Abstract:
OBJECTIVES:Overuse of laboratory tests is a persistent issue. We examined the use and overuse of serum immunofixation electrophoresis and serum free light chain assays to develop an algorithm for optimizing utilization. METHODS:A retrospective review of all tests, for investigation of monoclonal gammopathies, for all patients who had any of these tests done from April 24, 2014, through July 25, 2014, was carried out. The test orders were categorized as warranted or not warranted according to criteria presented in the article. RESULTS:A total of 237 patients were tested, and their historical records included 1,503 episodes of testing for one or more of serum protein electrophoresis, serum immunofixation electrophoresis, and serum free light chain assays. Only 46% of the serum immunofixation and 42% serum free light chain assays were warranted. Proper utilization, at our institution alone, would have obviated $64,182.95/year in health care costs, reduced laboratory cost of reagent alone by $26,436.04/year, and put $21,904.92/year of part B reimbursement at risk. CONCLUSIONS:Fewer than half of the serum immunofixation and serum free light chain assays added value. The proposed algorithm for testing should improve utilization. Risk to part B billing may be a disincentive to reducing test utilization.
journal_name
Am J Clin Patholjournal_title
American journal of clinical pathologyauthors
Heaton C,Vyas SG,Singh Gdoi
10.1093/ajcp/aqw026subject
Has Abstractpub_date
2016-04-01 00:00:00pages
531-7issue
4eissn
0002-9173issn
1943-7722pii
aqw026journal_volume
145pub_type
杂志文章abstract::A rapid, convenient immunologic assay technic for fibrinogen is reported. Basically a latex agglutination, the assay technic, called kinetic latex agglutinometry, quantitates the increase in light transmission that occurs in a stirred suspension of anti-fibrinogen-coated latex beads after the addition of a plasma or w...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/77.4.424
更新日期:1982-04-01 00:00:00
abstract::Cardiac-related death has been reported following strenuous exercise, and biochemical markers predicting adverse outcomes would be useful. Despite the fact the myeloperoxidase (MPO) release may precede myocardial injury and identify at-risk patients earlier than traditional markers, information on the effects of marat...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1309/1D62H6KRFTVQRJ0A
更新日期:2006-12-01 00:00:00
abstract::Basaloid squamous cell carcinoma (BSCC) and carcinosarcoma of the esophagus are rare entities, making up fewer than 2% of esophageal malignancies. Comparative genomic hybridization (CGH) in 1 case of BSCC and 2 cases of carcinosarcoma and subsequent array CGH in 1 case each of BSCC and carcinosarcoma revealed common c...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1309/AJCPZ1O7UUUISPNR
更新日期:2011-04-01 00:00:00
abstract::The authors describe an unusual variant of alkaline phosphatase (ALP) discovered in a patient with a 90-fold increase in serum ALP. The variant ALP was indistinguishable from the bone isoenzyme when subjected to chemical inhibition, heat inactivation, lectin precipitation, and routine electrophoresis. However, treatme...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/95.5.749
更新日期:1991-05-01 00:00:00
abstract::Statin is a 57 kDa nuclear protein exclusively found in noncycling cells. Its expression in hematolymphoid cells had not been examined previously. The authors studied statin immunoreactivity in nonneoplastic lymphoid tissues from 26 lymph nodes, 3 tonsils, and 2 spleens. Statin was detected primarily in small lymphoid...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/101.4.421
更新日期:1994-04-01 00:00:00
abstract::This study was undertaken to evaluate the precision and sensitivity of three different commercial APTT reagents containing the activators kaolin, micronized silica, or ellagic acid. These reagents varied greatly in their ability to detect mild coagulopathies. The ellagic acid reagent was able to detect the mildest def...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/82.4.436
更新日期:1984-10-01 00:00:00
abstract::Two patients with essential thrombocythemia showed a marked decrease in ristocetin-induced platelet aggregation in addition to other aggregation defects during routine aggregation studies for prolonged bleeding times. Further investigation revealed type I von Willebrand's disease (vWD) in one patient and a variant of ...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/88.1.102
更新日期:1987-07-01 00:00:00
abstract::A prospective double-blind trial was performed to investigate the safety of long-term oral anticoagulant control when dosaged adjustment depends on the prothrombin times assessed with one type of thromboplastin being calculated as if assayed by another type. The three main types of thromboplastin, i.e., bovine (Thromb...
journal_title:American journal of clinical pathology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/ajcp/75.3.297
更新日期:1981-03-01 00:00:00
abstract::This study focused on women who had an abnormal Papanicolaou smear and a subsequent colposcopic examination negative for a cervical squamous intraepithelial lesion. Cervical swabs obtained during the initial colposcopic examination were analyzed for human papillomavirus (HPV) DNA, and these results were correlated wit...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/98.5.489
更新日期:1992-11-01 00:00:00
abstract::The recent clinical and commercial success of anticancer antibodies such as rituximab and trastuzumab has created great interest in antibody-based therapeutics for hematopoietic malignant neoplasms and solid tumors. Given the likelihood of lower toxic effects of antibodies that target tumor cells and have limited impa...
journal_title:American journal of clinical pathology
pub_type: 杂志文章,评审
doi:10.1309/Y6LP-C0LR-726L-9DX9
更新日期:2003-04-01 00:00:00
abstract::A patient who had masses in the breasts clinically suggestive of neoplasia had fibrous mastopathy and striking deposition of ochronotic pigment within the soft tissue of the breast. The gross appearance and light microscopic features are illustrated. The histochemical features of ochronotic pigment and the difficulty ...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/71.3.349
更新日期:1979-03-01 00:00:00
abstract::Riedel thyroiditis (RT) is an uncommon form of chronic thyroiditis in which the thyroid gland is replaced by fibrous tissue. The etiologic mechanisms underlying RT are unclear: the prevailing view is that it is part of a generalized fibroinflammatory process also involving other organs. The clinical manifestations of ...
journal_title:American journal of clinical pathology
pub_type: 杂志文章,评审
doi:10.1309/NUU88VAFR9YEHKNA
更新日期:2004-06-01 00:00:00
abstract::An automated fluorescent immunoassay system (FIAX) was compared with complement fixation (CF) for measuring antibodies to cytomegalovirus (CMV) and herpes simplex virus (HSV) in clinical specimens. Compared with CF the specificity of FIAX (ability to detect a negative titer) was 95% for CMV and 92% for HSV. The sensit...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/76.3.305
更新日期:1981-09-01 00:00:00
abstract::A 26-year-old woman who had undergone orthotopic heart transplantation because of dilative cardiomyopathy received a triple-drug immunosuppressive regimen (cyclosporine A, azathioprine, and prednisolone). During her relatively frequent episodes of acute rejection, she was treated with methylprednisolone and repeated a...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/94.1.95
更新日期:1990-07-01 00:00:00
abstract::Borrelia burgdorferi is difficult to detect in routine biopsy material from patients with skin lesions of borreliosis. In this study, a new immunohistochemical method, focus floating microscopy (FFM), was developed to detect B burgdorferi in tissue sections and was compared with polymerase chain reaction (PCR). By usi...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1309/3369XXFPEQUNEP5C
更新日期:2007-02-01 00:00:00
abstract:Objectives:A report on the multicenter evaluation of the Bruker MALDI Biotyper CA System (MBT-CA; Bruker Daltonics, Billerica, MA) for the identification of clinically important bacteria and yeasts. Methods:In total, 4,399 isolates of medically important bacteria and yeasts were assessed in the MBT-CA. These included ...
journal_title:American journal of clinical pathology
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1093/ajcp/aqw225
更新日期:2017-06-01 00:00:00
abstract::Because T-regulatory cells (Tregs) can harmfully impair HIV-specific responses or beneficially limit immune activation, we compared the number of Tregs in lymph nodes from 48 HIV+ patients and 106 HIV- subjects. By using a microscope counting grid, we found that the mean ± SD number of Tregs in lymph nodes was 3 times...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1309/AJCPAR39BFWNHWRO
更新日期:2011-07-01 00:00:00
abstract::In a case of secondary syphilis with gastric involvement, the clinical history and roentgenographic and gastroscopic examiniations initially suggested an infiltrative malignant neoplasm. However, macroscopic and histologic examination of the partial gastrectomy specimen demonstrated an erosive, inflammatory lesion. Su...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/63.6.895
更新日期:1975-06-01 00:00:00
abstract::Oxidant-antioxidant balance is known to regulate growth factors and invasion of tumor cells. Manganese superoxide dismutase (MnSOD), copper zinc SOD (CuZnSOD), and extracellular SOD (ECSOD), the first-line antioxidant defenses, were studied in lung carcinomas by immunohistochemical analysis (n = 139, 56, and 37, respe...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1309/A45Q-HB0Q-RRX6-CT9A
更新日期:2004-09-01 00:00:00
abstract:OBJECTIVES:To examine Hedgehog signaling in cutaneous fibrosing disorders for which effective approved therapies are lacking, expand our knowledge of pathophysiology, and explore the rationale for targeted inhibition. METHODS:Stain intensity and percentage of cells staining for Sonic hedgehog (Shh), Indian hedgehog (I...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/aqw192
更新日期:2016-12-01 00:00:00
abstract::Three policies for decreasing unnecessary cerebrospinal fluid (CSF) management Venereal Disease Research Laboratory (VDRL) tests were compared. The first policy attempted to educate physicians about the use of serologic tests for diagnosing neurosyphilis but allowed the CSF VDRL to be performed either as a screening t...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/95.3.397
更新日期:1991-03-01 00:00:00
abstract::The greater precision in prothrombin time monitoring obtained using thromboplastins with low international sensitivity index (ISI) values are believed to result in improved patient care. The authors conducted a blinded prospective study of 84 random patients on low-intensity warfarin therapy who were monitored with ei...
journal_title:American journal of clinical pathology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/ajcp/102.1.134
更新日期:1994-07-01 00:00:00
abstract::Monoclonal immunoradiometric assays (IRMA) for human chorionic gonadotropin (hCG) are available for either intact hCG (IhCG) or beta subunit hCG (beta hCG). The authors evaluated the clinical applications of both methods. Serum samples (N = 180) were divided into the following five clinical groups: Group 1: elevated l...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/93.3.347
更新日期:1990-03-01 00:00:00
abstract::The expression of the cell-cycle-associated Ki-67 antigen by MIB-1 monoclonal antibody was retrospectively assessed in 35 surgically resected neuroendocrine tumor specimens of the pancreas embedded in paraffin. The MIB-1 proliferation index was correlated with the classification of the neuroendocrine tumors of the pan...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/109.3.286
更新日期:1998-03-01 00:00:00
abstract::A nodule of the liver was incidentally noted during left colectomy for a large villous adenoma in a 74-year-old man. Microscopic examination disclosed a granuloma of the liver containing numerous Enterobius vermicularis ova and a cross-section of the nematode. This is the fourth reported case of hepatic oxyuriasis and...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/91.1.97
更新日期:1989-01-01 00:00:00
abstract::Intrauterine clostridial infections have historically been associated with puerperal sepsis, often subsequent to instrumented abortions. Isolated reports have been associated with a malignant neoplasm or degenerating leiomyoma, most often after instrumentation, radiation therapy, or chemotherapy. In these cases, well-...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/91.1.104
更新日期:1989-01-01 00:00:00
abstract::This article explores 3 aspects of breast diagnosis that are currently under investigation and about which our thinking has recently undergone considerable reshaping. The trend toward more frequent evaluation of clinically subtle lesions has suggested that it might be necessary to understand thefine-needle aspiration ...
journal_title:American journal of clinical pathology
pub_type: 杂志文章,评审
doi:10.1309/29FP-0QAU-CMJY-BK3U
更新日期:2000-05-01 00:00:00
abstract::A goat anti-serum was prepared against mucinous ovarian cyst fluid and absorbed with normal colon and a variety of normal tissues until the only residual immunoreactivity was directed against colon cancer and ovarian tumor mucin. The set of antigenic determinants defined by this anti-serum has been called COTA, standi...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/86.1.1
更新日期:1986-07-01 00:00:00
abstract::Remarkable improvements have been made in blood safety since the onset of the HIV epidemic. However, the current paradigm does not prevent all transfusion-transmitted infections and is reactive to new agents, thus accepting that some patients may be harmed before preventive measures are introduced. Several methods are...
journal_title:American journal of clinical pathology
pub_type: 杂志文章,评审
doi:10.1309/RAPQ3NXG3MV9AL94
更新日期:2007-12-01 00:00:00
abstract::A case of septicemia caused by Pseudomonas paucimobilis is reported. This represents the first definitive case of disease produced by this yellow-pigmented, nonfermentative bacillus. ...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/72.5.882
更新日期:1979-11-01 00:00:00