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1.

Introduction

We aimed to determine the number of repeated cholesterol (RC) tests and the ratio of unnecessary-repeated cholesterol (URC) tests among patients admitted to Pamukkale University Hospital (Denizli, Turkey) and provide solutions to avoid URC testing.

Materials and methods

Total cholesterol (T-cholesterol) tests (N = 86,817) between June 2014 and May 2015 were evaluated. The tests performed more than once per patient were determined as RC test (N = 28,811). RC test with an interval shorter than 4 weeks were determined as URC test (N = 3968) according to the shortest retest interval stated in ACC/AHA blood cholesterol guideline. RC testing included internal medicine, surgery and paediatric outpatients and inpatients. Reference change value (RCV) of total cholesterol was calculated.

Results

The 33.1% of the T-cholesterol tests were RC tests (N = 28,811), 13.7% of them were URC tests (N = 3968). Our RCV value was 25%. The percentage change between consecutive tests was less than RCV in 86.1% (N = 3418) of URC tests. URC tests were performed more frequently in patients with desirable total cholesterol value (P < 0.001).

Conclusion

There is a significant part of repeated T-cholesterol tests requested in our hospital. URC test requests can be evaluated by laboratories and the obtained data should be shared with clinicians. Laboratories can calculate RCV for the tests they performed and report this value with the test result. To prevent from URC tests, a warning plug-in can be added to hospital information software in accordance with guidelines to prevent from URC test requests.Key words: unnecessary repeated cholesterol test, cholesterol retest interval, reference change value, laboratory costs, preanalytical phase, test requesting  相似文献   

2.
IntroductionThe intraindividual variability in urinary creatinine excretion is notoriously large. The aims of this study were to investigate the variability of duplicate consecutive 24-hour urinary creatinine excretions in patients and to develop a model for the detection and correction of discrepant creatinine excretions.Materials and methodsA group of 270 patients (82 men and 188 women) were included in the study. We collected the following data: urinary 24-hour volumes (volumetric/gravimetric) and urinary creatinine concentrations (Jaffé/enzymatic) on both collection days. We performed specific calculations to detect discrepant creatinine excretions.ResultsIn 60 patients (22%) discrepant collections were found. Among the remaining 78%, 22% of the patients collected very accurately (almost identical urinary creatinine excretions). In this subgroup the volume ratios and the creatinine concentration ratios behave inversely as in a dilution curve. A theoretical model and six collection scenarios were developed to detect, interpret and correct discrepant collections. Practical examples are given to illustrate the use of the model in successful correction of creatinine and other analytes for under- or overcollection.ConclusionsWe conclude that missed or overcollected urine volumes are the largest source of variation in creatinine excretion. Discrepancies in consecutive duplicate 24-hour creatinine excretions can be detected and corrected with specific calculations by means of the presented model. The effectiveness of these corrections is demonstrated with examples from daily practice. These calculations can be easily automated.  相似文献   

3.

Background:

Overcrowding and prolonged length of stay in emergency departments (ED) are increasing problems in hospitals. Rapid availability of all laboratory results has an impact on clinical decision-making, admissions or discharge decisions and resource utilisation. Increasing number of our urinary drugs of abuse (DOA) screens had a turnaround time (TAT) of up to 33 days after the discharge of the patient.

Materials and methods:

Following an audit and a consultation period with clinicians using the service, a policy change was implemented to reduce the use of gas chromatography mass spectroscopy (GCMS): all requests would have a standard immunoassay (IA) test panel undertaken unless specifically they requested GCMS (including medico-legal) analysis.

Results:

Almost all of the clinicians interviewed had no understanding of the DOA screening or the difference in the information generated between a confirmatory GCMS urine toxicology screen and IA DOA panel. It appeared none of the patients surveyed in the audit would have had a different clinical decision made if a GCMS had not been undertaken. Post change audit showed only 4.3% of drug requests for IA also received a confirmatory GCMS testing. The estimated saving post change implementation was $127,000 (AU $) in test costs alone over a two year period. The TAT of GCMS results was reduced to 3–4 days.

Conclusion:

A laboratory-led behavioural change in test requesting is possible and sustainable provided the reason is clinically sound and accompanied by consultation and availability of advice by phone when requested on test requesting or interpretation.  相似文献   

4.
IntroductionIt is often quoted that 70% of clinical decisions are based on laboratory results, but the evidence to substantiate this claim is lacking. Since clinical guidelines aim to document best-practice decision making for specific disease conditions, inclusion of any laboratory test means that the best available evidence is recommending clinicians use it. Cardiovascular disease (CVD) is the world’s most common cause of mortality, so this study reviewed all CVD guidelines published by five national/international authorities to determine what proportion of them recommended laboratory testing.Materials and methodsFive leading CVD guidelines were examined, namely the European Society of Cardiology (ESC), the UK National Institute for Health and Clinical Excellence (NICE), the American College of Cardiology (ACC), the Australian Heart Foundation (AHF) and the Cardiac Society of Australia and New Zealand (CSANZ).ResultsA total of 101 guidelines were reviewed. Of the 33 individual ESC guidelines relating to CVD, 24/33 made a direct reference to the use of clinical laboratory tests in either diagnosis or follow-up treatment. The same applied to 15/20 of NICE guidelines, 24/32 from the ACC and 15/16 from the AHF/CSANZ. Renal function and blood count testing were the most recommended (39 and 26 times), with lipid, troponin and natriuretic peptide measurement advocated 25, 19 and 19 times respectively.ConclusionsThis study has shown that laboratory testing is advocated by between 73% and 94% of individual CVD guideline recommendations from five national/international authorities. This provides an index to assess the potential value of laboratory medicine to healthcare.  相似文献   

5.
IntroductionGeneral Data Protection Regulation (GDPR) focuses on important elements of data ethics, including protecting people’s privacy, accountability and transparency. According to the GDPR, certain public institutions are obliged to appoint a Data Protection Officer (DPO). However, there is little publicly available data from national EU surveys on DPOs. This study aimed to examine the scope of work, type of work, and education of DPOs in institutions in Croatia.Materials and methodsDuring 2020-2021, this cross-sectional study surveyed DPOs appointed in Croatia. The survey had 35 items. The questions referred to their appointment, work methods, number and type of cases handled by DPOs, the sources of information they use, their experience and education, level of work independence, contacts with ethics committees, problems experienced, knowledge, suggestions for improvement of their work, changes caused by the GDPR, and sociodemographic information.ResultsOut of 5671 invited DPOs, 732 (13%) participated in the study. The majority (91%) indicated that they could perform their job independently; they did not have prior experience in data protection before being appointed as DPOs (54%) and that they need additional education in data protection (82%).ConclusionsMost DPOs indicated that they had none or minimal prior experience in data protection when they were appointed as DPO, that they would benefit from further education on data protection, and exhibited insufficient knowledge on basic concepts of personal data protection. Requirements for DPO appointments should be clarified; mandatory education and certification of DPOs could be introduced and DPOs encouraged to engage in continuous education.  相似文献   

6.
《普罗米修斯》2012,30(2):145-160

Patients and carers now have unprecedented access to health information via specialist journals and the popular media, while the worldwide web has revolutionised public access to clinical information. Levels of patient demand for information about health have grown and there is evidence to suggest that patients wish to receive more information than is sometimes currently provided by clinicians. In secondary care, some specialisms have more readily adopted the use of information communication technologies (ICT) in clinician/patient communication than others. This paper focuses on clinicians' perceptions of client Internet use for psychiatric conditions and studies the influence this has had on the consultation process in the United Kingdom. The research method consisted of a postal questionnaire distributed to the members of the Women in Psychiatry Group on the register of the Royal College of Psychiatry. Telephone interviews were conducted, employing the critical incident method, as well as a brief additional questionnaire. The data show that psychiatrists who used the Internet discerned client usage more readily. Where the client sought to discuss information acquired electronically with the consultant this tended to extend the consultation period, but a number of psychiatrists reported a greater sense of partnership as a result. The paper explores consultant perceptions of client motivations for Internet use and the perceived advantages and disadvantages for both client and psychiatrist. Overall, the psychiatry profession appears to be following the lead of clients in the use of ICT. Policy recommendations are offered with respect to the provision of profession-validated information on the Internet and psychiatrists' training in IT.  相似文献   

7.
赵丹  周佳君 《情报科学》2022,40(9):115-122
【目的/意义】厘清信息细化概念边界,剖析区块链环境下舆情信息细化特征,解构舆情信息细化网络,推动 信息细化理论应用,为网络舆情管理提供启示。【方法/过程】本研究基于信息细化和舆情传播理论,提出区块链环 境下舆情信息细化系统模型,采集 Steemit和新浪微博新冠疫情数据,采用社会网络分析方法运用 Gephi工具进行 实证研究。【结果/结论】区块链环境下的舆情信息细化网络为无标度网络,用户信息细化水平较高,信息精致阐释 基础上展开信息细化行为特征明显。【创新/局限】本文所构建的舆情信息细化模型拓展了信息细化理论在舆情管 理领域的应用,对发挥信息细化在舆情信息传播和知识创新之间的桥梁作用也具有实用价值,但在数据采集规模、 数据标注结果检验、信息细化概念边界等方面还有待完善和拓展。  相似文献   

8.

We examine practice theories concerned with knowledge sharing in complex organizations to distinguish common trends and variations in this complex body of work. We suggest that an analytical framework highlighting the relational thinking in practice theories can serve as a tool to sort through the literature on knowledge sharing. First, we delineate a relational framework consisting of seven attributes associated with a practice theory. Second, we use this framework to analyze a narrow set of practice theories represented by three seminal works on communities of practice. Third, we compare and contrast the relational dynamics found in the three seminal works in regard to how they conceptualize knowledge sharing within and across communal boundaries.  相似文献   

9.
Conversational Recommendation Systems (CRSs) have recently started to leverage pretrained language models (LM) such as BERT for their ability to semantically interpret a wide range of preference statement variations. However, pretrained LMs are prone to intrinsic biases in their training data, which may be exacerbated by biases embedded in domain-specific language data (e.g., user reviews) used to fine-tune LMs for CRSs. We study a simple LM-driven recommendation backbone (termed LMRec) of a CRS to investigate how unintended bias — i.e., bias due to language variations such as name references or indirect indicators of sexual orientation or location that should not affect recommendations — manifests in substantially shifted price and category distributions of restaurant recommendations. For example, offhand mention of names associated with the black community substantially lowers the price distribution of recommended restaurants, while offhand mentions of common male-associated names lead to an increase in recommended alcohol-serving establishments. While these results raise red flags regarding a range of previously undocumented unintended biases that can occur in LM-driven CRSs, there is fortunately a silver lining: we show that train side masking and test side neutralization of non-preferential entities nullifies the observed biases without significantly impacting recommendation performance.  相似文献   

10.
BackgroundGardnerella vaginalis is a bacterial vaginosis (BV)-associated vaginal bacterium that produces the toxin vaginolysin (VLY). VLY is a pore-forming toxin that is suggested to be the main virulence factor of G. vaginalis. The high recurrence rate of BV and the emergence of antibiotic-resistant bacterial species demonstrate the need for the development of recombinant antibodies as novel therapeutic agents for disease treatment. Single-chain variable fragments (scFvs) generated against VLY exhibited reduced efficacy to neutralize VLY activity compared to the respective full-length antibodies. To improve the properties of scFvs, monospecific dimeric scFvs were generated by the genetic fusion of two anti-VLY scFv molecules connected by an alpha-helix-forming peptide linker.ResultsN-terminal hexahistidine-tagged dimeric scFvs were constructed and produced in Escherichia coli and purified using metal chelate affinity chromatography. Inhibition of VLY-mediated human erythrocyte lysis by dimeric and monomeric scFvs was detected by in vitro hemolytic assay. The circulating half-life of purified scFvs in the blood plasma of mice was determined by ELISA. Dimeric anti-VLY scFvs showed higher neutralizing potency and extended circulating half-life than parental monomeric scFv.ConclusionsThe protein obtained by the genetic fusion of two anti-VLY scFvs into a dimeric molecule exhibited improved properties in comparison with monomeric scFv. This new recombinant antibody might implement new possibilities for the prophylaxis and treatment of the diseases caused by the bacteria G. vaginalis.  相似文献   

11.
Abstract

Social media and news use arguably contribute to the prevalence of contentious politics because individuals may express dissent through their social networks as they consume news. This study seeks to test whether individuals might be more open to political persuasion in this context, especially if they are exposed to political disagreement or discuss politics in a civil manner. Relying on survey data from the UK, results based on a moderated moderation model show that (a) social media news use predicts political persuasion on social media (direct effects) and, (b) discussion disagreement and civil reasoning moderate this relationship in two-way and three-way interactions.  相似文献   

12.
IntroductionIt is common for patients to switch between several healthcare providers. In this context, the long-term follow-up of medical conditions based on laboratory test results obtained from different laboratories is a challenge. The measurement uncertainty in an inter-laboratory context should also be considered in data mining research based on routine results from randomly selected laboratories. As a proof-of-concept study, we aimed at estimating the inter-laboratory reference change value (IL-RCV) for exemplary analytes from publicly available data on external quality assessment (EQA) and biological variation.Materials and methodsExternal quality assessment data of the Reference Institute for Bioanalytics (RfB, Bonn, Germany) for serum creatinine, calcium, aldosterone, PSA, and of whole blood HbA1c from campaigns sent out in 2019 were analysed. The median CVs of all EQA participants were calculated based on 8 samples from 4 EQA campaigns per analyte. Using intra-individual biological variation data from the EFLM database, positive and negative IL-RCV were estimated with a formula based on log transformation under the assumption that the analytes under examination have a skewed distribution.ResultsWe estimated IL-RCVs for all exemplary analytes, ranging from 13.3% to 203% for the positive IL-RCV and - 11.8% to - 67.0% for the negative IL-RCV (serum calcium - serum aldosterone), respectively.ConclusionExternal quality assessment data together with data on the biological variation – both freely available – allow the estimation of inter-laboratory RCVs. These differ substantially between different analytes and can help to assess the boundaries of interoperability in laboratory medicine.  相似文献   

13.
IntroductionActivated partial thromboplastin time (aPTT) is determined and reported as clotting time in seconds aPTT(s), but it is presumed that reporting results as patient-to-normal clotting time ratio, aPTT(r), could minimize within-laboratory variability. The aim of study was to investigate differences in reporting aPTT results that can affect comparability of the results among Croatian laboratories and suggest further steps for its harmonization.Materials and methodsThe questionnaire on aPTT reporting practice was distributed to 83 laboratories through Survey Monkey application in March 2019 as the part of the first regular round of Croatian Centre for Quality Assessment in Laboratory Medicine proficiency testing.ResultsThe survey response rate was 0.49. Majority of laboratories report aPTT results as both, seconds and ratio. Participants reported use of 23 different aPTT(s) reference intervals along with 17 different combinations of reagent/coagulometer and 25 aPTT(s) denominators of different origin for aPTT(r) calculation. Despite the same aPTT(s) results, the use of different denominators caused a dispersion of aPTT(r) results that can lead to exceeding external quality assessment performance criteria of 7%, particularly when results were compared for the same reagent group only. By applying aPTT(s) reference interval mean as denominator for calculation of aPTT(r) reference interval better concordance to harmonized one was obtained (17 vs. 27; χ2 = 3.972; P = 0.046).ConclusionIn order to improve comparability of the results, laboratories are advised to use mean of aPTT(s) reference interval as denominator for aPTT(r) calculation. Type of coagulometer need to be considered when evaluating aPTT proficiency test results and its currently acceptable limit of performance evaluated accordingly.  相似文献   

14.
【目的】学科分类作为科学研究的框架,在科学的发展中具有重要的作用。以计量学理论为基础,以《中国图书馆分类法》自然科学领域二级类目为分析对象,利用引文数据分析学科之间的相关关系,对二级类目进行修正,希望构建适应期刊分类定位需求的合适的分类体系。【方法】基于中国科学引文数据库,借助期刊之间的耦合强度研究学科之间的相关关系。【结果】通过聚类分析的方法,建立起一个经过整合之后的改进的学科分类体系,在此基础上运用关键词识别、主题挖掘等文本挖掘方法对新构建的学科分类体系的合理性进行解释。【结论】基于期刊耦合强度的学科分类体系具有符合目前期刊发展和学科发展的特点。  相似文献   

15.

Background:

Presently the necessity of fasting time for coagulation tests is not standardized. Our hypothesis is that this can harm patient safety. This study is aimed at evaluating whether a light meal (i.e. breakfast) can jeopardize laboratory coagulation tests.

Materials and methods:

A blood sample was firstly collected from 17 fasting volunteers (12 h). Immediately after blood collection, the volunteers consumed a light meal. Then samples were collected at 1, 2 and 4 h after the meal. Coagulation tests included: activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (Fbg), antithrombin III (AT), protein C (PC) and protein S (PS). Differences between samples were assessed by Wilcoxon ranked-pairs test. The level of statistical significance was set at P < 0.05. Mean % differences were determined and differences between and baseline and 1, 2 and 4h samples were compared with reference change value (RCV).

Results:

A significantly higher % activity of AT was observed at 1 h and 4 h after meal vs. baseline specimen [113 (104–117) and 111 (107–120) vs. 109 (102–118), respectively; P = 0.029 and P = 0.016]. APTT at 2 h was found significantly lower than baseline samples [32.0 (29.9–34.8) vs. 34.1 (32.2–35.2), respectively; P = 0.041]. The results of both Fbg and PS tests were not influenced by a light meal. Furthermore, no coagulation tests had significant variation after comparison with RCV.

Conclusion:

A light meal does not influence the laboratory coagulation tests we assessed, but we suggest that the laboratory quality managers standardize the fasting time for all blood tests at 12 hours, to completely metabolize the lipids intake.  相似文献   

16.
IntroductionThe current study aimed to assess the interference of in vitro haemolysis on complete blood count (CBC) using Abbott Alinity hq system, and to determine which haemolysis levels affect the reliability of sample results.Materials and methodsBlood samples obtained from 25 volunteers in K3-EDTA tubes were divided into four aliquots. The first aliquot was not subjected to any intervention. The second, third and fourth aliquots were passed through a fine needle 2, 4 and 6 times, respectively. Complete blood count was performed by multi-angle polarized scatter separation technology and haemolysis index (HI) was assessed from the plasma samples separated by centrifugation. Five groups were formed according to the HI values. The percentage biases between the results of non-haemolysed and haemolysed groups were compared with the desirable bias limits from The European Federation of Clinical Chemistry and Laboratory Medicine database and reference change values (RCVs).ResultsIn groups 1 to 4, the effects of haemolysis on CBC parameters were acceptable comparing to the analytical bias except for lymphocytes (7.26%-7.42%), MCH (2.59%), and MCHC (0.47%-2.81%). Results of group 5 (gross haemolysis) showed decreases in HCT(- 4.56%), RBC (- 4.07%) count and increase in lymphocyte (11.60%) count higher than the analytical performance specifications. Moreover, variations in MCH (4.65%) and MCHC (5.24%) were exceeding the RCVs.ConclusionsGross haemolysis (haemoglobin concentration > 10 g/L) is likely to produce unreliable CBC results on non-pathological samples. Further studies including pathological specimens are needed.  相似文献   

17.
IntroductionAn appropriate management of anaemia laboratory tests is crucial for a correct diagnosis and treatment. A non-sequential “shotgun” approach (where every anaemia related test is ordered) causes workload and cost increases and could be potentially harmful. We have implemented a Decision Support System through our laboratory information system (LIMS) based on reflexive algorithms and automatic generation of interpretative reports specifically in diagnosis of anaemia for primary care patients.Materials and methodsWhen a request contained an “Anaemia Suspicion Study” profile, more than twenty automatic reflexive rules were activated in our LIMS based upon laboratory results. These rules normally involved the addition of reflexive tests. A final report was automatically generated for each interpretation which was always reviewed for their validity by two staff pathologists. We measured the impact of this system in the ordering of most common anaemia related tests and if a proper treatment was established based on the interpretive report.ResultsFrom all the studies performed, only 12% were positive being “iron deficiency” and “anaemia of chronic disease” the most frequent causes, 62% and 17%, respectively. Proper treatment was established in 88% of these anaemic patients. Total iron, transferrin, ferritin, folate and vitamin B12 demand decreased substantially after implementation representing a cost reduction of 40% only for these five tests.ConclusionsOur system has easily improved patient outcomes, advising on individual clinical cases. We have also noticeably reduced the number of over-requested tests and laboratory costs.  相似文献   

18.
A variety of the web-mining techniques are now being extensively utilized to extract useful knowledge about customer behaviors on the Internet. However, the naive interpretation of the web-mining results would lead to poor decision on customer behaviors, which is likely to cause waste of time and efforts on managing electronic commerce strategy. To overcome this pitfall, this study proposes using the cognitive map-based interpretation of the web-mining results. Conventional approach to obtaining the web-mining results is based on the association rule approach (ARA), while the cognitive map approach (CMA) is believed to provide more robust support in interpreting the web-mining results. Therefore, to compare the interpretation capability of the two approaches, the four constructs such as perceived usefulness, causality, information richness, users’ attitude and intention to use the approaches are adopted in the research model and tested against the questionnaire data. The test results obtained through applying the structural equation models reveal that CMA is comparable to ARA and the cognitive map has a great potential in helping enrich the interpretation of the web mining results and build more effective Internet business strategy.  相似文献   

19.
《普罗米修斯》2012,30(1):23-40

Much of the Knowledge Management (KM) literature assumes that all relevant knowledge can be represented as information and 'managed'. But the meaning of information is always context-specific and open to subsequent reinterpretation. Moving over time or between contexts affords scope for new meanings to emerge. Making sense of information signals (speech, body language, tone-of-voice or whatever)--Aand the absence of such signals--Ainvolves dimensions of individual and collective tacit knowledge that are frequently misrepresented or ignored in mainstream KM. By relating power and knowledge to 'rules of the game', it is possible to consider how the contexts in which information is rendered meaningful are bounded, as well as crucially related in the stretch between macro-level processes and micro-level practices. In the knowledge debate, Japan stands as a counterfactual to Anglo-Saxon expectations about formal rules, liberal individualism and market-rational entrepreneurship. While seminal accounts of knowledge creation in Japanese companies impelled the West towards KM, there has been no corresponding KM-boom in Japan. Our interpretation of the processes by which Japanese and Anglo-Saxon practices are situated suggests that KM is limited by the separation of knowledge from power and information from meaning.  相似文献   

20.
2001-2010年鄱阳湖圩区水稻多熟种植时空格局变化   总被引：2，自引：1，他引：1  
李文叶  姜鲁光  李鹏 《资源科学》2014,36(4):809-816
在耕地面积有限、粮食单产水平较高的地区,提高粮食生产能力的主要途径是提高复种指数,加大土地利用强度。鄱阳湖圩区是我国重要的水稻生产基地,是我国水稻多熟种植最典型的地区之一。弄清鄱阳湖圩区时间上与空间上的水稻多熟种植变化特征,为兼顾粮食安全与新型城镇化发展研究提供现实基础。本文利用较高空间分辨率卫星影像(Landsat-TM/ETM+),选择合适时间窗口,识别了2001年鄱阳湖圩区水稻多熟种植的空间格局,并利用K-means算法对解译结果进行精度验证。研究表明,2001年圩堤水田面积为34.54万hm2,其中单季稻13.02万hm2,双季稻21.52万hm2,分别占水田面积的37.7%与62.3%,复种指数为162.3%。对比分析2001年与2010年的多熟种植空间格局变化表明,2001-2010年鄱阳湖圩区水田面积减少了1.09万hm2,但复种指数增加了15.9%。本文利用时间窗口阈值法不需经过目视解译即可达到81.6%的精度,是一种有效的水稻多熟种植空间格局提取的方法,并且大大减少了所需的遥感影像。  相似文献   

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