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PubMed2005

Assessment of iodine intake in mildly iodine-deficient pregnant women by a new automated kinetic urinary iodine determination method.

Maternal iodine deficiency can compromise the thyroid status of the mother, fetus and newborn child. Therefore, it is important to assess the iodine excretion level of groups of pregnant women. In this study we aimed to determine iodine intake in pregnancy using a recently reported automated kinetic method for urinary iodine determination. Urinary iodine measurements of 123 pregnant women (18 first, 28 second and 77 third trimester) were carried out using a new automated kinetic assay based on the Sandell-Kolthoff reaction at 37 degrees C and its kinetic measurement at 340 nm in a random-access automated analyzer after ammonium persulfate digestion at 95 degrees C in a water bath with +/-0.1 degree C precision. Statistical analyses were carried out using SPSS software. Whole group, first trimester, second trimester and third trimester urinary iodine concentrations (mean+/-SD) in pregnant women were 1.13+/-0.81, 1.08+/-0.71, 0.86+/-0.58 and 1.27+/-0.87 micromol/L, respectively. The urinary iodine concentration significantly increased with gestational age (p<0.05). We found that our study group was mildly iodine-deficient according to WHO criteria. Furthermore, the pregnant women were found to be mildly iodine-deficient in the first and third trimesters and moderately so in the second trimester. The only statistical difference was between second and third trimester values (p<0.05). Even though the increased iodine deficiency in the second trimester is not useful for early detection of iodine deficiency in pregnancy, the severity of this deficiency in the second trimester may lead to important effects on thyroid metabolism for both mother and fetus. Our study suggests that the iodine excretion of pregnant women living in iodine-deficient areas could be assessed using this fast and automated method.

Adolescent↗
PubMed2006

Automated processing of whole blood samples for the determination of immunosuppressants by liquid chromatography tandem-mass spectrometry.

BACKGROUND: Liquid chromatography tandem-mass spectrometry (LC-MS/MS) is an efficient technology for routine determination of immunosuppressants in whole blood; however, time-consuming manual sample preparation remains a significant limitation of this technique. METHODS: Using a commercially available robotic pipetting system (Tecan Freedom EVO), we developed an automated sample-preparation protocol for quantification of tacrolimus in whole blood by LC-MS/MS. Barcode reading, sample resuspension, transfer of whole blood aliquots into a deep-well plate, addition of internal standard solution, mixing, and protein precipitation by addition of an organic solvent is performed by the robotic system. After centrifugation of the plate, the deproteinized supernatants are submitted to on-line solid phase extraction, using column switching prior to LC-MS/MS analysis. The only manual actions within the entire process are decapping of the tubes, and transfer of the deep-well plate from the robotic system to a centrifuge and finally to the HPLC autosampler. Whole blood pools were used to assess the reproducibility of the entire analytical system for measuring tacrolimus concentrations. RESULTS: A total coefficient of variation of 1.7% was found for the entire automated analytical process (n=40; mean tacrolimus concentration, 5.3 microg/L). Close agreement between tacrolimus results obtained after manual and automated sample preparation was observed. CONCLUSIONS: The analytical system described here, comprising automated protein precipitation, on-line solid phase extraction and LC-MS/MS analysis, is convenient and precise, and minimizes hands-on time and the risk of mistakes in the quantification of whole blood immunosuppressant concentrations compared to conventional methods.

Autoanalysis↗
PubMed2006

Automation and validation of a fast method for the assessment of in vivo oxidative stress levels.

BACKGROUND: The d-ROMs test for the evaluation of serum hydroperoxides (HP) is simple, reliable, and cheap. Furthermore, it can easily be adapted to automated analyzers. Changing from the manual to an automated procedure allows the simultaneous processing of a large number of samples in a greatly reduced time, avoiding manual handling of samples and reagents and reducing variability sources. METHODS: This study was performed to adjust the manual procedure to a routine automated method in the clinical laboratory. We carried out the d-ROMs test in sera from 90 subjects of both sexes (34 men and 56 women) with age ranging from 20 to 80 years (mean 51+/-14 years). All subjects were free from acute or chronic inflammatory disease, immunological disease and history or evidence of malignancy. Subjects were not on vitamin and/or antioxidant therapies. RESULTS: The detection limit of the assay was 40 AU. Linearity was observed up to 475 AU. The recovery ranged between 97% and 105%. Within- and between-run imprecision was <5%. The mean HP value was 304+/-8 AU, with no significant difference between men (291+/-10 AU) and women (311+/-11 AU). A significant positive correlation was observed between age and HP in the whole population (r=0.4, p=0.0002). CONCLUSIONS: The automated test for the estimation of serum hydroperoxides represents a reliable and feasible procedure for increasing efficiency and reducing costs compared to the manual method, and is particularly suitable for evaluating oxidative stress in a variety of clinical conditions.

Adult↗
PubMed2006

A new automated software system to evaluate breast MR examinations: improved specificity without decreased sensitivity.

OBJECTIVE: We sought to compare the accuracy of breast MRI interpretations with and without a new software application (CADstream) that provides automated evaluations of breast MR examinations. MATERIALS AND METHODS: Thirty-three consecutive lesions seen only on MRI (nine malignant, 24 benign) were evaluated with and without the automated software system. Automated analyses of kinetic enhancement for each lesion were recorded at 50%, 80%, and 100% enhancement thresholds. Computer-assisted analyses included presence or absence of "significant" enhancement and classification of enhancement patterns into percent volumes of washout, plateau, and persistent enhancement. Fisher's exact tests were performed to compare the likelihood of malignancy based on the presence of software-defined significant enhancement at the three thresholds. Enhancement profiles of malignant versus benign lesions were compared using the Student's t test. RESULTS: All malignant lesions showed significant enhancement at all thresholds. Compared with the unassisted interpretations, the computer-assisted analyses yielded false-positive rates that were reduced by 25% at a 50% threshold (not significant [NS]), 33% at an 80% threshold (p = 0.05), and 50% at a 100% threshold for enhancement (p < 0.01). There were no significant differences between enhancement profiles of benign and malignant lesions, with all lesions showing a wide range of washout, plateau, and persistent patterns of enhancement. CONCLUSION: New automated software applied to interpret breast MR examinations accurately showed significant enhancement in all the malignant lesions while depicting 12 of 24 benign lesions as showing insignificant enhancement. If these results are validated by a larger study, the number of unnecessary biopsies of MR lesions could be reduced without a concomitant decrease in cancer detection.

Breast Neoplasms↗
PubMed2000

An automated PACS workstation interface: a timesaving enhancement.

OBJECTIVE: Interface design is a key element in the efficient use of a picture archiving and communication system (PACS) workstation. In many cases, multiple mouse clicks or keyboard commands are required to open and close a case, to mark it as complete, and to retrieve and allocate screen positions to the next case. We evaluated the work flow effect of software designed for automated image display in which all of these operations are consolidated in a single mouse click. CONCLUSION: Automated image display increases efficiency in image interpretation and remedies the normally cluttered presentation environment. At our institution, acceptance of automated image display has been overwhelmingly positive. In fact, automated image display has improved radiologist productivity.

Efficiency, Organizational↗
PubMed2005

Accuracy of automated CT angiography measurement of vascular diameter in phantoms: effect of size of display field of view, density of contrast medium, and wall thickness.

OBJECTIVE: The objective of this study was to assess the effect of wall thickness, density of intravascular contrast material, and size of the display field of view on the accuracy of measurements of vascular diameter in phantoms yielded by automated software for CT angiography. MATERIALS AND METHODS: Vascular models with three wall thicknesses (1.0, 0.8, and 0.5 mm) and an inner diameter of approximately 4 mm were filled with contrast material of three different densities (198, 270, and 350 H) and scanned with helical CT. Three sizes of display field of view (10, 15, and 20 cm) were used. We evaluated the measurement error of the automated software, which was defined as the difference between the diameter measurement of the automated software and the true inner diameter of the vascular model. Statistical analysis involved three-way analysis of variance with repeated measures. RESULTS: There were significant differences in the measurement errors among the three wall thicknesses of the vascular model, three densities of intravascular contrast material, and three sizes of display field of view. The overall measurement errors progressively increased with larger sizes of display field of view (p < 0.01) and with lower densities of intravascular contrast material (p < 0.001). The measurement errors tended to progressively increase as the thickness of the wall of the vascular models increased. CONCLUSION: The accuracy of the diameter measurements by automated software for CT angiography was affected by the size of the display field of view, intravascular density of the contrast material, and wall thickness of the vessel. It is necessary to consider the effects of these factors on the diameter measurements of small arteries.

Angiography↗
PubMed2003

Typing of Listeria monocytogenes isolates originating from the food processing industry with automated ribotyping and pulsed-field gel electrophoresis.

A total of 486 Listeria monocytogenes isolates originating from 17 Finnish food processing plants (representing meat, poultry, fish, and dairy production) were collected and typed by automated ribotyping using EcoRI as the restriction enzyme. The isolates were divided into 16 different ribotypes (RTs). Some of these isolates (121), representing all EcoRI types and 16 food plants, were subjected to ribotyping with the PvuII enzyme, to pulsed-field gel electrophoresis (PFGE) typing with AscI and SmaI restriction enzymes, and to serotyping with O-antigen antisera. Nineteen ribotypes were generated with PvuII, 42 macrorestriction patterns were generated with AscI and 24 with SmaI, and three serotypes were generated with antisera. When the results were combined, the overall number of RTs was 23, and that of the PFGE types was 46. Thus, the overall discrimination power of PFGE was higher (discrimination index [DI] 0.966) than that of ribotyping (DI 0.906). The most common serotype (90.1% of the isolates) was 1/2, and isolates of serotype 4 (3.3%) were rare. There was no connection between food sectors and RTs or PFGE types, but PFGE indicated the single plants (78.3% of the types) better than ribotyping (56.5%). On the basis of its automation and on the availability of identification databases, automated ribotyping had some advantages over PFGE. Overall, automated ribotyping can be considered a practical and rapid tool when Listeria contamination is suspected and when screening a large number of isolates is necessary, e.g., when tracing contamination sources. However, in cases of outbreaks, the identical patterns must be confirmed by PFGE, which is a more discriminatory method.

Animals↗
PubMed2003

Automation of gross photography using a remote-controlled digital camera system.

CONTEXT: Conventional gross photography requires a series of tedious and time-consuming steps, including taking, developing, labeling, sorting, filing, and tracking numerous photographs. OBJECTIVE: To describe how to automate the gross photographic process by way of controlling a digital camera remotely. DESIGN: After defining the requirements of automation regarding gross photography, a remote control board, foot switch, barcode system, and image retrieval system were devised. SETTING: The surgical pathology laboratory of a university medical center with a commercially available megapixel digital camera. RESULTS: The digital camera zoom and shutter were controlled remotely by a foot switch. A large portion of the gross photographic process, including specimen number labeling, image downloading, labeling, sorting, filing, and tracking, were automated. In addition, the elimination of several manual specimen-processing steps, along with not having to wait for the developing and mounting of conventional 35-mm film, reduced the entire time span required in conventional gross photography from 2 to 5 days, to a few minutes. It was also possible to review the gross images at the time of microscopic sign-out. CONCLUSIONS: The automation of gross photography using a remote-controlled digital camera changes the conventional gross workflow markedly. We found use of a remote-controlled gross photography system to be practical, convenient, and efficient.

Cost-Benefit Analysis↗
PubMed2005

[Study of automated segmentation of the cerebellum and brainstem on brain MR images].

MR imaging is an important method for diagnosing abnormalities of the brain. This paper presents an automated method to segment the cerebellum and brainstem for brain MR images. MR images were obtained from 10 normal subjects (male 4, female 6; 22-75 years old, average 31.0 years) and 15 patients with brain atrophy (male 3, female 12; 62-85 years of age, average 76.0 years). The automated method consisted of the following four steps: (1) segmentation of the brain on original images, (2) detection of an upper plane of the cerebellum using the Hough transform, (3) correction of the plane using three-dimensional (3D) information, and (4) segmentation of the cerebellum and brainstem using the plane. The results indicated that the regions obtained by the automated method were visually similar to those obtained by a manual method. The average rates of coincidence between the automated method and manual method were 83.0+/-9.0% in normal subjects and 86.4+/-3.6% in patients.

Adult↗
PubMed1999

Evaluation of a new method for the analysis of free catecholamines in plasma using automated sample trace enrichment with dialysis and HPLC.

BACKGROUND: Analysis of urinary free catecholamines was automated recently, but analysis of plasma samples posed special difficulties. The present study was undertaken to evaluate a new method for the automated analysis of plasma catecholamines. METHODS: The procedure is based on an improved sample handling system that includes dialysis and sample clean-up on a strong cation trace-enrichment cartridge. The catecholamines norepinephrine, epinephrine, and dopamine are then separated by reversed-phase ion-pair chromatography and quantified by electrochemical detection. RESULTS: Use of a 740- microL sample is required to give the catecholamine detection limit of 0.05 nmol/L and analytical imprecision (CV) between 1.1% and 9.3%. The assay can be run unattended, although >12 h of analysis time is not recommended without cooling of the autosampler rack. Comparison (n = 68) of the automated cation-exchange clean-up with the well-established manual alumina procedure gave excellent agreement (mean, 3.78 +/- 2.76 and 3.8 +/- 2.89 nmol/L for norepinephrine and 0.99 +/- 1.72 and 1.08 +/- 1.78 nmol/L for epinephrine). Hemodialysis had no clear effect on plasma norepinephrine. Epinephrine concentrations were similar (0.05 < P < 0.1) in chronic renal failure patients (0.24 +/- 0.3 nmol/L; n = 15) and healthy controls (0.5 +/- 0.24 nmol/L; n = 31). Dopamine was not quantified, being usually <0.2 nmol/L. CONCLUSION: The availability of such a fully automated procedure should encourage the more widespread use of plasma catecholamine estimation, e.g., after dialysis, exercise, or trauma/surgery and in the investigation of catecholamine-secreting tumors, particularly in the anuric patient.

Autoanalysis↗
PubMed1991

Standards for automated patient records.

The work in standards development is essential to the rapid development of automated patient records. The standards set forth the common pathways needed to support and strengthen parallel efforts in automation throughout medicine. Automation fosters a changing paradigm in patient records. Automated records will not only provide more timely, accessible patient information, but will provide opportunities to link practitioners to knowledge systems, thereby supporting the diagnostic process and quality indicators that generate clinical interventions and reminders. A dynamic, complete patient record consistently maintained across diverse care sites will continue to be an essential component in patient care. Standards for the information content, vocabulary, and linkage between systems will provide the foundations for patient care information systems. Because the individual patient record uniquely represents the patient, these systems will advocate more completely for individual patients and support practitioners' decision making on their behalf. As expressed by Waters and Murphy, "We can describe a patient in many ways, according to many needs, according to many characteristics, yet in so doing we will inevitably compile a set of information inseparable from a particular individual." That concept is unchanging. Technology supported by accepted standards ensures that patients can be served through effective, timely, complete information. In serving the patient, the health care system can be served. In an article in Decisions in Decision Economics Dr. Paul Lang explained that Successful management, that is, the acquisition, collation, organization, storage and retrieval of patient-related information, is not only essential to an acceptable future for the health care-system, but is also critical to surviving the crisis of the present.(ABSTRACT TRUNCATED AT 250 WORDS)

Documentation↗
PubMed1993

Electronic forms: a next step in hospital automation.

Information consists of two parts, facts and communication. It is not enough for one person to know a fact; the fact must be communicated for it to be of any value to anyone else. Forms were invented to do just that--communicate facts in a systematic manner from one party to the next. Automating forms with computers on a local area network or a wide area network allows for hospital personnel to input a patient's information once and electronically share the information from one department to another, simultaneously. Switching from a paper-based forms system to a fully automated workflow forms system or combining the two can save a healthcare institution money, errors, time and even lives. The levels of an automated forms system include: electronic forms design, demand printing, typewriter replacement, intelligent forms, intelligent mail and true workflow automation.

Communication↗
PubMed1993

A clinical case study: moving toward an automated patient record.

Automation of patient records is a concept that has slowly evolved into practical application during the last decade within the health care environment. Although limited progress has been made as far as standardizing automated record content and data exchange industrywide, we can be encouraged by individual hospital progress as illustrated by the Washington Hospital. This organization was successful in visualizing its goal, thoroughly planning its strategy, involving key players in the design, and following a methodical, purposely slow implementation plan to ensure system success. Benefits, both financial and intangible, have been achieved and recognized both within the organization and by those facilities that have been privy to its success first hand. Facilities contemplating automation of their patient record can be encouraged by Washington's example and the relentless pursuit of its vision for the automated patient record.

Cost-Benefit Analysis↗
PubMedDate not supplied

Automation: triumph or trap?

Automation, a hot topic in the laboratory world today, can be a very expensive option. Those who are considering implementing automation can save time and money by examining the issues from the standpoint of an industrial/manufacturing engineer. The engineer not only asks what problems will be solved by automation, but what problems will be created. This article discusses questions that must be asked and answered to ensure that automation efforts will yield real and substantial payoffs.

Capital Expenditures↗
PubMed1998

Using artificial intelligence to automate remittance processing.

The consolidated business office of the Allegheny Health Education Research Foundation (AHERF), a large integrated healthcare system based in Pittsburgh, Pennsylvania, sought to improve its cash-related business office activities by implementing an automated remittance processing system that uses artificial intelligence. The goal was to create a completely automated system whereby all monies it processed would be tracked, automatically posted, analyzed, monitored, controlled, and reconciled through a central database. Using a phased approach, the automated payment system has become the central repository for all of the remittances for seven of the hospitals in the AHERF system and has allowed for the complete integration of these hospitals' existing billing systems, document imaging system, and intranet, as well as the new automated payment posting, and electronic cash tracking and reconciling systems. For such new technology, which is designed to bring about major change, factors contributing to the project's success were adequate planning, clearly articulated objectives, marketing, end-user acceptance, and post-implementation plan revision.

Accounts Payable and Receivable↗
PubMedDate not supplied

An automated image cytometry system for monitoring DNA ploidy and other cell features of radiotherapy and chemotherapy patients.

DNA content and distribution in cell nuclei were studied in samples of fine-needle aspiration (FNA) from 27 locally advanced breast and head and neck cancers in two going randomized trials that compared accelerated fractionation to standard fractionation radiation in locally advanced breast cancer and head and neck cancer. Two image cytometry methods were compared: a new, fully automated DNA image cytometry system (AIC) and a conventional image cytometry (CIC) system with manual selection, focusing, and segmentation of cells. The results of both techniques were compared on the basis of DNA histogram parameters including DNA index (DI), mean DNA values (MDV), and Auer's DNA histogram patterns. An excellent correlation was achieved between the two imaging techniques in terms of DI (r=0.985, p<0.001) and MDV (r=0.951, p<0.001) as well as between Auer's histogram patterns, where both methods agreed completely. It was concluded in these analyses that the two image cytometry methods were equivalent. However, the AIC offered an advantage by scanning samples in a fully automated way, which represented significant time saving for cytopathologists working with the system, as well as a larger number of cells used in the automated analysis. With the automated image cytometer, 500 relevant cells were collected and analyzed in about 10 minutes, where with the interactive (manual) method, it took typically an hour to collect and analyze only about 250 cells. Seventeen samples were sufficient for flow analysis. Image cytometry and flow cytometry showed good agreement in DI determination; however, three cases reported as diploid by flow cytometry were found to be aneuploid by image cytometry techniques.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

A comparative analysis on the incidence of peritonitis and exit-site infection in CAPD and automated peritoneal dialysis.

OBJECTIVE: To compare the incidence of peritonitis and exit-site infection in an ample group of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis in a single center during a 10-year period. DESIGN: Nonrandomized, prospective study. SETTING: Public, tertiary care hospital providing peritoneal dialysis care to a population of (approximately) 750 000 people. PATIENTS: We studied 213 patients on CAPD and 115 on automated peritoneal dialysis (APD) starting therapy between January 1989 and August 1998, with a minimum follow-up of 3 months. MAIN OUTCOME MEASURES: Using a multivariate approach, we compared the incidence, clinical course, and outcome of peritonitis and exit-site infections in both groups, controlling for other risk factors for the complications studied. RESULTS: The incidence of peritonitis was higher in CAPD than in APD (adjusted difference 0.20 episodes/ patient/year, 95% confidence interval 0.08 - 0.32). There was a trend for CAPD patients to present earlier with peritonitis than APD patients, yet the incidence of and survival to the first exit-site infection were similar in both groups. The etiologic spectrum of infections displayed minor differences between groups. Automated PD patients were more frequently hospitalized for peritonitis, but otherwise, the complications and outcome of peritonitis and exit-site infections did not differ significantly between patients on CAPD and those on APD. CONCLUSIONS: Automated PD is associated with a lower incidence of peritonitis than is CAPD, while exit-site infection is similarly incident under both modes of therapy. The etiologic spectrum, complications, and outcome of peritonitis and exit-site infection do not differ markedly between CAPD and APD. Prevention of peritonitis should be included among the generic advantages of APD over CAPD.

Catheters, Indwelling↗
PubMed1999

Automating a severity score guideline for community-acquired pneumonia employing medical language processing of discharge summaries.

Obtaining encoded variables is often a key obstacle to automating clinical guidelines. Frequently the pertinent information occurs as text in patient reports, but text is inadequate for the task. This paper describes a retrospective study that automates determination of severity classes for patients with community-acquired pneumonia (i.e. classifies patients into risk classes 1-5), a common and costly clinical problem. Most of the variables for the automated application were obtained by writing queries based on output generated by MedLEE1, a natural language processor that encodes clinical information in text. Comorbidities, vital signs, and symptoms from discharge summaries as well as information from chest x-ray reports were used. The results were very good because when compared with a reference standard obtained manually by an independent expert, the automated application demonstrated an accuracy, sensitivity, and specificity of 93%, 92%, and 93% respectively for processing discharge summaries, and 96%, 87%, and 98% respectively for chest x-rays. The accuracy for vital sign values was 85%, and the accuracy for determining the exact risk class was 80%. The remaining 20% that did not match exactly differed by only one class.

Community-Acquired Infections↗