[EXTERNAL] Re: [IMPROVEDX] Support Tests.

Maureen Cahill MCahill at NCSBN.ORG
Tue Jan 26 14:01:31 UTC 2016


Good points, Peggy, and today getting that education out in multiple formats -easy to use-  is very doable.
Maureen

Maureen Cahill [Associate] 312.525.3646 (D) mcahill at ncsbn.org<mailto:mcahill at ncsbn.org>
National Council of State Boards of Nursing (NCSBN) 111 E. Wacker Drive, Ste 2900, Chicago, IL 60601-4277 312.279.1032 (F) www.ncsbn.org<http://www.ncsbn.org>
Our Mission – NCSBN, Leading in nursing regulation

From: Peggy Zuckerman [mailto:peggyzuckerman at GMAIL.COM]
Sent: Monday, January 25, 2016 5:33 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] [EXTERNAL] Re: [IMPROVEDX] Support Tests.

Speaking on behalf of patients, I am always concerned that patients are the last to know of results that might be of concern to their doctors.  (To think that the measures re the prostate are not noted as being specific for those with prostates is pretty shocking.  Having just one kidney, I monitor my creatinine, but wonder how the one kidney vs two might be affected in standard lab reporting.

It would be quite  easy to keep website page to teach patients about those lab results, what the ranges are for their lab provider, and the simplest of explanation as to what that lab is measuriing.  In an ideal world, the doctor would have explained what he was most concerned about, and the reason for the labs in the first place!  Since 15-30% of labs which are problematic are not reported to the patient, and more frequently not given to them in a meaningful way, i.e., with no normal ranges indicated, this could go a long way to educating the patient, and making certain that the results reach the patient. I would like to assume that the doctor reviews all such labs, but knowing otherwise, this would be a second look.

When the patient must return to the doctor to receive the labs, only to be told they are normal, and that no further follow up is needed, he may come to distruct the doctor or feel that the financial incentives outweighed his own needs.  And on the way home, the patient will hear on the radio that we need more doctors or that patients cannot find physicians when they are clearly in need.

Getting some basic education to as many patients as possible is certainly part of sharing the burden of a diagnosis, and we should encourage it in many forms.

Peggy Zuckerman

Peggy Zuckerman
www.peggyRCC.com<http://www.peggyRCC.com>

On Mon, Jan 25, 2016 at 2:08 PM, Dwight Oxley <oxley.dwight at gmail.com<mailto:oxley.dwight at gmail.com>> wrote:
After thirty-five years as a hospital lab director, I can safely say that clinicians rarely share your view; they send the tests out to the cheapest vendor and there is usually no interpretation.

On Jan 25, 2016, at 2:20 PM, Sherri Loeb <sherriloeb at GMAIL.COM<mailto:sherriloeb at GMAIL.COM>> wrote:

I understand it is the same, but interpretation is vitally important!

On Mon, Jan 25, 2016 at 2:10 PM, Samuel, Rana <Rana.Samuel at va.gov<mailto:Rana.Samuel at va.gov>> wrote:
The test is the same – just may be reported with a different reference range or with an interpretive comment as in Lucy’s example below.

From: Sherri Loeb [mailto:sherriloeb at GMAIL.COM<mailto:sherriloeb at GMAIL.COM>]
Sent: Monday, January 25, 2016 2:41 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [EXTERNAL] Re: [IMPROVEDX] Support Tests.

I find this comment particularly interesting considering my husband passed away from metastatic prostate cancer. One he was diagnosed. We noticed that occasionally his psa was ordered as psa screening to check response to chemo and hormone therapy and other times as psa diagnostic. We were told it is exactly the same. From reading this email, it is obviously not the same.

Thanks for the clear explanation.

Sherri Loeb RN, BSN

On Mon, Jan 25, 2016 at 1:01 PM, Knapp, Lucy <LKnapp at peacehealthlabs.org<mailto:LKnapp at peacehealthlabs.org>> wrote:
In a word – speaking for the laboratory world – Communicate those needs to your laboratories. As an example, here we have two tests, “PSA, Screening” which has a reference range up to 4 and “PSA, Diagnostic” which also has a reference range of up to 4 but also includes an interpretative comment: “According to the American Urological Association (AUA), serum PSA should decrease and remain at undetectable levels after radical prostatectomy. The AUA defines biochemical recurrence as an initial PSA value of greater than or equal to 0.20 ng/mL followed by a subsequent confirmatory PSA value of greater than or equal to 0.20 ng/mL.”

In a prior life – we had 2 tests with different reference ranges, plus a comment on the PSA, Diagnostic. Both options are easily done in an LIS (lab information system).

We in the laboratory would love to have better communication from physicians – we want to make your lives easier. So my advice to all the physicians out there is to build relationships with the pathologists and laboratory personnel where you practice. Let us know where improvement is needed to the LIS, you need a new test, you need better sensitivity on a current test – whatever.

I’m copying the to our medical director, we are trying to establish better communication with our physicians throughout our system.

Lucy

Lucy Knapp, MT(ASCP)   |  Technical Specialist, Chemistry  |  Laboratory
PeaceHealth<http://www.peacehealth.org/>  |  400 NE Mother Joseph Place  |  Vancouver, WA 98664
office 360-514-2732<tel:360-514-2732>  |  fax 360-514-1646<tel:360-514-1646>

From: robert bell [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>]
Sent: Sunday, January 24, 2016 1:56 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] Support Tests.

I have suggested that at the same time, or even before we tackle Errors in Diagnosis, we see that all our support diagnostic tests (Lab, X-ray, etc.) are in good order so as to help make the correct diagnoses more often.

I have been made aware that it is easy to miss a low but rising PSA in someone who has had a past radical prostatectomy.

The Lab reports results as ng/mL with a reference range of (0.000 - 4.000). The range for someone with a prostate present.

I asked myself with all the technology is there anything that could be done to prevent such happenings?

And then I thought there must be 100s of similar situations when time, disease, surgery, treatments, etc effect lab interpretations - the PSA lab reports on the ones I have seen do not mention that the ranges are for someone with a prostate. Should they?

Yes, good clinical skills would help but could the lab with or without technology do anything to help avoid such problems?  Could training or anything else help prevent?

I wondered how often this happens - and if you decided to do something about it, could you triage it - presumably not without good error data!?

Robert Bell




________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1<https://mail2.peacehealth.org/enduser/classify_url.html?url=P4JeiEdQ8JXS0jGbSQNeoCNP5x6BIz6Aj0TpSUpjJFwveji9BsZVeZFgSweiLOutgugZP9kVnYEPuFAsUQb2hEZA9boc5hH3cvuDGw+3Y8w=>
or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/

This message is intended solely for the use of the individual and entity to whom it is addressed, and may contain information that is privileged, confidential, and exempt from disclosure under applicable state and federal laws. If you are not the addressee, or are not authorized to receive for the intended addressee, you are hereby notified that you may not use, copy, distribute, or disclose to anyone this message or the information contained herein. If you have received this message in error, immediately advise the sender by reply email and destroy this message.

________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/


________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/


________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1

or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX


Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/



________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/


________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/

The information contained in this e-mail and any accompanying documents is intended for the sole use of the recipient to whom it is addressed, and may contain information that is privileged, confidential, and prohibited from disclosure under applicable law. If you are not the intended recipient, or authorized to receive this on behalf of the recipient, you are hereby notified that any review, use, disclosure, copying, or distribution is prohibited. If you are not the intended recipient(s), please contact the sender by e-mail and destroy all copies of the original message. The integrity and security of this message cannot be guaranteed on the Internet. Thank you.

To unsubscribe from the IMPROVEDX:
mail to:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
or click the following link: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

For additional information and subscription commands, visit:
http://www.lsoft.com/resources/faq.asp#4A

http://LIST.IMPROVEDIAGNOSIS.ORG/ (with your password)

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
</p>

HTML Version:
URL: <../attachments/20160126/295773bc/attachment.html>


More information about the Test mailing list