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PubMed1987

The significance of asymptomatic microhematuria in men 50 or more years old: findings of a home screening study using urinary dipsticks.

In an ongoing home screening study 231 men 50 or more years old without known causes of hematuria have tested their urine each week with a chemical reagent strip for the presence of blood. After 3 months of testing 23 patients have had hematuria at least once. Of these men 5 have had urinary cancers and 5 have had other serious underlying diseases requiring immediate treatment. In only 3 of these 10 men (only 1 with cancer) did hematuria occur in more than a third of the testings or on subsequent microscopic urinalysis. The degree of hematuria was unrelated to the seriousness of its cause. We conclude that in this population hematuria occurs so intermittently that when found on routine urinalysis, regardless of quantity, serious underlying pathological conditions must be ruled out aggressively. Furthermore, regular hematuria home testing appears to offer promise as an economical means to detect urinary cancers and other serious diseases in asymptomatic men 50 or more years old.

Hematuria↗
PubMed1995

Hematuria home screening: repeat testing results.

To determine at what interval screening should be repeated to detect bladder cancer before it becomes muscle invasive 856 men who had 14 negative daily home tests for hematuria with a chemical reagent strip 9 months previously performed repeat tests. Of these men 50 (5.8%) had at least 1 positive test during the second 14-day screening period and 38 were evaluated, 15 of whom (39.5%) had significant urological pathological conditions, including 8 with malignancies. Bladder cancer was noted in 7 men, with no tumor invading the muscularis propria. The finding of 7 bladder cancers in 856 men (0.82%) who had a negative test 9 months previously indicates that bladder cancer has a brief preclinical duration and that testing must be repeated at least annually for screening to detect bladder cancer consistently before invasion occurs.

Adenocarcinoma↗
PubMed2001

[Comparative study of 3 Schistosoma haematobium foci in Burkina Faso].

The comparative study of the three most common schistosomiasis foci in Burkinabé villages shows a great disparity both in parasitological and malacological results. Parasitological investigations by reagent strips and urine filtration conducted on school children indicated respective prevalence rates of 85% at Thion, 37.5% at Donsin and 10.5% at Djerma. Malacological prospections found two species (Bulinus senegalensis and Bulinus truncatus) of intermediate hosts of schistosomiasis in the water biotopes in Thion and Donsin, and only one species (B globosus) at Djerma. We speculate that this situation could be related to initial levels of endemicity, to the distance between living quarters and sites of transmission, to sociological practices as well as to the mollusc vector species. Given the large distribution of these foci throughout the country, the Burkinabé medical authorities should recognise their importance with regard to the disease on a public health level and support the current orientation of the national schistosomiasis control programme which is coordinated around district health services.

Animals↗
PubMed1989

Urinary tract cancers found by homescreening with hematuria dipsticks in healthy men over 50 years of age.

In a homescreening study 235 asymptomatic men, 50 years of age and older without known causes of hematuria, tested their urine each week with a chemical reagent strip for the presence of blood for 1 year. Forty-four men had hematuria at least once, and 31 had a full urologic evaluation. Of these, eight were found to have urinary cancers and seven had nonmalignant diseases warranting immediate treatment. In six of these 15 men (only two with cancer) hematuria occurred in over 1/3 of the testings, and in four hematuria was found on microscopic urinalysis at the time of urologic evaluation. The degree of hematuria was unrelated to the seriousness of its cause. We conclude that in this population hematuria occurs intermittently and when found, regardless of quantity or symptoms, serious underlying pathology must be ruled out. Furthermore, regular hematuria home testing offers a promising means of detecting urinary cancers and other diseases that warrant therapy in asymptomatic men 50 years of age and older.

Aged↗
PubMed1988

Prevalence of asymptomatic bacteriuria in subjects with NIDDM in San Luis Valley of Colorado.

This study examined whether non-insulin-dependent diabetic (NIDDM) subjects have an increased prevalence of asymptomatic bacteriuria compared with subjects with normal glucose tolerance. Diabetic (n = 206) and normal (n = 418) subjects were identified from a defined geographic area in the San Luis Valley of southern Colorado. Presence of asymptomatic bacteriuria was determined by testing the subjects' urine with a reagent-strip test for nitrite and leukocyte esterase (Chemstrip LN). The ability of the Chemstrip LN to detect bacteriuria was evaluated by comparing its results with those from urine culture on a subsample of subjects. There were 7 control and 12 diabetic subjects with bacteriuria as measured by the Chemstrip LN. The prevalence of urinary tract colonization among diabetic compared with control subjects was increased 3.5-fold (95% confidence interval 1.4-8.6). Adjustment for confounding by age, sex, ethnicity, and county of residence resulted in an adjusted prevalence ratio of 4.4 (95% confidence interval 1.1-17.4). Among diabetic subjects, prevalence of bacteriuria increased with longer disease duration but was not affected by measures of glucose control. We conclude that NIDDM increases the prevalence of bacterial colonization of the urine and, therefore, probably also increases the risk of symptomatic urinary tract infection.

Bacteriuria↗
PubMed1990

The quality of self-monitoring of blood glucose.

The accuracy of self-monitoring of blood glucose (SBGM) was assessed by a quality control programme. Ninety diabetic patients who were routinely performing SBGM were supplied with a series of quality control solutions which they tested with their usual meter and reagent strip. The overall error rate (a result outside the range of the mean +/- 3SD for each quality control solution) was 39% for users of the Ames system and 33% in Boehringer Mannheim system users. The clinical relevance of these errors was determined by examining the effect on the clinical decision which would have been based on the erroneous result, either in taking inappropriate action or in failing to take appropriate action. In 30% of all patients, 25% or more of the errors were of such a degree as to be clinically misleading. The most common error was an underestimation of the result, which gave the impression of better than actual blood glucose control. The main reason for these errors was the failure of patients to take sufficient care in following the manufacturers' instructions when performing the test. Clinically relevant erroneous results are common among patients performing SBGM.

Blood Glucose↗
PubMedDate not supplied

Management of diabetics with the use of a microprocessor: comparison of insulin treatments based on blood and urine glucose levels.

The insulin treatment of 8 insulin-dependent diabetics was controlled with a microprocessor (Better Control Medical Computer, BCMC, Inc., Toronto, Canada) with information derived from blood or first voided urine glucose concentrations assessed by reagent strips four times a day, before the three main meals and bedtime snack. The microprocessor recommends modification of the insulin doses so as to reach a pre-prandial blood glucose value of 110 mg/dl or a urine glucose concentration of 0.1 g/dl. During the first two weeks self-management was uniformly applied by the patients, based on their blood glucose concentration. Subsequently, it was continued by the patients who were divided into two groups, one using the blood, the other the urine glucose concentrations, each for three weeks, alternately. During microprocessor treatment the patients' mean blood glucose profiles decreased from 152 +/- 37 mg/dl to 126 +/- 28 mg/dl. No difference was found between treatments based on blood or urine glucose concentrations concerning either the mean blood glucose profiles or the number of hypoglycemic episodes in the presence of an average glucose threshold and good renal function. The first voided urine glucose concentration and mean and maximal blood glucose values obtained at the time of urine filtration were closely correlated (r = 0.82 and 0.86, p less than 0.001).

Adult↗
PubMed1992

A population-based prevalence survey of known diabetes mellitus in northern Italy based upon multiple independent sources of ascertainment.

The aims of this survey were (1) to estimate the prevalence of known diabetes mellitus in 1988 in Casale Monferrato (Northern Italy); (2) to validate different data sources available in Italy; (3) to identify a population-based cohort of diabetic patients. Multiple independent data sources were used and the capture-recapture method was applied to estimate the completeness of ascertainment of the survey. The primary data source was the list of all patients attending the diabetic clinic or those referred by family physicians and paediatricians of the area. The secondary data sources were the list of hospital discharges, the prescriptions data source and the list of all people using reagent strips and insulin syringes. On 1 October 1988 (the cut-off date) 2,069 cases of known diabetes were identified. The estimated completeness of ascertainment of the survey was 91%. Prevalence of known diabetes, Type 1 (insulin-dependent), Type 2 (non-insulin-dependent) and insulin-treated diabetes were, respectively, 2.21% (95% CI 2.13-2.29), 0.80/1,000 (0.62-0.98) and 2.10% (2.01-2.19), 2.92/1,000 (2.57-3.27). A higher prevalence of Type 2 diabetes was observed in women (2.30%, 2.18-2.42) than in men (1.88%, 1.76-2.00). Age-specific prevalence of Type 2 diabetes increased with age. Computerized data sources routinely available in the Piedmont Region (hospital discharges and prescriptions data sources) showed a low completeness of ascertainment when considered together (65%, 1,338 of 2,069), indicating the need to involve the diabetic clinic and family physicians in the ascertainment of known diabetes. In conclusion, the prevalence of known diabetes in Italy was lower than in Northern Europe and the United States.

Adolescent↗
PubMedDate not supplied

Evaluation of a new reflectance photometer for use in home blood glucose monitoring.

A new reflectance photometer (Glucometer, Ames Division, Miles Laboratories, Elkhart, Indiana) has been developed for use with the Dextrostix reagent strip. The device measures 8 X 17 cm, weighs 330 g, uses AA batteries, and requires no warm-up. High (330 mg/dl) and low (50 mg/dl) calibrations are stored in memory and need be repeated only when: (1) a control solution (100 mg/dl) reading is in error, (2) ambient temperature changes by more than 5 degrees C, (3) a new bottle of Dextrostix is used, and (4) batteries are changed. A 60-s timer with alarm helps make timing of the procedure consistent. Nineteen insulin-dependent and one non-insulin-dependent diabetic subjects each performed a minimum of 20 blood glucose determinations over a 3-mo period in the investigators' laboratories. Simultaneous capillary blood samples were obtained for plasma glucose analysis by a comparative method. A total of 602 patient-determined glucose values ranging from 30 to 400 mg/dl were compared with simultaneous laboratory values. These values correlated significantly (r = 0.96, P less than 0.0001, y = 2.6 + 0.92x). The Glucometer-Dextrostix System is an accurate and convenient method for home blood glucose monitoring by diabetic patients.

Adolescent↗
PubMedDate not supplied

The dynamics of a soluble egg antigen of Schistosoma haematobium in relation to egg counts, circulating anodic and cathodic antigens and pathology markers before and after chemotherapy.

A cohort of Schistosoma haematobium infected schoolchildren from Cameroon (n = 146) was studied for urine circulating soluble egg antigen (SEA), in comparison to other urine infection parameters: the circulating adult worm-derived antigens, circulating anodic and cathodic antigens (CAA and CCA), egg counts and the reagent strip index (RSI). Before treatment, SEA prevalence was 90%, while 89% and 65% of the children were positive for CCA and CAA respectively. The children were treated with 2 doses of praziquantel (2 x 40 mg/kg bodyweight) at an interval of 10 days and followed-up at 1, 2, 3, 5 and 12 months after treatment. Urine SEA correlated significantly with egg counts and RSI; levels of CAA and CCA were also significantly correlated with those of SEA. The levels of SEA showed a better correlation to both egg counts and RSI than did the levels of CAA and CCA. SEA levels dropped sharply 1 month after treatment, with few children excreting any SEA whereas egg counts decreased less rapidly. The prevalence and levels of SEA remained low during the whole post-treatment period whereas egg counts, RSI and CCA in urine rose progressively in the post-treatment period with a final egg count prevalence of 78%. The results of the present study indicate that for S. haematobium infections, measurement of SEA in urine is a valuable additional diagnostic parameter.

Adolescent↗
PubMedDate not supplied

Intravenous home blood glucose monitoring.

This study examines the correlation between the blood glucose concentration estimated by diabetic subjects at home using a Chemstrip bG reagent strip, and the blood glucose concentration subsequently measured in a Beckman glucose analyzer. Blood samples were obtained by eight diabetic patients throughout a period of 30 days in the home environment. Using the technique of i.v. blood withdrawal, a 250-microliters portion of each blood sample was stored for later physician verification of the blood glucose concentration. The preservative in these stored sampled inhibited the utilization of glucose in the blood samples for at least 30 days. Our results demonstrate that in the home setting, a highly significant correlation (R = 0.85, P less than 0.001) can be obtained between the plasma glucose concentration as estimated by Chemstrip bGs and the blood glucose concentration as estimated by Beckman automated glucose analysis. However, within the diabetic group, marked variation existed in correlation coefficients such that the highest correlation coefficient was 0.94, and the lowest was 0.72. Furthermore, the use of Chemstrip bGs tends to influence a patient's reading toward the preselected color chart of glucose concentration on the Chemstrip bG label. We conclude that i.v. home blood glucose monitoring provides a method whereby the physician can assess the accuracy with which his patients can monitor their blood glucose concentrations in a home environment.

Adult↗
PubMed2003

[History, accuracy and precision of SMBG devices].

Self-monitoring of blood glucose started only fifty years ago. Until then metabolic control was evaluated by means of qualitative urinary blood measure often of poor reliability. Reagent strips were the first semi quantitative tests to monitor blood glucose, and in the late seventies meters were launched on the market. Initially the use of such devices was intended for medical staff, but thanks to handiness improvement they became more and more adequate to patients and are now a necessary tool for self-blood glucose monitoring. The advanced technologies allow to develop photometric measurements but also more recently electrochemical one. In the nineties, improvements were made mainly in meters' miniaturisation, reduction of reaction time and reading, simplification of blood sampling and capillary blood laying. Although accuracy and precision concern was in the heart of considerations at the beginning of self-blood glucose monitoring, the recommendations of societies of diabetology came up in the late eighties. Now, the French drug agency: AFSSAPS asks for a control of meter before any launching on the market. According to recent publications very few meters meet reliability criteria set up by societies of diabetology in the late nineties. Finally because devices may be handled by numerous persons in hospitals, meters use as possible source of nosocomial infections have been recently questioned and is subject to very strict guidelines published by AFSSAPS.

Blood Glucose↗
PubMed1999

A survey of bedside methods used to detect pulmonary aspiration of enteral formula in intubated tube-fed patients.

BACKGROUND: The most frequently recommended methods to assess for pulmonary aspiration of enteral formula in intubated, tube-fed patients are (1) adding dye to enteral formulas and observing for dye-stained tracheal secretions and (2) testing tracheal secretions with glucose oxidase reagent strips to detect the presence of glucose-rich formula. Reportedly, the glucose method is more sensitive than the dye method, and the dye method may have greater potential for harm. It is not known if this information has resulted in wider use of the glucose method in practice settings. OBJECTIVES: To describe the frequency with which nurses in intensive care units use the dye and glucose methods to detect pulmonary aspiration of enteral formula in tube-fed, intubated patients. METHODS: One registered nurse in the medical intensive care unit at 285 acute-care facilities was contacted by telephone and asked about the methods used to detect pulmonary aspiration of enteral formula in tube-fed, intubated adult patients. RESULTS: Responses were obtained from 281 facilities. More than 73% of the respondents reported using only the dye method; about 1% reported using only the glucose method. Approximately 13% used both methods; another 13% did not use either method. CONCLUSIONS: The dye method is used far more often than is the glucose method. Two probable reasons are that the dye method is easier to implement, and it is recommended in commonly used basic nursing textbooks.

Adult↗
PubMed2005

Can the urine dipstick test reduce the need for microscopy for assessment of systemic lupus erythematosus disease activity?

OBJECTIVE: Urine microscopic examination is an important component of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). We investigated whether the urine dipstick test can reduce the need for microscopy for the assessment of SLEDAI. METHODS: We studied 269 urine samples from 259 SLE patients with Albustix and Hemastix reagent strips. The results were compared to concomitant microscopic examination of urinary sediment. RESULTS: When trace red blood cell was defined as the cutoff, the sensitivity, specificity, and negative predictive value (NPV) of the Hemastix urine test were 0.98, 0.53, and 0.99, respectively, for hematuria; 0.82, 0.47, and 0.90, respectively, for the presence of pyuria; and 0.91, 0.44, and 0.98, respectively, for the presence of casts by microscopic examination. When proteinuria of 1+ was defined as the cutoff, the sensitivity, specificity, and NPV of the Albustix test were 1.00, 0.46, and 0.99, respectively, for urinary casts; and 0.82, 0.49, and 0.90, respectively, for the presence of pyuria. When both Albustix and Hemastix were applied as screening test, urine microscopy could be reduced by 27%; however, 8% of cases with normal Albustix and Hemastix tests had at least one abnormality on urine microscopy examination. CONCLUSION: In patients with SLE, a combination of Albustix and Hemastix urine tests showed reasonable sensitivity to detect abnormalities in urine sediment. Based on these results, routine urine microscopy can be limited to SLE patients with abnormal Albustix or Hemastix tests. Rarer causes of abnormal renal function in lupus, such as tubulointerstitial nephritis or drug induced interstitial nephritis, would be manifested by pyuria and therefore would not necessarily be detected by changes in the blood and protein detectors on the urine dipstick.

Adolescent↗
PubMed1999

Laboratory-based quality assurance programme for near-patient urine dipstick testing, 1990-1997: development, management and results.

The need for quality assurance (QA) programmes covering near-patient testing technologies has been acknowledged since the mid-1980s. However, most effort has been directed towards capillary blood glucose monitoring techniques. The most common biochemical near-patient testing device is the dry reagent strip or 'dipstick' for urinalysis. This report describes a quality assurance programme for urinalysis, used in the wards and clinics of a district general hospital, and in some of the general practitioner surgeries within its catchment area. The project describes the preparation of an aqueous 'urine' sample, the design of a report form, the dispatch of the sample and report forms to the ward/clinic/health centre, the receipt and scoring of the returned results, and the assessment of the results, both in terms of management information and sources of error. Samples were spiked to give a target value midway between two colour blocks for each analyte. Results were scored as +/- 1 if adjacent colour block to the target, +/- 2 for results two colour blocks (error) and +/- 3 (gross error) for results three or more colour blocks from the target value. For urine glucose, results showed an overall 14.7% error and 2.6% gross error rate. Similar scoring gave the following error and gross error rates for the other analytes: bilirubin (1.0%, 3.3%); ketone (4.3%, 0.3%); specific gravity (13.4%, 3.1%); pH (11.2%, 6.5%); blood (7.7%, 2.9%); protein (9.7%, 2.3%); and nitrite (gross errors 4.9%). Investigation of the results of the programme showed four types of error in dipstick testing-timing, misalignment, misunderstanding and transcription. Analysis of the results showed a reduction in error rates when an electronic reader was used (errors 2.0%, gross errors 0.75%), compared to reading against the colour blocks on the side of the bottle (7.7%, 1.6%) or using the colour blocks on a flat card reader (7.4%, 1.7%). The report demonstrates the importance of a QA scheme in providing a reliable screening service. It gives confidence to the users of dipsticks, information on training needs to clinical managers, and an understanding of both types of error and how they can be reduced.

England↗
PubMed1995

Comparison of bladder cancer outcome in men undergoing hematuria home screening versus those with standard clinical presentations.

OBJECTIVES: Because repetitive hematuria home screening with a chemical reagent strip can detect early stage bladder cancer (BC) in asymptomatic middle-aged and elderly men, the ability of this screening to effect earlier detection and reduce BC mortality was investigated. METHODS: Grades, stages, and outcomes of BCs detected by hematuria screening in 1575 men were compared with those of all newly diagnosed BCs in men age 50 years or older reported to the Wisconsin cancer registry in 1988. BC grades and stages were assigned by review of all pathology slides/blocks, and causes of deaths were determined from cancer registry records. As an additional control group, outcomes of BC cases diagnosed in men solicited to take part in screening, who declined, were also determined. RESULTS: The proportions of low-grade (grades 1 and 2) superficial (Stages Ta and T1) versus high-grade (grade 3) or invasive (Stage T2 or higher) cancers in cases detected by hematuria screening (screened cases) and those reported to the tumor registry (unscreened cases) were not significantly different (52.4% versus 47.7% in 21 screened and 56.8% versus 43.3% in 511 unscreened cases) (P > 0.20). Of the high-grade or invasive cases, however, the proportion of late stage (T2 or higher) tumors was significantly lower in the screening-detected BCs compared to unscreened ones (P = 0.007). No screened case has died of BC (3- to 9-year follow-up), whereas 16.4% of unscreened cases have within 2 years of diagnosis (P = 0.025). Twenty-three of 1940 (1.2%) men who were solicited but chose not to participate in screening were diagnosed with BC within 18 months after what would have been their last home screening date, compared with 1.3% of participants having BC detected by screening. Thus, screening participants and those who were solicited and declined had similar likelihoods of developing BC. CONCLUSIONS: Hematuria home screening detects high-grade cancers before they become muscle invading and significantly reduces BC mortality.

Aged↗
PubMed1987

New dip-and-read test for determining leukocytes in urine.

A new reagent strip for the determination of leukocytes in urine (LEUKOSTIX; Ames) is described. The test is based on the esterase activity in leukocytes as a marker. Upon contact between the reagent matrix and a urine containing leukocytes, an amino acid ester is hydrolyzed by the esterase to its corresponding alcohol. The free alcohol then couples with a diazonium salt to produce a purple azo dye. The relative concentration of leukocytes in the urine is obtained by visually comparing the strip reaction with a color chart. Performance of the strip was evaluated in a clinical study involving eight different sites and 867 urine specimens. The comparison method was sediment microscopy; specimens containing five cells or more per high-power field were considered to be positive. Sensitivity was 76.3%, specificity 80.8%. Performance was comparable with that of the CHEMSTRIP LN (Boehringer-Mannheim Diagnostics, Inc.) leukocyte test, which we evaluated concurrently.

Albuminuria↗
PubMed2003

The incidence and immediate respiratory consequences of pulmonary aspiration of enteral feed as detected using a modified glucose oxidase test.

Pulmonary micro-aspiration of enteral feed in intubated critically ill patients has been reported to occur commonly. In this prospective observational study the incidence of micro-aspiration, diagnosed by a modified glucose oxidase test, is reported in 25 enterally fed critically ill and tracheally intubated patients on a general intensive care unit. Episodes of microaspiration were correlated with changes in PaO2/FiO2 ratio as an index of changes in degree of lung injury. The modified glucose oxidase test differs from the traditional glucose oxidase test because of the enrichment of the feed with glucose (10 g glucose added to 500 ml enteral feed resulting in a tenfold increase in glucose concentration). Pulmonary aspiration of feed was detected by exposing a glucose oxidase strip to tracheal secretions. The feed was enriched with glucose to improve the ability of the reagent strip to detect the feed. The incidence of aspiration of feed was 44% with a prevalence of 6.9% per day of intubation. Only 43% of these episodes of aspiration were detected by the feed being seen in the tracheal secretions. Aspiration was associated with a mean fall in the PaO2/FiO2 ratio of 5.6 kPa from 27.1 kPa to 21.5 kPa (P = 0.002). Aspiration of enteral feed is common and causes a demonstrable morbidity. Detection using this simple bedside test may alert the clinician to institute measures to minimize further aspiration.

Enteral Nutrition↗