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PubMed2003

Reliability of a modified medication appropriateness index in community pharmacies.

BACKGROUND: The medication appropriateness index (MAI) has demonstrated reliability in selected outpatient clinics where medical data were easily accessible from medical charts. However, its use in the community setting where patient data may be limited has not been examined. OBJECTIVE: To evaluate the usefulness of a modified MAI for use in the community pharmacy setting by testing interrater reliability using 3 different rating schemes. METHODS: Two raters evaluated 160 medications for 32 elderly ambulatory patients. Patient information was acquired using community pharmacist-collected medication histories. A summated MAI score, percent agreement, kappa, positive agreement, negative agreement, and intraclass correlation coefficient were calculated for each criterion using 3 scoring schemes. A paired samples t-test (95% CI) was used to test interrater reliability. RESULTS: The kappa statistics were >0.75 for indication and effectiveness, but good (0.41-0.66) for the remaining criteria using the Hanlon scoring scheme. The intraclass coefficients (0.82, 0.86, 0.87) and overall kappa (0.65, 0.66, 0.61) were similar for the 3 schemes. CONCLUSIONS: This study suggests that the modified MAI has the potential to detect medication appropriateness and inappropriateness in the community pharmacy setting; however, it is not without limitations. Because the MAI has the most clinimetric and psychometric data available, the instrument should be studied further to increase its reliability and generalizability.

Data Collection↗
PubMed2005

Prenatal detection of congenital renal malformations by fetal ultrasonographic examination: an analysis of 709,030 births in 12 European countries.

The study was performed to evaluate the prevalence of prenatal ultrasound diagnoses for renal anomalies in 20 registries of 12 European countries, and to compare the different prenatal scanning policies. Standardized data were acquired from 709,030 livebirths, stillbirths, and induced abortions during the study period of 2.5 years and transmitted for central analysis. At least one renal malformation was diagnosed in 1130 infants and fetuses. Prenatal diagnosis (PD) was given in 81.8% of all cases, 29% of these pregnancies were terminated. The highest detection rate was reported for unilateral multicystic dysplastic kidneys with 97% (102/105). An early diagnosis was documented for exstrophy of bladder at a mean gestational age of 18.5 weeks. Dilatations of the upper urinary tract were seen late in pregnancy at 28.3 weeks. Terminations of pregnancies (TOP) were performed in 67% (58/86) of the detected bilateral renal agenesis/dysgenesis, but only 4% of the unilateral multicystic dysplastic renal malformations (4/102). In about 1/3 of the cases, renal malformations are within the category of associated malformations, which include multiple non-syndromal malformations, chromosomal aberrations, and non-chromosomal syndromes. Renal malformations were detected in 2/3 of the associated category by the first prenatal ultrasound scan. Detection rates vary in the different countries of the European community due to diverse policies, ethical, and religious background. Countries with no routine ultrasound show the lowest rates in detection, and termination of pregnancy. Prenatally detected renal malformations should result in a careful examination for further anomalies. Prenatal ultrasound fulfills the needs of screening examinations and is a good tool in detecting lethal and severe renal malformations.

Congenital Abnormalities↗
PubMed2006

Pathological characteristics of prostate cancer detected through prostate specific antigen based screening.

PURPOSE: Since the introduction of PSA testing for CaP, there has been an increase in CaP detection. However, it is uncertain to what extent clinically insignificant tumors are being diagnosed and treated. In a large, community based population we determined the pathological characteristics of screening detected cancers. MATERIALS AND METHODS: From 1989 to 2001, 35,661 men were enrolled in a longitudinal prostate cancer screening study. Data were available on 3,492 of the 3,568 men (98%) diagnosed with CaP during this study period. Radical prostatectomy was performed in 2,254 men (63%). Clinical stage, Gleason score and pathological analysis were recorded and analyzed in the context of preoperative PSA, digital rectal examination findings, PSA velocity and the year of cancer detection. RESULTS: CaP was detected in 10% of men. Virtually all cases were clinically localized (99.8%) and approximately 70% treated with radical prostatectomy were pathologically organ confined disease. Fewer than 10% of tumors would be considered clinically insignificant based on 2 previously published pathological criteria. CONCLUSIONS: Compared to the high prevalence of CaP found in autopsy studies there is a lower detection rate using current screening protocols. Although the outcomes are unknown if these tumors had been left untreated, the majority met pathological criteria for significant cancer.

Adult↗
PubMed1999

Guidelines for carrying out leprosy elimination campaigns 1996. WHO, Action Programme for the Elimination of Leprosy.

A Leprosy Elimination Campaign (LEC) is an initiative which aims to detect leprosy cases, particularly the more serious ones referred to as 'cases of consequence', that remain undetected in the community, and to treat them with MDT. This will subsequently reduce the delay in managing such cases in the community and ensure that the existing health services are able to treat them. It is a time-bound, one-time activity. Leprosy of consequence is defined as cases with more than five skin lesions and skin smear positive cases. Such cases are regarded as being of consequence because they act as a major source of infection in the community and are either already disabled or at high risk of becoming disabled. LEC is a focused combination of activities which includes: orientation courses for local health workers and volunteers; community awareness creation activities; case-finding and treating every detected case immediately with MDT. These campaigns are to be carried out primarily in endemic regions where the prevalence and new case detections are high and where the gap between estimated and registered cases is large. It is a national activity, implemented by the national staff with technical cooperation from WHO and other agencies.

Drug Therapy, Combination↗
PubMed2000

Changes in bacterial community structure in the colon of pigs fed different experimental diets and after infection with Brachyspira hyodysenteriae.

Bacterial communities in the large intestines of pigs were compared using terminal restriction fragment length polymorphism (T-RFLP) analysis targeting the 16S ribosomal DNA. The pigs were fed different experimental diets based on either modified standard feed or cooked rice supplemented with dietary fibers. After feeding of the animals with the experimental diets for 2 weeks, differences in the bacterial community structure in the spiral colon were detected in the form of different profiles of terminal restriction fragments (T-RFs). Some of the T-RFs were universally distributed, i.e., they were found in all samples, while others varied in distribution and were related to specific diets. The reproducibility of the T-RFLP profiles between individual animals within the diet groups was high. In the control group, the profiles remained unchanged throughout the experiment and were similar between two independent but identical experiments. When the animals were experimentally infected with Brachyspira hyodysenteriae, causing swine dysentery, many of the T-RFs fluctuated, suggesting a destabilization of the microbial community.

Animals↗
PubMedDate not supplied

SAR11 clade dominates ocean surface bacterioplankton communities.

The most abundant class of bacterial ribosomal RNA genes detected in seawater DNA by gene cloning belongs to SAR11-an alpha-proteobacterial clade. Other than indications of their prevalence in seawater, little is known about these organisms. Here we report quantitative measurements of the cellular abundance of the SAR11 clade in northwestern Sargasso Sea waters to 3,000 m and in Oregon coastal surface waters. On average, the SAR11 clade accounts for a third of the cells present in surface waters and nearly a fifth of the cells present in the mesopelagic zone. In some regions, members of the SAR11 clade represent as much as 50% of the total surface microbial community and 25% of the subeuphotic microbial community. By extrapolation, we estimate that globally there are 2.4 x 10(28) SAR11 cells in the oceans, half of which are located in the euphotic zone. Although the biogeochemical role of the SAR11 clade remains uncertain, these data support the conclusion that this microbial group is among the most successful organisms on Earth.

Alphaproteobacteria↗
PubMed2005

Influence of different Oryza cultivars on expression of nifH gene pools in roots of rice.

Cultivation-independent studies suggest that roots of rice (Oryza sativa) are colonized by a diverse community of nitrogen-fixing bacteria. Here we report for the first time mRNA-based profiling of nitrogenase (nifH) genes, to study the impact of lowland-rice genotypes at the cultivar level on the functional diversity of root-associated diazotrophs. Root RNA extracts from all plants contained nifH mRNA at levels detectable by reverse transcription polymerase chain reaction (RT-PCR). Terminal restriction fragment length polymorphism (T-RFLP) analysis of RT-PCR products showed only small interplant variations. However, RNA- and DNA-based profiles obtained from the same root extractions differed from each other, suggesting that presence of diazotrophs did not necessarily coincide with active transcription of nif genes. Application of N-fertilizer at planting had a long-term effect on the profile of expressed nitrogenase genes. Phylogenetic analysis of a clone library constructed for nifH fragments expressed in wild species of rice roots indicated that active diazotrophs were not related to cultured strains. The composition of active diazotrophic communities was compared for six related cultivars of O. sativa, wild species Oryza brachyantha, and a genetic cross between it and cv. IR56, grown under identical conditions in rice field soil in the Philippines without N-fertilizer application. Remarkable varietal differences in root associated nifH-gene expressing communities were detected. This underlines the importance of mRNA-based approaches to study functional diversity and eventually identify key diazotrophs in a particular environment.

Bacteria↗
PubMed1993

Is the medical community ready for worker notification?

Although the potential for early detection of disease has been of central importance in the evolution of worker notification policy and practice, it is not the only positive outcome of medical intervention. The provider-patient encounter also creates an important opportunity for patient-centered risk communication that may result in workplace modifications as well as lifestyle changes to reduce the likelihood of subsequent illness and injury--both work and nonwork related. At the same time, it may signal the beginning of a series of social, legal, and political actions that may have positive or negative consequences for notified workers. This article identifies several important roles for members of the medical community relating to worker and community notification programs and explores the readiness of health care professionals in assuming these roles. It is suggested that health care providers lack both the training and sociopolitical sensitivity needed for meaningful participation in the notification process. This article addresses possible short-term and long-term approaches to enhancing the readiness of health care providers and suggests that effective intervention with notified workers requires a willingness to step beyond the confines of the medical model.

Communication↗
PubMed2004

Neuropsychosocial features of very mild Alzheimer's disease (CDR 0.5) and progression to dementia in a community: the Tajiri project.

The borderline condition between normal aging and dementia should be detected to predict further deterioration. The authors cross-sectionally analyzed neuropsychological data, memory complaints, and social activities for community-dwelling older adults. The rate of decline from Clinical Dementia Rating (CDR) 0.5 to dementia during a 3-year interval was also analyzed. Short-term memory rather than long-term memory was found to be sensitive in distinguishing those with CDR 0 from those with CDR 0.5. Relatives' observations of memory decline rather than subjective memory complaints were significantly different. Participants with CDR 0.5 reported fewer problems with social activities than did their relatives. Ten of the 29 CDR 0.5 participants (34.5%) showed cognitive decline, the decliners showing lower scores on short-term memory and orientation at the baseline condition. The neuropsychological data showed CDR 0.5 to be similar to very mild Alzheimer's disease. It would be better if subjective complaints were excluded from the criteria of the borderline condition.

Aged↗
PubMedDate not supplied

Simultaneous nosocomial and community outbreak of epidemic keratoconjunctivitis with types 8 and 19 adenovirus.

In a simultaneous community and nosocomial (hospital-based) epidemic of keratoconjunctivitis lasting one year, 97 patients had clinical findings characteristic of EKC. Seventy-one percent of the cases were confirmed by laboratory tests including viral isolation, antibody response detected by complement fixation and hemagglutination inhibition tests, or immunofluorescent detection of adenovirus antigen in conjunctival scrapings. The community epidemic was a mixed adenovirus type 19 and type 8 outbreak. The nosocomial outbreak was due primarily to adenovirus type 8 (91%). The epidemiologic data of the nosocomial epidemic were representative of the population involved. The community outbreak was primarily in young individuals between 11 and 40 years of age. The secondary household attack rates were 20% and essentially were equal in both epidemics. The primary mode of spread in the nosocomial outbreak was by contamination of the examiner's fingers. In the community epidemic the mode of spread was believed to be close personal contact in a young and active age group.

Adenoviridae Infections↗
PubMed2000

Findings from 752,081 clinical breast examinations reported to a national screening program from 1995 through 1998.

BACKGROUND AND METHODS: Mammography programs have received extensive study, but little is known about the outcome of clinical breast examinations (CBEs) performed in community settings. Consequently, we analyzed data from the National Breast and Cervical Cancer Early Detection Program on CBEs provided to low-income women from 1995 through 1998 and determined the percentage of CBEs considered to be abnormal, suspicious for cancer; the rates of cancer detection; and the sensitivity, specificity, and positive predictive value of CBEs. RESULTS: We analyzed data from 752081 CBEs and found that 6.9% of all CBEs were coded abnormal, suspicious for cancer, and that 5.0 cancers were detected per 1000 examinations (95% confidence interval [CI] = 4.9-5.2). The values observed for sensitivity (58.8%) and specificity (93.4%) were comparable to those reported for the CBE component of clinical trials. The observed positive predictive value was 4.3%. About 74% of all records also reported mammography results. The cancer-detection rate among records reporting an abnormal CBE and normal mammography was 7.4 cancers per 1000 records (95% CI = 6. 3-8.4). When the CBE was normal but the mammography was abnormal, the rate was 42.0 cancers per 1000 records (95% CI = 39.9-44.1). When both CBE and mammography results were abnormal, the rate was 170.3 cancers per 1000 records (95% CI = 162.7-177.9). Cancer detection could not be attributed entirely to CBE or mammography on 38% of the records in the latter subset because the tests were performed on the same day. CONCLUSION: CBEs performed in community-based screening programs can detect breast cancers as effectively as CBEs performed in clinical trials and may modestly improve early-detection campaigns.

Adult↗
PubMed1996

Establishing a reliable visual function test and applying it to screening optic nerve disease in onchocercal communities.

The computer Controlled Video Perimetry (CCVP) is a computer screening test for detecting visual function loss caused by onchocerciasis, glaucoma, etc. Installed on portable computers, the CCVP has been shown to be high acceptability in field community investigation. However, it is regarded to be difficult in obtaining reliable results from portable computer screening tests because of human behavioural variants and the lack of standard testing environment. In this paper, we propose an architecture for implementing a more reliable CCVP system. In particular, a self-organising neural network is applied to manage measurement noise caused by behavioural factors. A control unit is introduced to manage the overall behaviour of the system. The integrated test system has been used to screen optic nerve disease in onchocercal communities of rural Nigeria and the experimental results obtained from a large number of test records are very encouraging: reliable results from volatile test environments may be obtained using the proposed method.

Artifacts↗
PubMed2006

Determination of fluoroquinolones in milk samples by postcolumn derivatization liquid chromatography with luminescence detection.

A liquid chromatography (LC) method with luminescence detection for the determination of eight quinolone antibiotics is reported. The system encompasses three consecutive steps: (a) chromatographic separation using reverse-phase mode (RP-LC), (b) postcolumn derivatization reaction, and (c) luminescence detection by monitoring fluorescence (FL) and time-resolved (TR) signals. The derivatization step is based on the reaction between quinolones and terbium(III) to form luminescent chelates, which were determined at lambda(ex) 340 and lambda(em) 545 nm (FL mode) or at lambda(ex) 281 and lambda(em) 545 nm (TR mode). Dynamic ranges of the calibration graphs, obtained with standard solutions of analytes and FL and TR modes, respectively, were 190-3500 and 316-2000 ng mL-1 for marbofloxacin, 8-3500 and 8.1-1500 ng mL-1 for ciprofloxacin, 6.2-3500 and 13-1500 ng mL-1 for danofloxacin, 7.4-3500 and 8.4-1500 ng mL-1 for enrofloxacin, 14-3500 and 20-2000 ng mL-1 for sarafloxacin, 12.5-3500 and 13.9-1200 ng mL-1 for difloxacin, 7.6-3500 and 13-3000 ng mL-1 for oxolinic acid, and 9-2000 and 130-3000 ng mL-1 for flumequine. Limit of detection values obtained using FL and TR modes, respectively, were 60 and 95 ng mL-1 for marbofloxacin, 2 and 2.4 ng mL-1 for ciprofloxacin, 1.9 and 3.9 ng mL-1 for danofloxacin, 2.2 and 2.5 ng mL-1 for enrofloxacin, 3.8 and 7 ng mL-1 for sarafloxacin, 4 and 4.2 ng mL-1 for difloxacin, 2.3 and 4 ng mL-1 for oxolinic acid, and 2.7 and 40 ng mL-1 for flumequine. The precision was established at two concentration levels of each analyte and expressed as the percentage of relative standard deviation with values ranging between 1.9 and 7.8%. The validation procedure for the analysis of samples was carried out using European Community recommendations, and the decision limit and detection capability were calculated for bovine whole milk. The method was applied to whole, semiskimmed, and skimmed milk samples spiked with the target analytes, and the recoveries ranged between 93.3 and 106.0%.

Animals↗
PubMed2004

Using the Strengths and Difficulties Questionnaire (SDQ) multi-informant algorithm to screen looked-after children for psychiatric disorders.

BACKGROUND: Child psychiatric disorders are common among children in foster and residential care, but often go undetected and therefore untreated. AIMS: To assess the Strengths and Difficulties Questionnaire (SDQ) as a potential means for improving the detection of child psychiatric disorders in the community. METHOD: SDQ predictions and independent psychiatric diagnoses were compared in a community sample of 1,028 looked-after 5-17 year olds from a nationwide English survey. RESULTS: Multi-informant SDQs (parents, teachers, older children) identified individuals with a psychiatric diagnosis with a specificity of 80 % and a sensitivity of 85%. The SDQ prediction works best when SDQs have been completed by both carers and teachers. When it is only possible to have one adult informant, carers and teachers provide information of roughly equal predictive value. By contrast, self-reports by 11-17 year olds provide little extra information when there is already an adult informant. CONCLUSION: Using multi-informant SDQs as a regular screening measure for looked-after children could potentially increase the detection of child psychiatric disorders, thereby improving access to effective treatments.

Adolescent↗
PubMed1995

Assessing the side-effects of antipsychotic drugs: a survey of CPN practice.

The provision of community-based care for people with serious and enduring mental health problems requires an approach that combines drug therapy, psychological interventions and skills training. Mental health nurses are being required to place more emphasis on their work with this client group. It has been suggested that community psychiatric nurses (CPNs) will require training in appropriate skills to work with the seriously mentally ill. While the training of CPNs to use psychological intervention strategies has received limited attention, the area of medication management, including the detection of side-effects, is relatively unexplored. Community psychiatric nurses' practice with clients on antipsychotic medication was investigated. This paper reports selected findings on the assessment of medication side-effects and CPNs' attitude to this aspect of their role. Fifty CPNs in three health districts completed a self-administered questionnaire. The results showed that the CPNs were supervising the medication of large numbers of clients. They reported that their training had adequately prepared them to assess clients for medication side-effects and that this was being done frequently. They also felt that their reports of side-effects influence the prescribers' decisions on medication when clients are reviewed. However, the data also suggested that CPNs were only monitoring their clients for three to four side-effects and that they held an unfavourable attitude towards their involvement with medication.

Antipsychotic Agents↗
PubMed1990

Early detection and control of cancer in clinical practice.

As part of the Community Cancer Care Evaluation, a random-sample survey of practicing physicians in 12 geographic areas was conducted in 1985 to provide information about physician practice patterns with reference to cancer detection, control, and treatment. All respondents were asked whether they routinely performed comprehensive physical examinations, breast palpations, mammography, rectal examinations, chest roentgenography, and stool guaiac examinations on normal healthy patients older than 50 years. Responses were examined in terms of American Cancer Society and National Cancer Institute (Bethesda, Md) recommendations. Conformity with recommendations was dependent on the geographic area, the specific procedure, and the specialty of the physician. Across all procedures, frequency of performance varied with years since graduation from medical school, with more recent graduates more likely to conform to recommended standards.

Adult↗
PubMed2007

Monitoring the effect of chemicals on biological communities. The biofilm as an interface.

Biofilms can be regarded as early warning systems for detection of the effects of toxicants on aquatic systems, because they have been successfully used for detection of other environmental stressors (e.g. pH, salinity, organic pollution). A variety of methods is used for detection of the effects of toxicants by use of biofilms. The methods range from structurally-based to functionally-based, and from in vitro-based to systemic approaches. Physiological approaches may be appropriate for detection of acute effects. Among these methods, photosynthesis is more related to the effect of toxicants affecting algal communities, directly or indirectly, and extracellular enzyme activity is less specific. Selecting one or the other may depend on the suspected direct effect of the toxicant. Integrated studies have revealed the relevance of toxicants to top-down or bottom-up regulation of the biofilm community. Persistent or chronic effects should affect other biofilm indicators, for example growth or biomass-related factors (e.g. chlorophyll), or community composition. Among these, community composition might better reflect the effects of the toxicant(s), because this may cause a shift from a sensitive to a progressively tolerant community. Community composition-based approaches do not usually adequately reflect cause-effect relationships and require complementary analysis of properties affected in the short-term, for example physiological properties. The current array of methods available must be wisely combined to disentangle the effects of chemicals on biofilms, and whether these effects are transient or persistent, to successfully translate the chemical action of toxicants into the effect they might have on the river ecosystem.

Animals↗
PubMed1990

Prevalence and diagnosis of Legionella pneumonia: a 3-year prospective study with emphasis on application of urinary antigen detection.

During a 3-year period the frequency of legionellosis in hospitalized patients with community-acquired and nosocomial pneumonias was 3.4% (23/684 cases) and 5.9% (33/559), respectively. Of the diagnostic tests evaluated, detection of Legionella pneumophila serogroup 1 antigen in urine had the highest sensitivity, with 86% of culture-proven cases being positive. Sensitivities of serologic tests and examination of respiratory secretions (culture and direct immunofluorescence) were 36% and 26%, respectively. The diagnostic value of serology and of examination of respiratory secretions can be low when specimens are obtained and processed under the typical conditions of hospitalization. Urinary antigen detection represents an important diagnostic addition, and examination of postmortem lung tissue from fatal cases with pneumonia is an important adjunct for estimating the prevalence of legionellosis and for assessing the effectiveness of premortem diagnostic tests.

Antibodies, Bacterial↗