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Indirect methods for the indirect estimation of reference intervals are increasingly being used, especially for validation of reference intervals, as they can be applied to routine patient data. In this study, we compare three statistically different indirect methods for the verification and validation of reference intervals in eight laboratories distributed throughout Europe. The RefLim method is a fast and simple approach which calculates the reference intervals by extrapolating the theoretical 95 % of non-pathological values from the central linear part of a quantile-quantile plot. The Truncated Maximum Likelihood (TML) method estimates a smoothed kernel density function for the distribution of the mixed data, for which it is assumed that the "central" part of the distribution represents the healthy population. The refineR utilizes an inverse modelling approach. This algorithm identifies a model that best explains the observed data before transforming the data with the Box-Cox transformation. We show that the different indirect methods each have their advantages but can also lead to inaccurate or ambiguous results depending on the approximation of the mathematical model to real-world data. A combination of different methodologies can improve the informative value and thus the reliability of results. Based on routine measurements of four enzymes alkaline phosphatase (ALP), total amylase (AMY), cholinesterase (CHE) and gamma-glutamyl transferase (GGT) in adult women and men, we demonstrate that some reference limits taken from the literature need to be adapted to the laboratory's particular local and population characteristics. [ABSTRACT FROM AUTHOR]

This study was conducted to compare attitudes of psychiatrists, other professionals, and laypeople towards compulsory admission and treatment of patients with schizophrenia in different European countries. Three case reports of patients with schizophrenia were presented to N=1,737 persons: 235 in England, 622 in Germany, 319 in Hungary, and 561 in Switzerland; 298 were psychiatrists, 687 other psychiatric or medical professionals, and 752 laypeople. The case reports presented typical clinical situations with refusal of consent to treatment (first episode and social withdrawal, recurrent episode and moderate danger to others and patient with multiple episodes and severe self-neglect). The participants were asked whether they would agree with compulsory admission and compulsory neuroleptic treatment. The rates of agreement varied between 50.8 and 92.1% across countries and between 41.1 and 93.6% across the different professional groups. In all countries, psychologists and social workers supported compulsory procedures significantly less than the psychiatrists who were in tune with laypeople and nurses. Country differences were highly significant showing more agreement with compulsion in Hungary and England and less in Germany and Switzerland (odds ratios up to 4.33). Own history of mental illness and having mentally ill relatives had no major impact on the decisions. Evidence suggests that compulsory procedures are based on traditions and personal attitudes to a considerable degree. Further research should provide empirical data and more definite criteria for indications of compulsive measures to achieve a common ethical framework for those critical decisions across Europe. [ABSTRACT FROM AUTHOR]