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@#Introduction: Laboratory tests account for 66% of clinical decision making and reducing inappropriate test utilisation is a step towards optimising patients’ care and hospital cost savings. This study aims to identify the rate and cost of redundant test requests in our centre. Methods: A cross-sectional study comprising laboratory results of 14 analytes in renal function test (RFT) and liver function test (LFT) were made. Data involved blood results from adult patients admitted to Hospital Universiti Sains Malaysia from January to December 2018. The redundant test is defined as test results consecutively normal twice and requested within 26 hours for analytes in RFT and 50 hours for analytes in LFT. Cost contributions were estimated by multiplying cost-per-test with total redundant requests. The test redundancy in different wards and disease groups were also evaluated. Results: Equal distribution of RFT and LFT requests were observed in both genders (50% respectively), with the most requests seen in the 60 – 79 years age group. More than 20% redundancy rate was observed for seven analytes (ALT, total bilirubin, sodium, urea, potassium, AST, Chloride), and overall redundancy was 19.7%, equals to Malaysian Ringgit (MYR) 669,105.00. Oncology wards and genitourinary diseases contribute to the highest redundancy rate. Conclusion: This study estimated MYR 600 thousands of saving if test redundancy were to be eliminated. The finding is hoped to serve as a platform for future intervention and policymaking. Future planning to optimise the current laboratory request system and collaboration among physicians and laboratory professionals can minimise test inappropriateness.
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The types and the reasons of changing the original test result after retesting in national medical device sampling and testing from 2013 to 2016, are summarized and analyzed. Firstly, collecting data of "standards not complied" and retesting. Then, giving specific examples when summarizing five types of changing the original test result after retesting. Meanwhile, analyzing the relevant reasons, discovering the deep problems. Finally, giving suggestions for the above problems.
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Equipment and Supplies , Reference Standards , Quality ControlABSTRACT
Aims: The sample retention policy for Clinical Chemistry analytes in accredited medical laboratories as per ISO 15189:2012 is 24 hrs. Serum/ plasma to be separated in aliquot within 20 minutes of collection unless the primary containers are gel vacutainers. Rigorous maintenance of such procedure is difficult and as a result the possibility of deviation from such schedule may not be very uncommon. The 1 year Turn Around Time (TAT) analysis of the laboratory is a good guide to find out time lag from sample collection to sample processing & average time of collecting samples in aliquot for retained sample testing. The laboratory retested 22 common analytes on the basis of such time lag and evaluated the deviation from 1st observation. The accumulated data has helped to evaluate and implement sample retention policy. Study Design: The average time lag from collection to completion of test performance of a batch is 4hrs± 30 minutes. The analytes were retested in the time lag. After accumulation of sufficient data the time lag increased to 6 hours±30 minutes which is the average lag from sample collection to end of the day duty personnel. In the 3rd phase total retention time ie, 24 hrs has been considered as time interval of retained sample retesting. But the samples remained at room temperature for 6hrs±30minutes before being preserved at 2°C-8°C. Hence time lag was (6hrs±30min) at room temperature and 17hrs ±30min at 2°C-8°C. The samples always retested from primary container. Place and Duration of Study: The study took place in JMD Diagnostics Private Limited, Kolkata, India. The duration of study is 2 yrs. Methodology: The analytes were tested in Cobas Integra 400plus system. The tests have been performed as routine tests and considered as 1st observation. 2nd observation values obtained after the specified time lag. The results obtained were compared using statistical software. Comparison of 1st and 2nd results and bias of all analytes were studied. Electrolytes have been eliminated from the study as the electrolytes are preferred to be retested from freshly collected sample. Labile parameters like L-Lactate, ammonia, bicarbonate were also not considered for the same reason. Conclusion: Only 3 analytes, total protein, total calcium and inorganic phosphorus cannot be preserved in primary containers. The analytes also need not to be separated within 20 minutes of collection. Upto 4hrs±30 minutes all the parameters have shown excellent correlation coefficient. Hence, the laboratory earns a time lag between collection to preservation of samples for these analytes. For other 19 analytes sample may be kept in primary container.
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The re-testing for postgraduate candidates is an important part in the work of enrollment.The article expounds the general development of re-testing for postgraduate candidates,especially in the new period(since 2003).After a series of reform taking place since 2003,the development of the re-testing for postgraduate candidates has a positive effect on enhancing the quality of enrollment.
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PURPOSE: Adults with GH deficiency(GHD) have abnormal body composition, reduced physical performance, altered lipid metabolism, increased cardiovascular diseases, and reduced quality of life. Administration of GH to these patients reduce clinical abnormalities to normal ranges. Therefore, patients with childhood-onset GHD might need to continue GH replacement after the attainment of final height. Recently studies have shown that a high proportion of patients with childhood-onset GHD are no longer GHD when retested at young adult. METHODS: GH secretion was reevaluated with insulin and clonidine after completion of GH treatment in 29 young adult patients(21.3+/-2.8 yrs, 17 men, 12 women) with childhood-onset GHD diagnosed at a mean age of 11.4+/-3.5 yr. The mean duration of GH treatment was 3.7+/-3.0 yrs. Eleven(11 men) with idiopathic patients presented in 2(18%) isolated GHD and 9(82%) in multiple pituitary hormonal deficiencies. Eighteen(6 men, 12 women) with organic patients presented in 4(22%) isolated GHD and 14(88%) in multiple pituitary hormomal deficiencies, which was caused from craniopharyngioma, germinoma & other lesions. Blood sampling were done as usual method for checking LH, FSH and TSH concentration after injection of gonadotropin releasing hormone & thyrotropin releasing hormone. Serum cortisol levels were also checked after insulin injection and all hormonal concentrations were measured with radioimmunoassay method. Total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein(LDL)-cholesterol concentrations were measured by standard techniques. Bone density was measured in the level of lumbar spine and femur with DEXA. M-mode, two-dimensional and pulsed Doppler echocardiographic studies were performed. Quality of life was assessed from Beck depression inventory questionnaire with age-matched control. RESULTS: All patients with idiopathic and organic GHD were confirmed as GHD through combined pituitary function retesting at young adult. The additional pituitary hormonal deficiencies were increased in numbers. Their total cholesterol and triglyceride levels were increased especially in patients with organic GHD. There were no specific abnormal findings in echocardiographic findings compared to normal reference. Bone density with DEXA showed osteopenia(T score <-1) was found in 20/24(83%) and osteoporosis(T score <-2.5) in 8/24(33%) in young adult GHD. Quality of life was evaluated with BDI questionnaire and showed mild depression in 32% and moderate to severe depression in 11%. CONCLUSION: 82% of patients with idiopathic and 88% of organic GHD have additional pituitary hormonal deficiencies in childhood, showing multiple pituitary hormonal deficiencies rather than isolated GHD and has GHD permanently in all young adults with idiopathic and organic GHD and that is a little different findings from other foreign reports and needs to follow up in future.