The impact of repeat-testing of common chemistry analytes at critical concentrations

2014 ◽  
Vol 52 (12) ◽  
Author(s):  
Chinelo P. Onyenekwu ◽  
Careen L. Hudson ◽  
Annalise E. Zemlin ◽  
Rajiv T. Erasmus
Keyword(s):  
Clinical Laboratory ◽  
Clinical Laboratory Improvement Amendment ◽  
Average Delay ◽  
Repeat Testing ◽  
Retrospective Audit ◽  
Significant Difference ◽  
Allowable Error ◽  
The Cost ◽  
Academic Laboratory ◽  
The Impact

AbstractEarly notification of critical values by the clinical laboratory to the treating physician is a requirement for accreditation and is essential for effective patient management. Many laboratories automatically repeat a critical value before reporting it to prevent possible misdiagnosis. Given today’s advanced instrumentation and quality assurance practices, we questioned the validity of this approach. We performed an audit of repeat-testing in our laboratory to assess for significant differences between initial and repeated test results, estimate the delay caused by repeat-testing and to quantify the cost of repeating these assays.A retrospective audit of repeat-tests for sodium, potassium, calcium and magnesium in the first quarter of 2013 at Tygerberg Academic Laboratory was conducted. Data on the initial and repeat-test values and the time that they were performed was extracted from our laboratory information system. The Clinical Laboratory Improvement Amendment criteria for allowable error were employed to assess for significant difference between results.A total of 2308 repeated tests were studied. There was no significant difference in 2291 (99.3%) of the samples. The average delay ranged from 35 min for magnesium to 42 min for sodium and calcium. At least 2.9% of laboratory running costs for the analytes was spent on repeating them.The practice of repeating a critical test result appears unnecessary as it yields similar results, delays notification to the treating clinician and increases laboratory running costs.

scholarly journals POS1189 THE IMPACT OF TELEMEDICINE AND COVID-19 ON A TERTIARY RHEUMATOLOGY SERVICE: A RETROSPECTIVE AUDIT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 876-877
Author(s):  
W. Zhu ◽  
T. De Silva ◽  
L. Eades ◽  
S. Morton ◽  
S. Ayoub ◽  
...  
Keyword(s):  
Immunosuppressive Therapy ◽  
Univariate Analysis ◽  
Diagnostic Delay ◽  
Cohort Differences ◽  
Phone Calls ◽  
Retrospective Audit ◽  
Common Diagnosis ◽  
Significant Difference ◽  
The Impact

Background:Telemedicine was widely utilised to complement face-to-face (F2F) care in 2020 during the COVID-19 pandemic, but the impact of this on patient care is poorly understood.Objectives:To investigate the impact of telemedicine during COVID-19 on outpatient rheumatology services.Methods:We retrospectively audited patient electronic medical records from rheumatology outpatient clinics in an urban tertiary rheumatology centre between April-May 2020 (telemedicine cohort) and April-May 2019 (comparator cohort). Differences in age, sex, primary diagnosis, medications, and proportion of new/review appointments were assessed using Mann-Whitney U and Chi-square tests. Univariate analysis was used to estimate associations between telemedicine usage and the ability to assign a diagnosis in patients without a prior rheumatological diagnosis, the frequency of changes to immunosuppression, subsequent F2F review, planned admissions or procedures, follow-up phone calls, and time to next appointment.Results:3,040 outpatient appointments were audited: 1,443 from 2019 and 1,597 from 2020. There was no statistically significant difference in the age, sex, proportion of new/review appointments, or frequency of immunosuppression use between the cohorts. Inflammatory arthritis (IA) was a more common diagnosis in the 2020 cohort (35.1% vs 31%, p=0.024). 96.7% (n=1,444) of patients seen in the 2020 cohort were reviewed via telemedicine. In patients without an existing rheumatological diagnosis, the odds of making a diagnosis at the appointment were significantly lower in 2020 (28.6% vs 57.4%; OR 0.30 [95% CI 0.16-0.53]; p<0.001). Clinicians were also less likely to change immunosuppressive therapy in 2020 (22.6% vs 27.4%; OR 0.78 [95% CI 0.65-0.92]; p=0.004). This was mostly driven by less de-escalation in therapy (10% vs 12.6%; OR 0.75 [95% CI 0.59-0.95]; p=0.019) as there was no statistically significant difference in the escalation or switching of immunosuppressive therapies. There was no significant difference in frequency of follow-up phone calls, however, patients seen in 2020 required earlier follow-up appointments (p<0.001). There was also no difference in unplanned rheumatological presentations but significantly fewer planned admissions and procedures in 2020 (1% vs 2.6%, p=0.002). Appointment non-attendance reduced in 2020 to 6.5% from 10.9% in 2019 (OR 0.57 [95% CI 0.44-0.74]; p<0.001), however the odds of discharging a patient from care were significantly lower in 2020 (3.9% vs 6%; OR 0.64 [95% CI 0.46-0.89]; p=0.008), although there was no significance when patients who failed to attend were excluded. Amongst patients seen via telemedicine in 2020, a subsequent F2F appointment was required in 9.4%. The predictors of needing a F2F review were being a new patient (OR 6.28 [95% CI 4.10-9.64]; p<0.001), not having a prior rheumatological diagnosis (OR 18.43 [95% CI: 2.35-144.63]; p=0.006), or having a diagnosis of IA (OR 2.85 [95% CI: 1.40-5.80]; p=0.004) or connective tissue disease (OR 3.22 [95% CI: 1.11-9.32]; p=0.031).Conclusion:Most patients in the 2020 cohort were seen via telemedicine. Telemedicine use during the COVID-19 pandemic was associated with reduced clinic non-attendance, but with diagnostic delay, reduced likelihood of changing existing immunosuppressive therapy, earlier requirement for review, and lower likelihood of discharge. While the effects of telemedicine cannot be differentiated from changes in practice related to other aspects of the pandemic, they suggest that telemedicine may have a negative impact on the timeliness of management of rheumatology patients.Disclosure of Interests:None declared.

scholarly journals Comparative Impact of Individual Quarantine vs. Active Monitoring of Contacts for the Mitigation of COVID-19: a modelling study

2020 ◽  
Author(s):  
Corey M. Peak ◽  
Rebecca Kahn ◽  
Yonatan H. Grad ◽  
Lauren M. Childs ◽  
Ruoran Li ◽  
...  
Keyword(s):  
Control Strategies ◽  
Emerging Infectious Diseases ◽  
Cost Benefit ◽  
Mitigation Measures ◽  
Individual Liberty ◽  
Average Delay ◽  
Active Monitoring ◽  
Serial Interval ◽  
The Cost ◽  
The Impact

SummaryBackgroundVoluntary individual quarantine and voluntary active monitoring of contacts are core disease control strategies for emerging infectious diseases, such as COVID-19. Given the impact of quarantine on resources and individual liberty, it is vital to assess under what conditions individual quarantine can more effectively control COVID-19 than active monitoring. As an epidemic grows, it is also important to consider when these interventions are no longer feasible, and broader mitigation measures must be implemented.MethodsTo estimate the comparative efficacy of these case-based interventions to control COVID-19, we fit a stochastic branching model to reported parameters for the dynamics of the disease. Specifically, we fit to the incubation period distribution and each of two sets of the serial interval distribution: a shorter one with a mean serial interval of 4.8 days and a longer one with a mean of 7.5 days. To assess variable resource settings, we consider two feasibility settings: a high feasibility setting with 90% of contacts traced, a half-day average delay in tracing and symptom recognition, and 90% effective isolation; and low feasibility setting with 50% of contacts traced, a two-day average delay, and 50% effective isolation.FindingsOur results suggest that individual quarantine in high feasibility settings where at least three-quarters of infected contacts are individually quarantined contains an outbreak of COVID-19 with a short serial interval (4.8 days) 84% of the time. However, in settings where this performance is unrealistically high and the outbreak continues to grow, so too will the burden of the number of contacts traced for active monitoring or quarantine. When resources are prioritized for scalable interventions such as social distancing, we show active monitoring or individual quarantine of high-risk contacts can contribute synergistically to mitigation efforts.InterpretationOur model highlights the urgent need for more data on the serial interval and the extent of presymptomatic transmission in order to make data-driven policy decisions regarding the cost-benefit comparisons of individual quarantine vs. active monitoring of contacts. To the extent these interventions can be implemented they can help mitigate the spread of COVID-19.FundingThis work was supported in part by Award Number U54GM088558 from the US National Institute Of General Medical Sciences.

Impact of Advancing Technology on Nuclear Facility Operation

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Jonathan K. Corrado ◽  
Ronald M. Sega
Keyword(s):  
Human Error ◽  
New Technologies ◽  
Nuclear Industry ◽  
Nuclear Facilities ◽  
Event Scale ◽  
Technological Advances ◽  
Significant Difference ◽  
The Cost ◽  
The Impact ◽  
The U.S

Abstract Many unfortunate and unintended adverse industrial incidents occur across the U.S. each year, and the nuclear industry is no exception. Depending on the severity, these incidents can be problematic for people, the facilities, and surrounding environments. These incidents occur for a number of varying reasons, but more often than not, human error is an accomplice. This article explores whether the complexity and changing technologies, which affect the way operators interact within the systems of the nuclear facilities, exacerbate the severity of incidents caused by human error. A review of nuclear incidents in the U.S. from 1955 to 2010 reaching level three or higher on the International Nuclear Event Scale (INES) scale was conducted. The cost of each incident at facilities that had recently undergone technological changes affecting plant operator's jobs was compared to those facilities which had not undergone changes. A t-test was applied and determined a statistically significant difference between the two groups. This affirmed that technological advances at nuclear facilities that affect how operators interact within the plant system increase the severity of resulting incidents. Next, a follow-on study was conducted to determine the impact from the incorporation of new technologies into nuclear facilities. The data indicated that spending more money on upgrades increased the capacity of the facility as well as the number of incidents reported, but the incident severity was minor.

scholarly journals Impact of the Cooling Equipment on the Key Design Parameters of a Core–Form Power Transformer

2016 ◽  
Vol 67 (6) ◽  
pp. 399-406
Author(s):  
Tamás Orosz ◽  
Zoltán Ádám Tamus
Keyword(s):  
Power Transformer ◽  
Short Circuit ◽  
Design Parameters ◽  
Significant Difference ◽  
Previous Algorithm ◽  
Transformer Design ◽  
New Variables ◽  
The Cost ◽  
Mathematical Optimisation ◽  
The Impact

Abstract The first step in the transformer design process is to find the active part’s key design parameters. This is a non-linear mathematical optimisation task, which becomes more complex if the economic conditions are considered by the capitalisation of the losses. Geometric programming combined with the method of branch and bound can be an effective and accurate tool for this task even in the case of core-form power transformers, when formulating the short-circuit impedance in the required form is problematic. Most of the preliminary design methods consider only the active part of the transformer and the capitalised costs in order to determine the optimal key design parameters. In this paper, an extension of this meta-heuristic transformer optimisation model, which takes the cost of the insulating oil and the cooling equipment into consideration, is presented. Moreover, the impact of the new variables on the optimal key design parameters of a transformer design is examined and compared with the previous algorithm in two different economic scenarios. Significant difference can be found between the optimal set of key-design parameters if these new factors are considered.

scholarly journals Open access journals are as likely to be referenced by the Orthopaedic literature, despite having a lower impact factor than subscription-based journals

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 64
Author(s):  
Robert Cooke ◽  
Neil Jain
Keyword(s):  
Open Access ◽  
Impact Factor ◽  
Open Access Journal ◽  
Open Access Journals ◽  
Significant Difference ◽  
Orthopaedic Literature ◽  
Top 40 ◽  
The Cost ◽  
Number Of Citations ◽  
The Impact

Background: The internet has changed the way we access and publish Orthopaedic literature. Traditional subscription journals have been challenged by the open access method of publication which permits the author to make their article available to all readers for free, often at a cost to the author. This has also been adopted in part by traditional subscription journals forming hybrid journals. One of the criticisms of open access publications is that it provides the author with a “pay to publish” opportunity. We aimed to determine if access to the journals impacts their influence. Methods: We selected the top 40 Trauma and Orthopaedic Journals as ranked by the SCImago Rank. Each journal was reviewed and assessed for the journal quality, defined by reviewing the journal impact factor and SCImago rank; influence, defined by reviewing the top 10 articles provided by the journal for the number of citations; and cost of open access publication. Results: Of the top 40 journals, 10 were subscription, 10 were open access, and 20 were hybrid journals. Subscription journals had the highest mean impact factor, and SCImago rank with a significant difference in the impact factor (p = 0.001) and SCImago rank (p = 0.021) observed between subscription and open access journals. No significant difference was seen between citation numbers of articles published in subscription and open access journals (p = 0.168). There was a positive correlation between the cost of publishing in an open access journal and the impact factor (r = 0.404) but a negative correlation between cost and the number of citations (r = 0.319). Conclusion: Open access journals have significantly lower quality measures in comparison to subscription journals. Despite this, we found no difference between the number of citations, suggestive of there being no difference in the influence of these journals in spite of the observed difference in quality.

Impact of coil price knowledge by the operator on the cost of aneurysm coiling. A single center study

2017 ◽  
Vol 10 (6) ◽  
pp. 602-605 ◽  
Author(s):  
Stephanos Finitsis ◽  
Robert Fahed ◽  
Ian Gaulin ◽  
Daniel Roy ◽  
Alain Weill
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Additional Measure ◽  
Total Cost ◽  
Aneurysm Embolization ◽  
Significant Difference ◽  
The Cost ◽  
The Impact ◽  
Aneurysm Coiling ◽  
Reference Cohort

BackgroundEndovascular treatment of aneurysms with coils is among the most frequent treatments in interventional neuroradiology, and represents an important expense. Each manufacturer has created several types of coils, with prices varying among brands and coil types. The objective of this study was to assess the impact of cost awareness of the exact price of each coil by the operating physician on the total cost of aneurysm coiling.Materials and methodsThis was a comparative study conducted over 1 year in a single tertiary care center. The reference cohort and the experimental cohort consisted of all aneurysm embolization procedures performed during the first 6 months and the last 6 months, respectively. During the second period, physicians were given an information sheet with the prices of all available coils and were requested to look at the sheet during each procedure with the instruction to try to reduce the total cost of the coils used. Expenses related to the coiling procedures during each period were compared.Results77 aneurysms (39 ruptured) in the reference cohort and 73 aneurysms (36 ruptured) in the experimental cohort were treated, respectively. There was no statistically significant difference regarding aneurysm location and mean size. The overall cost of the coiling procedures, the mean number of coils used per procedure, and the median cost of each procedure did not differ significantly between the two cohorts.ConclusionAwareness of the precise price of coils by operators without any additional measure did not have a scientifically proven impact on the cost of aneurysm embolization.

scholarly journals Atopy and Allergic Diseases Have No Impact on the Severity of COVID-19

2021 ◽  
Vol 19 (3) ◽  
pp. 174-182
Author(s):  
Ali Can ◽  
Deniz Eyice KARABACAK ◽  
Can TÜZER ◽  
Alpay Medet ALİBEYOĞLU2 ◽  
Murat KÖSE ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Allergic Diseases ◽  
Blood Eosinophil ◽  
Cytokine Storm ◽  
Allergen Sensitization ◽  
Total Ige ◽  
Significant Difference ◽  
History Of ◽  
The Impact ◽  
Eosinophil Counts

Objective: The clinical features of COVID-19 range from asymptomatic disease to severe pneumonia or even death. Therefore, many researchers have investigated the factors that could affect the severity of COVID-19. We aimed to assess the impact of aero-allergen sensitization and allergic diseases on the severity of COVID-19. Materials and Methods: We included 60 adult patients with symptomatic COVID-19 and allocated them into two groups equal in number as having severe and non-severe COVID-19. We evaluated the demographic features and allergic diseases in addition to clinical, laboratory and radiological findings of COVID-19. Skin prick tests (SPTs) with common aero-allergens, serum total IgE levels and blood eosinophil counts were evaluated 3 months after the patient’s recovery from COVID-19.Results: The mean age of the patients was 52 ± 11 years and 73.3% of the patients were male. There was no significant difference between the two groups in terms of age, gender, smoking habits, obesity and comorbidities. Although the frequency of sensitization to aero-allergens and the allergic diseases were similar, the history of allergic diseases in the family was higher in the severe group (p<0.001). The polysensitization in SPTs was associated with the presence of a cytokine storm during the infection (p=0.02). Total IgE levels and blood eosinophil counts were not significantly different between the two groups.Conclusion: The presence of atopy or allergic diseases does not seem to be related to the severity of COVID-19. However, polysensitization and a family history of allergic diseases are more prominent in those having a cytokine storm and severe COVID-19, respectively. Keywords: COVID-19, atopy, allergic disease, aero-allergen sensitization, cytokine storm

scholarly journals How Well Does the Traffic System Protect Transit from Congestion? Measuring Route-Level Costs That Congestion Imposes on Transit Operators and Users

2018 ◽  
Vol 2018 ◽  
pp. 1-11
Author(s):  
Peter G. Furth ◽  
Ahmed T. M. Halawani
Keyword(s):  
Early Morning ◽  
Service Reliability ◽  
Average Delay ◽  
Running Time ◽  
Location Data ◽  
Late Night ◽  
Buffer Time ◽  
Transit Agencies ◽  
The Cost ◽  
The Impact

As transit agencies and road owners adopt the objective of protecting transit from congestion, it becomes important to have a method for measuring the cost that congestion imposes on transit. Congestion impacts transit both by lowering average speed and by increasing service unreliability. Altogether, five congestion impacts were identified: increased running time and recovery time for transit operators and increased riding time, waiting time, and buffer time for passengers. A methodology for estimating those impacts was developed using automatic vehicle location data. The basic approach was to compare the impact variables during various periods of the week against a base period when there is no congestion (late night and early morning), making adjustments to account for differences in demand that affect running time apart from congestion. The methodology was successfully applied to a sample of 10 bus routes in the Boston area. The cost of congestion on the sample routes was found to range from $1 to $2 per passenger, with annual costs as great as $8 M per year on some routes. Of the total congestion cost, just under 20% applies to the operator, with the remainder applying to passengers. And while the operator is mainly affected by increased average delay, passengers are mainly affected by worsening service reliability.

Economic impact of comorbidities in spine surgery

2011 ◽  
Vol 14 (3) ◽  
pp. 318-321 ◽  
Author(s):  
M. Sami Walid ◽  
Joe Sam Robinson
Keyword(s):  
Spine Surgery ◽  
Severe Obesity ◽  
Hospital Costs ◽  
Hospital Charges ◽  
Female Patients ◽  
Obesity And Diabetes ◽  
Significant Difference ◽  
Severely Obese ◽  
The Cost ◽  
The Impact

Object Comorbidities in patients undergoing spine surgery may reasonably be factors that increase health care costs. To verify this hypothesis, the authors conducted the following study. Methods Major comorbidities and age-adjusted Charlson Comorbidity Index scores were retrospectively analyzed for 816 patients who underwent spine surgery at the authors' institutions between 2005 and 2008, and treatment costs (hospital charges) were assessed with the help of statistical software. The sample was collected by a nonmedical staff (hired at the beginning of 2006). Patients underwent one of the three most common types of spine surgery: lumbar microdiscectomy (20.5%), anterior cervical decompression and fusion (ACDF; 60.3%), or lumbar decompression and fusion (LDF; 19.2%). Patients were nearly equally divided by sex (53% were female and 47% male), and 78% were Caucasian versus 21% who were African American; the rest were of mixed or unidentified race. The average age was 54 years, with an SD of ± 14 years. Results There were significant differences in the prevalence of major comorbidities between male and female and between severely obese and nonseverely obese patients. The impact of comorbidities on the cost of spine surgery was more prominent in older patients, and an additive effect from some comorbidities was recorded in various types of spine surgery. For instance, in the ACDF group, female patients with both severe obesity and diabetes mellitus (DM) had significantly higher hospital charges than those with only one or neither of these conditions ($34,943 for both severe obesity and DM vs $25,633 for severe obesity only; $25,826 for DM only; and $25,153 for those with neither condition [p < 0.05]). In the LDF group, female patients with both DM and a history of depression had significantly higher hospital charges than those with only one or neither of these conditions ($65,782 for both DM and depression vs $53,504 for DM only; $55,990 for depression only; and $52,249 for those with neither condition [p < 0.05]). A significant difference was also found in hospital cost ($16,472 [p < 0.01]; 32% increase over baseline) in the LDF group between patients with the lowest and highest scores on the Charlson Index. Conclusions Comorbidities additively increase hospital costs for patients who undergo spine surgery, and should be considered in payment arrangements.

scholarly journals Reality Check 2: The Cost-Effectiveness of Policy Disallowing Body Checking in Non-Elite 13- to 14-Year-Old Ice Hockey Players

2021 ◽  
Vol 18 (12) ◽  
pp. 6322
Author(s):  
Gillian R. Currie ◽  
Raymond Lee ◽  
Luz Palacios-Derflingher ◽  
Brent Hagel ◽  
Amanda M. Black ◽  
...  
Keyword(s):  
Healthcare System ◽  
Healthcare Costs ◽  
Injury Rate ◽  
Ice Hockey ◽  
Sensitivity Analyses ◽  
Public Healthcare ◽  
Body Checking ◽  
Significant Difference ◽  
The Cost ◽  
The Impact

Sport-related injuries are the leading cause of injury in youth and are costly to the healthcare system. When body checking is disallowed in non-elite levels of Bantam (ages 13–14 years) ice hockey, the injury rate is reduced, but the impact on costs is unknown. This study compared rates of game injuries and costs among non-elite Bantam ice hockey leagues that disallow body checking to those that did not. Methods: An economic evaluation was conducted alongside a prospective cohort study comparing 608 players from leagues where body checking was allowed in games (Calgary/Edmonton 2014–2015, Edmonton 2015–2016) with 396 players from leagues where it was not allowed in games (Vancouver, Kelowna 2014–2015, Calgary in 2015–2016). The effectiveness measure was rate of game injuries per 1000 player-hours. Costs were estimated based on associated healthcare use within the publicly funded healthcare system as well as privately paid healthcare costs. Probabilistic sensitivity analysis was conducted using bootstrapping. Results: Disallowing body checking reduced the rate of injuries by 4.32 per 1000 player-hours (95% CI −6.92, −1.56) and reduced public and total healthcare system costs by $1556 (95% CI −$2478, −$559) and $1577 (95% CI −$2629, −$500) per 1000 player-hours, respectively. These finding were robust in over 99% of iterations in sensitivity analyses in the public healthcare and the total healthcare system perspectives. There was no statistically significant difference in privately paid healthcare costs (−$65 per 1000 player-hours (95% CI −$220, $99)). Interpretation: Disallowing body checking in non-elite 13–14-year-old ice hockey nationally would prevent injuries and reduce public healthcare costs.

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