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Inappropriate lab testing

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https://www.readbyqxmd.com/read/28540846/role-of-thromboelastography-in-the-management-of-snake-bite-a-case-report-from-india
#1
Ipsita Nag, Suvro Sankha Datta, Dibyendu De, Partha Pal, Shantanu K Das
In the absence of a specific laboratory test of envenomation, there is a need for an alternative mechanism for the early recognition of envenomation following hematotoxic snake-bite in tropical countries. Abnormalities of clotting are commonly associated with hematotoxic snake bite either due to systemic envenomation or due to the release of an inappropriate tourniquet applied as 'first-aid' often by the rural people before presentation to the hospital. Thromboelastography (TEG) has been used to monitor the coagulation abnormalities in various clinical scenarios...
April 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28521798/use-of-malaria-rdts-in-various-health-contexts-across-sub-saharan-africa-a-systematic-review
#2
Matthew R Boyce, Wendy P O'Meara
BACKGROUND: The World Health Organization recommends parasitological confirmation of malaria prior to treatment. Malaria rapid diagnostic tests (RDTs) represent one diagnostic method that is used in a variety of contexts to overcome limitations of other diagnostic techniques. Malaria RDTs increase the availability and feasibility of accurate diagnosis and may result in improved quality of care. Though RDTs are used in a variety of contexts, no studies have compared how well or effectively RDTs are used across these contexts...
May 18, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28483406/rates-of-inappropriate-laboratory-test-utilization-in-ontario
#3
Nadine Chami, Janet Simons, Arthur Sweetman, Andrew C Don Wauchope
BACKGROUND: Medical laboratory tests ordered redundantly represent one of the targets for reducing diagnostic testing without negatively, and possibly positively, affecting patient care. We study a clearly defined category of excessive laboratory utilization for nine analytes where inappropriate diagnostic testing is defined in terms of the time interval between tests; that is, ordering a test too soon following the previous order of the same test. METHODS: Population data from the near universal public Ontario Health Insurance Plan for the years 2006-2010 are employed where the tests are fulfilled by community medical laboratories...
May 5, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/28478722/diagnostic-error-in-pediatric-cancer
#4
Andrea R Carberry, Keith Hanson, Ashley Flannery, Megan Fischer, Jonathan Gehlbach, Carol Diamond, Ellen R Wald
The purpose of this study was to ( a) determine the frequency of diagnostic errors in pediatric cancer, ( b) categorize errors, and ( c) underscore themes associated with misdiagnosis. This is a retrospective cohort study at a tertiary children's hospital of 265 patients with new oncologic diagnoses. The diagnostic error rate was 28%. Compared with those with no diagnostic error, those in whom there was an error were more likely to have ( a) more visits before diagnosis ( P < .001), ( b) not been seen in an acute care setting ( P = ...
May 1, 2017: Clinical Pediatrics
https://www.readbyqxmd.com/read/28476493/promoting-appropriate-urine-culture-management-to-improve-health-care-outcomes-and-the-accuracy-of-catheter-associated-urinary-tract-infections
#5
REVIEW
Robert Garcia, Eric D Spitzer
Published literature indicates that the unjustified ordering or improper collection of urine for urinalysis or culture from either catheterized patients or those without indwelling devices, or misinterpretation of positive results, often leads to adverse health care events, including increased financial burdens, overreporting of mandated catheter-associated urinary tract infection events, overtreatment of patients with antimicrobial agents, selection of multidrug-resistant organisms, and Clostridium difficile infection...
May 2, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28474099/a-three-step-diagnosis-of-pediatric-pneumonia-at-the-emergency-department-using-clinical-predictors-c-reactive-protein-and-pneumococcal-pcr
#6
Gabriel Alcoba, Kristina Keitel, Veronica Maspoli, Laurence Lacroix, Sergio Manzano, Mario Gehri, René Tabin, Alain Gervaix, Annick Galetto-Lacour
Recommendations for the management of community-acquired pneumonia (CAP) advocate that, in the absence of the clinical and laboratory findings typical of bacterial CAP, antibiotics are not required. However, the true value of the clinical and laboratory predictors of pediatric CAP still needs to be assessed. This prospective cohort study in three emergency departments enrolled 142 children with radiological pneumonia. Pneumonia with lung consolidation was the primary endpoint; complicated pneumonia (bacteremia, empyema, or pleural effusion) was the secondary endpoint...
May 4, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28470652/laboratory-diagnostics-of-antiphospholipid-syndrome
#7
Vittorio Pengo, Elisa Bison, Gentian Denas, Seena Padayattil Jose, Giacomo Zoppellaro, Alessandra Banzato
Diagnosis of antiphospholipid syndrome (APS) lies in the recognition of antiphospholipid antibodies (aPL). As standardization of tests for the detection of aPL is far from being optimal and reference material is not available, inappropriate diagnoses of APS are not unusual. In the last few years, the concept of triple test positivity has emerged as a useful tool to identify patients with APS. Clinical studies on patients and carriers of triple positivity clearly show that these individuals are at high risk of thromboembolic events and pregnancy loss...
May 3, 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/28458798/advances-in-rapid-identification-and-susceptibility-testing-of-bacteria-in-the-clinical-microbiology-laboratory-implications-for-patient-care-and-antimicrobial-stewardship-programs
#8
REVIEW
Florian P Maurer, Martin Christner, Moritz Hentschke, Holger Rohde
Early availability of information on bacterial pathogens and their antimicrobial susceptibility is of key importance for the management of infectious diseases patients. Currently, using traditional approaches, it usually takes at least 48 hours for identification and susceptibility testing of bacterial pathogens. Therefore, the slowness of diagnostic procedures drives prolongation of empiric, potentially inappropriate, antibacterial therapies. Over the last couple of years, the improvement of available techniques (e...
March 30, 2017: Infectious Disease Reports
https://www.readbyqxmd.com/read/28441899/clinical-and-financial-outcomes-evaluation-of-multimodal-pharmacist-warfarin-management-of-a-statewide-urban-and-rural-population
#9
James C Lee, Kathleen E Horner, Michelle L Krummel, Deanna L McDanel
PURPOSE: To evaluate the efficacy, safety, and indirect financial outcomes of pharmacist face-to-face warfarin management with telephone-based distance management utilizing local laboratories or patient self-testing (PST). METHODS: A retrospective analysis of a clinic population of 336 patients on established warfarin therapy distributed statewide in rural and urban settings over a 6-month period was conducted. Participants were stratified into face-to-face management, telephone-based management utilizing local laboratory testing, and telephone-based management utilizing PST...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28439218/pediatric-reference-intervals-for-biochemical-markers-gaps-and-challenges-recent-national-initiatives-and-future-perspectives
#10
Houman Tahmasebi, Victoria Higgins, Angela W S Fung, Dorothy Truong, Nicole M A White-Al Habeeb, Khosrow Adeli
Reference intervals provide valuable information to medical practitioners in their interpretation of quantitative laboratory test results, and are critical in the assessment of patient health and in clinical decision-making. The reference interval serves as a health-associated benchmark with which to compare an individual test result. While the concept of reference intervals and their utility appear straightforward, the process of establishing accurate and reliable reference intervals is considerably complex and involved...
March 2017: EJIFCC
https://www.readbyqxmd.com/read/28429690/-our-experience-in-the-diagnosis-and-treatment-of-postural-orthostatic-tachycardia-syndrome-vasovagal-syncope-and-inappropriate-sinus-tachycardia-in-children
#11
Sezen Ugan Atik, Reyhan Dedeoğlu, Aida Koka, Funda Öztunç
OBJECTIVES: The aim of this study was to share our experience in the diagnosis and treatment of patients who presented at our clinic with syncope, pre-syncope, dizziness, and palpitations. STUDY DESIGN: Patients who were treated at pediatric cardiology clinic for complaints of syncope, dizziness, and palpitations between 2014 and 2016 were enrolled in the study. Detailed history of the patients, physical examination findings, laboratory and electrocardiogram results were recorded...
April 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/28429163/antimicrobial-susceptibility-of-bacterial-isolates-from-patients-presenting-with-ear-nose-and-throat-ent-infections-in-the-german-community-healthcare-setting
#12
B Olzowy, M Kresken, M Havel, D Hafner, B Körber-Irrgang
Empiric initial antibiotic therapy of bacterial infections is based primarily upon the susceptibility of the most common causative pathogens. The purpose of this study was to provide susceptibility data on six bacterial species known to cause ear, nose and throat (ENT) infections. A total of 1066 isolates collected during a nationwide laboratory-based surveillance study were analysed. All Streptococcus pyogenes isolates were penicillin (PEN)-susceptible, indicating that natural penicillins can still be recommended as the first-line treatment for group A streptococcal tonsillopharyngitis...
April 20, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/28419981/thiazide-associated-hyponatremia-report-of-the-hyponatremia-registry-an-observational-multicenter-international-study
#13
Volker Burst, Franziska Grundmann, Torsten Kubacki, Arthur Greenberg, Ingrid Becker, Despina Rudolf, Joseph Verbalis
BACKGROUND: Hyponatremia is a frequent and potentially life-threatening adverse side effect of thiazide diuretics. This sub-analysis of the Hyponatremia Registry database focuses on current management practices of thiazide-associated hyponatremia (TAH) and compares differences between TAH and syndrome of inappropriate antidiuretic hormone secretion (SIADH). METHODS: We analyzed 477 patients from 225 US and EU sites with euvolemic hyponatremia ([Na+] ≤130 mEq/L) who were receiving a thiazide diuretic...
2017: American Journal of Nephrology
https://www.readbyqxmd.com/read/28419265/validation-of-the-sepsis-metascore-for-diagnosis-of-neonatal-sepsis
#14
Timothy E Sweeney, James L Wynn, María Cernada, Eva Serna, Hector R Wong, Henry V Baker, Máximo Vento, Purvesh Khatri
What’s Known on This Subject.: Neonates are at increased risk for developing sepsis, but this population often exhibits ambiguous clinical signs that complicate the diagnosis of infection. No biomarker has yet shown enough diagnostic accuracy to rule out sepsis at the time of clinical suspicion. What This Study Adds.: We show that a gene-expression-based signature is an accurate objective measure of the risk of sepsis in a neonate or preterm infant, and it substantially improves diagnostic accuracy over that of commonly used laboratory-based testing...
April 13, 2017: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/28399675/evaluating-the-appropriateness-of-hospital-doctors-requests-for-pulmonary-function-tests-beyond-basic-spirometry-results-from-a-prospective-observational-study
#15
Krishna Bajee Sriram, Zoe Fountain, Jessica Hockenhull, Debbie Zagami
OBJECTIVES: Hospitalists request 'complete' pulmonary function tests (PFTs), typically comprising of spirometry, diffusion capacity of the lung for carbon monoxide (DLCO) and absolute lung volumes (ALVs), the results of which assist in the management of patients with respiratory disorders. Recently, concerns have been raised about over-requesting of 'complete' PFTs, but there is a paucity of information on the proportion of requests that can be considered clinically inappropriate. This study prospectively evaluated the 'complete' PFTs requested in a hospital service and assessed the impact of medical review of the requests...
April 19, 2017: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/28392741/policies-and-practices-in-haemostasis-testing-among-laboratories-in-croatia-a-survey-on-behalf-of-a-working-group-for-laboratory-coagulation-of-the-croatian-society-of-medical-biochemistry-and-laboratory-medicine
#16
Ana Bronić, Desiree Coen Herak, Sandra Margetić, Marija Milić
INTRODUCTION: The objective of this survey was to assess current policies and practice in haemostasis testing among both hospital and outpatient laboratories in Republic of Croatia. MATERIALS AND METHODS: A questionnaire with seventy questions divided into nine sections was created in May 2015. Participants were asked about their practice related to test request form, sample collection, prothrombin time (PT) and activated partial thromboplastin time assays, other individual haemostasis assays, point-of-care testing (POCT), reporting of coagulation tests results and quality assurance of procedures, the personnel and other laboratory resources, as well as on issues related to education and implementation of additional coagulation assays in their laboratory...
February 15, 2017: Biochemia Medica: časopis Hrvatskoga Društva Medicinskih Biokemičara
https://www.readbyqxmd.com/read/28369370/diagnostic-performance-and-clinical-feasibility-of-a-point-of-care-test-for-respiratory-viral-infections-in-primary-health-care
#17
Andrea H L Bruning, Wilhelmina B de Kruijf, Henk C P M van Weert, Wim L M Willems, Menno D de Jong, Dasja Pajkrt, Katja C Wolthers
Background.: Inappropriately high levels of antibiotics are still prescribed in primary health care for respiratory tract infections (RTIs). Access to diagnostic point-of-care tests (POCTs) for RTIs might reduce this over-prescription. Objective.: The purpose of our study was to determine the diagnostic performance and clinical feasibility of a recently developed diagnostic POCT for respiratory viruses, the mariPOC®, in a Dutch primary healthcare setting. Methods...
March 24, 2017: Family Practice
https://www.readbyqxmd.com/read/28353386/the-effects-of-computerized-clinical-decision-support-systems-on-laboratory-test-ordering-a-systematic-review
#18
REVIEW
Nicolas Delvaux, Katrien Van Thienen, Annemie Heselmans, Stijn Van de Velde, Dirk Ramaekers, Bert Aertgeerts
CONTEXT: - Inappropriate laboratory test ordering has been shown to be as high as 30%. This can have an important impact on quality of care and costs because of downstream consequences such as additional diagnostics, repeat testing, imaging, prescriptions, surgeries, or hospital stays. OBJECTIVE: - To evaluate the effect of computerized clinical decision support systems on appropriateness of laboratory test ordering. DATA SOURCES: - We used MEDLINE, Embase, CINAHL, MEDLINE In-Process and Other Non-Indexed Citations, Clinicaltrials...
April 2017: Archives of Pathology & Laboratory Medicine
https://www.readbyqxmd.com/read/28344140/high-value-cost-conscious-care-iterative-systems-based-interventions-to-reduce-unnecessary-lab-testing
#19
Brett W Sadowski, Alison B Lane, Shannon M Wood, Sara L Robinson, Chin Hee Kim
BACKGROUND: Inappropriate testing contributes to soaring health care costs within the United States and teaching hospitals are vulnerable to providing care largely for academic development. Via its 'Choosing Wisely' campaign, the American Board of Internal Medicine recommends avoiding repetitive testing for stable inpatients. We designed systems-based interventions to reduce laboratory orders for patients admitted to the wards at an academic facility. METHODS: We identified the computer-based order entry system as an appropriate target for sustainable intervention...
March 23, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28339692/decrease-in-unnecessary-vitamin-d-testing-using-clinical-decision-support-tools-making-it-harder-to-do-the-wrong-thing
#20
Andrew H Felcher, Rachel Gold, David M Mosen, Ashley B Stoneburner
Objective: To evaluate the impact of clinical decision support (CDS) tools on rates of vitamin D testing. Screening for vitamin D deficiency has increased in recent years, spurred by studies suggesting vitamin D's clinical benefits. Such screening, however, is often unsupported by evidence and can incur unnecessary costs. Materials and Methods: We evaluated how rates of vitamin D screening changed after we implemented 3 CDS tools in the electronic health record (EHR) of a large health plan: (1) a new vitamin D screening guideline, (2) an alert that requires clinician acknowledgement of current guidelines to continue ordering the test (a "hard stop"), and (3) a modification of laboratory ordering preference lists that eliminates shortcuts...
February 19, 2017: Journal of the American Medical Informatics Association: JAMIA
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