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Inappropriate lab testing

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https://www.readbyqxmd.com/read/29340450/therapeutic-drug-monitoring-of-benznidazole-and-nifurtimox-a-systematic-review-and-quality-assessment-of-published-clinical-practice-guidelines
#1
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
https://www.readbyqxmd.com/read/29328082/linear-iterative-near-field-phase-retrieval-lipr-for-dual-energy-x-ray-imaging-and-material-discrimination
#2
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
https://www.readbyqxmd.com/read/29326146/prior-authorization-requirements-for-proprotein-convertase-subtilisin-kexin-type-9-inhibitors-across-us-private-and-public-payers
#3
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
https://www.readbyqxmd.com/read/29315909/seeking-excellence-an-evaluation-of-235-international-laboratories-conducting-water-isotope-analyses-by-isotope-ratio-and-laser-absorption-spectrometer
#4
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
https://www.readbyqxmd.com/read/29286568/utilization-of-frozen-plasma-cryoprecipitate-and-recombinant-factor-viia-for-children-with-hemostatic-impairments-an-audit-of-transfusion-appropriateness
#5
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
https://www.readbyqxmd.com/read/29241593/rapid-differential-diagnosis-of-diabetes-insipidus-in-a-7-month-old-infant-the-copeptin-approach
#6
J Vergier, J Fromonot, A Alvares De Azevedo Macedo, A Godefroy, E Marquant, R Guieu, M Tsimaratos, R Reynaud
INTRODUCTION: Diabetes insipidus is characterized by hypoosmotic polyuria related to deficiency of arginine-vasopressin (AVP) secretion (central diabetes insipidus, CDI) or renal insensitivity to AVP (nephrogenic diabetes insipidus, NDI). The water deprivation test with assessment of AVP activity is currently the gold standard for differential diagnosis in patients presenting polyuria-polydipsia syndrome. Nevertheless, it can be dangerous without proper surveillance and its interpretation may be challenging...
January 2018: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/29220884/a-black-swan-in-clinical-laboratory-practice-the-analytical-error-due-to-interferences-in-immunoassay-methods
#7
Aldo Clerico, Lucia Belloni, Cinzia Carrozza, Mario Correale, Ruggero Dittadi, Claudio Dotti, Antonio Fortunato, Giulio Vignati, Gian Carlo Zucchelli, Marco Migliardi
It is well known that the results of immunoassay methods can be affected by specific or non-specific interferences, ranging from 0.4% to 4.0%. The presence of interference may greatly compromise the accuracy of immunoassay analyses causing an error in the measurement, producing false-positive or false-negative results. From a clinical point of view, these analytical errors may have serious implications for patient care because they can cause misdiagnosis or inappropriate treatment. Unfortunately, it is a very difficult task to identify the irregular analytical errors related to immunoassay methods because they are not detectable by normal laboratory quality control procedures, are reproducible within the test system, may be clinically plausible and are relatively rare...
December 7, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/29216348/mic-based-dose-adjustment-facts-and-fables
#8
Johan W Mouton, Anouk E Muller, Rafael Canton, Christian G Giske, Gunnar Kahlmeter, John Turnidge
Over recent decades, several publications have described optimization procedures for antibiotic therapy in the individual patient based on antimicrobial MIC values. Most methods include therapeutic drug monitoring and use a single MIC determination plus the relevant pharmacokinetics/pharmacodynamics to adjust the dose to optimize antimicrobial drug exposure and antibacterial effects. However, the use of an MIC obtained by a single MIC determination is inappropriate. First, routine clinical laboratories cannot determine MICs with sufficient accuracy to guide dosage owing to the inherent assay variation in the MIC test...
December 5, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29212546/electronic-laboratory-medicine-ordering-with-evidence-based-order-sets-in-primary-care-elmo-study-protocol-for-a-cluster-randomised-trial
#9
Nicolas Delvaux, An De Sutter, Stijn Van de Velde, Dirk Ramaekers, Steffen Fieuws, Bert Aertgeerts
BACKGROUND: Laboratory testing is an important clinical act with a valuable role in screening, diagnosis, management and monitoring of diseases or therapies. However, inappropriate laboratory test ordering is frequent, burdening health care spending and negatively influencing quality of care. Inappropriate tests may also result in false-positive results and potentially cause excessive downstream activities. Clinical decision support systems (CDSSs) have shown promising results to influence the test-ordering behaviour of physicians and to improve appropriateness...
December 6, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/29210591/duplicate-type-and-screen-testing-waste-in-the-clinical-laboratory
#10
Margaret L Compton, Penny C Szklarski, Garrett S Booth
CONTEXT: - In the United States, approximately 65 billion dollars is spent per year on clinical laboratory testing, of which 20% to 30% of all testing is deemed inappropriate. There have been multiple studies in the field of transfusion medicine regarding evidence-based transfusion practices, but limited data exist regarding inappropriate pretransfusion testing and its financial and clinical implications. OBJECTIVE: - To assess duplicative testing practices in the transfusion medicine service...
December 6, 2017: Archives of Pathology & Laboratory Medicine
https://www.readbyqxmd.com/read/29206938/misidentification-of-acinetobacter-baumannii-as-alcaligenes-faecalis-by-vitek-2-system-case-report
#11
Suekyeung Kim, Myeong Hee Kim, Woo In Lee, So Young Kang, You La Jeon
Acinetobacter baumannii (A. baumannii) is widely known as an opportunistic bacterial pathogen that causes infection more frequently among immunocompromised individuals. Our case demonstrated the limitation of the current VITEK 2 system for the idendification of A. baumannii. Four clinical isolates of A. baumannii were identified as Alcaligenes faecalis by the VITEK 2 system. Misidentification might lead to unnecessary tests and inappropriate treatments. Additional methods appear to be helpful for the accurate identification of A...
December 1, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29163728/results-of-a-quality-improvement-project-aimed-at-eliminating-healthcare-waste-by-changing-medical-resident-test-ordering-behavior
#12
Sushilkumar Satish Gupta, Radhika Voleti, Vimbai Nyemba, Selma Demir, Olaoluwatomi Lamikanra, Nomsa Musemwa, Angela Saverimuthu, Kamaldeen Agoro, Robert D Kalter, Peter Homel, Melvyn Hecht, Lawrence B Wolf, Edward K Chapnick, Michael G Kantrowitz, Stephan L Kamholz
Background: In light of rising healthcare costs and evidence of inefficient use of medical resources, there is growing interest in reducing healthcare waste by clinicians. Unwarranted lab tests may lead to further tests, prolonged hospital stays, unnecessary referrals and procedures, patient discomfort, and iatrogenic anemia, resulting in significant economic and clinical effects. Blood tests are essential in guiding medical decisions, but they are also associated with significant financial and clinical costs...
December 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/29153025/annals-express-gestational-age-specific-reference-intervals-for-15-biochemical-measurands-during-normal-pregnancy-in-china
#13
Yanpeng Dai, Junjie Liu, Enwu Yuan, Yushan Lee, Quanxian Wang, Liting Jia, Linkai Wang, Yanhua Su
AIMS: Physiological changes that occur during pregnancy can influence biochemical parameters. Therefore, using reference intervals based on specimens from non-pregnant women to interpret laboratory results during pregnancy may be inappropriate. This study aimed to establish essential to establish reference intervals for a range of analytes during pregnancy. METHODS: The cross-sectional study was performed in 13656 healthy pregnant and 2634 non-pregnant women. Fifteen biochemical measurands relating to renal and hepatic function were analyzed using an Olympus AU5400 analyzer (Olympus, Tokyo, Japan)...
January 1, 2017: Annals of Clinical Biochemistry
https://www.readbyqxmd.com/read/29117669/late-diagnosis-of-influenza-in-adult-patients-during-a-seasonal-outbreak
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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