A clinical decision support system improves antibiotic therapy for upper urinary tract infection in a randomized single-blinded study

BACKGROUND

Due to increasing bacterial resistance rates choosing a correct empiric antibiotic therapy is getting more and more complex. Often medical doctors use information tools to make the right treatment choice.

METHODS

One hundred sixty six participants (77 medical doctors and 89 medical students) were asked to provide a diagnosis and antibiotic therapy in a simple fictive paper case of upper urinary tract infection (UTI) in a randomized single-blinded study. Participants were randomized to one of four information tools they were allowed to use in the study or control: 1. free internet access, 2. pharmaceutical pocket guide, 3. pocket guide antibiotic therapy, 4. clinical decision support system (CDSS), and control (no information tool). The CDSS was designed for the study. The adherence to the national German UTI guideline was evaluated.

RESULTS

Only 27.1% (n = 45/166) provided a correct diagnosis of upper UTI and 19.4% (n = 32/166) an antibiotic treatment recommended by national German treatment guidelines indicating their need for information tools. This result was not significantly different between medical doctors and medical students, residents and medical specialists or level of working experience. Using CDSS improved results significantly compared to conventional tools (diagnosis 57.1%; treatment recommendation 40.5%; p < 0,01). Processing time was not different between the use of CDSS and conventional information tools. CDSS users based their decision making on their assigned information tool more than users of conventional tools (73.8% vs. 48.0%; p < 0.01). Using CDSS improved the confidence of participants in their recommendation significantly compared to conventional tools (p < 0.01).

CONCLUSIONS

Our study suggests that medical professionals require information tools in diagnosing and treating a simple case of upper UTI correctly. CDSS appears to be superior to conventional tools as an information source.

Optically induced transient enhancement of a structural order parameter

We photoexcite SrTiO3 and EuTiO3 in their purely soft-mode-driven structurally distorted phase and trace the structural order parameter via ultra-short x-rays. We observe a rapid decay for SrTiO3 and an intriguing transient enhancement for EuTiO3.

[Cognitive-perceptive approaches in the treatment of chronic pain]

In the treatment of difficult chronic pain conditions, cognitive-perceptive approaches offer an alternative to conventional therapies. Especially phantom limb pain and complex regional pain syndrome (CRPS) are frequently treated with these promising modalities. This article provides an overview of the most important cognitive-perceptive therapies and the research results concerning their clinical efficacy. In addition, we discuss their neurobiological foundation and clinical perspectives.

Solar Plasma Experiment

A preliminary summary of the data received from the Mariner II solar plasma experiment for the period 29 August through 31 October 1962 is presented. During this period there was always a measurable flow of plasma from the direction of the sun. The velocity of this ion motion was generally in the range 400 to 700 km/sec. Time variations, plasma density, and ion temperatures are also discussed.

Determination of aflatoxin B1 in tiger nut-based soft drinks

An analytical method for the determination of aflatoxin B1 in a tiger nut-based soft drinks named 'horchata' is described. The method is based on an immunoaffinity clean-up, followed by HPLC separation and fluorescence detection after electrochemical post-column derivatization. The detection limit (S/N = 3) and the quantification limit (S/N = 10) were 0.02 and 0.06 microg kg(-1), respectively. The mean recovery at a level of 2 microg l(-1) was 88% (n = 6) and the coefficient of variation was 9%. The method was applied to conduct a small market survey for a beverage named 'horchata' that is frequently consumed by parts of the population in Southern Europe. Twenty-two samples from Spanish and Belgian supermarkets were analysed. As a result, only one sample was found to contain aflatoxin B1 at the limit of quantitation of the method.

Crystal structure of (1R*,2S*,5S*,6S*,7R*)-6-(3,5-dinitrobenzoyloxy)methyl-2,7-dimethyl-tricyclo [5.2.2.01,5]undec-8-ene, C21H24N2O6

C21H24N2O6, orthorhombic, P212121 (No. 19), a = 6.285(2) Å, b = 9.044(4) Å, c = 35.52(2) Å, V = 2019.0 Å3, Z = 4, R(F) = 0.095, wRref(F2) = 0.279, T = 295 K.

[Cutaneous lesions and blood count changes in a 9-month old girl with glutaric aciduria type I]

Non-specific cutaneous lesions are common in patients suffering from acute myeloid leukemia (AML). Leukemic skin infiltrates are present in about 30% of cases of monoblastic or myelomonocytic leukemia. The appearance of specific skin lesions can precede bone marrow involvement. We report the case of a 9-month-old girl with acute myelogenous leukemia (FAB M5) and glutaric aciduria type I which initially presented with cutaneous lesions, anemia and leukopenia.

Autosomal dominant optic atrophy with unilateral facial palsy: a new hereditary condition?

A mother and daughter are reported with bilateral optic atrophy with onset in infancy and unilateral facial palsy. This appears to be a novel autosomal dominant disorder.

Stereoselective metabolic study of famprofazone

Famprofazone (1) metabolites were studied in human urine after medication by 50 mg oral dose. The human urine was collected over 48 h from six volunteers at time intervals of 6, 12, 24 and 48 h. The amount of famprofazone metabolites were recovered from the urine samples by application of Extrelut extraction method. The resultant extracts were derivatized using N-methyl-N-trimethylsilytrifluoroacetamide (MSTFA) for trimethylsilylation followed by N-methyl-bis-trifluoroacetamide (MBTFA) for trifluoroacetylation. Methamphetamine (2) and 3-hydroxymethyl-propyphenazone (3), excreted in human urine, were identified as famprofazone metabolites by gas chromatography-mass spectrometry (GC-MS). The quantitative results revealed that the average amounts of 2 and 3, excreted in human urine were equal to 2.6 and 4 mg, respectively, through 48 h. However, 3 was analysed after enzymatic hydrolysis of the urine samples using beta-glucuronidase/arylsulphatase. The excreted methamphetamine enantiomers could be separated by application of indirect GC-technique using S-(-)-N-trifluoroacetylprolyl chloride (TPC) as a chiral derivatizing agent. The average amount of (-)-methamphetamine isomer excreted in the urine was found to be three fold those of the (+)-isomer.

The Suess-Urey mission (return of solar matter to Earth)

The Suess-Urey (S-U) mission has been proposed as a NASA Discovery mission to return samples of matter from the Sun to the Earth for isotopic and chemical analyses in terrestrial laboratories to provide a major improvement in our knowledge of the average chemical and isotopic composition of the solar system. The S-U spacecraft and sample return capsule will be placed in a halo orbit around the L1 Sun-Earth libration point for two years to collect solar wind ions which implant into large passive collectors made of ultra-pure materials. Constant Spacecraft-Sun-Earth geometries enable simple spin stabilized attitude control, simple passive thermal control, and a fixed medium gain antenna. Low data requirements and the safety of a Sun-pointed spinner, result in extremely low mission operations costs.

The essential oil of Sideritis syriaca

The volatile oil of Sideritis syriaca L. has been investigated by means of GC/MS, resulting in the identification of 29 terpenes, fatty acids, esters, and alcohols. The presence of glycosylated derivatives of terpenes could not be established.

Ulysses Solar Wind Plasma Observations at High Southerly Latitudes

Solar wind plasma observations made by the Ulysses spacecraft through -80.2 degrees solar latitude and continuing equatorward to -40.1 degrees are summarized. Recurrent high-speed streams and corotating interaction regions dominated at middle latitudes. The speed of the solar wind was typically 700 to 800 kilometers per second poleward of -35 degrees . Corotating reverse shocks persisted farther south than did forward shocks because of the tilt of the heliomagnetic streamer belt. Sporadic coronal mass ejections were seen as far south as -60.5 degrees . Proton temperature was higher and the electron strahl was broader at higher latitudes. The high-latitude wind contained compressional, pressure-balanced, and Alfvénic structures.

[Biotransformation of (+)-methamphetamine in fertile hen's eggs]

On application of (+)-methamphetamine (1) to the albumen of embryonated hen's eggs it is possible to detect phase I as well as phase II metabolites of 1 in the allantois liquid. When application is effected on the first day of incubation, methamphetamine is less toxic than when effected on the sixth day of incubation. Besides unchanged 1 ten metabolites have been identified. Principal pathways of biotransformation are N-dealkylation as well as aromatic p-hydroxylation and--as phase II reactions--N-acetylation and other conjugation reactions. The total amount of the metabolites produced depends on time of incubation and is up to about 25% of the applied dose. Differences from, but also similarities to human metabolism have been noticed. Consequently, the experiment is likely to be suitable as an alternative method for testing biotransformation reactions.

Recombination fractions in the HLA system based on the data set 'provinces Françaises': indications of haplotype-specific recombination rates

In the large genetic survey "Provinces Françaises' the recombination fractions in the HLA system have been estimated by a family analysis programme (FAP). A total of 1332 families were analysed and in general the findings were in agreement with recombination fractions reported previously. The maternal recombination rates were on average 1.8 times higher than the corresponding ones for males. The comparison of the recombination fractions with the corresponding physical distances suggests the existence of hot spots of recombination. The analysis did not show deviations from expected values for HLA-A and B alleles on HLA-A/B recombinant haplotypes. However, analysis of HLA-B/DR recombinant haplotypes showed a skewed distribution of B and DR alleles. The significance of the findings is difficult to evaluate as all results are estimated numbers and frequencies but a manual analysis of the recombinant families confirmed the observations. HLA-B/DR recombinant haplotypes carried often HLA-DR3 and DR11 whereas DR2 and DR7 were more rarely present on recombinant haplotypes. DR4 had an increased incidence on BF/DR recombinant haplotypes but not on A/B or B/BF recombinant haplotypes. Some of the haplotypes with the strongest linkage disequilibria as A1,B8,DR3 and A3,B7,DR2 seem to be less frequently involved in recombinations than other haplotypes. Variations of recombination rates depending on certain alleles or haplotypes might partially explain the conservation of some haplotypes or part of haplotypes in Caucasoids.

[Quantitative determination of alpha-peroxyachifolide in yarrow by HPLC with amperometric detection]

A HPLC method with amperometric detection is established for the contact allergen alpha-peroxyachifolid (1) from yarrow (Achillea millefolium L., s. str.). The amounts of 1 are between 0.25 and 0.60% in blossoms, dried 2 h at room temperature, and between 0.01 and 0.05% in the leaves. In completely dried material and in some preparations from the market 1 could also be quantified.

An estimate on the frequency of duplicated haplotypes and silent alleles of human C4 protein polymorphism. II. Investigations in healthy Negro families

The first investigation of complete MHC marker data in South African Negroes by segregation analysis in 11 families with up to three generations is presented, including quantitative evaluation of C4 allotype patterns and C4 beta chain determinations according to Steuer et al. (1). The frequency of homo- and heteroduplicated, hybrid, and non-expressed C4 alleles was determined from C4 protein phenotyping, including C4 alpha and beta chains, quantitative estimates of the relative electrophoretic C4 banding patterns by scanning densitometry, and from the other classical MHC markers by submitting all results to the family analysis program (FAP). From unrelated non-diseased individuals (n = 105) in these families with 62 haplotypes, the following frequencies were observed for non-expressed alleles: C4A*Q0 0.1189, C4B*Q0 0.2552, and for the total of heteroduplicated alleles: C4A 0.0645, C4B 0.0608. Applying additionally quantitative determinations of C4 banding patterns, homoduplications such as C4A*3 A*3, C4B*1 B*1, C4B*3 B*3, and the heteroduplication C4A*3 A*2 were assumed. In the investigated individuals the heteroduplications of C4A*12 and C4A*3 with the A*91 allele and of C4B*2 with C4B*92 were observed. It was concluded that not only allele frequencies but also the frequency of heteroduplications seems to be of specific ethnic character. Furthermore, the prior hypothesis that deletion or non-expression at one C4 locus is accompanied by duplication at the other was only confirmed for non-expressed B-alleles with C4A*3 A*91 or C4A*12 A*91.(ABSTRACT TRUNCATED AT 250 WORDS)

Jupiter's Magnetosphere: Plasma Description from the Ulysses Flyby

Plasma observations at Jupiter show that the outer regions of the Jovian magnetosphere are remarkably similar to those of Earth. Bow-shock precursor electrons and ions were detected in the upstream solar wind, as at Earth. Plasma changes across the bow shock and properties of the magnetosheath electrons were much like those at Earth, indicating that similar processes are operating. A boundary layer populated by a varying mixture of solar wind and magnetospheric plasmas was found inside the magnetopause, again as at Earth. In the middle magnetosphere, large electron density excursions were detected with a 10-hour periodicity as planetary rotation carried the tilted plasma sheet past Ulysses. Deep in the magnetosphere, Ulysses crossed a region, tentatively described as magnetically connected to the Jovian polar cap on one end and to the interplanetary magnetic field on the other. In the inner magnetosphere and lo torus, where corotation plays a dominant role, measurements could not be made because of extreme background rates from penetrating radiation belt particles.

Study on the metabolism of racemic prolintane and its optically pure enantiomers

1. Asian and European volunteers were given racemic prolintane, and the metabolites in the 24 h urine were identified and quantified by g.l.c. mass spectroscopy using synthetic reference compounds. 2. R-(+)- and S-(-)-prolintane were synthesized from optically active phenylalanine. The metabolism of the enantiomers differs mainly in the quantitative amounts of metabolites.

[Synthesis of metabolites and enantiomers of prolintane]

The synthesis of 15 possible metabolites of prolintane (1) (Katovit) which is used in the treatment of blood pressure disregulations is described. Furthermore, the preparation of the enantiomers of 1 is reported, starting with R-(+)- and S-(-)-phenylalaninol respectively.