Establishing and Leading a 3D Postprocessing Radiology Lab: A Managerial and Leadership Perspective.

The rapid acquisition of larg volumes of thin-section CT images has created a considerable need and interest for 3D postprocessing during the interpretation of medical imaging. As a result of the increasing number of postprocessing applications, requiring diagnostic radiologists to perform postprocessing is no longer realistic. This article is a comprehensive review of medical resources regarding establishing a postprocessing radiology laboratory. Besides, leadership and managerial aspects have been covered through a professional business lens. In large-volume settings, a dedicated 3D postprocessing lab ensures the quality, reproducibility, and efficiency of images. Adequate staffing is necessary to fulfill the postprocessing requirements. Educational and experience requirements for 3D technologists may vary among different running laboratories. To evaluate the establishment and running of a 3D lab, it is beneficial to implement diagnostic radiology cost-effectiveness tools. Although establishing a 3D lab has many benefits, certain challenges should be considered. Outsourcing or offshoring may serve as alternatives for establishing a postprocessing laboratory. Building and operating a 3D lab is a significant change in healthcare facilities, and it is crucial for organizations to be aware of the strong resistance toward alternatives the status quo, known as the status quo trap. The change process has essential steps, and skipping the steps creates an illusion of speed but never produces satisfactory results. The organization should ensure the engagement of all interested parties in the whole process. Moreover, a clear vision and proper communication of the vision are vital, and it is crucial to value small wins and ensure expectation clarity in leading the lab during the process.

Biosafety of personnel of microbiological laboratories in the context of the Federal Law of the Russian Federation № 492-FZ of December 30, 2020 «On the biological safety of the Russian Federation¼.

One of the most important requirements for the personnel of microbiological laboratories working with pathogenic and infectious agents is the observance of precautionary measures and the implementation of a set of preventive measures, collectively interpreted as biological safety (biosafety). To a large extent, biosafety problems are also relevant for all clinical laboratories working with biosubstrates, with the potential threat of containing pathogens of bloodborne infections in them. On December 30, 2020, the President of the Russian Federation signed Federal Law № 492 «On the Biological Safety of the Russian Federation¼ (№ 492-FZ), which regulates the basic legal norms and regulation of biosafety issues, as well as a list of measures to prevent the risks of the spread of infections due to accidents, bioterrorist acts and sabotage. The current pandemic of the coronavirus infection COVID-19 has demonstrated, on the one hand, the epidemiological vulnerability of the single world space, and on the other hand, the decisive influence of biological emergencies on the emergence of negative political and economic processes in the world community. In this regard, the issues of ensuring biosafety in the work of microbiological laboratories in the context of protecting personnel and the environment from accidental or unintentional spread of infections are relevant. Working with pathogenic biological agents in microbiological laboratories is constantly associated with the risk of accidents and possible laboratory infection (laboratory-acquired infections) of employees, environmental pollution if the requirements of regulatory documents on biological safety are not met. In accordance with the requirements of № 492-FZ, in order to prevent biological threats, it is necessary to create a system for monitoring biological risks in microbiological laboratories when working with any infected material.

Health impacts in pathology workforce during mergers and acquisitions (M&A).

AIMS: To compare burn-out in laboratory professionals (LPs) with exposure to consolidation to those without, and to investigate the role of social support as a moderator in the exposure to mergers and acquisitions (M&A). METHODS: Surveys were sent to the clinical LPs, including 732 with exposure to M&A and 819 without. The dependent variable was burn-out, and the independent variable was exposure to M&A. In investigating the role of social support in exposure group, a logistic regression was used with education, time since M&A, gender, merger types, practice setting, lab hierarchy and race as covariates. RESULTS: Exposure to M&A was associated with higher levels of burn-out (p<0.05). In logistic regression of the workforce exposed to M&A, the odds for LP developing a high level of burn-out are lowered by 7.1% for every unit of increase in social support (OR 0.93; 95% CI 0.88 to 0.98; p=0.004). CONCLUSION: LPs exposed to M&A are more likely to experience higher levels of burn-out but having social support can protect against burn-out, which has policy implications for leadership managing laboratories in times of M&A.

Digital odyssey: lessons learnt from a reverse transition from a digital to a manual pathology workflow.

In the fully digital Caltagirone pathology laboratory, a reverse shift from a digital to a manual workflow occurred due to a server outage in September 2023. Here, insights gained from this unplanned transition are explored. Surveying the affected pathologists and technicians revealed unanimous preferences for the time-saving and error-reducing capabilities of the digital methodology. Conversely, the return to manual methods highlighted increased dissatisfaction and reduced efficiency, emphasising the superiority of digital workflows. This case study underscores that transition challenges are not inherent to digital workflows but to transitioning itself, advocating for the adoption of digital technologies in all pathology practices.

Causes of Inappropriate Laboratory Test Ordering from the Perspective of Medical Laboratory Technical Professionals: Implications for Research and Education.

OBJECTIVE: Inappropriate laboratory test ordering is a significant and persistent problem. Many causes have been identified and studied. Medical laboratory professionals (MLPs) are technical staff within clinical laboratories who are uniquely positioned to comment on why inappropriate ordering occurs. We aimed to characterize existing MLP perceptions in this domain to reveal new or underemphasized interventional targets. METHODS: We developed and disseminated a self-administered survey to MLPs in Canada, including open-ended responses to questions about the causes of inappropriate laboratory test ordering. RESULTS: Four primary themes were identified from qualitative analysis: ordering-provider factors, communication factors, existing test-ordering processes, and patient factors. Although these factors can largely be found in previous literature, some are under-studied. CONCLUSION: MLP insights into nonphysician triage ordering and poor result communication provide targets for further investigation. A heavy focus on individual clinician factors suggests that current understandings and interprofessional skills in the MLP population can be improved.

Prion disease risk perception in Canadian medical laboratories.

BACKGROUND: There are no national guidelines specific for handling prion-associated specimens in Canadian medical laboratories. Medical laboratory workers may perceive themselves at risk of prion transmission and, on occasion, decline to process such specimens. OBJECTIVE: To examine the knowledge, attitudes and reported behaviours of medical laboratory workers in relation to prion disease to understand their risk perception and the need for national laboratory guidelines on prion infection control. DESIGN: Survey development and cross-sectional web-based administration. METHODS: The survey was developed through key informant interviews and a modified Delphi process. Medical laboratory workers across Canada were invited by laboratory managers and national organizations to complete the web-based survey. RESULTS: Twelve key informant interviews were performed. Consensus for questionnaire content was reached through two rounds of the Delphi process. Responses were received from 426 Canadian medical laboratory workers; 37% of medical laboratory staff reported processing prion-associated specimens. Different protocols for specimen processing were followed, and 18% believed they were at risk when processing these specimens. Less than one-third of those receiving specimens believed they were adequately trained. The mean (±SD) knowledge score was 9.25±4.5/24; individuals who had received training scored significantly higher than those who were untrained (P<0.01). Eighty-one per cent of respondents would be more comfortable processing specimens if national guidelines existed and were used in their laboratory. CONCLUSION: There is a high perception of risk and few perceived benefits of processing prion-associated specimens. National guidelines for prion infection control in medical laboratories and adequate training would enable medical laboratory workers to process these specimens efficiently and confidently.

HISTORIQUE: Il n'existe pas de lignes directrices nationales propres à la manipulation d'échantillons associés aux infections à prion dans les laboratoires médicaux canadiens. Les travailleurs de ces laboratoires peuvent se percevoir comme vulnérables à la transmission d'une infection à prion et parfois refuser de traiter ces échantillons. OBJECTIF: Examiner les connaissances, les attitudes et les comportements déclarés des travailleurs de laboratoire pour comprendre leur perception du risque et la nécessité de préparer des lignes directrices nationales de laboratoire sur le contrôle des infections à prion. CONCEPTION: Élaboration de l'administration transversale d'un sondage par voie électronique. MÉTHODOLOGIE: Les chercheurs ont préparé le sondage par suite d'entrevues avec des informateurs clés et d'une méthode Delphi modifiée. Des directeurs de laboratoire et des organisations nationales ont invité les travailleurs de laboratoire du Canada à répondre au sondage par voie électronique. RÉSULTATS: Les chercheurs ont effectué 12 entrevues auprès d'informateurs clés. Ils sont parvenus à un consensus quant au contenu du questionnaire après deux rondes de la méthode Delphi. Ils ont reçu la réponse de 426 travailleurs de laboratoire canadiens, dont 37 % déclaraient traiter des échantillons liés à des infections à prion. Divers protocoles de traitement des échantillons étaient respectés, et 18 % des travailleurs se sentaient vulnérables dans le cadre de ce traitement. Moins du tiers des travailleurs qui recevaient ces échantillons se sentaient bien formés pour le faire. L'indice de connaissance moyen s'élevait à 9,25/24 (ÉT±4,5). Les personnes qui avaient reçu une formation obtenaient un indice considérablement plus élevé que celles qui n'en avaient pas reçu (P<0,01). Quatre-vingt-un pour cent des répondants seraient plus à l'aise de traiter les échantillons s'il existait des lignes directrices nationales mises en œuvre dans leur laboratoire. CONCLUSION: La perception du risque est élevée et celle des avantages du traitement des échantillons liés à des infections à prion est faible. Des lignes directrices nationales sur le contrôle des infections à prion dans les laboratoires médicaux et une formation convenable permettraient aux travailleurs de laboratoire de traiter ces échantillons avec efficacité et en toute confiance.

Cellular pathology in the COVID-19 era: a European perspective on maintaining quality and safety.

COVID-19 is a zoonotic viral infection that originated in Wuhan, China, in late 2019. WHO classified the resulting pandemic as a 'global health emergency' due to its virulence and propensity to cause acute respiratory distress syndrome. The COVID-19 pandemic has had a major impact on diagnostic laboratories, particularly those handling cell and tissue specimens. This development carries serious implications for laboratory practice in that safety of personnel has to be balanced against high-quality analysis and timely reporting of results. The aim of this article is to present some recommendations for the handling of such specimens in the preanalytical, analytical and postanalytical phases of laboratory testing and analysis in an era of high COVID-19 prevalence, such as that seen, for example, in the UK, Spain, Italy and France.

Predictive molecular pathology in the time of COVID-19.

AIMS: In the time of COVID-19, predictive molecular pathology laboratories must still timely select oncological patients for targeted treatments. However, the need to respect social distancing measures may delay results generated by laboratory-developed tests based on sequential steps a long hands-on time. Laboratory workflows should now be simplified. METHODS: The organisation of the University of Naples Federico II predictive pathology laboratory was assessed before (March-April 2019) and during (March-April 2020) the Italian lockdown. RESULTS: The number of patients undergoing single or multiple biomarker testing was similar in 2019 (n=43) and in 2020 (n=45). Considering adequate samples for molecular testing, before the outbreak, next-generation sequencing was mostly used (35/42, 83.3%). Testing six genes had a reagent cost of €98/patient. Conversely, in 2020, almost all cases (38/41, 92.7%) were analysed by automated testing. This latter had for any single assay/gene a significant reagent cost (€95-€136) and a faster mean turnaround time (5.3 vs 7.9 working days). CONCLUSION: In the times of coronavirus, laboratory fully automated platforms simplify predictive molecular testing. Laboratory staff may be more safely and cost-effectively managed.

Initial Clinical Laboratory Response to COVID-19: A Survey of Medical Laboratory Professionals.

OBJECTIVE: To explore the experiences of medical laboratory professionals (MLPs) and their perceptions of the needs of clinical laboratories in response to COVID-19. METHODS: We surveyed laboratory professionals working in United States clinical laboratories during the initial months of the pandemic. RESULTS: Overall clinical laboratory testing and overtime work for laboratorians decreased during the first months of the pandemic. Laboratory professionals reported better or unchanged job satisfaction, feelings toward their work, and morale in their workplace, which were related to healthcare facility and laboratory leadership response. They reported receiving in-kind gifts, but no hazard pay, for their essential work. Important supply needs included reagents and personal protective equipment (PPE). CONCLUSION: The response by healthcare facilities and laboratory leadership can influence MLPs job satisfaction, feelings toward their work, and laboratory morale during a pandemic. Current COVID-19 laboratory testing management, in the absence of sufficient reagents and supplies, cannot fully address the needs of clinical laboratories.

The use of denaturing solution as collection and transport media to improve SARS-CoV-2 RNA detection and reduce infection of laboratory personnel.

Accurate testing to detect SARS-CoV-2 RNA is key to counteract the virus spread. Nonetheless, the number of diagnostic laboratories able to perform qPCR tests is limited, particularly in developing countries. We describe the use of a virus-inactivating, denaturing solution (DS) to decrease virus infectivity in clinical specimens without affecting RNA integrity. Swab samples were collected from infected patients and from laboratory personnel using a commercially available viral transport solution and the in-house DS. Samples were tested by RT-qPCR, and exposure to infective viruses was also accessed by ELISA. The DS used did not interfere with viral genome detection and was able to maintain RNA integrity for up to 16 days at room temperature. Furthermore, virus loaded onto DS were inactivated, as attested by attempts to grow SARS-CoV-2 in cell monolayers after DS desalt filtration to remove toxic residues. The DS described here provides a strategy to maintain diagnostic accuracy and protects diagnostic laboratory personnel from accidental infection, as it has helped to protect our lab crew.

Histopathology laboratory paperwork as a potential risk of COVID-19 transmission among laboratory personnel.

BACKGROUND: Healthcare workers have a higher risk of acquiring coronavirus disease 2019 (COVID-19). The process of requesting pathological investigations is usually handled manually through paper-based forms. This study evaluated the potential for paper-based request forms to transmit severe acute respiratory virus coronavirus-2 (SARS-CoV-2) to laboratory staff in order to make recommendations for dealing with hospital paperwork in a post-COVID-19 world. METHODS: Paper-based forms were tracked from the time of test ordering until the release of the pathology report by calculating the time taken for the forms to reach the laboratory, and the exposure of each staff group to forms received from both high and moderate COVID-19 risk areas. RESULTS: Four hundred and thirty-two (83%) of 520 forms were received in the laboratory within 24 h. The remaining 88 (17%) forms took ≥24 h to be handled by laboratory personnel. The mean daily exposure time to the paperwork for various laboratory staff was as follows: receptionists, 2.7 min; technicians, 5.5 min; and pathologists, 54.6 min. CONCLUSION: More than 80% of the forms were handled by laboratory personnel within 24 h, carrying a high potential risk for viral transmission. It is recommended that paper-based request forms should be replaced by electronic requests that could be printed in the laboratory if required. Another option would be to sterilize received paperwork to ensure the safety of laboratory personnel. More studies are needed to detect the stability of SARS-CoV-2 on different surfaces and determine the potential risk of COVID-19 transmission via paper.

Clinical Laboratory Employees' Attitudes Toward Artificial Intelligence.

OBJECTIVE: The objective of this study was to determine the attitudes of laboratory personnel toward the application of artificial intelligence (AI) in the laboratory. METHODS: We surveyed laboratory employees who covered a range of work roles, work environments, and educational levels. RESULTS: The survey response rate was 42%. Most respondents (79%) indicated that they were at least somewhat familiar with AI. Very few (4%) classified themselves as experts. Contact with AI varied by educational level (P = .005). Respondents believed that AI could help them perform their work by reducing errors (24%) and saving time (16%). The most common concern (27%) was job security (being replaced by AI). The majority (64%) of the respondents expressed support for the development of AI projects in the organization. CONCLUSIONS: Laboratory employees see the potential for AI and generally support the adoption of AI tools but have concerns regarding job security and quality of AI performance.

Clinical reasoning - an approach for decision-making in education and training for biomedical scientists.

Aim: Explicitly addressing clinical reasoning (CR) is seen as a promising opportunity in the teaching of the biomedical sciences to enable students to acquire the skills to meet the challenges posed by ever more complex health care processes. The quality of diagnostic decisions plays an essential role here. Our aim is to examine if biomedical scientists recognize the practical relevance of CR and are able to apply it as a reflective framework for their professional practice. Method: In two different educational settings, biomedical science students were asked to look closely at CR in the context of the degree program and to indentify the different forms of reasoning used in their internships and professional practice. The written descriptions were analyzed for content and discussed in the seminars. Results: In both scenarios, the analyses of the students' descriptions and discussions showed that examining the different forms of CR helped to raise conscious awareness of thought and decision-making processes, encouraging students to think critically about them and to articulate insights about them, as well as recognize the importance of different reasoning strategies when making specific medical decisions. Conclusion: CR for biomedical scientists could help make decision-making processes visible for other occupational groups and thus advantageously integrate specific professional expertise into health care. Over the long term, an interdisciplinary focus on CR could foster and promote the development of a shared discourse and interprofessional collaboration.

Medical laboratory technician professional pathologies: a 2006-2016 literature review.

The trade of laboratory technician (TL) exposes to many risks to health, because of biological or chemical or physical exposures. But the TL occupation is constantly evolving, the techniques are constantly changing. The purpose of this article is to take stock of the occupational TL pathologies which were recently described in the literature. This is a literature review, based on Medline® and Scopus® medical databases, on publications between 01/01/2006 and 31/12/2016. The research was conducted in French and English. Only articles about TL in Hospital or Teaching Hospital were selected. Twenty-eight articles were studied. The main infectious pathology described was brucellosis and a case of meningitis was studied. The cutaneous allergies reported concerned sensitization to certain solvents. There was no allergy to latex. Musculoskeletal disorders (MSD) were studied in 4 articles. The main MSDs were low back pain and neck pain. Several articles have alerted on the occurrence of burnout syndrome (BO). However, no prevalence studies were conducted over the period studied. In conclusion, TL can present many occupational pathologies. Few articles studied the prevalence of MSD and BO.

[Clinical governance and patient safety culture in clinical laboratories in the Spanish National Health System]. / Gobierno clínico y cultura en seguridad de los laboratorios clínicos en el Sistema Nacional de Salud español.

AIM: To conduct a situational analysis of patient safety culture in public laboratories in the Spanish National Health System and to determine the clinical governance variables that most strongly influence patient safety. METHOD: A descriptive cross-sectional study was carried out, in which a Survey of Patient Safety in Clinical Laboratories was addressed to workers in 26 participating laboratories. In this survey, which consisted of 45 items grouped into 6 areas, scores were assigned on a scale from 0 to 100 (where 0 is the lowest perception of patient safety). Laboratory managers were asked specific questions about quality management systems and technology. RESULTS: The mean scores for the 26 participating hospitals were evaluated, and the following results observed: in 4of the 6areas, the mean score was higher than 70 points. In the third area (equipment and resources) and the fourth area (working conditions), the scores were lower than 60 points. Every hospital had a digital medical record system. This 100% level of provision was followed by that of an electronic request management system, which was implemented in 82.6% of the hospitals. CONCLUSIONS: The results obtained show that the culture of security is homogeneous and of high quality in health service laboratories, probably due to the steady improvement observed. However, in terms of clinical governance, there is still some way to go, as shown by the presence of weaknesses in crucial dimensions of safety culture, together with variable levels of implementation of fail-safe technologies and quality management systems.

Additional technician tasks and turnaround time in the clinical Stat laboratory.

INTRODUCTION: Many additional tasks in the Stat laboratory (SL) increase the workload. It is necessary to control them because they can affect the service provided by the laboratory. Our aim is to calculate these tasks, study their evolution over a 10 year period, and compare turnaround times (TAT) in summer period to the rest of the year. MATERIALS AND METHODS: Additional tasks were classified as "additional test request" and "additional sample". We collected those incidences from the laboratory information system (LIS), and calculated their evolution over time. We also calculated the monthly TAT for troponin for Emergency department (ED) patients, as the difference between the verification and LIS registration time. A median time of 30 minutes was our indicator target. TAT results and tests workload in summer were compared to the rest of the year. RESULTS: Over a 10-year period, the technologists in the SL performed 51,385 additional tasks, a median of 475 per month. The workload was significantly higher during the summer (45,496 tests) than the rest of the year (44,555 tests) (P = 0.019). The troponin TAT did not show this variation between summer and the rest of the year, complying always with our 30 minutes indicator target. CONCLUSION: The technicians accomplished a significant number of additional tasks, and the workload kept increasing over the period of 10 years. That did not affect the TAT results.

Lack of knowledge regarding the microscopic diagnosis of malaria by technicians of the laboratory network in Luanda, Angola.

INTRODUCTION: Malaria is still one of the most important public health problems worldwide. The diagnosis of this disease is still mainly based on thick blood films.  OBJECTIVE: To evaluate the knowledge about malaria diagnosis of the technicians of the public health network in Luanda, Angola, by means of a survey.  MATERIALS AND METHODS: This survey was carried out in three phases. In the first one, open interviews were done to technicians related with the different procedures for malaria diagnosis. In the second one, a preliminary questionnaire was prepared and evaluated. In the third phase, a definitive questionnaire was applied to 120 technicians from Luanda between April and July, 2013. The proportions of correct and incorrect answers were compared for every question of the survey.  RESULTS: Significantly higher proportions of incorrect answers (p<0.05) were found in the questions related to clinical manifestations, 68/52 (p<0.05), species of Plasmodium according to geographical areas, 76/44 (p<0.05), the type of granulations according to species, 96/24 (p<0.01), the class of microscope magnifying glasses used to observe the thick smear, 105/15 (p<0.01), the thick smear report, 76/44 (p<0.01), the time and preparation of different stain solutions, 81/39 (p<0.01), and the number of parasites counted per 200 leukocytes, 96/24 (p<0.01).  CONCLUSIONS: Various failures for the microscopic diagnosis of malaria were observed amongst the evaluated technicians. These results will be useful as a baseline study before applying an educational intervention aimed to improve the quality of malaria diagnosis in Luanda's laboratory network.