Clinical laboratory science : journal of the American Society for Medical Technology最新文献

Objective: To evaluate the use of selective agar and broth combination in a regular laboratory daily workflow.

Design: Swabs from 173 surveillance specimens were inoculated onto half of the Bio-Rad MRSASelect (M), SaSelect (S) and Sheep Blood agars (SBA) and the swab placed in the LIM broth. After overnight incubation, 10 microL of the LIM broth was inoculated onto the other half of the three agars and incubated overnight. All the and examined worked after agars were up approximate 14-18 hours of incubation for day one and two according to the regular workflow of the laboratory, without incubating for the full 24 hours for each incubation day. M agar and SBA were evaluated for Methicillin-Resistant Staphylococcus aureus (MRSA), while the S agar was evaluated for Staphylococcus aureus (SA) based on typical colony morphology development. Colonies on the SBA were picked and processed for definitive identification and cefoxitin susceptibility result.

Setting: Trinity Medical Center, a community hospital with network hospitals

Patients: Patient admitted to the hospital submitted swab for surveillance culture

Results: There were a total of 29 MRSA isolated in the study. On day one, both M agar and SBA detected 14 MRSA (48.3%) and on day two, M agar detected 10 (82.7%), while SBA detected 8 (75.8%) additional MRSA. LIM broth added 5 more MRSA to both agars on day 2, to give M agar a total of 29 (100%) and SBA agar a total of 27 (93.1%) of MRSA from the 173 specimens. There were a total of 62 SA isolated. Both the S agar and SBA isolated 34 (54.8%) on day one and 15 more (79%) on day two. The LIM broth added an additional 13 SA for both agars on day two.

Conclusion: Using half of the agar plate for the initial swab and the other half for the broth creates an economic strategy for the detection of MRSA using the M agar and SA using the S agar. Both the M and S agars provided excellent identification and recovery of MRSA or SA based on color and colony morphology unless the colony was too young for color development. The color morphology from the M and S agars was distinguishable overnight after being subcultured from LIM broth. Working up the specimen according to the workflow of the laboratory without having to wait for each plate to incubate a full 24 hours, can still detect all the targeted organisms within 2 workdays using this cost effective strategy.

From 2006 through 2008, patient safety events cost the Medicare program $8.9 billion and were associated with 99,180 hospital deaths. Of the $2.5 trillion spent on healthcare in 2009, 2.3% or $57.5 million was spent on laboratory costs. Reduction of laboratory-associated errors to 3.4 errors per 1 million tests could save money and lives. The organizational culture of a facility has an impact on quality improvement implementation. Clinical laboratories in Mississippi were surveyed to determine the predominant culture type as perceived by the medical laboratory professionals. Of the 1200 surveys mailed to 90 facilities, 272 were returned complete. It was determined that although the individual participant return rate was 28.6%, 49 of the 90 hospitals or 54.4% of the Mississippi facilities were represented through one or more individual participant responses. The culture scores revealed the following distribution for the individual respondents: group/clan culture scores were predominant for 106 (39.0%), hierarchical culture scores for 94 (34.6%), rational/market culture scores for 36 (13.2%), and developmental/adhocratic culture scores for 24 (8.8%) of the individual respondents. The remaining 12 (4.4%) individuals reported blended or codominant culture scores with 50% claiming a group/clan and hierarchical split. The consolidation of the data to represent the 49 healthcare institutions revealed a different distribution, with 24 (49%) as hierarchical culture, 22 (44.9%) as group/clan culture, and 3 (6.1%) as rational/market culture. Mississippi hospital data parallels previous findings with either hierarchical or group being the predominant organizational culture.

The Abstract Review Committee (ARC) has an ongoing objective of encouraging abstract submissions for the American Society of Clinical Laboratory Science's (ASCLS) Annual Meeting. The purpose of this research study was to survey ASCLS members to determine the cause of historically low abstract submissions and how submissions could be increased. An electronic survey was developed and sent to ASCLS members via electronic mail blast. The survey focused on five areas: 1) participant demographics, 2) positives and negatives of the current submission and review process, 3) suggestions for improvement, 4) barriers to participation, and 5) level of attendance at poster and oral presentation sessions at annual meetings. Results of the survey indicated that the foremost reason cited for not submitting an abstract was lack of active research. The ARC believes limited research activity is due to the lack of educational preparedness of educators and practitioners to conduct research.

The adrenal gland, while small in size, provides a major punch to human metabolism. The interplay between the adrenal cortex hormones aldosterone and cortisol provides needed regulation to human metabolism. Aldosterone regulates the body sodium content affecting blood pressure thru fluid-volume regulation by the kidney. Cortisol, also from the adrenal cortex, contributes to regulation of glucose and protein metabolism. Diseases like addison's disease and Cushing's syndrome that affect the normal levels of these hormones can lead to serious pathologies that need to be detected thru clinical laboratory testing. The inner core of the adrenal gland, called the medulla, houses the catecholamine epinephrine, a fast acting neuropeptide hormone that can influence body action and energy levels quickly. The pheochromocytomas pathology of the adrenal medulla adversely affects the medulla hormones and needs to be recognized by clinical laboratory testing. The overview of the adrenal gland and its potential pathologies needs to be looked at anew in relation to post-traumatic stress disorder to find any linkage that may aid in the treatment and cure of our affected military soldiers. This interrelationship between cortisol and epinephrine in PTSD should be closely evaluated to determine if the suspected linkages are significant.

Objective: Glucose levels decrease in whole blood in vitro, but there are several methods that minimize the loss, including special tubes and ice. This study evaluated whether sedimentation by gravity in an upright position was a viable alternative.

Design: Lithium heparinized blood was collected from 20 individuals without a diagnosis of diabetes. The samples were allowed to sediment at ambient temperature and were tested in quadruplicate at 30 minute intervals. A Repeated Measures ANOVA compared the means of each time-point.

Results: Plasma glucose results were not statistically different between 30 minutes and 60 minutes after collection (p = 0.156). At 90 minutes after collection, glucose was significantly different than the initial glucose readings (p <0.001). Each reading thereafter also showed a statistically significant difference from the initial reading.

Conclusions: Samples for glucose measurement are stable in lithium heparin for no longer than 60 minutes when held in an upright position prior to centrifugation.