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Impulsivity resulting from frontostriatal dysfunction in drug abuse: implications for the control of behavior by reward-related stimuli blood pressure medication when pregnant order plavix cheap online. Cannabinoids and value-based decision making: implications for neurodegenerative disorders best blood pressure medication kidney disease cheap plavix 75mg amex. On the ability to hypertension lifestyle modification buy plavix online from canada inhibit simple and choice reaction-time responses—a model and a method heart attack 6 fragger generic plavix 75mg without a prescription. Enhanced alcohol self administration and reinstatement in a highly impulsive, inattentive recombinant inbred mouse strain. Balanced placebo design with marijuana: pharmacological and expectancy effects on impulsivity and risk taking. Impulsivity differences in recreational cannabis users and binge drinkers in a university population. Local glutamate receptor antagonism in the rat prefrontal cortex disrupts response inhibition in a visuospatial attentional task. Involvement of dopamine D1 and D2 receptors in the nucleus accumbens core and shell in inhibitory response control. Receptors and channels targeted by synthetic cannabinoid receptor agonists and antagonists. The 5-choice serial reaction time task: behavioural pharmacology and functional neurochemistry. Restraint and cancellation: multiple inhibition deficits in attention deficit hyperactivity disorder. Puberty as a highly vulnerable developmental period for the conse quences of cannabis exposure. Dopamine axon varicosities in the prelimbic division of the rat prefrontal cortex exhibit sparse immuno reactivity for the dopamine transporter. Frontal lobe gamma-aminobutyric acid levels during adolescence: associations with impulsivity and response inhibition. Reflection impulsivity in adolescent cannabis users: a comparison with alcohol using and non-substance-using adolescents. Biosynthesis and degradation of anandamide and 2-arachidonoylglycerol and their possible physiological significance. Effects of amphetamine and methylphenidate on delay discounting in rats: interactions with order of delay presenta tion. Latency differentiation of hits and false alarms in an oper ant psychophysical test. Altering endocannabinoid neurotransmission at critical developmental ages: impact on rodent emotionality and cognitive performance. Critical involvement of dopaminergic neurotransmission in impulsive decision making. Impulsivity as a vulnerability marker for substance-use disorders: review of findings from high-risk research, problem gam blers and genetic association studies. Measuring “waiting” impulsivity in substance addictions and binge eating disorder in a novel analogue of rodent serial reaction time task. Depression and impulse control disorders in Parkinson’s disease: two sides of the same coin The utility of rat models of impulsivity in developing pharma cotherapies for impulse control disorders. Insight into the relation ship between impulsivity and substance abuse from studies using animal models. Effects of cannabis on impulsivity: a systematic review of neuroimaging find ings. It has a chronic and fluctuating course and tends to be underdiagnosed (Jenike, 2004). Failure to perform a particular ritual can result in severe anxiety (Jenike, 2004; Wu et al. Deep brain stimulation of the ventral striatum, subthalamic nucleus, and thalamo reticular and inferior thalamic peduncles has also been recently approved for refractory cases (Albelda and Joel, 2012; Heeramun-Aubeeluck and Lu, 2013). Family studies have also indicated that the risk in first-degree relatives is 3A12 times greater than in the gen eral population (Do Rosario-Campos et al. Increased glucose metabolism and blood flow (detected at pretreatment baseline or during symptom provocation) have been consistently reported in one or more of the following regions: orbitofrontal and anterior cingulate cortices, caudate, and thalamus (Saxena and Rauch, 2000; Whiteside et al. In a simplified model, the output structures of the basal ganglia provide inhibitory tone to the thalamus, which in turn is modu lated by the balance between activity of the direct and indirect pathways (Graybiel, 2000). Conversely, a shift favoring activity in the indirect pathway has a net effect of reinforcing or strengthening the inhibitory tone to the thalamus and thereby inhibits the selection of behavioral sequences. The direct pathway is usually associated with facilitating motor behavior whereas activity of the indirect pathway more likely results in motor inhibition (Graybiel, 2000). For example, there is evidence for involvement of the limbic system with respect to its anxiety component. Altered amygdala volume and dysfunctional amygdala activation have been reported in these patients (Szeszko et al. However, subse quent studies showed that, contrary to most anxiety tests based on exploratory behavior, repeated exposure to the marbles does not cause behavioral habituation. This led to the proposal that this test, instead of measuring novelty-induced anxi ety, is rather evaluating a natural, repetitive behavior that can become compulsive (Njung’e and Handley, 1991; Thomas et al. They also failed to find any association between marble-burying behavior and familiarity with the test or the burying material (Thomas et al. This suggestion is in line with the view that compulsive behaviors result from an inability to achieve a sense of task completion (Szechtman and Woody, 2004). Finally, clomipramine can par tially attenuate quinpirole-induced compulsive checking (Szechtman et al. In each trial a certain magazine is cued by a light stimulus in a random order and the animal learns to collect a food reward from the cued magazine. Perseveration in this task is defined as repeated responses to a specific magazine after it has been rewarded (Robbins, 2002). These models have not been planned on the basis of known mutations in humans but are largely based on face validity (behavioral similarity). They include the Hoxb8 mutant and genetic manipulations of dopamine, serotonin, and glutamate function. Mice with mutations in this gene groomed excessively to the point of hair removal and skin lesions (Greer and Capecchi, 2002). Welch and colleagues (2007) found that at the age of 4A6monthsSapap3 knockout mice show excessive self-grooming with no sign of peripheral cutane ous defects, as well as increased anxiety-like behaviors in several tests, with no change in general activity. Sapap3 knockout mice had specific defects in the structure of the postsynaptic complex of cortico striatal synapses. Further experi mentation showed that variation within the human Sapap3 gene was associated with grooming disorders (pathologic nail biting, pathologic skin picking, and trichotillomania), suggesting that Sapap3 is a promising functional candidate gene for human grooming disorders (Bienvenu et al. Slitrk5 knockout mice showed a selective overactivation of the orbitofrontal cortex, as well as abnormalities in striatal anatomy and cell mor phology and alterations in glutamate receptor composition, which contribute to deficient cortico-striatal neurotransmission. This model suggests an imbalance between the direct and indirect pathways that produces a hyperactive circuit responsible for the repetitive behaviors (Saxena and Rauch, 2000). Since D1 preferentially acti vates the direct and D2 the indirect pathway, and the density of D1 in the basal ganglia is higher than that of D2 receptors, increased concentrations of dopamine are most likely to result in a dominant D1-regulated direct circuit, and conse quently in a hyperactive cortico-striatal system. Reduced medial prefrontal cortex inhibitory tone could generate abnormal striatal activation either directly, due to anterior cin gulate cortex projections to the striatum, or indirectly, due to anterior cingulate cor tex projections to the orbitofrontal cortex (Price and Drevets, 2010). At least in the striatum these receptors are not homogeneously distributed, being more concentrated in the areas involved in sensory motor aspects (Van Waes et al. Even if their pre cise role in this circuitry is not fully understood, several pieces of evidence reviewed above (Table 15. The endocannabinoid and dopaminergic systems control each other by several mechanisms (van der Stelt and Di Marzo, 2003; El Khoury et al. Anandamide treatment of primary cell cultures derived from the embryonic cortex arrests cell differentiation and blocks the neurite outgrowth (Rueda et al. In addition, a limited number of studies indicate that other anti glutamatergic drugs, such as N-acetylcysteine (Lafleur et al. Additional studies are clearly needed to investigate the role of these neurotransmitters in this disorder.

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The duration requirement for schizo­ phreniform disorder is intermediate between that for brief psychotic disorder arrhythmia heart murmur order cheapest plavix, which lasts more than 1 day and remits by 1 month blood pressure chart high diastolic generic 75 mg plavix with amex, and schizophrenia arrhythmia reentry discount plavix amex, which lasts for at least 6 months heart attack jack black widow cheap plavix 75mg with mastercard. In this case, the diagnosis should be noted as "schizophreniform disorder (provisional)" because it is uncertain if the indi­ vidual will recover from the disturbance within the 6-month period. If the disturbance per­ sists beyond 6 months, the diagnosis should be changed to schizophrenia. Another distinguishing feature of schizophreniform disorder is the lack of a criterion requiring impaired social and occupational functioning. While such impairments may po­ tentially be present, they are not necessary for a diagnosis of schizophreniform disorder. Associated Features Supporting Diagnosis As with schizophrenia, currently there are no laboratory or psychometric tests for schizo­ phreniform disorder. There are multiple brain regions where neuroimaging, neuropa thological, and neurophysiological research has indicated abnormalities, but none are diagnostic. Prevaience Incidence of schizophreniform disorder across sociocultural settings is likely similar to that observed in schizophrenia. In the United States and other developed countries, the in­ cidence is low, possibly fivefold less than that of schizophrenia. In developing countries, the incidence may be higher, especially for the specifier 'with good prognostic features"; in some of these settings schizophreniform disorder may be as common as schizophrenia. Deveiopment and Course the development of schizophreniform disorder is similar to that of schizophrenia. About one-third of individuals with an initial diagnosis of schizophreniform disorder (provi­ sional) recover within the 6-month period and schizophreniform disorder is their final di­ agnosis. The majority of the remaining two-thirds of individuals will eventually receive a diagnosis of schizophrenia or schizoaffective disorder. Relatives of individuals with schizophreniform disorder have an increased risk for schizophrenia. Functionai Consequences of Sciiizophreniform Disorder For the majority of individuals with schizophreniform disorder who eventually receive a diagnosis of schizophrenia or schizoaffective disorder, the functional consequences are similar to the consequences of those disorders. Most individuals experience dysfunction in several areas of daily functioning, such as school or work, interpersonal relationships, and self-care. Individuals who recover from schizophreniform disorder have better functional outcomes. A wide variety of mental and medical conditions can manifest with psychotic symptoms that must be considered in the differ­ ential diagnosis of schizophreniform disorder. These include psychotic disorder due to another medical condition or its treatment; delirium or major neurocognitive disorder; substance/medication-induced psychotic disorder or delirium; depressive or bipolar disorder with psychotic features; schizoaffective disorder; other specified or unspecified bi­ polar and related disorder; depressive or bipolar disorder with catatonic features; schizophre nia; brief psychotic disorder; delusional disorder; other specified or unspecified schizo­ phrenia spectrum and other psychotic disorder; schizotypal, schizoid, or paranoid personality disorders; autism spectrum disorder; disorders presenting in childhood with disorganized speech; attention-deficit/hyperactivity disorder; obsessive-compulsive dis­ order; posttraumatic stress disorder; and traumatic brain injury. Since the diagnostic criteria for schizophreniform disorder and schizophrenia differ primarily in duration of illness, the discussion of the differential diagnosis of schizophre­ nia also applies to schizophreniform disorder. Schizophreniform disorder differs in duration from brief psy­ chotic disorder, which has a duration of less than 1 month. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). For a significant portion of the time since the onset of the disturbance, level of function­ ing in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning). This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Cri­ terion A. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness. If there is a history of autism spectrum disorder or a communication disorder of child­ hood onset, the additional diagnosis of schizophrenia is made only if prominent delu­ sions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated). Specify if: the following course specifiers are only to be used after a 1-year duration of the disorder and if they are not in contradiction to the diagnostic course criteria. First episode, currently in partial remission: Partial remission is a period of time during which an improvement after a previous episode is maintained and in which the defining criteria of the disorder are only partially fulfilled. First episode, currently in full remission: Full remission is a period of time after a previous episode during which no disorder-specific symptoms are present. Unspecified Specify if: With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. Diagnostic Features the characteristic symptoms of schizophrenia involve a range of cognitive, behavioral, and emotional dysfunctions, but no single symptom is pathognomonic of the disorder. The di­ agnosis involves the recognition of a constellation of signs and symptoms associated with impaired occupational or social functioning. Individuals with the disorder will vary sub­ stantially on most features, as schizophrenia is a heterogeneous clinical syndrome. At least two Criterion A symptoms must be present for a significant portion of time during a 1-month period or longer. At least one of these symptoms must be the clear pres­ ence of delusions (Criterion Al), hallucinations (Criterion A2), or disorganized speech (Criterion A3). Grossly disorganized or catatonic behavior (Criterion A4) and negative symptoms (Criterion A5) may also be present. In those situations in which the active phase symptoms remit within a month in response to treatment. Criterion A is still met if the clinician estimates that they would have persisted in the absence of treatment. Schizophrenia involves impairment in one or more major areas of functioning (Crite­ rion B). If the disturbance begins in childhood or adolescence, the expected level of func­ tion is not attained. The dysfunction persists for a substantial period during the course of the disorder and does not appear to be a direct result of any single feature. There is also strong evidence for a relationship between cognitive impairment (see the section "Associated Features Supporting Diagnosis" for this disorder) and func­ tional impairment in individuals with schizophrenia. Some signs of the disturbance must persist for a continuous period of at least 6 months (Criterion C). Pi;odromal symptoms often precede the active phase, and residual symp­ toms may follow it, characterized by mild or subthreshold forms of hallucinations or delusions. Individuals may express a variety of unusual or odd beliefs that are not of de­ lusional proportions. Negative symptoms are common in the pro­ dromal and residual phases and can be severe. Individuals who had been socially active may become withdrawn from previous routines. Mood symptoms and full mood episodes are common in schizophrenia and may be con­ current with active-phase symptomatology. However, as distinct from a psychotic mood dis­ order, a schizophrenia diagnosis requires the presence of delusions or hallucinations in the absence of mood episodes. In addition, mood episodes, taken in total, should be present for only a minority of the total duration of the active and residual periods of the illness. Associated Features Supporting Diagnosis Individuals with schizophrenia may display inappropriate affect. Depersonalization, derealization, and so­ matic concerns may occur and sometimes reach delusional proportions. Cognitive deficits in schizophrenia are conrmion and are strongly linked to vocational and functional impairments. These deficits can include decrements in declar­ ative memory, working memory, language function, and other executive functions, as well as slower processing speed. Abnormalities in sensory processing and inhibitory capacity, as well as reductions in attention, are also found. Some individuals with schizophrenia show social cognition deficits, including deficits in the ability to infer the intentions of other people (theory of mind), and may attend to and then inte ret irrelevant events or stimuli as meaningful, perhaps leading to the generation of explanatory delusions. Some individuals with psychosis may lack insight or awareness of their disorder. Unawareness of illness is typically a symptom of schizophrenia itself rather than a coping strategy. It is comparable to the lack of awareness of neurological deficits following brain damage, termed anoso­ gnosia.

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Glossary descriptions In addition to blood pressure medication lotrel cheap plavix 75 mg on line inclusion or exclusion terms arteria coronaria derecha purchase plavix master card, Chapter V pulse pressure graph buy cheap plavix 75mg on-line, Mental and behavioural disorders blood pressure risks purchase cheapest plavix and plavix, uses glossary descriptions to indicate the content of rubrics. To enclose supplementary words, which may follow a diagnostic term without affecting the code number to which the words outside the parentheses would be assigned. Sometimes an unqualified term is nevertheless classified to a rubric for a more specific type of the condition. These inbuilt assumptions have to be taken into account in order to avoid incorrect classification. Careful inspection of inclusion terms will reveal where an assumption of cause has been made; coders should be careful not to code a term as unqualified unless it is quite clear that no information is available that would permit a more specific assignment elsewhere. For example: J16 Pneumonia due to other infectious organisms, not elsewhere classified this category includes J16. G03 Meningitis due to other and unspecified causes, Excludes: meningoencephalitis (G04. Symbols † the dagger symbol is used to indicate a code that represents the etiology or underlying cause of a disease. This code should be paired with a dagger (etiology) code and should follow this in sequence. Identify the type of statement to be coded and refer to the appropriate section of the Alphabetical Index. However, some conditions expressed as adjectives or eponyms are included in the Index as lead terms. Read any terms enclosed in parentheses after the lead term (these modifiers do not affect the code number), as well as any terms indented under the lead term (these modifiers may affect the code number), until all the words in the diagnostic expression have been accounted for. It may be necessary to refer to all codes appearing under the three-character level in order to identify the most appropriate code. Be guided by any inclusion or exclusion terms under the selected code or under the chapter, block or category heading. Dr Jardel spoke of the extensive consultations and preparatory work that had gone into the revision proposals and had necessitated a longer than usual interval between revisions. Loy United Kingdom of Great Britain and Northern Ireland (Temporary Adviser) Mr R. Even with a new structure, it was plain that one classification could not cope with the extremes of the requirements. Decisions made on these matters had paved the way for the preparation of successive drafts of chapter proposals for the Tenth Revision. This had the effect of more than doubling the size of the coding frame in comparison with the Ninth Revision and enabled the vast majority of chapters to be assigned a unique letter or group of letters, each capable of providing 100 three-character categories. As a matter of policy, some three-character categories had been left vacant for future expansion and revision, the number varying according to the chapters: those with a primarily anatomical axis of classification had fewer vacant categories as it was considered that future changes in their content would be more limited in nature. The order of entry of chapters in the proposals for the Tenth Revision had originally been the same as in the Ninth Revision; however, to make effective use of the available space, disorders of the immune mechanism were later included with diseases of the blood and blood-forming organs, whereas in the Ninth Revision they had been included with endocrine, nutritional and metabolic diseases. The new chapter on "Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism" now followed the "Neoplasms" chapter, with which it shared the letter D. During the elaboration of early drafts of the chapter on "Diseases of the nervous system and sense organs", it had soon become clear that it would not be possible to accommodate all the required detail under one letter in 100 three-character categories. It had been decided, therefore, to create three separate chapters "Diseases of the nervous system" having the letter G, and the two chapters on "Diseases of the eye and adnexa" and on "Diseases of the ear and mastoid process" sharing the letter H. With the inclusion of the former supplementary classifications as part of the core classification and the creation of two new chapters, the total number of chapters in the proposal for the Tenth Revision had become 21. The titles of some chapters had been amended to give a better indication of their content. Postprocedural conditions that were not specific to a particular body system, including immediate complications such as air embolism and postoperative shock, continued to be classified in the chapter on "Injury, poisoning and certain other consequences of external causes". Another change was that in the Ninth Revision, the four-digit titles had often had to be read in conjunction with the three-digit titles to ascertain the full meaning and intent of the subcategory, whereas in the draft presented to the Conference the titles were almost invariably complete and could stand alone. The dual classification scheme for etiology and manifestation, known as the dagger and asterisk system, introduced in the Ninth Revision, had been the subject of a certain amount of criticism. These characteristics of the proposed Tenth Revision were accepted by the Conference. These recommendations were the outcome of a series of special meetings and consultations and were directed towards improving the comparability of data. After some discussion, the Conference set up a working party on the subject of maternal mortality and, on the basis of its recommendations, also agreed to retain the definition of maternal death as it appeared in the Ninth Revision. In order to improve the quality of maternal mortality data and provide alternative methods of collecting data on deaths during pregnancy or related to it, as well as to encourage the recording of deaths from obstetric causes occurring more than 42 days following termination of pregnancy, two additional definitions, for "pregnancy-related deaths" and "late maternal deaths", were formulated by the working party. With respect to perinatal, neonatal and infant mortality, it was strongly advised that published rates based on birth cohorts should be so identified and differentiated. The Conference confirmed the practice of expressing age in completed units of time and thus designating the first day of life as day zero. In considering the international form of medical certificate of cause of death, the Expert Committee had recognized that the situation of an aging population with a greater proportion of deaths involving multiple disease processes, and the effects of associated therapeutic interventions, tended to increase the number of possible statements between the underlying cause and the direct cause of death: this meant that an increasing number of conditions were being entered on death certificates in many countries. This led the Committee to recommend the inclusion of an additional line (d) in Part I of the certificate. Experience gained in the use of the definitions and rules in the Ninth Revision had proved their usefulness and generated requests for their clarification, for further elaboration regarding the recording of diagnostic information by health care practitioners, and for more guidance on dealing with specific problem situations. The Conference agreed that extensive notes and examples should be added to provide further assistance. Considerable concern was expressed about the applicability of such lists to all morbidity in the broadest sense. There was general agreement that the lists as presented were probably more suited to inpatient morbidity, and it was felt that further efforts should be made to develop lists suitable for other morbidity applications and also that both mortality and morbidity tabulation lists should be accompanied in the Tenth Revision by appropriate explanations and instructions on their use. In the light of the concerns raised in the Conference and the conclusions of the working party, the Conference agreed that the tabulation and publication lists should appear in the Tenth Revision, while an effort should be made to establish clearer, more descriptive titles for these lists. After studies and discussions in cooperation with the various Collaborating Centres, a concept of a family of classifications had been elaborated and subsequently revised by the Expert Committee in 1987, which had recommended the scheme shown opposite. Clinical guidelines would accompany a version intended for use by clinicians working in the field of psychiatry; research criteria would be proposed for use in investigations of mental health problems; and multi-axial presentations for use in dealing with childhood disorders and for the classification of adult problems would be developed as well as a version for use by general practitioners. The topography codes of the second edition would be based on categories C00-C80 in the Tenth Revision and publication would, therefore, await World Health Assembly approval of the Tenth Revision. It had drawn up a detailed list of symptom associations, and from this, two short lists were derived, one for causes of death and one for reasons for contact with health services. Field trials of this system had been carried out in countries of the Region and the results used to revise the list of symptom associations and the reporting forms. At the International Conference on Health Statistics for the Year 2000 (Bellagio, Italy, 1982) (6), the integration of "lay reporting" information with other information generated and used for health management purposes had been identified as a major problem inhibiting the wider implementation of lay reporting schemes. This list had been presented to the Centre Heads at their 1989 meeting and it had been agreed that it could serve as a guide for national presentation or publication of statistics on surgical procedures and could also facilitate intercountry comparisons. At the time of the Conference, volumes had been published on diseases of the lower respiratory tract, infectious diseases (viral, bacterial and parasitic diseases and mycoses) and cardiac and vascular diseases, and work was under way on volumes for the digestive system, female genital system, urinary and male genital system, metabolic and endocrine diseases, blood and blood forming organs, immunological system, musculoskeletal system and nervous system. Subjects proposed for future volumes included psychiatric diseases, as well as diseases of the skin, ear, nose and throat, and eye and adnexa. It would also contain all related definitions, standards, rules and instructions and a shortened Alphabetical Index. With respect to the physical appearance of the pages and type formats for both the Tabular List and the Alphabetical Index, the Conference was assured that recommendations from the Centre Heads and complaints from coders would be considered, and every attempt made to improve those aspects as compared with the Ninth Revision. As with the Ninth Revision, it was intended to develop materials for the reorientation of trained coders, with the help of the Collaborating Centres. They would be carried out from late 1991 to the end of 1992, to finish before the implementation of the Tenth Revision. Various suggestions for mechanisms to overcome these difficulties and avoid similar problems with respect to the Tenth Revision were discussed. There was discussion on the type of forum in which such changes and the potential for use of the vacant letter "U" in new or temporary code assignments could be discussed. It was agreed that it would not be feasible to hold revision conferences more frequently than every 10 years. Report of the Expert Committee on the International Classification of Diseases 10th Revision: First Meeting.

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Furthermore arteria vesicalis medialis buy 75 mg plavix amex, the average medical student receives 10 weeks or 70 hours of didactic coursework in medical genetics arrhythmia synonym order plavix online from canada. Heterogeneity of test values also makes it difficult for clinicians to prehypertension ppt cheap plavix 75mg without a prescription work in an integrated health system using more than one testing method arteria pudenda externa buy plavix canada. Laboratory reports will need to make better use of graphical displays to facilitate rapid assimilation and comprehension of important data by clinicians, other laboratory professionals, and patients. Improving the quality of health management through clinician and laboratorian teamwork: the concept and the practice of quality. A study of the College of American Pathologists/Centers for Disease Control and Prevention Outcomes Working Group. Enhanced clinical consulting-moving toward the core competencies of laboratory professionals. Customer satisfaction in anatomic pathology: a College of American Pathologists Q-Probes study of 3065 physician surveys from 94 laboratories. The human factor: the critical importance of effective teamwork and communication in providing safe care. Application of a diagnostic algorithm in autoantibody testing: assessment of clinical effectiveness and economic efficiency. Development, implementation, and impact of acceptability criteria for serologic tests for infectious diseases. Application of hepatitis serology testing algorithms to assess inappropriate laboratory utilization. Duplicate laboratory orders: a College of American Pathologists Q-Probes study of thyrotropin requests in 502 institutions. A multicenter cluster randomized controlled trial of strategies to improve thyroid function testing. Effect of population-based interventions on laboratory utilization: a time-series analysis. Outpatient order accuracy: a College of American Pathologists Q Probes study of requisition order entry accuracy in 660 institutions. Ordering accuracy: a College of American Pathologists Q Probes study of 577 institutions. Health Smart Strategy for the modernisation and replacement of information technology. Medication-related clinical decision support in computerized provider order entry systems: a review. The impact of computerized physician order entry systems on pathology services: a systematic review. Consumer direct access to clinical laboratory testing: what are the critical issues A College of American Pathologists Q-Probes study of 666 institutions and 18,679 toxic levels. Use of an electronic barcode system for patient identification during blood transfusion: 3-year experience in a regional hospital. Life after phlebotomy deployment: reducing major patient and specimen identification errors. Improving patient safety by identifying side effects from introducing bar coding in medication administration. Outpatient phlebotomy success and reasons for specimen rejection: a Q Probes study. Improving transfusion safety by electronic identification of patient, blood samples, and blood units. Inpatient phlebotomy practices: a College of American Pathologists Q-Probes quality management study of 2,351,643 phlebotomy requests. Atypical epithelial cells and specimen adequacy-current laboratory practices of participants in the College of American Pathologists interlaboratory comparison program in cervicovaginal cytology. Specimen collection volumes for laboratory tests: a College of American Pathologists study of 140 laboratories. Effective measures for reducing blood loss from diagnostic laboratory tests in intensive care unit patients. Contaminated blood cultures and resource utilization: the true consequences of false-positive results. Trends in blood culture contamination: a College of American Pathologists Q-Tracks study of 356 institutions. Contamination rates of blood cultures obtained by dedicated phlebotomy versus intravenous catheter. Simplifying collection of corneal specimens in cases of suspected bacterial keratitis. Effects of a pneumatic tube system on routine and novel hematology and coagulation parameters in healthy volunteers. Effects of transportation and delay in processing on the stability of nutritional and metabolic biomarkers. Laboratory network of excellence: enhancing patient safety and service effectiveness. Evaluation of an automated preanalytic robotic workstation at two academic health centers. Sources of variability: a College of American Pathologists therapeutic drug monitoring survey study. Analytic performance goals based on direct effect on analytic bias on medical classification decisions. The accuracy of laboratory measurements in clinical chemistry: a study of 11 routine chemistry analytes in the College of American Pathologists Chemistry Survey with fresh frozen serum, definitive methods, and reference methods. Maximizing efficacy of endocrine tests: importance of decision-focused testing strategies and appropriate patient preparation. Wrong biochemistry results: two case reports and observational study in 5310 patients on potentially misleading thyroid-stimulating hormone and gonadotropin immunoassay results. The impact of calibration error in medical decision making (planning report 04-1). The effects of modifying proficiency testing materials on thyroid function test results: a College of American Pathologists ligand assay survey study. Preanalytic and analytic sources of variations in C-reactive protein measurement: implications for cardiovascular disease risk assessment. Accreditation and Quality Assurance: Journal for Quality, Comparability and Reliability in Chemical Measurement 2006;11(6):303-7. Extraneous tissue in surgical pathology: a College of American Pathologists Q-Probes study of 275 laboratories. Diagnostic discrepancies and their clinical impact in a neuropathology referral practice. Patient safety in anatomic pathology: measuring discrepancy frequencies and causes. Cytohistologic discrepancies: a means to improve pathology practice and patient outcomes. Interinstitutional comparison of frozen-section consultation: a College of American Pathologists Q-Probe study of 79,647 consultations in 297 North American institutions. Interinstitutional comparison of frozen-section consultations: a College of American Pathologists Q-Probes study of 90,538 cases in 461 institutions. Amended reports in surgical pathology and implications for diagnostic error detection and avoidance: a College of American Pathologists Q-Probes study of 1,667,547 accessioned cases in 359 laboratories. Using outlier events to monitor test turnaround time: a College of American Pathologists Q-Probes study in 496 laboratories. Early morning blood collections: a College of American Pathologists Q-Probes study of 657 institutions. Nongynecologic cytology turnaround time: a College of American Pathologists Q-Probes study of 180 laboratories. Intralaboratory timeliness of surgical pathology reports: results of two College of American Pathologists Q-probes studies of biopsies and complex specimens. Assessment of monitoring of laboratory critical values: a College of American Pathologists Q-Tracks study of 180 institutions. Laboratory critical values policies and procedures: a college of American Pathologists Q-Probes Study in 623 institutions. Clinicians are from Mars and pathologists are from Venus: clinical interpretation of pathology reports. Third report of the National Cholesterol Education Program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults.

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