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  • 1
    Online Resource
    Online Resource
    The burden of incidental SARS-CoV-2 infections in hospitalized patients across pandemic waves in Canada
    Springer Science and Business Media LLC ; 2023
    In:  Scientific Reports Vol. 13, No. 1 ( 2023-04-24)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2023-04-24)
    Abstract: Many health authorities differentiate hospitalizations in patients infected with SARS-CoV-2 as being “for COVID-19” (due to direct manifestations of SARS-CoV-2 infection) versus being an “incidental” finding in someone admitted for an unrelated condition. We conducted a retrospective cohort study of all SARS-CoV-2 infected patients hospitalized via 47 Canadian emergency departments, March 2020-July 2022 to determine whether hospitalizations with “incidental” SARS-CoV-2 infection are less of a burden to patients and the healthcare system. Using a priori standardized definitions applied to hospital discharge diagnoses in 14,290 patients, we characterized COVID-19 as (i) the “Direct” cause for the hospitalization (70%), (ii) a potential “Contributing” factor for the hospitalization (4%), or (iii) an “Incidental” finding that did not influence the need for admission (26%). The proportion of incidental SARS-CoV-2 infections rose from 10% in Wave 1 to 41% during the Omicron wave. Patients with COVID-19 as the direct cause of hospitalization exhibited significantly longer LOS (mean 13.8 versus 12.1 days), were more likely to require critical care (22% versus 11%), receive COVID-19-specific therapies (55% versus 19%), and die (17% versus 9%) compared to patients with Incidental SARS-CoV-2 infections. However, patients hospitalized with incidental SARS-CoV-2 infection still exhibited substantial morbidity/mortality and hospital resource use.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-023-33569-2
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2615211-3
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  • 2
    Online Resource
    Online Resource
    Access to and quality of elective care: a prospective cohort study using hernia surgery as a tracer condition in 83 countries
    Elsevier BV ; 2024
    In:  The Lancet Global Health Vol. 12, No. 7 ( 2024-07), p. e1094-e1103
    Details
    In: The Lancet Global Health, Elsevier BV, Vol. 12, No. 7 ( 2024-07), p. e1094-e1103
    Type of Medium: Online Resource
    ISSN: 2214-109X
    URL: Article
    DOI: 10.1016/S2214-109X(24)00142-6
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2024
    detail.hit.zdb_id: 2723488-5
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  • 3
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    Online Resource
    Artificially raised creatinine concentrations due to analytical interference for samples contaminated with total parenteral nutrition fluid
    SAGE Publications ; 2023
    In:  Annals of Clinical Biochemistry: International Journal of Laboratory Medicine
    Details
    In: Annals of Clinical Biochemistry: International Journal of Laboratory Medicine, SAGE Publications
    Abstract: A sample received in the laboratory from a patient receiving total parenteral nutrition (TPN) indicated that the patient may have renal dysfunction, but the results were not considered to be reliable enough to report. Investigations using a reference method for measurement of creatinine confirmed positive interference in the creatinine assay and distribution of samples via an External Quality Assessment (EQA) Scheme showed that this positive interference was method dependent. Methods Residual TPN fluid (Nutriflex Lipid Special) left in the bag after the patient had completed the infusion was collected and added to a patient serum pool in increasing amounts and distributed to different laboratories for analysis of creatinine and glucose through an EQA Scheme. Results Positive interference in a number of different creatinine assays was identified as a result of a component in the TPN fluid. Positive interference from high concentrations of glucose has been demonstrated to be a cause for falsely high results in Jaffe creatinine assays. Conclusions The concern would be that a sample contaminated with TPN fluid would have both abnormal electrolytes and creatinine concentrations and give the impression that the patient was in renal failure due to analytical interference in the creatinine assay and laboratory staff need to be aware of this problem.
    Type of Medium: Online Resource
    ISSN: 0004-5632 , 1758-1001
    URL: Article
    DOI: 10.1177/00045632231186058
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2041298-8
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  • 4
    Online Resource
    Online Resource
    Lipid external quality assessment: commutability between external quality assessment and clinical specimens
    SAGE Publications ; 2008
    In:  Annals of Clinical Biochemistry: International Journal of Laboratory Medicine Vol. 45, No. 3 ( 2008-05), p. 260-265
    Details
    In: Annals of Clinical Biochemistry: International Journal of Laboratory Medicine, SAGE Publications, Vol. 45, No. 3 ( 2008-05), p. 260-265
    Abstract: Targets for cholesterol reduction are part of the Quality Outcomes Framework and general practitioners have to meet these targets to fulfil their remuneration package. By contrast, there are no targets for the accuracy of cholesterol or other lipid measurements and no recent surveys on performance of these assays. We have assessed the performance of lipid measurement of the available methods in the UK. Methods Serum samples collected from individual donors attending the national blood service were distributed after values were obtained from a secondary reference laboratory. Samples were sent to participant laboratories to assess different methods' analytical performance on single donation specimens, on routine external quality assessment pooled specimens, on specimens subjected to a range of freeze–thaw cycles and on frozen-stored specimens. Results Differences in measured cholesterol were found that were method-dependent and related to triglyceride content. HDL-cholesterol (HDL-C) showed significant positive bias in all assays. Individual donor specimens showed no significant changes with differing numbers of freeze–thaw cycles. Pooled serum was stable for up to six months. Conclusions Most cholesterol measurements are accurate but some methods are affected by triglyceride interference. HDL-C methods show significant positive bias. Although there are potential matrix effects introduced as a result of specimen preparation, additional work is needed to show if these effects are present in fresh patient samples.
    Type of Medium: Online Resource
    ISSN: 0004-5632 , 1758-1001
    URL: Article
    DOI: 10.1258/acb.2007.007120
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2008
    detail.hit.zdb_id: 2041298-8
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  • 5
    Online Resource
    Online Resource
    Human Response to Escherichia coli O157:H7 Infection: Antibodies to Secreted Virulence Factors
    American Society for Microbiology ; 2000
    In:  Infection and Immunity Vol. 68, No. 9 ( 2000-09), p. 5090-5095
    Details
    In: Infection and Immunity, American Society for Microbiology, Vol. 68, No. 9 ( 2000-09), p. 5090-5095
    Abstract: Vaccination has been proposed for the prevention of disease due to enterohemorrhagic Escherichia coli (EHEC), but the immune response following human infection, including the choice of potential antigens, has not been well characterized. To study this, sera were obtained from five pediatric patients with acute diarrhea caused by E. coli O157:H7 0, 8, and 60 days after hospitalization. These sera were used to examine the immune response to four different EHEC virulence factors: Tir (translocated intimin receptor, which is inserted into the host cell membrane), intimin (bacterial outer membrane protein which binds to Tir), EspA (secreted protein which forms filamentous structures on EHEC surface), and EspB (inserted into the host membrane and cytoplasm). The response to O157:H7 lipopolysaccharide was also examined. Sera were assayed against purified recombinant proteins using immunoblot analysis and by enzyme-linked immunosorbent assay to determine the sera's titers to each of the antigens in all patients. We found that there was little reaction to EspA, EspB, and intimin in the acute-phase sera, although there was some reactivity to Tir. By day 8, titers of antibody to all four virulence factors were present in all patients, with a very strong response against Tir (up to a titer of 1:256,000), especially in hemolytic-uremic syndrome patients, and lesser strong responses to the other three antigens. The titer to the antigens 60 days after hospitalization was decreased but was still highest for Tir. These results suggest that there is a strong immune response to Tir, and to a lesser extent to the other three virulence factors, following EHEC disease, indicating that these bacterial molecules are potential vaccine candidates for preventing EHEC disease. They also suggest that bacterial virulence factors that are inserted into host cells during infection by type III secretion systems (Tir or EspB) are still recognized by the host immune response.
    Type of Medium: Online Resource
    ISSN: 0019-9567 , 1098-5522
    URL: Article
    DOI: 10.1128/IAI.68.9.5090-5095.2000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society for Microbiology
    Publication Date: 2000
    detail.hit.zdb_id: 1483247-1
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  • 6
    Online Resource
    Online Resource
    Variation of eGFR reporting and CKD equations used in the United Kingdom
    SAGE Publications ; 2023
    In:  Annals of Clinical Biochemistry: International Journal of Laboratory Medicine Vol. 60, No. 5 ( 2023-09), p. 328-338
    Details
    In: Annals of Clinical Biochemistry: International Journal of Laboratory Medicine, SAGE Publications, Vol. 60, No. 5 ( 2023-09), p. 328-338
    Abstract: UK Clinical laboratories have been routinely reporting an estimated glomerular filtration rate (eGFR) based on creatinine measurements using an eGFR equation since the early 2000s. Though there have been recommendations to use enzymatic based creatinine assays, and a recommendation of which equation to use, there still remains a high degree of variation in calculated eGFR results. Methods Data from the UK NEQAS for Acute and Chronic Kidney Disease Scheme have been reviewed to look at the CKD equations that are currently in use in the UK and the impact on eGFR results reported. The UK NEQAS for Acute and Chronic Kidney Disease has over 400 participants measuring creatinine across all major clinical biochemistry platforms. Results An audit of EQA registration against results returned showed that in February 2022 at most 44% of registered participants were correctly reporting the 2009 CKD-EPI equation. At higher creatinine concentrations (which give rise to lower eGFR results), the spread of eGFRs is tight and there is little difference between results from different method principles. However, at lower creatinine concentrations, where it is known that there is more variation in creatinine depending on method choice, both method principle and eGFR equation choice can influence calculated eGFR. In some cases, this can impact CKD Stage classification. Conclusions CKD is a serious public health issue that requires accurate assessment of eGFR. Laboratories should be in constant dialogue with their renal teams about their creatinine assay performance and impact on eGFR reporting across their service.
    Type of Medium: Online Resource
    ISSN: 0004-5632 , 1758-1001
    URL: Article
    DOI: 10.1177/00045632231173233
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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  • 7
    Online Resource
    Online Resource
    Development of a rapid assay for the analysis of serum cortisol and its implementation into a routine service laboratory
    SAGE Publications ; 2013
    In:  Annals of Clinical Biochemistry: International Journal of Laboratory Medicine Vol. 50, No. 4 ( 2013-07), p. 345-352
    Details
    In: Annals of Clinical Biochemistry: International Journal of Laboratory Medicine, SAGE Publications, Vol. 50, No. 4 ( 2013-07), p. 345-352
    Abstract: LC-MS/MS is rapidly becoming the technology of choice for measuring steroid hormones. We have developed a rapid LC-MS/MS assay for the routine analysis of serum cortisol. We have used this assay to investigate the effects of gender and exogenous steroid interference on the immunoassay measurement of serum cortisol. Methods Zinc sulphate (40  µL) was added to 20  µL of sample. This was vortexed for 10 s followed by the addition of 100  µL of internal standard in methanol. Following mixing and centrifugation, 10  µL of sample was injected into an Acquity LC system coupled to a Quattro Premier tandem mass spectrometer. Serum samples ( n = 149) were analysed by LC-MS/MS and two commercial immunoassays. Results were then compared for all samples and for gender differences. A further set of serum samples ( n = 171) was analysed by the LC-MS/MS assay and a GC-MS assay. Results Cortisol had a retention time of 0.98 min and the assay had an injection-to-injection time of 2.6 min per sample. Mean recovery was 99% and mean CV was 8%. The immunoassays gave comparisons of: Roche = 1.23 × LC-MS/MS −1.12 nmol/L and Abbott = 0.94 × LC-MS/MS + 11.97. The comparison with GC-MS showed LC-MS/MS = 1.11 × GC-MS – 22.90. Discussion We have developed an LC-MS/MS assay for serum cortisol analysis that is suitable for routine clinical use and has been in use in our laboratory for 12 months. The availability of this assay will give more reliable results in patients receiving exogenous steroid therapy.
    Type of Medium: Online Resource
    ISSN: 0004-5632 , 1758-1001
    URL: Article
    DOI: 10.1177/0004563212473448
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
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  • 8
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    Online Resource
    Thyroid guidelines - are thyroid-stimulating hormone assays fit for purpose?
    SAGE Publications ; 2007
    In:  Annals of Clinical Biochemistry: International Journal of Laboratory Medicine Vol. 44, No. 3 ( 2007-05-01), p. 203-208
    Details
    In: Annals of Clinical Biochemistry: International Journal of Laboratory Medicine, SAGE Publications, Vol. 44, No. 3 ( 2007-05-01), p. 203-208
    Abstract: Most thyroid-stimulating hormone (TSH) assays now have the sensitivity required by thyroid guidelines and allow the reliable identification of patients with both overt and subclinical hyperthyroidism. Clinical guidelines usually quote decision limits for TSH, but often ignore the issue of whether variability in bias between assays should be considered when such decision limits are implemented. Clinicians and laboratories should appreciate that these decision limits arise largely from historical data that used TSH assays with poorly defined bias. It is thus unlikely that laboratories will be able to apply an appropriate method-related bias adjustment to these TSH cut-offs. Clinicians should appreciate that TSH decision limits should thus be regarded as typical target figures rather than an absolute cut-off and thus can be applied with some degree of flexibility. There is currently insufficient evidence to justify a significant lowering of the upper reference limit for TSH, but fine-tuning of current reference ranges is required since there appears to be no association between the ranking of the assay bias in the UK National External Quality Assessment Service scheme and the manufacturers' quoted reference ranges. There is room for further improvement in TSH assays and this can best be achieved if manufacturers, laboratories and clinicians work together to produce TSH assays and reference ranges that show closer agreement between methods. Until this is achieved, future studies that examine the relationship of TSH with symptoms and treatment should ensure that sufficient information is included in the publication to allow the method related bias of the TSH assay to be clearly described.
    Type of Medium: Online Resource
    ISSN: 0004-5632 , 1758-1001
    URL: Article
    DOI: 10.1258/000456307780480945
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2007
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  • 9
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    Online Resource
    Recommendations for Setting a Criterion for Assessing Commutability of Secondary Calibrator Certified Reference Materials
    Oxford University Press (OUP) ; 2023
    In:  Clinical Chemistry Vol. 69, No. 9 ( 2023-09-01), p. 966-975
    Details
    In: Clinical Chemistry, Oxford University Press (OUP), Vol. 69, No. 9 ( 2023-09-01), p. 966-975
    Abstract: A secondary higher-order calibrator is required to be commutable with clinical samples to be suitable for use in the calibration hierarchy of an end-user clinical laboratory in vitro diagnostic medical device (IVD-MD). Commutability is a property of a reference material that means results for a reference material and for clinical samples have the same numeric relationship, within specified limits, across the measurement procedures for which the reference material is intended to be used. Procedures for assessing commutability have been described in the literature. This report provides recommendations for establishing a quantitative criterion to assess the commutability of a certified reference material (CRM). The criterion is the maximum allowable noncommutability bias (MANCB) that allows a CRM to be used as a calibrator in a calibration hierarchy for an IVD-MD without exceeding the maximum allowable combined standard uncertainty for a clinical sample result (umaxCS). Consequently, the MANCB is derived as a fraction of the umaxCS for the measurand. The suitability of an MANCB for practical use in a commutability assessment is determined by estimating the number of measurements of clinical samples and CRMs required based on the precision performance and nonselectivity for the measurand of the measurement procedures in the assessment. Guidance is also provided for evaluating indeterminate commutability conclusions and how to report results of a commutability assessment.
    Type of Medium: Online Resource
    ISSN: 0009-9147 , 1530-8561
    URL: Article
    DOI: 10.1093/clinchem/hvad104
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 10
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    Online Resource
    A Progress Report of the IFCC Committee for Standardization of Thyroid Function Tests
    Bioscientifica ; 2014
    In:  European Thyroid Journal Vol. 3, No. 2 ( 2014), p. 109-116
    Details
    In: European Thyroid Journal, Bioscientifica, Vol. 3, No. 2 ( 2014), p. 109-116
    Type of Medium: Online Resource
    ISSN: 2235-0640 , 2235-0802
    URL: Article
    DOI: 10.1159/000358270
    Language: English
    Publisher: Bioscientifica
    Publication Date: 2014
    detail.hit.zdb_id: 2659767-6
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