How Much Diagnosis Can We Afford?
Pat Croskerry, Karen S. Cosby, Mark L. Graber, Hardeep Singh in Diagnosis, 2017
The escalating costs of diagnosis reflect a host of factors, including the ever-increasing complexity of medical care, new and better tests, increased utilization of expensive imaging, better access to medical care, increased adherence to recommendations for screening tests, and inevitably, some waste. It all adds up. Consider the costs of a simple chemistry test, like measuring serum calcium. Run as part of a multi-channel analyzer on 5 microliters of blood, the cost for the reagent is about 10 cents. The autoanalyzer can run over 1000 tests per hour! The final charge might well be $25, the difference reflecting the lab’s overhead for its clinical and administrative staff, the amortized cost of the $5 million instrument, and a healthy “profit” for the clinical lab, one of the few departments in the hospital that actually makes money for the institution.
Physiology and Disorders of Human Bilirubin Metabolism
Karel P. M. Heirwegh, Stanley B. Brown in Bilirubin, 1982
The quantitation of rubins is assessed in Chapter 4, Volume 1. Usually, assays149–152 in serum or plasma are based on treatment of the samples with diazotized sulphanilic acid in presence of an accelerating agent (total bilirubin) or in its absence (direct-reacting bilirubin). Estimation of total bilirubin by direct spectrophotometry is particularly useful in neonatology.153 Owing to the varying complexity of rubin composition in the blood and to lack of studies with reference compounds other than unconjugated bilirubin, the notions of direct-reacting and total bilirubin are chemically ill-defined (Chapter 4, Volume I). However, from a practical point of view they remain of key importance for clinical diagnosis and are the basis for distinguishing conjugated and unconjugated hyperbilirubinemia.154,155 More precise methods have recently been forthcoming, using novel approaches such as the alkaline methanolysis/HPLC technique.156–159 Further efforts remain necessary to render such techniques suitable for routine determinations and for use by an autoanalyzer.
Medicine, Technology and Industry
Roger Cooter, John Pickstone in Medicine in the Twentieth Century, 2020
Leonard Skeggs, a Cleveland (Ohio) biochemist who also ran the local VA hospital’s chemistry laboratory, faced with an increasing work load and inadequate staffing, set about trying to develop an instrument that could analyse blood on a continuous flow basis. Between 1951 and 1954 Dr Skeggs showed his prototype to four companies, all of which turned him down. In the early 1940s industry could not yet conceive of hospitals investing in such expensive instrumentation for the laboratory. Finally, in February 1954, a small company named Technicon, which had been in the health field since 1939, purchased the technology and went on to develop the ‘Autoanalyzer’ commercially. It remained the only automated blood chemistry analyzer on the market until 1963.
Serum osteoprotegerin level is positively associated with peripheral artery disease in patients with peritoneal dialysis
Published in Renal Failure, 2020
Wei-Chen Lin, Jen-Pi Tsai, Yu-Hsien Lai, Yu-Li Lin, Chiu-Huang Kuo, Chih-Hsien Wang, Bang-Gee Hsu
Biochemical tests were performed on morning samples obtained after an overnight 8–10 h fasting before the dialysis exchange. Approximately 5 mL of fasting blood samples were obtained and immediately centrifuged at 3000 × g for 10 min. Within 1 h of collection, blood samples were stored at 4 °C and used for biochemical analyses. An autoanalyzer (Siemens Advia 1800, Siemens Healthcare GmbH, Henkestr, Germany) was used to measure serum total calcium, phosphorus, fasting glucose, albumin, blood urea nitrogen, creatinine, total cholesterol, triglyceride (TG), and C-reactive protein (CRP) levels. A commercially available enzyme immunoassay or enzyme-linked immunosorbent assays were used to measure serum intact parathyroid hormone (iPTH) (Diagnostic Systems Laboratories, Texas, USA) and OPG (eBioscience Inc., San Diego, CA, USA) levels, respectively [12].
The Association of Measures of the Micro- and Macro-Vasculature with Selenium and GPx Activity in a Young Bi-Ethnic Population: The African-PREDICT Study
Published in Journal of the American College of Nutrition, 2019
Rijané Swart, Aletta E. Schutte, Johannes M. van Rooyen, Wayne Smith, Catharina M. C. Mels
After an overnight fast (8–10 hours), blood samples were collected from brachial antecubital vein branches with a sterile winged infusion set. Serum and plasma were prepared according to standard procedures and stored at −80 °C until biochemical analyses were performed. For the preparation of serum samples, the blood samples without any anticoagulant were allowed to clot on the bench for 30 minutes, after which it was centrifuged at 1600 g at room temperature for 30 minutes. For the preparation of ethylenediaminetetraacetic acid (EDTA) plasma samples, the blood tubes were centrifuged at 2500 g at 4 °C for 10 minutes, while sodium fluoride plasma samples were centrifuged at 2300 g at 4 °C for 10 minutes. Calibration curves were constructed for each new lot of reagents or when requested by the autoanalyzer used (COBAS INTEGRA 400 plus, Roche, Basel, Switzerland). The prescribed quality control material as indicated in the order information section of each test was used to assess accuracy of results. The quality assurance procedures as programmed by the supplier of the autoanalyzer used also consider other factors (e.g., bias), which may affect the quality of the results.
Effect of nocturnal melatonin intake on cellular damage and recovery from repeated sprint performance during an intensive training schedule
Published in Chronobiology International, 2020
Mohamed Amine Farjallah, Kais Ghattassi, Lobna Ben Mahmoud, Ahmed Graja, Mariem Boudaya, Henda Elleuch, Kamel Jammoussi, Zouheir Sahnoun, Nizar Souissi, Hamdi Chtourou, Omar Hammouda
AOPP levels were determined by the method of Kayali et al. (2006). GPx activity was quantified by the procedure of Flohe and Gunzler (1984). Plasma GR levels were measured as described by Weckbercker and Cory (1988). TBIL, UA, CK, ASAT and ALAT measurements were done as adapted for the autoanalyzer by Siemens ADVIA 1800 chemistry system (Erlangen, Germany). TBIL measurements were performed by a diazo reaction (Watson 1961). The total analytical imprecision of the TBIL method was 1.4% at 18 μmol·L−1 and 1.1% at 90 μmol·L−1. UA was determined by an enzymatic method at 550 nm (Suzuki et al. 1991). Intra-assay coefficient of variation for UA was <1.9%. CK was measured by the N-acetyl-L-cysteine method (Nealon and Henderson 1977). The intra-assay coefficient of variation for this parameter kit was 1.85%. ASAT was determined by measuring NADH oxidation with intra-assay coefficient of variation of 1.1% (Huang et al. 2006). ALAT was determined by the enzymatic rate method (Huang et al. 2006). The intra-assay coefficient of variation for this parameter was <8%. Hematological parameters were generally performed within 3 h of blood sampling by a multichannel automated blood cell analyzer Beckman Coulter Gen system-2 (Coulter T540) (Brittin et al. 1969). We measured simultaneously WBC and the principal derivative subpopulations (i.e., MO, NE, LY).
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