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PubMed1996

Division of labour in clinical microbiology. Co-operation and fragmentation.

The aim of this study was to describe clinical microbiological practices in a hospital setting. A grounded theory was developed from qualitative data in two steps: initial participant observation to describe the clinical work-flow, and a main case study based in depth interviews and analyses of work practices using a video-based stimulated recall technique. Six physicians, 2 senior medical laboratory technologists and one head nurse were interviewed in depth based on their organizational positions. Stimulated recall interviews were conducted with 11 nurses, 6 secretaries, 6 medical laboratory technologists, and 3 physicians. An informal clinical microbiological 'workgroup' was found to co-operate around two physical objects: the microbiological sample and the laboratory request form. Work organization was divided into planning, based on science and legislations, and performance based on tradition and local supervision. None of the practitioners had a total overview of an analysis cycle, all being occupied with a discrete part of planning, practical work and information management. The conclusion of the study is that fragmentation in the division of labour may be a critical hindrance to development in clinical microbiology. If a common strategy is not shared between specialties and professions, even minor changes in routines by individual practitioners may influence patient outcome.

Cooperative Behavior↗

PubMedDate not supplied

The unexpected result: fault of the laboratory? Traps in laboratory diagnostics.

In designing valid medical laboratory studies, it is imperative that the quantity of an analyte present in the body fluid in vivo, be transferred unchanged to the analytical process. Preanalytical variables acting as influence and interference factors have been described. From the practical point of view, these factors are usually not considered in quality assurance programs which only cover the analytical process.

Clinical Laboratory Techniques↗

PubMed2001

A centrifuge-less plasma separation method from whole blood anticoagulated with EDTA-2K for the use of clinical laboratory tests.

In the modern medical laboratory system, simple and rapid processing of specimens are required. In the current system with the transportation line, its centrifugation part would disturb smooth flow of the testing because it needs much time for the centrifugation. To solve the problems, a serum separation method was tried for the whole blood specimen using poly-L-lysine, concanavalin A and phyto-hemoagglutinin. Ploy-L-lysine with molecular weight 130,000 to 210,000 in a final concentration of 0.1% could accelerate blood sedimentation, although its supernatant contaminated platelets. Concanavalin and phytohemoagulutinin could accelerate the sedimentation and obtained plasma, but the method could yield enough amount of supernatant by 1 hour standing. As the purpose of this study is to develop a centrifugeless method, a sieve method using a steel mesh and a magnet was applied to the mixture of EDTA blood, red-cell adhesives and thrombin. The method was unique to separate plasma, but the yield was not so high and chemistry data were not fitted with serum data in some of tests. Thus, the trial would be a new technology, but it was judged that some further improvement will be needed technically.

Anticoagulants↗

PubMedDate not supplied

[The immunology laboratory in digestive tract disorders].

Medical laboratory immunology can be useful, for the overall study of patients with gastrointestinal and hepatic diseases, at three different levels. In those diseases where an abnormal immune response has been through to contribute to the pathophysiological process, the specialized laboratory may yield useful information regarding the activation or presence of such mechanisms; in infectious diseases of the liver and/or gastrointestinal tract, the immunology laboratory can contribute- sometimes decisively- to the etiological diagnosis and, finally, in malignant gastrointestinal diseases, immunological studies might provide information that is useful for the diagnosis, and the most importantly, for the follow-up and prognosis of such patients.

Biomarkers, Tumor↗

PubMed1987

A cancer screening skills laboratory for medical students.

At St. Louis University School of Medicine a 15-hour Integrated Oncology Module is part of the required second-year Introduction to Medicine course. In place of a one-hour lecture in the module, a required one-hour laboratory was introduced to teach cancer screening as a means of secondary cancer prevention. This activity follows completion of the Introduction to Physical Diagnosis course. The laboratory utilized anatomically correct models to instruct students in fundamental screening procedures for cervical, breast, prostate, and colorectal cancer. Emphasis was placed on a professional interaction with the patient. The Cancer Prevention Laboratory sessions were conducted by registered nurses with specialized training in cancer screening. The Socratic method was employed by the instructors as each of 157 students moved through a series of stations screening appropriate models. The student described the procedure as it was performed, and answered questions pertinent to the activity. The instructors assessed performance using a checklist developed for this purpose. Questions relative to secondary cancer prevention and proper physical detection of cancer appeared on the final exam of the Integrated Oncology Module. One hundred fifty-seven students completed the screening laboratory. Four nurse instructors were employed at each session. Thirty-nine hours were required for all students to complete the lab. Student critique of the activity was overwhelmingly positive, particularly in the acceptance of the registered nurse instructors. Eighty-six percent of the 157 students reported that the teaching methodologies used by the nurses were excellent. The nurses were also perceived as knowledgeable and nonthreatening.

Education, Medical, Undergraduate↗

PubMedDate not supplied

Educational program survival strategies: preserving and expanding capacity.

The clinical laboratory workforce picture is clear, and it is not pretty. Vacancy rates in 2000 were the highest reported over a 12-year comparison period (1). Eleven percent of staff medical technologist positions were vacant, and 14% of staff medical laboratory technician positions were vacant. Of course, personnel shortages in the clinical laboratory are not unique in the health-care sector. The current nurse vacancy rate of 13% to 15% has drawn the majority of the attention about health-care labor shortages (2).

Laboratories↗

PubMed1994

Proficiency testing in parasitology. An educational tool to improve laboratory performance.

In 1977, the Laboratory Proficiency Testing Program began testing laboratories that examine samples for gastrointestinal parasites and operated with little change in the subsequent 17 years. Four surveys, each containing four samples, are distributed each year to every currently licensed medical laboratory in Ontario. Participation is mandatory. Survey results indicate a remarkable improvement in laboratory performance during this period. Improvement is believed to result from a combination of the voluntary withdrawal from testing by laboratories with poor performance and the improved performance of the others. The extensive educational services devised and carried out by the Parasitology Committee is believed to have been a significant factor leading to this improvement.

Data Collection↗

PubMed1989

Infections in British clinical laboratories, 1986-87.

During 1986-87 this continuing survey showed 15 specific infections in the staff of 235 laboratories, representing 28,524 person years of exposure. The community was the probable source of four of the five cases of tuberculosis and one of the five cases of salmonellosis. Occupational exposure was the probable cause of four infections by Shigella flexneri, three by Salmonella typhimurium, and one by S typhi, all affecting medical laboratory scientific officers (MLSOs) in microbiology. Occupational exposure was also the probable cause of one case of tuberculosis in a mortuary technician and one of probable non-A, non-B hepatitis in a medical laboratory scientific officer haematology worker. The overall incidence of reported infections was 52.6/100,000 person years (35/100,000 for infections of probable occupational origin). The highest rates of laboratory acquired infections related to MLSO microbiology workers and mortuary technicians. No additional infections were seen as a result of extending the survey to forensic laboratories.

Adult↗

PubMed1997

[How reliable are laboratory results? Many factors are to be considered].

Variation in medical laboratory results is predominantly due to biological factors in the patients and differences in sampling and sample handling procedures, factors which are unaffected by quality assurance procedures in the laboratory. Regarding medical diagnostics, physicians are often deficient in their knowledge of optimal analytical alternatives appropriate for different clinical requirements, and of biological and pre-analytical factors characterised by variation. This reduces the efficacy of laboratory diagnostics. Laboratory results are reliable when they are obtained by competent personnel, and reach their optimal diagnostic potential when they are interpreted by experienced and well informed diagnosticians.

Clinical Laboratory Techniques↗

PubMed2001

Accreditation and postgraduate training in European countries: an FESCC survey. Federation of European Societies of Clinical Chemistry.

The mission of the Federation of European Societies of Clinical Chemistry is to support and promote clinical chemistry and laboratory medicine in Europe, to aid communication between the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and National Scientific Societies, to develop education and quality in the discipline, and to encourage young scientists to take an active role in these activities. One recent initiative of the Federation was a survey on accreditation of medical laboratories and training in laboratory medicine in Europe. Among European countries, three promote accreditation according to EN 45001, several countries apply systems based on professional and nationally defined standards (e.g. CPA in the UK) and other countries are moving to define accreditation standards at a national level. Data on vocational training demonstrate that this is based on a postgraduate education with duration ranging from 6 months to 11 years; in most countries the average length of university education is 5 years and that of postgraduate training is 4 years. A great difference, moreover, exists regarding the polyvalent versus monovalent training. Taken together, these data indicate that a great effort should be made by the Federation for promoting harmonization and coordination in Europe.

Accreditation↗

PubMed2002

Evaluation of the in vitro activity of six broad-spectrum beta-lactam antimicrobial agents tested against recent clinical isolates from India: a survey of ten medical center laboratories.

The widespread use of beta-lactam antimicrobial agents as first-line therapy for the treatment of serious infections has led to the development of various resistances that have compromised the use of some agents. In certain countries, the lack of local or national surveillance programs limits the ability to detect these resistant strains and prevent their dissemination. A 10 medical center study in India was initiated to benchmark prevailing resistance rates for a range of bacterial pathogens to beta-lactams, and it found high rates of beta-lactamase-mediated resistance in Escherichia coli and Klebsiella spp. These rates included: cephalosporins (55.6-61.3% resistance), with extended-spectrum beta-lactamase (ESBL) phenotypes noted in over 60% of E. coli isolates and in Salmonella spp. (3.2-8.1%). Imipenem, a carbapenem, was the only antimicrobial agent tested with 100% activity against Enterobacteriaceae. Cefpirome was the most active of the tested cephalosporins, and all were fully active against methicillin-susceptible staphylococci with the exception of ceftazidime. Molecular and susceptibility characterization of 52 selected ESBL-producing strains showed a high level of co-resistance with aminoglycosides and fluoroquinolones, and clonal dissemination of resistant strains within medical centers. Collaborative studies, such as those presented here, can accurately detect changes in resistance patterns, and their continued use may help limit the further development and spread of bacterial resistances in India.

Anti-Bacterial Agents↗

PubMed1998

Creation and maintenance of Helix, a Web based database of medical genetics laboratories, to serve the needs of the genetics community.

Helix (healthlinks.washington.edu/helix) is a web accessible database that serves as the main U.S. directory of laboratories offering genetic testing. The database was designed to address the previously unmet need for a centralized, continuously updated source of information about clinical and research genetic testing to keep pace with the rapid rate of gene discovery resulting from the Human Genome Project. The Helix project began in 1992 at the University of Washington and Children's Hospital and Regional Medical Center. It has evolved from a single user stand alone relational database to a fully Web enabled database queried and maintained via the web and linked to other web accessible genomic databases. As of February, 1998 it lists more than 500 diseases and 290 laboratories, with over 5,200 registered users making approximately 250 queries/day (90% via the Internet). We describe the iterative design, implementation, population and assessment of the database over a six year period.

Database Management Systems↗

PubMed2003

Prevalence of rotavirus, adenovirus and astrovirus infection in young children with gastroenteritis in Gaborone, Botswana.

OBJECTIVE: To determine the prevalence of three enteric viruses, namely rotavirus, adenovirus and astrovirus, as agents of diarrhoea in and around Gaborone, Botswana. DESIGN: The sample were categorised into four groups according to the age of the patient: 0-3 months, 4-6 months, 7-12 months and 25-60 months. Total monthly samples across age groups formed basis for calcultating seasonal prevalence of rotavirus infection. SETTING: Stool samples were collected from three medical laboratories in Gaborone and one in the town of Mochudi. These were collected from children under the age of five years with gastroenteritis. SUBJECTS: Stool samples were collected between March 2001 and February 2002 from 346 children less than five years of age suffering from gastroenteritis. These samples had been sent to medical laboratories for microbiological examination. METHODS: The samples were screened for rotavirus (RV), adenovirus (Ad) and astrovirus (AsV) antigens using commercially available ELISA kits. The Ad positive samples were further analysed by commercially available group specific Ad type 40/41 Enzyme Immuno Assays (EIA). RESULTS: Shedding of RV was detected in 9.2%, Ad in 7.8% and AsV in 2.7% of the samples analysed. The enteric Ad (types 40 and 41) were detected in 2% of the samples and the remaining 5.8% of Ad positive samples were non-enteric Ad. An increase of RV was noted in the autumn-winter season but no seasonal pattern was observed in Ad shedding. Seasonal prevalence of AsV could not be determined. The average age of children infected with these agents was less than one year. CONCLUSION: The incidence of rotavirus infection amongst children in Botswana appears to be relatively low. The prevalence rate of adenovirus and astrovirus is similar to other studies in parts of Southern Africa. However, continued enteric virus surveillance and epidemiology amongst this group is required.

Adenovirus Infections, Human↗

PubMed2005

Enzyme immunoassay (EIA)/enzyme-linked immunosorbent assay (ELISA).

This brief note addresses the historical background of the invention of the enzyme immunoassay (EIA) and enzyme-linked immunosorbent assay (ELISA). These assays were developed independently and simultaneously by the research group of Peter Perlmann and Eva Engvall at Stockholm University in Sweden and by the research group of Anton Schuurs and Bauke van Weemen in The Netherlands. Today, fully automated instruments in medical laboratories around the world use the immunoassay principle with an enzyme as the reporter label for routine measurements of innumerable analytes in patient samples. The impact of EIA/ELISA is reflected in the overwhelmingly large number of times it has appeared as a keyword in the literature since the 1970s. Clinicians and their patients, medical laboratories, in vitro diagnostics manufacturers, and worldwide healthcare systems owe much to these four inventors.

Animals↗

PubMed2002

Coverage and perceptions of Medical Sciences students towards hepatitis B virus vaccine in Sana'a City, Yemen.

OBJECTIVE: The present study was conducted to estimate vaccination coverage against hepatitis B virus and the perceptions of 1198 medical sciences students in Sana'a City, Yemen. METHODS: Only those who practice clinical training or are in contact with body fluids were included. The students were enrolled in the Faculty of Medicine and Health Sciences, Sana'a University, Republic of Yemen. Data was collected from 1999-2000. Arabic pre-tested questionnaire forms were completed by 840 students at a response rate of 70.6%. RESULTS: The study revealed a reported vaccination rate of 29.5%. The rate among Faculty of Medicine and Health Sciences students was 32.3%, whereas only 21.3% among the students of High Institute of Health Sciences. Students of dentistry attained the highest rate of vaccination (38.8%), while nursing students of the High Institute of Health Sciences achieved the lowest rate (17.1%). Rate of vaccination (46.6%) among female students was significantly higher than male students (22.3%) with a P- value of 0.0001. Medical assistants of the High Institute of Health Sciences scored the best (56%) in terms of knowledge, medical laboratory sciences students achieved the highest (43.6%) in attitude and dentistry students had the highest scores (35.5%) in practices. The mean knowledge of females and males was comparable, however, females achieved higher attitudes and practices. Final stage students attained better attitude scores than the pre-final and intermediate students. CONCLUSION: Vaccination coverage of medical sciences students in Sana'a City, Yemen is low. Knowledge of medical assistants is the best, attitude of medical laboratory sciences students and practices of dental students is the highest. Attitudes and practices of female students are better than that of males.

Health Knowledge, Attitudes, Practice↗

PubMed1993

[Roles of pathology laboratories on medical care service and quality assessment system for pathological diagnosis].

In practical medicine, pathologists provide highly specialized medical information (pathological diagnosis) to clinicians. Pathological diagnosis includes histopathology, cytology, intraoperative consultation (rapid diagnosis by frozen section) and autopsy service. In particular, histopathological diagnosis of biopsy specimens, nearly always gives a qualitative diagnosis to unknown pathological process, in other words, a final diagnosis. In addition, pathological diagnosis contributes to supporting medical audit. Thus it is quite important that to establish the quality assessment system for pathological diagnosis which is hard to be judged with the value.

Autopsy↗

PubMed1987

Infections in British clinical laboratories, 1984-5.

During 1984-5 this continuing survey showed that 41 infections occurred in the staff of 193 laboratories, representing 23,043.5 person years of exposure. The community was the probable source of two cases each of hepatitis A and B, one of tuberculosis, two of campylobacter enteritis, and 12 of Norwalk viral diarrhoea. Occupational exposure was the probable cause of six hepatitis B infections (affecting haematology, biochemistry, and microbiology staff), three of tuberculosis (affecting mortuary and morbid anatomy workers), seven shigella, three salmonella (including one typhoid) and one pseudocholera infection (all in microbiology medical laboratory scientific officers), and a streptococcal infection in a mortuary technician. An episode of hepatitis of uncertain cause affected a carrier of hepatitis B. The incidence of reported infections of all types was 178 per 100,000 person years (91 for infections of suspected occupational origin). The highest incidence was in morbid anatomy and mortuary workers, followed by microbiology medical laboratory scientific officers.

Adult↗

PubMedDate not supplied

Successful community-based laboratory services program for long-term care facilities, Part 1.

Hagerstown Medical Laboratory, Inc. (HML) is a regional reference laboratory in Hagerstown, Maryland, that provides laboratory services to more than 50 long-term care facilities (LTCFs, or nursing homes) in Western Maryland and West Virginia. HML also operates the rapid response laboratory at Washington County Hospital and performs house calls for homebound or bedridden patients through its Nursing Home Program (NHP). This article relates HML's successful experience with an outreach program that provides laboratory services to LTCFs.

Community Health Services↗