A surgical pathologist views practice parameters.
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This paper reviews concepts of multivariate statistical modeling via the logistic regression model, which has become very popular for modeling the relationship between a positive clinical outcome and a variety of predictor variables. The process is illustrated using a composite of data from three large prostate specific antigen based screening studies of prostate cancer.
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Appropriate use of critical values improves patient outcome by ensuring that physicians are promptly notified of immediate life-threatening conditions. Conversely, overuse squanders resources and actually may impair patient outcome. A generic critical values list derived from interlaboratory surveys is an excellent starting point, but every laboratory must customize its list to meet the needs of the organization that it serves. Category-specific and once-per-period critical values can limit superfluous reporting, but they make the critical values list more complicated. Strict semantic interpretation of critical limits is appropriate. The best ways to report critical values are by telephone and by alphanumeric pager. When required, repeat analysis should precede critical value reporting. Laboratories should avoid reporting invalid results (due to poor specimen integrity, for example) as critical values. An institutional committee initially should approve, and periodically should review and revise, the critical values policy.
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The use of Rh immune globulin (RhIG) has dramatically decreased the incidence of hemolytic disease of the fetus and newborn resulting from the production of anti-D by an Rh-negative woman. However, despite the widespread use of RhIG, instances of Rh immunization continue to occur, most likely through failure to administer RhIG when indicated or in the appropriate dose. This utilization gap can be closed only through continued active surveillance by health care providers. The following report summarizes recommendations for the administration of RhIG, the dose required in various circumstances, prenatal and postnatal serologic testing of the obstetric patient, and the methods used to determine the degree of fetomaternal hemorrhage or the amount of Rh-positive RBCs in the circulation.
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