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PubMed1995

Analytical artifacts in hematocrit measurements by whole-blood chemistry analyzers.

Compact analyzers suited to near-patient testing estimate hematocrit by measuring the conductivity of undiluted blood. We evaluated the accuracy of hematocrit determination of one such analyzer (Instrumentation Laboratory BGE analyzer) against an automated cell counter (EPC) and packed cell volume (PCV) microhematocrit. When specimens (n = 34) from outpatient and ward patients were analyzed with all three methods, the BGE analyzer correlated well with both EPC and PCV hematocrit determinations (BGE = 1.00 PCV + 0.3%, S(y)/x = 2.0%), suggesting that all three methods are similar in performance for most patients. However, a patient with increased plasma osmolality showed significant decreases in BGE and PCV hematocrits relative to the EPC method. The differences in hematocrit measurements could be reproduced by adding solutes to blood in vitro or by modifying the plasma osmolality of rats in vivo. Samples from patients undergoing cardiac surgery, whose blood had large changes in protein concentration, showed discrepancies between hematocrits by conductivity and other methods; similar effects could be produced by changes in protein concentration or in vitro addition of polyethylene glycol. We conclude that conductivity measurements provide accurate hematocrit results for physiologically normal subjects but not for some intensive-care and surgical patients.

Animals↗
PubMed1997

Pseudohypertriglyceridaemia.

A mistake can be made in interpreting plasma triglyceride levels since in some cases pseudohypertriglyceridaemia may result from increased plasma glycerol due to a glycerol kinase deficit. Most automated triglyceride assays used in laboratories do not contain a negative control, i.e. a glycerol assay. We report two cases with pseudohypertriglyceridaemia due to hyperglycerolaemia and describe the clinical and biological features which suggested the diagnosis.

Adult↗
PubMed1995

Automated approaches to rapid-response testing. A comparative evaluation of point-of-care and centralized laboratory testing.

This study evaluates the premise that point-of-care or near-patient testing provides more effective medical care because laboratory turnaround time is reduced and, therefore, presumably the time before therapy begins is reduced. An accurate evaluation of this premise must compare the operation of a point-of-care laboratory and an alternative dedicated, centralized laboratory. Assessment of both laboratory operations with respect to turnaround time, costs and benefits, regulatory factors, and finally patient care outcome are all essential in reaching a conclusion. In this study, laboratory operations in a centralized urgent care laboratory were compared with those of a point-of-care satellite laboratory. Turn-around time analysis for whole blood (heparinized specimens requiring no centrifugation) and serum analytes were measured during a representative time period. Analysis of turnaround time considered both the preanalytic time, defined as collection to receipt of the specimen in the laboratory, and the analytic time component that accounts for receipt, processing, analysis, and reporting of the final data into the laboratory information system. The preanalytic component of the point-of-care satellite laboratory was also compared with the urgent care laboratory equipped with a rapid-transport specimen system. Turnaround time in the point-of-care satellite laboratory and urgent care laboratory equipped with a rapid-transport specimen system. Turnaround time in the point-of-care satellite laboratory and urgent care laboratory equipped with a rapid-transport system were comparable. In this analysis, staff requirements, ability to comply with regulatory requirement, and the increasing demand for a larger selection of tests needed urgently were considered. In a tertiary care medical center, such as the authors', a dedicated, centralized laboratory equipped with a rapid-transport specimen system provides better comprehensive laboratory service than does a point-of-care facility with limited capability.

Automation↗
PubMed1999

Public health aspects of antibiotic resistance monitoring in the USA.

Treatment of food-producing animals with antimicrobial agents that are important in human therapy may present a public health risk by the transfer of resistant zoonotic pathogens or resistant genes from animals to humans via consumption of contaminated food. Resistant bacteria can diminish the effectiveness of antibiotics and demand the use of more expensive or less safe alternatives. In 1996, the U. S. Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the Department of Agriculture (USDA) established the National Antimicrobial Resistance Monitoring Program to prospectively monitor changes in antimicrobial susceptibilities of zoonotic enteric pathogens from human and animal clinical specimens, from healthy farm animals, and from carcasses of food-producing animals at slaughter plants. Data resulting from the monitoring program will be used to redirect antimicrobial drug use, primarily through educational initiatives directed at health practitioners, in order to diminish the development and spread of resistance. Veterinary testing is conducted at USDA's Agricultural Research Service and CDC's Foodborne Disease Laboratory is testing human isolates under contract to FDA. Both the CDC and USDA laboratories are using a semi-automated system (Sensititre, Accumed, Westlake, Ohio) for testing susceptibilities of the isolates to 17 antimicrobial agents on a minimum inhibitory concentration plate. Comparable methods for isolate handling are used in both laboratories. This paper describes the development, implementation, and objectives of the National Antimicrobial Resistance Monitoring Program, presents initial data generated by the program, and discusses future plans.

Animals↗
PubMed2004

Evaluation of Advia Centaur automated chemiluminescence immunoassay for determining total homocysteine in plasma.

BACKGROUND: A lot of methods are now available for total plasma homocysteine (tHcy) determination. HPLC with fluorescence detection were the most widely used methods until recently but immunoassays, easier to use, currently supplant in-house laboratory methods. METHODS: The latest commercial automated chemiluminescence immunoassay (ICL) for tHcy, developed on the ADVIA Centaur analyzer (Bayer Diagnostics), was fully evaluated and compared with a current HPLC method. RESULTS: The ICL-ADVIA Centaur method had a detection limit <0.9 micromol/l and was linear for tHcy between 2.4 and 58.8 micromol/l. The within- and between assay imprecision was <6% and <7%, respectively. The analytical recovery ranged from 93.5% to 109.7%. The comparison of 168 clinical plasma specimens indicated a good correlation between the two methods (r=0.96, p<0.0001) but a systematic positive bias for ICL-ADVIA Centaur method (mean difference=3.0 micromol/l). CONCLUSIONS: The ADVIA Centaur method is a useful and practicable alternative to HPLC methods for tHcy determination. The ICL method is even more convenient than chromatographic methods for routine use because of its significantly higher throughput (200 samples/h vs. 40 per 24 h). However, the agreement among methods is insufficient to allow them to be used interchangeably.

Adolescent↗
PubMedDate not supplied

Testing strategies in behavioral teratology: IV. Review and general conclusions.

Three laboratories collaborated to evaluate and compare different test concepts to be used for routine testing in behavioral teratology. Rat dams were treated orally with methylmercury starting two weeks prior to pairing until weaning of their offspring. In the first laboratory, the usual reproduction parameters were assessed in the dams, and all offspring (96-103 per group) were subjected to a routine developmental and behavioral test battery. After termination of the tests a random selection of these animals was further tested by multiparametric automated techniques in the other two laboratories. In one of these laboratories 12-13 males and females per group (one of each per litter) were tested in a visual discrimination reversal schedule, using nose-poking as operand. In the other laboratory the free behavioral of eight randomly selected males per dose group was studied in a wheel-shaped activity monitor with respect to locomotion magnitude and structure. In the same laboratory eight other males per group were trained in a discrete trial spatial alternation schedule, using lever press as operand. Both the developmental and behavioral testing battery as well as the automated techniques showed some significant effects in the offspring even at the low dose, where no reproduction effects had been noted. However, whereas the testing battery results were of unspecific nature, results of the automated techniques gave precise and specific information. In order to obtain optimal information, it is proposed to combine both approaches for routine testing. This combination could be achieved by using a balanced testing battery in young pups followed by an appropriate operant conditioning schedule in selected young adults.

Animals↗
PubMed2006

Common laboratory methods in pharmacogenomics studies.

PURPOSE: Common laboratory methods used in pharmacogenomics studies are described. SUMMARY: The reliable and accurate determination of a person's genetic makeup at a particular locus in the DNA molecule, or genotype, is fundamental to pharmacogenomics. Whole blood cells and buccal cells are commonly collected to obtain a DNA sample. Once DNA is collected, the genomic DNA must be isolated from other cellular material. Next, a specific region of interest must be identified and amplified, performed via polymerase chain reaction (PCR). Gel electrophoresis is often performed after PCR to verify that PCR was successful and that the amplified target sequence is the correct size. Numerous methods are available to determine a person's genotype and differ based on allele discrimination and detection. PCR coupled with restriction fragment length polymorphism (RFLP) analysis, a conventional genotyping method, does not rely on automated technology and is practical for laboratories that genotype a limited number of samples. Pyrosequencing is an automated genotyping method in which the principal allele discrimination method is a primer extension reaction coupled with a luciferase-based enzyme reaction. TaqMan relies on the use of fluorescencelabeled probes, in addition to PCR primers, in the reaction mixture, enabling PCR amplification and allele discrimination in the same step. Mass spectrometry differentiates DNA molecules using a defined mass. Denaturing high-performance liquid chromatography (DHPLC) uses a reverse-phase ion-pair column to discriminate between variant and nonvariant alleles. CONCLUSION: An understanding of the common genotyping methods used in pharmacogenomics studies, including PCR-RFLP analysis, pyrosequencing, TaqMan, mass spectrometry, and DHPLC, will aid pharmacy practitioners and students when interpreting the methods sections of such studies.

Clinical Laboratory Techniques↗
PubMed1980

When to do diffs: how often should differential counts be repeated?

Large numbers of differential counts are generated in hospital laboratories by physician requesting repeat counts, often daily. Their purpose is to detect trends in polymorphonuclear neutrophils (PMN) to monitor infections or therapy with marrow-depressant drugs. Recently, a number of automated differential counters have come on the market to handle the still increasing load of differentials. We proposed that a strategy of performing differential counts only after a significant change in total WBCs had taken place would result in little or no loss of information. Since WBC counts are routinely performed by automated instruments already available in most laboratories, the purchase of expensive differential counters might thus be avoided. To test this thesis, we analyzed 415 successive sequences of WBC and differential counts, each sequence consisting of four determinations within a 10-day period. Criteria for significant trends in WBC and PMN were based on clinical judgment or on recently determined day-to-day physiologic variations. Among 415 sequences examined, only four could be found in which PMN had changed without a concomitant change of equal significance in WBC. It was concluded that the proposed strategy of using WBC as an indicator of developing neutropenia or neutrophilia was sound. It would have resulted in loss of information in about 1% of instances only, at a considerable saving in differential counts.

Computers↗
PubMed1992

Bronchial provocation tests in small animals: a quantified and automated procedure.

Bronchial provocation tests using aerosols in laboratory animals are difficult to standardize and quantify, because the amount of drug actually reaching the airways is unknown. To improve the quantification of aerosolized inhaled stimuli, we designed an apparatus that allows, in anesthetized intubated ventilated animals, control of temperature and hygrometry of inspired air, computerized measurement of pulmonary resistance, and fully automated delivery of a known amount of aerosolized drug directly into the trachea. Calibration of the aerosol delivery involved direct measurement of liquid delivered at the tip of the tracheal cannula. Despite all our efforts at standardization and full automation of all steps, reproducibility of aerosol delivery was poor, with stroke-by-stroke differences of 26 or 42%, according to whether an air-jet or an ultrasonic nebulizer was used. Histamine dose-response curves performed in 15 guinea pigs with this device confirmed marked differences among animals and also disclosed large intraindividual changes in bronchial responsiveness.

Aerosols↗
PubMed1996

Comparison of efficacy and cost-effectiveness of BIOMIC VIDEO and Vitek antimicrobial susceptibility test systems for use in the clinical microbiology laboratory.

Antimicrobial susceptibility testing expense may be a significant portion of a clinical microbiology laboratory's budget. This study compares the BIOMIC VIDEO system (Giles Scientific, Inc., New York, N.Y.) with the Vitek system (bioMérieux Vitek, Inc., Hazelwood, Mo.), an established automated method of antimicrobial susceptibility testing with the ability to generate MIC data. The BIOMIC system is relatively inexpensive and automates the reading of the classical disk agar diffusion test to provide both qualitative (susceptibility interpretation) and quantitative (MIC) data. The overall MIC correlation between the two systems for the 2,913 drug-organism combinations tested was 92.6%. The overall agreement for susceptibility interpretation was 97.4%. The BIOMIC system offers a 57.4% savings per test over the Vitek system. The BIOMIC system utilizes an older technology which is more efficient and yet yields results comparable to those of established automated MIC methods. The savings achievable in laboratories and hospitals nationwide may contribute significantly to the containment of national health care expenditures.

Automation↗
PubMed2004

Continuous flow 2H/1H and 18O/16O analysis of water samples with dual inlet precision.

A method for isotope ratio analysis of water samples is described comprising an on-line high-temperature reduction technique in a helium carrier gas. Using a gas-tight syringe, injection of 0.5 to 1 microL sample is made through a heated septum into a glassy carbon reactor at temperatures in excess of 1300 degrees C. More than 150 injections can be made per day and both isotope ratios of interest, delta2H and delta18O, can be measured with the same setup. The technique has the capability to transfer high-precision stable isotope ratio analysis of water samples from a specialized to a routine laboratory task compatible with other common techniques (automated injection for GC, LC, etc.). Experiments with an emphasis on the reactor design were made in two different laboratories using two different commercially available high-temperature elemental analyser (EA) systems. In the Jena TC/EA unit, sample-to-sample memory (single injection) has been reduced to approximately 1% and high precision of about 0.1 per thousand for delta18O and < 1 per thousand for delta2H has been achieved by a redesign of the glassy carbon reactor and by redirecting the gas flow of the commercial TC/EA unit. With the modified reactor, the contact of water vapour with surfaces other than glassy carbon is avoided completely. The carrier gas is introduced at the bottom of the reactor thereby flushing the outer tube compartment of the tube-in-tube assembly before entering the active heart of the reactor.With the Leipzig high-temperature reactor (HTP) similar precision was obtained with a minor modification (electropolishing) of the injector metal sleeve. With this system, the temperature dependence of the reaction has been studied between 1100 and 1450 degrees C. Complete yield and constant isotope ratio information has been observed only for temperatures above 1325 degrees C. For temperatures above 1300 degrees C the reactor produces an increasing amount of CO background from reaction of glass carbon with the ceramic tube. This limits the usable temperature to a maximum of 1450 degrees C. Relevant gas permeation through the Al2O3 walls has not been detected up to 1600 degrees C.

Deuterium↗
PubMed1993

Improving customer relations and telephone response in Abbott Northwestern Hospital's laboratory department.

PROJECT: Improve the Laboratory's phone answering process. Principals: Clinical and administrative laboratory staff and a telecommunications specialist. Process Improvement Method: Modification of model used by the National Demonstration PROJECT on Quality Improvement in Healthcare. Timeline: May 1991-present. RESULTS reported here: August 1991-July 1992. The team is currently reviewing a computerized voice processing system that will take requests to reprint lab reports, take outpatient lab orders directly from doctors' offices, and provide test results and information on test tube specification for specific blood tests. Key Findings or Improvements: More than half the calls to the Laboratory needed to be transferred to Microbiology. Alternative communication systems such as a computerized voice answering system and the hospital's computer network could be used in place of phones to transmit information to and from the Laboratory. RESULTS: With the installation of an automated answering system, calls to Microbiology are automatically re-routed and the number of incoming calls to the Laboratory have dropped. More lab requests and reports are being handled by computer.

Consumer Behavior↗
PubMed2000

ASHP national survey of pharmacy practice in acute care settings: dispensing and administration--1999.

Results of the 1999 ASHP national survey of pharmacy practice in acute care settings that pertain to drug dispensing and administration practices are presented. Pharmacy directors at 1050 general and children's medical-surgical hospitals in the United States were surveyed by mail. The response rate was 51%. About three-fourths of respondents described their inpatient pharmacy's distribution system as centralized. Of those with centralized distribution, 77.4% indicated that their system was not automated. Decentralized pharmacists were used in 29.4% of the hospitals surveyed; an average of 58.9% of their time was spent on clinical, as opposed to distributive, activities. About 67% of directors reported pharmacy computer access to hospital laboratory data, 38% reported access to automated medication-dispensing-unit data, and 19% reported computer access to hospital outpatient affiliates. Only 13% of hospitals had an electronic medication order-entry system; another 27% reported they were in the process of developing such a system. Decentralized medication storage and distribution devices were used in 49.2% of hospitals, while 7.3% used bedside information systems for medication management. Machine-readable coding was used for inpatient pharmacy dispensing by 8.2% of hospitals. Ninety percent reported a formal, systemwide committee responsible for data collection, review, and evaluation of medication errors. Virtually all respondents (98.7%) reported that their staff initiated manual reports. Only two thirds tracked these reports and reported trends to the staff. Fewer than 15% reported that staff were penalized for making or contributing to an error. Pharmacists are making a significant contribution to the safety of medication distribution and administration. The increased use of technology to improve efficiency and reduce costs will require that pharmacists continue to focus on the impact of changes on the safety of the medication-use system.

Ambulatory Care↗
PubMed1979

Automated determination of total plasma cholesterol: a serum calibration technique.

The automated (AutoAnalyzer II) determination of cholesterol in nine serum pools in the concentration range 3.465-8.871 mmol/l, gave results that were approximately 10% higher than reference values when the analyses were based on unesterified cholesterol standards containing the same amount of water as the sample extracts (1963 analyses in 12 laboratories during a 12 month period; automated value = 0.032 + 1.10 X (Reference value)). A serum calibration procedure was successful ilues, and was equally effective in correcting the values observed for aliquots of 368 fresh-frozen plasma samples analyzed in each of the 12 laboratories during a 38 month period.

Autoanalysis↗
PubMed1989

Application of automated human voice delivery to warning devices in an intensive care unit: a laboratory study.

Environmental concerns about the delivery of warning messages in intensive care units exist in the belief that conventional non-verbal alarm signals are perceived to be threatening by some patients. There is also a significant opportunity for error in interpretation by fatigued or anxious personnel. A laboratory study was undertaken to determine whether human subjects made fewer errors when messages regarding ICU related tasks were delivered by tape recorded human voice than by the non-verbal signals derived from devices in the ICU. Results demonstrated a statistically significant superiority of human voice messages over non-verbal signals. It is concluded that taped human voice messages merit field trials in intensive care units.

Computer Systems↗
PubMed1998

Validation of an automated technique for determining the mechanical characteristics of coronary arteries during balloon angioplasty: laboratory assessment with necropsy segments.

OBJECTIVES: To develop a technique for automatic inflation of a percutaneous transluminal coronary angioplasty (PTCA) balloon, with continuous measurement of the balloon pressure and volume; to validate the technique for determining the mechanical characteristics of coronary arteries. METHODS: During necropsy examination of the hearts of nine patients, 17 coronary artery samples were obtained for histological examination. A PTCA balloon was inserted into each artery, and the balloon pressure and volume were measured continuously during four repeat automatic inflations of the balloon. RESULTS: Of the 17 arteries, eight showed elastic, six plastic, and three fracture pressure-volume deformation characteristics. For the plastic deformations, the first inflation required a higher pressure than subsequent repeat inflations of 82 (61) kPa (mean (SD), range 25 to 175 kPa). For the three in the fracture group, the pressure drop because of the fracture occurred between 210 and 540 kPa. Two of these three showed a tear on visual inspection, and the other showed disruption of the intimal plaque on blinded histological examination. Of the six with plastic deformation characteristics alone, one showed a tear, and on histological examination two others showed splitting of the internal and external elastic lamina and one showed separation of intima and media. None in the elastic group showed any of these characteristics. CONCLUSIONS: Plastic and fracture deformation characteristics could be differentiated from elastic characteristics. Visual or histological evidence of fracturing was present in all three arteries identified during angioplasty as having pressure-volume fracture characteristics.

Angioplasty, Balloon, Coronary↗