Algorithmic Approaches to Hemostasis Testing

2014 ◽  
Vol 40 (02) ◽  
pp. 195-204 ◽  
Author(s):  
Kandice Kottke-Marchant
Keyword(s):  
Clinical History ◽  
Storage Conditions ◽  
Patient Specific ◽  
Diagnostic Process ◽  
Medication Therapy ◽  
Fill Volume ◽  
Time To Diagnosis ◽  
Algorithmic Approaches ◽  
Temperature Storage ◽  
Thrombotic Disorder

There are many unique issues that may make a pathologist's consultation helpful in hemostasis testing. Besides the rapidly expanding knowledge of both bleeding and thrombotic disorders and a wide test menu, hemostasis testing is very sensitive to preanalytical issues (hemolysis, fill volume, time, temperature, storage conditions) and the interference of many commonly prescribed drugs. The pathologist can serve an important role in the evaluation of a patient for a bleeding or thrombotic disorder. Using defined algorithms, hemostasis testing can proceed in a logical fashion and be reported using patient-specific comments that take into account clinical history and medication therapy. This approach can improve the diagnostic process, preventing misdiagnoses and leading to a decreased time to diagnosis and an improved utilization of laboratory resources.

Physician Survey of a Laboratory Medicine Interpretive Service and Evaluation of the Influence of Interpretations on Laboratory Test Ordering

2004 ◽  
Vol 128 (12) ◽  
pp. 1424-1427 ◽  
Author(s):  
Martha E. Laposata ◽  
Michael Laposata ◽  
Elizabeth M. Van Cott ◽  
Dion S. Buchner ◽  
Mohammed S. Kashalo ◽  
...  
Keyword(s):  
Laboratory Testing ◽  
Medical Center ◽  
Academic Medical Center ◽  
Physician Satisfaction ◽  
Patient Specific ◽  
Diagnostic Process ◽  
Reference Laboratory ◽  
Academic Medical ◽  
Coagulation Testing ◽  
Test Ordering

Abstract Context.—Complex coagulation test panels ordered by clinicians are typically reported to clinicians without a patient-specific interpretive paragraph. Objectives.—To survey clinicians regarding pathologist-generated interpretations of complex laboratory testing panels and to assess the ability of the interpretations to educate test orderers. Design.—Surveys were conducted of physicians ordering complex coagulation laboratory testing that included narrative interpretation. Evaluation of order requisitions was performed to assess the interpretation's influence on ordering practices. Setting.—Physicians ordering coagulation testing at a large academic medical center hospital in Boston, Mass, and physicians from outside hospitals using the academic medical center as a reference laboratory for coagulation testing. Outcome Measures.—Physician surveys and evaluation of laboratory requisition slips. Results.—In nearly 80% of responses, the ordering clinicians perceived that the interpretive comments saved them time and improved the diagnostic process. Moreover, the interpretations were perceived by ordering clinicians to help prevent a misdiagnosis or otherwise impact the differential diagnosis in approximately 70% of responses. In addition, interpretations appeared to be able to train the ordering clinicians as to the standard ordering practices. Conclusions.—The results demonstrate physician satisfaction with an innovative information delivery approach that provides laboratory diagnostic interpretation and test-ordering education to clinicians in the context of their daily workflow.

Radiation protection perspective to recurrent medical imaging: what is known and what more is needed?

2021 ◽  
pp. 20210477
Author(s):  
Jenia Vassileva ◽  
Ola Holmberg
Keyword(s):  
Radiation Protection ◽  
Current Knowledge ◽  
Clinical History ◽  
Patient Specific ◽  
Individual Radiosensitivity ◽  
Dose Saving ◽  
End Stage ◽  
Future Work ◽  
Standardised Patient

This review summarises the current knowledge about recurrent radiological imaging and associated cumulative doses to patients. The recent conservative estimates are for around 0.9 million patients globally who cumulate radiation doses above 100 mSv, where evidence exists for cancer risk elevation. Around one in five is estimated to be under the age of 50. Recurrent imaging is used for managing various health conditions and chronic diseases such as malignancies, trauma, end-stage kidney disease, cardiovascular diseases, Crohn’s disease, urolithiasis, cystic pulmonary disease. More studies are needed from different parts of the world to understand the magnitude and appropriateness. The analysis identified areas of future work to improve radiation protection of individuals who are submitted to frequent imaging. These include access to dose saving imaging technologies; improved imaging strategies and appropriateness process; specific optimisation tailored to the clinical condition and patient habitus; wider utilisation of the automatic exposure monitoring systems with an integrated option for individual exposure tracking in standardised patient-specific risk metrics; improved training and communication. The integration of the clinical and exposure history data will support improved knowledge about radiation risks from low doses and individual radiosensitivity. The radiation protection framework will need to respond to the challenge of recurrent imaging and high individual doses. The radiation protection perspective complements the clinical perspective, and the risk to benefit analysis must account holistically for all incidental and long-term benefits and risks for patients, their clinical history and specific needs. This is a step toward the patient-centric health care.

scholarly journals Internet of Things Smart Sunscreen Station: Descriptive Proof-of-Concept Study

10.2196/17079 ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. e17079
Author(s):  
Helen Ford ◽  
Jeremy Herbert ◽  
Caitlin Horsham ◽  
Alexander Wall ◽  
Elke Hacker
Keyword(s):  
Skin Cancer ◽  
Internet Of Things ◽  
Field Testing ◽  
Storage Conditions ◽  
Mining Site ◽  
Increased Risk ◽  
Electrical Components ◽  
Internet Of Things Technology ◽  
Temperature Storage

Background Skin cancer is the most prevalent but also most preventable cancer in Australia. Outdoor workers are at increased risk of developing skin cancer, and improvements in sun protection are needed. Sunscreen, when applied at the recommended concentration (2 mg/cm2), has been shown to block the harmful molecular effects of ultraviolet radiation in vivo. However, sunscreen is often not applied, reapplied sufficiently, or stored adequately to yield protection and reduce sunburns. Objective The primary aim of this study was to test an Internet of Things approach by deploying a smart sunscreen station to an outdoor regional mining site. Methods We deployed a smart sunscreen station and examined the key technological considerations including connectivity, security, and data management systems. Results The smart sunscreen station was deployed for 12 days at a mining workplace (Dalby, Australia). The smart sunscreen station’s electrical components remained operational during field testing, and data were received by the message queuing telemetry transport server automatically at the end of each day of field testing (12/12 days, 100% connectivity). Conclusions This study highlights that an Internet of Things technology approach can successfully measure sunscreen usage and temperature storage conditions.

Dual Guidance Structure for Evaluation of Patients with Unclear Diagnosis in Centers for Rare Diseases (ZSE-DUO): Study Protocol for a Controlled Multi-center Cohort Study

2021 ◽  
Author(s):  
Helge Hebestreit ◽  
Cornalia Zeigler ◽  
Christopher Schippers ◽  
Martina de Zwaan ◽  
Jürgen Deckert ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Rare Disease ◽  
Rare Diseases ◽  
Health Care Professionals ◽  
Standard Care ◽  
Controlled Study ◽  
Diagnostic Process ◽  
Two Phase ◽  
Time To Diagnosis

Abstract Background In individuals suffering from a rare disease the diagnostic process and the confirmation of a final diagnosis often extends over many years. Factors contributing to delayed diagnosis include health care professionals' limited knowledge of rare diseases and frequent (co-)occurrence of mental disorders that may complicate and delay the diagnostic process. The ZSE-DUO study aims to assess the benefits of a combination of a physician focusing on somatic aspects with a mental health expert working side by side as a tandem in the diagnostic process.Study design This multi-center, prospective controlled study has a two-phase cohort design. Methods Two cohorts of 682 patients each are sequentially recruited from 11 university-based German Centers for Rare Diseases (CRD): the standard care cohort (control, somatic expertise only) and the innovative care cohort (experimental, combined somatic and mental health expertise). Individuals aged 12 years and older presenting with symptoms and signs which are not explained by current diagnoses will be included. Data will be collected prior to (T0) and at the first visit (T1) to the CRD’s outpatient clinic and 12 months thereafter (T2). Outcomes Primary outcome is the percentage of patients with one or more confirmed diagnoses covering the symptomatic spectrum presented. Sample size is calculated to detect a 10 percent increase from 30% in standard care to 40% in the innovative dual expert cohort. Secondary outcomes are a) time to diagnosis/diagnoses explaining the symptomatology; b) proportion of patients successfully referred from CRD to standard care; c) costs of diagnosis including incremental cost effectiveness ratios; d) predictive value of screening instruments administered at T0 to identify patients with mental disorders ; e) patients’ quality of life and evaluation of care; and f) physicians’ satisfaction with the innovative care approach. Conclusions This is the first multi-center study to investigate the effects of a mental health specialist working in tandem with a somatic expert physician in CRDs. If this innovative approach proves successful, it will be made available on a larger scale nationally and promoted internationally. In the best case, ZSE-DUO can significantly shorten the time to diagnosis for a suspected rare disease.

Low-temperature storage of the poultry red mite, Dermanyssus gallinae, facilitates laboratory colony maintenance and population growth

Parasitology ◽  
2020 ◽  
Vol 147 (7) ◽  
pp. 740-746
Author(s):  
Chuanwen Wang ◽  
Xiaolin Xu ◽  
He Yu ◽  
Yu Huang ◽  
Hao Li ◽  
...  
Keyword(s):  
Low Temperature ◽  
Survival Rates ◽  
Storage Conditions ◽  
Egg Laying ◽  
Dermanyssus Gallinae ◽  
Control Group ◽  
Poultry Red Mite ◽  
Low Temperature Storage ◽  
Laboratory Colony ◽  
Temperature Storage

AbstractThe poultry red mite, Dermanyssus gallinae, is currently the most common ectoparasite affecting egg-laying hens. Since continuous culture of D. gallinae on birds is a biologically and economically costly endeavour, storage techniques for mites are urgently needed. Effects of temperature on adult and nymph survival were first studied to optimize storage conditions. Then, fecundity of D. gallinae was studied after mites were stored at optimal storage conditions. Results showed the survival rates of protonymphs (42.11%), deutonymphs (8.19%) and females (19.78%) at 5°C after 84 days were higher than those at 0, 25 and 30°C. Thereafter the fecundity and the capability of re-establishing colonies of D. gallinae were evaluated after they were stored for 40 and 80 days at 5°C. After storage, the mean number of eggs showed no statistical difference between treated (5°C for 40 or 80 days) and control groups (25°C for 7 days), while the hatching rates of eggs were in all cases above 97%. The dynamic changes of mite populations and egg numbers showed similar trends to the control group after the stored adult or nymph mites were fed on chicks. Dermanyssus gallinae can be successfully stored at 5°C for 80 days with no interference with the fecundity of mites, and the stored mites could re-establish colonies successfully. Adults and nymphs were two main stages with capability for low temperature storage. These results suggest that low temperature storage is a viable option for colony maintenance of D. gallinae under laboratory conditions.

Survival of Hepatitis A Virus in Spinach during Low Temperature Storage

2009 ◽  
Vol 72 (11) ◽  
pp. 2390-2393 ◽  
Author(s):  
Y. CAROL SHIEH ◽  
DIANA S. STEWART ◽  
DAVID T. LAIRD
Keyword(s):  
Hepatitis A ◽  
Hepatitis A Virus ◽  
Plaque Assay ◽  
Storage Conditions ◽  
Inactivation Rate ◽  
Low Temperature Storage ◽  
Foodborne Outbreaks ◽  
Phosphate Buffered Saline ◽  
Temperature Storage ◽  
Spinach Leaves

Spinach leaves are frequently consumed raw and have been involved with past foodborne outbreaks. In this study, we examined the survival of hepatitis A virus (HAV) on fresh spinach leaves in moisture- and gas-permeable packages that were stored at 5.4 ± 1.2°C for up to 42 days. Different eluents including phosphate-buffered saline (PBS), pH 7.5 (with and without 2% serum), and 3% beef extract (pH 7.5 and 8) were compared for how efficiently they recovered viruses from spinach by using a simple elution procedure (<1 h). The recoveries were compared and determined by a plaque assay with FRhK-4 cells. Culture grade PBS containing 2% serum was found to be appropriate for HAV elution from spinach leaves, with an average recovery of 45% ± 10%. Over 4 weeks of storage at 5.4 ± 1.2°C, HAV in spinach decreased slightly more than 1 log, with 6.75% of the original titer remaining. HAV survived under refrigerated temperatures on spinach leaves with a D-value of 28.6 days (equivalent to an inactivation rate of 20.035 log of HAV per day, r2 = 0.88). In comparison, HAV in PBS containing 2% serum under the same storage conditions remained constant throughout 7 weeks. The inactivation rate of 20.035 log each day for HAV on spinach leaves was possibly due to the interaction of the virus and the leaf.

scholarly journals Does the Primary Care Experience Influence the Cancer Diagnostic Process?

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Sylvie Provost ◽  
Raynald Pineault ◽  
Pierre Tousignant ◽  
Danièle Roberge ◽  
Dominique Tremblay ◽  
...  
Keyword(s):  
Primary Care ◽  
Metastatic Cancer ◽  
Diagnostic Process ◽  
Process Time ◽  
Care Experience ◽  
Usual Source ◽  
Point Of Entry ◽  
Experience Of Care ◽  
Time To Diagnosis ◽  
The Impact

Objective. To analyze the impact of patients’ experience of care at their usual source of primary care on their choice of point of entry into cancer investigation process, time to diagnosis, and presence of metastatic cancer at time of diagnosis. Method. A questionnaire was administered to 438 patients with cancer (breast, lung, and colorectal) between 2011 and 2013 in four oncology clinics of Quebec (Canada). Multiple regression analyses (logistic and Cox models) were conducted. Results. Among patients with symptoms leading to investigation of cancer (n=307), 47% used their usual source of primary care as the point of entry for investigation. Greater comprehensiveness of care was associated with the decision to use this source as point of entry (OR = 1.25; CI 90% = 1.06–1.46), as well as with shorter times between first symptoms and investigation (HR = 1.11; p=0.05), while greater accessibility was associated with shorter times between investigation and diagnosis (HR = 1.13; p<0.01).  Conclusion. Experience of care at the usual source of primary care has a slight influence on the choice of point of entry for cancer investigation and on time to diagnosis. This influence appears to be more related to patients’ perceptions of the accessibility and comprehensiveness of their usual source of primary care.

Moisture diffusivity of table grape stems during low temperature storage conditions

2013 ◽  
Vol 115 (3) ◽  
pp. 346-353 ◽  
Author(s):  
Mduduzi E.K. Ngcobo ◽  
Pankaj B. Pathare ◽  
Mulugeta A. Delele ◽  
Lan Chen ◽  
Umezuruike Linus Opara
Keyword(s):  
Low Temperature ◽  
Moisture Diffusivity ◽  
Storage Conditions ◽  
Table Grape ◽  
Low Temperature Storage ◽  
Temperature Storage

scholarly journals Further studies on the sterilization of T.A.B.C. vaccine

1939 ◽  
Vol 39 (2) ◽  
pp. 131-142 ◽  
Author(s):  
S. G. Rainsford
Keyword(s):  
Silver Nitrate ◽  
Saline Solution ◽  
Physiological Saline ◽  
Storage Conditions ◽  
Destructive Effect ◽  
Low Temperature Storage ◽  
Physiological Saline Solution ◽  
The Stability ◽  
Vi Antigen ◽  
Temperature Storage

1. Silver nitrate or sodium merthiolate can be used for the sterilization of suspensions of B. typhosus and neither have any immediate destructive effect on the Vi, O or H antigens.2. Two methods of employing silver nitrate as a sterilizing agent are described.3. Physiological saline solution with silver nitrate added is bactericidal for B. typhosus and the staphylococcus but has no inhibitory action on the growth of moulds.4. Vaccines sterilized and preserved with silver nitrate after storage for 6 months at 7° C. were found to have retained their Vi antibody stimulating properties.5. A vaccine sterilized and preserved with “katadyn” after storage for 18 months at 7° C. still contained some Vi antigen and was superior as an immunogenic agent to a freshly prepared heat-killed-phenolized vaccine.6. It would appear that the stability of Vi antigen is increased by the addition of silver within certain limits, but this effect is only obtained if low temperature storage conditions are maintained.7. A vaccine sterilized and preserved with sodium merthiolate after 6 months' storage at 7°C. failed to stimulate any Vi antibody in the rabbit.

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