Issue:4 Citation

ABSTRACT Melamine is a toxic triazine used as an adulterant in milk & milk related products to increase the protein content. RP-HPLC method has been developed using water as mobile phase to detect and quantify the melamine residue in powdered milk. Melamine was extracted by precipitation of milk protein at its isoelectric point with dilute acids. Samples were purified by using membrane filter of 0.45 µm pore size, AmChemteq ACI C 18 (4.6mmx250mm, 5µm) column as the stationary phase. The linearity curve was constructed for the concentration of melamine ranging from 1 mg/kg to 25 mg/kg. The correlation co-efficient was found to be 1.000. Ten marketed powdered milk brands were studied by this method. It was observed that all the ten brands were found to contain melamine residue ranging from 0.00001 mg/kg to 0.00006 mg/kg. The results were below the limits set by Food Safety and Standards Authority of India. This is the first study to confirm the existence of melamine residue in powdered milk marketed in Tamilnadu

Clinical encounters about obesity: systematic review of patients’ perspectives

Guidelines recommend clinicians intervene on obesity but it is unclear how people with overweight react. In this systematic review, we searched 20 online databases for qualitative studies interviewing people with overweight or obesity who had consulted a primary care clinician. Framework synthesis was used to analyse 21 studies to produce a new theoretical understanding. Consultations in which patients discussed their weight were more infrequent than patients would have liked, which some perceived was because they were unworthy of medical time; others that it indicated doctors feel being overweight is not a serious risk. Patients reported that doctors offered banal advice assuming that the patient ate unhealthily or was not trying to address their weight. Patients reported doctors assumed that their symptoms were due to overweight without a proper history or examination, creating concern that serious illness may be missed. Patients responded positively to offers of support for weight loss and active monitoring of weight. Patients with overweight internalize weight stigma sensitizing them to clues that clinicians are judging them negatively, even if weight is not discussed. Patients' negative experiences in consultations relate to perceived snap judgements and flippant advice and negative experiences appear more salient than positive ones

Impact of point-of-care panel tests in ambulatory care: a systematic review and meta-analysis

Objectives This article summarises all the available evidence on the impact of introducing blood-based point-of-care panel testing (POCT) in ambulatory care on patient outcomes and healthcare processes. Design Systematic review and meta-analysis of randomised-controlled trials and before-after studies. Data sources Ovid Medline, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, Database of Abstracts of Reviews and Effects, Science Citation Index from inception to 22 October 2019. Eligibility criteria for selecting studies Included studies were based in ambulatory care and compared POCT with laboratory testing. The primary outcome was the time to decision regarding disposition that is, admission/referral termed disposition decision (DD) time. Secondary outcomes included length of stay (LOS) at the ambulatory care unit/practice and mortality. Results 19 562 patients from nine studies were included in the review, eight of these were randomised-controlled trials, and one was a before-after study. All the studies were based in either emergency departments or the ambulance service; no studies were from primary care settings. General panel tests performed at the POCT resulted in DDs being made 40 min faster (95% CI −42.2 to −36.6, I2=0%) compared with the group receiving usual care, including central laboratory testing. This in turn resulted in a reduction in LOS for patients who were subsequently discharged by 34 min (95% CI −63.7 to −5.16). No significant difference in mortality was reported. Discussion Although statistical and clinical heterogeneity is evident and only a small number of studies were included in the meta-analysis, our results suggest that POCTs might lead to faster discharge decisions. Future research should be performed in primary care and identify how POCTs can contribute meaningful changes to patient care rather than focusing on healthcare processes

The clinical utility of point-of-care tests for influenza in ambulatory care: A systematic review and meta-analysis

Background Point-of-care tests (POCTs) for influenza are diagnostically superior to clinical diagnosis, but their impact on patient outcomes is unclear. Methods A systematic review of influenza POCTs versus usual care in ambulatory care settings. Studies were identified by searching six databases and assessed using the Cochrane risk of bias tool. Estimates of risk ratios (RR), standardised mean differences, 95% confidence intervals and I2 were obtained by random effects meta-analyses. We explored heterogeneity with sensitivity analyses and meta-regression. Results 12,928 citations were screened. Seven randomized studies (n = 4,324) and six non-randomized studies (n = 4,774) were included. Most evidence came from paediatric emergency departments. Risk of bias was moderate in randomized studies and higher in non-randomized studies. In randomized trials, POCTs had no effect on admissions (RR 0.93, 95% CI 0.61–1.42, I2 = 34%), returning for care (RR 1.00 95% CI = 0.77–1.29, I2 = 7%), or antibiotic prescribing (RR 0.97, 95% CI 0.82–1.15, I2 = 70%), but increased prescribing of antivirals (RR 2.65, 95% CI 1.95–3.60; I2 = 0%). Further testing was reduced for full blood counts (FBC) (RR 0.80, 95% CI 0.69–0.92 I2 = 0%), blood cultures (RR 0.82, 95% CI 0.68–0.99; I2 = 0%) and chest radiography (RR 0.81, 95% CI 0.68–0.96; I2 = 32%), but not urinalysis (RR 0.91, 95% CI 0.78–w1.07; I2 = 20%). Time in the emergency department was not changed. Fewer non-randomized studies reported these outcomes, with some findings reversed or attenuated (fewer antibiotic prescriptions and less urinalysis in tested patients). Conclusions Point-of-care testing for influenza influences prescribing and testing decisions, particularly for children in emergency departments. Observational evidence shows challenges for real-world implementation.</p

John Campbell, attorney for Joe Ricci in his lawsuit against the city of Portlan

John Campbell, attorney for Joe Ricci in his lawsuit against the city of Portland, in September received a new page of statements allegedly made by Holiday Inn West bartender Peg Manson to Portland Police Detective John Virginio. Campbell said he suspected some of the original interview between Virginio and Manson was deleted to strengthen the city\u27s case against Ricci. Ricci filed the lawsuit after a September 7, 1996, incident in which he was arrested at the Holiday Inn and taken to jail. Details

The clinical utility of point-of-care tests for influenza in ambulatory care: A systematic review and meta-analysis

Background Point-of-care tests (POCTs) for influenza are diagnostically superior to clinical diagnosis, but their impact on patient outcomes is unclear. Methods A systematic review of influenza POCTs versus usual care in ambulatory care settings. Studies were identified by searching six databases and assessed using the Cochrane risk of bias tool. Estimates of risk ratios (RR), standardised mean differences, 95% confidence intervals and I2 were obtained by random effects meta-analyses. We explored heterogeneity with sensitivity analyses and meta-regression. Results 12,928 citations were screened. Seven randomized studies (n = 4,324) and six non-randomized studies (n = 4,774) were included. Most evidence came from paediatric emergency departments. Risk of bias was moderate in randomized studies and higher in non-randomized studies. In randomized trials, POCTs had no effect on admissions (RR 0.93, 95% CI 0.61–1.42, I2 = 34%), returning for care (RR 1.00 95% CI = 0.77–1.29, I2 = 7%), or antibiotic prescribing (RR 0.97, 95% CI 0.82–1.15, I2 = 70%), but increased prescribing of antivirals (RR 2.65, 95% CI 1.95–3.60; I2 = 0%). Further testing was reduced for full blood counts (FBC) (RR 0.80, 95% CI 0.69–0.92 I2 = 0%), blood cultures (RR 0.82, 95% CI 0.68–0.99; I2 = 0%) and chest radiography (RR 0.81, 95% CI 0.68–0.96; I2 = 32%), but not urinalysis (RR 0.91, 95% CI 0.78–w1.07; I2 = 20%). Time in the emergency department was not changed. Fewer non-randomized studies reported these outcomes, with some findings reversed or attenuated (fewer antibiotic prescriptions and less urinalysis in tested patients). Conclusions Point-of-care testing for influenza influences prescribing and testing decisions, particularly for children in emergency departments. Observational evidence shows challenges for real-world implementation.</p