scholarly journals National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Recommendations for the Use of Laboratory Tests to Support Poisoned Patients Who Present to the Emergency Department

2003 ◽  
Vol 49 (3) ◽  
pp. 357-379 ◽  
Author(s):  
Alan H B Wu ◽  
Charles McKay ◽  
Larry A Broussard ◽  
Robert S Hoffman ◽  
Tai C Kwong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Laboratory Tests ◽  
Drug Testing ◽  
Drugs Of Abuse ◽  
Clinical Laboratory ◽  
Clinical Biochemistry ◽  
Clinical Chemistry ◽  
Clinical Toxicology ◽  
New Drugs ◽  
Background Exposure

Abstract Background: Exposure to drugs and toxins is a major cause for patients’ visits to the emergency department (ED). Methods: Recommendations for the use of clinical laboratory tests were prepared by an expert panel of analytical toxicologists and ED physicians specializing in clinical toxicology. These recommendations were posted on the world wide web and presented in open forum at several clinical chemistry and clinical toxicology meetings. Results: A menu of important stat serum and urine toxicology tests was prepared for clinical laboratories who provide clinical toxicology services. For drugs-of-abuse intoxication, most ED physicians do not rely on results of urine drug testing for emergent management decisions. This is in part because immunoassays, although rapid, have limitations in sensitivity and specificity and chromatographic assays, which are more definitive, are more labor-intensive. Ethyl alcohol is widely tested in the ED, and breath testing is a convenient procedure. Determinations made within the ED, however, require oversight by the clinical laboratory. Testing for toxic alcohols is needed, but rapid commercial assays are not available. The laboratory must provide stat assays for acetaminophen, salicylates, co-oximetry, cholinesterase, iron, and some therapeutic drugs, such as lithium and digoxin. Exposure to other heavy metals requires laboratory support for specimen collection but not for emergent testing. Conclusions:Improvements are needed for immunoassays, particularly for amphetamines, benzodiazepines, opioids, and tricyclic antidepressants. Assays for new drugs of abuse must also be developed to meet changing abuse patterns. As no clinical laboratory can provide services to meet all needs, the National Academy of Clinical Biochemistry Committee recommends establishment of regional centers for specialized toxicology testing.

scholarly journals Proteomics: A New Diagnostic Frontier

2006 ◽  
Vol 52 (7) ◽  
pp. 1218-1222 ◽  
Author(s):  
Glen L Hortin ◽  
Saeed A Jortani ◽  
James C Ritchie ◽  
Roland Valdes ◽  
Daniel W Chan
Keyword(s):  
Laboratory Tests ◽  
Clinical Laboratory ◽  
Clinical Chemistry ◽  
Biological Fluids ◽  
Great Promise ◽  
Structural Variations ◽  
Protein Fragments ◽  
Recent Conference ◽  
Complete Set ◽  
Source Of Information

Abstract Background: Analysis of proteins has been an integral part of the field of clinical chemistry for decades. Recent advances in technology and complete identification of the human genome sequence have opened up new opportunities for analysis of proteins for clinical diagnostic purposes. Methods: Content of a recent conference of proteomics is summarized. Results: New analytical methods allow the simultaneous analysis of a large number of proteins in biological fluids such as serum and plasma, offering partial views of the complete set of proteins or proteome. Plasma presents many analytical challenges, such as the complexity of components, predominance of a few major components, and the large concentration range of components, but the number of proteins that can be detected in plasma has expanded dramatically from hundreds to thousands. At the same time, there is increased capability to detect structural variations of proteins. Recent studies also identified the presence of complex sets of small protein fragments in plasma. This set of protein fragments, the fragmentome or peptidome, is potentially a rich source of information about physiologic and disease processes. Conclusions: Advances in proteomics offer great promise for the discovery of markers that might serve as the basis for new clinical laboratory tests. There are many challenges, however, in the translation of newly discovered markers into clinical laboratory tests.

Hair as a Biological Indicator of Drug Use, Drug Abuse or Chronic Exposure to Environmental Toxicants

2006 ◽  
Vol 25 (3) ◽  
pp. 143-163 ◽  
Author(s):  
Vassiliki A. Boumba ◽  
Kallirroe S. Ziavrou ◽  
Theodore Vougiouklakis
Keyword(s):  
Drug Use ◽  
Chronic Exposure ◽  
Drug Testing ◽  
Drugs Of Abuse ◽  
Hair Analysis ◽  
Clinical Chemistry ◽  
Biological Indicator ◽  
Environmental Toxicants ◽  
Hair Samples ◽  
Hair Testing

In recent years hair has become a fundamental biological specimen, alternative to the usual samples blood and urine, for drug testing in the fields of forensic toxicology, clinical toxicology and clinical chemistry. Moreover, hair-testing is now extensively used in workplace testing, as well as, on legal cases, historical research etc. This article reviews methodological and practical issues related to the application of hair as a biological indicator of drug use/abuse or of chronic exposure to environmental toxicants. Hair structure and the mechanisms of drug incorporation into it are commented. The usual preparation and extraction methods as well as the analytical techniques of hair samples are presented and commented on. The outcomes of hair analysis have been reviewed for the following categories: drugs of abuse (opiates, cocaine and related, amphetamines, cannabinoids), benzodiazepines, prescribed drugs, pesticides and organic pollutants, doping agents and other drugs or substances. Finally, the specific purpose of the hair testing is discussed along with the interpretation of hair analysis results regarding the limitations of the applied procedures.

A New Approach to the Costing of Clinical Laboratory Tests

1981 ◽  
Vol 18 (6) ◽  
pp. 330-342 ◽  
Author(s):  
P M G Broughton ◽  
T C Hogan
Keyword(s):  
Laboratory Tests ◽  
Clinical Laboratory ◽  
Clinical Chemistry ◽  
Indirect Costs ◽  
Working Hours ◽  
Total Annual Cost ◽  
New Approach ◽  
Laboratory Facilities ◽  
The Individual ◽  
The Cost

A method of costing clinical laboratory tests is described which avoids the assumptions and omissions of previous methods and overcomes the basic theoretical difficulty of allocating indirect (overhead) costs, which form the major component. The method develops the concept of a ‘cost per request” to cover indirect costs, which reflect the cost of providing laboratory facilities, and a ‘cost per test” to cover the direct analytical costs of the individual tests done. The direct cost per test was found to vary with the workload, which makes it difficult to predict the effect of changes in demand on expenditure. The Canadian Schedule of Unit Values was found to be an unreliable basis for calculating direct labour costs. Examples are given of the direct and indirect costs of consumables, labour, and capital, and their contribution to the total cost of clinical chemistry tests done either during or outside normal working hours. The total annual cost for each analyte may be a more useful indicator of expenditure than the cost per test.

scholarly journals Clinical Laboratory Tests in Some Acute Exogenous Poisonings

Folia Medica ◽  
2017 ◽  
Vol 59 (3) ◽  
pp. 303-309
Author(s):  
Stoilka G. Tufkova ◽  
Ivan V. Yankov ◽  
Diana A. Paskaleva
Keyword(s):  
Laboratory Tests ◽  
Clinical Laboratory ◽  
Alcohol Intoxication ◽  
Statistical Significance ◽  
Hematological Parameters ◽  
Clinical Toxicology ◽  
University Hospital ◽  
Toxic Substances ◽  
Laboratory Parameters ◽  
Vital Functions

AbstractBackground:There is no specific toxicological screening of clinical laboratory parameters in clinical toxicology when it comes to acute exogenous poisoning.Aim:To determine routine clinical laboratory parameters and indicators for assessment of vital functions in patients with acute intoxications.Materials and methods:One hundred and fifty-three patients were included in the present study. They were hospitalized in the Department of Clinical Toxicology at St. George University Hospital, Plovdiv for cerebral toxicity inducing medication (n = 45), alcohol (n = 40), heroin abuse (n = 33). The controls were 35. The laboratory tests were conducted in compliance with the standards of the clinical laboratory. We used the following statistical analyses: analysis of variance (the ucriterion of normal distribution, the Student’s t-test, dispersion analysis based on ANOVA) and non-parametric analysis.Results and discussion:Based on the routine hematological parameters with statistically significant changes in three groups of poisoning are: red blood cells, hematocrit, hemoglobin (except alcohol intoxication) and leukocytes. We found statistically significant changes in serum total protein, sodium and bilirubin. The highest statistical significance is the increased activity of AST and ALT.Conclusion:We present a model for selection of clinical laboratory tests for severe acute poisoning with modern equipment under standardized conditions. The results of the study suggest that the clinical laboratory constellation we used can be used as a mandatory element in the diagnosis of moderate and severe intoxication with the mentioned toxic substances.

Diagnostic performances of clinical laboratory tests using Triton X-100 to reduce the biohazard associated with routine testing of Ebola virus-infected patients

2015 ◽  
Vol 53 (12) ◽  
Author(s):  
Massimo Tempestilli ◽  
Luigia Pucci ◽  
Stefania Notari ◽  
Antonino Di Caro ◽  
Concetta Castilletti ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Ebola Virus ◽  
Clinical Laboratory ◽  
Clinical Symptoms ◽  
Virus Disease ◽  
Clinical Chemistry ◽  
Chemical Agent ◽  
Enveloped Virus ◽  
Before And After ◽  
Triton X

AbstractEbola virus, an enveloped virus, is the cause of the largest and most complex Ebola virus disease (EVD) outbreak in West Africa. Blood or body fluids of an infected person may represent a biohazard to laboratory workers. Laboratory tests of virus containing specimens should be conducted in referral centres at biosafety level 4, but based on the severity of clinical symptoms, basic laboratories might be required to execute urgent tests for patients suspected of EVD. The aim of this work was to compare the analytical performances of laboratory tests when Triton X-100, a chemical agent able to inactivate other enveloped viruses, was added to specimens.Results of clinical chemistry, coagulation and haematology parameters on samples before and after the addition of 0.1% (final concentration) of Triton X-100 and 1 h of incubation at room temperature were compared.Overall, results showed very good agreement by all statistical analyses. Triton X-100 at 0.1% did not significantly affect the results for the majority of the analytes tested.Triton X-100 at 0.1% can be used to reduce the biohazard in performing laboratory tests on samples from patients with EVD without affecting clinical decisions.

scholarly journals Lead - a preanalytical/analytical variable in clinical chemistry

2014 ◽  
Vol 12 (1) ◽  
pp. 65-76
Author(s):  
Ivana Rasic-Misic ◽  
Emilija Pecev-Marinkovic
Keyword(s):  
Lead Poisoning ◽  
Laboratory Tests ◽  
Review Paper ◽  
Clinical Laboratory ◽  
Clinical Chemistry ◽  
Clinical Chemical ◽  
Analytical Variable ◽  
Lead Intake ◽  
Proper Interpretation

Lead is one of the most studied clinically important metals due its high toxicity and a high number of workers exposed to it. The interest toward Pb is elevated by the fact that children are especially susceptible to lead poisoning. Research regarding lead poisoning requires a complex, multi-disciplinary (clinical medical and clinical chemical) approach. Monitoring human exposure to lead (intake, i.e. poisoning) may be achieved by quantification of Pb in tissues and body fluids. For that reason, a number of accurate and reliable analytical methods for the determination of Pb (analytical/preanalytical variable) were developed. An objective of this review paper is to provide key information necessary for proper interpretation of results of lead related clinical/laboratory tests.

scholarly journals Evaluation of Quality Control Data of Clinical Chemistry Parameters using Six Sigma Metrics Tool in Clinical Laboratory

2021 ◽  
pp. 305-309
Author(s):  
G. Anuradha ◽  
S. Santhinigopalakrishnan ◽  
S. Sumathy
Keyword(s):  
Quality Control ◽  
Six Sigma ◽  
Clinical Laboratory ◽  
Clinical Biochemistry ◽  
Clinical Chemistry ◽  
Control Data ◽  
Laboratory Performance ◽  
Clinical Biochemistry Laboratory ◽  
Quality Control Data

Background: Physicians rely on laboratory results for treating patients. So it is the duty of laboratories to assure quality of the results released. So laboratory performance should be validated to maintain the quality. Six sigma has now gained recent interest in monitoring the laboratory quality.This study was designed to gauge the clinical chemistry parameters based on six sigma metrics. Materials and Methods: In this retrospective study, both the internal and external quality control data of 26 clinical chemistry parameters were collected for a period of 6 months from June 2020 to November 2020 and the six sigma analysis was done at the Central clinical biochemistry laboratory of Chettinad Hospital and research institute. Results: AST, amylase, lipase, triglyceride, HDL, iron, magnesium, creatine kinase showed sigma values more than 6.Uric acid, total protein, ALT, direct bilirubin, GGT,cholesterol, cholesterol, calcium, TIBC and phosphorus shows sigma values between 3.5 to 6. Glucose, BUN, creatinine, albumin, Na, K, Chloride, showed sigma values less than 3.5. Conclusion: Six sigma metrics can help in improving the quality of laboratory performance and also helps to standardisethe actual amount of QC that is required by the laboratory for maintaining quality.

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