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Background: Although objective measures of cytotechnologist (CT) and cytopathologist (CP) performance exist, challenges remain. Two assumptions deserve examination: CPs' interpretations are correct, and CTs and CPs render interpretations independently of each other. This study presents a CT-CP interpretation comparison and provides insight into these assumptions., Methods: Every gynecologic cytology specimen examined by both a CT and a CP from December 2004 to March 2015 was extracted from the laboratory information system; glandular interpretations were excluded. Excel and SAS were used for CT-CP pair analysis. CT-CP pairs with fewer than 32 specimens (the lowest quartile) were excluded. For the remaining CT-CP pairs, 30 specimens or 10% of the specimens (whichever was higher) were randomly selected for comparison by a weighted κ statistic. κ values greater than 0.6 represented good agreement within CT-CP pairs., Results: This study evaluated 7116 of 53,241 gynecologic cytology specimens (13.4%) that received CT and CP interpretations. This resulted in 155 pair-specific κ values from 15 CTs and 16 CPs. In aggregate, the κ values had a mean of 0.64, a standard deviation of 0.14, a median of 0.65, and a range of 0.27 to 0.91. Nine CTs exhibited good agreement in the majority of their pair-specific κ values with CPs (high-concordance CTs; 88 pair-specific κ values). This allowed us to identify outlier CPs who did not demonstrate good agreement with high-concordance CTs (16 of 88 pair-specific κ values [18.2%])., Conclusions: Laboratories can use this κ to determine when CP levels of agreement with CTs depart from those of their peers. Adding this to established metrics can give a more nuanced impression of CP performance. Cancer Cytopathol 2017;125:576-80. © 2017 American Cancer Society., (© 2017 American Cancer Society.)

Purpose: The assessment of technical staff members' competency has been a challenge for laboratory workers, to ensure patient safety and high quality services. The aim of this study was to (1) investigate awareness on best ways to assess lab competencies; (2) identify existing institutional methods of competency assessment and how staff perceptions; and (3) gather opinions of respondents about a proposed program for competency assessment in laboratory medicine., Methods: A cross-sectional survey was conducted, followed by an interview and discussion with laboratory stakeholders about a proposed competency assessment program that included all the six procedural elements of laboratory personnel competency assessment. An online questionnaire was sent via email to different hospitals in Saudi Arabia through survey monkey. A proposed competency assessment program was circulated via email to laboratory stakeholders who agreed to be enrolled in structured interviews., Results: A total of 47 out of the 168 (25.3%) laboratory workers responded to the emailed survey administered via survey monkey. Among the survey respondents, 16 out of the 47 (34%) participated in the structured interview and the discussion and formed the community of practice group that provided insight and opinion about the proposed competency program. Among stakeholders, 87.2% practiced in accredited laboratories. Over half (52%) of respondents positively rated the proposed program. Results of interviews and discussions revealed suggestions about continuous ongoing assessment, such as the inclusion of laboratory quality management and safety as separate items to be unified for all sections., Conclusions: The proposed competency assessment program overcomes challenges noted in competency assessment and has been positively received by stakeholders. This program will be validated by a group of experts then implemented as part of a core curriculum for laboratory staff, in their assessment, certification, recertification, registration, evaluation and licensure in sample laboratories in Saudi Arabia. The program will be monitored and evaluated during and after implementation for processes and outcomes. Conclusions will be utilized for national competency program. This study represents an important step towards the implementation of a standardized laboratory competence assessment program at a national level.

Preparation of amniotic membrane (AM) by air drying method followed by radiation sterilization is simple and valuable approach; sterility and quality of the final AM product are depending on the quality management system at the tissue bank. Validation and substantiation of radiation sterilization dose (RSD) for tissue allografts is an essential step for the development and validation of the standard operating procedures (SOP). Application of SOP is perfectly relying on trained staff. Skills differences among personnel involved in AM preparation could have an effect on microbiological quality of the finished product and subsequently on the RSD required. AM were processed by four different couples of the tissue bank technicians. The AM grafts were randomly selected and subjected to bioburden test to validate and substantiate the 25 kGy RSD. Bioburden test for AM grafts were also useful to evaluate the skill of the tissue bank technicians and thus, to validate the current SOP for air dried AM. Moreover, the effect of placental source on bioburden counts on AM grafts was assessed. Substantiation of the 25 kGy RSD at a sterility assurance level of 10(-1), and sample item portion = 1, was carried out using Method VD max (25) of the International Organization for Standardization, document no. 11137-2 (ISO in Sterilization of healthcare products-radiation-part 2: establishing the sterilization dose, Method VDmax-substantiation of 25 kGy or 15 kGy as the sterilization dose, International Standard Organization, 2006). The results showed that there were no significant differences in the bioburdens of the four batches (α = 1 %), this means no significant differences in the skill of the four couples of the tissue bank technicians in terms of their ability to process AM according to the air dried AM SOP. The 25 kGy RSD was validated and substantiated as a valid sterilization dose for the AM prepared with the current established SOP at the Biotechnology Research Center experimental tissue bank. The donor's type of delivery, normal or caesarean, showed no significant effect on the levels of microbial counts on the tested AMs (α = 1 %).

Information technology has radically changed the way that many people work and think. Over the years, technology has touched a new acme and now it is not confined to developed countries. Developing countries such as India have kept pace with the world in modern technology. Healthcare professionals can no longer ignore the application of information technology to healthcare because they are key to e-health. This study was conducted to enlighten the perspective and implications of computers among healthcare professionals, with the objective to assess the knowledge, use, and need of computers among healthcare professionals. A cross-sectional study of 240 healthcare professionals, including doctors, nurses, lab technicians, and pharmacists, was conducted. Each participant was interviewed using a pretested, semistructured format. Of 240 healthcare professionals, 57.91% were knowledgeable about computers. Of them, 22.08% had extensive knowledge and 35.83% had partial knowledge. Computer knowledge was greater among the age group 20-25 years (high knowledge-43.33% and partial knowledge-46.66%). Of 99 males, 21.21% were found to have good knowledge and 42.42% had partial knowledge. A majority of doctors and nurses used computer for study purposes. The remaining healthcare professionals used it basically for the sake of entertainment, Internet, and e-mail. A majority of all healthcare professionals (95.41%) requested computer training, which according to them would definitely help to make their future more bright and nurtured as well as to enhance their knowledge regarding computers.

The laboratory comprises an invaluable part of the total health care provided to patients. Competency assessment is one method by which we can verify that our employees are competent to perform laboratory testing and report accurate and timely results. To derive the greatest benefit from the inclusion of competency assessment in the laboratory, we must be sure that we are addressing areas where our efforts can be best utilized to optimize patient care. To be competent, an employee must know how to perform a test, must have the ability to perform the test, must be able to perform the test properly without supervision, and know when there is a problem with the test that must be solved. In some cases, competency assessment protocols may demonstrate areas of competence but can fail to disclose incompetence. For example, challenges of low-complexity tasks (such as reading the technical procedure manual) are inferior to challenges that measure understanding and execution of a protocol, and poorly designed competency challenges will probably not detect substandard laboratory performance. Thus, if we are to receive the greatest benefit from our competency assessment programs, which may be time-consuming for the supervisors and the staff as well, we must not only meet the letter of the law but also find a way to make these assessments meaningful, instructive, and able to detect areas of concern. As we address competency assessment in our laboratories, we must understand that when done properly, competency assessment will reward our organizations and assist us in providing the best possible care to our patients.

We noted that our competency assessment activities did not predict actual performance and, in questioning why, we discovered a world very similar to our experience in clinical testing. We found that, with careful attention to measurement design, we could detect incompetent performance and find improvement opportunities. This article explores several of the design principles on which one can build competency measurements. It also discusses the reasons why organizations should invest in this activity, which go beyond the most obvious reason--it is the right thing to do.

This 4-year study examined 165 medical technologists generally in the achievement phase of their careers. After distinguishing between two types of skills, fundamental and complex, different antecedents for each type of skill were found. Prior professional commitment was related positively to fundamental skills, whereas professional withdrawal intent was related negatively. Prior scholarly professional development and job involvement were related positively to complex skills, whereas job insecurity was related negatively. Complex skills time acquisition had a stronger positive relationship to complex skills than the relationship of fundamental skills time acquisition to fundamental skills.

The large menu of laboratory assays available today makes it increasingly difficult for the non-specialist to order all necessary tests, avoid medical errors, and still contain cost. Curbside consultations, "intelligent" laboratory information systems, and medical information from the Internet cannot fully fill the need for expert advice on test selection and interpretation of laboratory results. In this communication, we show the need for a more active role for laboratory physicians to select and interpret tests, demonstrate that existing attempts to deal with this issue are insufficient, and describe the model system which we have instituted at our institution. We combine reflexive testing algorithms with narrative interpretations provided by medical laboratory professionals and thereby enable physicians to obtain relevant laboratory results and to arrive at a definitive diagnosis without having to order individual tests. In our experience, such an arrangement can significantly improve the quality of care and reduce the cost per case by decreasing the time to diagnosis, the number of tests ordered, and the number of patient visits. In addition, interpretations provide a new source of professional revenue for the expert laboratory physician. This leads to a new role for laboratory professionals, in which their expertise in the selection and interpretation of laboratory tests is fully utilized.

We describe a simple method for displaying and evaluating the concordance or discordance between cytotechnologists (CTs) and cytopathologists (CPs) on gynecologic cases. The provisional diagnoses made by the CTs and the final diagnoses of the CPs are captured by the laboratory information system; data generated for specified periods are displayed as a 10 x 10 matrix that classifies each possible diagnosis made by the CT and CP into 1 of 10 major categories. Matrices are generated for the entire laboratory and for individual CTs; individual CTs are evaluated based on their deviation from the laboratory average. Three statistical measures are generated: percentage of discordant diagnoses, a kappa statistic, and a weighted measure. During a 2.5-year period, approximately 4,200 cases were referred to a CP for review every 6 months. The median discordance in diagnoses increased during 2 years from 21% to 34%, and the kappa value fell from 0.69 to 0.38. This was attributed primarily to 1 CT, whose performance, as well as that of the entire laboratory, improved after remedial action. Measures of CT-CP diagnostic concordance are a useful and efficient measure of CT performance and can be incorporated into mandatory semiannual performance evaluations.

In Part I of this series, I introduced the concept of memes (1). Memes are ideas or concepts, the information world equivalent of genes. The goal of this series of articles is to infect you with my memes, so that you will assimilate, translate, and express them. We discovered that no matter what our area of expertise or "-ology," we all are in the information business. Our goal is to be in the wisdom business. We saw that when we convert raw data into wisdom we are moving along a value chain. Each step in the chain adds a different amount of value to the final product: timely, relevant, accurate, and precise knowledge which can then be applied to create the ultimate product in the value chain: wisdom. In Part II of this series, I infected you with a set of memes for measuring the cost of adding value (2). In Part III of this series, I infected you with a new set of memes for measuring the added value of knowledge, i.e., intellectual capital (3). In Part IV of this series, I will infect you with memes for measuring the value of people, structural, and customer capital.

The introduction of automated chemical analyzers in the laboratory service has the potential of adversely affecting professionalism in laboratory practice. The present study assesses the quality of medical laboratory technicians in Trinidad and Tobago using structured questionnaires. Some of the critical questions included job status, years of experience, training, qualification(s) and knowledge of quality assurance and its application. About 82% of laboratory technicians responded to the study. The majority of technicians (62%) had diploma certificates while only one (1.2%) had a postgraduate degree. Although the majority (91.7%) of technicians knew about quality assurance, 36% learnt on the job and 59% knew they were not professionally trained. The results showed that there is paucity of highly trained laboratory technicians in Trinidad and Tobago and this has significant implications on the technical initiative and quality of medical laboratory practice in this country. We recommend the establishment of appropriate professional institutions for training medical laboratory technologists and regular expert inspection and accreditation of all medical laboratories in the country.

Objective: To survey employee competence assessment practices in departments of pathology and laboratory medicine and provide suggestions for improvement., Design: A 3-part study consisting of a questionnaire about current competence assessment practices, an evaluation of compliance with stated competence assessment practices using personnel records of 30 employees, and a written appraisal of competence of 5 specimen-processing staff members per institution., Setting: A total of 522 institutions participating in the College of American Pathologists 1996 Q-Probes program., Main Outcome Measures: Institutional competence assessment practices, compliance of each institution with their own practices, and determination of competence of specimen-processing personnel., Results: Of the participating institutions, 89.8% had a written competence plan and 98.1% reported reviewing employee competence at least yearly. General competence was reviewed by direct observations (87.5%), review of test or quality control results (77.4%), review of instrument preventive maintenance (60.0%), written testing (52.2%), and/or other methods (20.8%). In 8.6% of institutions, employees who failed competence assessment were not allowed to continue their usual work. On review of records of 14 029 employees for adherence to the laboratory's general competence plan, adherence was 89.7% for direct observations, 85.8% for review of quality control and test results, 78.0% for review of instrument records, and 74.0% for written testing. Employee failure rate ranged from 0.9% to 6.4%, depending on the competence evaluated. Adherence to an institution's plan was 90.4% for new employees, 93.1% for computer skills, 95.8% for laboratory safety, and 92.1% for continuing education. When a written competence assessment was given to 2853 specimen-processing staff members, 90.0% responded satisfactorily., Conclusions: Opportunities for improvement in employee competence assessment are numerous, and we provide several specific suggestions.

No matter what your job position or title, YOU are President and Chief Executive Officer of "Me Incorporated", the single most exciting company in the world. We are in the midst of a great revolution, summarized in the "Delta Table of Revolutions". Part one of this table looks at macro trends--trends affecting our economy and society. Part two examines the revolution taking place within health care. Part three looks at the revolution taking place within laboratory medicine. To survive and thrive in the 21st century, Me Inc. must adopt the best practices of any highly successful company. Me Inc. must develop its core competencies--transferable skills that you can take with you from one organization to another. There are 10 core competencies of Me Inc. These are over and above the essential technical, scientific, and/or medical knowledge and skills that you have. The core competencies you require minus the core competencies you possess equal your skills gap. The key to success for Me Inc. is to close the skills gap. This must be undertaken in a carefully planned way. You must form a clear, concise, and, above all, written plan with specific, realistic, and measurable goals.

In this study the influence of orbital sinus blood sampling on clinical signs was studied within the framework of various nutritional experiments. In order to assess the clinical signs in a random design, the rats were punctured in either the left or the right orbit. Thus, the effect of puncture within rats could be determined by comparing the left and right eye. Four animal technicians punctured a total of 303 rats, using different techniques. Orbital sinus blood sampling caused clinically visible alterations. The type, frequency and prognosis of the alterations differed with the person performing the puncture. Two experienced animal technicians were able to perform the technique without causing a statistically significant increase in alterations in punctured orbits. One less experienced animal technician caused severe abnormalities. The use of either a Pasteur pipette or a haematocrit capillary did not necessarily produce different results. Neither did puncturing the lateral vs the medial canthus of the orbit. By not applying chloramphenicol eye ointment in the conjunctival sac after puncture, the number of abnormalities in 'ocular discharge' and 'corneal alterations' in the punctured orbits was significantly decreased. Four punctures in the same orbit with 14-day intervals by a skilled animal technician did not cause a significant increase in abnormalities.

CLIA '88 regulations require that laboratories evaluate and assure the competency of all personnel who perform laboratory tests. The study objective was to determine the interpretation of, compliance with, and implementation of these regulations by laboratories. Interviews were conducted with a stratified nonrandom sample of 20 laboratories including hospital, blood bank, commercial reference, physician office, group practice, and independent laboratories from 12 selected states. Information was collected about the history and development of their competency assessment programs and activities, their definition of competent staff, the interrelationship of competency assessment with performance appraisals, cost, benefits, and the assessment methods and tools used. Competence of laboratory personnel is a complex issue reflecting the dynamics and environment of each unique laboratory setting. This research found no consistent method of competency assessment implementation. This report provides a summary of methods and approaches. Learning what other laboratories are doing will assist managers in developing meaningful and cost-effective competency assessment programs. Documenting all competency assessment activities is important; it serves as a personnel performance management tool and satisfies inspectors. Used in the spirit of continuous quality improvement, the competency assessment program may point to ways of improving processes, personnel, and performance.

The objective of this study was to evaluate the effect of operator experience and ultrasound interpretation technique on the accuracy of ultrasound estimates of amniotic fluid volume. Ultrasound evaluation was carried out by an obstetric resident, a nurse sonographer, a maternal-fetal medicine fellow, and a maternal-fetal medicine staff member to subjectively estimate (visual interpretation without sonographic measurements) amniotic fluid volume in 63 pregnancies. Amniotic fluid volume was also evaluated using ultrasound measurements based on the largest vertical pocket technique, the amniotic fluid index, and the two-diameter pocket method. The accuracy of these ultrasound estimates was assessed by comparing the ultrasound results to actual amniotic fluid volume as determined by a dye-dilution technique. For analysis, amniotic fluid volumes were classified as oligohydramnios, normal, or hydramnios using established volumetric criteria for singleton pregnancies. Subjective estimates ranged from 65% to 70% correct and did not differ by operator experience except for the more accurate diagnosis of hydramnios by the maternal-fetal medicine staff. The three sonographic measurements were similar in overall accuracy (59-67%). The two-diameter pocket method was, however, significantly more accurate in identifying oligohydramnios. It appears that neither operator experience nor sonographic technique greatly affects the accuracy of ultrasound estimates of amniotic fluid volume.