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Kremser M, Weiss N, Kaufmann-Stoeck A, Vierbaum L, Schmitz A, Schellenberg I, Holdenrieder S. Longitudinal evaluation of external quality assessment results for CA 15-3, CA 19-9, and CA 125. Front Mol Biosci 2024; 11:1401619. [PMID: 38966130 PMCID: PMC11222321 DOI: 10.3389/fmolb.2024.1401619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/30/2024] [Indexed: 07/06/2024] Open
Abstract
Background Tumor markers are established laboratory tools that help to diagnose, estimate prognosis, and monitor the course of cancer. For meaningful decision-making in patient care, it is essential that methods and analytical platforms demonstrate high sensitivity, specificity, precision, and comparability. Regular participation at external quality assessment (EQA) schemes is mandatory for laboratories. Here, a longitudinal evaluation of EQA data was performed to assess the performance of tumor marker assays over time. Methods Longitudinal data of the cancer antigens (CA) 15-3 (n = 5,492), CA 19-9 (n = 6,802), and CA 125 (n = 5,362) from 14 INSTAND EQAs conducted between 2019 and 2023 were evaluated. A median of 197, 244 and 191 laboratories participated at the EQAs for CA 15-3, CA 19-9 and CA 125, respectively. Data evaluation encompasses intra- and inter-manufacturer specific variations over time, assay precision, and adherence to the EQA limits of ±24% for CA 15-3, ±27% for CA 19-9 and ±36% for CA 125. Results The study showed median manufacturer-dependent differences of up to 107% for CA 15-3, 99% for CA 125, and even 549% for CA 19-9 between the highest and the lowest methods over the studied period. Regarding the normalized median of all methods, the values of the most deviant methods were 0.42 for CA 15-3, 7.61 for CA 19-9, and 1.82 for CA 125. Intra-manufacturer variability was generally low, with median coefficients of variation (CV) below 10%. As the methods were evaluated according to method-specific consensus values, most participants passed the EQAs within the acceptance criteria. When the criteria were consistently set at 24%, the central 90% of participants passed the EQAs in 78.6%-100% for CA 15-3 (with exception of AX), 89.3%-100% for CA 125, and 64.3%-100% for CA 19-9. Conclusion While intra-method precision of most analytical platforms is acceptable for all three tumor markers, considerable inter-method variability was observed over the whole studied period demonstrating the necessity for better standardization and harmonization of the methods, development of international reference materials, and comprehensive commutability studies with patient samples.
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Affiliation(s)
- Marcel Kremser
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Nathalie Weiss
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Anne Kaufmann-Stoeck
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Laura Vierbaum
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Arthur Schmitz
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Ingo Schellenberg
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- Center of Life Sciences, Institute of Bioanalytical Sciences (IBAS), Anhalt University of Applied Sciences, Bernburg, Germany
| | - Stefan Holdenrieder
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- Munich Biomarker Research Center, Institute of Laboratory Medicine, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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2
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Stavelin A, Sandberg S. Analytical performance specifications and quality assurance of point-of-care testing in primary healthcare. Crit Rev Clin Lab Sci 2024; 61:164-177. [PMID: 37779370 DOI: 10.1080/10408363.2023.2262029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
Point-of-care testing (POCT) is the fastest-growing segment of laboratory medicine. This review focuses on the essential aspects of setting analytical performance specifications (APS) and performing quality assurance for POCT in primary healthcare. In-vitro diagnostic medical devices for POCT are typically small and easy to operate. Users often have little to no laboratory experience and may not necessarily see the value of conducting quality assurance on their devices. Therefore, training, guidance, and motivation should be integral parts of the total quality management system, as they are vital for managing errors and ensuring reliable results. It is common to believe that the analytical quality of POCT should be comparable to that of laboratory testing, and as a result, APS should be the same. This paper challenges this concept. The APS for POCT can often be less stringent compared to those used in a central laboratory because the requester is closer to both the analytical and clinical situation. Point-of-care instruments should be selected based on clinical needs, the required analytical quality and user-friendliness in the intended usage setting.Quality assurance should include both internal quality control (IQC) and external quality assessment (EQA). It is recommended that IQC protocols should be dependent on the complexity of the POCT device. A scoring system to determine how frequent IQC should be analyzed in primary healthcare on different types of POCT devices has been suggested. The main challenge in EQA for POCT involves using suitable control materials that reflect instrument performance on patient samples. Obtaining commutable control materials for POCT is difficult since the matrix often is whole blood. An essential aspect of EQA for POCT is that feedback reports should be easily interpretable. Users should receive advice from the EQA organizer regarding the root causes of deviating results. Quality assurance for POCT is not an easy task and presents numerous challenges. However, there is evidence that quality assurance improves the quality of POCT measurements and, consequently, can enhance patient outcomes.
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Affiliation(s)
- Anne Stavelin
- The Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Diaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- The Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Diaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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3
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Queraltó J, Brady J, Carobene A, Homšak E, Wieringa G. The European Register of Specialists in Clinical Chemistry and Laboratory Medicine: code of conduct, version 3 - 2023. Clin Chem Lab Med 2023; 61:981-988. [PMID: 36724108 DOI: 10.1515/cclm-2023-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 02/02/2023]
Abstract
Whilst version 2 focussed on the professional conduct expected of a Specialist in Laboratory Medicine, version 3 builds on the responsibilities for ethical conduct from point of planning to point of care. Particular responsibilities that are outlined include: - The need for evidence when planning a new service, providing assurance that a new test does not do harm - Maintaining respect for patient confidentiality, their religious/ethnic beliefs, the need for informed consent to test, agreement on retrospective use of samples as part of governance envelopes in the pre-analytical phase - Ensuring respect for patient autonomy in the response to untoward results generated in the analytical phase - Supporting the safety of patients in the post-analytical phase through knowledge-based interpretation and presentation of results - The duty of candour to disclose and respond to error across the total testing process - Leading initiatives to harmonise and standardise pre-analytical, analytical and post-analytical phases to ensure more consistent clinical decision making with utilisation of demand management to ensure more equitable access to scarce resources - Working with emerging healthcare providers beyond the laboratory to ensure consistent application of high standards of clinical care In identifying opportunities for wider contributions to resolving ethical challenges across healthcare the need is also highlighted for more external quality assurance schemes and ethics-based quality indicators that span the total testing process.
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Affiliation(s)
- Josep Queraltó
- SEQCML - The Spanish Society of Laboratory Medicine SEQCML Barcelona, Spain
| | - Jennifer Brady
- Department of Paediatric Laboratory Medicine, UCD School of Medicine, Children's Health Ireland (CHI) Dublin, Ireland
| | - Anna Carobene
- Laboratory Medicine Department, IRCCS San Raffaele Hospital Milan, Italy
| | - Evgenija Homšak
- European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Milan, Italy
| | - Gijsbert Wieringa
- European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Milan, Italy
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4
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López Yeste ML, Pons Mas AR, Guiñón Muñoz L, Izquierdo Álvarez S, García FM, Blanco Font A, Pascual Gómez NF, Sánchez Gancedo L, García Álvarez A, Bernabeu Andreu FA, Chueca Rodríguez MP, Álvarez Domínguez L. Management of post-analytical processes in the clinical laboratory according to ISO 15189:2012. Considerations about the management of clinical samples, ensuring quality of post-analytical processes, and laboratory information management. ADVANCES IN LABORATORY MEDICINE 2021; 2:373-389. [PMID: 37362414 PMCID: PMC10197280 DOI: 10.1515/almed-2021-0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/07/2021] [Indexed: 06/28/2023]
Abstract
ISO 15189:2012 establishes the requirements for clinical sample management, ensuring quality of process and laboratory information management. The accreditation authority, ENAC in Spain, established the requirements for the authorized use of the label in reports issued by accredited laboratories. These recommendations are applicable to the postanalytical processes and the professionals involved. The Standard requires laboratories to define and document the duration and conditions of sample retention. Laboratories are also required to design an internal quality control scheme to verify whether postanalytical activities attain the expected standards. Information management requirements are also established and laboratories are required to design a contingency plan to ensure the communication of laboratory results. Instructions are finally provided about the correct use of the accreditation label in laboratory reports. A range of nations and scientific societies support that clinical laboratories should be required to obtain accreditation. With ISO 15189 being the most specific standard for demonstrating technical performance, a clear understanding of its requirements is essential for proper implementation.
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Affiliation(s)
| | - Antonia R. Pons Mas
- Clinical Analysis Service, Hospital Universitari Son Espases, Mallorca, Spain
| | - Leonor Guiñón Muñoz
- Quality Department, Laboratories, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Fernando Marqués García
- Clinical Biochemistry Department, Metropolitan North Clinical Laboratory (LUMN), Germans Trias i Pujol Universitary Hospital, Badalona, Barcelona, Spain
| | - Aurora Blanco Font
- Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | | | - Francisco A. Bernabeu Andreu
- Service of Clinical Analysis – Clinical Biochemistry, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Luisa Álvarez Domínguez
- Laboratory Accreditation Board of the Spanish Society of Laboratory Medicine, Barcelona, Spain
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5
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López Yeste ML, Izquierdo Álvarez S, Pons Mas AR, Álvarez Domínguez L, Blanco Font A, Marqués García F, Bernabeu Andreu FA, Rodríguez MPC, García Álvarez A, Contreras Sanfeliciano T, Pascual Gómez N, Sánchez Gancedo L, Guiñón Muñoz L. Gestión del proceso posanalítico en los laboratorios clínicos según los requisitos de la norma ISO 15189:2012. Consideraciones sobre la revisión, notificación y comunicación de los resultados. ADVANCES IN LABORATORY MEDICINE 2021; 2:61-70. [PMCID: PMC10197772 DOI: 10.1515/almed-2020-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/03/2020] [Indexed: 06/28/2023]
Abstract
El objeto de este trabajo es establecer unas consideraciones para facilitar la gestión del proceso posanalítico respecto a la revisión, notificación y comunicación de los resultados, de acuerdo con los requisitos de la Norma UNE-EN ISO 15189:2013. El ámbito de aplicación incluye las actividades del proceso posanalítico del laboratorio clínico, así como el personal implicado en él (dirección y personal del laboratorio). Se indican los criterios y la información necesaria para realizar la revisión y validación de los resultados de las pruebas analíticas y así enviar a los destinatarios informes claros, asegurando siempre una transcripción fidedigna de los resultados e incluyendo toda la información necesaria para su correcta interpretación. Asimismo, se describen los requisitos para una correcta comunicación de los resultados del laboratorio, haciendo especial hincapié en la comunicación de aquellos resultados alarmantes o críticos. En algunos países de Europa es obligatoria la acreditación, total o parcial, de los laboratorios clínicos, siguiendo la Norma ISO 15189 y esta parece ser la hoja de ruta marcada en otros muchos países. Por ello, es indispensable la comprensión de sus requisitos para realizar una implementación progresiva y más fácil.
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Affiliation(s)
- Ma Liboria López Yeste
- CATLAB, Barcelona, España
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
| | - Silvia Izquierdo Álvarez
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
| | - Antonia R. Pons Mas
- Servicio de Análisis Clínicos, Hospital Universitari Son Espases, Mallorca, España
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
| | - Luisa Álvarez Domínguez
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
| | - Aurora Blanco Font
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Laboratori Clínic, Hospital Universitari de Bellvitge, Barcelona, España
| | - Fernando Marqués García
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
| | - Francisco A. Bernabeu Andreu
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Servicio de Análisis Clínicos- Bioquímica Clínica, Hospital Universitario Puerta de Hierro, Madrid, España
| | | | - Ana García Álvarez
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Servicio Análisis Clínicos, Hospital Clínico San Carlos, Madrid, España
| | - Teresa Contreras Sanfeliciano
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Servicio de Análisis Clínicos y Bioquímica Clínica, Complejo Asistencial Universitario, Salamanca, España
| | - Natalia Pascual Gómez
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Servicio de Análisis Clínicos, Hospital Universitario de la Princesa, Madrid, España
| | - Lorena Sánchez Gancedo
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Instituto de Medicina Oncológica y Molecular, Oviedo, Asturias, España
| | - Leonor Guiñón Muñoz
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Hospital de la Santa Creu i Sant Pau, Barcelona, España
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6
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López Yeste ML, Izquierdo Álvarez S, Pons Mas AR, Álvarez Domínguez L, Marqués García F, Rodríguez MPC, Blanco Font A, Bernabeu Andreu FA, García Álvarez A, Contreras Sanfeliciano T, Pascual Gómez N, Sánchez Gancedo L, Guiñón Muñoz L. Management of postanalytical processes in the clinical laboratory according to ISO 15189:2012 Standard requirements: considerations on the review, reporting and release of results. ADVANCES IN LABORATORY MEDICINE 2021; 2:51-70. [PMID: 37359206 PMCID: PMC10197272 DOI: 10.1515/almed-2020-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/03/2020] [Indexed: 06/28/2023]
Abstract
The objective of this paper is to share some considerations about the management of postanalytical processes in relation to the review, reporting and release of test results in accordance with UNE-EN ISO 15189:2013 Standard requirements. The scope of this paper includes postanalytical activities and the personnel involved (laboratory management and staff). We describe the criteria and information required to review and validate analytical results and ensure that clear reports are sent to requesters. These criteria also guarantee that results are transcribed in a reliable way and that all necessary information is provided for the correct interpretation of results. Likewise, the requirements for the correct release of laboratory results are described, with special emphasis on the release of alarming or critical results. In some European countries, clinical laboratories are required to hold partial or full ISO 15189 accreditation, which is a global trend. Therefore, understanding ISO 15189 requirements is imperative for a progressive and more effective implementation of the Standard.
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Affiliation(s)
- Mᵃ Liboria López Yeste
- CATLAB, Barcelona, Spain
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
| | - Silvia Izquierdo Álvarez
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Antonia R. Pons Mas
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio de Análisis Clínicos, Hospital Universitari Son Espases, Mallorca, Spain
| | - Luisa Álvarez Domínguez
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
| | - Fernando Marqués García
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio de Análisis Clínicos y Bioquímica Clínica, Laboratorio Clínico de la Metropolitana Norte, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona
| | | | - Aurora Blanco Font
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Laboratori Clínic, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Francisco A. Bernabeu Andreu
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio de Análisis Clínicos- Bioquímica Clínica, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Ana García Álvarez
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio Análisis Clínicos, Hospital Clínico San Carlos, Madrid, Spain
| | - Teresa Contreras Sanfeliciano
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio de Análisis Clínicos y Bioquímica Clínica, Complejo Asistencial Universitario, Salamanca, Spain
| | - Natalia Pascual Gómez
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio de Análisis Clínicos, Hospital Universitario de la Princesa, Madrid, Spain
| | - Lorena Sánchez Gancedo
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Instituto de Medicina Oncológica y Molecular, Oviedo, Asturias, Spain
| | - Leonor Guiñón Muñoz
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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7
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Coucke W, Vlašić Tanasković J, Hećimović A, Honović L, Hrabrić Vlah S, Ferenčak G, Vuković Rodríguez J, Leniček Krleža J. A new method for monitoring harmonization of laboratory results within EQA schemes. Clin Chem Lab Med 2020; 58:e217-e219. [DOI: 10.1515/cclm-2020-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/20/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Wim Coucke
- Quality of Laboratories , Sciensano, J. Wytsmanstraat 14, 1050 Brussels , Belgium
| | - Jelena Vlašić Tanasković
- Department of Medical Biochemistry and Laboratory Medicine , General Hospital Pula , Pula , Croatia
- Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine , Zagreb , Croatia
| | - Ana Hećimović
- Croatian Institute of Transfusion Medicine , Zagreb , Croatia
| | - Lorena Honović
- Department of Medical Biochemistry and Laboratory Medicine , General Hospital Pula , Pula , Croatia
| | - Snježana Hrabrić Vlah
- Department of Laboratory Diagnostics, Rijeka Clinical Hospital Center , Rijeka , Croatia
| | | | | | - Jasna Leniček Krleža
- Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine , Zagreb , Croatia
- Children’s Hospital Zagreb , Zagreb , Croatia
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8
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De Wolf HA, Langlois MR, Suvisaari J, Aakre KM, Baum H, Collinson P, Duff CJ, Gruson D, Hammerer-Lercher A, Pulkki K, Stankovic S, Stavljenic-Rukavina A, Laitinen P. How well do laboratories adhere to recommended guidelines for dyslipidaemia management in Europe? The CArdiac MARker Guideline Uptake in Europe (CAMARGUE) study. Clin Chim Acta 2020; 508:267-272. [DOI: 10.1016/j.cca.2020.05.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 01/05/2023]
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9
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Cheung CC, Barnes P, Bigras G, Boerner S, Butany J, Calabrese F, Couture C, Deschenes J, El-Zimaity H, Fischer G, Fiset PO, Garratt J, Geldenhuys L, Gilks CB, Ilie M, Ionescu D, Lim HJ, Manning L, Mansoor A, Riddell R, Ross C, Roy-Chowdhuri S, Spatz A, Swanson PE, Tron VA, Tsao MS, Wang H, Xu Z, Torlakovic EE. Fit-For-Purpose PD-L1 Biomarker Testing For Patient Selection in Immuno-Oncology: Guidelines For Clinical Laboratories From the Canadian Association of Pathologists-Association Canadienne Des Pathologistes (CAP-ACP). Appl Immunohistochem Mol Morphol 2020; 27:699-714. [PMID: 31584451 PMCID: PMC6887625 DOI: 10.1097/pai.0000000000000800] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 12/16/2022]
Abstract
Since 2014, programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) checkpoint inhibitors have been approved by various regulatory agencies for the treatment of multiple cancers including melanoma, lung cancer, urothelial carcinoma, renal cell carcinoma, head and neck cancer, classical Hodgkin lymphoma, colorectal cancer, gastroesophageal cancer, hepatocellular cancer, and other solid tumors. Of these approved drug/disease combinations, a subset also has regulatory agency-approved, commercially available companion/complementary diagnostic assays that were clinically validated using data from their corresponding clinical trials. The objective of this document is to provide evidence-based guidance to assist clinical laboratories in establishing fit-for-purpose PD-L1 biomarker assays that can accurately identify patients with specific tumor types who may respond to specific approved immuno-oncology therapies targeting the PD-1/PD-L1 checkpoint. These recommendations are issued as 38 Guideline Statements that address (i) assay development for surgical pathology and cytopathology specimens, (ii) reporting elements, and (iii) quality assurance (including validation/verification, internal quality assurance, and external quality assurance). The intent of this work is to provide recommendations that are relevant to any tumor type, are universally applicable and can be implemented by any clinical immunohistochemistry laboratory performing predictive PD-L1 immunohistochemistry testing.
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Affiliation(s)
- Carol C. Cheung
- Laboratory Medicine Program, Division of Pathology, University Health Network
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto
| | - Penny Barnes
- Department of Pathology, Dalhousie University, Halifax, NS
| | | | - Scott Boerner
- Laboratory Medicine Program, Division of Pathology, University Health Network
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto
| | - Jagdish Butany
- Laboratory Medicine Program, Division of Pathology, University Health Network
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health
- University of Padova Medical School, Padova, Italy
| | | | - Jean Deschenes
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton
| | | | - Gabor Fischer
- Department of Pathology, University of Manitoba, Winnipeg, MB
| | | | | | | | - C. Blake Gilks
- Canadian Immunohistochemistry Quality Control
- Department of Pathology and Laboratory Medicine, University of British Columbia
| | - Marius Ilie
- Laboratory of Clinical and Experimental Pathology
- Hospital-Related Biobank (BB-0033-00025), Université Côte d'Azur, University Hospital Federation OncoAge, Hôpital Pasteur, Nice, France
| | | | - Hyun J. Lim
- Department of Community Health and Epidemiology
| | - Lisa Manning
- Department of Pathology, University of Manitoba, Winnipeg, MB
| | - Adnan Mansoor
- Department of Pathology and Laboratory Medicine, University of Calgary
| | - Robert Riddell
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital
| | | | | | - Alan Spatz
- Department of Pathology, McGill University
- Division of Pathology and Molecular Genetics, McGill University Health Center
- Lady Davis Institute, Jewish General Hospital, Montreal, QC
| | - Paul E. Swanson
- Calgary Laboratory Services, Calgary, AB
- Department of Pathology, University of Washington, School of Medicine, Seattle, WA
| | - Victor A. Tron
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto
- Department of Laboratory Medicine, St. Michael’s Hospital, Toronto
| | - Ming-Sound Tsao
- Laboratory Medicine Program, Division of Pathology, University Health Network
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto
| | - Hangjun Wang
- Department of Pathology, McGill University
- Division of Pathology and Molecular Genetics, McGill University Health Center
- Lady Davis Institute, Jewish General Hospital, Montreal, QC
| | - Zhaolin Xu
- Department of Pathology, Dalhousie University, Halifax, NS
| | - Emina E. Torlakovic
- Canadian Immunohistochemistry Quality Control
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan
- Department of Pathology and Laboratory Medicine, Royal University Hospital, Saskatchewan Health Authority, Saskatoon, SK, Canada
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10
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Keppel MH, Kolbitsch T, Hoppe UC, Auer S, Felder TK, Oberkofler H, Mrazek C, Haschke-Becher E, Cadamuro J. The clinically effective use of cardiac markers by restructuring laboratory profiles at Cardiology wards. Clin Chem Lab Med 2020; 58:1565-1571. [PMID: 32305953 DOI: 10.1515/cclm-2019-1229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/04/2020] [Indexed: 12/20/2022]
Abstract
Background Laboratory overutilization is associated with diagnostic error and potential patient risk. We applied a demand management strategy in collaboration with the local Department of Cardiology to reduce the cardiac markers high-sensitive troponin T (hsTropT) and N-terminal pro brain natriuretic peptide (NTproBNP) in laboratory ordering profiles (LOPs). The present study aimed to retrospectively evaluate the implemented strategies. Methods Strategies included educational measures and evidence-guided, active test de-selection from all cardiology ward LOPs, and/or permanent removal from LOPs. Tests remained available at all times. We evaluated overutilization by reductions in monthly orders, and assessed differences in 30-day all-cause readmission rate and length of patients' hospital stay. Results Overall, we observed a mean reduction of 66.1% ± 7.6% (n = 277 ± 31) in hsTropT tests. Educational measures effectively reduced NTproBNP orders by 52.8% ± 17.7% (n = 60 ± 20). Permanent removal of tests from LOPs additionally decreased orders to a final extent of 75.8% ± 8.0% (n = 322 ± 31) in NTproBNP tests. The 30-day readmission rate and overall length of hospital stay did not increase. Conclusions Our results indicate that cardiac markers in routine care are subject to extensive overutilization when used within LOPs. Educational measures are an effective strategy to overcome the overutilization of cardiac markers but may be more effective when combined with the removal of cardiac markers from LOPs.
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Affiliation(s)
- Martin H Keppel
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Tobias Kolbitsch
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Uta C Hoppe
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Simon Auer
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Thomas K Felder
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hannes Oberkofler
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Cornelia Mrazek
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
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11
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Paquette P, Higgins J, Danino MA, Harris P, Lamontagne M, Gagnon DH. Effects of a preoperative neuromobilization program offered to individuals with carpal tunnel syndrome awaiting carpal tunnel decompression surgery: A pilot randomized controlled study. JOURNAL OF HAND THERAPY : OFFICIAL JOURNAL OF THE AMERICAN SOCIETY OF HAND THERAPISTS 2020. [PMID: 32151500 DOI: 10.1016/b978-0-12-815499-1.00003-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN Pilot randomized controlled trial with parallel groups. INTRODUCTION Engaging individuals with carpal tunnel syndrome (CTS) awaiting carpal tunnel decompression surgery in a preoperative rehabilitation program may mitigate pain and sensorimotor impairments, enhance functional abilities before surgery, and improve postoperative outcomes. PURPOSE OF THE STUDY To assess the feasibility and the efficacy of a novel preoperative neuromobilization exercise program (NEP). METHODS Thirty individuals with CTS were randomly allocated into a four-week home-based neuromobilization exercise group or a standard care group while awaiting surgery. Outcome measures included feasibility (ie, recruitment, attrition, adherence, satisfaction, and safety) and efficacy metrics (ie, median nerve integrity and neurodynamics, tip pinch grip, pain, and upper limb functional abilities) collected before (ie, at the baseline and about four weeks later) and four weeks after surgery. RESULTS Thirty individuals with CTS were recruited (recruitment rate = 11.8%) and 25 completed the study (attrition rate = 16.7%). Adherence (94%) and satisfaction with the program (eg, enjoy the exercises and likeliness to repeat the NEP (≥4.2/5) were high and no serious adverse event was reported. NEP-related immediate pre- and post-surgery beneficial effects on pain interference were documented (P = .05, η2 = .10), whereas an overall increased neurodynamics (P = .04, η2 = .11) and decreased pain severity (P = .01, η2 = .21) were observed. DISCUSSION Engaging in the proposed NEP has limited beneficial effect as a stand-alone intervention on pre- and post-surgery outcomes for individuals with CTS. Expanding the program's content and attribute by adding other components including desensitization maneuvers and novel therapies promoting corticospinal plasticity is recommended. CONCLUSION A preoperative NEP completed by individuals with CTS awaiting surgery is feasible, acceptable, and safe. However, given the limited beneficial effectsof the program, revision of its content and attributes is recommended before proceeding to large-scale trials.
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Affiliation(s)
- Philippe Paquette
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Johanne Higgins
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Michel Alain Danino
- Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Patrick Harris
- Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Martin Lamontagne
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Dany H Gagnon
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.
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12
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McKeeman GC, Hall SL, Freedman DB. Reflex and reflective testing practice in Clinical Biochemistry in the United Kingdom – a national survey. Ann Clin Biochem 2019; 57:77-87. [DOI: 10.1177/0004563219888541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background/aims The addition of further tests to patient samples, whether by reflex (automated) methods or reflectively after result review, remains an important function of the diagnostic laboratory. This can assist clinicians with interpretation of results and aid further management. We aimed to investigate how this is performed within Clinical Biochemistry laboratories across the United Kingdom (UK). Methods A questionnaire, consisting of 16 clinical scenarios, was circulated to Clinical Biochemistry laboratories across the UK via the Association for Clinical Biochemistry and Laboratory Medicine (ACB) office. The survey sought to examine opinion on what tests are considered reflex and reflective, which staff members are involved in addition of further tests, whether clinicians are contacted and how abnormal results are handled. Results Responses were received from 74 laboratories, and data were compiled for each scenario surveyed. The majority of laboratories are adding calcium and magnesium, reflectively, to confirm hyperkalaemia or hypocalcaemia, and a number of additional endocrine tests are also commonly performed in particular scenarios. However, there are variations in what is regarded as reflex and reflective testing, in how this testing is conducted within the laboratory and in the level of communication with the requesting clinician. Discussion We present the consensus views of the survey participants for a number of commonly used additional tests within Clinical Biochemistry and a discussion on current reflex and reflective testing practice based on the survey results and evidence, where it exists. There is a need for harmonization and national guidance in this area.
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Affiliation(s)
- Gareth C McKeeman
- Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast, UK
| | - Sally L Hall
- Department of Clinical Biochemistry, Luton and Dunstable University Hospital, Luton, UK
| | - Danielle B Freedman
- Department of Clinical Biochemistry, Luton and Dunstable University Hospital, Luton, UK
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13
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Flatman R. Terminology, units and reporting - how harmonized do we need to be? Clin Chem Lab Med 2019; 57:1-11. [PMID: 29883319 DOI: 10.1515/cclm-2017-1083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/23/2018] [Indexed: 12/29/2022]
Abstract
Harmonization initiatives in laboratory medicine seek to eliminate or reduce illogical variations in service to patients, clinicians and other healthcare professionals. Significant effort will be required to achieve consistent application of terminology, units and reporting across laboratory testing providers. Current variations in practice for nomenclature, reference intervals, flagging, units, standardization and traceability between analytical methods, and presentation of cumulative result data are inefficient and inconvenient, or worse yet, patient safety risks. All aspects of laboratory service across the "total testing process" ultimately depend on concise, reliable communication. Clinical terminologies (e.g. SNOMED-CT, LOINC, IFCC/IUPAC NPU) provide a mechanism to correctly identify an analyte or panel of tests within a request for testing and communicate the results back to the clinician or electronic health record (EHR). Electronic systems for requesting and reporting laboratory testing are said to be interoperable when reliable connection and communication of content occur. Modern electronic reports and EHRs will provide greater flexibility and functionality, but also require effective guidelines or standards to ensure consistent representation of laboratory data. Programs to harmonize service in these areas require ongoing local, national and international efforts and should incorporate stakeholders from laboratories, medical staff, information technology and informatics specialists, patient representatives and government. The process of identifying harmonized best practice, then ensuring uptake across many laboratory testing providers, is generally iterative rather than "one off". New opportunities for additional harmonization will be generated as analytical performance, standardization and traceability, and diagnosis and treatment continue to evolve.
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Affiliation(s)
- Robert Flatman
- Sullivan Nicolaides Pathology - Biochemistry Department, 24 Hurworth St, Bowen Hills, Qld 4068, Australia, Phone: 0733778526
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14
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Church DL, Naugler C. Benefits and risks of standardization, harmonization and conformity to opinion in clinical laboratories. Crit Rev Clin Lab Sci 2019; 56:287-306. [PMID: 31060412 DOI: 10.1080/10408363.2019.1615408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Large laboratory systems that include facilities with a range of capabilities and capacity are being created within consolidated healthcare systems. This paradigm shift is being driven by administrators and payers seeking to achieve resource efficiencies and to conform practice to the requirements of computerization as well as the adoption of electronic medical records. Although standardization and harmonization of practice improves patient care outcomes and operational efficiencies, administratively driven practice conformity (conformity to opinion) also has serious drawbacks and may lead to significant system failure. Juxtaposition of the distinct philosophical approaches of physicians and scientists (i.e. "professionalism") versus administrators and managers (i.e. "managerialism") towards bringing about conformity of the laboratory system inherently creates conflict. Despite an administrative edict to "perform all tests using the same methods" regardless of available "best practice" evidence to do so, medical/scientific input on these decisions is critical to ensure quality and safety of patient care. Innovation within the laboratory system, including the adoption of advanced technologies, practices, and personalized medicine initiatives, will be enabled by balancing the relentless drive by non-medical administration to meet "business" requirements, the medical responsibility to provide the best care possible, and customizing practice to meet individual patient care needs.
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Affiliation(s)
- Deirdre L Church
- a Department of Pathology and Laboratory Medicine , University of Calgary , Calgary , Canada.,b Department of Medicine , University of Calgary , Calgary , Canada
| | - Christopher Naugler
- a Department of Pathology and Laboratory Medicine , University of Calgary , Calgary , Canada.,c Department of Community Health Sciences , University of Calgary , Calgary , Canada.,d Department of Family Medicine , University of Calgary , Calgary , Canada
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15
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Jacobs JFM, Bossuyt X. Standardization and harmonization of autoimmune diagnostics. Clin Chem Lab Med 2019; 56:1563-1567. [PMID: 30120908 DOI: 10.1515/cclm-2018-0807] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Joannes F M Jacobs
- Department of Laboratory Medicine, Laboratory Medical Immunology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Geert Grooteplein 10 (Route 469), 6525 GA Nijmegen, The Netherlands
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
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16
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Vasikaran S. Assessment of bone turnover in osteoporosis: harmonization of the total testing process. Clin Chem Lab Med 2019; 56:1603-1607. [PMID: 29381471 DOI: 10.1515/cclm-2017-1109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/02/2018] [Indexed: 11/15/2022]
Abstract
Abstract
An imbalance between bone formation and bone resorption is a factor in the development of osteoporosis. Bone turnover markers (BTM) are useful in assessing bone remodeling at the cellular level. Measurement of BTM is useful for assessing bone turnover and therefore fracture risk as well as for monitoring response to treatment response. This paper describes the steps that have been taken so far and the ongoing work to harmonize the total testing process for the assessment of bone turnover in osteoporosis internationally and collaboratively between the clinical and laboratory professions. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) in collaboration with the International Osteoporosis Foundation (IOF) as well as the National Bone Health Association (NBHA) in the US have designated procollagen type I N propeptide (s-PINP), and cross-linked β-isomerized type I collagen C-telopeptide (s-βCTX), in blood as reference standard BTM. Collaborative efforts are ongoing in order to standardize preanalytical steps as well as the analysis of s-PINP and s-CTX by standardizing or harmonizing their measurement as appropriate and reporting of values. Reporting units have been standardized. Reference interval studies and examination of appropriate decision thresholds, reference change values and treatment targets are ongoing with the aim of harmonizing the total testing process for the assessment of bone turnover in osteoporosis.
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Affiliation(s)
- Samuel Vasikaran
- Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
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17
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Bukve T, Sandberg S, Vie WS, Sølvik U, Christensen NG, Stavelin A. Commutability of a Whole-Blood External Quality Assessment Material for Point-of-Care C-Reactive Protein, Glucose, and Hemoglobin Testing. Clin Chem 2019; 65:791-797. [DOI: 10.1373/clinchem.2018.300202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/06/2019] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
The optimal situation in external quality assessment (EQA) is to use commutable materials. No previous study has examined the commutability of a whole-blood material for point-of-care (POC) testing. The aim of this study was to determine the commutability of the Norwegian Quality Improvement of Laboratory Examinations (Noklus) organization's “in-house” whole-blood EQA material for C-reactive protein (CRP), glucose, and hemoglobin for frequently used POC instruments in Norway and to determine the possibility of using a common target value for each analyte.
METHODS
The study was performed according to the Clinical and Laboratory Standards Institute guidelines. The EQA material was pooled stabilized EDTA venous whole-blood containing different concentrations of the analytes. The EQA material and native routine patient samples were analyzed using 17 POC and 3 hospital instruments. The commutability was assessed using Deming regression analysis with 95% prediction intervals for each instrument comparison.
RESULTS
The EQA material was commutable for all CRP and hemoglobin POC instruments, whereas for glucose the material was commutable for all POC instruments at the lowest concentration analyzed [126.0 mg/dL (7.0 mmol/L)] and for 3 POC instruments at all of the concentrations analyzed.
CONCLUSIONS
Noklus EQA participants using CRP and hemoglobin POC instruments now receive results that are compared with a reference target value, whereas the results for participants using glucose POC instruments are still compared with method-specific target values. Systematic deviations from a reference target value for the commutable glucose POC instruments can be calculated, and this additional information can now be offered to these participants and to the manufacturers.
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Affiliation(s)
- Tone Bukve
- Norwegian Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- Norwegian Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Wenche S Vie
- Norwegian Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Una Sølvik
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Nina G Christensen
- Norwegian Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Anne Stavelin
- Norwegian Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
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18
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Plebani M. Harmonization in laboratory medicine: more than clinical chemistry? Clin Chem Lab Med 2018; 56:1579-1586. [DOI: 10.1515/cclm-2017-0865] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Abstract
The goal of harmonizing laboratory information is to contribute to quality in patient care, ultimately improving upon patient outcomes and safety. The main focus of harmonization and standardization initiatives has been on analytical processes within the laboratory walls, clinical chemistry tests in particular. However, two major evidences obtained in recent years show that harmonization should be promoted not only in the analytical phase but also in all steps of the testing process, encompassing the entire field of laboratory medicine, including innovative areas (e.g. “omics”) rather than just conventional clinical chemistry tests. A large body of evidence demonstrates the vulnerability of the extra-analytical phases of the testing cycle. Because only “good biological samples” can assure good analytical quality, a closer interconnection between the different phases of the cycle is needed. In order to provide reliable and accurate laboratory information, harmonization activities should cover all steps of the cycle from the “pre-pre-analytical” phase (right choice of test at right time for right patient) through the analytical steps (right results with right report) to the “post-post-analytical” steps (right and timely acknowledgment of laboratory information, right interpretation and utilization with any necessary advice as to what to do next with the information provided). In addition, modern clinical laboratories are performing a broad menu of hundreds of tests, covering both traditional and innovative subspecialties of the discipline. In addition, according to a centered viewpoint, harmonization initiatives should not be addressed exclusively to clinical chemistry tests but should also include all areas of laboratory medicine.
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Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine , University-Hospital of Padova , Via Nicolo Giustiniani 2 , 35128 Padova , Italy
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19
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Choy KW. Global call to arms for physicians and clinical laboratories: harmonised approach to non-serum body fluid testing. Intern Med J 2018; 48:1007-1008. [PMID: 30133986 DOI: 10.1111/imj.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/25/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Kay W Choy
- Department of Pathology, Monash Health, Melbourne, Victoria, Australia
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20
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Stavelin A, Sandberg S. Harmonization activities of Noklus – a quality improvement organization for point-of-care laboratory examinations. ACTA ACUST UNITED AC 2018; 57:106-114. [DOI: 10.1515/cclm-2018-0061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/13/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Noklus is a non-profit quality improvement organization that focuses to improve all elements in the total testing process. The aim is to ensure that all medical laboratory examinations are ordered, performed and interpreted correctly and in accordance with the patients’ needs for investigation, treatment and follow-up. For 25 years, Noklus has focused on point-of-care (POC) testing in primary healthcare laboratories and has more than 3100 voluntary participants. The Noklus quality system uses different tools to obtain harmonization and improvement: (1) external quality assessment for the pre-examination, examination and postexamination phase to monitor the harmonization process and to identify areas that need improvement and harmonization, (2) manufacturer-independent evaluations of the analytical quality and user-friendliness of POC instruments and (3) close interactions and follow-up of the participants through site visits, courses, training and guidance. Noklus also recommends which tests that should be performed in the different facilities like general practitioner offices, nursing homes, home care, etc. About 400 courses with more than 6000 delegates are organized annually. In 2017, more than 21,000 e-learning programs were completed.
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Affiliation(s)
- Anne Stavelin
- The Norwegian Quality Improvement of Laboratory Examinations (Noklus) , Haraldsplass Deaconess Hospital , Box 6165 , N-5892 Bergen , Norway , Phone: +4755979503, Fax: +4755979510
| | - Sverre Sandberg
- The Norwegian Quality Improvement of Laboratory Examinations (Noklus) , Haraldsplass Deaconess Hospital , Bergen , Norway
- Department of Public Health and Primary Health Care , Faculty of Medicine and Dentistry , University of Bergen , Bergen , Norway
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21
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Tozzoli R, Bizzaro N. Harmonization in autoimmune thyroid disease diagnostics. ACTA ACUST UNITED AC 2018; 56:1778-1782. [DOI: 10.1515/cclm-2018-0037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/16/2018] [Indexed: 11/15/2022]
Abstract
Abstract
In this review we analyze all aspects of total testing process regarding the measurement of antithyroid peroxidase, antithyroglobulin and antithyrotropin receptor autoantibodies. The main critical points related to the preanalytical, analytical and postanalytical steps of autoimmune thyroid disease diagnostics are considered, focusing on harmonization of autoimmune thyroid tests request, retesting intervals, terminology of thyroid autoantibodies, measurement units and definition of reference limits. Harmonization in thyroid autoantibody testing is a relevant example of feasible harmonization in autoimmunology.
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Affiliation(s)
- Renato Tozzoli
- Laboratory of Clinical Pathology, S. Maria degli Angeli Hospital , Pordenone , Italy
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, S. Maria degli Angeli Hospital , Pordenone , Italy
- Via M.L. King 25 , 30027 San Donà di Piave , Venice , Italy
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Du H, Markus C, Metz M, Feng M, Loh TP. Derivation of Outcome-Based Pediatric Critical Values. Am J Clin Pathol 2018; 149:324-331. [PMID: 29474506 DOI: 10.1093/ajcp/aqx165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES There is currently a lack of an outcomes-based definition of critical values for the pediatric population. This has contributed to a highly heterogeneous critical value reporting practice between laboratories. METHODS Anonymized results were extracted from a laboratory information system for 10 biochemistry tests. The probability of high-dependency/intensive care unit admission (as a proxy for adverse outcomes) for each individual laboratory concentration was calculated and adjusted to fit using a polynomial function to model the probability trend. The laboratory value that intersected the 90% probability trend line was considered the critical value threshold. RESULTS The critical value thresholds for the serum analytes were sodium (mmol/L: <131, >148), potassium (mmol/L: <2.4, >6.4), bicarbonate (mmol/L: <13, >37), chloride (mmol/L: <91, >115), urea (mmol/L: >12), creatinine (μmol/L: >129), glucose (mmol/L: >17.2), total calcium (mmol/L: <1.9), magnesium (mmol/L: <0.6, >1.2), and phosphate (mmol/L: <0.4, >2.6). CONCLUSIONS This study described an approach to derive contemporary pediatric critical value thresholds.
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Affiliation(s)
- Hao Du
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Corey Markus
- Division of Chemical Pathology, SA Pathology, Women’s and Children’s Hospital, South Australia, Australia
| | - Michael Metz
- Division of Chemical Pathology, SA Pathology, Women’s and Children’s Hospital, South Australia, Australia
- School of Paediatrics and Reproductive Health, University of Adelaide, South Australia, Australia
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Tze Ping Loh
- Biomedical Institute for Global Health Research and Technology, National University of Singapore, Singapore
- Department of Laboratory Medicine, National University Hospital, Singapore
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Buoro S, Da Rin G, Fanelli A, Lippi G. Harmonization of interpretative comments in laboratory hematology reporting: the recommendations of the Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH-SIBioC). ACTA ACUST UNITED AC 2018; 57:66-77. [DOI: 10.1515/cclm-2017-0972] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022]
Abstract
Abstract
The goal of harmonizing laboratory testing is contributing to improving the quality of patient care and ultimately ameliorating patient outcome. The complete blood and leukocyte differential counts are among the most frequently requested clinical laboratory tests. The morphological assessment of peripheral blood cells (PB) through microscopic examination of properly stained blood smears is still considered a hallmark of laboratory hematology. Nevertheless, a variable inter-observer experience and the different terminology used for characterizing cellular abnormalities both contribute to the current lack of harmonization in blood smear revision. In 2014, the Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH-SIBioC) conducted a national survey, collecting responses from 78 different Italian laboratories. The results of this survey highlighted a lack of harmonization of interpretative comments in hematology, which prompted the WGDH-SIBioC to develop a project on “Harmonization of interpretative comments in the laboratory hematology report”, aimed at identifying appropriate comments and proposing a standardized reporting system. The comments were then revised and updated according to the 2016 revision of the World Health Organization classification of hematologic malignancies. In 2016, the Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH SIBioC) published its first consensus based recommendation for interpretative comments in laboratory hematology reporting whit the purpose of evaluating comments and the aim to (a) reducing their overall number, (b) standardizing the language, (c) providing information that could be easily comprehended by clinicians and patients, (d) increasing the quality of the clinical information, and (e) suggesting additional diagnostic tests when necessary. This paper represents a review of the recommendations of the former document.
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Affiliation(s)
- Sabrina Buoro
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII , Bergamo , Italy
| | - Giorgio Da Rin
- Laboratory Medicine, San Bassiano Hospital , AULSS 7 Pedemontana, Via dei Lotti, 40 , 36061 Bassano del Grappa , Italy
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry , University Hospital of Verona , Verona , Italy
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Kalra S, Agarwal S, Aggarwal R, Ranabir S. Trimester-specific Thyroid-stimulating Hormone: An Indian Perspective. Indian J Endocrinol Metab 2018; 22:1-4. [PMID: 29535927 PMCID: PMC5838886 DOI: 10.4103/ijem.ijem_107_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - Sameer Agarwal
- Department of Endocrinology, PGIMS, Rohtak, Haryana, India
| | | | - Salam Ranabir
- Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
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Orth M, Averina M, Chatzipanagiotou S, Faure G, Haushofer A, Kusec V, Machado A, Misbah SA, Oosterhuis W, Pulkki K, Twomey PJ, Wieland E. Opinion: redefining the role of the physician in laboratory medicine in the context of emerging technologies, personalised medicine and patient autonomy ('4P medicine'). J Clin Pathol 2017; 72:191-197. [PMID: 29273576 PMCID: PMC6580792 DOI: 10.1136/jclinpath-2017-204734] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/22/2017] [Accepted: 12/01/2017] [Indexed: 11/12/2022]
Abstract
The role of clinical pathologists or laboratory-based physicians is being challenged on several fronts—exponential advances in technology, increasing patient autonomy exercised in the right to directly request tests and the use of non-medical specialists as substitutes. In response, clinical pathologists have focused their energies on the pre-analytical and postanalytical phases of Laboratory Medicine thus emphasising their essential role in individualised medical interpretation of complex laboratory results. Across the European Union, the role of medical doctors is enshrined in the Medical Act. This paper highlights the relevance of this act to patient welfare and the need to strengthen training programmes to prevent an erosion in the quality of Laboratory Medicine provided to patients and their physicians.
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Affiliation(s)
- Matthias Orth
- Vinzenz von Paul Kliniken gGmbH, Institut für Laboratoriumsmedizin, Stuttgart, Germany.,Medizinische Fakultät Mannheim, Ruprecht Karls Universität, Mannheim, Germany
| | - Maria Averina
- Diagnostisk klinikk, Laboratoriemedisin, Universitessykehuset Nord-Norge HF, Tromsø, Norway
| | - Stylianos Chatzipanagiotou
- Department of Clinical Microbiology and Medical Biopathology, National and Kapodistrian University of Athens, Medical School - Aeginition Hospital, Athens, Greece
| | - Gilbert Faure
- Laboratoire d'Immunologie, Pole Laboratoires, Centre Hospitalier Universitaire de Nancy, Nancy, Lorraine, France
| | - Alexander Haushofer
- Klinikum Wels - Grieskirchen GmbH, Institut für Medizinische und Chemische Labordiagnostik mit Blutbank, Wels, Austria
| | - Vesna Kusec
- Klinicki Zavod za Laboratorijsku Dijagnostiku, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia
| | - Augusto Machado
- Department of Botelho Moniz Análises Clínicas, SA, Porto, Portugal
| | - Siraj A Misbah
- Department of Clinical Immunology, Oxford University Hospitals, Oxford, UK
| | - Wytze Oosterhuis
- Department of Clinical Chemistry and Haematology, Atrium Medical Center, PC Heerlen, Netherlands
| | - Kari Pulkki
- Department of Clinical Chemistry, Eastern Finland Laboratory Centre and University of Eastern Finland, Kuopio, Finland
| | - Patrick J Twomey
- Department of Clinical Chemistry, St. Vincent's University Hospital/St Vincent's Group Healthcare Group, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Eberhard Wieland
- Klinikum Stuttgart, Zentrum für Diagnostik, Zentralinstitut für Klinische Chemie und Laboratoriumsmedizin, Stuttgart, Germany
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Bezzegh A, Takács I, Ajzner É. Toward harmonization of interpretive commenting of common laboratory tests. Clin Biochem 2017; 50:612-616. [DOI: 10.1016/j.clinbiochem.2017.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/29/2017] [Accepted: 05/22/2017] [Indexed: 12/11/2022]
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National Survey of Adult and Pediatric Reference Intervals in Clinical Laboratories across Canada: A Report of the CSCC Working Group on Reference Interval Harmonization. Clin Biochem 2017. [PMID: 28647526 DOI: 10.1016/j.clinbiochem.2017.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Reference intervals are widely used decision-making tools in laboratory medicine, serving as health-associated standards to interpret laboratory test results. Numerous studies have shown wide variation in reference intervals, even between laboratories using assays from the same manufacturer. Lack of consistency in either sample measurement or reference intervals across laboratories challenges the expectation of standardized patient care regardless of testing location. Here, we present data from a national survey conducted by the Canadian Society of Clinical Chemists (CSCC) Reference Interval Harmonization (hRI) Working Group that examines variation in laboratory reference sample measurements, as well as pediatric and adult reference intervals currently used in clinical practice across Canada. DESIGN AND METHODS Data on reference intervals currently used by 37 laboratories were collected through a national survey to examine the variation in reference intervals for seven common laboratory tests. Additionally, 40 clinical laboratories participated in a baseline assessment by measuring six analytes in a reference sample. RESULTS Of the seven analytes examined, alanine aminotransferase (ALT), alkaline phosphatase (ALP), and creatinine reference intervals were most variable. As expected, reference interval variation was more substantial in the pediatric population and varied between laboratories using the same instrumentation. Reference sample results differed between laboratories, particularly for ALT and free thyroxine (FT4). Reference interval variation was greater than test result variation for the majority of analytes. CONCLUSION It is evident that there is a critical lack of harmonization in laboratory reference intervals, particularly for the pediatric population. Furthermore, the observed variation in reference intervals across instruments cannot be explained by the bias between the results obtained on instruments by different manufacturers.
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Ceriotti F, Barhanovic NG, Kostovska I, Kotaska K, Perich Alsina MC. Harmonisation of the laboratory testing process: need for a coordinated approach. Clin Chem Lab Med 2017; 54:e361-e363. [PMID: 27149202 DOI: 10.1515/cclm-2016-0244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 03/29/2016] [Indexed: 11/15/2022]
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Armbruster D. Metrological Traceability of Assays and Comparability of Patient Test Results. Clin Lab Med 2017; 37:119-135. [DOI: 10.1016/j.cll.2016.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Plebani M. Harmonization in laboratory medicine: Requests, samples, measurements and reports. Crit Rev Clin Lab Sci 2015; 53:184-96. [DOI: 10.3109/10408363.2015.1116851] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tate JR, Johnson R, Barth JH, Panteghini M. “Harmonization of laboratory testing — A global activity”. Clin Chim Acta 2014; 432:1-3. [DOI: 10.1016/j.cca.2014.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 02/07/2014] [Indexed: 11/27/2022]
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