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At least 145 records · Page 8Linked to original sources
PubMed1994

Medical laboratory audit: performance of twelve selected laboratories in metropolitan Enugu, Nigeria.

The abilities of 12 medical diagnostic laboratories situated in Enugu metropolis to estimate haemoglobin concentration accurately and precisely, by the cyanmethaemoglobin photometric method, were assessed. Nine (75%) of these laboratories showed good precision. Three (25%) were imprecise. As assessed by variance index (VI), only 5 (8.3%) of the entire haemoglobin results obtained from the participating laboratories showed good excellent accuracy (VI = 0 < or = 0.5). Conversely, 16 (26.7%), 9 (15%) and 30 (50%) of the entire haemoglobin results were satisfactory (VI > 0.5 - 1), acceptable (VI > 1 - 2) and rejectable (VI > 2) respectively. Furthermore, only 4 (33.3%) of the laboratories produced haemoglobin results that were both accurate and precise. Non-compliance with desirable practices that ensure quality of laboratory determinations were observed as possible contributing factor to this rather poor performance. The latter underscores the need for institution of external quality control laboratories in Nigeria.

Hemoglobins↗
PubMed1993

[Current state and problems in the microbiology laboratory--organizing the laboratory].

The microbiological laboratory in the hospital has many roles including the rapid and precise identification of pathogenic bacteria in specimens, their antimicrobial susceptibility tests, microbial antigen detection using immunological methods and DNA hybridization methods, surveillance of bacterial milieu of the hospital environment, monitoring quality control of microbiological methods, to educate microbiological skills of staffs, the economical management of laboratory and so on. The last two issues are our major concerns. Improvement of the microbiological skills of the staff is most important in the laboratory, but is a time-consuming. From our experience, a technical expert, intermediately skilled technicians and beginners should always work in the laboratory, together. On the other hand, the economical management of the microbiological laboratory is also another concern. Although the mechanization of procedures comes to mind, it is hard to improve the economical conditions in the laboratory. Because of the control of the machines is not completely automatic and requires the knowledges and decisions of technical experts, the work force and running cost can not be reduced. As the technical expert can economize in the use of media or tests for identification of pathogens, good training of beginners into skillful successors, is important.

Humans↗
PubMed2000

Laboratory managers' perceptions of the impact of teaching on the clinical laboratory.

OBJECTIVE: To determine managers' perceptions of the impact of teaching students on the clinical laboratory, including: productivity, costs, recruitment/new employee orientation, staff morale/attitude, and staff professionalism. Managers' views on responsibility for teaching and reasons for not having students were also determined. DESIGN: Written survey, randomized sampling. PARTICIPANTS: Five hundred laboratory managers certified by the National Credentialing Agency. MAIN OUTCOME MEASURES: Participants completed a forced-choice written survey consisting of demographic information and statements assessing the impact of teaching. RESULTS: Managers agreed with impact statements on professionalism, recruitment, and new employee orientation. They were also in agreement that clinical teaching is essential. Neutral responses were obtained for impact statements related to laboratory productivity, costs, and staff morale and attitude. Over 90% of respondents who presently had students or who had had students at one time indicated that they hired their graduates. CONCLUSIONS: Laboratory managers understand the importance of clinical education and the benefits to recruitment, new employee orientation, and staff professionalism. Managers are undecided about the effects of teaching on laboratory costs and staff productivity.

Administrative Personnel↗
PubMed1985

The laboratory test justified. An effective means to reduce routine laboratory testing.

In an attempt to reduce clinical laboratory testing, a strategy was designed for a clinician-oriented restriction policy imposed on the laboratory test-ordering mechanism. The program examined the requirement of a written justification to accompany test requests. Directed justification, where specified conditions were required for test performance, was applied to the prothrombin and partial thromboplastin times and resulted in a mean reduction of 44% (P less than 0.001) in these tests; a nonspecific justification directive for leukocyte differentials, where any clinical condition listed generated the test, reduced differentials 35% (P less than 0.001). The justification policy then was extended more broadly and applied on a trial basis to general medical wards. Although no review was made on validity of listed test rationalizations, the justification process alone significantly reduced four common laboratory tests from 28% (BUN/creatinine) to 45% (electrolytes); significant reductions were not seen in less frequently ordered tests. The authors concluded that the most common clinical laboratory tests may be reduced by demanding that the clinician perform a clerical justification when requesting these tests. This mild restrictive policy in the ordering process allows the clinician to maintain responsibility over laboratory testing, while effectively reducing laboratory volume.

Attitude of Health Personnel↗
PubMed1997

Health Care Financing Administration/American Society for Cytotechnology inspections: government assessment of cytology laboratory practice under the regulations of the Clinical Laboratory Improvement Amendments of 1988.

Since 1988, the American Society for Cytotechnology has performed inspections of 206 cytology laboratories in the United States under contract to the Health Care Financing Administration. These surveys are conducted by a team of supervisory-qualified cytotechnologists, including a specially trained survey team leader. A board-certified anatomic pathologist is assigned to each team and is on call for each survey. Laboratories are assessed for compliance with the regulations of the Clinical Laboratory Improvement Amendments of 1988 and, in particular, the area of quality control in cytology. These surveys are unique in that a sample of at least 0.1% of a laboratory's annual case volume is reevaluated by the survey team. Of the 206 laboratories surveyed, 116 were found to be in substantial compliance with the regulations while 90 were found to have Condition level deficiencies. Of those with Condition level deficiencies, 8 have had their Clinical Laboratory Improvement Amendments of 1988 certificates limited for cytology, and 16 have been terminated from Medicare participation.

Accreditation↗
PubMed1998

College of American Pathologists Conference XXXI on laboratory monitoring of anticoagulant therapy: laboratory monitoring of oral anticoagulant therapy.

OBJECTIVE: To review the state of the art of laboratory monitoring of oral anticoagulant therapy, as reflected by the medical literature and the consensus opinion of recognized experts in the field, and to make recommendations for improvement in laboratory monitoring of oral anticoagulant therapy. DATA SOURCES: Review of the medical literature, primarily from the last 10 years, and current laboratory practices by a panel of 8 international experts in the field of oral anticoagulant monitoring. DATA EXTRACTION AND SYNTHESIS: After an initial assessment of the literature, key points were identified. Experts were assigned to do an in-depth review of the literature and current practices relevant to each of the key points and to prepare a summary of their findings and recommendations. A draft manuscript was prepared and circulated to every participant in the College of American Pathologists Conference XXXI on Laboratory Monitoring of Anticoagulant Therapy prior to the conference. Each of the key points and associated recommendations was then presented for discussion at the Conference. Recommendations were accepted if a consensus of the 26 experts attending the Conference was reached. The results of the discussion were used to revise the manuscript into its final form. CONCLUSIONS: Consensus was reached on 12 recommendations concerning the laboratory monitoring of oral anticoagulant therapy. Detailed discussion of the rationale for each of these recommendations is found in the text of this article. Discussion of points on which consensus was not reached is also included in the text. It is hoped that widespread adoption of these recommendations will further improve the laboratory monitoring of oral anticoagulant therapy.

Administration, Oral↗
PubMed1993

The laboratory workstation: a data management model for a small laboratory section.

Many small sections of clinical chemistry laboratories fail to benefit fully from laboratory information system (LIS) installation because the volume does not justify cost of interfacing the instruments in these sections to the LIS. The opportunity for manual data entry errors remains a problem in these sections. This paper describes the design of a laboratory workstation that serves as a data hub that makes it feasible to use one instrument interface line from the LIS to acquire data from four instruments. This approach reduces the likelihood of data entry error and improves the efficiency of personnel in the laboratory section. Further, the tools necessary to create such a workstation are commercially available and do not depend on microcomputer programming and support personnel within the chemistry laboratory.

Chemical Phenomena↗
PubMed1976

Cost and quality control of laboratory services: the New York City medicaid centralized laboratory proposal.

Faced with constantly increasing costs for the provision of laboratory services to Medicaid recipients, the New York City Department of Health last year attempted to implement a program to fundamentally restructure the organizational patterns and financing mechanisms of New York City's clinical laboratory industry. The program, based on competitive bidding, gave one laboratory in each of New York's five boroughs exclusive rights to process Medicaid lab samples and replaced presently existing fee-for-service reimbursement mechanisms with a unique system combining unit pricing and capitation. This paper outlines the principal provisions of the City's proposed contract, analyzes the underlying motivations of the City's decision, and describes the reactions of the existing laboratory service delivery system. In addition, the generic problems of implementing effective administrative techniques for cost and quality control of laboratory services are discussed.

Clinical Laboratory Techniques↗
PubMed1999

[Laboratory automation and information technology in clinical microbiology--computerized support system and clinical competence of laboratory physician].

Laboratory automation and new information technology have considerable potential to improve care through protocols that reduce errors and guide diagnosis and therapy. Computer-based decision-support systems are now in place in many hospitals in the USA. For example, optimal decisions about the use of antibiotics in critically ill patients require access to a large amount of complex information, therefore a computerized decision-support program linked to computer-based patient records can assist physicians in the use of antiinfective agents and improve the quality of care. The support systems can educate physicians, guide their clinical reasoning, and measure the quality of the care that they provide. The installation of the computer components of the system is relatively easy, but the human components of the system may be much more difficult to transfer from hospital to hospital. The successful operation of the system should require a high level of clinical competence in every staff member of the hospital. The project should encompass a broad range of complex clinical conditions and decision algorithms. It must not be focused solely on the sophistication of laboratory methods. We, laboratory physicians/clinical pathologists must modify our behavior effectively and accept the value and limitations of laboratory automation and information technology. We must work more closely with physicians and other health care professionals as the best clients of our clinical laboratories and establish a good collaborative partnership with them.

Clinical Competence↗
PubMed1999

[Acquisition of evidence and facts for a consulting service in the department of clinical laboratory to support effective usage of laboratory tests].

We are developing an integrated laboratory information database to share the evidences and facts with clinicians for effective application of diagnostic laboratory tests for the care of individual patients. It includes high quality evidence acquired from the clinical trials and systematic reviews as well as basic information about the analytical method, related disorders and so on of each laboratory test. We should also have the skills to appropriately obtain information from articles about relevant subjects and obtain the original facts from the laboratory database combined with the database from the department of medical records to review diagnostic data of individual cases. These strategies to acquire and accumulate those kinds of knowledge and information are essential for the management of a consulting service room as part of the clinical laboratory department. We must contribute to the improvement of clinical diagnoses and treatments, and serve as professional consultants with the expertise.

Clinical Laboratory Information Systems↗
PubMed1991

[Systematization of clinical laboratory--some problems caused from specimen transport through laboratory reports].

Through error and trials we have designed an ideal system for the clinical laboratory. Truly, it has been a very difficult task requiring our long-term experience working in the clinical laboratory. For example, if we purchase new examination equipment without any consideration or if we decide what type of equipment to introduce according to the common advice of the purchase committee of the hospital or the medical school, then we cannot design an ideal system of laboratory examinations and are forced to invest a large sum of money in vain. Moreover, the use of innumerable examination containers or test tubes which are disposable, can become a financial burden to the hospital. We have been trying to design a system of laboratory automation for more than ten years and have been successful in designing not only a specimen transport system using conveyer-belts but also various kinds of examination robotic systems. This report describes our own examples of designing a system of laboratory automation.

Automation↗
PubMed1999

Lessons learned from the review of cardiac catheterization laboratories: a report from the Laboratory Survey Committee of the Society for Cardiac Angiography and Interventions.

The Laboratory Survey Committee of the Society for Cardiac Angiography and Interventions was created as a resource for physicians and administrators to provide comprehensive independent outside review services for cardiac catheterization laboratories. Since 1989, when the committee began its work, surveys of 23 catheterization laboratories have been completed. Our review of this experience identified several recurring problems among the laboratories. The purpose of this paper is to summarize our experience and highlight the lessons we learned in the hope that this information will benefit many other laboratories.

Cardiac Catheterization↗
PubMed2002

One core laboratory at two international sites, is that feasible? An inter-core laboratory and intra-observer variability study.

To assess the magnitude of differences in QCA outcomes between two cooperating core laboratories in a single trial, we have carried out an inter-core laboratory variability study. Two QCA experts at the Montreal Heart Institute and Heart Core Leiden both analyzed 32 lesions (pre- and post-intervention) in accordance with previously agreed upon standard operating procedures. One of the experts analyzed the whole image set twice to determine the intraobserver variability. The inter-core laboratory differences in the acute gain (n = 31 pairs) are non-significant. The systematic errors of the individual measurements (n = 63 analyses) show an excellent intraclass correlation coefficient of reliability (>75%), except for the stent length (67.7%). The corresponding random errors are small. In general, the intra-observer systematic and random errors are both slightly smaller than those for the inter-core laboratory study. QCA analyses in clinical trials can be carried out in core laboratories at two different locations if and only if highly standardized conditions are maintained.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

The Häma-COM laboratory data management system (LDS): tailor-made computerization of the individual working procedures arising in a hematology laboratory with a high throughput of pathologic samples.

A laboratory data management system (Häma-COM) is presented that is individually adaptable to the different working procedures arising in a hematology laboratory. The Häma-COM can be easily integrated into a hospital and/or another laboratory computer system, providing the facilities of total electronic data transfer between the referring institutions and the laboratory. The system is based on a network of personal computers running Novell Network software and coordinates two hematology analyzers (NE-8000, R-1000) and several microscopic work stations. The entire information provided by the hematology analyzers including scatterplots and histograms is captured by the system, whereby automated results are validated and worklists for further sample workup are created. Corrections of and/or additions to automated analysis results might be directly entered into the system from the respective microscopic working places. The Häma-COM system minimizes the administrative workload without interfering with the individual laboratory organization.

Blood Cell Count↗
PubMed1986

Infection of laboratory workers with hantavirus acquired from immunocytomas propagated in laboratory rats.

Hantavirus has been isolated in cell culture from rat immunocytomas used and stored at a research laboratory in the U.K. where there was evidence of a laboratory-acquired infection leading to haemorrhagic fever with renal syndrome. Both transplantation into LOU/M/Wsl rats and storage of passaged immunocytomas at -70 degrees C over a period of 8-10 years had not eliminated the virus. The isolates were identified as Hantavirus by means of serum obtained from patients with hantavirus infection as well as polyclonal serum derived from laboratory animals. This paper identifies a potential source of hantavirus infection in laboratories. The importing of rats, rat immunocytomas and anti-immunocytoma serum in relation to the potential risks of laboratory-acquired hantavirus infection is discussed.

Animals↗
PubMed1999

Mortality and cancer incidence among laboratory technicians in medical research and routine laboratories (Sweden).

OBJECTIVES: To investigate cancer incidence and mortality among laboratory employees. METHODS: Mortality and cancer incidence were investigated among 2553 female and male laboratory workers employed at the Karolinska Institute and Karolinska Hospital in Stockholm between 1950 and 1989. Mortality was followed from 1952-1993 and cancer incidence from 1958-1992. Expected numbers were based on the general population in Stockholm, standardizing for age, gender, and calendar period. RESULTS: The overall mortality and cancer incidence in the cohort was lower than expected. There were in all 10 cases of hemato-lymphatic malignancies (three acute myeloid leukemias, four non-Hodgkin lymphomas, two Hodgkin's lymphomas, and one multiple myeloma) in the cohort. The standardized incidence ratio (SIR) for hematolymphatic tumors was increased among workers who had ever been employed in laboratories with a high probability for chemical exposure, SIR 224 (95% CI 108-412). The risk of breast cancer among women was increased after more than 10 years of work in high-exposure laboratories, SIR 225 (128-365). The number of malignant melanomas exceeded those expected. CONCLUSIONS: The findings support earlier observations of an increased risk of hematolymphatic cancer among laboratory workers. The routine for handling chemicals and functionality of ventilatory equipment must be under continuous supervision.

Adult↗