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PubMed1992

Self-administration of cocaine by humans: a laboratory perspective.

Laboratory research evaluating the behavioural and physiological effects of cocaine has produced important basic information relevant to the prediction and control of cocaine abuse. Adaptation for human subjects of laboratory procedures originally developed with non-humans has provided the methodology for assessing the relationship between cocaine-taking and the self-reported effects of cocaine. This laboratory model for evaluating drug-taking has been adapted to include all the routes of administration by which cocaine is abused. Data collected in cocaine choice/self-administration studies indicate that there is a generally good correlation between cocaine self-administration and its stimulant-like 'positive' effects. There are, however, areas in which these two measures clearly diverge, and drug self-administration procedures provide a sensitive measure of cocaine's effects when it is taken by the routes and in the patterns people use outside the laboratory. Combining these measures with other behavioural evaluations provides useful information for understanding cocaine use and abuse. In addition, and importantly, these laboratory procedures are useful tools in the development and assessment of treatment interventions which might be used effectively.

Choice Behavior↗
PubMed1996

Implementation of internal laboratory quality control procedures for the monitoring of ELISA performance at a regional veterinary laboratory.

Quality control (QC) procedures for antigen detection enzyme-linked immunosorbent assays (ELISAs) for hog cholera (HC) virus, foot and mouth disease (FMD) virus, and an antibody detection ELISA for FMD virus were established at a regional veterinary laboratory in northern Thailand. A recently developed computer software package, QCEL, was used to facilitate management and analysis of QC data. The program was used to assess test performance by producing Shewhart-CUSUM control charts which monitored control data for unacceptable fluctuations or trends. QCEL-generated control charts and analyses are presented and discussed. The use of a simple integrated computerised system for storage and analysis of QC control data provided the laboratory with the opportunity to achieve increased confidence in the results of tests performed.

Animals↗
PubMed2003

Hormonal monitoring of ovarian activity using the Ovarian Monitor, part I. Validation of home and laboratory results obtained during ovulatory cycles by comparison with radioimmunoassay.

A study was conducted to determine the accuracy and reliability of the Home Ovarian Monitor for measuring estrone glucuronide (E1G) and pregnanediol glucuronide (PdG) during ovulatory cycles as a means of monitoring ovarian activity. Approximately 60 ovulating women in three centres collected timed specimens of urine (3h or more) for a total of six cycles each. The women measured the E1G and PdG excretion per 24h in their urine specimens using the Monitor. A local laboratory using the Monitor also measured the excretion. Urine specimens from 18 to 19 cycles were sent frozen to the WHO Reference Laboratory in London where they were analysed for E1G and PdG by the Monitor and by radioimmunoassay (RIA). The correlation coefficients between the Monitor and radioimmunoassay results obtained in London were better than 0.84 in 80% of the cycles. A urine bias caused the Monitor E1G results to be higher than those obtained by radioimmunoassay but the daily patterns were the same. In 50% of the cycles, this bias caused a delay of up to 3 days in identifying the beginning of the E1G rise compared with radioimmunoassay. Timing of the preovulatory E1G peak and the postovulatory PdG rise agreed within the experimental errors of the two systems. The study confirmed that women using the Monitor at home obtained results that were as accurate as those obtained by laboratory procedures. Careful supervision was required to maintain laboratory levels of quality control and interpretation of results.

Adult↗
PubMed1983

Laboratory diagnosis of cystic fibrosis.

The demonstration of abnormally high concentrations of electrolytes in eccrine sweat is still the only practical laboratory procedure available for diagnosis of cystic fibrosis. Properly performed, the sweat test is very reliable, but there are many published reports that all of the methods in current use frequently generate incorrect diagnoses. Analysis of potential for error in sweat test methods shows that of the three essential phases involved, stimulation, collection, and analysis, the major cause of intrinsic inaccuracy occurs in the collection process. In this case the problem is due to condensate formation, which leads to the subsequent analysis of nonrepresentative sweat. Human error is also an important cause of false results and is a direct function of the number of critical manual operations involved in the technic. This review provides a critical examination of sweat test methods, identifying problem areas and suggesting ways to improve procedures in the interests of clinically reliable laboratory data in support of diagnosis.

Adolescent↗
PubMed2004

Cell processing: current status and future directions.

Specialized clinical cell processing began in the Department of Transfusion Medicine at the National Institutes of Health in 1984. The number and complexity of procedures performed increased quickly and in 1997 a highly specialized cell processing laboratory was opened. The laboratory has approximately 3,000 square feet, specialized air handing, a highly trained staff, and written laboratory procedures. In addition to standard laboratory equipment, the laboratory has numerous cell isolation instruments, flow cytometers, and automated cell counting instruments. The laboratory supports blood and bone marrow transplant protocols by isolating CD34+ stem cells, removing T lymphocytes, culturing lymphocytes to eliminate donor lymphocytes that are reactive with recipient alloantigens, and stimulating lymphocytes to induce Th2 type cells to reduce graft versus host disease. The laboratory has also been preparing dendritic cells to support protocols using immune therapy to treat cancer. In addition, pancreatic islet cells are isolated from organ donors for transplantation to treat type I diabetes mellitus.

Antigens, CD34↗
PubMed2001

Therapeutic biomechanics concepts and clinical procedures to reduce implant loading. Part II: therapeutic differential loading.

Practical laboratory procedures were suggested in order to provide a modified occlusal anatomy to reduce implant loading. The concept of differential mobility caused by the flexion between a natural tooth/periodontal ligament interface with its supporting bone, compared with the stiffness of the implant/bone interface, was described. When individual tooth-supported and implant-supported prostheses coexist in the same arch, this differential mobility can shift the loading disproportionately from the natural teeth to the implants. A new concept of therapeutic differential loading is introduced and a clinical technique of differential occlusal adjustment is described to bring about a more favorable distribution of loading to all the supporting bone. Long-term natural tooth intrusion can cause implant overload. Therefore, it is suggested that periodic differential occlusal adjustment procedures be used to re-establish a long-term balance of loading between individual implant- and tooth-supported prostheses within the same arch.

Biomechanical Phenomena↗
PubMed1986

[Anesthesia for surgery of insulinoma].

The difficulties of interpretation of blood sugar level changes during the postoperative period in the anaesthetic management of insulinoma are discussed. Several specific means reduced the errors in the assessment of the hyperglycemic rebound which occurred after the removal of the tumour. They consisted of continuous sugar infusion accorded to measured glucose levels, in order to maintain a constant blood sugar value between 50 and 70 mg X 100 ml-1 before removal of the insulinoma. Furthermore, analgesia was provided by high doses fentanyl. Sugar containing solutes were avoided during the procedure. Glucose levels rose slowly after tumour removal and reached 170 mg X 100 ml-1 at 120 min. This rebound was known to be of no help in ascertaining complete resection. Simultaneous determinations of blood glucose and insulin were obtained. The value of portal blood insulin was found to be normal (12.3 mU X l-1) 30 min after insulinoma removal. Turner's index calculated every 30 min decreased simultaneously (143) and reached a normal value at 120 min (39). These results, obtained during the surgical procedure all the more easily because of rapid laboratory procedures, could be better arguments in determining whether tumour removal has been complete.

Adenoma, Islet Cell↗
PubMed2004

The professions of dentistry and dental laboratory technology: improving the interface.

BACKGROUND: Dentistry's mission to provide rehabilitation services to patients who experienced dental disease is being jeopardized through the continual reduction of critical to quality skills and knowledge in dental laboratory technology being offered in dental and dental laboratory technician education. These reductions are creating a shortage of knowledgeable dentists and dental laboratory technicians who will be needed to address the projected public demand for laboratory-fabricated tooth replacements and restorations. METHODS: Demographic trend analysis supports a hypothesis that without immediate action by dentistry, substantial patient needs will not be met owing to inadequate levels of dental laboratory support for general dentists. RESULTS: The sophistication of laboratory-based rehabilitative and elective therapies demand closer cooperation between dentists and dental laboratory technologists. CONCLUSIONS: Dentistry must not abdicate its responsibilities in dental technology as it pursues a path away from rehabilitation services toward a projected future of prevention services. With decreasing educational exposure and training in dental laboratory procedures, dentists will have difficulty participating with dental laboratory technologists to fabricate laboratory-based rehabilitative and elective therapies. Without significant guidance from dental professionals in establishing laboratory standards in both education and practice, proprietary interests and commercial biases may set the laboratory and clinical standards of the future. CLINICAL IMPLICATIONS: Dentists will have limited experience or background to evaluate the dental laboratory technology offered in the marketplace and will be subject to the marketing of the industry. A shortage of educationally trained dental laboratory technologists will create a clinical and an economic burden on both dentists and patients.

Dental Technicians↗
PubMed2003

Obtaining a clinical laboratory science degree via distance technology.

OBJECTIVE: To identify institutions and program officials associated with clinical laboratory science (CLS) academic programs available via distance technology; to collect and summarize data from these programs with regard to on-line instructional methodologies; to determine the level of success of educational strategies and methodologies utilized in on-line CLS programs; to determine the feasibility of developing an on-line program at Seward County Community College (SCCC), Liberal, Kansas. DESIGN: An on-line CLS program survey tool was sent to eight higher education institutions which had previously indicated that they offer a CLS academic program at the associate, bachelor, or master level via distance technology. Program officials were asked to answer questions pertaining to areas such as program format, on-line admission requirements, program costs, student costs, faculty workload, and on-campus versus on-line student performance. SETTING AND PARTICIPANTS: The survey was sent to eight program officials who identified their institutions as having a CLS program available through distance technology. MAIN OUTCOME MEASURES: Responses from current distance technology CLS program officials were collected and tallied. Responses were recorded as 'yes' or 'no' in categories such as program format, program and student costs, and comparison of on-campus versus on-line student performance. The two groups of students were compared in areas of success rate, retention rate, graduation rate, external certification pass rate, employment placement rate, and employer satisfaction level. RESULTS: The response rate for the survey was 87.5% (7/8). Program officials indicated that various educational methodologies were incorporated in providing CLS education via distance technology. All of the respondents utilize some type of Web-enhanced, Internet based access to deliver course material. Clinical laboratory procedures are taught via instruction within a cooperative laboratory, program clinical affiliate laboratory, or during on-campus student laboratories. Program officials indicated that student enrollment has increased due to the availability of the distance technology. Students enrolled via distance technology perform as well or better than the on-campus students on certification exams and in the clinical setting. Data from these institutions indicate that it is feasible to develop an on-line program at SCCC in an effort to increase student enrollment. CONCLUSION: The results indicate that CLS programs which offer the curriculum via distance technology have experienced increased student enrollment thus graduating more students to fill the employment needs. These current distance technology programs are leading the future trends in CLS education of the 21st century.

Clinical Laboratory Techniques↗
PubMed1978

Laboratory standardizatin in an international study: the Kaunas--Rotterdam intervention study (KRIS).

Laboratory results obtained in different laboratories over lengthy periods of time usually are difficult to compare. In cooperative long-term studies where such results must be pooled, thorough standardization of methods is vital. We describe a program in which comparable plasma cholesterol and glucose analyses have been obtained, by simple methods. In the Netherlands and the Soviet Union in close collaboration with the Center for Disease Control, Atlanta, Ga., U.S.A. The two laboratories produced glucose values (direct o-toluidine reaction) within 2% of the target reference values and cholesterol results (direct Liebermann-Burchard reaction) with a consistent 6-8% positive bias over the reference method values. Intralaboratory precision was subject to preset acceptance limits. The use of common control materials, exchange of patient samples, and on-site comparison of all details of laboratory procedures are vital tools in standardization efforts. A laboratory protocol that included quality requirements and rejection criteria was developed and proved to be indispensable. The experience gained should be useful in standardizing inter-laboratory results in similar studies.

Blood Glucose↗
PubMed2006

Fads and foibles in ART: where is the evidence?

This commentary on the scientific basis of laboratory procedures in assisted conception discusses the origins of widespread discrepancies in 'standard' laboratory techniques experienced by patients and their embryos. The lack of direct evidence from clinical laboratory trials and the reasons for this will be highlighted using some examples drawn mainly from embryo culture. Inconsistencies and grey areas in the governance framework of this unique field could usefully be eliminated and attention focused on the need for a rational approach to procedural trials and pilot studies necessarily conducted in clinical laboratories. This may help progress towards a consensus on fundamental questions for which the evidence is currently lacking.

Clinical Trials as Topic↗
PubMed1985

Custom-made denture teeth and denture base material for removable partial dentures.

A method that uses Isosit material to fabricate custom-made denture teeth and denture base has been described. The advantages of this technique are the denture teeth can be made to function in harmony with dynamics of the stomatognathic system; any type of occlusal scheme can be used; the material is esthetically pleasing; it can be characterized; it can be used as a denture base material, which can also be characterized; it can be repaired, relined, or rebased with little difficulty; and laboratory procedures can be accomplished in the dental office or laboratory.

Acrylic Resins↗
PubMed1997

Maintenance of hemostasis after invasive cardiac procedures: implications for outpatient catheterization.

OBJECTIVES: This study investigated the efficacy of four different methods of arterial puncture site management during recovery from invasive cardiac procedures. The primary goals were less patient discomfort and improved clinical outcome. BACKGROUND: The increasing use of outpatient catheterization, large interventional devices and potent periprocedural anticoagulation regimens has made the reduction of groin complications a high priority. Despite these trends, there are no randomized trials comparing commonly used techniques in treating the catheter entry site for the first few hours after the procedure. METHODS: Four-hundred consecutive patients undergoing catheterization laboratory procedures were randomly assigned to one of four dressing techniques applied after achieving hemostasis: a sandbag placed over the site; a pressure dressing constructed from surgical gauze and elastic tape; a commercially available compression device; and no use of compressive dressing. Of these 400 patients, 171 would have been eligible for outpatient procedures in the absence of geographic constraints. The dressings were removed, and ambulation was encouraged 5 h after sheath removal. Uniform initial compression times, patient instructions, nursing follow-up and a structured interview and physical examination at 24 h were used. RESULTS: The level of patient discomfort before and after dressing removal, as well as site tenderness at 24-h follow-up, was statistically similar in all four groups. Hematomas (typically small) and areas of ecchymosis were observed in 58 and 122 patients, respectively, but both their frequency and size were equally represented in each group. Important adverse events were confined to bleeding, rated as mild in 5.8%, moderate in 0.8% and severe in 0.6% of patients. Again, all four groups were statistically similar. Comparable findings were observed in the subgroup of patients eligible for outpatient procedures. CONCLUSIONS: Despite an increase in inconvenience and expense, none of the three compression techniques that were investigated improved patient satisfaction or outcome. Therefore, the routine use of compression dressings after invasive cardiac procedures cannot be recommended.

Cardiac Catheterization↗
PubMed2005

Changing needs, opportunities and constraints for the 21st century microbiology laboratory.

Clinical microbiologists and microbiology laboratories are experiencing changes due to evolving views on 'healthcare delivery' as an economic activity, due to changes in the medical environment and the demographics of the workforce, and technical evolution. Cost-effectiveness of laboratory procedures has been achieved through consolidation and integration of laboratories. Consolidation offers economy of scale and reduction in numbers of on-site staff, but also leads to separation of microbiologists from their clinical colleagues. Integration puts different laboratory disciplines under a single management, and leads to reorganisation of laboratories along common work-lines. Cost-savings combined with on-site availability of laboratories are achieved at the expense of a reduction in the influence of microbiologists in the daily running of the laboratory. Medically, there is growing emphasis on evidence-based diagnostics. Because of time-delays inherent in culturing, microbiology through rapid testing is mandatory. There is an increasing shortage in Europe and the USA of trained microbiology laboratory technicians and microbiologists. This reinforces the trend towards more automation and integration. Technological advances, particularly in molecular diagnostics, offer the possibility of rapid reporting and improvement of the impact of clinical microbiology on patient management. Molecular tests, however, fit perfectly the concept of an integrated laboratory and may further loosen the link between microbiologist and microbiology tests. The challenge for clinical microbiology will be to use new techniques to improve its cost-effectiveness and impact on infectious disease management. The future organisation of microbiology laboratories must support this but is itself of secondary importance. The training of future microbiologist must prepare them for this changing environment.

Communicable Disease Control↗
PubMed2002

Satisfaction on outpatient services in hospitals of the Amhara Region.

A cross sectional survey was conducted to assess patients' satisfaction on outpatient services in the hospitals of the Amara Region. A total of 898 patients from nine hospitals were interviewed on exit. The majority (95.9%) had come due to illness, and of which, 53.2% had illnesses that lasted for more than 30 days. Among those who were sick, 47.5% were non-paying (free) patients. Long waiting hours during registration, visiting of doctors after registration, laboratory procedures, and revisiting of the doctors for evaluation with laboratory results and obtaining drugs from pharmacies were associated with dissatisfaction. When logistic regression was applied, waiting time for registration, physician consultation/examination, obtaining the prescribed drugs from the pharmacies, and overall time taken to receive prescriptions were associated with dissatisfaction. Among the sociodemographic factors, age was associated with dissatisfaction. More than one-third of the patients did not get the medications prescribed in the hospital pharmacies. Failure to find the prescribed drugs was associated with dissatisfaction. Unnecessary patient delays should be reduced to the minimum by assessing hospitals' processes. Ensuring drug supply with facilitated administrative processes is recommended.

Adolescent↗
PubMed1990

Automated differentials in the hematology laboratory.

The white blood cell differential continues to be one of the most widely performed clinical laboratory procedures. However, its clinical usefulness is affected by sampling error and, to some extent, by classification criteria. It is also labor intensive and expensive to perform. Automated leukocyte differential instrumentation addresses many of the sources of error that occur with the manual differential. Current state-of-the-art instrumentation will give results that equal or exceed the routine manual differential. Because these instruments also examine red blood cell and platelet parameters, as well as providing white blood cell information, they can better screen for significant abnormalities as well as greatly reduce the expensive and time-consuming manual differential procedures.

Automation↗
PubMed1995

Advances in urological laparoscopy.

PURPOSE: Since its introduction 5 years ago, almost all open urological procedures have been performed laparoscopically. We provide an in-depth critical review. MATERIALS AND METHODS: More than 200 articles on laparoscopic urology were reviewed. All laparoscopic procedures were divided into clinically established, clinically anecdotal and laboratory procedures. Comparisons between the laparoscopic and open method were carefully analyzed. RESULTS: There were 5 clinically established procedures identified. In general, the laparoscopic procedures were as efficacious but less morbid and required less convalescence than their open counterparts; however, none was less costly. CONCLUSIONS: Despite the time-consuming and costly nature of laparoscopy, the decreased morbidity and brief convalescence that are the hallmarks of minimally invasive surgery are evident and well documented. Further dissemination of laparoscopic skills through postgraduate urology training programs and during urology residency is of the utmost importance.

Cystectomy↗
PubMed1982

Professional review of laboratory utilization.

Overutilization of laboratory procedures is a significant problem, particularly in teaching institutions. The purpose of this study was to assess laboratory utilization patterns on the medical service of a university hospital, comparing data from implicit peer review by a pathologist with those from a group of practicing primary care physicians. Also, utilization of the most frequently ordered laboratory tests was compared with that of less common procedures. For charts reviewed both by the pathologist and by a panel of primary physicians, the pathologist found 26.5 per cent of tests unnecessary, while the primary physicians found 42.8 per cent unnecessary. The ten most frequently ordered tests had a significantly higher rate of overutilization than all other tests. Attempts to modify physicians' laboratory utilization should include concomitant peer review of the most commonly ordered procedures.

Clinical Laboratory Techniques↗