Abstract:
Objectives:To curtail inappropriate plasma transfusions, we instituted clinical decision support as an alert upon order entry if the patient's recent international normalized ratio (INR) was 1.7 or less. Methods:The alert was suppressed for massive transfusion and within operative or apheresis settings. The plasma order was automatically removed upon alert acceptance while clinical exception reasons allowed for continued transfusion. Alert impact was studied comparing a 7-month control period with a 4-month intervention period. Results:Monthly plasma utilization decreased 17.4%, from a mean ± SD of 3.40 ± 0.48 to 2.82 ± 0.6 plasma units per hundred patient days (95% confidence interval [CI] of difference, -0.1 to 1.3). Plasma transfused below an INR of 1.7 or less decreased from 47.6% to 41.6% (P = .0002; odds ratio, 0.78; 95% CI, 0.69-0.89). The alert recommendation was accepted 33% of the time while clinical exceptions were chosen in the remaining cases (active bleeding, 31%; other clinical indication, 33%; and apheresis, 2%). Alert acceptance rate varied significantly among different provider specialties. Conclusions:Clinical decision support can help curtail inappropriate plasma use but needs to be part of a comprehensive strategy including audit and feedback for comprehensive, long-term changes.
journal_name
Am J Clin Patholjournal_title
American journal of clinical pathologyauthors
Shah N,Baker SA,Spain D,Shieh L,Shepard J,Hadhazy E,Maggio P,Goodnough LTdoi
10.1093/ajcp/aqx061subject
Has Abstractpub_date
2017-08-01 00:00:00pages
154-160issue
2eissn
0002-9173issn
1943-7722pii
3976049journal_volume
148pub_type
杂志文章abstract::Current methods for testing stool samples for hemoglobin utilize peroxidase oxidation of chemical indicators such as guaiac or benzidine. These tests have frequent false-positive and false-negative results, complicating random screening for occult gastrointestinal bleeding. The authors have developed an immunochemical...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/69.1.342
更新日期:1978-03-01 00:00:00
abstract::Pathologists are expected to accurately diagnose increasingly smaller breast carcinomas. Correct classification (ie, lobular vs ductal or in situ vs invasive) directly affects subsequent management, especially when the focus is near a surgical margin or present in a needle core biopsy and is further challenging if the...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1309/AJCPF4O0ADKFMGRJ
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abstract::The defined antigen substrate sphere system is a simple method for detecting antigen or antibody in the circulation. The technic is based on the coupling of antigen or antibody with Sepharose 4B beads that have been activated by cyanogen bromide. In this study the activated beads were exposed to dengue antigen in the ...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/70.3.343
更新日期:1978-09-01 00:00:00
abstract::Malignant B-cell lymphomas represent a heterogenous group of lymphoreticular disorders that involve the skin in about 20% of reported cases. Skin involvement may be primary or secondary (ie, the result of hematogenous spread). Primary cutaneous B-cell lymphomas (PCBCLs) are thought to take a comparatively favorable co...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/106.6.749
更新日期:1996-12-01 00:00:00
abstract:OBJECTIVES:To determine the public health surveillance severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing volume needed, both for acute infection and seroprevalence. METHODS:Required testing volumes were developed using standard statistical methods based on test analytical performance, disease preval...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
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更新日期:2020-07-07 00:00:00
abstract::Over a four-month period, methanol was found in the blood of 18 patients among 687 sequential emergency room admissions screened for alcohols by gas chromatography. In the patients with positive results, blood ethanol ranged from 6 to 570 mg/dL (1.3-123.7 mmol/L), blood methanol from 2.3 to 4.0 mg/dL (0.72-1.25 mmol/L...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/87.6.773
更新日期:1987-06-01 00:00:00
abstract::A case of microcystic adenoma (glycogen-rich cystadenoma) of the exocrine pancreas in a 62-year-old white female presenting with adult-onset diabetes mellitus is reported. Clinical, histopathologic, and ultrastructural findings are discussed with particular emphasis on the presence of myoepithelial cells, a morphologi...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/84.1.114
更新日期:1985-07-01 00:00:00
abstract::Two unusual cases of acute lymphoblastic leukemia-hand mirror variant (ALL-HMV) are presented. One patient demonstrated a mixed immunophenotype with HLA-DR, My7, transferrin receptor surface markers, and terminal deoxynucleotidyl transferase positivity. To the authors' knowledge, this is the first ALL-HMV reported wit...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/91.4.410
更新日期:1989-04-01 00:00:00
abstract::We tested the hypothesis that extensively keratinized squamous intraepithelial lesions (SILs) are difficult to grade precisely by identifying 100 Papanicolaou smears with a keratinizing SIL that had been originally judged difficult to grade. Of these, 65 were confirmed as low-grade SIL (LSIL) or high-grade SIL (HSIL) ...
journal_title:American journal of clinical pathology
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更新日期:2001-01-01 00:00:00
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journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/111.3.349
更新日期:1999-03-01 00:00:00
abstract::A tumor of the larynx composed of a small infiltrating and well-differentiated squamous cell carcinoma and a large polypoid sarcomatous mass showing the histologic features of the malignant giant cell tumor of soft parts (MGCT) is reported. Other types of sarcomatous components have been described with squamous cell c...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/82.3.340
更新日期:1984-09-01 00:00:00
abstract::An unusual case of acute myelomonocytic leukemia (AMML) in an 81-year-old man is described. Ultrastructural examination revealed the presence of distinct Auer bodies, which commonly are found in acute promyelocytic leukemia (APL). The Auer bodies had a splinterlike appearance with a distinct tubular substructure. The ...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/80.2.216
更新日期:1983-08-01 00:00:00
abstract::The authors report the use of cardiac troponin I (cTnI) for the early, noninvasive determination of coronary reperfusion following thrombolytic therapy. Cardiac troponin I, creatine kinase (CK)-MB, and myoglobin concentrations were measured in early serum specimens at 30, 60, and 90 minutes after initiation of therapy...
journal_title:American journal of clinical pathology
pub_type: 临床试验,杂志文章
doi:10.1093/ajcp/105.1.6
更新日期:1996-01-01 00:00:00
abstract::To establish the feasibility of immunotyping specimens transported over great distance, the University of Arizona and the Cleveland Clinic exchanged 39 lymphoma cases (26 B-cell, 13 T-cell cases) via air express for phenotyping. They were exchanged with the use of glass slides with adherent snap-frozen sections. The m...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/87.4.478
更新日期:1987-04-01 00:00:00
abstract::In a university-affiliated community hospital, medical records of 58 patients on whom the intact parathyroid hormone immunoassay (I-PTH) and 29 patients on whom both the carboxyl terminal PTH(C-PTH) and I-PTH ordered by physicians were reviewed to determine the reasons for requesting these tests. Reasons for ordering ...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/77.6.720
更新日期:1982-06-01 00:00:00
abstract::A practical acidimetric assay for penicillinase production using penicillin and phenol red impregnated in paper discs was developed. Blank discs were first impregnated with buffered penicillin G and, after drying, with 1% phenol red. For use, a disc was added to a bacterial suspension made in saline solution. A yellow...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/75.4.557
更新日期:1981-04-01 00:00:00
abstract::Terminal transferase (TdT) activity and antigen have been measured in 267 specimens of human bone marrow and peripheral blood by using a biochemical assay for enzymatic activity and an immunofluorescence test for antigen. Oligo p(dA)50 and dGTP were used as reagents in the biochemical assay and either rabbit anti-calf...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/77.4.420
更新日期:1982-04-01 00:00:00
abstract:OBJECTIVES:We wished to discover (1) in what circumstances surgeons wished to request frozen sections (FSs) on thyroid nodules having a prior fine needle aspiration (FNA) and the preoperative plan in these cases; (2) what the surgeons did with the information provided by FS and (3) in what types of cases was value adde...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/aqw042
更新日期:2016-05-01 00:00:00
abstract::A column chromatographic method for the simultaneous single-eluate isolation of CPK-MB and LDH 1,2 has been evaluated. The method is rapid in that the entire isolation is completed in less than an hour and subsequent analysis can be performed using presently available spectrophotometric methods and reagents without th...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/66.2.425
更新日期:1976-08-01 00:00:00
abstract::Data collection can be enhanced with the use of computers. Care must be taken, however, to ensure that the data collected have a purpose and meet either the quality assessment needs or business functions of the transfusion service. Required data elements are frequently in several data repositories and must be merged t...
journal_title:American journal of clinical pathology
pub_type: 杂志文章,评审
doi:
更新日期:1997-04-01 00:00:00
abstract::Platelet volume measurements have been used to differentiate consumptive and hypoplastic thrombocytopenia. Since thrombocytopenia is a frequent complication of neonatal sepsis, the authors explored the utility of correlating mean platelet volume (MVP) and platelet distribution width (PDW) with bacteremia. In a sample ...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/93.3.391
更新日期:1990-03-01 00:00:00
abstract::There are few studies that examine prevalence, quantity, and cellular proclivity of latent human herpesvirus 6 (HHV-6) in healthy populations. We examined 69 tonsils with paired blood specimens from children without evidence of acute infection. By polymerase chain reaction (PCR), HHV-6 was detected at low levels in 10...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1309/Y2HH-B1CK-0F5L-U7B8
更新日期:2001-11-01 00:00:00
abstract::Transbronchoscopic biopsies of lung (transbronchial) or bronchus (endobronchial) have a high diagnostic of yield when performed by a single expert bronchoscopist or a small group of expert bronchoscopists. This procedure's diagnostic yield was evaluated in a general hospital where biopsies are performed by a diverse g...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/72.6.926
更新日期:1979-12-01 00:00:00
abstract:OBJECTIVES:Endocervical curettage (ECC) specimens may be limited by scant tissue. We evaluated whether a cellular concentration processing method could improve their diagnostic quality. METHODS:Between October 2018 and June 2019, ECC specimens were assigned chronologically to one of two groups: nonconcentrated ECC (NE...
journal_title:American journal of clinical pathology
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更新日期:2021-01-04 00:00:00
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journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1309/AJCPUXLP7XD8OQYY
更新日期:2015-12-01 00:00:00
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journal_title:American journal of clinical pathology
pub_type: 杂志文章
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更新日期:2008-04-01 00:00:00
abstract::Reference values for hematologic parameters are determined using data from patient populations of a whole year. As a consequence, the authors are not dependent on a limited selected population and can determine reference values for all age and sex groups. It turns out that from the possible compilation technics the ga...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
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更新日期:1987-08-01 00:00:00
abstract::Eight cases are reported of an unusual breast lesion consisting of dense intralobular, perilobular, and perivascular lymphocytic infiltrates associated with lobular atrophy and sclerosis. Immunologic studies on paraffin-embedded tissue (seven cases) and frozen tissue (two cases) demonstrated a predominance of B-cells ...
journal_title:American journal of clinical pathology
pub_type: 杂志文章
doi:10.1093/ajcp/93.6.725
更新日期:1990-06-01 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::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