Abstract. The development of good quality and affordable ultrasound machines has led to the establishment and implementation of numerous point-of-care ultrasound (POCUS) protocols in various medical disciplines. POCUS for major infectious diseases endemic in tropical regions has received less attention, despite its likely even more pronounced benefit for populations with limited access to imaging infrastructure. Focused assessment with sonography for HIV-associated TB (FASH) and echinococcosis (FASE) are the only two POCUS protocols for tropical infectious diseases, which have been formally investigated and which have been implemented in routine patient care today. This review collates the available evidence for FASH and FASE, and discusses sonographic experiences reported for urinary and intestinal schistosomiasis, lymphatic filariasis, viral hemorrhagic fevers, amebic liver abscess, and visceral leishmaniasis. Potential POCUS protocols are suggested and technical as well as training aspects in the context of resourcelimited settings are reviewed. Using the focused approach for tropical infectious diseases will make ultrasound diagnosis available to patients who would otherwise have very limited or no access to medical imaging.
The presence of acid-fast bacilli (AFB) in laboratories has traditionally been demonstrated using the fluorochrome method, which requires a fluorescent microscope or the Ziehl-Neelsen (ZN) method employing light microscopy. Low sensitivity of the ZN method and high costs of fluoroscopy make the need for a more effective means of diagnosis a top priority, especially in developing countries where the burden of tuberculosis is high. The QBC ParaLens™ attachment (QBC Diagnostic Inc., Port Matilda, PA) is a substitute for conventional fluoroscopy in the identification of AFB. To evaluate the efficacy of the ParaLens LED (light-emitting diode) system, the authors performed a two-part study, looking at usefulness, functionality and durability in urban/rural health clinics around the world, as well as in a controlled state public health laboratory setting. In the field, the ParaLens was durable and functioned well with various power sources and lighting conditions. Results from the state laboratory indicated agreement between standard fluorescent microscopy and fluorescent microscopy using the ParaLens. This adaptor is a welcome addition to laboratories in resource-limited settings as a useful alternative to conventional fluoroscopy for detection of mycobacterial species.
Numerical precision is a science with a mission And I think it's gonna drive me insane -Jimmy Buffett 1 We recently finished data analysis on a study in which we calculated the reliability of our resident selection process. The process involved scoring resident candidates in nine categories. We spent substantial time and energy on study design and statistical validity. The study required seven physicians to evaluate the residency applications of 33 candidates with a score of 1-5 in all nine categories. The individual score in each category was multiplied by the weight for the category (0.5, 1.0, 1.5). The physicians were required to add the scores to arrive at a total. The lowest possible score was 10.5 and the highest was 52. Thus, each physician had to multiply the individual scores in each category by 0.5, 1.0, or 1.5, then add the nine scores together for a total. This was a total of ten calculations for each candidate involving nine very simple multiplications and one addition problem. In all, there were 2,310 calculations required for the study.We noticed early in our data collection that some of the totals were not added correctly. This was in spite of the fact that each physician had access to a hand-held calculator. A computer program was generated to automatically add the nine categories and compare the results with the physician-calculated total. We found 30 discrepancies between the computer-calculated and physiciancalculated total scores. This represents a discrepancy of 13% for the 231 addition problems. At least one discrepancy was found for every physician in the study, with a range between one and eight per physician. The differences between the computer-calculated and physiciancalculated addition ranged between Ϫ9.0 and ϩ5.0.Data entry for the study was performed by the authors and was checked at the time of entry. It is possible that at least several of the differences between the computer and physician totals were due to errors in data entry, as there were 2,310 data points. Nevertheless, many of the errors of addition were large. This suggests that when the physicians added up the total score, an entire category was simply omitted.For the purposes of the original study we used the physician-generated total. We thought this most accurately reflected the way the score sheet performed in practice. We would point out that there were no time constraints on either the raters or the physicians performing the data entry.While we do not believe that these inaccuracies are typical of research performed in our department, it does cause us to wonder how prevalent simple math errors are in studies requiring large numbers of elementary calculations. Certainly this serves as an example of how poorly a group of otherwise intelligent, well-educated individuals can perform at a mundane task.-DAVID LEDRICK, MD (dledrick@
Recommendations for diagnosis and treatment of malignant ovarian tumors with regard to the most recent data were worked out in a consensus process and valued by level of evidence (LoE) and grade of recommendation (GoR) of the Canadian Task Force for Preventive Health Care by the members of the Kommission Ovar der Arbeitsgemeinschaft für Gynäkologische Onkologie (AGO) in June 2005. A short version of these guidelines is presented.
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