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Antigen Testing (antigen + testing)
Kinds of Antigen Testing Selected AbstractsA systematic review on communicating with patients about evidenceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2006Lyndal J Trevena MBBS (Hons) MPhilPH Abstract Objective, To conduct a systematic search for (1) the effectiveness of evidence-based communication tools to increase patient understanding of evidence, (2) effective formats for representing probabilistic information and (3) effective strategies for eliciting patient preferences about evidence. A case scenario is used to illustrate some of the difficulties of putting these results into practice., ,Data sources, Systematic search of The Cochrane Library, Medline, Psychinfo, Embase and Cancerlit. Review methods, Systematic reviews of randomized controlled trials (RCTs) and high quality RCTs were included. Studies were excluded if they did not address the question, were focused on behavioural outcomes without attempting to increase understanding, were concerned with counselling as a therapeutic intervention, or were specific to communication regarding clinical trial participation., ,Results, We found 10 systematic reviews of RCTs and 30 additional RCTs addressing our questions. Communication tools in most formats (verbal, written, video, provider-delivered, computer-based) will increase patients' understanding but are more likely to do so if structured, tailored and/or interactive. Probabilistic information is best represented as event rates (natural frequencies) in relevant groups of people, rather than words, probabilities or summarized as effect measures such as relative risk reduction. Illustrations such as cartoons, or graphs (vertical bar charts) appear to aid understanding. Values clarification exercises may be better than standard utility techniques for eliciting preferences in individual decision making. Looking for effective evidence-based communication tools for prostatic specific antigen testing highlighted the challenges for clinicians and consumers in accessing tools that are evidence-based in design as well as content. Conclusion, There is an increasing body of evidence supporting the design of effective evidence-based communication tools but variable access to such tools in practice. [source] Role of ,atypical pathogens' among adult hospitalized patients with community-acquired pneumoniaRESPIROLOGY, Issue 8 2009Grace LUI ABSTRACT Background and objective: Agents such as Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila are recognized as important causes of community-acquired pneumonia (CAP) worldwide. This study examined the role of these ,atypical pathogens' (AP) among adult hospitalized patients with CAP. Methods: A prospective, observational study of consecutive adult CAP (clinico-radiological diagnosis) patients hospitalized during 2004,2005 was conducted. Causal organisms were determined using cultures, antigen testing and paired serology. Clinical/laboratory/radiological variables and outcomes were compared between different aetiologies, and a clinical prediction rule for AP was constructed. Results: There were 1193 patients studied (mean age 70.8 ± 18.0 years, men 59.3%). Causal organisms were identified in 468 (39.2%) patients: ,bacterial' (48.7%), ,viral' (26.9%), ,AP' (28.6%). The AP infections comprised Mycoplasma or Chlamydophila pneumoniae (97.8%) and co-infection with bacteria/virus (30.6%). The majority of AP infections involved elderly patients (63.4%) with comorbidities (41.8%), and more than one-third of patients were classified as ,intermediate' or ,high' risk CAP on presentation (pneumonia severity index IV,V (35.1%); CURB-65 2,5 (42.5%)). Patients with AP infections had disease severities and outcomes similar to patients with CAP due to other organisms (oxygen therapy 29.1% vs 29.8%; non-invasive ventilation 3.7% vs 3.3%; admission to the intensive care unit 4.5% vs 2.7%; length of hospitalization 6 day vs 7 day; 30-day mortality: 2.2% vs 6.0%; overall P > 0.05). Age <65 years, female gender, fever ,38.0°C, respiratory rate <25/min, pulse rate <100/min, serum sodium >130 mmol/L, leucocyte count <11 × 109/L and Hb < 11 g/dL were features associated with AP infection, but the derived prediction rule failed to reliably discriminate CAP caused by AP from bacterial CAP (area under the curve 0.75). Conclusions: M. pneumoniae and C. pneumoniae as single/co-pathogens are important causes of severe pneumonia among older adults. No reliable clinical indicators exist, so empirical antibiotic coverage for hospitalized CAP patients may need to be considered. [source] Prostate-specific antigen testing: uncovering primary care influencesBJU INTERNATIONAL, Issue 5 2006Gerard J. Gormley OBJECTIVES To examine influences on the behaviour of General Practitioner (GP) in relation to prostate-specific antigen (PSA) testing. SUBJECTS AND METHODS In Northern Ireland in 2003,2004, all GPs (1067) were invited to complete a self-administered postal questionnaire survey that was then matched with a regional PSA-testing database. The main outcome measures were individual GP responses for demographic, practice and training characteristics, PSA testing behaviour and perceived influences, matched against GP-initiated first PSA tests performed in 2003 and 2004 (22 207 tests). RESULTS In all, 704 GPs (66%) responded and 49% of these reported awareness of the national guidelines, which was highest among those attending postgraduate meetings. PSA tests were more likely to be ordered by full-time male GPs who had attended a local postgraduate urology meeting; ran a ,well-man' clinic; tested men with unrelated complaints; and were not in a training practice. Testing levels were highest among GPs who had been practising for 21,30 years and those in rural practices. Awareness of national guidelines or having had a postgraduate post in urology did not affect testing behaviour. After adjusting for gender, working hours, duration in practice and urban/rural setting, independent influences increasing testing behaviour were: testing men with a positive family history or unrelated complaints; testing any man who requests it; and previous experience of prostate cancer being detected in an asymptomatic patient by PSA testing. Working in an accredited training practice was associated with lower testing levels. CONCLUSION There are complex influences on the PSA testing behaviour of GPs; addressing these influences could contribute to the rationalization of testing. A low awareness of national guidelines indicates a need for new strategies to disseminate and implement guidelines. The influence of local educational meetings on PSA testing is an unharnessed force. [source] Measuring the psychosocial impact of population-based prostate-specific antigen testing for prostate cancer in the UKBJU INTERNATIONAL, Issue 4 2006Lucy A. Brindle OBJECTIVE To evaluate the psychosocial impact of participation in a population-based prostate-specific antigen (PSA) testing programme, akin to screening, and to explore the relationship between urinary symptoms reported before PSA testing and the response to the subsequent PSA result. PATIENTS AND METHODS This prospective questionnaire study was nested within the case-finding component of the ProtecT (prostate testing for cancer and treatment) feasibility study (ISRCTN20141297). Men aged 50,69 years from 18 general practices in three cities in the UK completed the Hospital Anxiety and Depression Scale (HADS), the Short Form-12 (SF-12) Health Survey, and the International Continence Society ,male' (ICSmale) questionnaires before giving consent for a PSA test in a community clinic (baseline). Men with an ,abnormal' PSA result returned for further investigation (including biopsy) and repeated these questionnaires before biopsy. RESULTS At baseline, study participants had similar levels of anxiety and depression to the general male population. There was no increase in the HADS scores, or reduction in the SF-12 mental health component summary score, on attendance at the biopsy clinic after receiving an ,abnormal' PSA result. Urinary symptoms were associated with levels of anxiety and depression before receiving a PSA result (baseline), but were not associated with anxiety and depression at biopsy independently of baseline scores. Therefore changes in anxiety or depression at biopsy did not appear to differ between those with and without urinary symptoms. CONCLUSIONS This study confirms the findings of other studies that the deleterious effects of receiving an abnormal PSA result during population screening are not identified by generic health-status questionnaires. Comparisons with outcomes of studies measuring cancer-specific distress and using qualitative research methods raise the question of whether a prostate cancer screening-specific instrument is required. However, a standardized measure of anxiety identified differences at baseline between those who did and did not report urinary symptoms. These findings suggest that it might be advisable to better inform men undergoing PSA testing about the uncertain relationship between urinary symptoms and prostate cancer, to minimize baseline levels of psychological distress. [source] Recent trends in the use of radical prostatectomy in England: the epidemiology of diffusionBJU INTERNATIONAL, Issue 4 2003S.E. Oliver OBJECTIVE To describe recent trends in the use of radical prostatectomy (RP) in England, as there is currently no consensus on the most effective treatment for localized prostate cancer, although RP is the treatment of choice among urological surgeons for men aged < 70 years. METHODS Routine data were assessed to establish the number of RPs performed in England in 1991,99. Age-standardized operation rates were compared by region and socio-economic group, and the geographical spread of use mapped. RESULTS The number of RPs performed annually increased nearly 20-fold between 1991 and 1999. Rates of surgery were greatest in the London National Health Service (NHS) regions and lowest in the Trent region. Outside London, the risk of surgery in a NHS hospital was significantly greater for men living in the least deprived areas; in London this trend was reversed. CONCLUSION Rapid increases in the use of RP showed marked regional variations, most likely related to access to prostate-specific antigen testing and the location of surgeons able to carry out radical surgery. By 1999, a third of procedures were still being undertaken in ,low-volume' hospitals, with implications for the quality of care and outcomes. Crucially, these developments occurred in the absence of robust information about the effectiveness of RP. Recent funding of a randomized trial of treatment options in this area is welcome, but wider questions remain about the timing of the evaluation of surgical technologies. [source] Correlates of screening sigmoidoscopy use among men in a large nonprofit health planCANCER, Issue 2 2007Reina Haque PhD Abstract BACKGROUND. As the majority of patients diagnosed with colorectal cancer have no known risk factors, regular screening is strongly recommended. The authors examined factors associated with screening sigmoidoscopy use among participants in the California Men's Health Study (CMHS). METHODS. The authors conducted a cross-sectional study over a 5-year period nested within a prospective cohort study. The CMHS enrolled a large multiethnic cohort (n = 84,170) of men from 2 major California health plans. Because screening sigmoidoscopy was the preferred and most commonly used test for patients at average risk of colorectal cancer in the health plans, the authors excluded from the analysis men who completed a barium enema colonoscopy or a fecal occult blood test. RESULTS. Eligible subjects included 39,559 men at average risk for colorectal cancer. Prevalence of screening sigmoidoscopy use decreased with older age and increased with higher education and household income over the 5-year study period. Compared with whites, Asians (adjusted OR, 1.42; 95% CI, 1.30,1.56) and African Americans (adjusted OR, 1.18; 95% CI, 1.08,1.29) were more likely to undergo screening sigmoidoscopy. Screening increased with the number of outpatient visits and with having a primary care provider in internal medicine. Men who did not undergo prostate-specific antigen testing were also less likely to undergo sigmoidoscopy screening. Only 24.5% of current smokers had a screening sigmoidoscopy examination and were 25% less likely to undergo this procedure compared with nonsmokers (adjusted OR, 0.75; 95% CI, 0.69,0.82). CONCLUSIONS. In this insured population for whom financial barriers are minimized, screening sigmoidoscopy use was as low as reported in the general population. However, minority patients were not less likely to be screened. Cancer 2007. © 2007 American Cancer Society. [source] Patterns of care for men with prostate cancer after failure of primary treatmentCANCER, Issue 2 2006Tracey L. Krupski MD Abstract BACKGROUND. This study sought to determine trends in patterns of care after failure of primary prostate cancer treatment and to determine whether nonclinical factors influenced the receipt of secondary treatment. METHODS. The authors identified individuals treated for nonmetastatic prostate cancer in the years 1991,1999 from the linked databases of Medicare and the National Cancer Institute's Surveillance, Epidemiology, and End Results registry. The outcome of interest was receipt of secondary therapy. They performed Cox proportional hazard analyses to investigate the link between demographic and clinical characteristics and the likelihood of receiving secondary treatment after either surgery or radiation. RESULTS. Of 65,716 subjects who met our inclusion criteria, 10,200 (15%) received some form of secondary therapy. For men undergoing initial surgical or radiation therapy, tumor grade, year of diagnosis, and geographic region were associated with secondary therapy. No socioeconomic factors such as education, ethnicity, or income level were associated with secondary therapy. CONCLUSIONS. Patterns of care after primary prostate cancer therapy continue to vary regionally. Standardized clinical algorithms and utilization of prostate-specific antigen testing appear to have influenced secondary therapy rates. Cancer 2006. © 2006 American Cancer Society. [source] A population-based survey of prostate-specific antigen testing among California men at higher risk for prostate carcinomaCANCER, Issue 4 2006Benjamin A. Spencer M.D., M.P.H. Abstract BACKGROUND Despite the lack of evidence demonstrating a survival benefit from prostate-specific antigen (PSA) screening, its use has become widespread, organizations have encouraged physicians to discuss early detection of prostate carcinoma, and two higher risk groups have been recognized. In the current study, the authors examined whether African-American men and men who had a family history of prostate carcinoma underwent PSA testing preferentially, and patterns of test use were examined according to age, race, and other factors. METHODS Data regarding self-reported PSA test use in the past year among men age 50 years and older without a history of prostate carcinoma (n = 8713 men) were analyzed from the 2001 California Health Interview Survey. RESULTS The overall rate of PSA use was 43.0%. Older age, higher socioeconomic status, having a usual source of healthcare, and a family history of prostate carcinoma were the strongest predictors of testing. Higher risk African-American men age 50 years and older were no more likely to be tested than white men. Men at higher risk who had a family history of prostate carcinoma were more likely to have been tested than men who had no such family history. CONCLUSIONS Rates of PSA use among higher risk men who had a family history of prostate carcinoma were higher compared with the rates among men without such a family history. However, PSA testing rates among higher risk African-American men were no different than the rates among lower risk white men, suggesting that some risk factors for prostate carcinoma (but not others) are associated with preferential testing. Testing in all groups was associated with access to care variables, highlighting the importance of removing barriers to preventive healthcare services. Cancer 2006. © 2006 American Cancer Society. [source] Cytomegalovirus transmission to extremely low-birthweight infants through breast milkACTA PAEDIATRICA, Issue 1 2005S. Doctor Abstract Aim: To determine the incidence, timing and clinical significance of acquired postnatal cytomegalovirus (CMV) in extremely low-birthweight (ELBW) infants. Methods: Prospective, longitudinal surveillance study. ELBW infants were recruited in the first week of life. Maternal blood was tested for CMV-specific IgG antibodies. Weekly urine samples were obtained from infants for CMV culture and rapid antigen testing. Data were collected regarding clinical course and breast milk intake. Results: Of 181 eligible infants, 119 infants, born to 101 mothers, were enrolled. Eighty of the 101 mothers had their serum checked for CMV status. Seventy percent of those tested were seropositive for CMV. Of the 65 infants born to seropositive mothers, 94% received breast milk during their hospital stay. Complete urine collection was obtained in 92 infants. CMV was cultured from the urine of only four infants, all of whom were born to seropositive mothers. Only one of these four infants was symptomatic. The range at which CMV was first detected was between 48 and 72 postnatal days of age. Conclusions: Despite a very high CMV seropositivity rate in mothers of ELBW infants, and the previously reported high rate of CMV excretion into breast milk, the incidence of postnatal CMV transmission was extremely low in our study. [source] | ||||||||||