scholarly journals What Alert Thresholds Should Be Used to Identify Critical Risk Results: A Systematic Review of the Evidence

2016 ◽  
Vol 62 (11) ◽  
pp. 1445-1457 ◽  
Author(s):  
Craig A Campbell ◽  
Andrew Georgiou ◽  
Johanna I Westbrook ◽  
Andrea R Horvath
Keyword(s):  
Laboratory Tests ◽  
Literature Search ◽  
State Of The Art ◽  
Significant Risk ◽  
Well Being ◽  
Laboratory Medicine ◽  
Outcome Studies ◽  
Confounding Factors ◽  
Performance Specifications ◽  
American Laboratory

Abstract BACKGROUND Pathology laboratories are required to immediately report results which indicate a patient is at critical risk, but there is little consensus about what values are deemed critical. The aim of this review was to systematically review the literature on alert thresholds for common chemistry and hematology tests in adults and to provide an explicit and ranked source of this evidence. METHODS The literature search covered the period of 1995–2014. Evidence sources were critically appraised and ranked using the 1999 Stockholm hierarchy for analytical performance specifications in laboratory medicine modified for establishing decision limits. RESULTS The 30 most frequently reported laboratory tests with alert thresholds are presented with evidence rankings. Similar thresholds were reported in North America, Europe and Asia. Seventy percent of papers reported thresholds set by individual institutions, while 18% contained thresholds from surveys of laboratories or clinicians. Forty-six percent of the papers referred to 1 or both of the 2 American laboratory surveys from the early 1990s. “Starter sets” of alert thresholds were recommended by 6 professional bodies, 3 of which were collaborations between pathologists and clinicians. None of the 9 outcome studies identified dealt with confounding factors. CONCLUSIONS Recommendations by professional bodies based on outdated surveys of the former state of the art or consensus are currently the best sources of evidence for laboratories to build their alert list. Well-designed outcome studies and greater collaboration between clinicians and the laboratory are needed to identify the most appropriate alert thresholds that signify actionable, critical or significant risk to patient well-being.

scholarly journals Plant-based fructans for increased animal welfare: provision processes and remaining challenges

2021 ◽  
Author(s):  
A. Zimmermann ◽  
C. Visscher ◽  
M. Kaltschmitt
Keyword(s):  
Animal Welfare ◽  
Dietary Fibre ◽  
Animal Feed ◽  
State Of The Art ◽  
Public Awareness ◽  
Well Being ◽  
Glycosidic Bonds ◽  
Health Promoting ◽  
Branched Structure ◽  
Stimulation Of

AbstractFructans are carbohydrates consisting of fructose monomers linked by β-2,1- and/or β-2,6-glycosidic bonds with linear or branched structure. These carbohydrates belong to the group of prebiotic dietary fibre with health-promoting potential for humans and mammals due to their indigestibility and selective stimulation of microorganisms in the gastrointestinal tract. This makes fructans interesting mainly for healthy food as well as animal feed applications. As a consequence of a growing public awareness for animal welfare, dietary fibre and thus fructans move into the focus as a fibre-rich feeding improving not only animals’ health but also their well-being. Against this background, this paper summarises the known effects of fructans focusing on pigs and highlights the state of the art in fructan production processes from plant material as well as selected current research lines. Additionally, an attempt is made to assess the potential of European fructan production for an application as animal feed. Based on this, challenges in the field of fructan production are addressed and alternative substrates for fructans are discussed and pointed out.

scholarly journals Spanish society of laboratory medicine external quality assurance programmes: evolution of the analytical performance of clinical laboratories over 30 years and comparison with other programmes

2020 ◽  
Vol 1 (2) ◽  
Author(s):  
Carmen Perich ◽  
Carmen Ricós ◽  
Fernando Marqués ◽  
Joana Minchinela ◽  
Angel Salas ◽  
...  
Keyword(s):  
Quality Assurance ◽  
State Of The Art ◽  
Laboratory Medicine ◽  
Analytical Performance ◽  
External Quality Assurance ◽  
Biological Variability ◽  
External Quality ◽  
Spanish Society ◽  
Clinical Laboratories ◽  
Quality Specifications

AbstractThe purpose of this study is to understand the evolution of the analytical performance of the laboratories participating in the Spanish society of laboratory medicine (SEQCML) external quality assurance (EQA) programmes during its 30 years of operation and to compare it with the performance of other EQA programmes to establish whether the results are similar. The results obtained during this period are evaluated by applying the biological variability (BV) and state of the art-derived quality specifications. In addition, the results are compared with those obtained by other EQA programme organisations. It is noted that the laboratories participating in the EQA–SEQCML programmes have improved their performance over 30 years of experience and that the specifications derived from biological variation are achievable. It is difficult to compare EQA programmes, due to lack of accessibility and the differences in the design of these programmes (control materials, calculations used and analytical specifications established). The data from this study show that for some biological magnitudes the results obtained by the programmes are not yet harmonised, although efforts are being made to achieve this. Organisers of EQA programmes should also join the harmonisation effort by providing information on their results to enable comparison.

scholarly journals Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Marta Claramonte Nieto ◽  
Eva Meler Barrabes ◽  
Sandra Garcia Martínez ◽  
Mireia Gutiérrez Prat ◽  
Bernat Serra Zantop
Keyword(s):  
Risk Factor ◽  
Gestational Diabetes ◽  
Maternal Age ◽  
Placenta Previa ◽  
Significant Risk ◽  
Advanced Maternal Age ◽  
Obstetric Outcomes ◽  
Chronic Hypertension ◽  
Mediterranean Population ◽  
Confounding Factors

Abstract Background Women of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona. Methods Retrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed. Results A total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30–39, 40–44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40–44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50–2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30–5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found. Conclusions Maternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population.

Bridging the Gap With Choosing Wisely Recommendations: What Laboratory Topics Matter Most to Other Medical Specialty Societies?

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S143-S143
Author(s):  
Barbara Caldwell
Keyword(s):  
Women’S Health ◽  
Women's Health ◽  
Laboratory Tests ◽  
Pap Smear ◽  
Medical Specialty ◽  
Laboratory Medicine ◽  
Choosing Wisely ◽  
Topic Area ◽  
Medical Specialties ◽  
Smear Testing

Abstract Introduction This study sought to evaluate the nature and frequency of laboratory recommendations made by medical societies other than ASCP. Methods Review of all 2012 to 2018 ABIM Choosing Wisely (CW) non-ASCP laboratory recommendations and categorization of recommendations per topic area. Results There are 107 total recommendations made by other medical specialties that involve laboratory medicine. The most common recommendations are (1) Transfusion Medicine: to minimize transfusion of PRCs (19 recommendations, 18%); (2) Women’s Health: Pap smear testing, other women’s health testing (18 recommendations, 17%); and (3) General Laboratory: reducing repetitive routine laboratory tests (10 recommendations, 9%). Most (64, 60%) recommendations addressed screening while 29 (27%) focused on treatment and 14 (13%) were related to monitoring disease. Conclusion Almost one-half (44%) of all recommendations fell into three common areas and there were more recommendations related to screening for disease than for treatment or monitoring. For Choosing Wisely to achieve increasing success, increasing efforts are needed to disseminate this information, promote multidisciplinary effective test utilization, and encourage continued laboratory medicine recommendations from all medical stakeholders.

scholarly journals A Combined Approach to Predicting Rest in Dogs Using Accelerometers

Sensors ◽  
2018 ◽  
Vol 18 (8) ◽  
pp. 2649 ◽  
Author(s):  
Cassim Ladha ◽  
Christy Hoffman
Keyword(s):  
Resting State ◽  
State Of The Art ◽  
Hybrid Approach ◽  
Well Being ◽  
Housing Conditions ◽  
Combined Approach ◽  
Current State ◽  
Healthy Dogs ◽  
State Of Rest ◽  
Health And Well Being

The ability to objectively measure episodes of rest has clear application for assessing health and well-being. Accelerometers afford a sensitive platform for doing so and have demonstrated their use in many human-based trials and interventions. Current state of the art methods for predicting sleep from accelerometer signals are either based on posture or low movement. While both have proven to be sensitive in humans, the methods do not directly transfer well to dogs, possibly because dogs are commonly alert but physically inactive when recumbent. In this paper, we combine a previously validated low-movement algorithm developed for humans and a posture-based algorithm developed for dogs. The hybrid approach was tested on 12 healthy dogs of varying breeds and sizes in their homes. The approach predicted state of rest with a mean accuracy of 0.86 (SD = 0.08). Furthermore, when a dog was in a resting state, the method was able to distinguish between head up and head down posture with a mean accuracy of 0.90 (SD = 0.08). This approach can be applied in a variety of contexts to assess how factors, such as changes in housing conditions or medication, may influence a dog’s resting patterns.

scholarly journals Role of social support in tobacco cessation

2017 ◽  
Vol 4 (11) ◽  
pp. 3942 ◽  
Author(s):  
Shruthi P. S. ◽  
Niveditha B. S. ◽  
Punith Shetty ◽  
Krishna Chaitanya ◽  
Naveen Khargekar
Keyword(s):  
Social Support ◽  
Behaviour Change ◽  
Relapse Prevention ◽  
Tobacco Cessation ◽  
Literature Search ◽  
Well Being ◽  
Psychological Well Being ◽  
Tobacco Intervention ◽  
Comprehensive Literature Search

Most tobacco intervention focus on behavioural methods to reduce dependence, the role of social support is unclear. The objective is to evaluate the evidence of social support as well as its efficacy with respect to tobacco cessation. It explores to understand the role of social support for an individual to make a behaviour change. Social support is one resource in the environment, if used effectively can be extremely beneficial for someone wanting to quit tobacco. A comprehensive literature search on the contribution of social support with respect to tobacco cessation was conducted to give a practical review for practitioners in the field. Overall, it was seen that all the studies strengthened the evidence for the role of social support in tobacco cessation. Although, more research is required in this field to comprehend the long haul advantages of social support and additionally its effects on psychological well-being as well as relapse prevention. 

scholarly journals Conflict between Guideline Methodologic Quality and Recommendation Validity: A Potential Problem for Practitioners

2006 ◽  
Vol 52 (1) ◽  
pp. 65-72 ◽  
Author(s):  
Joseph Watine ◽  
Bruno Friedberg ◽  
Eva Nagy ◽  
Rita Onody ◽  
Wytze Oosterhuis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Practice Guidelines ◽  
Laboratory Tests ◽  
Current Practice ◽  
Research Evidence ◽  
Potential Problem ◽  
Guideline Development ◽  
Laboratory Medicine ◽  
Small Cell Lung ◽  
Methodologic Quality

Abstract Background: It is not clear if good methodologic quality in current practice guidelines necessarily leads to more valid recommendations, i.e., those that are supported with consistent research evidence or, when evidence is conflicting or lacking, with sufficient consensus among the guideline development team. To help clarify this issue, we assessed whether there is a link between methodologic quality and recommendation validity in practice guidelines for the use of laboratory tests in the management of patients with non-small cell lung cancer (NSCLC). Methods: We conducted a systematic review of data on laboratory tests in NSCLC published in English or in French within the last 10 years and retrieved 11 practice guidelines for the use of these tests. The guidelines were critically appraised and scored for methodologic quality and recommendation validity based on the Appraisal of Guidelines Research and Evaluation (AGREE) criteria and on the systematic review. Results: Overall, these 11 guidelines had considerable shortcomings in methodologic quality and, to a lesser extent, in recommendation validity. Practice guidelines with the best methodologic quality were not necessarily the most valid in their recommendations, and conversely. Conclusions: Poor methodologic quality and lack of recommendation validity in laboratory medicine call for methodologic standards of guideline development and for international collaboration of guideline development agencies. We advise readers of guidelines to critically evaluate the methods used as well as the content of the recommendations before adopting them for use in practice.

scholarly journals Association of Breastfeeding with Asthma in Young Aboriginal Children in Canada

2012 ◽  
Vol 19 (6) ◽  
pp. 361-366 ◽  
Author(s):  
Ming Ye ◽  
Piushkumar J Mandhane ◽  
Ambikaipakan Senthilselvan
Keyword(s):  
Multiple Logistic Regression Analysis ◽  
Age Groups ◽  
Significant Risk ◽  
Well Being ◽  
Asthma Prevalence ◽  
Asthma Incidence ◽  
Early Life Factors ◽  
Male Sex ◽  
Aboriginal Children ◽  
Older Siblings

BACKGROUND: Few studies have investigated the factors associated with asthma in young Aboriginal children.OBJECTIVE: To characterize the association of demographic, environmental and early life factors with asthma in young Aboriginal children in Canada.METHODS: The 2006 Aboriginal Children’s Survey was conducted among off-reserve Aboriginal children zero to six years of age to obtain information on Aboriginal children’s development and well-being. The prevalence of asthma in Aboriginal children was obtained from the parental report of asthma as diagnosed by a health care professional.RESULTS: The prevalence of reported asthma among off-reserve Aboriginal children zero to six years of age (n=14,170) was 9.4%. Asthma prevalence in both exclusively breastfed children (6.8%) and ever but not exclusively breastfed children (9.0%) was significantly lower than that in nonbreastfed children (11.0%). In the multiple logistic regression analysis, exclusive breastfeeding was protective of asthma compared with nonbreastfeeding (OR 0.59 [95% CI 0.44 to 0.78]). Older age groups, male sex, having two or more older siblings, low birth weight, day care attendance and ear infection were significant risk factors for asthma.CONCLUSIONS: The prevalence of asthma among young Aboriginal children zero to six years of age living off reserve was slightly lower than that reported for all other Canadian children. Breastfeeding, especially exclusively breastfeeding, was protective of asthma in Aboriginal children, which is consistent with what has been observed in non-Aboriginal children in Canada. Public health interventions intended for reducing asthma incidence in young Aboriginal children should include breastfeeding promotion programs.

Innovation in Laboratory Medicine

2019 ◽  
pp. 117-137
Author(s):  
Carlos Lemos
Keyword(s):  
Cost Effectiveness ◽  
Resource Management ◽  
Outcome Measures ◽  
Laboratory Tests ◽  
Laboratory Medicine ◽  
Process Change ◽  
Medical Test ◽  
A Value ◽  
Improve Patient

Laboratory medicine has a unique capability to evaluate the correct management of a medical test, its results, and the decisions it can determine. Therefore, laboratory medicine should try to improve patient outcomes, while improving quality and productivity, so that innovation in healthcare may proceed. Innovation in laboratory medicine demands an adequate identification of the unmet clinical need, evidence of clinical and cost-effectiveness of laboratory tests, and a managed implementation that takes into account the process change, appropriate resource management, and monitoring of outcomes. The main objectives of this chapter are to elucidate the role of innovation in laboratory medicine, identifying its main issues and the barriers it faces; to define a value proposition for laboratory tests and to point out several outcome measures that can be adopted in laboratory medicine.

scholarly journals Cost, profitability and value of laboratory diagnostics: in God we trust, all others bring data

2018 ◽  
Vol 0 (0) ◽  
Author(s):  
Giuseppe Lippi ◽  
Mario Plebani
Keyword(s):  
Laboratory Tests ◽  
Clinical Pathways ◽  
Laboratory Medicine ◽  
Scale Economy ◽  
Therapeutic Monitoring ◽  
Laboratory Diagnostics ◽  
Clinical Value ◽  
Healthcare Budget ◽  
The Impact ◽  
Diagnostic Investigations

Abstract Although laboratory tests are the most used diagnostic investigations for screening, diagnosing, prognosticating and therapeutic monitoring of most human diseases, laboratory medicine is currently seen as many other economic industries by some policymakers and administrators, and is hence subjected to scale economy and assessed accordingly, despite the incremental clinical value that laboratory tests can generate. According to a genuine economic perspective, the impact of diagnostic testing on a healthcare budget is lower than 2.5%, whilst its profitability is over 100%, a net profit margin over 7-fold larger than whatever other human industry. Even more importantly, the impact of laboratory tests on clinical outcomes is now clear and virtually incontestable, as their use will improve clinical pathways much more than any other diagnostic investigations. The many ongoing attempts to downsize the importance of laboratory medicine as costs centers, or even the concept that public laboratory services can be safely eliminated or outsourced to external private professional organizations, shall hence be challenged. Laboratory medicine not only is vital to patient care and patient flow, and will remain so for many years to come, but is also a valuable economical resource for the healthcare facilities.

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