Archives of pathology & laboratory medicine
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Arch. Pathol. Lab. Med. · Jun 1998
Multicenter Study Comparative StudyInterinstitutional comparison of bedside blood glucose monitoring program characteristics, accuracy performance, and quality control documentation: a College of American Pathologists Q-Probes study of bedside blood glucose monitoring performed in 226 small hospitals.
To assess the accuracy of bedside blood glucose monitoring (BGM) in small hospitals, to assess the compliance with which hospital workers performing bedside BGM adhere to quality control (QC) procedures, and to identify those practice characteristics in small hospitals that are associated with better BGM accuracy and with better performance of BGM QC. ⋯ We found the rates of BGM accuracy and of QC performance adequacy achieved in small hospitals to be similar to those determined in previous Q-Probes studies conducted in large institutions. A significant amount of institutional bedside testing does not meet current standards for accuracy or for quality control. Some institutions may improve their accuracy and/or QC performances by having laboratory personnel intimately involved in their institution's BGM QC program, by routinely comparing BGM results with those performed using glucose analyzers in the clinical laboratory, by routinely running three rather than two glucose QC control levels, by participating in external proficiency programs, and by strictly adhering to institutional QC protocols.
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Arch. Pathol. Lab. Med. · Apr 1998
Evaluation of a proposed panel of cardiac markers for the diagnosis of acute myocardial infarction in patients with atraumatic chest pain.
The purpose of this study was to evaluate retrospectively the efficacy of a proposed panel of three cardiac markers (myoglobin, creatine kinase-MB mass [CK-MB], and cardiac troponin I) in the diagnosis of acute myocardial infarction (AMI) in patients with atraumatic chest pain. ⋯ Our preliminary results indicate that this panel is highly effective for evaluation of AMI in patients with atraumatic chest pain. Elevated myoglobin levels were useful in detecting patients at high risk for AMI who initially were not detected with other markers. The combination of CK-MB and cardiac troponin I provided much higher sensitivity and had a much higher negative predictive value for the evaluation of AMI than cardiac troponin I or CK-MB alone. The 100% negative predictive value is particularly important because it indicates that patients with negative CK-MB and cardiac troponin I values 12 hours after admission have a negligible likelihood of AMI.
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Arch. Pathol. Lab. Med. · Apr 1998
Amended reports in surgical pathology and implications for diagnostic error detection and avoidance: a College of American Pathologists Q-probes study of 1,667,547 accessioned cases in 359 laboratories.
To evaluate amended report rates relative to surveillance methods and to identify surveillance methods or other practice parameters that lower amended report rates. ⋯ There is an association between lower amended report rates and diagnostic slide review of cases prior to completion of the pathology report. The level of case review and type of case mix that is necessary for optimal quality assurance needs further investigation.
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Arch. Pathol. Lab. Med. · Mar 1998
ReviewA strategy for the use of cardiac injury markers (troponin I and T, creatine kinase-MB mass and isoforms, and myoglobin) in the diagnosis of acute myocardial infarction.
To design a strategy for cardiac injury marker testing in the diagnosis of acute myocardial infarction. ⋯ Creatine kinase-MB mass, myoglobin, and troponin I were selected as the cardiac injury markers of choice at our institution. The strategy calls for serial testing of myoglobin and CK-MB mass initially-and serially if warranted by heightened clinical suspicion--with troponin I added if indicated for (1) specific confirmation, (2) late presentation, or (3) risk stratification.
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Arch. Pathol. Lab. Med. · Mar 1998
Blood culture contamination: a College of American Pathologists Q-Probes study involving 640 institutions and 497134 specimens from adult patients.
To examine clinical and laboratory practices associated with contamination of blood culture specimens from adults. ⋯ There is wide variation in blood culture contamination rates among institutions. Three specimen collection factors and three culture variables were identified as having a significant effect on blood culture contamination.