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PubMed1997

Clinical and laboratory evaluation of powered electric toothbrushes: laboratory determination of relative interproximal cleaning efficiency of four powered toothbrushes.

The clinical brushing data from the paper entitled, Clinical and Laboratory Evaluation of Powered Electric Toothbrushes: In Vivo Determination of Average Force for Use of Manual and Powered Toothbrushes, by Boyd et al. in this Special Issue, were incorporated into a laboratory cleaning model. Utilizing a standardized brushing machine and a methyl methacrylate substrate, four powered brushing instruments were tested for cleaning efficiency: Rota-dent. Braun Oral-B. Interplak and Sonicare, and a manual toothbrush (Oral-B P40). The Sonicare powered brushing instrument was tested at the manufacturer's recommended brushing force of 0.5 N as well as a calculated force of 1.0 N. The results showed that the Rota-dent was more efficient (p < 0.01-0.001) in removing stain from both flat and interproximal surfaces than any of the other tested brushes. These results, together with those reported by McLey, et al. in Clinical and laboratory Evaluation of Powered Electric Toothbrushes: Laboratory Determination of Relative Abrasion of Three Powered Toothbrushes in this Special Issue, demonstrate that the rotary action Rota-dent instrument has the most efficient combination of low abrasion and high cleaning efficiency of the four powered brushes and the manual brush when all instruments were tested using clinically documented pressures.

Analysis of Variance↗
PubMed2004

Metallo-beta-lactamase-producing gram-negative bacilli: laboratory-based surveillance in cooperation with 13 clinical laboratories in the Kinki region of Japan.

A total of 19,753 strains of gram-negative rods collected during two 6-month periods (October 2000 to March 2001 and November 2001 to April 2002) from 13 clinical laboratories in the Kinki region of Japan were investigated for the production of metallo-beta-lactamases (MBLs). MBLs were detected in 96 (0.5%) of the 19,753 isolates by the broth microdilution method, the 2-mercaptopropionic acid inhibition test, and PCR and DNA sequencing analyses. MBL-positive isolates were detected in 9 of 13 laboratories, with the rate of detection ranging between 0 and 2.6% for each laboratory. Forty-four of 1,429 (3.1%) Serratia marcescens, 22 of 6,198 (0.4%) Pseudomonas aeruginosa, 21 of 1,108 (1.9%) Acinetobacter spp., 4 of 544 (0.7%) Citrobacter freundii, 3 of 127 (2.4%) Providencia rettgeri, 1 of 434 (0.2%) Morganella morganii, and 1 of 1,483 (0.1%) Enterobacter cloacae isolates were positive for MBLs. Of these 96 MBL-positive strains, 87 (90.6%), 7 (7.3%), and 2 (2.1%) isolates carried the genes for IMP-1-group MBLs, IMP-2-group MBLs, and VIM-2-group MBLs, respectively. The class 1 integrase gene, intI1, was detected in all MBL-positive strains, and the aac (6')-Ib gene was detected in 37 (38.5%) isolates. Strains with identical PCR fingerprint profiles in a random amplified polymorphic DNA pattern analysis were isolated successively from five separate hospitals, suggesting the nosocomial spread of the organism in each hospital. In conclusion, many species of MBL-positive gram-negative rods are distributed widely in different hospitals in the Kinki region of Japan. The present findings should be considered during the development of policies and strategies to prevent the emergence and further spread of MBL-producing bacteria.

Anti-Bacterial Agents↗
PubMed1990

Medicare, Medicaid and CLIA programs; revision of the laboratory regulations for the Medicare, Medicaid, and Clinical Laboratories Improvement Act of 1967 programs--HCFA. Final rule with comment period.

This rule revises regulations for laboratories regulated under the Medicare, Medicaid and Clinical Laboratories Improvement Act of 1967 (CLIA '67) programs. The revisions recodify the regulations for these programs into a new part 493 in order to simplify administration and unify the health and safety requirements for all programs as much as possible. We will now have a single set of regulations for the three programs, with an additional subpart for the licensure procedures unique to the CLIA program. We are revising the regulations to remove outdated, obsolete and redundant requirements, make provision for new technologies and place increased reliance on outcome measures of performance. We provide for new uniform proficiency testing standards. We have also added requirements for additional specialties, such as clinical cytogenetics. We also implement the now and self-implementing provisions of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88).

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Ensuring universal access to quality laboratory services: CLMA White Paper. National Affairs Committee, Clinical Laboratory Management Association.

As part of its National Affairs Plan, approved in 1991, CLMA committed to publishing periodic position, or "white," papers to explore contemporary public policy issues in laboratory services administration. As CLMA's first white paper, this article is an in-depth analysis of the historical and economic background to today's clinical laboratory industry in the United States. It provides the logic and rationale behind CLMA's position statement on Health-Care Reform and the Clinical Laboratory. The statement has been formally adopted by consensus and has been widely circulated to both Congress and our membership. It will help form the policy basis for the development of the Association's legislative agenda on health-care reform. The principles are intended to be universal and apply not only to U.S. reform efforts at the national level, but also to states and other nations.

Chronology as Topic↗
PubMedDate not supplied

Clinical laboratory technician to clinical laboratory scientist articulation and distance learning.

Laboratory workers and educators alike are challenged to support access to education that is current and provides opportunities for career advancement in the work place. The clinical laboratory science (CLS) program at the Medical College of Georgia in Augusta developed a clinical laboratory technician (CLT) to CLS articulation option, expanded it through distance learning, and integrated computer based learning technology into the educational process over a four year period to address technician needs for access to education. Both positive and negative outcomes were realized through these efforts. Twenty-seven students entered the pilot articulation program, graduated, and took a CLS certification examination. Measured in terms of CLS certification, promotions, pay raises, and career advancement, the program described was a success. However, major problems were encountered related to the use of unfamiliar communication technology; administration of the program at distance sites; communication between educational institutions, students, and employers; and competition with CLT programs for internship sites. These problems must be addressed in future efforts to provide a successful distance learning program. Effective methods for meeting educational needs and career ladder expectations of CLTs and their employers are important to the overall quality and appeal of the profession. Educational technology that includes computer-aided instruction, multimedia, and telecommunications can provide powerful tools for education in general and CLT articulation in particular. Careful preparation and vigilant attention to reliable delivery methods as well as students' progress and outcomes is critical for an efficient, economically feasible, and educationally sound program.

Computer-Assisted Instruction↗
PubMedDate not supplied

Direct access testing in the clinical laboratory: should laboratories offer testing services directly to the consumer?

This article outlines the author's views on the many issues to consider if a laboratory plans to initiate a program to offer clinical laboratory testing directly to the public. Direct access testing and why is it important are discussed in detail. The regulatory issues are outlined with some alternatives for laboratories in states with restrictive regulations. To illustrate many of the operational issues to consider, the author describes the Personal Diagnostic Center (PDC) in Kansas City. Finally, some of the key business issues are mentioned, including several approaches to promote this type of testing program.

Clinical Laboratory Techniques↗
PubMed2003

[Educational program of clinical laboratory medicine to develop the ability to use proper laboratory examinations in medical practice].

A model core curriculum for medical education was proposed in 2001 as a guideline to standardize and improve the educational program in Japanese medical schools. Many subjects involved in clinical laboratory medicine were listed in this model core curriculum. Original and characteristic educational curricula in each medical school were also required in this guideline. In our university, we constructed the educational program of clinical laboratory medicine with lectures, clinical practice, and small group seminars including reversed CPC, according to the guideline. We need further trials to achieve the goal, i.e. education to develop the ability to use proper laboratory examinations in medical practice, as a good clinical doctor.

Clinical Laboratory Techniques↗
PubMed2006

Preanalytic indicators of laboratory performances and quality improvement of laboratory testing.

Laboratory diagnosis is traditionally a three-part process that develops within the preanalytic, analytic and post-analytic phases. There is consolidated evidence that lack of standardization and monitoring of preanalytic variables, including procedures for patient identification, sample collection, handling and processing has an adverse influence on the reliability of test results, consuming valuable healthcare resources and compromising the patient's outcome. The preanalytic phase enfolds the greatest potential for quality improvement, once reliable strategies are identified and applied. A comprehensive quality program should outstrip the traditional confines of clinical laboratories, encompassing reliable monitoring policies of the state of quality across the entire process. Such an approach requires the adoption of a reliable global quality monitoring system based on a core set of broad, evidence-based preanalytic performance measures. The present article synthesizes current evidence on this topic, defining a tentative approach for implementation of a preanalytic quality monitoring system in clinical laboratories.

Clinical Laboratory Information Systems↗
PubMed1991

Using the laboratory information system to achieve strategic advantage over the competitors of hospital-based clinical laboratories.

The competitors of hospital pathologists are commercial reference laboratories, hospital special function laboratories, pathology groups in neighboring hospitals, hospital mainframe computer personnel, and users of patient proximity testing systems. The laboratory information system can provide a strategic advantage over these competitors by matching, exceeding, or substituting for their capabilities and by creating switching costs for clinics, administrations, and patients. For example, the installation of microcomputers in clinicians' private offices provides them with ready access to the pathology data base, bonds them to the hospital, and capitalizes on the willingness of the hospital to invest in information technology.

Clinical Laboratory Information Systems↗
PubMed2003

Cancer incidence among laboratory workers in biomedical research and routine laboratories in Israel: Part II-nested case-control study.

BACKGROUND: A case-control study nested within a cohort study of biomedical laboratory workers was conducted to examine whether the excess cancer morbidity that we found can be explained by exposure to a particular group of substances, taking into consideration potential confounders. METHODS: The study population included 163 cases and two matched control groups: laboratory workers (311) and general population (448) workers. RESULTS: Multiple conditional regression analysis showed that working in research laboratories involved an increased risk of cancer generally among women [risk ratio 2.2 (1.2-4.3)], and of breast cancer particularly [risk ratio 2.3 (1.1-4.7). Seventy-six percent (76%) of breast, 87% of thyroid, 60% of ovary and prostate, 94% of melanoma, and 50% of leukemia cases were ever exposed to at least one known human carcinogen. CONCLUSION: Our results exclude the possibility that the excess cancer morbidity was related to personal risk factors but they may be explained by exposure factors. Am. J. Ind. Med. 44:611-626, 2003.

Adult↗
PubMed1985

The Laboratory Information System (LIS): I-Application to the clinical chemistry laboratory.

The Laboratory Information System (LIS) was designed as a "turn-key" system. The main functions are operated interactively on a mini-computer which gives the laboratory complete control over daily processing. Collection of results from automated analyzers is accomplished via a micro-computer/micro-processor network. Links are provided with a central main frame computer for immediate patient identification and historical data processing. LIS is designed to manage all the operations involved in laboratory activities. The system has 14 major functions: registration of test requests, production of specimen collection sheets and identification labels, confirmation of specimen collection, production of aliquot labels, workload inquiry, production of worksheets, manual entry of test results, automated entry of test results, results inquiry, preliminary report, final report, daily activities reports, statistical reports, billing. System security is provided along three directions: data entry validation, system access control, and memory protection. The main advantages of LIS are: reduced clerical work, better evaluation of workload, faster communication, improvement of information given to the clinician: adapted reference values, interpretation, comments, improved retrieval operations, faster billing.

Autoanalysis↗
PubMed1984

Prosthodontic laboratory and curriculum survey. Part III: Fixed prosthodontic laboratory survey.

A questionnaire was mailed to 488 dental laboratories in five midwestern states. One hundred ninety (39%) of the questionnaires were returned. The purposes of the survey were (1) to discern what fixed prosthodontic techniques were most frequently used by practicing dentists, (2) to provide insight into the laboratory technician's perception of the quality of fixed prosthodontic care, (3) to point out problems in dentist/technician interaction, and (4) to indicate areas of undergraduate fixed prosthodontic education that may need revision. Results indicate that dentists are using techniques that require a minimum of appointment time and are delegating a great portion of their responsibilities for fixed prosthodontic procedures to the laboratory technician. Dentist/technician interaction is a significant problem, and from the technician's point of view the quality of fixed prosthodontic care provided by the average practicing dentist is marginal at best.

Curriculum↗
PubMed1977

Chromosome aberrations and sister-chromatid exchange in workers in chemical laboratories and a rotoprinting factory and in children of women laboratory workers.

Cultured lymphocytes from 73 workers in chemical laboratories and the printing industry were found to have a significantly increased frequency of chromatid and isochromatid breaks, in comparison with 49 control subjects (42 adults and 7 children). An increase of the same magnitude was also found in 14 children, aged 4 days--11 yr, of 11 women laboratory workers who had worked during pregnancy. A significant correlation between age and frequency of chromosome aberrations was noted for both the exposed and control children but not for the adults. The frequency of sister-chromomatid exchange was significantly increased in 12 technicians working in laboratories performing hormone analysis. 4 children of 2 female technicians working during pregnancy also had a significnatly increased frequency of sister-chromatid exchange. The cause and biological significance of these findings are not yet known.

Adolescent↗
PubMed1993

Hamilton Health Sciences Laboratory Program: a provider developed model for hospital, university and community laboratory services.

Clinical Laboratory Sciences are under pressure to reduce the number of tests and cut staff and supply costs. The ability of academic centres to continue to deliver high quality service, teaching and research is threatened. In difficult economic times imaginative strategies are needed to look for solutions which will permit continued advancement in academic and clinical standards. Rationalization of service and cost-effective use of resources are not new concepts; however, there is a scarcity of models which have been developed and promoted by the providers of laboratory services, rather than those imposed by governments and other paying agencies. A model developed and evolved over the last two decades by The Hamilton Health Sciences Laboratory Program (HHSLP) is outlined.

Data Collection↗
PubMed1992

Laboratory assessment of feeding behavior in bulimia nervosa and healthy women: methods for developing a human-feeding laboratory.

We have designed a human-feeding laboratory to be used to study feeding behavior in patients with eating disorders. Twenty-one normal-weight bulimic subjects consumed 29.711 +/- 39.940 MJ (range 0.862-178.632 MJ; 7101 +/- 9546 kcal, range 206 to 42,694 kcal) in 24 h. In comparison, 11 healthy volunteer women, when instructed to eat ad lib for 48 h, ate 7.715 +/- 2.590 MJ (1844 +/- 619 kcal) during the first 24 h and 7665 +/- 1828 MJ (1832 +/- 437 kcal) during the second 24 h. Bulimics and control subjects had a similar number of eating intervals (6.6 +/- 2.6 vs 5.0 +/- 1.7); 72% of the bulimic subjects' meals were similar in size to the meals of the controls [167-4100 kJ (40-980 kcal)] but these meals were higher in carbohydrate and lower in fat in bulemic patients. Excessive caloric intake by bulimic subjects was because 28% of their meals were very large [range 4.427-28.150 MJ (1058-6728 kcal)]. Data gathered in a laboratory setting appears to be a reasonable replication of naturalistic feeding and suggest that such a laboratory may prove useful for future studies of feeding behaviors in humans.

Adult↗
PubMedDate not supplied

Series: infectious diseases and the office laboratory. Office laboratory diagnosis of sexually transmitted diseases.

The office laboratory can be a tremendous resource for the physician. This is particularly true in the evaluation of STD, where many simple procedures may provide at least a preliminary diagnosis. Instead of waiting for more expensive culture results, the physician can make the diagnosis of Candida, Trichomonas or Gardnerella in the female and N. gonorrhoeae in the male, while the patient is in the office. Cultures for N. gonorrhoeae can be, with the use of the Phadebact or newer enzymatic sugar tests, completed in the office. This, however, is not recommended for an office which performs this test infrequently, because quality control procedures and known positives and negatives which should be incorporated into these procedures are often neither practical nor readily available. The wrong diagnosis in the area of STD leads not only to medical mismanagement but also to tremendous emotional and personal trauma. A good working relationship with a referral laboratory will augment the care and services you and your office laboratory can offer to the patient.

Adolescent↗
PubMed1988

Performance of a solid phase enzyme immunoassay for detection of group A streptococci in a pediatric office laboratory as refereed by a hospital laboratory.

We evaluated the performance of a new rapid solid phase enzyme immunoassay, SUDS Group A Strep (MUREX Corp., Norcross, GA) for the detection of Group A beta-hemolytic streptococci in a pediatric office practice. Duplicate throat swabs were obtained from 341 children with pharyngitis. One swab was used in the SUDS test and the other was cultured in the office laboratory. Office SUDS and culture (sheep blood agar plate, aerobic 24-hour incubation) were compared with culture using reference techniques (sheep blood agar plate, anaerobic 48-hour incubation) in a hospital laboratory. Compared with hospital laboratory culture, the sensitivity of office SUDS (73.8%) was superior to that of office culture (66.6%) at P = 0.05. Specificities were 93.1 and 98.6%, respectively; positive predictive values were 86.1 and 96.6%; and negative predictive values were 85.9 and 83.5%. The sensitivity and specificity of SUDS compared with office culture were 88.5 and 87.8%, respectively, but would have been 93 and 94% had hemolyzed media not been used on several occasions in the office culture procedure. We conclude that SUDS Group A Strep was significantly more sensitive than throat cultures as performed in a typical pediatric practice although the performance of office cultures could have been improved by standard quality control techniques.

Bacteriological Techniques↗
PubMed1981

A computer-based laboratory record system in an endocrinology laboratory.

A computer-based system for maintaining cumulative laboratory result records is described. The system is also intended to help in the organisation of laboratory work schedules. The system has been in use for over a year and has proved to be successful in improving the service offered by the laboratory.

Computers↗