Diagnostic accuracy of a prototype rapid chlamydia and gonorrhoea recombinase polymerase amplification assay: a multicentre cross-sectional preclinical evaluation

Objectives

Rapid and accurate sexually transmitted infection diagnosis can reduce onward transmission and improve treatment efficacy. We evaluated the accuracy of a 15-minute run-time recombinase polymerase amplification–based prototype point-of-care test (TwistDx) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG).

Methods

Prospective, multicentre study of symptomatic and asymptomatic patients attending three English sexual health clinics. Research samples provided were additional self-collected vulvovaginal swab (SCVS) (female participants) and first-catch urine (FCU) aliquot (female and male participants). Samples were processed blind to the comparator (routine clinic CT/NG nucleic acid amplification test (NAAT)) results. Discrepancies were resolved using Cepheid CT/NG GeneXpert.

Results

Both recombinase polymerase amplification and routine clinic NAAT results were available for 392 male and 395 female participants. CT positivity was 8.9% (35/392) (male FCU), 7.3% (29/395) (female FCU) and 7.1% (28/395) (SCVS). Corresponding NG positivity was 3.1% (12/392), 0.8% (3/395) and 0.8% (3/395). Specificity and positive predictive values were 100% for all sample types and both organisms, except male CT FCU (99.7% specificity (95% confidence interval (CI) 98.4–100.0; 356/357), 97.1% positive predictive value (95% CI 84.7–99.9; 33/34)). For CT, sensitivity was ≥94.3% for FCU and SCVS. CT sensitivity for female FCU was higher (100%; 95% CI, 88.1–100; 29/29) than for SCVS (96.4%; 95% CI, 81.7–99.9; 27/28). NG sensitivity and negative predictive values were 100% in FCU (male and female).

Conclusions

This prototype test has excellent performance characteristics, comparable to currently used NAATs, and fulfils several World Health Organization ASSURED criteria. Its rapidity without loss of performance suggests that once further developed and commercialized, this test could positively affect clinical practice and public health.

A scheme to recruit Pakistani and Bangladeshi trainee dental nurses in a multiethnic area of Greater Manchester

The primary dental care services in Oldham, Greater Manchester have established an innovative scheme to encourage diversity in primary dental care services. The scheme involves the recruitment of bilingual trainee dental nurses in order to improve accessibility and appropriateness of the services and to improve communication with Pakistani and Bangladeshi patients. The scheme has raised a number of issues for trainees, existing staff and management. However all groups evaluated the scheme as worthwhile. Achievements of the scheme include better communication, better understanding of different ethnic communities among the staff and increased confidence and employability of trainees. It is recommended that similar schemes be adopted for primary dental care and other health services in areas with significant ethnic minority populations.

The development of a national oral health promotion programme for pre-school children in England

Dental caries amongst pre-school children remains a significant dental public health problem in the UK. The well-developed and extensive treatment and preventive services in the UK have failed to effectively prevent dental caries in a significant proportion of pre-school children, especially within disadvantaged communities. This paper outlines the development of an innovative national oral health promotion programme in England which has targeted the carers of pre-school children attending day care facilities. Extensive background research informed the approach of the programme and the resource requirements. Particular emphasis in the programme has been on the development of policies and guidelines in day care settings that promote oral health. Key features of the programme have been the integration of oral health and nutrition, and joint working across sectors and professional disciplines. An evaluation framework, which outlines a range of outcome measures that can be used to assess the effects and impact of the programme, is also described.

Enabling, empowering, inspiring: research and mentorship through the years

The interrelationship between research and mentorship in an association such as the Medical Library Association (MLA) is revealed through the contributions of individuals and significant association activities in support of research. Research is vital to the well-being and ultimate survival of health sciences librarianship and is not an ivory tower academic activity. Mentorship plays a critical role in setting a standard and model for those individuals who want to be involved in research and, ultimately, for the preparation of the next generation of health sciences librarians. Research and mentorship are discussed in the context of personal experiences, scholarship, and problem solving in a practice environment. Through research and mentorship, we are enabled to enhance our services and programs, empowered to look beyond our own operations for information puzzles to be solved, and inspired to serve society by improving health.

Integrating knowledge resources at the point of care: opportunities for librarians

Health sciences librarians at the University of Washington (UW) are partners in the evolution of Internet-based clinical information systems for two medical centers, University of Washington Medical Center and Harborview Medical Center, as well as the UW Primary Care Network clinics. Librarians lead information resource and systems development projects and play a variety of roles including facilitator, publisher, integrator, and educator. These efforts have been coordinated with parallel development efforts by the Integrated Advanced Information Management Systems (IAIMS) clinical informatics group in developing electronic medical record systems and clinical decision support tools. The outcome is MINDscape, a very heavily used Web view of the patient medical record with tightly integrated knowledge resources as well as numerous Web-accessible information resources and tools. The goal of this article is to provide a case study of librarian involvement in institutional information systems development at UW and to illustrate the variety of roles that librarians can assume in hospital settings.

Oral health promotion--opportunity knocks!

The soon to be published White Paper Our Healthier Nation will set out the Government's new public health agenda for the NHS. To improve oral health and reduce inequalities it is vitally important that the dental profession becomes an active player in the implementation of this policy. Each member of the dental team has an important role to play in oral health promotion.

The rationale, organisation and evaluation of a campaign to increase the use of sugar-free paediatric medicines

OBJECTIVE

To conduct and evaluate a dental health education campaign to encourage the use of sugar-free rather than sugar-containing medicines.

DESIGN

Meetings were organised for general medical practitioners, pharmacists and health visitors where the campaign was explained and discussed. Leaflets were given to parents by the health professionals. The campaign targeted the use of children's medicines from several aspects, namely when recommended, prescribed, sold and used.

SETTING

The campaign was conducted in the North West Region.

SUBJECTS

The campaign was directed at parents of young children, and health professionals, namely, general medical practitioners, pharmacists and health visitors.

OUTCOME MEASURES

Evaluation was by means of questionnaires, sales figures and prescriptions of medicines.

RESULTS

There was an increase in the proportion of sugar-free paracetamol prescribed in five out of six districts. The frequency of sugar intakes as an important cause of dental caries was not understood by many health professionals.

CONCLUSIONS

Continued education for health professionals is needed in order to show the importance of the frequency of sugar intakes and to dispel some prevalent dental health misconceptions.

Internet connectivity for hospitals and hospital libraries: strategies

Access to Internet resources and communications has rapidly become a necessity in many hospitals nationally. The results of a Pacific Northwest pilot Intenet connections project provides important evidence of the value of librarians in establishing such connections in their institutions The pilot project has resulted in a wealth of information regarding approaches to promoting the utility of the Internet to health professionals in hospitals. Roles that librarians are playing in support of such connections include facilitator, negotiator, provider, publisher, integrator, and educator.

Creating the future: IAIMS planning premises at the University of Washington

In September 1990, the University of Washington (UW) received a Phase I IAIMS Planning Grant from the National Library of Medicine and embarked upon a planning process involving the entire health sciences center. As a result of our relatively late entry into IAIMS planning, we have been able to learn from the experiences of other health sciences centers and to leverage our existing institutional efforts. Consequently, our progress has been rapid, and in a little over a year, we drafted a long-range plan and embarked on several related research and development projects. The hallmarks of our planning process include careful study of both the UW institutional environment and the experiences of other IAIMS institutions throughout the United States; broad, interdisciplinary participation of faculty, librarians, and administrators; an intensive educational process; a focus on people rather than technology; and, above all, leveraging of existing institutional and research projects that support our vision for the future.

Collaborative development of a uniform graphical interface

A uniform graphical user interface to informational databases is evolving at the University of Washington through a collaborative development process. The interface, called WILLOW, has grown from model analysis and preliminary design to working prototype. The design replicates a natural flow of search retrieval. Development continues in a spiral of test and linear improvements based on user analysis. WILLOW's internal structure is built on a Unix client-server model communicating over the campus TCP/IP backbone network. Its external structure is an X-Windows/Motif visual presentation emphasizing a simple, consistent, graphical face to disparate information databases. The WILLOW collaborators have grown from an initial group composed of the Health Sciences Library & Information Center and Computing & Communications' Information Systems to the University Libraries, Computing & Communications divisions, Medical Center Information Systems, and departments throughout the health sciences.

The use of the sugar clock in dental health education

An important factor in the prevention of dental caries is limiting the number of times in a day that sugar enters the mouth. This can be simply illustrated by using the sugar clock. The effectiveness of this as a technique for teaching 9-11-year-old children the importance of limiting frequency of sugar intakes was tested in a controlled study. Four weeks and 4 months after sugar clocks were used with a study group of children, they showed a significant increase over baseline in the number of correct answers given to a questionnaire. A control group showed no significant increase. It was concluded that the sugar clock is an effective method of teaching the importance of limiting frequency of sugar intake to this age group.

Perceived choice, social interaction, and dimensions of moral of residents in a home for the aged

In a study of 50 residents in a home for the aged, the relationships of health at relocation, choice in relocation, income, perceived choice within an institutional environment, and social interaction to four indices of morale were examined in hierarchical multiple regression designs. The theoretical concept of decisional control (i.e., perceived choice) guided the investigation. Significant multivariate effects were found for all dimensions of morale: agitation, attitude toward own aging, lonely dissatisfaction, and a combined morale index. Choice within the institution and social interaction were the major contributors to these significant multivariate relationships, but income was also influential in analysis of the attitudinal and combined morale indices for a subsample. Retrospective measures of health at relocation and choice in relocation were unstable in their contributions to overall multivariate relationships. Relationships of age, recency of loss of a significant other, and length of residency to morale were explored and found not to be significant. Results are discussed against the background of theoretical expectations, and avenues for future research are identified.

Life events, emotional support, and health of older people

The effects of life events, emotional support, interaction of life events and emotional support, and age on indices of physical and psychological health were examined within a hierarchical multiple-regression design. Fifty older people who were randomly selected from among the residents of a high-rise apartment building provided retrospective data on their life events and emotional support. These same subjects provided more recent data on their functional health, distress arising from chronic health problems, and four indices of morale (agitation, attitude toward own aging, lonely dissatisfaction, and a combined index of the morale dimensions). As expected, significant multivariate effects were demonstrated on all but two measures: distress arising from chronic health problems and attitude toward aging. Examination of the independent contributions to these effects showed variations depending on the health index of focus. Expected moderations of the effects of life events by emotional support effects were not demonstrated. Results are discussed in relationship to previous research and the theoretical expectation that emotional support would moderate the effects of life events on health.

The effects of cognitive and behavioral control on coping with an aversive health examination

The effects of cognitive and behavioral control on coping with an aversive health examination were tested in a 2 x 2 factorial design. Cognitive control was represented by sensory or health-education information; instruction or no instruction in abdominal relaxation constituted the levels of behavioral control. The study was conducted in the natural setting of a family-planning clinic with 24 young women who were undergoing a routine pelvic examination. Subjects who received sensory information prior to the examination showed less distress, as indicated by overt distress behaviors and pulse rates, than did subjects who received health-education information. Cognitive control did not show a significant effect on self-report of fear. No significant effects were demonstrated for the factor of behavioral control. The results suggested that cognitive control information, which emphasizes the sensory experiences typically accompanying an aversive event, limits reactivity to aversive stimuli. The reduction in reactivity is thought to result in an increased ability to cope with aversive events.

Characteristics of posthospitalization recovery following hysterectomy

A study to determine the characteristics of posthospitalization recovery after hysterectomy was designed and implemented. Explicit consideration was given to women's feelings of sexuality and the fears and myths which precede and follow the surgery. Retrospective and current self-report data on four major areas were obtained: a) physical changes, b) emotional changes, c) changes in sexuality, and d) fears or beliefs. The results identify some common posthysterectomy physical and emotional experiences. The data challenge the belief that hysterectomy is usually a blow to a woman's concept of self and indicate that most women do not harbor unrealistic fears of physical, emotional, and sexual sequelae. The study findings have implications for nursing care of hysterectomy patients.