scholarly journals Attitudes and beliefs of emergency physicians on lab tests utilization in clinical practice. A multicenter survey

2019 ◽  
Vol 15 (3) ◽  
Author(s):  
Carlotta Saccenti ◽  
Marco Lunian ◽  
Martina Montagnana ◽  
Andrea Balloni ◽  
Giulia Maria Azin ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Pathways ◽  
Medical Knowledge ◽  
Nationwide Survey ◽  
Laboratory Diagnostics ◽  
Attitudes And Beliefs ◽  
Emergency Physicians ◽  
Digital Format ◽  
Multicenter Survey ◽  
Real Scenario

It is commonly perceived that the main obstacle for an effective partnership between Emergency Medicine (EM) and Laboratory Medicine (LM) is the lack of reciprocal knowledge and understanding. A further aspect is a partial comprehension of clinical significance and implications of some tests. The real scenario of attitudes and beliefs of Emergency Physicians (EPs) on lab tests utilization in clinical practice remains largely unclear. Therefore, this original study was designed to explore this field of medical knowledge, by using a survey on attitudes and beliefs in laboratory diagnostics which was disseminated among many Italian EPs. A questionnaire containing 20 different items/statements was designed and then disseminated either directly, or in a digital format. Overall, 183 questionnaires were compiled and collected. The results of this nationwide survey seem to confirm the existence of a suboptimal knowledge of both clinical and economic impact of urgent laboratory tests by Italian EPs. An unsatisfactory relationship between EPs and laboratory professionals seems also to emerge. Several EPs attribute this to Shortage of time to think (18.6%), followed by Fair of medical-legal litigation (13.6%). On the other hand, interestingly, it also emerged that some Italian hospitals still include obsolete o redundant tests in panels of urgent laboratory analyses, potentially misleading for the diagnostic reasoning in the Emergency Department (ED). In conclusion, the virtuous circle between EM and LM should be further reinforced for optimizing clinical pathways in Italian EDs, improving clinical outcomes and reducing unnecessary expenditures. A major agreement between laboratory and emergency professionals

Achilles tendinopathy attitudes and beliefs, knowledge and clinical practice: Survey of Brazilian physical therapists

2021 ◽  
Vol 47 ◽  
pp. e1
Author(s):  
Paulo Ricardo Pinto Camelo ◽  
Rodrigo Ribeiro de Oliveira ◽  
Maria Fernanda Mendonça de Sousa ◽  
Luciana de Michelis Mendonça
Keyword(s):  
Clinical Practice ◽  
Physical Therapists ◽  
Achilles Tendinopathy ◽  
Attitudes And Beliefs ◽  
Practice Survey

scholarly journals Period prevalence and identification challenges of viral haemorrhagic fever suspect cases in a tertiary referral hospital in Guinea: a cross-sectional, retrospective study of triage and emergency room patient profiles

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Manuel Raab ◽  
Lisa M. Pfadenhauer ◽  
Vinh-Kim Nguyen ◽  
Dansira Doumbouya ◽  
Michael Hoelscher ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Emergency Room ◽  
Retrospective Chart Review ◽  
Laboratory Diagnostics ◽  
Haemorrhagic Fever ◽  
Case Definitions ◽  
Tertiary Referral Hospital ◽  
Cross Sectional ◽  
Viral Haemorrhagic Fever ◽  
Suspect Case

Abstract Background A functioning Viral Haemorrhagic Fever (VHF) surveillance system in countries at risk for outbreaks can reduce early transmission in case of an outbreak. Surveillance performance depends on the application of suspect case definitions in daily clinical practice. Recommended suspect case criteria during outbreaks are designed for high sensitivity and include general symptoms, pyrexia, haemorrhage, epidemiological link and unexplained death in patients. Non-outbreak criteria are narrower, relying on the persistence of fever and the presence of haemorrhagic signs. Methods This study ascertains VHF suspect case prevalence based on outbreak and non-outbreak criteria in a Guinean regional hospital for a period of three months. The study further describes clinical trajectories of patients who meet non-outbreak VHF suspect case criteria in order to discuss challenges in their identification. We used cross-sectional data collection at triage and emergency room to record demographic and clinical data of all admitted patients during the study period. For the follow-up study with description of diagnostic trajectories of VHF suspect cases, we used retrospective chart review. Results The most common symptoms of all patients upon admission were fever, tiredness/weakness and abdominal pain. 686 patients met EVD outbreak criteria, ten adult patients and two paediatric patients met study-specific non-outbreak VHF suspect case criteria. None of the suspect cases was treated as VHF suspect case and none tested positive for malaria upon admission. Their most frequent discharge diagnosis was unspecific gastrointestinal infection. The most common diagnostic measures were haemoglobin level and glycaemia for both adults and for children; of the requested examinations for hospitalized suspect cases, 36% were not executed or obtained. Half of those patients self-discharged against medical advice. Conclusions Our study shows that the number of VHF suspect cases may vary greatly depending on which suspect case criteria are applied. Identification of VHF suspect cases seems challenging in clinical practice. We suggest that this may be due to the low use of laboratory diagnostics to support certain diagnoses and the non-application of VHF suspect case definitions in clinical practice. Future VHF suspect case management should aim to tackle such challenges in comparable hospital settings.

Myelodysplastic syndromes – current diagnostics

2019 ◽  
Vol 55 (1) ◽  
pp. 35-42
Author(s):  
Beata Celuch ◽  
Iwona Urbanowicz ◽  
Jadwiga Nowicka ◽  
Wiesława Nahaczewska ◽  
Iwona Bil-Lula
Keyword(s):  
Myelodysplastic Syndromes ◽  
Myeloid Leukemia ◽  
Medical Knowledge ◽  
Laboratory Diagnostics ◽  
Multi Stage ◽  
Increased Risk ◽  
Cytogenetic Changes ◽  
Near Future ◽  
Clinical Problems ◽  
Over Time

Myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic neoplastic diseases characterized by inefficient hematopoiesis, resistant peripheral cytopenias and an increased risk of transformation to acute myeloid leukemia. They may exist as primary forms, which most often are accompanied by molecular and cytogenetic changes or secondary forms, among others after chemotherapy or other cancers. MDS diagnostics are multi-stage and time-consuming. Includes multidirectional examination of peripheral blood and bone marrow for cytomorphology, cytogenetics, molecular disorders, immunohistopatology and immunophenotyping. The evolution of molecular changes in the course of MDS makes the clinical picture and laboratory parameters change over time, which requires constant updating of medical knowledge and high competences from cytomorphologists and histopathologists. The development of hematooncological diagnostics resulted in updating the MDS classification in 2016. The aging population will undoubtedly increase the incidence of myelodysplastic syndromes, which will be one of the most demanding diagnostic and clinical problems for haematologists and laboratory diagnostics in the near future.

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.

scholarly journals Valuing variance: the importance of variance analysis in clinical pathways utilisation

2007 ◽  
Vol 31 (4) ◽  
pp. 565 ◽  
Author(s):  
Kate L Hyett ◽  
Mike Podosky ◽  
Nick Santamaria ◽  
Jenni C Ham
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Clinical Pathways ◽  
Service Planning ◽  
Practice Change ◽  
Variance Analysis ◽  
Analysis Software ◽  
Health Service Planning ◽  
Management Techniques ◽  
Clinical Practice Change

Variations from the anticipated course of events in clinical pathways provide valuable information that could be used to improve clinical practice and health service planning. Surprisingly, variance data are rarely collected in health care organisations using clinical pathways. This paper describes a project which aimed to improve reporting and analysis of variance data in a large regional and a smaller rural hospital using clinical pathways for a number of surgical, medical and obstetric procedures. The project used change management techniques and a variance analysis software program to inform clinical practice change.

Hypothermia for neonatal encephalopathy: Nationwide Survey of Clinical Practice in Japan as of August 2010

2012 ◽  
Vol 101 (5) ◽  
pp. e197-e202 ◽  
Author(s):  
Osuke Iwata ◽  
Makoto Nabetani ◽  
Toshiki Takenouchi ◽  
Takayuki Iwaibara ◽  
Sachiko Iwata ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Nationwide Survey ◽  
Neonatal Encephalopathy
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