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Quality assessment of smear microscopy by stratified lot sampling of treatment follow-up slides

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Abstract
SETTING: Ten peripheral laboratories performing routine acid-fast bacilli (AFB) smear microscopy in Lima, Peru. OBJECTIVES: To test whether external quality assessment (EQA) rechecking of AFB smears becomes more efficient with stratified lot sampling of treatment follow-up smears. DESIGN: In 2 consecutive years, a stratified lot sample of 36 treatment follow-up slides and 24 diagnostic slides were randomly selected and blindly rechecked. A second controller determined the final result for discordant slides. Feedback was provided to laboratory technicians during supervisory visits. RESULTS: More false-negative errors were found in the follow-up slides than in the tuberculosis suspect slides: 25 vs. 3. This represented a yield of 3.5% in 720 follow-up slides and only 0.6% in 480 diagnostic slides. Positive predictive values were high in both years. Respectively three and eight laboratories did not reach a relative sensitivity of >65% during the first and second year, and a clear improvement was seen in only one laboratory. Excessive workload seemed to preclude raising the level of routine performance. CONCLUSIONS: EQA with stratified lot sampling of treatment follow-up slides proved very efficient and effective for identifying laboratories with substandard performance in a setting with low positivity rates in routine diagnostic smears.
Keywords
quality control, diagnosis, sputum smear microscopy, tuberculosis, BLINDED RECHECKING, ACID-FAST BACILLI, FLUORESCENCE MICROSCOPY, SPUTUM, TUBERCULOSIS, DIAGNOSIS, YIELD, TB

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MLA
Otero, L., et al. “Quality Assessment of Smear Microscopy by Stratified Lot Sampling of Treatment Follow-up Slides.” INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, vol. 15, no. 2, 2011, pp. 211–16.
APA
Otero, L., Van Deun, A., Agapito, J., Ugaz, R., Prellwitz, G., Gotuzzo, E., & Van Der Stuyft, P. (2011). Quality assessment of smear microscopy by stratified lot sampling of treatment follow-up slides. INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, 15(2), 211–216.
Chicago author-date
Otero, L, A Van Deun, J Agapito, R Ugaz, G Prellwitz, E Gotuzzo, and Patrick Van Der Stuyft. 2011. “Quality Assessment of Smear Microscopy by Stratified Lot Sampling of Treatment Follow-up Slides.” INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE 15 (2): 211–16.
Chicago author-date (all authors)
Otero, L, A Van Deun, J Agapito, R Ugaz, G Prellwitz, E Gotuzzo, and Patrick Van Der Stuyft. 2011. “Quality Assessment of Smear Microscopy by Stratified Lot Sampling of Treatment Follow-up Slides.” INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE 15 (2): 211–216.
Vancouver
1.
Otero L, Van Deun A, Agapito J, Ugaz R, Prellwitz G, Gotuzzo E, et al. Quality assessment of smear microscopy by stratified lot sampling of treatment follow-up slides. INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE. 2011;15(2):211–6.
IEEE
[1]
L. Otero et al., “Quality assessment of smear microscopy by stratified lot sampling of treatment follow-up slides,” INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, vol. 15, no. 2, pp. 211–216, 2011.
@article{2023783,
  abstract     = {{SETTING: Ten peripheral laboratories performing routine acid-fast bacilli (AFB) smear microscopy in Lima, Peru. 
OBJECTIVES: To test whether external quality assessment (EQA) rechecking of AFB smears becomes more efficient with stratified lot sampling of treatment follow-up smears. 
DESIGN: In 2 consecutive years, a stratified lot sample of 36 treatment follow-up slides and 24 diagnostic slides were randomly selected and blindly rechecked. A second controller determined the final result for discordant slides. Feedback was provided to laboratory technicians during supervisory visits. 
RESULTS: More false-negative errors were found in the follow-up slides than in the tuberculosis suspect slides: 25 vs. 3. This represented a yield of 3.5% in 720 follow-up slides and only 0.6% in 480 diagnostic slides. Positive predictive values were high in both years. Respectively three and eight laboratories did not reach a relative sensitivity of >65% during the first and second year, and a clear improvement was seen in only one laboratory. Excessive workload seemed to preclude raising the level of routine performance. 
CONCLUSIONS: EQA with stratified lot sampling of treatment follow-up slides proved very efficient and effective for identifying laboratories with substandard performance in a setting with low positivity rates in routine diagnostic smears.}},
  author       = {{Otero, L and Van Deun, A and Agapito, J and Ugaz, R and Prellwitz, G and Gotuzzo, E and Van Der Stuyft, Patrick}},
  issn         = {{1027-3719}},
  journal      = {{INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE}},
  keywords     = {{quality control,diagnosis,sputum smear microscopy,tuberculosis,BLINDED RECHECKING,ACID-FAST BACILLI,FLUORESCENCE MICROSCOPY,SPUTUM,TUBERCULOSIS,DIAGNOSIS,YIELD,TB}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{211--216}},
  title        = {{Quality assessment of smear microscopy by stratified lot sampling of treatment follow-up slides}},
  url          = {{http://www.ingentaconnect.com/content/iuatld/ijtld/2011/00000015/00000002/art00013}},
  volume       = {{15}},
  year         = {{2011}},
}

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