INTRODUCTION Patients with heart failure often have concomitant renal disease which can result in uremic platelet dysfunction. Determining whether uremia has affected platelets by platelet aggregometry can be challenging in these patients since they are often on antiplatelet medications. The current study was undertaken to determine if platelet aggregation studies could identify heart failure patients at risk for uremic bleeding prior to cardiac surgery. MATERIALS AND METHODS Platelet aggregation studies from three groups were studied and compared: 17 heart failure patients with mild to moderate renal impairment, 17 heart failure patient without renal abnormalities, and 17 healthy volunteers. RESULTS Platelet aggregation was severely impaired in both heart failure groups with and without renal abnormalities compared to healthy controls, and there were no significant differences in platelet aggregation in response to any of the agonists. There was a pan-decrease in platelet aggregation to all agonists in all heart failure patients. CONCLUSION Platelet aggregometry does not appear to be useful in measuring platelet dysfunction in heart failure patients with mild to moderate renal impairment.
We recently developed a clinical pathology consult service that uses best-practice algorithms for the work-up of certain autoimmune disorders. Using templates, the average time to generate two reports was approximately 1 hour. As a result, we sought to automate the process further to reduce workload and ensure accuracy. RA-EASY, the software that was developed to accomplish this for rheumatoid arthritis consults, is described herein. FileMaker Pro was used as the platform for creating RA-EASY. The user enters the results of laboratory tests, physical examination, and imaging studies into text boxes, and then clicks a button in the user interface to generate reports. On the right panel, a complete draft appears, which incorporates all the input data into generating a diagnostic conclusion. This draft is based on a comprehensive algorithm consisting of over 700 lines of database execution scripts. This algorithm thoroughly analyzes all the patient's data before rendering a complete report. The user can edit the draft to incorporate any further clinical judgment into the final report. The user can then "copy and paste" this report into the laboratory information system (LIS) to release the final report. A draft for an e-mail message to the ordering physician, which summarizes the report findings, is also created by the software and displayed in the left panel. A version of RA-EASY has been made available on our departmental intranet for clinical reporting. Using RA-EASY, efficiency in writing reports is now increased to four reports per hour compared to two using the manual method. In addition, fewer typographical errors were noted due to the nature of automation. FileMaker Pro is a powerful tool for generating clinical pathology consult reports with regards to efficiency and accuracy.
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