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Objective: To determine the impact of lean thinking on the original time required to prepare the necessary documentation in relation to the preparation of parenteral chemotherapy/monoclonal antibodies., Method: Four pharmacists and one pharmacy technician from the oncology hospital (Malta) all participated in eight focus groups linked to the different constructs of Normalisation Process Theory (NPT): coherence, cognitive participation, collective action and reflexive monitoring. The value stream documentation process was mapped by analysing all steps in the process where each activity must add value for the patient; tools of lean thinking were applied. Points causing delay in processing were considered critical; possible changes to minimise time waste were discussed and implemented. Time spent on critical points was measured by timing in minutes each step of the process 1 month before and after the changes had been implemented and calculating the mean±SD. An audit was performed comparing the process with standard operating procedures to determine whether any steps required quality improvement., Results: Three critical points were identified: time required to search for pharmacy patient medication records for chemotherapy/monoclonal antibodies required on the day; time to generate preparation labels; and time to generate worksheets. Overall, a total of 122±8.6 min (p=0.06) were saved per day, a 37% decrease from the original documentation time. Five deficiencies were identified in the documentation process audit; corrective action was proposed., Conclusions: By applying lean thinking, non-value-added steps leading to time waste in the documentation process were eliminated. This concept could be implemented by using NPT as part of a strategic system to reduce waste., Competing Interests: Competing interests: None declared.

We directly compared a monoclonal antibody-based enzyme immunoassay (IDEIA) with isolation of Chlamydia trachomatis in cell culture (Buffalo Green Monkey cells) by changing the transport medium used for the IDEIA test so as to allow use of a single swab for both tests of the two techniques. We also modified the IDEIA test to exclude any possibility of false positive results caused by non-specific interference by Staphylococcus aureus. The observed sensitivity of the IDEIA compared to cell culture was rather low, 80.3% (57/71). However the IDEIA test's specificity was excellent, 99.7% (566/564) giving a positive predictive value of 96.6% and a negative predictive value of 97.9% (isolation rate by cell culture = 11%).

Chlamydiae represent the aetiological agent in non-gonococcal urethritis in about 50% of the cases, but it is also increasingly recognized that Chlamydia trachomatis can cause prostatitis or epididymitis. The introduction of methods for the direct detection of chlamydia in clinical materials allows early diagnosis and therefore effective antibiotic therapy. The new tests however give both false positive and false negative results.