The ITDS detected fever in patients through split-second, non-contact skin temperature measurements. Fever is a primary symptom of seasonal influenza, H1N1, avian influenza, SARS and other infectious diseases.
Angela Hewlett and colleagues evaluated the ITDS during the height of the H1N1 pandemic from November 18, 2009 to January 9, 2010 to test the tool's viability in a practical clinical setting. The ITDS employs a thermal imaging camera to measure skin temperature by detecting and quantifying the infrared energy being emitted from the face. The ITDS temperature measurements were compared with standard temperature measurements for 566 patients, ages 15 days to 89 years old.
Infrared thermal detection systems have been used in several countries to screen for fever in travellers. Hewlett and her team wanted to utilize the technology as an infection control option in a clinical setting. "This technology allows clinicians to rapidly screen people for fever, so that incoming patients and visitors who may be ill can be identified quickly and reduce the danger of spreading diseases like influenza to other people in the hospital," said Hewlett.
During the study period, participating patients at the emergency department had their temperature measured by the ITDS and then by routine oral or rectal temperature measurements. Patients who were identified with fever were managed with routine protocols, including separation or surgical masks.
The ITDS proved to be an effective screening tool for identifying patients with fever across all age ranges and genders. While the ITDS had a high negative predictive value–correctly excluding most patients without fever–the machine also generated a high percentage of false positive results, measuring higher temperatures than routine temperature measurements. According to the study, if fever was not detected by the ITDS, then there was a 97 percent chance that there was no fever present. Further evaluation of the performance and utility of the device is needed.
Wednesday, 31 March 2010
T Cells: Surprise for Stroke Researchers
The blood vessels tend to be blocked by clotted blood. Dissolving these clots or stopping them from occurring in the first place is the primary objective in the treatment and prevention of strokes.
Consequently, the search for new and better therapies starts where the cause of the illness lies: with the blood coagulation that leads to the formation of clots. The Würzburg scientists were all the more astonished, then, when they made a discovery elsewhere - the T cells of the immune system also play a role in strokes. These are actually the cells responsible for combating pathogens.
What exactly did the researchers discover? Mice with no T cells due to a genetic defect suffer less severe strokes than their normal fellow mice. What is more, they develop fewer symptoms of neurological deficiencies, such as paralyses, after a stroke. This means that T cells have a negative effect on the progression of a stroke. This has been proven by the working groups of Guido Stoll, Christoph Kleinschnitz, and Heinz Wiendl from the university's Department of Neurology together with Bernhard Nieswandt from the Rudolf Virchow Center for Experimental Biomedicine.
"The fact that T cells have such a damaging effect in the case of acute strokes came as a complete surprise to us," reports Christoph Kleinschnitz. The adverse effect can be traced back to two sub-groups of immune cells, the so-called CD4- and CD8-positive T helper cells. Further research is now needed to clarify how the T cells exercise their damaging effect.
The Würzburg researchers hope that their work will help improve stroke therapy for humans. If the findings can be transferred to people, it might be possible to devise new approaches by purposefully manipulating the T cells. It is conceivable, for example, that in the early stages of a stroke the harmful fraction of the T cells may be deactivated temporarily to thereby reduce the symptoms of deficiencies. "But further studies are needed before we reach that point," says neurologist Guido Stoll.
Source: MEDICA.de Julius-Maximilians-Universität Würzburg
Consequently, the search for new and better therapies starts where the cause of the illness lies: with the blood coagulation that leads to the formation of clots. The Würzburg scientists were all the more astonished, then, when they made a discovery elsewhere - the T cells of the immune system also play a role in strokes. These are actually the cells responsible for combating pathogens.
What exactly did the researchers discover? Mice with no T cells due to a genetic defect suffer less severe strokes than their normal fellow mice. What is more, they develop fewer symptoms of neurological deficiencies, such as paralyses, after a stroke. This means that T cells have a negative effect on the progression of a stroke. This has been proven by the working groups of Guido Stoll, Christoph Kleinschnitz, and Heinz Wiendl from the university's Department of Neurology together with Bernhard Nieswandt from the Rudolf Virchow Center for Experimental Biomedicine.
"The fact that T cells have such a damaging effect in the case of acute strokes came as a complete surprise to us," reports Christoph Kleinschnitz. The adverse effect can be traced back to two sub-groups of immune cells, the so-called CD4- and CD8-positive T helper cells. Further research is now needed to clarify how the T cells exercise their damaging effect.
The Würzburg researchers hope that their work will help improve stroke therapy for humans. If the findings can be transferred to people, it might be possible to devise new approaches by purposefully manipulating the T cells. It is conceivable, for example, that in the early stages of a stroke the harmful fraction of the T cells may be deactivated temporarily to thereby reduce the symptoms of deficiencies. "But further studies are needed before we reach that point," says neurologist Guido Stoll.
Source: MEDICA.de Julius-Maximilians-Universität Würzburg
Images Speed Decision Making
"The imaging exam report provides an important means of communication between the radiologist and the other physicians rendering care and is often the only form of communication between the radiologist and the referring physician," said researcher Veena R. Iyer. It has been suggested that providing the referring physician with selected images embedded in the text report over the web could improve and support the information contained in the report. "We undertook this study to measure the utility to the referring physician, of radiology reports with attached, relevant images of the abnormal findings," said Iyer.
Thirty-five cases referred for abdominal computed tomography (CT) scans were included in the study, which was performed at Massachusetts General Hospital. Referring physicians were asked to view a text-only report followed by the same report with pertinent embedded images. "In 32 of the 35 cases, the text-only report satisfactorily answered the clinical query. In these 32 cases, the report with the attached images helped in making a more confident management decision and reduced time in planning management. Attached images altered management in two cases," said Iyer.
"The results of our study indicate that although clinician's queries are satisfactorily answered by the current itemized report, providing additional images conveys useful information. It may enable the referring clinician to formulate response plans more rapidly and with increased confidence," she said.
"Providing referring clinicians with a selected subsample of relevant images attached to the report improves the radiologist's communication with them. Such a report has the ability to save the clinician's time, and possibly improve patient management," said Iyer.
Source: American College of Radiology / American Roentgen Ray Society
Thirty-five cases referred for abdominal computed tomography (CT) scans were included in the study, which was performed at Massachusetts General Hospital. Referring physicians were asked to view a text-only report followed by the same report with pertinent embedded images. "In 32 of the 35 cases, the text-only report satisfactorily answered the clinical query. In these 32 cases, the report with the attached images helped in making a more confident management decision and reduced time in planning management. Attached images altered management in two cases," said Iyer.
"The results of our study indicate that although clinician's queries are satisfactorily answered by the current itemized report, providing additional images conveys useful information. It may enable the referring clinician to formulate response plans more rapidly and with increased confidence," she said.
"Providing referring clinicians with a selected subsample of relevant images attached to the report improves the radiologist's communication with them. Such a report has the ability to save the clinician's time, and possibly improve patient management," said Iyer.
Source: American College of Radiology / American Roentgen Ray Society
Inappropriate CT and MRI Referrals
"Radiologists, hospitals, health plans, and policy makers have struggled with ways to improve the rate of appropriate utilization of imaging studies, particularly CT, MRI, and PET," said Robert L. Bree, lead author of the study. "Our study looked at a large group of CT and MRI examinations. Evidence-based appropriateness criteria developed by a radiology management company were used to determine if the examinations were appropriate," said Bree.
The study, performed at Harborview Medical Center in Seattle, included medical records from 459 elective outpatient CT and MRI examinations from primary care physicians that were reviewed. "Of the 459 reviewed, 74 percent were considered appropriate and 26 percent were considered inappropriate. 58 percent of the appropriate studies were positive and affected subsequent management while only 24 percent of inappropriate studies were positive affecting management," said Bree. Examples of inappropriate examinations include brain CT for chronic headache, lumbar spine MR for acute back pain, and knee or shoulder MRI in patients with osteoarthritis.
"Our study shows that CT and MRI examinations ordered in the outpatient primary care setting are frequently not appropriate based on the application of a national radiology benefit management company's evidence-based guidelines. A high percentage of examinations not meeting appropriateness criteria and subsequently yielding negative results suggest a need for tools to help primary care physicians improve the quality of their imaging decision requests," said Bree.
Source : MEDICA.de / American College of Radiology / American Roentgen Ray Society