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Biomedical subjects

A Wagg

Publications and source records attributed to A Wagg.

25 records · Page 2Linked to original sources
PubMedDate not supplied

Rapid urinalysis assays for the diagnosis of urinary tract infection.

Urinary tract infection (UTI) in premenopausal women is a frequent complaint in general practice. UTI is usually diagnosed on the basis of clinical symptoms and the use of one or more laboratory tests, the most common being rapid urinalysis reagent assays (urine dip) or midstream urine culture. In order to correlate the leucocyte esterase results of a rapid urinalysis assay with direct urine microscopy for pyuria, undiluted non-centrifuged urine samples from 206 volunteer female healthcare professionals were subjected to analysis using direct urine microscopy using a counting chamber and a rapid urinalysis assay. Of the 206 specimens, 74 were positive for leucocyte esterase using the rapid urinalysis assay, and 39 specimens demonstrated significant pyuria (greater than or equal to 10 leucocytes/microl) on direct microscopy. When the leucocyte esterase results were correlated with the direct urine microscopy results, an assay reading of 15 leucocytes/microl ('trace' on the visual scale) had a sensitivity of 91%, specificity of 79%, positive predictive value of 53% and a negative predictive value of 97%. An assay reading of 25 leucocytes/microl ('+' on the visual scale) or greater had a sensitivity of 63%, specificity of 95%, positive predictive value of 75% and a negative predictive value of 91%. In premenopausal, non-pregnant females, a rapid urinalysis assay result of 25 leucocytes/microl or greater will predict significant pyuria on urine microscopy with reasonable confidence, thereby reducing the need for more costly urine cultures.

Adult↗
PubMedDate not supplied

Cardiopulmonary resuscitation: doctors and nurses expect too much.

Doctors and nurses in the UK and US have an over-optimistic view of patients' chances of surviving an attempt at cardiopulmonary resuscitation (CPR). If medical staff are to follow the recommendation that they should discuss the pros and cons of CPR with patients and their relatives, they should at least be able to give them realistic expectations of survival; otherwise inappropriate decisions may be made. Resuscitation training programmes should routinely include data on survival from CPR in differing circumstances.

Cardiopulmonary Resuscitation↗
PubMedDate not supplied

Does audit improve DNR decision making?

The use of 'do not resuscitate' (DNR) orders in hospitals has been the subject of considerable comment in both the medical and the lay press. Guidelines have been produced to help make DNR decisions but, as yet, there have been no published accounts of these in practice. We have used audit to accounts of these in practice. We have used audit to develop DNR policy in our hospital, and have reviewed practice after the introduction of guidelines. This led to early consultant involvement in making decisions in 55 of 80 patients (69%) who were assessed as DNR at the time of death or discharge, documentation of reasons for DNR in all 55 of these and documentation of discussion with nurses in 49 (89%). Consultants agreed with DNR decisions made by their juniors in 31 of 34 cases (91%) and changed 'for CPR' decisions to DNR in 24 of 108 (22%). We have demonstrated that audit is an appropriate way to change and develop practice in sensitive areas such as this.

Adolescent↗
PubMedDate not supplied

When can elderly patients be excluded from discussing resuscitation?

Case notes of elderly medical patients were surveyed to determine when "do not resuscitate' (DNR) decisions could legitimately be made without consulting them. Patients were thought to be suitable for exclusion from decisions if morbidity scores indicated that they were unlikely to survive cardiopulmonary resuscitation (CPR) or if they were mentally incompetent. Thirty per cent of all patients were predicted not to survive CPR; another 28% were deemed incompetent. Of those with DNR decisions, 59% were predicted not to survive and a further 24% were incompetent. Discussing resuscitation would have been appropriate with 17% of those with DNR decisions.

Advance Care Planning↗