Number Of Diagnostic Tests Research Articles

Analysis of the causes and consequences of decreased antibiotic consumption over the last 5 years in Slovenia

Compared with European countries, the use of antibiotics in Slovenia is moderate. In the period 1999-2002 an 18.67% decrease in outpatient antibiotic consumption was noted. The aim of the present study was to analyse this decrease and its consequences. The data on outpatient antibiotic consumption were obtained from the Institute of Public Health and Health Insurance Institute of Slovenia and expressed in defined daily doses (DDD)/1000 inhabitant-days. The number of media publications on 'antibiotic drugs' and 'bacterial resistance' during the study period was obtained. In 2000, the prescription of co-amoxiclav and fluoroquinolones was restricted because of a constant increase in the consumption of these drugs. The data on incidence of acute mastoiditis and penicillin resistance among invasive pneumococci were obtained. The total outpatient consumption of antibacterials increased from 15.21 DDD/1000 inhabitant-days in 1996 to 20.08 in 1999, and decreased to 16.97 in 2003. The consumption of restricted antibiotics decreased from 7.29 in 1999 to 5.25 DDD/1000 inhabitant-days in 2003. There was a positive correlation between antibiotic consumption and the number of newspaper articles (r=0.92), and a negative correlation between the number of diagnostic tests and antibiotic consumption (r=-0.73 for the C-reactive protein test and -0.68 for the streptococcal antigen detection test). Reduced antibiotic consumption was paralleled by a decrease in penicillin resistance among invasive pneumococci. No increase in mastoiditis cases was observed in spite of reduced antibiotic consumption. Restriction of antibiotic prescription proved to be effective in reducing outpatient antibiotic consumption. The effect was prolonged and affected restricted antibiotics as well as non-restricted drugs.

Adult Idiopathic Thrombocytopenic Purpura

Idiopathic thrombocytopenic purpura (ITP) in adults is an autoimmune disorder characterised by persistent thrombocytopenia due to autoantibodies directed against platelet antigens. There have been major advances in our understanding of the pathophysiology of ITP and an increasing number of diagnostic tests and treatments available. Despite this, the diagnosis remains largely one of exclusion and treatment decisions vary widely and are hindered by a lack of good quality, randomised clinical trials. This review will cover the pathogenesis, diagnosis and management of adult ITP.

Insulin-like growth factor-I: marker for diagnosis of acromegaly and monitoring the efficacy of treatment

Acromegaly is caused by chronic excess secretion of growth hormone (GH) and resultant persistent elevation in concentrations of insulin-like growth factor-I (IGF-I), also called somatomedin-C. A number of diagnostic tests are available to support the diagnosis of acromegaly, but those that rely on measurement of serum GH concentrations have important limitations. Concentrations of serum IGF-I, which is produced principally in the liver and mediates the actions of GH, have been shown to correlate with clinical and metabolic markers of disease activity. Additionally, normalisation of IGF-I levels in acromegaly is associated with the resolution of symptoms and normal life expectancy. Thus, serum IGF-I is an important marker of disease activity and a sensitive, practical, and reliable measure of integrated GH concentrations in patients with acromegaly.

Triage and approach to the acute abdomen

The presentation of a patient with acute abdominal pain often is both a diagnostic and therapeutic challenge for the veterinary practitioner. Rapid physical examination and assessment of the patient's cardiovascular status are critical to initiating appropriate and often aggressive medical management as diagnostic tests are being performed. A number of diagnostic tests can be performed, including complete blood count, serum biochemistry profile, serum amylase and lipase, abdominal radiographs, abdominal ultrasound, abdominal paracentesis or diagnostic peritoneal lavage, cytology, and fluid analysis. In some cases, surgical exploration may be indicated, depending on each patient's clinical signs and response to therapy. Of the most important aspects of medical management of the patient with acute abdominal pain is to maintain oxygen delivery to tissues and to treat aggressively for pain or discomfort. The initial triage and approach to the patient with acute abdomen are discussed.

More Support for d-Dimer as a Screening Test for PE

The diagnosis of pulmonary embolism (PE) in the emergency department is often a difficult challenge. A number of diagnostic tests of varying usefulness, invasiveness, and cost have become part of the ED approach to patients with suspected PE, but there is much interest in a screening instrument that could exclude PE in …

Physician reimbursement and the medical encounter: an observational study in Dutch pediatrics.

Pediatrician reimbursement is shifting from fee-for-service to a fixed salary. In the Netherlands, as physicians working on a fee-for-service basis have a financial interest in talking less and in carrying out more diagnostic tests and investigations, it may be questioned whether this will influence the structure and content of medical visits. With use of 302 videotaped outpatient encounters with either salaried or fee-for-service pediatricians, differences were examined in visit length, number of requests for diagnostic tests and investigations (laboratory test, endoscopy, and radiography), pediatrician-parent communication behaviors, and patient satisfaction. This investigation was carried out by means of bivariate and multilevel analysis. The results showed that the visits with salaried pediatricians lasted almost 4 minutes longer. This surplus time was not spent on social talk or on a more elaborate history taking but was used to provide more information and advice. In addition, salaried pediatricians engaged in more empathic behavior toward the patient, thereby facilitating a therapeutic relationship. No differences were found in the number of diagnostic tests and investigations or in patient satisfaction. It may be concluded that history taking and social talk took place in a fixed part of the visit. Salaried pediatricians spent more time on exchanging information with their patients and paid more attention to patient concerns and emotions. As the reimbursement shift is not likely to diminish the number of diagnostic tests and investigations and will increase the length of the medical visits, overall financial benefits may be limited.

Bladder cancer.

Bladder tumor antigen, nuclear matrix protein 22, telomerase activity, fibrin degradation products assay, and a number of diagnostic tests on exfoliated urethelial cells are being tried to replace or decrease the frequency of cystoscopies. The results of these studies have shown that although some of these tests are promising, the standard of care for patients with hematuria or previously treated bladder carcinoma is still cystoscopy. New and non-invasive tests are on the horizon, however. It is essential to find accurate prognostic factors in patients with T1 disease which will predict the cases which will progress to muscle invasive disease. It has been clearly shown that the depth of invasion within the submucosa is closely related with survival. It has been established that continent diversions improve the quality of life in patients who have undergone cystectomy. Furthermore, this type of diversion was shown to improve survival. This fact can be attributed to early cystectomy which was prompted by the increased patient acceptance.

Diagnosis of Helicobacter pylori infection.

A number of diagnostic tests have been developed for the detection of H. pylori. Diagnostic techniques can be divided into invasive and noninvasive methods. The invasive methods require upper gastrointestinal endoscopy and involve culture of gastric biopsy specimens, examination of stained biopsies and detection of urease activity in the biopsies themselves. In addition, we have developed endoscopic diagnosis of H. pylori infection in gastric mucosa using phenol red dye-spraying. The noninvasive methods include urea breath test and serological techniques. Although there has been considerable improvement in the techniques, a combination of at least two different techniques should be used in order to optimize the diagnostic yield. We recommend the use of one rapid test in the combination. The rapid urease test, cytology and the phenol red dye-spraying endoscopy give results available before the patient leaves the endoscopy suite.

The Successful Application of a Heparin Nomogram in a Community Hospital

Heparin administration by physicians can vary greatly, and this variance can result in ineffective anticoagulation and reduced effectiveness of treatment. To examine the use of a heparin nomogram in two community hospitals to validate its effect on anticoagulation parameters and to determine its influence on length of hospital stay. Prenomogram and postnomogram intervention in two community hospitals in Sudbury, Ontario. All patients who presented and were admitted to the hospitals between 1991 and 1994 with a confirmed primary diagnosis of deep vein thrombosis and/or pulmonary embolism were eligible for the study. A heparin nomogram was instituted in April 1993 for treatment of deep vein thrombophlebitis and pulmonary embolism in hospitalized patients. The study patients were designated as prenomogram or postnomogram. Anticoagulation parameters (time to therapeutic activated partial thromboplastin time), number of diagnostic tests, percentage of times within the therapeutic range, and length of hospital stay were recorded for both groups. A total of 326 patients were identified from the database; 163 (50%) met the inclusion criteria. Patients in both groups appeared to be similar. Adequate anticoagulation was achieved faster (17.9 hours postnomogram vs 48.8 hours prenomogram; P < .001) and remained subtherapeutic less frequently in the postnomogram group (number of activated partial thromboplastin time tests below the therapeutic window; 56% prenomogram vs 28% postnomogram; P < .001). There were no differences between the groups with respect to length of stay (11.3 days prenomogram vs 10.9 days postnomogram; P = .60). More activated partial thromboplastin time tests were ordered in the postnomogram group (15.6 postnomogram vs 12.7 prenomogram; P = .001); however, fewer prothrombin time tests were ordered in the postnomogram group. A heparin nomogram was successfully used in a community hospital without a structured hematology-thrombosis service. Therapeutic anticoagulation was achieved faster and maintained more frequently, with less logistical problems, with this protocol. However, additional measures may be required to reduce the length of hospital stay.

Recurrent pregnancy loss and cytokines. Not as simple as it seems

Recurrent pregnancy loss is a particularly vexing problem. The patient desperately wants to achieve a successful pregnancy and is frustrated by her seeming inability to accomplish a life goal often taken for granted. The physician feels stymied because an identifiable cause can be found in only about 50% of women with recurrent pregnancy loss. Because of the unique immunologic state of pregnancy and similarities to allogeneic transplantation, putative immunologic causes have been attributed to recurrent pregnancy loss. In other words, "If we don't understand it, it must be immunologic." Consequently, a number of diagnostic tests and immunologic treatments have been tried with limited success. Currently the most widely used immunotherapy for recurrent pregnancy loss is injecting the patient with white blood cells obtained from the potential father. The rationale for this immunotherapy was derived from studies of kidney transplant patients, who were less likely to reject renal allografts if they

Recurrent Pregnancy Loss and Cytokines

Recurrent pregnancy loss is a particularly vexing problem. The patient desperately wants to achieve a successful pregnancy and is frustrated by her seeming inability to accomplish a life goal often taken for granted. The physician feels stymied because an identifiable cause can be found in only about 50% of women with recurrent pregnancy loss. Because of the unique immunologic state of pregnancy and similarities to allogeneic transplantation, putative immunologic causes have been attributed to recurrent pregnancy loss. In other words, "If we don't understand it, it must be immunologic." Consequently, a number of diagnostic tests and immunologic treatments have been tried with limited success. Currently the most widely used immunotherapy for recurrent pregnancy loss is injecting the patient with white blood cells obtained from the potential father. The rationale for this immunotherapy was derived from studies of kidney transplant patients, who were less likely to reject renal allografts if they

Prevalence of Leptospira spp. in wild brown rats (Rattus norvegicus) on UK farms.

Wild brown rats (Rattus norvegicus) are frequently implicated in the carriage and spread of Leptospira spp. Wild brown rats (n = 259) were trapped from 11 UK farms and tested for Leptospira spp. using a number of diagnostic tests. The prevalence of leptospiral infection was low, but there was variation in the results obtained with the different diagnostic tests. Estimates of prevalence ranged between 0% by silver-staining of tissues, 1% by the microscopic agglutination test, 4% by the enzyme-linked immunosorbent assay, 4% by culture, and 8% by fluorescent antibody technique. In total, 37 (14%) rats were positive by at least one of the tests, which contrasts with the frequently reported prevalences of 50-70% for wild rats in the UK. Serovar bratislava was a prevalent as icterohaemorrhagiae, although it was present only on farms with larger rat populations.

Serial Verb Constructions in Namakir of Central Vanuatu

Based on a review of the Oceanic and other theoretical literature on Serial Verb Constructions (SVCs), a descriptive model is adopted to describe SVCs in the Namakir language. Two main types are recognized: core layer and nuclear layer serialization. Argument-sharing possibilities for both types include same-subject, switch-subject, multiple-object, and ambient serialization. Analysis of the available data suggests that all except switch-subject SVCs occur in Namakir. These various types and subtypes of SVCs are exemplified and discussed. Like other SVO serializing languages, Namakir shows more productive core layer serialization than nuclear layer serialization. The main analytical difficulty for the Namakir data is distinguishing between serialized verbs and adverbial constructions. A number of diagnostic tests argue that possible cases of ambient serialization are actually adverbial constructions. The question of free and fixed verbal slots in SVCs is also discussed, as is the notion of a serialization hierarchy.

The current status of surgery for bullous emphysema

The great majority of cases of emphysema are generalized with diffuse involvement of all portions of the lung: Clearly, surgery has little to offer in such cases. In contrast, there is an uncommon variant involving primarily the upper lobes and the superior portions of the lingula and lower lobes, which spares the relatively normally functioning lower lobes. A number of diagnostic tests are available to identify compression of uninvolved lower lobe tissue, the most reliable of which identify pulmonary vasculature that is crowded together. We suggest that whole lung tomograms or pulmonary angiograms provide the most convincing evidence of compression of normal tissue. In properly selected patients with compression or displacement of normal lung, thoracotomy with simple excision of the bullae is tolerated by even the most ill patients if care is taken to carefully support the patient postoperatively with assisted ventilation and prolonged chest tube suction. There were no deaths in 19 patients and the results were rewarding, often spectacular, and surprisingly enduring. It is likely that some patients with operable bullous emphysema are not being studied or offered operation because of a lack of knowledge about the benefits possible with bullectomy.

DRGs and outpatient antibiotics.

The advent of a non-cost reimbursement system has served as an impetus for the re-examination of the methods by which infectious processes are treated. This system prospectively sets payment rates for illnesses that require hospitalization. Diagnostic-Related Groups (DRGs) are the basis of this new system. DRGs attempt to link reimbursement to the broad category of clinical diagnosis by separating diagnoses into nearly 500 groups; each with a defined reimbursement rate. This rate does not substantially vary with regard to the length of hospital stay, the number of diagnostic tests performed or the cost of therapy employed.

Thyroid Function Tests in a Group of Euthyroid Dogs

Summary A number of diagnostic tests of thyroid function were performed on a group of euthyroid dogs. The tests consisted of the thyroid uptake of radioiodine, protein bound 131 iodine (PB131I) estimations, the T3 (resin-sponge)-uptake test, protein bound iodine (PBI) determination and measurement of the serum cholesterol level. In addition to clinical and post-mortem examinations the normality of the dogs was checked by biochemical and haematological estimations. The most valuable tests of thyroid function appeared to be the thyroid uptake test, the T3 (resin-sponge)-uptake test and the PBI determination. The convenience in use of the T3 (resin-sponge)-uptake test was confirmed.

Taxonomy of the genus Thiobacillus: the outcome of numerical taxonomy applied to the group as a whole.

SUMMARY: Data from previous numerical analyses have been combined to produce an over-all classification of the genus Thiobacillus; 93 strains were examined using 38 tests and 106 character states. The results indicated the possible existence of a new species and demonstrated an unexpectedly close similarity between T. neapolitanus and T. thio-oxidans. A number of diagnostic tests have been selected from those used for the numerical analysis. A brief description of the other important features of each species recognized is also given.