Patients admitted to the emergency room with dizziness often get a CT scan to rule out stroke. But an abstract of a study presented last week at a Florida medical conference suggests ordering CT scans for dizzy patients might not be cost-effective.
The study, conducted by Henry Ford Hospital researchers in Detroit, found that although nearly half of all patients complaining of dizziness and vertigo got a CT scan, fewer than 1 percent had any significant pathology that required intervention.
During the three-year period of the study, nearly $1 million was spent on brain CTs of the patients, the researchers said. As a result, the researchers argued "stricter guidelines" for ordering CT scans in the ER for dizzy patients could generate cost savings.
"It is our hope that our investigation into our own practices will shed light on avenues to run leaner practices within our institution as well as serve as a model for other health care systems," the authors wrote in the abstract. The authors were Drs. Syed F. Ahsan, neuro-otologist at Henry Ford, Mausumi N. Syamal and Kathleen Yaremchuk.
The study, which ran from January 2008 to January 2011 at a Detroit city ER, involved 1,681 patients, 810 of whom received brain or head CTs, of which only 0.74 percent were clinically significant. Older and poorer patients were more likely to get scanned, according to the authors' analysis.
The study, which has not appeared yet in a peer-reviewed journal, was presented Jan. 26 at the Triological Society's Combined Sections Meeting in Miami Beach.
Blood protein is measured as part of routine blood work, and is also used to diagnose and evaluate patients with cancer, immune disorders, malnutrition and digestive disorders, and diseases of the liver, kidney and intestines. For adults, normal levels of total protein are between 6.4 and 8.3 grams per deciliter (g/dl). (Reference values may vary from lab to lab.) Low protein is caused by malnutrition, malabsorption, overhydration, liver disease, immune deficiency and some drugs.
Blood Proteins
Albumin and globulin are the main proteins found in blood. Albumin accounts for about 60 percent of total protein. It functions as a transport for enzymes, hormones and drugs. Albumin also accounts for the "colloidal osmotic pressure," which is responsible for keeping fluid within the vessels. Globulins are the main building block for several substances, including antibodies, glycoproteins, lipoproteins, clotting factors and other components of the immune system. They also act as transport proteins. Together, the levels of albumin and globulin make up the total blood protein level. These proteins can also be measured separately.
Malnutrition
Amino acids are the building blocks of proteins. Humans can produce 10 of the 20 amino acids, but must take in the others through diet. If a person's diet lacks protein or any of these amino acids, his body cannot make albumin and globulin, resulting in low blood protein.
Malabsorption and Loss of Proteins
Conditions that affect the intestines can reduce the body's ability to absorb proteins from food. These are known as "protein-losing enteropathies," because the proteins are lost from the intestines rather than digested. Crohn's disease, Celiac disease and Whipple's disease can all damage the intestines, resulting in low blood protein. Renal disease can damage the filtration system of the kidneys, causing protein to "spill" into the urine and be lost to the body.
Overhydration
Blood protein levels are measured as the concentration of proteins per deciliter of blood. With overhydration, the blood volume increases, causing the protein level to decrease in proportion. The absolute levels of albumin and globulin are normal, but the ratio of proteins to fluid has decreased.
Liver Disease
Albumin and some globulins are made in the liver. When liver cells are damaged by disease, they cannot synthesize albumin. Thus total protein levels, and especially albumin levels, are used to diagnose and evaluate liver disease.
Immune Deficiency
Globulin is the building block for immunoglobulins, the main protein of the immune system. With immune deficiency, the number of immunoglobulins is reduced, which decreases blood protein levels.
Drugs
Several pharmaceuticals can reduce total blood protein levels. Among them are estrogens, oral contraceptives and any drug that is toxic to the liver.
If you have an headache , your doctor may order any of the following blood tests by blood analyzer or other medical analyzer.
A complete blood count, or CBC.
Your doctor may order this blood test if he or she suspects an infection is causing your headache. A complete blood count, or CBC, shows if you have an elevated white blood cell count. This could indicate an infection or other disease your body is fighting.
An erythrocyte sedimentation rate, or ESR.
If you are older than 65 years, your doctor may take blood to test for giant cell, or temporal, arteritis. Temporal arteritis is an inflammation of the arteries in the temple. This blood test is called an erythrocyte sedimentation rate, or ESR. An ESR tests the speed at which mature red blood cells settle. An elevated rate can indicate many types of disease or inflammation.
A C-reactive protein test.
Your doctor may also do a C-reactive protein test. This blood test measures abnormal protein that is detectable in the blood during the active phase of certain illnesses or inflammation.
Serum-based biomarkers have been integral to the advancement of the field of cardiology during the past half-century, and with better knowledge about their role in the pathophysiology of cardiovascular disease (CVD), their utility has expanded from merely aiding in the diagnosis of disease to being important in predicting risk and prognosis. Some, such as the natriuretic peptides, B-type natriuretic peptide (BNP) and its amino-terminal pro peptide equivalent, N-terminal-proBNP (NT-proBNP), also are being actively explored as a means of guiding therapy. Novel biomarkers continue to be evaluated, along with new lines of investigation, including genomics and metabolomics, which hold the potential for even greater insights into CVD and its treatments.
Though by any measure this progress has been significant, the best may be yet to come, according to Fred Apple, PhD, medical director of clinical laboratories at Hennepin County Medical Center and professor of laboratory medicine and pathology at the University of Minnesota School of Medicine, in Minneapolis. “Our world is expanding in the sense that predominantly we’ve been using proteins to follow diagnosis and are now slowly inching into following outcomes. In the protein world, the question is, are there going to be other biomarkers that complement or replace the current ones that are pretty solid,” he said. “Now, looking down the road, there’s clearly growth in genomics and metabolomics, and the questions will be, how will these emerging fields assist in detecting disease early on, and how will they improve patient outcomes and care?” Apple co-edited the January issue of Clinical Chemistry, which explores the impact of biomarkers, proteomics, and genomics in CVD.
In modern hospitals, doctors need to master many modern information medical equipments. Now, intelligent phones invented are convenient for doctors.
Recently, America FDA has approved iPad/iPhone as auxiliary products using of medical image diagnosis radiation. The experts thought that iPad mobile technology can make doctors check images at once. iPad can realize Computed Tomography scans and results reading of MRI.
In some places, iPhone has become necessary diagnosis tools of doctors. According to the latest research of the university of Calgary, Canada medical college, doctors use iPhone to do stroke diagnosis and achieve the same precision of using medical computer and accurate rate is 94% to 100%. This technology is very useful in country medical equipments, no matter where doctors and patients are, it can connect with experts in real-time.
There are many people doubting intelligent phones, but intelligent phones have three advantages.
First, it is the price. It takes five thousands yuan to buy iPhones. But it is cheaper than hundreds of thousands yuan mobile medical diagnosis equipments,such as mobile x ray machines.
For morden hospitals doctors needing to master many modern medical equipments, from MRI, ultrasound instruments and medical x ray machine to all kinds of handheld medical equipments, have brought many troubles for doctors. If intelligent phones can replace for some functions, it is convenient for doctors.
Accreditation and Personnel
1 Check with your State's department of health for any licensing required to operate the laboratory. Certain cities and local governments may also requiring licensing and monitoring of the lab.
In addition to licensing, federal statues require that laboratories be accredited by the Joint Commission on Accreditation of Health Organizations (or an equivalent accreditation agency). Without accreditation, the laboratory cannot charge certain public and private insurance programs for services.
2 Hire all the necessary personnel for the operations of the laboratory. Make sure that they all meet the qualifications set forth by your state, including education and licensing. Medical technologists are qualified to supervise departments within the lab. Medical laboratory technicians are qualified to operate the analyzers and do testing.
3 Hire the appropriate people for the positions of leadership. A pathologist, who is a physician with specialized training in laboratory medicine, will oversee the scientific aspects of the lab. A lab manager, who will have business management training, will oversee the budgeting and personnel aspects of the lab. Support staff, such as administrative assistants and sample processing staff, are also key.
4 Advertise your services to the local physician offices, hospitals, and clinics. Explain to them what types of testing you will perform at the laboratory, the cost, and why your laboratory is better than others.
Medical laboratories differ from research or academic laboratories in that they handle biological samples and confidential patient information. They are staffed by professionals of different backgrounds and expertise in the clinical lab sciences. A person with a business background is usually the one to manage the financial and human resources of a lab. Starting a lab as a business requires acquiring the right equipment and people.
Instructions
Location and Equipment
1 Find a location that will house all of the equipment that will go into the lab. Remember that the lab must also have areas for a front office, sample processing, and a place for employees to store their personal belongings. The lab will also need plenty of storage for equipment reagents and parts and for sample collection supplies.
2 Make sure your location has plentiful water supply and disposal access to feed into the analyzers and to get rid of waste. Electric plugs must also be plentiful for all the laboratory analyzers to be plugged in. Likewise, an electric generator for electrical backup must be available.
3 Install all the laboratory analyzers in a configuration that will allow the greatest amount of mobility of personnel from one analyzer to the next. Remember that the analyzers produce a lot of heat, so the rooms where they are located must be well ventilated.
