Impact of Endogenous and Exogenous Interferences on Clinical Chemistry Parameters Measured on Blood Gas Analyzers

Grieme, Caleb V; Voss, Dena; Davis, Scott R; Krasowski, Matthew D.

doi:10.7754/clin.lab.2016.160932

Cited by 16 publications

(6 citation statements)

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“…Epic Reporting Workbench (RWB) was used to retrieve patient demographics, MyChart status, pathology results, and radiology reports covering dates from October 1, 2016, to October 1, 2017, using methods previously described. 22,26,27 For the diagnostic test results, RWB captured whether patient had an active MyChart account and whether he/she (or a proxy) accessed outpatient diagnostic results. The RWB report included age, gender, MyChart status, zip code, patient location at order (inpatient, outpatient, or emergency department), and diagnostic test order.…”

Section: Methodsmentioning

confidence: 99%

Activation and Utilization of an Electronic Health Record Patient Portal at an Academic Medical Center—Impact of Patient Demographics and Geographic Location

2018

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The advent of the online electronic health record patient portal has provided an efficient and practical means for patients to become more involved in their health care. In this report, we analyze how demographic variables such as age, gender, race, and geographic location affect patient portal activation and usage at the University of Iowa Hospitals and Clinics, the sole academic medical center in the state of Iowa, a predominantly rural state. Our primary end points were activation of the patient portal (MyChart, Epic, Inc) and access of outpatient laboratory and radiology results, among the most commonly accessed and popular features of the patient portal. We thus analyzed data from 536 378 patients to determine rates of patient portal activation and data from 219 671 patient encounters to determine the frequency at which patients access their online diagnostic test results. Higher rates of patient portal activation and usage were associated with female gender, Caucasians/non-underrepresented minorities, geographic location in closer proximity to the medical center (Iowa City and neighboring cities/suburbs), and nonelderly adults. For underrepresented minority and rural patients, opportunities for improvement exist for both activation and more robust use of online patient portal accounts. Overall, these data highlight existing disparities with online patient portal usage and provide a base on which further studies and interventions can help to improve utilization of these systems.

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Section: Methodsmentioning

confidence: 99%

Activation and Utilization of an Electronic Health Record Patient Portal at an Academic Medical Center—Impact of Patient Demographics and Geographic Location

2018

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“…This study was carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki). As previously described, 21 , 22 Epic Reporting Workbench was used to retrieve order descriptions, order and result date/times, patient demographics, patient location, and results for clinical laboratory testing. The analysis also utilized preexisting TAT and specimen tracking reports from Healthcare Enterprise Decision Intelligence, a data warehouse managed by UIHC hospital information technology (Health Care Information Systems).…”

Section: Discussionmentioning

confidence: 99%

Impact of Daylight Saving Time on the Clinical Laboratory

et al. 2018

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Daylight saving time is a practice in some countries and local regions to set clocks forward (typically 1 hour) during the longer days of summer and back again in autumn. Time changes resulting from daylight saving time have the potential to impact clinical laboratory instruments, computer interfaces, and information systems. We analyzed turnaround time data for an academic medical center clinical laboratories (chemistry, hematology, blood gas analyzer, and transfusion medicine), examining how turnaround time was impacted by the daylight saving time shifts in 2017. We also determined whether the daylight saving time shift on November 5, 2017 (“fall back” by 1 hour) resulted in any “absurd” time combinations such as a receipt time occurring “before” a normally later time such as final result. We also describe challenges resulting from daylight saving time changes over a 5-year period. The only significant impact on turnaround time was for clinical chemistry samples during the autumn daylight saving time change, but the overall impact was low. Four instances of absurd time combinations occurred in the autumn time change with only a transfusion medicine example resulting in an interface error (a Type and Screen resulted “before” receipt in laboratory). Over a 5-year period, other daylight saving time impacts included problems of reestablishing interface to instruments, inadvertent discrepancies in manual time changes at different points of the core laboratory automation line, and time change errors in instruments with older operating systems lacking patches that updated daylight saving time rules after 2007. Clinical laboratories should be aware that rare problems may occur due to issues with daylight saving time changes.

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“…University of Iowa Hospitals and Clinics (UIHC) is a 761 bed tertiary/quaternary care academic medical center located in Iowa City, Iowa. As described in our previous studies, Epic Reporting Workbench (RWB) search functions were used to identify patients from data in the electronic medical record (EMR) based on specific parameters [23]. RWB search queries identified patients who had urine amphetamine screening performed and who were known to be prescribed vilazodone.…”

Section: Methodsmentioning

confidence: 99%

Accidental intoxications in toddlers: lack of cross-reactivity of vilazodone and its urinary metabolite M17 with drug of abuse screening immunoassays

et al. 2019

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Background Vilazodone is an FDA approved medication used to treat major depressive disorder. The authors describe two cases of accidental vilazodone exposure in toddlers who presented with symptoms similar to amphetamine exposure and also with unexplained positive amphetamine urine immunoassay drug screens. Given a lack of published data on cross-reactivity of vilazodone and its metabolites with drug of abuse screening tests, the authors investigated drug of abuse immunoassay cross-reactivity of vilazodone and metabolites using computational and empirical approaches. Methods To ascertain the likelihood that vilazodone would cross-react with drug of abuse screening immunoassays, the authors assessed the two-dimensional (2D) similarity of the vilazodone parent molecule and known metabolites to an array of antigenic targets for urine immunoassay drug screens. To facilitate studies of the commercially unavailable M17 metabolite, it was prepared synthetically through a novel scheme. Urine and serum were spiked with vilazodone and M17 into urine (200–100,000 ng/mL) and serum (20–2000 ng/mL) samples and tested for cross-reactivity. Results Computational analysis using 2D similarity showed that vilazodone and metabolites have generally low similarity to antigenic targets of common drug of abuse screening immunoassays, predicting weak or no cross-reactivity. The M17 metabolite had 2D similarity to amphetamines and tricyclic antidepressants in a range similar to some other compounds exhibiting weak cross-reactivity on these immunoassays. Cross-reactivity testing was therefore performed on two different urine amphetamines immunoassays and a serum tricyclic antidepressant immunoassay. However, actual testing of cross reactivity for vilazodone and the M17 metabolite did not detect cross-reactivity for any urine amphetamines screen at concentrations up to 100,000 ng/mL and for a serum tricyclic antidepressants assays at concentrations up to 2000 ng/mL. Conclusion While the vilazodone metabolite M17 has weak 2D structural similarity to amphetamines and tricyclic antidepressants, the current study did not demonstrate any experimental cross-reactivity with two different urine amphetamines immunoassays and a serum tricyclic antidepressant immunoassay. Vilazodone ingestions in young children present a diagnostic challenge in their similarity to amphetamine ingestions and the lack of routine laboratory tests for vilazodone. Further work is needed to understand the metabolic profile for vilazodone in children versus adults. Electronic supplementary material The online version of this article (10.1186/s12907-019-0084-9) contains supplementary material, which is available to authorized users.

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Impact of Endogenous and Exogenous Interferences on Clinical Chemistry Parameters Measured on Blood Gas Analyzers

Cited by 16 publications

References 0 publications

Activation and Utilization of an Electronic Health Record Patient Portal at an Academic Medical Center—Impact of Patient Demographics and Geographic Location

Activation and Utilization of an Electronic Health Record Patient Portal at an Academic Medical Center—Impact of Patient Demographics and Geographic Location

Impact of Daylight Saving Time on the Clinical Laboratory

Accidental intoxications in toddlers: lack of cross-reactivity of vilazodone and its urinary metabolite M17 with drug of abuse screening immunoassays

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