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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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2
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Theodorsson E, Meijer P, Badrick T. External quality assurance in the era of standardization. Clin Chim Acta 2024; 557:117876. [PMID: 38493945 DOI: 10.1016/j.cca.2024.117876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
Metrology in clinical chemistry aims to ensure the equivalence of measurement results from different in-vitro diagnostic measurement devices (IVD MD) for use in healthcare. The metrological traceability of measurement results to higher-order references is the cornerstone to achieving equivalent results. However, other fundamentals are also needed, including the commutability of reference materials and external quality assessment (EQA) materials for monitoring the equivalence of measurement results at the end-user level. This manuscript summarizes the findings and opinions expressed at the Joint Community for Traceability in Laboratory Medicine (JCTLM) workshop held on December 4-5, 2023. The workshop explored the relationship between EQA/proficiency testing and metrological traceability to higher-order references. EQA monitors the equivalence of measurement results from end-user IVD MDs. The workshop discussed the role and challenges of using EQA to improve and maintain the equivalence of measurement results. It also elucidated current developments in establishing the clinical suitability of laboratory results expressed as analytical performance specifications (APS).
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Affiliation(s)
- Elvar Theodorsson
- Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden.
| | - Piet Meijer
- ECAT Foundation, Voorschoten, The Netherlands
| | - Tony Badrick
- RCPA Quality Assurance Programs, St Leonards, Sydney, Australia
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3
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Nsawotebba A, Ibanda I, Mujuni D, Nabadda S, Nadunga D, Kabugo J, Adam I, Wekiya E, Nyombi A, Nsubuga R, Ademun P, Musisi K, Kangave F, Joloba M. Impact of randomized blinded rechecking program on the performance of the AFB Microscopy Laboratory Network in Uganda: a decadal retrospective study. BMC Infect Dis 2023; 23:494. [PMID: 37495964 PMCID: PMC10373387 DOI: 10.1186/s12879-023-08406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Smear microscopy has remained the initial diagnostic test for presumptive tuberculosis (TB) patients in health facilities without the World Health Organization (WHO) recommended rapid diagnostic tools. In the Uganda TB laboratory network, the technique remains the only tool to monitor response to treatment among drug susceptible TB patients, with the country currently having over 1,600 microscopy TB testing units. It has been evidenced that acid-fast bacilli (AFB) microscopy's yield highly depends on the staining technique and reading ability of the laboratory personnel. For the quality of TB testing in the country, the TB control program set up a Randomized Blinded Rechecking (RBRC) program in 2008 to monitor the testing performance of laboratories to continuously improve the reliability and efficiency of results. This is the first study to determine the effectiveness and impact of the RBRC program on the performance of the participating laboratories in Uganda. METHODS This was a retrospective cross-sectional study based on a record review of the RBRC's annual results compilations between January 2008 and December 2017. RESULTS Between January 2008 and December 2017, a total of 265,523 smears were re-checked during the RBRC program. The number of enrolled laboratories in the RBRC program rose from 660 to 2008 to 1,406 in 2017. The RBRC program resulted in a statistically significant reduction in microscopy errors, with false positives decreasing from 12.8% to 2008 to 7.6% in 2017, false positive errors decreasing from 10 to 6.3%, false negative errors decreasing from 2.9 to 0.7%, quantification errors decreasing from 6.0 to 1.8%, and the overall sensitivity of smear microscopy compared to the controllers increased with statistical significance from 93 to 97%. CONCLUSION The study reveals an overall significant error reduction and an improved sensitivity of smear microscopy upon continuous implementation of the RBRC program in an AFB microscopy TB laboratory network. Implementation of a RBRC program is crucial and essential to maintaining a reliable TB laboratory service that can facilitate accurate diagnosis and offset the disadvantages of using smear microscopy.
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Affiliation(s)
- Andrew Nsawotebba
- Department of National Health Laboratory and Diagnostic Services, National Health Laboratory Services, Kampala, Uganda.
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda.
| | - Ivan Ibanda
- Department of National Health Laboratory and Diagnostic Services, National Health Laboratory Services, Kampala, Uganda
- Department of Pharmacology and Pharmacotherapeutics, School of Medicine and Surgery, King Ceasor University, Kampala, Uganda
| | - Dennis Mujuni
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Susan Nabadda
- Department of National Health Laboratory and Diagnostic Services, National Health Laboratory Services, Kampala, Uganda
| | - Diana Nadunga
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Joel Kabugo
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Isa Adam
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Enock Wekiya
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Abdunoor Nyombi
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Richard Nsubuga
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Patrick Ademun
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Kenneth Musisi
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Fredrick Kangave
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Moses Joloba
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University, Kampala, Uganda
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4
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An Adequate Pharmaceutical Quality System for Personalized Preparation. Pharmaceutics 2023; 15:pharmaceutics15030800. [PMID: 36986661 PMCID: PMC10059061 DOI: 10.3390/pharmaceutics15030800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
The pharmacy compounding of personalized preparations has evolved a great deal, and with it, the way of working and the legal requirements have also evolved. An adequate pharmaceutical quality system for personalized preparations presents fundamental differences with respect to the system designed for industrial medicines since the size, complexity, and characteristics of the activity of the manufacturing laboratory and the applications and uses of the manufactured medicines must be taken into account. Legislation must advance and adapt to the needs of personalized preparations, filling the deficiencies currently found in this field. The limitations of personalized preparation in its pharmaceutical quality system are analysed and a method based on a proficiency testing program specially designed to overcome these limitations is proposed: the Personalized Preparation Quality Assurance Program (PACMI). This method makes it possible to expand the samples and destructive tests, and dedicate more resources, facilities, and equipment. It allows for more in-depth knowledge of the product and the processes used, and for proposed improvements that increase the overall quality for improved patient health. PACMI introduces tools used in risk management in order to guarantee the quality of an essentially heterogeneous service: personalized preparation.
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Buchta C, Coucke W, Huf W, Griesmacher A, Müller MM, Mayr WR, Flesland Ø, Politis C, Wiersum-Osselton J, Aburto A, Badrick T, Bouacida L, Budina M, Duenas JA, Geilenkeuser WJ, Guimarães AVP, Hecimovic A, Jutzi M, Lee CK, Lim YA, Mammen J, Molnár PM, Mokhtari A, Morabito G, Muñiz-Diaz E, Niekerk T, Pakkanen A, Pezzati P, Popa R, Sárkány E, Siest JP, Suvagandha D, Thelen M, Ullhagen J, Vitkus D, Körmöczi GF. External quality assessment providers' services appear to more impact the immunohaematology performance of laboratories than national regulatory and economic conditions. Clin Chem Lab Med 2022; 60:361-369. [PMID: 35041777 DOI: 10.1515/cclm-2021-1219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Medical laboratories may, at their own discretion, exceed but not undercut regulatory quality requirements. Available economic resources, however, may drive or hinder eagerness to exceed minimum requirements. Depending on the respective scopes of regulatory and economic framework conditions, differing levels of quality efforts to safeguard laboratory performance can be anticipated. However, this has not yet been investigated. METHODS Immunohaematology external quality assessment (EQA) results collected by 26 EQA providers from their participant laboratories in 73 countries from 2004 to 2019 were evaluated. Error rates were aggregated in groups according to the respective national regulatory and economic framework conditions, to whether or not expert advice was provided in case of incorrect results, and the frequency of EQA samples. RESULTS These representative data indicate no association between national regulatory (mandatory participation in EQA, monitoring of performance of individual laboratories by authorities, financial consequences of incorrect results) and economic (level of national income, share of national health expenditure) conditions to the quality performance of medical laboratories in immunohaematology. However, EQA providers' support for laboratories in the event of incorrect results appear to be associated with lower error rates, but a high EQA sample frequency with higher error rates. CONCLUSIONS Further research into the impact of introducing or changing services of EQA providers is needed to confirm the results found in this first of its kind study.
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Affiliation(s)
- Christoph Buchta
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | | | - Wolfgang Huf
- Karl Landsteiner Institute for Clinical Risk Management, Vienna, Austria
| | - Andrea Griesmacher
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Mathias M Müller
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Wolfgang R Mayr
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria.,Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Constantina Politis
- Coordinating Haemovigilance Centre and Surveillance of Transfusion (SKAEM) of the Hellenic National Public Health Organization, Marousi, Greece
| | - Johanna Wiersum-Osselton
- TRIP (Transfusion and Transplantation Reactions in Patients) Hemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - Andrés Aburto
- Instituto de Salud Pública de Chile (ISPCH), Santiago, Chile
| | - Tony Badrick
- The Royal College of Pathologists of Australasia, Quality Assurance Programs (RCPAQAP), St. Leonards, Australia
| | | | | | - Joseph A Duenas
- American Association of Bioanalysts Proficiency Testing (AAB-PT), Houston, TX, USA
| | | | | | - Ana Hecimovic
- Croatian Institute for Transfusion Medicine (CITM), Zagreb, Croatia
| | - Markus Jutzi
- Interregionale Blutspende SRK AG, Ringversuchszentrum (RVZ SRK), Bern, Switzerland
| | - Chang-Keun Lee
- Institute for Quality Management in Healthcare (IQMH) Centre for Proficiency Testing, Toronto, Canada
| | - Young Ae Lim
- Korean Association of External Quality Assessment Service (KAEQAS), Seoul, Korea.,Department of Laboratory Medicine, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Joy Mammen
- Christian Medical College Vellore (CMC Vellore), Vellore, Tamil Nadu, India
| | | | - Azita Mokhtari
- Bio-Rad Laboratories - External Quality Assurance Services (EQAS), Irvine, CA, USA
| | | | - Eduardo Muñiz-Diaz
- Immunohematology Department, Blood and Tissue Bank of Catalonia, External Quality Assessment on Immunohematology of the Spanish Society of Blood Transfusion (SETS), Barcelona, Spain
| | - Truscha Niekerk
- South African National Blood Service Proficiency Testing Scheme (SANBS PTS), Weltevreden Park, South Africa
| | | | | | - Razvan Popa
- Asociatia Pentru Calitate in Laboratoare (CALILAB), Bucharest, Romania
| | - Erika Sárkány
- QualiCont In vitro Diagnostic Quality Control Nonprofit Ltd., Szeged, Hungary
| | | | - Dhitiwass Suvagandha
- Division of Proficiency Testing, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Marc Thelen
- Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), Nijmegen, Netherlands
| | | | - Dalius Vitkus
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Günther F Körmöczi
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria.,Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
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6
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Buchta C, Camp JV, Jovanovic J, Radler U, Benka B, Puchhammer-Stöckl E, Müller MM, Griesmacher A, Aberle SW, Görzer I. Inadequate design of mutation detection panels prevents interpretation of variants of concern: results of an external quality assessment for SARS-CoV-2 variant detection. Clin Chem Lab Med 2021; 60:291-298. [PMID: 34751522 DOI: 10.1515/cclm-2021-0889] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Mutation-specific PCR assays have quickly found their way into laboratory diagnostics due to their capacity to be a fast, easy to implement and high-throughput method for the detection of known SARS-CoV-2 variants of concern (VoCs). However, little is known about the performance of such assays in routine laboratory analysis. METHODS The results reported in a recent round of an external quality assessment (EQA) scheme for SARS-CoV-2 mutation-specific PCR were retrospectively analyzed. For the determination of individual variant-specific sequences as well as for the interpretation results for certain virus variants, correct, incorrect, and unreported results were evaluated, and their possible causes were investigated. RESULTS A total of 34 laboratories participated in this study. For five samples containing the VoC Alpha + E484K, Beta, Gamma, Delta, or B.1.1.318 (as a variant of interest), 848 results for SARS-2-CoV mutation detection were reported, 824 (97.2%, range per sample 88-100%) of which were correct. Melting curve assays gave 99% correct results, real-time RT-qPCR 94%, microarray-based assays 100%, and MALDI-TOF MS 96%. A total of 122/167 (73%) reported results for SARS-CoV-2 variant determination were correct. Of the 45 inconclusive or incorrect results, 33 (73%) were due to inadequate selection of targets that did not allow identification of contemporary VoC, 11 (24%) were due to incorrect results, and one (3%) was due to correct results of mutation-specific PCR. CONCLUSIONS Careful and up-to-date selection of the targets used in mutation-specific PCR is essential for successful detection of current SARS-CoV-2 variants.
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Affiliation(s)
- Christoph Buchta
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Jeremy V Camp
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Jovana Jovanovic
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Ulla Radler
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Bernhard Benka
- Division Public Health, AGES - Austrian Agency for Health and Food Safety, Vienna, Austria
| | | | - Mathias M Müller
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Andrea Griesmacher
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Stephan W Aberle
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Irene Görzer
- Center for Virology, Medical University of Vienna, Vienna, Austria
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7
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Buchta C, Camp JV, Jovanovic J, Chiba P, Puchhammer-Stöckl E, Mayerhofer M, Plicka H, Lercher A, Popa AM, Endler L, Bergthaler A, Huf W, Benka B, Delatour V, Müller MM, Griesmacher A, Aberle SW, Görzer I. The versatility of external quality assessment for the surveillance of laboratory and in vitro diagnostic performance: SARS-CoV-2 viral genome detection in Austria. Clin Chem Lab Med 2021; 59:1735-1744. [PMID: 34187131 DOI: 10.1515/cclm-2021-0604] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES External quality assessment (EQA) schemes provide information on individual and general analytical performance of participating laboratories and test systems. The aim of this study was to investigate the use and performance of SARS-CoV-2 virus genome detection systems in Austrian laboratories and their preparedness to face challenges associated with the pandemic. METHODS Seven samples were selected to evaluate performance and estimate variability of reported results. Notably, a dilution series was included in the panel as a measure of reproducibility and sensitivity. Several performance criteria were evaluated for individual participants as well as in the cohort of all participants. RESULTS A total of 109 laboratories participated and used 134 platforms, including 67 different combinations of extraction and PCR platforms and corresponding reagents. There were no false positives and 10 (1.2%) false negative results, including nine in the weakly positive sample (C t ∼35.9, ∼640 copies/mL). Twenty (22%) laboratories reported results of mutation detection. Twenty-five (19%) test systems included amplification of human RNA as evidence of proper sampling. The overall linearity of C t values from individual test systems for the dilution series was good, but inter-assay variability was high. Both operator-related and systematic failures appear to have caused incorrect results. CONCLUSIONS Beyond providing certification for participating laboratories, EQA provides the opportunity for participants to evaluate their performance against others so that they may improve operating procedures and test systems. Well-selected EQA samples offer additional inferences to be made about assay sensitivity and reproducibility, which have practical applications.
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Affiliation(s)
- Christoph Buchta
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Jeremy V Camp
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Jovana Jovanovic
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Peter Chiba
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | | | - Maximilian Mayerhofer
- Armament and Defence Technology Agency, NBC & Environmental Protection Technology Division, Vienna, Austria
| | - Helga Plicka
- Armament and Defence Technology Agency, NBC & Environmental Protection Technology Division, Vienna, Austria
| | - Alexander Lercher
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Alexandra M Popa
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Lukas Endler
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Andreas Bergthaler
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Wolfgang Huf
- Karl Landsteiner Institute for Clinical Risk Management, Vienna, Austria
| | - Bernhard Benka
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection, Vienna, Austria
| | - Vincent Delatour
- Laboratoire National de Métrologie et d'Essais (LNE), Paris, France
| | - Mathias M Müller
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Andrea Griesmacher
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Stephan W Aberle
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Irene Görzer
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria.,Center for Virology, Medical University of Vienna, Vienna, Austria
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Shrivastava J. Assessors assemble: the need for harmonised external quality assessment schemes for emerging diagnostic methodologies in the field of parasitology. Trans R Soc Trop Med Hyg 2020; 113:820-822. [PMID: 30576480 DOI: 10.1093/trstmh/try129] [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: 09/14/2018] [Revised: 11/12/2018] [Accepted: 12/06/2018] [Indexed: 11/14/2022] Open
Abstract
Global travel and migration trends have meant a huge increase in the numbers of people exposed to tropical parasitic diseases. Thus, there is an increasing need for robust, reproducible and reliable diagnostic techniques in the field. Advanced molecular and lateral flow techniques have pushed the boundaries of clinical parasite diagnostics with their enhanced sensitivities and specificities. These emerging technologies are, however, not without their challenges, and recently there has been multiple evidence of a lack of consensus among protocols and results obtained by quality assessment of these novel technologies. This commentary discusses findings from some recent quality assessment studies in the field of blood and faecal parasitology. The article also makes recommendations for a unified and harmonised approach towards delivering high-quality clinical parasitology diagnoses, especially through the use of proficiency testing.
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Affiliation(s)
- Jaya Shrivastava
- UK NEQAS Parasitology, National Infection Services, Public Health England, The Halo, 1 Mabledon Place, London WC1H 9AZ, United Kingdom
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9
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Badrick T, Stavelin A. Harmonising EQA schemes the next frontier: challenging the status quo. Clin Chem Lab Med 2020; 58:1795-1797. [DOI: 10.1515/cclm-2020-0343] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/28/2020] [Indexed: 01/17/2023]
Abstract
Abstract
There is a focus on standardisation and harmonisation of laboratory results to reduce the risk of misinterpretation of patient results assayed in different laboratories. External quality assessment (EQA) is critical to assess the need for harmonisation and to monitor the success of procedures to achieve harmonisation. However, EQA providers are being stretched to meet the needs of their participants with proven commutable material with reference method targets, a range of clinically significant levels of the materials, detailed and customised data analysis, and educational support. The path ahead for harmonisation of EQA schemes will require leadership from an organisation that has the support and confidence of EQA providers, like the European Organisation for External Qualily Assurance Providers in Laboratory Medicine.
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Affiliation(s)
- Tony Badrick
- Royal College of Pathologists of Australasia Quality Assurance Programs , St Leonards, Sydney , Australia
| | - Anne Stavelin
- The Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Diaconess Hospital , Bergen , Norway
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10
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Kristoffersen AH, Stavelin AV, Ajzner E, Kristensen GB, Sandberg S, Van Blerk M, Kitchen S, Kesseler D, Woods TA, Meijer P. Pre-analytical practices for routine coagulation tests in European laboratories. A collaborative study from the European Organisation for External Quality Assurance Providers in Laboratory Medicine (EQALM). ACTA ACUST UNITED AC 2019; 57:1511-1521. [DOI: 10.1515/cclm-2019-0214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 04/01/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Correct handling and storage of blood samples for coagulation tests are important to assure correct diagnosis and monitoring. The aim of this study was to assess the pre-analytical practices for routine coagulation testing in European laboratories.
Methods
In 2013–2014, European laboratories were invited to fill in a questionnaire addressing pre-analytical requirements regarding tube fill volume, citrate concentration, sample stability, centrifugation and storage conditions for routine coagulation testing (activated partial thromboplastin time [APTT], prothrombin time in seconds [PT-sec] and as international normalised ratio [PT-INR] and fibrinogen).
Results
A total of 662 laboratories from 28 different countries responded. The recommended 3.2% (105–109 mmol/L) citrate tubes are used by 74% of the laboratories. Tube fill volumes ≥90% were required by 73%–76% of the laboratories, depending upon the coagulation test and tube size. The variation in centrifugation force and duration was large (median 2500 g [10- and 90-percentiles 1500 and 4000] and 10 min [5 and 15], respectively). Large variations were also seen in the accepted storage time for different tests and sample materials, for example, for citrated blood at room temperature the accepted storage time ranged from 0.5–72 h and 0.5–189 h for PT-INR and fibrinogen, respectively. If the storage time or the tube fill requirements are not fulfilled, 72% and 84% of the respondents, respectively, would reject the samples.
Conclusions
There was a large variation in pre-analytical practices for routine coagulation testing in European laboratories, especially for centrifugation conditions and storage time requirements.
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Affiliation(s)
- Ann Helen Kristoffersen
- Department of Medical Biochemistry and Pharmacology , Haukeland University Hospital , Bergen , Norway
- Norwegian Quality Improvement of Laboratory Examinations (Noklus) , Haraldsplass Deaconess Hospital , Bergen , Norway
| | - Anne V. Stavelin
- Norwegian Quality Improvement of Laboratory Examinations (Noklus) , Haraldsplass Deaconess Hospital , Bergen , Norway
| | - Eva Ajzner
- Central Laboratory , Jósa University Hospital , Nyíregyháza , Hungary
| | - Gunn B.B. Kristensen
- Norwegian Quality Improvement of Laboratory Examinations (Noklus) , Haraldsplass Deaconess Hospital , Bergen , Norway
| | - Sverre Sandberg
- Department of Medical Biochemistry and Pharmacology , Haukeland University Hospital , Bergen , Norway
- Norwegian Quality Improvement of Laboratory Examinations (Noklus) , Haraldsplass Deaconess Hospital , Bergen , Norway
- Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
| | | | - Steve Kitchen
- UK NEQAS for Blood Coagulation , Sheffield , UK
- Sheffield Haemophilia and Thrombosis Centre , Sheffield , UK
| | - Dagmar Kesseler
- Quality Control Center Switzerland (CSCQ) , Chêne-Bourg , Switzerland
| | | | - Piet Meijer
- ECAT foundation , Voorschoten , The Netherlands
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Verderio P, Pizzamiglio S, Ciniselli CM. Methodological and statistical issues in developing an External Quality Assessment scheme in laboratory medicine: Focus on biomarker research. N Biotechnol 2019; 52:54-59. [PMID: 31059865 DOI: 10.1016/j.nbt.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 11/16/2022]
Abstract
External Quality Assessment (EQA) schemes are well-established tools with which to evaluate, monitor and improve the output quality of clinical laboratories, recognising that high quality laboratory medicine is essential for patient care. EQA programs involve the testing of multiple laboratories and the statistical comparison of their results, according to a multistep workflow. New clinical laboratory activities, such as biomarker research, require new EQA schemes. Critical elements in designing EQA programs are choosing the statistical methods and defining reference values and control limits. This article summarizes the key features of an EQA scheme, including designing the study, identifying reference values and control limits for qualitative and quantitative data, and graphically reporting laboratory performance statistics. These steps are illustrated with examples taken from the authors' experience in national and international quality assessment schemes for biomarker research.
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Affiliation(s)
- Paolo Verderio
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Sara Pizzamiglio
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Maura Ciniselli
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Stavelin A, Sandberg S. Essential aspects of external quality assurance for point-of-care testing. Biochem Med (Zagreb) 2017; 27:81-85. [PMID: 28392729 PMCID: PMC5382857 DOI: 10.11613/bm.2017.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/24/2016] [Indexed: 11/18/2022] Open
Abstract
External quality assurance (EQA) or proficiency testing for point-of-care (POC) testing is in principle similar to EQA for larger hospital laboratories, but the participants are different. The participants are usually health care personnel with little or no knowledge of laboratory medicine. The implication of this is that the EQA provider has to a) convince the participants that participation in EQA schemes are important, b) be able to circulate materials with reasonable time intervals, c) produce feedback reports that are understandable, and d) offer help and guidance to the participants when needed. It is also important that EQA for POC testing e) address the pre-examination, the examination and the post-examination processes, and f) that schemes for measurement procedures using interval or ordinal scale are offered. The aim of the present paper is to highlight important issues of these essential aspects of EQA for POC testing.
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Affiliation(s)
- Anne Stavelin
- The Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- The Norwegian Quality Improvement of Primary Care Laboratories (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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De la Salle B, Meijer P, Thomas A, Simundic AM. Special issue on External Quality Assessment in Laboratory Medicine - current challenges and future trends. Biochem Med (Zagreb) 2017; 27:19-22. [PMID: 28392722 PMCID: PMC5382846 DOI: 10.11613/bm.2017.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | - Piet Meijer
- ECAT Foundation, Voorschoten, The Netherlands
| | - Annette Thomas
- WEQAS Quality Laboratory, Cardiff and Vale University Health Board, Llanishen, Cardiff, UK
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia; Editor-in-Chief, Biochemia Medica, Zagreb, Croatia
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Lippi G, Simundic AM. The EFLM strategy for harmonization of the preanalytical phase. ACTA ACUST UNITED AC 2017; 56:1660-1666. [DOI: 10.1515/cclm-2017-0277] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/27/2017] [Indexed: 11/15/2022]
Abstract
Abstract
The Working Group for the Preanalytical Phase (WG-PRE) was officially established by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) in 2013, with the aim of improving harmonization in the preanalytical phase across European member societies. Since its early birth, the WG-PRE has already completed a number of projects, including harmonizing the definition of fasting status, patient and blood tubes identification, color coding of blood collection tubes, sequence of tubes during blood drawing and participation in the development of suitable preanalytical quality indicators. The WG-PRE has also provided guidance on local validation of blood collection tubes, has performed two European surveys on blood sampling procedures and has organized four European meetings to promote the importance of quality in the preanalytical phase. The future activities entail development and validation of an external quality assessment scheme focused on preanalytical variables, development and dissemination of a survey about the local management of unsuitable samples in clinical laboratories, as well as release of EFLM phlebotomy guidelines. This article summarizes all recent achievements of the WG-PRE and illustrates future projects to promote harmonization in the preanalytical phase.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry , University Hospital of Verona , P.le LA Scuro 10, 37134 Verona , Italy , European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE)
| | - Ana-Maria Simundic
- European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE) ; and Department of Medical Laboratory Diagnostics , University Hospital Sveti Duh , Zagreb , Croatia
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