Background  Rapid influenza testing decreases antibiotic and ancillary test use in febrile children, yet its effect on the care of hospitalized adults is unexplored. We compared the clinical management of patients with influenza whose rapid antigen test result was positive (Ag+) with the management of those whose rapid antigen test result was negative or the test was not performed (Ag0).

Methods  Medical record review was performed on patients with influenza hospitalized during 4 winters (1999-2003). Hospital policy mandated influenza testing (antigen or culture) for all patients with acute cardiopulmonary diseases admitted from November 15 through April 15. A subset of patients participated in an epidemiological study and had reverse-transcriptase polymerase chain reaction or serologic testing performed. Clinical data from Ag+ and Ag0 patients were compared.

Results  Of 166 patients with available records, 86 were Ag+ and 80 were Ag0. Antibiotic use (74 [86%] of 86 patients vs 79 [99%] of 80 patients; P = .002) was less and antibiotic discontinuance (12 [14%] of 86 patients vs 2 [2%] of 80 patients; P=.01) was greater in Ag+ compared with Ag0 patients. No significant differences in antibiotic days, length of hospital stay, or antibiotic complications were noted. Antiviral use (63 [73%] of 86 patients vs 6 [8%] of 80 patients; P<.001) was greater in Ag+ than Ag0 patients. Antigen status was independently associated with withholding or discontinuing antibiotics in multivariate analysis. Of 44 Ag+ patients deemed low risk for bacterial infection, 27 continued to receive antibiotics despite positive influenza test results. These patients more commonly had pulmonary disease and had significantly more abnormal lung examination results (P = .005) compared with those in whom antibiotics were withheld or discontinued.

Conclusions  Rapid influenza testing leads to reductions in antibiotic use in hospitalized adults. Better tools to rule out concomitant bacterial infection are needed to optimize the impact of viral testing.

Published online January 22, 2007 (doi:10.1001/archinternmed.167.4.ioi60207).

In a couple of interviews I did recently, I mentioned my sixth grade science fair project that was called something like Heredity, Genetics, and You. Back in 1983, the Human Genome Project hadn’t been launched yet and it was the year Kary Mullis invented PCR (according to the Genome News Network, although other sources point to 1980). My elementary school didn’t have much of a science education curriculum let alone labs where we could try to extract DNA or practice RFLP DNA fingerprinting. So I was left to my own devices without even the Internet to help me do research! *GASP*

My genetics science project was not experimental but explanatory* with a three part display board. On one section, I had diagrammed Mendel’s pea experiment and on another section, I created a family tree showing pictures of my mother and father plus baby pictures of my sister and me. The most difficult part of the project was creating the DNA helices out of pipe cleaners for the sides and rungs of the “ladder” and construction paper for the bases**. Sounds so simple, doesn’t it? Can’t believe I actually won a prize for it.

Nowadays, I’d probably be laughed out of school for creating a science fair project that was so rudimentary. A glimpse of genetics projects listed at All Science Fair Projects*** is both intimidating and impressive. Later on in eighth grade, our science teacher allowed my lab partner and I to experiment with Drosophila melanogaster (most of which we drowned with ether) but it was nothing compared to the project listed at California Science Fair 2006 - The Effects of Intermittent and Constant EMFs on Drosophila.

What was your science fair project(s)?

For more info on science fairs, start here. Elmers.com also has a list of supplies.
*There are apparently five types of science fair projects. Mine would be classified as Research and Poster.
**Of course, instructions for creating DNA helices out of pipe cleaners are now available everywhere online, including the National Human Genome Research Institute.
***Warning: some annoying pop-up ads and other talking ads.

Photo: Jeffrey Putman at the Bronx Borough Science Fair (not sure what year)

Tags: science fair, science fair projects, genetics, genes, dna, diseases, illness, health, school

When you haven’t seen kids in awhile, it’s always nice to have a review of the anatomy and pictures of normals and abnormals. Big help.

Bush is scheduled to announce a health insurance plan for the nation at his State of the Union address this week, but don’t worry—GoozNews (which I just started reading a couple weeks ago, and it’s great) has already summed things up for us. He does the math for the poor and the rich:

You don’t have to be a rocket scientist to figure out that this proposal provides a powerful incentive for healthy, well-off families to abandon their employer plans if their employer gives them that option. And employers will increasingly want to do that since it will save them money: the cash grants will always be less than the cost of insurance. Indeed, as more and more well-off, healthier families opt for the grants, only the sickest and most costly employees will remain in the insurance pool. This will drive the cost of regular insurance higher and further erode employers’ willingness to continue paying for it.

It’s hard not to conclude that this plan was carefully designed to put another nail in the coffin of the employer-based health insurance system, and build upper-middle-class support for individual families purchasing their own plans and care. It has nothing to do with insuring the uninsured, since the benefits are far less than what is needed to effectively move them into the insurance pool.

In the spirit of belated New Year’s resolutions, and the fact that I’m way past gay fat, and on my way to straight fat, I hit the gym today, and boy did it feel good to exercise again. I go through these cycles q 3-5 months, as I eventually will pull something and need to take a break and then just get out of the habit. But better late than never.

Go do something healthy today!

(I also believe in not being a medical hypocrite: if I’m going to tell my patients they need to find time and energy to do something — eat healthier, exercise, stop smoking, stop drinking — I’ve got to put in my own effort, too.)