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The aim of this study was to estimate and subsequently measure the occupational radiation exposure for all personnel involved in producing, administering, or performing imaging or surgery with [99mTc]Tc-PSMA-I&S, which has been introduced for identification of tumor-positive lymph nodes during salvage prostate cancer surgery. Methods: The effective dose was estimated and subsequently measured with electronic personal dosimeters for the following procedures and personnel: labeling and quality control by the radiopharmacy technologist, syringe preparation by the nuclear medicine laboratory technologist, patient administration by the nuclear medicine physician, patient imaging by the nuclear medicine imaging technologist, and robot-assisted laparoscopic salvage lymph node dissection attended by an anesthesiology technologist, scrub nurse, surgical nurse, and surgeon. The dose rate of the patient was measured immediately after administration of [99mTc]Tc-PSMA-I&S, after imaging, and after surgery. Results: The estimated dose per procedure ranged from 1.59 × 10-10 μSv (imaging technologist) to 9.74 μSv (scrub nurse). The measured effective dose ranged from 0 to 5 μSv for all personnel during a single procedure with [99mTc]Tc-PSMA-I&S. The highest effective dose was received by the scrub nurse (3.2 ± 1.3 μSv), whereas the lowest dose was measured for the surgical nurse (0.2 ± 0.5 μSv). If a single scrub nurse were to perform as many as 100 procedures with [99mTc]Tc-PSMA-I&S in a year, the total effective dose would be 320 μSv/y. Immediately after administration, the dose rate at 50 cm from the patient was 18.5 ± 1.6 μSv/h, which dropped to 1.8 ± 0.3 μSv/h after imaging the following day, reducing even further to 0.56 ± 0.33 μSv/h after surgery. Conclusion: The effective dose for personnel involved in handling [99mTc]Tc-PSMA-I&S is comparable to that of other 99mTc-radiopharmaceuticals and therefore safe for imaging and radioguided surgery.

In the face of the COVID-19 pandemic, efficient outpatient management is paramount to minimise wait times and reduce exposure to respiratory illnesses, particularly in patients with cancer receiving chemotherapy. The complete blood cell count (CBC) with white cell count (WCC) differential (CBC-D) is an essential laboratory test used to screen cancer patients prior to chemotherapy. Patients receiving cytotoxic chemotherapy are at risk for developing neutropenia; the absolute neutrophil count (ANC) can be used to determine if a patient is neutropenic.1 Neutropenia is generally defined as an ANC

Background Genome cohort studies are used to analyze interactions between genetic and environmental factors, providing valuable information for personalized healthcare. Large-scale and long-term cohort studies require a number of specially trained personnel, of whom those involved in obtaining informed consent play a vital role, especially during the initial phase of such studies. The Japanese Society of Human Genetics (JSHG) previously established a certification system for genome medical research coordinators (GMRCs) responsible for obtaining written consent via face-to-face explanation. Meanwhile, in the Tohoku Medical Megabank Organization (ToMMo), GMRCs are expected to play important roles not only in obtaining informed consent and conducting various assessments, but also in communicating with participants throughout the long-term follow-up. Based on the JSHG program, we therefore developed a specific education and training program for ToMMo GMRCs consisting of 17 lectures, one practical training session on the informed consent procedure, and written and interview examinations. Re-education workshops aimed at self-improvement are also carried out following certification. In this study, we evaluated the education and training program in terms of overall understanding, usefulness, and satisfaction using an anonymous questionnaire. Methods An anonymous questionnaire addressing each aspect of the education and training program (understanding, usefulness, and satisfaction) was distributed among 152 qualified ToMMo GMRCs. Responses were received from 94 participants (61.8%). Results There was a significant association between the level of overall understanding of lectures and medical qualification (nurse or clinical laboratory technologist), but not with age or educational background. The level of understanding and overall usefulness were lower in sessions related to genetics and epidemiology than those dealing with ToMMo practices. In the re-education workshops, GMRCs showed a preference for and hoped to learn more about both background knowledge and research progress in the ToMMo. Conclusions The results of our questionnaire suggest that not all ToMMo GMRCs are able to understand everything during the initial education and training program, especially in terms of genomic medicine. Continuous re-education is therefore vital in improving knowledge, skills and motivation, and preparing GMRCs for a specialist role in community-based personalized healthcare. Electronic supplementary material The online version of this article (10.1186/s12909-019-1725-5) contains supplementary material, which is available to authorized users.

Context.—Syphilis serology screening in laboratory practice is evolving. Traditionally, the syphilis screening algorithm begins with a nontreponemal immunoassay, which is manually performed by a laboratory technologist. In contrast, the reverse algorithm begins with a treponemal immunoassay, which can be automated. The Centers for Disease Control and Prevention has recognized both approaches, but little is known about the current state of laboratory practice, which could impact test utilization and interpretation. Objective.—To assess the current state of laboratory practice for syphilis serologic screening. Design.—In August 2015, a voluntary questionnaire was sent to the 2360 laboratories that subscribe to the College of American Pathologists syphilis serology proficiency survey. Results.—Of the laboratories surveyed, 98% (2316 of 2360) returned the questionnaire, and about 83% (1911 of 2316) responded to at least some questions. Twenty-eight percent (378 of 1364) reported revision of their syphilis screening algorithm within the past 2 years, and 9% (170 of 1905) of laboratories anticipated changing their screening algorithm in the coming year. Sixty-three percent (1205 of 1911) reported using the traditional algorithm, 16% (304 of 1911) reported using the reverse algorithm, and 2.5% (47 of 1911) reported using both algorithms, whereas 9% (169 of 1911) reported not performing a reflex confirmation test. Of those performing the reverse algorithm, 74% (282 of 380) implemented a new testing platform when introducing the new algorithm. Conclusion.—The majority of laboratories still perform the traditional algorithm, but a significant minority have implemented the reverse-screening algorithm. Although the nontreponemal immunologic response typically wanes after cure and becomes undetectable, treponemal immunoassays typically remain positive for life, and it is important for laboratorians and clinicians to consider these assay differences when implementing, using, and interpreting serologic syphilis screening algorithms.

Objectives: Using a clinical research laboratory as a case study, we sought to characterize barriers to maintaining Good Clinical Laboratory Practice (GCLP) services in a developing world setting. Methods: Using a US Centers for Disease Control and Prevention framework for program evaluation in public health, we performed an evaluation of the Kilimanjaro Christian Medical Centre–Duke University Health Collaboration clinical research laboratory sections of the Kilimanjaro Clinical Research Institute in Moshi, Tanzania. Laboratory records from November 2012 through October 2014 were reviewed for this analysis. Results: During the 2-year period of study, seven instrument malfunctions suspended testing required for open clinical trials. A median (range) of 9 (1-55) days elapsed between instrument malfunction and biomedical engineer service. Sixteen (76.1%) of 21 suppliers of reagents, controls, and consumables were based outside Tanzania. Test throughput among laboratory sections used a median (range) of 0.6% (0.2%-2.7%) of instrument capacity. Five (55.6%) of nine laboratory technologists left their posts over 2 years. Conclusions: These findings demonstrate that GCLP laboratory service provision in this setting is hampered by delays in biomedical engineer support, delays and extra costs in commodity procurement, low testing throughput, and high personnel turnover.

Quality assurance in a cytopathology laboratory is achieved by involving all the parties that contributes to cytopathology procedures. Quality assurance measures start with the laboratory directors to the cytopathotechnologists at work. High-quality results are achieved when all the parties work together by following the Standard operation procedures failure to which quality is undermined. Laboratory directors in a cytopathology laboratory are responsible for risk analysis and management. Proper risk analysis techniques help the lab manager to identify the weak points among the technologists. Proper management involves giving out good guidelines or instructions on what should be done to solve the problems that have been identified. There is the need to accredit and comply with the international accepted policies and procedures and excellent documentation to help deal with malpractices. Modern health care has faced a revolution due to a variety of factors, some of which are: newest techniques in laboratory medicine, trained staff operating diagnostic medical laboratories and ultra-modern analytical equipment. A Quality Management System (QMS) has been suggested by the ISO 15189 International Standard, which if followed, can help sustain and improve the testing services offered by diagnostic laboratories, such as cytopathology laboratories. Cytopathology laboratories should only employ laboratory technologists have undergone through the recommended training and have licenses from the regulatory bodies. The staff members of cytopathology laboratory should follow the standard operating procedures. SOPs help in coming up with high-quality results.

Testing for antinuclear antibodies is the most frequently prescribed analysis for the diagnosis of rheumatic diseases. Indirect immunofluorescence remains the gold standard method for their detection despite the increasing use of alternative techniques. In order to standardize the manual microscopy reading, automated acquisition and interpretation systems have emerged. This publication enables us to present our method of interpretation and characterization of antinuclear antibodies based on a cascade of analyses and to share our everyday experience of the G Sight from Menarini. The positive/negative discrimination on Hep cells 2000 is correct in 85% of the cases. In most of the false negative results, it is a question of aspecific or low titers patterns, but a few cases of SSA speckled patterns of low titers demonstrated a probability index below 8. Regarding the pattern recognition, some types and mixed patterns are not properly recognized. Concerning the probability index correlated in some studies to final titer, the weak fluorescence of certain patterns and the random presence of artifacts that distort the index don't lead us to continue it in our daily practice. In conclusion, automated reading systems facilitate the reporting of results and traceability of patterns but still require the expertise of a laboratory technologist for positive/negative discrimination and for pattern recognition.

Background Historically, implants were placed in the available bone with little consideration of the prosthetic rehabilitation. More recently, a ‘‘top-down, prosthetically driven’’ approach using conventional surgical templates has been used to ensure optimal final tooth position. Understanding the planned prosthetic outcome during surgical placement improves the predictability of implant restorations based on providing a visual positioning reference. Interactive computed tomography (CT) technology has allowed for greater preoperative knowledge of a patient’s anatomy, aiding in diagnosis and strategic execution of therapy. In addition, CT-based analysis provides for prosthetic and surgical performance objectives to be established before the rendering of irreversible treatment. Furthermore, this process allows for preoperative collaboration among the restoring dentist, laboratory technologist, surgeon, and patient. This multistep process has been called ‘‘collaborative accountability.’’1

Beginning in the 1920s, many Canadian hospitals underwent an extensive period of modernization. A wide variety of workers, generally termed "allied health professionals," began to work alongside physicians and nurses. This paper examines the history of two such groups, x-ray and laboratory technicians, paying particular attention to the ways in which technical education was transformed and, through this transformation, new occupational identities forged. Initially, those who staffed the laboratory and x-ray departments were given quick, practical instruction. In many cases, these workers continued to work in various settings across the hospital. The informal instruction of the 1920s and 1930s was displaced by formal, accredited training programs, replete with national examinations linked to a practice registry in the 1940s. Hospital administrators, the Canadian Medical Association and technicians themselves were all engaged in this transformation. At the same time, national organizations such as the Canadian Society of Laboratory Technologists or the Canadian Society of Radiological Technicians, founded in the late 1930s and early 1940s respectively, attempted to create a common professional identity with a clear scope of practice. Despite this, technical workers' professional identity remained malleable and highly dependent upon context long after the creation of supposedly national accreditation standards., Les années 1920 marquent le début d’une longue phase de modernisation pour de nombreux hôpitaux canadiens. Un grand nombre d’employés, généralement qualifiés de « personnel paramédical », commencent à collaborer avec les médecins et le personnel infirmier. Cet article observe l’évolution de deux de ces deux groupes, soit les techniciens en radiologie et les techniciens de laboratoire. Il met l’accent sur le développement d’une formation technique et, à travers celle-ci, de l’établissement de nouvelles identités professionnelles. Au début, le personnel des laboratoires et des services de radiologie reçoit une formation rapide et pratique. Dans de nombreux cas, ces personnes poursuivent leur travail dans plusieurs autres services de l’hôpital. La formation informelle fournie dans les années 1920 et 1930 est ensuite remplacée par une formation formelle au moyen de programmes accrédités, complétés par des examens nationaux qui donnent lieu à l’établissement d’un registre des pratiques dans les années 1940. Les directeurs d’hôpitaux, l’Association médicale canadienne et les techniciens eux-mêmes participèrent à cette évolution. En même temps, les organisations nationales telles que la Société canadienne des technologistes de laboratoire ou la Société canadienne des techniciens en radiologie, fondées respectivement à la fin des années 1930 et au début des années 1940, tentent de créer une identité professionnelle commune ancrée dans un ensemble de pratiques clairement identifiables. Malgré cela, longtemps après la création des prétendues accréditations nationales, l’identité professionnelle des techniciens demeure flexible et extrêmement tributaire de l’environnement local.

The purpose of our study was to improve the quality of care in an emergency department (ED) as measured by length of stay (LOS), total turnaround time (TAT) for laboratory result reporting, and the blood culture contamination rate. Data were included for patients who had at least 1 of 5 laboratory tests performed as part of their care. The study was conducted in 2 phases. First, phlebotomy was performed by a dedicated phlebotomist or nonlaboratory personnel. The second phase added a dedicated laboratory technologist. There was a significant reduction in total TAT for all tests (at least 46 and 75 minutes in the respective interventions), and blood culture contamination rates dropped from 5.0% to 1.1%, although the overall LOS did not change. Estimated cost avoidance is more than $400,000 annually. Quality of care in an ED is improved when samples are collected by a dedicated phlebotomist, but overall LOS does not change.

Background: Globally, accurate diagnosis of malaria is essential for effective management of malaria and other frequently fatal non-malarial febrile illnesses that share the same signs and symptoms with malaria. Although malaria microscopic diagnosis using stained blood slides is considered to be a standard technique, it suffers subjectivity in its accuracy depending on the knowledge and skill of the technologist reading the slides. The purpose of this retrospective cross-sectional study done in 2013 was therefore to assess the reliability of microscopic diagnosis of malaria using stained blood slides by laboratory technologists in three Kayonza District health centres, Eastern Province, Rwanda. Methods : Forty archived stained blood slides of which 20 had been reported to be positive and 20 negative were selected from each of the three identified health centres by systematic sampling. Overall, 120 stained blood slides were collected and read by the Principal Investigator, and the quality control was done by the National Reference Laboratory. Results and conclusion The results of the diagnosis done by the health centre technologists and principal investigator agreed by 96.67% and was categorized as almost perfect according to the calculated Cohen’s kappa of 0.933, p

Summary This study investigated both the impact of glove usage on bacterial hand contamination of laboratory technicians and extent of environmental contamination of a microbiology laboratory with potential bacterial pathogens. Two groups of laboratory technologists participated in the study – one group who always used gloves when handling bacterial cultures and another group who did not. Semiquantitative bacterial sampling from technicians' hands was performed before and after a defined work period. Frequently touched areas of the laboratory were sampled over a four-week period and selective or chromogenic media utilised for the identification of meticillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa , Salmonella spp. and Enterobacteriaceae. Laboratory technicians who did not use gloves were at significantly greater risk of acquiring MRSA following their work periods but no protective effect was demonstrated for glove usage against acquisition of Enterobacteriaceae. Hand washing was equally effective at removing acquired bacterial pathogens in both groups of workers. Environmental sampling documented the presence of MRSA in one-fifth of sampled sites, with the most frequent recovery from computer keyboards. Enterobacteriaceae and P. aeruginosa were less commonly recovered from the environment. This study demonstrates that glove usage is protective against the acquisition of MRSA and that MRSA is the most frequently recovered bacterial pathogen from our microbiology laboratory environment.

Change, challenge, and commitment motivate staff at the University of Miami/Jackson Memorial Medical Center in Miami, Florida, to prepare its health care system for the 21st century. Doctors, nurses, environmental workers, pharmacists, cashiers, nursing assistants, laboratory technologists, and many others are participating on a variety of teams to bring about the changes needed for our delivery system to be competitive.

Preliminary studies : A facility review at Enugu-Ukwu General Hospital in Anambra State revealed limited blood transfusion and no blood storage capabilities. Focus groups indicated fears and misconceptions in the population regarding risks of blood donation and transfusion. Interventions : In 1994, a blood bank was established, including a refrigerator, backup generator, reagents and supplies. Refresher training was provided to the laboratory technologist. A public education campaign was launched one year later to encourage blood donation and dispel fears of transfusion. Results : Voluntary blood donations in the hospital increased from zero units before the program to 15 in 1995. Transfusions increased from three in 1993 to 17 in 1995. Eight of the 17 were for obstetric cases. No donations or transfusions occurred until six months after the establishment of the blood bank. Problems encountered in obtaining the cooperation of hospital management may partly explain the delayed response. Costs : The cost of establishing the blood bank was US $8800: 51% material costs and 42% training. Conclusions : Improving the availability of blood at small hospitals need not be very expensive. Community education activities may increase blood donation, but sustained efforts are likely to be required. Ministry of Health (MOH) involvement is important to the success of interventions in government hospitals. © 1997 International Journal of Gynecology and Obstetrics

Background: Prolonged laboratory turnaround time (TAT) contributes to prolonged length of stay in emergency departments (EDs). The TAT of laboratory test results is a common key performance indicator by which clinicians and regulatory bodies evaluate laboratory performance. Establishing satellite laboratories in EDs staffed by laboratory technologists is one approach towards reducing TAT. Methods: TAT data were collected for three time intervals: (a) sampling time to time samples received in the laboratory (transportation time), (b) sample received in the laboratory until results were available for viewing on the laboratory information system monitor or collection by ED staff (within laboratory TAT), and (c) sampling to availability of results (total TAT, e.g., a+b). The target was to achieve a median within laboratory TAT of 45 min for samples received from the ED. Results: The median transportation times for samples to be delivered to the central and satellite laboratory were 22 min and 1 min, respectively (p

Competency assessment is critical for laboratory operations and is mandated by the Clinical Laboratory Improvement Amendments of 1988. However, no previous reports describe methods for assessing competency in patient safety. We developed and implemented a Web-based tool to assess performance of 875 laboratory staff from 29 laboratories in patient safety. Question categories included workplace culture, categorizing error, prioritization of patient safety interventions, strength of specific interventions, and general patient safety concepts. The mean score was 85.0%, with individual scores ranging from 56% to 100% and scores by category from 81.3% to 88.6%. Of the most difficult questions (

The role and figure of biomedical laboratory technologists have undergone important changes over the past decades. The increasingly complex functions and responsibility of biomedical laboratory technologists both require an updated education and training process. Here, we describe the current situation in Italy regarding the education of biomedical laboratory technologists and the results of a survey conducted in 28 universities. A significant variability between the different universities was observed regarding both the teaching subjects and the distribution of credits among the different courses. The results of this survey highlight that a greater uniformity in the distribution of credits and a better balance among teaching sectors might be advisable.

Background/Aims: Continuing education is important to laboratory technologists. It helps them keep pace with the advances in medicine and pathology and thus to provide quality service. A survey was conducted to assess the attitudes of pathology laboratory technologists towards different educational activities. Methods: Relevant continuing education activities include lectures, case discussions, journal clubs, short courses, scientific conferences and higher educational courses. Technologists were asked for their views on these various activities, scoring each item 1–5 out of 5. Results: The response rate was 66% (19/29); respondents’ work experience ranged from 20 years. Short courses was rated the most highly; 89% of respondents considered them good/excellent. General medical knowledge and the methods and rationale of key histopathology procedures were the preferred lecture topics. Most respondents (58%) were interested (4–5/5) to have their own journal club. 84% of respondents were fairly keen/keen (4–5/5) to participate in conferences. 74% responded that they were fairly keen/keen to consider pursuing higher education. 84% were fairly keen/keen to upgrade themselves and to assume higher responsibilities. Discussion: The results indicate a positive outlook of technologists towards continuing education. The planning of future lecture topics has taken into account their preferences, and talks on the pursuit of higher education have been organised. It is hoped that these measures and others, will help boost the usefulness of continuing education and enhance the work environment.

A survey to determine the need for training in medical mycology was sent to 605 US laboratories. Training needs were determined by comparing actual laboratory mycology practices with recommended practices, documenting the extent of mycology training reported by employees, and asking respondents to specify the fungi they considered most difficult to identify. The response rate was 56.7% (with only 316 laboratories providing sufficient information). Results showed a large degree of interlaboratory variation in practices and suggested that more judicious practices could lower costs and improve clinical relevance. Only 55.6% of laboratories reported that at least 1 employee attended a formal mycology continuing education program in the 4 years before the survey. Species of dermatophytes, dematiaceous fungi, and non-Candida yeasts were the most difficult to identify. Training may be needed in basic isolation procedures and in advanced topics such as identification of problematic molds and yeasts and antifungal susceptibility testing. Educators should consider clinical relevance and costcontainment without sacrificing quality when designing courses. Support for additional mycology training may improve if hospital and laboratory administrators are alerted to potential dangers and costs involved in treating patients with invasive fungal infections. Although some laboratory tests are becoming less difficult as technology advances, identification of fungi in the medical laboratory requires more expertise now than in the past because laboratory technologists are asked to identify a larger group of fungi. The distinction between well-known fungal pathogens and “contaminants” is no longer clear since species once considered harmless may now produce lifethreatening infections. 1 The patient population susceptible to

This study compared the proficiency of military medical technicians in the diagnosis of malaria using Giemsa-stained thick blood films (GSF) and the QBC system. Fourteen technicians, with no previous experience of the QBC and limited experience in interpreting GSF, were given training in the 2 techniques and then tested on their ability to make a malaria diagnosis when provided with previously prepared GSF and QBC specimens (9 positive and 10 negative). The students achieved a sensitivity of 75% and 84%, respectively, with the QBC and GSF; specificity was 84% and 76%. There was no difference in the concordance of the 2 techniques with the actual diagnosis (80% vs. 81%).

The profession of clinical laboratory technologist has undergone profound changes in the last decades and scientific as well as technological advancement will cause further continued evolution. Therefore, adaptability to a rapidly evolving environment and willingness to continuously update knowledge as well as skills seem to be the most important demands confronting technologists. I compare the current training of clinical laboratory technologist in industrialized countries with emerging educational schemes, which include curricula based on national requirements comprising a total of 3–4 years of formal lectures and practical training.

Hundreds of patients in Canada’s Newfoundland and Labrador province with breast cancer were given inaccurate results of oestrogen and progesterone receptor hormone testing in a wholesale failure of accountability and oversight at all levels of the healthcare system, an inquiry found this week. In the report Justice Margaret Cameron made 60 recommendations to ensure that what went wrong will not happen again, including more training for physicians, mandatory continuing education for laboratory technologists, and better record keeping. The health authority at the centre of the scandal has announced that …

To the Editor.— According to Dr Soloway, 1 open access to laboratory testing is desirable and inevitable. By removing the physician as "gatekeeper" for laboratory testing, Dr Soloway argues that there would be less need for inconvenient and expensive office visits, particularly for sophisticated patients who desire only a pregnancy test or serum cholesterol test. Patient-initiated testing would create a new and unprecedented channel of information transfer from the laboratory to the patient that would bypass the physician. Test interpretation would become the responsibility of the patient, encouraging self-diagnosis and treatment. This would place inappropriate emphasis on test results, supplanting other important sources of information such as the history and physical examination. Does Dr Soloway consider test interpretation by the knowledgeable and unbiased physician to be of no value? Should laboratory technologists be informing patients that they have serious illnesses such as acute leukemia? Is the laboratory responsible (and liable)

California is uniquely free of the shortage of well-trained clinical laboratory technologists that currently prevails elsewhere in the nation. Yet its standards for both laboratory personnel and laboratory performance are the country's highest. This article reviews the 40-year voluntary and continuing effort that underlies this achievement.

Objective : To report a probable case of laboratory-acquired typhoid fever involving a female laboratory technologist at a major diagnostic bacteriology laboratory in Kuala Lumpur, Malaysia. Methods : The technologist presented with clinical symptoms of typhoid fever and was admitted to a major hospital in Kuala Lumpur. Salmonella typhi isolated from her stools, as well as other S. typhi isolates she had been working with, were analyzed by Vi phage typing, antibiogram studies, and pulsed-field gel electrophoresis. The phage type and antibiograms of the isolate were identical to those of one of the laboratory strains she had been working with during her routine duties. Results : Pulsed-field gel electrophoresis analysis of restricted chromosomal DNA confirmed the identity of the isolate with that of the laboratory isolate. The isolate involved was phage type E1 and was resistant to multiple antibiotics. Conclusion : The results strongly suggest that the laboratory technologist acquired the infection in the laboratory in the course of her work.

The successful interfacing of a low-cost micro-mini-computer to an SMA 12–60 Autoanalyzer and its performance are described. The advantages of the system, most particularly the ease with which laboratory technologists can be trained to programme, thus having economic control of the system “in house” is stressed; further developments, with more equipment being brought on-line, and the future potential of data manipulation and reduction are discussed.

The accuracy and precision of the Kodak DT-60 tabletop chemistry analyzer were evaluated in the clinical laboratory at the Portland (Ore) Veterans Administration Medical Center, and its operational throughput and cost were estimated. All DT-60 tests that were studied exhibited clinically acceptable precision and, except for the glucose method, accuracy. The accuracy of the glucose method was indeterminate with the available data. Throughput under field conditions was found to be less than half of the manufacturer's claim. The estimated supply cost per test could vary from $1.20 to $5.49 per test, depending on the test type and the number of assays expected to be performed daily. The instrument seems to be accurate, precise, and generally reliable when operated by professional medical technologists. ( JAMA 1987;258:353-356)

We prospectively evaluated the accuracy with which clerical and laboratory staff carried out physicians' written orders for thyroid function testing in 181 patients at two institutions. In 54% of the patients studied, support staff were found to have added or deleted one or more tests from the original written orders. When the ordering physicians were asked to identify the clinical indications for the tests they had ordered, 37% of their orders either lacked an appropriate test or included an unnecessary test request. In contrast, after clerical and laboratory staff had changed orders, only 25% of patients had inappropriate tests performed or necessary tests omitted. Clerical staff using computer-based ordering menus significantly improved the appropriateness of physicians' orders compared with clerks who lacked such guidance. Laboratory technologists who used informal, knowledge-based rules also tended to improve the appropriateness of physicians' orders. We conclude that a substantial proportion of physicians' orders for diagnostic tests may be modified during the test requisitioning process. The use of testing regimens by ward clerks and laboratory technologists may explain their ability to improve on physicians' orders. ( JAMA 1988;259:2549-2552)

Excerpt To the editor: A few days before Halloween a young woman laboratory technologist was admitted to the Hospital of the University of Pennsylvania with complaints of hematuria, abdominal pain,...

a hematologist or experienced laboratory technologist. W. M. Fowler, M.D. Modern Occupational Medicine. Edited by A. J. Fleming, M.Sc., M.D., F.A.C.P., and C. A. D'Alonzo, M.D., F.A.C.P. Associate Editor: J. A. Zapp, Ph.D. Price, not stated. Pp. 587, with 66 illustrations. Lea & Febiger, 600 S. Washington Sq., Philadelphia 6, 1960. Like many books with multiple contributors, this one suffers from unevenness in the quality of the chapters presented and in spottiness in covering the field. There is a detailed and excellent survey on occupational chest diseases, but also almost no mention of other organ systems. The chapters on psychiatry are of variable usefulness, but some very interesting concepts unique to industrial psychiatry are explained. Psychosomatic dermatology is well covered, but other psychosomatic areas are barely touched. In spite of a large section