scholarly journals Pathology Residents as Testing Personnel in the Hematology Laboratory

2021 ◽  
Author(s):  
Claudiu V. Cotta ◽  
Sarah L. Ondrejka ◽  
Megan O. Nakashima ◽  
Karl S. Theil
Keyword(s):  
Peripheral Blood ◽  
Body Fluid ◽  
Clinical Laboratory ◽  
Turnaround Time ◽  
Self Assessment ◽  
Professional Activities ◽  
Hands On ◽  
Before And After ◽  
The Impact ◽  
Clinical Laboratory Improvement Amendments

Context.— Clinical laboratories and the training of pathology residents are tightly regulated environments. Compliance with regulatory requirements must be addressed when developing entrustable professional activities (EPAs) for pathology residents. Objective.— To describe the development of EPAs for peripheral blood and body fluid review in compliance with Clinical Laboratory Improvement Amendments and College of American Pathologists personnel and testing requirements. To examine the impact of EPA implementation on the workflow in a busy hematology laboratory. Design.— A training program was designed to prepare pathology residents to function as independent testing personnel in compliance with Clinical Laboratory Improvement Amendments. After a series of lectures, hands-on microscopy sessions, self-assessment quizzes, and achievement of a passing score on a training assessment exam, residents were deemed competent to release certain results independently. The volume and the turnaround time of hematology tests were compared before and after residents were integrated into the laboratory workflow. Faculty and residents were surveyed to assess satisfaction with the training. Results.— Empowering residents to independently release noncritical results from peripheral blood and body fluid reviews had no adverse impact on test turnaround time. The resident contribution to workflow resulted in a corresponding decrease in the number of cases that required attending pathologist review. Faculty and residents viewed the EPAs as beneficial to service and education. Conclusions.— The implementation of the EPAs had a beneficial effect on the laboratory, the trainees, and faculty. Our experience may be helpful to other training programs as EPAs become more widely implemented in residency training.

Building Entrustable Professional Activities In Residency Training: Peripheral Blood Smear And Body Fluid Analysis

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S96-S96
Author(s):  
K S Theil ◽  
M O Nakashima ◽  
S L Ondrejka ◽  
C V Cotta
Keyword(s):  
Peripheral Blood ◽  
Laboratory Testing ◽  
Body Fluid ◽  
Blood Smear ◽  
Peripheral Blood Smear ◽  
Entrustable Professional Activities ◽  
Self Assessment ◽  
Cell Identification ◽  
Professional Activities ◽  
Competency Assessments

Abstract Introduction/Objective Entrustable professional activities (EPAs) are defined as specialty-specific tasks representing a unit of professional practice that can be entrusted to unsupervised performance by a trainee following attainment of sufficient task-specific competence. EPAs and periodic competency assessments also provide a framework for evaluating relevant ACGME milestones. We describe our experience creating EPAs for peripheral blood smear (PBS) and body fluid (BF) analysis through which residents became qualified to act as laboratory testing personnel. Methods Training occurred during a 6 week “boot camp” for PGY2 and PGY4 residents in July-August 2018 and July-August 2019. Training for PBS included didactic lectures in automated hematology and RBC morphology (2 hr) and WBC and platelet morphology (2 hr); faculty-guided microscope reviews of RBC (2 hr) and WBC morphology (2 hr) using a training checklist; completion of RBC and WBC self-assessment quizzes; and a 40 question graded exam that covered cell identification, lab protocols, and case scenarios. Training for BF included didactic lectures (2 hr); faculty-guided microscope review of BF slides using a training checklist; completion of a BF self-assessment quiz; and a 40 question graded exam that covered cell identification, lab protocol, and case scenarios. Following successful completion of the graded exam residents were deemed competent to perform unsupervised review of cases initially flagged as abnormal by laboratory technologists; they were required to obtain attending review prior to release of results in defined situations. Formal competency assessments according to CLIA standards were done at 6 and 12 months after initial training. Impact on laboratory workflow and turnaround time was assessed before and after training. Conclusion We successfully created EPAs for PBS and BF analysis through which residents became qualified to act as laboratory testing personnel. There was no adverse impact on laboratory turnaroud time, and the number of PBS and BF cases requiring attending pathologist review decreased. Residents appreciated this tangible opportunity to gain graduated responsibility that prepared them for future practice. Periodic competency assessments provide an opportunity to evaluate relevant ACGME milestones. Our training and assessment program and EPAs can serve as a template for other residency programs.

scholarly journals Results Analysis of Russian Students’ Participation in the Online International Educational Project X-Culture

2019 ◽  
Vol 9 (3) ◽  
pp. 168 ◽  
Author(s):  
Irina Zakharova ◽  
Aleksandra Kobicheva ◽  
Natalia Rozova
Keyword(s):  
Focus Group ◽  
Student Satisfaction ◽  
English Language ◽  
International Project ◽  
Self Assessment ◽  
Intercultural Communications ◽  
Project Participant ◽  
Before And After ◽  
The Impact ◽  
Quantitative And Qualitative Methods

The purpose of the paper is to assess the experience of Russian students in the online project class. The authors studied the impact of the international project “X-Culture” on the level of development of socio-cultural competencies of students and their knowledge of the English language. An additional aspect of the analysis was the question of the connection of students’ perception of the goal of participation in the international project “X-Culture” with their self-motivation and self-assessment of the success of the results achieved. The study used both quantitative and qualitative methods—student testing, database analysis provided by the project “X-culture”, and focus group records. The result of the participation has been inconsistent. As expected, such sociocultural competence as the level of proficiency in English increased among the majority of students, as confirmed by the values of the student’s criterion for the results of language testing, conducted before and after the project. At the same time, average indicators of sociocultural competences such as “interpersonal skills”, “creativity”, “leadership”, and “friendliness” have deteriorated during the project that is confirmed by the trends lines of time series. The focus group revealed differences in terms of participation in the X-Culture project, their connection with self-motivation, and student satisfaction with the results achieved. Students who have achieved high levels of sociocultural competences have set themselves the goals of participation in the project related to the improvement of professional competencies and intercultural communications. At the same time, students were most satisfied with their activities in the project and the results achieved, aimed at obtaining new professional knowledge and skills, and students whose goal was simply to obtain an international certificate of the project participant.

scholarly journals The Benefits and Challenges of an Interfaced Electronic Health Record and Laboratory Information System: Effects on Laboratory Processes

2017 ◽  
Vol 141 (3) ◽  
pp. 410-417 ◽  
Author(s):  
Athena K. Petrides ◽  
Ida Bixho ◽  
Ellen M. Goonan ◽  
David W. Bates ◽  
Shimon Shaykevich ◽  
...  
Keyword(s):  
Information System ◽  
Electronic Health Record ◽  
Government Regulation ◽  
Turnaround Time ◽  
Health Record ◽  
Laboratory Information System ◽  
Before And After ◽  
Electronic Health ◽  
Ordered Data ◽  
The Impact

Context.— A recent government regulation incentivizes implementation of an electronic health record (EHR) with computerized order entry and structured results display. Many institutions have also chosen to interface their EHR with their laboratory information system (LIS). Objective.— To determine the impact of an interfaced EHR-LIS on laboratory processes. Design.— We analyzed several different processes before and after implementation of an interfaced EHR-LIS: the turnaround time, the number of stat specimens received, venipunctures per patient per day, preanalytic errors in phlebotomy, the number of add-on tests using a new electronic process, and the number of wrong test codes ordered. Data were gathered through the LIS and/or EHR. Results.— The turnaround time for potassium and hematocrit decreased significantly (P = .047 and P = .004, respectively). The number of stat orders also decreased significantly, from 40% to 7% for potassium and hematocrit, respectively (P < .001 for both). Even though the average number of inpatient venipunctures per day increased from 1.38 to 1.62 (P < .001), the average number of preanalytic errors per month decreased from 2.24 to 0.16 per 1000 specimens (P < .001). Overall there was a 16% increase in add-on tests. The number of wrong test codes ordered was high and it was challenging for providers to correctly order some common tests. Conclusions.— An interfaced EHR-LIS significantly improved within-laboratory turnaround time and decreased stat requests and preanalytic phlebotomy errors. Despite increasing the number of add-on requests, an electronic add-on process increased efficiency and improved provider satisfaction. Laboratories implementing an interfaced EHR-LIS should be cautious of its effects on test ordering and patient venipunctures per day.

scholarly journals Analysis of the sources of COVID-19 transmission in France by Self-assessment Web-application before and after the Partial Autumnal Lockdown: Observational Study (Preprint)

2021 ◽  
Author(s):  
Fabrice Denis ◽  
Anne-Lise Septans ◽  
Florian Le Goff ◽  
Stephan Jeanneau ◽  
François-Xavier Lescure
Keyword(s):  
Observational Study ◽  
Incubation Time ◽  
Web Application ◽  
Close Relative ◽  
Media Campaign ◽  
Self Assessment ◽  
National Media ◽  
Before And After ◽  
The Impact ◽  
Second Wave

BACKGROUND We developed a questionnaire on a web-application for COVID-19 circumstances of contamination analysis in France during the 2nd wave of pandemic. OBJECTIVE To analyze the impact on contaminations characteristics of the second partial lockdown in France to adapt health public restrictions to further pandemic surges. METHODS Between 12/15/2020 and 12/24/2020, after a national media campaign, users of sourcecovid.fr web-application were asked questions about their own or a close relative COVID-19 contamination after 8/15/2020 in France. Data of contamination’s circumstances were assessed and compared before and after the second partial lockdown which occurred on 10/25/2020 during the second wave of pandemic and was ongoing on 12/24/2020. RESULTS As of December 24, 2020, 441 000 connections on web-application were observed. 2218 questionnaires were assessable for analysis. 61.8% were sure of their contamination origin and 38.2% thought they knew it. The median age of users was 43.0 years (IQR 32 to 56), 50.7% were male. The median incubation time of the assessed cohort was 4.0 days (IQR 3 to 5). Private area (family and friends) was the main source of contamination (50.2%) followed by work colleagues: 27.7%. The main time of contamination of the day was the evening (35.3%) before the lockdown and was reduced to 18.2% after it (P<0.001). The person who transmitted the virus to the user before and after the lockdown was significantly different (P<0.001): a friend (29.0% vs 14.1%), a family close relative (23.1% vs 32.7%), a work colleague (23.9% vs 34.2%). The main location where the virus was transmitted to the users before and after lockdown was significantly different too (P<0.001), respectively: Home (21.3% vs 25.5%), at work (22.4% vs 29.6%), collective places (33.0% vs 15.0%), and care centers (4.4% vs 9.7%). CONCLUSIONS Modalities of transmissions significantly changed before and after the 2nd lockdown in France. The main sources of contaminations remained the private area and work colleagues. Work became the main location of contamination after lockdown whereas collective places contaminations were strongly reduced. CLINICALTRIAL ClinicalTrials.gov NCT04670003

scholarly journals Addiction peer recovery coach training pilot: assessment of confidence levels

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e10783
Author(s):  
Nicholas Guenzel ◽  
Hongying Dai
Keyword(s):  
American Indians ◽  
Addiction Treatment ◽  
Initial Attempt ◽  
Self Assessment ◽  
Systematic Analysis ◽  
Confidence Levels ◽  
Before And After ◽  
Average Confidence ◽  
Self Assessments ◽  
The Impact

Background Peer recovery coaches (PRCs) have become a critical tool in addiction treatment in many areas of the world. Despite this fact, no identified research has examined the process or impact of PRC training. Furthermore, no scales were identified to measure trainee confidence in various PRC techniques. The goal of this article is to analyze the process and immediate impact of PRC training of twelve American Indians (AIs) in a culturally-specific program. We focus most specifically on trainee confidence levels. Methods No written consent was obtained and completion of the assessment was considered consent. Trainees completed self-assessments before and after the training. The self-assessment examined nine areas ranging from understanding the role of PRCs to knowledge of effective PRC techniques. Paired t-tests were used to assess for changes in individual trainee responses between the pre- and post-assessments. Results Pre-training responses ranged from moderate to high. Questions with the lowest average confidence levels address PRC activities or specific techniques to facilitate recovery. All nine questions showed statistically significant mean improvements in the post-training self-assessments. Questions regarding specific PRC activities and techniques showed the greatest improvement. Questions relating to helping people more generally showed the smallest improvement. Average post-training responses fell within a very narrow range indicating relatively consistent confidence levels across skills. Analysis indicates participants were possibly over-confident in certain areas (i.e., maintaining boundaries). This small pilot represents an initial attempt to measure confidence levels of PRC trainees. The findings may inform future training by identifying certain areas where emphasis might be most helpful for trainees. In addition, it is hoped that this work will encourage more systematic analysis of the impact of PRC training on individuals.

scholarly journals Improved Sample Quality and Decreased Turnaround Time When Using Plasma Blood Collection Tubes with a Mechanical Separator in a Large University Hospital

2020 ◽  
Author(s):  
Pierre-Olivier Hétu ◽  
Sacha Hobeila ◽  
François Larivière ◽  
Marie-Claire Bélanger
Keyword(s):  
Clinical Chemistry ◽  
Turnaround Time ◽  
Error Rates ◽  
University Hospital ◽  
Blood Collection ◽  
Sample Quality ◽  
Paired Samples ◽  
Deming Regression ◽  
Before And After ◽  
The Impact

Abstract Background Serum is commonly used for clinical chemistry testing but many conditions can affect the clotting process, leading to poor sample quality and impaired workflow. With serum gel tubes, we found a high proportion of sample probe aspiration errors on our Beckman AU5800 analyzers. We decided to implement the BD Barricor™ plasma tubes, and we validated an off-specification centrifugation scheme and verified that results obtained for 65 chemistry and immunochemistry tests were comparable to those obtained in serum gel tubes. Finally, we evaluated the impact of this new tube on sample error rate and laboratory turnaround time. Methods To validate centrifugation settings, 50 paired samples were collected in Barricor tubes and centrifuged at 1912 × g for 10 min or 5 min (off-specification). To compare serum gel tubes with Barricor plasma tubes, 119 paired samples were collected from volunteers and results were analyzed using weighed Deming regression. Finally, the proportion of aspiration errors and laboratory TAT for potassium were measured before and after implementing Barricor tubes. Results Barricor tubes showed clinically acceptable equivalence to serum gel tubes for the studied analytes, and the off-specification centrifugation scheme did not affect the results. Implementing Barricor tubes improved the laboratory workflow by decreasing the aspiration error rates (2.01% to 0.77%, P &lt; 0.001) and lowering hemolysis (P &lt; 0.001). The laboratory TAT for potassium were also significantly lowered (P &lt; 0.001). Conclusion Use of Barricor tubes instead of serum gel tubes leads to better sample quality, shorter more reproducible laboratory TAT, and decreases costs associated with error management.

Social media's impact on the empowerment of women and youth male entrepreneurs in Egypt

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rania Miniesy ◽  
Engy Elshahawy ◽  
Hadia Fakhreldin
Keyword(s):  
Self Assessment ◽  
Female Entrepreneurs ◽  
Content Type ◽  
Psychological Dimension ◽  
Before And After ◽  
Greater Cairo ◽  
One Year ◽  
Almost All ◽  
The Impact ◽  
Digital Entrepreneurship

PurposeThis study aims to examine the impact of social media (SM) on the creation of digital entrepreneurship by female (irrespective of age) and youth male (aged 18–29 years) entrepreneurs, investigate if SM empowers those entrepreneurs and compare the empowerment characteristics between female and youth male entrepreneurs before and after starting their businesses.Design/methodology/approachSelf-assessment questionnaires were collected from a sample of 408 Egyptian female and youth male digital entrepreneurs from Greater Cairo, whose businesses had been operating for more than one year.FindingsThe research showed the following four results: Of the surveyed entrepreneurs, 95% asserted that without SM, they would not have started their businesses. Female and youth male entrepreneurs are empowered both on personal and relational levels, and women’s empowerment is more evident in the latter. Before digital entrepreneurship, youth males have significantly higher averages than female entrepreneurs in almost all empowerment characteristics, whereas after digital entrepreneurship, female entrepreneurs have significantly higher averages in making decisions related to investment, personal education and personal health, as well as those of other household members. Female entrepreneurs are relatively more empowered than youth males after digital entrepreneurship when each group is compared with its initial status.Originality/valueThis study’s originality stems from using a large sample of entrepreneurs, including youth males, not just females; employing a more structured, comprehensive measure of empowerment than found in the literature because it included the rarely used psychological dimension; considering more than one SM tool and comparing empowerment of females to that of youth males.

The Impact of Rhg-CSF on the LFA-1 Conformation of CD4+T Cells in Mobilized Hematopoietic Stem Cell Allografts

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3464-3464
Author(s):  
Chunji Gao ◽  
Weihua Chen ◽  
Fei Wang ◽  
Meng Li ◽  
Haiyan Zhu ◽  
...  
Keyword(s):  
T Cells ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Peripheral Blood ◽  
Cd4 T Cells ◽  
Hematopoietic Stem ◽  
High Affinity ◽  
Before And After ◽  
Adhesion Activity ◽  
The Impact

Abstract In hemotopoietic stem cell transplantation (HSCT), the primary effects of G-CSF on cells of the hemotopoietic system include stimulation of proliferation and differentiation of HSCs, acceleration of neutrophil reconstitution after HSCT and mobilization of bone marrow HSCs into the peripheral blood. In recent years, several investigators have unraveled that G-CSF-mediated immune regulation including the switching T cell cytokine secretion profile to Th2 response, the altering adhesion activity of CD4+T cells to ICAM-1 and so on. Most of these cellular interactions of T cells are dependent on the integrin leukocyte function associated antigen-1 (LFA-1, αLβ2, CD11a/CD18) binding to intercellular adhesion molecule-1 (ICAM-1). Integrin αLβ2 adopts a bent, compact conformation in their low affinity state and an extended conformation in the high affinity state. The epitope of MEM148 is only expressed on the free β2 integrin subunit but is masked on LFA-1. The monoclonal antibody MEM148 reacts with an epitope exposed on free human CD18 chain as well as on high affinity state of LFA-1 that represents a reporter for αLβ2 active conformation. Our previous studies have demonstrated that rhG-CSF mobilization decreased the adhesion activity of CD4+T cells to ICAM-1, but did not find that rhG-CSF mobilization had effect on the level of CD11a expression. rhG-CSF maybe has effect on conformational change of LFA-1 on CD4+T cells. In order to explore the impact of rhG-CSF mobilization on LFA-1 conformation of CD4+ T cells, human CD4+T cells were isolated from peripheral blood mononuclear cells by positive selection with Miltenyi MACS. Isolated CD4+T cells were activated by OKT3+ICAM-1 and PMA+Ion separately. The slides with CD4+T cells were incubated with FITC-CD11a and FITC-MEM148 mAb, then were examined by using fluorescence microscope. The results show that the level of CD25, CD69 expression and MEM148 epitope exposure on activated CD4+T cells were significantly higher compared with unactivated CD4+T cells. rhG-CSF mobilization had no effect on the expression of CD11a, but could decrease expression of CD25, CD69 and exposure of MEM148 epitope on activated CD4+T cells. The percentage of LFA-1 polarized CD4+T cells before and after rhG-CSF mobilization was 85.32%, 61.86% respectively (p <0.01). No MEM148 epitope exposure on unactivated CD4+T cells was detected, but MEM148 epitope exposure on activated CD4+T cells before and after rhGCSF mobilization was 63.63%, 32.79% respectively (p <0.01). Overall, these data suggest that rhG-CSF can affect on the activation of CD4+T cells in mobilized hematopoietic stem cell allografts by altering the conformation of LFA-1.

scholarly journals A Quantitative Self-Assessment of Seminarians’ Response to a Curriculum Addition on Marriage, Sexuality, FertilityCare, and Naprotechnology: The Kenrick–Glennon Experience (2006–2015)

2019 ◽  
Vol 86 (1) ◽  
pp. 83-88
Author(s):  
K. Diane Daly ◽  
Edward Richárd ◽  
Thomas W. Hilgers
Keyword(s):  
Family Planning ◽  
Statistical Significance ◽  
Human Reproduction ◽  
Natural Family Planning ◽  
Self Assessment ◽  
Natural Family ◽  
The Family ◽  
Before And After ◽  
The Impact ◽  
Natural Method

A special course on Marriage, the Family and Human Sexuality was established at Kenrick-Glennon Seminary in St. Louis so as to assist the seminarians in their better understanding of the Church’s teaching relative to natural methods of family planning and women’s health care. This article compares the response at the beginning of this three-credit semester course to the same seven-item questionnaire given at the conclusion of the course. The pre- and postcourse scores were calculated for each of the questions. The scores obtained after the course were all significantly higher than they were before the course with p values ranging from 0.01 to <0.0001. Four of the items showed marked improvement including an understanding of the church’s teaching related to natural methods, current methods of natural family planning, the impact of a natural method on a couple’s marriage, and also the impact of a natural method on family life. Statistically significant improvement was also seen in their understanding of the topic of natural family planning and the Creighton Model System and its relevance toward the seminarian’s vocation, the use of the methods to either achieve or avoid pregnancy, and how contraception and abortion are linked. In these last three items, the level of statistical significance was quite high, although not as high as the other four items. There were 104 seminarians over an eight-year period of time, who provided answers to these questions, both before and after the course. This course was modeled after a course that was initiated at the Pope Paul VI Institute for the Study of Human Reproduction, which was for priests, seminarians, and Catholic leaders, titled Love & Life Unlimited. Nontechnical Summary: This is an evaluation of a ten-point, seven-question questionnaire that was utilized at the beginning of a course at Kenrick Seminary in Marriage, Sexuality, Creighton Model and NaProTECHNOLOGY. The same questionnaire was given to the students at the beginning of the course and then two to three months later at the conclusion of the three-credit course. The results show that there is a significant improvement in the seminarians’ knowledge and general attitude about natural methods of family planning and suggests that such courses would be beneficial to establish in seminaries throughout the country.

The Impact of New Regulations on Laboratory Testing in Physicians' Offices

1992 ◽  
Vol 38 (7) ◽  
pp. 1273-1279
Author(s):  
D J Loschen
Keyword(s):  
Laboratory Testing ◽  
Clinical Laboratory ◽  
Practice Group ◽  
Laboratory Services ◽  
Educational Processes ◽  
Trained Personnel ◽  
Related Group ◽  
Organized Medicine ◽  
The Impact ◽  
Clinical Laboratory Improvement Amendments

Abstract The reaction of the clinician to the specter of regulation of any part of his or her practice mirrors the reaction of the laboratorian to the implementation of Medicare and Clinical Laboratory Improvement Amendments legislation in 1965 and 1967, respectively. Whether the regulatory burdens that will be visited upon these laboratories are justified or necessary is arguable; the fact of the upcoming regulation is not. The volume and breadth of testing in physicians' office laboratories (POLs) has increased exponentially since passage of the Diagnosis Related Group legislation by Congress in 1983, an increase made possible by remarkable developments in technology. State regulatory initiatives and private accrediting agencies have been perceived as being inadequate to prevent the proliferation of poorly controlled testing in the nontraditional laboratory environment. The testing menu of a given POL varies according to the scope of clinical services offered; the size of the practice group; the funding available for equipment and personnel acquisition; and the general availability of hospital, reference, and consultative laboratory services. Physicians who offer laboratory services as part of their practices must now prepare their laboratories to meet whatever requirements are mandated by regulation. This will include acquisition of trained personnel, improvement of instrumentation and methodologies, participation in proficiency testing, establishment of comprehensive quality-assurance programs, and adequate documentation of laboratory services. Organized medicine should devote its energies to assisting with needed educational processes to assure the survival of POLs.

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