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Bekka E, Christen SE, Hermann L, Exadaktylos AK, Haschke M, Liakoni E. Residents' Knowledge regarding Recreational Drug Screening Immunoassays at a Swiss Hospital Group. Int J Anal Chem 2024; 2024:4400606. [PMID: 38938263 PMCID: PMC11208805 DOI: 10.1155/2024/4400606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 03/28/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024] Open
Abstract
Introduction In case of suspected acute recreational drug toxicity, immunoassays are commonly used as diagnostic tools. Although easy to handle, understanding of their limitations is necessary for a correct interpretation of the results. The aim of this project was to investigate residents' knowledge regarding drug screening immunoassays at a Swiss hospital group. Methods All residents of a large hospital group in Switzerland were invited by e-mail to participate in an anonymous survey. Following ten multiple choice questions on drug screening tests, the participants were also asked about their demographics, whether they used drug screening tests on a regular basis, and how confident they felt in their ability to interpret test results. Results The ten knowledge questions were answered by 110 of the 1026 residents (11%). Among the 108 participants with available demographics, 90% were 25-35 years old, 63% were female, and 70% were at least in their 4th year of residency. The median score of correct answers was 4 out of 10 (range 0-7) and in 50% of the questions, the correct answer was the most frequently selected response. No significant differences in the knowledge scores were found based on the training, confidence level, or the frequency of drug tests used in daily work. Conclusion This survey revealed widespread knowledge gaps among residents regarding the interpretation of immunoassay-based drug test results. These findings can be used to implement educational measures on this topic and might provide a basis for targeted information on common pitfalls to be included in laboratory reports.
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Affiliation(s)
- Elias Bekka
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel E. Christen
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Laura Hermann
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Manuel Haschke
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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2
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Plebani M. Harmonizing the post-analytical phase: focus on the laboratory report. Clin Chem Lab Med 2024; 62:1053-1062. [PMID: 38176022 DOI: 10.1515/cclm-2023-1402] [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: 12/06/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
The final, post-analytical, phase of laboratory testing is increasingly recognized as a fundamental step in maximizing quality and effectiveness of laboratory information. There is a need to close the loop of the total testing cycle by improving upon the laboratory report, and its notification to users. The harmonization of the post-analytical phase is somewhat complicated, mainly because it calls for communication that involves parties speaking different languages, including laboratorians, physicians, information technology specialists, and patients. Recently, increasing interest has been expressed in integrated diagnostics, defined as convergence of imaging, pathology, and laboratory tests with advanced information technology (IT). In particular, a common laboratory, radiology and pathology diagnostic reporting system that integrates text, sentinel images and molecular diagnostic data to an integrated, coherent interpretation enhances management decisions and improves quality of care.
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Affiliation(s)
- Mario Plebani
- Clinical Biochemistry and Clinical Molecular Biology, University of Padova, Padova, Italy
- Department of Pathology, University of Texas, Medical Branch, Galveston, TX, USA
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3
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Jagtap GA, Badge A, Kohale MG, Wankhade RS. The Role of the Biosafety Cabinet in Preventing Infection in the Clinical Laboratory. Cureus 2023; 15:e51309. [PMID: 38288229 PMCID: PMC10823295 DOI: 10.7759/cureus.51309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
Clinical laboratories are essential in healthcare to better diagnose, treat, and track medical diseases. However, handling infectious organisms and possibly infectious materials in these laboratories puts the safety of laboratory workers and the general public at risk. By controlling the distribution of infectious substances and stopping the spread of diseases, biosafety cabinets (BSCs) have become crucial tools in guaranteeing laboratory safety. The prevention of infections is most important in medical and laboratory settings. In clinical laboratories, biological and infectious agents are handled, posing threats to healthcare workers and the general public. To avoid infections, proper training of the BSC is essential. Laboratory employees are instructed in aseptic procedures, proper hand posture, and efficient personal protection when working in the cabinet. These instructions decrease the chance of contaminating the surrounding area. Additionally, user ergonomics are taken into account while designing BSC, reducing operator fatigue, and guaranteeing that staff can execute tasks precisely for extended periods. This review highlights the importance of biosafety cabinets in maintaining a secure laboratory environment and explains their crucial function in infection control.
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Affiliation(s)
- Gaurav A Jagtap
- Pathology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Ankit Badge
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Mangesh G Kohale
- Pathology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Rashmi S Wankhade
- Pathology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
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4
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Chaudhry AS, Inata Y, Nakagami-Yamaguchi E. Quality analysis of the clinical laboratory literature and its effectiveness on clinical quality improvement: a systematic review. J Clin Biochem Nutr 2023; 73:108-115. [PMID: 37700849 PMCID: PMC10493209 DOI: 10.3164/jcbn.23-22] [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: 04/01/2023] [Accepted: 04/29/2023] [Indexed: 09/14/2023] Open
Abstract
Quality improvement in clinical laboratories is crucial to ensure accurate and reliable test results. With increasing awareness of the potential adverse effects of errors in laboratory practice on patient outcomes, the need for continual improvement of laboratory services cannot be overemphasized. A literature search was conducted on PubMed and a web of science core collection between October and February 2021 to evaluate the scientific literature quality of clinical laboratory quality improvement; only peer-reviewed articles written in English that met quality improvement criteria were included. A structured template was used to extract data, and the papers were rated on a scale of 0-16 using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). Out of 776 studies, 726 were evaluated for clinical laboratory literature quality analysis. Studies were analyzed according to the quality improvement and control methods and interventions, such as training, education, task force, and observation. Results showed that the average score of QI-MQCS for quality improvement papers from 1981-2000 was 2.5, while from 2001-2020, it was 6.8, indicating continuous high-quality improvement in the clinical laboratory sector. However, there is still room to establish a proper system to judge the quality of clinical laboratory literature and improve accreditation programs within the sector.
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Affiliation(s)
- Ahmed Shabbir Chaudhry
- Department of Medical Quality and Safety Science, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Yu Inata
- Department of Medical Quality and Safety Science, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
- Department of Intensive Care Medicine, Osaka Women’s and Children’s Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Etsuko Nakagami-Yamaguchi
- Department of Medical Quality and Safety Science, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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5
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Morgan G, Briollais L, Clausen M, Casalino S, Mighton C, Chowdhary S, Frangione E, Yiu Jordan Fung C, Arnoldo S, Bearss E, Binnie A, Borgundvaag B, Dagher M, Devine L, Friedman SM, Khan Z, McGeer A, McLeod SL, Richardson D, Stern S, Taher A, Wong I, Zarei N, Bombard Y, Lerner-Ellis J, Taher J. Public knowledge of SARS-CoV-2 serological and viral lineage laboratory testing and result interpretation: A GENCOV study cross-sectional survey. Clin Biochem 2023:110607. [PMID: 37406717 DOI: 10.1016/j.clinbiochem.2023.110607] [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: 02/16/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES Concepts related to SARS-CoV-2 laboratory testing and result interpretation can be challenging to understand. A cross-sectional survey of COVID-19 positive adults residing in Ontario, Canada was conducted to explore how well people understand SARS-CoV-2 laboratory tests and their associated results. DESIGN AND METHODS Participants were recruited through fliers or by prospective recruitment of outpatients and hospitalized inpatients with COVID-19. Enrolled participants included consenting adults with a positive SARS-CoV-2 polymerase chain reaction test result. An 11-item questionnaire was developed by researchers, nurses, and physicians in the study team and was administered online between April 2021 to May 2022 upon enrolment into the study. RESULTS Responses were obtained from 940 of 1106 eligible participants (85% participation rate). Most respondents understood 1) that antibody results should not influence adherence to social distancing measures (n=602/888, 68%), 2) asymptomatic SARS-CoV-2 infection following test positivity (n=698/888, 79%), 3) serological test sensitivity in relation to post-infection timeline (n=540/891, 61%), and 4) limitations of experts' knowledge related to SARS-CoV-2 serology (n=693/887, 78%). Conversely, respondents demonstrated challenges understanding 1) conflicting molecular and serological test results and their relationship with immune protection (n=162/893, 18%) and 2) the impact of SARS-CoV-2 variants on vaccine effectiveness (n=235/891, 26%). Analysis of responses stratified by sociodemographic variables identified that respondents who were either: 1) female, 2) more educated, 3) aged 18-44, 4) from a high-income household, or 5) healthcare workers responded expectedly more often. CONCLUSIONS We have highlighted concepts related to SARS-CoV-2 laboratory tests and associated results which may be challenging to understand. The findings of this study enable us to identify 1) misconceptions related to various SARS-CoV-2 test results, 2) groups of individuals at risk, and 3) strategies to improve people's understanding of their test results.
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Affiliation(s)
- Gregory Morgan
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Marc Clausen
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Selina Casalino
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Chloe Mighton
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sunakshi Chowdhary
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Erika Frangione
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Chun Yiu Jordan Fung
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Saranya Arnoldo
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; William Osler Health System, Brampton, ON, Canada
| | - Erin Bearss
- Mount Sinai Academic Family Health Team, Mount Sinai Hospital, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Bjug Borgundvaag
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Department of Emergency Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Marc Dagher
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| | - Luke Devine
- Division of General Internal Medicine, Mount Sinai Hospital, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Steven M Friedman
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Emergency Medicine, University Health Network, Toronto, ON, Canada
| | | | - Allison McGeer
- Department of Microbiology, Mount Sinai Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shelley L McLeod
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, ON, Canada
| | | | - Seth Stern
- Mackenzie Health, Richmond Hill, ON, Canada
| | - Ahmed Taher
- Mackenzie Health, Richmond Hill, ON, Canada; Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Iris Wong
- Mackenzie Health, Richmond Hill, ON, Canada
| | | | - Yvonne Bombard
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jordan Lerner-Ellis
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Jennifer Taher
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
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6
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Abstract
Laboratory clinical decision support (CDS) typically relies on data from the electronic health record (EHR). The implementation of a sustainable, effective laboratory CDS program requires a commitment to standardization and harmonization of key EHR data elements that are the foundation of laboratory CDS. The direct use of artificial intelligence algorithms in CDS programs will be limited unless key elements of the EHR are structured. The identification, curation, maintenance, and preprocessing steps necessary to implement robust laboratory-based algorithms must account for the heterogeneity of data present in a typical EHR.
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7
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Kalaria T, Ford C, Gama R. Effect of automated feedback laboratory comments promoting good phlebotomy practice on the frequency of ethylenediaminetetraacetic acid (EDTA) contamination of serum samples. Ann Clin Biochem 2023; 60:63-67. [PMID: 36200920 DOI: 10.1177/00045632221134190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Ethylenediaminetetraacetic acid (EDTA) contamination of serum samples is common but under-recognized unless EDTA is measured. Incorrect order of draw with closed phlebotomy (vacutainer) does not cause EDTA contamination. EDTA contamination occurs largely or solely during open phlebotomy due to syringe tip or needle-tip contamination when delivering blood into EDTA sample tubes before other sample tubes or direct transfer of blood from EDTA containing tubes to other tubes. Therefore, preference for closed phlebotomy or following the order of tube fill when open phlebotomy is used may reduce EDTA contamination. METHODS The laboratory's comments for EDTA-contaminated serum samples were amended to encourage closed phlebotomy and with open phlebotomy filling of serum tubes before EDTA and fluoride-EDTA tubes. The weekly frequency of EDTA sample contamination, normalized for weekly urea and electrolyte (U&E) requests, was studied 52 weeks before and 43 weeks after amending the comments. RESULTS Median (IQR) frequency of EDTA-contaminated samples per week per 10,000 U&Es decreased by 58% [5.6 (3.1-9.2) versus 2.3 (1.1-4.4); P < 0.001] after the introduction of the new comment. CONCLUSION Explicit automated laboratory feedback comments promoting closed phlebotomy and order of tube fill with open phlebotomy were associated with a 58% reduction in EDTA-contaminated samples and thus may play a role in improving phlebotomy practise.
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Affiliation(s)
- Tejas Kalaria
- Clinical Biochemistry, New Cross Hospital, 592016Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Clare Ford
- Clinical Biochemistry, New Cross Hospital, 592016Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Rousseau Gama
- Clinical Biochemistry, New Cross Hospital, 592016Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,School of Medicine and Clinical Practice, University of Wolverhampton, Wolverhampton, UK
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8
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Zaninotto M, Graziani MS, Plebani M. The harmonization issue in laboratory medicine: the commitment of CCLM. Clin Chem Lab Med 2022; 61:721-731. [PMID: 36383396 DOI: 10.1515/cclm-2022-1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
Abstract
The analytical quality of the clinical laboratory results has shown a significant improvement over the past decades, thanks to the joint efforts of different stakeholders, while the comparability among the results produced by different laboratories and methods still presents some critical issues. During these years, Clinical Chemistry and Laboratory Medicine (CCLM) published several papers on the harmonization issue over all steps in the Total Testing Process, training an important number of laboratory professionals in evaluating and monitoring all the criticisms inherent to the pre-analytical, as well as analytical and post analytical phases: from the consensus statement on the most informative testing in emergency setting, to the prevention and detection of hemolysis or to patients identification and tube labeling procedures, as far as to different approaches to harmonize hormones measurements or to describe new reference methods or to harmonize the laboratory report. During these years the commitment of the journal, devoted to the harmonization processes has allowed to improve the awareness on the topic and to provide specific instruments to monitor the rate of errors and to improve patients safety.
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9
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Brown AS, Badrick T. The next wave of innovation in laboratory automation: systems for auto-verification, quality control and specimen quality assurance. Clin Chem Lab Med 2022; 61:37-43. [DOI: 10.1515/cclm-2022-0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/26/2022] [Indexed: 11/15/2022]
Abstract
Abstract
Laboratory automation in clinical laboratories has made enormous differences in patient outcomes, with a wide range of tests now available that are accurate and have a rapid turnaround. Total laboratory automation (TLA) has mechanised tube handling, sample preparation and storage in general chemistry, immunoassay, haematology, and microbiology and removed most of the tedious tasks involved in those processes. However, there are still many tasks that must be performed by humans who monitor the automation lines. We are seeing an increase in the complexity of the automated laboratory through further platform consolidation and expansion of the reach of molecular genetics into the core laboratory space. This will likely require rapid implementation of enhanced real time quality control measures and these solutions will generate a significantly greater number of failure flags. To capitalise on the benefits that an improved quality control process can deliver, it will be important to ensure that an automation process is implemented simultaneously with enhanced, real time quality control measures and auto-verification of patient samples in middleware. Therefore, it appears that the best solution may be to automate those critical decisions that still require human intervention and therefore include quality control as an integral part of total laboratory automation.
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Affiliation(s)
- A. Shane Brown
- Abbott Digital Health Solutions , Macquarie Park, Sydney , NSW , Australia
| | - Tony Badrick
- Royal College of Pathologists of Australasia Quality Assurance Programs , Sydney , QLD , Australia
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10
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Bauça JM, Ajzner É, Cadamuro J, Hillarp A, Kristoffersen AH, Meijer P. An international study on activated partial thromboplastin time prolongation. Part 2: Interpretative commenting. Clin Chim Acta 2022; 535:174-179. [PMID: 36055391 DOI: 10.1016/j.cca.2022.08.026] [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: 05/31/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Providing evidence-based interpretative comments (IC) is an integral task of clinical laboratory professionals. It may be of special relevance for coagulation testing, where pathological first-line tests could trigger more specialized tests. Our aim was to evaluate the quality of ICs provided to the physician in two samples with activated partial thromboplastin time (APTT) prolongation. MATERIAL AND METHODS Two lyophilized plasma samples and their respective fictional clinical cases (case 1: heparin contamination and case 2: factor VIII deficiency) were sent to European laboratories for APTT and APTT mixing test measurement, and elaboration of ICs based on their results. The quality of ICs was evaluated in terms of analytical classification, laboratory interpretation, advice to physician, clarity, length and whether the clinical question was answered. RESULTS A total of 214 laboratories were included. Classification of the analytical result was stated in 57 % of comments. Laboratory interpretation was found in 91 % of comments for case 1 and 83.3 % for case 2, among which 9.3 % and 6.5 % were considered wrong, respectively. Advice for the requesting physician was provided in 65.8 % of comments for case 1 and 61.2 % for case 2, among which 36 % and 4.7 % were considered wrong, respectively. More than 70 % of comments for both cases were evaluated as clear and of an adequate length. CONCLUSION A significant number of laboratories provide clear interpretations and helpful advice for the management of altered coagulation results. Nevertheless, the finding of several confusing and misleading comments highlights the need for recommendations on elaboration of interpretative comments.
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Affiliation(s)
- Josep Miquel Bauça
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain.
| | - Éva Ajzner
- Central Laboratory, András Jósa University Hospital, Nyíregyháza, Hungary
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Hillarp
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Ann Helen Kristoffersen
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Piet Meijer
- ECAT Foundation (External Quality Control for Assays and Tests), Voorschoten, Netherlands
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11
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Plebani M. Quality in laboratory medicine and the Journal: walking together. Clin Chem Lab Med 2022; 61:713-720. [PMID: 35969689 DOI: 10.1515/cclm-2022-0755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/15/2022]
Abstract
Quality in laboratory medicine is defined as "an unfinished journey", as the more essential the laboratory information provided, the more assured its quality should be. In the past decades, the Journal Clinical Chemistry and Laboratory Medicine has provided a valuable forum for garnering new insights into the analytical and extra-analytical phases of the testing cycle, and for debating crucial aspects of quality in clinical laboratories. The impressive number of papers published in the Journal is testimony to the efforts made by laboratory professionals, national and international scientific societies and federations in the quest to continuously improve upon the pre-, intra- and post-analytical steps of the testing cycle, thus enhancing the quality of laboratory information. The paper appearing in this special issue summarizes the most important and interesting contributions published in the Journal, thus updating our knowledge on quality in laboratory medicine and offering further stimuli to identify the most valuable measures of quality in clinical laboratories.
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Affiliation(s)
- Mario Plebani
- Clinical Biochemistry and Clinical Molecular Biology, University of Padova, Padova, Italy
- Department of Pathology, University of Texas Medical Branch, Galveston, USA
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12
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Rimac V, Podolar S, Jokic A, Vlasic Tanaskovic J, Honovic L, Lenicek Krleza J. Interpretative comments - need for harmonization? Results of the Croatian survey by the Working Group for Post-analytics. Biochem Med (Zagreb) 2022; 32:010901. [PMID: 34955674 PMCID: PMC8672392 DOI: 10.11613/bm.2022.010901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/25/2021] [Indexed: 11/01/2022] Open
Abstract
Introduction Interpretation of laboratory test results is a complex post-analytical activity that requires not only understanding of the clinical significance of laboratory results but also the analytical phase of laboratory work. The aims of this study were to determine: 1) the general opinion of Croatian medical biochemistry laboratories (MBLs) about the importance of interpretative comments on laboratory test reports, and 2) to find out whether harmonization of interpretative comments is needed. Materials and methods This retrospective study was designed as a survey by the Working Group for Post-analytics as part of national External Quality Assessment (EQA) program. All 195 MBLs participating in the national EQA scheme, were invited to participate in the survey. Results are reported as percentages of the total number of survey participants. Results Out of 195 MBLs, 162 participated in the survey (83%). Among them 59% MBLs implemented test result comments in routine according to national recommendations. The majority of laboratories (92%) state that interpretative comments added value to the laboratory reports, and a substantial part (72%) does not have feedback from physicians on their significance. Although physicians and patients ask for expert opinion, participants stated that the lack of interest of physicians (64%) as well as the inability to access patient's medical record (62%) affects the quality of expert opinion. Conclusion Although most participants state that they use interpretative comments and provide expert opinions regarding test results, results of the present study indicate that harmonization for interpretative comments is needed.
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Affiliation(s)
- Vladimira Rimac
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sonja Podolar
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Medical Biochemistry Laboratory, General Hospital "Dr. Tomislav Bardek", Koprivnica, Croatia
| | - Anja Jokic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Medical Biochemistry, Haematology and Coagulation with Cytology, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
| | - Jelena Vlasic Tanaskovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia.,Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM), Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Lorena Honovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia
| | - Jasna Lenicek Krleza
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, Children's Hospital Zagreb, Zagreb, Croatia.,Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM), Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
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13
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Hansen RS, Ejdesgaard BA, Madsen KSB, Fruekilde PBN, Vinholt PJ. Computerized clinical decision support tool for diagnosing porphyria - improving efficiency in a specialized laboratory. Scandinavian Journal of Clinical and Laboratory Investigation 2022; 82:167-169. [PMID: 35130463 DOI: 10.1080/00365513.2022.2034937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Bo Andersen Ejdesgaard
- Section of Health Data Management and Automation, Odense University Hospital, Odense, Denmark
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14
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Preparing Laboratories for Interconnected Health Care. Diagnostics (Basel) 2021; 11:diagnostics11081487. [PMID: 34441421 PMCID: PMC8391810 DOI: 10.3390/diagnostics11081487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/01/2022] Open
Abstract
In an increasingly interconnected health care system, laboratory medicine can facilitate diagnosis and treatment of patients effectively. This article describes necessary changes and points to potential challenges on a technical, content, and organizational level. As a technical precondition, electronic laboratory reports have to become machine-readable and interpretable. Terminologies such as Logical Observation Identifiers Names and Codes (LOINC), Nomenclature for Properties and Units (NPU), Unified Code for Units of Measure (UCUM), and SNOMED-CT can lead to the necessary semantic interoperability. Even if only single “atomized” results of the whole report are extracted, the necessary information for correct interpretation must be available. Therefore, interpretive comments, e.g., concerns about an increased measurement uncertainty must be electronically attached to every affected measurement result. Standardization of laboratory analyses with traceable standards and reference materials will enable knowledge transfer and safe interpretation of laboratory analyses from multiple laboratories. In an interconnected health care system, laboratories should strive to transform themselves into a data hub that not only receives samples but also extensive information about the patient. On that basis, they can return measurement results enriched with high-quality interpretive comments tailored to the individual patient and unlock the full potential of laboratory medicine.
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15
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Vasikaran S, Loh TP. Interpretative commenting in clinical chemistry with worked examples for thyroid function test reports. Pract Lab Med 2021; 26:e00243. [PMID: 34286057 PMCID: PMC8280506 DOI: 10.1016/j.plabm.2021.e00243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/24/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
Correct interpretation of pathology results is a requirement for accurate diagnosis and appropriate patient management. Clinical Pathologists and Scientists are increasingly focusing on providing quality interpretative comments on their reports and these comments are appreciated by clinicians who receive them. Interpretative comments may improve patient outcomes by helping reduce errors in application of the results in patient management. Thyroid function test (TFT) results are one of the areas in clinical chemistry where interpretative commenting is practised by clinical laboratories. We have provided a series of TFT reports together with possible interpretative comments and a brief explanation of the comments. It is felt that this would be of help in setting up an interpretative service for TFTs and also assist in training and continuing education in their provision.
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Affiliation(s)
- Samuel Vasikaran
- Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, WA, 6150, Australia
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore
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16
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Requirements for electronic laboratory reports according to the German guideline Rili-BAEK and ISO 15189. J LAB MED 2021. [DOI: 10.1515/labmed-2020-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Legal regulations and guidelines such as the Guidelines of the German Medical Association for the Quality Assurance of Laboratory Medical Examinations (Rili-BAEK) and ISO 15189 apply to electronic laboratory reports. However, many laboratories struggle with practical implementation of these regulations and guidelines.
Methods
Laboratory and legal experts analyse the relevant guidelines and provide checklists and practical recommendations for implementation.
Results
Laboratories have less control over the display of electronic laboratory reports than over paper documents. However, an electronic report alone is legally sufficient and need not be accompanied by a paper copy. Rili-BAEK and ISO 15189 stipulate a set of minimum information in every report. The laboratory must verify that reports are transmitted and displayed correctly. To help laboratories do so, agreements between laboratories and the report recipients can clarify responsibilities.
Conclusions
Electronic laboratory reports can improve patient care, but laboratories need to verify their quality. Towards this end, Rili-BAEK and ISO 15189 set out helpful provisions.
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Kalaria T, Ford C, Gama R. Participant case marks for identical comments in UK-NEQAS for interpretative comments have good precision. Ann Clin Biochem 2021; 58:670-671. [PMID: 34053239 DOI: 10.1177/00045632211016025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tejas Kalaria
- Clinical Biochemistry, Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Clare Ford
- Clinical Biochemistry, Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Rousseau Gama
- Clinical Biochemistry, Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,School of Medicine and Clinical Practice, University of Wolverhampton, Wolverhampton, UK
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18
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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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19
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López Yeste ML, Izquierdo Álvarez S, Pons Mas AR, Álvarez Domínguez L, Blanco Font A, Marqués García F, Bernabeu Andreu FA, Rodríguez MPC, García Álvarez A, Contreras Sanfeliciano T, Pascual Gómez N, Sánchez Gancedo L, Guiñón Muñoz L. Gestión del proceso posanalítico en los laboratorios clínicos según los requisitos de la norma ISO 15189:2012. Consideraciones sobre la revisión, notificación y comunicación de los resultados. ADVANCES IN LABORATORY MEDICINE 2021; 2:61-70. [PMCID: PMC10197772 DOI: 10.1515/almed-2020-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/03/2020] [Indexed: 06/28/2023]
Abstract
El objeto de este trabajo es establecer unas consideraciones para facilitar la gestión del proceso posanalítico respecto a la revisión, notificación y comunicación de los resultados, de acuerdo con los requisitos de la Norma UNE-EN ISO 15189:2013. El ámbito de aplicación incluye las actividades del proceso posanalítico del laboratorio clínico, así como el personal implicado en él (dirección y personal del laboratorio). Se indican los criterios y la información necesaria para realizar la revisión y validación de los resultados de las pruebas analíticas y así enviar a los destinatarios informes claros, asegurando siempre una transcripción fidedigna de los resultados e incluyendo toda la información necesaria para su correcta interpretación. Asimismo, se describen los requisitos para una correcta comunicación de los resultados del laboratorio, haciendo especial hincapié en la comunicación de aquellos resultados alarmantes o críticos. En algunos países de Europa es obligatoria la acreditación, total o parcial, de los laboratorios clínicos, siguiendo la Norma ISO 15189 y esta parece ser la hoja de ruta marcada en otros muchos países. Por ello, es indispensable la comprensión de sus requisitos para realizar una implementación progresiva y más fácil.
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Affiliation(s)
- Ma Liboria López Yeste
- CATLAB, Barcelona, España
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
| | - Silvia Izquierdo Álvarez
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
| | - Antonia R. Pons Mas
- Servicio de Análisis Clínicos, Hospital Universitari Son Espases, Mallorca, España
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
| | - Luisa Álvarez Domínguez
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
| | - Aurora Blanco Font
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Laboratori Clínic, Hospital Universitari de Bellvitge, Barcelona, España
| | - Fernando Marqués García
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
| | - Francisco A. Bernabeu Andreu
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Servicio de Análisis Clínicos- Bioquímica Clínica, Hospital Universitario Puerta de Hierro, Madrid, España
| | | | - Ana García Álvarez
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Servicio Análisis Clínicos, Hospital Clínico San Carlos, Madrid, España
| | - Teresa Contreras Sanfeliciano
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Servicio de Análisis Clínicos y Bioquímica Clínica, Complejo Asistencial Universitario, Salamanca, España
| | - Natalia Pascual Gómez
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Servicio de Análisis Clínicos, Hospital Universitario de la Princesa, Madrid, España
| | - Lorena Sánchez Gancedo
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Instituto de Medicina Oncológica y Molecular, Oviedo, Asturias, España
| | - Leonor Guiñón Muñoz
- Sociedad Española de Medicina de Laboratorio (SEQC), Comisión de Acreditación de Laboratorios, Barcelona, España
- Hospital de la Santa Creu i Sant Pau, Barcelona, España
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20
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López Yeste ML, Izquierdo Álvarez S, Pons Mas AR, Álvarez Domínguez L, Marqués García F, Rodríguez MPC, Blanco Font A, Bernabeu Andreu FA, García Álvarez A, Contreras Sanfeliciano T, Pascual Gómez N, Sánchez Gancedo L, Guiñón Muñoz L. Management of postanalytical processes in the clinical laboratory according to ISO 15189:2012 Standard requirements: considerations on the review, reporting and release of results. ADVANCES IN LABORATORY MEDICINE 2021; 2:51-70. [PMID: 37359206 PMCID: PMC10197272 DOI: 10.1515/almed-2020-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/03/2020] [Indexed: 06/28/2023]
Abstract
The objective of this paper is to share some considerations about the management of postanalytical processes in relation to the review, reporting and release of test results in accordance with UNE-EN ISO 15189:2013 Standard requirements. The scope of this paper includes postanalytical activities and the personnel involved (laboratory management and staff). We describe the criteria and information required to review and validate analytical results and ensure that clear reports are sent to requesters. These criteria also guarantee that results are transcribed in a reliable way and that all necessary information is provided for the correct interpretation of results. Likewise, the requirements for the correct release of laboratory results are described, with special emphasis on the release of alarming or critical results. In some European countries, clinical laboratories are required to hold partial or full ISO 15189 accreditation, which is a global trend. Therefore, understanding ISO 15189 requirements is imperative for a progressive and more effective implementation of the Standard.
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Affiliation(s)
- Mᵃ Liboria López Yeste
- CATLAB, Barcelona, Spain
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
| | - Silvia Izquierdo Álvarez
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Antonia R. Pons Mas
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio de Análisis Clínicos, Hospital Universitari Son Espases, Mallorca, Spain
| | - Luisa Álvarez Domínguez
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
| | - Fernando Marqués García
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio de Análisis Clínicos y Bioquímica Clínica, Laboratorio Clínico de la Metropolitana Norte, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona
| | | | - Aurora Blanco Font
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Laboratori Clínic, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Francisco A. Bernabeu Andreu
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio de Análisis Clínicos- Bioquímica Clínica, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Ana García Álvarez
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio Análisis Clínicos, Hospital Clínico San Carlos, Madrid, Spain
| | - Teresa Contreras Sanfeliciano
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio de Análisis Clínicos y Bioquímica Clínica, Complejo Asistencial Universitario, Salamanca, Spain
| | - Natalia Pascual Gómez
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Servicio de Análisis Clínicos, Hospital Universitario de la Princesa, Madrid, Spain
| | - Lorena Sánchez Gancedo
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Instituto de Medicina Oncológica y Molecular, Oviedo, Asturias, Spain
| | - Leonor Guiñón Muñoz
- Sociedad Española de Medicina de Laboratorio (SEQCML), Comisión de Acreditación de Laboratorios, Barcelona, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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21
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Secchiero S, Fogazzi GB, Manoni F, Epifani M, Plebani M. The Italian External Quality Assessment (EQA) program on urinary sediment by microscopy examination: a 20 years journey. Clin Chem Lab Med 2020; 59:845-856. [PMID: 33554535 DOI: 10.1515/cclm-2020-1656] [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: 11/04/2020] [Accepted: 11/24/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In spite of the introduction of automated systems for urinary sediment analysis, microscopy examination remains the gold standard, and it is more than ever important to perform it with a good and reliable quality. External Quality Assessment (EQA) programs on urinary sediment are rare. The present paper provides an analysis of results from 2001 to date of the EQA Italian program which involves today 230 laboratories. METHODS The program includes four surveys per year. Participants are asked the identification and clinical associations of urinary sediment particles, shown as phase contrast microscopy images in the website of the Center of Biomedical Research (CRB) (2 surveys), and the diagnosis of clinical cases presented by both images and a short clinical history (2 surveys). The results of each survey are then scored and commented. In 20 years, 298 images were presented: 90 cells (9 types), 23 lipids (5 types), 87 casts (21 types), 53 crystals (14 types), 22 microorganisms (5 types), and 23 contaminants (9 types). Moreover, 27 clinical cases, covering a wide spectrum of conditions with different degrees of complexity, were presented to participants. RESULTS Identification: among urinary particle categories, the correct identification rate (obtained for each particle from the sum of correct + partially correct answers) was very high for micro-organisms (mean ± SD: 96.2 ± 3.5%), high for lipids (88.0 ± 11.8%) and crystals (87.0 ± 16.5%) followed, in decreasing order, by cells (82.1 ± 15.9%), casts (81.8 ± 14.8%), and contaminants (76.7 ± 22.1%). Clinical associations (n=67): the rate of correct answers was 93.5 ± 5.7% ranging from 75.0 to 100% for all but one clinical association (i.e., acute glomerulonephritis: 55.4%). Clinical cases: throughout surveys, due to the overall rate of particle misidentification, only 59.8 ± 17.1%, (range 32.5-88.7%) of participants achieved access to clinical diagnosis. Of these, 88.7 ± 10.6% (range 59.9-99.3%) were able to indicate the correct diagnosis. CONCLUSIONS Our program can be used as a tool to improve the identification of urine particles and the knowledge of their clinical meaning and to encourage specialists of laboratory medicine to correlate urinary findings with other laboratory data and the clinical history, an aspect that improves the value of the day by day work.
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Affiliation(s)
- Sandra Secchiero
- Centre of Biomedical Research for Quality in Laboratory Medicine, University-Hospital of Padova, Padova, Italy.,Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Giovanni B Fogazzi
- Clinical and Research Laboratory on Urinary Sediment, U.O.C. di Nefrologia, Dialisi e Trapianto di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Fabio Manoni
- Dipartimento Area Servizi di Diagnosi e Cura, Ospedali Riuniti "Madre Teresa di Calcutta", Monselice, Padova, Italy
| | - MariaGrazia Epifani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Centre of Biomedical Research for Quality in Laboratory Medicine, University-Hospital of Padova, Padova, Italy.,Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
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Jokic A, Milevoj Kopcinovic L, Culej J, Kocijan I, Bozovic M. Laboratory testing of extravascular body fluids: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Part II - Synovial fluid. Biochem Med (Zagreb) 2020; 30:030501. [PMID: 32774119 PMCID: PMC7394252 DOI: 10.11613/bm.2020.030501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 10/22/2019] [Indexed: 11/01/2022] Open
Abstract
Joint diseases are conditions with an often progressive and generally painful nature affecting the patient's quality of life and, in some cases, requiring a prompt diagnosis in order to start the treatment urgently. Synovial fluid (SF) laboratory testing is an important part of a diagnostic evaluation of patients with joint diseases. Laboratory testing of SF can provide valuable information in establishing the diagnosis, be a part of a patient's follow-up and treatment with the purpose of improving the patient's health and quality of life. Synovial fluid laboratory testing is rarely performed in Croatian medical biochemistry laboratories. Consequently, procedures for SF laboratory testing are poorly harmonized. This document is the second in the series of recommendations prepared by the members of the Working group for extravascular body fluid samples of the Croatian Society of Medical Biochemistry and Laboratory Medicine. It addresses preanalytical, analytical, and postanalytical issues and the clinical significance of tests used in SF laboratory testing with the aim of improving the value of SF laboratory testing in the diagnosis of joint diseases and assisting in the achievement of national harmonization. It is intended for laboratory professionals and all medical personnel involved in synovial fluid collection and testing.
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Affiliation(s)
- Anja Jokic
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Department of Medical Biochemistry, Haematology and Coagulation with Cytology, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
| | - Lara Milevoj Kopcinovic
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Jelena Culej
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Irena Kocijan
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Medical Biochemistry Laboratory, General hospital Varaždin, Varaždin, Croatia
| | - Marija Bozovic
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Morjaria S, Chapin KC. Who to Test, When, and for What: Why Diagnostic Stewardship in Infectious Diseases Matters. J Mol Diagn 2020; 22:1109-1113. [PMID: 32623114 DOI: 10.1016/j.jmoldx.2020.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/05/2020] [Accepted: 06/18/2020] [Indexed: 02/07/2023] Open
Abstract
New rapid molecular diagnostic technologies for infectious diseases provide faster diagnostic test results and, if used correctly, will enable more rapid delivery of care to patients. This perspective piece outlines how this new technology can be used more effectively-with a focus on collaborative team approaches and tools clinicians and laboratorians can use to optimally affect patient care. This article also showcases a patient case, outlining problems with the diagnostic process as it currently stands, and poses potential strategies on how this process may be improved.
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Affiliation(s)
- Sejal Morjaria
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kimberle C Chapin
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
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Tosato F, Sciacovelli L, Pelloso M, Giraudo C, Piva E, Plebani M. Assessment and monitoring of agreement among professionals for morphological evaluation in compliance with International accreditation standard requirements. Clin Chim Acta 2020; 501:72-82. [DOI: 10.1016/j.cca.2019.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
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25
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Huang Y, Wang W, Zhao H, Du Y, Liu J, He F, Zhong K, Yuan S, Wang Z. Quality assessment of interpretative commenting and competency comparison of comment providers in China. Clin Chem Lab Med 2020; 57:832-837. [PMID: 30332389 DOI: 10.1515/cclm-2018-0877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/14/2018] [Indexed: 11/15/2022]
Abstract
Background This study aimed to evaluate the ability of comment providers who were responsible for interpreting results in clinical laboratories in China and to improve the quality of interpretative comments. Methods Basic information and interpretative comments for five cases of 1912 routine chemistry External Quality Assessment (EQA) participant laboratories were collected by web-based EQA system in May 2018. EQA organizers assigned scores to each key phrase of comments based on predetermined marking scale and calculated total scores for each participant's answer. Final scores and ranking were calculated according to scores of cases. Finally, we comprehensively analyzed the type of hospital and the professional title of participants. Results In total, 772 clinical laboratories, 1472 participants, from different Chinese provinces submitted interpretative comments. Median scores, interquartile ranges and score ranges of the five cases were 13 (11-15, 1-20), 13 (10-16, 0-20), 15 (12-17, 0-21), 7 (5-9, -2 to 14) and 12 (10-13, -2 to 18). The final scores and ranking of participants that came from tertiary hospitals were higher than those from secondary and other hospitals; however, there were no significant differences (0.774). When grouped by professional title, we found that although no significant variability existed among senior, intermediate, junior and others (0.699), it existed between laboratory physicians and technicians, as the median final scores of the former were higher than the latter. Conclusions Practice and quality of interpretative comments are indeed different among different laboratories and participants in China. Laboratories should train and assess the interpretative ability of personnel. EQA organizers should also improve the scoring method and establish peer assessors team through this survey.
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Affiliation(s)
- Yuzhu Huang
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Wei Wang
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Haijian Zhao
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Yuxuan Du
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Jiali Liu
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Falin He
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Kun Zhong
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Shuai Yuan
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Zhiguo Wang
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China
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26
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Aita A, Sciacovelli L, Plebani M. The silk road to total quality in Laboratory Medicine. Clin Chem Lab Med 2020; 57:769-772. [PMID: 30982003 DOI: 10.1515/cclm-2019-0331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ada Aita
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Laura Sciacovelli
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy.,Department of Medicine - DIMED, University of Padova, Padova, Italy
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Payne DA, Baluchova K, Russomando G, Ahmad-Nejad P, Mamotte C, Rousseau F, van Schaik RHN, Marriott K, Maekawa M, Chan KCA. Toward harmonization of clinical molecular diagnostic reports: findings of an international survey. Clin Chem Lab Med 2019; 57:78-88. [PMID: 29729139 DOI: 10.1515/cclm-2017-1080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/06/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The International Organization for Standardization (ISO) 15189 standard provides recommendations for the postexamination reporting phase to enhance quality in clinical laboratories. The purpose of this study was to encourage a broad discussion on current reporting practices for molecular diagnostic tests by conducting a global survey of such practices. METHODS The International Federation of Clinical Chemistry and Laboratory Medicine's Committee for Molecular Diagnostics (IFCC C-MD) surveyed laboratories on selected ISO 15189 recommendations and topics. The survey addressed the following aspects: (1) laboratory demographics, (2) report format, (3) result reporting/layout, (4) comments in report and (5) interpretation and clinical decision-making information. Additionally, participants indicated categories needing standardization. RESULTS Sixteen responses from laboratories located in Asia, Europe, the Middle East, North America and South America were received. Several categories yielded 100% agreement between laboratories, whereas other categories had less than or equal to 50% concordance. Participants scored "nomenclature" and "description of methodologies" as the two most frequently cited aspects needing standardization. CONCLUSIONS The postexamination phase requires extensive and consistent communication between the laboratory, the healthcare provider and the end user. Surveyed laboratories were most likely to follow explicit ISO 15189 recommendations vs. recommendations when the term(s) "where appropriate or where applicable" was used. Interpretation and reporting of critical values varied among participants. Although the outcome of this study may not fully represent the practices of all molecular testing laboratories in countries around the world, the survey identified and specified several recommendations that are requirements for harmonized reporting in molecular diagnostics.
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Affiliation(s)
- Deborah A Payne
- American Pathology Partners-Unipath LLC - Clinical Trials and Development, Denver, CO, USA
| | - Katarina Baluchova
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Biomedical Center, Division of Oncology, Martin, Slovakia
| | - Graciela Russomando
- Universidad Nacional de Asunción, Molecular Biology and Biotechnology Department, Instituto de Investigaciones en Ciencias de la Salud, San Lorenzo, Paraguay
| | - Parviz Ahmad-Nejad
- Institute for Medical Laboratory Diagnostics, Centre for Clinical and Translational Research (CCTR), Wuppertal, Germany.,Universitat Witten/Herdecke, Witten, Germany
| | - Cyril Mamotte
- Curtin University, School of Biomedical Sciences and CHIRI Biosciences, Perth, Australia
| | - Francois Rousseau
- CHU de Québec, Université Laval, Department of Laboratory Medicine and Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Centre de recherché, Québec City, Quebec, Canada
| | - Ron H N van Schaik
- Erasmus Medical Center, IFCC Expert Center Pharmacogenetics, Department of Clinical Chemistry, Rotterdam, The Netherlands
| | | | - Masato Maekawa
- Hamamatsu University School of Medicine, Department of Laboratory Medicine, Hamamatsu, Japan
| | - K C Allen Chan
- The Chinese University of Hong Kong, Department of Chemical Pathology, Hong Kong SAR, P.R. China
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Lenicek Krleza J, Honovic L, Vlasic Tanaskovic J, Podolar S, Rimac V, Jokic A. Post-analytical laboratory work: national recommendations from the Working Group for Post-analytics on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochem Med (Zagreb) 2019; 29:020502. [PMID: 31223256 PMCID: PMC6559616 DOI: 10.11613/bm.2019.020502] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 03/14/2019] [Indexed: 12/20/2022] Open
Abstract
The post-analytical phase is the final phase of the total testing process and involves evaluation of laboratory test results; release of test results in a timely manner to appropriate individuals, particularly critical results; and modification, annotation or revocation of results as necessary to support clinical decision-making. Here we present a series of recommendations for post-analytical best practices, tailored to medical biochemistry laboratories in Croatia, which are intended to ensure alignment with national and international norms and guidelines. Implementation of the national recommendations is illustrated through several examples.
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Affiliation(s)
- Jasna Lenicek Krleza
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, Children's Hospital Zagreb, Zagreb, Croatia
| | - Lorena Honovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia
| | - Jelena Vlasic Tanaskovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia
| | - Sonja Podolar
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Medical Biochemistry Laboratory, General Hospital "Dr. Tomislav Bardek", Koprivnica, Croatia
| | - Vladimira Rimac
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Anja Jokic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Medical Biochemistry, Haematology and Coagulation, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
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29
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Bronić A, Coen Herak D, Margetić S, Milić M. Croatian Society of Medical Biochemistry and Laboratory Medicine: National recommendations for blood collection, processing, performance and reporting of results for coagulation screening assays prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen and D-dimer. Biochem Med (Zagreb) 2019; 29:020503. [PMID: 31223257 PMCID: PMC6559624 DOI: 10.11613/bm.2019.020503] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 08/07/2018] [Indexed: 12/20/2022] Open
Abstract
A modern diagnostic laboratory offers wide spectrum of coagulation assays utilized in the diagnosis and management of patients with haemostatic disorders, preoperative screening and anticoagulation therapy monitoring. The recent survey conducted among Croatian medical biochemistry and transfusion laboratories showed the existence of different practice policies in particular phases of laboratory process during coagulation testing and highlighted areas that need improvement. Lack of assay standardization together with non-harmonized test results between different measurement methods, can potentially lead to incorrect decisions in patient’s treatment. Consequently, patient safety could be compromised. Therefore, recommended procedures related to preanalytical, analytical and postanalytical phases of prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen and D-dimer testing are provided in this review, aiming to help laboratories to generate accurate and reliable test results.
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Affiliation(s)
- Ana Bronić
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Desiree Coen Herak
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sandra Margetić
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marija Milić
- Department of Clinical Laboratory Diagnostics, Osijek University Hospital, Osijek, Croatia.,Faculty of Medicine, University of Osijek, Osijek, Croatia
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Manoni F, Gessoni G, Fogazzi GB, Alessio MG, Ravasio R, Caleffi A, Gambaro G, Secchiero S, Pieretti B, Ottomano C, Liverani A, Drago C, Balboni F, Epifani MG, Saccani G, Di Rienzo G, Valverde S, Brunori G, Gesualdo L. Esame fisico, chimico e morfologico delle urine: raccomandazioni per la fase postanalitica del Gruppo Interdisciplinare Laboratorio e Clinica Apparato Urinario (GIAU). ACTA ACUST UNITED AC 2019. [DOI: 10.23736/s1825-859x.19.00008-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Plebani M. Harmonization in laboratory medicine: more than clinical chemistry? Clin Chem Lab Med 2018; 56:1579-1586. [DOI: 10.1515/cclm-2017-0865] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Abstract
The goal of harmonizing laboratory information is to contribute to quality in patient care, ultimately improving upon patient outcomes and safety. The main focus of harmonization and standardization initiatives has been on analytical processes within the laboratory walls, clinical chemistry tests in particular. However, two major evidences obtained in recent years show that harmonization should be promoted not only in the analytical phase but also in all steps of the testing process, encompassing the entire field of laboratory medicine, including innovative areas (e.g. “omics”) rather than just conventional clinical chemistry tests. A large body of evidence demonstrates the vulnerability of the extra-analytical phases of the testing cycle. Because only “good biological samples” can assure good analytical quality, a closer interconnection between the different phases of the cycle is needed. In order to provide reliable and accurate laboratory information, harmonization activities should cover all steps of the cycle from the “pre-pre-analytical” phase (right choice of test at right time for right patient) through the analytical steps (right results with right report) to the “post-post-analytical” steps (right and timely acknowledgment of laboratory information, right interpretation and utilization with any necessary advice as to what to do next with the information provided). In addition, modern clinical laboratories are performing a broad menu of hundreds of tests, covering both traditional and innovative subspecialties of the discipline. In addition, according to a centered viewpoint, harmonization initiatives should not be addressed exclusively to clinical chemistry tests but should also include all areas of laboratory medicine.
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Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine , University-Hospital of Padova , Via Nicolo Giustiniani 2 , 35128 Padova , Italy
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32
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External quality assessment programs in the context of ISO 15189 accreditation. ACTA ACUST UNITED AC 2018; 56:1644-1654. [DOI: 10.1515/cclm-2017-1179] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 04/04/2018] [Indexed: 02/04/2023]
Abstract
Abstract
Effective management of clinical laboratories participating in external quality assessment schemes (EQAS) is of fundamental importance in ensuring reliable analytical results. The International Standard ISO 15189:2012 requires participation in interlaboratory comparison [e.g. external quality assessment (EQA)] for all tests provided by an individual laboratory. If EQAS is not commercially available, alternative approaches should be identified, although clinical laboratories may find it challenging to choose the EQAS that comply with the international standards and approved guidelines. Great competence is therefore required, as well as knowledge of the characteristics and key elements affecting the reliability of an EQAS, and the analytical quality specifications stated in approved documents. Another skill of fundamental importance is the ability to identify an alternative approach when the available EQAS are inadequate or missing. Yet the choice of the right EQA program alone does not guarantee its effectiveness. In fact, the fundamental steps of analysis of the information provided in EQA reports and the ability to identify improvement actions to be undertaken call for the involvement of all laboratory staff playing a role in the specific activity. The aim of this paper was to describe the critical aspects that EQA providers and laboratory professionals should control in order to guarantee effective EQAS management and compliance with ISO 15189 accreditation requirements.
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Role of laboratory medicine in collaborative healthcare. ACTA ACUST UNITED AC 2018; 57:134-142. [DOI: 10.1515/cclm-2017-0853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/28/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Healthcare delivery and responsibility is changing. Patient-centered care is gaining international acceptance with the patient taking greater responsibility for his/her health and sharing decision making for the diagnosis and management of illness. Laboratory medicine must embrace this change and work in a tripartite collaboration with patients and with the clinicians who use clinical laboratory services. Improved communication is the key to participation, including the provision of educational information and support. Knowledge management should be targeted to each stakeholder group. As part of collaborative healthcare clinical laboratory service provision needs to be more flexible and available, with implications for managers who oversee the structure and governance of the service. Increased use of managed point of care testing will be essential. The curriculum content of laboratory medicine training programs will require trainees to undertake practice-based learning that facilitates interaction with patients, clinicians and managers. Continuing professional development for specialists in laboratory medicine should also embrace new sources of information and opportunities for collaborative healthcare.
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Buoro S, Da Rin G, Fanelli A, Lippi G. Harmonization of interpretative comments in laboratory hematology reporting: the recommendations of the Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH-SIBioC). ACTA ACUST UNITED AC 2018; 57:66-77. [DOI: 10.1515/cclm-2017-0972] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022]
Abstract
Abstract
The goal of harmonizing laboratory testing is contributing to improving the quality of patient care and ultimately ameliorating patient outcome. The complete blood and leukocyte differential counts are among the most frequently requested clinical laboratory tests. The morphological assessment of peripheral blood cells (PB) through microscopic examination of properly stained blood smears is still considered a hallmark of laboratory hematology. Nevertheless, a variable inter-observer experience and the different terminology used for characterizing cellular abnormalities both contribute to the current lack of harmonization in blood smear revision. In 2014, the Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH-SIBioC) conducted a national survey, collecting responses from 78 different Italian laboratories. The results of this survey highlighted a lack of harmonization of interpretative comments in hematology, which prompted the WGDH-SIBioC to develop a project on “Harmonization of interpretative comments in the laboratory hematology report”, aimed at identifying appropriate comments and proposing a standardized reporting system. The comments were then revised and updated according to the 2016 revision of the World Health Organization classification of hematologic malignancies. In 2016, the Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH SIBioC) published its first consensus based recommendation for interpretative comments in laboratory hematology reporting whit the purpose of evaluating comments and the aim to (a) reducing their overall number, (b) standardizing the language, (c) providing information that could be easily comprehended by clinicians and patients, (d) increasing the quality of the clinical information, and (e) suggesting additional diagnostic tests when necessary. This paper represents a review of the recommendations of the former document.
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Affiliation(s)
- Sabrina Buoro
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII , Bergamo , Italy
| | - Giorgio Da Rin
- Laboratory Medicine, San Bassiano Hospital , AULSS 7 Pedemontana, Via dei Lotti, 40 , 36061 Bassano del Grappa , Italy
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry , University Hospital of Verona , Verona , Italy
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35
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Booth RA, McCudden CR, Balion CM, Blasutig IM, Bouhtiauy I, Rodriguez-Capote K, Catomeris P, Chan PC, Chen Y, Collier C, Hauff K, Kalra J, Li D, Lin DC, Lou AH, Meng QH, Morrison T, Pasic MD, Qureshi M, Randell E, Sohn KY, Thakur V, Thomas D, Thoni A, Tomalty C, Yang L, Zamkanei M. Candidate recommendations for protein electrophoresis reporting from the Canadian Society of Clinical Chemists Monoclonal Gammopathy Working Group. Clin Biochem 2018; 51:10-20. [DOI: 10.1016/j.clinbiochem.2017.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/26/2022]
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36
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Antonelli G, Padoan A, Aita A, Sciacovelli L, Plebani M. Verification of examination procedures in clinical laboratory for imprecision, trueness and diagnostic accuracy according to ISO 15189:2012: a pragmatic approach. Clin Chem Lab Med 2017; 55:1501-1508. [PMID: 28222014 DOI: 10.1515/cclm-2016-0894] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/04/2017] [Indexed: 11/15/2022]
Abstract
Background The International Standard ISO 15189 is recognized as a valuable guide in ensuring high quality clinical laboratory services and promoting the harmonization of accreditation programmes in laboratory medicine. Examination procedures must be verified in order to guarantee that their performance characteristics are congruent with the intended scope of the test. The aim of the present study was to propose a practice model for implementing procedures employed for the verification of validated examination procedures already used for at least 2 years in our laboratory, in agreement with the ISO 15189 requirement at the Section 5.5.1.2. Methods In order to identify the operative procedure to be used, approved documents were identified, together with the definition of performance characteristics to be evaluated for the different methods; the examination procedures used in laboratory were analyzed and checked for performance specifications reported by manufacturers. Then, operative flow charts were identified to compare the laboratory performance characteristics with those declared by manufacturers. Results The choice of performance characteristics for verification was based on approved documents used as guidance, and the specific purpose tests undertaken, a consideration being made of: imprecision and trueness for quantitative methods; diagnostic accuracy for qualitative methods; imprecision together with diagnostic accuracy for semi-quantitative methods. Conclusions The described approach, balancing technological possibilities, risks and costs and assuring the compliance of the fundamental component of result accuracy, appears promising as an easily applicable and flexible procedure helping laboratories to comply with the ISO 15189 requirements.
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Chan PC, Chen Y, Randell EW. On the path to evidence-based reporting of serum protein electrophoresis patterns in the absence of a discernible monoclonal protein - A critical review of literature and practice suggestions. Clin Biochem 2017; 51:29-37. [PMID: 28916439 DOI: 10.1016/j.clinbiochem.2017.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Pak Cheung Chan
- Sunnybrook Health Sciences Center & University of Toronto, Ontario, Canada.
| | - Yu Chen
- Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, NB, & Dalhousie University, Halifax, NS, Canada
| | - Edward W Randell
- Laboratory Medicine, Faculty of Medicine, Memorial University St. John's, NL, Canada
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Bezzegh A, Takács I, Ajzner É. Toward harmonization of interpretive commenting of common laboratory tests. Clin Biochem 2017; 50:612-616. [DOI: 10.1016/j.clinbiochem.2017.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/29/2017] [Accepted: 05/22/2017] [Indexed: 12/11/2022]
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39
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Epner PL. Appraising laboratory quality and value: What's missing? Clin Biochem 2017; 50:622-624. [DOI: 10.1016/j.clinbiochem.2017.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/21/2017] [Accepted: 04/18/2017] [Indexed: 11/30/2022]
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