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PubMed1984

Precision and costs of techniques for self-monitoring of serum glucose levels.

The poor correlation between serum and urine glucose measurements has led to the development of new techniques for monitoring the blood glucose level in diabetic patients. Either a nurse or the patient can perform these tests, which involve spreading a single drop of blood onto a reagent strip. A colour change that is proportional to the serum glucose level can be read visually or with a reflectance meter. Evaluated against simultaneous serum glucose levels determined by the hospital biochemistry laboratory, those of the new techniques employing reflectance meters all showed excellent correlation (r2 = 0.85 to 0.96). Reagent strips used without meters showed poorer correlation (r2 = 0.69 to 0.90). The instruction given to the patients and one nurse enabled them to obtain more accurate results with one of the meters than nurses not specially trained (r2 = 0.94 and 0.92 v. 0.85 respectively). The mean cost per glucose determination with the new techniques was 75, compared with +1.45 for the laboratory determinations done with automated equipment. It was concluded that the new techniques compared well with the reference method, particularly when reflectance meters were used, and that they were easily applied by the patient, as well as the medical staff, at a reasonable cost.

Blood Glucose↗
PubMedDate not supplied

Automated health testing in a medical group practice. Effects on physician behavior and economic influences.

An automated health testing (AHT) laboratory was introduced into a large medical group practice in January 1970. The impact of AHT was studied by means of a matrix of before and after its introduction and the physicians with high and low volumes of referrals to this service. An epidemiologic data-gathering approach was used to obtain information with minimal interference with normal clinic operation during a 3-year period. Data were obtained from the business office, appointment rosters, AHT laboratory results, and clinic records. AHT was accepted and used more frequently by the general and family practice physicians and internists than by the other physicians in the group practice. After AHT was introduced, the general physicians saw fewer patients but held longer visits, performed more procedures, and ordered fewer tests. On the other hand, the internists saw more patients but held shorter visits, performed more periodic reexaminations, and ordered fewer tests. The study findings indicate that in the short term AHT does not appear to reduce the cost of medical care. However, patients benefited from followup of AHT results; often, this followup resulted in significant newly diagnosed diseases or conditions, treatment, and sometimes surgery.

Adult↗
PubMed1995

Enumeration of platelets by multiparameter flow cytometry using platelet-specific antibodies and fluorescent reference particles.

The correct enumeration of platelets is still an elusive matter. This is mainly due to the fact that commercial instruments which are used for platelet counting cannot discriminate platelets from other cellular particles and precipitates that cause similar signals. Visual (chamber counting) methods are still frequently used in routine laboratories to verify low automated platelet counts (< 50 x 10/l) despite obvious technical and statistical drawbacks. The following report shows how platelet counts can be measured by multiparameter flow cytometry with the help of reference particles (fluorescent latex beads) and platelet-specific antibodies i.e. anti-GPIIb/IIIa(CD41a), anti-GP Ib-alpha (CD42b) and anti-GP IIIa (CD61). The linearity of this method was highly satisfactory and the observed imprecision was within acceptable limits. At a platelet concentration of 10 x 10(9)/l the coefficient of variation (CV, n = 10) ranged from 5.3% (PCV = 0.456) to 5.6% (PCV = 0.148). Accuracy was evaluated by comparing results to the ICSH-selected method for platelet counting. The correlation of both methods was significant (P < 0.005) and Passing-Bablok's linear regression analysis showed no systematic differences between the two methods. Comparisons of this new platelet counting technique were also performed with routine visual methods, automated blood analysers (Technicon H-1, Sysmex E-5000) and a different flow cytometric method using only forward and side light scatter properties of platelets for their discrimination. The linear correlation of all methods was significant (P < 0.01) at platelet concentrations above 50 x 10(9)/l. At lower platelet concentrations, our new platelet counting technique correlated significantly only with the visual and the forward/side scatter methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies↗
PubMed1996

Development and evaluation of a urine protein expert system.

Based on the quantitative determination of creatinine, total protein, albumin, alpha 1-microglobulin, IgG, alpha 2-macroglobulin, and N-acetyl-beta, D-glucosaminidase in urine in combination with a test strip screening, the findings of hematuria, leukocyturia, and proteinuria can be assigned to prerenal, renal, or postrenal causes. Using this graded diagnostic strategy as a knowledge base, we developed a computerbased expert system for urine protein differentiation ("UPES") as a decision-supporting tool. The knowledge base was implemented as a combination of "if/then" rules and two-step bivariate distance classification of marker proteins. The knowledge for this form of pattern recognition was derived from the results for a set of 267 patients with clinically and histologically documented nephropathies. To determine the diagnostic value of UPES, we tested another set of data: results for 129 urine analyses from 94 patients. Using these data, the system reached 98% concordance with the clinical diagnoses for the patients and was superior to the diagnostic interpretations of four human experts. UPES has been successfully integrated into the laboratory routine process, including automated data import.

Acetylglucosaminidase↗
PubMed1977

The calibration of automated instruments for accuracy in hemoglobinometry.

The surveys of the College of American Pathologists indicate a consistent bias between the manual "reference" method for hemoglobin determinations and the Coulter S measurements. The Coulter S hemoglobin values are invariably lower; the difference averages 0.3 g/dl. The commonly used calibration methods for the Coulter appear to be subobtimal. The hemoglobin calibration and quality assurance method proposed by Bull and colleagues is advocated as the presently most acceptable method. Commercial hemoglobin control materials should not be used for hemoglobin calibration.

Automation↗
PubMed2005

Microbial DNA typing by automated repetitive-sequence-based PCR.

Repetitive sequence-based PCR (rep-PCR) has been recognized as an effective method for bacterial strain typing. Recently, rep-PCR has been commercially adapted to an automated format known as the DiversiLab system to provide a reliable PCR-based typing system for clinical laboratories. We describe the adaptations made to automate rep-PCR and explore the performance and reproducibility of the system as a molecular genotyping tool for bacterial strain typing. The modifications for automation included changes in rep-PCR chemistry and thermal cycling parameters, incorporation of microfluidics-based DNA amplicon fractionation and detection, and Internet-based computer-assisted analysis, reporting, and data storage. The performance and reproducibility of the automated rep-PCR were examined by performing DNA typing and replicate testing with multiple laboratories, personnel, instruments, DNA template concentrations, and culture conditions prior to DNA isolation. Finally, we demonstrated the use of automated rep-PCR for clinical laboratory applications by using isolates from an outbreak of Neisseria meningitidis infections. N. meningitidis outbreak-related strains were distinguished from other isolates. The DiversiLab system is a highly integrated, convenient, and rapid testing platform that may allow clinical laboratories to realize the potential of microbial DNA typing.

Automation↗
PubMed2006

Overview: methods and applications for droplet compartmentalization of biology.

Three protocols in this issue highlight applications of emulsification procedures, which deliver high-throughput potential to the molecular biology laboratory, without the need for automation. These procedures have already generated interesting results and spurred the development of exciting new technologies, while requiring only readily available laboratory equipment.

Biology↗
PubMed1998

Application of an on-line liquid chromatographic system for the determination of polar herbicides in drinking water within a routine laboratory.

A previously developed on-line automated system for the analysis of polar herbicides in raw and drinking water, was further optimised for use within a routine environmental monitoring laboratory. One-hundred-ml portions of sample were extracted onto interchangeable, PLRP-S packed cartridges, prior to desorption by the mobile phase of an HPLC system. Determination of triazine and phenylurea herbicides was achieved by UV diode array detection, with detection limits ranging between 0.002 and 0.012 microgram l-1. Precision, in HPLC grade water, ranged from 3.1 to 9.7% R.S.D. at the 0.090 microgram l-1 level, as determined at those wavelengths selected for routine analysis. Confirmation of positive results was achieved by library searching of UV spectra. The system was found to be robust for routine analysis, with a sample throughput of ten samples per day.

Chromatography, High Pressure Liquid↗
PubMedDate not supplied

A task-targeted automation system: a case study.

Kaiser Permanente's Northern California Regional Laboratory recently achieved an important milestone in its continuous quality improvement project by automating time-consuming and labor-intensive tasks involved in preanalytical and postanalytical sample processing. The new task-targeted automation system, the most sophisticated of its kind in the world, consists of three key components: the Roche Diagnostics PSD 1 primary sample decapper/sorter/archiver, the Roche Diagnostics VS 250 aliquoter, and a data manager/process controller developed by Data Innovations. The system was placed into service in April 1998, culminating more than a year of planning and implementation. Within months after the system went into operation, the laboratory observed significant improvements in workflow and efficiency, as well as a reduction in work-related injuries. The purpose of this article is to provide management teams in other laboratories with a description of the planning and implementation process and offer suggestions for those contemplating a similar program.

Automation↗
PubMed1992

Food intake measured by an automated food-selection system: relationship to energy expenditure.

Measuring food intake in a laboratory usually involves limited food choices. An automated food-selection system with two vending machines containing a large variety of foods was used to measure food intake in 10 male volunteers (31 +/- 6 y, 69.2 +/- 7.1 kg, 18 +/- 7% fat, mean +/- SD) on a metabolic ward. The effect of carbohydrate, fat, and protein intakes on 24-h energy expenditure (24EE) and substrate oxidations was measured in a respiratory chamber during day 4 of weight maintenance and day 7 of ad libitum intake. Ad libitum intake resulted in a 7-d overfeeding of 6468 +/- 3824 kJ/d above weight-maintenance requirements, leading to a 2.3 +/- 1.2-kg gain. The 10,975 +/- 3774 kJ excess energy intake on day 7 of ad libitum intake caused a 1205 +/- 920 kJ/d increase in 24EE (delta 24EE = 0.17 x delta intake - 695; r = 0.71, P less than 0.02). Of the excess carbohydrate intake, 74% was oxidized (r = 0.86, P less than 0.001), whereas excess fat intake was not. Carbohydrate and protein stores are regulated whereas excess fat intake is channeled to fat stores.

Adult↗
PubMed1997

The MDA-180 coagulation analyser: a laboratory evaluation.

We have evaluated the technical performance of the MDA-180 automated coagulation analyser in a working diagnostic hemostasis laboratory environment. The analyser has been on site now for over 18 months, and has undergone considerable testing. More than 22,000 samples have been processed, with over 90% of these via the MDA-180's cap-piercing facility. The instrument has been primarily assessed for its technical ease of use and continued reliability, as well as its analytical performance. The instrument has also been successfully interfaced to, and used with, our Laboratory information (CERNER PATHNET) system. A major feature of our evaluation has been an assessment of the MDA-180's ability to perform assays currently performed using alternative methodology or instrumentation (eg; ELISA methodology or the Coagamate-X2 and ACL-300R instruments), as well as its potential to streamline the technical performance of some of these assays. We have co-evaluated the following assays: PT/INR, APTT, TT, Fibrinogen, Protein C, ATIII, Factors II, V, VII, VIII, IX, X, XI, and XII, Lupus anticoagulant (dRVVT), and heparin (alpha Xa). In addition, a number of different reagents (particularly for PT and APTT assays) have been tested on the instrument. Intra-assay and inter-assay variation appears to be remarkably low (five different plasmas tested: PT: 0.6 to 1.3% and 0.5 to 1.3% respectively; APTT: 0.7 to 3.2% and 0.6 to 3.6% respectively; single day analysis). Other comparative assessment data typically showed good correlation to existing test assay systems. A review of other features which may enhance or detract from the instrument's worth in a given hemostasis laboratory is also presented. In summary however, we conclude that the instrument is reliable, easy to use and capable of fast sample through-put.

Blood Coagulation Factors↗
PubMed2001

Protein standardization III: Method optimization basic principles for quantitative determination of human serum proteins on automated instruments based on turbidimetry or nephelometry.

Quantitative protein determinations in routine laboratories are today most often carried out using automated instruments. However, slight variations in the assay principle, in the programming of the instrument or in the reagents may lead to different results. This has led to the prerequisite of method optimization and standardization. The basic principles of turbidimetry and nephelometry are discussed. The different reading principles are illustrated and investigated. Various problems are identified and a suggestion is made for an integrated, fast and convenient test system for the determination of a number of different proteins on the same instrument. An optimized test system for turbidimetry and nephelometry should comprise high-quality antibodies, calibrators, controls, and buffers and a protocol with detailed parameter settings in order to program the instrument correctly. A good user program takes full advantage of the optimal reading principles for the different instruments. This implies--for all suitable instruments--sample preincubation followed by real sample blanking, which automatically corrects for initial turbidity in the sample. Likewise it is recommended to measure the reagent blank, which represents any turbidity caused by the antibody itself. By correcting all signals with these two blank values the best possible signal is obtained for the specific analyte. An optimized test system should preferably offer a wide measuring range combined with a wide security range, which for the user means few re-runs and maximum security against antigen excess. A non-linear calibration curve based on six standards is obtained using a suitable mathematical fitting model, which normally is part of the instrument software.

Antigen-Antibody Reactions↗
PubMed1983

Detection of oxacillin-resistant staphylococci by the AutoMicrobic system.

The AutoMicrobic system (Vitek Systems, Inc., Hazelwood, Mo.) is an automated instrument designed for rapid microbiological identification and susceptibility reporting in the clinical laboratory. The reliability of a rapid, automated approach to testing methicillin-resistant staphylococci was evaluated. To determine the accuracy in detecting oxacillin-methicillin resistance by the AutoMicrobic system, 746 staphylococci from seven different geographical areas were tested. Results were compared with the Bauer-Kirby agar disk diffusion technique as the reference method. Of the 304 staphylococci, 209 coagulase-positive and 95 coagulase-negative strains were resistant to oxacillin-methicillin. These organisms fell into three categories of resistance detection. The first category had resistance levels high enough for initial detection, the second category had low resistance levels requiring modified data analysis techniques for detection, and the third category had resistance levels too low for detection. Of the resistant strains tested, 21% showed a category two resistant growth pattern. Major errors, as a result of hetero-resistant growth patterns of the tested strains, were resolved by computer analysis of growth curves. These data analysis applications enabled detection of 96% of the oxacillin-methicillin-resistant organisms. Results for all resistant staphylococci tested were available in an average time of 5.5 h.

Autoanalysis↗