Outpatient Care: Planning a Satellite Laboratory for Ambulatory Patient Care

Peripheral neuropathy is a common consequence of diabetes that often results in loss of protective sensation. Early identification of this loss is critical to minimize secondary complications. The authors’ purpose was to assess the behavior patterns of physical therapists as to their opinions and behaviors related to sensory testing for individuals with diabetes. A questionnaire was sent to physical therapists across the United States with the following results: a high level of agreement concerning the benefits of sensory testing, but with a far less agreement as to the actual performance of sensory testing by those same physical therapists.     

A simple decision analytic solution to the comparison of two binary diagnostic tests

One of the most basic biostatistical problems is the comparison of two binary diagnostic tests. Commonly, one test will have greater sensitivity, and the other greater specificity. In this case, the choice of the optimal test generally requires a qualitative judgment as to whether gains in sensitivity are offset by losses in specificity. Here, we propose a simple decision analytic solution in which sensitivity and specificity are weighted by an intuitive parameter, the threshold probability of disease at which a patient will opt for treatment. This gives a net benefit that can be used to determine which of two diagnostic tests will give better clinical results at a given threshold probability and whether either is superior to the strategy of assuming that all or no patients have disease. We derive a simple formula for the relative diagnostic value, which is the difference in sensitivities of two tests divided by the difference in the specificities. We show that multiplying relative diagnostic value by the odds at the prevalence gives the odds of the threshold probability below which the more sensitive test is preferable and above which the more specific test should be chosen. The methodology is easily extended to incorporate combinations of tests and the risk or side effects of a test. Copyright © 2012 John Wiley & Sons, Ltd.     

Preamble to the proposal for a United Nations second assembly

Maralinga, South Australia was an important site in the United Kingdom nuclear weapons test programme. Seven bombs were exploded and a series of ‘safety’ tests carried out; the latter in particular disseminated appreciable amounts of uranium and plutonium over a wide area. A programme to clean up the test site over several years was instituted, with in-situ vitrification as a principal measure. The final report on the programme has now been published. However, both the programme and the Report are seriously flawed; this article provides criticisms of both.     

超声在慢性附睾炎治疗中的应用价值

目的 观察慢性附睾炎治疗的临床效果和治疗前后超声图像的改变情况,为临床诊断提供参考.方法 2007年1月至2009年2月采用中西医结合治疗的慢性附睾炎患者78例,给予口服司帕沙星片,0.1g/片,3片/次,1次/d,同时采用中药丹红通精方,1剂/d,开水煎,分早晚服.治疗30 d后观察疗效,并采用超声观察治疗前、治疗中(治疗15d时)、治疗后患者附睾大小、内部回声强度、血流阻力指数(RI)、最大与最小血流速度(Vmax及Vmin)、动脉收缩压与舒张压的比值(S/D)、彩色超声多普勒(CDFI)血流变化情况.结果 治愈50例,好转20例,无效8例.有效(治愈+好转)患者治疗中、治疗后附睾大小、Vmax及Vmin、RI和S/D均较治疗前显著改善[附睾大小:尾部厚度:(1.14±0.19)、(0.75±0.13) cm比(1.68±0.25) cm,体部厚度:(0.54±0.17)、(0.46±0.11) cm比(0.63±0.12) cm,头部厚度:(1.12±0.16)、(0.80±0.15) cm比(1.53±0.27) cm;Vmax:(0.22±0.12)、(0.19±0.10)m/s比(0.28±0.13) m/s;Vmin:(0.14±0.05)、(0.07±0.02) m/s比(0.19±0.08) m/s;RI:0.64±0.13、0.52±0.10比0.89±0.17;S/D:3.64±1.40、2.78±1.26比4.35±1.62],差异均有统计学意义(P＜0.05).结论 超声能够较为准确地检测到慢性附睾炎患者治疗前后附睾大小、内部回声强度、RI、Vmax、Vmin及S/D、CDFI血流分级等指标的显著变化,能够给出预后判断,指导临床治疗,在慢性附睾炎的诊治中有重要的应用价值.     

The Cancer Series: An Introduction

A 77-year-old man presented to the emergency department with chest pain. Severe pain had occurred while he was walking, persisted for ten minutes, and was relieved when he took two nitroglycerine tablets. He had experienced intermittent chest pain for the past 11 days, mostly on exertion. The patient had hypertension, an elevated serum cholesterol level, and was a former smoker. His medications included aspirin, pravastatin, isosorbide dinitrate, metoprolol, and nitroglycerine.

The patient was in no apparent distress and without chest pain when he was examined. His blood pressure was 154/88 mm Hg; pulse, 70 bpm; respirations, 18 per min; temperature, 36.8° C; and oxygen saturation, 97% by pulse oximetry. The physical examination was unremarkable. The ECG is shown.