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PubMedDate not supplied

Automated external defibrillators in National Collegiate Athletic Association Division I Athletics.

BACKGROUND: Sudden cardiac death is the leading cause of death in athletes. Evidence on current sudden cardiac death prevention through preparticipation history, physicals, and noninvasive cardiovascular diagnostics has demonstrated a low sensitivity for detection of athletes at high risk of sudden cardiac death. Data are lacking on automated external defibrillator programs specifically initiated to respond to rare dysrhythmia in younger, relatively low-risk populations. METHODS: Surveys were mailed to the head athletic trainers of all National Collegiate Athletic Association Division I athletics programs listed in the National Athletic Trainers' Association directory. In all, 303 surveys were mailed; 186 departments (61%) responded. RESULTS: Seventy-two percent (133) of responding National Collegiate Athletic Association Division I athletics programs have access to automated external defibrillator units; 54% (101) own their units. Proven medical benefit (55%), concern for liability (51%), and affordability (29%) ranked highest in frequency of reasons for automated external defibrillator purchase. Unit cost (odds ratio = 1.01; 95% confidence interval, 1.01-1.0), donated units (odds ratio = 1.92; confidence interval, 3.66-1.01), institution size (odds ratio =.0001; confidence interval, 1.3 E-4 to 2.2E-05), and proven medical benefit of automated external defibrillators (odds ratio = 24; confidence interval, 72-8.1) were the most significant predictors of departmental defibrillator ownership. Emergency medical service response time and sudden cardiac death event history were not significantly predictive of departmental defibrillator ownership. The majority of automated external defibrillator interventions occurred on nonathletes. CONCLUSIONS: Many athletics medicine programs are obtaining automated external defibrillators without apparent criteria for determination of need. Usage and maintenance policies vary widely among departments with unit ownership or access. Programs need to approach the issue of unit acquisition and implementation with knowledge of the surrounding emergency medical service system, geography of their individual sports medicine facilities, numbers and relative risk of their athletes, and budgetary constraints.

Chi-Square Distribution↗
PubMed2006

Bias due to false-positive diagnoses in an automated health insurance claims database.

BACKGROUND AND OBJECTIVE: Automated database studies have become a cornerstone of drug safety assessment. To assess the reliability of automated data, we compared the hospitalisation and mortality rates among three similar studies of automated healthcare databases in North America. METHODS: Similar protocols were used to identify patients diagnosed with chronic obstructive pulmonary disease (COPD) who were treated with inhaled bronchodilators or inhaled corticosteroids in the Saskatchewan Health Database (SHD), the Kaiser Permanente Medical Care Program (KPMCP) of Northern California, and a proprietary automated insurance claims database available from i3 (formerly Ingenix). Automated data were used to compute incidence rates of total hospitalisation, cardiovascular (CV) hospitalisation and hospitalisation due to several specific types of CV outcomes. Record linkage with registries of vital statistics was used to identify deaths, obtain death certificates, and compute rates of total mortality, CV mortality and deaths due to certain CV outcomes. We compared rates in the i3 population with rates in the other two populations using age-adjusted rate ratio estimates and 95% CIs. RESULTS: The i3 cohort had approximately one-half the rates of total mortality, CV mortality and total hospitalisations, but twice the rate of CV hospitalisations, compared with each of the other two database cohorts. DISCUSSION: The unexpectedly higher rates of CV hospitalisations in the i3 population are inconsistent with its lower CV mortality, total mortality and total hospitalisation rates. This discrepancy is not readily explained by a higher prevalence of CV disease or procedures, random variation or confounding. Instead, high CV hospitalisation rates in the i3 population are consistent with a high rate of false-positive diagnoses recorded on insurance billing claims. CONCLUSION: These results underscore the importance of ensuring valid endpoints in automated claims databases.

Bias↗
PubMed1992

Automation of the Kaolin Clotting Time.

An automated Kaolin Clotting Time (KCT) has been developed to simplify screening for the Lupus Anticoagulant (LA). The assay is performed on the ACL300 Research coagulation analyser, but may be modified for other centrifugal analysers. Automation of the KCT allows up to 17 delta KCT (delta KCT) screens (Gibson J, Starling E, Date L et al. Simplified screening procedure for detecting lupus inhibitor. J Clin Pathol 1988; 44: 226-31) or 2 full Exner curves (Exner T, Rickard KA, Kronenberg H. A sensitive test demonstrating lupus anticoagulant and its behavioural patterns. Br J Haematol 1978; 40: 143-51) to be performed in one test cycle. An automated and manual delta KCT screen was performed on 17 patients with a previously diagnosed LA, 41 hospital patients having routine coagulation studies and 37 blood donors. In addition, 11 patients on full-dose heparin and 12 patients with stable warfarin anticoagulation were tested. The correlation between the automated delta KCT and the manual delta KCT was 0.958 (p less than 0.001). A full Exner curve was performed on 5 of the patients with a LA and 1 blood donor which demonstrated that the automated KCT produced results entirely comparable with the manual method. The automated KCT is a quick, inexpensive approach to screening patients for the presence of LA.

Blood Coagulation Tests↗
PubMedDate not supplied

Autologous keratophakia for the correction of consecutive hyperopia after automated lamellar keratoplasty for myopia.

PURPOSE: Consecutive hyperopia occurs if too much corneal tissue is resected during automated lamellar keratoplasty for myopia. We report what are, to our knowledge, the first two cases of consecutive hyperopia after automated lamellar keratoplasty that were treated by keratophakia with autologous corneal tissue. METHODS: The patient in case 1 had a spherical equivalent refraction of +3.38 diopters (D) and the patient in case 2 a refraction of +3.63 D in each eye after automated lamellar keratoplasty for myopia. Corneal tissue from the contralateral eye of each patient was obtained with an automated microkeratome and transferred to the overcorrected eye in an autologous keratophakia procedure. RESULTS: The patient in case 1 had an unaided visual acuity of 20/20, with a spherical equivalent refraction of +0.63 D 4 months after the autologous keratophakia. The patient in case 2 had an unaided visual acuity of 20/60, with a spherical equivalent refraction of -2.25 D 2.5 months postoperatively. CONCLUSION: These two cases illustrate the use of simultaneous contralateral myopic automated lamellar keratoplasty with autologous keratophakia to treat eyes overcorrected following previous automated lamellar keratoplasty for myopia.

Adult↗
PubMed1985

Automated leukocyte differential counters.

The leukocyte or white blood cell (WBC) differential count has been an established laboratory examination for almost a century. In recent years, the number of clinicians' requests for the test has grown steadily, and presently over 1,000,000 WBC differentials are performed daily in the United States. The manual WBC differential count requires tedious and repetitious cell classification, which is prone to subjective bias. Quite understandably, the WBC differential count has been a prime candidate for automation. Manufacturers have developed automated WBC differential counters that are accurate and that more precisely classify WBCs than do experienced morphologists. However, the WBC differential count, initially controversial because of technologists' subjective cell classification, has again become an object of debate following the substitution of automated instruments to perform cell identification. Instead of significantly better test results, automated WBC differential counters have demonstrated that variables inherent in the methodology, which cannot be controlled by automated techniques, limit the validity of information derived from the WBC differential. This report discusses the issues surrounding the use of automated WBC differential counters that need to be addressed by those contemplating acquisition of the technology. More fundamental questions are also explored, i.e., if the acknowledged clinical utility of the WBC differential in its present status is limited, what alternatives are available, and is investment in the currently available technology prudent?

Autoanalysis↗
PubMed2002

Modification of fully automated total iron-binding capacity (TIBC) assay in serum and comparison with dimension TIBC method.

BACKGROUND: We previously reported the development of a fully automated assay for total iron-binding capacity (TIBC) in serum, using a multipurpose automated analyzer. However, this method requires four different reagents and is thus useful only with a limited number of available analyzers. We simplified our original assay and compared the analytical performance of the modified method with that of a commercial, fully automated TIBC assay (Dimension TIBC assay). METHODS: We simplified our original method to require only three reagents. Calibration was also altered and was performed with human transferrin standard solutions. An advantage of this method is that it does not require separation of excess unbound iron after the first step of transferrin saturation. Unbound iron is eliminated by formation of a complex with the chromogenic reagent ferrozine in the second step. Iron dissociated from transferrin by acidic pH reacts with ferrozine to form a colored complex in the final step, and the increase in absorbance at 570/660 nm is directly proportional to the TIBC measured. TIBC values were determined for 49 healthy individuals and 148 patients with this modified TIBC assay and with a commercial, fully automated TIBC method (Dimension clinical chemistry system), and calculation of TIBC based on the sum of the serum iron and unsaturated iron-binding capacity was performed for 97 patients. RESULTS: The within-run CVs for the modified TIBC assay and the Dimension TIBC assay were <4.8% and <2.4%, and the between-run CVs were 1.2% and 1.7%, respectively. The dilution curves were linear for TIBC values up to at least 180 micromol/L with both methods. TIBC values obtained by our method were linearly correlated with serum transferrin concentrations (r = 0.984; S(y/x) = 3.18 micromol/L; P <0.001). The correlation between the values obtained with the present method (y) and those obtained with the Dimension TIBC method (x) was y = 1.04x + 1.19 micromol/L (r = 0.985; S(y/x) = 2.47 micromol/L), and with the calculation method (x) was y = 1.18x + 2.62 micromol/L (r = 0.976; S(y/x) = 3.27 micromol/L). CONCLUSIONS: Our modified, fully automated TIBC assay performed similarly to the Dimension TIBC assay and is adaptable for use with many multipurpose automated analyzers.

Autoanalysis↗
PubMed2005

Clinical testing of an optimized software solution for an automated, observer-independent evaluation of dopamine transporter SPECT studies.

UNLABELLED: A lack of standardized evaluation procedures for dopamine transporter (DAT) SPECT investigations impairs both intra- and interindividual comparisons as well as multicenter trials-for example, for assessment of disease progression or the response to various drug treatments. Therefore, the aim of this study was to evaluate a novel automated method, which has been specifically developed for a standardized quantification of N-(3-fluoropropyl)-2beta-carbomethoxy-3beta-(4-iodophenyl)nortropane (123I-FP-CIT) SPECT studies. METHODS: DAT binding ratios of 155 (123)I-FP-CIT SPECT studies in 14 control subjects and 141 patients referred to confirm or exclude a presynaptic dopaminergic deficit were determined manually and by a fully automated technique. The latter included coregistration of patient studies to an 123I-FP-CIT mean template of controls with specialized, nonrigid adjustment for variation in striatal location, followed by calculation of specific striatal DAT binding using a standardized 3-dimensional volume-of-interest (VOI) map. The map is based on a MR scan and covers the striatum (S), caudate (C), putamen (P), and an occipital reference region. The semiquantitative ratios of both methods were compared with the visual findings. RESULTS: Excellent linear correlations were observed between manually and automatically determined results (S: r = 0.99; C: r = 0.99; P: r = 0.99; P < 0.001, respectively). Automated evaluations delivered highly reproducible and visually exact coregistrations. Individual variations in striatal anatomy (e.g., atrophy) were considered and VOI positions were corrected before quantification. Both the manual and the automated method showed identical accuracy in supporting the visual diagnoses. CONCLUSION: In a large patient population, excellent agreement was observed between quantitative DAT results using a time-consuming, observer-dependent, conventional manual method and the objective, automated evaluation specifically developed for a standardized evaluation of 123I-FP-CIT SPECT studies. It is suggested that the novel automated technique may substantially facilitate both intra- and interindividual comparisons as well as multicenter trials.

Adult↗
PubMed2006

Comparison of two methods (precipitation manual and fully automated enzymatic) for the analysis of HDL and LDL cholesterol.

OBJECTIVE: To compare accuracy and throughput time for the measurement of HDL and LDL cholesterol by manual precipitation and fully automated enzymatic methods. METHODS: Fifty, serum samples collected over a 4 months period (February - May 2004) were analyzed for HDL and LDL cholesterol by two different methods i.e. precipitation manual and automatic enzymatic method in the section of chemical pathology, Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi Pakistan. RESULTS: The mean standard deviation for HDL Cholesterol by precipitation method and automated method were 43.12 +/- 8.97mg/dl and 43.86 +/- 10.34mg/dl respectively (p-value = 0.301). The mean standard deviation for LDL cholesterol by precipitation method and automated method were 111.76 +/- 25.57mg/dl and 111.8 +/- 28.41mg/dl respectively (p-value = 0.981). The calculated "t" and "F" value for HDL-C was 0.0172 and 0.75 respectively, and calculated "t" and "F" values for LDL-C were 0.047 and 0.809 respectively. Average time for manual method was 45 minutes and automation 20 minutes. CONCLUSION: Both the precipitation (manual) method and the automated method provide reliable, precise and accurate results. In both the methods "t" and "F" values were less than critical. Automated method provide high throughput and are less labor intensive. The choice of method can depend on laboratory facilities and workload

Autoanalysis↗
PubMed1989

Serum fructosamine determination as an index of glycaemic control: comparison between an automated and manual method, and the effect of serum storage.

The measurement of glycated serum proteins was recently introduced as an alternative index of diabetic control of glycated haemoglobin. Manual and automated serum fructosamine colorimetric assays are available for glycated serum proteins determination. We have assessed two serum fructosamine assays, an automated and a manual method, and compared them with a glycated haemoglobin assay. We also studied the effect of serum storage on serum fructosamine concentrations. Serum fructosamine at four different concentrations measured by automated method gave an inner-assay of a 2% (range 1.29 - 1.56%) and an inter-assay variation of 3% (range 1.63-2.92%). There was a good correlation between the automated and manual methods, with a coefficient of r = 0.944. Serum fructosamine by either method is a sample assay to perform and is relatively inexpensive. With automated analysis, a large number of tests can be performed more rapidly. Comparing serum fructosamine with glycated haemoglobin, coefficients = 0.54 (automated) and r = 0.50 (manual) were obtained. An increase in serum fructosamine by 5-20% occurred when the assay is performed on serum samples stored for more than two weeks. It is recommended therefore that test should be performed soon after blood collection, preferably within one week.

Blood Glucose↗
PubMedDate not supplied

Automated sample cleanup for pesticide multiresidue analysis. III. Evaluation of complete system for screening subtolerance residues in vegetables.

An automated continuous flow sample cleanup system intended for rapid screening of foods for pesticide residues in fresh and processed vegetables has been developed. Recovery and precision data for 8 pesticides in each of 3 crops are compared for the automated and manual procedures. Average recovery for samples fortified with pesticides between 0.026 and 0.277 ppm was 98% for the automated system and 92% for the manual procedure. Average coefficient of variation was 6.6% for the automated system and 4.2% for the manual procedure. In another evaluation, the automated system gave an average recovery of 95% for 12 pesticides commonly found in imported foods; the manual procedure gave an average recovery of 91%. Thus, the results obtained so far indicate that the automated system for sample cleanup gives results comparable to those obtained by manual procedures.

Chromatography, Ion Exchange↗
PubMed1981

Automated determination of urea and ammoniacal nitrogen (NPN) in animal feeds.

A minor modification in the automated analytical system of the official AOAC semiautomated method for determining crude proteins results in an automated method for determining urea and ammoniacal nitrogen in animal feeds and their ingredients. Urease enzyme which has high activity, yields a clear solution in water, has low ammonia impurity, and is inexpensive is used in the automated method. Weights from 1 to 2.5 g feed sample are dissolved in water, and sample solutions are analyzed at the rate of 40 samples/h. Five AAFCO feed check samples were analyzed repeatedly by the automated method, and results were compared with the grand averages from the check sample reports. The official AOAC manual urease method was used by AAFCO participants. Average recovery of urea and ammoniacal nitrogen was 100.6% by the automated method relative to the AAFCO reported averages. The range of recoveries as 98.5-102.7%. The non-protein nitrogen (NPN) concentrations, expressed as protein equivalent, ranged from 3.40 to 63.04% protein on these samples. The average relative standard deviation for the automated analyses was 0.77%, compared with 1.54% for the manual method. This method is an important adjunct to laboratories using or considering use of the semiautomated method for crude protein and needing further information on NPN.

Ammonia↗
PubMed1995

Automated information technology in Air Force optometry.

BACKGROUND: Military optometry is experiencing changes at an unprecedented rate. Despite decreased staffing and budgets, the military must deal with more complicated deployment requirements as it takes on more humanitarian missions. New and emerging technologies, particularly automated information systems, will enhance its ability to meet these challenges. METHODS: Workgroups consisting of Army, Navy, and Air Force optometrists are developing operational strategies to meet future demands, employing 1) analysis to identify opportunities for business process improvement, 2) software prototyping to elicit and test automated system concepts and 3) functional economic analysis to evaluate the costs and benefits of automated information technologies. RESULTS: The workgroups have developed an operational concept that incorporates the development of a comprehensive Defense Vision Information System (DVIS). The DVIS is an automated information system that supports five general functional areas: 1) deployment readiness, 2) clinical examinations, 3) vision conservation (preventive medicine), 4) resource management, and 5) expert referencing. A full-scope DVIS will require integration with other military systems such as personnel, logistics, and existing hospital information systems. CONCLUSIONS: Technology will enable the military to expand the scope and nature of optometry services through automation. The ultimate goal of automation is to support providers through efficient clinical operation and quick access to quality information for decision making. Eye care providers and patients will benefit as we use technology to optimize quality and cost effectiveness in the wartime and peacetime delivery of primary eye care.

Aerospace Medicine↗
PubMed1994

Automation of the Maxam-Gilbert chemical sequencing reactions.

A practical automated method of Maxam-Gilbert chemical sequencing reactions that uses solid-phase chromatography methods to purify DNA following chemical modification and cleavage is described in this report. The automation has primarily been made possible by using specially designed BioPak mini-columns, compatible with the Biomek 1000 automated workstation, which can be utilized in a manner similar to that of standard pipet tips. This automated chromatographic sequencing method produces rapid and reliable data as verified by sequencing a known human factor IX exon VIII gene fragment. The procedure presented in this report is a prototype for a single-fragment reaction and can easily be expanded to perform reactions on as many as 8 fragments at a time. The automation eliminates the tedious and time-consuming steps in the original method and increases the rate of sequence acquisition. This technology makes the Maxam-Gilbert chemical sequencing protocol more accessible, especially in large-scale, automated sequencing projects.

Autoanalysis↗
PubMed1994

Automated blood pressure monitoring. Should it be used routinely in managing hypertension?

Twenty-four-hour automated blood pressure measurements are representative of and more reliable than casual office blood pressure measurements; they also are more closely correlated with evidence of target-organ damage caused by hypertension and may have better diagnostic specificity. Nevertheless, broad use of automated monitoring in the routine evaluation and management of hypertension has been discouraged because of the lack of prospective epidemiologic studies linking automated measurements to cardiovascular morbidity and mortality, the inability to define a normal range for such measurements, and the cost of the monitoring. However, if it is accepted that conventions established for casual office blood pressure measurements are applicable to data obtained by automated methods, then routine use of automated monitoring is justified, since automated monitoring has better diagnostic capabilities that offset much of its cost.

Ambulatory Care↗
PubMed1993

Automation of thyroid function testing.

This article discusses the automation of thyroid function testing. The needs for automation are included in the introduction. The issues concerning automation of immunoassay are discussed, including homogeneous or heterogeneous immunoassay, competitive or immunometric assay, reagent stability, data management, sample management, signal detection, and the disadvantages of automation. Individual immunoassay systems are summarized with a table outlining the key features. Both technical and clinical performance of automated thyroid function testing are described. The article ends with a discussion of the future trends of automated immunoassay testing.

Autoanalysis↗
PubMed1993

Automated suprathreshold screening for glaucoma: the Baltimore Eye Survey.

PURPOSE: To evaluate automated suprathreshold perimetric screening for glaucoma in a population-based survey of ocular disorders in east Baltimore, Maryland. METHODS: A population-based sample of persons > or = 40 years of age residing in 16 clusters was selected for an ocular screening examination that included automated suprathreshold testing with the Full Field 120 program of the Humphrey Field Analyzer. Subjects who failed the test underwent manual testing to confirm the defect. Subjects were referred for definitive examination by an ophthalmologist if they had an abnormal field, visual acuity worse than 20/30, intraocular pressure > 21 mm Hg, optic disc damage, a history of glaucoma, or shallow angles. The sensitivity and specificity of the automated visual field testing for identifying glaucoma was estimated and compared with other methods to screen for glaucoma. RESULTS: Of 5,341 subjects > or = 40 years of age who underwent a screening eye examination at neighborhood centers, 4,735 (89%) completed the automated field test. The median test time was 7.25 minutes per eye. Screening test results were abnormal in one or both eyes in 1,234 (26%) of the subjects. Kinetic perimetry was performed on 95% of these subjects, and defects were confirmed for 448 (36%) of them. Hence, 9.5% of the 4,735 subjects who completed the automated test were referred for definitive examination because the defect on automated perimetry was confirmed on manual testing. For a specificity of 90%, the sensitivity of the screening visual field test to detect glaucoma was 52% for 17 or more relative or absolute defects, higher than that of intraocular pressure at 39% for a cut-off of 20.5 mm Hg, vertical cup-to-disc ratio at 45% for a cut-off of 0.53, narrowest remaining rim width at 42% for a cut-off of 0.16, and was comparable to a combination of these and other nonfield parameters. CONCLUSION: Suprathreshold testing performed better than nonperimetry-based screening tests for glaucoma. However, a number of logistical weaknesses of this visual field screening method were identified.

Adult↗
PubMedDate not supplied

Automated technique for sampling milk from farm bulk tanks: collaborative study.

An automated, in-line, mechanical technique for sampling milk from farm bulk tanks was evaluated in a collaborative study. The automated sampling device, which is mounted on the milk intake line, contains an electronically controlled peristaltic pump. The device takes a representative sample of the entire volume pumped through the system. Samples taken can be analyzed for both composition and microbiological quality. The study was performed in 3 phases. In the first 2 phases, samples taken by manual and automated methods were compared in analyses for somatic cell count, antibiotics, fat, protein, lactose, and solids-not-fat. The third phase, using a modified procedure, was designed to compare sampling methods in analyses for total bacteria count (standard plate count), psychrotrophic bacteria count, and coliform count. Evaluation of the data by a nested ANOVA indicated no difference between results for samples taken by the automated and manual methods (P = 0.05) in Phases 1 and 2, irrespective of whether the bulk milk was agitated before sampling. By introducing a sanitizing step between farms in Phase 3, the automated method also provided samples comparable with those taken manually for microbial analyses. The automated method has been adopted first action by AOAC International.

Animals↗
PubMed1983

Human communication needs and organizational productivity: the potential impact of office automation.

Much of what white collar workers do in offices is communication-related. White collar workers make up the majority of the labor force in the United States today and the majority of current labor costs. Because office automation represents more productive structured techniques for handling both written and oral communication, office automation therefore offers the potential to make organizations more productive by improving organizational communication. This article: (1) defines communication, (2) identifies the potential benefits to be realized from implementing office automation, and (3) offers caveats related to the implementation of office automation systems. Realization of the benefits of office automation depends upon the degree to which new modes of communication may be successfully substituted for traditional modes.

Automation↗