Laboratorios tradicionales versus nuevas tecnologías para el estudio de anatomía humana en estudiantes de medicina: revisión sistemática y meta análisis / Traditional laboratories versus new technologies for the study of human anatomy in medical students: a systematic review and meta-analysis

RESUMEN: El estudio de la anatomía humana, ha transcendido con diversos recursos y escenarios. El objetivo fue compararlos estudios publicados sobre prácticas de laboratorio tradicionales con nuevas tecnologías para el estudio del cuerpo humano en estudiantes de medicina. Se realizó revisión sistemática y meta-análisis. Cuatro revisores efectuaron búsqueda sistemática y exhaustiva de la literatura, a partir de la localización y selección de 54 estudios primarios publicados en diez bases de datos, tres revisores cegados evaluaron calidad metodológica de 33 estudios, con listas de chequeo para la evaluación crítica de la validez interna, según tipo de estudio y el cuarto revisor cegado, calculó grado de acuerdo entre revisores con Kappa de Fleiss y valoró riesgo de sesgo, sensibilidad, heterogeneidad y análisis combinado a través del Software RevMan 5.4. Se obtuvo revisión sistemática cualitativa y combinación mediante métodos estadísticos de los resultados con meta-análisis de siete estudios primarios, con muestra de 465 participantes, 260 expuestos a laboratorios tradicionales y 205 a nuevas tecnologías. Encontrando satisfacción del proceso y resultados positivos de aprendizaje comprensión y aplicación con favorabilidad inicial a las prácticas tradicionales no significativa al valorar los intervalos de confianza. Así, el contraste entre métodos para estas prácticas reveló desenlaces relacionados con reacciones físico-emocionales, focalización en el constructo rendimiento académico y con los procesos de aprendizaje. Concluyendo que los laboratorios con nuevas tecnologías para estudio de anatomía, no impactan en forma prerrogativa a los estudiantes, dada su experiencia favorable con los laboratorios tradicionales, y pueden emplearse como una estrategia útil complementaria.

SUMMARY: The study of human anatomy has transcended with various resources and scenarios. The objective was to compare published studies on traditional laboratory practices with new technologies for the study of the human body in medical students. A systematic review and meta-analysis were carried out. Four reviewers carried out a systematic and exhaustive search of the literature, based on the location and selection of 54 primary studies published in ten databases, three reviewers evaluated the methodological quality of 33 studies, with checklists for the critical evaluation of internal validity, according to type of study. The fourth blinded reviewer, calculated degree of agreement between reviewers with Kappa de Fleiss and assessed risk of bias, sensitivity, heterogeneity and combined analysis using RevMan 5.4. A qualitative systematic review and combination by statistical methods of the results were obtained with meta-analysis of seven primary studies, with a sample of 465 participants, 260 exposed to traditional laboratories and 205 to new technologies. Finding satisfaction with the process and positive results of learning, understanding and application, with initial favorability to traditional practices not significant when assessing the confidence intervals. Thus, the contrast between methods for these practices revealed outcomes related to physical-emotional reactions, focus on the academic performance construct and with the learning processes. Concluding that laboratories with new technologies for the study of anatomy do not prerogatively impact students, given their favorable experience with traditional laboratories, and can be used as a useful complementary strategy.

Navigating COVID-19: Starting a lab during the pandemic.

For new principal investigators, the first years are key to getting a laboratory off the ground and running. COVID-19 has changed the world, bringing on unforeseen difficulties and challenges at every level. We asked these investigators to share their experiences in navigating the unique environment since the start of the pandemic-what has changed in their vision for their laboratory, how they have adapted, and what advice they can share with others in a similar situation.

Adapting to the Coronavirus Pandemic: Building and Incorporating a Diagnostic Pipeline in a Shared Resource Laboratory.

In March 2020, with lockdown due to the coronavirus pandemic underway, the Francis Crick Institute (the Crick) regeared its research laboratories into clinical testing facilities. Two pipelines were established, one for polymerase chain reaction and the other for Serology. This article discusses the Cricks Flow Cytometry Science Technology Platform (Flow STP) role in setting up the Serology pipeline. Pipeline here referring to the overarching processes in place to facilitate the receipt of human sera through to a SARs-CoV-2 enzyme-linked immunosorbent assay result. We examine the challenges that had to be overcome by a research laboratory to incorporate clinical diagnostics and the processes by which this was achieved. It describes the governance required to run the service, the design of the standard operating procedures (SOPs) and pipeline, the setting up of the assay, the validation required to show the robustness of the pipeline and reporting the results of the assay. Finally, as the lockdown started to ease in June 2020, it examines how this new service affects the daily running of the Flow STP. © 2020 The Authors. Cytometry Part A published by Wiley Periodicals LLC on behalf of International Society for Advancement of Cytometry.

Toxicity from illegitimate slimming agents - a 10-year case series at a tertiary toxicology laboratory in Hong Kong.

CONTEXT: This retrospective case-series study aims to provide an overview of the clinical, biochemical and analytical findings in patients who presented with toxicity related to the use of illegitimate slimming agents in Hong Kong from the perspective of a tertiary referral toxicology laboratory. METHODS: All clinical cases referred to the Hospital Authority Toxicology Reference Laboratory, Hong Kong with clinical suspicion of illegitimate slimming agent-related toxicity between January 2008 and December 2017 were reviewed retrospectively. The use of illegitimate slimming agents included the use of (1) deregistered slimming agents, (2) drug analogues that were not registered drugs, (3) registered drugs not approved for the indication of weight reduction (whether prescribed by a doctor or not), and (4) prescription-only slimming agents without a doctor's prescription. Patients taking registered weight-reducing drugs prescribed by a doctor were excluded. Patient demographics, clinical features, relevant laboratory investigations, and toxicological findings were analyzed. RESULTS: From 2008 to 2017, a total of 346 patients were analytically confirmed by our laboratory to have clinical toxicity related to the use of illegitimate slimming agents. The median age of the patients was 27 years and 92.5% of the patients were female. The most common clinical presentations included psychiatric features, sympathomimetic toxicity, hypokalemia, and abnormal thyroid function tests. Fatal or severe clinical toxicity was observed in 10% of the cases. The major classes of drugs detected on our analytical platforms were stimulants (e.g., sibutramine), laxatives (e.g., anthraquinones), diuretics (e.g., hydrochlorothiazide), and thyroid hormones (e.g., animal thyroid tissue). These illegitimate slimming agents were obtained from various sources including the Internet, over-the-counter in community pharmacy, or unspecified local sources. DISCUSSION AND CONCLUSIONS: The use of slimming agents is common worldwide; apart from taking registered slimming agents prescribed by registered practitioners, many users obtain slimming agents from various illegitimate sources. The unregulated use of these drugs can be associated with significant clinical toxicity. This study provides a current landscape of illegitimate slimming agent toxicity in Hong Kong to frontline clinicians and other toxicology professionals. Collaboration between clinicians, laboratories, and government authorities would be imperative to prevent further health adversities related to the misuse of these agents.

Laboratory Perspective on Racial Disparities in Sexually Transmitted Infections.

BACKGROUND: Rates of sexually transmitted infections (STI) have risen steadily in recent years, and racial and ethnic minorities have borne the disproportionate burden of STI increases in the United States. Historical inequities and social determinants of health are significant contributors to observed disparities and affect access to diagnostic testing for STI. CONTENT: Public health systems rely heavily on laboratory medicine professionals for diagnosis and reporting of STI. Therefore, it is imperative that clinicians and laboratory professionals be familiar with issues underlying disparities in STI incidence and barriers to reliable diagnostic testing. In this mini-review, we will summarize contributors to racial/ethnic disparity in STI, highlight current epidemiologic trends for gonorrhea, chlamydia, and syphilis, discuss policy issues that affect laboratory and public health funding, and identify specific analytic challenges for diagnostic laboratories. SUMMARY: Racial and ethnic disparities in STI in the US are striking and are due to complex interactions of myriad social determinants of health. Budgetary cuts for laboratory and public health services and competition for resources during the COVID-19 pandemic are major challenges. Laboratory professionals must be aware of these underlying issues and work to maximize efforts to ensure equitable access to diagnostic STI testing for all persons, particularly those most disproportionately burdened by STI.

Biosafety during a pandemic: shared resource laboratories rise to the challenge.

Biosafety has always been an important aspect of daily work in any research institution, particularly for cytometry Shared Resources Laboratories (SRLs). SRLs are common-use spaces that facilitate the sharing of knowledge, expertise, and ideas. This sharing inescapably involves contact and interaction of all those within this working environment on a daily basis. The current pandemic caused by SARS-CoV-2 has prompted the re-evaluation of many policies governing the operations of SRLs. Here we identify and review the unique challenges SRLs face in maintaining biosafety standards, highlighting the potential risks associated with not only cytometry instrumentation and samples, but also the people working with them. We propose possible solutions to safety issues raised by the COVID-19 pandemic and provide tools for facilities to adapt to evolving guidelines and future challenges.

Remote Training of SRL Users and Staff in a Global Pandemic.

The impact of the COVID-19 pandemic on training and Shared Resource Laboratory (SRL) operations such as staffing, facility access, and social distancing, has affected facilities around the globe to different degrees based on restrictions set by various geographical and institutional settings. With these restrictions come unique challenges regarding user and staff training and education, for both theory and practice. Most notably, limitations in facility access, occupancy, staffing availability, network restrictions and trainee engagement call for innovative solutions for training when traditional in-person options are not feasible. Through the use of remote access tools and prerecorded educational and training materials, SRLs are able to overcome these obstacles. Here, we focus on readily available technologies and general guidelines that SRLs in different environments can use for remote cytometry training and education, while highlighting key obstacles that still remain. Although SRLs may face initial struggles in transitioning trainings to a virtual format, remote technologies provide unique opportunities to advance current training programs. © 2020 International Society for Advancement of Cytometry.

Critical Steps in Data Management During a Crisis.

Data management is essential in a flow cytometry (FCM) shared resource laboratory (SRL) for the integrity of collected data and its long-term preservation, as described in the Cytometry publication from 2016, ISAC Flow Cytometry Shared Resource Laboratory (SRL) Best Practices (Barsky et al.: Cytometry Part A 89A(2016): 1017-1030). The SARS-CoV-2 pandemic introduced an array of challenges in the operation of SRLs. The subsequent laboratory shutdowns and access restrictions brought to the forefront well-established practices that withstood the impact of a sudden change in operations and illuminated areas that need improvement. The most significant challenges from a data management perspective were data access for remote analysis and workstation management. Notably, lessons learned from this challenge emphasize the importance of safeguarding collected data from loss in various emergencies such as fire or natural disasters where the physical hardware storing data could be directly affected. Here, we describe two data management systems that have been successful during the current emergency created by the pandemic, specifically remote access and automated data transfer. We will discuss other situations that could arise and lead to data loss or challenges in interpreting data. © 2020 International Society for Advancement of Cytometry.

Solutions for Shared Resource Lab Remote Quality Control and Instrument Troubleshooting during a Pandemic.

The COVID-19 pandemic has dramatically affected shared resource lab (SRL) staff in-person availability at institutions globally. This article discusses the challenges of ensuring reliable instrument performance and quality data output while facility staff and external service provider on-site presence is severely limited. Solutions revolve around the adoption of remote monitoring and troubleshooting platforms, provision of self-service troubleshooting resources specific to facility instruments and workflows, development of an assistance contact policy, and ensuring efficiency of limited in-person staff time. These solutions employ software and hardware tools that are already in use or readily available in the SRL community, such as remote instrument access tools, video hosting and conferencing platforms, and ISAC shared resources. © 2020 International Society for Advancement of Cytometry.

Psychoactive drug and medication use among patients referred to a tertiary sleep laboratory population.

Psychoactive drugs including alcohol, caffeine, and prescription medications are commonly consumed to alter sleep/wake states, however the prevalence and impact of these drugs among populations seeking assessment from sleep physicians are unknown. We investigated the prevalence of commonly used drugs (alcohol and caffeine), and medications in a population (N=120; 50 females and 70 males) attending a tertiary sleep clinic for diagnostic polysomnography (PSG) assessment. In addition to objective sleep assessment, participants completed questionnaires assessing sleep quality (Pittsburgh Sleep Quality Index, PSQI), daytime sleepiness (Epworth Sleepiness Scale, ESS), depression and anxiety (Hospital Anxiety and Depression Scale, HADS), alcohol use (Alcohol Use Disorders Identification Test, AUDIT), caffeine and medication use, as well as their experience of adverse events (motor vehicle accidents and near-miss crashes). Caffeine was consumed by 90% of the population and was associated with a reduction in excessive sleepiness symptomology; while high AUDIT scores were associated with increased near-miss crashes. Polypharmacy was common, with a greater number of medications associated with poorer sleep quality, and changes in sleep architecture. This study maps commonly used drugs in those attending a tertiary sleep clinic, and demonstrates associations between drug use and sleep outcomes assessed objectively and subjectively.

Real-world big-data studies in laboratory medicine: Current status, application, and future considerations.

With the recent developments in information technology, real world big data studies (RWBDSs) have attracted increasing attention in the field of medicine. In RWBDSs, clinical laboratory data is an important part of the wider scope of real-world medical data, and its standardized use is critical for the generation of high-quality real-world evidence. To improve the core functioning and competitiveness of clinical laboratories as well as provide high-quality medical services for patients, it is important to construct an information analysis model and perform RWBDSs. However, among the majority of developing countries, as well as in some developed countries, due to the poorly developed neglect of data formatting standards information construction and the lack of consideration for, and experience with, the ideas and methods of RWBDSs, many clinical laboratories are unable to make use of the vast amount of data stored in their systems. Additionally, in the literature, there remain many areas that require improvements, such as the correct misuse of research methods, appropriate unreasonable data presentation methods, and optimal opaque methods for data cleaning, storage, and mining. In this review, we describe both the advantages and disadvantages of RWBDSs in laboratory medicine. In addition, we summarize the current application and methods of RWBDS in laboratory medicine from seven different perspectives: the establishment of a reference interval, patient data-based real time quality control, diagnostic or prognostic modeling, epidemiological investigation, laboratory management, analysis of sources of variations for analytes, and external quality assessment. Finally, we discuss the future prospects of this research. This review can provide the basis for clinical laboratories to carry out real world research; additionally, it promotes and standardizes RWBDS in laboratory medicine.

Molecular, serological, and biochemical diagnosis and monitoring of COVID-19: IFCC taskforce evaluation of the latest evidence.

The global coronavirus disease 2019 (COVID-19) has presented major challenges for clinical laboratories, from initial diagnosis to patient monitoring and treatment. Initial response to this pandemic involved the development, production, and distribution of diagnostic molecular assays at an unprecedented rate, leading to minimal validation requirements and concerns regarding their diagnostic accuracy in clinical settings. In addition to molecular testing, serological assays to detect antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are now becoming available from numerous diagnostic manufacturers. In both cases, the lack of peer-reviewed data and regulatory oversight, combined with general misconceptions regarding their appropriate use, have highlighted the importance of laboratory professionals in robustly validating and evaluating these assays for appropriate clinical use. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Task Force on COVID-19 has been established to synthesize up-to-date information on the epidemiology, pathogenesis, and laboratory diagnosis and monitoring of COVID-19, as well as to develop practical recommendations on the use of molecular, serological, and biochemical tests in disease diagnosis and management. This review summarizes the latest evidence and status of molecular, serological, and biochemical testing in COVID-19 and highlights some key considerations for clinical laboratories operating to support the global fight against this ongoing pandemic. Confidently this consolidated information provides a useful resource to laboratories and a reminder of the laboratory's critical role as the world battles this unprecedented crisis.