Systemic COVID-19 vaccination also enhances the humoral immune response after SARS CoV-2 infection in the population of an oncology hospital in Poland. Criteria for COVID-19 re-immunization are needed.

Systemic vaccination of the BNT162b2 mRNA stimulates humoral response. Our study aimed to compare the intensity of humoral immune response, measured by SARS CoV-2 IgG, SARS CoV-2 IgM, and neutralization S-RBD IgG antibodies level, post COVID-19 vaccination versus post-SARS COV-2 infection. We analysed 1060 people in the following groups: convalescents, healthy vaccinated, vaccinated with COMIRNATY, AstraZeneca, Moderna, Johnson & Johnson, and vaccinated SARS CoV-2 convalescents. A concentration of SARS CoV-2 IgG, SARS CoV-2 IgM, and neutralizing S-RBD IgG was estimated in hospital laboratory by chemiluminescent immunoassay - CLIA, MAGLUMI. Results: 1. We observed a rise of antibodies response in both convalescent SARS CoV-2 and COVID-19 vaccinated groups 2. The level of all antibodies’ concentrations in vaccinated COVID-19 convalescents was significantly higher. 3. We differentiated asymptomatic SARS CoV-2 convalescents from the control group. Based on our analysis, we suggest that it is essential to monitor SARS CoV-2 antibodies concentrations as an indicator of asymptomatic COVID-19 infection and equivalent to the effectiveness of humoral response in convalescents and vaccinated people. Considering the time-limited nature of the effects of post-infection SARS CoV-2 recovery or vaccination, among others physiological half-life, we suggested monitoring IgG antibodies level as a criterium for the next vaccination.

Kualitas Pelayanan dan Kepuasan Pasien (Studi Kasus Instalasi Laboratorium Rumah Sakit ST. Theresia Jambi)

The purpose of this study is to see the extent to which service quality affects patient satisfaction, the subjects used as the unit of analysis in this study are patients who use the services of the ST hospital laboratory installation. Theresia Jambi, totaling 57 patients, the data collection technique used a closed questionnaire given to respondents with alternative answers that had been provided, then the data was processed using regression analysis. The results of this study prove that the higher the level of service quality provided, it can affect the increase in patient satisfaction.

Impact of ABCDE Bundle Implementation in the Intensive Care Unit on Specific Patient Costs

Objectives: To measure the impact of full versus partial ABCDE bundle implementation on specific cost centers and related resource utilization. Design: Retrospective cohort study. Setting: Two medical ICUs within Montefiore Health System (Bronx, NY). Patients: Four hundred and seventy-two mechanically ventilated patients admitted to the medical ICUs during a hospitalization which began and ended between January 1, 2013 and December 31, 2013. Interventions: The full (A)wakening, (B)reathing, (C)oordination, (D)elirium Monitoring/Management and (E)arly Mobilization bundle was implemented in the intervention ICU while a portion of the bundle (A, B, and D components) was implemented in the comparison ICU. Measurements and Main Results: Relative to the comparison ICU, implementation of the entire bundle in the intervention ICU was associated with a 27.3% (95% CI: 9.9%, 41.3%; P = 0.004) decrease in total hospital laboratory costs and a 2,888.6% (95% CI: 77.9%, 50,113.2%; P = 0.018) increase in total hospital physical therapy costs. Cost of total hospital medications, diagnostic radiology and respiratory therapy were unchanged. Relative to the comparison ICU, total hospital resource use decreased in the intervention ICU (incidence rate ratio [95% CI], laboratory: 0.68 [0.54, 0.87], P = 0.002; diagnostic radiology: 0.75 [0.59, 0.96], P = 0.020). Conclusions: Full ABCDE bundle implementation resulted in a decrease in total hospital laboratory costs and total hospital laboratory and diagnostic resource utilization while leading to an increase in physical therapy costs.

Comparison of Diagnostic Accuracy of Portal Serum Ascitic Albumin Gradient (SAAG) with Ascitic Fluid Total Protien (AFTP) Differentiating Portal Hypertension from Non-Portal in Patients with Ascites

Introduction: Although majority of the cases of ascites have cirrhosis, there are 15% patients where there is a non-hepatic cause of fluid retention like malignancy, congestive heart failure and tuberculous peritonitis. Ascites is the most common complication of cirrhosis that leads to hospital admission. Objective:To compare the diagnostic Accuracy of Serum Ascitic Albumin Gradient (SAAG) and Ascitic Fluid Total Proteins in patients with ascites by taking Ultrasound abdomen & Pelvis as gold standard. There are international studies on the accuracy of SAAG in determining cause of ascites but not much local data. Additionally, SAAG is not widely used in our setup. The results of this study will add to the existing knowledge and will help in the diagnosis and better management of these patients. Material & Methods: A cross sectional validation study was conducted in the department of General Medicine, DHQTH, Dera Ismail Khan from 29th April to 29th Oct, 2019. Diagnostic Ascitic fluid was aspirated from the peritoneal cavity and ascitic fluid was sent to hospital laboratory for total protein and albumin. Blood was taken at the same time and was send to the hospital laboratory for the serum albumin. SAAG was calculated by subtracting ascitic albumin value from the serum albumin value. Both, Ascitic fluid total protein and SAAG values was documented in the proforma. Ultrasound Abdomen & Pelvis was done on each patient with special instruction for radiologist to comment upon Portal Vein diameter and any changes in its diameter with respiration. Results: As per comparison Of SAAG with ultrasound in detecting ascites, sensitivity was 36.26%, specificity was 75%, PPV was 84.62%, NPV was 23.68% and accuracy was 44.35%. P Value was 0.299. As per comparison of AFTP with ultrasound in detecting ascites, sensitivity was 33.33%, specificity was 59.34%, PPV was 17.78%, NPV was 77.14% and accuracy was 53.91%. P value was 0.513. Conclusion:SAAG exhibits that patients with ascites fluid possess the basis of portal hypertension. Thus we have come to this conclusion that SAAG can effectively enhance the diagnostic value of ascites fluid tests and therefore its classification can be considered to be a novel standard in the analysis of ascites fluid. Keywords: Diagnostic Accuracy, Ascites Volume, Ascitic Albumin Gradient (SAAG), Ascitic Fluid Total Proteins (AFTP)

Evolution of anatomic pathology workload from 2011 to 2019 assessed in a regional hospital laboratory via 574,093 pathology reports

Objective Quantify changes in workload in relation to the anatomic pathologist workforce. Methods In house pathology reports for cytology and surgical specimens from a regional hospital laboratory over a nine- year period (2011–2019) were analyzed, using custom computer code. Report length for the diagnosis+microscopic+synoptic report, number of blocks, billing classification (L86x codes), billings, national workload model (L4E 2018), regional workload model (W2Q), case count, and pathologist workforce in full-time equivalents (FTEs) were quantified. Randomly selected cases (n = 1,100) were audited to assess accuracy. Results The study period had 574,093 pathology reports that could be analyzed. The coding accuracy was estimated at 95%. From 2011 to 2019: cases/year decreased 6% (66,056 to 61,962), blocks/year increased 20% (236,197 to 283,751), L4E workload units increased 23% (165,276 to 203,894), W2Q workload units increased 21% (149,841 to 181,321), report lines increased 19% (606,862 to 723,175), workforce increased 1% (30.42 to 30.77 FTEs), billings increased 13% ($6,766,927 to $7,677,109). W2Q in relation to L4E underweights work in practices with large specimens by up to a factor of 2x. Conclusions Work by L4E for large specimens is underrated by W2Q. Reporting requirements and pathology work-up have increased workload per pathology case. Work overall has increased significantly without a commensurate workforce increase. The significant practice changes in the pathology work environment should prompt local investment in the anatomic pathology workforce.

Assessment of Clinical laboratory using WHO AFRO-SLIPTA Quality Standards in a Referral Hospital laboratory in Ghana

Introduction: The hospital laboratory exists to provide accurate and reliable results to physicians for effective management of patients. The Quality Management System (QMS) in the laboratory must be effective and efficient so that reliable results will be produced for patient care. Quality System Essentials together with International Organization for Standardization (IOS) 15189 are the core components used to establish a QMS in the Laboratory. Laboratory assessments are an effective means to determine whether a laboratory is providing accurate and reliable results and adhering to good laboratory practices. We assessed the Suhum Hospital laboratory to identify gaps in the components of Quality System Essentials. Method: This exploratory study investigated the practice of QMS in Suhum Hospital laboratory, a public district hospital laboratory in Ghana, in January 2016. Data collected comprised activities by laboratory staff during onsite visits and evidence of documentation. Permission to collect data was sought from the Hospital Management and Laboratory Manager. We used the WHO-AFRO laboratory Strengthening Checklist to assess the laboratory. We reviewed the records to verify if the laboratory quality manuals, policies, logs, Standard Operating Procedures (SOPs) were complete, current, accurate, and annually reviewed. Finally, we interviewed staff of the laboratory and clinicians to obtain information to learn their perspective on the laboratory’s performance. Results: The undepartmentalized laboratory is headed by a manager with a staff strength of 13 trained professionals. It receives averagely 100 patient samples daily and runs 30 different tests. The main strengths of the laboratory in terms of Quality System Essentials were information management 15/18 (83%), process control 25/33 (77%), internal audit 6/10 (60%), facilities and safety 25/43 (58%), purchasing and inventory 17/30 (57%). However, equipment management 8/30 (27%), occurrence management 3/12 (25%), documents and records 7/25 (28%), organization and personnel 8/20 (40%), corrective actions 5/12 (42%) and client management 5/17 (29%) required improvement. Conclusion: Findings from the laboratory audit pointed to an overall weak laboratory QMS based on WHO/AFRO laboratory strengthening checklist and rating. Concerted efforts are therefore required to improve the laboratory QMS rating to improve quality of care to clients in all district hospital laboratories in Ghana.