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PubMed1970

Experience with a hospital laboratory admission screen.

A comprehensive laboratory admission screen can be instituted in any large laboratory but only in one in command of conventional technology and with the co-operation of the laboratory, medical, nursing and admitting staff.The capital equipment required is costly and subject to early obsolescence. The operating costs are initially high, but the influence of the screen on the general work load indicates that the total overall procedures ordered by the physician will be reduced in number and that over a three-year period, in an economy subject to continuous inflationary pressure, the total cost will approach what might have been expected had the screen not been instituted.By presenting, shortly after admission, a truly comprehensive laboratory profile, the total number of procedures ordered will be reduced and this reduction bears no relationship to whether or not the data supplied are medically useful.The equipment more recently available for a large admission screen is far superior, from the point of view of speed of assay and cost of maintenance and production, to the equipment that has been available to us in this study.It is believed that the unit cost of assay will continue to decline and that the principle of unsolicited testing will be expanded in the future to include procedures not presently in the profile.It is predicted that in the relatively near future almost all of the laboratory procedures that a clinician could conceivably request will have been done prior to his examination of the patient.

Autoanalysis↗

PubMed1985

Laboratory computers: tools for increased productivity.

Revolutionary changes in the computer industry brought about in part by the introduction of personal computers are now reaching into clinical laboratories everywhere. Although the true justification for any computer tool may be an intangible one such as improvement in service, such tools can typically be cost justified by increases in productivity alone. A broad spectrum of applications software useful in the medical laboratory is now available in any scale required to meet the needs of any size of laboratory. Perhaps one of the most dramatic changes in this field in the last several years has been the introduction of small-scale integrated laboratory systems that are true small-scale laboratory information systems. As a result, smaller laboratories can now acquire laboratory information systems appropriately scaled to their workload for a fraction of the cost of the large systems. These small laboratory information systems are typically more easily cost justified than larger ones. Achieving productivity gains using computer tools in the laboratory is a management-intensive process requiring careful analysis and thorough planning. Laboratory managers who eschew computer tools are now an anachronism; extinction of this species is imminent.

Computers↗

PubMed2003

Intensive care in a field hospital in an urban disaster area: lessons from the August 1999 earthquake in Turkey.

OBJECTIVE: To describe our experience with the implementation of intensive care in the setting of a field hospital, deployed to the site of a major urban disaster. DESIGN: Description of our experience during mission to Turkey; conclusions regarding implementation of intensive care at disaster sites. SETTING: Military Field Hospital at Adapazari in Turkey. PATIENTS: Civilian patients admitted for care at the field hospital. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: On August 17, 1999 a major earthquake occurred in western Turkey, causing approximately 16,000 fatalities and leaving >44,000 injured. Approximately 66,000 buildings were severely damaged or destroyed. A medical unit of the Israeli Defense Forces Medical Corps, consisting of 23 physicians, 13 nurses, nine paramedics, 13 medics, laboratory and roentgen technicians, pharmacists, and associated support personnel, were sent to Adapazari in Turkey. The field hospital treated approximately 1,200 patients over a period of 2 wks, 70 surgical operations were performed, 20 babies were delivered, and a variety of medical, surgical, orthopedic, and pediatric/neonatal care was provided. The 12-bed intensive care unit operated by the unit, was staffed by three physicians and eight nursing/paramedic personnel. Patient mix was: a total of 63 patients, among them five with major trauma, 20 with acute cardiac disease, 15 patients with various acute medical conditions, and 11 surgical and postoperative patients. Three patients were intubated and mechanically ventilated (one cardiogenic pulmonary edema and two major trauma). The intensive care unit provided the following functions to the field hospital: care of the critically ill and injured, preparation for and implementation of transportation of such patients, pre- and postoperative care for major surgical procedures, expertise, and equipment for the care of very ill patients throughout the field hospital. CONCLUSIONS: In suitable circumstances, an intensive care capability should be an integral part of medical expeditions to major disasters.

Disaster Planning↗

PubMed1991

A comparison of field and laboratory polygraphs in the detection of deception.

This study compared the effectiveness of field and laboratory polygraphs in discriminating guilty and innocent subjects tested using the Control Question Technique (CQT). Subjects were 48 prisoners examined regarding a mock theft in a peer threat context; physiological responses were recorded simultaneously on a Lafayette field polygraph and a Sensor Medics laboratory polygraph. Overall hit rates were essentially the same whether classifications were based on quantitative measures from the laboratory polygraph or on numerical scores from the field polygraph (i.e., 73% and 79%, respectively), and in both cases the best discriminating measures were electrodermal activity and indices of respiration suppression. Further analyses revealed that errors of classification were mostly due to the failure of the available measures to differentiate between relevant and control questions for innocent subjects. These results indicate that the CQT is susceptible to false positive errors when subjects are tested under field-like circumstances, a problem that is not likely to be eliminated by refinements in instrumentation and scoring.

Adult↗

PubMed2005

Making the most of a patient's laboratory data: optimisation of signal-to-noise ratio.

All results in laboratory medicine are compared to some reference for interpretation. This reference may be a previous result from the same patient, a reference population--either healthy or diseased, or both--or a decision limit recommended by an expert group. The aim for the medical laboratory is to improve the signal-to-noise ratio by increasing the signal or reducing the noise. This presentation deals with the more general tools for reduction of the noise component, and focuses on biological within-subject variation, reference intervals and decision models. Regarding biological within-subject variation, the estimation of reference change value (RCV) as a yardstick for judging measured differences within the patient over time is an important tool. Here, only type 1 errors are usually applied, but type 2 errors should also be taken into consideration. Moreover, variance homogeneity is assumed for the application of RCV, but this assumption is not always fulfilled, and erroneous interpretations may be introduced. A tool for comparison of different and more complicated algorithms applied to serial measurements is computer simulation (e.g. on data from tumour markers). In order to reduce the noise component from reference intervals, partitioning according to relevant subgroups is a tool, and useful criteria for judging whether subgroups should be combined are reported. Geographical and racial differences may cause different reference distributions (e.g. plasma proteins), but it has been possible to establish common reference intervals for 25 common components in Caucasians in the five Nordic countries. Transformation of data and presentation of accumulated ranked values in rankit plots where Gaussian (or log-Gaussian) distributions show up as straight lines is a valuable tool for interpretation of the distributions and comparison of subgroups. In this way it is often possible to isolate a low-risk group which fits a log-Gaussian distribution. In case of thyroid autoantibodies the distributions look biphasic, even after all possible rule-out criteria have been exhausted, but a composite model makes it possible to extract a reference population from the mixture. The classical decision model is bimodal, reflecting an assumption of two independent but overlapping distributions, with a clear but unknown prevalence for the disease. When a decision limit (cut-off point) is applied, the percentages of false positive and false negative results will be determined, but the underlying prevalence is unchanged. In contrast to this, the unimodal distributions cover a continuum of probabilities for a certain disease (risk) and the decision limit is arbitrarily chosen. Thus, the disease or risk is defined by the measured component. Consequently, the decision limit directly defines the prevalence, and this limit can be different over time and geography as has been the case for cholesterol or glucose.

Journal Article↗

PubMed1982

[Double-blind comparative trial of lonazolac-Ca versus naproxen in spinal osteoarthrosis, coxarthrosis and gonarthrosis (author's transl)].

Two groups of patients, each consisting of 20 patients suffering from spinal osteoarthrosis, coxarthrosis or gonarthrosis participated in a double-blind comparative trial. They received either Lonazolac-Ca (200 mg three times daily) or Naproxen (250 mg twice daily plus 1 placebo capsule in between doses) for three weeks. The therapeutic response was assessed by monitoring pain intensity at rest and on exercise, joint tenderness and joint movement, muscular tension, morning stiffness and walking ability. In spinal osteoarthrosis vertebral flexibility was also measured. Nine out of 11 parameters showed significant improvement with Lonazolac-Ca, whereas only 6 out of 11 improved with Naproxen. However, no clinically relevant differences were recorded between both medications. Laboratory tests in both treatment groups revealed no changes in haematological or biochemical parameters nor in urinanalysis results. Drug-related gastro-intestinal side effects were observed in 2 patients of each treatment group. The patients on Lonazolac-Ca tolerated their medication with the aid of concomitant antacids whereas Naproxen had to be discontinued. One case of dermatitis, which was probably not drug-related was observed in each group. One patient suffering from migraine experienced vertigo and headache on taking Lonazolac-Ca; although this was probably not drug-related medication was discontinued.

Adolescent↗

PubMed1981

[A general view of the ambulatory care sector: Structural and functional study in the cantons of Vaud and Fribourg].

The project "Quantification and qualification of ambulatory health care", financed by the Swiss National Science Foundation and covering the Cantons of Vaud and Fribourg, has two main goals: --a structural study of the elements of the ambulatory care sector. This is done through inventories of the professions concerned (physicians, public health nurses, physiotherapists, pharmacists, medical laboratories), allowing to better characterize the "offer". This inventory work includes the collect and analysis of existing statistical data as well as surveys, by questionnaires sent (from September 1980) to the different professions and by interviews. --a functional study, inspired from the US National Ambulatory Medical Care Survey and from similar studies elsewhere, in order to investigate the modes of practice of various providers, with particular regard to interprofessional collaboration (through studying referrals from the ones to the others). The first months of the project have been used for a methodological research in this regard, centered on the use of systems analysis, and for the elaboration of adequate instruments.

Ambulatory Care↗

PubMed2006

A web-based interactive database system for a transcranial Doppler ultrasound laboratory.

BACKGROUND: Variations in transcranial Doppler (TCD) examination performance techniques and interpretive paradigms between individual laboratories are a common challenge in the practice of TCD. Demand for rapid access to patient ultrasound examination data and report for use in intensive care settings has necessitated a more flexible approach to data management. Both of these issues may benefit from a computerized approach. METHODS: We describe the application of a World Wide Web-based database system for use in an ultrasound laboratory. Results. Databasing information while generating a TCD report is efficient. Web accessibility allows rapid and flexible communication of time-sensitive report information and interpretation for more expeditious clinical decision making. CONCLUSIONS: Web-based applications can extend the reach and efficiency of traditionally structured medical laboratories.

Cerebrovascular Disorders↗

PubMed1993

Medically relevant laboratory-performance goals: a listing of the complexities and a call for action.

This 1992 Clinical Chemistry Forum asks if accuracy and precision goals for the laboratory can be specified by reference to medical requirements, which are a function of the total laboratory testing process as well as the needs of patients, clinicians, and societal institutions. Furthermore, medical decisions and decisions about medical requirements must be made in situations of uncertainty and thus are subject to predictable cognitive errors. The interaction of all these factors must be considered by patients, laboratorians, and clinicians to identify practical and effective performance goals. Pathologists and clinical chemists are uniquely trained to identify thoughtful clinicians who are knowledgeable in quantitative judgment to participate in this goal-setting endeavor. It is time for these parties to accumulate the available data and engage in the synthesis of effective performance goals.

Bias↗

PubMedDate not supplied

Comparative study of haematological values using manual and automated techniques in apparently healthy adult Nigerians.

BACKGROUND: Many public medical laboratories use automated techniques for analysis of samples due to the few number of laboratory staff required and the speed at which it operates. This study was carried out to compare haematological values obtained from automated techniques and manual techniques. METHOD: A total of 86 apparently healthy adult Nigerians, aged 18-50 years comprising 50 males and 36 females who came for medical examination between June, 2004 and May, 2005 at Aminu Kano Teaching Hospital, Kano were used for the study. Standard manual methods and cell-dyn 3700cs system techniques were used to determine haematocrit, total and differential leucocyte counts. RESULTS: Statistically significant differences were found between automated and manual techniques in males with regard to haematocrit levels, total white cell counts, differential monocyte and basophil counts (0.45 +/- 0.031/1, 5.1 +/- 1.9 x 10(9)/l, 0.54 +/- 0.19 x 10(9)/l and 0.11 +/- 0.08 x 10(9)/l respectively) for automation and 0.42 +/- 0.041/l, 4.4 +/- 1.4 x 10(9)/1, 0.05 +/- 0.06 x 10(9)/l and 0.004 +/- 0.013 x 10(9)/l respectively for manual methods at P < 0.001, P < 0.05, P < 0.001 and P < 0.001 respectively while there were no significant differences in differential neutrophil, lymphocyte and eosinophil counts (2.1 +/- 0.7 x 10(9)/l, 2.2 +/- 0.7 x 10(9)/l and 0.14 +/- 0.16 x 10(9)/l respectively) of the automation when compared to 2.1 +/- 0.5 x 10(9)/l, 2.1 +/- 0.5 x 10(9)/l and 0.09 +/- 0.09 x 10(9)/l respectively using manual methods (P > 0.05). There were no statistically significant differences between automated and manual methods in females with regard to total white cell count, differential neutrophil, lymphocyte and eosinophil counts (5.8 +/- 2.3 x 10(9)/l, 2.6 +/- 0.9 x 10(9)/l, 2.4 +/- 0.8 x 10(9)/l and 0.1 +/- 0.1 x 10(9)/l respectively) of the automation when compared to 4.9 +/- 1.6 x 10(9)/l, 2.5 +/- 0.7 x 10(9)/l, 2.3 +/- 0.6 x 10(9)/l and 0.06 +/- 0.09 x 10(9)/l respectively of manual techniques (P > 0.05) while significant differences were observed in haematocrit, differential monocyte and basophil counts (0.39 +/- 0.03 l/l, 0.55 +/- 0.3 x 10(9)/l and 0.1 +/- 0.09 x 10(9)/l respectively) of automation when compared to 0.37 +/- 0.03 l/l, 0.03 +/- 0.04 x 10(9)/l and 0.002 +/- 0.01 x 10(9)/l respectively of the manual methods at P < 0.01, P < 0.001 and P < 0.001 respectively. CONCLUSION: The results have proven that differential monocyte and basophil counts from automation are unreliable and efforts should be made to carry out manual differential counts for confirmation.

Adolescent↗

PubMed2001

Macroprolactinaemia, the major unknown in the differential diagnosis of hyperprolactinaemia.

We report on 10 cases of macroprolactinaemia and discuss recent evidence that many patients with hyperprolactinaemia (8-26%, depending on the population studied) have in fact normal amounts of circulating prolactin but false-high values in commercial assays. This is caused by macromolecular prolactin (also named big-big prolactin or macroprolactin), a complex of prolactin with IgG antibodies leading to apparent hyperprolactinaemia. In spite of the expanding literature on this topic, it remains an underrecognised problem, typically causing unnecessary procedures such as laboratory controls, MRI of the pituitary, treatment with dopamine agonists or even pituitary surgery. Physicians involved with diagnosis and treatment of hyperprolactinaemia (general practitioners, gynaecologists, neurosurgeons, endocrinologists and biochemists) should suspect the presence of apparent hyperprolactinaemia in any patient with a high prolactin value but no related symptoms. Medical laboratories should be aware that their prolactin assay can interfere with macroprolactin and should implement the use of the PEG precipitation test in the work-up of hyperprolactinaemia, a simple and effective means of correctly diagnosing apparent hyperprolactinaemia.

Adolescent↗

PubMed1959