What extreme laboratory values can be obtained that (some) patients can survive with?

Objectives: We wanted to have a more substantiated idea about the extreme values which are possible in patients not dying or being moribund.

Methods: for nine regular analytes the five most extreme results registered between 2014 and 2018 in our database were searched. Results had to have been confirmed by multiple analyses in different samples.

The AID study: protocol for a randomised controlled trial of intrauterine insemination in the natural cycle compared with intracervical insemination in the natural cycle.

Introduction: At present, studies comparing intrauterine insemination in the natural cycle versus intracervical insemination in the natural cycle in women undergoing artificial insemination with donor sperm are scarce.

Methods And Analysis: We perform a randomised controlled non-inferiority trial among five secondary and tertiary fertility clinics in the Netherlands and one tertiary fertility clinic in Belgium. Women eligible for artificial insemination with donor sperm are included.

Improved prospective risk analysis for clinical laboratories compensated for the throughput in processes.

Background: Practical application of prospective risk analysis (PRA) in clinical laboratories should reflect processes as they are carried out, while making the PRA results obtained from different processes comparable. This means that not only STAT and standard testing and testing for critical and less critical parameters should be distinguished (as published), but also that the throughput in processes and process steps should be taken into account.

Methods: Building on our previously published PRA, a method was developed to compensate for the throughput in processes and process steps.

Recognizing and differentiating uncommon body fluids: Considerations and tools for a proper practical approach.

Clinical laboratories are regularly requested to inspect uncommon body fluids obtained from patients because clinicians are uncertain as to the origin of the collected material. They may need this information for the actual diagnosis, to confirm a supposition, or for guiding treatment and invasive operations like draining and puncturing. Often there is also a need to know more precisely what is going on in the cavity that gave rise to the fluid, for instance a local infection or metastasis, or whether the cavity is connected to organs or fluid compartments nearby etcetera.

Practical motives are prominent in test-ordering in the Emergency Department.

Background: Laboratory test ordering under time pressure may impact test-ordering behavior.

Methods: To investigate the test-ordering behavior of doctors working under such pressure, we designed a questionnaire for trainees and staff in the Emergency Department (ED). This questionnaire addressed topics such as necessity of requested tests, time spent on ordering, costs and availability of tests, and the time of the day.

Prospective risk analysis adjusted to the reality of clinical and fertility laboratory processes.

Background: Prospective risk analysis (PRA) is a valuable instrument in quality assurance. The practical application of PRA in clinical laboratories according to the method we have described elsewhere leaves room for a number of adaptations to make it more applicable to and consistent with actual laboratory processes.

Methods: We distinguished between more and less critical tests and products in the laboratory processes and scored the consequences of failures at different steps in line with the previously described failure type and effect analysis (FMEA) method.

What motivates men to offer sperm donation via the internet?

To investigate why men offer sperm donation via the internet, a questionnaire was disseminated via 39 Dutch-language websites thought to be visited by potential sperm donors. Nine internet donors completed the survey, men who typically knew the women they were donating to. Their responses were compared with those of a control group of 35 general sperm bank donors who were recruited using flyers in Dutch sperm banks, and who were typically unaware of the identity of the eventual recipients.

Evolving minimum standards in responsible international sperm donor offspring quota.

An international working group was established with the aim of making recommendations on the number of offspring for a sperm donor that should be allowable in cases of international use of his sperm. Considerations from genetic, psychosocial, operational and ethical points of view were debated. For these considerations, it was assumed that current developments in genetic testing and Internet possibilities mean that, now, all donors are potentially identifiable by their offspring, so no distinction was made between anonymous and non-anonymous donation.

Active intervention in hospital test request panels pays.

Background: Ordering laboratory tests by means of test panels is a convenient way of requesting tests, preventing necessary tests from being forgotten. However, it also leads to redundant test ordering, as not all tests in a given panel are required for each patient. As test panels proposed by doctors may contain redundant, overlapping or infrequently used tests, the active involvement of knowledgeable laboratory staff in the organisation of test panels is advisable to promote efficient test use.

A survey of doctors reveals that few laboratory tests are of primary importance at the Emergency Department.

Background: Laboratory tests in hospitals are among the most important diagnostic tools for medical decision making at the Emergency Department. They are often ordered as part of extended test panels, which, although helpful and convenient for doctors, may lead to overuse of tests and overdiagnosis. To improve the ordering process, we investigated which laboratory tests are essential for optimal decision making at the Emergency Department of our hospital.

[Artificial insemination with donor sperm in the Netherlands: future-proof?].

In recent years much has changed in care for artificial insemination with donor sperm (AID). Since new laws and regulations were implemented, a large number of sperm banks have closed and the total number of sperm donors and their availability have decreased. Long waiting times and the use of sperm donors recruited by foreign commercial sperm banks can indicate a shortage of sperm donors.

An inventory of reasons for sperm donation in formal versus informal settings.

The shortage of sperm donors in formal settings (i.e., assisted reproduction clinics) and the availability of sperm donors in informal settings (such as through contacts on the internet) motivated us to investigate why men may prefer either a formal or an informal setting for sperm donation.

Practical, transparent prospective risk analysis for the clinical laboratory.

Background: Prospective risk analysis (PRA) is an essential element in quality assurance for clinical laboratories. Practical approaches to conducting PRA in laboratories, however, are scarce.

Methods: On the basis of the classical Failure Mode and Effect Analysis method, an approach to PRA was developed for application to key laboratory processes.

Managing laboratory test ordering through test frequency filtering.

Background: Modern computer systems allow limits to be set on the periods allowed for repetitive testing. We investigated a computerised system for managing potentially overtly frequent laboratory testing, calculating the financial savings obtained.

Methods: In consultation with hospital physicians, tests were selected for which 'spare periods' (periods during which tests are barred) might be set to control repetitive testing.

A taxonomy of possible reasons for and against sperm donation.

Objective: Various reasons may guide the decision of men to become a sperm donor. Our aim was to identify a comprehensive set of possible reasons for and against sperm donation.

Design: Concept mapping.

Reducing the number of clinical stat phlebotomy orders: feasible or not?

Background: To manage the costs and performance of diagnostic services involving laboratory testing permanent evaluation is required. Among these, the ever increasing use of stat ordering, involving labour intensive phlebotomy,warrants explanation, especially for a phlebotomy service organised by the laboratory, not by those responsible for and/or carrying out the requests, such as doctors and nurses.

Methods: To explore the possibilities to reduce the number of stat phlebotomy requests, we conducted a survey among nurses and doctors of their motives in requesting 109 randomly selected stat orders.

Reconsidering the number of offspring per gamete donor in the Dutch open-identity system.

The introduction of legislation in the Netherlands in 2004 enabling donor offspring to identify and make contact with their donors has led to a need to reconsider the number of offspring that an individual semen donor may produce. To this end, we made a survey on the limits for offspring per donor in 29 different countries, distinguishing between systems with anonymous and open-identity sperm donation. We counted donations as individual offspring conceived, or as the number of women/families helped, by a single donor.

Managing the demand for laboratory testing: options and opportunities.

The possibilities for ordering laboratory testing in hospitals inevitably need to be managed, given physicians' knowledge on the use of laboratory testing, their attitudes towards test ordering, the constant increase in testing and the limited resources available. On the assumption that some tests may not be strictly necessary or are even redundant, this paper reviews various methods to manage the demand for laboratory tests, evaluating the extent to which these methods are applicable and effective in daily practice. The most promising new management tools seem to be computerised laboratory management systems (CDSS), a reimbursement system based on the diagnosis-treatment combination (as in The Netherlands), and the allocation of laboratory budget to those requesting laboratory services.

Approaching risk analysis and risk management in the fertility laboratory and semen bank.

Present-day quality consciousness, as reflected in the newest European Directives and guidelines, demands from laboratories working with human gametes and embryos that attention be paid to risk analysis and management. Using these Directives and guidelines as reference, while also aiming at accreditation, we have worked out an approach for risk analysis in the fertility laboratory and semen bank for the processing of semen to be used for intrauterine insemination and for the preservation of semen in the semen bank, based on the general principles of failure mode and effect analysis. In this overview, we describe how risk analyses and various aspects of risk management in the fertility laboratory and semen bank can be carried out.

Lysosomal storage diseases in non-immune hydrops fetalis pregnancies.

Background: At least 20 inborn errors of metabolism may cause hydrops fetalis. Most of these are lysosomal storage diseases. The study proposes a diagnostic flowchart for prenatal diagnosis of non-immune hydrops fetalis.

Multicentre evaluation of a new assay for determination of carbohydrate-deficient transferrin.

Aims: The analytical performance of the new Tina-quant % carbohydrate-deficient transferrin (%CDT) was assessed in a multicentre study on Roche/Hitachi analysers.

Methods: Intra-assay/total precision studies revealed median coefficients of variation (CVs) of 4.7/7.

No reason for a reduction in the number of offspring per sperm donor because of possible transmission of autosomal dominant diseases.

A limit of 25 offspring per sperm donor has been imposed in The Netherlands since 1992, in order to prevent children from donors having a greater risk of consanguineous relationships than would occur in random individuals. An incident with a donor who developed a serious hereditary brain disease raised the question whether the limit of 25 should be reduced. Here I consider this suggestion from a genetic, psychological and legal standpoint.