THE "AVERAGE OF NORMALS" METHOD OF QUALITY CONTROL
|
|
- Dinah Jacobs
- 6 years ago
- Views:
Transcription
1 THE AMERICAN JOURNAL OF CLINICAL PATHOLOGY Copyright 1965 by The Williams & Wilkins Co. Vol. 43, No. 2 Printed in U.S.A. THE "AVERAGE OF NORMALS" METHOD OF QUALITY CONTROL ROBERT G. HOFFMANN, PH.D., AND M. E. WAID, M.D. % Computing Center, University of Florida, Gainesville, and Department of Pathology, Wuesthoff Hospital, Rockledge, Florida A new method of laboratory quality control is described in this paper which is simple, sensitive, and requires only a little clerical work for its use. It is based on the use of certain patients' specimens, but it is practical for small laboratories because few tests are needed. It also has the desirable feature of providing information that is useful in other ways than for quality control. The routine work required for use of the method is so simple that it can be described in the following 2 sentences: 1. At the end of each day, average the patient's test values that fall within the normal range. 2. Plot this "average of normals" on a control chart. This is all there is to the procedure, and as will be demonstrated, it provides useful information. The basis of the method is described with 2 examples from clinical laboratories. BASIS OF THE "AVERAGE OF NORMALS" QUALITY CONTROL METHOD A biological basis of the method is described here. It can be seen by laboratory personnel simply by scanning their own records. Study of a "laboratory log" for virtually any test will reveal that: (1) a substantial portion of tests of a patient's specimens falls within the normal range, and (2) the normal range is about as stable as anything in medicine can be. These are the biological facts on which the method is based. The procedures described here are designed to make the best use of them for laboratory control and other purposes. In the examples about to be presented, Received, July 31, 1964; revision received, November 6; accepted for publication November 6. Dr. Hoffmann was formerly Research Assistant Professor, University of Florida. Dr. Waid is Consultant in Pathology, Wuesthoff Hospital, Rockledge, Florida. 134 an electronic computer (IBM 709) was used for establishing normal ranges, but it is not necessary for any user of the method to have access to one. Computing can be done for a laboratory, however, regardless of its size or location, if it is desired. (For further information about computing services, write to the authors.) Figure 1 illustrates frequency distributions for 600 consecutively determined patients' tests for blood urea nitrogen (BUN) and fasting blood glucose (FBG). The test results were simply copied from laboratory records. Note that everything said to this point can be verified by study of the distributions in Figure 1. A large proportion of tests do fall within the normal range. The normal ranges shown were actually computed from the distributions of patients' values, 1 ' 2 as indicated by the Gaussian curves indicated as dashed lines on the charts. Laboratories need not go through this process, but it is important that the midpoint of the normal range used coincide with a reasonable estimate of the true highest point (mode) of the distribution of patients' values. A study of the distributions in the figures should make this clear. For instance, the midpoint of the normal range for glucose (Fig. 1) is 77.5 mg. and the range is 58 to 97 mg. From the statistical point of view, the method is based on the most frequently reported tests. Satisfactory results for this laboratory would not be obtained if a normal range of 70 to 120 mg. were used. COMPUTING THE AVERAGES OF NORMALS The daily routine of the control process consists of computing the averages of patients' values which fall within the normal range and plotting the averages on a chart. For instance, suppose the following results were obtained from a morning group of fasting blood glucose tests. Postprandial
2 Feb THE "AVERAGE OF NORMALS" METHOD B.U.N Mean Gaussian S.D. 4.2 mg/iooml.a> XI E Z IUU mg/ioo ml GLUCOSE A t \ i > / \ " /. NORMAL \ 1 IV V RANGE C / \ 1 1 ^ ^ r i i Gaussian Mean S.D mg/ioo ml -^*ft-p»» i i i i ma/ion ml FIG. 1. Frequency distribution of BUN test values of 600 patients (upper). Frequency distribution of fasting blood glucose test values of 000 patients (lower). In both charts the dashed curve is Gaussian, and the normal range was determined by adding and subtracting 2 standard deviations to the mean. or glucose tolerance tests are not included and would be ignored because thej r have different normal values In this laboratory, the normal range is 58 to 97 mg., so values of 55 or less and 100 or greater will be ignored. Keeping exactly to the normal range is not necessary; just keep close to it. It should be emphasized that these "cut off" points of 55 and 100 need be established only once, but after they are established they should be rigidly adhered to when averages of normals are computed. The dash following each test above indicates it is to be used in the average. There are 10 tests within the normal range, and their average is 80.5 mg. This average would be plotted on a control chart similar to those in Figure 2. Figure 2 illustrates "average of normals" control charts for glucose from 2 laboratories. A total of 600 patients' tests were obtained from each laboratory, and 10 tests were averaged for each point on each chart. The dashed lines are 95 per cent confidence limits. The solid horizontal line in the center of the chart is the midpoint of the normal range. The upper chart indicates a fairly stable testing procedure and the lower chart an unstable testing procedure. The purpose of a control chart is to detect
3 136 HOFFMANN AND WAID Vol.43 0> O 0 3 O <D tj> O k_ a> > < 90 Hh 80 7ft 70 GLUCOSE (stable procedure) r GLUCOSE (unstable procedure) O 0) k- <D < BO -M»_._»-. 75 L Date of Average FIG. 2. "Average of normals" control charts for fasting blood glucose. Each point on each chart is the average of 10 patients' tests which fall within the normal range. The dashed lines are 95 per cent confidence limits. The upper chart indicates a fairly stable testing procedure, and the lower chart, instability. trouble at the time it occurs, or as soon as possible afterwards. Averages should be plotted on the chart immediately after testing a patient's specimens. If a point falls outside the limits, an investigation should be made before reporting the patients' test results. With 95 per cent confidence limits, however, an occasional point outside the limits is to be expected with a stable procedure. Even normal values vary. But 2 successive points outside the same limit are an almost certain indication of trouble. Sources of the trouble encountered by the unstable laboratory (Fig. 2, lower) are known and will be discussed later. The point to be stressed here is that these charts give useful, not misleading, information. It was stated earlier that this control method can be used even by small laboratories. The averages in Figure 2 were computed by an electronic computer, using 10 tests for each average, and data were obtained from laboratory records. On a day-today basis, the number of normal tests will vary and, of course, will depend on the size of the laboratory. The confidence limits are determined partially by the number of tests included in each average, so "variable" confidence limits are needed. The simplest way to obtain them is to have them computed with an electronic computer,* but satisfactory limits can probably be obtained from * Limits are computed using the "within groups of normals" as the variation source for the standard deviation, from which the standard deviation of the average of normals is computed.
4 Feb THE "AVERAGE OF NORMALS" METHOD 137 the following procedure: 1. Estimate the "standard deviation of normals" by dividing the normal range by 4. This should be a realistic normal range verified by hand tabulating a frequency distribution of a patient's values, similar to those in Figure Determine the "standard deviation of averages of normals" by dividing the standard deviation obtained in step 1, above, by the square root of the number of tests in an average of normals group. 3. Multiply the value obtained in step 2 by Add the result obtained in step 3 to the midpoint of the normal range. This will yield the upper 95 per cent confidence limit. Subtracting from the midpoint of the normal range yields the lower confidence limit. For instance, suppose a laboratory is testing 5 to 10 "normal" specimens each day (or every 2 or 3 days). Its normal range for fasting blood glucose is 65 to 115 mg., so the midpoint of the normal range is 90 mg. Then: 1. (115-65)/4 = 12.5 mg. 2. (a) 12.5/V5 = 5.59 for 5 tests in an average (b) 12.5/VlO = 3.95 for 10 tests in an average 3. (a) (5.59)(1.96) = 11.0 mg. (b) (3.95) (1.96) = 7.7 mg. 4. (a) 90.0 ± 11.0 Upper = Lower = 79.0 (b) 90.0 =fc 7.7 Upper = 97.7 Lower = 82.3 The 2 sets of limits would be plotted on the control chart. Note that limits for 10 tests would be approximately 7 mg. narrower than for 5 tests. Common sense indicates that more variation is to be expected when few tests are available as is indicated by the limits. On any given day, the number of tests would be known, so no trouble would be encountered in estimating the proper limit if it was needed. As a matter of record, however, it might be also helpful to make a small chart which indicates the number of tests included in each average. If fewer than 5 tests are available on any given day, these values should be carried over and included in the next day's average. Figure 3 illustrates control charts for BUN, with 10 tests included in each average. Data from 2 laboratories are again illustrated, with the upper chart presenting the appearance of a stable laboratory testing procedure and the lower chart an unstable procedure. Sources of difficulties are known and will be described later. CHARTS AS A MEANS OF INFORMATION CONVEYING The charts in the figures of this paper are useful for purposes in addition to laboratory quality control. The frequency distributions in Figure 1 are concise means of conveying information about a given laboratory procedure. In several laboratories, these frequency distributions are displayed on a large board just outside the laboratory. Physicians may study them at any time without interrupting laboratory personnel. One pathologist makes a point of explaining their meaning to every new staff physician. They show, as only charts can, the complete situation with regard to a given test. The proportion of normal values reflects medical practice. The level at which normal values are reported reflects laboratory practice. Frequency distributions can be made even more easy to read by preparing them in "standard form." A standard form chart is a frequency distribution similar to those in Figure 1. Instead of being tabulated in arbitrary class intervals, such as the 2 mg. intervals used for BUN (Fig. 1), each class interval is 1 standard deviation of a normal subject's values; i.e., approximately onefourth of the normal range. An example of a standard form chart is illustrated in Figure 4, which includes results of testing 600 patients' specimens for chloride. The scale at the bottom of the frequency distribution is in meq. per 1., and each class interval is 1 standard deviation of "normals" computed from the Gaussian curve indicated by the dashed line. The scale at the top of the frequency distribution is a "normal quotient" scale, a normal quotient scale being one in which the midpoint of the normal range is always 100 and the normal range is 90 to 110 N/Q units. The shaded band is the normal
5 138 HOFFMANN AND WAID Vol. 43 B.U.N, (stable procedure) ID CD <U en o t- 0) > < r B.U.N, (unstable procedure) z> m <u en o k_ <u > < Date of Average FIG. 3. "Average of normals" control charts for BUN. Each point on each chart is the average of 10 patients' tests which fall within the normal range. The dashed lines are 95 per cent confidence limits. The upper chart indicates a stable testing procedure, and the lower chart, instability. range. Any group of medical measurements, where the distribution of healthy subjects is Gaussian, can be displayed by means of a standard form chart. Other examples and uses of normal quotient units may be found. 1-4 The control chart in the lower portion of Figure 4 is an average of normals chart for the 600 chloride values and includes 10 normal tests in each control point. No shift is apparent, but the testing procedure is a bit erratic. Too many points are below the lower control limit. The control charts illustrated in Figures 2, 3, and 4 are also useful in ways other than quality control. Inasmuch as they are based on the clinically normal range, they convey information about the normal range as it is continuously being estimated in the laboratory which tests the specimens. The amount of a shift in the testing procedure, if it occurs, can be estimated because the averages are in the same units as the original measurements. A control chart displayed immediately below its frequency distribution (Fig. 4) tells a story as almost nothing else can. The frequency distribution reveals how a test is used over a period of time, the level at which the laboratory is operating, and the normal range. The control chart indicates the stability of the testing procedure. With a stable procedure, the frequency distribution will remain the same. If the procedure has shifted, a new distribution should be prepared if the test is to be maintained at the new level. This is useful information
6 Feb THE "AVERAGE OF NORMALS" METHOD 139 Normal Quotient Scale 103 r CT llj E a> o k. a> > < »i ~» 5" Date of Average Fro. 4. "Standard form" frequency distribution of 600 chloride tests of patients' specimens (upper). The scale at the bottom of the chart is meq. per 1., and the scale at the top is a normal quotient scale. The shaded band represents the normal range. Average of normals control chart for chloride (lower). Each point is the average of 10 normal values. The procedure seems to be stable but erratic. for everyone concerned with the clinical laboratory. Charts are presented and discussed here from the quality control point of view, so "all" patients' results are included in each chart. Similar charts can be prepared for age, sex, diagnosis, treatment, or other specific pertinent factors. This would best be done by pooling information from many laboratories. Technics are available for doing this, so it is only a matter of putting them to use. PROBLEMS DISCLOSED BY USING AVERAGES OF NORMALS CONTROL CHARTS The examples of BUN and glucose shown indicate unstable testing procedures for 2 laboratories. Sources of the difficulties will now be discussed. The rise in glucose values (Fig. 2, lower) was apparently caused by a particular lot of glucose oxidase reagent. Even though it had freshly arrived in the laboratory, rapid development of color even before the filtrate was added indicated deterioration. The
7 140 HOFFMANN AND WAID Vol. 48 problem was corrected by a new lot number of reagent, but not until quite a few tests were reported as erroneously high. Physicians complained about test values during this period. Glucose data from approximately 25 laboratories has been analyzed by the methods described here. Study of them indicates that glucose is a difficult test to control properly. BUN tests can have low values when detergent or other substances interfere with the enzyme action of urease. When Nessler's reagent is not prepared properly, the solution is cloudy, and erroneously high values are the result. Both of these troubles have been seen, but most laboratories maintain control over BUN better than their glucose control. A detailed study of 5 laboratories, using a few tests from each, has been made. In these laboratories, one of us actually visited the laboratory and discussed quality control problems with laboratory personnel after averages of normals charts had been prepared from their own records. In all laboratories studied, commercial reference standards were used daily. It seems as though things are still to be learned about their best use. In 1 laboratory, values from patients were adjusted to an erroneously low commercial reference standard. The company eventually called in the erroneous lot. The average of normals method is not afflicted with such difficulties. A new set of "normal values" is available every day that 5 or more of their specimens are tested APPLICABILITY OF THE METHOD The method of averages of normals has been studied using data from laboratories all over the country. Data from 36 different laboratories has been analyzed for BUN. Study of their distributions and average of normals control charts indicates the problem is much the same for any laboratory regardless of size or location. Considerable variation among normal ranges was seen, and midpoints varied from 10.5 to 18.9 mg. Data from at least 1 laboratory has also been obtained for the following procedures: Prothrombin time C0 2 Sodium Protein bound iodine Spinal fluid sugar Spinal fluid protein Bilirubin (total) White cell count Thymol turbidity Total lipids Uric acid Potassium Alkaline phosphatase Acid phosphatase Serum phosphate Serum glutamic-pyruvic transaminases Serum glutamic-oxalacetic transaminases Hemoglobin Lactic dehydrogenase Serum globulin Serum protein Serum albumin Cholesterol Ammonia Amylase Calcium Hematocrit Chloride Creatinine Lipase In every instance, a high proportion of "normal values" was seen when a frequency distribution was tabulated. Averages of normals control charts prepared from the same data also seem to be reasonable. There is little question as to the usefulness of the method for a wide range of tests. DISCUSSION Laboratory quality control is still a perplexing problem to many directors of clinical laboratories, despite the number of papers written about it. A good bibliography and review of the problem is reported by Young. 6 The control method described here takes a trivial amount of time each day and anyone can be trained to compute and plot the averages. In other words, the routine of the process is so simple and straightforward that it can be done mechanically. But this is not quality control. Quality control is the control of the laboratory testing procedures. The charts should be reviewed constantly by the laboratory's most expert personnel. Here is how this might best be done: 1. Persons expert in the use of adding or calculating machines should be given the responsibility of keeping up the charts. As long as the control points stay within the confidence limits, no "alarm" is sounded. When a point goes outside the limits, the matter should immediately be brought to the attention of the laboratory director or other responsible, knowledgeable person. 2. Periodically, the laboratory director
8 Feb THE "AVERAGE OF NORMALS" METHOD 141 should review the control charts regardless of whether or not any difficulties have been brought to his attention. An abrupt shift, for example, caused by use of a new lot of a reagent will be detected by a control point going outside the confidence limits. A gradual shift, such as the deterioration of a reagent or part of an instrument might best be seen with periodic review of the chart, although it eventually will be detected as points go outside the limits. Maintaining an accurate and precise testing procedure is quality control. The charts help achieve this goal and reflect the success (or failure) of the process. Periodic review of all control charts can lead to the correction of problems that otherwise might not be detected as quickly. For instance, it was noticed in one laboratory that values of sodium as well as potassium were a bit low. A quick check of the flame photometer revealed that soot had accumulated in the optical path. Intervals between periodic cleaning of the instrument had been too long. This is an example of real quality control detection and correction of a problem before it causes major trouble. Quality control in clinical laboratories is the control of measuring processes, and no measuring process is perfect. Variability is an inescapable part of it. This is what seems to give laboratory personnel the greatest difficulty with quality control methods. Statistics, which can be regarded as a body of methods for dealing with problems in which variability is encountered, are not given much attention in the training of laboratory personnel. Quality control methods, and the statistics on which they are based, should be helpful as a portion of the training programs. Most laboratory tests are used solely for the purpose of estimating a portion of the condition of a patient at a given time or over a short period of time. The test results are then discarded. In this paper, a glimpse is given of how some of this information presently being discarded can be put to use for many beneficial purposes in clinical pathology. REFERENCES 1. Hoffman, R. G.: Statistics in the practice of medicine. J. A. M. A. 185: S64-873, 19G3. 2. Hoffman, R. G., Waid, M. E., Todaro, E., and Alston, R.: Retrieving and processing medical measurement data. Rochester Conference on Data Acquisition and Processing in Biology and Medicine, in press, Hoffman, R. G., and Waid, M. E.: A new scale of normal values for physicians. GP, SO: , Hoffman, R. G., and Waid, M. E.: Keeping informed about the clinical laboratory. Clin. Med., in press, Young, D. M.: Experience with and thoughts on quality control. Canad. J. Med. Techn., 25: 2-9, 1963.
Delta Check Calculation Guide
Delta Check Calculation Guide National Technology 2017, All Rights Reserved By Senior Scientific Researcher, Asmaa Taher Table of Contents Definition... 2 Purpose... 2 Delta Check Research Studies... 2
More informationRoutine Clinic Lab Studies
Routine Lab Studies Routine Clinic Lab Studies With all lab studies, a Tacrolimus level will be obtained. These drug levels are routinely assessed to ensure that there is enough or not too much anti-rejection
More informationThe analytical phase
The analytical phase Result interpretation Test request Result Sampling Black box: the lab ANALYTICAL PHASE The CASE Uncle Pete, 67 years old Marked abdominal pain 8 pm, ED Acute abdomen? Assessment (+
More informationChemistry Reference Ranges and Critical Values
Alanine Aminotransferase (ALT, SGPT) 3-9 years 9-18 years 1-9 years 9-18 years 10-30 U/L 10-30 U/L 10-20 U/L Albumin 0-6 days 6 days - 37 months 37 months - 7 years 7-20 years 2.6-3.6 g/dl 3.4-4.2 g/dl
More informationChemistry Reference Ranges and Critical Values
Alanine Aminotransferase (ALT, SGPT) 3-9 years 9-18 years 1-9 years 9-18 years 10-25 U/L 10-35 U/L 10-30 U/L 10-25 U/L 10-30 U/L 10-35 U/L 10-25 U/L 10-35 U/L 10-25 U/L 10-20 U/L 10-35 U/L Albumin 0-6
More information11 - Blood Tests (Completed 05/29/18) Transcript by Rev.com. Page 1 of 5
Megan: Hey everyone, I'm Megan Ramos, and I'm here today to answer your questions. Today's question involves lab tests, and what blood tests you should ask your doctor for. You can find a list of recommended
More informationAssessment of "Average of Normals" Quality Control Procedures and Guidelines for Implementation
Assessment of "Average of Normals" Quality Control Procedures and Guidelines for Implementation GEORGE S. CEMBROWSKI, M.D., PH.D., ELLIOT P. CHANDLER, M.D., AND JAMES O. WESTGARD, PH.D. The capabilities
More informationWhat Does My Blood Test Mean
What Does My Blood Test Mean CBC with Differential This means that your doctor wants to know the amounts and proportions among the various components of your blood, explained below. The term differential
More informationInspector's Accreditation Unit Activity Menu
01/12/20XX 15:58:57 Laboratory Accreditation Program Page 1 of 9 CHEMISTRY 1501 ALT, serum/plasma 1502 Albumin, serum/plasma 1504 Alkaline phosphatase, serum/plasma 1506 Amylase, serum/plasma 1508 Bilirubin,
More informationSeparation of Plasma and Serum and Their Proteins from Whole Blood
Separation of Plasma and Serum and Their Proteins from Whole Blood BCH 471 [Practical] BLOOD COMPOSITION Other names to blood cells Red blood cells (erythrocytes) White blood cells (leukocytes) Platelets
More informationClinician Blood Panel Results
Page 1 of 7 Blood Panel - Markers Out of Range and Patterns (Pattern: proprietary formula using one or more Blood Markers) Blood Panel: Check for Markers that are out of Lab Range ***NOTE*** Only one supplement
More informationMethod Comparison Report Semi-Annual 1/5/2018
Method Comparison Report Semi-Annual 1/5/2018 Prepared for Carl Commissioner Regularatory Commission 123 Commission Drive Anytown, XX, 12345 Prepared by Dr. Mark Mainstay Clinical Laboratory Kennett Community
More informationMultiphasic Blood Analysis
Understanding Your Multiphasic Blood Analysis Test Results Mon General thanks you for participating in the multiphasic blood analysis. This test can be an early warning of health problems, including coronary
More information1) What is the independent variable? What is our Dependent Variable?
1) What is the independent variable? What is our Dependent Variable? Independent Variable: Whether the font color and word name are the same or different. (Congruency) Dependent Variable: The amount of
More informationAttention and Concentration Problems Following Traumatic Brain Injury. Patient Information Booklet. Talis Consulting Limited
Attention and Concentration Problems Following Traumatic Brain Injury Patient Information Booklet Talis Consulting Limited What are Attention and Concentration? Attention and concentration are two skills
More informationC-1: Variables which are measured on a continuous scale are described in terms of three key characteristics central tendency, variability, and shape.
MODULE 02: DESCRIBING DT SECTION C: KEY POINTS C-1: Variables which are measured on a continuous scale are described in terms of three key characteristics central tendency, variability, and shape. C-2:
More informationSupplementary materials
Supplementary materials Table S Adverse events identified by participants diary logs and blood hematologic and biochemical tests (n=2) group (n=) Placebo group (n=) P value for chi-squared test Asthma
More informationCHAPTER 3 DATA ANALYSIS: DESCRIBING DATA
Data Analysis: Describing Data CHAPTER 3 DATA ANALYSIS: DESCRIBING DATA In the analysis process, the researcher tries to evaluate the data collected both from written documents and from other sources such
More informationENROLLMENT CONFIRMATION
Step 1: Please review the Facility/Contact information. If any of the information is incorrect, please make the appropriate changes below: Facility/Contact Phone: (850)474-3660 Fax: (850)474-3659 6431
More informationClinical Laboratory Science: Urinalysis
Clinical Laboratory Science: Urinalysis Urine is produced by the kidney to maintain constant plasma osmotic concentration; to regulate ph, electrolyte and fluid balances and to excrete some 50 grams of
More informationCLINICAL CHEMISTRY REAGENTS. Product Profile
Product Profile Why Clinical Chemistry Reagents? Quantitative determination of specific analytes associated with various types of disease. Diagnosis Identifying a disease already present Prognosis Forecasting
More informationBIOO LIFE SCIENCE PRODUCTS
BIOO LIFE SCIENCE PRODUCTS FOR REFERENCE PURPOSES This manual is for Reference Purposes Only. DO NOT use this protocol to run your assays. Periodically, optimizations and revisions are made to the kit
More informationSpecimen Collection Requirements
The following is a job aid listing the specimen collection requirements for laboratory testing at Colchester East Hants Health Center. Specimens must be accompanied by the Patient Information Form G09.
More informationSpecimen Collection Requirements
The following is a job aid listing the specimen collection requirements for laboratory testing at Colchester East Hants Health Center. Specimens must be accompanied by the Patient Information Form G09.
More informationThe Fallacy of Taking Random Supplements
The Fallacy of Taking Random Supplements Healthview interview with Dr. Paul Eck Healthview: We can see from our conversations that you are totally against people taking random supplements even if people
More informationTABLE OF CONTENTS GENERAL INFORMATION... 1
BIOO RESEARCH PRODUCTS Glucose Assay Kit Manual Catalog #: 5611-01 BIOO Scientific Corp. 2011 TABLE OF CONTENTS GENERAL INFORMATION... 1 Product Description... 1 Procedure Overview... 1 Required Materials
More informationProblem with Traditional QC
Hurdles and Benefits of Implementing a QA Program Based on Patient Moving Averages Mark A. Cervinski, PhD, DABCC The Geisel School of Medicine at Dartmouth Dartmouth-Hitchcock Medical Center Problem with
More informationHurdles and Benefits of Implementing a QA Program Based on Patient Moving Averages
Hurdles and Benefits of Implementing a QA Program Based on Patient Moving Averages Mark A. Cervinski, PhD, DABCC The Geisel School of Medicine at Dartmouth Dartmouth-Hitchcock Medical Center Problem with
More informationManufacturer Report for Siemens Unassayed Chemistry Lot Exp 30 Jun 2018
Acetaminophen Enzymatic, colorimetric µg/ml.09 0..0.09 0..0 0. 0. 0. 0. 9.. 9.0 0.9.0..9.. Albumin Bromcresol Purple (BCP) g/dl.0 0.0..0 0.00.. 0.0.. 0.09..9 0.0..9 0.0..0 0.0..0 0.0. Alkaline Phosphatase
More informationUnderstanding Blood Tests
PATIENT EDUCATION patienteducation.osumc.edu Your heart pumps the blood in your body through a system of blood vessels. Blood delivers oxygen and nutrients to all parts of the body. It also carries away
More informationResults Report. Welcome to Your ABT Report!
Results Report Athlete Name: SHEPPARD, JOSEPH Date of Blood Draw: Feb 10, 2018 Panel: ABT Bronze Panel ABT Expert: Dr. Rock Welcome to Your ABT Report! Thank you for trusting AthleteBloodTest.com to be
More informationExploration and Exploitation in Reinforcement Learning
Exploration and Exploitation in Reinforcement Learning Melanie Coggan Research supervised by Prof. Doina Precup CRA-W DMP Project at McGill University (2004) 1/18 Introduction A common problem in reinforcement
More informationEvaluation of VACUETTE CAT Serum Fast Separator Blood Collection Tube for Routine Chemistry Analytes in Comparison to VACUTAINER RST Tube
Evaluation of VACUETTE CAT Serum Fast Separator Blood Collection Tube for Routine Chemistry Analytes in Comparison to VACUTAINER RST Tube Background: Greiner-Bio-One, Austria has been selling plastic evacuated
More informationMaking Your Treatment Work Long-Term
Making Your Treatment Work Long-Term How to keep your treatment working... and why you don t want it to fail Regardless of the particular drugs you re taking, your drugs will only work when you take them.
More informationGeneral Chemistry Scheme Guide
General Chemistry Scheme Guide Copyright WEQAS. All rights reserved. No part of this document may be reproduced or utilised in any form without permission from WEQAS Contents. Scheme details and repertoire.....
More informationResults Report. Welcome to Your ABT Report! Introduction to the ABT Report
Results Report Athlete Name: SHEPPARD, JOSEPH Date of Blood Draw: Dec 08, 2017 Panel: ABT Gold Panel ABT Expert: Dr. Rock Welcome to Your ABT Report! Thank you for trusting AthleteBloodTest.com to be a
More informationGlucose Determination by Automatic
Glucose Determination by Automatic Chemical Analysis Harold J. Grady and Martha A. Lamar 1HE GENERAL CONSTRUCTION and operation of an automatic chemical analyzer essentially identical with the one used
More informationChapter 12. The One- Sample
Chapter 12 The One- Sample z-test Objective We are going to learn to make decisions about a population parameter based on sample information. Lesson 12.1. Testing a Two- Tailed Hypothesis Example 1: Let's
More informationSleep & Relaxation. Session 1 Understanding Insomnia Sleep improvement techniques Try a new technique
Sleep & Relaxation Sleep & Relaxation Session 1 Understanding Insomnia Sleep improvement techniques Try a new technique Session 2 Dealing with unhelpful thoughts Putting these techniques together for better
More informationM.D.IPA, M.D.IPA Preferred, Optimum Choice and Optimum Choice Preferred STAT Laboratory List Revised Jan. 5, 2017
M.D.IPA, M.D.IPA Preferred, Optimum Choice and Optimum Choice Preferred STAT Laboratory List Revised Jan. 5, 2017 If laboratory results are required on a STAT basis, the designated commercial medical laboratory
More informationMedical Disclaimer. Quick Start Guide. Bikini Belly Diet
Medical Disclaimer This program is for educational and informative purposes only and is not intended as medical or professional advice. Always consult your doctor before making any changes to your diet
More informationAnalyte Specimen Demographic Reference Range Units
Acetone Negative titer Alanine aminotransferase (ALT/SGPT) 10-49 U/L Albumin 3.2-4.8 g/dl Alcohol < 10 Alpha-fetoprotein (AFP) < 1.3-8.1 ng/ml Alkaline phosphatase 0 7 days 7 30 days 1 3 3 6 6 12 1 3 3
More informationCHAPTER 15: DATA PRESENTATION
CHAPTER 15: DATA PRESENTATION EVIDENCE The way data are presented can have a big influence on your interpretation. SECTION 1 Lots of Ways to Show Something There are usually countless ways of presenting
More informationStability of VACUETTE Lithium Heparin Separator tubes with modified centrifugation conditions
Stability of VACUETTE Lithium Heparin Separator tubes with modified centrifugation conditions Background: Greiner-Bio-One, Austria has been selling plastic evacuated tubes (VACUETTE ) for venous blood
More informationTables of Normal Values (As of February 2005)
Tables of Normal Values (As of February 2005) Note: Values and units of measurement listed in these Tables are derived from several resources. Substantial variation exists in the ranges quoted as normal
More informationReagent Set DAS ELISA, Alkaline phosphatase label SRA 22001, SRA 23203, SRA 27703, SRA & SRA ToRSV, ArMV, GFLV, AnFBV and PDV
List of contents Lot number Reagent Set Item 96 wells 500 wells 1000 wells 5000 wells Capture antibody 0.150 ml 0.275 ml 0.525 ml 2.525 ml Alkaline phosphatase enzyme conjugate 0.150 ml 0.275 ml 0.525
More informationFebruary 1, 2016 Body Fluid order changes
February 1, 2016 Body order changes Laboratory will be making the following changes to Body tests: 1. Changing orders in Power plans (see below list). 2. All folders will be updated accordingly: If the
More informationNEXTGEN ICD10 TIPS DEMONSTRATION
NEXTGEN ICD10 TIPS DEMONSTRATION This demonstration reviews some of the changes you ll see in NextGen after ICD10 goes into effect October 1, 2015. Details of the workflow will likely vary somewhat, depending
More informationOptimization and Experimentation. The rest of the story
Quality Digest Daily, May 2, 2016 Manuscript 294 Optimization and Experimentation The rest of the story Experimental designs that result in orthogonal data structures allow us to get the most out of both
More informationWhat is PlaqueOff (PO)? A new study in Beagle dogs. Oral effects of
Oral effects of What is? PO is a dry food supplement. Sprinkle it onto your pet s food daily. PO is an algae that has been harvested in the Atlantic ocean in northern Norway and contains nothing else such
More informationBiostatistics 2 - Correlation and Risk
BROUGHT TO YOU BY Biostatistics 2 - Correlation and Risk Developed by Pfizer January 2018 This learning module is intended for UK healthcare professionals only. PP-GEP-GBR-0957 Date of preparation Jan
More informationAppendix B Statistical Methods
Appendix B Statistical Methods Figure B. Graphing data. (a) The raw data are tallied into a frequency distribution. (b) The same data are portrayed in a bar graph called a histogram. (c) A frequency polygon
More informationHow to Conduct Direct Preference Assessments for Persons with. Developmental Disabilities Using a Multiple-Stimulus Without Replacement
How to Conduct Direct Preference Assessments for Persons with Developmental Disabilities Using a Multiple-Stimulus Without Replacement Procedure: A Self-Instruction Manual Duong Ramon and C.T. Yu University
More informationPHYSICAL PROPERTIES AND DETECTION OF NORMAL CONSTITUENTS OF URINE
PHYSICAL PROPERTIES AND DETECTION OF NORMAL CONSTITUENTS OF URINE - OBJECTIVES: 1- The simple examination of urine. 2- To detect some of the normal organic constituents of urine. 3- To detect some of the
More informationWhat is the routine? What do they tell us?
What is the routine? What do they tell us? This is the cause of some of the greatest anxiety among patients and their parents The anxiety is related to physical pain and emotional stress Having a strategy
More informationAdams Memorial Hospital Decatur, Indiana EXPLANATION OF LABORATORY TESTS
Adams Memorial Hospital Decatur, Indiana EXPLANATION OF LABORATORY TESTS Your health is important to us! The test descriptions listed below are for educational purposes only. Laboratory test interpretation
More informationA Patient s Guide to Chronic Pain Management
A Patient s Guide to Chronic Pain Management 264 Pleasant Street Concord, NH 03301 Phone: 6032243368 Fax: 6032287268 marketing.copa@concordortho.com DISCLAIMER: The information in this booklet is compiled
More informationResults & Statistics: Description and Correlation. I. Scales of Measurement A Review
Results & Statistics: Description and Correlation The description and presentation of results involves a number of topics. These include scales of measurement, descriptive statistics used to summarize
More informationLab Values Explained. working at full strength. Other possible causes of an elevated BUN include dehydration and heart failure.
Patient Education Lab Values Explained Common Tests to Help Diagnose Kidney Disease Lab work, urine samples and other tests may be given as you undergo diagnosis and treatment for renal failure. The test
More informationContents. Section 1: Basic Laboratory Principles. 1. Laboratory Equipments, Glassware, Laboratory Hazards and General Laboratory Rules...
Contents Section 1: Basic Laboratory Principles 1. Laboratory Equipments, Glassware, Laboratory Hazards and General Laboratory Rules...3 Laboratory Equipments 3 Laboratory Glassware 4 Laboratory Hazards
More informationPRELIMINARY RESULTS: SERUM CHEMISTRY VALUES BEFORE AND AFTER THE INTRAVAGINAL ADMINISTRATION OF 5% NONOXYNOL-9 CREAM
FERTILITY AND STERILITY Copyright" 1981 The American Fertility Society Vol. 35, No.6, June 1981 Printed in U.8A. PRELIMINARY RESULTS: SERUM CHEMISTRY VALUES BEFORE AND AFTER THE INTRAVAGINAL ADMINISTRATION
More informationAm I at Risk for Type 2 Diabetes?
NATIONAL DIABETES INFORMATION CLEARINGHOUSE Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes U.S. Department of Health and Human Services National Institutes of Health
More informationSMALL ANIMAL SOFT TISSUE CASE- BASED EXAMINATION
SMALL ANIMAL SOFT TISSUE CASE- BASED EXAMINATION CASE-BASED EXAMINATION INSTRUCTIONS The case-based examination measures surgical principles in case management prior to, during, and after surgery. Information
More informationEFFECT OF HIGH SALT CONCENTRATIONS ON COLOR PRODUCTION OF THE BIURET REACTION FOR PROTEIN ANALYSIS
EFFECT OF HIGH SALT CONCENTRATIONS ON COLOR PRODUCTION OF THE BIURET REACTION FOR PROTEIN ANALYSIS HAROLD L. ROSENTHAL, PH.D., AND TOYOKO KAWAKAMI, M.T. (ASC1>) Division of Biochemistry, Department of
More informationGet to know yourself better. Attend our health screening event.
Get to know yourself better. Attend our health screening event. Putting your knowledge to action is Powerful. Get the information and guidance you need with the Wellness Screening Program. 1 SIMPLE ACTION
More informationSerodos and Serodos plus
Design Verification Serodos and Serodos plus Contents 1 Value Adjustment... 2 2 Target Determination... 2 3 Stability... 2 Real-Time Stability... 3 Stability after Reconstitution... 4 Stability after Reconstitution
More informationS ERUM ALKALINE PHOSPHATASE ACTIVITY is the enzyme analysis most
Rapid Method for the Quantitative Determination of Serum Alkaline Phosphatase Bernard Klein, Prunella A. Read, and Arthur L. Babson S ERUM ALKALINE PHOSPHATASE ACTIVITY is the enzyme analysis most frequently
More informationISC- GRADE XI HUMANITIES ( ) PSYCHOLOGY. Chapter 2- Methods of Psychology
ISC- GRADE XI HUMANITIES (2018-19) PSYCHOLOGY Chapter 2- Methods of Psychology OUTLINE OF THE CHAPTER (i) Scientific Methods in Psychology -observation, case study, surveys, psychological tests, experimentation
More informationEvaluation of VACUETTE SECONDARY Tubes
Evaluation of VACUETTE SECODARY Tubes Background VACUETTE SECODARY Tubes are used as a secondary container for aliquoting, storing and transporting blood, blood components and urine from the primary tube
More information5 Easy Steps to Optimize Your GFR, Creatinine, and BUN Levels
1 Understand your lab test numbers and learn how to improve them with these 5 amazing tips! Check out the e-book Renal Progress: A Kidney Patient s Guide to Improving Kidney Function Test Results, also
More informationGet to know yourself better. Attend our health screening event.
Gateway Technical College Get to know yourself better. Attend our health screening event. Putting your knowledge to action is Powerful. Get the information and guidance you need with the Wellness Screening
More informationSRI NATHELLA SAMPATHU CHETTY CLINICAL LABORATORY (UNIT OF MEDICAL RESEARCH FOUNDATION) Test Master List
S. No Lab/ Ref/ code Name of the Test CLINICAL BIOCHEMISTRY TESTS MASTER LIST Storage of Specimen Anti Reportable examined Required Coagulants interval specimen / (vacutainer) (vacutainer) (TAT) Temp.
More informationLab 2: Investigating Variation Across Spatial Scales
Lab 2: Investigating Variation Across Spatial Scales What are scales and variation in a biological context? The world around us displays incredible diversity across many scales. Today s lab investigates
More informationPROFICIENCY TESTING. Clinical Laboratory Improvement Amendments (CLIA) DOs and DON Ts. Brochure # 8
Clinical Laboratory Improvement Amendments (CLIA) Brochure # 8 PROFICIENCY TESTING DOs and DON Ts NOTE: Congress passed the Clinical Laboratory Improvement Amendments (CLIA) in 1988 establishing quality
More informationUrea Nitrogen (BUN) detection Kit
K-ASSAY KAMIYA BIOMEDICAL COMPANY KAMIYA BIOMEDICAL COMPANY Urea Nitrogen (BUN) detection Kit For the quantitative determination of urea nitrogen in saliva and TCM Cat. No. KT-747 For Research Use Only.
More informationTHE EFFECT OF ANTICOAGULANTS ON DETERMINA- TIONS OF INORGANIC PHOSPHATE AND PROTEIN IN PLASMA BY OLIVER HENRY GAEBLER
THE EFFECT OF ANTICOAGULANTS ON DETERMINA TIONS OF INORGANIC PHOSPHATE AND PROTEIN IN PLASMA BY OLIVER HENRY GAEBLER (From the Department of Laboratories, Henry Ford Hospital, Detroit) (Received for publication,
More informationSession 21 Leader Guide: Heart Health
Session 21 Leader Guide: Heart Health Objectives In this session, the participants will: Identify the leading cause of death in American adults. Define heart disease. Learn the risk factors for heart disease.
More informationObservational studies; descriptive statistics
Observational studies; descriptive statistics Patrick Breheny August 30 Patrick Breheny University of Iowa Biostatistical Methods I (BIOS 5710) 1 / 38 Observational studies Association versus causation
More informationEvaluation of new MiniCollect Z Serum (Separator) Tubes
Evaluation of new MiniCollect Z Serum (Separator) Tubes Background: Greiner Bio-One has developed a newly designed MiniCollect tube offering an integrated collection scoop. The advantage of the new tube
More informationGLUCOSE MONITORING. How. When
GLUCOSE MONITORING Why Self-monitoring of blood glucose is the best way to see how your body handles food, activity, diabetes medication (pills and/or insulin), stress and illness. You can also see what
More informationNORMAL LABORATORY VALUES FOR CHILDREN
Pediatric Drug Lookup Normal Laboratory Values for NORMAL LABORATORY VALUES FOR CHILDREN CHEMISTRY Normal Values Albumin 0-1 y 2.0-4.0 g/dl 1 y to adult 3.5-5.5 g/dl Ammonia Newborns 90-150 mcg/dl 40-120
More informationYou should know the T max for any substance that you use and for PAH ; T max = mg / min
Tubular function - What is clearance? o clearance referred to the theoretical volume of plasma from which a substance is cleared ( cleaned ) over a period of time and so its unit would be ((ml/min)) -
More informationYou can use this app to build a causal Bayesian network and experiment with inferences. We hope you ll find it interesting and helpful.
icausalbayes USER MANUAL INTRODUCTION You can use this app to build a causal Bayesian network and experiment with inferences. We hope you ll find it interesting and helpful. We expect most of our users
More informationMEDICAL HISTORY. 23-Jan-2018 to 23-Jan VCA Miller-Robertson Animal Hospital 8807 Melrose Ave, Los Angeles, CA (310)
8807 Melrose Ave, Los Angeles, CA 90069 (310) 657-7050 MEDICAL HISTORY 23-Jan-2018 to 23-Jan-2018 Client Linnea Engdahl (1810) C: Linnea: (310) 351-9547 Patient Abby (6487) Canine Mixed Breed 3y (22-Jan-2015)
More informationReagent Set DAS ELISA, Alkaline phosphatase label
List of contents Lot number Item 96 wells 500 wells 1000 wells 5000 wells Capture antibody 0.150 ml 0.275 ml 0.525 ml 2.525 ml Alkaline phosphatase enzyme conjugate 0.150 ml 0.275 ml 0.525 ml 2.525 ml
More informationPhlebotomy Top Gun. Drawing Blood From a Patient Receiving Intravenous Fluids. HOT TOPIC / Phlebotomy Top Gun, Intravenous Fluids HOT TOPIC / 2018
Phlebotomy Top Gun Drawing Blood From a Patient Receiving Intravenous Fluids HOT TOPIC / 2018 Presenter: Brad Karon, M.D., Ph.D. Professor Laboratory Medicine and Pathology Department of Laboratory Medicine
More informationFullerton Healthcare Screening Centres
Fullerton Healthcare Screening Centres Fullerton Healthcare Screening Centre @ Ngee Ann City The Penthouse, #26-02 Ngee Ann City Tower B, 391B Orchard Road, Singapore 238874 Operating hours: Monday - Friday
More informationDIABETES AND CHRONIC KIDNEY DISEASE
DIABETES AND CHRONIC KIDNEY DISEASE Stage 5 www.kidney.org National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Did you know that the National Kidney Foundation's Kidney Disease Outcomes
More informationHosta virus X ELISA KIT
Hosta virus X ELISA KIT Cat. No.:DEIA9256 Pkg.Size:96T Intended use The Hosta virus X ELISA KIT is used to detect HVX in both leaves and roots of hosta plants. Reagents And Materials Provided 1. Capture
More informationROUTINE LAB STUDIES. Routine Clinic Lab Studies
ROUTINE LAB STUDIES Routine Clinic Lab Studies With all lab studies, a tacrolimus or cyclosporine level will be obtained. These drug levels are routinely assessed to ensure that there is enough or not
More informationHuman Hemoglobin Colorimetric Detection Kit
Human Hemoglobin Colorimetric Detection Kit CATALOG NO: IRAAKT2522 LOT NO: SAMPLE INTENDED USE The Hemoglobin detection kit is designed to quantitatively measure all forms of hemoglobin present in blood
More informationPVY Reagent Set Compound ELISA, Alkaline phosphatase label Potato virus Y Catalog number: SRA 20001
List of contents Lot number PVY Reagent Set Item 96 wells 500 wells 1000 wells 5000 wells Capture antibody 0.150 ml 0.275 ml 0.525 ml 2.525 ml Detection antibody, bottle A 0.150 ml 0.275 ml 0.525 ml 2.525
More informationEpic Labs Orderable As STAT PRIORITY As of 06/22/2016
ABG+HB(CORDARTERIAL) - BABY A ABG+HB(CORD ARTERIAL)- BABY B ABG+HB(CORD ARTERIAL)- BABY C ACETAMINOPHEN LEVEL ALANINE AMINOTRANSFERASE (ALT) ALBUMIN, FLUID ALBUMIN, PLEURAL FLUID ALBUMIN, SYNOVIAL FLUID
More informationAspirin Resistance and Its Implications in Clinical Practice
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/aspirin-resistance-and-its-implications-in-clinicalpractice/3819/
More informationComputer Science 101 Project 2: Predator Prey Model
Computer Science 101 Project 2: Predator Prey Model Real-life situations usually are complicated and difficult to model exactly because of the large number of variables present in real systems. Computer
More informationThe antihypertensive and diuretic effects of amiloride and. of its combination with hydrochlorothiazide
The antihypertensive and diuretic effects of amiloride and of its combination with hydrochlorothiazide The hypotensive effect as well as changes in serum electrolytes and uric acid of amiloride (AM) and
More informationChapter 2--Norms and Basic Statistics for Testing
Chapter 2--Norms and Basic Statistics for Testing Student: 1. Statistical procedures that summarize and describe a series of observations are called A. inferential statistics. B. descriptive statistics.
More informationCardiovascular Controversies: Exploring the ACC and AHA Guidelines on the Treatment of Blood Cholesterol
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationBIOL 305L Spring 2019 Laboratory Six
Please print Full name clearly: BIOL 305L Spring 2019 Laboratory Six Osmosis in potato and carrot samples Introduction Osmosis is the movement of water molecules through a selectively permeable membrane
More information