Ten years of preanalytical monitoring and control: Synthetic Balanced Score Card Indicator

Introduction

Preanalytical control and monitoring continue to be an important issue for clinical laboratory professionals. The aim of the study was to evaluate a monitoring system of preanalytical errors regarding not suitable samples for analysis, based on different indicators; to compare such indicators in different phlebotomy centres; and finally to evaluate a single synthetic preanalytical indicator that may be included in the balanced scorecard management system (BSC).

Materials and methods

We collected individual and global preanalytical errors in haematology, coagulation, chemistry, and urine samples analysis. We also analyzed a synthetic indicator that represents the sum of all types of preanalytical errors, expressed in a sigma level. We studied the evolution of those indicators over time and compared indicator results by way of the comparison of proportions and Chi-square.

Results

There was a decrease in the number of errors along the years (P < 0.001). This pattern was confirmed in primary care patients, inpatients and outpatients. In blood samples, fewer errors occurred in outpatients, followed by inpatients.

Conclusion

We present a practical and effective methodology to monitor unsuitable sample preanalytical errors. The synthetic indicator results summarize overall preanalytical sample errors, and can be used as part of BSC management system.Key words: Preanalytical phase, errors in laboratory medicine, balanced scorecard, patient safety     

Cómo no impedir que los niños aprendan inglés

Se revisan en este artículo los problemas que un enfoque comunicativo basado en el adulto presentan para el diseño curricular del inglés para niños y se propone pasar a un diseño basado en actividades (más que en contenidos lingüísticos), alertando a la vez de las condiciones (que hoy no se cumplen) necesarias para aplicarlo con eficacia, como la formación de los docentes o los recursos en el centro.     

An Example of the Informative Potential of Polar Coordinate Analysis: Sprint Tactics in Elite 1,500-m Track Events

Polar coordinate analysis is a powerful data reduction technique based on the Zsum statistic, which is calculated from adjusted residuals obtained by lag sequential analysis. Its use has been greatly simplified since the addition of a module in the free software program HOISAN for performing the necessary computations and producing easy-to-interpret results in the form of polar coordinate maps. In this study, we provide a simple and practical example of how this technique can be used to analyze tactical behaviors in sport and physical exercise. We studied 158 performances by 82 male runners in thirteen 1,500-m finals held at the Olympic Games, the World Championships in Athletics, and the European Athletics Championships between 2000 and 2012 to investigate associations between the initiation of sprints by race winners and other runners (focal behaviors) and the lap and zone of the track in which the sprints were initiated (conditional behaviors). The significant prospective/retrospective activating/inhibitory relationships shown in the polar coordinate maps confirm the decision to start a sprint is a tactical one and are consistent with a winning strategy consisting of avoiding giving rivals the benefit of the slipstream while conserving sufficient energy for a final winning burst. Polar coordinate analysis is a powerful technique for studying tactical behaviors in the field of sport.     

Physical fitness predicts the academic achievement over one-school year follow-up period in adolescents

The purposes of this study were to examine how fitness at the baseline could predict both academic achievement and academic achievement changes one school year in advance. A total of 194 adolescents (mean age: 14.15 ± 0.97 years old, 112 boys) who attended secondary school participated in our study. Cardiorespiratory fitness was measured with the 20 m endurance shuttle-run test. We also assessed the lower-limbs muscular strength with the standing long jump test and flexibility with the sit-and-reach test. The academic achievement was assessed by school grades. We performed linear regression analyses. Additionally, we examined the relationship between fitness and changes in the academic performance following the same statistical methodology. Cardiorespiratory fitness was positively associated with mathematics one school year in advance (p = 0.025). Cardiorespiratory fitness was also positively associated with changes in Spanish language (p = 0.005), mathematics (p = 0.023), and the grade point average (p = 0.006). Muscular strength was also positively associated with changes in Spanish language (p = 0.040) and mathematics (p = 0.010), while flexibility was associated with changes in Spanish language (p = 0.039) and the grade point average (0.027). Our results suggest that cardiorespiratory fitness was positively associated with academic achievement in adolescents.     

Identifying profiles of children at risk of being less physically active: an exploratory study using a self-organised map approach for motor competence

This study aims to develop profiles in children according to physical fitness, actual and perceived motor competence, and to examine the level of engagement in physical activity and weight status according to these profiles. In the study, 156 typically developing Spanish children (47.4% girls) of primary school age (5–11 years-old) participated voluntarily. Children’s perceived and actual motor competence, physical fitness, physical activity participation and weight status were assessed. A Self-Organising Map and K-means cluster analysis were used to classify and visualise the values. Four profiles were found: profile 2 was aligned – high capacity, high perception, profile 1 was partially aligned – medium capacity and perception, profile 3 and 4 were both non-aligned – low capacity, medium perception and medium capacity, low perception; respectively. Children in profile 2 were more active than children in profile 3 and 4 (P < .05). In profile 2 there was a lower frequency of overweight/obese children than normal-weight children. On the contrary, in profiles 1, 3 and 4 a similar distribution of normal-weight and overweight/obese children was found. High capable children with high perception exhibited higher physical activity participation and were more likely to be of normal-weight compared to those with low capacity and/or perception.     

Price-effectiveness: pharmacoeconomics,value and the right price for HPV vaccines

ABSTRACT

Drawing on a pragmatist approach to pricing, this article discusses the impact of cost-effectiveness analysis (CEA) in the pricing strategies of pharmaceutical companies. Through an analysis of the human papillomavirus (HPV) vaccination, this article illustrates the strategic appropriation of evidence-based medicine (narratives and practices) that pharmaceutical companies have undertaken to enhance the value of their products. While governments are concentrated on the measurement of costs and efficiency (cost-effectiveness), companies attempt to find the threshold of effectiveness that supports their estimation of value. I have called such mode of calculation, price-effectiveness. Pharmaceutical companies engage in different ways with CEA in devising their own price strategies. First, CEA is used as an instrument to raise HPV vaccines as a matter of interest for health authorities. Second, companies produce models to maximise the effectiveness of their products. Third, the expense side of CEA has opened an opportunity to represent some conditions as diseases in order to increase the potential value of the vaccine, expressed in a higher price. Debates and practices of pricing offer a unique opportunity to trace how particular forms of quantification have become the common ground in the demonstration of value in healthcare and the adaptation of companies.     

Validity of a single lactate measure to predict fixed lactate thresholds in athletes

This study aimed to validate the use of a single blood lactate concentration measure taken following a 12 km h^?1 running stage (BLC₁₂) to predict and monitor fixed blood lactate concentration (FBLC) thresholds. Three complementary studies were undertaken. Study I: the relationships between BLC₁₂ and the running speeds at FBLC of 3 mmol L^?1 (S3mM) and 4 mmol L^?1 (S4mM) measured during a multistage running field test were examined in 136 elite athletes. Study II: data from 30 athletes tested one year apart were used to test the predictive capacity of the equations obtained in Study I. Study III: 80 athletes were tested before and after an intensified training period to examine whether training-induced changes in FBLC thresholds could be predicted and monitored by BLC₁₂. Study I: BLC₁₂ was significantly (P < 0.001) and inversely related to S3mM (R² = 0.89) and S4mM (R² = 0.95). Study II: prediction models yielded robust correlations between the estimated and measured FBLC thresholds (r = 0.94–0.99; P < 0.001). Study III: estimated changes predicted actual training-induced changes in FBLC thresholds (r = 0.81–0.91; P < 0.001). This study gives empirical support to use a single lactate measure during a sub-maximal running field test as a simple, low-cost and practical alternative to FBLC thresholds in athletes.