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PubMedDate not supplied

Critical limits (alert values) for physician notification: universal or medical center specific limits?

The concept of critical limits (alert values), defined as an imminent life threatening laboratory result requiring immediate physician notification, has been widely adopted as a standard of good laboratory practice. Although virtually all laboratories have tests with critical limits, surveys have shown that there is no universal alert value list. Recently, nine VA medical centers in the New England region, which now constitute one consolidated entity, were surveyed with the objective of summarizing critical limits. Universal (100 percent) critical limit tests for clinical chemistry were: Calcium; mean low/high, 6.5/12.4 mg/dL: Glucose 48/432 mg/dL: Potassium 2.8/6.1 mmol/L: Sodium 121/159 mmol/L. Universal hematology tests included: Hematocrit 22.2/59.7 percent: Platelet count 61K/983K: white blood count 1.9K/29K. Although there was universal agreement that abnormal coagulation tests (PT, PTT) should be included on the hematology critical limit list, there was wide variation in the reporting of coagulation tests (seconds and INR) and patient therapeutic status (anticoagulant or no-anticoagulant). Universal alert values for microbiology were: Positive blood culture: Positive cerebral spinal fluid (CSF) culture: Positive CSF Gram stain. There was no universal agreement regarding critically high (potentially toxic) therapeutic drugs, with two medical centers declining to notify physicians of any abnormally high therapeutic drug level. No other qualitative critical limits for other laboratory sections, such as physician notification of an unexpected malignancy (surgical pathology) were universal. Medical center specific critical limits, designed to meet the clinical needs of each facility, are the norm in the nine medical centers. Laboratories do need periodically to review their critical limit lists with appropriate clinical input to avoid including critical limits for laboratory tests not required for urgent physician notification and patient evaluation and treatment.

Chemistry, Clinical↗

PubMed1989

Adolescent contraceptive use and parental notification.

Little research exists regarding the relationship between family communication and the sexual behavior and contraceptive use of adolescent females. A self-administered questionnaire was used to survey 196 adolescent females regarding communication with their parents about sexual issues and their reaction to proposed parental notification of the dispensing of prescription contraception. Parents of 80% of the subjects who were sexually experienced were aware of this activity. Parents of 80% of those subjects who had used contraception were aware of this use; 59% of these subjects informed their parents before their family planning visit. The majority of female adolescents (57%) were unwilling to communicate with their parents about sexual issues; 64% felt they should be able to receive prescription contraception without parental knowledge. Communication regarding sexual issues was related to lifetime contraceptive use. Eighteen percent of the sexually experienced subjects would not allow their parents to be notified of their family planning visit; 86% would use less effective contraception if family planning services were not sought. Our findings suggest that a parental notification policy will not compel all adolescents to inform parents about their contraceptive use; most adolescents will resort to less effective contraceptive methods.

Adolescent↗

PubMed2006

[The duty of notification for pathologists according to the infectious disease control act. Tuberculosis as dominating disease].

The Infectious Disease Control Act enacted in Germany in 1.1.2001 led to a duty of notification also for institutes of pathologic-anatomical diagnostics. All reports within 45 months after enacting concerning diseases and agents being subject to registration were evaluated. Among the notifiable diseases with fatal outcome ( section sign 6) belonged 3 cases of Meningococcus sepsis, 13 of tuberculosis und 5 cases of Creutzfeldt-Jacob disease. During lifetime 54% of tuberculosis cases remained undetected. Notifiable agents ( section sign 7.1) concerned 92 times Mycobacterium-tuberculosis-complex, twice Influenza Virus and one case of Cryptosporidiosis and Giardia lamblia each. Six Echinococcus granulosus cysts were reported ( section sign 7.2). Notification needs exact diagnosis of infectious diseases and agents being subject of registration. By this pathologists participate in the control of infectious diseases.

Bacterial Infections↗

PubMed1994

Delay in the diagnosis, notification and initiation of treatment and compliance in children with tuberculosis.

SETTING: The mortality and morbidity from childhood tuberculosis may be influenced by the delay from the time of first symptoms until the start of and compliance with treatment. OBJECTIVE: This study investigated these delay periods and the compliance with therapy in children with tuberculosis. DESIGN: During the study period there were 49 children with probable and 123 with confirmed pulmonary tuberculosis (WHO criteria). The mean period from first symptoms until presentation was 4.3 weeks, from presentation until notification 5 weeks and from notification until therapy 0.9 weeks. 16% of children notified as having tuberculosis never received therapy. Significantly fewer children in the urban squatter communities received therapy than in urban settled (P = 0.02), rural agricultural (P = 0.0001) and rural settled (P = 0.09) communities. 12% of children did not complete their therapy. CONCLUSION: The delay in presentation ('patient delay') was shorter than the delay in diagnosis ('doctor delay'). Failure to trace children and to complete therapy was particularly likely to occur in urban squatter communities. Easier access to health care facilities may shorten the 'patient delay' while greater awareness of tuberculosis and proper investigation of children may shorten the 'doctor delay'.

Child↗

PubMed1996

Deaths from active tuberculosis: can we rely on notification and mortality figures?

SETTING: Notification rates and mortality are the main indicators in the epidemiology of tuberculosis. While errors in case notification are known to be considerable, the quality of the data on deaths is largely unknown. OBJECTIVE: To validate the quality of data on deaths from active tuberculosis. DESIGN: We compared deaths from active tuberculosis in Statistics Norway with the National Tuberculosis Register (NTR) and cases found by autopsy in two Norwegian counties in 1977-1989. We also assessed the diagnostic classification and inclusion criteria for tuberculosis. RESULTS: 110 patients were entered into the study. We excluded 30 of 106 patients in Statistics Norway, primarily because of inactive tuberculosis (16) or minimal lesions (7). We found an additional 20 patients in the NTR and 14 more from autopsy reports. These missing cases were registered in Statistics Norway with a different diagnosis (28), inactive tuberculosis (4) or not found (2). Nineteen of them were diagnosed with tuberculosis by autopsy and five by cultures reported after death. We altered the diagnostic classification of underlying cause in 14% and found tuberculosis to be the underlying cause in 65 patients. CONCLUSION: The mortality rate from active tuberculosis in Statistics Norway was fairly correct, but one-third were under-reported and one-third over-reported. The mortality rate includes only half of all the deaths from active tuberculosis. All the cases in which active tuberculosis is mentioned on the death certificate are a clearer indication of tuberculosis deaths.

Autopsy↗

PubMed2002

An inverse correlation between estimated tuberculosis notification rates and asthma symptoms.

BACKGROUND: A recent ecological analysis demonstrated a strong inverse relationship between tuberculosis notification rates and the prevalence of asthma symptoms in 13-14-year-old children as obtained from the International Study of Asthma and Allergies in Childhood (ISAAC). However, the analysis was confined to the 23 countries in which the tuberculosis notification rates were considered to be of sufficient validity. METHODS: A similar analysis was performed using estimated tuberculosis incidence rates obtained from the World Health Organization Global Tuberculosis Programme and asthma symptom prevalence data from ISAAC for both the 6-7 and 13-14 years age groups in 38 and 55 countries, respectively. RESULTS: For the 6-7-year-old children, there was a significant inverse relationship between estimated tuberculosis incidence and the prevalence of key asthma symptoms. However, in the 13-14 year age group, a significant inverse relationship was only demonstrated for 'asthma ever'. CONCLUSION: The present study extends the inverse relationship between tuberculosis rates and asthma prevalence to the 6-7-year-old age group and suggests that the association, if causal, may be stronger at this younger age.

Adolescent↗

PubMed2004

[Spatial-statistical analysis of infectious disease notification data in lower saxony].

BACKGROUND: In Lower Saxony the analysis of notification data according to the infection protection law is based on two pillars: one pillar is the weekly analysis to identify clusters and locally non-detectable outbreaks by an early warning system. The second pillar is an annual reporting system for obtaining an overall picture and for identifying long-term trends. In both fields methods of spatial statistics are applied. METHODS: For the 16 most frequent notifiable diseases, the notification data of the districts of Lower Saxony are analysed and presented on the Internet. The presentation starts with an overview page, on which differences between observed and expected case counts for these diseases are presented tabulated and graphically. On a separate page for each disease the temporal and spatial distribution is shown by means of the following graphs: Time series presentation (weekly case counts and moving averages), chloropleth map of regional incidence rates and dot map of regional case counts. For identification of outbreaks, Kulldorff's "scan statistic" is used to search the data for clusters and to assess the significance of these clusters. The methods are executed mainly automatically using predominantly public domain software. RESULTS AND DISCUSSION: The approach attempts to meet the surveillance principle of providing the participants with immediate feedback. The scan statistics is a universal objective instrument for detecting and assessing spatial clusters. A special advantage is the identification of clusters which include several districts. The properties of the identified clusters (spatial extension, number of cases) offer some insight into the characteristic epidemiology of the diseases.

Cluster Analysis↗

PubMed1999

Return rates and partner notification in HIV-positive men seeking anonymous versus confidential antibody testing.

This study investigated whether HIV-positive men who seek confidential versus anonymous HIV counseling and testing differ in demographic variables, risk behaviors, return rates for posttest appointments, and agreement to partner notification. chi 2 tests were not statistically significant for return rates for post-test appointments or partner notification between the two groups. HIV-positive individuals in the confidential groups were more likely to utilize medical and follow-up services than those in the anonymous group. Anonymous and confidential counseling and testing both appear to achieve the public health objectives of HIV case finding and referral. Hypotheses are offered regarding what may be a progression of testing behaviors (i.e., from anonymous to confidential) with suggestions for future research are suggested.

Adult↗

PubMed2005

Screening of new entrants for tuberculosis: responses to port notifications.

BACKGROUND: Tuberculosis in England and Wales is associated with recently arrived immigrants. Screening new entrants for tuberculosis has received considerable attention recently. Despite several calls to reorganize screening processes for new entrants because of perceived ineffectiveness, some systems at ports have remained largely unchanged, including notification arrangements. METHODS: A postal questionnaire was sent to Consultants in Communicable Disease Control (CsCDC) who normally receive port health notification forms from London Heathrow Port Health Control Unit relating to new entrants who had either been screened and found to have a normal chest X-ray, not had an chest X-ray due to pregnancy or young age or whose examination was inconclusive (Port 101 and 102 forms). RESULTS: Almost half of the responding CsCDC attempted to follow-up all Port 101 and 102 referrals; of these CsCDC, 46 percent reported that they were actually able to follow-up under 50 percent. CsCDC had developed their own criteria to aid decisions as to which referrals to follow-up. CONCLUSION: The follow-up by CsCDC of new entrants passing through Heathrow Port Health Control Unit who have been screened and found to have a normal chest X-ray, not had an X-ray due to pregnancy or young age, or whose examination was inconclusive varies considerably and there is no consistent national practice. Substantial efforts are being expended on attempting to follow-up new entrants, many of whom may be at low risk of tuberculosis. The effectiveness (and efficiency) of this approach is probably low.

Algorithms↗

PubMed2001

Recently diagnosed sexually HIV-infected patients: seroconversion interval, partner notification period and a high yield of HIV diagnoses among partners.

We collected data on the outcome of partner notification (PN) for 356 index patients (iPs) newly diagnosed with HIV, all sexually infected, in six European countries, 1995-96. The PN period (the period during which exposed partners should be notified about their risk of being HIV infected) could be defined on the basis of last negative HIV test in 170/356 (48%), from other key dates for 12, and for 14 more on the sole basis of known HIV exposure (total 196/356, 55%). However, of the 170 iPs with a last negative HIV test date, PN period was not defined in 52 (31%), even though 28/52 were recent seroconverters (negative HIV test within 24 months of HIV diagnosis). Discrepancies in PN period evaluation were common: of the 85 iPs for whom PN period was reportedly defined as '3 months before last HIV-negative date', the period actually used was equal to this in only 12. A user-friendly worksheet would simplify the task of eliciting and using key dates to define the PN period. Forms on PN outcome were received for 166/200 (83%) reported current partners, but only 124/508 (24%) ex-partners. Fifty-two of 290 (18%) notified partners already knew they were HIV-positive, and 38/130 (29%) notified partners for whom pre-PN status was negative or unknown were HIV-positive on post-PN testing. Results of HIV tests (if any) after PN were unknown for 37/133 (28%) current partners not already known to be HIV-positive, and for 71/105 (68%) ex-partners-a doubling of the information loss rate. Notification of 133 current and 105 ex-partners not previously identified as HIV-positive thus produced 28 (21%) and 10 (10%) new HIV diagnoses, respectively. The total yield of HIV diagnoses was 38/100 (38%) partners of recent seroconverters (22 already known plus 16 PN-diagnosed), compared with 52/190 (27%) partners of other iPs (30 already known plus 22 PN-diagnosed). We propose prioritization for PN of partners of recent seroconverters, augmented surveillance for HIV diagnoses and recurrence in PN networks of at-risk, non-notified partners, and new measures that preserve anonymity to alert potential and past sexual contacts of HIV-diagnosed individuals who are unable or unwilling to assist in PN.

Adult↗

PubMed2002

Consent for prenatal testing: a preliminary examination of the effects of named HIV reporting and mandatory partner notification.

The effect of named reporting and mandatory partner notification in New York State on the rate of consent for prenatal HIV testing was examined by retrospective chart review. In the six months prior to the introduction of mandatory partner notification and named reporting, 318/328 patients (96.95%) accepted HIV testing. In the six months after implementation, 303/305 patients (99.34%) accepted HIV testing. Although limited in power, no significant decline in the rate of consent for testing or the number of patients receiving testing was detected. [RR 1.02 (1.00 < RR < 1.05)].

AIDS Serodiagnosis↗

PubMed2005

Nowhere near the point of diminishing returns: correlations between chlamydia testing and notification rates in New South Wales.

OBJECTIVE: To examine the relationship between chlamydia testing and chlamydia detection rates in New South Wales, Australia, from 1999 to 2001. METHODS: Correlations between population-based chlamydia testing and notification rates--stratified by age group, area of residence, and year--were determined by linear regression. RESULTS: Strong positive correlations between chlamydia testing and notification rates were observed for both women (r = 0.91, p < 0.001) and men (r = 0.94, p < 0.001). Between 1999 and 2001, the chlamydia test positivity rate increased from 4.3% to 7.3% for women (p < 0.0001) and from 7.8% to 10.5% for men (p < 0.0001). CONCLUSIONS AND IMPLICATIONS: This study suggests that Australia could benefit from a major chlamydia screening program.

Adolescent↗

PubMed2004

The donor notification process from the donor's perspective.

BACKGROUND: Despite large numbers of blood donors being notified of abnormal infectious disease screening results, there has been little scientific study of the effects of this process. STUDY DESIGN AND METHODS: With a 28-item questionnaire, an anonymous mail survey was conducted of 4141 blood donors notified of 15 distinct categories of abnormal infectious disease screening and confirmatory test results. RESULTS: The survey had a 42 percent response rate, and 10 percent of the respondents did not recall being notified of their results. Of the 1556 respondents who recalled being notified, 27 percent contacted the blood center for further information, 60 percent discussed their results with a health care provider, and 73 percent of permanently or indefinitely deferred donors correctly understood their deferral status. Confusion and emotional upset were reported in 81 and 75 percent of notified donors, respectively. CONCLUSIONS: The notification process appears to achieve most of its aims in the majority of donors. Nevertheless, some donors did not understand that they were ineligible for future donation, and many donors were confused and upset. These data indicate that the adverse impact of notifying donors about abnormal test results needs to be considered when new blood donor screening tests and confirmatory algorithms are being licensed and implemented. Further studies of the effectiveness of newer revised donor notification materials are needed.

Adult↗

PubMed1998

Occupational skin diseases: reliability and utility of the data in the various registers; the course from notification to compensation and the costs. A case study from Denmark.

Occupational diseases affect many people and may have serious social and economic consequences. In 1984, the National Labour Inspection Service established the Register of Occupational Diseases (ROD). The purpose of the central register was to provide information about injury-causing factors and risk groups, etc., changes in risk factors (ongoing monitoring and warning system), and to document the effects of preventive activities. However, we are dealing with several uncertain factors (i.e., whether the number of notified cases is too high or too low), and although the ROD contains a lot of information, it basically represents only notified (suspected) cases, until otherwise proven. Therefore, the utility and reliability of the data in the ROD may be questionable. The National Board of Industrial Injuries and the insurance companies represent recognized and compensated (genuine) cases, but their registers in general contain little information on variables. Thus, it is difficult to obtain exact information of occupational diseases (i.e., the real frequency and causes). What is known, is the number of cases that are notified, recognized and compensated, and the costs. Clearly, the higher the frequency of recognition, the more representative the data in the ROD of the recognized (genuine) cases. Therefore, the course from notification to recognition, and from recognition to compensation was calculated, and, for each step, the importance of skin diseases was considered. Only in the case of skin diseases, was the frequency of recognition high (2/3), and the data in the ROD were considered in more detail, and, where possible, compared with recognized and compensated cases. The various registers concurrently showed that nearly all occupational skin diseases were eczematous in nature (98%), most cases belonged to the younger age group (2/3), women (2/3) predominated over men, and the dominant type of occupational eczema was irritant (2/3). It has not been possible to get further information about exposure sources, occupations and trades from the other registers. However, considering the high frequency of recognition for skin diseases (eczemas), it is likely that the information in the ROD is also to some extent representative of the recognized (genuine) cases. As regards the importance of various disease categories, skin diseases (eczemas) ranked 1st (numerically) among both recognized and compensated cases, and were the most expensive. Therefore preventive activities are mandatory, and because of the high frequency of recognition, the data in the ROD may provide a basis for establishment of the most relevant preventive activities. For other disease categories, the frequency of recognition was low, and the utility and reliability of the data in ROD is in questionable. Therefore, in general, an improvement in the notification system is desirable, but a system that takes into account the many uncertain factors is extremely difficult to set up. Linking of the registers is in progress, and this will be useful during everyday situations.

Adolescent↗

PubMed1995

The impact of the first notification of positive blood cultures on antibiotic therapy. A one-year survey.

The impact on antibiotic therapy of the first notification of positive blood cultures was assessed for 735 episodes of bacteraemia detected during 1992 in the County of Northern Jutland, Denmark. A primary focus of infection was defined in 498 episodes, the urinary tract being the most frequent (n = 182, 25%). Twenty-nine patients (3.5%) had died prior to the initial contact. In 12 episodes antibiotic therapy had either been stopped or data were not available, leaving 694 episodes for further assessment. In 567 episodes antibiotic therapy had been started prior to the initial contact, the most frequent regimen being ampicillin or an ampicillin-aminoglycoside combination (295 episodes), whereas cephalosporins, thienamycin, and fluoroquinolones were seldom used (41 episodes). The ongoing antibiotic coverage was deemed appropriate in 418 episodes (60%), non-optimal in 90 (13%), and lacking in 186 (27%). The notification of positive blood cultures elicited changes in antibiotic therapy in 315 episodes (45%), including commencement of antibiotic therapy in 127 (18%). Thus, blood culture results have a measurable impact on antibiotic therapy.

Adult↗

PubMed2006

Developing school-based BMI screening and parent notification programs: findings from focus groups with parents of elementary school students.

School-based body mass index (BMI) screening and parent notification programs have been advanced as an obesity prevention strategy. However, little is known about how to develop and implement programs. This qualitative study explored the opinions and beliefs of parents of elementary school students concerning school-based BMI screening programs, notification methods, message content, and health information needs related to promoting healthy weight for school-aged children. Ten focus groups were conducted with 71 participants. Parents were generally supportive of school-based BMI screening. However, they wanted assurance that student privacy and respect would be maintained during measurement and that BMI results would be provided to parents in a neutral manner that avoided weight labeling. They also believed that aggregate results should be disseminated to the larger school community to support healthy change in the nutrition and physical activity environments of schools. Implications for practitioners and researchers are discussed.

Adult↗

PubMed1999

Social factors associated with increases in tuberculosis notifications.

This study assessed the contribution of immigration and deprivation to the changes in tuberculosis notifications in Liverpool over the last 20 yrs. Ethnic origin was retrospectively assigned to all named cases from 1974 to 1995. Average tuberculosis rates were calculated for the 33 council wards in Liverpool for 1981-1985 and 1991-1995. Multiple regression was used to determine the independent effects of socioeconomic and population measures from the 1981 and 1991 censuses in explaining these ward-based rates. Since 1974, there has been a steady increase in the percentage of non-Caucasian cases of tuberculosis, from 8.7% in 1975-1977, 15.1% in 1981-1983, 17.5% in 1987-1989 to 28.0% in 1993-1995. Multiple regression analysis showed that in 1981 only unemployment had a significant independent relationship with tuberculosis rates, but in 1991 two indices of deprivation and ethnicity had a significant influence. The increasing proportion of non-Caucasian tuberculosis cases, both while the number of notifications was declining before 1987 and increasing afterwards, is not necessarily consistent with the concept that immigration has influenced the recent increase. However, the fact that ethnicity now independently explains some of the council ward variations but did not in the early 1980s suggests that immigration does influence the distribution of disease within the city.

Adolescent↗

PubMed1996

[Compulsory notification of cysticercosis in Ribeiräo Preto-SP, Brazil].

Cysticercosis is a severe public health problem in several regions of Asia, Africa and Latin America. Epidemiologic studies based on the frequency of cases observed in specialized neurology, neurosurgery and computed tomography services, at autopsy and in seroepidemiologic studies do not permit the determination of the true prevalence of the disease in the population. The objective of the present study was to investigate the prevalence of cysticercosis by compulsory notification. The coefficient of prevalence was 54 cases/100,000 inhabitants in the municipality of Ribeirão Preto. The results also indicated that cysticercosis is not under control in our region since 21% of cases presented the active form of the disease. Compulsory notification proved to be a valuable resource for the epidemiologic study of cysticercosis, also permitting the mapping of more affected areas for a better direction of prevention strategies.

Adolescent↗