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Silva IL, Martinello F. Analytical performance of publicly dispensed glucometers in primary health care in a southern Brazilian city. Pract Lab Med 2024; 41:e00421. [PMID: 39155971 PMCID: PMC11328008 DOI: 10.1016/j.plabm.2024.e00421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/12/2024] [Accepted: 07/21/2024] [Indexed: 08/20/2024] Open
Abstract
Aims This study aimed to assess the use of glucometers by patients and the analytical performance of glucometers provided by the primary care services. Methods The analytical performance of 48 glucometers Accu-Chek® Active, was assessed through quintuplicate analyses of one Roche and one PNCQ (National Quality Control Program) control sample at different concentrations; 31 were also evaluated by a single proficiency testing sample. The evaluation metrics included imprecision, bias, and total error and were measured according to quality specifications based on biological variation (QSBV). Glucometer users answered a questionnaire regarding their experience. Results Among the 48 glucometers evaluated with internal control samples, 17 met precision criteria at both control levels according to QSBV, while 24 met the criteria at only one control level. Of the 31 glucometers further evaluated through proficiency test, 11 met accuracy criteria according to QSBV, and only one device showed an unacceptable result. Out of these 31, only 15 demonstrated a total error within the acceptable maximum limits based on QSBV. Conclusions Overall, our findings showed that patients had a good understanding of glucometer usage and suggested that some glucometers should be replaced, as they sometimes failed to meet even the manufacturer's acceptable variation limits, and/or did not meet QSBV.
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Affiliation(s)
- Isabelle L. Silva
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, Santa Catarina State, Brazil
| | - Flávia Martinello
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, Santa Catarina State, Brazil
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2
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Panteghini M. An improved implementation of metrological traceability concepts is needed to benefit from standardization of laboratory results. Clin Chem Lab Med 2024; 0:cclm-2024-0428. [PMID: 38687497 DOI: 10.1515/cclm-2024-0428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
Non-harmonization of laboratory results represents a concrete risk for patient safety. To avoid harms, it is agreed that measurements by in vitro diagnostic medical devices (IVD-MD) on clinical samples should be traceable to higher-order references and adjusted to give the same result. However, metrological traceability is not a formal claim and has to be correctly implemented, which in practice does not happen for a non-negligible number of measurands. Stakeholders, such as higher-order reference providers, IVD manufacturers, and External Quality Assessment organizers, have major responsibilities and should improve their contribution by unambiguously and rigorously applying what is described in the International Organization for Standardization 17511:2020 standard and other documents provided by the international scientific bodies, such as Joint Committee on Traceability in Laboratory Medicine and IFCC. For their part, laboratory professionals should take responsibility to abandon non-selective methods and move to IVD-MDs displaying proper selectivity, which is one of the indispensable prerequisites for the correct implementation of metrological traceability. The practicality of metrological traceability concepts is not impossible but relevant education and appropriate training of all involved stakeholders are essential to obtain the expected benefits in terms of standardization.
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Affiliation(s)
- Mauro Panteghini
- Department of Laboratory Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
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3
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Panteghini M. Redesigning the surveillance of in vitro diagnostic medical devices and of medical laboratory performance by quality control in the traceability era. Clin Chem Lab Med 2022; 61:759-768. [PMID: 36542481 DOI: 10.1515/cclm-2022-1257] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Abstract
IVD manufacturers have total responsibility in terms of the traceability of marketed in vitro diagnostic medical devices (IVD-MD). This includes the provision of a quality control (QC) material as a part of the measuring system, suitable for traceability verification and alignment surveillance by end-users in daily practice. This material [to be used for the internal QC (IQC) component I as described in this paper] should have unbiased target values and an acceptability range corresponding to analytical performance specifications (APS) for suitable (expanded) measurement uncertainty (MU) on clinical samples. On the other hand, medical laboratories (by the IQC component II as described in this paper) should improve the IQC process and its judging criteria to establish a direct link between their performance, estimated as MU of provided results, and APS defined according to recommended models to apply corrective actions if the performance is worsening with the risk to jeopardize the clinical validity of test results. The participation to external quality assessment (EQA) programs that meet specific metrological criteria is also central to the evaluation of performance of IVD-MDs and of medical laboratories in terms of harmonization and clinical suitability of their measurements. In addition to the use of commutable materials, in this type of EQA it is necessary to assign values to them with selected reference procedures and to define and apply maximum allowable APS to substantiate the suitability of laboratory measurements in the clinical setting.
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Affiliation(s)
- Mauro Panteghini
- Centre for Metrological Traceability in Laboratory Medicine (CIRME) , University of Milan , Milano , Italy
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4
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Badrick T. Integrating quality control and external quality assurance. Clin Biochem 2021; 95:15-27. [PMID: 33965412 DOI: 10.1016/j.clinbiochem.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022]
Abstract
Effective management of clinical laboratories relies upon an understanding of Quality Control and External Quality Assurance principles. These processes, when applied effectively, reduce patient risk and drive quality improvement. In this Review, we will describe the purpose of QC and EQA and their role in identifying analytical and process error. The two concepts are linked, and we will illustrate that linkage. Some EQA providers offer far more than analytical surveillance. They facilitate training and education and extend quality improvement and identify areas where there is potential for patient harm into the pre-and post-analytical phases of the total testing process.
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Affiliation(s)
- Tony Badrick
- Royal College of Pathologists of Australasia Quality Assurance Program, St Leonards, Sydney 2065, Australia.
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Tong Q, Zhang S, Zuo C. EQA/PT scheme to improve the equivalence of enzymatic results between mutual recognition laboratories in Beijing. J Clin Lab Anal 2021; 35:e23814. [PMID: 33948986 PMCID: PMC8183905 DOI: 10.1002/jcla.23814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background To utilize the external quality assessment (EQA)/proficiency testing (PT) scheme to evaluate the equivalence of different clinical enzymatic measuring systems in Beijing. Methods The Beijing Center for Clinical Laboratory (BCCL) distributed three investigation samples to mutual recognition clinical laboratories in Beijing including alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ‐glutamyltransferase (GGT), creatine kinase (CK), and lactate dehydrogenase (LDH). These samples were derived from serum pools with values assigned by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) enzymatic reference measurement procedures (RMPs). Each laboratory performed duplicate tests of the samples. Then, the samples at level 1 were used to recalibrate individual measuring systems for repeating the tests. BCCL collected data for evaluation of their analytical quality. Results Before recalibration, the biases of ALT and AST tests were not traceable to the IFCC RMPs, and the bias pass rates of GGT, CK, and LDH tests were only 51.2%, 55.7%, and 48.6% respectively. After recalibration, the pass rates of ALT, AST, GGT, CK, and LDH increased to 95.1%, 82.9%, 95.1%, 97.1%, and 70.0% respectively. The EQA/PT also showed that after recalibration, more than 95% of laboratories met the optimum level specifications of the biological variation for ALT, AST, GGT, and CK tests and the desirable for LDH tests. Conclusion The enzymatic tests in Beijing need to be further standardized by category 1 or 2 EQA/PT scheme for mutual recognition between clinical laboratories. The criteria of biological variation are more relevant for determining the equivalence of clinical enzymatic tests.
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Affiliation(s)
- Qing Tong
- Beijing Center for Clinical Laboratories, Beijing Chao-Yang Hospital affiliated to Capital Medical University, Beijing, China
| | - Shunli Zhang
- Department of Clinical Laboratory, Beijing Chao-Yang Hospital affiliated to Capital Medical University, Beijing, China
| | - Chang Zuo
- Department of Clinical Laboratory, Beijing Chao-Yang Hospital affiliated to Capital Medical University, Beijing, China
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6
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van der Hagen EAE, Weykamp C, Sandberg S, Stavelin AV, MacKenzie F, Miller WG. Feasibility for aggregation of commutable external quality assessment results to evaluate metrological traceability and agreement among results. Clin Chem Lab Med 2020; 59:117-125. [PMID: 32759402 DOI: 10.1515/cclm-2020-0736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/22/2020] [Indexed: 11/15/2022]
Abstract
Objectives External quality assessment (EQA) with commutable samples is used for assessing agreement of results for patients' samples. We investigated the feasibility to aggregate results from four different EQA schemes to determine the bias between different measurement procedures and a reference target value. Methods We aggregated EQA results for creatinine from programs that used commutable EQA material by calculating the relative difference between individual participant results and the reference target value for each sample. The means and standard errors of the means were calculated for the relative differences. Results were partitioned by methods, manufacturers and instrument platforms to evaluate the biases for the measurement procedures. Results Data aggregated for enzymatic methods had biases that varied from -8.2 to 3.8% among seven instrument platforms for creatinine at normal concentrations (61-85 μmol/L). EQA schemes differed in the evidence provided about the commutability of their samples, and in the amount of detail collected from participants regarding the measurement procedures which limited the ability to sub-divide aggregated data by instrument platforms and models. Conclusions EQA data could be aggregated from four different programs using different commutable samples to determine bias among different measurement procedures. Criteria for commutability for EQA samples as well as standardization of reporting the measurement methods, reagents, instrument platforms and models used by participants are needed to improve the ability to aggregate the results for optimal assessment of performance of measurement procedures. Aggregating data from a larger number of EQA schemes is feasible to assess trueness on a global scale.
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Affiliation(s)
- Eline A E van der Hagen
- Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), Nijmegen, The Netherlands.,Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, The Netherlands
| | - Cas Weykamp
- Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), Nijmegen, The Netherlands.,Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, The Netherlands
| | - Sverre Sandberg
- The Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Noklus, Bergen, Norway
| | - Anne V Stavelin
- The Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Noklus, Bergen, Norway
| | - Finlay MacKenzie
- Birmingham Quality/UK NEQAS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
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Jassam N, Thomas A, Hayden K, Dearman R, Barth JH. The impact of the analytical performance specifications of calcium and albumin on adjusted calcium. Ann Clin Biochem 2020; 57:382-388. [DOI: 10.1177/0004563220944426] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AimThe generation of accurate, comparable results from traceable measurement procedures is a primary goal in harmonization efforts. In this study, the analytical performance of routine methods for calcium and albumin measurement is assessed to define the impact of the analytical bias of calcium and albumin on adjusted calcium equation performance and on reference intervals.MethodIn collaboration with the Wales External Quality Assurance Scheme, six months’ worth of anonymized data that cover a concentration range of clinical interest were collected. The data were grouped by analytical platforms/methods.ResultsAlbumin BCG methods are positively biased (8%) to BCP methods. The overall bias for BCP methods ranges from 5.1 to –4.3% and the overall bias for BCG methods is from 2 to –6.7%. Bias for both methods is higher than the allowable minimal bias for albumin. Calcium concentrations for Roche Cobas CPC and NM-BAPTA, Beckman Arsenazo III, Abbott Architect Arsenazo III were within bias of 1.5 to –1%. However, Siemens calcium methods CPC and Arsenazo III appear to suffer from concentration-dependent bias ranging from +3 to –6%, which exceeds even the minimal allowable limits for calcium (1.3%). Adjusted calcium shows significant bias of 11%. Even with the exclusion of Siemens Advia, the scatter of adjusted calcium results exceeds that for total calcium.ConclusionThis study shows wider than acceptable analytical variation for albumin and calcium. This variation may contribute to overall adjusted calcium equations variation and invalidate the application of a harmonized reference interval for calcium and albumin.
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Affiliation(s)
- N Jassam
- Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK
| | - A Thomas
- Weqas, Cardiff and Vale University Health Board, Cardiff, UK
| | - K Hayden
- Faculty of Biology, Medicine and Health, Manchester University, Manchester, UK
| | - R Dearman
- Department Clinical Biochemistry, Manchester University Hospital, Manchester, UK
| | - JH Barth
- Departments of Clinical Biochemistry, Leeds Teaching Hospitals Trust, Leeds, UK
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Kim S, Chang J, Kim SK, Park S, Huh J, Jeong TD. Sample size and rejection limits for detecting reagent lot variability: analysis of the applicability of the Clinical and Laboratory Standards Institute (CLSI) EP26-A protocol to real-world clinical chemistry data. Clin Chem Lab Med 2020; 59:127-138. [PMID: 32628625 DOI: 10.1515/cclm-2020-0454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/19/2020] [Indexed: 12/29/2022]
Abstract
Objectives To maintain the consistency of laboratory test results, between-reagent lot variation should be verified before using new reagent lots in clinical laboratory. Although the Clinical and Laboratory Standards Institute (CLSI) document EP26-A deals with this issue, evaluation of reagent lot-to-lot difference is challenging in reality. We aim to investigate a practical way for determining between-reagent lot variation using real-world data in clinical chemistry. Methods The CLSI EP26-A protocol was applied to 83 chemistry tests in three clinical labs. Three criteria were used to define the critical difference (CD) of each test as follows: reference change value and total allowable error, which are based on biological variation, and acceptable limits by external quality assurance agencies. The sample size and rejection limits that could detect CD between-reagent lots were determined. Results For more than half of chemistry tests, reagent lot-to-lot differences could be evaluated using only one patient sample per decision level. In many cases, the rejection limit that could detect reagent lot-to-lot difference with ≥90% probability was 0.6 times CD. However, the sample size and rejection limits vary depending on how the CD is defined. In some cases, impractical sample size or rejection limits were obtained. In some cases, information on sample size and rejection limit that met intended statistical power was not found in EP26-A. Conclusions The CLSI EP26-A did not provide all necessary answers. Alternative practical approaches are suggested when CLSI EP26-A does not provide guidance.
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Affiliation(s)
- Sollip Kim
- Department of Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Jeonghyun Chang
- Department of Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Soo-Kyung Kim
- Department of Laboratory Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Sholhui Park
- Department of Laboratory Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jungwon Huh
- Department of Laboratory Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Tae-Dong Jeong
- Department of Laboratory Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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Perich Alsina C, Ricós C, Marqués F, Minchinela J, Salas A, Martínez-Bru C, Boned B, Gómez-Rioja R, Cortés M, González-Lao E, García Lario JV, Tejedor X, Bullich S, Ventura M, González-Tarancón R, Fernández-Fernández P, Ramón F, Corte Z, Llopis MA, Díaz-Garzón J, Simón M, Fernández-Calle P. Programas de garantía externa de la calidad SEQC ML. Evolución de las prestaciones analíticas de los laboratorios clínicos a lo largo de 30 años y comparación con otros programas. ADVANCES IN LABORATORY MEDICINE 2020; 1:20190024. [PMCID: PMC10159287 DOI: 10.1515/almed-2019-0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/02/2020] [Indexed: 12/29/2023]
Abstract
Objetivos El objetivo de este estudio es conocer la evolución de la prestación analítica de los laboratorios participantes en los programas EQA de la SEQCML durante los 30 años de funcionamiento y compararla con la prestación obtenida en otros programas EQA para saber si los resultados son similares. Métodos Se evalúan los resultados obtenidos durante este periodo, aplicando las especificaciones de la calidad derivadas de la VB y del estado del arte. Además, se realiza una comparación con los resultados obtenidos por otras organizaciones de programas EQA. Resultados Se observa que los laboratorios participantes en los programas EQA-SEQCML han mejorado su prestación durante los 30 años de experiencia y que las especificaciones derivadas de la variación biológica son alcanzables. La comparación entre programas EQA es difícil, debido a: la falta de accesibilidad y a las diferencias en el diseño de estos programas (materiales control, cálculos empleados y especificaciones analíticas establecidas). Conclusiones Los datos de este estudio ponen de manifiesto que para algunas magnitudes biológicas los resultados obtenidos en los programas todavía no están armonizados, aunque se estan realizando esfuerzos para alcanzar la armonización. Los organizadores de programas EQA deberían sumarse al esfuerzo de armonización, facilitando la información sobre sus resultados para permitir su comparación.
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Affiliation(s)
- Carmen Perich Alsina
- Comisión de Calidad Analítica de la SEQC, Barcelona, España
- Comité de Programas Externos de la SEQC, C/Aribau 263, 08021, Barcelona, España
| | - Carmen Ricós
- Comité de Programas Externos de la SEQC, Barcelona, España
- Comisión de Calidad Analítica de la SEQC, Barcelona, España
| | | | | | - Angel Salas
- Comité de Programas Externos de la SEQC, Barcelona, España
| | | | - Beatriz Boned
- Comisión de Calidad Analítica de la SEQC, Barcelona, España
| | | | - Marià Cortés
- Comité de Programas Externos de la SEQC, Barcelona, España
| | | | | | - Xavier Tejedor
- Comisión de Calidad Analítica de la SEQC, Barcelona, España
| | - Sandra Bullich
- Comité de Programas Externos de la SEQC, Barcelona, España
| | | | | | | | | | - Zoraida Corte
- Comisión de Calidad Analítica de la SEQC, Barcelona, España
| | | | | | | | - Pilar Fernández-Calle
- Comité de Programas Externos de la SEQC, Barcelona, España
- Comisión de Calidad Analítica de la SEQC, Barcelona, España
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10
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Perich C, Ricós C, Marqués F, Minchinela J, Salas A, Martínez-Bru C, Boned B, Gómez-Rioja R, Cortés M, González-Lao E, García Lario JV, Tejedor X, Bullich S, Ventura M, González-Tarancón R, Fernández-Fernández P, Ramón F, Corte Z, Llopis AM, Díaz-Garzón J, Simón M, Fernández-Calle P. Spanish society of laboratory medicine external quality assurance programmes: evolution of the analytical performance of clinical laboratories over 30 years and comparison with other programmes. ADVANCES IN LABORATORY MEDICINE 2020; 1:20200019. [PMID: 37363776 PMCID: PMC10158744 DOI: 10.1515/almed-2020-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/02/2020] [Indexed: 06/28/2023]
Abstract
The purpose of this study is to understand the evolution of the analytical performance of the laboratories participating in the Spanish society of laboratory medicine (SEQCML) external quality assurance (EQA) programmes during its 30 years of operation and to compare it with the performance of other EQA programmes to establish whether the results are similar. The results obtained during this period are evaluated by applying the biological variability (BV) and state of the art-derived quality specifications. In addition, the results are compared with those obtained by other EQA programme organisations. It is noted that the laboratories participating in the EQA-SEQCML programmes have improved their performance over 30 years of experience and that the specifications derived from biological variation are achievable. It is difficult to compare EQA programmes, due to lack of accessibility and the differences in the design of these programmes (control materials, calculations used and analytical specifications established). The data from this study show that for some biological magnitudes the results obtained by the programmes are not yet harmonised, although efforts are being made to achieve this. Organisers of EQA programmes should also join the harmonisation effort by providing information on their results to enable comparison.
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Affiliation(s)
- Carmen Perich
- Comité de Programas Externos de la SEQC-ML, Barcelona, Spain
- Comisión de Calidad Analítica de la SEQC-ML, Barcelona, Spain
| | - Carmen Ricós
- Comité de Programas Externos de la SEQC-ML, Barcelona, Spain
- Comisión de Calidad Analítica de la SEQC-ML, Barcelona, Spain
| | | | | | - Angel Salas
- Comité de Programas Externos de la SEQC-ML, Barcelona, Spain
| | | | - Beatriz Boned
- Comisión de Calidad Analítica de la SEQC-ML, Barcelona, Spain
| | | | - Marià Cortés
- Comité de Programas Externos de la SEQC-ML, Barcelona, Spain
| | | | | | - Xavier Tejedor
- Comisión de Calidad Analítica de la SEQC-ML, Barcelona, Spain
| | - Sandra Bullich
- Comité de Programas Externos de la SEQC-ML, Barcelona, Spain
| | | | | | | | - Francisco Ramón
- Comité de Programas Externos de la SEQC-ML, Barcelona, Spain
| | - Zoraida Corte
- Comisión de Calidad Analítica de la SEQC-ML, Barcelona, Spain
| | | | | | - Margarita Simón
- Comisión de Calidad Analítica de la SEQC-ML, Barcelona, Spain
| | - Pilar Fernández-Calle
- Comité de Programas Externos de la SEQC-ML, Barcelona, Spain
- Comisión de Calidad Analítica de la SEQC-ML, Barcelona, Spain
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11
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Robijns K, Boone NW, Jansen RTP, Kuypers AWHM, Neef C, Touw DJ. Commutability of proficiency testing material containing amitriptyline and nortriptyline: A study within the framework of the Dutch Calibration 2.000 project. Clin Chim Acta 2019; 498:6-10. [PMID: 31374190 DOI: 10.1016/j.cca.2019.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/08/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND External quality assessment schemes (EQAS) can provide important information regarding accuracy and comparability of different measurement methods if the sample matrices are composed of commutable material. The aim of this study was to assess the commutability of different matrices for the material used in an EQAS for amitriptyline and nortriptyline. METHODS Proficiency testing material (PTM) and patient samples containing amitriptyline and nortriptyline were prepared, collected, pooled, and distributed to participating laboratories for analysis. Low, medium and high concentrations of both drugs in liquid pooled human, lyophilized human and lyophilized bovine serum were tested in this study. The measurement deviation of the PTM results to the patient serum regression line were normalized by dividing trough the average within-laboratory SD (SDwl) derived from the results reported in the official EQAS, resulting in a relative residual. The commutability decision limit was set at 3 SDwl. RESULTS With 10 laboratories participating in this study, 45 laboratory couples were formed. All matrix types delivered several relative residuals outside the commutability decision limit. The number and the magnitude of relative residuals for both drugs were lower for liquid human sera as compared to lyophilized human and bovine sera. CONCLUSIONS The PTM used for amitriptyline and nortriptyline is preferably prepared with human serum, although not all relative residuals are within the commutability decision limit.
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Affiliation(s)
- Karen Robijns
- Association for Quality Assessment in Therapeutic Drug Monitoring and Clinical Toxicology (KKGT), Section of the Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), The Hague, the Netherlands; Central Hospital Pharmacy, The Hague, the Netherlands; Haga Teaching Hospital, The Hague, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Niels W Boone
- Department of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Rob T P Jansen
- Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), Nijmegen, the Netherlands
| | - Aldy W H M Kuypers
- Department of Clinical Chemistry and Haematology, Maasziekenhuis Pantein, Beugen, the Netherlands
| | - Cees Neef
- Association for Quality Assessment in Therapeutic Drug Monitoring and Clinical Toxicology (KKGT), Section of the Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), The Hague, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Daan J Touw
- Association for Quality Assessment in Therapeutic Drug Monitoring and Clinical Toxicology (KKGT), Section of the Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), The Hague, the Netherlands; University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, the Netherlands
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12
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Ceriotti F, Cobbaert C. Harmonization of External Quality Assessment Schemes and their role - clinical chemistry and beyond. Clin Chem Lab Med 2019; 56:1587-1590. [PMID: 29715181 DOI: 10.1515/cclm-2018-0265] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/05/2018] [Indexed: 11/15/2022]
Abstract
Abstract
The article tries to reply to the following three questions: Are External Quality Assessment Schemes (EQAS) really fit for purpose? Are all schemes equivalent and sufficiently harmonized? Is the role of EQAS similar and necessary in all branches of laboratory medicine? Although the reply to the first two questions is, unfortunately, negative for several reasons (lack of commutable material with reference method values, EQAS with different scopes, etc.), the reply to the third one is positive: EQAS are a necessary source of information on trueness and accuracy and must be fully developed for all the branches of the clinical laboratory.
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Affiliation(s)
- Ferruccio Ceriotti
- Clinical Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan 20122, Italy, Phone: +390255032876, Fax: +3902255032219
| | - Christa Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
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13
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Brewster LM, Karamat FA, van Montfrans GA. Creatine Kinase and Blood Pressure: A Systematic Review. Med Sci (Basel) 2019; 7:medsci7040058. [PMID: 30970679 PMCID: PMC6524008 DOI: 10.3390/medsci7040058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Hypertension is a main risk factor for premature death. Although blood pressure is a complex trait, we have shown that the activity of the ATP-generating enzyme creatine kinase (CK) is a significant predictor of blood pressure and of failure of antihypertensive drug therapy in the general population. In this report, we systematically review the evidence on the association between this new risk factor CK and blood pressure outcomes. Method: We used a narrative synthesis approach and conducted a systematic search to include studies on non-pregnant adult humans that address the association between plasma CK and blood pressure outcomes. We searched electronic databases and performed a hand search without language restriction. We extracted data in duplo. The main outcome was the association between CK and blood pressure as continuous measures. Other outcomes included the association between CK and blood pressure categories (normotension and hypertension, subdivided in treated controlled, treated uncontrolled, and untreated hypertension). Results: We retrieved 139 reports and included 11 papers from 10 studies assessing CK in 34,578 participants, men and women, of African, Asian, and European ancestry, aged 18 to 87 years. In 9 reports, CK was associated with blood pressure levels, hypertension (vs. normotension), and/or treatment failure. The adjusted increase in systolic blood pressure (mmHg/log CK increase) was reported between 3.3 [1.4 to 5.2] and 8.0 [3.3 to 12.7] and the odds ratio of hypertension with high vs. low CK ranged between 1.2 and 3.9. In addition, CK was a strong predictor of treatment failure in the general population, with an adjusted odds ratio of 3.7 [1.2 to 10.9]. Discussion: This systematic review largely confirms earlier reports that CK is associated with blood pressure and failure of antihypertensive therapy. Further work is needed to address whether this new risk factor is useful in clinical medicine.
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Affiliation(s)
- L. M. Brewster
- Creatine Kinase Foundation, POB 23639, 1100 EC Amsterdam, the Netherlands
- Correspondence:
| | - F. A. Karamat
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands;
| | - G. A. van Montfrans
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands;
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Braga F, Panteghini M. Commutability of reference and control materials: an essential factor for assuring the quality of measurements in Laboratory Medicine. ACTA ACUST UNITED AC 2019; 57:967-973. [DOI: 10.1515/cclm-2019-0154] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/25/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Traceability to a common reference ensures equivalence of results obtained by different assays. Traceability is achieved by an unbroken sequence of calibrations, using reference materials (RMs) that must be commutable. Using non-commutable RMs for calibration will introduce a bias in the calibrated method producing incorrect results for clinical samples (CS). Commutability was defined in 1973 as “the ability of an enzyme material to show inter-assay activity changes comparable to those of the same enzyme in human serum” and later extended as a characteristic of all RMs. However, the concept is still poorly understood and appreciated. Commutability assessment has been covered in CLSI guidelines and requires: (a) selection of 20 CS spanning the relevant concentration range; (b) analysis of both RM and CS with the pair of procedures; (c) data elaboration using regression analysis and calculation if RM fall within the 95% prediction interval defined by CS. This approach has been criticized and to improve it The International Federation of Clinical Chemistry and Laboratory Medicine established a working group that recently finalized recommendations. Commutability is also a requirement for the applicability of external quality assessment (EQA) results in the evaluation of the performance of participating laboratories in terms of standardization of their measurements. Unfortunately, EQA materials are usually not validated for commutability.
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Affiliation(s)
- Federica Braga
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan , Via G.B. Grassi 74 , Milano , Italy , Phone: +39 02 39042766
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan , Milano , Italy
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15
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Ricós C, Perich C, Boned B, González-Lao E, Diaz-Garzón J, Ventura M, Bullich S, Corte Z, Minchinela J, Marques F, Simón M, Alvarez V, García-Lario JV, Fernández-Fernández P, Fernández-Calle P. Standardization in laboratory medicine: Two years' experience from category 1 EQA programs in Spain. Biochem Med (Zagreb) 2018; 29:010701. [PMID: 30591811 PMCID: PMC6294154 DOI: 10.11613/bm.2019.010701] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/25/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Standardization is the ability to obtain interchangeable results leading to same medical interpretation. External quality assessment (EQA) is the main support of the on-going harmonization initiatives. Aim of study was to evaluate results obtained from two years category 1 EQA program experience in Spain and determine the impact of applying this type of EQA program on the analytical standardization. Materials and methods According to the analytical method, traceability and instrument different groups were established which results were evaluated by calculating mean, coefficient of variation and percent of deviation to the reference value. Analytical performance specifications used to the results' evaluation were derived from biological variation for bias and from the inter-laboratory coefficients of variation found in a previous pilot study. Results Only creatinine measured by enzymatic methods gave excellent results, although few laboratories used this method. Creatine kinase and GGT gave good precision and bias in all, but one instrument studied. For the remaining analytes (ALT, ALP, AST, bilirubin, calcium, chloride, glucose, magnesium, potassium, sodium, total protein and urate) some improvement is still necessary to achieve satisfactory standardization in our setting. Conclusions The two years of category 1 EQA program experience in Spain have manifested a lack of standardization of 17 most frequent biochemistry tests used in our laboratories. The impact of the information obtained on the lack of standardization is to recommend abandoning methods such as ALT, AST without exogenous pyridoxal phosphate, Jaffe method for creatinine, and do not use non-commutable calibrators, such as aqueous solutions for calcium and sodium.
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Affiliation(s)
- Carmen Ricós
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain
| | - Carmen Perich
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Clinical Laboratory Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Beatriz Boned
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Aragonese Health Service, Royo Villanova Hospital, Zaragoza, Spain
| | - Elisabet González-Lao
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Quality Healthcare Consulting, ACMS Group, Madrid, Spain
| | - Jorge Diaz-Garzón
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,La Paz University Hospital, Madrid, Spain
| | | | - Sandra Bullich
- External Quality Assurance Programs, SEQCML, Barcelona, Spain
| | - Zoraida Corte
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Clinical Analysis Service, Hospital San Agustin, Aviles, Principality of Asturias, Spain
| | - Joana Minchinela
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Metropolitana Nord Unified Laboratory (LUMN), Germans Trias I Pujol University Hospital, Badalona, Spain
| | - Fernando Marques
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Department of Clinical Biochemistry, University Hospital of Salamanca, Salamanca, Spain
| | - Margarita Simón
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Intercomarcal laboratory consortiums of Alt Penedès, Anoia and Garraf, Barcelona, Spain
| | - Virtudes Alvarez
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain
| | - José-Vicente García-Lario
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Clinical Laboratory, Hospital Campus de la Salud, Granada, Spain
| | | | - Pilar Fernández-Calle
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,La Paz University Hospital, Madrid, Spain
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16
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Alfthan G, Sundvall J, Råman L, Kuulasmaa K, Tolonen H. Standardisation of laboratories engaged in lipid analyses of population health examination surveys. J Epidemiol Community Health 2018; 72:653-657. [PMID: 29636400 DOI: 10.1136/jech-2018-210763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Reliable data on clinical biomarkers are necessary in order to assess the health risks of populations and especially in assessing long-term trends related to disease incidence. METHODS Ten European laboratories participated in a two-phase quality control exercise of total cholesterol (TC) and high-density lipoprotein-cholesterol (HDL-C) analysis. The European Health Examination Survey Reference Laboratory prepared plasma batches for analysis, and provided target values for them. Two criteria were set for the precision and the systematic error (bias). Three plasma samples were analysed in duplicate on separate days (n=12). RESULTS In Round 1, all laboratories met the acceptable criterion (3%) for precision of TC. The mean bias of all laboratories was 0.99% (95% CI 0.03% to 1.95%). Six laboratories measured samples from Round 2. Five laboratories met the goal criterion of 3%; one failed to meet the acceptable criterion of 5%. The mean bias for HDL-C of the three batches of six laboratories was within goal limits (±5% from target) and that of all 10 within acceptable (±10%). The mean bias of all laboratories was 1.1% (95% CI -0.18 to 2.32). In Round 2 four laboratories met the goal criterion and one the acceptable criterion. CONCLUSION The quality control exercise demonstrated that although the majority of the laboratories met the strict criteria for systematic error for TC and HDL-C, standardisation of methods is still needed to improve the accuracy of biomarker measurements of laboratories engaged in population health surveys. A protocol is recommended for obtaining reliable and comparable biomarker data between countries.
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Affiliation(s)
- Georg Alfthan
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
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Braga F, Pasqualetti S, Panteghini M. The role of external quality assessment in the verification of in vitro medical diagnostics in the traceability era. Clin Biochem 2018; 57:23-28. [PMID: 29428441 DOI: 10.1016/j.clinbiochem.2018.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/31/2018] [Accepted: 02/07/2018] [Indexed: 01/28/2023]
Abstract
Once an in-vitro diagnostic (IVD) measuring system has been marketed and introduced into daily practice, the possible sources of degradation of its performance are numerous. It is therefore essential to put in place a continuous post-market surveillance of the quality of performance of the IVD system and of the laboratories that perform measurements in clinical setting. The participation to external quality assessment (EQA) schemes that meet specific metrological criteria is central to the evaluation of performance of clinical laboratories in terms of standardization and clinical suitability of their measurements. In addition to the use of commutable materials, in this type of EQA it is necessary to assign values (and uncertainty) to them with reference procedures and to define and apply clinically permissible analytical performance specifications to substantiate the suitability of laboratory measurements in the clinical setting. Unfortunately, there are still few permanent EQA programs fully covering these requirements because some practical constraints, including technical and economic aspects, which limit their introduction. It is, however, clear that these issues should be quickly overcome, since EQA schemes are in a unique position to add substantial value to the practice of laboratory medicine, by identifying analytes that need improved harmonization and by stimulating and sustaining standardization initiatives that are needed to support clinical practice. Importantly, this will definitively help those manufacturers that produce superior products to demonstrate the superiority of those products and oblige end users (and consequently industry) to abandon assays with demonstrated insufficient quality.
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Affiliation(s)
- Federica Braga
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy.
| | - Sara Pasqualetti
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
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18
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Jansen RT, Cobbaert CM, Weykamp C, Thelen M. The quest for equivalence of test results: the pilgrimage of the Dutch Calibration 2.000 program for metrological traceability. ACTA ACUST UNITED AC 2018; 56:1673-1684. [DOI: 10.1515/cclm-2017-0796] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/17/2017] [Indexed: 01/02/2023]
Abstract
Abstract
Calibration 2.000 was initiated 20 years ago for standardization and harmonization of medical tests. The program also intended to evaluate adequate implementation of the In Vitro Diagnostics (IVD) 98/79/EC directive, in order to ensure that medical tests are fit-for-clinical purpose. The Calibration 2.000 initiative led to ongoing verification of test standardization and harmonization in the Netherlands using commutable external quality assessment (EQA)-tools and a type 1 EQA-design, where feasible. National support was guaranteed by involving all laboratory professionals as well as laboratory technicians responsible for EQA and quality officers. A category 1 EQA-system for general chemistry analytes, harmonizers for specific analytes like hGH and IGF-1, and commutable materials for other EQA-sections have been developed and structurally introduced in the EQA-schemes. The type 1 EQA-design facilitates the dialogue between individual specialists in laboratory medicine and the IVD-industry to reduce lot-to-lot variation and to improve standardization. In such a way, Calibration 2.000 sheds light on the metrological traceability challenges that we are facing and helps the laboratory community to get the issues on the table and resolved. The need for commutable trueness verifiers and/or harmonizers for other medical tests is now seen as paramount. Much knowledge is present in the Netherlands and for general chemistry, humoral immunology and protein chemistry, a few endocrinology tests, and various therapeutic drug monitoring (TDM) tests, commutable materials are available. Also the multi sample evaluation scoring system (MUSE) and the category 1 EQA-design offer many possibilities for permanent education of laboratory professionals to further improve the between and within laboratory variation and the test equivalence.
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Affiliation(s)
- Rob T.P. Jansen
- SKML , Mercator 1, Toernooiveld 214 , 6525EC Nijmegen , The Netherlands
| | | | - Cas Weykamp
- Queen Beatrix Hospital , MCA Laboratory , Winterswijk , The Netherlands
| | - Marc Thelen
- Amphia Hospital, Clinical Chemistry and Haematology , Breda , The Netherlands
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19
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Pre-analytical and analytical aspects affecting clinical reliability of plasma glucose results. Clin Biochem 2017; 50:587-594. [PMID: 28300544 DOI: 10.1016/j.clinbiochem.2017.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/01/2017] [Accepted: 03/10/2017] [Indexed: 12/24/2022]
Abstract
The measurement of plasma glucose (PG) plays a central role in recognizing disturbances in carbohydrate metabolism, with established decision limits that are globally accepted. This requires that PG results are reliable and unequivocally valid no matter where they are obtained. To control the pre-analytical variability of PG and prevent in vitro glycolysis, the use of citrate as rapidly effective glycolysis inhibitor has been proposed. However, the commercial availability of several tubes with studies showing different performance has created confusion among users. Moreover, and more importantly, studies have shown that tubes promptly inhibiting glycolysis give PG results that are significantly higher than tubes containing sodium fluoride only, used in the majority of studies generating the current PG cut-points, with a different clinical classification of subjects. From the analytical point of view, to be equivalent among different measuring systems, PG results should be traceable to a recognized higher-order reference via the implementation of an unbroken metrological hierarchy. In doing this, it is important that manufacturers of measuring systems consider the uncertainty accumulated through the different steps of the selected traceability chain. In particular, PG results should fulfil analytical performance specifications defined to fit the intended clinical application. Since PG has tight homeostatic control, its biological variability may be used to define these limits. Alternatively, given the central diagnostic role of the analyte, an outcome model showing the impact of analytical performance of test on clinical classifications of subjects can be used. Using these specifications, performance assessment studies employing commutable control materials with values assigned by reference procedure have shown that the quality of PG measurements is often far from desirable and that problems are exacerbated using point-of-care devices.
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González-Lao E, Díaz-Garzón J, Corte Z, Ricós C, Perich C, Álvarez V, Simón M, Minchinela J, García-Lario JV, Boned B, Biosca C, Cava F, Fernández-Fernández P, Fernández-Calle P. Category 1 external quality assessment program for serum creatinine. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:133. [PMID: 28462213 PMCID: PMC5395480 DOI: 10.21037/atm.2017.03.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/13/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Commission of Analytical Quality and the Committee of External Quality Programs of Spanish Society of Laboratory Medicine (SEQC) in collaboration with the Dutch Foundation for the Quality organized the first national category 1 External Quality Assessment Programs (EQAP) pilot study. The aim is to evaluate the standardization of serum creatinine measurements in the Spanish laboratories through a category 1 external quality assurance program with commutable material and reference method assigned values. METHODS A total of 87 Spanish laboratories were involved in this program in 2015. Each day a sample control was measured by duplicate during 6 consecutive days. Percentage deviations and coefficients of variation obtained were compared with quality specifications derived from biological variation. RESULTS A total of 1044 creatinine results were obtained. Laboratories were coded in 11 different method-traceability combinations. Only enzymatic methods get all results within the acceptability limits. DISCUSSION To participate in a category 1 EQAP is a valuable tool to assess the standardization degree in our country; a big effort should be made to promote laboratories to change their procedures and to use enzymatic creatinine methods, in order to achieve a satisfactory standardization degree for this important analyte.
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Affiliation(s)
- Elisabet González-Lao
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Spain
- Catlab,Clínic Laboratory, Mutua Terrassa University Hospital , Barcelona, Spain
| | - Jorge Díaz-Garzón
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Spain
- La Paz University Hospital, Madrid, Spain
| | - Zoraida Corte
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Spain
- San Agustin University Hospital, Aviles, Asturias, Spain
| | - Carmen Ricós
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Spain
| | - Carmen Perich
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Spain
- Clinic Laboratory Hospital Vall d’Hebron, Barcelona, Spain
| | - Virtudes Álvarez
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Spain
| | - Margarita Simón
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Spain
- Laboratory de l’Alt Penedés, l’Anoia i el Garraf, Barcelona, Spain
| | - Joana Minchinela
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Spain
- Laboratory Metropolitana Nord, Germans Trias i Pujol University Hospital , Badalona, Spain
| | - José Vicente García-Lario
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Spain
- Virgen de las Nieves University Hospital , Granada, Spain
| | - Beatriz Boned
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Spain
- Royo Villanova Hospital, Zaragoza, Spain
| | - Carmen Biosca
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Spain
- Laboratory Metropolitana Nord, Germans Trias i Pujol University Hospital , Badalona, Spain
| | - Fernando Cava
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Spain
- Clinic Laboratory BR Salud, Infanta Sofía,Hospital, San Sebastián de los Reyes, Madrid, Spain
| | | | - Pilar Fernández-Calle
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Spain
- La Paz University Hospital, Madrid, Spain
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21
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Jones GRD. The role of EQA in harmonization in laboratory medicine - a global effort. Biochem Med (Zagreb) 2017; 27:23-29. [PMID: 28392723 PMCID: PMC5382853 DOI: 10.11613/bm.2017.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 12/27/2016] [Indexed: 12/03/2022] Open
Abstract
There are many activities currently being undertaken in the field of laboratory medicine under the broad heading of "harmonization". These include traceability of results to international reference standards, processes to align results from assays where traceability has not been achieved (analytical harmonization) and international or national clinical guidelines based on studies from many parts of the world. Many of these issues are global in nature, with clinical evidence derived from studies performed in all parts of the world and multinational diagnostic companies providing assays worldwide. As with all aspects of medicine, progress can only be assured where these is evidence of effectiveness of the activities. External Quality Assurance (EQA) programs are designed to meet this need. Currently EQA processes have significant limitations in meeting the global needs of the laboratory medicine community. This paper aims to identify the steps that can be taken to allow current and future EQA programs to provide information on global variation in results. It is only by being aware of result differences that steps can be taken to improve performance.
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Affiliation(s)
- Graham R D Jones
- Department of Chemical Pathology, SydPath, St Vincent's Hospital, Sydney, NSW Australia; University of NSW, Sydney, Australia
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