Clinical Consequences of Specimen Rejection: A College of American Pathologists Q-Probes Analysis of 78 Clinical Laboratories

2014 ◽  
Vol 138 (8) ◽  
pp. 1003-1008 ◽  
Author(s):  
Donald S. Karcher ◽  
Christopher M. Lehman
Keyword(s):  
Clinical Laboratory ◽  
High Rate ◽  
Significant Delay ◽  
Clinical Laboratories ◽  
Increased Risk ◽  
Specimen Test ◽  
Clinical Consequences ◽  
The Impact ◽  
Test Result ◽  
Urine Specimens

Context.—Clinical laboratory specimens may be rejected as unsuitable for analysis for a variety of reasons and specimen rejection may have significant clinical consequences. Objective.—To quantify the clinical consequences of specimen rejection and determine the impact of laboratories' policies and practices on these consequences. Design.—Participants prospectively reviewed consecutive blood and urine specimens submitted to the chemistry and/or hematology laboratories to identify rejected specimens. For each rejected specimen, the patient's age, specimen type, testing priority, rejection reason, time from specimen receipt to receipt of recollected/relabeled specimen, recollection method, and test result time were recorded. Specimen/test abandonment was determined by failure to recollect or relabel a rejected specimen. Each laboratory's policy regarding relabeling of incorrectly labeled specimens was recorded, along with how many relabeled specimens were subsequently discovered to be mislabeled. Results.—Specimen rejection led to a (1) high rate of specimen recollection, (2) delay in result availability (median of 65 minutes), and (3) high rate of specimen/test abandonment. Longer test result delay was associated with higher hospital bed size; and higher test abandonment rate, with failure of the laboratory to request specimen recollection. Relabeling of incorrectly labeled specimens was found to be of little benefit and was associated with a substantial percentage of subsequently mislabeled specimens. Conclusion.—Specimen rejection has significant clinical consequences, including patient discomfort, significant delay in result availability, and high rate of specimen/test abandonment. Allowing routine relabeling of incorrectly labeled specimens is a dangerous practice, with little measureable benefit and with an increased risk to patient safety.

scholarly journals High Rate of Fatal Overdose After Release from Prison In BC, Canada: A Data Linkage Study

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Stuart A Kinner ◽  
Wenqi Gan ◽  
Amanda Slaunwhite
Keyword(s):  
Risk Factors ◽  
Target Population ◽  
Linkage Study ◽  
High Rate ◽  
Physical And Mental Health ◽  
Overdose Death ◽  
Fatal Overdose ◽  
Increased Risk ◽  
The Impact ◽  
Release From Prison

IntroductionThe province of BC, Canada is in the grips of a sustained overdose epidemic. People released from prison are at increased risk of fatal drug overdose, but the impact of the overdose epidemic on mortality after release from prison in BC is poorly understood. Few studies have been able to examine risk factors for overdose death in this population. Objectives and ApproachWe aimed to (a) measure risk of overdose-related and all-cause death in different time periods after release from prison; and (b) identify risk factors for overdose-related and all-cause death. In a random 20% sample of the population of BC, Canada, we identified those released from prison 2015-2017 and examined linked health and correctional records for this cohort. ResultsOf 6106 persons released from prison 2015-2017, 77 (1.3%) died from any cause and 48 (0.8%) died from overdose 2015-2017. The incidence of all-cause death was 16.1 (95%CI 13.7-18.8) per 1000 person years, and the incidence of overdose death was 11.2 (95%CI 9.2-13.5) per 1000 person years. Risk factors for overdose death included a history of 3 or more incarcerations (HR=3.00, 95%CI 1.67-5.39), co-occurring substance use disorder and mental illness (HR=4.73, 95%CI 2.94-7.62), chronic physical morbidity (HR=3.10, 95%CI 1.97-4.88), and being dispensed benzodiazepines (HR=3.31, 95%CI 2.27-4.84) or opioids for pain (HR=6.77, 95%CI 3.86-11.89). The incidence of fatal overdose was significantly higher in the first two weeks post-release than at any other time during follow-up. ConclusionPeople released from prison in BC are at markedly increased risk of preventable death, mainly due to overdose. As such, people transitioning from prison to the community should be a key target population for overdose prevention efforts. To be maximally effective, these efforts must go beyond provision of methadone and naloxone on release, to consider physical and mental health comorbidities, and psychosocial disadvantage.

scholarly journals A Brazilian Cohort of Patients With Immuno-Mediated Chronic Inflammatory Diseases Infected by SARS-CoV-2 (ReumaCoV-Brasil Registry): Protocol for a Prospective, Observational Study

10.2196/24357 ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. e24357
Author(s):  
Claudia Marques ◽  
Adriana Maria Kakehasi ◽  
Ana Paula Monteiro Gomides ◽  
Eduardo Dos Santos Paiva ◽  
Edgard Torres dos Reis Neto ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Inflammatory Diseases ◽  
Progression Rate ◽  
Immune Mediated ◽  
Increased Risk ◽  
Observational Cohort ◽  
And Function ◽  
The Impact ◽  
Brazilian Cohort

Background Patients with immune-mediated rheumatic diseases (IMRD) are at increased risk of infections, including significant morbidity and high mortality. Considering the potential for unfavorable outcomes of SARS-CoV-2 infection in patients with IMRD, several questions were raised regarding the impact of COVID-19 at the start of the pandemic. Objective This paper presents the protocol of a study that aims to prospectively evaluate patients with IMRD and a confirmed COVID-19 diagnosis (using criteria provided by the Brazilian Ministry of Health). Methods The study comprised a prospective, observational cohort (patients with IMRD and COVID-19) and a comparison group (patients with only IMRD), with a follow-up time of 6 months to evaluate differences in health outcomes. The primary outcomes will be changes in IMRD disease activity after SARS-CoV-2 infection at 4 time points: (1) at baseline, (2) within 4-6 weeks after infection, (3) at 3 months after the second assessment (±15 days), and (4) at 6 months (±15 days). The secondary outcomes will be the progression rate to moderate or severe forms of COVID-19, need for intensive care unit admission and mechanical ventilation, death, and therapeutic changes related to IMRD. Two outcomes—pulmonary and thromboembolic events in patients with both IMRD and SARS-CoV-2 infection—are of particular interest and will be monitored with close attention (clinical, laboratory, and function tests as well as imaging). Results Recruitment opened in May 2020, with 1300 participants recruited from 43 sites as of November 2020. Patient recruitment will conclude by the end of December 2020, with follow-up occurring until April 2021. Data analysis is scheduled to start after all inclusion data have been collected, with an aim to publish a peer-reviewed paper in December 2020. Conclusions We believe this study will provide clinically relevant data on the general impact of COVID-19 on patients with IMRD. Trial Registration Brazilian Registry of Clinical Trials RBR-33YTQC; http://www.ensaiosclinicos.gov.br/rg/RBR-33ytqc/ International Registered Report Identifier (IRRID) DERR1-10.2196/24357

Comparison of Head and Neck Cancer Distribution in Turkish and Syrian Populations

2020 ◽  
Author(s):  
Gozde SERİNDERE ◽  
Behiye BOLGUL ◽  
Didar GURSOY ◽  
Sibel HAKVERDİ ◽  
Nazan SAVAS
Keyword(s):  
Head And Neck ◽  
Turkish Population ◽  
Developed Countries ◽  
University Hospital ◽  
High Rate ◽  
Pathology Report ◽  
Increased Risk ◽  
Turkish Patients ◽  
Risk Of Cancer ◽  
The Impact

Background: Although oral health improves in several countries, global problems are still present. Predictably, the disadvantaged and poor population groups in both developing and developed countries have high rate of malign disease. The aim of this study was to evaluate the prevalence of head and neck cancers (HNCs) and to compare them between Syrian and Turkish population. Methods: A total of 4570 patients confirmed to have HNC histopathologically from Hatay Mustafa Kemal University Hospital Pathology report archive were retrospectively evaluated. Among them, 452 were Syrian patients while 4118 were Turkish patients. Data were collected from 2010 to 2017. Gender and age information were taken from medical records. According to the pathological results, HNCs were classified. Results: In 474 patients, HNCs were inscriptived, of which 317 were in males and 157 in females aged 23–80 years with histologically approved cancer of head and neck area. Overall, 100 were Syrian patients while 374 were Turkish patients. In both Syrian and Turkish patients, the most observed HNC was squamous cell carcinoma (SCC). Conclusion: Nowadays, the prevalence of cancer is higher because of the excessive consumption of alcohol, tobacco, chewing, and smoking. For the higher cancer incidence in Syrian refugees, we thought that the impact of war such as stress may have been effective as well as the known several etiologic factors of cancer. For the increased risk of cancer, the early diagnosis of this become more important.  

scholarly journals The impact of COVID-19 on morbidity and mortality in neck of femur fracture patients

2020 ◽  
Vol 1 (11) ◽  
pp. 669-675
Author(s):  
Alex E. Ward ◽  
Daniel Tadross ◽  
Fiona Wells ◽  
Lawrence Majkowski ◽  
Umna Naveed ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Bacterial Pneumonia ◽  
Femur Fracture ◽  
Kidney Injury ◽  
High Rate ◽  
Neck Of Femur ◽  
Increased Risk ◽  
Neck Of Femur Fracture ◽  
The Impact

Aims Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum of clinical presentations with the elderly, and those with pre-existing comorbidities are at a higher risk of severe respiratory compromise and death. Further increased risk has been observed in the postoperative period. The aim of this study was to assess the impact of COVID-19 infection on the complication and mortality rates of NOF fracture patients. Methods All NOF fracture patients presenting between March 2020 and May 2020 were included. Patients were divided into two subgroup: those with or without clinical and/or laboratory diagnosis of COVID-19. Data were collected on patient demographics, pattern of injury, complications, length of stay, and mortality. Results Overall, 132 patients were included. Of these, 34.8% (n = 46) were diagnosed with COVID-19. Bacterial pneumonia was observed at a significantly higher rate in those patients with COVID-19 (56.5% vs 15.1%; p =< 0.000). Non respiratory complications such as acute kidney injury (30.4% vs 9.3%; p =0.002) and urinary tract infection (10.9% vs 3.5%; p =0.126) were also more common in those patients with COVID-19. Length of stay was increased by a median of 21.5 days in patients diagnosed with COVID-19 (p < 0.000). 30-day mortality was significantly higher in patients with COVID-19 (37.0%) when compared to those without (10.5%; p <0.000). Conclusion This study has shown that patients with a neck of femur fracture have a high rate of mortality and complications such as bacterial pneumonia and acute kidney injury when diagnosed with COVID-19 within the perioperative period. We have demonstrated the high risk of in hospital transmission of COVID-19 and the association between the infection and an increased length of stay for the patients affected. Cite this article: Bone Joint Open 2020;1-11:669–675.

scholarly journals Improving American Healthcare Through “Clinical Lab 2.0”

2017 ◽  
Vol 4 ◽  
pp. 237428951770106 ◽  
Author(s):  
James M. Crawford ◽  
Khosrow Shotorbani ◽  
Gaurav Sharma ◽  
Michael Crossey ◽  
Tarush Kothari ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Laboratory ◽  
Care Delivery ◽  
The United States ◽  
Evidence Base ◽  
Cost Of Care ◽  
Laboratory Diagnostics ◽  
Santa Fe ◽  
Clinical Laboratories ◽  
The Impact

Project Santa Fe was established both to provide thought leadership and to help develop the evidence base for the valuation of clinical laboratory services in the next era of American healthcare. The participants in Project Santa Fe represent major regional health systems that can operationalize laboratory-driven innovations and test their valuation in diverse regional marketplaces in the United States. We provide recommendations from the inaugural March 2016 meeting of Project Santa Fe. Specifically, in the transition from volume-based to value-based health care, clinical laboratories are called upon to provide programmatic leadership in reducing total cost of care through optimization of time-to-diagnosis and time-to-effective therapeutics, optimization of care coordination, and programmatic support of wellness care, screening, and monitoring. This call to action is more than working with industry stakeholders on the basis of our expertise; it is providing leadership in creating the programs that accomplish these objectives. In so doing, clinical laboratories can be effectors in identifying patients at risk for escalation in care, closing gaps in care, and optimizing outcomes of health care innovation. We also hope that, through such activities, the evidence base will be created for the new value propositions of integrated laboratory networks. In the very simplest sense, this effort to create “Clinical Lab 2.0” will establish the impact of laboratory diagnostics on the full 100% spend in American healthcare, not just the 2.5% spend attributed to in vitro diagnostics. In so doing, our aim is to empower regional and local laboratories to thrive under new models of payment in the next era of American health care delivery.

scholarly journals Impact of body mass index on complications of gastric endoscopic submucosal dissection

2020 ◽  
Author(s):  
Na Young Kim ◽  
Hye Sun Lee ◽  
Ki-Young Lee ◽  
Soyoung Jeon ◽  
Seung Yeon Choi ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Endoscopic Submucosal Dissection ◽  
Body Mass ◽  
Normal Group ◽  
Obese Group ◽  
High Rate ◽  
Asia Pacific ◽  
Submucosal Dissection ◽  
Increased Risk ◽  
The Impact

Background: Gastric endoscopic submucosal dissection (ESD) has a high rate of complications. However, it is unclear whether body mass index (BMI) affects ESD complications. We aimed to investigate the impact of BMI on ESD complications. Methods: A total of 7263 patients who underwent gastric ESD were classified into three groups according to the Asia-Pacific classification of BMI: normal (BMI <23 kg/m2, n = 2466), overweight (BMI 23–24.9 kg/m2, n = 2117), and obese (BMI ≥25 kg/m2, n = 2680). Adjusted logistic regression analyses were conducted to assess the association between BMI and ESD complications. Results: Compared to the normal group, a lower incidence of perforation and a higher incidence of pneumonia and leukocytosis were found in the overweight and obese groups, and intra-ESD desaturation and hypertension were more frequent in the obese group. After adjustment for confounders, the risk of perforation significantly decreased in the overweight (odds ratio [OR] = 0.24, 95% confidence interval [CI]: 0.17–0.33) and obese (OR = 0.12, 95% CI: 0.08–0.18) groups compared to that in the normal group. Meanwhile, the risk of pneumonia significantly increased in the overweight (OR = 11.04, 95% CI: 6.31–19.31) and obese (OR = 10.71, 95% CI: 6.14–18.66) groups compared to the normal group. During sedation, the obese group had a significantly increased risk of desaturation (OR = 2.81, 95% CI: 1.18–6.69) and hypertension (OR = 1.35, 95% CI: 1.11–1.63) compared to the normal group. Conclusions: High BMI was significantly associated with ESD complications. More caution is needed in cases of obese patients undergoing ESD. 

scholarly journals Impact of Obesity in Kidney Diseases

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4482
Author(s):  
Vasilios Kotsis ◽  
Fernando Martinez ◽  
Christina Trakatelli ◽  
Josep Redon
Keyword(s):  
Renal Damage ◽  
Cardiometabolic Risk ◽  
Urinary Albumin Excretion ◽  
Kidney Diseases ◽  
Urinary Albumin ◽  
Lifestyle Changes ◽  
Metabolic Abnormalities ◽  
Increased Risk ◽  
Clinical Consequences ◽  
The Impact

The clinical consequences of obesity on the kidneys, with or without metabolic abnormalities, involve both renal function and structures. The mechanisms linking obesity and renal damage are well understood, including several effector mechanisms with interconnected pathways. Higher prevalence of urinary albumin excretion, sub-nephrotic syndrome, nephrolithiasis, increased risk of developing CKD, and progression to ESKD have been identified as being associated with obesity and having a relevant clinical impact. Moreover, renal replacement therapy and kidney transplantation are also influenced by obesity. Losing weight is key in limiting the impact that obesity produces on the kidneys by reducing albuminuria/proteinuria, declining rate of eGFR deterioration, delaying the development of CKD and ESKD, and improving the outcome of a renal transplant. Weight reduction may also contribute to appropriate control of cardiometabolic risk factors such as hypertension, metabolic syndrome, diabetes, and dyslipidemia which may be protective not only in renal damage but also cardiovascular disease. Lifestyle changes, some drugs, and bariatric surgery have demonstrated the benefits.

scholarly journals Clotting events among hospitalized patients infected with COVID-19 in a large multisite cohort in the United States

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262352
Author(s):  
Sondra Maureen Nemetski ◽  
Andrew Ip ◽  
Joshua Josephs ◽  
Mira Hellmann
Keyword(s):  
United States ◽  
Venous Thrombosis ◽  
Influenza Infection ◽  
The United States ◽  
High Rate ◽  
Scientific Discussion ◽  
Time Period ◽  
Increased Risk ◽  
Infection Risk Factors ◽  
The Impact

Introduction COVID-19 infection has been hypothesized to precipitate venous and arterial clotting events more frequently than other illnesses. Materials and methods We demonstrate this increased risk of blood clots by comparing rates of venous and arterial clotting events in 4400 hospitalized COVID-19 patients in a large multisite clinical network in the United States examined from April through June of 2020, to patients hospitalized for non-COVID illness and influenza during the same time period and in 2019. Results We demonstrate that COVID-19 increases the risk of venous thrombosis by two-fold compared to the general inpatient population and compared to people with influenza infection. Arterial and venous thrombosis were both common occurrences among patients with COVID-19 infection. Risk factors for thrombosis included male gender, older age, and diabetes. Patients with venous or arterial thrombosis had high rates of admission to the ICU, re-admission to the hospital, and death. Conclusion Given the ongoing scientific discussion about the impact of clotting on COVID-19 disease progression, these results highlight the need to further elucidate the role of anticoagulation in COVID-19 patients, particularly outside the intensive care unit setting. Additionally, concerns regarding clotting and COVID-19 vaccines highlight the importance of addressing the alarmingly high rate of clotting events during actual COVID-19 infection when weighing the risks and benefits of vaccination.

scholarly journals Hyponatremia in Coronavirus Disease-19 Patients: A Retrospective Analysis

2021 ◽  
Vol 8 ◽  
pp. 205435812110670
Author(s):  
Phani Krishna Machiraju ◽  
Neetu Mariam Alex ◽  
Safinaaz ◽  
Vivek Vadamalai
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Inflammatory Markers ◽  
Clinical Laboratory ◽  
Polymerase Chain Reaction Test ◽  
Total Leucocyte Count ◽  
Radiographic Findings ◽  
Icu Admission ◽  
Increased Risk ◽  
The Impact

Background: Hyponatremia (serum Na+ < 135 mmol/L) is the most common electrolyte abnormality detected in clinical practice and an important cause of mortality and morbidity in hospital settings. Hyponatremia in patients with pneumonia is usually mild but is associated with increased risk of intensive care unit (ICU) admission, prolonged hospital stays, and increased mortality rates. The purpose of this study is to understand the impact of varying degrees of hyponatremia and various other inflammatory markers on the severity and outcome of coronavirus disease-19 (COVID-19). Objective: The main objective of this study is to evaluate the prevalence of hyponatremia in COVID-19 patients and to assess the correlation between hyponatremia and severity and outcome of COVID-19. The other objective is to evaluate the correlation between various inflammatory markers and outcome (ICU vs non-ICU admission, discharged vs deceased) in patients with COVID-19 pneumonia. Methods: A total of 113 participants who have been diagnosed with COVID-19 infection by reverse transcriptase-polymerase chain reaction test were included in the study. Epidemiological, demographic, clinical, investigative work-up, and outcome data were extracted from electronic health records using a standard data collection form. Based on serum sodium levels, patients were divided into two groups: normonatremic (serum Na+ ≥ 135 mEq/L) and hyponatremic (serum Na+ < 135 mEq/L). Various clinical, laboratory, and outcome parameters were compared between the two groups. Results: Hyponatremia was present in 50 out of 113 (44%) patients in our study, and it was generally mild. There were more male patients in hyponatremia group ( P = .006), and hyponatremic patients were older than normonatremic patients ( P = .001). Forty (35%) of the 113 patients were transferred to the ICU, and 17 (15%) needed mechanical ventilation during their hospitalization. Interleukin-6 (IL-6) levels were higher in the hyponatremic group ( P = .022). Intensive care unit admissions and oxygen requirement were significantly higher in hyponatremic patients ( P = .001 and .016, respectively). Ferritin, lactate dehydrogenase (LDH), IL-6, total leucocyte count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were significantly elevated in those patients requiring ICU admission and those who died due to COVID-19. Conclusions: Our study revealed that demography, clinical features, radiographic findings, complications like renal insufficiency, and inflammatory markers like IL-6 play a considerable role in hyponatremic COVID-19 patients. Hyponatremia patients required significantly higher rates of ICU admissions and oxygen support. Our results suggest that monitoring inflammatory markers such as ESR, CRP, total white blood cell (WBC) count, ferritin, LDH, and IL-6 may serve as an early warning system for progression to severe COVID-19.

scholarly journals Initial Clinical Laboratory Response to COVID-19: A Qualitative Lookback at a Survey of Medical Laboratory Professionals

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S114-S115
Author(s):  
D P Baker ◽  
A P Jones ◽  
K Edwardson ◽  
L Nunez-Argote
Keyword(s):  
Job Satisfaction ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Demographic Data ◽  
Medical Laboratory ◽  
Cross Sectional ◽  
Clinical Laboratories ◽  
Laboratory Test Results ◽  
Medical Laboratory Professionals ◽  
The Impact

Abstract Introduction/Objective In this 2020 survey, the co-investigators of this study explored the experiences of medical laboratory professionals (MLPs) and their perceptions of the testing needs of clinical laboratories in the initial response to the COVID-19 pandemic. The responses gathered in this survey highlighted changes in the laboratory workforce and the impact on laboratory operations moving forward. Methods/Case Report This cross-sectional, anonymous, web-based survey of MLPs was conducted between April 29, 2020, and May 31, 2020. To recruit participants, ‘invitation to participate’ messages were posted using online forums and social media platforms (i.e. LinkedIn, Twitter). Furthermore, the survey link was shared with professional contacts and laboratory professional groups. The main source of recruitment was the membership of the American Society for Clinical Laboratory Science (ASCLS), which had more than 6,800 active members at the time of the study. Data provided from individuals who provided informed consent was included in the sample. The inclusion criteria for the survey were that participants self-identify as a current employee of a clinical laboratory whose usual employment involved participating in the diagnostic testing and providing of clinical laboratory test results using human specimens. The instrument gathered demographic data about participants and their workplace using 32 closed-ended questions with 8 questions containing branching that allowed for optional open-ended responses. This project was approved by the institutional review board at the University of Kansas Medical Center. Results (if a Case Study enter NA) Notably, there was an overall decrease in clinical laboratory testing and overtime work for laboratorians during the first months of the COVID-19 pandemic. Respondents noted a lack of pay increase during the pandemic; however, some received in-kind gifts and messages of support in recognition of their essential work. MLPs reported better (or unchanged) job satisfaction and morale in their respective workplaces. Conclusion The response to the testing needs by healthcare facilities and clinical laboratory leadership can influence the job satisfaction of MLPs, perceptions toward their work, and overall morale during the initial phase of the pandemic. Additionally, cost-reducing measures further shaped the perceptions of MLPs while impacting the operational efficiency of clinical laboratories.

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