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Reiner-Benaim A, Amar S. Trends in decision-making by primary care physicians regarding common infectious complaints. Infect Dis (Lond) 2024; 56:644-652. [PMID: 38647537 DOI: 10.1080/23744235.2024.2344795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Primary care physicians played an important role in the global response during the COVID-19 pandemic, but with the absence of laboratory and diagnostics services, the move to telehealth and the focus on respiratory assessment, they faced increased uncertainty when making clinical decisions. OBJECTIVES This paper aims to examine the impact of the pandemic on decisions made by primary care physicians, as measured by referrals to chest X-ray and laboratory tests and by prescriptions of antibiotics. METHODS We conducted a retrospective study of all visits recorded with fever or cough, presenting to 209 community clinics in Southern Israel during the years 2018-2022. We describe changes in outcome rates across time and use multivariate generalised linear mixed effects model to compare the odds of referrals and prescriptions between periods, while accounting for gender, age, clinic sector, visit type, diagnosis, and season. RESULTS In total, 609,823 visits to primary care physicians complied with the cohort definitions. Social restrictions were associated with a decline in all measured outcomes for primary care physician decisions, most prominently among ages 20-59, for throat culture referral during the first lockdown (OR = 0.46) and for cephalosporine prescription during the second lockdown (OR = 0.55). This trend persisted following the cancellation of the restrictions. CONCLUSIONS Despite higher uncertainty during the COVID-19 social restrictions, the overall course of clinical decision-making processes was maintained, and was associated with a reduction in the use of auxiliary resources, which can improve the quality of patient care by lowering costs and supporting prevention of future antibiotics resistance.
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Affiliation(s)
- Anat Reiner-Benaim
- Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Shimon Amar
- Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev and Clalit Health Services, Southern District, Be'er-Sheva, Israel
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Sharma A, Al-Haidose A, Al-Asmakh M, Abdallah AM. Integrating Artificial Intelligence into Biomedical Science Curricula: Advancing Healthcare Education. Clin Pract 2024; 14:1391-1403. [PMID: 39051306 PMCID: PMC11270210 DOI: 10.3390/clinpract14040112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/28/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024] Open
Abstract
The integration of artificial intelligence (AI) into healthcare practice has improved patient management and care. Many clinical laboratory specialties have already integrated AI in diagnostic specialties such as radiology and pathology, where it can assist in image analysis, diagnosis, and clinical reporting. As AI technologies continue to advance, it is crucial for biomedical science students to receive comprehensive education and training in AI concepts and applications and to understand the ethical consequences for such development. This review focus on the importance of integrating AI into biomedical science curricula and proposes strategies to enhance curricula for different specialties to prepare future healthcare workers. Improving the curriculum can be achieved by introducing specific subjects related to AI such as informatics, data sciences, and digital health. However, there are many challenges to enhancing the curriculum with AI. In this narrative review, we discuss these challenges and suggest mitigation strategies.
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Affiliation(s)
- Aarti Sharma
- College of Health Sciences, QU Health Sector, Qatar University, Doha 2713, Qatar
| | - Amal Al-Haidose
- Department of Biomedical Sciences, College of Health Sciences, QU Health Sector, Qatar University, Doha 2713, Qatar
| | - Maha Al-Asmakh
- Department of Biomedical Sciences, College of Health Sciences, QU Health Sector, Qatar University, Doha 2713, Qatar
| | - Atiyeh M. Abdallah
- Department of Biomedical Sciences, College of Health Sciences, QU Health Sector, Qatar University, Doha 2713, Qatar
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Awwad S, Al-Hamdani M, Abdallah AM, Abu-Madi M. Laboratory testing efficiency during the COVID pandemic: Findings from the Primary Health Care Corporation laboratories in the State of Qatar. J Infect Public Health 2024; 17:681-686. [PMID: 38471258 DOI: 10.1016/j.jiph.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Little is known about how the COVID-19 pandemic altered laboratory testing efficiency in the State of Qatar. The aim of this study was to assess laboratory testing efficiency with respect to the total number and proportion of C-reactive protein (CRP), complete blood count (CBC), and comprehensive metabolic panel (CMP) tests completed on time in 2019-2021 in several ordinary and COVID-converted Primary Health Care Corporation (PHCC) health centers across Qatar. METHODS Secondary data from 2019 to 2021 were accessed from the PHCC-Clinical Information System center. Six randomly selected centers from three regions of Qatar (Northern, Central, and Western), two of which were COVID-converted, were analyzed. RESULTS A total of 404,316 laboratory tests were analyzed. There were decreasing, U-shaped, and inverted-U-shaped patterns in the numbers of tests conducted in different regions between 2019 and 2021 according to test type. The proportion of urgent (STAT) CBC and CMP tests increased from 2019 to 2021, and the proportion of tests completed by COVID-converted health centers increased for CRP and CBC and decreased for CMP between 2019 and 2021. Northern and Western regions in Qatar showed higher efficiency than the Central region with respect to the proportion of STAT tests completed on time in 2019-2021. COVID-converted centers completed fewer STAT CBC tests on time than ordinary centers. CONCLUSION Pandemics such as COVID-19 shift the allocation of resources from routine tests to urgent tests, as exemplified by the increase in STAT test proportions in 2019 to 2021. High population densities, as noted in the Central region of Qatar, may require additional resources during pandemics to complete urgent tests more efficiently. The conversion of centers to COVID-converted centers may not necessarily translate into higher urgent test efficiency, as exemplified by the STAT CBC test results.
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Affiliation(s)
- Sara Awwad
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Mohammed Al-Hamdani
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Atiyeh M Abdallah
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Marawan Abu-Madi
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
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Mboweni SH. Strategies that enabled access to chronic care during the COVID-19 pandemic and beyond in South Africa. Health SA 2024; 29:2412. [PMID: 38628228 PMCID: PMC11019043 DOI: 10.4102/hsag.v29i0.2412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/27/2023] [Indexed: 04/19/2024] Open
Abstract
Background The COVID-19 epidemic has revealed disturbing information about how chronic diseases are treated globally. Healthcare providers and coronavirus response teams have primarily reported on how individuals with chronic conditions sought care and treatment. However, individuals' experiences of patients are yet unknown. Aim This study aimed to explore those strategies that enabled patients with chronic diseases access to chronic care and treatment during and beyond the COVID-19 pandemic. Setting The study was conducted in the predominantly rural district of the Northwest Province, South Africa. Methods An explorative qualitative research design was followed. Information-rich participants were chosen using a purposive sampling technique. Individual face-to-face interviews were used to gather data. Data saturation was achieved after interviewing n = 28 people in total. The six steps of Braun and Clarke thematic data analysis were used to analyse the data. Results The study revealed three themes, which includes improved healthcare structural systems, shift from traditional chronic care to digital care services and medication refill and buddy system. Conclusion The findings of this study revealed a range of effective and noteworthy approaches that facilitated access to treatment and continuity of care. As a result, enhancing telemedicine as well as structural systems such as appointment scheduling, decanting choices, mobile and medication home delivery can improve access to care and treatment. Contribution The burden of disease and avoidable death will be eventually addressed by maximising the use of telemedicine and sustaining the new norm of ongoing care through digital and remote care and decanting strategies.
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Affiliation(s)
- Sheillah H Mboweni
- Department of Health Studies, Collage of Human Sciences, University of South Africa, Pretoria, South Africa
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Lilly K, Proudlove N, Bethune C. Successful demand management in diagnostic immunology testing. J Clin Pathol 2024; 77:266-277. [PMID: 36535742 DOI: 10.1136/jcp-2022-208334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
AIMS We investigated whether we could have a material and sustained impact on immunology test ordering by primary care clinicians by building evidence-based and explanatory algorithms into test ordering software. METHODS A service evaluation revealed cases of over-requesting of antinuclear antibody, allergen-specific IgE and total IgE tests, and under-requesting of urine protein electrophoresis. We conducted a quality improvement programme to address this. We determined the most effective and efficient intervention would be to embed evidence-based and advice-based decision-support algorithms in the ordering software. Consultation with general practitioners revealed lack of knowledge and confidence about testing, and an appetite for support. We iteratively designed and implemented algorithms for the four sets of tests for the primary care practices in our catchment and made them available to other hospital trusts in our region. The ordering system now contains links to advice sheets for clinicians and their patients and to an email address for queries to the lab. RESULTS We observe large (36% to 88%) reductions in testing activity (workload) for the over-requested tests and large (28%-135%) increases for the under-requested test. We show that these changes are sustained. There have been no complaints from the clinicians and queries to the lab are now minimal (less than one per month on average). CONCLUSIONS Embedding algorithms in the ordering software can be acceptable to clinicians and have a major and sustained impact on overuse or underuse of tests. The algorithms can be replicated by other hospital trusts.
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Affiliation(s)
- Kristen Lilly
- Department of Immunology and Allergy, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Nathan Proudlove
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Claire Bethune
- Department of Immunology and Allergy, University Hospitals Plymouth NHS Trust, Plymouth, UK
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Rakeman-Cagno JL, Persing DH, Loeffelholz MJ. Maintaining point of care testing capacity and pandemic preparedness in the post-COVID-19 era. Expert Rev Mol Diagn 2024; 24:147-151. [PMID: 37724428 DOI: 10.1080/14737159.2023.2260743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Testing at the point of care (we also refer to the 'point of need'), with rapid, actionable results reported to the patient and provider within hours can impact the individual as well as public health. Faster testing is good for patients and public health outcomes during 'peace time' (outside of the pandemic setting). AREAS COVERED Testing at the point of need was important during the COVID-19 pandemic to meet testing capacity demands, providing actionable results, and for providing testing within communities to increase access for all populations. Resources were acquired and built up dramatically during the pandemic as part of the response. With the end of the COVID-19 public health emergency and transition back to 'peace time' some testing sites have successfully shifted to using this capacity for testing for other critical needs, like sexually transmitted infection (STI) testing, and response to other seasonal diseases and for outbreak response. EXPERT OPINION The increased testing capacity added to handle unprecedented testing volume during the COVID-19 pandemic can be repurposed for other critical infectious diseases during 'peace time' (post-COVID-19 pandemic). This maintains testing capacity for the next pandemic.
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Affiliation(s)
| | - David H Persing
- Department Pathology, Stanford University, Palo Alto, CA, USA
- Scientific Affairs, Cepheid, Sunnyvale, CA, USA
| | - Michael J Loeffelholz
- Department Pathology, University of Texas Medical Branch, Galveston, TX, USA
- Scientific Affairs, Cepheid, Sunnyvale, CA, USA
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Durant TJS, Peaper DR. Retrospective evaluation of clinical decision support for within-laboratory optimization of SARS-CoV-2 NAAT workflow. J Clin Microbiol 2024; 62:e0078523. [PMID: 38132702 PMCID: PMC10865785 DOI: 10.1128/jcm.00785-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/28/2023] [Indexed: 12/23/2023] Open
Abstract
The unprecedented demand for severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) testing led to challenges in prioritizing and processing specimens efficiently. We describe and evaluate a novel workflow using provider- and patient-facing ask at order entry (AOE) questions to generate distinctive icons on specimen labels for within-laboratory clinical decision support (CDS) for specimen triaging. A multidisciplinary committee established target turnaround times (TATs) for SARS-CoV-2 nucleic acid amplification test (NAAT) based on common clinical scenarios. A set of AOE questions was used to collect relevant clinical information that prompted icon generation for triaging SARS-CoV-2 NAAT specimens. We assessed the collect-to-verify TATs among relevant clinical scenarios. Our study included a total of 1,385,813 SARS-CoV-2 NAAT conducted from March 2020 to June 2022. Most testing met the TAT targets established by institutional committees, but deviations from target TATs occurred during periods of high demand and supply shortages. Median TATs for emergency department (ED) and inpatient specimens and ambulatory pre-procedure populations were stable over the pandemic. However, healthcare worker and other ambulatory test TATs varied substantially, depending on testing volume and community transmission rates. Median TAT significantly differed throughout the pandemic for ED and inpatient clinical scenarios, and there were significant differences in TAT among label icon-signified ambulatory clinical scenarios. We describe a novel approach to CDS for triaging specimens within the laboratory. The use of CDS tools could help clinical laboratories prioritize and process specimens efficiently, especially during times of high demand. Further studies are needed to evaluate the impact of our CDS tool on overall laboratory efficiency and patient outcomes. IMPORTANCE We describe a novel approach to clinical decision support (CDS) for triaging specimens within the clinical laboratory for severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) nucleic acid amplification tests (NAAT). The use of our CDS tool could help clinical laboratories prioritize and process specimens efficiently, especially during times of high demand. There were significant differences in the turnaround time for specimens differentiated by icons on specimen labels. Further studies are needed to evaluate the impact of our CDS tool on overall laboratory efficiency and patient outcomes.
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Affiliation(s)
- Thomas J. S. Durant
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - David R. Peaper
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Zha L, MacLeod S, Love T, Fortuna RJ, Zhang YV. Longitudinal impact of COVID-19 pandemic on the utilization of hemoglobin A1c testing in outpatients. Clin Chim Acta 2024; 552:117686. [PMID: 38042461 DOI: 10.1016/j.cca.2023.117686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, concerns arose about disparate access to health care and laboratory testing. There is limited information about the pandemic's impact on the frequency of diabetic laboratory testing across demographic subgroups (e.g., sex, age over 65 y, and race). METHODS This retrospective study examined outpatient hemoglobin A1c (HbA1c) testing in a large academic medical center in Upstate New York between March 2019 and March 2021. Multivariate Poisson regression models were used to evaluate the pandemic's effects on HbA1c utilization. RESULTS Over 190,000 HbA1c results from predominately white (76.1 %) and older (mean age, 60.6 y) outpatients were analyzed. Compared to pre-pandemic time period, the average number of HbA1c tests per patient during COVID time period experienced a small, though significant, drop (1.3 to 1.2; p < 0.001) on aggregate and in outpatients, males, females, and seniors. The modest reduction was not significant by race except for the white seniors (p < 0.001). However, the testing frequency remained within recommendations from the American Diabetes Association for monitoring prediabetic patients and patients with stable glycemic control. CONCLUSION Given the propensity for healthcare disruptions to widen disparities, it is reassuring that we did not observe a worsening of disparities in rates of HbA1c testing during the COVID-19 pandemic.
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Affiliation(s)
- Li Zha
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, United States; Present Address: Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, United States
| | - Sara MacLeod
- Division of Endocrinology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, United States
| | - Tanzy Love
- Department of Biostatistics and Computational Biology, University of Rochester, 265 Crittenden Boulevard, CU 420630, Rochester, NY, United States
| | - Robert J Fortuna
- Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, United States
| | - Y Victoria Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, United States.
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Parrón I, Carol M, Bes N, Izquierdo C, Godoy P, Barrabeig I, Sala MR, Minguell S, Ferras J, Rius C, Martínez AI, Domínguez À. The impact of COVID-19 pandemic on the incidence of acute gastroenteritis outbreaks in Catalonia (Spain). Epidemiol Infect 2023; 152:e10. [PMID: 38073577 PMCID: PMC10804134 DOI: 10.1017/s0950268823001851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/29/2023] [Accepted: 11/16/2023] [Indexed: 01/19/2024] Open
Abstract
We carried out a retrospective study of acute gastroenteritis (AGE) outbreaks reported between 1 January 2015 and 31 December 2021 in Catalonia (Spain) to compare the incidence from 2015 to 2019 with that observed from 2020 to 2021. We observed a higher incidence rate of outbreaks during the prepandemic period (16.89 outbreaks/1,000,000 person-years) than during the pandemic period (6.96 outbreaks/1,000,000 person-years) (rate ratio (RR) 0.41; 95% confidence interval (CI) 0.34 to 0.51). According to the aetiology of the outbreak, those of viral aetiology decreased from 7.82 to 3.38 outbreaks/1,000,000 person-years (RR 2.31; 95% CI 1.72 to 3.12), and those of bacterial aetiology decreased from 5.01 to 2.78 outbreaks/1,000,000 person-years (RR 1.80; 95% CI 1.29 to 2.52). There was a great reduction in AGE outbreaks in Catalonia. This reduction may have been due to the effect of the nonpharmaceutical measures applied to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the collapse of the healthcare system and epidemiological surveillance services may also have had a strong influence.
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Affiliation(s)
- Ignasi Parrón
- Agència de Salut Pública de Catalunya, Barcelona, Spain
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Mònica Carol
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Núria Bes
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | | | - Pere Godoy
- Facultat de Medicina, Universitat de Lleida, Spain
- Grup d’Epidemiologia Aplicada, Institut de Recerca Biomédica (IRBLleida), Lleida, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Irene Barrabeig
- Agència de Salut Pública de Catalunya, Barcelona, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - M. Rosa Sala
- Agència de Salut Pública de Catalunya, Barcelona, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | - Cristina Rius
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - Àngela Domínguez
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
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Yang L, Tang S, He M, Guo J, Gabriel N, Swabe G, Gellad WF, Essien UR, Saba S, Benjamin EJ, Magnani JW, Hernandez I. COVID-19 pandemic and initiation of treatment for atrial fibrillation: a nationwide analysis of claims data. BMC Cardiovasc Disord 2023; 23:604. [PMID: 38066445 PMCID: PMC10704685 DOI: 10.1186/s12872-023-03614-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic profoundly disrupted the delivery of medical care. It remains unclear whether individuals diagnosed with new onset disease during the pandemic were less likely to initiate treatments after diagnosis. We sought to evaluate changes in the treatment initiation of patients newly diagnosed with atrial fibrillation (AF) after the onset of the COVID-19 pandemic. METHODS In this retrospective cohort study, we identified individuals with incident AF from 01/01/2016-09/30/2021 using Optum's de-identified Clinformatics® Data Mart Database. The primary outcome was initiation of oral anticoagulation (OAC) within 30 days of AF diagnosis. Secondary outcomes included initiation of OAC within 180 days of diagnosis, initiation of warfarin, direct oral anticoagulants (DOACs), rhythm control medications and electrical cardioversion within 30 days of diagnosis. We constructed interrupted time series analyses to examine changes in the outcomes following the onset of the pandemic. RESULTS A total of 573,524 patients (age 73.0 ± 10.9 years) were included in the study. There were no significant changes in the initiation of OAC, DOAC, and rhythm control medications associated with the onset of the pandemic. There was a significant decrease in initiation of electrical cardioversion associated with the onset of the pandemic. The rate of electronic cardioversion within 30 days of diagnosis decreased by 4.9% per 1,000 patients after the onset of the pandemic and decreased by about 35% in April 2020, compared to April 2019, from 5.53% to 3.58%. CONCLUSION The COVID-19 pandemic did not affect the OAC initiation within 30 days of AF diagnosis but was associated with a decline in the provision of procedures for patients newly diagnosed with AF.
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Affiliation(s)
- Lanting Yang
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Shangbin Tang
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Meiqi He
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Nico Gabriel
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Gretchen Swabe
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Walid F Gellad
- Division of General Internal Medicine, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Utibe R Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Center for the Study of Healthcare Innovation, Implementation & Policy, University of California, Greater Los Angeles VA Healthcare System, Los Angeles, Los Angeles, CA, USA
| | - Samir Saba
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Emelia J Benjamin
- Department of Epidemiology, Boston University School of Public Health, Department of Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Jared W Magnani
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Inmaculada Hernandez
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA.
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Pighi L, Henry BM, De Nitto S, Gianfilippi G, Salvagno GL, Plebani M, Lippi G. Clinical assessment of SNIBE Maglumi SARS-CoV-2 antigen fully-automated chemiluminescent immunoassay. Clin Chem Lab Med 2023; 61:1506-1510. [PMID: 36883744 DOI: 10.1515/cclm-2023-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES Given that SARS-CoV-2 antigen tests will represent a pillar for supporting or surrogating molecular testing in the endemic period, we report here the clinical performance of the new SNIBE Maglumi SARS-CoV-2 antigen fully-automated chemiluminescent immunoassay (MAG-CLIA SARS-CoV-2 Ag). METHODS The study population consisted of 181 subjects (mean age 61 ± 21 years; 92 females) undergoing coronavirus disease 2019 (COVID-19) testing at the local diagnostic facility, from December 2022 to February 2023. Routine diagnostic practice involved the collection of a double nostril nasopharyngeal swab, analyzed in duplicate with SARS-CoV-2 antigen (MAG-CLIA SARS-CoV-2 Ag) and molecular (Altona Diagnostics RealStar SARS-CoV-2 RT-PCR Kit) tests. RESULTS A significant Spearman's correlation was found between MAG-CLIA SARS-CoV-2 Ag and mean Ct values of SARS-CoV-2 E and S genes (r=-0.95; p<0.001). In all nasopharyngeal samples, the area under the curve (AUC) of MAG-CLIA SARS-CoV-2 Ag was 0.86 (95% CI, 0.81-0.90), with 0.71 sensitivity and 1.00 specificity at 7 ng/L cut-off, increasing to 0.98 (95% CI, 0.96-1.00) AUC and 0.96 sensitivity (with 0.97 specificity) in high viral load samples. When SARS-CoV-2 N protein concentration was replaced with raw instrumental readings (i.e., relative light units [RLU]), the AUC in all samples increased to 0.94. A RLU value of 945 was associated with 88.4% accuracy, 0.85 sensitivity, 0.95 specificity, 0.77 negative predictive value (NPV) and 0.97 positive predictive value (PPV), respectively. CONCLUSIONS We found satisfactory analytical performance of MAG-CLIA SARS-CoV-2 Ag, which could be used as surrogate of molecular testing for identifying high viral load samples. Broadening the reportable range of values may generate even better performance.
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Affiliation(s)
- Laura Pighi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
- Service of Laboratory Medicine, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Brandon M Henry
- Clinical Laboratory, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA
| | - Simone De Nitto
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
- Service of Laboratory Medicine, Pederzoli Hospital, Peschiera del Garda, Italy
| | | | - Gian Luca Salvagno
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
- Service of Laboratory Medicine, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Mario Plebani
- Department of Medicine, University of Padova, Padova, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
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Mujuru TN, Mahlangu NP, Ngwetjana SJ, Bekker LC, Tanyanyiwa DM. The impact of lockdown measures during the SARS-CoV-2 pandemic on the management of diabetes in a Northern Gauteng Region of South Africa. Pan Afr Med J 2023; 45:129. [PMID: 37790163 PMCID: PMC10543907 DOI: 10.11604/pamj.2023.45.129.39255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/26/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction coronavirus disease 2019 (SARS-CoV-2), a global pandemic, popularised the term "lockdown" due to its rapid spread around the world. "Lockdown" was used as an emergency measure to temporarily prevent people from entering or leaving their communities in an effort to reduce the spread of the virus. The effects of the "lockdown" measures on the management of chronic medical conditions in African populations have been inconsistent. This study aimed to assess the effects of the lockdown on glycaemic control in patients with diabetes. Methods retrospective study that examined metadata from 1st January 2019 to 31st December 2021, to assess the impact of the national SARS-CoV-2 response on the quantity and average level of haemoglobin A1c and random glucose in patients with diabetes at Dr. George Mukhari Academic Hospital. The data was retrieved from the National Health Laboratory Services corporate data warehouse. Results from 2019 to 2021, a total of 9,039 tests were performed, with females accounting for 63.21% (n = 5,714) and males for 36.08% (n = 3,261), while 0.7% (n = 70) did not have an assigned gender. Mean age was 49, with a standard deviation (SD) of 21.71. The testing rate (TR) in 2019 was 10.74 per day, 2020 had a TR of 6.07, and 2021 had a TR of 7.95. During the pandemic phase, all other age groups had TRs below 1.85, except the 50-59, 60-69, and 70+ year-old groups. Conclusion the study revealed that SARS-CoV-2 lockdown measures were linked to poor diabetes control in patients. As a result, the consequences of managing SARS-CoV-2 had a direct influence on diabetes management.
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Affiliation(s)
- Tatenda Nyasha Mujuru
- South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa
- Department of Chemical Pathology, National Health Laboratory Service, Dr. George Mukhari Academic Hospital, Johannesburg, Gauteng, South Africa
| | - Nelly Petunia Mahlangu
- Department of Chemical Pathology, National Health Laboratory Service, Dr. George Mukhari Academic Hospital, Johannesburg, Gauteng, South Africa
- Department of Chemical Pathology, Sefako Makgatho Health Sciences University, Pretoria North, Gauteng Province, South Africa
| | - Sekwedi Jackson Ngwetjana
- Department of Chemical Pathology, National Health Laboratory Service, Dr. George Mukhari Academic Hospital, Johannesburg, Gauteng, South Africa
| | - Lasya Christina Bekker
- Department of Chemical Pathology, Sefako Makgatho Health Sciences University, Pretoria North, Gauteng Province, South Africa
| | - Donald Moshen Tanyanyiwa
- Department of Chemical Pathology, National Health Laboratory Service, Dr. George Mukhari Academic Hospital, Johannesburg, Gauteng, South Africa
- Department of Chemical Pathology, Sefako Makgatho Health Sciences University, Pretoria North, Gauteng Province, South Africa
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Liu X, Tabibzada N, Lindgren H, Sjöstedt A. Utility of Borrelia-specific IgM and IgG antibody titer determinations during a 12-year period - results from a clinical laboratory in Northern Sweden. Front Cell Infect Microbiol 2023; 13:1192038. [PMID: 37465761 PMCID: PMC10350645 DOI: 10.3389/fcimb.2023.1192038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Interpretation of serological findings in suspected Lyme borreliosis (LB) is challenging and IgM reactivities may have low predictive value. Therefore, if used indiscriminately, there is a risk for incorrect diagnosis of LB. To evaluate the usefulness of IgM titer determination, we performed a study of the prevalence of Borrelia-specific antibodies in serological samples from patients with suspected LB analyzed during the period 2010 - 2021 at the University Hospital of Umeå in Sweden. In total, 19,335 samples had been analyzed for the presence of IgG and IgM antibodies. Overall, there were higher percentages of IgM positive or borderline titers, 1,847 (9.6%) and 905 (4.7%), respectively, than IgG positive or borderline titers, 959 (5.0%) and 406 (2.1%), respectively. Peak number of samples were recorded 2012 - 2013, exceeding 1,800, whereas there were around 1,200 during 2020 - 2021. The peak number of positive IgG and/or positive IgM samples were observed during the period 2015 - 2017 with close to, or above 400, and concomitantly, the proportion of IgG positive samples increased markedly. For IgG positive samples, the increase followed a positive linear time trend (P< 0.001). Peak monthly numbers were observed during August, September, and October. This seasonal increase was significant for the IgG positive group (P< 0.05), but not for the IgM positive/IgG negative group. Repeated samples were obtained from 3,188 individuals and of the initial samples 2,817 were (88%) IgG negative and 2,315 (72%) were IgM negative and of these, 130 (4%) showed IgG seroconversion and 300 (9%) IgM seroconversion. Collectively, the data demonstrate that IgG and/or IgM positive samples represented a minority of all samples, even when repeated sampling had occurred, and IgM positive samples were much more common than IgG positive samples. Thus, the accuracy of the clinical suspicion was low and this will lead to a low predictive value of the analysis, in particular of IgM. These findings question the use of IgM titer determination as a routine analysis.
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Affiliation(s)
- Xijia Liu
- Umeå School of Business, Economics and Statistics, Statistics, Västerbotten, Sweden
| | | | - Helena Lindgren
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Anders Sjöstedt
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
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14
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Mathura P, Marini S, Hagtvedt R, Spalding K, Duhn L, Kassam N, Medves J. Factors of a physician quality improvement leadership coalition that influence physician behaviour: a mixed methods study. BMJ Open Qual 2023; 12:e002016. [PMID: 37290908 PMCID: PMC10255283 DOI: 10.1136/bmjoq-2022-002016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND A coalition (Strategic Clinical Improvement Committee), with a mandate to promote physician quality improvement (QI) involvement, identified hospital laboratory test overuse as a priority. The coalition developed and supported the spread of a multicomponent initiative about reducing repetitive laboratory testing and blood urea nitrogen (BUN) ordering across one Canadian province. This study's purpose was to identify coalition factors enabling medicine and emergency department (ED) physicians to lead, participate and influence appropriate BUN test ordering. METHODS Using sequential explanatory mixed methods, intervention components were grouped as person focused or system focused. Quantitative phase/analyses included: monthly total and average of the BUN test for six hospitals (medicine programme and two EDs) were compared pre initiative and post initiative; a cost avoidance calculation and an interrupted time series analysis were performed (participants were divided into two groups: high (>50%) and low (<50%) BUN test reduction based on these findings). Qualitative phase/analyses included: structured virtual interviews with 12 physicians/participants; a content analysis aligned to the Theoretical Domains Framework and the Behaviour Change Wheel. Quotes from participants representing high and low groups were integrated into a joint display. RESULTS Monthly BUN test ordering was significantly reduced in 5 of 6 participating hospital medicine programmes and in both EDs (33% to 76%), resulting in monthly cost avoidance (CAN$900-CAN$7285). Physicians had similar perceptions of the coalition's characteristics enabling their QI involvement and the factors influencing BUN test reduction. CONCLUSIONS To enable physician confidence to lead and participate, the coalition used the following: a simply designed QI initiative, partnership with a coalition physician leader and/or member; credibility and mentorship; support personnel; QI education and hands-on training; minimal physician effort; and no clinical workflow disruption. Implementing person-focused and system-focused intervention components, and communication from a trusted local physician-who shared data, physician QI initiative role/contribution and responsibility, best practices, and past project successes-were factors influencing appropriate BUN test ordering.
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Affiliation(s)
- Pamela Mathura
- Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton Zone Medicine, Edmonton, Alberta, Canada
| | - Sandra Marini
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Reidar Hagtvedt
- Alberta School of Business, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Spalding
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Lenora Duhn
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Narmin Kassam
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Medves
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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15
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Ahamad A, Guglielmo J. A historical perspective on diversity in Clinical Laboratory Sciences Programs. Lab Med 2023; 54:e70-e76. [PMID: 36282278 DOI: 10.1093/labmed/lmac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE Diversity is integral for an effective learning environment and pedagogy. In this study, we aim to determine the student and faculty diversity in the Clinical Laboratory Sciences programs at Stony Brook University. METHODS We retrospectively analyzed data over 20 years for the traditional program and 8 years for the hybrid program. RESULTS Over 20 years, 502 students graduated from the traditional program, and 96 students graduated from the hybrid program. In the traditional program, an average of 25 students enrolled with 75% female and 25% male and in the hybrid program, an average of 12 students with 8.5 female and 3.5 male enrolled. The traditional program had the highest proportion of Asian students (50%), with White students making up 24.5%, whereas the highest proportions in the hybrid program were 35% White students and 24% Hispanic students. Among the 5 boroughs of New York City, the highest proportion of student representation was from Queens and Manhattan in both traditional (24.1%) and hybrid programs (16.7%). There were 30% male and 70% female faculty served in the traditional program whereas the current representation of fulltime faculty is 100% female. CONCLUSION Our data show the diversity of students and faculty in clinical laboratory sciences programs at Stony Brook University institution.
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Affiliation(s)
- Afrinash Ahamad
- Clinical Laboratory Sciences Program, School of Health Professions, Stony Brook University, Stony Brook, NY
- Department of Neuroscience and Behavior, Stony Brook University, Stony Brook, NY
- Department of Clinical Microbiology, NYU Langone Hospital, New York, NY
| | - Jeannie Guglielmo
- Clinical Laboratory Sciences Program, School of Health Professions, Stony Brook University, Stony Brook, NY
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16
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Conrad ZA, Salazar AP, Akers A, Jodlowski TZ, Wang L, Drechsler H, Storey DF, Arasaratnam RJ. Impact of an Educational and Laboratory Stewardship Intervention on Inpatient COVID-19 Therapeutics at a Veterans Affairs Medical Center. Fed Pract 2023; 40:146-151. [PMID: 37727509 PMCID: PMC10506492 DOI: 10.12788/fp.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Background Accurate and timely prescriptions of COVID-19 therapeutics, laboratory testing, and antimicrobial stewardship have been a challenge throughout the pandemic as new evidence emerges. While universal consultation with infectious disease specialists on patients admitted with COVID-19 is desirable, it is not always feasible due to limited resources. Observations In this single-center study, we implemented a combined educational and laboratory stewardship intervention geared toward hospitalist practitioners resulting in improved accuracy of remdesivir and dexamethasone prescriptions, reduced laboratory use of blood cultures, interleukin 6 assay, and Legionella sputum cultures, and a decrease in antibiotic use for patients with mild-to-moderate oxygen requirements over 6 months. These improvements were seen in tandem with decreased reliance on infectious disease consultation. Conclusions These efforts support proof of the principle of combined educational and laboratory stewardship interventions to improve the care of COVID-19 patients, especially where infectious disease consultation may not be available or is accessed remotely.
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Affiliation(s)
- Zane A Conrad
- University of Texas Southwestern Medical Center, Dallas
| | | | | | | | - Li Wang
- University of Texas Southwestern Medical Center, Dallas
| | - Henning Drechsler
- University of Texas Southwestern Medical Center, Dallas
- Dallas Veterans Affairs Medical Center, Texas
| | - Donald F Storey
- University of Texas Southwestern Medical Center, Dallas
- Dallas Veterans Affairs Medical Center, Texas
| | - Reuben J Arasaratnam
- University of Texas Southwestern Medical Center, Dallas
- Dallas Veterans Affairs Medical Center, Texas
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Park M, Kim YJ, Jung D, Kim Y, Kim HM, Lee Y, Choi IY. Quality improvement of outpatient clinical chemistry tests through a novel middleware-laboratory information system solution. Clin Biochem 2023; 113:21-28. [PMID: 36603804 DOI: 10.1016/j.clinbiochem.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Rapid and accurate laboratory tests are essential to support clinical decision-making. Despite the various efforts to control quality in the laboratory, our outpatient chemistry turnaround time (TAT) has deteriorated since 2018. Moreover, these difficulties have accelerated further due to the COVID-19 pandemic. Therefore, we aimed to improve laboratory work efficiency by identifying and eliminating the causes of reduced laboratory work efficiency. DESIGN & METHODS We surveyed to identify tasks that reduce work efficiency. Based on our survey, a new-concept of work assistance middleware linked to laboratory information system (LIS) was developed. The middleware supports test end-time prediction, automatic real-time TAT monitoring, and urgent test requests so that medical technologists can focus on their chemistry tests. The developed middleware was used for 6 months in laboratory and outpatient clinics, and its effectiveness was evaluated. RESULTS The median TAT for outpatient chemistry tests was reduced by 6.6 min, from 72.4 min to 65.8 min. And not only did the maximum TAT for the sample decrease from 353 min to 214 min, but the proportion of samples exceeding the TAT target (120 min) also decreased by 77%; from 2.00% in 2010 (1,905 out of 94,989 samples) to 0.46% in 2021 (453 out of 98,117 samples). 2,199 samples were urgently requested through middleware, and they were processed about 15% faster than other samples, effectively performing urgent tests. The test end-time prediction showed an error of 8.6 min in the evaluation using the MAE (Mean Absolute Error) index. CONCLUSIONS Through this study, the quality and efficiency of the laboratory were improved, and while reducing the workload of medical staff, it contributed to enhancing patient safety and satisfaction.
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Affiliation(s)
- Minwoo Park
- Department of Laboratory Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do 16247, Republic of Korea
| | - Young-Jin Kim
- H.A.S. Inc., 24, Yeonje-ro, Yeonje-gu, Busan 47605, Republic of Korea
| | - Dawoon Jung
- Department of Mathematics, Pusan National University, 2, Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan 46241, Republic of Korea
| | - Yeongsic Kim
- Department of Laboratory Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do 16247, Republic of Korea
| | - Hyun-Min Kim
- National Institute for Mathematical Sciences, 70, Yuseong-daero 1689beon-gil, Yuseong-gu, Daejeon 34047, Republic of Korea
| | - Youjin Lee
- Department of Mathematics, Pusan National University, 2, Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan 46241, Republic of Korea.
| | - In Young Choi
- The Catholic University of Korea, College of Medicine, Catholic University of Korea Songeui Campus, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea.
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18
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Hernandez I, He M, Guo J, Tadrous M, Gabriel N, Swabe G, Gellad WF, Essien UR, Saba S, Benjamin EJ, Magnani JW. COVID-19 pandemic and trends in new diagnosis of atrial fibrillation: A nationwide analysis of claims data. PLoS One 2023; 18:e0281068. [PMID: 36730318 PMCID: PMC9894497 DOI: 10.1371/journal.pone.0281068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/15/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with a five-fold increased risk of stroke and a two-fold increased risk of death. We aimed to quantify changes in new diagnoses of AF following the onset of the COVID-19 pandemic. Investigating changes in new diagnoses of AF is of relevance because delayed diagnosis interferes with timely treatment to prevent stroke, heart failure, and death. METHODS Using De-identified Optum's Clinformatics® Data Mart, we identified 19,500,401 beneficiaries continuously enrolled for 12 months in 2016-Q3 2020 with no history of AF. The primary outcome was new AF diagnoses per 30-day interval. Secondary outcomes included AF diagnosis in the inpatient setting, AF diagnosis in the outpatient setting, and ischemic stroke as initial manifestation of AF. We constructed seasonal autoregressive integrated moving average models to quantify changes in new AF diagnoses after the onset of the COVID-19 pandemic (3/11/2020, date of pandemic declaration). We tested whether changes in the new AF diagnoses differed by race and ethnicity. RESULTS The average age of study participants was 51.0±18.5 years, and 52% of the sample was female. During the study period, 2.7% of the study sample had newly-diagnosed AF. New AF diagnoses decreased by 35% (95% CI, 21%-48%) after the onset of the COVID-19 pandemic, from 1.14 per 1000 individuals (95% CI, 1.05-1.24) to 0.74 per 1000 (95% CI, 0.64 to 0.83, p-value<0.001). New AF diagnoses decreased by 37% (95% CI, 13%- 55%) in the outpatient setting and by 29% (95% CI, 14%-43%) in the inpatient setting. The decrease in new AF diagnoses was similar across racial and ethnic subgroups. CONCLUSION In a nationwide cohort of 19.5 million individuals, new diagnoses of AF decreased substantially following the onset of the COVID-19 pandemic. Our findings evidence pandemic disruptions in access to care for AF, which are concerning because delayed diagnosis interferes with timely treatment to prevent complications.
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Affiliation(s)
- Inmaculada Hernandez
- Division of Clinical Pharmacy, University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California, United States of America
- * E-mail:
| | - Meiqi He
- Division of Clinical Pharmacy, University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California, United States of America
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, United States of America
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Nico Gabriel
- Division of Clinical Pharmacy, University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California, United States of America
| | - Gretchen Swabe
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Walid F. Gellad
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System Pittsburgh, Pennsylvania, United States of America
| | - Utibe R. Essien
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System Pittsburgh, Pennsylvania, United States of America
| | - Samir Saba
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Emelia J. Benjamin
- Department of Medicine, Boston Medical Center and Boston University Department of Medicine, Chobanian and Avedisian School of Medicine, and Department of Epidemiology, School of Public Health, Boston, Massachusetts, United States of America
| | - Jared W. Magnani
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
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19
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Kalaiselvan P, Yingchoncharoen P, Thongpiya J, Motes A, Nugent K. COVID-19 Infections and Inflammatory Markers in Patients Hospitalized During the First Year of the Pandemic. J Prim Care Community Health 2023; 14:21501319231206911. [PMID: 37864436 PMCID: PMC10590050 DOI: 10.1177/21501319231206911] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/05/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The clinical presentations in patients with SARS-CoV-2 (COVID-19) infections range from asymptomatic upper respiratory infections to acute respiratory failure with bilateral pulmonary infiltrates requiring mechanical ventilation. Clinicians often measured inflammatory markers in hospitalized patients to characterize the severity of the infection. Multiple studies published in 2020 reported information on the frequency of elevated inflammatory markers in hospitalized patients in various categories of disease severity. METHODS The PubMed database was searched using the terms "Inflammatory markers in COVID-19 patients" and "Clinical features of patients infected with COVID-19." Thirty-three publications were analyzed in detail to determine which inflammatory markers were increased and the frequency of these increases in various clinical classifications, including patients requiring hospitalization, patients with pneumonia, patients with severe infection, patients requiring intensive care unit admission, and patients who died. RESULTS C-reactive protein (CRP) was the most frequently elevated inflammatory marker in all categories. Ferritin, D-dimer, and erythrocyte sedimentation rate levels were also frequently elevated. In general, frequencies were higher in patients with more severe infections. For example, 24 out of 24 patients who died had an elevated CRP level. CONCLUSION This review provides concrete information about the frequency of various inflammatory markers in patients with COVID-19 infection who required hospitalization. It also provides us some insight into the approach clinicians took in the early phase of this pandemic in their efforts to characterize these patients and perhaps understand the disease process better. However, these results might suggest that clinicians and laboratory directors should develop protocols to optimize laboratory testing.
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Affiliation(s)
| | | | | | - Arunee Motes
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kenneth Nugent
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
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20
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Cohen R, Martinón-Torres F, Posiuniene I, Benninghoff B, Oh KB, Poelaert D. The Value of Rotavirus Vaccination in Europe: A Call for Action. Infect Dis Ther 2023; 12:9-29. [PMID: 36355309 PMCID: PMC9647247 DOI: 10.1007/s40121-022-00697-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/08/2022] [Indexed: 11/12/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has pushed many healthcare systems into crisis. High vaccine coverage amongst children reduces emergency room presentations, hospital admissions and deaths due to vaccine-preventable diseases, freeing up healthcare resources including polymerase chain reaction testing for patients with SARS-CoV-2. In Europe, rotavirus gastroenteritis leads to 75,000-150,000 hospitalisations and up to 600,000 medical encounters annually. Nevertheless, in 2022, only 18 countries in Europe (out of 38) have a publicly funded routine universal mass immunisation programme against rotavirus gastroenteritis. Evidence available in the last few years re-emphasises that rotavirus vaccines currently available in Europe are highly effective, preventing up to 96% of rotavirus-related hospitalisations in children less than 1 year of age (potentially 72,000-144,000 hospitalisations Europe-wide). Long-term surveillance indicates that rotavirus vaccination does not result in an overall increase in intussusception. On the contrary, increasing evidence suggests an overall reduction in intussusception in the first 12 months of life when early, high rotavirus vaccine coverage is achieved. Prevention of rotavirus gastroenteritis has marked positive impacts on parental wages and government tax revenue, with benefits extending across the whole economy. In the SARS-CoV-2 pandemic setting there is a new imperative to achieve high levels of paediatric vaccination against vaccine-preventable diseases, including rotavirus gastroenteritis. The introduction of rotavirus universal mass vaccination can be expected to reduce the number of preventable illnesses, hospitalisations and deaths caused by rotavirus gastroenteritis. Reducing vaccine-preventable diseases is particularly urgent at this time when healthcare systems are preoccupied and overwhelmed with SARS-CoV-2. Graphical abstract available for this article.
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Affiliation(s)
- Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France ,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France ,Clinical Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, France ,Université Paris Est, Mondor Institute of Biomedical Research-Groupement de Recherche Clinique Groupe d’étude de Maladies Infectieuses Néonatales Et Infantiles, Créteil, France ,Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain ,Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain ,Centro de Investigación Biomédica en Enfermedades Respiratorias (CIBERES), Instituto Carlos III, Madrid, Spain
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Richter TA, Wilkinson CD, Griffiths BB, Hunter RG. Pipette Olympics: An Engaging Exercise for Undergraduate Laboratory Training. JOURNAL OF UNDERGRADUATE NEUROSCIENCE EDUCATION : JUNE : A PUBLICATION OF FUN, FACULTY FOR UNDERGRADUATE NEUROSCIENCE 2022; 21:A81-A84. [PMID: 38322045 PMCID: PMC10558238 DOI: 10.59390/noyq7921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 02/08/2024]
Abstract
Pipetting is an important technique used in almost every molecular neuroscience method including but not limited to, PCR, reverse transcription, immunohistochemistry, chromatin immunoprecipitation, and cell culture. The COVID-19 pandemic has robbed the undergraduate population of time to practice in person laboratory techniques. In response, we have devised a standardized, quick, and fun way to instruct students on the fundamentals of pipetting, serial dilutions, and basic statistical analysis. Here, we offer a standardized protocol for instructors to use to teach undergraduates valuable skills while providing friendly competition. We also offer an example of an undergraduate performing the steps of this protocol with example results and the results from three separate undergrads' first two attempts. This exercise provides laboratories with a method to reintroduce undergraduates to lab basics while standardizing the training thereby saving time lost to the pandemic.
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Affiliation(s)
- Troy A Richter
- Psychology Department, University of Massachusetts Boston, Boston, MA 02125
| | - Cooper D Wilkinson
- Psychology Department, University of Massachusetts Boston, Boston, MA 02125
| | - Brian B Griffiths
- Psychology Department, University of Massachusetts Boston, Boston, MA 02125
| | - Richard G Hunter
- Psychology Department, University of Massachusetts Boston, Boston, MA 02125
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22
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Lasierra Monclús AB, González Á, Bernabéu Andreu FA, Caballé Martín I, Buño Soto A, Ibarz M, González Rodríguez C, Puzo Foncillas J. Effects of the COVID-19 pandemic on the activity of clinical laboratories in Spain, evolution in the 2019-2021 period. ADVANCES IN LABORATORY MEDICINE 2022; 3:361-382. [PMID: 37363429 PMCID: PMC10197302 DOI: 10.1515/almed-2022-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/12/2022] [Indexed: 06/28/2023]
Abstract
Objectives To assess the impact of the COVID-19 pandemic on the activity of clinical laboratories in Spain. Methods A descriptive, observational, retrospective, multicenter study. Results Between March and December 2020, there was a statistically significant decrease in the number of test requests (-17.7%, p=<0.001) and total tests performed (-18.3%, p<0.001) with respect to the same period in 2019. A decrease was observed in the number of requests from primary care (-37.4%) (p<0.001) and in the number of foecal occult blood (-45.8%); qualitative urine (-30.1%); PSA (-28.5%); TSH (-27.8%); total cholesterol (-27.2%) and HbA1c (-24.7%) tests performed, p<0.001. A significant increase was found in the number of requests from ICUs (76.6%, p<0.001) and number of IL-6 (+22,350.9), D-dimer (+617.2%), troponin (+46.8%) and arterial blood gas (+3.9%) tests carried out, p<0.001. During the first months of 2021, there were significant changes in the number of requests for qualitative urine (-8.7%, p<0.001), PSA (-6.3%, p=0.009), IL-6 (+66,269.2, p<0.001), D-dimer (+603.6%, p<0.001), troponin (+28.7%, p<0.001), arterial blood gas (+26,2%, p=0.014) and ferritin (+16.0%, p=0.002) tests performed. Conclusions There were changes in the origin and number of test requested to clinical laboratories in Spain. The number of requests for the evaluation and monitoring of COVID-19 patients increased, whereas requests for the control of non-COVID patients and for population screening decreased. Long-term analysis reveals that the volume of tests performed for the control of chronic diseases returned to normal over time, whereas the increase observed in the volume of tests performed for the management of COVID-19 patients is maintained.
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Affiliation(s)
| | - Álvaro González
- Service of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | - Antonio Buño Soto
- Service of Clinical Analysis, Hospital Universitario La Paz, Madrid, Spain
| | - Mercè Ibarz
- Service of Clinical Analysis, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | | | - José Puzo Foncillas
- Service of Clinical Analysis and Biochemistry, Hospital Universitario San Jorge, Huesca, Spain
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Lin DC, Parakati I, Haymond S. The Impact of COVID-19 on Laboratory Test Utilization at a Pediatric Medical Center. J Appl Lab Med 2022; 7:1076-1087. [PMID: 35723285 PMCID: PMC9384293 DOI: 10.1093/jalm/jfac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The epidemiology and clinical manifestation of coronavirus disease 2019 (COVID-19) in the pediatric population is different from the adult population. The purpose of this study is to identify effects of the COVID-19 pandemic on laboratory test utilization in a pediatric hospital.
Methods
We performed retrospective analysis on test utilization data from Ann & Robert H. Lurie Children’s Hospital of Chicago, an academic pediatric medical center. Data between two 100-day periods prior to (prepandemic) and during the pandemic (mid-pandemic) were analyzed to evaluate changes in test volume, lab utilization, and test positivity rate. We also evaluated these metrics based on in- vs outpatient testing and performed modeling to determine what variables significantly impact the test positivity rate.
Results
During the pandemic period, there was an expected surge in COVID-19 testing, while over 84% of lab tests studied decreased in ordering volume. The average number of tests ordered per patient was not significantly different during the pandemic for any of the laboratories (adjusted P value > 0.05). Thirty-three studied tests showed significant change in positivity rate during the pandemic. Linear modeling revealed test volume and inpatient status as the key variables associated with change in test positivity rate.
Conclusions
Excluding severe acute respiratory syndrome coronavirus 2 tests, the COVID-19 pandemic has generally led to decreased test ordering volume and laboratory utilization. However, at this pediatric hospital, the average number of tests performed per patient and test positivity rates were comparable between pre- and mid-pandemic periods. These results suggest that, overall, clinical test utilization at this site remained consistent during the pandemic.
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Affiliation(s)
- David C Lin
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, IL , USA
- Northwestern University, Feinberg School of Medicine, Department of Pathology , Chicago, IL , USA
| | - Isaac Parakati
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, IL , USA
| | - Shannon Haymond
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, IL , USA
- Northwestern University, Feinberg School of Medicine, Department of Pathology , Chicago, IL , USA
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Lab practices that improve coronavirus disease 2019 detection accuracy using real-time PCR. INT J EVID-BASED HEA 2022; 20:172-179. [PMID: 35981309 PMCID: PMC9593322 DOI: 10.1097/xeb.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The number of coronavirus disease 2019 (COVID-19) cases significantly increased with the emergence of multiple variants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This has led to an ongoing effort focused on developing the diagnostic detection tests. Among the currently available tests, real-time reverse transcriptase PCR (RT-PCR) has been considered as the ‘golden method’ for the detection of SARS-COV-2. However, a significant number of inaccurate (false-negative/false-positive) results have been reported in spite of this method's reliability and effectiveness. These unreliable results may arise because of various issues encountered throughout the entire testing process starting with the sampling phase, going through the PCR process, and ending with the result analysis. This article aims to shed light on the errors that occur during the COVID-19 testing process and suggest ways to overcome them effectively. Accurate testing could be optimized by following the correct swabbing technique, using adequate RT-PCR kits and controls, setting clear lab guidelines, and properly interpreting the results.
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Mukhopadhyay T, Kumar N, Pandey S, Subramanian A, Madaan N, Malhotra R. Variation in Laboratory Utilization and Correlation with Hospital Bed Utilization: Experience of a Trauma-Care Hospital during the COVID-19 Pandemic. J Lab Physicians 2022; 14:210-217. [PMID: 35982878 PMCID: PMC9381313 DOI: 10.1055/s-0041-1739540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objectives The present study was planned with the following objectives: (i) to calculate the difference in frequency of laboratory test ordered and use of consumables between the prepandemic and pandemic phases, (ii) to determine and compare the monthly average number of tests ordered per patient between the prepandemic and pandemic phases, and (iii) to correlate the monthly test ordering frequency with the monthly bed occupancy rate in both phases. Materials and Methods Records of laboratory tests ordered and use of consumables were collected for the prepandemic phase (1.8.2019 to 31.3.2020) and the pandemic phase (1.4.2020 to 31.10.2020). The absolute and relative differences were calculated. Monthly average number of tests ordered per patient and bed occupancy rate between prepandemic and pandemic phases was determined, compared, and correlated. Statistical Analysis The absolute and the relative differences between the two periods were calculated. The continuous variables were analyzed between groups using Mann-Whitney U test. Spearman correlation was used to correlate the monthly test ordering frequency with the monthly bed occupancy rate in both phases. Results A total of 946,421 tests were ordered, of which 370,270 (39%) tests were ordered during the pandemic period. There was a decrease in the number of the overall laboratory tests ordered (12%), and in the use of blood collection tubes (34%), and an increase in the consumption of sanitizers (18%), disinfectants (3%), masks (1633%), and gloves (7011%) during the pandemic period. Also, the monthly average number of tests ordered per patients significantly reduced ( p -value < 0.001). Test ordering frequency had strong positive correlation with bed occupancy rate during pandemic (Spearman co-efficient = 0.73, p -value = 0.03). Conclusions An overall decline in laboratory utilization during pandemic period was observed. Understanding and correlating the trends with hospital bed utilization can maximize the productivity of the laboratory and help in better preparedness for the challenges imposed during similar exigencies.
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Affiliation(s)
- Tapasyapreeti Mukhopadhyay
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Narinder Kumar
- Department of Hospital Administration, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Arulselvi Subramanian
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Nirupam Madaan
- Department of Hospital Administration, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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26
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Chuang HN, Shih CH, Tsai HW, Jiang RS, Hsiao TH, Liu PY, Jan YJ, Wang JM. Laboratory Surge Response to the COVID-19 Pandemic: An Incident Command System Approach. J Multidiscip Healthc 2022; 15:1083-1088. [PMID: 35586076 PMCID: PMC9109728 DOI: 10.2147/jmdh.s358096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Han-Ni Chuang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, 407204, Taiwan
| | - Chien-Hung Shih
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, 407204, Taiwan
| | - Hung-Wen Tsai
- Medical Administration Department, Taichung Veterans General Hospital, Taichung, 47204, Taiwan
| | - Rong-San Jiang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, 407204, Taiwan
| | - Tzu-Hung Hsiao
- Medical Administration Department, Taichung Veterans General Hospital, Taichung, 47204, Taiwan
- Department of Public Health, Fu Jen Catholic University, New Taipei City, 24205, Taiwan
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, 40227, Taiwan
| | - Po-Yu Liu
- Division of Infection, Taichung Veterans General Hospital, Taichung, 47204, Taiwan
| | - Yee-Jee Jan
- Department of Pathology & Laboratory Medicine, Taichung Veterans General Hospital, Taichung, 407, Taiwan
- Correspondence: Yee-Jee Jan; Jiunn-Min Wang, Department of Pathology & Laboratory Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, Tel +886-4-23592525, Fax +886-4-2359-5046, Email ;
| | - Jiunn-Min Wang
- Department of Pathology & Laboratory Medicine, Taichung Veterans General Hospital, Taichung, 407, Taiwan
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Evaluation of Pre-Analytical and Analytical Methods for Detecting SARS-CoV-2 in Municipal Wastewater Samples in Northern Italy. WATER 2022. [DOI: 10.3390/w14050833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
(1) Background: The surveillance of SARS-CoV-2 RNA in urban wastewaters allows one to monitor the presence of the virus in a population, including asymptomatic and symptomatic individuals, capturing the real circulation of this pathogen. The aim of this study was to evaluate the performance of different pre-analytical and analytical methods for identifying the presence of SARS-CoV-2 in untreated municipal wastewaters samples by conducting an inter-laboratory proficiency test. (2) Methods: three methods of concentration, namely, (A) Dextran and PEG-6000 two-phase separation, (B) PEG-8000 precipitation without a chloroform purification step and (C) PEG-8000 precipitation with a chloroform purification step were combined with three different protocols of RNA extraction by using commercial kits and were tested by using two primers/probe sets in three different master mixes. (3) Results: PEG-8000 precipitation without chloroform treatment showed the best performance in the SARS-CoV-2 recovery; no major differences were observed among the protocol of RNA extraction and the one-step real-time RT-PCR master mix kits. The highest analytic sensitivity was observed by using primers/probe sets targeting the N1/N3 fragments of SARS-CoV-2. (4) Conclusions: PEG-8000 precipitation in combination with real-time RT-PCR targeting the N gene (two fragments) was the best performing workflow for the detection of SARS-CoV-2 RNA in municipal wastewaters.
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Church DL, Naugler C. Using a systematic approach to strategic innovation in laboratory medicine to bring about change. Crit Rev Clin Lab Sci 2022; 59:178-202. [DOI: 10.1080/10408363.2021.1997899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Deirdre L. Church
- Departments of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Departments of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Christopher Naugler
- Departments of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Departments of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Ravi V, Chakrabarti A, Wattal C, Raveendran R. COVID-19: a boon or a bane for the microbiologists. Indian J Med Microbiol 2022; 40:7-11. [PMID: 35063300 PMCID: PMC8767984 DOI: 10.1016/j.ijmmb.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND In the situation where COVID-19 pandemic has placed unprecedented demands and pressure on the health care system, we wanted to analyze how the medical microbiologists of our country were affected. Was it actually an opportunity to showcase the specialty or was it a doom? A debate was organized as a key session in the national e-conference of the Indian Association of Medical Microbiologists, held on 10 December 2020. OBJECTIVES The objective of the debate was to examine and analyze the various positive as well as negative impacts of COVID-19 on the discipline of the medical microbiology of our country. CONTENT Before the debate a voting session was conducted to assess the opinion of the audience followed by a very interesting debate where both the speakers presented their view points. The points in favor of the discipline were, mainly up-gradation of the specialty of microbiology in terms of learning, skill development, infrastructure, networking & research opportunities related to COVID-19. While the main points against were, nerve wracking work load without much acknowledgement, performance pressure from hospital administration to maintain rapid turnaround time, and a forceful neglect of all other infectious diseases like tuberculosis and antimicrobial resistance which were the key battle fields of the medical microbiologists. Postgraduate & even undergraduate training programs got completely derailed to their disadvantage. By the end of the debate, it was concluded that COVID-19 was neither a boon nor a bane to the microbiologists. A balanced approach to the problem in hand is required without ignoring the pre-existing infectious diseases in our country. The post debate voting swayed the audience considerably for it to be a bane & the faculty debating for boon had a huge margin to begin with but finally won with a whisker indicating the intensity of the debate.
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Affiliation(s)
- Vasanthapuram Ravi
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bengaluru, India.
| | | | - Chand Wattal
- Department of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India.
| | - Reena Raveendran
- Department of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India.
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30
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Nagy E, Infantino M, Bizzaro N, Andreeva H, Bontkes HJ, Bossuyt X, Fabien N, Fischer K, Heijnen IAFM, Herold M, Kozmar A, Kuhi L, López-Hoyos M, Pullerits R, Sousa MJR, Tsirogianni A, Damoiseaux J. The impact of the COVID-19 pandemic on autoimmune diagnostics in Europe: A lesson to be learned. Autoimmun Rev 2021; 20:102985. [PMID: 34718167 PMCID: PMC8552636 DOI: 10.1016/j.autrev.2021.102985] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The first wave of COVID-19 pandemic has disrupted almost all areas of the health care services to some extent throughout the world. Although the negative impact of COVID-19 on patients with autoimmune diseases has also been recognized, available data in this regard are limited. In the current study of the European Autoimmunity Standardisation Initiative (EASI) we aimed to provide reliable data on the extent of the impact of COVID-19 pandemic on test requests for different autoantibodies in European countries. METHODS Data on test numbers and on the number of positive results were collected in 97 clinical laboratories from 15 European countries on a monthly basis for the year before (2019) and the year during (2020) the COVID-19 pandemic. RESULTS A reduction in the number of autoantibody tests was observed in all European countries in the year 2020 compared to 2019. The reduction affected all autoantibody tests with an overall decrease of 13%, ranging from 1.4% (Switzerland) to 25.5% (Greece). In all countries, the decrease was most pronounced during the first wave of the pandemic (March-May 2020) with an overall decrease in those three months of 45.2%. The most affected autoantibodies were those commonly requested by general practitioners (anti-tTG IgA (-71%), RF IgM (-66%) and ACPA (-61%)). In the second wave of the pandemic (October-December 2020) the decrease was less pronounced (6.8%). With respect to the rate of positive results, subtle differences were observed for distinct autoantibodies during the pandemic, but the total rate of positive results was similar in both years. CONCLUSIONS Our study demonstrated a strong decrease in autoantibody requests during the first wave of the COVID-19 pandemic in 15 European countries. The second wave was characterized by a less pronounced impact, with some participating countries hardly affected, while some other countries experienced a second decline. The decrease was clearly associated with the level of lock-down and with the required adjustments in the health care systems in different countries, supporting the importance of an effective strategy for the coordination of autoimmune testing in challenging situations as the COVID-19 pandemic.
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Affiliation(s)
- Eszter Nagy
- National Institute of Locomotor diseases and Disabilities, Budapest, Hungary; Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary.
| | - Maria Infantino
- Immunologia Allergologia, Dipartimento di Medicina di Laboratorio, Ospedale San Giovanni di Dio Azienda, Usl Toscana Centro, Florence, Italy
| | - Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale San Antonio (Tolmezzo), Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Hristina Andreeva
- Division of Immunology and Transfusion Medicine, Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Hetty J Bontkes
- Department of Clinical Chemistry, Medical Immunology Laboratory, Amsterdam Infection & Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Xavier Bossuyt
- Department of Microbiology, Immunology and Transplantation, KU Leuven and Laboratory Medicine, University Hospital Leuven, Belgium
| | - Nicole Fabien
- Department of Immunology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Katarzyna Fischer
- Individual Laboratory for Rheumatologic Diagnostics, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Ingmar A F M Heijnen
- Medical Immunology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Manfred Herold
- Medical University of Innsbruck, Department of Internal Medicine II, Rheumatology Laboratory, Innsbruck, Austria
| | - Ana Kozmar
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Liisa Kuhi
- Central Laboratory, East Tallinn Central Hospital, Tallinn, Estonia
| | - Marcos López-Hoyos
- Servicio de Inmunología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad Cantabria, Santander, Spain
| | - Rille Pullerits
- The Sahlgrenska Academy at University of Gothenburg, Institution of Medicine, Department of Rheumatology and Inflammation Research, Gothenburg, Sweden; Sahlgrenska University Hospital, Department of Clinical Immunology and Transfusion Medicine, Gothenburg, Sweden
| | | | - Alexandra Tsirogianni
- Immunology-Histocompatibility Department, "Evangelismos" General Hospital of Athens, Greece
| | - Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
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Ferraro S, Biganzoli EM. The clinical value of assessing the inter-method bias: the lesson from prostate specific antigen measurement. Clin Chem Lab Med 2021; 60:149-151. [PMID: 34751521 DOI: 10.1515/cclm-2021-1125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Simona Ferraro
- Department of Laboratory Medicine in Endocrinology Laboratory Unit, "Luigi Sacco" University Hospital, Milan, Italy
| | - Elia Mario Biganzoli
- Department of Biomedical and Clinical Sciences L. Sacco, Medical Statistics Unit, "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
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Phamduy TT, Smith S, Herbst KW, Phamduy PT, Brimacombe M, Hogan AH, Salazar JC, Sturm J. Kawasaki Disease Hospitalizations in the United States 2016-2020: A Comparison of Before and During the Coronavirus Disease 2019 Era. Pediatr Infect Dis J 2021; 40:e407-e412. [PMID: 34382611 PMCID: PMC8505141 DOI: 10.1097/inf.0000000000003289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is an acute vasculitis of young children. A comparison of US hospitalization rates and epidemiologic features of KD in 2020 to those of precoronavirus disease years has yet to be reported. METHODS Using a large, inpatient database, we conducted a retrospective cohort study and analyzed data for patients with (1) diagnosis coding for KD, (2) IV immunoglobulin treatment administered during hospitalization and (3) discharge date between January 1, 2016, and December 30, 2020. Severe cases were defined as those requiring adjunctive therapy or IV immunoglobulin-resistant therapy. RESULTS The annual number of KD hospitalizations were stable from 2016 to 2019 (n = 1652, 1796, 1748, 1692, respectively) but decreased in 2020 (n = 1383). KD hospitalizations demonstrated seasonal variation with an annual peak between December and April. A second peak of KD admissions was observed in May 2020. The proportion of KD cases classified as severe increased to 40% in 2020 from 33% during the years 2016-2019 (P < 0.01). Median age in years increased from 2.9 in subjects hospitalized from 2016 to 2019 to 3.2 in 2020 (P = 0.002). CONCLUSIONS Compared with the previous 4 years, the annual number of pediatric KD admissions decreased, and children discharged with diagnostic codes for KD in 2020 were generally older and more likely to have severe morbidity possibly reflective of misdiagnosed multisystem inflammatory syndrome in children. Clinicians should be wary of a possible rise in KD rates in the postcoronavirus disease 2019 era as social distancing policies are lifted and other viruses associated with KD return.
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Affiliation(s)
- Timothy T. Phamduy
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Sharon Smith
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
- Division of Emergency Medicine, Connecticut Children’s Medical Center
| | | | - Paul T. Phamduy
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
- Division of Emergency Medicine, Connecticut Children’s Medical Center
- Division of Research, Connecticut Children’s Medical Center
- Division of Pediatric Hospital Medicine, Connecticut Children’s Medical Center
- Division of Pediatric Infectious Diseases and Immunology, Connecticut Children’s Medical Center, Hartford, Connecticut
| | | | - Alexander H. Hogan
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
- Division of Pediatric Hospital Medicine, Connecticut Children’s Medical Center
| | - Juan C. Salazar
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
- Division of Pediatric Infectious Diseases and Immunology, Connecticut Children’s Medical Center, Hartford, Connecticut
| | - Jesse Sturm
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
- Division of Emergency Medicine, Connecticut Children’s Medical Center
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Carbone T, Picerno V, Pafundi V, Esposito E, Leccese P, Padula AA, D'Angelo S. Impact of the COVID-19 Pandemic on the Appropriateness of Diagnostic Pathways of Autoimmune Rheumatic Diseases. J Rheumatol 2021; 49:219-224. [PMID: 34654735 DOI: 10.3899/jrheum.210611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Early diagnosis of autoimmune rheumatic diseases (ARDs) is key to achieving effective treatment and improving prognosis. The coronavirus disease 2019 (COVID-19) pandemic has led to major changes in clinical practice on a global scale. We aimed to evaluate the impact of the COVID-19 pandemic on rheumatological clinical practice and autoimmunity testing demands. METHODS Data regarding the first rheumatological visits and new diagnoses, together with the autoimmunity laboratory testing volumes related to the COVID-19 pandemic phase (January-December 2020), were collected from medical records and the laboratory information system of a regional reference hospital (Basilicata, Italy) and compared with those obtained during the corresponding period in 2019. RESULTS A significant decrease in the 2020 autoimmunity laboratory test volume was found when compared with the same period in 2019 (9912 vs 14,100; P < 0.05). A significant decrease in first rheumatological visits and diagnosis (1272 vs 2336; P < 0.05) was also observed. However, an equivalent or higher percentage of positive autoimmunity results from outpatient services was recorded during 2020 when compared to the prepandemic state. Of note, COVID-19-associated decline in new diagnoses affected mainly less severe diseases. In contrast, ARDs with systemic involvement were diagnosed at the same levels as in the prepandemic period. CONCLUSION The COVID-19 pandemic has affected access to health services. However, our study highlighted that during the outbreak, greater appropriateness of the requests for laboratory tests and visits emerged, as shown by a greater percentage of positive test results and new diagnoses of more severe ARDs compared to the prepandemic period.
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Affiliation(s)
- Teresa Carbone
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Valentina Picerno
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Vito Pafundi
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Ernesto Esposito
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Pietro Leccese
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Angela Anna Padula
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
| | - Salvatore D'Angelo
- T. Carbone, PhD, Laboratory of Clinical Pathology, Azienda Sanitaria di Matera (ASM), Matera; V. Picerno, MD, P. Leccese, MD, A.A. Padula, MD, S. D'Angelo, MD, PhD, Rheumatology Institute of Lucania - San Carlo Hospital, Potenza; V. Pafundi, MD, Immunopathology Laboratory, San Carlo Hospital, Potenza; E. Esposito, MD, Health Department, Basilicata Region, Potenza, Italy. T. Carbone and V. Picerno contributed equally. The authors declare no conflict of interests relevant to this article. Address correspondence to Dr. V. Pafundi, Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100 Potenza, Italy. . Accepted for publication September 30, 2021
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Mitra P, Misra S, Sharma P. Impact of COVID-19 on Clinical Biochemistry: Indian Scenario. Indian J Clin Biochem 2021; 36:385-386. [PMID: 34511753 PMCID: PMC8419656 DOI: 10.1007/s12291-021-01003-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Prasenjit Mitra
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
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Aisyah DN, Mayadewi CA, Igusti G, Manikam L, Adisasmito W, Kozlakidis Z. Laboratory Readiness and Response for SARS-Cov-2 in Indonesia. Front Public Health 2021; 9:705031. [PMID: 34350153 PMCID: PMC8326463 DOI: 10.3389/fpubh.2021.705031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
The laboratory diagnosis of SARS-CoV-2 infection comprises the informational cornerstone in the effort to contain the infections. Therefore, the ability to leverage laboratories' capacity in diagnostic testing and to increase the number of people being tested are critical. This paper reviews the readiness of Indonesian laboratories during the early months of the pandemic. It discusses the success of cross-sectoral collaboration among previously siloed national and sub-national government institutions, international development agencies, and private sector stakeholders. This collaboration managed to scale-up the COVID-19 referral laboratory network from one Ministry of Health NIHRD laboratory in the capital to 685 laboratories across 34 provinces. However, this rapid growth within 12 months since the first Indonesian case was discovered remained insufficient to cater for the constantly surging testing demands within the world's fourth most populous country. Reflecting on how other countries built their current pandemic preparedness from past emergencies, this paper highlights challenges and opportunities in workforce shortage, logistic distribution, and complex administration that need to be addressed.
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Affiliation(s)
- Dewi N. Aisyah
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
- Indonesia One Health University Network, Depok, Indonesia
| | | | - Gayatri Igusti
- Aceso Global Health Consultants Limited, London, United Kingdom
| | - Logan Manikam
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
- Aceso Global Health Consultants Limited, London, United Kingdom
| | - Wiku Adisasmito
- Indonesia One Health University Network, Depok, Indonesia
- Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Zisis Kozlakidis
- International Agency for Research on Cancer World Health Organization, Lyon, France
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Pearson LN, Johnson SA, Greene DN, Chambliss AB, Farnsworth CW, French D, Herman DS, Kavsak PA, Merrill AE, Lo SYM, Lyon ME, SoRelle JA, Schmidt RL. Side-Effects of COVID-19 on Patient Care: An INR Story. J Appl Lab Med 2021; 6:953-961. [PMID: 33760097 PMCID: PMC8083676 DOI: 10.1093/jalm/jfab025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/15/2021] [Indexed: 01/07/2023]
Abstract
Background Numerous studies have documented reduced access to patient care due to the COVID-19 pandemic including access to a diagnostic or screening tests, prescription medications, and treatment for an ongoing condition. In the context of clinical management for venous thromboembolism, this could result in suboptimal therapy with warfarin. We aimed to determine the impact of the pandemic on utilization of International normalized ratio (INR) testing and the percentage of high and low results. Methods INR data from 11 institutions were extracted to compare testing volume and the percentage of INR results ≥3.5 and ≤1.5 between a pre-pandemic period (January-June 2019, period 1) and a portion of the COVID-19 pandemic period (January-June 2020, period 2). The analysis was performed for inpatient and outpatient cohorts. Results Testing volumes showed relatively little change in January and February, followed by a significant decrease in March, April and May, and then returned to baseline in June. Outpatient testing showed a larger percentage decrease in testing volume compared to inpatient testing. At 10 of the 11 study sites we observed an increase in the percentage of abnormal high INR results as test volumes decreased, primarily among outpatients. Conclusion The COVID-19 pandemic impacted INR testing among outpatients which may be attributable to several factors. Increased supratherapeutic INR results during the pandemic period when there was reduced laboratory utilization and access to care is concerning because of the risk of adverse bleeding events in this group of patients. This could be mitigated in the future by offering drive through testing and/or widespread implementation of home INR monitoring.
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Affiliation(s)
- Lauren N Pearson
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Stacy A Johnson
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Dina N Greene
- Kaiser Permanente Washington, Washington, Renton, WA, USA
| | - Allison B Chambliss
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Deborah French
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel S Herman
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna E Merrill
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Martha E Lyon
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan, CA, USA
| | - Jeffrey A SoRelle
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert L Schmidt
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
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Singh IR, Dowlin M, Chong TH, Nakamoto JM, Hilborne LH. Changes in Test Volumes During Coronavirus Disease 2019 (COVID-19): A Laboratory Stewardship Opportunity. Arch Pathol Lab Med 2021; 145:821-824. [PMID: 33765119 DOI: 10.5858/arpa.2021-0058-sa] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Coronavirus disease 2019 (COVID-19) changed the dynamics of health care delivery, shifting patient priorities and deferring care perceived as less urgent. Delayed or eliminated care may place patients at risk for adverse outcomes. OBJECTIVE.— To identify opportunities for laboratory test stewardship to close potential gaps in care created by the COVID-19 pandemic. DESIGN.— The study was a retrospective time series design examining laboratory services received before and during the COVID-19 pandemic at a large metropolitan health system serving women and children. RESULTS.— Laboratory test volumes displayed 3 distinct patterns: (1) a decrease during state lockdown, followed by near-complete or complete recovery; (2) no change; and (3) a persistent decrease. Tests that diagnose or monitor chronic illness recovered only partially. For example, hemoglobin A1c initially declined 80% (from 2232 for April 2019 to 452 for April 2020), and there was a sustained 16% drop (28-day daily average 117 at August 30, 2019, to 98 at August 30, 2020) 4 months later. Blood lead dropped 39% (from 2158 for April 2019 to 1314 for April 2020) and remained 23% lower after 4 months. CONCLUSIONS.— The pandemic has taken a toll on patients, practitioners, and health systems. Laboratory professionals have access to data that can provide insight into clinical practice and identify pandemic-related gaps in care. During the pandemic, the biggest patient threat is underuse, particularly among tests to manage chronic diseases and for traditionally underserved communities and people of color. A laboratory stewardship program, focused on peri-pandemic care, positions pathologists and other laboratory professionals as health care leaders with a commitment to appropriate, equitable, and efficient care.
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Affiliation(s)
- Ila R Singh
- From the Department of Pathology and Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston (Singh, Dowlin, Chong)
| | - Michael Dowlin
- From the Department of Pathology and Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston (Singh, Dowlin, Chong)
| | - Thomas H Chong
- From the Department of Pathology and Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston (Singh, Dowlin, Chong)
| | | | - Lee H Hilborne
- the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Hilborne).,Quest Diagnostics, Secaucus, New Jersey (Hilborne)
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