Inappropriate testing for diarrheal diseases in the hospital

Article Abstract:

Although bacterial stool pathogens and parasitic organisms such as Salmonella, Shigella, or Campylobacter do not usually cause hospital-acquired diarrhea, it remains common practice in many institutions to order routine stool cultures and ova and parasite (O & P) examinations on all patients with symptoms. The degree to which these tests are inappropriately ordered was studied by examining the relation between test results from stool cultures, O & P examinations, and Clostridium difficile toxin assays and the time at which these tests were ordered after hospital admission. During a three-year period, only one of 191 positive stool cultures and none of the positive O & P examinations were obtained from patients whose stool specimens were obtained at least three days after admission. As expected, most positive results were not related to hospital-acquired diarrhea. However, analysis of laboratory workload for a one-year period showed that half of more than 3,000 stool specimens received each year are from patients hospitalized for three days or more. Twenty-five percent of the stool samples were positive for C. difficile, regardless of the patients' admission status, indicating that testing for C. difficile toxin is warranted. The results demonstrate that eliminating routine stool culture and O & P examinations on hospitalized patients would reduce hospital and patient costs without affecting patient care and possibly would result in a nationwide cost savings of $20 to $30 million per year. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, Testing, Diarrhea, Clostridium infections, Diagnostic specimens, Diagnosis, Laboratory, Laboratory diagnosis

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The Papanicolaou test for cervical cancer detection: the triumph and a tragedy

Article Abstract:

The complex system for detecting and treating precancerous growths and early cancer of the cervix is described and discussed in detail. The most difficult and underestimated component of the diagnostic series is the screening and interpretation of smear samples from the cervix ("Pap" smears). Analyses of cell samples thus obtained may fail due to inadequate samples, insufficient screening time, or human error caused by fatigue. Other problems include inadequate patient compliance, non-reproducible test results and ineffective aftercare. For example, taking a second smear to refute a diagnosis is often misleading. Although the cancer detection system has helped reduce disease and death from cervical cancer in properly screened populations, there is no evidence that the pap test has anywhere succeeded in eradicating this theoretically preventable disease. The public should be informed about these failures of the system and the reasons for them.

Methods, Evaluation, Cervix uteri, Pap test, Cytodiagnosis, Exfoliative cytology

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Detection and surveillance of colorectal cancer

Article Abstract:

Cancer of the rectum, or colon, is the second most common form of cancer in the US. The rectum is the last section of the digestive tract; the colon is the section of the large intestine just before it. The death rate of such cancer patients exceeds 60 percent overall, but drops to 20 percent if the cancer is detected early enough. Therefore, survival rates can best be improved by enhancing early detection and eradication of tumors. In the absence of a consensus about how to achieve this, this article aims to serve as a practical guideline for improving early detection and management of colorectal cancer and its precursors.

Colorectal cancer, Periodic health examinations, Sigmoidoscopy

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