Tracking and controlling everything that affects quality is the key to a quality management system.

Every laboratory has a need to track and control the variables that drive the quality of the results. However, each laboratory is unique and what one organization deems to be a critical process to track and control will likely differ from other organizations. Furthermore, there is more than just the end product or result that needs to be tracked and controlled. All of the intermediate products and resources play a significant role in producing the final product and each of these needs to be included in the LIMS. At a high level, this article will present ideas and opinions on the following topics in relation to implementing a LIMS process tracking and control system in a laboratory: The difference between tracking and controlling processes; What to track and control in the lab; The "product" of the laboratory; Preventing mistakes in a laboratory; Comprehensive software platform options; The value of seeing a system as opposed to imagining it; The use of barcodes in the laboratory; and an assessment on using the Risk Based Approach in deciding what to include in the tracking system.

MalPEG-hemoglobin (MP4) improves hemodynamics, acid-base status, and survival after uncontrolled hemorrhage in anesthetized swine.

OBJECTIVES: MalPEG-hemoglobin, 4 g/dL (MP4), is a hemoglobin-based oxygen carrier with a low hemoglobin concentration, low P50 (oxygen half-saturation pressure of hemoglobin), high colloid osmotic pressure, and high viscosity. This study evaluated resuscitation with MP4 in anesthetized swine hemorrhaged 250 mL by controlled withdrawal, followed by a 5-mm tear in the abdominal aorta. DESIGN: Randomized, unblinded. SETTING: Academic animal laboratory. SUBJECTS: Anesthetized male and female Swedish Landrace pigs. INTERVENTIONS: Four groups of pigs (n = 7 each) were randomized after hemorrhage by aortic tear to receive 250 mL of MP4, Ringer's acetate, 10% pentastarch, or 4 g/dL of stroma-free hemoglobin, followed by aortic repair and transfusion of 250 mL of autologous blood. End points were 20-hr survival, hemodynamic variables, and acid-base status. MEASUREMENTS AND MAIN RESULTS: Measurements included continuous aortic, pulmonary arterial, and central venous pressures, cardiac output by thermodilution, arterial and venous blood gases; electrolytes; lactate; base excess; oxygen delivery, consumption, and extraction ratio; hematocrit; hemoglobin; and urine output. Body weight (24-27 kg) and hemorrhage volume (26-33 mL/kg) were similar in the four groups. The nadir of mean arterial pressure (22-28 mm Hg) and the increase in lactic acid (5-8 mEq/L) after hemorrhage were similar in all groups, indicating equivalent shock in the four groups. Survival was greatest in the MP4-treated animals (six of seven) compared with Ringer's acetate (two of seven), 10% pentastarch (one of seven), and stroma-free hemoglobin (two of seven) and was accompanied by an improved recovery of arterial pressure, cardiac output, and lactate. Total hemoglobin concentration was equivalent in all groups. Arterial pressure did not increase above baseline values, and systemic vascular resistance was unchanged following administration of MP4, indicating the lack of peripheral vasoconstriction. Mortality in Ringer's acetate, stroma-free hemoglobin, and 10% pentastarch treated animals was associated with deteriorating acid-base status, low urine output, and hyperkalemia. CONCLUSION: These data demonstrate that restoration of oxygen delivery with a small volume of MP4 yields significant recovery from hemorrhage without systemic vasoconstriction.