Subject(s)
Academic Medical Centers/standards , Conflict of Interest , Ethics, Institutional , Research Support as Topic/standards , Facility Design and Construction/economics , Humans , Industry/economics , Industry/standards , Organizational Case Studies , Organizational Culture , Research Support as Topic/economics , United StatesSubject(s)
Confidentiality/standards , Ethics, Institutional , Famous Persons , Hospital-Patient Relations , Hospitals, University/standards , Laboratories, Hospital/standards , Acquired Immunodeficiency Syndrome/etiology , Humans , Newspapers as Topic , Organizational Case Studies , Transfusion ReactionABSTRACT
The object of our study was to determine if any association exists between low serum cholesterol (< 4.14 mmol/l) and adverse outcomes in elderly patients > 60 years. Patients with low serum cholesterol were compared to a patient population with high serum cholesterol (> 6.22 mmol/l) and normal cholesterol (> or = 4.14 to < or = 6.22 mmol/l). Only hospitalized patients > 60 years, who were not on cholesterol lowering drugs, and did not have cardiovascular or liver disease were included in this study. The study group was 157 patients (79 with low, 78 with high, and 23 with normal cholesterol concentrations). Using the Kruskal-Wallis tests, the low cholesterol group was found to have statistically (p < 0.05) longer length of stay (average difference of > 11.1 days), higher hospital re-admission rate over a 1-year period (average difference of > 0.4 re-admissions), greater use of acute care services (average difference of > 0.6 days), and more emergency room (ER) visits over 1 year (average difference of > 0.5 admissions).
Subject(s)
Cholesterol/blood , Hospitalization , Severity of Illness Index , Age Factors , Aged , Cholesterol, HDL/blood , Female , Humans , Length of Stay , Male , Middle Aged , Patient Readmission , Retrospective Studies , Risk Factors , Sex Factors , Treatment Outcome , Triglycerides/bloodSubject(s)
Ethics, Institutional , Fraud , Laboratories/standards , California , Organizational Case StudiesABSTRACT
The improvement of quality in clinical care can greatly benefit form continuous benchmarking with information based on laboratory data. To be most effective, the information is best provided in the form of real-time disease management decision support. Such an approach requires advances in the implementation of hospital information systems. This article describes ground-breaking work at LDS Hospital in Salt Lake City, Utah that provides examples of major well-documented impacts of the "intelligent laboratory report" on patient outcomes.
Subject(s)
Benchmarking , Clinical Medicine/standards , Decision Making, Computer-Assisted , Decision Support Systems, Clinical/statistics & numerical data , Pathology, Clinical/standards , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Communicable Diseases/drug therapy , Communicable Diseases/economics , Cost-Benefit Analysis , HumansABSTRACT
In clinical practice, the measurement of urinary free cortisol (UFC) provides the most sensitive and specific diagnostic information for excess adrenal production of cortisol. The existing methodologies (RIA and HPLC) are time consuming, costly, involve tedious extractions, derivatizations and problems with non-specific interactions with cortisol metabolites in urine. In the present study, we describe the development of an SPE-CE method for the rapid analysis of UFC. UFC was concentrated using SPE C18 cartridges (3M Empore) under a vacuum and eluted with acetonitrile-SDS. The use of 10% acetone to wash cartridges before final elution with acetonitrile-SDS showed significant improvements in the free cortisol recovery. The complete extraction was accomplished in 10-15 min with a recovery of 89-94%. CE analysis was done on a Beckman P/ACE 5010 with detection at 254 nm using a neutral capillary. Detection limits of free cortisol in urine was improved to 10 microg/l with SPE compared to 500 microg/l without SPE. No interferences either from BSA or other urinary cortisol metabolites affected the free cortisol determinations. The results showed the feasibility of a rapid UFC detection with improved sample handling capacity.
Subject(s)
Electrophoresis, Capillary/methods , Hydrocortisone/urine , Humans , Reference Standards , Reproducibility of Results , Spectrophotometry, UltravioletABSTRACT
From the clinical perspective, steroids have always held a great deal of interest, since they are highly specific in their function. They do not have a general or systemic effect, but instead regulate specific physiological functions, such as sex differentiation, fetus implantation and growth, electrolyte balance, menstrual cycles, and muscle and bone development. Many disorders have been identified as being caused by under- or oversecretion of steroids, i.e., Addison's disease, Cushing's syndrome, hirsutism and virilism, adenomas, congenital adrenal hyperplasia, acromegaly, Liddle's syndrome, hypertension, and so on (1). Diseases resulting from steroid imbalance usually result from the cumulative effect of one or more steroids. To get a better understanding of the patho-physiology resulting from steroid imbalances, the measurement of a profile of steroids is potentially more beneficial than measuring a single steroid. Fiet et al. (2), who used a profile of eight steroids to gain a better understanding of hirsutism and acne in women, demonstrated a good example of this type of study.
Subject(s)
Health Services Research/organization & administration , Laboratories/organization & administration , Leadership , Societies, Medical , Guideline Adherence , Health Policy , Laboratories/economics , Laboratories/standards , Organizational Objectives , Outcome Assessment, Health Care , Professional Competence , Quality Assurance, Health Care , United StatesABSTRACT
The dynamism of change in the evolution of integrated health-care systems is driving change in the skills and competencies required to manage diagnostic services. Formal educational preparation and practical experience in a wider array of disciplines will be essential to the backgrounds of those who will be chosen for these new and ever more complex roles. Curricular elements relevant to this educational challenge are outlined herein. This article is intended to expand on the position of CLMA as reflected in the position paper "New Path for Health-Care Leadership: Clinical Systems Management," issued in August 1997 (1).
