The effectiveness of a routine versus an extensive laboratory analysis in the diagnosis of anaemia in general practice

2018 ◽  
Vol 55 (5) ◽  
pp. 535-542 ◽  
Author(s):  
Annemarie Schop ◽  
Michelle MA Kip ◽  
Karlijn Stouten ◽  
Soraya Dekker ◽  
Jurgen Riedl ◽  
...  
Keyword(s):  
General Practitioners ◽  
Online Survey ◽  
Correct Diagnosis ◽  
Laboratory Work ◽  
Test Results ◽  
Anaemia Of Chronic Disease ◽  
Routine Work ◽  
Laboratory Test Results ◽  
Underlying Causes ◽  
Work Up

Background We investigated the percentage of patients diagnosed with the correct underlying cause of anaemia by general practitioners when using an extensive versus a routine laboratory work-up. Methods An online survey was distributed among 836 general practitioners. The survey consisted of six cases, selected from an existing cohort of anaemia patients ( n = 3325). In three cases, general practitioners were asked to select the laboratory tests for further diagnostic examination from a list of 14 parameters (i.e. routine work-up). In the other three cases, general practitioners were presented with all 14 laboratory test results available (i.e. extensive work-up). General practitioners were asked to determine the underlying cause of anaemia in all six cases based on the test results, and these answers were compared with the answers of an expert panel. Results A total of 139 general practitioners (partly) responded to the survey (17%). The general practitioners were able to determine the underlying cause of anaemia in 53% of cases based on the routine work-up, whereas 62% of cases could be diagnosed using an extensive work-up ( P = 0.007). In addition, the probability of a correct diagnosis decreased with the patient’s age and was also affected by the underlying cause itself, with anaemia of chronic disease being hardest to diagnose ( P = 0.003). Conclusion The use of an extensive laboratory work-up in patients with newly diagnosed anaemia is expected to increase the percentage of correct underlying causes established by general practitioners. Since the underlying cause can still not be established in 31.3% of anaemia patients, further research is necessary.

scholarly journals Assessing the cost-effectiveness of a routine versus an extensive laboratory work-up in the diagnosis of anaemia in Dutch general practice

2018 ◽  
Vol 55 (6) ◽  
pp. 630-638 ◽  
Author(s):  
Michelle MA Kip ◽  
Annemarie Schop ◽  
Karlijn Stouten ◽  
Soraya Dekker ◽  
Geert-Jan Dinant ◽  
...  
Keyword(s):  
General Practice ◽  
Cost Effectiveness ◽  
General Practitioners ◽  
Laboratory Work ◽  
Additional Patient ◽  
Decision Analytic Model ◽  
Published Data ◽  
Routine Work ◽  
The Cost ◽  
Work Up

Background Establishing the underlying cause of anaemia in general practice is a diagnostic challenge. Currently, general practitioners individually determine which laboratory tests to request (routine work-up) in order to diagnose the underlying cause. However, an extensive work-up (consisting of 14 tests) increases the proportion of patients correctly diagnosed. This study investigates the cost-effectiveness of this extensive work-up. Methods A decision-analytic model was developed, incorporating all societal costs from the moment a patient presents to a general practitioner with symptoms suggestive of anaemia (aged ≥ 50 years), until the patient was (correctly) diagnosed and treated in primary care, or referred to (and diagnosed in) secondary care. Model inputs were derived from an online survey among general practitioners, expert estimates and published data. The primary outcome measure was expressed as incremental cost per additional patient diagnosed with the correct underlying cause of anaemia in either work-up. Results The probability of general practitioners diagnosing the correct underlying cause increased from 49.6% (95% CI: 44.8% to 54.5%) in the routine work-up to 56.0% (95% CI: 51.2% to 60.8%) in the extensive work-up (i.e. +6.4% [95% CI: −0.6% to 13.1%]). Costs are expected to increase slightly from €842/patient (95% CI: €704 to €994) to €845/patient (95% CI: €711 to €994), i.e. +€3/patient (95% CI: €−35 to €40) in the extensive work-up, indicating incremental costs of €43 per additional patient correctly diagnosed. Conclusions The extensive laboratory work-up is more effective for diagnosing the underlying cause of anaemia by general practitioners, at a minimal increase in costs. As accompanying benefits in terms of quality of life and reduced productivity losses could not be captured in this analysis, the extensive work-up is likely cost-effective.

scholarly journals Diagnosis of cardiomyopathies: tips and tricks for internists and general practitioners

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Giuseppe Palmiero ◽  
Guido Carlomagno ◽  
Giacomo Lucivero
Keyword(s):  
General Practitioners ◽  
Imaging Technique ◽  
Simplified Approach ◽  
Complex Disorders ◽  
Cardiac Imaging Technique ◽  
Underlying Causes ◽  
Artery Disease ◽  
Diagnostic Work ◽  
And Function ◽  
Work Up

Cardiomyopathies are little known to internists and general practitioners (GPs), and not always able to arouse the interest of cardiologists. Probably, this happens because cardiomyopathies are perceived as rare and complex disorders, a prerogative of a few dedicated centers. This may partly explain why the diagnosis of cardiomyopathy is often missed and, consequently, why cardiomyopathies are largely underdiagnosed. Internists and general practitioners should have an interest in these conditions, because cardiomyopathies are not as rare as generally perceived, and because their complexity can be unravelled with knowledge and methodology. Cardiomyopathies are defined as myocardial disorders in which the heart is structurally and functionally abnormal in the absence of coronary artery disease or abnormal loading conditions. Irrespective of the cardiac imaging technique used, a limited number of phenotypes are defined based on ventricular morphology and function. These <em>basic phenotypes</em> include hypertrophic, dilated, restrictive and right ventricular arrhythmogenic cardiomyopathies. Aim of this review is to describe a simplified approach to the detection of the underlying causes of specific phenotypes. We will focus our attention on the basic phenotypes, presenting a diagnostic work-up and a suggestive clinical case for each phenotype.

Effect of Ibuprofen on Serum Laboratory Test Results

1983 ◽  
Vol 40 (6) ◽  
pp. 1025-1034
Author(s):  
Carol L. Colvin ◽  
Raymond J. Townsend ◽  
William R. Gillespie ◽  
Kenneth S. Albert
Keyword(s):  
Laboratory Test ◽  
Test Results ◽  
Laboratory Test Results

scholarly journals Influence of serum iron test results on the diagnosis of iron deficiency in children: a retrospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046865
Author(s):  
Gorkem Sezgin ◽  
Ling Li ◽  
Johanna Westbrook ◽  
Elisabeth Wearne ◽  
Denise Azar ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Observational Study ◽  
General Practitioners ◽  
Serum Ferritin ◽  
Serum Iron ◽  
Estimating Equation ◽  
Normal Serum ◽  
Retrospective Observational Study ◽  
Test Results ◽  
General Practices

Background and objectiveSerum iron results are not indicative of iron deficiency yet may be incorrectly used to diagnose iron deficiency instead of serum ferritin results. Our objective was to determine the association between serum iron test results and iron-deficiency diagnosis in children by general practitioners.Design, setting, patients and main outcome measuresA retrospective observational study of 14 187 children aged 1–18 years with serum ferritin and serum iron test results from 137 general practices in Victoria, Australia, between 2008 and 2018. Generalised estimating equation models calculating ORs were used to determine the association between serum iron test results (main exposure measure) and iron-deficiency diagnosis (outcome measure) in the following two population groups: (1) iron-deplete population, defined as having a serum ferritin <12 µg/L if aged <5 years and <15 µg/L if aged ≥5 years and (2) iron-replete population, defined as having a serum ferritin >30 µg/L.Results3484 tests were iron deplete and 15 528 were iron replete. Iron-deplete children were less likely to be diagnosed with iron deficiency if they had normal serum iron levels (adjusted OR (AOR): 0.73; 95% CI 0.57 to 0.96). Iron-replete children had greater odds of an iron-deficiency diagnosis if they had low serum iron results (AOR: 2.59; 95% CI 1.72 to 3.89). Other contributors to an iron-deficiency diagnosis were female sex and having anaemia.ConclusionSerum ferritin alone remains the best means of diagnosing iron deficiency. Reliance on serum iron test results by general practitioners is leading to significant overdiagnosis and underdiagnosis of iron deficiency in children.

scholarly journals Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers

2021 ◽  
Vol 10 (2) ◽  
pp. e001309
Author(s):  
Jennifer Gosling ◽  
Nicholas Mays ◽  
Bob Erens ◽  
David Reid ◽  
Josephine Exley
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
General Practitioners ◽  
Service Improvement ◽  
Protected Time ◽  
Routine Work ◽  
Professional Interest ◽  
Quality And Outcomes ◽  
Nationally Representative ◽  
The Uk

BackgroundThis paper presents the results of the first UK-wide survey of National Health Service (NHS) general practitioners (GPs) and practice managers (PMs) designed to explore the service improvement activities being undertaken in practices, and the factors that facilitated or obstructed that work. The research was prompted by growing policy and professional interest in the quality of general practice and its improvement. The analysis compares GP and PM involvement in, and experience of, quality improvement activities.MethodsThis was a mixed-method study comprising 26 semistructured interviews, a focus group and two surveys. The qualitative data supported the design of the surveys, which were sent to all 46 238 GPs on the Royal College of General Practitioners (RCGP) database and the PM at every practice across the UK (n=9153) in July 2017.ResultsResponses from 2377 GPs and 1424 PMs were received and were broadly representative of each group. Ninety-nine per cent reported having planned or undertaken improvement activities in the previous 12 months. The most frequent related to prescribing and access. Key facilitators of improvement included ‘good clinical leadership’. The two main barriers were ‘too many demands from external stakeholders’ and a lack of protected time. Audit and significant event audit were the most common improvement tools used, but respondents were interested in training on other quality improvement tools.ConclusionGPs and PMs are interested in improving service quality. As such, the new quality improvement domain in the Quality and Outcomes Framework used in the payment of practices is likely to be relatively easily accepted by GPs in England. However, if improving quality is to become routine work for practices, it will be important for the NHS in the four UK countries to work with practices to mitigate some of the barriers that they face, in particular the lack of protected time.

Quality benchmarking of smartphone laboratory medicine applications: comparison of laboratory medicine specialists’ and non-laboratory medicine professionals’ evaluation

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Snežana Jovičić ◽  
Joanna Siodmiak ◽  
Marta Duque Alcorta ◽  
Maximillian Kittel ◽  
Wytze Oosterhuis ◽  
...  
Keyword(s):  
Information Quality ◽  
Rating Scale ◽  
Laboratory Medicine ◽  
Test Results ◽  
Content Quality ◽  
Laboratory Test Results ◽  
System Usability Scale ◽  
Mobile Health Applications ◽  
Fit For Purpose ◽  
Health Applications

AbstractObjectivesThere are many mobile health applications (apps) now available and some that use in some way laboratory medicine data. Among them, patient-oriented are of the lowest content quality. The aim of this study was to compare the opinions of non-laboratory medicine professionals (NLMP) with those of laboratory medicine specialists (LMS) and define the benchmarks for quality assessment of laboratory medicine apps.MethodsTwenty-five volunteers from six European countries evaluated 16 selected patient-oriented apps. Participants were 20–60 years old, 44% were females, with different educational degrees, and no professional involvement in laboratory medicine. Each participant completed a questionnaire based on the Mobile Application Rating Scale (MARS) and the System Usability Scale, as previously used for rating the app quality by LMS. The responses from the two groups were compared using the Mann-Whitney U test and Spearman correlation.ResultsThe median total score of NLMP app evaluation was 2.73 out of 5 (IQR 0.95) compared to 3.78 (IQR 1.05) by the LMS. All scores were statistically significantly lower in the NLMP group (p<0.05), except for the item Information quality (p=0.1631). The suggested benchmarks for a useful appear: increasing awareness of the importance and delivering an understanding of persons’ own laboratory test results; understandable terminology; easy to use; appropriate graphic design, and trustworthy information.ConclusionsNLMP’ evaluation confirmed the low utility of currently available laboratory medicine apps. A reliable app should contain trustworthy and understandable information. The appearance of an app should be fit for purpose and easy to use.

scholarly journals COVID-19 and pregnancy – where are we now? A review

2020 ◽  
Vol 48 (5) ◽  
pp. 428-434 ◽  
Author(s):  
Aleksandra Rajewska ◽  
Wioletta Mikołajek-Bedner ◽  
Joanna Lebdowicz-Knul ◽  
Małgorzata Sokołowska ◽  
Sebastian Kwiatkowski ◽  
...  
Keyword(s):  
Case Fatality ◽  
Fetal Distress ◽  
Delivery Mode ◽  
Test Results ◽  
Rt Pcr ◽  
Third Trimester ◽  
The Third ◽  
Laboratory Test Results ◽  
Protective Antibodies ◽  
Polymerase Chain

AbstractThe new acute respiratory disease severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is highly contagious. It has caused many deaths, despite a relatively low general case fatality rate (CFR). The most common early manifestations of infection are fever, cough, fatigue and myalgia. The diagnosis is based on the exposure history, clinical manifestation, laboratory test results, chest computed tomography (CT) findings and a positive reverse transcription-polymerase chain reaction (RT-PCR) result for coronavirus disease 2019 (COVID-19). The effect of SARS-CoV-2 on pregnancy is not already clear. There is no evidence that pregnant women are more susceptible than the general population. In the third trimester, COVID-19 can cause premature rupture of membranes, premature labour and fetal distress. There are no data on complications of SARS-CoV-2 infection before the third trimester. COVID-19 infection is an indication for delivery if necessary to improve maternal oxygenation. Decision on delivery mode should be individualised. Vertical transmission of coronavirus from the pregnant woman to the fetus has not been proven. As the virus is absent in breast milk, the experts encourage breastfeeding for neonatal acquisition of protective antibodies.

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