Change of pathology request forms can reduce unwanted requests and tests

BACKGROUND: Developments in clinical and laboratory medical practice have resulted in a large increase in laboratory workload, with considerable financial implications. It has been shown that the design of laboratory request cards can influence patterns of test ordering and possibly reduce inappropriate requests. AIMS/METHODS: To redesign pathology request cards with a view to reducing inappropriate test requesting. RESULTS: A redesign of the request cards used by general practitioners in the Bradford area led to a significant reduction in the ordering of specific investigations. CONCLUSIONS: The redesigning of pathology request cards can have a beneficial effect on test requesting.     

Identifying sputum specimens of high priority for examination by enhanced mycobacterial detection, identification, and susceptibility systems (EMDISS) to promote the rapid diagnosis of infectious pulmonary tuberculosis

AIMS: To compare clinical information and sputum microscopy as methods for the selection of samples for enhanced mycobacterial detection, identification, and susceptibility systems (EMDISS) to promote the rapid diagnosis of patients with infectious pulmonary tuberculosis. METHODS: Two thousand, two hundred and sixty four specimen request forms were examined for clinical details, which were then used to identify specimens likely to yield Mycobacterium tuberculosis on culture. These results were compared with the results of sputum microscopy for acid fast bacilli (AFB). Both methods were assessed against the results of culture using a combination of continuous automated mycobacterial liquid culture (CAMLiC) and conventional solid culture. RESULTS: Classification based on clinical details was an inefficient method of identifying high priority specimens for EMDISS. Although, when given, clinical details were often consistent, a substantial proportion of specimens arrived with no details. This approach would result in the referral of at least 16% of the workload but lead to the detection by culture of only 46% of the M tuberculosis present within it. In contrast, microscopy for AFB defined a much smaller number of specimens (4.8% of the total), which contained 90% of the M tuberculosis isolates. CONCLUSIONS: Microscopy for AFB is the most efficient method for defining sputum specimens suitable for referral for enhanced mycobacteriological techniques. However, it is essential that the methods used for smear preparation and microscopy are of the highest possible standard, otherwise some patients with infectious pulmonary tuberculosis will be denied, unnecessarily, the benefits of important advances in mycobacteriology.     

Punch card data processing in haematology

A method of processing haematological laboratory data based on the IBM 870 system is described. As the cards are being punched with the identification particulars of the patient and source of the sample, a worksheet is automatically generated on which the tests are indicated. The results of the laboratory tests are recorded by the technician on the worksheet and reproduced on the punch cards which are subsequently used for the automatic printout of the results on self-adhesive preprinted labels. The resulting report is clear and legible and is transferred onto the request/report document.The data processing is carried out by clerk/typists who have been trained as punch card operators. The present workload of approximately 2,000 items of information obtained from some 170 samples per day is handled by one punch card operator in less than three hours. The punch cards are manipulated in a sorter for quality control purposes and are stored for subsequent retrieval of information.     

Automated measurement of arterial pressure in patients by use of a digital computer

A digital computer system has been developed for clinical use to repetivively measure intra-arterial pressure. Measurements are taken and reported at intervals of 5 min or more frequently. Summary reports are generated on request and a complete set of data is recorded on punched cards. The system has been used to monitor arterial pressure in over 160 patients in the Shock Research Unit of the University of Southern California at the Los Angeles County Hospital.     

Responses to reprint requests: form letters versus preprinted cards

Nine hundred ninety-four reprint requests were made for almost all the original articles that appeared in five pediatric journals between August and October in 1985, 1986, and 1987. Half of the reprint requests were made with form letters and the other half with preprinted cards. A total of 636 (64%) reprints were received within 6 months of mailing the request. The return rates for reprints solicited by form letters and preprinted cards were 68% and 60%, respectively. The response to reprint requests was greater for more recent articles. The number of articles that came in the form of photocopies was directly proportional to the time interval between the publication and the reprint request. Forty-one requests (4.1%) were returned by the authors because their reprint supply was exhausted. Thirty-eight requests (3.8%) were returned undelivered. We conclude that letter requests solicit a slightly better response than card requests and that the response is greater for more recent articles.     

Interviewing Preschoolers From Low- and Middle-SES Communities: A Test of the Narrative Elaboration Recall Improvement Technique

Tested the effectiveness of Narrative Elaboration (NE), a memory enhancement and interview preparation technique, with 99 preschool children from middle- and low-socioeconomic status (SES) communities. Half were trained with the NE intervention to utilize generic visual cue cards to provide forensically relevant details within four information categories: participants, settings, actions, conversation. One day after the NE training, interviewers asked participants to recount an event staged 1 week earlier. Analyses revealed that NE-trained children from both SES levels recalled significantly more about the event than control children, without producing more errors, particularly when given an opportunity to elaborate on initial free recall using the visual cue cards. No such difference in free recall alone was found. Additionally, preschoolers from low-SES communities generated more errors than their middle-SES counterparts, regardless of treatment condition.     

Use of a digital computer to produce a psychological test— Rabbitt's test of selective attention

Summary A PDP-8/S digital computer has been used to produce a psychological test—Rabbitt's test of selective attention —which consists of packs of cards with varying numbers of letters, some of which are classified as relevant and some as irrelevant. Central processing ability is assessed by timing the sorting of the cards on the basis of the relevant information, the irrelevant information being ignored. The program both chooses and positions the symbols randomly and the prints the card face on its Teletype output. A flow diagram of the program and details of the random number generator are described. The use of the computer for this purpose has reduced the time taken to produce one pack of cards by a factor of at least 10. Further developments of the technique are discussed.     

The effects of interference on verbal learning in multiple sclerosis.

Thirty multiple sclerosis (MS) patients were compared with 30 matched (age and education) controls and were asked to learn and recall 20 target words that were placed among 24 distracter words. Targets and distracters were printed on different colored cards, and the subjects were asked to read each word aloud and recall the target words. This task was repeated four times. The MS patients recalled significantly fewer words across the four trials. A second list without distracters was presented for two trials, and there were no significant differences between the groups' recall. Subsequent recall (short delay and long delay) for List 1 revealed significantly poorer recall for the MS group and significantly poorer cued recall but not recognition memory. Retrieval processes were implicated such as source memory, or contextual stamping, rather than encoding mechanisms.     

Lossless medical image compression by multilevel decomposition

Lossless image coding is important for medical image compression because any information loss or error caused by the image compression process could affect clinical diagnostic decisions. This paper proposes a lossless compression algorithm for application to medical images that have high spatial correlation. The proposed image compression algorithm uses a multilevel decomposition scheme in conjunction with prediction and classification. In this algorithm, an image is divided into four subimages by subsampling. One subimage is used as a reference to predict the other three subimages. The prediction errors of the three subimages are classified into two or three groups by the characteristics of the reference subimage, and the classified prediction errors are encoded by entropy coding with corresponding code words. These subsampling and classified entropy coding procedures are repeated on the reference subimage in each level, and the reference subimage in the last repetition is encoded by conventional differential pulse code modulation and entropy coding. To verify this proposed algorithm, it was applied to several chest radiographs and computed tomography and magnetic resonance images, and the results were compared with those from well-known lossless compression algorithms.     

Handling information in general practice—using feature cards with computers

A two-tier system of handling information has been developed for use in general practice. Punched feature cards, with the conventional patients' record cards are used for the handling of primary data in the doctor's surgery. At the same time the feature cards provide an input to the computer using a feature card reader, converter, and paper-tape punch. This is especially useful where information has to be collected together centrally, for more advanced statistical analysis and where multiple searches of individual feature cards are required.     

Cytomegalovirus DNA detection in Guthrie cards: a powerful tool for diagnosing congenital infection.

BACKGROUND: A simple and reliable diagnosis of congenital cytomegalovirus infection is necessary both for clinical and epidemiological purposes. This could be accomplished through the demonstration of cytomegalovirus (CMV) DNA in blood spots (DBS) on Guthrie cards. OBJECTIVES: (1) To assess the sensitivity and specificity of the method (DBS test) in diagnosing congenital CMV infection compared with viral isolation and (2) to evaluate the applications of the test to the late diagnosis of congenital CMV. STUDY DESIGN: The method was tested on the cards of (1) 509 babies examined through viral isolation within their third week of life (72 positive cases) and (2) 191 children studied after 3 weeks of life (25 days to 5 years). Blood was eluted from Guthrie cards and heat extracted. The products of a nested polymerase chain reaction (PCR) amplifying one region in the CMV glycoprotein B (gB) gene were detected by agarose gel electrophoresis. RESULTS: DBS test was positive in all 72 congenitally infected babies and in four of the 437 negative at cytomegalovirus isolation (sensitivity 100%, specificity 99%). Infection in 16 of the 92 infants with a late viral isolation was demonstrated to be congenital by the test, which also detected congenital infection in 18 of 83 children in whom viral culture was not performed (13 with and five without symptoms). Fifty-six additional control cases tested negative. CONCLUSIONS: DBS test is a reliable assay for diagnosing congenital cytomegalovirus infection and could be used as an alternative to viral culture. It is able to reveal whether ascertained CMV infection is congenital or postnatal at an age when viral isolation is not able to do so. It can assess the role of risky procedures such as transfusion and it can ascertain the etiology of morbid conditions diagnosed late or of controversial origin.     

The automicrobic system for detection of bacteriuria. Efficacy of revised urine identification cards

The results of clinical urine specimens tested in the Vitek AutoMicrobic System (AMS) using two different urine identification (UID) cards were compared with the results obtained by a quantitative culture method. AMS injector UID card results were evaluated with the use of 1,136 consecutive clinical specimens collected March 4 to May 23, 1983. Revised AMS UID cards were used to test 1,634 clinical specimens from November 8, 1983, to March 2, 1984. The revised UID card was less sensitive, more specific, had a greater predictive value for positive results, and had greater accuracy than the injector UID card in detecting organisms in urine. The revised urine card accurately quantified organisms in 90.1% of specimens versus 85.1% in injector cards. The revised card was superior in the predictive value of positive identification of urinary pathogens. Ninety percent of all organisms were identified within nine hours with either card. Improved accuracy of the revised cards makes it practical to electronically report automated urine screening results (detection, quantitation, and preliminary identification of urinary pathogens) by interfacing the AMS with hospital information systems.     

Red blood cell diluent composition is important for detection of some anti-E

Commercially prepared 0.8% reagent red blood cells (RBCs) eliminate the need to manually dilute 3 to 5% RBCs for use in gel cards. Ortho-Clinical Diagnostics investigated twelve anti-E samples detected in MTS Anti-IgG gel cards using Ortho 3% reagent RBCs manually diluted to 0.8% in MTS Diluent 2 trade mark (MTS2) that were not detected with commercially prepared Ortho 0.8% reagent RBCs. In gel tests, using additional examples of E-positive RBCs, 22 of 26 anti- E were reactive when the cells were suspended in MTS2. Only 6 of 28 anti-E were reactive with E-positive Ortho 0.8% reagent RBCs. Five anti-E were tested in gel with five R2 R2 RBCs that had been washed and resuspended in four low-ionic-strength diluents. Fifty-eight percent of tests performed in MTS2 were positive compared to 13 to 41 percent for the other diluents. Anti-E detection also varied from 6 to 56 percent based on the donor of the RBCs. Seven anti-E were characterized by their reactvity in tube techniques and were reactive using PEG and/or ficin-treated RBCs only. As a comparison, 25 archived examples of anti-E were detected using RBCs suspended in MTS2 and Ortho 0.8% reagent RBCs. These data show that some anti-E are not detected by Ortho reagent RBCs in MTS Anti-IgG gel cards. However, these anti-E have characteristics of antibodies of questionable clinical significance.     

Use of positive blood cultures for direct identification and susceptibility testing with the vitek 2 system

In order to further decrease the time lapse between initial inoculation of blood culture media and the reporting of results of identification and antimicrobial susceptibility tests for microorganisms causing bacteremia, we performed a prospective study in which specially processed fluid from positive blood culture bottles from Bactec 9240 (Becton Dickinson, Cockeysville, Md.) containing aerobic media were directly inoculated into Vitek 2 system cards (bio-Mérieux, France). Organism identification and susceptibility results were compared with those obtained from cards inoculated with a standardized bacterial suspension obtained following subculture to agar; 100 consecutive positive monomicrobic blood cultures, consisting of 50 gram-negative rods and 50 gram-positive cocci, were included in the study. For gram-negative organisms, 31 of the 50 (62%) showed complete agreement with the standard method for species identification, while none of the 50 gram-positive cocci were correctly identified by the direct method. For gram-negative rods, there were 50% categorical agreements between the direct and standard methods for all drugs tested. The very major error rate was 2.4%, and the major error rate was 0.6%. The overall error rate for gram-negatives was 6.6%. Complete agreement in clinical categories of all antimicrobial agents evaluated was obtained for 19 of 50 (38%) gram-positive cocci evaluated; the overall error rate was 8.4%, with 2.8% minor errors, 2.4% major errors, and 3.2% very major errors. These findings suggest that the Vitek 2 cards inoculated directly from positive Bactec 9240 bottles do not provide acceptable bacterial identification or susceptibility testing in comparison with corresponding cards tested by a standard method.     

A model driven approach for the German health telematics architectural framework and security infrastructure

Shared care concepts such as managed care and continuity of care are based on extended communication and cooperation between different health professionals or between them and the patient respectively. Health information systems and their components, which are very different in their structure, behavior, data and their semantics as well as regarding implementation details used in different environments for different purposes, have to provide intelligent interoperability. Therefore, flexibility, portability, and future orientation must be guaranteed using the newest development of model driven architecture. The ongoing work for the German health telematics platform based on an architectural framework and a security infrastructure is described in some detail. This concept of future proof health information networks with virtual electronic health records as core application starts with multifunctional electronic health cards. It fits into developments currently performed by many other developed countries.     

Childhood accidents: a practice survey using general practitioners'' records and parental reports.

A survey of accidents in children under 16 years of age from one general practice (list size 6400) was carried out using a postal questionnaire to parents and an audit of medical records. Incidence rates were estimated by audit of medical records as 97% of accidents 'other than minor cuts and bruises' reported by parents had resulted in a medical consultation, and parental reporting was incomplete. For 1986, these rates were 254 per 1000 patients at the age of four years or less, 218 per 1000 at age five to nine years and 238 per 1000 at age 10 to 15 years. However, parental reports of accidents provided better detail of the circumstances of accidents than the medical records: in the latter, the circumstances of accidents were noted in 75% of records and the location in only 40%. Various options for monitoring accidents and near accidents utilizing parental information which could be administered by general practitioners are proposed, including the use of parent-held child health record cards and a 'yellow card' system analogous to that used for reporting adverse drug reactions.     

Artificial neural networks estimate the contribution of taste neurons to coding

Taste qualities are believed to be coded in the activity of populations of taste neurons. However, it is not clear whether all neurons are equally responsible for coding. To clarify the point the relative contribution of each taste neuron to coding was assessed by constructing simple three-layer neural networks with input neurons that represent cortical taste neurons of the rat. The networks were trained by the back-propagation learning algorithm to classify the neural response patterns to the basic taste stimuli (sucrose, HCl, quinine-hydrochloride, and NaCl). The networks had four output neurons representing the basic taste qualities, the values of which provide a measure for similarity of test stimuli to the basic taste stimuli. We estimated relative contributions of input neurons to the taste discrimination of the network by examining their significance S(j), which is defined as the sum of the absolute values of the connection weights from the jth input neuron to the hidden layer. When the input neurons with a smaller S(j) (e.g., 15 out of 39 input units) were "pruned" from the trained network, the ability of the network to discriminate the basic taste qualities was not greatly affected. On the other hand, the taste discrimination of the network progressively deteriorated much more rapidly with pruning of input neurons with a larger S(j). These results suggest that cortical taste neurons differentially contribute to the coding of taste qualities. Input neurons with a larger S(j) tended to be with a larger variation of neural discharge rates to the basic taste stimuli. The variation of neural discharges may be important in the coding of taste qualities.     

Screening of the entire coding region of p53 in low grade lymphoproliferative disorders.

This report details a rapid method for screening the entire p53 coding region (exons 2-11). This method, based on the non-isotopic RNase cleavage assay, uses novel primer sequences and an adaptation of the MutationScreener method. A mutation in 20% of the sample was easily detectable by this method, whereas mutations below 50% were undetectable using the original method. Alterations to the wild-type p53 mRNA sequence were found in nine of the 130 patients with low grade lymphoproliferative disorders screened, and this was confirmed by DNA sequencing in eight of eight samples. The method is a simple and reliable technique for screening for p53 mutations.     

Survey of a Royal Air Force practice in Germany

Throughout 1974 records were kept of all patients seen by the medical staff at Royal Air Force Bruggen, an RAF Station in Germany. Full details of patients and diagnoses were recorded and an analysis was made of the patterns of consultation and morbidity. The method of storing and analysis the information on punched cards is discussed, and the results are compared with service and civilian general practice in the UK and abroad.     

Performances of VITEK 2 colorimetric cards for identification of gram-positive and gram-negative bacteria

The purpose of this study was to evaluate the new VITEK 2 identification cards that use colorimetric reading to identify gram-positive and gram-negative bacteria (GP and GN cards, respectively) in comparison to fluorimetric cards (ID-GPC and ID-GNB, respectively). A total of 580 clinical isolates and stock collection strains belonging to 116 taxa were included in the study. Of the 249 gram-positive strains tested with both the ID-GPC and GP cards, 218 (87.5%) and 235 (94.4%) strains were correctly identified (to the genus and species level), respectively. Of the 331 gram-negative strains tested with the ID-GNB and GN cards, 295 (89.1%) and 321 (97%) strains were correctly identified, respectively. Another focus of the study was to apply the percentages of correct identifications obtained in this study to the list of bacteria isolated in our laboratory (32,739 isolates) in the year 2004. We obtained 97.9% correct identifications with the colorimetric cards and 93.9% with fluorescent cards.