Alex Galoro - Academia.edu (original) (raw)

Papers by Alex Galoro

Diagnosis, 2020

Objectives In the laboratory medicine segment, benchmarking is the process in which institutions ... more Objectives In the laboratory medicine segment, benchmarking is the process in which institutions seek to compare with the macro environment (performance comparison and best practices with different laboratories) and improve their results based on quality indicators. The literature has highlighted the vulnerability of the pre-analytical phase in terms of risks and failures and the use of interlaboratory comparison as an opportunity to define a strategic performance benchmark aligned with the laboratory medicine sector, which has been a promising strategy to ensure continuous improvement, identifying within the pre-analytical process the critical activities to guarantee patient safety. In this context, this paper aims to present the three-year experience (2016–2018) of the Benchmarking Program and Laboratory Indicators – in Portuguese, Programa de Benchmarking e Indicadores Laboratoriais (PBIL) – with emphasis on pre-analytical indicators and their comparison against literature refere...

Clinical Chemistry and Laboratory Medicine (CCLM), 2014

Quality indicators (QIs) are fundamental tools for enabling users to quantify the quality of all ... more Quality indicators (QIs) are fundamental tools for enabling users to quantify the quality of all operational processes by comparing it against a defined criterion. QIs data should be collected over time to identify, correct, and continuously monitor defects and improve performance and patient safety by identifying and implementing effective interventions. According to the international standard for medical laboratories accreditation, the laboratory shall establish and periodically review QIs to monitor and evaluate performance throughout critical aspects of pre-, intra-, and post-analytical processes. However, while some interesting programs on indicators in the total testing process have been developed in some countries, there is no consensus for the production of joint recommendations focusing on the adoption of universal QIs and common terminology in the total testing process. A preliminary agreement has been achieved in a Consensus Conference organized in Padua in 2013, after revising the model of quality indicators (MQI) developed by the Working Group on "Laboratory Errors and Patient Safety" of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). The consensually accepted list of QIs, which takes into consideration both their importance and applicability, should be tested by all potentially interested clinical laboratories to identify further steps in the harmonization project.

Clinical Chemistry and Laboratory Medicine (CCLM), 2012

Background: This paper describes the evolution, structure, operation and some outcomes of the Bra... more Background: This paper describes the evolution, structure, operation and some outcomes of the Brazilian Laboratory Indicators Program created by the Brazilian Society of Clinical Pathology/Laboratory Medicine (Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial, or SBPC/ML), in partnership with ControlLab, a Brazilian Company that provides services for proficiency testing, internal control, calibration, and training indicators for clinical laboratories. Methods: This web-based program is confidential for all participants. It contains 61 indicators categorized into three groups. Program operation and data analysis methods are described and indicators are reported in box plot format, with grouping varying in accordance with the profiles of the participating laboratories. Three indicators were selected as examples of program effectiveness in 2011: hemolysis, blood re-collection and productivity. Results: Participants profile, examples of three indicators for the year 2011 (...

A prática da Medicina Laboratorial vem mudando em conseqüência do desenvolvimento tecnológico e r... more A prática da Medicina Laboratorial vem mudando em conseqüência do desenvolvimento tecnológico e regulamentações dos Sistemas de Saúde levando à implantação de Sistemas de Qualidade e monitoramento de indicadores. A aplicabilidade e os potenciais benefícios do Benchmarking como instrumento de análise da qualidade foram testados em um grupo de oito laboratórios hospitalares através do recebimento, análise e devolução aos participantes de Relatórios de Acompanhamento relativos a indicadores diversos dos anos de 2005 e 2006. O método 6 foi utilizado, quando aplicável, para avaliar a qualidade dos processos. Foram colhidos dados de indicadores de produção, produtividade, absenteísmo segurança no trabalho, recoletas e tempo para liberação de laudos. O Benchmarking é uma ferramenta útil e aplicável para a gestão de qualidade nos laboratórios clínicos, principalmente quando associado a instrumento independente de avaliação de qualidade de processos, porém é necessária a definição de mecanis...

Benchmarking: An International Journal, 2009

Purpose – The purpose of this paper is to test the applicability and benefits of benchmarking as ... more Purpose – The purpose of this paper is to test the applicability and benefits of benchmarking as a tool for quality analysis in Brazilian laboratory medical services.Design/methodology/approach – A primary observational study is performed in eight hospital laboratories by tracking the receipt, analysis and return to participants of monitoring reports relating to several quality indicators for the years 2005 and 2006. Whenever possible, the paper applies 6σ criteria as an independent assessment of process quality.Findings – Data obtained for the eight laboratories showed a monthly average (±SD) of 178,579 (±153,670) tests performed per laboratory, with 40,256 (±44,858) requisitions and 4.77 (±1.33) tests per requisition. Overall, productivity was 7.35 (±2.46) tests per man‐hour of work (MHW), increasing to 15.36 (±6.00) when considering only the analytical sector staff. An average of 1.63 (±1.14) lost hours per hundred MHW were reported (level 3.6σ), with 3.86 (±5.10) accidents at wo...

Arquivos Brasileiros de Cardiologia, 2017

Arq Bras Cardiol. 2017; 108(3):195-197 Positioning about the Flexibility of Fasting for Lipid Pro... more Arq Bras Cardiol. 2017; 108(3):195-197 Positioning about the Flexibility of Fasting for Lipid Profiling Marileia Scartezini,1 Carlos Eduardo dos Santos Ferreira,2 Maria Cristina Oliveira Izar,3 Marcello Bertoluci,4 Sergio Vencio,5 Gustavo Aguiar Campana,2 Nairo Massakazu Sumita,2 Luiz Fernando Barcelos,1 André A. Faludi,3 Raul D. Santos,3, Marcus Vinícius Bolívar Malachias,3 Jerolino Lopes Aquino,1 César Alex de Oliveira Galoro,2 Cleide Sabino,4 Maria Helane Costa Gurgel,4 Luiz Alberto Andreotti Turatti,5 Alexandre Hohl,4 Tania Leme da Rocha Martinez3 Sociedade Brasileira de Análises Clínicas (SBAC),1 Rio de Janeiro, RJ; Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (SBPC/ ML),2 Rio de Janeiro, RJ; Sociedade Brasileira de Cardiologia (SBC),3 Rio de Janeiro, RJ; Sociedade Brasileira de Endocrinologia e Metabologia (SBEM),4 Rio de Janeiro, RJ; Sociedade Brasileira de Diabetes (SBD),5 São Paulo, SP – Brazil

Diagnosis

ObjectivesIn the laboratory medicine segment, benchmarking is the process in which institutions s... more ObjectivesIn the laboratory medicine segment, benchmarking is the process in which institutions seek to compare with the macro environment (performance comparison and best practices with different laboratories) and improve their results based on quality indicators. The literature has highlighted the vulnerability of the pre-analytical phase in terms of risks and failures and the use of interlaboratory comparison as an opportunity to define a strategic performance benchmark aligned with the laboratory medicine sector, which has been a promising strategy to ensure continuous improvement, identifying within the pre-analytical process the critical activities to guarantee patient safety. In this context, this paper aims to present the three-year experience (2016–2018) of the Benchmarking Program and Laboratory Indicators – in Portuguese, Programa de Benchmarking e Indicadores Laboratoriais (PBIL) – with emphasis on pre-analytical indicators and their comparison against literature referen...

Clinical Laboratory, 2018

Background: Laboratory medicine is an important part of the healthcare system and directly contri... more Background: Laboratory medicine is an important part of the healthcare system and directly contributes to preventive actions, diagnostics, treatment, and management of diseases. The level and quality of the utilization of laboratory resources have been frequently questioned. A dissemination of conflicting data regarding the quantity of laboratory tests not accessed by the requesting doctors or by the patients themselves is observed, although very often the sources and methodologies used to raise those numbers are not properly clarified. The objective of this study was to obtain data about access to results of tests taken in Brazilian private clinical analysis laboratories which use the laboratory information system developed by SHIFT Consultoria e Sistemas. Methods: Information was extracted from 81 laboratories, which were responsible for the performance of 93,240,651 tests, collected from 7,067,087 patients. Results: The total number of tests not accessed, considering all the regions, was 5,071,454, corresponding to a proportion of 5.4%. In the face of the potential risks of adverse events or impacts in the management of diagnostics and treatments, including economic impacts due to prolonged hospitalization time, the proportion of 17.9% which was found corresponding to tests "not accessed" showing "abnormal" results, is worrisome, mainly if we observe that of those, 2.5% were related to "abnormal" test results processed by laboratories which work in hospital care. Conclusions: SBPC/ML, in face of the relevance of the theme, will keep stimulating the monitoring and utilization of adequate laboratory resources, in order to allow sustainable healthcare systems.

Febs Letters, Aug 14, 1995

In the present study we have examined the levels and phosphorylation state of the insulin recepto... more In the present study we have examined the levels and phosphorylation state of the insulin receptor and insulin receptor substrate 1 (IRS-1) as well as the association between IRS-1 and phosphatidylinositol 3-kinase (PI 3-kinase) in the liver and muscle of rats treated with glucagon. There was a decrease in the insulin-stimulated receptor and IRS-1 phosphorylation levels which was paralleled by a reduced association between IRS-1 and PI 3-kinase in vivo in the liver and muscle of glucagon-treated rats. These observations suggest that glucagon, probably acting through cAMP, may impair insulin signaling in the three early steps in insulin action after binding.

Clinical Chemistry and Laboratory Medicine (CCLM)

The improving quality of laboratory testing requires a deep understanding of the many vulnerable ... more The improving quality of laboratory testing requires a deep understanding of the many vulnerable steps involved in the total examination process (TEP), along with the identification of a hierarchy of risks and challenges that need to be addressed. From this perspective, the Working Group “Laboratory Errors and Patient Safety” (WG-LEPS) of International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) is focusing its activity on implementation of an efficient tool for obtaining meaningful information on the risk of errors developing throughout the TEP, and for establishing reliable information about error frequencies and their distribution. More recently, the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has created the Task and Finish Group “Performance specifications for the extra-analytical phases” (TFG-PSEP) for defining performance specifications for extra-analytical phases. Both the IFCC and EFLM groups are working to provide laboratori...

Epinephrine is known to produce insulin resistance, but the exact molecular mechanism involved is... more Epinephrine is known to produce insulin resistance, but the exact molecular mechanism involved is unknown. In the present study we have examined the levels and phospborylation state of the insulin receptor and of insulin receptor substrate 1 (IRS-1), as well as the association between IRS-1 and phosphatidylinositol 3-kinase (PI 3-kinase) in the liver and muscle of rats treated with epinephrine. The results demonstrate a decrease in insulinstimulated receptor and IRS-1 phosphorylation levels which was accompanied by a reduction in the association of IRS-1 with PI 3-kinase in vivo in liver and muscle of epinephrine treated rats. These data suggest that molecular post-receptor defects may explain some aspects of the insulin resistance induced by catecholamines.