Search

Objectives: Urinary tract infections (UTIs) are common infections within the Emergency Department (ED), causing increased laboratory workloads and unnecessary antibiotics prescriptions. The aim of this study was to improve UTI diagnostics in clinical practice by application of machine learning (ML) models for real-time UTI prediction. Methods: In a retrospective study, patient information and outcomes from Emergency Department patients, with positive and negative culture results, were used to design models – ‘Random Forest’ and ‘Neural Network’ – for the prediction of UTIs. The performance of these predictive models was validated in a cross-sectional study. In a quasi-experimental study, the impact of UTI risk assessment was investigated by evaluating changes in the behaviour of clinicians, measuring changes in antibiotic prescriptions and urine culture requests. Results: First, we trained and tested two different predictive models with 8692 cases. Second, we investigated the performance of the predictive models in clinical practice with 962 cases (Area under the curve was between 0.81 to 0.88). The best performance was the combination of both models. Finally, the assessment of the risk for UTIs was implemented into clinical practice and allowed for the reduction of unnecessary urine cultures and antibiotic prescriptions for patients with a low risk of UTI, as well as targeted diagnostics and treatment for patients with a high risk of UTI. Conclusion: The combination of modern urinalysis diagnostic technologies with digital health solutions can help to further improve UTI diagnostics with positive impact on laboratory workloads and antimicrobial stewardship.

Background: New tools for health information technology have been developed in recent times, such as Clinical Decision Support (CDS) systems, which are any digital solutions designed to help healthcare professionals when making clinical decisions. The study aimed to show how we have adopted a CDS system in the San Juan de Alicante Clinical Laboratory and facilitate the implementation of our protocol in other clinical laboratories. We have user experience and the motivation to improve healthcare tools. The improvement, measurement, and monitoring of interventions and laboratory tests has been our motto for years. Materials and methods: A descriptive research was conducted. All stages in the design of the project are as follows: 1. Set up a multidisciplinary workgroup. 2. Review patients’ data. 3. Identify relevant data from main sources. 4. Design the likely outcomes. 5. Define a complete integration scenario. 6. Monitor and track the impact. To set up this protocol, two new software systems were implemented in our laboratory: AlinIQ CDS v8.2 as Rule Engine, and AlinIQ AIP Integrated Platform v1.6 as Business Intelligence (BI) tool. Results: Our protocol shows the workflow and actions that can be done with a CDS system and also how it could be integrated with other monitoring systems, as well as some examples of KPIs and their outcomes. Conclusions: CDS could be a great strategic asset for clinical laboratories to improve the integration of care, optimize the use of laboratory tests, and add more clinical value to physicians in the interpretation of results.

Introducción: Los tumores carcinoides pulmonares son tumores infrecuentes. Las manifestaciones clínicas dependen de su localización anatómica. En caso de localización central puede existir la presencia de hemoptisis, obstrucción bronquial y disnea. Alrededor del 25% de todos los casos son asintomáticos. Objetivo: Presentar una serie de pacientes con diagnóstico de tumor carcinoide pulmonar y su abordaje quirúrgico. Material y método: Análisis retrospectivo de pacientes con diagnóstico de tumor carcinoide broncopulmonar en un período de 5 años (enero 2007-enero 2012). Se analizaron edad y género del paciente, tiempo de evolución de sintomatología pulmonar, antecedentes de patología respiratoria, hallazgos radiológicos, resultado histopatológico, tipo de intervención quirúrgica y días de estancia hospitalaria. Se realizó toracotomía posterolateral en todos los pacientes. Resultados: En un período de 5 años (enero 2007-enero 2012) se encontraron 5 pacientes diagnosticados con tumor carcinoide broncopulmonar. Todos fueron intervenidos quirúrgicamente en el servicio de Neumología y Cirugía Toracopulmonar. Se realizó toracotomía posterolateral en todos los pacientes. Tres derechas y 2 izquierdas: neumonectomía en 3 pacientes, una bilobectomía derecha, una lobectomía inferior izquierda. En todos los casos se realizó exéresis completa del tumor. La edad promedio fue de 37,8 años (rango 25-48). El tiempo de evolución promedio de sintomatología al momento del diagnóstico fue de 8,4 meses (rango 6-12 meses). El tiempo de estancia hospitalaria fue de 6,2 días (rango 5-7). Conclusiones: El tratamiento quirúrgico es orientado hacia la resección pulmonar conservadora; en casos de tumores atípicos, se prefiere resección amplia y extirpación de ganglios linfáticos mediastínicos.

Objetivo: proponer un sistema de indicadores como instrumento de dirección para el laboratorio clínico, desde la perspectiva de gestión interna de un cuadro de mando integral. Material y métodos: los indicadores se obtienen de distintas fuentes, a través de registros internos del sistema informático del laboratorio, control externo de calidad de la Generalitat Valenciana. Se muestran los resultados de los indicadores de proceso analítico (proporción) de un año. Resultados: se proponen indicadores de gestión interna (divididos en proceso, adecuación y control de calidad). Los indicadores de proceso muestran una progresiva mejora desde su establecimiento. Conclusión: tras un año de utilización de los indicadores de proceso analítico de un cuadro de mando integral en el laboratorio, los resultados obtenidos validan su utilidad como instrumento para la gestión del laboratorio.Objective: to propose a set of indicators as a management tool for a clinical laboratory, by using the balanced scorecard internal business processes perspective. Material and methods: indicators proposed are obtained from different sources; external proficiency testing of the Valencia Community Government, by means of internal surveys and laboratory information system registers. One year testing process proportion indicators results are showed. Results: internal management indicators are proposed (process, appropriateness and proficiency testing). The process indicators results show gradual improvement since its establishment. Conclusion: after one years of using a conceptually solid Balanced Scorecard Internal business processes perspective indicators, the obtained results validate the usefulness as a laboratory management tool.