Avoiding regression analysis pitfalls when calibrating white blood cell differential counters.

Method comparison and calibration are important for clinical hematologists and for manufacturers of new methods and instruments. Automation of the white blood cell (WBC) differential count poses unique problems in this regard because the reference method is a microscopic manual cell count of 200 WBCs. A highly variable reference method can obscure the true relation between the reference and the test methods and reduce sensitivity to miscalibration. A computer model based on published cell distributions and on the statistical properties of proportions was created to enable testing of alternative approaches to calibration. Ordinary linear regression (OLR) and standard Deming regression (SDR) were applied to a comparison of the results obtained with a virtual cell counter (counting 2,000 WBCs) and that obtained with a virtual 200-cell reference method for monocytes (mean population percentage of 7.1%) and lymphocytes (mean population percentage of 29%). Both regression approaches can misrepresent the known mathematical relation between the methods. This problem almost always occurs when OLR is used and the proportion of the cell of interest is low, as in the case of monocytes (7.1% of the total count). OLR comparisons, however, introduce significant error even for cell counts of 29%. SDR performed much better for both cell types.

Recreational music-making: an integrative group intervention for reducing burnout and improving mood states in first year associate degree nursing students: insights and economic impact.

The challenges of providing exemplary undergraduate nursing education cannot be underestimated in an era when burnout and negative mood states predictably lead to alarming rates of academic as well as career attrition. While the multi-dimensional nature of this complex issue has been extensively elucidated, few rational strategies exist to reverse a disheartening trend recognizable early in the educational process that subsequently threatens to undermine the future viability of quality healthcare. This controlled prospective crossover study examined the impact of a 6-session Recreational Music-making (RMM) protocol on burnout and mood dimensions as well as Total Mood Disturbance (TMD) in first year associate level nursing students. A total of 75 first year associate degree nursing students from Allegany College of Maryland (ACM) participated in a 6-session RMM protocol focusing on group support and stress reduction utilizing a specific group drumming protocol. Burnout and mood dimensions were assessed with the Maslach Burnout Inventory and the Profile of Mood States respectively. Statistically significant reductions of multiple burnout and mood dimensions as well as TMD scores were noted. Potential annual cost savings for the typical associate degree nursing program (16,800 dollars) and acute care hospital (322,000 dollars) were projected by an independent economic analysis firm. A cost-effective 6-session RMM protocol reduces burnout and mood dimensions as well as TMD in associate degree nursing students.

Recreational music-making: a cost-effective group interdisciplinary strategy for reducing burnout and improving mood states in long-term care workers.

OBJECTIVES: This controlled, prospective, randomized study examined the clinical and potential economic impact of a 6-session Recreational Music-making (RMM) protocol on burnout and mood dimensions, as well as on Total Mood Disturbance (TMD) in an interdisciplinary group of long-term care workers. METHODS: A total of 112 employees participated in a 6-session RMM protocol focusing on building support, communication, and interdisciplinary respect utilizing group drumming and keyboard accompaniment. Changes in burnout and mood dimensions were assessed with the Maslach Burnout Inventory and the Profile of Mood States respectively. Cost savings were projected by an independent consulting firm, which developed an economic impact model. RESULTS: Statistically-significant reductions of multiple burnout and mood dimensions, as well as TMD scores, were noted. Economic-impact analysis projected cost savings of $89,100 for a single typical 100-bed facility, with total annual potential savings to the long-term care industry of $1.46 billion. CONCLUSIONS: A cost-effective, 6-session RMM protocol reduces burnout and mood dimensions, as well as TMD, in long-term care workers.

Control of analyzer slope and intercept in the measurement of packed red cell volume (PCV): part II.

A majority of packed cell volume (PCV) assays performed in the United States are performed by multichannel hematology analyzers rather than by centrifugation of blood samples in glass capillary tubes. PCV results from both analytical approaches were compared to the recently described ICSH reference method to determine the effect of assay slope on clinical utility. Though not controllable by the end user, the slope of the PCV assay versus the reference was satisfactory when performed in centrifuged glass capillaries. In the small sample of multichannel analyzers surveyed, only two of six machines functioned as well in this respect as did the glass capillaries. The worst of the unsatisfactory multichannel analyzers would have identified correctly only about half of the anemic and the polycythemic patients in the 12,623 males surveyed in the Third National Health and Nutrition Examination Survey (NHANES III). The performance on the females in this U.S. Department of Health and Human Services study would have been similarly poor. It is important that manufacturers of multichannel analyzers attend to the slopes of their PCV assays if the results are to be diagnostically useful.