A B S T R A C T S   N U M E R I   1   e   2 / 1998

Preliminary study about workload in a representative sample of hospital laboratories (biochemistry and haematology units) in Lombardia region (Italy). Comparison with international workload recording methods.

*Mocarelli P, Alieri U, Carati L, De Francesco D, De Leo G, Ferrari L, Franzini C, Malacrida V, Mariani F, Marocchi A, Nichelatti T, Ottomano C, Robba L, Spandrio L, Troina E, Colombo L, Gerthoux PM, Salemi A, Vecchi L, Cespa A, Vegezzi PG, Bassi L, Morelli AM, Pirali A, Bartolotti E, Palma F, Mercantini F, Tavani G, Crippa A, Panteghini M., Brignani A, Ruggeri G, Tarantino M, Buratta A, Carreri V
*Servizio di Patologia Clinica, Ospedale di Desio, Desio (MI)

Biochimica Clinica 1998; 22(1-2): 5-27 [Article in italian]

ABSTRACT. Comparison with international workload recording methods. A group of of laboratories at public hospitals in the the Region Lombardia (Italy) (pop. about 9.000.000) conducted a pilot study of the possibility of applying international workload recording methods that have been used and repeatedly reviewed in Canada, USA and Wales for the past 25 years. This project was carried out with the consent of the Italian Federation of Laboratory Medicine Scientific Societies (FISMELAB) and the Comitato Regionale Lombardo di Ordinamento per i Servizi di Patologia (CROSP). The study was performed during the period from October 1995 to January 1996. Seventeen laboratories in the Region Lombardia were involved. Altogether these hospitals represented about the 27% of the public hospital beds in the region and performed about the 18% of the total laboratory tests in the region. Methods of data collection and workload record systems were developed in specific areas of biochemistry, haematology, and the serological diagnosis of A, B and C hepatitis. Participants completed a specific questionnaire for each laboratory unit under examination. The questionnaire covered a period of five days and gathered information with regard to the average time spent by the staff (including technicians, clerks, nurses and aides) to complete each laboratory procedure. Particpants were specifically required to record: a) the number of venipunctures and outpatients registrations performed; b) the type and number of tests; c) the methods and apparatus in use; d) the number of workers, their professional qualification (including, degreed vs. non-degreed staff), and the time spent by each worker to complete a procedure. The time spent by the Laboratory Director was not included in the data for analysis. The registered Full Time Equivalents (FTE) of only non-graduated staff were compared with the FTE's assigned by the USA and Wales System, respectively. The comparison with the Canadian System, which partially includes the graduated staff activity, was performed by adding the number of the graduates working in the laboratory units related to the recorded FTE. The observed FTE's in Lombardia, on average, are lower by 11% and 12% than the FTE assigned for the considered workload by the USA and the Wales System respectively. When graduates are included, the recorded FTE on average are lower by 11% than those assigned by the Canadian System. Looking at specific laboratories, the observed FTE's in Lombardia are lower in 11 out of 17 laboratories than the FTE norms according to the USA System. They are equal in 1, and higher in 5. Using the Wales System, 12 laboratories have lower FTE's than the assigned FTE, 1 laboratory has an equal level of FTE, and four laboratories have higher recorded FTE's. With the Canadian System, 12 out of 17 laboratories have recorded FTE's (including the degreed staff) lower than the reference FTE; three are equal to the referenced FTE; and two laboratories are higher in terms of their FTE's. The average time needed to complete a single test on the automated analysers in the 17 laboratories participating in the study was always lower or equal to the time fixed by each workload recording method, indicating a very high level of productivity. These results show that the laboratories of Lombardia Region on average reach a higher productivity than Canadian, USA and Wales laboratories. The result of the comparison between Canada and Lombardia is very notable, considering the similarities with those two national health Systems. The Canadian workload recording method is used as a reference system in other European countries, such as Switzerland, Germany and France. These preliminary results, although they will be have to be confirmed by larger scale studies, show levels of FTE comparable with most advanced European experiences. It indicate that new workload recording methods limited to the Lombardia Region may be redundant. In future studies, particular attention will have to be paid to the comparison between turn-around-times (TAT) in different countries, since that relevant parameter may explain differences observed between laboratory performace Lombardia vis-avis that in Canada and other countries. The shortening of TAT could allow notable savings to the whole hospital system. However, it demands considerable changes in management practice as well as investment in terms of apparatus and education.

Influence of blood-drawing stress on blood prolactin concentration values: assessing the usefulness of zero-time measurement.

*Morrica B, Gnocchi E, Rizzardi S, Ferrari A, Pelati M, Masone M, Buontempi D
*Azienda Ospedale "Istituti Ospitalieri di Cremona", Divisione di Radioterapia e Medicina Nucleare, Laboratorio di Radiochimica

Biochimca Clinica 1998; 22(1-2): 28-29 [Article in italian]

ABSTRACT. Prolactin concentration values, as measured in venous blood samples, are known to be influenced by the stress due to blood-drawing manoeuvres. It is therefore recommended to measure prolactin as a "curve", consituted by determinations in three subsequent samples, obtained respectively at zero, thirty and sivxty minutes after inserting a needle in the vein. The statistical analysis of a number of such "curves" showed that only the first sample is significnatly influenced by the stress, and that the final analysis bears no relationship to the zero-time sample concentration. We therefore suggest measuring prolactin only in two samples, obtained thirty and sixty minutes respectively after inserting the needle.

Biological variation of some tumor markers in serum.

*Porreca WP, Biondi ML, Turrini D, Guagnellini E
*Laboratorio Analisi, Ospedale S. Paolo, Milano

Biochimica Clinica 1998; 22(1-2): 30-35 [Article in italian]

ABSTRACT. The clinical use of serum tumor markers (TM) involves comparing observed with previous values. The observed difference should be compared with the critical difference, calculated on the basis of the biological within-individual variation (CVBw). This work aimed at generating new data-sets for the biological variation of some commonly used serum TM, and to compare them with data in the literature. Blood samples were drawn from 20 healthy subjects of both sexes (aged 23-26 years), on six occasions in the time interval of six months. AFP, CA 15.3, CA 19.9, CA 125 and CEA were measured in duplicate with an automatic system and the different components of variation were calculated by means of the analysis of variance. Comparison with the relevant data from the literature showed acceptable homogeneity of the CVBw values, with the main exception of CEA (one study out of nine). Data from the literature concerning 4 additional TM (BCA, PSA,TPA and TPS) not included in this study were compiled: again, acceptable homogeneity of the CVBw values was found, with the main exception of PSA (one study out of three). The between-individual biological variation values (CVBb) also showed some homogeneity, but they were not always available in the published studies, and were often unacceptably high ( 35 %). Weighed average values for the CVBw of the five TM included in this study were in the interval from 10 % to 15 %, this corresponding to critical differences from 35 % to 46 % (for an average analytical variation equal to 7,5 %). For the additional four. TM, the average CVBw values varied from 13 % (BCA) to 36 % (PSA). The high average value for PSA (a value of 49 % reported in one study was included in the calculation) indicates the need for a better definition of the biological variation of this TM.

Assessment of bone mineral density, blood parathormone and estradiol, in post-menopausal women before and efter exercise training.

*El-Badry SM, Hassan Fouad H
*Obstetric & Gynaecology Dept, Faculty of physical Therapy, Cairo University, Cairo, Egypt.

Biochimica Clinica 1998; 22(1-2): 36-38 [Article in italian]

ABSTRACT. Bone mineral density (BMD) of lumbar spine 3,4 & 5 as well as parthormone (PTH) and estradiol (E2) were studied in two groups of post menopausal women. The first group (A) included 25 subjects who participated in exercise training. The second group (B) comprised 15 subjects who did not participate in training. In group (A), significant rise in BMD, significant decrease in PTH and non significant changes in E2 were observed 6 months after exercise training. In group (B), non significant changes in PTH & BMD and significant decrease in E2 were observed 6 moths after starting the study.

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