Current Status of Quality Assurance Scheme in Selected Undergraduate Medical Colleges of Bangladesh

This descriptive cross sectional study was carried out to determine the current status of Quality Assurance Scheme in undergraduate medical colleges of Bangladesh. This study was carried out in eight (four Government and four Non- Government) medical colleges in Bangladesh over a period from July 2015 to June 2016. The present study had an interview schedule with open question for college authority and another interview schedule with open question for head of department of medical college. Study revealed that 87.5% of college had Quality Assurance Scheme (QAS) in their college, 75% of college authority had regular meeting of academic coordination committee in their college, 50% of college had active Medical Education Unit in their college, 87.5% of college authority said positively on publication of journal in their college. In the present study researchers interviewed 53 heads of department with open question about distribution, collection of personal review form, submission with recommendation to the academic co-coordinator, and annual review meeting of faculty development. The researchers revealed from the interviews that there is total absence of this practice which is directed in national guidelines and tools for Quality Assurance Scheme (QAS) for medical colleges of Bangladesh. Bangladesh Journal of Medical Education Vol.13(1) January 2022: 33-39

P–792 The introduction of an embryo morphokinetics annotation quality assurance scheme across ten fertility clinics including 59 participants

Study question Can a group-wide quality assurance scheme be developed to effectively determine inter-operator agreement for morphokinetic parameters of interest. Summary answer Very strong agreement was found between all operators except for one, therefore this scheme effectively identified areas of improvement in inter-operator annotations. What is known already Where fertility clinics use embryo morphokinetics to determine viability potential, quality assurance of annotations is essential. Embryo selection algorithms rely on the manual determination of certain morphokinetic parameters. Variations in these parameters can lead to differences in the algorithm score attributed to an embryo thus potentially affecting its fate. It is vital that all embryologists involved in embryo annotation and selection are consistent with their annotation approach through regular quality assurance mechanisms. Study design, size, duration Each participant was required to annotate the same three embryos for morphokinetic parameters of interest, including tPB2, tPNf, t2 to t5, t8, tM, tSB, tB. Participants were also required to grade embryos at 68 hours post insemination (hpi), 112hpi and to assess additional parameters used for embryo selection or future investigations, such as the extent of morula compaction. The aim of this scheme is to release new distribution each quarter to ensure regular participation. Participants/materials, setting, methods All embryologists responsible for embryo annotation in a single, UK fertility group were enrolled onto the scheme. A total of 59 participants from 10 fertility clinics in the UK were included. Inter-operator agreement was assessed using two-way, mixed intraclass correlation coefficient (ICC) for consistency. Five categories of agreement were determined based on ICC score; very weak (0–0.2), weak (0.21–0.4), moderate (0.41–0.6), strong (0.61–0.8) and very strong (0.81–1.0). Main results and the role of chance Very strong agreement (0.81–1.0) was observed between all operators for all parameters assessed except for one operator who showed a weak agreement (0.21–0.4) with all other operators. Descriptive statistics revealed standard deviations (SD) ranging from 0.34 (t3) to 3.43 (t5). For each parameter the SD across the three assessed embryos ranged from 0.34–3.43; tPB2 (0.11–0.98), tPNf (2.06–4.40), t2 (0.22–0.80), t3 (0.16–0.70), t4 (0.39–0.65). t5 (2.40–5.44), t8 (0.33–2.72), tM (1.00–2.72), tSB (1.08–2.67), tB (1.12–1.81). These results indicate a high concordance with less subjective annotations such as the cell stage divisions and more variability with the subjective annotations such as the blastulation parameters. The concordance with less well practiced or understood annotations, such as extent of morula compaction, planar or tetrahedral orientation at the four cell stage as well as angle of extrusion of second polar body in relation to the first polar body, was poorer as indicated using descriptive statistics. This highlighted the need for experience in performing these annotations before drawing conclusions regarding their predictive nature in relation to an embryo’s viability. Limitations, reasons for caution The variability between more subjective parameters would be expected to be higher than others. The participation in these schemes can create false environments which do not reflect how an embryologist would usually score; they may spend longer on some decisions given the nature of the scheme. Wider implications of the findings: Quality assurance of morphokinetic annotations across clinics utilising standardised selection models is crucial. Robust annotation policies and education programmes are essential in achieving consistent results between operators. Quality assurance schemes can identify individuals who lack consistency overall and can identify reliably annotated parameters to inform inclusion in embryo selection algorithms. Trial registration number Not applicable

An evaluation of ten external quality assurance scheme (EQAS) materials for the faecal immunochemical test (FIT) for haemoglobin

ObjectivesExternal quality assessment schemes (EQAS) are being established worldwide to support the faecal immunochemical test (FIT) for haemoglobin (Hb). FIT is widely used as a screening test for colorectal cancer and increasingly in assessment of patients presenting with symptoms. EQA for FIT is provided in several matrices, each unique to the individual scheme. These include Hb suspended in a faecal-like matrix, lyophilised samples and liquid samples. The aim of this study was to evaluate commercially available EQAS and assess their suitability for use.MethodsTen EQAS provided material for the study. EQA samples were analysed on four quantitative FIT systems. 15 faecal-like matrix samples were loaded per concentration per FIT system. Reconstituted lyophilised samples were examined five times on three separate occasions and liquid samples were examined 10 times per concentration per FIT system. The coefficient of variation (CV) was calculated per concentration of EQA for each FIT system.ResultsResults from faecal-like matrix schemes had a higher median CV (12.4–19.0%) when compared to those from schemes providing liquid matrices (0.8–2.3%). The spread of CV values was also higher for results from faecal-like matrix schemes with an interquartile range (IQR) 4.4–24.0% vs. liquid IQR range of 0.3–2.5%.ConclusionsHb results from faecal-like matrices, whilst more aligned to a patient or participant sample, are prone to pre-examination variation so do not assess the analytical accuracy of a FIT system. Liquid matrices are not prone to pre-examination variation and are better able to assess the accuracy of a FIT system.

Plasma oxalate: comparison of methodologies

Measurement of oxalate in the blood is essential for monitoring primary hyperoxaluria patients with progressive renal impairment and on dialysis prior to transplantation. As no external quality assurance scheme is available for this analyte, we conducted a sample exchange scheme between six laboratories specifically involved with the investigation of primary hyperoxaluria to compare results. The methodologies compared were gas chromatography/mass spectrometry (GCMS), ion chromatography with mass spectrometry (ICMS), and enzymatic methods using oxalate oxidase and spectrophotometry. Although individual laboratories performed well in terms of reproducibility and linearity, there was poor agreement (absolute values) between centres as illustrated by a longer-term comparison of patient results from two of the participating laboratories. This situation was only partly related to differences in calibration and mainly reflected the lower recoveries seen with the ultrafiltration of samples. These findings lead us to conclude that longitudinal monitoring of primary hyperoxaluria patients with deteriorating kidney function should be performed by a single consistent laboratory and the methodology used should always be defined. In addition, plasma oxalate concentrations reported in registry studies and those associated with the risk of systemic oxalosis in published studies need to be interpreted in light of the methodology used. A reference method and external quality assurance scheme for plasma oxalate analysis would be beneficial.

European Perspective

Cancer is a major health concern in the EU. Currently, it is the second largest cause of death in Europe, and, due to the rapidly ageing population, its prevalence is increasing. Cancer is expected to affect one in two people in the future. Given this significant impact on society, policymakers at both the European and national levels have devoted much attention to the battle against cancer. It should be noted, however, that the EU’s leverage within health policy is limited to complementing national policies through coordination or information sharing. By providing a framework for cooperation between national entities, the EU promotes efficient research and development, propagates best practices regarding cancer prevention and treatment, encourages information exchange, and regulates the use of carcinogenic substances. It facilitates coordination and cooperation by bringing stakeholders together and harmonizing the cancer policy between member states. The European quality assurance scheme for breast cancer services (the ‘European QA scheme’) covers the entire pathway of care from screening to end-of-life care, and it is person-centred and evidence-based. The European QA scheme is being developed for European countries, but its use, implementation, and impact may extend beyond geographic boundaries.