Effect of laboratory error on the identification of persons with hypercholesterolemia in an employee health service.

Cholesterol is a major risk factor for coronary heart disease. Of 117 employees seen consecutively in the Tennessee State Employee Health Service voluntary screening program, 86 (74%) had cholesterol levels above the reference range reported by a commercial clinical laboratory. This was three times greater than the calculated expected number of 29 (25%, 17 at moderate risk, 12 at high risk for coronary disease). Age and sex adjustment using Lipid Research Clinic guidelines reduced the number with elevated cholesterol to 55 (47%, 24 at moderate risk, 31 at high risk). Split sample cholesterol assays run independently by the commercial laboratory and a university laboratory showed excellent correlation (r = 0.99, commercial laboratory = 1.0 (university laboratory) + 10.8), but a systematic difference of 12.4 mg/dL (SD = 6.4 mg/dL, paired-t = 9.63, p less than 0.00001) between the two laboratories. Further adjustment for this difference reduced the number with elevated cholesterol to 41 (36%, 26 at moderate risk, 15 at high risk). This experience illustrates how small systematic laboratory errors in cholesterol determination can greatly exaggerate the number of persons reported to have clinically important cholesterol elevations. Clinical laboratories should report age and sex adjusted cholesterol reference ranges and provide clients periodic quality assurance reports that their measurements of cholesterol levels are accurate.

Vision screening requirements under 52 Early and Periodic Screening Diagnosis and Treatment (EPSDT) Programs.

A 1979 survey of vision screening requirements in 52 Early and Periodic Screening Diagnosis and Treatment (EPSDT) programs revealed that 17 percent of the programs had no requirements, and 17 percent required only distance visual acuity testing. An additional 25 percent required distance vision and ocular muscle-fusion tests only, and the remaining programs required various combinations of three or more tests. Fewer than two-thirds of the programs with requirements had referral criteria for the tests. The ages at which initial testing was required also varied among the programs. The differences in requirements were not related to the demographic, socioeconomic, and other variables analyzed in this study. Programs with specific referral criteria, however, had a higher percentage of referrals for vision screening than those without such criteria. Because of the variability in vision screening standards and referral criteria observed among the programs, the authors conclude that national standards are needed.

[Quality control for MHTS region and possibility of the standardization].

There is a final purpose of the standardization of the external quality control for the resolution of the difference between facilities. Two solutions are promoted in order to unify the evaluation level. They are that it unifies the reference value and common evaluation method used common display. However, it is the prior settlement that there is some a problem on both method and that absolute value is made to agree using standard substance.

[Exploration of screening scores for pediatric obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To evaluate the feasibility of screening for pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) according to OSA-18,physical examination and electronic nasopharyngoscopy. METHOD: Outpatients with snoring received questionnaire, physical examination and electronic nasopharyngoscopy in Pediatric Sleep Center of Beijing Children's Hospital from 2009.1 to 2009.12. All children were divided into OSAHS or non-OSAHS group based on the results of polysomnography (PSG). The material was compared between these two groups. RESULT: The differences of age,tonsil scores, adenoid scores,total OSA-18 sores, the loudness of snoring scores, sleep asthma or suffocation scores, worrying lack of oxygen scores were significant (P < 0.05). And then put them into the logistic equation Y and make ROC analysis, if Y is higher than 0. 735, these children were more likely with OSAHS. The sensitivity was 62.7% and the specificity was 79.4%. CONCLUSION: It is feasible to screen for pediatric OSAHS according to questionnaire, physical examination and electronic nasopharyngoscopy.