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PubMed2006

Use of benzodiazepines and benzodiazepine-related drugs among 223 patients with an acute hip fracture in Finland: Comparison of benzodiazepine findings in medical records and laboratory assays.

BACKGROUND AND OBJECTIVE: CNS drugs are a risk factor for falls and fractures among older people. Our aim was to describe the use of benzodiazepines and benzodiazepine-related drugs among patients admitted to two Finnish hospitals as a result of an acute hip fracture, and to analyse the concordance of benzodiazepine findings from different data sources. PATIENTS AND METHODS: We studied the use of benzodiazepines and benzodiazepine-related drugs by (i) asking the patient or his/her relatives about his/her use of hypnotics; (ii) checking the patient's medical records; and (iii) analysing for the presence of benzodiazepines in serum and urine. Blood and urine samples were taken at admission. Detection of benzodiazepines in serum and urine was achieved by the fluorescence polarisation method. Concordance in benzodiazepine findings between medical records and laboratory results was estimated by calculating the degree of agreement (kappa) and described graphically using a Venn diagram. RESULTS: A total of 223 patients were enrolled in the study. Of these, 71% were women. The mean age of women was 80.5 years (SD: 10) and of men, 73 years (SD: 12) [p < 0.0001]. Thirty percent of the patients reported that they used hypnotics. Benzodiazepine in serum or urine was detected in 83 (37%) patients. Over half of the patients coming from residential homes (53%) and institutions (54%) were benzodiazepine-positive. For home dwellers the proportion of patients that were benzodiazepine-positive was 29%. In 48% (40/83) of the benzodiazepine-positive patients, the type of benzodiazepine could not be identified because of a lack of drug records regarding benzodiazepines. A total of 113 (51%) patients used benzodiazepines or benzodiazepine-related drugs when both laboratory results and medical drug records were taken into account. Thirty-nine percent of these patients were home dwellers, 69% came from residential care and 76% from institutional care. The concordance between medical records and laboratory results expressed as overlap area was 32% in men and 59% in women, 38% in community-dwelling patients, 63% in residential home patients, and 68% in patients from institutions. CONCLUSION: Half of patients with an acute hip fracture used benzodiazepines or benzodiazepine-related drugs. The highest prevalences were found in institutional and residential care where it should be well known that the use of CNS drugs increases the risk of hip fracture. Concordance of benzodiazepine findings was moderate in all patients and poorest among men. Concordance was poorer among home dwellers than among those living in residential homes and institutions. Analysing benzodiazepine in serum seems to be the most reliable method for ascertaining benzodiazepine exposure. This laboratory test could be performed routinely when the elderly patient is admitted to hospital because of a fall or, at least, in case of hip fracture. Then, if needed, the patient should be informed about the risks of benzodiazepine use, and further falls and fractures could be prevented.

Accidental Falls↗
PubMed2002

[Obesity: risk factor for steatohepatitis and hepatic fibrosis].

BACKGROUND: Nonalcoholic fatty liver (NAFL) has been recognized as a cause of chronic liver disease. Its main risk factor is obesity. AIM: To describe the clinical and liver pathological findings in a group of patients who underwent surgery as obesity treatment. PATIENTS AND METHODS: Sixty eight patients with severe or morbid obesity were subjected to surgery as obesity treatment. Each patient was evaluated with a complete clinical and laboratory medical assessment. A wedge of liver was excised during surgery. Liver biopsies were analyzed without knowledge of clinical and laboratory findings. The presence of steatosis, inflammation (portal or lobular), fibrosis and cirrhosis were recorded in the pathological analysis. Age and body mass index (BMI) were correlated with pathological data. Significance was set at a p value of less than 0.05. RESULTS: Ninety one percent of patients had steatosis, 45% inflammation and 47% fibrosis. One patient had cirrhosis (1.4%). There was a statistically significant association between BMI and moderate or severe steatosis (p < 0.03). There was also an association between BMI and portal (p = 0.017) and lobular inflammation (p = 0.034). A BMI over 40 kg/m2 (morbid obesity) was significantly associated with the presence of fibrosis (p = 0.032). Moreover, the presence of moderate or severe steatosis was a risk factor for the development of hepatic fibrosis (p = 0.026). CONCLUSIONS: Obesity is a major and independent risk factor for steatohepatitis and fibrosis. The degree of steatosis in the liver biopsy, is a risk factor for the development of fibrosis.

Adolescent↗
PubMed1996

[Quality of the performance of clinical laboratories].

The quality performance of clinical laboratories plays a basic role in the quality and effectiveness of health care. The reliability of laboratory tests, however, depends on the quality assurance system existing in the working place, which comprises not only the analytical activities but includes all preventive measures and their regular control in connection with the preanalytical phase, as well as the plausibility control and interpretation of results. The external quality assessment of laboratory work gives information about the systematic errors existing between results of different laboratories, and it helps to discover rough errors of either random or systematic origin. The external quality assessment of medical laboratories has its beginning in early 1970's in Hungary and since 1975 it is organized continuously by the National Institute. In recent years, the external quality assessment of laboratories is performed in cooperation and support of the INSTAND e.V./WHO Collaborating Center (Düsseldorf). The paper surveys the quality performance of laboratories in routine clinical chemistry, haematology, blood-coagulation, hormone and blood-gas analysis. Moreover, the evaluation of results on the basis of reference and assigned values measured in the reference laboratories and according to the statistical error of results of participants is also discussed. Further improvement in the quality performance of health laboratory service needs the introduction of unified quality system which includes details of all elements of knowledges and technical activities necessary to fulfill requirement of reliable and effective laboratory work.

Humans↗
PubMed2005

Clinical factors and outcomes in patients with acute mesenteric ischemia in the emergency department.

BACKGROUND: The purpose of this study was to determine the initial clinical characteristics of acute mesenteric ischemia and identify variables associated with adverse outcomes in the emergency department (ED). METHODS: The charts of 124 consecutive patients with surgically and pathologically identified acute mesenteric ischemia from September 1990 to September 2000 were reviewed retrospectively to obtain data about demographics, initial clinical presentations, predisposing diseases, previous medications, laboratory tests, and common findings on computed tomography scans with contrast. Only patients admitted through the ED and treated on medical or surgical wards were enrolled. RESULTS: Mean patient age was 71.1 years (range, 25-100 years). The overall mortality rate was 50%. There were no significant differences in gender, underlying disease, previous medication, initial signs and symptoms, and causes of mesenteric infarction, between survivors and non-survivors. Univariate analysis demonstrated that older age, bandemia, hepatic and renal impairment, hyperamylasemia, metabolic acidosis, hypoxia, intramural pneumatosis, and septic syndrome, were more frequent in patients who died than in those who survived (p < 0.05). Logistic regression identified the following variables as independent predictors of death: old age (odds ratio, OR, 1.077; 95% confidence interval, Cl, 1.013, 1.146; p = 0.02); bandemia (OR, 3.894; 95% Cl, 1.160, 13.074; p = 0.03); elevated serum aspartate aminotransferase (AST; OR, 4.532; 95% Cl, 1.274, 16.122; p = 0.02); increased blood urea nitrogen (BUN; OR, 7.219; 95% Cl, 1.166, 44.696; p = 0.03); and metabolic acidosis (OR, 6.604; 95% Cl, 1.804, 24.171; p < 0.01). CONCLUSION: A high index of suspicion and aggressive diagnostic imaging can facilitate early diagnosis and improve outcomes for patients with acute mesenteric ischemia. Risk stratification showed that elderly patients with metabolic acidosis, bandemia, or elevated AST and BUN had a poor prognosis. Greater therapeutic intervention is advocated to reduce mortality in high-risk patients with acute mesenteric ischemia.

Acute Disease↗
PubMed2004

ISO 15189, some comments on its application in the coagulation laboratory.

In laboratory medicine, the two main general aims are good service and good quality. Presently, external reviews and the accreditation of medical laboratories involve more than the mere assessment of conformance with standards for organizational processes. ISO series have been widely applied for clinical laboratory for recent years. ISO 15189 is the new quality system in the laboratory. It can be applied to coagulation study. Based on this system, the harmonization and standardization of coagulation laboratories are expected.

Blood Coagulation Tests↗
PubMed1986

Investigation of cholera acquired from the riverine environment in Queensland.

Since February 1977, five patients with cholera apparently acquired the infection from the riverine environment in Queensland. A total of 13 rivers have now yielded at least one isolate of Vibrio cholerae 01 biovar El Tor. Investigations indicate that the organism, including toxigenic strains, can survive and multiply in the riverine environment. No human or animal reservoirs and no ecological niches were identified and no route of importation or dissemination of the organism was discovered. The microbiological examination of faeces in all medical laboratories in Australia should include methods for detecting the cholera organism as a routine. When confronted with a cholera infection, medical practitioners should obtain a history of recent travel, both in Australia and overseas.

Adult↗
PubMedDate not supplied

Performance evaluation of a hematology blood counter with five-part leukocyte differential capability.

The summarized data and other studies to date indicate that performance of the Pentra 60 is comparable to other hematology analyzers for all CBC and 5-Diff parameters. Comparative studies indicate good correlation for all the reportable CBC parameters, lymphocyte counts, and neutrophil counts with 24 hr stability on blood samples. Good intermethod correlations on monocyte and eosinophil counts were observed. Only basophil counts showed poor intermethod correlations, but this is expected on a statistical basis, and the counts are similar to those reported for other hematology analyzer performance studies. The combination of the MDSS and stepper motor fluidic system allows for low-volume blood sampling, compact size, and low operational noise level. The Pentra 60 is well suited for physician's office laboratories, medical clinics, small- or medium-size hospitals with less than 100 CBCs per day, and larger hospitals or reference laboratories that need back-up for a high-end automated hematology analyzer.

Blood Cell Count↗
PubMed2006

Wide variability in laboratory reference values for serum testosterone.

INTRODUCTION: The laboratory determination of testosterone levels consistent with a diagnosis of hypogonadism is complicated by the availability of multiple testosterone assays and varying reference ranges. AIM: To assess current laboratory practices regarding availability of testosterone assays and use of reference values. METHODS: A telephone survey of 12 academic, 12 community medical laboratories, and one national laboratory. MAIN OUTCOME MEASURES: Types of androgen assays offered and determination of reference values. RESULTS: All of the academic and eight of the community centers performed total testosterone testing. Free testosterone was performed in-house by six of the 12 academic and one community center. Testing for bioavailable testosterone, free androgen index, and percent free testosterone was performed in-house by no more than two centers. There were eight and four different assays used for total and free testosterone, respectively. One national laboratory offered equilibrium dialysis measurement of free testosterone. Of the 25 labs, there were 17 and 13 different sets of reference values for total and free testosterone, respectively. The low reference value for total testosterone ranged from 130 to 450 ng/dL (350% difference), and the upper value ranged from 486 to 1,593 ng/dL (325% difference). Age-adjusted reference values were applied in four centers for total testosterone and in seven labs for free testosterone. All reference values were based on a standard statistical model without regard for clinical aspects of hypogonadism. Twenty-three of the 25 lab directors responded that clinically relevant testosterone reference ranges would be preferable to current standards. CONCLUSIONS: Laboratory reference values for testosterone vary widely, and are established without clinical considerations.

Androgens↗
PubMed1996

The acute phase response and laboratory testing.

Medical practitioners use laboratory testing to define disease states more precisely than is possible by clinical assessment alone. With this expectation it is easy to overemphasise the significance of numerical test results. There are many pitfalls in the interpretation of tests used to assess the body's general response to injury. This article reviews the nature of the response and highlights both the use of the available laboratory tests and some of the difficulties commonly encountered.

Acute-Phase Proteins↗
PubMedDate not supplied

[Fast tests in bacteriology].

Advances in biotechnologies and miniaturization over the past few decades have led to an explosion in the number of rapid tests in in vitro diagnosis and explain their ever-growing presence in international markets. Although based on classic immunological and biochemical methods, these tests deliver many more benefits for laboratories. They are rapid and simple to perform, provide results rapidly and can be performed in remote laboratories, making them invaluable for both routine and emergency analyses. As beneficial as they may be, however, they still have a long way to go before they find widespread use in infectious disease control. Currently, rapid testing methods are used only to screen for urinary tract infections, monitor certain infectious parameters and make more accurate diagnosis of a still small number of species of bacteria. This narrow catalogue of available tests is yet another disadvantage in a list of drawbacks typically associated with rapid tests. A good portion of complaints centers on the fact that they are still too recent to have sufficient information on their levels of sensitivity and reliability. Furthermore, regulations, in particularly concerning accountability, remain to be established. Nevertheless, constant innovation coupled with the experience of laboratory professionals in the field should open the way for rapid testing to earn its place in the line-up of medical laboratory tests.

Bacterial Infections↗
PubMed1993

Prediction of CD4 count from CD4 percentage: experience from three laboratories.

OBJECTIVE: CD4 counts have been used to monitor progression of disease in HIV infection as criteria for initiation of therapy, and to stratify and follow patients in clinical trials. Recently, the Centers for Disease Control and Prevention (CDC) has made CD4 counts part of the classification of HIV disease. Because a CD4 percentage may be the only laboratory information available, this study was initiated to determine whether the correlation between CD4 percentages and CD4 counts is sufficiently high to enable these measures to be substituted for each other. DESIGN, SETTING AND PATIENTS: One thousand consecutive CD4 measurements from the University of Washington (UW) were used to create a model that was tested using datasets of 1000 CD4 measurements each from Maryland Medical Laboratories (MML) and Rush-Presbyterian-St Luke's Medical Center (Rush). The patients were not selected for age, sex, risk group or treatment. All patients from MML and Rush were known to be HIV-positive, while the HIV status of all UW patients was unknown. RESULTS: The model predicted that a patient with a CD4 percentage > or = 14% would have a CD4 count > or = 200 x 10(6)/l(if CD4 percentage of 14% was used, 9% of patients would have a CD4 count > or = 200 x 10(6)/l), and a patient with a CD4 percentage > or = 27% would have a CD4 count > or = 500 x 10(6)/l(if CD4 percentage of 27% was used, 17% of patients would have a CD4 count > or = 500 x 10(6)/l). CONCLUSIONS: These CD4 percentage correlations may be useful when a white blood cell and lymphocyte count are not available to calculate the CD4 count.

CD4-Positive T-Lymphocytes↗
PubMed2003

Students' responses to the introduction of a digital laboratory guide in medical neuroscience.

This study investigated student acceptance of a digital laboratory guide in a medical neuroscience course. The guide was created in Macromedia Authorware 5.2 by transforming a text-based lab manual into a comprehensive multimedia program. Student attitudinal survey data indicated that the guide was used primarily as a study tool at home. Some 53% of students (primarily males) used the guide for independent study exclusively, while the remainder used it for both independent and group study; 87% of the class used the guide as a routine study tool rather than as a final review for examinations. Most students perceived that the guide increased their study efficiency and lab performance while decreasing their out-of-class study time in the lab. Female students were significantly more enthusiastic about the guide's impact on their study efficiency, lab performance and laboratory study time. Gender differences in student satisfaction with and use of instructional multimedia are discussed.

Attitude of Health Personnel↗
PubMed1999

Observations on the Liber medicine orinalibus by Hermogenes.

Our report is based on a text of the philosopher Hermogenes entitled Liber medicine orinalibus now conserved in Cod. Casin. 69 (10th century), pp 545-551, of the Montecassino Archive. This text was written in Beneventano-Cassinese characters. The Liber medicine orinalibus presents an articulate description of urines, which is interesting because of the information it provides regarding the knowledge of medicine in the 2nd century AD. This text allows us to appreciate the level reached in urine diagnostics that were performed in the medical laboratory annexed to the 'Ospitium'.

Greek World↗
PubMedDate not supplied

The new lab law. How will group practices fare? The 1990 AGPA laboratory survey.

The cost of doing business will increase due to the fact that hospital and reference labs charges will be higher than the cost of performing tests on-site. These higher costs will be reflected in higher charges to patients. Patients will lose the ability to have face-to-face discussion with physicians regarding lab results.

Attitude of Health Personnel↗