scholarly journals LO26: The mean abnormal response rates of laboratory tests ordered in the emergency department: shooting percentage insights from a multicentre study

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S16-S16
Author(s):  
E. Enwere ◽  
D. Wang ◽  
M. Guo ◽  
C. Naugler ◽  
E. Lang
Keyword(s):  
Administrative Data ◽  
Laboratory Tests ◽  
Population Data ◽  
Primary Objective ◽  
High Yield ◽  
Test Results ◽  
Abnormal Result ◽  
Component Test ◽  
Abnormal Response ◽  
The Mean

Introduction: There is ongoing concern about the burden placed on healthcare systems by lab tests. Although these concerns are widespread, it is difficult to quantify the extent of the problem. One approach involves use of a metric known as the Mean Abnormal Response Rate (MARR), which is the proportion of tests ordered that return an abnormal result; a higher MARR value indicates higher yield. The primary objective of this study was to calculate MARRs for tests ordered between April 2014 and March 2019 at the four adult emergency departments (EDs) covering a metropolitan population of 1.3 million. Secondary objectives included identifying tests with highest and lowest MARRs; comparison of MARRs for nurse- and physician-initiated orders; correlation of the number of tests per order requisition to MARR; and correlation of physician experience to MARR. Methods: In total, 40 laboratory tests met inclusion criteria for this study. Administrative data on these tests as ordered at the four EDs were obtained and analyzed. Multi-component test results, such as from CBC, were consolidated such that an abnormal result for any component was coded as an abnormal result for the entire test. Repeat tests ordered within a single patient visit were excluded. Physician experience was quantified for 209 ED physicians as number of years since licensure. Analyses were descriptive where appropriate for whole-population data. Risk of bias was attenuated by the focus on administrative data. Results: The population dataset comprised 33,757,004 test results on 415,665 unique patients. Of these results, 30.3% were the outcomes of nurse-initiated orders. The 5-year MARRs for the four hospitals were 38.3%, 40.0%, 40.7% and 40.9%. The highest per-test MARRs were for BNP (80.5%) and CBC (62.6%), while the lowest were for glucose (7.9%) and sodium (11.6%). MARRs were higher for nurse-initiated orders than for physician-initiated orders (44.7% vs. 38.1%), likely due to the greater order frequency of high-yield CBC in nurse-initiated orders (38.6% vs. 18.1%). The number of tests per order requisition was inversely associated with MARR (r = -0.90, p < 0.001). Finally, the number of years since licensure was modestly but significantly associated with MARR (r = 0.28, p < 0.001). Conclusion: This is the first and largest study to apply the MARR in an ED setting. As a metric, MARR effectively identifies differences in test ordering practices on per-test and per-hospital bases, which could be useful for data-informed practice optimization.

The Usefulness of Laboratory Tests in Health-Screening Programs

1973 ◽  
Vol 19 (4) ◽  
pp. 366-372 ◽  
Author(s):  
David L Sackett
Keyword(s):  
Laboratory Test ◽  
Laboratory Tests ◽  
Health Screening ◽  
Test Results ◽  
Screening Programs ◽  
Laboratory Screening ◽  
Rare Exception ◽  
Laboratory Test Results ◽  
The Mean ◽  
Regression Toward The Mean

Abstract I discuss pitfalls in laboratory-screening programs: regression toward the mean on repeated biochemical determinations; the problem of defining normalcy in the interpretation of laboratory test results; and a remarkable professional myopia in which clinical chemists have, with rare exception, failed to accept responsibility for evaluating whether the programs in which they are engaged are of benefit to patients.

scholarly journals Novel method to determine diagnosis-defining refraction points

2019 ◽  
Author(s):  
Tsuneto Yamauchi ◽  
Mitsuhiro Ohshima ◽  
Yoko Yamaguchi ◽  
Kazunori Konishi ◽  
Kai Kappert ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Diabetic Patients ◽  
Reference Ranges ◽  
Test Results ◽  
Mathematical Methods ◽  
Distribution Of Values ◽  
Clinical Diagnoses ◽  
Novel Method ◽  
The Mean ◽  
Data Sorting

AbstractDiagnosis of a certain disease generally relies on definitions established by professional medical societies and comprise the patient’s history, physical examination, and test results. These include physical compositions such as body mass index (BMI), and laboratory tests such as serum creatinine and albumin in urine samples. In general, laboratory tests are based on mathematical methods,e.g.defining critical values from the mean ± kσ of a population, where k is a natural number and the standard deviation is σ (“mean ± kσ-method”). In most cases k is defined as 2, leading to reference ranges defining 95% of test results as normal. However, this method mostly depends on a normal distribution of values.Here we applied a novel method (“SoFR-method”) based on data sorting to define refraction points, which carry informative value as diagnostic criteria. Applying the SoFR-method, standard measures such as critical BMI-values are categorized by equal robustness as by the mean ± kσ-method. However, the SoFR-method showed higher validity when analyzing non-normalized values such as creatinine and albumin, as well as hepatocyte growth factor (HGF) and hemoglobin in a novel Perioscreen assay in saliva of diabetic and non-diabetic patients.Taken together, we defined a novel method based on data sorting of test results from patients to effectively define refraction points which might guide more accurately clinical diagnoses and define relevant thresholds.

Platelet Suruival and Function in Rats with Enhanced Thrombotic Tendency

1985 ◽  
Vol 54 (04) ◽  
pp. 739-743 ◽  
Author(s):  
Federica Delaini ◽  
Elisabetta Dejana ◽  
Ine Reyers ◽  
Elisa Vicenzi ◽  
Germana De Bellis Vitti ◽  
...  
Keyword(s):  
Arachidonic Acid ◽  
Nephrotic Syndrome ◽  
Platelet Function ◽  
Laboratory Tests ◽  
Thrombus Formation ◽  
The Other ◽  
Mean Survival Time ◽  
The Mean ◽  
And Function ◽  
Thrombotic Tendency

SummaryWe have investigated the relevance of some laboratory tests of platelet function in predicting conditions of thrombotic tendency. For this purpose, we studied platelet survival, platelet aggregation in response to different stimuli, TxB2 and 6-keto-PGFlα production in serum of rats bearing a nephrotic syndrome induced by adriamycin. These animals show a heavy predisposition to the development of both arterial and venous thrombosis. The mean survival time was normal in nephrotic rats in comparison to controls. As to aggregation tests, a lower aggregating response was found in ADR-treated rats using ADP or collagen as stimulating agents. With arachidonic acid (AA) we observed similar aggregating responses at lower A A concentrations, whereas at higher AA concentrations a significantly lower response was found in nephrotic rats, despite their higher TxB2 production. Also TxB2 and 6-keto-PGFlα levels in serum of nephrotic rats were significantly higher than in controls. No consistent differences were found in PGI2-activity generated by vessels of control or nephrotic rats.These data show that platelet function may appear normal or even impaired in rats with a markedly increased thrombotic tendency. On the other hand, the significance of high TxB2 levels in connection with mechanisms leading to thrombus formation remains a controversial issue.

Faktor yang Berhubungan dengan Penggunaan Partograf dalam Persalinan oleh Bidan Praktik Mandiri

2020 ◽  
Vol 2 (2) ◽  
pp. 72-80
Author(s):  
Niluh Nita Silfia
Keyword(s):  
Total Population ◽  
Sampling Technique ◽  
Population Data ◽  
Statistical Test ◽  
Influential Factor ◽  
Test Results ◽  
Cross Sectional ◽  
Factors Associated ◽  
Survey Results ◽  
Research Criteria

Partographs are guidelines for childbirth observations that will facilitate labor assistants in first identifying emergency cases and complications for mothers and fetuses. Preliminary survey at the Sigi Community Health Sub-Center (Pustu) of the 8 Pustu midwives found two midwives (25%) to complete a complete partograph, six midwives (75%) incomplete. The purpose of this study was to determine the determinant factors associated with the use of partographs in labor. The design of this study used observational analytic methods with a cross-sectional approach. 24 BPM survey results were obtained with 30 samples of midwives who met the research criteria and data completeness. The sampling technique was by the total population. Data analysis used logistic regression. The multivariate analysis results showed that APN training was the most influential factor in the use of partographs in labor by midwives. Statistical test results obtained a POR value of 37.7 (95% CI 12.1 - 60.2). This study suggests that midwives must have APN certificates to be valid in providing services.

Epidemiology of pheochromocytoma and paraganglioma: population-based cohort study

2021 ◽  
Vol 184 (1) ◽  
pp. 19-28
Author(s):  
Alexander A Leung ◽  
Janice L Pasieka ◽  
Martin D Hyrcza ◽  
Danièle Pacaud ◽  
Yuan Dong ◽  
...  
Keyword(s):  
Cohort Study ◽  
Administrative Data ◽  
Laboratory Data ◽  
Population Based ◽  
Incidence Rates ◽  
Primary Objective ◽  
Administrative Databases ◽  
Secondary Objective ◽  
True Frequency ◽  
Clinical Records

Objective Despite the significant morbidity and mortality associated with pheochromocytoma and paraganglioma, little is known about their epidemiology. The primary objective was to determine the incidence of pheochromocytoma and paraganglioma in an ethnically diverse population. A secondary objective was to develop and validate algorithms for case detection using laboratory and administrative data. Design Population-based cohort study in Alberta, Canada from 2012 to 2019. Methods Patients with pheochromocytoma or paraganglioma were identified using linked administrative databases and clinical records. Annual incidence rates per 100 000 people were calculated and stratified according to age and sex. Algorithms to identify pheochromocytoma and paraganglioma, based on laboratory and administrative data, were evaluated. Results A total of 239 patients with pheochromocytoma or paraganglioma (collectively with 251 tumors) were identified from a population of 5 196 368 people over a period of 7 years. The overall incidence of pheochromocytoma or paraganglioma was 0.66 cases per 100 000 people per year. The frequency of pheochromocytoma and paraganglioma increased with age and was highest in individuals aged 60–79 years (8.85 and 14.68 cases per 100 000 people per year for males and females, respectively). An algorithm based on laboratory data (metanephrine >two-fold or normetanephrine >three-fold higher than the upper limit of normal) closely approximated the true frequency of pheochromocytoma and paraganglioma with an estimated incidence of 0.54 cases per 100 000 people per year. Conslusion The incidence of pheochromocytoma and paraganglioma in an unselected population of western Canada was unexpectedly higher than rates reported from other areas of the world.

scholarly journals Ex vivo evaluation of a multilayered sealant patch for watertight dural closure: cranial and spinal models

2021 ◽  
Vol 32 (8) ◽  
Author(s):  
A. Kinaci ◽  
S. van Thoor ◽  
S. Redegeld ◽  
M. Tooren ◽  
T. P. C. van Doormaal
Keyword(s):  
Ex Vivo ◽  
Resistance Test ◽  
Burst Pressure ◽  
Cerebrospinal Fluid Leakage ◽  
Computer Assisted ◽  
Dural Defect ◽  
Test Results ◽  
Physiological Conditions ◽  
Dural Attachment ◽  
The Mean

AbstractCerebrospinal fluid leakage is a frequent complication after cranial and spinal surgery. To prevent this complication and seal the dura watertight, we developed Liqoseal, a dural sealant patch comprising a watertight polyesterurethane layer and an adhesive layer consisting of poly(DL-lactide-co-ε-caprolactone) copolymer and multiarmed N-hydroxylsuccinimide functionalized polyethylene glycol. We compared acute burst pressure and resistance to physiological conditions for 72 h of Liqoseal, Adherus, Duraseal, Tachosil, and Tisseel using computer-assisted models and fresh porcine dura. The mean acute burst pressure of Liqoseal in the cranial model (145 ± 39 mmHg) was higher than that of Adherus (87 ± 47 mmHg), Duraseal (51 ± 42 mmHg) and Tachosil (71 ± 16 mmHg). Under physiological conditions, cranial model resistance test results showed that 2 of 3 Liqoseal sealants maintained dural attachment during 72 hours as opposed to 3 of 3 for Adherus and Duraseal and 0 of 3 for Tachosil. The mean burst pressure of Liqoseal in the spinal model (233 ± 81 mmHg) was higher than that of Tachosil (123 ± 63 mmHg) and Tisseel (23 ± 16 mmHg). Under physiological conditions, spinal model resistance test results showed that 2 of 3 Liqoseal sealants maintained dural attachment for 72 hours as opposed to 3 of 3 for Adherus and 0 of 3 for Duraseal and Tachosil. This novel study showed that Liqoseal is capable of achieving a strong watertight seal over a dural defect in ex vivo models.

scholarly journals Growth and population biology of the sand-bubbler crab Scopimera crabricauda Alcock 1900 (Brachyura: Dotillidae) from the Persian Gulf, Iran

2021 ◽  
Vol 82 (1) ◽  
Author(s):  
Sana Sharifian ◽  
Vahid Malekzadeh ◽  
Ehsan Kamrani ◽  
Mohsen Safaie
Keyword(s):  
Persian Gulf ◽  
Population Biology ◽  
Slow Growth ◽  
Carapace Width ◽  
Population Data ◽  
Natural Mortality ◽  
Frequency Distributions ◽  
Iranian Coast ◽  
The Mean ◽  
The Persian Gulf

Abstract Background Dotillid crabs are introduced as one common dwellers of sandy shores. We studied the ecology and growth of the sand bubbler crab Scopimera crabricauda Alcock, 1900, in the Persian Gulf, Iran. Crabs were sampled monthly by excavating nine quadrats at three intertidal levels during spring low tides from January 2016 to January 2017. Results Population data show unimodal size-frequency distributions in both sexes. The Von Bertalanffy function was calculated at CWt = 8.76 [1 − exp (− 0.56 (t + 0.39))], CWt = 7.90 [1 − exp (− 0.59 (t + 0.40))] and CWt = 9.35 [1 − exp (− 0.57 (t + 0.41))] for males, females, and both sexes, respectively. The life span appeared to be 5.35, 5.07, and 5.26 years for males, females, and both sexes, respectively. The cohorts were identified as two age continuous groups, with the mean model carapace width 5.39 and 7.11 mm for both sexes. The natural mortality (M) coefficients stood at 1.72 for males, 1.83 for females, and 1.76 years−1 for both sexes, respectively. The overall sex ratio (1:0.4) was significantly different from the expected 1:1 proportion with male-biased. Recruitment occurred with the highest number of annual pulse once a year during the summer. Conclusions The results, which show slow growth, emphasize the necessity of proper management for the survival of the stock of S. crabricauda on the Iranian coast of the Persian Gulf.

scholarly journals How Does Administrative Data Compare with Census Data for the Measurement of Internal Migration? The Case of Northern Ireland, 2001–2011

2021 ◽  
Author(s):  
Brian Foley ◽  
Tony Champion ◽  
Ian Shuttleworth
Keyword(s):  
Administrative Data ◽  
Internal Migration ◽  
Census Data ◽  
Local Population ◽  
Population Data ◽  
Population Estimates ◽  
Demographic Groups ◽  
Small Areas ◽  
Intercensal Period ◽  
Statistical Agencies

AbstractThe paper compares and contrasts internal migration measured by healthcard-based administrative data with census figures. This is useful because the collection of population data, its processing, and its dissemination by statistical agencies is becoming more reliant on administrative data. Statistical agencies already use healthcard data to make migration estimates and are increasingly confident about local population estimates from administrative sources. This analysis goes further than this work as it assesses how far healthcard data can produce reliable data products of the kind to which academics are accustomed. It does this by examining migration events versus transitions over a full intercensal period; population flows into and out of small areas; and the extent to which it produces microdata on migration equivalent to that in the census. It is shown that for most demographic groups and places healthcard data is an adequate substitute for census-based migration counts, the exceptions being for student households and younger people. However, census-like information is still needed to provide covariates for analysis and this will still be required whatever the future of the traditional census.

Immunoadsorption for Recurrent Primary Focal Segmental Glomerulosclerosis on Kidney Allografts: A Single-Center Experience and Literature Review

2020 ◽  
Vol 49 (3) ◽  
pp. 322-333 ◽  
Author(s):  
Hamza Naciri Bennani ◽  
Juste Yérémandé Bonzi ◽  
Johan Noble ◽  
Florian Terrec ◽  
Lionel Motte ◽  
...  
Keyword(s):  
Primary Objective ◽  
Allograft Survival ◽  
Frequent Adverse Event ◽  
Single Center Experience ◽  
Cytomegalovirus Reactivation ◽  
Segmental Glomerulosclerosis ◽  
The Mean ◽  
Allograft Loss

Introduction: Primary focal and segmental glomerulosclerosis (FSGS) frequently reoccurs on kidney transplants and may lead to premature allograft loss. There are no guidelines for treating FSGS recurrence on allografts; treatment is based on apheresis (plasma exchange plasmapheresis [PP], semi-specific immunoadsorption [IA] with reusable columns) plus rituximab. Objective: We aimed to assess the efficacy of IA to treat recurrent FSGS. Methods: We report on 7 patients with recurrent FSGS on kidney allograft (proteinuria ≥3 g/g of urinary creatinine or ≥3 g/day); they all received IA. Our primary objective was to reduce proteinuria by >50%. Patients’ mean age was 45 ± 10 years. Postoperative immunosuppression relied on steroids, mycophenolate mofetil, tacrolimus, with an induction therapy of basiliximab or antithymocyte globulins. Prophylaxis to prevent FSGS recurrence was either rituximab alone (n = 3), rituximab plus either PP or IA (n = 3), or no treatment (n = 1). Mean follow-up was 20 ± 13 months. There was a median of 72 (14–101) IA sessions per patient, that is, a mean of 14 ± 1 sessions per IA column. Results: At 12 months after starting IA, all patients had partial (n = 6) or complete (n = 1) remission, and allograft survival was 100%. The mean reduction in proteinuria within an IA session was 45 ± 15%. At last follow-up, 2 patients are in remission without IA, 3 patients are in partial remission that is IA dependent, and 2 patients lost their allograft due to FSGS recurrence. The most frequent adverse event was cytomegalovirus reactivation (n = 13), which subsided after valganciclovir therapy. Conclusions: We show that recurrence of FSGS can be controlled long term with IA plus rituximab. However, some patients remained dependent on IA.

Sign in / Sign up

Export Citation Format

Share Document