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Biomedical subjects

A Quinlan

Publications and source records attributed to A Quinlan.

16 recordsLinked to original sources
PubMed1999

Role of the toxic neutrophil count in the early diagnosis of Kawasaki disease.

OBJECTIVE: To determine whether the toxic neutrophil count (TNC), defined as the sum of the number of peripheral blood neutrophils with vacuoles plus the number with toxic granulations per 100 neutrophils examined, can be used as an aid to early diagnosis of Kawasaki disease (KD). METHODS: Prospective evaluation at a tertiary care pediatric hospital of 56 acutely febrile children with at least one other clinical criterion for KD. Clinical characteristics and TNC were compared for 3 groups of patients: those with (1) definite KD, (2) probable KD, and (3) unlikely KD. The sensitivity and specificity of the TNC at various cutoff points was determined. RESULTS: We evaluated 56 patients (Group 1, N=27; Group 2, N=4; Group 3, N=25). Mean TNC (TNC/mm3) were higher in the patients with definite KD compared to patients with unlikely KD (38 vs 24; p=0.037). At a TNC cutoff of > or =70, the test had a specificity of 100%, but a sensitivity of only 18%. The likelihood ratio (the number of times more likely this TNC result is to be found in KD versus non-KD subjects) was 8.89. At a cutoff of > or =10, the test had a high sensitivity of 92% and specificity of 38%. CONCLUSION: No laboratory test replaced the need for careful clinical evaluation in cases of suspected KD. The TNC may be a useful adjunct to the clinical assessment of children with KD, particularly at the extremes of measurement.

Child↗
PubMed1994

Innovations in case flow analysis: using midlier variance analysis.

This article presents the use of midlier and case flow analysis during a retrospective chart review to study the costs of hospital length of stay. The results showed that considerable savings can be realized by using these methods for one group of patients with the same diagnosis. We were able to redefine and track patients during their pre-, peri-, and postoperative period and estimated the time and cost opportunities for work flow improvement. We concluded that considerable savings are possible by extending the analysis to patients in other DRG groups.

Analysis of Variance↗
PubMed1994

Influencing physician behavior with CQI: a case study.

Health care reform will require unprecedented levels of cooperation among physicians, health care administrators, and other providers in order to ensure high-quality, affordable care for all. At the University of Massachusetts Medical Center, CQI techniques helped engage physicians in an effort to substantially alter ordering patterns to cut costs and achieve quality goals.

Academic Medical Centers↗
PubMed1991

Value of degenerative change in neutrophils as a diagnostic test for Kawasaki syndrome.

STUDY OBJECTIVE: To determine whether the presence of vacuoles and toxic granulation in neutrophils can be used as a diagnostic test to help differentiate children with Kawasaki syndrome from those with clinically similar illnesses. DESIGN: Peripheral blood smears of 23 patients with Kawasaki syndrome, 23 disease control patients, and 23 hematology laboratory control subjects were examined in random order by technicians unaware of either the diagnosis or the previously recorded laboratory results. SETTING: Tertiary care children's hospital in Ottawa, Canada. PATIENTS: All 23 consecutive patients with Kawasaki syndrome satisfied established criteria for the diagnosis. Disease control patients were selected from the hospital registry of patients with other illnesses frequently considered as part of the differential diagnosis for Kawasaki syndrome. MEASUREMENTS AND MAIN RESULTS: Compared with disease control patients, patients with Kawasaki syndrome had a higher percentage of neutrophils with vacuoles (mean +/- SEM, 31% +/- 5% vs 14% +/- 3%; p = 0.006) and toxic granulation (mean +/- SEM, 43% +/- 7% vs 14% +/- 4%; p less than 0.001). If the sum of the number of neutrophils with vacuoles and the number with toxic granulation (per 100 mature neutrophils examined) was at least 70, this "toxic neutrophil" test had a specificity of 0.96 and a likelihood ratio of a positive test result of 12. CONCLUSIONS: Degenerative change in neutrophils is common in the early stages of Kawasaki syndrome. The toxic neutrophil test is potentially a helpful adjunct to the clinical examination, particularly in the case of infants and other patients with subtle manifestations who might otherwise be at risk for delayed diagnosis.

Blood Sedimentation↗
PubMed1986

Quality assurance programs cope with today's demands.

Pathologists face new demands resulting from malpractice litigation, health regulations, increased competition, and heightened consumer activism. Yet despite the concerns about quality and cost that beset the field, the pathologist's mission remains the same: the provision of quality care. Against the backdrop of current pressures, the authors describe the benefits and organization of a quality assurance program to help achieve this goal.

Hospital Departments↗
PubMed1986

Risk management enhances quality care and protection from liability.

Two externally imposed economic pressures that grip the health care industry are on a collision course: tightening reimbursement and exploding costs of malpractice litigation and insurance. Physicians practice defensive medicine to cope with the latter, but regulatory agencies are no longer willing to pay for this habit. Pathologists must be aware of the laboratory's liability exposure, which is likely to increase in the future. Hospitals and physicians are turning to risk management programs to help limit potential losses and monitor performance.

Financial Management↗
PubMed1984

Survival after high blood alcohol levels. Association with first-order elimination kinetics.

A patient survived acute alcohol intoxication with an unprecedented blood alcohol level of 1,500 mg/dL. Treatment included peritoneal dialysis and intravenously administered fructose. Alcohol elimination followed first-order kinetics, in which the elimination rate is proportional to concentration, rather than zero order in which the metabolic rate is independent of concentration. The report provides further evidence for first-order elimination kinetics with high blood alcohol levels and for an adaptive increase in alcohol metabolism with long-term alcohol consumption.

Adult↗
PubMed1977

Effect of lead on globin synthesis in vitro.

A defect in heme synthesis is well documented to occur in lead intoxication. Globin synthesis and the alpha/beta globin chain synthesis ratio have been shown to be disturbed in lead poisoning. To elucidate further the nature of the inhibitory effect of lead on hemoglobin synthesis, reticulocyte-rich peripheral blood samples have been incubated with lead at concentrations of 10(-6), 10(-5), and 10(-4) M, equivalent to 20, 200, and 2,000 mug/dl (.96, 9.6 and 96.0 mumol/l), respectively. The incorporation of tritiated leucine into globin was determined. Globin chain synthesis decreased to 85, 49 and 15% of the control value with increasing lead concentrations. The effect of heme on inhibition of globin synthesis by lead was studied by incubating reticulocyte-enriched blood with lead 10(-5) M (200 mug/dl; 9.6 mumol/l) in the presence or absence of heme at a concentration of 10(-3) M. Lead alone depressed the incorporation of tritiated leucine to 45% of control, while globin synthesis with heme alone was 109% of control. Although in the presence of both heme and lead, the mean incorporation of leucine into globin was 69.2% of control, the increase was not significantly different from that obtained with lead alone. It is concluded that (1) lead has an inhibitory effect on globin synthesis at a concentration considered to be within the acceptable range encountered in environmental lead pollution, and the extent of inhibition is dose-dependent; (2) the effect of lead on globin synthesis is not significantly prevented by heme and, therefore, does not appear to be mediated through the well-documented inhibitory effect of lead on heme synthesis.

Dose-Response Relationship, Drug↗