Using nonrapid HIV technology for routine, opt-out HIV screening in a high-volume urban emergency department.

OBJECTIVE: We implement an opt-out routine screening program in a high-volume, urban emergency department (ED), using conventional (nonrapid) technology as an alternative to rapid HIV tests. METHODS: We performed a retrospective cohort study. Since October 2008, all patients who visited Ben Taub General Hospital ED and had blood drawn were considered eligible for routine opt-out HIV screening. The hospital is a large, publicly funded, urban, academic hospital in Houston, TX. The ED treats approximately 8,000 patients monthly. Screening was performed with standard chemiluminescence technology, batched hourly. Patients with positive screening test results were informed of their likely status, counseled by a service linkage worker, and offered follow-up care at an HIV primary care clinic. Confirmatory Western blot assays were automatically performed on all new HIV-positive samples. RESULTS: Between October 1, 2008, and April 30, 2009, 14,093 HIV tests were performed and 39 patients (0.3%) opted out. Two hundred sixty-two (1.9%) HIV test results were positive and 80 new diagnoses were made, for an incidence of new diagnoses of 0.6%. There were 22 false-positive chemiluminescence results and 7 indeterminate Western blot results. Nearly half the patients who received a new diagnosis were not successfully linked to HIV care in our system. CONCLUSION: Opt-out screening using standard nonrapid technology, rather than rapid testing, is feasible in a busy urban ED. This method of HIV screening has cost benefits and a low false-positivity rate, but aggressive follow-up and referral of patients with new diagnoses for linkage to care is required.

Children's knowledge and degree of participation in decision making when undergoing a clinical diagnostic procedure.

Twenty-three children, (6-11 years, 9 boys and 14 girls), admitted to a pediatric day care department for a planned diagnostic procedure were interviewed with the aim of investigating their level of knowledge regarding a current diagnostic procedure, and the level of participation in discussions and decision making relating to their hospitalization. While the children were being interviewed, their attendant parent completed a questionnaire. The children's level of knowledge was documented and graded. The children's statements and their parents' evaluation of the information given to the child were sorted into groups and compared. The children's descriptions of their participation in discussions and decision-making were assessed and summarized. Finally, the children's and their parents' experiences of the children's anxiety and fear before the hospital visit were compared. The children were undergoing different kinds of diagnostic procedures and they had received information from different people. They were prepared for their admission in different ways, and had participated in discussions and decisions to various degrees. Despite this preparation, it would be safe to state that the participants as a group were not very well informed nor did they participate fully. More knowledge is needed regarding how to prepare each child prior to admission, before, during, and after the hospital visit and which additional factors, e.g., trust and a familiar environment, have influence on the child's experience.

Reflective testing--what do our service users think?

BACKGROUND: Reflective testing incorporates the clinical judgement, knowledge and experience of an individual biochemist to request additional tests appropriate to the clinical scenario. Despite being vigorously debated within the biochemistry profession, little is known about how the clinicians directly involved in patient care feel about it. We have conducted a survey to elicit our service users' opinion of reflective testing. METHODS: Ten clinical scenarios, each involving the possible addition of a specific test, were circulated to 520 hospital doctors and 152 general practitioners. The four response options were to add further tests, phone and discuss the case, add a comment to the original results or do nothing. RESULTS: A total of 216 (32%) responses were received. Overall, the majority were in favour of 'adding on' free triiodothyronine (86%), gamma-glutamyltransferase (78%), lipid profile (59%), thyroid peroxidase antibodies (63%), pituitary hormones (58%), troponin (55%) and serum electrophoresis (68%) in the given scenarios. However, only 30% would like a pregnancy test added and only 45% a prostate-specific antigen added without prior consultation. The response differed according to grade and specialty. CONCLUSIONS: Reflective testing is generally welcomed by our service users, provided the nature and implications of the specific test is considered in addition to the full clinical scenario.

Reflective testing: what do patients think?

INTRODUCTION: Reflective testing refers to the practice of adding on tests by laboratory staff. Little is known about what patients think of this practice. METHODS: We surveyed patients attending a general practice surgery and patients attending hospital outpatient clinics. We sought their views about the practice of adding on tests and about the information they received from requesting clinicians about their investigations. RESULTS: In both groups of patients, large majorities favoured an approach in which relevant additional tests are performed without consulting the requesting clinician or patient first. Most patients also felt that the requesting clinicians had provided a satisfactory explanation about what tests were to be performed and why. CONCLUSION: Most patients are content to let NHS professionals add on relevant tests if this is felt to be in their interest.

Cognitive-behavioural predictors of children's tolerance of laboratory-induced pain: implications for clinical assessment and future directions.

This study sought to investigate cognitive-behavioural predictors of children's tolerance for laboratory-induced cold-pressor pain. It was hypothesised that pain tolerance, as measured by immersion time, would be greater in children who were high in self-efficacy for pain, high in self-reported use of cognitive-coping strategies, and low in emotion-focused coping strategies such as catastrophising. Age and sex differences were also examined in post hoc analyses. Children between the ages of 7 and 14 years (N = 53) participated in the study. Offering partial support for the hypotheses, use of cognitive distraction was found to be associated with greater pain tolerance, while use of internalising/catastrophising was associated with lower pain tolerance. Older boys tended to have greater pain tolerance than younger boys, whereas younger and older girls had intermediate pain tolerance levels. Self-efficacy for pain, in general, was found to be positively correlated with age. The results support efforts to identify children who, because they have lower confidence or lower skills in coping with distress, may need extra support and preparation for painful procedures. Further research is needed to investigate these findings within a clinical pain context.

Diseases the doctor (or autoanalyser) says you have got.

Much of modern medical practice involves treating patients with asymptomatic conditions or risk factors which I call 'diseases the doctors says you've got'. These generally asymptomatic conditions, which are usually discovered by screening, include hypertension, hyperlipidaemia, many cases of type 2 diabetes and the post-menopausal state. My argument is that many doctors do not have the interest or inclination to follow such patients. However, persuading them to take their tablets or modify their diets or lifestyles is arguably more difficult than in the 'proper' diseases on which physicians spend most of their training. I suggest that the only way of doing this is to educate and enthuse the patients and find a way to make them as interesting as the cases of the rare diseases we all find so fascinating.

Non-treatment laboratory stress- and cue-reactivity studies are associated with decreased substance use among drug-dependent individuals.

INTRODUCTION: Human laboratory paradigms for examining stress- or cue-reactivity in substance-dependent individuals often involve exposure to pharmacological, psychosocial or physical laboratory procedures or drug paraphernalia. This study examines whether participation in such studies alters drug-seeking behavior and which patient attributes contribute to increased use. METHODS: In two separate studies, the relationship between participation and drug use post-study were examined. Cocaine-dependent participants received 1 microg/kg of corticotropin releasing hormone intravenously, underwent the Trier Social Stress Task, and were exposed to drug cues and various measures obtained. Cocaine use for 90 days prior and 28 days following the study was assessed. Methamphetamine-dependent participants were exposed to drug cues and various measures obtained. Methamphetamine use for 90 days prior and 14 days following the study was assessed. Weekly drug use was modeled using a 2-state hidden Markov model assuming two possible underlying states at each week. Bayesian estimation was used. Results are presented as posterior mean odds ratios (OR) and 95% credible intervals (CI). RESULTS: Participation decreased the odds of remaining in or transitioning to the high use state (cocaine study OR=0.04 [CI=0.01, 0.11]; methamphetamine study OR=0.39 [CI=0.07, 1.70]). In the cocaine study, older age increased the odds of remaining in or transitioning into the high use state (1.66 [CI=0.99, 2.96]). In the methamphetamine study, male gender increased the odds (2.70 [CI=1.10, 6.17]). CONCLUSION: Stress and cue exposure paradigms were associated with a decreased odds of drug use following participation.

[The historical meaning of serological surveys as a laboratory technology applied to the immunization campaigns. The case of poliomyelitis in Spain]. / El significado histórico de las encuestas de seroprevalencia como tecnología de laboratorio aplicada a las campañas de inmunización. El caso de la poliomielitis en España.

The aim of the paper is to analyse the introduction, use and diffusion of the serological surveys, a public health technology on the borderline between epidemiology and laboratory, in connection with poliomyelitis in Spain during the Francoism period. Within the framework of the "new history" of medical technologies and innovations, the serological surveys played an important role both in the improvement of knowledge on socio-demographic distribution and the health politics arena.

Cardiovascular recovery from acute laboratory stress: reliability and concurrent validity.

OBJECTIVE: We assessed the value of laboratory measures of cardiovascular recovery across four criteria: reliability across multiple tasks, reliability across a 3-year time interval, ability to predict daily ambulatory blood pressure, and interrelationships with coronary risk factors and psychosocial variables. METHODS: Three hundred twenty-nine healthy adults (mean age = 27.1 years) completed a two-part protocol consisting of 1 day of laboratory testing and 1 day of ambulatory monitoring. The laboratory protocol included a 15-minute baseline assessment followed by three 5-minute laboratory challenges (mental arithmetic, speech, and handgrip). Five-minute recovery periods followed each exercise. One hundred twenty-five participants returned after 3 years to repeat the protocol. RESULTS: When aggregated across tasks, cardiovascular recovery showed acceptable levels of internal consistency (alpha values = 0.7) and proved relatively stable across time (r values = 0.22-0.35). Recovery values statistically improved the prediction of daily ambulatory readings above baseline and stress reactivity laboratory values (p values < .001) but were largely unrelated to coronary risk factors or psychosocial measures. CONCLUSION: These results suggest that cardiovascular recovery from acute laboratory stress can be treated as a stable individual difference variable that can -improve standard laboratory-based predictor models of ambulatory readings.

Donor self-exclusion patterns and human immunodeficiency virus antibody test results over a twelve-month period.

Donor behavior in completing a pre-donation confidential self-exclusion form, which identified blood donors at high-risk of AIDS exposure, was evaluated. The form was completed by all donors during a 12 month period beginning in September, 1985. 188,824 units of blood were collected from 123,608 donors. On the first donation occasion 901 donors (0.73%) laboratory (LAB) designated, 224 (0.18%) did not complete the form correctly, and the remaining 122,483 transfusion (TRAN) designated. A greater proportion of LAB donors were men, under the age of 30 and had not donated in the previous two years than TRAN designated donors. Confirmed reactive anti-HIV, Western blot positive (WB+) results were greater in LAB than TRAN donors (1.664% vs 0.014%) on the first donation occasion. There were 43,982 donors who returned to donate on at least one other occasion. Of these, 43,778 designated TRAN initially, and only 217 (0.49%) changed their designation to LAB on any subsequent donation event. In contrast, of the 204 donors who designated LAB initially, 134 (65.6%) changed to TRAN on at least one other occasion. A variety of designation combinations from LAB to TRAN and back to LAB occurred. Thus, donors who initially LAB designated were more likely to change their designation on at least one other occasion than those who initially designated for TRAN. Of two donors who became anti-HIV WB positive on the second donation, one of these LAB designated on both occasions, was negative for anti-HIV by enzyme-linked immunoassay (EIA-) on the first donation but converted to EIA+, WB+ on the second.(ABSTRACT TRUNCATED AT 250 WORDS)

Os efeitos da música no escolar na punção venosa: estudo preliminar / The effects of the music in the scholar during the veined puncture: study preliminary

Este trabalho foi realizado com o objetivo de observar os efeitos da música no escolar durante a punção venosa na possibilidade de utilizá-la como terapia complementar. Por meio de um estudo caso-controle foram observadas as reações de 30 crianças em idade escolar que necessitavam de punção venosa para coleta de exames laboratoriais sendo que em 15 crianças foi utilizado música e nas outras quinze não, o procedimento habitual da unidade foi mantido. As crianças demonstravam contentamento e vontade de ouvir a música após a explicação do procedimento com música embora não apresentassem alterações estatísticamente significativas, com exceção da Frequência Cardíaca que diminuiu em relação àquelas em que a música não foi usada.Dentre as variáveis analisadas a Tensão Muscular, o Choro e a Agitação ocorreram nos dois grupos (Com e sem música). Os resultados preliminares obtidos mostraram que a música não interfere nas reações esperadas da criança em idade escolar durante a punção venosa mas, acredita-se que foi uma importante experiência para tornar esse procedimento menos "agressivo" e traumático...