[Employee Safety and Biosafety Applications in Microbiology Laboratories; A Multicenter Evaluation in Turkey]. / Mikrobiyoloji Laboratuvarlarinda Çalisan Güvenligi ve Biyogüvenlik Uygulamalari Açisindan Türkiye'de Çok Merkezli Bir Degerlendirme.

Medical laboratory personnel may be exposed to various hazards, especially biological and chemical, during their routine activities. In this multicenter study, which could reflect the nation wide results, it was aimed to determine the safety and biosecurity practices of the employee working in medical microbiology laboratories and to reveal the current situation. A total of 1072 personnel working in the Medical Microbiology Laboratory of 23 hospitals (14 medical faculty hospitals, seven ministry of health training and research hospitals and two state hospitals) from different provinces were provided with a questionnaire consisting of 33 questions inquiring about the rules, opinions, attitudes and behaviors regarding safety and biosafety practices. Statistical analyses were made with institutions, age groups, gender, educational background, working time and occupational groups in terms of exposure to biological and chemical hazards. It was determined that approximately 50% personnel of the university/ training and research hospitals and 2/3 of the state hospitals personnel consumed food and beverages in the laboratories (p<0.05). Compared with other hospitals, it was determined that in state hospitals; the absence of separate resting room (35%), the personnel finding their own knowledge and practices inadequate (28.9%), laboratory coats washed at home (95%), educational organization and participation rates (90%) and medical waste information levels of the personnel were higher (p< 0.05). It was determined that as the age progresses, the rate of education, food and beverage consumption in the laboratory, not being outside the laboratory with protective equipment (gloves, masks and laboratory coats) and the history of laboratory acquired infections were increased (p< 0.05). It was observed that washing the laboratory coats at home was higher in the younger age group and hospital washing was higher in the elderly group (p< 0.05). There was no significant difference between the genders in terms of food and beverage consumption in the laboratory (p= 0.09). It was determined that periodic health checks were not performed in 1/3 of both sexes, but the use of gloves and compliance with medical waste rules was lower in men. Female employees find themselves inefficient in terms of knowledge and practices (p< 0.05). The rate of those who did not have their periodic checkups at regular intervals was higher in the high school and master of science education groups; While non-compliance with medical waste rules, food and beverage consumption in the laboratory was highest in the primary and high school graduates, the lowest rates were found in the master and doctorate groups (p< 0.05). The rate of those who had regular health checkups was higher in the group of specialist physicians and technicians (p< 0.05). It was observed that the rule of not going out of the laboratory with protective equipment was fully observed in the 35+ years working group, while compliance was 70-85% in other groups (p< 0.05), hepatitis B vaccination rate was highest in specialist doctors and lowest in cleaning and other personnel group (p< 0.05). Highest non-compliance rate with medical waste rules was observed in the cleaning personnel group (p< 0.05). As a result, although advances have been made in employee safety practices in medical microbiology laboratories in our country in recent years, it has been found that it is not yet sufficient. The results indirectly reflected the profile of medical laboratories in our country. In the laboratories, physical space and equipment deficiencies should be eliminated, periodic health checkups and vaccination should be provided, non-staff entrance to the laboratory and food, beverage and cigarette consumption should be prevented, laboratory coats should be washed in the hospital, in-service trainings, including medical waste training, should be conducted and these trainings should be developed through mechanisms that will change the behavior.

Occupational Exposure to Needle Stick Injuries and Hepatitis B Vaccination Coverage Among Clinical Laboratory Staff in Sana'a, Yemen: Cross-Sectional Study.

BACKGROUND: Laboratory staff handling blood or biological samples are at risk for accidental injury or exposure to blood-borne pathogens. Hepatitis B virus (HBV) vaccinations for laboratory staff can minimize these risks. OBJECTIVE: The aims of this study were to determine the prevalence of occupational exposure to needle stick injuries (NSIs) and assess HBV vaccination coverage among clinical laboratory staff in Sana'a, Yemen. METHODS: A cross-sectional survey was conducted among clinical laboratory staff who were involved in handling and processing laboratory samples at the main public and private clinical laboratories in Sana'a. Data collection was done using a semistructured questionnaire. The questionnaire was divided into 3 parts. Part 1 included information on sociodemographic characteristics of participants. Part 2 included information on the availability of the personal protective equipment in the laboratories, such as lab coats and gloves. Part 3 included questions about the history of injury during work in the laboratory and the vaccination status for HBV. RESULTS: A total of 219/362 (60%) participants had been accidentally injured while working in the laboratory. Of those, 14.6% (32/219) had been injured during the last 3 months preceding the data collection. Receiving the biosafety manual was significantly associated with lower risk of injury. Out of those who were injured, 54.8% (120/219) had received first aid. About three-quarters of respondents reported that they had been vaccinated against HBV. The vaccination against HBV was significantly higher among laboratory staff who were working at private laboratories (P=.01), who had postgraduate degrees (P=.005), and who received the biosafety manual (P=.03). CONCLUSIONS: Occupational exposure to NSI is still a major problem among laboratory staff in public and private laboratories in Sana'a, Yemen. The high incidence of injuries among laboratory staff and the low rate of receiving first aid in laboratories combined with low vaccination coverage indicates that all laboratory staff are at risk of exposure to HBV. Therefore, strengthening supervision, legalizing HBV vaccinations for all laboratory staff, and optimizing laboratory practices regarding the management of sharps can minimize risks and prerequisites in Yemen.

Laboratory Staff Turnover: A College of American Pathologists Q-Probes Study of 23 Clinical Laboratories.

CONTEXT.­: Knowledge of laboratory staff turnover rates are important to laboratory medical directors and hospital administrators who are responsible for ensuring adequate staffing of their clinical laboratories. The current turnover rates for laboratory employees are unknown. OBJECTIVE.­: To determine the 3-year average employee turnover rates for clinical laboratory staff and to survey the types of institutional human resource practices that may be associated with lower turnover rates. DESIGN.­: We collected data from participating laboratories spanning a 3-year period of 2015-2017, which included the number of full-time equivalent (FTE) staff members that their laboratories employed in several personnel and departmental categories, and the number of laboratory staff FTEs who vacated each of those categories that institutions intended to refill. We calculated the 3-year average turnover rates for all laboratory employees, for several personnel categories, and for major laboratory departmental categories, and assessed the potential associations between 3-year average all laboratory staff turnover rates with institutional human resource practices. RESULTS.­: A total of 23 (20 US and 3 international) participating institutions were included in the analysis. Among the 21 participants providing adequate turnover data, the median of the 3-year average turnover rate for all laboratory staff was 16.2%. Among personnel categories, ancillary staff had the lowest median (11.1% among 21 institutions) and phlebotomist staff had the highest median (24.9% among 20 institutions) of the 3-year average turnover rates. Among laboratory departments, microbiology had the lowest median (7.8% among 18 institutions) and anatomic pathology had the highest median (14.3% among 14 institutions) of the 3-year average turnover rates. Laboratories that developed and communicated clear career paths to their employees and that funded external laboratory continuing education activities had significantly lower 3-year average turnover rates than laboratories that did not implement these strategies. CONCLUSIONS.­: Laboratory staff turnover rates among institutions varied widely. Two human resource practices were associated with lower laboratory staff turnover rates.

Evaluación de la calidad del diagnóstico de malaria en la red local de laboratorios y en los laboratorios intermedios en el contexto de la eliminación de la enfermedad en Ecuador / Quality evaluation of malaria diagnosis in the local laboratories network and in intermediate laboratories in a setting towards the disease elimination in Ecuador

Resumen Introducción. El cumplimiento de la meta de eliminación de la malaria en Ecuador en el 2020 exige contar con la capacidad requerida para el diagnóstico microscópico ajustado a los estándares de calidad de la Organización Mundial de la Salud (OMS) y de la Organización Panamericana de la Salud (OPS) y proveer el tratamiento adecuado a los pacientes. Objetivo. Conocer la idoneidad o competencia de los microscopistas de la red pública local para el diagnóstico parasitológico de la malaria y el desempeño de los laboratorios intermedios de referencia. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal a partir de la información obtenida en los talleres de evaluación de idoneidad en el diagnóstico microscópico de la red de laboratorios en las coordinaciones zonales de salud utilizando un panel de láminas para evaluar la concordancia del diagnóstico. Además, se calificó el desempeño de los laboratorios intermedios en el diagnóstico en el marco del programa de evaluación externa del desempeño. Los resultados se compararon con los obtenidos por el laboratorio supranacional de Perú. Resultados. En los 11 talleres realizados, se evaluó la idoneidad de 191 microscopistas, de los cuales 153 (80,1 %) aprobaron las pruebas. Las medianas de los indicadores fueron las siguientes: concordancia entre la detección y el resultado, 100 % (Q1- Q3: 96-100); concordancia en la especie, 100 % (Q1- Q3: 93-100); concordancia en el estadio, 93,0 % (Q1- Q3: 86-95) y concordancia en el recuento, 77 % (Q1- Q3: 71-82). En el programa de evaluación externa de desempeño, los tres laboratorios intermedios obtuvieron una concordancia del 100 % en el resultado y una del 96 % en la especie. Conclusiones. Los indicadores de competencia de la red local y de desempeño de los laboratorios intermedios alcanzaron altos estándares de calidad acordes con el proceso de entrenamiento implementado en el país.

Abstract Introduction: To reach the goal of malaria elimination in Ecuador for the year 2020, it is necessary to have a laboratory network with the capacity to perform microscopic diagnosis according to the WHO/PAHO quality standards and to provide the adequate treatment of cases. Objective: To determine the level of competence for parasitological diagnosis of the microscopists from the local public network and the performance of intermediate reference laboratories. Materials and methods: We conducted a cross-sectional study based on the information collected in workshops carried out to appraise the competence for microscopic diagnosis of the local laboratory network (zonal health coordinating offices 1 to 8) using a slide panel to evaluate diagnosis agreement, as well as the diagnostic performance of the intermediate laboratories using an external quality assessment program. The results were compared against the reference standards of the supranational laboratory in Perú. Results: We evaluated the competencies of 191 microscopists in 11 workshops and 153 (80.1%) of them were approved. The medians of the indicators were the following: concordance for parasite detection, 100% (Q1- Q3: 96-100), concordance for species identification, 100% (Q1- Q3: 93-100), and concordances for stage identification, 93.0% (Q1- Q3: 86-95) and parasite counting, 77.0% (Q1- Q3: 71-82). In the external quality assessment, the three intermediate laboratories obtained 100% in parasite detection concordance and 96% for species detection concordance. Conclusions: The results for the primary network and the performance indicators for the intermediate laboratories showed the high-quality standards of the training program implemented in the country.

Risk of professional accidental exposure to biological agents in health care workers: a retrospective analysis carried out in a southern Italian tertiary hospital.

Worldwide the needlestick injuries of health care workers (HCWs) still represent a major health problem. The authors aimed to evaluate the risk of HCW needlestick injuries in a tertiary university hospital in southern Italy in relation to some HCW characteristics (age, sex, professional profile, work department) and the source of infection. All HCWs of the University Hospital "Federico II" in Naples, Italy, attending the Infectious Diseases Unit after potential accidental contact to blood-borne viruses through needlestick injuries were enrolled during a 22-year period. HCWs underwent clinical analysis and were administered a specific questionnaire to collect (in anonymous fashion) data about age, sex, professional profile and work department. From 1995 to 2016 1,477 needlestick injuries in the same number of people (one accident per person) were recorded by our service. The HCWs were predominately males (n = 806, 55%) and the mean age was 39.4 years (±10.1 SD). The job categories most involved were: physicians (41%), followed by nurses (33%) and healthcare assistants (HCAs, 10%). The incidence proportion was calculated for these highest-risk categories in three defined time points (at the beginning, in the middle and at the end of the study period): 104/2149 (4.86%) in 1995, 41/2498 (1.64%) in 2005 and 25/2057 (1.22%) in 2015. Most injuries occurred in General Surgery (14.21%), Gynecology and Obstetrics (9%) and Pediatrics (6.49%). In about 34% the HCWs had been exposed to HCV infected fluids. Over time, a significant decrease in accidental exposure was recorded for physicians (p= 0.019), nurses (p< 0.0001) and HCAs (p< 0.0001). Our results confirm that some profiles, namely physicians, nurses and healthcare assistants, are still at risk of needlestick injuries, especially in surgical areas, including obstetric wards. Further primary and secondary prevention strategies are needed to decrease the incidence of new cases of needlestick injuries.

Cytotechnologists' education and work in Finland.

OBJECTIVE: The aim of this study was to survey the work that cytotechnologists carry out in Finland. METHODS: An electronic questionnaire was planned with the Board of the Finnish Association of Cytotechnologists and an email containing the link was sent to all 107 of its members in January 2018. It included 17 questions on their age and work experience, education and work. There was also space for them to add other comments. RESULTS: Just under half (45%) replied. Their average age was 51 years (range 28-64), 41% had a Bachelor's degree, 59% had college-level training and they had spent an average of 15 years screening cytology specimens. After basic professional education, they had completed their cytology education in many ways and the most common routes were internship training (71%) and 1-year cytology specialisation (38%). Most of the cytotechnologists (85%) had duties other than screening and they mostly included a combination of histotechnology and cytotechnology (37.5%) or just cytotechnology (17%) or histotechnology (9%). The other 15% only screened cytology specimens. All cytotechnologists screened Papanicolaou smears, 94% screened urinary and respiratory specimens, 82% screened effusions and 39% screened fine-needle aspirations. CONCLUSIONS: We found that internship training provided essential training for Finnish cytotechnologists after they complete their basic professional studies. They reported many other duties in addition to microscopy screening.

Improvement of blood culture contamination rate, blood volume, and true positive rate after introducing a dedicated phlebotomy team.

The introduction of dedicated phlebotomy teams certified for blood collection has been reported to be highly cost-effective by reducing contamination rates. However, data on their effects on blood volume and true positive rate are limited. Therefore, we investigated the effect of replacing interns with a phlebotomy team on blood culture results. We performed a 24-month retrospective, quasi-experimental study before and after the introduction of a phlebotomy team dedicated to collecting blood cultures in a 2700-bed tertiary-care hospital. The microbiology laboratory database was used to identify adult patients with positive blood culture results. During the study period, there were no changes in blood collection method, blood culture tubes, and the application of antiseptic measures. Blood volume was measured by the BACTEC™ FX system based on red blood cell metabolism. A total of 162,207 blood cultures from 23,563 patients were analyzed, comprising 78,673 blood cultures during the intern period and 83,534 during the phlebotomy team period. Blood volume increased from a mean of 2.1 ml in the intern period to a mean of 5.6 ml in the phlebotomy team period (p < 0.001). Introduction of the phlebotomy team also reduced contamination rate (0.27% vs. 0.45%, p < 0.001) and led to a higher true positive rate (5.87% vs. 5.01%, p < 0.05). The increased true positive rate associated with the phlebotomy team involved both gram-positive and gram-negative bacteria. The introduction of a dedicated phlebotomy team can increase blood volumes, reduce blood culture contamination rate, and increase true positive rate.

Changing Practice Patterns for Cytotechnologists: A Comparative Analysis of Data from the 2009 and 2015 ASCP BOC Practice Analysis Surveys.

BACKGROUND: The American Society for Clinical Pathology (ASCP) Board of Certification (BOC) surveys US certified cytotechnologists (CTs) at approximately 5-year intervals to gain information about current practice patterns. Although the purpose of this survey is to inform valid content development for the BOC CT examination, comparative longitudinal analysis of the survey data provides information about changes in cytotechnology practice. MATERIALS AND METHODS: BOC Practice Analysis Survey data for 2009 and 2015 were examined, comparing survey demographics and performance of laboratory tasks. The 2015 survey added tasks not previously surveyed and considered them emerging when performed by a majority of respondents. RESULTS: Two hundred thirty-five participants completed the survey in 2015 and 151 in 2009. Respondents reported an overall decrease in performing conventional Papanicolaou tests (-25.3%). Respondents reported increases in morphologic tasks such cytologyehistology correlation (17.5%), cell-block interpretation (17.5%), and preliminary interpretation of histochemical stains (e.g., mucin and Grocott's methenamine silver stain) (16.7%), as well as quality assurance tasks. Majority-performed, newly surveyed tasks included touch prep preparation (57.8%) and interpretation (59.2%) and ancillary test triage (59.6%). Molecular tasks such as tumor identification (6.8%) and preparation of cytology specimens for oncology molecular testing (9.4%) did not meet majority reporting thresholds. CONCLUSIONS: Although performance of the Papanicolaou test is declining, CTs report increases in additional morphologic as well as other laboratory tasks. Emerging tasks (2015) focus on FNA specimens. Knowledge of cytology practice patterns will help guide development of education and training resources toward maintaining an appropriately trained workforce.

Radiation exposure of cardiac sonographers working in an academic noninvasive cardiovascular imaging laboratory.

BACKGROUND AND AIM: Exposure to workplace radiation among cardiac sonographers has been felt to be low, and patient-related sources have been considered negligible. Sonographers may be exposed to radiation from patient emitted sources as well as external sources in interventional laboratories. This study quantified radiation exposure to cardiac sonographers. METHODS: Cardiac sonographers, vascular imaging technologists, exercise physiologists, noninvasive nursing staff, and CT/MRI technologists were provided body dosimeter badges. Sonographers were provided dosimeter rings for their scanning hands. Radiation exposure was quantified from the dosimeter data, reported in millirems (mrem) for deep, eye, and shallow exposure, as well as shallow exposure data from the rings. Data were prospectively collected for 63 employees over a 12-month period and retrospectively analyzed. RESULTS: The mean annual deep body exposure in sonographers was 8.2 mrem/year, shallow exposure 9.8 mrem/year, eye exposure 8.5 mrem/year, and ring exposure 207 mrem/year. There was a significant difference between body and ring exposure (P = .0002). When comparing exposure data between the vascular imaging technologists, CT/MRI technologists, noninvasive nursing staff, and the cardiac sonographers, there were no statistical differences (P > .23). Exercise physiologists had significantly higher exposure compared to sonographers (P < .03). CONCLUSION: This single-center experience demonstrates that, while exposure is low, cardiac sonographers are exposed to workplace radiation, most likely from patient emitted radiation. The finding that radiation exposure from rings exceeded body exposure supports this conclusion. Continued education and assessment of work flow practices should be employed to minimize staff radiation exposure.

The impact of trained radiographers as concurrent readers on performance and reading time of experienced radiologists in the UK Lung Cancer Screening (UKLS) trial.

OBJECTIVES: To compare radiologists' performance reading CTs independently with their performance using radiographers as concurrent readers in lung cancer screening. METHODS: 369 consecutive baseline CTs performed for the UK Lung Cancer Screening (UKLS) trial were double-read by radiologists reading either independently or concurrently with a radiographer. In concurrent reading, the radiologist reviewed radiographer-identified nodules and then detected any additional nodules. Radiologists recorded their independent and concurrent reading times. For each radiologist, sensitivity, average false-positive detections (FPs) per case and mean reading times for each method were calculated. RESULTS: 694 nodules in 246/369 (66.7%) studies comprised the reference standard. Radiologists' mean sensitivity and average FPs per case both increased with concurrent reading compared to independent reading (90.8 ± 5.6% vs. 77.5 ± 11.2%, and 0.60 ± 0.53 vs. 0.33 ± 0.20, respectively; p < 0.05 for 3/4 and 2/4 radiologists, respectively). The mean reading times per case decreased from 9.1 ± 2.3 min with independent reading to 7.2 ± 1.0 min with concurrent reading, decreasing significantly for 3/4 radiologists (p < 0.05). CONCLUSIONS: The majority of radiologists demonstrated improved sensitivity, a small increase in FP detections and a statistically significantly reduced reading time using radiographers as concurrent readers. KEY POINTS: • Radiographers as concurrent readers could improve radiologists' sensitivity in lung nodule detection. • An increase in false-positive detections with radiographer-assisted concurrent reading occurred. • The false-positive detection rate was still lower than reported for computer-aided detection. • Concurrent reading with radiographers was also faster than single reading. • The time saved per case using concurrently reading radiographers was relatively modest.

Breast cancer risk and protracted low-to-moderate dose occupational radiation exposure in the US Radiologic Technologists Cohort, 1983-2008.

BACKGROUND: Although high-dose ionising radiation is associated with increased breast cancer risks, the association with protracted low-dose-rate exposures remains unclear. The US Radiologic Technologist study provides an opportunity to examine the association between low-to-moderate dose radiation and breast cancer incidence and mortality. METHODS: One thousand nine hundred and twenty-two self-reported first primary cancers were diagnosed during 1983-2005 among 66 915 female technologists, and 586 breast cancer deaths occurred during 1983-2008 among 83 538 female cohort members. Occupational breast dose estimates were based on work histories, historical data, and, after the mid-1970s, individual film badge measurements. Excess relative risks were estimated using Poisson regression with birth cohort stratification and adjustment for menopause, reproductive history, and other risk factors. RESULTS: Higher doses were associated with increased breast cancer incidence, with an excess relative risk at 100 mGy of 0.07 (95% confidence interval (CI): -0.005 to 0.19). Associations were strongest for technologists born before 1930 (excess relative risk at 100 mGy=0.16; 95% CI: 0.03-0.39) with similar patterns for mortality among technologists born before 1930. CONCLUSIONS: Occupational radiation to the breast was positively associated with breast cancer risk. The risk was more pronounced for women born before 1930 who began working before 1950 when mean annual doses (37 mGy) were considerably higher than in later years (1.3 mGy). However, because of the uncertainties and possible systematic errors in the occupational dose estimates before 1960, these findings should be treated with caution.

Changing Patterns in the Performance of Fluoroscopically Guided Interventional Procedures and Adherence to Radiation Safety Practices in a U.S. Cohort of Radiologic Technologists.

OBJECTIVE: Information is limited on changes over time in the types of fluoroscopically guided interventional procedures performed and associated radiation safety practices used by radiologic technologists. MATERIALS AND METHODS: Our study included 12,571 U.S. radiologic technologists who were certified for at least 2 years in 1926-1982 and who reported in a 2012-2013 survey that they ever performed or assisted with fluoroscopically guided interventional procedures. They completed a mailed questionnaire in 2013-2014 describing their detailed work practices for 21 fluoroscopically guided interventional procedures and associated radiation safety practices from the 1950s through 2009. RESULTS: Overall, the proportion of technologists who reported working with therapeutic fluoroscopically guided interventional procedures, including percutaneous coronary interventions, increased over time, whereas the proportion of technologists who worked with diagnostic fluoroscopically guided interventional procedures, including diagnostic cardiovascular catheterization and neuroangiographic procedures, decreased. We also observed substantial increases in the median number of times per month that technologists worked with diagnostic cardiovascular catheterizations and percutaneous coronary interventions. In each time period, most technologists reported consistently (≥ 75% of work time) wearing radiation monitoring badges and lead aprons during fluoroscopically guided interventional procedures. However, fewer than 50% of the technologists reported consistent use of thyroid shields, lead glasses, and room shields during fluoroscopically guided interventional procedures, even in more recent time periods. CONCLUSION: This study provides a detailed historical assessment of fluoroscopically guided interventional procedures performed and radiation safety practices used by radiologic technologists from the 1950s through 2009. Results can be used in conjunction with badge dose data to estimate organ radiation dose for studies of radiation-related health risks in radiologic technologists who have worked with fluoroscopically guided interventional procedures.

Proceedings of the African Pathologists Summit; March 22-23, 2013; Dakar, Senegal: a summary.

CONTEXT: This report presents the proceedings of the African Pathologists Summit, held under the auspices of the African Organization for Research and Training in Cancer. OBJECTIVES: To deliberate on the challenges and constraints of the practice of pathology in Sub-Saharan Africa and the avenues for addressing them. PARTICIPANTS: Collaborating organizations included the American Society for Clinical Pathology; Association of Pathologists of Nigeria; British Division of the International Academy of Pathology; College of Pathologists of East, Central and Southern Africa; East African Division of the International Academy of Pathology; Friends of Africa-United States and Canadian Academy of Pathology Initiative; International Academy of Pathology; International Network for Cancer Treatment and Research; National Cancer Institute; National Health and Laboratory Service of South Africa; Nigerian Postgraduate Medical College; Royal College of Pathologists; West African Division of the International Academy of Pathology; and Faculty of Laboratory Medicine of the West African College of Physicians. EVIDENCE: Information on the status of the practice of pathology was based on the experience of the participants, who are current or past practitioners of pathology or are involved in pathology education and research in Sub-Saharan Africa. CONSENSUS PROCESS: The deliberations were carried out through presentations and working discussion groups. CONCLUSIONS: The significant lack of professional and technical personnel, inadequate infrastructure, limited training opportunities, poor funding of pathology services in Sub-Saharan Africa, and their significant impact on patient care were noted. The urgency of addressing these issues was recognized, and the recommendations that were made are contained in this report.

Assessment of high-risk human papillomavirus infections using clinician- and self-collected cervical sampling methods in rural women from far western Nepal.

INTRODUCTION: Nepal has one of the highest cervical cancer rates in South Asia. Only a few studies in populations from urban areas have investigated type specific distribution of human papillomavirus (HPV) in Nepali women. Data on high-risk HPV (HR-HPV) types are not currently available for rural populations in Nepal. We aimed to assess the distribution of HR- HPV among rural Nepali women while assessing self-collected and clinician-collected cervico-vaginal specimens as sample collection methods for HPV screening. METHODS: Study participants were recruited during a health camp conducted by Nepal Fertility Care Center in Achham District of rural far western Nepal. Women of reproductive age completed a socio-demographic and clinical questionnaire, and provided two specimens; one cervical-vaginal specimen using a self-collection method and another cervical specimen collected by health camp auxiliary nurse midwives during a pelvic examination. All samples were tested for 14 different HR-HPV mRNA and also specific for HPV16/18/45 mRNA. RESULTS: Of 261 women with both clinician- and self-collected cervical samples, 25 tested positive for HR-HPV, resulting in an overall HR-HPV prevalence of 9.6% (95% confidence Interval [CI]: 6.3-13.8). The overall Kappa value assessing agreement between clinician- and self-collected tests was 0.62 (95% CI: 0.43-0.81), indicating a "good" level of agreement. Abnormal cytology was reported for 8 women. One woman identified with squamous cell carcinoma (SCC), and 7 women with high grade squamous intraepithelial lesions (HSIL). Seven of the 8 women tested positive for HR-HPV (87.5%) in clinician-collected samples and 6 in self-collected samples (75.0%). CONCLUSION: This is the first study to assess HR-HPV among rural Nepali women. Self-collected sampling methods should be the subject of additional research in Nepal for screening HR-HPV, associated with pre-cancer lesions and cancer, in women in rural areas with limited access to health services.

Personalized technologist dose audit feedback for reducing patient radiation exposure from CT.

PURPOSE: The aim of this study was to determine whether providing radiologic technologists with audit feedback on doses from CT examinations they conduct and education on dose-reduction strategies reduces patients' radiation exposure. METHODS: This prospective, controlled pilot study was conducted within an integrated health care system from November 2010 to October 2011. Ten technologists at 2 facilities received personalized dose audit reports and education on dose-reduction strategies; 9 technologists at a control facility received no intervention. Radiation exposure was measured by the dose-length product (DLP) from CT scans performed before (n = 1,630) and after (n = 1,499) the intervention and compared using quantile regression. Technologists were surveyed before and after the intervention. RESULTS: For abdominal CT, DLPs decreased by 3% to 12% at intervention facilities but not at the control facility. For brain CT, DLPs significantly decreased by 7% to 12% at one intervention facility; did not change at the second intervention facility, which had the lowest preintervention DLPs; and increased at the control facility. Technologists were more likely to report always thinking about radiation exposure and associated cancer risk and optimizing settings to reduce exposure after the intervention. CONCLUSIONS: Personalized audit feedback and education can change technologists' attitudes about, and awareness of, radiation and can lower patient radiation exposure from CT imaging.

Cytogenetic endpoints and Xenobiotic gene polymorphism in lymphocytes of hospital workers chronically exposed to ionizing radiation in Cardiology, Radiology and Orthopedic Laboratories.

Ionizing radiation (IR) is known as a classical mutagen capable of inducing various kinds of stable and unstable chromosomal aberrations (CA) including the possibility of increasing the incidence of DNA damage. This study aims to assess occupationally induced CA in workers chronically exposed to low doses of IR in Radiology (RL), Cardiology (CL) and Orthopedic (OL) Laboratories in hospitals of Tamil Nadu. We performed the analysis of CA by trypsin G-banding, micronucleus (MN) assay, Comet assay and Xenobiotic-metabolizing gene polymorphisms (GSTM1, GSTT1 and GSTP1) in 56 exposed and 56 control subjects who were matched for gender and age (± 2 years). Higher degree of CA and MN frequencies were observed in exposed groups, especially in CL subjects compared to other exposed groups and controls (p<0.05). Higher frequency of DNA tail length and tail moment was observed in the CL exposed subjects compared to the RL and OL subjects. The frequencies of GSTM1 and GSTT1 null genotypes were 39.3 percent and 14.3 percent, respectively. No significant difference in allele frequencies between exposed subjects and controls were observed (p=0.0128). Using multiple linear regression analysis, statistical significance was determined for work duration and age for the CL, RL and OL workers and the examination of the possible impact by confounding factors showed few significant influences on the radiation exposure, as a specific biomarker. However, the findings from the present study suggest that, awareness should be created among the personnel exposed to radiations in hospital laboratories, highlighting the necessity of applying radiation protection principles against medical radiation exposure.

Ionising radiation awareness among resident doctors, interns, and radiographers in a university hospital emergency department.

PURPOSE: In emergency medicine practice, radiological investigations relying on ionising radiation are increasingly used to diagnose a wide range of diseases and injuries. The aim of this study was to investigate the knowledge of radiation exposure doses and risks among interns, resident doctors, and radiographers. MATERIALS AND METHODS: A questionnaire, consisting of 14 questions in multiple choice format, was distributed to 300 participants (100 interns, 100 radiographers, 100 resident doctors) working in the emergency department. The participants were asked to estimate the radiation dose that patients received during the different radiological procedures. The questionnaire was designed to determine the participants' knowledge about radiation-related hazards. RESULTS: None of the radiation doses delivered by the imaging modalities was 100% correctly estimated. A total of 41.4% of all participants and 46.3% of resident doctors underestimated the radiation doses. The frequency of answers underestimating doses was found to be significantly higher (p < 0.001). Resident doctors, with a 39.4% correct answer rate, were found to be significantly less knowledgeable when compared with the interns and radiographers (p = 0.003). Emergency resident doctors had a statistically significantly higher rate of correct answers for the lowest and highest radiation sources for a foetus when compared with other groups (p = 0.001, p = 0.008). CONCLUSION: Our study showed that the resident doctors', interns', and radiographers' knowledge of radiation exposure from radiological investigations and the associated risks was poor. This result could imply that we are not aware of the radiation risks, and we are inattentive in informing our patients about the radiation exposure related to the different imaging modalities.

Value-added benefits and utilization of pathologists' assistants.

CONTEXT: The role of pathologists' assistants (PAs) in terms of surgical and autopsy prosection has been well established; however, the role of PAs in areas beyond surgical and autopsy pathology, such as laboratory administration and management, education, and research, is not so well understood. OBJECTIVE: To determine the scope and extent of ancillary duties (value-added benefits) performed by PAs. DESIGN: A self-administered, electronic survey was disseminated to all members of the American Association of Pathologists' Assistants with fellowship status to analyze the ancillary duties PAs provide in laboratory administration and management, education, and research. RESULTS: Respondents were from 44 states and most had 6 or more years of experience in various work settings: community hospitals (50%), academic hospitals (30%), private pathology laboratories (15%), and "other" settings (5%). Most were involved in quality assurance programs (64.0%), laboratory accreditation inspections (56.2%), and a large percentage (44.4%) also had direct supervisory experience. Roughly 36% of respondents reported training residents in prosection skills in a clinical setting, while a small percentage reported teaching for-credit courses in a classroom setting (4.9%). The primary research responsibility was fresh tissue procurement for tumor banking (52.7%). CONCLUSIONS: Pathologists' assistants currently are involved in ancillary duties beyond surgical and autopsy prosection. Our findings indicate that PAs have a desire to become more involved in these duties, and there is opportunity for pathologists to benefit further by using PAs to the full extent of their knowledge, skills, and interests.

Current experience and attitudes to biomedical scientist cut-up: results of an online survey of UK consultant histopathologists.

AIMS: To assess the current utilisation of biomedical scientist (BMS) surgical specimen cut-up in the UK and attitudes of consultant histopathologists to the practice. METHODS: Email invitations were sent to all UK consultant histopathologists to participate in an online survey (SurveyMonkey) assessing attitudes to and utilisation of BMS surgical specimen cut-up. RESULTS: 463 individual replies were received (35% response rate) from 1320 invitations to participate, covering 181 UK histopathology departments. A majority of the respondents were either fully in favour of BMS cut-up (52.7%), or in favour but with some reservation (46.2%). Only five respondents (1.1%) were completely opposed to BMS cut-up. 267 (57.7%) respondents reported that their BMS staff loaded biopsies only. 148 (32%) reported BMS cut-up of more complex benign specimens, and 83 (17.9%) reported BMS handling of orientated skin specimens. Only 39 (8.4%) reported that BMS staff in their departments currently cut-up larger cancer resections. CONCLUSIONS: This survey is representative of current BMS cut-up practice in the UK. The majority of UK consultant histopathologists replying to this survey support BMS cut-up to some degree, but utilisation of BMS cut-up is rather limited and patchy at present. Cost, staffing constraints, perceived quality issues and individual consultant preferences are cited as reasons for limited uptake currently. Recognised benefits of promoting BMS cut-up include better use of consultant time, enhanced team working, BMS job satisfaction and career progression, and better adherence to standard operating procedures.

Laboratory work and adverse pregnancy outcomes.

BACKGROUND: Laboratory workers are commonly exposed to chemical, biological and physical agents. They also may adopt poor postures for long periods and be engaged in moving and handling. These factors may increase the risk of adverse pregnancy outcome in female laboratory workers. AIMS: To assess whether laboratory work during pregnancy increases the risk of adverse pregnancy outcomes. METHODS: The 1990-2006 Finnish Medical Birth Registry was used to identify all singleton newborns of all Finnish laboratory workers (n = 5425) and those of teachers (n = 21,438) as the reference population. The main outcomes were sexual differentiation (female gender), low birth weight, high birth weight, preterm delivery, post-term delivery, small-for-gestational age (SGA), large-for-gestational age and perinatal death. The generalized estimating equation (GEE) analysis was used to estimate odds ratios (ORs) adjusted for maternal age, parity, marital status and maternal smoking during pregnancy. RESULTS: In the GEE analysis, the risk of low birth weight (adjusted OR: 1.27, 95% CI: 1.08-1.45) and SGA (adjusted OR: 1.27, 95% CI: 1.02-1.52) was higher in laboratory workers than in teachers. Correspondingly the prevalence of high birth weight (> or = 4000 g) was lower in newborns of laboratory workers (adjusted OR: 0.90, 95% CI: 0.83-0.98). The prevalence of post-term deliveries was close to being significantly higher among newborns of laboratory workers (adjusted OR: 1.16, 95% CI: 1.00-1.31). CONCLUSIONS: This large population-based study provides evidence that laboratory work may be associated with reduced foetal growth.