- Page navigation anchor for Astonishing resultsAstonishing results
We thank Dr Forte for his comments on our findings. Our randomised, controlled clinical trial reported on the use of two urine collection devices in women presenting to primary care with symptoms attributable to urinary tract infection (UTI). Frequency is a cardinal symptom of acute urinary tract infection. Requiring these women to have a full bladder before using such devices is not feasible, nor is it easy to objectively confirm.
Our participants were only eligible for inclusion if they felt able to produce a urine sample at the time of randomisation. As such the use of urine collection devices in our pragmatic study is likely to be similar to how the devices might be used by women with UTI symptoms who consult in routine general practice. We made no claim that our findings apply to use in the populations that Dr Forte refers to, such as asymptomatic pregnant women and in preoperative assessment.
Competing Interests: None declared. - Page navigation anchor for Astonishing resultsAstonishing results
Peezy was developed in response to patient feedback to address the hygiene and dignity issues complained of by patients. Evidence of reduced contamination of urine samples was found later. Our UK and US customers have found reduced contamination, and savings in reduced retesting, overall expenditure and antibiotic prescribing due to improved accuracy of diagnosis. Device failure is almost unknown. A recent anecdotal report from a US distributor states: "Some lab employees and the supervisor stated they had previously taken Peezy home for personal use. The lab supervisor felt Peezy was “indestructible”, and she was unable to get it to fail.”
Had we experienced the massive 25% device failure rate quoted, we would never have launched the product. We provide training for staff issuing Peezy. In turn first-time users are correctly instructed in its use. Other than device supply, we were excluded from any involvement in the study, so this was not possible.
We wrote to the principal author asking to clarify if Peezy patients were asked to ensure a full bladder before sampling but this specific question was not answered. We cannot verify that Peezy was used correctly. The authors admit that the Peezy failure rate may have affected the analysis. “About a quarter of Peezy UCDs failed, and this may have impacted the intention-to-treat analysis “. As an SME we are unable to fund large clinical trials and rely on smaller inde...
Show MoreCompeting Interests: Inventor of the Peezy and a Founder Director of Forte Medical Ltd. - Page navigation anchor for Mid-stream vs. first-void urine samplesMid-stream vs. first-void urine samples
In general practice simple practices should be endorsed to avoid overcomplicating patient management. We have always been told to recommend the use of mid-stream samples when collecting a specimen of urine for culture, with or without previous cleansing and with or without soap or disinfectants. Notwithstanding, usage of these instructions is variable across practices and across countries. In addition, a midstream urine sample is not always easy to collect, mainly among elderly patients, let alone when patients are instructed to use external devices as recently analysed by Hayward et al.1 It is no wonder that a high number of patients failed to accomplish the proper use of these devices. The results were expected and the use of two devices did not reduce the number of contaminated samples when compared to the classical procedure of recommending a midstream urine collection. The need to collect a midstream urine clean-catch sample has also been controversial.2. Only Eley et al. found a significantly lower number of contaminations among emergency department female patients when they were provided illustrated instructions about how to collect a proper midstream urine sample compared to those who only received verbal instructions.3 Other studies, however, failed to show a benefit from cleansing prior to sample collection.
We certainly do not know how patients collect the urine samples despite being instructed...
Competing Interests: None declared.