British Journal of Biomedical Science最新文献

This paper describes a planned, continuous improvement journey, of a laboratory that has installed a system with a single sample touch from blood draw to result. To achieve this, physical connectivity of systems from phlebotomy through pre-analytical to the analytical phase were paired with informatics connectivity from the patient's national identity card to the hospital and laboratory informatics management systems (LIMS) and associated middleware. This allowed accurate time stamps to track turnaround time (TAT). TAT metrics were collected from the LIMS for inpatient, emergency room and outpatient samples and tests over a period of 7 months. This time span incorporated the 2-month period before automation was implemented. The results for all tests and specific tests are shown and the results of an analysis of the outpatient phlebotomy workflow are given. The implemented solution has improved outpatient TAT by over 54% and has shown that samples can be collected, and results obtained without touching the sample. Improving intra-laboratory TAT is an important quality goal for all laboratories. The implementation of automation is important in achieving this albeit more about obtaining predictable TAT. Automation does not necessarily improve TAT it removes variation which leads to predictable TAT (PTAT). Automation should only be considered with a strategic vision for the future as it is important to have clear goals and objectives based on the individual laboratories process and needs. Automating a poor process leads to an automated poor process. Here, an innovative use of automation, hardware and software has resulted in marked improvement in TAT across all samples processed in the central laboratory.

Diagnosis of superficial/cutaneous fungal infections from skin, hair and nail samples is generally achieved using microscopy and culture in a microbiology laboratory, however, any presentation that is unusual or subcutaneous is sampled by taking a biopsy. Using histological techniques a tissue biopsy enables a pathologist to perform a full examination of the skin structure, detect any inflammatory processes or the presence of an infectious agent or foreign body. Histopathological examination can give a presumptive diagnosis while a culture result is pending, and may provide valuable diagnostic information if culture fails. This review demonstrates how histopathology contributes to the diagnosis of fungal infections from the superficial to the life threatening.

The COVID-19 pandemic had a wide global impact on society, including the clinical laboratory workforce. This historically underrepresented group of highly skilled professionals have now started to gain the attention they deserve. There had already been dramatic changes to laboratory training over the past 2 decades resulting from advances in technology, changes to service needs, and as a consequence of Pathology reform initiatives. The pandemic has had an additional impact. Higher education institutions and students adapted to emergency remote teaching. Clinical laboratories faced unprecedented challenges to meet COVID-19 testing demands and adjust to new ways of working whilst maintaining their usual high quality service provision. Training, assessment, and development arrangements had to convert to online platforms to maintain social distancing. The pandemic also had a global impact on mental health and wellbeing, further impacting learning/training. Despite these challenges, there have been many positive outcomes. This review highlights pre- and post-pandemic training and assessment for clinical laboratory professionals, with particular emphasis on Biomedical Scientists, outlining recent improvements among a history of challenges. There is increasing interest surrounding this vital workforce, accelerated thanks to the pandemic. This new public platform has emphasised the importance of quality diagnostic services in the patient pathway and in the response to national crises. The ability to maintain a quality service that is prepared for the future is grounded in the effective training and development of its staff. All of which can only be achieved with a workforce that is sustainable, invested in, and given a voice.

Gout with associated AA amyloidosis is an unusual finding. This form of amyloid is associated with chronic inflammatory changes often associated with amyloid deposits in the urine, as well as tissue involvement, and organ enlargement in some cases. The large majority of cases in the literature to date refer to gout with AA amyloid within the kidney. However, this is not exclusive, with reports in the liver, gastrointestinal tract, adrenal glands rectum, skin, and subcutaneous fat. The pathophysiological association between these two disease processes is open to debate. The employment of specific anti-inflammatory treatments is believed to have an impact on reducing the incidence of AA amyloidosis in some gout cases-notably the use of colchicine in cases of clinically defined gout attacks. However, this is by no means a universal finding. Here we report on a cutaneous case of gout with AA amyloidosis in a 73-year-old man Included in this case study is a review of the other 16 cases reported within the literature in an attempt to clarify the associated pathophysiological process between these two diseases and the anti-inflammatory treatment regimens employed which may impact the occurrence of AA amyloidosis.

Introduction: Scientific communication, particularly the dissemination of research findings to both the scientific community and the general public, are skills required of graduates embarking on post-graduate studies and employment within the biomedical sciences sector. The aims of this action research project were to i) co-design an online scientific communication and digital capabilities resource, constructively aligned to the learning objectives of a final year undergraduate investigative research project; ii) ensure resource flexibility for future adaptation by others iii) embed authentic scientific communication learning assessments, namely, the preparation of a lay summary and visual abstract and iv) promote students' awareness of developed digital capabilities and transferable skills through written reflection. Materials and Methods: Student engagement, self-efficacy, experiences and performance and staff perceptions (n = 15) were evaluated by a mixed methods approach. Qualitative data was gathered from focus sessions, free text responses within questionnaires and content analysis of students' written reflections (n = 104). Quantitative data from 5-point Likert responses within student questionnaires (n = 31) and analysis of student scientific and lay writing (n = 146) using the readability parameters Flesch-Kincaid Grade Level and Flesch Reading Ease were analysed using non-parametric statistical methods. Results: A learning resource was co-designed with students, staff, local, national and international contributors and valued by both students and staff, enabling students to prepare scientific communication outputs of a professional standard by application of digital, analytical and scientific communication skills. Students prepared lay summaries which were statistically (p < 0.0001) more readable than their paired scientific abstracts. Significant correlations between easier readability of lay summaries and awarded marks for the written elements of the module were noted. Students reported their digital and communication capabilities increased significantly (p < 0.0001) throughout, from limited to good/excellent and reflected on the numerous transferable skills developed during preparation of assessments, with 75% reflecting on their digital capabilities. Discussion: Undergraduate students developed, appreciated and used varied scientific communication and digital skills to articulate research findings. The embedding of such activities throughout all levels of higher education will enable students to develop their digital and scientific skills and reflect on the development of such transferable skills for application in their future careers.

Background: Provision of "dry-lab" final year honours projects, based outside the laboratory, have been proposed as a viable alternative to traditional "wet-lab" projects in bioscience subjects, but their value has not been widely evaluated to date. In 2020-21, the COVID-19 pandemic meant all students in the School of Biomedical Sciences at Ulster University (UU) undertook dry-lab projects, due to campus lockdown. Therefore, this provided an ideal opportunity to evaluate the provision of dry-lab projects in a large student cohort. Methods: A pilot group of final year students (n = 4) studying Biomedical Science at UU were interviewed to evaluate their experience of conducting a dry-lab project. This evaluation and the themes that emerged were subsequently used to inform the co-creation of a survey to appraise student experience of dry-lab research project learning across the final year student cohort in School of Biomedical Sciences (n = 140). Quantitative and qualitative data was collected and analysed for trends and themes. Results: The results of this project identified four main themes related to dry-lab projects; expectations, skills & employability, quality of experience and choice. Student expectations about dry-lab projects were not dramatically changed, although initial negative opinions of some individuals were over-turned. Most students recognised that they had developed many useful employability skills through dry-lab projects, although lack of practical laboratory experience was still perceived as a drawback. Student experience was influenced by personal circumstances but students reporting poor project experience had significantly lower levels of communication with supervisor (p < 0.05). Most students agreed that choice of dry- and wet-lab projects would be valuable for future cohorts. Conclusion: This report concludes that dry-lab project provision can be a suitable and equitable alternative for wet-lab projects. Dry-lab projects can be valuable for learning new skills and may be an attractive option for some students and supervisors who prefer to work outside the laboratory setting. A choice of both dry-lab and wet-lab projects is highly recommended as it provides more choice for students to tailor their final year experience to their individual circumstances, strengths and future career aspirations.

As part of the Biomedical Sciences undergraduate degree course students are required to apply biological principles to the interpretation of clinical case studies and the diagnosis of patients. Case study-based learning, i.e., application of knowledge to patient diagnosis, is new to most students as case studies do not form part of non-applied A level courses in biological sciences. This approach is an example of Problem Based Learning (PBL) which has been shown to support higher levels of student learning, encouraging critical thinking and analysis. PBL approaches have also been shown to increase academic satisfaction and student engagement. In recent years we have observed a downwards trend in student engagement and historically student performance in applied case study-based assessments to be lower than that observed for assessments based on detailing fundamental biological principles. We hypothesised that PBL teaching delivery would support students in preparing for case study-based assessments, helping them to demonstrate their critical evaluation and problem-solving skills, and hence, improve student performance. We also hypothesised that the student learning experience would be enhanced by a PBL teaching delivery approach which would improve overall engagement. We therefore redesigned a second year Biomedical Sciences degree haematology and clinical biochemistry unit: "Blood Science," with a stronger focus on PBL, including case study focussed activities throughout the unit. We subsequently analysed whether this PBL-focussed unit design improved student experience and feedback, student engagement and student confidence for biomedical science undergraduate students. We present here, our teaching strategy and the impact our changes had on student feedback for the 21/22 and 22/23 academic years. Our findings demonstrate that case study-based activities and tutorial PBL exercises, when incorporated into the curriculum design, can improve student experience in the Biomedical Sciences and other biological science undergraduate degree courses.

Environmental contamination is estimated to contribute to up to 20% of all hospital acquired infections. Acinetobacter baumannii is an example of one the most prevalent opportunistic pathogens causing severe and persistent infections in immunocompromised patients. It has proven ability to form biofilms, has significant associated multi-drug resistance and is able to transfer mobile genetic elements to other clinically relevant pathogens. All of these factors point to a definite utility of A. baumannii as an indicator organism for effectiveness of decontamination regimens as well as environmental screening. There is an increased cost, both financial and clinical, associated with multi drug resistant organisms, carbapenem resistant A. baumannii. With a dearth of new antimicrobials in development, now is the time to radically transform and lead the introduction of scientifically based environmental screening and microbiological verified decontamination to control the dissemination of further resistance.

Background: Diagnosis of hyperparathyroidism requires measurement of parathyroid hormone (PTH) in the context of the plasma calcium and other factors, such as vitamin D status and renal function. Accurate classification depends upon an appropriate population reference interval. We examined local population plasma PTH reference intervals at four different UK sites using a common platform. Methods: Plasma PTH results were extracted from laboratory information systems at four different UK sites, all using the Abbott Architect i2000 method. We included only people with normal adjusted serum calcium, magnesium, vitamin D, and renal function. Following outlier rejection lower and upper reference limits were derived. Results: An overall reference interval for plasma PTH of 3.0-13.7 pmol/L was observed using a non-parametric approach compared to 2.9-14.1 pmol/L using a parametric approach, notably higher than the manufacturer's representative range of 1.6-7.2 pmol/L. We also noted statistically significant differences (p < 0.00001) between some sites with upper limits ranging from 11.5 to 15.8 pmol/L which may be due to different population characteristics of each group. Conclusion: Locally derived reference intervals may be beneficial for UK populations and revised upper thresholds are necessary when using the Abbott PTH method to avoid inappropriate classification of patients as having hyperparathyroidism.

Antimicrobial resistance (AMR) has now emerged as a chronic public health problem globally, with the forecast of 10 million deaths per year globally by 2050. AMR occurs when viruses, bacteria, fungi and parasites do not respond to antimicrobial treatments in humans and animals, thus allowing the survival of the microorganism within the host. The prominent cause contributing to the current crisis remains to be the overuse and misuse of antimicrobials, particularly the inappropriate usage of antibiotics, increasing the global burden of antimicrobial resistance. The global consumption and usage of antibiotics are therefore closely monitored at all times. This review provides a current overview of the implications of strategies used by international governmental organisations, including the UN's 17 Sustainable Development Goals (SDGs), to address the problem of antibiotic resistance, as well as the "One Health Approach," a system incorporating a multidisciplinary effort to achieve the best possible health outcome by acknowledging the clear connections between humans, animals and their shared environment. The importance of public awareness and health literacy of lay audiences still needs to be further emphasised as part of global and local action plans. Antimicrobial resistance continues to be a major global public health dilemma of the 21st century. Already this topic is receiving substantial political input from the G7 countries and continues to be on the agenda of numerous political conferences. The consequences of failure to adequately address AMR are profound, with estimations of a return to the pre-antibiotic era, where everyday infections relating to childbirth, surgery and open fractured limbs could be potentially life-threatening. AMR itself represents a microcosm of factors, including social anthropology, civil unrest/war, diasporas, ethnic displacement, political systems, healthcare, economics, societal behaviour both at a population and individual level, health literacy, geoclimatic events, global travel and pharmaceutical innovation and investment, thus finding a solution that adequately addresses AMR and which helps stem further AMR emergence is complicated. Success will involve individuals, communities and nations all working together to ensure that the world continues to possess a sufficient armamentarium of effective antimicrobials that will sustain human and animal health, both now and in the future.