A blood lead survey was conducted on samples from 2459 children aged 3-6 years to determine the prevalence of lead poisoning in children of this age in the Province of Ontario. Lead poisoning, defined as a blood lead concentration greater than or equal to 1.21 mumol 1-1 (25 micrograms dl-1), was found in 26 subjects (1.1% of the samples). The mean blood lead concentration for children from southern Ontario was 0.50 mumol l-1, and for those from northern Ontario it was 0.37 mumol l-1. Stringent quality controls and independent cross-checks of finger-prick capillary blood sampling were employed in the study. The free erythrocyte protoporphyrin levels were also monitored to detect the presence of iron deficiency in the children.
Errors in the preanalytical phase in clinical laboratories affect patient safety. The aim of this study was to evaluate the effect of intensive educational efforts together with external quality assessment (EQA) of the preanalytical phase from 2013 to 2015 to improve patient identification in primary health care in Norway. In addition, routines for venous and capillary blood sampling were investigated.
A preanalytical EQA was circulated in 2013 by the Norwegian Quality Improvement of Laboratory Examinations (Noklus) to general practitioner offices and nursing homes (n=2000) to obtain information about important issues to focus on before launching an intensive educational program with courses, posters and visits in 2013-2015. Preanalytical EQA surveys were further circulated in 2014 and 2015.
The response rate varied between 42% and 55%. The percentages of participants asking for the patients' name and the Norwegian identification number increased from about 8% in 2013 to about 35% in 2015. The increase was similar for those participating in only one EQA survey and for those who participated in EQA surveys both in 2013 and 2015. Guidelines for venous and capillary blood sampling were not always followed.
Educational efforts more than the preanalytical EQA influenced the actions and resulted in an increase in the percentages of participants that followed the guidelines for patient identification. Some aspects of blood sampling routines need improvement.
The purpose of this study was to determine the inter-rater agreement between reviewers on the quality of abstract submissions to an annual national scientific meeting (Canadian Association of Emergency Physicians; CAEP) to identify factors associated with low agreement.
All abstracts were submitted using an on-line system and assessed by three volunteer CAEP reviewers blinded to the abstracts' source. Reviewers used an on-line form specific for each type of study design to score abstracts based on nine criteria, each contributing from two to six points toward the total (maximum 24). The final score was determined to be the mean of the three reviewers' scores using Intraclass Correlation Coefficient (ICC).
495 Abstracts were received electronically during the four-year period, 2001-2004, increasing from 94 abstracts in 2001 to 165 in 2004. The mean score for submitted abstracts over the four years was 14.4 (95% CI: 14.1-14.6). While there was no significant difference between mean total scores over the four years (p = 0.23), the ICC increased from fair (0.36; 95% CI: 0.24-0.49) to moderate (0.59; 95% CI: 0.50-0.68). Reviewers agreed less on individual criteria than on the total score in general, and less on subjective than objective criteria.
The correlation between reviewers' total scores suggests general recognition of "high quality" and "low quality" abstracts. Criteria based on the presence/absence of objective methodological parameters (i.e., blinding in a controlled clinical trial) resulted in higher inter-rater agreement than the more subjective and opinion-based criteria. In future abstract competitions, defining criteria more objectively so that reviewers can base their responses on empirical evidence may lead to increased consistency of scoring and, presumably, increased fairness to submitters.
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Research shows that there are often problems with cooperation between rehabilitation professionals within vocational rehabilitation. The aim of this study was to describe employers' experiences of how cooperation between different rehabilitation professionals can be improved in a vocational rehabilitation planning process. Ten employers who had sent their employees to vocational rehabilitation at a rehabilitation centre in the north of Sweden during 2000 and 2001 participated in the study. Qualitative interviews were performed and analysed by thematic content analysis. The employers' cooperation with clients could be improved by a focus on clients' needs and participation in the rehabilitation process. The employers cooperation with Social Insurance companies could be improved by, 1) early prevention and intervention, 2) knowledge of each other's roles, responsibilities and opportunities and 3) priority making. The employers' cooperation with rehabilitation professionals could be improved by, 1) early identification of rehabilitation needs and goals and early rehabilitation and, 2) increased focus on own responsibilities from each part in the process.
Gamma-Dynacare is a Canadian-based community laboratory partnership formed in the mid-1990s through the merger of 3 prominent Ontario medical diagnostic laboratories. Laboratory Corporation of America acquired an interest in the GD partnership in mid 2002. We service more than 10,000 community-based Canadian clinicians, hospital partners, and private clients with an integrated customer-focused system that includes specimen collection, transportation, and results reporting services. With more than 1,700 highly qualified medical, technical, and support staff and a network of laboratories, Gamma Dynacare aims to be at the forefront of technological innovation to better service the clinician base and ultimately deliver better patient care. We were looking for a hematology analyzer that would allow. (1) standardization throughout Ontario in our 4 largest sites and (2) better performance to effectively handle aged samples and minimize slide review. To select the best, most productive hematology analyzer for our environment, it was decided to perform a side-by-side comparison of the top hematology analyzers from Abbott (Cell-Dyn 3500), Beckman Coulter (LH 750), Bayer (Advia 120), and Sysmex (XE 2100), utilizing the same samples. CBC, differential and reticulocyte parameters were all evaluated according to CLSI (formerly NCCLS) and established hematology analyzer evaluation guidelines. We assessed each analyzer for precision, linearity, carryover, stability, differential capabilities, slide review rates, and throughput (clean bench studies). Two hundred samples were assessed for differential and morphology flagging on each analyzer using the reference 400 cell manual differential for comparison. Throughput was assessed by analyzing 700 consecutive samples representative of our workload mix. Stability studies at 24 hours showed that the Beckman Coulter LH 750 was least affected by EDTA, effect with minimal changes in the mean corpuscular volume (MCV) and hematocrit. Both the Bayer Advia 120 and Sysmex XE 2100 showed an elevation of the MCV (up to 5 fL) and Hematocrit over the 24 hours. Analysis of the 200 randomly selected patient samples showed that, while the false-negative rates on each of the instruments were comparable, there were significant differences in the false-positive rates. This has important implications for slide review rates. For our specimen mix, the Sysmex XE 2100 had the highest false-positive rate (15%), followed by the Cell-Dyn 3500 (8%), Advia 120 (6.5%) and the Beckman Coulter LH 750 (1.5%). Reticulocyte analysis performance was observed to be satisfactory with the Beckman Coulter LH 750, Cell-Dyn 3500, and XE 2100, while the Bayer Advia 120 showed a decrease in retic values after 12 hours. In conclusion, many laboratories will not be able to perform a 4-way evaluation such as described here due to time, space, and resource constraints. For our laboratories, result quality, sample stability performance, slide review rates, and efficiency were the primary criteria in selection of the most suitable hematology analyzer. Our 4-way evaluation resulted in selection of the Beckman Coulter LH 750 for Gamma-Dynacare Laboratories because it enabled the lowest slide review rate and handled aged samples better than the other analyzers.
The educational experience in the operating room is considered the centerpiece of learning for surgical residents. The educational environment is defined as the "ethos" or "climate" that affects all aspects of learning within an educational setting. A measure of the educational environment in the operating room as perceived by residents would assist educators and trainees in gauging the quality of the learning occurring within this important venue. The Operating Room Educational Environment Measure (OREEM) was adapted from an inventory validated for use with basic surgical trainees in Scotland to determine whether an inventory specifically adapted to the specialized environment of the operating room can produce a valid assessment of trainee perception of the overall educational environment and the contributing factors therein at a North American institution.
The 40-item inventory was piloted on a group of general surgery residents at the University of Calgary from November 26, 2003, to January 31, 2004.
With a response rate of 96%, the OREEM was shown to be a relevant, internally consistent (Cronbach proportional, variant = .8656) and valid tool for assessing the overall educational environment in the operating room within a Canadian surgical residency program. Four subscales included teaching and training, learning opportunities, atmosphere, and workload/supervision/support. The overall mean score of 74% suggests the learning environment may be considered satisfactory; however, areas for potential improvement are identifiable. Results reveal strengths such as a nondiscriminatory operating room atmosphere on racial and gender grounds. However, differences were shown in male and female perceptions of learning opportunities and in junior versus senior perceptions of workload, supervision, and support.
The OREEM has potential to be applied further as a quality assessment tool whose results could be used by faculty and program directors to improve the learning experiences of residents in the operating room.