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Bais R, Vassault A, Blasutig IM, Dabla PK, Lin J, Perret-Liaudet A, Thomas A, Cendejas KA, Wheeler SE, Giannoli JM, Meng QH, Amann EP. External quality assessment performance in ten countries: an IFCC global laboratory quality project. Clin Chem Lab Med 2024; 62:2435-2443. [PMID: 39238208 DOI: 10.1515/cclm-2024-0859] [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: 07/27/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVES This study aimed to assess the validity of external quality assessment (EQA) laboratory results across various cultural and environmental contexts and to identify potential improvement areas. METHODS The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Task Force on Global Laboratory Quality (TF-GLQ) conducted a 2-year study (2022 and 2023) in which EQA materials, related software and online training was provided by a commercial vendor to 100 laboratories in ten IFCC member society countries. The results were analysed on a monthly basis by the TF-GLQ, to show the number of submissions per country, tests per lab, acceptability rates, random failures and to get a measure of which analytes performed poorly. RESULTS The EQA material was dispatched on a quarterly basis. Some countries had problems with customs releasing the material in a timely manner, resulting in laboratories not receiving them on time leading to no submission. We report here the results for the second year of the survey. The number of examinations varied between laboratories, ranging from seven to 84 analytes. Of the ten countries surveyed, six averaged greater than 90 % acceptable results over the whole 12-months cycle, one had unacceptable results for two of the nine months they returned results and the other four were considered to not perform to an acceptable standard. CONCLUSIONS All 100 participating laboratories indicated satisfaction with the EQA survey and related services, including on-site training, and report handling. However, specimen receiving issues, suggest benefits in dispatching materials for a full 12-month cycle. Significant discrepancies in EQA performance indicate that four countries require long-term assistance, training and guidance. To ensure reliable patient results, promoting EQA in certain countries is essential to achieve the required level of quality.
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Affiliation(s)
| | | | - Ivan M Blasutig
- Department of Pathology and Laboratory Medicine, Division of Biochemistry, Children's Hospital of Eastern Ontario, Eastern Ontario Regional Laboratory Association, University of Ottawa, Ottawa, ON, Canada
| | - Pradeep Kumar Dabla
- Department of Biochemistry, G. B Pant Institute of Postgraduate Medical Education & Research, Associated Maulana Azad Medical College, New Delhi, India
| | - Ji Lin
- AQR, Abbott Labs, Abbott Park, IL, USA
| | | | - Annette Thomas
- Weqas, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Sarah E Wheeler
- School of Medicine, Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Qing H Meng
- Director of Clinical Chemistry and Special Chemistry Laboratories, Director of Postdoctoral Clinical Chemistry Fellowship Program, and MD Anderson Cancer Center, Department of Laboratory Medicine, The University of Texas, Houston, TX, USA
| | - Egon P Amann
- Philipps University Marburg, Marburg, Germany
- University of Applied Sciences, Hamm-Lippstadt, Hamm, Germany
- Consultant in Life Sciences, Quality Systems & Clinical Chemistry, Am Martsacker 3, Marburg, Germany
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Plebani M. External quality assurance (EQA): navigating between quality and sustainability. Clin Chem Lab Med 2024; 62:2337-2338. [PMID: 39236251 DOI: 10.1515/cclm-2024-0975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Affiliation(s)
- Mario Plebani
- Honorary Professor of Clinical Biochemistry and Clinical Molecular Biology, University of Padova, Padova, Italy
- Department of Pathology, University of Texas, Galveston, TX, USA
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Neirinck J, Buysse M, Brdickova N, Perez-Andres M, De Vriendt C, Kerre T, Haerynck F, Bossuyt X, van Dongen JJM, Orfao A, Hofmans M, Bonroy C, Kalina T. The EuroFlow PIDOT external quality assurance scheme: enhancing laboratory performance evaluation in immunophenotyping of rare lymphoid immunodeficiencies. Clin Chem Lab Med 2024:cclm-2024-0749. [PMID: 39423371 DOI: 10.1515/cclm-2024-0749] [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: 06/26/2024] [Accepted: 09/24/2024] [Indexed: 10/21/2024]
Abstract
OBJECTIVES The development of External Quality Assessment Schemes (EQAS) for clinical flow cytometry (FCM) is challenging in the context of rare (immunological) diseases. Here, we introduce a novel EQAS monitoring the primary immunodeficiency Orientation Tube (PIDOT), developed by EuroFlow, in both a 'wet' and 'dry' format. This EQAS provides feedback on the quality of individual laboratories (i.e., accuracy, reproducibility and result interpretation), while eliminating the need for sample distribution. METHODS In the wet format, marker staining intensities (MedFIs) within landmark cell populations in PIDOT analysis performed on locally collected healthy control (HC) samples, were compared to EQAS targets. In the dry format, participants analyzed centrally distributed PIDOT flow cytometry data (n=10). RESULTS We report the results of six EQAS rounds across 20 laboratories in 11 countries. The wet format (212 HC samples) demonstrated consistent technical performance among laboratories (median %rCV on MedFIs=34.5 %; average failure rate 17.3 %) and showed improvement upon repeated participation. The dry format demonstrated effective proficiency of participants in cell count enumeration (range %rCVs 3.1-7.1 % for the major lymphoid subsets), and in identifying lymphoid abnormalities (79.3 % alignment with reference). CONCLUSIONS The PIDOT-EQAS allows laboratories, adhering to the standardized EuroFlow approach, to monitor interlaboratory variations without the need for sample distribution, and provides them educational support to recognize rare clinically relevant immunophenotypic patterns of primary immunodeficiencies (PID). This EQAS contributes to quality improvement of PID diagnostics and can serve as an example for future flow cytometry EQAS in the context of rare diseases.
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Affiliation(s)
- Jana Neirinck
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
- Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium
| | - Malicorne Buysse
- Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium
| | - Naděžda Brdickova
- CLIP Cytometry, Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Martín Perez-Andres
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer, Consejo Superior de Investigaciones Científicas (CSIC)-University of Salamanca (USAL), Department of Medicine, IBSAL and CIBERONC, University of Salamanca, Salamanca, Spain
- Cancer Research Centre (Instituto de Biologıa Molecular y Celular del Cancer (IBMCC), USAL-CSIC; CIBERONC CB16/12/00400), Institute for Biomedical Research of Salamanca (IBSAL), Department of Medicine and Cytometry Service (NUCLEUS Research Support Platform), University of Salamanca (USAL), Salamanca, Spain
| | - Ciel De Vriendt
- Department of Haematology, University Hospital Ghent, Ghent, Belgium
| | - Tessa Kerre
- Department of Haematology, University Hospital Ghent, Ghent, Belgium
| | - Filomeen Haerynck
- Department of Pediatric Pulmonology and Immunology and PID Research Laboratory, University Hospital Ghent, Ghent, Belgium
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Jacques J M van Dongen
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer, Consejo Superior de Investigaciones Científicas (CSIC)-University of Salamanca (USAL), Department of Medicine, IBSAL and CIBERONC, University of Salamanca, Salamanca, Spain
- Cancer Research Centre (Instituto de Biologıa Molecular y Celular del Cancer (IBMCC), USAL-CSIC; CIBERONC CB16/12/00400), Institute for Biomedical Research of Salamanca (IBSAL), Department of Medicine and Cytometry Service (NUCLEUS Research Support Platform), University of Salamanca (USAL), Salamanca, Spain
| | - Alberto Orfao
- Translational and Clinical Research Program, Centro de Investigación del Cáncer and Instituto de Biología Molecular y Celular del Cáncer, Consejo Superior de Investigaciones Científicas (CSIC)-University of Salamanca (USAL), Department of Medicine, IBSAL and CIBERONC, University of Salamanca, Salamanca, Spain
- Cancer Research Centre (Instituto de Biologıa Molecular y Celular del Cancer (IBMCC), USAL-CSIC; CIBERONC CB16/12/00400), Institute for Biomedical Research of Salamanca (IBSAL), Department of Medicine and Cytometry Service (NUCLEUS Research Support Platform), University of Salamanca (USAL), Salamanca, Spain
| | - Mattias Hofmans
- Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium
| | - Carolien Bonroy
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
- Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium
| | - Tomas Kalina
- CLIP Cytometry, Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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Leach A, Murphy KJ, Godard M, Schwartz M, Sokoll LJ. Proficiency Testing Customization in Clinical Trials: How the pSMILE Project Ensures High-Quality Proficiency Testing Coverage for International Laboratories. J Appl Lab Med 2024; 9:1097-1102. [PMID: 39225459 DOI: 10.1093/jalm/jfae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/29/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Anne Leach
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kristin J Murphy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mandana Godard
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Matthew Schwartz
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lori J Sokoll
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Toll L, Weiss N, Vierbaum L, Schellenberg I, Thevis M, Wenzel F. Longitudinal evaluation of laboratory results and method precision in worldwide erythropoietin external quality assessments. Front Mol Biosci 2024; 11:1390079. [PMID: 38974321 PMCID: PMC11224661 DOI: 10.3389/fmolb.2024.1390079] [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: 02/22/2024] [Accepted: 05/10/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction: This study presents a longitudinal analysis of external quality assessment (EQA) results for erythropoietin (EPO) determinations conducted between 2017 and 2022 with a continuously increasing number of participating laboratories. The aim of this work was to evaluate participant performance and methodological aspects. Methods: In each of the eleven EQA surveys, a blinded sample set of lyophilized human serum containing one sample with lower EPO concentrations (L) and one with higher EPO concentrations (H) was sent to the participating laboratories. Results: A total of 1,256 measurements were included. The median (interquartile range) fraction of participants not meeting the criteria of acceptance set at 20% around the robust mean of the respective survey was 9.5% (6.1%-10.7%) (sample L) and 9.1% (5.8%-11.8%) (sample H) but lacked a clear trend in the observed period. Some surveys exhibited unusually high interlaboratory variation, suggesting interfering components in the EQA samples. Different immunological methods and reagent manufacturers also showed variability in measurement outcomes to some extent. Conclusion: These findings highlight the need for continuous quality assessment in EPO measurements to ensure patient safety and identify areas for further research and investigation.
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Affiliation(s)
- Luisa Toll
- Faculty of Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany
- Institute of Biochemistry/ Center for Preventive Doping Research, German Sport University Cologne, Cologne, Germany
| | - Nathalie Weiss
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Düsseldorf, Germany
| | - Laura Vierbaum
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Düsseldorf, Germany
| | - Ingo Schellenberg
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Düsseldorf, Germany
- Institute of Bioanalytical Sciences (IBAS), Center of Life Sciences, Anhalt University of Applied Sciences, Bernburg, Germany
| | - Mario Thevis
- Institute of Biochemistry/ Center for Preventive Doping Research, German Sport University Cologne, Cologne, Germany
| | - Folker Wenzel
- Faculty of Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Düsseldorf, Germany
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Huf W, Mohns M, Almeta E, Lister R, Buchta C, Demyanets S, Buchberger W, Ettl B. Benchmarking medical laboratory performance on a global scale. Front Public Health 2024; 12:1363957. [PMID: 38952740 PMCID: PMC11215183 DOI: 10.3389/fpubh.2024.1363957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 05/28/2024] [Indexed: 07/03/2024] Open
Abstract
Background and aims Laboratory performance as a relative concept needs repetitive benchmarking for continuous improvement of laboratory procedures and medical processes. Benchmarking as such establishes reference levels as a basis for improvements efforts for healthcare institutions along the diagnosis cycle, with the patient at its center. But while this concept seems to be generally acknowledged in laboratory medicine, a lack of practical implementation hinders progress at a global level. The aim of this study was to examine the utility of a specific combination of indicators and survey-based data collection approach, and to establish a global benchmarking dataset of laboratory performance for decision makers in healthcare institutions. Methods The survey consisted of 44 items relating to laboratory operations in general and three subscales identified in previous studies. A global sample of laboratories was approached by trained professionals. Results were analyzed with standard descriptive statistics and exploratory factor analysis. Dimensional reduction of specific items was performed using confirmatory factor analysis, resulting in individual laboratory scores for the three subscales of "Operational performance," "Integrated clinical care performance," and "Financial sustainability" for the high-level concept of laboratory performance. Results and conclusions In total, 920 laboratories from 55 countries across the globe participated in the survey, of which 401 were government hospital laboratories, 296 private hospital laboratories, and 223 commercial laboratories. Relevant results include the need for digitalization and automation along the diagnosis cycle. Formal quality management systems (ISO 9001, ISO 15189 etc.) need to be adapted more broadly to increase patient safety. Monitoring of key performance indicators (KPIs) relating to healthcare performance was generally low (in the range of 10-30% of laboratories overall), and as a particularly salient result, only 19% of laboratories monitored KPIs relating to speeding up diagnosis and treatment. Altogether, this benchmark elucidates current practice and has the potential to guide improvement efforts and standardization in quality & safety for patients and employees alike as well as sustainability of healthcare systems around the globe.
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Affiliation(s)
- Wolfgang Huf
- Karl Landsteiner Institute for Clinical Risk Management, Vienna, Austria
- Research Unit for Quality and Efficiency in Medicine, Institute for Public Health, Medical Decision Making and HTA, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | | | | | | | - Christoph Buchta
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Svitlana Demyanets
- Department of Laboratory Medicine, Clinic Hietzing, Vienna, Austria
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Buchberger
- Research Unit for Quality and Efficiency in Medicine, Institute for Public Health, Medical Decision Making and HTA, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Brigitte Ettl
- Karl Landsteiner Institute for Clinical Risk Management, Vienna, Austria
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7
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Theodorsson E, Meijer P, Badrick T. External quality assurance in the era of standardization. Clin Chim Acta 2024; 557:117876. [PMID: 38493945 DOI: 10.1016/j.cca.2024.117876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
Metrology in clinical chemistry aims to ensure the equivalence of measurement results from different in-vitro diagnostic measurement devices (IVD MD) for use in healthcare. The metrological traceability of measurement results to higher-order references is the cornerstone to achieving equivalent results. However, other fundamentals are also needed, including the commutability of reference materials and external quality assessment (EQA) materials for monitoring the equivalence of measurement results at the end-user level. This manuscript summarizes the findings and opinions expressed at the Joint Community for Traceability in Laboratory Medicine (JCTLM) workshop held on December 4-5, 2023. The workshop explored the relationship between EQA/proficiency testing and metrological traceability to higher-order references. EQA monitors the equivalence of measurement results from end-user IVD MDs. The workshop discussed the role and challenges of using EQA to improve and maintain the equivalence of measurement results. It also elucidated current developments in establishing the clinical suitability of laboratory results expressed as analytical performance specifications (APS).
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Affiliation(s)
- Elvar Theodorsson
- Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden.
| | - Piet Meijer
- ECAT Foundation, Voorschoten, The Netherlands
| | - Tony Badrick
- RCPA Quality Assurance Programs, St Leonards, Sydney, Australia
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Cherie N, Teketelew BB, Tamir M, Angelo AA, Terekegne AM, Chane E, Nigus M, Berta DM. Performances and determinants of proficiency testing in clinical laboratory services at comprehensive specialized hospitals, northwest Ethiopia. Sci Rep 2024; 14:7745. [PMID: 38565637 PMCID: PMC10987491 DOI: 10.1038/s41598-024-58525-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/01/2024] [Indexed: 04/04/2024] Open
Abstract
Proficiency testing (PT) is an impartial laboratory performance-evaluating system using an independent body. It is a mandatory accreditation requirement and means for improving the laboratory's performance. The study aimed to evaluate the performance of PT, with a focus on identifying and discussing determinants that influence PT performance at comprehensive specialized hospitals in northwest Ethiopia. A retrospective cross-sectional study was carried out from 2020 to 2022. Using a convenient sampling technique, laboratory tests with recorded PT results in each hospital laboratory were included. A data collection template and customized checklists were used to collect the data. Epi Data Version 3.1 for data entry and STATA Version 14.1 for cleaning and analysis were used. Binary logistic regression analyses were used. Variables with p < 0.05 in the multivariable logistic regression were considered to be statistically significant. Over nine cycles, 3807 PT challenges were distributed. The total failure rate of the laboratories was 32.4%, with a peak failure rate of 40.3% in 2020, after which the failure rate was decline to 20.6% in 2022. Among the five laboratory sections, molecular biology had the lowest failure rate (22.2%), while microbiology had the highest failure rate (56.5%). Multivariate logistic regression revealed that PT results reported without appropriate unit of measurement (AOR 7.5), lack of corrective action for PT nonconformance (AOR 7.1), and reagent unavailability (AOR 6.1) had significant effects on PT performance (p < 0.001). The results of this study showed that the overall performance of the laboratory was lower. Reporting PT results without appropriate units of measurement and not taking corrective action for PT nonconformance were the major aggravating factors for high failure rates.
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Affiliation(s)
- Negesse Cherie
- Department of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Bisrat Birke Teketelew
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mebratu Tamir
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abiy Ayele Angelo
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Mekuanint Terekegne
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Elias Chane
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mesele Nigus
- Department of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dereje Mengesha Berta
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Scherf-Clavel M, Baumann P, Hart XM, Schneider H, Schoretsanitis G, Steimer W, Zernig G, Zurek G. Behind the Curtain: Therapeutic Drug Monitoring of Psychotropic Drugs from a Laboratory Analytical Perspective. Ther Drug Monit 2024; 46:143-154. [PMID: 36941240 DOI: 10.1097/ftd.0000000000001092] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE Therapeutic drug monitoring (TDM) is a well-established tool for guiding psychopharmacotherapy and improving patient care. Despite their established roles in the prescription of psychotropic drugs, the "behind the curtain" processes of TDM requests are invariably obscure to clinicians, and literature addressing this topic is scarce. METHODS In the present narrative review, we provide a comprehensive overview of the various steps, starting from requesting TDM to interpreting TDM findings, in routine clinical practice. Our goal was to improve clinicians' insights into the numerous factors that may explain the variations in TDM findings due to methodological issues. RESULTS We discussed challenges throughout the TDM process, starting from the analyte and its major variation forms, through sampling procedures and pre-analytical conditions, time of blood sampling, sample matrices, and collection tubes, to analytical methods, their advantages and shortcomings, and the applied quality procedures. Additionally, we critically reviewed the current and future advances in the TDM of psychotropic drugs. CONCLUSIONS The "behind the curtain" processes enabling TDM involve a multidisciplinary team, which faces numerous challenges in clinical routine. A better understanding of these processes will allow clinicians to join the efforts for achieving higher-quality TDM findings, which will in turn improve treatment effectiveness and safety outcomes of psychotropic agents.
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Affiliation(s)
- Maike Scherf-Clavel
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
| | - Pierre Baumann
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn, Germany
| | - Xenia M Hart
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Heike Schneider
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich, Munich, Germany
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn
- INSTAND e.V. Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn, Germany
| | - Georgios Schoretsanitis
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Werner Steimer
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich, Munich, Germany
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn
| | - Gerald Zernig
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
- Private Practice for Psychotherapy and Court-certified Expert Witness, Hall in Tirol, Austria; and
| | - Gabriela Zurek
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Medical Laboratory Bremen, Bremen, Germany
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10
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Cherie N, Deress T, Berta DM, Chane E, Teketelew BB, Adane K, Nigus M. Navigating Quality Assessment Hurdles in Clinical Laboratory Services: A Comprehensive Review in Resource-Limited Settings. Risk Manag Healthc Policy 2024; 17:497-504. [PMID: 38476199 PMCID: PMC10929212 DOI: 10.2147/rmhp.s453020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
External quality assessment is the process of evaluating the performance of a laboratory and the competence of professionals. Participation in EQA and standardizing the quality of laboratory services are a mandatory requirements for accreditation. This review is aimed at identifying and discussing challenges that hinder the effective implementation of an EQA program in countries with resource limited setting. To obtain abundant information, articles were identified by searching the literature publishedin English using the National Library of Medicine, PubMed, Science Direct and AMC digital library databases. The articles identified in the references were manually searched and included. After the article was identified, it was imported to Endnote version 8.1 and exported to Microsoft Word for citation. Based on this review, the major identified challenges that hinder the implementation of an EQA program include the high cost of control materials, malfunction and lack of maintenance for equipment failure and breakdown, a knowledge gap among laboratory professionals, noncommutability of control samples, and difficulty in assigning target values. In addition, failing to participate in EQA and failing to take corrective action are the major challenges identified. As a result, applying to an EQA program in resource-limited counties was highly challenging. To attain high performance in the laboratory and to provide quality laboratory service for patient care, the EQA supplier and the user laboratory must pay attention to these issues and take appropriate corrective actions for ongoing quality improvement and accreditation.
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Affiliation(s)
- Negesse Cherie
- Department of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Teshiwal Deress
- Department of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dereje Mengesha Berta
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Elias Chane
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bisrat Birke Teketelew
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kasaw Adane
- Department of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mesele Nigus
- Department of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Fitzpatrick M, Andersen T, Bush J, Greaves RF, Woollard G, Hoad K, Collie JTB, Browning S, Harrower T, Graham P, Punyalack W. Quality assurance programs for vitamin A and E in serum: are we doing enough to assess laboratory performance? Clin Chem Lab Med 2024; 62:288-292. [PMID: 37724812 DOI: 10.1515/cclm-2023-0670] [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: 06/29/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Monitoring serum vitamin A (retinol) and vitamin E (α-tocopherol) concentrations is common practice for assessing nutritional status. Measurement of these vitamins can be challenging due to several factors. Whilst the RCPAQAP Vitamins: Serum Program assists participating laboratories in harmonisation, the materials provided do not contain the analogues of retinol and α-tocopherol that may be present in real patient samples. We aimed to assess participants' capacity to accurately report retinol and α-tocopherol in the presence of the vitamin E analogues tocopherol acetate and γ-tocopherol. METHODS A supplementary series of a control sample and three matched spiked samples were distributed to each laboratory participating in the Program. Retinol and α-tocopherol results for each spiked sample were compared to the results of the control sample submitted by each participant. Acceptability of retinol and α-tocopherol results was determined based on the RCPAQAP allowable performance specifications (APS). RESULTS Thirteen participants returned results for the supplementary sample series. Interference from α-tocopherol acetate was observed with results below the APS in 30 % (n=4) of laboratories for retinol quantification and in 23 % (n=3) for α-tocopherol quantification. One laboratory returned results above the APS for α-tocopherol when γ-tocopherol was present. CONCLUSIONS This supplementary sample series has shown that the presence of vitamin E analogues can lead to the over or under estimation of nutritional status by some participants. Affected laboratories are encouraged to review their analytical procedures. To further assess laboratory competence, EQA providers should consider using patient samples or spiked challenge samples.
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Affiliation(s)
- Michael Fitzpatrick
- AACB/RCPAQAP Vitamins Advisory Committee, St Leonards, NSW, Australia
- New South Wales Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Trisha Andersen
- AACB/RCPAQAP Vitamins Advisory Committee, St Leonards, NSW, Australia
- Australian Scientific Enterprises, Hornsby, NSW, Australia
| | - Jonathan Bush
- AACB/RCPAQAP Vitamins Advisory Committee, St Leonards, NSW, Australia
- RCPAQAP, St Leonards, NSW, Australia
| | - Ronda F Greaves
- AACB/RCPAQAP Vitamins Advisory Committee, St Leonards, NSW, Australia
- Victorian Clinical Genetics Service, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Gerald Woollard
- AACB/RCPAQAP Vitamins Advisory Committee, St Leonards, NSW, Australia
- Auckland District Health Board, Auckland City Hospital, Auckland, New Zealand
| | - Kirsten Hoad
- AACB/RCPAQAP Vitamins Advisory Committee, St Leonards, NSW, Australia
- PathWest, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Jake T B Collie
- AACB/RCPAQAP Vitamins Advisory Committee, St Leonards, NSW, Australia
- Agilent Technologies, Mulgrave, VIC, Australia
| | - Sarah Browning
- AACB/RCPAQAP Vitamins Advisory Committee, St Leonards, NSW, Australia
- Sullivan Nicolaides Pathology, Brisbane, QLD, Australia
| | - Tamantha Harrower
- AACB/RCPAQAP Vitamins Advisory Committee, St Leonards, NSW, Australia
- Sullivan Nicolaides Pathology, Brisbane, QLD, Australia
| | - Peter Graham
- AACB/RCPAQAP Vitamins Advisory Committee, St Leonards, NSW, Australia
- RCPAQAP, St Leonards, NSW, Australia
| | - Wilson Punyalack
- AACB/RCPAQAP Vitamins Advisory Committee, St Leonards, NSW, Australia
- RCPAQAP, St Leonards, NSW, Australia
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Blasutig IM, Wheeler SE, Bais R, Dabla PK, Lin J, Perret-Liaudet A, Thomas A, Cendejas KA, Giannoli JM, Vassault A, Amann E, Meng QH. External quality assessment practices in medical laboratories: an IFCC global survey of member societies. Clin Chem Lab Med 2023; 61:1404-1410. [PMID: 36779362 DOI: 10.1515/cclm-2023-0057] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVES Clinical laboratory results are required for critical medical decisions, underscoring the importance of quality results. As part of total quality management, external quality assessment (EQA) is a vital component to ensure laboratory accuracy. The goal of this survey was to evaluate the current status of global laboratory quality systems and assess the need for implementation, expansion, or harmonization of EQA programs (EQAP) for Clinical Chemistry and Laboratory Medicine. METHODS The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Task Force on Global Laboratory Quality (TF-GLQ) conducted a survey of IFCC full and affiliate members (n=110) on laboratory quality practice. A total of 41 (37.3%) countries representing all IFCC regions except North America provided responses about EQA availability and practices. RESULTS All 41 countries perform EQA, 38 reported that their laboratories had EQA policies and procedures, and 39 further act/evaluate unacceptable EQA results. 39 countries indicated they have international and/or national EQAP and 30 use alternative performance assessments. EQA frequency varied among countries. Generally, an EQAP provided the EQA materials (40/41) with four countries indicating that they did not have an EQAP in their country. CONCLUSIONS Globally, most laboratories participate in an EQAP and have defined quality procedures for EQA. There remain gaps in EQA material availability and implementation of EQA as a part of a total laboratory quality system. This survey highlights the need for education, training, and harmonization and will guide efforts of the IFCC TF-GLQ in identifying areas for enhancing global laboratory quality practices.
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Affiliation(s)
- Ivan M Blasutig
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Ottawa, Canada
- Division of Biochemistry, Children's Hospital of Eastern Ontario, Eastern Ontario Regional Laboratory Association, Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarah E Wheeler
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Ottawa, Canada
- School of Medicine, Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Renze Bais
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Ottawa, Canada
- rbaisconsulting, St. Leonards, NSW, Australia
| | - Pradeep Kumar Dabla
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Ottawa, Canada
- Department of Biochemistry, G. B Pant Institute of Postgraduate Medical Education & Research, Associated Maulana Azad Medical College, New Delhi, India
| | - Ji Lin
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Ottawa, Canada
- Core Diagnostics, Abbott Labs, Lake Forest, IL, USA
| | - Armand Perret-Liaudet
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Ottawa, Canada
- Hospices Civils de Lyon, Lyon, France
| | - Annette Thomas
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Ottawa, Canada
- Weqas, Cardiff and Vale University Health Board, Cardiff, UK
| | - Kandace A Cendejas
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Ottawa, Canada
- Bio-Rad Laboratories, Quality Systems, Hercules, CA, USA
| | - Jean-Marc Giannoli
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Ottawa, Canada
- Technical Direction Biogroup and Labac, Lyon, France
| | - Anne Vassault
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Ottawa, Canada
- University Paris City, Paris, France
| | - Egon Amann
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Ottawa, Canada
- Philipps University Marburg, Marburg, Germany
- University of Applied Sciences, Hamm-Lippstadt, Hamm, Germany
- Consultant in Life Sciences, Quality Systems & Clinical Chemistry, Marburg, Germany
| | - Qing H Meng
- International Federation of Clinical Chemistry and Laboratory Medicine, Task Force on Global Lab Quality, Ottawa, Canada
- MD Anderson Cancer Center, Department of Laboratory Medicine, Houston, TX, USA
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13
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Dokubo EK, Shang JD, N'Dir A, Ndongmo CB, Okpu G, Fadil YM, Takang LE, Angumua C, Lyonga E, Mayer M, Ayukotabe T, Nkwoh TK, Hedje J, Etoundi GA, Njock RL. Building on Capacity Established through US Centers for Disease Control and Prevention Global Health Programs to Respond to COVID-19, Cameroon. Emerg Infect Dis 2022; 28:S181-S190. [PMID: 36502395 DOI: 10.3201/eid2813.221193] [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] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has highlighted the need for resilient health systems with the capacity to effectively detect and respond to disease outbreaks and ensure continuity of health service delivery. The pandemic has disproportionately affected resource-limited settings with inadequate health capacity, resulting in disruptions in health service delivery and worsened outcomes for key health indicators. As part of the US government's goal of ensuring health security, the US Centers for Disease Control and Prevention has used its scientific and technical expertise to build health capacity and address health threats globally. We describe how capacity developed through global health programs of the US Centers for Disease Control and Prevention in Cameroon was leveraged to respond to coronavirus disease and maintain health service delivery. The health system strengthening efforts in Cameroon can be applied in similar settings to ensure preparedness for future global public health threats and improve health outcomes.
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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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Ricós C, Fernández-Calle P, Perich C, Sandberg S. Control externo de la calidad en medicina del laboratorio. Avances y futuro. ADVANCES IN LABORATORY MEDICINE 2022; 3:232-242. [PMCID: PMC10197501 DOI: 10.1515/almed-2022-0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 12/29/2023]
Abstract
Objectivos Un programa de control externo distribuye las mismas muestras control entre varios laboratorios y evalúa los resultados obtenidos con un criterio común. El objetivo de este trabajo es resumir la evolución de los programas externos, poner de manifiesto los progresos conseguidos y deducir consecuencias prácticas para el laboratorio participante. Métodos El material es una breve revisión de los diferentes tipos de programas externos utilizados a lo largo de cuarenta años. El método es el análisis crítico de las ventajas e inconvenientes de cada modelo, a la luz de nuestra experiencia. Resultados A mitad del siglo XX se iniciaron los programas EQA, detectándose gran discrepancia entre resultados emitidos por distintos laboratorios. Se desarrollaron EQA en muchos países y se propusieron mecanismos para armonizarlos, como: establecer especificaciones derivadas de la variación biológica, promover el uso de métodos analíticos homogéneos, usar el EQA como herramienta educacional. A partir del 2000 se hacen importantes avances: asegurar el adecuado uso clínico de las pruebas del laboratorio, utilizar material control conmutable con el espécimen humano, armonizar los distintos modelos de EQA, promover una organización de cooperación entre organizadores de programas EQA. Conclusiones Participar en un EQA con controles conmutables y valores asignados por método de referencia certificado permite conocer la inexactitud real de los resultados y el impacto en las muestras de pacientes. Si se participa en programas con controles no conmutables solo se conoce si la prestación del laboratorio es similar a la de otros usuarios del mismo método analítico.
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Affiliation(s)
- Carmen Ricós
- Sociedad Española de Medicina del Laboratorio (SEQC), Barcelona, España
| | - Pilar Fernández-Calle
- Sociedad Española de Medicina del Laboratorio (SEQC), Barcelona, España
- Departamento de Medicina del Laboratorio, Hospital Universitario La Paz, Madrid, España
| | - Carmen Perich
- Sociedad Española de Medicina del Laboratorio (SEQC), Barcelona, España
| | - Sverre Sandberg
- Organización noruega para la mejora de la calidad de los exámenes del laboratorio (NOKLUS), Hospital Universitario Haukeland, Bergen, Norway
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Plebani M. Control interno de la calidad y garantía externa de la calidad: un gran pasado abre el camino a un brillante futuro. ADVANCES IN LABORATORY MEDICINE 2022; 3:218-220. [PMCID: PMC10197387 DOI: 10.1515/almed-2022-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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17
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Plebani M. Internal quality control and external quality assurance: a great past opens the way to a bright future. ADVANCES IN LABORATORY MEDICINE 2022; 3:215-220. [PMID: 37362140 PMCID: PMC10197377 DOI: 10.1515/almed-2022-0075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Affiliation(s)
- Mario Plebani
- Honorary Professor of Clinical Biochemistry and Clinical Molecular Biology, School of Medicine, University of Padova, Padova, Italy
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18
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Ricós C, Fernández-Calle P, Perich C, Sandberg S. External quality control in laboratory medicine. Progresses and future. ADVANCES IN LABORATORY MEDICINE 2022; 3:221-242. [PMID: 37362144 PMCID: PMC10197337 DOI: 10.1515/almed-2022-0058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/30/2022] [Indexed: 06/28/2023]
Abstract
Objectives An external quality control program distributes same control samples to various laboratories and evaluates results obtained with a common criterion. The aim of this work is to summarize the evolution of various types of external programs, to point out the progresses ant to preclude practical consequences of the participant laboratories. Content The material consists on a brief revision of the different types of external programs that have been used for the last forty years. The method is the critical analysis of the strong and weak points of each program model, from the light of our experience. External quality assessment (EQA) programs were initiated at half the XX century, evidencing big discrepancies among laboratory results. EQA were developed in various countries and some mechanisms to harmonize them were proposed: to establish common performance specifications derived from biological variation, to use EQS as educational tool. Since the 2000 important advances were seen: to focus EQA to assure the adequate clinical use of laboratory tests, to use commutable controls, to harmonize the different EQA models, to promote a forum for co-operation and exchange of knowledge on quality-related matters for EQA organizers. Summary and Outlook To participate in an EQA with commutable-reference method assigned values controls allows to know the real inaccuracy of results and their impact on patient' samples. To participate in a EQA with non commutable controls allows to know whether the individual laboratory performance agrees with that from other laboratories using same analytical method.
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Affiliation(s)
- Carmen Ricós
- Sociedad Española de Medicina del Laboratorio (SEQC), Barcelona, Spain
| | - Pilar Fernández-Calle
- Sociedad Española de Medicina del Laboratorio (SEQC), Barcelona, Spain
- Departamento de Medicina del Laboratorio, Hospital Universitario La Paz, Madrid, Spain
| | - Carmen Perich
- Sociedad Española de Medicina del Laboratorio (SEQC), Barcelona, Spain
| | - Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations (NOKLUS), Hospital Universitario Haukeland, Bergen, Norway
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Glynn EH, Nelson AM, Tesfazghi M, Harb R, Amukele T. Pathologists Overseas: A volunteer-based model for building sustainable, high-quality pathology and laboratory medicine services in low- and middle-income countries. Front Med (Lausanne) 2022; 9:977840. [PMID: 36111111 PMCID: PMC9468261 DOI: 10.3389/fmed.2022.977840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
For thirty years Pathologists Overseas (PO) has worked in low- and middle-income countries (LMICs) to provide affordable, sustainable, and high-quality pathology and laboratory medicine (PALM) services through strategic partnerships and the efforts of our large volunteer network. We address low quality diagnostic services by targeting the 3 pillars of PALM quality: human resources, systems, and quality and accreditation. To improve human resource capacity, PO and our partnering organizations provide virtual continuing education to pathologists and laboratory professionals in these countries. To improve systems, we provide laboratory information system installation and implementation support. Lastly, to improve quality and help laboratories progress toward accreditation, we support an external quality assurance program for laboratories in LMICs. As a relatively small organization, PO demonstrates that a network of dedicated volunteers, in partnership with corporations and professional organizations, can initiate sustainable change in the quality of PALM services in LMICs by focusing efforts on the core components of laboratory quality.
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Affiliation(s)
- Emily H. Glynn
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
- *Correspondence: Emily H. Glynn,
| | | | - Merih Tesfazghi
- Department of Pathology, Rush University, Chicago, IL, United States
| | - Roa Harb
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Timothy Amukele
- ICON Laboratory Services, ICON plc, Farmingdale, NY, United States
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20
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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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21
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Huf W, Mohns M, Bünning Z, Lister R, Garmatiuk T, Buchta C, Ettl B. Benchmarking medical laboratory performance: survey validation and results for Europe, Middle East, and Africa. Clin Chem Lab Med 2022; 60:830-841. [PMID: 35344647 DOI: 10.1515/cclm-2021-1349] [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: 12/31/2021] [Accepted: 03/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Medical laboratory performance is a relative concept, as are quality and safety in medicine. Therefore, repetitive benchmarking appears to be essential for sustainable improvement in health care. The general idea in this approach is to establish a reference level, upon which improvement may be strived for and quantified. While the laboratory community traditionally is highly aware of the need for laboratory performance and public scrutiny is more intense than ever due to the SARS-CoV-2 pandemic, few initiatives span the globe. The aim of this study was to establish a good practice approach towards benchmarking on a high abstraction level for three key dimensions of medical laboratory performance, generate a tentative snapshot of the current state of the art in the region of Europe, Middle East, and Africa (EMEA), and thus set the stage for global follow-up studies. METHODS The questionnaire used and previously published in this initiative consisted of 50 items, roughly half relating to laboratory operations in general with the other half addressing more specific topics. An international sample of laboratories from EMEA was approached to elicit high fidelity responses with the help of trained professionals. Individual item results were analyzed using standard descriptive statistics. Dimensional reduction of specific items was performed using exploratory factor analysis and assessed with confirmatory factor analysis, resulting in individual laboratory scores for the three subscales of "Operational performance", "Integrated clinical care performance", and "Financial sustainability". RESULTS Altogether, 773 laboratories participated in the survey, of which 484 were government hospital laboratories, 129 private hospital laboratories, 146 commercial laboratories, and 14 were other types of laboratories (e.g. research laboratories). Respondents indicated the need for digitalization (e.g. use of IT for order management, auto-validation), automation (e.g. pre-analytics, automated sample transportation), and establishment of formal quality management systems (e.g. ISO 15189, ISO 9001) as well as sustainably embedding them in the fabric of laboratory operations. Considerable room for growth also exists for services provided to physicians, such as "Diagnostic pathways guidance", "Proactive consultation on complex cases", and "Real time decision support" which were provided by less than two thirds of laboratories. Concordantly, the most important kind of turn-around time (TAT) for clinicians, sample-to-result TAT, was monitored by only 40% of respondents. CONCLUSIONS Altogether, the need for stronger integration of laboratories into the clinical care process became apparent and should be a main trajectory of future laboratory management. Factor analysis confirmed the theoretical constructs of the questionnaire design phase, resulting in a reasonably valid tool for further benchmarking activities on the three aimed-for key dimensions.
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Affiliation(s)
- Wolfgang Huf
- Karl Landsteiner Institute for Clinical Risk Management, Vienna, Austria
| | | | | | | | | | - Christoph Buchta
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Brigitte Ettl
- Karl Landsteiner Institute for Clinical Risk Management, Vienna, Austria
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22
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Vu HQ, Le OH, Truong DC, Nguyen DN, Van TH, Le VTK, Vang LTT. Formation and Evaluation of Complete Blood Count Proficiency Testing Program. Hematol Rep 2022; 14:73-84. [PMID: 35466176 PMCID: PMC9036311 DOI: 10.3390/hematolrep14020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The haematology external quality assessment (EQA) scheme is the most commonly used service of quality assurance. The provision of complete blood count (CBC) materials must meet the quality requirements at a reasonable cost. These requirements are the most significant challenges for EQA organisers in Vietnam. This study’s objective was to evaluate the homogeneity, long-term stability, and peer-group performance of 10-parameter stabilised CBC EQA samples. Methods: The CBC EQA material was prepared using the following steps, including (1) adjusting levels of stabilised erythrocyte, leukocyte, and platelet samples, (2) mixing those cells into batches at three levels, and (3) dispensing and storing them at 2–6 °C. A set of 10 and 30 specimens were randomly chosen from each batch to study the homogeneity and long-term stability following ISO 13528:2015. In total, 166 samples at two levels were randomly distributed to 40 participants, which reported 83 automatic cell counters among six automated analyser models in the CBC EQA program. Results: The 10-parameter stabilised CBC EQA materials at three levels became homogeneous and stable in 12 weeks when preserved at 2–6 °C. Meanwhile, for five parameters (RBC, Hb, MCH, MCV, and MPV), this process was prolonged for up to 16 weeks in stock condition. In terms of peer-group performance, the CV (%) values increased at the low concentration for almost all parameters, especially in platelet counts. Conclusions: The stabilised CBC EQA samples prepared using the partial fixation method with aldehyde and gutaraldehyde in this study meet the ISO 13528:2015 requirements of homogeneity and long-term stability for the CBC EQA scheme. Analytical performance evaluation should categorise participant methods into peer groups.
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Affiliation(s)
- Huy Quang Vu
- Faculty of Nursing and Medical Technology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 748010, Vietnam;
- Quality Control Center for Medical Laboratory, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 748010, Vietnam; (V.T.K.L.); (L.T.T.V.)
- Correspondence: ; Tel.: +84-913-586-389
| | - Oanh Hoang Le
- Cho Ray Transfusion Blood Center, Cho Ray Hospital, Ho Chi Minh City 748010, Vietnam;
| | - Duan Cong Truong
- Laboratory Department, Vinmec Times City International Hospital, Hanoi 100000, Vietnam;
| | - Dung Ngoc Nguyen
- Department of Cytology and Histology, National Institute of Hematology and Blood Transfusion, Hanoi 100000, Vietnam;
| | - Triet Hy Van
- Faculty of Nursing and Medical Technology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 748010, Vietnam;
- Quality Control Center for Medical Laboratory, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 748010, Vietnam; (V.T.K.L.); (L.T.T.V.)
| | - Van Thi Kieu Le
- Quality Control Center for Medical Laboratory, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 748010, Vietnam; (V.T.K.L.); (L.T.T.V.)
| | - Linh Thi Truc Vang
- Quality Control Center for Medical Laboratory, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 748010, Vietnam; (V.T.K.L.); (L.T.T.V.)
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Mo X, Wang X, Zhu Z, Yu Y, Chang D, Zhang X, Li D, Sun F, Zhou L, Xu J, Zhang H, Gao C, Guan M, Xiao Y, Wu W. Quality Management for Point-Of-Care Testing of Pathogen Nucleic Acids: Chinese Expert Consensus. Front Cell Infect Microbiol 2021; 11:755508. [PMID: 34722341 PMCID: PMC8548827 DOI: 10.3389/fcimb.2021.755508] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/28/2021] [Indexed: 02/05/2023] Open
Abstract
COVID-19 continues to circulate globally in 2021, while under the precise policy implementation of China’s public health system, the epidemic was quickly controlled, and society and the economy have recovered. During the pandemic response, nucleic acid detection of SARS-CoV-2 has played an indispensable role in the first line of defence. In the cases of emergency operations or patients presenting at fever clinics, nucleic acid detection is required to be performed and reported quickly. Therefore, nucleic acid point-of-care testing (POCT) technology for SARS-CoV-2 identification has emerged, and has been widely carried out at all levels of medical institutions. SARS-CoV-2 POCT has served as a complementary test to conventional polymerase chain reaction (PCR) batch tests, thus forming an experimental diagnosis platform that not only guarantees medical safety but also improves quality services. However, in view of the complexity of molecular diagnosis and the biosafety requirements involved, pathogen nucleic acid POCT is different from traditional blood-based physical and chemical index detection. No guidelines currently exist for POCT quality management, and there have been inconsistencies documented in practical operation. Therefore, Shanghai Society of Molecular Diagnostics, Shanghai Society of Laboratory Medicine, Clinical Microbiology Division of Shanghai Society of Microbiology and Shanghai Center for Clinical Laboratory have cooperated with experts in laboratory medicine to generate the present expert consensus. Based on the current spectrum of major infectious diseases in China, the whole-process operation management of pathogen POCT, including its application scenarios, biosafety management, personnel qualification, performance verification, quality control, and result reporting, are described here. This expert consensus will aid in promoting the rational application and robust development of this technology in public health defence and hospital infection management.
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Affiliation(s)
- Xi Mo
- Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xueliang Wang
- Department of Molecular Biology, Shanghai Centre for Clinical Laboratory, Shanghai, China
| | - Zhaoqin Zhu
- Department of Laboratory Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yuetian Yu
- Department of Critical Care Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dong Chang
- Department of Laboratory Medicine, Shanghai Pudong Hospital, Fudan University Affiliated Pudong Medical Center, Shanghai, China
| | - Xinxin Zhang
- Department of Infectious Diseases, Research Laboratory of Clinical Virology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dong Li
- Department of Laboratory Medicine, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fenyong Sun
- Department of Clinical Laboratory Medicine, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Lin Zhou
- Department of Laboratory Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jin Xu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, Shanghai, China
| | - Hong Zhang
- Department of Clinical Laboratory, Shanghai Children's Hospital, Shanghai, China
| | - Chunfang Gao
- Clinical Laboratory Medicine Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine Shanghai, Shanghai, China
| | - Ming Guan
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yanqun Xiao
- Department of Molecular Biology, Shanghai Centre for Clinical Laboratory, Shanghai, China
| | - Wenjuan Wu
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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24
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Huf W, Mohns M, Garmatiuk T, Lister R, Buchta C, Ettl B, Köller U. Benchmarking diagnostic laboratory performance: Survey results for Germany, Austria, and Switzerland. Wien Klin Wochenschr 2021; 134:174-181. [PMID: 34709471 PMCID: PMC8552210 DOI: 10.1007/s00508-021-01962-4] [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: 01/04/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The need for patient safety through consistent diagnostic performance has increasingly been brought into focus during the last two decades. Around the globe operational efficiency of diagnostic laboratories plays a key role in satisfying this need, which has impressively been shown during the recent months of the SARS-CoV‑2 pandemic. On a global level, however, there has been a lack to collate and benchmark data for diagnostic laboratories. The goals of this study were to design and pilot a questionnaire addressing key aspects of diagnostic laboratory management. METHODS The questionnaire was designed using an iterative process and taking into consideration information that could be extracted from the literature, author experience and feedback from informal focus groups of laboratory professionals. The resulting tool consisted of 50 items, either relating to general information or more specifically addressing the topics of "operational performance", "integrated clinical care performance", and "financial sustainability". A limited number of laboratories were surveyed to be able to further improve the newly developed tool and motivate the global laboratory community to participate in further benchmarking activity. RESULTS AND CONCLUSION Altogether, 65 laboratories participated in the survey, 42 were hospital laboratories and 23 were commercial laboratories. Potential for further improvement and standardization became apparent across the board, e.g. use of IT for order management, auto-validation, or turn-around time (TAT) monitoring. Notably, a gap was identified regarding services provided to physicians, in particular "reflexive test suggestions", "proactive consultation on complex cases", and "diagnostic pathways guidance", which were only provided by about two thirds of laboratories. Concordantly, within-laboratory TAT (Lab TAT) was monitored by about 80% of respondents, while sample-to-result TAT, which is arguably the TAT most relevant to clinicians, was only monitored by 32% of respondents. Altogether, the need for stronger integration of the laboratory into the clinical care process became apparent and should be a main trajectory of future laboratory management.
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Affiliation(s)
- Wolfgang Huf
- Karl Landsteiner Institute for Clinical Risk Management, Vienna, Austria. .,Department of Laboratory Medicine, Hietzing Hospital, Vienna Healthcare Group, Vienna, Austria.
| | | | - Tetiana Garmatiuk
- Department of Laboratory Medicine, Hietzing Hospital, Vienna Healthcare Group, Vienna, Austria
| | | | - Christoph Buchta
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | - Brigitte Ettl
- Karl Landsteiner Institute for Clinical Risk Management, Vienna, Austria
| | - Ursula Köller
- Department of Laboratory Medicine, Hietzing Hospital, Vienna Healthcare Group, Vienna, Austria
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25
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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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26
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Causes behind error rates for predictive biomarker testing: the utility of sending post-EQA surveys. Virchows Arch 2020; 478:995-1006. [PMID: 33225398 PMCID: PMC8099794 DOI: 10.1007/s00428-020-02966-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022]
Abstract
External quality assessment (EQA) schemes assess the performance of predictive biomarker testing in lung and colorectal cancer and have previously demonstrated variable error rates. No information is currently available on the underlying causes of incorrect EQA results in the laboratories. Participants in EQA schemes by the European Society of Pathology between 2014 and 2018 for lung and colorectal cancer were contacted to complete a survey if they had at least one analysis error or test failure in the provided cases. Of the 791 surveys that were sent, 325 were completed including data from 185 unique laboratories on 514 incorrectly analyzed or failed cases. For the digital cases and immunohistochemistry, the majority of errors were interpretation-related. For fluorescence in situ hybridization, problems with the EQA materials were reported frequently. For variant analysis, the causes were mainly methodological for lung cancer but variable for colorectal cancer. Post-analytical (clerical and interpretation) errors were more likely detected after release of the EQA results compared to pre-analytical and analytical issues. Accredited laboratories encountered fewer reagent problems and more often responded to the survey. A recent change in test methodology resulted in method-related problems. Testing more samples annually introduced personnel errors and lead to a lower performance in future schemes. Participation to quality improvement projects is important to reduce deviating test results in laboratories, as the different error causes differently affect the test performance. EQA providers could benefit from requesting root cause analyses behind errors to offer even more tailored feedback, subschemes, and cases.
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Keppens C, Schuuring E, Dequeker EMC. Managing Deviating EQA Results: A Survey to Assess the Corrective and Preventive Actions of Medical Laboratories Testing for Oncological Biomarkers. Diagnostics (Basel) 2020; 10:E837. [PMID: 33080995 PMCID: PMC7603102 DOI: 10.3390/diagnostics10100837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 12/24/2022] Open
Abstract
Laboratories testing predictive biomarkers in lung and colorectal cancer are advised to participate in external quality assessment (EQA) schemes. This study aimed to investigate which corrective actions were taken by laboratories if predetermined performance criteria were not met, to ultimately improve current test practices. EQA participants from the European Society of Pathology between 2014 and 2018 for lung and colorectal cancer were contacted, if they had at least one analysis error or test failure in the provided cases, to complete a survey. For 72.4% of 514 deviating EQA results, an appropriate action was performed, most often including staff training (15.2%) and protocol revisions (14.6%). Main assigned persons were the molecular biologist (40.0%) and pathologist (46.5%). A change in test method or the use of complex techniques, such as next-generation sequencing, required more training and the involvement of dedicated personnel to reduce future test failures. The majority of participants adhered to ISO 15189 and implemented suitable actions by designated staff, not limited to accredited laboratories. However, for 27.6% of cases (by 20 laboratories) no corrective action was taken, especially for pre-analytic problems and complex techniques. The surveys were feasible to request information on results follow-up and further recommendations were provided.
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Affiliation(s)
- Cleo Keppens
- Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Kapucijnenvoer 35d, 3000 Leuven, Belgium;
| | - Ed Schuuring
- Department of Pathology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands;
| | - Elisabeth MC Dequeker
- Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Kapucijnenvoer 35d, 3000 Leuven, Belgium;
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Arnaud J, Patriarca M, Fofou-Caillierez BM, González-Estecha M, Gómez MG, De Graaf I, Patriarca V, Ropert-Bouchet M, Schröer-Janssen L, Siebelder C, Te Winkel M, Ventura Alemany M, Weykamp C. External quality assessment schemes for inorganic elements in the clinical laboratory: Lessons from the OELM scheme. J Trace Elem Med Biol 2020; 59:126414. [PMID: 31810809 DOI: 10.1016/j.jtemb.2019.126414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/05/2019] [Accepted: 10/03/2019] [Indexed: 12/01/2022]
Abstract
Measurements of inorganic elements in clinical laboratories produce results used for the diagnosis, the treatment and the monitoring of deficiencies or overloads. The main objective of External Quality Assessment Schemes is to verify, on a regular frequency, that clinical laboratory results correspond to the quality requirement for patient care. Therefore, External Quality Assessment Schemes represent an essential component of a laboratory's quality management system. However, External Quality Assessment Schemes within the same analytical field remain heterogeneous for different reasons such as samples, determination of assigned value, acceptable limits, content of the reports. The aim of this review was to describe and illustrate some major critical aspects of External Quality Assessment Schemes based on Occupational and Environmental Laboratory Medicine external quality assessment scheme experience.
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Affiliation(s)
- Josiane Arnaud
- Unité de biochimie hormonale et nutritionnelle, Institut de Biologie et Pathologie, CHU Grenoble Alpes, CS 10217, 38043, Grenoble cedex 9, France.
| | - Marina Patriarca
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma (I), Italy.
| | - Béatrice Ma'atem Fofou-Caillierez
- Biochimie et Biologie Moléculaire, Nutrition et Métabolisme, Hôpital Brabois, CHRU Nancy, 5 rue du Morvan, 54511 Vandoeuvre-les-Nancy Cedex, France.
| | - Montserrat González-Estecha
- Servicio de Análisis Clínicos, IML. IdISSC, Hospital Clínico San Carlos, Calle Profesor Martín Lagos 1, 28040, Madrid, Spain.
| | - MªCarmen González Gómez
- Programas de Garantía Externa de la Calidad para Laboratorios Clínicos, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Padilla 323, despacho 68, 08025 Barcelona, Spain.
| | - Irene De Graaf
- MCA Laboratorium, Streekziekenhuis Koningin Beatrix, Beatrixpark 1, Postbus 9005, 7100 GG Winterswijk, the Netherlands.
| | - Valeria Patriarca
- Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Roma (I), Italy.
| | - Martine Ropert-Bouchet
- Laboratoire de Biochimie Toxicologie, CHU de Rennes, 2 rue Henri Le Guilloux, 35033 Rennes cedex 9, France.
| | - Liesbeth Schröer-Janssen
- MCA Laboratorium, Streekziekenhuis Koningin Beatrix, Beatrixpark 1, Postbus 9005, 7100 GG Winterswijk, the Netherlands.
| | - Carla Siebelder
- MCA Laboratorium, Streekziekenhuis Koningin Beatrix, Beatrixpark 1, Postbus 9005, 7100 GG Winterswijk, the Netherlands.
| | - Marieke Te Winkel
- MCA Laboratorium, Streekziekenhuis Koningin Beatrix, Beatrixpark 1, Postbus 9005, 7100 GG Winterswijk, the Netherlands.
| | - Montserrat Ventura Alemany
- Programas de Garantía Externa de la Calidad para Laboratorios Clínicos, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Padilla 323, despacho 68, 08025 Barcelona, Spain.
| | - Cas Weykamp
- MCA Laboratorium, Streekziekenhuis Koningin Beatrix, Beatrixpark 1, Postbus 9005, 7100 GG Winterswijk, the Netherlands.
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29
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The internal quality control in the traceability era. ACTA ACUST UNITED AC 2020; 59:291-300. [DOI: 10.1515/cclm-2020-0371] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/15/2022]
Abstract
Abstract
To be accurate and equivalent, laboratory results should be traceable to higher-order references. Furthermore, their quality should fulfill acceptable measurement uncertainty (MU) as defined to fit the intended clinical use. With this aim, in vitro diagnostics (IVD) manufacturers should define a calibration hierarchy to assign traceable values to their system calibrators. Medical laboratories should know and verify how manufacturers have implemented the traceability of their calibrators and estimate the corresponding MU on clinical samples. Accordingly, the internal quality control (IQC) program should be redesigned to permit IVD traceability surveillance through the verification by medical laboratories that control materials, provided by the manufacturer as a part of measuring systems, are in the clinically suitable validation range (IQC component I). Separately, laboratories should also monitor the reliability of employed IVD measuring systems through the IQC component II, devoted to estimation of MU due to random effects and to obtaining MU of provided results, in order to apply prompt corrective actions if the performance is worsening when compared to appropriate analytical specifications, thus jeopardizing the clinical validity of test results.
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30
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Plebani M, Padoan A, Sciacovelli L. Measurement uncertainty: light in the shadows. ACTA ACUST UNITED AC 2020; 58:1381-1383. [DOI: 10.1515/cclm-2020-0134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine , University-Hospital of Padova , 3218 Padova , Italy
- Department of Medicine-DIMED, Medical School , University of Padova , Padova , Italy
| | - Andrea Padoan
- Department of Medicine-DIMED, Medical School , University of Padova , Padova , Italy
- Department of Laboratory Medicine , University-Hospital of Padova , Padova , Italy
| | - Laura Sciacovelli
- Department of Laboratory Medicine , University-Hospital of Padova , Padova , Italy
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31
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Performance evaluation of 14 specific proteins measurement checked by an External Quality Assessment Scheme. Clin Chim Acta 2019; 502:73-83. [PMID: 31836500 DOI: 10.1016/j.cca.2019.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 11/23/2022]
Abstract
AIMS OF THE STUDY To evaluate the state-of-the-art of 14 specific proteins measurement; to evaluate the laboratories' performance and the degree of harmonization in reporting results of participants in the External Quality Assessment Program of the Centre of Biomedical Research (CRB). METHODS Overall and system-related inter-laboratory analytical variability (mean CVs%) and between-system differences (mean bias%) were evaluated from data of six EQA cycles 2013-2018. Moreover, we evaluated the analytical performance of participants as well as the units used to express proteins results. RESULTS Overall inter-laboratory variability ranged from 3.8% for haptoglobin (HPT) to 12.5% for α1-antitrypsin (AAT) and decreased for IgA, α2-macroglobulin (A2M) and transferrin (TRF). Mean CVs% were generally higher for Siemens BN and Beckman Immage immunonephelometric systems, but <7.0% for all proteins. Mean bias > 7.0% was observed for BN (IgA, C4, AAT, transthyretin TTR), Siemens Vista (IgA, C4) and Immage (C4), whereas mean bias < -7.0% was found for Immage (AAT), Beckman AU (IgM) and Roche Cobas (C4, TTR, C-reactive protein). The laboratories' performance within the limits ranged from 85.1% of albumin (ALB) to 97.2% of HPT. The census of units employed in 2018, demonstrated that ~ 70% of laboratories still express the results in mg/dL. CONCLUSIONS Despite a reduction in inter-laboratory variability for some proteins, different analytical systems showed both proportional and constant bias between methods. Units used by participants have not been substantially changed and dL is still largely used. The CRB EQA Program, with its performance data sets, is a valuable resource for laboratories and IVD manufacturers and support the goals of harmonization.
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32
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Church DL, Naugler C. Benefits and risks of standardization, harmonization and conformity to opinion in clinical laboratories. Crit Rev Clin Lab Sci 2019; 56:287-306. [PMID: 31060412 DOI: 10.1080/10408363.2019.1615408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Large laboratory systems that include facilities with a range of capabilities and capacity are being created within consolidated healthcare systems. This paradigm shift is being driven by administrators and payers seeking to achieve resource efficiencies and to conform practice to the requirements of computerization as well as the adoption of electronic medical records. Although standardization and harmonization of practice improves patient care outcomes and operational efficiencies, administratively driven practice conformity (conformity to opinion) also has serious drawbacks and may lead to significant system failure. Juxtaposition of the distinct philosophical approaches of physicians and scientists (i.e. "professionalism") versus administrators and managers (i.e. "managerialism") towards bringing about conformity of the laboratory system inherently creates conflict. Despite an administrative edict to "perform all tests using the same methods" regardless of available "best practice" evidence to do so, medical/scientific input on these decisions is critical to ensure quality and safety of patient care. Innovation within the laboratory system, including the adoption of advanced technologies, practices, and personalized medicine initiatives, will be enabled by balancing the relentless drive by non-medical administration to meet "business" requirements, the medical responsibility to provide the best care possible, and customizing practice to meet individual patient care needs.
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Affiliation(s)
- Deirdre L Church
- a Department of Pathology and Laboratory Medicine , University of Calgary , Calgary , Canada.,b Department of Medicine , University of Calgary , Calgary , Canada
| | - Christopher Naugler
- a Department of Pathology and Laboratory Medicine , University of Calgary , Calgary , Canada.,c Department of Community Health Sciences , University of Calgary , Calgary , Canada.,d Department of Family Medicine , University of Calgary , Calgary , Canada
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33
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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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34
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Plebani M, Graziani MS, Tate JR. Harmonization in laboratory medicine: Blowin' in the wind. Clin Chem Lab Med 2019; 56:1559-1562. [PMID: 29982235 DOI: 10.1515/cclm-2018-0594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, via Nicolo Giustiniani 2, 35128 Padova, Italy
| | | | - Jillian R Tate
- Pathology Queensland, Chemical Pathology Department, Royal Brisbane and Woman's Hospital, Herston, Queensland, Australia
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Verderio P, Pizzamiglio S, Ciniselli CM. Methodological and statistical issues in developing an External Quality Assessment scheme in laboratory medicine: Focus on biomarker research. N Biotechnol 2019; 52:54-59. [PMID: 31059865 DOI: 10.1016/j.nbt.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 11/16/2022]
Abstract
External Quality Assessment (EQA) schemes are well-established tools with which to evaluate, monitor and improve the output quality of clinical laboratories, recognising that high quality laboratory medicine is essential for patient care. EQA programs involve the testing of multiple laboratories and the statistical comparison of their results, according to a multistep workflow. New clinical laboratory activities, such as biomarker research, require new EQA schemes. Critical elements in designing EQA programs are choosing the statistical methods and defining reference values and control limits. This article summarizes the key features of an EQA scheme, including designing the study, identifying reference values and control limits for qualitative and quantitative data, and graphically reporting laboratory performance statistics. These steps are illustrated with examples taken from the authors' experience in national and international quality assessment schemes for biomarker research.
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Affiliation(s)
- Paolo Verderio
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Sara Pizzamiglio
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Maura Ciniselli
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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36
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Lippi G, Da Rin G. Advantages and limitations of total laboratory automation: a personal overview. ACTA ACUST UNITED AC 2019; 57:802-811. [DOI: 10.1515/cclm-2018-1323] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/14/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Automation is considered one of the most important breakthroughs in the recent history of laboratory diagnostics. In a model of total laboratory automation (TLA), many analyzers performing different types of tests on different sample matrices are physically integrated as modular systems or physically connected by assembly lines. The opportunity to integrate multiple diagnostic specialties to one single track seems effective to improve efficiency, organization, standardization, quality and safety of laboratory testing, whilst also providing a significant return of investment on the long-term and enabling staff requalification. On the other hand, developing a model of TLA also presents some potential problems, mainly represented by higher initial costs, enhanced expenditure for supplies, space requirements and infrastructure constraints, staff overcrowding, increased generation of noise and heat, higher risk of downtime, psychological dependence, critical issues for biospecimen management, disruption of staff trained in specific technologies, along with the risk of transition toward a manufacturer’s-driven laboratory. As many ongoing technological innovations coupled with the current scenario, profoundly driven by cost-containment policies, will promote further diffusion of laboratory automation in the foreseeable future, here we provide a personal overview on some potential advantages and limitations of TLA.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry , University Hospital of Verona , Piazzale LA Scuro , 37134 Verona , Italy
| | - Giorgio Da Rin
- Laboratory Medicine , San Bassiano Hospital , Bassano del Grappa , Italy
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