Office Laboratory Research Articles

A-280 The Good, the Bad, and the Downright Inappropriate reporting of Gram Positive Resistance Genes in a Proficiency Testing Program

Abstract Background Molecular technologies can rapidly identify the pathogen, allowing for the correct antimicrobial agent to be used for initial treatment. Many laboratories have implemented molecular technologies to identify the causative agents of infections from various bodily sources. Screening for potential resistance genes to common antimicrobial agents provides high value to clinicians to help guide optimal antimicrobial therapy selection. CLIA ‘88 required proficiency testing for physician office laboratories in 1994. This was in addition to the requirement for hospital and reference laboratories instituted under CLIA ‘67. This study compares the accuracy of laboratory performance for molecular multiplex platforms in the detection of Gram positive resistance genes from gold standard qualified samples in a novel proficiency program. Methods American Proficiency Institute, an independent proficiency testing provider, reviewed the reporting of various molecular multiplex systems against simulated patient samples in proficiency samples offered in 2023. Participants were instructed to only report resistance genes their systems were capable of testing for, and ensure they were appropriate for the organism recovered. Failure rates for participants were evaluated against an 80% participant consensus standard for detection of resistance genes. Results During the 2023 proficiency year, Gram positive targets were included 14 times in 4 different multiplex programs. Accuracy for correct reporting of resistance genes appropriate for the organism recovered ranged between 71.0%- 100%. Conversely, the number of laboratories reporting resistance genes that were inappropriate for the organism recovered ranged between 2.0% - 67.0%. Conclusions Based on the results reported by participants in API’s proficiency event, Molecular Multiplex platforms are accurately identifying Gram positive resistance genes. However, many participants using both FDA approved and LDT systems reported results for resistance genes that were not applicable for the organism recovered. This inaccurate reporting could potentially lead to inappropriate antimicrobial therapies being prescribed.

Development of Aedes spp Larvae in Media with Various pH and Salinity: Study on Experiment Approach in Laboratory

The development of Aedes spp, a type of mosquito, is closely tied to the water. They can adapt to different aquatic environments regardless of their characteristics. Understanding the traits of Aedes spp and the environmental factors that affect them is crucial for vector control. This study aimed to examine the impact of water acidity and salinity on the development of pre-imago Aedes spp. The observed developments included hatchability of eggs, ability to change from larvae to pupa (ecdysis), transformation from pupa to imago (explosion), and the longevity of the preimago stage. The research followed an experimental approach with a posttest only control group. Mosquito eggs obtained from Semarang Port Health Office Laboratory Semarang were used as research subjects. Data analysis was conducted using the Kruskal-Wallis test followed by the Mann-Whitney test. The tests for pre-imago development were carried out at different average acidity levels (5.2, 6.6, 7.2, 7.4, 8.5, and 9.3) and average salinity levels (0‰, 2‰, 4‰, 6‰, 8‰, 10‰), with four replications. The analysis revealed that there were no significant differences in the development of preimago Aedes spp under various water acidity conditions (egg hatchability pvalue = 0.736, ecdysis p-value = 0.814, explosion p-value = 0.591, longevity p-value = 0.227). However, the salinity analysis indicated different developments in pre-imago Aedes spp under varying salinity conditions (egg hatchability p-value = 0.006, ecdysis p-value = 0.001, explosion p-value = 0.001, longevity p-value = 0.003).

Analytical validation of the PROphet test for treatment decision-making guidance in metastatic non-small cell lung cancer

The blood proteome, consisting of thousands of proteins engaged in various biological processes, acts as a valuable source of potential biomarkers for various medical applications. PROphet is a plasma proteomics-based test that serves as a decision-support tool for non-small cell lung cancer (NSCLC) patients, combining proteomic profiling using SomaScan technology and subsequent computational algorithm. PROphet was implemented as a laboratory developed test (LDT). Under the Clinical Laboratory Improvement Amendments (CLIA) and Commission on Office Laboratory Accreditation (COLA) regulations, prior to releasing patient test results, a clinical laboratory located in the United States employing an LDT must examine its performance characteristics with regard to analytical validity. This study describes the experimental and computational analytical validity of the PROphet test, as required by CLIA/COLA regulations. Experimental precision analysis displayed a median coefficient of variation (CV) of 3.9 % and 4.7 % for intra-plate and inter-plate examination, respectively, and the median accuracy rate between sites was 88 %. Computational precision exhibited a high accuracy rate, with 93 % of samples displaying complete concordance in results. A cross-platform comparison between SomaScan and other proteomics platforms yielded a median Spearman's rank correlation coefficient of 0.51, affirming the consistency and reliability of the SomaScan platform as used under the PROphet test. Our study presents a robust framework for evaluating the analytical validity of a platform that combines an experimental assay with subsequent computational algorithms. When applied to the PROphet test, strong analytical performance of the test was demonstrated.

Analisis Kualitas Depot Air Minum Isi Ulang Yang Ada Di Wilayah Puskesmas Tamalanrea

Introduction: The Minister of Health Regulation (PERMENKES) No. 492 of 2010 states that drinking water is water that goes through a treatment process or without a treatment process that meets health requirements and can be drunk directly. Population growth, which increases rapidly every year, is one of the factors causing groundwater pollution that is getting worse until now, so that the availability of proper drinking water is decreasing. This is what encourages the emergence of business entities that treat raw water into water that is ready to drink. Objective: to determine whether or not the quality of drinking water produced by the Refill Drinking Water Depot in the Tamalanrea Health Center working area is feasible. Methods: The type of research conducted is experimental research which is a physical, chemical and microbiological laboratory study of drinking water produced by the Refillable Drinking Water Depot in the Tamalanrea Health Center area and at the Makassar City Health Office Laboratory based on 32 samples on July 21, 2020. Results: physical parameters can be done by looking and observing directly whether the water is colored, smells, tastes or not. For chemical tests the sample is carried out by the UV-Vis method, microbiological parameters (Escherichia Coli) or the number of Escherichia Coli in the sample. Conclusion: 1. The results obtained from 27 depots (32 samples) studied showed that all depots in the Tamalanrea Health Center area met the requirements (100%) in terms of physical parameters, chemical parameters, where the results obtained that all drinking water from the depot was odorless. 2. The results obtained show that of the 27 depots (32 samples) examined, 18 depots studied in the Tamalanrea Health Center area are Qualified (59.26%) and 9 depots are Not Qualified (40.74%).

Conditions of Chemical Parameters of the Anahoni River to Detect Water Quality

This study aims to analyze the water quality of the Anahoni river due to gold mining by covering chemical parameters (pH, DO, BOD, COD, heavy metal mercury (Hg), iron (Fe), copper (Cu), Cadmium (Cd), Arsenic (As) ) and cyanide (CN).Metal mercury, iron, copper, cadmium, arsenic, and cyanide were tested at the Proling Bogor Agricultural Institute (IPB) laboratory. Meanwhile, DO, BOD parameters were analyzed at the Maluku Provincial Health Office Laboratory. pH and temperature parameters were carried out measured in situ. The pH value of the waters was obtained in the range of 7.1-10.5.The measured DO concentration has a value that varies in the range of 4.6-10.4 mg/L.The concentration of BOD has a value in the range of 0.5-10 .25 mg/L. COD concentrations have values ​​in the range of 1.7-12.11 mg/L. Hg, Fe, Cu, As, and CN metals were detected in water and sediments.

Estimation of Numbers of Testing Personnel and Test Volume in the Clinical Laboratory Improvement Amendments of 1988 Certificate of Accreditation and Certificate of Compliance Laboratories in the United States.

Two major categories of laboratories performing nonwaived testing under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) are the Certificate of Accreditation (CoA) and Certificate of Compliance (CoC) laboratories. Accreditation organizations collect more detailed laboratory personnel information than the Centers for Medicare & Medicaid Services (CMS) Quality Improvement and Evaluation System (QIES). To estimate total numbers of testing personnel and testing volumes in CoA and CoC laboratories, by laboratory type and state. We developed a statistical inference method by using the respective correlations between testing personnel counts and test volume by laboratory type. QIES reported 33 033 active CoA and CoC laboratories in July 2021. We estimated testing personnel to be 328 000 (95% CI, 309 000-348 000), which is supported by the count of 318 780 reported by the US Bureau of Labor Statistics. There were twice as many testing personnel in hospital laboratories as in independent laboratories (158 778 versus 74 904, P < .001). Independent laboratories had the highest test volume per person, which was twice as high as physician office laboratories (62 228 versus 30 102, P < .001). Hospital and independent laboratories comprised 34% of all CoA and CoC laboratories but performed the largest portion of testing (81%). Physician office laboratories, accounting for 44% of all CoA and CoC laboratories, performed a comparatively low proportion of total tests (9%). Numbers of testing personnel vary considerably by laboratory type and across states. These data can provide valuable insight when assessing laboratory workforce training needs and planning for public health emergencies.

Physically Secure Wearable–Wearable Through-Body Interhuman Body Communication

Human body communication (HBC) has recently emerged as an alternative method to connect devices on and around the human body utilizing the electrical conductivity properties of the human body. HBC can be utilized to enable new interaction modalities between computing devices by enhancing the natural interaction of touch. It also provides the inherent benefit of security and energy-efficiency compared to a traditional wireless communication, such as Bluetooth, making it an attractive alternative. However, most state-of-the-art HBC demonstrations show communication between a wearable and an Earth ground–connected device, and there have been very few implementations of HBC systems demonstrating communication between two wearable devices. Also, most of the HBC implementations suffer from the problem of signal leakage out of the body which enables communication even without direct contact with the body. In this article, we present BodyWire which uses an electro-quasistatic HBC (EQS-HBC) technique to enable communication between two wearable devices and also confine the signal to a very close proximity to the body. We characterize the human body channel loss under different environment (office desk, laboratory, and outdoors), posture, and body location conditions to ascertain the effect of each of these on the overall channel loss. The measurement results show that the channel loss varies within a range of 15dB across all different posture, environmental conditions, and body location variation, illustrating the dynamic range of the signal available at the input of any receiver. Leakage measurements are also carried out from the devices to show the distance over which the signal is available away from the body to illustrate the security aspect of HBC and show its effect on the channel loss measurements. For the first time, a through-body interhuman channel loss characterization is presented. Finally, a demonstration of secure interhuman information exchange between two battery-operated wearable devices is shown through the BodyWire prototype, which shows the smallest form factor HBC demonstration according to the authors’ best knowledge.

Hydration and Urine Quality in Workers Exposed to Heat Stress (Study on Ceramic Production Workers)

Workers in the ceramic industry were exposed to high heat stress every day, that can caused dehydration. Dehydration can be identified by urine color, urine pH, and urine specific gravity (USG). It is also necessary to know urine quality to indicate the health condition of workers, including by turbidity, presence of protein, epithelium, bacteria, and leucosit. This research is analytic and descriptive, with a cross-sectional. The population and sample are all workers in the ceramic industry center in Klampok Village, Banjarnegara Regency, Central Java, are 55 workers. The variables studied were heat stress, amount of drinking water consumption, dehydration status, and urine quality. Heat stress is measured using a heat stress meter, the amount of drinking water consumption is identified through interviews, dehydration status is measured through urine examination taken after work and analyzed in the Banjarnegara District Health Office laboratory, including color (with standard urine color indicator), pH (with digital pH), and the USG (with a refractometer). The quality of urine is seen from the turbidity, the presence of protein, epithelium, bacteria, and leucocyte levels that analyzed in the laboratory. Based on the urine pH no worker is dehydrated. However, based on the urine colour, 60% of the workers were dehydrated, and based on the USG, 76.4% of the workers were dehydrateded. The relationship between the amount of water consumption based on urine color, p value = 0,013, and based on USG p value= 0,863. 21,8% urine were cloudy, 91% positive protein, 91% positive leucosite, 96,4% normal epithel, 100% positive contains bacteria. There is a relationship between the amount of drinking water consumption with dehidration status based on urine color.

Is active sitting on a dynamic office chair controlled by the trunk muscles?

Today's office chairs are not known to promote active sitting or to activate the lumbar trunk muscles, both of which functions are ergonomically recommended. This study investigated a newly developed dynamic office chair with a moveable seat, specifically designed to promote trunk muscle controlled active sitting. The study aimed to determine the means by which the seat movement was controlled during active sitting. This was accomplished by quantifying trunk and thigh muscular activity and body kinematics. Additionally, the effect of increased spinal motion on muscular activity and body kinematics was analysed. Ten subjects were equipped with reflective body markers and surface electromyography on three lumbar back muscles (multifidus, iliocostalis, longissimus) and two thigh muscles (vastus lateralis and medialis). Subjects performed a reading task during static and active sitting in spontaneous and maximum ranges of motion in a simulated office laboratory setting. The temporal muscle activation pattern, average muscle activity and body segment kinematics were analysed and compared using Friedman and post-hoc Wilcoxon tests (p≤0.05). Active sitting on the new chair significantly affected the lumbar trunk muscles, with characteristic cyclic unloading/loading in response to the seat movement. Neither thigh muscle activity nor lateral body weight shift were substantially affected by active sitting. When participants increased their range of motion, the lumbar back muscles were activated for longer and relaxation times were shorter. The characteristic activity pattern of the lumbar trunk muscles was shown to be the most likely dominant factor in controlling seat movement during active sitting. Consequently, the new chair may have a potential positive impact on back health during prolonged sitting. Further studies are necessary to analyse the frequency and intensity of active sitting during daily office work.

Междисциплинарный подход к профилактике рецидивов мочекаменной болезни

Urolithiasis is a multifactorial metabolic disease caused by the interaction of genetic, environmental factors and is directly related to lifestyle. Multiple factors influencing the initiation of stone formation and the growth of urinary crystals are presented in the article. Based on the available data, an involvement of various specialists, including urologists, geneticists, physician office laboratory, radiation diagnostics specialists, nutritionists, endocrinologists, immunologists, physiotherapy and balneotherapy specialists, general practitioner, is necessary for effective treatment of patients with kidney stones.

Blood pressure response in exercise is associated with future cardiac structural alterations in hypertensive patients

Abstract Background/Introduction Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) is often observed in individuals without known cardiovascular disease. Although it is generally considered as an abnormal response and a risk factor for hypertension development, its clinical significance remains controversial. On the other hand, regression of left ventricular hypertrophy (LVH) is independently associated with improved cardiovascular outcome. Purpose In this study we aimed to investigate the role of EBPR during exercise in LVH regression in hypertensive subjects over time. Methods 1413 hypertensive subjects, (mean age 57±11 years), 51% males, with baseline office blood pressure (BP) 144/89mmHg were followed for a mean period of 6.4±3.0 years. At baseline and last follow-up visit all patients underwent office BP, laboratory tests and echocardiographical determination of left ventricular mass index (LVMI). At baseline, all subjects underwent treadmill exercise testing (Bruce protocol) in order to identify the presence of EBPR based on the systolic BP elevation at peak exercise (&amp;gt; or =210 mmHg for men and &amp;gt; or =190 mmHg for women). Main outcome variable was LVH Regression/prevention (LVH Regr/prev), defined as: LVH at baseline visit with normal LVMI values at last visit or absence of LVH at baseline and last visit. BP control was considered optimal when the mean of office BP measurements during follow-up was &amp;lt;140/90mmHg. Results 46% of study population presented LVH Regr/prev during follow-up period. Cox-regression analysis, after adjustment for clinical and biochemical variables, revealed that low levels of baseline LVMI (HR=0.98, 95% CI 0.97–0.99, p&amp;lt;0.0001), absence of EBPR (HR=0.81, 95% CI 0.67–0.98, p=0.02) and optimal BP control during follow-up (HR=1.19, 95% CI 1.01–1.56, p=0.03) were independent predictors of LVH Regr/prev during follow-up. Conclusions Beyond optimal BP control, EBPR is a significant predictor of left ventricular mass changes overtime. Hence, ETT can provide clinical relevant information, including EBPR, which may help in the improvement of risk stratification of hypertensive subjects. Funding Acknowledgement Type of funding source: None

Direct Healthcare Costs Associated with Oligoarticular Juvenile Idiopathic Arthritis at a Single Center.

Oligoarticular juvenile idiopathic arthritis (JIA) is a common disease in pediatric rheumatology. The management of oligoarticular JIA can result in a considerable economic burden. This study is a four-year, retrospective cost identification analysis performed to determine the annual direct cost of care for patients with oligoarticular JIA and possible predictive clinical factors. Direct healthcare costs were defined as those associated with office visits, laboratory studies, hospital admissions, joint injections, medications, infusions, radiology tests, and emergency room visits. Disease characteristics and patient information included ANA status, gender, age at diagnosis, duration from diagnosis to initial visit during the study period, and whether uveitis had been diagnosed. We identified 97 patients with oligoarticular JIA eligible for the study. The median age of diagnosis was 4.3 years. Positive ANA were noted in 75% of patients. 34% of patients received at least one intra-articular steroid injection. 32% of patients were prescribed a biologic during the study period, predominantly with other medications, while 23% of patients received only NSAIDs. 20% of patients were prescribed oral steroids. The average total direct medical cost in this study per year for an oligoarticular JIA patient was $3929 ± 6985. Medications accounted for 85% of annual direct medical costs. Clinic visits and laboratory testing accounted for 8% and 5%, respectively. Patient characteristics and demographics were tested for association with direct medical costs by the Wilcoxon rank sum test and Kruskal-Wallis test. Patients who were ANA positive had increased annual costs compared to patients who are ANA negative. ANA-positive patients were found to have statistically significant costs, particularly, in laboratory tests, procedural costs, radiology costs, and medication costs. The results reported here provide information when allocating healthcare resources and a better understanding of the economic impact oligoarticular JIA has on the United States healthcare system.

Clinical Validation and Performance Evaluation of the Automated Vitros Total Anti-SARS-CoV-2 Antibodies Assay for Screening of Serostatus in COVID-19.

ObjectivesEvaluation of serostatus against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as an important tool in identification of exposure to coronavirus disease 2019 (COVID-19). We report on the validation of the Vitros Anti–SARS-CoV-2 Total (CoV2T) assay for qualitative serologic testing of SARS-CoV-2 antibodies.MethodsWe performed validation studies according to Commission of Office Laboratories Accreditation guidelines, using samples previously tested for SARS-CoV-2 by reverse transcription–polymerase chain reaction (RT-PCR). We evaluated precision, analytical interferences, and cross-reactivity with other viral infections; evaluated concordance with molecular and other serologic testing; and evaluated seroconversion.ResultsThe Vitros CoV2T assay exhibited acceptable precision and did not exhibit cross-reactivity with other acute respiratory virus infections. The CoV2T assay exhibited 100% negative predictive agreement (56/56) and 71% positive predictive agreement (56/79) with RT-PCR across all patient samples and was concordant with other serologic assays. Concordance with RT-PCR was 97% more than 7 days after symptom onset. The CoV2T assay was robust to icterus and lipemia but had interference from significant hemolysis.ConclusionsThe Vitros CoV2T assay was successfully validated in our laboratory. We anticipate it will be a useful tool in screening for exposure to SARS-CoV-2; however, the use of the CoV2T and other serologic assays in the clinical management of patients with COVID-19 is unknown and must be evaluated in future studies.

Improving Inferior Vena Cava Filter Retrieval and Success Rates Using an Office Endovascular Center

The Food and Drug Administration recommends that retrievable inferior vena cava filters (IVCFs) be removed 29-54days postinsertion. Nationally, the retrieval rate is around 23-25%. The objectives of this study are to assess the effect of a plan for IVCF retrieval and access to an office endovascular center (OEC) on filter removal rates and to assess the safety of the procedure in an OEC. In this institutional review board-exempt retrospective study, the medical records of all patients who had an IVCF placed or removed in the hospital and OEC setting by one group of vascular surgeons between January 2011 and February 2017 were analyzed. Informed consent was not required for this retrospective chart review. The following data were abstracted: filter model, procedure site, retrieval plan, number of removal attempts, complications attributed to removal, success of removal, and the duration that the filter was in place. Anticoagulation was not discontinued before filter retrieval. Filters were removed under local anesthesia with or without mild conscious sedation. IVCF removal was attempted in all eligible patients, 120 of 191 with IVCFs, whereas 71 patients were lost to follow-up (46), died (19), or the indication changed (6). Of the patients who had filters placed in the hospital (n=161), 62% were removed (n=101), of which 86% had a removal attempt in the OEC, whereas 14% had the filter removed in the hospital. Sixty-three percent of patients who had filters placed in the OEC (n=30) had the filter removed in the OEC (n=19). All patients with a newly placed filter were given an office appointment with a vascular surgeon for evaluation and removal planning. Of patients who had their filter removed at the OEC, all were removed via the jugular approach, resulting in 103 of 106 (97%) successful removals in the OEC. Visipaque (GE Healthcare, Chicago, IL) contrast was used during filter removal. Intravascular ultrasound was not used because the study predates the insurance coverage of this technology in the office laboratory. There was no mortality related to filter removal. In addition, there were no bleeding complications, despite patients remaining on anticoagulant therapy during the removal. In 4% of patients, the filter was removed in less than 3weeks, 30% of patients between 3 and 6weeks, 26% of patients between 6weeks and 3months, and 40% of patients after 3months. Having access to both an OEC and a documented retrieval plan increases the frequency of IVCF removal in a community compared with national rates. Retrievable filters can be safely removed in an OEC with extremely high success and safety. Anticoagulation therapy can be continued during retrieval attempt without increased risk of bleeding.

The need of practical teaching in vocational high school of Automation and Office Management Program

The success of vocational education cannot be separated from the proper management of learning by its objectives. This study aims to explore the pitfalls and the needs of practical teaching in the Vocational High School of Automation and Office Management Program (AOMP) in Yogyakarta city. This research uses a descriptive method with a qualitative approach. The data obtained were analyzed by using the qualitative analysis model of Miles and Huberman with stages: data reduction, presenting data, verifying data, and concluding data. The results of this study show that the complex equations that are occurred in practical learning of the Vocational High School of AOMP are including the absence of practical teaching materials that are relevant to the industry, there is no specific time for practical learning, lack of facilities and infrastructures, deficiency tools and time to use office laboratories, and there are new types of jobs in the office workforce that are difficult to be followed. Moreover, these matters are complicated for schools to be embodied in the form of practical learning, resulting in poorly trained vocational students in doing their duty that fit the areas of expertise learned. This hardship implies that vocational students become less confident in doing their jobs in the industry either during an internship program or when working in the industry. This research is limited to pitfalls that occur in Yogyakarta City and in schools, which are the subject of this research.

Clinical outcomes associated with pathogenic genomic instability mutations in prostate cancer: a retrospective analysis of US pharmacy and medical claims data

Background: Prostate cancer (PC) is a clinically heterogenous disease, and genetic mutations may be useful for patient risk stratification. This retrospective cohort study compared clinical outcomes, pharmacy use, and outpatient resource use in PC patients with and without pathogenic genomic instability mutations, including DNA repair deficiency (DRD) mutations and those in TP53, PTEN, and RB1.Methods: Patients ≥18 years newly-diagnosed with PC between June 2011–March 2016 were identified in medical and prescription claims databases linked to a genomic dataset. All-cause and PC-specific pharmacy use and outpatient resource use (office visits, laboratory tests, radiology examinations, and radiation therapies) over 1, 2, and 3 years and time to evidence of disease progression after PC diagnosis, based on secondary cancer diagnosis codes and treatments received, were evaluated in mutation carriers with ≥1 of 24 gene mutations and in a sub-set of DRD gene mutation carriers, with each compared to non-mutation carriers.Results: Mutation carriers (n = 274) and non-mutation carriers (n = 74) had similar demographic and clinical features. Non-mutation carriers had lower risks of developing metastasis and castration-resistant PC than mutation carriers (hazard ratio [HR] = 0.7, 95% CI = 0.5–0.9; HR = 0.5, 95% CI = 0.3–0.9, respectively) and DRD mutation carriers (HR = 0.5, 95% CI = 0.3–0.7; HR = 0.4, 95% CI = 0.2–0.7, respectively). Compared to non-mutation carriers, mutation carriers had more all-cause pharmacy claims over 2 years of follow-up (74.4 vs 59.1, p = 0.04) and more PC-specific pharmacy claims over 2 years (11.1 vs 6.5, p = 0.01) and 3 years (17.9 vs 9.8, p = 0.01) of follow-up. No differences were observed in outpatient resource use during the follow-up period by mutation status.Conclusion: PC patients carrying ≥1 pathogenic DNA instability mutation, and DRD mutation carriers specifically, had higher clinical burden than non-mutation carriers. Targeted therapies for these patients are needed to reduce clinical burden and associated healthcare resource utilization.

PERSPECTIVES OF LISOTATHOLOGICAL MONITORING BY MATERIALS OF RESISTANCE OF FUSION SCANNING OF FORESTS BY THE EXAMPLE OF ZHYTOMYR REGIONAL MANAGEMENT OF FOREST AND HORTICULTURAL HOLDING

PERSPECTIVES OF LISOTATHOLOGICAL MONITORING BY MATERIALS OF RESISTANCE OF FUSION SCANNING OF FORESTS BY THE EXAMPLE OF ZHYTOMYR REGIONAL MANAGEMENT OF FOREST AND HORTICULTURAL HOLDING

Can mentorship improve laboratory quality? A case study from influenza diagnostic laboratories in Southeast Europe

BackgroundStrengthening the quality of laboratory diagnostics is a key part of building global health capacity. In 2015, the Centers for Disease Control and Prevention (CDC), the Southeast European Center for Surveillance and Control of Infectious Diseases (SECID), WHO European Regional Office (WHO EURO) and American Public Health Laboratories (APHL) collaborated to address laboratory quality training needs in Southeast Europe. Together, they developed a quality assurance (QA) mentorship program for six national laboratories (Laboratories A-E) in five countries utilizing APHL international consultants. The primary goal of the mentorship program was to help laboratories become recognized by WHO as National Influenza Centers (NICs). The program aimed to do this by strengthening influenza laboratory capacity by implementing quality management systems (QMS) action steps. After 1 year, we evaluated participants’ progress by the proportion of QMS action steps they had successfully implemented, as well as the value of mentorship as perceived by laboratory mentees, mentors, and primary program stakeholders from SECID and WHO EURO.MethodsTo understand perceived value we used the qualitative method of semi-structured interviews, applying grounded theory to the thematic analysis.ResultsMentees showed clear progress, having completed 32 to 68% [median: 62%] of planned QMS action steps in their laboratories. In regards to the perceived value of the program, we found strong evidence that laboratory mentorship enhances laboratory quality improvement by promoting accountability to QMS implementation, raising awareness of the importance of QMS, and fostering collaborative problem solving.ConclusionIn conclusion, we found that significant accomplishments can be achieved when QA programs provide dedicated technical mentorship for QMS implementation. Since the start of the mentoring, Laboratory “B” has achieved NIC recognition by WHO, while two other labs made substantial progress and are scheduled for recognition in 2018. In the future, we recommend that mentorship is more inclusive of laboratory directors, and that programs evaluate the amount of staff time needed for mentorship activities, including lab-based assessments and mentoring.

Near point-of-care adoption of Cepheid Xpert® Flu/RSV XC testing within an integrated healthcare delivery network

Flu/RSV testing was implemented in out-patient clinic-based physician office laboratories throughout Pennsylvania. On-site testing reduced the collect-to-result time by 70% when compared to testing in a centralized core laboratory; over- or under-treatment for influenza A and B (measured by anti-viral prescription) was reduced by 15% (P < 0.0001). Antimicrobial prescription was not affected by on-site testing.

KEUNTUNGAN DAN KERUGIAN PENJAMINAN MUTU BERDASARKAN UJI MEMASTIKAN KECERMATAN (POCT)

Laboratory examination especially for critical care such as emergency care, intensive care has been developed near the site of patientcare which is referred to point-of-care testing (POCT). As to the definition of POCT, there are many synonyms such as ancillary testing,satellite testing, and bedside testing, near patient testing, home testing, self-management, patient self-management, remote testing andphysician's office laboratories. Based on evidence-based POCT, the National Academy of Clinical Biochemistry (NACB) has recommendedsome POCT such as coagulation tests, transcutan bilirubin testing, marker for acute coronary syndromes, diabetes mellitus, drugsand ethanol, Infectious disease testing, occult blood test, pH testing, renal function test, intraoperative PTH, renal function test andreproduction test. Some researchers conclude that performing POCT for critical care is efficient, while others found it not efficient,therefore, careful assessment of the advantages and disadvantages is important when implementing POCT. Nurses are the personnelin the acute care unit who often perform POCT; however they desire that laboratory personnel take the responsibility, therefore it isimportant to discuss which personnel are appropriate to conduct quality control of POCT.