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28 papers 1000+ followers A bucket of best available evidence on testing.Questioning Medicine previous podcast #FOAMed #MedQuestioning
By Joe Weatherly FM/Hospitalist-CoFounder of QuestioningMedicine and PCRAP contributor.
Sol F Green
The increase in the prevalence of medical errors represents a disturbing trend; hospital-based errors are the eighth leading cause of death in the United States. For the clinical laboratory, errors that occur in the preanalytical phase of testing may account for up to 75% of total laboratory errors; 26% of these may have detrimental effects on patient care, which contribute to unnecessary investigations or inappropriate treatment, increase in lengths of hospital stay, as well as dissatisfaction with healthcare services...
September 2013: Clinical Biochemistry
Matt Brown
No abstract text is available yet for this article.
November 2013: Annals of Family Medicine
Matt Brown
No abstract text is available yet for this article.
May 2013: Annals of Family Medicine
H Zulewski, B Müller, P Exer, A R Miserez, J J Staub
The classical signs and symptoms of hypothyroidism were reevaluated in the light of the modern laboratory tests for thyroid function. We analyzed 332 female subjects: 50 overt hypothyroid patients, 93 with subclinical hypothyroidism (SCH), 67 hypothyroid patients treated with T4, and 189 euthyroid subjects. The clinical score was defined as the sum of the 2 best discriminating signs and symptoms. Beside TSH and thyroid hormones, we measured parameters known to reflect tissue manifestations of hypothyroidism, such as ankle reflex relaxation time and total cholesterol...
March 1997: Journal of Clinical Endocrinology and Metabolism
J M Wood, D L Gordon, A N Rudinger, M M Brooks
A clinically euthyroid patient was found to have a normal serum thyroxine level and an elevated plasma thyrotropin (TSH) level measured by fluoroimmunoassay. Thyroid hormone therapy failed to suppress the TSH level. The TSH level was unresponsive to thyrotropin-releasing hormone (TRH) administration, alpha-subunits of pituitary glycoproteins were undetectable in her plasma, and imaging of the pituitary-hypothalamic region was normal. Measurement of TSH with an assay containing sheep antibody to TSH failed to reveal TSH in the patient's plasma...
February 1991: American Journal of Medicine
J M Vanelle, M F Poirier, C Benkelfat, A Galinowski, D Sechter, H Suzini de Luca, H Lôo
The thyrotropin-releasing hormone (TRH) test was performed in 100 depressed patients, including 73 patients with a major depressive episode (MDE) according to DSM-III. Thirty-one patients subsequently received an antidepressant with a predominant serotoninergic action (indalpine or citalopram), and 27 patients received a noradrenergic antidepressant (maprotiline). The diagnostic value of the TRH test was not conclusive for any of the subgroups of depressed patients: MDE, MDE with melancholia or MDE in bipolar patients...
February 1990: Acta Psychiatrica Scandinavica
Issac Sachmechi, David M Reich, Michael Aninyei, Francisca Wibowo, Garima Gupta, Paul J Kim
OBJECTIVE: To examine retrospectively the effect of proton pump inhibitors (PPIs) on thyrotropin (thyroid-stimulating hormone or TSH) values in patients with hypothyroidism and normal TSH levels receiving levothyroxine (LT4) replacement therapy. METHODS: The data collection was done by retrospective review of electronic medical records from the period of December 2002 to August 2005 from patients with hypothyroidism who were receiving at least 25 mug of LT4 replacement daily at Queens Hospital Center...
July 2007: Endocrine Practice
Jennifer Pecina, Gregory M Garrison, Matthew E Bernard
OBJECTIVE: In patients treated for hypothyroidism, the usual practice is to monitor thyroid-stimulating hormone values yearly once a therapeutic dosage of levothyroxine is determined. This study investigates whether there are any clinical predictors that could identify a subset of patients who might be monitored safely on a less frequent basis. METHODS: With the use of a retrospective study design, 715 patients treated for hypothyroidism who had a normal (ie, therapeutic) thyroid-stimulating hormone value in 2006 while taking levothyroxine were identified...
March 2014: American Journal of Medicine
Veronique Gibbons, John V Conaglen, Ross Lawrenson
INTRODUCTION: Subclinical hypothyroidism (SCH) is common in older patients. AIM: To review the management of patients identified with a raised thyroid stimulating hormone (TSH) result in a 12-month period and compare this to current guidelines from the New Zealand Best Practice Advocacy Centre (BPAC). METHODS: We collected laboratory data on thyroid function tests (TFTs) that were reported between December 2005 and November 2006 from two general practices with an adult population of approximately 21 000...
March 2010: Journal of Primary Health Care
Liang Li-Bo, Lü Rui-Xue, Huang Heng-Jian, He He, An Zhen-Mei, Li Shuang-Qing
OBJECTIVE: To detect changes of thyroid stimulating hormone (TSH) with gender, age and levels of thyroid peroxidase antibodies (TPO-Ab) in patients with subclinical hypothyroidism, and to establish composite reference intervals for TSH and free thyroxine (FT4) in determination of subclinical hypothyroidism. METHODS: From Oct. 2011 to July 2012, 7 964 healthy people (males: 4 789, females: 3 175) undergoing medical examinations were recruited. Their serum levels of TSH and FT4 were determined...
March 2014: Sichuan da Xue Xue Bao. Yi Xue Ban, Journal of Sichuan University. Medical Science Edition
Brian M Gilfix
Folic acid is an essential nutrient involved in one-carbon metabolism. Insufficient folate can result in megaloblastic anemia and an increased risk of neural tube defects. In response to the latter, some governments have mandated the fortification of flour with folate. This had resulted in a documented rise in the serum and red blood cell folate levels in the population. This has impacted the potential utility of folate measurements to detect folate deficiency in the clinical context. Folate measurements, whether done in serum or red blood cells, are subject to analytical variation, especially the latter, which also affects the utility of such measurements...
May 2014: Clinical Biochemistry
Jennifer Vuong, Yuelin Qiu, Myanh La, Gwen Clarke, Dorine W Swinkels, George Cembrowski
Body mass index (BMI), the prevalent indicator of obesity, is not easily grasped by patients nor physicians. Waist circumference (WC) is correlated to obesity, is better understood and has a stronger relationship to the metabolic syndrome. We compiled WC, complete blood count (CBC) parameters as well as other pertinent data of 6766 25-55-year-old US volunteers sampled in the US National Health and Nutrition Examination Survey, in the years 2005-2010. To determine reference intervals of typical US patients visiting their clinician, we used minimal exclusion criteria...
July 2014: American Journal of Hematology
Jie Zhang, Lang Chen, Elizabeth Delzell, Paul Muntner, William B Hillegass, Monika M Safford, Iris Yolanda Navarro Millan, Cynthia S Crowson, Jeffrey R Curtis
OBJECTIVE: To examine the association of serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and serum lipid measures (low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol) with risk of myocardial infarction (MI) and ischaemic stroke (IS) among rheumatoid arthritis (RA) patients. METHODS: We conducted a retrospective cohort study using 2005-2010 data from a US commercial health plan. Eligible patients had two or more physician diagnoses of RA during a baseline period of at least 180 days with continuous medical and pharmacy coverage...
July 2014: Annals of the Rheumatic Diseases
Heidi L Frankel, Paul L Rogers, Rajesh R Gandhi, Eugene B Freid, Orlando C Kirton, Michael J Murray
INTRODUCTION: Addressing an unexpected shortfall of intensivists requires early identification and training of appropriate personnel. The purpose of this study was to determine how U.S. medical students are currently educated and tested on acute care health principles. HYPOTHESIS/METHODS: A survey of critical care education with telephone follow-up was mailed to the deans of all 126 medical schools. Web site review of medical school curricula for critical care education was performed...
September 2004: Critical Care Medicine
Daniel M Horn, Kate E Koplan, Margaret D Senese, E John Orav, Thomas D Sequist
BACKGROUND: Physicians are under increased pressure to help control rising health care costs, though they lack information regarding cost implications of patient care decisions. OBJECTIVE: To evaluate the impact of real-time display of laboratory costs on primary care physician ordering of common laboratory tests in the outpatient setting. DESIGN: Interrupted time series analysis with a parallel control group. PARTICIPANTS: Two hundred and fifteen primary care physicians (153 intervention and 62 control) using a common electronic health record between April 2010 and November 2011...
May 2014: Journal of General Internal Medicine
J Joelle Donofrio, Genevieve Santillanes, Bradley D McCammack, Chun Nok Lam, Michael D Menchine, Amy H Kaji, Ilene A Claudius
STUDY OBJECTIVE: We assess whether screening laboratory tests obtained to medically clear pediatric psychiatric patients altered management or disposition. METHODS: This was a retrospective chart review of consecutive patients younger than 18 years and presenting to an academic pediatric emergency department for medical clearance of an acute psychiatric emergency potentially requiring an involuntary hold (danger to self, danger to others, grave disability) from July 2009 to December 2010...
June 2014: Annals of Emergency Medicine
Kevin H Chu, Amol S Wagholikar, Jaimi H Greenslade, John A O'Dwyer, Anthony F Brown
OBJECTIVES: To determine whether a pathology request form allowing interns and residents to order only a limited range of laboratory blood tests prior to consultation with a registrar or consultant can reduce test ordering in an emergency department (ED). METHODS: A prospective before-and-after study in an adult tertiary-referral teaching hospital ED was conducted. A pathology request form with a limited list of permissible tests was implemented for use by junior medical officers...
October 2013: Postgraduate Medical Journal
Jonathan G Rogg, J Tyler Rubin, Paul Hansen, Shan W Liu
INTRODUCTION: Health care costs continue to rise; reducing unnecessary laboratory testing may reduce costs. The goal of this study was to calculate the frequency and estimated costs of repeat normal laboratory testing of patients transferred to a tertiary care emergency department (ED). METHODS: This was a retrospective cohort study of patients transferred to a tertiary care, level -one trauma ED with an annual census of 90,000 patients. We defined "repeat normal testing" as laboratory tests repeated within 8 hours that were normal at both the sending hospital and the receiving tertiary care hospital...
July 2013: American Journal of Emergency Medicine
C P M Hayward, K A Moffat
Laboratory testing is essential for diagnosing bleeding disorders. The tests and panels that laboratories currently use for bleeding disorder evaluation are not standardized, although most offer coagulation screening tests in bleeding disorder panels. Some tests for bleeding disorders, including von Willebrand factor multimer assays and tests for rarer disorders, are not widely available. Accordingly, clinicians and laboratories need tailored strategies for evaluating common and rare bleeding disorders. Coagulation screening tests have high specificity, however, false positives and false negatives do occur among subjects evaluated for bleeding disorders and more specific tests (e...
June 2013: International Journal of Laboratory Hematology
Jean-Jacques Blanc
The first step in the diagnostic evaluation of patients with suspected syncope begins with an "initial evaluation" consisting of careful history taking, physical examination including orthostatic blood pressure measurement and electrocardiogram. However, even in expert centers the diagnostic yield of this "initial evaluation" is only approximately 50%. In the remaining cases in which a satisfactory diagnosis is either unknown or uncertain after initial assessment, additional clinical testing is needed. This article reviews the role of some of the more commonly used additional diagnostic tests, including: tilt-table testing, the active standing test, carotid sinus massage, electrophysiological testing, and the adenosine triphosphate (ATP) test...
January 2013: Progress in Cardiovascular Diseases
2014-06-04 16:56:42
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