A Knowledge-Based System to Aid with the Clinical Interpretation of Complex Serum Protein Data

Ritchie, Robert F.

doi:10.1515/cclm.2001.170

Cited by 9 publications

(10 citation statements)

References 21 publications

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“…This technique does not require explicit definition of external data costs, benefits, and preferences typically used in decision analysis techniques. Many traditional decision support systems use simple yes-no branch points with predefined decision points, such as hematocrit Ͻ30% or albumin greater than a median value (40,41 ). These types of models are less useful for assessing the impact of analytic performance.…”

Section: Approach 6: Analyte Performance Characteristics Based On Decmentioning

confidence: 99%

Establishment of Outcome-Related Analytic Performance Goals

Klee

2010

Clinical Chemistry

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BACKGROUND:Accrediting organizations require laboratories to establish analytic performance criteria that ensure their tests provide results of the high quality required for patient care. However, the procedures for instituting performance criteria that are directly linked to the needs of medical practice are not well established, and therefore alternative strategies often are used to create and implement surrogate performance standards.CONTENT: We reviewed 6 approaches for establishing outcome-related analytic performance goals: (a) limits defined by regulations and external assessment programs, (b) limits based on biologic variation, (c) limits based on surveys of clinicians about their needs, (d) limits based on effects on guideline driven medical decisions, (e) limits based on analysis of patterns for ordering follow-up clinical tests, and (f) limits based on formal medical decision models. Performance criteria were tabulated for 12 common chemistry analytes and 4 routine hematology tests.

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Section: Approach 6: Analyte Performance Characteristics Based On Decmentioning

confidence: 99%

Establishment of Outcome-Related Analytic Performance Goals

Klee

2010

Clinical Chemistry

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“…Expanding the limited algorithm described here to include more traditional chemistry testing could provide the very assistance that all in clinical care desire, a laboratory tool as powerful and adaptable as the traditional physical exam (27 ). Examples of six different patterns of proteinuria.…”

Section: Discussionmentioning

confidence: 99%

Windows to the Ward: Graphically Oriented Report Forms. Presentation of Complex, Interrelated Laboratory Data for Electrophoresis/Immunofixation, Cerebrospinal Fluid, and Urinary Protein Profiles

Regeniter¹,

Steiger

Scholer³

et al. 2003

Clinical Chemistry

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Background: Automated laboratory analyzers that mass produce data have been linked to information systems for more than two decades, but little progress has been made in developing more comprehensible report forms. Results are still reported in computer-generated printouts containing hundreds of numbers crowded into columns on each printed page. Methods: We developed three software applications focusing on the graphic presentation of laboratory results. Results: The first application summarizes data for a patient with a monoclonal gammopathy. The report provides a cumulative graphic presentation of immunofixation/electrophoresis data without any additional interpretation, focuses on a color-coded electrophoresis scan, and records up to 5 years on a single page. The second application deals with cerebrospinal fluid analysis. The report calculates relevant data and graphs the complex relationship between albumin and immunoglobulin results from paired serum and cerebrospinal fluid samples. Manually added interpretive text assures an output comprehensible to clinicians in all specialties. The third application produces a report summarizing quantitatively measured urinary marker protein profiles. The report form is generated by a flexible, completely user-definable knowledge-based system. It calculates numerous ratios and formulae, supports reflex testing, supplies an automated interpretation, and generates a specific graphic signature pattern of the results (MDI LabLink proteinuria differentiation). Conclusions: Increased clinical demand for graphically oriented report forms 5 years after their introduction has provided evidence that these reports transfer complex laboratory data and results to the clinician more effectively. The highest (more than threefold) increase in demand has been for reports for urinary marker protein profiles that feature a largely self-explanatory graphic signature pattern.

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“…However, the fact that we can now produce large amounts of precise laboratory data (84) inescapably increases our desire for better understanding (85,86). Technological advances and corporate competitiveness has made available a variety of automated instruments that make largescale studies possible, but costly.…”

Section: Measurementmentioning

confidence: 99%

Selecting clinically relevant populations for reference intervals

Ritchie

Palomaki²

2004

Clinical Chemistry and Laboratory Medicine (CCLM)

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The selection of individuals to represent a group for any purpose can commit the effort to success or failure from the very outset. The description of this group must reflect what is, in reality, the purpose for which the group is being studied. Considering that reference intervals are designed to assist clinicians during diagnostic triage, criteria must reflect the nature of the subjects entering the system for care. The majority of people seeking care have non-life-threatening, yet troublesome complaints. In other words, persons who are in a reasonable state of health and who are not suffering from significant illness. Therefore the relevant cohort should fit this description, not individuals who lack any clinical or laboratory issues. Our focus is to employ reference intervals to exclude disease and not to define normality. Normality in the eyes of statisticians is quite different from the word as viewed by clinical staff, yet the term is used interchangeably without concern for its ultimate use. As a result medicine today stumbles over this issue at every turn. Scientists and artists do not speak the same language. Compounding this awkward situation has been the conviction that by increasing laboratory precision and accuracy, the utility of laboratory data, reference intervals in particular, will improve clinical understanding. This has, after many years, not proven to be the case. What has become very evident, however, is that unsustainably large sums of money are being devoted to improving laboratory performance. To what end, when we are unable to grasp the significance of what is available now including published reference intervals for common test values? A realistic perspective on the value of prevailing laboratory performance, as illustrated by reference intervals, must be adopted. The obligation of laboratories, its regulators and professional groups is to create a sustainable mechanism to provide clinically usable information, in a timely and affordable manner, to our population and to those legions of less fortunate humans.

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A Knowledge-Based System to Aid with the Clinical Interpretation of Complex Serum Protein Data

Cited by 9 publications

References 21 publications

Establishment of Outcome-Related Analytic Performance Goals

Establishment of Outcome-Related Analytic Performance Goals

Windows to the Ward: Graphically Oriented Report Forms. Presentation of Complex, Interrelated Laboratory Data for Electrophoresis/Immunofixation, Cerebrospinal Fluid, and Urinary Protein Profiles

Selecting clinically relevant populations for reference intervals

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