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Renal ultrasound is an excellent screening examination for suspected urinary tract obstruction. Its usefulness is based on the ability to detect hydronephrosis. However, it must be recognized that a significant number of conditions exist which can mimic or produce dilatation of the collecting system without urinary tract obstruction. Similarly, obstruction without hydronephrosis, although infrequent, exists. Situations causing either false positive or false negative renal sonograms are discussed. Renal sonography suggesting hydronephrosis should be followed with additional diagnostic studies to confirm or exclude obstruction. Similar persistence should be used when obstruction is strongly suggested clinically, and ultrasound fails to demonstrate hydronephrosis.

Two hundred and four men with impaired glucose tolerance (borderline diabetes) discovered in a screening examination have been observed for five years and repeated tests of glucose tolerance performed. By pre-determined criteria 27 men ‘worsened to diabetes’ and this metabolic deterioration was not significantly influenced by treatment with carbohydrate restriction with or without a daily dose of 50 mg phenformin. Of the baseline variables measured prior to treatment allocation only the blood glucose values were significantly predictive of ultimate worsening to diabetes.

H E UTILlZAnON of scintillation-camera image studies incorporating quantitation, which is the topic dealt with in this issue of the Seminars, is a tool that to us equals in importance the emergence of radiology as it is applied to the diagnosis of renal and urinary-tract disease. The modern gamma camera, with its potential to quantitate dynamic events as well as to picture morpho­ logical occurrences, can no more be compared with the renogram as it came into being in 1955 1 than can modern television transmitter and receiver be com­ pared with Marconi's wireless communication. It is important that the urologist and the nephrologist recognize that such modern technology can yield exeed­ ingly useful information concerning static and dynamic events that is not ob­ tainable by other means. It should further be recognized that renal physiology and pathophysiology can today be studied with radionuclide techniques that cause no morbidity and may be used with ease and accuracy without invasion of the urinary tract. This modern approach to renal physiology compares favorably with difficult clinical and laboratory procedures such as differential renal function studies previously used to obtain information that often was not physiological and that certainly was connected with considerable morbidity. In order for the nephrologist and urologist to properly assess the tremendous potential of nuclear medicine, it appears overdue that their training include some background in this field. At the Section of Urology at the Tulane Medical Center we have over the last 4 to 5 years performed more than 5,000 scintilla­ tion-camera studies on patients, following a standardized approach to allow not only comparison from patient to patient but also follow-up comparison of re­ peat studies on the same patient. The standard procedure'? requires adequate hydration, since one of the determinations made is the amount of radionuclide excreted within a 30-min period. Hippuran labeled with 131 1 is routinely used as the radiopharmaceutical in the initial screening examination. The minute sequence study will reveal functional discrepancies between the two kidneys. A visual image of the two kidneys is obtained where abnormalities such as tumor or hydronephrosis may be detected. An accurate evaluation of the amount of residual urine is subsequently performed by obtaining counts over the bladder before and after urination 30 min after injection of the radio­ iodinated Hippuran. Utilizing this screening examination combined with uri­ nalysis and a brief history, it is possible to determine the presence or absence of renal or urinary-tract disease above the bladder neck in 30 min. It is true that a stone or small tumor causing neither hematuria nor any degree of ob­ struction or renal damage can be missed. However, if there is no syrnptornatol

A case of "masked" macrocytosis in an iron and folate deficient male alcoholic is presented. Reliance on algorithms based on mean corpuscular volume (MCV) values for decision-making in the workup of anemic patients may, occasionally, produce diagnostic difficulties, and combination deficiencies or concomitant disease states may affect test interpretation. Appropriate use of radioisotopic dilution assays for vitamin B12 and folate depends on careful clinical observation, blood count, and screening examination of the peripheral smear before confirmatory tests are ordered.

Accuracy of the detailed per-oral small bowel series and enteroclysis was compared in 134 patients known to have (or not have) disease of the small bowel. Overall sensitivity of the per-oral examination was 92% and specificity 94%, compared to 94% and 89%, respectively, for enteroclysis. There was no difference between the two in Crohn disease, adhesions, and metastatic disease; however, enteroclysis was thought to be more effective in delineating peritoneal adhesions in patients with obstruction. The authors conclude that while the per-oral study and enteroclysis are equally valid methods of examining the small bowel, the per-oral study is preferable as a screening examination because it requires less time, has fewer side effects, and involves a lower radiation exposure.

During 1978-80, 7735 men aged 40-59 took part in a screening examination which included an administered version of the WHO (Rose) questionnaire on chest pain. Those men who had 'possible' angina were as likely to have an ischaemic electrocardiogram at rest as those with 'definite' angina. Furthermore, the heart attack rate over 7.5 years was similar in men with 'definite' and 'possible' angina and did not diminish with length of follow-up. Five years after the initial screening 98% of the surviving men replied to a postal questionnaire which included a self-administered version of the chest pain questionnaire. Age-specific prevalence rates of angina based on the administered questionnaire at screening and on the self-administered postal version five years later, were similar. Men who had angina ('definite' or 'possible') on both occasions had the highest prevalence rate of ischaemic electrocardiograms, men who were positive on only one occasion had intermediate rates and those who were negative on both occasions had the lowest rates. We conclude that in cardiovascular studies of middle-aged men which use the WHO (Rose) questionnaire for the purposes of determining prevalence or assessing risk of a heart attack, angina should include both 'possible' and 'definite' angina.

To the Editor.— In the editorial by DePaulo entitled "Psychiatric Morbidity From Long-term Medications" (1982;247:1867), he recommends the use of standardized and structured examinations to identify and quantitate psychopathological and cognitive impairment. While we fully agree with this approach, we would caution that the information obtained from two of these instruments, the Cognitive Capacity Screening Examination (CCSE) 1 and the Mini-Mental State Examination (MMSE), 2 might be different. To date, we have used these screening tests on 25 patients with a variety of CNS degenerative diseases, including Parkinson's disease, Huntington's disease, and Alzheimer's dementia. None of these patients had clouding of consciousness at the time of examination. They ranged in age from 19 to 82 years (mean, 66.2 years). The two tests were administered on separate occasions, in random sequence, and usually within a three-month interval.

An important use of the preoperative chest radiograph is as a baseline for comparison when complications occur after surgery. Many authors have commented on the value of preoperative chest radiography as a screening examination, but no statistics have been presented regarding its impact on postoperative management. In 369 consecutive general surgical patients, the need for a baseline chest radiograph was evaluated. In 65 patients undergoing chest radiography postoperatively, a preoperative baseline was essential in making an accurate interpretation in 33 (51%). The value of preoperative chest radiography proved to be twofold. Some minimal abnormalities on postoperative radiographs were demonstrated to be clearly new, necessitating treatment or further evaluation. Second, significant abnormalities detected on postoperative radiographs that may have otherwise been subjected to expensive evaluation were often shown to have been present preoperatively. In approximately 9% of patients the preoperative chest radiograph had a significant impact on postoperative management.

Excerpt To the editor: In the January 1977 issue, two of us (John Jacobs and James Strain) (1) reported the development and testing of the Cognitive Capacity Screening Examination designed to quick...

From 1977 to 1983 we have used electric drill needle biopsy of suspicious masses in the breast in 437 patients. In 104 patients with primary breast carcinoma 94 were diagnosed correctly by the initial biopsy, 9 were found on the second or third biopsy and one on the subsequent excisional biopsy. The rate of accuracy of the initial biopsy was 90.4 per cent. The diameters of the 104 carcinomas were less than 2 cm in 62 (59.6 per cent), 2–5 cm in 39 (37.5 per cent) and 5 cm or more in 3 (2.9 per cent). There were 17 patients (16.3 per cent) with a tumor 10 mm or less in diameter. Three hundred and thirty three patients had benign lesions. This drill needle biopsy method can be performed easily and accurately on nodules less than 2 cm, or even 10 mm or less nodules. For a diagnosis of early breast carcinoma made in the outpatient clinic or in screening examination programs, this method may be the most appropriate.

Ultrasonic examination is an established technique for the diagnosis of congenital hip dysplasia. The procedure is outlined and results of screening examinations of 2,000 newborn hips according to the classification of Graf are presented. A differentiated diagnostic-therapeutic concept is available for each sonographic hip type. Social and economic advantages call for an ultrasonic screening examination of newborn hips worldwide.

Ninety-eight young adult patients were examined and scored according to the criteria of the Navy Periodontal Screening Examination. The population examined had a 98% incidence of inflammatory periodontal disease. The relationship of the Navy Periodontal Disease Index and the Navy Plaque Index total scores was determined to +0.55 (P 0.01). The relationship of the gingival score of the NPDI and the NPI was found to be +0.75 (P 0.01). The Navy Plaque Index, like others reported, has a better relationship to a reversible index of inflammatory periodontal disease. The use of the NPDI total is recommended as an aid in determining treatment recommendations.

The results of an oral health survey in five countries by four examiners showed marked between-examiner variation in the interpretation of diagnostic criteria for the assessment of periodontal disease. A new method for the assessment of periodontal disease is described. It is a modification of the Periodontal Screening Examination of O'Leary and is designed to distinguish four degrees of periodontal disease in terms of preventive or curative action required for the problem. In a second survey using this method two examiners obtained closely comparable results in their assessment of calculus, gingivitis and periodontal pockets.

The continued occurrence of advanced cervical carcinoma (stage II, III, IV) was studied. Patients were evaluated with regard to age, racial origin, socioeconomic status, geographic distribution, and presenting symptoms. Particular emphasis was placed on the role of screening in disease detection. The disturbing finding was that of the 170 patients reviewed, disease was diagnosed by screening examination in only 20 patients. Furthermore, 62 patients were not diagnosed even though they were exposed to the health care system. Factors which influence obtaining Pap smears are discussed, with suggestions as to how to enhance use of the Pap smear.

Hungarian citizens travelling to malaria endemic regions have been supplied with malaria chemoprophylactics since the compulsory screening examinations initiated in 1962. Upon return to Hungary after long-term service an additional screening examination is performed. In this present study we report information gained from examination of 15,600 persons. From our examinations we found that chemoprophylactics given by our Institute (chloroquine, pyrimethamine) and taken regularly by our patients provide sufficient protection against manifest disease. The data from 12,780 persons show that with regular chemoprophylaxis the occurrence of malaria was one-tenth of that in persons not taking the drug (1.2% compared with 12%).

A total of 103 consecutive patients with suspected biliary obstruction were studied using both computed tomography (CT) and ultrasound (US) to evaluate the relative accuracy of the methods. In 47 patients with confirmed obstruction, CT and US were comparable accurate in differentiating obstruction from nonobstruction. The precise level of obstruction was identified by CT in 88% and by US in 60%; the cause of obstruction was accurately predicted by CT in 70% and by US in 38%. Both methods detected useful additional information, such as cholelithiasis or retroperitoneal adenopathy. The authors use US as a screening examination; if there is doubt about the level and cause of sonographically demonstrated obstruction, CT has proved to be an accurate means of further evaluation.

• The clinical significance of various diagnostic tests and the length of monitoring required for myocardial contusion were evaluated in 172 patients. Cardiac isoenzyme levels, electrocardiograms, and echocardiograms were evaluated. Twenty-eight patients had a documented myocardial contusion based on at least one positive diagnostic study. The majority of positive studies were detected on admission and all positive tests were present within 24 hours. No patients developed positive diagnostic studies after 24 hours and, likewise, no clinical deterioration occurred late or in patients with a negative screening examination. The electrocardiogram and the clinical course were the primary determinants of the need for cardiac monitoring and therapeutic intervention. Cardiac isoenzyme levels had negligible significance on outcome, and the two-dimensional echocardiogram was not particularly valuable as a screening technique. If no abnormality is detected within 24 hours post injury, further investigation or monitoring does not appear warranted. ( Arch Surg. 1989;124:805-808)

A three-year old patient had ichthyosis and neutral lipid storage disease (Chanarin-Dorfman syndrome), characterized by congenital ichthyosiform erythroderma and leukocyte vacuoles. He did not show any of the internal system involvement that was found in previously described cases. Patients with this syndrome demonstrate a great variability of clinical involvement. The affliction may be very mild as in our case or it may lead to rapid death, as with the patient’s brother born a Harlequin baby, who only survived 5 days. Because of this wide spectrum of clinical variability mild cases might escape diagnosis. It is, therefore, suggested that every case of ichthyosis should have a peripheral blood smear evaluation with special attention to the morphology of the leukocytes. Our case clearly demonstrates the value of such a screening examination. Although the patient had been under treatment for almost 3 years, only screening examination of blood smears of all the patients with ichthyosis finally led to the correct diagnosis.

In its early applications, CT was the preferred method for obtaining additional information in complex cases already studied by angiography and gas encephalography. Nowadays CT has grown into a screening examination for all patients suspected of an organic cerebral pathology, including a pathology of the posterior fossa.

Routine use of the periodontal screening examination and classification of case patterns should help to prevent and control periodontal disease.

On the basis several-year subject in connection with the gynaecologiccal control examinations and cancer screenings, according to epithelia lesions of different location and extension as well as seriousness, the authors suggest different laser surgical solutions taking the histological diagnosis of the lesion into consideration that is established from the result of the test-excision prior to the intervention in the cases wherethe screening examination proves an epithelia lesion going forward in the direction of malignancy.

Mammography, whether film or xerography, is a complementary examination to breast palpation in the detection of breast cancer. According to the guidelines of the American Cancer Society, mammography should be performed on every asymptomatic woman, at least once, over the age of 35. Annual mammography after 50 is also advised. The radiation dose to the breast from current equipment is so low as to not be considered a factor in denying a woman this screening examination. Mammography has a role in evaluating the woman with solitary and multiple breast masses. It is the only proved reliable modality able to detect nonpalpable breast cancers and small tumors less than 2 cm in size. All nonpalpable lesions should be excised by directed biopsy, using a preoperative localization technique.

A new descriptive index, the HHI (hypocalcification-hypoplasia index), is described for comparing enamel defects in groups of people. The index was used in a study completed in 1986, in which 1251 11-year-old children from different ethnic groups resident in South Africa were examined: 210 rural black, 203 urban black, 206 urban colored, 426 urban Indian, and 206 urban white. The index can be used as a screening examination, and the results from these different ethnic groups are presented.

A primary preventive trial against cardiovascular diseases has been in progress since 1970 in Goteborg, Sweden. The study population comprises all men in the city born in 1915-22 and 1924-25, a total of about 30 000 men. One third of this population constitutes the intervention group. The prevalence of angina pectoris and myocardial infarction among men aged 47-53 years has been studied in this group. The cases were identified by means of a postal questionnaire, direct interview at screening examination and by clinical examination. A validation of the postal questionnaire technique gave a sensitivity of 74% and a specificity of 94%. The minimum prevalence of angina pectoris amounted to 4.3% and the prevalence of myocardial infarction to 1.6%. In the angina series, 22% had suffered a myocardial infarction that preceded angina pectoris in 9%.

A 30-item screening examination for cognitive deficits was administered to 65 hospitalized elderly patients and to 60 elderly controls. A high proportion (73 per cent) of the hospitalized patients were found to have low cognitive scores indicative of probable organic mental syndrome (OMS). Especially high deficits were found among the patients with orthopedic and cerebrovascular conditions. The test correctly identified the 15 cases of established OMS. The percentage of false positive results in the normal controls was reasonably low. The importance of routine cognitive measurements in medical wards is stressed.

• Disagreement persists as to whether all patients with inguinal hernia should undergo screening examinations for colorectal cancers before hernia repair. The purpose of this study was to prospectively evaluate the effectiveness of flexible sigmoidoscopy (FS) as a screening examination for these patients. In an 18-month period, 110 patients with inguinal hernia (99% men) with an average age of 63±10 years underwent FS. Diverticulosis was found in 36% of the patients, colorectal polyps in 26%, and colorectal cancers in 3.6%. Occult blood was found in the stool of only 11% of these patients and, thus, was an ineffective screening test. These results suggest that FS is an effective means of screening for premalignant and malignant colorectal lesions in patients with inguinal hernias. ( Arch Surg 1987;122:296-299)

Some eight years ago, an experimental community hypertension screening programme was started in the Province of Liege (Belgium) [1]. In order to make the best use of this experiment, it was decided to include an electrocardiogram in the screening examination. The present paper reports on the first 43,809 tracings and analyses the electrocardiographic changes occurring with advancing age. Three main problems will be successively envisaged: 1) What are the electrocardiographic abnormalities showing an age-related increase of frequency? 2) What are the clinical features most frequently associated with these electrocardiographic findings? 3) What are the prognostic implications of these electrocardiographic anomalies, especially when they are disclosed in individuals without apparent heart disease?

Parallel to the comprehensive interscandinavian project on DYSLEXIA (the so-called BERGEN PROJECT), all primary school children beginning their 1st school year in Bergen in the autumn of 1977 (N= 3442) have been incorporated in a specialized visual and orthoptic examination program. All the children have had a screening examination which has given informations concerning: Visual acuity, stereoscopic vision, strabismus (manifest/latent, type and degree), fusion, convergence, bifoveal fixation and dominant eye and preferred hand. 106 children were found to be in need of orthoptic/ophthalmological treatment. 12 of those have dyslectic problems, whilst in another 221 dyslectic children the orthoptic examination was concluded “NORMAL”. Dyslectic children which have not profitted well on the educational training programs will be re-assessed by the orthoptist/opthalmologist in consultation with the teachers and pschycologist. They will then be treated for small “pschycological” latent deviations, minimal refractiv and binocular errors and for crossed reference eye. Progress of readincr ability for these orthoptically treated children will be evaluated.

The Cognitive Capacity Screening Examination, developed to detect cognitive deficits as possible manifestations of diffuse organic mental syndromes, was administered on admission and at discharge to 106 patients on a medical ward of a general hospital (mean age, 56 years). Thirty-three percent of the patients showed diminished cognitive capacity at admission, of which 16% were undetected by the house staff. Restudy at discharge revealed that 28% of the sample continued to have diminished cognitive capacity. This study documents the incidence of cognitive deficits, highlights the need for early detection, and offers practical considerations for discharge procedures.

Thirty-five survivors of extremity sarcomas being followed in a University-Hospital orthopedic clinic were evaluated for current and lifetime presence of psychiatric disorders. Patients were assessed for cognitive abilities using the Cognitive Capacity Screening Examination and for psychiatric disorders using a structured interview format, the Schedule for Affective Disorders and Schizophrenia-Lifetime version. The criteria for psychiatric disorders were the Research Diagnostic Criteria. Two patients were excluded because of cognitive deficiencies; thirty-three patients (mean age=37.7 yr) were formally evaluated at a mean time of 2.6 yr following cancer diagnosis and surgery. Forty-five per cent of patients were given the diagnosis of at least one lifetime psychiatric disorder. Fifteen per cent of patients reported a current episode. Affective disorders and alcoholism were the most frequently reported disorders.

Studies to determine the validity of the Mini-Mental State Examination (MMSE) and the Cognitive Capacity Screening Examination (CCSE) have indicated unacceptably high false-negative rates for these tests. To determine whether a new examination, the Neurobehavioral Cognitive Status Examination (NCSE), is more sensitive in the detection of cognitive dysfunction, we compared the three examinations in 30 patients with documented brain lesions. The CCSE had a false-negative rate of 53%; the MMSE, of 43%; and the NCSE, of 7%. The sensitivity of the NCSE is derived from two features of its design: the use of independent tests to assess skills within five major areas of cognitive functioning, and the use of graded tasks within each of these cognitive domains.

The serum alkaline phosphatase (ALP) is often included among the tests used for case-finding among ambulatory patients. To determine the positive predictive value of the ALP, test results for all adults screened by a health maintenance organization between March and December 1969 were obtained by computer. The authors reviewed the charts of all 661 patients with abnormal tests whose primary source of medical care was at this facility. Complete two-year follow-up data were available for 91% of these patients. There were 56 patients (9%) with a diagnosis that could have explained an abnormal ALP. Of those cases in which ALP would have been clinically useful all but one could have been diagnosed by a simple, noninvasive work-up, and in that one case, no management change would have occurred. The authors conclude that in the absence of a small number of specific indications, extensive testing need not be performed to evaluate an isolated abnormal ALP obtained from a screening examination.

Blood pool imaging of the lower limbs with Tc-99m-erythrocytes demonstrates the deep venous channels of the leg. The radionuclide image of deep vein thrombosis, by this method, appears sufficiently distinctive to suggest that Tc-99m-erythrocyte venography may be a useful screening examination for deep vein patency.

SUMMARY The personnel needed for a dental service are the dentist, the dental assistant, or an appropriately trained aide, and a nurse's aide. The initial visit would include a screening and review of all participants, and providing the home with necessary permission slips. A home care checklist chart is developed for each participating resident. If the forms reflect the organization, completion of the forms is simple, and easily managed and updated. An emergency care room should be established with ample light, a dental chair, a sink, and necessary supplies (Table). On the second and subsequent visits, an aide can organize the charts and bring patients to the dental room for screening. It is easy for the aide or nurse to tell what the personal health and mood of the patient is. A screening examination is charted with potential and immediate problems written on the conservator's form (Fig 2). Treatment may consist of directions to staff, temporary medicated dressing (cement or denture liner, or trimming of denture flanges), and the recommendation for extensive treatment or absolute immediate care in the office of an oral surgeon or a hospital based dental department. Subsequent treatment visits should include education for untrained aides and an update for staff members already trained. Treatment should be done after consultation with staff. New patients with completed conservator's request forms may be screened for potential or immediate need. Any billing would be completed by the dentist or aide, using the same procedures that he or she would use in the private office. The dentist is responsible for billing. Instruction sheets are left at the home on the first day by the secretary. These directives help to keep things slowly smoothly when the dentist comes for the first visit (Fig 2).

In an ongoing multifactor primary preventive trial in Goteborg, Sweden, one third of all men born in 1918–19 were invited to a screening examination including history-taking and blood pressure (BP) and heart rate (HR) measurement. The screening examination was attended by 1427 men (76%). Those who were considered to have “borderline” BP, i.e. SBP 160–175 or DBP 95–115 mmHg, were reexamined two years later regarding BP and HR. Of these 493 subjects 12% were considered hypertensives, i.e. they had SBP>175 or DBP> 115 mmHg or had been put on antihypertensive treatment. If the majority of new cases of hypertension is assumed to come from the borderline group, the incidence of new hypertension in this age (52 y) is about 2%. At the reexamination 39% of the former borderline hypertensives had normal BP. A substantial part of those with borderline BP thus had normalized their BP within two years. Those who developed hypertension were characterized by higher SBP and HR already at the initial screening examination. They also tended to have lower physical activity at work and during leisure, and higher stress experience. These differences were, however, not statistically significant.

In this study we were concerned with detecting iron deficiency without anaemia, using a laboratory index, the M.C.H.C. as a screening test. During a multiple screening survey we examined women who were not anaemic but who had low M.C.H.C. values, and compared them with control patients who had normal M.C.H.C.s and who were also not anaemic. Those with a low M.C.H.C. were significantly more likely to have latent iron deficiency than those with a normal M.C.H.C. The M.C.H.C. cannot be recommended as a screening test, however, because of poor sensitivity and specificity. Other authors have described symptoms accompanying iron deficiency without anaemia which improve when iron therapy is given. The clinician faced with a low M.C.H.C. value in screening work should keep the above information in mind and should remember that one in four of our non-anaemic patients with a low M.C.H.C. had latent iron deficiency. If we are going to concern ourselves with anticipating morbidity in population groups, then such simple information as the M.C.H.C. may have a proper place in a screening examination.

Methods of detecting gingival and periodontal breakdown and periodontal irritants were studied: (1) With a comprehensive periodontal examination used as a criterion, three screening examinations for the detection of periodontal disorders were evaluated. Two systems, the ''mesial'' and the ''mesial plus distal'' proved 94.1 and 98.0 % accurate. (2) By use of the mesial screening system, inter- and intra-examiner consistency between examinations on the same individual was considered. (3) Agreement of the periodontists on scoring disease was checked. (4) General dentists were trained in the use of the mesial screening system and the system for scoring local irritants. After 3 hours of training, six dentists independently assessed 20 subjects on two occasions. With the chief investigator's score used as the criterion, the participating dentists failed to detect advanced gingival or periodontal disease in only 3 of 78 subjects. When failures to refer and wrong referrals were combined, errors by dentist ranged from 10 to 30%.

– The effectiveness of the Charters', scrub, and roll methods of toothbrushing in removing plaque was studied in 182 college students. At an initial screening examination, plaque was assessed using the gingival index. These plaque scores were used to divide the group into those with poor and those with good oral cleanliness. Within each of the two groups, the subjects were randomly assigned to a toothbrushing method and to one of three instructors. Then the participants had their teeth cleaned and were asked to abstain from toothbrushing for one week. After this period of plaque accumulation the participants were again scored for plaque. The test subjects were carefully instructed in the particular tooth-brushing method they were to use and the controls were asked to resume their usual methods. One week later the participants were again examined for plaque. An interaction between toothbrushing method and instructor was found indicating that the effectiveness of a particular method depended in part on the instructor. Nevertheless, the Charters’and scrub methods of brushing appeared to be more effective in removing plaque. Generally, subjects with cleaner teeth prior to the stu achieved grater plaque reductions than those with initially poor oral cleanliness. All methods of bruching were relatively ineffective in removing proximal plaque.

The examination of the petrous temporal bone by zonography is presented. The prerequisite theoretical criteria for successful zonography are restated and applied to the radiological examination of the petrous bone. The technique is advocated as a screening examination for abnormalities of the internal auditory canals; as an important addition to hypocycloidal tomography in the investigation of congenital ear disease; for the evaluation of the incudo-mallear joint in the axial projection following trauma to the temporal bone; and for the demonstration of the temporo-mandibular joint.

Background Untreated dental caries afflicts almost one third of school-aged children in the United States and many of them are from disadvantaged families. This cross-sectional study was undertaken to investigate the prevalence of untreated caries in north central Kentucky, USA and to examine the relationships between the available demographic variables and untreated childhood caries as reported on the forms from the Smile Kentucky! program. Methods During the fall of 2008, caries status was assessed during the visual oral screening examination component of “SmileKentucky!”– a model of the American Dental Association’s Give Kids A Smile program. Parents had completed brief surveys concerning 3,488 elementary school children aged 5 to 13 years who participated in the program. A secondary analysis was conducted using univariate, bivariate and multivariate statistical methods. Results Untreated caries was reported in 33% of children. Bivariate and logistic regression analyses found that the most significant risk factors for having untreated caries were living in the metropolitan Louisville, Kentucky area, not having had a dental visit in the previous 3 years and not having any form of dental insurance. Conclusions Untreated caries in elementary school children is prevalent in north-central Kentucky despite efforts to improve access to care. The results suggest that additional family and community preventive initiatives are needed to reduce the development of childhood caries in this area of the United States.

Introduction: Both colonoscopy and CT-colonography (CTC) are eligible for populationbased colorectal cancer (CRC) screening. The potential time spent in screening examinations may be a barrier to undergo screening. Furthermore, the Consensus Panel on Cost-Effectiveness in Health and Medicine (U.S. Public Health Service) has recommended the incorporation of patient time costs in economic analyses. Aim: To measure the amount of time individuals spend in the colonoscopy and CTC-screening process. Methods: A total of 8844 average-risk individuals (50-75 years) were invited to participate in a randomized controlled screening trial comparing colonoscopy and CTC for primary CRC screening. Colonoscopy was performed with 2 liter cathartic (Moviprep) and CTC with 3x50 ml iodine-based bowel preparation (Telebrix). Between February 16 and May 27 2010, all consecutive participants were asked to participate in a diary study. Participants were contacted during the consultation prior to their examination. Individuals unable to read and/or speak the Dutch language were excluded. Participants recorded different time intervals in the screening process, from starting with the preparation until feeling completely back to normal. All time intervals are reported as median and interquartile range (IQR). Results: Of 600 eligible subjects, 538 (90%) were willing to complete the diary. Thirty-five colonoscopy and 13 CTC subjects cancelled their examination or did not show up. The diary was returned by 75% (240/320) of colonoscopy and 75% (127/170) of CTC screenees. There were no significant differences between colonoscopy and CTC screenees with respect to gender (men 52% (124/240) and 48% (61/127) respectively) and age (mean age 61 ± SD 5.9 and 61 ± SD 6.2 resp.). For colonoscopy and CTC, the median intervals between starting the Moviprep or Telebrix and leaving home for the examination were 17 hrs (IQR 15-18) and 19 hrs (IQR 18-20) resp. (p

Thermal sensibility was quantitatively assessed in the feet of 46 diabetic patients. In subjects with sensibility deficits the perception threshold for warmth or cold, or of heat pain, was either increased or lost. Four stages of impaired thermal sensibility were defined, and a classification of dysfunction is proposed which could be useful in routine clinical examination of patients with diabetic polyneuropathy. The classification of impaired thermal sensibility correlated significantly with the results of a bedside screening examination aimed at describing the severity of the polyneuropathy in terms of its regional extent.

Neurologists and neurosurgeons are becoming increasingly aware of how assessments from allied health professionals, specifically occupational therapists, speech pathologists, and physical therapists are valuable adjuncts to the physician's diagnosis and can assist in determining treatment regimens. These assessments give the physician a baseline with which to assess objectively a patient's level of neurological functioning before and after surgery, the effects of medications, and the rehabilitative progress and potential. With the rising cost of health care, excessive and redundant testing must be minimized; testing must promote the quality of patient care. We designed a screening examination for this purpose. Speech pathologists, occupational therapists, and physical therapists have combined their knowledge to create a comprehensive and thorough screening examination for the neurologically involved patient. Staff members are cross-trained by individuals in the different disciplines in necessary skills so that one examiner can perform the screening.…

Transrectal biopsy was performed on 173 unselected patients, aged 45-85 years, with disease of the prostate, who had previously had a screening examination. The findings on palpation by the referring doctor and the authors' own assessment were compared with the histological findings. Of 37 histologically confirmed cases of carcinoma of the prostate 16 (44%) had been correctly diagnosed by the referring doctor and 28 (76%) after examination at hospital. On the other hand, of 136 histologically negative cases the referring doctor's diagnosis had been correct in 112 (81%) instances and at hospital 94 (69%).

Reliability and validity of three mental status questionnaires--the Short Portable Mental Status Questionnaire, Mini-Mental State Examination, and Cognitive Capacity Screening Examination (CCSE)--were assessed using 66 elderly (age greater than or equal to 65 years) hospitalized medical-surgical patients. Internal consistency as well as content, criterion-related, and construct validities were examined. The CCSE was found to be the most valid and reliable measure of mental status in this patient population. Implications of the findings regarding selection of mental status questionnaires for differing purposes are discussed.

In this brief paperbound volume, the authors set as goals that the reader become able to conduct and interpret a comprehensive evaluation of neuropsychological functioning and a 15-minute mental status screening examination. The last of these goals remains just beyond the reach of this worthwhile book. Here one finds concise presentation of a wealth of important material. The authors recognize that organic diseases often present with emotional and behavioral changes, caused by subtle language or memory disturbances. In 11 chapters, they move from the "Rationale and Overview of the Mental Status Examination" to "Evaluation of the Level of Consciousness," "Attention," "Behavioral Observations," "Language," "Memory," "constructional Ability," "Higher Cognitive Functions," "Related Cortical Functions," "Summary of the Examination," and an explanation of "Further Evaluations" ordinarily done by a neuropsychologist. One appendix explains standard psychological tests and provides addresses for obtaining them, a second outlines the complete mental status

• Phleborheography is a well-established technique for the noninvasive diagnosis of deep venous thrombosis of the lower extremity. For ten years we have used phleborheography in the diagnosis of axillary and subclavian venous thrombosis. We developed modifications in technique and interpretation that are necessary for accurate application of phleborheography to the upper extremity. When compared with venography, the sensitivity and specificity of this technique approached 90%. Therefore, phleborheography appears to be a useful screening examination for deep venous thrombosis of the upper extremity. ( Arch Surg 1983;118:1134-1136)

THE UPPER gastrointestinal (UGI) series is a roentgenographic screening examination of the UGI tract for patients exhibiting a wide variety of clinical symptoms and signs. The findings on the UGI series often determine the need for further evaluative procedures. The clinician is well aware that many diseases of the stomach can manifest the same symptoms; he must also realize they can demonstrate identical roentgenographic findings on the UGI series. If an irregular polypoid or an infiltrating lesion of the stomach is demonstrated on the UGI series, the radiologist naturally considers malignant neoplasms as the most likely diagnosis. But he also must remember that benign processes in the stomach can grossly simulate malignant neoplasms and that they, too, must always be considered in the differential diagnosis. The diagnoses made by the radiologist on the basis of gross roentgenographic findings are, in effect, predictions based on statistical probabilities. The purpose of this