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It is recommended that researchers compare interventions, use longitudinal designs, better describe their methodology and implement greater adherence to treatment fidelity to enhance research quality and strengthen conclusions.

A survey of specimens submitted to five English laboratories2 showed that the most important contribution of the results to patient management was that they helped to exclude particular possible diagnoses. Urine examinations are a substantial proportion of the work of any microbiology laboratory, and it is clearly unacceptable that the reports on up to 20% of such specimens may be misleading. With the help and encouragement of our clinical colleagues we are reviewing both the rationale and the cost effectiveness of microbiological investigation generally. While the major areas of concern are "routine" screening tests, duplicated specimens on the same patient, and out-ofhours requests, substantial savings in time, money, and temper can clearly be made by avoiding self-inflicted clinical confusion like that described here. Reports on other specimens too may be misleading but faults are not generally as easily demonstrable as in urine.

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