CA2341226A1 - Methods and apparatus for interpreting measured laboratory data - Google Patents
Methods and apparatus for interpreting measured laboratory data Download PDFInfo
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- CA2341226A1 CA2341226A1 CA002341226A CA2341226A CA2341226A1 CA 2341226 A1 CA2341226 A1 CA 2341226A1 CA 002341226 A CA002341226 A CA 002341226A CA 2341226 A CA2341226 A CA 2341226A CA 2341226 A1 CA2341226 A1 CA 2341226A1
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
- G16H50/20—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for computer-aided diagnosis, e.g. based on medical expert systems
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H30/00—ICT specially adapted for the handling or processing of medical images
- G16H30/40—ICT specially adapted for the handling or processing of medical images for processing medical images, e.g. editing
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
- G16H50/30—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for calculating health indices; for individual health risk assessment
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S128/00—Surgery
- Y10S128/92—Computer assisted medical diagnostics
Abstract
Systems, methods, and computer program products for determining relative normalcy and abnormalcy of a plurality of test results are provided. Test results are transformed into respective unitized values and then graphically displayed with a unitized reference range. An analytical variation of each of the respective unitized values may be determined and displayed.
Description
WO 00/12968 PCT/US99l20125 METHODS AND APPARATUS FOR INTERPRETING
MEASURED LABORATORY DATA
Field of the Invention The present invention relates generally to data analysis and, more particularly, to reporting and comparison of data analysis results.
Background of the Invention The method of reporting numerical laboratory test data, such as biological laboratory tests, has essentially remained unchanged since its modern inception, beginning in the first half of the twentieth century. The traditional method includes reporting a measured value (i.e., a test result) and its relevant set of normal values, known as a reference range. It is often inadequate to report only a measured value because different tests may have different respective reference ranges. Generally, all reference ranges include a set of two values with one value designated as an upper reference range limit and another designated as a lower reference range limit.
In the last quarter of the twentieth century the number of available laboratory tests has risen prodigiously and there are now many hundreds of numerically reported tests, each continuing to have its own unique set of reference ranges. This marked proliferation of data has offered an interpreter of the data an abundant variety of tests from which to conduct physiological as well as disease investigations.
However, the sheer volume of available tests has also contributed to information overload. An interpreter typically attempts to remember hundreds of reference ranges when evaluating test data. For example, a single composite tabular listing of lab results on one biological entity can include forty or more tests, all of which may have different reference ranges.
Another aspect of the interpretation and application of measured biological laboratory data is the observation that a test value that falls within the reference range has variable significance depending on whether the measured value is near the upper limit, the lower limit, or the mean value of the reference range.
The relative significance of a test has to be qualitatively assessed and committed to memory because it is not typically quantified on the traditional report. If multiple tests are simultaneously reported, an interpreter of the test data typically tries to retain in his/her memory the relative position of each measured value and make qualitative interpretive decisions among the tests utilizing mentally calculated relative positions in the reported test data. For example, one test may have a measured value two paints below the upper reference range value and another test may have a measured value eight points below the upper reference range value. The interpreter may wish to know if one of these tests is at more risk for being abnormally elevated than the other test. A qualitative evaluation may be required because the number of points in the reference range for each of these tests may be different. The relative closeness of one value to the upper reference range (or the lower reference range for that matter) may be dependent on the number of units in the reference range. Table 1 below illustrates this situation.
Table 1 Test MV=-2 MV=-8 Reference Range Sodium 145 139 136-147 Glucose 111 105 68-113 Cholesterol 198 192 100-200 In Table 1, the second column (MV=-2) indicates a measured value two numbers less than the upper limit of the reference range. The third column (MV=-8) indicates a measured value eight numbers less than the upper limit of the reference range. Each of the six measured values (MVs) in Table 1 are considered normal values because each lies within the reference range for a respective test. When measured values are viewed in the format of Table 1, which resembles traditional reporting formats, it may be difficult to determine which measured value is relatively greater than, or less than, any other measured value.
Consequently, if measured values that fall within a reference range are to be compared among the many different tests, then an interpreter should perform a qualitative analysis on each test and retain this information in memory for each test. If this type of mental calculation is not performed, then refinement in the application of measured values may not be possible and diagnostic information may be lost.
The concept of relative normalcy of a measured value that falls within a reference range is also applicable to measured abnormal values that are above or below a reference range. The same qualitative mental assessment is involved in determining the relative abnormalcy of an abnormal value. An example of this would be to determine whether a liver function test that is elevated ten points above the upper reference range is as qualitatively elevated as another liver function test that is also ten points above the upper reference range. Since these two tests may indicate different parts of the liver, it is reasonable to ask whether one part of the liver is more diseased than the other. This process of test comparison may become even more complex when the interpreter is attempting to assess a panel of many tests that relate to different organs or different diseases. This type of analysis is generally referred to as multiparametric analysis.
There have been attempts to present multiparametric test data from biological entities in a non-traditional format in order to enhance an interpreter's perception of inter-test relationships and abnormal values. For example, U.S. Patent No.
MEASURED LABORATORY DATA
Field of the Invention The present invention relates generally to data analysis and, more particularly, to reporting and comparison of data analysis results.
Background of the Invention The method of reporting numerical laboratory test data, such as biological laboratory tests, has essentially remained unchanged since its modern inception, beginning in the first half of the twentieth century. The traditional method includes reporting a measured value (i.e., a test result) and its relevant set of normal values, known as a reference range. It is often inadequate to report only a measured value because different tests may have different respective reference ranges. Generally, all reference ranges include a set of two values with one value designated as an upper reference range limit and another designated as a lower reference range limit.
In the last quarter of the twentieth century the number of available laboratory tests has risen prodigiously and there are now many hundreds of numerically reported tests, each continuing to have its own unique set of reference ranges. This marked proliferation of data has offered an interpreter of the data an abundant variety of tests from which to conduct physiological as well as disease investigations.
However, the sheer volume of available tests has also contributed to information overload. An interpreter typically attempts to remember hundreds of reference ranges when evaluating test data. For example, a single composite tabular listing of lab results on one biological entity can include forty or more tests, all of which may have different reference ranges.
Another aspect of the interpretation and application of measured biological laboratory data is the observation that a test value that falls within the reference range has variable significance depending on whether the measured value is near the upper limit, the lower limit, or the mean value of the reference range.
The relative significance of a test has to be qualitatively assessed and committed to memory because it is not typically quantified on the traditional report. If multiple tests are simultaneously reported, an interpreter of the test data typically tries to retain in his/her memory the relative position of each measured value and make qualitative interpretive decisions among the tests utilizing mentally calculated relative positions in the reported test data. For example, one test may have a measured value two paints below the upper reference range value and another test may have a measured value eight points below the upper reference range value. The interpreter may wish to know if one of these tests is at more risk for being abnormally elevated than the other test. A qualitative evaluation may be required because the number of points in the reference range for each of these tests may be different. The relative closeness of one value to the upper reference range (or the lower reference range for that matter) may be dependent on the number of units in the reference range. Table 1 below illustrates this situation.
Table 1 Test MV=-2 MV=-8 Reference Range Sodium 145 139 136-147 Glucose 111 105 68-113 Cholesterol 198 192 100-200 In Table 1, the second column (MV=-2) indicates a measured value two numbers less than the upper limit of the reference range. The third column (MV=-8) indicates a measured value eight numbers less than the upper limit of the reference range. Each of the six measured values (MVs) in Table 1 are considered normal values because each lies within the reference range for a respective test. When measured values are viewed in the format of Table 1, which resembles traditional reporting formats, it may be difficult to determine which measured value is relatively greater than, or less than, any other measured value.
Consequently, if measured values that fall within a reference range are to be compared among the many different tests, then an interpreter should perform a qualitative analysis on each test and retain this information in memory for each test. If this type of mental calculation is not performed, then refinement in the application of measured values may not be possible and diagnostic information may be lost.
The concept of relative normalcy of a measured value that falls within a reference range is also applicable to measured abnormal values that are above or below a reference range. The same qualitative mental assessment is involved in determining the relative abnormalcy of an abnormal value. An example of this would be to determine whether a liver function test that is elevated ten points above the upper reference range is as qualitatively elevated as another liver function test that is also ten points above the upper reference range. Since these two tests may indicate different parts of the liver, it is reasonable to ask whether one part of the liver is more diseased than the other. This process of test comparison may become even more complex when the interpreter is attempting to assess a panel of many tests that relate to different organs or different diseases. This type of analysis is generally referred to as multiparametric analysis.
There have been attempts to present multiparametric test data from biological entities in a non-traditional format in order to enhance an interpreter's perception of inter-test relationships and abnormal values. For example, U.S. Patent No.
4,527,240 to Kvitash describes a process whereby measured patient values are transformed to units referred to as "Balascopic" units. Unfortunately, in data analysis according to Kvitash, the Balascopic units are plotted on an axial graph. These axial graphs may be somewhat difficult to use. Furthermore, the Balascopic process of Kvitash does not distinguish between test data reported as whole integers and decimals. Consequently, interpretative decisions that are made based on decimal values may be difficult to make with the Kvitash process. Another drawback of the Kvitash process is that it does not provide analytical variation associated with each measured value.
U.S. Patent No. 5,541,854 to Yundt describes displaying conventional mufti-level hematology quality control data (three levels) in a complex graphic form.
Yundt is concerned with the presentation of tri-level quality control data and not with the presentation of measured unknown samples.
Statistical methods utilizing "Z scores" to specify the relative frequency or probability of a random number in a normally distributed set of measurements are known. Unfortunately, Z scores are somewhat difficult to use to identify the relative value of one test result to another. Furthermore Z
score techniques are somewhat limited because data beyond the maximum and minimum limits of normal distribution cannot be used.
Summary of the Invention In view of the above discussion, it is an object of the present invention to reduce much of the complexity associated with interpreting laboratory test data.
It is another object of the present invention to facilitate determining relative relationships of measured values from laboratory tests to respective reference ranges.
These and other objects are provided by systems, methods, and computer program products for determining relative normalcy or abnormalcy of a plurality of test results, by transforming test results into respective unitized values and then graphically displaying each of the unitized values with a unitized reference range. Additionally, an unitized analytical variation of each of the respective unitized values may be determined and displayed.
Initially, a reference range for a test is unitized to a single number. A total number of possible test results within respective equal halves of the reference range is then determined. This is accomplished by determining a total number of possible test results within the reference range to produce a reference range spread, and then dividing the reference range spread in half.
The fractional value of the plurality of test results in the respective halves of the reference range is then determined. The fractional value of the plurality of test results comprises a reciprocal of one-half of the total number of possible test results in the reference range. Each of the plurality of separately determined test results are then transformed into respective equilibrated values. This is accomplished by determining the mean of the reference range and then determining a difference between the mean and each of the plurality of test results. Each equilibrated value represents relative position of a respective test result with respect to a mean of the reference range.
Each of the equilibrated values is then transformed into respective unitized values by multiplying each respective equilibrated value with a respective fractional value of the plurality of test results in one half of the reference range. Each unitized value represents relative normalcy or abnormalcy of a respective test result with respect to the unitized reference range.
According to the present invention, unitized values with the same numerical value indicate the same quantitative variation from any reference points?
within the unitized reference range. According to the present invention, a unitized value of 1.5 for a glucose level within a patient and a unitized value of 1.5 for a sodium level within a patient will mean the same quantitative increase for each test. Furthermore, the present invention may allow an interpreter to recognize problems and undertake corrective actions sooner. By utilizing unitized values according to the present invention, an interpreter could more easily recognize that a unitized sodium value of 1.5 is more severe than a unitized glucose value of 1.1 and, therefore, take action to rectify the sodium level.
The present invention may be applied to the interpretation of any type of laboratory test data, both biological and non-biological, and particularly where the test data is interpreted by referring to a reference range. The present invention is particularly useful where multiparametric data is obtained from testing.
Brief Description of the Drawings Fig. 1 schematically illustrates operations for unitizing test data having different reference ranges, according to an embodiment of the present invention.
Fig. 2 illustrates an exemplary data processing system in which the present invention may be implemented.
Detailed Description of the Invention The present invention now is described more fully hereinafter with reference to the accompanying drawings, in which preferred embodiments of the invention are shown. This invention may, however, be~
embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the invention to those skilled in the art. Like numbers refer to like elements throughout.
As will be appreciated by one of skill in the art, the present invention may be embodied as a method, data processing system, or computer program product.
Accordingly, the present invention may take the form of _g_ an entirely hardware embodiment, an entirely software embodiment or an embodiment combining software and hardware aspects. Furthermore, the present invention may take the form of a computer program product on a computer-readable storage medium having computer-readable program code means embodied in the medium. Any suitable computer readable medium may be utilized including hard disks, CD-ROMs, optical storage devices, or magnetic storage devices.
The present invention is described below with reference to flowchart illustrations of methods, apparatus (systems) and computer program products according to an embodiment of the invention. It will be understood that each block of the flowchart illustrations, and combinations of blocks in the flowchart illustrations, can be implemented by computer program instructions. These computer program instructions may be loaded onto a general purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions which execute on the computer or other programmable data processing apparatus create means for implementing the functions specified in the flowchart block or blocks. These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means which implement the function specified in the _g_ flowchart block or blocks. The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart block or blocks.
Accordingly, blocks of the flowchart illustrations support combinations of means for performing the specified functions, combinations of steps for performing the specified functions and program instruction means for performing the specified functions. It will also be understood that each block of the flowchart illustrations, and combinations of blocks in the flowchart illustrations, can be implemented by special purpose hardware-based computer systems which perform the specified functions or steps, or combinations of special purpose hardware and computer instructions.
Referring now to Fig. l, operations for unitizing test data having different reference ranges, according to an embodiment of the present invention, are schematically illustrated. Operations include:
unitizing a reference range (Block 100); determining the number of measured values in the reference range (Block 102); unitizing the equal halves of the reference range (Block 104); determining the number of measured values in the upper one half and the lower one half of the reference range (Block 106); determining the fractional value of the measured values in the equal one halves of the reference range (Block 108);
equilibrating the measured values (Block 110);
unitizing the equilibrated values (Block 112);
unitizing the analytical variation (Block 114); and reporting the unitized values (Block 116). Each of these operations will be described in detail below.
Referring now to Fig. 2, an exemplary data processing system in which the present invention may be implemented is illustrated. As seen in Fig. 2, a data processor 10 may have an operating system 11 resident therein. An application program 12 for performing operations according to the present invention typically executes via the operating system 11. The processor 10 displays information on a display device 13 which has a plurality of picture elements (collectively referred to as a screen). The information is displayed on the display device 13, preferably within a graphical user interface. The contents of the screen of the display device 13 and the appearance of a graphical user interface, may be controlled or altered by an application program 12 or the operating system 11 either individually or in combination. For obtaining input from a user, the operating system 11 and the application program 12 may utilize user input devices 14. User input devices 14 may include a pointing device 15, such as a mouse, and a keyboard 16 or other input devices known to those of skill in the art.
Table 2 below defines abbreviations used throughout this disclosure.
Table 2 Abbreviation Definition EV equilibrated value FV fractional value HRRS half reference range spread LRRL lower reference range limit MV measured value RR reference range RRS reference range spread UAV unitized analytical variance URRL upper reference range limit W unitized value It is understood that the term "measured value" as used herein is synonymous with the term "test result", such as a blood glucose level produced by a blood test.
Unitizinct a Reference Range An initial operation of the present invention involves unitizing a reference range (Block 100).
Unitization of a reference range is defined as grouping all measured values for each laboratory (or other) test within a reference range into a single number. By way of explanation, inherent in the definition of a RR is the possibility that any MV that falls within a RR is as potentially normal, in an equivalent biological sense, as any other MV within the same RR, or any other RR. Since this potential exists, it is conceptually feasible to consider all MVs in any RR as equivalent values. As a derivative of this consideration, all of WO 00/1296$ PCT/US99/20125 the MVs in any RR can be conceptually consolidated into one number which would have no need of any assigned concentration units.
For example, if the number 1.0 is selected, the reference range may be any value greater than 0.0 and equal to or less than 1.0, since this comprises the number 1Ø However, it is to be understood that any number can be used for this purpose. From this concept, it does follow that if one test has a MV of 100 milligrams per deciliter (mg/dl) in its RR and another test has a MV of 10 millimoles per liter (mmol/L) in its RR, these different MVs lose the concentration units (mg/dl and mmol/L); and, the 100 MV and the 10 MV
are biological equivalents. This conceptual process is an initial necessary process in order to restructure the ordinarily disparate MVs in RRs into one number.
The equation that expresses this relationship is 0.0 < Unitized RR <_ 1.0 (Equation 1) Equation 1 states that a unitized RR is greater than zero but less than or equal to one.
Determinincr the Number of Measured Values in the 2 5 Re f erence Rancte Next a determination of the number of measured values that are included in the reference range from the lower reference range limit to, and including, the upper reference range limit is made (Block I02). The number of measured values in this range is determined by both the unique analytical properties of the test and by the actual measured values discovered in the reference (normal) population, and represents a fixed number of MVs peculiar to each test and the methodology used in the testing procedure.
The RR is not only different for each test, but the RR
will also change for any given test if the methodology for that test is changed, which further adds to the memory requirements of an interpreter and the need for advance notice by a laboratory when methodology is changed. The number of MVs within the RR is calculated from the high and low numbers listed under the heading "Reference Range", or sometimes otherwise described as "Reference Interval" or "Normal Range". The total number of measured values in the reference range spread is preferably determined by Equation 2 below.
RRS = (URRL - LRRL) + 1 (Equation 2) The URRL and LRRL, when used in Equation 2, refer to the numbers given in a traditional report (e.g., Table 1 above) under the heading of RR, and not to the unitized reference range of 1Ø
Equation 2 includes all units in the reference range by the addition of a whole integer to the difference between the minimum and maximum of the reference range. For example, the RR for glucose may be given as 68 - 113 mg/dl. Since the UV will be unit-less, the concentration units of mg/dl can be dropped.
Under this arrangement the URRL = 113 and the LRRL =
68. The RR numbers are then inserted into Equation 2, as follows:
RRS = (113 - 68) + 1 V. VON :1-.PA-1NUENCIi~"\ U5 : 28- 9- 0 : 19 : 34 : 919 854 14U 1-. +49 E39 23994465 : # 11 uW . LU. LVV4 I.Jtlnl muvu~: 717 UJ? ITV I Iw. TI 1 i I. I 1 = 45 + Z
In the proce$s of eventually converting measured values to unitised values, all reported decimal values in the reference ranges and all measured values reported in decimals need to be converted to their equivalent whole values. For example a reference range of 4.6 - 8.7 is converted tc 46 - B? and the number of MVs in the RRS is (87 - 46) f 1 = 42.
1~ Measured decimal values are also converted to their equivalent whole numbers. All subsequent calculations are performed on the converted whole numbers. This modification is required because the interpreter would have most likely used "tenths" of a number in evaluating increases or decreases in measured _v_alues.
Once decimal values are converted to their equivalent whsle numbers, the subsequently calculated DV reflects the original MV as it was expressed in tenths, or other decimal points.
SUBSTITUTE SHEET
Coped f~o~ PCTIl~~99/2D2~ 5 ~o~ 02='~ 0 ~~a0 :V.VON:EPA-ML'ENCHE~ U5 :28- 9- U : 19:84 : 979 854 1401-. +49 89 23994465:#12 vm. LV~ LVVV I.JJmn muuyu 717 V~T IT1; I mv. Tr I ~ ~. IL
Unitizing the Ea~ual Halves of the Reference R,~nce The initial unitization of the reference range and the sui~sequent determinations of the RRS need to be restructured for the following reason. A low abnormal measured value, subsequently unitized to -0.5 would be the analytical equivalent, in the opposite direction, of a ~righ abnormal unitized value of ~+1.5, since both values would be a 0.5 units beyond the lower and upper limits, respectively, of the unitized reference range. In a reporting format a reviewer would find these equidistant analytical values disconcerting since they are different numbers.
The above anomaly can be rectified by i5 dividing the reference range into equal halves and then unitizing the separate equal components (Block 104).
The mean o~ the reference range then beaornes O.fl. The range from the mean to the LRRL is defzned as 0.0 tQ
i.o. The range from the mean to the URRL is defined as ZO 0.0 to +1.D. However, as was indicated in the initial unitizat~,oa of the reference range, any number can be used. For purposes of this discussion, the number 1,0 is retained, but modified to -1.0 and +1.0 far the equal halves of the reference range spread.
SUBSTITUTE SHEET
i~NDED S~-i~LT -15-Copied frog 'PCTlL~~991202'~ ~ rn ~2~~ ~-2~0' Determining the Number of Measured Values in U~,per and Lower Halves of Reference Range Because the RR is divided into equal halves, the previously calculated number of MVs in the RRS
(Equation 2) needs to be divided between the two halves. The number of MVs in each half of the RRS can be determined by the following equation:
HRRS = RRS/2 (Equation 3) For example, the HRRS for glucose is:
HRRS = 46/2 = 23 Determining the Fractional Value of the Measured Values in the Upper and Lower Halves of the Reference Range One of the components of the equation used to calculate UVs is the fractional value (FV). FV is defined as the reciprocal value of the MVs that are present in the HRRS. The fractional value of each of the measured values in the HRRS is determined by Equation 4:
FV = 1/HRRS (Equation 4) For example, the FV for glucose is:
FV = 1/23 - 0.04 The FV can be expressed as either a fraction or a percent.
'.CV. VU!~ : EPA-IvIUEIVCHEI~ U , : 28- 9- 0 : 19: 35 : 919 854 1401-~ +49 89 23994465: ~i13 VL1. LV, IVVV I,JJnI~i IWJV~V Jl) VJT ITVI tlU. TI 11 i. :J
E i r M s V
Prior to the conversion of a measured value to a unitized value, the measured value needs co be equilibrated with the mean of the reference range (block 110), since the mean now represents zero. (ln the traditional reporting process, zero is the value assigned to no detectable analyte levels.? This is accomplished by removing from the measured value the SUBSTITUTE SHEET
~MMEN~E~ , . ~ _ i s _ 5~~~~~
~D~7E8C~ fi'flP~Tll~~991202~ 5' opt 02 7 0-200.::
same number of units that were removed in converting the mean to zero. Equation 5 below illustrates the conversion of the measured value (MV) to an equilibrated value (EV).
EV = MV - MEAN (Equation 5) Fundamental to this concept is that equilibrated values less than the mean will show increasingly more negative values, whereas equilibrated values above the mean will show increasingly more positive values. For example, the mean of the RR f or glucose is (68 + 113)/2 = 90.5, rounded to 91. A MV of 71 would have an EV of 71 - 91 =
-20; a MV of 91 would have an EV of 91 - 91 = 0; and, a MV of 111 would have an EV of 111 - 91 = +20. Because the + or - EV will be multiplied by the always positive FV in a subsequent step to obtain the UV, the UV will carry the same + or - sign that the EV carried.
Unitizing the Equilibrated Values Once a measured value has been equilibrated (Block 110), the result can be unitized by determining the number of unitized values (UVs) that are present in the equilibrated values (Block 112). Equation 6 illustrates how to determine the unitized value (UV) of an equilibrated value (EV).
UV = EV X FV (Equation 6) Utilizing the operations of Block 100-Block 112, all of the different tests that were measured can be converted to Ws. All of the tests will now be fractions, or multiples, of the unitized upper or lower halves of the reference range. All measured values will be proportionately represented in comparison to one another. For example, a unitized value of +0.25 may represent a 40 measured value for one test and a 20 measured value for another test. However, when these measured values are unitized they could both represent +0.25 and the interpreter would then very quickly make a judgment of analytical equivalence between these two measured results.
Although analytical equivalence of two (or more) tests is indicated by the same unitized value, it does not follow that these equivalent values connote the same priority of urgency to the interpreter. For example, equivalent unitized values for potassium and alkaline phosphatase do not obviate the greater sense of immediate concern for illness that the evaluation of an elevated unitized potassium value brings when judged against an analytically equivalent elevated unitized alkaline phosphatase value. However, the interpreter is now free to make decisions without having to deal with the ambiguity of visually non-equivalent reported values. This reporting of unitized values eliminates the need for the interpreter to make mental calculations from the traditional report on the relative position of any measured value (raw data) to its reference range. All tests will now be proportionately equivalent. The interpreter can assess whether a glucose of +1.5 is medically more critical than a creatinine of +1.5 without having to do mental calculations on the relative deviation of the measured value from the upper reference range.
Example 1 The measured values obtained from two different biological laboratory tests (i.e., sodium and glucose levels) are set forth below in Table 3. These MVs will be processed according to the operations represented by Blocks 100 - 112 described above. The resulting unitized values are tabulated in Table 4.
Table 3 Test MV#1 MV#2 MV#3 Reference (-2) (-8) (+g) Range Sodium 145 139 155 136-147 Glucose 111 105 121 68-113 -In Table 3, MV#1, MV#2, and MV#3 are -2, -8, and +8, respectively, from the upper limit of the reference range.
1) Unitize reference range: 0.0 - 1.0 2) Determine number of MVs in reference range:
Sodium = 147 - 136 + 1 = 12 Glucose = 113 - 68 + 1 = 46 3) Determine number of MVs in upper and lower halves of reference range:
Sodium = 12/2 - 6 Glucose = 46/2 - 23 4) Determine fractional value of MVs in upper and lower halves of reference range:
Sodium = 1/6 = 0.17 Glucose = 1/23 - 0.04 5) Convert each MV to an equilibrated value (EV):
Sodium: Mean = (136 + 147)/2 142 -Glucose: Mean = (68 + 113)/2 91 -Sodium: EV#1 = MV#1 - Mean 145 - 142 3 = =
EV#2 - MV#2 - Mean 139 - 142 -3 = =
EV#3 - MV#3 - Mean 155 - 142 13 = =
Glucose: EV#1 = MV#1 - Mean 111 - 91 20 = =
EV#2 = MV#2 - Mean 105 - 91 14 = =
EV#3 = MV#3 - Mean 121 - 91 30 = =
6) Unitize equilibrated values:
Sodium: UV#1 = EV#1 x FV = 3 x 0.17 - 0.51 UV#2 - EV#2 x FV = -3 x 0.17 = -0.51 UV#3 - EV#3 x FV = 13 x 0.17 = 2.21 Glucose: UV#1 = EV#1 x FV = 20 x 0.04 = 0.80 UV#2 = EV#2 x FV = 14 x 0.04 = 0.56 UV#3 - EV#3 x FV = 30 x 0.04 - 1.20 Table 4 Test MV#1 W#1 MV#2 UV#2 MV#3 W#3 (-2) (-8) (+8) Sodium 145 0.51 139 -0.51 155 2.21 Glucose 111 0.80 105 0.56 121 1.20 From the unitized data, an interpreter can readily determine that a sodium value of 145 (a -2 MV) with a 5 W of 0.51 is essentially the analytical equivalent of a glucose value of 105 (a -8 MV) with a UV of 0.56.
Similarly, an interpreter can quickly observe that a sodium value of 139 (a -8 MV) is significantly different from a glucose of 105 (also a -8 MV), which have Ws of -0.51 and 0.56, respectively.
The traditional method of reporting laboratory data, as seen in Table 4 under the columns giving the MVs, does not allow one to determine the relative relationships that can be readily perceived by 15 evaluating the unitized values seen in the columns listing the Ws. After many years of interpreting the traditionally reported raw data (MVs), users may develop variably refined cognitive perceptions of relative normalcy and abnormalcy of MVs. However, with the reporting of Ws, the relative normalcy and abnormalcy are quantified on the report and a new user will more quickly develop a refined capacity to engage in multiparametric analyses, with sundry benefits to the diagnostic process(es), many years prior to that learned by only utilizing the current state of the art.
Unitizing the Analytical Variation All measured values have a degree of analytical variability, due to imprecision that is inherent in all laboratory and other testing 5 instruments and the reagents used to determine the MVs.
This variation is determined by running controls of known values with the samples from which measured values are determined. The analytic variation of control samples are usually subjected to statistical 10 analysis wherein means and standard deviations are calculated. Often the mean is divided into one standard derivation to yield a value defined as the coefficient of variation. In conventional reports neither the standard deviation nor the coefficient of variation are 15 reported with the measured value. The only values traditionally reported with measured values are the URRL and the LRRL, which constitute the reference range. If the analytical variations were available, the interpreter would be better able to make interpretive 20 judgments on measured values that are near the URRL and the LRRL.
In most analytical systems at least two levels of known control are measured, in order to assess the analytical variability of the testing system 25 near its lower and upper linear limits. The control closest to the measured value may be the most applicable value; however, in practice it may be a complex process to align the measured value and the closest control value. The average of the standard 30 deviations of the controls can be used. The standard deviations of the controls are traditionally calculated from the MVs of the controls in such a manner that they do not need to be equilibrated. Since there is no need to perform the equilibration step on the standard deviation of the control value, and the FV has already been calculated, the conversion of the unitized analytical variation (Block 114) (UAV) may be accomplished by Equation 7.
~UAV = ~ Standard Deviation X FV (Equation 7) Instead of using the standard deviations) of the control values as the measure of the analytical variability of a testing system, other measures of variance can be used and could include the entities of 1) the mean absolute deviation from the mean, or 2) the mean deviation from the median, or 3) any other useful approach to determining variance. Due to the traditional use of standard deviations to express the analytical variability of the control values, the standard variation is used herein.
Reporting the Unitized Values The following eight examples represent formats that can be used in reporting the unitized values, as well as traditional values (Block 116).
The MVs, RRs and the standard deviations (used to calculate the UAVs) set forth below are representative and not specific to an individual, a particular testing system, or a designated lab site.
This is a traditional report in which the abnormal measured values have been accentuated for instant recognition. The abnormal values have been notated as HI or L0. Abnormal values may also be printed in bold, offset or printed in a different color in order to alert an interpreter to the abnormal value.
The tests are listed alphabetically. They are not ranked by high or low values because the data in this traditional report does not allow the interpreter to determine the relative value among the various tests.
TEST RESULT REFERENCE RANGE
Albumin LO 3.3 g/dL 3.4 - 5.3 Bilirubin, total HI 6.2 mg/dL 0.2 - 1.3 Calcium 9.4 mg/dL 8.9 - 10.8 Chloride LO 93 mEq/L 97 - 109 Creatinine 0.7 mg/dL 0.6 - 1.4 2 0 Glucose HI 270 mg/dL 68 - 113 Phosphatase, alkaline 62 IU/L 23 - 140 Potassium 4.4 mEq/L 3.7 - 5.3 Protein, total 7.7 g/dL 6.1 - 8.2 Sodium LO 131 mEq/L 136 - 147 2 5 Transferase(GOT) HI 70 IU/L 4 - 39 Urea Nitrogen 17 mg/dL 7 - 24 TRADITIONAL REPORT
Example 3 represents the unitized report in an enhanced manner, with the tests ranked highest to lowest. This example demonstrates the deletion of the reference ranges and their replacement with a ~ 1.0 unitized reference range. Also reported is the unitized analytical variation. These tests can be ranked because all of the tests have been unitized and the unitized results represent the true relationships among the tests. A greater enhancement of the data could be accomplished by color printing the background so that the higher normal values (greater +0.5 to +1.0) and the lower normal values (less than -0.5 to -1.0) would be in amber; mid normal ranges (-0.5 to +0.5) would be in green; abnormally low values would be in blue; and, abnormally high values would be in red, or in any other color enhanced schemes.
TEST RESULT ~UAV
Bilirubin, total HI +9.1 0.3 Glucose HI +7.8 0.2 Transferase(GOT) HI +2.7 0.2 Protein, total +0.5 0.1 Urea Nitrogen +0.2 0.2 Potassium -0.1 0.1 Phosphatase, alkaline -0.3 0.1 Calcium -0.5 0.1 Creatinine -0.7 0.1 2 0 Albumin LO -1.1 0.0 Chloride LO -1.5 0.2 Sodium LO -1.8 0.2 Reference Range = 0.0~1.0 2 5 UAV = Unitized Analytical Variation UNITARY REPORT
Example 4 represents the unitized data restructured to present the tests in a horizontal graphic format. The hierarchical ranking is retained.
This manner of presentation is allowed due to the unitization of the data. The data could also be reversed ranked if desired. And, the background could be color enhanced, if desired.
ABN LO HI ABN
TEST RESULT LO ( NORMAL / NORMAL ) HI
Bili, T HI +9.1.....( ........./.........).....
X
Glucose HI +7.8.....( ........./.........).....
X
Trans(GOT) HI +2.7.....( ........./.........).....
X
Prot, T +0.5.....( ........./....X....).....
Urea N +0.2.....( ........./.X.......).....
Potassium -0.1.....( ........X/.........).....
Phos, Alk -0.3.....( ......X../.........).....
Calcium -0.5.....( ....X..../.........).....
Creat -0.7.....( ..X.:..../.........).....
Albumin LO -1.1....X( ........./.........).....
Chloride LO -1.5X....( ........./.........).....
Sodium LO -1.8X .....( ........./.........).....
-1. 0 0.0 +1.0 UNITARY METHOD WITH GRAPH
Example 5 displays a composite report including both the traditional report and the newly invented unitized report. This example represents the combining of Examples 2 and 3. In this manner the interpreter could compare the conventionally used reporting format with the new Unitary Report, without any loss of informational content. In this example the traditional report format has been altered to place the tests in the same rank that can be found in the Unitary Report. This minor rearrangement of the traditional alphabetically formatted data further enhances the interpreter's ability to compare the results.
Traditional Report TEST RESULT REFERENCE RANGE
Bilirubin, total HI '6.2 mg/dL 0.2 1.3 -Glucose HI 270 mg/dL 68 113 -Transferase(GOT) IU/L 4 - 39 Protein, g/dL 6.1 8.2 total 7.7 -Urea Nitrogen mg/dL 7 - 24 Potassium 4.4 mEq/L 3.7 5.3 -Phosphatase, IU/L 23 140 alkaline -Calcium 9.4 mg/dL 8.9 10.8 -Creatinine 0.7 mg/dL 0.6 1.4 -Albumin LO 3.3 g/dL 3.4 5.3 -Chloride LO 93 mEq/L 97 109 -Sodium LO 131 mEq/L 136 147 --_--~-____-.--_-.as__--___---__--_--_--_---_-_-~aa-__ _-___.____---a0 -_-.- ----_-_-__ _---_-__--_-----_---_---_--_--.sa ---~-_------Unitary Report TEST RESULT tUAV
2 5 Bilirubin, total HI +9.1 0.3 Glucose HI +7.8 0.2 Transferase(GOT) HI +2.7 0.2 Protein, total +0.5 0.1 Urea Nitrogen +0.2 0.2 3 0 Potassium -0.1 0.1 Phosphatase, alkaline -0.3 0.1 Calcium -0.5 0.1 Creatinine -0.7 0.1 Albumin LO -1.1 0.0 35 Chloride LO -1.5 0.2 Sodium LO -1.8 0.2 Reference Range = 0.01.0 UAV ~ Unitized Analytical Variation COMBINED TRADITIONAL REPORTS
AND UNITARY
Example 6 represents the traditional data and the graphed unitized data combined into a composite report. This example essentially combines Examples 2, 3, and 4 into one report, allowing maximal extraction of information from the data.
Traditional Report TEST RESULT REFERENCE RANGE
Bilirubin, total HI 6.2 mg/dL 0.2 - 1.3 Glucose HI 270 mgJdL 68 - 113 Transferase(GOT} HI 70 IU/L 4 - 39 Protein, total 7.7 g/dL 6.1 - 8.2 Urea Nitrogen 17 mg/dL 7 - 24 Potassium 4.4 mEq/L 3.7 - 5.3 Phosphatase, alkaline 62 IU/L 23 - 140 Calcium 9.4 mg/dL 8.9 - 10.8 2 Creatinine 0.7 mg/dL 0.6 - 1.4 Albumin LO 3.3 g/dL 3.4 - 5.3 Chloride LO 93 mEq/L 97 - 109 Sodium LO 131 mEq/L 136 - 147 -===scscs=a-=-amzssssatsc---==-=ss=-=-=- __===-=ss==- -xo==ose=-o=o ABN LO HI ABN
TEST RESULT LO ( NORMAL/ NORMAL HI
) 3 Bili, T HI +9.1 .....(........./.........)..... X
Glucose HI +7.8 .....(........./.........)..... X
Trans(GOT) HI +2.7 .....(........./.........)..... X
Prot, T +0.5 .....(........./....X....).....
Urea N +0.2 .....(........./.X.......).....
3 Potassium -0.1 .....(........X/.........).....
Phos, Alk -0.3 .....(......X../.........).....
Calcium -0.5 .....(....X..../.........).....
Great -0.7 .....(..X.:..../.........}.....
Albumin LO -1.1 ....X(........./.........).....
4 Chloride LO -1.5 X....(........./.........).....
Sodium LO -1.8 X .....(........./.........).....
-1.0 0.0 +1. 0 COMBINED TRADITIONAL AND UNITARY REPORTS - WITH GRAPH
Example 7 illustrates the combination of two different styles of reporting unitized data, according to the present invention. The traditional reporting format has not been incorporated into this report. In some circumstances, it may not be necessary to utilize the traditional format.
TEST RESULT ~UAV
Bilirubin, total HI +9.10.3 Glucose HI +7.80.2 Transferase(GOT) HI +2.70.2 Protein, total +0.5 0.1 Urea Nitrogen +0.2 0.2 Potassium -0.1 0.1 Phosphatase, -0.3 0.1 alkaline Calcium -0.5 0.1 Creatinine -0.7 0.1 2 0 Albumin LO -1.10.0 Chloride LO -1.50.2 Sodium LO -1.80.2 _=_______~__-___-__~-__________________-__~_~~~__~___~_~_-_=-===z TEST RESULT LO ( NORMAL
/
NORMAL
) HI
Bili, T HI +9.1 ..... (........./.........)..... X
Glucose HI +7.8 ..... (........./.........)..... X
3 0 Trans (GOT) ( . . . . . . . . . ) HI +2 . . . . . . . . . X
U.S. Patent No. 5,541,854 to Yundt describes displaying conventional mufti-level hematology quality control data (three levels) in a complex graphic form.
Yundt is concerned with the presentation of tri-level quality control data and not with the presentation of measured unknown samples.
Statistical methods utilizing "Z scores" to specify the relative frequency or probability of a random number in a normally distributed set of measurements are known. Unfortunately, Z scores are somewhat difficult to use to identify the relative value of one test result to another. Furthermore Z
score techniques are somewhat limited because data beyond the maximum and minimum limits of normal distribution cannot be used.
Summary of the Invention In view of the above discussion, it is an object of the present invention to reduce much of the complexity associated with interpreting laboratory test data.
It is another object of the present invention to facilitate determining relative relationships of measured values from laboratory tests to respective reference ranges.
These and other objects are provided by systems, methods, and computer program products for determining relative normalcy or abnormalcy of a plurality of test results, by transforming test results into respective unitized values and then graphically displaying each of the unitized values with a unitized reference range. Additionally, an unitized analytical variation of each of the respective unitized values may be determined and displayed.
Initially, a reference range for a test is unitized to a single number. A total number of possible test results within respective equal halves of the reference range is then determined. This is accomplished by determining a total number of possible test results within the reference range to produce a reference range spread, and then dividing the reference range spread in half.
The fractional value of the plurality of test results in the respective halves of the reference range is then determined. The fractional value of the plurality of test results comprises a reciprocal of one-half of the total number of possible test results in the reference range. Each of the plurality of separately determined test results are then transformed into respective equilibrated values. This is accomplished by determining the mean of the reference range and then determining a difference between the mean and each of the plurality of test results. Each equilibrated value represents relative position of a respective test result with respect to a mean of the reference range.
Each of the equilibrated values is then transformed into respective unitized values by multiplying each respective equilibrated value with a respective fractional value of the plurality of test results in one half of the reference range. Each unitized value represents relative normalcy or abnormalcy of a respective test result with respect to the unitized reference range.
According to the present invention, unitized values with the same numerical value indicate the same quantitative variation from any reference points?
within the unitized reference range. According to the present invention, a unitized value of 1.5 for a glucose level within a patient and a unitized value of 1.5 for a sodium level within a patient will mean the same quantitative increase for each test. Furthermore, the present invention may allow an interpreter to recognize problems and undertake corrective actions sooner. By utilizing unitized values according to the present invention, an interpreter could more easily recognize that a unitized sodium value of 1.5 is more severe than a unitized glucose value of 1.1 and, therefore, take action to rectify the sodium level.
The present invention may be applied to the interpretation of any type of laboratory test data, both biological and non-biological, and particularly where the test data is interpreted by referring to a reference range. The present invention is particularly useful where multiparametric data is obtained from testing.
Brief Description of the Drawings Fig. 1 schematically illustrates operations for unitizing test data having different reference ranges, according to an embodiment of the present invention.
Fig. 2 illustrates an exemplary data processing system in which the present invention may be implemented.
Detailed Description of the Invention The present invention now is described more fully hereinafter with reference to the accompanying drawings, in which preferred embodiments of the invention are shown. This invention may, however, be~
embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the invention to those skilled in the art. Like numbers refer to like elements throughout.
As will be appreciated by one of skill in the art, the present invention may be embodied as a method, data processing system, or computer program product.
Accordingly, the present invention may take the form of _g_ an entirely hardware embodiment, an entirely software embodiment or an embodiment combining software and hardware aspects. Furthermore, the present invention may take the form of a computer program product on a computer-readable storage medium having computer-readable program code means embodied in the medium. Any suitable computer readable medium may be utilized including hard disks, CD-ROMs, optical storage devices, or magnetic storage devices.
The present invention is described below with reference to flowchart illustrations of methods, apparatus (systems) and computer program products according to an embodiment of the invention. It will be understood that each block of the flowchart illustrations, and combinations of blocks in the flowchart illustrations, can be implemented by computer program instructions. These computer program instructions may be loaded onto a general purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions which execute on the computer or other programmable data processing apparatus create means for implementing the functions specified in the flowchart block or blocks. These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means which implement the function specified in the _g_ flowchart block or blocks. The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart block or blocks.
Accordingly, blocks of the flowchart illustrations support combinations of means for performing the specified functions, combinations of steps for performing the specified functions and program instruction means for performing the specified functions. It will also be understood that each block of the flowchart illustrations, and combinations of blocks in the flowchart illustrations, can be implemented by special purpose hardware-based computer systems which perform the specified functions or steps, or combinations of special purpose hardware and computer instructions.
Referring now to Fig. l, operations for unitizing test data having different reference ranges, according to an embodiment of the present invention, are schematically illustrated. Operations include:
unitizing a reference range (Block 100); determining the number of measured values in the reference range (Block 102); unitizing the equal halves of the reference range (Block 104); determining the number of measured values in the upper one half and the lower one half of the reference range (Block 106); determining the fractional value of the measured values in the equal one halves of the reference range (Block 108);
equilibrating the measured values (Block 110);
unitizing the equilibrated values (Block 112);
unitizing the analytical variation (Block 114); and reporting the unitized values (Block 116). Each of these operations will be described in detail below.
Referring now to Fig. 2, an exemplary data processing system in which the present invention may be implemented is illustrated. As seen in Fig. 2, a data processor 10 may have an operating system 11 resident therein. An application program 12 for performing operations according to the present invention typically executes via the operating system 11. The processor 10 displays information on a display device 13 which has a plurality of picture elements (collectively referred to as a screen). The information is displayed on the display device 13, preferably within a graphical user interface. The contents of the screen of the display device 13 and the appearance of a graphical user interface, may be controlled or altered by an application program 12 or the operating system 11 either individually or in combination. For obtaining input from a user, the operating system 11 and the application program 12 may utilize user input devices 14. User input devices 14 may include a pointing device 15, such as a mouse, and a keyboard 16 or other input devices known to those of skill in the art.
Table 2 below defines abbreviations used throughout this disclosure.
Table 2 Abbreviation Definition EV equilibrated value FV fractional value HRRS half reference range spread LRRL lower reference range limit MV measured value RR reference range RRS reference range spread UAV unitized analytical variance URRL upper reference range limit W unitized value It is understood that the term "measured value" as used herein is synonymous with the term "test result", such as a blood glucose level produced by a blood test.
Unitizinct a Reference Range An initial operation of the present invention involves unitizing a reference range (Block 100).
Unitization of a reference range is defined as grouping all measured values for each laboratory (or other) test within a reference range into a single number. By way of explanation, inherent in the definition of a RR is the possibility that any MV that falls within a RR is as potentially normal, in an equivalent biological sense, as any other MV within the same RR, or any other RR. Since this potential exists, it is conceptually feasible to consider all MVs in any RR as equivalent values. As a derivative of this consideration, all of WO 00/1296$ PCT/US99/20125 the MVs in any RR can be conceptually consolidated into one number which would have no need of any assigned concentration units.
For example, if the number 1.0 is selected, the reference range may be any value greater than 0.0 and equal to or less than 1.0, since this comprises the number 1Ø However, it is to be understood that any number can be used for this purpose. From this concept, it does follow that if one test has a MV of 100 milligrams per deciliter (mg/dl) in its RR and another test has a MV of 10 millimoles per liter (mmol/L) in its RR, these different MVs lose the concentration units (mg/dl and mmol/L); and, the 100 MV and the 10 MV
are biological equivalents. This conceptual process is an initial necessary process in order to restructure the ordinarily disparate MVs in RRs into one number.
The equation that expresses this relationship is 0.0 < Unitized RR <_ 1.0 (Equation 1) Equation 1 states that a unitized RR is greater than zero but less than or equal to one.
Determinincr the Number of Measured Values in the 2 5 Re f erence Rancte Next a determination of the number of measured values that are included in the reference range from the lower reference range limit to, and including, the upper reference range limit is made (Block I02). The number of measured values in this range is determined by both the unique analytical properties of the test and by the actual measured values discovered in the reference (normal) population, and represents a fixed number of MVs peculiar to each test and the methodology used in the testing procedure.
The RR is not only different for each test, but the RR
will also change for any given test if the methodology for that test is changed, which further adds to the memory requirements of an interpreter and the need for advance notice by a laboratory when methodology is changed. The number of MVs within the RR is calculated from the high and low numbers listed under the heading "Reference Range", or sometimes otherwise described as "Reference Interval" or "Normal Range". The total number of measured values in the reference range spread is preferably determined by Equation 2 below.
RRS = (URRL - LRRL) + 1 (Equation 2) The URRL and LRRL, when used in Equation 2, refer to the numbers given in a traditional report (e.g., Table 1 above) under the heading of RR, and not to the unitized reference range of 1Ø
Equation 2 includes all units in the reference range by the addition of a whole integer to the difference between the minimum and maximum of the reference range. For example, the RR for glucose may be given as 68 - 113 mg/dl. Since the UV will be unit-less, the concentration units of mg/dl can be dropped.
Under this arrangement the URRL = 113 and the LRRL =
68. The RR numbers are then inserted into Equation 2, as follows:
RRS = (113 - 68) + 1 V. VON :1-.PA-1NUENCIi~"\ U5 : 28- 9- 0 : 19 : 34 : 919 854 14U 1-. +49 E39 23994465 : # 11 uW . LU. LVV4 I.Jtlnl muvu~: 717 UJ? ITV I Iw. TI 1 i I. I 1 = 45 + Z
In the proce$s of eventually converting measured values to unitised values, all reported decimal values in the reference ranges and all measured values reported in decimals need to be converted to their equivalent whole values. For example a reference range of 4.6 - 8.7 is converted tc 46 - B? and the number of MVs in the RRS is (87 - 46) f 1 = 42.
1~ Measured decimal values are also converted to their equivalent whole numbers. All subsequent calculations are performed on the converted whole numbers. This modification is required because the interpreter would have most likely used "tenths" of a number in evaluating increases or decreases in measured _v_alues.
Once decimal values are converted to their equivalent whsle numbers, the subsequently calculated DV reflects the original MV as it was expressed in tenths, or other decimal points.
SUBSTITUTE SHEET
Coped f~o~ PCTIl~~99/2D2~ 5 ~o~ 02='~ 0 ~~a0 :V.VON:EPA-ML'ENCHE~ U5 :28- 9- U : 19:84 : 979 854 1401-. +49 89 23994465:#12 vm. LV~ LVVV I.JJmn muuyu 717 V~T IT1; I mv. Tr I ~ ~. IL
Unitizing the Ea~ual Halves of the Reference R,~nce The initial unitization of the reference range and the sui~sequent determinations of the RRS need to be restructured for the following reason. A low abnormal measured value, subsequently unitized to -0.5 would be the analytical equivalent, in the opposite direction, of a ~righ abnormal unitized value of ~+1.5, since both values would be a 0.5 units beyond the lower and upper limits, respectively, of the unitized reference range. In a reporting format a reviewer would find these equidistant analytical values disconcerting since they are different numbers.
The above anomaly can be rectified by i5 dividing the reference range into equal halves and then unitizing the separate equal components (Block 104).
The mean o~ the reference range then beaornes O.fl. The range from the mean to the LRRL is defzned as 0.0 tQ
i.o. The range from the mean to the URRL is defined as ZO 0.0 to +1.D. However, as was indicated in the initial unitizat~,oa of the reference range, any number can be used. For purposes of this discussion, the number 1,0 is retained, but modified to -1.0 and +1.0 far the equal halves of the reference range spread.
SUBSTITUTE SHEET
i~NDED S~-i~LT -15-Copied frog 'PCTlL~~991202'~ ~ rn ~2~~ ~-2~0' Determining the Number of Measured Values in U~,per and Lower Halves of Reference Range Because the RR is divided into equal halves, the previously calculated number of MVs in the RRS
(Equation 2) needs to be divided between the two halves. The number of MVs in each half of the RRS can be determined by the following equation:
HRRS = RRS/2 (Equation 3) For example, the HRRS for glucose is:
HRRS = 46/2 = 23 Determining the Fractional Value of the Measured Values in the Upper and Lower Halves of the Reference Range One of the components of the equation used to calculate UVs is the fractional value (FV). FV is defined as the reciprocal value of the MVs that are present in the HRRS. The fractional value of each of the measured values in the HRRS is determined by Equation 4:
FV = 1/HRRS (Equation 4) For example, the FV for glucose is:
FV = 1/23 - 0.04 The FV can be expressed as either a fraction or a percent.
'.CV. VU!~ : EPA-IvIUEIVCHEI~ U , : 28- 9- 0 : 19: 35 : 919 854 1401-~ +49 89 23994465: ~i13 VL1. LV, IVVV I,JJnI~i IWJV~V Jl) VJT ITVI tlU. TI 11 i. :J
E i r M s V
Prior to the conversion of a measured value to a unitized value, the measured value needs co be equilibrated with the mean of the reference range (block 110), since the mean now represents zero. (ln the traditional reporting process, zero is the value assigned to no detectable analyte levels.? This is accomplished by removing from the measured value the SUBSTITUTE SHEET
~MMEN~E~ , . ~ _ i s _ 5~~~~~
~D~7E8C~ fi'flP~Tll~~991202~ 5' opt 02 7 0-200.::
same number of units that were removed in converting the mean to zero. Equation 5 below illustrates the conversion of the measured value (MV) to an equilibrated value (EV).
EV = MV - MEAN (Equation 5) Fundamental to this concept is that equilibrated values less than the mean will show increasingly more negative values, whereas equilibrated values above the mean will show increasingly more positive values. For example, the mean of the RR f or glucose is (68 + 113)/2 = 90.5, rounded to 91. A MV of 71 would have an EV of 71 - 91 =
-20; a MV of 91 would have an EV of 91 - 91 = 0; and, a MV of 111 would have an EV of 111 - 91 = +20. Because the + or - EV will be multiplied by the always positive FV in a subsequent step to obtain the UV, the UV will carry the same + or - sign that the EV carried.
Unitizing the Equilibrated Values Once a measured value has been equilibrated (Block 110), the result can be unitized by determining the number of unitized values (UVs) that are present in the equilibrated values (Block 112). Equation 6 illustrates how to determine the unitized value (UV) of an equilibrated value (EV).
UV = EV X FV (Equation 6) Utilizing the operations of Block 100-Block 112, all of the different tests that were measured can be converted to Ws. All of the tests will now be fractions, or multiples, of the unitized upper or lower halves of the reference range. All measured values will be proportionately represented in comparison to one another. For example, a unitized value of +0.25 may represent a 40 measured value for one test and a 20 measured value for another test. However, when these measured values are unitized they could both represent +0.25 and the interpreter would then very quickly make a judgment of analytical equivalence between these two measured results.
Although analytical equivalence of two (or more) tests is indicated by the same unitized value, it does not follow that these equivalent values connote the same priority of urgency to the interpreter. For example, equivalent unitized values for potassium and alkaline phosphatase do not obviate the greater sense of immediate concern for illness that the evaluation of an elevated unitized potassium value brings when judged against an analytically equivalent elevated unitized alkaline phosphatase value. However, the interpreter is now free to make decisions without having to deal with the ambiguity of visually non-equivalent reported values. This reporting of unitized values eliminates the need for the interpreter to make mental calculations from the traditional report on the relative position of any measured value (raw data) to its reference range. All tests will now be proportionately equivalent. The interpreter can assess whether a glucose of +1.5 is medically more critical than a creatinine of +1.5 without having to do mental calculations on the relative deviation of the measured value from the upper reference range.
Example 1 The measured values obtained from two different biological laboratory tests (i.e., sodium and glucose levels) are set forth below in Table 3. These MVs will be processed according to the operations represented by Blocks 100 - 112 described above. The resulting unitized values are tabulated in Table 4.
Table 3 Test MV#1 MV#2 MV#3 Reference (-2) (-8) (+g) Range Sodium 145 139 155 136-147 Glucose 111 105 121 68-113 -In Table 3, MV#1, MV#2, and MV#3 are -2, -8, and +8, respectively, from the upper limit of the reference range.
1) Unitize reference range: 0.0 - 1.0 2) Determine number of MVs in reference range:
Sodium = 147 - 136 + 1 = 12 Glucose = 113 - 68 + 1 = 46 3) Determine number of MVs in upper and lower halves of reference range:
Sodium = 12/2 - 6 Glucose = 46/2 - 23 4) Determine fractional value of MVs in upper and lower halves of reference range:
Sodium = 1/6 = 0.17 Glucose = 1/23 - 0.04 5) Convert each MV to an equilibrated value (EV):
Sodium: Mean = (136 + 147)/2 142 -Glucose: Mean = (68 + 113)/2 91 -Sodium: EV#1 = MV#1 - Mean 145 - 142 3 = =
EV#2 - MV#2 - Mean 139 - 142 -3 = =
EV#3 - MV#3 - Mean 155 - 142 13 = =
Glucose: EV#1 = MV#1 - Mean 111 - 91 20 = =
EV#2 = MV#2 - Mean 105 - 91 14 = =
EV#3 = MV#3 - Mean 121 - 91 30 = =
6) Unitize equilibrated values:
Sodium: UV#1 = EV#1 x FV = 3 x 0.17 - 0.51 UV#2 - EV#2 x FV = -3 x 0.17 = -0.51 UV#3 - EV#3 x FV = 13 x 0.17 = 2.21 Glucose: UV#1 = EV#1 x FV = 20 x 0.04 = 0.80 UV#2 = EV#2 x FV = 14 x 0.04 = 0.56 UV#3 - EV#3 x FV = 30 x 0.04 - 1.20 Table 4 Test MV#1 W#1 MV#2 UV#2 MV#3 W#3 (-2) (-8) (+8) Sodium 145 0.51 139 -0.51 155 2.21 Glucose 111 0.80 105 0.56 121 1.20 From the unitized data, an interpreter can readily determine that a sodium value of 145 (a -2 MV) with a 5 W of 0.51 is essentially the analytical equivalent of a glucose value of 105 (a -8 MV) with a UV of 0.56.
Similarly, an interpreter can quickly observe that a sodium value of 139 (a -8 MV) is significantly different from a glucose of 105 (also a -8 MV), which have Ws of -0.51 and 0.56, respectively.
The traditional method of reporting laboratory data, as seen in Table 4 under the columns giving the MVs, does not allow one to determine the relative relationships that can be readily perceived by 15 evaluating the unitized values seen in the columns listing the Ws. After many years of interpreting the traditionally reported raw data (MVs), users may develop variably refined cognitive perceptions of relative normalcy and abnormalcy of MVs. However, with the reporting of Ws, the relative normalcy and abnormalcy are quantified on the report and a new user will more quickly develop a refined capacity to engage in multiparametric analyses, with sundry benefits to the diagnostic process(es), many years prior to that learned by only utilizing the current state of the art.
Unitizing the Analytical Variation All measured values have a degree of analytical variability, due to imprecision that is inherent in all laboratory and other testing 5 instruments and the reagents used to determine the MVs.
This variation is determined by running controls of known values with the samples from which measured values are determined. The analytic variation of control samples are usually subjected to statistical 10 analysis wherein means and standard deviations are calculated. Often the mean is divided into one standard derivation to yield a value defined as the coefficient of variation. In conventional reports neither the standard deviation nor the coefficient of variation are 15 reported with the measured value. The only values traditionally reported with measured values are the URRL and the LRRL, which constitute the reference range. If the analytical variations were available, the interpreter would be better able to make interpretive 20 judgments on measured values that are near the URRL and the LRRL.
In most analytical systems at least two levels of known control are measured, in order to assess the analytical variability of the testing system 25 near its lower and upper linear limits. The control closest to the measured value may be the most applicable value; however, in practice it may be a complex process to align the measured value and the closest control value. The average of the standard 30 deviations of the controls can be used. The standard deviations of the controls are traditionally calculated from the MVs of the controls in such a manner that they do not need to be equilibrated. Since there is no need to perform the equilibration step on the standard deviation of the control value, and the FV has already been calculated, the conversion of the unitized analytical variation (Block 114) (UAV) may be accomplished by Equation 7.
~UAV = ~ Standard Deviation X FV (Equation 7) Instead of using the standard deviations) of the control values as the measure of the analytical variability of a testing system, other measures of variance can be used and could include the entities of 1) the mean absolute deviation from the mean, or 2) the mean deviation from the median, or 3) any other useful approach to determining variance. Due to the traditional use of standard deviations to express the analytical variability of the control values, the standard variation is used herein.
Reporting the Unitized Values The following eight examples represent formats that can be used in reporting the unitized values, as well as traditional values (Block 116).
The MVs, RRs and the standard deviations (used to calculate the UAVs) set forth below are representative and not specific to an individual, a particular testing system, or a designated lab site.
This is a traditional report in which the abnormal measured values have been accentuated for instant recognition. The abnormal values have been notated as HI or L0. Abnormal values may also be printed in bold, offset or printed in a different color in order to alert an interpreter to the abnormal value.
The tests are listed alphabetically. They are not ranked by high or low values because the data in this traditional report does not allow the interpreter to determine the relative value among the various tests.
TEST RESULT REFERENCE RANGE
Albumin LO 3.3 g/dL 3.4 - 5.3 Bilirubin, total HI 6.2 mg/dL 0.2 - 1.3 Calcium 9.4 mg/dL 8.9 - 10.8 Chloride LO 93 mEq/L 97 - 109 Creatinine 0.7 mg/dL 0.6 - 1.4 2 0 Glucose HI 270 mg/dL 68 - 113 Phosphatase, alkaline 62 IU/L 23 - 140 Potassium 4.4 mEq/L 3.7 - 5.3 Protein, total 7.7 g/dL 6.1 - 8.2 Sodium LO 131 mEq/L 136 - 147 2 5 Transferase(GOT) HI 70 IU/L 4 - 39 Urea Nitrogen 17 mg/dL 7 - 24 TRADITIONAL REPORT
Example 3 represents the unitized report in an enhanced manner, with the tests ranked highest to lowest. This example demonstrates the deletion of the reference ranges and their replacement with a ~ 1.0 unitized reference range. Also reported is the unitized analytical variation. These tests can be ranked because all of the tests have been unitized and the unitized results represent the true relationships among the tests. A greater enhancement of the data could be accomplished by color printing the background so that the higher normal values (greater +0.5 to +1.0) and the lower normal values (less than -0.5 to -1.0) would be in amber; mid normal ranges (-0.5 to +0.5) would be in green; abnormally low values would be in blue; and, abnormally high values would be in red, or in any other color enhanced schemes.
TEST RESULT ~UAV
Bilirubin, total HI +9.1 0.3 Glucose HI +7.8 0.2 Transferase(GOT) HI +2.7 0.2 Protein, total +0.5 0.1 Urea Nitrogen +0.2 0.2 Potassium -0.1 0.1 Phosphatase, alkaline -0.3 0.1 Calcium -0.5 0.1 Creatinine -0.7 0.1 2 0 Albumin LO -1.1 0.0 Chloride LO -1.5 0.2 Sodium LO -1.8 0.2 Reference Range = 0.0~1.0 2 5 UAV = Unitized Analytical Variation UNITARY REPORT
Example 4 represents the unitized data restructured to present the tests in a horizontal graphic format. The hierarchical ranking is retained.
This manner of presentation is allowed due to the unitization of the data. The data could also be reversed ranked if desired. And, the background could be color enhanced, if desired.
ABN LO HI ABN
TEST RESULT LO ( NORMAL / NORMAL ) HI
Bili, T HI +9.1.....( ........./.........).....
X
Glucose HI +7.8.....( ........./.........).....
X
Trans(GOT) HI +2.7.....( ........./.........).....
X
Prot, T +0.5.....( ........./....X....).....
Urea N +0.2.....( ........./.X.......).....
Potassium -0.1.....( ........X/.........).....
Phos, Alk -0.3.....( ......X../.........).....
Calcium -0.5.....( ....X..../.........).....
Creat -0.7.....( ..X.:..../.........).....
Albumin LO -1.1....X( ........./.........).....
Chloride LO -1.5X....( ........./.........).....
Sodium LO -1.8X .....( ........./.........).....
-1. 0 0.0 +1.0 UNITARY METHOD WITH GRAPH
Example 5 displays a composite report including both the traditional report and the newly invented unitized report. This example represents the combining of Examples 2 and 3. In this manner the interpreter could compare the conventionally used reporting format with the new Unitary Report, without any loss of informational content. In this example the traditional report format has been altered to place the tests in the same rank that can be found in the Unitary Report. This minor rearrangement of the traditional alphabetically formatted data further enhances the interpreter's ability to compare the results.
Traditional Report TEST RESULT REFERENCE RANGE
Bilirubin, total HI '6.2 mg/dL 0.2 1.3 -Glucose HI 270 mg/dL 68 113 -Transferase(GOT) IU/L 4 - 39 Protein, g/dL 6.1 8.2 total 7.7 -Urea Nitrogen mg/dL 7 - 24 Potassium 4.4 mEq/L 3.7 5.3 -Phosphatase, IU/L 23 140 alkaline -Calcium 9.4 mg/dL 8.9 10.8 -Creatinine 0.7 mg/dL 0.6 1.4 -Albumin LO 3.3 g/dL 3.4 5.3 -Chloride LO 93 mEq/L 97 109 -Sodium LO 131 mEq/L 136 147 --_--~-____-.--_-.as__--___---__--_--_--_---_-_-~aa-__ _-___.____---a0 -_-.- ----_-_-__ _---_-__--_-----_---_---_--_--.sa ---~-_------Unitary Report TEST RESULT tUAV
2 5 Bilirubin, total HI +9.1 0.3 Glucose HI +7.8 0.2 Transferase(GOT) HI +2.7 0.2 Protein, total +0.5 0.1 Urea Nitrogen +0.2 0.2 3 0 Potassium -0.1 0.1 Phosphatase, alkaline -0.3 0.1 Calcium -0.5 0.1 Creatinine -0.7 0.1 Albumin LO -1.1 0.0 35 Chloride LO -1.5 0.2 Sodium LO -1.8 0.2 Reference Range = 0.01.0 UAV ~ Unitized Analytical Variation COMBINED TRADITIONAL REPORTS
AND UNITARY
Example 6 represents the traditional data and the graphed unitized data combined into a composite report. This example essentially combines Examples 2, 3, and 4 into one report, allowing maximal extraction of information from the data.
Traditional Report TEST RESULT REFERENCE RANGE
Bilirubin, total HI 6.2 mg/dL 0.2 - 1.3 Glucose HI 270 mgJdL 68 - 113 Transferase(GOT} HI 70 IU/L 4 - 39 Protein, total 7.7 g/dL 6.1 - 8.2 Urea Nitrogen 17 mg/dL 7 - 24 Potassium 4.4 mEq/L 3.7 - 5.3 Phosphatase, alkaline 62 IU/L 23 - 140 Calcium 9.4 mg/dL 8.9 - 10.8 2 Creatinine 0.7 mg/dL 0.6 - 1.4 Albumin LO 3.3 g/dL 3.4 - 5.3 Chloride LO 93 mEq/L 97 - 109 Sodium LO 131 mEq/L 136 - 147 -===scscs=a-=-amzssssatsc---==-=ss=-=-=- __===-=ss==- -xo==ose=-o=o ABN LO HI ABN
TEST RESULT LO ( NORMAL/ NORMAL HI
) 3 Bili, T HI +9.1 .....(........./.........)..... X
Glucose HI +7.8 .....(........./.........)..... X
Trans(GOT) HI +2.7 .....(........./.........)..... X
Prot, T +0.5 .....(........./....X....).....
Urea N +0.2 .....(........./.X.......).....
3 Potassium -0.1 .....(........X/.........).....
Phos, Alk -0.3 .....(......X../.........).....
Calcium -0.5 .....(....X..../.........).....
Great -0.7 .....(..X.:..../.........}.....
Albumin LO -1.1 ....X(........./.........).....
4 Chloride LO -1.5 X....(........./.........).....
Sodium LO -1.8 X .....(........./.........).....
-1.0 0.0 +1. 0 COMBINED TRADITIONAL AND UNITARY REPORTS - WITH GRAPH
Example 7 illustrates the combination of two different styles of reporting unitized data, according to the present invention. The traditional reporting format has not been incorporated into this report. In some circumstances, it may not be necessary to utilize the traditional format.
TEST RESULT ~UAV
Bilirubin, total HI +9.10.3 Glucose HI +7.80.2 Transferase(GOT) HI +2.70.2 Protein, total +0.5 0.1 Urea Nitrogen +0.2 0.2 Potassium -0.1 0.1 Phosphatase, -0.3 0.1 alkaline Calcium -0.5 0.1 Creatinine -0.7 0.1 2 0 Albumin LO -1.10.0 Chloride LO -1.50.2 Sodium LO -1.80.2 _=_______~__-___-__~-__________________-__~_~~~__~___~_~_-_=-===z TEST RESULT LO ( NORMAL
/
NORMAL
) HI
Bili, T HI +9.1 ..... (........./.........)..... X
Glucose HI +7.8 ..... (........./.........)..... X
3 0 Trans (GOT) ( . . . . . . . . . ) HI +2 . . . . . . . . . X
7 . . . . . .
. . . / .
.
Prot, T +0.5 ..... (........./....X....).....
Urea N +0.2 ..... (........./.X.......).....
Potassium -0.1 ..... (........X/.........).....
Phos, Alk -0.3 ..... (......X../.........).....
35 Calcium -0.5 ..... (....X..../.........).....
Great -0.7 ..... (..X.:..../.........).....
Albumin LO -1.1 ....X (........./.........).....
Chloride LO -1.5 X.... (........./.........).....
Sodium LO -1.8 X .....(........./.........).....
4 0 -1 .0 0.0 +1.0 UNITARY REPORT - TABULAR AND GRAPH
. . . / .
.
Prot, T +0.5 ..... (........./....X....).....
Urea N +0.2 ..... (........./.X.......).....
Potassium -0.1 ..... (........X/.........).....
Phos, Alk -0.3 ..... (......X../.........).....
35 Calcium -0.5 ..... (....X..../.........).....
Great -0.7 ..... (..X.:..../.........).....
Albumin LO -1.1 ....X (........./.........).....
Chloride LO -1.5 X.... (........./.........).....
Sodium LO -1.8 X .....(........./.........).....
4 0 -1 .0 0.0 +1.0 UNITARY REPORT - TABULAR AND GRAPH
EXAMPLE S
This example illustrates the utilization of unitized data in the setting of repeat analyses of the same test. Both traditional and unitized data according to the present invention have been incorporated into the report. Also, day-to-day running averages of both types of data and a graphic report of the unitized data have been included. The data may also be presented without averaging or a cumulative type of running average may be used. The type of averaging used can be adapted to accommodate the user's requirements. Again, maximal information has been extracted from the primary data.
TRADITIONAL REPORT UNITARY REPORT
TEST RESULT AVG RESULT AVG
Glucose 270 --- +7.8 ---200 235 +6.3 +7.0 2 0 160 180 +3.9 +5.1 111 136 +2.0 +2.9 94 103 +0.5 +1.2 90 92 +0.1 +0.3 89 90 0.0 0.0 2 5 80 85 -0.3 -0.2 78 79 -0.5 -0.4 80 79 -0.5 -0.5 REFERENCE RANGE 68 - 113 -1.0 - +1.0 3 0 ===o:==ce==e~aao==Boa===escaa=c=====--==c====~~c===---_______=___ UNITARY GRAPHIC REPORT
ABN LO HI ABN
LO ( NORMAL / NORMAL) HI
35 TEST RESULT -1 .0 0.0 +1 .0 AVG
Glucose HI +7.8 ... (........./.........)...X ___ +6.3 ... (........./.........)...X +7.0 +3.9 ... (........./.........)...X +5.1 +2.0 ... (........./.........)...X +2.9 4 0 +0.5 ... (........./....X....)... +1.2 +0.1 ... (........./X........)... +0.3 +0.0 ... (.........X.........)... 0.0 -0.3 ... (......X../.........)... -0.2 -0.5 ... (....X..../.........)... -0.4 4 5 -0.5 ... (...'.X..../.........)... -0.5 REPEAT ANALYSES OF THE SAME TEST
A vertical graphic presentation is illustrated in this example. As was mentioned in earlier examples, the background could be color enhanced. This type of presentation may be preferred in some settings.
X X X
0____________________________________ +2.
5______________-_____________________ +l.
_ _ _ _ _ _ _ _ _ _ _ _ 0 ______________________________r__ _h +1. _-_____ _ _ _ _ _ _ _ _ _ _ _ _ a i _ _ _ _ _ _ _ _ _ _ _ _ f _ _ _ _ _ _ _ _ _ _ _ _ a _ _ _ _ _ _ _ _ _ _ _ r n V
+0.5--_______________________X__________a o E
_ _ _ _ _ - - - - - _ - n r E R
_ _ _ _ _ _ _ _ _ _ _ _ C m X T
_ _ - - - - - X - - - - a a A I
_ _ _ _ _ _ _ _ _ _ _ _ . 1 M C
0.0--__________________________________, . P A
_ _ _ _ _ _ X _ _ _ _ _ , n L L
- _ _ _ _ _ _ _ _ _ _ _ , o E
_ _ _ _ _ X _ _ _ _ _ _ , r G
_ _ _ _ _ _ _ _ _ _ _ _ , m 9 R
-0.5--___________X______________________, a A
_ _ _ _ _ _ _ _ _ _ _ _ r 1 P
_ _ _ X _ _ _ _ _ _ _ _ a H
_ _ _ _ _ _ _ _ _ _ _ _ g 1 -1.0--______-_____________________________e___o _ _ X _ _ _ _ _ _ _ _ _ 3 _ _ _ _ _ _ _ _ _ _ _ _ -1.5---_X_______________________________ -2.0---__________________--_____________ s c a c c a p a t t g t 4 o h 1 r a 1 o r r 1 d 1 b a 1 k t a p a a b i o a a c a a r n c i a r m t i p s o s o 1 m i i a h s n t f s i 5 d n m o i i a a a a s a t I r m r n The foregoing is illustrative of the present invention and is not to be construed as limiting thereof. Although a few exemplary embodiments of this invention have been described, those skilled in the art will readily appreciate that many modifications are possible in the exemplary embodiments without materially departing from the novel teachings and advantages of this invention. Accordingly, all such modifications are intended to be included within the scope of this invention as defined in the claims. In the claims, means-plus-function clause are intended to cover the structures described herein as performing the recited function and not only structural equivalents but also equivalent structures. Therefore, it is to be understood that the foregoing is illustrative of the present invention and is not to be construed as limited to the specific embodiments disclosed, and that modifications to the disclosed embodiments, as well as other embodiments, are intended to be included within the scope of the appended claims. The invention is defined by the following claims, with equivalents of the claims to be included therein.
This example illustrates the utilization of unitized data in the setting of repeat analyses of the same test. Both traditional and unitized data according to the present invention have been incorporated into the report. Also, day-to-day running averages of both types of data and a graphic report of the unitized data have been included. The data may also be presented without averaging or a cumulative type of running average may be used. The type of averaging used can be adapted to accommodate the user's requirements. Again, maximal information has been extracted from the primary data.
TRADITIONAL REPORT UNITARY REPORT
TEST RESULT AVG RESULT AVG
Glucose 270 --- +7.8 ---200 235 +6.3 +7.0 2 0 160 180 +3.9 +5.1 111 136 +2.0 +2.9 94 103 +0.5 +1.2 90 92 +0.1 +0.3 89 90 0.0 0.0 2 5 80 85 -0.3 -0.2 78 79 -0.5 -0.4 80 79 -0.5 -0.5 REFERENCE RANGE 68 - 113 -1.0 - +1.0 3 0 ===o:==ce==e~aao==Boa===escaa=c=====--==c====~~c===---_______=___ UNITARY GRAPHIC REPORT
ABN LO HI ABN
LO ( NORMAL / NORMAL) HI
35 TEST RESULT -1 .0 0.0 +1 .0 AVG
Glucose HI +7.8 ... (........./.........)...X ___ +6.3 ... (........./.........)...X +7.0 +3.9 ... (........./.........)...X +5.1 +2.0 ... (........./.........)...X +2.9 4 0 +0.5 ... (........./....X....)... +1.2 +0.1 ... (........./X........)... +0.3 +0.0 ... (.........X.........)... 0.0 -0.3 ... (......X../.........)... -0.2 -0.5 ... (....X..../.........)... -0.4 4 5 -0.5 ... (...'.X..../.........)... -0.5 REPEAT ANALYSES OF THE SAME TEST
A vertical graphic presentation is illustrated in this example. As was mentioned in earlier examples, the background could be color enhanced. This type of presentation may be preferred in some settings.
X X X
0____________________________________ +2.
5______________-_____________________ +l.
_ _ _ _ _ _ _ _ _ _ _ _ 0 ______________________________r__ _h +1. _-_____ _ _ _ _ _ _ _ _ _ _ _ _ a i _ _ _ _ _ _ _ _ _ _ _ _ f _ _ _ _ _ _ _ _ _ _ _ _ a _ _ _ _ _ _ _ _ _ _ _ r n V
+0.5--_______________________X__________a o E
_ _ _ _ _ - - - - - _ - n r E R
_ _ _ _ _ _ _ _ _ _ _ _ C m X T
_ _ - - - - - X - - - - a a A I
_ _ _ _ _ _ _ _ _ _ _ _ . 1 M C
0.0--__________________________________, . P A
_ _ _ _ _ _ X _ _ _ _ _ , n L L
- _ _ _ _ _ _ _ _ _ _ _ , o E
_ _ _ _ _ X _ _ _ _ _ _ , r G
_ _ _ _ _ _ _ _ _ _ _ _ , m 9 R
-0.5--___________X______________________, a A
_ _ _ _ _ _ _ _ _ _ _ _ r 1 P
_ _ _ X _ _ _ _ _ _ _ _ a H
_ _ _ _ _ _ _ _ _ _ _ _ g 1 -1.0--______-_____________________________e___o _ _ X _ _ _ _ _ _ _ _ _ 3 _ _ _ _ _ _ _ _ _ _ _ _ -1.5---_X_______________________________ -2.0---__________________--_____________ s c a c c a p a t t g t 4 o h 1 r a 1 o r r 1 d 1 b a 1 k t a p a a b i o a a c a a r n c i a r m t i p s o s o 1 m i i a h s n t f s i 5 d n m o i i a a a a s a t I r m r n The foregoing is illustrative of the present invention and is not to be construed as limiting thereof. Although a few exemplary embodiments of this invention have been described, those skilled in the art will readily appreciate that many modifications are possible in the exemplary embodiments without materially departing from the novel teachings and advantages of this invention. Accordingly, all such modifications are intended to be included within the scope of this invention as defined in the claims. In the claims, means-plus-function clause are intended to cover the structures described herein as performing the recited function and not only structural equivalents but also equivalent structures. Therefore, it is to be understood that the foregoing is illustrative of the present invention and is not to be construed as limited to the specific embodiments disclosed, and that modifications to the disclosed embodiments, as well as other embodiments, are intended to be included within the scope of the appended claims. The invention is defined by the following claims, with equivalents of the claims to be included therein.
Claims (18)
1. A method of determining relative normalcy and abnormalcy of a plurality of test results, wherein the test includes a reference range of normal test results associated therewith, the method comprising the following steps that are performed in a data processing system:
unitizing all singularly possible normal test results in the normal reference range to a single number, wherein the normal reference range is bounded by upper and lower values of normalcy, wherein a single fractional value of each normal value in the normal reference range is equal to a single fractional value of every other normal value in the normal reference range, and wherein a sum of all fractional values equals the single number;
determining a total number of singularly possible normal test results within respective halves of the normal reference range, comprising:
converting each singularly possible normal test result in the normal reference range having a decimal value to a whole number;
determining a total number of singularly possible test results within the normal reference range to produce a normal reference range spread, comprising:
subtracting the lower value of normalcy from the upper value of normalcy; and adding an integer to the value obtained by subtracting the lower value of normalcy from the upper value of normalcy; and dividing the normal reference range spread in half;
transforming each of the plurality of test results into respective equilibrated values, wherein each equilibrated value represents relative position of a respective test result with respect to a mean of the normal reference range so as to yield numerically like data values when the data values are equally less than or greater than the respective lower and upper values of normalcy;
transforming each of the equilibrated values into respective unitized values, wherein each unitized value represents relative normalcy or abnormalcy of a respective test result with respect to the upper and lower values of normalcy of the normal reference range;
and graphically displaying and sorting each of the unitized values with the unitized reference range and a unitized analytical variation, wherein each test is displayed on a single line with each test referenced to a single uniform reference range for all of the tests, wherein the single uniform reference range comprises the single number, so as to enhance perceptions of relative normalcy and abnormalcy.
unitizing all singularly possible normal test results in the normal reference range to a single number, wherein the normal reference range is bounded by upper and lower values of normalcy, wherein a single fractional value of each normal value in the normal reference range is equal to a single fractional value of every other normal value in the normal reference range, and wherein a sum of all fractional values equals the single number;
determining a total number of singularly possible normal test results within respective halves of the normal reference range, comprising:
converting each singularly possible normal test result in the normal reference range having a decimal value to a whole number;
determining a total number of singularly possible test results within the normal reference range to produce a normal reference range spread, comprising:
subtracting the lower value of normalcy from the upper value of normalcy; and adding an integer to the value obtained by subtracting the lower value of normalcy from the upper value of normalcy; and dividing the normal reference range spread in half;
transforming each of the plurality of test results into respective equilibrated values, wherein each equilibrated value represents relative position of a respective test result with respect to a mean of the normal reference range so as to yield numerically like data values when the data values are equally less than or greater than the respective lower and upper values of normalcy;
transforming each of the equilibrated values into respective unitized values, wherein each unitized value represents relative normalcy or abnormalcy of a respective test result with respect to the upper and lower values of normalcy of the normal reference range;
and graphically displaying and sorting each of the unitized values with the unitized reference range and a unitized analytical variation, wherein each test is displayed on a single line with each test referenced to a single uniform reference range for all of the tests, wherein the single uniform reference range comprises the single number, so as to enhance perceptions of relative normalcy and abnormalcy.
2. A method according to Claim 1 wherein the step of transforming each of the plurality of test results into respective equilibrated values comprises the stage of:
converting each test result haing a decimal value to a whole number value;
determining a mean of the normal reference range for each of a plurality of tests; and determining a difference between the respective mean and each of the plurality of test results.
converting each test result haing a decimal value to a whole number value;
determining a mean of the normal reference range for each of a plurality of tests; and determining a difference between the respective mean and each of the plurality of test results.
3. A method according to Claim 1 wherein the step of transforming each of the equilibrated values into respective unitized values comprises multiplying each respective equilibrated value with a fractional value of the plurality of normal test results in one-half of the normal reference range for each of a plurality of tests.
4. ~A method according to Claim 3 Wherein the fractional value of the plurality of test results for each of a plurality of tests comprises a reciprocal of one-half of the total number of singularly possible test results in the normal reference range.
5. A method according to Claim 1 further comprising the step of determining a unitized analytical variation of each of the respective unitized values, wherein a traditionally determined analytical variation of the test is multiplied by a fractional value of the respective test of a plurality of tests.
6. A method according to Claim 1 wherein the unitizing step is preceded by the step of storing a single unitizing normal reference range number; a plurality of test identifications and associated test results; and reference range spreads, halves of reference range spreads, fractional values, equivalent values, and normal reference ranges in the data processing system.
7. A data processing system for determining relative normalcy and abnormalcy of a plurality of test results, wherein the test includes a normal reference range of test results associated therewith, comprising:
means for unitizing all singularly possible normal test results in the normal reference range to a single number, wherein the normal reference range is bounded by upper and lower values of normalcy, wherein a single fractional value of each normal value in the normal reference range is equal to a single fractional value of every other normal value in the normal reference range, and wherein a sum of all fractional values equals the single number;
means for determining a total number of singularly possible normal test results within respective halves of the normal reference range, comprising:
converting each singularly possible normal test result in the normal reference range having a decimal value to a whole number;
determining a total number of singularly possible test results within the normal reference range to produce a normal reference range spread, comprising:
subtracting the lower value of normalcy from the upper value of normalcy; and adding an integer to the value obtained by subtracting the lower value of normalcy from the upper value of normalcy. and dividing the normal reference range spread in half;
means for transforming each of the plurality of test results into respective equilibrated values, wherein each equilibrated value represents relative position of a respective test result with respect to a mean of the normal reference range so as to yield numerically like data values when the data values are equally less than or greater than the respective lower and upper values of normalcy;
means for transforming each of the equilibrated values into respective unitized values, wherein each unitized value represents relative normalcy or abnormalcy of a respective test result with respect to the upper and lower values of normalcy of the normal reference range; and graphically displaying and sorting each of the unitized values with the unitized reference range and a unitized analytical variation, wherein each test is displayed on a single line with each test referenced to a single uniform reference range for all of the taste, wherein the single uniform reference range comprises the single number, so as to enhance perceptions of relative normalcy and abnormalcy,
means for unitizing all singularly possible normal test results in the normal reference range to a single number, wherein the normal reference range is bounded by upper and lower values of normalcy, wherein a single fractional value of each normal value in the normal reference range is equal to a single fractional value of every other normal value in the normal reference range, and wherein a sum of all fractional values equals the single number;
means for determining a total number of singularly possible normal test results within respective halves of the normal reference range, comprising:
converting each singularly possible normal test result in the normal reference range having a decimal value to a whole number;
determining a total number of singularly possible test results within the normal reference range to produce a normal reference range spread, comprising:
subtracting the lower value of normalcy from the upper value of normalcy; and adding an integer to the value obtained by subtracting the lower value of normalcy from the upper value of normalcy. and dividing the normal reference range spread in half;
means for transforming each of the plurality of test results into respective equilibrated values, wherein each equilibrated value represents relative position of a respective test result with respect to a mean of the normal reference range so as to yield numerically like data values when the data values are equally less than or greater than the respective lower and upper values of normalcy;
means for transforming each of the equilibrated values into respective unitized values, wherein each unitized value represents relative normalcy or abnormalcy of a respective test result with respect to the upper and lower values of normalcy of the normal reference range; and graphically displaying and sorting each of the unitized values with the unitized reference range and a unitized analytical variation, wherein each test is displayed on a single line with each test referenced to a single uniform reference range for all of the taste, wherein the single uniform reference range comprises the single number, so as to enhance perceptions of relative normalcy and abnormalcy,
8.~A data processing system according to Claim 7 wherein the means for transforming each of the plurality of test results into respective equilibrated values comprises:
means for converting each test result having a decimal value to a whole number value;
means for determining a mean of the normal reference range for each of a plurality of tests; and means for determining a difference between the respective mean and each of the plurality of test results,
means for converting each test result having a decimal value to a whole number value;
means for determining a mean of the normal reference range for each of a plurality of tests; and means for determining a difference between the respective mean and each of the plurality of test results,
9.~A data processing system according to Claim 7 wherein the means for transforming each of the equilibrated values into respective unitized values comprises means for multiplying each respective equilibrated value with a fractional value of the plurality of normal test results in one-half of the normal reference range for each of a plurality of tests.
10. A data processing system according to Claim 9 wherein the fractional value of the plurality of test results for each of a plurality of tests comprises a reciprocal of one-half of the total number of singularly possible test results in the normal reference range.
11. A data processing system according to Claim 7 further comprising means for determining a unitized analytical variation of each of the respective unitized values, wherein a traditionally determined analytical variation of the test is multiplied by a fractional value of the respective test of a plurality of tests.
12. A data processing system according to Claim 7 further comprising means for storing a single unitizing normal reference range number; a plurality of test identifications and associated test results; and reference range spreads, halves of reference range spreads, fractional values, equivalent values, and normal reference ranges in the data processing system.
13. A computer program product for determining relative normalcy and abnormalcy of a plurality of test results, Wherein the test includes a normal reference range of test results associated therewith, the computer program product comprising a computer usable storage medium having computer readable program code means embodied in the medium, the computer readable program code means comprising:
computer readable program code means for unitizing all singularly possible normal test results in the normal reference range to a single number, wherein the normal reference range is bounded by upper and lower values of normalcy, wherein a single fractional value of each normal value in the normal reference range is equal to a single fractional value of every other normal value in the normal reference range, and wherein a sum of all fractional values equals the single number;
computer readable program code means for determining a total number of singularly possible normal test results within respective halves of the normal reference range, comprising;
converting each singularly possible normal test result in the normal reference range having a decimal value to a whole number;
determining a total number of singularly possible test results within the normal reference range to produce a normal reference range spread, comprising:
subtracting the lower value of normalcy from the upper value of normalcy: and adding an integer to the value obtained by subtracting the lower value of normalcy from the upper value of normalcy; and dividing the normal reference range spread in half;
computer readable program code means for transforming each of the plurality of test results into respective equilibrated values, wherein each equilibrated value represents relative position of a respective test result with respect to a mean of the normal reference range so as to yield numerically like data values when the data values are equally less than or greater than the respective lower and upper values of normalcy;
computer readable program code means for transforming each of the equilibrated values into respective unitized values, wherein each unitized value represents relative normalcy or abnormalcy of a respective test result with respect to the upper and lower values of normalcy of the normal reference range;
and graphically displaying and sorting each of the unitized values with the unitized reference range and a unitized analytical variation, wherein each test is displayed on a single line with each test referenced to a single uniform reference range for all of the tests, wherein the single uniform reference range comprises the single number, so as to enhance perceptions of relative normalcy and abnormalcy.
computer readable program code means for unitizing all singularly possible normal test results in the normal reference range to a single number, wherein the normal reference range is bounded by upper and lower values of normalcy, wherein a single fractional value of each normal value in the normal reference range is equal to a single fractional value of every other normal value in the normal reference range, and wherein a sum of all fractional values equals the single number;
computer readable program code means for determining a total number of singularly possible normal test results within respective halves of the normal reference range, comprising;
converting each singularly possible normal test result in the normal reference range having a decimal value to a whole number;
determining a total number of singularly possible test results within the normal reference range to produce a normal reference range spread, comprising:
subtracting the lower value of normalcy from the upper value of normalcy: and adding an integer to the value obtained by subtracting the lower value of normalcy from the upper value of normalcy; and dividing the normal reference range spread in half;
computer readable program code means for transforming each of the plurality of test results into respective equilibrated values, wherein each equilibrated value represents relative position of a respective test result with respect to a mean of the normal reference range so as to yield numerically like data values when the data values are equally less than or greater than the respective lower and upper values of normalcy;
computer readable program code means for transforming each of the equilibrated values into respective unitized values, wherein each unitized value represents relative normalcy or abnormalcy of a respective test result with respect to the upper and lower values of normalcy of the normal reference range;
and graphically displaying and sorting each of the unitized values with the unitized reference range and a unitized analytical variation, wherein each test is displayed on a single line with each test referenced to a single uniform reference range for all of the tests, wherein the single uniform reference range comprises the single number, so as to enhance perceptions of relative normalcy and abnormalcy.
14. A computer program product according to Claim 13 wherein the computer readable program code means for transforming each of the plurality of test results into respective equilibrated values comprises;
computer readable program code means for converting each test result having a decimal value to a whole number value;
computer readable program code means for determining a mean of the normal reference range for each of a plurality of tests; and computer readable program code means for determining a difference between the respective mean and each of the plurality of test results.
computer readable program code means for converting each test result having a decimal value to a whole number value;
computer readable program code means for determining a mean of the normal reference range for each of a plurality of tests; and computer readable program code means for determining a difference between the respective mean and each of the plurality of test results.
15. A computer program product according to Claim 13 wherein the computer readable program code means for transforming each of the equilibrated values into respective unitized values comprises computer readable program code means for multiplying each respective equilibrated value with a fractional value of the plurality of normal test results in one-half of the normal reference range for each of a plurality of tests.
16. A computer program product according to Claim 15 wherein the fractional value of the plurality of test results for each of a plurality of tests comprises a reciprocal of one-half of the total number of singularly possible test results in the normal reference range,
17.~A computer program product according to Claim 13 further comprising computer readable program code means for determining a unitized analytical variation of each of the respective unitized values, wherein a traditionally determined analytical variation of the test is multiplied by a fractional value of the respective test of a plurality of tests.
18. A computer program product according to Claim 13 further comprising computer readable program code means for storing a single unitizing normal reference range number; a plurality of test identifications and associated test results; and reference range spreads, halves of reference range spreads, fractional values, equivalent values, and normal reference ranges in the data processing system.
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| PCT/US1999/020125 WO2000012968A1 (en) | 1998-09-02 | 1999-09-01 | Methods and apparatus for interpreting measured laboratory data |
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| US6292761B1 (en) * | 1998-09-02 | 2001-09-18 | William Franklin Hancock, Jr. | Methods and apparatus for interpreting measured laboratory data |
| KR100391199B1 (en) * | 2000-06-01 | 2003-07-12 | 기아자동차주식회사 | Method for processing tracking-data and the program for the method |
| US7302292B2 (en) | 2002-04-04 | 2007-11-27 | Mirabel Medical Ltd. | Breast cancer screening |
| US7409243B2 (en) * | 2001-04-04 | 2008-08-05 | Mirabel Medical Ltd. | Breast cancer detection |
| US8099257B2 (en) | 2001-08-24 | 2012-01-17 | Bio-Rad Laboratories, Inc. | Biometric quality control process |
| EP1933247B1 (en) * | 2001-08-24 | 2016-10-05 | Bio-Rad Laboratories, Inc. | Biometric quality control process |
| US7050933B2 (en) * | 2001-08-24 | 2006-05-23 | Bio-Rad Laboratories, Inc. | Biometric quality control process |
| US20040030676A1 (en) * | 2002-08-07 | 2004-02-12 | International Business Machines Corporation | System and method for representation independent comparison of numerical data according to user-specified criteria |
| US6768948B2 (en) * | 2002-10-29 | 2004-07-27 | Vadim Kvitash | Balascopy system and method with improved sensitivity |
| US7158890B2 (en) * | 2003-03-19 | 2007-01-02 | Siemens Medical Solutions Health Services Corporation | System and method for processing information related to laboratory tests and results |
| US7273453B2 (en) * | 2004-04-12 | 2007-09-25 | Frank Shallenberger | Method for analyzing the biological age of a subject |
| WO2007065283A1 (en) | 2005-12-09 | 2007-06-14 | Swissrtec Gmbh | Stator for an impact crusher |
| US9639667B2 (en) * | 2007-05-21 | 2017-05-02 | Albany Medical College | Performing data analysis on clinical data |
| US7666137B2 (en) * | 2008-04-10 | 2010-02-23 | Frank Shallenberger | Method for analyzing mitochondrial function |
| US8200466B2 (en) | 2008-07-21 | 2012-06-12 | The Board Of Trustees Of The Leland Stanford Junior University | Method for tuning patient-specific cardiovascular simulations |
| US9405886B2 (en) | 2009-03-17 | 2016-08-02 | The Board Of Trustees Of The Leland Stanford Junior University | Method for determining cardiovascular information |
| US8589081B2 (en) * | 2009-07-24 | 2013-11-19 | Bio-Rad Laboratories, Inc. | System and method to determine sigma of a clinical diagnostic process |
| US8315812B2 (en) | 2010-08-12 | 2012-11-20 | Heartflow, Inc. | Method and system for patient-specific modeling of blood flow |
| US20130321446A1 (en) * | 2012-06-01 | 2013-12-05 | The Board Of Trustees Of The University Of Illinois | Methods And Systems For Visualizing Data |
| WO2023014313A1 (en) * | 2021-08-02 | 2023-02-09 | Acibadem Mehmet Ali Aydinlar Universitesi | A method used for determining personal reference range of medical laboratory tests |
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| JPS53667B2 (en) | 1971-10-23 | 1978-01-11 | ||
| US4527240A (en) | 1982-12-29 | 1985-07-02 | Kvitash Vadim I | Balascopy method for detecting and rapidly evaluating multiple imbalances within multi-parametric systems |
| DE3819101A1 (en) | 1988-06-04 | 1989-12-07 | Conducta Mess & Regeltech | METHOD AND DEVICE FOR PROCESSING MEASURED VALUES |
| JPH05307524A (en) | 1992-05-01 | 1993-11-19 | Sharp Corp | Function electronic desk calculator |
| JPH09500199A (en) | 1993-02-23 | 1997-01-07 | ザ・ゼネラル・ホスピタル・コーポレーション | Computer system and method for measuring analyte concentration by affinity assay |
| US5734591A (en) | 1993-05-26 | 1998-03-31 | Xyletech Systems, Inc. | Method of analyzing multiple range test data |
| US5541854A (en) | 1993-05-26 | 1996-07-30 | Xyletech Systems, Inc. | Method of analyzing multiple range test data |
| US5545895A (en) | 1995-03-20 | 1996-08-13 | The Dow Chemical Company | Method of standardizing data obtained through mass spectrometry |
| US5619428A (en) | 1995-05-31 | 1997-04-08 | Neopath, Inc. | Method and apparatus for integrating an automated system to a laboratory |
| EP0753283A1 (en) * | 1995-07-14 | 1997-01-15 | Hewlett-Packard Company | Method and apparatus for comparing a sample with a reference using a spider diagram |
| US5993388A (en) * | 1997-07-01 | 1999-11-30 | Kattan; Michael W. | Nomograms to aid in the treatment of prostatic cancer |
| US6292761B1 (en) * | 1998-09-02 | 2001-09-18 | William Franklin Hancock, Jr. | Methods and apparatus for interpreting measured laboratory data |
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