Objectives To compare the efficacy, safety, and acceptability of treatment with intravenous antibiotics for cellulitis at home and in hospital.

Newspapers tended to overrepresent support for screening mammography for women aged 40 to 49 years. Reports would have been improved by identification of all sources for information cited, less reliance on relatively few sources, and discussion of benefits in absolute as well as relative terms. Medical journalism may benefit from identification of standards similar to those used for reporting medical research.

PURPOSE Traditionally fi rst-void urine specimens are used to test for Chlamydia trachomatis. In contrast, midstream urine specimens are traditionally recommended for microscopy and culture of presumptive bacterial urinary tract infections. The ability to test for both C trachomatis and urinary tract infection on a single midstream urine specimen would greatly aid clinical practice, as an urinary tract infection is an extremely common complaint in primary care. This study set out to determine how well positive C trachomatis results obtained on fi rst-void specimens would correlate with positive fi ndings in matched midstream specimens. METHODSOne hundred women with a fi rst-void urine specimen positive for C trachomatis also provided midstream specimens for comparison. All specimens had C trachomatis testing performed using a DNA detection method. RESULTSOf the 100 eligible participants with a fi rst-void specimen positive for C trachomatis, 96 (96%) also had a positive midstream specimen (95% exact confi dence limits, 90.1%, 98.9%).CONCLUSIONS These results suggest that by using newer nucleic acid amplifi cation techniques (NAATs), timing of specimen collection is not so important in testing for C trachomatis as previously thought. The sensitivity of NAAT testing on midstream urine specimens in women is suffi ciently equivalent to testing on fi rst-void specimens to consider in clinical practice and research settings where fi rst-void specimens have formerly been collected. 2012;10:50-53. doi:10.1370/afm.1323. Ann Fam Med INTRODUCTION C hlamydia trachomatis (C trachomatis)is the most common sexually transmitted bacterial infection.1 It may have few, if any, symptoms in women. The complications of infertility, pelvic infl ammatory disease, and ectopic pregnancy are serious, yet treatment is simple once infection is detected. Although there are a variety of methods for testing for C trachomatis, no single test is ideal. Currently, to test for the infection in women, nucleic acid amplifi cation tests (NAATs) are preferred, and either a vaginal swab or fi rst-void urine specimen is recommended for case fi nding, but neither has a 100% sensitivity. In the United States vaginal swabs are the preferred sample. 2-4Dysuria and increased urinary frequency associated with presumed urinary tract infection are extremely common reasons for seeking treatment in primary care.5 About 10% of women suffer from symptoms of a urinary tract infection in any year, 6 and seeking treatment provides a potential opportunity to detect both symptomatic and asymptomatic infection with C trachomatis. The sexually active woman is at risk of both urinary tract infection and C trachomatis infection. 51 UR INE T ES T ING F OR C T R ACHO M AT ISOne diffi culty in testing for C trachomatis in women seeking treatment for dysuria and frequency is that traditionally a fi rst-void urine specimen has been recommended, which is different from the midstream specimen used to diagnose a urinary tract infection. This distinction is made on the basi...

In randomised controlled trials of breast cancer screening women are randomly allocated to an intervention group that is offered screening, or a control group that receives the usual medical care. Not all women in the intervention group accept screening; the women who do so may differ from other women in their underlying risk of breast cancer. This self selection for screening can result in either women at high risk or at low risk being overrepresented in the screened group. When comparisons between trials are made it is important to take self selection for screening into account, as a trial with self selection of women at high risk has the potential to have greater efficacy than a trial with self selection of women at low risk. A method of adjusting for self selection when comparing randomised controlled trials of breast cancer screening is described.

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