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PubMed1994

Automated processing of endoscopic surgical instruments.

This paper deals with the requirements for automated processing of endoscopic surgical instruments. After a brief analysis of the current problems, solutions are discussed. Test-procedures have been developed to validate the automated processing, so that the cleaning results are guaranteed and reproducable. Also a device for testing and cleaning was designed together with Netzsch Newamatic and PCI, called TC-MIC, to automate processing and reduce manual work.

Automation↗
PubMed1994

Experience of an academic reference laboratory using automation for analysis of cystic fibrosis mutations.

OBJECTIVE: To examine the use of partial automation for molecular analysis of cystic fibrosis and to evaluate the diagnostic experience gained. DESIGN: Twenty-four cystic fibrosis mutations, with cumulative mutation detection of 89% in North American whites and of 97% in the Ashkenazim, were tested by multiplex amplification and allele-specific oligonucleotide hybridization. SETTING: A university-based DNA diagnostic laboratory. SUBJECTS: More than 700 serial specimens were analyzed for cystic fibrosis mutations over a 5-month period. The study included 377 individuals tested for carrier status, of which 288 had no family history for cystic fibrosis; prenatal diagnosis for 17 fetuses at a one in four risk and eight pregnancies at lower risk; fetal or parental samples for 33 pregnancies with fetal ultrasound abnormalities; 40 individuals diagnosed with cystic fibrosis; and 87 individuals with a possible diagnosis of the disease. RESULTS: Automation has permitted increasing numbers of mutations while decreasing personnel time and cost. Mutation testing identified 10 carriers with no family history for cystic fibrosis, four couples at a one in four risk, and five affected fetuses, one ascertained by abnormal fetal ultrasound. Mutation analysis also identified two mutant copies of the gene in 26 of 40 individuals with a clinical diagnosis of cystic fibrosis, and in two of 87 patients with possible cystic fibrosis. CONCLUSION: This partially automated, direct mutation analysis provides DNA diagnostic laboratories with the capacity to process a larger number of samples at lower cost with greater sensitivity for mutation detection. As pilot screening programs are reported, it is appropriate to reevaluate recommendations regarding population-based carrier screening for cystic fibrosis.

Automation↗
PubMed1993

Automated sample preparation by on-line dialysis and trace enrichment. Analysis of morphine, 6-monoacetylmorphine, codeine, ethylmorphine and pholcodine in plasma and whole blood by capillary gas chromatography and capillary gas chromatography-mass spectrometry.

A fully automated sample preparation method for the determination of five opiates in human plasma and whole blood is described. The technique combines dialysis and trace enrichment prior to gas chromatography and gas chromatography-mass spectrometry. Dialysis and trace enrichment on a polymer column was shown to be a highly reliable method for sample preparation. The method can be used, after minor modification, to determine other basic drugs in plasma and whole blood. The method demonstrates the potential of the automated sequential trace enrichment of dialysate (ASTED) system for automated sample preparation.

Automation↗
PubMed1993

Automated determination of cross-linked fibrin derivatives in plasma.

Automated assays for the measurement of cross-linked fibrin derivatives in plasma (XL-FbDP) have been developed utilizing latex beads coated with anti-D dimer monoclonal antibody (DD-3B6/22) for both the Cobas Fara Chemistry Centrifugal and the Cobas Mira analysers (Roche, Basle, Switzerland). The analysers were programmed to mix plasma and latex reagent simultaneously and analyse absorbance changes over a 10-15 min period. Results were interpolated by the analyser from a standard curve derived from a polymer of D-dimer. Both assays had high precision (< 5% CV) for values between 100 and 1000 ng/ml and provided clear discrimination between normal samples and samples from patients suffering from the thrombotic diseases, DVT/PE and DIC. The results obtained for XL-FbDP determination with both methods compared well with established methods: a high correlation was obtained with a semi-quantitative manual latex method for both the Fara (r = 0.92) and Mira (r = 0.83) and correlations (r) of 0.81 (Fara) and 0.84 (Mira) were obtained with an enzyme immunoassay (EIA). Correlation between the two automated procedures was high (r = 0.96). The automated method will enable laboratories to provide a rapid and accurate quantitation of XL-FbDP.

Antibodies, Monoclonal↗
PubMed1993

Automated compounder for adding ingredients to parenteral nutrient base solutions.

The effects of using an automated compounder for adding ingredients to parenteral nutrient (PN) base solutions was evaluated. Work-sampling methods were used to determine the amount of time spent by pharmacists and technicians in the production of PN solutions before and after the implementation of an automated device for adding ingredients to PN base solutions. Costs of materials and supplies were evaluated before and after the PN compounder was implemented. Qualitative (sterility) and quantitative (accuracy) analyses were performed by the hospital laboratory. A personnel time savings of 5.4 minutes per PN solution (1.0 full-time equivalent [FTE]) was shown. There was also an additional 0.5 FTE saved in activities not directly related to PN production. There was a 1.5% increase in pharmacist time (mean +/- S.D. preimplementation, 12.66 +/- 2.33 minutes; postimplementation, 12.85 +/- 1.96 minutes) and a significant 27.9% decrease in technician time (mean +/- S.D. preimplementation, 20.29 +/- 2.47 minutes; postimplementation, 14.62 +/- 2.24 minutes) per PN solution. The break-even point for personnel and supply costs was 33 PN solutions. Qualitative analysis resulted in one positive culture preimplementation and no positive cultures postimplementation. Quantitative analysis showed an improvement in compounding accuracy. The use of an automated compounder for adding ingredients to PN base solutions resulted in personnel time savings and improved accuracy.

Automation↗
PubMed1996

Automated counting of in situ hybridization dots in interphase cells of leukemia samples.

Twenty-seven samples (cell cultures prepared for routine cytogenetics) of leukemia patients with known cytogenetic abnormalities were stained by in situ hybridization for interphase cytogenetics with centromere specific probes for chromosome Nos 4, 6, 7, 8, 9, 12, 17, 18, X and Y. The number of hybridization domains per nucleus was quantified using a semi-automated system developed in our laboratory. Results of this automated counting procedure (with and without verification of the counting results by the operator) were compared with conventional cytogenetic data and with visual scoring of the number of hybridization dots. The findings show that the system is capable of analysing 1000 cell nuclei in less than 30 min, including the necessary verification of the results by the operator. Automated counting and visual scoring were in good agreement. Conventional cytogenetics and interphase cytogenetics agreed in only 50% of the cases, confirming other studies showing that conventional cytogenetic results are not always representative for the majority of the cell population.

Adolescent↗
PubMed1995

Evaluation of monocyte counting with two automated instruments by the use of CD 14-specific immunomagnetic Dynabeads.

Accurate determination of monocytes can be a problem with automated haematological analysers as well as with visual microscopy. We have compared monocyte counts from our two routine automated instruments, Technicon H*1 and Sysmex NE-1500. In the NE-1500 the monocyte counts appear to increase with increasing concentrations of neutrophils, compared with the H*1 results. The accuracy of the monocyte counts was assessed using Dynabeads M-450 CD14. These uniform magnetizable polystyrene beads coated with monoclonal antibody specific for CD14 membrane antigen isolated monocytes from the blood samples. The influence of this depletion on the monocyte counts and histograms from the two instruments and by visual microscopy were compared. On average 90% of the monocytes counted by visual microscopy were removed from six blood samples. In the same samples the beads removed an average of 75% of cells identified as monocytes by the H*1 but only 49% of those identified as monocytes by the NE-1500. These Dynabeads can be a useful tool in evaluating monocyte identification in different haematological situations and for manufacturers developing technology for automated leucocyte differential counting.

Antibody Specificity↗
PubMed1977

Automated zone electrophoresis--experiments and new concepts.

I have investigated various modalities of automation of zone electrophoresis. One system has already been previously described (U.S. Pat. No. 3,896,021). Other systems investigated can be divided into batch systems and one random-access system; the former involve separation on cellulose acetate that is supported on 0.127 mm thick polyester (Mylar) film in the form of tape, cards, or discs. Systems in which the separation is in a direction transverse to the long axis of the tape use a typical tape width of 7.5 cm; systems in which separation is longitudinal make use of supports of various widths, depending upon the assay rate desired. Concepts were also developed for a random-access systems for automated electrophoresis, which requires no start-up time. Small Lucite cassettes are used, one for each sample. Each cassette has one surface of either cellulose acetate or any of several gels used for electrophoretic separation. There are further small wells for sample and calibrator. The loaded cassette is inserted into an input queue that allows serial processing. The cassettes move sequentially through prewetting (if needed), sample application, electrophoretic separation, staining, and scanning. This system should also be suitable for automated isoelectric focusing.

Automation↗
PubMed1986

Automation of data acquisition and of experiment control: application to the study of sleep-wake cycles and behavioral paradigms.

The low cost of microcomputers allows them to be dedicated full time to data acquisition and analysis of experimental paradigms. The usual interfaces required for such interaction with the experiment are briefly explained, namely, analog-to-digital converters, input-output control lines and real time clocks. Some basic concepts on the use of microcomputers for the automation of data acquisition and control are summarized, including the characterization of waveshapes, the structure of data storage and on-line data reduction. Off-line, the matrices generated by the data acquisition program become the input for ad-hoc processing programs. Precision, flexibility and fluidity of analysis are outstanding advantages of computer controlled setups. A system for automation of sleep studies and a system for automation of scheduled-controlled behavior are presented as working examples.

Activity Cycles↗
PubMed1996

Automated decentralized pharmacy dispensing systems.

Automated decentralized pharmacy dispensing systems (ADPDSs) are medication management systems that allow hospitals to store and dispense drugs near the point of use. These systems, which can be compared with the automated teller machines used by banks, provide nurses with ready access to medications while maintaining tight control of drug distribution. In this study, we evaluated three ADPDSs from two suppliers, focusing on whether these systems can store and dispense drugs in a safe, secure, and effective manner. When rating the systems, we considered their applicability to two different implementation schemes: The use of a system with a pharmacy profile interface. This feature broadens the capabilities of the system by allowing more information to be provided at the dispensing cabinet and by providing better integration of the information from this cabinet with the pharmacy's information system. Two of the evaluated systems have this feature and were rated Acceptable. The use of a system without a pharmacy profile interface. We rated all three of the evaluated systems Acceptable for such implementations. To decide which scheme is most appropriate for a particular hospital, the facility will need to determine both how it intends to use the ADPDS and what it hopes to achieve by implementing the system. By performing this type of analysis, the facility can then determine which ADPDS features and capabilities are needed to accomplish its goals. To help facilities make these decisions, we have provided an Equipment Management Guide, "Improving the Drug Distribution Process-Do You Need an Automated Decentralized Pharmacy Dispensing System?," which precedes this Evaluation. In addition, readers unfamiliar with the roles of both the pharmacy and the pharmacist within the hospital can refer to the Primer, "Functions of a Hospital Pharmacy," also published in this issue.

Automation↗
PubMed1997

Automation of the Papanicolaou smear: a technology assessment perspective.

Cytology automation has captured the attention of industry, the public, and the pathology community as a potential solution to false negatives and other limitations of the conventional Papanicolaou smear. However, cytology automation includes a mixed group of technologies, including cytology rescreening, prescreening, independent screening, automated preparation technologies, and screening process control. While certain of these technologies may prove valuable to improving the quality of the Papanicolaou test, a structured analysis approach, such as is offered by technology assessment, is required to determine whether the technology is safe, effective under conditions of actual use, cost-effective, and whether it adds value and improves outcomes in patient care. Such studies must be carefully constructed to eliminate bias so that proper decisions can be made. The implications of these devices on individual screening standards are yet to be determined; sufficient peer-reviewed literature studies must accumulate to document their value, and the cytology community must participate with other interested parties in establishing the standard for care.

Automation↗
PubMed1997

Automated identification and quantitative morphometry of the senile plaques of Alzheimer's disease.

OBJECTIVE: Senile plaques (SP) are one of the characteristic neuropathologic lesions of Alzheimer's Disease (AD), and studies of SP cortical distribution, density and morphology may lead to new information about the mechanism and pathogenesis of AD. We used an automated, digital image analysis program to detect and measure SP size, shape and total fractional area in digital images of silver-stained tissue sections. STUDY DESIGN: The program observed 94,000 SP in 2,800 digitized microscope fields from tissue sections from 42 postmortem cases ranging from healthy aged to severely demented subjects, studied prospectively before death. RESULTS: Automated pattern recognition can measure SP densities in excellent agreement with an expert and can generate morphometric information not obtainable by conventional microscopy. SP densities (number of SPs/mm2) strongly correlate with tissue load (fraction of tissue area occupied by lesions). SP densities strongly correlate between cortical regions within the same subjects. SP densities, while correlating with the occurrence of AD, do not display a significant trend with respect to dementia severity; likewise, mean SP area and shape properties do not vary significantly with dementia severity. Finally, all the computed SP densities would have produced the same diagnoses of AD in these subjects as the manual SP densities according to the consensus criteria. CONCLUSION: This is the first fully automated program to identify SPs and measure SP morphometry; it uses well-established digital image analysis and statistical pattern recognition methods. The computed SP densities correlate highly with expert results, and the systematic differences are smaller than the interrater differences reported in several multicenter Alzheimer's disease neuropathology studies. The program measures morphometric properties that would be impractical to measure by manual means and, with program-controlled, scanning stage microscopy, can measure lesion densities exhaustively across large cortical areas without stereologic sampling. SP densities rise from near zero to significant values at the mildest diagnosed stage of AD, but beyond this point, there is no demonstrable correlation of density, or any other SP property, with dementia severity. Computed SP densities for even the mildest dementia satisfy the consensus diagnostic criteria.

Aged↗
PubMed1998

Automated high-resolution polymerase chain reaction fragment analysis: a method for detecting T-cell receptor gamma-chain gene rearrangements in lymphoproliferative diseases.

Southern blot analysis and the polymerase chain reaction (PCR) are powerful tools for detecting clonal antigen receptor gene rearrangements. However, a number of limitations restrict the predictive value of the results obtained by these techniques as they are commonly used. We describe a new method, automated high-resolution PCR fragment analysis, that can partially overcome many of the limitations of analyzing the T-cell receptor (TCR) gamma-chain gene. Analysis of TCR-gamma is performed using PCR with four sets of primers, previously described by others, specific for all variable (V) and joining (J) regions of the TCR gamma-chain gene. In addition, the four V region primers are 5' end-labeled with a fluorescent compound, 5-carboxyfluorescein. After amplification, the labeled PCR products are separated with an automated sequencing system, ABI 373 (Applied Biosystems, Weiterstadt, Germany). With the help of the Gene-Scan software ABI 672 (Applied Biosystems) and fluorescent-labeled DNA length markers, the exact size of each peak can be displayed and analyzed. The resolution of this method allows separation of PCR products differing in length by as little as 1 bp. Semiquantitative estimation of specific clones also can be performed. Infiltrate-specific gene rearrangement patterns can be identified and recognized in different tissue specimens at the time of diagnosis or in subsequent biopsy specimens. We conclude that automated high-resolution PCR fragment analysis allows more accurate and convenient analysis of the TCR gamma-chain gene.

Automation↗
PubMed2003

Percutaneous renal biopsy by automated biopsy gun.

OBJECTIVE: To study the safety and efficacy of automated biopsy gun in obtaining the renal tissue by percutaneous renal biopsy. DESIGN: Single centered prospective hospital based study. PLACE AND DURATION OF STUDY: Department of Medicine, Unit II, Lahore General Hospital, Lahore for more than one year from January 2000 to February 2001. SUBJECTS AND METHODS: Forty patients of either gender having clinical features of renal disease with overt proteinuria were included in the study. An informed consent was taken from patients. Patients were lied prone, local anaesthesia was given at lower pole of left kidney. Renal biopsy was performed under ultrasound guidance, using 18G spring loaded automated biopsy gun. RESULTS: Majority of patients, 28(70%), was male. The mean age was 26.9 years with range of 5-70 years. In 37 (97.5%) patients successful biopsy was done while there was its failure in 3 (7.5%) patients. The average core length of renal tissue obtained was Mean+/-SD (1.02+/-0.34) cm with a mean number of glomeruli per core Mean+/-SD (7.76+/-2.36) and histopathological diagnosis was made in all cases. Total number of attempts were 1-3. In 70% patients single attempt was done. No major complication related to the procedure was seen. CONCLUSION: Renal biopsy with automated biopsy gun is relatively safe and effective in establishing the diagnosis of renal diseases. Although renal biopsy can be done on outpatient basis, it is better to observe the patients for 24 hours post-operatively for any complication

Adolescent↗
PubMed1998

Accuracy of an automated blood pressure device in stable inpatients: optimum vs routine use.

BACKGROUND: Despite widespread use of the automated blood pressure (BP) device (IVAC model 4200, IVAC Corporation, San Diego, Calif), there is little formal validation in the literature on its accuracy. OBJECTIVE: To assess the accuracy of the IVAC 4200 device, both under standardized conditions and as routinely used by ward staff, compared with the true indirect BP measured by mercury manometer (MM). METHODS: One hundred forty-five stable inpatients were randomly selected for BP measurements by 3 randomly ordered protocols: (1) MM performed by certified investigators, (2) IVAC 4200 BP performed by trained investigators (research automated [RA]), and (3) IVAC 4200 BP performed by ward personnel (ward automated [WA]). RESULTS: For RA compared with MM ("true" indirect BP), 59% of systolic and 54% of diastolic readings were within 5 mm Hg and 83% of systolic and 86% of diastolic were within 10 mm Hg for a British Hypertension Society grade C for both. For WA compared with MM, 40% of systolic and 50% of diastolic readings were within 5 mm Hg and 70% of systolic and 80% of diastolic readings were within 10 mm Hg for British Hypertension Society grades D and C, respectively. The presence of arrhythmias and/or low K5 values (fifth phase of Korotkoff sounds <30 mm Hg) significantly increased the inaccuracy for diastolic values. Inappropriate cuff selection significantly increased inaccuracy of systolic BP (WA vs MM). CONCLUSIONS: The IVAC 4200 yields substandard estimates of systolic and diastolic BP even under standardized, thus optimum conditions. The presence of arrhythmias or low K5 values and the selection of inappropriate cuff size by the ward staff also contributed to inaccuracy.

Adult↗
PubMed1998

Hyperopic automated lamellar keratoplasty: complications and visual results.

OBJECTIVE: To examine the long-term safety and efficacy of hyperopic automated lamellar keratoplasty (H-ALK) for correction of primary hyperopia and for consecutive hyperopia following overcorrected myopic refractive surgery. METHODS: A prospective study was done on 67 eyes of 50 consecutive patients who underwent H-ALK between March 17, 1993, and August 18, 1995. Hyperopic automated lamellar keratoplasty was performed for primary hyperopia in 25 eyes (group 1) and for consecutive hyperopia after myopic refractive surgery in 42 eyes (group 2, radial keratotomy, 41 eyes, and myopic automated lamellar keratoplasty, 1 eye). The eyes were followed up for a mean+/-SD of 19.2+/-12.8 months (range, 3-49 months), 58 (87%) of them with 6 months' follow-up, and 45 (67%) of them with at least 1 year's follow-up. Twenty-one eyes were followed up for 2 to 4 years. RESULTS: The overall mean+/-SD preoperative spherical equivalent was +2.87+/-1.28 diopters (D). The mean+/-SD postoperative spherical equivalent was -0.03+/-1.42 D at 3 months, -0.42+/-2.25 D at 6 months, -0.55+/-3.00 D at 1 year, -1.58+/-1.53 D at 2 years, and -0.35+/-1.79 D at the last follow-up. A mean myopic shift of 0.50 D was noted between 3 months and 1 year, and of 1.00 D between 1 and 2 years. Hyperopia was meaningfully reduced and visual acuity was improved by H-ALK, especially for patients with primary hyperopia. Long-term refractive instability, however, is a serious problem with this procedure. In this series, 11 (26%) of 42 eyes in which H-ALK was performed for consecutive hyperopia developed iatrogenic keratoconus. CONCLUSION: Based on this study, the long-term instability of H-ALK and the high incidence of iatrogenic keratoconus following the procedure should discourage its use, especially for consecutive hyperopia following radial keratotomy.

Adult↗
PubMed2000

A comparison of manual kinetic and automated static perimetry in obtaining ptosis fields.

OBJECTIVE: To compare examination time and visual field loss for ptosis fields obtained with manual kinetic (Goldmann) perimetry and automated static (Humphrey) perimetry. METHODS: Both eyes of 12 patients with bilateral aponeurogenic ptosis were prospectively examined using Goldmann and Humphrey (ptosis protocol) perimetry with the eyelids ptotic and taped into a normal position. RESULTS: Bilateral examination time for Goldmann fields was 10 +/- 2 minutes and for Humphrey fields was 50 +/- 10 minutes (P<.001, n = 12). Superior fields at the 12:00 meridian were 46 degrees +/- 6 degrees taped, and 28 degrees +/- 12 degrees untaped for Goldmann perimetry (P<.001), and 38 degrees +/- 8 degrees taped, and 24 degrees +/- 12 degrees untaped for Humphrey perimetry P<.001). Goldmann field loss was 18 degrees +/- 9 degrees (taped minus untaped). Humphrey field loss was 14 degrees +/- 13 degrees (P<.04, n = 24). Mean Goldmann radial fields were 56 degrees +/- 6 degrees taped and 39 degrees +/- 13 degrees untaped (P<.001). Goldmann superior hemifield areas were 5,167 +/- 964 degrees2 taped and 2,830 +/- 1,466 degrees2 untaped (P<.001). Humphrey mean vertical superior hemifield was 37 degrees +/- 9 degrees taped and 21 degrees +/- 11 degrees untaped (P<.001). Mean sensitivity of Humphrey fields was 15 +/- 3 dB taped and 9 +/- 5 dB untaped (P<.001). Mean vertical center of gravity was 23 degrees +/- 3 degrees taped and 16 degrees +/- 5 degrees untaped (P <.001). CONCLUSION: Goldmann manual kinetic and Humphrey automated static visual field testing are both effective in documenting ptosis associated visual field loss. Humphrey automated ptosis fields, as performed in this study, require longer examination times than Goldmann manual fields and may be a less sensitive indicator of field loss.

Adult↗
PubMed2006

Automated combined kinetic and static perimetry: an alternative to standard perimetry in patients with neuro-ophthalmic disease and glaucoma.

OBJECTIVES: To create a fully automated, combined perimetry program consisting of a static examination and a kinetic examination, and to compare the results of this test with standard static and kinetic visual fields (VFs). METHODS: Fifty-six patients (74 eyes) undergoing neuro-ophthalmic or glaucoma evaluation who had standard static or kinetic perimetry examinations underwent the combined perimetry test. This automated, combined test, performed on the Octopus 101 perimeter, consisted of a static tendency-oriented perimetry examination and a preprogrammed kinetic examination. Three masked physician reviewers independently classified all of the VFs. The VF pairs were considered a match if the consensus descriptions of the standard and combined VFs matched. RESULTS: Thirty-seven eyes underwent evaluation for neuro-ophthalmic disease (comparison standard test, 20 static and 17 kinetic) and 37 for glaucoma (comparison standard test, 17 static and 20 kinetic). The VP pairs matched in 32 eyes (86%) in the neuro-ophthalmic group and 28 (76%) in the glaucoma group. On inspection by a fourth reviewer, many of the nonmatching VF pairs were those for which a consensus was not reached, but still conveyed similar information. Two glaucomatous eyes demonstrated central scotomata not delineated by the combined examination findings. Two subtle nasal steps were detected solely by the combined examination. The combined test ranged in time from 6 to 12 minutes per eye. CONCLUSIONS: The Octopus 101 perimeter can be used to create an automated test that combines the advantages of static and kinetic perimetry and produces equivalent results while not requiring examiner expertise.

Adolescent↗