Abstract 16805: Assessing Correlation and Agreement in Activated Clotting Time (ACT) Measurement Using Hemochron Signature Elite

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ankita Aggarwal ◽  
Anubhav Jain ◽  
Arjun Bhardwaj ◽  
Nishit Choksi
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
P Value ◽  
Clotting Time ◽  
Paired Samples ◽  
Activated Clotting Time ◽  
Cardiac Procedures ◽  
Heparin Administration ◽  
Device Reliability ◽  
Before And After

Introduction & Hypothesis: ACT is the preferred mode of assessing degree of anti-coagulation during cardiac catheterization. Studies have shown significant variability in ACT measurement with different company analysers. We aimed to assess correlation and agreement between two instruments of the same company, Hemochron Signature Elite. Method: Paired samples were collected before and after heparin administration for each patient. Each paired sample was collected and entered into the two instruments tagged A & B using the same syringe and at the same time. Results: A total of 46 samples were included in the study. There was a significant correlation between the two instruments (r= 0.92, p- value 0.02). However, the two devices had significant discordance with a mean bias of 11.1 , 95% CI 0.77 to 24.9 and limits of agreement -35.8 to 58.1. Mean ACT between the two devices was significantly different (231 vs 248, p-value 0.01). Inter-device reliability was 30%. There was a more than 10% difference in about 30% of the paired samples and more than 20% difference in 9% of the samples. Conclusion: Significant correlation but discordance exists in ACT measurement even between the same type of device. This may affect clinical decision making during cardiac procedures and need further investigation.

A Prediction Model for Positive Infant Meconium and Urine Drug Tests

2020 ◽  
Author(s):  
Elizabeth A. Simpson ◽  
David A. Skoglund ◽  
Sarah E. Stone ◽  
Ashley K. Sherman
Keyword(s):  
Prediction Model ◽  
Drug Testing ◽  
Clinical Decision Making ◽  
Drugs Of Abuse ◽  
Clinical Decision ◽  
P Value ◽  
Test Characteristics ◽  
Drug Test ◽  
Urine Drug ◽  
Urine Drug Test

Objective This study aimed to determine the factors associated with positive infant drug screen and create a shortened screen and a prediction model. Study Design This is a retrospective cohort study of all infants who were tested for drugs of abuse from May 2012 through May 2014. The primary outcome was positive infant urine or meconium drug test. Multivariable logistic regression was used to identify independent risk factors. A combined screen was created, and test characteristics were analyzed. Results Among the 3,861 live births, a total of 804 infants underwent drug tests. Variables associated with having a positive infant test were (1) positive maternal urine test, (2) substance use during pregnancy, (3) ≤ one prenatal visit, and (4) remote substance abuse; each p-value was less than 0.0001. A model with an indicator for having at least one of these four predictors had a sensitivity of 94% and a specificity of 69%. Application of this screen to our population would have decreased drug testing by 57%. No infants had a positive urine drug test when their mother's urine drug test was negative. Conclusion This simplified screen can guide clinical decision making for determining which infants should undergo drug testing. Infant urine drug tests may not be needed when a maternal drug test result is negative. Key Points

scholarly journals PEMBERIAN SUPLEMEN KOLAGEN TERHADAP ELASTISITAS DAN WARNA KULIT WANITA MENOPAUSE

2021 ◽  
Vol 7 (1) ◽  
pp. 65-72
Author(s):  
Lhedys Angela ◽  
Sri Dinengsih ◽  
Risza Choirunissa
Keyword(s):  
Skin Color ◽  
Statistical Test ◽  
P Value ◽  
Skin Elasticity ◽  
Paired Samples ◽  
Menopausal Women ◽  
Before And After ◽  
Quasi Experimental ◽  
Color Background ◽  
Quasi Experiment

ABSTRACT GIVING COLLAGENT SUPPLEMENTS ON ELASTICITYAND MENOPAUSE WOMEN'S SKIN COLOR Background: Physical changes that are generally more visible when a person reaches menopause are changes in skin elasticity and skin color. Reduced water and oil content in the skin will result in reduced skin elasticity resulting in fine lines and wrinkles on the skin and factors that cause skin discoloration are the use of drugs, use of unsafe cosmetics or absorption of ultraviolet (UV) rays. that comes from sunlight. This is caused by reduced collagen production by cells. Due to the reduced amount of collagen, there will also be a reduction in the amount of reduced glycosaminoglycans which then results in reduced skin turgor.Purpose: The purpose of this study was to determine the effect of collagen consumption on skin elasticity and skin color in menopausal women in Cikande, Serang District, Banten Province.Methods: This study used quantitative descriptive statistics with a Quasi-Experimental research design with a One-Group Pretest-Posttest Design approach, which is a quasi-experiment where a group is measured and observed before and after the treatment (treatement). The sample of this research was 20 menopausal women in July in Cikande Village, Serang Regency, Banten Province.Results: Based on the results of the Paired Samples statistical test before and after collagen consumption on skin elasticity, a P value of 0.0118 was obtained from the significance value α => 0.05, this indicates that there is no effect between collagen consumption on skin elasticity. Based on the results of the Paired Samples statistical test before and after collagen consumption on skin color, the P value was obtained of 0.603 from the significance value α => 0.05, this indicates that there is no effect between collagen consumption on skin color.Conclusion: There is no effect of collagen consumption on skin elasticity and skin color in menopausal women in Cikande Village, Serang Regency, Banten Province. Suggestion:It is hoped that further researchers can carry out further research on the effect of collagen consumption on skin elasticity and skin color and for future researchers to be able to continue this research, as well as become a reference in conducting further research and can be developed again, especially on variables that have not been studied. Keywords: Menopause, Collagen, Skin elasticity, Skin color ABSTRAKLatar Belakang:Perubahan fisik yang umumnya lebih terlihat nampak ketika seorang sampai pada masa menopause adalah perubahan terhadap elastisitas kulit dan warna kulit.Berkurangnya kadar air dan minyak didalam kulit akan mengakibatkan berkurangnya elastisitas kulit sehingga timbul garis-garis halus dan kerut-kerut pada kulit dan faktor yang menyebabkan terjadinya perubahan warna kulit adalah penggunaan obat-obatan, penggunaan kosmetik yang tidak aman atau penyerapan sinar ultraviolet (UV) yang berasal dari cahaya matahari. Hal ini disebabkan oleh berkurangnya produksi kolagen yang dilakukan oleh sel. Akibat berkurangnya jumlah kolagen maka akan berkurang pula jumlah pengurangan glycosaminoglycans yang kemudian berakibat pada berkurangnya turgor kulitTujuan: Tujuan penelitian ini untuk mengetahui pengaruh konsumsi kolagen terhadap elastisitas kulit dan warna kulit pada wanita menopause di Kelurahan Cikande Kabupaten Serang Provinsi Banten.Metode: Penelitian ini menggunakan kuantitatif stastistik deskriptif dengan desain penelitian Quasi-Eksperimen dengan pendekatan One-Group Pretest-Posttest Design yang merupakan quasi-experiment dimana sebuah kelompok diukur dan diobservasi sebelum dan setelah perlakuan (treatement).Sample penelitian ini adalah 20 wanita menopause pada bulan Juli di Kelurahan Cikande Kabupaten Serang Provinsi Banten.Hasil Penelitian:Berdasarkan hasil uji Paired Samples statistik sebelum dan sesudah konsumsi kolagen terhadap elastisitas kulit diperoleh nilai P value sebesar 0,0118 dari angka kemaknaan α = > 0,05 hal tersebut menunjukkan tidak ada pengaruh antara konsumsi kolagen terhadap elastisitas kulit. Berdasarkan hasil uji Paired Samples statistik sebelum dan sesudah konsumsi kolagen terhadap warna kulit diperoleh nilai P value sebesar 0,603 dari angka kemaknaan α = > 0,05 hal tersebut menunjukkan tidak ada pengaruh antara konsumsi kolagen terhadap warna kulit.Kesimpulan:Tidak ada pengaruh konsumsi kolagen terhadap elastisitas kulit dan warna kulit pada wanita menopause di di Kelurahan Cikande Kabupaten Serang Provinsi Banten.Saran:Diharapkan bagi peneliti selanjutnya dapat melakukan penelitian lebih lanjutmengenai pengaruh konsumsi kolagen terhadap elastisitas kulit dan warna kulit dan bagi peneliti selanjutnya agar dapat melanjutkan penelitian ini, serta menjadi sebuah acuan dalam melakukan penelitian selanjutnya dan dapat dikembangkan lagi terutama pada variabel-variabel yang belum diteliti. Kata Kunci:Menopause, Kolagen, Elastisitas kulit, Warna kulit.

Comparison of activated clotting times obtained using Hemochron and Medtronic analysers in patients receiving anti-thrombin therapy during cardiac catheterisation

2009 ◽  
Vol 101 (03) ◽  
pp. 535-540 ◽  
Author(s):  
Stanley Chia ◽  
Elizabeth M. Van Cott ◽  
Christopher O. Raffel ◽  
Ik-Kyung Jang
Keyword(s):  
Strong Association ◽  
Cardiac Catheterisation ◽  
Excellent Correlation ◽  
Heparin Group ◽  
Activated Clotting Time ◽  
Cardiac Procedures ◽  
Heparin Administration ◽  
Heparin Anticoagulation ◽  
The Difference ◽  
High Range

SummaryAccurate monitoring of anti-thrombin therapy with activated clotting time (ACT) is important to prevent thrombotic and haemorrhagic complications during cardiac catheterisation. Significant variability in ACT tests exists when different analysers are used. Our objective was to compare ACT results obtained using Hemochron→ and Medtronic ACT PLUS→ devices and anti-Xa activity in patients undergoing cardiac catheterisation. Thirty-two patients who received unfractionated heparin or argatroban therapy during cardiac catheterisation were enrolled. Blood sampling was performed to determine ACT values using Hemochron and Medtronic (with high-range cartridges) devices in all patients (n=130 pairs), and anti-Xa activity following heparin administration. In the heparin group, ACT tests (n=95 pairs) showed very good correlation (r=0.84, y=1.31x–0.81; p<0.001). However, Hemochron values were consistently higher and the difference more pronounced with increasing ACT (for ACT>150 sec, mean difference 65 ± 48 sec; p<0.001). Both Hemochron and Medtronic ACT tests correlated well with plasma anti-Xa levels (r=0.85, r=0.81, respectively; p<0.001); Hemochron ACT>300 sec corresponded to anti-Xa>1.48 IU/ml. With concomitant eptifibatide therapy, the divergence in ACT was greater compared to heparin alone. In the argatroban group, ACT tests (n=35 pairs) demonstrated excellent correlation (r=0.94, y=0.61x+79.9; p<0.001). In contrast to the heparin group, ACT values were higher with Medtronic compared to Hemochron. Therefore, despite good correlation between Hemochron and Medtronic ACT results, and strong association with anti-Xa activity, Medtronic ACT values were consistently lower compared to Hemochron following heparin anticoagulation. Paradoxically, Medtronic ACT results were higher after argatroban therapy. Understanding this discrepancy is crucial when using ACT to guide invasive cardiac procedures.

scholarly journals The Impact of a Policy-Based Multicomponent Nutrition Pilot Intervention on Young Adult Employee’s Diet and Health Outcomes

2018 ◽  
Vol 33 (3) ◽  
pp. 342-357 ◽  
Author(s):  
Désirée Schliemann ◽  
Michelle McKinley ◽  
Jayne V. Woodside
Keyword(s):  
Young Adult ◽  
P Value ◽  
Insurance Company ◽  
Diet Intervention ◽  
Work Related ◽  
Paired Samples ◽  
Before And After ◽  
Strict Diet ◽  
Pilot Intervention ◽  
The Impact

Purpose: Evaluate the effect of a policy-based, multicomponent workplace diet intervention on young adult employees’ diet and health. Design: A 6-month, single-armed pilot study with before and after assessments. Setting: Insurance company in Belfast, Northern Ireland. Participants: Employees who worked at the company throughout the intervention period were included. Employees were excluded if pregnant, breast-feeding, or following a strict diet. Intervention: Multicomponent diet intervention: ban of unhealthy foods brought into the premises, free fruit, education, individual advice, and further support. Measures: Mixed-methods approach: Diet-, health-, and work-related measures were assessed quantitatively. The campaign was evaluated quantitatively (via questionnaire) and qualitatively (via semistructured interviews). Analysis: Changes in measures were analyzed using paired samples t tests. Interviews were analyzed using thematic analysis. Results: Sixty (75.9%) staff completed all assessments. Males reduced their sugar intake on working days (−8.7% of total energy standard deviation [SD]: 20.1; P value <.01). Systolic blood pressure reduced in males and females (−3.3 SD: 9.9; P value <.05 and −8.0 SD: 7.7; P value <.001, respectively); 85.2% of staff strongly agreed/agreed that they appreciated the healthy eating ethos. This was supported by the qualitative analysis which furthermore suggested that the education, team support, individual advice, and free fruit were beneficial. Conclusion: Influencing workplace policies and offering additional dietary support could lead to meaningful changes in employees’ diet and health and may change workplace culture.

scholarly journals Anticoagulation in Cardiopulmonary Bypass

1977 ◽  
Author(s):  
C. Thomas Kisker ◽  
John A. Young ◽  
Donald B. Doty ◽  
Barbara J. Taylor
Keyword(s):  
Cardiopulmonary Bypass ◽  
Antithrombin Iii ◽  
Human Subjects ◽  
Mean Value ◽  
Clotting Time ◽  
Excessive Bleeding ◽  
Safe Level ◽  
Activated Clotting Time ◽  
Before And After ◽  
The Mean

Prolonging the activated clotting time (ACT) 2 to 3 times normal is said to provide a “safe” level of anticoagulation during cardiopulmonary bypass. To test this level of anticoagulation 9 monkeys were anticoagulated with heparin at the start of cardiopulmonary bypass so that ACT’s ranged from 201 sec to > 1000 sec (normal 91 sec). ACT, platelet count (P), fibrinogen (F), and fibrin monomer (FM) were measured at 10, 30, 60, 90, and 120 minutes during bypass. Antithrombin III (AT3) was measured before and after bypass. Six monkeys developed increased FM indicating active coagulation beginning from 10 to 60 minutes on bypass. ACT’s were > 200 sec in all animals at the time of FM detection. P fell below 100,000/mm3 in the 6 animals with elevated FM, but remained above 100,000/mm3 in the other 3 animals. The mean value of AT3 (69%) decreased to 24.4% after bypass in the 6 animals with elevated FM, but was 61% after bypass in the others. Scanning electron microscopy of the oxygenator membranes showed significant amounts of fibrin on the membranes used in monkeys who developed increased FM levels, but not on those with normal FM concentrations. F decreased from 167 mgm/dl to 80.5 mgm/dl in monkeys with elevated FM and to 117 mgm/dl in those with normal FM concentrations. Excessive bleeding did not occur in the animals without increased FM although ACT’s were in excess of 1000 sec. Subsequently three human subjects on cardiopulmonary bypass whose ACT’s were maintained above 400 sec have not shown increased FM levels. The results suggest that prolonging the ACT more than 2 - 3 times normal is required to prevent activation of clotting during cardiopulmonary bypass.

Revisiting the Role of the Stat Laboratory: Is It Safe to Perform Activated Clotting Time Determinations (ACTs) Out of the Operating Room

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4256-4256
Author(s):  
Michael Plietz ◽  
Aaron Leifer ◽  
Vilma Padilla ◽  
Carole Pineda ◽  
Khrishan Naraine ◽  
...  
Keyword(s):  
Half Life ◽  
Conflicts Of Interest ◽  
P Value ◽  
Clotting Time ◽  
Heparin Group ◽  
Platelet Factor ◽  
Activated Clotting Time ◽  
Significant Difference ◽  
Stat Laboratory ◽  
Over Time

Abstract Abstract 4256 Background: Activated clotting time (ACT) is determined during cardiac procedures in order to assess the level of anti-coagulation. There are three main anticoagulants used during cardiac procedures:heparin, angiomax and Plavix. Heparin is often used in the cardiac OR for major procedures and is neutralized, over time, by platelet factor 4(PF4). Angiomax, bivalirudin, has a quick onset of action, but a much shorter half-life when compared to Heparin. Plavix, clopidogrel, irreversibly inhibits platelets from clotting and is used on patients in need of anticoagulation for an extended period of time. The purpose of this study was to evaluate the stability of ACT results over time utilizing different coagulation regimens. If the ACT value remains stable over time, this would enable us to remove the device from the OR and place it in a stat laboratory. Methods: ACTs were determined by the ISTAT (Abbott), a hand held point of care device, using kaolin activated cartridges. A single blood sample was obtained and was evaluated at intervals of 0, 5, 10, 15, and 20 minutes. In addition, temperature, age, body surface area and platelet count of patient were recorded. The time 0 specimen was used to determine the patients ACT and interval testing was performed on the remnant. Results: 36 samples representing 22 patients had ACT tests performed using the ISTAT. There was no significant change from 0 to 20 minutes over the entire dada set. However, when divided into different anti-clotting agents there were significant changes. Patients who had only taken Angiomax had a significant difference within the first 5 minutes (p value=.0094). Patients taking Angiomax and Plavix together had no change in ACT values at 20 minutes. Patients on Heparin alone demonstrated a loss of ACT stability at 10 minutes with values both increasing and decreasing. Conclusions: Patients on Angiomax alone demonstrated a significant difference in ACT value within the first 5 minutes and all intervals thereafter. Based on Angiomax short half-life the ACT should be performed as soon as possible. The ACT values in patients taking both Angiomax and Plavix achieved steady state throughout the 20 minutes and had little if any decrease in value. The results for the Heparin group were unreliable at 10 minutes. As a result of these findings, performing an ACT outside the OR is feasible assuming the test can be performed by 10 minutes. Disclosures: No relevant conflicts of interest to declare.

scholarly journals NLP Methods for Extraction of Symptoms from Unstructured Data for Use in Prognostic COVID-19 Analytic Models

2021 ◽  
Vol 72 ◽  
pp. 429-474
Author(s):  
Greg M. Silverman ◽  
Himanshu S. Sahoo ◽  
Nicholas E. Ingraham ◽  
Monica Lupei ◽  
Michael A. Puskarich ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Decision Making ◽  
Quality Care ◽  
Vital Signs ◽  
Clinical Decision ◽  
Prognostic Models ◽  
P Value ◽  
Rule Based ◽  
Presenting Symptoms ◽  
Increased Risk

Statistical modeling of outcomes based on a patient's presenting symptoms (symptomatology) can help deliver high quality care and allocate essential resources, which is especially important during the COVID-19 pandemic. Patient symptoms are typically found in unstructured notes, and thus not readily available for clinical decision making. In an attempt to fill this gap, this study compared two methods for symptom extraction from Emergency Department (ED) admission notes. Both methods utilized a lexicon derived by expanding The Center for Disease Control and Prevention's (CDC) Symptoms of Coronavirus list. The first method utilized a word2vec model to expand the lexicon using a dictionary mapping to the Uni ed Medical Language System (UMLS). The second method utilized the expanded lexicon as a rule-based gazetteer and the UMLS. These methods were evaluated against a manually annotated reference (f1-score of 0.87 for UMLS-based ensemble; and 0.85 for rule-based gazetteer with UMLS). Through analyses of associations of extracted symptoms used as features against various outcomes, salient risks among the population of COVID-19 patients, including increased risk of in-hospital mortality (OR 1.85, p-value < 0.001), were identified for patients presenting with dyspnea. Disparities between English and non-English speaking patients were also identified, the most salient being a concerning finding of opposing risk signals between fatigue and in-hospital mortality (non-English: OR 1.95, p-value = 0.02; English: OR 0.63, p-value = 0.01). While use of symptomatology for modeling of outcomes is not unique, unlike previous studies this study showed that models built using symptoms with the outcome of in-hospital mortality were not significantly different from models using data collected during an in-patient encounter (AUC of 0.9 with 95% CI of [0.88, 0.91] using only vital signs; AUC of 0.87 with 95% CI of [0.85, 0.88] using only symptoms). These findings indicate that prognostic models based on symptomatology could aid in extending COVID-19 patient care through telemedicine, replacing the need for in-person options. The methods presented in this study have potential for use in development of symptomatology-based models for other diseases, including for the study of Post-Acute Sequelae of COVID-19 (PASC).

scholarly journals SP2.2.9Using high fidelity simulation to improve hospital-based medical student education

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Marc Huttman ◽  
Hui Fen Koo ◽  
Charlotte Boardman ◽  
Michael Saunders
Keyword(s):  
Medical Students ◽  
Clinical Decision Making ◽  
Medical Student Education ◽  
District General Hospital ◽  
Clinical Decision ◽  
Free Text ◽  
High Fidelity ◽  
High Fidelity Simulation ◽  
Qualitative Feedback ◽  
Before And After

Abstract Introduction The evidence shows that experiential learning has multiple benefits in preparing medical students for foundation training. An immersive ‘on call simulation’ session was designed for final-year medical students at a district general hospital. The aim of this project was to assess how beneficial the sessions were and how they can be improved. Methods Pairs of students received 12 bleeps over 2 hours directing them to wards where mock patient folders were placed. Students prioritised bleeps involving deteriorating patients, chasing results and dealing with nursing queries. Simulated senior input was available from the session facilitator. A structured debrief session allowed discussion of each case. Quantitative feedback was gathered using a sliding scale (measured in percentage) for confidence before and after the session. Qualitative feedback was gathered using a free-text box. Results Four sessions were held between October 2020 and January 2021 for a total of 28 students, of which 26 provided feedback. Average confidence increased from 38% to 66%. 96% of students were ‘extremely satisfied’ with the session. Feedback included: “Incredibly immersive and fun” and “I was made to think through my priorities and decisions”. Improvements could be made by using actors/mannequins to simulate unwell patients and by use of skills models. Conclusion High fidelity simulation training is valuable and should be considered a standard part of the student curriculum. It is particularly suited to final year students who have the required clinical knowledge for foundation training but are still developing confidence in clinical decision making and prioritisation.

scholarly journals Bibliotherapy Strategy: Experimental Study To Reduce Hospitalization Stress In Pre-School Children

2020 ◽  
Vol 9 (2) ◽  
pp. 917-925
Author(s):  
Kili Astarani ◽  
Selvia David Richard
Keyword(s):  
Preschool Children ◽  
P Value ◽  
Test Design ◽  
Paired Samples ◽  
Data Collection Process ◽  
Average Change ◽  
Before And After ◽  
Post Test ◽  
Quota Sampling ◽  
Baptist Hospital

The research design used the Pre Experiment Design with a one-group pre-post test design. The population, preschool-aged children who experience hospitalization stress in the Karunia Room of Kediri Baptist Hospital. The sample is 15 respondents who were selected by Quota Sampling. The research variable was Bibliotherapy. The data collection process was carried out using a questionnaire. Data analysis using Paired Samples Test. The results of the research before doing bibliotherapy, stress hospitalization of preschool children were severe as 9 respondents (60.0%), mild as many as 4 respondents (26.7%), and moderate as many as 2 respondents (13.3%). The average change in stress hospitalization before and after bibliotherapy was 7.67 with a p-value of 0.000. Bibliotherapy is effective in reducing hospitalization stress in preschool children in the Karunia Room of Kediri Baptist Hospital

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