Development of a preanalytical errors recording software

Uvod: Iako je doprinos laboratorijskoj dijagnostici od integralne važnosti u procesu donošenja kliničkih odluka, kvaliteta rada i sigurnost tijekom dijagnostičkih analiza od ključnog su značaja za unaprjeđenje zdravstvene zaštite koja je na visokom stupnju što se kvalitete i sigurnosti tiče. Unatoč izvanrednom napretku u kvaliteti cjelokupnog procesa laboratorijske analize, prijeanalitička varijabilnost predstavlja vodeći izvor pogrešaka i nesigurnosti. Uvođenje sistematične politike bilježenja prijeanalitičkih pogrešaka uvelike bi poboljšala definiranje ključnih aktivnosti tog procesa, planiranje i praćenje učinkovitih radnji s ciljem poboljšanja cjelokupnog procesa. U ovom članku želimo dati opis kompjuterskog programa razvijenog za bilježenje prijeanalitičkih pogrešaka u našem laboratoriju. Materijali i metode: Naš smo program razvili na temelju Microsoftovog programa Access. Glavna polja uključena u program obuhvaćala su brojač za progresivno brojanje uzoraka, datum primitka uzorka, identifikacijski broj uzorka, ime bolesnika, tip pretrage, odjel s kojeg je bolesnik upućen, matriks uzorka, tip nesukladnosti, radnja koja je poduzeta kako bi se riješio problem, drugo polje za moguće radnje koje su dodatno poduzete, identifikacijski broj operatera. Baza podataka nalazi se na središnjem računalu unutar našeg laboratorijskog informatičkog sistema, tako da se do nje može doći s bilo kojeg računala u laboratoriju, što omogućuje kontinuirani i standardizirani unos podataka. Rezultati i rasprava: Uvođenje kompjuterskog programa za sistematično bilježenje prijeanalitičkih pogrešaka donosi velika poboljšanja, kao što su harmonizacija protokola za bilježenje incidenata, jednostavnost digitalnog bilježenja, eliminaciju rukom pisanih izvješća, uključivanje mjera učinkovitosti ključnih segmenata laboratorijskog rada, jednostavna prilagodba korisniku (laboratoriju), korištenje tablica s podacima za opsežne statističke analize, poboljšano pretraživanje i obrada podataka kao i poboljšana izrada statističkih izvješća.Background: Although the contribution of laboratory diagnostics is integral to the clinical decision making, quality and safety in diagnostic testing are essential to furthering the goal of high-quality and safe healthcare. Despite remarkable advances in the quality of the total testing process, the preanalytical variability is the leading source of errors and uncertainty. As such, the implementation of a systematic policy for recording preanalytical errors would grant major benefits for identifying critical activities of this process, planning and monitoring effective actions for improvement. The aim of this article is to describe the software developed for the recording of preanalytical errors in our laboratory. Materials and methods: We have developed error recording software based on Microsoft Access. The main fields included in the software comprehend a numerator for progressive enumeration of the samples, the date of receipt of the specimen, the Sample ID, the patient\u27s name, the type of request, the referring ward, sample matrix, the type of non-conformity, the action undertaken to solve the problem, a second field for possible additional actions undertaken, and the operator ID. The database is stored on a common repository in our laboratory information system, so that it can be accessed by any computer in the laboratory, allowing continuous and standardized input of the data. Results and discussion: The implementation of a software for systematical recording of preanalytical errors grants major benefits, including harmonization of incident reporting practices, simplicity of digital recording, elimination of handwritten reports, inclusion of validated measures of laboratory performance, handily customization, exportation on worksheets for comprehensive statistical analyses, improved data searching and processing, as well as production of improved statistical reports

Development of a preanalytical errors recording software

Uvod: Iako je doprinos laboratorijskoj dijagnostici od integralne važnosti u procesu donošenja kliničkih odluka, kvaliteta rada i sigurnost tijekom dijagnostičkih analiza od ključnog su značaja za unaprjeđenje zdravstvene zaštite koja je na visokom stupnju što se kvalitete i sigurnosti tiče. Unatoč izvanrednom napretku u kvaliteti cjelokupnog procesa laboratorijske analize, prijeanalitička varijabilnost predstavlja vodeći izvor pogrešaka i nesigurnosti. Uvođenje sistematične politike bilježenja prijeanalitičkih pogrešaka uvelike bi poboljšala definiranje ključnih aktivnosti tog procesa, planiranje i praćenje učinkovitih radnji s ciljem poboljšanja cjelokupnog procesa. U ovom članku želimo dati opis kompjuterskog programa razvijenog za bilježenje prijeanalitičkih pogrešaka u našem laboratoriju. Materijali i metode: Naš smo program razvili na temelju Microsoftovog programa Access. Glavna polja uključena u program obuhvaćala su brojač za progresivno brojanje uzoraka, datum primitka uzorka, identifikacijski broj uzorka, ime bolesnika, tip pretrage, odjel s kojeg je bolesnik upućen, matriks uzorka, tip nesukladnosti, radnja koja je poduzeta kako bi se riješio problem, drugo polje za moguće radnje koje su dodatno poduzete, identifikacijski broj operatera. Baza podataka nalazi se na središnjem računalu unutar našeg laboratorijskog informatičkog sistema, tako da se do nje može doći s bilo kojeg računala u laboratoriju, što omogućuje kontinuirani i standardizirani unos podataka. Rezultati i rasprava: Uvođenje kompjuterskog programa za sistematično bilježenje prijeanalitičkih pogrešaka donosi velika poboljšanja, kao što su harmonizacija protokola za bilježenje incidenata, jednostavnost digitalnog bilježenja, eliminaciju rukom pisanih izvješća, uključivanje mjera učinkovitosti ključnih segmenata laboratorijskog rada, jednostavna prilagodba korisniku (laboratoriju), korištenje tablica s podacima za opsežne statističke analize, poboljšano pretraživanje i obrada podataka kao i poboljšana izrada statističkih izvješća.Background: Although the contribution of laboratory diagnostics is integral to the clinical decision making, quality and safety in diagnostic testing are essential to furthering the goal of high-quality and safe healthcare. Despite remarkable advances in the quality of the total testing process, the preanalytical variability is the leading source of errors and uncertainty. As such, the implementation of a systematic policy for recording preanalytical errors would grant major benefits for identifying critical activities of this process, planning and monitoring effective actions for improvement. The aim of this article is to describe the software developed for the recording of preanalytical errors in our laboratory. Materials and methods: We have developed error recording software based on Microsoft Access. The main fields included in the software comprehend a numerator for progressive enumeration of the samples, the date of receipt of the specimen, the Sample ID, the patient\u27s name, the type of request, the referring ward, sample matrix, the type of non-conformity, the action undertaken to solve the problem, a second field for possible additional actions undertaken, and the operator ID. The database is stored on a common repository in our laboratory information system, so that it can be accessed by any computer in the laboratory, allowing continuous and standardized input of the data. Results and discussion: The implementation of a software for systematical recording of preanalytical errors grants major benefits, including harmonization of incident reporting practices, simplicity of digital recording, elimination of handwritten reports, inclusion of validated measures of laboratory performance, handily customization, exportation on worksheets for comprehensive statistical analyses, improved data searching and processing, as well as production of improved statistical reports

Studies on in vitro hemolysis and utility of corrective formulas for reporting results on hemolyzed specimens

Introduction: Spuriously hemolyzed specimens are the most common preanalytical problems in clini-cal laboratories. Corrective formulas have been proposed to allow the laboratory to release test re-sults on these specimens. This study aimed to assess the influence of spurious hemolysis and reliability of corrective formulas. Materials and methods: Blood collected into lithium heparin vacuum tubes was divided in aliquots and subjected to mechanical injury by aspiration with an insulin syringe equipped with a thin needle (30 gauge). Each aliquot (numbered from “#0” to “#5”) was subjected to a growing number of passa-ges through the needle, from 0 to 5 times. After hematological testing, plasma was separated by cen-trifugation and assayed for lactate dehydrogenase (LD), aspartate aminotransferase (AST), potassi-um and hemolysis index (HI). Results: Cell-free hemoglobin concentration gradually increased from aliquot #0 (HI: 0) to #5 (HI: 76±22, cell-free hemoglobin č 37.0 g/L). A highly significant inverse correlation was observed between HI and red blood cell count (RBC), hematocrit, mean corpuscular volume (MCV), LD, AST, potassium, whereas the correlation was negative with mean corpuscular hemoglobin (MCH). No cor-relation was found with hemoglobin, platelet count and glucose. A trend towards decrease was also observed for white blood cells count. The ANCOVA comparison of analyte-specific regression lines from the five subjects studied revealed significant differences for all parameters except potassium. In all circumstances the sy,x of these equations however exceeded the allowable clinical bias. Conclusions: Mechanical injury of blood, as it might arise from preanalytical problems, occurs dishomogeneously, so that corrective formulas are unreliable and likely misleading

Freezing of gait in Parkinson’s disease patients treated with bilateral subthalamic nucleus deep brain stimulation: A long-term overview

Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment in advanced Parkinson’s Disease (PD). However, the effects of STN-DBS on freezing of gait (FOG) are still debated, particularly in the long-term follow-up (>/=5-years). The main aim of the current study is to evaluate the long-term effects of STN-DBS on FOG. Twenty STN-DBS treated PD patients were included. Each patient was assessed before surgery through a detailed neurological evaluation, including FOG score, and reevaluated in the long-term (median follow-up: 5-years) in different stimulation and drug conditions. In the long term follow-up, FOG score significantly worsened in the off-stimulation/off-medication condition compared with the preoperative off-medication assessment (z = -1.930; p = 0.05) but not in the on-stimulation/off-medication (z = -0.357; p = 0.721). There was also a significant improvement of FOG at long-term assessment by comparing on-stimulation/off-medication and off-stimulation/off-medication conditions (z = -2.944; p = 0.003). These results highlight the possible beneficial long-term effects of STN-DBS on FOG

Freezing of Gait in Parkinson's Disease Patients Treated with Bilateral Subthalamic Nucleus Deep Brain Stimulation: A Long-Term Overview

Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment in advanced Parkinson's Disease (PD). However, the effects of STN-DBS on freezing of gait (FOG) are still debated, particularly in the long-term follow-up (≥5-years). The main aim of the current study is to evaluate the long-term effects of STN-DBS on FOG. Twenty STN-DBS treated PD patients were included. Each patient was assessed before surgery through a detailed neurological evaluation, including FOG score, and revaluated in the long-term (median follow-up: 5-years) in different stimulation and drug conditions. In the long term follow-up, FOG score significantly worsened in the off-stimulation/off-medication condition compared with the pre-operative off-medication assessment (z = -1.930; p = 0.05) but not in the on-stimulation/off-medication (z = -0.357; p = 0.721). There was also a significant improvement of FOG at long-term assessment by comparing on-stimulation/off-medication and off-stimulation/off-medication conditions (z = -2.944; p = 0.003). These results highlight the possible beneficial long-term effects of STN-DBS on FOG

Long-term effects of bilateral subthalamic nucleus deep brain stimulation on gait disorders in Parkinson's disease: a clinical-instrumental study

Objective: To assess the long-term effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on gait in a cohort of advanced Parkinson's Disease (PD) patients. Methods: This observational study included consecutive PD patients treated with bilateral STN-DBS. Different stimulation and drug treatment conditions were assessed: on-stimulation/off-medication, off-stimulation/off-medication, and on-stimulation/on-medication. Each patient performed the instrumented Timed Up and Go test (iTUG). The instrumental evaluation of walking ability was carried out with a wearable inertial sensor containing a three-dimensional (3D) accelerometer, gyroscope, and magnetometer. This device could provide 3D linear acceleration, angular velocity, and magnetic field vector. Disease motor severity was evaluated with the total score and subscores of the Unified Parkinson Disease Rating Scale part III. Results: Twenty-five PD patients with a 5-years median follow-up after surgery (range 3-7) were included (18 men; mean disease duration at surgery 10.44 ± 4.62 years; mean age at surgery 58.40 ± 5.73 years). Both stimulation and medication reduced the total duration of the iTUG and most of its different phases, suggesting a long-term beneficial effect on gait after surgery. However, comparing the two treatments, dopaminergic therapy had a more marked effect in all test phases. STN-DBS alone reduced total iTUG duration, sit-to-stand, and second turn phases duration, while it had a lower effect on stand-to-sit, first turn, forward walking, and walking backward phases duration. Conclusions: This study highlighted that in the long-term after surgery, STN-DBS may contribute to gait and postural control improvement when used together with dopamine replacement therapy, which still shows a substantial beneficial effect

Interplay between speech and gait variables in PD patients treated with STN-DBS: a long-term instrumental assessment

Objective: To evaluate correlations between speech and gait parameters in the long-term and under different medication and subthalamic nucleus deep brain stimulation (STN-DBS) conditions in a cohort of advanced Parkinson's Disease (PD) patients. Methods: This observational study included consecutive PD patients treated with bilateral STN-DBS. Axial symptoms were evaluated using a standardized clinical-instrumental approach. Speech and gait were assessed by perceptual and acoustic analyses and by the instrumented timed up and go test (iTUG) respectively. Disease motor severity was evaluated with the total score and subscores of the UPDRS part III. Different stimulation and drug treatment conditions were assessed: on-stimulation/off-medication, off-stimulation/off-medication, and on-stimulation/on-medication. Results: Twenty-five PD patients with a five-year median follow-up after surgery (range 3-7) were included (18 M; disease duration at surgery:10.44 [sd:4.62] years; age at surgery:58.40 [sd:5.73] years). In the off-stimulation/off-medication and on-stimulation/on-medication conditions, patients who spoke louder had also the greater acceleration of the trunk during gait whereas, in the on-stimulation/on-medication condition only, patients with the poorer voice quality were also the worse to perform sit to stand and gait phases of the iTUG. On the contrary, patients with the higher speech rate performed well the turning and walking phases of the iTUG. Conclusions: This study underlines the presence of different correlations between treatment effects of speech and gait parameters in PD patients treated with bilateral STN-DBS. This may allow us to better understand the common pathophysiological basis of these alterations and to develop a more specific and tailored rehabilitation approach for axial signs after surgery