A novel approach to managing hemolyzed specimens.

Hemolyzed specimens continue to cost the laboratory time and money. However, the core laboratory at Georgia Regents Health System, Inc. has instituted a novel approach to managing this problem. The purpose of this study was to determine whether the laboratory's new approach had a significant impact on the turn-around time (TAT) and cost of processing hemolyzed and non-hemolyzed specimens in the laboratory. The investigators queried the laboratory information systems for hemolyzed and non-hemolyzed specimens categorized as routine or STAT from the core laboratory and calculated statistical differences between the groups with respect to TAT and cost.The investigators found a statistically significant difference in the time it takes to process STAT hemolyzed specimens versus non-hemolyzed specimens with the new approach. Because of the new approach, hemolyzed specimens were actually processed as fast as, or faster than non-hemolyzed specimens in the core laboratory.

Sequential assessment of troponin in the diagnosis of myocardial infarction.

According to the American Heart Association, cardiovascular disease accounts for more than one third of all deaths in the United States. 1 The purpose of this retrospective case-control study was to determine which sample taken in a sequential draw was most important in diagnosing an acute myocardial infarction (AMI). One-hundred subjects were selected from a convenience sample. The "risk" of AMI diagnosis was modeled using binary multiple logistic regression. Overall, 78% (39 out of 50 cases) were diagnosed with an AMI at Tinitiai. Clearly, the initial cTnI assay is the most critical of the four sequential time points for the accurate assessment of the presence or absence of an AMI. Most importantly, sequential troponin testing increased the ability to diagnose AMI by 10-fold.

Causes of historically low abstract submissions for the ASCLS annual meeting.

The Abstract Review Committee (ARC) has an ongoing objective of encouraging abstract submissions for the American Society of Clinical Laboratory Science's (ASCLS) Annual Meeting. The purpose of this research study was to survey ASCLS members to determine the cause of historically low abstract submissions and how submissions could be increased. An electronic survey was developed and sent to ASCLS members via electronic mail blast. The survey focused on five areas: 1) participant demographics, 2) positives and negatives of the current submission and review process, 3) suggestions for improvement, 4) barriers to participation, and 5) level of attendance at poster and oral presentation sessions at annual meetings. Results of the survey indicated that the foremost reason cited for not submitting an abstract was lack of active research. The ARC believes limited research activity is due to the lack of educational preparedness of educators and practitioners to conduct research.

Student molecular laboratory performance outcomes in a baccalaureate CLS program.

UNLABELLED: As new molecular assays are developed in research laboratories and approved by the Food and Drug Administration (FDA) for clinical use, molecular diagnostics becomes an integral discipline of clinical laboratory science. Since 2001, guidelines of the National Accreditation Agency for Clinical Laboratory Science (NAACLS) have required that CLS Educational Programs incorporate molecular diagnostics into the curriculum. SETTING: In fall of 2005, CLS faculty/researchers, affiliated with a baccalaureate program in an academic medical university, incorporated molecular diagnostic lecture content with online virtual laboratories into the Clinical Chemistry course. Then beginning in fall of 2006, manual performance of molecular laboratory exercises was introduced. OBJECTIVE: The aim of this study was to assess whether inclusion of hands-on molecular laboratories improved student outcomes on molecular questions during the final course examination. METHOD: CLS faculty evaluated student learning by written examination of lecture and laboratory content. Researchers performed two-sample t-tests to establish if significant differences existed in molecular questions scores achieved by students exposed to virtual and hands-on exercises. RESULTS: The researchers found a statistically significant difference in examination performance between the students that had a hands-on experience and students with virtual laboratory experience only. Further data analysis suggested that hands-on experiential laboratories had the greatest effect on students who performed in the middle percentiles. CONCLUSION: The researchers proposed that in order to improve examination scores of the weakly performing students other interventions may be necessary such as more lecture or laboratory time. This prompted development of a full time clinical molecular methods course, separate from Clinical Chemistry.

Evidence based practice and advanced competencies in a MHS-CLS program.

The goals, curriculum, implementation, and immediate impacts of an entry-level Master of Health Science in Clinical Laboratory Science (MHS-CLS) degree are described as compared to the baccalaureate program (BS-CLS) in the same institution. The MHS-CLS program was instituted in fall semester, 2008; the inaugural class graduated in spring semester 2010. To document the need for the MHS-CLS, program statistics, such as the number of students entering the current BS-CLS program with previous baccalaureate degrees, numbers of students graduating with biology and chemistry degrees in the United States, CLS workforce shortages and pending retirement statistics were used. The shortage of CLS practitioners able to perform and publish evidence-based practice research also supported program need. The MHS-CLS curriculum includes advanced courses, advanced competencies incorporated into existing BS-CLS courses, and a capstone research project in evidence based practice.

COMPARISON OF PATELLA ALIGNMENT AND CARTILAGE BIOMARKERS IN YOUNG ADULT FEMALES WITH AND WITHOUT PATELLOFEMORAL PAIN: A PILOT STUDY.

BACKGROUND: Evidence suggests that individuals with patellofemoral pain (PFP) may develop patellofemoral joint osteoarthritis (PFJOA). Limited data exist regarding an absolute association between PFP and PFJOA. Understanding this relationship will support the need for early interventions to manage PFP. HYPOTHESIS/PURPOSE: This study was conducted to determine if females with PFP have a patella position and cartilage biomarkers similar to individuals with PFJOA. It was hypothesized that females with PFP and excessive patella lateralization would have higher cartilage biomarker levels than controls. It also was hypothesized that a significant association would exist between pain and cartilage biomarker levels in subjects with excessive patella lateralization. STUDY DESIGN: Single-occasion, cross-sectional, observational. METHODS: Pain was assessed using a 10-cm visual analog scale (VAS) for activity pain over the previous week. Patella offset position (RAB angle) was measured using diagnostic ultrasound. Urine was collected and cartilage biomarkers quantified by analyzing C-telopeptide fragments of type II collagen (uCTX-II). Independent t-tests were used to determine between-group differences for RAB angle and uCTX-II. Bivariate correlations were used to determine associations between VAS and uCTX-II for females with PFP. RESULTS: Subjects (age range 20 to 30 years) had similar RAB angles (p = 0.21) and uCTX-II (p = 0.91). A significant association only existed between VAS scores and uCTX-II for females with PFP who had a RAB angle > 13 ° (r = 0.86; p = 0.003). Comparison of uCTX-II in the 25-to-30-year-old females with PFP and excessive patella lateralization in the current study to published normative data showed that this cohort had elevated biomarkers. CONCLUSION: These findings support that a certain cohort of individuals with PFP have features similar to individuals with confirmed PFJOA (patella lateralization and elevated biomarkers). Additional studies are needed to determine if interventions can reverse not only pain but biomarker levels. LEVEL OF EVIDENCE: 2b (diagnosis).

A quality improvement cycle: hemolyzed specimens in the emergency department.

OBJECTIVE: To determine the cause of and possible solution for an excessive number of hemolyzed specimens received from the emergency department (ED) of a large medical center. DESIGN: The clinical laboratory staff collected data on hemolyzed specimens for all departments of the medical center. The clinical laboratory management team and ED management team intervened with training and surveillance of the ED staff to heighten the awareness of the problem. SETTING: The clinical chemistry laboratory of a large medical center. MAIN OUTCOME MEASURE: The number of specimens submitted by inpatient departments and the ED was measured in relationship to the number ofhemolyzed specimens received from the departments. The clinical laboratory measured specimen processing times and turnaround times to determine their role in possibly contributing to the large number of hemolyzed specimens. Direct observation by a certified phlebotomist documented anecdotal evidence of the ED staffs phlebotomy practices. ED and clinical laboratory practitioners communicated realistic impressions of the medical centers problem with hemolyzed specimens. RESULTS: The laboratory processing times were not responsible for the hemolyzed specimens. The collection equipment was not responsible for the hemolyzed specimens. The ED had an excessive number ofhemolyzed specimens when compared to the rest of the medical center. The collection techniques in the ED appeared to be the origin of the problem. CONCLUSION: The intervention of the laboratory manager with the ED chief and nurse manager abated some of the professional arrogance between the departments. The dialogue educated the staffs about specific data that pointed to a possible origin of the problem. The ED chief placed his department on surveillance against problematic draws. Communication was improved between the two departments. However, only a moderate improvement in the number of hemolyzed specimens was noted. More training of medical center departments in phlebotomy and periodic proficiency evaluation of the all staff was indicated as a possible long-term solution.

Effects of Barometric Pressure and Temperature on Acute Ischemic Stroke Hospitalization in Augusta, GA.

Several studies worldwide have demonstrated significant relationships between meteorological parameters and stroke events. However, authors often reported discordant effects of both barometric pressure and air temperature on stroke occurrence. The present study investigated whether there was an association between weather parameters (barometric pressure and temperature) and ischemic stroke hospitalization. The aim of the study was to find out whether daily barometric pressure may be used as a prognostic variable to evaluate the workload change of a neurological intensive care unit. We conducted a retrospective review study in which we collected the independent (barometric pressure and temperature) and dependent variables (stroke hospitalization) every 24 h for the periods 10/1/2016-4/30/2017 at Augusta University Medical Center of Augusta, GA. We analyzed the data with zero-inflated Poisson model to assess the relationship between the barometric pressure, temperature, and daily stroke hospitalization. The results showed that there was a significantly correlation between daily barometric pressure variation and daily stroke hospitalization, especially on elder male patients (≥ 65). Stroke events were more likely to occur in the patients with risk factors than in those without risk factors when exposed to barometric pressure and temperature changes. Decreased barometric pressure and increased temperature were associated with increased daily stroke hospitalization. Furthermore, there was a potential delayed effect of increased stroke events after cold temperature exposure. Barometric pressure and temperature changes over the preceding 24 h are associated with daily stroke hospitalization. These findings may enhance our understanding of relationship between stroke and weather and maybe used in the development of public health strategies to minimize the weather-related stroke risk.

Using community-based participatory research to develop a culturally sensitive smoking cessation intervention with public housing neighborhoods.

PURPOSE: To describe surface and deep structure dimensions of a culturally sensitive smoking cessation intervention developed with southeastern US public housing neighborhoods. PROCEDURES: Community-based participatory research (CBPR) methods were used to develop this culturally sensitive smoking cessation intervention by the following research partners: academicians, neighborhood residents, community health workers, and community advisory board. This CBPR involved a cyclical process with the following phases: assembling a research team; identifying smoking cessation as the health need of interest; developing the research method; establishing evaluation, feedback, and dissemination mechanisms; implementing the initial "Sister to Sister" community trial; analyzing and interpreting the data; disseminating the results; revising the intervention; and, establishing mechanisms to sustain outcomes. Culturally sensitive dimensions emerged during this process and were categorized as surface structure and deep structure. FINDINGS: Surface structure dimensions included written materials, incentives and food, and protocol delivery strategies. Deep structure dimensions included kinships, collectivism, storytelling, and spiritual expressions. Community health workers and the advisory board contributed to the identification and integration of both surface and deep structure dimensions. The six-month continuous smoking abstinence outcomes from the initial community trial were 27.5% vs 5.77% for the intervention and comparison groups, respectively. CONCLUSIONS: Community-based participatory research (CBPR) methods facilitate processes in which culturally sensitive dimensions can be effectively identified and integrated into health promotion interventions for marginalized populations. The incorporation of surface structure dimensions increases acceptance and feasibility, while deep structure improves overall impact and efficacy of the intervention.

Evaluating distance learning in clinical laboratory science.

OBJECTIVE: The purpose of this study was to determine if there were any significant differences in academic performance between distance students and on-campus students in clinical laboratory science. DESIGN: A quantitative causal comparative research design was used. SETTING: The research study was conducted at an academic health sciences university in the eastern United States. PATIENTS OR OTHER PARTICIPANTS: Anecdotal graduate data were collected from students that had graduated from the Clinical Laboratory Science (CLS) program. INTERVENTIONS: The students had either received their CLS education via distance or through the traditional on-campus methods. MAIN OUTCOME MEASURES: Academic performance was the major outcome measured. This was determined by comparing distance students' final grade point average (GPA) scores and certification scores to their on-campus counterparts. RESULTS: The researchers found no significant difference in gender between distance and on-campus students; however, there was a significant difference in age. On average the distance students were older than their on-campus counterparts. There were no significant differences found for mean overall admission GPA, mean math science admission GPA, mean final GPA score, and mean certification score. There were also no differences found in any of the subcategories of the certification exam except for urinalysis. For the urinalysis subcategory the distance students significantly outperformed their on-campus counterparts. Correlation studies showed that there were significant positive correlations between overall admission GPAs, math science admission GPAs, final GPA scores, and certification scores. CONCLUSIONS: The researchers have shown that distance learning CLS graduates are as academically prepared as their on-campus counterparts.

Evaluating distance learning in health informatics education.

The purpose of this study was to compare academic performance between distance-learning and on-campus health informatics students. A quantitative causal-comparative research design was utilized, and academic performance was measured by final GPA scores and Registered Health Information Administrator certification exam scores. Differences in previous academic performance between the two groups were also determined by comparing overall admission GPA and math/science admission GPA. The researchers found no difference in academic performance between the two groups when final GPA scores and total certification scores were compared. However, there were statistically significant differences between the two groups in 4 of the 17 sub-domains of the certification examination, with the on-campus students scoring slightly higher than the distance students. Correlation studies were also performed, and the researchers found significant correlations between overall admission GPA, math/science admission GPA, final GPA, and certification scores.

Type II estrogen binding site agonist: synthesis and biological evaluation of the enantiomers of methyl-para-hydroxyphenyllactate (MeHPLA).

A high-affinity ligand for the type II estrogen binding site (EBS) was identified. Methyl para-hydroxyphenyllactate (MeHPLA) was observed to suppress the cellular proliferation of estrogen-sensitive MCF-7 breast cancer cells in vitro and to suppress the growth of rat uteri in vivo. The high affinity of MeHPLA for the type II EBS suggests that this interaction is responsible for the observed suppression of cell growth. In this study, the enantiomers of MeHPLA were synthesized and separated by three methods and evaluated for biological activity. When the methods were compared, it was found that the method using an optically pure amine to form the diastereomers of the enantiomers gave the superior yield. Binding studies for the enantiomers to the type II EBS showed that the S-MeHPLA had a higher affinity for the binding site. However, higher binding affinity did not translate into superior cell growth suppression. Both enantiomers suppressed cell growth equally.