcomes. Our results showed that the mCI could predict survival. Moreover, adding mCI to the baseline evaluation model consisting of classical risk factors significantly improved the predictably of all-cause mortality, as observed in the discrimination analysis model. Thus, the mCI classified by the cutoff value was useful in stratifying risks of all-cause mortality and was preferred over the MQSGA for predicting death in patients undergoing HD. These results validated the clinical value of the mCI as a simple tool to detect persons at risk of adverse outcomes from probable sarcopenia. A few studies involving patients undergoing HD also reported that the mCI was significantly associated with greater survival, and those studies analyzed data using arbitrary cutoff points for high mCI derived from their cohorts and the cutoff points were not always consistent. Differently from them, we determined the optimal cutoff value of the mCI to identify probable sarcopenia and validated the prognostic value, which was important and practical in clinical use. To the best of our knowledge, this is the first study. Our research provides a convenient and adequate method that can be easily adopted clinically to identify persons with probable sarcopenia, who may be amenable to treatment.
Well-being and dietary adherence in patients with coeliac disease depending on follow-up
Published in Scandinavian Journal of Gastroenterology, 2021
Jesper Lexner, Henrik Hjortswang, Rickard Ekesbo, Klas Sjöberg
While the baseline characteristics of the two cohorts did not differ, there were differences in coeliac disease-related health at the time of diagnosis. The patients in the GP group had lower levels of albumin and ferritin, which may indicate that they had more severe gastrointestinal inflammation and malabsorption. There was also a tendency that these patients had more severe villous atrophy. Weight loss was a more common cause of investigation in the GP than in the GE group. The patients in the GP group thus seem to have been in a worse condition at the time of diagnosis. This raises the question whether milder cases could be missed in Malmö. In line with this hypothesis there were 70% more cases of coeliac disease in Linköping (GE cohort) compared to Malmö (GP cohort) during the study (121 cases vs 73) despite the fact that the population is more than twice as big in Malmö as in Linköping [27]. At least in childhood coeliac disease, no difference in incidence has previously been reported between the south of Sweden, where Malmö is situated, and central Sweden, where Linköping is located [28]. This raises the question if differences in case finding strategies could result in fewer detected cases and also detection at a later stage when the patients are more affected by the disease or if the incidence may really differ between different regions in Sweden.
Fatal self-poisoning with amitriptyline: a case report and brief review of literature
Published in Journal of Substance Use, 2023
Qing Gao, Bin Lv, Weisheng Huang, Tianying Sun, Hongmei Dong
It should be noted that the drug concentration detected at postmortem was affected by the following factors: time of death, environment, time and site of sampling, redistribution and drug metabolism after death (Kennedy, 2010). A study that was conducted in rats revealed that the concentrations of amitriptyline in the heart blood was increased significantly at a time period of 2 h following animal sacrifice (Hilberg et al., 1994). A retrospective study further demonstrated that the concentration of amitriptyline in the cardiac peripheral blood of the decedent were higher than the antemortem drug concentration (Han et al., 2012). Thus, the present case finding has potential limitations. Firstly, amitriptyline intake wasn’t explicit although 3 empty amitriptyline bottles were found on the scene. Secondly, the cardiac blood was analyzed, which is used routinely in toxicological analyses in China. The concentation in the cardiac and peripheral blood weren’t compared in the case. Thirdly, the toxicology analysis at postmortem was affected by many factors. These factors may limit the generalizability of the case findings. In a word, the postmortem factors should be considered with caution when the toxicology results were interpreted in intoxication death case, and further study is needed.
Related Knowledge Centers
- Adverse Effect
- Cancer Screening
- Sensitivity & Specificity
- Risk Factor
- Overdiagnosis
- Medical Error
- Incidence
- Sensitivity & Specificity
- False Positives & False Negatives
- High-Risk People
- Pap Test