Water vapour permeability of wood – remarks on cup method procedure and measured data of spruce wood

Although the water vapour permeability of wood has been determined many times, there can be found a wide spread of values even related to only one wood specie and its single anatomical direction. This spread can possibly be attributed to the measurement method itself, since the cup method often shows high inter-laboratory error. However, even if the measurement and evaluation processes are well performed and under control, there were found several factors that can still highly affect the resulting value – up to ca. 70 %. These factors are neither mentioned in standards, nor were found in other sources. This paper theoretically describes those factors and their possible impact to the final value of water vapour permeability. Paper also presents one particular measurement scheme and obtained data from four cup tests performed on spruce wood in transverse direction.

Continuation of Over-the-Counter Biotin Supplements in the Inpatient Setting: An Unexpected Source of Laboratory Error

Background Over the past decade, use of high-dose biotin has increased significantly and can lead to erroneous results on some clinical immunoassays. In collaboration with pharmacists at our institution, we discovered that high biotin doses were being administered to inpatients as a continuation of patient-reported home biotin use. Methods This retrospective study evaluated high-dose biotin administration in 226 inpatient encounters from 2009 to 2019 and its potential impact on concurrent immunoassay testing. Results In 96% of cases, biotin was administered in the inpatient setting as a continuation of patient-reported home use. In total, 322 immunoassays capable of biotin interference were performed across 100 inpatient encounters with high-dose biotin administration. Troponin T and TSH were the most commonly performed immunoassays in this cohort. Discussion Even though less than 5% of all high-dose biotin orders at our institution are placed for inpatients, hospitalized patients are still at risk for mismanagement due to erroneous immunoassay results. Immunoassay testing susceptible to biotin interference was performed in approximately 45% of inpatient encounters with biotin administration. Laboratories utilizing biotin-susceptible, sensitive cardiac troponin assays should be particularly cautious. Pharmacokinetic data for biotin clearance is especially lacking for certain populations likely to be hospitalized, such as those with renal failure. Given that medical conditions requiring high-dose biotin therapy are extremely rare, we recommend restricting biotin dosing during inpatient encounters for all other patients.

Identifikasi Waste Tahap Pra Analitik dengan Pendekatan Lean Hospital di Laboratorium Patologi Klinik RS XYZ Depok Jawa Barat Tahun 2021

ABSTRACT The pre-analytic stage includes a series of processes that are difficult to define because they occur in different places and times. Pre-analytical stage errors account for 50% to 70% laboratory error. The research aims to identify waste and provide recommendations for improvement. This type of research is operational research with a mix method research design. Quantitative data from direct observation of the laboratory examination process. Qualitative data from in-depth interviews with Laboratory Medical Technical Analysts (ATLM), on duty doctors and nurses. Non-participant observations use themethod Time and Motion study and calculate the time of each pre-analytical stage activity using a stopwatch to get the standard movement of the sample staged effectively and efficiently. Analysis with lean stages identify activities that do not provide added value (non added value) and waste (waste). Exploring the root causes of problems through in-depth interviews using the 5 (five) Whys approach and proposing recommendations for improvement. The results of the average length of time for the pre-analytic stage are due to the waiting time for new samples due to hemolysis samples. Waste found waiting for samples to be sent back (waiting time), no inspection orders, non-standard identity stickers (defect) and sticker repair (over processing). Phlebotomy training, re-education on handling laboratory specimens for nurses as well as SOPs on laboratory examination packages and sample handover, are expected to reduce pre-analytic waste.Keywords: Waste, Pre Analytical Stage, Concept Lean ABSTRAKTahap pra analitik mencakup serangkaian proses yang sulit didefinisikan karena terjadi ditempat dan waktu yang berbeda. Kesalahan tahap pra analitik menyumbang kesalahan hasil laboratorium sebesar 50% hingga 70%. Penelitian bertujuan mengidentifikasi pemborosan dan memberikan rekomendasi perbaikan. Jenis penelitian adalah penelitian operasional dengan disain penelitian mix method. Data kuantitatf dari observasi langsung proses pemeriksaan laboratorium. Data kualitatif dari wawancara mendalam dengan Analis Teknis Medik Laboratorium (ATLM), dokter jaga dan perawat. Observasi non partisipan menggunakan metode Time and Motion study serta menghitung waktu setiap kegiatan tahap pra analiitk menggunakan stopwatch untuk mendapatkan pergerakan standar sampel ditahap secara efektif dan efisien. Analisis dengan tahapan lean mengidentifikasi kegiatan yang tidak memberikan nilai tambah ( non added value) dan pemborosan (waste). Menggali akar penyebab masalah melalui wawancara mendalam menggunakan pendekatan 5 (lima) Whys dan mengusulkan rekomendasi perbaikan. Hasil rata rata lama waktu tahap pra analitik disebabkan waktu tunggu sampel baru karena sampel hemolisis. Waste yang ditemukan menunggu sampel dikirim ulang (waiting time), tidak ada order pemeriksaan, stiker identitas tidak standar (defect) dan perbaikan stiker (over processing). Pelatihan plebotomi, re edukasi penanganan spesimen laboratorium untuk perawat serta SPO tentang paket pemeriksaan laboratorium dan serah terima sampel, diharapkan dapat mengurangi pemborosan tahap pra analitik.

Uromodulin – biomarker of renal function with promising clinical application

Uromodulin (also known as Tamm-Horsfall protein) is a glycoprotein produced exclusively in the kidneys, mainly in the epithelial cells of the thick ascending limb of the loop of Henle. Under physiological conditions, it is the most abundant urinary protein. A small proportion is released into the renal interstitium and then into the blood, where it can be detected and used as a potential parameter of renal function. Uromodulin has numerous physiological roles and potential pathogenetic significance, including providing protection against urinary tract infections and the formation of urinary deposits, as well as being involved in the immunomodulatory functions and regulation of water and electrolyte balance by the kidneys. Unlike classic renal markers (such as creatinine), uromodulin levels decrease with progressive renal dysfunction. A significant advantage of this parameter is therefore the detectable changes in concentration at the early stages of development of chronic kidney disease. In addition, assessment in clinical materials, such as urine and blood, is relatively simple by immunoenzymatic methods. It is evident that the quantitative determination of uromodulin in blood serum is associated with a lower risk of laboratory error and has a better correlation with renal function. Based on previous studies, Tamm-Horsfall protein / uromodulin can be considered a valuable parameter for standard diagnostics of kidney function and renal diseases. It appears that no other marker is currently able to reflect the integrity and functional state of the renal tubules as sensitively as uromodulin. Due to the potential of this parameter, the article presents and overview of the current information available about uromodulin, as well as the available diagnostic tests and the frequency of their use in clinical practice.

Overdosing the Overdosed

In this case, a middle-aged male presents to the emergency department (ED) of a general hospital with dizziness and weakness and a history of falling the previous day associated with seizures. There is also a possibility of head injury. He is well known to the department and has been seen previously by the head of the department regarding inappropriate use of the ED. Some difficulty ensues in terms of whether he has been having seizures or not, which, combined with a medication error and a laboratory error, results in him being overdosed with a significantly toxic drug. The case is an example of groupthink as well as fundamental attribution error.

The usefulness of quality indicators of preanalitical phase in medical labs, according to the Quality standards requirements, ISO 15189:2013 and WG-LEPS recommendation, Jan 2017

This paper presents the usefulness of pre-analytical process in medical diagnostic laboratories, recommended by WG-LEPS, according to departmental requirements and ISO 15189, with regard to clinical hospital laboratory. It is known that the pre-analytical process generates over 70% of all laboratory errors. The tested materials are laboratory test referrals data for a period of one year (2017), mainly from the Laboratory Information Management System. The study includes the mean annual pre-laboratory error rates. The results showed low error rates in the areas related to the laboratory testing. The highest error rates were found in the field relevant to clinical information and data that are not related the laboratory processing.

Postprandial Blood Glucose can be less than Fasting Blood Glucose and this is not a Laboratory Error

Higher fasting blood glucose level than post prandial level can be seen in variety of conditions in both normal population and diabetics. Various modifiable factors along with underlying condition of patient behind such laboratory picture are discussed in this article. Keywords: clinical laboratory; diabetes; fasting blood glucose; postprandial blood glucose.