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Kremser M, Weiss N, Kaufmann-Stoeck A, Vierbaum L, Kappler S, Schellenberg I, Hiergeist A, Fingerle V, Baier M, Reischl U. Longitudinal analysis of 20 Years of external quality assurance schemes for PCR/NAAT-based bacterial genome detection in diagnostic testing. Front Mol Biosci 2024; 11:1373114. [PMID: 38601324 PMCID: PMC11004257 DOI: 10.3389/fmolb.2024.1373114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/28/2024] [Indexed: 04/12/2024] Open
Abstract
Background Quality control (QC), quality assurance, and standardization are crucial for modern diagnostic testing in the field of medical microbiology. The need for efficient QC to ensure accurate laboratory results, treatment, and infection prevention has led to significant efforts in standardizing assay reagents and workflows. External quality assessment (EQA) schemes, like those offered by INSTAND, play a vital role in evaluating in-house and commercial routine diagnostic assays, regarded as mandatory by national and global guidelines. The recent impact of polymerase chain reaction/nucleic acid amplification technology (PCR/NAAT) assays in medical microbiology requires that high-performing assays be distinguished from inadequately performing ones, especially those made by inexperienced suppliers. Objectives The study assesses the evolving diagnostic performance trends over 2 decades for the detection of EHEC/STEC, Borrelia (B.) burgdorferi, and MRSA/cMRSA. It explores the historical context of assay utilization, participant engagement, and rates of correct results in EQA schemes. The research seeks to identify patterns in assay preferences, participant proficiency, and the challenges encountered in detecting emerging variants or clinical strains. Results The study highlights the decline in in-house PCR assay usage, the emergence of new diagnostic challenges, and educational aspects within EQA schemes. Specific examples, such as the inclusion, in certain EQA surveys, of EHEC strains carrying stx-2f or B. miyamotoi, highlight the role of EQAs in increasing awareness and diagnostic capabilities. Advancements in MRSA detection, especially through the adoption of commercial assays, demonstrate the impact that technology evolution has had on diagnostic performance. Conclusion Achieving excellence in diagnostic molecular microbiology involves a multifaceted approach, including well-evaluated assays, careful instrumentation selection, and structured training programs. EQA schemes contribute significantly to this pursuit by providing insights into the evolving diagnostic landscape and identifying areas for improvement in the diagnostic workflow as well as in PCR/NAAT assay design.
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Affiliation(s)
- Marcel Kremser
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Nathalie Weiss
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Anne Kaufmann-Stoeck
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Laura Vierbaum
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Silke Kappler
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
| | - Ingo Schellenberg
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- Institute of Bioanalytical Sciences (IBAS), Center of Life Sciences, Anhalt University of Applied Sciences, Bernburg, Germany
| | - Andreas Hiergeist
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Volker Fingerle
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Michael Baier
- Institute of Medical Microbiology, University Hospital Jena, Jena, Germany
| | - Udo Reischl
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
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Ricós C, Fernández-Calle P, Perich C, Sandberg S. Control externo de la calidad en medicina del laboratorio. Avances y futuro. ADVANCES IN LABORATORY MEDICINE 2022; 3:232-242. [PMCID: PMC10197501 DOI: 10.1515/almed-2022-0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 12/29/2023]
Abstract
Objectivos Un programa de control externo distribuye las mismas muestras control entre varios laboratorios y evalúa los resultados obtenidos con un criterio común. El objetivo de este trabajo es resumir la evolución de los programas externos, poner de manifiesto los progresos conseguidos y deducir consecuencias prácticas para el laboratorio participante. Métodos El material es una breve revisión de los diferentes tipos de programas externos utilizados a lo largo de cuarenta años. El método es el análisis crítico de las ventajas e inconvenientes de cada modelo, a la luz de nuestra experiencia. Resultados A mitad del siglo XX se iniciaron los programas EQA, detectándose gran discrepancia entre resultados emitidos por distintos laboratorios. Se desarrollaron EQA en muchos países y se propusieron mecanismos para armonizarlos, como: establecer especificaciones derivadas de la variación biológica, promover el uso de métodos analíticos homogéneos, usar el EQA como herramienta educacional. A partir del 2000 se hacen importantes avances: asegurar el adecuado uso clínico de las pruebas del laboratorio, utilizar material control conmutable con el espécimen humano, armonizar los distintos modelos de EQA, promover una organización de cooperación entre organizadores de programas EQA. Conclusiones Participar en un EQA con controles conmutables y valores asignados por método de referencia certificado permite conocer la inexactitud real de los resultados y el impacto en las muestras de pacientes. Si se participa en programas con controles no conmutables solo se conoce si la prestación del laboratorio es similar a la de otros usuarios del mismo método analítico.
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Affiliation(s)
- Carmen Ricós
- Sociedad Española de Medicina del Laboratorio (SEQC), Barcelona, España
| | - Pilar Fernández-Calle
- Sociedad Española de Medicina del Laboratorio (SEQC), Barcelona, España
- Departamento de Medicina del Laboratorio, Hospital Universitario La Paz, Madrid, España
| | - Carmen Perich
- Sociedad Española de Medicina del Laboratorio (SEQC), Barcelona, España
| | - Sverre Sandberg
- Organización noruega para la mejora de la calidad de los exámenes del laboratorio (NOKLUS), Hospital Universitario Haukeland, Bergen, Norway
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Ricós C, Fernández-Calle P, Perich C, Sandberg S. External quality control in laboratory medicine. Progresses and future. ADVANCES IN LABORATORY MEDICINE 2022; 3:221-242. [PMID: 37362144 PMCID: PMC10197337 DOI: 10.1515/almed-2022-0058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/30/2022] [Indexed: 06/28/2023]
Abstract
Objectives An external quality control program distributes same control samples to various laboratories and evaluates results obtained with a common criterion. The aim of this work is to summarize the evolution of various types of external programs, to point out the progresses ant to preclude practical consequences of the participant laboratories. Content The material consists on a brief revision of the different types of external programs that have been used for the last forty years. The method is the critical analysis of the strong and weak points of each program model, from the light of our experience. External quality assessment (EQA) programs were initiated at half the XX century, evidencing big discrepancies among laboratory results. EQA were developed in various countries and some mechanisms to harmonize them were proposed: to establish common performance specifications derived from biological variation, to use EQS as educational tool. Since the 2000 important advances were seen: to focus EQA to assure the adequate clinical use of laboratory tests, to use commutable controls, to harmonize the different EQA models, to promote a forum for co-operation and exchange of knowledge on quality-related matters for EQA organizers. Summary and Outlook To participate in an EQA with commutable-reference method assigned values controls allows to know the real inaccuracy of results and their impact on patient' samples. To participate in a EQA with non commutable controls allows to know whether the individual laboratory performance agrees with that from other laboratories using same analytical method.
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Affiliation(s)
- Carmen Ricós
- Sociedad Española de Medicina del Laboratorio (SEQC), Barcelona, Spain
| | - Pilar Fernández-Calle
- Sociedad Española de Medicina del Laboratorio (SEQC), Barcelona, Spain
- Departamento de Medicina del Laboratorio, Hospital Universitario La Paz, Madrid, Spain
| | - Carmen Perich
- Sociedad Española de Medicina del Laboratorio (SEQC), Barcelona, Spain
| | - Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations (NOKLUS), Hospital Universitario Haukeland, Bergen, Norway
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Poloni JAT, de Oliveira Vieira A, Dos Santos CRM, Simundic AM, Rotta LN. Survey on reporting of epithelial cells in urine sediment as part of external quality assessment programs in Brazilian laboratories. Biochem Med (Zagreb) 2021; 31:020711. [PMID: 34140834 PMCID: PMC8183119 DOI: 10.11613/bm.2021.020711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/14/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Epithelial cells (ECs) are structures regularly observed during urine microscopy analysis. The correct identification of EC subtypes can be useful since renal tubular epithelial cells (RTECs) are clinically relevant. We investigate the urinary ECs report and the judgement of its clinical importance by Brazilian laboratories. Materials and methods A survey with four questions was made available to participants of the Urinalysis External Quality Assessment Program (EQAP) from Controllab. Laboratories composed 3 groups: (1) differentiating ECs subtypes: “squamous”, “transitional” and “RTECs”; (2) differentiating ECs subtypes: “squamous” or “non-squamous” cells; (3) without ECs subtype identification. Participants did not necessarily answer to all questions and the answers were evaluated both within the same laboratory’s category and within different categories of laboratories. Results A total of 1336 (94%) laboratories answered the survey; Group 1, 119/140 (85%) reported that ECs differentiation is important to the physician and 62% want to be evaluated by EQAP, while in Group 3, 455/1110 (41%) reported it is useful to them, however only 25% want be evaluated by EQAP. Group 2 laboratories 37/51 (73%) reported that the information is important, but only 13/52 (25%) are interested in an EQAP with differentiation of the 3 ECs subtypes. Conclusion Most of the laboratories do not differentiate ECs in the three subtypes, despite the clinical importance of RTECs. Education of laboratory staff about the clinical significance of urinary particles should be considered a key priority.
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Affiliation(s)
- José A T Poloni
- Health School, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil.,Controllab, Rio de Janeiro, Brazil
| | | | | | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Liane N Rotta
- Department of Diagnostic Methods and Post Graduation Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Giansante S, Giana HE, Fernandes AB, Silveira L. Analytical performance of Raman spectroscopy in assaying biochemical components in human serum. Lasers Med Sci 2021; 37:287-298. [PMID: 33537931 DOI: 10.1007/s10103-021-03247-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 01/05/2021] [Indexed: 01/17/2023]
Abstract
Chronic non-infectious diseases are important to research as they are the main causes of death in Brazil and worldwide. One very important chronic non-infectious disease is cardiovascular disease, whose risk factors (diabetes, dyslipidemia, and renal failure) can be detected through assessments of serum biochemical components. The objective of this study was to evaluate the analytical performance of Raman spectroscopy for analysis of lipid profile (total cholesterol, triglycerides, and HDL cholesterol), non-protein nitrogenous compounds (urea and creatinine), and glucose in 242 human serum samples. Models to discriminate and quantify the samples were developed using the predicted concentration by quantitative regression model based on partial least squares (PLS). The analytical error for the "leave-one-out" cross-validation based on the predicted PLS concentration was 10.5 mg/dL for total cholesterol, 21.4 mg/dL for triglyceride, 13.0 mg/dL for HDL cholesterol, 4.9 mg/dL for urea, 0.21 mg/dL for creatinine, and 15.4 mg/dL for glucose. The Kappa coefficient indicate very good agreement for cholesterol (0.83), good for triglyceride (0.77), urea (0.70) and creatinine (0.66), and fair for HDL cholesterol (0.38) and glucose (0.30). The results of the analytical performance demonstrated that Raman spectroscopy can be considered an important methodology to screen the population, especially for serum triglycerides and cholesterol.
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Affiliation(s)
- Stella Giansante
- Center for Innovation, Technology and Education - CITÉ, Universidade Anhembi Morumbi - UAM, Parque Tecnológico de São José dos Campos, Estr. Dr. Altino Bondensan, 500, São José dos Campos, SP, 12247-016, Brazil
| | - Hector Enrique Giana
- Laboratory of Clinical Analyses Oswaldo Cruz, Praça Cândida Maria Cesar Sawaya Giana, 128, Jardim Nova América, São José dos Campos, SP, 12243-003, Brazil
| | - Adriana Barrinha Fernandes
- Center for Innovation, Technology and Education - CITÉ, Universidade Anhembi Morumbi - UAM, Parque Tecnológico de São José dos Campos, Estr. Dr. Altino Bondensan, 500, São José dos Campos, SP, 12247-016, Brazil
| | - Landulfo Silveira
- Center for Innovation, Technology and Education - CITÉ, Universidade Anhembi Morumbi - UAM, Parque Tecnológico de São José dos Campos, Estr. Dr. Altino Bondensan, 500, São José dos Campos, SP, 12247-016, Brazil.
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Caldwell JA, Niro PJ, Farina EK, McClung JP, Caron GR, Lieberman HR. A Z-score based method for comparing the relative sensitivity of behavioral and physiological metrics including cognitive performance, mood, and hormone levels. PLoS One 2019; 14:e0220749. [PMID: 31415596 PMCID: PMC6695149 DOI: 10.1371/journal.pone.0220749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/22/2019] [Indexed: 11/19/2022] Open
Abstract
A method for assessing the relative sensitivity of research metrics is proposed and illustrated by comparing 18 outcome measures from a published study of the cognitive, mood, and hormonal effects of four different levels of stress induced by intense military training. Research on the human response to stress often assesses multiple disparate dependent measures. Selecting the most sensitive is difficult as formal methods to compare varied dependent measures have not been developed. The method first converts the outcome measures into standard scores (z-scores) and then compares them using analysis of variance to determine whether there are differences in how they assess the impact of graded levels of exposure to stress. The analysis detected various significant interactions in several measures and suggests self-report mood questionnaires were more sensitive to the stressors present in the study than the cognitive or hormonal measures which were used. These findings support the effectiveness of the z-score based method as a useful procedure for objectively evaluating the differential sensitivity of various metrics. This method could be useful for research on other independent variables when use of multiple assessment strategies is appropriate. It could be used for evaluating studies yielding conflicting results, such as those detecting effects on one parameter but not others. In such instances, cross-metric inconsistencies may be due to differential sensitivity of measurement strategies rather than actual differences in the effects of the independent-variable on the domains under investigation.
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Affiliation(s)
- John A. Caldwell
- Oak Ridge Institute for Science and Education, Belcamp, MD, United States of America
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States of America
| | - Philip J. Niro
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States of America
| | - Emily K. Farina
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - James P. McClung
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States of America
| | - Gregory R. Caron
- SERE EAST, Center for Security Forces, Brunswick, ME, United States of America
| | - Harris R. Lieberman
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States of America
- * E-mail:
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Quality assurance of genetic laboratories and the EBTNA practice certification, a simple standardization assurance system for a laboratory network. EUROBIOTECH JOURNAL 2018. [DOI: 10.2478/ebtj-2018-0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Analytical laboratory results greatly influence medical diagnosis, about 70% of medical decisions are based on laboratory results. Quality assurance and quality control are designed to detect and correct errors in a laboratory’s analytical process to ensure both the reliability and accuracy of test results. Unreliable performance can result in misdiagnosis and delayed treatment. Furthermore, improved quality guarantees increased productivity at a lower cost. Quality assurance programmes include internal quality control, external quality assessment, proficiency surveillance and standardization. It is necessary to try to ensure compliance with the requirements of the standards at all levels of the process. The sources of these standards are the International Standards Organization (ISO), national standards bodies, guidelines from professional organisations, accreditation bodies and governmental regulations. Laboratory networks increase the performance of laboratories in support of diagnostic screening programme. It is essential that genetic laboratories of a network have procedures underpinned by a robust quality assurance system to minimize errors and to reassure the clinicians and the patients that international standards are being met. This article provides an overview of the bases of quality assurance and its importance in genetic tests and it reports the EBTNA quality assurance system which is a clear and simple system available for access to adequate standardization of a genetic laboratory’s network.
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