Quality Control Reports Research Articles

Differences in laboratory requesting patterns in emergency department in Spain

It is necessary to achieve a reduction in the number of requests for laboratory tests by improving the appropriateness of testing behaviour. The aim of the study was, first, to compare laboratory requiring patterns for emergency department (ED) patients in clinical laboratories of different institutions in Spain; second, to design an appropriateness pre-pre-analytical quality control report based on appropriateness indicators. A call for data was posted on a website. We obtained production statistics for the year 2010 from emergency laboratories at 36 hospitals. Two types of appropriateness indicators were calculated: test request per 1000 ED admissions or related test requesting ratios. In order to explore the inter-practice variability in tests requests, the 'index of variability' was calculated. A pre-pre-analytical quality control report was designed, prepared and sent to each participating laboratory. The savings generated, if each Health-care Department would have achieved the appropriate indicator standard, were calculated. The rate of request of the stat tests ranged from 44 to 412 per 1000 ED patient admissions. There was a high and peculiar dispersion of related test requesting ratio results. If every single laboratory would have achieved the appropriate indicator, we would have saved 1,019,230 urea, 302,511 AST and 316,161 CK unnecessary tests. There are large variations of test requesting in the emergency setting. An appropriateness pre-pre-analytical quality control report was useful for comparing requesting patterns. The study shows the need to unify demand. The key to achieve this goal will be interdepartmental cooperation between ED clinicians and laboratory professionals.

A Simple Tool for Neuroimaging Data Sharing

Event Abstract Back to Event A Simple Tool for Neuroimaging Data Sharing Christian Haselgrove1* 1 University of Massachusetts Medical School, United States Data sharing is becoming increasingly common, but despite encouragement and facilitation by funding agencies, journals [1], and some labs and larger research efforts, there remain political, financial, social, and technical barriers to sharing data [2]. In particular, technical solutions are few for researchers that are not a part of larger efforts with dedicated sharing infrastructures, and social excuses such as the time commitment required to share or the lack of motivation to share can keep data from becoming public [3]. We present a system for sharing neuroimaging data, designed to be simple to use and to provide benefit to the data provider. The system consists of a server at the International Neuroinformatics Coordinating Facility (INCF) and client tools for uploading data to the server. The primary design principle for the client side is ease of use: the user identifies a directory containing DICOM data and provides his INCF Portal user name and (public) identifiers for the subject and imaging session. The client probes the data for metadata and prompts the user for additional or missing information, then anonymizes the data and sends it to the server. The server first checks anonymization of incoming data, deleting data that is not property anonymized. The server then runs quality control routines on the data, and the data and the quality control reports are made public. The user is notified by e-mail when this is complete, and retains control of the data and may delete it from the server if necessary. The result is that in the time required for upload and quality control processing, including a scant minute or two of the user's time, the data is anonymized, made publicly available, and quality control is performed. Recent enhancements to the system are a GUI uploader to better facilitate preparation and upload of data and the addition of diffusion and structural QA procedures. The system now also presents structural and time series QA measures in the context of other data in the database, giving an indication of relative data quality. The client tools and access to the public image database are available at http://xnat.incf.org/. Figure 1 Acknowledgements This work was conducted within the Neuroimaging Datasharing Task Force of the INCF Program on Standards for Datasharing.

SU‐E‐I‐87: Pilot Testing of Software for Automated Remote Quality Control of Digital Mammography Equipment for Use in the Ontario Breast Screening Program

Purpose: We have evaluated the feasibility of using a software package to monitor the results of quality control (QC) testing on digital mammography units in the Ontario Breast Screening Program. The intent is to make the quality control process more efficient for the technologist and physicist, and improve the consistency of test performance and results interpretation. Methods: A DICOM service class provider, “GLADYS” (originally developed at University Hospitals Leuven) was installed at pilot screening sites. All images acquired on the sitesˈ mammography systems are automatically sent to GLADYS over the PACS networks. GLADYS recognizes QC images by predetermined patient names and performs an automated analysis, measuring various parameters and generating summary thumbnail images. Clinical images are de‐identified and the technique factors and dose are extracted for tracking. The QC and dose reports are sent by email to the central monitoring site. At the central site QC image measures are plotted and thumbnail images displayed for artefact evaluation. The patient header information is stored such that dose reports can be generated. Results: GLADYS has been installed at two remote screening sites, and locally for a total of six machines. QC and dose data have been collected for the past 5.5 months. 285 QC images have been analyzed. Artefacts and changes in automatic exposure control or detector behaviour are easily perceived. Dosimetry information from 18282 patient images has been collected, with an average mean glandular dose of 1.3 mGy. Conclusions: The automated analysis works well, and reduces the technologistˈs QC workload. The addition of features to allow for automated immediate feedback to the remote sites of test results to ensure rapid response to detected problems is under development. Incorporation of centralized automatic quality control has the potential to improve the consistency and reliability of the tests and results, while streamlining QC procedures.

A cluster of deaths following influenza vaccination, Israel, 2006

When four deaths occurred in one week among influenza vaccine recipients, the Israeli Health Ministry suspended its 2006 influenza vaccination campaign pending investigation of the causes of death. Medical histories of the deceased vaccinees, quality control reports, and laboratory test results were examined. Prior vaccine use that season and a risk assessment of the vaccinated population were also considered. All four decedents had been treated for cardiac and other chronic diseases, and none had experienced post-injection symptoms suggesting adverse reaction to influenza vaccine. Quality control and laboratory reports confirmed vaccine batch safety, and no adverse effects had been reported among any other vaccine recipients. Investigators found no causal connection between the deaths and the vaccine, and the Health Ministry resumed the campaign. Israeli public health officials viewed the investigation as vital to maintaining broad confidence in the public health system, and in future vaccination campaigns.

Hematopoietic stem cell transplantation in Switzerland: a comprehensive quality control report on centre effect.

Interest groups advocate centre-specific outcome data as a useful tool for patients in choosing a hospital for their treatment and for decision-making by politicians and the insurance industry. Haematopoietic stem cell transplantation (HSCT) requires significant infrastructure and represents a cost-intensive procedure. It therefore qualifies as a prime target for such a policy. We made use of the comprehensive database of the Swiss Blood Stem Cells Transplant Group (SBST) to evaluate potential use of mortality rates. Nine institutions reported a total of 4717 HSCT - 1427 allogeneic (30.3%), 3290 autologous (69.7%) - in 3808 patients between the years 1997 and 2008. Data were analysed for survival- and transplantation-related mortality (TRM) at day 100 and at 5 years. The data showed marked and significant differences between centres in unadjusted analyses. These differences were absent or marginal when the results were adjusted for disease, year of transplant and the EBMT risk score (a score incorporating patient age, disease stage, time interval between diagnosis and transplantation, and, for allogeneic transplants, donor type and donor-recipient gender combination) in a multivariable analysis. These data indicate comparable quality among centres in Switzerland. They show that comparison of crude centre-specific outcome data without adjustment for the patient mix may be misleading. Mandatory data collection and systematic review of all cases within a comprehensive quality management system might, in contrast, serve as a model to ascertain the quality of other cost-intensive therapies in Switzerland.

Hematopoietic stem cell transplantation in Switzerland: a comprehensive quality control report on centre effect.

Interest groups advocate centre-specific outcome data as a useful tool for patients in choosing a hospital for their treatment and for decision-making by politicians and the insurance industry. Haematopoietic stem cell transplantation (HSCT) requires significant infrastructure and represents a cost-intensive procedure. It therefore qualifies as a prime target for such a policy. We made use of the comprehensive database of the Swiss Blood Stem Cells Transplant Group (SBST) to evaluate potential use of mortality rates. Nine institutions reported a total of 4717 HSCT - 1427 allogeneic (30.3%), 3290 autologous (69.7%) - in 3808 patients between the years 1997 and 2008. Data were analysed for survival- and transplantation-related mortality (TRM) at day 100 and at 5 years. The data showed marked and significant differences between centres in unadjusted analyses. These differences were absent or marginal when the results were adjusted for disease, year of transplant and the EBMT risk score (a score incorporating patient age, disease stage, time interval between diagnosis and transplantation, and, for allogeneic transplants, donor type and donor-recipient gender combination) in a multivariable analysis. These data indicate comparable quality among centres in Switzerland. They show that comparison of crude centre-specific outcome data without adjustment for the patient mix may be misleading. Mandatory data collection and systematic review of all cases within a comprehensive quality management system might, in contrast, serve as a model to ascertain the quality of other cost-intensive therapies in Switzerland.

SU-GG-I-92: Comparative Study of US and Brazilian Data of Unshielded Primary Air Kerma Per Patient

PURPOSE According to NCRP 147 (2004), the quantity unshielded primary air kerma per patient at 1m (KP 1) must be used during shielding design for radiological facilities. Although the publication suggests some values, these are based on North‐American clinical routine. Because of this fact, the present study aims to provide estimation of Brazilian values of this quantity. METHODS AND MATERIAL A survey of 2213 values of workload (W ‐ [mA.min / week]), patient workflow (N ‐ [patients/week]) and tube output were conducted. The data was originated on 2002 radiometric and quality control reports performed during the period of 1999 to 2009. Forty‐three different institutions, located in the southern and southeastern of Brazil participated in this analysis. Average workload normalized per patient (W norm ‐ [mA.min / patient]) and tube output (R ‐ [mGy/mA.min]) were calculated by means of statistical quantifying methods of the central tendency and data dispersion. These data were grouped in 15 clinical modalities. RESULTS It was obtained the values of Wnorm equals to (1.33 ± 6.35) mA.min.pac −1 for conventional radiology to and (0.56 ± 0.40) mA.min.pac −1 for chest examinations. These values differs on −27.5% and −6.7% compared to the NCRP 147 data. In contrast, mammography presented values of (10.00 ± 18.77) mA.min.pac −1 against (6.69 ± 3.40) mA.min.pac −1 from NCRP 147. Using the obtained results for the calculation of KP 1 and comparing them with the values suggested by the NCRP 147, differences of 18.7% for conventional radiology and −17.7% for chest x‐rays were found. CONCLUSION Studies around national adaptation of international protocols are important to avoid systematic and unrealistic practice. This study allowed the observation of significant differences compared to NCRP 147 standards, especially in modalities such as mammography. This evaluation also provided information on other modalities, such as interventional radiology, dentistry and veterinary medicine.

Microseismic Monitoring Quality-Control (QC) Reports as an Interpretative Tool for Nonspecialists

Summary In the oilfield industry, microseismic monitoring is widely applied to determine induced fracture network geometry and stress changes in reservoirs. The basic result is usually a map of the distribution of the microseismic events describing the area influenced by injection/production of reservoir fluids (e.g., hydraulic fracturing). As every microearthquake event (i.e., "dot" on the map) is processed individually, it has its own level of location accuracy. To prevent any misinterpretations based on events with low accuracy, quality-control (QC) reports can provide important information regarding location accuracy and other attributes that help in the overall interpretation of the maps, in addition to the standard event location. However, much of the information needed to assess the quality of the data is very specialized and technical, therefore, the figures presented in the QC reports often appear complicated and are not easy to read for the nonspecialist. By introducing easy-to-read figures that summarize the essential information, these reports have become more useful to the occasional user.

CoCAS: a ChIP-on-chip analysis suite

Motivation: High-density tiling microarrays are increasingly used in combination with ChIP assays to study transcriptional regulation. To ease the analysis of the large amounts of data generated by this approach, we have developed ChIP-on-chip Analysis Suite (CoCAS), a standalone software suite which implements optimized ChIP-on-chip data normalization, improved peak detection, as well as quality control reports. Our software allows dye swap, replicate correlation and connects easily with genome browsers and other peak detection algorithms. CoCAS can readily be used on the latest generation of Agilent high-density arrays. Also, the implemented peak detection methods are suitable for other datasets, including ChIP-Seq output.Availability: The software is available for download along with a sample dataset at http://www.ciml.univ-mrs.fr/software/ferrier.htm.Contact: ferrier@ciml.univ-mrs.fr; andrau@ciml.univ-mrs.fr; spicuglia@ciml.univ-mrs.frSupplementary information: Supplementary data are available at Bioinformatics online.

Three years of preanalytical errors: Quality specifications and improvement through implementation of statistical process control

Background: The objectives of this research were to show the most frequent preanalytical sample errors from two distinct patient populations and blood-drawing personnel, to calculate preanalytical quality specifications, and to demonstrate an improvement strategy for patients whose samples have been drawn in the primary health care center by means of a monthly preanalytical quality control report based on statistical process control (SPC). Material and methods: We collected preanalytical errors from the tests requested for hematology, coagulation, chemistry, and urine samples in both populations. To monitor an improvement strategy, we designed a set of indicators. The indicator results for 35 months were entered into the statistical software application, where they were statistically analyzed. The preanalytical quality specifications were calculated using the SPC control charts. The intervention consisted of the sending of a monthly preanalytical quality report to a pilot Decentralized Phlebotomy Center (DPC) and setting up a direct communication channel between the laboratory and the DPC. Results: Fewer errors were observed when the sample drawing was carried out by the laboratory personnel, showing distinct preanalytical quality specifications. Improvements were seen in the DPC after four months of the improvement strategy. Conclusions: We show a practical and effective methodology for the identification, monitoring, and reduction of preanalytical errors using the technology employed in daily total testing laboratory process.

Changes in radiological protection and quality control in Spanish dental installations: 1996-2003

The European Union has established specific directives concerning radiological protection which are obligatory for member States. In addition, all Spanish dental clinics with radiological equipment are required to have an annual quality control check. To analyze the effect of new European legislation on dental radiological practice in Spain and to determine whether it has resulted in lower doses being administered to patients. A total of 10,171 official radiological quality control reports on Spanish dental clinics, covering 16 autonomous regions, were studied following the passing of Royal Decree 2071/1995 on quality criteria in radiodiagnostic installations. The reports, compiled by U.T.P.R Asigma S.A., a company authorised by the Nuclear Safety Council, cover the years 1996 to 2003, which has enabled us to monitor the evolution of radiological procedures in dental clinics over a seven year period. According to the reports for 2003, 77.3 % of clinics complied with EU requirements, using equipment of 70 kVp, 8 mA, 1.5 mm Al filters, with a collimator length of 20 cm. However, non-compliance was detected in approximately a third (30.8%) of the equipment inspected: alterations in the kilovoltage used, exposure time, performance of the tubing, dosage, linearity/intensity of current and acoustic-luminous signal 6.86%. The mean skin dose reached 3.11 mGy for patients who received an x-ray of an upper molar, representing a decrease of 18% over the seven years studied. there has obviously been a general improvement in the parameters studied, but only 77.3% of the installations complied fully with official EU regulations concerning dental radiological protection.

MDQC: a new quality assessment method for microarrays based on quality control reports

The process of producing microarray data involves multiple steps, some of which may suffer from technical problems and seriously damage the quality of the data. Thus, it is essential to identify those arrays with low quality. This article addresses two questions: (1) how to assess the quality of a microarray dataset using the measures provided in quality control (QC) reports; (2) how to identify possible sources of the quality problems. We propose a novel multivariate approach to evaluate the quality of an array that examines the 'Mahalanobis distance' of its quality attributes from those of other arrays. Thus, we call it Mahalanobis Distance Quality Control (MDQC) and examine different approaches of this method. MDQC flags problematic arrays based on the idea of outlier detection, i.e. it flags those arrays whose quality attributes jointly depart from those of the bulk of the data. Using two case studies, we show that a multivariate analysis gives substantially richer information than analyzing each parameter of the QC report in isolation. Moreover, once the QC report is produced, our quality assessment method is computationally inexpensive and the results can be easily visualized and interpreted. Finally, we show that computing these distances on subsets of the quality measures in the report may increase the method's ability to detect unusual arrays and helps to identify possible reasons of the quality problems. The library to implement MDQC will soon be available from Bioconductor.

Electronic Data Processing: The Pathway to Automated Quality Control of Cardiopulmonary Bypass

Electronic data collection during cardiac surgery creates an enormous data source that has many potential applications. After the introduction of the Stockert Data Management System (DMS; Munich, Germany) to our perfusion practice, we recognized that the data could be used for the purpose of quality control (QC). Our aim was to create an automated technique of data analysis and feedback for cardiopulmonary bypass (CPB) procedures. Using visual basic programming, we created a process by which data from the DMS is analyzed and processed in a Microsoft Access database after a CPB procedure. The processing is designed to transfer the collected data to a research database and create a number of CPB quality indicator (QI) parameters, such as mean arterial pressure being less than 40 mmHg for more than 5 minutes or a venous saturation of less than 60% for more than 5 minutes. In the event of QI parameter detection, a QC report is generated and e-mailed to the senior perfusionist and the perfusionist performing the procedure. The introduction of electronic data collection and subsequent development of electronic data processing techniques has enabled us to transfer the data into a readily accessible database and create a data set of perfusion variables and quality indicators for CPB procedures. This data set may be used for immediate automated QC feedback after CPB procedures and direction of performance improvement initiatives through retrospective or prospective data analysis as part of a continuous quality improvement process.

Computer-aided statistical evaluation of the strength data obtained during construction of Khairabad bridge in Pakistan

This paper describes results of computer evaluation of concrete strength test data obtained during construction of the Khairabad bridge in Pakistan. The data were processed using a spreadsheet model the Complete Quality Control Report (CQC Report), a set of statistical tools, and the industry-developed Quality Control criteria. The Complete Quality Control Report was set up to check compliance of concrete with the specified strength requirements, to appraise control over batch-to-batch variations, and to determine the adequacy of testing procedures. Prior to evaluation, the data were analyzed for the presence of doubtful readings, normality, and for the belonging to the same population.

PP-9-18 French association of cytometry quality control report on FCM-DNA content and S-phase fraction

PP-9-18 French association of cytometry quality control report on FCM-DNA content and S-phase fraction

Computer aided evaluation of concrete strength data at the water tower project in Al Kharj, Saudi Arabia—Case study

Compressive strength data representing concrete used to slipform the water tower shaft were evaluated. The evaluation was performed utilizing the computer model, the complete quality control report (CQC Report), which was set up on the basis of the project specification, and statistical methods and criteria given in ACI 214-77. A continuing record of the strength data was maintained and analysed for individual strength tests, cumulative average, moving average, average required strength, overall standard deviation, coefficient of variation, ranges of individual tests, moving range, within-test coefficient of variation, and the adequacy of control over concrete and testing operations. The test data were used for three main purposes: (a) to assist the batch plant in the production of uniform, high quality concrete for slipforming; (b) to determine the adequacy of testing procedures, and (c) towards establishing and refining the statistical relationships for future similar projects. An early indication of the quality of concrete, which is vital for continuous slipforming, was obtained by estimating the predicted 28-day strengths using 1-, 3- and 7-day data and the strength-maturity relationship developed in accordance with ASTM C 918. Based on the total weighted percentage average errors and the integral absolute error it appears that all three sets of early strentth data were approximately equal in their validity as prediction bases. Analyses of test results show that the same prediction equation which was used to determine the potential 28-day strength can also be used, in the reverse form, to specify the early strength criterion for quality control purposes, provided that the data are normally or near normally distributed. Using CQC Report it was possible to process and analyse the vast amount of data in a very short time, and to provide the slipform contractor with key information regarding the probable quality of the concrete as placed. This allowed the contractor to note immediately a descending trend in quality of the concrete, to make corrective adjustments in the manufacturing process and to continue concreting with a high degree of confidence.

Computer files and analyses of laboratory data from tuberculosis patients.

A data management computer system is described for all mycobacteriologic laboratory data from tuberculous patients. A laboratory data file for each patient is maintained in 6 records and printed out in 2 reports; also, laboratory quality control reports are generated monthly and semi-annually. In addition to furnishing a complete mycobacteriologic history of the patient, this file represents a significant source of research data.

COMPUTER HANDLING OF AMBULATORY CLINIC RECORDS.

A computer is used to improve the quality, consistency, and legibility of the patients' records in an ambulatory diabetes clinic of a large, teaching hospital. It has been programmed to produce printed records in a format familiar to the attending physician: the history and physical examination in a narrative style, and the laboratory data in a tabular display. When new data on a patient enter the system, a new report is generated automatically, superseding previous reports. Physicians enter data into the system by completing special forms which are a combination of check-lists and free narrative description. The results of the first six months of the routine operation of the system have encouraged its continued use and have stimulated the development of information searching programs, as well as automatic quality control reports.

Quality Control Reports, Nos. 1-12.

Quality Control Reports, Nos. 1-12.