Laboratory medicine best practices: systematic evidence review and evaluation methods for quality improvement.

OBJECTIVE: To develop methods for systematically reviewing evidence for identifying effective laboratory medicine (LM) practices associated with improved healthcare quality outcomes. RELEVANCE: Although many evidence-evaluation systems have been developed, none are designed to include and rate healthcare quality improvement studies to identify evidence-based practices that improve patient safety and LM quality. METHODS: Validated evidence-based medicine methods established by governmental agencies, the Guide to Community Preventive Services, and others were adapted for the LM field. Key methods modifications included (a) inclusion of quality improvement study designs; (b) mechanisms for inclusion of unpublished evidence, (c) combining of individual ratings of study quality, effect size, and relevance of outcome measures to evaluate consistency of practice evidence; and (d) deriving an overall strength rating to support evidence-based best practice recommendations. The methods follow the process steps of: ask; acquire; appraise; analyze; apply; and assess. Expert panels used the systematic evidence review results on practice effectiveness for improving healthcare quality outcomes consistent with the Institute of Medicine's healthcare quality aims (safe, timely, effective, equitable, efficient, and patient-centered). CONCLUSIONS: Adapting and developing methods from validated systems and applying them to systematically review and evaluate practices in LM by using published and unpublished studies is feasible. With these methods, evidence from quality improvement studies can be systematically synthesized and summarized to identify effective LM practices. Practical and scientifically validated demonstration of a positive impact on outcomes ensures that practitioners, policy makers, and decision makers at all levels have the evidence needed for improving healthcare quality and public health.

Tris(tert-butyl isocyanide)bis[tris(4-methoxyphenyl)phosphine]cobalt(I) perchlorate dichloromethane disolvate and tris(tert-butyl isocyanide)bis[tris(4-methoxyphenyl)phosphine]cobalt(II) bis(perchlorate) dichloromethane disolvate: modification of a trigonal-bipyramidal structure with change of metal oxidation state.

The title complexes, [Co(C(5)H(9)N)(3)(C(21)H(21)O(3)P)(2)]ClO(4).2CH(2)Cl(2), (I), and [Co(C(5)H(9)N)(3)(C(21)H(21)O(3)P)(2)](ClO(4))(2).2CH(2)Cl(2), (II), respectively, crystallize in the hexagonal space group P6(3)/m and the monoclinic space group P2(1)/n, respectively. The cation of complex (I) has D(3h) site symmetry around the Co atom and the overall symmetry is C(3h). Complex (II) is best described as having a distorted trigonal-bipyramidal coordination, with a Co site symmetry of C(s). Compounds (I) and (II) form an analogous pair of five-coordinate Co(I) and Co(II) complexes with the same ligands, making it possible to establish (i) if the Co site coordination for both complexes is indeed trigonal-bipyramidal, as initially assumed, and (ii) if significant structural differences occur when the oxidation state of the metal is changed.

4-Nitro-anilinium triiodide monohydrate.

In the title compound, C(6)H(7)N(2)O(2) (+)·I(3) (-)·H(2)O, the triiodide anions form two-dimensional sheets along the a and c axes. These sheets are separated by the 4-nitro-anilinium cations and water mol-ecules, which form part of an extended hydrogen-bonded chain with the triiodide along the c axis, represented by the graph set C(3) (3)(14). The second important hydrogen-bonding inter-action is between the nitro group, the water mol-ecule and the anilinium group, which forms an R(2) (2)(6) ring and may be the reason for the deviation of the torsion angle between the benzene ring and the nitro group from 180 to 163.2 (4)°. These two strong hydrogen-bonding inter-actions also cause the benzene rings to pack off-centre from one another, with an edge-on-edge π-π stacking distance of 3.634 (6) Šand a centroid-centroid separation of 4.843 (2) Å.

2,2'-[(Propane-1,3-diyldinitrilo)bis-(phenyl-methyl-idyne)]diphenol.

In the title mol-ecule, C(29)H(26)N(2)O(2), there are two strong intra-molecular O-H⋯N hydrogen bonds involving the hydr-oxy and imine groups, forming S(6) ring motifs. The dihedral angles between adjacent phenyl rings and phenol-containing planes are 85.27 (19) and 91.38 (18)°. In the crystal structure, weak inter-molecular C-H⋯O hydrogen bonds connect mol-ecules into a two-dimensional network.

N,N'-Bis[(2-hydroxy-phen-yl)(phen-yl)methyl-idene]propane-1,2-diamine.

In the the title compound, C(29)H(26)N(2)O(2), two strong intra-molecular O-H⋯N hydrogen bonds involving the hydr-oxy and imine groups generate S(6) ring motifs. The dihedral angles between the pairs of terminal benzene rings are 89.8 (2) and 87.8 (2)°.

Diaquatetrakis(tert-butyl isocyanide)cobalt(II) bis(perchlorate): an example of cobalt(II) coordinated by only four alkyl isocyanide ligands.

The title compound, [Co(C5H9N)4(H2O)2](ClO4)2, crystallizes in the monoclinic space group C2/m. The cation has space-group-imposed 2/m symmetry, while the perchlorate ion is disordered about a mirror plane. The two slightly non-equivalent Co-C bonds [1.900 (3) and 1.911 (3) A] form a rectangular plane, with a C-Co-C bond angle of 86.83 (11) degrees, and the linear O-Co-O C2 axis is perpendicular to this plane. The C[triple-bond]N bond lengths are 1.141 (4) A and the Co-C[triple-bond]N and C[triple-bond]N-C angles average 175.5 (4) degrees. The perchlorate counter-ions are hydrogen bonded to the water molecules. The title compound is the first example of four alkyl isocyanide ligands coordinating Co(II) upon initial reaction of Co(ClO4)(2).6H2O/EtOH with alkyl isocyanide. In all other known examples, five alkyl isocyanide molecules are coordinated, as in [(RNC)5Co-Co(CNR)5](ClO4)4 (R = Me, Et, CHMe2, CH2Ph, C4H9-n or C6H11) or [Co(CNC8H17-t)5](ClO4)2. This complex, therefore, is unique and somewhat unexpected.