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PubMed1978

The diagnostic laboratory and its relationship to practitioners. Diagnostic laboratory professional staff.

Diagnostic services provided to practitioners include necropsy, histopathology, bacteriology, virology, parasitology, immunopathology, clinical pathology and toxicology. Services are also available at the college in avian and aquatic diseases. The laboratory expects to continually upgrade its services through the addition of appropriate tests, re-evaluation of existing tests, development of methods for more convenient specimen collection and shipment, increased responsiveness to veterinarians' needs, epidemiological investigations, and continuing education.

Animals↗
PubMed1994

Continuous improvement, quality control, and cost containment in clinical laboratory testing. Enhancement of physicians' laboratory-ordering practices.

In 1991, the University of Massachusetts Medical Center, in Worcester, developed a model for change by using a program of continuous quality improvement to enhance physicians' laboratory-ordering practices, particularly the test for bleeding times. We describe a model that was developed through a seven-step continuous quality improvement process, and we discuss our success in increasing the appropriateness of ordering the tests for bleeding times while significantly reducing the costs for patients and hospitals. The following factors contributed to the program's success: an advisory structure; presentations to the medical staff; focused feedback sessions; and most important, well-documented guidelines with institutional support for new behavior.

Clinical Laboratory Techniques↗
PubMed2001

Comparison of a virtual microscope laboratory to a regular microscope laboratory for teaching histology.

Emerging technology now exists to digitize a gigabyte of information from a glass slide, save it in a highly compressed file format, and deliver it over the web. By accessing these images with a standard web browser and viewer plug-in, a computer can emulate a real microscope and glass slide. Using this new technology, the immediate aims of our project were to digitize the glass slides from urinary tract, male genital, and endocrine units and implement them in the Spring 2000 Histology course at the University of Iowa, and to carry out a formative evaluation of the virtual slides of these three units in a side-by-side comparison with the regular microscope laboratory. The methods and results of this paper will describe the technology employed to create the virtual slides, and the formative evaluation carried out in the course. Anat Rec (New Anat) 265:10-14, 2001.

Computer-Assisted Instruction↗
PubMed1993

FRAR course on laboratory approaches to aging. Microbiological effects and quality control in laboratory rodents.

Numerous viruses, mycoplasmas, bacteria and parasites have been associated with infectious diseases in laboratory animals. It is clear that pathogenic agents causing overt disease represent a serious hazard to research results in both short- as well as long-term studies. However, these organisms may contaminate colonies without causing any clinical or pathological symptom. This makes research less reliable because of the more subtle effects of the silent infections, especially in long-term studies as in aging research. The establishment of animal colonies that were free from these (micro-) organisms has increased substantially the value of animals used in biomedical research. Characterization of the health status and microbiological monitoring of the animals in experiments are particularly important. This paper reviews many of the major considerations in the efforts to maintain animals free of unwanted organisms, including quality and sources of animals, transportation and quarantine, maintenance during experimentation, microbiological characterization and monitoring of animals and environment.

Animal Husbandry↗
PubMed2001

A simple and rapid laboratory method for determination of haemostasis potential in plasma. II. Modifications for use in routine laboratories and research work.

To offer a suitable method for use in routine laboratories and research work, some modifications were made in the assay of overall haemostatsis potential (OHP) we developed earlier. Thrombin in a decreased dose with or without tissue-type plasminogen activator was added to plasma for initiation of fibrinogen clotting. Areas under two fibrin-aggregation curves i.e., above-mentioned OHP and overall coagulation potential (OCP) were thus created. A difference between the two parameters reflects the overall fibrinolysis potential (OFP), calculated by ((OCP-OHP)/OCP) x 100%. To obtain reference ranges, investigations were performed in 142 healthy adults of different ages and in 29 healthy women with a normal pregnancy. In 16 patients suffering from coronary heart disease (CHD), OCPs and OHPs increased but OFPs decreased. In 10 pre-eclamptic women with moderate enhancement of OCP, the OHPs became noticeably higher in most while the OFPs lower. Extremely low or undetectable levels of OHP and OCP were shown in samples of Factors VIII-, IX-, VII-, V-, X- or II-deficient plasma. In 13 healthy volunteers treated with acetylsalicylic acid (ASA), OHPs expectedly declined during the administration and rose again after withdrawal. The above findings demonstrate that the modifications in the present study have rendered the method more effective for detecting haemostatic changes and relevant for monitoring treatments.

Adult↗
PubMed2004

Incorporation of microwave tissue processing into a routine pathology laboratory: impact on turnaround times and laboratory work patterns.

AIMS: To examine the impact of microwave (MW) tissue processing on turnaround times (TATs) in a routine diagnostic laboratory. METHODS: A retrospective review of TATs for tissue processing (specimen receipt to completion of H&E-stained section) and pathologists' report generation (receipt of stained section to validation of completed report) for small biopsies processed in a MW-histoprocessor (Milestone RHS-2, Italy) was performed and compared with similar TATs for specimens processed conventionally prior to the introduction of MW histoprocessing. RESULTS AND CONCLUSIONS: The TAT for conventional tissue processing was almost 21 h compared with 6.5 h by MW-processing. Reporting TATs fell from 4.3 to 3.2 hours per case, respectively, largely because stained sections became available for reporting in the early afternoon instead of towards the end of the working day. If small biopsies are triaged and handled separately, the TATs can be further reduced, and in selected urgent cases, sections can be available for diagnosis within 90 minutes. The quality of MW processed sections was indistinguishable from those obtained with routine 4-hour processing. The drastic reduction in TATs signifies a new era in histopathological diagnosis in which the majority of reports can be generated within 24 hours of specimen receipt with attendant impact on patient management and hospitalisation costs.

Biopsy↗
PubMed2001

Benefits of a joint nursing and laboratory point-of-care program: nursing and laboratory working together.

Critical care nurses contend daily with high pace, crisis-care, and dealing with patients, physicians, coworkers, and patients' family members. A point-of-care testing (POCT) program can assist with the quick decision making required of today's critical care nursing staff. By meshing the backgrounds of nursing and the central laboratory into one workable philosophy, POCT can ensure optimal patient care.

Critical Care↗
PubMed1997

Laboratory diagnosis of anaemia in dialysis patients: use of common laboratory tests.

Almost all patients with end-stage renal disease suffer from renal anaemia of multifactorial pathogenesis. The use of recombinant human erythropoietin to raise the haematocrit has been a major advance in the care of patients with end-stage renal disease. The majority of these patients develop absolute or functional iron deficiency. However, the diagnosis of iron deficiency is hindered by the inaccuracy of commonly used tests. Serum ferritin and transferrin saturations are frequently used, but limitations with both parameters in end-stage renal disease patients have resulted in the development of new tests to assess iron sufficiency. The percentage of hypochromic red blood cells and particularly reticulocyte haemoglobin content are new measures of iron status in end-stage renal disease patients. An enhanced knowledge of the interpretation of available laboratory parameters will ensure that the patients receive the full benefit from their treatment with recombinant human erythropoietin and iron.

Anemia↗
PubMed2001

Characterization of clinical isolates of Klebsiella pneumoniae from 19 laboratories using the National Committee for Clinical Laboratory Standards extended-spectrum beta-lactamase detection methods.

Extended-spectrum beta-lactamases (ESBLs) are enzymes found in gram-negative bacilli that mediate resistance to extended-spectrum cephalosporins and aztreonam. In 1999, the National Committee for Clinical Laboratory Standards (NCCLS) published methods for screening and confirming the presence of ESBLs in Klebsiella pneumoniae, Klebsiella oxytoca, and Escherichia coli. To evaluate the confirmation protocol, we tested 139 isolates of K. pneumoniae that were sent to Project ICARE (Intensive Care Antimicrobial Resistance Epidemiology) from 19 hospitals in 11 U.S. states. Each isolate met the NCCLS screening criteria for potential ESBL producers (ceftazidime [CAZ] or cefotaxime [CTX] MICs were > or =2 microg/ml for all isolates). Initially, 117 (84%) isolates demonstrated a clavulanic acid (CA) effect by disk diffusion (i.e., an increase in CAZ or CTX zone diameters of > or =5 mm in the presence of CA), and 114 (82%) demonstrated a CA effect by broth microdilution (reduction of CAZ or CTX MICs by > or =3 dilutions). For five isolates, a CA effect could not be determined initially by broth microdilution because of off-scale CAZ results. However, a CA effect was observed in two of these isolates by testing cefepime and cefepime plus CA. The cefoxitin MICs for 23 isolates that failed to show a CA effect by broth microdilution were > or =32 microg/ml, suggesting either the presence of an AmpC-type beta-lactamase or porin changes that could mask a CA effect. By isoelectric focusing (IEF), 7 of the 23 isolates contained a beta-lactamase with a pI of > or =8.3 suggestive of an AmpC-type beta-lactamase; 6 of the 7 isolates were shown by PCR to contain both ampC-type and bla(OXA) genes. The IEF profiles of the remaining 16 isolates showed a variety of beta-lactamase bands, all of which had pIs of < or =7.5. All 16 isolates were negative by PCR with multiple primer sets for ampC-type, bla(OXA), and bla(CTX-M) genes. In summary, 83.5% of the K. pneumoniae isolates that were identified initially as presumptive ESBL producers were positive for a CA effect, while 5.0% contained beta-lactamases that likely masked the CA effect. The remaining 11.5% of the isolates studied contained beta-lactamases that did not demonstrate a CA effect. An algorithm based on phenotypic analyses is suggested for evaluation of such isolates.

Algorithms↗
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↗
PubMedDate not supplied

CLMA position on laboratory direction. Clinical Laboratory Management Association.

In July 1991, CLMA's National Affairs Committee (NAC) developed a proposed position statement on the laboratory director standard. The proposed statement was submitted to the 24-member National Affairs Reactor Panel and, based on their input, appropriate revisions were made. In August 1991, CLMA surveyed the full membership, and, as a result, the following position was adopted. NAC members include Royal A. Crystal, Chair; Linda D. Bielitzki, J.D., Vice Chair; Michael G. Bissell, M.D., Ph.D.; Earl C. Buck; Michael A. Maffetone, D.A.; Timothy Murray; Laurence J. Peterson; Marianne C. Watters; and Martha A. Feichter, National Affairs Analyst.

Hospital Administrators↗
PubMed1992

Origin of the v. portae and variability of its tributaries in laboratory animals. VI. The laboratory mouse (Mus musculus var. alba).

The authors studied the origin and variability of the tributaries of the v. portae in 30 adult laboratory mice (Mus musculus var. alba) of both sexes, after first injecting the portal bed with bluedyed latex. In 19 cases (63.3%) the v. portae was formed by the union of three tributaries and in 11 cases (36.7%) by the union of four to eight. The v. mesenterica cranialis was a constant tributary in every case (100%). The v. lieanalis was a tributary in 27 cases (90.0%) and the next most frequent tributary was the v. pancreaticoduodenalis (14 cases--46.7%) A v. gastrica sinistra was found in every case (100.0%), in 24 cases (80.0%) it joined the v. lienalis and in the other six (20.0%) it was a direct tributary of the v. portae. A v. cardiaca was also observed in every case (100%). In 28 cases (93.3%) it was a tributary of the v. gastrica sinistra and in the remaining two (6.7%) it was a direct tributary of the v. portae. A v. pylorica was found in 27 mice (90.0%). Most often it was a tributary of the v. gastroepiploica dextra (11 cases--36.7%) or the v. gastrica sinistra (9 cases--30.0%). In only one case was it a direct tributary of the v. portae. A v. pancreaticoduodenalis cranialis was present in a total of 28 cases (93.3%). In 12 cases (40.0%) of already originated in the region of the cauda pancreatis and in 16 cases (53.3%) it arose only from the corpus and caput pancreatis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Bringing measurement and management science to the cath laboratory: the National Cardiovascular Data Registry (ACC-NCDR) and the Cardiac Catheterization Laboratory Continuous Quality Improvement Toolkit (ACC-CathKIT).

Diagnostic cardiac catheterization and percutaneous coronary interventions are widely performed for the evaluation and treatment of patients with cardiac disease. Because of high utilization, cost, and complication rates, invasive cardiac procedures are closely monitored and frequently measured using national benchmark databases and public reports. Before decision makers can accept these data and reports as accurate, it is necessary that the measurement process be performed correctly. However, collecting and measuring data is only the first step and does not automatically lead to improvements in quality. For an improvement to occur, a continuous quality improvement effort must exist to transform data into improved outcomes for patients. Recognizing the need to supply healthcare providers with methods and standards for measurement reporting and tools to assist facilities in the development of effective continuous quality improvement efforts, the American College of Cardiology developed the National Cardiovascular Data Registry (ACC-NCDR). Subsequently, the American College of Cardiology Foundation, in cooperation with the Society for Cardiovascular Angiography and Interventions, the American College of Cardiovascular Administrators, and several other professional organizations, developed the ACC-Cardiac Catheterization Laboratory Continuous Quality Improvement Toolkit (ACC-CathKIT). The development and usefulness of these products is described in this paper.

Cardiac Catheterization↗
PubMed1992

[Development of laboratory investigation methods in phthisio-pulmonology (summary of activities of the Central Research Institute of Tuberculosis, USSR Ministry of Health, during the twelfth 5-year plan of the laboratory section of the All-Union program 0.69.08)].

Comprehensive laboratory studies were performed to develop and introduce new techniques for examining patients with respiratory tuberculosis and some other pulmonary diseases. The techniques should improve and develop the immunologic and bacteriological diagnosis of tuberculosis, sarcoidosis, various exogenous allergic alveolitis and nonspecific inflammatory (microbial and mycotic) pulmonary diseases. Some of the methods were elaborated for morphological verification of sarcoidosis, alveolitis and rare pulmonary diseases. Radioimmuno-, enzyme immuno-, and other assays for the activity of various enzymes, as well as biochemical methods for assessing the superficial properties of individual cellular elements have found application in performing biochemical studies in pulmonary tuberculosis and non-specific diseases. Immunologic, bacteriological, cytologic and biochemical methods of study have been adjusted to examine the amount of bronchoalveolar washings in patients with different pulmonary diseases.

Alveolitis, Extrinsic Allergic↗
PubMed1990

Interpretation of pathophysiology by laboratory data (3). A consultation program based on clinical laboratory data.

Based on previous studies, a consultation program using clinical laboratory data has been constructed. After converting all data into the standard deviation index (SDI), the score for preregistered diseases was calculated by integrating products of SDI and the weighting factors (WF) pre-determined empirically by medical experts for each item. Ten diseases in order of their maximum scores, the most predictable ones, and additional comments were printed out. The principle of our consultation program is based on the modified Bayesian theory which employs, instead of probability a posteriori, weighting factors (WF) corresponding to the grade of membership in the "fuzzy set" concept. Evaluations based on this interpretation performed 2-3 times during the clinical course in nine patients were found to agree qualitatively with each clinical course and diagnosis. This report also contains 1) an outline of the progress of this consultation program in Japan and abroad, 2) the actual level of acceptance of this system by physicians, 3) and the characteristics and problems of our program. We are now planning to report a quantitative evaluation of this program using many cases in some specified field, instead of one case of each disease.

Clinical Laboratory Techniques↗