RESUMO
Fecha de actualización: 22 de mayo 2020. Actualizar a los profesionales de pediatría, Medicina Interna, Gineco obstetricia, personal de enfermería, de laboratorio y el comité de gestión de riesgo en el manejo clínico de casos del nuevo coronavirus COVID-19.
Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Capacitação Profissional , Betacoronavirus , Gestão de Riscos/organização & administração , Pessoal de Laboratório Médico/educação , Infecções por Coronavirus/diagnóstico , Administração de Caso , Contenção de Riscos Biológicos/métodos , Assistência Hospitalar/organização & administração , Monitoramento Epidemiológico , Guatemala , Recursos Humanos de Enfermagem/educaçãoRESUMO
Introduction: To reach the goal of malaria elimination in Ecuador for the year 2020, it is necessary to have a laboratory network with the capacity to perform microscopic diagnosis according to the WHO/PAHO quality standards and to provide the adequate treatment of cases. Objective: To determine the level of competence for parasitological diagnosis of the microscopists from the local public network and the performance of intermediate reference laboratories. Materials and methods: We conducted a cross-sectional study based on the information collected in workshops carried out to appraise the competence for microscopic diagnosis of the local laboratory network (zonal health coordinating offices 1 to 8) using a slide panel to evaluate diagnosis agreement, as well as the diagnostic performance of the intermediate laboratories using an external quality assessment program. The results were compared against the reference standards of the supranational laboratory in Perú. Results: We evaluated the competencies of 191 microscopists in 11 workshops and 153 (80.1%) of them were approved. The medians of the indicators were the following: concordance for parasite detection, 100% (Q1- Q3: 96-100), concordance for species identification, 100% (Q1- Q3: 93-100), and concordances for stage identification, 93.0% (Q1- Q3: 86-95) and parasite counting, 77.0% (Q1- Q3: 71-82). In the external quality assessment, the three intermediate laboratories obtained 100% in parasite detection concordance and 96% for species detection concordance. Conclusions: The results for the primary network and the performance indicators for the intermediate laboratories showed the high-quality standards of the training program implemented in the country.
Introducción. El cumplimiento de la meta de eliminación de la malaria en Ecuador en el 2020 exige contar con la capacidad requerida para el diagnóstico microscópico ajustado a los estándares de calidad de la Organización Mundial de la Salud (OMS) y de la Organización Panamericana de la Salud (OPS) y proveer el tratamiento adecuado a los pacientes. Objetivo. Conocer la idoneidad o competencia de los microscopistas de la red pública local para el diagnóstico parasitológico de la malaria y el desempeño de los laboratorios intermedios de referencia. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal a partir de la información obtenida en los talleres de evaluación de idoneidad en el diagnóstico microscópico de la red de laboratorios en las coordinaciones zonales de salud utilizando un panel de láminas para evaluar la concordancia del diagnóstico. Además, se calificó el desempeño de los laboratorios intermedios en el diagnóstico en el marco del programa de evaluación externa del desempeño. Los resultados se compararon con los obtenidos por el laboratorio supranacional de Perú. Resultados. En los 11 talleres realizados, se evaluó la idoneidad de 191 microscopistas, de los cuales 153 (80,1 %) aprobaron las pruebas. Las medianas de los indicadores fueron las siguientes: concordancia entre la detección y el resultado, 100 % (Q1- Q3: 96-100); concordancia en la especie, 100 % (Q1- Q3: 93-100); concordancia en el estadio, 93,0 % (Q1- Q3: 86-95) y concordancia en el recuento, 77 % (Q1- Q3: 71-82). En el programa de evaluación externa de desempeño, los tres laboratorios intermedios obtuvieron una concordancia del 100 % en el resultado y una del 96 % en la especie. Conclusiones. Los indicadores de competencia de la red local y de desempeño de los laboratorios intermedios alcanzaron altos estándares de calidad acordes con el proceso de entrenamiento implementado en el país.
Assuntos
Eritrócitos/parasitologia , Ensaio de Proficiência Laboratorial , Malária Falciparum/diagnóstico , Malária Vivax/diagnóstico , Pessoal de Laboratório Médico/estatística & dados numéricos , Microscopia/métodos , Parasitemia/diagnóstico , Plasmodium falciparum/isolamento & purificação , Plasmodium vivax/isolamento & purificação , Estudos Transversais , Equador , Eritrócitos/ultraestrutura , Feminino , Humanos , Laboratórios/classificação , Laboratórios/normas , Malária Falciparum/sangue , Malária Falciparum/prevenção & controle , Malária Vivax/sangue , Malária Vivax/prevenção & controle , Masculino , Pessoal de Laboratório Médico/educação , Microscopia/normas , Parasitemia/sangue , Parasitemia/prevenção & controle , Prática Profissional/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Fatores SocioeconômicosRESUMO
Resumen Introducción. El cumplimiento de la meta de eliminación de la malaria en Ecuador en el 2020 exige contar con la capacidad requerida para el diagnóstico microscópico ajustado a los estándares de calidad de la Organización Mundial de la Salud (OMS) y de la Organización Panamericana de la Salud (OPS) y proveer el tratamiento adecuado a los pacientes. Objetivo. Conocer la idoneidad o competencia de los microscopistas de la red pública local para el diagnóstico parasitológico de la malaria y el desempeño de los laboratorios intermedios de referencia. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal a partir de la información obtenida en los talleres de evaluación de idoneidad en el diagnóstico microscópico de la red de laboratorios en las coordinaciones zonales de salud utilizando un panel de láminas para evaluar la concordancia del diagnóstico. Además, se calificó el desempeño de los laboratorios intermedios en el diagnóstico en el marco del programa de evaluación externa del desempeño. Los resultados se compararon con los obtenidos por el laboratorio supranacional de Perú. Resultados. En los 11 talleres realizados, se evaluó la idoneidad de 191 microscopistas, de los cuales 153 (80,1 %) aprobaron las pruebas. Las medianas de los indicadores fueron las siguientes: concordancia entre la detección y el resultado, 100 % (Q1- Q3: 96-100); concordancia en la especie, 100 % (Q1- Q3: 93-100); concordancia en el estadio, 93,0 % (Q1- Q3: 86-95) y concordancia en el recuento, 77 % (Q1- Q3: 71-82). En el programa de evaluación externa de desempeño, los tres laboratorios intermedios obtuvieron una concordancia del 100 % en el resultado y una del 96 % en la especie. Conclusiones. Los indicadores de competencia de la red local y de desempeño de los laboratorios intermedios alcanzaron altos estándares de calidad acordes con el proceso de entrenamiento implementado en el país.
Abstract Introduction: To reach the goal of malaria elimination in Ecuador for the year 2020, it is necessary to have a laboratory network with the capacity to perform microscopic diagnosis according to the WHO/PAHO quality standards and to provide the adequate treatment of cases. Objective: To determine the level of competence for parasitological diagnosis of the microscopists from the local public network and the performance of intermediate reference laboratories. Materials and methods: We conducted a cross-sectional study based on the information collected in workshops carried out to appraise the competence for microscopic diagnosis of the local laboratory network (zonal health coordinating offices 1 to 8) using a slide panel to evaluate diagnosis agreement, as well as the diagnostic performance of the intermediate laboratories using an external quality assessment program. The results were compared against the reference standards of the supranational laboratory in Perú. Results: We evaluated the competencies of 191 microscopists in 11 workshops and 153 (80.1%) of them were approved. The medians of the indicators were the following: concordance for parasite detection, 100% (Q1- Q3: 96-100), concordance for species identification, 100% (Q1- Q3: 93-100), and concordances for stage identification, 93.0% (Q1- Q3: 86-95) and parasite counting, 77.0% (Q1- Q3: 71-82). In the external quality assessment, the three intermediate laboratories obtained 100% in parasite detection concordance and 96% for species detection concordance. Conclusions: The results for the primary network and the performance indicators for the intermediate laboratories showed the high-quality standards of the training program implemented in the country.
Assuntos
Feminino , Humanos , Masculino , Plasmodium falciparum/isolamento & purificação , Plasmodium vivax/isolamento & purificação , Malária Vivax/diagnóstico , Malária Falciparum/diagnóstico , Pessoal de Laboratório Médico/estatística & dados numéricos , Parasitemia/diagnóstico , Eritrócitos/parasitologia , Ensaio de Proficiência Laboratorial , Microscopia/métodos , Prática Profissional/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Fatores Socioeconômicos , Estudos Transversais , Malária Vivax/sangue , Malária Vivax/prevenção & controle , Malária Falciparum/sangue , Malária Falciparum/prevenção & controle , Pessoal de Laboratório Médico/educação , Parasitemia/sangue , Parasitemia/prevenção & controle , Equador , Eritrócitos/ultraestrutura , Laboratórios/classificação , Laboratórios/normas , Microscopia/normasRESUMO
OBJECTIVE: To assess a LED-fluorescence microscopy (LED-FM) capacitation program for the training of laboratory technicians without previous experience in FM. METHODS: We evaluated a teaching program that consists of a three-day course followed by an "in situ" two-month phase in which technicians acquired skills without the help of a FM expert; in order to gain confidence to recognize auramine-stained bacillus, during this phase, technicians examined duplicate slides stained by Ziehl Neelsen (ZN) and FM in a unblinded way. Technicians with acceptable performance, continued with a blinded-training period. Testing panels and rechecking process were used to evaluate proficiency after different length of experience. RESULTS: Post-course panel results showed that 70% of trainees made Low False Positive errors (LFPs). Analysis of two other panels showed that LFPs significantly decreased (Chi-squared test, p<0.05) as the "in situ" training phase progressed. Processing at least three slides/day was associated with acceptable performance. During the blinded-training period, results of the rechecking process showed that sensitivity (96.8%) and specificity (99.8%) levels were satisfactory. CONCLUSION: Moderate training (a three-day course) is not enough to make technicians proficient in LED-FM; however, great ability can be reached after a short "in situ" training phase even without the presence of experienced staff available in field to review doubtful results. Training was more effective in services with a minimum workload of 750 slides/year.
Assuntos
Pessoal de Laboratório Médico/educação , Microscopia de Fluorescência , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/diagnóstico , Argentina , Fortalecimento Institucional , Competência Clínica , Estudos de Viabilidade , Feminino , Humanos , Masculino , Microscopia de Fluorescência/métodos , Controle de QualidadeRESUMO
The President's Emergency Plan for AIDS Relief (PEPFAR) programme for the Caribbean Region was established in 2008 to address health system challenges, including fragile laboratory services and systems. The laboratory component of this programme consisted of several phases: assessment of laboratory needs of all 12 countries engaged in the programme; addressing gaps identified during the assessment; and monitoring and evaluation of the progress achieved. After one year of PEPFAR collaboration with national governments and other partners, laboratory services and systems greatly improved. Some of the milestones include: (1) the accreditation of a public laboratory; (2) improved access to HIV diagnosis with faster turnaround time; (3) establishment of capacity for platforms for DNA PCR, viral load and HIV drug resistance; (4) development of the laboratory workforce; and (5) establishment of a framework for implementation of sustainable quality management systems for laboratory accreditation. The progress recorded in strengthening laboratory health systems after one year of initiating this collaboration shows that with a rigorous initial assessment, programme design and intervention and strategic partnership, national laboratory health systems can be greatly enhanced to support programme implementation. Continued collaboration and country leadership is critical to create an integrated and sustainable laboratory network in the Caribbean.
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Síndrome da Imunodeficiência Adquirida/diagnóstico , Laboratórios/organização & administração , Laboratórios/normas , Avaliação das Necessidades , Garantia da Qualidade dos Cuidados de Saúde , Acreditação , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Região do Caribe , Técnicas de Laboratório Clínico/normas , Países em Desenvolvimento , Humanos , Pessoal de Laboratório Médico/educação , Pessoal de Laboratório Médico/normas , Programas Nacionais de Saúde , Fatores de TempoRESUMO
The microbiology laboratory provides a strategic support for infectious disease diagnosis and also alerts the medical community about bacterial resistance to antibiotics. The microbiologists' training is a challenge in Brazil, a country with an extensive territory, a diverse population, and disparity of resource allocation. The aim of this study was to implement an interactive tele-educational course in clinical microbiology to reach distant laboratory workers and to improve their professional skills. The course scientific content was defined according to competences associated, distributed in 560 h, with laboratory practices (knowledge matrix-contextual education). The 11-module course structure comprised 70% distance learning, 22% on campus (integrated modules), and 8% monographs. The group included 7 physicians and 21 microbiologists from 20 different Brazilian cities. The time flexibility and location were the two main reasons for student participation, thus decreasing absences to the workplace, different from the traditional teaching methodologies. The group performance was measured by monthly evaluations, and 1 year postcourse, the researcher visited their workplace. There was significant improvement in microbiological practices performed before compared with after group participation. Therefore, 76.9% of laboratory practices were modified because of the knowledge acquired in the course. Students showed behavioral changes in relation to performance in infection control as well as on the dissemination of their knowledge. This specialization course using distance education did not compromise the quality. This educational methodology represents an alternative to teach clinical microbiology to laboratory workers from remote hospitals, as a nationwide continuing educational strategy.
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Educação a Distância/métodos , Pessoal de Laboratório Médico/educação , Microbiologia/educação , Telemedicina , Brasil , Currículo , Médicos , Avaliação de Programas e Projetos de Saúde , População Rural , Universidades , Interface Usuário-ComputadorRESUMO
Os laboratórios de medicina diagnóstica auxiliam nas decisões médicas frente aos pacientes. Por essa razão os médicos e pacientes necessitam ter confiança e segurança nos laudos fornecidos pelos laboratórios clínicos. Porém, a fase do laboratório conhecida como pré-analítica, vem sendo apontada por diferentes estudos, como a grande responsável pelos erros laboratoriais. A principal razão para a alta frequência de erros nesta fase do processo está na dificuldade de controlar as variáveis pré-analíticas e em realizar melhoria nos processos, pois diversas variáveis encontram-se no preparo do paciente e no momento da coleta e identificação de amostras biológicas. Esta fase é mais suscetível a erros devido ser uma fase onde a maioria dos processos não é automatizada, envolvendo atividades manuais. Para alcançar as metas de redução dos erros e aumentar a segurança e confiabilidade dos processos pré-analíticos, se faz necessário implantar atividades que visem à educação continuada de todos os profissionais envolvidos nos processos de obtenção e manipulação de amostras biológicas.
Medical diagnostic laboratories can assist with medical decision making. For this reason, delivering reliable laboratory results is essential to providing physicians and patients with a sense of trust and safety. However, currently available evidence demonstrates that most laboratory errors are identified in the pre-analytical phase of the total testing process. The high frequency of errors at this stage is mainly attributable to the difficulty in monitoring all pre-analytical variables and in implementing improvement processes, particularly because several variables involve patient preparation and specimen collection and identification. This phase is more susceptible to errors because most pre-analytical steps involve manual rather than automated activities. To achieve the goal of error reduction and to increase the safety and reliability of pre-analytical processes, it is necessary to implement continuing education programs for all professionals involved in the process of collection and handling of biological samples.
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Humanos , Técnicas de Laboratório Clínico , Erros de Diagnóstico , Pessoal de Laboratório Médico/educação , Flebotomia/normas , Controle de Qualidade , Manejo de Espécimes/normasRESUMO
HIV rapid testing is a key tool in the fight against the HIV/AIDS epidemic; it enables the rapid expansion of prevention and treatment programs in resource-limited countries. Meeting the goals of these programs means that millions of people will need testing annually. Accuracy and reliability of these tests are critical to the success of these programs. Given the enormous number of rapid tests that are performed each year, even a low error rate of 0.5% applied to 100 million people will result in 500,000 erroneous results. Ensuring the quality of HIV rapid testing presents unique challenges in that testing is often performed in various settings by personnel without formal laboratory training. This article describes the development and implementation of a generic HIV rapid test training package using a systems approach in an effort to standardize training and ensure the quality of rapid tests. It also highlights achievements from Uganda, Haiti, and Botswana.
Assuntos
Sorodiagnóstico da AIDS/normas , Agentes Comunitários de Saúde/educação , Infecções por HIV/diagnóstico , Botsuana , Países em Desenvolvimento , Infecções por HIV/prevenção & controle , Haiti , Humanos , Pessoal de Laboratório Médico/educação , Projetos Piloto , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Pobreza , UgandaRESUMO
BACKGROUND: Peru has a concentrated HIV epidemic with an estimated 76,000 people living with HIV (PLHIV). Access to highly active antiretroviral therapy (HAART) expanded between 2004-2006 and the Peruvian National Institute of Health was named by the Ministry of Health as the institution responsible for carrying out testing to monitor the effectiveness of HAART. However, a national public health laboratory information system did not exist. We describe the design and implementation of an e-health driven, web-based laboratory information system--NETLAB--to communicate laboratory results for monitoring HAART to laboratory personnel, health providers and PLHIV. METHODS: We carried out a needs assessment of the existing public health laboratory system, which included the generation and subsequent review of flowcharts of laboratory testing processes to generate better, more efficient streamlined processes, improving them and eliminating duplications. Next, we designed NETLAB as a modular system, integrating key security functions. The system was implemented and evaluated. RESULTS: The three main components of the NETLAB system, registration, reporting and education, began operating in early 2007. The number of PLHIV with recorded CD4 counts and viral loads increased by 1.5 times, to reach 18,907. Publication of test results with NETLAB took an average of 1 day, compared to a pre-NETLAB average of 60 days. NETLAB reached 2,037 users, including 944 PLHIV and 1,093 health providers, during its first year and a half. The percentage of overall PLHIV and health providers who were aware of NETLAB and had a NETLAB password has also increased substantially. CONCLUSION: NETLAB is an effective laboratory management tool since it is directly integrated into the national laboratory system and streamlined existing processes at the local, regional and national levels. The system also represents the best possible source of timely laboratory information for health providers and PLHIV, allowing patients to access their own results and other helpful information about their health, extending the scope of HIV treatment beyond the health facility and providing a model for other countries to follow. The NETLAB system now includes 100 diseases of public health importance for which the Peruvian National Institute of Health and the network of public health laboratories provide testing and results.
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Terapia Antirretroviral de Alta Atividade , Sistemas de Informação em Laboratório Clínico , Infecções por HIV/tratamento farmacológico , Telemedicina , Atitude Frente aos Computadores , Custos e Análise de Custo , Pessoal de Saúde/educação , Humanos , Pessoal de Laboratório Médico/educação , Sistemas Computadorizados de Registros Médicos , Avaliação das Necessidades , Educação de Pacientes como Assunto , Peru , Interface Usuário-ComputadorRESUMO
OBJECTIVE: To develop a bovine protocol for training in preimplantation genetic diagnosis (PGD) using PCR. DESIGN: Randomized study. SETTING: Human reproduction PCR laboratory. PATIENT(S): Cow ovaries obtained from slaughterhouses. INTERVENTION(S): The ovaries were punctured and the oocytes were matured and submitted to in vitro fertilization. On the third day after fertilization, the embryos were biopsied and 1-2 blastomeres removed. A blastomere and the rest of the embryo were submitted to PCR for sex determination. MAIN OUTCOME MEASURE(S): Establishment of a possible training protocol. RESULT(S): A total of 50 embryos and 50 biopsied blastomeres were submitted to DNA amplification for sexing. Of the 50 embryos, 41 (82%) achieved successful DNA amplification and 9 (18%) did not. Of the 50 biopsies, 31 (62%) amplified and 19 (38%) did not. In 27 (65.9%) of the 41 embryos with DNA amplification, sex was identified as female and in 14 (34.1%) as male. In 40 cases (80%) amplification and sex determination were successful in both embryos and blastomeres. Sex was identical in all these cases. CONCLUSION(S): This training model seems to be useful in identifying mistakes and difficulties and improving the professional's performance in the various stages of preimplantation genetic diagnosis.