Determination of a reference interval in a population

The reference interval is the most widely used medical decision-making tool that separates healthy from diseased individuals. We briefly discuss the methods used to determine reference interval and its limitations.

It takes a community to resurrect a CLS program

Florida Gulf Coast University (FGCU) revised and reactivated its former 2+2 NAACLS accredited program in 2006, by instituting an innovative 3+1 approach. With the efforts of the community laboratories, FGCU instituted an innovative structure which made its CLS program more viable by greatly reducing expenses of operation without sacrificing the quality of education.

Research in the Medical Laboratory Science curriculum

Medical Laboratory Science (MLS) is increasing its numbers of advanced degree offerings and is accelerating involvement in evidence-based practice. Expectations of MLS faculty have increased to include research and scholarship. Many MLS programs have undergraduate requirements for research. To assist MLS faculty as they increase research productivity, information is provided to guide professionals and students striving to expand their research achievements.

The utility of essential functions in clinical laboratory science programs

OBJECTIVE

Essential functions (EF) define the nonacademic criteria used to determine an individual's qualifications for admission and capabilities of performing in the classroom and laboratory with or without reasonable accommodations. Directors of NAACLS approved and accredited programs were surveyed to investigate their knowledge and perceptions of EF and associations with disabilities and student behaviors.

DESIGN

This was a non-experimental survey consisting of questions related to the use of essential functions (EF) and student behaviors in NAACLS laboratory programs. SurveyMonkey was used to electronically provide the survey of 33 questions to 564 NAACLS programs.

RESULTS

Descriptive statistics were reported as aggregate data with a response rate of 267 (47.3%). EF are utilized in 95.5% of the programs; however, only 38.6% of the participants responded that EF are required by both the ADA and NAACLS. A student had never been dismissed based on EF in 80.0% of the programs. Many programs have been successful in mentoring students with disabilities to successful completion. Hearing impairment was the most reported disability (30.0%). Participants felt most comfortable referring students for academic coaching (96.2%) when compared to medical concerns (86.5%), and psychological concerns (82.7%).

CONCLUSIONS

While most programs utilized EF, many program directors were not aware that EF are required by both NAACLS and the ADA. Programs have successfully instructed and graduated students with a variety of disabilities and generally feel comfortable in referring students for assistance. Concerns with inappropriate behaviors present unique, generational challenges to faculty.

CLS entry level competencies in flow cytometry

OBJECTIVE

To define entry level competencies in flow cytometry for CLS generalists.

DESIGN

Flow cytometry practitioners completed an electronic survey. Of 134 respondents, 131 met the desired demographics and were analyzed.

SETTING

Links to the survey were mailed to 3 listservs (Medlab-L, CLSEduc, Purdue Cytometry) and 2 email groups (ASCLS and AMLI). Participants completed the survey on-line.

PARTICIPANTS

The target population was flow cytometry practitioners who had experienced CLS education, earned certification and practiced at least one year in flow. Survey instructions asked participants not to complete the survey if they did not meet the demographic criteria.

MAIN OUTCOME MEASURES

A competency was deemed important at entry level if > or = 50% of respondents agreed.

RESULTS

There was strong consensus (62-87%) that entry level CLS generalists should be able to 1) perform HIV CD4/CD8 monitoring, 2) gate cell populations using forward/side scatter and CD45/bright/dim markers and 3) evaluate specimen acceptability. Concepts to understand included leukemia immunophenotyping, quality control and instrument principles (61-83%). Most respondents (74%) felt that memorization of the leukemic CD panels was unnecessary. However, survey results indicated that the markers and cell type associations to memorize are CD3, CD4, CD8, CD19/20, CD34, CD45 and light chains. Hands-on experience with instruments was not identified as critical.

CONCLUSION

CLS educational programs can deliver almost all flow cytometry content in the didactic portion of the curriculum and can restrict CD marker memorization to a limited list. At minimum, HIV monitoring via CD4/CD8 counts and concepts of leukemia immunophenotyping should be included.

Technology as a force for improved diagnosis and treatment of breast disease

Increasing numbers of women are seeking evaluation of screen-detected breast abnormalities, and more women with breast cancer are living with the consequences of treatment. Improved technologies have helped to individualize diagnostic evaluation and treatment, improve efficacy and minimize morbidity. This article highlights some of these technologies. Superior imaging techniques have improved breast cancer screening and show promise for intraoperative surgical guidance and postoperative specimen evaluation. Digital mammography improves the sensitivity of mammography for women younger than 50 years with dense breasts, and tomosynthesis may improve specificity. Magnetic resonance imaging provides sensitive delineation of the extent of the disease and superior screening for women with a greater than 25% lifetime risk of breast cancer Minimally invasive techniques have been developed for the assessment of intraductal lesions, biopsy of imaging abnormalities, staging of the axilla and breast radiotherapy. Ductoscopy facilitates intraductal biopsy and localization of lesions for excision, sentinel lymph node biopsy is becoming standard for axillary staging, and intraoperative radiotherapy has the potential to reduce treatment time and morbidity. Three-dimensional imaging allows correlation of final histology with preoperative imaging for superior margin assessment. Related techniques show promise for translation to the intraoperative setting for surgical guidance. New classifications of breast cancers based on gene expression, rather than morphology, describe subtypes with different prognoses and treatment implications, and new targeted therapies are emerging. Genetic fingerprints that predict treatment response and outcomes are being developed to assign targeted treatments to individual patients likely to benefit. Surgeons play a vital role in the successful integration of new technologies into practice.

[Approach for prevention of medical test malpractice using ISO 15189]

With the increasing need for medical laboratory data, the importance of the medical laboratory in medical care has grown exponentially. Therefore, it is necessary that the medical laboratory provide the doctor and the patient receiving medical care with accurate, precise, and reliable medical laboratory data. Quality assurance and safety management in the medical laboratory are necessary to prevent medical test malpractice, which would lead to a medical accident, and to manage the overall processes required to provide high quality medical laboratory data. ISO 15189 is an international standard known as an organizational management tool for medical laboratories. Our medical laboratory acquired this ISO in March 2005 and we utilized PDCA cycle as required by the international standard in order to establish appropriate safety management and crisis control. We introduced practices for quality improvement and prevention of medical test malpractice proposed by the ISO committee of our medical laboratory and describe these practices in this report.

[Comprehensive management of clinical laboratory for appropriate antimicrobial use]

Accurate diagnosis of infectious diseases is essential for appropriate antimicrobial use. The following five factors should be promoted to accurately diagnose infectious diseases; everyday availability of microbiology laboratory, submitting only appropriate specimens for laboratory examination, providing accurate results to physicians with a rapid turnaround time, and reporting useful information to assist in treatment and delivering educational lectures on clinical microbiology to hospital staff. As a director of a clinical laboratory in a university hospital, I have tackled these issues. Not only laboratory performance and activity, but the information system for healthcare workers were significantly improved. As a result, appropriate antimicrobial use has been achieved in part.

The technology acceptance model: its past and its future in health care

Increasing interest in end users' reactions to health information technology (IT) has elevated the importance of theories that predict and explain health IT acceptance and use. This paper reviews the application of one such theory, the Technology Acceptance Model (TAM), to health care. We reviewed 16 data sets analyzed in over 20 studies of clinicians using health IT for patient care. Studies differed greatly in samples and settings, health ITs studied, research models, relationships tested, and construct operationalization. Certain TAM relationships were consistently found to be significant, whereas others were inconsistent. Several key relationships were infrequently assessed. Findings show that TAM predicts a substantial portion of the use or acceptance of health IT, but that the theory may benefit from several additions and modifications. Aside from improved study quality, standardization, and theoretically motivated additions to the model, an important future direction for TAM is to adapt the model specifically to the health care context, using beliefs elicitation methods.

Management of a point-of-care testing program

The approach to managing a point-of-care testing (POCT) program has evolved over recent years. Although many of the essential features of early POCT management programs remain intact, contemporary challenges including expansion of the test menu, changing regulatory requirements, and the development of more sophisticated data management connectivity require ongoing adaptation of POCT management programs. Despite improvements in test quality and regulatory compliance, significant challenges for the management of POCT will continue for the foreseeable future.

Preparing online students for comprehensive examinations

OBJECTIVE

Identify and remedy difficulties in the preparation of online students for certification examination success.

DESIGN

The final examination scores for the CLS Seminar course for the 2008 class of 27 on-campus and 10 online students were compared for statistical differences in seven examination areas. Problem areas were identified and changes in the CLS Seminar course were made in 2009 to improve the scores of the online students. The examination scores for the 2009 class of 33 on-campus and 10 online students were studied to determine improvement. Student's two-tailed t-test was used to determine statistical significance of differences between scores of on-campus and online students.

INTERVENTIONS

Interactive video over the web; used to answer online student questions, review games, more class time, and more recorded review sessions; were added to the Seminar. The study guides provided during preceptorships were tied to the objectives of the seminar course and the questions on examinations. Specific objectives for each question missed on the final examinations were provided to the student.

RESULTS

In 2008, examination scores for online students were lower in two of seven areas by a statistically significant amount than on-campus students. The difference approached significance in a third area. After interventions in 2009, the examinations scores had equalized with the exception of one area, Immunology.

CONCLUSION

Increasing the amount and method of review in areas deemed important to online education was successful in improving examination scores.

[On the issue of supplying the high-technology medical care to the oncological patients residing in the distant territories]

The article deals with the issue of improving the high-technology medical care provision to population with oncological pathology residing the northern territory. The results of sociological survey are presented. The medical personnel made the expertise of the criteria to develop the specification listing of medical services related to the category of high-technology medical care exemplified by the oncological care. This approach can be applied as a foundation for further identification of the population need in high-technology medical care at municipal and regional levels.

['State of the nation's healthcare 2008' annual report: technology is useful, but training comes first]

The Netherlands Health Care Inspectorate's annual report on the state of the nation's healthcare in 2008 is dedicated to the use of medical technology. The subtitle of the report is 'Risks of medical technology underestimated'. Lack of education and training expose patients to an unacceptable risk of injury within both the care and the cure setting. The Inspectorate urgently recommends applying a certification system to physicians to guarantee safe and appropriate use of devices and equipment. The administration of an institution has the primary responsibility for the visible implementation of risk and safety management. Also, the medical professional must become familiar with the principles of engineering and be trained in applying a systematic approach to safety and reliability within medical technology. This annual report provides recommendations on how to incorporate biomedical engineering into medical education.

Performance standards of the nerve conduction study technologist

The primary performance standard of the nerve conduction study technologist is to perform nerve conduction studies (NCS) on patients with trauma or diseases of the peripheral nervous system. However, to be in compliance with various healthcare/medical accreditation agencies, such as Occupational Safety and Health Administration (OSHA), Centers for Disease Control and Prevention (CDC), or The Joint Commission [formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)], there are many other important performance objectives that must be met as well. It is the responsibility of the NCS technologist to meet these standards on a daily basis. Once these standards become an expected responsibility of the NCS technologist's position, the patient undergoing a nerve conduction study should be assured of a high quality test performed in an optimal safety environment.