Impacto de la informatización de procesos del Laboratorio Clínico ICS Lleida en seguridad del paciente

El objetivo del presente trabajo fue valorar el impacto de la informatización del proceso de solicitud analítica sobre la seguridad del paciente, en el laboratorio clínico del ICS de Lleida, a partir de indicadores de calidad preanalíticos. Se trata de un estudio descriptivo y transversal que se desarrolló en dos partes: En una primera se llevó a cabo un análisis descriptivo de la población a estudio y en la segunda parte, un estudio analítico de la muestra, en que se estudió la asociación entre los indicadores de calidad del proceso preanalítico antes, inmediatamente después, al año y a los tres años de la implantación de la petición electrónica en grupos independientes. El periodo inmediatamente posterior a la implantación presentó en conjunto el mayor número de errores preanalíticos, para descender en los años siguientes. El impacto de la informatización de la solicitud analítica fue positivo para la seguridad del paciente una vez consolidado el proceso, pero otros factores como la formación del personal extractor y la comunicación bidireccional con el laboratorio deben ser considerados.L’objectiu d’aquest treball fou valorar l’ impacte de la informatització del procés de sol•licitud analítica sobre la seguretat del pacient, al laboratori clínic del ICS de Lleida, en base indicadors de qualitat preanalítics. Es tracta d’un estudi descriptiu i transversal desenvolupat en dues parts: En una primera es va dur a terme una anàlisi descriptiva de la població a estudi i a la segona part, un estudi analític de la mostra, es va estudiar l’associació entre els indicadors de qualitat del procés preanalític abans, immediatament després, a l’any i als tres anys de la implantació de la petició electrònica en grups independents. El període immediatament posterior a la implantació va presentar en conjunt el major nombre d’errors preanalítics, per a disminuir els anys següents. L’impacte de la informatització de la sol•licitud analítica va ser positiu per a la seguretat del pacient un cop consolidat el procés, però cal considerar altres factors com la formació del personal extractor i la comunicació bidireccional amb el laboratori.The aim of this study was to assess analytical request computerization impact on patient safety using quality preanalytical indicators, in a Lleida laboratory belonging to the Catalonian Health Institute (ICS). This is a descriptive cross study developed in two parts. In the first, a population descriptive analysis was carried out. In the second part, a sample analytical study, the association between preanalytical quality indicators was studied before, immediately after, one year after and three years after of the implementation of the computerized system in independent groups. Period immediately after implementation was the worst in terms of preanalytical errors. Errors decrease in subsequent years. The impact of computerization of analytical request was positive for patient safety once the process was consolidated, but other factors such as phlebotomy staff training and bidirectional communication with laboratory specialists must also be taken into account

Aproximación a la distribución del espacio funerario en El Argar (Antas, Almería)

El Argar (Antas, Almería) is the main reference site for the study of the Bronze Age in the Iberian Peninsula. The burial assemblages of more than 1000 excavated tombs show the social diversity of the interred. This article analyses the spatial distribution of the burials, considering the multiple variables of the funerary ritual in relation to their location. The aim is to try to understand whether socioeconomic patterns can explain their location. For this, based on the documentation from the Siret Archive, we have been able to situate a considerable number of graves on the plateau that forms the site and we have considered the variability of funerary containers, the burial assemblages and the physical characteristics of the interred.Statistical significance tests do not show a relation between sex, age and location, but they indicate one between rich grave assemblages and spatial distribution, which cluster in a particular area of the site.El Argar (Antas, Almería) es el yacimiento de referencia para el estudio de la Edad del Bronce en la península ibérica. Los ajuares de las más de 1000 tumbas excavadas muestran la diversidad social de los inhumados. Este trabajo analiza su distribución espacial considerando las múltiples variables del ritual funerario en relación a su ubicación. El objetivo es tratar de comprender si existe algún patrón socioeconómico en su localización. Para ello, a partir de la documentación del Archivo Siret, se ha logrado posicionar un número importante de sepulturas en la meseta del yacimiento y se ha considerado la variabilidad de los contenedores funerarios, los ajuares y las características antropológicas de los individuos inhumados. Las pruebas de significación estadística no muestran ninguna asociación entre sexo o edad y ubicación, pero sí entre los ajuares de prestigio y su distribución espacial, concentrándose en una determinada zona del yacimiento

Oxidative stability of a heme iron-fortified bakery product: Effectiveness of ascorbyl palmitate and co-spray-drying of heme iron with calcium caseinate

Fortification of food products with iron is a common strategy to prevent or overcome iron deficiency. However, any iron form is a pro-oxidant and its addition will cause off-flavours and reduce product's shelf life. A highly bioavailable heme iron ingredient was selected to fortify a chocolate cream used to fill sandwich-type cookies. Two different strategies were assessed for avoiding the heme iron catalytic effect on lipid oxidation: ascorbyl palmitate addition and co-spray-drying of heme iron with calcium caseinate. Oxidation development and sensory acceptability were monitored in the cookies over one-year of storage at room temperature in the dark. The addition of ascorbyl palmitate protected from oxidation and from tocopherols and tocotrienols loss during cookies preparation. In general, ascorbyl palmitate, either alone or in combination with the co-spray-dried heme iron, prevented primary oxidation and hexanal formation during storage. The combination of both strategies resulted in cookies that were sensory acceptable after 1 year of storage

Antioxidative effect of lipophilized caffeic acid in fish oil enriched mayonnaise and milk

The antioxidative effect of lipophilized caffeic acid was assessed in two different fish oil enriched food products: mayonnaise and milk. In both emulsion systems, caffeic acid esterified with fatty alcohols of different chain lengths (C1-C20) were better antioxidants than the original phenolic compound. The optimal chain length with respect to protection against oxidation was, however, different for the two food systems. Fish oil enriched mayonnaise with caffeates of medium alkyl chain length (butyl, octyl and dodecyl) added resulted in a better oxidative stability than caffeates with shorter (methyl) or longer (octadecyl) alkyl chains. Whereas in fish oil enriched milk emulsions the most effective caffeates were those with shorter alkyl chains (methyl and butyl) rather than the ones with medium and long chains (octyl, dodecyl, hexadecyl and eicosyl). These results demonstrate that there might be an optimum alkyl chain length for each phenolipid in each type of emulsion systems

Co-spray-drying of a heme iron ingredient to decrease its pro-oxidant effect in lipid-containing foods

Fortification of food products with non-heme or heme iron is a common strategy to overcome nutritional iron deficiency. Heme iron is highly bioavailable but it promotes oxidation, as do other iron forms. Palm oil is widely used in the formulation of bakery products and chocolate fillings. The work reported here aims to delay the onset of oxidation of a palm oil matrix fortified with heme iron, as a model for bakery products, through the use of ascorbyl palmitate (0 and 400 mg/kg) and the co-spray-drying of the heme iron with calcium caseinate in two ratios (heme iron concentrate:caseinate, 2:1 and 1:1, w/w). Primary (peroxide value and lipid hydroperoxide content) and secondary (p-anisidine value and hexanal content) oxidation were measured over one year of storage at room temperature in the dark. The combination of ascorbyl palmitate at 400 mg/kg and the co-spray-dried heme iron in a 1:1 ratio was the treatment that best protected iron fortified samples from oxidation during the storage time

Order of blood draw:Opinion Paper by the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase (WG-PRE)

It has been well reported over recent years that most errors within the total testing process occur in the pre-analytical phase (46%-68.2%), an area that is usually outside of the direct control of the laboratory and which includes sample collection (phlebotomy). National and international (WHO, CLSI) guidelines recommend that the order of draw of blood during phlebotomy should be blood culture/sterile tubes, then plain tubes/gel tubes, then tubes containing additives. This prevents contamination of sample tubes with additives from previous tubes that could cause erroneous results. There have been a number of studies recently looking at whether order of draw remains a problem with modern phlebotomy techniques and materials, or it is an outdated practice followed simply because of historical reasons. In the following article, the European Federation of Clinical Chemistry and Laboratory Medicine Working Group for the Preanalytical Phase (EFLM WG-PRE) provides an overview and summary of the literature with regards to order of draw in venous blood collection. Given the evidence presented in this article, the EFLM WG-PRE herein concludes that a significant frequency of sample contamination does occur if order of draw is not followed during blood collection and when performing venipuncture under less than ideal circumstances, thus putting patient safety at risk. Moreover, given that order of draw is not difficult to follow and knowing that ideal phlebotomy conditions and protocols are not always followed or possible, EFLM WG-PRE supports the continued recommendation of ensuring a correct order of draw for venous blood collection

Managing inappropriate utilization of laboratory resource

Background The inappropriate use of laboratory resources, due to excessive number of tests not really necessary for patient care or by failure to order the appropriate diagnostic test, may lead to wrong, missed or delayed diagnosis, thus potentially jeopardizing patient safety. It is estimated that 5-95% of tests are currently used inappropriately, depending on the appropriateness criteria, thus significantly contributing to the potential of generating medical errors, the third leading cause of death in the US. Content In this review, we discuss the reasons as well as the medical and financial consequences of inappropriate utilization of laboratory tests. We then provide demand management (DM) tools as a means for overcoming this issue and also discuss their benefits, challenges, limitations and requirements for successful implementation. Summary and outlook When based on current evidence, adapted to local conditions and developed in close collaboration with clinicians, DM is a reasonable strategy for progressing toward better management of over- and underuse of laboratory resources

Patient identification and tube labelling:a call for harmonisation

Venous blood sampling (phlebotomy) is the most common invasive procedure performed in patient care. Guidelines on the correct practice of phlebotomy are available, including the H3-A6 guideline issued by the Clinical Laboratory Standards Institute (CLSI). As the quality of practices and procedures related to venous blood sample collection in European countries was unknown, the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase conducted an observational study in 12 European countries. The study demonstrated that the level of compliance of phlebotomy procedures with the CLSI H3-A6 guideline was unacceptably low, and that patient identification and tube labelling are amongst the most critical steps in need of immediate attention and improvement. The process of patient identification and tube labelling is an essential safety barrier to prevent patient identity mix-up. Therefore, the EFLM Working Group aims to encourage and support worldwide harmonisation of patient identification and tube labelling procedures in order to reduce the risk of preanalytical errors and improve patient safety. With this Position paper we wish to raise awareness and provide recommendations for proper patient and sample identification procedure

Elimination of Vitamin D Signaling Causes Increased Mortality in a Model of Overactivation of the Insulin Receptor: Role of Lipid Metabolism

Vitamin D (VD) deficiency has been associated with cancer and diabetes. Insulin signaling through the insulin receptor (IR) stimulates cellular responses by activating the PI3K/AKT pathway. PTEN is a tumor suppressor and a negative regulator of the pathway. Its absence enhances insulin signaling leading to hypoglycemia, a dangerous complication found after insulin overdose. We analyzed the effect of VD signaling in a model of overactivation of the IR.We generated inducible double KO (DKO) mice for the VD receptor (VDR) and PTEN. DKO mice showed severe hypoglycemia, lower total cholesterol and increased mortality. No macroscopic tumors were detected. Analysis of the glucose metabolism did not show clear differences that would explain the increased mortality. Glucose supplementation, either systemically or directly into the brain, did not enhance DKO survival. Lipidic liver metabolism was altered as there was a delay in the activation of genes related to -oxidation and a decrease in lipogenesis in DKO mice. High-fat diet administration in DKO significantly improved its life span. Lack of vitamin D signaling increases mortality in a model of overactivation of the IR by impairing lipid metabolism. Clinically, these results reveal the importance of adequate Vitamin D levels in T1D patients