The incidence of interval cancers in the German mammography screening program: results from the population-based cancer registry in North Rhine-Westphalia.

Background: Cancer screening programs must meet high standards for quality and effectiveness, because many healthy persons need to be screened to detect relatively few cases of cancer. In this study, we use the rate of interval cancers as an important surrogate indicator for evaluating the German mammography screening program (MSP).

Methods: All first-time participants in the MSP in the German federal state of North Rhine-Westphalia over the period 2005-2008 whose screening mammogram had been read as negative were followed over the next 24 months for the potential development of breast cancer (an "interval cancer" or IC).

Digital mammography screening: how many breast cancers are additionally detected by bilateral ultrasound examination during assessment?

Objective: To assess the positive predictive values of incremental breast cancer detection (PPV1) in relation to the mammographic breast density and of performed biopsies (PPV3) resulting from supplemental bilateral physician-performed whole-breast ultrasound (US) at recall of a population-based digital mammography screening programme.

Methods: A total of 2,803 recalled screening participants (50-69 years), who had additional bilateral US with prospectively completed documentation [grading of breast density (ACR 1-4), biopsy recommendation related to US and mammography], were included.

Results: The PPV1 of supplemental cancer detection only by US was 0.

Mammography Screening: Evidence, History and Current Practice in Germany and Other European Countries.

SUMMARY: In this review, we describe the history, evidence, and current practice of mammography screening in Europe and the newly implemented screening program in Germany. We report results of the first screening rounds in North Rhine-Westphalia and compare these with reference values set by the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis. Finally, we summarize and compare performance indicators of the organized screening program in England, Italy, North Rhine-Westphalia and The Netherlands.

The role of mammography screening attendance and detection mode in predicting breast cancer survival-is there added prognostic value?

Introduction: The aim of this study was to examine whether screening exposure status, defined as detection mode (screening, interval or symptomatic) combined with breast cancer screening attendance prior to diagnosis, had any additional value over detection mode in predicting breast cancer survival. We also assessed the effect of hormone replacement therapy (HRT) on the association of detection mode with breast cancer survival.

Methods: We analysed and compared the associations of both screening exposure status and detection mode with 5-year breast cancer survival on a cohort of 3013 breast cancer patients, aged 50-74 years in Sweden.

Waist circumference and waist-to-height ratio in Han Chinese children living in Chongqing, south-west China.

Objective: To derive age- and sex-specific reference values for waist circumference (WC) and waist-to-height ratio (WHtR) for Han Chinese children and adolescents and to establish the prevalence of excess central adiposity in our study population.

Design: Cross-sectional study of schoolchildren attending randomly selected primary and secondary schools in south-west China in October 2003 and April 2004. Anthropometry was measured using standard procedures.

Advances in diagnostics for microbial agents: can clinical validation keep pace with the technical promises?

New technologies are revolutionizing diagnostic microbiology, but implementation of methodological advances in test evaluation has been extraordinarily slow. Published reports frequently fail to clearly distinguish between studies of analytical accuracy and those of clinical diagnostic performance. We argue that the evaluation of sensitivity and specificity, while necessary and occasionally problematic, is often inadequate to define the appropriate role of a new diagnostic test.

The natural history of vitamin D deficiency in African refugees living in Sydney.

Objective: To describe the natural history of vitamin D deficiency in an at-risk population of African migrants living in Sydney.

Design, Setting And Participants: Opportunistic study of 25-hydroxyvitamin D [25(OH)D] concentrations over time in a community-based cohort of North African refugee families living in south-western Sydney. As part of a health-screening program, serum concentrations of 25(OH)D, parathyroid hormone (PTH), calcium, phosphate (PO(4)) and alkaline phosphatase (ALP) were measured in September 2006 (end of winter, T1).

Impact of minimally invasive surgery on the pediatric surgical profession.

We conducted a survey among pediatric surgeons to examine the impact of the advent of minimally invasive surgery (MIS) on the pediatric surgical profession with respect to job satisfaction and training challenges. An invitation to participate in a web-based questionnaire was sent out to 306 pediatric surgeons. Apart from demographic details and training recommendations, parameters relevant to job satisfaction, including patient interaction, peer pressure, ethical considerations, academic progress, ability to train residents, and financial remuneration, were studied.

Advantages of the nested case-control design in diagnostic research.

Background: Despite its benefits, it is uncommon to apply the nested case-control design in diagnostic research. We aim to show advantages of this design for diagnostic accuracy studies.

Methods: We used data from a full cross-sectional diagnostic study comprising a cohort of 1295 consecutive patients who were selected on their suspicion of having deep vein thrombosis (DVT).

Evaluation of adrenal function using the human corticotrophin-releasing hormone test, low dose Synacthen test and 9am cortisol level in children and adolescents with central adrenal insufficiency.

Background: The insulin tolerance test (ITT) has become less popular in paediatrics because of the risks associated with hypoglycaemia. Human corticotrophin-releasing hormone (hCRH) test results correlate with the ITT and may be an acceptable method to test for central adrenal insufficiency (CAI). Simpler tests, such as the low dose Synacthen test (LDST) and 9am cortisol, have also been proposed.

Distraction from randomization in diagnostic research.

The ultimate goal of medical care, including diagnostic testing, is to improve patient outcome. Accordingly, it has been advocated widely that when establishing a test's diagnostic accuracy, the impact of the test on patient outcome subsequently must be quantified. When studying patient outcome in medical research, the use of randomized comparisons comes into perspective.

Validating and updating a prediction rule for neurological sequelae after childhood bacterial meningitis.

Recently, a prediction rule for developing neurological sequelae after childhood bacterial meningitis was developed on a small derivation set. Before implementing in practice a prediction rule must first be tested in new patients (external validation). Our aim was to study the external validity of this rule and, if necessary, to update the rule.

Genetic programming outperformed multivariable logistic regression in diagnosing pulmonary embolism.

Objective: Genetic programming is a search method that can be used to solve complex associations between large numbers of variables. It has been used, for example, for myoelectrical signal recognition, but its value for medical prediction as in diagnostic and prognostic settings, has not been documented.

Study Design And Setting: We compared genetic programming and the commonly used logistic regression technique in the development of a prediction model using empirical data from a study on diagnosis of pulmonary embolism.

Walking exercise in patients with intermittent claudication. Experience in routine clinical practice.

Background: In patients with intermittent claudication, exercise in the form of walking is effective in reducing pain and maximising achievable walking distance. However, data are lacking on the implementation of walking exercise in these patients.

Aims: To explore the current behaviour and views of patients with intermittent claudication towards taking walking exercise.