Synthesis and reactivity of a cyclopentadienyl-indenyl ligand ring-coupled by a chiral bridge derived from ethyl (S)-(-) lactate.

In order to prepare a new unsymmetrical chiral ligand, C9H7CH(CH3)CH2C5H5, with an indenyl moiety connected to a cyclopentadienyl unit by a chiral ethylene bridge, we reacted the optically active tosylate 4, derived from ethyl (S)-(-) lactate, with LiCp. The only product resulting from this reaction was an optically active spirocyclopropane 6 obtained with a high diastereoselectivity (81.8% de).

Diagnostic triage and the role of natriuretic peptide testing and echocardiography for suspected heart failure: an appropriateness ratings evaluation by UK GPs.

Background: Some UK GPs are acquiring access to natriuretic peptide (NP) testing or echocardiography as diagnostic tests for heart failure. This study developed appropriateness ratings for the diagnostic application of these tests in routine general practice.

Aim: To develop appropriateness ratings for the diagnostic application of NP testing or echocardiography for heart failure in general practice.

Prioritisation criteria for the selection of new diagnostic technologies for evaluation.

Background: Currently there is no framework for those involved in the identification, evaluation and prioritisation of new diagnostic technologies. Therefore we aimed to develop prioritisation criteria for the assessment of new diagnostic technologies, by gaining international consensus on not only which criteria should be used, but also their relative importance.

Methods: A two-round Delphi process was used to generate consensus amongst an international panel of twenty-six experts on priority criteria for diagnostic health technology assessment.

Toward the development of a stable, freeze-dried formulation of Helicobacter pylori killed whole cell vaccine adjuvanted with a novel mutant of Escherichia coli heat-labile toxin.

No vaccine exists for the prevention of infection with the ubiquitous gastric pathogen Helicobacter pylori, and drug therapy for the infection is complicated by poor patient compliance, the high cost of treatment, and ineffectiveness against drug-resistant strains. A new medical advancement is required to reduce the incidence of peptic ulcer disease and stomach cancer, two conditions caused by infection with H. pylori.

The medical history as a diagnostic technology.

The medical history is a powerful diagnostic technology. However, in seeking to establish an appropriate balance between the history and the other diagnostic modalities more explicit consideration must be given to the performance characteristics of the medical history. Building on recent work undertaken in the UK and elsewhere in Europe it is now feasible to develop a library of setting-specific likelihood ratios and kappa statistics for key elements of the medical history.

Effects of the medical liability system in Australia, the UK, and the USA.

Although the direct costs of the medical liability system account for a small fraction of total health spending, the system's indirect effects on cost and quality of care can be much more important. Here, we summarise findings of existing research on the effects of the medical liability systems of Australia, the UK, and the USA. We find systematic evidence of defensive medicine--medical practice based on fear of legal liability rather than on patients' best interests.

Statistical methods in epidemiology. VIII. On the use of likelihood ratios for diagnostic testing with an application to general practice.

Purpose: An array of statistical methods is available for 2 x 2 contingency table analysis. These include odds ratios, reliability coefficients and the Chi-squared test. This paper continues the '2 x 2' theme but extends it to look at diagnostic testing.

Clinical management. Close encounters.

Primary care trusts are increasingly using 'local enhanced service' programmes to target excluded groups, according to new research. One in seven PCTs were using an LES for asylum seekers and other examples include homelessness, learning disabilities and work with young people. Other PCTs are using LESs to shift work from secondary to primary care via referral management incentive schemes, while one in five had set up an LES-based phlebotomy service.