101
|
Jovičić S, Siodmiak J, Alcorta MD, Kittel M, Oosterhuis W, Aakre KM, Jørgensen P, Palicka V, Kutt M, Anttonen M, Velizarova MG, Marc J. Quality benchmarking of smartphone laboratory medicine applications: comparison of laboratory medicine specialists' and non-laboratory medicine professionals' evaluation. Clin Chem Lab Med 2021; 59:693-699. [PMID: 33554583 DOI: 10.1515/cclm-2020-0869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/29/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES There are many mobile health applications (apps) now available and some that use in some way laboratory medicine data. Among them, patient-oriented are of the lowest content quality. The aim of this study was to compare the opinions of non-laboratory medicine professionals (NLMP) with those of laboratory medicine specialists (LMS) and define the benchmarks for quality assessment of laboratory medicine apps. METHODS Twenty-five volunteers from six European countries evaluated 16 selected patient-oriented apps. Participants were 20-60 years old, 44% were females, with different educational degrees, and no professional involvement in laboratory medicine. Each participant completed a questionnaire based on the Mobile Application Rating Scale (MARS) and the System Usability Scale, as previously used for rating the app quality by LMS. The responses from the two groups were compared using the Mann-Whitney U test and Spearman correlation. RESULTS The median total score of NLMP app evaluation was 2.73 out of 5 (IQR 0.95) compared to 3.78 (IQR 1.05) by the LMS. All scores were statistically significantly lower in the NLMP group (p<0.05), except for the item Information quality (p=0.1631). The suggested benchmarks for a useful appear: increasing awareness of the importance and delivering an understanding of persons' own laboratory test results; understandable terminology; easy to use; appropriate graphic design, and trustworthy information. CONCLUSIONS NLMP' evaluation confirmed the low utility of currently available laboratory medicine apps. A reliable app should contain trustworthy and understandable information. The appearance of an app should be fit for purpose and easy to use.
Collapse
|
102
|
Mohammed-Ali Z, Bhandarkar S, Tahir S, Handford C, Yip D, Beriault D, Hicks LK. Implementing effective test utilization via team-based evaluation and revision of a family medicine laboratory test requisition. BMJ Open Qual 2021; 10:bmjoq-2020-001219. [PMID: 33731485 PMCID: PMC7978073 DOI: 10.1136/bmjoq-2020-001219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/16/2021] [Accepted: 02/28/2021] [Indexed: 11/21/2022] Open
|
103
|
Beriault DR, Gilmour JA, Hicks LK. Overutilization in laboratory medicine: tackling the problem with quality improvement science. Crit Rev Clin Lab Sci 2021; 58:430-446. [PMID: 33691585 DOI: 10.1080/10408363.2021.1893642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Overutilization of tests and treatments is a widespread problem in contemporary heath care, and laboratory medicine is no exception. It is estimated that 10-70% of laboratory tests may be unnecessary, with estimates in the literature varying depending on the situation and the laboratory test. Inappropriate use of laboratory tests can lead to further unnecessary testing, adverse events, inaccurate diagnoses, and inappropriate treatments. Altogether, this increases the risk of harm to a patient, which can be physical, psychological, or financial in nature. Overutilization in healthcare is driven by complex factors including care delivery models, litigious practice environments, and medical and patient culture. Quality improvement (QI) methods can help to tackle overutilization. In this review, we outline the global healthcare problem of laboratory overutilization, particularly in the developed world, and describe how an understanding of and application of quality improvement principles can help to address this challenge.
Collapse
|
104
|
Delinasios GJ, Fragkou PC, Gkirmpa AM, Tsangaris G, Hoffman RM, Anagnostopoulos AK. The Experience of Greece as a Model to Contain COVID-19 Infection Spread. In Vivo 2021; 35:1285-1294. [PMID: 33622932 DOI: 10.21873/invivo.12380] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 12/23/2022]
Abstract
The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) emerged in late 2019 and has caused a pandemic known as corona virus disease 2019 (COVID-19), responsible for the death of more than 2 million people worldwide. The outbreak of COVID-19 has posed an unprecedented threat on human lives and public safety. The aim of this review is to describe key aspects of the bio-pathology of the novel disease, and discuss aspects of its spread, as well as targeted protective strategies that can help shape the outcome of the present and future health crises. Greece is used as a model to inhibit SARS-COV-2 spread, since it is one of the countries with the lowest fatality rates among nations of the European Union (E.U.), following two consecutive waves of COVID-19 pandemic. Furthermore, niche research technological approaches and scientific recommendations that emerged during the COVID-19 era are discussed.
Collapse
|
105
|
Ronzio L, Cabitza F, Barbaro A, Banfi G. Has the Flood Entered the Basement? A Systematic Literature Review about Machine Learning in Laboratory Medicine. Diagnostics (Basel) 2021; 11:372. [PMID: 33671623 PMCID: PMC7926482 DOI: 10.3390/diagnostics11020372] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 02/08/2023] Open
Abstract
This article presents a systematic literature review that expands and updates a previous review on the application of machine learning to laboratory medicine. We used Scopus and PubMed to collect, select and analyse the papers published from 2017 to the present in order to highlight the main studies that have applied machine learning techniques to haematochemical parameters and to review their diagnostic and prognostic performance. In doing so, we aim to address the question we asked three years ago about the potential of these techniques in laboratory medicine and the need to leverage a tool that was still under-utilised at that time.
Collapse
|
106
|
Zohoun A, Agbodandé TB, Kpadé A, Goga RO, Gainsi R, Balè P, Sambo BM, Charlebois R, Crane R, Merkel M, Anani L, Milgotina E. From benchmarking to best practices: Lessons from the laboratory quality improvement programme at the military teaching hospital in Cotonou, Benin. Afr J Lab Med 2021; 10:1057. [PMID: 33824854 PMCID: PMC8008048 DOI: 10.4102/ajlm.v10i1.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2015, the Army Teaching Hospital-University Teaching Hospital (HIA-CHU [Hôpital D'instruction des Armées de Cotonou Centre Hospitalier et Universitaire]) laboratory in Benin launched a quality improvement programme in alignment with the World Health Organization Regional Office for Africa's Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA). Among the sub-Saharan African laboratories that have used SLIPTA, few have been francophone countries, and fewer have belonged to a military health system. The purpose of this article was to outline the strategy, implementation, outcomes and military-specific challenges of the HIA-CHU laboratory quality improvement programme from 2015 to 2018. INTERVENTION The strategy for the quality improvement programme included: external baseline SLIPTA evaluation, creation of work plan based on SLIPTA results, execution of improvement projects guided by work plan, assurance of accountability via regular meetings, training of personnel to improve personnel competencies, development of external stakeholder relationships for sustainability and external follow-up post-SLIPTA evaluation. LESSONS LEARNT Over a period of 3 years, the HIA-CHU laboratory improved its SLIPTA score by 29% through a quality improvement process guided by work plan implementation, quality management system documentation, introduction of new proficiency testing and internal quality control programmes, and enhancement of personnel competencies in technical and quality management through training. RECOMMENDATIONS The programme has yielded achievements, but consistent improvement efforts are necessary to address programme challenges and ensure continual increases in SLIPTA scores. Despite successes, military-specific challenges such as the high mobility of personnel have hindered programme progress. The authors recommend that further implementation research data be shared from programmes using SLIPTA in under-represented settings such as military health systems.
Collapse
|
107
|
Mrazek C, Lippi G, Keppel MH, Felder TK, Oberkofler H, Haschke-Becher E, Cadamuro J. Errors within the total laboratory testing process, from test selection to medical decision-making - A review of causes, consequences, surveillance and solutions. Biochem Med (Zagreb) 2021; 30:020502. [PMID: 32550813 PMCID: PMC7271754 DOI: 10.11613/bm.2020.020502] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022] Open
Abstract
Laboratory analyses are crucial for diagnosis, follow-up and treatment decisions. Since mistakes in every step of the total testing process may potentially affect patient safety, a broad knowledge and systematic assessment of laboratory errors is essential for future improvement. In this review, we aim to discuss the types and frequencies of potential errors in the total testing process, quality management options, as well as tentative solutions for improvement. Unlike most currently available reviews on this topic, we also include errors in test-selection, reporting and interpretation/action of test results. We believe that laboratory specialists will need to refocus on many process steps belonging to the extra-analytical phases, intensifying collaborations with clinicians and supporting test selection and interpretation. This would hopefully lead to substantial improvements in these activities, but may also bring more value to the role of laboratory specialists within the health care setting.
Collapse
|
108
|
Aktas M, Demirci H. Sleep quality and obstructive sleep apnoea and triple screen test results in pregnancy. J OBSTET GYNAECOL 2021; 41:1067-1070. [PMID: 33455535 DOI: 10.1080/01443615.2020.1845629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this study, we aimed to examine the relationship between sleep quality, sleep apnoea and triple screen test results. This was an observational descriptive research study. The STOP questionnaire and the STOP-BANG questionnaire were performed to assess obstructive sleep apnoea risk and Pittsburgh Sleep Quality Index was used to evaluate sleep quality. The average Pittsburgh Sleep Quality Index score of the participants was 5.92 ± 3.26. According to the STOP test, 11.40% (87) of the pregnant women had a high risk of OSAS, and, according to the STOP-BANG test, 32 participants were under high risk of OSAS. An increased risk was detected in 1.30% of the participants in terms of Trisomy18 and in 1.60% in terms of neural tube defects. A direct and significant relationship was detected between Trisomy 21 risk and STOP-BANG score. This is the first study to show this relationship. Sufficient evidence needs to be collected on this issue. Testing in earlier weeks of pregnancy and in the conception period may allow more meaningful assessment of the relationship of OSAS with chromosomal abnormalities.IMPACT STATEMENTWhat is already known on this subject? There is a link between OSAS and epigenetic changes. Components of the triple screen test, levels of serum total β-hCG and unconjugated oestriol are increased in OSAS.What do the results of this study add? An increase in Trisomy 21 risk is correlated with increased OSAS risk. Alpha Fetoprotein levels were higher in the low OSAS risk group.What are the implications of these findings for clinical practice and/or further research? This is the first study to show this relationship. Sufficient evidence needs to be collected on this issue. Treatment of OSAS may be necessary during pregnancy.
Collapse
|
109
|
Raza S, Amaral AC, Pang J, Moussa F, Shelton D, Notario L, Harrington H, Callum JL, Yip PM. Reducing redundant creatine kinase testing in cardiac injury. BMJ Open Qual 2020; 9:bmjoq-2020-001182. [PMID: 33376105 PMCID: PMC7778776 DOI: 10.1136/bmjoq-2020-001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/03/2020] [Accepted: 12/15/2020] [Indexed: 01/09/2023] Open
Abstract
Background Creatine kinase (CK) testing in the setting of suspected cardiac injury is commonly performed yet rarely provides clinical value beyond troponin testing. We sought to evaluate and reduce CK testing coupled with troponin testing by 50% or greater. Methods We performed root cause analysis to study prevailing processes and patterns of CK testing. We developed new institutional guidelines, removed CK from high-volume paper and electronic order bundles and conducted academic detailing for departments with highest ordering frequency. We evaluated consecutive patients at Sunnybrook Health Sciences Centre between 1 January 2018 and 31 March 2020 who had either a CK or troponin level measured. We prespecified successful implementation as a reduction of 50% in total CK orders and a decrease in the ratio of CK-to-troponin tests to one-third or less. We retained additional data beyond our study period to assess for sustained reductions in testing. Results Total CK tests decreased over the study period from 3963 to 2111 per month, amounting to a 46.7% reduction (95% CI 33.2 to 60.2; p<0.001) equalling 61 fewer tests per hospital day. Troponin testing did not significantly change during the intervention. Ratio of CK-to-troponin tests decreased from 0.91 to 0.49 (p<0.001). The reduction coincided with changes to order-sets, was observed across all clinical units and was sustained during additional months beyond the study period. These reductions in testing resulted in a projected annual cost savings of C$28 446. Conclusions We demonstrate that a low-cost and feasible quality improvement initiative may lead to significant reduction in unnecessary CK testing and substantial savings in healthcare costs for patients with suspected cardiac injury.
Collapse
|
110
|
Franks CE, Gronowski AM. The Faces of Women in AACC - A Historical Reflection on AACC Leadership and Awards. Clin Chem 2020; 67:449-453. [PMID: 33523219 DOI: 10.1093/clinchem/hvaa253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/19/2020] [Indexed: 11/12/2022]
|
111
|
Bank PCD, Jacobs LHJ, van den Berg SAA, van Deutekom HWM, Hamann D, Molenkamp R, Ruivenkamp CAL, Swen JJ, Tops BBJ, Wamelink MMC, Wessels E, Oosterhuis WP. The end of the laboratory developed test as we know it? Recommendations from a national multidisciplinary taskforce of laboratory specialists on the interpretation of the IVDR and its complications. Clin Chem Lab Med 2020; 59:cclm-2020-1384. [PMID: 33554568 DOI: 10.1515/cclm-2020-1384] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/20/2020] [Indexed: 11/15/2022]
Abstract
The in vitro diagnostic medical devices regulation (IVDR) will take effect in May 2022. This regulation has a large impact on both the manufacturers of in vitro diagnostic medical devices (IVD) and clinical laboratories. For clinical laboratories, the IVDR poses restrictions on the use of laboratory developed tests (LDTs). To provide a uniform interpretation of the IVDR for colleagues in clinical practice, the IVDR Task Force was created by the scientific societies of laboratory specialties in the Netherlands. A guidance document with explanations and interpretations of relevant passages of the IVDR was drafted to help laboratories prepare for the impact of this new legislation. Feedback from interested parties and stakeholders was collected and used to further improve the document. Here we would like to present our approach to our European colleagues and inform them about the impact of the IVDR and, importantly we would like to present potentially useful approaches to fulfill the requirements of the IVDR for LDTs.
Collapse
|
112
|
Fink NE. Foreword: Ethics in Laboratory Medicine. EJIFCC 2020; 31:260-261. [PMID: 33376465 PMCID: PMC7745295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
113
|
Parra-Herran C, Romero Y, Milner D. Pathology and Laboratory Medicine in cancer care: A global analysis of national cancer control plans. Int J Cancer 2020; 148:1938-1947. [PMID: 33152147 DOI: 10.1002/ijc.33384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 10/29/2020] [Indexed: 11/11/2022]
Abstract
In order to understand the structure and effectiveness of national cancer control systems, the International Cancer Control Partnership, the World Health Organization, the National Cancer Institute and the Union for International Cancer Control underwent a review of available national cancer health plans (NCCPs) and noncommunicable diseases plans (NCDPs) worldwide. Pathology and Laboratory Medicine (PALM) plays a major role in cancer management, from prevention and screening to patient care (diagnosis and treatment) and population-level cancer surveillance. This review concentrates on the analysis of elements in national cancer care plans pertaining to PALM. Of 157 countries surveyed, 90 (57%) had a NCCP and 123 (78%) had a NCDP. While 54% of plans included guidelines on cancer diagnosis or plans to develop standards protocols for diagnosis, only 14% included PALM as a component of the plan. PALM-related variables such as synoptic pathology reporting, cancer staging guidelines and cancer genetics programs were similarly underrepresented (being mentioned in only 6%, 17% and 16% of plans, respectively). Absence of PALM-related variables tended to be more frequent in lower-income countries. Our analysis highlights an important gap in national cancer control initiatives worldwide represented by the overall lack of inclusion of PALM resources. Cancer control will only be effective if laboratory sciences are placed as a priority. Based on the data presented herein, there is a need to increase awareness about the importance of PALM in cancer care, and to incorporate this discipline in the design and implementation of multilevel cancer control strategies.
Collapse
|
114
|
Banys V. How does the MedTech Europe Code of Ethical Business Practice Affect the Activities of Professional Societies in Laboratory Medicine? EJIFCC 2020; 31:320-325. [PMID: 33376472 PMCID: PMC7745294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The MedTech Europe Code of Ethical Business Practice came into effect on 1 January 2018. It was created by the medical technology industry. It addresses the importance of fair management of educational grants: public disclosure of provided educational grants, compliance of conferences with the Conference Vetting System; allocation of grants to healthcare organizations (HCOs) but not to the healthcare professionals (HCPs); the need for written contracts with HCOs, etc. As a National Society and member of IFCC and EFLM, the Lithuanian Society of Laboratory Medicine (LLMD) has created a fund dedicated to the continuous professional development of LLMD member HCPs. The fund, as an instrument for the ethical use of money, corresponds to the principles of the MedTech Code of Ethical Business Practice and is an example on how HCOs can implement it to ensure ethical communication between the IVD (In Vitro Diagnostics) industry, HCOs and their member HCPs. Scarce data exists on the level of MedTech acceptance and implementation among HCOs and HCPs, thus more effort has to be made to better communicate and consequently improve fair use of the funds received from the industry, and to improve the ethical behavior of HCPs.
Collapse
|
115
|
Datta SK. Ethics in Laboratory Medicine: Perspectives and Challenges in Resource Limited Settings. EJIFCC 2020; 31:274-281. [PMID: 33376467 PMCID: PMC7745303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Currently diagnosis and management of patients in Clinical Practice is very much dependent on laboratory diagnostics. Laboratory Medicine, like any other branch of Medicine, is therefore, mandated with ethical usage of materials and data obtained from patients. Several countries, professional societies and the have developed policies and guidance materials on ethical issues related to laboratory medicine. However, ethical standards and practices vary between different cultures, geographies, legal architecture and according to available resources. In this article, we try to understand the challenges presented in terms of Ethics, where there are constraints of resources.
Collapse
|
116
|
Beshir L. Research Ethics Committees in Laboratory Medicine. EJIFCC 2020; 31:282-291. [PMID: 33376468 PMCID: PMC7745300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Biomedical research that involves human subjects requires compliance with ethical principles and guidelines. The ethical and scientific standards of research have been thoroughly discussed by international ethical guidelines and declarations. Compliance with these ensures the autonomy, dignity and well-being of research subjects; as well as the integrity and credibility of research results. Research ethics committees (RECs) are mandated to ensure that research proposals are scientifically sound and ethical. In this review, we define RECs in laboratory medicine and describe their role based on the examination of the requirements of ethical research; discuss particular ethical issues that arise in laboratory medicine research using biological samples, what challenges they face and how they can ensure the quality of their review. RECs need to be put into a broader framework that ensures institutional governance with continuous evaluation and auditing that ensure the quality of ethical review.
Collapse
|
117
|
Bartlett KJ, Vo AP, Rueckert J, Wojewoda C, Steckel EH, Stinnett-Donnelly J, Repp AB. Promoting appropriate utilisation of laboratory tests for inflammation at an academic medical centre. BMJ Open Qual 2020; 9:bmjoq-2019-000788. [PMID: 32098777 PMCID: PMC7047503 DOI: 10.1136/bmjoq-2019-000788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/28/2020] [Accepted: 02/11/2020] [Indexed: 11/30/2022] Open
Abstract
Erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) are commonly ordered in clinical practice to evaluate for inflammation. CRP is a more sensitive and specific test for detecting acute phase inflammation, and the American Society for Clinical Pathology recommends ordering CRP rather than ESR to detect acute phase inflammation in patients with undiagnosed conditions. We sought to understand CRP and ESR ordering practices and reduce unnecessary use of ESR testing at our academic medical centre. We surveyed physician leaders in clinical areas with high utilisation of ESR testing to understand the drivers of potential overutilisation of these tests. Based on survey responses, we designed an intervention focused on education, clinical decision support within the electronic medical record and quarterly audit and feedback. We evaluated appropriateness of ESR ordering before and after the intervention via structured chart audit. Comparison of monthly rates of ESR tests during the preintervention and postintervention periods was conducted using interrupted time series analysis. Clinical habit and ease of test ordering were identified as key drivers of ESR overuse. Compared with the preintervention period, we observed a 33% reduction in the number of ESR tests per month and a 25% reduction in combined CRP and ESR tests per month during the postintervention period. This reduction corresponded to an annual avoidance of 2633 ESR tests with a corresponding estimated direct cost avoidance of $23 701 annually. Although the rate of ESR testing decreased, there was no significant improvement in the clinical appropriateness of residual ESR test ordering following the intervention. A multifaceted intervention was associated with significant decreases in unnecessary ESR tests and concurrent ESR and CRP tests at our academic medical centre. Despite these reductions, there are continued opportunities to reduce inappropriate ESR testing.
Collapse
|
118
|
Wieringa G, Jassam N, Homsak E, Rako I, Racek J. The Academy of the European Federation of Clinical Chemistry and Laboratory Medicine and the European Register of Specialists in Laboratory Medicine: guide to the Academy and the Register, version 4 - 2020. Clin Chem Lab Med 2020; 59:499-503. [PMID: 33079701 DOI: 10.1515/cclm-2020-1507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/11/2020] [Indexed: 11/15/2022]
Abstract
The 4th version of the guide to the Register for European Specialists in Laboratory Medicine (EuSpLM) established by the European Communities Confederation of Clinical Chemistry and Laboratory Medicine describes the transfer of the register to the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) in 2016, the extension in 2018 of the Register beyond the European Union to Europe and the benefits of membership of the EFLM Academy to which the Register transferred on the Academy's launch in 2019. The Academy offers EuSpLM registrants access to benefits that include reduced registration rates at selected conferences and free subscription to Clinical Chemistry and Laboratory Medicine. With effect from 2020 eligibility was extended to anyone with an interest in laboratory medicine. The updated guide describes the electronically driven processes for individual membership and block enrolment from national societies/organisations, and the stepping stones to recognition as an EuSpLM within the Academy. Whilst eligibility for recognition as an EuSpLM remains largely unchanged new expectations across Europe in education, training, professional regulation and qualifications are reflected in updated criteria. The continuing driver for establishing the Academy and growing the EFLM Register reflects the federation's leadership role in the harmonisation of high quality education and training for those with an interest in laboratory medicine as well as ongoing initiatives to establish a Common Training Framework for Specialists in Laboratory Medicine under EU Directive 2013/55/EC (The Recognition of Professional Qualifications).
Collapse
|
119
|
Bohn MK, Loh TP, Wang CB, Mueller R, Koch D, Sethi S, Rawlinson WD, Clementi M, Erasmus R, Leportier M, Grimmler M, Yuen KY, Mancini N, Kwon GC, Menezes ME, Patru MM, Gramegna M, Singh K, Najjar O, Ferrari M, Horvath AR, Lippi G, Adeli K. IFCC Interim Guidelines on Serological Testing of Antibodies against SARS-CoV-2. Clin Chem Lab Med 2020; 58:2001-2008. [PMID: 33027043 DOI: 10.1515/cclm-2020-1413] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 12/16/2022]
Abstract
Serological testing for the detection of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is emerging as an important component of the clinical management of patients with coronavirus disease 2019 (COVID-19) as well as the epidemiological assessment of SARS-CoV-2 exposure worldwide. In addition to molecular testing for the detection of SARS-CoV-2 infection, clinical laboratories have also needed to increase testing capacity to include serological evaluation of patients with suspected or known COVID-19. While regulatory approved serological immunoassays are now widely available from diagnostic manufacturers globally, there is significant debate regarding the clinical utility of these tests, as well as their clinical and analytical performance requirements prior to application. This document by the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC) Taskforce on COVID-19 provides interim guidance on: (A) clinical indications and target populations, (B) assay selection, (C) assay evaluation, and (D) test interpretation and limitations for serological testing of antibodies against SARS-CoV-2 infection. These evidence-based recommendations will provide practical guidance to clinical laboratories in the selection, verification, and implementation of serological assays and are of the utmost importance as we expand our pandemic response from initial case tracing and containment to mitigation strategies to minimize resurgence and further morbidity and mortality.
Collapse
|
120
|
Geer LI, Kagele S, Townshend S, Watson B, Reed EF, Hickey MJ. Design of a state of the art reporting system and process improvement for reporting of high complexity single antigen bead data for transplant patients to the electronic medical record. BMJ Open Qual 2020; 9:bmjoq-2019-000813. [PMID: 31986117 PMCID: PMC7011947 DOI: 10.1136/bmjoq-2019-000813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/28/2019] [Accepted: 12/18/2019] [Indexed: 11/04/2022] Open
Abstract
The UCLA Immunogenetics Center is an Immunogenetics and Histocompatibility laboratory that performs testing for multiple transplant programmes within and outside of UCLA. The single antigen bead (SAB) test is a high complexity luminex bead test used to assess pretransplant and post-transplant patients for the presence of pathogenic human leucocyte antigen donor-specific antibody associated with allograft rejection. Efficient reporting of the SAB test has been difficult as data analysis and reports are generated in the laboratory information system (LIS) and uploaded to the electronic medical record (EMR) as PDFs. To solve this, we recently developed a state of the art reporting workflow allowing discrete reporting of SAB data (antibody specificity, mean fluorescent intensity and interpretative comments) from the LIS HistoTrac to UCLA Health System’s EMR EPIC:CareConnect. However, a proportion of tests did not report to the EMR appropriately. Baseline system performance data evaluated over a 10-week period showed that ~4.5/100 tests resulted in EPIC as ‘preliminary result’ or ‘in process’ instead of ‘final result’ with only common cause variation. Quality improvement methods were employed to improve the process with the SMART Aim of reporting 100% of tests as ‘final result’. Pareto analysis identified two errors accounting for 79% of common system-level failures—status errors and interface errors. We hypothesised that addressing the status error would reduce or eliminate the interface errors. We used the Model For Improvement to test a reprogramming intervention. Status and interface errors were completely resolved through the process improvement. Continuous monitoring revealed a system-level shift with only ~1.9/100 tests resulting inappropriately. Through the audit process, the remaining common system-level failures were identified and resolved. Therefore, 100% of tests result to EPIC as ‘final result’. The study demonstrates that high complexity SAB bead data can be efficiently reported EPIC:CareConnect from HistoTrac as discrete data.
Collapse
|
121
|
Lee AYS, Beroukas D, Brown L, Lucchesi C, Kaur A, Gyedu L, Hughes N, Ng YH, Saran O, Gordon TP, Wang JJ. Identification of a unique anti-Ro60 subset with restricted serological and molecular profiles. Clin Exp Immunol 2020; 203:13-21. [PMID: 32852779 DOI: 10.1111/cei.13508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/06/2020] [Accepted: 08/14/2020] [Indexed: 12/30/2022] Open
Abstract
Anti-Ro60 is one of the most common and clinically important serum autoantibodies that has a number of diagnostic and predictive capabilities. Most diagnostic laboratories report this simply as a qualitative positive/negative result. The objective of this study was to examine the clinical and serological relevance of a novel subset of anti-Ro60 in patients who display low levels of anti-Ro60 (anti-Ro60low ). We retrospectively identified anti-Ro60 sera during a 12-month period at a major immunopathology diagnostic laboratory in Australia. These all were anti-Ro60-precipitin-positive on the diagnostic gold standard counter-immuno-electrophoresis (CIEP). Lineblot immunoassay was used to stratify patients into either anti-Ro60low or anti-Ro60high subsets. We compared the medical and laboratory parameters associated with each group. Enzyme-linked immunosorbent assay (ELISA) and mass spectrometry techniques were used to analyse the serological and molecular basis behind the two subsets. Anti-Ro60low patients displayed less serological activity than anti-Ro60high patients with less intermolecular spreading, hypergammaglobulinaemia and less tendency to undergo anti-Ro60 isotype-switching than anti-Ro60high patients. Mass spectrometric typing of the anti-Ro60low subset showed restricted variable heavy chain subfamily usage and amino acid point mutations. This subset also displayed clinical relevance, being present in a number of patients with systemic autoimmune rheumatic diseases (SARD). We identify a novel anti-Ro60low patient subset that is distinct from anti-Ro60high patients serologically and molecularly. It is not clear whether they arise from common or separate origins; however, they probably have different developmental pathways to account for the stark difference in immunological maturity. We hence demonstrate significance to anti-Ro60low and justify accurate detection in the diagnostic laboratory.
Collapse
|
122
|
Lippi G, Henry BM, Sanchis-Gomar F, Mattiuzzi C. Updates on laboratory investigations in coronavirus disease 2019 (COVID-19). ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020030. [PMID: 32921725 PMCID: PMC7716967 DOI: 10.23750/abm.v91i3.10187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 12/23/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is still spreading worldwide, affecting several million people. Unlike the previous two coronavirus outbreaks, COVID-19 has caused several thousand deaths for respiratory and multiple organ failure. As specifically concerns this latest infectious pathology, laboratory medicine can provide a substantial contribution to diagnosing an acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection through molecular testing, establishing the presence and extent of an immune response against the virus, mostly through serological testing. However, it can also help to predict the risk of unfavorable disease progression by measuring some conventional laboratory tests and, last but not least, can provide reliable therapeutic guidance. This article is hence aimed at offering recent updates on the important role and value of laboratory investigations in COVID-19, also providing information on some hot topics such as virus RNA detection in different biological samples, causes of recurrent positivity of reverse-transcription polymerase chain reaction (RT-PCR), potential strategies for enhancing the throughput of molecular testing (i.e., pre-test probability assessment, sample pooling, use of rapid tests), as well as pragmatic indications for enhancing the quality and value of serological testing and laboratory-based monitoring.
Collapse
|
123
|
Henry B, Cheruiyot I, Vikse J, Mutua V, Kipkorir V, Benoit J, Plebani M, Bragazzi N, Lippi G. Lymphopenia and neutrophilia at admission predicts severity and mortality in patients with COVID-19: a meta-analysis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020008. [PMID: 32921706 PMCID: PMC7716963 DOI: 10.23750/abm.v91i3.10217] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is a compelling need to identify clinical and laboratory predictors of unfavorable clinical course and death in patients with coronavirus disease (COVID-19). A trend towards low lymphocyte count and high neutrophil counts in patients with poor outcomes has been reported by earlier studies. We aim to synthesize existing data evaluating the relationship between clinical outcomes and abnormal neutrophil and lymphocyte counts at admission in COVID-19 patients. METHODS An electronic search was carried out in PubMed, China National Knowledge Infrastructure (CNKI) and Cochrane Central Register of Controlled Trials (CENTRAL) to identify eligible studies reporting frequency data on neutrophilia and lymphopenia at admission in hospitalization in COVID-19 patients. Pooled odds ratios of clinical outcomes for each parameter were calculated using Comprehensive Meta-Analysis. RESULTS A total of 22 studies (4,969 patients) were included in this meta-analysis. Lymphopenia at admission was found to be significantly associated with increased odd of progression to severe disease (odds ratio [OR], 4.20; 95% confidence interval [95CI%], 3.46-5.09) and death (OR, 3.71; 95%CI, 1.63-8.44). Neutrophilia at admission was also found to be significantly associated with increased odd of progression to severe disease (OR, 7.99; 95%CI, 1.77-36.14) and death (OR, 7.87; 95%CI, 1.75-35.35). Subgroup analysis revealed that COVID-19 patients with severe lymphopenia (<0.5 x10×9/L) had 12-fold increased odds of in-hospital mortality. CONCLUSION Admission lymphopenia and neutrophilia are associated with poor outcomes in patients with COVID-19. Regular monitoring and early and even more aggressive intervention shall hence be advisable in patients with low lymphocyte and high neutrophil counts. These variables may be useful in risk stratification models.
Collapse
|
124
|
Carpenter CR, Vandenberg J, Solomon M, McAndrew C, Lane MA, Burnham CA, Scott M, Farnsworth C. Diagnostic Accuracy of Synovial Lactate, Polymerase Chain Reaction, or Clinical Examination for Suspected Adult Septic Arthritis. J Emerg Med 2020; 59:339-347. [PMID: 32819785 DOI: 10.1016/j.jemermed.2020.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/12/2020] [Accepted: 06/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adult septic arthritis can be challenging to differentiate from other causes of acute joint pain. The diagnostic accuracy of synovial lactate and polymerase chain reaction (PCR) remains uncertain. OBJECTIVE Our aim was to quantify the diagnostic accuracy of synovial lactate, PCR, and clinical evaluation for adults with possible septic arthritis in the emergency department (ED). METHODS We report a prospective sampling of ED patients aged ≥ 18 years with knee symptoms concerning for septic arthritis. Clinicians and research assistants independently performed history and physical examination. Serum and synovial laboratory testing was ordered at the discretion of the clinician. We analyzed frozen synovial fluid specimens for l- and d-lactate and PCR. The criterion standard for septic arthritis was bacterial growth on synovial culture and treated by consultants with operative drainage, prolonged antibiotics, or both. Diagnostic accuracy measures included sensitivity, specificity, likelihood ratios, interval likelihood ratios, and receiver operating characteristic area under the curve. RESULTS Seventy-one patients were included with septic arthritis prevalence of 7%. No finding on history or physical examination accurately ruled in or ruled out septic arthritis. Synovial l- and d-lactate and PCR were inaccurate for the diagnosis of septic arthritis. Synovial white blood cell count and synovial Gram stain most accurately rule in and rule out septic arthritis. CONCLUSIONS Septic arthritis prevalence in ED adults is lower than reported previously. History and physical examination, synovial lactate, and PCR are inadequate for the diagnosis of septic arthritis. Synovial white blood cell count and Gram stain are the most accurate tests available for septic arthritis.
Collapse
|
125
|
Dodig S, Čepelak I, Čepelak Dodig D, Laškaj R. SARS-CoV-2 - a new challenge for laboratory medicine. Biochem Med (Zagreb) 2020; 30:030503. [PMID: 32774121 PMCID: PMC7394259 DOI: 10.11613/bm.2020.030503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022] Open
Abstract
The new corona virus SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona Virus 2) causes a disease called COVID-19 (coronavirus disease 2019), that develops mostly in subjects with already impaired immune system function, primarily in the elderly and in individuals with some chronic disease or condition. The reasons for this should be sought in the processes of aging and chronic latent inflammation, i.e. immunosenescence and inflammaging. Laboratory medicine specialists are currently focused on proving the presence of the virus and defining biomarkers that would enable the prediction of disease progression. For now, it has been shown that useful biomarkers can include general biomarkers of inflammation (parameters of complete blood count, C-reactive protein, interleukin-6, procalcitonin), biomarkers of myocardial damage (high sensitivity troponin I/T, B-type natriuretic peptide, and N-terminal B type natriuretic peptide), and vascular biomarkers (D-dimer, prothrombin time, fibrinogen). Their actual diagnostic specificity, sensitivity and predictive value need to be tested on a larger number of subjects. In addition, it is important to find and evaluate specific biomarkers of immunosenescence.
Collapse
|