A multiplexed point-of-care assay for C-reactive protein and N-terminal pro-brain natriuretic peptide.

Several new plasma protein biomarkers have been associated with increased risk of cardiovascular events. It would be of great value if sets of these markers could be measured in a multiplexed format at point-of-care settings. A major challenge is the extremely wide concentration range in which different plasma biomarkers are present. Two promising biomarkers for cardiac risk prediction are C-reactive protein (CRP) and N-terminal pro-brain natriuretic peptide (NTproBNP). The concentrations of these markers can differ by more than six orders of magnitude. Here we present a chip-based multiplexed assay for CRP and NTproBNP. The high-concentration analyte, CRP, is analyzed in a competitive format, whereas the low-concentration analyte, NTproBNP, is analyzed in a sandwich format. This allows concurrent measurement of the two analytes in a single multiplexed assay. The dynamic ranges for the two assays were optimized to match the relevant serum concentration ranges; thus, no dilutions were needed. Both assays exhibit good precision (5-15% in the clinically relevant concentration ranges), and the limit of detection for the NTproBNP assay was 5 ng/L. Patient plasma samples were used for comparison with clinical methods, resulting in coefficients of determination (R(2)) of 0.9762 and 0.9606 for NTproBNP and CRP, respectively.

Hospital, simulation center, and teamwork training for eclampsia management: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of training for eclampsia in local hospitals and a regional simulation center, with and without teamwork theory. METHODS: This study is a randomized controlled trial of training in local hospitals and in a simulation center in the United Kingdom. Midwives and obstetricians working at participating hospitals were randomly assigned to 24 teams. Teams were randomly allocated to training in local hospitals or at a simulation center, and to teamwork theory or not. Performance was evaluated before and after training with a standardized eclampsia scenario captured on video. Outcome measures were completion of tasks, time to completion of tasks, administration of magnesium sulfate, and quality of teamwork. RESULTS: Training was associated with an increase in completion of basic tasks; 87% before training and 100% afterward. Basic tasks were completed more quickly; 55 seconds compared with 27 seconds, P=.012. The magnesium sulfate loading dose was administered by 61% of teams before training and by 92% afterward (P=.040). There was a shorter median time to administration (116 seconds less; P=.011). Training at the simulation center was not associated with additional improvement. Teamwork generally improved (median global score rose from 2.5 to 4.0; P<.001) but there was no additional benefit from teamwork training. CONCLUSION: Training resulted in enhanced performance with higher rates of completion for basic tasks, shorter times to administration of magnesium sulfate, and improved teamwork. There was no additional benefit from training in a simulation center, and none from teamwork theory. CLINICAL TRIAL REGISTRATION: ISRCTN, http://isrctn.org, ISRCTN67906788, reference number 0270030.

Shoulder dystocia training using a new birth training mannequin.

Shoulder dystocia 'skill drills' are a requirement for the Maternity CNST standards. However, there is, as yet, no evidence that training in the management of shoulder dystocia improves outcome. We developed a mannequin for training and investigated its effectiveness. The management of shoulder dystocia improved following training with the mannequin. There was a reduction in the head-to-body delivery duration, and the maximum applied delivery force, following training; however, these did not reach statistical significance. After training no subject applied a delivery force of greater than 100 N, a level above which fetal injury has been shown to occur.

Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 2: Psychosocial effects.

The aims of this project were to evaluate whether early orthodontic treatment with the Twin-block appliance for the developing Class II Division 1 malocclusion resulted in any psychosocial benefits. This multicenter trial was carried out in the United Kingdom, with 174 children aged 8 to 10 years with Class II Division 1 malocclusions randomly allocated to receive treatment with Twin-block appliances or to an untreated control group. Data were collected at the start of the study and 15 months later. Results showed that early treatment with Twin-block appliances resulted in an increase in self-concept and a reduction of negative social experiences. The subjects also reported treatment benefits that could be related to improved self-esteem. Further research is needed to determine the extent to which these effects translate into social behavior and experiences.

Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 1: Dental and skeletal effects.

This study evaluated the effectiveness of early orthodontic treatment with the Twin-block appliance for the developing Class II Division 1 malocclusion. This multicenter trial was carried out in the United Kingdom. A total of 174 children, aged 8 to 10 years old, with Class II Division 1 malocclusion were randomly allocated to receive treatment with a Twin-block appliance or to an untreated, control group. Data were collected at the start of the study and 15 months later. Results showed that early treatment with Twin-block appliances resulted in reduction of overjet, correction of molar relationships, and reduction in severity of malocclusion. Most of this correction was due to dentoalveolar change, but some was due to favorable skeletal change. Early treatment with the Twin-block appliance is effective in reducing overjet and severity of malocclusion. The small change in the skeletal relationship might not be considered clinically significant.

Effectiveness of treatment for Class II malocclusion with the Herbst or twin-block appliances: a randomized, controlled trial.

The aim of this study was to evaluate the effectiveness of Herbst and Twin-block appliances for established Class II Division I malocclusion. The study was a multicenter, randomized clinical trial carried out in orthodontic departments in the United Kingdom. A total of 215 patients (aged 11-14 years) were randomized to receive treatment with either the Herbst or the Twin-block appliance. Treatment with the Herbst appliance resulted in a lower failure-to-complete rate for the functional appliance phase of treatment (12.9%) than did treatment with Twin-block (33.6%). There were no differences in treatment time between appliances, but significantly more appointments (3) were needed for repair of the Herbst appliance than for the Twin-block. There were no differences in skeletal and dental changes between the appliances; however, the final occlusal result and skeletal discrepancy were better for girls than for boys. Because of the high cooperation rates of patients using it, the Herbst appliance could be the appliance of choice for treating adolescents with Class II Division 1 malocclusion. The trade-off for use of the Herbst is more appointments for appliance repair.