American journal of clinical pathology
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Am. J. Clin. Pathol. · Jun 2007
Comparative Study Clinical TrialAccuracy of roche accu-chek inform whole blood capillary, arterial, and venous glucose values in patients receiving intensive intravenous insulin therapy after cardiac surgery.
Intravenous insulin protocols are increasingly common in the intensive care unit to maintain normoglycemia. Little is known about the accuracy of point-of-care glucometers for measuring glucose in this patient population or the impact of sample source (capillary, arterial, or venous whole blood) on the accuracy of glucometer results. We compared capillary, arterial, and venous whole blood glucose values with laboratory plasma glucose values in 20 patients after cardiac surgery. ⋯ There were no significant differences between median capillary whole blood (149 mg/dL [8.3 mmol/L]) and laboratory plasma (151 mg/dL [8.4 mmol/L]) glucose levels. The median arterial (161 mg/dL [8.9 mmol/L]) and venous (162 mg/dL [9.0 mmol/L]) whole blood glucose levels were significantly higher than the median laboratory plasma glucose level. Capillary whole blood glucose levels correlate most closely with laboratory plasma glucose levels in patients receiving intensive intravenous insulin therapy after cardiac surgery.
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Am. J. Clin. Pathol. · Nov 2006
Comparative StudyComparison of disagreement and amendment rates by tissue type and diagnosis: identifying cases for directed blinded review.
We sought to determine whether a group of cases that was relatively high in disagreements and subsequent amendments could be identified and targeted for blinded review. During a 4-year period, 8,916 surgical pathology and nongynecologic cytology cases were subjected to blinded review; of these, there were 616 disagreements (6.9%), 69 (0.8%) had subsequent amendments issued, and 33 (0.4%) represented false-negative errors of blinded review. Tissues with the highest amendment rates were breast (4.4%), endocrine (4%), gynecologic (1.8%), and cytology (1.3%). ⋯ Reviewing only nondiagnostic and atypical cases would have involved reviewing only 4.0% of cases and detected 14% of amendments. Reviewing all breast, gynecologic, nongynecologic cytology, and endocrine material would have involved reviewing 26.9% of cases and detected 88% of amendments. These data can be used to define material for directed blinded review that is relatively high in potential errors.
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Am. J. Clin. Pathol. · Sep 2006
Comparative StudyComparative performance of three anti-factor Xa heparin assays in patients in a medical intensive care unit receiving intravenous, unfractionated heparin.
The availability of automated anti-Xa heparin assays provides the opportunity to manage patient unfractionated heparin levels directly, rather than by the activated partial thromboplastin time. Because critically ill patients can acquire an antithrombin deficiency, we compared the performance of 3 anti-Xa heparin assays, 1 with and 2 without antithrombin supplementation, by analyzing in vitro aliquots of plasma with defined antithrombin levels and specimens from intensive care patients receiving intravenous heparin therapy. Heparin concentration recovery, in vitro, was dependent on the plasma antithrombin concentration for all 3 assays. ⋯ Analysis of patient specimens demonstrated significant correlation among the 3 assays. Classification of the clinical adequacy of patient heparin levels showed agreement of 80% or more between the antithrombin-supplemented and nonsupplemented assays. The antithrombin-supplemented assay did not significantly improve clinical usefulness.
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Am. J. Clin. Pathol. · Aug 2006
Comparative StudyReducing unnecessary inpatient laboratory testing in a teaching hospital.
After an inpatient phlebotomy-laboratory test request audit for 2 general inpatient wards identified 5 tests commonly ordered on a recurring basis, a multidisciplinary committee developed a proposal to minimize unnecessary phlebotomies and laboratory tests by reconfiguring the electronic order function to limit phlebotomy-laboratory test requests to occur singly or to recur within one 24-hour window. The proposal was implemented in June 2003. ⋯ We also observed 17,207 (21.4%) fewer inpatient phlebotomies, a decrease sustained in fiscal year 20042005. Labor savings allowed us to redirect phlebotomists to our understaffed outpatient phlebotomy service.
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Am. J. Clin. Pathol. · Jul 2006
Toward rational fresh frozen plasma transfusion: The effect of plasma transfusion on coagulation test results.
Numerous published guidelines encourage appropriate use of fresh frozen plasma (FFP). However, adherence is documented as poor. Therefore, we sought to determine the laboratory effect of FFP administration to patients with an international normalized ratio (INR) less than 1.6 (prothrombin time < 1.6 times normal). ⋯ With an observed analytic variation of 3.2%, a significant amount of change in the INR following FFP transfusion is expected at an INR of more than 1.7. Indeed, only 50% of patients with an INR of 1.7 showed a significant change in INR with FFP transfusion. Therefore, transfusion for patients not meeting current FFP guidelines does not reliably reduce the INR and exposes patients to unnecessary risk.