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Abstract Background Influenza infection remains a major health threat for animals and humans which crucially requires effective antiviral remedies. The usage of herbal medications as readily available alternatives for their compatibility with the body and fewer side effects compared to synthetic chemical treatments has become popular globally. The aim of this study was to investigate and screen in vitro anti-influenza activity of extracts of five South African medicinal plants, namely Tabernaemontana ventricosa, Cussonia spicata, Rapanea melanophloeos, Pittosporum viridiflorum and Clerodendrum glabrum, species which are used traditionally for the treatment of several diseases such as inflammatory and respiratory diseases. Methods Methanol, ethanol (100% and 30%), acetone, hot and cold water extracts of the powdered plants leaves were obtained by standard methods. The cytotoxicity was determined by the MTT colorimetric assay on MDCK cells. The concentrations below CC50 values were tested for antiviral activity against influenza A virus (IAV) in different combination treatments. The effect of extracts on viral surface glycoproteins and viral titer were tested by HI and HA virological assays, respectively. Results Based on the applied methods, the most effective results against IAV were obtained from Rapanea melanophloeos methanol leaf extract (EC50 = 113.3 μg/ml) and Pittosporum viridiflorum methanol, 100% and 30% ethanol and acetone leaf extracts (EC50 values = 3.6, 3.4, 19.2, 82.3 μg/ml, respectively) in all types of combined treatments especially in pre- and post-penetration combined treatments with highly significant effects against viral titer (P ≤ 0.01). Conclusion The outcomes offer for the first time a scientific basis for the use of extracts of Rapanea melanophloeos and Pittosporum viridiflorum against IAV. It is worth focusing on the isolation and identification of effective active compounds and elucidating the mechanism of action from these species. However, Tabernaemontana ventricosa, Cussonia spicata and Clerodendrum glabrum leaf extracts were ineffective in vitro in this study.

Ventriculoperitoneal shunting (VPS) is the surgical technique of choice to manage pediatric hydrocephalus. Despite having good results, it is prone to complications, some of which are rare. This is the case report of a 2-year-old male, with an uncomplicated VPS done at 6 months of age, presenting with vomiting, irritability, anorexia, and drooling. There was an oral protrusion of a tube dripping clear fluid. Imaging studies demonstrated evidence of gastric perforation with a cephalic migration and transoral protrusion of the distal end of the shunt tubing. A gastroplasty, and immediate revision of the distal shunt were done free of any complications. This case report underlines the importance of recognizing and managing trans-oral protrusion of the distal end of VPS system in a timely manner, and raises awareness of this uncommon complication and its potential influence on patient health and survival, given ventriculitis' high lethality., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Produced water, a major by-product of oil and gas production, represents the most significant amount of waste by volume in the oil and gas industry. Focusing on the hydrocarbon's lifecycle, this review delves into the composition and global variations of produced water. It assesses the current treatment methods for their effectiveness and their potential for reuse in sectors beyond oil and gas, such as agriculture. The review highlights the environmental trade-offs in maximising energy production, analysing the ecological implications of produced water disposal in marine environments and the potential risks to marine biodiversity. Regional regulatory frameworks and their role in mitigating these environmental impacts are examined, alongside the challenges faced in standardising treatment solutions due to the complex nature of produced water. The conclusion underscores the need for continuous research to develop innovative and effective treatment technologies and advocates for a balanced approach to energy production that prioritises environmental stewardship., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the clinical performance of the novel PivNG primers and probes set (PivNG test) used in the cobas omni Utility Channel for supplemental testing of Neisseria gonorrhoeae (NG)., Methods: Oropharyngeal, urogenital and rectal samples were self-collected during routine testing at Barts Health sexual health clinics, London, UK. Samples were tested by the cobas CT/NG test and PivNG cobas omni Utility Channel test on cobas 6800/8800 Systems. Supplemental testing was carried out with the Xpert CT/NG test. PivNG overall percent agreements, positive percent agreements (PPAs)/negative percent agreements (NPAs) and positive/negative predictive values were calculated for each sample type. Microscopy and/or culture data were included for a randomised subset of concordant/discordant results, and a composite reference standard (cobas CT/NG, Xpert CT/NG and culture results) adjusted for partial verification bias was used to determine PivNG PPA and NPA., Results: Of 447 evaluable samples with valid results from all three assays (cobas CT/NG, PivNG and Xpert CT/NG), 288 (64.4%) were NG-positive by both PivNG and cobas CT/NG; 117 (26.2%) were NG-negative in both tests; and 42 (9.4%) had discordant results (with NG-negative supplementary Xpert) CT/NG results in 40/42 instances). Of 19 PivNG/Xpert CT/NG-discordant samples, 11 were confirmed NG-positive by microscopy and/or culture results. PivNG PPA and NPA were 100% and 91% for oropharyngeal swabs, 100% and 100% for vaginal swabs, 100% and 100% for male urine samples, and 100% and 97% for rectal swabs, respectively, compared with the partially adjusted composite reference standard., Conclusions: PivNG is a reliable supplementary test with high sensitivity for confirming NG infection when used in conjunction with the cobas CT/NG test and samples collected in cobas PCR Media. Moreover, the PivNG test offers a convenient, high-throughput solution for supplemental NG testing of various sample types, with the potential to reduce the number of indeterminate reports., Competing Interests: Competing interests: MH received support from Roche Molecular Systems for study protocol costs and is a member of the speaker's bureau of Roche Molecular Systems. XCP received support from Roche Diagnostics to attend past meetings not related to this study. DP, RS and SS have nothing to disclose. RA, ML and AH are employees of Roche Molecular Systems and report receiving stocks and stock options from Roche. MN is an employee of Roche Molecular Systems., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) can lead to long-term sequelae in males and females; however, global prevalence data vary between geographical regions, as these sexually transmitted infections are not included in routine screening. The objective of this study was to use the cobas ® TV/MG assay to assess the point prevalence of TV and MG in specimens from men and women over a broad European geographical area. Urine, vaginal, endocervical, and rectal samples were collected from patients aged ≥ 18 years receiving Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (NG) screening as per local standard of care at sites in Belgium, Germany, Spain, and the UK (Wales). Remnant samples were assessed using the cobas TV/MG assay. Analysis of 2795 samples showed that MG prevalence varied slightly across female sample types (range: 1.7-5.8%; p = 0.0042). MG prevalence was higher in male rectal samples (12.5%) than in male urine samples (3.9%; p < 0.0001). TV prevalence was low in male (0.8%; 12/1535) and female (1.3%; 16/1260) samples across all sites. Co-infection of TV/MG with CT or NG was 10.0% (19/190) and 9.6% (7/73), respectively, in both male and female samples. MG and TV prevalence rates were comparable to the published literature in Europe. MG prevalence was highest in male rectal samples; as rectal testing is an off-label use of the cobas TV/MG assay, the clinical utility of this assay for rectal testing should be further investigated., (© 2022. The Author(s).)

Background: HIV-1 viral load assays are essential tools for clinical management of people living with HIV-1., Objectives and Study Design: We evaluated concordance between three assays: the cobas® HIV-1 test for use on the cobas® 6800 and cobas® 8800 systems (cobas HIV-1); the COBAS® TaqMan® HIV-1 Test, v2.0 for use with the High Pure System and the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 test, v2.0. Analytical sensitivity, precision and accuracy of all three methods were assessed using the WHO 2nd International Standard for HIV-1, with concentrations from 5 to 1000 copies/mL. Accuracy and concordance were evaluated using 212 clinical specimens. Overall percent agreement (OPA) was determined using three different thresholds used as medical decision points., Results: The limit of detection was below 20 copies/mL for each assay. The hit rate for each assay was 100 % for concentrations ≥ 50 copies/mL. Only the cobas HIV-1 test generated quantifiable data for all replicates at 50 copies/mL. Between 50 and 400 copies/mL, results for all assays were accurate within 0.09 log 10 copies/mL, with standard deviation less than 0.14 log 10 copies/mL. The mean difference between paired results in clinical specimens ranged from -0.050 to 0.107 log 10 copies/mL across all assay comparisons. The OPA between pairs of assays ranged from 94.8 to 98.1% at the 50 copies/mL cutoff, and improved to a range of 97.6-99.0% at the 200 copies/mL cutoff. At the 1000 copies/mL cutoff, OPA between assays was 98.5-99.0%., Conclusions: The cobas HIV-1 assay is highly sensitive, accurate and suitable for use in clinical practice., (Copyright © 2021. Published by Elsevier B.V.)

This paper assesses the performance of an integrated multistage laboratory-scale plant, for the treatment of poultry slaughterhouse wastewater (PSW). The system was comprised of an eco-flush dosed bio-physico pre-treatment unit for fats, oil, and grease (FOG) hydrolysis prior to the PSW being fed to a down-flow expanded granular bed reactor (DEGBR), coupled to a membrane bioreactor (DEGBR-MBR). The system's configuration strategy was developed to achieve optimal PSW treatment by introducing the enzymatic pre-treatment unit for the lipid-rich influent (PSW) in order to treat FOG including odour causing constituents such as H 2 S known to sour anaerobic digestion (AD) such that the PSW pollutant load is alleviated prior to AD treatment. This was conducted to aid the reduction in clogging and sludge washout in the DEGBR-MBR systems and to achieve the optimum reactor and membrane system performance. A performance for the treatment of PSW after lipid reduction was conducted through a qualitative analysis by assessing the pre- and post-pre-treatment units' chemical oxygen demand (COD), total suspended solids (TSS), and FOG concentrations across all other units and, in particular, the membrane units. Furthermore, a similar set-up and operating conditions in a comparative study was also performed. The pre-treatment unit's biodelipidation abilities were characterised by a mean FOG removal of 80% and the TSS and COD removal reached 38 and 56%, respectively. The final acquired removal results on the DEGBR, at an OLR of ~18-45 g COD/L.d, was 87, 93, and 90% for COD, TSS, and FOG, respectively. The total removal efficiency across the pre-treatment-DEGBR-MBR units was 99% for COD, TSS, and FOG. Even at a high OLR, the pre-treatment-DEGBR-MBR train seemed a robust treatment strategy and achieved the effluent quality set requirements for effluent discharge in most countries.

This study presents the biological treatment of poultry slaughterhouse wastewater (PSW) using a combination of a biological pretreatment stage, an expanded granular sludge bed reactor (EGSB), and a membrane bioreactor (MBR) to treat PSW. This PSW treatment was geared toward reducing the concentration of contaminants present in the PSW to meet the City of Cape Town (CoCT) discharge standards and evaluate an alternative means of treating medium- to high-strength wastewater at low cost. The EGSB used in this study was operated under mesophilic conditions and at an organic loading rate (OLR) of 69 to 456 mg COD/L·h. The pretreatment stage of this laboratory-scale (lab-scale) plant played an important role in the pretreatment of the PSW, with removal percentages varying between 20% and 50% for total suspended solids (TSS), 20% and 70% for chemical oxygen demand (COD), and 50% and 83% for fats, oil, and grease (FOG). The EGSB further reduced the concentration of these contaminants to between 25% and 90% for TSS, 20% and 80% for COD, and 20% and >95% for FOG. The last stage of this process, i.e., the membrane bioreactor (MBR), contributed to a further decrease in the concentration of these contaminants with a peak removal performance of >95% for TSS and COD and 80% for the FOG. Overall, the system (pretreatment-EGSB-MBR) exceeded 97% for TSS and COD removal and 97.5% for FOG removal. These results culminated in a product (treated wastewater) meeting the discharge standards.

The Roche cobas MTB and MTB-RIF/INH assays allow for detection of Mycobacterium tuberculosis complex (MTBC) nucleic acid and rifampicin (RIF) and isoniazid (INH) resistance-associated mutations in an automated, high-throughput workflow. In this study, we evaluated the performance of these assays, employing samples from settings of low and high tuberculosis (TB) burdens. A total of 325 frozen, leftover respiratory samples collected from treatment-naive patients with presumptive TB in Germany ( n  = 280) and presumptive RIF-resistant TB in Sierra Leone ( n  = 45) were used in this study. cobas MTB results for detection of MTBC DNA from N -acetyl-l-cysteine-sodium hydroxide (NALC-NaOH)-treated samples were compared to culture results. Predictions of RIF and INH resistance by the cobas MTB-RIF/INH assay were compared to a composite reference standard (phenotypic drug susceptibility testing and line probe assay). Whole-genome sequencing was used to resolve discordances. The overall sensitivity of cobas MTB for detection of MTBC DNA in culture-positive samples ( n  = 102) was 89.2% (95% confidence interval [CI], 81.7 to 93.9%). The specificity of cobas MTB was 98.6% (95% CI, 96.1 to 99.5%). Sensitivity and specificity for detection of RIF and INH resistance were 88.4% (95% CI, 75.5 to 94.9%) and 97.6% (95% CI, 87.4 to 99.6%) and 76.6% (95% CI, 62.8 to 86.4%) and 100.0% (95% CI, 90.8 to 100.0%), respectively. Discordant results for RIF and INH resistance were mainly due to uncommon mutations in samples from Sierra Leone that were not covered by the cobas MTB-RIF/INH assay. In conclusion, cobas MTB and MTB-RIF/INH assays provide accurate detection of MTBC DNA and resistance-associated mutations in respiratory samples. The influence of regional variations in the prevalence of resistance-conferring mutations requires further investigation., (Copyright © 2021 Nadarajan et al.)

In this study, the treatment of poultry slaughterhouse wastewater (PSW) was evaluated using two new down-flow high-rate anaerobic bioreactor systems (HRABS), including the down-flow expanded granular bed reactor (DEGBR) and the static granular bed reactor (SGBR). These two bioreactors have demonstrated a good performance for the treatment of PSW with removal percentages of the biochemical oxygen demand (BOD 5 ), the chemical oxygen demand (COD), and fats, oil, and grease (FOG) exceeding 95% during peak performance days. This performance of down-flow HRABS appears as a breakthrough in the field of anaerobic treatment of medium to high-strength wastewater because down-flow anaerobic bioreactors have been neglected for the high-rate anaerobic treatment of such wastewater due to the success of up-flow anaerobic reactors such as the UASB and the EGSB as a result of the granulation of a consortium of anaerobic bacteria required for efficient anaerobic digestion and biogas production. Hence, to promote the recourse to such technologies and provide further explanation to their performance, this study approached the kinetic analysis of these two down-flow HRABS using the modified Stover-Kincannon and the Grau second-order multi-component substrate models. From a comparison between the two models investigated, the modified Stover-Kincannon model provided the best prediction for the concentration of the substrate in the effluent from the two HRABS. This analysis led to the determination of the kinetic parameters of the two models that can be used for the design of the two HRABS and the prediction of the performance of the SGBR and DEGBR. The kinetic parameters determined using the Modified Stover-Kincannon were Umax = 40.5 gCOD/L.day and K B = 47.3 gCOD/L.day for the DEGBR and U max = 33.6 gCOD/L.day and K B = 44.9 gCOD/L.day for the SGBR; while, using the Grau second-order model, the kinetic models determined were a = 0.058 and b = 1.112 for the DEGBR and a = 0.135 and b = 1.33 for the SGBR.

Rapid detection of methicillin-resistant Staphylococcus aureus (MRSA) colonization status facilitates isolation and decolonization and reduces MRSA infections. Liquid but not dry swabs allow fully automated detection methods. However, the accuracy of culture and polymerase chain reaction (PCR) using liquid and dry swabs has not been analyzed. We compared different swab collection systems for routine nasal-throat MRSA screening in patients admitted to a tertiary care trauma center in Germany. Over 3 consecutive months, dry swabs (month 1), ESwabs (month 2), or MSwabs (month 3) were processed using Cepheid GeneXpert, Roche cobas and BD-MAX™ MRSA tests compared to chromogenic culture. Among 1680 subjects, the MRSA detection rate using PCR methods did not differ significantly between dry swabs, ESwab, and MSwab (6.0%, 6.2%, and 5.3%, respectively). Detection rates using chromogenic culture were 2.9%, 3.9%, and 1.9%, using dry, ESwab, and MSwab, respectively. Using chromogenic culture as the "gold standard", negative predictive values for the PCR tests ranged from 99.2-100%, and positive predictive values from 33.3-54.8%. Thus, efficient and accurate MRSA screening can be achieved using dry, as well as liquid E- or MSwab, collection systems. Specimen collection using ESwab or MSwab facilitates efficient processing for chromogenic culture in full laboratory automation while also allowing molecular testing in automated PCR systems., Competing Interests: Conflict of Interest EMM, MN, and JD are current employees of Roche Molecular Systems, and OL was an employee of Roche Molecular Systems., (© 2019, The Author(s).)

Background: HBV DNA is the most important molecular marker in hepatitis B, used to determine treatment indication and monitoring. Most patients require lifelong hepatitis B virus (HBV) management, thus viral load (VL) monitoring may be performed at different laboratories, with different HBV assays, which may result in different VL results. This multicenter study compares the commutability and concordance of results from four different HBV DNA assays: CAP/CTM HBVv2, HPS/CTM HBVv2 and the new cobas 6800/8800 HBV and cobas 4800 HBV assays., Methods: Across all four assays, HBV limit of detection (LoD) and linearity at lower concentrations were assessed using panels traceable to the World Health Organization international standard, and concordance was investigated at the important medical decision cutoffs 2000 and 20,000 IU/ml, using specimens from HBV-positive patients., Results: The calculated LoD via a probit curve was 2.7 IU/ml for cobas 6800/8800 HBV, 2.8 IU/ml for cobas 4800 HBV, 9.6 IU/ml for CAP/CTM HBVv2, and 6.2 IU/ml for HPS/CTM HBVv2. The average accuracy was comparable between cobas 6800/8800 HBV, cobas 4800 HBV and CAP/CTM HBVv2 (0.04-0.05 log 10 IU/ml), while a slightly lower accuracy was documented for HPS/CTM HBVv2 (-0.16 log 10 IU/ml). A total of 211-245 clinical samples were used for a pairwise comparison. Mean paired log differences ranged from -0.17 log 10 IU/ml to -0.01 log 10 IU/ml. Coefficient of determination was over 98% for all pairs with high overall percent agreement at the 2000 and 20,000 IU/ml cutoffs (from 91.7% to 96.3%). In a subset of samples with VL±0.5 log 10 to the 2000 and 20,000 IU/ml thresholds, concordance was still 72% and 82%, respectively., Conclusions: The new cobas 6800/8800 HBV and 4800 HBV assays show high accuracy in samples with low-level viremia and a high concordance with the established HBV tests, CAP/CTM HBVv2 and HPS/CTM HBVv2, at 2000 and 20,000 IU/ml. Thus, all four HBV assays have high commutability and may be used interchangeably in routine clinical practice., Competing Interests: Conflict of interest statement: BM has received speaking or consulting fees from Abbott, AbbVie, Bristol Myers Squibb, Fujirebio Europe and Falk, Janssen-Cilaq, and Roche; research support from Abbott Molecular and Roche; travel grants from Bristol Myers Squibb, Gilead, and Janssen-Cilaq. MC received speaker or consulting fees from AbbVie, BMS, Falk, Gilead, Janssen-Cilag, Merck/MSD, Roche Pharma, Roche, and Novartis; research support from Fujirebio, Gilead, Merck/MSD, and Roche. JV has received advisory board or teaching fees from Abbott, AbbVie, Bristol-Myers Squibb, Gilead, Medtronic, and Roche. CV has received grants or research support from Abbott, Gilead, Janssen, Quintiles, Roche, and Siemens; speaking or consulting fees from Abbott, AbbVie, Achillion, Bristol-Myers Squibb, Gilead, Janssen, Merck/MSD, and Roche. MPM has received grants and personal fees from Bristol Myers Squibb, Boehringer Ingelheim, Gilead, GlaxoSmithKline, Janssen-Cilaq, MSD/Merck, Novartis, and Roche. YC and JYS have received research support from Roche. HW has received speaking or consulting fees from Abbott, AbbVie, Siemens, Bristol Myers Squibb, Janssen-Cilaq, Elger, Novartis, and Roche; research support from Abbott Molecular, Bristol Myers Squibb, Janssen-Cilaq, Elger, Novartis, and Roche. EM, COS, MN, and EP are employed by Roche. BB, PL, and VMT have no interests to declare.

The South African poultry industry has grown exponentially in recent years due to an increased demand for their products. As a result, poultry plants consume large volumes of high quality water to ensure that hygienically safe poultry products are produced. Furthermore, poultry industries generate high strength wastewater, which can be treated successfully at low cost using anaerobic digesters. In this study, the performance of a bench-scale mesophilic static granular bed reactor (SGBR) containing fully anaerobic granules coupled with an ultrafiltration (UF) membrane system, as a post-treatment system, was investigated. The poultry slaughterhouse wastewater was characterized by a chemical oxygen demand (COD) range between 1,223 and 9,695mg/L, average biological oxygen demand of 2,375mg/L and average fats, oil and grease (FOG) of 554mg/L. The SGBR anaerobic reactor was operated for 9 weeks at different hydraulic retention times (HRTs), i.e. 55 and 40 h, with an average organic loading rate (OLR) of 1.01 and 3.14g COD/L.day. The SGBR results showed an average COD, total suspended solids (TSS) and FOG removal of 93%, 95% and 90% respectively, for both OLR. The UF post-treatment results showed an average of COD, TSS and FOG removal of 64%, 88% and 48%, respectively. The overall COD, TSS and FOG removal of the system (SGBR and UF membrane) was 98%, 99.8%, and 92.4%, respectively. The results of the combined SGBR reactor coupled with the UF membrane showed a potential to ensure environmentally friendly treatment of poultry slaughterhouse wastewater.

Aim: This study aimed to assess the effectiveness of a blended-teaching intervention using Internet-based tutorials coupled with traditional lectures in an introduction to research undergraduate nursing course. Effects of the intervention were compared with conventional, face-to-face classroom teaching on three outcomes: knowledge, satisfaction, and self-learning readiness., Method: A two-group, randomized, controlled design was used, involving 112 participants. Descriptive statistics and analysis of covariance (ANCOVA) were performed., Results: The teaching method was found to have no direct impact on knowledge acquisition, satisfaction, and self-learning readiness. However, motivation and teaching method had an interaction effect on knowledge acquisition by students. Among less motivated students, those in the intervention group performed better than those who received traditional training., Conclusion: These findings suggest that this blended-teaching method could better suit some students, depending on their degree of motivation and level of self-directed learning readiness.

Objective: To compare the ability of users of 2 medical search engines, InfoClinique and the Trip database, to provide correct answers to clinical questions and to explore the perceived effects of the tools on the clinical decision-making process., Design: Randomized trial., Setting: Three family medicine units of the family medicine program of the Faculty of Medicine at Laval University in Quebec city, Que., Participants: Fifteen second-year family medicine residents., Intervention: Residents generated 30 structured questions about therapy or preventive treatment (2 questions per resident) based on clinical encounters. Using an Internet platform designed for the trial, each resident answered 20 of these questions (their own 2, plus 18 of the questions formulated by other residents, selected randomly) before and after searching for information with 1 of the 2 search engines. For each question, 5 residents were randomly assigned to begin their search with InfoClinique and 5 with the Trip database., Main Outcome Measures: The ability of residents to provide correct answers to clinical questions using the search engines, as determined by third-party evaluation. After answering each question, participants completed a questionnaire to assess their perception of the engine's effect on the decision-making process in clinical practice., Results: Of 300 possible pairs of answers (1 answer before and 1 after the initial search), 254 (85%) were produced by 14 residents. Of these, 132 (52%) and 122 (48%) pairs of answers concerned questions that had been assigned an initial search with InfoClinique and the Trip database, respectively. Both engines produced an important and similar absolute increase in the proportion of correct answers after searching (26% to 62% for InfoClinique, for an increase of 36%; 24% to 63% for the Trip database, for an increase of 39%; P = .68). For all 30 clinical questions, at least 1 resident produced the correct answer after searching with either search engine. The mean (SD) time of the initial search for each question was 23.5 (7.6) minutes with InfoClinique and 22.3 (7.8) minutes with the Trip database (P = .30). Participants' perceptions of each engine's effect on the decision-making process were very positive and similar for both search engines., Conclusion: Family medicine residents' ability to provide correct answers to clinical questions increased dramatically and similarly with the use of both InfoClinique and the Trip database. These tools have strong potential to increase the quality of medical care.

Objective: To develop and evaluate items for inclusion in PRIDe (Preferred Role in Decision Making), a new tool to assess changes of role preference among professionals exposed to training in shared decision making (SDM)., Methods: This study was part of a pilot trial to evaluate the effectiveness of SDM training on the doctors' prescription of antibiotics for acute respiratory infections. Thirty-nine family physicians were randomized to immediate exposure to training or to delayed exposure. Potential items for PRIDe and a questionnaire about physicians' intention to engage in SDM were administered at baseline and at follow-up., Results: Following analysis, we retained five items that captured a change in physicians' preference. The items' scores were pooled and the resulting tool showed limited internal consistency (Cronbach's alpha = 0.41) but significant test-retest reliability (immediate group: P = 0.03; delayed group: P = 0.008) and acceptable discriminant validity, with patients involved in decision making more actively after training than before (Fisher's test, P = .02)., Conclusion: This initial step to develop an evaluation tool to assess changes in doctors' preference of role in decision making following SDM training shows promising results. The next step is to develop more clinical vignettes followed by questions inspired from this analysis., Practice Implications: The PRIDe instrument can be used in the assessment of health professionals' attitude towards shared decision making after training in shared decision making. Additional research is needed to evaluate its validity before it can be recommended for use., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: To assess the willingness of women and their family physicians (FPs) to engage in shared decision-making (SDM) as regards prenatal Down-syndrome screening and the factors that might influence their willingness to do so., Methods: We conducted a survey of participants in Québec City, Canada, using the theory of planned behavior. We used a general linear model and multilevel approach that took the fact that some women consulted the same FP into account., Results: This study comprised 109 pregnant women and 41 FPs. On a scale of - 3 to + 3, the pregnant women's and FPs' response scores were, respectively, 2.11 ± 1.38 and 2.66 ± 0.40. In women, attitude, significant others, self-efficacy, perceived moral correctness, and their FP's attitude influenced their willingness to engage in SDM. However, women without a post-secondary education were less likely to engage in SDM than women with a post-secondary education, mostly because the former lacked a sense of self-efficacy. In FPs, only attitude and significant others influenced their willingness to engage in SDM., Conclusion: Overall, the women and their FPs wished to engage in SDM as regards prenatal Down-syndrome screening. Only a few factors influenced this desire which therefore may be modifiable., (Copyright © 2011 John Wiley & Sons, Ltd.)

Background: Experts estimate that the prevalence of antibiotics use exceeds the prevalence of bacterial acute respiratory infections (ARIs)., Objective: To develop, adapt and validate DECISION+ and estimate its impact on the decision of family physicians (FPs) and their patients on whether to use antibiotics for ARIs., Design: Two-arm parallel clustered pilot randomized controlled trial., Setting and Participants: Four family medicine groups were randomized to immediate DECISION+ participation (the experimental group) or delayed DECISION+ participation (the control group). Thirty-three FPs and 459 patients participated., Intervention: DECISION+ is a multiple-component, continuing professional development program in shared decision making that addresses the use of antibiotics for ARIs., Main Outcome Measures: Throughout the pilot trial, DECISION+ was adapted in response to participant feedback. After the consultation, patients and FPs independently self-reported the decision (immediate use, delayed use, or no use of antibiotics) and its quality. Agreement between their decisional conflict was assessed. Two weeks later, patients assessed their decisional regret and health status., Results: Compared to the control group, the experimental group reduced its immediate use of antibiotics (49 vs. 33% absolute difference = 16%; P = 0.08). Decisional conflict agreement was stronger in the experimental group (absolute difference of Pearson's r = 0.26; P = 0.06). Decisional regret and perceptions of the quality of the decision and of health status in the two groups were similar., Discussion and Conclusions: DECISION+ was developed successfully and appears to reduce the use of antibiotics for ARIs without affecting patients' outcomes. A larger trial is needed to confirm this observation., (© 2010 Blackwell Publishing Ltd.)

Purpose: This paper presents the evidence on the effectiveness of interventions promoting the use of clinical information retrieval technologies (CIRTs) by healthcare professionals., Methods: We electronically searched articles published between January 1990 and March 2008 using following inclusion criteria: (1) participants were healthcare professionals; (2) specific intervention promoted CIRT adoption; (3) studies were randomised controlled trials, controlled clinical trials, controlled before and after studies or interrupted time series analyses; and (4) they objectively reporting measured outcomes on CIRT use., Results: We found nine studies focusing on CIRT use. Main outcomes measured were searching skills and/or frequency of use of electronic databases by healthcare professionals. Three studies reported a positive effect of the intervention on CIRT use, one showed a positive impact post-intervention, and four studies failed to demonstrate significant intervention effect. The ninth study examined financial disincentives, and found a significant negative effect of introducing user fees for searching MEDLINE in clinical settings. A meta-analysis showed that educational meetings were the only type of interventions reporting consistent positive effects on CIRT adoption., Conclusion: CIRT is an information and communication technology commonly used in healthcare settings. Interventions promoting CIRT adoption by healthcare professionals have shown some success in improving searching skills and use of electronic databases. However, the effectiveness of these interventions remains uncertain and more rigorous studies are needed., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Purpose: We describe pain scores for a modified anesthesia technique for no-scalpel vasectomy using a 1-inch 30 gauge mini-needle., Materials and Methods: A prospective study was performed in 277 patients who received anesthesia using a 3 cc syringe filled with approximately 2 cc 2% lidocaine without epinephrine and a 1-inch 30 gauge needle. Local anesthesia was given directly to the vas at the expected surgical site on each side., Results: Mean +/- SD pain intensity score on the 10 cm visual analog scale was 1.5 +/- 1.6 (95% CI 1.3-1.7) during the anesthesia and 0.6 +/- 1.0 (95% CI 0.5-0.7) during the procedure. Patients experienced less pain during anesthesia and the procedure than they expected before vasectomy (average 3.1 +/- 1.8, 95% CI 2.8-3.3)., Conclusions: The mini-needle technique provides excellent anesthesia for no-scalpel vasectomy. It compares favorably to the standard vasal block and other anesthetic alternatives with the additional benefit of minimal equipment and less anesthesia., (2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the extent to which family physicians (FPs) involve women in decisions about prenatal screening for Down syndrome., Methods: Based on transcripts of consultations between 41 FPs and 128 women, two raters independently assessed clinician's efforts to involve women in decisions about prenatal screening for Down syndrome using the French-language version of OPTION. Descriptive statistics of OPTION scores were calculated. Construct validity was assessed by performing a principal factor analysis and by measuring association with consultation duration and FPs sociodemograhics. Internal consistency was assessed with Cronbach's alpha and inter-rater reliability with the intraclass correlation coefficient., Results: The overall mean OPTION score was low: 19 +/- 7 (range = 0 [no involvement] to 100 [high involvement]). One factor accounted for 80% of the variance. Both internal consistency and inter-rater reliability were very good (Cronbach's alpha = 0.73; ICC = 0.76). OPTION scores were lower for residents than for licensed FPs (17 +/- 5 vs 21 +/- 4; p = 0.02) and were positively associated with duration of consultation (r = 0.56; p < 0.001)., Conclusion: Based on the French-language version of OPTION, which showed satisfactory psychometric properties, FPs studied put minimal efforts to involve women in decisions about prenatal screening for Down syndrome., ((c) 2009 John Wiley & Sons, Ltd.)