bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Diagnosis of
In Utero
and Intrapartum HIV Infection in Infants Prior to 6 Weeks of Age
Authors: Lilian Rivka R. , Kalk Emma , Bhowan Kapila , Berrie Leigh , Carmona Sergio , Technau Karl , Sherman Gayle G. 
Published: April 2012

ABSTRACT

Early initiation of antiretroviral therapy reduces HIV-related infant mortality. The early peak of pediatric HIV-related deaths in South Africa occurs at 3 months of age, coinciding with the earliest age at which treatment is initiated following PCR testing at 6 weeks of age. Earlier diagnosis is necessary to reduce infant mortality. The performances of the Amplicor DNA PCR, COBAS AmpliPrep/COBAS TaqMan (CAP/CTM), and Aptima assays for detecting early HIV infection (acquired
in utero
and intrapartum) up to 6 weeks of age were compared. Dried blood spots (DBS) were collected at birth and at 2, 4, and 6 weeks from HIV-exposed infants enrolled in an observational cohort study in Johannesburg, South Africa. HIV status was determined at 6 weeks by DNA PCR on whole blood. Serial DBS samples from all HIV-infected infants and two HIV-uninfected, age-matched controls were tested with the 3 assays. Of 710 infants of known HIV status, 38 (5.4%) had
in utero
(
n
= 29) or intrapartum (
n
= 9) infections. By 14 weeks, when treatment should have been initiated, 13 (45%)
in utero
-infected and 2 (22%) intrapartum-infected infants had died or were lost to follow-up. The CAP/CTM and Aptima assays identified 76.3% of all infants with early HIV infections at birth and by 4 weeks were 96% sensitive. DNA PCR demonstrated lower sensitivities at birth and 4 weeks of 68.4% and 87.5%, respectively. All assays had the lowest sensitivity at 2 weeks of age. CAP/CTM was the only assay with 100% specificity at all ages. Testing at birth versus 6 weeks of age identifies a higher total number of HIV-infected infants, irrespective of the assay.
Detection of Methicillin-Resistant Staphylococcus aureus in Clinical Specimens from Cystic Fibrosis Patients by Use of Chromogenic Selective Agar
Authors: Perez Leandro Reus Rodrigues , Antunes Ana Lúcia Souza , Bonfanti Jéssica Weiss , Pinto Jaqueline Becker , Roesch Eliane Wurdig , Rodrigues Diógenes , Dias Cícero Armídio Gomes 
Published: April 2012

ABSTRACT

We evaluated the use of a chromogenic selective medium (MRSA ID) as a useful tool for the detection of methicillin-resistant
Staphylococcus aureus
(MRSA) in cystic fibrosis (CF) patient samples. Fifty-four MRSA isolates were detected by MRSA ID, while only 24/54 (44%) (odds ratio [OR], 2.79; 95% confidence interval [CI], 1.63 to 4.76) were detected by conventional methods. A chromogenic selective medium for MRSA detection may improve its surveillance in CF patients.
OXA-163-Producing Klebsiella pneumoniae in Cairo, Egypt, in 2009 and 2010
Authors: Abdelaziz Mohammed O. , Bonura Celestino , Aleo Aurora , El-Domany Ramadan A. , Fasciana Teresa , Mammina Caterina 
Published: April 2012

ABSTRACT

Two genetically unrelated OXA-163-carrying
Klebsiella pneumoniae
strains were identified from two infection cases in June 2009 and May 2010 in Cairo, Egypt. OXA-163-producing
Enterobacteriaceae
had been previously reported in Argentina only. Both patients had no history of travel abroad. The emergence of this newly recognized OXA-48-related β-lactamase able to hydrolyze cephalosporins and carbapenems is especially worrying in a geographic area where OXA-48 is endemic and effective surveillance for antibiotic resistance is largely unaffordable.
Clinical Significance of Low Cytomegalovirus DNA Levels in Human Plasma
Authors: Waggoner Jesse , Ho Dora Y. , Libiran Paolo , Pinsky Benjamin A. 
Published: April 2012

ABSTRACT

The clinical significance of the detection of low copy numbers of cytomegalovirus (CMV) DNA in immune-suppressed patients remains unclear. In this study, we compared the
artus
CMV Rotor-Gene PCR, utilizing an automated nucleic acid extraction and assay setup (the
artus
CMV protocol), with the COBAS Amplicor CMV Monitor test (our reference protocol). We then analyzed the results of all CMV PCR tests ordered following the implementation of the
artus
CMV protocol at our institution and followed 91 adult patients with positive test results. The
artus
CMV protocol had a linear range extending from 2.0 to 7.0 log
10
copies/ml and had a lower limit of 95% detection of 57 copies/ml. With archived plasma samples, this protocol demonstrated 100% sensitivity and 94% specificity for the detection of CMV DNA. Following implementation of the
artus
CMV protocol, 320 of 1,403 (22.8%) plasma samples tested positive (compared with 323/3,579 [9.0%] samples in the preceding 6 months), and 227 (16.2%) samples had copy numbers of <400/ml. Ninety-one adult patients had at least one positive test. The data were analyzed using a threshold of 200 copies/ml, and in 22 episodes, the viral load increased from <200 copies/ml to ≥200 copies/ml on sequential tests. In 21 of these 22 episodes, either the viral load continued to increase or antiviral treatment was initiated in response to the repeat value. In summary, we evaluate the performance characteristics of a protocol utilizing the
artus
CMV PCR and identify clinically meaningful changes in CMV DNA copy numbers even when they are initially detected at a low level.
Inhaled hypertonic saline in adults hospitalised for exacerbation of cystic fibrosis lung disease: a retrospective study
Authors: Pezzulo Alejandro A , Stoltz David A , Hornick Douglas B , Durairaj Lakshmi 
Published: April 2012

BackgroundInhaled hypertonic saline (HTS) improves quality of life and reduces pulmonary exacerbations when given long term in patients with cystic fibrosis (CF). While increasingly being offered for acute pulmonary exacerbations, little is known about the efficacy in this setting.ObjectivesThe authors examined the tolerability and efficacy of HTS use among adult subjects hospitalised with a CF pulmonary exacerbation and hypothesised that use of HTS would improve pulmonary function during the admission.DesignPilot retrospective non-randomised study.SettingSingle tertiary care centre.Participants45 subjects admitted to the inpatient service for acute CF pulmonary exacerbation in 2006–2007. A subset of 18 subjects who were also admitted in 2005 when HTS was not available was included in the comparative study.Primary outcomeChange in forced expiratory volume in one second from admission to discharge.Secondary outcomesChange in weight from admission to discharge and time to next exacerbation.ResultsMean age was 32.5 years, and mean length of stay was 11.5 days. HTS was offered to 33 subjects and was well tolerated for a total use of 336 days out of 364 days of hospital stay. Baseline demographics, lung function and sputum culture results were comparable in first and second visits. Use of HTS was not associated with an improvement in forced expiratory volume in one second (p=0.1), weight gain (p=0.24) or in the time to next admission (p=0.08).ConclusionsThese pilot data suggest that HTS is well tolerated during CF pulmonary exacerbation but offers no clear outcome benefits. It is possible that HTS may not have much advantage above and beyond intensive rehabilitation and intravenous antibiotics and may add to hospital costs and treatment burden.
Knowledge about epilepsy among health professionals: a cross-sectional survey in São Paulo, Brazil
Authors: Vancini Rodrigo Luiz , Benedito-Silva Ana Amélia , Sousa Bolivar Saldanha , Gomes da Silva Sergio , Souza-Vancini Maria Iones , Vancini-Campanharo Cássia Regina , Cabral Francisco Romero , de Lima Cristiano , Barbosa de Lira Claudio Andre 
Published: April 2012

ObjectiveTo evaluate the epilepsy knowledge among health professionals in São Paulo, Brazil.DesignThis is a cross-sectional study.ParticipantsProfessionals with academic degrees in physical education (n=134), nutrition (n=116), medicine (n=100), psychology (n=53), nursing (n=122) and physiotherapy (n=99) who lived in São Paulo City, Brazil.Primary and secondary outcome measuresKnowledge of health professionals about epilepsy.MethodsProfessionals with academic degrees in physical education (n=134), nutrition (n=116), medicine (n=100), psychology (n=53), nursing (n=122) and physiotherapy (n=99) who lived in São Paulo City, Brazil, were invited to participate in the study. The subjects (n=624) answered a questionnaire composed of 25 simple closed-ended questions from three areas: personal, educational and knowledge.ResultsOut of all subjects, 88.5% (n=552) had a postgraduate education, while 11.5% (n=72) had only an undergraduate degree. The authors found that physical educators, nutritionists and physiotherapists received lower scores on their epilepsy knowledge than other health professionals.ConclusionsHealth professionals are considered better-educated group inside the society, especially with regards to healthcare issues. Thus, it is important they also have an accurate and correct knowledge about epilepsy. The findings of the present study indicate an imperative improvement in education about epilepsy, as well as an inclusion of formal programmes for epilepsy education especially for non-medical professionals. An improvement in epilepsy education might contribute to an improvement in epilepsy care and management.
Current practices for paediatric procedural sedation and analgesia in emergency departments: results of a nationwide survey in Korea
Authors: Seo Jun Seok , Kim Do Kyun , Kang Youngjoon , Kyong Yeon Young , Kim Jin Joo , Ahn Ji Yun , Lee Ji Sook , Jang Hye Young , Jung Jin Hee , Choi Yoon Hee , Han Seung Baik , Lee Jin Hee 
Published: April 2012

ObjectiveProcedural sedation and analgesia (PSA) in children has become a standard tool in emergency settings, but no national PSA guidelines have been developed for the emergency department (ED) in Korea. Therefore, we investigated the practice of PSA and the level of adherence to institutional PSA guidelines in EDs of teaching hospitals.MethodsThis study was a cross-sectional, web-based survey. The study subjects were the faculty of EDs from 96 teaching hospitals. The questionnaire was posted on an internet site, and the participants were requested that the questionnaire be answered by email and telephone in May 2009.ResultsThe questionnaires were completed by 67.7% of the participants. Only 20% of EDs had institutional PSA guidelines, 21.5% of those had discharge criteria and 13.8% of EDs had a discharge instruction form. Residents were administered PSA at 76.9% of EDs. The airway rescue equipment was near the area where PSA was performed in 76.9% of EDs. The most commonly used medication for both diagnostic imaging and painful procedure was oral chloral hydrate (87.7%, 61.5%). In 64.6% of EDs, patients were monitored. In only 21 cases, EDs (50.0%) monitored the patients to recovery after PSA or discharge.ConclusionsCurrent PSA for paediatric patients have not been appropriately applied in Korea. Unified PSA guidelines were rare in the hospitals surveyed, and many patients were not monitored over an appropriate duration, nor did they receive adequate medications for sedation by the best trained personnel. Therefore, the national PSA guidelines must be developed and implemented as early as possible.
The impact of changing the 4 h emergency access standard on patient waiting times in emergency departments in England
Authors: Woodcock Thomas , Poots Alan J , Bell Derek 
Published: April 2012

ObjectiveTo determine whether the process of emergency care waiting in England has changed following the modification of the operational standard for the 4 h waiting time target from 98% to 95% in June 2010.DesignRetrospective analysis of publicly available ‘total time spent in accident and emergency’ data from Department of Health.Setting and participantsPatients attending emergency departments (EDs) in England between October 2002 and September 2011. In 2005, the government set an operational standard that 98% of patients should wait <4 h in ED. In June 2010, the government announced that the operating standard would change to 95% immediately.Outcome measuresPercentage of patients waiting <4 h (weekly and quarterly), and total number of patients waiting >4 h.ResultsThe average percentage of patients waiting <4 h fell from 98% to 95% almost immediately following the operational standard change. Consequently, between October 2010 and September 2011, approximately 383 000 additional patients in England EDs waited in excess of 4 h than had the 98% standard been attained. The emergency care system appears to have been stabilised at this new level.ConclusionsThe policy change for waiting times in EDs in England has resulted in the process of emergency care in England adjusting to the new operational standard of 95% of patients waiting <4 h. As a result, more patients are waiting >4 h to receive the care they need; consequently, outcomes are likely to suffer.
Diagnostic value of a hand-carried ultrasound device for free intra-abdominal fluid and organ lacerations in major trauma patients
Authors: Schleder Stephan , Dendl Lena-Marie , Ernstberger Antonio , Nerlich Michael , Hoffstetter Patrick , Jung Ernst-Michael , Heiss Peter , Stroszczynski Christian , Schreyer Andreas G 
Published: April 2012

BackgroundTechnological progress has led to the introduction of hand-carried ultrasound (HCU) imagers in clinical workflow. The aim of this study is to analyse whether examination with a HCU device is a rapid and reliable alternative to contrast-enhanced multidetector CT (MDCT) scans in diagnosis of free intra-abdominal fluid and organ lacerations in major trauma patients.Methods31 major trauma patients with an injury severity score >15 and the necessity of a MDCT scan (standard of reference) were enrolled prospectively to this study, and additionally examined with a HCU, according to ‘focused assessment with sonography for trauma’ principles for the assessment of organ lacerations and free intra-abdominal fluid. The HCU device employed was of the latest generation. Statistical analysis was performed using PASW V.18.ResultsFour patients were diagnosed with free intra-abdominal fluid (prevalence 12.9%). HCU showed a sensitivity and specificity of 75% and 100%, respectively. Positive predictive value and negative predictive value were 100% and 96%, respectively. Five patients had organ lacerations (prevalence 16.1%). In these cases, the HCU was able to detect organ lacerations with a sensitivity and specificity of 80% and 100%, respectively. Therefore, a positive predictive value and negative predictive value of 100% and 96%, respectively, were calculated.ConclusionIn major trauma patients, examination with HCU according to the ‘focused assessment with sonography for trauma’ principles for the diagnosis of organ lacerations and free intra-abdominal fluid is a reliable and rapid alternative to MDCT scans and can help save precious time in emergency situations, and should, additionally, be evaluated in the pre-clinical workflow.
Republished original research: Understanding how rapid response systems may improve safety for the acutely ill patient: learning from the frontline
Authors: Mackintosh Nicola , Rainey Helen , Sandall Jane 
Published: April 2012

Abstract

Introduction
Rapid response systems (RRSs) have been introduced to facilitate effective ‘rescue’ of seriously ill patients on hospital wards. While research has demonstrated some benefit, uncertainty remains regarding impact on patient outcomes. Little is known about the relationship between social contexts and the application of the RRS.

Design
This comparative case study of the RRS within the medical services of two UK hospitals used ethnographic methods over a 12-month period in 2009, including observation (ward work and shadowing medical staff = 150 h), interviews with doctors, ward and critical care nurses, healthcare assistants, safety leads and managers (n=35), documentary review and analysis of routine data. Data were analysed using NVivo software.

Results
The RRS reduced variability in recording, recognition and response behaviour. The RRS formalised understandings of deterioration and provided a mandate for escalating care across professional and hierarchical boundaries. However, markers of deterioration not assimilated into risk scores were marginalised and it was harder for staff to escalate care without the ‘objective evidence’ provided by the score. Contextual features (eg, leadership, organisational culture and training) shaped implementation, utilisation and impact of the RRS. Reporting and feedback of audit data enabled learning about ‘selected’ escalation work on the wards. Difficulties with referral upwards and across medical boundaries were reported by junior medical staff.

Conclusion
Locating a RRS within a pathway of care for the acutely ill patient illustrates the role of these safety strategies within the social organisation of clinical work. There is a need to broaden the focus of inquiry from detection and initiation of escalation (where the strategies are principally directed) towards team response behaviour and towards those medical response practices which to date have escaped scrutiny and monitoring.
SMS reminders improve re-screening in women and heterosexual men with chlamydia infection at Sydney Sexual Health Centre: a before-and-after study
Authors: Guy Rebecca , Wand Handan , Knight Vickie , Kenigsberg Aurelie , Read Phillip , McNulty Anna M 
Published: April 2012

BackgroundIn 2009, Sydney Sexual Health Centre implemented a short message service (SMS) reminder system to improve re-screening after chlamydia infection. SMS reminders were sent at 3 months recommending the patient make an appointment for a re-screen.MethodsUsing a before-and-after study, the authors compared the proportion re-screened within 1–4 months of chlamydia infection in women and heterosexual men who were sent an SMS in January to December 2009 (intervention period) with a 18-month period before the SMS was introduced (before period). The authors used a χ2test and multivariate regression. Visitors and sex workers were excluded.ResultsIn the intervention period, 141 of 343 (41%) patients were diagnosed with chlamydia and sent the SMS reminder. In the before period, 338 patients were diagnosed as having chlamydia and none received a reminder. The following baseline characteristics were significantly different between those sent the SMS in the intervention period and the before period: new patients (82% vs 72%, p=0.02), aged <25 years (51% vs 33% p<0.01), three or more sexual partners in the last 3 months (31% vs 27%, p<0.01) and anogenital symptoms (52% vs 38%, p<0.01). The proportion re-screened 1–4 months after chlamydia infection was significantly higher in people sent the SMS (30%) than the before period (21%), p=0.04, and after adjusting for baseline differences, the OR was 1.57 (95% CI 1.01 to 2.46).ConclusionsSMS reminders increased re-screening in patients diagnosed as having chlamydia at a sexual health clinic. The clinic now plans to introduce electronic prompts to maximise the uptake of the initiative and consider strategies to further increase re-screening.
Genotyping ofChlamydia trachomatisin rectal and pharyngeal specimens: identification of LGV genotypes in Finland
Authors: Korhonen Suvi , Hiltunen-Back Eija , Puolakkainen Mirja 
Published: April 2012

ObjectivesLymphogranuloma venereum (LGV) infections caused byChlamydia trachomatisL types have recently emerged in Europe among HIV-positive men having sex with men. Our aim was to introduce a genotyping strategy suitable for a diagnostic laboratory using nucleic acid amplification tests (NAATs) for detection ofC trachomatisand to investigate the prevalence of LGV types in rectal and pharyngeal specimens in Finland.MethodsAptima Combo 2 (Gen-Probe) was used to detectC trachomatisin swabs. Altogether 140C trachomatisNAAT-positive rectal and pharyngeal samples were genotyped bypmpHandompAreal-time PCR.ResultsOf the 140 NAAT-positive rectal and pharyngeal specimens, 114 (81%) were successfully typed bypmpHPCR. One hundred and four samples contained non-LGV, nine samples LGV and one sample both non-LGV and LGVC trachomatistypes. TheC trachomatisLGV types were mainly found in rectal samples. Six of the L types were confirmed to be genotype L2b and two were L2 withompAPCR and sequencing.ConclusionsOur experience suggests that genotypingC trachomatisbypmpHPCR can be introduced as a function of a diagnostic laboratory already using NAAT for detection ofC trachomatis. The data show that LGV infections occur also in Finland. LGV should be taken into account when considering treatment and management of rectalC trachomatisinfections.
What is the appropriate treatment for the management of rectalChlamydia trachomatisin men and women?
Authors: Hathorn Emma , Opie Catherine , Goold Penny 
Published: April 2012

BackgroundThere is no UK guidance specifically for the management of rectalChlamydia trachomatisyet there is documented treatment failure with single-dose azithromycin suggesting that test of cure (TOC) and alternative treatment may be needed.ObjectivesTo evaluate the efficacy of single-dose azithromycin compared with 1 week of doxycycline in the treatment of rectalC trachomatis.MethodsData were collected prospectively on all patients diagnosed with rectalC trachomatiswho received azithromycin 1 g stat between 1 January and 30 June 2010 and between 1 October 2010 and 31 March 2011 following a local change in treatment protocol to 1 week of doxycycline 100 mg twice a day. Information was collected on gender, concurrent sexually transmitted infections, treatment received, re-infection risk, re-treatment and TOC at 6 weeks.Results11 patients (26.2%) had a positive TOC following treatment with stat azithromycin. The risk of re-infection was excluded in two, identifying nine of the 11 (81.8%) as treatment failures. Two patients had a positive TOC following treatment with 1 week of doxycycline, both were found to have a risk of re-infection. There was a significantly higher treatment failure rate in patients receiving azithromycin (p=0.0025).ConclusionsA higher treatment failure rate was found following azithromycin for rectalC trachomatisthan previously published. If azithromycin is used for treatment of rectalC trachomatis, TOC may be required or alternative treatment with doxycycline may be preferable, but further data are required.