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Inappropriate lab testing

Khansoudaphone Phakhounthong, Pimwadee Chaovalit, Podjanee Jittamala, Stuart D Blacksell, Michael J Carter, Paul Turner, Kheng Chheng, Soeung Sona, Varun Kumar, Nicholas P J Day, Lisa J White, Wirichada Pan-Ngum
BACKGROUND: Dengue fever is a re-emerging viral disease commonly occurring in tropical and subtropical areas. The clinical features and abnormal laboratory test results of dengue infection are similar to those of other febrile illnesses; hence, its accurate and timely diagnosis for providing appropriate treatment is difficult. Delayed diagnosis may be associated with inappropriate treatment and higher risk of death. Early and correct diagnosis can help improve case management and optimise the use of resources such as hospital staff, beds, and intensive care equipment...
March 13, 2018: BMC Pediatrics
Abdul Aziz Al Wazzan, Eline Tommelein, Katrien Foubert, Stefano Bonassi, Graziano Onder, Annemie Somers, Mirko Petrovic, Koen Boussery
BACKGROUND: Renal function progressively worsens with age. Potentially inappropriate prescribing (PIP) of renally excreted active drugs (READs) is common in older adults, leading to an increased rate of iatrogenic illness. The Ghent Older People's Prescription community Pharmacy Screening (GheOP3 S-) tool is an effective, explicit instrument that was developed for community pharmacists (CPs) to detect PIP. So far, this tool does not assess PIP of the frequently used READs in older patients with renal impairment...
March 5, 2018: Drugs & Aging
Philipp Ganser, Christoph Baum, David Chargin, Alexis F Sauer-Budge, Andre Sharon
A reduced channel height in microfluidic Lab-on-a-Chip (LOC) devices enables a reduction in the required volume of sample and reagents. LOC devices are most often manufactured by microstructuring a planar substrate and subsequently sealing it with a cover film. However, shallow chip designs, made from polymers, are sensitive to channel deformation during the sealing of the microfluidic device. Inappropriate bonding conditions often result in the loss of the microfluidic functionality. A systematic and practical approach for the identification of suitable bonding process parameters is missing...
February 24, 2018: Biomedical Microdevices
Tomáš Šálek
Hyperkalemia is a potentially lethal condition. Pseudohyperkalemia should be always excluded before implementing treatment to prevent inappropriate cause of hypokalemia - equally a potentially lethal condition. Here we present a case report of a 62 year female with chronic myeloproliferative disorder, i.e. essential thrombocythemia. The laboratory test results for potassium concentration were 6.3 mmol/L, for platelet count 1305 x109 /L and for leukocyte count 39.8 x109 /L. This was due to a temporary drug withdrawal after a surgical intervention for gastric bleeding...
February 15, 2018: Biochemia Medica: časopis Hrvatskoga Društva Medicinskih Biokemičara
T M Sørensen, C R Bjørnvad, G Cordoba, P Damborg, L Guardabassi, V Siersma, L Bjerrum, L R Jessen
BACKGROUND: Clinical signs of urinary tract disease in dogs often lead to prescription of antibiotics. Appropriate diagnostic work-up could optimize treatment and reduce the risk of inappropriate use of antibiotics. HYPOTHESIS/OBJECTIVES: To describe and evaluate the impact of diagnostic work-up on decision to treat (DTT) and choice of antibiotic treatment (COT) for dogs presenting with clinical signs of urinary tract disease. ANIMALS: One hundred and fifty-one dogs presenting to 52 Danish veterinary practices...
February 22, 2018: Journal of Veterinary Internal Medicine
Tomaz Crochemore, Thiago Domingos Corrêa, Marcus D Lance, Cristina Solomon, Ary Serpa Neto, João Carlos de Campos Guerra, Priscila Scolmeister Lellis, Livia Muller Bernz, Natalia Nunes, Cassio Massashi Mancio, Ana Paula Hitomi Yokoyama, Eliézer Silva
BACKGROUND: Transfusion therapy is associated with increased morbidity, mortality and costs. Conventional coagulation tests (CCT) are weak bleeding predictors, poorly reflecting coagulation in vivo. Thromboelastometry (ROTEM) provides early identification of coagulation disorders and can guide transfusion therapy by goals, reducing blood components transfusion. OBJECTIVE: The aim of this study is to describe coagulation profile of critically ill patients using ROTEM and evaluate the association between CCT and thromboelastometry...
2018: PloS One
Yukiko Abe, Tsutomu Kawasaki, Kazuhiro Shimaya, Toshihisa Ishikawa, Yuki Kata, Kaori Okayasu, Koji Unoura, Yoichi Nakamura
A 47-year old man presented to our hospital with a 6-month history of malaise, cough and dyspnea on exertion. Laboratory testing revealed the severe hyponatremia. A chest X-ray showed bilateral diffuse micronodules. Anti-Trichosporon asahii antibody and environmental provocation test were positive. Bronchoalveolar lavage fluid showed lymphocytosis and low CD4/8 ratio. The specimens obtained by transbronchial lung biopsy revealed alveolitis. Based on these findings, the patient was diagnosed as having summer-type hypersensitivity pneumonitis (SHP)...
2018: Arerugī, [Allergy]
Kristin Torre, Preeti Jhorar, Rong Wu, John Pfeifer, Zendee Elaba, Michael Murphy
BACKGROUND: We evaluated how dermatopathologists are employing molecular testing in the setting of neoplastic skin diseases, and assess their opinions of the broader role and utility of molecular technologies in clinical practice. METHODS: A 15-question online survey was sent to Fellows of the American Society of Dermatopathology in April 2017. RESULTS: One hundred and thirty-six dermatopathologists completed the survey (response rate = 16%)...
February 13, 2018: Journal of Cutaneous Pathology
Mario Plebani
In the last few decades, laboratory medicine has undergone monumental changes, and laboratory technology, which has made enormous advances, now has new clinical applications thanks to the identification of a growing number of biomarkers and risk factors conducive to the promotion of predictive and preventive interventions that have enhanced the role of laboratory medicine in health care delivering. However, the paradigm shift in the past 50 years has led to a gap between laboratory and clinic, with an increased risk of inappropriateness in test request and interpretation, as well as the consolidation of analytical work in focused factories and megastructurers oriented only toward achieving greater volumes, decreasing cost per test and generating a vision of laboratory services as simple commodities...
February 10, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
Emily Wakefield, Haley Keller, Hannah Mianzo, Chinmayee B Nagaraj, Sanjukta Tawde, Elizabeth Ulm
The goal of this study was to evaluate the impact of genetic counselor (GC) review of incoming test orders received in an academic diagnostic molecular genetics laboratory. The GC team measured the proportion of orders that could be modified to improve efficiency or sensitivity, tracked provider uptake of GC proposed testing changes, and calculated the health care dollar savings resulting from GC intervention. During this 6-month study, the GC team reviewed 2367 incoming test orders. Of these, 109 orders (4...
February 9, 2018: Journal of Genetic Counseling
Janne Cadamuro, Martin Gaksch, Helmut Wiedemann, Giuseppe Lippi, Alexander von Meyer, Astrid Pertersmann, Simon Auer, Cornelia Mrazek, Ulrike Kipman, Thomas K Felder, Hannes Oberkofler, Elisabeth Haschke-Becher
BACKGROUND: Inappropriate utilization of laboratory resources is an increasing concern especially in high-throughput facilities. Until now, no reliable information has been published addressing to which extent laboratory results are actually used for clinical decision-making. Therefore, we aimed to close this gap using a novel retrospective approach including a survey of clinicians and nurses. METHODS: We retrospectively evaluated the number of re-orders for potassium (K), lactate dehydrogenase (LD), aspartate-aminotransferase (AST), activated partial thromboplastin-time (APTT) and prothrombin-time/INR (PT/INR), after the initial order had to be cancelled due to preanalytical non-conformities...
February 2, 2018: Clinical Biochemistry
Shin Han Song, Gyeong Ah Sim, Seon Ha Baek, Jang Won Seo, Jung Weon Shim, Ja Ryong Koo
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hypo-osmotic hyponatremia. There are several etiologies of SIADH including neuroendocrine tumor, pulmonary disease, infection, trauma, and medications. Here, we report a case of SIADH associated with a schwannoma involving the mediastinum in a 75-year-old woman who presented with nausea, vomiting, and general weakness. Laboratory testing showed hypo-osmolar hyponatremia, with a serum sodium level of 102mmol/L, serum osmolality of 221mOsm/kg, urine osmolality of 382mOsm/kg, urine sodium of 55 mmol/L, and plasma antidiuretic hormone (ADH) of 4...
December 2017: Electrolyte & Blood Pressure: E & BP
Hassan Tariq, Muhammad Umar Kamal, Pavithra Reddy, Bharat Bajantri, Masooma Niazi, Ajsza Matela, Cosmina Zeana, Ariyo Ihimoyan, Anil Dev, Sridhar Chilimuri
RATIONALE: Strongyloidiasis hyperinfection and disseminated disease have high mortality rates due to several complications and early detection of Strongyloides infection is therefore prudent. PATIENT CONCERNS: A 37-year-old male patient came with chronic diarrhea, intractable vomiting and was found to have hyponatremia, and anemia on the initial laboratory tests. DIAGNOSES: Further work up revealed syndrome of inappropriate antidiuretic secretion to be the cause of the hyponatremia in addition to gastrointestinal loses...
December 2017: Medicine (Baltimore)
Catherine Fillée, Claire Beguin, Laurence Habimana, Catherine Hubert, Marianne Philippe
In the context of the flat-rate reimbursements in healthcare, we reviewed physicians' behavior towards laboratory test ordering. We demonstrated how it could be improved when a specific stage of the patient management is considered. We took a multi-step approach to analyze the laboratory test orders in the context of planned laparoscopic cholecystectomy in a general teaching hospital. A reference order set was defined through a collaborative analysis between clinicians and laboratory physicians. The clinical and financial impacts were then evaluated over a period of 24 months...
January 30, 2018: Scandinavian Journal of Clinical and Laboratory Investigation
Sweta Kulkarni, R Ramesh, A R Srinivasan, C R Wilma Delphine Silvia
Preanalytical steps are the major sources of error in clinical laboratory. The analytical errors can be corrected by quality control procedures but there is a need for stringent quality checks in preanalytical area as these processes are done outside the laboratory. Sigma value depicts the performance of laboratory and its quality measures. Hence in the present study six sigma and Pareto principle was applied to preanalytical quality indicators to evaluate the clinical biochemistry laboratory performance. This observational study was carried out for a period of 1 year from November 2015-2016...
January 2018: Indian Journal of Clinical Biochemistry: IJCB
Mario Javier Olivera, Johana Alexandra Fory, Antonio José Olivera
The pharmacological management of adults with chronic-phase Chagas disease is challenging despite it being the recent focus of extensive research. One of the challenges in the current clinical practice guidelines (CPGs) landscape is the existence of non-evidence-based recommendations for the use of laboratory tests in treatment monitoring. This study aimed to systematically assess the quality and consistency of recommendations of CPGs on the pharmacological management of adults with chronic-phase Chagas disease...
November 2017: Revista da Sociedade Brasileira de Medicina Tropical
Heyang Thomas Li, Andrew M Kingston, Glenn R Myers, Levi Beeching, Adrian P Sheppard
Near-field x-ray refraction (phase) contrast is unavoidable in many lab-based micro-CT imaging systems. Quantitative analysis of x-ray refraction (a.k.a. phase retrieval) is in general an under-constrained problem. Regularizing assumptions may not hold true for interesting samples; popular single-material methods are inappropriate for heterogeneous samples, leading to undesired blurring and/or over-sharpening. In this paper, we constrain and solve the phase-retrieval problem for heterogeneous objects, using the Alvarez-Macovski model for x-ray attenuation...
January 1, 2018: Journal of the Optical Society of America. A, Optics, Image Science, and Vision
Jalpa A Doshi, Justin T Puckett, Michael S Parmacek, Daniel J Rader
BACKGROUND: Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9is) are an innovative treatment option for patients with familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease who require further lowering of low-density lipoprotein cholesterol. However, the high costs of these agents have spurred payers to implement utilization management policies to ensure appropriate use. We examined prior authorization (PA) requirements for PCSK9is across private and public US payers...
January 2018: Circulation. Cardiovascular Quality and Outcomes
L I Wassenaar, S Terzer-Wassmuth, C Douence, L Araguas-Araguas, P K Aggarwal, T B Coplen
RATIONALE: Water stable isotope ratios (δ2 H and δ18 O values) are widely used tracers in environmental studies; hence, accurate and precise assays are required for providing sound scientific information. We tested the analytical performance of 235 international laboratories conducting water isotope analyses using dual-inlet and continuous-flow isotope ratio mass spectrometers and laser spectrometers through a water isotope inter-comparison test. METHODS: Eight test water samples were distributed by the IAEA to international stable isotope laboratories...
January 5, 2018: Rapid Communications in Mass Spectrometry: RCM
Lani Lieberman, Yulia Lin, Christine Cserti-Gazdewich, Qi Long Yi, Jacob Pendergrast, Wendy Lau, Jeannie Callum
BACKGROUND: Blood transfusions and fractionated products are not without risk and may lead to acute and long-term adverse events. The objective of this study was to evaluate the appropriateness of usage of frozen plasma (FP), cryoprecipitate (CRYO), and recombinant factor VIIa (rVIIa) in a pediatric setting. METHODS: All orders for FP, CRYO, and rVIIa were prospectively audited over 6 weeks. Data collected included demographics, laboratory values, indication, and adverse reactions...
December 29, 2017: Pediatric Blood & Cancer
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