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At least 451 records · Page 25Linked to original sources
PubMed1998

The risk of eye splash injuries in surgery.

BACKGROUND: This study arose out of a concern about the transmission of infectious diseases through eye splash injuries in surgery. The purpose of this study was to identify the extent of the risk of eye splash injuries. METHODS: A prospective trial was undertaken which examined 160 consecutive eye shields used by surgeons and assistants in operations of 30 min or longer. The shields were inspected for macroscopic splashes and then tested for microscopic splashes using reagent strips. RESULTS: Of the 160 eye shields used in surgery, 71 tested positive for blood (44%). The surgeon was aware of a spray episode in only 13 cases (8%). The splashes were macroscopically visible in only 26 (16%) cases. The risk of eye splash was higher for the surgeon than for the assistants and increased with the length of the operation. CONCLUSIONS: This study demonstrates that the risk of eye splash injury in surgery is much greater than that perceived by most surgeons and trainees. Eye protection should be mandatory for all personnel in the operating theatre, particularly for those directly involved with the operation.

Blood-Borne Pathogens↗
PubMed1993

Capillary blood glucose measurements in hospital inpatients using portable glucose meters.

BACKGROUND: The use of portable glucose meters by nursing staff to perform bedside capillary blood glucose measurements is standard practice in the management of diabetic hospital inpatients. Few studies, however, have examined the practical limitations or the cost of this technology. AIM: To investigate the performance and cost of capillary blood glucose measurements using portable glucose meters in a hospital inpatient population being managed for diabetes mellitus. METHODS: The setting was a 500 bed metropolitan University Teaching hospital, with 22 meters (Glucometer-M) in routine use by about 450 accredited nursing staff. The Glucometer-M was also compared with an operator-independent meter (Hemocue) to assess the effect of operator bias on the overall efficacy and cost of the programme. RESULTS: Retrospective analysis of Glucometer-M reagent strips and comparison of measurements (n = 72) with the Hemocue revealed a marked operator bias which diminished accuracy and increased costs. The significant proportion of low haematocrits (< 30%) in the hospital population limited the applicability of the Glucometer-M which only operates reliably over the haematocrit range 35-50%. The excess of blood glucose measurements was highlighted by both a hospital ward audit and the frequency which exceeded that of routine electrolyte assays. CONCLUSIONS: Reliable bedside estimation of capillary blood glucose levels in hospitals requires a meter which is accurate, has negligible operator bias, is largely unaffected by haematocrit, and has insignificant risk of cross-contamination. At present only the Hemocue fulfils these specifications. Irrespective of meter choice, it is necessary to develop criteria for glucose measurements and monitor adherence.

Australia↗
PubMed1985

Rapid ward assessment of renal function by reflectance photometric determination of plasma creatinine.

The Ames Seralyzer reflectance photometer and disposable reagent strips for the determination of plasma creatinine were evaluated in the laboratory and on a urology ward over a 3-month period. Principles of the instrument used are described, as are details of the evaluation procedures. Reproducibility of results under optimum conditions gave coefficients of variation less than 7%. Under routine conditions of use, medical staff and laboratory analysts achieved high correlation with the routine laboratory method of analysis (r = 0.986, N = 108: r = 0.996, N = 102 respectively). Potential sources of inaccuracy were identified. Seralyzer determination of plasma creatinine can be rapidly, simply and reliably performed by medical staff on a urology ward, thereby facilitating assessment of renal function governed by clinical requirement rather than by laboratory convenience.

Creatinine↗
PubMed1991

Attitudes and intentions of UK general practitioners to diabetes care at the time of implementation of their new contract.

Prior to the introduction of their new contract, the intentions of general practitioners in Leeds (UK) towards diabetes care were assessed. All general practices in one Health District (n = 74) were contacted. Assessment was made of 46 (62%), while 28 expressed lack of interest. Of the 46 assessed, 2 (4%) were single-handed, and 44 (96%) were group practices, and list size was 700-15,500. Practice nurses were employed in 44 (96%) practices. There were 35 (76%) practices which expressed an interest in starting a diabetic clinic, while 6 (13%) had established a clinic. Practice facilities necessary to establish and run a clinic were surveyed. Those available were: register of diabetic patients in 12 (26%) (six of which were incomplete); blood sampling facilities in 45 (98%); blood glucose reagent strips in 45 (98%); glucose meters in 21 (46%) (but five with inappropriate test strips). All practices could check urine, blood pressure, and fundi (dark room available in 40 (87%) practices). Access to dietetic and chiropody services on the premises was available in 19 (41%) and 17 (37%) practices, respectively. Some expertise in diabetes was claimed by only 10 (22%) doctors. Staff at all practices desired further training in diabetes. In conclusion, despite the interest of most practices in starting a diabetic clinic, access to dietetic and chiropody services was inadequate. Expertise was generally lacking, but enthusiasm and desire for training were strong.

Attitude to Health↗
PubMed1997

Alcohol use among injured patients aged 12 to 18 years.

OBJECTIVE: To examine the scope of alcohol use among a population of injured adolescents. METHODS: A convenience sample of injured patients aged 12-18 years seen at a pediatric ED was tested for the presence of alcohol. Injured patients seen within 6 hours of their injuries were asked to submit urine samples for testing using reagent strips. Data were collected from the patient, out-of-hospital emergency care personnel, and parents regarding the circumstances of the injury. RESULTS: Of the 243 injured patients who were tested during an 8-month period, 231 were included in the final analysis. Ninety patients (39%) were alcohol-positive. The mean age of the alcohol-positive group was 16.0 +/- 1.64 years, compared with 15.3 +/- 1.8 years for the alcohol-negative group (p < 0.003). There was no significant difference between the 2 groups based on race, gender, or injury characteristics. A positive urine alcohol test was found for 18 (33%) of motor vehicle crash victims, 9 (38%) of the motor vehicle drivers, 10 (37%) of the patients who attempted suicide, and 49 (44%) of the assault victims. CONCLUSIONS: A substantial percentage of injured adolescent patients were alcohol-positive. The authors recommend the use of alcohol screening when treating injured adolescents.

Adolescent↗
PubMed1985

Rapid measurement of creatine kinase activity in a coronary care unit using a portable benchtop reflectance photometer.

Rapid measurements of plasma creatine kinase activity using an inexpensive benchtop reflectance photometer (Ames Seralyzer) and disposable reagent strips were evaluated in the laboratory and coronary care unit. The system proved simple to use and capable of yielding rapid (four minutes per analysis), precise (coefficient of variation less than 9%), and accurate results (correlation with routine method 0.995) when used by medical staff. Creatine kinase values were available 6.5-102 hours earlier than routine laboratory data, depending on the time and day of sampling, thereby facilitating appropriate and economic patient management. This instrument might be used to supplement the routine enzyme service for selected admissions, resulting in greatly improved availability of results and hence contributing to the early discharge of patients from intensive care facilities.

Clinical Enzyme Tests↗
PubMed1989

Quality of plasma cholesterol measurements in primary care.

Three surveys were made of the quality of plasma cholesterol measurements performed with a commercial desktop analyser (BCL Reflotron) in primary care. Each survey included three specimens, and results were received from 37, 61, and 69 participants. Although many participants obtained satisfactory results, 8.6% of the results differed by 1.0 mmol/l or more from the target values, and the overall between instrument dispersion of results was 1.3 times that between hospital laboratories. It was found that common sources of error were poor technique and the use of outdated reagent strips. Users of such instruments outside the laboratory need help and advice with training, and guidelines for this are provided. The main recommendations are that users should establish contact with a local clinical chemistry laboratory for training and support and should participate in external quality assessment schemes.

Cholesterol↗
PubMed1996

Measuring blood glucose in neonatal units: how does hemocue compare?

Rapid and reliable determination of blood glucose concentration is essential during the neonatal period to prevent adverse neurodevelopmental outcome from hypoglycaemia. Despite their unreliability, reagent strip methods continue to be used extensively in neonatal nurseries due to their rapidity and convenience. Recently, a new portable laboratory standard technique has been introduced (HemoCue B-Glucose system) for whole blood glucose determination. It is particularly suitable for near-patient testing in neonatal units. This new method, as well as other established methods of whole blood (Yellow Springs Instrument (YSI) and a hexokinase method on Cobas Bio), and plasma (Kodak Ektachem) glucose measurement, were therefore evaluated for their accuracy and concordance of measurements taken in the neonatal period. There were substantial discrepancies among the four methods of glucose measurement with wide limits of agreement between these methods. The glucose concentrations measured by HemoCue and YSI (n = 206), HemoCue and hexokinase (n = 113), HemoCue and plasma glucose on Ektachem (n = 69) and hexokinase and Ektachem (n = 66) were likely to differ by -29 to +61%, -23 to +56%, -36 to +65%, and -19 to +30%, respectively. Even the laboratory methods of blood glucose determination, therefore, can not be used interchangeably. Using a model based approach, the probabilities of "discordant" classification as hypo- or normo-glycaemia were estimated to be 6.8%, 6.5%, and 7.1% between HemoCue and YSI, HemoCue and hexokinase on Cobas Bio, and HemoCue and Ektachem analysers, respectively. In view of these low probabilities of discordant classification with other glucose analysers, the HemoCue system may offer a reasonable compromise between bedside and laboratory blood glucose estimations in neonates.

Blood Glucose↗
PubMed1989

Diagnosis of acute myocardial infarction from sequential enzyme measurements obtained within 12 hours of admission to hospital.

A prospective study was made of sequential changes in serum creatine kinase (CK) and CK-MB isoenzyme activity within the 12 hours following admission to the coronary care unit on 65 patients with recent chest pain. CK determinations were performed in the laboratory or in the coronary care unit using a dry reagent strip analyser. Slope values for log CK/hour and log CK-MB/hour were calculated, used to confirm or exclude the diagnosis of myocardial infarction, and compared with diagnosis by conventional means. Compared with retrospective diagnosis using all available information, the CK slope had a sensitivity of 100% and a specificity of 94%. This compared with a sensitivity of 94% and specificity of 90% for diagnosis using upper reference limits alone. Determination of CK slope permits very rapid and accurate biochemical confirmation or exclusion of myocardial infarction and the possibility of performing the measurements on the coronary care unit. It additionally offers the prospect of major cost savings resulting from early discharge or transfer from the coronary care unit.

Adult↗
PubMed1993

Beta 2-glycoprotein-1 (apolipoprotein H) excretion and renal tubular malfunction in diabetic patients without clinical proteinuria.

AIM: To compare the urinary excretion of beta 2-glycoprotein-1 with that of two other markers of early tubular disorder in diabetic patients without clinical proteinuria. METHODS: The urinary excretion of retinol binding protein, beta 2-glycoprotein-1, and N-acetyl-beta-D-glucosaminidase was measured in 90 known diabetic patients who had a negative reagent strip test for proteinuria. RESULTS: Among 43 patients with urinary albumin excretion within the reference range, 23 (53%) had raised urinary N-acetyl-beta-D-glucosaminidase activity, five (12%) increased excretion of beta 2-glycoprotein-1, and five (12%) increased loss of retinol binding protein. Among 47 patients with an albumin excretion of 0.9-7.9 mg/mmol creatinine, 42 (89%) had increased urinary N-acetyl-beta-D-glucosaminidase, 23 (49%) an increased output of beta 2-glycoprotein-1, and 16 (34%) a raised excretion of retinol binding protein. The excretion of these markers of tubular defects seldom exceeded two and a half times the upper reference limit and the differences between the findings in the insulin dependent and non-insulin dependent patients with similar albumin excretion were small and insignificant. CONCLUSIONS: In diabetic patients with a negative dipstick test for proteinuria: (a) assay of urinary beta 2-glycoprotein-1 may be a more sensitive test for the detection of impaired tubular reabsorption of protein than measurement of retinol-binding protein; (b) assay of N-acetyl-beta-D-glucosaminidase can detect tubular injury at a time when protein reabsorption remains normal; and (c) impaired renal tubular function may be present in the absence of evidence of glomerular malfunction.

Acetylglucosaminidase↗
PubMed2001

The incidence of hematuria in middle distance track running.

The purpose of this study was to establish if middle distance track athletes experience hematuria during their competitive season interval workouts and, if so, what type of workout based on intensity and distance was most associated with hematuria. During a 4-week observational period, athletes (n = 10) underwent reagent strip urinalysis before and after their twice weekly interval sessions. Positive samples for hematuria were analyzed microscopically to accurately determine red blood cell (RBC) loss. Seventy-one individual interval workouts were observed, of which 32 cases of hematuria were reported. Nine cases of hematuria exhibited >100 RBC per High Power Field (Hpf). Furthermore, 90% of the athletes experienced post-workout hematuria at least once. The highest incidence of hematuria was observed after workouts run at 110% of VO(2peak) over short (600-1,500 m) to moderate (1,501-3,000 m) distances. All post-exercise cases of hematuria resolved within 2 hr of recovery.

Adult↗
PubMed1999

Mouse urine collection using clear plastic wrap.

Qualitative urinalysis using Multistix reagent strips for the detection of urinary pH, protein, glucose, bilirubin, blood, ketone, urobilinogen and creatinine can be carried out with a few drops of mouse urine. The use of metabolic cages is not practical for such qualitative studies particularly when several animals are involved. Here we describe two different methods for collecting pure mouse urine. The single animal method (SAM) involves allowing a single mouse to urinate on Glad cling wrap outside of the animal cage. The multiple animal method (MAM) involves partitioning seven mice into seven different make-shift compartments laid out on top of the cling wrap and allowing them to urinate. The voided urine, in each case, is then aspirated into micro-centrifuge tubes using a Pipetman. Without coercion pure urine was obtained as early as 12 s. Volumes in the range of 10-250 microl were obtained. Modifications of the SAM could prove useful for rat or mouse urine collection under conditions of microgravity.

Animals↗
PubMed2003

The effects of birth weight discordance and prematurity on twin neonatal outcome.

OBJECTIVE: The purpose of this study was to determine the effect of birth weight discordance (BWD) and prematurity on twin neonatal outcome by measuring Apgar scores and blood glucose concentrations at birth. METHODS: This was a retrospective cross-sectional study. All twins born at NY Methodist Hospital between January 1998 and December 2001 were eligible. Excluded were fetal deaths, maternal systemic disease, maternal infections, major neonatal malformations, neonates with birth weight < 500 g and multiple gestation greater than 2. BWD was defined as intrapair difference in birth weight expressed as percentage of the larger twin greater than 20% and prematurity as gestation of less than 37 weeks. Hypoglycemia was defined as blood glucose concentration < 40 mg/dl. RESULTS: There were 75 (48%) preterm and 80 (52%) term twin pairs. Nineteen (12%) of the preterm and 15 (9.6%) of the term showed BWD. Mean Apgar scores at 1 and 5 minutes were higher for the term twins as expected. Neither prematurity nor hypoglycemia was present predominantly in BWD twins. Twelve of the preterm and six of the term BWD twins showed evidence of hypoglycemia. CONCLUSION: Hypoglycemia in the early hours of postnatal life is relatively common in preterm BWD twins. Blood glucose measurement using reagent strips is an efficient way of monitoring blood glucose concentrations in these infants.

Apgar Score↗
PubMed2006

Urinary albumin excretion and glomerular filtration rate across the spectrum of glucose abnormalities in essential hypertension.

The objective of this study was to assess the relationship between urinary albumin excretion (UAE) and GF across the spectrum of the glucose metabolism abnormalities in a large population of patients with hypertension. The Microaluminuria en Pacientes con Glucemia Basal Alterada (MAGAL) is a multicenter, cross-sectional study that was carried out by 1723 primary care physicians. A total of 6227 patients with essential hypertension (in three groups: [1] normal fasting glucose <100 mg/dl, [2] impaired fasting glucose > or =100 to 126 mg/dl, and [3] type 2 diabetes) were analyzed in this substudy. GFR was estimated by using the Modification of Diet in Renal Disease (MDRD) abbreviated equation. A single first-morning urine albumin/creatinine ratio was measured using Bayer reagent strip Microalbustix, a semiquantitative method. Abnormal UAE was defined as an albumin/creatinine ratio > or =3.4 mg/mmol (equivalent to > or =30 mg/g). The prevalence of abnormal UAE, > or =3.4 mg/mmol, increased across the spectrum of glucose abnormalities: 39.7, 46.2, 48.6, and 65.6% for normoglycemic, low-range, and high-range impaired fasting glucose and diabetes, respectively. UAE was positively related to SBP (P = 0.003) and inversely to GFR (P < 0.001). Renal insufficiency (GFR <60 ml/min per 1.73 m2) was present in 21.8% of the patients, more frequently older patients, women, and those with diabetes. The factors that were related to renal insufficiency were UAE > or =3.4 mg/mmol (odds ratio 1.86; 95% confidence interval 1.60 to 2.17) and diabetes (odds ratio 1.62; 95% confidence interval 1.29 to 2.04). There is a close relationship between abnormal UAE and renal insufficiency in essential hypertension. This is more marked in patients with diabetes and moderate in patients with high-range impaired fasting glucose.

Aged↗
PubMed1999

Relationship between glycosylated hemoglobin and the prevalence of proteinuria in Japanese men.

A total of 5,174 Japanese men were included in a cross-sectional study to examine the relationship between the glycated hemoglobin (HbA1C) level and the prevalence of proteinuria as determined using a reagent strip. The prevalence of proteinuria rose significantly at HbA1C levels above 5.9%, whereas no relationship was observed at HbA1C levels below 5.9%. Multiple logistic regression analysis showed that blood pressure and a family history of diabetes were independent factors associated with proteinuria in subjects with a HbA1C below 5.9% who were not under medication for diabetes. In contrast, HbA1C, obesity and smoking were associated with proteinuria in subjects who were under medication for diabetes and/or have a HbA1C above 5.9%. These findings suggest that maintaining a HbA1C level below 5.9%, non-smoking and a standard body weight may reduce the prevalence of proteinuria in Japanese men. Healthy life-style and standard body weight are especially important for subjects with a family history of diabetes.

Adult↗
PubMed1995

Ten-year incidence of gross proteinuria in people with diabetes.

There are few population-based epidemiological data describing the long-term incidence of gross proteinuria in people with diabetes. We performed a population-based study in southern Wisconsin of individuals with diabetes diagnosed at either < 30 years of age and taking insulin (younger-onset, n = 666) or > or = 30 years of age either taking (older-onset taking insulin, n = 376) or not taking insulin (older-onset not taking insulin, n = 418). The presence of gross proteinuria (> or = 0.3 g/l) was determined by means of a reagent strip. The incidence of proteinuria in the 10-year interval was 28% in the younger-onset group, it was 40% in the older-onset group taking insulin, and it was 33% in the older-onset group not taking insulin. After we controlled for other risk factors, the 10-year incidence of proteinuria was significantly related to higher glycosylated hemoglobin level and diastolic blood pressure at baseline and to an increase in glycosylated hemoglobin level and an increase in diastolic blood pressure from baseline to the 4-year follow-up in the younger-onset group and to higher glycosylated hemoglobin level, higher systolic blood pressure, and higher total pack-years of cigarettes smoked at baseline and an increase in systolic blood pressure from baseline to the 4-year follow-up in the older-onset groups. These data suggest that modification of three factors--hyperglycemia, high blood pressure, and smoking--may lead to a reduction in the long-term incidence of proteinuria.

Adult↗
PubMed1994

National diabetes programs. Application of capture-recapture to count diabetes?

OBJECTIVE: To evaluate the utility of capture-recapture methods using multiple, routinely collected, computerized data sources to estimate the numbers and prevalence of diabetes. Methods employed for regional and national monitoring of diabetes have been too inaccurate or too expensive. RESEARCH DESIGN AND METHODS: A survey was undertaken that used four sources of ascertainment to identify prevalent cases of known diabetes in community of Northern Italy: diabetic clinic and family physicians, hospital discharges, prescriptions, and reagent strips and insulin syringes. Capture-recapture methods were employed to estimate the number of missing cases and to adjust for undercount to accurately estimate the number of people who had diabetes. RESULTS: We identified 2,069 unique prevalent cases of known diabetes with the intensive case-finding procedure. The diabetic clinic and family physicians data source identified the largest number of cases. The evaluation of the two sample capture-recapture estimates showed that they were all biased downward because of dependencies between sources. Log-linear modeling was employed to take into account the dependence among all data sources and the heterogeneity of diabetic patients. This method estimated that 2,586 cases existed, resulting in an ascertainment-adjusted prevalence of 2.77% (95% confidence interval, 2.44-3.10). Thus, despite the active case identification, approximately 20% could not be identified. However, the number of cases and rates could easily be adjusted using capture-recapture. CONCLUSIONS: The study shows that a two-sample capture-recapture estimate could be very biased if the investigator is not assured that the sources are independent. However, if at least three data sources are employed, log-linear models allow estimation of the number and prevalence rate adjusted for the degree of undercount (in spite of both the dependence of data sources and the heterogeneity of the diabetic population). The critical factor, however, is that the application of multiple sources with capture-recapture methods could be applied across broad geographical areas and across time to have cost-effective monitoring of diabetes at local and national level.

Adolescent↗
PubMedDate not supplied

Teaching diabetic ptients about self-management.

It takes approximately 20 min to teach a patient how to use Dextrostix reagent strips in conjunction with an Eyetone reflectance meter (or the more recently introduced Glucochek). Blood glucose monitoring is no more difficult or time consuming than conventional urine testing and can be learned and executed by patients of various levels of intelligence. It is important to emphasize the need for an adequate drop of blood and the use of Monolet blood lancets has greatly facilitated this. Emphasis is put on the most useful times to make recordings and the importance of good record-keeping. The more intelligent patients readily learn how to adjust their insulin to improve their blood glucose readings while the less intelligent need help and advice. Experience has shown that no only are blood glucose levels improved but also hypoglycemic episodes are less commmon.

Blood Glucose↗