Systematic investigations of novel validity parameters in urine drug testing and prevalence of urine adulteration in a two-year cohort.

Urinalysis is well established for drug screening. Various methods of urine adulteration such as dilution, addition of oxidative/reductive chemicals or detergents, and handing over urine-like fluids are used to circumvent a positive screen. Validity parameters such as determination of pH, gravidity, urine temperature, or testing for oxidative/reductive chemicals are therefore used to uncover adulterated urine specimens. However, synthetic urine ("fake urine") has nowadays been used for manipulations, leading to inconspicuous results with common validity test systems. Therefore, the aims of the study were (a) to evaluate additional validity parameters, (b) to evaluate the prevalence of urine adulteration, (c) to identify adulteration markers in purchased fake urine samples. Urine samples (n = 550) submitted for drug abstinence testing were analyzed by a standard urine liquid chromatography-tandem mass spectrometry (LC-MS/MS) screening approach using library-assisted identification of 10 different endogenous biomolecules. The detection rates of biomolecules in authentic samples were phenylalanine (93.4%), tryptophan (97.1%), propionyl-carnitine (67.1%), butyryl-carnitine (99.6%), isovaleryl-carnitine (92.8%), hexanoyl-carnitine (91.0%), heptanoyl-carnitine (97.1%), octanoyl-carnitine (98.9%), and indoleacetylglutamine (98,2%). Phenylacetylglutamine was detected in each authentic sample. Based on the detection rates and measured creatinine levels, six manipulated samples were identified in this study. In two cases, fake urine was handed over, one time fake urine was most likely used for dilution. Once dilution with other fluids was used as adulteration method, while in another sample a detergent solution was handed over. Additionaly, one sample contained reactive chemicals. All fake urine samples were additionally identified by the detection of unique polyglycole patterns, which were observed in purchased fake urine samples.

Telemedical versus conventional heart patient monitoring: a survey study with German physicians.

OBJECTIVES: In this study, we explored crucial factors that explain a person's attitude toward and his or her assessment of telemedical systems. Special focus lies on the link between the perspective of physicians (telemedicine users) and technicians (telemedicine designers) to find potential barriers hindering the broad application of telemedical systems in hospitals and doctors' offices. METHODS: A survey among medical professionals (n = 34), technical professionals (n = 39), and a control group (n = 44) was conducted. The collected data were assessed in terms of domain knowledge, attitudes toward telemedicine, and potential implementation barriers. RESULTS: Participants favored the conventional method over telemedical monitoring in regards to privacy, security, and time efficiency. In contrast, telemedicine was preferred with reference to efficiency of data analysis, long-term care, and emergency adequacy. Significant differences between the professional groups were found regarding perceived cost effectiveness, patients' compliance, privacy protection, and false alarm sensitivity. Medical professionals exhibited the most reluctance toward using telemedical treatments. CONCLUSIONS: The perceived drawbacks are attributed to a general uncertainty about the reliability of telemedical systems, in combination with concerns about personal data privacy, security, and loss of control. The reported fear of not being able to correctly use and handle the systems assumes a low usability of devices. To acquaint medical professionals with the benefits and limitations of telemedical systems, telemonitoring and tele-treatment should be included in the education of medical personnel at an early stage.