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PubMed1997

Simple devices and their possible application in clinical laboratory downsizing.

The pressure to contain medical costs prompted the development of sophisticated downsizing options for the clinical laboratory, such as automation, information systems, or miniaturization of analytical methods. Faced with an array of approaches to choose from, medical institutions have to select the method that can best serve their particular purposes and circumstances. However, the concept of downsizing needs to be revised and applied to the entire medical system. One way to reduce total medical expenditure would be to shift to near-patient or POC testing, through the adoption of simple devices for immunoassay based on immunochromatography. Recent advancements in the area of simple devices have suggested their possible application for emergency testing sites. This paper reviews the specific situation of Japan with respect to laboratory downsizing and market environment, and discusses the possible future applications of simple devices to near-patient or POC testing.

Clinical Laboratory Techniques↗
PubMed2004

Pseudobasophilia as an erroneous white blood cell differential count with a discrepancy between automated cell counters: report of two cases.

We report two cases that showed erroneous white blood cell differential counts by automated cell counters. Each case showed an interesting discrepancy of differential count between cell counters, and marked pseudobasophilia was observed by one of the two counters. The first patient was a 44-year-old female who suffered from multiple myeloma for more than one and a half years. Increased myeloma cells (43%) in peripheral blood were counted as basophils by the ADVIA 120, and as monocytes by SE-9000, respectively. The second patient was a 72-year-old female diagnosed as having chronic myelomonocytic leukemia. Dysgranulopoietic neutrophils (50%) and monocytes (31%) were increased in the peripheral blood. Dysgranulopoietic neutrophils were counted as basophils by STKS. In contrast, about half of the increased monocytes were counted as neutrophils by the ADVIA 120. These interesting findings highlight the importance of microscopic examination of the blood film in routine laboratory practice, and automated cell counters, especially for the hematologic patients, cannot completely substitute for it. These results also imply that at least some subpopulations with different membrane or cytoplasmic properties may exist even in the similarly classified cells.

Adult↗
PubMed2005

Emergence of KPC-possessing Klebsiella pneumoniae in Brooklyn, New York: epidemiology and recommendations for detection.

Among 257 isolates of Klebsiella pneumoniae collected in Brooklyn, NY, 24% were found to possess bla(KPC). Clinical microbiology laboratories that used automated broth microdilution systems reported 15% of the KPC-possessing isolates as susceptible to imipenem. The imipenem MIC was found to be markedly affected by the inoculum. For accurate detection of KPC-possessing K. pneumoniae, particular attention should be paid to proper inoculum preparation for broth-based susceptibility methods. In addition, using ertapenem or meropenem for class reporting of carbapenem susceptibility will improve detection.

Anti-Bacterial Agents↗
PubMed2000

Automated immature reticulocyte counts are early markers of engraftment following autologous PBSC transplantation in patients with lymphoma.

The traditional indicators of engraftment following PBSC transplantation (PBSCT) are the rising total WBC count and ANC. Reticulocytes may be an earlier indicator, since as reticulocytes mature, there is a gradual loss of cellular RNA, which can be measured using methylene blue and light scatter with an Abbott CD 3500 automated counter (Abbott Laboratories, Maidenhead, U.K.). Reticulocytes can be divided into three fluorescence ratios depending on the amount of light scatter generated, high, medium, and low. The most immature are the high fluorescence reticulocytes (HFR). Standard engraftment parameters together with HFR were measured in a homogeneous group of 25 patients with lymphoma after PBSCT using a standard conditioning protocol. An ANC of 0.5 x 10(9)/L was achieved after a median of 10 days (mean 11.2 days, range 9-22). The recovery of the HFR to 2% of the total reticulocytes was significantly shorter, with a median of 8 days (mean 7.5 days, range 6-10) (p < 0.0001). The values of HFR to 2% preceded the ANC of 0.5 x 10(9)/L in 24 of the 25 patients by a median of 3 days (mean 3.8 days, range 2-12 days). On this basis, it can be determined that in 96% of cases, engraftment was indicated earlier by HFR measurement. The HFR to 2% even preceded the ANC of 0.1 x 10(9)/L in 23 of the 25 patients, showing that engraftment was indicated earlier in 92% of patients. Immature reticulocytes appearing in peripheral blood can be reliably measured by automated cytometers, and HFR can, therefore, be used as an earlier indicator of engraftment following PBSCT. This information provides the opportunity for earlier cessation of antibiotics and growth factors and could lead to earlier discharge from hospital, with cost savings.

Adult↗
PubMed1985

Quality control of lipid measurements in epidemiological studies: the U.S. Air Force HEART program.

A special standardization and quality assurance program, similar to that created for the Lipid Research Clinics Program (LRC), was developed for the American Health Foundation Laboratory by the Centers for Disease Control (CDC) to assure the quality of lipid measurements in the U.S. Air Force Health Evaluation and Risk Tabulation (HEART) Program. This study was designed to test the feasibility of reducing the incidence of heart disease in active-duty U.S. Air Force personnel through life-study intervention. During the 18-month study, CDC provided serum calibrators and reference materials for internal control and an external surveillance program for measurements of total cholesterol (TC) and high-density-lipoprotein cholesterol (HDLC). The Laboratory, using an automated enzymic method to measure cholesterol, achieved an overall goal for accuracy of less than 2% error (av systematic error, -30.6 mg/L) for TC, as measured on nine reference pools for which values were assigned by CDC. The average bias of measurements of HDLC with heparin-manganese to separate the lipoproteins in five CDC reference pools was -4.6 mg/L. Bias was estimated relative to the values assigned to the reference materials by the CDC reference methods for TC and HDLC. The average CV for TC was 0.89%, for HDLC 2.66%. Accuracy of cholesterol measurements can be assured over time with a standardization and quality-assurance program that incorporates accurately labeled reference materials for calibration, internal quality control, and external surveillance.

Cholesterol↗
PubMed1985

[From automation to robotics].

The introduction of automation into the laboratory of biology seems to be unavoidable. But at which cost, if it is necessary to purchase a new machine for every new application? Fortunately the same image processing techniques, belonging to a theoretic framework called Mathematical Morphology, may be used in visual inspection tasks, both in car industry and in the biology lab. Since the market for industrial robotics applications is much higher than the market of biomedical applications, the price of image processing devices drops, and becomes sometimes less than the price of a complete microscope equipment. The power of the image processing methods of Mathematical Morphology will be illustrated by various examples, as automatic silver grain counting in autoradiography, determination of HLA genotype, electrophoretic gels analysis, automatic screening of cervical smears... Thus several heterogeneous applications may share the same image processing device, provided there is a separate and devoted work station for each of them.

Automation↗
PubMed2006

[Endemic tendencies and bacterial resistance markers in third-level hospitals in Bogotá, Colombia].

OBJECTIVE: Determining antimicrobial resistance profiles and endemic channels in 14 third-level hospitals. METHODS: A high complexity hospital network was created between 2001 and 2003 in Bogotá, Colombia, comprising 14 hospitals belonging to the Bogotá Bacterial Resistance Control Group (BBRCG) and a database was established from participating institutions' microbiology laboratory data (using automated and manual methods) using BacLink 2.0 and Whonet 5.3. Isolate susceptibility profiles were determined according to NCCLS (2003). A descriptive analysis was made of the different resistance markers and such resistance's endemic channel was determined for all hospitals using a 25% to 75% range for every month during the study period. RESULTS: 84,664 isolates were analysed, the most frequently found being Escherichia coli, Staphylococcus aureus, coagulase negative Staphylococcus, Klebsiella pneumoniae and Pseudomonas aeruginosa. S. aureus resistance to oxacillin in 2001, 2002 and 2003 was 41%, 48% and 48%, respectively, Staphylococcus coagulasa negative resistance to oxacillin 75%, 73% and 72%, E. faecium resistance to vancomycin was 14%, 9%, 3%, K. pneumoniae resistance to third-generation cephalosporins 37%, 25% and 23%, P. aeruginosa resistance to imipenem 24%, 22% and 17%, P. aeruginosa resistance to ciprofloxacin 46%, 46% and 35% and A. baumannii resistance to imipenem 11%, 29% and 39%, respectively. The problem of bacterial resistance became evident in the endemic channels; this was centred on the presence of oxacillin-resistant S. aureus and a marked increase in A. baumanni resistance to imipenem. CONCLUSIONS: High resistance levels were observed in epidemiologic impact markers, especially in Intensive Care Units.

Bacterial Infections↗
PubMed1977

Comparison between the automated reagin test and reagin screen test methods of VDRL screening tests for syphilis in use in a routine laboratory.

A comparison is made between the automated reagin test (ART) using Technicon AutoAnalyzer equipment and the reagin screen test (RST) introduced by Lederle using a new antigen formulation. Treponemal haemagglutination tests (TPHA) were done simultaneously as second screen tests. The absorbed fluorescent treponemal antibody test (FTA-ABS) was used in all seropositive cases. Altogether 1154 sera were tested; 1028 were negative with all tests, 66 were positive with all tests, 42 were positive with TPHA and negative with ART and RST, and 16 were positive with TPHA and RST and negative with ART. It was concluded that the use of the RST and TPHA together would be the more sensitive screen test.

Antibodies, Bacterial↗
PubMedDate not supplied

Automated techniques in haematology.

BACKGROUND: Manual techniques have been mostly in use in developing countries until recently because of its low cost even though it is laborious. Many laboratories are however changing to automated techniques since many samples can be analysed within a short time. It is likely that more laboratories will use these instruments either as semi automated or fully automated multichannel instruments. There is therefore a need for laboratories to become more responsive to the needs of physicians making request by providing help in the presentation and interpretation of results. METHOD: Available literature on automation in Haematology was sourced for using both manual library search and Medline search. RESULTS: Quality control in automated blood cell counts and related topics are extensively researched but there is still dearth of knowledge on automation in other areas of Haematology and on the clinical implications of automation. CONCLUSION: It is therefore necessary to make provision for automated facilities in laboratories in view of the high precision and cost effectiveness of these machines. This review is geared towards a critical look at this technology and its application to disease states.

Autoanalysis↗
PubMed1991

Acquiring a laboratory computer system. Understanding the issues.

This article reviews the issues involved in introducing or upgrading computer automation in the clinical laboratory. The strengths and weaknesses of computers and computer systems are discussed. Information on selecting and educating the laboratory team who will use the computer and analyzing the needs of a particular laboratory is included.

Clinical Laboratory Information Systems↗
PubMed1996

Integrating instruments and the laboratory information system.

Significant progress has been made over the last 30 years in the interfacing of automated analytical instruments with laboratory information systems (LIS). Much of the progress has resulted from technology advances in microelectronics, improvements in information systems, implementation of bar code recognition in instruments, and better communications between instrument vendors, LIS vendors, and users. Further improvements, however, should be possible through a more consistent user interface(s), better integration into the laboratory work-flow, and interfaces that allow the LIS to query instruments regarding their internal operating status. These improvements are needed to extract improvements in productivity that are expected from the laboratory.

Clinical Laboratory Information Systems↗
PubMed2000

A simple procedure for the preparation of fritless columns by entrapping conventional high performance liquid chromatography sorbents.

A rapid and direct method for immobilizing conventional high performance liquid chromatography (HPLC) packing material inside fritless capillaries has been developed. Due to the simple composition of the entrapment matrix (tetraethoxysilane, alkyltriethoxysilane, ethanol and water), straightforward manufacturing procedure and modest equipment requirement, the method can readily be transferred to any laboratory and easily automated. The entrapment procedure has minimal influence on the structure and chromatographic properties of the original reverse-phase sorbent. Various immobilization solutions have been tested, and a comparison between columns entrapped with different immobilization mixtures and conventional packed capillaries is presented. High efficiency separations were obtained using tert-butyl-triethoxysilane entrapped columns in both capillary electrochromatography (reduced plate heights of 1.1-1.4 were measured) and microliquid chromatography (reduced plate heights of 2.2-2.6 were observed) formats. Elimination of frits, stabilization of the packed bed and on-the-fly customization of column length render mechanically robust columns that are remarkably stable over time, from which manufacturing imperfections can be removed easily.

Capillary Action↗
PubMed1984

Functional evaluation of total knee replacement.

The assessment of patients following prosthetic knee replacement suffers from a lack of objective criteria. An automated method of laboratory assessment that permits the objective evaluation of knee joint function is described. Nine biomechanical parameters were statistically selected, weighted, and combined to develop a Performance Index (Ip). One hundred ninety-two patients (274 diseased knees) were studied prior to total knee replacement surgery, with 107 patients (138 knees) returning for a 1-year postoperative study. Preoperative rheumatoid knees were found to have significantly poorer function than those involved with degenerative disease. Overall, the patients experienced a marked improvement 1 year post-total knee replacement (TKR), with their functional scores approaching the lower limits of normal. Prostheses were assessed according to generic classes as well as specific design types. The newer generation devices were found to produce better functional results. In the patients receiving Anametric and Total Condylar total knee devices, a patellar resurfacing component was found to produce improved knee function in comparison with patients receiving the same prosthesis but without patellar resurfacing.

Adult↗
PubMed2004

Increasing the efficiency of pharmacokinetic sample procurement, preparation and analysis by liquid chromatography/tandem mass spectrometry.

The movement towards a 96-well format has greatly increased productivity and throughput in bioanalytical laboratories. Improvements in automated sample preparation and analytical methods have further contributed to increased productivity. We have focused on sample collection and transfer to the bioanalyst and have found improvements to the current available methods. The problem of manual transfers and plasma clotting issues can be overcome with the use of microtainers. Specifically, for illustrative purposes, three proprietary Theravance compounds were tested for stability, non-specific binding, and electrospray ion suppression in microtainers. There were no issues with stability, non-specific binding or ion suppression for the above compounds even after leaving plasma samples in the microtainers over long periods of time. The microtainers are robot-compatible and the resulting plasma can be transferred without clotting issues. To date, all in-house compounds successfully analyzed and tested using the microtainers have mass ranges between 200 and 1800 Da, pK(a) ranges between 3.8 and 10.3, and logD ranges between -1.7 and 4.2. Once samples are transferred into 96-well plates, flexibility in preparation and analysis is available. Together with automated sample preparation and the use of liquid chromatography/tandem mass spectrometry (LC/MS/MS) as an analytical tool, the use of microtainers as sample collection tubes and for sample storage saved considerable time, cost and effort in both of our pharmacokinetic (PK) and bioanalytical groups. This in turn has led to an increased efficiency and overall throughput in support of our drug discovery effort.

Animals↗