Treatment of out-of-hospital status epilepticus.
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Biomedical subjects
Publications and source records attributed to R K Knopp.
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The ideal of patient confidentiality has mutated over the last several years to accommodate the factors that infringe upon its meaning; such as expanding health care information technologies, physical environments that promote breaches of patient privacy, and health care workers who are unaware of how their routine behavior infringes on patients' right to privacy. This article examines the various ways in which confidentiality is breached in the emergency department and the legal issues involved, and explores options for the improvement of patient privacy for physicians and other health care professionals.
STUDY OBJECTIVE: To determine whether squamous cells in urine indicate bacterial contamination. METHODS: We prospectively studied 105 consecutive women who presented to the emergency department with symptoms suggestive of a urinary tract infection. Two urine samples were collected from each woman, a midstream clean-catch (MSCC) sample and a catheterized (CATH) sample. Microscopic urinalyses to assess for squamous cells and urine cultures to assess for bacterial contamination were performed on all samples. Bacterial contamination was defined as growth of fewer than 10,000 colonies of a single species per milliliter or growth of three or more species of commensal bacteria (mixed flora) in a urine sample. RESULTS: Squamous cells were found in 99 of 105 CATH samples (94%); however, no CATH samples had bacterial contamination. Squamous cells were found in 101 of 105 MSCC samples (96%); however, only 22 MSCC samples (21%) had bacterial contamination. CONCLUSION: The presence of squamous cells in CATH urine samples obtained from women is not indicative of bacterial contamination. The presence of squamous cells in MSCC urine samples obtained from women also is not a good indicator, with an overall predictive value for bacterial contamination of 21%.
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Abruptio placentae is a complication of pregnancy associated with significant morbidity and mortality for both fetus and mother. The presence of uterine pain and tenderness traditionally has been considered a useful criterion for distinguishing abruptio placentae from other causes of bleeding in pregnancy. We report the case of a 25-year-old woman who presented with painless abruptio placentae and coagulopathy during the second trimester. This case illustrates the importance of considering this diagnosis in pregnant patients with vaginal bleeding.
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We conducted a study to determine if there were any significant differences in urinalyses or urine cultures obtained by midstream clean-catch (MSCC) urine sampling in comparison with in-and-out catheterization (CATH). One hundred five women with symptoms suggestive of a urinary tract infection were studied prospectively. Each woman had a MSCC urine sample obtained initially, followed by a CATH sample. The MSCC and CATH urine samples were analyzed and compared for urine culture, leukocyte esterase, nitrites, microscopic bacteriuria, and pyuria. Of the 105 patients, 42 (40%) had a culture-proven urinary tract infection. The concordance rates between MSCC and CATH urine cultures, nitrites, leukocyte esterase, significant microscopic bacteriuria, and pyuria were 96%, 94%, 93%, 90%, and 90%, respectively. There were no statistically significant differences between MSCC and CATH sensitivities, specificities, or positive or negative predictive values for any urinalysis variable (leukocyte esterase, nitrites, significant microscopic bacteriuria, or pyuria). We conclude that if proper MSCC technique is used, the differences between MSCC and CATH urinalyses or urine cultures do not appear to be significant in the majority of ambulatory women without active vaginal bleeding who present with symptoms suggestive of a urinary tract infection.