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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.

Point-of-care glucometers (PCGs) have of recent almost replaced the conventional laboratory methods of blood glucose determination in animals. This study evaluated the level of awareness and knowledge about the use of handheld PCGs among veterinarians and veterinary technologists. Respondents to a structured questionnaire included academic staff and laboratory technologists from veterinary schools and public and private veterinarians across Nigeria. Design of the questions progressed from whether one had ever used a PCG before or not, how they knew about the PCG, the brands used, for what purposes and on which animals. Results showed that out of 209 respondents, 75 (36%) had used PCGs. Of this number, 37 (49.33%) used PCGs for research purposes, while 36 and 6.67% had used the PCGs for diagnosis of glucose disorders in animals and for both research and diagnostic purposes, respectively. The distribution of respondents that knew about the validation status of the PCGs used was 2.67%. As values generated by each PCG vary significantly in different species, there may be chances of reporting erroneous research conclusions as well as misdiagnosis of glucose disorders with consequent erroneous therapies in such species. Keywords: Point-of-care Glucometers, Validation status, Veterinarians.

Background: Despite the investments made in veterinary diagnostic laboratory service delivery in Uganda, the scope and level of utilization remains low. This study aimed to determine the priority livestock diseases for which farmers and animal health professionals require veterinary diagnostic laboratory services, document the perceptions and opinions of key stakeholders on veterinary diagnostic laboratory services, and determine the factors that influence the delivery and utilization of animal disease diagnostic services in Uganda.Methods: A qualitative study approach involving a survey and key informant interviews was used to collect relevant data from four stakeholder groups: animal health workers, laboratory technologists and technicians, farmers, and key informants. The survey data were exported to excel, and descriptive statistics performed. The key informant interview recordings were transcribed, and thematic analysis performed.Results: The most reported diseases and conditions for which diagnostic services were needed were hemoparasites (including East Coast fever, anaplasmosis, babesiosis, and trypanosomosis), viral (including Foot and mouth disease, lumpy skin disease, rift valley fever, and papillomatosis), bacteria (including brucellosis, colibacillosis, anthrax, leptospirosis, and paratuberculosis) and protozoa diseases (coccidiosis), endoparasites (helminths), and mastitis. The most common diagnostic laboratory tests requested by clients, but laboratories were unable to provide included: rapid tests for contagious bovine pleuropneumonia, Foot and mouth disease, Newcastle disease, acaricide analysis, culture and antimicrobial sensitivity test, serology, and complete blood count. The most frequently reported challenges to providing diagnostic laboratory services were poor or lack of relevant equipment, insufficient or lack of supplies and reagents, high cost of reagents, inadequate or lack of laboratory staff to perform tests, and inadequate training of laboratory staff.Conclusions: This study highlighted the need to improve provision of laboratory diagnostic services to meet the prioritized diagnostic needs of farmers and animal health professionals. Increased intersectoral engagement and funding support from the private, industry, and government sectors is necessary to help address the observed challenges to provision of diagnostic laboratory services, including equipping of the laboratories, provision of supplies, and hiring and training of laboratory staff. Finally, the findings also suggest that the education of farmers and animal health workers on the value and benefits of laboratory diagnostic services may contribute to increase in sample submission and subsequent demand for diagnostic laboratory services.

Background The urine lipoarabinomannan (LAM) lateral flow assay is a point-of-care test to diagnose HIV-associated tuberculosis (TB). We assessed the performance of urine LAM in HIV-positive patients presenting to the emergency center and evaluated the interobserver agreement between emergency center physicians and laboratory technologists. Setting A cross-sectional diagnostic study was performed at the emergency center of a district hospital in a high HIV-prevalence community in South Africa. Methods Consecutive HIV-positive adults presenting with ≥1 WHO TB symptom were enrolled over a 16-month period. A urine LAM test was performed at point-of-care by an emergency physician and interpreted independently by 2 physicians. A second test was performed in the laboratory and interpreted independently by 2 laboratory technologists. The reference standard was a positive TB culture or Xpert MTB/RIF test on sputum or appropriate extrapulmonary samples. We compared diagnostic accuracy and reproducibility of urine LAM between point-of-care readers and laboratory readers. Results One thousand three hundred eighty-eight samples (median, 3 samples/participant) were sent for TB microbiology tests in 411 participants; 170 had confirmed TB (41.4%). Point-of-care and laboratory-performed urine LAM had similar sensitivity (41.8% vs 42.0%, P = 1.0) and specificity (90.5% vs 87.5%, P = 0.23). Moderate agreement was found between point-of-care and laboratory testing (κ = 0.62), but there was strong agreement between point-of-care readers (κ = 0.95) and between laboratory readers (κ = 0.94). Positive percent agreement between point-of-care and laboratory readers was 68% and negative percent agreement 92%. Conclusion There is no diagnostic accuracy advantage in laboratory-performed versus point-of-care-performed urine LAM tests in emergency care centers in high-burden settings.

Multidetector CT technology has advanced during the past 2 decades from single-digit numbers of sections to 320-section CT scanners. The ability to perform three-dimensional (3D) postprocessing of acquired data has accompanied this technical progress. Multiple considerations are involved in developing and deploying a 3D and advanced imaging laboratory to provide postprocessing for both CT and MRI examinations. Establishing and running a 3D laboratory requires administrators to buy into the process and also requires regular input from radiologists and other stakeholders. Technologists with prior 3D experience are rare, and extensive immersive training is typically required. Laboratory space and equipment must be maintained and updated regularly to continue to meet stakeholders' needs. Postprocessing protocols must be established and reviewed periodically. Quality control is also necessary to ensure that postprocessing outputs adhere to the protocols. Laboratory technologists can also provide postprocessing support for research examinations and can lend their technical expertise to research projects. Regular review of laboratory productivity is essential to ensure longevity and availability of necessary resources (human, environmental, and technical). As the technologies for the imaging equipment, the picture archiving and communication system, and postprocessing continue to advance, the role of the 3D laboratory will also evolve to include other services. This evolution will affect ongoing training of technologists, as well as the requirements when new technologists are hired. The 3D laboratory is often positioned to take on novel technology and augment radiologists' workflow as new modalities and techniques enter the clinical workflow. ©RSNA, 2018.

Measures and procedures to ensure the protection and quality of marine products are very relevant. The inherent attributes including nutritional value and fresh degree are given more importance. To track seafood quality, the food processing industries use control systems. Most of these guidelines still apply on paper, and laboratory technicians frequently refer to them for standards. This research presents the development of ontology to represent the concepts of tests used to ensure the quality in the seafood domain. It provides information on the type of tests, standard values and classifies the seafood into accepted and rejected classes. We concentrate on five types of seafood, and the case study is conducted in Oman. Protege is the main tool used to implement the ontology. The ontology supports the laboratory technologists in knowledge discovery and information retrieval.

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 aims The Division of Transfusion Medicine and Cellular Therapy at New York-Presbyterian/Columbia University Irving Medical Center (NYPH-CUIMC) comprises the immunohematology laboratory and blood bank (transfusion service), hemotherapy/apheresis and the cellular therapy laboratory (CTL). The CTL processes and stores hematopoietic progenitor cells for bone marrow transplantation from all currently acceptable sources, including bone marrow, peripheral blood and umbilical cord blood. The laboratory provides services for the pediatric and adult blood and marrow transplant programs at both NYPH-CUIMC and the Morgan Stanley Children's Hospital of New York-Presbyterian. The laboratory processes and stores approximately 200 cellular therapy products per year, and the division participates in numerous clinical trials within the institution and with external pharmaceutical manufacturing facilities. As a licensed tissue bank, commercial chimeric antigen receptor T-cell products and other cellular-based therapies that are approved by the US Food and Drug Administration (FDA) are routed through the CTL for storage, processing, coordination of transportation, chain of custody and, eventually, thaw and distribution. Currently, we are distributing four such products from Kite Pharma, Novartis and Bristol Meyers Squid. In comparison to the amount of work, we employ a small staff of only four full-time clinical laboratory technologists, one technical specialist, one quality and operations manager and one medical director. In recent years, the growing use of the hematology/oncology service and the introduction of new immunotherapies have put significant pressure on our division to accommodate and scale up operations. Accompanying this growth is a mounting administrative burden and upsurge in regulatory and protocol-specific oversight. The purpose of this article is to share lessons learned and creative solutions to help better accommodate the surge in development of novel cellular therapies. Methods To handle this increase in demand, the CTL worked to standardize administrative procedures, implement comprehensive document control solutions, digitize data collection and implement lean design concepts to increase effectiveness and mitigate risk. Results Distribution of a standard operating procedure for clinical trial management improved the “on-boarding” process and allowed the laboratory to have more influence in the decision-making process. Implementation of digital workflows and a comprehensive document control system allowed for improved organization of critical documents and proved to be flexible enough to accommodate various protocol-specific requirements. Introduction of visual ques and reorganization of the workspace facilitated better organization, mitigated risk and assisted the laboratory in maintaining regulatory compliance. Conclusions Better-defined, structured and controlled laboratory processes helped laboratory management implement new clinical trials and track critical data. Implementing digital solutions using widely available tools like Microsoft SharePoint has proven to be a very secure, low-cost and flexible solution to keeping us “up-to-date” and inspection-ready.

Introduction Laboratories are vital in disease diagnosis, prevention, treatment and outbreak investigations. Although recent decades have seen rapid advancements in modernised equipment and laboratory processes, minimal investments have been made towards strengthening laboratory professionals in Africa. This workforce is characterised by insufficient numbers, skewed rural-urban distribution, inadequate qualifications, inadequate skill-mix and limited career opportunities. These factors adversely affect the performance of laboratory professionals, who are the backbone of quality services. In the era of Global Health Initiatives, this study describes the status of laboratory human resource and assesses the experiences, constrains and opportunities for strengthening them in Uganda. Methods This paper is part of a study, which assessed laboratory capacity in 21 districts during December 2015 to January 2016. We collected data using a laboratory assessment tool adapted from the WHO and USAID assessment tool for laboratory services and supply chain (ATLAS), 2006. Of the 100 laboratories, 16 were referral laboratories (hubs). To assess human resource constraints, we conducted 100 key informant interviews with laboratory managers and in charges. Results Across the facilities, there was an excess number of laboratory technicians at Health Center (HC) IV level by 30% and laboratory assistants were in excess by 90%. There was a shortage of laboratory technologists with only 50% of the posts filled at general hospitals. About 87.5% of hub laboratories had conducted formal onsite training compared to 51.2% of the non-hub laboratories. Less than half of HC III laboratories had conducted a formal onsite training; hospital laboratories had not conducted training on the use and maintenance of equipment. Almost all HC III laboratories had been supervised though supervision focused on HIV/AIDS. Financial resources, workload and lack of supervision were major constraints to human resource strengthening. Conclusion Although opportunities for continuous education have emerged over the past decade, they are still threatened by inadequate staffing, skill mix and escalating workload. Moreover, excesses in staffing are more in favour of HIV, TB and malaria. The Ministry of Health needs to develop work-based staffing models to ensure adequate staff numbers and skill mix. Staffing norms need to be revised to accommodate laboratory technologists and scientists at high-level laboratories. Training needs to extend beyond HIV, TB and malaria.

This study assessed the availability and use of ICT-based Instructional tools in selected medical colleges in Ogun State, Nigeria. This study adopted a descriptive survey research design. The population to be studied is medical lecturers (328), clinical instructors (42) and laboratory technologist (92) from Ben Carson Snr. Medical School, Babcock University, Obafemi Awolowo College of Health Sciences, and Olabisi Onabanjo University (OOU); total being 462. Simple random sampling technique was used to select 248 respondents for the study. This will represent the population to be studied. Data was collected with the use of titled questionnaires (ICT-bIPIMC) and a checklist during their faculty meetings/seminars, and the data collected were analysed uisng simple frequency and percentage techniques. It was revealed that Computer Aided Instruction (CAI), Social Media, Human Patient Simulation (HPS), PowerPoint Slides (Microsoft) [PP slides, and Medical videos (MV), Multimedia Classrooms (Audio Visual Centre), Projectors, E-Medical journals and animation clips] were the available ICT-based tools for Instructional tools in Ogun State medical colleges. Based on the available finding in this study, social media (45%), E-medical journals (40%), computer-aided instructions (39%), online educational forum (37%), and Internet connected laptops (34%), were the major ICT-based tools used at least twice daily. The study recommended that ICT-based instructional tools should be compulsory for instructional practices among lecturers, laboratory technologists and clinical instructors; also medical colleges should be motivated to use ICT-based tools as instructional tools through training and workshop on how to effectively use the available tools. Key words: ICT-based Instructional tools, medical colleges, availability, usage.

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.

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.

BACKGROUND A quality medical laboratory service is an important part of the health care system. In developing countries like Ethiopia, the laboratory quality system remains weak due to several factors. Therefore, assessing the factors affecting quality of medical laboratory service is highly important in order to improve service quality. OBJECTIVE Assessment of factors affecting the quality of medical laboratory service in Gondar town public health facilities, Amhara regional state, Northwest Ethiopia, 2018. METHODS An institution based cross-sectional study was conducted at Gondar town governmental health facilities from March to April 2018. A pretested, self-administered, semi-structured questionnaire and checklist was used to collect the socio-demographic information of the study participants and to assess factors affecting the provision of quality medical laboratory services. Data were checked for completeness, entered, and analyzed using SPSS version 20 (IBM Corporation, Armonk, NY, USA). Data were reported in tables and figures. The strength of association between the dependent and independent variables was assessed by the chi-square test. A p-value < 0.05 was considered statistically significant. RESULTS A total of 103 medical laboratory professionals participated in the study. Of these, 62 (60.2%) were males. The majority of the study participants, 63 (61.2%), were laboratory technologists. Of these participants, 72 (69.9%) did not attend laboratory refresher training and 93 (90.3%) of participants were not satisfied with their salary. Sixty-three (61.2%) of the participants reported that their laboratory did not provide quality laboratory service. Lack of quality and adequate equipment, non-adherence to standard operating procedures, no continuing professional development, unavailability of adequate supplies and reagents, no customer service management, no regular internal and external quality assessment activity, no diagnostic service for all requested tests, no result verification, and laboratory safety were the major factors significantly associated with poor quality laboratory service (p < 0.05). CONCLUSIONS A high proportion of the study participants reported that their laboratory did not provide quality laboratory services. The shortage of adequate equipment, reagents, and lack of motivation and employees' recognitions are the major factors that affect the quality of laboratory services.

Objectives: We investigated factors affecting turnover and assessed satisfaction with an existing Incentive Management System and to which extent it motivates employees. We also provide recommendations to improve the Incentive Management System. Methods: A cross-sectional questionnaire study utilizing a convenience sample from of a population of 250 Medical Laboratory Technologists. Findings: 100 medical laboratory technologists responded to the survey. We found discrepancy in wage allocation to be the most prominent factor affecting turnover intention with 51% strongly agreeing, followed by low incremental system with 48%. Other factors were: limited opportunities for promotion, insufficient allowances and benefits, and lack of continuing education and professional growth opportunities with 49%. 26% of respondents found lack of autonomy/independence to be a factor. Poor workgroup cohesion was least ranked (17%). 39% reported dissatisfaction with workload, 31% were dissatisfied with their provided allowance, with management support, and the working hours, and opportunities for promotion (44%). Opportunities for career growth and higher pay were highest ranked as incentives to remain, and additional vacation time and supportive colleagues to be the least relevant factors. There was a significant correlation between age and motivation levels (r = 0.223, p = 0.026). Discussion and Conclusions: Burnout and turnover can be costly to healthcare organizations, due to the impact on productivity and healthcare quality. Human resource departments must ensure to not only attract skilled employees, but also influence their motivation and retention due to the impact on productivity and health care quality. Incentive management systems support practices to enhance skills, knowledge, abilities and retention rates for healthcare employees. Our study findings support the continued improvement of Incentive Management Systems within the healthcare organization to reduce turnover rates, maximize quality outcomes, and increase the levels of commitment and motivation of employees.

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.

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.

John Stelter, an advanced laboratory technologist at 3M, is the recipient of the 2020 National Chemical Technician Award. The award, administered by the American Chemical Society Committee on Techn...

Background: Laboratory workers are exposed to a variety of potential occupational health hazards including infectious materials and cultures, toxic and flammable chemicals, as well as electrical hazard. It is important for laboratory workers to be aware of the potential hazards and ensure safety in practices. Carelessness, negligence, and unsafe practices may result in serious injuries not only to the individual but also coworkers and patients as well. Objective: The objective of the study was to assess the knowledge, attitude, and practice (KAP) of laboratory safety precautions among technicians working in clinical microbiology laboratory. Materials and Methods: The study was a cross-sectional study on KAP of laboratory safety precautions among technicians. A close-ended structured questionnaire was canvassed to the technicians and responses were analyzed. Results: A total of 30 laboratory workers participated in the study. The overall correct responses regarding knowledge of laboratory safety precautions were 74% (673/900) and practices of the same were 79% (427/540). Few (10/30) perceived biomedical waste management as a burden and some (9/30) felt that too much of effort is required to follow optimal hand hygiene. Conclusion: Training and retraining on laboratory safety precautions are required along with counseling to induce a positive attitudinal change.

Laboratory testing to support the care of patients with highly infectious diseases may pose a risk for laboratory workers. However, data on the risk of virus transmission during routine laboratory testing conducted using standard personal protective equipment (PPE) are sparse. Our objective was to measure laboratory contamination during routine analysis of patient specimens. Remnant specimens were spiked with the nonpathogenic bacteriophage MS2 at 1.0 × 10 7 PFU/ml, and contamination was assessed using reverse transcriptase PCR (RT-PCR) for MS2. Specimen containers were exteriorly coated with a fluorescent powder to enable the visualization of gross contamination using UV light. Testing was performed by two experienced laboratory technologists using standard laboratory PPE and sample-to-answer instrumentation. Fluorescence was noted on the gloves, bare hands, and laboratory coat cuffs of the laboratory technologist in 36/36 (100%), 13/36 (36%), and 4/36 (11%) tests performed, respectively. Fluorescence was observed in the biosafety cabinet (BSC) in 8/36 (22%) tests, on test cartridges/devices in 14/32 (44%) tests, and on testing accessory items in 29/32 (91%) tests. Fluorescence was not observed on or in laboratory instrumentation or adjacent surfaces. In contrast to fluorescence detection, MS2 detection was infrequent (3/286 instances [1%]) and occurred during test setup for the FilmArray instrument and on FilmArray accessory equipment. The information from this study may provide opportunities for the improvement of clinical laboratory safety practices so as to reduce the risk of pathogen transmission to laboratory workers.

The clinical microbiology laboratory has historically been considered “low-tech,” especially when compared to the clinical chemistry laboratory. However, systems are emerging for the clinical microbiology laboratory with the potential to automate almost all areas of testing, including inoculation of primary culture plates, detection of growth on culture media, identification of microorganisms, susceptibility testing, and extraction and detection of nucleic acids in clinical samples. As a result, the workflow in the microbiology laboratory is changing at a rapid pace and microbiologists have the challenge of selecting the most appropriate, clinically useful, and cost-effective automation for their laboratories. We have asked 4 experts in this field, from clinical microbiology laboratories in the US and Europe, as well as from industry, to comment on the feasibility and impact of automation in the clinical microbiology laboratory. Are you currently using or do you anticipate using an automation platform in your microbiology laboratory? If yes, which sections of your laboratory are automated? Robin Patel: Mayo Clinic's clinical microbiology laboratory has been performing testing since 1911. Although select tests today resemble those performed a century ago, we have many examples of automated, state-of-the-art tests. These include blood cultures, infectious disease serologic platforms, and nucleic acid and proteomic diagnostics, to name a few. For over 2 decades, microbiology laboratories have been using automated blood culture instruments that “sense” microbial growth in blood culture bottles and “flag” positive bottles for immediate attention by laboratory technologists. Before the availability of such systems (in the not-so-distant past), laboratory technologists manually evaluated each blood culture bottle on multiple occasions. Technologists today could not fathom returning to the manual approach used a mere 3 decades ago. As with many chemistry tests, a myriad of infectious disease serologic tests are performed on automated platforms. Nucleic acid diagnostics, which have been used in our …

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

The past 25 years have witnessed the field of molecular pathology evolving from an imprecisely defined discipline to a firmly established medical subspecialty that plays an essential role in patient care. During this time, the training, certification, and licensure requirements for directing and performing testing in a molecular pathology or molecular diagnostics laboratory have become better defined. The purpose of this document is to describe the various board certifications available to individuals seeking certification in molecular diagnostics at the level of laboratory director, supervisor, or technologist. Several national organizations offer certification in molecular pathology or molecular diagnostics for doctoral-level clinical scientists to function as the director of a molecular diagnostics laboratory. Furthermore, 12 states and Puerto Rico require licensing of medical technologists, including those working in molecular diagnostic laboratories. The information provided here updates a 2002 document by the Training and Education Committee of the Association for Molecular Pathology and has been expanded to include certification and licensing requirements for laboratory technologists.

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: 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

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.

Rapid carbohydrate antigen tests are frequently used to diagnose group A streptococcal (GAS) pharyngitis. Despite evidence of modest sensitivity in medical settings, rapid antigen tests are available to the public for self-testing. We sought to determine if the personnel performing a rapid streptococcal antigen test influence the test's performance characteristics. Throat swabs of pediatric patients performed for GAS pharyngitis in a tertiary-care children's hospital network were included during two study periods in 2004 and 2005. The performance characteristics of a rapid carbohydrate antigen test were evaluated in three clinical settings against a nucleic acid probe test method according to the personnel performing the test (laboratory technologist versus nonlaboratory personnel). Between the study periods, nonlaboratory personnel from one site underwent retraining. Subsequently, the performance characteristics of the rapid antigen test were reassessed. The sensitivity of the rapid antigen test varied widely among the different testing sites (56 to 90%). Notably, test sensitivity was consistently greater when the test was performed by laboratory technologists than when it was performed by nonlaboratory personnel ( P < 0.0001). Although the rapid antigen test sensitivity significantly improved after nonlaboratory personnel at one testing site were retrained (sensitivity before versus after retraining; P < 0.0001), the sensitivity remained greater in the laboratory technologist cohort ( P < 0.0001). These data confirm the important relationship of the operator performing a rapid streptococcal antigen test with the test's accuracy, even in a clinical setting, where operator training is mandated. Therefore, its use outside the medical setting by lay persons cannot be recommended without culture backup.

Background The Ministry of Health (MOH) of Botswana adopted Strengthening Laboratory Management Toward Accreditation (SLMTA), a structured quality improvement programme, as a key tool for the implementation of quality management systems in its public health laboratories. Coupled with focused mentorship, this programme aimed to help MOH achieve the goals of the National Laboratory Strategic Plan to provide quality and timely clinical diagnoses. Objectives This article describes the impact of implementing SLMTA in Sekgoma Memorial Hospital Laboratory (SMHL) in Serowe, Botswana. Methods SLMTA implementation in SMHL included trainings, improvement projects, site visits and focused mentorship. To measure progress, audits using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist were conducted at baseline and exit of the programme, with scores corresponding to a zero- to five-star scale. Turnaround times, customer satisfaction, and several other health service indicators were tracked. Results The laboratory scored 53% (zero stars) at the baseline audit and 80% (three stars) at exit. Nearly three years later, the laboratory scored 85% (four stars) in an official audit conducted by the African Society for Laboratory Medicine. Turnaround times became shorter after SLMTA implementation, with reductions ranging 19% to 52%; overall patient satisfaction increased from 56% to 73%; and clinician satisfaction increased from 41% to 72%. Improvements in inventory management led to decreases in discarded reagents, reducing losses from US $18 000 in 2011 to $40 in 2013. Conclusion The SLMTA programme contributed to enhanced performance of the laboratory, which in turn yielded potential positive impacts for patient care at the hospital.

The management of quality in the Division of Transfusion Medicine at our institution has undergone a lengthy, sometimes painful but always progressive evolution over nearly four decades. Initially, it consisted of one laboratory technologist who was assigned the task of performing certain basic QC checks on a predetermined list of laboratory, collection, and processing steps. This technologist reported directly to the medical director. The tasks gradually grew in volume and complexity so that a four-person quality unit was established, administratively quite separate from the operations and accountable only to the Medical Director. The next stage in the evolutionary process was more revolutionary in scope because it involved a comprehensive cultural shift toward the concept of "quality is everyone's responsibility." The evolutionary process in our institution to date and the planning and organization involved in the direction and management of the evolution itself are described.

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.

Within microbiology, Ellen Jo Baron discovered the visual aesthetics of microscopy and the ability to describe and identify bacteria. A diagnostic microbiology laboratory at a county public health department had an opening for a person with a B.S. in microbiology. Ellen Jo Baron smelled the autoclave and the unique odors of a busy microbiology laboratory. She rotated through many areas of the laboratory, learning the basics from the ground up-Mycobacterium tuberculosis laboratory, urines, susceptibilities, wounds, genital cultures, and others. The author talks about the time when she found herself at the bottom rung of the clinical profession. An incident involving an anesthesiologist led her to seek a higher academic degree. This anesthesiologist controlled the postappendectomy care for a young patient and demanded antibiotic susceptibility tests on all organisms recovered from the patient's respiratory secretion. Ellen Jo Baron knew that the organisms recovered were simply the patient's normal mucosal and saliva flora and that antibiotic therapy to try to remove them was inappropriate. Nevertheless, the anesthesiologist would not listen to a lowly laboratory technologist, and the pathologists did not have the microbiological background to refuse the doctor's requests. Multiple successive antibiotics were prescribed to treat that patient's "pathogens," and as a result the patient developed pneumonia with a panresistant Pseudomonas aeruginosa and died. At this point the author thought that if she had a master of science degree she could gain credibility and respect from clinicians. This incident urged the author to enter a master's program in medical microbiology.

Concerns about recruitment and retention of nursing staff are currently increasing in a number of countries. This article describes a study which identifies sources of job satisfaction among nurses and medical laboratory technologists in Sweden. A previously validated questionnaire was translated into Swedish and sent to all relevant staff working at a large hospital in southern Sweden. Analysis of responses suggests that while staff still found their work interesting, rewards are potentially decreasing and sources of stress increasing. Comparisons are made with literature from the UK and USA and the need for action to address a number of concerns is highlighted.

Written by Adam Seegmiller, MD, PhD, and Mary Ann Thompson, MD, PhD, 116 pages. New York, NY: Demos Medical Publishing. $55.00. ISBN: 978-1620700334 Hematology and Immunology: Quality in Laboratory Diagnosis , a title in the Diagnostic Standards of Care series, focuses on common and uncommon errors encountered in hematology and immunology laboratories that can lead to misinterpretation of test results and misdiagnosis of patients by health care professionals. The book is intended to serve as a learning resource for pathologists, laboratory technologists and technicians, supervisors, and students based on real life laboratory experiences. I believe that the authors have done an excellent job of providing detailed explanations to educate the reader on how to recognize and manage these errors. The book is divided into 2 main sections, Hematology and …

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.

The purpose of this study was to examine the attitudes of laboratory staff towards AIDS and AIDS patients and related factors. The population consisted of the working-age laboratory technologists living in Finland (n = 5,973). A sample of 249 laboratory technologists was selected from the register of the National Research and Development Centre for Welfare and Health using systematic random selection. The material was collected with a questionnaire. The younger laboratory technologists had more knowledge about AIDS than the older ones, and those who had more knowledge about AIDS had a more positive attitude than those with less knowledge. The attitudes were connected with the way the disease was contracted: the most positive attitudes were expressed towards the patients who had contracted AIDS through blood transfusion and the most negative towards the patients who had contracted AIDS from non-sterile needles. The factor analysis yielded six factors representing attitudes. The fear factor explained most (19%) of the laboratory technologists' attitudes towards AIDS and AIDS patients. The older laboratory technologists were more afraid of work-related infections than the younger ones. The laboratory technologists with adequate knowledge of AIDS were less afraid of contracting the virus than those with little knowledge. They wanted information mainly on the care of AIDS patients, on how to respond to them and on the ways AIDS is transmitted.

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: Early diagnosis of infants infected with HIV (EID) and early initiation of treatment significantly reduces the rate of disease progression and mortality. One of the challengesto identification of HIV-1-infected infants is availability and/or access to quality molecular laboratory facilities which perform molecular virologic assays suitable for accurate identificationof the HIV status of infants.Method: We conducted a joint site assessment and designed laboratories for the expansion of DNA polymerase chain reaction (PCR) testing based on dried blood spot (DBS) for EID insix regions of Ethiopia. Training of appropriate laboratory technologists and development of required documentation including standard operating procedures (SOPs) was carried out. The impact of the expansion of EID laboratories was assessed by the number of tests performed as well as the turn-around time.Results: DNA PCR for EID was introduced in 2008 in six regions. From April 2006 to April 2008, a total of 2848 infants had been tested centrally at the Ethiopian Health and Nutrition Research Institute (EHNRI) in Addis Ababa, and which was then the only laboratory with the capability to perform EID; 546 (19.2%) of the samples were positive. By November 2010, EHNRI and the six laboratories had tested an additional 16 985 HIV-exposed infants, of which 1915 (11.3%) were positive. The median turn-around time for test results was 14 days (range 14−21 days).Conclusion: Expansion of HIV DNA PCR testing facilities that can provide quality and reliable results is feasible in resource-limited settings. Regular supervision and monitoring for quality assurance of these laboratories is essential to maintain accuracy of testing.

The Soil and Plant Analytical Laboratories Network of Africa (SPALNA) was established in 1991, during an inaugural meeting at the International Institute of Tropical Agriculture (IITA). The objective of SPALNA is to support the national agricultural research systems in Africa by improving their soil and plant analytical laboratories which are facing many problems that are difficult to solve by the individual laboratories. Problems such as low quality of data, poor infrastructure (water, electricity, etc), lack of spare parts and equipment maintenance, low training skills, etc., are common to many laboratories in Africa and can best be solved through collaboration and networking. SPALNA has, therefore, organized training courses at various laboratories in Africa, in order to improve the skills of laboratory technologists in the following areas: equipment maintenance, soil and plant analysis methodology, laboratory information management, and good laboratory practices. Pre‐owned equipment donated t...

Urinalysis with microscopic sediment is examination a commonly performed laboratory test. The microscopic examination often is performed under poorly controlled conditions that limit the clinical relevance, particularly of quantitative findings. We review features of several commercially available systems that can improve the procedures accuracy and precision. All methods rely on interpretation by a well-trained laboratory technologist for accurate results. Studies of the effect of urinalysis on patient outcomes should not be based on methods that lack adequate discriminative ability, nor should laboratories imply a false sense of precision when reporting results to clinicians. This is the first in a three-part series on urinalysis. Other articles in the series focus on testing urine crystals and urine cytodiagnostics.

The objective of this study is to propose a method of hot fomentation for a lower-back care for stress relief. Experimental evidence statistically validated this approach for relieving stress. In the experiment, hot fomentation was applied to twenty senior college students (from 21 to 22 years old) who had complained of stiffness in their shoulder and lumbar region of the back during the month prior to a national examination for clinical Medical technologist. Before and after the 30-minute hot fomentation care with a hot-pack, we measured their psychological and physical reactions. The changes in their psychological reactions were evaluated using the visual analog scale (VAS) to assess the degree of comfort. The physical reactions were evaluated using the cortisol level of blood serum as an index of stress.

Embalmment is the method of preservation of bodies after death and in recent times, different methods have been developed in order to preserve the bodies more accurately and more perfectly. This study was designed to test the knowledge of Nigeria laboratory technologists and mortuary attendants on various methods of embalmment techniques. Semi structured questionnaire was administered to 72 randomly selected respondents comprising of laboratory and mortuary attendants (94.4% males and 5.6% females) from different Medical schools, teaching and general hospitals and funeral homes across the country. 41.7% of the respondents are laboratory technologists in anatomy departments, 48.6% are mortuary attendants and 7.9% are embalmers at funeral homes. All the respondents are very knowledgeable about the arterial embalmment while about 2.3% have some knowledge about plastination method of embalmment. We came to the conclusion that the respondents need to have training and re-training in various methods of modern embalmment techniques in order for them to cope with the day to day challenges required in embalmment services.

Objective. The objective of this study was to determine the accuracy of a near-patient blood gas and electrolyte analyzer when used by non-laboratory-trained clinicians in the critical care setting.Methods. One hundred eighty-five blood samples (split samples) from 50 intensive care unit patients were analyzed by clinicians in the critical care environment using a near-patient blood gas and electrolyte analyzer (GEM Premier, Mallinckrodt Sensor Systems, Ann Arbor, MI). Near-patient measurements were compared with those obtained by laboratory technologists in an established intensive care unit laboratory.Results. There was good agreement between the near-patient analyzer and the laboratory for pH, $$P_{CO_2 } $$ , sodium, potassium, ionized calcium, and hematocrit. Bias and precision were 0.006 and 0.03 for pH, 0.03 and 0.34 kPa for $$P_{CO_2 } $$ , 0.78 and 2.61 mmol/L for sodium, −0.11 and 0.12 mmol/L for potassium, −0.007 and 0.05 mmol/L for ionized calcium, and −0.99 and 1.33% for hematocrit. Bias between the laboratory instrument and the bedside analyzer was small for PO2 (−0.56 kPa). However, precision between instruments was significantly higher (2.39 kPa for all PO2 values and 1.61 kPa for PO2 ≤ 13 kPa).Conclusions. The test instrument is accurate and reproducible when used in the clinical setting by non-laboratory-trained individuals. Non-laboratory-trained individuals can obtain laboratory results in the near-patient setting comparable to those obtained by trained laboratory technologists.

Rapid tests for detecting group A streptococci in throat swabs are often performed outside hospitals or commercial laboratories by individuals with little or no technical training. We compared the abilities of nurses and technologists to perform and interpret three commercial kits (Directigen 1-2-3, ICON Strep A, and Culturette Brand 10-Minute Strep A ID) in three hospital satellite locations (the emergency department, a walk-in emergency clinic, and a general pediatric clinic). When the three tests were compared with culture, the sensitivities of the tests as performed by nurses and technologists, respectively, were 39 versus 44% for Directigen, 55 versus 51% for Culturette, and 72 versus 39% for ICON. A significant difference in sensitivity was found only with ICON tests. This result was largely explained by the tendency of technologists to test moist swabs, while nurses generally processed dry swabs; ICON test sensitivity was significantly greater with dry swabs. The specificities of Directigen and ICON tests performed by nurses and technologists were high (97 to 100%). The difference in the specificities of the Culturette test as determined from results obtained by nurses and technologists (80 versus 98%) was due to the tendency of one nurse to overinterpret the latex agglutination reaction. Analysis of the accuracies of the tests during practice periods compared with the accuracies of the tests during the study periods revealed statistically significant improvement in test performance. We conclude that these tests are specific but not sensitive when performed by nurses and technologists in satellite laboratories. With one exception, nurses and technologists performed the tests with comparable accuracy after brief training periods.