Analytic laboratory performance of a point of care urine culture kit for diagnosis and antibiotic susceptibility testing.

Currently available point-of-care (POC) diagnostic tests for managing urinary tract infections (UTIs) in general practice are limited by poor performance characteristics, and laboratory culture generally provides results only after a few days. This laboratory evaluation compared the analytic performance of the POC UK Flexicult(™) (Statens Serum Institut) (SSI) urinary kit for quantification, identification and antibiotic susceptibility testing and routine UK National Health Service (NHS) urine processing to an advanced urine culture method. Two hundred urine samples routinely submitted to the Public Health Wales Microbiology Laboratory were divided and: (1) analysed by routine NHS microbiological tests as per local laboratory standard operating procedures, (2) inoculated onto the UK Flexicult(™) SSI urinary kit and (3) spiral plated onto Colorex Orientation UTI medium (E&O Laboratories Ltd). The results were evaluated between the NHS and Flexicult(™ )methods, and discordant results were compared to the spiral plating method. The UK Flexicult(™) SSI urinary kit was compared to routine NHS culture for identification of a pure or predominant uropathogen at ≥ 10(5) cfu/mL, with a positive discordancy rate of 13.5% and a negative discordancy rate of 3%. The sensitivity and specificity were 86.7% [95% confidence interval (CI) 73.8-93.7] and 82.6% (95% CI 75.8-87.7), respectively. The UK Flexicult(™) SSI urinary kit was comparable to routine NHS urine processing in identifying microbiologically positive UTIs in this laboratory evaluation. However, the number of false-positive samples could lead to over-prescribing of antibiotics in clinical practice. The Flexicult(™) SSI kit could be useful as a POC test for UTIs in primary care but further pragmatic evaluations are necessary.

Antibiotic prescribing for adults with acute cough/lower respiratory tract infection: congruence with guidelines.

European guidelines for treating acute cough/lower respiratory tract infection (LRTI) aim to reduce nonevidence-based variation in prescribing, and better target and increase the use of first-line antibiotics. However, their application in primary care is unknown. We explored congruence of both antibiotic prescribing and antibiotic choice with European Respiratory Society (ERS)/European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for managing LRTI. The present study was an analysis of prospective observational data from patients presenting to primary care with acute cough/LRTI. Clinicians recorded symptoms on presentation, and their examination and management. Patients were followed up with self-complete diaries. 1,776 (52.7%) patients were prescribed antibiotics. Given patients' clinical presentation, clinicians could have justified an antibiotic prescription for 1,915 (71.2%) patients according to the ERS/ESCMID guidelines. 761 (42.8%) of those who were prescribed antibiotics received a first-choice antibiotic (i.e. tetracycline or amoxicillin). Ciprofloxacin was prescribed for 37 (2.1%) and cephalosporins for 117 (6.6%). A lack of specificity in definitions in the ERS/ESCMID guidelines could have enabled clinicians to justify a higher rate of antibiotic prescription. More studies are needed to produce specific clinical definitions and indications for treatment. First-choice antibiotics were prescribed to the minority of patients who received an antibiotic prescription.

Left Antegrade Continent Enema (LACE): review of the literature.

PURPOSE: LACE is gradually becoming more established for the treatment of constipation. The purpose of this study was to review the current status of LACE procedure in paediatric practice. MATERIALS AND METHODS: A systematic database search was performed. Patients who underwent a LACE procedure between 2002 and May 2007 were reviewed retrospectively. The data was analysed with respect to indications for operation, operative techniques, outcome, and complications. The outcomes were compared with those of right-sided antegrade colonic enema (RACE) procedures, published in the same period. RESULTS: Nine studies describing 93 patients were identified. The underlying diagnoses were spina bifida (70 %), anorectal malformation (10 %), idiopathic constipation (10 %), Hirschsprung's disease (4 %) and other (6 %). The mean age at operation was 10 years. The various operative procedures used included retubularisation of the sigmoid colon (31 %), retubularisation of the splenic flexure (28 %), left Monti from the descending colon (15 %), and retubularisation of the ileum (3 %). Minimally invasive techniques were used in 23 % of cases. Mean volume of enema used was 414 ml. The mean transit time for enema was 31 minutes. Social continence was achieved in 94 % (complete in 72 %; partial in 22 %) cases. Stomal stenosis was seen in 14 % of cases, of which 9 % required revision of the stoma and 5 % responded to dilatation. Sixteen studies describing 583 patients were found for RACE. Indications for operation were similar to those for LACE. Open procedures were done in 86 % of cases, and laparoscopic assisted procedures in 14 % of cases. Mean age at operation was 10 years. Mean volume of enema used 618 ml. Median evacuation time was 53 minutes. Continence was achieved in 94 % of cases. Stomal stenosis occurred in 26 %. CONCLUSION: The results of LACE procedures are encouraging, especially in light of the lower amount of enema fluid required, the quicker enema transit time and fewer complications. Overall outcome (continence) is comparable to that of RACE.

Calculation of human health risk-based screening levels (RBSLs) for petroleum.

Hazardous waste site managers and regulators can decide easily whether site contamination requires remediation to protect human health, but defining the extent of cleanup is often an enormous challenge. When is the site clean enough for human access and use? Risk assessment tools can be used to help answer this question. One can calculate chemical-specific risk-based screening levels (RBSLs) in environmental media (e.g. soil, water, and food) that correspond to "acceptable" levels of risk. RBSLs can be calculated for individual chemicals and chemical mixtures, specific to various exposure pathways. In calculating RBSLs, one must account for the fact that people may be exposed to more than one chemical by more than one exposure pathway. Fate and transport models may be needed to predict how people might become exposed to site contamination in the future. Examples RBSLs for non-cancer effects are calculated to illustrate the utility and limitations of RBSLs for making risk-based decisions at petroleum release sites.

Placebo responses: an experimental study of psychophysiological processes in asthmatic volunteers.

This study evaluated the effects of placebo medication on pulmonary responses in asthmatics, and investigated the roles of expectancy and anxiety. Twelve adult asthmatics were recruited for a laboratory experiment described as a study of the effectiveness of a new bronchodilator. Distilled nebulized water was inhaled in each session. The solution was described as water in session 1 (control), while in sessions 2 and 3 subjects were told that the nebulizer contained a chemical likely to cause chest tightness and wheezing (bronchoconstrictive suggestion). Prior to the inhalation sequence in sessions 2 and 3, subjects inhaled from an aerosol that they were told contained either a powerful new drug (placebo) or a non-active substance (neutral). Pulmonary function was measured with the forced oscillation technique and spirometry, while autonomic parameters, anxiety and expectancies were also monitored. Pulmonary function deteriorated following the inhalations accompanied by bronchoconstrictive suggestion, and this effect was abolished by pre-treatment with placebo. Neither subject expectations nor changes in anxiety were associated with the experimental manipulations. The implications of these results for theories of placebo action are considered.