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Inappropriate lab testing

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https://www.readbyqxmd.com/read/29769025/use-of-diagnostic-tests-and-the-appropriateness-of-the-treatment-decision-in-patients-with-suspected-urinary-tract-infection-in-primary-care-in-denmark-observational-study
#1
Gloria Córdoba, Anne Holm, Tina Møller Sørensen, Volkert Siersma, Håkon Sandholdt, Marjukka Makela, Niels Frimodt-Møller, Lars Bjerrum
BACKGROUND: Inappropriate prescription of antibiotics is the leading driver of antimicrobial resistance (AMR). The majority of antibiotics are prescribed in primary care. Understanding how general practitioners (GPs) use diagnostic tests and the effect on treatment decision under daily practice conditions is important to reduce inappropriate prescription of antibiotics. The aim of the study was to investigate the use of diagnostic tests in primary care patients with suspected urinary tract infection (UTI) and to assess the appropriateness of the treatment decision (TD) under daily practice conditions in Denmark...
May 16, 2018: BMC Family Practice
https://www.readbyqxmd.com/read/29764746/appropriateness-and-clinical-outcome-of-chest-computed-tomography-without-intravenous-contrast-a-study-conducted-in-pakistan
#2
Amjad Sattar, Sohail Ahmed Khan, Nauman Al-Qamari, Hatem Adel, Syed Omair Adil, Kashif Shafique
BACKGROUND: Chest computed tomography (CT), including high-resolution CT (HRCT), has become an integral part of modern healthcare. It enables the physician to arrive at a diagnosis using a noninvasive approach. Our practice has shown that various chest CT scans without intravenous (IV) contrast, including HRCT, have no proper clinical indication. For the same reason, we have assessed the appropriateness of chest CT without IV contrast based on the evidence-based American College of Radiology (ACR) appropriateness criteria...
March 28, 2018: Respiratory Investigation
https://www.readbyqxmd.com/read/29756541/does-reverse-triiodothyronine-testing-have-clinical-utility-an-analysis-of-practice-variation-based-on-data-from-a-national-reference-laboratory
#3
Robert L Schmidt, Jonathan LoPresti, Michael T McDermott, Suzanna M Zick, Joely A Straseski
BACKGROUND: Clinical laboratories are under pressure to increase value by improving test utilization. The clinical utility of reverse triiodothyronine (rT3) is controversial. We conducted a study to identify order patterns that might suggest inappropriate utilization of reverse triiodothyronine. METHODS: We reviewed all orders for thyroid tests placed over a period of one year at a national reference laboratory. We analyzed order patterns by client (hospital) and by provider...
May 14, 2018: Thyroid: Official Journal of the American Thyroid Association
https://www.readbyqxmd.com/read/29731285/prehospital-acute-st-elevation-myocardial-infarction-identification-in-san-diego-a-retrospective-analysis-of-the-effect-of-a-new-software-algorithm
#4
Christanne Coffey, John Serra, Mat Goebel, Sarah Espinoza, Edward Castillo, James Dunford
BACKGROUND: A significant increase in false positive ST-elevation myocardial infarction (STEMI) electrocardiogram interpretations was noted after replacement of all of the City of San Diego's 110 monitor-defibrillator units with a new brand. These concerns were brought to the manufacturer and a revised interpretive algorithm was implemented. OBJECTIVES: This study evaluated the effects of a revised interpretation algorithm to identify STEMI when used by San Diego paramedics...
May 3, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29730617/what-is-the-epidemiology-of-medication-errors-error-related-adverse-events-and-risk-factors-for-errors-in-adults-managed-in-community-care-contexts-a-systematic-review-of-the-international-literature
#5
Ghadah Asaad Assiri, Nada Atef Shebl, Mansour Adam Mahmoud, Nouf Aloudah, Elizabeth Grant, Hisham Aljadhey, Aziz Sheikh
OBJECTIVE: To investigate the epidemiology of medication errors and error-related adverse events in adults in primary care, ambulatory care and patients' homes. DESIGN: Systematic review. DATA SOURCE: Six international databases were searched for publications between 1 January 2006 and 31 December 2015. DATA EXTRACTION AND ANALYSIS: Two researchers independently extracted data from eligible studies and assessed the quality of these using established instruments...
May 5, 2018: BMJ Open
https://www.readbyqxmd.com/read/29724239/defining-and-measuring-population-health-quality-of-outpatient-diabetes-care-in-israel-lessons-from-the-quality-indicators-in-community-health-program
#6
REVIEW
Leonard M Pogach, David C Aron
In Israel, as in other Organization for Economic Co-operation and Development countries, performance measurement is a key public health strategy in monitoring and improving population health outcomes. The Israeli Quality Indicators in Community Healthcare (QICH) program has utilized electronic health records to monitor ambulatory care for the entire Israeli population since 2002. In 2006 the measures were updated to include laboratory values. They have been subsequently revised by stratifying by age, duration, adding medications, and changing frequency of testing for certain process measures...
May 3, 2018: Israel Journal of Health Policy Research
https://www.readbyqxmd.com/read/29716490/strategies-to-reduce-inappropriate-laboratory-blood-test-orders-in-intensive-care-are-effective-and-safe-a-before-and-after-quality-improvement-study
#7
J A Dhanani, A G Barnett, J Lipman, M C Reade
Unnecessary pathology tests performed in intensive care units (ICU) might lead to increased costs of care and potential patient harm due to unnecessary phlebotomy. We hypothesised that a multimodal intervention program could result in a safe and effective reduction in the pathology tests ordered in our ICU. We conducted a single-centre pre- and post-study using multimodal interventions to address commonly ordered routine tests. The study was performed during the same six month period (August to February) over three years: 2012 to 2013 (pre-intervention), 2013 to 2014 (intervention) and 2014 to 2015 (post-intervention)...
May 2018: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29692996/predicting-pulmonary-tuberculosis-in-immigrants-a-retrospective-cohort-study
#8
Courtney Heffernan, Alexander Doroshenko, Mary Lou Egedahl, James Barrie, Ambikaipakan Senthilselvan, Richard Long
Our objective was to investigate whether pulmonary tuberculosis (PTB) can be predicted from features of a targeted medical history and basic laboratory investigations in immigrants. A retrospective cohort of 391 foreign-born adults referred to the Edmonton Tuberculosis Clinic (Edmonton, AB, Canada) was studied using multiple logistic regression analysis to predict PTB. Seven characteristics of disease were used as explanatory variables. Cross-validation assessed performance. Each predictor was tested on two outcomes: "culture-positive" and "smear-positive"...
April 2018: ERJ Open Research
https://www.readbyqxmd.com/read/29675893/characteristics-of-opioid-maintained-clients-smoking-fentanyl-patches-the-importance-of-confirmatory-drug-analysis-illustrated-by-a-case-series-and-mini-review
#9
Andreas Kimergård, Jacklyn Dunne, Anette Bøgen, Peter Hindersson, Torben Breindahl
The increase in opioid prescribing in many European countries over the last decade has raised concerns about associated diversion, overdose, and mortality. Fentanyl is one of these synthetic opioids that is typically prescribed as a transdermal patch for pain that requires continuous pain relief and has been the focus of investigation due to reports of overdose and death. We report a case series of 14 drug addiction treatment entrants, who entered treatment in a service located in the region of Southern Denmark from August 2015 to December 2015 for smoking fentanyl patches...
April 19, 2018: Drug Testing and Analysis
https://www.readbyqxmd.com/read/29674129/polymyxin-b-etest%C3%A2-compared-to-gold-standard-broth-microdilution-in-carbapenem-resistant-enterobacteriaceae-exhibiting-a-wide-range-of-polymyxin-b-mics
#10
Brandon Kulengowski, Julie A Ribes, David S Burgess
OBJECTIVES: Polymyxins have been revitalized to combat carbapenem-resistant Enterobacteriaceae (CRE). However, evaluating the activity of these agents by traditional broth dilution methods is not practical for busy clinical laboratories. We compared polymyxin B (PMB) activity utilizing two quantitative susceptibility testing methods, Etest® and broth microdilution (BMD), against CRE isolates from patients at an academic medical center. METHODS: PMB activity against 70 CRE clinical isolates was determined by EtestP® P according to manufacturer and by BMD according to CLSI guidelines...
April 16, 2018: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/29659534/clinical-management-of-low-vitamin-d-a-scoping-review-of-physicians-practices
#11
REVIEW
Michelle Rockwell, Vivica Kraak, Matthew Hulver, John Epling
The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies do not recommend population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. To assess patterns of physicians’ management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and the gray literature...
April 16, 2018: Nutrients
https://www.readbyqxmd.com/read/29652881/the-simultaneous-assessment-of-glycosylated-hemoglobin-fasting-plasma-glucose-and-oral-glucose-tolerance-test-does-not-improve-the-detection-of-type-2-diabetes-mellitus-in-colombian-adults
#12
Jose Lopez-Lopez, Jennifer Garay, Edwin Wandurraga, Paul A Camacho, Fernando Higuera-Escalante, Daniel Cohen, Patricio Lopez-Jaramillo
INTRODUCTION: Guidelines recommend early detection of type 2 diabetes mellitus (DM2). The objective of the present study was to evaluate the capacity to identify DM2 in subjects that were screened for DM2 simultaneously with all three of the tests recommended-fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and a 2-hour post 75-g oral glucose tolerance test (OGTT). METHODS AND RESULTS: The present analysis of an anonymous database of 1113 adults from a reference clinical laboratory in Bucaramanga, Colombia, was an observational, descriptive, cross-sectional secondary source study...
2018: PloS One
https://www.readbyqxmd.com/read/29606123/the-impact-of-temperature-on-insecticide-toxicity-against-the-malaria-vectors-anopheles-arabiensis-and-anopheles-funestus
#13
Katey D Glunt, Shüné V Oliver, Richard H Hunt, Krijn P Paaijmans
BACKGROUND: It is anticipated that malaria elimination efforts in Africa will be hampered by increasing resistance to the limited arsenal of insecticides approved for use in public health. However, insecticide susceptibility status of vector populations evaluated under standard insectary test conditions can give a false picture of the threat, as the thermal environment in which the insect and insecticide interact plays a significant role in insecticide toxicity. METHODS: The effect of temperature on the expression of the standard WHO insecticide resistance phenotype was examined using Anopheles arabiensis and Anopheles funestus strains: a susceptible strain and the derived resistant strain, selected in the laboratory for resistance to DDT or pyrethroids...
April 2, 2018: Malaria Journal
https://www.readbyqxmd.com/read/29590138/effect-of-multiple-drug-resistance-on-total-medical-costs-among-patients-with-intra-abdominal-infections-in-china
#14
Xuemei Zhen, Yuanyuan Li, Yixi Chen, Peng Dong, Stephanie Liu, Hengjin Dong
BACKGROUND: Multiple drug resistant (MDR) intra-abdominal infections (IAIs) are associated with notable direct and societal costs. As previous studies have not considered the impact of MDR on the total medical costs (TMCs) of IAIs, the present one examines this, as well as further estimates the additional costs at a national level. METHODS: This is a retrospective study. Firstly, we randomly selected a sample of 40% of all inpatients discharged between 2014 and 2015 from a teaching hospital, due to limits in budget and the large number of patients...
2018: PloS One
https://www.readbyqxmd.com/read/29551406/heart-failure-micronutrient-profile-and-its-connection-with-thyroid-dysfunction-and-nutritional-status
#15
Livia Fernandes de Lima, Fernando Barbosa, Marcus Vinícius Simões, Anderson Marliere Navarro
INTRODUCTION: Heart failure (HF) is a growing public health issue; its risk factors include inappropriate dietary intake of microelements such as iodine, selenium, zinc and iron, which may lead to thyroid dysfunction. OBJECTIVE: This study aimed to assess the correlation among the functional class stages of patients with HF, iodine, selenium, iron and zinc levels with the presence of thyroid dysfunction. METHODOLOGY: One hundred nine patients from the HF outpatient clinic of the Clinics Hospital of Ribeirão Preto whose blood and urine were collected for micronutrient analysis and laboratory tests were selected...
March 3, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/29534694/predicting-the-severity-of-dengue-fever-in-children-on-admission-based-on-clinical-features-and-laboratory-indicators-application-of-classification-tree-analysis
#16
Khansoudaphone Phakhounthong, Pimwadee Chaovalit, Podjanee Jittamala, Stuart D Blacksell, Michael J Carter, Paul Turner, Kheng Chheng, Soeung Sona, Varun Kumar, Nicholas P J Day, Lisa J White, Wirichada Pan-Ngum
BACKGROUND: Dengue fever is a re-emerging viral disease commonly occurring in tropical and subtropical areas. The clinical features and abnormal laboratory test results of dengue infection are similar to those of other febrile illnesses; hence, its accurate and timely diagnosis for providing appropriate treatment is difficult. Delayed diagnosis may be associated with inappropriate treatment and higher risk of death. Early and correct diagnosis can help improve case management and optimise the use of resources such as hospital staff, beds, and intensive care equipment...
March 13, 2018: BMC Pediatrics
https://www.readbyqxmd.com/read/29508369/development-and-application-of-the-gheop-3-s-tool-addendum-on-potentially-inappropriate-prescribing-pip-of-renally-excreted-active-drugs-reads-in-older-adults-with-polypharmacy
#17
Abdul Aziz Al Wazzan, Eline Tommelein, Katrien Foubert, Stefano Bonassi, Graziano Onder, Annemie Somers, Mirko Petrovic, Koen Boussery
BACKGROUND: Renal function progressively worsens with age. Potentially inappropriate prescribing (PIP) of renally excreted active drugs (READs) is common in older adults, leading to an increased rate of iatrogenic illness. The Ghent Older People's Prescription community Pharmacy Screening (GheOP3 S-) tool is an effective, explicit instrument that was developed for community pharmacists (CPs) to detect PIP. So far, this tool does not assess PIP of the frequently used READs in older patients with renal impairment...
April 2018: Drugs & Aging
https://www.readbyqxmd.com/read/29478142/a-practical-approach-for-the-optimization-of-channel-integrity-in-the-sealing-of-shallow-microfluidic-devices-made-from-cyclic-olefin-polymer
#18
Philipp Ganser, Christoph Baum, David Chargin, Alexis F Sauer-Budge, Andre Sharon
A reduced channel height in microfluidic Lab-on-a-Chip (LOC) devices enables a reduction in the required volume of sample and reagents. LOC devices are most often manufactured by microstructuring a planar substrate and subsequently sealing it with a cover film. However, shallow chip designs, made from polymers, are sensitive to channel deformation during the sealing of the microfluidic device. Inappropriate bonding conditions often result in the loss of the microfluidic functionality. A systematic and practical approach for the identification of suitable bonding process parameters is missing...
February 24, 2018: Biomedical Microdevices
https://www.readbyqxmd.com/read/29472808/pseudohyperkalemia-potassium-released-from-cells-due-to-clotting-and-centrifugation-a-case-report
#19
REVIEW
Tomáš Šálek
Hyperkalemia is a potentially lethal condition. Pseudohyperkalemia should be always excluded before implementing treatment to prevent inappropriate cause of hypokalemia - equally a potentially lethal condition. Here we present a case report of a 62 year female with chronic myeloproliferative disorder, i.e. essential thrombocythemia. The laboratory test results for potassium concentration were 6.3 mmol/L, for platelet count 1305 x109 /L and for leukocyte count 39.8 x109 /L. This was due to a temporary drug withdrawal after a surgical intervention for gastric bleeding...
February 15, 2018: Biochemia Medica: časopis Hrvatskoga Društva Medicinskih Biokemičara
https://www.readbyqxmd.com/read/29469943/effects-of-diagnostic-work-up-on-medical-decision-making-for-canine-urinary-tract-infection-an-observational-study-in-danish-small-animal-practices
#20
T M Sørensen, C R Bjørnvad, G Cordoba, P Damborg, L Guardabassi, V Siersma, L Bjerrum, L R Jessen
BACKGROUND: Clinical signs of urinary tract disease in dogs often lead to prescription of antibiotics. Appropriate diagnostic work-up could optimize treatment and reduce the risk of inappropriate use of antibiotics. HYPOTHESIS/OBJECTIVES: To describe and evaluate the impact of diagnostic work-up on decision to treat (DTT) and choice of antibiotic treatment (COT) for dogs presenting with clinical signs of urinary tract disease. ANIMALS: One hundred and fifty-one dogs presenting to 52 Danish veterinary practices...
March 2018: Journal of Veterinary Internal Medicine
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