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Over the last decades, the use of artificial intelligence, machine learning and deep learning in medical fields has skyrocketed. Well known for their results in segmentation, motion management and posttreatment outcome tasks, investigations of machine learning and deep learning models as fast dose calculation or quality assurance tools have been present since 2000. The main motivation for this increasing research and interest in artificial intelligence, machine learning and deep learning is the enhancement of treatment workflows, specifically dosimetry and quality assurance accuracy and time points, which remain important time-consuming aspects of clinical patient management. Since 2014, the evolution of models and architectures for dose calculation has been related to innovations and interest in the theory of information research with pronounced improvements in architecture design. The use of knowledge-based approaches to patient-specific methods has also considerably improved the accuracy of dose predictions. This paper covers the state of all known deep learning architectures and models applied to external radiotherapy with a description of each architecture, followed by a discussion on the performance and future of deep learning predictive models in external radiotherapy.
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Aprendizaje Profundo , Dosificación Radioterapéutica , Humanos , Planificación de la Radioterapia Asistida por Computador/métodos , Neoplasias/radioterapia , Radioterapia/métodos , Inteligencia ArtificialRESUMEN
The radiation therapy quality assurance of clinical trials is internationally recognized as a key factor to control the quality of radiotherapy for its impact on clinical trial's goals. Quality assessment may be performed at different levels and by different means, which are now quite standardized. The optimal radiation therapy quality assurance of clinical trials trade-off to maintain accrual rates, radiotherapy quality and optimize clinical trial research processes is yet to be defined. This article addresses current definitions, processes, limitations and directions.
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Garantía de la Calidad de Atención de Salud , Oncología por Radiación , Humanos , Ensayos Clínicos como AsuntoRESUMEN
PURPOSE: Adaptive radiotherapy with the Ethos® therapy Varian system has been recently implemented at the Montpellier Cancer Institute, France. This article details the commissioning performed before the implementation of this new treatment planning system (TPS). MATERIAL AND METHODS: To validate the golden beam data of the machine (Halcyon linear accelerator), percentage depth doses (PDD) and profiles were measured for several field sizes and at different depths with a microdiamond chamber. The final doses calculated for different plan types with the Ethos Acuros XB algorithm and the Halcyon Eclipse Analytic Anisotropic Algorithm were compared using the gamma index method. Lastly, for the patient quality assurance (QA) process, the patient treatment plan results obtained with the Mobius3D QA platform (Varian) were compared with the portal dosimetry results obtained with Epiqa (Epidos). RESULTS: Minor differences were observed for the PDD and profile curves (mean difference of 0.2% and 2%, respectively). The χ index pass rate was above 98% for all measures using the 1%/1mm and 2%/2mm criteria for PDD and profile evaluations. The Ethos AXB algorithm was validated for every configuration (fixed fields, standard IMRT and VMAT fields, and clinical plans) with 2D/3D gamma index values>99%. Seventy-three 3-arcs-VMAT QA plans and 27 9-fields-IMRT QA plans were evaluated. Both showed excellent agreement with the TPS calculations (mean gamma pass rate higher than 99%). No difference was observed between IMRT and VMAT. CONCLUSION: The beam delivery, the Ethos AXB algorithm, and the patient QA were comprehensively validated using independent tools.
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Planificación de la Radioterapia Asistida por Computador , Radioterapia de Intensidad Modulada , Humanos , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador/métodos , Radiometría , Algoritmos , Aceleradores de PartículasRESUMEN
Quality assurance for radiotherapy of a clinical trial is an important step from the design of the clinical trial. A precise definition of quality assurance must be given in detail in the clinical protocol of the clinical trial. By its implementation, quality assurance allows a homogeneity of the clinical trial, which can lead to a reduction of the biases of results interpretation for the clinical trial. The complexity of the radiotherapy to be carried out within the framework of the clinical trial can induce a gradation for the radiotherapy quality assurance program of the trial. However, the following steps are always present and must be described either directly in the clinical protocol or in a specific chapter, radiotherapy quality assurance, of the clinical protocol. The detailed characteristics of the medical imaging required to prepare for the treatment, the delineation of the targets and organs at risk, the requirements related to the planning, the treatment itself, possibly including the positioning repositioning control images, of the patient. For the delineation and planning stages, it is common to set up benchmarking based on test cases (dummy run, dry run). Their validation makes it possible for the center to get credentials for the clinical trial. Some trials can provide for an additional quality assurance point, such End-to-End test for which the investigating center must carry out, according to the clinical protocol, the preparation, the planning, the treatment on an anthropomorphic test object containing models of targets, organs at risk as well as dosimeters. Quality assurance of radiotherapy in clinical research is an essential part to be taken into account from the design of the clinical study. The commitment of the investigating center in terms of human and material resources in compliance with the protocol and in the quality assurance of the trial constitute a guarantee of limitation of the biases for the study and its interpretation, facilitating the answer of the scientific question asked by the trial.
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Garantía de la Calidad de Atención de Salud , Radioterapia , Ensayos Clínicos como Asunto , HumanosRESUMEN
Although certification in France is at the health establishment level, maternity wards are directly and indirectly concerned by the certification of their establishment. The purpose of this article is to help perinatal caregivers in maternity wards to prepare, as well as possible, for the certification visit of their establishment. The 7 stages of preparation for the visit are explained with concrete examples from the Haute Autorité de santé (HAS) certification guide. With good organization, the certification visit can go stress-free and professionals will be ready to meet HAS experts.
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Certificación , Hospitales , Femenino , Francia , Humanos , EmbarazoRESUMEN
OBJECTIVES: The objective of this study was to assess the value of applying operating principles for High Reliability Organizations (HROs) to Assisted Reproductive Technology (ART) centres in order to optimise their operation and results. METHODS: Two exploratory qualitative case studies, in the form of ethnographic observations, were conducted in two public hospitals (Antoine-Béclère Hospital, Clamart and Nantes University Hospital). The studies analysed the structural and functional characteristics of these centres compared to HROs. Specific interviews, based on the HRO model from Roberts and Rousseau (1989), were also carried out. RESULTS: The in vitro fertilisation (IVF) procedure is comprised of a sequence of steps for which success depends on the cooperation of a range of medical staff across various specialties. Patients themselves must also play an active part in the protocol. From the different points analysed, the comparison between the characteristics of IVF activity at the ART units and those of HROs reveals structural and functional similarities, however there are also cultural differences. CONCLUSION: The study concluded that ART centres are complex healthcare organisations that face similar challenges to HROs and that they could improve their operational performance by adopting an HRO culture. To confirm the interest of this strategy, it would be useful to clarify these preliminary results by extending the exploratory study to include several public and private ART centres, and to explore the patient/couple dimension before initiating an interventional study.
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Organizaciones de Alta Confiabilidad , Técnicas Reproductivas Asistidas , Fertilización In Vitro , Humanos , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: A Benchmark Case (BC) was performed as part of the quality assurance process of the randomized phase 2 GORTEC 2014-14 OMET study, testing the possibility of multisite stereotactic radiation therapy (SBRT) alone in oligometastatic head and neck squamous cell carcinoma (HNSCC) as an alternative to systemic treatment and SBRT. MATERIAL AND METHODS: Compliance of the investigating centers with the prescription, delineation, planning and evaluation recommendations available in the research protocol was assessed. In addition, classical dosimetric analysis was supplemented by quantitative geometric analysis using conformation indices. RESULTS: Twenty centers participated in the BC analysis. Among them, four major deviations (MaD) were reported in two centers. Two (10%) centers in MaD had omitted the satellite tumor nodule and secondarily validated after revision. Their respective DICE indexes were 0.37 and 0 and use of extracranial SBRT devices suboptimal There were significant residual heterogeneities between participating centers, including those with a similar SBRT equipment, with impact of plan quality using standard indicators and geometric indices. CONCLUSION: A priori QA using a BC conditioning the participation of the clinical investigation centers showed deviations from good SBRT practice and led to the exclusion of one out of the twenty participating centers. The majority of centers have demonstrated rigorous compliance with the research protocol. The use of quality indexes adds a complementary approach to improve assessment of plan quality.
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Benchmarking , Neoplasias de Cabeza y Cuello/radioterapia , Radiocirugia/normas , Carcinoma de Células Escamosas de Cabeza y Cuello/radioterapia , Francia , Neoplasias de Cabeza y Cuello/patología , Humanos , Metástasis de la Neoplasia/radioterapia , Órganos en Riesgo , Neoplasias Faríngeas/patología , Neoplasias Faríngeas/radioterapia , Garantía de la Calidad de Atención de Salud , Radiometría , Radiocirugia/instrumentación , Radiocirugia/métodos , Dosificación Radioterapéutica , Carcinoma de Células Escamosas de Cabeza y Cuello/secundarioRESUMEN
In radiotherapy, patient-specific quality assurance is very time-consuming and causes machine downtime. It consists of testing (using measurement with a phantom and detector) if a modulated plan is correctly delivered by a treatment unit. Artificial intelligence and in particular machine learning algorithms were mentioned in recent reports as promising solutions to reduce or eliminate the patient-specific quality assurance workload. Several teams successfully experienced a virtual patient-specific quality assurance by training a machine learning tool to predict the results. Training data are generally composed of previous treatment plans and associated patient-specific quality assurance results. However, other training data types were recently introduced such as actual positions and velocities of multileaf collimators, metrics of the plan's complexity, and gravity vectors. Different types of machine learning algorithms were investigated (Poisson regression algorithms, convolutional neural networks, support vector classifiers) with sometimes promising results. These tools are being used for treatment units' quality assurance as well, in particular to analyse the results of imaging devices. Most of these reports were feasibility studies. Using machine learning in clinical routines as a tool that could fully replace quality assurance tests conducted by physics teams has yet to be implemented.
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Inteligencia Artificial , Garantía de la Calidad de Atención de Salud/métodos , Radioterapia/normas , Algoritmos , Estudios de Factibilidad , Humanos , Aprendizaje Automático , Redes Neurales de la Computación , Fantasmas de Imagen , Distribución de Poisson , Carga de TrabajoRESUMEN
The point-of-care tests (POCT) are subject to accreditation. A national inventory survey provides a synthesis of knowledge. The survey distributed 31 questions in 2019. 147 responses were received (75% biologists, 49% CHU, 42% CHG). Only 20.41% are accredited ISO22870, the majority for <50% of the medical departments; 70% say they are going there at the end of 2019 or in 2020. The maps are unknown for 32% (EBMD) and 82% (TROD). Visibility is poor with: medical establishment committee (40%), IT department (31%). Connection is necessary for 87-95% depending on the criterion (QC, authorizations, etc.) and 66% of answers highlight that less than 50% of connexion is effective. The major advantage is the delay of the result (62.5%), then the relationship with the health teams (33.3%). The disadvantages: difficulty of the quality approach (45%), cost of tests (34.3%). Human resource requirements are identified for technicians (82%) and biologists (76%). The multiplicity of sites, devices and operators means that it is difficult to set up and maintain. Biology outside the laboratories, under biological responsibility, must meet a rigorous imperative quality approach.
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Técnicas de Laboratorio Clínico , Salud Global , Laboratorios/estadística & datos numéricos , Laboratorios/normas , Pruebas en el Punto de Atención , Acreditación , COVID-19 , Prueba de COVID-19 , Servicios de Laboratorio Clínico/normas , Servicios de Laboratorio Clínico/estadística & datos numéricos , Técnicas de Laboratorio Clínico/normas , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Francia/epidemiología , Salud Global/normas , Salud Global/estadística & datos numéricos , Historia del Siglo XXI , Humanos , Internacionalidad , Ensayos de Aptitud de Laboratorios/normas , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Sistemas de Atención de Punto/normas , Sistemas de Atención de Punto/estadística & datos numéricos , Pruebas en el Punto de Atención/organización & administración , Pruebas en el Punto de Atención/normas , Pruebas en el Punto de Atención/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud/organización & administración , Encuestas y CuestionariosRESUMEN
INTRODUCTION: The extent to which Swiss veterinary practitioners follow the guidelines for quality assurance of the American Society for Veterinary Clinical Pathology (ASVCP) for point-of-care (POC) testing is unknown. Thus, the aim of this study was to assess the availability, application, and quality management of POC analyzers in Swiss veterinary practices/clinics. For this purpose, we created an online questionnaire on laboratory equipment, quality management, and biosafety, which all members of the Society of Swiss Veterinarians (GST) were invited to complete. In total, 192 clinics/practices participated, of which 69% had automated POC analyzers, mainly for clinical chemistry (99%) and/or hematology (86%). Sample analyses and equipment maintenance were mostly performed by veterinary technicians (81% and 68%, respectively). Reference intervals were adopted from manufacturers (80%) or literature (17%). The results showed that most participants perform basic internal quality control (chemistry: 75%; hematology: 86%), and many use at least two levels of quality control material (47%-48%). Controls are mostly run once a month (chemistry: 36%; hematology: 35%) or ≤4 times/year (36% and 25%). Only three clinics/practices reported participation in an external quality assessment program; comparative testing was more common (chemistry: 42%; hematology: 52%). Only one-quarter of the participants stated that they make use of the data generated through internal and external quality control measures. In conclusion, POC analyzers are widely available in Swiss veterinary clinics/practices, and internal quality control is performed to some extent. However, quality assessment and management and biosafety awareness and measures need to be improved, ideally with the support of clinical pathologists.
INTRODUCTION: On ignore dans quelle mesure les vétérinaires suisses respectent les directives d'assurance qualité de l'American Society for Veterinary Clinical Pathology (ASVCP) pour les tests au point de service (Point of Care, POC). Ainsi, l'objectif de cette étude était d'évaluer la disponibilité, l'application et la gestion de la qualité des analyseurs POC dans les cabinets/cliniques vétérinaires suisses. À cette fin, nous avons créé un questionnaire en ligne sur les équipements de laboratoire, la gestion de la qualité et la biosécurité que tous les membres de la Société suisse des vétérinaires (GST) ont été invités à remplir. Au total, 192 cliniques/cabinets ont participé, dont 69% avaient des analyseurs POC automatisés, principalement pour la chimie clinique (99%) et/ou l'hématologie (86%). Les analyses des échantillons et la maintenance de l>équipement ont été principalement effectuées par des assistant(e)s en médecine vétérinaires (81% et 68%, respectivement). Les intervalles de référence ont été fixés sur la base des indications des fabricants (80%) ou de la littérature (17%). Les résultats ont montré que la plupart des participants effectuent un contrôle de qualité interne de base (chimie: 75%; hématologie: 86%) et que beaucoup utilisent au moins deux niveaux de matériel de contrôle de la qualité (47% 48%). Les contrôles sont principalement effectués une fois par mois (chimie: 36%; hématologie: 35%) ou ≤4 fois / an (36% et 25%). Seules trois cliniques/cabinets ont déclaré avoir participé à un programme externe d'évaluation de la qualité. Les tests comparatifs étaient plus courants (chimie: 42%; hématologie: 52%). Un quart seulement des participants ont déclaré utiliser les données générées par des mesures de contrôle de qualité internes et externes. En conclusion, les analyseurs POC sont largement disponibles dans les cliniques/cabinets vétérinaires suisses et le contrôle qualité interne est effectué dans une certaine mesure. Cependant, l'évaluation et la gestion de la qualité ainsi que la sensibilisation et les mesures en matière de biosécurité doivent être améliorées, idéalement avec le soutien de pathologistes cliniciens.
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Hospitales Veterinarios/estadística & datos numéricos , Laboratorios/estadística & datos numéricos , Laboratorios/normas , Pruebas en el Punto de Atención/estadística & datos numéricos , Animales , Hospitales Veterinarios/normas , Pruebas en el Punto de Atención/normas , SuizaRESUMEN
Intensity modulated radiotherapy combined with image guided radiotherapy has led to increase the precision of external beam radiotherapy. However, intra or inter-fraction anatomical variations are frequent during the treatment course and can cause under-dosing of the target volume and/or over-dosing of the organs at risk. Several adaptive radiotherapy (ART) strategies can be defined to compensate these anatomical variations. The purpose of this article is to provide an overview of available ART strategies: offline, online, hybrid (library of treatment plans) or in real-time, while considering the arrival of MR-Linac devices in radiotherapy departments. The tools required to these ART strategies such as auto-segmentation, deformable image registration, calculation of the daily dose or dose accumulation, are also described. Implementing an ART strategy requires a rigorous quality assurance process, at each stage and on the entire workflow, as well as prior organization and training from of all the trades. A strong multidisciplinary involvement is finally required in order to ensure ART treatments.
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Órganos en Riesgo/efectos de la radiación , Garantía de la Calidad de Atención de Salud , Traumatismos por Radiación/prevención & control , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia Guiada por Imagen/métodos , Radioterapia de Intensidad Modulada/métodos , Tomografía Computarizada de Haz Cónico/métodos , Humanos , Neoplasias/diagnóstico por imagen , Neoplasias/patología , Neoplasias/radioterapia , Dosificación Radioterapéutica , Radioterapia de Alta Energía , Radioterapia Guiada por Imagen/instrumentación , Radioterapia de Intensidad Modulada/instrumentaciónRESUMEN
Unregulated supply of medicines compromises quality assurance and risks patient safety. The emergence of illegal medicines trafficking in Morocco presents a major health threat, which highlights the need for region-wide alignment in policies to drive stringent regulatory enforcement and robust health systems that ensure population- wide access to safe medicines. Herein, we draw on insights from a situational analysis in Morocco, as a lower- middle income setting, to present access to medicines through regulated supply procedures as a vital prerequisite for quality assurance and patient safety.
L'approvisionnement non réglementé en médicaments compromet l'assurance qualité et la sécurité des patients. L'émergence du trafic illégal de médicaments au Maroc constitue une menace majeure pour la santé, ce qui souligne la nécessité d'un alignement régional des politiques pour une application stricte de la réglementation et des systèmes de santé robustes garantissant l'accès de la population à des médicaments sûrs. Nous nous inspirons d'une analyse situationnelle menée au Maroc, en tant que pays à revenu moyen-inférieur, pour présenter l'accès aux médicaments par le biais de procédures d'approvisionnement réglementées, prérequis indispensable à l'assurance qualité et à la sécurité des patients.
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Medicamentos Falsificados , Accesibilidad a los Servicios de Salud/economía , Medicamentos bajo Prescripción/economía , Humanos , Marruecos , Seguridad del PacienteRESUMEN
OBJECTIVES: To introduce the Laboratory Quality Stepwise Implementation (LQSI) tool and provide data about its roll-out, usage and effectiveness in assisting laboratories with quality improvement. METHODS: The LQSI tool, a freely available stepwise guide, was developed by WHO to assist laboratories with efficiently implementing a quality management system. RESULTS: Since the tool's launch in 2014, it has been accessed by 130 986 unique users from 195 of 206 listed states. Of 35 respondents to a survey, 12 (34%) indicated that their laboratory had been able to achieve accreditation/certification/licensing as a result of using the tool. CONCLUSIONS: The LQSI tool, currently being used worldwide and available in English, French, Russian, Spanish, Arabic and Turkish, positively impacts the quality of services provided by clinical and public health laboratories, leading to improved clinical care and disease surveillance capacity as required by the IHR (2005) and envisioned by the Global Health Security Agenda.
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Laboratorios/normas , Control de Calidad , Mejoramiento de la Calidad , Organización Mundial de la Salud , HumanosRESUMEN
The surgical hand disinfection by friction (SDF) helps to reduce the risk of surgical site infections. For this purpose and in order to promote good compliance to quality care, the urology service of Centre Hospitalier Lyon Sud achieved a continuous internal audit to improve the quality of the SDF. METHODS: An internal audit executed by the medical students of urology was established in 2013. The study population was all operators, instrumentalists and operating aids of urology operating room (OR). Each student realized 5-10 random observations, of all types of professionals. The criteria measured by the audit were criteria for friction. RESULTS: The evolution of indicators was positive. Particularly, the increasing duration of the first and second friction was statistically significant during follow-up (P=0.001). The total duration of friction shows a similar trend for all professionals. CONCLUSION: The surgical hand disinfection by friction in the urology OR of the Centre Hospitalier Lyon Sud has gradually improved over the iterative audits.
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Desinfección de las Manos/normas , Auditoría Médica , Quirófanos/normas , Procedimientos Quirúrgicos Urológicos/normas , Humanos , Indicadores de Calidad de la Atención de SaludRESUMEN
OBJECTIVE: To present the findings of the Pan American Health Organization's 2014 survey on syphilis testing policies and practices in the Americas. METHODS: Representatives of national/regional reference and large, lower-level laboratories from 35 member states were invited to participate. A semi-structured, electronically administered questionnaire collected data on syphilis tests, algorithms, equipment/commodities, challenges faced and basic quality assurance (QA) strategies employed (i.e. daily controls, standard operating procedures, technician training, participating in external QA programmes, on-site evaluations). RESULTS: The 69 participating laboratories from 30 (86%) member states included 41 (59%) national/regional reference and 28 (41%) lower-level laboratories. Common syphilis tests conducted were the rapid plasma reagin (RPR) (62% of surveyed laboratories), venereal disease research laboratory (VDRL) (54%), fluorescent treponemal antibody absorption (FTA-ABS) (41%) and Treponema pallidum haemagglutination assay (TPHA) (32%). Only three facilities reported using direct detection methods, and 28 (41% overall, 32% of lower-level facilities) used rapid tests. Most laboratories (62%) used only traditional testing algorithms (non-treponemal screening and treponemal confirmatory testing); however, 12% used only a reverse sequence algorithm (treponemal test first), and 14% employed both algorithms. Another nine (12%) laboratories conducted only one type of serologic test. Although most reference (97%) and lower-level (89%) laboratories used at least one QA strategy, only 16% reported using all five basic strategies. Commonly reported challenges were stock-outs of essential reagents or commodities (46%), limited staff training (73%) and insufficient equipment (39%). CONCLUSIONS: Many reference and clinical laboratories in the Americas face challenges in conducting appropriate syphilis testing and in ensuring quality of testing.
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Laboratorios , Control de Calidad , Sífilis/diagnóstico , Treponema pallidum , Algoritmos , Américas , Recursos en Salud , Humanos , Técnicas para Inmunoenzimas , Encuestas y Cuestionarios , Sífilis/microbiología , Serodiagnóstico de la SífilisRESUMEN
French clinical investigation centers (CICs) are academic platforms dedicated to clinical research. The QUALI-CIC working group helps to improve and harmonize practices within the CIC network. After some years of implementation, the manual of good professional practices of CICs (MGPP CIC) completed in 2010, needed to be revised to best fit with the large panel of CIC activities. The aim was also to make it more accurate and to reinforce requirements about participants safety and data security. In its second version published in the present article, the MGPP CIC includes 255 items divided into 15 chapters. An explanatory document, currently being drafted, will complete the manual to facilitate its implementation.
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Centros Médicos Académicos , Investigación Biomédica/normas , Manuales como Asunto , Garantía de la Calidad de Atención de Salud , Francia , HumanosRESUMEN
Adjuvant radiation therapy following breast cancer surgery continues to improve locoregional control and overall survival. But the success of highly targeted-conformal radiotherapy such as intensity-modulated techniques, can be compromised by respiratory motion. The intrafraction motion can potentially result in significant under- or overdose, and also expose organs at risk. This article summarizes the respiratory motion and its effects on imaging, dose calculation and dose delivery by radiotherapy for breast cancer. We will review the methods of respiratory synchronization available for breast radiotherapy to minimize the respiratory impact and to spare organs such as heart and lung.
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Neoplasias de la Mama/radioterapia , Radioterapia de Intensidad Modulada/métodos , Respiración , Contencion de la Respiración , Femenino , Corazón/efectos de la radiación , Humanos , Pulmón/efectos de la radiación , Órganos en Riesgo , Educación del Paciente como Asunto , Selección de PacienteRESUMEN
May-Grünwald-Giemsa (MGG) stain is a Romanowsky-type, polychromatic stain as those of Giemsa, Leishman and Wright. Apart being the reference method of haematology, it has become a routine stain of diagnostic cytopathology for the study of air-dried preparations (lymph node imprints, centrifuged body fluids and fine needle aspirations). In the context of their actions of promoting the principles of quality assurance in cytopathology, the French Association for Quality Assurance in Anatomic and Cytologic Pathology (AFAQAP) and the French Society of Clinical Cytology (SFCC) conducted a proficiency test on MGG stain in 2013. Results from the test, together with the review of literature data allow pre-analytical and analytical steps of MGG stain to be updated. Recommendations include rapid air-drying of cell preparations/imprints, fixation using either methanol or May-Grünwald alone for 3-10minutes, two-step staining: 50% May-Grünwald in buffer pH 6.8 v/v for 3-5minutes, followed by 10% buffered Giemsa solution for 10-30minutes, and running water for 1-3minutes. Quality evaluation must be performed on red blood cells (RBCs) and leukocytes, not on tumour cells. Under correct pH conditions, RBCs must appear pink-orange (acidophilic) or buff-coloured, neither green nor blue. Leukocyte cytoplasm must be almost transparent, with clearly delineated granules. However, staining may vary somewhat and testing is recommended for automated methods (slide stainers) which remain the standard for reproducibility. Though MGG stain remains the reference stain, Diff-Quik(®) stain can be used for the rapid evaluation of cell samples.
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Colorantes , Citodiagnóstico/normas , Eosina Amarillenta-(YS) , Azul de Metileno , Guías de Práctica Clínica como Asunto , Coloración y Etiquetado/métodos , Automatización , Colorantes Azulados , Biología Celular/organización & administración , Colorantes/química , Citodiagnóstico/métodos , Eosina Amarillenta-(YS)/química , Eritrocitos/ultraestructura , Francia , Humanos , Concentración de Iones de Hidrógeno , Leucocitos/ultraestructura , Azul de Metileno/química , Orgánulos/ultraestructura , Garantía de la Calidad de Atención de Salud , Reproducibilidad de los Resultados , Sociedades Científicas , Coloración y Etiquetado/instrumentación , Coloración y Etiquetado/normas , Fijación del Tejido/métodos , XantenosRESUMEN
INTRODUCTION: PostOperative Nausea and Vomiting (PONV)is a major side effect related to surgery and anesthesia. Our institution is equipped with Anesthesia Information Management System (AIMS). We used this database to assess and follow the effect of our quality assurance program for PONV. METHODS: Our AIMS system permits automatic storage of vital signs while other information are indexed by anesthesia providers and PACU personnel. Intra-operative and PACU events were extracted from a database by sequential query language (SQL) interrogation from year 2005 to 2010. A new prophylactic antiemetic protocol was issued for high-risk patients in our institution (dexamethasone, droperidol in the operating room and odansetron in the PACU) and initiated in 2006; in parallel, adjuvant measures influencing PONV were taken for anesthetic interventions. PONV scores and related medications, intra- and postoperative opioids and inhalational anesthetics consumption were extracted, and results were regularly shared with anesthesia providers and PACU personnel as part of quality assurance program. RESULTS: The study concerned 40,045 patients, exhaustivity or completeness was 70% in 2005 but reached 90% in 2010. PONV scores significantly improved during the years after the instauration of the new protocol (31% in 2005 vs. 13% in 2010). Concomitantly, morphine consumption and intra-operative nitrous oxide showed a steady decrease. No significant difference was noticed in the use of inhalational anesthetics. CONCLUSION: Using our AIMS database, we indirectly monitored the effectiveness of our PONV protocol but also other possible component of a multimodal approach toward these side effects.
Asunto(s)
Anestesiología , Antieméticos/administración & dosificación , Sistemas de Información en Hospital , Neoplasias/cirugía , Náusea y Vómito Posoperatorios/prevención & control , Garantía de la Calidad de Atención de Salud , Adulto , Anciano , Anciano de 80 o más Años , Periodo de Recuperación de la Anestesia , Anestésicos/efectos adversos , Dexametasona/administración & dosificación , Droperidol/administración & dosificación , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ondansetrón/administración & dosificación , Náusea y Vómito Posoperatorios/epidemiología , Evaluación de Programas y Proyectos de Salud , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVES: Evaluate the incidence of perinatal mortality and evaluate the percentage of non optimal care management of fatal pregnancies between 2005 and 2011 in the Rhone-Alpes region in France, by the use of the Aurore network. Evaluate the development of morbi-mortality revues (MMR) in this region. METHODS: Retrospective study of perinatal mortality in the Aurore network, from 2005 to 2011. Systematic analysis of care management (adapted, non adapted, non evaluable), of each perinatal death that occurred in the Aurore network, by a multidisciplinary committee during regional MMR. RESULTS: The incidence of perinatal mortality has diminished from 2005 to 2011 (8,4 vs. 6,4, P<0.07) as well as the percentage of non adapted care management (13% vs. 5,6%, P<0.001). An underestimation of irregularities in the fetal heart rate was described in 34% of per partum deaths. The percentage of optimal care management was significantly higher when the obstetrician was in the maternity rather than on call at home (P<0.03) and in type 3 maternities compared to type 1 and 2 maternities (P<0.04). The attendance of the MMR organized in the AURORE network progressed between 2006 and 2011. CONCLUSION: Since 2005, a decrease in perinatal mortality and in non-adapted care management was observed. More studies are necessary to evaluate the link between the development of MMR in this network and the amelioration of these two indicators.