Improve Laboratory Efficiency Research Articles

Dissection‐based Audiovisual Modules to Supplement Laboratory‐based Human Anatomy Education

The notion of “doing more with less” is ubiquitous. At the University of Guelph, over 500 undergraduate students attend the human anatomy program yearly. Courses are accompanied by weekly dissection‐ and prosection‐based laboratories. Dissection‐based audiovisual modules were developed to ameliorate the high student to teaching assistant (TA) ratio, improve laboratory efficiency, promote deep learning (DL), and ultimately improve the overall educational experience.Through high‐definition videography, photography, and anatomical illustration, the modules capture a regional‐based dissection for the first 12 weeks of the course (back, upper limb, thorax, and abdomen). Each module is comprised of three chapters; 1) an introduction, presenting learning outcomes and objectives of the laboratory; 2) an overview, using hyper‐lapse videography to demonstrate the full dissection in a minute; 3) the main chapter, presenting the dissection procedure and techniques to achieve laboratory goals, along with important anatomical relationship and concepts. The modules are packaged in a user‐friendly, multiplatform package, offering interactive quizzes, supplementary resources, and user tracking.The revised two‐factor study process questionnaire (RSPQ‐2F) was used to measure students' approach to learning. An extended version of the course experience questionnaire (CEQ) was used to quantify the students' subjective course experiences. Weekly laboratory exit surveys were used to quantify the students' module usage characteristics. Additional data such as age, sex, and overall GPA average were collected during the semester. Lastly, focus group sessions were conducted with students and TAs.Dissection students utilized the modules 240% more than prosection students over the length of the semester (Di: 110.2 ± 8.17 min, Pro: 45.8 ± 10.8 min, t(73.22) = 4.76, p = < .0005, d = .54) (Fig. 1). Morning dissection laboratories which typically initiate new dissections utilized the modules 186% more than the afternoon dissection laboratories (AM: 143.6 ± 14.4 min, PM 77.2 ± 6.7 min, 45.8 ± 10.8 min, t(173.94) = 3.96, p = < .0005, d = 0.50). Module usage peaked during the deep back and axilla dissections, and dipped during the practical exam review laboratories, suggesting students focused on reviewing from the donors (Fig. 2). Lastly, as students became more self‐directed throughout the semester, module usage was reduced (Fig. 2).Overall CEQ score increased by 7.93 points when compared to the previous year (t(228) = 3.71, p < .0005, d = 0.25). The highest categorical increase was attributed to the “Clear Goals and Standards” scale, with a 20.35 point increase (t(228) = 5.84, p < .0005, d = 0.39). There was no significant correlation between module usage and deep approach scores. However, positive correlation was observed between module usage and the deep strategy subscale (rs(242) = 0.155, p = .023).TA focus groups suggests students relied less on the TAs for basic identification and guidance questions, providing TAs with more time to explain important anatomical relationship and concepts. Responses for student focus groups and surveys suggests expedience of this tool and need for online availability as a pre‐laboratory study resource. Overall, data suggests that dissection‐based modules are an effective supplementary tool for laboratory‐based human anatomy education.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Improving Laboratory Efficiency in the Caribbean to Attain the World Health Organization HIV Treat All Recommendations.

Scientific evidence showing the benefits of early initiation of antiretroviral therapy (ART) prompted World Health organization (WHO) to recommend that all persons diagnosed as HIV positive should commence ART irrespective of CD4 count and disease progression. Based on this recommendation, countries should adopt and implement the HIV "Treat All" policy to achieve the UNAIDS 90-90-90 targets and ultimately reach epidemic control. Attaining this goal along the HIV treatment cascade depends on the laboratory to monitor progress and measure impact. The laboratory plays an important role in HIV diagnosis to attain the first 90 and in viral load (VL) and HIV drug resistance testing to reinforce adherence, improve viral suppression, and measure the third 90. Countries in the Caribbean region have endorsed the WHO HIV "Treat all" recommendation; however, they are faced with diminishing financial resources to support laboratory testing, seen as a rate-limiting factor to achieving this goal. To improve laboratory coverage with fewer resources in the Caribbean there is the need to optimize laboratory operations to ensure the implementation of high quality, less expensive evidence-based approaches that will result in more efficient and effective service delivery. Suggested practical and innovative approaches to achieve this include: (1) targeted testing within HIV hotspots; (2) strengthening sample referral systems for VL; (3) better laboratory data collection systems; and (4) use of treatment cascade data for programmatic decision-making. Furthermore, strengthening quality improvement and procurement systems will minimize diagnostic errors and guarantee a continuum of uninterrupted testing which is critical for routine monitoring of patients to meet the stated goal.

Comparative Characterization of Aroma Compounds in Merlot Wine by LiChrolut-EN-Based Aroma Extract Dilution Analysis and Odor Activity Value

It has been challenging to select the best method to extract and analyze aroma-active compounds in wine due to high concentration of alcohols in the sample. The objectives of this study were to investigate the applicability of a LiChrolut-EN-based solid-phase extraction (SPE) for wine aroma extraction and to characterize the aroma-active compounds in Merlot wine. Volatile compounds in a Merlot wine were extracted with Lichrolut-EN SPE or liquid-liquid extraction (LLE) followed by solvent-assisted flavor evaporation (SAFE). Both extracts were used for aroma extract dilution analysis (AEDA). Selected aroma-active compounds were further quantitated and their odor activity values (OAV) were calculated. Both SPE and LLE extracts can be used for aroma extract dilution analysis. The odorants with high flavor dilution (FD ≥ 64) values in Merlot wine were ethyl 2-methylpropanoate, ethyl butanoate, ethyl 2-methylbutanoate, ethyl 3-methylbutanoate, ethyl hexanoate, ethyl octanoate, 3-methylbutyl acetate, 2/3-methyl-1-butanol, 2-phenylethanol, acetic acid, 2-methylpropanoic acid, butanoic acid, 3-methylbutanoic acid, hexanoic acid, β-damascenone, E-whiskeylactone, γ-nonalactone, 3-(methylthio) propanol, 4-hydroxy-2,5-dimethyl-3(2H)-furanone, 2-ethyl-4-hydroxy-5-methyl-3(2H)-furanone, sotolon, vanillin, guaiacol, and eugenol. Quantitative analysis and calculated odor activity value (OAV) suggested that ethyl butanoate, ethyl 2-methylbutanoate, ethyl hexanoate, 3-methylbutyl acetate, ethyl octanoate, ethyl acetate, 2/3-methyl-1-butanol, butanoic acid, 3-methylbutanoic acid, hexanoic acid, β-damascenone, and acetaldehyde could be the major contributors (OAV ≥ 5) to Merlot wine aroma. Lichrolut-EN SPE was generally comparable with LLE to obtain wine aroma compounds. SPE extract had higher flavor dilution values for esters, and lower for acids and some alcohols than LLE, which is advantageous to study aroma-active compounds in alcoholic beverages due to less interferences from alcohol and acid and improved chromatography. This study confirmed the applicability of LiChrolut-EN SPE as an alternative extraction method for wine aroma characterization to improve laboratory efficiency and minimize the usage of organic solvent.

Compatibility of preparatory procedures for the analysis of cortisol concentrations and stable isotope (δ13C, δ15N) ratios: a test on brown bear hair.

The measurement of naturally occurring glucocorticoids and stable isotopes of several elements has gained importance in wildlife studies in recent decades and opened a myriad of ecological applications. Cortisol and stable isotopes equilibrate in animal tissues over periods of integration related to the growth rate of the tissue, providing information reflecting systemic cortisol secretion and dietary intake. Sample preparation shares the common step of first cleaning the sample of external contamination. However, it is not well understood how different solvents used in sample preparation affect isotopic and cortisol values, and whether it is safe to follow the same procedures for both measures to optimize analyses of the same sample. We conducted an experiment to compare different preparation protocols for the analysis of cortisol concentrations and stable carbon (δ13C) and nitrogen (δ15N) isotope ratios in hair. Hair samples from 12 brown bears (Ursus arctos) were each divided into five aliquots; two aliquots were rinsed with a 2:1 chloroform:methanol (v/v) mixture with one aliquot ground prior to cortisol analysis and the other left intact for stable isotope analyses; two aliquots were washed with methanol with one aliquot ground prior to cortisol analysis and the other left intact for stable isotope analyses; and one aliquot washed with methanol and ground prior to stable isotope analyses. The cortisol, δ13C and δ15N values remained consistent following all treatments. Our results indicate that hair samples rinsed with a 2:1 chloroform:methanol mixture or washed with methanol can be used for both types of analyses. Further, hair that has been ground in a standard hair cortisol procedure can also be used for stable isotope analysis. This information is important for improving laboratory efficiency and compatibility of procedures used for wildlife physiological ecology studies where concurrent measurements of cortisol and stable isotopes in hair are required.

Dieting – a very risky business? Simultaneous determination of anti-diabetic and weight-loss agents in herbal and dietary supplements

The presence of undeclared pharmaceuticals, including drugs that have been withdrawn from the market, in anti-diabetic and weight-loss herbal and dietary supplements can pose a serious health risk to consumers; they also undermine confidence in legitimate products. To protect consumers from potentially harmful products that are marketed as dietary supplements, the Drug QC Laboratory, Qatar is involved in the testing of herbal and dietary products. Traditionally this testing has required a combination of several analytical methods which presents a substantial investment of time and resources. To improve laboratory efficiency a single UPLC-MS/MS method was developed for the supplement screening followed by a confirmatory method based on multiple reaction monitoring (MRM) analysis. Screening analysis comprised LC/MS with automated searching against an in-house generated MS spectral library. Confirmation and quantification was performed by MRM analysis. The developed method was applied to 654 supplements submitted to our laboratory in 2014-15. Analysis revealed that 42 herbal anti-diabetic and weight lost products were tainted with undeclared registered or banned drugs, namely sibutramine (n = 30), phenolphthalein (n = 21), glibenclamide (n = 4), metformin (n = 4), phenformin (n = 2), pioglitazone (n = 1), fluoxetine (n = 2), orlistat (n = 1), methylephedrine (n = 1) and methamphetamine (n = 2). Five hot beverages tea and coffee were found to contain a combination of sibutramine and phenolphthalein.

Impact of cord blood banking technologies on clinical outcome: a Eurocord/Cord Blood Committee (CTIWP), European Society for Blood and Marrow Transplantation and NetCord retrospective analysis.

Techniques for banking cord blood units (CBUs) as source for hematopoietic stem cell transplantation have been developed over the past 20 years, aimed to improve laboratory efficiency without altering the biologic properties of the graft. A large-scale, registry-based assessment of the impact of the banking variables on the clinical outcome is currently missing. A total of 677 single cord blood transplants (CBTs) carried out for acute leukemia in complete remission in centers affiliated with the European Society for Blood and Marrow Transplantation were selected. An extensive set of data concerning CBU banking were collected and correlations with clinical outcome were assessed. Clinical endpoints were transplant-related mortality, engraftment, and graft-versus-host disease (GVHD). The median time between collection and CBT was 4.1 years (range, 0.2-16.3 years). Volume reduction (VR) of CBUs before freezing was performed in 59.2% of available reports; in half of these the frozen volume was less than 30 mL. Cumulative incidences of neutrophil engraftment on Day 60, 100-day acute GVHD (II-IV), and 4-year chronic GVHD were 87, 29, and 21 ± 2%. The cumulative incidence of nonrelapse mortality (NRM) at 100 days and 4-year NRM were, respectively, 16 ± 2 and 30 ± 2%. Neither the variables related to banking procedures nor the interval between collection and CBT influenced the clinical outcome. These findings indicate a satisfactory validation of the techniques associated with CBU VR across the banks. Cell viability assessment varied among the banks, suggesting that efforts to improve the standardization of CBU quality controls are needed.

Refining peripheral blood smear review rules for neonatal inpatients in a South African academic laboratory

Peripheral blood smear review (PBSR) is a labour-intensive test, and skilled morphologists are in short supply. It is therefore helpful for laboratories to establish rules for PBSR to improve laboratory efficiency. Previously published guidelines in this regard are useful, but make few recommendations specific to neonates. Neonatal blood is characterized by several peculiarities which would be considered pathological if present in adults. Consequently, smear review rules (SRR) are often triggered in neonates without significant value being added on review. This study aimed to assess and fine-tune the SRR triggered in neonatal samples in order to improve laboratory efficiency. Full blood counts collected from 188 neonatal inpatients of the Chris Hani Baragwanath Academic Hospital in South Africa were retrospectively reviewed, the triggered rules documented, and the value added on PBSR determined. Smear review rules were triggered in 148 (78.7%) samples, with significant morphological abnormalities identified in 84 (54.4%), and a false-positive rate of 34.0%. In patients with unhelpful review, the commonest rules triggered were the flags querying the presence of abnormal lymphocytes, blasts or nucleated red blood cells. When one or more of these flags were triggered in the absence of any other SRR, PBSR was always noncontributory. Disregarding these flags in the current cohort would reduce both the review and the false-positive rates by >20% without increasing the false-negative rate. False-positive smear review is common in neonates, and minor modifications to SRR can substantially reduce the smear review rate without increasing the false-negative rate.

Impact of Laboratory Test Use Strategies in a Turkish Hospital

ObjectivesEliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH) and calculate potential savings in costs.MethodsA collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months.ResultsLaboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6–85.0%) was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars.ConclusionHospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory tests.

Capillary Microsampling of Mouse Blood in Early Pre-Clinical Studies: A Preferred Alternative to Dried Blood Spot Sampling

Recent advances in sensitivity of analytical instrumentation has resulted in the routine practice of low-volume blood sampling in pre-clinical pharmacokinetic studies. Mice, the species of choice in oncology, have a limited blood volume; hence demand a small volume sampling strategy to avoid unwanted physiological side effects. When assessing drug exposure in mice, a serial sampling methodology requires less than 20 μl of blood per time point in order to comply with animal welfare guidelines. Various microsampling techniques have been employed in pharmacokinetic studies to achieve exact sampling of low blood volumes. The aim of this work was to explore capillary microsampling as an alternative methodology to dried blood spot sampling for the analysis of whole blood in mouse pharmacokinetic studies. Concentration-time profiles of both blood sampling techniques were compared following intravenous administration of four compounds to female Balb C mice. In each case pharmacokinetic parameters from the two different sampling methods were equivalent. Compared to dried blood spots, capillary microsampling provided an inexpensive, reliable and robust method for low volume sampling in the pre-clinical pharmacokinetic setting. In vivo and bioanalytical workflows were integrated with the result of improving laboratory efficiency and lowering consumable costs. Compared to the previous blood spot method there was an improvement in animal welfare through faster handling times due to refined microsampling procedures.

Automated saliva processing for LC-MS/MS: Improving laboratory efficiency in cortisol and cortisone testing

ObjectivesThe aim of this study was to implement in our routine practice an automated saliva preparation protocol for quantification of cortisol (F) and cortisone (E) by LC-MS/MS using a liquid handling platform, maintaining the previously defined reference intervals with the manual preparation. Design and methodsAddition of internal standard solution to saliva samples and calibrators and SPE on μ-elution 96-well plate were performed by liquid handling platform. After extraction, the eluates were submitted to LC-MS/MS analysis. The manual steps within the entire process were to transfer saliva samples in suitable tubes, to put the cap mat and transfer of the collection plate to the LC auto sampler. Transference of the reference intervals from the manual to the automated procedure was established by Passing Bablok regression on 120 saliva samples analyzed simultaneously with the two procedures. ResultsCalibration curves were linear throughout the selected ranges. The imprecision ranged from 2 to 10%, with recoveries from 95 to 116%. Passing Bablok regression demonstrated no significant bias. ConclusionsThe liquid handling platform translates the manual steps into automated operations allowing for saving hands-on time, while maintaining assay reproducibility and ensuring reliability of results, making it implementable in our routine with the previous established reference intervals.

Improving Laboratory Efficiency by Automation of Preanalytic Processing of ThinPrep Specimens for Real-Time PCR High-Risk HPV Testing.

Cervical specimens collected in liquid-based cytology (LBC) media are the most common sample type used for high-risk human papillomavirus (HPV) testing. Since preanalytic steps such as vortexing and decapping vials, liquid transfer to a sample input tube with matching unique identifier, and recapping the original vials are required for processing LBC samples prior to running the Abbott RealTime High Risk HPV assay (Abbott, Wiesbaden, Germany), a full manual execution can be complicated, especially in high-throughput diagnostic contexts. Here, a custom-configured worktable setup for the Tecan Freedom EVO (Tecan, Männedorf, Switzerland) designed to automate and control preanalytic steps for ThinPrep (Hologic, Marlborough, MA) samples was used to evaluate the impact of automated versus manual preanalytics. Archival results for manual processing of 226 samples were compared with those obtained with the Tecan protocol, observing a very good overall concordance for final assay interpretation (95.6%). High overall agreement (100%) resulted also from retesting 99 samples by both the preanalytical protocols. High reproducibility was observed analyzing 23 randomly selected samples by automated preprocessing in triplicate. Hence, the new configuration of the Tecan platform translates the manual steps required to process ThinPrep specimens into automated operations, controls sample identification, and allows for saving hands-on time, while maintaining assay reproducibility and ensuring reliability of results, making it suitable for screening settings.

Implementation of an Electronic Laboratory Notebook to Accelerate Data Review in Bioanalysis

Electronic laboratory notebooks increase opportunities for collaboration and information exchange when compared with paper records. Depending on the degree of implementation, a laboratory- or enterprise-wide system can unify the collection, review and dissemination of data to improve laboratory efficiency and productivity. The advantages of an electronic laboratory notebook for speeding data review in bioanalysis are discussed, through the use of validated templates and organizational constructs to block errors in real-time and reduce manual audit tasks.

Direct analysis in real time-mass spectrometry (DART-MS) for rapid qualitative screening of toxic glycols in glycerin-containing products

In 2007, the United States Food and Drug Administration released guidance recommending testing of glycerin used in regulated consumer products, such as cough syrup preparations, toothpaste, and other pharmaceutical and food products, for the toxic compounds ethylene glycol and diethylene glycol. Regulatory laboratories routinely test glycerin, and products containing glycerin or related compounds for these toxic glycols, using an official gas chromatographic method, to ensure the safety of these products. The current work describes a companion technique to compliment this GC-FID method utilizing Orbitrap mass spectrometry with direct analysis in real time ionization to rapidly screen these samples qualitatively, with results in as little as five seconds, with no sample preparation required. This allows the more time and resource intensive method to be reserved for those rare cases when these compounds are detected, potentially greatly improving laboratory efficiency. The technique was evaluated for qualitative sensitivity and repeatability, and compared against the GC-FID method. The method appears to perform well against these metrics.

Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction

BackgroundIn selected patients, stress-only SPECT imaging has been proposed as an alternative to rest-stress SPECT imaging to improve laboratory efficiency and reduce radiation exposure. The impact of attenuation correction (AC) upon interpretation, post-test patient management and cardiac risk stratification in relation to stress-only imaging is not well understood. ObjectivesThe purpose of this study was to determine the clinical value for laboratory throughput and predicting outcomes of normal and abnormal stress-only SPECT imaging with AC in a consecutive series of clinically referred patients. MethodsA retrospective analysis of 1,383 consecutive patients who were scheduled for stress-only SPECT imaging for symptom assessment of suspected myocardial ischemia was performed. All images had been interpreted and categorized using the standard 17-segment model without AC followed by AC. Follow-up data for 2.1 ± 1.3 years after SPECT imaging for the occurrence of cardiac events (non-fatal MI, cardiac death, and cardiac revascularization) previously collected by routine methods were reviewed. ResultsNon-AC SPECT image interpretation revealed that 58% (802/1383) of patients had abnormal stress images. AC image interpretation of the abnormal non-AC images re-classified 83% (666/802) of these as normal. Among patients with abnormal stress images after AC (136/1383), 63% (86/136) returned for additional rest scans, while the remaining 37% (50/136) were clinically managed without further rest images. The incidence of cardiac death or non-fatal MI was very low in patients with normal stress-only scans (0.7%). ConclusionA strategy of stress-only imaging with AC in symptomatic patients is an efficient method which appropriately identifies at risk and low-risk patients yielding a low percentage requiring rest imaging. Clinical decisions can be made based on abnormal stress-only imaging without further rest imaging if clinically appropriate.

Clinical role of the Duke Activity Status Index in the selection of the optimal type of stress myocardial perfusion imaging study in patients with known or suspected ischemic heart disease

BackgroundExercise treadmill stress myocardial perfusion imaging (MPI) with single photon emission computed tomography is commonly used to evaluate the extent and severity of inducible ischemia as well as to risk stratify patients with suspected and known coronary artery disease (CAD). Failure to reach adequate stress, defined as not attaining age-appropriate metabolic equivalents (METs), can underestimate the extent and severity of ischemic heart disease, resulting in false negative results. This study evaluates the efficacy of the Duke Activity Status Index (DASI), a simple self-administered 12-item questionnaire, as a predictor of METs achieved by treadmill stress testing. MethodsThe DASI was prospectively administered to 200 randomly selected men and women referred to the nuclear cardiology laboratory at New York University Langone Medical Center for stress MPI. Each patient was asked to complete the 12-item DASI questionnaire independently. 136 patients underwent treadmill exercise with MPI and 64 had pharmacologic stress with MPI. The association between exercise capacity in METs as estimated by the DASI questionnaire and performance on the Bruce treadmill protocol in METS was compared using chi-square statistics. ResultsOver 70% of those patients whose DASI score predicted the ability to perform <10 METs were unable to exercise beyond stage 2 of the Bruce protocol (7 METs). For those whose DASI score predicted ability to perform >12.5 METs, over 80% of patients reached >stage 2 of the Bruce protocol with 40% reaching beyond stage 3 (10 METs). When patient age was incorporated into the calculation, a more linear relationship was observed between predicted and obtained METs. ConclusionThe DASI is a simple self-administered questionnaire which is a useful pretest tool to determine a patient’s ability to achieve appropriate METs. In the nuclear cardiology laboratory, the DASI has the potential to guide selection of exercise treadmill vs pharmacologic stress and ultimately improve laboratory efficiency.

MATRIX-ASSISTED LASER DESORPTION IONIZATION-TIME OF FLIGHT MASS SPECTROMETRY FOR THE IDENTIFICATION OF BACTERIA AND YEASTS IN A CLINICAL MICROBIOLOGICAL LABORATORY: A REVIEW

Recently, MALDI-TOF MS devices designed for use in clinical laboratories have been commercially introduced in various large centres worldwide. All published studies conclude that MALDI-TOF MS can be implemented easily for routine identification of bacteria and yeasts in a clinical microbiological laboratory. Although all data show that MALDI-TOF MS correctly identifies the great majority of isolates processed routinely, it cannot yet identify every such isolate. Until today, MALDI-TOF MS is inappropriate for the identification of Shigella species, pneumococci and viridans streptococci. Database upgrades and sample enrichment are essential elements to refine the MALDI-TOF MS technique, allowing the method to increase its power.For the identification of a significant proportion of yeasts, an extraction method prior to analysis in the mass spectrometer is mandatory to obtain appropriate spectra. Because of the low marginal costs, and the extreme speed of MALDI-TOF MS, the technique can improve laboratory efficiency when used early in identification protocols. Lengthier, more labour-intensive, and costlier techniques can be reserved for the minority of isolates not identified with high confidence by MALDI-TOF MS.MALDI-TOF MS also has the potential to directly identify pathogens in biological fluids, such as urine samples and blood cultures. For this application however, further well-designed prospective studies are warranted. The potential for identification at the serotype or strain level, and antibiotic resistance profiling within minutes make MALDI-TOF mass spectrometry an ongoing revolution in the clinical microbiology laboratory.

Digitized microscopy in the diagnosis of bladder cancer

Fluorescent in situ hybridization (FISH) analysis of urine samples has proven to be a valuable adjunctive test to urine cytology for both diagnosis and monitoring recurrence of urothelial carcinoma. Automated FISH analysis has the potential to improve laboratory efficiency and to reduce interobserver and intraobserver variability, resulting in more accurate, reproducible, assay performance. A total of 3200 slides containing urine specimens, hybridized with the UroVysion Bladder Cancer Kit (Abbott Molecular, Des Plaines, Illinois), a 4-probe set for chromosomes 3, 7, 17, and 9p21, was evaluated at Acupath Laboratories. The slides were analyzed over a 7-month period, using the Ikoniscope - oncoFISH bladder Test System (Ikonisys, New Haven, Connecticut). Analysis included the incorporation of a "flagging" system developed by Acupath Laboratories to identify cases, based on specific criteria, likely to benefit from further manual review. By using US Food and Drug Administration (FDA)-cleared scoring criteria, 96.3% of the slides could be reported directly from the automated scan, requiring no manual review of the slide. For the remaining 3.7% of the samples (all of which were very hypocellular), a manual review of each slide subsequently allowed diagnoses to be successfully reported. The average scan time was 31.7 minutes, and the average slide scan review time was 8.3 minutes. This study demonstrated the value of an automated approach to the analysis of FISH slides, affording the benefit of high-throughput while providing the user with the necessary images and tools to quickly and accurately report a case.

Colouring within the lines: improving laboratory efficiency whilst maintaining compliance with quality standards

This diagnostic genetic laboratory sought to enhance operating efficiency by increasing automation levels, and by improving the throughput of existing processes. The aim of this project was to ensure that compliance with the regulatory framework of the National Pathology Accreditation Advisory Council (NPAAC) standards¹ was maintained by this strategy. A continuing consultative process was undertaken with both scientific and management staff. Education regarding the NPAAC standards was provided throughout. The increase in automated equipment necessitated a laboratory reconfiguration. Options were canvassed and assessed using a visual scaled system. The only compliant reconfiguration identified by this process required changing the designated role of each room in the laboratory. The efficiency of the proposed reconfiguration was trialled through use of dynamic mapping to detail movements during various processes. A sequential process of moving equipment was designed to ensure the ability of the laboratory to continue operating with compliance. Efficiency of DNA decontamination procedures was assessed using sensitive PCR-based assays. In conclusion, this project provided a valuable perspective on laboratory quality improvement strategies, and the application of these within the context of accreditation standards.

Automation, Lean, Six Sigma: Synergies for Improving Laboratory Efficiency

Automation, Lean, Six Sigma: Synergies for Improving Laboratory EfficiencyThe Pathology Services worldwide, surrounded by products are today requesting solutions. The approach aims towards the brain-to-brain cycle between caregivers and laboratory professionals. Despite budgets limited to 2-3% of total healthcare expenses, Laboratories are providing information for &gt; 70% of medical actions. »Perianalytics« is becoming the focus; understanding information and sample flow in the whole journey and processes. Process analysis is the main component to understand and shape the best combination of components in designing a truly cost-effective Laboratory solution. Methodologies like Lean (or Toyota Production System) and Six Sigma have started recently to be adopted also in healthcare and in the Laboratory environment. Those techniques showed already successful implementations in healthcare, after their development in other sectors. Their tools are addressing the definition of »value«, »waste«, »flow« as key drivers to improve performances. The synergy among the methods allows decision makers to identify the degree of automation really necessary in their laboratory, with streamlined processes. The different platforms made available by industries, forin vitrodiagnostic testing, could become not cost-effective or efficient without a careful assessment of needs, pathways and value-related variables. Total laboratory automation or stand-alone islands for systems can be identified and chosen after process mapping and recommendations deployed with Lean and Six Sigma techniques. This article highlights some key concepts of Lean and their fit in laboratory organization, as methodologies to be implemented before selecting and adopting automated systems.

Bone Marrow Cytogenetics Workup: Application of Lean Management System to Determine if Additional Cell Workup is Helpful and Necessary to Analysis

High workload volumes in a Cytogenetics laboratory can lead to long result turn-around times (TAT). This study aimed to improve laboratory efficiency by adopting Lean Management System initiatives to increase productivity through the elimination of wastes. This study examined if the prerequisite 20-cell analysis was sufficient for a conclusive result or if additional cell workup was necessary to ascertain the presence of a previous chromosome abnormality among cases on follow-up, or when a single abnormal cell was encountered during the analysis to determine the presence of a clone. The karyotype results of cases that had additional workup were retrieved from among 8040 bone marrow cases of various haematological disorders performed between June 2003 and June 2008. Of 8040 cases analysed, 2915 cases (36.3%) had additional cell workup. Only 49 cases (1.7%) led to the establishment of a clone. The majority of these cases could have been resolved without the additional workup, especially if fluorescence in situ hybridization (FISH) or polymerase chain reaction (PCR)-based assays had been utilised. This study shows that the additional workup procedure is redundant. The time saved by discontinuing the workup procedure can be used to analyse other cases, leading to increased laboratory efficiency and a faster TAT without compromise to patient care. The practice of additional workup over and above the 20- cell analysis should be dispensed with as little benefit was derived for the amount of additional manpower expended. FISH or PCR-based assays should be utilised to elucidate a case further.