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Table 1. Comparison of laboratory investigations using the conventional approach and the LAS (Clin Chem 45:8 1168-1175 (1999) ConventionalLAS Results Mean number of tests ordered32.717.8 t -Test for two related samples t = 5.4, P <0.01

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Table 1. Comparison of laboratory investigations using the conventional approach and the LAS (Clin Chem 45:8 1168-1175 (1999)

ConventionalLAS

Results

Mean number of tests ordered32.717.8

t-Test for two related samplest = 5.4, P <0.01

Mean number of samples collected7.55.8

t-Test for two related samplest = 3.4, P <0.02

Observations

Mean costs, $$232$194

t-Test for two related samplest = 3.3, P <0.05

Turnaround time (mean no. of days)3.21

Diagnostic accuracy66%100%

Number of referrals120

Established guidelines: thyroid testing

Mean number of tests ordered1.71.7

Total number of sample collections128

No established guidelines: hepatitis and autoimmune testing

Mean number of tests ordered6.73.3

Total number of sample collections3830

Results returned negative

Mean number of tests ordered4.82

Total number of sample collections149


Generate Rule

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RULE EXISTS

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Enter Data


Qualitative

Gender

Clinical details

Drug therapy

Quantitative

Age

Total T4

TSH

Free T4

Free T3

Variables UsedTFT application


Decision Range

>=60

>=20; <60

>=10; <20

>5; <10

>4; <=5

>=0.4; <4

>=0.25; <0.4

<0.25

Description

Markedly high

Very High

High

Mildly raised

Near URL

Normal

Near LRL

Below detection limit

Adult decision rangesTSH (mu/L)


CLINICAL DETAILS

A. Suspected hyperthyroidism

B. Suspected hypothyroidism

C.Post Radioiodine therapy

D. Post thyroid surgery

E. On thyroxine treatment

F. On T3 treatment

G. On Carbimazole

H. On PTU

Z. Non-specific

DRUG THERAPY

A. Lithium

B. Oestrogens

C. Amiodarone

D. Beta-blockers

E. Glucocorticoids

F. Phenytoin

G. Carbamazepine

H. Androgens

Z. No relevant drugs

Clinical and Drug detailsTFT


Variables UsedProtein electrophoresis

  • Quantitative

    • patients age

    • serum total protein, albumin, -globulin, paraprotein concentrations

  • Semi-quantitative

    • Visual assessment of albumin, 1,,2,, 1,,,,2,, and  concentrations

  • Qualitative

    • patients gender

    • Visual inspection of zones and interzones (11 variables), e.g. 1 zone,- interzone findings


Primer knowledge basesTFT application


Primer knowledge basesprotein electrophoresis


Performance evaluation - TFTPercentage of automatically assigned interpretations (AAI) per TFT batch


TFT application statistics

  • Number of variables specified: 8

  • Number of options/decision levels: 70

  • Number of theoretical data combinations: 20,412,000

  • Number of cases entered via primer knowledge bases: 1142

  • Number of rules: >2900

  • Percentage of automatically assigned interpretations [using the primer knowledge bases]

    • At the outset: 66%

    • After the first 500 patient cases: 70%

    • Maximum achieved: 95%

  • Number of interpretations rejected: <1%


electrophoresis application statistics

  • Number of variables specified: 23 (22 used in rule generation)

  • Number of options/decision levels: 183

  • Number of theoretical data combinations: 8,800,000,000,000,000,000

  • Number of cases entered via primer knowledge bases: 206

  • Number of rules: 350

  • Percentage of automatically assigned interpretations [using the primer knowledge bases]

    • At the outset: 78%

    • After the first 500 patient cases: 72%

    • Maximum achieved: 70-80%

  • Number of interpretations rejected: 0


Clinical evaluationTFT application(27 TFT requests on 15 randomly-selected new referrals to a thyroid clinic were studied; 2 evaluators participated)


Clinical evaluationElectrophoresis application(115 questionnaires circulated, 64 returned, 56% response)


Clinical evaluationElectrophoresis application(115 questionnaires circulated, 64 returned, 56% response)


Performance evaluationElectrophoresis application


Performance evaluationElectrophoresis application(to demonstrate knowledge acquisition)


Cooperativity

DATA

KBS

Interpretation

Diagnostic outcome


Diagnostic outcome (2)

Diagnostic outcome (4)

Diagnostic outcome (3)

KBS-2

KBS-4

KBS-3

Comment

Comment

Comment

Cooperativity

KBS-i

Diagnostic outcome (1)

KBS-1

Comment

Integrating

Comment


CooperativityOrgan-related profiles

  • Renal profile

    • Na, K, Urea, Creatinine

  • Bone profile

    • Ca, Alb, Corr Ca, Phosphate, AlkPhos

  • Liver profile

    • Bili, Alb, T Protein, AST, Alk Phos, GGT

  • Cardiac profile

  • Lipid profile


140 mmol/L

130 mmol/L

CooperativityDecision Levels

160 mmol/L

150 mmol/L

Plasma

Sodium

Concentration

120 mmol/L

110 mmol/L


Rule Elements

Rules and rule elements

Diagnostic outcomes

Comments

R

Tr

L

Tl

B

Tb

C

Tc

Integrating rule and its elements

i

Age

Sex

Clin

Ti


PRIMER

Renal

KBS

PRIMER

Bone

KBS

PRIMER

Liver

KBS

PRIMER

Cardiac/

Lipid

KBS

CooperativityPrimer knowledge bases

Universe KBS (Primers are subsets)


Renal profile

prerenal impairment

Renal impairment

hyponatraemia

hypokalaemia

hypernatraemia

hyperkalaemia

etc

Bone profile

osteomalacia pattern

renal osteomalacia

primary hyperparathyroidism

etc

Selected Diagnostic Outcomes


Renal

Na 133 [Low]

K 5.8 [Raised]

Urea 30.5 [raised]

Creatinine 400 [Raised]

Interpretation

Renal impairment with hyperkalaemia and mild hyponatraemia

Diagnostic outcome

renal impairment

Bone

Ca 1.94 Corr Ca 2.04 [Low]

Alb 35 [Normal]

Phosphate 1.88 [High]

Alk Phos 450 [High]

Interpretation

Hypocalcaemia, raised phosphate and Alk Phos: osteomalacia pattern

Diagnostic outcome

osteomalacia pattern

Profile interpretations


Cooperative KBS output

  • Renal KBS comment

    • Renal impairment with hyperkalaemia and mild hyponatraemia. [DO= renal impairment]

  • Bone KBS comment

    • hypocalcaemia, raised phosphate and Alk Phos. DO = osteomalacia pattern.

  • Integrating KBS comment

    • These results are consistent with renal failure and associated renal osteodystrophy


Decision Support SystemsSupport for Health Care Professionals


Alarm/Alert Systems


Alarm/Alert Systems


Alarm/Alert Systems


Alarm/Alert Systems


Alarm/Alert Systems


Alarm/Alert Systems


Alarm/Alert Systems


Alarm/Alert Systems


Alarm/Alert Systems


Alarm/Alert Systems


Decision Support SystemsSupport for Health Care Professionals

  • Microbiology Applications

    • Computerised infectious disease monitor (Evans, 1986). Computer-generated alarms were produced for (1) all patients with hospital-acquired infections; (2) patients on antibiotics to which they were not susceptible; (3) who could be receiving less expensive antibiotics; (4) who were receiving prophylactic antibiotcis for too long. Use of the system saved time for hospital infection control staff, and improved antibiotic use.

    • MRSA monitor (Safran, Scherrer 1994). Infection control nurses were provided daily with computer-generated lab alerts giving details of MRSA+ together with re-admission alerts giving details of new admissions previously known to be colonised with MRSA. System saved time for ICNs and helped as a preventive warning.


Decision Support SystemsSupport for Health Care Professionals

  • Histopathology/Cytopathology applications

    • PAPNET Cervical Screening Neural Network

    • Telepathology


Decision Support SystemsSupport for Health Care Professionals

  • Haematology applications

    • Diamond and Nguyen/Coulter Electronics. Various DSS applications for use with Coulter systems, flow cytometry, classification of haematological malignancies etc.


EQA Applications

  • EQA Toolkit


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