• 핵의학기술
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• 제13권3호
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• pp.185-188
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• 2009

목적 : 건진센터 종양 검사가 정상범위 내에서 재검기준이 명확히 설정되어 있지 않아 검사자마다 각자의 재검기준에 따라 재검을 시행함에 따라 재검상의 편차가 크고 일괄적이지 못했다. 이를 개선하기 위해 정상치이하값에서의 재검기준을 마련하고 정상치이하인 값에서 trend 결과를 관리할 수 있는 본원 OCS QC (order communication system quality control)프로그램을 이용하여 건진 센터 종양 검사의 결과보고오류에 개선을 하고자 한다. 대상 및 방법 : 2009년 2월부터 3월까지 본원 건진 센터에서 종양 검사(AFP, CEA, CA19-9, CA125, PSA)를 실시한 환자들을 대상으로 하였다. 우선 각 검사의 정상범위에서 Inter assay CV%를 구하여 screening 기준 값을 설정하였다. OCS QC program에 진료과, 대상 검사종목, screening 기준 값을 입력하여 기준 값에 벗어난 결과는 색깔에 반전을 주었다. 1차로 5가지종양 검사를 전 결과대비 ${\pm}$ 30% 기준을 벗어난 screening 건수를 구하였고 2차로 각각의 종양 검사에 대해 전 결과 대비 AFP는 ${\pm}$ 60%, CEA와 CA19-9는 ${\pm}$50%, CA125와 PSA는 ${\pm}$40%로 기준 값을 상향조정하여 screening 건수를 구하였으며 정상치 이하에서의 재검기준도 설정하여 비교하였다. 결과 : 1차 screening 건수 백분율은 30~40%의 결과를 얻었고, 2차 screening 건수 백분율은 AFP 26.1%, CEA 18.9%, CA19-9 17.3%, CA-125 18.7%, PSA 21.0%로 평균 20%의 screening 백분율을 얻었다. 정상치 이하에서의 재검기준은 AFP 5.0이하$\leftrightarrow$10.0이상, CEA 1.0이하$\leftrightarrow$3.0이상, 2.0이하$\leftrightarrow$4.0이상, CA19-9와 CA-125 10.0이하$\leftrightarrow$30.0이상, PSA 1.0이하$\leftrightarrow$2.0이상으로 정하였으며 평균 20.4%의 screening 백분율에 재검기준을 적용시켜 실제 재검사 건수를 얻었다. 2달 동안 재검사 건수는 AFP 0건, CEA 15건, CA19-9 3건, CA-125 2건, PSA 5건이었다. 결론 : OCS QC 프로그램을 이용하여 시스템적인 재검기준을 마련함으로 검사자간 재검 실시 편차의 감소가 있었고 정상치 이하 값에서 결과보고오류에 대해 개선이 있을 것으로 사료된다.

• Journal of Preventive Medicine and Public Health
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• 제44권3호
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• pp.101-110
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• 2011

Objectives: Screening for colorectal cancer is considered cost effective, but is underutilized in the U.S. Information on the efficiency of "tailored interventions" to promote colorectal cancer screening in primary care settings is limited. The paper reports the results of a cost effectiveness analysis that compared a survey-only control group to a Centers for Disease Control (CDC) web-based intervention (screen for life) and to a tailored interactive computer-based intervention. Methods: A randomized controlled trial of people 50 and over, was conducted to test the interventions. The sample was 1224 partcipants 50-70 years of age, recruited from Kelsey-Seybold Clinic, a large multi-specialty clinic in Houston, Texas. Screening status was obtained by medical chart review after a 12-month follow-up period. An "intention to treat" analysis and micro costing from the patient and provider perspectives were used to estimate the costs and effects. Analysis of statistical uncertainty was conducted using nonparametric bootstrapping. Results: The estimated cost of implementing the web-based intervention was $40 per person and the cost of the tailored intervention was $45 per person. The additional cost per person screened for the web-based intervention compared to no intervention was $2602 and the tailored intervention was no more effective than the web-based strategy. Conclusions: The tailored intervention was less cost-effective than the web-based intervention for colorectal cancer screening promotion. The web-based intervention was less cost-effective than previous studies of in-reach colorectal cancer screening promotion. Researchers need to continue developing and evaluating the effectiveness and costeffectiveness of interventions to increase colorectal cancer screening.

• Asian Pacific Journal of Cancer Prevention
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• 제16권14호
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• pp.5889-5897
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• 2015

Background: The performance of combined testing visual inspection with acetic acid (VIA) and cervical cytology tests might differ from one setting to another. The average estimate of the testing accuracy across studies is informative, but no meta-analysis has been carried out to assess this combined method. Objective: The objective of this study was to estimate the average sensitivity and specificity of the combined VIA and cervical cytology tests for the detection of cervical precancerous lesions. Materials and Methods: We conducted a systematic review and a meta-analysis, according to the Cochrane Handbook for Systematic Review of Diagnostic Test Accuracy. We considered two cases. In the either-positive result case, a positive result implies positivity in at least one of the tests. A negative result implies negativity in both tests. In the both-positive case, a positive result implies having both tests positive. Eligible studies were identified using Pubmed, Embase, Website of Science, CINHAL and COCRANE databases. True positive, false positive, false negative and true negative values were extracted. Estimates of sensitivity and specificity, positive and negative likelihood (LR) and diagnostic odds ratios (DOR) were pooled using a hierarchical random effect model. Hierarchical summary receiver operating characteristics (HSROC) were generated and heterogeneity was verified through covariates potentially influencing the diagnostic odds ratio. Findings: Nine studies fulfilled inclusion criteria and were included in the analysis. Pooled estimates of the sensitivities of the combined tests in either-positive and both-positive cases were 0.87 (95% CI: 0.83-0.90) and 0.38 (95% CI: 0.29-0.48), respectively. Corresponding specificities were 0.79 (95% CI: 0.63-0.89) and 0.98 (95% CI: 0.96-0.99) respectively. The DORs of the combined tests in either-positive or both-positive result cases were 27.7 (95% CI: 12.5-61.5) and 52 (95% CI: 22.1-122.2), respectively. When including only articles without partial verification bias and also a high-grade cervical intraepithelial neoplasia as a threshold of the disease, DOR of combined test in both-positive result cases remained the highest. However, DORs decreased to 12.1 (95% CI: 6.05-24.1) and 13.8 (95% CI: 7.92-23.9) in studies without partial verification bias for the combined tests in the either-positive and both-positive result cases, respectively. The screener, the place of study and the size of the population significantly influenced the DOR of combined tests in the both-positive result case in restriction analyses that considered only articles with CIN2+ as disease threshold. Conclusions: The combined test in the either-positive result case has a high sensitivity, but a low specificity. These results suggest that the combined test should be considered in developing countries as a primary screening test if facilities exist to confirm, through colposcopy and biopsy, a positive result.

• 대한소아치과학회지
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• 제30권2호
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• pp.254-262
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• 2003

개량형 Dentocult-SM 키트의 치아우식활성검사로서의 활용도와 임상적 지수와의 상관관계 그리고 민감도 및 특이도를 조사하기 위하여 만 5-6세 남녀아동 128명을 대상으로 구강검사와 screening strip 검사와 site strip 검사를 시행한 후 일정 부위의 치면세균막을 채취하여 뮤탄스 연쇄상구균 배양검사를 실시하여 다음과 같은 결론을 얻었다. Screening strip 및 site strip 검사 모두에서 우식활성도가 0에서부터 3까지로 증가할수록 아동들이 보유하고 있는 dft index와 dfs index는 각각 통계적으로 유의하게 증가하였고 아동들의 치면세균막 내의 뮤탄스 연쇄상구균 집락수 역시 우식활성도가 0에서 3으로 높아질수록 통계적으로 유의하게 수적인 증가를 나타내었다. Screening strip과 site strip 검사결과의 일치정도는 Spearman의 상관계수가 0.775 그리고 kappa 지수는 0.496으로 두 검사법의 일치도가 높았다. 또한 screening strip 검사의 민감도는 0.74-1.00, 특이도는 0.11-0.67로 나타났고, site strip 검사의 민감도와 특이도는 각각 0.48-1.00 및 0.11-0.66으로 계산되었다. 따라서 치과임상에서도 종래의 우식활성검사법들 보다 시간과 비용이 그리 많이 들지 않으며, 또한 각종 미생물학적, 생화학적인 기술이나 장비가 많이 필요치 않도록 간편하게 개량된 Dentocult-SM 검사법을 활용하면 치아우식증을 예측하는 진단학적인 측면이나 환자들을 대상으로 한 구강보건교육적인 측면에서 많은 도움이 될 수 있을 것으로 사료되었다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권12호
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• pp.7607-7611
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• 2013

Background: Cervical cancer continues to be a major problem in Bangladesh with approximately 18,000 new cases annually of which over 10,000 women die from it. Visual inspection of the cervix after 3-5% acetic acid (VIA) application is a simple and easy to learn method for cervical cancer screening, although cytology-based screening is more often applied in developed countries where it has successfully reduced the prevalence of cervical cancer. Objective: To compare the efficacy of VIA and cytology-based primary methods for cervical cancer screening in Bangladesh. Materials and Methods: This hospital based comparative study was conducted at the VIA centre and Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from October 2008 to October 2010. Results: Among 650 women, 74 (11.4%) were VIA+ve and 8 (1.2%) had abnormalities in their Pap smear reports. During colposcopy, 38 (7.7%) women had different grades of CIN and 4 (0.6%) had cervical cancer. The gold standard histology findings proved 20 women had CIN I, 14 had CIN II/II and 4 had cervical cancer. Among the 38 histology diagnosed abnormalities, VIA test could identify 30 abnormalities including two cervical cancers. However, Pap smear could detect only 8 cases of histological abnormalities (2 low grade and 6 had high grade lesion) and it missed all the cervical cancer cases. The sensitivity and specificity of VIA were 88.9% and 52.1%. The positive predictive value (PPV) and negative predictive value (NPV) were 41.0%, and 92.6% respectively. Moreover, the sensitivity, specificity, PPV and NPV of Pap smear were 33.3%, 95.8%, 75.0% and 79.3%, respectively. Conclusions: VIA test should be used as the primary screening tool even with its low sensitivity and specificity in low resource countries like Bangladesh. False positive results may be greater, but overtreatment can be minimized by colposcopy evaluation of the VIA positive women.

• 가정간호학회지
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• 제15권2호
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• pp.99-105
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• 2008

Purpose: We evaluated patient nutritional status in a home care setting. Method: We recruited 81 patients who received in-home care using a screening sheet. The level of nutrition-related serum marker (albumin) was checked via medical records and data analyzed using descriptive analysis, t-tests, and $X^2$-test. Results: Nutritional status varied according to the primary medical diagnosis. Poor nutritional status was significantly higher in cancer patients than in other diseases. Serum albumin levels were significantly lower in the malnutrition group than the good nutrition group. Conclusions: Nutrition screening can determine the nutritional status in home care patients. Home care nurse practitioners should consider nutritional status when assessing patient health.

• Journal of Genetic Medicine
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• 제11권2호
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• pp.49-55
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• 2014

Genetic ultrasonography refers to the evaluation of risk of chromosomal abnormalities via various soft sonographic markers. Although the maternal serum test is the primary screening method for chromosomal abnormalities, genetic ultrasonography is also widely used and can help increase detection rates. To date, many soft markers, including choroid plexus cysts, echogenic intracardiac foci, mild ventriculomegaly, nuchal fold thickening, echogenic bowel, mild pyelectasis, short femur and humerus length, and absent or hypoplastic nasal bone, have been reported. An aberrant right subclavian artery was the most novel soft marker introduced. Because these soft markers involve diverse relative risks of chromosomal abnormalities, it is difficult to apply them to clinical practice. To optimize the efficacy of genetic ultrasonography, it is important to understand the precise relative risks of chromosomal abnormalities innumerous soft markers and integrate these risks with each other and the results of maternal serum screening.

• Journal of Digestive Cancer Research
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• 제1권2호
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• pp.73-77
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• 2013

Gastrointestinal (GI) cancers are top priorities for cancer control in Korea. In terms of epidemiological, population-health and economic burden, GI cancers such as stomach, liver and colorectal cancers have been top four cancers in the nation during the past decade and this trend is likely to continue in the near future. In order to reduce the great burden of GI cancer in Korea, the nation might need the following strategies: (1) to put more focus on primary prevention on infection/diet and related research; (2) to improve screening rates for colorectal and stomach cancers, and conduct more cost-effectiveness analysis of these screening programs, e.g., Fecal Occult Blood Test vs. colonoscopy; (3) to establish a more consistent and integrative cost-effectiveness analysis system for new cancer treatments and anticancer drugs; and (4) to place more emphasis on hospice and other palliative care of GI cancer, as well as on the etiology, staging and treatment of pancreas cancer with its poor survival rate.

• Asian Pacific Journal of Cancer Prevention
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• 제16권16호
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• pp.6909-6912
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• 2015

Cancer is a major public health problem due to the jeavy disease burden, fatality and tendency for increased incidence. Of all cancer types, cervical cancer is reported to be the fourth most common cancer in women, and the seventh overall, with an estimated 528,000 new cases worldwide in 2012. It features a long preclinical phase with slowly progressing precancerous lesions such as CIN 2 and 3 and adenocarcinoma in situ. Therefore, screening programs such as with Pap smear tests may play an important role in cervical cancer prevention. The purpose of this study was to present results of a Pap smear screening survey for cervical cancer targeting women living in an urban area in the province of Mersin, located in the Mediterranean region of Turkey. This community-based descriptive study included women living at Akdeniz county of Mersin province. A total of 1,032 screened women between 30 and 65 ages within the routine screening programme constituted the study population. The mean age of the participants was $43.8{\pm}8.6$ (min. 30, max. 65) years. The percentage of the participants who had previously undergone smears was 40.6%. Epithelial cell changes were found in 26 (2.5%) participants, with ASC-US in 18 (1.7%), ASC-H in 2 (0.2%), LSIL in 5 (0.5%) and HSIL in 1 (0.1%). The most common clinical presentation together with epithelial changes was abnormal vaginal discharge. Taking into account the presence of women who had never undergone Pap test; it should be offered at primary level of health care in the form of a community-based service to achieve reduced morbidity and mortality rates.

• Asian Pacific Journal of Cancer Prevention
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• 제17권6호
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• pp.2901-2907
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• 2016

Background: Despite increasing debate about overdiagnosis and overtreatment of thyroid cancer in Korea, information to guide decisions on whether or not to undergo screening for and treatment of abnormal lesions of the thyroid is lacking. Moreover, studies have yet to outline what lay people know and want to know about thyroid cancer. The primary aim of this study was to explore general awareness of thyroid cancer among Korean women, their sources of information, and their satisfaction with the information they are provided. The secondary aim was to investigate information needs about thyroid cancer. Materials and Methods: A qualitative study using focus group interviews was conducted. Twenty-nine women were divided into four groups: (1) participants who had never undergone thyroid ultrasound screening; (2) those who had undergone screening, (3) those who continued to undergo regular check-ups with ultrasonography for benign nodules of the thyroid; and (4) participants who had undergone surgery for thyroid cancer. Results: A widespread lack of awareness of information on thyroid cancer was noted among participants in groups 1 and 2 who were not well aware of thyroid cancer and generally recognized it as a 'good cancer'. Surprisingly, instead of doctors and medical personnel, most participants reported obtaining information from acquaintances and media outlets. Moreover, most participants described dissatisfaction with their experience with screening and a lack of explanation on treatment and test results from medical personnel. Conclusions: Women in Korea seek reliable information on thyroid cancer that could help them to better understand the disease and make informed decisions regarding screening and treatment. More effort is needed from medical personnel to communicate the implications of thyroid cancer, screening results, and treatments thereof to lay people.