Diagnostic value and cost utility analysis for urine Gram stain and urine microscopic examination as screening tests for urinary tract infection
ABSTRACT The aim of this study was to evaluate the diagnostic properties of urine Gram stain and urine microscopic examination for screening for urinary tract infection (UTI), and to perform an additional cost utility analysis. This descriptive study was performed on 95 urine samples sent for urine culture to the Department of Microbiology, Faculty of Medicine, Chulalongkorn University. The first part of the study was to determine the diagnostic properties of two screening tests (urine Gram stain and urine microscopic examination). Urine culture was set as the gold standard and the results from both methods were compared to this. The second part of this study was to perform a cost utility analysis. The sensitivity of urine Gram stain was 96.2%, the specificity 93.0%, the positive predictive value 94.3% and the negative predictive value 95.2%. False positives occurred with a frequency of 7.0% and false negatives 3.8%. For the microscopic examination, the sensitivity was 65.4%, specificity 74.4%, positive predictive value 75.6% and negative predictive value 64.0%. False positives occurred with a frequency of 25.6% and false negatives 34.6%. Combining urine Gram stain and urine microscopic examination, the sensitivity was 98.1%, specificity 74.4%, positive predictive value 82.3% and negative predictive value 97.0%. False positives occurred with a frequency of 25.6% and false negatives 1.9%. However, the cost per utility of the combined method was higher than either urine microscopic examination or urine Gram stain alone. Urine Gram stain provided the lowest cost per utility. Economically, urine Gram stain is the proper screening tool for presumptive diagnosis of UTI.
- SourceAvailable from: Zhi-De Hu
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- "Urine sediment analysis using microscopy to count the white blood cells (WBCs) is a promising approach to screen for UTI   . However, special training for laboratory staff is required for this method, and it is susceptible to observer variation. "
ABSTRACT: BACKGROUND: Automated urine sediment analysis of white blood cells (WBCs) and bacteria is a promising approach for urinary tract infections (UTIs) screening. However, available data on their screening efficacy is inconsistent. METHODS: English articles from Pubmed, EMBASE, and Web of Science published before December 1, 2012 were analyzed. The Quality Assessment for Studies of Diagnostic Accuracy (QUADAS) tool was used to evaluate the quality of eligible studies. Performance characteristics of WBCs and bacteria (sensitivity, specificity, and other measures of accuracy) were pooled and examined by random-effects models. RESULTS: Fifteen studies containing 18,966 samples were included. Pooled sensitivities were 0.89 (95% confidence interval [CI], 0.88-0.91) for WBCs and 0.94 (95% CI, 0.93-0.94) for bacteria. Corresponding pooled specificities were 0.66 (95% CI, 0.65-0.67) for WBCs and 0.56 (95% CI, 0.55-0.57) for bacteria. Areas under the summary receiver operating characteristics curves were 0.92 and 0.93 for WBCs and bacteria, respectively. The major limitation of eligible studies was that enrolled subjects were often not representative of clinical patient populations in which UTI would be suspected. CONCLUSIONS: WBC and bacterial measurements by the UF-100 and UF-1000i are useful indicators in UTI screening; however, the performances of these systems should be rigorously evaluated by additional studies.Clinica chimica acta; international journal of clinical chemistry 05/2013; 424. DOI:10.1016/j.cca.2013.05.014 · 2.76 Impact Factor
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ABSTRACT: Catheter-associated urinary tract infection (CAUTI) is a common and costly problem for hospitalized patients. Policymakers have taken notice of the importance of these infections, and changes to the prospective payment rules of Medicare, Medicaid, and many additional third-party payers have been implemented to hold hospitals accountable for the delivery of poor quality health care services. As key members of the health care team, nurses must be prepared to utilize evidence-based practices to prevent CAUTI in hospitalized patients. This article describes several variable-technology interventions to remind clinicians to remove unnecessary urinary catheters and proposes potential roles for nursing informatics in the prevention of CAUTI in hospitalized adults.Urologic nursing: official journal of the American Urological Association Allied 29(5):369-78; quiz 379.
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ABSTRACT: In modern control systems, there is a tremendous demand and requirement to implement the necessary control dynamically and also remotely. In addition, with the availability of the programmable devices such as complex programmable logic devices (CPLD) and field programmable gate arrays, it is now possible to design the systems with these type of devices and reprogram them online from remote locations. In this paper, the authors discuss the nature of the dynamic control methodology that is being followed and the model systems which are being implemented at the Florida International University Electrical and Computer Engineering Research Laboratories. The remote and dynamic control methodologies are implemented using the VHDL coding and remotely programming the CPLDs at the remote locations, using the VHDL code from host and network based data transfersSoutheastcon '99. Proceedings. IEEE; 02/1999