Can urinary nitrite results be used to guide antimicrobial choice for urinary tract infection?

Enterococcus is unable to reduce nitrates and is also considered clinically resistant to trimethoprim/sulfamethoxazole (TMP/SMX), the drug of choice for uncomplicated urinary tract infection (UTI). The purpose of this study was to determine whether urinalysis nitrite results can be used to guide antimicrobial therapy when treating UTI in the emergency department (ED). A retrospective chart review examined 159 university hospital ED outpatients who had signs or symptoms of UTI and had a urinalysis with positive culture. Patients were categorized into two groups based on nitrite results. The proportion of isolates sensitive to TMP/SMX in each group was compared by using a two-sample z-test. Eighty-six urinalyses were nitrite positive: 67 (78%) contained TMP/SMX-sensitive isolates. Seventy-three urinalyses were nitrite negative; 60 (82%) contained sensitive isolates. There was no statistically significant difference in the proportion of isolates sensitive to TMP/SMX. Thus, we conclude that emergency physicians should not adjust antibiotic therapy for UTI based on nitrite results.

The gamma mass scanning technique for inertial anthropometric measurement.

The validity of the gamma mass scanner in predicting center of mass and moment of inertia of biological tissue was tested using legs of lamb. The reaction board, immersion and pendulum methods were used to obtain one or both the center of mass and moment of inertia of the legs. The results from these methods were compared with those obtained from the scanner. Results indicated that the gamma mass scanner consistently predicted the mass of the legs to within a 1% error, the center of gravity within 2.1% and moment of inertia to within 4.8%. Within the limits of this investigation it was concluded that the gamma mass scanner shows promise as a valid and exact method for determining the center of gravity and moment of inertia of biological tissue.

Are emergency physicians too stingy with analgesics?

Several recent reports suggest that emergency physicians do not use adequate analgesia for patients with acutely painful conditions in the emergency department (ED). To quantify the extent of this problem, we retrospectively studied 401 patients who were treated for acute fracture over a 17-day period in eight area-wide emergency departments. Patient age, fracture site, and ED setting (urban or suburban, teaching or nonteaching) were noted. Only 121 patients (30%) received analgesics while in the ED; neither fracture site, ED setting, or patient age significantly altered analgesic dispensing practices. We conclude that inadequate use of analgesics in patients who come to the ED for treatment of acute fractures is widespread and that efforts aimed at improving the appropriate use of analgesics in the ED are warranted.