Cardiologists' knowledge and perceptions of the seasonal influenza immunisation

BACKGROUND

Seasonal influenza immunisation reduces cardiovascular events in high-risk patients, but 50% do not receive routine immunisation. The perceptions and current role of cardiologists in recommending and prescribing influenza immunisation has not been well described.

METHODS

We used an exploratory sequential mixed methods design. Semi-structured interviews of 10 cardiologists were performed to identify themes for quantitative evaluation. 63 cardiologists undertook quantitative evaluation in an online survey. The interviews and surveys addressed (a) attitudes and behaviours regarding influenza immunisation and (b) preventative care in cardiology.

RESULTS

One quarter (25.4%, n = 16) of cardiologists recommended influenza immunisation to all patients. Less than half (49.2%, n = 31) recommended influenza immunisation to secondary prevention patients. Almost 1/3 of respondents (31.7%, n = 20) were uncertain or unaware of the guidelines regarding influenza immunisation and patients with cardiac disease. Most cardiologists believed that general practitioners were responsible for ensuring patients received influenza immunisation (76.2%, n = 48).

CONCLUSIONS

Despite reducing cardiovascular events in high-risk patients, influenza immunisation is not widely recommended by cardiologists. Further clinician education is needed to address the knowledge gaps which prevent recommendation and uptake of this guideline directed treatment.

Use of a paediatric advice line for parents of infants recruited to a randomised controlled trial

BACKGROUND

This study aims to describe the use of a paediatric advice line (PAL) provided to parents whose infants were recruited to a large randomised controlled trial (RCT), including the number and types of medical concerns addressed, seasonal variability and call outcomes. Additionally, sociodemographic characteristics of the parents and children of those parents who used the PAL are compared with those who did not.

METHODS

Prospective cohort of 1246 children nested in the Melbourne Infant Study: BCG for Allergy and Infection Reduction (MIS BAIR) RCT. All MIS BAIR participants were offered access to the PAL. Data were collected over the initial 2 years of a 5-year follow-up. Data were analysed using χ² tests, and ORs were calculated using multiple logistic regression.

RESULTS

The PAL was used by 230 (18.5%) participants, who made a total of 586 calls during the 2-year study period. The reasons for calling the PAL were dermatological (24%); gastrointestinal (18%); disturbances in feeding, sleeping and crying (14%); respiratory (7%); and developmental/neurological (6%). Analysis revealed that those who used the PAL were more likely to be first-time parents (OR 1.4, 95% CI 1.1 to 1.9) and mothers who hold a university degree (OR 3.3, 95% CI 1.3 to 8.4). PAL costs were minimal and comprised 15 clinicians with paediatric experience.

CONCLUSIONS

A cost-effective PAL service for clinical trial participants was used appropriately by parents for relatively minor concerns and may have a role in trials to promote participant engagement and reduce demand for other health services.

Virolysis of feline calicivirus and human GII.4 norovirus following chlorine exposure under standardized light soil disinfection conditions

The relationship between the infectivity of the feline calicivirus (FCV) vaccine strain F-9 and capsid destruction (virolysis) in response to available chlorine was investigated under standardized light soil disinfection conditions. Virolysis was measured using RNase pretreatment (in order to destroy exposed RNA following chlorine treatment) and quantitative reverse transcription PCR. A comparison between the results of plaque assays and virolysis following exposure of FCV F-9 grown in tissue culture to different concentrations of available chlorine showed a similar log-linear relationship, with >4-log reductions occurring at 48 and 66 ppm, respectively. Three non-epidemiologically linked human GII.4 noroviruses (NoVs) present in dilute clinical samples showed behavior similar to each other and were 10 times more resistant to virolysis than cultured FCV F-9. FCV F-9 when present in dilute human GII.4 samples acquired increased resistance to virolysis approaching that of human NoVs. This study represents a direct comparison between the virolysis of a surrogate virus (FCV F-9) and that of human GII.4 NoVs within the same matrix in response to available chlorine. The results support the view that matrix effects have a significant effect on virus survival.

Reduction in morbidity of rotavirus induced diarrhoea in mice by yeast produced monovalent llama-derived antibody fragments

Apart from the use of oral rehydration solution, there are currently no treatment modalities for rotavirus induced diarrhoea, which is particularly relevant to developing countries. Fragments derived from llama heavy chain antibodies were previously shown to be highly stable, efficiently produced in yeast and exhibiting high epitope specific affinity. We now aim to demonstrate that these antibody fragments are capable of reducing morbidity of rotavirus induced diarrhoea. Here we show the isolation of rotavirus specific antibody fragments and their capability of reducing the morbidity of rotavirus induced diarrhoea in vivo in mice. They could provide a treatment modality for the moderation of human rotavirus infections having a significant impact on the course of an often fatal childhood disease.

A rapid chromatographic strip test for the pen-side diagnosis of rinderpest virus

Rinderpest is a contagious viral disease of cloven-hoofed domestic and wild animals. Eradication of the virus following outbreaks depends on rapid and accurate diagnosis of infection and the implementation of control measures. Reporting and confirmatory diagnosis precede the implementation of control measures. A number of techniques have been used for diagnosis such as agar gel immunodiffusion, enzyme-linked immunosorbent assay (ELISA), molecular biological techniques such as polymerase chain reaction (PCR) and virus isolation in tissue culture. Many of these methods are both time consuming and require skilled personnel. The development of a rapid pen-side test for the detection of rinderpest virus (RPV) antigen in lachrymal fluid of cattle is described using the Clearview chromatographic strip test technology (Unipath, Bedford). Optimum conditions for binding monoclonal antibody to nitrocellulose and latex microspheres were determined and a prototype device was developed. The device detected viral antigen in lachrymal fluids from experimentally and naturally infected cattle and showed no cross-reactivity with other related viruses. A field trial was carried out at the Landhi Cattle Colony (LCC), Pakistan, to assess the performance of the rinderpest test under field conditions. Ninety-seven animals, some of which were showing various clinical signs, at LCC and neighbouring colonies were sampled and tested at the pen-side by Clearview and later by immunocapture ELISA (IC-ELISA) at IAH, Pirbright. Nineteen animals were positive by Clearview and/or IC-ELISA. Seventeen out of 19 rinderpest positive animals were positive by Clearview and 15 out of 19 were positive by IC-ELISA. Reverse transcription polymerase chain reaction (RT-PCR) confirmed the 19 animals to be rinderpest positive. This simple, rapid, specific test allows for the first time, accurate pen-side diagnosis of rinderpest.

Detection of viruses and body fluids which may contain viruses in the domestic environment

The domestic environment was investigated for the presence of viruses and body fluids that may contain viruses. A range of surfaces in 39 homes (17 visited on 2 occasions) were sampled by swabbing and analysed using cell culture, reverse transcription polymerase chain reaction for enteroviral RNA, haemoglobin as a marker for blood, amylase as an indicator of urine, saliva and sweat, and protein as an indicator of general hygiene. Haemoglobin was found on 1.9% of surfaces sampled and of the positive samples 30% were from articles frequently handled. Amylase (> 5 U/l) was found in 29.3% of samples tested. Protein was found in 97.8% of samples tested. Enteroviral RNA, indicating the presence of virus, was detected in 3 out of 448 samples tested; they were from a tap handle, telephone handpiece and a toilet bowl. No viruses were isolated in cell culture, however significant problems were encountered with bacterial and fungal contamination. This work demonstrates that only testing environmental samples for bacteria and ATP may not give a total view of the microbiological problem in the home. A range of test methods is useful to gain a broad view of the problems of hygiene in the home and to allow comparative studies of specific areas such as the kitchen and bathroom.

Research for medical illustrators. Part 2: Trial design, protocols, results and reporting

Medical illustrators have long been involved in the research projects of other workers, by providing photographic and other visual records. These illustrations may be used for measurement purposes, in which case it is important that medical illustrators understand the requirements for using tested protocols, which ensure that all variables of the recording medium are controlled. Now that there are degree courses in medical illustration an increasing number of medical illustrators in the UK are instigating their own research projects, making it all the more important that they understand the research process. In this second of a two-part article, consideration is given to: the design of experiments and research trials; the production of research protocols; data analysis and interpretation; the writing of the research report or dissertation; and the role of the supervisor or mentor.

Research for medical illustrators. Part 1: The research process and planning research

Medical illustrators have long been involved in the research projects of other workers, by providing photographic and other visual records. These illustrations may be used for measurement purposes, in which case it's important that medical illustrators understand the requirements for using tested protocols which ensure that all variables of the recording medium are controlled. Now that there are degree courses in Medical illustration an increasing number of medical illustrators in the UK are instigating their own research projects, making it all the more important that they understand the research process. This two-part article looks at some of the relevant issues for medical illustrators who are embarking on a research project. Part 1 covers the research method, the selection and planning of projects, ethical, economic and practical considerations, and writing a research proposal. In Part 2, research protocols, trial design, data analysis, writing the report and the role of the supervisor or mentor, will be considered.

Design standards for computer-generated teaching slides

This article looks at the increasing use of the computer-generated teaching slide in a large teaching hospital, where the medical illustration department provides a bureau service for output. Lack of understanding by clients of basic design principles can present a number of problems. A study was undertaken on the slide making habits of professional healthcare educators and, from the information gathered, common problems were identified and a multifaceted approach to improving the design capability of clients was adopted.

Photography in wound assessment

A guide to some of the principles and techniques of medical photography

A review of the test methods used to establish virucidal activity

Testing the efficacy of disinfectants has been the domain of bacteriologists for many years. Recently interest has grown in the virucidal effects of disinfectants, due to increased awareness of viral infections and concern for possible cross-infection. Findings have demonstrated significant differences in the susceptibility of certain viruses, particularly non-enveloped viruses, e.g. enteroviruses, to disinfectants compared to some bacteria. For example Escherichia coli and herpes simplex virus are inactivated by 20% isopropyl alcohol (IPA) whereas Staphylococcus aureus requires > or = 50% and poliovirus is not inactivated by IPA. Currently there is little or no standardization in the methods used for the determination of virucidal activity in suspension, or on hands and surfaces. Methods in use in Europe and the USA will be reviewed and their relevance to the clinical situation discussed.

Assessment of chemical disinfectants against human immunodeficiency virus: overcoming the problem of cytotoxicity and the evaluation of selected actives

The aim of this study was to develop a standardised technique for assessing the virucidal activity of commercial disinfectants against human immunodeficiency virus (HIV). In the absence of any model procedure for HIV a protocol based on German DVV guidelines was developed. A major difficulty associated with such studies is the cytotoxic effect of the biocide on the target cells used in infectivity assays. This problem is most commonly overcome by dilution of the virus-disinfectant mixture, however, this requires high titre (> or = 10(7) TCID50) virus which is difficult to achieve with HIV. We employed a simple washing technique which effectively removed cytotoxicity while retaining infectivity. Incorporated into a standard suspension test, this method supported by virus isolation procedures was sensitive and reproducible. The reliability of the procedure was confirmed by evaluating the efficacy of some commercially available cidals which were known to be cytotoxic; namely two instrument disinfectants, Sactimed-I-Steril, an aldehyde based product, Sactimed-I-Sinald a guanide/quaternary-ammonium combination, and Levermed, an alcohol based hand disinfectant.

A test for the assessment of 'hygienic' hand disinfection using rotavirus

A standardized test procedure is described in which finger tips are inoculated with bovine rotavirus. The level of virus recovered after disinfection of artificially contaminated hands with various disinfectant detergents, alcoholic solutions and alcoholic formulations was determined. The method was found to be easy to perform and reproducible. The most efficient method for removal of virus from fingertips was found to be treatment with alcoholic solutions or products. Soap and water and disinfectant detergents were found to be a much less effective method of removing virus from contaminated hands.

The use of bacteriophage MS2 as a model system to evaluate virucidal hand disinfectants

A model system which would closely reflect the resistance of poliovirus but could be easily performed in any microbiology laboratory would offer considerable advantages for rapidly screening hand decontamination products. The use of the bacteriophage MS2 as a simple model for virucidal testing has been evaluated. In suspension tests the sensitivity of MS2 to alcohols, organic acids and alkalis generally reflected that observed in studies using poliovirus. MS2 could be applied and recovered from the hands of volunteers with high efficiency. Furthermore MS2 proved to be a suitable replacement for Escherichia coli in a standard hand-decontamination test.

Neutron fibre diffraction study of DNA hydration

Interactions with water are crucial to the conformation assumed by the DNA double helix. The location of water around the D conformation has been investigated in a neutron fibre diffraction study which shows that water is ordered in the minor groove of the DNA. The D conformation is important since its occurrence is limited to specific DNA base pair sequences which have been identified as functionally significant. This study is of particular interest because the D conformation has not been reported in single crystal studies of oligonucleotides.

The development of an M antibody capture ELISA for rubella IgM

An M antibody capture enzyme-linked immunosorbent assay for rubella IgM was developed. The enzyme label was prepared from a monoclonal antibody raised against rubella haemagglutinin (Tedder et al., 1982). Paired sera from acute rubella infections and vaccines as well as sera from blood donors, antenatal patients and patients whose sera contained rheumatoid factor and patients with acute non-rubella infections were tested by this method.

Public Health Laboratory Service IgM antibody capture enzyme linked immunosorbent assay for detecting rubella specific IgM

A total of 468 sera were selected for the evaluation of the Public Health Laboratory Service's IgM antibody capture enzyme linked immunosorbent assay kit (MACELISA) for detecting rubella specific IgM. The results obtained were compared with those obtained by IgM antibody capture radioimmunoassay (MACRIA). Sera from patients with primary postnatal rubella, congenital rubella, remote rubella, infectious mononucleosis, and recent infection with other agents were included, in addition to sera taken after rubella immunisation and sera containing rheumatoid factor and rubella specific IgG antibody. The assay exhibited a similar ability and comparable specificity to MACRIA for detecting rubella specific IgM antibody. The Public Health Laboratory Service MACELISA can be recommended if, as for all assays that detect rubella specific IgM, all the available clinical and serological data are taken into account when the results are interpreted.

Enzyme-linked immunosorbent assay for the detection of human rotavirus in stools

A simple method for the detection of human rotavirus in stools is described, using a double antibody sandwich enzyme-linked immunosorbent assay. Polysterene microtitre plates were used as solid phase. Four capture antibodies were tried, bovine, egg-derived, guinea pig and monoclonal antibody to rotavirus. Both bovine and egg-derived antirotavirus labelled with horseradish peroxidase were used as the detecting antibodies. The results obtained were compared with a commercially available ELISA, Rotazyme (Abbott Laboratories), and also with the direct detection of rotavirus by electron microscopy. Bovine antibody was found to be an unsuitable capture antibody due to non-specific false positive reactions.