Symposium on endocrinology and aging: the 1st meeting of the European Interest Group hormones and aging.
Explore the source record for details and available documents.
SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Supports the integration of appropriate complementary therapies into healthcare. Encourages the use of evidence-based practice. Promotes the development of appropriate education for nurses wishing to use complementary therapies in their practice. Encourages its members to raise public awareness of the potential benefits and possible areas of concern relating to the use of complementary therapies.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A written survey of all licensed medical laboratories performing coagulation testing in Canada was undertaken in 1996 as a follow-up to a study performed in 1992. The an overall response rate was 77.4% of the laboratories surveyed. During the 4-year period between surveys, the percentage of responding laboratories using some format for international normalized ratio (INR) reporting increased from 57% to 98%. The mean International Sensitivity Index (ISI) of the various thromboplastins used had decreased from 2.07 to 1.63. However, only 35% of responding laboratories used a thromboplastin with an ISI of 1.2 or less as recommended by the American College of Chest Physicians. In 92% of cases, the ISI was said to be specified for the type of instrument, ie, optical density vs mechanical. However, in only 52% of cases was the ISI known to be specific for the particular reagent-analyzer combination used in the individual laboratory. Nine percent of the laboratories were still using an inappropriate denominator for the INR calculation. While 87% of laboratories quoted a therapeutic INR range of 2.0 to 3.0 for venous thromboembolism, there was much greater variation in the range reported for patients undergoing heart valve replacement. The situation in Canada has improved in using the INR system for prothrombin time reporting. However, additional education is required, as is greater use of thromboplastins with a lower ISI.
The international normalized ratio (INR) was established as a means of standardizing the prothrombin time regardless of the thromboplastin used in the individual laboratories. The INR is the prothrombin time ratio of the sample raised to the power of the International Sensitivity Index (ISI). Traditionally, the ISI is determined by using a manual clotting technique by comparing the test thromboplastin with a World Health Organization international reference thromboplastin with results from 60 patient samples standardized on warfarin, and 20 samples from normal volunteers. Most laboratories no longer perform prothrombin time testing by a manual technique but instead automate the procedure by using a variety of coagulation instruments. Thromboplastin ISI values have the potential to be modified considerably by instrumentation, and as a consequence, they, may result in INRs that are unreliable when compared to those obtained by the traditional manual method. It has been proposed that the use of calibrant plasmas tested with the laboratory's thromboplastin and instrument may overcome this problem and a local ISI value could be established. Our study objective was to determine whether a local ISI calibration with the plasma calibrants could reduce the variation of the INR over a wide range of thromboplastin/ instrument combinations. A total of 58 laboratories from across Canada, including community hospitals, private laboratories, and large tertiary care units, participated. The findings indicate that the use of calibrant plasmas to calculate the local ISI does improve the accuracy of INR reporting in the majority of thromboplastin/instrument combinations.