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Byline: Harold K Simon, Naghma S Khan, Dale F Nordenberg, Jean A Wright Abstract: Study objective: To determine the concordance rate of plain radiograph interpretations by pediatric emergency physicians and pediatric radiologists, to evaluate the effect of incorrect radiologic diagnosis on patient management, and to evaluate the necessity and cost-effectiveness of routine follow-up review of all plain radiographs by a radiologist. Methods: We assembled a prospective series of all patients who presented to the emergency department of an urban tertiary care children's hospital and underwent plain radiography between October 1 and October 31, 1994. Pediatric emergency physicians documented their interpretations. Within 24 hours, films were reviewed by a pediatric radiologist. The two interpretations were classified as concordant or discordant and were further assessed for medical significance and subsequent change in management. Results: During the study period, 707 radiographic examinations were performed: chest, 56%; skeletal excluding spine, 20.1%; abdomen, 11.9%; sinus, 4.2%; spine, 3.6%; and other, 4%. The accuracy or concordance rate was 90.2% (638 of 707) for pediatric emergency physician interpretations; clinical management was unchanged in 96.9% (685 of 707) of the cases. Of the 69 discordant interpretations, 48 were clinically significant, with 22 requiring changes in management. They included 9 false-negative interpretations by pediatric emergency physicians: (5 fractures, 2 cases of pneumonia, 1 case of sinusitis, 1 case of cardiomegaly); 10 false-positive interpretations by pediatric emergency physicians (5 fractures, 4 cases of pneumonia, 1 case of sinusitis), and 3 false-positive interpretations by radiologists (1 case of C-2 spine subluxation, 1 retropharyngeal abscess, and 1 case of necrotizing enterocolitis). No adverse outcomes resulted from these misinterpretations. Routine review of all plain radiographs by a radiologist represents an estimated $210,000 annual cost to the patients and payers. Conclusion: Radiograph interpretations by pediatric emergency physicians were generally accurate, and no adverse outcomes occurred as a result of misinterpretation. Clinical assessment probably assisted these physicians in interpreting the radiographs of high-risk patients. Judicious consultation with a radiologist during the initial presentation of a high-risk patient, when deemed warranted by the pediatric emergency physician, will help the emergency physician deliver high-quality, cost-effective health care. Given the overall clinical accuracy rate of radiograph interpretations by the pediatric emergency physicians and the cost of routine review of all plain radiographs in the ED by a radiologist, routine review versus selective specialty consultation must be further evaluated. [Simon HK, Khan NS, Nordenberg DF, Wright JA: Pediatric emergency physician interpretation of plain radiographs: Is routine review by a radiologist necessary and cost-effective? Ann Emerg Med March 1996;27:295-298.] Article History: Received 10 April 1995; Revised 5 July 1995; Accepted 12 July 1995 Article Note: (footnote) [star] From the Department of Pediatrics, Division of Emergency Medicne, Egleston Children's Hospital, Emory University School of Medicine, Emory University, Atlanta, Georgia., [star][star] Address for reprints: Harold K Simon, MD, Department of Pediatrics, Division of Emergency Medicine, Egleston Children's Hospital, Atlanta, Georgia 30322, 404-315-2761, Fax 404-325-6233, a Reprint no. 47/1/70826

Multidrug-resistant tuberculosis (MDR-TB), caused by drug-resistant strains of Mycobacterium tuberculosis, is an increasingly serious problem worldwide. Here we examined a data set of whole-genome sequences from 5,310 M. tuberculosis isolates from five continents. Despite the great diversity of these isolates with respect to geographical point of isolation, genetic background and drug resistance, the patterns for the emergence of drug resistance were conserved globally. We have identified harbinger mutations that often precede multidrug resistance. In particular, the katG mutation encoding p.Ser315Thr, which confers resistance to isoniazid, overwhelmingly arose before mutations that conferred rifampicin resistance across all of the lineages, geographical regions and time periods. Therefore, molecular diagnostics that include markers for rifampicin resistance alone will be insufficient to identify pre-MDR strains. Incorporating knowledge of polymorphisms that occur before the emergence of multidrug resistance, particularly katG p.Ser315Thr, into molecular diagnostics should enable targeted treatment of patients with pre-MDR-TB to prevent further development of MDR-TB.

Public health laboratories (PHLs) are critical components of the nation's healthcare system, serving as stewards of valuable specimens, delivering important diagnostic results to support clinical and public health programs, supporting public health policy, and conducting research. This article discusses the need for and challenges of creating standards-based data-sharing networks across the PHL community, which led to the development of the PHL Interoperability Project (PHLIP). Launched by the Association of Public Health Laboratories and the Centers for Disease Control and Prevention in September 2006, PHLIP has leveraged a unique community-based collaborative process, catalyzing national capabilities to more effectively share electronic laboratory-generated diagnostic information and bolster the nation's health security. PHLIP is emerging as a model of accelerated innovation for the fields of laboratory science, technology, and public health.

AbstractThis investigation describes the epidemiology of Reye’s syndrome (RS) during 1991–1994 and compares two different sources of information in the United States. Estimates of the incidence of RS from the Centers for Disease Control and Prevention (CDC) are compared with hospital inpatient data from approximately one third of the hospitals from HCIA, Inc. During 1991–1994, 48 RS cases were reported to the CDC and 93 RS hospitalizations based on HCIA data. When the HCIA data are extrapolated to the US population, there were an estimated 284 hospitalizations. Cases reported from both data sources were similar in distribution by onset, age, and sex. CDC data probably underestimate the incidence of RS due to incomplete reporting and HCIA data may overestimate it because not all cases were known to meet the CDC case definition. The true annual incidence of RS during the study years was probably between 0.2 and 1.1 cases per million population <18 years of age.Copyright © 2000 S. Karger AG, Basel

In 1994, nearly half of the pregnancies in the United States (49 percent) were unwanted or occurred before the woman intended to conceive. About half of these pregnancies result in abortion and, when there is a live birth, the chance of a maternal complication or poor infant outcome is greater than when pregnancy is intended. Although past studies establish childhood sexual and physical abuse as risk factors for adolescent pregnancy, the relation between abuse and unintended adult pregnancy, if any, is unclear. This question was addressed by analyzing responses to the Adverse Childhood Experiences Survey received from 1193 women aged 20 to 50 years whose first pregnancy was at or after age 20. The response rate was about 63 percent. The upper age limit was intended to exclude women who were reproductively active before the era of oral contraception. Most of the respondents were white, married, and had some college education. Most were first pregnant when 20 to 24 years of age and were aged 40 to 50 years when interviewed.