The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison With Published Practice Guidelines

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 623-627 ◽  
Author(s):  
Paul C. Young
Keyword(s):  
Primary Care ◽  
Practice Guidelines ◽  
Laboratory Tests ◽  
Blood Count ◽  
Response Rate ◽  
Expert Panel ◽  
Complete Blood Count ◽  
Age Groups ◽  
Design Case ◽  
Primary Care Pediatricians

Objective. To determine primary-care pediatricians' management of febrile infants and compare them with published practice guidelines. Design. Case scenarios were sent to 194 primary-care pediatricians in Utah, describing three febrile infants, ages 21 days, 60 days, and 20 months, corresponding to the three age groups: 0 to 28 days; 29 to 90 days, and 91 days to 36 months for which the guidelines suggest different strategies. Results. Ninety-four pediatricians responded (response rate, 48%). Compliance with the guidelines was 39% for the 21 day old, 9.6% for the 60 day old, and 75% for the 20 month old. No respondent followed the guidelines for all three infants. Performance of tests to determine if an infant was low risk varied from 3%, for a stool white cell examination in a febrile 2 month old with diarrhea, to 75% for a complete blood count in a 20 month old with a temperature of 40°C. Compliance did not differ between private and academic practitioners. Those in practice less than 5 years (n = 22) were more likely than those with more experience to follow the guidelines for the 21 day old but not the other two infants. Conclusion. Primary-care pediatricians in Utah manage febrile infants with fewer laboratory tests and less hospitalization than recent practice guidelines developed by an expert panel of academic specialists suggest.

Practice and Guidelines

PEDIATRICS ◽  
1996 ◽  
Vol 97 (4) ◽  
pp. 604-605
Author(s):  
John T. Benjamin
Keyword(s):  
Primary Care ◽  
Otitis Media ◽  
Practice Guidelines ◽  
Primary Care Pediatricians

As a former practicing pediatrician turned academic, I found the article entitled "The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison with Published Practice Guidelines"1 interesting if not disturbing. Three case scenarios were sent to 194 pediatricians: a 3-week-old infant with fever, a 2-month-old infant with rales and bilateral otitis media, and a 20-month-old infant with fever. Ninety-four pediatricians responded and their workups and approaches to treatment compared to ‘practice guidelines" developed by Baraff et al.2

scholarly journals NILAI RUJUKAN HEMATOLOGI PADA ORANG DEWASA SEHAT BERDASARKAN SYSMEX XT-1800i

2018 ◽  
Vol 12 (3) ◽  
pp. 137
Author(s):  
T Esa ◽  
S Aprianti ◽  
M Arif ◽  
Hardjoeno .
Keyword(s):  
Reference Values ◽  
Laboratory Tests ◽  
Blood Count ◽  
Healthy Adult ◽  
Blood Donation ◽  
Complete Blood Count ◽  
Reference Value

The reference values of laboratory tests are affected by factors such as instruments and methods of tests, which are always beingdeveloped. For these reasons, each laboratory is recommended to determine their own reference values. To determine the reference valuesof complete blood count in healthy adult people, and compare them to the reference values which is taken from the references. A crosssectional study was conducted on 200 healthy adult people, aged 18-60 years, selected during blood donation. The eight haematologicalparameters were estimated using Sysmex Xt-1800i at Dr.Wahidin Sudirohusodo Hospital. The data were analyzed statistically by SPSS11.5 programs. The reference values of leukocyte, erythrocyte, haemoglobin, hematocrit, MCV, MCH, MCHC and platelet were: 4400 to10000 /µL; %:4.2–6.2 × 106/µL; &:3.8–5.5 × 106/µL; %:12.5–17.3 g/dL; &:11.8–15.4 g/dL; %:38.1–50.4 %; &:31.1–49.7 %; 80,1to 94,3 fL, 25,9–31,9 pg, 31,4–35,2 g/dL, and %:171.2–405.1 × 103/µL; &:191.8–441.5 × 103/µL, respectively. Significant differenceswere observed in the MCH and platelet values (p< 0,005). The values found in this study were similar to the reference value commonlyused in our laboratory, except for the MCH value which was lower and the platelet value which was higher..

scholarly journals The Correlation between Complete Blood Count Parameters and Appendix Diameter for the Diagnosis of Acute Appendicitis

Healthcare ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 39 ◽  
Author(s):  
Emin Daldal ◽  
Hasan Dagmura
Keyword(s):  
Acute Appendicitis ◽  
Laboratory Tests ◽  
Blood Count ◽  
Complete Blood Count ◽  
Lymphoid Hyperplasia ◽  
White Blood Count ◽  
C Reactive Protein ◽  
Distribution Width ◽  
Lymphocyte Ratio ◽  
Reactive Protein

Acute appendicitis is one of the most common causes of acute abdominal diseases seen between the ages of 10 and 19, mostly seen in males. The lifetime risk of developing acute appendicitis is 8.6% for males and 6.7% for females. We aimed to investigate the efficacy of the complete blood count parameters, C-reactive protein, and Lymphocyte-C-reactive Protein Ratio laboratory tests in the diagnosis of acute appendicitis, as well as their relationship with appendix diameter. We retrospectively examined all patients who underwent appendectomy between 1 January 2012 and 30 June 2019 in the General Surgery Clinic of Gaziosmanpasa University Faculty of Medicine. Laboratory tests, imaging findings, age, and gender were recorded. Lymphoid hyperplasia is considered as normal appendix—in other words, as negative appendicitis. The distribution of Lymphoid hyperplasia and appendicitis rates were statistically different in the groups formed according to appendix diameter (≤6 and >6 mm) (p < 0.001). We found a significant correlation between appendix diameter and WBC (White blood count), Lymphocyte, Neutrophil, RDW(Red blood cell distribution width), NLR(Neutrophil to lymphocyte ratio), and PLT/L (Platelet to lymphocyte ratio), MPV (Mean platelet volume) and RDW were significantly different in patients with an appendix diameter of ≤6 mm (p = 0.007, p = 0.006, respectively). WBC, Neutrophil, PDW, and NLR values were significantly different between appendicitis and hyperplasia groups in patients with an appendix diameter of >6 mm. The sensitivity of the NLR score (cutoff = 2.6057) in the diagnosis of appendicitis was 86.1% and selectivity was 50% in these patients. Complete blood count parameters evaluation with the clinical findings revealed that NLR is an important parameter that may help the diagnosis of acute appendicitis with an appendix diameter of >6 mm. In patients whose pathological results indicated acute appendicitis but who had a diameter of ≤6 mm, we found an elevated MPV and low RDW values.

Concern About Guidelines

PEDIATRICS ◽  
1995 ◽  
Vol 96 (3) ◽  
pp. 544-544
Author(s):  
Chuck Lallier
Keyword(s):  
Primary Care ◽  
Practice Guidelines ◽  
Treatment Options ◽  
The Individual ◽  
Primary Care Pediatricians

I enjoyed reading Dr Paul Young's article "The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison With Published Practice Guidelines" in the May 1995 issue of Pediatrics. It seems we, as general pediatricians, are barraged with an increasing number of "guidelines" for the management of everything from fever to hyperbilirubinemia. These guidelines are very useful in helping one think of diagnostic/treatment options, but need to leave a lot of room for variation with the individual patient.

scholarly journals A Comparison of Complete Blood Count Reference Intervals in Healthy Elderly Versus Younger Korean Adults: A Large Population Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4708-4708
Author(s):  
Young Kyung Lee ◽  
Eun Jin Lee ◽  
Miyoung Kim ◽  
Eunyup Lee ◽  
Kibum Jeon ◽  
...  
Keyword(s):  
Blood Count ◽  
Complete Blood Count ◽  
Conflicts Of Interest ◽  
Large Population ◽  
Age Groups ◽  
Reference Interval ◽  
Reference Intervals ◽  
Healthy Elderly ◽  
Elderly Koreans ◽  
Lower Limits

Abstract Background: The use of laboratory reference intervals based on younger populations is of questionable validity in older populations. We established reference intervals for 16 complete blood count (CBC) parameters in healthy elderly Koreans aged ≥60 years and compared them to those of individuals aged 20-59 years. Methods: Among 64,532 individuals (39,609 men and 24,923 women) aged ≥20 years who underwent medical check-ups, 8,151 healthy subjects (12.6%, 5,270 men and 2,881 women, including 675 and 511, respectively, who were ≥60 years of age) were enrolled based on stringent criteria including laboratory, imaging, and endoscopy results; previous medical history; and medication history. CBC parameters were measured using an Advia2120i instrument. The difference between 2 age groups in subjects of each sex was compared using the Mann-Whitney U-test. P-values <0.05 were considered statistically significant. The reference intervals for measured CBC parameters were established according to a nonparametric method based on the CLSI EP28A-3C in each subgroup. The 90% confidence intervals for the upper and lower limits of each reference interval were calculated; the Reed method was used to remove extreme outliers. The Harris and Boyd method was used to determine the necessity of separating the reference intervals for different age groups within each sex group. To identify reference intervals in different age groups in individuals aged 60 years and over, such individuals of each sex were subdivided into 5 age subgroups with 5-year age interval: since the sizes of 4 of these subgroups were not sufficiently large, we used the Robust method. Results: A statistical difference in the medians of the following parameters were observed between the <60- and ≥60-year age groups: RBC, Hb, hematocrit (Hct), basophils, and platelets in men aged <60 years were higher than those in men aged ≥60 years; furthermore, MCV, MCH, and RDW in men aged ≥60 years were higher than those in men aged <60 years. Neutrophils in women aged <60 years were higher than in those aged ≥60 years. Hb, Hct, MCV, MCH, MCHC, lymphocytes, and basophils in women aged ≥60 years were higher than in those aged <60 years. Separate reference intervals were required only for RDW and MCH in women ≥60 from those < 60 years of age. Men aged ≥60 years versus those <60 years did not require separate reference intervals for any of the 16 measured parameters. In subjects aged ≥60 years, RBC, Hb, Hct, MCV, MCH, MCHC, RDW, WBC, neutrophils, monocytes, eosinophils, MPV, and PDW were higher in men than in women, while the opposite was true for lymphocytes and platelets. Partitioning of reference intervals by sex was required for RBC, Hb, Hct, MCH, monocytes, and eosinophils. In men, median values and the lower limits of the reference intervals for RBC, Hb, and Hct tended to decrease with advancing age. The upper and lower limits of reference intervals for WBC, neutrophils, lymphocytes, and MPV also showed increasing and decreasing tendencies, respectively, widening the reference intervals as the subjects aged (except in the 70-74-year-old group for men). Among women, the lower limits of the reference intervals for RBC, Hb, and Hct showed a tendency to decrease with increasing age for those >70 years of age; however, the median values did not show such a tendency. The reference interval for PDW narrowed as women aged. Separate reference intervals were required among men for MCH and eosinophils in the 70-74-year group, and for basophils in the 65-69-year group. Among women, separate reference intervals were required for MCV in the 65-69-year group; for MCH in the 60-64, 65-69, and ≥75-years groups; and for RDW in all the 4 elderly age subgroups. Conclusion: Healthy elderly Koreans can use the same reference intervals as younger populations. Thus, abnormal CBC results may not necessarily be attributable to physiologic changes but possible underlying diseases that should be investigated. Disclosures No relevant conflicts of interest to declare.

The Complete Blood Count

2010 ◽  
Vol 29 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Terri Lynne Milcic
Keyword(s):  
Gestational Age ◽  
Laboratory Tests ◽  
Blood Count ◽  
Neonatal Period ◽  
Complete Blood Count ◽  
Clinical Information ◽  
Diagnostic Assessment ◽  
Reference Ranges ◽  
Hematopoietic System ◽  
Common Laboratory

THE COMPLETE BLOOD COUNT (CBC) is one of the more common laboratory tests ordered during the neonatal period. The CBC may be obtained to evaluate for anemia, infection, and thrombocytopenia.1 The test offers a wealth of clinical information about the hematopoietic system, including erythrocyte, leukocyte, and thrombocyte values. Establishing normal neonatal ranges has been difficult because blood has not been drawn on healthy neonates of similar ages.2 Reference ranges that consist of the 5th to 95th percentile compiled from various studies have been used to approximate normal neonatal values.3 A variety of factors such as sample site, timing of the sample, gestational age, and the neonate’s degree of health can affect the CBC.1 Therefore, the astute practitioner must be able to recognize the clues and nuances of the CBC to guide the diagnostic assessment.4

scholarly journals Complete Blood Count (CBC) Status among Hypertensive Subjects in Isiala Mbano, Imo State, South East, Nigeria

2020 ◽  
pp. 62-72
Author(s):  
M. U. Elendu ◽  
A. A. Nwankwo ◽  
J. N. Egwurugwu ◽  
P. I. Ugwu ◽  
P. C. Ugwuezumba ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Count ◽  
Complete Blood Count ◽  
Venous Blood ◽  
Age Groups ◽  
Heart Association ◽  
Age Group ◽  
Imo State ◽  
Normotensive Subjects ◽  
Wbc Count

Aim: The Complete Blood Count (CBC) among hypertensive subjects in Isiala Mbano, Imo State, Nigeria West Africa were studied. Methodology: The American College of Cardiology/American Heart Association (2017) current definition of hypertension was used to ascertain, diagnoses and assigned eighty (80)hypertensive subjects after three different consecutive blood pressure check into tests groups. Other blood pressure measures such as pulse pressure and mean arterial pressure were calculated appropriately. Venous blood samples were collected with 5mls syringe and immediately emptied into EDTA container for complete blood count analysis. Results: The results showed increase in RBC count, HB, PCV and decrease in MCV among hypertensive subjects compared with normotensive subjects. It was statistically insignificant in all age groups. No changes were seen in MCHC and MCH. The results also, showed increase in PLTS count. The increase in PLTS count was statistically significant at P<0.05 and <0.001 among hypertensive age groups 36-65yrs and >66yrs respectively. Increase in PLTS count among 20-35yr age group was not significant. There were increase in WBC count among hypertensive subjects compared with normotensive subjects in all age groups. It was statistically significant at P<0.05 and <0.001 among hypertensive age groups 36-50yrs and >66yrs respectively. Neutrophil was increased in all age groups and was statistically significant at P<0.05 except 20-35yr age group. No changes were seen on lymphocytes, monocytes, eosinophils and basophils. Conclusion: Haematological parameters investigated could predict possible cardiovascular abnormalities such as hypertension.

scholarly journals Hirudin as an anticoagulant for both haematology and chemistry tests

2000 ◽  
Vol 22 (4) ◽  
pp. 109-112 ◽  
Author(s):  
Takeo Kumura ◽  
Masayuki Hino ◽  
Takahisa Yamane ◽  
Noriyuki Tatsumi
Keyword(s):  
Blood Cells ◽  
Laboratory Tests ◽  
Blood Count ◽  
Complete Blood Count ◽  
Clinical Chemistry ◽  
Laboratory Medicine ◽  
Differential Count ◽  
Blood Collection ◽  
Tetraacetic Acid ◽  
Coagulation Pathway

Hirudin, an extract from the leech, has powerful antithrombin activity affecting the blood coagulation pathway. We evaluated the usefulness of hirudin in anticoagulating specimens for routine laboratory tests. Results using blood anticoagulated with hirudin corresponded well with results with blood treated with ethylenediamine tetraacetic acid (EDTA) in the complete blood count (CBC), including white blood cell (WBC) differential count and morphology of blood cells, when CBC was performed within 2 h of blood collection. Clinical chemistry results from hirudin-treated samples were similar to results obtained with serum specimens. Thus, hirudin may be a useful anticoagulant for emergency laboratory medicine.

Wstępna diagnostyka chorób krwi

2021 ◽  
Vol 99 (4) ◽  
pp. 177-181
Author(s):  
Wiesław Wiktor Jędrzejczak
Keyword(s):  
Laboratory Tests ◽  
Blood Count ◽  
Urine Analysis ◽  
Complete Blood Count ◽  
Doctor Who ◽  
Blood Disorders ◽  
Blood Disorder ◽  
Erythrocyte Sedimentation ◽  
Initial Symptoms ◽  
Current Article

Final result of treatment of majority of neoplastic and non‑neoplastic blood disorders depends on their early diagnosis and immediate referral to hematologist. This determines that initial hematological diagnosis has to be carried out on the level of family physician or other doctor, who in the process of diagnosis of other disorder will detect abnormalities that may suggest a blood disorder. Current article concerns the use of a triad of laboratory tests: complete blood count, erythrocyte sedimentation rate, and urine analysis. Borderline values are provided that should prompt referral to a hematologist, and it is explained why these particular values were accepted. Common use of such information should shorten time from initial symptoms of blood disorders to the beginning of therapy.

Profile of General Practices in Malaysia

1998 ◽  
Vol 10 (2) ◽  
pp. 88-93
Author(s):  
Khoo Ee Ming ◽  
Christina Tan Phoay Lay
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Laboratory Tests ◽  
Response Rate ◽  
Medical Practitioners ◽  
Community Activities ◽  
Postgraduate Qualification ◽  
General Practices ◽  
The Mean ◽  
Primary Care Medicine

In this survey all practices under the headings of “Clinics”, “Medical Practitioners” and “Medical Practitioners - Registered” in the Yellow Pages telephone directories for the thirteen states of Malaysia were selected. Those excluded were clinics or medical practitioners who advertised themselves as specialists in other disciplines. A total of 2291 practices were surveyed and a response rate of 51.2% was obtained. 383(33%) of the general practitioners were trained locally for the first degree. 258(22%) had at least one postgraduate qualification. 69(6%) possessed a postgraduate qualification in primary care medicine. About 80% of general practitioners participated in continuing medical education and 4% did research in the last 3 years. 42% were involved in community activities. 75% ran solo practices. Over 90% of the practices opened six or seven days a week. The mean workload per doctor per day was 44.66. Most practices provided a comprehensive range of services including curative, preventive, dispensing services, counselling, laboratory tests, and home visits. 43% of practices had a computer.

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