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Awwad S, Al-Hamdani M, Abdallah AM, Abu-Madi M. Laboratory testing efficiency during the COVID pandemic: Findings from the Primary Health Care Corporation laboratories in the State of Qatar. J Infect Public Health 2024; 17:681-686. [PMID: 38471258 DOI: 10.1016/j.jiph.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Little is known about how the COVID-19 pandemic altered laboratory testing efficiency in the State of Qatar. The aim of this study was to assess laboratory testing efficiency with respect to the total number and proportion of C-reactive protein (CRP), complete blood count (CBC), and comprehensive metabolic panel (CMP) tests completed on time in 2019-2021 in several ordinary and COVID-converted Primary Health Care Corporation (PHCC) health centers across Qatar. METHODS Secondary data from 2019 to 2021 were accessed from the PHCC-Clinical Information System center. Six randomly selected centers from three regions of Qatar (Northern, Central, and Western), two of which were COVID-converted, were analyzed. RESULTS A total of 404,316 laboratory tests were analyzed. There were decreasing, U-shaped, and inverted-U-shaped patterns in the numbers of tests conducted in different regions between 2019 and 2021 according to test type. The proportion of urgent (STAT) CBC and CMP tests increased from 2019 to 2021, and the proportion of tests completed by COVID-converted health centers increased for CRP and CBC and decreased for CMP between 2019 and 2021. Northern and Western regions in Qatar showed higher efficiency than the Central region with respect to the proportion of STAT tests completed on time in 2019-2021. COVID-converted centers completed fewer STAT CBC tests on time than ordinary centers. CONCLUSION Pandemics such as COVID-19 shift the allocation of resources from routine tests to urgent tests, as exemplified by the increase in STAT test proportions in 2019 to 2021. High population densities, as noted in the Central region of Qatar, may require additional resources during pandemics to complete urgent tests more efficiently. The conversion of centers to COVID-converted centers may not necessarily translate into higher urgent test efficiency, as exemplified by the STAT CBC test results.
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Affiliation(s)
- Sara Awwad
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Mohammed Al-Hamdani
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Atiyeh M Abdallah
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Marawan Abu-Madi
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
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Rao P, Mathur N, Kalyanpur A. Utilization of Teleradiology by Intensive Care Units: A Cohort Study. Indian J Crit Care Med 2024; 28:20-25. [PMID: 38510772 PMCID: PMC10949298 DOI: 10.5005/jp-journals-10071-24593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/29/2023] [Indexed: 03/22/2024] Open
Abstract
Aim and background Imaging is indispensable to the diagnostic and treatment process. By facilitating access to rapid timely image interpretation, teleradiology plays a prominent role in improving access, quality of critical care, and management of the patients in intensive care units (ICU). The aim of the study is to investigate the role of teleradiology in ICU patient care and management. Materials and methods In our study, a total of 22,081 studies of a cohort of 14,900 patients which had been transmitted from intensive care units of 80 hospitals located across the United States of America through a teleradiology reporting workflow, were interpreted by the American Board Certified Radiologists empanelled by a teleradiology service provider, located in India. Results Among all modalities, the highest percentage of studies performed were computed tomography scan (47%) followed by radiographs (37.22%). Out of 22,081 cases under the study, 16,582 cases were reported during nighttime with a mean turnaround time (TAT) of 46.66 minutes 95% CI (46.27-47.04) while 5,499 cases were reported during daytime with a mean TAT of 44.66 minutes 95% CI (45.40-43.92). Conclusion Setting up teleradiology service connectivity with a teleradiology service provider located in India, providing high-quality diagnostic interpretations and lower turnaround time with the ICUs in the US hospitals reduces the interval to intervention time and leads to efficient patient care management. Moreover, it also provides time advantage for US hospitals when on-site radiologists at night are unable to provide immediate coverage. Clinical significance The ICU teleradiology service model designed in the study would greatly help overcome the shortfall of radiologists in the hospitals, provide better patient management and care by quality reporting in short turnaround time, not only during daytime but also in the night hours or on holidays when on-site radiologists are unable to provide immediate coverage. How to cite this article Rao P, Mathur N, Kalyanpur A. Utilization of Teleradiology by Intensive Care Units: A Cohort Study. Indian J Crit Care Med 2024;28(1):20-25.
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Affiliation(s)
- Pallavi Rao
- Department of Clinical Research, Image Core Lab, Bengaluru, Karnataka, India
| | - Neetika Mathur
- Department of Clinical Research, Image Core Lab, Bengaluru, Karnataka, India
| | - Arjun Kalyanpur
- Department of Clinical Radiology, Teleradiology Solutions, Bengaluru, Karnataka, India
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Hyslop A, Swazo R, Smith JP. "A friendly reminder" - Improving workflow and efficiency in a pulmonary fellows' outpatient continuity clinic. Heart Lung 2024; 63:167-174. [PMID: 37925749 DOI: 10.1016/j.hrtlng.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Seeing patients in an ambulatory clinic generates electronic medical record (EMR) inbox tasks. Little is known about the standard baseline message turnaround time to EMR inbox task completion and whether electronic reminders improve turnaround time. OBJECTIVE 1) Obtain baseline message type and mean message turnaround time (MTT) to EMR inbox task completion data, 2) Standardize EMR workflow education, 3) Disseminate bi-weekly electronic reminders to fellows in their continuity clinic and measure MTT. METHODS Prospective, non-randomized, unblinded, cross-over pre- and post-intervention pilot study in an ambulatory pulmonary clinic at a large, urban, academic referral health system. Sixteen pulmonary and critical care fellows affiliated with the Indiana University School of Medicine Pulmonary and Critical Care Fellowship were divided equally into two groups, with the study period from October of 2021 to May of 2022, and were given bi-weekly calendar reminders in Microsoft Outlook with measurement of EMR messages and MTT. RESULTS 2554 messages were acknowledged with result notes (n = 1676, 59.16 %) being the most common. There was a 40 % decrease in overall MTT from the pre- to the post-intervention period (MTT = 33 days in pre-intervention period for whole cohort, MTT = 19 days in post-intervention period). CONCLUSIONS MTT for EMR inbox tasks at a large, academic center with fellowship trainees is roughly 2.5 weeks. These findings should prompt other institutions to investigate their own trainees' inbox handling habits and validates the benefit of EMR training and reminders on fellowship trainee's in-basket task turnaround time.
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Affiliation(s)
- Alan Hyslop
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine; Indiana University School of Medicine, Indianapolis, IN, United States of America.
| | - Roberto Swazo
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine
| | - Joseph P Smith
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine; Indiana University School of Medicine, Indianapolis, IN, United States of America
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Li L, Lowe CF, McLachlan E, Romney MG, Wright A, Matic N. Epidemiology of cytomegalovirus antiviral resistance testing for solid organ and bone marrow transplant patients from 2011 - 2019. J Clin Virol 2023; 166:105549. [PMID: 37478805 DOI: 10.1016/j.jcv.2023.105549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND CMV reactivation post-transplantation is common, with need for prompt identification of patients most at-risk for CMV antiviral drug resistance (AVDR). OBJECTIVES This study describes CMV AVDR frequencies, antiviral prescribing practices, and AVDR risk factors in patients from 2011 to 2019 in British Columbia, Canada. STUDY DESIGN Retrospective review of demographics, transplant type, viral loads, antiviral exposure duration, and 12-month mortality was conducted for all patients with samples submitted for CMV AVDR testing from 2011 to 2019. Genotyping of AVDR mutations occurred at the national reference laboratory. Mann-Whitney U, T-test or Fisher's exact tests examined differences between patients with and without AVDR. RESULTS Fifty-three plasma and three tissue/fluid specimens successfully underwent CMV AVDR testing; of these samples, 27/56 (48%) had AVDR mutations detected. The commonest AVDR mutations were at UL97 loci A594 (20%), H596 (12%) and L595 (12%). Mutations occurred more frequently in requests from solid organ than hematopoietic stem cell transplant patients (58% vs. 27%, p = 0.05). Previous resistance testing was a significant risk factor for AVDR (p < 0.001). Patients with AVDR had approximately 51 more days of antiviral therapy (p = 0.007) and took 9 days longer to clear viremia (p = 0.23). The median turnaround time from sample send-out to reporting was nine days. However, empiric use of second-line antivirals occurred in most cases (39/53, 74%) before results were available. DISCUSSION Laboratories should strive to provide timely CMV AVDR testing for transplant patients, to minimize unnecessary exposure to second-line antiviral agents. The findings of this study may help guide clinicians when selecting empiric antiviral therapy.
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Affiliation(s)
- Lynne Li
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christopher F Lowe
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Elizabeth McLachlan
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Marc G Romney
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Alissa Wright
- Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Nancy Matic
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada.
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Mwanza J, Doherty T, Lubeya MK, Gray GE, Mutale W, Kawonga M. Laboratory services in the context of prevention of mother-to-child transmission of HIV testing requirements in Copperbelt Province, Zambia: a qualitative inquiry. BMC Health Serv Res 2023; 23:753. [PMID: 37443064 DOI: 10.1186/s12913-023-09747-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Reliable and timely laboratory results are crucial for monitoring the Prevention of the Mother-to-Child Transmission (PMTCT) cascade, particularly to enable early HIV diagnosis and early intervention. We sought to explore whether and how laboratory services have been prepared to absorb new testing requirements following PMTCT Test-and-Treat policy changes in three districts of Zambia. METHOD We employed in-depth interviews and thematic data analysis, informed by the health system dynamic framework. Twenty-Six health workers were purposively selected and a document review of laboratory services in the context of PMTCT was undertaken. All face-to-face interviews were conducted in three local government areas in the Copperbelt Province (one urban and two rural) between February 2019 and July 2020. We extracted notes and markings from the transcripts for coding. Different codes were sorted into potential themes and the data extracted were put within the identified themes. Trustworthiness was confirmed by keeping records of all data field notes, transcripts, and reflexive journals. RESULTS The findings revealed that the health system inputs (infrastructure and supplies, human resources, knowledge, and information and finance) and service delivery were unequal between the rural and urban sites, and this affected the ability of health facilities to apply the new testing requirements, especially, in the rural-based health facilities. The major barriers identified include gaps in the capacity of the existing laboratory system to perform crucial PMTCT clinical and surveillance functions in a coordinated manner and insufficient skilled human resources to absorb the increased testing demands. The centralized laboratory system for HIV testing of mothers and exposed neonates meant facilities had to send specimens to other facilities and districts which resulted in high turnaround time and hence delayed HIV diagnosis. CONCLUSION New guidelines implemented without sufficient capacitation of health system laboratory capacity severely limited the effectiveness of PMTCT program implementation. This study documented the areas relating to health system inputs and laboratory service delivery where greater support to enable the absorption of the new testing requirements is needed.
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Affiliation(s)
- Jonathan Mwanza
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Tanya Doherty
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Mwansa Ketty Lubeya
- Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Glenda E Gray
- Office of the President, South Africa Medical Research Council, Cape Town, South Africa
| | - Wilbroad Mutale
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mary Kawonga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Community Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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Runde B, Harms C. Vet the journal before you submit: turnaround times of journals publishing in zoological medicine and related fields. PeerJ 2023; 11:e15656. [PMID: 37456893 PMCID: PMC10348302 DOI: 10.7717/peerj.15656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
Many factors influence selection of a target journal for publishing scientific papers, including "fit" within the journal's scope, acceptance rate, readership, open access options, submission and publication costs, journal quality, and timeliness of publication. Timeliness of publication can be a critical factor affecting career development, but many journals are not transparent about turnaround times. Here we evaluated 49 journals publishing papers in zoological medicine and related fields between 2017 and 2022, and aggregated and examined distributions of turnaround time of journals that publicly provided the requisite data, in order to aid authors in selecting target journals that best meet their needs. Of 49 journals evaluated, 39 provided necessary dates for reconstructing turnaround times. Of these, median times to acceptance ranged from 37 to 338 days, and median times to publication ranged from 41 to 403.5 days. The percentage of papers published in greater than 1 year ("slow") ranged from 0 to 57.1%, while the percentage of papers published in under 6 months ("timely") ranged from 0.8 to 99.8%. Acceptance rates and times to first decision were available for only 22% and 20%, respectively, of journals evaluated. Results may prove useful for authors deciding where to submit their works, depending on how they prioritize the many factors involved.
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Affiliation(s)
- Brendan Runde
- Department of Applied Ecology, College of Agriculture and Life Sciences, Center for Marine Sciences and Technology, North Carolina State University, Morehead City, NC, United States of America
- The Nature Conservancy, Charlottesville, VA, United States of America
| | - Craig Harms
- Department of Clinical Sciences, College of Veterinary Medicine, Center for Marine Sciences and Technology, North Carolina State University, Morehead City, NC, United States of America
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Shafique U, Hillis SL, Park JM, Kuehn DM, Rajput M. Radiologists Help Each Other to Improve Efficiency by Decreasing the Time to Look Up a Patient's Relevant Clinical History in the Electronic Medical Record. J Digit Imaging 2023; 36:388-394. [PMID: 36357753 PMCID: PMC10039210 DOI: 10.1007/s10278-022-00726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
The study aims to prove that it takes less time to look up relevant clinical history from an electronic medical record (EMR) if the information is already provided in a specific space in the EMR by a fellow radiologist. Patients with complex oncological and surgical histories need frequent imaging, and every time a radiologist may spend a significant amount of time looking up the same clinical information as their peers. In collaboration with ACMIO and Radiant Epic team, a space labeled "Specialty Comments" was added to the SNAPSHOT of patient's chart in EMR. For our research purpose, the specialty comment was labeled as boxed history as a variable for data analysis. If the history was not provided in that particular space, it was labeled as without boxed history. Inclusion criteria included outpatients with complex oncological histories undergoing CT chest, abdomen, and pelvis with IV contrast. The time to look up history (LUT) was documented in minutes and seconds. Two assistant professors from Abdominal Imaging provided LUT. A total of 85 cases were included in the study, 39 with boxed history and 46 without boxed history. Comparing averages of the individual reader means for history, mean LUT differed by 2.03 min (without boxed history) versus 0.57 min (with boxed history), p < 0.0001. The t-test and the nonparametric Wilcoxon tests for a difference in the population means were highly significant (p < 0.0001). A history directed to radiologist's needs resulted in a statistically significant decrease in time spent by interpreting radiologists to look through the electronic medical records for patients with complex oncological histories. Availability of history pertinent to radiology has wide-ranging advantages, including quality reporting, decrease in turnaround time, reduction in interpretation errors, and radiologists' continued learning. The space for documenting clinical history may be reproduced, or some similar area may be developed by optimizing the electronic medical records.
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Affiliation(s)
- Umber Shafique
- Indiana University School of Medicine, 2554 Congress Street, Carmel, IN 46032 USA
| | - Stephen L. Hillis
- Departments of Radiology and Biostatistics, Hospitals and Clinics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242-1077 USA
| | - Jinha M. Park
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - David M. Kuehn
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Maheen Rajput
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 USA
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Li A, Wang Z, Moghadas SM. Modelling the impact of timelines of testing and isolation on disease control. Infect Dis Model 2023; 8:58-71. [PMID: 36467718 PMCID: PMC9704027 DOI: 10.1016/j.idm.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
Testing and isolation remain a key component of public health responses to both persistent and emerging infectious diseases. Although the value of these measures have been demonstrated in combating recent outbreaks including the COVID-19 pandemic and monkeypox, their impact depends critically on the timelines of testing and start of isolation during the course of disease. To investigate this impact, we developed a delay differential model and incorporated age-since-symptom-onset as a parameter for delay in testing. We then used the model to compare the outcomes of reverse-transcription polymerase chain reaction (RT-PCR) and rapid antigen (RA) testing methods when isolation starts either at the time of testing or at the time of test result. Parameterizing the model with estimates of SARS-CoV-2 infection and diagnostic sensitivity of the tests, we found that the reduction of disease transmission using the RA test can be comparable to that achieved by applying the RT-PCR test. Given constraints and inevitable delays associated with sample collection and laboratory assays in RT-PCR testing post symptom onset, self-administered RA tests with short turnaround times present a viable alternative for timely isolation of infectious cases.
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Gretser S, Hoeh B, Kinzler MN, Reitz A, Preisser F, Kluth LA, Mandel P, Chun FKH, Reis H, Wild PJ, Köllermann J. The NeuroSAFE frozen section technique during radical prostatectomy - Implementation and optimization of technical aspects in a routine pathology workflow. Pathol Res Pract 2023; 242:154297. [PMID: 36621159 DOI: 10.1016/j.prp.2022.154297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS In prostate cancer patients, application of the NeuroSAFE frozen section technique during radical prostatectomy has been shown to increase the rate of nerve sparing surgery and to improve functional outcome for the patients. The aim of this study is to report on technical and organizational optimization opportunities of the procedure. MATERIAL AND METHODS All patients submitted to bilateral intraoperative frozen section from January 2018 until December 2020 (n = 452) were retrospectively analyzed and parameters such as turnaround time, staff situation in the laboratory and histologic properties of the tumors were assessed. RESULTS The median turnaround time per case was 40.3 ( ± 10.5) min. In 2020 the average time needed from accessioning to diagnosis was 38.1 min. Multivariate linear regression suggested that the number of technical assistants/cryotomes (46.1 min vs. 39.13 min; p < 0.001), the place of microscopic examination (43.0 min vs. 38.7 min; p < 0.001) and the presence of a positive margin (38.0 vs. 44.0 min; p < 0.001) were significant influential factors. The turnaround time was independent of the uropathological expertize of the consultant (39.84 min vs. 40.7 min; p = 0.09), the tumor grade (42.3 vs 39.8 min; p = 0.493) and the presence of extraprostatic extension (44.0 vs 39.8 min; p = 0.099). CONCLUSION The implementation of simple optimization measures in the workflow as well as structured training of all pathology staff involved in the examination leads to a significant increase in the efficiency of the examination while maintaining the same level of resources. The results could thus be a contribution to the broader application of the procedure.
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Affiliation(s)
- S Gretser
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - B Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - M N Kinzler
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany; Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - A Reitz
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - F Preisser
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - L A Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - P Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - F K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - H Reis
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - P J Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany; Wildlab, University Hospital Frankfurt MVZ GmbH, Frankfurt am Main, Germany; Frankfurt Institute for Advanced Studies (FIAS), Frankfurt am Main, Germany; Frankfurt Cancer Institute (FCI), University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - J Köllermann
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
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Colton H, Parker M, Stirrup O, Blackstone J, Loose M, McClure C, Roy S, Williams C, McLeod J, Smith D, Taha Y, Zhang P, Hsu S, Kele B, Harris K, Mapp F, Williams R, Flowers P, Breuer J, Partridge D, de Silva T. Factors affecting turnaround time of SARS-CoV-2 sequencing for inpatient infection prevention and control decision making: analysis of data from the COG-UK HOCI study. J Hosp Infect 2023; 131:34-42. [PMID: 36228768 PMCID: PMC9550290 DOI: 10.1016/j.jhin.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Barriers to rapid return of sequencing results can affect the utility of sequence data for infection prevention and control decisions. AIM To undertake a mixed-methods analysis to identify challenges that sites faced in achieving a rapid turnaround time (TAT) in the COVID-19 Genomics UK Hospital-Onset COVID-19 Infection (COG-UK HOCI) study. METHODS For the quantitative analysis, timepoints relating to different stages of the sequencing process were extracted from both the COG-UK HOCI study dataset and surveys of study sites. Qualitative data relating to the barriers and facilitators to achieving rapid TATs were included from thematic analysis. FINDINGS The overall TAT, from sample collection to receipt of sequence report by infection control teams, varied between sites (median 5.1 days, range 3.0-29.0 days). Most variation was seen between reporting of a positive COVID-19 polymerase chain reaction (PCR) result to sequence report generation (median 4.0 days, range 2.3-27.0 days). On deeper analysis, most of this variability was accounted for by differences in the delay between the COVID-19 PCR result and arrival of the sample at the sequencing laboratory (median 20.8 h, range 16.0-88.7 h). Qualitative analyses suggest that closer proximity of sequencing laboratories to diagnostic laboratories, increased staff flexibility and regular transport times facilitated a shorter TAT. CONCLUSION Integration of pathogen sequencing into diagnostic laboratories may help to improve sequencing TAT to allow sequence data to be of tangible value to infection control practice. Adding a quality control step upstream to increase capacity further down the workflow may also optimize TAT if lower quality samples are removed at an earlier stage.
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Affiliation(s)
- H. Colton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK,Directorate of Laboratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK,Corresponding author. Address: Department of Infection, Immunity and Cardiovascular Disease, Faculty of Medicine, Dentistry & Health, University of Sheffield, Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - M.D. Parker
- Sheffield Biomedical Research Centre, University of Sheffield, Sheffield, UK,Sheffield Bioinformatics Core, University of Sheffield, Sheffield, UK
| | - O. Stirrup
- Institute for Global Health, University College London, London, UK
| | - J. Blackstone
- The Comprehensive Clinical Trials Unit, University College London, London, UK
| | - M. Loose
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - C.P. McClure
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - S. Roy
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, UK
| | - C. Williams
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, UK
| | - J. McLeod
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - D. Smith
- Department of Applied Biology, Cellular and Molecular Sciences/Microbiology Group, Northumbria University, Newcastle, UK
| | - Y. Taha
- Department of Infection and Tropical Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - P. Zhang
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - S.N. Hsu
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK,Sheffield Bioinformatics Core, University of Sheffield, Sheffield, UK
| | - B. Kele
- Virology Department, East and South East London Pathology Partnership, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - K. Harris
- Virology Department, East and South East London Pathology Partnership, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - F. Mapp
- Institute for Global Health, University College London, London, UK
| | - R. Williams
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, UK
| | | | - P. Flowers
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - J. Breuer
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, UK
| | - D.G. Partridge
- Directorate of Laboratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - T.I. de Silva
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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11
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Razak NA, Masood I, Baneen U, Ahmad Z, Shamsi H. Eliminate TB by 2025? A case report of MDR TB to reaffirm the need of follow UP! Indian J Tuberc 2023; 70:134-138. [PMID: 36740311 DOI: 10.1016/j.ijtb.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/30/2022] [Accepted: 05/16/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Nader Abdul Razak
- Department of Tuberculosis & Respiratory Diseases, Jawaharlal Nehru Medical College, Aligarh Muslim University, India.
| | - Imrana Masood
- Department of Tuberculosis & Respiratory Diseases, Jawaharlal Nehru Medical College, Aligarh Muslim University, India
| | - Ummul Baneen
- Department of Tuberculosis & Respiratory Diseases, Jawaharlal Nehru Medical College, Aligarh Muslim University, India
| | - Zuber Ahmad
- Department of Tuberculosis & Respiratory Diseases, Jawaharlal Nehru Medical College, Aligarh Muslim University, India
| | - Hassan Shamsi
- Department of Tuberculosis & Respiratory Diseases, Jawaharlal Nehru Medical College, Aligarh Muslim University, India
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12
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Hayatghaibi SE, Cazaban CG, Chan SS, Dillman JR, Du XL, Huang YT, Iyer RS, Mikhail OI, Swint JM. Turnaround time and efficiency of pediatric outpatient brain magnetic resonance imaging: a multi-institutional cross-sectional study. Pediatr Radiol 2022;:1-9. [PMID: 36526870 DOI: 10.1007/s00247-022-05563-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/28/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Aside from single-center reports, few data exist across pediatric institutions that examine overall MRI turnaround time (TAT) and the determinants of variability. OBJECTIVE To determine average duration and determinants of a brain MRI examination at academic pediatric institutions and compare the duration to those used in practice expense relative value units (RVUs). MATERIALS AND METHODS This multi-institutional cross-sectional investigation comprised four academic pediatric hospitals. We included children ages 0 to < 18 years who underwent an outpatient MRI of the brain without contrast agent in 2019. Our outcome of interest was the overall MRI TAT derived by time stamps. We estimated determinants of overall TAT using an adjusted log-transformed multivariable linear regression model with robust standard errors. RESULTS The average overall TAT significantly varied among the four hospitals. A sedated brain MRI ranged from 158 min to 224 min, a non-sedated MRI from 70 min to 112 min, and a limited MRI from 44 min to 70 min. The most significant predictor of a longer overall TAT was having a sedated MRI (coefficient = 0.71, 95% confidence interval [CI]: 0.66-0.75; P < 0.001). The median MRI scan time for a non-sedated exam was 38 min and for a sedated exam, 37 min, approximately double the duration used by the Relative Value Scale (RVS) Update Committee (RUC). CONCLUSION We found considerable differences in the overall TAT across four pediatric academic institutions. Overall, the significant predictors of turnaround times were hospital site and MRI pathway (non-sedated versus sedated versus limited MRI).
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Capraro GA. Replacement of Culture with Molecular Testing for Diagnosis Infectious Diseases. Clin Lab Med 2022; 42:547-555. [PMID: 36368781 DOI: 10.1016/j.cll.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Gerald A Capraro
- Clinical Microbiology Laboratory, Carolinas Pathology Group, Atrium Health, 5040 Airport Center Parkway, Building H, Suite A, Charlotte, NC 28208, USA.
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Zhang SM, Xian ZH. A retrospective analysis of the diagnostic accuracy and technical quality of frozen sections in detecting hepatobiliary lesions. Ann Diagn Pathol 2022; 61:152048. [PMID: 36152353 DOI: 10.1016/j.anndiagpath.2022.152048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pathological consultation on intraoperative frozen sections plays a crucial role in the management of patients undergoing surgical therapy, and is also a key indicator for quality assurance in anatomical pathology. This study aimed to evaluate the diagnostic accuracy and technical quality of frozen sections in detecting hepatobiliary lesions with malignant potential. PATIENTS AND METHODS A retrospective database review was performed for 1208 cases intraoperative pathology consultation who underwent hepatobiliary lesions resection at our institution from 2016 to 2020. The intraoperative consultation cases during a 5-year period were reviewed and analyzed, including the measurement of the diagnostic accuracy and turnaround time of frozen sections, the reasons for discrepancies, and the rates of discordance and deferral. RESULTS In this study, we confirmed that the overall accuracy, sensitivity and specificity were 95.3 %, 96.3 % and 96.6 %, respectively, in distinguishing benign from malignant lesions. The rates of deferred and discordant diagnoses were 2.57 % and 2.2 %, respectively. The overall frozen section turnaround time was 22.1 min. The most common cause of deferred and discordant was poor section quality, the lesion of bile duct margin on the frozen section, misinterpretation of difficult and complicated cases, etc. CONCLUSIONS: This study confirms that the intraoperative frozen sections can serve as a rapid, accurate and robust method for the pathological diagnosis of suspected hepatobiliary lesions. However, it should be noted that some poor technical problems, pathological assessment of tumor margin and difficult cases are the most frequently causes of deferred and discordant interpretations.
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Affiliation(s)
- Shun-Min Zhang
- Department of Pathology, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Zhi-Hong Xian
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Naval Military Medical University, Shanghai, China.
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15
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Nam M, Yoon S, Hur M, Lee GH, Kim H, Park M, Kim HN. Digital Morphology Analyzer Sysmex DI-60 vs. Manual Counting for White Blood Cell Differentials in Leukopenic Samples: A Comparative Assessment of Risk and Turnaround Time. Ann Lab Med 2022; 42:398-405. [PMID: 35177560 PMCID: PMC8859564 DOI: 10.3343/alm.2022.42.4.398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/10/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background Digital morphology (DM) analyzers are increasingly being used for white blood cell (WBC) differentials. We assessed the laboratory efficiency of the Sysmex DI-60 system (DI-60; Sysmex, Kobe, Japan) in comparison with manual counting in leukopenic samples. Methods In total, 40 peripheral blood smear samples were divided into normal, mild leukopenia, moderate leukopenia, and severe leukopenia groups based on WBC count. In each group, the risk and turnaround time (TAT) were compared between DI-60 and manual counting. Risk was determined by failure mode and effect analysis using the risk priority number (RPN) score, and TAT was recorded for the analytical phase. Results Overall, DI-60 showed a five-fold lower risk (70 vs. 350 RPN) and longer TAT than manual counting. In severe leukopenic samples, DI-60 showed a shorter TAT/slide and a remarkably lower cell count/slide than manual counting. In all samples, the TAT/cell for DI-60 was substantially longer than that for manual counting (DI-60 vs. manual total, 1.8 vs. 1.0 sec; normal, 1.5 vs. 0.7 sec; mild leukopenia, 1.9 vs. 0.9 sec; moderate leukopenia, 1.8 vs. 1.0 sec; severe leukopenia, 28.8 vs. 19.0 sec). Conclusions This is the first comparative assessment of risk and TAT between DI-60 and manual counting in leukopenic samples. DI-60 decreases the laboratory risk and improves patient safety, but requires more time to count fewer cells, especially in severe leukopenic samples. DM analyzers should be applied selectively depending on the WBC count to optimize laboratory efficiency.
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Affiliation(s)
- Minjeong Nam
- Department of Laboratory Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Sumi Yoon
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Gun Hyuk Lee
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Mikyoung Park
- Department of Laboratory Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Gatti M, Cojutti PG, Bartoletti M, Tonetti T, Bianchini A, Ramirez S, Pizzilli G, Ambretti S, Giannella M, Mancini R, Siniscalchi A, Viale P, Pea F. Expert clinical pharmacological advice may make an antimicrobial TDM program for emerging candidates more clinically useful in tailoring therapy of critically ill patients. Crit Care 2022; 26:178. [PMID: 35701812 PMCID: PMC9199203 DOI: 10.1186/s13054-022-04050-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/02/2022] [Indexed: 12/13/2022] Open
Abstract
Background Therapeutic drug monitoring (TDM) may represent an invaluable tool for optimizing antimicrobial therapy in septic patients, but extensive use is burdened by barriers. The aim of this study was to assess the impact of a newly established expert clinical pharmacological advice (ECPA) program in improving the clinical usefulness of an already existing TDM program for emerging candidates in tailoring antimicrobial therapy among critically ill patients. Methods This retrospective observational study included an organizational phase (OP) and an assessment phase (AP). During the OP (January–June 2021), specific actions were organized by MD clinical pharmacologists together with bioanalytical experts, clinical engineers, and ICU clinicians. During the AP (July–December 2021), the impact of these actions in optimizing antimicrobial treatment of the critically ill patients was assessed. Four indicators of performance of the TDM-guided real-time ECPA program were identified [total TDM-guided ECPAs July–December 2021/total TDM results July–December 2020; total ECPA dosing adjustments/total delivered ECPAs both at first assessment and overall; and turnaround time (TAT) of ECPAs, defined as optimal (< 12 h), quasi-optimal (12–24 h), acceptable (24–48 h), suboptimal (> 48 h)]. Results The OP allowed to implement new organizational procedures, to create a dedicated pathway in the intranet system, to offer educational webinars on clinical pharmacology of antimicrobials, and to establish a multidisciplinary team at the morning bedside ICU meeting. In the AP, a total of 640 ECPAs were provided for optimizing 261 courses of antimicrobial therapy in 166 critically ill patients. ECPAs concerned mainly piperacillin–tazobactam (41.8%) and meropenem (24.9%), and also other antimicrobials had ≥ 10 ECPAs (ceftazidime, ciprofloxacin, fluconazole, ganciclovir, levofloxacin, and linezolid). Overall, the pre–post-increase in TDM activity was of 13.3-fold. TDM-guided dosing adjustments were recommended at first assessment in 61.7% of ECPAs (10.7% increases and 51.0% decreases), and overall in 45.0% of ECPAs (10.0% increases and 35.0% decreases). The overall median TAT was optimal (7.7 h) and that of each single agent was always optimal or quasi-optimal. Conclusions Multidisciplinary approach and timely expert interpretation of TDM results by MD Clinical Pharmacologists could represent cornerstones in improving the cost-effectiveness of an antimicrobial TDM program for emerging TDM candidates.
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Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.,Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pier Giorgio Cojutti
- Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michele Bartoletti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.,Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tommaso Tonetti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.,Anesthesia and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Amedeo Bianchini
- Division of Anesthesiology, Department of Anesthesia and Intensive Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Giacinto Pizzilli
- Anesthesia and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Ambretti
- Operative Unit of Microbiology, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.,Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Mancini
- LUM Metropolitan Laboratory, AUSL Bologna, Bologna, Italy
| | - Antonio Siniscalchi
- Division of Anesthesiology, Department of Anesthesia and Intensive Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.,Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. .,Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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Ehret R, Breuer S, Dhein J, Reinhardt B, Obermeier M. Clinical evaluation of the automated Abbott RealTime SARS-CoV-2, Alinity m SARS-CoV-2, and Alinity m Resp-4-Plex assays. J Virol Methods 2022; 299:114338. [PMID: 34695479 DOI: 10.1016/j.jviromet.2021.114338] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Detection of SARS-CoV-2 infections relies on the use of sensitive, accurate and high throughput RT-PCR assays. OBJECTIVES We assessed the analytical performance of the Abbott RealTime SARS-CoV-2 (RT-SARS), Alinity m SARS-CoV-2 (AlinSARS) assays and compared the clinical performance of the RT-SARS, AlinSARS, and Alinity m Resp-4-Plex (Alin4Plex) assays to the Seegene Allplex assay (Allplex) and an inhouse test (Inhouse). RESULTS We found 100 % positive percent agreement (PPA) and 100 % negative percent agreement (NPA) comparing RT-SARS and Allplex. RT-SARS, AlinSARS and Inhouse showed 100 % NPA and 100 % PPA across all assays, except for the RdRp target of Inhouse (PPA = 84 %). Similarly, Alin4Plex and Allplex showed high agreement with specimens containing either SARS-CoV-2, influenza A, influenza B, or RSV. Detection rates of 100 % for SARS-CoV-2 at 50 copies/mL, high precision, and no cross-reactivity with non-SARS-CoV-2 respiratory pathogens were observed for RT-SARS and AlinSARS. AlinSARS detected SARS-CoV-2 in spiked throat washes and in specimens infected with SARS-CoV-2 Alpha or Beta variants. CONCLUSIONS The newly developed RT-SARS, AlinSARS, and Alin4Plex assays proved to be useful for detecting SARS-CoV-2 RNA in clinical samples.
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Kim K, Lee SG, Kim TH, Lee SG. Economic Evaluation of Total Laboratory Automation in the Clinical Laboratory of a Tertiary Care Hospital. Ann Lab Med 2022; 42:89-95. [PMID: 34374353 PMCID: PMC8368223 DOI: 10.3343/alm.2022.42.1.89] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/14/2020] [Accepted: 07/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background Total laboratory automation (TLA) is an innovation in laboratory technology; however, the high up-front costs restrict its widespread adoption. To examine whether the capital investment for TLA is worthwhile, we analyzed its clinical- and cost-effectiveness for the expected payback period. Methods Clinical chemistry tests and immunoassays performed in the clinical laboratory of a tertiary care hospital were divided into a post-TLA group, including 1,182,419 tests performed during December 2019, and a pre-TLA group, including 1,151,501 tests performed during December 2018. Laboratory information system data were used to measure clinical effectiveness, and depreciation data were used to calculate TLA costs. Results Laboratory performance improved after TLA adoption in all four key performance indicators mean turn-around time (TAT), representing the timeliness of result reporting, decreased by 6.1%; the 99th percentile of TAT, representing the outlier rate, decreased by 13.3%; the TAT CV, representing predictability, decreased by 70.0%; and weighted tube touch moment (wTTM), representing staff safety, improved by 77.6%. Based on these effectiveness results, economic evaluation was performed using two approaches. First, the incremental cost-effectiveness ratio and wTTM were used as the most cost-effective performance indicators. Second, the expected payback period was calculated. Considering only staff cost reduction, it was anticipated that 4.75 yrs would be needed to payback the initial investment. Conclusions TLA can significantly enhance laboratory performance, has a relatively quick payback period, and can reduce total hospital expenses in the long term. Therefore, the capital investment for TLA adoption is considered to be worthwhile.
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Affiliation(s)
- KyungYi Kim
- Department of Medical Device Engineering and Management, Yonsei University Graduate School, Seoul, Korea
| | - Sang-Guk Lee
- Department of Laboratory Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Sang Gyu Lee
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea
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Guo Z, Guo B, Wang S, Zhang H, Zhang W, Qin B, Shao H. Impact of satellite blood culture on early diagnosis of sepsis. J Intensive Med 2021; 2:56-60. [PMID: 36789234 PMCID: PMC9924021 DOI: 10.1016/j.jointm.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/28/2021] [Accepted: 11/17/2021] [Indexed: 12/29/2022]
Abstract
Background The aim of this study was to assess whether satellite blood culture (SBC) can improve turnaround times, antibiotic switching, and patient prognosis, relative to laboratory blood culture (LBC). . Methods Patients with sepsis treated in the intensive care units (ICUs) of Henan Provincial People's Hospital from February 5, 2018 to January 19, 2019 who met the inclusion criteria were recruited to the study and divided into the SBC group and LBC group according to different blood culture methods. Patient demographics, blood culture, antibiotic adjustment, and prognosis data were collected and compared between the two groups. . Results A total of 204 blood culture sets from 52 ICU patients, including 100 from the medical microbiology LBC group and 104 from the SBC group, were analyzed in this study. There was no significant difference in the positive rates between the two groups. Time from specimen collection to incubation was significantly shorter in the SBC group than that in the LBC group (1.65 h vs. 3.51 h, z=-4.09, P<0.001). The median time from specimen collection to notification of blood culture positivity was 24.83 h in the SBC group and 27.83 h in the LBC group. Median times from adjustment of antibiotics according to the first report were 26.05 h and 51.71 h in the SBC and LBC groups, respectively, while those according to the final report were 97.17 h and 111.45 h, respectively. Median ICU lengths of stay were 15.00 days and 17.00 days in the SBC and LBC groups, respectively, and median ICU lengths of stay were 18.00 days and 23.50 days, respectively. Mean hospitalization costs were 157.99 and 186.73 thousand yuan in the SBC and LBC groups, respectively. . Conclusion SBC can significantly reduce blood culture turnaround times; however, there were no significant differences between the two blood culture methods in initial reporting of positive cultures, time to adjustment of antibiotic therapy, or medical costs, despite a trend toward improvement.
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Affiliation(s)
- Ziqi Guo
- Department of Critical Care Medicine, Henan University People's Hospital, Zhengzhou, Henan 455000, China,Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 455000,China,Henan Key Laboratory for Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 455000, China
| | - Bo Guo
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 455000,China,Henan Key Laboratory for Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 455000, China,Department of Critical Care Medicine, Zhengzhou University People's Hospital, Zhengzhou, Henan 455000, China
| | - Shanmei Wang
- Department of Microbiology Laboratory, Henan Provincial People's Hospital, Zhengzhou, Henan 455000, China
| | - Huifeng Zhang
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 455000,China,Henan Key Laboratory for Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 455000, China,Department of Critical Care Medicine, Zhengzhou University People's Hospital, Zhengzhou, Henan 455000, China
| | - Wenxiao Zhang
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 455000,China,Henan Key Laboratory for Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 455000, China,Department of Critical Care Medicine, Zhengzhou University People's Hospital, Zhengzhou, Henan 455000, China
| | - Bingyu Qin
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 455000,China,Henan Key Laboratory for Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 455000, China,Department of Critical Care Medicine, Zhengzhou University People's Hospital, Zhengzhou, Henan 455000, China
| | - Huanzhang Shao
- Department of Critical Care Medicine, Henan University People's Hospital, Zhengzhou, Henan 455000, China,Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 455000,China,Henan Key Laboratory for Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 455000, China,Department of Critical Care Medicine, Zhengzhou University People's Hospital, Zhengzhou, Henan 455000, China,Corresponding author: Huanzhang Shao, Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan 455000, China.
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Cerna S, Arcolezi HH, Guyeux C, Royer-Fey G, Chevallier C. Machine learning-based forecasting of firemen ambulances' turnaround time in hospitals, considering the COVID-19 impact. Appl Soft Comput 2021; 109:107561. [PMID: 34899108 DOI: 10.1016/j.asoc.2021.107561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 12/11/2022]
Abstract
When ambulances’ turnaround time (TT) in emergency departments is prolonged, it not only affects the victim severely but also causes unavailability of resources in emergency medical services (EMSs) and, consequently, leaves a locality unprotected. This problem may worsen with abnormal situations, e.g., the current coronavirus disease 2019 (COVID-19) pandemic. Taking this into consideration, this paper presents a first study on the COVID-19 impact on ambulances’ TT by analyzing historical data from the Departmental Fire and Rescue Service of the Doubs (SDIS 25), in France, for three hospitals. Because the TTs of SDIS 25 ambulances increased, this paper also calculated and analyzed the number of breakdowns in services, which augmented due to shortage of ambulances that return on service in time. It is, therefore, vital to have a decision-support tool to better reallocate resources by knowing the time EMSs ambulances and personnel will be in use. Thus, this paper proposes a novel two-stage methodology based on machine learning (ML) models to forecast the TT of each ambulance in a given time and hospital. The first stage uses a multivariate model of regularly spaced time series to predict the average TT (AvTT) per hour, which considers temporal variables and external ones (e.g., COVID-19 statistics, weather data). The second stage utilizes a multivariate irregularly spaced time series model, which considers temporal variables of each ambulance departure, type of intervention, external variables, and the previously predicted AvTT as inputs. Four state-of-the-art ML models were considered in this paper, namely, Light Gradient Boosted Machine, Multilayer Perceptron, Long Short-Term Memory, and Prophet. As shown in the results, the proposed methodology provided remarkable results for practical purposes. The AvTT accuracies obtained for the three hospitals were 90.16%, 97.02%, and 93.09%. And the TT accuracies were 74.42%, 86.63%, and 76.67%, all with an error margin of ±10 min.
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21
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Alfsen GC, Gulczyński J, Kholová I, Latten B, Martinez J, Metzger M, Michaud K, Pontinha CM, Rakislova N, Rotman S, Varga Z, Wassilew K, Zinserling V. Code of practice for medical autopsies: a minimum standard position paper for pathology departments performing medical (hospital) autopsies in adults. Virchows Arch 2021; 480:509-517. [PMID: 34888730 PMCID: PMC8660654 DOI: 10.1007/s00428-021-03242-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/17/2022]
Abstract
The medical autopsy (also called hospital or clinical autopsy) is a highly specialised medical procedure, which requires professional expertise and suitably equipped facilities. To ensure high standards of performance, the Working Group of Autopsy Pathology of the European Society of Pathology (ESP) suggests a code of practice as a minimum standard for centres performing medical autopsies. The proposed standards exclusively address autopsies in adults, and not forensic autopsies, perinatal/or paediatric examinations. Minimum standards for organisation, standard of premises, and staffing conditions, as well as minimum requirements for level of expertise of the postmortem performing specialists, documentation, and turnaround times of the medical procedure, are presented. Medical autopsies should be performed by specialists in pathology, or by trainees under the supervision of such specialists. To maintain the required level of expertise, autopsies should be performed regularly and in a number that ensures the maintenance of good practice of all participating physicians. A minimum number of autopsies per dedicated pathologist in a centre should be at least 50, or as an average, at least one autopsy per working week. Forensic autopsies, but not paediatric/perinatal autopsies may be included in this number. Turnaround time for final reports should not exceed 3 weeks (14 working days) for autopsies without fixation of brain/spinal cord or other time-consuming additional examinations, and 6 weeks (30 working days) for those with fixation of brain/spinal cord or additional examinations.
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Affiliation(s)
- G Cecilie Alfsen
- Department of Pathology, Akershus University Hospital, Loerenskog, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Jacek Gulczyński
- Department of Pathology and Neuropathology, Medical University of Gdańsk, Gdansk, Poland
| | - Ivana Kholová
- Pathology, Fimlab Laboratories, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Bart Latten
- Department of Forensic Pathology, Netherlands Forensic Institute, The Hague, The Netherlands.,Department of Pathology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Javier Martinez
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de León (CAULE), Leon, Spain
| | - Myriam Metzger
- Department of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne, Switzerland.,Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Carlos M Pontinha
- Department of Anatomical Pathology, Central Lisbon University Hospital Centre, Lisbon, Portugal
| | - Natalia Rakislova
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, 08036, Barcelona, Spain
| | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Vsevolod Zinserling
- Department of Pathomorphology, Institute of Experimental Medicine V.A. Almazov National Research Center, Saint Petersburg, Russian Federation
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22
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Moon SY, Lee HS, Park MS, Kim IS, Lee SM. Evaluation of the Barricor Tube in 28 Routine Chemical Tests and Its Impact on Turnaround Time in an Outpatient Clinic. Ann Lab Med 2021; 41:277-284. [PMID: 33303712 PMCID: PMC7748094 DOI: 10.3343/alm.2021.41.3.277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/17/2020] [Accepted: 11/30/2020] [Indexed: 01/19/2023] Open
Abstract
Background We recently introduced the Barricor (BD, Franklin Lakes, NJ, USA) plasma separation tube, which uses a mechanical separator instead of a gel. We evaluated the effects of using the Barricor tube in a stat (statin) laboratory on the results and turnaround time (TAT) of routine chemical tests. We verified the impact of Barricor tube on reducing TAT and providing results similar to those obtained using serum separator tubes (SSTs). Methods We collected venous blood samples from 166 outpatients in Barricor tubes and SSTs and measured 28 routine analytes using an AU5800 instrument (Beckman Coulter, Brea, CA, USA). TAT indexes were compared before and after using Barricor tube. Results Mean percent differences were <5%, except for alanine aminotransferase , total CO2, high-density lipoprotein, phosphate, total protein, and direct bilirubin. The median TAT decreased from 45 to 38 minutes, and the rate of a TAT >60 minutes decreased from 7.84% to 2.66%, which was approximately one-third of that for SST. The reduction in TAT was attributable to a decrease in centrifugation time. Incomplete clotting and repeated centrifugation, which occurred frequently when using SST, also decreased after using the Barricor tubes. Conclusions The Barricor tube is an alternative to SST for routine chemical tests in institutions aiming to reduce TAT, with clinically allowable differences in test results.
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Affiliation(s)
- Soo Young Moon
- Department of Laboratory Medicine, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Han Sol Lee
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Min Soon Park
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - In-Suk Kim
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Laboratory Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Sun Min Lee
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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23
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Gebreyes M, Sisay A, Tegen D, Asnake A, Wolde M. Evaluation of Laboratory Performance, Associated Factors and Staff Awareness Towards Achieving Turnaround Time in Tertiary Hospitals, Ethiopia. Ethiop J Health Sci 2021; 30:767-776. [PMID: 33911839 PMCID: PMC8047274 DOI: 10.4314/ejhs.v30i5.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background WHO recommends that each laboratory should establish turnaround time (TAT) to monitor and evaluate performance throughout processes. The status of established TAT was not yet assessed in Ethiopian Armed Force Comprehensive Specialized Hospital. The aim of this study was to evaluate the laboratory performance and associated factors towards achieving TAT in clinical chemistry and hematology tests at Armed Force Comprehensive Specialized Hospital, Addis Ababa, Ethiopia. Methods Hospital-based cross-sectional study was conducted from April 2019 to June 2019. Standardized questionnaire was designed to collected data on awareness of laboratory staffs about TAT. The data was entered, cleaned and analyzed using SPSS version 24.0 Software. Logistic regression analysis was done to find out statistically significant association and strength of association between dependent and independent variables at pvalue <0.05. Result A total of 422 test results were systematically selected with 100% response rates. Of these, 253(59.9%) were chemistry tests. From the expected < 90min TAT clinical chemistry tests, only 41(16.2%) and from < 60min TAT time for hematology tests, 37(21.9%) met the target. The laboratory TAT was affected by factors including high work load, laboratory information system problem, power interruption and sample collection time. Moreover, the level of knowledge, attitude and practices of laboratory staffs towards laboratory TAT were 60%, 85.7% and 62.9% respectively. Conclusion Overall achievement of clinical Chemistry and hematology tests TAT was poor. The finding might reflect other public hospital situation in Addis Ababa. Thus, additional large scale studies need to conduct.
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Affiliation(s)
- Mebrat Gebreyes
- Department of Medical Laboratory, Armed Force Comprehensive and Specialized Hospital, Addis Ababa, Ethiopia
| | - Abay Sisay
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dilargachew Tegen
- Department of Medical Laboratory, Armed Force Comprehensive and Specialized Hospital, Addis Ababa, Ethiopia
| | - Abushet Asnake
- Department of Medical Laboratory, Armed Force Comprehensive and Specialized Hospital, Addis Ababa, Ethiopia
| | - Mistire Wolde
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Abstract
OBJECTIVES Composite frozen section turnaround time has limited value, precluding assessment of certain processes: slide preparation (technical) and diagnosis (interpretation). We examined whether measuring these elements could identify delays, hypothesizing that longer times were related to (1) inefficient technical processes and (2) case-specific diagnostic challenges. METHODS Technical and interpretive times were determined for 1,992 specimens submitted for frozen section in 2017; the data were sorted by surgical specialty. Mean and quartile times were determined for each category with all specimens assessed equally, including those with multiple frozen section blocks. RESULTS Technical times were significantly longer than interpretive times. Specialty grouping facilitated trend identification and enabled assessment of technical and interpretation challenges. We identified technical issues with certain gross specimens involving overdissection and interpretation delays for specific neoplasms and margins. CONCLUSIONS Measuring technical and interpretative times and subcategorizing by specialty has aided the assessment of frozen section processing in our laboratory, enabling case isolation for process improvement.
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Affiliation(s)
- Joseph M Laakman
- Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Stephanie J Chen
- Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - John L Blau
- Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - D Anand Rajan
- Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Megan I Samuelson
- Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Robert A Robinson
- Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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25
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Mumba JM, Kasonka L, Owiti OB, Andrew J, Lubeya MK, Lukama L, Kasempa C, Msadabwe SC, Kalinda C. Cervical cancer diagnosis and treatment delays in the developing world: Evidence from a hospital-based study in Zambia. Gynecol Oncol Rep 2021; 37:100784. [PMID: 34095422 PMCID: PMC8165546 DOI: 10.1016/j.gore.2021.100784] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 01/07/2023] Open
Abstract
Expedited diagnostic processes for all suspected cervical cancer cases remain essential in the effort to improve clinical outcomes of the disease. However, in some developing countries like Zambia, there is paucity of data that assesses factors influencing diagnostic and treatment turnaround time (TAT) and other metrics vital for quality cancer care. We conducted a retrospective hospital-based study at the Cancer Diseases Hospital (CDH) for cervical cancer cases presenting to the facility between January 2014 and December 2018. Descriptive statistics were used to summarize demographic characteristics while a generalized linear model of the negative binomial was used to assess determinants of overall TAT. Our study included 2121 patient case files. The median age was 49 years (IQR: ±17) and most patients (n = 634, 31%) were aged between 41 and 50 years. The International Federation of Gynaecology and Obstetrics (FIGO) Cancer stage II (n = 941, 48%) was the most prevalent while stage IV (n = 103, 5.2%) was the least. The average diagnostic TAT in public laboratories was 1.48 (95%CI: 1.21-1.81) times longer than in private laboratories. Furthermore, referral delay was 55 days (IQR: 24-152) and the overall TAT (oTAT) was 110 days (IQR: 62-204). The age of the patient, HIV status, stage of cancer and histological subtype did not influence oTAT while marital status influenced oTAT. The observed longer oTAT may increase irreversible adverse health outcomes among cervical cancer patients. There is a need to improve cancer care in Zambia through improved health expenditure especially in public health facilities.
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Affiliation(s)
- Jane Mwamba Mumba
- The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110, Ridgeway, Lusaka, Zambia
- Ndola Teaching Hospital, Department of Obstetrics and Gynaecology, Broadway Road, Postal Agency Ndola, Ndola, Zambia
| | - Lackson Kasonka
- The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110, Ridgeway, Lusaka, Zambia
- Women and Newborn Hospital-University Teaching Hospitals, Nationalist Road, P/Bag RWX1 Ridgeway, Lusaka, Zambia
| | - Okola Basil Owiti
- Hasselt University, Faculty of Science, Campus Diepenbeek, Agoralaan Building D, 3590 Diepenbeek, Belgium
| | - John Andrew
- Hasselt University, Faculty of Science, Campus Diepenbeek, Agoralaan Building D, 3590 Diepenbeek, Belgium
| | - Mwansa Ketty Lubeya
- The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110, Ridgeway, Lusaka, Zambia
- Women and Newborn Hospital-University Teaching Hospitals, Nationalist Road, P/Bag RWX1 Ridgeway, Lusaka, Zambia
| | - Lufunda Lukama
- Ndola Teaching Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Broadway Road, Postal Agency Ndola, Ndola, Zambia
- University of KwaZulu-Natal, College of Health Sciences., Nelson R Mandela School of Medicine, Durban 4001, South Africa
| | - Charlotte Kasempa
- Cancer Diseases Hospital, Nationalist Road, Nationalist Road, P/Box RWX1 50110 Ridgeway, Lusaka, Zambia
| | - Susan C. Msadabwe
- Cancer Diseases Hospital, Nationalist Road, Nationalist Road, P/Box RWX1 50110 Ridgeway, Lusaka, Zambia
- Zambia College of Medicine and Surgery, Levy Mwanawasa Medical University, Great East Campus, Box 33991, Lusaka, Lusaka
| | - Chester Kalinda
- University of Namibia, Faculty of Agriculture, Engineering and Science, School of Science, Katima Mulilo Campus, Winele Road, Private Bag 1096, Ngweze, Katima Mulilo, Namibia
- University of KwaZulu-Natal, Howard College Campus, College of Health Sciences, School of Public Health and Nursing, Desmond Clarence Building, Durban 4001, South Africa
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Mumba JM, Kasonka L, Owiti OB, Andrew J, Lubeya MK, Lukama L, Kasempa C, Msadabwe SC, Kalinda C. Dataset evaluating the treatment timeliness of cervical cancer in Zambia. Data Brief 2021; 37:107201. [PMID: 34189197 PMCID: PMC8217689 DOI: 10.1016/j.dib.2021.107201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
Cervical cancer is the fourth most common cancer diagnosed among women globally. Effective screening routines and early detection are vital in reducing its disease burden and mortality. Several factors can influence the timely detection and treatment of cervical cancer, especially in low middle-income countries where the burden of this disease is highest. The data presented in this paper relates to the research article “Cervical cancer diagnosis and treatment delays in the developing world: Evidence from a hospital-based study in Zambia”. The raw and analysed data include the studied patients’ social demographic factors, clinical data concerning the stage and histological subtype of cancer, dates at which the various activities within the cancer treatment pathway occurred and delays to definitive treatment of cervical cancer at Zambia's only cancer treatment facility. Detailing delays to the treatment of cervical cancer allows recognition of specific points in the cancer treatment pathway requiring intervention to effectively improve cancer care and reduce the morbidity and mortality associated with the disease.
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Affiliation(s)
- Jane Mwamba Mumba
- The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110 Ridgeway, Lusaka, Zambia
- Ndola Teaching Hospital, Department of Obstetrics and Gynaecology, Broadway Road, Postal Agency Ndola, Ndola, Zambia
| | - Lackson Kasonka
- The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110 Ridgeway, Lusaka, Zambia
- Women and Newborn Hospital-University Teaching Hospitals, Nationalist Road, P/Bag RWX1 Ridgeway, Lusaka, Zambia
| | - Okola Basil Owiti
- Hasselt University, Faculty of Science, Campus Diepenbeek, Agoralaan building D, 3590 Diepenbeek, Belgium
| | - John Andrew
- Hasselt University, Faculty of Science, Campus Diepenbeek, Agoralaan building D, 3590 Diepenbeek, Belgium
| | - Mwansa Ketty Lubeya
- The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110 Ridgeway, Lusaka, Zambia
- Women and Newborn Hospital-University Teaching Hospitals, Nationalist Road, P/Bag RWX1 Ridgeway, Lusaka, Zambia
| | - Lufunda Lukama
- Ndola Teaching Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Broadway Road, Postal Agency Ndola, Ndola, Zambia
- University of KwaZulu-Natal, College of Health Sciences, Nelson R Mandela School of Medicine, Durban 4001, South Africa
| | - Charlotte Kasempa
- Cancer Diseases Hospital, Nationalist Road, Nationalist Road, P/Box RWX1 50110 Ridgeway, Lusaka, Zambia
| | - Susan C. Msadabwe
- Cancer Diseases Hospital, Nationalist Road, Nationalist Road, P/Box RWX1 50110 Ridgeway, Lusaka, Zambia
- Zambia College of Medicine and Surgery, Levy Mwanawasa Medical University, Great East Campus, Box 33991, Lusaka
| | - Chester Kalinda
- University of Namibia, Faculty of Agriculture, Engineering and Natural Science, School of Science, Katima Mulilo Campus, Winele Road, Private Bag 1096, Ngweze, Katima Mulilo, Namibia
- University of KwaZulu-Natal, Howard College Campus, College of Health Sciences, School of Public Health and Nursing, Desmond Clarence Building, Durban 4001, South Africa
- Corresponding author. @ChesterKal
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Zhu J, Bao Z, Xie Y, Werngren J, Hu Y, Davies Forsman L, Bruchfeld J, Hoffner S. Additional drug resistance for Mycobacterium tuberculosis during turnaround time for drug-susceptibility testing in China: A multicenter observational cohort study. Int J Infect Dis 2021; 108:81-88. [PMID: 33862209 DOI: 10.1016/j.ijid.2021.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Although phenotypic drug susceptibility testing (DST) of Mycobacterium tuberculosis (Mtb) takes up to 6-8 weeks, little is known about how drug susceptibility is affected during this period. METHODS We performed a prospective cohort study to investigate the development of drug resistance (DR) during turnaround time (TAT), including 359 pulmonary tuberculosis (PTB) patients with a baseline DST result of an Mtb isolate collected at TB diagnosis and a follow-up DST result of an Mtb isolate collected when baseline DST result was available between 2013 and 2018. Whole-genome sequencing (WGS) was used to differentiate between acquired drug resistance, exogenous reinfection, and mixed infection. RESULTS Among the studied patients, during TAT for DST, 116 (32.3%) developed DR to four first-line drugs (rifampicin, isoniazid, pyrazinamide, ethambutol). Among 116 pairs of isolates included for WGS, 21 pairs were classified as acquired drug resistance with single nucleotide polymorphisms (SNPs) differences less than 12. Four pairs with an intermediate SNPs differences displayed minor differences in related genotypes and were assessed as mixed infection. The remaining 91 pairs had high SNPs differences consistent with exogenous reinfection. CONCLUSIONS The exogenous reinfection of drug-resistant strains played a vital role in the development of DR of Mtb isolates during TAT for DST, highlighting the need for both rapid DST methods and improved infection control.
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Affiliation(s)
- Jiahui Zhu
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Ziwei Bao
- The Fifth People's Hospital of Suzhou, Infectious Disease Hospital Affiliated to Soochow University, Suzhou, China
| | - Yan Xie
- Department Tuberculosis Control, Zigong Center for Disease Control and Prevention, Zigong, China
| | - Jim Werngren
- Department of Microbiology, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Yi Hu
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China.
| | - Lina Davies Forsman
- Department of Infectious Disease, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Division of Infectious Diseases, Karolinska Institutet Solna, Sweden
| | - Judith Bruchfeld
- Department of Infectious Disease, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Division of Infectious Diseases, Karolinska Institutet Solna, Sweden
| | - Sven Hoffner
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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28
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Shukla S, Upadhyay V, Maurya VK. Evaluating the efficiency of specimen (sample) pooling for real-time PCR based diagnosis of COVID-19. Indian J Med Microbiol 2021; 39:339-342. [PMID: 33781658 PMCID: PMC7997677 DOI: 10.1016/j.ijmmb.2021.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
Purpose This study is aims at evaluating the efficacy and sensitivity of specimen pooling for testing of SARS-CoV-2 virus to determine the accuracy, resource savings, and identification of borderline positive cases without impacting the accuracy of the testing. Method This study was conducted between August and October 2020, we performed COVID-19 testing by RT-PCR on the samples from varying prevalence of rural population (non-hot spot) referred to COVID laboratory, in the first step, the samples were collated into pools of 5 or 10. These pools were tested by RT-PCR. Negative pools were reported as negative whereas positive pools of 5 and 10 were then de-convoluted and each sample was tested individually. Results In the present study, we tested 1580 samples in 158 pools of 10 and 17,515 samples in 3503 pools of 5. Among 10 samples pool, 11 (13%) pools flagged positive in the first step. In the second step, among 11 pools (110 samples) de-convoluted strategy was followed in which 10 individual samples came positive. Among 5 samples pool, 164 (13%) pools flagged positive in the first step. In the second step, among 164 pools (820 samples) de-convoluted strategy was followed in which 171 individual samples came positive. The pooled sample testing strategy saves substantial resources and time during surge testing and enhanced pandemic surveillance. This approach requires around 76%–93% fewer tests in low to moderate prevalence settings and group sizes up to 5–10 in a population, compared to individual testing. Conclusion Pooled sample RT- PCR analysis strategies can save substantial resources and time for COVID-19 mass testing in comparison with individual testing without compromising the quality of outcome of the test. In particular, the pooled sample approach can facilitate mass screening in the early asymptomatic stages of COVID-19 infections.
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Affiliation(s)
- Surabhi Shukla
- Department of Microbiology, Maharshi Vashistha Autonomous State Medical College, Basti, Uttar Pradesh, 272124, India
| | - Vandana Upadhyay
- Department of Microbiology, Maharshi Vashistha Autonomous State Medical College, Basti, Uttar Pradesh, 272124, India
| | - Vinod Kumar Maurya
- Department of Microbiology, Maharshi Vashistha Autonomous State Medical College, Basti, Uttar Pradesh, 272124, India.
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29
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Sparks R, Balgahom R, Janto C, Polkinghorne A, Branley J, Samarasekara H. An Australian diagnostic microbiology surge response to the COVID-19 pandemic. Diagn Microbiol Infect Dis 2021; 100:115309. [PMID: 33486387 DOI: 10.1016/j.diagmicrobio.2021.115309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/04/2021] [Accepted: 01/10/2021] [Indexed: 01/08/2023]
Abstract
Diagnostic microbiology services form a critical component of the response to infectious disease outbreaks. Like previous respiratory virus pandemics, the COVID-19 pandemic has placed significant strains on the standing capacity of laboratories around the world. In this case study, we describe the surge response required by our laboratory to meet the fluctuating demand for SARS-CoV-2 in our regional pathology service in Western Sydney, Australia between March and May 2020. While the overall number of SARS-CoV-2 PCR positive cases was relatively low compared to other Australian local health districts, testing numbers were highly unpredictable and changed on a weekly basis as local outbreaks were detected. As with other laboratories, numerous other challenges were also faced during this period, including the requirement to introduce a new and unaccredited diagnostic PCR assay for SARS-CoV-2, local and global shortages of reagents for sampling and sample processing, and a significant institutional SARS-CoV-2 outbreak in our laboratory catchment area. A successful service delivery during this period could only be maintained by a dynamic whole-of-laboratory and organizational response including (1) operational changes to the hours of service and the expansion of diagnostic testing at our laboratory site and other sites within our organization (2) careful management of specialist staff and re-training and recruitment of additional staff (3) changes to laboratory workflows to improve SARS-CoV-2 PCR test turnaround time and to accommodate limits to precious laboratory reagents; (4) clear communication within our laboratory and the NSW Health Pathology organization; and (5) collaborative co-ordination and support by NSW Health Pathology.
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Yoo IY, Kim JY, Yoon YK, Huh HJ, Lee NY. Comparison Between the SFTS-QS Kit and the PowerChek SFTSV Real-time PCR Kit for the Detection of Severe Fever With Thrombocytopenia Syndrome Virus. Ann Lab Med 2020; 40:317-320. [PMID: 32067431 PMCID: PMC7054697 DOI: 10.3343/alm.2020.40.4.317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/17/2019] [Accepted: 01/15/2020] [Indexed: 12/20/2022] Open
Abstract
The recent increase in severe fever with thrombocytopenia syndrome (SFTS) cases has led to the development of the SFTS-QS kit (MiCoBioMed, Seongnam, Korea) for detecting the SFTS virus (SFTSV, now renamed Huaiyangshan banyangvirus). SFTS-QS is a qualitative real-time reverse transcription PCR assay based on lab-on-a-chip technology. We evaluated the performance of the SFTS-QS kit and compared it with that of the PowerChek SFTSV Real-time PCR kit (PowerChek; Kogene Biotech, Seoul, Korea). A total of 117 serum samples were simultaneously assayed using the SFTS-QS and PowerChek kits. Sanger sequencing targeting the S and M segments of SFTSV was performed as the reference method. The total turnaround time of the two kits was compared. The SFTS-QS results agreed with those of PowerChek with a kappa value of 0.92. The diagnostic sensitivity and specificity of the SFTS-QS kit were both 100% (14/14 and 103/103, respectively), whereas those of the PowerChek kit were 100% (14/14) and 98.1% (101/103), respectively. The results of SFTS-QS and PowerChek were comparable; however, the SFTS-QS kit required a shorter total turnaround time. The SFTS-QS kit produced accurate and fast results and thus could serve as a useful tool for detecting SFTSV.
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Affiliation(s)
- In Young Yoo
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Youn Kim
- Center for Clinical Medicine, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.,Institute of Emerging Infectious Diseases, Korea University College of Medicine, Seoul, Korea
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Mukhopadhyay T, Subramanian A, Pati HP, Saxena R. Characterization of analytical errors in thromboelastography interpretation. Pract Lab Med 2021; 23:e00196. [PMID: 33385053 DOI: 10.1016/j.plabm.2020.e00196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/11/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Interpretation of Thromboelastography (TEG) curve involves correlating patient's clinical profile with TEG parameters and the tracing, keeping in mind the potential sources of errors, and hence requires expertise. We aimed to analyse the analytical errors in TEG interpretation due to paucity of literature in this regard. Material and methods The retrospective study was conducted in an apex trauma center in North India. Five months of data was reviewed by two laboratory physicians, with differences resolved by consensus. Cases with pre-analytical errors, missing data and TEG runs lasting <10 min were excluded. The analytical errors were classified into: preventable, potentially preventable, non-preventable, and non-preventable but care could have been improved. Results Out of 440 TEG tracings reviewed, 70 were excluded. An analytical error was present in 60/370 (16.2%) tracings. There were six types analytical errors, of which, tracings of severe hypocoagulable states showing k-time = 0 (33.3%) was the commonest, followed by tracings with spikes at irregular intervals (30%). Of all the analytical errors, 29/60 (48.2%) were preventable and 5/60 (8.3%) were potentially preventable. Conclusion Analytical variables that lead to errors in TEG interpretation were identified in about one-sixth of the cases and almost half of them were preventable. Awareness about the common errors amongst clinicians and laboratory physicians is critical to prevent treatment delay and safeguard patient safety.
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Frater JL, Anderson J. The impact of biosafety enhancement on stat laboratory quality metrics: Lessons from the COVID-19 pandemic. Clin Chim Acta 2020; 512:58-62. [PMID: 33285119 PMCID: PMC7836754 DOI: 10.1016/j.cca.2020.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/14/2020] [Accepted: 11/24/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE It is unclear if implementation of biosafety action plans in response to the COVID-19 pandemic has affected laboratory quality metrics. METHODS This retrospective study used quality data, including turnaround time (TAT) and number/type of unacceptable specimens from a stat laboratory supporting an outpatient medical clinic serving predominantly elderly cancer patients. Four months of data from the height of the COVID-19 pandemic (March-June 2020) were compared to the same months in 2019. RESULTS March-May 2020 test volumes were decreased compared to 2019. June 2020 test volume was slightly increased compared to 2019. TATs in 2020 were similar/ slightly improved compared to the same months in 2019, due to shortened collect to receive and receive to verify TATs. The number and types of unacceptable specimens were similar in 2020 and 2019. CONCLUSIONS Despite the challenges to the system caused by the pandemic, laboratory quality metrics were maintained.
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Affiliation(s)
- John L Frater
- Department of Pathology and Immunology, Washington University, St Louis, MO, USA.
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Blanc DS, Poncet F, Grandbastien B, Greub G, Senn L, Nordmann P. Evaluation of the performance of rapid tests for screening carriers of acquired ESBL-producing Enterobacterales and their impact on turnaround time. J Hosp Infect 2020; 108:19-24. [PMID: 33122041 DOI: 10.1016/j.jhin.2020.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales constitute a global burden for hospital infection, and the identification of carriers by screening patients at risk is recommended by several guidelines. AIM To evaluate the impact of rapid ESBL tests on the turnaround time (TAT) of screening. METHODS Rectal swabs were analysed by culture and synergism tests for identification of non-Esherichia coli Enterobacterales that produce ESBLs (NEcESBL-producing Enterobacterales). The Rapid ESBL NP and NG CTX-M MULTI tests were performed on colonies grown on chromogenic media. The results of polymerase chain reaction and sequencing of ESBL genes were used as the gold standard. RESULTS Among 473 analysed swabs, 75 (15.9%) grew NEcESBL-producing Enterobacterales, leading to 89 isolates. Sensitivities of the synergism, Rapid ESBL NP and NG CTX-M MULTI tests were 0.97 [95% confidence interval (CI) 0.88-0.99], 0.81 (95% CI 0.69-0.89) and 0.90 (95% CI 0.80-0.96), respectively. Specificities were 0.92 (95% CI 0.73-0.99), 0.85 (95% CI 0.64-0.95) and 0.96 (95% CI 0.78-1.00), respectively. Considering the 473 rectal swabs, ESBL screening using the synergism, Rapid ESBL NP and NG CTX-M MULTI tests was calculated. Sensitivities were 0.96 (95% CI 0.86-0.99), 0.81 (95% CI 0.68-0.90) and 0.91 (95% CI 0.79-0.97); specificities were 1.00 (95% CI 0.98-1.00), 0.99 (95% CI 0.98-1.00) and 1.00 (95% CI 0.99-1.00); positive predictive values were 0.96 (95% CI 0.86-0.99), 0.94 (95% CI 0.81-0.98) and 1.00 (95% CI 0.91-1.00); and negative predictive values were 1.00 (95% CI 0.98-1.00), 0.98 (95% CI 0.96-0.99) and 0.99 (95% CI 0.97-1.00), respectively. When no NEcESBL-producing Enterobacterales were observed, the mean TAT was 30 h. When NEcESBL-producing Enterobacterales were identified, the mean TATs were 74.7, 38.0 and 36.7 h for the synergism, Rapid ESBL NP and NG CTX-M MULTI tests, respectively. CONCLUSION The two rapid ESBL tests showed good performance and allowed a reduction in TAT for screening protocols to identify patients carrying ESBL-producing Enterobacterales.
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Affiliation(s)
- D S Blanc
- Service of Hospital Preventive Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Swiss National Reference Centre for Emerging Antibiotic Resistance, University of Fribourg, Fribourg, Switzerland.
| | - F Poncet
- Service of Hospital Preventive Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Swiss National Reference Centre for Emerging Antibiotic Resistance, University of Fribourg, Fribourg, Switzerland
| | - B Grandbastien
- Service of Hospital Preventive Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G Greub
- Institute of Microbiology of Lausanne, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - L Senn
- Service of Hospital Preventive Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - P Nordmann
- Swiss National Reference Centre for Emerging Antibiotic Resistance, University of Fribourg, Fribourg, Switzerland; Institute of Microbiology of Lausanne, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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Shin S, Oh J, Park HD. Comparison of Three Blood Collection Tubes for 35 Biochemical Analytes: The Becton Dickinson Barricor Tube, Serum Separating Tube, and Plasma Separating Tube. Ann Lab Med 2020; 41:114-119. [PMID: 32829587 PMCID: PMC7443522 DOI: 10.3343/alm.2021.41.1.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/05/2020] [Accepted: 07/29/2020] [Indexed: 01/17/2023] Open
Abstract
The Barricor tube (Becton Dickinson [BD], Sunnyvale, CA, USA) was recently developed to mechanically separate plasma by increasing the centrifugation rate. We compared the Barricor tube with existing serum- and plasma-based tubes based on 35 biochemical analytes and preanalytical turnaround time (TAT). Blood samples were collected from 30 healthy volunteers in a Barricor tube, serum separating tube (SST, Vacutainer SST II Tube 8.5 mL, #368972; BD), or plasma separating tube (PST, Vacutainer PST Tube 8.0 mL, #367964; BD) in random order. Next, 27 chemistry analytes, six immunochemistry analytes, and two cardiac markers were compared using Passing-Bablok regression and the Bland-Altman method. Preanalytical TAT was measured for each tube. The Barricor tube exhibited bias exceeding the desirable limit for nine and four analytes compared with the SST and PST, respectively. The Barricor tube lactate dehydrogenase value showed a bias of −10.29% and −9.86% compared with that of the SST and PST, respectively. The preanalytical TAT of Barricor tube was 8.8 minutes, which was the shortest among the three tubes. The clinical performance of the Barricor tube was equivalent to that of the SST and PST for most analytes, with an apparent advantage in preanalytical TAT. When using the Barricor tube, the reference range needs to be changed for some analytes that exceed the desirable bias limit.
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Affiliation(s)
- Sunghwan Shin
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jongwon Oh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung-Doo Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Laurent-Bellue A, Poullier E, Pomerol JF, Adnet E, Redon MJ, Posseme K, Trassard O, Cherqui D, Zarca K, Guettier C. Four-Year Experience of Digital Slide Telepathology for Intraoperative Frozen Section Consultations in a Two-Site French Academic Department of Pathology. Am J Clin Pathol 2020; 154:414-423. [PMID: 32459303 DOI: 10.1093/ajcp/aqaa055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To share our experience with digital slide telepathology for intraoperative frozen section consultations (IOCs) and to describe its evolution over time by reporting performance metrics and addressing organizational and economic aspects. METHODS Since 2013, a technician has been alone at the surgical site. At the other site, the pathologist opens the digital slide from a local server via the intranet. Three periods were compared: a 6-month period of conventional IOC (period 1), a 24-month period of telepathology at 6 months after implementation (period 2), and a 12-month period of telepathology at 3.5 years after implementation (period 3). RESULTS In total, 87 conventional IOCs and 464 and 313 IOCs on digital slides were performed respectively during periods 1, 2, and 3; mean turnaround time was 27, 36, and 38 minutes, respectively, and there were a mean number of 1.1, 1.1, and 1.3 slides, respectively, per IOC. Diagnostic accuracy was achieved in 95.4%, 92.7%, and 93.9%, respectively, of IOCs (not significant). The additional cost is in the same range as the cost of urgent transport by courier. CONCLUSIONS Developing IOC with digital slides is a challenge but is necessary to optimize medical time in the current context of pathologist shortage and budget restrictions.
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Affiliation(s)
- Astrid Laurent-Bellue
- Department of Pathology, AP-HP-Université Paris Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Eric Poullier
- Information System Department, AP-HP, Campus Picpus, Paris, France
| | | | - Eric Adnet
- Information System Department, AP-HP-Université Paris Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Marie-José Redon
- Department of Pathology, AP-HP-Université Paris Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Katia Posseme
- Department of Pathology, AP-HP-Université Paris Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Olivier Trassard
- Department of Pathology, AP-HP-Université Paris Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Daniel Cherqui
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Department of Surgery, Centre Hépato-Biliaire, AP-HP-Université Paris Saclay, Hôpital Paul Brousse, Villejuif, France
| | - Kevin Zarca
- URC eco Ile-de-France, AP-HP-Université Paris V, Paris, France
| | - Catherine Guettier
- Department of Pathology, AP-HP-Université Paris Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
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Alfaro CR, Madrigal GB, Hernández MC. Improving forensic processes performance: A Lean Six Sigma approach. Forensic Sci Int Synerg 2020; 2:90-94. [PMID: 32412005 PMCID: PMC7219196 DOI: 10.1016/j.fsisyn.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 11/25/2022]
Abstract
Quality practices in forensic science are often in tension with providing timely results. When the Costa Rican Department of Forensic Sciences ballistics unit achieved accreditation under ISO/IEC 17020:2012 in 2018, the unit started experiencing slower turnaround times. With a view to expediting the resolution of forensic examination processes, the unit undertook a Lean Six Sigma project with a five-phase problem-solving methodology. The unit began to use data and process tools to transform its current state. The completion of all phases showed that two main aspects were preventing the laboratory from fulfilling the customers’ expectations: standardization and constraints. This project took 6 months and improvements were seen through the reduction of the number of pending cases with a backlog of more than 3 months by 97% and the turnaround time from 4 months to 1 month. Through this project, leadership identified an effective methodology, creating a positive impact on customers’ expectations.
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Anand K, Phung TL, Bernicker EH, Cagle PT, Olsen RJ, Thomas JS. Clinical Utility of Reflex Ordered Testing for Molecular Biomarkers in Lung Adenocarcinoma. Clin Lung Cancer 2020; 21:437-42. [PMID: 32600793 DOI: 10.1016/j.cllc.2020.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/24/2020] [Accepted: 05/06/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In order to standardize and expedite molecular biomarker testing, we implemented reflex ordered testing of targeted gene alterations in newly diagnosed lung adenocarcinomas within our hospital system. PATIENTS AND METHODS Reflex ordered testing of specific molecular biomarkers at the time of pathologic diagnosis of lung adenocarcinoma was approved and adopted system-wide in our hospital during 2017. Through institutional review board approval, we retrospectively looked at cohort of patients whose specimens received a diagnosis of lung adenocarcinoma, with molecular biomarker testing performed at Houston Methodist Hospital between 2016 and 2018. We compared average turnaround time (TAT) from 2016 (prior to reflex ordered testing) to 2017 and 2018 (post reflex ordered testing). RESULTS Standard molecular testing performed on 39 patients in 2016 had an average TAT of 52.6 days, whereas reflex ordered molecular testing in 2017 yielded an average TAT of 26.5 days (n = 127) and 15.6 days in 2018 (n = 54). The average TAT for reporting of molecular results significantly decreased by 37 days (P = .0002) within our hospital system post adoption of reflex ordered testing for lung adenocarcinoma. Reflex ordered testing also resulted in a higher variant detection rate than standard molecular biomarker ordering practices (48.8% vs. 25.6%; P < .05). Overall, the frequencies and types of variants identified among our cohort were similar to previous reports. CONCLUSIONS Reflex ordered testing of molecular biomarkers in lung adenocarcinoma led to significantly decreased TAT within our hospital system and higher detection rates of targeted gene alterations.
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Cherkaoui A, Renzi G, Viollet A, Fleischmann M, Metral-Boffod L, Dominguez-Amado D, Vuilleumier N, Schrenzel J. Implementation of the WASPLab™ and first year achievements within a university hospital. Eur J Clin Microbiol Infect Dis 2020; 39:1527-34. [PMID: 32248509 DOI: 10.1007/s10096-020-03872-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/19/2020] [Indexed: 12/22/2022]
Abstract
In essence, automation can be driven by several of the following incentives: increased processing capacity of the laboratory, better costs control through processes standardization, optimized traceability, or improved workflows to reduce turnaround times (TAT). This project aims at presenting an overview of the project management and change management with a focus on the major challenges addressed by lab staff and laboratory leadership during the different phases of the implementation of the WASPLab™ in a routine clinical bacteriology laboratory. This paper reports our experience and reviews changes in the bacteriology laboratory at Geneva University Hospitals when shifting to the WASPLab™. Practically, the whole automation process was segmented into different packages (specimen type-based segmentation) allowing sequential validation, staff training, and routine implementation. Such process allowed reaching 90% of the identified "automatable" samples within 1 year, including personal training, documentation for accreditation supported by publications, without interrupting routine operations. In addition, we implemented a validated automated solution for antimicrobial disk diffusion susceptibility testing. Structured supervision and accurate monitoring of all the activities related to the automation project including key partners such as IT support, technical committee, and after-sales service guaranteed a swift and timely achievement of the project allowing the improvement of the workflow in routine bacteriology within 1 year.
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Affiliation(s)
- Giorgis Okubazgi
- St Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bereket Berhane
- St Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Boland L, Streel C, De Wolf H, Rodriguez H, Verroken A. Rapid antimicrobial susceptibility testing on positive blood cultures through an innovative light scattering technology: performances and turnaround time evaluation. BMC Infect Dis 2019; 19:989. [PMID: 31752735 PMCID: PMC6873430 DOI: 10.1186/s12879-019-4623-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/07/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A bacteremia diagnosis with speeded-up identification and antimicrobial susceptibility testing (AST) is mandatory to adjust empirical broad-spectrum antibiotherapy and avoid the emergence of multi-resistant bacteria. Alfred 60AST (Alifax, Polverara, PD, Italy) is an innovative automated system based on light scattering measurements allowing direct AST from positive blood cultures with rapid results. In this study we aimed to evaluate the system's performances and turnaround time (TAT) compared to routine AST. METHODS The study was conducted during 2 non-consecutive 3-month periods at the microbiology laboratory of the Cliniques universitaires Saint-Luc. All blood cultures detected positive in the 0 AM-10 AM time frame with a pure Gram-positive cocci or Gram-negative bacilli stain were included for Alfred 60AST testing. Two customized EUCAST antibiotic panels were set up composed of 1) a "Gram-negative" panel including cefuroxime, ceftazidime Enterobacteriaceae, piperacillin-tazobactam Enterobacteriaceae, ciprofloxacine, and ceftazidime Pseudomonas 2) a "Gram-positive" panel including cefoxitin Staphylococcus aureus, cefoxitin coagulase-negative (CNS) Staphylococci and ampicillin Enterococci. Categorical agreement (CA), very major errors (VME), major errors (ME), minor errors (mE) and TAT to Alfred 60AST results were calculated in comparison with AST results obtained from direct testing on positive blood cultures with the Phoenix system (Becton Dickinson, Franklin Lakes, NJ, USA). RESULTS Five hundred seventy and one hundred nine antibiotics were evaluated on respectively 166 Gram-negative bacilli and 109 Gram-positive cocci included in the studied population. During the first study period regarding Gram-negative strains a CA of 89.5% was obtained with a high rate of VME (19 and 15.4% respectively) for cefuroxime and piperacillin-tazobactam Enterobacteriaceae. Considering this, Alifax reviewed these antibiotics' formulations improving Gram-negative bacilli total CA to 92.2% with no VME during the second study period. For Gram-positive cocci, total CA was 88.1% with 2.3% VME, 13.8% ME (mainly cefoxitin CNS) and 12% mE rates both study periods combined. Median TAT to AST results was 5 h with Alfred versus 12 h34 with Phoenix. CONCLUSION The Alfred 60AST system shows correct yet improvable microbiological performances and a major TAT reduction compared to direct automated AST testing. Clinical studies measuring the impact of the approach on antibiotic management of patients with bacteremia are recommended.
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Affiliation(s)
- Lidvine Boland
- Department of Laboratory Medicine, Microbiology Laboratory, Saint-Luc University Hospital and Catholic University of Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Corentin Streel
- Department of Laboratory Medicine, Microbiology Laboratory, Saint-Luc University Hospital and Catholic University of Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Hélène De Wolf
- Department of Laboratory Medicine, Microbiology Laboratory, Saint-Luc University Hospital and Catholic University of Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Hector Rodriguez
- Department of Laboratory Medicine, Microbiology Laboratory, Saint-Luc University Hospital and Catholic University of Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Alexia Verroken
- Department of Laboratory Medicine, Microbiology Laboratory, Saint-Luc University Hospital and Catholic University of Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
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Mayer M, Sebro R. An Important and Often Ignored Turnaround Time in Radiology - Clinician Turnaround Time: Implications for Musculoskeletal Radiology. J Belg Soc Radiol 2019; 103:49. [PMID: 31523748 DOI: 10.5334/jbsr.1834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: There has been an increase in routine musculoskeletal (MSK) MRI studies performed on weekends. Study Aims: First, to assess whether radiologist interpretation of routine MSK MRI studies on weekends decreases the time to when the clinician reads the radiologist’s report compared to studies performed on the weekend but interpreted the following Monday. Second, to evaluate whether reports are more likely to be read by clinicians if the MRIs are interpreted by radiologists on weekends compared to the following Monday. Methods: A random sample of 1765 patients who underwent routine MSK MRIs from January 1, 2015 to December 31, 2016 was evaluated. The radiologist turnaround times (rTATs), clinician turnaround times (cTATs) and the provider turnaround time (pTAT) were calculated. The pTAT was the sum of the rTAT and the cTAT. Fisher’s exact tests were used to compare proportions. Wilcoxon Rank Sum tests were used to compare turnaround time metrics. Results: There was no difference in the pTAT for studies performed and interpreted on the weekends compared to those performed on the weekend but interpreted the following Monday (P = 0.750). However, clinicians were significantly less likely to read the reports interpreted on the weekend compared to studies interpreted on weekdays (P = 0.001). Conclusion: Routine MSK MRI studies performed on weekends can be interpreted by radiologists on the following weekday (Monday) without affecting the time at which the clinician reads the reports and these reports are more likely to be read by clinicians if the radiologist interprets the study on a weekday.
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Wang Z, Peng C, Kang H, Fan X, Mu R, Zhou L, He M, Qu B. Design and evaluation of a LIS-based autoverification system for coagulation assays in a core clinical laboratory. BMC Med Inform Decis Mak 2019; 19:123. [PMID: 31269951 PMCID: PMC6609390 DOI: 10.1186/s12911-019-0848-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 06/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background The autoverification system for coagulation consists of a series of rules that allow normal data to be released without manual verification. With new advances in medical informatics, the laboratory information system (LIS) has growing potential for the autoverification, allowing rapid and accurate verification of clinical laboratory tests. The purpose of the study is to develop and evaluate a LIS-based autoverification system for validation and efficiency. Methods Autoverification decision rules, including quality control, analytical error flag, critical value, limited range check, delta check and logical check, as well as patient’s historical information, were integrated into the LIS. Autoverification limited range was constructed based on 5 and 95% percentiles. The four most commonly used coagulation assays, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (FBG), were followed by the autoverification protocols. The validation was assessed by the autoverification passing rate, the true-positive cases, the true-negative cases, the false-positive cases, the false-negative cases, the sensitivity and the specificity; the efficiency was evaluated in the turnaround time (TAT). Results A total of 157,079 historical test results of coagulation profiles from January 2016 to December 2016 were collected to determine the distribution intervals. The autoverification passing rate was 77.11% (29,165/37,821) based on historical patient data. In the initial test of the autoverification version in June 2017, the overall autoverification passing rate for the whole sample was 78.75% (11,257/14,295), with 892 true-positive cases, 11,257 true-negative cases, 2146 false-positive cases, no false-negative cases, sensitivity of 100% and specificity of 83.99%. After formal implementation of the autoverification system for 6 months, 83,699 samples were assessed. The average overall autoverification passing rate for the whole sample was 78.86% and the 95% confidence interval (CI) of the passing rate was [78.25, 79.59%]. TAT was reduced from 126 min to 101 min, which was statistically significant (P < 0.001, Mann-Whitney U test). Conclusions The autoverification system for coagulation assays based on LIS can halt the samples with abnormal values for manual verification, guarantee medical safety, minimize the requirements for manual work, shorten TAT and raise working efficiency.
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Affiliation(s)
- Zhongqing Wang
- Department of Health Statistics, School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China.,Department of Information Center, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Cheng Peng
- Key Lens Laboratory of Liaoning Province, Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Hui Kang
- Department of Clinical Laboratory, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xia Fan
- Department of Clinical Laboratory, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Runqing Mu
- Department of Clinical Laboratory, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Liping Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Miao He
- Department of Information Center, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bo Qu
- Department of Health Statistics, School of Public Health, China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China.
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Langlois NEI, Sully CJ, Edwards S. Turnaround time data for Coronial autopsies - time to complete forensic post-mortem examination reports and influencing factors for Australia and New Zealand in 2015 and 2010. Forensic Sci Med Pathol 2019; 15:56-66. [PMID: 30627976 DOI: 10.1007/s12024-018-0074-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 11/21/2022]
Abstract
This study aimed to provide information regarding key performance indicators (KPIs) for forensic pathology in Australia and New Zealand, focusing on the time to complete a Coronial post-mortem examination report. Data was obtained from the National Coronial Information System (NCIS). The mean and median time to complete a post-mortem examination report in 2015 was determined from a sample of 100 cases from each of the nine Coronial jurisdictions. Results of univariate and multivariable analysis of factors potentially influencing the completion time are presented. The multivariable analysis indicated the time to complete a post-mortem examination report was significantly dependent on if any internal examination had been performed, the Coronial jurisdiction and requesting toxicological analysis. The number of days for Coroners to close cases is also presented as well as the number of days for a post-mortem examination to be performed. A comparison between 2015 and 2010 was instigated. However, this data had to be constrained to eight of the Coronial jurisdictions. Within this dataset, the time to complete a post-mortem examination report when an internal examination had been performed was statistically significant greater in 2015. However, the time to complete reports for all Coronial post-mortem examinations in 2015 was not statistically significantly different to 2010. This could be attributed to a higher proportion of post-mortem examinations without internal examination ('external only') in 2015. The time to perform a post-mortem examination following the death being reported to a Coroner increased, but the time for Coroners to close a case decreased.
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Affiliation(s)
- Neil E I Langlois
- Forensic Science SA, GPO Box 2790, Adelaide, SA, 5001, Australia. .,University of Adelaide, School of Medicine, Adelaide Health & Medical Sciences (AHMS), North Terrace, South Australia, 5000, Australia.
| | - Claire J Sully
- Forensic Science SA, GPO Box 2790, Adelaide, SA, 5001, Australia
| | - Suzanne Edwards
- University of Adelaide, Adelaide Health Technology Assessment / School of Public Health, Adelaide Health & Medical Sciences (AHMS), North Terrace, South Australia, 5000, Australia
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Abstract
Purpose The purpose of this paper is to discuss the implementation of lean methodology to reduce the turnaround time (TAT) of a clinical laboratory in a super speciality hospital. Delays in report delivery lead to delayed diagnosis increased waiting time and decreased customer satisfaction. The reduction in TAT will lead to increased patient satisfaction, quality of care, employee satisfaction and ultimately the hospital's revenue. Design/methodology/approach The generic causes resulting in increasing TAT of clinical laboratories were identified using lean tools and techniques such as value stream mapping (VSM), Gemba, Pareto Analysis and Root Cause Analysis. VSM was used as a tool to analyze the current state of the process and further VSM was used to design the future state with suggestions for process improvements. Findings This study identified 12 major non-value added factors for the hematology laboratory and 5 major non-value added factors for the biochemistry lab which were acting as bottlenecks resulting in limiting throughput. A four-month research study by the authors together with hospital quality department and laboratory staff members led to reduction of the average TAT from 180 to 95minutes in the hematology lab and from 268 to 208 minutes in the biochemistry lab. Practical implications Very few improvement initiatives in Indian healthcare are based on industrial engineering tools and techniques, which might be due to a lack of interaction between healthcare and engineering. The study provides a positive outcome in terms of improving the efficiency of services in hospitals and identifies a scope for lean in the Indian healthcare sector. Social implications Applying lean in the Indian healthcare sector gives its own potential solution to the problem caused, due to a wide gap between lean accessibility and lean implementation. Lean helped in changing the mindset of an organization toward providing the highest quality of services with faster delivery at an optimal cost. Originality/value This paper is an effort to reduce the gap between healthcare and industrial engineering and enhancing the use of lean practices in Indian healthcare. The study is motivated toward implementing lean methodology successfully in services.
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Affiliation(s)
- Shradha Gupta
- Malaviya National Institute of Technology Jaipur, Jaipur, India
| | - Sahil Kapil
- National Institute of Technical Teachers Training & Research, Chandigarh, India
| | - Monica Sharma
- Malaviya National Institute of Technology Jaipur, Jaipur, India
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Yarbrough ML, Lainhart W, McMullen AR, Anderson NW, Burnham CD. Impact of total laboratory automation on workflow and specimen processing time for culture of urine specimens. Eur J Clin Microbiol Infect Dis 2018; 37:2405-11. [PMID: 30269180 DOI: 10.1007/s10096-018-3391-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
Abstract
Total laboratory automation (TLA) has the potential to reduce specimen processing time, improve standardization of cultures, and decrease turnaround time (TAT). The objective of this study was to perform a detailed interrogation of the impact of TLA implementation in all aspects of the workflow for routine culture of urine specimens. Using a detailed motion capture study, the time required for major steps of processing and result reporting were prospectively assessed for urine samples prior to (n = 215) and after (n = 203) implementation of the BD Kiestra TLA system. Specimens were plated on all shifts, but cultures were read only during the day shift for both time periods. Significant increases were noted in the time from receipt to inoculation (23.0 min versus 32.0 min, p < 0.001) and total processing time (28.0 min versus 66.0 min, p < 0.0001) for urine specimens post-TLA. Rates of positive (18.6% versus 16.3%) and negative (71.2% versus 79.3%) urine cultures remained stable through the pre- and post-TLA time periods (p = 0.58). There were no changes in TAT for organism identification or susceptibility results. The time to final report was decreased from 43.8 h pre-TLA to 42.0 h post-TLA, which was attributed to significant decreases in TAT for negative cultures (42.0 h versus 37.5 h, p = 0.01). These findings demonstrate that changes in laboratory workflow are necessary to maximize efficiency of TLA and optimize TAT.
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Hayashi H, Tanishima S, Fujii K, Mori R, Okamura Y, Yanagita E, Matsuoka R, Amano T, Kinoshita I, Komatsu Y, Dosaka-Akita H, Nishihara H. Genomic testing for pancreatic cancer in clinical practice as real-world evidence. Pancreatology 2018; 18:647-654. [PMID: 30055942 DOI: 10.1016/j.pan.2018.07.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/20/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Precision medicine guided by comprehensive genome sequencing represents a potential treatment strategy for pancreatic cancer. However, clinical sequencing for pancreatic cancer entails several practical difficulties. We have launched an in-house clinical sequencing system and started genomic testing for patients with cancer in clinical practice. We have analyzed the clinical utility of this system in pancreatic cancer. METHODS We retrospectively reviewed 20 patients with pancreatic cancer who visited our division. Genomic DNA was extracted from both tumor tissue and peripheral blood mononuclear cells obtained from the patients. We performed a comprehensive genomic testing using targeted amplicon sequencing for 160 cancer-related genes. The primary endpoints were the detection rates of potential actionable and druggable gene alterations. The secondary endpoints were the detection rate of secondary germline findings, the rate of re-biopsy required for genome sequencing, survival time after the initial visit (post-sequencing survival time), and turnaround time. RESULTS Although re-biopsy was required for 25% (5/20) of all patients, genomic testing was performed in all patients. Actionable and druggable gene alterations were detected in 100% (20/20) and 35% (7/20) of patients, respectively, whereas secondary germline findings were detected in 5% (1/20) of patients. The median turnaround times for physicians and patients were 20 and 26 days, respectively. The median post-sequencing survival time was 10.3 months. Only 10% (2/20) of all patients were treated with therapeutic agents based on the outcomes of genomic testing. CONCLUSIONS The clinical application of comprehensive genomic testing for pancreatic cancer was feasible and promising in clinical practice.
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Affiliation(s)
- Hideyuki Hayashi
- Division of Clinical Cancer Genomics, Hokkaido University Hospital, Sapporo, Japan.
| | - Shigeki Tanishima
- Department of Biomedical Informatics Development, Mitsubishi Space Software Co., Ltd, Tokyo, Japan
| | - Kyoko Fujii
- Division of Clinical Cancer Genomics, Hokkaido University Hospital, Sapporo, Japan
| | - Ryo Mori
- Department of Biomedical Informatics Development, Mitsubishi Space Software Co., Ltd, Tokyo, Japan
| | - Yasunobu Okamura
- Department of Biomedical Informatics Development, Mitsubishi Space Software Co., Ltd, Tokyo, Japan
| | - Emmy Yanagita
- Division of Clinical Cancer Genomics, Hokkaido University Hospital, Sapporo, Japan
| | - Ryosuke Matsuoka
- Division of Clinical Cancer Genomics, Hokkaido University Hospital, Sapporo, Japan
| | - Toraji Amano
- Hokkaido University Hospital Clinical Research and Medical Innovation Center, Sapporo, Japan
| | - Ichiro Kinoshita
- Department of Medical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoshito Komatsu
- Department of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, Japan
| | - Hirotoshi Dosaka-Akita
- Division of Clinical Cancer Genomics, Hokkaido University Hospital, Sapporo, Japan; Department of Medical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Nishihara
- Division of Clinical Cancer Genomics, Hokkaido University Hospital, Sapporo, Japan
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Thelen P, Hornberg K, Hamprecht A. Efficient processing of MRSA screening specimens by a modified inoculation protocol. Eur J Clin Microbiol Infect Dis 2018; 37:1857-1861. [PMID: 29980897 DOI: 10.1007/s10096-018-3319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/27/2018] [Indexed: 11/30/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections and mortality, and therefore constitutes a serious cost factor in public health. Culture-based MRSA screening is a crucial part of MRSA-infection prevention and control strategies in the hospital setting. Manual inoculation of screening swabs onto culture plates still constitutes the major part of the technicians' workload in laboratories. We present a modified inoculation protocol that comprises direct inoculation of specimen onto a chromogenic MRSA-selective agar plate without further streaking for isolation. This study aims to evaluate the impact of this inoculation protocol on technicians' workload and the downstream workflow in our laboratory. Batches of 50 specimens were processed by different technicians and the hands-on time was compared between the standard and modified inoculation protocol. To assess the impact on downstream processing, a retrospective analysis of the rate of subcultures and turnaround time (TAT) of specimens yielding putative MRSA colonies from 9 months before (n = 1548) and after (n = 1267) the protocol change was carried out based on laboratory information system (LIS) data. The implementation of the modified protocol significantly reduced technicians' hands-on time needed for inoculation by 26.5% without altering the overall turnaround time of surveillance cultures or causing higher costs for extra plates needed for subcultures. Our modified inoculation protocol offers a cost-effective and easy to implement procedure for MRSA surveillance cultures which significantly decreases technicians' workload and does not impede the downstream workflow. It therefore increases the capacity of laboratory technicians' to execute more demanding tasks.
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Affiliation(s)
- Philipp Thelen
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - Kirsten Hornberg
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - Axel Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
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48
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Rigby J, Cox D, Julian K. Journal peer review: a bar or bridge? An analysis of a paper's revision history and turnaround time, and the effect on citation. Scientometrics 2018; 114:1087-1105. [PMID: 29491545 PMCID: PMC5814533 DOI: 10.1007/s11192-017-2630-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Indexed: 11/02/2022]
Abstract
Journal peer review lies at the heart of academic quality control. This article explores the journal peer review process and seeks to examine how the reviewing process might itself contribute to papers, leading them to be more highly cited and to achieve greater recognition. Our work builds on previous observations and views expressed in the literature about (a) the role of actors involved in the research and publication process that suggest that peer review is inherent in the research process and (b) on the contribution reviewers themselves might make to the content and increased citation of papers. Using data from the journal peer review process of a single journal in the Social Sciences field (Business, Management and Accounting), we examine the effects of peer review on papers submitted to that journal including the effect upon citation, a novel step in the study of the outcome of peer review. Our detailed analysis suggests, contrary to initial assumptions, that it is not the time taken to revise papers but the actual number of revisions that leads to greater recognition for papers in terms of citation impact. Our study provides evidence, albeit limited to the case of a single journal, that the peer review process may constitute a form of knowledge production and is not the simple correction of errors contained in submitted papers.
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Affiliation(s)
- J Rigby
- Manchester Institute of Innovation Research, Alliance Manchester Business School, The University of Manchester, c/o Room 8.23, Harold Hankins Building, Oxford Road, Manchester, M13 9PL UK
| | - D Cox
- Manchester Institute of Innovation Research, Alliance Manchester Business School, The University of Manchester, c/o Room 8.23, Harold Hankins Building, Oxford Road, Manchester, M13 9PL UK
| | - K Julian
- Manchester Institute of Innovation Research, Alliance Manchester Business School, The University of Manchester, c/o Room 8.23, Harold Hankins Building, Oxford Road, Manchester, M13 9PL UK
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Jensen CT, Blair KJ, Le O, Sun J, Wei W, Korivi BR, Morani AC, Wagner-Bartak NA. Utility of CT oral contrast administration in the emergency department of a quaternary oncology hospital: diagnostic implications, turnaround times, and assessment of ED physician ordering. Abdom Radiol (NY) 2017; 42:2760-8. [PMID: 28523416 DOI: 10.1007/s00261-017-1175-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare studies with and without oral contrast on performance of multidetector computed tomography (CT) and the order to CT examination turnaround time in cancer patients presenting to the emergency department (ED). To the best of our knowledge, oral contrast utility has not previously been specifically assessed in cancer patients presenting to the emergency department. MATERIALS & METHODS Retrospective review of CT abdomen examinations performed in oncology patients presenting to the emergency department during one month. CT examinations performed with and without oral contrast were rated by two consensus readers for degree of confidence and diagnostic ability. Correlations were assessed for primary cancer type, age, sex, chief complaint/examination indication, body mass index, intravenous contrast status, repeat CT examination within 4 weeks, and disposition. Turnaround times from order to the start of the CT examination were calculated. RESULTS The studied group consisted of 267 patients (127 men and 140 women) with a mean age of 56 years and a mean body mass index of 27.8 kg/m2. One hundred sixty CT examinations were performed without oral contrast, and 107 CT examinations were performed with oral contrast. There was no significant difference between cases with oral contrast and cases without oral contrast in the number of cases rated as "improved confidence" (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.23-1.31, P = 0.17), "improved diagnosis" (OR 0.58, 95% CI 0.20-1.64, P = 0.3), "impaired confidence" (OR 3.92, 95% CI 0.46-33.06, P = 0.21), or "impaired diagnosis" (OR 2.63, 95% CI 0.29-23.89, P = 0.39). The turnaround time in the group receiving oral contrast (mean, 141 min; standard deviation, 49.8 min) was significantly longer than that in the group not receiving oral contrast (mean, 109.2 min; standard deviation, 64.8 min) with a mean difference of 31.8 min (P < 0.0001). CONCLUSION On the basis of our findings and prior studies, targeted rather than default use of oral contrast shows acceptable diagnostic ability in the emergency setting for oncology patients. Benefit from oral contrast use is suggested in scenarios such as suspected fistula/bowel leak/abscess, hypoattenuating peritoneal disease, prior bowel surgery such as gastric bypass, and the absence of intravenous contrast administration. Improvement through the use of targeted oral contrast administration also supports the emergency department need for prompt diagnosis and disposition.
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van den Bijllaardt W, Janssens MM, Buiting AG, Muller AE, Mouton JW, Verweij JJ. Extended-spectrum β-lactamase (ESBL) polymerase chain reaction assay on rectal swabs and enrichment broth for detection of ESBL carriage. J Hosp Infect 2017; 98:264-269. [PMID: 29080706 DOI: 10.1016/j.jhin.2017.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Extended-spectrum β-lactamase (ESBL) screening and contact precautions on patients at high risk for ESBL carriage are considered important infection control measures. Since contact precautions are costly and may negatively impact patient care, rapid exclusion of ESBL carriage and therefore earlier discontinuation of contact precautions are desired. AIM In the present study, the performance of an ESBL polymerase chain reaction (PCR) targeting blaCTX-M genes was evaluated as a screening assay for ESBL carriage. METHODS Two methods were assessed: PCR performed directly on rectal swabs and PCR on enrichment broth after incubation overnight. The reference standard was culture of ESBL-producing Enterobacteriaceae on selective agar after overnight enrichment and confirmation by the combination disc diffusion method. Microarray was used for discrepancy analysis. A secondary analysis was performed to evaluate the added value of including a blaSHV target in the PCR. FINDINGS A total of 551 rectal swabs from 385 patients were included, of which 28 (5%) were ESBL positive in culture. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 86%, 98%, 67%, and 99%, respectively, for PCR directly on swabs, and 96%, 98%, 75%, and 100%, respectively, for PCR on enrichment broth. Adding a blaSHV target to the assay resulted in a lower PPV without increasing the sensitivity and NPV. CONCLUSION Screening for ESBL by PCR directly on rectal swabs has a high negative predictive value, is up to 48h faster than traditional culture and therefore facilitates earlier discontinuation of contact precautions, thereby improving patient care and saving valuable resources in the hospital.
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Affiliation(s)
- W van den Bijllaardt
- Laboratory for Medical Microbiology and Immunology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
| | - M M Janssens
- Laboratory for Medical Microbiology and Immunology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - A G Buiting
- Laboratory for Medical Microbiology and Immunology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - A E Muller
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands; Department of Medical Microbiology, Haaglanden Medical Centre, The Hague, The Netherlands
| | - J W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - J J Verweij
- Laboratory for Medical Microbiology and Immunology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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