RESUMO
INTRODUCTION: The Shared Resource Laboratory (SRL) model recently described for research activities would also appear to be highly suitable for diagnostic services. Using modern SRL design criteria and benchmarks, the aim of our study was to verify whether the consolidation of a diagnostic cytofluorimetric activity could improve the overall service. METHODS: Outcome indicators such as impact on analytical quality, clinical satisfaction, team work involvement, and economic performance were evaluated in the planning and setting up of a new central laboratory. Comparison with preconsolidation status allowed us to investigate possible indicators of improvement. RESULTS: A total of 30 140 cytofluorimetric analyses performed before and after consolidation at the Central Laboratory in Pievesestina in north-central Italy were evaluated. The overall score of the clinical satisfaction questionnaire (range, between 1 and 5) increased from 4.3 to 4.9. Full-time equivalent (FTE) operators were reduced from 9 to 4.5 and cytofluorimeters from 6 to 2; economic indicator analyses showed a 17.75% reduction in unitary test costs. CONCLUSIONS: The adoption of new benchmarks and design criteria increased the quality of cytofluorimetric analysis, thus improving specialized diagnostic services and promoting the shared resource clinical laboratory.
Assuntos
Técnicas de Laboratório Clínico/estatística & dados numéricos , Serviços de Diagnóstico/estatística & dados numéricos , Citometria de Fluxo/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Benchmarking/economia , Benchmarking/normas , Benchmarking/estatística & dados numéricos , Coleta de Amostras Sanguíneas/economia , Coleta de Amostras Sanguíneas/normas , Coleta de Amostras Sanguíneas/estatística & dados numéricos , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/normas , Análise Custo-Benefício , Serviços de Diagnóstico/economia , Serviços de Diagnóstico/normas , Citometria de Fluxo/economia , Citometria de Fluxo/normas , Recursos em Saúde/economia , Recursos em Saúde/normas , Humanos , Pessoal de Laboratório Médico/economia , Pessoal de Laboratório Médico/normas , Pessoal de Laboratório Médico/estatística & dados numéricos , Reprodutibilidade dos TestesRESUMO
Trichophyton mentagrophytes was treated in vitro for 24 h with an inhibitory concentration of miconazole (10(-5) M). The youngest, apical hyphal cells showed alterations of the ultrastructure of their membranes and cell wall as well as several vacuoles of an autophagic nature. Cellular autophagy appeared as a multi-step process beginning with swelling of the endoplasmic reticulum, whose membranes later fused and gave rise to large vacuoles that entrapped previously demarcated portions of the cytoplasm. Sequestered materials, initially unaltered, were ultimately degraded. The initial event in vacuolation was interpreted as entry of water into the cells, especially into the luminal space of the endoplasmic reticulum, in response to a decrease of wall pressure on the cytoplasm.
