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Background. Acute pharyngitis caused by Group A Streptococcus (GAS) is a common presentation to pediatric emergency departments (ED). Diagnosis with conventional throat culture requires 18–24 hours, which prevents point-of-care treatment decisions. Rapid antigen detection tests (RADT) are faster, but previous reports demonstrate significant operator influence on performance. Objective. To measure operator influence on the diagnostic accuracy of a RADT when performed by pediatric ED nurses and clinical microbiology laboratory technologists, using conventional culture as the reference standard. Methods. Children presenting to a pediatric ED with suspected acute pharyngitis were recruited. Three pharyngeal swabs were collected at once. One swab was used to perform the RADT in the ED, and two were sent to the clinical microbiology laboratory for RADT and conventional culture testing. Results. The RADT when performed by technologists compared to nurses had a 5.1% increased sensitivity (81.4% versus 76.3%) (p = 0.791) (95% CI for difference between technologists and nurses = −11% to +21%) but similar specificity (97.7% versus 96.6%). Conclusion. The performance of the RADT was similar between technologists and ED nurses, although adequate power was not achieved. RADT may be employed in the ED without clinically significant loss of sensitivity.

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Twenty hyperactive 6- to 9-year-old children of normal intelligence were studied in a half-day laboratory classroom in a 2-week period baseline-treatment-reversal design for behavior modification. Under double-blind conditions half the children were placed on .3 mg/kg of Ritalin and half on placebo for the entire program. The classroom program consisted of a group period with immediate reinforcement possible, and an individual time period without immediate reinforcement possible. Behavior modification caused a significant decrease in nonattending, out-of-seat, inappropriate vocalizing and inappropriate peer interaction behavior in the group period. Fidgeting, a nontargeted behavior, was not significantly decreased during this period but did significantly decrease as a result of medication. No other drug effects occurred during this period. During the individual period, the results were essentially reversed. There were no significant behavior modification effects observed. Significant reductions resulted from medication in all behaviors except out-of-seat and fidgeting. Behavior modification alone significantly affected the two academic measures. No signigicant effects were seen on the Conners Abbreviated Teacher Rating Scale. No significant interactions were noted between medication and behavior modification.