Does Reverse Triiodothyronine Testing Have Clinical Utility? An Analysis of Practice Variation Based on Order Data from a National Reference Laboratory

Thyroid ◽  
2018 ◽  
Vol 28 (7) ◽  
pp. 842-848 ◽  
Author(s):  
Robert L. Schmidt ◽  
Jonathan S. LoPresti ◽  
Michael T. McDermott ◽  
Suzanna M. Zick ◽  
Joely A. Straseski
Keyword(s):  
Clinical Utility ◽  
Practice Variation ◽  
Reference Laboratory ◽  
National Reference Laboratory ◽  
Reverse Triiodothyronine ◽  
National Reference

scholarly journals Laboratory capacity of Greek hospitals for diagnosis of salmonellosis and surveillance systems’ performance in the years of economic crisis, 2010–2016

2018 ◽  
Vol 147 ◽  
Author(s):  
K. Mellou ◽  
E. Saranti-Papasaranti ◽  
G. Mandilara ◽  
T. Georgakopoulou
Keyword(s):  
Public Hospitals ◽  
Geographical Region ◽  
Reference Laboratory ◽  
Laboratory System ◽  
Surveillance Systems ◽  
National Reference Laboratory ◽  
Notification System ◽  
National Reference ◽  
Laboratory Capacity ◽  
Mandatory Notification

AbstractAusterity might have affected the capacity of public hospitals in Greece to diagnose salmonellosis (laboratory capacity) over the period 2010–2016, as well as the performance of the existing surveillance systems. The scope of this paper is to present data on laboratory capacity over these years, as well as the results of a two-source capture-recapture study (data from Mandatory Notification System and National Reference Laboratory System for Salmonella). The main findings were that: (a) laboratory capacity was high and steady besides the financial crisis, (b) the estimated number of laboratory-confirmed cases (n = 6017, 95% CI 5892–6142) resulted in an incidence rate (7.9 cases/100 000 population) almost twice than that reported by the two systems Mandatory Notification System (MNS); 4.1 and National Reference Laboratory System (NRLS); 4.5 cases/100 000 population, (c) underreporting was high for both systems (MNS; 47.5% and NRLS; 42.8%) and (d) differences by geographical region, size and type of hospital were identified. We suggest that (a) specific interventions are needed to increase completeness of the systems by type of hospital and geographical region, (b) record linkage can help in estimating the disease burden in a more valid way than each system separately and (c) a common electronic database in order to feed one system to the other could significantly increase completeness of both systems.

scholarly journals Evaluation of optimal urine screening and confirmation cut-off values for opiates, at a national reference laboratory

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Çiğdem Karakükcü ◽  
Mehmet Zahid Çıracı ◽  
Derya Kocer ◽  
Mine Yüce Faydalı ◽  
Muhittin Abdulkadir Serdar
Keyword(s):  
False Positive ◽  
False Positive Rate ◽  
False Negative ◽  
Urine Samples ◽  
Reference Laboratory ◽  
National Reference Laboratory ◽  
Urine Screening ◽  
National Reference ◽  
Positive Rate ◽  
Sensitivity Specificity

Abstract Objectives To obtain optimal immunoassay screening and LC-MS/MS confirmation cut-offs for opiate group tests to reduce false positive (FP) and false negative (FN) rates. Methods A total of 126 urine samples, −50 opiate screening negative, 76 positive according to the threshold of 300 ng/mL by CEDIA method – were confirmed by a full-validated in-house LC-MS/MS method. Sensitivity, specificity, FP, and FN rates were determined at cut-off concentrations of both 300 and 2,000 ng/mL for morphine and codeine, and 10 ng/mL for heroin metabolite 6-mono-acetyl-morphine (6-MAM). Results All CEDIA opiate negative urine samples were negative for morphine, codeine and 6-MAM. Although sensitivity was 100% for each cut-off; specificity was 54.9% at CEDIA cut-off 300 ng/mL vs. LC-MS/MS cut-off 300 ng/mL and, 75% at CEDIA cut-off 2,000 ng/mL vs. LC-MS/MS cut-off 2,000 ng/mL. False positive rate was highest (45.1%) at CEDIA cut-off 300 ng/mL. At CEDIA cut-off 2,000 ng/mL vs. LC-MS/MS cut-off 300 ng/mL, specificity increased to 82.4% and FP rate decreased to 17.6%. All 6-MAM positive samples had CEDIA concentration ≥2,000 ng/mL. Conclusions 2,000 ng/mL for screening and 300 ng/mL for confirmation cut-offs are the most efficient thresholds for the lowest rate of FP opiate results.

Bad Tests Die Slowly: The Myelin Basic Protein Example

2019 ◽  
Vol 5 (1) ◽  
pp. 136-141
Author(s):  
Lisa M Johnson ◽  
Sandra K White ◽  
Dina N Greene ◽  
Robert L Schmidt
Keyword(s):  
Myelin Basic Protein ◽  
Clinical Utility ◽  
Basic Protein ◽  
Practice Variation ◽  
Oligoclonal Bands ◽  
Reference Laboratory ◽  
Variation Analysis ◽  
Time Period ◽  
Medium Strength ◽  
Before And After

Abstract Background Our national reference laboratory sought to improve stewardship for multiple sclerosis (MS) testing, which included orders for myelin basic protein (MBP) and oligoclonal bands (OCB). From 2011 to 2012, we performed 2 interventions for MS testing: one gentle-strength intervention of a publication designed to educate others about the lack of utility for MBP results and a second medium-strength intervention that included removal of MBP from the panel of MS tests. The ordering trends and practice variation were examined for OCB and MBP to retrospectively observe the effect of the interventions. Methods Data from clients within academic and community hospitals were examined (n = 1710 clients). Ordering patterns for OCB and MBP were investigated from 2008 to 2018 by calculating the %OCB: %OCB = (OCB)/(OCB + MBP). Practice variation was examined by comparing the distribution of clients with different %OCB statistics before and after the interventions in 5-year blocks (2008–2012 vs 2014–2018). Results From 2000 to 2011, the %OCB was approximately 50%, but gradually increased to 67% in 2018. For practice variation, analysis of the distribution of clients by %OCB also demonstrated a shift toward clients favoring OCB alone vs OCB + MBP for MS testing for the later time period of 2014–2018. Conclusion Our 2 interventions had a measurable, beneficial effect on ordering trends for MS testing over a 10-year period at a single reference laboratory. However, given that MBP has questionable clinical utility, stronger interventions are likely needed to bring about larger changes in ordering behavior.

scholarly journals Spectral Karyotyping for identification of constitutional chromosomal abnormalities at a national reference laboratory

2012 ◽  
Vol 5 (1) ◽  
pp. 3 ◽  
Author(s):  
Arturo Anguiano ◽  
Boris T Wang ◽  
Shirong R Wang ◽  
Fatih Z Boyar ◽  
Loretta W Mahon ◽  
...  
Keyword(s):  
Chromosomal Abnormalities ◽  
Reference Laboratory ◽  
National Reference Laboratory ◽  
Spectral Karyotyping ◽  
National Reference

Hemoglobin Phenotypes in Nigeria: Data From a National Reference Laboratory

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S115-S116 ◽  
Author(s):  
Ademola Adewoyin ◽  
Olusogo Busari ◽  
Oladapo Aworanti
Keyword(s):  
High Performance ◽  
Health Planning ◽  
Laboratory Data ◽  
Global Scale ◽  
Suboptimal Control ◽  
Reference Laboratory ◽  
National Reference Laboratory ◽  
Cellulose Acetate Electrophoresis ◽  
National Reference ◽  
Hemoglobin Variants

Abstract On a global scale, 5% to 7% of the population carries an abnormal hemoglobin. With a sickle hemoglobin (HbS) carrier prevalence of 25% to 40%, Nigeria bears the greatest burden of sickle cell disorder worldwide. Until recent times, detection of other clinically significant hemoglobin variants associated with HbS has been unavailable, resulting in missed/wrong diagnosis, weak national data, and suboptimal control of hemoglobin disorders. This study aimed to review hemoglobin assays over a 2-year period at a national reference laboratory in Nigeria, in order to describe the prevalent hemoglobin phenotypes for health planning. The study was a retrospective, laboratory data-based survey. Sociodemographics and hemoglobin assay results of 6,851 specimens between January 2016 and December 2017 were analyzed. Study protocol was approved by the Institutional Review Board. Participants aged less than 1 year and who had recent transfusions and a history of hydroxyurea therapy were excluded. At the hemoglobin laboratory, specimens were analyzed using cation exchange high-performance liquid chromatography (CE-HPLC) (Bio Rad D10, California). When indicated, further analysis of suspected abnormal hemoglobins was confirmed using a second method, capillary electrophoresis (SEBIA Capiflex II, France). The distribution of the identified hemoglobin phenotypes was determined as a proportion of the total number of participants. The mean (SD) age of the participants was 31.8 (14.9) years. The most frequent hemoglobin phenotypes were AA (59.4%), AS (23.3%), and SS (13.3%). Hemoglobin phenotypes AC (2.1%), SC (0.9%), AGPhiladelphia (0.2%), and CC (0.2%) were less frequent. Least occurring phenotypes were ADIbadan, AE, AGPhiladelphia, AOArab, DD, and hereditary persistence of fetal hemoglobin (HPFH). In the Nigerian context, accurate diagnosis of hemoglobin variants using quantitative, high-resolution hemoglobin assays, compared to zone (cellulose acetate) electrophoresis at alkaline pH will provide data for health planning, better access to genetic counseling, informed reproductive health choices, and secondary prevention of hemoglobinopathies.

scholarly journals Laboratory Blood-Based Testing for Non-Lyme Disease Tick-Borne Infections at a National Reference Laboratory

2019 ◽  
Vol 153 (1) ◽  
pp. 139-145 ◽  
Author(s):  
Elizabeth Lee-Lewandrowski ◽  
Zhen Chen ◽  
John Branda ◽  
Jason Baron ◽  
Harvey W Kaufman
Keyword(s):  
Lyme Disease ◽  
State Level ◽  
Reference Laboratory ◽  
National Reference Laboratory ◽  
Geographic Concentration ◽  
National Reference ◽  
Public Health Reporting ◽  
The Us ◽  
Control And Prevention ◽  
Tick Borne Disease

Abstract Objectives We evaluated trends in non-Lyme disease tick-borne disease (NLTBI) testing at a national reference laboratory. Methods Testing data performed at Quest Diagnostics during 2010 to 2016 were analyzed nationally and at the state level. Results Testing and positivity for most NLTBIs increased dramatically from 2010 through 2016 based on testing from a large reference laboratory. The number of positive cases, though not as stringent as criteria for public health reporting, generally exceeds that reported by the Centers for Disease Control and Prevention. The frequency of NLTBI in the US is seasonal but testing activity and positive test results are observed throughout all months of the year. Positive results for NLTBI testing mostly originated from a limited number of states, indicating the geographic concentration and distribution of NLTBIs reported in this study. Conclusions This report provides an important complementary source of data to best understand trends in and spread of NLTBI.

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