Monthly Archives: November 2014

“The Power of the Microbiology Report Comment”

If you give an educational talk, with the aim of changing people’s behaviour, then assuming your case is well presented and argued, you are likely to succeed.

But only temporarily…..

The problem with one-off educational initiatives is in their failure to make a sustained change in behaviour. For example if you are trying to encourage clinicians to switch from method A to method B to diagnose disease X, then an educational talk may have an initial effect, but unless there is a clear incentive for sustainability, people tend to drift back to old habits…

So what are the secrets to sustaining a change in behaviour? All of the following are options:

  • Make it cheaper.
  • Make it better.
  • Make it the easier option.
  • Make it the only option.
  • Constant encouragement….

It is the last point of constant encouragement where the power of the report comment comes into effect. If on every result report, a comment is added to the effect “This disease is optimally diagnosed using method B”, then the requestors will get a recurring yet subtle reminder of what the laboratory would like them to do.

Other such examples might include:

  • Please provide appropriate Clinical Details for Microbiology Test Requests.
  • This micro-organism is best treated with antibiotic X.
  • The optimal sample for this test is Y
  • Laboratory testing is rarely useful in the management of this condition.
  • One sample is sufficient for the diagnosis of condition Z.

and many many more….

Most laboratory systems now have functionality that allows them to add comments to result reports, either automatically, semi-automatically (with a coded comment) or manually.

Don’t under-estimate the power of a well worded report comment to influence future behaviour of the requestor. The continuous reinforcement induces a slow but sustained change in people’s thinking. Personally I have used them to good effect and plan to further increase the use and range of report comments. They are worth more than most presentations, no matter how well they are given….


Click here for another article on tailored reporting.


“Point of Care Testing and the Laboratory, Relationship or Rivalry”

File:POCT rheumachec.jpg

I have had to do some work on Ebola Preparedness recently and this has involved looking at the role in such cases of various point of care tests (POCT), that can thus be utilised at the patient’s bedside.

At first sight, the POCTs I have looked at seem fantastic. They generally produce accurate results, they are very quick and even I can use them.

However there is a darker side..

There are aspects of POCT where the lab still wins hands down. This is with regards to electronic recording and interfacing of results into a result repository, external and internal quality control of the test, maintenance of the equipment, and training the users.

With regards to the first problem I think wireless interfacing of POCTs will start to become more prevalent as the technology is now available (click here for an example).

With regards to the other problems, I think it is extremely important that the laboratory has complete jurisdiction over POCT within any given institution, and that the accreditation agencies recognise these pieces of equipment as part of the laboratory. It is only by doing this that all the quality control measures that are necessary for such equipment can be implemented and assessed.

I don’t see POCT as a threat to the laboratory, just because the equipment is not physically in the laboratory itself. A good laboratory should embrace POCT and see it as an integral part of their operation.


Click here for another article on the development of POCT and Quality Control issues (about a 10 min read)


“Clavulanic Acid and Treasure Hunting”

Clavulanic acid. It’s not an antibiotic in the classical sense of the word, but where would be without it? Probably one of the most important discoveries in the history of antibiotic development.

Clavulanic acid, or potassium clavulanate, was discovered in the early 1970s by scientists at Beecham pharmaceuticals. Produced naturally by the bacterium Streptomyces clavuligerus, it is a potent inhibitor of (Class A) beta-lactamases.

We know that Streptomyces are soil bacteria and there are hundreds of different Streptomyces species recorded in the taxonomy. A majority of Streptomyces species produce beta-lactam antibiotics and a lot of them also produce beta-lactamases, showing the lengths that these bacteria would go to to survive amongst other streptomyces and also other micro-organisms living in close proximity

It is interesting therefore that one of the Streptomyces species (Streptomyces clavuligerus) had the “brains” to produce a beta-lactamase inhibitor. Why? This would have given the bacterium a selection advantage aginst other beta-lactamase producing Streptomyces in a beta-lactam rich environment, in a sense “dis-arming” its competitors.

For Streptomyces clavuligerus, it is thus impressive that it has produced a third line of defence after beta-lactams and beta-lactamases, demonstrating just how sophisticated antibiotic defences are amongst soil streptomyces.

We have obviously taken full advantage of this from a clinical point of view. By combining clavulanic acid with penicillins such as amoxycillin (co-amoxyclav) or ticarcillin (co-ticarclav), it extends antimicrobial activity way beyond what is afforded by the penicillin alone.

This takes my thoughts onto the major clinical problem of carbapenemases. We know that carbapenems (often produced naturally by Streptomyces) and carbapenemases (often originating in Bacillus species) occur naturally. It is thus highly possible, even probable, that carbapenemase inhibitors are also present in the environment. We just have to find them.

Bacteria will go to extraordinary lengths to ensure their own survival….


For a nice article on cutting edge research being done with beta-lactamases, click here. It also includes the Ambler classification of beta-lactamases, which I often read, then forget, then read again, then forget…..and so on!

For another related article on carbapenemases, click here