[Early recognition and screening consultation: a necessary way to improve early detection and treatment in rheumatology? : Overview of the early recognition and screening consultation models for rheumatic and musculoskeletal diseases in Germany]. / Früh- und Screeningsprechstunden: Ein notwendiger Weg zur besseren Frühversorgung in der internistischen Rheumatologie? : Rheumatologische Früh- und Screeningsprechstundenmodelle in Deutschland.

In order to reduce the prognostically relevant time interval between the initial manifestation of a rheumatic and musculoskeletal disease and diagnosis as well as the consecutive initiation of an appropriate treatment, several rheumatological centers in Germany have improved the access to initial rheumatologic evaluation by establishing early recognition/screening clinics at their respective sites. Corresponding models located at Altoetting·Burghausen, Bad Pyrmont, Berlin Buch, Duesseldorf, Heidelberg, Herne, Mannheim as well as supraregional/multicenter initiatives Rheuma Rapid, RhePort and Rheuma-VOR are presented in this overview along with the respective characteristics, potential advantages and disadvantages, but also first evaluation results of several models. The aim of this publication is to promote early detection of rheumatic and musculoskeletal diseases as one of the most important challenges in current rheumatology by encouraging further rheumatologic centers and practices to launch their own early recognition/screening consultation model on the basis of aspects presented herein.

Seizure in gradual clonazepam withdrawal.

Convulsions from abrupt clonazepam withdrawal in patients with a seizure history or concurrent neuroleptic use have been described in the literature. This is a report of a patient without these precipitating factors developing seizure despite "gradual" reduction of clonazepam by .5 mg every 4 days. The possibility of clonazepam withdrawal seizures should be kept in mind even in patients not considered at risk for developing seizures. Clonazepam cessation should be more gradual, even slower than .5 mg every 4 days.

Evaluation of TestPack Strep A for Rapid Identification of Group A Streptococci.

The performance of a 10-minute immunoassay, TestPack Strep A, was compared with culture for the detection of Group A ß-hemolytic streptococci (GABHS) from 298 throat swabs. When cultured, 17.4% of the samples grew GABHS. The values calculated for the test were sensitivity, 67.3%; specificity, 99.2%; positive predictive value, 94.6%; negative predictive value, 93.5%; positive likelihood ratio, 82.79; and negative likelihood ratio, 0.33. The sensitivity decreased with decreasing growth of GABHS in the culture. If cultures with only light GABHS growth were eliminated from the analysis, the sensitivity was increased to 74.4%. The test has the advantages of immediate results, available while the patient is still in the office; simplicity; easy-to-interpret end-points, high positive likelihood ratio; high specificity; and high predictive values, which make it a rather attractive supplement to sore throat management in a busy family practice. The cost of the kit, however, may diminish its attractiveness.

Managing sore throat: theory versus practice.

The authors address the reliability of clinical impression in the management of sore throat. Five primary care family physicians in rural Ontario examined 222 patients with sore throats. The clinical impression of either Group A ß-hemolytic streptococcal (GABHS) or non-GABHS pharyngitis was recorded and throat cultures were ordered in each case. The physicians predicted that 50% of the cultures would be positive for GABHS, whereas only 13.5% actually had positive results. The initial clinical diagnosis of "strep throat" was correct only one in five times. Without cultures, at least 112 patients would have been treated with antibiotics, 87 unnecessarily. The authors conclude that the clinical prediction of GABHS is inaccurate and can lead to unnecessary use of antibiotics.