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{"title"=>"The landscape of inappropriate laboratory testing: A 15-year meta-analysis", "type"=>"journal", "authors"=>[{"first_name"=>"Ming", "last_name"=>"Zhi", "scopus_author_id"=>"56039363100"}, {"first_name"=>"Eric L.", "last_name"=>"Ding", "scopus_author_id"=>"54413849800"}, {"first_name"=>"Jesse", "last_name"=>"Theisen-Toupal", "scopus_author_id"=>"23135789200"}, {"first_name"=>"Julia", "last_name"=>"Whelan", "scopus_author_id"=>"7202610313"}, {"first_name"=>"Ramy", "last_name"=>"Arnaout", "scopus_author_id"=>"6603419002"}], "year"=>2013, "source"=>"PLoS ONE", "identifiers"=>{"pmid"=>"24260139", "doi"=>"10.1371/journal.pone.0078962", "sgr"=>"84894132782", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)", "scopus"=>"2-s2.0-84894132782", "issn"=>"19326203", "pui"=>"372403491"}, "id"=>"14c5fa81-26a9-3423-89a0-aeb440380470", "abstract"=>"BACKGROUND: Laboratory testing is the single highest-volume medical activity and drives clinical decision-making across medicine. However, the overall landscape of inappropriate testing, which is thought to be dominated by repeat testing, is unclear. Systematic differences in initial vs. repeat testing, measurement criteria, and other factors would suggest new priorities for improving laboratory testing. METHODS: A multi-database systematic review was performed on published studies from 1997-2012 using strict inclusion and exclusion criteria. Over- vs. underutilization, initial vs. repeat testing, low- vs. high-volume testing, subjective vs. objective appropriateness criteria, and restrictive vs. permissive appropriateness criteria, among other factors, were assessed. RESULTS: Overall mean rates of over- and underutilization were 20.6% (95% CI 16.2-24.9%) and 44.8% (95% CI 33.8-55.8%). Overutilization during initial testing (43.9%; 95% CI 35.4-52.5%) was six times higher than during repeat testing (7.4%; 95% CI 2.5-12.3%; P for stratum difference <0.001). Overutilization of low-volume tests (32.2%; 95% CI 25.0-39.4%) was three times that of high-volume tests (10.2%; 95% CI 2.6-17.7%; P<0.001). Overutilization measured according to restrictive criteria (44.2%; 95% CI 36.8-51.6%) was three times higher than for permissive criteria (12.0%; 95% CI 8.0-16.0%; P<0.001). Overutilization measured using subjective criteria (29.0%; 95% CI 21.9-36.1%) was nearly twice as high as for objective criteria (16.1%; 95% CI 11.0-21.2%; P = 0.004). Together, these factors explained over half (54%) of the overall variability in overutilization. There were no statistically significant differences between studies from the United States vs. elsewhere (P = 0.38) or among chemistry, hematology, microbiology, and molecular tests (P = 0.05-0.65) and no robust statistically significant trends over time. CONCLUSIONS: The landscape of overutilization varies systematically by clinical setting (initial vs. repeat), test volume, and measurement criteria. Underutilization is also widespread, but understudied. Expanding the current focus on reducing repeat testing to include ordering the right test during initial evaluation may lead to fewer errors and better care.", "link"=>"http://www.mendeley.com/research/landscape-inappropriate-laboratory-testing-15year-metaanalysis", "reader_count"=>144, "reader_count_by_academic_status"=>{"Unspecified"=>4, "Professor > Associate Professor"=>8, "Librarian"=>3, "Researcher"=>23, "Student > Doctoral Student"=>16, "Student > Ph. D. Student"=>13, "Student > Postgraduate"=>9, "Other"=>26, "Student > Master"=>22, "Student > Bachelor"=>8, "Lecturer"=>1, "Professor"=>11}, "reader_count_by_user_role"=>{"Unspecified"=>4, "Professor > Associate Professor"=>8, "Librarian"=>3, "Researcher"=>23, "Student > Doctoral Student"=>16, "Student > Ph. D. 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• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/6756d7c2-6999-4a81-b45e-e3ad02705ec5", "title"=>"The problem lies in the tests themselves.", "body"=>"The pathologists can only be as right as the tests themselves. Immunohistochemistry and standard H&E staining both have a notorious and disturbing amount of inter-observer variability. The entire American medical enterprise is far, far too focused on \"cures\" rather than the underlying \"causes\", which results in high percentages of misdiagnoses- not because the pathologists are doing the tests wrong, but because the tests themselves are highly inadequate. \n\nIt's somewhat akin to having the world's deadliest arsenal but no map of the enemy territory. I'm working on this from my end with Raman and IR tissue mapping and analysis, should be far more accurate, reliable, and cheaper than anything that uses dyes or labels to sense disease phenotypes. (Esp. when combined with other non-destructive, optical methods.) \n\nFor a recent overview of the complexities of brain tumor diagnostics as an example, see Figure 1 in this lovely article on the field: http://www.ncbi.nlm.nih.gov/pubmed/23689616 \"Refined brain tumor diagnostics and stratified therapies: the requirement for a multidisciplinary approach.\" Riemenschneider MJ, Louis DN, Weller M, Hau P. ", "isRemoved"=>false, "created"=>"2013-11-20T13:40:33Z", "lastModified"=>"2013-11-20T13:40:33Z", "creator"=>{"userId"=>"318283"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0078962", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2013-11-20T13:40:33Z", "replies"=>[]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/93777e86-e239-45e5-b3cd-d46ee57ae4ab", "title"=>"Can you please clarify the definition of underutilization- I think I may have misunderstood.", "body"=>"\"underutilization (the number indicated but not ordered divided by the total number indicated �100)\"\n\n\nThe above part of the article makes it sound like the denominator is the total number of tests that SHOULD have been made if tests were ordered appropriately.\n\nThis would imply that test volume would increase roughly ~81% from current levels in order to hit current levels of utilization.\n\nIs this correct?\n\nBest,\n\nAbe ", "highlightedText"=>"", "isRemoved"=>false, "created"=>"2016-03-04T04:25:48Z", "lastModified"=>"2016-03-04T04:25:48Z", "creator"=>{"userId"=>"541009"}, "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0078962", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>1, "mostRecentActivity"=>"2016-03-04T04:26:51Z", "replies"=>[{"type"=>"REPLY", "parentID"=>88528, "annotationUri"=>"info:doi/10.1371/annotation/ee7cd587-d8f6-4be8-ae6e-21354c1beb49", "title"=>"RE: Can you please clarify the definition of underutilization- I think I may have misunderstood.", "body"=>"Sorry I meant to say \"This would imply that test volume would increase roughly ~81% from current levels in order to hit appropriate levels of utilization.\"", "highlightedText"=>"", "isRemoved"=>false, "created"=>"2016-03-04T04:26:51Z", "lastModified"=>"2016-03-04T04:26:51Z", "creator"=>{"userId"=>"541009"}, "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0078962", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2016-03-04T04:26:51Z", "replies"=>[]}]}

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• {"id"=>"401569675110543360", "text"=>"\"The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis\" / okunmasını öneririm http://t.co/w6YjIXNQPl", "created_at"=>"2013-11-16T04:37:26Z", "user"=>"AlpSirman", "user_name"=>"Alp", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000095121763/a2ad1fe451ca42dcee650dbd60ba3d0a_normal.jpeg"}
• {"id"=>"401580118063083520", "text"=>"The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis http://t.co/XcRUQzs7B9", "created_at"=>"2013-11-16T05:18:55Z", "user"=>"pash22", "user_name"=>"Ash Paul", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3295856896/66ab958422d28c521d0143bddbb90233_normal.jpeg"}
• {"id"=>"401706221998067713", "text"=>"RT @pash22: The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis http://t.co/XcRUQzs7B9", "created_at"=>"2013-11-16T13:40:01Z", "user"=>"MccabeCJM", "user_name"=>"Christopher J McCabe", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000580665664/050b05f1c48891f79695174e59bee3ff_normal.jpeg"}
• {"id"=>"401720667336216576", "text"=>"15-yr meta-analysis from @BIDMChealth on inapprop. lab tests has implications in qual. of care &amp; #healthcare cost http://t.co/aOaC4jEFFP", "created_at"=>"2013-11-16T14:37:25Z", "user"=>"erikreinertsen", "user_name"=>"Erik Reinertsen", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000656663263/ebe6e46160621a9586c69c6810d938e6_normal.jpeg"}
• {"id"=>"402073467363016704", "text"=>"#PLOSOne #metaanalysis of #clinical #laboratory #tests looks at utilisation, recommend right tests at beginning http://t.co/6jWHoP9Ccz", "created_at"=>"2013-11-17T13:59:19Z", "user"=>"TAWOP", "user_name"=>"Justin Marley", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1077224902/27426_100000195614923_5872_q_normal.jpg"}
• {"id"=>"402391929591037952", "text"=>"Laboratory testing is the single highest-volume medical activity. The Landscape of Inappropriate Laboratory Testing. http://t.co/kAjYVRcTPk", "created_at"=>"2013-11-18T11:04:46Z", "user"=>"nevitdilmen", "user_name"=>"Nevit Dilmen", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2890582779/609f1e3dbe73a28aea283aedd4f5002c_normal.jpeg"}
• {"id"=>"402450392287432705", "text"=>"@plosone study on overuse and underuse of lab tests. http://t.co/rfuOuFa7tB", "created_at"=>"2013-11-18T14:57:05Z", "user"=>"jessicawapner", "user_name"=>"Jessica Wapner", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3329018733/ad9693c66403569c9de9542b29c403c8_normal.jpeg"}
• {"id"=>"403141314151063553", "text"=>"The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis http://t.co/0hYS0plJoP #premed #meded", "created_at"=>"2013-11-20T12:42:33Z", "user"=>"ThompsonAdvisin", "user_name"=>"Thompson Advising", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3492057876/ab4f19c533ac79cd55f69f1955753079_normal.jpeg"}
• {"id"=>"403141412574621696", "text"=>"15yr meta analysis of lab testing by BIDMC #hospitalist Jesse Theisen-Toupal &amp; colleagues #internists http://t.co/nzWA2NoX4q", "created_at"=>"2013-11-20T12:42:57Z", "user"=>"bidhospitalists", "user_name"=>"BIDMC Hospitalists", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2846846590/750253ef79e46920c048b86a919d9eab_normal.jpeg"}
• {"id"=>"403211473859522560", "text"=>"This is an important study of inappropriate lab testing, a subject that's gotten little attention. http://t.co/SY5TA16CzW", "created_at"=>"2013-11-20T17:21:21Z", "user"=>"judith_graham", "user_name"=>"Judith Graham", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1311438728/tryit_normal.JPG"}
• {"id"=>"403213196917358592", "text"=>"Agreed @judith_graham: Important study of inappropriate lab testing, a subject that's gotten little attention. http://t.co/G0U0HyqiVw", "created_at"=>"2013-11-20T17:28:12Z", "user"=>"jburns18", "user_name"=>"Joe Burns", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2881710270/6f39f84deaaf52766984e49a4249dba6_normal.jpeg"}
• {"id"=>"403269683773992960", "text"=>"Inappropriate laboratory testing, a pertinent study!! http://t.co/VXuo7Be8WN", "created_at"=>"2013-11-20T21:12:39Z", "user"=>"levasseur1", "user_name"=>"Jean Levasseur", "user_profile_image"=>"http://abs.twimg.com/sticky/default_profile_images/default_profile_4_normal.png"}
• {"id"=>"403568141269094400", "text"=>"#PLOSONE: The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis http://t.co/DYIMc3keLk", "created_at"=>"2013-11-21T16:58:37Z", "user"=>"KentBottles", "user_name"=>"KentBottles", "user_profile_image"=>"http://pbs.twimg.com/profile_images/855175841/Kent_Photo_1712-1_normal.jpg"}
• {"id"=>"404024204229496832", "text"=>"15Years of Lab Testing: 30% are unnecessary, especially initial tests, but overuse &amp; underuse equally common #PLOSONE http://t.co/eWirzYd1qq", "created_at"=>"2013-11-22T23:10:51Z", "user"=>"jsross119", "user_name"=>"Joseph Ross", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1225492578/ross_MSSM_photo_normal.jpg"}
• {"id"=>"406025746834931712", "text"=>"The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis http://t.co/hxiChdozeX", "created_at"=>"2013-11-28T11:44:16Z", "user"=>"DrFerdowsi", "user_name"=>"Conciergedoc", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1773207404/sahba-ferdowsi-do--8db9f814-f594-4b55-b142-eeca6b4617a6large_normal.jpg"}
• {"id"=>"406030518502035456", "text"=>"RT @DrFerdowsi: The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis http://t.co/hxiChdozeX", "created_at"=>"2013-11-28T12:03:13Z", "user"=>"TeamMDrs", "user_name"=>"Rahul Nayak", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3418430081/1daf9e1b33b99279e70cc910b24622bf_normal.jpeg"}
• {"id"=>"406044309314863104", "text"=>"“@DrFerdowsi: The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis http://t.co/uTGBinH5Qa”", "created_at"=>"2013-11-28T12:58:01Z", "user"=>"dr_safran", "user_name"=>"Dr Safran", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000020135527/5b87a30689a370b26b4a5abd5da494ae_normal.jpeg"}
• {"id"=>"406049889001680897", "text"=>"RT @dr_safran: “@DrFerdowsi: The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis http://t.co/uTGBinH5Qa”", "created_at"=>"2013-11-28T13:20:12Z", "user"=>"BaronianConsult", "user_name"=>"Baronian Consulting", "user_profile_image"=>"http://pbs.twimg.com/profile_images/344513261580112136/1bef8d5247ba652c1f6a57a1311172d0_normal.jpeg"}
• {"id"=>"423829041313894400", "text"=>"PLOS ONE: The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis http://t.co/ekeLfnxF5g", "created_at"=>"2014-01-16T14:48:12Z", "user"=>"hhask", "user_name"=>"Helen Haskell", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1097944071/IMG_1593__2__-_Copy_normal.JPG"}
• {"id"=>"451365426342006784", "text"=>"#PLOSONE: The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis http://t.co/YVuSYiw3qG", "created_at"=>"2014-04-02T14:27:58Z", "user"=>"GregoryIngle", "user_name"=>"Gregory Ingle", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3519889551/deec6a3465f2775815a3372f38295c0f_normal.jpeg"}
• {"id"=>"456088265414557697", "text"=>"Over-utilization of testing dwarfed by over-utilization money spent in other areas. Lab tests still = great value! http://t.co/0Ml1imxaTW", "created_at"=>"2014-04-15T15:14:50Z", "user"=>"jhuntpath", "user_name"=>"Jennifer Hunt", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000707438698/9ab8fa995b0f1b91fa223ac25aea72b3_normal.jpeg"}
• {"id"=>"457794036435148802", "text"=>"The [Dangerous and Expensive] Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis http://t.co/3xGJ28i9U4", "created_at"=>"2014-04-20T08:12:58Z", "user"=>"invadingpirate", "user_name"=>"Tom Lewis", "user_profile_image"=>"http://pbs.twimg.com/profile_images/412651002353831936/P8ohsChs_normal.jpeg"}
• {"id"=>"458074166730575872", "text"=>"#PLOSONE: The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis http://t.co/tFwAuXNDuh", "created_at"=>"2014-04-21T02:46:06Z", "user"=>"Tarush_Kothari", "user_name"=>"Tarush Kothari", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000354545003/6b477671bf3ba2a69f89fe2fbe6822e4_normal.jpeg"}
• {"id"=>"458642775156588544", "text"=>"RT @jhuntpath: Over-utilization of testing dwarfed by over-utilization money spent in other areas. Lab tests still = great value! http://t…", "created_at"=>"2014-04-22T16:25:33Z", "user"=>"JMGardnerMD", "user_name"=>"Jerad Gardner, MD", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2334969478/hgzjb559a84xiozxvqw8_normal.jpeg"}
• {"id"=>"458800901897998336", "text"=>"RT @jhuntpath: Over-utilization of testing dwarfed by over-utilization money spent in other areas. Lab tests still = great value! http://t…", "created_at"=>"2014-04-23T02:53:54Z", "user"=>"bihlms", "user_name"=>"Sharon Gauthier MD", "user_profile_image"=>"http://pbs.twimg.com/profile_images/418545360408031232/hxFEtaaz_normal.jpeg"}
• {"id"=>"534710789832441857", "text"=>"#Informatics #YIR Zhi. Landscape of inappropriate laboratory testing @PLOSONE\nhttp://t.co/KMJDUFgYVO #AMIA2014", "created_at"=>"2014-11-18T14:12:41Z", "user"=>"puhfu", "user_name"=>"Paul Fu, Jr.", "user_profile_image"=>"http://pbs.twimg.com/profile_images/486170859141206017/YeyDQq14_normal.jpeg"}
• {"id"=>"534710866735022080", "text"=>"RT @puhfu: #Informatics #YIR Zhi. Landscape of inappropriate laboratory testing @PLOSONE\nhttp://t.co/KMJDUFgYVO #AMIA2014", "created_at"=>"2014-11-18T14:12:59Z", "user"=>"jessiet1023", "user_name"=>"Jessie Tenenbaum", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3397129837/43d0861ec80a7ff6bf4c31371fd3016f_normal.jpeg"}
• {"id"=>"534712202646016000", "text"=>"MT @puhfu: #Informatics #YIR Zhi &amp; @dcihmfp's Arnaout Landscape of inappropriate lab testing @PLOSONE\nhttp://t.co/BhKO2HCK8t #AMIA2014", "created_at"=>"2014-11-18T14:18:18Z", "user"=>"bradcrotty", "user_name"=>"Bradley Crotty", "user_profile_image"=>"http://pbs.twimg.com/profile_images/496766473369427968/w3WCH8O-_normal.png"}
• {"id"=>"712718731164581888", "text"=>"Lab tests: 2/10 shouldn't be ordered &amp; 4/10 follow ups should. Team care with patients would ? effectiveness. https://t.co/6ZwVa0Olj2", "created_at"=>"2016-03-23T19:12:41Z", "user"=>"allan_katz", "user_name"=>"Allan Katz", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1681227843/Allan_Katz__June_2010__normal.PNG"}
• {"id"=>"712759951043731457", "text"=>"RT @allan_katz: Lab tests: 2/10 shouldn't be ordered &amp; 4/10 follow ups should. Team care with patients would ? effectiveness. https://t.co/…", "created_at"=>"2016-03-23T21:56:29Z", "user"=>"CJMOM1", "user_name"=>"Cynthia Johnston", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3350900125/7c5b66d6a04fa04262762f8072da3c64_normal.jpeg"}
• {"id"=>"714234330260901888", "text"=>"2/2 Study: other necessary #LabTest under-ordered #PatientSafety\nhttps://t.co/CUZ0KEmCDd", "created_at"=>"2016-03-27T23:35:08Z", "user"=>"VirginiaWalley", "user_name"=>"Virginia Walley", "user_profile_image"=>"http://pbs.twimg.com/profile_images/664591530242478081/JM1xIJTJ_normal.png"}
• {"id"=>"714234331833753600", "text"=>"1/2 Study: of every 10 #LabTests ordered about 2 tests on average should not have been ordered #PatientSafety\nhttps://t.co/CUZ0KEmCDd", "created_at"=>"2016-03-27T23:35:09Z", "user"=>"VirginiaWalley", "user_name"=>"Virginia Walley", "user_profile_image"=>"http://pbs.twimg.com/profile_images/664591530242478081/JM1xIJTJ_normal.png"}
• {"id"=>"714235038112415744", "text"=>"\"Underutilization is also widespread, but understudied.\" https://t.co/wZC45052oE", "created_at"=>"2016-03-27T23:37:57Z", "user"=>"doctorfullerton", "user_name"=>"Merrilee Fullerton", "user_profile_image"=>"http://pbs.twimg.com/profile_images/526576403907493888/m4YbwjGi_normal.jpeg"}
• {"id"=>"714235066642092032", "text"=>"RT @VirginiaWalley: 2/2 Study: other necessary #LabTest under-ordered #PatientSafety\nhttps://t.co/CUZ0KEmCDd", "created_at"=>"2016-03-27T23:38:04Z", "user"=>"doctorfullerton", "user_name"=>"Merrilee Fullerton", "user_profile_image"=>"http://pbs.twimg.com/profile_images/526576403907493888/m4YbwjGi_normal.jpeg"}
• {"id"=>"714261106072674304", "text"=>"RT @doctorfullerton: \"Underutilization is also widespread, but understudied.\" https://t.co/wZC45052oE", "created_at"=>"2016-03-28T01:21:32Z", "user"=>"Jibt", "user_name"=>"Jib Turner", "user_profile_image"=>"http://pbs.twimg.com/profile_images/493195360987119616/D9jyVfOt_normal.jpeg"}
• {"id"=>"714267314074611713", "text"=>"RT @VirginiaWalley: 1/2 Study: of every 10 #LabTests ordered about 2 tests on average should not have been ordered #PatientSafety\nhttps://t…", "created_at"=>"2016-03-28T01:46:12Z", "user"=>"erdocAA", "user_name"=>"ERdocAA", "user_profile_image"=>"http://pbs.twimg.com/profile_images/712270909927591937/YqHj4z6Y_normal.jpg"}
• {"id"=>"715594666364821504", "text"=>"1/2 Study: of every 10 #LabTests ordered about 2 tests on average should not have been ordered #PatientSafety\nhttps://t.co/HPVi4QrHBY", "created_at"=>"2016-03-31T17:40:38Z", "user"=>"VirginiaWalley", "user_name"=>"Virginia Walley", "user_profile_image"=>"http://pbs.twimg.com/profile_images/664591530242478081/JM1xIJTJ_normal.png"}
• {"id"=>"719324178944540672", "text"=>"2/2 Study: other necessary #LabTest under-ordered #PatientSafety\nhttps://t.co/CUZ0KEmCDd", "created_at"=>"2016-04-11T00:40:23Z", "user"=>"VirginiaWalley", "user_name"=>"Virginia Walley", "user_profile_image"=>"http://pbs.twimg.com/profile_images/664591530242478081/JM1xIJTJ_normal.png"}
• {"id"=>"719324181503062016", "text"=>"1/2 Study: of every 10 #LabTests ordered about 2 tests on average should not have been ordered #PatientSafety\nhttps://t.co/IzJnv2qlIL", "created_at"=>"2016-04-11T00:40:23Z", "user"=>"VirginiaWalley", "user_name"=>"Virginia Walley", "user_profile_image"=>"http://pbs.twimg.com/profile_images/664591530242478081/JM1xIJTJ_normal.png"}
• {"id"=>"719324275912519681", "text"=>"RT @VirginiaWalley: 1/2 Study: of every 10 #LabTests ordered about 2 tests on average should not have been ordered #PatientSafety\nhttps://t…", "created_at"=>"2016-04-11T00:40:46Z", "user"=>"supermarioelia", "user_name"=>"Mario Elia", "user_profile_image"=>"http://pbs.twimg.com/profile_images/560625750223486977/LEpEWNMh_normal.png"}
• {"id"=>"719324283122483200", "text"=>"RT @VirginiaWalley: 2/2 Study: other necessary #LabTest under-ordered #PatientSafety\nhttps://t.co/CUZ0KEmCDd", "created_at"=>"2016-04-11T00:40:48Z", "user"=>"supermarioelia", "user_name"=>"Mario Elia", "user_profile_image"=>"http://pbs.twimg.com/profile_images/560625750223486977/LEpEWNMh_normal.png"}
• {"id"=>"719376891321319424", "text"=>"RT @VirginiaWalley: 1/2 Study: of every 10 #LabTests ordered about 2 tests on average should not have been ordered #PatientSafety\nhttps://t…", "created_at"=>"2016-04-11T04:09:50Z", "user"=>"fauldsca", "user_name"=>"Cathy Faulds", "user_profile_image"=>"http://pbs.twimg.com/profile_images/460253223082000384/XDmwWHqj_normal.jpeg"}
• {"id"=>"931916667315261440", "text"=>"@LifeLabs Dr. don-Wauchope presents @LabUtilization Symposium fr the Community Lab Perspective #smarttesting https://t.co/wVK5IKeyhb", "created_at"=>"2017-11-18T16:07:02Z", "user"=>"jpougnet", "user_name"=>"Jennifer Pougnet", "user_profile_image"=>"http://pbs.twimg.com/profile_images/476568156186480640/tZZfZnMP_normal.jpeg"}

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• {"files"=>["https://ndownloader.figshare.com/files/1284309", "https://ndownloader.figshare.com/files/1284310"], "description"=>"<div><p>Background</p><p>Laboratory testing is the single highest-volume medical activity and drives clinical decision-making across medicine. However, the overall landscape of inappropriate testing, which is thought to be dominated by repeat testing, is unclear. Systematic differences in initial vs. repeat testing, measurement criteria, and other factors would suggest new priorities for improving laboratory testing.</p><p>Methods</p><p>A multi-database systematic review was performed on published studies from 1997–2012 using strict inclusion and exclusion criteria. Over- vs. underutilization, initial vs. repeat testing, low- vs. high-volume testing, subjective vs. objective appropriateness criteria, and restrictive vs. permissive appropriateness criteria, among other factors, were assessed.</p><p>Results</p><p>Overall mean rates of over- and underutilization were 20.6% (95% CI 16.2–24.9%) and 44.8% (95% CI 33.8–55.8%). Overutilization during initial testing (43.9%; 95% CI 35.4–52.5%) was six times higher than during repeat testing (7.4%; 95% CI 2.5–12.3%; <i>P</i> for stratum difference <0.001). Overutilization of low-volume tests (32.2%; 95% CI 25.0–39.4%) was three times that of high-volume tests (10.2%; 95% CI 2.6–17.7%; <i>P</i><0.001). Overutilization measured according to restrictive criteria (44.2%; 95% CI 36.8–51.6%) was three times higher than for permissive criteria (12.0%; 95% CI 8.0–16.0%; <i>P</i><0.001). Overutilization measured using subjective criteria (29.0%; 95% CI 21.9–36.1%) was nearly twice as high as for objective criteria (16.1%; 95% CI 11.0–21.2%; <i>P</i> = 0.004). Together, these factors explained over half (54%) of the overall variability in overutilization. There were no statistically significant differences between studies from the United States vs. elsewhere (<i>P</i> = 0.38) or among chemistry, hematology, microbiology, and molecular tests (<i>P</i> = 0.05–0.65) and no robust statistically significant trends over time.</p><p>Conclusions</p><p>The landscape of overutilization varies systematically by clinical setting (initial vs. repeat), test volume, and measurement criteria. Underutilization is also widespread, but understudied. Expanding the current focus on reducing repeat testing to include ordering the right test during initial evaluation may lead to fewer errors and better care.</p></div>", "links"=>[], "tags"=>["inappropriate", "15-year"], "article_id"=>853488, "categories"=>["Biological Sciences"], "users"=>["Ming Zhi", "Eric L. Ding", "Jesse Theisen-Toupal", "Julia Whelan", "Ramy Arnaout"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0078962.s001", "https://dx.doi.org/10.1371/journal.pone.0078962.s002"], "stats"=>{"downloads"=>15, "page_views"=>14, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_Landscape_of_Inappropriate_Laboratory_Testing_A_15_Year_Meta_Analysis_/853488", "title"=>"The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2013-11-15 03:28:37"}
• {"files"=>["https://ndownloader.figshare.com/files/1284306"], "description"=>"<p>Cumulative distributions of <b>A</b>, overutilization vs. underutilization (<i>P</i><0.001); <b>B</b>, overutilization, initial vs. repeat testing (<i>P</i><0.001); <b>C</b>, overutilization, restrictive vs. permissive criteria (<i>P</i><0.001); and <b>D</b>, overutilization, subjective vs. objective criteria (<i>P</i> = 0.027). Each curve can be interpreted as the probability (y-axis) that a test was at least as inappropriate as indicated on the x-axis. For example in panel B, a third of study measures of initial testing (open arrowhead, y-axis) found at least 60% inappropriateness (closed arrowhead, x-axis).</p>", "links"=>[], "tags"=>["measures", "inappropriate"], "article_id"=>853485, "categories"=>["Biological Sciences"], "users"=>["Ming Zhi", "Eric L. Ding", "Jesse Theisen-Toupal", "Julia Whelan", "Ramy Arnaout"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0078962.g002", "stats"=>{"downloads"=>2, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Histograms_of_Study_Measures_of_Inappropriate_Laboratory_Test_Utilization_1997_8211_2012_/853485", "title"=>"Histograms of Study Measures of Inappropriate Laboratory Test Utilization, 1997–2012.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-11-15 03:28:37"}
• {"files"=>["https://ndownloader.figshare.com/files/1284307"], "description"=>"<p>Subgroup Summary Statistics.</p>a<p><i>P</i> for stratum differences is meaningful only when there is a natural ordering for categories. <i>P</i> for difference of means: chemistry vs. hematology, <i>P</i> = 0.05; chemistry vs. microbiology, <i>P</i> = 0.65; chemistry vs. molecular, <i>P</i> = 0.17; hematology vs. microbiology, <i>P</i> = 0.43; hematology vs. molecular, <i>P</i> = 0.07; microbiology vs. molecular, <i>P</i> = 0.19.</p>", "links"=>[], "tags"=>["inappropriate"], "article_id"=>853486, "categories"=>["Biological Sciences"], "users"=>["Ming Zhi", "Eric L. Ding", "Jesse Theisen-Toupal", "Julia Whelan", "Ramy Arnaout"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0078962.t001", "stats"=>{"downloads"=>1, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Rates_of_inappropriate_laboratory_testing_1997_2012_/853486", "title"=>"Rates of inappropriate laboratory testing, 1997-2012.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-11-15 03:28:37"}
• {"files"=>["https://ndownloader.figshare.com/files/1284305"], "description"=>"<p>The indicated databases were searched as described in the main text and File*Results from searching with and without subheadings.</p>", "links"=>[], "tags"=>[], "article_id"=>853484, "categories"=>["Biological Sciences"], "users"=>["Ming Zhi", "Eric L. Ding", "Jesse Theisen-Toupal", "Julia Whelan", "Ramy Arnaout"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0078962.g001", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Literature_Search_Strategy_and_Results_1997_8211_2012_/853484", "title"=>"Literature Search Strategy and Results, 1997–2012.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-11-15 03:28:37"}

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• {"unique-ip"=>"74", "full-text"=>"90", "pdf"=>"14", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"14", "supp-data"=>"0", "cited-by"=>"2", "year"=>"2019", "month"=>"2"}
• {"unique-ip"=>"80", "full-text"=>"110", "pdf"=>"28", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"5", "supp-data"=>"3", "cited-by"=>"0", "year"=>"2019", "month"=>"3"}
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Relative Metric

{"start_date"=>"2013-01-01T00:00:00Z", "end_date"=>"2013-12-31T00:00:00Z", "subject_areas"=>[{"subject_area"=>"/Biology and life sciences/Biochemistry", "average_usage"=>[266, 468, 593, 703, 804, 903, 993, 1084, 1171, 1256, 1339, 1422, 1492]}, {"subject_area"=>"/Biology and life sciences/Neuroscience", "average_usage"=>[261, 444, 554, 655, 748, 834, 923, 1004, 1089, 1170, 1244, 1315, 1380]}, {"subject_area"=>"/Medicine and health sciences/Hematology", "average_usage"=>[238, 424, 545, 650, 749, 839, 926, 1006, 1090, 1167, 1243, 1316, 1380]}]}

F1000Prime