Less is more: Two automated interventions to increase vitamin B12 measurement when long-term proton pump inhibitor and decrease redundant testing

Salinas, María; López-Garrigós, Maite; Flores, Emilio; Blasco, Álvaro; Leiva‐Salinas, Carlos

doi:10.1016/j.cca.2020.03.038

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…As a research group focused on the optimisation of laboratory requests from primary care, we have extensive experience in setting up protocols in agreement with primary and secondary care to improve the cost-effectiveness of diagnosis in various disease areas (Salinas et al, 2013;Salinas et al, 2014;Salinas et al, 2020). We observed a clear need for an intervention in the diagnosis of RA.…”

Section: Discussionmentioning

confidence: 97%

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Double positivity for rheumatoid factor and anti-CCP autoantibodies: improving referral from primary care of patients suspected of having rheumatoid arthritis

Salinas,

Blasco,

Flores

et al. 2024

Prim Health Care Res Dev

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Background: Rheumatoid arthritis (RA) is a chronic progressive autoimmune inflammatory disease with significant morbidity and mortality. The course of the disease can be modified if diagnosis is early and treatment appropriate. Aim: In this study, we aimed to evaluate a new strategy for early identification of RA patients in primary care settings (the ‘diagnostic bottleneck’) based on serological biomarkers and to manage inappropriate rheumatoid factor (RF) laboratory test requests. Method: A two-arm study was carried out. The first arm corresponded to a retrospective observational descriptive study of patients referred for RF testing from primary care using the current laboratory workflow. The second arm included the following prospective interventions: cancelation of RF requests corresponding to patients with previous negative results for RF over a one-year period; and automatic reflex testing antibodies against cyclic citrullinated proteins (anti-CCP) for patients displaying RF values >30 IU/ml. Outcomes from both arms were then compared. Findings: As double positivity for RF and anti-CCP notably increases the positive likelihood ratio of RA. The intervention enabled a reduction of 2813 tests in 22 months. Moreover, the frequency of unnecessary referrals was reduced from 22% to 8.2%, while that of missed patients decreased slightly (from 21% to 16%), with the number of patients diagnosed per RF request remaining unchanged. In terms of costs, we saved 19.4 RF tests per anti-CCP test added. We developed a simple and cost-effective strategy for reducing the time to diagnosis of RA that can improve patients’ quality of life. This approach was supported by primary and specialised care.

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Section: Discussionmentioning

confidence: 97%

“…, 2014 ; Salinas et al. , 2020 ). We observed a clear need for an intervention in the diagnosis of RA.…”

Section: Discussionmentioning

confidence: 99%

Double positivity for rheumatoid factor and anti-CCP autoantibodies: improving referral from primary care of patients suspected of having rheumatoid arthritis

Salinas,

Blasco,

Flores

et al. 2024

Prim Health Care Res Dev

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“…New developments in information technologies such as patient electronic medical history (PEMH), laboratory information system (LIS) [ 11 ], and computerized physician order entry (CPOE) [ 12 ] could be used to improve test laboratory request, and consequently, the diagnosis, and hence patient outcome, as the number of laboratory requests with patient clinical information has greatly increased [ 13 ]. Consequently, it is now possible to automatically customize the requests according to the patient suspected diagnosis or current situation [ 14 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

Alopecia and Iron Deficiency: An Interventional Pilot Study in Primary Care to Improve the Request of Ferritin

Salinas

Leiva-Salinas

Flores

et al. 2020

Advances in Hematology

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Background. The aim was to study the demographic and laboratory pattern of primary care patients with alopecia undergoing laboratory testing, more specifically, the request of hemoglobin and ferritin and values showing anemia and iron deficiency, and to evaluate the effects of an intervention involving automatic ferritin registration and measurement when not requested. Methods. Retrospective and prospective observational cross-sectional studies were conducted, as well as an intervention to automatically register and measure ferritin when not requested by the general practitioner. Results. There were 343 and 1032 primary care laboratory requests prompted by alopecia in the retrospective and prospective studies. Hemoglobin was requested in almost every patient and ferritin in 88%. 5% of the cohort had anemia, and 25% had iron deficiency. The intervention registered and measured that 123 ferritin and 24 iron deficiencies were detected in patients with alopecia, all women, at a cost of 10.6€. Conclusion. Primary care patients with alopecia and laboratory tests request were mainly young female. Our intervention added ferritin when not requested, detecting iron deficiency in 27.9% of women, potentially avoiding the adverse effects of iron deficiency on hair loss.

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“…In view of the research on anti-tumor drugs, it has been transferred from the traditional cytotoxic drugs to targeted drugs and it is featured as accurate treatment, low toxicity and remarkable curative effect, focusing on the biological characteristics of tumor cells [5] . In recent years, the effect analysis of therapeutic drugs for other diseases in the field of tumor has become a research hotspot and there are more researches on the Proton Pump Inhibitor (PPI) [6] . The PPI is an important drug in inhibiting the gastric acid secretion and it could inhibit the tumor cell proton pump to play an anti-tumor role.…”

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confidence: 99%

Effect of Esomeprazole on Biological Characteristics of Hepatoma Cells by Regulating Protein Kinase B/Forkhead Box O3 Pathway

Zhang¹,

Xie²,

Sun³

2022

IJPS

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Zhang et al.: Esomeprazole on the Biological Characteristics of Hepatoma CellsTo explore the effect of esomeprazole on the biological characteristics of hepatoma cells by regulating protein kinase B/forkhead box O3 pathway. Hepatoma cell lines were cultured and subcultured and divided into model group, low dose group and high dose group. The changes of proliferation, colony formation and apoptosis of hepatoma cells in each group and the expression levels of proliferation, apoptosis related proteins and protein kinase B/forkhead box O3 pathway related proteins were detected. Esomeprazole inhibited tumor cells in a time and dose-dependent manner and the difference was statistically significant (p<0.05). With the increase of drug dose, the number of liver cancer cell colony formation decreased gradually and the difference was statistically significant (p<0.05). Esomeprazole induced apoptosis of tumor cells in a time and dose-dependent manner and the difference was statistically significant (p<0.05). Compared with the model group, the expression levels of cyclin-dependent kinase 1, cyclin-dependent kinase 2, cyclin A2 and cyclin E2 decreased with the increase of esomeprazole dose (p<0.05). Compared with the model group, the level of apoptotic protein procaspase-9 in high and low dose groups decreased significantly, while the level of cleaved caspase-9 increased in a dose-dependent manner (p<0.05). The level of protein kinase B in high dose group was lower than that in model group and low dose group, while the level of forkhead box O3 protein increased; the difference was statistically significant (p<0.05). Esomeprazole can affect the biological characteristics of tumor cells such as proliferation and apoptosis by activating protein kinase B/forkhead box O3 pathway, which provides a new method for the treatment of liver cancer.

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Less is more: Two automated interventions to increase vitamin B12 measurement when long-term proton pump inhibitor and decrease redundant testing

Cited by 8 publications

References 17 publications

Double positivity for rheumatoid factor and anti-CCP autoantibodies: improving referral from primary care of patients suspected of having rheumatoid arthritis

Double positivity for rheumatoid factor and anti-CCP autoantibodies: improving referral from primary care of patients suspected of having rheumatoid arthritis

Alopecia and Iron Deficiency: An Interventional Pilot Study in Primary Care to Improve the Request of Ferritin

Effect of Esomeprazole on Biological Characteristics of Hepatoma Cells by Regulating Protein Kinase B/Forkhead Box O3 Pathway

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