Impact of laboratory test use strategies in a Turkish hospital

Objectives: Eliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH) and calculate potential savings in costs. Methods: A collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months. Results: Laboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6-85.0%) was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars. Conclusion: Hospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory test

BÖBREK HÜCRELİ KANSERİ TAKLİT EDEN ABDOMİNAL KAYNAKLI DESMOPLASTİK KÜÇÜK YUVARLAK HÜCRELİ TÜMÖR: BİR OLGU SUNUMU VE YAYINLARIN GÖZDEN GEÇİRİLMESİ

Introduction: A 25 year-old woman admitted to our clinic due to left lomber pain, weakness and abdominal mass. On computerized tomography, 140×110×50 mm in diameter solid mass was detected in upper pole of the left kidney on computerized tomography (CT). The patient underwent left radical nephrectomy and histopathological examination of the specimen was reported as pyelonephritis. Six months after the operation, the patient admitted to our clinic with huge intraabdominal mass. It was defined as hematoma or abcess on CT. One thousand cc necrotic clot like material was evacuated in exploration. Histopathological examination of this material indicated desmoplastic small round cell tumor

The relationship between platelet–lymphocyte ratio, neutrophil–lymphocyte ratio, and survival in metastatic gastric cancer on firstline modified docetaxel and cisplatinum plus 5 Fluorourasil Regimen: A single institute experience

Background/Aims: The association between platelet–lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR), and survival with response rates were evaluated in metastatic gastric cancer (MGC). Patients and Methods: MGC patients on firstline modified docetaxel/cisplatinum/5-fluorourasil [mDCF; docetaxel 60 mg/m2 (days 1–5), cisplatin 60 mg/m2 (day 1), 5FU 600 mg/m2 (days 1–5), q3w] were evaluated retrospectively. The cutoff values were 160 for PLR and 2.5 for NLR. Progression-free survival (PFS) and overall survival (OS) were estimated for group I (PLR >160), group II (PLR ≤ 160), group III (NLR ≥ 2.5), group IV (NLR 160 and NLR ≥ 2.5), group VI (PLR ≤ 160 and NLR 160 and NLR 160 and/or NLR ≥ 2.5 had significantly shorter PFS and OS (P = 0.04, 0.01, 0.019, and P = 0.003, 0.002, 0.000, respectively). Conclusion: High PLR (> 160) and/or NLR (≥ 2.5) seem to be poor prognostic factors in MGC

Clinicopathologic features of gastric cancer in young patients

Background/Aim: Gastric cancer (GC) is considered to be a disease of elderly patients. It has been suggested that GC in young adults has more aggressive clinical and pathologic features than in adults. In this study we aimed to evaluate clinical and pathologic features of GC under age 40 years. Patients and Methods: Patients included in this study were those treated and followed up for GC under age 40 years in Ankara Numune Education and Research Hospital from 2002 to 2011. Results: Clinical and pathologic features of 82 patients have been evaluated retrospectively. Of the patients 44 were male (54%) and 38 were (46%) female, and the median age was 35 years (min-max: 18-40 years). The tumor was grade 3 in 77% of the patients, 79% had diffuse type tumor, 64% had lymphovascular invasion, and 76% had perineural invasion. Forty-seven patients (57%) were metastatic at the time of diagnosis. The median follow up was 9 (1-101) months. The median overall survival (OS) was 9 months in metastatic patients and 8-year OS was 64% in nonmetastatic patients. Conclusions: We observed that young GC patients had more aggressive histopathologic features and more than half was metastatic at the time of diagnosis. We need more studies comparing young and elderly patients to confirm that young patients had more aggressive disease