scholarly journals How Can Routine Clinical Laboratories Keep Up with the Opioid Crisis?

2020 ◽  
Author(s):  
Christine L H Snozek ◽  
Leland B Baskin ◽  
Jessica M Boyd ◽  
Brian N Kelly ◽  
Matthew D Krasowski ◽  
...  
Keyword(s):  
Opioid Crisis ◽  
Clinical Laboratories

scholarly journals Measuring What Matters: How the Laboratory Contributes Value in the Opioid Crisis

2020 ◽  
Vol 5 (6) ◽  
pp. 1378-1390
Author(s):  
Jill S Warrington ◽  
Kathleen Swanson ◽  
Monique Dodd ◽  
Sheng-Ying Lo ◽  
Aya Haghamad ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Improve Patient Safety ◽  
Clinical Care ◽  
Active Role ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Crisis ◽  
Clinical Laboratories ◽  
National Quality

Abstract With over 20 years of the opioid crisis, our collective response has evolved to address the ongoing needs related to the management of opioid use and opioid use disorder. There has been an increasing recognition of the need for standardized metrics to evaluate organizational management and stewardship. The clinical laboratory, with a wealth of objective and quantitative health information, is uniquely poised to support opioid stewardship and drive valuable metrics for opioid prescribing practices and opioid use disorder (OUD) management. To identify laboratory-related insights that support these patient populations, a collection of 5 independent institutions, under the umbrella of the Clinical Laboratory 2.0 movement, developed and prioritized metrics. Using a structured expert panel review, laboratory experts from 5 institutions assessed possible metrics as to their relative importance, usability, feasibility, and scientific acceptability based on the National Quality Forum criteria. A total of 37 metrics spanning the topics of pain and substance use disorder (SUD) management were developed with consideration of how laboratory insights can impact clinical care. Monitoring these metrics, in the form of summative reports, dashboards, or embedded in laboratory reports themselves may support the clinical care teams and health systems in addressing the opioid crisis. The clinical insights and standardized metrics derived from the clinical laboratory during the opioid crisis exemplifies the value proposition of clinical laboratories shifting into a more active role in the healthcare system. This increased participation by the clinical laboratories may improve patient safety and reduce healthcare costs related to OUD and pain management.

Utilizing Dark Field Electron Microscopy to Produce Lantern Slides

1974 ◽  
Vol 32 ◽  
pp. 116-117
Author(s):  
J. N. Meador ◽  
C. N. Sun ◽  
H. J. White
Keyword(s):  
Electron Microscope ◽  
Electron Micrographs ◽  
Dark Field ◽  
Limiting Factor ◽  
Clinical Laboratories ◽  
Field Electron ◽  
Time Element ◽  
Field Electron Microscopy ◽  
Dark Field Electron ◽  
Dark Field Micrographs

The electron microscope is being utilized more and more in clinical laboratories for pathologic diagnosis. One of the major problems in the utilization of the electron microscope for diagnostic purposes is the time element involved. Recent experimentation with rapid embedding has shown that this long phase of the process can be greatly shortened. In rush cases the making of projection slides can be eliminated by taking dark field electron micrographs which show up as a positive ready for use. The major limiting factor for use of dark field micrographs is resolution. However, for conference purposes electron micrographs are usually taken at 2.500X to 8.000X. At these low magnifications the resolution obtained is quite acceptable.

The Opioid Crisis on Our Caseloads

ASHA Leader ◽  
2018 ◽  
Vol 23 (11) ◽  
pp. 42-49 ◽  
Author(s):  
Kerry Proctor-Williams
Keyword(s):  
Opioid Crisis

Naloxon – Medizinische Grundlagen und internationale Erfahrungen

2019 ◽  
Vol 65 (5) ◽  
pp. 335-342
Author(s):  
Norbert Wodarz ◽  
Jörg Wolstein ◽  
Heike Wodarz-von Essen ◽  
Oliver Pogarell
Keyword(s):  
Randomized Controlled Trial ◽  
Glasgow Coma Scale ◽  
Controlled Trial ◽  
Cochrane Library ◽  
Coma Scale ◽  
International Standard ◽  
Trial Number ◽  
Randomized Controlled ◽  
Opioid Crisis ◽  
Lebensrettende Basismaßnahmen

Zusammenfassung. Hintergrund: Die Abhängigkeit von Opioiden ist mit erheblichen gesundheitlichen Gefährdungen der Betroffenen und einer hohen Mortalität assoziiert. Derzeit werden insbesondere die dramatisch gestiegenen Mortalitätsraten in den USA diskutiert (‚opioid crisis‘), aber auch in Deutschland war in den letzten Jahren ein kontinuierlicher Anstieg der Drogentoten, überwiegend verursacht durch Opioide, zu verzeichnen. Die Risiken einer Opioid Überdosierung bzw. Intoxikation resultiert vor allem aus der hemmenden Wirkung der Opioide auf den Atemantrieb, die durch andere gleichzeitig konsumierte Substanzen noch verstärkt werden kann. Neben Erstmaßnahmen (Notruf, lebensrettende Basismaßnahmen der Ersten Hilfe) kommt auch der Einsatz des Opioidantagonisten Naloxon in Betracht. Methode: Literaturrecherche in PubMed, Cochrane Library und im International Standard Randomized Controlled Trial Number (ISRCTN) Register. Ergebnisse: Auch aus ethischen Gründen liegen bislang eher wenig systematische Untersuchungen zum nicht-ärztlichen Einsatz von Naloxon bei Opioidüberdosierung vor. Trotzdem kann nach aktuellem Stand geschlussfolgert werden, dass die intranasale Verabreichung vergleichbar wirksam mit einer intramuskulären Anwendung zu sein scheint. Bei Überdosierten, die nach erfolgreichem Naloxon-Einsatz aus unterschiedlichen Gründen nicht in einer Klinik gebracht wurden, wurden in ca. 1 %. Todesfälle dokumentiert. Falls 60 min nach Naloxongabe unauffällige Vitalparameter und auf der Glasgow Coma Scale mind. 15 Punkte erreicht werden, besteht wohl ein sehr niedriges Rebound-Risiko. Im Vergleich dazu ist das Auftreten von Naloxon-induzierten Entzugssyndromen deutlich häufiger, hängen jedoch von der Dosis und dem konsumierten Opioid ab, wie auch von der verabreichten Naloxon-Dosis. Schlussfolgerungen: Naloxon kann mittlerweile auch in Deutschland als zugelassenes Nasalspray verabreicht werden und ist daher im Prinzip auch für den Einsatz durch Ersthelfer geeignet. Verbesserte Rahmenbedingungen, wie z. B. spezifische Schulungen könnten dazu beitragen, Take-Home Naloxon als erfolgreichen Baustein zur Reduktion von Drogentod zu implementieren.

Imprecision of Laboratory Determinations and Diagnostic Accuracy: Theoretical Considerations

1974 ◽  
Vol 13 (03) ◽  
pp. 151-158 ◽  
Author(s):  
D. A. B. Lindbebo ◽  
Fr. R. Watson
Keyword(s):  
Mathematical Model ◽  
Diagnostic Accuracy ◽  
Diagnostic Process ◽  
Clinical Laboratories ◽  
Non Linear ◽  
Theoretical Considerations ◽  
Made In

Recent studies suggest the determinations of clinical laboratories must be made more precise than at present. This paper presents a means of examining benefits of improvement in precision. To do this we use a mathematical model of the effect upon the diagnostic process of imprecision in measurements and the influence upon these two of Importance of Diagnosis and Prevalence of Disease. The interaction of these effects is grossly non-linear. There is therefore no proper intuitive answer to questions involving these matters. The effects can always, however, be calculated.Including a great many assumptions the modeling suggests that improvements in precision of any determination ought probably to be made in hospital rather than screening laboratories, unless Importance of Diagnosis is extremely high.

Factor VII Clotting Assay: Influence of Different Thromboplastins and Factor VII-Deficient Plasmas

1991 ◽  
Vol 65 (02) ◽  
pp. 160-164 ◽  
Author(s):  
Marina Poggio ◽  
Armando Tripodi ◽  
Guglielmo Mariani ◽  
Pier Mannuccio Mannucci ◽  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Dose Response ◽  
Response Curve ◽  
Ischemic Heart ◽  
Factor Vii ◽  
Response Curves ◽  
Assay Sensitivity ◽  
Clinical Laboratories ◽  
Coagulant Activity

SummaryBeing a putative predictor of ischemic heart disease, the measurement of factor VII (FVTI) coagulant activity will be presumably requested to clinical laboratories with increasing frequency. To assess the influence on FVII assays of different thromboplastins and FVII-deficient plasmas we compared performances of all possible combinations of 5 thromboplastins and 6 deficient plasmas. The reproducibility of the clotting times of the dose-response curves for human and rabbit thromboplastins were acceptable (CV lower than 7%), whereas bovine thromboplastin had a higher CV. Reproducibility was very similar for all deficient plasmas when they were used in combination with a given thromboplastin. Responsiveness of the dose-response curve did not depend on the deficient plasma but rather on the thromboplastin: one rabbit thromboplastin was the least responsive, the bovine thromboplastin the most responsive, the human and the remaining two rabbit thromboplastins had intermediate responsiveness. Assay sensitivity to cold-activated FVII varied according to the thromboplastin: the bovine thromboplastin was the most sensitive, the human thromboplastin the least sensitive, of the three rabbit thromboplastins two were relatively sensitive, one was almost insensitive. In conclusion, our results indicate that thromboplastin rather than deficient plasma is the crucial factor in the standardization of FVII assay.

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