Hematological health-related intervals estimated using an indirect method in order to satisfy the accreditation standards

 The estimation of reference limits represents quite a taxing task for laboratories which frequently adopt the limits suggested by manufacturers or those reported in the literature. This practice does not meet the requirements of accreditation programs (i.e. Essential Criteria, Clinical Pathology Accreditation) that require laboratories to produce or check all their reference intervals. We collected 15 244 hematological results from females aged 0–99 years obtained by the Rovereto Hospital Laboratory and calculated the reference intervals, or to be more precise the health-related intervals, using an indirect method (based on all the inpatient and outpatient results). All the measurements were carried out using an automatic Coulter STK S analyzer, and the results were transferred to Verona by e-mail. The results for hemoglobin were: <1 year (n=154)=90–171 g/l; 2–8 years (n=619)=104–136 g/l; 9–14 years (n=322)=118–143 g/l; 15–44 years (n=6329)=106–144 g/l; 45–75 years (n=4893)=107–148 g/l; 75–99 years (n=2927)=90–153 g/l. The results appear different from the results currently used by Rovereto Hospital (120–160 g/l) but comparable to those reported in the literature with the exception of the subjects under 1 year and over 75 years, probably due to the excess of "diseased" subjects in these classes. The indirect method allows even small laboratories to produce or check their reference intervals for all age groups, increasing the clinical effectiveness of laboratory results and satisfying the accreditation standards. Received: 15 April 2000 · Accepted: 20 April 2000     

Global trends in quality specifications: a report from the Stockholm Conference

 In Stockholm a conference entitled: "Strategies to Set Global Quality Specifications in Laboratory Medicine" was held in April 1999. The primary aim in organizing the Conference was to provide a vehicle for reaching consensus on global quality specifications in laboratory medicine. This objective was achieved and a lively constructive debate, after the presentations were complete, led to agreement on the principles laid down in the Consensus Statement. The International Federation of Clinical Chemistry (IFCC), the International Union of Pure and Applied Chemistry (IUPAC) and the World Health Organization (WHO) kindly sponsored the Conference but it must be noted that the Consensus Statement reflects the views of the presenters and registrants who participated in the Conference and does not necessarily represent those of the sponsoring bodies. This paper reports on the standardization efforts so far, the Stockholm Consensus Conference, the ISO uncertainty concept and the consensus reality. A hierarchy of quality specifications in laboratory medicine was defined and agreed on. Received: 15 April 2000 · Accepted: 15 April 2000     

Telematics applications in a laboratory cluster

 The laboratories of six hospitals in the Canton of Wallis in Switzerland have been connected to one central laboratory, using the same database, the same software applications for the laboratory, pathology and pharmacy, and the same office and administration software. Some instruments in "Point of Care" sites are online for result transmission and for telemaintenance. The physicians may order drugs, material for sampling, analyses for specified patients and may consult knowledge bases, the patient data base, results and reports in different formats (ASCII, HTML, PDF, JPG, GIF, ...) using browsers like Netscape or MS-Explorer. To guarantee privacy, the access is restricted and protected by user-name, password and firewall. This report describes conditions for a successful introduction and usage of quality management through laboratory telematics. Received: 15 April 2000 · Accepted: 15 April 2000     

Reference intervals of serum folate and vitamin B12 developed from data of healthy subjects

 In this study the reference intervals for folate and vitamin B₁₂ were estimated according to the National Committee for Clinical Laboratory Standards Approved Guideline C28-A and International Federation of Clinical Chemistry recommendations. The study included 155 women and 124 men between ages 18–40. The health status was confirmed by history, physical examination and a questionnaire. The central 95% reference intervals of serum folate and vitamin B12 for women, determined non-parametrically, were found to be 3.9–18.1 ng/ml and 101–666.7 pg/ml, respectively. The reference values of serum folate and vitamin B12 for men were also found to be 2,5–17.6 ng/ml and 100–699.57 pg/ml, respectively. We did not observe subclass differences between females and males. Received: 15 April 2000 · Accepted: 15 April 2000     

Total quality management in hematology

 Healthcare is changing and clinical laboratory testing must change with it. In no discipline is this change more profound than in hematology. The principles of total quality management (TQM) including continuous quality improvement, reengineering and strategic planning can facilitate these changes. In the past, hematology has often been exlcuded from these processes due to its many manual procedures and the degree of expertise and skill needed to perform the testing. As automated technology continues to evolve, hematology testing, like other testing, will become integrated into the core, clinical laboratory. We suggest TQM can, and should, guide the way. Received: 15 April 2000 · Accepted: 19 April 2000     

Keeping the spotlight on quality from a distance

 Maintaining the quality of testing in remote locations can be demanding of laboratory resources in terms of daily visits to instruments and providing support outside of normal working hours. Recently technology and software solutions have appeared to reduce this burden for laboratory scientists dramatically. The AVL Auto QC unit, in conjunction with OMNILink software, allow laboratory staff to perform many quality control and maintenance procedures on instruments in wards and medical units from a PC in the central laboratory. Assessment of this technology and software in the Special Baby Care Unit at Bradford Royal Infirmary has demonstrated many benefits including reduction in ward visits, better support out of hours, regular quality control checks, and improved analytical quality. Received: 15 April 2000 · Accepted: 15 April 2000     

The practical advantages of hospital quality systems such as NIAZ/PACE

 The Netherlands Institute for Accreditation of Hospitals (NIAZ) was established at the end of 1998. It was founded by the PACE foundation, the Society of University Hospitals, the Netherlands Association of General Hospitals and the Society of Medical Specialists in the Netherlands. Since then in the Netherlands 19 pilot accreditations have been performed based upon 35 NIAZ-PACE standards for hospital departments and functions, and the overall standard 'quality system'. The aims and methods of the accreditation system were inspired by examples from the other side of the Atlantic, especially from Canada. The characteristics are: voluntary-based, self-evaluation, peer-review and aiming at continuous improvement of quality of care. Received: 15 April 2000 · Accepted: 15 April 2000     

The measurement assurance concept in calibration and traceability at NBS/NIST

During the last quarter of the twentieth century, The United States National Bureau of Standards (NBS), later the National Institute of Standards and Technology (NIST), introduced a measurement quality control concept called ”measurement assurance,” and developed measurement assurance programs, or MAPs, for high-level calibration processes. The measurement assurance approach has, over time, become increasingly popular in the metrology community, and in recent years has become well accepted both inside and, to some extent, outside the United States as a rigorous way to ensure the quality of calibrations. The concept has also found application in defining traceability to national standards. This paper traces the history of the measurement assurance concept. Received: 23 October 2000 Accepted: 2 November 2000     

The quest for comparability: Calibration 2000

 Most efforts in quality control have been focussed on the reduction of intralaboratory variation and the assessment of interlaboratory variation. Over the last few years, the importance of bias in interlaboratory variation and intralaboratory shifts has become clear. Small shifts can sometimes have a large impact on the number of treated patients, particularly in assays where cut off values are used. For example in cholesterol, HDL-cholesterol, HbA1c and TSH assays. There is an obvious need for adequate calibration material. However, the process of development of international primary reference materials and reference methods takes time, and even if reference materials exist and are used by in vitro diagnostics manufacturers, there still remains significant and clinically relevant interlaboratory variance and intralaboratory shifts, as is seen, e.g. in protein chemistry. The harmonization of inter laboratory and intralaboratory results needs an impulse from professional organizations to convince individual laboratories of the importance and significance of bias. This applies to all subdisciplines of laboratory medicine. On the occasion of the 25th anniversary of the Foundation for External Quality Assessment (SKZL), a large interdisciplinary harmonization project called Calibration 2000 was launched in The Netherlands The strategy and first results are reported in this paper. The project aims at harmonization of laboratory data of several disciplines, using secondary calibration materials, leading to common reference ranges throughout The Netherlands. Received: 15 April 2000 · Accepted: 15 April 2000     

Metrology in laboratory medicine – Reference measurement systems

 The medical laboratory must provide results of measurements that are comparable over space and time in order to aid medical diagnosis and therapy. Thus, metrological traceability, preferably to the SI, is necessary. The task is formidable due to the many disciplines involved, the high production rate, short request-to-report time, small sample volumes, microheterogeneity of many analytes, and complex matrices. The prerequisite reference measurement systems include definition of measurand, unit of measurement (when applicable), consecutive levels of measurement procedures and calibrators in a calibration hierarchy, international organizations, reference measurement laboratories, dedicated manufacturers, written standards and guides for the medical laboratory, production of reference materials, internal and external quality control schemes, and increasingly accreditation. The present availability of reference measurement procedures and primary calibrators is shown to be insufficient to obtain international comparability of all types of quantity in laboratory medicine. Received: 19 April 2000 / Accepted: 3 July 2000     

Analysis of long-term distributions of calibration parameters and calibration intervals for an atomic absorption spectrophotometer

 A combination of "black box" and "calendar-time" methods for the determination of calibration intervals of an analytical measuring instrument is discussed. Since the methods require information on the distributions of the calibration parameters, such information is described for an atomic absorption spectrophotometer, as an example. The hypotheses on the normal distribution of the calibration parameters are tested using the ω²-criterion and accepted at 0.90–0.95 levels of confidence. Corresponding control charts are designed for indication of warning and action limits of the calibration parameters, and diagnoses of outliers in further calibrations. Control charts indicate also when the calibration should be done according to the full program of the equipment manufacturer. Received: 15 April 2000 / Accepted: 24 July 2000     

The analysis of process gases: a review

 A general review of key issues involved in the analysis of process gases is presented. The reasons for such measurements – which include safety, quality, environmental and economic factors are considered. The technical issues arising from these measurements are dependent upon a variety of factors, including the overall sampling system, the type of analytical instrumentation, methods of data collection and the specified calibration protocols. The use of gas calibration cylinders as transfer standards is detailed and issues of stability and traceability to reference material discussed. Received: 1 March 2000 / Accepted: 31 March 2000     

Proficiency testing schemes for therapeutics and toxicology

 This report addresses the proposition: current proficiency testing (PT) schemes for therapeutics and toxicology can easily engender complacency. The proposition was based on the premise that there are substantial between-laboratory differences and objectives in the supply of services for the measurement of drugs, as a result of which it is difficult to design PT schemes which adequately cover the requirements of all laboratories. Thus, acceptable performance in a PT scheme may lead participants to consider that they have tested their procedures more rigorously than is the case. Four areas, validity of the PT scheme, PT material, frequency of testing and acceptance criteria are examined. Received: 15 April 2000 · Accepted: 15 April 2000     

Determination of selenium in soils by slurry-sampling graphite-furnace atomic-absorption spectrometry with polytetrafluoroethylene as silica modifier

A 6% slurry of polytetrafluoroethylene (PTFE) in 4% hydrofluoric acid and 1% nickel nitrate were used as modifiers for determination of selenium in soils by GF AAS. PTFE was used to remove silica from the soil sample, because this resulted in severe matrix effects. The temperature of fluorination, determined thermogravimetrically, was 600 °C. The yield of fluorination depends on the molar ratio of PTFE/silica, particle size, and the time and temperature of fluorination. The soil samples were pretreated with a small amount of concentrated hydrofluoric acid placed directly in the cup of autosampler. The results for the determination of selenium in the reference soil materials by means of the slurry-sampling technique and use of aqueous standards are in good agreement with the certified values. Received: 20 December 2000 / Revised: 3 April 2001 / Accepted: 5 April 2001     

Highly selective thiocyanate poly(vinyl chloride) membrane electrode based on a cadmium–Schiff’s base complex

A PVC membrane electrode based on a cadmium–salen (N,N′-bis-salicylidene-1,2ethylenediamine) complex as an anion carrier is described. The electrode has an anti-Hofmeister selectivity sequence with a preference for thiocyanate at pH 1.5–11.0. It has a linear response to thiocyanate from 1.0 × 10^–6 to 1.0 × 10^–1 mol L^–1 with a slope of 59.1 ± 0.2 mV per decade, and a detection limit of 7 × 10^–7 mol L^–1. This electrode has high selectivity for thiocyanate relative to many common organic and inorganic anions. The proposed sensor has a fast response time of approximately 15 s. It was applied to the determination of thiocyanate in a milk sample. Received: 1 December 2000 / Revised: 19 April 2001 / Accepted: 30 April 2001     

Radioactivity standards for environmental monitoring

The low-level radioactivity laboratory in the Radioactivity Section of the National Bureau of Standards, and its work in producing standards for monitoring in the environment, are described. Contribution of the National Bureau of Standards, not subject to copyright.     

Plans for implementation of a quality system in the control laboratory of the Romanian National Medicines Agency

This paper describes the practical implementation of a quality system in the control laboratory of the National Medicines Agency, Romania, the main aim being the alignment of the requirements of the control of drugs in Romania with European Union standards. Activity in this field is relatively new in Romania, however, it is of great importance to Romania’s compliance with international standards. Received: 13 September 2000 Accepted: 19 February 2001     

Development of metrology for pH measurement in Thailand

It has not been long that metrology is well accepted as an important part in analytical chemistry since it helps the chemists to receive the best measurement and accurate results with traceability. The National Institute of Metrology Thailand (NIMT), which is a public agency under the supervision of the Ministry of Science and Technology, not only focuses on physical standards but also provides and maintains standards in chemical field. pH measurement is one of the most widely used in the laboratories including industries and medical area in Thailand. The chemical laboratory starts working on the project with the objective of disseminating an accurate result in routine pH measurement. In 2002, the laboratory provided a service in calibration of pH meter and organized the first local interlaboratory comparison program (NIMT–C-ILC-1: pH buffer) in pH measurement. There were three buffer solution samples in the range of acid, neutral, and base. A total of 44 laboratories participated in this program. The NIMT chemical laboratory also participated in the proficiency testing program that was conducted by PSB Corporation Testing Group in Singapore. In 2003, NIMT started research in preparation of secondary buffers by using highly accurate pH meters with glass electrode systems. The laboratory produced three secondary buffers, which were pH 4.01, 6.86, and 9.18 with uncertainty 0.020 pH at 25°C. The competence of the laboratory was shown by the measurement results of the pilot study (APMP.QM-P06), which was organized by the APMP electrochemical analysis working group (EAWG/TCQM) in 2005. The title of this study was “pH determination of two phosphate buffers by Harned cell method and glass electrode method”. NIMT aims to achieve for establishment of the primary method for pH measurement in the near future. Presented at -- “BERM-10” -- April 2006, Charleston, SC, USA     

Unitary perturbation theory: a generalization of two-by-two rotations

A generalization of the two-by-two rotation technique is proposed, permitting a whole row (column) of the matrix to be treated simultaneously. The method is based on the explicit analytical evaluation of the matrix exponent representing a symmetric combination of the individual rotations. Besides constructing the unitary transformation matrices, a new orthogonalization algorithm is also proposed. The resulting “unitary perturbation theory” and orthogonalization method may be useful in different areas. Received: 15 November 1999 / Accepted: 30 January 2000 / Published online: 19 April 2000     

Standardization of pH measurements based on the ion interaction approach

The Pitzer method was used to calculate the pH values on the conventional and “true” scales for the TRIS—TRIS·HCl−NaCl−H₂O buffer system in the 0–40 °C temperature region and 0–4 NaCl molality interval. This buffer can be used as a standard for pH measurements in a wide range of ionic strengths. The conventional scale is used in cells without a salt bridge. The “true” scale is recommended for pH measurements using cells with a salt bridge. At the same concentrations of the buffer solution, the “true” scale is essentially transformed into the scale of the National Bureau of Standards (NBS) of the USA. Translated fromIzvestiya Akademii Nauk. Seriya Khimicheskaya, No. 4, pp. 676–680, April, 2000.