[Emergency tests. The clinical laboratory technicians' viewpoint: after-hour work schedules at the Central Laboratory Sapporo Medical College].
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Requisite to the development of competency-based curricula in the medical laboratory sciences is the translation of competency statements into terminal performance objectives so that the achievement of career-entry competence can be measured. To truly represent competence in practice, the conditions and standards of acceptable performance for the objectives must be those expected of career-entry practitioners on their jobs. A method is presented for the establishment of conditions under which the behaviors specified in competency statements are carried out in the "real world" of medical laboratory practice and the verification of standards of accuracy and speed in performance that represent competence at career entry. The career-entry practitioner is defined as the graduate of a medical laboratory education program who has been working in the field for six months to one year. The specification of that target group for verification of career-entry competence is explained. The necessity for use of the clinical laboratory for evaluation of career-entry competence of students prior to graduation through acheivement of terminal performance objectives is stressed.
A statistical analysis of the results obtained over a 5-year period from 1997 to 2001 and the partial results from 2002 demonstrated the role of the medical biology laboratory in studying spread of the HIV virus. The pertinence of prevention campaigns was also evaluated.
Medical laboratories in Singapore subscribe to External Quality Assurance Schemes run by the Licensing and Accreditation Unit of the Ministry of Health, Singapore, as well as a number of foreign medical laboratory quality assurance institutions. Through these organisations, a comprehensive range of laboratory tests are externally monitored for quality assurance at regular intervals in all medical laboratories. In recent years, an increasing number of local quality assurance schemes have been implemented, and an increasing number of laboratories have gained accreditation by foreign quality assurance institutions. The respective roles of these quality assurance activities are discussed.
In the recent past, the role of laboratory medicine has changed from merely supplier of analytical data to supplier of results together with clinical interpretation. In addition, the role of medical laboratories as important partners of health care management by providing data for management functions and decisions is rapidly growing. The article has the purpose of giving an overview of Austria's population, the governmental system and Austrian health politics in context with European health care. The existing health care system with its historical development, to-date status and recent changes due to socio-economic pressure are outlined. Special emphasis is given to the present situation of medical laboratories in Austria. Furthermore, hospital management strategies and some adjustment processes in the authors' clinical-medical laboratory to alleviate the ongoing economic pressure are described. As far as possible, an attempt of forecasting future scenarios is made.
The role of pharmacists and the process of military drug supply in the American Civil War are described. Most raw drugs used in the United States in the mid-1800s were imported. During the Civil War, imports into the North continued, but the Union blockade forced the Confederacy to obtain medicines through means such as smuggling, capture of enemy supplies, and processing of indigenous medicinal plants. Medical supplies for Civil War troops were typically purchased by military physicians called medical purveyors and sometimes by pharmacists serving as acting medical purveyors. In the latter half of the war, U.S. Army medical laboratories, in which many pharmacists were employed, inspected purchases, repackaged supplies bought in bulk, and manufactured medicines from raw materials. The Confederacy also had medical laboratories, which were primarily responsible for manufacturing medicines from indigenous plant material but also inspected drugs that had been smuggled into the South. At a few large Union medical depots, pharmacists called medical storekeepers assumed many of the responsibilities of medical purveyors by receiving, storing, issuing, and accounting for supplies. Noncommissioned officers called hospital stewards assumed diverse duties that included dispensing drugs prescribed by military physicians. Although many hospital stewards were pharmacists or physicians, others had no previous pharmaceutical experience. Civilian pharmacists were employed in the medical laboratories and in military general hospitals. Pharmacists participated in nearly every aspect of military drug supply during the Civil War.
During the past 10 years, many activities have taken place in the field of quality systems and accreditation in medical laboratories. Each country in Europe has a slightly different approach. The Working Group on Accreditation of the European Communities Confederation of Clinical Chemistry (EC4) tries to support harmonisation of these efforts. For this purpose, they edited the Essential Criteria for quality systems of medical laboratories and supported the forthcoming International ISO standard "Quality management for the medical laboratory". At this moment, a Model Quality Manual is nearly ready for publication. The next items are setting up criteria for auditing the quality system and criteria for the accreditation process.
Many infectious disease threats to U.S. military operations are uncommon in the United States. The advanced development and testing of countermeasures, such as vaccines, drugs, or insect repellents, requires the capability to study militarily important infectious diseases where they occur. With formal agreements between the U.S. and each host country, the U.S. military operates seven overseas medical research laboratories (labs). Six labs conduct infectious disease research and are distributed over three continents: Africa (labs in Egypt and Kenya), Asia (labs in Indonesia and Thailand), and South America (labs in Brazil and Peru). One other lab is located in Germany and conducts psychosocial research related to military personnel and their families. In addition to product development, these labs play vital roles supporting overseas deployments, providing technical training, and promoting international relations. Also, these labs are well positioned to become part of a developing global surveillance and response system to help address the threat posed by emerging infectious diseases. This article will present an overview of this unique medical research capability, describe the history and some of the activities of each lab, and discuss the importance of maintaining these labs in the 21st century.
Substantial data collected from large numbers of accessions, the need for comprehensive reporting of negative as well as positive laboratory findings, and the necessity for obtaining rapid diagnostic correlations prompted the development of a computer based system of accession data management for collection, storage, rapid retrieval, reporting, concording, and administrative compiling in a state-university Veterinary Medical Diagnostic Laboratory.
The study reports job satisfaction among a sample of 370 physicians, nurses, pharmacists, and medical laboratory technologists in the Ministry of Health hospitals in Kuwait. Job satisfaction was measured using Dunnette's scale. The respondents in all four categories were satisfied with all aspects of their jobs except salary. The medical laboratory technologists were, however, dissatisfied with professional advancement as well. The physicians were found to be most satisfied, closely followed by nurses and pharmacists, while medical laboratory technologists were least satisfied. Multivariate analysis was used to assess the net effects of background and work environment characteristics on overall job satisfaction. Introduction to job, in-service training, and monthly income had significant positive effects on overall job satisfaction. These findings may have serious implications for health care delivery systems that recruit expatriate care providers.
Although Saudi medical laboratories have developed enormously over the past 25 years, the absence of a national body for medical laboratory accreditation has meant the number of accredited laboratories (seven) remains low. Of these, five are accredited by the College of American Pathologists' Laboratory Accreditation Program (LAP)--the 'gold standard' of laboratory accreditation. It requires successful performance in the College of American Pathologists' proficiency testing programme as well as passing on-site inspections carried out by practising laboratory technicians, after which the laboratory is accredited for a 2-year period. This article gives an insight into the current situation of laboratory accreditation in Saudi Arabia and an updated overview of the process involved in obtaining laboratory accreditation from the College of American Pathologists.
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We describe an animal laboratory using anesthetized swine to demonstrate the regulation of arterial blood pressure to second-year medical students at Saint Louis University School of Medicine (St. Louis, MO). The laboratory is designed to illustrate basic pharmacological and physiological concepts learned in the classroom. The specific learning objectives covered in this lab include maintenance of anesthesia, basic surgical technique including cannulation of blood vessels, understanding the measurement and significance of basic physiological parameters, premortem examination of in situ heart and lungs, direct cardiac massage and induction of ventricular fibrillation, understanding the fundamentals of the baroreceptor reflex, and cardiovascular responses to various pharmacological agents. Pharmacologic agents used include epinephrine, norepinephrine, isoproterenol, atropine, prazosin, propranolol, acetylcholine, nitroprusside, and angiotensin II. The laboratory demonstration has proven effective in reinforcing the fundamental principles of cardiovascular physiology and autonomic pharmacology. By the completion of this experiment, students are expected to be able to: 1) describe the basics of maintenance of anesthesia in a live animal; 2) describe basic surgical technique; 3) observe the procedure for proper cannulation of blood vessels; 4) describe the proper method of controlling hemorrhage from a bleeding source; 5) describe the measurement and recording of four physiological parameters: mean arterial pressure from a pressure transducer, heart rate from an ECG, hindquarters resistance from Doppler measurement of femoral arterial blood flow, and cardiac contractility by calculating dP/dt from left ventricular pressure measured with a Millar transducer; 6) perform a premortem exam of the heart and lungs and appreciate the in situ cardiothoracic anatomy of the living animal; 7) assist in the induction of ventricular fibrillation and perform direct cardiac massage; 8) characterize the autonomic responses activated by the baroreceptor reflex; 9) describe the effects of the adrenergic agonists epinephrine, norepinephrine, and isoproterenol on cardiovascular parameters and construct a dose response curve for each agent; 10) describe the effects of the adrenergic antagonists propranolol and prazosin on cardiovascular parameters and explain how they affect cardiovascular responses to adrenergic agonists; 11) describe the difference between endothelium-dependent and endothelium-independent vasodilation using acetylcholine, nitroprusside, and atropine; 12) observe the pressor response of angiotensin II and describe why this response is not blocked by pretreatment with prazosin; and 13) participate in the collection and analysis of experimental data and the presentation of results.
The International Commission on Radiation Protection have recently recommended an annual dose limit for the skin of radiation workers of 500 mSv at a depth of 20-100 microns averaged over any 1 cm2 regardless of the area exposed. It has previously been shown by the authors that beta dose rates on the outer surfaces of typical laboratory containers (vials, test tubes) or on medical syringes can exceed 100 mSv h-1 for radionuclide concentrations of the order of 1 MBq g-1, depending on container diameter, wall thickness and material and the beta particle energy spectrum. Since the fingers are frequently in contact with such containers it is of some importance to extend these dose calculations to depths below the skin surface, taking into consideration the anatomy of skin on the fingers. Using an extension of a Monte Carlo method previously described, dose rates have been calculated for the clinically useful radionuclides 90Y, 32P, 198Au, 153Sm and 131I. For polypropylene syringes the beta dose rates at a depth of 270 microns (a typical basal cell depth in the fingers) range from 77 to 135 mGy h-1 per MBq g-1 for 90Y (maximum energy 2.27 MeV) and approximately zero to 0.62 mGy h-1 per MBq g-1 for 131I (maximum energy 0.61 MeV). These results emphasize the importance of adequate finger protection when using high energy beta emitters and especially for clinicians who typically inject specific activities of the order of 100 MBq g-1 of 32P; in such cases annual permissible dose rates are exceeded in a matter of minutes. It is recommended that a minimum of 5 mm perspex finger protection be used for 90Y and 32P.
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The aim of this study was two-fold: to make available to the medical community a fast, efficient tool for troubleshooting PCR problems, and to demonstrate that hypermedia allow one to approach this kind of problem in a new, more useful way. The Web provides access to an enormous amount of information in the medical area, and in particular enables troubleshooting of new techniques in the medical laboratory. Currently it is possible to find textual information but it is not always easy to find hypermedia information. In many cases authors change only the means of dissemination of a book or paper to the Web, but do not adapt the information to the features of this new medium. The prototype of our hypermedia application was developed using Director and Flash programs (Macromedia), the application was developed from a decision tree built as a result of information compiled from expert PCR users and the existing literature. It was implemented on a website using Dreamweaver (Macromedia). The usefulness and possibilities of this application have been tested with physicians, medical laboratory technicians, and health science students, and have been proven to be more effective than traditional methods, both in education processes and in helping researchers and medical laboratory technicians in their daily work. The advance and popularization of the Internet in the medical profession requires information on the Web to adapt to the advantages offered by hypermedia. This new step must be taken, and the Web must offer medical users not only a different medium of information distribution but also a new way of handling and obtaining information.