The effective reduction of tourniquet application time after minor modification of the CLSI H03-A6 blood collection procedure

Introduction:

The phlebotomists’ procedures are a still source of laboratory variability. The aim of this study was to verify the efficacy of minor modification in procedure for collection of diagnostic blood specimens by venipuncture from CLSI H03-A6 document is able to reduce the tourniquet application time.

Materials and methods:

Thirty phlebotomists were invited to participate. Each phlebotomist was trained individually to perform the new venipuncture procedure that shortens the time of tourniquet release and removal. The phlebotomy training program was delivered over 8h. After training, all phlebotomists were monitored for 20 working days, to guarantee the adoption of the correct new procedures for collection of diagnostic blood specimens. After this time frame the phlebotomists were evaluated to verify whether the new procedure for blood collection derived from CLSI H03-A6 document was effective to improve the quality process by decrease in tourniquet application time. We compared the tourniquet application time and qualitative difference of phlebotomy procedures between laboratories before and after phlebotomy training.

Results:

The overall mean ± SD tourniquet application time before and after this intervention were 118 ± 1 s and 30 ± 1 s respectively. Minor modifications in procedure for blood collection were able to reduce significantly the tourniquet application time (−88 s, P < 0.001).

Conclusions:

The minor modifications in procedure for collection of diagnostic blood specimens by venipuncture from CLSI H03-A6 document were able to reduce the tourniquet application time. Now the proposed new procedure for collection of diagnostic blood specimens by venipuncture could be considered usefulness and should be put into practice by all quality laboratory managers and/or phlebotomy coordinators to avoid preanalytical errors regard venous stasis and guarantee patient safety.     

Testing Extension Services through AKAP Models

Abstract

Purpose: The aim of the paper is to analyse the attitude of Italian farms in gaining access to agricultural extension services (AES).

Design/methodology/approach: The ways Italian farms use AES are described through the AKAP (Awareness, Knowledge, Adoption, Product) sequence. This article investigated the AKAP sequence by submitting a questionnaire to a sample of Italian farms, providing questions on each step of the sequence.

Findings: The results confirm the validity of the model and the necessity to evaluate AES in each phase of the sequence, through an in-depth analysis of the possible motivation for not adopting them.

Practical implications: The functional repositioning of agriculture redefines the role of the farm, by introducing new possibilities of production and by fostering multifunctional activities. In this context, new tasks for AES emerge, aiming at sustaining farm development along either sectorial or territorial paths. Difficulties in adopting AES call for both fostering higher levels of access to services on behalf of farms and the adequate supply of services to farms' new needs.

Originality/value: AKAP models have been prevailingly used in developing countries to evaluate the efficacy of extension in increasing agricultural productivity. This article demonstrates how this model could be of help in developed agriculture too in performing new lines of development rooted in the new models of multifunctional agriculture.     

Cycling shoe aerodynamics

The present paper describes the activity carried out to investigate the aerodynamic effects of cycling shoes for time trial competitions. This subject has not been widely studied but can be important for an accurate aerodynamic optimisation of a time trial cyclist. The study was carried out by means of wind tunnel testing: an appropriate test setup and an appropriate test procedure (based on “effective angle of attack approach”) were developed in order to produce realistic test conditions. The developed testing procedure was applied to two different shoe models, differently fastened. Furthermore, an important point was the investigation of the overshoe effect. The results showed that the power required to overcome the shoe’s drag is almost a tenth of the total power and that differences between the shoes can affect the cyclist’s performance.     

Swelling damage in clay-rich sandstones used in the church of San Mateo in Tarifa (Spain)

This study shows that the sandstone used in the construction of the Church of San Mateo in Tarifa (Cádiz, Spain) is highly sensitive to processes of decay because of a combination of factors that are intrinsic and extrinsic to the material. The mineralogy, texture and porous system of the sandstone and the proximity of the church to the sea all play a part in these processes. X-ray diffraction reveals that there are interstratified chlorite/smectite clays among the minerals that make up the rock. These mixed layer clays have been shown to undergo hydric expansion. This phenomenon may be accompanied and augmented by the presence of NaCl which acts as an electrolyte in osmotic swelling processes. Two varieties of sandstone were used in the construction of the church, namely grey sandstone and brown sandstone. The latter is more porous and undergoes greater hydric expansion, showing a higher degree of deterioration. Ultrasound analysis has demonstrated that both varieties are anisotropic because they contain bedding planes and are affected by the preferred orientation of the phyllosilicates in the rock. The anisotropic nature of these stones was confirmed by capillary suction tests. The capillary front reaches a relatively low height which means that when water is absorbed, the anisotropic textural properties combined with the presence of chlorite–smectite mixed layers in the sandstone result in mechanical (shear) stress between the first few centimetres of the wet stone and the dry area behind. The latter effect favours the development of flakes, so causing the decay of the ornamental stone and the church façade.     

Impact of the phlebotomy training based on CLSI/NCCLS H03-A6 - procedures for the collection of diagnostic blood specimens by venipuncture.

Introduction:

The activities involving phlebotomy, a critical task for obtaining diagnostic blood samples, are poorly studied as regards the major sources of errors and the procedures related to laboratory quality control. The aim of this study was to verify the compliance with CLSI documents of clinical laboratories from South America and to assess whether teaching phlebotomists to follow the exact procedure for blood collection by venipuncture from CLSI/NCCLS H03-A6 - Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture might improve the quality of the process.

Materials and methods:

A survey was sent by mail to 3674 laboratories from South America to verify the use of CLSI documents. Thirty skilled phlebotomists were trained with the CLSI H03-A6 document to perform venipuncture procedures for a period of 20 consecutive working days. The overall performances of the phlebotomists were further compared before and after the training program.

Results:

2622 from 2781 laboratories that did answer our survey used CLSI documents to standardize their procedures and process. The phlebotomists’ training for 20 days before our evaluation completely eliminated non-conformity procedures for: i) incorrect friction of the forearm, during the cleaning of the venipuncture site to ease vein location; ii) incorrect sequence of vacuum tubes collection; and iii) inadequate mixing of the blood in primary vacuum tubes containing anticoagulants or clot activators. Unfortunately the CLSI H03-A6 document does not caution against both unsuitable tourniquet application time (i.e., for more than one minute) and inappropriate request to clench the fist repeatedly. These inadequate procedures were observed for all phlebotomists.

Conclusion:

We showed that strict observance of the CLSI H03-A6 document can remarkably improve quality, although the various steps for collecting diagnostic blood specimens are not a gold standard, since they may still permit errors. Tourniquet application time and forearm clench should be verified by all quality laboratory managers in the services. Moreover, the procedure for collecting blood specimens should be revised to eliminate this source of laboratory variability and safeguard the quality.     

pH controlled staining of CD4+ and CD19+ cells within functionalized microfluidic channel

Herein proposed is a simple system to realize hands-free labeling and simultaneous detection of two human cell lines within a microfluidic device. This system was realized by novel covalent immobilization of pH-responsive poly(methacrylic acid) microgels onto the inner glass surface of an assembled polydimethylsiloxane/glass microfluidic channel. Afterwards, selected thiophene labeled monoclonal antibodies, specific for recognition of CD4 antigens on T helper/inducer cells and CD19 antigens on B lymphocytes cell lines, were encapsulated in their active state by the immobilized microgels. When the lymphocytes suspension, containing the two target subpopulations, was flowed through the microchannel, the physiological pH of the cellular suspension induced the release of the labeled antibodies from the microgels and thus the selective cellular staining. The selective pH-triggered staining of the CD4- and CD19-positive cells was investigated in this preliminary experimental study by laser scanning confocal microscopy. This approach represents an interesting and versatile tool to realize cellular staining in a defined module of lab-on-a-chip devices for subsequent detection and counting.     

Hierarchical web resources retrieval by exploiting Fuzzy Formal Concept Analysis

In recent years, knowledge structuring is assuming important roles in several real world applications such as decision support, cooperative problem solving, e-commerce, Semantic Web and, even in planning systems. Ontologies play an important role in supporting automated processes to access information and are at the core of new strategies for the development of knowledge-based systems. Yet, developing an ontology is a time-consuming task which often needs an accurate domain expertise to tackle structural and logical difficulties in the definition of concepts as well as conceivable relationships. This work presents an ontology-based retrieval approach, that supports data organization and visualization and provides a friendly navigation model. It exploits the fuzzy extension of the Formal Concept Analysis theory to elicit conceptualizations from datasets and generate a hierarchy-based representation of extracted knowledge. An intuitive graphical interface provides a multi-facets view of the built ontology. Through a transparent query-based retrieval, final users navigate across concepts, relations and population.     

Correlation Between Organizational Culture and Compensation Strategies Using Charles Handy's Typology

Alignment between management strategies, policies, and practices with organizational cultures holds great potential to meet the challenges of retaining professionals and maintaining their commitment. In this article, authors consider that when it is aligned with company strategy, compensation acts as an incentive for developing common visions within organizational culture.     

Evaluation of sample hemolysis in blood collected by S-Monovette? using vacuum or aspiration mode

Background:

In vitro hemolysis can be induced by several biological and technical sources, and may be worsened by forced aspiration of blood in vacuum tubes. This study was aimed to compare the probability of hemolysis by drawing blood with a commercial evacuated blood collection tube, and S-Monovette used either in the “vacuum” or “aspiration” mode.

Materials and methods:

The study population consisted in 20 healthy volunteers. A sample was drawn into 4.0 mL BD Vacutainer serum tube from a vein of one upper arm. Two other samples were drawn with a second venipuncture from a vein of the opposite arm, into 4.0 mL S-Monovette serum tubes, by both vacuum an aspiration modes. After separation, serum potassium, lactate dehydrogenase (LD) and hemolysis index (HI) were tested on Beckman Coulter DxC.

Results:

In no case the HI exceed the limit of significant hemolysis. As compared with BD Vacutainer, no significant differences were observed for potassium and LD using S-Monovette with vacuum method. Significant increased values of both parameters were however found in serum collected into BD Vacutainer and S-Monovette by vacuum mode, compared to serum drawn by S-Monovette in aspiration mode. The mean potassium bias was 2.2% versus BD Vacutainer and 2.4% versus S-Monovette in vacuum mode, that of LD was 2.7% versus BD Vacutainer and 2.1% versus S-Monovette in vacuum mode. None of these variations exceeded the allowable total error.

Conclusions:

Although no significant macro-hemolysis was observed with any collection system, the less chance of producing micro-hemolysis by S-Monovette in aspiration mode suggest that this device may be used when a difficult venipuncture combined with the vacuum may increase the probability of spurious hemolysis.