Michael A. Noble

Epidemiology and clinical features associated with Blastocystis hominis infection.

A retrospective chart review was performed on 100 patients infected with Blastocystis hominis (Bh) and 50 randomly selected age and sex matched controls to examine the clinical and epidemiologic features associated with this organism. The finding of greater than 5 Bh per oil immersion field (1,000 X) was significantly associated with acute presentation of symptoms but was not predictive of the presence of gastrointestinal symptoms. Of patients infected with Bh, 57.5% had recently travelled to the tropics or had consumed untreated water as compared to 12.2% of controls (p less than 0.001). Forty Bh-positive patients were assessed on more than one occasion. No significant differences appeared to exist in the clinical responses of those treated with Metronidazole (14/18; 77.8%) or with dietary management (6/6; 100%) as compared with those not receiving treatment (13/16:81.2%). Patients tended to become less symptomatic with time and in the absence of specific treatment, and therefore treatment with Metronidazole may not be warranted in light of the natural history of Bh infection.

Lack of evidence for Mycobacterium avium subspecies paratuberculosis in Crohn's disease

collagenous colitis is a relatively ‘‘new’’disease, long-term follow-up studies are very limited, and it may be too early yet to appreciate a specific relationship with lymphoproliferative disorders. Similarly, the risk of different malignancies in lymphocytic colitis, another type of ‘‘microscopic’’ colitis, is unknown. Given the linkage of collagenous colitis with celiac disease, genetic and/or environmental factors may directly or indirectly modulate shared immune mechanisms that permit predisposition to lymphoproliferative disease. Additional long-term follow-up studies are needed to define if this relationship can be confirmed.

Inhibition of human neutrophil bacteriocidal activity by extracellular substance from slime-producing Staphylococcus epidermidis

The role of slime produced by Staphylococcus epidermidis as a virulence factor has been investigated by preincubating human neutrophils in fractions of extracellular material from cultures of slime-producing and non-slime-producing S. epidermidis. Extracellular product (molecular weight greater than 300,000) from slime-producing S. epidermidis did not affect neutrophil phagocytosis but did produce a generalized loss of bacteriocidal activity which was not found with non-slime-producing S. epidermidis, or broth.

Coordinated Response to SARS, Vancouver, Canada

Two Canadian urban areas received travelers with severe acute respiratory syndrome (SARS) before the World Health Organization issued its alert. By July 2003, Vancouver had identified 5 cases (4 imported); Toronto reported 247 cases (3 imported) and 43 deaths. Baseline preparedness for pandemic threats may account for the absence of sustained transmission and fewer cases of SARS in Vancouver.

Arcanobacterium hemolyticum infection: Confused with scarlet fever and diphtheria

Arcanobacterium hemolyticum infections are a common cause of pharyngitis and rash in the 10- to 30-year-old age group. Despite its prevalence, many emergency and primary care physicians may not be aware of the pathogenic potential of this organism. We present a case that illustrates the distinctive clinical spectrum of A. hemolyticum infections that may be confused with drug allergy, group A streptococcal scarlet fever, diphtheria, and even toxic shock syndrome. Recognition of this syndrome will reduce misdiagnoses and facilitate appropriate treatment.

Does external evaluation of laboratories improve patient safety

Abstract Laboratory accreditation and External Quality Assessment (also called proficiency testing) are mainstays of laboratory quality assessment and performance. Both practices are associated with examples of improved laboratory performance. The relationship between laboratory performance and improved patient safety is more difficult to assess because of the many variables that are involved with patient outcome. Despite this difficulty, the argument to continue external evaluation of laboratories is too compelling to consider the alternative. Clin Chem Lab Med 2007;45:753–5.

Medical laboratory associated errors: the 33-month experience of an on-line volunteer Canadian province wide error reporting system

Abstract Background: This article reports on the findings of 12,278 laboratory related safety events that were reported through the British Columbia Patient Safety & Learning System Incident Reporting System. Methods: The reports were collected from 75 hospital-based laboratories over a 33-month period and represent approximately 4.9% of all incidents reported. Results: Consistent with previous studies 76% of reported incidents occurred during the pre-analytic phase of the laboratory cycle, with twice as many associated with collection problems as with clerical problems. Eighteen percent of incidents occurred during the post-analytic reporting phase. The remaining 6% of reported incidents occurred during the actual analytic phase. Examination of the results suggests substantial under-reporting in both the post-analytic and analytic phases. Of the reported events, 95.9% were reported as being associated with little or no harm, but 0.44% (55 events) were reported as having severe consequences. Conclusions: It is concluded that jurisdictional reporting systems can provide valuable information, but more work needs to be done to encourage more complete reporting of events.

Making great strides in medical laboratory quality : editorial

Whilst the observation of blood and urine as a commentary of illness and disease can be traced back to Hippocrates as early as 300 BC, the true roots and foundations of the modern medical laboratory as a vital investigation process to better understand pathology and diagnosis were established in the late-19th and early-20th centuries. Modern day laboratory tests have become the cornerstone for objective data collection to assist, affirm and document diagnoses rather than depending on anecdotal and subjective opinion. Use of highly-crafted optical lenses made microscopic examination of urine, sputum, blood and spinal fluid achievable. Microbiology techniques for blood and sputum culture made the diagnosis of tuberculosis, diphtheria and typhoid both possible and documentable. Examination for bilirubinaemia and abnormal glucose levels also became feasible. The first hospital laboratories were established in London (Guys Hospital) and Baltimore (Johns Hopkins Hospital) and, by the early 20th century, laboratories began to become a permanent part of the infrastructure of hospitals.

Making progress in implementing quality in Canadian medical laboratories.

Laboratory errors happen and they happen in all laboratories everywhere. It is in the nature of the types of samples with which we work, how they are collected, the types of tests that we perform, and how and when we report the results. Some laboratories have more errors than others, sometimes with unfortunate consequences. Medical laboratories may not be able to prevent all errors, but they can reduce their occurrence, detected and remediate them sooner, and reduce the likelihood of experiencing the same error over and over again. They do that by adopting and embracing a functional Quality Management System (QMS), which includes both internal quality monitoring and external assessment activities, including proficiency testing and accreditation. Around the world there are a number of quality systems that laboratories can adopt, but since 2003, the single most adopted approach has been the International Organization for Standardization (ISO) 15189, Medical Laboratories Requirements for Quality and Competence. Now in its third iteration, ISO15189:2012 has been implemented in over 80 countries [1]. Canadians can be particularly proud of their role in the development of ISO15189:2012. With the support and assistance of Standards Council of Canada, and Canadian Standards Association, and countless hours of volunteer time by committed laboratorians from all regions of Canada, Canada has played a central role in the creation and development of this international standard from its inaugural meeting in 1994 through 2013. It has been adopted as aNational Standard of Canada since 2004 [2]. It is said that the nature of our Canadian political structure makes laboratory quality solely a provincial jurisdiction. While this may be correct within the political context, I argue that this impedes the development of a national strategy for medical laboratory quality. Other countries, such as the United States have similar jurisdictional issues, and yet were able to find a way to develop a consistent minimum requirement for medical laboratory quality through national regulation (Clinical Laboratory Improvement Act 1988). Significantly Canada has developed a consistent national structure for hospital accreditation by near complete voluntary participation through the organization now referred to as Accreditation Canada. So it would seem to be a logical extension that political barriers to a harmonized Canadianmedical laboratory quality system can and should be overcome. Canadian provinces jealously safeguard their jurisdictional rights, and while there are many areas of collaboration, there are others where the extent of cooperation has its limits. With regret, such is the case with respect to medical laboratory quality and accreditation. Medical laboratory quality has not always been uniformly embraced by Canadian laboratories. Some provinces, particularly in Western Canada were early adopters of accreditation supported quality during the 1970s [3], but other provinces were much slower to implement laboratory accreditation as a mandated norm. Ontario and Quebec

Laboratory error reporting rates can change significantly with year-over-year examination

Abstract Background: Incident reporting systems are useful tools to raise awareness of patient safety issues associated with healthcare error, including errors associated with the medical laboratory. Methods: Previously, we presented the analysis of data compiled by the British Columbia Patient Safety & Learning System over a 3-year period. A second comparable set was collected and analyzed to determine if reported error rates would tend to remain stable or change. Results: Compared to the original set, the second set presented changes that were both materially and statistically significant. Overall, the total number of reports increased by 297% with substantial changes between the pre-examination, examination and post-examination phases (χ2: 993.925, DF=20; p<0.00001). While the rate of change for pre-examination (clerical and collection) errors were not significantly different than the total year results, the rate of change for reporting examination errors rose by 998%. While the exact reason for dramatic change is not clear, possible explanations are provided. Conclusions: Longitudinal error rate tracking is a useful approach to monitor for laboratory quality improvement.