Impact of the cardiac troponin testing algorithm on excessive and inappropriate troponin test requests.

Cardiac troponin (cTn) is a key biomarker for the assessment of myocardial injury, but overutilization of this test has increased workload and costs. We developed and implemented an algorithm to eliminate excessive utilization. Significant reduction was observed after the implementation of the algorithm in total cTnI requests (29.9%; P = .007), requests from outpatient clinics (70.7%; P = .003), and other wards (42.8%; P = .003). Stat requests, the number of third requests, and more than 3 requests per patient were reduced significantly by 42.8% (P = .004), 35.8% (P = .003), and 49.4% (P = .008), respectively. The test and labor costs each were reduced by 29.9% (P = .007 for each). There was no significant change in cTnI orders from emergency and critical care departments. The cTnI testing algorithm reduced unnecessary orders for cTnI tests with no reduction in meeting patients'critical needs. Reduction in unnecessary and inappropriate requests reduces labor and test costs.

Knowledge and attitudes of economically disadvantaged women regarding exposure to environmental tobacco smoke: a Michigan, USA study.

BACKGROUND: Exposure to environmental tobacco smoke (ETS) is a global public health problem which is particularly acute in groups where smoking rates are higher than in the general population. A study was undertaken to investigate knowledge, attitudes and preventive efforts with regard to exposure to ETS in a sample of economically disadvantaged women residing in Michigan, USA. METHODS: Analysis-of-variance techniques were used to investigate how knowledge, attitudes and preventive efforts regarding exposure to ETS relate to demographic variables such as smoking status, ethnicity, education, employment, and income; and analysis-of-covariance techniques were applied to determine the degree to which knowledge, attitudes, age, smoking status, ethnicity, education, employment, income and home environment predict these women's preventive efforts regarding exposure to ETS. RESULTS: Generally, women with no high school diploma and women who were smokers were less knowledgeable about the adverse health effects of exposure to ETS, had worse attitudes concerning exposure to ETS and were less likely to take preventive steps to limit their exposure to ETS than were women who had more formal education or who were nonsmokers, respectively. The primary predictors of preventive efforts were knowledge, attitudes and smoking status. CONCLUSIONS: The results suggest that educational efforts focusing on increasing knowledge and improving attitudes regarding exposure to ETS, as well as providing practical strategies for limiting exposure to ETS, should be developed and delivered to at-risk populations.