scholarly journals Screening for phaeochromocytoma and paraganglioma: impact of using supine reference intervals for plasma metanephrines with samples collected from fasted/seated patients

2016 ◽  
Vol 54 (1) ◽  
pp. 170-173 ◽  
Author(s):  
R Casey ◽  
TP Griffin ◽  
D Wall ◽  
MC Dennedy ◽  
M Bell ◽  
...  
Keyword(s):  
Financial Analysis ◽  
Reference Intervals ◽  
Diagnostic Sensitivity ◽  
University Hospitals ◽  
Endocrine Society ◽  
Sampling Protocols ◽  
Diagnostic Sensitivity And Specificity ◽  
Plasma Free Metanephrines ◽  
The Impact ◽  
Result Interpretation

Background The Endocrine Society Clinical Practice Guideline on Phaeochomocytoma and Paraganglioma recommends phlebotomy for plasma-free metanephrines with patients fasted and supine using appropriately defined reference intervals. Studies have shown higher diagnostic sensitivities using these criteria. Further, with seated-sampling protocols, for result interpretation, reference intervals that do not compromise diagnostic sensitivity should be employed. Objective To determine the impact on diagnostic performance and financial cost of using supine reference intervals for result interpretation with our current plasma-free metanephrines fasted/seated-sampling protocol. Methods We conducted a retrospective cohort study of patients who underwent screening for PPGL using plasma-free metanephrines from 2009 to 2014 at Galway University Hospitals. Plasma-free metanephrines were measured using liquid chromatography-tandem mass spectrometry. Supine thresholds for plasma normetanephrine and metanephrine set at 610 pmol/L and 310 pmol/L, respectively, were used. Results A total of 183 patients were evaluated. Mean age of participants was 53.4 (±16.3) years. Five of 183 (2.7%) patients had histologically confirmed PPGL (males, n=4). Using seated reference intervals for plasma-free metanephrines, diagnostic sensitivity and specificity were 100% and 98.9%, respectively, with two false-positive cases. Application of reference intervals established in subjects supine and fasted to this cohort gave diagnostic sensitivity of 100% with specificity of 74.7%. Financial analysis of each pretesting strategy demonstrated cost-equivalence (€147.27/patient). Conclusion Our cost analysis, together with the evidence that fasted/supine-sampling for plasma-free metanephrines, offers more reliable exclusion of PPGL mandates changing our current practice. This study highlights the important advantages of standardized diagnostic protocols for plasma-free metanephrines to ensure the highest diagnostic accuracy for investigation of PPGL.

scholarly journals The impact of preferences for clinical and managerial leadership roles on the willingness to apply for a medical leadership position: Analysis of gender differences among a sample of German senior physicians

2021 ◽  
pp. 095148482110102
Author(s):  
Florian Liberatore ◽  
Julia Schätzle ◽  
Henrik Räwer ◽  
Kia Homayounfar ◽  
Jörg Lindenmeier
Keyword(s):  
Structural Equation ◽  
Medical Profession ◽  
Equation Modeling ◽  
Mentoring Programs ◽  
Leadership Roles ◽  
University Hospitals ◽  
Managerial Leadership ◽  
Clinical Leadership ◽  
Medical Leadership ◽  
The Impact

Background The hybrid role (clinical and managerial leadership tasks) of physicians in medical leadership positions (MLPs) is a driver of the attractiveness of these positions. The increasing feminization of the medical profession makes gender-related preferences for hybrid roles relevant. Purpose The current study uses the (EPL) career aspirations framework to analyze the (gender-related) effects that efficacy beliefs, motivations, and preferences for clinical leadership and managerial leadership have on the willingness of chief physicians to apply for an MLP. Methodology: A survey of senior physicians in German university hospitals yielded a sample size of N = 496. The resulting data were analyzed using a structural equation modeling approach. Findings The results confirm the low preference for MLPs among senior physicians, which is mainly affected by preferences for managerial leadership tasks. Female senior physicians perceive the position of an MLP to be less attractive than their male counterparts do, and female physicians’ willingness to apply for an MLP is concurrently driven by their preferences for clinical leadership and managerial leadership tasks. Practical implications: Mentoring programs could boost female senior physicians’ preparedness for MLPs. Further, flexibility in fulfilling managerial leadership tasks could be promoted to make MLPs more attractive to women.

scholarly journals Hyperandrogenism by Liquid Chromatography Tandem Mass Spectrometry in PCOS: Focus on Testosterone and Androstenedione

2020 ◽  
Vol 10 (1) ◽  
pp. 119
Author(s):  
Giorgia Grassi ◽  
Elisa Polledri ◽  
Silvia Fustinoni ◽  
Iacopo Chiodini ◽  
Ferruccio Ceriotti ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Liquid Chromatography ◽  
Polycystic Ovary ◽  
Free Testosterone ◽  
Reference Intervals ◽  
Model Assessment ◽  
Homeostatic Model Assessment ◽  
Liquid Chromatography Tandem Mass ◽  
And Control ◽  
The Impact

The identification of hyperandrogenism in polycystic ovary syndrome (PCOS) is concerning because of the poor accuracy of the androgen immunoassays (IA) and controversies regarding which androgens should be measured. The aim of our study was to evaluate the impact of the assessment of testosterone (T) and androstenedione (A) by liquid chromatography in tandem with mass spectrometry (LC/MS-MS), in the diagnosis of PCOS. We evaluated 131 patients referred for suspected PCOS. Fourteen patients in total were excluded, some because of other diagnosis (n = 7) or incomplete diagnostic workup (n = 7). We measured T and A both by IA and LC-MS/MS in the 117 subjects included. We calculated free T (fT) by the Vermeulen formula and recorded clinical and metabolic data. 73 healthy females served as controls to derive immunoassays (IA) and LC-MS/MS reference intervals for T, fT and A. PCOS was confirmed in 90 subjects by IA and in 93 (+3.3%) by LC-MS/MS. The prevalence of biochemical hyperandrogenism in PCOS by LC-MS/MS increased from 81.7% to 89.2% if A was also considered. The most frequently elevated androgens were fT (73.1%) and A (64.5%) and they had similar levels of accuracy in differentiating PCOS and controls (0.34 ng/dL, Sn 91% Sp 89%; 1.16 ng/mL, Sn 91% Sp 88%, respectively). Free testosterone correlated with body mass index (BMI), homeostatic model assessment (HOMA)-index, glycated hemoglobin (HbA1c), and sex-binding globulin (SHBG). The results confirm that LC-MS/MS is slightly more sensitive than IA in the diagnosis of PCOS with LC-MS/MS detecting higher levels of fT and A. Moreover, assessment of fT and A by LC-MS/MS had a similar level of accuracy in discriminating between PCOs and control subjects. Lastly, fT by LC-MS/MS correlates with adverse metabolic parameters.

Evaluation of Thyroid Function in Pregnant Women Using Automated Immunoassays

2021 ◽  
Author(s):  
K Aaron Geno ◽  
Matthew S Reed ◽  
Mark A Cervinski ◽  
Robert D Nerenz
Keyword(s):  
Pregnant Women ◽  
Equilibrium Dialysis ◽  
Reference Interval ◽  
First Trimester ◽  
Reference Intervals ◽  
Free Thyroxine ◽  
Specific Reference ◽  
Childbearing Age ◽  
Thyroid Autoantibody ◽  
The Impact

Abstract Introduction Automated free thyroxine (FT4) immunoassays are widely available, but professional guidelines discourage their use in pregnant women due to theoretical under-recoveries attributed to increased thyroid hormone binding capacity and instead advocate the use of total T4 (TT4) or free thyroxine index (FTI). The impact of this recommendation on the classification of thyroid status in apparently euthyroid pregnant patients was evaluated. Methods After excluding specimens with thyroid autoantibody concentrations above reference limits, thyroid-stimulating hormone (TSH), FT4, TT4, and T-uptake were measured on the Roche Cobas® platform in remnant clinical specimens from at least 147 nonpregnant women of childbearing age and pregnant women at each trimester. Split-sample comparisons of FT4 as measured by the Cobas and equilibrium dialysis were performed. Results FT4 decreased with advancing gestational age by both immunoassay and equilibrium dialysis. TSH declined during the first trimester, remained constant in the second, and increased throughout the third, peaking just before delivery. Interpretation of TT4 concentrations using 1.5-times the nonpregnant reference interval classified 13.6% of first trimester specimens below the lower reference limit despite TSH concentrations within trimester-specific reference intervals. Five FTI results from 480 pregnant individuals (about 1.0%) fell outside the manufacturer’s reference interval. Conclusions Indirect FT4 immunoassay results interpreted in the context of trimester-specific reference intervals provide a practical and viable alternative to TT4 or FTI. Declining FT4 and increasing TSH concentrations near term suggest that declining FT4 is not an analytical artifact but represents a true physiological change in preparation for labor and delivery.

scholarly journals Clinical significance of small molecule metabolites in the blood of patients with different types of liver injury

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hui Li ◽  
Yan Wang ◽  
Shizhao Ma ◽  
Chaoqun Zhang ◽  
Hua Liu ◽  
...  
Keyword(s):  
Oleic Acid ◽  
Clinical Diagnosis ◽  
Sensitivity And Specificity ◽  
Acid Amide ◽  
Hbv Infection ◽  
Diagnostic Sensitivity ◽  
Future Research ◽  
Diagnostic Efficacy ◽  
Metabolic Markers ◽  
Diagnostic Sensitivity And Specificity

AbstractTo understand the characteristic of changes of serum metabolites between healthy people and patients with hepatitis B virus (HBV) infection at different stages of disease, and to provide reference metabolomics information for clinical diagnosis of liver disease patients. 255 patients with different stages of HBV infection were selected. 3 mL blood was collected from each patient in the morning to detect differences in serum lysophosphatidylcholine, acetyl-l-carnitine, oleic acid amide, and glycocholic acid concentrations by UFLC-IT-TOF/MS. The diagnostic values of four metabolic substances were evaluated by receiver operating characteristic (ROC) curve. The results showed that the optimal cut-off value of oleic acid amide concentration of the liver cirrhosis and HCC groups was 23.6 mg/L, with a diagnostic sensitivity of 88.9% and specificity of 70.6%. The diagnostic efficacies of the three substances were similar in the hepatitis and HCC groups, with an optimal cut-off value of 2.04 mg/L, and a diagnostic sensitivity and specificity of 100% and 47.2%, respectively. The optimal cut-off value of lecithin of the HBV-carrier and HCC groups was 132.85 mg/L, with a diagnostic sensitivity and specificity of 88.9% and 66.7%, respectively. The optimal cut-off value of oleic acid amide of the healthy and HCC groups was 129.03 mg/L, with a diagnostic sensitivity and specificity of 88.4% and 83.3%, respectively. Lysophosphatidylcholine, acetyl-l-carnitine, and oleic acid amide were potential metabolic markers of HCC. Among them, lysophosphatidylcholine was low in the blood of HCC patients, and its diagnostic efficacy was better than that of acetyl-l-carnitine and oleic acid amide, providing reference metabolomics information in clinical diagnosis and future research.

scholarly journals The cultural and economic power of advertisers in the business press

Journalism ◽  
2017 ◽  
Vol 19 (8) ◽  
pp. 1078-1095 ◽  
Author(s):  
Maha Rafi Atal
Keyword(s):  
Economic Analysis ◽  
Financial Analysis ◽  
Cultural Analysis ◽  
Content Increase ◽  
Organizational Mission ◽  
Media Companies ◽  
Business Press ◽  
Business Journalism ◽  
The Impact

Media studies scholarship on advertising has traditionally fallen into two camps. Cultural analysis emphasizes the signals advertisements send to consumers, focusing primarily on the role of advertising creatives. Economic analysis emphasizes advertising’s impact on media companies’ financial performance, focusing on the role of sales managers and proprietors. Both approaches minimize the role of reporters, against whose work advertisers place their messages. This article draws on interviews, as well as financial analysis, at six newsrooms to examine the impact of advertising practices on the editorial independence of reporters. Combining cultural and economic analysis, the article highlights the unique threat advertiser influence poses to critical business reporting, which takes as its subject the very firms who must choose to advertise against it. The article argues that the new forms of advertising, where branded content is presented alongside, and intended to mimic, reported content, increase the threat of advertiser capture. At four legacy outlets studied, investigative business coverage has declined as media organizations react to the changed operating environment with practices that compromise the divide between news and advertising staff. At two online startups studied, where new advertising formats have always been part of strategy, news and sales staff remain separate. Yet there is limited appetite at these outlets for conducting critical business journalism, which is not seen as key to organizational mission. The article concludes with policy recommendations to safeguard the viability of critical business journalism.

scholarly journals Investigating the discriminative value of Early Warning Scores in patients with respiratory disease using a retrospective cohort analysis of admissions to Nottingham University Hospitals Trust over a 2-year period

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020269 ◽  
Author(s):  
Sarah Forster ◽  
Gemma Housley ◽  
Tricia M McKeever ◽  
Dominick E Shaw
Keyword(s):  
Respiratory Disease ◽  
Early Warning ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Scoring Systems ◽  
University Hospitals ◽  
Retrospective Cohort Analysis ◽  
Early Warning Scores ◽  
The Impact ◽  
Higher Sensitivity

ObjectiveEarly Warning Scores (EWSs) are used to monitor patients for signs of imminent deterioration. Although used in respiratory disease, EWSs have not been well studied in this population, despite the underlying cardiopulmonary pathophysiology often present. We examined the performance of two scoring systems in patients with respiratory disease.DesignRetrospective cohort analysis of vital signs observations of all patients admitted to a respiratory unit over a 2-year period. Scores were linked to outcome data to establish the performance of the National EWS (NEWS) compared results to a locally adapted EWS.SettingNottingham University Hospitals National Health Service Trust respiratory wards. Data were collected from an integrated electronic observation and task allocation system employing a local EWS, also generating mandatory referrals to clinical staff at set scoring thresholds.Outcome measuresProjected workload, and sensitivity and specificity of the scores in predicting mortality based on outcome within 24 hours of a score being recorded.Results8812 individual patient episodes occurred during the study period. Overall, mortality was 5.9%. Applying NEWS retrospectively (vs local EWS) generated an eightfold increase in mandatory escalations, but had higher sensitivity in predicting mortality at the protocol cut points.ConclusionsThis study highlights issues surrounding use of scoring systems in patients with respiratory disease. NEWS demonstrated higher sensitivity for predicting death within 24 hours, offset by reduced specificity. The consequent workload generated may compromise the ability of the clinical team to respond to patients needing immediate input. The locally adapted EWS has higher specificity but lower sensitivity. Statistical evaluation suggests this may lead to missed opportunities for intervention, however, this does not account for clinical concern independent of the scores, nor ability to respond to alerts based on workload. Further research into the role of warning scores and the impact of chronic pathophysiology is urgently needed.

scholarly journals Impact of Intellectual Capital Management and Human Capital Circulation on Business Practice at Macro- and Micro Level

2017 ◽  
Vol 9 (5) ◽  
pp. 6-16 ◽  
Author(s):  
Iryna Oleynikova ◽  
Zhanna Balabaniuk
Keyword(s):  
Human Capital ◽  
Intellectual Capital ◽  
Financial Analysis ◽  
Economic Value ◽  
Weighted Average ◽  
Value Added ◽  
General Acceptance ◽  
Managerial Implications ◽  
Standard Practices ◽  
The Impact

Nowadays the main potential for growth comes from the ability to innovate and succeed with breakthrough ideas. However, despite growing importance of the subject matter, there are still no standard practices that would perform such a measurement and employ tendencies of human capital circulation. Various attempts have been made over recent years, but none have achieved general acceptance among experts in the business field. Although there is no universally accepted theory, each has its own strengths and weaknesses in the deriving approximate value of intellectual capital for various companies. In this work, we looked over some theories that have been suggested to estimate intellectual capital and analyzed data from Ukrainian IT companies in order to prove how important measurement of intellectual capital and human capital circulation trends to allow for much better representation of an organization’s competitive position. Additionally, the impact of intellectual capital on various Key Performance Indicators, such as Economic Value Added and Weighted Average Cost of Capital, was examined with supporting financial analysis performed. The paper concludes with an overview of methodological and managerial implications of the research, theoretical and practical limitations and possible improvements, and considerations for further research in the field of study.

scholarly journals (The impact of financial performance assessment on the quality of banking performance An applied study on the Commercial Bank of Chad in the Republic of Chad for the period (2008-2013: أثر تقويم الأداء المالي على جودة الأداء المصرفي دراسة تطبيقية على مصرف شاري التجاري بجمهورية تشاد للفترة (2008-2013م)

2017 ◽  
Vol 1 (6) ◽  
Author(s):  
Mohammed Bukhari Hassan Ali
Keyword(s):  
Commercial Bank ◽  
Financial Distress ◽  
Financial Management ◽  
Financial Analysis ◽  
High Ratio ◽  
Bank Loans ◽  
General Classification ◽  
The Republic ◽  
The Impact

The study addressed the issue of the quality of financial Shari commercial bank management and the extent of their relationship to the funding of competence, to see how the quality of financial management, and to identify its transparency when granting credit, and to identify the general classification of the bank on CAMELS index of the banking classification. Study the problem in the following questions: Are the financial and credit policies of the bank bank?. It is that the bank actually applied followed in the granting of credit financial procedures? Is bank financing of the bank efficient? Is that the bank applied to all financial regulations and decisions of the Organization of the banking business? The study sought to analyze and test the hypotheses: The bank's reliance on financial analysis to rationalize decisions granting Alaitmat lead to the efficiency of the funding. The Bank’s general classification in term of quality, liquidity adequacy, financial level of default and loan-to deposit ratio are within the good classification. The Chari commercial Bank's performance is good. Used in the study are: descriptive analytical method and the historical approach in addition to the deductive approach. The study reached the following findings: The results of the study that there is a positive relationship between the quality of financial management bank (Shari) commercial financing and efficiency, the bank loans relative to deposits above the industry the desired level standard, the bank in case of default Mali due to the high ratio of non-performing loans and by passed the industry standard, the bank is suffering from an acute shortage of liquidity, causing falter in the bank's operations. The most important recommendations of the study: the need for Shari Commercial Bank to measure and find out the loans to deposits ratio and liquidity of the bank continuously to meet the obligations and withdrawals daily is expected, should the bank not to grant loans only after making sure it fits with deposits and ensure liquidity of the bank to avoid potential financial distress, the need to seek to provide all types of banking services offered by the rest of the workforce in the country's banks.

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