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Cirilli N, Floridia G, Amato A, Padoan R, Censi F, Ferrari G, Raia V, Castaldo G, Capoluongo E, Taruscio D, Salvatore M. The Italian external quality assessment program for Cystic Fibrosis sweat chloride test: CFTR modulators and the impact of a new sweat test report form. Pract Lab Med 2024; 40:e00403. [PMID: 38818249 PMCID: PMC11137549 DOI: 10.1016/j.plabm.2024.e00403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 06/01/2024] Open
Abstract
Background The advent of CFTR modulators highlighted that the sweat test (ST) for CF can be used also as an outcome measure for the basic defect of CFTR. Despite the technological advances, ST still remains operator-dependent and its execution should be strongly paired with guidelines. In 2022, due to the advent of CFTR modulators, the Italian CF Society introduced a specific ST report. The aim of the present paper is to discuss the impact of this new report in the 2022-23 round of the Italian External Quality Assessment program for ST (I-EQA-SCT). Methods The scheme of the I-EQA-SCT is prospective, enrolment is voluntary, the payment of a fee is required and results are shared through a web-facility. Assessment covers analysis, interpretation, and reporting of results. In the 2022-23 round, 2 out of the 3 mock clinical information referred to patients who started modulators. Results Fourteen laboratories completed the 2022-23 I-EQA-SCT round. Three of them failed in the interpretation of results from these two mock cases and/or used a wrong report not consistent with the more recent Italian Sweat Test Recommendations. Conclusions The overall results obtained from the laboratories involved in the I-EQA-SCT program clearly showed that the laboratories' qualitative and quantitative performance improved significantly. Results emerged from this round highlighted an issue in the report form used for monitoring patients on CFTR modulator therapy thus stressing the importance of these programs in improving both the performance of lab services and ameliorating the sweat test recommendations.
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Affiliation(s)
- Natalia Cirilli
- Cystic Fibrosis Centre, Department of Gastroenterology and Transplantation, Marche University Hospital, Ancona, Italy
| | | | - Annalisa Amato
- National Center Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, 00161, Rome, Italy
| | - Rita Padoan
- Italian Cystic Fibrosis Registry, Scientific Board, Rome, Italy
| | - Federica Censi
- National Center Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, 00161, Rome, Italy
| | - Gianluca Ferrari
- National Center Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, 00161, Rome, Italy
| | - Valeria Raia
- Pediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Center, University Naples Federico II, Naples, Italy
| | - Giuseppe Castaldo
- CEINGE-Advanced Biotechnology, Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Ettore Capoluongo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
- Department of Clinical Pathology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Domenica Taruscio
- National Center Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, 00161, Rome, Italy
| | - Marco Salvatore
- National Center Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, 00161, Rome, Italy
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Huang Y, Wang W, Zhao H, Du Y, Liu J, He F, Zhong K, Yuan S, Wang Z. Quality assessment of interpretative commenting and competency comparison of comment providers in China. Clin Chem Lab Med 2020; 57:832-837. [PMID: 30332389 DOI: 10.1515/cclm-2018-0877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/14/2018] [Indexed: 11/15/2022]
Abstract
Background This study aimed to evaluate the ability of comment providers who were responsible for interpreting results in clinical laboratories in China and to improve the quality of interpretative comments. Methods Basic information and interpretative comments for five cases of 1912 routine chemistry External Quality Assessment (EQA) participant laboratories were collected by web-based EQA system in May 2018. EQA organizers assigned scores to each key phrase of comments based on predetermined marking scale and calculated total scores for each participant's answer. Final scores and ranking were calculated according to scores of cases. Finally, we comprehensively analyzed the type of hospital and the professional title of participants. Results In total, 772 clinical laboratories, 1472 participants, from different Chinese provinces submitted interpretative comments. Median scores, interquartile ranges and score ranges of the five cases were 13 (11-15, 1-20), 13 (10-16, 0-20), 15 (12-17, 0-21), 7 (5-9, -2 to 14) and 12 (10-13, -2 to 18). The final scores and ranking of participants that came from tertiary hospitals were higher than those from secondary and other hospitals; however, there were no significant differences (0.774). When grouped by professional title, we found that although no significant variability existed among senior, intermediate, junior and others (0.699), it existed between laboratory physicians and technicians, as the median final scores of the former were higher than the latter. Conclusions Practice and quality of interpretative comments are indeed different among different laboratories and participants in China. Laboratories should train and assess the interpretative ability of personnel. EQA organizers should also improve the scoring method and establish peer assessors team through this survey.
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Affiliation(s)
- Yuzhu Huang
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Wei Wang
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Haijian Zhao
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Yuxuan Du
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Jiali Liu
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Falin He
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Kun Zhong
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Shuai Yuan
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Zhiguo Wang
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China
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Vasikaran SD. Anatomy and history of an external quality assessment program for interpretative comments in clinical biochemistry. Clin Biochem 2015; 48:467-71. [DOI: 10.1016/j.clinbiochem.2014.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
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Performance criteria of the post-analytical phase. ACTA ACUST UNITED AC 2015; 53:949-58. [DOI: 10.1515/cclm-2015-0016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/24/2015] [Indexed: 01/27/2023]
Abstract
AbstractQuality in healthcare is ideally at an optimal benchmark, but must be at least above the minimal standards for care. While laboratory quality is ideally judged in clinical terms, laboratory medicine has also used biological variations and state-of-the-art criteria when, as is often the case, clinical outcome studies or clinical consensus are not available. The post-analytical phase involves taking quality technical results and providing the means for clinical interpretation in the report. Reference intervals are commonly used as a basis for data interpretation; however, laboratories vary in the reference intervals they use, even when analysis is similar. Reference intervals may have greater clinical value if they are both optimised to account for physiological individuality, as well as if they are harmonised through professional consensus. Clinical decision limits are generally superior to reference intervals as a basis for interpretation because they address the specific clinical concern in any patient. As well as providing quality data and interpretation, the knowledge of laboratory experts can be used to provide targeted procedural knowledge in a patient report. Most profoundly critically abnormal results should to be acted upon to minimise the risk of mortality. The three steps in quality report interpretation, (i) describing the abnormal data, (ii) interpreting the clinical information within that data and (iii) providing knowledge for clinical follow-up, highlight that the quality of all laboratory testing is reflected in its impact on clinical management and improving patient outcomes.
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Schmidt RL, Garcia CA, Panlener J, Ashwood ER, Jackson BR, Hussong JW. An Analysis of Clinical Consultation Activities in Clinical Chemistry: Implications for Transformation and Resident Training in Chemical Pathology. Arch Pathol Lab Med 2014; 138:671-7. [DOI: 10.5858/arpa.2013-0017-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Clinical consultation is a key role of pathologists. Many have advocated that pathologists expand their consulting activities to improve laboratory utilization. Although many have suggested that residency programs need to provide experience in clinical consultation, little has been written on the nature of consultation or on the methods of training.
Objective.—To characterize the content of consultations and to describe training in consultation in chemical pathology within the residency program at the University of Utah, Salt Lake City.
Design.—Retrospective review of the consultation database for the period between July 2011 and July 2012.
Results.—Residents performed an average of 159 consultations a month covering 276 topics during the course of a year. Each topic involved 1 or more specific tests. Eighty percent of the topics received fewer than 12 calls. The most common topics involved virus testing (eg, hepatitis B virus, hepatitis C virus, human immunodeficiency virus). Consultations most often involved test interpretation (53%), selection (38%), and performance characteristics (21%). Twenty-seven percent of consultations involved 2 or more consultation categories (eg, interpretation and performance).
Conclusions.—Consultation calls in chemical pathology are widely distributed across topics. Consultations most often involve test interpretation and selection. Methods to assess the effectiveness of consultations and resident teaching should be devised.
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Affiliation(s)
- Robert L. Schmidt
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City (Drs Schmidt, Garcia, and Hussong); Path on Call, ARUP Laboratories, Salt Lake City, Utah (Ms Panlener); and the University of Utah School of Medicine and ARUP Laboratories, Salt Lake City (Drs Ashwood and Jackson)
| | - Christopher A. Garcia
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City (Drs Schmidt, Garcia, and Hussong); Path on Call, ARUP Laboratories, Salt Lake City, Utah (Ms Panlener); and the University of Utah School of Medicine and ARUP Laboratories, Salt Lake City (Drs Ashwood and Jackson)
| | - Jeanne Panlener
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City (Drs Schmidt, Garcia, and Hussong); Path on Call, ARUP Laboratories, Salt Lake City, Utah (Ms Panlener); and the University of Utah School of Medicine and ARUP Laboratories, Salt Lake City (Drs Ashwood and Jackson)
| | - Edward R. Ashwood
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City (Drs Schmidt, Garcia, and Hussong); Path on Call, ARUP Laboratories, Salt Lake City, Utah (Ms Panlener); and the University of Utah School of Medicine and ARUP Laboratories, Salt Lake City (Drs Ashwood and Jackson)
| | - Brian R. Jackson
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City (Drs Schmidt, Garcia, and Hussong); Path on Call, ARUP Laboratories, Salt Lake City, Utah (Ms Panlener); and the University of Utah School of Medicine and ARUP Laboratories, Salt Lake City (Drs Ashwood and Jackson)
| | - Jerry W. Hussong
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City (Drs Schmidt, Garcia, and Hussong); Path on Call, ARUP Laboratories, Salt Lake City, Utah (Ms Panlener); and the University of Utah School of Medicine and ARUP Laboratories, Salt Lake City (Drs Ashwood and Jackson)
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Bell DA, Bender R, Hooper AJ, McMahon J, Edwards G, van Bockxmeer FM, Watts GF, Burnett JR. Impact of interpretative commenting on lipid profiles in people at high risk of familial hypercholesterolaemia. Clin Chim Acta 2013; 422:21-5. [DOI: 10.1016/j.cca.2013.03.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/22/2013] [Accepted: 03/27/2013] [Indexed: 10/27/2022]
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Aakre KM, Oosterhuis WP, Sandberg S. How do laboratory specialists advise clinicians concerning the use and interpretation of renal tests? Scandinavian Journal of Clinical and Laboratory Investigation 2012; 72:143-51. [PMID: 22214324 DOI: 10.3109/00365513.2011.646298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to elucidate how laboratory specialists advise clinicians concerning renal parameters and to compare their advice with guideline recommendations. METHODS A questionnaire was distributed to laboratory specialists in Norway and The Netherlands together with two case histories from a primary health-care setting and one from a hospital setting, simulating questions from clinicians. The investigations that laboratory specialists suggested were compared to a test panel that was predefined based on clinical practice guideline recommendations (the 'recommended test panel'). The critical differences between two test results (creatinine, estimated glomerular filtration rate [eGFR] and albumin/creatinine ratio [ACR]) and the anticipated precision of the MDRD equation were evaluated. RESULTS Fifty-two of the 100 laboratory specialists responded, and most of these were regularly contacted by clinicians to discuss laboratory results. Less than 30% would suggest using the recommended test panel to evaluate renal function in the two primary-care patients. For creatinine and eGFR, median changes stated to signal improvement or deterioration in renal function (creatinine: -14% and +14%, respectively; eGFR: +18% and -13%, respectively) were similar to what could be calculated using information on analytical and within-subject variation from the literature. There were variable critical differences for the ACR results (median values of -50% for improvement and +67% for deterioration). Only 23% of the participants would recommend a gold standard clearance examination for a patient who was to undergo nephrotoxic chemotherapy. CONCLUSION Questions from GPs about renal parameters are answered differently by laboratory specialists, and adherences to guideline recommendations are low on some issues.
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Affiliation(s)
- Kristin M Aakre
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.
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Dorizzi RM, Katayev A, Horowitz GL, Giannone G, Cambiaso P, Cappa M, Muraca M. Indirect methods for TSH reference interval: at last fit for purpose? Am J Clin Pathol 2011; 135:167-8; author reply 168-9. [PMID: 21173139 DOI: 10.1309/ajcpx4piskjfdt8l] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Plebani M. Interpretative commenting: A tool for improving the laboratory–clinical interface. Clin Chim Acta 2009; 404:46-51. [DOI: 10.1016/j.cca.2009.03.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 03/10/2009] [Indexed: 11/26/2022]
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Vasikaran SD, Lai LC, Sethi S, Lopez JB, Sikaris KA. Quality of interpretative commenting on common clinical chemistry results in the Asia-Pacific region and Africa. Clin Chem Lab Med 2009; 47:963-70. [DOI: 10.1515/cclm.2009.225] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Barlow IM. Are biochemistry interpretative comments helpful? Results of a general practitioner and nurse practitioner survey. Ann Clin Biochem 2008; 45:88-90. [DOI: 10.1258/acb.2007.007134] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Adding or incorporating clinical interpretative comments on biochemistry results is widespread in UK laboratories; although this consumes considerable human resource, there is still little evidence to suggest that it is either effective or appreciated by our clinical colleagues. I therefore decided to survey our local general practitioners (GPs) and nurse practitioners to analyse whether they found biochemistry comments on reports helpful. Methods A simple questionnaire was designed and sent to 159 GPs and 81 nurse practitioners asking them whether they found this activity useful for the limited range of test groups that we routinely comment on and also whether they would like to see commenting on more groups of tests. Results Overall, 49.6% of questionnaires were returned. Of these, there was overwhelming support for commenting on reports and 77% would like to see comments on a greater range of tests. Conclusions Although adding clinical interpretative comments is very time-consuming for senior laboratory staff, there is overwhelming support of this activity among our GPs and nurse practitioner users; therefore, our local policy of routinely adding clinical comments will remain for the foreseeable future.
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Affiliation(s)
- Ian M Barlow
- PathLinks Pathology Department, Scunthorpe General Hospital, Cliff Gardens, Scunthorpe, North Lincolnshire DN15 7BH, UK
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