Turnaround Time For Results Research Articles

The influence of chronoanalysis on the delivery of laboratory results in a sugar-alcoholic process

Objective: The objective of this study is to describe the use of the chronoanalysis technique in laboratory processes of a medium-sized industry in the sugar and alcohol segment and its impacts on process improvement, particularly on the response time of analytical results. Theoretical Framework: Chronoanalysis is a technique based on the study of times and movements to identify and eliminate activities that do not add value to the process, aiming to optimize time and improve efficiency. Methodology/Approach: Applied research, with a descriptive objective, based on a case study of a sugar and alcohol plant, addressing qualitative aspects of the quality control sector where it presents the mapping of activities. Results: The application of chronoanalysis concepts allowed the identification and elimination of aspects that did not add value to the process, resulting in a significant reduction in analysis time by 33.65%. This improved the conditions for delivering results and facilitated the identification of flaws in the product manufacturing process. Contributions, practical and social implications: The study demonstrated that the application of chronoanalysis can have a positive impact on the efficiency of laboratory processes, reducing the turnaround time for results and contributing to improving quality and efficiency in the sugar and alcohol industry. Originality/Value: The findings could be highly relevant to other industries wanting to improve their laboratory processes and reduce the risk of non-conformities. Keywords: Chronoanalysis; Study of time and movements; Standard time; Process mapping; Analyses.

The Use of "Cancer Ratio" in Differentiating Malignant and Tuberculous Pleural Effusions: Protocol for a Prospective Observational Study.

Differentiating between tuberculosis and malignancy as the cause of an exudative lymphocyte predominant pleural effusion is difficult due to similarities in the cellular and biochemical characteristics of the pleural fluid in both conditions. Microbiological tests in tubercular pleural effusions have a poor diagnostic yield, and the long turnaround time for results prevents an early diagnosis. The diagnosis of malignant pleural effusion (MPE) is hampered by a variable yield of pleural fluid cytology and closed pleural biopsy and the fact that thoracoscopy may not be readily available or feasible in each patient. A key gap in the existing knowledge is the performance of the serum lactate dehydrogenase to pleural adenosine deaminase ratio (ie, "cancer ratio"; CR) in differentiating between tuberculous and MPE in a high tuberculosis prevalence country like India, although its use has been well established in Western literature. The CR may find a practical application in the community health care settings in low-income countries without ready access to biopsy. This study aimed to evaluate the CR as a test to differentiate tubercular and malignant etiology in patients with an exudative lymphocyte predominant pleural effusion. Secondary objectives to be assessed include a comparison of CR to pleural fluid carcinoembryonic antigen in MPE and the association of histologic type of lung carcinoma to the CR positivity. This hospital-based, prospective, observational study will include patients admitted with pleural effusion whose pleural fluid reports indicate a lymphocyte-predominant exudate. The ability of the CR to discriminate between tuberculous and MPE will be evaluated as a primary objective of this study. The performance of CR and pleural fluid carcinoembryonic antigen in the diagnosis of MPE will be compared using the receiver operating characteristics and area under the curve for both tests as a secondary objective. The association between a positive CR and histologic type of lung cancer will be analyzed as well. Data collection began in June 2022. As of March 24, 2024, we have recruited 22 patients. Outcomes of the study are expected at the end of 2024. The results of this study will provide an objective basis for the use of CR in differentiating between tuberculosis and malignancy as the cause of an exudative lymphocyte predominant pleural effusion. DERR1-10.2196/56592.

Comprehensive Review of Laboratory Automation, Quality Control, And Workforce Adaptation

There is a very close relationship that exists between the increased use of automation technology and the quality of diagnosis as well as the efficiency of the laboratory. Therefore, this review intends to describe the current position of automation for laboratory facilities and sample analysis and investigate its impact on quality control (QC), efficiency, and workforce flexibility. Automated technologies have been integrated into all functional ranges, beginning from sample management to result determination, increasing the sample & result turnaround time and accuracy. Nevertheless, automation and incorporation of technologies in laboratories have their own issues, such as quality assurance, human resource changes, and flow process challenges. This review summarizes the current literature with advances in laboratory automation, quality control, and workforce management, together with implications for the future of laboratories in clinical and research settings.

Enhancing Laboratory Efficiency: Implementing Custom Image Analysis Tools for Streamlined Pathology Workflows

In the field of pathology, the efficient analysis and interpretation of diagnostic images are critical for timely and accurate decision-making. Traditional manual methods for image analysis are often time-consuming, error-prone, and resource-intensive, leading to delays in diagnosis and increased workloads for pathologists. To address these challenges, this paper explores the development and implementation of custom image analysis tools to streamline pathology workflows. The integration of machine learning (ML) algorithms, computer vision techniques, and automation technologies into laboratory settings has the potential to significantly enhance the speed and accuracy of image processing tasks. This study examines how tailored image analysis solutions can optimize tasks such as tissue segmentation, feature extraction, and classification of abnormal cells. The use of such tools not only improves the diagnostic workflow but also reduces human error, enhances reproducibility, and facilitates real-time analysis. Additionally, the paper discusses the practical considerations for implementing these technologies, including software customization, integration with existing laboratory information systems, and user training. By leveraging the power of custom-built image analysis solutions, pathology laboratories can improve operational efficiency, reduce turnaround times for results, and ultimately enhance patient outcomes. The research provides insights into the future of digital pathology and offers a roadmap for laboratories looking to adopt cutting-edge technologies to stay at the forefront of diagnostic innovation.

Antibiotic stewardship with multiplex PCR for pneumonia in intensive care patients: A retrospective study.

Early initiation of targeted antibiotic therapy is important to achieve the best patient outcomes in intubated patients with pneumonia in the intensive care unit (ICU). This study aimed to investigate the applicability of multiplex polymerase chain reaction (PCR) in an ICU by comparing the test results to the results of conventional microbiological methods to assess the possible impact on antibiotic therapy. This retrospective study investigated adult patients with pneumonia on mechanical ventilation in the ICU. Tracheal aspirates were collected within 24h after intubation and the initiation of mechanical ventilation. Samples were initially tested by conventional microbiological methods and subsequently re-evaluated with rapid multiplex PCR on stored samples. Concordance between the two methods was assessed. An intensivist and a microbiologist retrospectively reviewed the patients' electronic health records for relevant clinical details to evaluate the potential impact of multiplex PCR results on antibiotic therapy. In this study, 76 patients were enrolled and 55 (72.4%) tested positive for 95 pathogens using multiplex PCR, while conventional microbiological methods identified 40 pathogens in 32 (42.2%) patients. Concordance between the two methods was observed in 42 (55.3%) patients. Multiplex PCR detected 39 additional pathogens in 31 (40.7%) patients. Retrospective analysis indicated potential antibiotic de-escalation in 35 (46.1%) patients and escalation in 4 (5.3%) patients. Multiplex PCR significantly reduced the turnaround time for test results. In ICU patients with suspected pneumonia, multiplex PCR identified a higher number of pathogens compared to CMM. A retrospective assessment indicates that the use of multiplex PCR could potentially have prompted the de-escalation of antibiotic therapy in nearly half of the patients. Therefore, multiplex PCR may serve as a supplement to CMM in guiding antibiotic stewardship.

The use of a point of care high sensitivity troponin in the investigation of patients presenting to the Emergency Department with undifferentiated chest pain

Abstract Background In 2012 in a hospital, New Zealand, a chest pain pathway was instituted for the use in patients presenting to the Emergency Department (ED) with undifferentiated chest pain. This reduced hospital admissions and ED length of stay (LOS) without adversely affecting outcomes. The pathway consists of risk stratification combined with ECG and troponin testing. The pathway suggests, but does not enforce, that low risk patients can be discharged after a single troponin, intermediate risk patients are for serial troponins (which can be done in ED or the next day in the community), with further testing if appropriate, and high risk patients are reviewed by Cardiology or General medicine. In August 2023, Siemens point of care high sensitivity troponin I (POC-hsTnI) was introduced for the use in ED, although Beckman laboratory troponin I (Lab–hsTnI) is still available. A POC test reduces result turnaround times but until recently there has been a lack of POC assays fulfilling criteria for "high sensitivity". Purpose To ascertain whether the availability of a POC-hsTnI in the ED is a viable option for use in the chest pain pathway Methods A 1 month "snap shot" of all consecutive patients presenting to the ED with chest pain was undertaken and the patients followed for adverse events using electronic notes review. October 2023 was selected for the post POC-hsTnI period and compared with April 2022. Results There were 688 patients presenting to ED with undifferentiated chest pain during October 2023 with a type 1 acute myocardial infarction (AMI) rate of 80 (11.6%), median age 58 (41-72), female 335 (48.7%). POC-hsTnI was used in isolation in 377 (54.8%), in conjunction with Lab-hsTnI in 218 (31.7%) and Lab-hsTnI was used alone in 93 (13.5%). The median turnaround time for POC-hsTnI was 11 minutes (10-11) compared with Lab-hsTnI 87 minutes (61-129). The POC-hsTnI was less sensitive for AMI than the Lab-hsTnI on presentation using the upper reference limit, 72.1% (60.6-81.6) versus 91.5% (83.0-96.4). However, when used with risk stratification, there were no excess adverse events (cardiac death or AMI) at 4 months in patients discharged with a diagnosis of non-cardiac chest pain – 7 (1.4%) (n=495) versus 5 (1.2%), (n=424) in 2022. Median LOS in the ED was 4.4 hours (2.9-6.2) versus 4.0h (3.0-5.9) in 2022. However, a higher proportion of patients had a second cTn: 414 (60.2%) versus 309 (48.4%) and a lower proportion had their second troponin the next day in the community, 28 (6.7%) versus 56 (18.1%). Conclusion The use of a POC-hsTnI is a practical solution to reduce turnaround times for troponin results and has the potential to reduce LOS or allow serial troponins to be measured in a timely manner during their ED visit, obviating the need for a next day community troponin. Whilst POC-hsTnI has a lower early sensitivity for AMI, the use of POC-hsTnI as part of a pathway does not adversely affect outcomes.

A success story in a low-resource setting: Advancing cancer diagnostics in underserved region

Abstract Introduction/Objective Shefaa Al Orman Hospital (SOH) is the first oncology hospital in Luxor. Since its inception in 2016, the hospital has served approximately 45,000 patients from Luxor and other governorates. The hospital’s lab provides excellent routine laboratory services. However, there is a pressing demand for molecular genetics and cytogenetics, that is necessary for diagnosis of hematological malignancies. This strategic expansion faced several challenges: lack of expertise and the need for special expensive equipment and reagents. Methods/Case Report The project started with collaboration with oncologists to convene on a simplified panel with the aim of prioritizing clinically relevant tests. At first, these investigations were referred to a specialized oncology hospital in Cairo. This entailed 2 problems: transport of samples led to deterioration of the quality of some samples and delay in results reporting. In the second phase, experienced consultants from Cairo were enlisted to provide training and mentorship to local staff. Infrastructure setup included the allocation of dedicated laboratory space and the procurement of specialized equipment. Test method selection was used to achieve successful transition. In cytogenetics, we started with FISH technique which, while more expensive, gave rapid and reliable results. After gaining experience, the technique of conventional karyotyping was established. On the other hand, in molecular genetics, we resorted to custom made reagent mix preparation, instead of commercial kits. This approach, while more laborious, is less expensive. Results (if a Case Study enter NA) With the gradual successful in-house setup of these tests, there has been a notable reduction of out-sourced samples to 5%. This has led to shorter result turnaround times. Cytogenetics and FISH improved from 4 to 1 week, while molecular genetics decreased from 4 to 2 weeks. Moreover, the local processing of samples has minimized the risk of sample damage during transportation, ensuring the integrity of test results. Conclusion The establishment of the Molecular Genetics and Cytogenetics Laboratory at SOH represents a significant milestone. The hospital has successfully overcome logistical challenges and enhanced diagnostic capabilities for hematological malignancies, contributing to better patient outcomes and satisfaction. Moving forward, the continued investment in infrastructure, personnel training, and quality assurance measures will further strengthen the hospital’s capacity to provide high-quality cancer care to the community.

Ultrasensitive Rapid Antigen Test by Geometric Lateral Flow Assays and Highly Doped Upconversion Nanoparticles.

The paper-based lateral flow assay (LFA) testing strips are currently the most widely used for point-of-care testing (POCT), valued for their rapid result turnaround times in a few minutes. However, their sensitivity has been limited. Upconversion nanoparticles (UCNPs), especially highly doped ones, have emerged as promising luminescent reporters to enhance the LFA sensitivity. These UCNPs exhibit a nonlinear enhancement in luminescence with excitation power density, necessitating higher power densities for higher brightness. In this study, we utilized a geometric paper strip design to minimize the immune reaction area and maximize the excitation power density, enabling ultrasensitive detection of the SARS-CoV-2 nucleoprotein antigen. This design also slowed the antigen flow on the paper strip, extending the reaction time between antigen and antibody, thereby enhancing the efficiency of the immune reaction. Through this design, our approach achieved over a 100-fold enhancement in the limit of detection (LOD) compared with the widely used LFAs, based on gold colloidal nanoparticles and europium nanoparticles. This innovation expands the scope of LFA applications that require a low LOD.

A-301 Evaluation of Second-Generation Visby Medical Sexual Health Point-of-Care Test: Clinical Concordance, Analytical Error Rates, and Result Turnaround Time

Abstract Background Rapid testing for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis may be useful for antibiotic stewardship initiatives. Our institution recently implemented the second-generation Visby Medical Sexual Health Test (Visby Gen2) for rapid diagnosis of STIs in our emergency department. Here we (1) compared result concordance of the (Visby Gen2) to the first-generation Visby Medical Sexual Health Click Test (Visby Gen1), (2) compared assay failure rates of the Visby Gen1 to Gen2 tests, and (3) compared result turnaround time (TAT) for clinically ordered rapid STI tests to central laboratory STI results. Methods Accuracy was assessed using residual clinical samples in Aptima buffer submitted for routine molecular STI testing (C. trachomatis, N. gonorrhoeae, and T. vaginalis) in the central laboratory on the Panther platform (Hologic). Aptima samples were diluted 1:33 in Visby collection buffer prior to testing on the Visby cartridge. Clinically reported results were used as reference results. Diluted samples with discordant results were re-tested on the reference method and the result from the dilution was used in calculations. Assay failure rates were calculated as the number of failed assays compared to the total assays performed. TAT for rapid and central lab testing was calculated as time of sample received in laboratory to time verified in laboratory information system. Results For Visby Gen1 we observed negative concordance of 100% (41/41) for C. trachomatis, 97.5% (39/40) for N. gonorrhoeae, and 97.1% (34/35) for T. vaginalis. Positive concordance was 91.7% (11/12) for C. trachomatis, 100% (11/11) for N. gonorrhoeae, and 100% (17/17) for T. vaginalis. For Visby Gen1 we observed a 10.5% (12/114) cartridge failure rate. For Visby Gen2, we observed negative concordance of 100% (59/59) for C. trachomatis, 100% (63/63) for N. gonorrhoeae, and 100% (55/55) for T. vaginalis while positive concordance was 100% (10/10) for C. trachomatis, 100% (6/6) for N. gonorrhoeae, and 90.9% (10/11) for T. vaginalis. The Visby Gen2 assay displayed a 4.9% (4/81) cartridge failure rate. Six weeks after implementing the Visby Gen2 assay in our ED, rapid STI panel TAT was 0.48 hours on average (n=20). In the central laboratory the average TAT was 22.31 hours (n=7892). Conclusions Assay concordance to reference method was similar for Visby Gen1 and Gen2 assays. The cartridge failure rate improved by 46.7% with the Gen2 assay which should decrease the need to repeat testing due to assay failure. Result TAT decreased by 97.8% when comparing rapid Visby results to central laboratory. Therefore, Visby STI testing using the Gen2 assay can provide accuracy and rapid results likely to facilitate more rapid patient management.

Optimizing workflow for OncotypeDx result turnaround time from surgery to report at safety net hospital.

317 Background: OncotypeDx test has been widely used for breast cancers patients with early-stage (I-IIIa), hormone-receptor positive, HER2-negative disease. It predicts the benefit of adjuvant chemotherapy in addition to hormone therapy. Delivering OncotypeDx results in a timely manner is important to inform treatment decisions. As a quality improvement project, we implemented a strategy to reduce the Turn Around Time (TAT) from breast surgery to OncotypeDx report at Bellevue Cancer Center, the tertiary referral center of the NYC Health and Hospitals System. Methods: The primary measure was TAT from surgery to receiving OncotoypeDx result in electronic medical record (EMR). We compared TAT before and after implementation of the strategy. The historical control was from 5/2021 through 3/2022, while the group after strategy implementation was from 6/2023 to 1/2024. The strategy revolved around streamlining the identification of eligible patients by collaborating with the breast surgery team, creating and utilizing a smart phrase in the EMR. It also involved ordering OncotypeDx by closely communicating with the pathology department, obtaining insurance approval by working with the OncotypeDx vendor, and tracking OncotypeDx results. The above process was done by a breast surgery provider that offered real time updates in the EMR. Results: The patient groups were similar both before and after implementing the strategy, including patient number (26 and 27 respectively) and patient mean age (61 and 59). The majority of both groups were minority patients (77% and 81%). We found that a higher percentage of patients were from Medically Underserved Areas and Populations (MUA/P) in the group after strategy implementation (35% and 56%). Our strategy reduced the average TAT from 56 days to 30 days. Conclusions: We developed a strategy to optimize the OncotypeDx workflow in a large safety net health system despite an increase in patients from MUA/P. Initiating ordering of OncotypeDx by breast surgery along with communication with pathology and the vendor significantly reduced TAT. EMR integration with OncotypeDx vendor would be the next step to further improve the process. Before Strategy Implementation (n=26) After Strategy Implementation (n=27) Patient Mean Age 61 59 Race (%) White 27 18.5 Hispanic 39 44.4 Black 7 25.9 Asian 23 11.1 Other 4 0 Ethnicity (%) Hispanic 39 44.4 Non-Hispanic 61 55.6 Underserved Area and Population (%) 35 56 Health Professional Shortage Area (%) 50 59 Non-English Speaking (%) 50 40.7

Barriers and facilitators of retention in care after cervical cancer screening: patients’ and healthcare providers’ perspectives

BackgroundCervical cancer continues to threaten women’s health, especially in low-resource settings. Regular follow-up after screening and treatment is an effective strategy for monitoring treatment outcomes. Consequently, understanding the factors contributing to patient non-attendance of scheduled follow-up visits is vital to providing high-quality care, reducing morbidity and mortality, and unnecessary healthcare costs in low-resource settings.MethodsA descriptive qualitative study was done among healthcare providers and patients who attended the cervical cancer screening clinic at Mbarara Regional Referral Hospital in southwestern Uganda. In-depth interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and thematically analysed in line with the social-ecological model to identify barriers and facilitators.ResultsWe conducted 23 in-depth interviews with 5 healthcare providers and 18 patients. Health system barriers included long waiting time at the facility, long turnaround time for laboratory results, congestion and lack of privacy affecting counselling, and healthcare provider training gaps. The most important interpersonal barrier among married women was lacking support from male partners. Individual-level barriers were lack of money for transport, fear of painful procedures, emotional distress, and illiteracy. Inadequate and inaccurate information was a cross-cutting barrier across the individual, interpersonal, and community levels of the socio-ecological model. The facilitators were social support, positive self-perception, and patient counselling.ConclusionsOur study revealed barriers to retention in care after cervical cancer screening, including lack of partner support, financial and educational constraints, and inadequate information. It also found facilitators that included social support, positive self-perception, and effective counselling.

Understanding hospital antimicrobial prescribing decisions and determinants of uptake of new local antimicrobial prescribing guidelines in Laos.

Antimicrobial use in Laos is among the highest in Southeast Asia. The first Lao comprehensive antimicrobial prescribing guidelines have been available since 2021. This study explored the determinants of antibiotic prescribing decisions and how the new prescribing guidelines were being used. In August 2022, in-depth interviews were conducted with 16 Lao prescribers from two hospitals. Participants were questioned about their prescribing behaviours, attitudes to guidelines, how they learned about the guidelines and factors influencing their uptake. The interviews were audio-recorded, transcribed, and translated into English. Thematic analysis of the transcripts was conducted. Lao prescribers considered multiple factors before deciding to prescribe antibiotics to their patients. The most common factor was based on the clinical judgement of the prescribers. Lack of certain antibiotics and turnaround times of laboratory results were the main challenges to prescribing antibiotics appropriately. The majority of participants were satisfied with the guidelines, regarding them as comprehensive, simple and convenient. However, most participants admitted that they did not access the guidelines very often. The main reason was that they could remember the treatment recommendations because they treat similar diseases on a daily basis. Improving antibiotic knowledge was the most common recommendation in order to improve the appropriate use of antibiotics. Raising awareness of the guidelines and promoting their use should also be considered. In addition, heads of the wards, and policy and implementation leaders, should support, monitor and feedback their use to encourage all prescribers to follow the guidelines. Several factors contribute to enhancing appropriate antibiotic prescription. Key factors for improving antibiotic prescription include enhancing prescribers' clinical knowledge, ensuring access to essential antibiotics, and updating guidelines regularly. Health leaders must get involved to promote their use.

Toward Laboratory Notification in Pediatric Emergency Departments.

This study explores how patient's laboratory result are accessed in pediatric emergency departments. The rapid turnaround of laboratory results and their timely access by the medical team are crucial for effective patient management and care decision-making. This study revealed a systematic access prioritization to the Electronic Health Record, led by physicians, followed by nurses, and then other healthcare staff Despite efforts to streamline access through computerized laboratory results, optimized laboratory turnaround time and integration of final results into the electronic health record remain key challenges. Delays in accessing analysis results issued by the central hospital laboratory are consistently experienced across various laboratory types, indicating broader systemic workflow issues rather than inefficiencies specific to individual laboratories.

Point-of-care CRISPR-based Diagnostics with Premixed and Freeze-dried Reagents.

Molecular diagnostics by Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-based detection have high diagnostic accuracy and attributes that are suitable for use at point-of-care settings such as fast turnaround times for results, convenient simple readouts, and no requirement of complicated instruments. However, the reactions can be cumbersome to perform at the point of care due to their many components and manual handling steps. Herein, we provide a step-by-step, optimized protocol for the robust detection of disease pathogens and genetic markers with recombinase-based isothermal amplification and CRISPR-based reagents, which are premixed and then freeze-dried in easily stored and ready-to-use formats. Premixed, freeze-dried reagents can be rehydrated for immediate use and retain high amplification and detection efficiencies. We also provide a troubleshooting guide for commonly found problems upon preparing and using premixed, freeze-dried reagents for CRISPR-based diagnostics, to make the detection platform more accessible to the wider diagnostic/genetic testing communities.

Reflex Xpert MTB/XDR Testing of Residual Rifampicin-Resistant Specimens: A Clinical Laboratory-Based Diagnostic Accuracy and Feasibility Study in South Africa.

The World Health Organization-approved Xpert MTB/XDR test detects Mycobacterium tuberculosis and resistance to isoniazid, fluoroquinolones, ethionamide, and injectable drugs directly in specimens. This pragmatic, laboratory-based study assessed the diagnostic accuracy and feasibility of a reflex testing approach, where Xpert MTB/XDR was performed on residual specimens previously processed for Xpert MTB/RIF Ultra. Routine respiratory specimens, processed for Xpert MTB/RIF Ultra, were stored in sample reagent buffer at 2°C-8°C. If rifampicin resistant, the residual specimen was assessed for adequate volume (≥2 mL) and tested with Xpert MTB/XDR, with storage time recorded. A second specimen was used for routine and reference standard testing (culture and sequencing). Specimens (99% sputum) from 763 participants submitted to 2 large routine laboratories were included. Xpert MTB/XDR yielded valid resistance detection results in 639 (84%), compared with 507 (66%) for routine testing (difference [95% CI], 18% [13%-22%]). The median turnaround time for results was 23 hours for Xpert MTB/XDR and 15 days for routine testing. While 748 specimens (98%) were ≥2 mL, only 102 (13%) were stored for ≤4 hours. By the reference standard, 284 of 394 (72%) were isoniazid resistant, and 57 of 380 (15%) were fluroquinolone resistant. The sensitivities of Xpert MTB/XDR were 94% (95% CI, 91%-97%) for isoniazid and 91% (81%-97%) for fluoroquinolone resistance detection. The specificities were 98% (94%-100%) and 100% (98%-100%), respectively. Xpert MTB/XDR performed favorably compared with the reference, and the reflex testing approach increased results availability over routine testing, while dramatically decreasing turnaround time from weeks to hours. Laboratory workflow precluded testing within the manufacturer-recommended 4-hour storage time, but longer storage did not appear detrimental.

Point of Care Liquid Biopsy for Cancer Treatment-Early Experience from a Community Center.

Liquid biopsy is rapidly becoming an indispensable tool in the oncologist's arsenal; however, this technique remains elusive in a publicly funded healthcare system, and real-world evidence is needed to demonstrate utility and feasibility. Here, we describe the first experience of an in-house point of care liquid biopsy program at a Canadian community hospital. A retrospective review of consecutive cases that underwent plasma-based next-generation sequencing (NGS) was conducted. Liquid biopsy was initiated at the discretion of clinicians. Sequencing followed a point of care workflow using the Genexus™ integrated sequencer and the Oncomine precision assay, performed by histotechnologists. Results were reported by the attending pathologist. Eligible charts were reviewed for outcomes of interest, including the intent of the liquid biopsy, results of the liquid biopsy, and turnaround time from blood draw to results available. A total of 124 cases, with confirmed or suspected cancer, underwent liquid biopsy between January 2021 and November 2023. The median turnaround time for liquid biopsy results was 3 business days (range 1-12 days). The sensitivity of liquid biopsies was 71%, compared to tissue testing in cases with matched tissue results available for comparison. Common mutations included EGFR (29%), in 86 lung cancer patients, and PIK3CA (22%), identified in 13 breast cancer patients. Healthcare providers ordered liquid biopsies to inform diagnostic investigations and treatment decisions, and to determine progression or resistance mechanisms, as these reasons often overlapped. This study demonstrates that rapid in-house liquid biopsy using point of care methodology is feasible. The technique facilitates precision treatment and offers many additional advantages for cancer care.

The impact of comparative genomic hybridization/single-nucleotide polymorphism microarray in risk stratification of pediatric acute lymphoblastic leukemia.

The objective of this study is to assess the concordance and added value of combined comparative genomic hybridization plus single-nucleotide polymorphism microarray (CGH/SNP) analyses in pediatric acute lymphoblastic leukemia (ALL) risk stratification compared to conventional cytogenetic methods. This is a retrospective study that included patients aged 1-18years diagnosed with de novo ALL at Sainte-Justine Hospital between 2016 and 2021. Results from conventional cytogenetic and molecular analyses were collected and compared to those of CGH/SNP. A total of 135 ALL patients were included. Sample failures or non-diagnostic analyses occurred in 17.8% cases with G-banding karyotypes versus 1.5% cases with CGH/SNP. The mean turnaround time for results was significantly faster for CGH/SNP than karyotype with 5.8 versus 10.7days, respectively. The comparison of ploidy assessment by CGH/SNP and G-banding karyotype showed strong concordance (r=.82, p<.001, r2=.68). Furthermore, G-banding karyotype did not detect additional clinically relevant aberrations that were missed by the combined analysis of CGH/SNP and fluorescence in situ hybridization. The most common gene alterations detected by CGH/SNP were deletions involving CDKN2A (35.8%), ETV6 (31.3%), CDKN2B (28.4%), PAX5 (20.1%), IKZF1 (12.7%), and copy-neutral loss of heterozygosity (CN-LOH) of 9p (9.0%). Among these, only ETV6 deletion was found to have a significant prognostic impact with superior event-free survival in both univariate and multivariate analyses (adjusted hazard ratio 0.08, 95% confidence interval: 0.01-0.50, p=.02). CGH/SNP provided faster, reliable, and highly concordant results than those obtained by conventional cytogenetics. CGH/SNP identified recurrent gene deletions in pediatric ALL, of which ETV6 deletion conferred a favorable prognosis.

Gender Disparities in Electronic Health Record Usage and Inbasket Burden for Internal Medicine Residents.

Studies have demonstrated patients hold different expectations for female physicians compared to male physicians, including higher expectations for patient-centered communication and addressing socioeconomic or emotional needs. Recent evidence indicates this gender disparity extends to the electronic health record (EHR). Similar studies have not been conducted with resident physicians. This study seeks to characterize differences in EHR workload for female resident physicians compared to male resident physicians. This study evaluated 12months of 156 Mayo Clinic internal medicine residents' inbasket data from July 2020 to June 2021 using Epic's Signal and Physician Efficiency Profile (PEP) data. Excel, BlueSky Statistics, and SAS analytical software were used for analysis. Paired t-tests and analysis of variance were used to compare PEP data by gender and postgraduate year (PGY). "Male" and "female" were used in substitute for "gender" as is precedent in the literature. Mayo Clinic internal medicine residents. Total time spent in EHR per day; time in inbasket and notes per day; time in notes per appointment; number of patient advice requests made through the portal; message turnaround time. Female residents received more patient advice requests per year (p = 0.004) with an average of 86.7 compared to 68, resulting in 34% more patient advice requests per day worked(p < 0.001). Female residents spent more time in inbasket per day (p = 0.002), in notes per day (p < 0.001), and in notes per appointment (p = 0.001). Resident panel comparisons revealed equivocal sizes with significantly more female patients on female (n = 55) vs male (n = 34) resident panels (p < 0.001).There was no difference in message turnaround time, total messages, or number of results received. Female resident physicians experience significantly more patient-initiated messages and EHR workload despite equivalent number of results and panel size. Gender differences in inbasket burden may disproportionally impact the resident educational experience.

Implementation of an ISO 15189 accredited next generation sequencing service for cell-free total nucleic acid (cfTNA) analysis to facilitate driver mutation reporting in blood: the experience of a clinical diagnostic laboratory

AimsNext generation sequencing (NGS) on tumour tissue is integral to the delivery of personalised medicine and targeted therapy. NGS on liquid biopsy, a much less invasive technology, is an emerging...

Opportunities to Enhance Diagnostic Testing and Antimicrobial Stewardship: A Qualitative Multinational Survey of Healthcare Professionals.

Antimicrobial resistance (AMR) is a global public health challenge. Global efforts to decrease AMR through antimicrobial stewardship (AMS) initiatives include education and optimising the use of diagnostic technologies and antibiotics. Despite this, economic and societal challenges hinder AMS efforts. The objective of this study was to obtain insights from healthcare professionals (HCPs) on current challenges and identify opportunities for optimising diagnostic test utilisation and AMS efforts. Three hundred HCPs from six countries (representing varied gross national incomes per capita, healthcare system structure, and AMR rates) were surveyed between November 2022 through January 2023. A targeted literature review and expert interviews were conducted to inform survey development. Descriptive statistics were used to summarise survey responses. These findings suggest that the greatest challenges to diagnostic test utilisation were economic in nature; many HCPs reported that AMS initiatives were lacking investment (32.3%) and resourcing (40.3%). High resistance rates were considered the greatest barriers to appropriate antimicrobial use (52.0%). Most HCPs found local and national guidelines to be very useful (≥ 51.0%), but areas for improvement were noted. The importance of AMS initiatives was confirmed; diagnostic practices were acknowledged to have a positive impact on decreasing AMR (70.3%) and improving patient outcomes (81.0%). AMS initiatives, including diagnostic technology utilisation, are pivotal to decreasing AMR rates. Interpretation of these survey results suggests that while HCPs consider diagnostic practices to be important in AMS efforts, several barriers to successful implementation still exist including patient/institutional costs, turnaround time of test results, resourcing, AMR burden, and education. While some barriers differ by country, these survey results highlight areas of opportunities in all countries for improved use of diagnostic technologies and broader AMS efforts, as perceived by HCPs. Greater investment, resourcing, education, and updated guidelines offer opportunities to further strengthen global AMS efforts.