Rheumatoid hand surgery: differing perceptions amongst surgeons, rheumatologists and therapists in the UK.

Rheumatoid arthritis is a systemic disease that requires coordinated management by rheumatologists, surgical specialists and therapists working in a multidisciplinary team. Differences of opinion within the team may adversely affect patient care. Our aim was to assess differences in perception about rheumatoid hand surgery between rheumatologists, hand surgeons and hand therapists in the UK. We used a postal questionnaire to assess commonly performed rheumatoid hand operations. For each procedure, respondents rated the most important indication for surgery and scored effectiveness at reducing pain, improving function and aesthetics, and preventing deformity. Statistically significant differences were found between all three groups with regards to expected outcome and main indications for surgery. We concluded that significant differences do exist in the perceptions of rheumatologists, surgeons and therapists. Rheumatoid hand operations require more detailed study, clarifying indications and outcome to allow consistent advice to patients from all members of the multidisciplinary team.

Factors affecting the test-retest variability of Heidelberg retina tomograph and Heidelberg retina tomograph II measurements.

AIMS: To evaluate the test-retest variability of stereometric parameter measurements made with the Heidelberg retina tomograph (HRT) and Heidelberg retina tomograph-II (HRT-II), and to establish which parameter(s) provided the most repeatable and reliable measurements with both devices. An investigation into the factors affecting the repeatability of the measurements of this parameter(s) was conducted. METHODS: 43 ocular hypertensive and 31 glaucoma subjects were recruited to a test-retest study. One eye from each subject underwent HRT and HRT-II imaging by two observers on each of two occasions within 6 weeks of each other. Lens grading was carried out by LOCS III grading and Scheimpflug camera generated densitogram analysis. RESULTS: Rim area (RA) and mean cup depth measurements were found to be least variable. Both inter-test reference height difference and image quality had a strong relation (R(2)>0.5, p<0.0001) with inter-test RA difference and, together, are responsible for 70% of RA measurement variability. Image quality was influenced by lens opacity, cylindrical error, and age. Inter-test RA measurement differences were unrelated to the observer or visit interval. CONCLUSIONS: RA represents an appropriate measure for monitoring glaucomatous progression. Reference height difference and image quality were the factors that most influenced RA measurement variability. Image analysis strategies that address these factors may reduce test-retest variability.

Improving the repeatability of Heidelberg retina tomograph and Heidelberg retina tomograph II rim area measurements.

AIMS: To devise and test strategies for improving Heidelberg retina tomograph (HRT and HRT-II) rim area (RA) repeatability and assess the benefit of the strategies in time series of HRT images. METHODS: The effect of the standard and 320 microm reference planes and image quality on RA repeatability was assessed in a test-retest HRT image dataset from 74 subjects. A longitudinal HRT image dataset from 30 ocular hypertensive subjects was analysed by linear regression of RA over time, with each of the reference planes and using a manual image alignment facility. RA variability was estimated by comparing the standard deviation of residuals (RSD) generated by each linear regression. RESULTS: RA repeatability was better with the 320 microm reference plane (repeatability coefficient 0.17 mm(2)), improving further with only good quality images (repeatability coefficient 0.08 mm(2)). For the longitudinal data, a significant (p<0.0001) reduction in the RSD from 0.10 to 0.05 mm(2) was obtained with the 320 microm reference plane. Manual alignment led to a further significant (p<0.0001) reduction in the RSD to 0.04 mm(2). CONCLUSIONS: The findings support the use of a 320 microm reference plane and manual image alignment to analyse RA over time. The estimates of RA repeatability may be used to define thresholds for glaucomatous change.

Is ultrasound useful for evaluating paediatric inflammatory neck masses?

OBJECTIVE: To determine the accuracy of ultrasound in detecting the presence of pus in a neck mass in children. DESIGN: Retrospective case sheet review. SETTING: A district general hospital. PARTICIPANTS: Children admitted from January 2000 to January 2004 with an acute cervical mass who were investigated by ultrasonography. MAIN OUTCOME MEASURES: The presence of a clinically relevant abscess that did not respond to clinical management was used to determine the accuracy of the ultrasound result. RESULTS: The sensitivity of ultrasound in the detection of an abscess was 65% and the specificity 88%. The predictive value of a positive ultrasound result was 81% and the predictive value of a negative test 77%. CONCLUSIONS: Ultrasound is a useful modality in the evaluation of acute cervical masses but is observer dependent and has a relatively low sensitivity in detecting whether or not pus is present. The clinical indicators for the presence of an abscess are discussed and clinicians should combine clinical findings with the ultrasound findings in order to determine treatment.

Market requirements for advanced biosensors in healthcare.

The Advanced Sensors Technology Transfer Programme (ASTTP) of the Department of Trade and Industry, stimulates and encourages the commercial exploitation of new sensor technology by UK industry. This review is based on the findings of a Study, sponsored under this programme, into the Market Requirements and Opportunities for Advanced Sensors in the Healthcare Industry.

Technology transfer in the diagnostics industry.

Initiatives are underway to increase links between researchers and inventors working in the diagnostics sector and companies ready to commercialize the new technologies. This article describes the formation and aims of two groups working in this area, and reports on a review that has been made of the market requirements and opportunities for advanced sensors in the health care sector. The medical sensors market is predicted to expand during the next few years and the best opportunities for their development are outlined.

Non-electrode biosensors in clinical biochemistry.

This review covers biosensors based on piezoelectric crystals, optical systems, field effect transistors and thermistors. Piezoelectric crystal or microgravimetric biosensors have been used for immunoassay. Optical biosensors are described in which waveguides are used to transmit changes in optical characteristics or, in an innovative mode, the evanescent wave component of a completely internally-reflected light beam is used to study optical changes. Optical biosensors have been used in immuno and in enzyme-based assays. Field effect transistors detect changes in ion concentrations and have been applied to the detection of biochemical reactions which involve a change in concentration of a specific ion. Thermistors are used to monitor the heat produced as the result of an exothermic enzymatic reaction and this has been applied to the assay of compounds or enzymes of interest. Biosensors may find a role in clinical biochemistry in low volume testing, patient self-testing and in vivo monitoring.

Triglyceride assay using the ABA-50 and Boehringer Mannheim Triglyceride reagent kit.

1. A procedure for the assay of triglycerides on the ABA-50 is described. 2. The Boehringer Mannheim Triglyceride (Fully Enzymatic method) reagent kit has been evaluated with this method and was found to be satisfactory.

Dupuytren's disease in epilepsy: result of prolonged administration of anticonvulsants.

In a study of chronic epileptics in a residential centre we recorded a 56% incidence of Dupuytren's disease. The lesions were usually bilateral and symmetrical and frequently associated with knuckle pads and plantar nodules. There was no direct relationship between Dupuytren's disease and frozen shoulder. Dupuytren's disease was seen equally in those with idiopathic or symptomatic epilepsy. The incidence increased with the duration of epilepsy and is probably a sequel to long-term administration of phenobarbitone. Reasons are given for presuming that the association between Dupuytren's disease and antiepileptic therapy is mediated through the peripheral stimulation of tissue growth factors and not through the central release of growth hormone or through alterations in liver metabolism.

Triglyceride assay using the ABA-100.

1. A fast, simple, accurate method for the assay of triglycerides on the ABA-100 is described. 2. The Abbott A-Gent Triglyceride kit, Calbiochem Triglyceride Stat-Pack reagent and the Smith Kline French Eskalab Triglyceride reagent were evaluated for use with this method. The reagents were all found to be satisfactory, but the Abbott A-Gent Triglyceride kit was found to be less stable than the other reagents.

Cholesterol in amniotic fluid, determined by gas chromatography.

Cholesterol was extracted from amniotic fluid, saponified, converted to its trimethylsilyl derivative, and gas chromatographed, with cholesteryl acetate as the internal standard. The method is sufficiently accurate and precise for use with the range of concentrations of cholesterol found in amniotic fluid (5 to 48 mg/litre). Total cholesterol was measured in amniotic fluids collected at different stages of gestation. No significant trend or change was observed nor was cholesterol in the amniotic fluid and the mother's serum correlated at any stage of gestation. Thus we conclude that cholesterol is not a useful indicator of fetal age or maturity. Cholesterol concentrations in amniotic fluid from complicated pregnancies were within the range found for normal pregnancies.