The relationship between COPD Assessment Test (CAT) scores and Distress Thermometer (DT) results in COPD patients.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is a condition that affects over 2 million adults in Poland. In recent years, increasing attention has been focused on improving the quality of life of patients with COPD, which includes alleviating their physical discomfort and relates to their mental health. It is therefore critically important to evaluate research tools that can accurately assess the relationship between the physical and mental health of patients with this disease. OBJECTIVE: This aim of the study is to evaluate the relationship between the COPD Assessment Test (CAT) and the Distress Thermometer and Problem List results in COPD patients. MATERIAL AND METHODS: The research evaluated 70 patients with COPD as defined by the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) criteria. Demographic data was obtained at baseline. Disease-specific quality of life was assessed using the CAT score, while overall distress was determined using the Distress Thermometer (DT) scale and a modified Problem List. The relationship between the CAT scores and the results of the Distress Thermometer and Problem List was statistically compared. The study was approved by the Bioethics Committee, and all patients provided written informed consent. RESULTS: The mean ± SD age was 69.6±9.05 (range 47-90) years. The average distress level was 4.09±1.95. A significant relationship was established between the CAT score and the results of the Distress Thermometer Scale (p<0.001); patients with higher CAT scores showed the highest level of distress. CONCLUSIONS: CAT was shown to be a simple, fast and clear measurement of disease-specific quality of life and was correlated with levels of distress in patients with COPD. Every patient with COPD should be evaluated using a scale such as the DT to measure their level of psychological distress.

Validación del termómetro como factor determinante de la eficacia en la toma de temperatura por infección de COVID-19 / Validation of the thermometer as a determining factor in the effectiveness of temperature measuring in covid-19 infection

FUNDAMENTOS: La pandemia por COVID-19 ha alcanzado más de cinco millones de contagios y trescientos mil fallecidos en el mundo. Todos ellos precisan la evaluación de factores pronósticos; además de la edad avanzada, las comorbilidades o la respuesta inflamatoria, es también evidente la necesidad de evaluar la temperatura corporal para determinar el contagio, la exposición, especialmente en personas con diferentes factores de riesgo, y distintos patrones evolutivos para conocer su influencia sobre los desenlaces clínicos. MÉTODOS: Se realizó un estudio transversal de tomas de temperatura a 42 sujetos voluntarios, para valorar la fiabilidad en términos de concordancia entre dos termómetros utilizados en las tomas de temperatura corporal; se compararon las mediciones de 2 termómetros en las zonas frontal y oído en 2 salas (mayor y menor iluminación). Se compararon los intervalos de confianza y se calculó el coeficiente de Correlación Intraclase (CCI) para obtener las diferencias estadísticas, proporcionando unos límites de concordancia a partir del cálculo del intervalo de confianza para la diferencia de dos mediciones. RESULTADOS: Con un intervalo de confianza del 95 %, una p < 0,5 y en las condiciones medidas, y sobre la muestra de sujetos, observamos que la correlación de las mediciones no tiene diferencia estadística significativa, pero sí en los diferentes ambientes con mayor iluminación. CONCLUSIONES: La media de temperatura corporal (frontal) medida con el termómetro láser es mayor que la temperatura (frontal) medida con el termómetro Testo. Existe diferencia significativa en las mediciones realizadas en las 2 salas, siendo mayores en la sala con menor iluminación. Hay correlación en las mediciones de temperatura del mismo instrumento en la zona frontal y en oído. Los termómetros láser son más efectivos para detectar las variaciones en la temperatura corporal, y más asertivos para identificar uno de los síntomas más asociados a la infección por SARS-CoV-2

BACKGROUND: The COVID-19 pandemic has reached more than five million infections and three hundred thousand deaths worldwide, all of which require the assessment of prognostic factors; in addition to advanced age, comorbidities or the inflammatory response, is also evident the need to assess body temperature to determine contagion, exposure, especially in people with different risk factors, and different evolutionary patterns to know its influence on clinical outcomes. METHODS: A cross-sectional study of temperature measurements was performed on 42 volunteer subjects, to assess the reliability in terms of agreement between two thermometers used in body temperature measurements; the measurements of 2 thermometers in the frontal and ear areas were compared in 2 rooms (higher and lower lighting). Confidence intervals were compared and the Intraclass Correlation Coefficient (ICC) was calculated to obtain the statistical differences, providing limits of agreement from the calculation of the confidence interval for the difference of two measurements. RESULTS: With a 95 % confidence interval, a p <0.5 and under the measured conditions, and on our sample of subjects, we observe that the correlation of the measurements does not have significant statistical difference, but indeed in different environments with greater lighting. CONCLUSIONS: The average body temperature (front) measured with the laser thermometer is greater than the temperature (front) measured with the Testo thermometer. There is a significant difference in the measurements made in the 2 rooms, being greater in the room with less lighting. There is correlation in the temperature measurements of the same instrument in the frontal zone and in the ear. Laser thermometers are more effective in detecting variations in body temperature, and more assertive in identifying one of the symptoms most associated with SARS-CoV-2 infection

Temperature in Nursing Home Residents Systematically Tested for SARS-CoV-2.

OBJECTIVES: Many nursing home residents infected with SARS-CoV-2 fail to be identified with standard screening for the associated COVID-19 syndrome. Current nursing home COVID-19 screening guidance includes assessment for fever, defined as a temperature of at least 38.0°C. The objective of this study was to describe the temperature changes before and after universal testing for SARS-CoV-2 in nursing home residents. DESIGN: Cohort study. SETTING AND PARTICIPANTS: The Veterans Administration (VA) operates 134 Community Living Centers (CLC), similar to nursing homes, that house residents who cannot live independently. VA guidance to CLCs directed daily clinical screening for COVID-19 that included temperature assessment. MEASURES: All CLC residents (n = 7325) underwent SARS-CoV-2 testing. We report the temperature in the window of 14 days before and after universal SARS-CoV-2 testing among CLC residents. Baseline temperature was calculated for 5 days before the study window. RESULTS: SARS-CoV-2 was identified in 443 (6.0%) residents. The average maximum temperature in SARS-CoV-2-positive residents was 37.66 (0.69) compared with 37.11 (0.36) (P = .001) in SARS-CoV-2-negative residents. Temperatures in those with SARS-CoV-2 began rising 7 days before testing and remained elevated during the 14-day follow-up. Among SARS-CoV-2-positive residents, only 26.6% (n = 118) met the fever threshold of 38.0°C during the survey period. Most residents (62.5%, n = 277) with confirmed SARS-CoV-2 did experience 2 or more 0.5°C elevations above their baseline values. One cohort of SARS-CoV-2 residents' (20.3%, n = 90) temperatures never deviated >0.5°C from baseline. CONCLUSIONS AND IMPLICATIONS: A single screening for temperature is unlikely to detect nursing home residents with SARS-CoV-2. Repeated temperature measurement with a patient-derived baseline can increase sensitivity. The current fever threshold as a screening criteria for SARS-CoV-2 infection should be reconsidered.

A Survey About Fever Knowledge, Attitudes, and Practices Among Parents.

A 21-question survey was conducted among parents attending 4 pediatric outpatient practices to assess their knowledge, perceptions, and attitudes about fever. One hundred and ninety-seven surveys were included. Most commonly the participating parent was the mother. Parents used mainly axillary thermometers to measure child's temperature and mentioned integers for their definition of fever, 100°F being the most frequent answer. Most parents would treat all fevers and would use alternating antipyretics. Parents had a generally negative perception of fever: only one third thought fever may have some benefit, and more than half thought there must be some risk. A positive perception of fever was associated with parental educational level but not with information by the pediatrician. There is much confusion about fever among our parents, a negative perception is prevalent, and parents seem to receive-or recall-little information from the pediatrician.

Evaluation of commercial, wireless dermal thermometers for surrogate measurements of core temperature.

Extensive research has been devoted to developing methods for assessing core body temperature, and to determine which method is most accurate. A number of wireless dermal thermometers for home use are presently available, but their relation to core body temperature and suitability for use in clinical research has hitherto not been assessed. The current study aimed to evaluate such thermometers by comparing them to the results of a rectal thermometer. Four wireless dermal thermometers for home use (FeverSmart, iThermonitor, Quest Temp Sitter, and Thermochron iButton) were applied to 15 patients during 24 h, and rectal temperature was measured at four occasions. Pearson correlation revealed moderate correlation for the Feversmart (r = 0.75), iThermonitor (r = 0.79), and Thermochron iButton (r = 0.71) systems. The Quest Temp Sitter system malfunctioned repeatedly, and the correlation (r = 0.29) for this method should therefore be assessed with caution. All dermal thermometers rendered lower average temperatures than Terumo c405 (Feversmart -0.70 ± 0.65 °C; iThermonitor -0.77 ± 0.53 °C, Quest Temp Sitter -1.18 ± 0.66 °C, and Thermochron iButton -0.87 ± 0.65 °C). Sensitivity of the dermal thermometers for detecting core temperatures ≥38.0 °C was low, ranging from 0.33 to 0.6, but improved to 0.60 to 0.80 after adjusting temperatures by the methods' average deviation from rectal temperature. The results from the dermal thermometers tested here showed an insufficient correlation to core temperature to be used for core temperature monitoring in clinical research and practice. Unfortunately, other options for non-invasive temperature measurements are few. The two thermometers with the least unsatisfactory performance profile in our evaluations were the Feversmart and iThermonitor systems.

Identifying positively deviant elderly medical wards using routinely collected NHS Safety Thermometer data: an observational study.

OBJECTIVE: The positive deviance approach seeks to identify and learn from exceptional performers. Although a framework exists to apply positive deviance within healthcare organisations, there is limited guidance to support its implementation. The approach has also rarely explored exceptional performance on broad outcomes, been implemented at ward level, or applied within the UK. This study develops and critically appraises a pragmatic method for identifying positively deviant wards using a routinely collected, broad measure of patient safety. DESIGN: A two-phased observational study was conducted. During phase 1, cross-sectional and temporal analyses of Safety Thermometer data were conducted to identify a discrete group of positively deviant wards that consistently demonstrated exceptional levels of safety. A group of matched comparison wards with above average performances were also identified. During phase 2, multidisciplinary staff and patients on the positively deviant and comparison wards completed surveys to explore whether their perceptions of safety supported the identification of positively deviant wards. SETTING: 34 elderly medical wards within a northern region of England, UK. PARTICIPANTS: Multidisciplinary staff (n=161) and patients (n=188) clustered within nine positively deviant and comparison wards. RESULTS: Phase 1: A combination of analyses identified five positively deviant wards that performed best in the region, outperformed their organisation and performed consistently well over 12 months. Five above average matched comparator wards were also identified. Phase 2: Staff and patient perceptions of safety generally supported the identification of positively deviant wards using Safety Thermometer data, although patient perceptions of safety were less concordant with the routinely collected data. CONCLUSIONS: This study tentatively supports a pragmatic method of using routinely collected data to identify positively deviant elderly medical wards; however, it also highlights the various challenges that are faced when conducting the first stage of the positive deviance approach. TRIAL REGISTRATION NUMBER: UK Clinical Research Network Portfolio (reference-18050).

Axillary and Tympanic Temperature Measurement in Children and Normal Values for Ages.

AIM: The aim of the study was define the normal values of tympanic and axillary body temperature in healthy children. METHODS: This observational cross-sectional study was performed in healthy children aged 0 to 17 years who visited the ambulatory general pediatric of Istanbul Medical Faculty. RESULTS: Of 1364 children, 651 (47.7%) were girls and 713 were boys, the mean (SD, range) age was 72.5 (53.6, 1-204) months. The mean (SD) axillary body temperature was 36.04°C (0.46°C; minimum, 35.0°C; maximum, 37.6°C). The 95th and 99th percentiles were 36.8°C and 37.0°C, respectively. The mean (SD) tympanic body temperature was 36.91°C (0.46°C; minimum, 35.15°C; maximum, 37.9°C). The 95th and 99th percentiles were 37.6°C and 37.8°C, respectively. There were statistically significant differences between sexes for only tympanic body temperatures. Both axillary and tympanic body temperatures were statistically higher in 0 to 2 months compared with other age groups. For this age group, the 99th percentile was 37.5°C for axillary and 37.85°C for tympanic temperature. CONCLUSIONS: Axillary and tympanic body temperatures should be considered as fever when they are more than 37.0°C and 37.8°C, respectively. For 0 to 2 months, fever is 37.5°C and 37.85°C in axillary and tympanic temperatures, respectively.

Infrared Skin Thermometry: Validating and Comparing Techniques to Detect Periwound Skin Infection.

OBJECTIVE: Diagnosis of wound infection can be challenging because it relies on a combination of clinical signs and symptoms that are often nonspecific. Increased periwound cutaneous temperature is a classic sign of deep and surrounding wound infection, and its quantitative measurement is one of the most reliable and valid clinical signs of deep and surrounding skin infection at the bedside. Skin surface temperature differences may be detected using commercially available noncontact infrared thermometers. However, techniques to detect temperature using noncontact infrared thermometers vary, and no studies have evaluated these methods. Two such measurement techniques include the "4-point" and "whole-wound" scanning methods. This study assessed the ability of different infrared thermometers using the aforementioned techniques to detect clinically meaningful differences in periwound cutaneous temperatures used in the diagnosis of wound infection. METHODS: A prospective cohort study was conducted from 2015 to 2016 of consenting adult patients 18 years or older with an open wound attending a regional wound care clinic. One hundred patients with wounds underwent surface temperature measurement. Infection was not a specific inclusion criterion as the primary objective was to conduct a comparative assessment of infrared thermometry devices. Demographic data (age, height, weight, gender, and ethnicity) were also collected. Each wound was measured using 4 different noncontact infrared thermometers: Exergen DermaTemp 1001 (Exergen Corporation, Watertown, Massachusetts), Mastercraft Digital Temperature Reader (Mastercraft, Toronto, Ontario, Canada), Mastercool MSC52224-A (Mastercool Inc, Randolph, New Jersey), and Etekcity ETC-8250 Temperature Heat Pen (Etekcity, Anaheim, California). Data analysis was based on a comparison of 4 periwound skin surface temperature measurement differences (ΔT in degrees Fahrenheit) between the wound site and an equivalent contralateral control site. OUTCOME MEASURES: The primary outcome of the ability of each thermometer to detect a clinically significant difference in temperature was assessed with χ analysis. Paired t tests were conducted to compare the ΔT measurements of each specific thermometry device between the 2 measurement techniques. Pearson product moment correlation coefficients were calculated for the temperature ΔT for both measuring techniques for all devices to determine level of agreement. A 1-way analysis of variance was conducted to compare temperature measurements among the infrared thermometry devices. MAIN RESULTS: There was no significant difference in the ability of each thermometer to detect a clinically meaningful difference of 3° F by either the 4-point (P = .10) or whole-wound techniques (P = .67). When a definition of 4° F was used, results were similar (4-point, P = .15; whole wound, P = .20). Comparisons among devices and techniques showed strong correlations (>0.80). Etekcity ETC-8250 and the 4-point measurement compared with the Exergen device using the whole-wound technique had a correlation coefficient of 0.72. Spearman ρ demonstrated a similarly high degree of correlation between techniques and devices, and only the Etekcity ETC-8250 device had a coefficient of 0.71 to 0.90 when compared with others. Paired t testing for each thermometry device comparing measurement techniques for raw temperatures ΔT demonstrated no significant difference (P > .05). No statistical differences among the ΔT values for the 3 different thermometers were noted when using the whole-wound method (P = .095). Similarly, no significant differences among the ΔT values were noted for the 4 different thermometers when using the 4-point method (P = .10). CONCLUSIONS: The results of this study demonstrate that both the 4-point and whole-wound methods of temperature acquisition using cost-efficient infrared thermometers provide accurate and similar results in clinical wound care settings.

The use of non-invasive thermometers in healthcare facilities: a scoping review protocol.

REVIEW OBJECTIVE AND QUESTIONS: The objective of the review is to map the available evidence to provide an overview of the use of non-invasive thermometers in the general context of health care. The specific questions, in regards to the available international published and unpublished literature, are.

Assessing the appropriateness of information on childhood fever in thermometer package leaflets: a systematic audit of thermometers available in the UK.

BACKGROUND: Thermometers are found in most parents' homes, but little is known about the quality and accuracy of the information they provide, nor its consistency with current guidelines for managing fever. AIM: To compare information included with commonly available thermometers with National Institute for Health and Care Excellence (NICE) guidance for management of feverish illness in children. DESIGN AND SETTING: Systematic thermometer sampling from UK retailers between February 2013 and May 2013. METHOD: Information was extracted from device packaging and leaflets on details and type of thermometer, instructions for use, normal ranges, and fever thresholds cited. This was compared with key parental recommendations from the 2013 NICE guidance on feverish illness in children. Associations were explored between cost of device and level of information. RESULTS: There were 123 thermometers identified (ranging from £0.99 to £69.99), none of which made explicit reference to NICE guidance. Most (n = 81, 65.9%) recommended use at a body site consistent with NICE guidance, but only 17 (13.8%) defined fever using the correct threshold (≥38.0°C), and few (n = 12, 9.8%) included advice on fever management, of which four suggested actions not advised by NICE. There was no association between thermometer cost and provision of information consistent with NICE guidance. CONCLUSION: Parents and caregivers have access to a large number of thermometers, yet they lack evidence-based information about fever detection and management, and in some cases contain misleading information. This represents a missed opportunity to disseminate best practices from guidelines for management of fever in children, and thermometer manufacturers are urged to include information consistent with current guidance.

Temperature sensor based on a hybrid ITO-silica resonant cavity.

Integrated optical devices comprised of multiple material systems are able to achieve unique performance characteristics, enabling applications in sensing and in telecommunications. Due to ease of fabrication, the majority of previous work has focused on polymer-dielectric or polymer-semiconductor systems. However, the environmental stability of polymers is limited. In the present work, a hybrid device comprised of an indium tin oxide (ITO) coating on a silicon dioxide toroidal resonant cavity is fabricated. Finite element method simulations of the optical field in the multi-material device are performed, and the optical mode profile is significantly altered by the high index film. The quality factor is also measured and is material loss limited. Additionally, its performance as a temperature sensor is characterized. Due to the high thermo-optic coefficient of ITO and the localization of the optical field in the ITO layer, the hybrid temperature sensor demonstrates a nearly 3-fold improvement in performance over the conventional silica device.

Differences in noninvasive thermometer measurements in the adult emergency department.

PURPOSE: Detection of accurate temperature in the emergency department (ED) is integral for assessment, treatment, and disposition. The primary objective was to compare temperature measurements from noninvasive temperature devices in the adult ED. The secondary objective was to evaluate the discrepancy between febrile and afebrile patients. METHODS: This was a prospective observational study of adult patients presenting to the ED. Patients who required a temperature measurement based on standard of care were included. Data collection included oral and temporal artery (TA) temperature measurement taken consecutively. Data were evaluated using the paired Student's t test. RESULTS: A total of 100 patients were identified. Mean oral temperature was 37.51°C (SD ±1.25), and mean TA temperature was 37.03°C (SD ±0.94). The mean difference was 0.48°C (SD ±0.8), P < .0001. Overall, 49% of patients had a difference in temperature measurements greater than or equal to 0.5°C. There were 47 febrile patients, determined by a measurement greater than 38°C on oral or TA thermometer. The mean temperature difference in these patients was 0.87°C (SD ±0.85) compared with a mean temperature difference of 0.12°C (SD ±0.55) in the afebrile patients, P < .0001. A total of 57% of fevers recorded by the oral thermometer were not recorded by the TA thermometer. CONCLUSIONS: There was a statistically significant difference in measured temperatures between oral and TA thermometers and a clinically significant difference in 49% of patients. Febrile patients had a greater discrepancy and variability between noninvasive temperature measurements. Caution should be taken when evaluating temperature measurements with these noninvasive devices.

Are temporal artery temperatures accurate enough to replace rectal temperature measurement in pediatric ED patients?

OBJECTIVE: This study examined the accuracy of temporal artery and axillary temperatures compared with rectal temperatures in pediatric ED patients younger than 4 years. METHODS: A method-comparison study design was used to examine the agreement between a temporal artery or axillary thermometer and a nondisposable, rectal electronic thermometer, which is the clinical reference standard for temperature measurement in children. Temperatures were taken with each device in a convenience sample of stable, pediatric ED patients who were younger than 4 years. Bias and precision were calculated to quantify the differences between the 2 devices, as well as the percentage of temporal artery and axillary temperatures that were >±1.0°C and >±1.5°C higher or lower than the rectal temperature. RESULTS: A total of 52 pediatric ED patients were studied over a 10-month period. Bias and precision for the temporal artery and axillary devices were -0.46°C ± 0.50°C and -0.93°C ± 0.49°C, respectively. The percentage of temporal artery and axillary temperatures that were >±1.0°C and/or >±1.5°C above or below the clinical reference temperature were 15% and 6%, respectively, for the temporal artery thermometer and 39% and 14%, respectively, for the axillary thermometer. DISCUSSION: Bias and precision values for the temporal artery, but not the axillary temperature, were within the acceptable range set by experts to use as a noninvasive substitute for core body temperature measurements. If properly used by ED staff, temporal artery thermometers could be used to obtain temperature in pediatric patients younger than 4 years, thus avoiding physical and psychological discomfort for the child and parent associated with obtaining rectal thermometers.

On the problems related to natural wet bulb temperature indirect evaluation for the assessment of hot thermal environments by means of WBGT.

This paper deals with the indirect evaluation of the natural wet bulb temperature, t (nw), one of the two quantities forming the basis of the well-known wet bulb globe temperature (WBGT) index, considered worldwide to be a suitable and user-friendly tool for the preliminary assessment of hot thermal environments. This quantity can be measured by a wet bulb thermometer (a temperature sensor covered with a wetted wick naturally ventilated) or, if this is not available, calculated from other microclimatic parameters (i.e. the air temperature, the globe temperature, the air velocity, and the humidity) using a quite trivial energy balance equation. Because of the strong non-linear structure of such an equation, the risk of a multiplicity of steady state solutions could result in the failure to obtain a reliable index evaluation. To dispel all doubts, this work carries out an in-depth analysis of the heat balance equation to be solved for the indirect evaluation of the natural wet bulb temperature. A preliminary investigation of each heat flow term involved in the heat balance on the sensor has been carried out; in a second phase a special continuation method has been implemented, highlighting the effect of microclimatic parameters on the multiplicity of solutions. Results show that under free convection the evaluation produces a single solution only under uniform conditions, whereas in the presence of even slight differences between the air temperature and the mean radiant temperature, there can be as many as three solutions. This phenomenon, if confirmed by a further experimental investigation, could become a difficult matter since a sensor, in principle, has to read a unique value of the quantity measured. In any case, from a numerical point of view, the presence of many values of tnw greatly reduces the possibility of an indirect WBGT calculation from the other involved physical quantities; as a consequence, the indirect evaluation of WBGT should be clearly avoided based on ISO 7243 Standard.

Trends in ownership and usage of food thermometers in the United States, 1998 through 2010.

Food safety research has shown that the use of a food thermometer is the best way to ensure that meat, poultry, and other foods reach an internal temperature sufficient to destroy foodborne pathogens. The 1998, 2001, 2006, and 2010 Food Safety Surveys were used to analyze changes in food thermometer ownership and usage for roasts, chicken parts, and hamburgers in the United States. A probit regression model was used to evaluate differing trends in ownership across demographic subgroups, and probit models with sample selection were used to evaluate differing trends in food thermometer usage for roasts, chicken parts, and hamburgers. The Food Safety Surveys are nationally representative telephone surveys tracking consumers' food safety attitudes and behaviors. Findings from these surveys indicate that the percentage of consumers who own food thermometers has increased from 49% in 1998 to 70% in 2010 (P < 0.05). The use of food thermometers has also increased over this time period but varies by food type. Of those who own food thermometers, a higher percentage reported using thermometers for roasts (76% in 1998 and 82% in 2010, P < 0.05) than for chicken parts (33% in 1998 and 53% in 2010, P < 0.05) and hamburgers (14% in 1998 and 23% in 2010, P < 0.05). The results also show that men, non-Hispanic whites, those with some college education or higher, those with higher incomes, and those 65 years and older were more likely to own food thermometers. After controlling for food thermometer ownership, those aged 18 to 29 years were more likely to use a food thermometer for roasts and chicken parts than those aged 65 to 101 years. The results suggest that educational programs encouraging food thermometer usage should focus first on food thermometer ownership.

The use of mercury-based medical devices across Croatian healthcare facilities.

In 2009, we conducted a survey to assess the use of mercury-based thermometers and sphygmomanometers and their disposal in Croatian healthcare facilities. The questionnaire addressing the use of mercury-based medical devices, waste management, preferences between mercury-based and electronic devices, and the knowledge on mercury toxicity was filled by ward nurses affiliated with 40 (71.4 %) out of 56 contacted healthcare facilities. Only one of these facilities had given up the use of mercury-containing medical devices at the time. As many as 84.6 % of the nurses believed that broken devices did not increase the risk of mercury exposure, even though 90 % claimed they were aware of mercury toxicity. In fact, 69.4 % of the nurses preferred mercury-containing devices on account of their precision and reliability and because they received little training in the use of electronic devices.Breaking of thermometers and sphygmomanometers is common in healthcare facilities. The number of broken thermometers and sphygmomanometers was estimated to 278 and five per month, respectively. Only 18 (46.2 %) of the surveyed healthcare facilities claimed to have had a proper disposal procedure for mercury from broken devices. Nurses, who most often handle these devices and collect mercury spills, are primarily exposed to mercury vapours via inhalation. Croatia has adopted the EU Directive 76/769/EEC intended to reduce mercury exposure in the living and working environment. Our survey suggests that all healthcare professionals need training in proper management of broken mercury-based medical devices, nurses in particular. To reduce the risk of exposure, all Croatian healthcare facilities should implement guidelines for staff protection and programmes to gradually replace mercury-based with electronic devices.

Fever determination in young infants: prevalence and accuracy of parental palpation.

OBJECTIVES: Pediatricians routinely advise parents to seek immediate medical attention if their young infant develops a fever. Many parents rely on palpation to assess their child's temperature. Our objective was to determine the prevalence and accuracy of parental palpation for fever in young infants. METHODS: We enrolled a convenience sample of infants younger than 3 months presenting to a pediatric emergency department with any complaint. Parents answered questions regarding their usual fever determination practices and palpated their infants to assess for fever. Parental predictions were then compared with the standard rectal temperature obtained at triage. RESULTS: Ninety-six infants were enrolled. Fifty-seven percent of parents reported palpation as a usual method of fever assessment, with 87% palpating for fever at least occasionally. Of the 78% of parents who owned a thermometer, nearly half used palpation regularly. As compared with the "gold standard" of rectal thermometry, parental palpation for fever had a sensitivity of 81%, specificity of 82%, positive predictive value of 59% and negative predictive value of 93%. After eliminating from analysis those infants whose parents had used a thermometer at home, we found a sensitivity of 67%, specificity of 84%, positive predictive value of 33%, and negative predictive value of 95%. CONCLUSIONS: Many parents rely on palpation as a usual method of fever determination in young infants, including nearly half of those who own a thermometer. Parental palpation overestimates the presence of fever, but is likely to be accurate when parents report that their baby is not febrile. As a sole method of determining fever, parental palpation is unreliable.

Meta-analysis of diagnostic test studies using individual patient data and aggregate data.

A meta-analysis of diagnostic test studies provides evidence-based results regarding the accuracy of a particular test, and usually involves synthesizing aggregate data (AD) from each study, such as the 2 by 2 tables of diagnostic accuracy. A bivariate random-effects meta-analysis (BRMA) can appropriately synthesize these tables, and leads to clinical results, such as the summary sensitivity and specificity across studies. However, translating such results into practice may be limited by between-study heterogeneity and that they relate to some 'average' patient across studies.In this paper we describe how the meta-analysis of individual patient data (IPD) from diagnostic studies can lead to clinical results more tailored to the individual patient. We develop IPD models that extend the BRMA framework to include study-level covariates, which help explain the between-study heterogeneity, and also patient-level covariates, which allow one to assess the effect of patient characteristics on test accuracy. We show how the inclusion of patient-level covariates requires a careful separation of within-study and across-study accuracy-covariate effects, as the latter are particularly prone to confounding. Our models are assessed through simulation and extended to allow IPD studies to be combined with AD studies, as IPD are not always available for all studies. Application is made to 23 studies assessing the accuracy of ear thermometers for diagnosing fever in children, with 16 IPD and 7 AD studies. The models reveal that between-study heterogeneity is partly explained by the use of different measurement devices, but there is no evidence that being an infant modifies diagnostic accuracy.