Developing and interpreting models to improve diagnostics in developing countries.
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Developing Countries↗
Biomedical subjects
Lee Hilborne
Publications and source records attributed to Lee Hilborne.
Patient safety in the clinical laboratory: a longitudinal analysis of specimen identification errors.
CONTEXT: Patient safety is an increasingly visible and important mission for clinical laboratories. Attention to improving processes related to patient identification and specimen labeling is being paid by accreditation and regulatory organizations because errors in these areas that jeopardize patient safety are common and avoidable through improvement in the total testing process. OBJECTIVE: To assess patient identification and specimen labeling improvement after multiple implementation projects using longitudinal statistical tools. DESIGN: Specimen errors were categorized by a multidisciplinary health care team. Patient identification errors were grouped into 3 categories: (1) specimen/requisition mismatch, (2) unlabeled specimens, and (3) mislabeled specimens. Specimens with these types of identification errors were compared preimplementation and postimplementation for 3 patient safety projects: (1) reorganization of phlebotomy (4 months); (2) introduction of an electronic event reporting system (10 months); and (3) activation of an automated processing system (14 months) for a 24-month period, using trend analysis and Student t test statistics. RESULTS: Of 16,632 total specimen errors, mislabeled specimens, requisition mismatches, and unlabeled specimens represented 1.0%, 6.3%, and 4.6% of errors, respectively. Student t test showed a significant decrease in the most serious error, mislabeled specimens (P < .001) when compared to before implementation of the 3 patient safety projects. Trend analysis demonstrated decreases in all 3 error types for 26 months. CONCLUSIONS: Applying performance-improvement strategies that focus longitudinally on specimen labeling errors can significantly reduce errors, therefore improving patient safety. This is an important area in which laboratory professionals, working in interdisciplinary teams, can improve safety and outcomes of care.
Clinical Laboratory Techniques↗
Fibrin sealant sclerotherapy for treatment of lymphoceles following renal transplantation.
PURPOSE: Fibrin sealant is used in various surgical fields for hemostasis and as an adhesive to approximate tissues. Its use was recently reported as a sclerosing agent for percutaneous treatment of lymphoceles following renal transplantation. We report on the use of fibrin glue sclerotherapy at this institution for the management of renal transplant related lymphoceles. MATERIALS AND METHODS: We reviewed the records of 8 patients at a single institution with lymphoceles after renal transplantation treated with percutaneous fibrin glue sclerosis. RESULTS: Treatment success was achieved in 6 patients (75%), with resolution of lymphoceles assessed with clinical and imaging findings. Four patients (50%) required 2 applications of fibrin sealant, with 2 (25%) subsequently requiring surgical management of the lymphoceles. Clinical followup averaged 27.7 months (range 4 to 44). Complications included lymphocele recurrence, clogging of drainage catheters and catheter dislodgement. CONCLUSIONS: The experience of 8 patients suggests that fibrin glue sclerotherapy may be considered a safe and effective method of treating symptomatic lymphoceles when simple percutaneous drainage has failed. The percutaneous approach does not require hospital admission and is less invasive than surgical treatment.
Adolescent↗
Visual acuity following cataract surgeries in relation to preoperative appropriateness ratings.
The authors initiated this study to consider if the formal preoperative assessment of appropriate or inappropriate utilization of cataract surgery by an expert panel could predict postoperative improvement or decline in visual acuity. They evaluated the association between ratings of appropriateness, as determined by the RAND-UCLA method, and measurements of postoperative visual acuity using Fisher's exact tests for tables greater than 2 x 2. For 768 patients, improvement of at least 2 Snellen chart lines occurred in 89% of surgeries rated as appropriate or appropriate and crucial, 68% rated as uncertain, and 36% rated as inappropriate (P < 0.0001, Fisher's exact test). These results provide evidence supporting the validity of the RAND-UCLA method to assess the appropriateness of surgery.
Aged↗