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Krintus M, Panteghini M. Laboratory-related issues in the measurement of cardiac troponins with highly sensitive assays. Clin Chem Lab Med 2021; 58:1773-1783. [PMID: 32134723 DOI: 10.1515/cclm-2020-0017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
A number of assay-related issues can affect the performance of cardiac troponin (cTn) measurement in everyday practice. In this respect, it is vital that all information on cTn assays is known and that the performance characteristics of assays are objectively assessed and adequately described. The advent of the latest generation of more sensitive cTn assays has heralded a new wave of information about low concentrations of cTn in blood. These recent generation assays have improved analytical sensitivity and corresponding performance at low cTn concentrations when compared to their predecessors, providing a convincing goal for laboratory medicine in helping clinicians in the diagnosis of acute myocardial infarction. Crucial to the clinical utility of highly sensitive cTn assays is the laboratorians' role in closely scrutinizing proposed assays and defining their value in relation to available evidence. Analytical, as well as pre-analytical and post-analytical, aspects must be documented. In this review, we describe what laboratory professionals should know about their cTn assay performance characteristics and the pre-analytical prerequisites for robustness to ensure optimal post-analytical reporting.
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Affiliation(s)
- Magdalena Krintus
- Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland, Phone: +48 52 585 44 90, Fax: +48 52 585 36 03
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
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Can Çubukçu H, Vanstapel F, Thelen M, Bernabeu-Andreu FA, van Schrojenstein Lantman M, Brugnoni D, Mesko Brguljan P, Milinkovic N, Linko S, Vaubourdolle M, O'Kelly R, Kroupis C, Lohmander M, Šprongl L, Panteghini M, Boursier G. Improving the laboratory result release process in the light of ISO 15189:2012 standard. Clin Chim Acta 2021; 522:167-173. [PMID: 34418364 DOI: 10.1016/j.cca.2021.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022]
Abstract
The ISO 15189:2012 standard section 5.9.1 requires laboratories to review results before release, considering quality control, previous results, and clinical information, if any, and to issue documented procedures about it. While laboratory result reporting is generally regarded as part of the post-analytical phase, the result release process requires a general view of the total examination process. Reviewing test results may follow with troubleshooting and test repetition, including reanalyzing an individual sample or resampling. A systematic understanding of the result release may help laboratory professionals carry out appropriate test repetition and ensure the plausibility of laboratory results. In this paper, we addressed the crucial steps in the result release process, including evaluation of sample quality, critical result notification, result reporting, and recommendations for the management of the result release, considering quality control alerts, instrument flags, warning messages, and interference indexes. Error detection tools and plausibility checks mentioned in the present paper can support the daily practice of results release.
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Affiliation(s)
- Hikmet Can Çubukçu
- Ankara University Stem Cell Institute, Interdisciplinary Stem Cells and Regenerative Medicine, Ankara, Turkey.
| | - Florent Vanstapel
- Laboratory Medicine, Department of Public Health, Biomedical Sciences Group, University Hospital Leuven, Belgium, KU Leuven, Leuven, Belgium
| | - Marc Thelen
- Result Laboratory for Clinical Chemistry, Amphia Hospital Breda, the Netherlands,; Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Marith van Schrojenstein Lantman
- Result Laboratory for Clinical Chemistry, Amphia Hospital Breda, the Netherlands,; Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Duilio Brugnoni
- Clinical Chemistry Laboratory, Spedali Civili, Brescia, Italy
| | - Pika Mesko Brguljan
- Department of Clinical Chemistry, University Clinic for Respiratory and Allergic Deseases, Golnik, Slovenia
| | - Neda Milinkovic
- Department of Medical Biochemistry, Pharmaceutical Faculty, University of Belgrade, Belgrade, Serbia
| | | | | | - Ruth O'Kelly
- Association of Clinical Biochemists in Ireland, Ireland
| | - Christos Kroupis
- Department of Clinical Biochemistry, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Haidari, Greece
| | - Maria Lohmander
- Regional Laboratoriemedicin, Sahlgrenska Universitetssjukhuset, Trollhättan/Göteborg, Sweden
| | - Luděk Šprongl
- Clinical Laboratory, Hospital Kladno, Kladno, Czech Republic
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", and Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milano, Italy
| | - Guilaine Boursier
- Dept of Genetics, Rare Diseases and Personalized Medicine Rare Diseases and Autoinflammatory Unit, CHU Montpellier, Montpellier, France
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Peters GW, Kelly JR, Beckta JM, White M, Marks LB, Ford E, Evans SB. An Evaluation of Health Numeracy among Radiation Therapists and Dosimetrists. Adv Radiat Oncol 2020; 6:100609. [PMID: 34027232 PMCID: PMC8134660 DOI: 10.1016/j.adro.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose Medical errors in radiation oncology sometimes involve tasks reliant on practitioners’ grasp of numeracy. Numeracy has been shown to be suboptimal across various health care professionals. Herein, we assess health numeracy among American Society of Radiologic Technologists (ASRT) members. Methods and materials The Numeracy Understanding for Medicine instrument (NUMi), an instrument to measure numeracy in the general population, was adapted to oncology for this study and distributed to ASRT members (n = 14,228) in 2017. Per NUMi scoring, health numeracy scores were categorized as low (0-7), low average (8-12), high average (13-17), or high (18-20). The impact of cGy versus Gy on numeracy performance was investigated. Spearman’s rho and a Wilcox-Mann-Whitney test were used for comparisons between the different groups. Results A total of 662 eligible participants completed the instrument and identified as radiation oncology professionals. In the cGy and Gy NUMi scores, approximately 2% of respondents scored low-average, approximately 40% scored high-average, and approximately 58% scored high, with a median score of 18.0. Although the optimum NUMi score for ASRT members is unknown, one might expect our cohort to have numeracy skills at least as high as college freshmen. Roughly one-sixth of our study group scored at or below the average score of college freshmen (NUMi = 15). In the subset analysis of NUMi questions pertaining to radiation dose unit (cGy vs Gy), respondents performed better with cGy (mean score: 2.94; range, 2-3) versus Gy (mean: 2.91; range, 0-3; P = .011). Conclusions In this study of limited sample size, overall numeracy is quite good compared with the general population. However, the range of scores is wide, and some respondents have lower scores that may be concerning, suggesting that numeracy may be an issue that requires improvement for a subset of the studied cohort. Performance was superior with the unit cGy; thus, the adoption of cGy as the standard unit is reasonable.
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Affiliation(s)
- Gabrielle W Peters
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Jacqueline R Kelly
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Jason M Beckta
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Marney White
- School of Public Health, Yale University School of Medicine, New Haven, Connecticut
| | - Lawrence B Marks
- Division of Health Care Engineering and Lineberger Cancer Center, Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Eric Ford
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Suzanne B Evans
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
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Panteghini M. How Clinical Laboratories May Improve Their Performance: The “High-Sensitivity” Troponin Paradigm. Clin Chem 2018; 64:621-623. [DOI: 10.1373/clinchem.2017.285577] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/02/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Mauro Panteghini
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan Medical School, Milan, Italy
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Schneider BSP, Nagelhout E, Feng D. Characteristics of Tables for Disseminating Biobehavioral Results. Biol Res Nurs 2017; 20:70-76. [PMID: 28929780 DOI: 10.1177/1099800417724901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To report the complexity and richness of study variables within biological nursing research, authors often use tables; however, the ease with which consumers understand, synthesize, evaluate, and build upon findings depends partly upon table design. OBJECTIVES To assess and compare table characteristics within research and review articles published in Biological Research for Nursing and Nursing Research. METHOD A total of 10 elements in tables from 48 biobehavioral or biological research or review articles were analyzed. To test six hypotheses, a two-level hierarchical linear model was used for each of the continuous table elements, and a two-level hierarchical generalized linear model was used for each of the categorical table elements. Additionally, the inclusion of probability values in statistical tables was examined. RESULTS The mean number of tables per article was 3. Tables in research articles were more likely to contain quantitative content, while tables in review articles were more likely to contain both quantitative and qualitative content. Tables in research articles had a greater number of rows, columns, and column-heading levels than tables in review articles. More than one half of statistical tables in research articles had a separate probability column or had probability values within the table, whereas approximately one fourth had probability notes. CONCLUSIONS Authors and journal editorial staff may be generating tables that better depict biobehavioral content than those identified in specific style guidelines. However, authors and journal editorial staff may want to consider table design in terms of audience, including alternative visual displays.
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Affiliation(s)
| | - Ed Nagelhout
- 2 Department of English, University of Nevada, Las Vegas, NV, USA
| | - Du Feng
- 1 School of Nursing, University of Nevada, Las Vegas, NV, USA
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Evans SB, Fraass BA, Berner P, Collins KS, Nurushev T, O'Neill MJ, Zeng J, Marks LB. Standardizing dose prescriptions: An ASTRO white paper. Pract Radiat Oncol 2016; 6:e369-e381. [PMID: 27693224 DOI: 10.1016/j.prro.2016.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/12/2016] [Accepted: 08/16/2016] [Indexed: 11/30/2022]
Abstract
This white paper recommends the standardization (content and presentation order) of several "key components" of the radiation therapy prescription to facilitate accurate communication between radiation therapy care providers. The rationale, other similar efforts, and detailed considerations are described. In brief, the Task Force recommends that the prescription's "elements" include: treatment site, method of delivery, dose per fraction, total number of fractions, total dose (eg, right breast, tangent photons, 267 cGy * 16 = 4272 cGy). A similar formalism is recommended for brachytherapy (eg, cervix, Ir-192 brachytherapy, 600cGy * 5 = 3000 cGy) and other modalities. The white paper also considers future directions for other items such as the simulation order, treatment planning objectives, prescription point or volume, treatment schedule, localization imaging, laboratory monitoring, concurrent chemotherapy, patient instructions for treatment, etc. The intent of this white paper is to facilitate accurate communication among providers to support safe practice as well as to guide vendors in product development that is consistent with this standard prescription.
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Affiliation(s)
- Suzanne B Evans
- Department of Radiation Oncology, Yale University, New Haven, Connecticut.
| | - Benedick A Fraass
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Paula Berner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kevin S Collins
- School of Allied Health, Southern Illinois University, Carbondale, Illinois
| | | | | | - Jing Zeng
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
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Eley R, Sinnott M, Steinle V, Trenning L, Boyde M, Dimeski G. The need to address poor numeracy skills in the emergency department environment. Emerg Med Australas 2014; 26:300-2. [PMID: 24712881 DOI: 10.1111/1742-6723.12207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2014] [Indexed: 11/27/2022]
Abstract
Substantial evidence exists for lack of numerical skills among many health professionals. Although poor numeracy has long been recognised as a contributor to medication error, other activities for which numerical literacy are required, such as interpretation of diagnostic results, have been largely ignored. Poor self-awareness of lack of numerical literacy increases the risk, especially in the busy and hurried emergency environment. System changes, such as standardising units and improving number presentation, reduce the potential for misinterpretation; however system changes do not address the underlying deficiencies in mathematical skills. The training of doctors in numeracy has been largely ignored. In contrast, education for nurses frequently occurs during both pre- and post-registration programmes. Interventions have had mixed success, although additional emphasis in increasing conceptual understanding of numbers is encouraging. The consequences of poor numerical literacy should be addressed in all clinical staff, not only by practice change to remove the potential for errors to be made, but also complemented by self-awareness and education.
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Affiliation(s)
- Robert Eley
- School of Medicine, Southside Clinical School, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia; Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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