Laboratory

The laboratory plays an integral part in providing quality, accurate, and reliable services to satisfy clinicians' needs, help improve patient outcomes, and safeguard public health. During a crisis and especially in a pandemic, laboratory may struggle to work on an existing continuity plan, potentially rendering it incapable of providing timely services. This possibility became a reality during the COVID-19 pandemic surge in the Spring of 2020 in New York City, and laboratory experienced a shortage of labor force, necessary tools, personal protective equipment, testing equipment, supplies, and an inability to store bodies in response to mass fatality. The importance of a laboratory response during a crisis, including effective preparation, and the necessity of having a continuity plan were refined. This chapter was developed based on lessons learned during COVID-19 pandemic at the SBH Health System, Bronx, New York, to provide guidelines to better manage a healthcare crisis, including the development of a more effective continuity plan to prevent disruption of laboratory services, enabling laboratory to continue providing accurate, reliable, and quality services to clinicians for timely decision-making in managing patient treatment and resultant fatality management. In addition, this chapter may help minimize and overcome the interruption in laboratory-continued operations if the crisis has already occurred, ensuring that rapid recovery is initiated, and laboratory operations can be resumed within an acceptable period of time to safeguard public health. © SBH Health System 2022.

Quantification of Vitamin D at Different Levels of Clinical Worsening of COVID-19.

INTRODUCTION AND AIM: Vitamin D is the name given to a group of lipid-soluble steroidal substances of physiological importance in the body, especially in bone metabolism. The active form of vitamin D is believed to have immunomodulatory effects on immune system cells, especially T lymphocytes, as well as on the production and action of several cytokines and on the expression of potent antimicrobial peptides in epithelial cells that line the respiratory tract, playing an important role in protecting the lung from infections. The aim of this study was to assess vitamin D levels in patients with COVID-19 in healthcare service and to verify that these levels are adequate to protect the progression of this infection. METHODS: The aim of this observational study was to evaluate the serum concentration of vitamin D in 300 patients suspected of being infected with COVID-19, treated at Basic Health Units (BHUs) and at the Hospital Complex in the municipality of São Bernardo do Campo. RESULTS: 294 patients were included, 195 (66%) of which tested positive for COVID-19 and 99 (34%) negative for COVID-19. Among the patients in the positive group, 163 patients were in the mild group (84%); 22 patients in the moderate group (11%); 8 patients in the severe group (4%), and 2 patients in the deceased group (1%). CONCLUSION: For the patients in this study, no association was observed for the protective factor of vitamin D against COVID-19 infection, and its role in controlling the clinical staging of the disease was not verified.

Patient Satisfaction with Clinical Laboratory Services in Public Health Sector Hospitals of Azad Kashmir, Pakistan

Objectives: To determine patient satisfaction and factors affecting patient satisfaction with laboratory services in Azad Jammu & Kashmir (AJK). Study Design: Cross-sectional study. Place and Duration of Study: Seven District Headquarter Hospitals, DHQ Neelum, DHQ Hattian Bala, DHQ Pallandari, DHQ Bagh, DHQ Kotli, DHQ Bhimber and DHQ Mirpur, Kashmir Pakistan from Dec 2019 to Feb 2020. Methodology: The patients who were referred from the Outdoor Patient Department of the hospital for undergoing investigative tests were included, and patients of age less than 18 and critically ill patients were excluded. Results: The total number of respondents included in the study was 400, with the median score of patient satisfaction with laboratory services being 59 (19), ranging from 32 to 100. Statistically significant disparities in client satisfaction were observed in different DHQ hospitals (p-value=0.01) with Mirpur (63) and Pallandri (40) showing the extreme variation. Residential area, age, and education level were also identified as statistically significant determinants of patient satisfaction (p-value <0.05). Conclusion: patient satisfaction with laboratory services in public hospitals of AJK was very low, and targeted strategies are needed to improve the overall quality of these services. © 2022, Army Medical College. All rights reserved.

Integrated use of laboratory services for multiple infectious diseases in the WHO European Region during the COVID-19 pandemic and beyond.

Technical advances in diagnostic techniques have permitted the possibility of multi-disease-based approaches for diagnosis and treatment monitoring of several infectious diseases, including tuberculosis (TB), human immunodeficiency virus (HIV), viral hepatitis and sexually transmitted infections (STI). However, in many countries, diagnosis and monitoring, as well as disease response programs, still operate as vertical systems, potentially causing delay in diagnosis and burden to patients and preventing the optimal use of available resources. With countries facing both human and financial resource constraints, during the COVID-19 pandemic even more than before, it is important that available resources are used as efficiently as possible, potential synergies are leveraged to maximise benefit for patients, continued provision of essential health services is ensured. For the infectious diseases, TB, HIV, hepatitis C (HCV) and STI, sharing devices and integrated services starting with rapid, quality-assured, and complete diagnostic services is beneficial for the continued development of adequate, efficient and effective treatment strategies. Here we explore the current and future potential (as well as some concerns), importance, implications and necessary implementation steps for the use of platforms for multi-disease testing for TB, HIV, HCV, STI and potentially other infectious diseases, including emerging pathogens, using the example of the COVID-19 pandemic.

Data Mining in Medical Laboratory Service Improves Disease Surveillance and Quality Healthcare

Day in day out, data are turned out in various medical laboratories which are adequately documented and used for surveillance in various diseases of concern in public health. Though data mining seems to be new in healthcare, medical laboratory services as very important component of healthcare need serious data mining for diagnosis of ailments and numerous public health diseases. This chapter was carried out based on review of literatures and practices available in Nigeria which contributes to healthcare quality improvement. The chapter examined origin, basic principles, advantages and disadvantages, uses, and challenges of data mining in relation to medical laboratory information management system (MLIMS) while looking at data management from hard to soft copies, possible applications, ethico-legal perspectives, implications of data mining, disease surveillance, and data mining toward quality improvement as used in medical laboratories. It is evident that most of decisions taken in healthcare and public health are based on information provided by data mining from medical laboratory services based on the diseases of interest. Data mining in medical laboratory services is a tool that aids in monitoring trends in the diagnosis of cancer, HIV, COVID-19, malaria, diabetes, and other diseases based on various parameters of assessment with all demographic variables well documented and analyzed. The interested agencies or ministries may apply data mining techniques based on medical laboratory results to find trends in disease outbreaks or deaths, per hospital, state, region, or country through which policies could be formulated and implemented toward surveillance and quality healthcare improvement. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Strategy of active case-finding for COVID-19 in Bogota city, 2020-2021

Introduction. With the national guidelines of the Sustainable Selective Test-Tracking-Isolation program (PRASS in spanish) and the districts strategy of Detect-Isolation-Report (DAR in spanish) from the Public Health Plan of Collective Interventions (PSPIC in spanish), during 2020 were implemented activities of active search for positive cases of SARS-CoV-2, in order to identify risk areas and implement mitigation and containment strategies for the COVID-19 pandemic in Bogota. The objective of this work is to describe the strategy of active case-finding for COVID-19 in Bogota city, 2020-2021. Materials y methods. Using descriptive statistics, we described the search sessions carried out in the city. Thus, the integrated health services subnets with their home environment public health teams, integrated by professionals and trained technicians, carried out swab sampling in the following clusters: Select groups with greater vulnerability or high exposure to the virus given their daily activities, or specific areas of the city with a high rate of virus transmissibility or apparently silent. Samples were sent to the district public health laboratory for processing using the Charite protocol RT-PCR, Berlin. They also carry out communication and education activities for health and notification of cases to the Public Health Surveillance System-SIVIGILA. Results. Between June 2020 and June 2021, were performed 9997 journeys of active search, where 1000.225 samples were taken along the 20 localities of Bogota city, with a higher concentration of samples in Ciudad Bolivar (11%), Kennedy (9%), Tunjuelito (7%), Suba (6%), Usme (6%), Puente Aranda (6%) and Bosa (6%). Acumulative positivity ratio of 20% was observed for the observed period, in the three moments with the highest frequency of positive cases for the SARS-CoV-2 virus in the city, positivity ratios of 14% were reached in the months of July and August 2020, 19% between December 2020 and January 2021 and 39% in the third peak of infections between May and June 2021, finding for the latter period time, days with positivity proportions that exceeded 45%. Conclusion. In the city, epidemiological surveillance actions are continued, such as Field Epidemiological Investigations (IEC in spanish), as well as the increasing of collective interventions in the different environments of daily life, wich are focused on the areas with the higher positivity, developing actions aimed at empowering the community in relation to care and biosecurity guidelines to reduce the COVID-19 contagion risk. © 2021 IEEE.

Initial Clinical Laboratory Response to COVID-19: A Survey of Medical Laboratory Professionals.

OBJECTIVE: To explore the experiences of medical laboratory professionals (MLPs) and their perceptions of the needs of clinical laboratories in response to COVID-19. METHODS: We surveyed laboratory professionals working in United States clinical laboratories during the initial months of the pandemic. RESULTS: Overall clinical laboratory testing and overtime work for laboratorians decreased during the first months of the pandemic. Laboratory professionals reported better or unchanged job satisfaction, feelings toward their work, and morale in their workplace, which were related to healthcare facility and laboratory leadership response. They reported receiving in-kind gifts, but no hazard pay, for their essential work. Important supply needs included reagents and personal protective equipment (PPE). CONCLUSION: The response by healthcare facilities and laboratory leadership can influence MLPs job satisfaction, feelings toward their work, and laboratory morale during a pandemic. Current COVID-19 laboratory testing management, in the absence of sufficient reagents and supplies, cannot fully address the needs of clinical laboratories.

The challenges and risk of laboratory handling on a histology specimen during COVID-19 pandemic.

The Coronavirus Disease 2019 (COVID-19) pandemic has taken the world into turmoil by surprise. The rapid spreading of this virus has led to an exponential increase in the number of cases. It has created a public health disaster, causing a collapse of the health system in every part of the world. Many sectors in the health area are affected, including histopathology services. The challenges and risk of viral transmission can come from various aspects and levels. For COVID-19 tests, there are even cases of no direct contact with the specimens; the specimens received infection from individuals of unknown status. The fixatives used for histopathology specimens are believed to be inactivated viruses, which can be an inactivate coronavirus. Even so, precautions have to be put in place to prevent the spread of infection to laboratory personnel, especially to those handling underfixed and fresh frozen cytology samples. Precautions must also be taken when dealing with histopathology services, by wearing full personal protective equipment and by executing other standard safety measures. The purpose of this review is to highlight the challenges faced in managing histopathology services in our centre during the COVID-19 pandemic.