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At least 865 records · Page 48Linked to original sources
PubMed1992

Toxoplasmosis and laboratory workers: a case-control assessment of risk.

The health risks to staff employed in a toxoplasma reference unit were studied. Sixteen laboratory staff exposed to Toxoplasma gondii and age/sex-matched controls from the general population and a routine microbiology laboratory were assessed. Multiple assays were performed to establish the presence of toxoplasma infection, and laboratory workers were questioned regarding environmental and work-related exposure to the parasite. Details of all of environmental exposure to toxoplasma between the two groups of laboratory personnel, and seroprevalence rates were comparable in all three groups. Three laboratory accidents were recorded, a rate of one per 9300 hours exposure. One case of presumed work-related infection was identified, but significant illness was not observed. Given adequate training, strict adherence to conventional laboratory protocols and medical supervision, laboratory accidents are infrequent and work-associated toxoplasma infection is uncommon. The risks associated with occupational exposure to T. gondii have been over-estimated and we conclude that this organism does not represent a significant health hazard to laboratory technicians.

Case-Control Studies↗
PubMed1978

Proposed classification of clinical laboratory methods.

A Task Force appointed by the College of American Pathologists studied the key elements that may affect a laboratory result, including the types of reagents, manufacturers of detection equipment, blanking procedures, calibrators, diluting and dispensing devices, and sample preparation. A field trial was conducted using cholesterol assay as the pilot study. Participants completed a lengthy questionnaire that requested information regarding the key elements used in the cholesterol assay. This report presents the preliminary findings of the field trial. Examples are shown to illustrate how obtaining additional information about how the laboratory test was performed led to identification of subtle differences in test results.

Cholesterol↗
PubMed1996

Extraction and anonymity protocol of medical file.

To carry out the epidemiological study of patients suffering from a given cancer, the Department of Medical Informatics (DIM) has to link information coming from different hospitals and medical laboratories in the Burgundy region. Demands from the French department for computerized information security (Commission Nationale de l'Informatique et des Libertés: CNIL), in regard to abiding by the law of January 6, 1978, completed by the law of July 1st, 1994 on nominal data processing in the framework of medical research have to be taken into account. Notably, the CNIL advised to render anonymous patient identities before the extraction of each establishment file. This paper describes a recently implemented protocol, registered with the French department for computerized information security (Service Central de la Sécurité des Systèmes d'information : SCSSI) whose purpose is to render anonymous medical files in view of their extraction. Once rendered anonymous, these files will be exportable so as to be merged with other files and used in a framework of epidemiological studies. Therefore, this protocol uses the Standard Hash Algorithm (SHA) which allows the replacement of identities by their imprints while ensuring a minimal collision rate in order to allow a correct linkage of the different information concerning the same patient. A first evaluation of the extraction and anonymity software with regard to the purpose of an epidemiological survey is described here. In this paper, we also show how it would be possible to implement this system by means of the Internet communication network.

Computer Communication Networks↗
PubMed2004

[Corresponding to an investigation of the Japan Council for Quality Health Care].

The Japan Council for Quality Health Care (JCQHC) was established in 1995, to improve medical facilities in Japan. After 2001, the medical service of a medical facility could be remunerated. When its activity level is authorized of JCQHC, thereafter the medical facilities applying the authorization have been increasing. For the authorization of a medical laboratory section, two functions must be evaluated by JCQHC, i.e., (1) reliable quality control of laboratory data, and (2) effective cooperation with the other sections within the facility. Items included in the latter are participation in hospital operation, teamwork and personnel management within the section, education-training, quality control of materials and equipments, reasonable utilization of out-sourcing, etc. The application documents for the assessment by the JCQHC describe the organization of the medical facility, available guidelines and manuals, and operation records. The operation records should be itemized into programming, inspection-analysis of the procedures, measures of incidents-accidents, etc. It is recommended that self-assessment of these items be established within a facility.

Accreditation↗
PubMed2006

Nonalcoholic fatty liver disease treated by gastroplasty.

Nonalcoholic steatohepatitis (NASH), which is the most severe histologic form of nonalcoholic fatty liver disease (NAFLD), is emerging as the most common clinically important form of liver disease in obese patients. The prevalence of NASH may increase with the rise in the rate of obesity and metabolic syndrome in affluent communities. The aim of this work is to describe clinical and histopathologic findings and correlate liver tissue damage to the length of duration of the obesity in the group of patients who underwent surgery as obesity treatment. Eighty-seven severely or morbidly obese patients underwent gastroplasty. Each patient was evaluated with complete clinical and laboratory medical assessment together with wedge liver biopsy taken from 59 unselected patients during the surgery. Patients were followed up for 41 months. Repeat liver biopsy was taken from 10 patients. Pathologic analysis recorded the presence and degree of steatosis, portal and lobular inflammation and fibrosis. Age, body mass index (BMI), and laboratory assessment correlated with pathologic data. Male patients showed more pronounced metabolic syndrome and fatty liver damage. Patients who become obese in childhood or as teenagers showed no differences in metabolic syndrome and NAFLD in mature age. There was statistically significant association between BMA, elevated transaminases, NAFLD, and fibrosis. Significant weight reduction was observed within first year after surgery, was slower in the second year, and stabilized within third year. Remarkable improvement followed in biological markers of metabolic syndrome. Ninety-six percent of initial liver biopsies had steatosis; 16% developed steatohepatitis and mild perivenular fibrosis. Significant improvement of the degenerative and inflammatory hepatic lesions in repeated biopsies and liver function readings was noted within 8 months after surgery. Obesity is a major and independent risk factor for the metabolic syndrome, NAFLD, NASH, and fibrosis. Surgical treatment improves metabolic abnormalities and hepatic lesions in long-term observations.

Adult↗
PubMedDate not supplied

Personal health records: evaluation of functionality and utility.

OBJECTIVES: Web-based applications have been developed that allow patients to enter their own information into secure personal health records. These applications are being promoted as a means of providing patients and providers with universal access to updated medical information. The authors evaluated the functionality and utility of a selection of personal health records. DESIGN: A targeted search strategy was used to identify eleven Web sites promoting different personal health records. Specific criteria related to the entry and display of data elements were developed to evaluate the functionality of each PHR. Information abstracted from an actual case was used to create a series of representative PHRs. Output generated for review was evaluated to assess the accuracy and completeness of clinical information related to the diagnosis and treatment of specific disorders. RESULTS: The PHRs selected for review employed data entry methods that limited the range and content of patient-entered information related to medical history, medications, laboratory tests, diagnostic studies, and immunizations. Representative PHRs created with information abstracted from an actual case displayed varying amounts of information at basic and comprehensive levels of representation. CONCLUSIONS: Currently available PHRs demonstrate limited functionality. The data entry, validation, and information display methods they employ may limit their utility as representations of medical information.

Access to Information↗
PubMed1993

Earthbound applications for NASA's physician workstation.

The dream of a space probe to Mars or an astronaut colony on the moon persists. Despite years of setbacks and delays, NASA continues to lay the foundation for a new frontier in space. The necessity of a self contained health maintenance facility is an integral part of this stellar venture. As a subsystem of this health maintenance facility, the physician or astronaut workstation was envisioned as the vehicle of interface between the computer resources of the space station and the care provider. Our efforts to define and build this interface have resulted in a series of programs which can now be tested and refined using earth-based applications. The modules which have dual-use application from the NASA workstation include: patient scheduling and master patient index, pharmacy, laboratory, medical library, problem list/progress notes, and digital medical records. Our current plan is to develop these tools as objects that can be assembled in a variety of configurations. This will allow the technology to be used by the private sector where each doctor can select the starting point of his outpatient office system and add modules as he makes progress in system integration and training.

Aerospace Medicine↗
PubMed1998

[Total quality management in laboratory medicine].

The German Public Health will be continuously challenged in the future. It has to be assumed that modified managed care will not only take place sporadically. Thus, quality aspects of services gain more and more significance. Only suppliers will be successful who can offer services of highest quality at lowest prices. Quality in a comprehensive sense has to be substantiated in the near future. It is recommended to apply industry proven models also in public health service. Medical laboratories can be pioneers in this field as they have been already in the past. All previously proposed procedures can not describe quality of results comprehensively. They are based to a high degree on external control. Total quality management, however, represents a comprehensive approach. Principles are zero-defect approach, customer orientation and system management. Quality is given in the sense of TQM if the customer is permanently satisfied with the service of the supplier. In such a way, the customer defines quality of service. A customer is everyone who receives products or services. TQM overcomes the drawbacks of quality management systems, which are strongly formal and oriented by external control, as accreditation (EN 45,000) or certification (ISO 9000). Competition between hospitals is a declared goal of German health politics because usually quality is increased and cost decreased as a consequence. Competition means also comparison of services. TQM emphasizes benchmarking especially among the best suppliers.

Forecasting↗
PubMed1990

[Proffered opinion forum medical decision making, impact on laboratory tests].

Raising medical expenditure is a universal problem. The Japanese government started taking measures not to increase medical expenses in the recent years. Laboratory tests are no exception. Therefore we as clinical pathologists have reevaluated laboratory tests from the primary care situations to more advanced stages of clinical medicine. As the first step, we formed a subcommittee to effective by utilize laboratory tests and agreed to establish the "essential lab tests". Essential lab tests are made of qualitative bed side tests (type I) and slightly advanced tests (type II) and these tests are to be done on every patient at their first clinic visit. These tests are also to be performed parallel to physical examination and history-taking. The results revealed 50% and 90% positivities on the type I and type II tests, which indicate rather effective means for making an initial impression.

Adolescent↗
PubMed1992

The British Society for Clinical Cytology Certificate of Competence in Cytology Screening: a report of the first 3 years' experience.

In 1988 the Department of Health (DOH) recognized the cytology screener grade of laboratory staff. Cytology screeners have a 2 year training period after which they must sit a 'competence examination'. The British Society for Clinical Cytology offers an examination to meet the DOH specification. It consists of a written paper, a practical screening test, a spot test and a short viva voce. The screening test is paramount and candidates who miss a dyskaryotic smear cannot be successful. In the first 3 years there have been 22 examinations, 294 candidates and a pass rate of 76%. The majority of candidates were Cytology Screeners of 2-3 years experience but significant numbers of Medical Laboratory Scientific Officers (MLSOs) and senior MLSOs also chose to sit the examination.

Cell Biology↗
PubMed1978

The 1977 College of American Pathologists Enzymology Survey. Principal findings.

A set of linearly related serum survey specimens was analyzed by more than 200 laboratories on four occasions in 1977 for the five enzymes lactate dehydrogenase, aspartate and alanine aminotransferases, creatine phosphokinase, and alkaline phosphatase. The survey technic, which employs specimens that are designed to have multiple informational redundancies for detecting discrepancies in the survey data, was found to be a feasible approach, as a variety of methodologic biases and analytic problems were readily detected. The specimens were shown to be stable,and the mean results obtained by a reference group of laboratories were quite reproducible. Consequently, changes observed in individual laboratories in successive surveys were attributable to intra-laboratory changes. The survey provides each participant with an objective evaluation of the linearity, precision, and calibration of his methods, in comparison with peer and reference laboratories, as well as information concerning the popularities of various methods, and the performances of various analytic systems. For each enzyme there are a few large peer groups and a large number of small peer groups. Differences among the laboratories within each peer group were due primarily to proportional biases that in some cases were clearly due to instrumental or reagent differences, rather than to methodologic differences.

Alanine Transaminase↗
PubMed1978

CAP Comprehensive Chemistry. Serum iron survey.

Approximately 1,600 participants replied to a special questionnaire about the serum iron determination used in their laboratories. The categories covered were (1) sample preparation, (2) system, (3) detection method, (4) reducing reagent, and (5) standards. Those using AutoAnalyzer methods uniformly had the highest reported values. The lowest values were reported by those using methods without protein removal. Whether this is a positive bias by the AutoAnalyzer group or a negative bias by methods without protein removal, or both, cannot be determined by this study. Hydroxylamine users reported lower results than others. No difference between the three commonly used chromogenic reagents, bathophenanthrolene sulfonate, tripyridyl-triazine, and ferrozine, could be demonstrated. Protein-based standards should be used when a method is found to be affected by protein. How to determine the assay value is an important problem yet to be solved.

Autoanalysis↗