Incorrect Testing Research Articles

Improving patient identification in an ophthalmology clinic using name alerts

ObjectiveTo develop a standardized process for reviewing daily patient lists and identifying potential risks of misidentification. Our goal was to develop a proactive approach to identify and eliminate risks of patient misidentification. MethodsAssessment of current patient identification practices took place over a period of 4 weeks. Using a process map, a patient survey was developed to determine the encounter points when patient identification was confirmed. This information was used to develop a standardized protocol for review of daily appointment lists. ResultsReview of daily appointment lists was completed to identify potential similar/same name risks. A standardized manual process of chart review, flagging, and tracking was developed. ConclusionsThe name alert process resulted in a simple manual process for identifying which patients have a higher name risk and allowed care providers to take preventative action to decrease potential risk of incorrect diagnostic testing, procedure, or medication administration.

European students are more likely to provide incorrect HIV testing indications as compared to other international students

<b>Introduction: </b> Expanding HIV testing is recognised as a major tool in halting the HIV epidemic. However, HIV testing is still advised inadequately by medical practitioners. Therefore we investigated medical students’ knowledge on HIV and indications for HIV testing. <br /> <b>Material and methods: </b>Fifth year students were pre-tested while entering the infectious diseases course. Questionnaires were anonymous and covered three areas: medical practice, transmission risk and indications for HIV testing. Logistic regression models were used to identify factors associated with incorrect responses to questions on HIV testing indications.<br /> <b>Results</b>: In total 224 students were included; 64% were female. The majority of students were from Europe (64.3%), followed by Asia (24.5%), North Africa (6.3%) and North America (4.9%); 72.8% were from high-income countries. Only 91 (41%) students provided correct indications for HIV testing, i.e. including sexual contacts, STDs or pregnancy in addition to medical condition. Over half (54%) listed only medical conditions related to immunodeficiency as an indication for HIV testing. In the multivariate logistic regression model the odds of incorrect indications for HIV testing were higher for European students (odds ratio (OR) = 2.56, 95% CI: 1.19–5.50; p < 0.016) and those overestimating the homosexual risk of HIV infection (OR = 1.03, 95% CI: 1.00–1.06; p = 0.026). The odds were lower for students overestimating the risk of mother-to-child transmission (OR = 0.97, 95% CI: 0.96–0.98; p < 0.001). <br /> <b>Conclusions</b>: Students tend to represent a condition-focused HIV testing approach, underscoring the importance of behaviour-related indications, as well as the asymptomatic character of HIV infection. This observation is especially relevant for students originating from Europe.

Effects of Between-classes Negative Relations Training on Equivalence Class Formation across Training Structures

This study compared three three-choice matching to sample (MTS) procedures on their probability to form equivalence relations for each of the three training structures: one to many (OTM), many to one (MTO), and linear series (LS). All three MTS procedures established the same within-class positive relations, but they differed in the number of between-class negative relations included in their baseline trials, with two in the standard (STD) matching procedure, one in the semi-standard (SEMI) procedure, and none in the altered (ALT) procedure. Positive and negative control baseline relations were assessed by using trials including novel stimuli or a blank comparison stimulus before symmetry and equivalence performance testing. The matching procedures did not differ in the rate of positive control that they yielded, but they did in the rate of negative control. The number of between-class negative relations in the baseline trials was directly related to the probability of equivalence class formation. However, this relation was different across training structures: it was lineal for the OTM structure, did not differ between the STD and SEMI procedures for the MTO structure, and did not differ between the SEMI and ALT procedures for the LS structure. Testing of positive baseline control by means of a blank comparison stimulus as an incorrect choice and testing of the negative baseline control by using novel stimuli as the correct choice proved more sensitive to the matching procedures and most discriminative between participants who formed equivalence relations and those who did not.

Pathway to Best Practice in Spirometry in the Ambulatory Setting.

Spirometry performed in the ambulatory setting is an invaluable tool for diagnosis, monitoring, and evaluation of respiratory health in patients with chronic lung disease. If spirometry is not performed according to American Thoracic Society (ATS) guidelines, unnecessary repeated testing, increased expenditure of time and money, and increased patient and family anxiety may result. Two respiratory therapists at Mission Health System in Asheville, NC, identified an increase in patients arriving at the pulmonary function testing (PFT) laboratories with abnormal spirometry results obtained in the ambulatory setting. These abnormal results were due to incorrect testing procedure, not chronic lung disease. Three training methods were developed to increase knowledge of correct spirometry testing procedure in the ambulatory setting. The therapists also created a plan to educate offices that do not perform spirometry on the importance and availability of PFT services at our hospital for the population of patients with chronic lung disease. Notable improvements in posttraining test results were demonstrated. The education process was evaluated by a leading respiratory expert, with improvements suggested and implemented. Next steps are listed.

Data Mining to Improve Laboratory Utilization and Patient Care

![Graphic][1] Laboratory testing is an integral part of modern medicine, with results influencing diagnosis, prognosis, and therapy. A number of published studies have focused on problems with laboratory utilization (“mis-utilization”) and interventions to improve test ordering,1,2 including over-utilization (ordering too many tests), under-utilization (not ordering clinically indicated testing), and ordering incorrect testing. Inappropriate test utilization can have a variety of adverse consequences, including iatrogenic blood loss, missed diagnoses, patient anxiety, unnecessary referrals, need for additional diagnostic tests, and patient financial liability for unreimbursed test costs. With a growing focus on healthcare costs, clinical laboratories are often tasked with improving laboratory utilization, while also remaining conscious of ensuring patients receive the appropriate testing for optimal patient care. ![Graphic][2] The focus on laboratory test utilization has primarily been on two major categories of testing.1 The first is high-volume, automated tests such as complete blood count and routine chemistry tests. Common interventions to tackle over-utilization of high-volume tests include limits on repetitive ordering, providing information to providers on ordering patterns and costs, and posting price information for tests in the electronic health record (EHR). The second category of testing that is often targeted is low-volume but very high-cost orders such as panels of genetic tests. These tests may have direct costs of thousands of dollars and sometimes poor reimbursement by health insurance. Frequent strategies for managing high-priced esoteric testing include requiring pre-approval prior to ordering (by pathology or other designated group) and limitation of certain tests to specific medical specialties. Some institutions have developed “laboratory test formularies” (following a model commonly employed by pharmacies), with a formal process for placing tiered restrictions on specific tests. ![Graphic][3] Hospital EHRs and laboratory information systems (LISs) contain large amounts of data that can potentially be analyzed to improve utilization of laboratory testing. Yet, a major … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif

Thinking about U: Theorizing and testing U‐ and inverted U‐shaped relationships in strategy research

Research summary:U‐ and inverted U‐shaped relationships are increasingly explored in strategy research, with 11 percent of all articles published in Strategic Management Journal (SMJ) in 2008–2012 investigating such quadratic relationships. Moreover, a movement towards introducing moderation to quadratic relationships has emerged. By reviewing 110 articles published in SMJ from 1980 to 2012, we identify several critical issues in theorizing and testing of these relationships for which current practice falls short. These include insufficient causal argumentation, incorrect testing, mixing up two different types of moderation, and not realizing that the curve can flip completely. For these and other issues, a guideline is provided which, when followed, may bring clarity to theoretical motivation and rigor to empirical testing.Managerial summary:Too much can be as bad as too little. Many relationships in strategic management follow an inverted U‐shaped pattern, where moderate levels of a strategy lead to optimal performance. To gain deeper insights into the conventional wisdom that too much of a good thing can be harmful to performance, we discuss how such relationships can be better theorized and tested based on a review of articles exploring U‐shaped relationships in Strategic Management Journal during 1980–2012. We identify several critical issues that require close attention and provide a guideline to further develop and validate this important managerial intuition. Copyright © 2015 John Wiley & Sons, Ltd.

Practical implementation of recommendations concerning diagnostic procedures in gestational diabetes

Gestational diabetes mellitus (GDM) is associated with health consequences for both, the mother and her offspring. In Poland, the diagnosis of GDM is based on the recommendations of the Polish Gynecological Society (PTG) and is usually made by obstetricians. The aim of the study was to assess practical implementation of PTG standards of GDM screening and diagnosis. The study group consisted of 351 pregnant women consulted by a diabetologist: 102 patients between 2008-2010 (PTG guidelines of 2005) and 249 patients between 2011-2013 (PTG guidelines of 2011). Data concerning diagnostic procedures performed by obstetricians--time of diagnostic tests, fasting glucose levels, oral glucose tolerance test (OGTT) results, and GDM risk factors--were collected. Adherence to the diagnostic procedures was assessed. Adherence to the diagnostic guidelines for 2008-2010 was 42.2%. The most common errors were incorrect time of OGGT (36.4%) and wrong interpretation of glycaemia (34.1%). Between 2011-2013 incorrect diagnostic testing was detected in 78.3% of the affected women. The most common deviation was lack of OGTT at the beginning of pregnancy in women with GDM risk factors (91.3%). A considerable number of GDM women underwent incorrect diagnostic procedures. More precise description of GDM risk factors in PTG recommendations seems to be necessary.

Effects of 2D misalignment on tensile results and corresponding correction methods to obtain the true stress–strain curve

In miniature horizontal-type in situ tensile devices, misalignments on the horizontal and vertical plane cause shearing and bending effects in the specimen and further lead to incorrect testing results of mechanical parameters. To investigate the effects of misalignment between the tensile axis and the specimen’s geometrical axis on the testing parameters and obtain the true stress and strain relationship, two correction methods based on linear deformation and deflection curve deformation were proposed, and the effect laws of the horizontal deviation angle α and vertical deviation angle β on mechanical parameters were analyzed. The feasibility of the proposed correction methods was verified with the help of a miniature device integrating a modified Arcan fixture. The establishment of α was achieved by adjusting the relative angle between the device and Arcan fixture, and the establishment of β was achieved by adding thin copper pieces under one of the fixtures. The experimental tests indicated that when adopting the deflection curve deformation correction method, the obtained corrected mechanical parameters were similar to the results obtained from the uniaxial tensile test. The correction methods could be appropriate for the calculation of the true stress–strain curve on the condition of 2D misalignment, particularly for the correction of testing results obtained by in situ tensile devices with compact structure and miniature size.

Modelling of the lock-in thermography process through finite element method for estimating the rail squat defects

Squats are a major problem on the world railways. The non-destructive evaluation technique is becoming increasingly attractive in the detection of near surface defects on track. Non-destructive thermal evaluation is one such method of inspection technique that can be used for the detection of near surface defects. Its sub-group of lock-in thermography is under analysis. Lock-in thermography utilizes an infrared camera to detect the thermal waves and then produces a thermal image, which displays the local thermal wave variation in phase or amplitude. There are few studies into the actual experimental representation of complex subsurface defects when concerning lock-in thermography processes. While this may be less of a concern given the purpose of numerical defect characterization to reduce the need for extensive experimental pre-tests, the necessity for (artificial) representations of a defect will inevitably be required for validation. The research outlined in this paper examines the use of 3D finite element modelling (FEM) as a potential flexible tool in simulating the lock-in thermography process for detecting squats in track. In addition, lock-in analysis proved that the correct frequency range had to be selected for the material to detect the defect. As maximum positive and negative phase angles were located at “optimum” frequencies, at certain frequencies lead to minimal phase angle difference to which the defects were not detectable (blind frequency) by using the incorrect testing. The 3D finite element method has advantage for determining the “optimum” thermal excitation frequencies compare with experimental investigation. The experimental results show that 3D FEM models can be used to defect the location and the depth of squats in the railway.

Genetic Counseling in Oncology

To the Editor: Dr Tung’s review of the difficult decisions faced by women with a BRCA mutation mentioned the importance of genetic counseling in the process of clinical decision making. Decisions about definitive breast surgery, prophylactic oophorectomy, and fertility options such as preimplantation diagnosis increasingly are being informed by the awareness of a BRCA mutation. Tung commented on the importance of compensating hospitals and physicians for trained genetic counselors. Fragmented reimbursement of genetic services has limited integration of genetic counselors into a collaborative oncology care model. However, we propose reframing the question from compensation of hospitals and physicians to determining how genetic counselors—many of whom are licensed to practice independently—could be reimbursed in a manner that is in the best interests of patients, clinicians, and health care systems. Currently Medicare does not recognize genetic counselors as “providers.” Recognition would lead to increased coverage by payers and benefit patients by improving access to genetic counseling. Institutions in which genetic counselors practice with physicians would benefit by increasing their efficiency in delivering genetic services. Genetic counselor certification ensures they are proficient in selecting appropriate genetic tests and interpreting them correctly. Appropriate use of genetic testing can reduce health system costs, contrary to a recent study in which a majority of nongeneticist physicians would order unnecessary or incorrect BRCA testing at considerable additional cost. Finally, Tung states that “most genetic counseling programs cost more than they generate in revenue.” This may reflect an incomplete accounting. Any truly useful calculation of the institutional value of genetic counseling programs must include a careful study of the “downstream revenue” institutions receive from performing surveillance, prophylactic surgery, or cancer treatment for individuals with BRCA mutations.

Evaluation Results of 21th Iranian External Quality Assessment Schemes (EQAS) of Microbiology laboratories in 2007

The aim of this study was to determine ability of Iranian microbiology laboratories for identification and susceptibility testing of two unknown microorganisms. In Feb 2007 21st run of proficiency testing of Iranian microbiology laboratories carried out by Iranian reference health laboratories. In this survey two unknown microorganisms including Salmonella paratyphi B and Staphylococcus aureus were submitted to 1305 microbiology laboratories. Of 1305 laboratories, 1122(.86%) laboratories participated in our survey and 183 (14%) laboratories did not participated in our program. Of 1122 laboratories, 523(46.6%) laboratories identified S.paratyphi B correctly. The results of susceptibility testing of S.paratyphi B were relatively satisfied for nalidixic acid, ciprofloxacin and trimethoprim-sulfamethoxazole. However the results of susceptibility testing for tetracycline and ampicillin were unsatisfied and only 578 (52.5%) and 558 (49.7%) Of laboratories reported correct answer for tetracycline and ampicillin respectively. Regarding to identification Staphylococus aureus of 1122 laboratories 767 (68.4%) identified this organism correctly It is concluded that the majority of microbiology laboratories were able for identification of S.parathyphi B and S.aureus. Nearly 50% of laboratories produced incorrect susceptibility testing answer according to S.paratyphi B for tetracycline and ampicillin.

Visual Field Quality Control in the Ocular Hypertension Treatment Study (OHTS)

To report the impact of visual field quality control (QC) procedures on the rates of visual field unreliability, test parameter errors, and visual field defects attributed to testing artifacts in the Ocular Hypertension Treatment Study (OHTS). OHTS technicians were certified for perimetry and were required to submit 2 sets of visual fields that met study criteria before testing study participants. The OHTS Visual Field Reading Center (VFRC) evaluated 46,777 visual fields completed by 1618 OHTS participants between February 1994 and December 2003. Visual field QC errors, rates of unreliability, and defects attributed to testing artifacts were assessed. The OHTS QC system addressed 3 areas of clinic performance: (1) test parameter errors, (2) patient data errors, and (3) shipment errors. A visual field was classified as unreliable if any of the reliability indices exceeded the 33% limit. Clinical sites were immediately contacted by the VFRC via fax, e-mail, and/or phone and instructed on how to prevent further testing errors on fields with defects attributed to testing artifacts. QC errors (test parameter errors) and unreliability rates. A total of 2.4% (1136/ 46,777) of the visual fields were unreliable and 0.23% (107/46,777) had incorrect test parameters. Visual field defects attributed to testing artifacts occurred in approximately 1% (483/46,777) of the visual fields. Prompt transmission of visual fields to the VFRC for ongoing and intensive QC monitoring and rapid feedback to technicians helps to reduce the frequency of unreliable visual fields and incorrect testing parameters. Visual field defects attributed to testing artifacts were infrequent in the OHTS.

Intelligent web-based learning system with personalized learning path guidance

Personalized curriculum sequencing is an important research issue for web-based learning systems because no fixed learning paths will be appropriate for all learners. Therefore, many researchers focused on developing e-learning systems with personalized learning mechanisms to assist on-line web-based learning and adaptively provide learning paths in order to promote the learning performance of individual learners. However, most personalized e-learning systems usually neglect to consider if learner ability and the difficulty level of the recommended courseware are matched to each other while performing personalized learning services. Moreover, the problem of concept continuity of learning paths also needs to be considered while implementing personalized curriculum sequencing because smooth learning paths enhance the linked strength between learning concepts. Generally, inappropriate courseware leads to learner cognitive overload or disorientation during learning processes, thus reducing learning performance. Therefore, compared to the freely browsing learning mode without any personalized learning path guidance used in most web-based learning systems, this paper assesses whether the proposed genetic-based personalized e-learning system, which can generate appropriate learning paths according to the incorrect testing responses of an individual learner in a pre-test, provides benefits in terms of learning performance promotion while learning. Based on the results of pre-test, the proposed genetic-based personalized e-learning system can conduct personalized curriculum sequencing through simultaneously considering courseware difficulty level and the concept continuity of learning paths to support web-based learning. Experimental results indicated that applying the proposed genetic-based personalized e-learning system for web-based learning is superior to the freely browsing learning mode because of high quality and concise learning path for individual learners.

Failure of bedside ABO testing is still the most common cause of incorrect blood transfusion in the Barcode era

Background and objectives. ABO-incompatible red blood cell (RBC) transfusions are a major risk in transfusion medicine. Identification of factors leading to this hazard is important to improve transfusion safety. Material and methods. All consecutive erroneous ABO-incompatible transfusions occurring from January 1997 to December 2004 at the Charité University Hospital in Berlin, Germany were analysed. Results. A total of 343,432 RBC units were transfused, and eight patients erroneously received 13 ABO-incompatible RBC concentrates. The most frequent error was incorrect bedside testing ( n = 7). Intensive care treatment was required in two cases, but there were no fatal mistransfusions. Four patients had no or only mild reactions. Conclusion. Mistransfusions are still a considerable risk in transfusion medicine despite quality control systems and electronic data processing. An increase in transfusion safety may require the introduction of further systems, e.g. radio-frequency identification (RFID) tags.

SHOULD RESULTS FROM GENETIC RESEARCH BE RETURNED TO RESEARCH SUBJECTS AND THEIR BIOLOGICAL RELATIVES?

1. Introduction Medical research focusing on genetic disorders and changes will occasionally generate knowledge about a research subject's possible carrier status and his or her current or future disease. Furthermore, the knowledge gained often pertains not only to the subjects but also to their biological relatives. In this paper, I address the question of how to treat personal information about disease and hereditary dispositions, resulting from research, including information that not only affects individuals, but can also be of interest to their biological relatives. First, I ask whether results should be returned at all. Perhaps the best way to keep difficulties at bay would be to avoid the issue. Second, if a case can be made for the desirability of returning information to the individual, I will ask whether this individual's biological relatives have a right or duty to know about familial information that may greatly affect their lives. How do we weigh the arguments? As Crouch and Elliott point out (1999:275), when it comes to decisions about the family, the tools of moral philosophy and the law have not always served us well, particularly when the question involves exposing one family member to risks for the sake of the other. I discuss how family ethics and a certain conception of autonomy challenge the often-undisputed notion of nondirectiveness. In this paper, I map the ethical terrain and provide reminders about important features, both moral and factual, that should guide any assessment of policymaking in this area. I do not try to propose what any individual should do in any particular situation. We need to remember that no ethical deliberation of the kind offered here can replace the subject's responsibility for his or her own actions. Facing up to responsibility and interacting with family members are identity-shaping actions and are thus closely connected to a person's innermost being. In Margaret Walker's words, in doing such things a person exercises moral self-definition (Walker 1987). 2. Should research results be returned to subjects? Those who answer this question in the negative do so on principle or because of misgivings concerning the results' usefulness. The first type of objection asserts that it is never necessary to return results to subjects, as this should not be the investigators' first priority. This argument merits discussion, and I will return to it below. Discussions of usefulness point to the quality of results. There is a concern that different types of errors could have crucial consequences, as individuals may change their entire lives because of a test result. With genetic information, an error may also greatly affect family (see, e.g. Fost and Farrell 1989). In the case of predictive information, it may be a long time before an error or a misinterpretation is recognized. One must be aware of the risk of errors due to situations such as misidentification or contamination of samples, incorrect testing procedures or transcription errors. A research laboratory seldom meets the same expectations regarding quality control as would a diagnostic laboratory. Therefore, strong requirements must be placed on the quality of results. This serves the initial purpose of limiting the results that may be considered for a return. Results from research are often very uncertain, difficult to interpret, or even not applicable to the individual. These shortcomings pertain to screening tests in general (Sasse 2002), not least since genetic prognostications apply mostly to the aggregate rather than individuals (Finkler et al. 2003:404). Hence, it can be said that information to be considered for disclosure must be such that is applicable to an individual, reasonably legible, and reliable--that it springs from a relatively certain research result (i.e., its sensitivity and specificity). To be a basis for information to be shared, knowledge should furthermore indicate that harm is foreseeable (the subject is at risk), that it is likely (e. …

Follow-up of infants of hepatitis B-infected women after hepatitis B vaccination, Connecticut, 1994 to 1997.

Follow-up of infants of hepatitis B-infected women after hepatitis B vaccination, Connecticut, 1994 to 1997.

Blood component recalls in the United States.

United States blood suppliers are required to recall marketed blood components later found to be in violation of Food and Drug Administration (FDA) regulations for safety, purity, and potency. Many recalled units have already been transfused. Analysis of the frequency and nature of blood component recalls would be useful for blood suppliers, transfusion services, and physicians. Each blood component recall in the weekly FDA Enforcement Report from 1990 through 1997 was examined for the number of units, recall reason, and hazard class. Units for manufacturing were excluded. In 8 years, an estimated 241,800 blood components were recalled, or approximately 1 in 700 units available to US hospitals. Eighty-eight percent of recalled units were in 22 large recalls of over 1000 units each. The most common reasons were incorrect testing for syphilis (57% of units) or viral markers (19%), reactive or previously reactive donor viral markers (6-11%), and inadequate donor-history screening (4%). Twelve units were in the FDA's highest hazard Class I, 24 percent were in Class II, and 76 percent were in Class III. Over 43,900 units had HIV-related problems, but only 3 units involved HIV transmission. Large recalls have declined since peaking in 1995, but units in small recalls increased 116 percent in 1997 over the previous 7-year average. Although high-risk recalls are rare, many blood component recalls pose medical concerns for physicians and patients. The recent decline in large recalls may be due to increased FDA oversight, stricter accreditation standards for quality improvement, and more centralized donor testing in large specialized laboratories. However, smaller recalls, which involve nearly all blood suppliers, were sharply higher in 1997.

An intraweek seasonality in the implied volatilities of T-bond and T-note options

This paper initiates the study of intraweek seasonalities in the implied volatilities of options on futures contracts on U.S. Treasury bonds and notes. Research on intraweek regularities is important to public policy because the structure and usage of derivative markets is a regulatory issue. The topic is also important to discussions of market efficiency. For example, empirical observation of various trading regularities has stimulated research into market closing effects, weekend perturbations in discount rates, and patterns in news dissemination. Other theoretical topics which are stimulated by day-of-the-week research are models of bid-asked spreads (Roll [21]), trading concentration due to the interaction of liquidity and information traders (Admati and Pfleiderer [l]), and the role of noise and its effect on liquidity (Black [4]). Poole [20] and Eisemann and Timme [4] discuss the micro-mechanics of the Federal Reserve system and the Federal funds market. Stigum [23] and Melton [16] provide anecdotal evidence of high Friday and Wednesday volatility of the Federal funds rate. Dyl [7] concludes that Friday Federal funds rates are on average higher than other days. Spindt and Hoffmeister [22] explain how the mechanics of the Federal funds system lead to high variability of rates on Friday, especially on the second Friday of each reporting period. Findings of intraweek regularities have often been accompanied by analysis of particular institutional features or related anomalies (see, for example, PhillipsPatrick and Schneeweis [19] who relate high Monday dividends to the putative Monday effect in stocks, or Jaffe and Westerfield [12] who study the effects of currency seasonals and clearing procedures in the weekend effect context). A healthy skepticism should prevail in all discussions of intraweek regularities. Using a Bayesian approach, Connally [S] claims that most perceived anomalies of this type are due to incorrect hypothesis testing procedures, unduly large samples and historical accidents.

Controversies in Thyroid Function Testing

Thyroid function tests can be abnormal in certain patients in the absence of thyroid dysfunction. All thyroid function tests can be affected in these patients, including the free thyroxine assays and free thyroxine index. Familiarity with the conditions affecting thyroid function tests is necessary to avoid incorrect diagnosis and unnecessary testing.