ABSTRACT
Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are two important viral pathogens that cause respiratory tract infections in the pediatric population. The rapid detection of these agents allows the prompt isolation and treatment of infected patients. In the present prospective study, we evaluated the performances of four rapid antigen detection assays, including a rapid chromatographic immunoassay (CIA) for RSV (Directigen EZ RSV; Becton Dickinson, Sparks, MD), a direct fluorescent-antibody assay (DFA) for RSV (Bartels; Trinity Biotech, Carlsbad, CA), and two DFAs for hMPV manufactured by Diagnostic Hybrids Inc. (DHI; Athens, OH) and Imagen (Oxoid Ltd., Basingstoke, Hampshire, United Kingdom). The clinical specimens tested comprised 515 nasopharyngeal aspirates submitted to the Clinical Microbiology Laboratory at Hartford Hospital from 1 November 2006 to 21 April 2007. Compared to the results of real-time reverse transcription-PCR (RT-PCR), the CIA had a sensitivity of 79.8% and a specificity of 89.5%. The RSV DFA with Bartels reagents showed a sensitivity of 94.1% and a specificity of 96.8%. For hMPV, the sensitivity and specificity were 62.5% and 99.8%, respectively, for the DHI DFA and 63.2% and 100%, respectively, for the Imagen DFA. The hands-on and test turnaround times for CIA were 10 and 30 to 60 min, respectively, and the hands-on and test turnaround times for the RSV and hMPV DFAs were 30 and 105 min, respectively. We conclude that while the RSV CIA is user-friendly, it lacks sensitivity and specificity, especially during off-peak months. In contrast, the RSV DFA is more sensitive and specific, but interpretation of its results is subjective and it demands technical time and expertise. Similarly, both hMPV DFAs are highly specific in comparison to the results of RT-PCR, but their sensitivities await further improvements.
Subject(s)
Antigens, Viral/immunology , Immunoassay/methods , Metapneumovirus/isolation & purification , Paramyxoviridae Infections/diagnosis , Respiratory Syncytial Virus Infections/diagnosis , Respiratory Syncytial Viruses/isolation & purification , Antigens, Viral/analysis , Female , Humans , Infant , Male , Metapneumovirus/immunology , Paramyxoviridae Infections/epidemiology , Paramyxoviridae Infections/virology , Pharynx/virology , Prospective Studies , Respiratory Syncytial Virus Infections/epidemiology , Respiratory Syncytial Virus Infections/virology , Respiratory Syncytial Viruses/immunology , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/virology , Reverse Transcriptase Polymerase Chain Reaction , Seasons , Sensitivity and Specificity , Time FactorsABSTRACT
OBJECTIVES: The Kingston Standardized Cognitive Assessment-Revised (KSCA-R) was designed to be a cognitive screening tool available to health professionals who were not trained in specialized cognitive assessment techniques. It was introduced to bridge the gap between brief, narrowly focused rating scales, and intensive, expensive, full neuropsychological assessments. We now present the Brief Kingston Standardized Cognitive Assessment-Revised (BriefKSCA-R). METHODS: Groups of Alzheimer's disease patients, patients suffering from other dementias, and a group of normal community dwelling elderly were assessed using the BriefKSCA-R. RESULTS: This shortened version of the full Kingston Standardized Cognitive Assessment-Revised can be given in half the time while retaining most of the full KSCA-R's effectiveness. CONCLUSIONS: Suitable for a quick screening, or follow-up of patients already more fully assessed.
Subject(s)
Cognition Disorders/diagnosis , Psychiatric Status Rating Scales , Aged , Aged, 80 and over , Alzheimer Disease/complications , Alzheimer Disease/psychology , Cognition Disorders/complications , Cognition Disorders/psychology , Dementia/complications , Dementia/psychology , Female , Geriatric Assessment/methods , Humans , Male , Predictive Value of Tests , PsychometricsABSTRACT
The original Kingston Standardized Cognitive Assessment (KSCA) was designed to assess cognitive functioning in the elderly with suspected organic brain damage (i.e. dementia). It was specifically designed to be a relatively quickly administered assessment tool available to mental health professionals who were not trained in specialized cognitive assessment techniques. It was introduced over a decade ago to bridge a gap between brief, narrowly focused rating scales, and intensive, expensive, full neuropsychological assessments. Recently, a revision of the KSCA was completed. This revision includes the addition of a word-list memory task with immediate recall, delayed recall and recognition formats, as well as new norms for patients with Alzheimer's disease (AD). The updated norms reflect the abilities of higher-functioning (community-dwelling) patients. In order to facilitate the Revised KSCAs use we have developed a new scoring and analysis form as well as a more comprehensive scoring and administration manual. These changes have resulted in better detection of earlier Alzheimer's disease and use of comparison groups that reflect the changing referral base. The structure of the revised scale and updated normative data are described. An illustrative clinical case example is also provided.
