Towards Harmonisation of Critical Laboratory Result Management - Review of the Literature and Survey of Australasian Practices

Timely release and communication of critical test results may have significant impact on medical decisions and subsequent patient outcomes. Laboratories therefore have an important responsibility and contribution to patient safety. Certification, accreditation and regulatory bodies also require that laboratories follow procedures to ensure patient safety, but there is limited guidance on best practices. In Australasia, no specific requirements exist in this area and critical result reporting practices have been demonstrated to be heterogeneous worldwide.Recognising the need for agreed standards and critical limits, the AACB started a quality initiative to harmonise critical result management throughout Australasia. The first step toward harmonisation is to understand current laboratory practices. Fifty eight Australasian laboratories responded to a survey and 36 laboratories shared their critical limits. Findings from this survey are compared to international practices reviewed in various surveys conducted elsewhere. For the successful operation of a critical result management system, critical tests and critical limits must be defined in collaboration with clinicians. Reporting procedures must include how critical results are identified; who can report and who can receive critical results; what is an acceptable timeframe within which results must be delivered or, if reporting fails, what escalation procedures should follow; what communication channels or systems should be used; what should be recorded and how; and how critical result procedures should be maintained and evaluated to assess impact on outcomes.In this paper we review the literature of current standards and recommendations for critical result management. Key elements of critical result reporting are discussed in view of the findings of various national surveys on existing laboratory practices, including data from our own survey in Australasia. Best practice recommendations are made that laboratories are expected to follow in order to provide high quality and safe service to patients.     

Hemoglobin: normal values

Hematologists are not in agreement as to the "normal" amount of hemoglobin in the blood, nor is there agreement as to what amount of hemoglobin can be considered "a hemoglobin value of 100 per cent." Different hospitals base reports of hemoglobin on different standards, which obviously can be misleading. By biometric study of the great mass of data on hemoglobin content that has become available as a result of the blood procurement program, it should be possible to determine what "normal" values are and to provide a basis for uniformity in reporting.     

What Is the Good of It—Ethical Controls of Human Subject Health Research?

The term “ethics” covers a multitude of virtues and possibly some sins where ethical perspectives differ. Given the diversity of ethical philosophies there is a question about what common ground can, or should, inform health research ethics. At a minimum it must be consistent with the law. Beyond that, ethics embraces a variety of possible approaches. This raises the question—what criteria are applied in determining the appropriate approach and what standards by way of quality control are applied to its decisional application by ethics committees or other authorities exercising responsibility in this difficult area. The particular issue of ethical perspectives on the use of “big data” in medical research also raises complex issues for consideration.     

HEMOGLOBIN: NORMAL VALUES

Hematologists are not in agreement as to the “normal” amount of hemoglobin in the blood, nor is there agreement as to what amount of hemoglobin can be considered “a hemoglobin value of 100 per cent.” Different hospitals base reports of hemoglobin on different standards, which obviously can be misleading.By biometric study of the great mass of data on hemoglobin content that has become available as a result of the blood procurement program, it should be possible to determine what “normal” values are and to provide a basis for uniformity in reporting.     

RightField: embedding ontology annotation in spreadsheets

MOTIVATION: In the Life Sciences, guidelines, checklists and ontologies describing what metadata is required for the interpretation and reuse of experimental data are emerging. Data producers, however, may have little experience in the use of such standards and require tools to support this form of data annotation. RESULTS: RightField is an open source application that provides a mechanism for embedding ontology annotation support for Life Science data in Excel spreadsheets. Individual cells, columns or rows can be restricted to particular ranges of allowed classes or instances from chosen ontologies. The RightField-enabled spreadsheet presents selected ontology terms to the users as a simple drop-down list, enabling scientists to consistently annotate their data. The result is 'semantic annotation by stealth', with an annotation process that is less error-prone, more efficient, and more consistent with community standards. Availability and implementation: RightField is open source under a BSD license and freely available from http://www.rightfield.org.uk     

Johnson Matthey electronics — a total quality management approach to customer support

Johnson Matthey is committed to Total Quality Management (TQM) aimed at setting standards in customer support. TQM achieves improvements in product quality and standards of service by continually improving production processes, analytical techniques, data processing and distribution channels.The Company has so far invested £1M in TQM training, which involves every employee what ever their role. In addition to TQM, the Company continues to invest heavily in a long term research and strategic acquisition policy, which achieves not only improvements in product quality but also provides new products and solutions to meet customers changing needs.     

After 7 years and 1000 citations: comparative assessment of the DNA barcoding and the DNA taxonomy proposals for taxonomists and non-taxonomists

In 2003, two different approaches-DNA taxonomy and DNA barcoding-were simultaneously proposed to overcome some of the perceived intrinsic weaknesses of the traditional morphology-based taxonomical system, and to help non-taxonomists to resolve their crucial need for accurate and rapid species identification tools. After 7 years, it seems unlikely that a completely new taxonomical system based on molecular characters only (DNA taxonomy) will develop in the future. It is more likely that both morphological and molecular data will be simultaneously analyzed, developing what has been coined as "integrative taxonomy". Concerning DNA barcoding, it is now clear that it does not focus on building a tree-of-life nor to perform DNA taxonomy, but rather to produce a universal molecular identification key based on strong taxonomic knowledge that is collated in the barcode reference library. The indisputable success of the DNA barcoding project is chiefly due to the fact that DNA barcoding standards considerably enhance current practices in the molecular identification field, and standardization offers virtually endless applications for various users.     

Re-thinking organisms: The impact of databases on model organism biology

Community databases have become crucial to the collection, ordering and retrieval of data gathered on model organisms, as well as to the ways in which these data are interpreted and used across a range of research contexts. This paper analyses the impact of community databases on research practices in model organism biology by focusing on the history and current use of four community databases: FlyBase, Mouse Genome Informatics, WormBase and The Arabidopsis Information Resource. We discuss the standards used by the curators of these databases for what counts as reliable evidence, acceptable terminology, appropriate experimental set-ups and adequate materials (e.g., specimens). On the one hand, these choices are informed by the collaborative research ethos characterising most model organism communities. On the other hand, the deployment of these standards in databases reinforces this ethos and gives it concrete and precise instantiations by shaping the skills, practices, values and background knowledge required of the database users. We conclude that the increasing reliance on community databases as vehicles to circulate data is having a major impact on how researchers conduct and communicate their research, which affects how they understand the biology of model organisms and its relation to the biology of other species.     

Storage and retrieval of microarray data and open source microarray database software

Microarray technology has been widely adopted by researchers who use both home-made microarrays and microarrays purchased from commercial vendors. Associated with the adoption of this technology has been a deluge of complex data, both from the microarrays themselves, and also in the form of associated meta data, such as gene annotation information, the properties and treatment of biological samples, and the data transformation and analysis steps taken downstream. In addition, standards for annotation and data exchange have been proposed, and are now being adopted by journals and funding agencies alike. The coupling of large quantities of complex data with extensive and complex standards require all but the most small-scale of microarray users to have access to a robust and scaleable database with various tools. In this review, we discuss some of the desirable properties of such a database, and look at the features of several freely available alternatives.     

The contribution of neighbouring countries to pesticide levels in Dutch surface waters

Compared with other European countries, Dutch consumption of pesticides is high, particularly in agriculture, with many of the compounds found in surface waters in high concentrations and various standards being exceeded. Surface water quality is routinely monitored and the data obtained are published in the Dutch Pesticides Atlas. One important mechanism for reducing pesticide levels in surface waters is authorisation policy, which proceeds on the assumption that the pollution concerned has taken place in the Netherlands. The country straddles the delta of several major European rivers, however, and as river basins do not respect national borders some of the water quality problems will derive from neighbouring countries. Against this background the general question addressed in this article is the following: To what extent do countries neighbouring on the Netherlands contribute to pesticide pollution of Dutch surface waters? To answer this question, data from the Pesticides Atlas for the period 2005-2009 were used. Border zones with Belgium and Germany were defined and the data for these zones compared with Dutch data. In the analyses, due allowance was also made for authorised and non-authorised compounds and for differences between flowing and stagnant waters. Monitoring efforts in the border zones and in the Netherlands were also characterised, showing that efforts in the former are similar to those in the rest of the country. In the border zone with Belgium the relative number of non-authorised pesticides exceeding the standards is clearly higher than in the rest of the Netherlands. These exceedances are observed mainly in flowing waters. In contrast, there is no difference in the relative number of standard-exceeding measurements between the border zones and the rest of the Netherlands. In the boundary zones the array of standard-exceeding compounds clearly deviates from that in the rest of the Netherlands, with compounds authorised in the neighbouring countries but not in the Netherlands, such as flufenacet, featuring prominently. The share of the neighbouring countries in the total number of exceedances in the Netherlands is roughly proportional to the relative area of the border zones. Although there is a certain influx of pesticides from across national borders, the magnitude of the problem appears to be limited.     

The future role of bio-ontologies for developing a general data standard in biology: chance and challenge for zoo-morphology

Due to lack of common data standards, the communicability and comparability of biological data across various levels of organization and taxonomic groups is continuously decreasing. However, the interdependence between molecular and higher levels of organization is of growing interest and calls for co-operations between biologists from different methodological and theoretical backgrounds. A general data standard in biology would greatly facilitate such co-operations. This article examines the role that defined and formalized vocabularies (i.e., ontologies) could have in developing such a data standard. I suggest basic criteria for developing data standards on grounds of distinguishing content, concept, nomenclatural, and format standards and discuss the role of data bases and their use of bio-ontologies in current activities for data standardization in biology. General principles of ontology development are introduced, including foundational ontology properties (e.g. class–subclass, parthood), and how concepts are defined. After addressing problems that are specific to morphological data, the notion of a general structure concept for morphology is introduced and why it is required for developing a morphological ontology. The necessity for a general morphological ontology to be taxon-independent and free of homology assumptions is discussed and how it can solve the problems of morphology. The article concludes with an outlook on how the use of ontologies will likely establish some sort of general data standard in biology and why the development of a set of commonly used foundational ontology properties and the use of globally unique identifiers for all classes defined in ontologies is crucial for its success.     

Metabolomics Standards Workshop and the development of international standards for reporting metabolomics experimental results

Informatics standards and controlled vocabularies are essentialfor allowing information technology to help exchange, manage,interpret and compare large data collections. In a rapidly evolvingfield, the challenge is to work out how best to describe, butnot prescribe, the use of these technologies and methods. AMetabolomics Standards Workshop was held by the US NationalInstitutes of Health (NIH) to bring together multiple ongoingstandards efforts in metabolomics with the NIH research community.The goals were to discuss metabolomics workflows (methods, technologiesand data treatments) and the needs, challenges and potentialapproaches to developing a Metabolomics Standards Initiativethat will help facilitate this rapidly growing field which hasbeen a focus of the NIH roadmap effort. This report highlightsspecific aspects of what was presented and discussed at the1st and 2nd August 2005 Metabolomics Standards Workshop.      

DISPUTING THE ETHICS OF RESEARCH: THE CHALLENGE FROM BIOETHICS AND PATIENT ACTIVISM TO THE INTERPRETATION OF THE DECLARATION OF HELSINKI IN CLINICAL TRIALS

In this paper we argue that the consensus around normative standards for the ethics of research in clinical trials, strongly influenced by the Declaration of Helsinki, is perceived from various quarters as too conservative and potentially restrictive of research that is seen as urgent and necessary. We examine this problem from the perspective of various challengers who argue for alternative approaches to what ought or ought not to be permitted. Key themes within this analysis will examine these claims and argue they have implications for the interests of the research subject, research governance and regulation. Using our work with TREAT‐NMD, the neuromuscular clinical trials network, we posit that there is a place for advancing the discourse of moral rights and moral duties in the context of research, especially from the perspective of patients and their families, and for including the politics of patient activism and empowerment. At the same time we remain vigilant to the danger that the therapeutic misconception and other serious vulnerabilities for the patient population in clinical trials, are at risk of being overlooked.     

Norms for emotions: biological functions and representational contents

Normative standards are often applied to emotions. Are there normative standards that apply to emotions in virtue solely of facts about their nature? I will argue that the answer is no. The psychological, behavioural, and neurological evidence suggests that emotions are representational brain states with various kinds of biological functions. Facts about biological functions are not (and do not by themselves entail) normative facts. Hence, there are no normative standards that apply to emotions just in virtue of their having various kinds of biological functions. Moreover, the peculiar features of emotions make the view that representational content is essentially normative very implausible. Hence, the representational properties of emotions cannot be seen as entailing normative standards. The conclusion is that there are no normative standards that apply to emotions solely in virtue of their nature.     

Floral morphology and phylogeny of the Disinae (Orchidaceae)

Previous classification of the Disinae has been based almost entirely on floral morphological data. These data are critically assessed by various methods to determine to what extent they support a classification resolved to sectional level. The variation in the characters relative to the sections and genera is mapped, homologies are established by careful morphological observation and ontogenetic studies, and finally hypotheses of homology are tested by congruence in several cladistic analyseS. It is found that although floral morphology allows the recognition of some groups, for others the results are ambiguouS. Floral morphological data are clearly inadequate to establish the taxonomy of the Disinae on a sound footing.     

WHAT ‘EMPIRICAL TURN IN BIOETHICS’?

Uncertainty as to how we should articulate empirical data and normative reasoning seems to underlie most difficulties regarding the ‘empirical turn’ in bioethics. This article examines three different ways in which we could understand ‘empirical turn’. Using real facts in normative reasoning is trivial and would not represent a ‘turn’. Becoming an empirical discipline through a shift to the social and neurosciences would be a turn away from normative thinking, which we should not take. Conducting empirical research to inform normative reasoning is the usual meaning given to the term ‘empirical turn’. In this sense, however, the turn is incomplete. Bioethics has imported methodological tools from empirical disciplines, but too often it has not imported the standards to which researchers in these disciplines are held. Integrating empirical and normative approaches also represents true added difficulties. Addressing these issues from the standpoint of debates on the fact‐value distinction can cloud very real methodological concerns by displacing the debate to a level of abstraction where they need not be apparent. Ideally, empirical research in bioethics should meet standards for empirical and normative validity similar to those used in the source disciplines for these methods, and articulate these aspects clearly and appropriately. More modestly, criteria to ensure that none of these standards are completely left aside would improve the quality of empirical bioethics research and partly clear the air of critiques addressing its theoretical justification, when its rigour in the particularly difficult context of interdisciplinarity is what should be at stake.     

Guidelines for medical practice: 1. The reasons why.

Various external special interest groups are promoting attempts to better measure and control the performance of the medical profession, primarily to restrain costs. We can neither afford to ignore the rising costs nor reject efforts by provincial licensing authorities to improve supervision of the quality of care. Furthermore, there is increasing public interest in the outcome of medical treatment and a suspicion that some care may be unnecessary or inappropriate. Much of what physicians do is not based on impeccable or complete scientific evidence, and we have not established a method whereby science can consistently be translated into practice. Optimal practice patterns must be defined to improve the quality of care and to maximize the efficiency with which scarce resources are used. Careful scientific evaluation of data is particularly necessary with the arrival of new drugs and technology. Sensible, flexible guidelines produced by appropriate panels will help promote improved practice. Rigid standards must be avoided to allow for individual consideration and scientific innovation. The recognized difficulties of influencing clinical practice by precept or education and the problems imposed by rapidly changing scientific knowledge are two hurdles to be overcome. Licensing bodies must identify and enforce minimal standards, but optimal practice patterns are better devised by a broader segment of the profession. Intervention by third-party payers, as is prevalent in the United States, intrudes upon physician autonomy and reduces access to care. Physicians must support the development of guidelines for optimal medical practice based on the best existing data and focused on improving the quality of care.     

Quality meets quantity - quality control, data standards and repositories

In recent years, standardization and quality control have become important key points in industry, e.g. in drug discovery and for developing medical products. Is quality control in academic Proteomics a minor problem nowadays, where standard data formats and public repositories for data sharing exist? In this article, it is discussed how standard formats and repositories already support the documentation of quality control criteria in protein identification and quantification, and what has to be improved in the future: It is stated that the Proteomics community (represented by a group like the Proteomics Standards Initiative) will have to define a minimum document regarding quality control and to extend existing standards with additional quality control criteria enabling a substantial and standardized quality control process.