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Inappropriate lab testing

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https://www.readbyqxmd.com/read/28127124/optimizing-laboratory-test-utilization-in-long-term-acute-care-hospitals
#1
Adan Mora, Brian S Krug, Antony M Grigonis, Amanda Dawson, Yuqing Jing, Samuel I Hammerman
Laboratory tests can be considered inappropriate if overused or when repeated, unnecessary "routine" testing occurs. For chronically critically ill patients treated in long-term acute care hospitals (LTACHs), inappropriate testing may result in unnecessary blood draws that could potentially harm patients or increase infections. A quality improvement initiative was designed to increase physician awareness of their patterns of lab utilization in the LTACH environment. Within a large network of LTACHs, 9 hospitals were identified as having higher patterns of lab utilization than other LTACHs...
January 2017: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/28107395/prevalence-of-pre-analytical-errors-in-clinical-chemistry-diagnostic-labs-in-sulaimani-city-of-iraqi-kurdistan
#2
Dereen Najat
BACKGROUND: Laboratory testing is roughly divided into three phases: a pre-analytical phase, an analytical phase and a post-analytical phase. Most analytical errors have been attributed to the analytical phase. However, recent studies have shown that up to 70% of analytical errors reflect the pre-analytical phase. The pre-analytical phase comprises all processes from the time a laboratory request is made by a physician until the specimen is analyzed at the lab. Generally, the pre-analytical phase includes patient preparation, specimen transportation, specimen collection and storage...
2017: PloS One
https://www.readbyqxmd.com/read/28078809/three-year-analysis-of-repeated-laboratory-tests-for-the-markers-total-cholesterol-ferritin-vitamin-d-vitamin-b12-and-folate-in-a-large-research-and-teaching-hospital-in-italy
#3
Monica Lanzoni, Marco Fornili, Irene Felicetta, Rita Maiavacca, Elia Biganzoli, Silvana Castaldi
RATIONALE, AIMS AND OBJECTIVES: The increasing number of diagnostic tests requests all over the world is a problem that can partially be explained by inappropriate testing. Impact on the total costs of health systems becomes relevant when tests are performed in a large amount. In this paper, retesting of total cholesterol, ferritin, vitamin B12 , vitamin D, and folate is assessed. METHODS: The Quality Unit of Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano (Fondazione) decided to perform a first assessment of the appropriate use of the laboratory tests cholesterol, ferritin, vitamin B12 , vitamin D, and folate focusing on the retesting interval for the same patient in the time period January 1, 2012, to December 31, 2014, in every care setting...
January 12, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28078322/diagnostic-dilemma-in-discordant-thyroid-function-tests-due-to-thyroid-hormone-autoantibodies
#4
Panudda Srichomkwun, Neal H Scherberg, Jasminka Jakšić, Samuel Refetoff
OBJECTIVE: Assay interference could be the cause of abnormal thyroid function tests. Early recognition prevents inappropriate patient management. The objective of this report is to present a case with discordant thyroid function tests in different thyroid assay platforms due to thyroid autoantibodies. METHODS: We present a case her family, laboratory data and methods that investigate immunoassay interference. RESULTS: A 21-year-old woman with autoimmune thyroid disease was treated for hypothyroidism with levothyroxine and noted to have elevated total and free thyroxine, free triiodothyronine but normal thyroid-stimulating hormone...
2017: AACE Clin Case Rep
https://www.readbyqxmd.com/read/28057873/attainment-of-guideline-targets-in-eurodopps-haemodialysis-patients-are-differences-related-to-a-country-s-healthcare-expenditure-and-nephrologist-workforce
#5
Sophie Liabeuf, Karlijn J Van Stralen, Fergus Caskey, Francesca Tentori, Ronald L Pisoni, Ayesha Sajjad, Kitty J Jager, Ziad A Massy
BACKGROUND: In the field of chronic kidney disease, global clinical practice guidelines have been developed and implemented with a view to improving patient care and outcomes. The attainment of international and European guideline targets for haemodialysis patients in European countries has not been audited recently. Hence, we sought to establish whether the attainment of the targets set out in guidelines and inappropriate care are similar across European countries and whether inter-country differences are related to disparities in national healthcare expenditures (as a percentage of gross domestic product) and/or the nephrologist workforce per capita...
January 5, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28050887/assessment-of-in-silico-protein-sequence-analysis-in-the-clinical-classification-of-variants-in-cancer-risk-genes
#6
Iain D Kerr, Hannah C Cox, Kelsey Moyes, Brent Evans, Brianna C Burdett, Aric van Kan, Heather McElroy, Paris J Vail, Krystal L Brown, Dechie B Sumampong, Nicholas J Monteferrante, Kennedy L Hardman, Aaron Theisen, Erin Mundt, Richard J Wenstrup, Julie M Eggington
Missense variants represent a significant proportion of variants identified in clinical genetic testing. In the absence of strong clinical or functional evidence, the American College of Medical Genetics recommends that these findings be classified as variants of uncertain significance (VUS). VUSs may be reclassified to better inform patient care when new evidence is available. It is critical that the methods used for reclassification are robust in order to prevent inappropriate medical management strategies and unnecessary, life-altering surgeries...
January 3, 2017: Journal of Community Genetics
https://www.readbyqxmd.com/read/28012249/inappropriate-documentation-of-heparin-allergy-in-the-medical-record-because-of-misdiagnosis-of-heparin-induced-thrombocytopenia-frequency-and-consequences
#7
C M McMahon, Y C Tanhehco, A Cuker
: Essentials Misdiagnosis of heparin-induced thrombocytopenia (HIT) may be associated with adverse outcomes. We conducted a study of patients with a heparin allergy in the chart due to misdiagnosis of HIT. 42% of patients with a heparin allergy due to suspected HIT were clearly HIT-negative. 68% were unnecessarily treated with an alternative anticoagulant, 66% of whom had major bleeding. SUMMARY: Background It is recommended that heparin be added to the allergy list of patients with heparin-induced thrombocytopenia (HIT)...
November 7, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/27999475/pre-analytical-issues-in-the-haemostasis-laboratory-guidance-for-the-clinical-laboratories
#8
REVIEW
A Magnette, M Chatelain, B Chatelain, H Ten Cate, F Mullier
Ensuring quality has become a daily requirement in laboratories. In haemostasis, even more than in other disciplines of biology, quality is determined by a pre-analytical step that encompasses all procedures, starting with the formulation of the medical question, and includes patient preparation, sample collection, handling, transportation, processing, and storage until time of analysis. This step, based on a variety of manual activities, is the most vulnerable part of the total testing process and is a major component of the reliability and validity of results in haemostasis and constitutes the most important source of erroneous or un-interpretable results...
2016: Thrombosis Journal
https://www.readbyqxmd.com/read/27997479/potential-for-pharmacy-public-health-collaborations-using-pharmacy-based-point-of-care-testing-services-for-infectious-diseases
#9
Paul O Gubbins, Michael E Klepser, Alex J Adams, David M Jacobs, Kelly M Percival, Gregory B Tallman
CONTEXT: Health care professionals must continually identify collaborative ways to combat antibiotic resistance while improving community health and health care delivery. Clinical Laboratory Improvement Amendments of 1988 (CLIA)-waived point-of-care (POC) testing (POCT) services for infectious disease conducted in community pharmacies provide a means for pharmacists to collaborate with prescribers and/or public health officials combating antibiotic resistance while improving community health and health care delivery...
December 16, 2016: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/27989277/unnecessary-investigations-in-environmental-medicine
#10
Annette Greiner, Hans Drexler
BACKGROUND: Patients in environmental medicine often want a thorough diagnostic evaluation of nonspecific symptoms. Unconventional testing, as well as conventional testing for indications other than the established ones, can lead to false diagnoses and, in turn, to substantial emotional, social, and financial harm. The goal of this single-center study was to assess inappropriate diagnostic testing among the patients of a specialized university outpatient clinic for environmental medicine...
November 18, 2016: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/27984339/diagnostic-evaluation-of-children-with-autism-spectrum-disorders-clinician-compliance-with-published-guidelines
#11
Alexis Tchaconas, Andrew Adesman
OBJECTIVE: To assess to what extent child neurologists (CNs) and developmental-behavioral pediatricians (DBPs) order diagnostic tests that are not recommended/indicated and/or fail to order tests that are recommended/indicated when evaluating children with an autism spectrum disorder (ASD). METHOD: CNs and DBPs in the United States were asked which laboratory tests they would "routinely order" for a preschool child with ASD and IQ = 58 (ASD + Intellectual Disability (ID)), and a preschool child with ASD and IQ = 85 (ASD-ID)...
January 2017: Journal of Developmental and Behavioral Pediatrics: JDBP
https://www.readbyqxmd.com/read/27935623/reducing-blood-volume-requirements-for-clinical-pathology-testing-in-toxicologic-studies-points-to-consider
#12
Florence Poitout-Belissent, Adam Aulbach, Niraj Tripathi, Lila Ramaiah
In preclinical safety assessment, blood volume requirements for various endpoints pose a major challenge. The goal of this working group was to review current practices for clinical pathology (CP) testing in preclinical toxicologic studies, and to discuss advantages and disadvantages of methods for reducing blood volume requirements. An industry-wide survey was conducted to gather information on CP instrumentation and blood collection practices for hematology, clinical biochemistry, and coagulation evaluation in laboratory animals involved in preclinical studies...
December 2016: Veterinary Clinical Pathology
https://www.readbyqxmd.com/read/27876480/noise-dosimetry-for-tactical-environments
#13
Christopher J Smalt, Joe Lacirignola, Shakti K Davis, Paul T Calamia, Paula P Collins
Noise exposure and the subsequent hearing loss are well documented aspects of military life. Numerous studies have indicated high rates of noise-induced hearing injury (NIHI) in active-duty service men and women, and recent statistics from the U.S. Department of Veterans Affairs indicate a population of veterans with hearing loss that is growing at an increasing rate. In an effort to minimize hearing loss, the U.S. Department of Defense (DoD) updated its Hearing Conservation Program in 2010, and also has recently revised the DoD Design Criteria Standard Noise Limits (MIL-STD-1474E) which defines allowable noise levels in the design of all military acquisitions including weapons and vehicles...
November 20, 2016: Hearing Research
https://www.readbyqxmd.com/read/27855476/-tuberculosis-contact-investigation-eight-years-of-experience-with-the-quantiferon-tb%C3%A2-gold-in-tube-in-lower-saxony-germany
#14
M Scharlach, K Brakensiek
Since the beginning of the 21(st) century, beside tuberculin skin tests (TST) and chest X-rays, interferon-gamma release assays (IGRA) have become available for diagnosing latent tuberculosis infection. In 2006, the Governmental Institute of Public Health of Lower Saxony (NLGA) established the IGRA in its laboratory, using the QuantiFERON-TB(®)Gold In-Tube (QFT). A cohort of 19 309 contact persons who were investigated during contact tracing by local public health departments (LPHD) was analyzed. Within 3 years, 75% of LPHDs in Lower Saxony established the QFT for tuberculosis contact tracing...
November 17, 2016: Das Gesundheitswesen
https://www.readbyqxmd.com/read/27756241/drug-susceptibility-profiles-of-pulmonary-mycobacterium-tuberculosis-isolates-from-patients-in-informal-urban-settlements-in-nairobi-kenya
#15
Glennah Kerubo, Evans Amukoye, Stefan Niemann, Samuel Kariuki
BACKGROUND: Anti-tuberculosis drug resistance is an emerging health problem in Kenya and especially in slums. Slum environments create a conducive environment for the spread of tuberculosis (TB) due to high population density and lack of basic amenities such as decent housing, access to clean water, lack of drainage and basic sanitation. Furthermore, ineffective health services in crowded and poorer populations, poor patient compliance, a large pool of untreated cases, delayed diagnosis and inappropriate treatment regimens are likely to favour selection and spread of drug resistant Mycobacterium tuberculosis (Mtb) strains in such settings, however, precise data on this problem are only sparsely available...
October 19, 2016: BMC Infectious Diseases
https://www.readbyqxmd.com/read/27732557/towards-a-new-paradigm-in-laboratory-medicine-the-five-rights
#16
Mario Plebani
A body of evidence collected in the last few decades demonstrates that the pre- and post-analytical phases of the testing cycle are more error-prone than the analytical phase. However, the paradigm of errors and quality in laboratory medicine has been questioned, analytical mistakes continuing to be a major cause of adverse clinical outcomes and patient harm. Although the brain-to-brain concept is widely recognized in the community of laboratory professionals, there is lack of clarity concerning the inter-relationship between the different phases of the cycle, interdependence between the pre-analytical phase and analytical quality, and the effect of the post-analytical steps on the quality of ultimate laboratory information...
December 1, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/27730116/introducing-pharmacogenetic-testing-with-clinical-decision-support-into-primary-care-a-feasibility-study
#17
Martin Dawes, Martin N Aloise, J Sidney Ang, Pieter Cullis, Diana Dawes, Robert Fraser, Gideon Liknaitzky, Andrea Paterson, Paul Stanley, Adriana Suarez-Gonzalez, Hagit Katzov-Eckert
BACKGROUND: Inappropriate prescribing increases patient illness and death owing to adverse drug events. The inclusion of genetic information into primary care medication practices is one solution. Our aim was to assess the ability to obtain and genotype saliva samples and to determine the levels of use of a decision support tool that creates medication options adjusted for patient characteristics, drug-drug interactions and pharmacogenetics. METHODS: We conducted a cohort study in 6 primary care settings (5 family practices and 1 pharmacy), enrolling 191 adults with at least 1 of 10 common diseases...
July 2016: CMAJ Open
https://www.readbyqxmd.com/read/27729353/development-of-guidance-on-the-timeliness-in-response-to-acute-kidney-injury-warning-stage-test-results-for-adults-in-primary-care-an-appropriateness-ratings-evaluation
#18
Tom Blakeman, Kathryn Griffith, Dan Lasserson, Berenice Lopez, Jung Y Tsang, Stephen Campbell, Charles Tomson
OBJECTIVES: Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care. DESIGN: An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method. SETTING: Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result...
October 11, 2016: BMJ Open
https://www.readbyqxmd.com/read/27723657/recent-developments-in-the-diagnosis-and-treatment-of-ocular-toxoplasmosis
#19
REVIEW
Cem Ozgonul, Cagri Giray Besirli
Ocular toxoplasmosis, a chorioretinal infection with Toxoplasma gondii, is the most common etiology of posterior uveitis in many countries. Accurate diagnosis depends heavily on the characteristic clinical features of this disease, but atypical presentations, especially in immunocompromised patients, may create diagnostic challenges and lead to misdiagnosis and inappropriate treatment. Molecular biology techniques to diagnose ocular toxoplasmosis have been available for many years and are now accessible as standard laboratory tests in many countries...
2017: Ophthalmic Research
https://www.readbyqxmd.com/read/27722127/establishing-the-heparin-therapeutic-range-using-aptt-and-anti-xa-measurements-for-monitoring-unfractionated-heparin-therapy
#20
Jung-Hyun Byun, In-Seok Jang, Jong Woo Kim, Eun-Ha Koh
BACKGROUND: Unfractionated heparin (UFH) has unstable pharmacokinetics and requires close monitoring. The activated partial thromboplastin time (aPTT) test has been used to monitor UFH therapy for decades in Korea, but its results can be affected by numerous variables. We established an aPTT heparin therapeutic range (HTR) corresponding to therapeutic anti-Xa levels for continuous intravenous UFH administration, and used appropriate monitoring to determine if an adequate dose of UFH was applied...
September 2016: Blood Research
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