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Inappropriate lab testing

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https://www.readbyqxmd.com/read/29117669/late-diagnosis-of-influenza-in-adult-patients-during-a-seasonal-outbreak
#1
Seong-Ho Choi, Jin-Won Chung, Tark Kim, Ki-Ho Park, Mi Suk Lee, Yee Gyung Kwak
Background/Aims: Due to advances in diagnostic techniques, clinicians are more frequently performing influenza diagnostic tests and referring to their test results ahead of the administration of neuraminidase inhibitors (NAIs). To investigate the clinical significance of the time from symptom onset to laboratory diagnosis, we reviewed the clinical characteristics of adult patients with influenza who had an early laboratory diagnosis (ED) or a late laboratory diagnosis (LD) at one of four tertiary care centers during a seasonal outbreak of influenza...
November 10, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29105255/analysis-of-current-thyroid-function-test-ordering-practices
#2
Joseph K Kluesner, Darrick J Beckman, Joshua M Tate, Alexis A Beauvais, Maria I Kravchenko, Jana L Wardian, Sky D Graybill, Jeffrey A Colburn, Irene Folaron, Mark W True
RATIONALE: Current guidelines recommend thyroid stimulating hormone (TSH) alone as the best test to detect and monitor thyroid dysfunction, yet free thyroxine (FT4) and free triiodothyronine (FT3) are commonly ordered when not clinically indicated. Excessive testing can lead to added economic burden in an era of rising healthcare costs, while rarely contributing to the evaluation or management of thyroid disease. OBJECTIVE: To evaluate our institution's practice in ordering thyroid function tests (TFTs) and to identify strategies to reduce inappropriate FT4 and FT3 testing...
November 3, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/29090586/diagnosis-and-treatment-of-myh9-rd-in-an-australasian-cohort-with-thrombocytopenia
#3
David J Rabbolini, Yenna Chun, Maya Latimer, Shinji Kunishima, Kathleen Fixter, Bhavia Valecha, Peter Tan, Lee Ping Chew, Benjamin T Kile, Rachel Burt, Kottayam Radhakrishnan, Robert Bird, Paul Ockelford, Sara Gabrielli, Qiang Chen, William S Stevenson, Christopher M Ward, Marie-Christine Morel-Kopp
MYH9-related disorders (MYH9-RDs) caused by mutation of the MYH9 gene which encodes non-muscle myosin heavy-chain-IIA (NMMHC-IIA), an important motor protein in hemopoietic cells, are the most commonly encountered cause of inherited macrothrombocytopenia. Despite distinguishing features including an autosomal dominant mode of inheritance, giant platelets on the peripheral blood film accompanied by leucocytes with cytoplasmic inclusion bodies (döhle-like bodies), these disorders remain generally under-recognized and often misdiagnosed as immune thrombocytopenia (ITP)...
November 1, 2017: Platelets
https://www.readbyqxmd.com/read/29075480/control-of-nematodirus-spp-infection-by-sheep-flock-owners-in-northern-ireland
#4
Connor McMahon, Hillary W J Edgar, Jason P Barley, Robert E B Hanna, Gerard P Brennan, Ian Fairweather
BACKGROUND: To address a lack of information on the control of ovine helminth parasites in Northern Ireland (NI), a number of research projects have been undertaken, dealing with gastrointestinal nematodes, tapeworms and liver fluke. This investigation concerns Nematodirus and concentrates on three aspects of disease: farm management strategies for its control, derived from the results of a Questionnaire; the efficacy of treatment used by farmers, as determined by a coprological survey; and the hatching requirements of Nematodirus eggs, that is, whether prolonged chilling is a pre-requisite for hatching...
2017: Irish Veterinary Journal
https://www.readbyqxmd.com/read/29075388/delivery-and-measurement-of-high-value-care-in-standardized-patient-encounters
#5
Jennifer DeLuca Baldwin, Jaclyn Cox, Zhao Helen Wu, Anne Kenny, Steven Angus
BACKGROUND : Residencies have incorporated high-value care (HVC) training to contain health care expenditures. Assessment methods of HVC curricula are limited. OBJECTIVE : In our clinical skills laboratory, we evaluated the effectiveness of HVC curricula using standardized patients (SPs) to determine if there is a correlation with performance in counseling, history and physical, HVC knowledge, and demographics. METHODS : Through ambulatory cases, SPs evaluated postgraduate year 2 (PGY-2) residents using checklists to determine if they obtained the chief complaint, medical and social history, focused physical examination, and conveyed information regarding patient management...
October 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/29056667/hyponatremia-as-the-presenting-feature-of-a-pituitary-abscess-in-a-calf
#6
Jamie L Stewart, Maria C Bates, B Wade Edwards, Brian M Aldridge
A 2-month-old Simmental heifer presented for acute onset of neurological behavior. Laboratory tests confirmed the presence of hyponatremia, hypochloremia, and hypokalemia that improved with intravenous fluid therapy. Despite an initial cessation of neurological signs, symptoms re-emerged, and the heifer was euthanized due to poor prognosis. A pituitary abscess (Trueperella pyogenes) was observed on gross necropsy, suggesting that the effects of panhypopituitarism (inappropriate anti-diuretic hormone (ADH), adrenocorticotropic hormone (ACTH), and/or thyroid-stimulating hormone (TSH) secretion) may have resulted in the clinical findings...
February 6, 2017: Veterinary Sciences
https://www.readbyqxmd.com/read/29056494/clustered-interventions-to-reduce-inappropriate-duplicate-laboratory-tests-in-an-irish-tertiary-hospital
#7
Hugh Brady, Laura Piggott, Suzanne S Dunne, Nuala H O'Connell, Colum P Dunne
BACKGROUND: There is increasing emphasis on understanding the rate, and avoidable costs, of inappropriate laboratory testing in hospitals, especially associated with duplication of tests following transfer of patients from one hospital to another. While studies of inappropriate testing have been reported previously, there are no published data relevant to Ireland. AIMS: To determine the baseline rate of inappropriate testing for a subset of clinical parameters, specifically, full blood counts (FBC), biochemistry profiles (Bio) and coagulation (Coag) screens for geriatric patients transferring to and from University Hospital Limerick (UHL)...
October 19, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/29034300/generating-method-specific-reference-ranges-a-harmonious-outcome
#8
Graham R Lee, Alison Griffin, Kieran Halton, Maria C Fitzgibbon
OBJECTIVES: When laboratory Reference Ranges (RR) do not reflect analytical methodology, result interpretation can cause misclassification of patients and inappropriate management. This can be mitigated by determining and implementing method-specific RRs, which was the main objective of this study. DESIGN AND METHODS: Serum was obtained from healthy volunteers (Male + Female, n > 120) attending hospital health-check sessions during June and July 2011. Pseudo-anonymised aliquots were stored (at - 70 °C) prior t° analysis on Abbott ARCHITECT c16000 chemistry and i2000SR immunoassay analysers...
December 2017: Pract Lab Med
https://www.readbyqxmd.com/read/29027030/diagnostic-accuracy-of-fungal-identification-in-histopathology-and-cytopathology-specimens
#9
V L Kung, R D Chernock, C-A D Burnham
Tools to diagnose fungal infection are microscopic examination, antigen or antibody-based detection tests, molecular diagnostics, and culture, with culture being the "gold standard" for species-level identification. Although these methods are commonly used in concert and yield concordant results, in some cases tissue is not available for culture, and/or different methodologies yield discrepant results. These discrepancies may be clinically significant, causing confusion and inappropriate or delayed initiation of antifungals...
October 13, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/29017389/the-canadian-laboratory-initiative-on-pediatric-reference-intervals-a-caliper-white-paper
#10
Khosrow Adeli, Victoria Higgins, Karin Trajcevski, Nicole White-Al Habeeb
Laboratory investigations provide physicians with objective data to aid in disease diagnosis, clinical decision making, and patient follow up. Clinical interpretation of laboratory test results relies heavily on the availability of appropriate population-based reference intervals (i.e. normative values) or decision limits developed through clinical outcome studies. Although reference intervals are fundamental to accurate laboratory test interpretation, and thus critically important to healthcare, the need for sound evidence-based reference intervals has been largely overlooked, particularly in the pediatric population...
October 11, 2017: Critical Reviews in Clinical Laboratory Sciences
https://www.readbyqxmd.com/read/28992593/small-mobile-persistent-trifluoroacetate-in-the-water-cycle-overlooked-sources-pathways-and-consequences-for-drinking-water-supply
#11
Marco Scheurer, Karsten Nödler, Finnian Freeling, Joachim Janda, Oliver Happel, Marcel Riegel, Uwe Müller, Florian Rüdiger Storck, Michael Fleig, Frank Thomas Lange, Andrea Brunsch, Heinz-Jürgen Brauch
Elevated concentrations of trifluoroacetate (TFA) of more than 100 μg/L in a major German river led to the occurrence of more than 20 μg/L TFA in bank filtration based tap waters. Several spatially resolved monitoring programs were conducted and discharges from an industrial company were identified as the point source of TFA contamination. Treatment options for TFA removal were investigated at full-scale waterworks and in laboratory batch tests. Commonly applied techniques like ozonation or granulated activated carbon filtration are inappropriate for TFA removal, whereas TFA was partly removed by ion exchange and completely retained by reverse osmosis...
December 1, 2017: Water Research
https://www.readbyqxmd.com/read/28989491/an-evaluation-of-the-effectiveness-of-an-algorithm-intervention-in-reducing-inappropriate-faecal-samples-sent-for-clostridium-difficile-testing
#12
Irene Thompson, Colin Lavelle, Laurence Leonard
BACKGROUND: Clostridium difficile (C. difficile) is a leading cause of infectious diarrhoea in hospitals. Sending faecal samples for testing expedites diagnosis and appropriate treatment. Clinical suspicion of C. difficile based on patient history, signs and symptoms is the basis for sampling. Sending faecal samples from patients with diarrhoea 'just in case' the patient has C. difficile may be an indication of poor clinical management. AIM: To evaluate the effectiveness of an intervention by an Infection Prevention and Control Team (IPCT) in reducing inappropriate faecal samples sent for C...
November 2016: Journal of Infection Prevention
https://www.readbyqxmd.com/read/28988220/laboratory-performance-of-sweat-conductivity-for-the-screening-of-cystic-fibrosis
#13
Ronda F Greaves, Lisa Jolly, John Massie, Sue Scott, Veronica C Wiley, Michael P Metz, Richard J Mackay
BACKGROUND: There are several complementary English-language guidelines for the performance of the sweat chloride test. These guidelines also incorporate information for the collection of conductivity samples. However, recommendations for the measurement and reporting of sweat conductivity are less clear than for sweat chloride. The aim of the study was to develop an understanding of the testing and reporting practices of sweat conductivity in Australasian laboratories. METHODS: A survey specifically directed at conductivity testing was sent to the 12 laboratories registered with the Royal College of Pathologists of Australasia Quality Assurance Programs...
October 9, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28974364/diagnostic-utilities-of-a-fully-automated-molecular-test-for-toxigenic-clostridium-difficile
#14
Yoshitomo Morinaga, Norihiko Akamatsu, Junichi Matsuda, Hiroko Tateno, Takeshi Tomaru, Ai Tanaka, Sayuri Morita, Makoto Nakamura, Hideaki Kato, Megumi Annaka, Yoshishige Masuda, Yasutomo Itakura, Takashi Inamatsu, Katsunori Yanagihara
Laboratory underdiagnosis of toxigenic Clostridium difficile can lead to inappropriate management of C. difficile infection (CDI). A fully automated molecular test (FAMT), BD MAX, and enzyme immunoassays for C. difficile glutamate dehydrogenase (GDH) and for toxin A/B antigen test were evaluated using clinical specimens. Laboratory analysis of 231 fecal specimens from patients suspected with CDI, indicated that the sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of FAMT was 98...
September 30, 2017: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
https://www.readbyqxmd.com/read/28963385/false-acute-kidney-injury-alert-due-to-model-car-fuel-ingestion
#15
Darren Powell, Louise Hassall, David Scholes, Mohammad Al-Jubouri
We report a case of accidental ingestion of model car fuel (Optifuel) resulting in an apparent elevation of serum creatinine of 274 µmol/L (3.1 mg/dL) as measured by the Jaffe (alkaline picrate) reaction, which resulted in an acute kidney injury (AKI) stage 3 alert being reported. Optifuel contains nitromethane, which has been reported to interfere in the Jaffe reaction causing falsely high creatinine measurements. The laboratory staff were vigilant about this potential interfering substance so repeated the analysis of the creatinine using an enzymatic method that showed a markedly lower result of 47 µmol/L (0...
September 28, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28962627/laboratory-acquired-infections-of-salmonella-enterica-serotype-typhi-in-south-africa-phenotypic-and-genotypic-analysis-of-isolates
#16
Anthony Marius Smith, Shannon Lucrecia Smouse, Nomsa Pauline Tau, Colleen Bamford, Vineshree Mischka Moodley, Charlene Jacobs, Kerrigan Mary McCarthy, Adré Lourens, Karen Helena Keddy
BACKGROUND: Workers in clinical microbiology laboratories are exposed to a variety of pathogenic microorganisms. Salmonella species is among the most commonly reported bacterial causes of laboratory-acquired infections. We report on three cases of laboratory-acquired Salmonella enterica serotype Typhi (Salmonella Typhi) infection which occurred over the period 2012 to 2016 in South Africa. METHODS: Laboratory investigation included phenotypic and genotypic characterization of isolates...
September 29, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28914278/magnitude-of-potentially-inappropriate-thrombophilia-testing-in-the-inpatient-hospital-setting
#17
Eric Mou, Henry Kwang, Jason Hom, Lisa Shieh, Andre Kumar, Ilana Richman, Caroline Berube
Laboratory costs of thrombophilia testing exceed an estimated $650 million (in US dollars) annually. Quantifying the prevalence and financial impact of potentially inappropriate testing in the inpatient hospital setting represents an integral component of the effort to reduce healthcare expenditures. We conducted a retrospective analysis of our electronic medical record to evaluate 2 years' worth of inpatient thrombophilia testing measured against preformulated appropriateness criteria. Cost data were obtained from the Centers for Medicare and Medicaid Services 2016 Clinical Laboratory Fee Schedule...
September 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28893597/evaluation-of-a-provincial-intervention-to-reduce-redundant-hemoglobin-a1c-testing
#18
Irene Ma, Maggie Guo, Jeannine Viczko, Christopher Naugler
BACKGROUND: The Canadian Diabetes Association recommends testing most individuals with diabetes mellitus using HbA1c once every 3months. In Alberta, Canada, a provincial intervention to reduce inappropriate HbA1c test orders was implemented to align with this guideline, where only one HbA1c test request every 90days for most individuals can be processed. Here, we evaluated the provincial intervention to reduce redundant HbA1c testing in Alberta. METHODS: Total counts of all HbA1c tests ordered within Edmonton and Calgary, Alberta, were collected from the respective Laboratory Information Systems each month between January 2013 and December 2016...
September 8, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/28886191/clinical-chemistry-reference-intervals-of-healthy-adult-populations-in-gojjam-zones-of-amhara-national-regional-state-northwest-ethiopia
#19
Zewdie Mekonnen, Asmare Amuamuta, Wondemagegn Mulu, Mulat Yimer, Yohannes Zenebe, Yesuf Adem, Bayeh Abera, Wondemu Gebeyehu, Yakob Gebregziabher
BACKGROUND: Reference interval is crucial for disease screening, diagnosis, monitoring, progression and treatment efficacy. Due to lack of locally derived reference values for the parameters, clinicians use reference intervals derived from western population. But, studies conducted in different African countries have indicated differences between locally and western derived reference values. Different studies also indicated considerable variation in clinical chemistry reference intervals by several variables such as age, sex, geographical location, environment, lifestyle and genetic variation...
2017: PloS One
https://www.readbyqxmd.com/read/28872277/misdiagnosed-hiv-infection-in-pregnant-women-initiating-universal-art-in-south-africa
#20
Nei-Yuan Hsiao, Allison Zerbe, Tamsin K Phillips, Landon Myer, Elaine J Abrams
INTRODUCTION: Rapid diagnostic tests (RDTs) are the primary diagnostic tools for HIV used in resource-constrained settings. Without a proper confirmation algorithm, there is concern that false-positive (FP) RDTs could result in misdiagnosis of HIV infection and inappropriate antiretroviral treatment (ART) initiation, but programmatic data on FP are few. METHODS: We examined the accuracy of RDT diagnosis among HIV-infected pregnant women attending public sector antenatal services in Cape Town, South Africa...
August 29, 2017: Journal of the International AIDS Society
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