An evaluation of near patient tests for detecting herpes simplex virus type-2 antibody

OBJECTIVES

To examine the "in use" test characteristics of the POCkit "near patient" HSV-2 rapid test for the detection of HSV-2 IgG antibodies for use in the clinic. This test relies on a visual interpretation of the result.

METHODS

2093 serum samples, 229 from UK and 919 from Italian genitourinary medicine clinic patients and 945 from obstetric and gynaecology clinic patients in Italy were tested. Tests were carried out according to manufacturers' protocol in the United Kingdom and Italy. Three readers independently recorded a score for each test carried out and the results were compared.

RESULTS

In the UK study, the three readers disagreed on the result on 5.2% of tests. In the Italian study, there was disagreement in 10.2% of tests.

CONCLUSIONS

This study has demonstrated a problem in the subjective nature of the interpretation of the POCkit HSV-2 test. It highlights the need for adequate training of clinic staff and the need for clinics to adopt policies of quality assurance and ongoing monitoring which will ensure the validity and accuracy of this clinic based test.

Automated purification and quantification of oligonucleotides

We have developed automated methods for the trityl-on purification and quantification of synthetic oligonucleotides. Oligonucleotide purification is by solid-phase extraction cartridges using Amberchrom CG-50 resin on an XYZ-axis robotic system. Quantification is by OD260nm using an online UV-visible spectrophotometer with sipper. The purification of 20 oligonucleotides requires 5 min of user set-up time, plus 20 min per sample of robot time. For a 15-25-mer at the 40 nmol scale of synthesis, the method gives a yield of 2.8 ODs from a load of 10.1 OD, i.e., a 28% average yield. Oligonucleotides purified by this method have proven to be successful for primers for automated DNA sequencing.

A randomized, placebo-controlled study of rifabutin added to a regimen of clarithromycin and ethambutol for treatment of disseminated infection with Mycobacterium avium complex

Current guidelines suggest that disseminated Mycobacterium avium complex (MAC) infection be treated with a macrolide plus ethambutol or rifabutin or both. From 1993 to 1996, 198 AIDS patients with MAC bacteremia participated in a prospective, placebo-controlled trial of clarithromycin (500 mg b.i.d.) plus ethambutol (1,200 mg/d), with or without rifabutin (300 mg/d). At 16 weeks, 63% of patients in the rifabutin group and 61% in the placebo group (P = .81) had responded bacteriologically. Changes in clinical symptoms and time to survival were similar in both groups. Development of clarithromycin resistance during therapy was similar in the two groups; of patients who had a bacteriologic response, however, only 1 of 44 (2%) receiving rifabutin developed clarithromycin resistance, vs. 6 of 42 (14%) in the placebo group (P = .055). Thus, rifabutin had no impact on bacteriologic response or survival but may protect against development of clarithromycin resistance in those who respond to therapy.

Acute fatigue in chronic fatigue syndrome patients

BACKGROUND

Chronic fatigue syndrome (CFS) patients often complain that they are more susceptible to acute mental fatigue. It is important to determine whether this is observed using objective tests of sustained attention and responding.

METHODS

Sixty-seven patients who fulfilled the criteria for CFS proposed by Sharpe et al. (1991) were compared with 126 matched healthy controls. Acute fatigue was assessed by comparing performance at the start and end of a lengthy test session and by examining changes over the course of individual tasks.

RESULTS

CFS patients showed impaired performance compared to the controls and these differences increased as the volunteers developed acute fatigue. In addition, differences between the two groups were larger at the end of the test session.

CONCLUSIONS

The present results show that CFS patients are more susceptible to acute fatigue than healthy controls. This could reflect motor fatigue or an inability to compensate for fatigue with increased effort. This profile is consistent with previous research on fatigue and suggests that interpretation of certain aspects of CFS may be helped by considering it as the end point of a continuum of fatigue rather than a distinct disease.

Risk of hepatitis A infection in sewage workers

OBJECTIVE

To evaluate the risk of hepatitis A virus (HAV) infection among sewage workers from occupational exposure to raw sewage.

METHODS

An analytical cross sectional study of 241 company employees with possible occupational exposure to sewage in a large water and sewerage company was carried out. Previous exposure to hepatitis A virus infection was assessed, as were its associations with possible risk factors.

RESULTS

Frequent occupational exposure to raw sewage was a significant risk factor for HAV infection, independently of other known risk factors (odds ratio 3.73, 95% confidence interval 1.48 to 9.37). Of 50 employees who reported occupational exposure to raw sewage most of the time, 30 (60%) had had HAV infection.

CONCLUSION

Employees who are likely to be at risk of frequent exposure should have their immunity ensured. The salivary assay for IgG anti-HAV used in the study was highly specific and would be suitable for prevaccination testing of older employees, who are more likely to be immune.

Caffeine and the common cold

An experiment was carried out to determine whether caffeinated and decaffeinated coffee removed the malaise (reduced alertness, slower psychomotor performance) associated with having a common cold. One hundred volunteers were tested when healthy and 46 returned to the laboratory when they developed colds. Those subjects who remained healthy were then recalled as a control group. On the second visit subjects carried out two sessions, one pre-drink and another an hour after the drink. Subjects were randomly assigned to one of the following three conditions, caffeinated coffee (1.5 mg/kg caffeine/body weight), decaffeinated coffee or fruit juice. Subjects with colds reported decreased alertness and were slower at performing psychomotor tasks. Caffeine increased the alertness and performance of the colds subjects to the same level as the healthy group and decaffeinated coffee also led to an improvement. These results suggest that drugs which increase alertness can remove the malaise associated with the common cold, and that increased stimulation of the sensory afferent nerves may also be beneficial.

Integration of laptop computer technology into an undergraduate nursing course

An evaluative study was done to determine the effects of laptop computer use on baccalaureate nursing students' attitudes toward computers, computer knowledge, and computer skills. Students in the experimental group (n = 20) received laptop computers and 9 hours of computer instruction. They were encouraged to use the laptop computers for e-mail, library searches, and word processing. The comparison group (n = 18) completed the same assignments in the usual manner. Students had positive attitudes toward computers both pretest and posttest with no significant increase or difference between the two groups. There was no significant difference between the two groups in computer knowledge outcomes; however, the experimental group had statistically significant gains in computer skills. Results of this study suggest that the integration of laptop computer technology into the undergraduate nursing curriculum can be an effective way to increase students' computer skills while maintaining positive attitudes toward computers in nursing.

A comparison of the acute effects of a low dose of alcohol on mood and performance of healthy volunteers and subjects with upper respiratory tract illnesses

An experiment was carried out to determine whether a low dose of alcohol produced different behavioural effects in healthy volunteers to those suffering from an upper respiratory tract illness. Ninety-nine subjects were tested, with 48 subjects being assigned to the alcohol condition and 51 to the juice only condition. A dose of 1.5 ml of vodka per kg body weight was used and the alcohol manipulation was double-blind. Approximately half of the subjects in each condition were healthy and the others had upper respiratory tract illnesses, probably colds. Subjects with colds reported an increase in negative affect and were slower at performing psychomotor tasks. Few main effects of alcohol were obtained. Of major interest were the interactions between health status and alcohol conditions. The alcohol improved the mood of healthy subjects but produced greater negative moods in subjects with colds. Similarly, performance of selective and sustained attention tasks showed different effects of alcohol in healthy and ill subjects.

Mediation of chemoattractant-induced changes in [Ca2+]i and cell shape, polarity, and locomotion by InsP3, DAG, and protein kinase C in newt eosinophils

During chemotaxis large eosinophils from newts exhibit a gradient of [Ca2+]i from rear to front. The direction of the gradient changes on relocation of the chemoattractant source, suggesting that the Ca2+ signal may trigger the cytoskeletal reorganization required for cell reorientation during chemotaxis. The initial stimulatory effect of chemoattractant on [Ca2+]i and the opposite orientations of the intracellular Ca2+ gradient and the external stimulus gradient suggest that more than one chemoattractant-sensitive messenger pathway may be responsible for the generation of spatially graded Ca2+ signals. To identify these messengers, Ca2+ changes were measured in single live cells stimulated with spatially uniform chemoattractant. On stimulation spatially averaged [Ca2+]i increased rapidly from < or = 100 nM to > or = 400 nM and was accompanied by formation of lamellipods. Subsequently cells flattened, polarized and crawled, and [Ca2+]i fluctuated around a mean value of approximately 200 nM. The initial Ca2+ spike was insensitive acutely to removal of extracellular Ca2+ but was abolished by treatments expected to deplete internal Ca2+ stores and by blocking receptors for inositol-trisphosphate, indicating that it is produced by discharge of internal stores, at least some of which are sensitive to InsP3. Activators of protein kinase C (PKC) (diacyl glycerol and phorbol ester) induced flattening and lamellipod activity and suppressed the Ca2+ spike, while cells injected with PKC inhibitors (an inhibitory peptide and low concentrations of heparin-like compounds) produced an enhanced Ca2+ spike on stimulation. Although cell flattening and lamellipod activity were induced by chemoattractant when the normal Ca2+ response was blocked, cells failed to polarize and crawl, indicating that Ca2+ homeostasis is required for these processes. We conclude that InsP3 acting on Ca2+ stores and DAG acting via PKC regulate chemoattractant-induced changes in [Ca2+]i, which in turn control polarization and locomotion. We propose that differences in the spatial distributions of InsP3 and DAG resulting from their respective hydrophilic and lipophilic properties may change Ca2+ distribution in response to stimulus reorientation, enabling the cell to follow the stimulus.

Peritoneal cytology for suspected acute appendicitis: an economic evaluation

Suspected acute appendicitis is a common reason for surgery. Unfortunately, diagnosis is not always simple and, in recent years, considerable attention has been devoted to developing better diagnostic techniques. Peritoneal cytology is one such technique. It is simple, minimally invasive, and has been established as clinically effective. This paper reports on an economic evaluation of peritoneal cytology, carried out at Wellington Hospital, New Zealand. The analysis is based on two trials totalling 192 patients. The perspective taken initially is that of a hospital financial manager, seeking to minimise costs. In the first trial, there was a marginal increase in overall cost per person presenting with suspected acute appendicitis, from using the test. In the second, there was a reduction. In both trials there were significant health benefits--unnecessary operations were avoided, and necessary operations done more quickly. Also, the practice developed, in the second trial, of sending patients home immediately following a negative test result. This further increased savings. We then discuss the results from a broader perspective. We conclude that the additional personal benefits--less time convalescing, and lower mortality, on average--ensure that the benefits outweigh the costs of the test.

Increasing patient satisfaction: simple ways to increase the effectiveness of interpersonal communication in the OPS/PACU

Because of changes in health care and reimbursement practices, nurses and staff are being required to do more with fewer measures while patients' needs increase. Nurses can make a difference in meeting those needs an in increasing patient satisfaction by using empathy, imagination, and the "human touch."

Pulmonary gas exchange during hypoxic exercise in the rat

Pulmonary gas exchange and O2 transport were studied at rest and during maximal treadmill exercise in rats in acute hypoxia (PIO2 approximately 71 Torr), and in littermates acclimatized to PB = 380 Torr (PIO2 approximately 71 Torr) for 3 weeks (chronic hypoxia). To obtain valid estimates of blood gas partial pressures, particularly during exercise, the temperature coefficients of blood pH, PO2 and PCO2 were determined (Appendix). In both acute and chronic hypoxia, the following changes were observed: alveolar and arterial PO2 increased considerably, but the difference, A-aPO2, did not change significantly; arterial O2 concentration (CaO2) decreased, and apparent pulmonary diffusing capacity for O2, Dapp, increased. The increase in Dapp, together with hyperventilation, may prevent further drop in CaO2 due to a large rightward shift in the blood-O2 equilibrium curve caused by lactic acidosis in conjunction with a large Bohr coefficient characteristic of this species. Comparison with corresponding results obtained in man reveals that during hypoxic exercise, the rat shows a larger increase in PAO2, an increase, instead of a decrease, in PaO2, and a larger increase in Dapp.