Renal point-of-care ultrasound performed by ED staff with limited training and 30-day outcomes in patients with renal colic.

BACKGROUND AND AIM: Emergency Department (ED) renal point-of-care ultrasound (PoCUS) in renal colic by accredited specialists has good prognostic value. This may not be generalizable to under-resourced EDs. We investigated PoCUS in renal colic in our ED with lesser training. METHODS: We performed a single-centre health records review of adult ED patients with renal colic and PoCUS. Patients were managed by a non-ED specialist/resident doctor with no POCUS accreditation in consultation with an attending. These doctors attended a 3.5-h training session conducted by accredited attendings to examine hydronephrosis. They needed to verify their PoCUS findings with an attending during the first two weeks of their six-month posting before performing it independently. The primary outcome was 30-day urological procedures in hydronephrotic vs. non-hydronephrotic groups. Secondary outcomes were the distribution of primary outcome with grades of hydronephrosis, 30-day ED nephrolithiasis-related reattendances in hydronephrotic vs. non-hydronephrotic groups and its distribution with grades of hydronephrosis. We compared outcomes using Fisher's exact test. We also reported crude odds ratio (COR) and 95% CI of primary outcome between hydronephrotic vs. non-hydronephrotic groups. p values ≤ 0.05 were significant. RESULTS: We recruited 651 patients; 160 (24.6%) without and 491 (75.4%) with hydronephrosis. Rates of grades of hydronephrosis were: mild (76.6%), moderate (13.8%), severe (1.2%) and undifferentiated (8.4%). There was a difference in 30-day urological procedures (rates [95% CI]) in hydronephrotic vs. non-hydronephrotic groups, 11.2 [8.7-14.0]% vs. 2.5 [1.0-6.3]%; p < 0.001; COR (95% CI) 4.9 (1.8-13.8); p = 0.002. Increasing 30-day urological procedural rates were associated with increasing grade of hydronephrosis [no: 2.5%, mild: 7.7%, moderate: 23.5%, severe: 67.0% and undifferentiated: 14.6%; p < 0.001]. No differences occurred in other secondary outcomes. CONCLUSIONS: Renal PoCUS could be performed by non-ED specialist/resident doctors to identify patients without hydronephrosis who rarely required urological intervention. Hydronephrotic patients could benefit from further risk stratification.

ABSTRAIT: CONTEXTE ET OBJECTIF: L'échographie rénale au point de soin (PoCUS) dans les coliques rénales par des spécialistes agréés a une bonne valeur pronostique. Cela peut ne pas être généralisable aux SU sous-financés. Nous avons étudié PoCUS dans les coliques rénales dans notre DE avec une formation moindre. MéTHODES: Nous avons effectué un examen des dossiers médicaux d'un seul centre des patients adultes atteints de coliques rénales et de PoCUS. Les patients étaient pris en charge par un médecin résident/spécialiste non-membre de la DG sans accréditation POCUS en consultation avec un médecin traitant. Ces médecins ont assisté à une séance de formation de 3,5 heures menée par des titulaires accrédités pour examiner l'hydronéphrose. Ils devaient vérifier leurs résultats PoCUS auprès d'un assistant pendant les deux premières semaines de leur affectation de six mois avant de l'effectuer de manière indépendante. Le critère de jugement principal était des procédures urologiques de 30 jours dans les groupes hydronéphrotiques vs non-hydronephrotiques. Les critères de jugement secondaires étaient la distribution du critère de jugement primaire avec les grades d'hydronéphrose, les reattendances liées à la néphrose ED de 30 jours dans les groupes hydronéphrotiques vs non hydronéphrotiques et sa distribution avec les grades d'hydronéphrose. Nous avons comparé les résultats en utilisant le test exact de Fisher. Nous avons également signalé un rapport de cotes brut (RC) et un IC à 95 % du critère de jugement principal entre les groupes hydronéphrotiques et non hydronéphrotiques. Les valeurs de P 0,05 étaient significatives. RéSULTATS: Nous avons recruté 651 patients; 160 (24,6%) sans et 491 (75,4%) avec hydronéphrose. Les taux d'hydronéphrose étaient les suivants : légère (76,6 %), modérée (13,8 %), sévère (1,2 %) et indifférenciée (8,4 %). Il y avait une différence dans les interventions urologiques de 30 jours (taux [IC à 95 %]) dans les groupes hydronéphrotiques par rapport aux groupes non-hydronephrotiques, 11,2 [8,7-14,0] % contre 2,5 [1,0-6,3]%; p < 0,001; RCC (IC à 95 %) 4,9 (1,8-13,8); p = 0,002. L'augmentation des taux de procédures urologiques de 30 jours était associée à l'augmentation du grade d'hydronéphrose [non : 2,5%, léger : 7,7%, modéré : 23,5%, sévère : 67,0% et indifférencié : 14,6%; p < 0,001]. Aucune différence n'est survenue dans les autres critères de jugement secondaires. CONCLUSIONS: La PoCUS rénale pourrait être réalisée par des médecins non spécialistes/résidents de la D pour identifier les patients sans hydronéphrose qui ont rarement nécessité une intervention urologique. Les patients hydronéphrotiques pourraient bénéficier d'une meilleure stratification des risques.

Poor quality of external validity reporting limits generalizability of overweight and/or obesity lifestyle prevention interventions in young adults: a systematic review.

Young adulthood is a high-risk life stage for weight gain. Evidence is needed to translate behavioural approaches into community practice to prevent weight gain in young adults. This systematic review assessed the effectiveness and reporting of external validity components in prevention interventions. The search was limited to randomized controlled trial (RCT) lifestyle interventions for the prevention of weight gain in young adults (18-35 years). Mean body weight and/or body mass index (BMI) change were the primary outcomes. External validity, quality assessment and risk of bias tools were applied to all studies. Twenty-one RCTs were identified through 14 major electronic databases. Over half of the studies were effective in the short term for significantly reducing body weight and/or BMI; however, few showed long-term maintenance. All studies lacked full reporting on external validity components. Description of the intervention components and participant attrition rates were reported by most studies. However, few studies reported the representativeness of participants, effectiveness of recruitment methods, process evaluation detail or costs. It is unclear from the information reported how to implement the interventions into community practice. Integrated reporting of intervention effectiveness and enhanced reporting of external validity components are needed for the translation and potential upscale of prevention strategies.

Detection of circulating gastric carcinoma-associated antigen MG7-Ag in human sera using an established single determinant immuno-polymerase chain reaction technique.

BACKGROUND: In 1994, a novel sensitive method termed immuno-polymerase chain reaction (PCR) for the detection of the gastric carcinoma-associated antigen MG7-Ag in the gastric carcinoma cell line KATO III was reported. Compared with the enzyme-linked immunoadsorbent assay, the single determinant immuno-PCR technique could allow for as few as 20 cells to be detected and was found to show an approximately 10,000-fold enhancement in sensitivity of the detection limit. The current study clinically evaluated the significance of serum MG7-Ag detection in gastric carcinoma patients. METHODS: The sera of patients were immobilized on wells and a specific DNA molecule, which could be amplified by PCR, was employed as a marker. The biotinylated monoclonal antibody against gastric carcinoma was added to bind the antigen immobilized on the wells. After the biotinylated antibody was bound to the antigen, free avidin was used to attach a biotinylated monoclonal antibody and biotinylated DNA molecule. The biotinylated DNA complexed with antigen-antibody-avidin was amplified by PCR and the PCR products were analyzed by agarose gel electrophoresis. In the current study this method was used to detect circulating MG7-Ag in the sera of patients with gastric carcinoma and other various malignancies. For comparison, carcinoembryonic antigen, CA 50, CA 19-9, and TAG-72 were quantitated by radioimmunoassay and immunoradiometric assay using the relevant commercial kits in the same sera samples from 86 patients with pathologically confirmed gastric carcinoma and 83 patients with relevant benign diseases of the stomach. In addition, the semiquantitative analysis of PCR products among gastric carcinoma patients with or without metastasis was performed to compare the intensity of DNA band amplification. RESULTS: Using the immuno-PCR assay, positive results were obtained in 164 of 198 patients with gastric carcinoma (82.8%). The rates of positivity in other malignancies were 17.4% for esophageal carcinoma (15 of 86 patients), 44.4% for colonic carcinoma (40 of 90 patients), 0% for liver carcinoma (none of 84 patients), 2.2% for ovarian carcinoma (1 of 45 patients), 0% for uterine carcinoma (none of 27 patients), and 6.1% for lung carcinoma (4 of 66 patients). The positive results obtained from those patients with benign diseases were: 7.7% for peptic ulcer (6 of 78 patients), 5.9% for chronic gastritis (7 of 118 patients), 3.3% for chronic colitis (2 of 60 patients), and 0.8% for healthy blood donors (2 of 236 patients). In addition, the semiquantitative analysis of PCR products showed that the intensity of DNA band amplified from the PCR products of those patients with metastasis was much higher than that of patients without metastasis or those with early stage tumors (1.94 +/- 0.03 vs. 1.28 +/- 0.02). In comparative studies of immuno-PCR and commercial assays for tumor-associated antigens the sensitivity of immuno-PCR was 81.4% and pseudopositivity was lower (8.4% vs. 7.2-12.0% with radioimmunoassay or immunoradiometric assay). CONCLUSIONS: The results of the current study demonstrate that introducing PCR into the indirect determination of tumor-associated antigen in the serum can improve the sensitivity of detection greatly. This novel assay also might be used to monitor the circulating amount of tumor-associated antigen after gastrectomy and provide information regarding recurrence or metastasis, as well as for screening elderly patients who have no indications for endoscopy and those with precancerous conditions. The application of immuno-PCR in the serologic diagnosis of carcinoma has significant advantages including ready application in the clinical setting as well as use as a potential screening tool in mass surveys of high risk populations with gastric carcinoma. (c) 2000 American Cancer Society.