Biomedical subjects
Publications and source records attributed to O Aspevall.
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Using the comparison method, we have evaluated the technical performance of Uricult Trio by culturing on Uricult Trio and agar plates. Urine samples (477) from patients in primary healthcare were cultured in parallel in a microbiology laboratory. The result for Uricult Trio evaluated using the comparison method was incorrect in 32% of the cultures. We also studied the performance of Uricult Trio when used in primary healthcare by using external control panels. External control panels consisting of Uricult Trio, inoculated with known concentrations of certain bacterial strains, were used to assess the performance of Uricult Trio in primary healthcare during the period 1993-7. Aberrations in reports of concentration have ranged from 10% to 33%, failure in reporting of mixed culture from 0% to 91% and reporting of E. coli from 15% to 86%. There has been no sign of improvement over the years. The results indicate that Uricult Trio is unsuitable for indications other than exclusion of urinary tract infection or diagnosis of urinary tract infection caused by E. coli. Further, there is need for quality assurance and training activities at primary healthcare laboratories, probably best carried out in collaboration with local clinical microbiology laboratories.
This study evaluates the effect of training on the results from Uricult Trio and an established urine culture when used at primary healthcare laboratories in two Swedish counties, Uppsala and Värmland. Urine cultures and dipslides, Uricult Trio, performed at these laboratories were interpreted a second time at central laboratories. Interpretation errors at the primary healthcare laboratories were calculated. Primary healthcare laboratories also received external control panels with urine cultures and dipslides. There was one study period each year for 3 years in Uppsala and for 2 years in Värmland. A training programme was completed between study periods in Värmland. In Uppsala, primary healthcare laboratory results could be reviewed, as interpretations by the central laboratory were returned to them. The main outcome measures were the percentage of interpretation errors which, in the first study period, was 33-39%. This dropped to 15-19% in the second study period. In the results from the external control panels there were no striking differences between the studied areas and Sweden as a whole, except that Uppsala showed a better result in reporting E. coli and failed in 10% compared to Sweden 46%. A method for both quality assessment and education is to ask the primary healthcare laboratories to send cultures to the central laboratory for interpretation requesting their return to the primary healthcare laboratory with the interpretation from the central laboratory attached.
This paper describes problems identified in our attempts to develop an expert system for management of urinary tract infections. We found three aspects which we believe are important to consider when developing such systems. The objective of our future work will be to evaluate the impact of these problems on expert system development and usage.
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OBJECTIVE: To estimate the prevalence of chlamydial infection among young women with UTI symptoms. To evaluate chlamydia diagnostics with the aid of enzyme immuno assay (EIA) on first-void urine. To evaluate rapid screening of bacteriuria, including low concentrations of common pathogens. DESIGN: EIA for detection of Chlamydia trachomatis antigen and confirmation with immunofluorescence test (DFA) in urine, cervical and urethral chlamydia culture, nitrite and granulocyte esterase test, urine sediment, chamber count, dipslide and conventional urine culture were performed. SETTING: Primary health care (PHC). PATIENTS: 217 women aged 15-35 years attending PHC for dysuria or urgency-frequency. MAIN OUTCOME MEASURES: Frequency of chlamydial infections. Sensitivity, specificity, predictive values of EIA and bacteriuria screening tests, respectively. RESULTS: The frequency of chlamydial infection was 3.7%. In spite of a high specificity of the EIA test (0.94 without DFA) the number of false positives exceeded the number of true positives. No single bacteriuria test showed sufficient diagnostic efficiency. CONCLUSIONS: Routine chlamydia testing in young women with UTI symptoms is recommended. EIA test on urine is of little use. Assessing diagnosis of UTI symptoms requires insight into the use of several rapid tests and a dialogue with the patient.
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We report a case of meningitis due to Gemella haemolysans. An 82-year-old man with trigeminal neuralgia and senile dementia developed signs of meningitis 24 h after retrogasserian glycerol injection. Cerebrospinal fluid cultures grew G. haemolysans. Initial treatment with ampicillin and cefotaxime followed by benzylpenicillin was successful.
In this study we present a concept system for the knowledge domain of urinary tract infections. The system was constructed using grounded theory methods, sampling from Swedish reference texts and patient records from consultations for urinary tract infections. The concept system is intended for use as an aid in the construction of a decision support system (DSS) for urinary tract infections, and as a search module in the mentioned DSS. In total 561 concepts were categorized in four major, and 58 subordinate categories. Relationships between the more important categories were developed, and the frequency of use of the most common concepts is presented. Using the presented categorical structure as domain model a prototype DSS for dipslide urine cultures has been developed.