National External Quality Assurance Scheme Research Articles

Comparison of traditional GP oral anticoagulation management with a nurse-led service involving near patient testing and computerized decision support

The use of oral anticoagulation therapy in primary care is increasing. We compared general practitioner (GP)-led oral anticoagulation monitoring with a nurse-led service involving near patient testing and computerized decision support (NPT-CDS). The nurse-led NPT-CDS service provided anticoagulation control equivalent to the traditional GP-led service, with identical mean international normalized ratio (INR) values and a nonsignificant trend towards improvement in all other parameters. Recording of indications for anticoagulation and target INR ranges were significantly improved using CDS software. For patients established on warfarin, the GP-led service was costed at £56.88 per patient per year, compared with £63.76 for the nurse-led NPT-CDS service. Patients overwhelmingly preferred the NPT-CDS service for reasons of convenience, avoidance of phlebotomy and improved dosage instructions. Performance of the NPT-CDS service within the National External Quality Assurance Scheme (NEQAS) was satisfactory. In conclusion, nurse-led oral anticoagulation utilizing NPT-CDS is an effective and acceptable alternative to traditional GP-led monitoring. The costs of an NPT-CDS service are higher, but need to be set against factors such as patient satisfaction and escalating GP workload.

Glycated haemoglobin assays. Approaches to standardization of results

To compare different approaches to DCCT standardization of glycated haemoglobin (HbA(1c)) results. In the first part of the study seven laboratories in the Mersey area participated, using a variety of methods of measurement. The approaches used were the Standardization Initiative for Glycated Haemoglobin Scheme (SIGH) using fresh blood samples and the Wales External Quality Assurance Scheme (WEQAS) using both fresh and lyophilized blood samples. Additional studies performed in the Royal Liverpool University Hospital (RLUH) laboratory involved: (i) re-calibration of the HPLC analyser using lyophilized blood samples supplied by the manufacturer and (ii) the use of fresh blood samples from the UK National External Quality Assurance Scheme (UKNEQAS). Inter-laboratory analytical coefficients of variation following DCCT alignment showed little change. The effect on percentage bias was more marked and was independent of the level of HbA(1c). Comparing DCCT-aligned HbA(1c) results from 3902 diabetic patients attending the RLUH, indicated that there was a statistically significant difference (P < 0.0001) between the corrected results produced by the five schemes. The effect of DCCT alignment on reported HbA(1c) values using the different approaches was variable resulting in an apparent increase in the number of diabetic patients with poor glycaemic control (HbA(1c) values > 7.0%) in all cases. The method of HbA1c standardization used determines the degree of correction required and a consensus approach is recommended. Implementation will assist extrapolation from research-based evidence to local practice. Associated changes to patient management must come under the jurisdiction of the physicians responsible for the diabetic service.

A networked computer program for managing a national external quality assurance scheme in cytopathology.

We described a computer program to manage a national external quality assurance (EQA) scheme in cytopathology which uses the international computer network, the Internet, to collect data directly from participants, thereby reducing errors of transcription and administrative costs. Feedback to screeners and pathologists is provided as high quality images of the diagnostic areas on the slide which are only available once all users at a centre have entered their answers. This allows comparison with the original material while it is still available at this site. Users are encouraged to register differences of opinion by labelling areas on images of the slides on the computer. The program performs the statistical analysis of the data for each centre and each slide.

National External Quality Assurance Scheme For Hiv Testing Using Dried Blood Spot: A Feasibility Study

Introduction: Dried Blood Spot (DBS) for National External Quality Assurance Scheme (NEQAS) is becoming popular in resource limited and geographically constrained settings. The feasibility of using DBS for EQAS for HIV testing in Nepal is studied. Methodology: National Public Health Laboratory (NPHL) and fi ve Voluntary Counseling and Testing Centers (VCT) located at the Mid-Western and Central region of Nepal were chosen as the organizing and participating laboratories, respectively. HIV tests were performed on 35 samples using rapid test kits following the National algorithm. Two sets of samples were blotted on a DBS card, dried, packed, stored and posted to NPHL using normal postal delivery. The eluted DBS were tested by rapid test and ELISA and results were compared. Results: All DBS cards were received in a good condition. The rapid test result obtained at VCT and NPHL was 100% concordant. By ELISA, 32 (91.4%) and 3 (8.6%) samples were concordant and discordant, respectively. The sensitivity and specifi city of the rapid test were 88.9% and 94.0%, respectively. The DBS was stable with mean transportation time of 2.25 days and storage time of one month. Conclusion: DBS is an easy, simple, cost effective and a dynamic platform for blood collection in a country like Nepal and can be considered for implementation for NEQAS for HIV testing. DOI: http://dx.doi.org/10.3126/saarctb.v8i2.5897 SAARCTB 2011; 8(2): 23-27