The computer as a diagnostic consultant, with emphasis on use of laboratory data.

Abstract In this preliminary study concerning the applicability of expert computer systems, such as INTERNIST-I, to providing advice to clinical pathologists regarding patients' diagnoses and the pertinence of performing further laboratory tests, 32 complex cases, drawn from Case Records of the Massachusetts General Hospital, were analyzed diagnostically by computer, on the basis of clinical laboratory data only. Half (16 cases) were diagnosed correctly, but in 15 of the rest no diagnostic conclusion could be reached. However, no diagnostic errors were made. The study provides preliminary evidence that expert computer systems can be useful to clinical pathologists and clinical internists in guiding the laboratory workup of patients toward correct diagnosis.

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Erythroderma: A clinico-etiological study of 58 cases in a tertiary hospital of North India

Asian Journal of Medical Sciences ◽

10.3126/ajms.v6i6.12265 ◽

2015 ◽

Vol 6 (6) ◽

pp. 20-24 ◽

Cited By ~ 2

Author(s):

Nadia Shirazi ◽

Rashmi Jindal ◽

Akanksha Jain ◽

Kanika Yadav ◽

Sohaib Ahmad

Keyword(s):

Mycosis Fungoides ◽

Clinical Laboratory ◽

Correct Diagnosis ◽

Laboratory Data ◽

North India ◽

Female Ratio ◽

Histopathological Findings ◽

Exfoliative Dermatitis ◽

Wide Range ◽

Erythrodermic Psoriasis

Background: Erythroderma (exfoliative dermatitis) is a cutaneous reaction pattern characterized by generalized erythema and scaling which can be seen in a wide range of cutaneous or systemic diseases. It is important to establish correct diagnosis whenever possible so that specific therapy may be initiated. The study was undertaken to evaluate the clinical profile and etiology of erythroderma and to correlate clinical diagnosis with histopathological findings. Methods: A retrospective study was done in the Department of Pathology. Fifty eight cases of erythroderma diagnosed clinically in the past 5 years were studied and their epidemiological, clinical, laboratory and histopathological findings were analyzed. Results: The mean age of presentation was 39.3 years and male to female ratio was 3:2. Apart from erythema and scaling that were present in all patients, pruritis (n=40,69%), edema (n=12,20.2%) and fever (n=11,19%) were the most common symptoms at presentation. The most common etiology of exfoliative dermatitis was drug reactions (n=19,32.7%) followed by atopic dermatitis (n=12,20.6%) and erythrodermic psoriasis (n=10,7.2%). Other causes were Mycosis Fungoides, Allergic/Air borne contact dermatitis, Lichen Planus, Pityriasis Rubra Pilaris. There was no significant contribution of laboratory data and all the patients were HIV negative. The best clinicopathological correlation (100%) was found in erythrodermic psoriasis and Mycosis Fungoides. Conclusion: Erythroderma often obscures the primary lesion. Clinicians should evaluate all cases of erythroderma by eliciting proper clinical history, taking biopsies and performing other ancillary haematological investigations. Hospitalization may be required as the disease carries risk of significant mortality.DOI: http://dx.doi.org/10.3126/ajms.v6i6.12265Asian Journal of Medical Sciences Vol.6(6) 2015 20-24

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A new predictive indicator for development of pressure ulcers in bedridden patients based on common laboratory tests results

Journal of Clinical Pathology ◽

10.1136/jcp.2007.050195 ◽

2008 ◽

Vol 61 (4) ◽

pp. 514-518 ◽

Cited By ~ 23

Author(s):

N Hatanaka ◽

Y Yamamoto ◽

K Ichihara ◽

S Mastuo ◽

Y Nakamura ◽

...

Keyword(s):

Laboratory Tests ◽

Pressure Ulcers ◽

Proportional Hazards Model ◽

Cox Regression ◽

Clinical Laboratory ◽

Laboratory Data ◽

Clinical Implementation ◽

Clinical Tool ◽

Braden Scale ◽

Hospitalised Patients

Background:Various scales have been devised to predict development of pressure ulcers on the basis of clinical and laboratory data, such as the Braden Scale (Braden score), which is used to monitor activity and skin conditions of bedridden patients. However, none of these scales facilitates clinically reliable prediction.Aims:To develop a clinical laboratory data-based predictive equation for the development of pressure ulcers.Methods:Subjects were 149 hospitalised patients with respiratory disorders who were monitored for the development of pressure ulcers over a 3-month period. The proportional hazards model (Cox regression) was used to analyse the results of 12 basic laboratory tests on the day of hospitalisation in comparison with Braden score.Results:Pressure ulcers developed in 38 patients within the study period. A Cox regression model consisting solely of Braden scale items showed that none of these items contributed to significantly predicting pressure ulcers. Rather, a combination of haemoglobin (Hb), C-reactive protein (CRP), albumin (Alb), age, and gender produced the best model for prediction. Using the set of explanatory variables, we created a new indicator based on a multiple logistic regression equation. The new indicator showed high sensitivity (0.73) and specificity (0.70), and its diagnostic power was higher than that of Alb, Hb, CRP, or the Braden score alone.Conclusions:The new indicator may become a more useful clinical tool for predicting presser ulcers than Braden score. The new indicator warrants verification studies to facilitate its clinical implementation in the future.

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Bringing the clinical laboratory into the strategy to advance diagnostic excellence

Diagnosis ◽

10.1515/dx-2020-0119 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Ira M. Lubin ◽

J. Rex Astles ◽

Shahram Shahangian ◽

Bereneice Madison ◽

Ritchard Parry ◽

...

Keyword(s):

Quality Management ◽

Health Care Providers ◽

Clinical Laboratory ◽

Laboratory Data ◽

Diagnostic Errors ◽

Care Quality ◽

Diagnostic Process ◽

Management Approach ◽

Care Providers ◽

Medical Diagnoses

Abstract Objectives Clinical laboratory testing provides essential data for making medical diagnoses. Generating accurate and timely test results clearly communicated to the treating clinician, and ultimately the patient, is a critical component that supports diagnostic excellence. On the other hand, failure to achieve this can lead to diagnostic errors that manifest in missed, delayed and wrong diagnoses. Content Innovations that support diagnostic excellence address: 1) test utilization, 2) leveraging clinical and laboratory data, 3) promoting the use of credible information resources, 4) enhancing communication among laboratory professionals, health care providers and the patient, and 5) advancing the use of diagnostic management teams. Integrating evidence-based laboratory and patient-care quality management approaches may provide a strategy to support diagnostic excellence. Professional societies, government agencies, and healthcare systems are actively engaged in efforts to advance diagnostic excellence. Leveraging clinical laboratory capabilities within a healthcare system can measurably improve the diagnostic process and reduce diagnostic errors. Summary An expanded quality management approach that builds on existing processes and measures can promote diagnostic excellence and provide a pathway to transition innovative concepts to practice. Outlook There are increasing opportunities for clinical laboratory professionals and organizations to be part of a strategy to improve diagnoses.

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Towards a new paradigm in laboratory medicine: the five rights

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2016-0848 ◽

2016 ◽

Vol 54 (12) ◽

Cited By ~ 19

Author(s):

Mario Plebani

Keyword(s):

Clinical Laboratory ◽

Laboratory Data ◽

Diagnostic Errors ◽

Laboratory Medicine ◽

Expert Advice ◽

Test Results ◽

Analytical Quality ◽

New Paradigm ◽

Analytical Phase

AbstractA body of evidence collected in the last few decades demonstrates that the pre- and post-analytical phases of the testing cycle are more error-prone than the analytical phase. However, the paradigm of errors and quality in laboratory medicine has been questioned, analytical mistakes continuing to be a major cause of adverse clinical outcomes and patient harm. Although the brain-to-brain concept is widely recognized in the community of laboratory professionals, there is lack of clarity concerning the inter-relationship between the different phases of the cycle, interdependence between the pre-analytical phase and analytical quality, and the effect of the post-analytical steps on the quality of ultimate laboratory information. Analytical quality remains the “core business” of clinical laboratories, but laboratory professionals and clinicians alike should never lose sight of the fact that pre-analytical variables are often responsible for erroneous test results and that quality biospecimens are pre-requisites for a reliable analytical phase. In addition, the pressure for expert advice on test selection and interpretation of results has increased hand in hand with the ever-increasing complexity of tests and diagnostic fields. Finally, the data on diagnostic errors and inappropriate clinical decisions made due to delay or misinterpretation of laboratory data underscore the current need for greater collaboration at the clinical-laboratory interface.

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Implementation of Laboratory Review of Test Builds Within the Electronic Health Record Reduces Errors

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2019-0239-oa ◽

2019 ◽

Vol 144 (6) ◽

pp. 742-747

Author(s):

Courtney Barry ◽

Tina Bocker Edmonston ◽

Snehal Gandhi ◽

Kennedy Ganti ◽

Nami Kim ◽

...

Keyword(s):

Clinical Laboratory ◽

Laboratory Data ◽

Diagnostic Errors ◽

Third Party ◽

Error Message ◽

Review Team ◽

Electronic Health ◽

The Impact ◽

Clinical Laboratory Improvement Amendments ◽

Regular Review

Context.— As electronic health records (EHRs) become more ubiquitous, physicians have come to expect that laboratory data from a variety of sources will be incorporated into the EHR in a structured format. The Clinical Laboratory Improvement Amendments have standards for data transmission traditionally met by pathologist review of their own hospital laboratory information system transmissions. However, with third-party laboratory data now being sent through external (nonhospital laboratory) interfaces, ownership of this review is less clear. Lack of an expert laboratory review process prior to changes being implemented can result in mapping and interfacing errors that could lead to misinterpretation and diagnostic errors. Objective.— To determine the impact of retrospective and prospective laboratorian-assisted review on the volume of interface errors and new builds. Design.— A seminal event led to a restructuring of the process for review of EHR laboratory builds, using laboratory expertise. Results.— A review of 26 500 test result fields found 61 of 4282 (1.4%) unique codes that could have led to misinterpretation. These were corrected and a process for proactive review and maintenance by laboratory experts was implemented. This resulted in monthly decreases in outbound error message from 4270 to 1820 (57.4%), in new test builds from 586 to 274 (53.2%), and in new result builds from 1116 to 552 (50.5%). Conclusions.— Regular review and maintenance of external laboratory test builds in EHRs by a laboratory review team reduces interface error messages and reduces the number of new builds required for results to file into the EHR.

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Encyclopedia of clinical laboratory tests. Ed. prof. N. W. Titsa. - M .: Labinform, 1997 (translation, edited by V.V. Menshikov)

Problems of Endocrinology ◽

10.14341/probl11709 ◽

2019 ◽

Vol 45 (1) ◽

pp. 55-55

Author(s):

G. A. Melnichenko

Keyword(s):

Laboratory Tests ◽

Clinical Laboratory ◽

Laboratory Data ◽

Significant Proportion ◽

Laboratory Studies ◽

Significant Enrichment ◽

New Hypothesis ◽

Intensive Development ◽

Active Interaction

The intensive development of biology and its branches, their active interaction with chemistry, physics, and also with the technical sciences in the second half of the 20th century led to a significant enrichment of the field of medicine called laboratory. Both in the diagnosis of most diseases and in monitoring their course, laboratory studies have firmly taken the place of a very extensive source of valuable information about the patient’s body condition. They play a role in preventive examinations and during follow-up, and in monitoring the condition in critical situations. The research results help the doctor to verify their diagnostic assumptions or turn to a new hypothesis. Despite the fact that not every case of the disease can be finally recognized on the basis of laboratory data, the vast majority of hospitalized patients and a significant proportion of outpatients undergo one or another laboratory study. For 1 patient in Russian hospitals in 1996, an average of 32.7 analyzes were made, and for 1 visit to the clinic - 0.88 analyzes.

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Can conversation analytic findings help with differential diagnosis in routine seizure clinic interactions?

Communication & Medicine ◽

10.1558/cam.v12i1.26851 ◽

2016 ◽

Vol 12 (1) ◽

pp. 13-24 ◽

Cited By ~ 7

Author(s):

Katie Ekberg ◽

Markus Reuber

Keyword(s):

Differential Diagnosis ◽

Correct Diagnosis ◽

Diagnostic Errors ◽

Epileptic Seizures ◽

Routine Clinical Setting ◽

Choice Of Treatment ◽

Transient Loss ◽

Factual Content ◽

Patient’S History ◽

Linguistic Methods

There are many areas in medicine in which the diagnosis poses significant difficulties and depends essentially on the clinician’s ability to take and interpret the patient’s history. The differential diagnosis of transient loss of consciousness (TLOC) is one such example, in particular the distinction between epilepsy and ‘psychogenic’ non-epileptic seizures (NES) is often difficult. A correct diagnosis is crucial because it determines the choice of treatment. Diagnosis is typically reliant on patients’ (and witnesses’) descriptions; however, conventional methods of history-taking focusing on the factual content of these descriptions are associated with relatively high rates of diagnostic errors. The use of linguistic methods (particularly conversation analysis) in research settings has demonstrated that these approaches can provide hints likely to be useful in the differentiation of epileptic and non-epileptic seizures. This paper explores to what extent (and under which conditions) the findings of these previous studies could be transposed from a research into a routine clinical setting.

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A STUDY OF HEPATITIS B VIRUS GENOTYPES IN CHRONIC HEPATITIS B PATIENTS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.3.4 ◽

2011 ◽

pp. 25-29

Author(s):

Keyword(s):

Chronic Hepatitis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Clinical Laboratory ◽

Laboratory Data ◽

Hbv Dna ◽

Hbv Genotypes ◽

B Virus ◽

Virus Genotypes ◽

Genotype C

Aims: To measure the prevalence of HBV genotypes in chronic hepatitis B patients and their relation to HBeAg and HBV DNA level. Methods: 81 patients were enrolled in this study from January 2009 to December 2010. Clinical, laboratory data were collected during the patient’s hospitalization. Sera were quantitatively tested for HBeAg and HBV DNA. HBV genotyping was made by real-time PCR. Results: Among the 81 patients, 60.5% had genotype B, 26.7% had genotype C and 8.6% had mixed genotype B-C. Prevalence of symptoms (fatigue, anorexia, insomnia...) was higher in genotype C than in genotype B. Genotype C patients had positivity higher HBeAg than genotype B patients (56% vs. 38,8%, p <0.05). The rate of HBV DNA > 107 copies/mL was higher in genotype C group than in genotype B group (36% vs. 28,6%, p > 0.05). Conclusions: Most of the patients had genotypes B or C. Patients with genotype C had positive HBeAg and may be related to higher serological HBV DNA level than in genotype B.

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