Improving serum calcium test ordering according to a decision algorithm.

AIM: To detect differences in the pattern of serum calcium tests ordering before and after the implementation of a decision algorithm. METHODS: We studied patients admitted to an internal medicine ward of a university hospital on April 2013 and April 2016. Patients were classified as critical or non-critical on the day when each test was performed. Adequacy of ordering was defined according to adherence to a decision algorithm implemented in 2014. RESULTS: Total and ionised calcium tests per patient-day of hospitalisation significantly decreased after the algorithm implementation; and duplication of tests (total and ionised calcium measured in the same blood sample) was reduced by 49%. Overall adequacy of ionised calcium determinations increased by 23% (P=0.0001) due to the increase in the adequacy of ionised calcium ordering in non-critical conditions. CONCLUSIONS: A decision algorithm can be a useful educational tool to improve adequacy of the process of ordering serum calcium tests.

Laboratory Tests Ordering Pattern by Medical Residents From a Brazilian University Hospital.

OBJECTIVES: The adequacy of laboratory test orders by medical residents is a longstanding issue. The aim of this study is to analyze the number, types, and pattern of repetition of tests ordered by medical residents. METHODS: We studied all tests ordered over a 1-year period for inpatients of an internal medicine ward in a university hospital. Types, results, and repetition pattern of tests were analyzed in relation to patients' diagnoses. RESULTS: We evaluated 117,666 tests, requested for 1,024 inpatients. The mean number of tests was 9.5 per day. The test repetition pattern was similar, regardless of patients' diagnoses, previous test results, or duration of stay. The probability of an abnormal result after a sequence of three normal tests was lower than 25%, regardless of the diagnosis. CONCLUSIONS: Number of tests and repetition were both high, imposing costs, discomfort, and risks to patients, thus warranting further investigation.

C-reactive protein: clinical applications and proposals for a rational use.

C-reactive protein (CRP) is an acute-phase protein whose requests have been growing exponentially in several countries, including Brazil. In this study, the use of CRP in several clinical situations was reviewed by a group of physicians comprised by specialists in internal medicine, medical emergencies, intensive care, screening, and laboratory medicine, aiming to analyze the applicable literature and to propose guidelines for a more rational use of this laboratory test. The result was the creation of flowcharts guiding CRP request, adjusted to four different healthcare environments, namely, intensive care units, emergency room, wards, and outpatient clinics. These flowcharts, as well as a more detailed discussion on several clinical recommendations for the test, are presented in this study.

Recommendations for quality assurance in multiparametric flow cytometry: first consensus of the Brazilian Group of Flow Cytometry (GBCFLUX) / Recomendações para garantia da qualidade em citometria de fluxo multiparamétrica: primeiro consenso do Grupo Brasileiro de Citometria de Fluxo (GBCFLUX)

ABSTRACT The Brazilian Group of Flow Cytometry (Grupo Brasileiro de Citometria de Fluxo [GBCFLUX]), founded on April 24, 2010, is composed of experts in flow cytometry (FC) area who have the common objective of contributing to technical and scientific advances in Brazilian clinical and research laboratories. Among GBCFLUX working groups, the Quality Control (QC) subcommittee is responsible for discussing data in the literature and contributes to the quality assurance of the pre-analytical, analytical and post-analytical process in FC. The QC subcommittee's actions began through meetings and lectures, in which data from the literature were reviewed and discussed with all participating members of the GBCFLUX. In a second step, it was decided to draw up a text of technical and scientific consensus recommendations, informative and educative, for dissemination to all FC working groups in Brazil. To this effect, a questionnaire with objective responses was designed and sent to 35 recognized Brazilian institutions, in order to evaluate the QC profile of these institutions. Thus, the QC technical-scientific recommendations, which will be described in this updating article, are intended to ensure the process quality, technical standardization, and reproducibility of results in FC.

RESUMO O Grupo Brasileiro de Citometria de Fluxo (GBCFLUX), fundado em 24 de abril de 2010, é composto por especialistas da área de citometria de fluxo (CF) que possuem o objetivo comum de contribuir para avanços técnico-científicos em laboratórios clínicos e de pesquisa brasileiros. Entre os grupos de trabalho do GBCFLUX, o subcomitê de Controle de Qualidade (CQ) é responsável por discutir dados da literatura e contribuir para a garantia da qualidade do processo pré-analítico, analítico e pós-analítico em CF. As ações do subcomitê de CQ iniciaram-se por meio de reuniões e palestras, nas quais dados da literatura foram revisados e discutidos com todos os membros participantes do GBCFLUX. Em uma segunda etapa, definiu-se elaborar um texto de recomendações consensuais técnicocientíficas, informativas e educativas para divulgação a todos os grupos que trabalham com CF no Brasil. Para tanto, foi elaborado um questionário com respostas objetivas, sendo enviado para 35 instituições brasileiras cadastradas, com a finalidade de avaliar o perfil de CQ dessas instituições. Dessa forma, as recomendações técnico-científicas de CQ que serão descritas neste artigo de atualização têm o objetivo de contribuir para a garantia da qualidade do processo, a padronização técnica e a reprodutibilidade dos resultados em CF.

Proteína C reativa: aplicações clínicas e propostas para utilização racional / C-reactive protein: clinical applications and proposals for a rational use

A proteína C reativa (PCR) é uma das proteínas de fase aguda cuja solicitação tem crescido de forma exponencial em vários países, incluindo o Brasil. Neste estudo, a utilidade da PCR em diversas situações clínicas foi revisada por um grupo de médicos composto por especialistas em Medicina Interna, Emergências Médicas, Terapia Intensiva, Rastreamento e Medicina Laboratorial com o objetivo de analisar a literatura pertinente e propor diretrizes para o uso mais racional desse exame laboratorial. O resultado foi a criação de fluxogramas orientadores da solicitação de PCR adaptados a quatro ambientes assistenciais diferentes, sendo eles unidades de terapia intensiva, pronto-socorro, enfermarias e ambulatórios. Esses fluxogramas e uma discussão mais detalhada sobre as diversas indicações clínicas do exame são apresentados neste estudo.

C-reactive protein (CRP) is an acute-phase protein whose requests have been growing exponentially in several countries, including Brazil. In this study, the use of CRP in several clinical situations was reviewed by a group of physicians comprised by specialists in internal medicine, medical emergencies, intensive care, screening, and laboratory medicine, aiming to analyze the applicable literature and to propose guidelines for a more rational use of this laboratory test. The result was the creation of flowcharts guiding CRP request, adjusted to four different healthcare environments, namely, intensive care units, emergency room, wards, and outpatient clinics. These flowcharts, as well as a more detailed discussion on several clinical recommendations for the test, are presented in this study.

Clonally rearranged T-cell receptor beta chain genes in HTLV-I carriers with abnormal, non-flower-like, lymphocytes.

BACKGROUND: The diagnosis of Adult T-cell leukemia/lymphoma ATLL subtypes in human T-lymphotropic virus type I (HTLV-I) carriers based in morphology and immunophenotype of lymphocytes can be challenger. We propose that polymerase chain reaction (PCR) amplification of the rearranged TCR gene in HTLV-I healthy carriers would be a convenient method for establishing the nature of the circulating T lymphocytes in asymptomatic HTLV-I carriers, presenting only mild and inconclusive signals of deviation from normality. METHODS: Using PCR, we analyzed the genetic recombination pattern of the T-cell beta-chain receptor gene (TCR-beta) in order to identify clonal expansion of peripheral blood T lymphocytes in 17 HTLV-I-positive healthy carriers and in nine normal HTLV-I-negative blood donors. To evaluate the performance of PCR in detection of clonality, we also analyzed 18 patients with post-thymic/mature T-cell malignancies presenting circulating abnormal lymphocytes. RESULTS: Seven of the 17 HTLV-I positive individuals presented circulating abnormal lymphocytes; monoclonal or oligoclonal expansion of T-cells was detected in five of the 17 HTLV-I-positive individuals, all of them presenting abnormal lymphocytes. Clonal expansion was not detected in any of the negative controls or in any of the 12 remaining healthy carriers. All patients in the positive control group tested positive by PCR and Southern blots. Southern blots were negative for all 17 healthy carriers. CONCLUSIONS: PCR amplification of segments of rearranged TCR-beta is reliable for allowing early detection of small populations of clonal T cells in blood samples from asymptomatic HTLV-I carriers, providing an additional alert in the follow-up of carriers with abnormal circulating lymphocytes.