scholarly journals MP14: Community paramedic point of care blood analysis: validity and usability testing of two commercially available devices

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S45-S45
Author(s):  
I. E. Blanchard ◽  
R. Kozicky ◽  
D. Dalgarno ◽  
S. Goulder ◽  
T. Williamson ◽  
...  
Keyword(s):  
Patient Care ◽  
Point Of Care ◽  
A Priori ◽  
Critical Value ◽  
Laboratory Analysis ◽  
Blood Analysis ◽  
Blood Draw ◽  
Calls For Service ◽  
Significant Difference ◽  
The Difference

Introduction: Community Paramedics (CPs) require access to timely blood analysis in the field to guide treatment and transport decisions. Point of care testing (POCT), as opposed to traditional laboratory analysis, may offer a solution, but limited research exists on CP POCT. The objective of this study is to compare the validity of two POCT devices (Abbott i-STAT® and Alere epoc®) and their use by CPs in the community. Methods: In a CP programme responding to 6,000 annual patient care events, a split sample validation of POCT against traditional laboratory analysis for seven analytes (sodium, potassium, chloride, creatinine, hemoglobin, hematocrit, and glucose) was conducted on a consecutive sample of patients. The difference of proportion of discrepant results between POCT and laboratory was compared using a two sample proportion test. Usability was analysed by survey of CP experience, an expert heuristic evaluation of devices, a review of device-logged errors, coded observations of POCT use during quality control testing, and a linear mixed effects model of Systems Usability Scale (SUS) adjusted for CP clinical and POCT experience. Results: Of 1,649 CP calls for service screened for enrollment, 174 had a blood draw, with 108 patient care encounters (62.1%) enrolled from 73 participants. Participants had a mean age of 58.7 years (SD16.3); 49% were female. In 4 of 646 (0.6%) individual comparisons, POCT reported a critical value that the laboratory did not; with no statistically significant difference in the number of discrepant critical values reported with epoc® compared to i-STAT®. There were no instances of the laboratory reporting a critical value when POCT did not. In 88 of 1,046 (8.4%) individual comparisons, the a priori defined acceptable difference between POCT and the laboratory was exceeded; occurring more often in epoc® (10.7%;95%CI:8.1%,13.3%) compared to i-STAT® (6.1%;95%CI:4.1%,8.2%)(p=0.007). Eighteen of 19 CP surveys were returned, with 11/18 (61.1%) preferring i-STAT® over epoc®. The i-STAT® had a higher mean SUS score (higher usability) compared to the epoc® (84.0/100 vs. 59.6/100; p=0.011). Fewer field blood analysis device-logged errors occurred in i-STAT® (7.8%;95%CI:2.9%,12.7%) compared to epoc® (15.5%;95%CI:9.3%,21.7%) although not statistically significant (p=0.063). Conclusion: CP programs can expect valid results from POCT. Usability assessment suggests a preference for i-STAT.

scholarly journals Effect of dengue hemorrhagic fever on thrombomodulin level

2009 ◽  
Vol 49 (5) ◽  
pp. 259
Author(s):  
Hendra Widjaja ◽  
Max F. J. Mantik
Keyword(s):  
Endothelial Cells ◽  
Dengue Hemorrhagic Fever ◽  
Pediatric Patients ◽  
Hemorrhagic Fever ◽  
Cross Sectional Study ◽  
Blood Analysis ◽  
Cross Sectional ◽  
Significant Difference ◽  
The Difference ◽  
Difference Test

Background Thrombocyte and endothelial cells play animportant role in dengue hemorrhagic fever pathogenesis.Thrombomodulin is a part of glycoprotein membrane inendothelial cells. Therefore, thrombomodulin level willincrease if endothelial cells disruption occurs.Objective To acknowledge the correlation between thedegree of dengue hemorrhagic fever and thrombomodulinlevel.Methods This was a cross-sectional study. Subjects werehospitalized pediatric patients with age ranging from oneto 13 year old in pediatric ward at Pro£ Dr. R.D. KandouHospital, Manado, who had fever. Three milliliters of bloodwere taken from vein, and were divided for two tests whichwere routine blood analysis and thrombomodulin analysis.Different data resulted from the dengue hemorrhagic fevergroup were processed, and analyzed statistically using F Testand LSD (least significant difference) test. The relationbetween dengue hemorrhagic fever and thrombomodulinwas analyzed with Spearman correlation coefficient.Results There was a significant result in the difference ofthrombomodulin level on four dengue hemorrhagic fevergroups which were classified according to the severity ofdengue hemorrhagic fever. There was a very significantpositive correlation between the severity of denguehemorrhagic fever and thrombomodulin level in detectingendothelial cells impairment.Conclusion Thrombomodulin level can be used as amarker to detect endothelial cells impairment in denguehemorrhagic fever. Higher grade of dengue hemorrhagicfever will have higher thrombomodulin level.

Differences in Glucose Values Obtained From Point-of-Care Glucose Meters and Laboratory Analysis in Critically Ill Patients

2009 ◽  
Vol 18 (1) ◽  
pp. 65-72 ◽  
Author(s):  
Anjannette Cook ◽  
Delyla Laughlin ◽  
Margery Moore ◽  
Doreen North ◽  
Kathleen Wilkins ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Method Comparison ◽  
Venous Catheter ◽  
Laboratory Analysis ◽  
Hematocrit Level ◽  
Convenience Sample ◽  
Indwelling Catheters ◽  
The Difference

Background Blood for glucose analysis is often obtained interchangeably from indwelling catheters and fingersticks. Objectives To determine the level of agreement between glucose values obtained by laboratory analysis and with a point-of-care device for blood from 2 different sources: fingerstick and a central venous catheter. Methods A method-comparison design was used. Point-of-care values for blood from fingersticks and catheters were compared with laboratory values for blood from catheters in a convenience sample of 67 critically ill patients. The effects of hematocrit level and finger edema on differences in glucose values between the 2 methods were also evaluated. A t test was used to determine differences in glucose values obtained via the 2 methods. Differences and limits of agreement were also calculated. Results Laboratory glucose values for blood from a catheter differed significantly from point-of-care values for blood from the catheter (t1,66 = −9.18; P < .001) and from a fingerstick (t1,66 = 6.53; P < .001). Glucose values for the 2 methods differed by 20 mg/dL or more for 1 of 6 patients (15%) for catheter samples and for 1 of 5 (21%) for fingerstick samples. Point-of-care glucose values for fingerstick and catheter samples did not differ (P = .98). Hematocrit level significantly explained the difference in glucose values between the 2 methods for both catheter (R2 = 0.288; P < .001) and fingerstick (R2 = 0.280; P = .02) samples. Conclusions Use of a commonly used point-of-care device when precise glucose values are needed may lead to faulty treatment decisions.

scholarly journals Relationship between 2-Hour Tacrolimus Concentrations and Clinical Outcomes in Long Term Kidney Transplantation

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 60 ◽  
Author(s):  
Jeffrey Yin ◽  
Tammy Hsu ◽  
Janice S Kerr ◽  
Robert Steiner ◽  
Linda Awdishu
Keyword(s):  
Kidney Transplant ◽  
Opportunistic Infections ◽  
A Priori ◽  
Area Under The Curve ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Entire Cohort ◽  
Significant Difference ◽  
The Difference

Background: Tacrolimus is routinely monitored using trough concentrations, however, recent data have suggested that area under the curve (AUC) provides better correlation with toxicity and efficacy. Area under the curve is cumbersome to measure, but studies have demonstrated that surrogate time points such as 2-hour concentrations are well correlated with AUC. Methods: This is a single center, retrospective study of adult kidney transplant recipients with 2-hour tacrolimus concentrations measured over three years post-transplant. The primary outcome was to determine the difference in serum creatinine (Scr) in those with 2-hour tacrolimus concentrations greater than 20 ng/mL versus those less than or equal to 20 ng/mL. Results: A total of 150 kidney transplant recipients were included. The mean Scr and glomerular filtration rate were 1.49 ± 1.01 mg/dL and 59 ± 23.2 mL/min/1.73 m2, respectively, for the entire cohort. The rate of donor specific antibody formation was 2% and 8% experienced biopsy-proven rejection. The rate of cytomegalovirus viremia was 2% and BK viremia was 13%. There was no significant difference in kidney function over 36 months for the groups specified a priori. Conclusions: Long-term outcomes of maintaining tacrolimus 2-hour concentrations over 20 ng/mL is favorable with minimal opportunistic infections.

A Forum for Researchers: A Note on the Power of Statistical Tests

1977 ◽  
Vol 8 (5) ◽  
pp. 385-389
Author(s):  
Robert C. Clark
Keyword(s):  
Null Hypothesis ◽  
Type I Error ◽  
A Priori ◽  
Type I ◽  
Type Ii ◽  
Type Ii Error ◽  
Error Type ◽  
Significant Difference ◽  
The Difference ◽  
A Priori Probability

In the classical decision-making model, the experimenter seeks to demonstrate a difference between the distributions of two or more samples (or a sample and a population) for some parameter. A null hypothesis is stated that there is no “significant” difference between the distributions, and probabilistic models are used to determine the probability that any difference is due to chance. Philosophically, the researcher decides in advance that he is only willing to accept a probability less than a given size for making the error of assuming that the difference is real when it is actually due to chance. The a priori probability of such an error (Type I) is designated α. But the possibility of another error exists: the error of failing to reject a null hypothesis when the difference is real. (The a priori probability of such an error is designated β.) Whereas the probability of a Type I error has been controlled by the choice of a significance criterion, the Type II error (failing to reject a false null hypothesis) has seldom been controlled. However, the use of the technique of power analysis now makes it possible to control the probability of a Type II error with little more difficulty than the technique used to control the probability of a Type I error.

scholarly journals THE EFFECTIVENESS OF USING VOCABULARY TREES AS A TECHNIQUE IN TEACHING VOCABULARY AT ELEMENTARY SCHOOL

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Binta Nugroho Septiyantono
Keyword(s):  
Conventional Method ◽  
Critical Value ◽  
Difficulty Level ◽  
Control Group ◽  
Test Items ◽  
Discriminating Power ◽  
Significant Difference ◽  
Post Test ◽  
The Difference ◽  
Experimental Group

The topic of the research is the effectiveness of vocabulary trees as a teaching aid to develop the students’ vocabulary mastery. The Objective to investigate whether there is any significant difference in the vocabulary mastery between teaching vocabulary trees and using conventional method. In order to achieve the objective of this research, the writer designed an experimental research. The subject used in the research was 60 students of the fifth grade of SD Negeri Bendungan Semarang; 30 students acted as the experimental group to be taught vocabulary using vocabulary trees and the other 30 students as the control group to be taught vocabulary using conventional method. Before the experiment was conducted, a pre-test was given to both groups. A post test was given after the experiment was done. The test consisted of 25 items of multiple choice types. The test items were first tried out to check the validity, reliability, difficulty level and discriminating power. The result shows that there are significant differences in mean score between control group and experimental group. Mean score of the pre test of the experimental group is 50.53 while that of the control group is 48.33. Thus, the difference between the two means is 2.46. In the post test, the mean score of the experimental group is 81.07 and of the control group is 69.73. Thus, the difference between the two means is 11.34. The result of the t-test based on the pre-test is 0.86, while the result on the post test is 4.52 and the critical value 2.000. Based on the result above, it can be concluded that teaching vocabulary using vocabulary trees resulted in a better learning achievement. The t-value of the post test is higher than the critical value, which means that the students got better understanding when they used vocabulary trees as a technique to improve students’ vocabulary mastery than when they used conventional method. In conclusion, vocabulary is effective and applicable enough as a learning aid to be used in developing students’ vocabulary.

Faster HbA1c Turnaround Times Using a Dedicated Analyzer Based on Turbidimetric Inhibition Immunoassay Technology

2020 ◽  
Author(s):  
Chin Shern Lau ◽  
Melva Lim ◽  
See Ping Hoo ◽  
Cherlyn Gan ◽  
Tar Choon Aw
Keyword(s):  
Complete Blood Count ◽  
Point Of Care ◽  
Altman Analysis ◽  
Bland Altman Analysis ◽  
Deming Regression ◽  
Significant Difference ◽  
The Difference ◽  
Interassay Precision ◽  
Hba1c Levels ◽  
Comparable Time

Abstract Introduction The Roche Cobas c513 (c513) is a dedicated stand-alone high throughput HbA1c analyzer. We evaluated the performance and the difference in turnaround times (TAT) of the c513 against our Cobas 8000 c502 (c502). Methods We assessed the linearity and precision of the c513, and its agreement (Deming regression and Bland–Altman analysis) with the c502 assay. We compared TAT for these analyzers for a single run of 50 samples and for all samples run over 2 comparable time periods. Results The c513 assay was linear from 4.4–18.3% HbA1c. Interassay precision (CV%) was 1.2 and 0.8 at HbA1c levels of 5.7 and 10.5%, respectively. The c513 assay showed excellent concordance with the c502 assay (r = 0.997) with no significant difference between methods by Bland–Altman analysis (mean difference = 0.021% HbA1c, P = 0.1422). The c513 took 17 min to analyze 50 samples, compared to 40 min on the c502. Over comparable 2-month periods, 90% of samples requiring HbA1c tests only were completed under 25 min (c513) vs 30–35 min (c502). For tubes sharing complete blood count (CBC) testing with HbA1c, the 90th percentile TAT was 35–40 min (c513) compared to 45–50 min (c502). Conclusion The c513 assay performs well with excellent correlation to the c502 assay. The improved TAT of the c513 is suitable when there are demands for rapid HbA1c results and it may forestall requests for point-of-care testing. It is also attractive to sites with heavy workloads with a claimed throughput of 400 tests / h.

Cranial crassicaudiasis in two coastal dolphin species from South Africa is predominantly a disease of immature individuals

2020 ◽  
Vol 139 ◽  
pp. 93-102 ◽  
Author(s):  
MF Van Bressem ◽  
P Duignan ◽  
JA Raga ◽  
K Van Waerebeek ◽  
N Fraijia-Fernández ◽  
...  
Keyword(s):  
South Africa ◽  
Bone Development ◽  
Bottlenose Dolphins ◽  
Fatal Outcome ◽  
Population Level ◽  
Cape Coast ◽  
Osteolytic Lesions ◽  
Immune Mediated ◽  
Significant Difference ◽  
The Difference

Crassicauda spp. (Nematoda) infest the cranial sinuses of several odontocetes, causing diagnostic trabecular osteolytic lesions. We examined skulls of 77 Indian Ocean humpback dolphins Sousa plumbea and 69 Indo-Pacific bottlenose dolphins Tursiops aduncus, caught in bather-protecting nets off KwaZulu-Natal (KZN) from 1970-2017, and skulls of 6 S. plumbea stranded along the southern Cape coast in South Africa from 1963-2002. Prevalence of cranial crassicaudiasis was evaluated according to sex and cranial maturity. Overall, prevalence in S. plumbea and T. aduncus taken off KZN was 13 and 31.9%, respectively. Parasitosis variably affected 1 or more cranial bones (frontal, pterygoid, maxillary and sphenoid). No significant difference was found by gender for either species, allowing sexes to be pooled. However, there was a significant difference in lesion prevalence by age, with immature T. aduncus 4.6 times more likely affected than adults, while for S. plumbea, the difference was 6.5-fold. As severe osteolytic lesions are unlikely to heal without trace, we propose that infection is more likely to have a fatal outcome for immature dolphins, possibly because of incomplete bone development, lower immune competence in clearing parasites or an over-exuberant inflammatory response in concert with parasitic enzymatic erosion. Cranial osteolysis was not observed in mature males (18 S. plumbea, 21 T. aduncus), suggesting potential cohort-linked immune-mediated resistance to infestation. Crassicauda spp. may play a role in the natural mortality of S. plumbea and T. aduncus, but the pathogenesis and population level impact remain unknown.

Blood Draw Barriers for Treatment with Clozapine and Development of a Point-of-Care Monitoring Device

2018 ◽  
Vol 12 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Deanna L. Kelly ◽  
Hadar Ben-Yoav ◽  
Gregory F. Payne ◽  
Thomas E. Winkler ◽  
Sheryl E. Chocron ◽  
...  
Keyword(s):  
Point Of Care ◽  
Monitoring Device ◽  
Blood Draw

Perbedaan Penggunaan Antikoagulan K2EDTA DAN K3EDTA Terhadap Hasil Pemeriksaan Indeks Eritrosit

2018 ◽  
Vol 1 (2) ◽  
pp. 114
Author(s):  
Wahdaniah Wahdaniah ◽  
Sri Tumpuk
Keyword(s):  
Screening Test ◽  
Venous Blood ◽  
The Body ◽  
Ethylene Diamine ◽  
P Value ◽  
Cross Sectional ◽  
Significant Difference ◽  
Ethylene Diamine Tetra Acetate ◽  
The Difference ◽  
Index Value

Abstract: Routine blood examination is the earliest blood test or screening test to determine the diagnosis of an abnormality. Blood easily froze if it is outside the body and can be prevented by the addition of anticoagulants, one of which Ethylene Diamine Tetra Acetate (EDTA). Currently available vacuum tubes containing EDTA anticoagulants in the form of K2EDTA and K3EDTA. K3EDTA is usually a salt that has better stability than other EDTA salts because it shows a pH approaching a blood pH of about 6.4. The purpose of this research is to know the difference of erythrocyte index results include MCH, MCV and MCHC using K3EDTA anticoagulant with K2EDTA. This research is a cross sectional design. This study used venous blood samples mixed with K2EDTA anticoagulant and venous blood mixed with K3EDTA anticoagulants, each of 30 samples. Data were collected and analyzed using paired different test. Based on data analysis that has been done on MCH examination, p value <0,05 then there is a significant difference between samples with K3EDTA anticoagulant with K2EDTA to erythrocyte index value. Then on the examination of MCV and MCHC obtained p value <0.05 then there is no significant difference between samples with K3EDTA anticoagulant with K2EDTA to erythrocyte index value.Abstrak: Pemeriksaan darah rutin merupakan pemeriksaan darah yang paling awal atau screening test untuk mengetahui diagnosis suatu kelainan. Darah mudah membeku jika berada diluar tubuh dan bisa dicegah dengan penambahan antikoagulan, salah satunya Ethylene Diamine Tetra Acetate (EDTA). Dewasa ini telah tersedia tabung vakum yang sudah berisi antikoagulan EDTA dalam bentuk  K2EDTA dan  K3EDTA. K3EDTA  biasanya berupa garam yang mempunyai stabilitas yang lebih baik dari garam EDTA yang lain karena menunjukkan pH yang mendekati pH darah yaitu sekitar 6,4. Tujuan dari penelitian ini adalah untuk mengetahui perbedaan hasil indeks eritrosit meliputi MCH, MCV dan MCHC menggunakan antikoagulan K3EDTA dengan K2EDTA. Penelitian ini merupakan penelitian dengan desain cross sectional. Penelitian ini menggunakan sampel darah vena yang dicampur dengan antikoagulan K2EDTA dan darah vena yang dicampur dengan antikoagulan K3EDTA, masing-masing sebanyak 30 sampel. Data dikumpulkan dan dianalisis menggunakan uji beda berpasangan. Berdasarkan analisis data yang telah dilakukan pada pemeriksaan MCH didapatkan nilai p < 0,05 maka ada perbedaan yang signifikan antara sampel dengan antikoagulan K3EDTA dengan K2EDTA terhadap nilai indeks eritrosit. Kemudian pada pemeriksaan MCV dan MCHC didapatkan nilai p < 0,05 maka tidak ada perbedaan yang signifikan antara sampel dengan antikoagulan K3EDTA dengan K2EDTA terhadap nilai indeks eritrosit.

Pengaruh Jumlah Pencucian Beras dengan Kadar Klorin

2017 ◽  
Vol 1 (1) ◽  
pp. 89
Author(s):  
Indah Purwaningsih ◽  
Supriyanto Supriyanto
Keyword(s):  
Mucous Membrane ◽  
Confidence Level ◽  
Iodometric Titration ◽  
Titration Method ◽  
Anova Test ◽  
Average Value ◽  
Significant Difference ◽  
The Difference

Abstract: Chlorine is a green halogen-shaped halogen gas at normal temperature and serves as bleach, stain remover and disinfectant. Chlorine is now widely used for bleaching rice so that less quality rice looks like quality rice. Chlorine is very toxic and causes mucous membrane irritation, highly reactive and very powerful oxidizer. The purpose of this research was to determine the difference of chlorine level in chlorinated rice washed once, twice and 3 times. The sample in this study amounted to 11 samples calculated by replication formula. Each sample was treated 3 times, ie 1 washed once, 2 washed twice and washed 3 times. The samples then examined by iodometric titration method. Based on the results of the study using ANOVA test, 11 samples obtained the average value of chlorine after washed once amount of 0.0176%, after washed twice amount of 0.0111%, and after washed 3 times amount of 0.0052% with the value significance p = 0.03 (p <0.05) at 95% confidence level which means there was a significant difference between chlorine levels in chlorinated rice washed once, twice and 3 times.Abstrak: Klorin merupakan unsur halogen berbentuk gas berwarna kuning kehijauan pada suhu normal danberfungsi sebagai pemutih, penghilang noda maupun desinfektan. Klorin sekarang banyak digunakan untuk bahan pemutih beras agar beras yang kurang berkualitas tampak seperti beras berkualitas. Klorin sangat toksik dan menyebabkan iritasi membran mukosa, sangat reaktif dan merupakan oksidator yang sangat kuat. Tujuan dari penelitian ini ialah untuk mengetahui perbedaan kadar klorin pada beras berklorin yang dicuci sebanyak 1 kali, 2 kali dan 3 kali. Sampel dalam penelitian ini berjumlah 11 sampel yang dihitung dengan rumus replikasi. Setiap sampel diberi perlakuan sebanyak 3 kali, yaitu 1 kali pencucian, 2 kali pencucian dan 3 kali pencucian. Sampel penelitian kemudian diperiksa dengan metode titrasi iodometri. Berdasarkan hasil penelitian menggunakan uji Anova secara komputerisasi terhadap 11 sampel diperoleh nilai rata-rata kadar klorin setelah 1 kali pencucian sebesar 0,0176 %, setelah 2 kali pencucian sebesar 0,0111 %, dan setelah 3 kali pencucian sebesar 0,0052 % dengan nilai signifkansi p = 0,03 (p<0,05) pada tingkat kepercayaan 95% yang artinya ada perbedaan yang bermakna antara kadar klorin pada beras berklorin yang dicuci sebanyak 1 kali, 2 kali dan 3 kali.

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