Human papillomavirus reporting: minimizing patient and laboratory risk

Risk management efforts in the cytology laboratory must address the gap between what can be achieved with medical history's most effective cancer screening test, the Papanicolaou (Pap) test, and even higher entrenched public expectations. Data from the Atypical Squamous Cells of Undetermined Significance (ASCUS)/Low-Grade Squamous Intraepithelial Lesion Triage Study (ALTS) now provide level I clinical evidence from a large, randomized, controlled, multicenter clinical trial that reflex human papillomavirus (HPV) DNA testing of ASCUS cases is generally the preferred method for initial assessment of the most prevalent category of abnormal Pap interpretation. The proposed combination of HPV DNA testing with cytologic Pap testing, the DNA Pap test, further shows the potential to nearly eliminate false-negative screening results, based on sensitivity and negative predictive values reported in available studies. Human papillomavirus DNA testing also appears to represent a significant enhancement for detection of endocervical adenocarcinomas, which are difficult to detect and prevent. Human papillomavirus DNA testing, when used in conjunction with cervical cytology, can significantly reduce risk to both the patient and the laboratory.

[Judicial expertise in blood alcohol determination and toxicological analysis]

Blood alcohol determination or toxicological expert evaluation are a part of the judicial inquiry. They are devoted to authorized professionals registrated by the court of appeal and they are obliged to perform themselves the analysis. They bind the civil and penal liability of the professionals who are designated. After a reapparaisal of the French legislation concerning blood alcohol levels, the authors review the totality of problems resulting from the interpretation of results as well as the relationship to judicial authorities: expert nomination procedure, professional criterions, legal points, daily practice. Among usual questions from magistrates and policemen, the expert has to estimate the quantity of alcohol taken by an individual, evaluate the blood ethanol content of a subject when the blood collection is late, calculate blood ethanol from breath alcohol analysis. For forensic toxicology, professional criterions and legal aspects are also touched on.

The EC4 register of European clinical chemists and EC4 activities

The freedom of movement of people and goods within the European Union (EU) has a large impact for the member states. Particularly within health care it is important to recognize, or if necessary obtain, an adequate level of the quality of profession and practice, so that citizens know that health care is offered in their country at a level comparable to other countries. The importance of recognition also applies to laboratory medicine. European Communities Confederation of Clinical Chemistry (EC4) is the organization of societies for clinical chemistry and laboratory medicine in the EU. In Europe, health care develops in the direction where patients are treated in a health care chain environment. In this chain, patients move quickly from primary health institutes to secondary and tertiary institutes, and vice versa. This situation involves many health care workers including several laboratories. Diagnosis and therapy are now 'core business' of health care. Medical laboratories play an essential role in this. The broad spectrum of medical laboratory investigations make consultancy of medical laboratory specialists ever more important. The quality of both professionals and laboratories, as well as continuity of laboratory data within and between laboratories, are of utmost importance.EC4 is active in giving support to attain such quality. In most countries, this is the case at present. EC4 plays a central role in the Coordination of Automatic Recognition of Equivalence of Standards (CARE), if such a level exists or is achieved. Such CARE is focussed at three levels, the profession, quality of laboratories and calibration of laboratory data. The EC4 Register of European Clinical Chemists is open for colleagues educated in (bio)chemistry, pharmacy, biology as well as medicine, and trained according to the EC4 Syllabus. Equivalence of standards has been granted to national training schemes of 13 European Union countries. Since its opening in 1998, the number of applicants is growing steadily and quickly, reaching 1225 in May 2001.EC4 has published essential criteria for quality systems of medical laboratories, which formed the basis for a ISO draft international standard regarding quality and competence of medical laboratories.EC4 stimulates projects like the Calibration 2000 project in the Netherlands which focus on continuity of laboratory data, within-as well as between-laboratories.

Medical laboratory accreditation: a Hong Kong perspective

This is an account of the accreditation of the Surgical Pathology, Cytopathology, Autopsy Service, Haematology, Blood Bank, Bone Marrow Transplant and Electronmicroscopy Laboratories of the Department of Anatomical and Cellular Pathology, the Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR, China, the first of their category to be accredited in the Special Administrative Region. The Australian-based National Association of Testing Authorities (NATA) used standards formulated by the National Pathology Accreditation Advisory Council (NPAAC) to measure the performance of the laboratory sections and to determine whether the laboratory service was of a sufficient standard to be granted accreditation. Some practices dating back to the colonial period required attention, while eliciting the support of staff at all levels was essential for achieving accreditation. Some cultural factors had to be taken into account when implementing changes. Finally, successful accreditation has provided the impetus for other Hong Kong laboratories to become accredited and this will have a beneficial flow-on effect for the entire region.