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Laboratory Management Services

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Cuker A.,University of Pennsylvania | Raby A.,Laboratory Management Services | Moffat K.A.,Laboratory Management Services | Moffat K.A.,McMaster University | And 2 more authors.
Thrombosis and Haemostasis | Year: 2010

Unfractionated heparin (UFH) monitoring is subject to substantial interlaboratory variation. We analysed results of annual coagulation surveys administered by the Quality Management Program-Laboratory Services (Toronto, ON, Canada) from 2003 to 2007 to evaluate variation in UFH monitoring across Ontario. Participating laboratories performed an activated partial thromboplastin time (APTT) utilising their local methodology on lyophilised human plasma spiked with UFH. In the 2006 and 2007 surveys, laboratories licensed to perform anti-Xa assays also reported anti-Xa activity results. The APTT differed significantly between heparin-sensitive and heparin-insensitive methods (p<0.0005). Withinmethod variation was observed and increased with increasing heparin concentration. Among laboratories performing an APTT and anti-Xa, the coefficient of variation was greater in the anti-Xa than in the APTT for both the 2006 (64.0% vs. 10.5%) and 2007 (15.0% vs. 11.6%) surveys. Substantial interlaboratory variation in UFH monitoring, both between and within APTT methods, was observed and was not reduced by use of an anti-Xa assay. © Schattauer 2010.


Raby A.,Laboratory Management Services | Moffat K.,McMaster University | Moffat K.,Hamilton Regional Laboratory Medicine Program | Crowther M.,McMaster University
Methods in Molecular Biology | Year: 2013

Antiphospholipid syndrome (APS) is an autoimmune disease and is a risk factor for a number of clinical manifestations; the classic presentations include fetal death or thrombosis (arterial or venous thromboembolism), in the presence of persistently increased titers of antiphospholipid (aPL) antibodies. The actual cause of APS is unknown but thought to be multifactorial. The disease is characterized by the presence of a heterogenous population of autoantibodies against phospholipid-binding proteins. APS presents either in isolation with no evidence of an underlying disease or in concert with an autoimmune disease such as systemic lupus erythematosus or rheumatoid arthritis. The wide diversity in clinical presentation often causes difficulty in identifying and treating patients and therefore a concise laboratory report containing interpretative comments is required to provide needed guidance to the clinician. For a diagnosis of APS to be made both clinical and laboratory classification criteria must be met. Laboratory testing to identify aPL antibodies includes lupus anticoagulant (liquid-based clotting assays) and immunological solid-phase assays (usually enzyme-linked immunosorbent assay formats) for IgG and/or IgM anticardiolipin (aCL) antibodies and anti-beta 2 glycoprotein I (β2-GPI) antibodies. Other autoantibodies, such as those directed against anionic phospholipids, can also be assayed; however they are not of clinical significance. Participation in a quality assurance program and an in-depth technical and clinical understanding of testing for aPL antibodies are required, as methods are limited by poor robustness, reproducibility, specificity, and standardization. Testing is further complicated by the lack of a "gold standard" laboratory test to diagnose or classify a patient as having APS. This chapter discusses the clinical and laboratory theoretical and technical aspects of aCL and anti-β2GPI antibody assays. © 2013 Springer Science+Business Media New York.


Moffat K.,McMaster University | Moffat K.,Hamilton Regional Laboratory Medicine Program | Raby A.,Laboratory Management Services | Crowther M.,McMaster University
Methods in Molecular Biology | Year: 2013

Antiphospholipid antibodies are a heterogenous group of autoantibodies directed against glycoproteins in concert with anionic phospholipids. In clinical laboratory practice, antiphospholipid antibody evaluations usually consist of a combination of the following: anticardiolipin antibody assay, anti-beta 2 glycoprotein I assay, and at least two lupus anticoagulant assays with an appropriate confirmatory test. Lupus anticoagulants produce their laboratory effect by prolonging recalcification times in assays within which phospholipid content is limited. Although many assays are available, all are based on the fundamental principle of demonstrating normalization of prolonged recalcification times with the addition of exogenous phospholipid. The antibody specificity of an individual lupus anticoagulant is difficult or impossible to determine; however a small proportion do demonstrate avidity for selected proteins such as prothrombin or beta 2 glycoprotein I. The mechanism by which these antibodies cause their clinical manifestations remains unknown; however their relationship to increased risk of thrombosis, pregnancy loss, and autoimmune thrombocytopenia is undoubted. There is no correlation between the "strength" of lupus anticoagulants and the level of thrombotic risk; thus it is important to identify both "weak" and "strong" lupus anticoagulants. © 2013 Springer Science+Business Media New York.


Korbel K.L.,University of Technology, Sydney | Hancock P.J.,Laboratory Management Services | Serov P.,University of New England of Australia | Lim R.P.,University of Technology, Sydney | Hose G.C.,Macquarie University
Journal of Environmental Quality | Year: 2013

Changes in surface land use may threaten groundwater quality and ecosystem integrity, particularly in shallow aquifers where links between groundwater and surface activities are most intimate. In this study we examine the response of groundwater ecosystem to agricultural land uses in the shallow alluvial aquifer of the Gwydir River valley, New South Wales, Australia. We compared groundwater quality and microbial and stygofauna assemblages among sites under irrigated cropping, non-irrigated cropping and grazing land uses. Stygofauna abundance and richness was greatest at irrigated sites, with the composition of the assemblage suggestive of disturbance. Microbial assemblages and water quality also varied with land use. Our study demonstrates significant differences in the composition of groundwater ecosystems in areas with different surface land use, and highlights the utility of groundwater biota for biomonitoring, particularly in agricultural landscapes. © American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America.


Fleming C.A.,Laboratory Management Services
Accreditation and Quality Assurance | Year: 2012

Quality Management Program-Laboratory Services (QMP-LS) is a mandatory external quality assessment (EQA) and accreditation programme for laboratories in Ontario. This report summarizes performance of Ontario laboratories on QMP-LS enteric parasitology EQA surveys and compares this performance over time. The results reported by participating laboratories were assessed against the expected results as determined by reference or referee laboratories. The number of laboratories licensed for parasitology decreased dramatically over the 20 years. On average, more than 80 % of participants and often more than 90 % were able to detect and identify the species and stages for the majority of parasites. Many of the challenges contained multiple parasites and about half contained low numbers, which affected performance on individual samples. The level of performance by Ontario laboratories on parasitology EQA surveys was consistently high over the 20 years. The parasites that presented the most difficulty were Enteromonas hominis and Trichomonas hominis. © 2012 Springer-Verlag.


Aslan B.,University of Toronto | Gun-Munro J.,Laboratory Management Services | Flynn G.J.,University of Toronto | Flynn G.J.,Laboratory Management Services
Accreditation and Quality Assurance | Year: 2012

After Hemoglobin A 1c (HbA 1c), therapeutic targets for monitoring diabetes therapy were recommended, first, National Glycohemoglobin Standardization Program (NGSP), then, the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) developed standardization initiatives. The aim of this article is to demonstrate the role of a proficiency testing (PT) programs in monitoring the long-term effect of these initiatives and the current status of HbA 1c measurement. Measurement precision as a coefficient of variation (CV), measurement bias (bias), and satisfactory HbA 1c result rates in proficiency testing (PT) surveys were evaluated using fresh single donor whole blood PT items and assigned values from a NGSP-certified secondary reference laboratory. Between 2000 and 2010, both CV and bias of the IC measurement method showed a decreasing trend. While the CV of the HPLC measurement method decreased, no significant change was observed in its bias. The rates of satisfactory HbA 1c results in PT surveys were higher in HPLC users than IC users. In 2010, the average CVs in HPLC and IC groups were 2. 6 and 3. 4%, biases were 2. 7 and 1. 8%, and corresponding total error (TE) estimates were 7. 8 and 8. 5%, respectively. These TE values were higher than the maximum permissible measurement error of 7%, developed based on clinical use of the test. The NGSP and the IFCC networks have promoted improvements in HbA 1c testing; however, tightening of NGSP method certification criteria seems to be necessary to achieve a maximum permissible measurement error of 7%. © 2012 Springer-Verlag.


Gun-Munro J.,Laboratory Management Services
Accreditation and Quality Assurance | Year: 2012

ISO/IEC 17043 Conformity assessment-general requirements for proficiency testing is intended to replace previous international guides used to assess the competence of proficiency testing (PT) providers. It expands on the requirements of previous guides and is intended to accommodate PT providers of calibration laboratories and testing laboratories handling both qualitative and quantitative data. QMP-LS is an office-based external quality assessment provider for medical laboratories in Ontario, Canada and operates 46 different PT schemes for approximately 250 diagnostic tests. In 2010, these schemes were accredited to ISO/IEC 17043. Schemes included tests from the following disciplines: chemistry, hematology, microbiology, transfusion medicine, cytology, histology and genetics. Thirty of the schemes were qualitative. The challenges and benefits of implementing ISO/IEC 17043 are discussed, with particular emphasis on clauses addressing the following requirements: statistical design, determination of assigned value, homogeneity and stability testing, packaging, labeling and distribution, performance evaluation and subcontracting services. © 2012 Springer-Verlag.


PubMed | Sinai University, McMaster University, University of London, Laboratory Management Services and University of Toronto
Type: Journal Article | Journal: Blood | Year: 2016

Treatment options for immune thrombocytopenia (ITP) in pregnancy are limited, and evidence to guide management decisions is lacking. This retrospective study of singleton pregnancies from 2 tertiary centers compared the effectiveness of intravenous immunoglobulin (IVIg) and corticosteroids in treatment of ITP. Data from 195 women who had 235 pregnancies were reviewed. Treatment was not required in 137 pregnancies (58%). Of the remaining 98 pregnancies in 91 women, 47 (48%) were treated with IVIg and 51 were treated with corticosteroids as the initial intervention. Mean maternal platelet count at birth did not differ between groups (IVIg 69 10(9)/L vs corticosteroids 77 10(9)/L; P = .71) nor did the proportion of mothers who achieved a platelet count response (IVIg 38% vs corticosteroids 39%; P = .85). There were no fatal or severe maternal, fetal, or neonatal hemorrhages. Of 203 neonates in whom platelet counts were available, 56 (28%) had a birth platelet count <150 10(9)/L and 18 (9%) had platelet counts <50 10(9)/L. Nadir platelet counts for most affected neonates occurred at birth, although for some neonates, nadir platelet counts occurred up to 6 days postnatally. Intracranial hemorrhage was noted in 2 neonates (nadir platelet counts were 135 and 18 10(9)/L). There were no neonatal deaths. The majority of pregnant women with a history of ITP did not require treatment, and neonatal outcomes were comparable for mothers who received IVIg or corticosteroids for treatment of maternal ITP.


PubMed | Laboratory Management Services and University of Sousse
Type: | Journal: International journal for quality in health care : journal of the International Society for Quality in Health Care | Year: 2017

To assess the patient safety culture(PSC) in operating rooms(ORs) and to determine influencing factors.A cross-sectional descriptive multicenter study which was conducted over a period of 7 months (October 2014-April 2015) using the French validated version of the Hospital Survey On Patient Safety Culture questionnaire.Of the note, 15 ORs of public and private healthcare institutions.In total, there were 368 participants including surgeons, anesthesiologists, surgical and anesthesia technicians, nurses and caregivers, divided into 316 professionals exercising in public sector and 52 working in private one.A self-administrated questionnaire investigating 10 dimensions of PSC (including 45 items), two items examining the staff perception of patient safety quality and reporting events, and five items regarding demographic characteristics of respondents.The participation rate in the study was 70.8%. All 10 dimensions were to be improved. The overall perception of patient safety had a score of 34.9%. The dimension that had the lowest score (20.5%) was the non-punitive response to error, and the one that had the highest score (41.67%) was teamwork in the ORs. Three dimensions were developed in private sector, and none in public hospitals.This study showed that the level of the PSC needs to be improved not only in public hospitals but also in private ones. The obtained results highlight the importance of implementing quality management systems and developing PSC.

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