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Virtual Learning: The Development of Case Study Based Lab Simulation in the Clinical Laboratory Science Undergraduate Curriculum 虚拟学习:基于案例研究的实验室模拟在临床检验科学本科课程中的发展
Stephanie Cochrane
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引用次数: 0
Pathophysiology of Thrombotic Thrombocytopenia Purpura 血栓性血小板减少性紫癜的病理生理学
Larry Smith

ABSTRACT

This review describes classic thrombotic thrombocytopenic purpura (TTP), discusses the pathogenesis of acquired and congenital TTP, describes clinical and laboratory manifestations observed in patients, and lists options for treating patients with TTP. TTP is a rare hematologic disorder characterized by thrombocytopenia and microangiopathic hemolytic anemia. It results from a congenital or acquired deficiency of a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS-13), in plasma. Most cases are caused by an autoimmune mechanism that interferes with ADAMTS-13; however, rare inherited forms of TTP have been described (e.g., Upshaw-Schulman syndrome). It is still considered a life-threatening disease with a mortality rate of 10%–20%. Severe deficiency of ADAMTS-13 (<10%) is most often associated with congenital TTP. Although TTP is a serious hematologic emergency that is almost always fatal in untreated cases, an understanding of its pathophysiology can lead to successful treatment strategies, resulting in improved patient care and outcomes.
本文综述了典型的血栓性血小板减少性紫癜(TTP),讨论了获得性和先天性TTP的发病机制,描述了患者观察到的临床和实验室表现,并列出了TTP患者的治疗方案。TTP是一种罕见的血液学疾病,以血小板减少和微血管病溶血性贫血为特征。它是由血浆中具有1型凝血反应蛋白基元的崩解素和金属蛋白酶13 (ADAMTS-13)的先天性或获得性缺乏引起的。大多数病例是由自身免疫机制干扰ADAMTS-13引起的;然而,罕见的遗传形式的TTP已被描述(例如,厄普肖-舒尔曼综合征)。它仍然被认为是一种危及生命的疾病,死亡率为10%-20%。严重缺乏ADAMTS-13(10%)通常与先天性TTP有关。尽管TTP是一种严重的血液学急症,在未经治疗的病例中几乎总是致命的,但对其病理生理学的理解可以导致成功的治疗策略,从而改善患者的护理和结果。
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引用次数: 0
Utilization of Apple iPads in Student Clinical Rotations to Improve Safety and Streamline Information Access 在学生临床轮转中使用苹果ipad提高安全性和简化信息获取
Jenica L. Harrison, Lisa Perkins, Teresa Nadder

ABSTRACT

American Society for Microbiology Guidelines for Biosafety in Teaching Laboratories (2012) state that educators must use best practices to minimize risk of biohazard contamination to students. Integrating mobile digital devices into medical laboratory science (MLS) programs’ clinical training is potentially one means of reducing this risk. The purpose of this pilot project was to ascertain attitudes from students and clinical educators on using mobile devices as a laboratory benchside educational tool during clinical rotations as a novel alternative to paper materials. In this study, 3 senior-level MLS students used Apple iPads in concert with Google Drive in lieu of paper manuals during Hematology and Transfusion Medicine clinical rotations at Virginia Commonwealth University Health (VCUH). Two VCUH clinical educators from these laboratories also participated. All participants were trained on usage and access of electronic material on the iPads as well as proper cleaning of the devices. Prestudy surveys were used to assess attitudes toward mobile devices. Focus groups, for students and clinical educators, separately, were conducted after completion of the clinical rotations. The results of the study indicate that advantages of employing mobile devices include improvement of safety by eliminating transfer of paper worksheets from laboratory to the outside, ability to electronically monitor students’ progress through clinical laboratory rotations, and ease of accessibility to electronic references at the benchside. Information gained from this pilot study implies that mobile devices can be used to decrease contamination risk while serving as a state-of-the-art educational tool on the laboratory benchside. Potential applications of mobile devices within the clinical laboratory include: (1) recording and tracking instrument maintenance, (2) tracking personnel training and competences, and (3) tracking reagent inventory.
美国微生物学会《教学实验室生物安全指南》(2012)指出,教育工作者必须采用最佳做法,以尽量减少对学生的生物危害污染风险。将移动数字设备整合到医学实验室科学(MLS)项目的临床培训中可能是降低这种风险的一种方法。该试点项目的目的是确定学生和临床教育工作者对在临床轮转期间使用移动设备作为实验室台式教育工具作为纸质材料的新颖替代品的态度。在本研究中,3名MLS高年级学生在弗吉尼亚联邦大学健康中心(VCUH)血液学和输血医学临床轮转期间使用Apple ipad和谷歌Drive来代替纸质手册。来自这些实验室的两名VCUH临床教育工作者也参加了会议。所有参与者都接受了ipad上电子材料的使用和访问以及设备的正确清洁方面的培训。研究前调查被用来评估人们对移动设备的态度。焦点小组,分别为学生和临床教育工作者,在完成临床轮转后进行。研究结果表明,使用移动设备的优势包括通过消除将纸质工作表从实验室转移到外部来提高安全性,能够通过临床实验室轮转来电子监控学生的进展,以及易于在工作台获取电子参考资料。从这项初步研究中获得的信息表明,移动设备可以用来降低污染风险,同时作为实验室工作台上最先进的教育工具。移动设备在临床实验室的潜在应用包括:(1)记录和跟踪仪器维护,(2)跟踪人员培训和能力,(3)跟踪试剂库存。
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引用次数: 0
Innovative Approach to Moderating Risk of Nosocomial Infection During Anesthesia 降低麻醉期间医院感染风险的创新方法
Thomas Corey Davis, Beverly George Gay, Melissa Jamerson, Sarah A. Marrs, Ronsard Daniel, Chuck J. Biddle

ABSTRACT

Infection control concerns abound in the surgical anesthesia workstation, placing patients and providers at significant, documented risk because of many factors, including provider hand hygiene lapses, equipment design and complexity, and challenging disinfection. A trial was performed to mitigate cross-contamination involving 30 general anesthesia surgical operations matched 1:1 as control (no intervention) or intervention group (condom-like barriers to 4 anesthesia workstation components that are frequently touched and contaminated and very difficult to disinfect). Wraps were removed at the end of the operation and then replaced with fresh ones before the start of the subsequent operation. Baseline culture samples were obtained prior to the first surgical operation of the day in each room and then performed on operations that followed in each room over a 3-day period. Baseline colony-forming unit density was equivalent in both conditions with total density significantly lower in the covered/wrapped (mean rank = 5.81) vs uncovered condition (mean rank = 11.19) at P < 0.01, r = −0.64. Bacterial species diversity was markedly decreased in the covered condition. The covered condition served as a barrier to contamination of apparatus elements, preventing downstream patient exposure and mitigating between-procedure disinfection need. Intervention group providers were debriefed, finding only rare, addressable concerns. This research further validates the need for routine, periodic culturing of anesthetic apparatus to reveal lapses in provider behaviors and disinfection practices.
手术麻醉工作站的感染控制问题比比皆是,由于许多因素,包括提供者的手部卫生失误、设备设计和复杂性,以及具有挑战性的消毒,使患者和提供者处于显著的、有记录的风险中。为了减少交叉污染,我们进行了一项试验,选取30例全麻手术,按1:1的比例作为对照组(无干预组)和干预组(对4个经常接触和污染且很难消毒的麻醉工作站部件设置避孕套状屏障)。在手术结束时取出包裹,然后在后续手术开始前换上新的包裹。在每个房间当天的第一次手术之前获得基线培养样本,然后在每个房间进行为期3天的后续手术。两种条件下的基线菌落形成单位密度相等,P <时,覆盖/包裹条件下的总密度(平均等级= 5.81)显著低于未覆盖条件下的总密度(平均等级= 11.19);0.01, r =−0.64。覆盖条件下细菌种类多样性明显降低。被覆盖的条件作为仪器元件污染的屏障,防止下游患者接触并减轻手术之间的消毒需求。对干预小组的提供者进行了汇报,只发现了一些罕见的、可解决的问题。本研究进一步验证了常规、定期培养麻醉器械的必要性,以揭示提供者行为和消毒实践中的失误。
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引用次数: 0
Pilot Program in Clinical Microbiology Laboratory Simulation for MLS Students MLS学生临床微生物实验室模拟试点项目
Angela Wilson

ABSTRACT

Medical laboratory science educational programs face the challenge of placing students for clinical practica/rotations. In a nonmedical university, this has been particularly true for clinical microbiology pracetica as local health care systems centralize microbiology, serology, and molecular testing services with smaller hospitals, which house “stat labs” only. Encouraged by the success of an immunohematology simulation practicum implemented over 15 years ago, in the summer 2018 faculty piloted a clinical microbiology simulation laboratory to satisfy entry-level practical competency requirements. The pilot program consisted of 3 weeks of on-campus laboratory simulation followed by a 2-week hospital clinical experience, as opposed to 5 weeks in the clinical setting in the traditional practicum. In the laboratory simulation, students completed clinical microbiology evaluations on all clinical specimen types. Identification techniques included bench-top tests, automated identification, and antibiotic susceptibility testing. Students used rapid-kit tests and performed quality control. Upon completion of the students’ practicum final examination and the microbiology section of the comprehensive program exit examination, faculty evaluated student learning using 2-sample t-tests to establish if statistically significant differences existed in the scores achieved by students enrolled in the pilot versus the traditional model. We hypothesized that no such differences would exist. There were no statistically significant differences among the postpracticum examination results achieved by both groups (P < 0.05). We conclude that students had an equally valuable learning experience in both practicum models and plan to expand the on-campus simulation to alleviate clinical site shortage.
医学检验科学教育项目面临着将学生安排到临床实习/轮转的挑战。在非医科大学中,临床微生物学实践尤其如此,因为当地的卫生保健系统将微生物学、血清学和分子检测服务集中在小型医院,这些医院只有“国家实验室”。受15年前实施的免疫血液学模拟实习成功的鼓舞,在2018年夏季,教师试点了临床微生物学模拟实验室,以满足入门级实践能力要求。该试点项目包括3周的校内实验室模拟,随后是2周的医院临床体验,而传统的实习是5周的临床环境。在实验室模拟中,学生完成了所有临床标本类型的临床微生物学评估。鉴定技术包括台式试验、自动鉴定和抗生素敏感性试验。学生们使用快速试剂盒测试并进行质量控制。在完成学生的实习期末考试和综合项目退出考试的微生物学部分后,教师使用2样本t检验来评估学生的学习情况,以确定参加试点的学生与传统模型的学生取得的分数是否存在统计学上的显著差异。我们假设不存在这样的差异。两组学生实习后考试成绩差异无统计学意义(P <0.05)。我们的结论是,学生在两种实习模式中都有同样宝贵的学习经验,并计划扩大校园模拟以缓解临床场地的短缺。
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引用次数: 0
An Overview of the Laboratory’s Role in the Diagnosis and Treatment of Thrombotic Thrombocytopenic Purpura 实验室在诊断和治疗血栓性血小板减少性紫癜中的作用综述
Billie Ketelsen

ABSTRACT

Thrombotic thrombocytopenic purpura (TTP) is a multifaceted disease for a clinical laboratory with diagnosis data and treatment spread across many different laboratory sections. By encompassing results from hematology, chemistry, molecular, and coagulation sections with treatment from the transfusion medicine/blood bank section of the laboratory, clinicians are able to accurately diagnose and treat TTP.
血栓性血小板减少性紫癜(TTP)是一种临床实验室的多方面疾病,诊断数据和治疗分布在许多不同的实验室部门。通过将血液学、化学、分子和凝血切片的结果与实验室输血医学/血库部门的治疗相结合,临床医生能够准确地诊断和治疗TTP。
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引用次数: 0
The Clinical Significance ofStaphylococcus aureusSmall Colony Variants 金黄色葡萄球菌小菌落变异的临床意义
Klara C. Keim, Isaiah K. George, Landrye Reynolds, Allie Clinton Smith

ABSTRACT

A burdensome, atypical phenotype of Staphylococcus aureus (SA) called SA small colony variants (SCVs) has been identified, which is induced because of a combination of environmental stressors, including polymicrobial interactions. SA-SCVs exhibit altered phenotypes because of metabolic dormancy caused by electron-transport deficiency, which leads to increased biofilm production and alterations to antimicrobial susceptibility. SA-SCVs typically exhibit altered colony morphology and biochemical reactions compared with wild-type SA, making them difficult to detect via routine diagnostic procedures. SA-SCVs have been found to contribute to chronic or recurrent infections, including skin and soft-tissue infections, foreign-body–associated infection, cystic fibrosis, and sepsis. There is evidence that SA-SCVs contribute to patient morbidity and mortality rates because of diagnostic difficulties and limited treatment options. New detection methods may need to be developed that can be incorporated into routine diagnostic procedures, which would allow for better assessment of specimens and introduce new considerations for management.
金黄色葡萄球菌(SA)的一种沉重的非典型表型被发现,称为SA小菌落变异(SCVs),它是由环境应激因子的组合诱导的,包括多微生物的相互作用。由于电子传递缺陷引起的代谢休眠,sa - scv表现出表型改变,这导致生物膜的产生增加和抗菌敏感性的改变。与野生型SA相比,SA- scv通常表现出改变的菌落形态和生化反应,这使得它们难以通过常规诊断程序检测到。已发现sa - scv可导致慢性或复发性感染,包括皮肤和软组织感染、异物相关感染、囊性纤维化和败血症。有证据表明,由于诊断困难和治疗选择有限,sa - scv增加了患者的发病率和死亡率。可能需要开发可纳入常规诊断程序的新检测方法,以便更好地评估标本并为管理引入新的考虑因素。
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引用次数: 0
Laboratory Findings in Hematology, Clinical Chemistry, and Urinalysis for Patients With Thrombotic Thrombocytopenic Purpura 血栓性血小板减少性紫癜患者血液学、临床化学和尿液分析的实验室结果
Kathy Doig, Susan McQuiston

ABSTRACT

Laboratory diagnosis of thrombotic thrombocytopenic purpura (TTP) often begins with routine laboratory tests; a complete blood count, clinical chemistry panel, and urinalysis. The classical findings may include anemia with schistocytes, thrombocytopenia, reticulocytosis or polychromasia, bilirubinemia, dark urine, and hemoglobinuria without red blood cells in the sediment. Additional findings, including decreased haptoglobin, can identify fragmentation as the cause for the hemolysis. The hemolysis in TTP arises from increased shear stress on red blood cells in arterioles and capillaries narrowed by microthrombi. Hemoglobinemia and schistocytes may generate spurious results in hematology analyzers that require correction before results can be released to the patient chart.
血栓性血小板减少性紫癜(TTP)的实验室诊断通常从常规实验室检查开始;全血细胞计数,临床化学检查和尿液分析。典型的表现可能包括贫血伴裂细胞、血小板减少、网状红细胞增多症或多色症、胆红素血症、深色尿和无红细胞沉淀的血红蛋白尿。其他发现,包括接触珠蛋白降低,可以确定碎片化是溶血的原因。TTP的溶血是由于微血栓使小动脉和毛细血管中的红细胞受到的剪切应力增加而引起的。血红蛋白血症和血吸虫细胞可能在血液学分析仪中产生虚假结果,需要在结果发布到患者图表之前进行纠正。
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引用次数: 0
Interprofessional Education: A Pilot for Future Collaboration 跨专业教育:未来合作的试点
Lisa Hochstein

ABSTRACT

Interprofessional education (IPE) has become an integral pedagogy within the St. John’s University College of Pharmacy and Health Sciences Department of Clinical Health Professions. An interprofessional case study activity was developed and incorporated into the Clinical Laboratory Sciences (CLS) and Physician Assistant (PA) programs. A pneumonia case involving aspects of patient care relevant to both programs was created. To not interfere with courses currently in progress for both programs, the event occurred during lunch hour and both programs asked for student volunteers. Ten students in total participated. Students worked together to better understand each other’s role in diagnosing the patient, emphasizing team practice. PA students illustrated techniques in history and physical examination. CLS students then led the PA students into a mock laboratory and shared examples of pneumococcal plating and microscopic isolation for diagnosis confirmation. At the conclusion of the event, students evaluated their experience. Using role perception questionnaires, CLS and PA students indicated greater perceived value for one another’s profession at activity completion. Evaluations indicated that students felt this was a worthwhile experience and that they learned a lot about each other’s role in patient care. They also indicated that they would like to have similar programs in the future.
跨专业教育(IPE)已经成为圣约翰大学药学与健康科学学院临床卫生专业不可或缺的教学方法。一个跨专业的案例研究活动被开发并纳入临床实验室科学(CLS)和医师助理(PA)计划。创建了一个肺炎病例,涉及与两个项目相关的患者护理方面。为了不影响两个项目目前正在进行的课程,活动发生在午餐时间,两个项目都要求学生志愿者。共有10名学生参加。学生们一起工作,以更好地了解彼此在诊断患者中的作用,强调团队实践。PA学生讲解历史和体格检查的技巧。CLS学生随后带领PA学生进入模拟实验室,并分享肺炎球菌电镀和显微镜分离确诊的例子。在活动结束时,学生们对他们的经历进行了评价。使用角色感知问卷,CLS和PA学生在活动完成时对彼此的职业有更高的感知价值。评估表明,学生们认为这是一次有价值的经历,他们对彼此在病人护理中的作用学到了很多。他们还表示,他们希望在未来有类似的计划。
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引用次数: 0
Increasing Awareness of Medical Laboratory Science through Summer Outreach Programs 通过暑期拓展计划提高医学实验室科学的意识
Lindsey Clark

ABSTRACT

A common challenge in the medical laboratory science (MLS) profession is that it does not often receive the attention it deserves. In an effort to overcome this issue, increase awareness of MLS as a career, and expand recruitment efforts to high school students, the Department of Laboratory Sciences faculty developed a hands-on laboratory experience to be implemented into existing summer outreach programs on the University of Arkansas for Medical Sciences campus. Participants in the outreach program included 175 high school students from rural areas of the state. This experience involved participants completing a process of DNA extraction using the Bio-Rad Genes in a BottleTM Kit and viewing a presentation highlighting the MLS profession, program prerequisites, laboratory career opportunities, and salary outlook. A post-experience survey was given to the participants with a 77% response rate. Results showed the overwhelming majority of participants enjoyed the laboratory activity. A total of 53% of survey participants indicated they did not have knowledge of the MLS profession prior to the activity, with 93% indicating the presentation and activity provided a better understanding of the field. While 24% of respondents indicated they were interested in pursuing a career in laboratory sciences, 48% would consider MLS as a steppingstone into another health care–related field. Implementing a laboratory component into existing summer programs proved to be an effective method for program outreach and recruitment among high school students. The department plans to continue offering this experience for future summer outreach opportunities.
医学实验室科学(MLS)行业面临的一个共同挑战是,它往往没有得到应有的重视。为了克服这一问题,提高人们对MLS作为一种职业的认识,并扩大对高中生的招聘力度,实验室科学系的教师开发了一个动手实验室经验,并将其应用于阿肯色大学医学院校园现有的暑期拓展项目中。参加外展项目的有175名来自该州农村地区的高中生。在这一体验中,参与者使用BottleTM试剂盒中的Bio-Rad基因完成了DNA提取过程,并观看了MLS专业、项目先决条件、实验室职业机会和薪资前景的介绍。对参与者进行了一项经验后调查,回复率为77%。结果显示,绝大多数参与者都喜欢实验室活动。共有53%的调查参与者表示,他们在活动之前并不了解MLS专业,93%的受访者表示,演讲和活动让他们更好地了解了该领域。24%的受访者表示,他们有兴趣从事实验室科学方面的职业,48%的人认为MLS是进入另一个医疗保健相关领域的垫脚石。在现有的暑期课程中加入实验室部分被证明是一种有效的方法,可以在高中学生中进行项目推广和招聘。该部门计划在未来的夏季拓展机会中继续提供这种体验。
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引用次数: 0
期刊
Clinical laboratory science : journal of the American Society for Medical Technology
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