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PubMedDate not supplied

Managerial decision-making in the laboratory.

Although managers make decisions daily, they do not always make them well. Because of the complexity of some decisions, a decision aid such as the multiattribute utility model is often helpful. This model can help a decision-maker in problem structuring, including determining the criteria on which the alternatives should be judged, how important these criteria are in relation to each other, and how well the alternatives stack up against these criteria. Finally, the model brings all this information together so that the decision-maker can make appropriate recommendations. By using a multiattribute utility model, this case study shows the applicability of the model to the decision of choosing among alternative hematologic instruments in a medical laboratory. The model, in any of its forms, is also useful for many other types of decisions. The model can be used either to help make a choice or to reinforce a choice made by other means and to help communicate the factors on which a choice was made.

Administrative Personnel↗
PubMed2004

Reference individuals, blood collection, treatment of samples and descriptive data from the questionnaire in the Nordic Reference Interval Project 2000.

The rules for recruitment of reference individuals, inclusion and preparation of individuals, blood collection, treatment of samples (and control materials) and analysis at the 102 medical laboratories attending the Nordic Reference Interval Project (NORIP) are given as well as the rules for central exclusion of reference individuals. The individuals (18-91-year-olds) should be evenly distributed on age and gender groups. The 3002 reference individuals who contributed at least one reference value to the finally suggested reference intervals were characterized using the information in the questionnaire. Gender, age and country are the main entries in the tables. Other variables in the cross-tables or figure are height, weight, body mass index, ethnic origin, heredity for diabetes, chronic disease, oestrogens or oral contraceptives, other medication, hard physical activity, previous blood donations, smoking habits, use of alcohol, hours since last meal and time of blood collection (hour, day of week, month, year). The Danes had the highest alcohol consumption and the Icelanders had the highest body mass index. The information in this article may interest potential users of the Nordic Reference Interval Project bio-bank and database (NOBIDA) in which serum, Li-heparin plasma and EDTA buffy coat from the mentioned individuals are stored below -80 degrees C.

Adolescent↗
PubMed1998

Improvement in resource utilization after development of a clinical pathway for patients with pressure ulcers.

Clinical pathways are interdisciplinary patient care plans intended to reduce variance and improve quality of care while lowering health care cost. This study was undertaken to determine whether the development of a clinical pathway for care of patients with pressure ulcers can indeed decrease health care costs while preserving quality of care. A clinical pathway for surgical reconstruction of pressure ulcers was developed by standardizing the current practices of our plastic surgeon group. The pathway provided direction in optimal scheduling of physician interventions along with nursing, physical and occupational therapies, and spinal cord rehabilitation interventions. It covered all potential elements of patient care, including laboratory, radiology, dietary services, intravenous fluids, and use of specialty beds. It defined patient outcomes and outlined discharge planning. Pathways were distributed throughout all services caring for patients with pressure ulcers. Patient charts and billing data were reviewed for the 16-month periods before and after initiation of the pathway. No other significant changes in treatment occurred during this time frame. Ninety-seven patient charts were examined (54 before pathway and 43 after pathway implementation). Parameters evaluated included length of stay and total charges (including bed use, medications, laboratory tests, and radiology). Patient readmission rate was also examined. A significant reduction in patient length of stay and total charges was achieved after implementation of the clinical pathway. Reduction was seen not only for patients treated with flaps by plastic surgery but also for patients with pressure ulcers who were not specifically targeted such as those from other services. The readmission rate decreased slightly, although not significantly, after the pathway inception. Total cost saving was almost $11,000 per patient (23 percent). In conclusion, implementation of a clinical pathway, because it standardizes care and reduces variations and duplication of care, can reduce health care cost without impairing quality of care in the treatment of decubitus ulcer patients.

Costs and Cost Analysis↗
PubMed1988

Ocular herpes simplex infection: pathogenesis and current therapy.

Ocular herpes simplex disease has a variable pattern of manifestations and recurrences as a result of the site and extent of the infection, the host immunologic events, the trophic damage within ocular tissues, and the toxic effects of antiviral medications. Laboratory research has established a clinical model and a working hypothesis about the complex pathophysiologic features of the disease and the interaction of the virus with its host tissue. Recent studies have further defined the viral genome and its role in virulence and pathogenicity. Antiviral therapy is effective in some but not all aspects of the ocular infection. A proposed clinical classification of ocular herpes simplex is based on the manifestations associated with viral disease and those associated with the host response and the subsequent structural damage. A plan for medical and surgical management of ocular herpes simplex, based on current knowledge of the disease process, relates to the integrity of the epithelium and the presence of active viral disease.

Humans↗
PubMed2004

Investigation of correlation between house-staff work hours and prescribing errors.

PURPOSE: The possible correlation between the frequency and significance of prescribing errors and the number of hours worked during a 24-hour shift by hospital house staff was studied. METHODS: A prospective observational trial was conducted in two internal medicine units at an academic medical center. Orders written by medical house staff covering the study units between January 8 and March 10, 2001, were collected daily and evaluated for obvious prescribing errors, the type and significance of the errors, and the number of hours the resident had worked during a 24-hour shift at the time of the prescribing error. RESULTS: A total of 45,366 orders (including orders for medications, laboratory tests, diagnostic procedures, and nursing care) were entered on the study units during the study period. A total of 498 erroneous prescribing orders were identified. A majority of the erroneous orders (77%) could have resulted in significant morbidity or mortality had they reached the patient. The most common errors involved the wrong dose (18%), the wrong dosage frequency (15%), and duplicate orders (15%). There was no statistically significant correlation between the number of hours worked and the frequency or significance of the errors. CONCLUSION: The number of hours worked by medical house staff during a 24-hour shift did not appear to affect the frequency or significance of their prescribing errors.

Drug Prescriptions↗
PubMed1998

The cost-effectiveness of automatic implantable cardiac defibrillators: results from MADIT. Multicenter Automatic Defibrillator Implantation Trial.

BACKGROUND: The recently reported Multicenter Automatic Defibrillator Implantation Trial (MADIT) showed improved survival in selected asymptomatic patients with coronary disease and nonsustained ventricular tachycardia. The economic consequences of defibrillator management in this patient population are unknown. METHODS AND RESULTS: Patients were followed up to quantify their use of healthcare services, including hospitalizations, physician visits, medications, laboratory tests, and procedures, during the trial. The costs of these services, including the costs of the defibrillator, were determined in patients randomized to defibrillator and nondefibrillator therapy. Incremental cost-effectiveness ratios were calculated by relating these costs to the increased survival associated with the use of the defibrillator. The average survival for the defibrillator group over a 4-year period was 3.66 years compared with 2.80 years for conventionally treated patients. Accumulated net costs were $97,560 for the defibrillator group compared with $75,980 for individuals treated with medications alone. The resulting incremental cost-effectiveness ratio of $27,000 per life-year saved compares favorably with other cardiac interventions. Sensitivity analyses showed that the incremental cost-effectiveness ratio would be reduced to approximately $23,000 per life-year saved if transvenous defibrillators were used instead of the older devices, which required thoracic surgery for implantation. CONCLUSIONS: An implanted cardiac defibrillator is cost-effective in selected individuals at high risk for ventricular arrhythmias.

Cost-Benefit Analysis↗
PubMed1994

[Cost of acute hepatitis A in adults in France].

OBJECTIVES: Seroprophylaxy against hepatitis A has been limited to subjects visiting endemic areas or in contact with acutely infected patients due to the short half-life and high cost of the non-specific immunoglobulins. Inactivated vaccines might offer a better solution, but the real cost factors remain unknown. We undertook this study to determine the cost of acute hepatitis A. METHODS: Serum samples from all the non-hospital medical laboratories in the Lyon (France) area were prospectively screened to identify 100 consecutive patients with acute hepatitis (positive for hepatitis A IgM antibodies). A questionnaire was addressed to these 100 subjects 1 year later requesting information on health care expenditures and work loss related to their episode of acute hepatitis A. Imprecise answers were completed by telephone interview. RESULTS: Answers were obtained from 92 subjects. Confirmation was obtained that the 8 other subjects had not died from their episode of acute hepatitis. Only two patients were hospitalized (for 2 and 4 days). Total mean cost (including medical expenditures and work loss was 11,789 French francs (range 1,524-62,117). Medical consultations and prescriptions comprised 20.0% of the total cost. The real mean cost of work loss (8,423 F) was greater than the cost calculated by the national health service (6,500 F). CONCLUSIONS: This evaluation of the real cost of hepatitis A in non-hospitalized patients should contribute to the definition of an adapted policy for the prevention of hepatitis A.

Acute Disease↗
PubMed1993

Physician goals and laboratory test turnaround times. A College of American Pathologists Q-Probes study of 2763 clinicians and 722 institutions.

Laboratory test turnaround times (TATs) for emergency department patients were studied in 722 institutions using Q-Probes, a quality improvement program of the College of American Pathologists. The medians of the TATs required by 2763 clinicians were 10 minutes for PO2, 20 minutes for hemoglobin, and 30 minutes for potassium and glucose measurements. Surgeons had the shortest TAT requirements for hemoglobin, potassium, and glucose measurements, whereas emergency department physicians had the shortest requirements for PO2. The measured TATs of most hemoglobin and potassium determinations did not meet clinician goals. In contrast to laboratorians, the majority of clinicians defined a TAT start time as test ordering, and a TAT ending time as result reporting. We recommend laboratorians and clinicians mutually agree on the definition of TAT, jointly develop timeliness goals, and together improve TAT performance to fulfill these goals.

Diagnostic Tests, Routine↗
PubMed2001

Risk factors and seroprevalence of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection in uzbekistan.

OBJECTIVES: The aim of this study was to elucidate the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection in Uzbekistan and to explore whether there is a correlation between those blood-borne agents and socioeconomic risk factors. METHODS: One thousand nine hundred and eighteen subjects were studied. The subjects were divided into a low-risk group, a high-risk group and a patient group. Sera were tested for HBV surface antigen (HBsAg), anti-HCV, and anti-HIV. RESULTS: The seroprevalence of HBsAg, anti-HCV, and anti-HIV in the general population was 13.3, 13.1 and 0%, respectively. The anti-HCV infection rate was significantly higher in intravenous drug users (62.7%) than in prostitutes (9.2%), homosexuals (11.1%), and medical laboratory employees (12.5%) (p < 0.01). In the low-risk group, positivity for anti-HCV increased with age from 2.2% in the 15- to 20-year-olds up to the highest rate of 17.6% in the 31- to 40-year-olds; the positivity then decreased to 0% in the group over 60 years of age. In the high-risk group, the positivity for anti-HCV in the age groups under 40 years was approximately 30% and significantly higher than in the low-risk group (p < 0.01). Risk factors for transmission of HCV were medical treatment in the low-risk group, drug abuse in the high-risk group, and both in the patient group. CONCLUSIONS: This study demonstrates that the seroprevalence of HBV and HCV infection is high, whereas HIV infection is yet uncommon in Uzbekistan.

Adolescent↗
PubMed1994

Where do all the placentas go?

Re-examining the disposal of placentas as pathological waste is suggested by the author. Placentas can be reprocessed safely for the production of blood derivatives necessary for human treatment by following accepted infection control guidelines in collection, transportation and reprocessing in approved medical laboratories. Money can be saved by removing placentas from the pathological waste stream. Historically, infection control reasons have often been cited as the rationale for preventing changes in the perinatal area. It may be time for infection control teams, administrators and obstetrical staff to review the ethical, legal and infection control issues related to disposal of placentas.

Female↗
PubMed2005

Prevalence of irritable bowel syndrome in a Nigerian student population.

Irritable bowel syndrome (IBS) is a widely recognized disorder accounting for up to 50% of referrals to gastroenterologists in the Western world. Existing literature had suggested that its prevalence is low among native Africans. The objective [corrected] is to document the prevalence of IBS in this environment. A cross-sectional study of clinical students at the Jos University Medical School and the School of Medical Laboratory Technology in Jos University were cohorted. Questionnaires based on the Rome II criteria were administered to 330 students (221 males and 109 females). Irritable bowel syndrome was present in 86 (26.1%) of the subjects, being present in 58 (26.4%) of the males and 28 (25.7%) of the females respectively (OR 0.97, 95% CI 0.57-1.63, p = 0.89). The mean age of subjects with IBS was 26.3 +/- 4.0 years and that of subjects without IBS was 26.5 +/- 3.8 years, p = 0.6. The majority (54.8%) of the subjects did not consider their symptoms as illness and therefore did not seek any form of care. More males sought medical care compared to females (19.6% vs. 3.6% respectively, p = 0.02). Depressive symptoms were present in 21 (24.4%) of subjects with IBS compared to 36 (14.8%) of those without (p = 0.06). Irritable bowel syndrome is a common disorder in the student population of a medical school in Northern Nigeria.

Adult↗
PubMed1994

The MAXM hematology autoanalyzer. An alternative?

The MAXM is a compact blood count and differential analyzer that appeals to both the space-limited, full-service laboratory and the large outpatient practice. The authors compared the performance of the Coulter MAXM to the larger Coulter STKS. Linearity and precision studies were comparable to the STKS. MAXM leukocyte differentials were closely correlated with STKS and manual readings, being excellent in the neutrophil, lymphocyte, and eosinophil categories but poorer on monocyte counts. Basophil counts did not correlate with STKS or manual counts. Analyzer suspect flagging was similar in both machines, with the MAXM exhibiting slightly reduced sensitivity and greater specificity. MAXM processing of a single sample requires twice the time. The MAXM functions well for a large office practice and as a backup for large medical laboratories but, because of its hands-on requirements and lack of speed, cannot replace the larger, more automated analyzers.

Autoanalysis↗