Laboratory Errors Research Articles

PSEUDOTHROMBOCYTOPENIA A CLINICAL UPDATE

Pseudothrombocytopenia is a complex phenomenon common nding in clinical laboratory error, misdiagnosis, inappropriate analysis caused due to various factors like time, temperature, technique, anticoagulants used for collecting samples, and few disease conditions the underlying mechanism is autoantibodies forming the clumping of the platelets which is interpretive as low platelet count, the present article discuss on various factors, mechanism and measures to correct the error and management of the pseudothrombocytopenia.

Abdominal Hysterectomy for Benign Gynecological Diseases

OBJECTIVES This study aims to assess the Pap smear screening method’s accuracy in detecting precancerous lesions. METHODOLOGY After fulfilling the inclusion criteria patients were selected, the patient’s bladder was emptied and put in a dorsal position, and Cusco’s speculum was introduced after lubrication followed by insertion of Ayer’s spatula, applied on the transformational zone, and rotated in 360 degrees. Specimen smeared on glass slides and sent to the laboratory with fulfilled lab pre-requisite form. Patients were requested to follow up with a histopathology report. RESULTS Mean age of the patient was 38.111+9.461 years. Among the 77 patients whose samples were taken 15.4% were asymptomatic, 32.1% with vaginal discharge, 17.9% vaginal discharge,17.0% with intermenstrual bleeding and 16.7% were having lower abdominal pain with p value=0.087. Histopathology reports were interpreted upon follow-up visit among those 1.3% came out to be positive for malignancy, 76.6% negative for malignancy while 22.1% had an inadequate sample. CONCLUSION The most common method for screening for cervical cancer is the Pap smear, but its efficacy in detecting early precancerous lesions is very low, possibly due to laboratory error or false technique to a gynecologist of sample technique in our tertiary care hospital. Other screening methods should be used instead of conventional Pap smear.

ROLE OF PAP SMEAR TEST: FROM SCREENING TO CURE IN TERTIARY CARE HOSPITAL

OBJECTIVE This study aims to assess the Pap smear screening method’s accuracy in detecting precancerous lesions. METHODOLOGY After fulfilling the inclusion criteria patients were selected, the patient’s bladder was emptied and put in a dorsal position, and Cusco’s speculum was introduced after lubrication followed by insertion of Ayer’s spatula, applied on the transformational zone, and rotated in 360 degrees. Specimen smeared on glass slides and sent to the laboratory with fulfilled lab pre-requisite form. Patients were requested to follow up with a histopathology report. RESULTS Mean age of the patient was 38.111+9.461 years. Among the 77 patients whose samples were taken 15.4% were asymptomatic, 32.1% with vaginal discharge, 17.9% vaginal discharge,17.0% with intermenstrual bleeding and 16.7% were having lower abdominal pain with p-value=0.087. Histopathology reports were interpreted upon follow-up visit among those 1.3% came out to be positive for malignancy, 76.6% negative for malignancy while 22.1% had an inadequate sample. CONCLUSION The most common method for screening for cervical cancer is the Pap smear, but its efficacy in detecting early precancerous lesions is very low, possibly due to laboratory error or false technique to a gynecologist of sample technique in our tertiary care hospital. Other screening methods should be used instead of conventional Pap smear.

S3450 Atypical Endoscopic and Clinical Presentation of Strongyloidiasis

Introduction: Strongyloidiasis is a helminthic parasitic infection caused by the nematode Strongyloides stercoralis. Due to its replication cycle within the human host, acute infection classically presents sequentially with skin irritation, dry cough, and then non-specific gastrointestinal (GI) symptoms. Mild GI and dermatologic symptoms appear to be more prevalent in chronic infections. Here we present a case of strongyloidiasis manifesting in atypical symptoms with normal endoscopic findings. Case Description/Methods: An 81-year-old female with a medical history of diverticulosis, hypertension, type 2 diabetes mellitus, hypercholesterolemia, and chronic kidney disease was admitted to the hospital for anorexia, abdominal pain, and unintentional 26-pound weight loss over 6 months. Computed tomography of chest, abdomen, and pelvis revealed a moderate left-sided pleural effusion and uncomplicated sigmoid diverticulitis. Pleural fluid studies showed exudative features, with negative cultures and cytology. She was started on ciprofloxacin and metronidazole for diverticulitis. The patient also had a chronic iron deficiency anemia with an average hemoglobin of 7.4 g/dL. Absolute eosinophil count, total IgE, sedimentation rate, and c-reactive protein were elevated. Enteroscopy up to the mid jejunum appeared normal except for a 4 cm hiatal hernia. Random duodenal biopsies showed chronic active duodenitis with several eosinophils and parasitic organisms (Figure). Colonoscopy was deferred due to acute diverticulitis. Strongyloides serum antibodies were positive. Stool studies were not analyzed due to lab errors. The patient was treated with oral ivermectin 200 mcg/kg/day for 14 days due to concern for disseminated infection and scheduled for an outpatient endoscopy and colonoscopy. Discussion: This case highlights the need to keep parasitic infections on the differential when patients present with symptoms concerning for malignancy, such as weight loss, anemia, abnormal laboratory markers, and new pleural effusions. While S. stercoralis has been found to mimic inflammatory bowel disease, it has not been associated with diverticulitis thus far. In addition, typical endoscopic findings include edematous and erythematous mucosa with white villi, however, this patient had normal endoscopic findings despite the extent of her infection. The duodenal biopsies aided in making the diagnosis for this case and should be considered in patients with similar presentations.Figure 1.: Duodenal biopsies showing chronic active duodenitis with several eosinophils and parasitic organisms.

Evaluation of preanalytical and postanalytical phases in clinical biochemistry laboratory according to IFCC laboratory errors and patient safety specifications.

IntroductionThe aim of the study was to determine the current state of laboratory’s extra-analytical phase performance by calculating preanalytical and postanalytical phase quality indicators (QIs) and sigma values and to compare obtained data according to desired quality specifications and sigma values reported by The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Working Group – Laboratory errors and Patient Safety.Materials and methodsPreanalytical and postanalytical phase data were obtained through laboratory information system. Rejected samples in preanalytical phase were grouped according to reasons for rejection and frequencies were calculated both monthly and for 2019. Sigma values were calculated according to “short term sigma” table.ResultsThe number of rejected samples in laboratory was 643 out of 191,831 in 2019. Total preanalytical phase rejection frequency was 0.22%. According to the reasons for rejection, QIs and sigma values were: “Samples with excessive transportation time”: 0.0036 and 5.47; “Samples collected in wrong container” 0.02 and 5.11. In December, QIs and sigma values were: “Samples with excessive transportation time”: 0.01 and 5.34; “Samples collected in wrong container”: 0.03 and 4.98. The postanalytical QIs and sigma values were: “Reports delivered outside the specified time”: 0.34 and 4.21; “Turn around time of potassium”: 56 minute and 3.84, respectively. There were no errors in “Critical values of inpatients and outpatients notified after a consensually agreed time”.ConclusionsExtra-analytical phase was evaluated by comparing it with the latest quality specifications and sigma values which will contribute to improving the quality of laboratory medicine.

NBI International Colorectal Endoscopic–derived high-confidence optical diagnosis of small polyps compared with histology: understanding errors to improve diagnostic accuracy

Developments in image-enhancing endoscopy and polyp classification systems have led to a number of gastroenterology societies endorsing an optical diagnosis (OD) approach for small polyps at colonoscopy. In this study we performed a root-cause analysis of ODs to determine the most likely causes of OD error. As part of a prospective feasibility study, DISCARD3 (Detect InSpect ChAracterise Resect and Discard 3), evaluating implementation and quality assurance of a "resect and discard" strategy for consecutive small polyps<10mm, a root-cause analysis of 184 cases of high-confidence OD error was performed. In all cases, histopathology underwent a second blinded review and, where discrepancy persisted, further review with deeper levels. After a root-cause analysis, 133 of 184 true OD errors were identified and classified into 4 types: A (OD, adenoma; histology, serrated), 45/133 (33.8%); B (OD, serrated; histology, adenoma), 55/133 (41.4%); C (OD, adenoma; histology, normal), 19/133 (14.3%); and D (OD, serrated; histology, normal), 14/133 (10.5%). The remaining 51 of 184 errors were because of a pathology error requiring deeper levels (43/184), pathology observer or laboratory error (7/184), or other error (1/184). OD errors can be related to endoscopist-related factors such as poor photodocumentation, failures of current classification systems, and incomplete histology. We identified a subset of serrated polyps frequently misdiagnosed as adenomas ("pseudoadenomas") using the NBI International Colorectal Endoscopic (NICE) classification. An enhanced algorithm for OD is proposed based on the NICE classification including morphologic and adjunct polyp features.

Multispecies, multisite, multi-age PLS regression models of chemical properties of eucalypts wood using Fourier Transformed near-Infrared (FT-NIR) spectroscopy

Near Infrared Spectroscopy (NIR) is often used to perform high throughput phenotyping on thousands of genotypes using prediction models with high variability. A study was therefore undertaken to analyze the potential of multispecies, multisite and multi-age NIR calibration models of seven chemical properties of eucalyptus wood. The models are based on 358 samples selected among more than 5000 samples that belong to five eucalypt species including hybrids. The samples were collected from trees aged 2-35 originating from four different countries. Spectra were measured on non-extracted wood powders using an FT-NIR spectrometer. Models were established in the spectral range of 9090-4040 cm−1 using the PLS regression method, tested by repeated cross-validation and validated on independent test sets. The results showed that the robust models for total extractives (R2 P = 0.91, RMSEP = 1.20%, RPD = 3.3) and KL (R2 P = 0.89, RMSEP = 1.21%, RPD = 3.0) provided good predictions. These two properties were the best predicted, followed by the S/G ratio (R2 P = 0.84, RMSEP = 0.19, RPD = 2.5) and ASL content (R2 P = 0.81, RMSEP of 0.54, RPD = 2.3). For holocellulose, alphacellulose, and hemicelluloses contents, the models provided approximate predictions. The prediction errors were always less than twice of the laboratory errors except for ASL and S/G ratio. For total extractives and ASL, β-coefficients of models were of approximately the same magnitude throughout the 9000-4000 cm−1 region while for the five other properties, they were higher in the 7500-4000 cm−1 region. Models were also established in narrower NIR regions, and the quality of models obtained was about the same as that of the models based in the 9090-4000 cm−1 wide range. These established robust models can be used to make predictions based on samples of high variability.

Study of pre-analytical errors in clinical biochemistry laboratory in Dhiraj General hospital, Piparia

Introduction: Pre-analytical errors is the major source of mistakes in laboratory diagnostics. It includes from order of test by physician to sample is ready for analysis. Preanalytical errors are upto 70 % of errors of total diagnostic process. Objectives: 1. To evaluate the pre-analytical errors during pre-analytical testing process; 2. To formulate the possible corrective measures to be taken to minimise such errors. Materials and Methods: A prospective study was done for a period of 2 months from January 2022 to February 2022 in clinical biochemistry laboratory, central laboratory, Dhiraj general hospital, Piparia. All types of preanalytical errors were recorded. Total 15189 specimens were received during this period. Out of which 569 were sorted with pre analytical errors. Results: They were categorised as follows: Improper test request forms (n-91), Improper labelling (n-118), Insufficient sample (n-121), invalid samples (n-127), sample mix ups (n-18), Delay in sample transportation (n-32), Wrong timing for Collection (n-37), sample not received (SNR) (n-17), Sample from IV running area (n-08). Conclusion: The overall percentage of rejection found is 3.75 %. Hemolysis was the most common cause for sample rejection in clinical laboratory.

Non‐invasive and rapid quality assessment of thermal processed and canned tender jackfruit: NIR spectroscopy and chemometric approach

SummaryThermal processing of tender jackfruit is a promising approach to enhance its shelf life and thereby retain the health benefits associated with its inherent antioxidants and phytochemicals. This research looked at the prospective and suitability of near‐infrared reflectance (NIR) spectroscopy (900–1700 nm) to assess the biochemical properties namely ascorbic acid (AA), total flavonoid content (TFC), and total phenolic content (TPC) of thermally treated (pasteurisation and sterilisation) tender jackfruit stored under different preservatives (2% brine, 0.1% KMS, and 0.3% citric acid) for a period of 5 months. The partial least square regression (PLSR) models were developed by using both raw as well as pre‐processed spectra. The pre‐processing of spectral data diminished the prediction accuracy of models. The models developed with raw spectral data reported best prediction accuracies for AA ( = 0.628; RMSEcv = 0.416 and RPDcv = 1.763), TFC ( = 0.915; RMSEcv = 1.909 and RPDcv = 3.719), and TPC ( = 0.882; RMSEcv = 0.032 and RPDcv = 3.013) as compared to models developed with pre‐processed spectral data. However, the lower prediction accuracies were observed in standard normal variate (SNV) pre‐processed data for AA ( = 0.449; RMSEcv = 0.51), TFC ( = 0.500; RMSEcv = 4.628), and TPC ( = 0.396; RMSEcv = 0.072). The standard error (SEP) values of AA, TPC and TFC were almost 1.5–2 times the standard error of laboratory (SEL); this implies the developed models have excellent performance. The results obtained in the present study affirmed that NIR spectroscopy in conjunction with appropriate chemometric techniques can be used for the rapid assessment of biochemical properties of thermal processed and canned tender jackfruit during transportation and storage.

JORDFALLET AT BOHUS: REINTERPRETING THE 14C DATING OF A MEDIEVAL LANDSLIDE EVENT

ABSTRACTRadiocarbon (14C) dating has, since its inception, become an integral part of disciplines such as geology and archaeology, underpinning many key findings made by researchers in the past seven decades. As 14C dating develops, the need arises to revisit older findings and legacy data which may well contain laboratory errors or post-analysis misinterpretations. In this paper we examine one such finding from Sweden, namely the 1958 14C dating of the great Jordfallet (“the Earthfall”) landslide, which was published in the very first volume of Radiocarbon in 1959. We further trace how the results of this 14C dating were misunderstood in a time prior to modern radiocarbon calibration, and the impact which this mistake has had throughout academic publications, state reports and local heritage literature through the course of over sixty years. Because of this flawed interpretation the credible date of 1249 AD given to the landslide by historical sources has been overlooked. Instead, a series of dates from the mid-12th and early 13th centuries have been attributed to the landslide event based on erroneous radiocarbon analysis, a mistake which has substantial implications for the understanding of both regional and international history in medieval Scandinavia.

Analysis of preanalytical errors in a clinical chemistry laboratory: A 2-year study.

Patient safety and medical diagnosis of patients are mainly influenced by laboratory results. The present study aimed to evaluate the errors in the preanalytical phase of testing in a Clinical Chemistry diagnostic laboratory.A review was conducted at the Clinical Chemistry Laboratory of a hospital in Saudi Arabia from January 2019 to December 2020. Using the laboratory information system, the data of all canceled tests and requests were retrieved and evaluated for preanalytical errors.A total of 55,345 laboratory test requests and samples from different departments were evaluated for preanalytical errors. An overall rate of 12.1% (6705) was determined as preanalytical errors. The occurrence of these errors was found to be highest in the emergency department (21%). The leading preanalytical errors were nonreceived samples (3.7%) and hemolysis (3.5%). The annual preanalytical errors revealed an increasing rate in outpatient and inpatient departments, while a decreasing rate was observed in the emergency department. An increased rate of errors was also noted for the 2-year study period from 11.3% to 12.9%.The preanalytical phase has a significant impact on the quality of laboratory results. The rate of error in the study was high and the leading causes were nonreceived samples and hemolysis. An increased occurrence of hemolyzed samples in the outpatient department was noted. Enhanced educational efforts emphasizing specimen quality issues and training in sample collection among hospital staff must be carried out.

The Value and Challenges of Internal Error Tracking in Anatomic Pathology Quality Management

Abstract A case of a sudden increase in reports of a specific error in the anatomic pathology laboratory is evaluated, yielding insights into the value, challenges, and limitations of using error reports as a quality management tool. The discussion considers the utility of a robust error-reporting system for anatomic pathology laboratories and identifies key factors at each step to improve success. Initial reporting must be easy and rewarding to reporters, and they must have confidence that reporting will not result in adverse impacts on coworkers. Categorization of common errors simplifies reporting, investigation, tracking, and data presentation. Response to errors should focus on addressing system design failures, while also providing nonjudgmental, nonpunitive feedback to individuals. Error categories can be chosen for systematic quality improvement projects based on severity and frequency of the error. When monitoring trends in error data, it is important to remember that the data are very sensitive to changes in reporting rates as well as changes in error rates, so they must be interpreted with great caution.

O-004 The bias is out of the bag: IVF culture dish well number influences embryo selection decision-making and implantation outcome

Abstract Study question Is there a selection bias against embryos placed in higher-numbered wells inside a multi-well IVF culture dish. Does this selection bias alone impact implantation outcomes? Summary answer Top-quality embryos present in higher-numbered wells are statistically less likely to be selected for transfer, independent of any differences in quality or development between wells. What is known already Substantial intra-and inter-observer variability in embryo selection, as well as differences in quality assessment and laboratory environment, have been shown to affect IVF success. Currently many clinics have adopted stringent guidelines to control for human errors and workflow variation. Still, the impact of errors in laboratory and medical procedures was reported as high as 12%. This is particularly relevant for the IVF lab, where high workload and stress influence rate of errors and patient outcome. This groundbreaking study emphasizes how cognitive tendencies are inherent to the embryo selection process. Study design, size, duration This study used a retrospective dataset from three highly experienced fertility clinics (1 US and 2 European clinics). A total of 4,275 Fresh IVF cycles were analyzed. For each treatment cycle, embryo quality grades, corresponding embryo well numbers, day 5 selection and implantation outcomes were documented. All cycles were performed using the EmbryoSlide 12-well culture dish and a time-lapse system. All three datasets were analyzed separately and also combined. Participants/materials, setting, methods For each dataset, three analyses were conducted: (1) total number of selected embryos were calculated for each corresponding well number; (II) the proportion of implanted embryos, relative to the total number of selected embryos, were quantified to calculate the “success rate” for each well number; (II) the distribution of top-quality embryos between wells were quantified and compared. Results were normalized by total number of transferred embryos and IVF implantation success rates reported for each clinic. Main results and the role of chance A negative trend was found between well number, ranging from 1-12, and number of embryos selected for transfer. This trend was significant (p &amp;lt; 0.05) and occurred independently in each dataset. Odds ratios (OR) for the relation between selecting embryos for transfer from wells 1-5, and from 8-12 = Clinic A: 2.16, Clinic B: 1.78, Clinic C: 2.45. Alternative hypotheses were tested: (1) top-quality embryos are clustered in lower-numbered wells during culture; (2) enhanced embryo quality and conditions are found in lower-numbered wells, which should manifest in higher rates of implantation. Results for each clinic showed a statistically even distribution of top-quality embryos between wells (within 2 standard deviations from the mean; not significant), yet ‘success rate’ for transferred embryos increased by well number (by 12-30% between wells 1-5 and wells 8-12; OR = 1.19, 1.06, 1.08 for Clinic A, B, and C, respectively). An inverse trend existed between an embryo’s likelihood of being selected for transfer, and its likelihood of implanting. We conclude that embryologists may tend to select the first acceptable embryo for transfer. Embryos from higher-numbered wells were significantly more likely to implant, since they overcame this bias when equitably evaluated and selected for transfer. Limitations, reasons for caution Though our findings were significant, they need to be repeated on larger datasets with more inter-centre variation, and key embryo culture and outcome variables recorded. Wider implications of the findings This study emphasizes the inherent human error that exists inside IVF clinics. Machine learning systems that reduce human bias and increase objective standardization, even if they are not inherently better than embryologists, would improve implantation rates. Future studies should be directed toward AI based technologies that can accomplish this. Trial registration number Not Applicable

False Negative Results in Cervical Cancer Screening-Risks, Reasons and Implications for Clinical Practice and Public Health.

False negative (FN) results in cervical cancer (CC) screening pose serious risks to women. We present a comprehensive literature review on the risks and reasons of obtaining the FN results of primary CC screening tests and triage methods and discuss their clinical and public health impact and implications. Misinterpretation or true lack of abnormalities on a slide are the reasons of FN results in cytology and p16/Ki-67 dual-staining. For high-risk human papillomavirus (HPV) molecular tests, those include: truly non-HPV-associated tumors, lesions driven by low-risk HPV types, and clearance of HPV genetic material before sampling. Imprecise disease threshold definition lead to FN results in visual inspection with acetic acid. Lesions with a discrete colposcopic appearance are a source of FN in colposcopic procedures. For FAM19A4 and hsa-miR124-2 genes methylation, those may originate from borderline methylation levels. Histological misinterpretation, sampling, and laboratory errors also play a role in all types of CC screening, as well as reproducibility issue, especially in methods based on human-eye evaluation. Primary HPV-based screening combined with high quality-assured immunocytochemical and molecular triage methods seem to be an optimal approach. Colposcopy with histological evaluation remains the gold standard for diagnosis but requires quality protocols and assurance measures.

Falsely elevated serum estradiol in woman of reproductive age led to unnecessary intervention and delayed fertility opportunity: a case report and literature review

BackgroundThe optimal management of patients in reproductive endocrinology relies on the accuracy and validity of sex hormone assays. Endogenous or exogenous substances can compete with the analyte. This competition can result in interfering errors and falsely indicate elevated serum levels. Obvious interference in estradiol assays appears to occur rarely. Consequently, clinicians who are not familiar with the potential of interference could be misled. In addition to unnecessary investigations and interventions and severe mental stress, falsely elevated estradiol results can result in missed or delayed fertility opportunities.CaseA 28-year-old female with pregnancy demand was diagnosed with polycystic ovary syndrome, Hashimoto’s thyroiditis and subclinical hypothyroidism. She was found to have persistently elevated levels of serum estradiol in the early follicular phase (between 527 and 642 pg/mL). Screening workup was performed for nearly 11 months to find the causes. Serum tumor biomarkers were normal. Abdominal and pelvic computed tomography were negative for adrenal or adnexal masses. A left mesosalpinx cyst and benign pathological results were achieved by laparoscopic surgery. Hormonal substances and dietary supplements were absent, as determined by dietary records. Ultrasound confirmed follicles could grow slowly and eventually ovulate. Falsely elevated estradiol levels were suspected due to the discrepancy among high estradiol levels, follicle growth and normal gonadotropin levels. Immunological interference by heterophile antibody was finally verified by two competitive chemiluminescent immunoassay platforms (estradiol levels in the early follicle phase: 619 pg/mL, Siemens ADVIA CENTAUR and 60 pg/mL, Beckman, DxI 800). Successful clinical pregnancy was eventually achieved by combining induced ovulation, ultrasound monitoring and intercourse guidance.ConclusionsAnalytical interference and laboratory error should be suspicious at first when the clinical characteristics contradict the laboratory results of serum hormones. Measuring serum estradiol with another immunoassay platform is an easy and non-time-consuming method to exclude the heterophile interfering.

A study of pre-analytical errors in the clinical biochemistry laboratory of Shri Mahant Indresh Hospital, Dehradun

The aim and objective of study was to categorize and calculate the percentage error of pre-analytical variables in the clinical biochemistry laboratory. A Prospective study was Conducted at Central laboratory Department of Biochemistry Shri Mahant Indresh Hospital for a period of three months from December 2021 to February 2022.During this period different types of pre-analytical errors were monitored. Out of 279,137 samples received during the study period, 152 samples were found to be unsuitable for testing, accounting 0.054% of the rejection. All the samples were rejected due to different types of pre-analytical errors that are due to haemolysis 140 (0.050%) followed by wrong sample 6 (0.0021%), Typing error 3 (0.00107%) and Wrong ID 1(0.00035%).Out of these rejection 148 samples were from IPD and 4 samples were from OPD. Pre-analytical errors occurring in each laboratory have to be checked. In this study pre-analytical errors in IPD samples were more than OPD samples. Such errors are not inevitable and can be avoided with diligent application of quality control, continuing education and effective collection system.

Evaluation of performance in the pre-analytical phase of a clinical biochemistry laboratory in a Tertiary Medical College Hospital

Background: Pre-analytical phase is the major source of errors in a clinical biochemistry laboratory. Aims and Objectives: The study aims to determine the quality of laboratory performance in the pre-analytical phase using quality indicators (QI) specified by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Working Group on Laboratory Errors and Patient Safety and sigma metric scale for both the inpatient and outpatient samples received in the clinical biochemistry laboratory. Materials and Methods: All samples and requisition forms received in the laboratory were examined before analysis. The percentages of the seven QI were calculated. The frequency, percentage, and defects per million rates of each pre-analytical error were calculated. Sigma value was obtained using an online sigma calculator. The laboratory performance was then categorized by the IFCC-based performance levels and sigma-based values. Results: Out of 30,546 samples received during a period of 6 months, pre-analytical errors occurred in 2.8% of them. The highest number of pre-analytical errors was due to hemolysis (29.9%). The outpatient samples showed a desirable to optimum performance with a good sigma value. There were more errors and lower quality-based performance, in the case of inpatient samples. Errors were highest in September at the start of the study followed by a gradual decrease over the next 5 months. Conclusion: The laboratory performance in the pre-analytical phase was found to be favorable and consistent with the international specifications.

Обзор практик применения бережливого производства в клинических лабораториях

The main role of clinical laboratory diagnostics is to obtain reliable, reproducible and timely results that help to make the right clinical decisions. As the literature review shows, there are a number of common problems for many clinical laboratories, such as: long turnaround times, high laboratory costs for consumables, insufficient level of satisfaction with quality of services received by patients and high number of complaints. The use of lean manufacturing can be one way of solving these problems. Purpose of the study is to summarize and analyze the literature regarding the application of lean manufacturing in clinical laboratories. Materials and methods. A literature review was performed using the following abstract databases: Web of Science, Scopus, PubMed, ScienceDirect, Mendeley, and NCBI. The depth of the search according to the time parameter had no limitations. The following keywords were used as search markers: “lean management”, “lean thinking”, “lean six sigma”, “lean tools”, “healthcare”, “health services”, “clinical laboratory”. More than 100 publications were analyzed, from which 28 most representative studies were selected. Results. The implementation of lean production methods provides a reduction in turnaround time, costs and errors in the clinical laboratory, reduces the contamination of biological material at the preanalytical stage and reduces waiting time for services and, as a consequence, reduces the number of patient complaints. Conclusion. The above results indicate that lean production methods can be used in laboratories to solve frequently occurring problems and demonstrate the effectiveness of their application in clinical laboratories.

Predicting the quality of soybean seeds stored in different environments and packaging using machine learning

The monitoring and evaluating the physical and physiological quality of seeds throughout storage requires technical and financial resources and is subject to sampling and laboratory errors. Therefore, machine learning (ML) techniques could help optimize the processes and obtain accurate results for decision-making in the seed storage process. This study aimed to analyze the performance of ML algorithms from variables monitored during seed conditioning (temperature and packaging) and storage time to predict the physical and physiological quality of stored soybean seeds. Data analysis was performed using the Artificial Neural Networks, decision tree algorithms REPTree and M5P, Random Forest, and Linear Regression. In predicting seed quality, the combination of the input variables temperature and storage time for REPTree and Random Forest algorithms outperformed the linear regression, providing higher accuracy indices. Among the most important results, it was observed for apparent specific mass that T + P + ST, T + ST, P + ST, and ST had the highest r means and the lowest MAE means, however, Person's r coefficient for these inputs was 0.63 and the MAE between 9.59 to 10.47. The germination results for inputs T + P + ST and T + ST had the best results (r = 0.65 and r = 0.67, respectively) in the ANN, REPTree, M5P and RF models. Using computational intelligence algorithms is an excellent alternative to predict the quality of soybean seeds from the information of easy-to-measure variables.

RELATIONSHIP OF ORGANIZATIONAL RESOURCES TO PRE-ANALYTIC ERRORS IN BANDUNG CITY PUSKESMAS LABORATORY

Background. Lack of awareness about the role of laboratory services in many developing countries causes a lack of resources which is the main factor that affects the poor quality of laboratory services. Quality control aims to reduce or minimize errors that occur in the laboratory. The laboratory error ranged from 0.012-0.6%. Errors that occur in the pre-analytic stage are the largest, reaching 60-70% of the total laboratory errors. Pre-analytical error data from one of the Puskesmas laboratories in Bandung is 4.7%.&#x0D; Destination. To find out the description of organizational resources, description of pre-analytical errors and to determine the relationship of organizational resources to pre-analytical errors in the Bandung City Health Center Laboratory.&#x0D; Method. This research is a correlation analytic research. The research subjects were laboratory officers at the Bandung City Health Center Laboratory as many as 20 respondents. The resource variable was measured using a questionnaire and the pre-analytic error variable was derived from secondary data.&#x0D; Results. The results of this study indicate that the organizational resources at the Bandung City Health Center Laboratory are 65% quite good, 30% good and 5% not good. Pre-analytical errors in the Bandung City Health Center Laboratory, as much as 20% did not have pre-analytic errors, as many as 80% had pre-analytical errors. There is no relationship between organizational resources and pre-analytic errors in the Bandung City Health Center Laboratory (Sig. 2-tailed 0.422).&#x0D; Conclusion. Most (65%) of Bandung City Health Center Laboratories have good organizational resources. Pre-analytical errors in the Bandung City Health Center Laboratory varied between 0.10-27.03%. There is no relationship between organizational resource variables and pre-analytic errors in the Bandung City Health Center Laboratory.