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Inappropriate lab testing

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https://www.readbyqxmd.com/read/28439218/pediatric-reference-intervals-for-biochemical-markers-gaps-and-challenges-recent-national-initiatives-and-future-perspectives
#1
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
#2
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
#3
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
#4
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...
April 19, 2017: American Journal of Nephrology
https://www.readbyqxmd.com/read/28419265/validation-of-the-sepsis-metascore-for-diagnosis-of-neonatal-sepsis
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
https://www.readbyqxmd.com/read/28339354/the-effects-of-an-educational-meeting-and-subsequent-computer-reminders-on-the-ordering-of-laboratory-tests-by-rheumatologists-an-interrupted-time-series-analysis
#12
Nienke Lesuis, Nathan den Broeder, Nadine Boers, Ester Piek, Steven Teerenstra, Marlies Hulscher, Ronald van Vollenhoven, Alfons A den Broeder
OBJECTIVES: To examine the effects of an educational meeting and subsequent computer reminders on the number of ordered laboratory tests. METHODS: Using interrupted time series analysis we assessed whether trends in the number of laboratory tests ordered by rheumatologists between September 2012 and September 2015 at the Sint Maartenskliniek (the Netherlands) changed following an educational meeting (September 2013) and the introduction of computer reminders into the Computerised Physician Order Entry System (July 2014)...
March 23, 2017: Clinical and Experimental Rheumatology
https://www.readbyqxmd.com/read/28338545/risperidone-and-cardiometabolic-risk-in-children-and-adolescents-clinical-and-instrumental-issues
#13
Emilia Matera, Lucia Margari, Vincenzo Ostilio Palmieri, Giuseppina Zagaria, Roberto Palumbi, Francesco Margari
PURPOSE/BACKGROUND: Although second-generation antipsychotics are used to treat and manage symptoms for several psychiatric disorders, data about their adverse effects in developmental age are limited. The aim of this prospective observational study was to verify the cardiovascular and metabolic risk in a sample of antipsychotic-naive children/adolescent patients starting risperidone therapy. METHODS: Twenty-two patients, younger than 18 years, were recruited. The assessment included anthropometric data, cardiovascular parameters, blood tests, and ultrasonographic abdominal study...
June 2017: Journal of Clinical Psychopharmacology
https://www.readbyqxmd.com/read/28322619/raising-the-bar-on-traumatic-brain-injury-biomarker-research-methods-make-a-difference
#14
Linda Papa, Kevin K W Wang
Research in blood-based traumatic brain injury (TBI) biomarkers has imploded over the last two decades and continues to grow at an unwavering pace. Commercialization of these biomarkers is ongoing, with a number of companies seeking FDA approval to market their test for clinical application. Although there are many papers being published, many lack the rigorous reporting required to adequately evaluate these markers for clinical use. Too often, there are inadequate sample sizes, inappropriate control groups and outcome measures, variable definitions of TBI, inconsistencies in when samples are drawn relative to time of injury, variability in how samples are processed and performance characteristics of the assays themselves are rarely known or poorly described...
March 21, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28321156/current-knowledge-on-the-laboratory-diagnosis-of-clostridium-difficile-infection
#15
REVIEW
Adrián Martínez-Meléndez, Adrián Camacho-Ortiz, Rayo Morfin-Otero, Héctor Jesús Maldonado-Garza, Licet Villarreal-Treviño, Elvira Garza-González
Clostridium difficile (C. difficile) is a spore-forming, toxin-producing, gram-positive anaerobic bacterium that is the principal etiologic agent of antibiotic-associated diarrhea. Infection with C. difficile (CDI) is characterized by diarrhea in clinical syndromes that vary from self-limited to mild or severe. Since its initial recognition as the causative agent of pseudomembranous colitis, C. difficile has spread around the world. CDI is one of the most common healthcare-associated infections and a significant cause of morbidity and mortality among older adult hospitalized patients...
March 7, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28306523/evaluation-of-thyroid-test-utilization-through-analysis-of-population-level-data
#16
Jasmine Gill, Vilte E Barakauskas, Dylan Thomas, Karina Rodriguez-Capote, Trefor Higgins, Don Zhang, Amanda VanSpronsen, Oksana Babenko, Roberta Martindale, Mathew P Estey
BACKGROUND: Inappropriate laboratory test utilization can result in unnecessary patient testing and increased healthcare costs. While several thyroid function tests are available, thyroid-stimulating hormone (TSH) is recommended as the first-line test for investigating and monitoring thyroid dysfunction. We evaluate thyroid test utilization in Northern Alberta in terms of testing patterns, frequencies, and reflex cutpoints. METHODS: This retrospective study analyzed thyroid test requests from January to December 2014...
March 15, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28295871/promoting-resource-stewardship-reducing-inappropriate-free-thyroid-hormone-testing
#17
Julie A Gilmour, Alanna Weisman, Steven Orlov, Robert J Goldberg, Alyse Goldberg, Hayley Baranek, Geetha Mukerji
RATIONALE: Free thyroxine (fT4) and free triiodothyronine (fT3) tests are often ordered when not clinically warranted. Preventing laboratory overuse by reducing inappropriate fT4 and fT3 testing is one strategy to promote resource stewardship. OBJECTIVES: (1) To characterize the frequency of inappropriate fT4 and fT3 testing and (2) to implement a quality improvement strategy aimed at reducing the number of these tests performed. METHODS: Quality improvement tools were used to create sequential change ideas: (1) education of physicians regarding appropriate indications for ordering fT4/fT3 and (2) implementation of a hospital-wide laboratory and forced-function system with a reflex fT4...
March 14, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28290971/delayed-diagnosis-of-tsh-secreting-adenoma-attributed-to-worsening-post-traumatic-stress-disorder-symptoms-in-a-military-veteran-because-of-provider-anchoring-bias
#18
Shyam K Daya, Andrew O Paulus, Ernest E Braxton, Penny J Vroman, Derek A Mathis, Ryan Lin, Mark W True
INTRODUCTION: Anchoring bias occurs when clinicians hold on to previously known information about a patient, with failure to consider the full realm of possibilities to explain new findings. We present a case of delayed diagnosis of thyroid-stimulating-hormone-secreting pituitary adenoma (TSHoma), a rare disorder, in a military veteran whose symptoms were misconstrued as being caused from worsening of his prior diagnosis of post-traumatic stress disorder (PTSD). Anchoring bias in this case led to 2-year delay in the correct diagnosis...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28288853/establishing-evidence-based-thresholds-and-laboratory-practices-to-reduce-inappropriate-treatment-of-pseudohyperkalemia
#19
Pratistha Ranjitkar, Dina N Greene, Geoffrey S Baird, Andrew N Hoofnagle, Patrick C Mathias
BACKGROUND: Unrecognized pseudohyperkalemia (PHK), defined as an artificial increase in measured potassium concentration, due to thrombocytosis and leukocytosis can lead to inappropriate patient treatment. Understanding the laboratory and patient characteristics that increase risk of PHK is key to preventing diagnostic errors. METHODS: Serum/plasma potassium results collected at 2 laboratories over 4years were selected based on blood cell counts collected within 24h and whole blood potassium concentrations determined within 2h of the serum/plasma sample...
March 10, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/28284827/the-role-of-laboratory-in-ensuring-appropriate-test-requests
#20
REVIEW
Simona Ferraro, Mauro Panteghini
This review highlights the role of laboratory professionals and the strategies to be promoted in strict cooperation with clinicians for auditing, monitoring and improving the appropriateness of test request. The introduction of local pathways and care maps in agreement with international and national guidelines as well as the implementation of reflex testing and algorithms have a central role in guiding test request and in correcting the overuse/misuse of tests. Furthermore, removing obsolete tests from laboratory menu and vetting of restricted tests is recommended to increase cost-effectiveness...
March 9, 2017: Clinical Biochemistry
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