Does clinical examination aid in the diagnosis of urinary tract infections in women? A systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Clinicians should be aware of the diagnostic values of various symptoms, signs and antecedents. This information is particularly important in primary care settings, where sophisticated diagnostic approaches are not always feasible. The aim of the study is to determine the probability that various symptoms, signs, antecedents and tests predict urinary tract infection (UTI) in women.</p> <p>Methods</p> <p>We conducted a systematic search of the MEDLINE and EMBASE databases to identify articles published in all languages through until December 2008. We particularly focused on studies that examined the diagnostic accuracy of at least one symptom, sign or patient antecedent related to the urinary tract. We included studies where urine culture, a gold standard, was preformed by primary care providers on female subjects aged at least 14 years. A meta-analysis of the likelihood ratio was performed to assess variables related to the urinary tract symptoms.</p> <p>Results</p> <p>Of the 1, 212 articles identified, 11 met the selection criteria. Dysuria, urgency, nocturia, sexual activity and urgency with dysuria were weak predictors of urinary tract infection, whereas increases in vaginal discharge and suprapubic pain were weak predictors of the absence of infection. Nitrites or leukocytes in the dipstick test are the only findings that clearly favored a diagnosis of UTI.</p> <p>Conclusions</p> <p>Clinical findings do not aid in the diagnosis of UTI among women who present with urinary symptoms. Vaginal discharge is a weak indicator of the absence of infection. The urine dipstick test was the most reliable tool for detecting UTI.</p

De huisarts en de tijdgeest

Issues of Huisarts and Wetenschap from 1957 to 2008 were analysed to see whether the professional ethics of general practitioners have changed in response to changes in patient characteristics and changes in government policy. In addition, semi-structured interviews with three generations of GPs were carried out. Results showed that professional standards have changed over the years. In the 1950s and 1960s, GPs acted as ‘parents’ for their patients, determining what was appropriate for them. GPs still had this role in the 1970s, but it was no considered important to teach patients to be independent and to take responsibility for their health. This change, with emphasis on one’s own responsibility, was instigated by GPs and not by changes in patient characteristics. In the 1990s, restraint became a professional standard, but this policy proved difficult to communicate to patients. The introduction of market forces to health care has made it increasingly difficult for GPs to be restrained in the provision of care. How the professional ethics of GPs will change in the future depends on the solidarity among GPs and on government policy