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The paper is concerned with the problems of technical equipment of standard clinico-diagnostic laboratories (CDL) in this country. The authors suggest a mathematic model that may minimize expenditures for laboratory studies. The model enables the following problems to be solved: to issue scientifically-based recommendations for technical equipment of CDL; to validate the medico-technical requirements for newly devised items; to select the optimum types of uniform items; to define optimal technical decisions at the stage of the design; to determine the lab assistant's labour productivity and the cost of some investigations; to compute the medical laboratory engineering requirement for treatment and prophylactic institutions of this country.
This study focused on the factors that influence students' choice of an allied health profession. A survey of 153 students in three allied health programs at the University of Connecticut revealed that "the need to help others," "prestige," "professional autonomy," "opportunities for advancement," "income potential," and "the effect of the specialty on family and personal life," were the major influencers of career choice among allied health students. Only a few students regarded malpractice suits and AIDS as negative influencers. While medical laboratory science majors regarded these as important factors, dietetics and physical therapy majors did not. The article suggests further use of these findings by program directors and career counselors.
OBJECTIVE: To develop a local quality assurance program in cytopathology based on circulation of patient specimens on glass slides, with limited resources. STUDY DESIGN: A working group was set up for design and running of the program. Participation is on a laboratory basis. The scope and frequency of testing are defined. Well-documented cases (including gynecologic, nongynecologic and fine needle aspiration cytology) with commonly encountered diagnoses are collected. Consensus concerning the diagnosis, interpretive menu and scoring system is sought before the actual slide circulations using express mail. After returning their answers to the program organizer, the participating laboratories receive immediate feedback on their scores, with reference answers, explanatory notes, "whole-mount" images of glass slides and cumulative responses of peer laboratories for on-site checking. At the end of each year, an electronic file containing representative photomicrographs of all cases examined is provided to individual laboratories for their permanent records and training purposes. RESULTS: The program was launched in mid-2003. There were 24 and 27 participating laboratories from Hong Kong (and Macau) in 2003 and 2004, respectively. To date, >150 well-documented cytology cases are available in the slide pool and ready for circulation. As the revenue is mainly to cover the expenses of express mail, the program can be carried out at a relatively low cost. CONCLUSION: In order to have any cytology quality assurance program accepted by local laboratories, it has to be fair and practical. Strict confidentiality needs to be observed throughout the process. This program emphasizes both performance assessment and educational value. Adequate representation from experienced local cytology workers, detailed documentation support from authorities and assistance from dedicated staff are essential to the success of any external proficiency testing scheme. Regular review and evaluation are also necessary for continuous improvement. The Hong Kong experience can serve as an example of running a glass slide-based cytology quality assurance program in a small region with limited resources.
During 1997, Oklahoma City's Hospital A reported penicillin-nonsusceptible Streptococcus pneumoniae in almost 67% of isolates. To confirm this finding, all Hospital A S. pneumoniae isolates from October 23, 1997, through February 19, 1998, were tested for antibiotic susceptibility and repeat-tested at two other hospital laboratories. Medical records of Hospital A patients with invasive S. pneumoniae infections during 1994 through 1997 were also reviewed. These data were compared with 1998 statewide sentinel hospital surveillance data for invasive S. pneumoniae. Of 48 S. pneumoniae isolates from Hospital A during October 23, 1997, through February 19, 1998, 31 (65%) were penicillin-nonsusceptible S. pneumoniae, and 23 (48%) were highly penicillin resistant. Similar prevalences were confirmed at the other hospital laboratories; however, significant interlaboratory differences were noted in the determination of third-generation cephalosporin susceptibility. During 1994 through 1997, a trend toward increasing penicillin nonsusceptibility (p <0.05) was noted among S. pneumoniae isolates from nursing home patients. During 1998, 85 (30%) of 282 invasive isolates reported to the state surveillance system were penicillin-nonsusceptible S. pneumoniae; 33 (12%) were highly resistant. The increase in resistance observed is notable; the interlaboratory discrepancies are unexplained. To respond, a vaccination program was implemented at Hospital A, and vaccination efforts were initiated at nursing homes.
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Throug the use of the statistical technic known as the linear model, a complete analysis has been made of data obtained in the Colleg of American Pathologists Survey of 1975 for calcium, potassium, and blood urea nitrogen (BUN). The analysis allows a separation of laboratories into core and non-core categories. It also allows for determination of the reproducibility of each analytic technic involved in this survey. For Ca and K, the results obtained by each analytic method were compared with the results obtained by the National Bureau of Standards through use of the definitive method. For BUN, the comparison was made with the average of values for all laboratories and all methods.
The CAP Interlaboratory Survey data from the non-core laboratories identified by Paule and Mandel were examined. Some laboratories were designated non-core because they submitted one or more values that were widely discrepant and were caused by unit problems, decimal shifts, or reversal of the specimens. A second group of laboratories submitted a number of discrepant results that appeared to be caused by problems within the laboratories. A third group submitted results that appeared acceptable, and the exclusion and the effectiveness of the criteria differed for each of the three analytes. The findings suggest that examination of data from excluded laboratories can provide a valuable source of information to supplement the central data.
Visual asymmetry patterns related to skill were examined during a target-probe matching task in 24 skilled medical technologists and 24 matched controls. On each of 240 test trials, digitized replicas of specimens commonly encountered in medical laboratory diagnostics were shown centrally for 500 msec. Each target was immediately followed by a lateralized probe item for 120 msec that was either an exact copy (positive probe) or a distorted version (negative probe) of the target. Difficulty level of target-probe matching was manipulated on negative probe trials; half of the negative items consisted of difficult discriminations which were selected to assess the effects of domain-specific experience on detecting small differences in salient morphological features. Medical technologists exhibited a right visual field advantage, but were not different from the control subjects in speed or accuracy to positive probes or to easy negative probes. The observed left-hemisphere advantage in skilled visual processing is attributed to the beneficial effects of experience on the development of domain-specific visual analysis skills.
The performance audit does not contain any startling news about human performance. It does, however, provide a unique perspective from which to view human performance. It asks the user to relate systematically each part to the whole, to test a hypothesis against actual data, and to formulate solutions based on a strong rationale. We have of necessity described this process very briefly, suggesting how specific tools may be derived for immediate use in the office laboratory. We conclude with a reminder that much useful information in the performance audit can be captured by constructing three tables with the following headings: 1. Job Description, Requirements, Standards; 2. Requirements, Standards, Deficiencies, Potential Impact; 3. Deficiencies, Possible Causes, Possible Solutions. Thus, the performance audit can provide useful information in regard to selecting personnel (item 1), monitoring the performance of laboratory personnel (item 2), and trouble-shooting specific problems (item 3).
The long-term stability of glucose in 45 commercial pools of lyophilized quality control serum is evaluated. The pools have been used in conjunction with the Quality Assurance Service (QAS) of the College of American Pathologists by laboratories participating in Regional Quality Control Programs. Directional instability of glucose was detected by at least one analytic method in 69% of the pools studied. Two distinct and opposite directional trends in glucose concentration were found. Increasing concentration of analyte, averaging 4.7 mg/dl per year, were observed with manual and automated glucose oxidase methods and the automated neocuproine procedure in approximately one fourth of pool--method combinations. Decreasing concentrations of glucose, averaging 3.0 mg/dl per year, were found with automated ferricyanide and hexokinase methods and the manual orthotoluidine procedure in approximately one third of pool--method combinations. The results are best explained by postulating that in affected pools there is a gradual diminution of free and bound glucose and/or a shift of glucose from the protein-bound to the free state.
Specimens used in the College of American Pathologists Survey Programs are sometimes manufactured in excess of Survey needs, and these excess specimens are made available to Survey participants after a survey is completed. These survey-validated reference materials (SVRM's) are a valuable resource to the clinical laboratory field. SVRM's are continually renewed, have a range of analyte concentrations, have reliable target values assigned for more than 20 analytes, and for all methods that are in common use. The materials are useful for assigning appropriate target values to other serum materials used by laboratories, for investigating the accuracy of a laboratory's analytic procedures, and as trouble-shooting aids. The wide availability of SVRM's offers a new opportunity for improving the analytic reliability of quantitative clinical assays.
OBJECTIVES: To describe professional advice- and information-seeking at primary health care (PHC) centres. DESIGN: Prospective cross-sectional data collection using semi-structured interviews. Statistical analysis of association between team-based and centralized organization, profession and pattern of advice-seeking. SETTING: 4 urban PHC centres in Ostergötland County, Sweden. PARTICIPANTS: 199 PHC centre staff members (25 doctors, 70 nurses, 49 nurses' aides, 12 medical laboratory technologists, 24 secretaries, 19 physiotherapists). Nine (4%) staff members did not participate in the study (4 doctors, 3 nurses, 1 nurses' aide, and 1 secretary). MAIN OUTCOME MEASURES: Number of staff using an advice source. RESULTS: For organizational advice, PHC centre managers were consulted at the centrally organized PHC centres, while staff at centres using team organization more often consulted outside sources. Having no one to ask for advice on patient communication was more common in the centralized organization. Regarding medical advice, only nurses' aides differed by consulting their own profession rather than doctors. For patient communication problems, the professions shared an intra-professional advice pattern. CONCLUSIONS: The PHC centre staff maintain parallel overlapping networks of professional advice-seeking. The observed networks can also be seen to answer simultaneous demands from patients, the local health care administration, social services and professional authorities. Straightforward ways to develop the professional communication at PHC centres would be to visualize these multiple dependencies and to support their optimal function in the organization.
OBJECTIVE: The purpose of this study was to assess the feasibility of using a prototype split-specimen design to assess integrity of a portion of the total testing process in medical clinics and laboratories. DESIGN: Two or three tubes of venous blood were collected from 177 patients for analysis of one of three analytes (serum potassium, serum total cholesterol, and whole-blood hemoglobin). Patients were seen at one of the nine clinics participating in this study. In all cases, one tube of blood from each patient was sent to a commercial referral laboratory, and the other tube(s) forwarded to the laboratory that routinely tested specimens for the clinic (participating laboratory) for analysis. Each participating laboratory removed a preanalysis and sometimes a post-analysis aliquot from each specimen and forwarded these to the referral laboratory for analysis. SETTING: The study was conducted in six physician office laboratories (three serving 1 to 4 [mean, 2.7] internists and three serving 3 to 24 [mean, 12] family physicians) and three hospital laboratories (serving hospitals with 100 to more than 700 beds). PATIENTS: Study patients were voluntary participants and provided informed consent. Patient age ranged from 18 to 80 years, and for all the laboratory test was specifically ordered for clinical reasons. Patients who were unable or unwilling to provide informed consent, those for whom testing would require that they provide more than 100 mL of blood, those whose blood was being collected by fingerstick, and those with results that were part of a laboratory test profile were excluded. MAIN OUTCOME MEASURES: Two main outcome measures were assessed: (1) percent differences between split-specimen results exceeding the maximum allowable imprecision level, which was based on published biological variation data (defined as one-half of the intraindividual percent coefficient of variation), for each analyte (result discrepancies); and (2) all "problems" (defined as departures from standard operating procedures) that could be documented by retrospective review of all relevant medical and laboratory records. RESULTS: The rate of result discrepancies was 1 in 20 (5%) for patients in whom hemoglobin was analyzed, 12 in 57 (21%) for patients in whom potassium was analyzed, and 1 in 60 (2%) for patients in whom total cholesterol was analyzed. Results of samples obtained during the aliquoting and storage phases of the total testing process were subject to study-induced problems and were generally not useful in tracing problems to specific stages of the testing process. A total of 28 problems (involving 26 patients) were documented, but only 6 problems were due to routine testing processes. CONCLUSIONS: The feasibility and limitations of a split-specimen design to detect result discrepancies were demonstrated. Most documented problems (22 of 28, or 79%) were study induced. To assess integrity of the total testing process, such problems need to be avoided.
OBJECTIVE: To compare the clinical characteristics and time course of severe hypoglycaemia (SH) on glimepiride and the reference drug glibenclamide. METHODS: SH was defined as a symptomatic event requiring administration of i.v. glucose or of glucagon. Four hundred doctors working in acute care hospitals were randomly selected from the membership directory of the German Diabetes Association and sent a standardised questionnaire about sulphonylurea-induced SH that occurred between June 2001 and August 2002. Detailed data on history, medication, laboratory parameters, treatment and time course of the SH were analysed. RESULTS: Altogether, 93 episodes of SH were registered, 37 on glimepiride and 56 on glibenclamide. The characteristics of the glimepiride- versus glibenclamide-induced SH were as follows: initial blood glucose 1.9+/-0.66 mmol/l versus 1.8+/-0.89 mmol/l, P=0.17; age 77+/-11.2 years versus 78+/-9.6 years, P=0.35; HbA1c 5.4+/-0.7% versus 5.2+/-0.9%, P=0.18; creatinine clearance 38+/-23 ml/min versus 54+/-32 ml/min, P=0.005; co-medication 6.2.+/-3 versus 3.6+/-3 preparations, P< 0.0001. Even very low doses of glimepiride (0.5 mg) and glibenclamide (0.88 mg) were associated with SH. Prolonged hypoglycaemia requiring more than 12 h i.v. glucose administration occurred in 8 of 37 of the glimepiride-treated subjects and 5 of 56 of those on glibenclamide. Prolonged hypoglycaemia necessitated infusion of 308+/-256 g (104-862 g) i.v. glucose over 43+/-16 h (24-64 h) in glimepiride-treated patients compared with 168+/-98 g (66-300 g) over 33+/-28 h (14-80 h) in glibenclamide-treated patients. Impaired renal function was present in 11 of 13 of all patients with prolonged hypoglycaemia and impaired liver function in 1 of 13. CONCLUSION: In glimepiride- and glibenclamide-treated individuals with SH, no essential differences in the clinical characteristics or time course were shown; prolonged courses also occurred on glimepiride. Even in patients with only mild renal failure both preparations should be used with caution.
Reference service in medical libraries should be considered more seriously by the members of the Japan Medical Library Association, as their interest so far has been focused mainly on interlibrary loan service, compilation of union lists and union catalogs, and the business side of library administration. The Association does not have enough funds to be very active, and its membership is limited to the libraries of medical and of some large dental schools. It should open its membership to other medical libraries, such as those of hospitals and medical laboratories, and eventually to individuals. Many of the member libraries do not have complete control of their own budget, as each department of the school earmarks part of its budget for the library while it still holds the right of deciding which books and journals are to be bought and keeps a large part of them in its departmental library. Lack of proper library school education among the library staff is one of the major problems. There are some training courses for medical librarians in the library schools and also some workshops held by the Association, but they are limited in their usefulness by the fact that there are not enough library school graduates who can take advantage of them.