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Chaudhry AS, Inata Y, Nakagami-Yamaguchi E. Quality analysis of the clinical laboratory literature and its effectiveness on clinical quality improvement: a systematic review. J Clin Biochem Nutr 2023; 73:108-115. [PMID: 37700849 PMCID: PMC10493209 DOI: 10.3164/jcbn.23-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/29/2023] [Indexed: 09/14/2023] Open
Abstract
Quality improvement in clinical laboratories is crucial to ensure accurate and reliable test results. With increasing awareness of the potential adverse effects of errors in laboratory practice on patient outcomes, the need for continual improvement of laboratory services cannot be overemphasized. A literature search was conducted on PubMed and a web of science core collection between October and February 2021 to evaluate the scientific literature quality of clinical laboratory quality improvement; only peer-reviewed articles written in English that met quality improvement criteria were included. A structured template was used to extract data, and the papers were rated on a scale of 0-16 using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). Out of 776 studies, 726 were evaluated for clinical laboratory literature quality analysis. Studies were analyzed according to the quality improvement and control methods and interventions, such as training, education, task force, and observation. Results showed that the average score of QI-MQCS for quality improvement papers from 1981-2000 was 2.5, while from 2001-2020, it was 6.8, indicating continuous high-quality improvement in the clinical laboratory sector. However, there is still room to establish a proper system to judge the quality of clinical laboratory literature and improve accreditation programs within the sector.
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Affiliation(s)
- Ahmed Shabbir Chaudhry
- Department of Medical Quality and Safety Science, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Yu Inata
- Department of Medical Quality and Safety Science, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
- Department of Intensive Care Medicine, Osaka Women’s and Children’s Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Etsuko Nakagami-Yamaguchi
- Department of Medical Quality and Safety Science, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Khanolkar A, Spiczka A, Bonfield TL, Alexander TS, Schmitz JL, Boras D, Fong K, Nandiwada SL, Miller GC, Tebo AE. Diplomate in Medical Laboratory Immunology Certification Examination: A New Chapter for Medical Laboratory Immunology. Immunohorizons 2023; 7:600-610. [PMID: 37639224 PMCID: PMC10587505 DOI: 10.4049/immunohorizons.2300030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/03/2023] [Indexed: 08/29/2023] Open
Abstract
It is indeed a privilege to be an immunologist in what is arguably the golden age of immunology. From astounding advances in fundamental knowledge to groundbreaking immunotherapeutic offerings, immunology has carved out an enviable niche for itself in basic science and clinical medicine. The need and the vital importance of appropriate education, training, and certification in clinical immunology was recognized by the World Health Organization as far back as 1972. In the United States, Ph.D. scientists with board certification in medical laboratory immunology have served as directors of high-complexity Clinical Laboratory Improvement Amendments- and College of American Pathologists-certified clinical immunology laboratories since 1977. From 1977 to 2017, board certification for medical laboratory immunology was administered by the American Society for Microbiology through the American Board of Medical Laboratory Immunology examination. The American Board of Medical Laboratory Immunology examination was phased out in 2017, and in the fall of 2019, the American Society for Clinical Pathology (ASCP) Board of Certification (BOC) examination committee took on the responsibility of developing a new doctoral-level certification examination for medical laboratory immunology. This transition to the ASCP BOC represents a well-deserved and much-needed recognition of the rapid advances in and the highly specialized nature of medical laboratory immunology and its ever-increasing relevance to patient care. This new ASCP BOC certification is called the Diplomate in Medical Laboratory Immunology, and, as of April 1, 2023, it is now available to potential examinees. In this report, we describe the examination, eligibility routes, and potential career pathways for successful diplomates.
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Affiliation(s)
- Aaruni Khanolkar
- Department of Pathology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
- Department of Pathology, Northwestern University, Chicago, IL
| | - Amy Spiczka
- American Society for Clinical Pathology, Chicago, IL
| | - Tracey L. Bonfield
- Department of Genomics and Genome Sciences & Pediatrics, Case Western Reserve University, Cleveland, OH
| | | | - John L. Schmitz
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Diana Boras
- American Society for Clinical Pathology, Chicago, IL
| | - Karen Fong
- American Society for Clinical Pathology, Chicago, IL
| | - Sarada L. Nandiwada
- Department of Pediatrics, Section of Allergy & Immunology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Anne E. Tebo
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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3
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Akech S, Nyamwaya B, Gachoki J, Ogero M, Kigo J, Maina M, Mutua E, Ooko E, Bejon P, Mwarumba S, Bahati F, Mvera B, Musyimi R, Onsare R, Hutter J, Tanui E, Wesangula E, Turner P, Dunachie S, Lucey O, McKnight J. The CINAMR (Clinical Information Network-Antimicrobial Resistance) Project: A pilot microbial surveillance using hospitals linked to regional laboratories in Kenya: Study Protocol. Wellcome Open Res 2022; 7:256. [PMID: 37786881 PMCID: PMC10541537 DOI: 10.12688/wellcomeopenres.18289.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 10/04/2023] Open
Abstract
Background: Antimicrobial resistance (AMR) is a global threat and is thought to be acute in low-and middle-income country (LMIC) settings, including in Kenya, but there is limited unbiased surveillance that can provide reliable estimates of its burden. Current efforts to build capacity for microbiology testing in Kenya are unlikely to result in systematic routine microbiological testing in the near term. Therefore, there is little prospect for microbiological support to inform clinical diagnoses nor for indicating the burden of AMR and for guiding empirical choice of antibiotics. Objective: We aim to build on an existing collaboration, the Clinical Information Network (CIN), to pilot microbiological surveillance using a 'hub-and-spoke' model where selected hospitals are linked to high quality microbiology research laboratories. Methods: Children admitted to paediatric wards of 12 participating hospitals will have a sample taken for blood culture at admission before antibiotics are started. Indication for blood culture will be a clinician's prescription of antibiotics. Samples will then be transported daily to the research laboratories for culture and antibiotic susceptibility testing and results relayed back to clinicians for patient management. The surveillance will take place for 6 months in each hospital. Separately, we shall conduct semi-structured interviews with frontline health workers to explore the feasibility and utility of this approach. We will also seek to understand how the availability of microbiology results might inform antibiotic stewardship, and as an interim step to the development of better national or regional laboratories linked to routine surveillance. Conclusions: If feasible, this approach is less costly and periodic 'hub-and-spoke' surveillance can be used to track AMR trends and to broadly guide empirical antibiotic guidance meaning it is likely to be more sustainable than establishing functional microbiological facilities in each hospital in a LMIC setting.
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Affiliation(s)
- Samuel Akech
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Brian Nyamwaya
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Jackline Gachoki
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Morris Ogero
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Joyce Kigo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Michuki Maina
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Edna Mutua
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ednah Ooko
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Salim Mwarumba
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Felix Bahati
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Benedict Mvera
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Robert Musyimi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Robert Onsare
- Kenya Medical Research Institute-Centre for Microbiology Research, Nairobi, Kenya
| | - Jack Hutter
- United States Army Medical Research Directorate-Africa/Kenya (USAMRD-A/K), Kombewa, Kenya
| | - Emmanuel Tanui
- Kenya Ministry of Health - AMR National Secretariat, Nairobi, Kenya
| | - Evelyn Wesangula
- Kenya Ministry of Health - AMR National Secretariat, Nairobi, Kenya
| | - Paul Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit (COMRU), Angkor Hospital for Children, Siem Reap, Cambodia
| | - Susanna Dunachie
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, University of Mahidol, Bangkok, Thailand
| | | | - Jacob McKnight
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - CINAMR Investigators
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Kenya Medical Research Institute-Centre for Microbiology Research, Nairobi, Kenya
- United States Army Medical Research Directorate-Africa/Kenya (USAMRD-A/K), Kombewa, Kenya
- Kenya Ministry of Health - AMR National Secretariat, Nairobi, Kenya
- Cambodia Oxford Medical Research Unit (COMRU), Angkor Hospital for Children, Siem Reap, Cambodia
- Mahidol-Oxford Tropical Medicine Research Unit, University of Mahidol, Bangkok, Thailand
- Imperial College London, London, UK
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Gumba H, Opiyo M, Musyoki J, Mutunga M, Ngetsa C, Mwarumba S, Mosobo M, Njuguna S, Kai O, Lambisia AW, Kimani D, Cheruiyot R, Kiyuka P, Lewa C, Gicheru E, Tendwa M, Said Mohammed K, Osoti V, Makale J, Tawa B, Odundo C, Cheruiyot W, Nyamu W, Gumbi W, Mwacharo J, Nyamako L, Otieno E, Amadi D, Ouma N, Karia B, Thoya J, Karani A, Mugo D, Gichuki BM, Riako D, Mutua S, Gitonga JN, Ominde K, Wanjiku P, Mutiso A, Mwanzu A, Sein Y, Bartilol B, Mwangi S, Omuoyo DO, Morobe JM, de Laurent ZR, Mitsanze F, Mwakubia A, Rono M, Nyaguara A, Tsofa B, Bejon P, Agoti CN, Ochola-Oyier LI. Maintaining laboratory quality assurance and safety in a pandemic: Experiences from the KEMRI-Wellcome Trust Research Programme laboratory’s COVID-19 response. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.16704.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Laboratory diagnosis plays a critical role in the containment of a pandemic. Strong laboratory quality management systems (QMS) are essential for laboratory diagnostic services. However, low laboratory capacities in resource-limited countries has made the maintenance of laboratory quality assurance, especially during a pandemic, a daunting task. In this paper, we describe our experience of how we went about providing diagnostic testing services for SARS-CoV-2 through laboratory reorganization, redefining of the laboratory workflow, and training and development of COVID-19 documented procedures, all while maintaining the quality assurance processes during the COVID-19 pandemic at the Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme (KWTRP) laboratory. The KWTRP laboratory managed to respond to the COVID-19 outbreak in Kenya by providing diagnostic testing for the coastal region of the country, while maintaining its research standard quality assurance processes. A COVID-19 team comprising of seven sub-teams with assigned specific responsibilities and an organizational chart with established reporting lines were developed. Additionally, a total of four training sessions were conducted for county Rapid Response Teams (RRTs) and laboratory personnel. A total of 11 documented procedures were developed to support the COVID-19 testing processes, with three for the pre-analytical phases, seven for the analytical phase, and one for the post-analytical phase. With the workflow re-organization, the development of appropriate standard operating procedures, and training, research laboratories can effectively respond to pandemic outbreaks while maintaining research standard QMS procedures.
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Gumba H, Opiyo M, Musyoki J, Mutunga M, Ngetsa C, Mwarumba S, Mosobo M, Njuguna S, Kai O, Lambisia AW, Kimani D, Cheruiyot R, Kiyuka P, Lewa C, Gicheru E, Tendwa M, Said Mohammed K, Osoti V, Makale J, Tawa B, Odundo C, Cheruiyot W, Nyamu W, Gumbi W, Mwacharo J, Nyamako L, Otieno E, Amadi D, Ouma N, Karia B, Thoya J, Karani A, Mugo D, Gichuki BM, Riako D, Mutua S, Gitonga JN, Ominde K, Wanjiku P, Mutiso A, Mwanzu A, Sein Y, Bartilol B, Mwangi S, Omuoyo DO, Morobe JM, de Laurent ZR, Mitsanze F, Mwakubia A, Rono M, Nyaguara A, Tsofa B, Bejon P, Agoti CN, Ochola-Oyier LI. Maintaining laboratory quality assurance and safety in a pandemic: Experiences from the KEMRI-Wellcome Trust Research Programme laboratory’s COVID-19 response. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16704.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Laboratory diagnosis plays a critical role in the containment of a pandemic. Strong laboratory quality management systems (QMS) are essential for laboratory diagnostic services. However, low laboratory capacities in resource-limited countries has made the maintenance of laboratory quality assurance, especially during a pandemic, a daunting task. In this paper, we describe our experience of how we went about providing diagnostic testing services for SARS-CoV-2 through laboratory reorganization, redefining of the laboratory workflow, and training and development of COVID-19 documented procedures, all while maintaining the quality assurance processes during the COVID-19 pandemic at the Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme (KWTRP) laboratory. The KWTRP laboratory managed to respond to the COVID-19 outbreak in Kenya by providing diagnostic testing for the coastal region of the country, while maintaining its research standard quality assurance processes. A COVID-19 team comprising of seven sub-teams with assigned specific responsibilities and an organizational chart with established reporting lines were developed. Additionally, a total of four training sessions were conducted for county Rapid Response Teams (RRTs) and laboratory personnel. A total of 11 documented procedures were developed to support the COVID-19 testing processes, with three for the pre-analytical phases, seven for the analytical phase, and one for the post-analytical phase. With the workflow re-organization, the development of appropriate standard operating procedures, and training, research laboratories can effectively respond to pandemic outbreaks while maintaining research standard QMS procedures.
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Timóteo M, Lourenço E, Brochado AC, Domenico L, da Silva J, Oliveira B, Barbosa R, Montemezzi P, Mourão CFDAB, Olej B, Alves G. Digital Management Systems in Academic Health Sciences Laboratories: A Scoping Review. Healthcare (Basel) 2021; 9:healthcare9060739. [PMID: 34208584 PMCID: PMC8234580 DOI: 10.3390/healthcare9060739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 01/02/2023] Open
Abstract
Good laboratory practices (GLP) increase the quality and traceability of results in health sciences research. However, factors such as high staff turnover, insufficient resources, and a lack of training for managers may limit their implementation in research and academic laboratories. This Scoping Review aimed to identify digital tools for managing academic health sciences and experimental medicine laboratories and their relationship with good practices. Following the PRISMA-ScR 2018 criteria, a search strategy was conducted until April 2021 in the databases PUBMED, Web of Sciences, and Health Virtual Library. A critical appraisal of the selected references was conducted, followed by data charting. The search identified twenty-one eligible articles, mainly originated from high-income countries, describing the development and/or implementation of thirty-two electronic management systems. Most studies described software functionalities, while nine evaluated and discussed impacts on management, reporting both improvements in the workflow and system limitations during implementation. In general, the studies point to a contribution to different management issues related to GLP principles. In conclusion, this review identified evolving evidence that digital laboratory management systems may represent important tools in compliance with the principles of good practices in experimental medicine and health sciences research.
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Affiliation(s)
- Margareth Timóteo
- Clinical Research Unit, Antônio Pedro Hospital, Fluminense Federal University, Niteroi 24020-140, Brazil; (M.T.); (L.D.); (J.d.S.); (B.O.); (B.O.)
- Post-Graduation Program in Medical Sciences, Fluminense Federal University, Niteroi 24020-140, Brazil
| | - Emanuelle Lourenço
- Post-Graduation Program in Dentistry, Fluminense Federal University, Niteroi 24020-140, Brazil;
| | - Ana Carolina Brochado
- Post-Graduation Program in Science and Biotechnology, Fluminense Federal University, Niteroi 24020-140, Brazil; (A.C.B.); (R.B.)
| | - Luciana Domenico
- Clinical Research Unit, Antônio Pedro Hospital, Fluminense Federal University, Niteroi 24020-140, Brazil; (M.T.); (L.D.); (J.d.S.); (B.O.); (B.O.)
| | - Joice da Silva
- Clinical Research Unit, Antônio Pedro Hospital, Fluminense Federal University, Niteroi 24020-140, Brazil; (M.T.); (L.D.); (J.d.S.); (B.O.); (B.O.)
| | - Bruna Oliveira
- Clinical Research Unit, Antônio Pedro Hospital, Fluminense Federal University, Niteroi 24020-140, Brazil; (M.T.); (L.D.); (J.d.S.); (B.O.); (B.O.)
| | - Renata Barbosa
- Post-Graduation Program in Science and Biotechnology, Fluminense Federal University, Niteroi 24020-140, Brazil; (A.C.B.); (R.B.)
| | | | - Carlos Fernando de Almeida Barros Mourão
- Clinical Research Unit, Antônio Pedro Hospital, Fluminense Federal University, Niteroi 24020-140, Brazil; (M.T.); (L.D.); (J.d.S.); (B.O.); (B.O.)
- Post-Graduation Program in Science and Biotechnology, Fluminense Federal University, Niteroi 24020-140, Brazil; (A.C.B.); (R.B.)
- Correspondence: (C.F.d.A.B.M.); (G.A.); Tel.: +1-941-830-1302 (C.F.d.A.B.M.); +55-21-26299255 (G.A.)
| | - Beni Olej
- Clinical Research Unit, Antônio Pedro Hospital, Fluminense Federal University, Niteroi 24020-140, Brazil; (M.T.); (L.D.); (J.d.S.); (B.O.); (B.O.)
| | - Gutemberg Alves
- Clinical Research Unit, Antônio Pedro Hospital, Fluminense Federal University, Niteroi 24020-140, Brazil; (M.T.); (L.D.); (J.d.S.); (B.O.); (B.O.)
- Correspondence: (C.F.d.A.B.M.); (G.A.); Tel.: +1-941-830-1302 (C.F.d.A.B.M.); +55-21-26299255 (G.A.)
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Abstract
Chimeric antigen receptor-T (CAR-T) cell therapy is a promising frontier of immunoengineering and cancer immunotherapy. Methods that detect, quantify, track, and visualize the CAR, have catalyzed the rapid advancement of CAR-T cell therapy from preclinical models to clinical adoption. For instance, CAR-staining/labeling agents have enabled flow cytometry analysis, imaging applications, cell sorting, and high-dimensional clinical profiling. Molecular assays, such as quantitative polymerase chain reaction, integration site analysis, and RNA-sequencing, have characterized CAR transduction, expression, and in vivo CAR-T cell expansion kinetics. In vitro visualization methods, including confocal and total internal reflection fluorescence microscopy, have captured the molecular details underlying CAR immunological synapse formation, signaling, and cytotoxicity. In vivo tracking methods, including two-photon microscopy, bioluminescence imaging, and positron emission tomography scanning, have monitored CAR-T cell biodistribution across blood, tissue, and tumor. Here, we review the plethora of CAR detection methods, which can operate at the genomic, transcriptomic, proteomic, and organismal levels. For each method, we discuss: (1) what it measures; (2) how it works; (3) its scientific and clinical importance; (4) relevant examples of its use; (5) specific protocols for CAR detection; and (6) its strengths and weaknesses. Finally, we consider current scientific and clinical needs in order to provide future perspectives for improved CAR detection.
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Affiliation(s)
- Yifei Hu
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL, United States
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Jun Huang
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL, United States
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