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ACB-CLIN-CHEM-GEN  1999

ACB-CLIN-CHEM-GEN 1999

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Subject:

Remote requesting by clinicians ( was Re: Ward / GP ordering)

From:

Jonathan Kay <[log in to unmask]>

Reply-To:

[log in to unmask][log in to unmask] 5403 219 34_Second Call for Electronic Posters13_John [log in to unmask], 11 Feb 1999 11:28:54 -0000499_iso-8859-1 Second Call for Electronic Posters

There will be two informatics sessions at FOCUS 99.

The first Will be Chaired by John O’Connor on Wednesday 19th of May and will concentrate on the delivery of the electronic pathology report be it to GP’s or Hospital wards and clinics. Particular emphasis will be placed on innovative solutions such as wireless technologies.
The second session will be Chaired by Rick Jones and concentrate on the Electronic Laboratory Handbook. [...]47_11Feb199911:28:[log in to unmask] 5623 74 28_Myoglobin stability in urine16_Sandra [log in to unmask], 11 Feb 1999 22:34:24 +1000529_iso-8859-1 Our current protocol for sample preservation for myoglobin in urine is to add 3 - 4 drops of 1N Sodium Hydroxide to approximately 10 ml urine (this adjusts the pH of the specimen to ~pH 8). The sample need only be kept refrigerated (ie. 4C). We have conducted our own stability studies to show that this procedure is better than simply freezing the urine. My problem is that I can't find the original reference that we adopted this procedure from. Can anyone help with any references with regards to this matter? [...]44_11Feb199922:34:[log in to unmask] 5698 60 28_Sample Packaging - an update20_Dr. Alan L [log in to unmask], 11 Feb 1999 12:02:02 -0500597_us-ascii Packaging requirements for biological samples and, in particular, the
distinction between diagnostic specimens and infectious substances have
recently been the subject of top-level discussions.
I enclose the text of a letter from Martin Castle of Pira, the packaging
industry's research organisation.

"At a meeting at the end of January hosted by DETR and attended by the
Royal Mail, HSE and Pira the problems of packaging and classification of
diagnostic specimens, and their transportation in so-called "UN602"
packagings were discussed. [...]53_11Feb199912:02:[log in to unmask] 5759 75 28_Myoglobin stability in urine16_Sandra [log in to unmask], 12 Feb 1999 07:12:47 +1000529_iso-8859-1 Our current protocol for sample preservation for myoglobin in urine is to add 3 - 4 drops of 1N Sodium Hydroxide to approximately 10 ml urine (this adjusts the pH of the specimen to ~pH 8). The sample need only be kept refrigerated (ie. 4C). We have conducted our own stability studies to show that this procedure is better than simply freezing the urine. My problem is that I can't find the original reference that we adopted this procedure from. Can anyone help with any references with regards to this matter? [...]44_12Feb199907:12:[log in to unmask] 5835 32 18_ReAbbot FK506 kits16_PETER J [log in to unmask], 12 Feb 1999 00:18:51 -000011_ISO-8859-1 47_12Feb199900:18:[log in to unmask] 5868 28 37_FREE MEDICAL AND PHARMACEUTICAL BOOKS16_Mr.Munaf [log in to unmask], 12 Feb 1999 09:50:27 +0530 (IST)599_us-ascii Elsevier,Medical and C.R.C.International,Pharmacological Books are available
FREE of cost,for (Amsterdam-Mumbai-ultimate destination) postal charges of
$20 only each from
World Book Centre,
Gr.Flr.,Rakhi Mahal,
209,D.V.Road,Churchgate,
Mumbai-400020,India,
Tel:91 22 2027299,Telfax:91 22 2844891.

The list of Books available can be viewed at www.in-india.com/wbc
Hope they will be of interest to you,
Please don't hesitate to get back to me at the above e-mail address if need be.
Thanks
Munaf Lakhani
MBA(Michigan,USA)
BSc.(Hons.)(Surrey,U.K.)49_12Feb199909:50:27+0530(IST)[log in to unmask] 5897 20‚>¾ºb

Date:

Thu, 23 Dec 1999 14:34:00 +0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (32 lines)

I think the big issues include:

1 Effect on workload

Reduction of the marginal cost of requesting to the user will, in theory, produce greater demand. This is supported in practice by the experiences of most laboratories I've asked,
including Tim's.

This can only be put in the advantages or disadvantages side of the account when you know:
* how the laboratory is funded: does the laboratory want to increase its workload or not? Most NHS laboratories do not receive adequate extra income to cover increase in workload.
* the clinical benefit from the change in the number of investigations being performed.

2 Do you set up smart remote requesting or dumb remote requesting? Smart requesting might include:
* informing the requester that an investigation was carried out several times recently and might not be necessary,
* automated "care pathways".
Dumb requesting is easier to implement but will probably exacerbate the increase in workload. Smart requesting is harder to implement but might ameliorate the increase in workload.

3 Do you encourage the use of predefined batteries of analyses or adopt a highly discriminatory approach?  This has big effects on the design of the human-computer interface.

4 Do you restrict the remote requesting to those requests which will use a phlebotomy service? This gives an extra step where problematic requests can be resolved before the specimen
arrives in the laboratory.

5 Where in the workflow do you put the barcode printers, readers or other AutoID devices? This is strongly related to 4.

6 Is it better to try and develop the LIMS to support remote requesting or to install a dedicated system that passes the requests to the LIMS?

Jonathan Kay
University of Oxford



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