'RETCIF': a rapid, sensitive method for detection of viruses, applicable for large numbers of clinical samples.

Rapid detection of viruses in clinical samples is important for continuing appropriate antiviral treatment and discontinuing unnecessary antibacterial treatment, as well as for excluding viral pathogens. Yet detection of viral agents may require numerous susceptible cell lines. Even with the shell vial culture method, it is cumbersome for handling large volumes of specimens. A procedure has been developed, which is time and cost-saving and uses specific cell lines in a 96-well microtitre plate and monoclonal antibodies (RETCIF-rapid enhanced tissue culture immunofluorescence). Each clinical sample was inoculated into 12 different wells with five different cell lines. Enhancement was achieved by sonication, centrifugation and hormonal supplementation to the medium used. Cytomegalovirus (CMV), herpes simplex virus (HSV) and respiratory viruses were detected by monoclonal antibodies on day 2, whilst varicella zoster virus (VZV) and enteroviruses were detected on days 5 and 7, respectively. During July-December 1998, 3298 patient specimens were compared by RETCIF and a modified shell vial method. Either or both methods isolated 779 viruses (24% positivity rate), whilst both methods detected 621. Of the 779 viruses, 87% (679) were isolated by the shell vial method in an average time of 4.9 days. For RETCIF the respective rate was 92.5% (721), in an average time of 3.0 days. The RETCIF method is a time-saving procedure, with higher isolation rates than the shell vial method.

A quality assurance audit: phase III trial of maximal androgen deprivation in prostate cancer (TROG 96.01).

In 1997 the Trans-Tasman Radiation Oncology Group (TROG) performed a quality assurance (QA) audit of its phase III randomized clinical trial investigating the effectiveness of different durations of maximal androgen deprivation prior to and during definitive radiation therapy for locally advanced carcinoma of the prostate (TROG 96.01). The audit reviewed a total of 60 cases from 15 centres across Australia and New Zealand. In addition to verification of technical adherence to the protocol, the audit also incorporated a survey of centre planning techniques and a QA time/cost analysis. The present report builds on TROG's first technical audit conducted in 1996 for the phase III accelerated head and neck trial (TROG 91.01) and highlights the significant progress TROG has made in the interim period. The audit provides a strong validation of the results of the 96.01 trial, as well as valuable budgeting and treatment planning information for future trials. Overall improvements were detected in data quality and quantity, and in protocol compliance, with a reduction in the rate of unacceptable protocol violations from 10 to 4%. Audit design, staff education and increased data management resources were identified as the main contributing factors to these improvements. In addition, a budget estimate of $100 per patient has been proposed for conducting similar technical audits. The next major QA project to be undertaken by TROG during the period 1998-1999 is an intercentre dosimetry study. Trial funding and staff education have been targeted as the key major issues essential to the continued success and expansion of TROG's QA programme.

Dental student assessment of learning programmes.

OBJECTIVES: To compare relevance, accessibility, role in the teaching-learning process, and user preference, of identical case-study-based teaching programmes in CAL and booklet format. DESIGN: Questionnaire assessment. SUBJECTS AND SETTING: Dental students at Sheffield Dental School. METHODS: 54 5th-year dental students were self-grouped as computer novice (n = 26) or proficient (n = 23) and sub-groups of 12 randomly selected from each. Half of each sub-group tested the CAL programme first and half the booklet-based programme, with cross-over, after 6 weeks. Assessment of packages was carried out immediately after use, and 2 weeks after completion, a further assessment was made on the basis of preference and value as a teaching medium. RESULTS: All subjects thought both packages relevant to clinical practice and written at an appropriate level, and the majority found the text, illustrations and tasks clear. Both groups competed the CAL package more quickly. Students asked to use such packages in the future,viewing them as support for, rather than replacement of, present teaching. The majority of computer-proficient students preferred CAL, considering it the superior teaching medium. CONCLUSIONS: Both CAL and booklet case-study materials were considered useful in addition to, rather than as a replacement for, other teaching methods. Most considered the CAL superior and preferred it. Nevertheless, while past computer experience determined preference for the format, it did not influence ability to access the medium. Future use of such materials is probably best in relation to preparation for tutorials and clinics. A key role is its availability as a revision aid.

Acute toxicity and cost analysis of a phase III randomized trial of accelerated and conventional radiotherapy for squamous carcinoma of the head and neck: a Trans-Tasman Radiation Oncology Group study.

The primary purpose of the present analysis was to assess the feasibility and acute toxicity of a pure accelerated fractionation regimen in a cooperative group setting. This analysis included the first 320 patients entered on to the Trans-Tasman Radiation Oncology Group (TROG) randomized controlled trial which compared accelerated radiotherapy (ART) with conventional radiotherapy (CRT) in stage III and IV squamous cell carcinoma (SCC) of the head and neck. Patients were randomized to either 59.4 Gy in 33 fractions over 24 days (ART) or to 70 Gy 35 fractions over 49 days (CRT) after being stratified for site and stage. Accrual began in 1991 and the trial was closed on 3 April 1998 with the targeted 350 patients. The 3-year survival for the whole group was 54%, and the 3-year disease-free survival was 41%. Toxicity data were available on 303 patients (148 ART; 155 CRT). Mucosal toxicity was worse in the accelerated arm, and it peaked approximately 3 weeks earlier than the conventional arm. Skin toxicity was equivalent but occurred approximately 7 days earlier in the accelerated arm. Acute effects in both arms healed completely. Hospitalization was more common in the ART arm (71 vs 52 patients; P = 0.01) but the total bed days in hospital was not greatly different (1707 bed days for ART and 1607 bed days for CRT). Patients were more likely to require nasogastric (NG) feeding in the ART arm (49 vs 33 patients; P = 0.02). There were 1157 NG feeding days for ART and 1154 NG feeding days for CRT. The average cost of radiation treatment per patient including hospitalization, NG feeding and accommodation was $11,750 in the ART arm and $11,587 in the CRT arm. The accelerated arm has been shown to be a tolerable, practical and cost-equivalent regimen. The assessment of the therapeutic ratio of this accelerated protocol (ART) will be determined when the analysis of late effects and loco-regional control is made when the data are more mature.

Outcome assessment after milieu-oriented rehabilitation: new considerations.

OBJECTIVE: This study incorporated level of functional impairment ratings at program admission into rehabilitation outcome (return to work/school) at the time of program discharge. HYPOTHESES: (1) Patients and families with better working alliance ratings will show better adjusted outcome; (2) patients seeking compensation will have poorer outcome than those not seeking compensation or receiving benefits; (3) speed of information processing and memory will relate to the level of adjusted outcome. DESIGN: Consecutive neurorehabilitation admissions from March 1992 to May 1996. SETTING: Outpatient milieu-based interdisciplinary day treatment program. SUBJECTS: Sixty-four patients with heterogeneous brain injury etiologies. MAIN OUTCOME MEASURES: Adjusted outcome, defined as level of discharge productivity adjusted by staff ratings of functional severity of impairment at program admission; work readiness and work eagerness, based on average staff ratings. RESULTS: At discharge, 89.5% of patients showed fair or good adjusted outcome; 62% were gainfully employed/full-time students; 15.6% resumed preinjury status. Better working alliance predicted better adjusted outcome. Patients seeking compensation showed significantly lower work eagerness ratings. Poorer outcome was associated with better neuropsychological status. CONCLUSIONS: Efficacy of neurorehabilitation was demonstrated for patients with better working alliance who were not seeking compensation. Adjusted outcome demonstrated greater sensitivity and utility by incorporating the variable of functional severity of impairment at program admission. Inclusion of "process" variables addressing working alliance, motivation, and capacity to work provide important contributions to understanding rehabilitation outcome.

Restorative treatment need assessment by dentally and nondentally trained subjects.

A study was carried out which compared how two groups of people, one with clinical dental experience and one without, assessed restorative dental treatment need. Using a visual analogue scale, a group of final year dental students (n = 50) and nonclinical university students (n = 50) assessed the extent to which they considered common dental imperfections, viz. spacing of the upper anterior teeth and discolouration of upper anterior teeth, warranted restorative correction. The group of dental students judged the necessity for treatment of discolouration to be more urgent than correction of spacing. The nondental group did not differentiate between the degrees of need. Data were non-normal in distribution but the use of appropriate statistical tests showed the differences in mean assessments to be significant.

Intracytoplasmic sperm injection for treatment of the infertile male.

Intracytoplasmic sperm injection (ICSI) with in vitro fertilization represents one of the most significant advances in fertility technology. In this relatively new procedure, a single viable sperm is microinjected into an oocyte that has been extracted transvaginally. After fertilization occurs, the embryo is transferred into the uterus. This procedure now affords men who were previously thought to be irreversibly infertile the chance to initiate their own biologic pregnancy. However, because of the procedure's significant costs and its potential risk to the mother, careful selection of couples following a thorough male factor evaluation is mandatory.

Comparisons of patient self-assessment of complete mandibular denture security.

Records of self-assessed complete mandibular denture security were made by visual analogue scale, four-category functional scale, and by self-expressed satisfaction or dissatisfaction on 57 subjects that presented for replacement of complete dentures at an undergraduate clinic. Visual analogue scale scores formed two groups corresponding approximately to the groups of subjects expressing satisfaction or dissatisfaction with the current security of their dentures. The self-assessed visual analogue scale scores enabled variations in denture security to be quantified. Visual analogue scale scores of denture security were not normally distributed, but formed two separate distributions which corresponded approximately with the sets of satisfied (visual analogue scale > 50) and dissatisfied (visual analogue scale < 50) patients. The data showed that the visual analogue scale method was superior to the other two types of patient self-assessment.

"Drugs and AIDS--reaching for help": a videotape on AIDS and drug abuse prevention for criminal justice populations.

This article describes the development of a videotape targeted at persons under supervision of the criminal justice system. The videotape seeks to encourage those who use illicit drugs to enter drug treatment and to motivate those at risk for exposure to human immunodeficiency virus (HIV) to alter behaviors that may transmit infection. The criminal justice system presents an important opportunity to deliver such messages, particularly to a large population of persons briefly detained in a jail or lockup and released without subsequent incarceration. Evidence suggests that, even in this audience, knowledge of how to prevent exposure to HIV is widespread, yet those at risk often fail to take appropriate precautions: motivating behavior change demands more than imparting information. In order to shape this videotape, we analyzed the target audience and developed a drama-based approach that applies the framework of social learning theory, the health belief model, and principles of social marketing. This article describes the integration of that theoretical framework into the production process, content, and strategy of the videotape.

Pathological assessment of mediastinal lymph nodes in lung cancer: implications for non-invasive mediastinal staging.

BACKGROUND: The use of computed tomography in mediastinal staging of lung cancer relies on the premiss that malignant lymph nodes are larger than benign ones. This hypothesis was tested by linking node size and presence or absence of malignancy and looking at factors possibly influencing the size of benign nodes. METHODS: All accessible mediastinal lymph nodes were taken from 56 consecutive patients with lung cancer who underwent thoracotomy. Nodes were measured and histologically examined. Resected cancer bearing lung from 44 of these patients was assessed for degree of acute and chronic inflammation. RESULTS: Lymph node size was not significantly related to the presence of metastatic disease, 58% of malignant and 43% of benign lymph nodes measuring over 15 mm. Similarly, there was no statistically significant relation between size of lymph nodes and the likelihood of malignancy, 20% of lymph nodes of 10 mm or more but also 15% of those less than 10 mm being malignant. Thresholds of 15 and 20 mm showed similar results. The maximum size of benign lymph nodes was significantly greater in those patients with histological evidence of acute pulmonary inflammation than in those without. CONCLUSIONS: The study shows that in patients with lung cancer (1) malignant mediastinal lymph nodes are not larger than benign nodes; (2) small mediastinal lymph nodes are not infrequently malignant; and (3) benign adenopathy is more common in patients with acute pulmonary inflammation.

Assessment of the effects of age and smoking on the media of muscular pulmonary arteries.

The effects of age and smoking on the media of muscular pulmonary arteries were studied in 23 subjects without cardio-pulmonary disease. The group ranged in age from 19 to 81 years and included 12 non-smokers and 11 smokers. Twelve representative tissue blocks were taken from each subject and all cross-sectionally cut arteries were measured from histological sections using a digitizer. Medial area was measured and artery size defined as total length of internal elastic lamina. Only arteries measuring less than 1500 micron length of internal elastic lamina were studied. For all subjects, the relationship between medial area and length of internal elastic lamina was a curve, which was linearized by plotting square root of medial area against artery size. These individual linear regression equations (y = A + bx) were used to 'predict' for each subject the amount of muscle in the walls of arteries of a specific size: 500, 1000, and 1500 micron length of internal elastic lamina. Using this type of summary data it was found that neither age nor smoking affected the media. Individual (inter-subject) variation was evident in the amount of muscle present in any size of artery, particularly in the smallest arteries. In arteries measuring 500 micron length of internal elastic lamina, the amount of muscle was positively and significantly correlated with the absolute weight of the right ventricle.