Use Of Urine Testing Research Articles

Changing the use of isolated urine-culture testing with diagnostic testing stewardship

Background: Urine testing is one of the more frequently ordered diagnostic tests among hospitalized patients. Many hospitals have implemented urinalysis with reflex culture (UARC) as a method of diagnostic testing stewardship to guide appropriate use of urine testing. Isolated urine culture, or urine culture without preceding urinalysis, is the most appropriate diagnostic test for patients who are neutropenic, pregnant, or those about to undergo an invasive urologic procedures. This testing is often used beyond these indications in hospitals though, potentially leading to overdiagnosis of UTI and overtreatment of asymptomatic bacteriuria. Methods: We compared outcomes in the preimplementation period (December 2018–November 2019) to those in the postintervention period (December 2019–October 2020) at an academic medical center. The intervention was the addition of an indication selection (ie pregnancy, neutropenia, etc) to the isolated urine-culture order in the electronic medical record (EMR). The primary outcomes were isolated urine culture rate per 1,000 patient days and urine-culture positivity. Our exploratory analysis included a review of selected indications after the intervention was implemented and a chart review of a subset of these tests for appropriateness. The primary analysis was performed using interrupted time-series negative binomial regression. Results: There was no significant change in isolated urine-culture rates after the intervention (11.18 cultures per 1,000 patient days before the intervention versus to 7.75 cultures per 1,000 patient days after the intervention; P > .90), and there were as no significant pre- or postintervention trends. We detected no significant change in isolated urine-culture positivity: 26.9% before the intervention versus 26.7% after the intervention (P > .90). These results are shown graphically in Fig. 1. In the exploratory analysis, of 661 isolated urine-culture tests ordered in the postintervention period, the indication for testing was left blank in 71.9% of tests. The other most common reasons for testing included other (16%), pregnancy (5.7%), and neutropenia (4.4%). In the 100 tests reviewed for appropriateness, only 8% had a documented diagnosis corresponding with the selected indication for testing. Discussion: The addition of an indication selection for isolated urine culture testing did not change the rates of culture ordering or the culture’s subsequent likelihood of positivity. In the exploratory analysis, most providers were incorrectly selecting this testing rather than UARC as prompted. Next steps could potentially be removing the “other” category and requiring a selected answer or requiring approval from stewardship team prior to ordering. Continued education of providers is paramount to the appropriate use of diagnostic testing.Funding: NoneDisclosures: None

High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips

BackgroundThe opioid epidemic has caused an increase in overdose deaths which can be attributed to fentanyl combined with various illicit substances. Drug checking programs have been started by many harm reduction groups to provide tools for users to determine the composition of their street drugs. Immunoassay fentanyl test strips (FTS) allow users to test drugs for fentanyl by either filling a baggie or cooker with water to dissolve the sample and test. The antibody used in FTS is very selective for fentanyl at high dilutions, a characteristic of the traditional use of urine testing. These street sample preparation methods can lead to mg/mL concentrations of several potential interferents. We tested whether these concentrated samples could cause false positive results on a FTS.Methods20 ng/mL Rapid Response FTS were obtained from BTNX Inc. and tested against 4 different pharmaceuticals (diphenhydramine, alprazolam, gabapentin, and naloxone buprenorphine) and 3 illicit stimulants [cocaine HCl, methamphetamine, and 3,4-methylenedioxymethamphetamine (MDMA)] in concentrations from 20 to 0.2 mg/mL. The FTS testing pad is divided into 2 sections: the control area and the test area. Control and test area signal intensities were quantified by ImageJ from photographs of the test strips and compared to a threshold set by fentanyl at the FTS limit of detection.ResultsFalse positive results indicating the presence of fentanyl were obtained from samples of methamphetamine, MDMA, and diphenhydramine at concentrations at or above 1 mg/mL. Diphenhydramine is a common cutting agent in heroin. The street sample preparation protocols for FTS use suggested by many online resources would produce such concentrations of these materials. Street samples need to be diluted more significantly to avoid interference from potential cutting agents and stimulants.ConclusionsFentanyl test strips are commercially available, successful at detecting fentanyl to the specified limit of detection and can be a valuable tool for harm reduction efforts. Users should be aware that when drugs and adulterants are in high concentrations, FTS can give a false positive result.

Preliminary results from Brazil's first recovery housing program.

The recovery housing (RH) program was initiated in São Paulo with the objective of providing treatment for substance use disorders and addressing users' housing and employment problems. The purpose of this study was to describe the model based on its first 11 months of operation, it was launched in June 2016 in Brazil. We carried out a retrospective analysis of the records of all subjects treated in the RH of the Restart Program (Programa Recomeço) since its creation, from June 2016 to May 2017. Sixty-nine subjects were included. Thirty-five (51%) remained in the household until the end of treatment or were reinserted in society. Thirty-four (49%) presented recurrence during their stay, of which 16 (47%) volunteered for treatment in a therapeutic community or psychiatric hospital, 8 (23.5%) chose to continue with outpatient treatment only, 6 (17.7%) returned to their families and continued to receive outpatient treatment, and 4 (11.8%) discontinued the treatment. Of the 35 subjects who completed the RH program, 28 (80%) were in employment and 7 (20%) received governmental support for permanent disability on medical or psychiatric grounds. RH can be an important component of integrated care and is used in several countries. Although controversial, the use of urine tests to control relapse seems to have a positive impact on adherence to treatment and maintenance of abstinence. These preliminary findings corroborate, with clear limitations, the evidence available in the literature showing that RH programs are effective for the treatment of addictions.

“Positive” urine testing for Cannabis is associated with increased risk of traffic crashes

Although recent Cannabis use is widely reported to be associated with drug-related traffic accidents, the evidence that Cannabis users show an increased risk of being involved in road crashes is still not unequivocally proved. The purpose of the present work is to provide an objective assessment of this hypothesis, by comparing the frequency of occurrence of positive urine analyses in drivers involved in traffic accidents (n = 1406) with that observed in a control population undergoing mandatory urine drug testing (n = 1953). Urine analyses for drugs of abuse were performed by screening immunometric techniques followed by confirmation with UHPLC-QQQ MS, adopting a cut-off concentration for THC-COOH of 15 ng/mL. A case was classified as “positive” when a driver admitted to hospital for road traffic injuries showed urine concentrations of THC-COOH higher than the cut-off. All samples showing positive results for any other controlled drug in urine or blood alcohol concentrations >0.5 mg/mL were excluded from the study. Subjects positive to THC-COOH, and negative to all the other tested substances were 116 in Group 1 (8.2%) and 16 in Group 2 (0.8%). Subjects resulting negative to any tested substances were 1290 in Group 1 and 1937 in Group 2. The frequency of THC-COOH detection in the two groups was compared by using the “chi square” test, which resulted = 119.57, i.e. highly significant (P <<< 0.01). The Odds Ratio of the two groups was =10.88, showing a high degree of association between the presence of THC-COOH in urine and the occurrence of traffic accidents (P < 0.0001). The presented data, proving a high degree of association between Cannabis use and the occurrence of traffic accidents with injuries of the driver, support the use of urine testing for Cannabis in the procedures for the issuing of the driving licence, particularly in the case of subjects formerly or presently using Cannabis. This finding looks even more relevant in the present times, because of the increasing success of the policies of legalization of Cannabis for medical and non-medical purposes.

A cluster randomised trial of strategies to increase cervical screening uptake at first invitation (STRATEGIC).

Falling participation by young women in cervical screening has been observed at a time that has seen an increase in the incidence of cervical cancer in the UK in women aged < 35 years. Various barriers to screening have been documented, including fear, embarrassment and inconvenience. To measure the feasibility, clinical effectiveness and cost-effectiveness of a range of interventions to increase the uptake of cervical screening among young women. A cluster randomised trial based on general practices performed in two phases. Primary care in Greater Manchester and the Grampian region in Scotland. Phase 1: 20,879 women receiving their first invitation for cervical screening. Phase 2: 10,126 women who had not attended by 6 months. Phase 1: pre-invitation leaflet or not, and access to online booking (Manchester only). Phase 2: (1) vaginal self-sampling kits (SSKs) sent unrequested (n = 1141); or (2) offered on request (n = 1290); (3) provided with a timed appointment (n = 1629); (4) offered access to a nurse navigator (NN) (n = 1007); or (5) offered a choice between a NN or a SSK (n = 1277); and 3782 women in control practices. Uplift in screening compared with control practices, cost-effectiveness of interventions, and the women's preferences explored in a discrete choice experiment. The pre-invitation leaflet and offer of online booking were ineffective when compared with control practices at 3 months, 18.8% versus 19.2% [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.88 to 1.06; p = 0.485] and 17.8% versus 17.2% (OR 1.02, 95% CI 0.87 to 1.20; p = 0.802), respectively. The uptake of screening at 3 months was higher among previously human papillomavirus (HPV)-vaccinated women than unvaccinated women, 23.7% versus 11% (OR 2.07, 95% CI 1.69 to 2.53; p < 0.001). Among non-attenders, the SSK sent intervention showed a statistically significant increase in uptake at 12 months post invitation, 21.3% versus 16.2% (OR 1.51, 95% CI 1.20 to 1.91; p = 0.001), as did timed appointments, 19.8% versus 16.2% (OR 1.41, 95% CI 1.14 to 1.74; p = 0.001). The offer of a NN, a SSK on request, and a choice between timed appointments and NN were ineffective. Overall, there was a gradual rather than prompt response, as demonstrated by uptake among control practices. A discrete choice experiment indicated that women invited who had not yet attended valued the attributes inherent in self-sampling. The health economic analysis showed that both timed appointments and unsolicited SSK sent were likely to be cost-effective at a cost per quality-adjusted life-year (QALY) gained of £7593 and £8434, respectively, if extended across the national 25-year-old cohort throughout the duration of screening. The certainty of these being cost-effective at a ceiling ratio of £20,000 per QALY gained was > 90%. Women receiving their initial screening invitation frequently delay taking up the offer and the net impact of interventions was small. Timed appointments and SSKs sent to non-attenders at 6 months are likely to be a cost-effective means of increasing uptake and should be considered further. HPV vaccination in the catch-up programme was associated with an increased uptake of cervical screening. Future work should focus on optimising self-sampling in terms of age range, timing of offer for non-attenders and use of urine testing instead of vaginal samples. Current Controlled Trials ISRCTN52303479. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 68. See the NIHR Journals Library website for further project information.

Determinants of practice patterns in pediatric UTI management

Urinary tract infection (UTI) affects 10% of girls and 3% of boys by age 16. Both the American Academy of Pediatrics and National Institute for Health and Clinical Excellence Guidelines recommend urine testing prior to initiation of antibiotic treatment and the use of local antibiograms to guide empiric antibiotic therapy. Urine culture results not only provide the opportunity to halt empiric therapy if there is no bacterial growth, but also allow for tailoring of broad-spectrum therapy. Additionally, the use of antiobiograms improves empiric antibiotic selection based on local resistance patterns. However, execution of guideline recommendations has proved challenging. Understanding barriers in implementation is critical to developing targeted interventions aimed to improve adherence to these guidelines. The present study sought to investigate practice patterns and factors that influence urine testing and antibiogram use in the setting of empiric antibiotic treatment of UTI in children to ultimately improve adherence to UTI management guidelines. A random, national sample of physicians caring for children was surveyed from the American Medical Association Masterfile. Participants were queried regarding practice type, length of time in practice, factors influencing urine testing, urine specimen collection method, and antibiogram utilization. Logistic regression was used to assess factors associated with use of urine testing, bagged specimens, and antibiograms. Of respondents who acknowledged contact by surveyors, 47% completed the survey (n=366). Most respondents (84%) obtain urinalysis and culture prior to treatment for UTI. Physicians report they would more likely order testing if the specimen were easier to collect (46%) and if results were available immediately (48%) (Table). Urine collection by bag was more common in circumcised boys (>30%) compared with girls (20%) and uncircumcised boys (20%) (P=0.02). The most common reasons for collection by bag were parental refusal for (49%) and difficulty with (42%) catheterization (Table). Of the 70% of respondents reporting antibiogram access (n=256), 50% report its use the majority of the time with empiric prescription (n=128). While most practitioners report following guidelines to obtain urine testing prior to antibiotic prescription for UTI, urine collection by bag is common. Additionally, <50% of practitioners adhere to guideline recommendations for empiric antibiotic selection based on local antibiograms. Interventions to improve adherence to UTI management guidelines should focus on (1) improving catheterization practices, (2) educating parents regarding the value of catheterization, and (3) incorporating local antibiograms into electronic medical records.

Urine tests for Down's syndrome screening.

Urine tests for Down's syndrome screening.

MP54-12 DETERMINANTS OF PRACTICE PATTERNS IN PEDIATRIC UTI MANAGEMENT

You have accessJournal of UrologyPediatrics: Urinary Tract Infections/Vesicoureteral Reflux1 Apr 2015MP54-12 DETERMINANTS OF PRACTICE PATTERNS IN PEDIATRIC UTI MANAGEMENT Rachel Sharon Selekman and Hillary L Copp Rachel Sharon SelekmanRachel Sharon Selekman More articles by this author and Hillary L CoppHillary L Copp More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2035AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The purpose of this study was to investigate practice patterns of and factors that influence urine testing and antibiogram use in the setting of empiric antibiotic treatment of urinary tract infection (UTI) in children. METHODS We surveyed a random, cross-sectional, national sample of physicians caring for children from the American Medical Association Masterfile. Participants were queried regarding practice location and type, length of time in practice, factors influencing urine testing, urine specimen collection method, and antibiogram utilization. Logistic regression was used to assess factors associated with use of urine testing, bagged specimens, and antibiograms. RESULTS Of respondents who acknowledged contact by surveyors 44% completed the survey. Most respondents (84%) obtain urinalysis and culture prior to treatment for UTI. Neither physician age (p =0.56) nor practice type (p =0.16) are associated with always ordering urine testing, though emergency physicians, pediatricians, and urologists are more likely to order testing compared with all other specialists (family practitioners, internists, adolescent specialists, and nephrologists), p =0.03. Physicians who do not always obtain urine testing report they would more likely order testing if the specimen were easier to collect (46%) and if results were available immediately (48%) by point of care testing. Urine collection by bag was more commonly performed in circumcised boys (>30%) compared with about 20% of girls and uncircumcised boys (p =0.02). The most common reasons for collection by bag were parental refusal for (49%) and difficulty with (42%) catheterization. Neither physician age (p =0.63) nor practice type (p =0.27) are associated with increased use of a collection bag, though urologists are less likely to use a collection bag (p =0.05) compared with all other specialists. Of 70% of respondents reporting antibiogram access, <50% report that they use an antibiogram the majority of the time with empiric prescription. Physician age, practice type, and specialty were not associated with antiobiogram use (p >0.05). CONCLUSIONS While most practitioners follow guidelines to obtain urinalysis and culture prior to antibiotic prescription for UTI, urine collection by bag specimen is common, especially in circumcised males, and <50% of practitioners adhere to guideline recommendations for empiric antibiotic selection based on local antibiograms. Knowledge of these practice patterns can help direct interventions to improve adherence to UTI management guidelines. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e669 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachel Sharon Selekman More articles by this author Hillary L Copp More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Use of Urine Testing in Outpatients Treated for Urinary Tract Infection

To characterize urine test use in ambulatory, antibiotic-treated pediatric urinary tract infection (UTI). We studied children <18 years who had an outpatient UTI and a temporally associated antibiotic prescription from 2002 through 2007 by using a large claims database, Innovus i3. We evaluated urine-testing trends and performed multivariable logistic regression to assess for factors associated with urine culture use. Of 40 603 treated UTI episodes in 28 678 children, urinalysis was performed in 76%, and urine culture in 57%; 32% of children <2 years had no urinalysis or culture performed for an antibiotic-treated UTI episode. Urine culture use decreased during the study period from 60% to 54% (P < .001). We observed variation in urine culture use with age (<2 years: odds ratio [OR] 1.0, 95% confidence interval [CI] 0.9-1.1; 2-5 years: OR 1.3, 95% CI 1.2-1.4; 6-12 years: OR 1.3, 95% CI 1.2-1.4, compared with 13-17 years); gender (boys: OR 0.8, 95% CI 0.8-0.9); and specialty (pediatrics: OR 2.6, 95% CI 2.5-2.8; emergency medicine, OR 1.2, 95% CI 1.1-1.3; urology: OR 0.5, 95% CI 0.4-0.6, compared with family/internal medicine). Recent antibiotic exposure (OR 1.1, 95% CI 1.1-1.2) and empirical broad-spectrum prescription (OR 1.2, 95% CI 1.1-1.2) were associated with urine culture use, whereas previous UTI and urologic anomalies were not. Providers often do not obtain urine tests when prescribing antibiotics for outpatient pediatric UTI. Variation in urine culture use was observed based on age, gender, and physician specialty. Additional research is necessary to determine the implications of empirical antibiotic prescription for pediatric UTI without confirmatory urine testing.

Use of Urine Testing in Outpatients Treated for Urinary Tract Infection

Use of Urine Testing in Outpatients Treated for Urinary Tract Infection

Implementation of Point-of-Care Rapid Urine Testing for Drugs of Abuse in the Emergency Department of an Academic Medical Center

We evaluated the impact of implementing a point-of-care (POC) rapid urine test panel for drugs of abuse on turnaround time (TAT), emergency department length of stay (LOS), and laboratory test utilization patterns. The mean TAT from sample collection to results reporting decreased by 69.4%, from 108 to 33 minutes, the mean LOS from 11.1 to 8.1 hours (27% P < .0001), and the median LOS from 8.0 to 7.0 hours (13% P = .0017). A method crossover between the POC and central laboratory methods revealed differences in sensitivity and specificity. Overall, there was no clear preference for either method. Differences in performance for individual drug classes were reconciled by providing interpretive comments with POC results. Following implementation, use of urine testing for drugs of abuse increased by 30%, which was offset by fewer requests for extended toxicology testing in the central laboratory and more selective ordering of toxicology tests not on the POC panel (alcohols and analgesics). The implementation of a POC urine test panel for drugs of abuse decreased LOS and TAT and essentially replaced central laboratory testing for drugs of abuse. Differences in sensitivity and specificity between POC and central laboratory results require provision of interpretive comments with results.

Acceptability of sexually transmitted infection screening among women in short-term substance abuse treatment.

Substance abuse treatment centers provide an opportunity to offer sexually transmitted infection (STI) screening to a high-risk and hard-to-reach population. The goal was to assess STI prevalence, risk factors, and acceptability of STI screening among females at substance abuse treatment centers with use of urine testing by ligase chain reaction and self-collected swab specimens. Adult, female inpatients were offered free testing and treatment for chlamydia infection, gonorrhea, and trichomonas infection. Interviews were conducted to collect risk behavior data. Eighty-six percent of inpatients (180/209) accepted testing. Twenty-three percent (41/177) had an STI. Of those with an STI, 90% (37/41) had trichomonas infection. All 41 infected patients received treatment. Drug use before sex, exchange of sex for money/drugs, and any gynecological complaint were significantly associated with infection. Most women were uninsured (76%). Only 45% had undergone a medical examination in the past year. STI screening is highly acceptable among women in substance abuse treatment centers. Substance users are at high risk for STIs and may not otherwise receive medical care.

Self report among injecting drug users

Darke weighed the evidence, and saw that self-report was good. Indeed, his review suggests what many of us believe—self-report is actually better than urine tests or criminal records, in that it yields much more information. Admittedly, criminal records are pretty bad as a measure of criminal activity, and there is always the nagging doubt that, in the absence of urine tests against which to verify self-report, self-reported drug use might not be quite so comprehensive. We can never know. Like psychotherapists, researchers must cultivate ‘negative capability’—the capacity to tolerate uncertainty and ambiguity. Rather than certainty, we need evidence—the more evidence, the better. In research, the better the study design and implementation, the more detailed the reporting, and the more corroborative the evidence, the more confidence we have in the conclusions. Even with strong, well-designed studies, we like to see the results replicated in a variety of settings before feeling convinced. Darke’s review is a reminder that studies relying solely on self-report should not be discounted. What is a clinician to make of the apparent reliability of self-report? For a variety of more or less valid reasons, clinicians are often keen to know details of their clients’ behaviour. It is a reasonable assumption that where consequences (such as loss of take-away dose privileges) attach to reporting drug use, it is wise not to rely on self-report. Where self-interest is involved, most of us (except, of course, researchers) adopt a flexible approach to truth. This sort of assumption might explain why many drug abuse treatment programs—particularly methadone clinics—conduct systematic urine drug tests. It is worth reflecting briefly on the reliance on urine testing in methadone programs. Much of methadone treatment is ritual, and urine testing has become part of that ritual. Other than the vague assumption that drug testing will get at ‘the truth’, why do we engage in this ritual? There is no evidence that routine urine tests contribute to the safety of treatment. There is no evidence that urine testing contributes to therapeutic efficacy. And despite our assumptions to the contrary, perhaps self-report is actually more informative. In the practice of addiction medicine, laboratory tests can be useful in puncturing denial. It is common to see alcohol-dependent clients whose lives are in disarray— the wife has left, work has suffered, the patient shakes each morning before his first drink—and despite this overwhelming evidence of problems, it is not uncommon that the client only becomes concerned when shown a laboratory printout, with an asterisk indicating an abnormal liver enzyme, because here is ‘objective’ evidence that he is drinking too much. The use of urine testing in methadone maintenance treatment is also a matter of puncturing denial. But in this case, it is not the clients’ denial that is being addressed—it is community denial of the value of methadone treatment. The perception that methadone treatment involves maintaining clients in a state of happy intoxication in which they will say they are doing well just to keep receiving methadone, underlies much of the community and professional scepticism about this form of treatment. It was to present objective evidence to counter prevailing scepticism as to the value of treatment that Dole introduced urine testing into his early methadone program. Both the scepticism and the urine testing have remained prominent aspects of methadone treatment ever since. Although it is possible to use random urine testing as a means of evaluating treatment, it is almost never used in this way. Rather,

Gender Verification in Competitive Sports

The possibility that men might masquerade as women and be unfair competitors in women's sports is accepted as outrageous by athletes and the public alike. Since the 1930s, media reports have fuelled claims that individuals who once competed as female athletes subsequently appeared to be men. In most of these cases there was probably ambiguity of the external genitalia, possibly as a result of male pseudohermaphroditism. Nonetheless, beginning at the Rome Olympic Games in 1960, the International Amateur Athletics Federation (IAAF) began establishing rules of eligibility for women athletes. Initially, physical examination was used as a method for gender verification, but this plan was widely resented. Thus, sex chromatin testing (buccal smear) was introduced at the Mexico City Olympic Games in 1968. The principle was that genetic females (46,XX) show a single X-chromatic mass, whereas males (46,XY) do not. Unfortunately, sex chromatin analysis fell out of common diagnostic use by geneticists shortly after the International Olympic Committee (IOC) began its implementation for gender verification. The lack of laboratories routinely performing the test aggravated the problem of errors in interpretation by inexperienced workers, yielding false-positive and false-negative results. However, an even greater problem is that there exist phenotypic females with male sex chromatin patterns (e.g. androgen insensitivity, XY gonadal dysgenesis). These individuals have no athletic advantage as a result of their congenital abnormality and reasonably should not be excluded from competition. That is, only the chromosomal (genetic) sex is analysed by sex chromatin testing, not the anatomical or psychosocial status. For all the above reasons sex chromatin testing unfairly excludes many athletes. Although the IOC offered follow-up physical examinations that could have restored eligibility for those 'failing' sex chromatin tests, most affected athletes seemed to prefer to 'retire'. All these problems remain with the current laboratory based gender verification test, polymerase chain reaction based testing of the SRY gene, the main candidate for male sex determination. Thus, this 'advance' in fact still fails to address the fundamental inequities of laboratory based gender verification tests. The IAAF considered the issue in 1991 and 1992, and concluded that gender verification testing was not needed. This was thought to be especially true because of the current use of urine testing to exclude doping: voiding is observed by an official in order to verify that a sample from a given athlete has actually come from his or her urethra. That males could masquerade as females in these circumstances seems extraordinarily unlikely. Screening for gender is no longer undertaken at IAAF competitions.

Drug Screening

To the Editor.— We are writing to express our strong opposition to the recently published American Academy of Pediatrics' (AAP) position paper concerning drug screening of adolescents (Pediatrics 1989;84:396-398). The improved accuracy and widespread use of urine tests for drugs of abuse has been one of the most significant advances in the diagnosis and management of diseases of addiction. Tests for drugs of abuse furnish objective evidence of exposure to illicit drugs—evidence that is difficult or impossible to obtain by any other means.

Self-Monitoring of Blood Glucose Levels in Diabetes

Self-monitoring of blood glucose levels has become popular due to the limitations in the use of urine testing for assessing the status of diabetes control. Furthermore, the recent emphasis on the importance of diabetes regulation entails that patients tailor the insulin doses based on blood glucose levels. This review discusses the methodology of capillary blood glucose monitoring and its application to insulin adjustments. When performed properly, self-monitoring is accurate, reliable, and effective. It can also be beneficial in detecting hypoglycemia and may have a positive psychological impact as well. The reduction in the frequency of office and laboratory visits makes self-monitoring potentially cost-effective. Although useful for a broad segment of the type I diabetic population and for an increasingly large number of individuals with type II diabetes, self-monitoring may have a limited role in patients with severe, irreversible complications.