1,720,978 research outputs found
Green Transition: Are Historical City Centres Residents Excluded? The Case of Venezia
No full textThe promotion of renewable energy in protected cities and heritage buildings is critical for sustainable development. As the world seeks cleaner energy alternatives, the significance of incorporating renewable sources, particularly photovoltaic panels, becomes evident. This transition not only contributes to decarbonization but also addresses the unique challenges faced by residents in historically rich city centres such as Venezia. While renewable energy sources have proven to be instrumental in fostering a sustainable and resilient energy ecosystem, their integration within protected urban areas poses a distinctive set of challenges. This study aims to examine the constraints and opportunities associated with the adoption of renewable energy sources, particularly photovoltaic panels, in protected environments as the city of Venezia. The analysis unfolds in several phases. Initially, the exploration of the technical and policy constraints that impede the seamless integration of renewables within historical contexts. Subsequently, viable pathways to ensure equitable access to renewable energy are identified including strategies to overcome the barriers that may hinder the adoption of clean energy solutions. An illustrative case study of a residential group in Venezia underscores both the possibilities and challenges associated with integrating photovoltaic panels in protected areas. Energy simulations are used to highlight the energy savings for the group of buildings when renewable energy is used. This work sheds light on the imperative role of renewable energy and the need for targeted efforts to not exclude people living in historical context from energy transition fighting energy poverty in particularly challenging areas
Quality control in coagulation testing
No full textThe term "QUALITY CONTROL" in laboratory medicine refers to all the procedures
commonly used in clinical laboratories to monitor the routine performance of
testing processes, to detect possible errors, and to correct problems before test
results are reported. In particular, internal quality control (IQC) and external
quality assessment (EQA) programs are used to evaluate and improve quality in
laboratory medicine. Laboratory testing is necessary for the diagnosis and
treatment of patients with hemostatic disorders. However, whereas the benefits of
quality control and quality assessment in hemostasis have been demonstrated many
times and are well documented, available scientific evidence is significantly
less than that in clinical chemistry and in other fields of laboratory medicine.
Currently available data on analytical quality in coagulation testing not only
demonstrates that quality is often unsatisfactory, but also highlights the need
for more objective establishment of performances goals. This should be useful for
better addressing both IQC and EQA programs. New challenges to EQA schemes for
coagulation testing derive from the introduction of innovative tests, genetic
analysis, and the need to assess not only analytical procedures but also all
steps included in the total testing process
Quality specifications in EQA schemes: from theory to practice
No full textBACKGROUND:
External quality assessment (EQA) is a tool for quality management in clinical laboratories and its main objectives are assessment of participants and methods performance, training and advice. This paper describes the quality specifications used in EQA schemes of the Centre of Biomedical Research (CRB), in order to design schemes that can assess laboratory reliability performances, meet the changing needs and quality recommendations.
METHODS:
Quality specifications for control materials, statistical procedures and goals to assess laboratory performance have been applied and introduced in EQA schemes managed by CRB.
RESULTS:
The application of well-defined quality specifications has demonstrated effective. In particular, we report results on alkaline phosphatase and cholesterol obtained using commercial control materials and human serum controls, in two different EQA surveys; the inter-laboratory variability (CVinter%) for troponin I analysed with a diagnostic system and assigned values of CK-MB mass obtained using four different diagnostic systems; the percentage of acceptable performances obtained by means of the application of goals based on clinical criteria, biological variation, state-of-the-art and used for EQA schemes, and referring to some analytes with significant clinical values such as cholesterol, glucose, glycated hemoglobin and sodium.
CONCLUSIONS:
The design of reliable EQA schemes based on evidence-based quality specifications is a pre-requisite for supporting the quality improvement of clinical laboratories
Risk management in laboratory medicine: quality assurance programs and professional competence.
No full textTo guarantee excellent performance and service, the process of identifying and treating error risks must be integrated into the total testing process. Quality Assurance Programs (QAPs) represent an important tool that allows us to identify errors and pinpoint any need for further systematic investigations, and to rectify procedures to improve the inputs and processes by which the service is delivered. The models used by the laboratory to assure quality and manage the risk of errors have been modified in line with an approach in which the identification of quality goals and the redefinition of professionals duties and responsibilities are indispensable. Error risk is currently high in some areas of laboratory activity, and QAP is needed now more than ever. The present paper provides some descriptive examples of an approach that can be followed to manage an External Quality Assessment Scheme (EQAS) and quality indicators (QIs), the main tools used by laboratories to assure the quality of their service, for the prevention of error risk. In particular, we describe the correct approach to choose EQAS, to use information from the EQAS report, to design a QI model, and to analyze any QI data. The examples highlight that any well-designed quality system can be ineffective if it is not managed by highly competent professionals with a deep sense of responsibility
External Quality Assessment Schemes: need for recognised requirements
No full textPrograms for Accreditation of clinical laboratories consider participation in External Quality Assessment Schemes (EQAS) a key element in the evaluation of testing procedures and improving them. One of the main functions of EQAS is to assess whether laboratories perform tests competently. It is therefore of utmost importance for laboratories to participate in EQAS that are in line with formally recognised requirements. Specific proposals have been made on how to design and execute EQAS by International Working Groups, but there seems to be no consensus on the best strategies to use and quality specifications to see out. The Clinical Pathology Accreditation (CPA) Program for EQA Scheme Accreditation (CPA-EQA) is the only program in Europe to provide a formal recognition of the quality of EQAS activities. The present paper reports on the experience of the Centre of Biomedical Research which is following an accreditation process for their own schemes in line with the CPA-EQA program and a proposal to set requirements that Italian schemes must follow to be recognised as valid and effective. (C) 2001 Elsevier Science B.V. All rights reserved
External Quality Assessment: an effective tool for Clinical Governance in Laboratory Medicine
No full textThe implementation of Clinical Governance will require a redefinition of duties and accountability as a prerequisite to develop and achieve an overall improvement in clinical care through a culture of assessment and monitoring of quality. External Quality Assessment Schemes (EQAS) are the main tool enabling laboratories to measure the quality of their results; they must carefully assess and monitor all elements contributing to the formulation of laboratory information (results, reference ranges/decisional levels, interpretative comments and diagnostic algorithms). There are different ways to design and manage a Scheme and EQAS coordinators are mainly responsible for its effectiveness. The present paper reports, as an example, some experiences of the Centre of Biomedical Research (CRB), which manages EQAS according to high quality specifications and laboratories' needs, that can reflect the Clinical Governance philosophy. Our findings show that EQAS are able to control all the above aspects and, if organisers are committed to fulfilling the responsibility and accountability principles, they will be of great value in quality assessment and in developing an External Quality Assurance Program (EQAP). This is an inter-laboratory comparison designed and conducted to assure the following: evaluation of participants' performance (by evaluating not only analytical performance, but also test interpretation, and advice for clinicians on laboratory requests and diagnosis); evaluation of method performance; and continuous education, training and help. The main aim of the activities of an EQAP in Laboratory Medicine is to sustain improvements in the quality of services provided by participating laboratories for the benefit of patients
The standardization of plasma protein checked by an external quality assessment scheme (EQAS)
No full textInterpretative comments and reference ranges in EQA programs as a tool for improving laboratory appropriateness and effectiveness
No full textINTRODUCTION:
Laboratory information is generated when a meaning is given to certain data. This is usually achieved by comparing a laboratory test result with the reference range/decisional limit (RL), and by providing consultation for the interpretation of data, advice, and follow-up testing.
AIM:
In this paper, we investigate factors affecting the conversion of data into useful information with regard to biochemical markers of myocardial damage (CK-MB mass, myoglobin, and troponins), in view of their importance in detecting myocardial necrosis. Our aim was to report results obtained in order to verify the consensus between laboratories with reference to interpretative comments and the reference ranges/decisional limits added to clinical reports.
METHODS:
A questionnaire and simulated medical reports on three different patients were distributed to participants (94 laboratories) in the 2001 cycle of the External Quality Assessment (EQA). Moreover, we analysed 113 medical reports sent by laboratories during the most recent EQA cycle 2002, and checked the number of different RLs used, both independent and within the diagnostic system used. We also compared each laboratory result of a control sample, obtained in the 2002 cycle, with declared RL in order to verify the clinical significance of results ("normal" or "pathological") for troponin I and CK-MB.
RESULTS:
Our findings show that few laboratories regularly add interpretative comments to medical reports. On the contrary, they cooperate with clinicians who require consultation, advice, and information for the appropriate use of biochemical markers. There is a general consensus among participants regarding probable syndromes suggested by the interpretation of the same result and most laboratories also agree on further investigations to be carried out for several diseases. Concerning RL, the data demonstrate that numerous different RLs are used to report the results of the biochemical markers evaluated, both when considered independent of the diagnostic system used and within the diagnostic system used.
DISCUSSION AND CONCLUSIONS:
The biochemist does not have the opportunity to verify the efficacy of the interpretation that he/she provided. An audit of this activity is therefore required to allow the laboratory to monitor its own performance and to assure good practice. The evaluation of interpretative comments, through specific surveys, should be a prime objective of EQA organisers. Well-designed EQA programs can, moreover, support laboratories in establishing appropriate RL and in verifying the clinical significance of their results with respect to that of other laboratories. Our survey on interpretative comments and the analysis of the RLs further demonstrate how laboratory medicine can contribute to the objective evaluation of the patients' health status
Appropriateness of cholesterol and triglycerides reporting checked by External Quality Assessment programs
No full textBACKGROUND:
The recommendations of the Second Joint Task Force of European and Other Societies on Coronary Prevention and the third Adult Treatment Panel report (ATPIII) released by the National Cholesterol Education Program are based on accumulating evidence concerning the contribution of lipoproteins and other risk factors in the development of coronary heart disease (CHD). The laboratories play an important role in the successful adoption of these guidelines.
METHODS:
In External Quality Assessment (EQA) programs managed by the Center of Biomedical Research, results and respective reference intervals (RI) are sent as laboratory's medical form. We assessed how well the 200 participants to EQA scheme 2002 for clinical biochemistry reported total cholesterol (TC) and triglycerides (TGs) results according to either European or National Cholesterol Education Program (NCEP) guidelines.
RESULTS:
Only 18% of laboratories reported total cholesterol concentrations correctly in terms of desirable, borderline-high, and high risk for the CHD development, 12% reported a single desirable value (180, 190, or 200 mg/dl), and 70% reported the RI (85 laboratories in the whole interval, 34 are the only upper reference limit and 15 are the desirable value in addition to RI). The upper reference limit was 200 mg/dl in 65% of cases, but 32% of laboratories presented higher limits, reaching values as high as 250-260 mg/dl. Only the 3.7% of laboratories reported triglyceride concentrations in terms of risk-oriented ranges for the CHD development, 6.8% the single desirable value, and 89.5% the RI.
CONCLUSION:
Our study demonstrates that the current practice of reporting results for cholesterol and triglycerides does not follow the guidelines, and appropriate changes are required to be mad
- …
