Risk analysis of the preanalytical process based on quality indicators data

BACKGROUND

Improving quality and patient safety in the medical biochemistry laboratory accredited according to the International Standard Organization (ISO 15189:2012) requires the patient-centered evaluation of errors based on the implementation of quality indicators (QIs) across the total testing process. Our main goal was to achieve quality improvement of the preanalytical process in an emergency laboratory which had the highest error rate using risk management principles.

METHODS

Failure mode and effects analysis (FMEA) was applied to analyze predefined preanalytical QIs and score laboratory failures for the failure demerit value (FDV), probability of failure (PF) and probability of failure remedy (PFR). Based on obtained scores (on a 10-point scale) risk priority numbers (RPNs) were calculated.

RESULTS

A total of five failure modes were identified in the preanalytic process. The calculated risks were "sample hemolysis" (RPN, 168),"misidentified samples" (RPN, 108),"samples clotted" (RPN, 90),"sample volume error" (RPN, 72) and "samples transported at inappropriate temperature" (RPN, 24). The activation of corrective risk-reducing measures for failure modes with RPN≥30 resulted in quality improvement with the significant decrease in reevaluated RPNs.

CONCLUSIONS

The implementation of a preanalytical quality monitoring system based on observation of evidence-based QIs and patient-centered evaluation of errors through risk analysis with regular tailored education as well as implementing process improvements can effectively reduce preanalytical errors in the emergency laboratory and improve patient safety.

The Effect of Seasonal Thermal Stress on Lipid Mobilisation, Antioxidant Status and Reproductive Performance in Dairy Cows

Heat stress is a major factor contributing to low fertility of dairy cows with a great economic impact in dairy industry. Heat-stressed dairy cows usually have reduced nutrient intake, resulting in a higher degree of negative energy balance (NEB). The aim of this study was to investigate the seasonal thermal effect on lipid metabolism, antioxidant activity and reproductive performance in dairy cows. Thirty-two healthy dairy heifers were included in the study. According to the ambient temperature, animals were divided into two groups: winter (N = 14) and summer season (N = 18). Metabolic parameters, paraoxonase-1 (PON1) activity and total antioxidant status (TAS) were monitored at the time of insemination (basal values) and from 1 week before until 8 weeks after calving. Number of services per conception and calving-to-conception (CC) interval were calculated from the farm recording data. Serum triglyceride, non-esterified fatty acids (NEFA) and beta-hydroxybutyrate (BHB) concentrations were significantly increased after calving in summer compared to winter, indicating higher degree of NEB in cows during summer. PON1 activity was significantly decreased after calving in both summer and winter group. TAS concentration was significantly lower in summer than that in winter. A significantly higher number of services were needed for conception in summer compared to winter, and CC interval was significantly longer in summer than that in winter as well. Additionally, reproductive performance significantly correlated with the severity of NEB, suggesting that lipid mobilization and lower antioxidant status contributed to poor reproduction ability in dairy cows during hot months.

Comparison of approaches and measurement of continuing professional development for specialists in laboratory medicine within four European countries

BACKGROUND

This study investigated approaches to continuing professional development (CPD) for specialists in laboratory medicine within four European countries: Croatia, the Czech Republic, Malta and the UK.

METHODS

The research questions focussed on ascertaining if continued registration/licence was linked to CPD and if so, were there requirements for certain amounts and types of CPD and for CPD activities to meet specified accreditation criteria. The Professional Associations Research Network (PARN) model of CPD measurement was applied to each country's registration/licencing body's CPD requirements.

RESULTS

Our results indicate a spectrum of approaches to CPD within participating countries.

CONCLUSIONS

It will be necessary for European employers to be familiar with these differences and to take them into account for this increasingly mobile European workforce.

Trace elements and oxidative stress in hypertensive disorders of pregnancy

PURPOSE

Due to increased metabolic requests, pregnancy can be considered as metabolic stress, especially if associated with oxidative stress triggered by disbalance of pro/antioxidants. The aim of the study was to determine serum concentrations of the trace elements iron (Fe), zinc (Zn) and copper (Cu) important in growth regulation and pro/anti-oxidant homeostasis, in relation to the total serum oxidant capacity (TOC) and total serum antioxidant capacity (TAC) in pregnant women with preeclampsia (n = 30) or with gestational hypertension (n = 30) and in healthy pregnant women (n = 37) and non-pregnant women (n = 30) as control groups expecting common differences between all pregnant women and controls and between preeclampsia and the other pregnancies indicating specific disbalance of the oxidative stress and analyzed trace elements.

METHODS

Serum Fe was determined by spectrophotometric method, Cu and Zn were determined by atomic absorption spectrometry, TOC was determined by Enzymatic ANTIOX-CAP assay and TAC by Peroxide-activity assay.

RESULTS

Serum Cu and TOC were significantly higher while Zn was lower in all pregnant groups regardless of hypertensive disorders. Serum Fe and TAC concentrations were found to be significantly higher in pregnant women with preeclampsia compared to pregnant controls.

CONCLUSION

Increase of TOC in all pregnant women our study points to latent oxidative stress in pregnancy. Fe might have a role in etiopathogenesis of preeclampsia while the increase of TAC in the very beginning of preeclampsia might represent a stressdefence mechanism of the body. It has still to be revealed whether significantly higher serum Fe levels are associated with preeclampsia as a cause or as a consequence of this disorder.

Serum platelet-activating factor acetylhydrolase and paraoxonase-1 activity in horses infected with Leptospira spp

The aim of the study was to investigate the effect of infection with Leptospira spp. in horses on activities of platelet-activating factor acetylhydrolase (PAF-AH) and paraoxonase-1 (PON1) considering the anti-inflammatory/anti-oxidative properties of both enzymes. A total of 63 sport and leisure horses' sera were chosen among those routinely serologically examined on leptospirosis during the year 2009 in Croatia. Sera were divided into three groups according to the estimated level of antibody titre against Leptospira spp; group 1: sera serologically negative to leptospirosis (antibody titre<50) (n=21); group 2: sera with residual or anamnestic antibody titre (50-200) (n=23); group 3: sera with high antibody titre (≥1600) indicating recent Leptospira infection (n=19). Serum PAF-AH and PON1 activity was not significantly different between investigated groups (p>0.05). There were no statistical differences in lipid status parameters (p>0.05) among study groups as well. However, significant positive correlations (p<0.05) of PAF-AH and PON1 with total cholesterol and HDL-C were found. Results may indicate low levels of systemic inflammatory response and oxidative stress in horses with subclinical leptospirosis. Further studies with clinically manifested disease are needed to elucidate the potential role of PAF-AH and PON1 as prognostic markers of the leptospirosis outcome.