Selecting clinically relevant populations for reference intervals

Author(s):  
Robert F. Ritchie ◽  
Glenn Palomaki

AbstractThe selection of individuals to represent a group for any purpose can commit the effort to success or failure from the very outset. The description of this group must reflect what is, in reality, the purpose for which the group is being studied. Considering that reference intervals are designed to assist clinicians during diagnostic triage, criteria must reflect the nature of the subjects entering the system for care. The majority of people seeking care have non-life-threatening, yet troublesome complaints. In other words, persons who are in aCompounding this awkward situation has been the conviction that by increasing laboratory precision and accuracy, the utility of laboratory data, reference intervals in particular, will improve clinical understanding. This has, after many years, not proven to be the case. What has become very evident, however, is that unsustainably large sums of money are being devoted to improving laboratory performance. To what end, when we are unable to grasp the significance of what is available now including published reference intervals for common test values?A realistic perspective on the value of prevailing laboratory performance, as illustrated by reference intervals, must be adopted. The obligation of laboratories, its regulators and professional groups is to create a sustainable mechanism to provide clinically usable information, in a timely and affordable manner, to our population and to those legions of less fortunate humans.

2021 ◽  
Vol 100 (2) ◽  
pp. 295-300
Author(s):  
Yu.V. Tikhonovich ◽  
◽  
A.Yu. Rtishchev ◽  
A.A. Glazyrina ◽  
D.Yu. Ovsyannikov ◽  
...  

For the first time in the domestic literature, the article presents a clinical observation of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 in the 6-year-old patient with manifestation of type 1 diabetes mellitus (T1DM) in the form of diabetic ketoacidosis. Anamnestic, clinical and laboratory data are presented on the basis of which two life-threatening diseases was diagnosed, as well as tactics of therapy, which made it possible to achieve a positive result. This clinical observation is compared with observations of foreign colleagues. Possible pathogenetic mechanisms of MIS-C and T1DM comorbidity are discussed.


2017 ◽  
Vol 55 (8) ◽  
pp. 1112-1114 ◽  
Author(s):  
Giuseppe Lippi ◽  
Gianfranco Cervellin ◽  
Mario Plebani

AbstractThe management of laboratory data in unsuitable (hemolyzed) samples remains an almost unresolved dilemma. Whether or not laboratory test results obtained by measuring unsuitable specimens should be made available to the clinicians has been the matter of fierce debates over the past decades. Recently, an intriguing alternative to suppressing test results and recollecting the specimen has been put forward, entailing the definition and implementation of specific algorithms that would finally allow reporting a preanalytically altered laboratory value within a specific comment about its uncertainty of measurement. This approach carries some advantages, namely the timely communication of potentially life-threatening laboratory values, but also some drawbacks. These especially include the challenging definition of validated performance specifications for hemolyzed samples, the need to producing reliable data with the lowest possible uncertainty, the short turnaround time for repeating most laboratory tests, the risk that the comments may be overlooked in short-stay and frequently overcrowded units (e.g. the emergency department), as well as the many clinical advantages of a direct communication with the physician in charge of the patient. Despite the debate remains open, we continue supporting the suggestion that suppressing data in unsuitable (hemolyzed) samples and promptly notifying the clinicians about the need to recollect the samples remains the most (clinically and analytically) safe practice.


2018 ◽  
Vol 11 (11) ◽  
pp. 6203-6230 ◽  
Author(s):  
Simon Ruske ◽  
David O. Topping ◽  
Virginia E. Foot ◽  
Andrew P. Morse ◽  
Martin W. Gallagher

Abstract. Primary biological aerosol including bacteria, fungal spores and pollen have important implications for public health and the environment. Such particles may have different concentrations of chemical fluorophores and will respond differently in the presence of ultraviolet light, potentially allowing for different types of biological aerosol to be discriminated. Development of ultraviolet light induced fluorescence (UV-LIF) instruments such as the Wideband Integrated Bioaerosol Sensor (WIBS) has allowed for size, morphology and fluorescence measurements to be collected in real-time. However, it is unclear without studying instrument responses in the laboratory, the extent to which different types of particles can be discriminated. Collection of laboratory data is vital to validate any approach used to analyse data and ensure that the data available is utilized as effectively as possible. In this paper a variety of methodologies are tested on a range of particles collected in the laboratory. Hierarchical agglomerative clustering (HAC) has been previously applied to UV-LIF data in a number of studies and is tested alongside other algorithms that could be used to solve the classification problem: Density Based Spectral Clustering and Noise (DBSCAN), k-means and gradient boosting. Whilst HAC was able to effectively discriminate between reference narrow-size distribution PSL particles, yielding a classification error of only 1.8 %, similar results were not obtained when testing on laboratory generated aerosol where the classification error was found to be between 11.5 % and 24.2 %. Furthermore, there is a large uncertainty in this approach in terms of the data preparation and the cluster index used, and we were unable to attain consistent results across the different sets of laboratory generated aerosol tested. The lowest classification errors were obtained using gradient boosting, where the misclassification rate was between 4.38 % and 5.42 %. The largest contribution to the error, in the case of the higher misclassification rate, was the pollen samples where 28.5 % of the samples were incorrectly classified as fungal spores. The technique was robust to changes in data preparation provided a fluorescent threshold was applied to the data. In the event that laboratory training data are unavailable, DBSCAN was found to be a potential alternative to HAC. In the case of one of the data sets where 22.9 % of the data were left unclassified we were able to produce three distinct clusters obtaining a classification error of only 1.42 % on the classified data. These results could not be replicated for the other data set where 26.8 % of the data were not classified and a classification error of 13.8 % was obtained. This method, like HAC, also appeared to be heavily dependent on data preparation, requiring a different selection of parameters depending on the preparation used. Further analysis will also be required to confirm our selection of the parameters when using this method on ambient data. There is a clear need for the collection of additional laboratory generated aerosol to improve interpretation of current databases and to aid in the analysis of data collected from an ambient environment. New instruments with a greater resolution are likely to improve on current discrimination between pollen, bacteria and fungal spores and even between different species, however the need for extensive laboratory data sets will grow as a result.


2009 ◽  
Vol 36 (10) ◽  
pp. 1667-1679 ◽  
Author(s):  
Ana Maria Ferreira da Silva

On the basis of previous work by the late Professor M. Selim Yalin and the author, the process of self-formation of alluvial streams and the final (equilibrium or regime) geometry of the self-formed stream are considered in the light of thermodynamic principles, including the first and second laws, and the Gibb’s equation; the stream is treated as an isolated and irreversible system. The present analysis suggests that stream self-formation is guided by the need of the stream to progressively decrease its average flow velocity to accommodate the increase in the entropy of the system with the passage of time. The reduction in flow velocity is achieved by an appropriate alteration of stream slope, cross-sectional geometry, and effective roughness, the regime development being the process of this appropriate alteration. A method is presented for the computation of regime width, depth, and slope. The method rests on the channel formation criterion derived from thermodynamic principles and the expression of regime flow width determined on the basis of zero net cross sediment transport rate at the regime state. The regime channels computed from this method are compared with field and laboratory data from various sources.


2020 ◽  
Vol 6 (2) ◽  
pp. 8-13
Author(s):  
Admin midwiferia ◽  
Pratiwi Cahya Skania ◽  
Djaswadi Dasuki ◽  
Fitriana Siswi Utami

Anemia is still a problem in developing countries. The World Health Organization states that there are still more than 50 percent of women in the world suffering from anemia. anemia can cause life-threatening bleeding, miscarriage, low birth weight and premature birth. WHO defines anemia as a condition where the hemoglobin level is less than 11 mg / dL in the first and last trimester or 10.5 mg / dL in the second trimester or the hematocrit level is less than 37 percent. The study aim to determine the effect of Fe tablets consumption on hemoglobin (Hb) level increase in pregnant women and to find out the factors related to the compliance of pregnant women taking Fe tablets.  This Systematic Literature Publication and Science uses databases with the period 2008-2018. The selection of articles was based on the inclusion and exclusion criteria. The Appraisal study employed The Joanna Briggs Institute Critical Appraisal Tools. Taking Fe tablets is very influential in increasing levels of Hb in pregnant women who suffer from anemia. Effective iron supplements to reduce anemia in pregnancy. Support from family and closest people has an important role in increasing adherence to taking Fe tablets.


Radiocarbon ◽  
1990 ◽  
Vol 32 (3) ◽  
pp. 267-270 ◽  
Author(s):  
G T Cook ◽  
D D Harkness ◽  
B F Miller ◽  
E M Scott ◽  
M S Baxter ◽  
...  

The success of any intercomparison exercise depends largely on participation and cooperation of a sufficient number of laboratories and the selection of a suitable suite of samples. Unless the latter is satisfactorily devised, the former cannot be guaranteed. The hierarchical nature of this study has necessarily resulted in a far more comprehensive set of sample types than has previously been employed. The exercise was structured to satisfy the following criteria: 1) to enable the participating laboratories to assess the experimental precision and accuracy of the component stages of the dating process; 2) samples should be typical of those routinely dated by the laboratories. This takes on a particular significance in Stage 1 where they should resemble as closely as possible the counting medium; 3) an objective statistical analysis of the results at each component stage of the study.


Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 104 ◽  
Author(s):  
Leslie A. Hamilton ◽  
Anthony J. Guarascio

Despite the widespread use of tetracycline antibiotics since the late 1940s, tetracycline hypersensitivity reactions have rarely been described in the literature. A comprehensive PubMed search was performed, including allergic and serious adverse reactions attributed to the tetracyclines class of antibiotics. Of the evaluated tetracycline analogs, minocycline was attributed to the greatest overall number and severity of serious adverse events reported in the literature, with notable reactions primarily reported as respiratory and dermatologic in nature. Reactions to tetracycline have also been well described in the literature, and although dermatologic reactions are typically less severe in comparison with minocycline and doxycycline, various reports of anaphylactic reactions exist. Although doxycycline has been noted to have had the fewest reports of severe allergic reactions, rare descriptions of life-threatening reactions are still reported in the literature. Allergic reactions regarding tetracyclines are rare; however, adverse reaction type, severity, and frequency among different tetracycline analogs is somewhat variable. A consideration of hypersensitivity and adverse reaction incidence should be performed prior to the selection of individual tetracycline entities.


1991 ◽  
Vol 37 (3) ◽  
pp. 430-434 ◽  
Author(s):  
Muriȵl Laureys ◽  
Jean-Pau Sion ◽  
Hans Slabbynck ◽  
Laurette Steenssens ◽  
Chrlsta Cobbaert ◽  
...  

Abstract The prevalence of circulating macromolecular creatine kinase type 1 (macro CK type 1 or CK-immunoglobulin complexes) is significantly higher in a patient population selected for CK isoenzyme assay than in age- and sex-matched blood donors (n = 1304). In greater than 8000 patients studied, 49 individuals with macro CK type 1 were identified, yielding an overall prevalence of 0.61%. Macro CK type 1 complexes occurred more frequently in women and in patients older than 70 years, and were often associated with complications of cardiovascular disease, life-threatening conditions, and poor outcome. These latter clinical associations could arise, at least partly, from the selection of patients for whom CK isoenzyme analysis was ordered.


1992 ◽  
Vol 27 (1) ◽  
pp. 43-56 ◽  
Author(s):  
Gary R. Peyton

Abstract AOPs can be modeled at several different levels, depending on the amount of kinetic information and computer resources available, and the purposes to which the results will be applied. Integration of the simplified rate equations gives the most information and provides the best check of the model with actual laboratory data. Even the simplest method discussed, comparison of target compound disappearance with oxidant consumption, is considerably better for optimization purposes than is simply comparing contaminant disappearance curves between experiments run under different conditions.


Blood ◽  
2019 ◽  
Vol 133 (5) ◽  
pp. 425-435 ◽  
Author(s):  
Siavash Piran ◽  
Sam Schulman

Abstract Anticoagulant therapy is often refrained from out of fear of hemorrhagic complications. The most frequent type of major bleeding is gastrointestinal, but intracranial hemorrhage has the worst prognosis. Management of these complications in patients on anticoagulants should follow the same routines as for nonanticoagulated patients, as described here with the previously mentioned bleeds as examples. In addition, for life-threatening or massive hemorrhages, reversal of the anticoagulant effect is also crucial. Adequate reversal requires information on which anticoagulant the patient has taken and when the last dose was ingested. Laboratory data can be of some help, but not for all anticoagulants in the emergency setting. This is reviewed here for the different types of anticoagulants: vitamin K antagonists, heparins, fondaparinux, thrombin inhibitors and factor Xa inhibitors. Specific antidotes for the latter are becoming available, but supportive care and nonspecific support for hemostasis with antifibrinolytic agents or prothrombin complex concentrates, which are widely available, should be kept in mind.


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