Costs of unnecessary tests.

Sandler, Gerald

doi:10.1136/bmj.2.6181.21

Cited by 124 publications

(36 citation statements)

References 2 publications

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“…23 Other studies also have demonstrated that the history and CANADIAN JOURNAL OF ANAESTHESIA physical examination accurately indicate all areas in which subsequent laboratory testing proves beneficial to patients. For example, Rabkin and Home 24'2s examined the records of 165 patients having "new" (i.e., a change from a previous tracing) abnormalities on electrocardiogram (ECG) that were potentially "surgically significant" (i.e., that might affect perioperative management or outcome).…”

Section: Routine Laborawry Testing Is Not the Most Effective Way Of Ementioning

confidence: 99%

Preoperative patient evaluation

Roizen

1989

Can J Anaesth

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Section: Routine Laborawry Testing Is Not the Most Effective Way Of Ementioning

confidence: 99%

Preoperative patient evaluation

Roizen

1989

Can J Anaesth

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“…. , tungssystems und Implementierung eines teil-oder Zur Vermeidung von Redundanz und Kosten bei der voUm echanisierten Verteügerätes nur unbefriedigend Bestimmung klinisch-chemischer Kenngroßen ist bei der " ^ Wefden Anforderung klinisch-chemischer Untersuchungen eine diskrimiriierte Auswahl sinnvoll (1)(2)(3)(4).…”

Section: Einführungunclassified

Optimierung der Probenverteilung in einem zentralisierten klinisch-chemischen Institut

Sator¹,

Neumeier²,

Knedel³

1981

CCLM

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Zusammenfassung: Mechanisierterem leistungsfähigen Labordatenverarbeitungssystemen ansteuerbare Proben-Verteilgeräte sind bislang nur in wenigen, zentralisierten klinisch-chemischen Instituten implementiert. Durch eine permanente und direkte, sowohl visuell als auch maschinenlesbare Identifikation der Sekundärgefäße und eine parallele Verteilung auf ausreichend viele Arbeitsplätze werden Identifikationsfehler und Engpässe in der Probenverarbeitung vermieden. Unsere Erfahrungen zeigen aber, daß die Probenverteilung notwendigerweise über diese grundsätzlichen Erfordernisse hinaus weiter zu optimieren ist. Die Verteilung muß insbesondere an die interne Labororganisation und an die Problematik individueller Proben mit in der Analytik interferierenden Substanzen oder mit inadäquatem Probenvolumen angepaßt werden. Neben einer sicheren Probenidentifikation sind die Sekundärgefäße mit dem Probenabnahmedatum und der Materialart zu kennzeichnen, um eine kumulative Abarbeitung seltener Untersuchungen und die simultane Bearbeitung verschiedener Materialien in einer Analysenserie zu ermöglichen. Darüberhinaus ist eine geeignete untersuchungs-oder gerätespezifische Durchführung der internen Qualitätskontrolle zu berücksichti-gen. Wir haben diese zusätzlichen Erfordernisse durch eine konsequente gegenseitige Abstimmung im Aufbau der Untersuchungsanträge (Markierung von Prioritäten, Zusatzinformationen), der Dateistrukturen und des Steuerprogramms des Proben-Verteilgerätes erfüllt. Optimization of sample splitting in a centralized clinical chemical instituteSummary: Mechanized sample splitting machines controlled by a laboratory data processing system have been realized in only a few centralized laboratories. Bottlenecks and mistakes in sample processing are avoided by means of direct machine readable identification and parallel splitting of the secondary tubes. Our previous experience has shown that a strategy for sample splitting has to go far beyond these basic functional requirements. The splitting process must be suited to the organization of the particular laboratory, and it must be adjusted to deal with problems of individual samples containing analytically interfering substances, or variable splitting may be required in cases of inadequate sample volumes. In addition to sample identification, the secondary tube has to be coded with the date and the type of material. This allows cumulative on-line processing and series of analyses of different materials. A suitable positional arrangement of containers for control material must be born in mind for quality control performances. We have realized these additional requirements by means of a consequent mutual adaptation in the layout of the request form (marking of priority and additional information), the file structure of the data processing system and the control program.of the sample splitting machine.

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“…Of these three elements, good doctor-patient communica tion during the interview is of critical impor tance in diagnostic decision making [2], Thus, Hampton et al [3] reported that the final diagnosis depended on the interview in 83% of general medical outpatients, while Sandler [4] estimated approximately 56%. In contrast, physical examination contrib uted only 17% of diagnostic decisions.…”

Section: Clinical Assessmentmentioning

confidence: 99%

Treatment Considerations in the Elderly Rheumatic Patient

Bellamy¹

1988

Gerontology

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The elderly represent a large subset of the rheumatic population, some of whom have experienced musculoskeletal disease since early life or middle age, whereas others are affected for the first time in their later years. They may be afflicted with a variety of musculoskeletal disorders, some of which occur almost exclusively in elderly individuals. Advancing age may be accompanied by failure of the musculoskeletal system and other major organs. As a result, elderly patients frequently receive concurrent treatment with several pharmacologically active compounds, which increases the potential for significant adverse drug-drug interactions. In addition, the elderly may be less tolerant of certain classes of compounds, including some antirheumatic drugs, necessitating careful drug selection and patient monitoring. Diagnostic and therapeutic decision making may be impeded by the patient’s inability to recall completely and accurately important historical details, particularly those relating to drug therapy. Treatment objectives may be compromised further by poor compliance, and adequate follow-up made more difficult by the patient’s lack of mobility and declining independence. Successful management of the elderly rheumatic patient, therefore, requires an accurate clinical assessment, comprehensive evaluation of major organ functioning, identification of potential drug-drug interactions, appropriate selection of anti-rheumatic drugs and other treatment modalities, effective doctor-patient communication, and careful monitoring for both beneficial and adverse responses to therapy.

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Costs of unnecessary tests.

Cited by 124 publications

References 2 publications

Preoperative patient evaluation

Preoperative patient evaluation

Optimierung der Probenverteilung in einem zentralisierten klinisch-chemischen Institut

Treatment Considerations in the Elderly Rheumatic Patient

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