The effect of electronic ordering on pre-analytical errors in primary care.

BACKGROUND: Pre-analytical variables are common across all laboratories and can negatively impact on patient care. The aim of this study was to review the impact of electronic requesting in Primary Care on the number of pre-analytical errors seen by the laboratory. METHOD: Error data were reviewed during two six-month periods, pre- and post-implementation of Primary Care electronic requesting. The outcome measures related to: the correct information on the sample tube (patient name, unique patient ID number, date of collection); the correct sample received and the availability of a clinical history. RESULTS: There was a marked decrease in the number of pre-analytical errors following the introduction of electronic requesting (2764 pre-implementation vs. 498 post-implementation, P < 0.001). There was an improvement in the quality of information provided with each request in the forms of clinical history, date and time of sample collection. CONCLUSIONS: The introduction of electronic requesting in Primary Care can reduce the number of pre-analytical errors and can improve the quality of information received with each request.

Relation of left atrial volume to B-type natriuretic peptide levels in patients with stable chronic heart failure.

This study assessed the relation between B-type natriuretic peptide (BNP) and echocardiographic indexes of left ventricular (LV) filling pressure in 53 patients with stable heart failure and without significant valvular dysfunction. Left atrial volume indexed to body surface area (LAVi), an indicator of chronic LV filling pressure, was correlated with BNP (r = 0.692, p <0.001) and was the strongest independent predictor of elevated levels in this cohort. LAVi was also the best predictor of BNP >or=100 pg/ml, with an area under the receiver-operating characteristic curve of 0.85 (95% confidence interval 0.74 to 0.96, p <0.001). Using the optimal cutoff of >31 ml/m(2), LAVi had a sensitivity of 92% and a specificity of 65% for BNP >or=100 pg/ml. Patients with LAVi >31 ml/m(2) had a median BNP of 122 pg/ml, compared with 21 pg/ml in patients with LAVi

Renal function and outcome from coronary artery bypass grafting: impact on mortality after a 2.3-year follow-up.

BACKGROUND: Severe renal dysfunction is associated with a worse outcome after coronary artery bypass graft surgery (CABG). Less is known about the effects of milder degrees of renal impairment, and previous studies have relied on levels of serum creatinine, an insensitive indicator of renal function. Recent studies have suggested that estimated glomerular filtration rate (eGFR) is a more discriminatory measure. However, data on the utility of eGFR in predicting outcome from CABG are limited. METHODS AND RESULTS: We studied 2067 consecutive patients undergoing CABG. Demographic and clinical data were collected preoperatively, and patients were followed up a median of 2.3 years after surgery. Estimated GFR was calculated from the Modification of Diet in Renal Disease equation. The primary outcome was all-cause mortality. Mean+/-SD eGFR was 57.9+/-17.6 mL/min per 1.73 m2 in the 158 patients who died during follow-up compared with 64.7+/-13.8 mL/min per 1.73 m2 in survivors (hazard ratio [HR], 0.71 per 10 mL/min per 1.73 m2; 95% CI, 0.64 to 0.80; P<0.001). Estimated GFR was an independent predictor of mortality in both models with other individual univariable predictors (HR, 0.80 per 10 mL/min per 1.73 m2; 95% CI, 0.72 to 0.89; P<0.001) and the European system for cardiac operative risk evaluation (HR, 0.88 per 10 mL/min per 1.73 m2; 95% CI, 0.78 to 0.98; P=0.02). CONCLUSIONS: Estimated GFR is a powerful and independent predictor of mortality after CABG.