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Sette P.,G. Fracastoro Hospital | Dorizzi R.M.,Laboratorio Unico Of Area Vasta Romagna | Azzini A.M.,University of Verona
Journal of Vascular Access | Year: 2012

Sir William Harvey (1578-1657), who had many precursors, discovered blood circulation in 1628 after a significant number of anatomic dissection of cadavers; his studies were continued by Sir Christopher Wren and Daniel Johann Major. The first central vein catheterization was performed on a horse by Stephen Hales, an English Vicar. In 1844, a century later, the French biologist Claude Bernard attempted the first carotid artery cannulation and repeated the procedure in the jugular vein, again on a horse. He was first to report the complications now well known to be associated with this maneuver. In 1929 Werner Forssmann tried cardiac catheterization on himself, but could not investigate the procedure further since his findings were rejected and ridiculed by colleagues. His work was continued by André Frédéric Cournand and Dickinson Woodruff Richards Jr in the United States. In 1956 the three physicians shared the Nobel Prize for Medicine for their studies on vascular and cardiac systems. The genius and the perseverance of the three physicians paved the way towards peripheral and central catheter vein placement, one of the most frequently performed maneuvers in hospitals. Its history still remains unknown to most and deserves a short description. © 2011 Wichtig Editore.

Dorizzi R.M.,Laboratorio Unico Of Area Vasta Romagna | Maltoni P.,Laboratorio Unico Of Area Vasta Romagna
Rivista Italiana della Medicina di Laboratorio | Year: 2011

The theory of the reference interval has been well-defined by authoritative professional institutions but its practical application in most clinical laboratories is far from optimal. Laboratories often use different reference intervals without any valid reason, such as variations in analytical methodology or the population served. The adoption of common reference intervals has become a matter of importance because: (1) several common decision points which are not determined or validated in individual laboratories, e.g. glucose and lipid measurements, have already been widely accepted; (2) common reference intervals have been developed in Scandinavia by an international clinical chemistry organisation(Nordic Reference Interval Project, NORIP) and are being developed in Oceania; (3) the approach has been discussed favourably at international meetings; and (4) assay standardisation has substantially advanced (e.g. in the European Union). In 1998 the NORIP programme was started with the participation of 102 Nordic clinical biochemistry laboratories which collected blood samples from at least 25 healthy reference individuals evenly distributed for gender and age, and determined 25 of the most commonly requested serum/plasma components for each reference individual. Analytical and methodological data and data describing the reference individuals were submitted to a central database for evaluation and calculation of reference intervals intended for common use in the Nordic countries. Today, common reference intervals are used by almost 100% of laboratories for some analytes (e.g. iron, bilirubin, urate, magnesium). In 2005/06 the UK Department of Health set up a national Action Learning Programme as a key part of its Modernising Pathology Programme to enable people working in NHS pathology services to tackle issues and problems they identify locally as a priority for action. The Department funded six action learning sets to work on priority areas in pathology: workforce, standardisation, networks, primary care and protocol-guided investigations. The first phase was a success and was followed by a second phase with 16 topics. Work on the learning set for harmonise of reference intervals was carried out in the West Midlands. The set took a pragmatic approach to harmonising the variations between laboratories. Different practices were identified and were examined to see whether reasons for the differences were technical, scientific or clinical (e.g. differences in equipment and reagents or in the population served). The variations at the top and bottom were then considered, and a proposal based on consensus was developed. From 2007, the Pathology Harmony Initiative started to look at the harmonisation within the clinical laboratory. Several areas were identified where it was felt that there was potential for harmonisation. Several topics (e.g. units of measurement, reference intervals, test name harmonisation) have been investigated. All these experiences demonstrate that harmonisation of the reference intervals for several analytes should at last also be considered in Italy. © Springer 2011.

Monti F.,Laboratorio Unico Of Area Vasta Romagna | Rosetti M.,Laboratorio Unico Of Area Vasta Romagna | Poletti G.,Laboratorio Unico Of Area Vasta Romagna | Clementoni A.,Laboratorio Unico Of Area Vasta Romagna | And 4 more authors.
Rivista Italiana della Medicina di Laboratorio | Year: 2010

Background. In the recent years diagnostic biotechnology rapidly evolved and today includes an increasingly sophisticated and complex approach. This required the development of the so called "Shared Resource Laboratory (SRL)", a "core" laboratory equipped with highly skilled operators and advanced instrumentation in order to enhance the scope and the quality of the laboratory services. Materials and methods. Central Laboratory of Area Vasta Romagna is a subregional reference laboratory providing diagnostic activity for an area with about one million inhabitants. In the present study we describe the results of the consolidation of 4 local Flow cytometry laboratories dealing with immunodeficiencies and lung diseases. In the first trimester of activity (May-July 2009), 3338 samples have been assayed: 3114 tests for lymphocyte subpopulations in blood and 224 samples in bronchoalveolar lavage fluid (BALf). The assays have been carried out using Cytomics FC 500 cytofluorimeters (Beckman Coulter, Miami, FL, USA). Results. In the investigated trimester we saved 9200 euros for the monoclonal antibodies required for the testing in blood and 3288 euros for the testing in BALf. The total number of flow cytometry instruments have been reduced from six to two saving 63382 euro. Conclusions. The consolidation of the cytofluorimetric testing caused saving in reagents and analyzer rentals confirming the efficiency of the proposed model in diagnostic laboratory service.

Monti F.,Laboratorio Unico Of Area Vasta Romagna | Rosetti M.,Laboratorio Unico Of Area Vasta Romagna | Masperi P.,Direzione Medica Centro Servizi Area Vasta Romagna | Tommasini N.,Laboratorio Unico Of Area Vasta Romagna | Dorizzi R.M.,Laboratorio Unico Of Area Vasta Romagna
International Journal of Laboratory Hematology | Year: 2012

Introduction: The Shared Resource Laboratory (SRL) model recently described for research activities would also appear to be highly suitable for diagnostic services. Using modern SRL design criteria and benchmarks, the aim of our study was to verify whether the consolidation of a diagnostic cytofluorimetric activity could improve the overall service. Methods: Outcome indicators such as impact on analytical quality, clinical satisfaction, team work involvement, and economic performance were evaluated in the planning and setting up of a new central laboratory. Comparison with preconsolidation status allowed us to investigate possible indicators of improvement. Results: A total of 30140 cytofluorimetric analyses performed before and after consolidation at the Central Laboratory in Pievesestina in north-central Italy were evaluated. The overall score of the clinical satisfaction questionnaire (range, between 1 and 5) increased from 4.3 to 4.9. Full-time equivalent (FTE) operators were reduced from 9 to 4.5 and cytofluorimeters from 6 to 2; economic indicator analyses showed a 17.75% reduction in unitary test costs. Conclusions: The adoption of new benchmarks and design criteria increased the quality of cytofluorimetric analysis, thus improving specialized diagnostic services and promoting the shared resource clinical laboratory. © 2012 Blackwell Publishing Ltd.

Dorizzi R.M.,Laboratorio Unico Of Area Vasta Romagna | Billi P.,Laboratorio Unico Of Area Vasta Romagna | Semprini S.,Laboratorio Unico Of Area Vasta Romagna | Della Strada M.,Laboratorio Unico Of Area Vasta Romagna
Rivista Italiana della Medicina di Laboratorio | Year: 2011

Interferon gamma release assays (IGRA) in tuberculosis diagnosis. New Guidelines of the Centers for Disease Control and Prevention After approval by the Food and Drug Administration of two new interferon gamma release assays (IGRA), the immunoassays QFT-GIT and T-Spot, for the diagnosis of infection with Mycobacterium tuberculosis, the Centers for Disease Control and Prevention (CDCs) convened a group of experts to review the scientific evidence and provide opinions regarding the use of IGRA. Sensitivity and specificity of IGRA were assessed in comparison with the tuberculin skin test (TST). The CDC published guidelines involving the major scientific societies in the field. The tests were evaluated in different groups of people at risk, and recommendations based on the assessment of the primary studies were developed on the best use of the tests for public health officials, health-careproviders and laboratory personnel. Data on the ability of the IGRA to predict subsequent active tuberculosis are still limited, but to date no major deficiencies have been reported. © Springer 2011.

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