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- Aspevall, Olle
(författare)
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Diagnosis of urinary tract infections : aspects of quality assurance and communication of concepts
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Urinary tract infection (UTI) is a common disease; most cases are managed in primary health care (PHC. Dipslide (a type of urine culture test designed for point of care testing) is used in PHC in Sweden for the diagnosis of UTI. The results in an external quality assessment programme initiated in 1993 for dipslide did not improve over the years. Thus, a comparison between Uricult Trio® (a type of dipslide) and conventional urine culture was made, in this 32 % of the dipslide results diverged from the result obtained by conventional urine culture. The effect of two training methods on performance of dipslide and conventional urine culture in PHC was also studied. The error rates decreased from 30-39 % to 13-19 % after training.Further, four chromogenic media for urine culture were compared to routine media for urine culture. A total of 1200 urine specimens were included. Evaluation using quantitative culture of reference strains was also done. There were only minor differences in isolation rate between the different media for Gram negative bacteria. Except for enterococci, Gram positive bacteria grew poorer on the chromogenic media than on blood or CLED agar. The isolation rate on any single medium was 92 - 96 % of the total Ndegrees of isolated strains (MacConkey excluded). The increase in isolation rate after two days of incubation was small on all media, 97 - 100 % of isolates were recovered after one day of incubation. These findings prompted studies concerning the communication of knowledge on UTI. The aim was to specify a categorical structure for the knowledge domain of UTI using grounded theory methodology. Swedish reference texts and patient records from visits for UTIs in primary healthcare were studied. In total 560 concepts were found. Four major categories: microorganism, disease, healthcare, and host, plus 58 subordinate categories were developed. Relations between concepts were defined. In an accompanying project this categorical structure was used in a decision support system for Uricult Trio® Both the needed level of granularity and the emphasis of different characteristics of a given concept differ between medical domains, e.g. general practice and clinical microbiology. In short: The concepts used in communication are adapted to the activity one is currently engaged in. For example, the concepts used in technical diagnosis at a clinical bacteriology laboratory must be translated to taxonomical concepts at a useful level before being communicated to the clinician. Another consideration in communication is the intended function of a statement. Authors seldom explicitly express if a statement is intended as a defining criterion, recognizing criterion, or characteristic. This has implications on statistics, health care and research. These studies concluded that dipslide culture is only suitable for diagnosis of UTI caused by E. coli in high colony counts or to exclude UTI. Further, the most important factor to improve the quality of dipslide culture in PH is establishing cooperation between clinical microbiology and point of care testing sites to develop a training and quality assurance programme. Finally a strategy for quality assurance of dipslide in PHC is suggested.
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- Karlsson, Daniel, et al.
(författare)
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A study of the concept of urinary tract infections in different domains of medicine using the MEDLINE® database
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- In the construction of decision-support systems, differences between expert and end-user domains may pose a problem. As a way of studying differences between medical domains regarding management of urinary tract infections, we investigated the MEDLINE® for differences in indexing patterns. Further, our intention was to assess the MEDLINE® database as a source for studying medical domains. We examined the use of main headings, subheadings and the level of main headings in six medical domains that manage urinary tract infections. Many intuitive but also some counterintuitive results were found. We conclude that it is difficult to use the MEDLINE® database for studying medical domains mainJy due to unclear semantics both in the headings and the indexing process, which results in variability in indexing. This variability probably hides significant results. We also conclude that the differences found indicate that in addition to differences between domains, there are also large variations within domains.
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- Karlsson, Daniel, 1969-, et al.
(författare)
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Concepts, contexts and expert systemms
- 1999
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Ingår i: Medical Informatics Europe99,1999. - Amsterdam : IOS Press. ; , s. 713-
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Konferensbidrag (refereegranskat)
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- Liss, Per-Erik, et al.
(författare)
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Terms used to describe urinary tract infections - The importance of conceptual clarification
- 2003
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Ingår i: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS). - : Wiley. - 0903-4641 .- 1600-0463. ; 111:2, s. 291-299
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Tidskriftsartikel (refereegranskat)abstract
- Inaccuracies in medical language are detrimental to communication and statistics in medicine, and thereby to clinical practice, medical science and public health. The purpose of this article is to explore inconsistencies in the use of some medical terms: urinary tract infection, bacteriuria and urethral syndrome. The investigated literature was collected from medical dictionaries, textbooks, and articles indexed in Medline«. We found various practices regarding how the medical terms should be defined, and had great difficulty in interpreting the status of the statements under the heading of 'definition'. The lesson to be learned, besides a reminder of the importance of clearly defined medical concepts, is that it must be explicitly stated whether what is presented as a definition is to be considered as defining criterion, as recognising criterion or as characteristic of the disease entity.
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- Palmqvist, Elisabeth, et al.
(författare)
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Difficulties for primary health care staff in interpreting bacterial findings on a device for simplified urinary culture
- 2008
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Informa UK Limited. - 0036-5513 .- 1502-7686. ; 68:4, s. 312-316
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Tidskriftsartikel (refereegranskat)abstract
- The reliability of interpretations of findings from dip-slide devices for culturing urine was investigated in a national Swedish external quality assessment (EQA) programme. Also investigated was the extent of improvement in the examination procedure achieved through personnel training programmes and information. According to Swedish national recommendations, dip-slide should only be used in primary health care (PHC) in cases of uncomplicated urinary tract infection (UTI) in females of childbearing age. The recommendations also define six possible outcomes of a dip-slide examination, outcomes that have formed the basis for the EQA programme since 2001. No improvement in ability to classify readings correctly into the six categories was noted for the period 2001 to 2006. Preparations containing 'mixed flora' presented participants with the greatest difficulty, with only 28% correct reports. The EQA programme, with educational components and voluntary participation, has not improved quality. The disappointing results might be a reflection of the limited effort and resources allocated by clinical microbiology laboratories for training and for sustaining proficiency in the evaluation of dip-slides. For these reasons, we cannot at present recommend the dip-slide technique for use in PHC settings. © 2008 Informa UK Ltd (Informa Healthcare, Taylor & Francis AS).
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