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July 2011

Monitoring PT/INR Monitoring PT/INR
There are aspects of the article on prothrombin time (PT) variance (“INR practice gaps found in Q-Probes,” March 2011, page 1) that warrant expansion, both focused on the user of the data. First, it is straightforward to measure in statistically valid terms the difference between two instruments, by use of common samples, preferably abnormal, and if feasible by using the same control lots, again with a focus on high INRs. Even comparisons between fingerstick and venous samples can be done by, on initial use of the fingerstick method, asking patients to consent to a venous sample as well, so as to compare their own results. This is beneficial both for the individuals as well as the aggregate data.

The reproducibility of possible instruments, and how they compare with existing equipment, should be evaluated before purchase. Given the primary use of PT testing, the comparisons should be on an INR basis, at several levels. The issue is whether there are statistically different values with instrument A versus B, and whether the delta is clinically important. Second, with consistent variances between instruments, the most important factor is communicating such to treating clinicians, and learning how they interpret changes in the INR on an individual patient. For example, if there is a consistent 10 percent INR difference in A versus B, in the normal range, 1.0 INR versus 1.1 INR is meaningless, but in the anticoagulated range a patient’s INR seemingly changing from 3.9 on instrument B to 4.4 on instrument A, a week later, could be interpreted as a need for a reduction in Coumadin dose, depending on the clinician. When consistent instrument differences exist, then not only might different critical values be discussed, but also different desirable anticoagulant INR ranges.

Laurence Sherman, MD, JD
St. Louis, Mo.

Unifying CP, AP data Unifying CP, AP data
We read with interest your article “All for one–unifying CP and AP data” (February 2011, page 1). In the article, one of your sources says that no vendor has a fully integrated solution that takes care of molecular imaging, all the handling of the assays, and the massive amounts of data relating to genomics and cytogenetics. The article says vendors like SCC Soft Computer and Cerner have standalone products to handle that, but that no one has a single solution that does it all.

We are pleased to say that SCC Soft Computer does, indeed, have a fully integrated system that covers not only molecular and cytogenetics but also biochemisty, CP and AP, flow cytometry, and HLA. It is true that based on a client’s needs, these systems are available and functional as standalone systems or with various modular combinations; however, the SCC Soft Computer Genetics Information Systems Suite was designed and built—and functions—as a fully integrated single solution suite.

Don Keller
Vice President
Education and Marketing
SCC Soft Computer
Clearwater, Fla.

Leading a laboratory Leading a laboratory
As a reader who always turned to Dale Dauten’s column first when CAP TODAY arrived, I was heartbroken to read that he would no longer be writing his column. In the medical technology field, little or no attention is paid to the best way to organize, manage, or lead a laboratory or department or motivate or engage the talented and educated people who push results out daily. These softer people skills are no less important than the laboratory skills we learned through our education. Skilled employees prefer to be led by knowledgeable leaders, not managed step by step, and if we do the latter, we demotivate and ultimately have a disengaged staff. Dale Dauten’s columns were enlightening and they will be missed.

Joanne Gibbs, MPA, M(ASCP)
York, Pa.