Clinical laboratory sciences data transmission: the NPU coding system.

In health care services, technology requires that correct information be duly available to professionals, citizens and authorities, worldwide. Thus, clinical laboratory sciences require standardized electronic exchanges for results of laboratory examinations. The NPU (Nomenclature, Properties and Units) coding system provides a terminology for identification of result values (property values). It is structured according to BIPM, ISO, IUPAC and IFCC recommendations. It uses standard terms for established concepts and structured definitions describing: which part of the universe is examined, which component of relevance in that part, which kind-of-property is relevant. Unit and specifications can be added where relevant [System(spec)-Component(spec); kind-of-property(spec) = ? unit]. The English version of this terminology is freely accessible at http://dior.imt.liu.se/cnpu/ and http://www.labterm.dk, directly or through the IFCC and IUPAC websites. It has been nationally used for more than 10 years in Denmark and Sweden and has been translated into 6 other languages. The NPU coding system provides a terminology for dedicated kinds-of-property following the international recommendations. It fits well in the health network and is freely accessible. Clinical laboratory professionals worldwide will find many advantages in using the NPU coding system, notably with regards to an accreditation process.

Portable monitoring and autotitration versus polysomnography for the diagnosis and treatment of sleep apnea.

STUDY OBJECTIVES: To compare a clinical pathway using portable monitoring (PM) for diagnosis and unattended autotitrating positive airway pressure (APAP) for selecting an effective continuous positive airway pressure (CPAP) with another pathway using polysomnography (PSG) for diagnosis and treatment of obstructive sleep apnea (OSA). DESIGN: Randomized parallel group SETTING: Veterans Administration Medical Center PATIENTS: 106 patients with daytime sleepiness and a high likelihood of having OSA MEASUREMENTS AND RESULTS: The AHI in the PM-APAP group was 29.2 +/- 2.3/h and in the PSG group was 36.8 +/- 4.8/h (P= NS). Patients with an AHI > or = 5 were offered CPAP treatment. Those accepting treatment (PM-APAP 45, PSG 43) were begun on CPAP using identical devices at similar mean pressures (11.2 +/- 0.4 versus 10.9 +/- 0.5 cm H2O). At a clinic visit 6 weeks after starting CPAP, 40 patients in the PM-APAP group (78.4% of those with OSA and 88.8% started on CPAP) and 39 in the PSG arm (81.2% of those with OSA and 90.6% of those started on CPAP) were using CPAP treatment (P = NS). The mean nightly adherence (PM-APAP: 5.20 +/- 0.28 versus PSG: 5.25 +/- 0.38 h/night), decrease in Epworth Sleepiness Scale score (-6.50 +/- 0.71 versus -6.97 +/- 0.73), improvement in the global Functional Outcome of Sleep Questionnaire score (3.10 +/- 0.05 versus 3.31 +/- 0.52), and CPAP satisfaction did not differ between the groups. CONCLUSIONS: A clinical pathway utilizing PM and APAP titration resulted in CPAP adherence and clinical outcomes similar to one using PSG.

Interpretation of the adult polysomnogram.

Polysomnography provides information on the physiological changes occurring in many different organ systems in relation to sleep stages and wakefulness. It allows qualitative and quantitative documentation of abnormalities of sleep and wakefulness, of sleep-wake transition, and of physiological function of other organ systems that are influenced by sleep. Polysomnography is considered to be the "gold standard" for diagnosing sleep disordered breathing (SDB) and other sleep disorders; however, as with most other diagnostic tests, polysomnography is not ideal, but is rather the best available method to diagnose SDB. Review of clinical history, pre- and post study questionnaires, medications, and technician's comments at the time of interpreting the PSG provides a unique opportunity to correlate clinical and electrophysiological data, and is a good investment of time toward improving patient outcomes and avoidance of unnecessary testing.

LOINC, a universal standard for identifying laboratory observations: a 5-year update.

The Logical Observation Identifier Names and Codes (LOINC) database provides a universal code system for reporting laboratory and other clinical observations. Its purpose is to identify observations in electronic messages such as Health Level Seven (HL7) observation messages, so that when hospitals, health maintenance organizations, pharmaceutical manufacturers, researchers, and public health departments receive such messages from multiple sources, they can automatically file the results in the right slots of their medical records, research, and/or public health systems. For each observation, the database includes a code (of which 25 000 are laboratory test observations), a long formal name, a "short" 30-character name, and synonyms. The database comes with a mapping program called Regenstrief LOINC Mapping Assistant (RELMA(TM)) to assist the mapping of local test codes to LOINC codes and to facilitate browsing of the LOINC results. Both LOINC and RELMA are available at no cost from http://www.regenstrief.org/loinc/. The LOINC medical database carries records for >30 000 different observations. LOINC codes are being used by large reference laboratories and federal agencies, e.g., the CDC and the Department of Veterans Affairs, and are part of the Health Insurance Portability and Accountability Act (HIPAA) attachment proposal. Internationally, they have been adopted in Switzerland, Hong Kong, Australia, and Canada, and by the German national standards organization, the Deutsches Instituts für Normung. Laboratories should include LOINC codes in their outbound HL7 messages so that clinical and research clients can easily integrate these results into their clinical and research repositories. Laboratories should also encourage instrument vendors to deliver LOINC codes in their instrument outputs and demand LOINC codes in HL7 messages they get from reference laboratories to avoid the need to lump so many referral tests under the "send out lab" code.