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ABSTRACT: To compare rapid screening techniques for detecting asymptomatic urinary tract infections (AUTIs) in pregnant women.
Comparison of results of the screening tests of urinalysis, urine dipstick, and Gram's staining with the results of standard urine culture at an initial prenatal visit. In follow-up visits, urine dipstick testing was compared with urinalysis.
Departments of Family Medicine and Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.
Pregnant women (1047) from the local community were screened for AUTI on initial and follow-up visits.
Initial prenatal urine was tested by using urine dipstick testing, urinalysis, Gram's staining, and urine culture. At each follow-up visit, urine specimens were tested by using urine dipstick and urinalysis.
Sensitivity and specificity, incremental patient costs, and clinical outcomes were used to assess the effectiveness of the techniques.
On initial visits, rapid screening tests for AUTI in pregnant women revealed the following: Gram's staining identified 22 of 24 patients with AUTI (sensitivity, 91.7%; specificity, 89.2%); urine dipstick, 12 of 24 (sensitivity, 50.0%; specificity, 96.9%); and urinalysis with presence of leukocytes, six of 24 (sensitivity, 25.0%; specificity, 99.0%). In follow-up visits, urine dipstick tests detected 19 infections and urinalysis, three (positive predictive value, 5% compared with 3%).
Urine dipstick testing for nitrites identified half of all patients with urinary tract infections and was superior to urinalysis on follow-up visits. Although Gram's staining is more expensive, it was more accurate for AUTI than urinalysis or urine dipstick test for nitrites. Urinalysis was never the test of choice because it was more expensive and detected fewer positive cultures. Leukocyte measurement correlated poorly with AUTI.
JAMA The Journal of the American Medical Association 11/1993; 270(16):1971-4. · 30.03 Impact Factor
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J W Bachman
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ABSTRACT: This article deals with improving the clinical examination of breasts, benign breast disorders, and breast cancer. The early detection of cancer is emphasized.
Primary Care Clinics in Office Practice 10/1988; 15(3):643-64. · 1.01 Impact Factor
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ABSTRACT: In recent years, several studies have produced contradictory data regarding the impact of emergency medical technicians trained in defibrillation on hospital admission and dismissal survival rates in rural areas. Fourteen communities (service area populations, 4,000 to 36,000) in rural south-eastern Minnesota participated in a two-year crossover study to further define the factors necessary for success. Automatic external defibrillators were used to defibrillate and record patient rhythms in the treatment group and to only record in the control group. Although six of 36 patients (17%) in ventricular fibrillation who experienced a witnessed arrest survived in communities using automatic external defibrillators, compared with one of 27 (4%) in the control group, five of the six survivors were from a single large community with a 911 system, full-time emergency medical technicians, police first-responders, and a well-equipped emergency facility. Our data suggest that certain prerequisites, especially CPR prior to ambulance arrival and collapse to defibrillation times of less than ten minutes, are clearly essential to produce significant benefits from emergency medical technicians trained in defibrillation in rural communities.
Annals of Emergency Medicine 05/1988; 17(4):318-21. · 4.13 Impact Factor
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ABSTRACT: Training in advanced cardiac life support and defibrillation and community programs in cardiopulmonary resuscitation (CPR) had limited success in resuscitating patients with cardiac arrest in the Arrowhead region of Minnesota. Factors associated with survival included advanced cardiac life support within 16 minutes, ambulance traveling less than 1 mile (less than 1.6 km), use of paramedics, CPR within four minutes, and a call for help within two minutes. The use of technicians trained in defibrillation was associated with a statistically significant increase in hospital admissions, but not in survivors. The study failed to confirm the findings of previous studies of resuscitation in some rural areas. It was consistent, however, with reports that associated poor survival in rural areas with poor response times. No victims of unwitnessed arrests survived. Of the hospital deaths, 80% were due to neurologic causes, and overall survival was low.
JAMA The Journal of the American Medical Association 08/1986; 256(4):477-83. · 30.03 Impact Factor
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J W Bachman
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ABSTRACT: A coordinated community response to cardiac arrest can be successful if the response time to administration of cardiopulmonary resuscitation (CPR) is less than four minutes and to administration of advanced cardiac life support (ACLS) is less than eight minutes. Elements needed to achieve this goal include rapid access to the emergency medical system; widespread CPR training; rapid response of first responders trained in basic life support; rapid response time to ACLS, including resuscitation at the scene; and an evaluation system to determine the effectiveness of the response and then implementation of changes to prevent future mistakes. The response to cardiac arrest should be kept simple, and the community should work with the resources it possesses. Most communities already have the necessary elements and simply need to coordinate the effort into a reasonable approach. Perhaps with such an approach, 80% of deaths from sudden cardiac arrest could be prevented.
Postgraduate Medicine 10/1984; 76(3):85-90, 92-5. · 1.78 Impact Factor
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J W Bachman
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ABSTRACT: The Good Neighbor Rescue Program utilizes volunteers who pay for their basic life support training. Acting as first responders during cardiac emergencies, they become involved in the emergency care of seriously ill patients. In the program described, they participated in saving two lives during the first two years of the program. They reduced the time for trained help to arrive at the scene in 90 percent of the emergencies. The program requires coordination of existing resources within the rural community, is inexpensive, and is heavily dependent on volunteerism. The program complements the goals of providing basic life support to cardiac victims before the arrival of an ambulance and of providing advanced life support at the scene.
The Journal of family practice 04/1983; 16(3):561-6. · 0.61 Impact Factor
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The Journal of the American Board of Family Practice / American Board of Family Practice 5(6):645-7.
