Background: Prenatal exposure to illicit substances is responsible for several long-term negative health consequences. It is critical for healthcare professionals to know the extent and scope of prenatal substance exp...Background: Prenatal exposure to illicit substances is responsible for several long-term negative health consequences. It is critical for healthcare professionals to know the extent and scope of prenatal substance exposure in their cases. Several studies exist with mixed results comparing the effectiveness of umbilical cord tissue (UCT) and meconium (MEC) as toxicology specimen types. The specific aim of this study is to compare the use of UCT and MEC regarding the time interval between the birth of the neonate, receipt of the specimen at the laboratory, and the hospital’s receipt of the final toxicology report. Method: The study queried de-identified results of 5358 consecutive UCT and 706 MEC from our laboratory. Results: The mean time from birth to receipt of the specimen at the laboratory for MEC and UCT was 4.5 days ± 2.9 days and 2.8 days ± 1.9 days, respectively. The mean time from birth to final report for MEC was 6.9 days ± 3.8 days, 5.7 days ± 3.3 days, and 8.4 days ± 3.8 days for all MEC specimens, negative MEC, and positive MEC, respectively. The mean time from birth to final report for UCT was 4.3 days ± 2.4 days, 3.5 days ± 2.2 days, and 5.4 days ± 2.2 days for all UCT, negative UCT and positive UCT, respectively. Discussion/Conclusion: Receipt of drug test results of the neonate prior to release from the hospital is critical. This study shows that UCT offers an advantage when results are needed quickly to make informed decisions about the health and well-being of newborns.展开更多
Turnaround time (TAT), is the total time interval from when a request for forensic laboratory analysis is received until when the results are collected by the client. The performance of the forensic science laboratory...Turnaround time (TAT), is the total time interval from when a request for forensic laboratory analysis is received until when the results are collected by the client. The performance of the forensic science laboratory (FSL) is affected by extended TAT in the case-file and sample processing steps necessitating critical analysis reported in this paper. The total TAT was obtained as the sum of measured time interval for each work station (six of which were studied). Extended TAT leads not only to customer complaints, but also paves way for customers to seek for services from competitors, leading to lost competitive edge for the FSL. This study was conducted to establish the baseline data on TAT (between 2014 and 2015) to enable implementation of corrective actions. Six casefile processing steps were identified for which starting and completion times were recorded in dates, giving TAT values in days. The TAT data for each step was collected as each case file is processed and analyzed separately using statistical analysis while comparing the data for the two years (Y2014 and Y2015) and?among?three forensic science laboratory disciplines (biology/DNA, chemistry and toxicology). The overall turnaround time (TTAT) was?the?highest for forensic biology/DNA compared to forensic toxicology and chemistry. The analysis time (TAT2) was the longest of all six case-file processing steps. Using Pareto analysis, the three major steps necessitating root-cause analysis and intervention to minimize TAT were analysis turnaround time (TAT2), report collection time (TAT6) and report review time (TAT4). It was concluded that the causes for extended TAT are within control by the FSL management, although financial and human resources are required.展开更多
The delay in the delivery of laboratory results can be fatal and can even lead to the death of patients. This study was conducted at the clinical laboratory of the University Hospital of Kinshasa (UHK) from October 20...The delay in the delivery of laboratory results can be fatal and can even lead to the death of patients. This study was conducted at the clinical laboratory of the University Hospital of Kinshasa (UHK) from October 2020 to April 2021, aimed to evaluate the laboratory tests’ turnaround time (TAT) and to identify reasons for delay. TAT was quantified using a time and motion analysis approach. The evaluation of TAT consisted of comparing the overall intra-lab TAT with the suggested TAT using student t-test at 95% confidence intervals. Brainstorming was the root cause analysis tool used for identifying reasons for delay. In this study, the laboratory tests’ TATs were significantly higher (p < 0.001) comparing to international guidelines (60 minutes) and customers’ suggested TAT (120 minutes). Only 0.98% of the samples were reported within 60 minutes of patient reception and 1.47% within 120 minutes, i.e. an outlier rate of 98.5%. Root causes of delay related to Machinery, Management, Manpower, Materials, Method and Milieu. Because of many reasons, the laboratory is not meeting the established TAT. Preventive and curative measures must be undertaken to reduce the delay and improve the TAT.展开更多
In Democratic Republic of the Congo (DRC), the laboratory TAT is significantly very long and do not comply with either international standards or the suggestions of customers. However, there is neither a national nor ...In Democratic Republic of the Congo (DRC), the laboratory TAT is significantly very long and do not comply with either international standards or the suggestions of customers. However, there is neither a national nor a local strategy to improve the laboratory TAT. The aim of the present study is to develop practical management strategies to shorten clinical laboratory tests’ TAT. This was a qualitative study conducted in Kinshasa. Focus groups and Lean tools were used respectively to generate a wide range of views from a variety of laboratory staff and to eliminate several form of waste in the laboratory flow process. Based on the identified root causes of delay, focus groups participants reported that there is a lot of scope for the improvement of TAT in DRC. Consistent attendance and punctuality are essential. The hospital management should implement the Laboratory Information Systems (LIS) and install Middleware. Total laboratory automation, inventory system for all reagents and supplies used in the laboratory, expansion of the sampling area, sufficient number of high-power machine and a clear job description are indispensable. LIS, 3.5 mL BD vacutainer Barricor<sup>TM</sup> tube and point-of-care testing (POCT) are necessary for workflow improvement. A reduction of 312 minutes was achieved by eliminating or decreasing non-value-added activities. Applying the suggested key strategies, and particularly the new workflow process, is a basis for improving the laboratory tests’ TAT. The algorithm presented can be easily implemented in other laboratories that face this type of problem.展开更多
BACKGROUND Rapid molecular testing has revolutionized the management of suspected viral meningitis and encephalitis by providing an etiological diagnosis in<90 min with potential to improve outcomes and shorten inp...BACKGROUND Rapid molecular testing has revolutionized the management of suspected viral meningitis and encephalitis by providing an etiological diagnosis in<90 min with potential to improve outcomes and shorten inpatient stays.However,use of molecular assays can vary widely.AIM To evaluate current practice for molecular testing of pediatric cerebrospinal fluid(CSF)samples across the United Kingdom using a structured questionnaire.METHODS A structured telephone questionnaire survey was conducted between July and August 2020.Data was collected on the availability of viral CSF nucleic acid amplification testing(NAAT),criteria used for testing and turnaround times including the impact of the coronavirus disease 2019 pandemic.RESULTS Of 196/212(92%)microbiology laboratories responded;63/196(32%)were excluded from final analysis as they had no on-site microbiology laboratory and outsourced their samples.Of 133 Laboratories included in the study,47/133(35%)had onsite facilities for viral CSF NAAT.Hospitals currently undertaking onsite NAAT(n=47)had much faster turnaround times with 39 centers(83%)providing results in≤24 h as compared to those referring samples to neighboring laboratories(5/86;6%).CONCLUSION Onsite/near-patient rapid NAAT(including polymerase chain reaction)is recommended wherever possible to optimize patient management in the acute setting.展开更多
In the recent past, propofol was temporarily removed from the emergency department （ED） for use in procedural sedation. We sought to determine which agents replaced it in clinical practice and the impact this change...In the recent past, propofol was temporarily removed from the emergency department （ED） for use in procedural sedation. We sought to determine which agents replaced it in clinical practice and the impact this change had on turnaround times （TAT） for sedated patients. This study is a retrospective chart review at a level one trauma center. Patients receiving sedative agents （propofol, ketamine, midazolam, and etomidate） were identified by pharmacy codes, and their charts were then reviewed for demographics and TAT. Propofol was unavailable in the emergency department （ED） between May 2010 and February 2011. The study period extended from May 2009 until May 2011. Patients receiving sedation by non-emergency medicine physicians and those receiving sedation related to intubation were excluded. In total 2466 charts were reviewed and 209 met inclusion criteria. When propofol was available, the most commonly used sedative agent was etomidate （40%）, followed by propofol （28%）, ketamine （20%）, and midazolam （6%）. When propofol was unavailable, etomidate remained the most commonly used agent （43%）, followed by ketamine （41%）, and midazolam （11%）. When propofol was available, the median TAT for sedated patients was 163 minutes compared to 178 minutes when propofol was unavailable （P=0.83）. When propofol was the primary sedative agent used, the median TAT was 166 minutes as compared with a median TAT of 172 minutes for all other sedative agents combined （P=0.87）. When propofol was unavailable, ketamine became a preferred ED sedation agent. Removal of propofol from the sedation armamentarium did not affect ED TAT.展开更多
Minimizing time cost in time-shared operating systems is considered basic and essential task,and it is the most significant goal for the researchers who interested in CPU scheduling algorithms.Waiting time,turnaround ...Minimizing time cost in time-shared operating systems is considered basic and essential task,and it is the most significant goal for the researchers who interested in CPU scheduling algorithms.Waiting time,turnaround time,and number of context switches are themost time cost criteria used to compare between CPU scheduling algorithms.CPU scheduling algorithms are divided into non-preemptive and preemptive.RoundRobin(RR)algorithm is the most famous as it is the basis for all the algorithms used in time-sharing.In this paper,the authors proposed a novel CPU scheduling algorithm based on RR.The proposed algorithm is called Adjustable Time Slice(ATS).It reduces the time cost by taking the advantage of the low overhead of RR algorithm.In addition,ATS favors short processes allowing them to run longer time than given to long processes.The specific characteristics of each process are;its CPU execution time,weight,time slice,and number of context switches.ATS clusters the processes in groups depending on these characteristics.The traditionalRRassigns fixed time slice for each process.On the other hand,dynamic variants of RR assign time slice for each process differs from other processes.The essential difference between ATS and the other methods is that it gives a set of processes a specific time based on their similarities within the same cluster.The authors compared between ATS with five popular scheduling algorithms on nine datasets of processes.The datasets used in the comparison vary in their features.The evaluation was measured in term of time cost and the experiments showed that the proposed algorithm reduces the time cost.展开更多
The medical sector values time when it determines life in its totality. Any waste of time, especially in critical conditions, compromises patients and puts lives at stake. From a diagnosis and treatment perspective, e...The medical sector values time when it determines life in its totality. Any waste of time, especially in critical conditions, compromises patients and puts lives at stake. From a diagnosis and treatment perspective, efficient use of time determines the success of procedures. Whether it be the inclusion of computing technologies or it be the implementation of informatics, the benefits of medical technology have been tremendous to the healthcare sector. This research has looked at the impact of the Radiology Information System (RIS) on CT reporting time in the King Khalid Hospital (KKH) in the Kingdom of Saudi Arabia. The approach of the study has been quasi-experimental, using the power calculation of a pair of 381 CT scan reports of 40,000 after which the data was collected and analyzed by using SPSS to deduce the impact that RIS has on CT reporting time. The comparison of CT reporting time is done between two distinct timeframes Pre- and Post-installation of RIS. The patients in the current study were organized into three primary categories: emergency patients, inpatients, and outpatients. The results show that the turnaround time was impacted positively with the incorporation of RIS and related technologies in CT scan patients. The outpatient department saw the most improvement among the three categories indicating the highest average percentage of reduction in Turnaround Time. Thus, it was concluded that the RIS has an overall positive impact on CT reporting time.展开更多
文摘Background: Prenatal exposure to illicit substances is responsible for several long-term negative health consequences. It is critical for healthcare professionals to know the extent and scope of prenatal substance exposure in their cases. Several studies exist with mixed results comparing the effectiveness of umbilical cord tissue (UCT) and meconium (MEC) as toxicology specimen types. The specific aim of this study is to compare the use of UCT and MEC regarding the time interval between the birth of the neonate, receipt of the specimen at the laboratory, and the hospital’s receipt of the final toxicology report. Method: The study queried de-identified results of 5358 consecutive UCT and 706 MEC from our laboratory. Results: The mean time from birth to receipt of the specimen at the laboratory for MEC and UCT was 4.5 days ± 2.9 days and 2.8 days ± 1.9 days, respectively. The mean time from birth to final report for MEC was 6.9 days ± 3.8 days, 5.7 days ± 3.3 days, and 8.4 days ± 3.8 days for all MEC specimens, negative MEC, and positive MEC, respectively. The mean time from birth to final report for UCT was 4.3 days ± 2.4 days, 3.5 days ± 2.2 days, and 5.4 days ± 2.2 days for all UCT, negative UCT and positive UCT, respectively. Discussion/Conclusion: Receipt of drug test results of the neonate prior to release from the hospital is critical. This study shows that UCT offers an advantage when results are needed quickly to make informed decisions about the health and well-being of newborns.
文摘Turnaround time (TAT), is the total time interval from when a request for forensic laboratory analysis is received until when the results are collected by the client. The performance of the forensic science laboratory (FSL) is affected by extended TAT in the case-file and sample processing steps necessitating critical analysis reported in this paper. The total TAT was obtained as the sum of measured time interval for each work station (six of which were studied). Extended TAT leads not only to customer complaints, but also paves way for customers to seek for services from competitors, leading to lost competitive edge for the FSL. This study was conducted to establish the baseline data on TAT (between 2014 and 2015) to enable implementation of corrective actions. Six casefile processing steps were identified for which starting and completion times were recorded in dates, giving TAT values in days. The TAT data for each step was collected as each case file is processed and analyzed separately using statistical analysis while comparing the data for the two years (Y2014 and Y2015) and?among?three forensic science laboratory disciplines (biology/DNA, chemistry and toxicology). The overall turnaround time (TTAT) was?the?highest for forensic biology/DNA compared to forensic toxicology and chemistry. The analysis time (TAT2) was the longest of all six case-file processing steps. Using Pareto analysis, the three major steps necessitating root-cause analysis and intervention to minimize TAT were analysis turnaround time (TAT2), report collection time (TAT6) and report review time (TAT4). It was concluded that the causes for extended TAT are within control by the FSL management, although financial and human resources are required.
文摘The delay in the delivery of laboratory results can be fatal and can even lead to the death of patients. This study was conducted at the clinical laboratory of the University Hospital of Kinshasa (UHK) from October 2020 to April 2021, aimed to evaluate the laboratory tests’ turnaround time (TAT) and to identify reasons for delay. TAT was quantified using a time and motion analysis approach. The evaluation of TAT consisted of comparing the overall intra-lab TAT with the suggested TAT using student t-test at 95% confidence intervals. Brainstorming was the root cause analysis tool used for identifying reasons for delay. In this study, the laboratory tests’ TATs were significantly higher (p < 0.001) comparing to international guidelines (60 minutes) and customers’ suggested TAT (120 minutes). Only 0.98% of the samples were reported within 60 minutes of patient reception and 1.47% within 120 minutes, i.e. an outlier rate of 98.5%. Root causes of delay related to Machinery, Management, Manpower, Materials, Method and Milieu. Because of many reasons, the laboratory is not meeting the established TAT. Preventive and curative measures must be undertaken to reduce the delay and improve the TAT.
文摘In Democratic Republic of the Congo (DRC), the laboratory TAT is significantly very long and do not comply with either international standards or the suggestions of customers. However, there is neither a national nor a local strategy to improve the laboratory TAT. The aim of the present study is to develop practical management strategies to shorten clinical laboratory tests’ TAT. This was a qualitative study conducted in Kinshasa. Focus groups and Lean tools were used respectively to generate a wide range of views from a variety of laboratory staff and to eliminate several form of waste in the laboratory flow process. Based on the identified root causes of delay, focus groups participants reported that there is a lot of scope for the improvement of TAT in DRC. Consistent attendance and punctuality are essential. The hospital management should implement the Laboratory Information Systems (LIS) and install Middleware. Total laboratory automation, inventory system for all reagents and supplies used in the laboratory, expansion of the sampling area, sufficient number of high-power machine and a clear job description are indispensable. LIS, 3.5 mL BD vacutainer Barricor<sup>TM</sup> tube and point-of-care testing (POCT) are necessary for workflow improvement. A reduction of 312 minutes was achieved by eliminating or decreasing non-value-added activities. Applying the suggested key strategies, and particularly the new workflow process, is a basis for improving the laboratory tests’ TAT. The algorithm presented can be easily implemented in other laboratories that face this type of problem.
文摘BACKGROUND Rapid molecular testing has revolutionized the management of suspected viral meningitis and encephalitis by providing an etiological diagnosis in<90 min with potential to improve outcomes and shorten inpatient stays.However,use of molecular assays can vary widely.AIM To evaluate current practice for molecular testing of pediatric cerebrospinal fluid(CSF)samples across the United Kingdom using a structured questionnaire.METHODS A structured telephone questionnaire survey was conducted between July and August 2020.Data was collected on the availability of viral CSF nucleic acid amplification testing(NAAT),criteria used for testing and turnaround times including the impact of the coronavirus disease 2019 pandemic.RESULTS Of 196/212(92%)microbiology laboratories responded;63/196(32%)were excluded from final analysis as they had no on-site microbiology laboratory and outsourced their samples.Of 133 Laboratories included in the study,47/133(35%)had onsite facilities for viral CSF NAAT.Hospitals currently undertaking onsite NAAT(n=47)had much faster turnaround times with 39 centers(83%)providing results in≤24 h as compared to those referring samples to neighboring laboratories(5/86;6%).CONCLUSION Onsite/near-patient rapid NAAT(including polymerase chain reaction)is recommended wherever possible to optimize patient management in the acute setting.
文摘In the recent past, propofol was temporarily removed from the emergency department （ED） for use in procedural sedation. We sought to determine which agents replaced it in clinical practice and the impact this change had on turnaround times （TAT） for sedated patients. This study is a retrospective chart review at a level one trauma center. Patients receiving sedative agents （propofol, ketamine, midazolam, and etomidate） were identified by pharmacy codes, and their charts were then reviewed for demographics and TAT. Propofol was unavailable in the emergency department （ED） between May 2010 and February 2011. The study period extended from May 2009 until May 2011. Patients receiving sedation by non-emergency medicine physicians and those receiving sedation related to intubation were excluded. In total 2466 charts were reviewed and 209 met inclusion criteria. When propofol was available, the most commonly used sedative agent was etomidate （40%）, followed by propofol （28%）, ketamine （20%）, and midazolam （6%）. When propofol was unavailable, etomidate remained the most commonly used agent （43%）, followed by ketamine （41%）, and midazolam （11%）. When propofol was available, the median TAT for sedated patients was 163 minutes compared to 178 minutes when propofol was unavailable （P=0.83）. When propofol was the primary sedative agent used, the median TAT was 166 minutes as compared with a median TAT of 172 minutes for all other sedative agents combined （P=0.87）. When propofol was unavailable, ketamine became a preferred ED sedation agent. Removal of propofol from the sedation armamentarium did not affect ED TAT.
基金The authors extend their appreciation to Deanship of Scientific Research at King Khalid University for funding this work through the Research Groups Project under Grant Number RGP.1/95/42.
文摘Minimizing time cost in time-shared operating systems is considered basic and essential task,and it is the most significant goal for the researchers who interested in CPU scheduling algorithms.Waiting time,turnaround time,and number of context switches are themost time cost criteria used to compare between CPU scheduling algorithms.CPU scheduling algorithms are divided into non-preemptive and preemptive.RoundRobin(RR)algorithm is the most famous as it is the basis for all the algorithms used in time-sharing.In this paper,the authors proposed a novel CPU scheduling algorithm based on RR.The proposed algorithm is called Adjustable Time Slice(ATS).It reduces the time cost by taking the advantage of the low overhead of RR algorithm.In addition,ATS favors short processes allowing them to run longer time than given to long processes.The specific characteristics of each process are;its CPU execution time,weight,time slice,and number of context switches.ATS clusters the processes in groups depending on these characteristics.The traditionalRRassigns fixed time slice for each process.On the other hand,dynamic variants of RR assign time slice for each process differs from other processes.The essential difference between ATS and the other methods is that it gives a set of processes a specific time based on their similarities within the same cluster.The authors compared between ATS with five popular scheduling algorithms on nine datasets of processes.The datasets used in the comparison vary in their features.The evaluation was measured in term of time cost and the experiments showed that the proposed algorithm reduces the time cost.
文摘The medical sector values time when it determines life in its totality. Any waste of time, especially in critical conditions, compromises patients and puts lives at stake. From a diagnosis and treatment perspective, efficient use of time determines the success of procedures. Whether it be the inclusion of computing technologies or it be the implementation of informatics, the benefits of medical technology have been tremendous to the healthcare sector. This research has looked at the impact of the Radiology Information System (RIS) on CT reporting time in the King Khalid Hospital (KKH) in the Kingdom of Saudi Arabia. The approach of the study has been quasi-experimental, using the power calculation of a pair of 381 CT scan reports of 40,000 after which the data was collected and analyzed by using SPSS to deduce the impact that RIS has on CT reporting time. The comparison of CT reporting time is done between two distinct timeframes Pre- and Post-installation of RIS. The patients in the current study were organized into three primary categories: emergency patients, inpatients, and outpatients. The results show that the turnaround time was impacted positively with the incorporation of RIS and related technologies in CT scan patients. The outpatient department saw the most improvement among the three categories indicating the highest average percentage of reduction in Turnaround Time. Thus, it was concluded that the RIS has an overall positive impact on CT reporting time.
