Browsing by Subject "Mass Screening"
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Item Acceptability of Screening for Sexually Transmitted Infections in an Urban Pediatric Emergency Department in the Southern Region of the United States(2016-01-19) Pfaff, Jamie; Johnson, DawnBACKGROUND: Adolescents age 13 to 24 years old are the demographic most affected by sexually transmitted infections (STIs) in the USA. The CDC, USPSTF and the AAP recommend screening sexually active females less than 25 years old in all health care settings for Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) and all high-risk females of this age group also for HIV and Syphilis. In regions with a high prevalence of STIs, such as Dallas County, the diagnosis and treatment of STIs is a vital step toward reducing the spread of these communicable diseases in this population. METHODS: All adolescents age 13-24 presenting to the Pediatric Emergency Department (PED) during the study period who met the study criteria were asked to participate. A total of 197 adolescents and 198 parents, 183 of which comprised parent-child dyads, were enrolled and completed separate surveys. Participants answered questions about adolescent and parent acceptability of STI screening, STI risk behaviors, and adolescents' history of STI screening and treatment. RESULTS: Analysis thus far shows that non-invasive STI screening is acceptable to the majority of both adolescents (70%) and parents (84%). Among patient/parent dyads, 59% had positive responses from both. No demographic factors demonstrated statistical significance. However, some factors displayed greater variability than others. In terms of age, adolescents greater than 15 years old were more likely to indicate acceptance of STI testing (73%) than those younger than age 15 (62%). Breakdown by adolescent race and ethnicity demonstrated a range of acceptability with 83% for those who identified as White or Caucasian, 59% for those identifying as Black or African American, 64% for those identifying as Hispanic, and 100% of the five participants identifying outside of the previous categories, "other". CONCLUSIONS: These acceptability results are similar to those found in a study performed in Jefferson County, AL where adolescents reported a 71% acceptance rate for GC and CT screening. This suggests that implementation of STI screening in the PED would be successful and well tolerated by the majority of adolescents and their parents. The variation in acceptability demonstrated by age and race were not statistically significant but may be useful in determining the minimum age of PED intervention and preparing culturally sensitive answers for questions from adolescents and patients in future testing interventions. Implementation of new PED HIV screening protocols are utilizing evidence based on this study and will further be assessed for continued improvement of Dallas adolescent health.Item Anal Cancer Screening in a High-Risk Population: A Quality Improvement Initiative(2019-03-29) Bieterman, Andrew; Reed, W. Gary; Anandam, Joselin; Lau, Abby; Quinn, AndrewBACKGROUND: The main risk factor for the development of anal cancer is acquisition of the human papilloma virus (HPV). Individuals infected with the human immunodeficiency virus (HIV) have a higher prevalence of HPV and subsequently developing HPV induced dysplasia. The incidence of anal cancer among HIV positive men who have sex with men (MSM) has been estimated to be approximately twice that of HIV negative MSM with rates as high as 112-144 per 100,000. By relying on similarities between the anus and the cervix, and the established success of cervical cytology screening in reducing the incidence of cervical cancer, anal cancer screening programs have been established to identify pre-cancerous lesions. LOCAL PROBLEM: A retrospective chart review of anal cancer incidence at Parkland Hospital revealed a significant burden of anal cancer amongst HIV positive patients. As such, Parkland has decided to implement a policy of annual anal cancer screening among all HIV patients via anal cytology screening and referrals to proctology for any abnormal anal cytology samples. METHODS: In order to assess the monthly anal cancer screening rate, we looked at the absolute number of anal cytology samples performed in a 28 day period. The list of anal cytology samples performed was pulled from the Cerner laboratory information system (LIS) and correlated with a quarterly chart review using the electronic medical record (EMR). Utilizing, QI MACROS in EXCEL, we were able to create a run chart to identify trends in anal cancer screening rates over the duration of the project. We used chi-squared test of independence and unpaired t-test to determine statistical significance. INTERVENTIONS: We implemented a multi-step process involving over 10 Plan-Do-Study Act (PDSA) cycles for increasing the number of anal cytology samples performed in the clinic. The three most impactful PDSA cycles are discussed in the article. RESULTS: The primary outcome of monthly anal cancer screening rate increased over the duration of the project from an average of 19.5 in 2015 to 58.6 samples collected per month in 2018, a 199.3% increase relative to baseline (p < 0.001). While the interventions implemented were successful in increasing anal cancer screening rates, we were unable to determine which of the PDSA intervention cycles had the biggest impact on altering the clinic practice. Over the duration of the project, we screened 1908 patients. Of the patients screened, we identified 249 patients with abnormal anoscopy findings. Amongst the patients that had anal lesions on anoscopy, 10 developed anal cancer, 4.0%. When taking a closer look at these individuals and the electronic medical record, 3 patients were found to be completely asymptomatic at the most recent clinic prior to collection of the anal pap and would not have been referred to proctology if it weren't for the screening test, which ultimately resulted in an earlier diagnosis CONCLUSION: We were successful in taking previously proven interventions for increasing cervical cancer and adapting them for anal cancer. By increasing awareness to both patients and providers on the risks of anal cancer, instructing providers on the methods to screen for the disease, and providing timely feedback, we were able to increase the anal cancer screening rate in this large urban clinic with limited resources.Item Defining Practices, Outcomes, and Barriers to Gestational Diabetes Mellitus Screening at a Large, Urban Indian Community Hospital(2019-04-02) Balijepally, Ramya; Chang, Mary; Rajora, Nilum; McGarry, MaryBACKGROUND: Gestational diabetes mellitus (GDM) is defined as a glucose intolerance of varying severity with onset or first recognition during pregnancy. Uncontrolled GDM is linked to various pre-and postpartum complications and long term maternal health issues. Complications of pregnancy due to GDM include abortion, preterm labor, polyhydramnios, oligohydramnios, and fetal death. Complications to the fetus include fetal macrosomia, fetal malnutrition, defects of the neural tube, and cardiac anomalies such as ventricular septal defects and atrial septal defects. In 2010, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) estimated that the prevalence of gestational diabetes mellitus (GDM) in Southeast Asia was 25%. Among the various populations globally, Indians have a higher frequency of GDM proving the need for an efficient screening process. This was an observational study conducted at large, urban community hospital in India. The purpose of this study was to define the patient population, GDM screening practices, and reasons why some women did not get screened for GDM. METHODS: This was an observational study conducted at a community hospital in south India. The timeframe of the study was from April 2017 to April 2018. The data was collected through patient interview and chart review. The patient's demographic information, risk factors for GDM, course during pregnancy, method of GDM screening used, mode of delivery, maternal, and neonatal outcomes were collected by a simple questionnaire. When accessible, data collected through patient interview was verified by the patient's chart. The inclusion criterion was post-partum women who delivered at Apollo General Hospital. The exclusion criterion for study participants was women with pre-GDM. FINDINGS: 55 interviews were conducted. The mean age at delivery was 24.5 years (n = 55). The mean gestational age that prenatal care was established was at 4.7 months (n = 54). Of the 42 of the 55 patients (76%) who were screened for GDM, 5 patients (9%) were diagnosed with GDM. All 42 patients were screened using the WHO 1999 criterion. Only 7 of the 42 patients were screened between 24 and 28 weeks. The mean gestational month that GDM screening occurred at the hospital was at 5.9 months (n = 40). Of the 13 patients who were not screened, 9 did not get screened because of physician recommendation. 4 were not screened because of lack of patient knowledge. INTERPRETATION: The incidence of GDM in this population was 9%. Although the screening method was standardized, the rate of screening was not universal (76%). Most women were not screened between 24 and 28 weeks, which is recommended by the American College of Obstetricians and Gynecologists (ACOG). Based on this study, future research should explore if there are any harmful consequences from not screening between 24 to 28 weeks in this population and consider educational outreach opportunities.Item Defining Screening Practices for Gestational Diabetes Mellitus at a Large, Urban Indian Community Hospital(2018-01-23) Iyengar, Meera; Balijepally, Ramya; Lingvay, IldikoBACKGROUND: The aim of this project was to outline screening practices for gestational diabetes mellitus (GDM) at Apollo General Hospital in Hyderabad, India to understand if GDM was being reliably diagnosed. Current screening guidelines for GDM advocate using an oral glucose challenge test in all high-risk women. Indian women have a 11-fold increased risk of developing GDM, demonstrating the need for a consistent and reliable screening practices. HYPOTHESIS: If Apollo General Hospital in Hyderabad, India is administering the gold standard screening method for GDM, then pregnant women coming to Apollo should receive an oral glucose tolerance test during their pregnancy. METHODS: A chart review of all deliveries at Apollo General Hospital from its opening in 2012 to 2016 was completed. Information from each chart regarding the hospitalメs screening practices for GDM including procedures, results, and follow-up practices was collected. RESULTS: GDM screening rates were high (92%), but not universal. Of the 208 patients reviewed, only 51% received a GTT or GCT sometime during pregnancy. An equal percentage of patients received either an RBS (36%) or GTT or GCT (36%) as their first screening test. The remaining patients received an FBS (21%) or PPBS (0.5%) as their first screening test. 8% were not screened for gestational diabetes mellitus during their pregnancy. 10 out of 208 reviewed patients were diagnosed with GDM, of whom 5 received either a GTT or GCT (45%). The prevalence of GDM at Apollo was 4.8% compared to global prevalence of 6%. CONCLUSIONS: Overall screening for GDM is high at Apollo General hospital. However, the screening practices vary considerably per patient, and only around 50% of women had received the gold standard test during their pregnancy. In addition, the prevalence of GDM at Apollo was lower than the global prevalence of 6%. This combined with the fact that Indian women have a 11-fold increased risk of developing GDM argue that RBS, FBS, PPBS or HbA1c may not be adequate tests to screen for GDM. Inconsistent screening practices prove the need for standardization and inquiry into patient and provider factors that influence the current variability in testing, as undiagnosed GDM can have serious consequences for both the mother and child.Item Evaluating Teleretinal Imaging Detection of Diabetic Retinopathy in the Dallas County Hospital System(2018-01-23) Lee, Jessica; Nguyen, Lilian; Lee, Roxanne; Blomquist, PrestonINTRODUCTION: Diabetes mellitus (DM) is one of the most prevalent diseases in the United States. Approximately one third of patients with diabetes have diabetic retinopathy, which is the leading cause of new cases of blindness among US adults ages 20-76 years. The American Academy of Ophthalmology recommends annual screenings for diabetic retinopathy beginning 5 years after the onset of DM1 and beginning promptly after diagnosis of DM2. Only 60% of people with DM have yearly screenings, which consist of a dilated eye exam. Nonmydriatic digital retinal imaging with remote image interpretation (teleretinal screening) is a promising new technology because it allows rapid retinal imaging without dilation of the pupil in primary care clinics, with the potential to reach more patients, detect disease earlier, facilitate compliance, and reduce barriers to specialized eye care. PURPOSE: To evaluate the effectiveness of a diabetic retinopathy teleretinal screening program and follow-up in a high-risk population. METHODS: Diabetic patients who had teleretinal imaging performed between April 1, 2013 and March 10, 2017 at the community-based primary care clinics of the Parkland Memorial Hospital system were identified through Epic electronic health records. Patient age, sex, screening date and interpretation, completed follow-up eye clinic appointments, and ocular diagnoses were recorded. RESULTS: 1155 patient charts were reviewed and of those, 399 (34.5%) underwent the screening and had a teleretinal image obtained. Of those screened, 279 (69.9%) were referred to optometry or ophthalmology clinic, and 114 (40.8%) were later seen in clinic. The most common reasons for referral were a yellow report without a specific interpretation (83.5%), mild or moderate non-proliferative diabetic retinopathy (6.8%), nerve-related disease (4.7%), and red report without a specific interpretation (2.2%). The percentage of agreement for all diagnoses was 76.3% and total sensitivity was 72.7%. Diabetic retinopathy was detected for the first time through teleretinal screening in 44 patients (11.0%). CONCLUSIONS: Teleretinal screening is a useful method for detecting diabetic retinopathy. However improvements need to be made in follow up of ordered screenings, image quality and interpretation, and referral follow-up.Item Hepatitis C: the evolving strategy to test and treat(2014-01-24) Jain, Mamta K.Item Implementing Mental Health Screening Assessment and Navigation (MH-SCAN) in a Community Oncology Clinic: Evaluations and Efficacy(2017-06-29) Jester, Bryan Elliott; Walker, Robrina; Howe-Martin, Laura; Jarrett, Robin B.; Jha, Manish; Lohrey, JaySignificant portions of cancer patients are attempting to manage the stressors of survivorship with undiagnosed depression. Untreated depression increases mortality rates, deteriorates patients' quality of life, and disrupts adherence to cancer treatment. Despite widespread recommendations, there remains a significant gap in identification of depression and engagement in depression treatment. To fill this gap, the University of Texas Southwestern Moncrief Cancer Institute implemented Mental Health Screening, Assessment, and Navigation (MH-SCAN) as standard of care. This study evaluated factors associated with screening positive for depression, as well as the impact of Mental Health Patient Navigation on depression treatment engagement and depression symptom reduction. Universal, tablet-based screening using the Patient Health Questionnaire (PHQ-2, PHQ-9) was implemented to screen for depressive symptoms. After screening positive, a patient navigator contacted the patient to engage them in navigation services. For the current study, patients (N=500) diagnosed with cancer two years prior to PHQ-2 screening were selected for inclusion. Clinical and demographic data were collected via electronic health record review to compare patients based on positive (n=173) and negative (n=327) depression screening result. Patients who were (n=106) and were not (n=67) navigated were then compared on their engagement in depression treatment and symptom reduction. Approximately one-third of all patients screened positive for depression. Individuals, who had a pre-existing mental illness, are unmarried, have less education, are on disability, and earn USD30,000-USD40,000 per year (i.e., the "working poor") were significantly more likely to screen positive for depression. Significantly more (χ2= 62.224, p < .001) patients initiated referred depression treatment who were navigated (67%) compared to patients unable to be navigated (6%). Furthermore, patients who were navigated had significantly greater reductions in depressive symptoms (M = -6.43, SD=6.63) compared to patients unable to be navigated (M = -1.46, SD=3.87), F = 30.91, p <.001. We conclude that Mental Health Patient Navigation successfully bridges the depression screening and treatment gap, fulfilling recent recommendations put forth by numerous psychoncology groups. Our MH-SCAN program can serve as the model for future iterations of screening and treatment programs, providing crucial psychosocial care to at-risk oncology populations whose mental health has often gone underserved.Item Integrated Model for Hepatitis C Screening and Linkage to Care in Homeless Population(2019-01-22) Xia, Amy; Balakrishnan, Naveen; Tran, Minh; Pagels, PattiBACKGROUND: Hepatitis C is a major cause of morbidity and mortality as up to 46% of people infected with Hepatitis C develop cirrhosis and up to 20% develop hepatocellular carcinoma. Over the past year, a new initiative through the DFW Hep B Free organization at the University of Texas Southwestern (UTSW) was formed to target Hepatitis C among the homeless population, starting with screening at the Union Gospel Mission's Calvert Place homeless shelter. This underserved population is vulnerable because of inadequate healthcare access and resources, in addition to other risk factors such as former incarceration and injection drug usage. The main barriers to care for a transient, homeless population are 1) their lack of access to regular healthcare and screenings, 2) their inability to receive screening results via phone or mail, and 3) the difficulty of linking patients to affordable, accessible healthcare and treatment. METHODS: Our model integrates a student-run screening program, an on-site clinic at the shelter, and specialized hepatology services at Parkland Health Hospital System (PHHS), a local safety-net provider, to maximize the strengths that each component offers. Using OraQuick Rapid Hepatitis C Virus (HCV) tests, which screen for HCV antibodies and produce results in 20 minutes, we can deliver test results and provide counseling on the screening day. Under an IRB through a faculty hepatologist, patients that test positive are registered into Parkland Hospital's hepatitis surveillance program. The program then provides patient navigation, financial support, and treatment. RESULTS: On average, the HCV antibody positive rate from screenings at Calvert Place is 12.7% (N=126). 100% of positive patients were contacted with their result. For patients who tested positive (n=16), 2 (12.5%) did not need care (resolved HCV). From the 14 of 16 that had active HCV infections, 50% were lost to follow up and 50% were linked to care at Parkland hepatology clinic. CONCLUSION: Through our integrated model, we have created the foundations for a sustainable system to break down barriers to care while ultimately connecting HCV-positive homeless patients to treatment.Item [News](1975-02-12) Harrell, AnnItem Pancreatitis and pancreatic cancer: genetics and clinical applications(2021-11-12) Rustgi, Anil K.Item Rethinking diabetes screening and case finding strategies in clinical practice: who's really at risk?(2016-08-26) Bowen, MichaelItem Screening and surveillance for colorectal cancer part of the couriculum(2006-09-15) Harford, William V.Item [UT Southwestern Medical Center News](2009-07-16) Stafford, Erin Prather