Extraction of high quality and high yield RNA from frozen EDTA blood.

Peripheral blood RNA profiling, which can reveal systemic changes in gene expression and immune responses to disease onset and progression, is a powerful tool for diagnosis and biomarker discovery. This technique usually requires high quality RNA, which is only obtainable from fresh blood, or frozen blood that has been collected in special RNA-stabilisation systems. The current study aimed to develop a novel protocol to extract high quality RNA from frozen blood that had been collected in the conventional EDTA tubes. We determined that thawing EDTA blood in the presence of cell lysis/RNA stabilisation buffers (Paxgene or Nucleospin) significantly improved RNA quality (RIN) from below 5 to above 7, which to date has not been shown possible. The EDTA-Nucleospin protocol resulted in 5 times higher yield than the EDTA-Paxgene-PreAnalytix method. The average RIN and mRNA expression levels of five different genes including 18 s, ACTB, MCP1, TNFa and TXNIP using this protocol were also indifferent to those from Paxgene blood, suggesting similar RNA quality and blood transcriptome. Moreover, the protocol allows DNA to be extracted simultaneously. In conclusion, we have developed a practical and efficient protocol to extract high quality, high yield RNA from frozen EDTA blood.

Patient-perspective and feasibility of home finger-prick testing to complement and facilitate large-scale research in rheumatology.

BACKGROUND: During the COVID-19 pandemic, we developed a digital research platform to longitudinally investigate COVID-19-related outcomes in patients with rheumatic diseases and healthy controls. We used home finger-prick testing in order to collect serum samples remotely and increase the overall efficiency of the platform. The aim of the present study was to evaluate the success rate of the finger prick and patients' perspective towards the finger prick. METHODS: Serum samples were collected up to five times during follow-up, either via a venepuncture at the research institute or a finger prick from participants' home. Participants were asked to complete a digital evaluation questionnaire of the finger prick after their attempts. RESULTS: A total of 2135 patients and 899 controls performed at least one finger prick and were included in this study. The first finger prick was successfully done by 92% (95% CI: 90% to 93%) of patients, 94% (95% CI: 92% to 95%) of controls, 93% (95% CI: 92% to 94%) of all participants aged ≤70 years and 89% (95% CI: 86% to 92%) of all participants aged >70 years. Sex did not impact these success rates. Repeated failure occurred in 11/439 (0.8%) patients and 4/712 (0.6%) controls. Both patients and controls were less willing to perform a finger prick for individual healthcare compared with scientific research. CONCLUSION: The vast majority of participants, among which elderly and patients with rheumatic diseases, were able to successfully draw the required amount of blood for serological analyses. This shows that finger-prick testing is suitable for a high-throughput implementation to monitor patients remotely.

Hemocultivos contaminados: bundle para lograr proporciones aceptables / Blood cultures contaminated: bundle to achieve acceptable proportions

Introducción. El problema de la contaminación de los hemocultivos es muy frecuente en establecimientos de atención hospitalaria, da lugar a la administración de antibióticos innecesarios y prolonga la hospitalización. Objetivo principal. Aplicar un bundle para reducir la proporción de contaminación de hemocultivos. Objetivo secundario. Realizar una encuesta anónima para detectar oportunidades de mejora en la técnica de extracción de hemocultivos. Metodología. Diseño del estudio: Estudio cuasi experimental que evaluó la proporción de contaminación de hemocultivos antes y después de implementar un bundle propio. Se determinó la proporción basal de contaminación de hemocultivos (ene-jul 2022), se realizó la intervención (agosto 2022) y se estableció la proporción de contaminación post intervención (sep.-abril 2023). Intervención: Se analizó la estructura, procedimiento y conocimiento del personal mediante una encuesta propia para detectar áreas de mejora. Se capacitó, a los técnicos de laboratorio, sobre el procedimiento de la toma de muestra mediante una simulación utilizando un brazo artificial. Se diseñó un bundle de seis medidas, se adaptó el procedimiento de toma de hemocultivo y se capacitó al personal. Análisis estadístico. Se analizó la proporción de hemocultivos contaminados entre los periodos pre y post utilizando Chi2 y la relación entre la proporción del periodo pre y post vs la literatura (3.00% contaminación aceptable) utilizando test Z para una proporción. Se consideró un p<0.05 como estadísticamente significativa. Se utilizo el software Stata 8. Resultados. Durante el estudio se analizaron un total de 3,965 hemocultivos. De estos, 1,978 corresponden al periodo pre-intervención y 1,987 corresponden al periodo post intervención. Durante la pre-intervención se detectaron 61 hemocultivos contaminados (3.08% vs 3.00% bibliografía, p:0.5866) mientras que en la etapa post intervención fue de 30 hemocultivos contaminados (1.51% vs 3.00% bibliografía, p:0.0000). La proporción de hemocultivos contaminados se redujo a la mitad, 3.08% vs 1.51%, p: 0.001. Se realizó una encuesta anónima pre y post intervención logrando mejoras en la técnica de toma de hemocultivos. Conclusión. La implementación del bundle propio para la extracción de hemocultivos, permitió reducir la proporción de contaminación a la mitad. El análisis de la encuesta nos permitió identificar oportunidades de mejora en la técnica de recolección de muestra de hemocultivos

Introduction: Contamination of blood cultures is very common in hospital care settings and results in the administration of unnecessary antibiotics and prolongs hospitalization. Main goal: Apply a bundle to reduce the rate of contamination of blood cultures. Secondary objective: Conduct an anonymous survey to detect opportunities for improvement in the blood culture extraction technique. Methodology: Study design: Quasi-experimental study that evaluated the proportion of blood culture contamination before and after implementing its own bundle. The baseline proportion of blood culture contamination was determined (Jan-July 2022), the intervention was performed (August 2022) and the post-intervention contamination proportion was established (September-April 2023). Intervention: The structure, procedure and knowledge of the staff was analyzed through an own survey to detect areas for improvement. Laboratory technicians were trained on the sample collection procedure through a simulation using an artificial arm. A bundle of six measures was designed: (hand hygiene with alcohol gel, use of common gloves and sterile gloves during extraction, antisepsis with alcoholic chlorhexidine gluconate, marking of the blood culture bottle up to the filling level, disinfection of the bottle cap). blood culture bottle with 70% alcohol, safety-lok kit with vacuum extraction system). The procedure was adapted and staff trained. Statistic analysis: The proportion of contaminated blood cultures between the pre and post periods was analyzed using Chi2 and the relationship between the proportion of the pre and post period vs the literature (3.00% acceptable contamination) using Z test for a proportion. P<0.05 was considered statistically significant. Stata 8 software was used.Results: A total of 3,965 blood cultures were analyzed during the study. Of these, 1,978 correspond to the pre-intervention period and 1,987 correspond to the post-intervention period. During the pre-intervention, 61 contaminated blood cultures were detected (3.08%) while in the post-intervention stage there were 30 contaminated blood cultures (1.51%). The proportion of contaminated blood cultures was reduced by half, 3.08% vs 1.51%, p: 0.001. An anonymous survey was carried out pre and post intervention, achieving improvements in the technique of taking blood cultures. Conclusion: The implementation of the own bundle for the extraction of blood cultures allowed the contamination rate to be reduced by ha

Establishing a plan to improve pediatric patient comfort during PIV insertions and blood specimen collection: a quality improvement effort.

HIGHLIGHTS: Patient comfort during peripheral intravenous (PIV) insertion and specimen collection was increased. The authors extended the contingency plan implemented for PICC insertion to include PIV insertion and specimen collection. The authors met their goals by using quality improvement methodology. Prioritizing patient comfort often requires institutional culture change. BACKGROUND: Needle procedures can cause pain and distress, especially in pediatric patients.1 Retrospective data collected at a freestanding pediatric facility revealed that approximately 30% of pediatric patients were not demonstrating sufficient levels of comfort during peripheral intravenous (PIV) catheter insertion and specimen collection (lab draws) even after successful implementation of comfort measures by the vascular access team (VAT) in an adjacent procedure (eg peripherally inserted central catheter placement). The current quality improvement project was implemented to support adaptation and expansion of previous lessons learned to PIVs and lab draws specifically. DESIGN AND METHODS: The VAT used the Pediatric Sedation State Scale,2 a standardized assessment tool integrated into the electronic medical record, to assess procedural comfort during PIVs and lab draws from February 2021 through April 2023. A total of 24 134 patients aged 0 to 18 years were included in the data collection. Interventions were delivered concurrently and included (1) reeducation/ongoing support for implementation of the Comfort Promise3 measures, (2) the creation and implementation of advanced comfort options, and (3) culture change. AIMS AND OBJECTIVES: The goal of the interventions was to improve the percentage of pediatric patients achieving adequate levels of comfort beginning at 68% in year 1 to 90% in year 2. RESULTS: From February 2021 to April 2023, the VAT team was able to improve procedural comfort scores from 68% to 90% of pediatric patients with adequate comfort for lab draws and/or PIV insertions. CONCLUSIONS: While standard comfort measures are a good first step in pain management during needle procedures, they are not sufficient for every pediatric patient. Nitrous, sedation, and the use of anxiolytics and analgesics can play an important role in reducing pain and anxiety during needle procedures and should be considered for patients not achieving adequate levels of comfort with standard comfort measures.

Prototype and evaluation of automatic fingertip-blood-sampling system that uses fingertip blood-vessel images to determine puncture position.

We are developing an automatic fingertip-blood-sampling system to reduce the burden on trained medical personnel. For this system to withdraw a consistent volume of sampled blood for blood tests, we developed a mechanism for our system to select and puncture the vicinity of a large blood vessel from the blood-vessel image of an individual's fingertip. We call this mechanism the fingertip-vessel-puncture mechanism. From the results of an experiment in which the fingertips of 20 individuals (men and women in their 20 s to 60 s) were manually punctured at near and far locations from the blood vessel selected with our mechanism, the following conclusions were obtained. The fingertip-vessel-puncture mechanism tends to increase the volume of sampled blood, thus is effective in sampling more than 650 µL of blood for automatic blood analyzers. It was also found that it is more effective in increasing the volume of sampled blood in the men and those who were younger.

LC-MS/MS measurement of endogenous steroid hormones and phase II metabolites in blood volumetric absorptive microsampling (VAMS) for doping control purposes.

BACKGROUND: Volumetric Absorptive Microsampling (VAMS) is emerging as a valuable technique in the collection of dried biological specimens, offering a potential alternative to traditional sampling methods. The objective of this study was to assess the suitability of 30 µL VAMS for the measurement of endogenous steroid hormones. METHODS: A novel LC-MS/MS method was developed for the quantification of 18 analytes in VAMS samples, including main endogenous free steroids and phase II metabolites of androgens. The method underwent validation in accordance with ISO/IEC 17025:2017 and World Anti-Doping Agency (WADA) requirements. Subsequently, it was applied to authentic VAMS samples obtained from 20 healthy volunteers to assess the stability of target analytes under varying storage conditions. RESULTS: The validation protocol assessed method's selectivity, matrix effect, extraction recovery, quantitative performance, carry-over and robustness. The analysis of authentic samples demonstrated the satisfactory stability of monitored steroids in VAMS stored at room temperature, 4 °C, -20 °C and -80 °C for up to 100 days and subjected to up to 3 freezing-thawing cycles. CONCLUSIONS: The validated LC-MS/MS method demonstrated its suitability for the measurement of steroids in dried blood VAMS. The observed stability of steroidal compounds suggests promising prospects for future applications of VAMS, both in anti-doping contexts and clinical research.

Five days serum glucose stability at room-temperature in centrifuged fast-clotting serum tubes and the comparability with glucose in heparin-plasma and plasma containing citrate-stabilizer.

Glucose measurement plays a central role in the diagnosis of gestational diabetes mellitus (GDM). Because of earlier reports of overestimation of glucose in the widely used tubes containing granulated glycolysis inhibitor, the study assessed the performance of fast-clotting serum tubes as an alternative sample for the measurement of glucose. Glucose concentration in fast-clotting serum was compared to lithium-heparin plasma placed in an ice-water slurry after sample collection and glucose stability at room-temperature was studied. Blood samples from 30 volunteers were drawn in four different types of tubes (serum separator tubes, fast-clotting serum tubes, lithium-heparin tubes and sodium fluoride, EDTA and a citrate buffer (NaF-EDTA-citrate) tubes, all from Greiner Bio-One). Lithium-heparin tubes were placed in an ice-water slurry until centrifugation in accordance with international recommendations and centrifuged within 10 min. After centrifugation, glucose was measured in all tubes (timepoint T0) and after 24, 48, 72, 96 and 120 h of storage at 20-22 °C. NaF-EDTA-citrate plasma showed significant overestimation of glucose concentration by 4.7% compared to lithium-heparin plasma; fast-clotting serum showed glucose concentrations clinically equivalent to lithium-heparin plasma. In fast-clotting serum tubes, mean bias between glucose concentration after 24, 48, 72, 96 and 120 h and T0 was less than 2.4%. All individual differences compared to T0 were less than 6.5%. The results fulfill the acceptance criteria for sample stability based on biological variation. Fast-clotting serum tubes can be an alternative for the measurement of glucose in diagnosis and management of GDM and diabetes mellitus, especially when prolonged transportation is necessary.

Association of major depressive disorder (MDD) with zinc levels and handgrip muscle strength in a sample of Colombian adults / Asociación del trastorno depresivo mayor con los niveles séricos de zinc y la fuerza muscular

Introduction: Depression is related with poor musclestrength, and deficiencies of microelements such as Zinc (Zn).Otherwise, Zn is related with muscle strength, but there is noevidence of the relations between muscle strength and Znlevels in depression. Objective: To determine the association between serum Zn levels, handgrip muscle strength, and depression. Methods: An observational, analytical case-control study. 102 depressive patients hospitalized at the San Juan de DiosClinic in Manizales, and 36 controls with no personal historyof mental illness were evaluated for depression severity,serum Zn levels, and handgrip muscle strength. The groupswere matched by sex, age, educational level, and socioeco-nomic stratum. The severity of depression was assessed us-ing the Montgomery–Asberg Rating Scale (MADRS). Serum Znlevels were determined, and handgrip muscle strength wasassessed using dynamometer. Descriptive analysis, logistic reression and linear models were performed with depressionand severity of depression as dependent variables. Results: Lower Zn levels and reduced handgrip musclestrength were related to the presence of depression with thelogistic model. Lower handgrip muscle strength and severityof depression were associated with the linear model. Conclusion: An association was found between depressionand low Zn levels, and an inverse association between severityof depression and handgrip muscle strength. Future studiesshould investigate causality, and to evaluate the relationshipbetween depression, muscle strength and nutritional status.(AU)

Introducción: La depresión se encuentra relacionada con una disminución de la fuerza muscular y deficiencia de microelementos como el Zinc (Zn). De otra parte, el Zn está relacionado con la fuerza muscular, sin embargo, no hay evidencia si existe una asociación entre fuerza muscular y Zn en depresión. Objetivo: Determinar la asociación entre niveles séricos de Zn, fuerza muscular y depresión. Metodología: Se realizó un estudio observacional, analítico de casos y controles. Participaron 102 pacientes hospitalizados en la Clínica San Juan de Dios de Manizales y 36 controles sin historia personal de enfermedad mental. Fueron evaluados la severidad de la depresión, los niveles séricos de Zn y la fuerza de agarre manual. Los grupos fueron pareados por edad, sexo, escolaridad y estrato socioeconómico. La severidad de la depresión se evaluó con la escala de depresión Montgomery-Asberg (MADRS), se determinaron niveles séricos de Zn y la fuerza muscular fue evaluada con por dinamometría. Se realizo un análisis descriptivo, y modelos de regresión logística y regresión lineal con depresión y severidad de la depresión como variables dependientes.Resultados: El modelo de regresión logística encontró una asociación entre los niveles bajos de Zn y la fuerza muscular con la presencia de depresión. El modelo de regresión lineal encontró una relación entre menor fuerza de agarre y severidad de la depresión.Conclusión: Existe una asociación entre depresión y niveles bajos de Zn, y una relación inversamente proporcional entre severidad de la depresión y menor fuerza muscular. Estudios en el futuro deben investigar relaciones de causalidad y evaluar la relación entre depresión, fuerza muscular y estado nutricional.(AU)

Fingerprick volumetric absorptive microsampling for therapeutic drug monitoring of antiseizure medications: Reliability and real-life feasibility in epilepsy patients.

Volumetric absorptive microsampling (VAMS) is increasingly proposed as a clinically reliable therapeutic drug monitoring (TDM) sampling methodology. The study aimed to establish the reliability and real-life feasibility of patient self-collected capillary VAMS for TDM of antiseizure medication (ASMs), using plasma ASMs concentrations from venous blood as a reference standard. Nurses collected venous and capillary blood samples using VAMS. Afterward, persons with epilepsy (PWE) performed VAMS sampling by themselves. All samples were analyzed by UHPLC-MS/MS. We performed a cross-validation study, comparing ASMs concentrations obtained by VAMS nurses and patients' self-collected versus plasma through Bland-Altman analysis and Passing-Bablok regression. We enrolled 301 PWE (M: F 42.5%:57.5%; mean age 44±16 years), treated with 13 ASMs, providing a total of 464 measurements. Statistical analysis comparing VAMS self-collected versus plasma ASMs concentrations showed a bias close to zero and slope and intercept values indicating a good agreement for CBZ, LCS, LEV, LTG, OXC, PB, and PHT, while a systematic difference between the two methods was found for VPA, PMP, TPM and ZNS. This is the first study showing the reliability and feasibility of the real-world application of PWE self-collected VAMS for most of the ASMs considered, giving a promising basis for at-home VAMS applications.

Pre-analytical stability of selected biochemical analytes in serum of horses and oxen stored at -20°C.

BACKGROUND: Delays between blood collection and analysis are inevitable, and samples are always stored in the refrigerator. The current study aimed to evaluate the stability of serum total cholesterol (TC), triglycerides (TG), total protein (TP), albumin and urea (URA) in horses and oxen after storage at -20°C. METHODS: Sera from apparently healthy 20 male horses and 20 oxen were obtained and aliquots of serum were divided into 3 portions. The first tube was used for baseline (T0) measurement of analyte values, whereas the other two tubes, T1 and T2, were stored at -20°C for 1 and 2 months, respectively, and analyte measurement was done. RESULTS: Results showed that the stability of TP (g/dL), URA (mg/dL) and TC (mg/dL) in oxen was statistically significant (p < 0.05). In horses, the stability of URA (mg/dL), TP (g/dL) and TG (mg/dL) were also statistically significant (p < 0.05). Additionally, URA and TC in oxen exceed TEa following measurement at T2 and TG in horses following measurement at T1 and T2. CONCLUSION: Laboratories should consider the storage temperature and time for specific analytes among animals. Therefore, stability studies at various storage temperatures and times are recommended to fully validate the stability of the analytes.

The effect of the simulated intrauterine sound on behavioral and physiological indices of pain during capillary blood sampling for screening preterm infants: a randomized clinical trial study.

INTRODUCTION: Due to medical procedures, preterm infants are at high risk for side effects of pain. In this regard, heel lancing for capillary blood sampling is a common painful procedure. The present study was conducted to assess the effectiveness of a simulated intrauterine sound on behavioral and physiological indices of pain due to heel-prick blood sampling in preterm infants. METHODS: A double­blind randomized clinical trial (RCT) was conducted. The data were collected from September 23 to December 22, 2019. We measured the effect of a simulated intrauterine sound on changes in the behavioral and physiological parameters of pain (heart rate, SPO2) caused by heel lance that was measured 5 min before the intervention, during the sampling, and 5 min after the procedure. We measured behavioral pain by video recording the infants' faces and then the scoring neonatal infant pain scale (NIPS). Heart rate and SPO2 were measured using a pulse oximeter device. The data were analyzed using analysis of variance (ANOVA) and independent t­test in SPSS software version 20.0. RESULTS: Eighty infants were randomized (40 in each group). Mean scores NIPS during and after intervention were in the intervention group (3.55 ± 0.84, 95% CI: 3.30-3.80(, and (1.15 ± 0.84, 95%: 0.95-1.35) and in the control group (5.57 ± 0.95, 95% CI:5.30-5.85) and (3.00 ± 0.98) respectively. There were significant differences in scores of NIPS between the two study groups during (p < 0.001) and five min after heel lancing (p < 0.001). Mean scores of heart rate in the three phases of before, during, and five min after the intervention were respectively in the intervention group (127.57 ± 4.45, 95% CI:126.27-128.99), (131.07 ± 6.54, 95% CI:129.20-133.22), (128.45 ± 5.15, 95% CI:127.02-130.07) and in the control group (128.67 ± 4.57, 95% CI:127.32-130.07), (136.07 ± 7.24, 95% CI:133.90-138.37), and (132.42 ± 6.47, 95% CI:130.37-134.49). There were significant differences in heart rate between the intervention and the control group during (p = 0.002) and five min after the heel lance (p = 0.003). Mean scores of SPO2 in the three phases of baseline, during, and five min after the intervention were respectively in the intervention group (96.72 ± 0.93, 95% CI:96.42-97.00), (91.47 ± 1.46, 95% CI:91.05-91.92), (94.17 ± 1.03, 95% CI:93.22-94.00) and in the control group (96.6 ± 0.84, 95% CI:96.35-96.85), (91.5 ± 1.24, 95% CI:91.12-91.87), and (93.60 ± 1.27, 95% CI:93.85-94.50). CONCLUSION: This study showed that the simulated intrauterine sound reduces the behavioral pain and heart rate in the intervention group during and after heel lance. These results suggest using the method during the painful heel lancing to reduce pain parameters in preterm infants.

Generic UPLC-MS/MS and Gyrolab assays with blood microsampling for pharmacokinetic assessments of therapeutic antibodies in mice.

Serial blood sampling from one animal is useful to understand relationship between pharmacokinetics (PK) and pharmacological or toxicological events in individual animals. To assess its feasibility in mice, two therapeutic antibodies were used to evaluate impacts by different blood sampling methods, sampling sites, and assay platforms on PK. Denosumab and Panitumumab were intravenously administered to mice and only 0.05 mL of blood sample per point was collected from jugular vein or tail vein. Blood samples were collected serially from a mouse or collected by traditional composite sampling from each mouse. Plasma concentrations of the two drugs were assayed by a generic ligand binding assay using Gyrolab or by a generic ultra-performance liquid chromatography with tandem mass spectrometry. The two assay platforms showed acceptable accuracy and precision and gave comparable PK parameters of the drugs, suggesting that both assays were successfully applied to the PK assessments. Comparable results in the PK profiles were noted between serial and composite blood samplings and differences in the two sampling sites did not impact PK. These findings suggest that microsampling combined with generic assays is useful to assess PK profiles of therapeutic antibodies in mice.

The influence of dead space in blood sampling needle on FVIII level and pharmacokinetic profiles in children with hemophilia.

OBJECTIVE: To investigate the influence of the dead space in disposable blood sampling needle on activated partial thromboplastin time (APTT), FVIII level and pharmacokinetic (PK) profiles in children with hemophilia. METHODS: Children (<18 years) with severe hemophilia A were enrolled. After three days' washout-period, blood samples were collected at pre-dose, 1 h, 3 h, 9 h, 24 h and 48 h post-infusion. At each timepoint, two 2 mL vacuum tubes with 3.2% trisodium citrate were used. The first tube was signed as 'non-standard' (NS) and the second tube was signed as 'standard' (S). FVIII activities were evaluated by one-stage assay. WAPPS-Hemo was used to generate PK profiles like half-life time (t1/2), clearance (CL), trough level and time to 1, 2 and 5IU/dL after a dose of 50 ± 10IU/dL. The FVIII activities at 9 h and 24 h post-infusion were put into WAPPS and thus brought four combinations by true or biased FVIII level that used. RESULT: Compared with standard-collected blood samples, prolonged APTT results (P-values < 0.01) and decreased FVIII activity (P-values < 0.05) were revealed in those non-standard blood samples. The corresponding bias was in positive relation to both APTT-S (r = 0.44, P < 0.0001) and FVIII-S level(r = 0.68, P < 0.001). The FVIII bias percentage got larger as FVIII-S level reduced (r = -0.24, P < 0.01). During the four combinations of FVIII activity at 9 h and 24 h, statistically longer t1/2, lower CL and longer time to 1, 2 or 5IU/dL were observed in 9H-S&24H-S group and 9H-NS&24H-S group. CONCLUSION: While using vacuum tubes for clotting indicators and PK profiles, the dead space of blood sampling needle should be eliminated in advance.

Utilidad de la realidad virtual en el manejo del dolor asociado a venopunción: ensayo clínico aleatorizado multicéntrico / Usefulness of virtual reality in the management of pain associated with venepuncture: A multicentre randomized clinical trial

Objetivo: Comprobar la eficacia de la realidad virtual (RV) en la disminución del dolor y ansiedad asociados a extracciones sanguíneas programadas. Material y métodos: Ensayo clínico aleatorizado multicéntrico realizado en atención primaria y hospitalaria. Se incluyeron los pacientes de 7 a 12 años que acudieron entre marzo y octubre de 2022 a realizarse una extracción sanguínea programada. En el grupo intervención se utilizaron gafas de RV y en el grupo control cuidados habituales. Se evaluó el dolor mediante la escala visual analógica y la ansiedad mediante la Groningen Distress Scale. Se evaluó la ansiedad de enfermería y la satisfacción de los familiares, mediante escala numérica del 1 al 10. Resultados: Se incluyeron 83 pacientes: 40 en el grupo control y 43 en el grupo RV. La mediana de edad fue de 10 años (rango de 7 a 12); 83,7% de los niños en el grupo RV refirió dolor leve, frente a 57,5% del grupo control (p = 0,012). Del grupo RV, 93% mostró calma o ansiedad leve (puntuación 1-2), frente a 72% del grupo control, aunque sin diferencias estadísticamente significativas (p = 0,08). La satisfacción de los familiares fue mayor en el grupo RV (≥ 9/10: 93% de RV vs. 72,5% de controles, p = 0,026). La ansiedad de enfermería fue < 5 en más del 90% de los casos, sin diferencias entre grupos (p = 0,13). Conclusiones: El uso de RV durante la venopunción disminuye el dolor percibido por los niños y aumenta la satisfacción de sus familiares.(AU)

Objective: To assess the efficacy of virtual reality (VR) in reducing pain and anxiety associated with scheduled blood draws. Material and methods: We conducted multicentre randomized clinical trial in both primary care and hospital settings. The study included children aged 7–12 years undergoing blood extraction procedures between March and October 2022. The intervention group used headsets, and the control group received usual care. Pain was assessed using the visual analogue scale and anxiety using the Groningen Distress Scale. The anxiety of the nursing staff and family satisfaction were assessed with numerical scales ranging from 1 to 10. Results: The study included 83 patients: 40 in the control group and 43 in the VR group. The median age was 10 years (range, 7–12 years). In the VR group, 83.7% of the children reported mild pain, compared to 57.5% in the control group (P = .012). Also, 93% of children in the VR group showed calm or mild anxiety (score, 1–2), compared to 72% of the control group, a difference that was not statistically significant (P = .08). Family satisfaction was higher in the RV group (score ≥ 9/10: 93% of RV group vs. 72.5% of control group; P = .026). The nursing staff anxiety score was less than 5 in more than 90% of cases, with no differences between groups (P = .13). Conclusions: The use of VR during venepuncture decreases the pain perceived by children and increases the satisfaction of their families.(AU)

Hematocrit-Independent Sampling Enables White Blood Cell Counts from Patterned Dried Blood Spot Cards.

The accurate and efficient measurement of white blood cell (WBC) counts is vital for monitoring general patient health and can aid in the diagnosis of a range of possible infections or diseases. Even with their importance universally acknowledged, access to WBC counts is largely limited to those with access to phlebotomists and centralized clinical laboratories, which house the instruments that perform the tests. As a result, large populations of people (e.g., those that are home-bound or live in remote locations) lack facile access to testing. Dried blood spot (DBS) cards are often used to bridge these gaps in access to testing by offering the ability to collect blood at home for ambient shipping to laboratories. However, it is well understood that these cards, which are prepared from cellulose cardstocks without further modification, suffer from variabilities in accuracy and precision due to uncontrolled sample spreading and hematocrit effects, which have hindered their use to determine WBC counts. In this paper, we present a method to obtain an accurate WBC count using a patterned dried blood spot (pDBS) card, which comprises collection zones that meter volumes of dried blood. Using an input volume of 75 µL of whole blood, we demonstrate that, unlike the gold standard DBS card (Whatman 903), our pDBS design allows for the collection of replicate zones containing a reproducible, average volume of dried blood (12.1 µL, 7.8% CV) over the range of hematocrits from 25 to 55%. We then used qPCR to quantify the 18S rRNA gene to determine WBC counts from the volumes of blood that are metered in pDBS zones. We observe that WBC counts generated from our method are comparable to those measured with a HemoCue point-of-care WBC analyzer. Our approach to using pDBS cards as a blood collection device has the potential to support at-home sampling and other patient populations that need WBC counts but lack access to clinical facilities.

Validation of Mitra® VAMS® as a blood collection technique for trace elements analysis using ICP-MS/MS.

Background: Clinical dosage of toxic and essential elements in blood is well established and the collection method is still by venipuncture. This method has drawbacks and is not suited for everyone. Volumetric absorptive microsampling (VAMS) has been shown to have advantages over venipuncture. Materials & methods: Using inductively coupled plasma tandem mass spectrometry, a method for quantifying elements in whole blood sampled on VAMS was developed/validated. Method's performance was assessed by comparison with whole blood results. Results: Validation and performance assessment tests tend to show that most of the targeted elements provides accurate and reproducible results comparing to a method of reference. Conclusion: Overall, VAMS presents good preliminary results to eventually become an alternative to venipuncture for blood sampling for some trace elements analysis purposes.

Enhancing specimen collection skills for dried blood spots through an immersive virtual learning environment: a cross-sectional study.

OBJECTIVE: The quality of dried blood spot (DBS) specimens impacts newborn screening (NBS) results, hence proper training is crucial for DBS specimen collection. To address this, a training module for Allied Health Professionals (AHPs) and nurses was created on Moodle, a virtual learning environment (VLE). The purpose of this research was to determine the feasibility and effectiveness of this module. METHODOLOGY: Participants were trained on-site (March to December 2019), through online training sessions (January to June 2020), and the two training strategies were compared. Data analysis included the total number of participants, cost-effectiveness, trainer engagement, and the number of unacceptable samples collected by nurses/AHPs trained by the two strategies. RESULTS: A total of 55 nurses/AHPs were trained on-site, while 79 nurses/AHPs completed the online module and received certificates through online VLE-based training. The trainer engagement and cost were more for onsite training. After online training, the specimen rejection rate was reduced from 0.84% (44 rejected out of 5220 total specimens collected) to 0.38% (15/3920). CONCLUSIONS: This study shows that using VLE-based DBS specimen collection training is feasible and effective for training nurses and AHPs.

Blood Samples from Midline Catheters: Clinically Equivalent to Venipuncture.

PowerGlide Pro™ Midline Catheters, manufactured by Becton Dickinson, are marketed as capable of obtaining blood specimens. However, there is insufficient research to validate the laboratory results collected from these specialty catheters. The purpose of this research study was to determine whether blood samples obtained via venipuncture and samples obtained directly from a midline catheter are clinically equivalent. A qualitative study was completed per recommendations published in Clinical and Laboratory Standards Institute (CLSI) standards EP-05-A3 to determine whether the 2 modalities are clinically equivalent. A 12-point correlation study was performed, comparing blood results from phlebotomy venipuncture and midline catheter blood draws for 20 successful participants. Results were compared with an EP Evaluator. Report interpretation was completed using the 2-instrument comparison module to determine whether the 2 methods were clinically equivalent. All correlated specimens resulted within the medically acceptable total allowable error, proving the 2 methods clinically equivalent. The study concluded that blood draws from midline catheters are clinically equivalent to venipuncture and are an acceptable form of specimen collection for laboratory studies.

Evaluating transport conditions of conventional, widely used EDTA blood tubes for gene expression analysis in comparison to expensive, specialized PAXgene tubes in preparedness for radiological and nuclear events.

PURPOSE: Gene expression (GE) analysis of a radio-sensitive gene set (FDXR, DDB2, WNT3, POU2AF1) has been introduced in the last decade as an early and high-throughput prediction tool of later developing acute hematologic radiation syndrome (H-ARS) severity. The use of special tubes for RNA extraction from peripheral whole blood (PAXgene) represent an established standard in GE studies, although uncommonly used in clinics and not immediately available in the quantities needed in radiological/nuclear (R/N) incidents. On the other hand, EDTA blood tubes are widely utilized in clinical practice. MATERIAL AND METHODS: Using blood samples from eleven healthy donors, we investigated GE changes associated with delayed processing of EDTA tubes up to 4 h at room temperature (RT) after venipuncture (simulating delays caused by daily clinical routine), followed by a subsequent transport time of 24 h at RT, 4 °C, and -20 °C. Differential gene expression (DGE) of the target genes was further examined after X-irradiation with 0 Gy and 4 Gy under optimal transport conditions. RESULTS: No significant changes in DGE were observed when storing EDTA whole blood samples up to 4 h at RT and subsequently kept at 4 °C for 24 h which is in line with expected DGE. However, other storage conditions, such as -20 °C or RT, decreased RNA quality and/or (significantly) caused changes in DGE exceeding the known methodological variance of the qRT-PCR. CONCLUSION: Our data indicate that the use of EDTA whole blood tubes for GE-based H-ARS severity prediction is comparable to the quality of PAXgene tubes, when processed ≤ 4 h after venipuncture and the sample is transported within 24 hours at 4 °C.