Evaluation of the Becton-Dickinson rapid serum tube: Does it provide a suitable alternative to lithium heparin plasma tubes?

Background: Obtaining a suitable specimen for analysis in a timely manner is pivotal in clinical chemistry service provision. Serum is recognized as the preferred specimen for most assays, but because of time constraints for completion of clotting and an increasing number of patients on anti-coagulant therapy, latent clotting or no clotting is an outcome which can lead to errors and delay in delivery of critical results. Although lithium heparin plasma has unique problems, it has become an alternative in hospital-based laboratories. Methods: The Becton-Dickinson (BD) rapid serum tube (RST) was evaluated in a hospital environment using a total of 53 participants, both healthy and anticoagulated, for 31 analytes against BD PST II and BD SST II tubes measured with Beckman DxC800 and DxI800 analyzers. Results: Most results from the RST tube were comparable with those from the SST II tube. Potassium results were closer to the PST II plasma concentrations. Incomplete and latent clotting was encountered in the RST specimens from participants (cardiac and dialysis) who had received a total of >7000 units of heparin [activated partial thromboplastin time (APTT) >150 s], warfarin/heparin combination, and specimens from cardiac surgery patients who had received a total of >25, 000 units of heparin (APTT >200 s) at the time of collection of specimens. Conclusions: The RST tube provides a suitable alternative to lithium heparin plasma tubes for most patients in a hospital environment. However, latent clotting continued to occur in specimens collected from participants who had received high concentrations of anticoagulants

Lesen wir Literatur oder lesen wir Comics?

This article shows how comics can be used in university seminars on literature to strengthen stu-dents’ competencies in relation to the so-called “multiliteracies”. This concept was developed by the New London Group (1996) and proposes a multimodal approach, while at the same time drawing attention to socio-political contexts and inter- or transcultural issues – and has often been reduced to a mere media perspective, especially in the field of literature didactics and comics. By contrast, I aim to take up the original concept of “multiliteracies” and – enhanced by Jens Schröter’s theory (2008) of the “primordial-intermedial network” – to use selected Czech comics to show how reading them can open up a new view of literary texts and, ultimately, of languages and cultures in their entirety

Errors in laboratory medicine: practical lessons to improve patient safety

• Context.-Patient safety is influenced by the frequency and seriousness of errors that occur in the health care system. Error rates in laboratory practices are collected routinely for a variety of performance measures in all clinical pathology laboratories in the United States, but a list of critical performance measures has not yet been recommended. The most extensive databases describing error rates in pathology were developed and are maintained by the College of American Pathologists (CAP). These databases include the CAP's Q-Probes and Q-Tracks programs, which provide information on error rates from more than 130 interlaboratory studies. Objectives.-To define critical performance measures in laboratory medicine, describe error rates of these measures, and provide suggestions to decrease these errors, thereby ultimately improving patient safety. Setting.-A review of experiences from Q-Probes and QTracks studies supplemented with other studies cited in the literature. Design.-Q-Probes studies are carried out as time-limited studies lasting 1 to 4 months and have been conducted since 1989. In contrast, Q-Tracks investigations are ongoing studies performed on a yearly basis and have been conducted only since 1998. Participants from institutions throughout the world simultaneously conducted these studies according to specified scientific designs. The CAP has collected and summarized data for participants about these performance measures, including the significance of errors, the magnitude of error rates, tactics for error reduction, and willingness to implement each of these performance measures. Main Outcome Measures.-A list of recommended performance measures, the frequency of errors when these performance measures were studied, and suggestions to improve patient safety by reducing these errors. Results.-Error rates for preanalytic and postanalytic performance measures were higher than for analytic measures. Eight performance measures were identified, including customer satisfaction, test turnaround times, patient identification, specimen acceptability, proficiency testing, critical value reporting, blood product wastage, and blood culture contamination. Error rate benchmarks for these performance measures were cited and recommendations for improving patient safety presented. Conclusions.-Not only has each of the 8 performance measures proven practical, useful, and important for patient care, taken together, they also fulfill regulatory requirements. All laboratories should consider implementing these performance measures and standardizing their own scientific designs, data analysis, and error reduction strategies according to findings from these published studies. (Arch Pathol Lab Med. 2005;129:1252-1261

Lese- und Literaturdidaktik

Wir freuen uns, Ihnen die fünfte Ausgabe der Zeitschrift DiSlaw vorzustellen. Sie ist der Lese- und Literaturdidaktik gewidmet und lotet dementsprechend Einsatzmöglichkeiten literarischer Texte im Fremdsprachenunterricht aus. Dabei spüren wir drei grundsätzlichen Fragen nach: Was ist Literatur? Wofür kann sie im Unterricht eingesetzt werden? Und: Wie kann das geschehen? Diese Fragen helfen uns, uns der Trias von Zielen, Inhalten und Methoden zu nähern, die den didaktischen Rahmen des Unterrichts bestimmt (vgl. z.B. Heimann et al. 1965; Klingberg, 1995, 41)

Rationale for using insensitive quality control rules for today's hematology analyzers

Diverse approaches have been used to assure the analytical quality of automated hematology; as such, there is great variation in their error detection capabilities. We summarize the intralaboratory performance of a cohort of Sysmex XE-2100’s running e-Check hematology quality control (QC). The imprecisions of a median performing (50th percentile imprecision) and more imprecise [15th percentile (15P) imprecision] Sysmex XE-2100 are compared with measures of total allowable error (regulatory and physiologically based) to obtain multiples of the usual imprecision that must be detected to prevent the hematology analyzer from producing medically unacceptable results. The resultant large multiples of the usual imprecision (s) demonstrate the need for insensitive QC rules employing very broad control ranges, control rules that have been implicitly supported by hematology analyzer manufacturers for the last several decades. For today’s highly precise hematology analyzers, the following control rules are strongly advised: 13.5s, 14s and 14.5s rules (violated if a single control observation exceeds either its ±3.5, ±4.0 and ±4.5s limits, respectively). In order for the hematology laboratory to totally embrace expanded QC limits, manufacturers must make available their instruments’ usual and poorer (e.g. the 15P performance) imprecision’s. Users of hematology analyzers that require more sensitive but less specific rules to prevent the reporting of clinically erroneous data are advised to acquire more precise (and thus more dependable) instrumentation

Managing the Pre- and Post-analytical Phases of the Total Testing Process

For many years, the clinical laboratory's focus on analytical quality has resulted in an error rate of 4-5 sigma, which surpasses most other areas in healthcare. However, greater appreciation of the prevalence of errors in the pre- and post-analytical phases and their potential for patient harm has led to increasing requirements for laboratories to take greater responsibility for activities outside their immediate control. Accreditation bodies such as the Joint Commission International (JCI) and the College of American Pathologists (CAP) now require clear and effective procedures for patient/sample identification and communication of critical results. There are a variety of free on-line resources available to aid in managing the extra-analytical phase and the recent publication of quality indicators and proposed performance levels by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) working group on laboratory errors and patient safety provides particularly useful benchmarking data. Managing the extra-laboratory phase of the total testing cycle is the next challenge for laboratory medicine. By building on its existing quality management expertise, quantitative scientific background and familiarity with information technology, the clinical laboratory is well suited to play a greater role in reducing errors and improving patient safety outside the confines of the laboratory

Does electronic clinical microbiology results reporting influence medical decision making: a pre- and post-interview study of medical specialists

Background: Clinicians view the accuracy of test results and the turnaround time as the two most important service aspects of the clinical microbiology laboratory. Because of the time needed for the culturing of infectious agents, final hardcopy culture results will often be available too late to have a significant impact on early antimicrobial therapy decisions, vital in infectious disease management. The clinical microbiologist therefore reports to the clinician clinically relevant preliminary results at any moment during the diagnostic process, mostly by telephone. Telephone reporting is error prone, however. Electronic reporting of culture results instead of reporting on paper may shorten the turnaround time and may ensure correct communication of results. The purpose of this study was to assess the impact of the implementation of electronic reporting of final microbiology results on medical decision making. Methods. In a pre- and post-interview study using a semi-structured design we asked medical specialists in our hospital about their use and appreciation of clinical microbiology results reporting before and after the implementation of an electronic reporting system. Results: Electronic reporting was highly appreciated by all interviewed clinicians. Major advantages were reduction of hardcopy handling and the possibility to review results in relation to other patient data. Use and meaning of microbiology reports differ significantly between medical specialties. Most clinicians need preliminary results for therapy decisions quickly. Therefore, after the implementation of electronic reporting, telephone consultation between clinician and microbiologist remained the key means of communication. Conclusions: Overall, electronic reporting increased the workflow efficiency of the medical specialists, but did not have an impact on their decision-making