routine measurement
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PEDIATRICS ◽  
2021 ◽  
Author(s):  
Rebecca Dang ◽  
Anisha I. Patel ◽  
Julia Marlow ◽  
Yingjie Weng ◽  
Marie E. Wang ◽  
...  

OBJECTIVES: To determine the (1) frequency and visit characteristics of routine temperature measurement and (2) rates of interventions by temperature measurement practice and the probability of incidental fever detection. METHODS: In this retrospective cohort study, we analyzed well-child visits between 2014–2019. We performed multivariable regression to characterize visits associated with routine temperature measurement and conducted generalized estimating equations regression to determine adjusted rates of interventions (antibiotic prescription, and diagnostic testing) and vaccine deferral by temperature measurement and fever status, clustered by clinic and patient. Through dual independent chart review, fever (≥100.4°F) was categorized as probable, possible, or unlikely to be incidentally detected. RESULTS: Temperature measurement occurred at 155 527 of 274 351 (58.9%) well-child visits. Of 24 clinics, 16 measured temperature at >90% of visits (“routine measurement clinics”) and 8 at <20% of visits (“occasional measurement clinics”). After adjusting for age, ethnicity, race, and insurance, antibiotic prescription was more common (adjusted odds ratio: 1.21; 95% CI 1.13–1.29), whereas diagnostic testing was less common (adjusted odds ratio: 0.76; 95% CI 0.71–0.82) at routine measurement clinics. Fever was detected at 270 of 155 527 (0.2%) routine measurement clinic visits, 47 (17.4%) of which were classified as probable incidental fever. Antibiotic prescription and diagnostic testing were more common at visits with probable incidental fever than without fever (7.4% vs 1.7%; 14.8% vs 1.2%; P < .001), and vaccines were deferred at 50% such visits. CONCLUSIONS: Temperature measurement occurs at more than one-half of well-child visits and is a clinic-driven practice. Given the impact on subsequent interventions and vaccine deferral, the harm–benefit profile of this practice warrants consideration.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0259252
Author(s):  
Katja Stahl ◽  
Oliver Groene

Objective Routine measurement of patient safety from the patients’ perspective receives increasing attention as an important component of safety measurement systems. The aim of this study was to examine patients’ experience with patient safety in ambulatory care and the results’ implications for routine patient safety measurement in ambulatory care. Design Cross-sectional mixed-mode survey. Setting General practitioner and specialist practices. Participants Patients aged >18 years seeking care in ambulatory care practices between February and June 2020. Methods A 22-item-questionnaire was completed in the practice or at home either on paper or online. Multivariate logistic regression was used to analyse the influence of survey mode and patient characteristics on patient experience with patient safety. Results The overall response rate was 71.1%. Most patients completed the questionnaire on site (76.6%) and on paper (96.1%). Between 30.1% to 68.5% of the respondents report the most positive option for patient experience with the main domains of patient safety. A total of 2.9% of patients reported having experienced a patient-safety event (PSE) during the last 12 months. Patients who filled in the questionnaire off site were more likely to report negative experiences for the scales communication & information (OR 1.2, 95% CI 1.0–1.5), rapport & participation (OR 1.4, 95% CI 1.1–1.7) and access (OR 1.3, 95% CI 0.9–1.4) than those who completed it on site. Those who chose a paper questionnaire were more likely to report negative experiences for all five scales compared to web responders. Conclusion Routine measurement of patient experience with factors contributing to the occurrence of PSEs can achieve high response rates by offering flexible participation options. Results gained from mixed-mode surveys need to take mode-effects into account when interpreting and using the results. Further research is needed in how to adequately assess number and type of experienced events in routine measurements.


2021 ◽  
Author(s):  
MIKO MIKO SULJATMIKO

The formation of an orderly culture of administration for educators and students in schools cannot be separated from the routines that were born in school policy. Mastery of the use of Information and Communication Technology (ICT) media will have a major impact on efforts to carry out of e-Government in Indonesia, which is implemented as a government program in effectively streamlining public services. Conventional administrative culture is still secure in person management to the level of institutionalization. Like routine measurement, administration and reporting still use conventional culture. Other conventional cultures such as accreditation, school control in governance, and documentation are clear. This conventional routine can affect the slow pace of government programs, especially in the transformation efforts towards e-Government. Research with this qualitative approach focuses on issues about the culture of e-Learning intranet implementation in schools in Malang, as well as factors that support and hinder the implementation of e-Learning intranet in schools. Analysis of the data used is interactive model analysis and force field analysis. The results showed that the culture of using the e-Learning intranet can be used as a habit towards e-Government efforts. Optimization of e-Government can be realized if the basis of administrative activities that cultivate e-Learning intranet routinely at school. By cultivating the e-Learning intranet in schools, government programs especially the transformation towards e-Government can be achieved.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alicia J. Jenkins ◽  
Barbara H. Braffett ◽  
Arpita Basu ◽  
Ionut Bebu ◽  
Samuel Dagogo-Jack ◽  
...  

AbstractIn type 2 diabetes, hyperuricemia is associated with cardiovascular disease (CVD) and the metabolic syndrome (MetS), but associations in type 1 diabetes (T1D) have not been well-defined. This study examined the relationships between serum urate (SU) concentrations, clinical and biochemical factors, and subsequent cardiovascular events in a well-characterized cohort of adults with T1D. In 973 participants with T1D in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC), associations were defined between SU, measured once in blood collected 1997–2000, and (a) concurrent MetS and (b) incident ‘any CVD’ and major adverse cardiovascular events (MACE) through 2013. SU was higher in men than women [mean (SD): 4.47 (0.99) vs. 3.39 (0.97) mg/dl, respectively, p < 0.0001], and was associated with MetS features in both (men: p = 0.0016; women: p < 0.0001). During follow-up, 110 participants (11%) experienced “any CVD”, and 53 (5%) a MACE. Analyzed by quartiles, SU was not associated with subsequent CVD or MACE. In women, SU as a continuous variable was associated with MACE (unadjusted HR: 1.52; 95% CI 1.07–2.16; p = 0.0211) even after adjustment for age and HbA1c (HR: 1.47; 95% CI 1.01–2.14; p = 0.0467). Predominantly normal range serum urate concentrations in T1D were higher in men than women and were associated with features of the MetS. In some analyses of women only, SU was associated with subsequent MACE. Routine measurement of SU to assess cardiovascular risk in T1D is not merited.Trial registration clinicaltrials.gov NCT00360815 and NCT00360893.


Author(s):  
Murat Çalapkulu ◽  
Muhammed Erkam Sencar ◽  
Sema Hepsen ◽  
Hayri Bostan ◽  
Davut Sakiz ◽  
...  

Routine calcitonin measurement in patients with nodular thyroid disease is rather controversial. The aim of this study was to evaluate the contribution of serum calcitonin measurement in the diagnostic evaluation of thyroid nodules with insufficient, indeterminate, or suspicious cytology. Out of 1668 patients who underwent thyroidectomy with the diagnosis of nodular thyroid disease and were screened, 873 patients with insufficient, indeterminate, or suspicious fine needle aspiration biopsy results were included in the study. From the total number of patients in this study, 10 (1.1%) were diagnosed as medullary thyroid cancer (MTC) using histopathology. The calcitonin level was detected to be above the assay-specific cut-off in 23 (2.6%) patients ranging between 6.5 - 4450 pg/mL. While hypercalcitoninemia was detected in all 10 MTC patients, a false positive elevation of serum calcitonin was detected in 13 patients (1.5%). Of the MTC group, 7 patients had cytology results that were suspicious for malignancy (Bethesda V), one patient’s cytology showed atypia of undetermined significance (Bethesda III) and two patient’s cytology results were suspicious for follicular neoplasm (Bethesda IV). Among the cases with non-diagnostic cytology (Bethesda I), none of the patients were diagnosed with MTC. In conclusion, routine serum calcitonin measurement can be performed in selected cases rather than in all nodular thyroid patients. While it is reasonable to perform routine calcitonin measurement in patients with Bethesda IV and Bethesda V, this measurement was not useful in Bethesda I patients. In Bethesda III patients, patient-based decisions can be made according to their calcitonin measurement. Read more in PDF.


Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1758
Author(s):  
Ludmila Máčová ◽  
Marie Bičíková

Vitamin D is a micronutrient with pleiotropic effects in humans. Due to sedentary lifestyles and increasing time spent indoors, a growing body of research is revealing that vitamin D deficiency is a global problem. Despite the routine measurement of vitamin D in clinical laboratories and many years of efforts, methods of vitamin D analysis have yet to be standardized and are burdened with significant difficulties. This review summarizes several key analytical and clinical challenges that accompany the current methods for measuring vitamin D. According to an external quality assessment, methods and laboratories still produce a high degree of variability. Structurally similar metabolites are a source of significant interference. Furthermore, there is still no consensus on the normal values of vitamin D in a healthy population. These and other problems discussed herein can be a source of inconsistency in the results of research studies.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Juan Jose Garcia Sanchez ◽  
Alyshah Abdul Sultan ◽  
Marcelo Costa Batista ◽  
Claudia Cabrera ◽  
Joshua Card-Gowers ◽  
...  

Abstract Background and Aims With an estimated global prevalence of 10%, chronic kidney disease (CKD) and its associated complications place a substantial strain on healthcare systems worldwide, which is compounded by the burden of undiagnosed CKD. Early CKD diagnosis followed by guideline-recommended interventions can improve patient outcomes and reduce associated healthcare-related costs, particularly by delaying or preventing the development of complications and progression to kidney failure. Urinary albumin-to-creatinine ratio (UACR) can be used to screen for CKD, but adherence to screening recommendations is suboptimal in routine care. Inside CKD aims to model the global clinical and economic burden of CKD using country-specific, patient-level microsimulation models. We used the Inside CKD microsimulation to model the potential clinical and economic impacts of routine measurement of UACR followed by appropriate intervention in patients aged 45 years and over in the US and Canada. Method The Inside CKD microsimulation model was used to model the clinical and economic impacts associated with measurement of UACR with subsequent appropriate intervention during routine primary care visits versus current practice in individuals aged 45 years and over. The model covers the period 2020–2025. In preliminary analyses, virtual populations representing the general populations of the US and Canada were constructed using published country-specific data, including demographics, prevalence of CKD and comorbidities (type 2 diabetes, uncontrolled hypertension and heart failure), incidence of complications (heart failure, myocardial infarction, stroke and acute kidney injury) and costs associated with CKD. The model also included parameters relating to the proportion of patients who visit a primary care physician at least once a year, the proportion of patients who agreed to UACR measurements, and the diagnostic sensitivity and specificity of UACR measurements. The modelling is being expanded to additional countries in the Americas and the Asia-Pacific region. Results Preliminary results from the US and Canada show that over the 2020–2025 period routine measurement of UACR during primary care visits followed by appropriate intervention could prevent progression to CKD stages 3b–5 in approximately 1.3M patients in the US and 160 000 in Canada, compared with current clinical practice, with linear increases in the cumulative numbers of prevented cases (Figure). Associated savings in healthcare costs in 2025 are projected to be approximately US$16B in the US and C$2.5B in Canada, corresponding to a reduction in cost for that year of 4.4% and 7.4%, respectively, compared with current clinical practice. Conclusion Preliminary results from the Inside CKD microsimulation model in the US and Canada show that routine measurement of UACR with subsequent intervention in primary care would prevent progression to CKD stages 3b–5 in a substantial number of patients compared with current screening practices, and could therefore decrease associated healthcare costs considerably. This analysis is being extended to further countries in the Americas and the Asia-Pacific region.


2021 ◽  
Author(s):  
Mounzer Agha ◽  
Maggie Blake ◽  
Charles Chilleo ◽  
Alan Wells ◽  
Ghady Haidar

Studies describing SARS-CoV-2 immune responses following mRNA vaccination in hematology malignancy (HM) patients are virtually non-existent. We measured SARS-CoV-2 IgG production in 67 HM patients who received 2 mRNA vaccine doses. We found that 46% of HM patients did not produce antibodies and were therefore vaccine non-responders. Patients with B-cell CLL were at a particularly high risk, as only 23% had detectable antibodies despite the fact that nearly 70% of these patients were not undergoing cancer therapy. HM patients should be counseled about the ongoing risk of COVID-19 despite vaccination. Routine measurement of post-vaccine antibodies in HM patients should be considered. Novel strategies are needed to prevent COVID-19 in these individuals.


Animals ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 1036
Author(s):  
Dorothee Ott ◽  
Katharina Schrapers ◽  
Jörg Aschenbach

We aimed to establish a model for prediction of iCa from tCa, using multivariable regressions with diverse blood constituents. Blood was taken from 14 cows at days −2, 0, 2, 4, 7, and 14 relative to parturition. Cows were clinically healthy, and no hypocalcaemia prophylaxis and treatment were applied. Total calcium and further parameters were determined from frozen serum. Ionized calcium, blood gases, and electrolytes were determined from heparin-stabilized blood samples. Linear regression between iCa and tCa was estimated. Precision improved only slightly using a multivariable model. Best precision was achieved when estimating the iCa:tCa ratio from other blood constituents. To identify the reason behind the poorly predictive value of tCa for iCa, the relative changes of iCa and tCa around calving were calibrated to the respective values of day −2 (=100%) for each cow. An increase in the iCa:tCa ratio was observed from 0.43 at day −2 to 0.48 at day 0, followed by a gradual decrease towards 0.43 at day 7. We conclude that routine measurement of iCa should be implemented in the diagnosis of hypocalcaemia. An optimized estimate of iCa from tCa with non-esterified fatty acids (NEFA), beta-hydroxybutyric acid, cholesterol, and phosphorous as co-predictors is still poorly satisfying.


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