Evaluating adult hematuria.

Hematuria, the presence of an increased number of red blood cells in the urine, may be a sign of a serious underlying genitourinary disease. The causes of hematuria may be classified as systemic disorders, those involving the renal parenchyma (glomerular versus tubulointerstitial), or those involving the urinary collecting system. The history, physical examination, and microscopic urinalysis are the key elements in reaching a diagnosis. Further testing is based on these results. The primary care provider's role in hematuria evaluation involves detection, confirmation, and initiation of the evaluation process, including appropriate laboratory studies and referral as necessary. The primary care provider's prompt referral and facilitation of the hematuria evaluation is critical in achieving the best possible outcome and avoiding renal failure or the other sequelae of genitourinary disorders.     

Assessment of microscopic hematuria in adults

Microscopic hematuria, a common finding on routine urinalysis of adults, is clinically significant when three to five red blood cells per high-power field are visible. Etiologies of microscopic hematuria range from incidental causes to life-threatening urinary tract neoplasm. The lack of evidence-based imaging guidelines can complicate the family physician's decision about the best way to proceed. Patients with proteinuria, red cell casts, and elevated serum creatinine levels should be referred promptly to a nephrology subspecialist. Microscopic hematuria with signs of urinary tract infection should resolve with appropriate treatment of the underlying infection. Patients with asymptomatic microscopic hematuria or with hematuria persisting after treatment of urinary tract infection also need to be evaluated. Because upper and lower urinary tract pathologies often coexist, patients should be evaluated using cytology plus intravenous urography, computed tomography, or ultrasonography. When urine cytology results are abnormal, cystoscopy should be performed to complete the investigation.     

Evaluating hematuria in children. Where to start and how to proceed

Bleeding from somewhere along the urinary tract is not unusual in children. Of the many causes, systemic infection and trauma are among the most common. History taking and physical examination should be careful and complete, because the results obtained help direct the laboratory evaluation. Diagnostic testing always begins with urinalysis but may progress to intravenous urography, voiding cystourethrography, endoscopic procedures in the upper and lower urinary tract, sonography, arteriography, or renal biopsy. Some cases remain unexplained and require follow-up to assess renal function.     

Evaluating involuntary weight loss in older adults

Involuntary weight loss is a common complaint among patients over 40 years of age. Few studies concerning the etiologies of weight loss, however, have been published. This article reviews two recent studies that address common causes of unintentional weight loss. In these investigations, almost half of the patients claiming significant weight loss had no decrease in weight at all. In 35 percent of patients with true weight loss, no physical source was found after six months of follow-up. Of those in whom a cause of weight loss was discovered, the etiology was usually apparent after a brief history, physical exam and screening laboratory evaluation. Common causes of involuntary weight loss are discussed. Guidelines for evaluation of the patient who complains of weight loss are offered.     

Evaluating functional activity in older Thai adults.

The purpose of this study was to translate the original English version of the Self-Efficacy and Outcome Expectations Scales for Exercise and Functional Activity and to establish their reliability in older Thai adults in geriatric rehabilitation. This study used a correlational design with repeated measures. Reliability of the Self-Efficacy for Exercise Scale (SEES), the Self-Efficacy for Functional Activity Scale (SEFAS), the Outcome Expectations for Exercise Scale (OEES), and the Outcome Expectations for Functional Activity Scale (OEFAS) developed by Resnick was measured in 20 older adults aged 60 years or older after hip or knee replacement or another orthopedic surgery of their lower extremity. All scales were translated into Thai and back translated into English according to the process described by Marin and Marin. The instruments were administered twice--the 1st and 2nd day in the participants' geriatric rehabilitation program (i.e., the 4th and 5th postoperative day). Results indicated that there was sufficient evidence for internal consistency of the SEES, SEFAS, OEES, and OEFAS with alpha coefficients of 0.84, 0.86, 0.70, and 0.86 respectively. Test-retest reliability of the tools was also demonstrated with Spearman correlation coefficients of 0.84 for the SEES, 0.87 for the SEFAS, 0.61 for the OEES, and 0.54 for the OEFAS. The findings from this study provide important information for instrument adaptation and the applicability of these scales for further studies of older Thai adults.     

Asymptomatic microscopic hematuria in adults: summary of the AUA best practice policy recommendations

The American Urological Association (AUA) convened the Best Practice Policy Panel on Asymptomatic Microscopic Hematuria to formulate policy statements and recommendations for the evaluation of asymptomatic microhematuria in adults. The recommended definition of microscopic hematuria is three or more red blood cells per high-power microscopic field in urinary sediment from two of three properly collected urinalysis specimens. This definition accounts for some degree of hematuria in normal patients, as well as the intermittent nature of hematuria in patients with urologic malignancies. Asymptomatic microscopic hematuria has causes ranging from minor findings that do not require treatment to highly significant, life-threatening lesions. Therefore, the AUA recommends that an appropriate renal or urologic evaluation be performed in all patients with asymptomatic microscopic hematuria who are at risk for urologic disease or primary renal disease. At this time, there is no consensus on when to test for microscopic hematuria in the primary care setting, and screening is not addressed in this report. However, the AUA report suggests that the patient's history and physical examination should help the physician decide whether testing is appropriate.     

Microscopic hematuria

Microscopic hematuria is a common problem that may affect up to 13 per cent of the population. The number of RBCs identified in the urine sediment is dependent, in part, upon the technique used in performing the urinalysis. The exact number of RBCs normally excreted into the urine has been difficult to establish. However, three to eight RBCs per HPF would be accepted by most investigators as an acceptable dividing point between normal and abnormal hematuria. Although the prevalence of microscopic hematuria in the general population is high, the number of patients who have serious urologic disease is low. Many diagnostic algorithms are available for evaluating these patients, but at the present time there is still uncertainty regarding how extensive the evaluation should be for patients with asymptomatic microscopic hematuria.     

Evaluation of hematuria

Hematuria is an important sign that indicates the presence of a pathologic condition in the genitourinary tract. Causes can be categorized by where in the urinary tract the problem is located--above the kidney, in the kidney or one of its structures, or below the kidney. Another category is false hematuria, such as urine that has been discolored by intake of a certain food or drug. A thorough history, physical examination, and appropriate laboratory studies, followed by more sophisticated diagnostic tests chosen on the basis of the assembled clues, can establish the diagnosis in most cases. Patients rarely have to be hospitalized or undergo invasive procedures for assessment of hematuria.     

Assessment of hematuria

The most common causes of hematuria in adults include urinary tract infections, urolithiasis, benign prostatic enlargement, and urologic malignancy. Once hematuria is confirmed, its cause should be investigated through a comprehensive history, a focused physical examination, laboratory studies, an image-based assessment of the upper urinary tract, and a cystoscopic evaluation of the lower urinary system. Prompt evaluation and appropriate referral of patients with documented hematuria should be initiated in the primary care setting according to the proposed guidelines, and aimed at cost-effective and early detection of urologic abnormality.     

Mechanism of hematuria in hematuric nephritis

Peripheral blood erythrocytic functional disorders were studied in 31 patients with primary and secondary hematuric nephritides. A decrease in erythrocyte normal charge was noted in 90%, erythrocyte fragmentation in 43%. Reverse correlation was established between a degree of lowered peripheral blood erythrocyte charge and serum IgA concentration (R = -0.65 +/- 0.15). The role of the detected erythrocytic disorders in the mechanisms of hematuria, the involvement of local (renal) intravascular coagulation in the pathogenesis of hematuric nephritides were discussed.     

An algorithm for hematuria

Two algorithms are presented to help clarify the diagnostic evaluation of hematuria. Utilizing an anatomic framework for adults and an etiologic framework for children, this complex clinical problem can be approached in a logical manner.     

Evaluating patient-centered care: feasibility of electronic data collection in hospitalized older adults

Evaluating patient-centered care (PCC) is crucial to its improvement. This pilot study tested the feasibility of an electronic format to assess PCC during hospitalization. Using a validated indicator of PCC embedded on a mobile device, 86 older adults evaluated its delivery by registered nurses. Patients older than 85 years rated PCC poorer than those who were younger (r = -0.22; P = .04). The electronic format was appraised as feasible; it performed well and took on average 30 minutes to complete.     

Evaluating clinical supervision in community homes and teams serving adults with learning disabilities

Evaluating clinical supervision in community homes and teams serving adults with learning disabilities This paper provides a discussion of some of the professional and policy outcomes associated with implementing clinical supervision within a community service for adults with learning disabilities. It is based upon a small qualitative study whose aim was to examine how clinical supervision was operating, its strengths, its weaknesses and where improvements might be made. The study followed the introduction of clinical supervision 9 months earlier for nurses and carers employed in three community homes and one community multiprofessional team. The method consisted of direct observation of individual and group supervision and staff completing critical incident questionnaires, followed by semi-structured, audio-taped interviews with seven registered nurses and four community team members, including a social worker, psychologist and physiotherapist. Outcomes were expressed in two ways: in terms of the benefits of clinical supervision or of its ambivalence. The range of matters brought for discussion, or resolution, in supervision reflected some of the difficulties or dilemmas staff faced working in this area, for example promoting empowerment and assisting clients to make choices, and dealing with clients' challenging and inappropriate behaviours. As for the role of supervisor there was some evidence of nurses expressing apprehension or unpreparedness, also a perceived general concern over the relatively low status of clinical supervision, thought to be due to absence of visible management approval or failure to articulate properly the objective of supervision. A limitation of the study was its small subject sample although considerable data were gathered in each of the units through relatively long-term contact.     

Evaluating the Emergency Department Observation Unit for the management of hyperglycemia in adults

Objective

To determine whether hyperglycemic patients can be successfully managed in the Emergency Department Observation Unit (EDOU), as determined by the frequency of inpatient admission following their EDOU stay.

Evaluating an Interpersonal Model of Depression among adults with Down syndrome

The Interpersonal Model of Depression (IMD) based on the Theory of Human Relatedness (Hagerty, Lynch-Sauer, Patusky, & Bouwsema, 1993) is evaluated among adults with Down syndrome. One hundred subjects participated, with 32% having elevated depression scores and 40% stating they felt lonely. The relationship between depression, perceived social support, loneliness, and life satisfaction is statistically significant, F(6, 172) = 4.36, p < .001. Loneliness, social isolation, loss of sense of well-being, self-hate, and social withdrawal are important interpersonal manifestations and represent increasing levels of depression. Social and emotional loneliness are two dimensions of loneliness. The IMD provides a framework to assess depression in this population. Research on the efficacy of depression treatment based on the IMD is needed.