Patterns of blood product use among patients with myelodysplastic syndrome.

BACKGROUND AND OBJECTIVES: Most patients with myelodysplastic syndrome (MDS) require blood product support to manage the severe anaemias, which frequently accompany MDS. Our objective was to show the feasibility of linking the Surveillance, Epidemiology and End Results (SEER) database with records from Puget Sound Blood Center (PSBC) to characterize blood product use over time in successive cohorts of patients with MDS. MATERIALS AND METHODS: We identified patients with MDS in the SEER registry. The cohort was then linked to PSBC records to discern blood product use. RESULTS: Included in the analysis were 783 patients with MDS entered in the SEER database from 2001 to 2007 for whom data were also available in the PSBC database. Among patients with MDS who received transfusions, 97% received packed red blood cells; 52% received platelets. The proportion of patients with MDS receiving blood products declined from 2001 to 2007. CONCLUSION: These data show a recent decline in blood product use for patients with MDS. Future studies are needed to further evaluate the reasons for this finding, specifically exploring the impact of newer medications on blood product use in patients with MDS.

CLT and CLS job responsibilities: current distinctions and updates.

OBJECTIVE: This study was undertaken to address the following questions: 1. What tasks distinguish the job of a clinical laboratory scientist (CLS) from that of a clinical laboratory technician (CLT)? 2. What changes in role distinctions, have occurred for entry-level CLS and CLT practitioners over the five-year period 1993-98? 3. What tasks have been deleted from the CLT and CLS content outlines because they were not frequently performed or not considered entry-level? 4. What changes in practice are reflected in the current job analyses? DESIGN: A national job analysis of tasks constituting the job of clinical laboratory scientists (CLSs) and clinical laboratory technicians (CLTs) was conducted in 1998-99 as part of a standard setting process for the certifying examinations of the National Credentialing Agency for Laboratory Personnel (NCA). The job analyses relied upon mail surveys to 1200 individuals for each job level asking respondents to identify tasks significant to effective practice at job entry. The task lists resulting from statistical analysis of those surveys were examined to answer the study questions. PARTICIPANTS: The sample for each survey included 1200 practitioners, educators and laboratory managers selected at random from membership in professional organizations or from NCA certificant lists. Sampling was stratified to insure adequate practitioner representation. MAIN OUTCOME MEASURES: The mean rating on a four point scale for each item on the surveys was evaluated for overall significance as well as significance across geographic regions. The tasks meeting specified criteria were retained in the final task lists. Tasks were counted and their content evaluated to compare CLS and CLT job tasks. RESULTS: The response rates to the surveys were 33% for CLT and 21% for CLS. Reliability was judged based on average intraclass correlation coefficients of .86 and .82 for the CLT and CLS surveys, respectively. There were 952 tasks retained on the CLS content outline and 725 retained on the CLT content outline of the 1151 tasks on the original survey. Seven hundred and twenty two tasks were found on content outlines of both job levels, representing a 76% overlap. Tasks found only on the CLS outline included advanced technical tasks, a few management tasks, and more communication tasks. CONCLUSIONS: The jobs of CLS and CLT practitioners are distinct at job entry level with CLSs performing a broader array of technical and communication tasks as well as some management tasks. Though CLS staff uses few management skills at job entry, those tasks are performed by CLS staff in the laboratory and curricula must help prepare graduates for these tasks expected of experienced staff. CLTs perform tasks requiring problem solving and high level reasoning. CLT curricula must address the need for CLTs to perform these tasks.

Laboratory managers' perceptions of the impact of teaching on the clinical laboratory.

OBJECTIVE: To determine managers' perceptions of the impact of teaching students on the clinical laboratory, including: productivity, costs, recruitment/new employee orientation, staff morale/attitude, and staff professionalism. Managers' views on responsibility for teaching and reasons for not having students were also determined. DESIGN: Written survey, randomized sampling. PARTICIPANTS: Five hundred laboratory managers certified by the National Credentialing Agency. MAIN OUTCOME MEASURES: Participants completed a forced-choice written survey consisting of demographic information and statements assessing the impact of teaching. RESULTS: Managers agreed with impact statements on professionalism, recruitment, and new employee orientation. They were also in agreement that clinical teaching is essential. Neutral responses were obtained for impact statements related to laboratory productivity, costs, and staff morale and attitude. Over 90% of respondents who presently had students or who had had students at one time indicated that they hired their graduates. CONCLUSIONS: Laboratory managers understand the importance of clinical education and the benefits to recruitment, new employee orientation, and staff professionalism. Managers are undecided about the effects of teaching on laboratory costs and staff productivity.

Clinical laboratory scientists' view of the competencies needed for current practice.

OBJECTIVE: To provide a current description of competent clinical laboratory scientists (CLSs) that can be used as a guide for educators, practitioners, and students. DESIGN: A survey of clinical laboratory science (CLS) practitioners was developed to assess current work settings and important competencies in those settings. The survey also addressed graduate school enrollment and the impact of multi-skilling on current practice. SETTINGS AND PARTICIPANTS: 135 graduates of the Division of Clinical Laboratory Science at the University of North Carolina at Chapel Hill from 1987 to 1996. MAIN OUTCOME MEASURES: Participants' responses to questions about their current job titles, clinical specialty, type of institution, multi-skilling, graduate school enrollment, and the competencies they considered important for their jobs were analyzed to provide a description of current practice. RESULTS: The response rate for the survey was 73%. The majority of the respondents were employed as staff CLSs in medium to large hospitals. Thirteen percent of the respondents indicated that they had graduate degrees and an additional 13% were currently enrolled in a graduate or professional program. Fourteen percent of the respondents reported that they were working in the laboratory profession and were performing some health care skills not included in the CLS program. The graduates described 15 major areas of competence important for current clinical practice. The skill or competency mentioned most frequently by the respondents was interpersonal skills followed by flexibility. Competence in technical and scientific skills was ranked third and problem solving abilities was ranked fourth. CONCLUSION: The results of this study describe a CLS practitioner who is able to communicate well with others as a team member; flexible and open to change in the work environment; technically component; able to solve problems and correlate clinical information; organized; and involved in the management and leadership of the clinical laboratory. This description can help educators design curricula, guide practitioners' self assessment, and inform students who are considering a career in CLS.

Use and abuse of the Children's Depression Inventory.

This study investigated current uses of the Children's Depression Inventory (CDI), a frequently cited self-report measure for children's depressive symptomatology. Recently published studies of "childhood depression" were reviewed: Half of them used the CDI. Of these studies, 68% did not use a clinical or structured interview to determine diagnostic status. When the CDI was used alone to assess depressive symptoms, 44% of studies referred to high CDI scorers as "depressed" without providing a clear cautionary statement (i.e., either stating that the CDI cannot be used to diagnose depression or clarifying limitations regarding generalization of findings from a nonclinical to a clinical sample). These results are similar to those previously published regarding the Beck Depression Inventory, and they suggest a need for caution in the administration and interpretation of results from self-report inventories for children's depressive symptoms.

Distressed and nondistressed third- and sixth-grade children's self-reports of life events and impact and concordance with mothers.

This study examined the concordance of third- and sixth-grade distressed and nondistressed children's self-reports of the occurrence and perceived impact of life events that had occurred during the preceding 12 months with their mothers' perceptions. The study also examined whether maternal self-reports of dysphoria affects concordance between mother/child dyads on children's self-reports of occurrence and perceived impact of life events. Eighty-eight mother/child dyads, matched on Children's Depression Inventory scores, grade, sex, race, and school were included. Results indicated that distressed children endorsed more items on the Coddington Life Events Record (LER), and perceived them more negatively, than nondistressed children. Small, but statistically significant concordance rates were found between dyads on the occurrence of life events and the perceived impact of these events: Distressed children and their mothers had more mutually endorsed items than nondistressed children and mothers, and third-grade children had higher concordance rates with their mothers when compared to sixth-grade children. Third-grade children also appeared to commit more errors of commission on the LER. Finally, maternal distress mediated mother/child concordance. Possible explanations for these results and future research directions are discussed.

Legal aspects associated with dismissal from clinical laboratory education programs.

OBJECTIVE: To review academic dismissals, students' rights in dismissal cases, and several key cases involving academic and disciplinary dismissals. DATA SOURCES: Recent academic literature and legal precedents. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: Students involved in dismissals are protected under the principles of constitutional law and/or contract law, depending on whether the institution is public or private. The basis for dismissal from educational programs is either academic or disciplinary in nature. In academic dismissals, a student has failed to meet either the cognitive or the noncognitive academic standards of the program. In disciplinary dismissals, a student has violated the institutional rules governing conduct. Policies that affect progress in the program and the dismissal process should be published and distributed to students, as well as reviewed for consistency with institutional policies. CONCLUSION: The amount of documentation needed in the defense of a dismissal decision has not been specified, but, in general, more is better. Procedures are suggested as a guide to dismissals in clinical laboratory programs.

Legal issues relevant to clinical laboratory education program admissions.

OBJECTIVE: To address the basic legal requirements for admissions, admissions standards, student and applicant records, and discrimination in admissions for clinical laboratory science (CLS) and clinical laboratory technician (CLT) educational programs. DATA SOURCES: Recent academic literature and legal precedents. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: CLS and CLT educational programs typically practice selective admissions. Program directors and faculty need to be aware of the issues relating to student selection that may have legal implications. Admissions practices should be guided by three basic legal requirements: that the selection process not be arbitrary or capricious, that the program adhere to its published admissions standards and honor admissions decisions, and that the program not have admissions policies that discriminate on the basis of race, gender, age, disability, or citizenship. Specific guidelines are offered for applying these legal requirements to the admissions practices typically used by CLS and CLT programs, including published admission policies and standards, application forms, interviews, rating of noncognitive attributes, and communication with applicants. CONCLUSION: Admissions practices in CLS and CLT programs need to be guided by the three basic legal requirements.

Assessing the educational preparation of clinical laboratory scientists.

OBJECTIVE: To assess the educational preparation of clinical laboratory science (CLS) graduates using an approach that addresses the general education and professional components of the curriculum and includes multiple programs. DESIGN: Survey of a convenience sample. SETTING: Four CLS programs in North Carolina. PARTICIPANTS: CLS graduates with one, three, and five years of experience. MAIN OUTCOME MEASURE: Results of 48 competency statements rated by graduates for level of preparation and importance in current jobs. RESULTS: Graduates indicated that they were well prepared in most conceptual and technical competencies with the exception of computers and management. Preparation in career marketability skills (interviewing, writing résumés, and career planning), contextual competence (understanding socioeconomic and governmental issues), and scholarly concern for professional improvement (research skills) was rated relatively low. Graduates considered the conceptual and technical competencies related to their current specialty as very important for their jobs. They also rated professional ethics, communication skills, and integrative competencies as very important for practice. Graduates in supervisory positions rated communication competencies significantly higher in importance than did graduates in other positions. Graduates rated as relatively unimportant competencies in conceptual and technical skills unrelated to their current specialties and scholarly concern for professional improvement. CONCLUSION: In the professional component of the curriculum, educators should review the amount of conceptual and technical content required and the level of preparation in career marketability skills. In the general education component of the curriculum, CLS students' preparation in contextual competencies and communication skills should be reviewed and strengthened.

Advances in transfusion therapy.

OBJECTIVE: To review several recent advances in blood transfusion therapy. DATA SOURCES: Professional journals and current American Association of Blood Banks (AABB) recommendations. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: Improvements in leukocyte reduction of blood components have been effective in preventing alloimmunization to white cell antigens and the transmission of cytomegalovirus. Leukocyte reduction has not proved effective, however, in preventing febrile reactions after platelet transfusions in alloimmunized patients. To reduce the risk of transfusion-associated graft-versus-host disease, new recommendations for the irradiation of blood components have been made. They include the irradiation of donor units from all blood relatives of the recipient and an increase in the recommended dose of irradiation to 2,500 cGy. Current investigations of both hemoglobin-based and fluorocarbon-based blood substitutes may improve the safety and efficacy of transfusion therapy in the future. CONCLUSION: Advances in transfusion therapy include the prevention of alloimmunization to leukocyte antigens, the prevention of CMV transmission by using leukocyte-reduced blood products, the reduction of the risk of transfusion-associated graft-versus-host disease, and the investigation of potential blood substitutes.

Maternal characteristics and perceptions of pervasive and situational hyperactives and normal controls.

Thirty 6- to 9-year-old boys were rated by their mothers and teachers as being pervasively hyperactive, situationally hyperactive, or not hyperactive at home or school. Maternal characteristics and perceptions of their children's behavior problems were collected. Children's global and molecular social skills were also assessed in a role-play format. Mothers of pervasive hyperactive boys reported significantly more overall stress in their relationship with their child and perceived their sons as displaying more behavioral problems compared to mothers of situational hyperactive and nonhyperactive children. Mothers of pervasive hyperactive boys also rated themselves as more depressed, less competent, more restricted, and frustrated compared to control mothers. Mothers of situational hyperactive children indicated that their sons displayed more behavior problems and reported more maternal stress compared to mothers of normal controls. Normal controls were rated as overall more socially skilled than situational hyperactive boys. The utility of the pervasive and situational hyperactivity distinction is discussed.

The relationship among guilt, dysphoria, anxiety and obsessions in a normal population.

Seventy-six college students reported intrusive thoughts and impulses on a checklist. These students also completed questionnaires assessing depression, trait anxiety and perceived guilt. Results indicated for this normal population that intrusive thoughts were more distressful, more difficult to dismiss and occur with a greater variety of content compared to intrusive impulses. Multiple regression analysis showed that guilt was the best predictor of intrusive thoughts and impulses. Self-reported depression and anxiety were not strong predictors with respect to nonclinical obsessions and impulses. Discussion focuses on the utility of assessing guilt with obsessional disorders, the lack of a relationship between self-report trait anxiety and nonclinical obsessions, and the need to examine the relationship between guilt and anxiety with clinically obsessional subjects.

Implementation and evaluation of a new approach to clinical instruction.

An approach to clinical instruction based on the Learning Vector model was introduced in a hospital laboratory during the 1985-86 academic year. Fifteen clinical instructors and nine medical technology students participated in the study. Clinical instructors attended an initial workshop on the model and met monthly during the academic year with the project directors to discuss their progress. The implementation of the model and the reactions of students and instructors to the model were evaluated using attitudinal questionnaires, interviews, and observations. Instructors were most successful using the model during the learning activities component of clinical instruction and were less consistent in implementing the model in the expectation-setting and evaluation components of instruction. According to instructors and students, advantages of this approach included improved communication, guidance and organization of instruction, and an increased emphasis on feedback and evaluation. The major constraint to implementation was a limited amount of time spent with students, due to scheduling or workload.

Validity of teacher nominations of child behavior problems.

The purpose of this study was to examine the validity of teachers' identification of problem children. Ninety-five third-grade children served as subjects. Teachers nominated children as a conduct problem, withdrawal problem, or normal, resulting in 16, 14 and 65 children being assigned to the three groups. Behavioral observation, peer sociometric ratings, and academic achievement scores were collected. The results indicated that conduct problem children differed from normal children on behavioral, sociomeptric, and academic measures, whereas withdrawal children differed from normals on the latter two measures. Conduct problem and withdrawal problem children did not differ on any of the dependent measures. The results suggest that teachers can identify children who are having difficulties in class but may be less accurate in differentiating between different types of problem children.