3,337 research outputs found
Causes, consequences, detection, and prevention of identification errors in laboratory diagnostics.
No full textLaboratory diagnostics, a pivotal part of clinical decision making, is no safer than other areas of health-care, with most errors occurring in the manually intensive preanalytical process. Patient misidentification errors are potentially associated with the worst clinical outcome due to the potential for misdiagnosis and inappropriate therapy. While it is misleadingly assumed that identification errors occur at a low frequency in clinical laboratories, misidentification of general laboratory specimens is around 1% and can produce serious harm to patients, when not promptly detected. This article focuses on this challenging issue, providing an overview on the prevalence and leading causes of identification errors, analyzing the potential adverse consequences, and providing tentative guidelines for detection and prevention based on direct-positive identification, the use of information technology for data entry, automated systems for patient identification and specimen labeling, two or more identifiers during sample collection and delta check technology to identify significant variance of results from historical values. Once misidentification is detected, rejection and recollection is the most suitable approach to manage the specimen
Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories.
No full textPrevention of medical errors is a major goal of healthcare, though healthcare workers themselves have not yet fully accepted or implemented reliable models of system error, and neither has the public. While there is widespread perception that most medical errors arise from an inappropriate or delayed clinical management, the issue of laboratory errors is receiving a great deal of attention due to their impact on the quality and efficiency of laboratory performances and patient safety. Haemolytic specimens are a frequent occurrence in clinical laboratories, and prevalence can be as high as 3.3% of all of the routine samples, accounting for up to 40%-70% of all unsuitable specimens identified, nearly five times higher than other causes, such as insufficient, incorrect and clotted samples. This article focuses on this challenging issue, providing an overview on prevalence and leading causes of in vivo and in vitro haemolysis, and tentative guidelines on identification and management of haemolytic samples in clinical laboratories. This strategy includes continuous education of healthcare personnel, systematic detection/quantification of haemolysis in any sample, immediate clinicians warning on the probability of in vivo haemolysis, registration of non-conformity, completing of tests unaffected by haemolysis and request of a second specimen for those potentially affected
Multicenter evaluation of the hemolysis index in automated clinical chemistry systems.
No full textBackground: In vitro hemolysis, the prevailing cause of preanalytical error in routine laboratory diagnostics, might influence the reliability of several tests, affect the quality of the total testing process and jeopardize patient safety. Although laboratory instrumentation is now routinely equipped with systems capable of automatically testing and eventually correcting for hemolysis interference, to our knowledge there are no reports that have compared the efficiency of different analytical platforms for identifying and classifying specimens with hemolysis.
Methods: Serum from a healthy volunteer was spiked with varying amounts of hemolyzed blood from the same volunteer, providing a serum free hemoglobin concentration ranging from 0.0 g/L to 2.0 g/L as measured by the reference cyanmethemoglobin assay. The spiked serum samples were shipped to seven separate laboratories and the hemolysis index (HI) was tested in triplicate on the following analytical platforms: Roche Modular System P (n=4) and Integra 400 Plus (n=1), Siemens Dimension RxL (n=3), ADVIA 2400 (n=1) and ADVIA 1800 (n=1), Olympus AU 680 (n=1) and Coulter DXC 800 (n=1).
Results: Satisfactory agreement of HI results was observed among the various analytical platforms, despite a trend toward overestimation by the ADVIA 2400 and 1800. After normalizing results according to the instrument-specific alert value, discrepancies were considerably reduced. All instruments except for the Dimension RxL gave values normalized to the instrument-specific alert value, 1.0 for the sample with 0.075 g/L free hemoglobin. The results of the four Modular System P tests were also highly reproducible among the different facilities. When evaluating instruments that provided quantitative HI results, the mean intra-assay coefficient of variation (CV) calculated for the triplicate determinations was always between 0.1% and 2.7%.
Conclusions: The results of this multicenter evaluation confirm that efficiency of different analytical platforms to correctly identify and classify unsuitable samples is satisfactory. However, more effort should be placed on the standardization of reporting HI. All the instruments that we tested provide either quantitative or qualitative results that are essentially comparable, but which should always be compared with the instrument-specific alert values to harmonize their efficienc
Causes, consequences, detection, and prevention of identification errors in laboratory diagnostics.
No full textLaboratory diagnostics, a pivotal part of clinical decision making, is no safer than other areas of healthcare, with most errors occurring in the manually intensive preanalytical process. Patient misidentification errors are potentially associated with the worst clinical outcome due to the potential for misdiagnosis and inappropriate therapy. While it is misleadingly assumed that identification errors occur at a low frequency in clinical laboratories, misidentification of general laboratory specimens is around 1% and can produce serious harm to patients, when not promptly detected. This article focuses on this challenging issue, providing an overview on the prevalence and leading causes of identification errors, analyzing the potential adverse consequences, and providing tentative guidelines for detection and prevention based on direct-positive identification, the use of information technology for data entry, automated systems for patient identification and specimen labeling, two or more identifiers during sample collection and delta check technology to identify significant variance of results from historical values. Once misidentification is detected, rejection and recollection is the most suitable approach to manage the specimen. © 2009 by Walter de Gruyter
Multicenter evaluation of the hemolysis index in automated clinical chemistry systems
No full textBackground: In vitro hemolysis, the prevailing cause of preanalytical error in routine laboratory diagnostics, might influence the reliability of several tests, affect the quality of the total testing process and jeopardize patient safety. Although laboratory instrumentation is now routinely equipped with systems capable of automatically testing and eventually correcting for hemolysis interference, to our knowledge there are no reports that have compared the efficiency of different analytical platforms for identifying and classifying specimens with hemolysis. Methods: Serum from a healthy volunteer was spiked with varying amounts of hemolyzed blood from the same volunteer, providing a serum free hemoglobin concentration ranging from 0.0 g/L to 2.0 g/L as measured by the reference cyanmethemoglobin assay. The spiked serum samples were shipped to seven separate laboratories and the hemolysis index (HI) was tested in triplicate on the following analytical platforms: Roche Modular System P (n=4) and Integra 400 Plus (n=1), Siemens Dimension RxL (n=3), ADVIA 2400 (n=1) and ADVIA 1800 (n=1), Olympus AU 680 (n=1) and Coulter DXC 800 (n=1). Results: Satisfactory agreement of HI results was observed among the various analytical platforms, despite a trend toward overestimation by the ADVIA 2400 and 1800. After normalizing results according to the instrument-specific alert value, discrepancies were considerably reduced. All instruments except for the Dimension RxL gave values normalized to the instrument-specific alert value, <1.0 for the sample with 0.048 g/L free hemoglobin, and >1.0 for the sample with 0.075 g/L free hemoglobin. The results of the four Modular System P tests were also highly reproducible among the different facilities. When evaluating instruments that provided quantitative HI results, the mean intra-assay coefficient of variation (CV) calculated for the triplicate determinations was always between 0.1% and 2.7%. Conclusions: The results of this multicenter evaluation confirm that efficiency of different analytical platforms to correctly identify and classify unsuitable samples is satisfactory. However, more effort should be placed on the standardization of reporting HI. All the instruments that we tested provide either quantitative or qualitative results that are essentially comparable, but which should always be compared with the instrument-specific alert values to harmonize their efficiency. Clin Chem Lab Med 2009;47:934–9.Peer Reviewe
On the AJ Conjecture for Knots
No full textWe confirm the AJ conjecture [Ga2] that relates the A-polynomial and the colored Jones polynomial for hyperbolic knots satisfying certain conditions. In particular, we show that the conjecture holds true for some classes of two-bridge knots and pretzel knots. This extends the result of the first author in [Le2], who established the AJ conjecture for a large class of two-bridge knots, including all twist knots. Along the way, we explicitly calculate the universal SL₂(C)-character ring of the knot group of the (−2, 3, 2n + 1)-pretzel knot, and show it is reduced for all integers n
Discovery of a single faint AGN in a large sample of z > 5 Lyman break galaxies
No full textAs part of a large spectroscopic survey of z > 5 Lyman break galaxies (LBGs), we have identified a single source which is clearly hosting an active galactic nucleus (AGN). Out of a sample of more than 50 spectroscopically confirmed R-band dropout galaxies at z∼ 5 and above, only J104048.6−115550.2 at z= 5.44 shows evidence for a high ionization potential emission line indicating the presence of a hard ionizing continuum from an AGN. Like most objects in our sample the rest-frame-UV spectrum shows the UV continuum breaking across a Lyα line. Uniquely within this sample of LBGs, emission from N V is also detected, a clear signature of AGN photoionization. The object is spatially resolved in Hubble Space Telescope (HST) imaging. This, and the comparatively high Lyα/N V flux ratio indicates that the majority of the Lyα (and the UV continuum longward of it) originates from stellar photoionization, a product of the ongoing starburst in the LBG. Even without the AGN emission, this object would have been photometrically selected and spectroscopically confirmed as a Lyman break in our survey. The measured optical flux (IAB= 26.1) is therefore an upper limit to that from the AGN and is of order 100 times fainter than the majority of known quasars at these redshifts. The detection of a single object in our survey volume is consistent with the best current models of high redshift AGN luminosity function, providing a substantial fraction of such AGN is found within luminous starbursting galaxies. We discuss the cosmological implications of this discovery
The author, the text, and the (post)critic: notes on the encounter between postcritique and postcolonial criticism
No full textThe article confronts postcolonial criticism with postcritique, a proposal by Rita Felski for a hermeneutic strategy aiming to overcome the limits of critique. Because of its self-reflexivity, its liaison with poststructuralism, and the societal categories it mobilizes, postcritics often see postcolonial criticism as a quintessential example of critique. However, postcolonial authors share similar concerns as postcritics, particularly when warning against any hasty conflation between intellectual work and political commitment. This article argues that the postcritical understanding of critique eschews the connection between critique and the realm of culture, thereby running the risk of doing away with context altogether. In order to account for the frameworks or contexts in which cultural objects are produced, without falling into some of the pitfalls of critique that postcritique aims to counter, the article proposes to look at the figure of the author as a bridge between the individual and the collective, as Edward Said suggests. The article closes with an analysis of several (critical and postcritical) readings of J. M. Coetzee’s The Childhood of Jesus to provide an example of how authorship can enter the interpretive scene through the figure of ‘late style’
Exploring the roles, effectiveness and impact of health information professionals within evidence based practice
No full textThis is the thesis (critical appraisal) component of a PhD by Published Works. The overall submission was a portfolio of ten published papers supported by a critical appraisal focusing on two key areas: an exploration of the roles that Health Information Professionals (HIPs) can play within evidence based practice (EBP) and an exploration of the effectiveness and impact of the traditional supportive role played by HIPs within EBP. The published papers are listed and referenced within this document but not contained within it. The majority are available elsewhere within the University of Salford Institutional Repository.Drawing on a model developed from the library literature, the thesis highlights a wide range of supportive and active roles that HIPs can potentially play within EBP. This model is informed and illuminated by the studies within the portfolio that demonstrate how the author has fulfilled a wide range of these roles in practice, and identified a new role within systematic reviews in health and social care. This demonstrates that HIPs can transfer their skills outside their traditional library and information practice domain, thus extending theirrole and offering a range of professional opportunities.Using a varied range of research methodologies, the thesis also explores the effectiveness and impact of the contribution made by HIPs when using traditional skills to support EBP. Two models are used to illustrate the outcomes to which HIPs contribute. These include improving search skills and providing evidence which can, over the longer term, contribute to policy making and patient care. At present the weight of the evidence presented tosupport these links is weak. Methodological issues and future research that needs to be addressed to improve the strength of the evidence base are therefore highlighted and discussed
The XMM-Newton long look of NGC 1365: uncovering of the obscured X-ray source
No full textWe present an analysis of the extreme obscuration variability observed during an XMM–Newton 5-d continuous monitoring of the active galactic nuclei (AGN) in NGC 1365. The source was in a reflection-dominated state in the first ∼1.5 d, then a strong increase in the 7–10 keV emission was observed in ∼10 h, followed by a symmetric decrease. The spectral analysis of the different states clearly shows that this variation is due to an uncovering of the X-ray source. From this observation, we estimate a size of the X-ray source DS < 1013 cm, a distance of the obscuring clouds R∼ 1016 cm and a density n∼ 1011 cm−3. These values suggest that the X-ray absorption/reflection originates from the broad-line region clouds. This is also supported by the resolved width of the iron narrow Kα emission line, consistent with the width of the broad Hβ line
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