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Evaluation of the IDS RapID SS/u system for rapid identification of urinary microorganisms.

The accuracy of a new rapid identification system for common urinary pathogens was compared with that of conventional methods and of miniaturized 18-24-hour identification panels. The rapid system, RapID SS/u (Innovative Diagnostic System Inc., Atlanta, GA) is a non-growth-dependent micro-method that identifies selected gram-negative bacilli, gram-positive cocci, and yeasts in two hours by detection of constitutive enzymes acting on chromogenic substrates. A total of 185 representative clinical urinary isolates were tested, including 24 gram-positive cocci, 140 gram-negative bacilli, and 21 yeasts. Identifications by the rapid system were compared with the ones obtained by reference conventional methods for gram-positive cocci and yeasts. For gram-negative bacilli, identifications were compared with the ones obtained by MicroScan Combo Panel (American MicroScan, Mahwah, NJ), and all discrepancies were resolved by testing with API 20E (Analytab Products, Plainview, NY). Overall, the RapID SS/u system correctly identified to genus 160 of 185 isolates (86.5%). For 14 additional isolates (7.6%) the system provided probability overlap identifications that required further testing. Two (1%) isolates failed to be identified, and nine isolates (4.9%) were misidentified by the system. Discrepancies involved five strains of Citrobacter, one Enterobacter, one Morganella, and one Providencia species. The authors conclude that the RapID SS/u system provided rapid and accurate genus identification of most microorganisms commonly isolated from urine.

Humans↗

The cost-utility of photodynamic therapy in eyes with neovascular macular degeneration--a value-based reappraisal with 5-year data.

PURPOSE: To assess the value conferred by photodynamic therapy (PDT) and the cost-utility of PDT for the treatment of classic, subfoveal choroidal neovascularization associated with age-related macular degeneration (ARMD). DESIGN: Average cost-utility analysis utilizing clinical trial data, patient-based time tradeoff utility preferences, and a third party insurer cost perspective. METHODS: Five-year visual acuity data from the TAP (Treatment of Age-related Macular Degeneration With Photodynamic Therapy) Investigation were modeled into a 12-year, value-based, reference case, cost-utility model utilizing year 2004 Medicare costs and an outcome of dollar/QALY (dollars/quality-adjusted life-year). Discounting of outcomes and costs using net present value analysis with a 3% annual rate was performed as recommended by the Panel for Cost-Effectiveness in Health and Medicine. RESULTS: PDT with verteporfin (Visudyne) dye for classic subfoveal choroidal neovascularization confers an 8.1% quality of life (value) improvement over the 12-year life expectancy of the reference case, while during the last 8 years the value improvement is 9.5%. The average cost-utility of the intervention is dollar 31,103/QALY (quality-adjusted life-year). Extensive one-way sensitivity analysis values range from dollar 20,736/QALY if treatment efficacy is increased by 50% to dollar 62,207 if treatment efficacy is decreased by 50%, indicating robustness of the model. CONCLUSIONS: PDT using verteporfin dye to treat classic subfoveal choroidal neovascularization is a very cost-effective treatment by conventional standards. The marked improvement in cost-effectiveness compared with a previous report results from the facts that the treatment benefit increasingly accrues during 5 years of follow-up while the number of yearly treatments diminishes markedly during that time.

Choroidal Neovascularization↗

Direct identification of mycobacteria in primary liquid detection media by partial sequencing of the 65-kilodalton heat shock protein gene.

We investigated extending the use of direct partial hsp65 gene sequencing for the identification of mycobacteria to isolates in primary liquid detection media as an economical, feasible, and more rapid means of identification. During the course of the study, the hsp65 sequence-based identifications for isolates from 670 primary liquid detection media determined to be positive for acid-fast bacilli were compared to the identifications derived from Accuprobes, biochemical test panels, or 16S rRNA gene sequencing. Preliminary analysis indicated a 97.6% concordance, with a final agreement of 99.1% between the identification algorithms. hsp65 sequencing costs (32.84 US dollars) were greater than the cost of identification with Accuprobe (9 US dollars) but less than the cost of the biochemical test panel identification (average cost, 98.90 US dollars) and equivalent to the cost of 16S rRNA sequencing, although there was a referral cost (59.85 US dollars) for the shipping of isolates to another reference laboratory. Analysis indicated that our laboratory would have recognized a cost savings of approximately 12,000 US dollars by using hsp65 sequencing to identify isolates from specimens with a negative fluorescent- smear status and would have achieved further savings by using it as an alternative to biochemical panel testing for fluorescent-smear-positive specimens. The time to identification by hsp65 gene sequencing was slightly longer than that required by the Accuprobe assay (1 versus 2 days), shorter than that required by the biochemical test panels (2 days versus 26 days on average), and more rapid than referral for 16S rRNA gene sequencing.

Bacterial Proteins↗

Preparation of a calibrant as certified reference material for determination of the Fusarium mycotoxin zearalenone.

In the field of mycotoxin analysis, substantial problems shown by high between-laboratory standard deviations and noncomparable and nontraceable results have been caused by the lack of proper calibrants for external calibration. During a large-scale Standard Measurement and Testing project of the European Commission (EC) dealing with preparation and certification of reference materials for determination of the mycotoxin zearalenone (ZON) in maize, a ZON calibrant in acetonitrile was prepared and checked for purity, homogeneity, and stability. Before certification, on the basis of preparation, the calibrant was checked in a mini-interlaboratory study by UV spectrophotometric determination. The molar absorptivities of ZON in acetonitrile at 236, 274, and 314 nm were established, and as a main result, a common reference wavelength of 274 nm with molar absorptivity of 12623 +/- 111 L/mol x cm can be recommended for ZON in acetonitrile. A concentration and expanded uncertainty of the ZON calibrant of 9.95 +/- 0.08 microg/mL was calculated as a preliminary value before final evaluation through the certification panel of the EC.

Acetonitriles↗

Female athlete triad.

The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in physical medicine and rehabilitation. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another.The epitomes included here were selected by the Advisory Panel to the Section on Physical Medicine and Rehabilitation of the California Medical Association, and the summaries were prepared under the direction of Murray E. Brandstater, MD, and the panel.

Amenorrhea↗

Escherichia coli O157:H7 infections.

The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in preventive medicine and public health. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another.The epitomes included here were selected by the Advisory Panel to the Section on Preventive Medicine and Public Health of the California Medical Association, and the summaries were prepared under the direction of Dr Thom and the Scientific Advisory Panel to the Section on Preventive Medicine and Public Health.

Diarrhea↗

Comparison of computer- and human-derived coronary angiographic end-point measures for controlled therapy trials.

The Cholesterol Lowering Atherosclerosis Study, a randomized angiographic clinical trial, demonstrated the beneficial effect of niacin/colestipol plus diet therapy on coronary atherosclerosis. Outcome was determined by panel-based estimates (viewed in both still and cine modes) of percent stenosis severity and change in native artery and bypass graft lesions. Computer-based quantitative coronary angiography (QCA) was also used to measure lesion and bypass graft stenosis severity and change in individual frames closely matched in orientation, opacification, and cardiac phase. Both methods jointly evaluated 350 nonoccluded lesions. The correlation between QCA and panel estimates of lesion size was 0.70 (p less than 0.0001) and for change in lesion size was 0.28 (p = 0.002). Agreement between the two methods in classifying lesion changes (i.e., regression, unchanged, or progression) occurred for 60% (210 of 350) of the lesions kappa +/- SEM = 0.20 +/- 0.05, p less than 0.001). The panel identified 442 nonoccluded lesions for which QCA stenosis measurements could not be obtained. Lesions not measurable by QCA included those with stenosis greater than 85% that could not be reliably edge tracked, segments with diffuse or ecstatic disease that had no reliable reference diameter, and segments for which matched frames could not be located. Seventy-nine lesions, the majority between 21% and 40% stenosis, were identified and measured by QCA but were not identified by the panel. This comparison study demonstrates the need to consider available angiographic measurement methods in relation to the goals of their use.

Adult↗

ARTS: a web-based tool for the set-up of high-throughput genome-wide mapping panels for the SNP genotyping of mouse mutants.

Genome-wide mapping in the identification of novel candidate genes has always been the standard method in genetics and genomics to correlate a clinically interesting phenotypic trait with a genotype. However, the performance of a mapping experiment using classical microsatellite approaches can be very time consuming. The high-throughput analysis of single-nucleotide polymorphisms (SNPs) has the potential of being the successor of microsatellite analysis routinely used for these mapping approaches, where one of the major obstacles is the design of the appropriate SNP marker set itself. Here we report on ARTS, an advanced retrieval tool for SNPs, which allows researchers to comb freely the public mouse dbSNP database for multiple reference and test strains. Several filters can be applied in order to improve the sensitivity and the specificity of the search results. By employing the panel generator function of this program, it is possible to abbreviate the extraction of reliable sequence data for a large marker panel including several different mouse strains from days to minutes. The concept of ARTS is easily adaptable to other species for which SNP databases are available, making it a versatile tool for the use of SNPs as markers for genotyping. The web interface is accessible at http://andromeda.gsf.de/arts.

Animals↗

Serogroup-specific and serogroup-cross-reactive epitopes of Legionella pneumophila.

A panel of monoclonal antibodies was used to serotype 343 Legionella pneumophila isolates, using the indirect immunofluorescence test and ELISA. In addition, the isolates were typed by means of absorbed rabbit antisera to provide a reference procedure. As shown by a comparison of reaction patterns, serogroup-specific monoclonal antibodies were found for serogroups 1, 2, 3, 4, 6, 7, 8, and 10. Monoclonal subtypes were found to exist within serogroups 1, 2, 5, and 6. Using the monoclonal antibody panel introduced for serogroups 1 to 8 and 10, it was possible to serotype or subtype 92% of the isolates tested. The remaining isolates belonged to serogroups 9, 11 to 14 and to a monoclonal subtype of serogroup 5. 8 monoclonal antibodies recognized serogroup-cross-reactive epitopes. Except for serogroups 1, 7, and 11, all others shared a common antigenic determinant. Another common epitope was shared by strains of serogroups 2 and 3. Additional cross-reactivity was associated in particular with strains of serogroups 5, 8, and 10.

Animals↗

Bone pain and radionuclide therapy.

The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in nuclear medicine. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another. The epitomes included here were selected by the Advisory Panel to the Section on Nuclear Medicine of the California Medical Association, and the summaries were prepared under the direction of Dr Lyons and the panel.

Bone Neoplasms↗

Melanoma--current concepts.

The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in plastic surgery. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another. The epitomes included here were selected by the Advisory Panel to the Section on Plastic Surgery of the California Medical Association, and the summaries were prepared under the direction of C. Gregory Jellinek, MD, and the panel.

Humans↗

Stereotactic neurosurgery for Parkinson's disease.

The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in neurosurgery. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another. The epitomes included here were selected by the Advisory Panel to the Section on Neurosurgery of the California Medical Association, and the summaries were prepared under the direction of John H. Neal, MD, and the panel.

Humans↗

New antiepileptic drugs for the treatment of childhood epilepsies.

The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in pediatrics. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another. The epitomes included here were selected by the Advisory Panel to the Section on Pediatrics of the California Medical Association, and the summaries were prepared under the direction of Susan B. Conley, MD, and the panel.

Anticonvulsants↗

Strategies for home-assisted ventilation.

The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in chest diseases. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another. The epitomes included here were selected by the Advisory Panel to the Section on Chest Diseases of the California Medical Association, and the summaries were prepared under the direction of Dr Cosentino and the panel.

Home Care Services↗

Keratorefractive surgery.

The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in ophthalmology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another. The epitomes included here were selected by the Advisory Panel to the Section on Ophthalmology of the California Medical Association, and the summaries were prepared under the direction of Alfred C. Marrone, MD, and the panel.

Cornea↗

New muscle relaxants.

The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in anesthesiology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another. The epitomes included here were selected by the Advisory Panel to the Section on Anesthesiology of the California Medical Association, and the summaries were prepared under the direction of Dr Jackson and the panel.

Androstanols↗

Group B streptococcal infections in pregnancy.

The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in obstetrics and gynecology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another. The epitomes included here were selected by the Advisory Panel to the Section on Obstetrics and Gynecology of the California Medical Association, and the summaries were prepared under the direction of Dr Chang and the panel.

Adult↗

Pediatric fever guidelines.

The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in emergency medicine. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another. The epitomes included here were selected by the Advisory Panel to the Section on Emergency Medicine of the California Medical Association, and the summaries were prepared under the direction of Scott Votey, MD, and the panel.

Adolescent↗