performed on Eastman Kodak EktaChem DT60,
DTSC or DTE analyzers.
These analyzers
provide a wide variety of basic chemistry tests with
a small amount of disposable waste. Urinalysis
included a dip-stick examination and, when
indicated, microscopic analysis. Stool exams were
performed on physicians’ request for identification
of parasites and occult blood, although the
physicians routinely perform a test for occult
blood at the time of examination.
Roentgenographicservices were provided using
a dedicated mammography unit and a standard xray unit manufactured by the Bennett
Corporation,
Long
Island,
NY.
X-ray
interpretation was done at the time of
examination. However, if no radiologist was part
of the medical team,the x-rayfilms were returned
to Brookhaven National Laboratory and then
referred to a consultant radiologist, Dr. R. Naylor,
at the University of Vermont.
A portable, battery powered,
electrocardiograph machine was available.
Electrocardiogram interpretation was done at the
time of examination, with a copy often being given
to the patient. All electrocardiograms were
subsequently returned to Brookhaven National
Laboratory and then referred to a consultant
cardiologist (Dr. M. Zema) at Brookhaven
Memorial Hospital on Long Island, NY, for
definitive analysis.
In recent years an ultrasound machine
(Hewlett Packard Sonos 100) has been available
on the ship for assessment of such diverse items
as abdominal pain, hematuria, gestational age, and
cardiac disease. It is used only when radiologist
or subspecialist physician with expertise in
ultrasound examination is part of the team.
Ultrasound has been available to confirm findings
on physical examination of the thyroid but this
requires special planning and an investigator
experiencedin thyroid ultrasound. It was not used
to screen for subclinical thyroid nodularity.
Sera collected during the routine physical
examinations were analyzed at the time of patient
examination, as clinically indicated.
The
remainder was frozen for further testing upon
return to Brookhaven National Laboratory. The
latter tests were performed at the Brookhaven
Clinical Laboratory or referred to university and
commercial laboratories. Among the referral
laboratories were:
Hazelton Washington, Inc.,
Vienna, VA, for hormone assays; Michael Reese
Hospital and Medical Center (Dr. A.B Schneider,
Division
of
Endocrinology
and
Metabolism),
Chicago, IL for thyroglobulin analysis; MetPath,
Teterboro, NJ; Smith Kline Beecham (Accupath),
Honolulu, HI; and Smith Kline Bio-Science, King of
Prussia, PA. Pathologists’ Laboratories, Inc. in
Aiea, HI, was the primary source for Papanicolaou
smear and cytology interpretations.
Quality control/quality assurance is an important
focus of the medical program. Accreditation by the
Joint Commission on Accreditation of Healthcare
Organizations is one manifestation of this. In the
laboratory quality control and quality assurance
involves
routine
calibration,
maintenance
and
monitoring of all instrumentation. Daily tri-level
analysis of reference materials is performed on the
hematology analyzer. The chemistry analyzer is
calibrated prior to each mission, andbi-level quality
control samples are run on all analyses.
Approximately 10 percent of all chemistry tests
performed in the field are re-analyzed at
Brookhaven National Laboratory to compare with
and to confirm the earlier results all of which
proved to be within acceptable tolerance. When
necessary, laboratory instrumentation is inspected
and repaired by company service representatives.
Other
instrumentation,
such
as
sphygmomanometers, electrocardiograph machines,
doppler units, are periodically calibrated and have
routine preventative maintenance performed at
Brookhaven National Laboratory between missions.
Other quality assurance methods include the use
of questionnaires given to patients.
These
questionnaires, translated into Marshallese, with the
responses being interpreted at the present time by
Mr.Alfred Capelle, Director of the Marshall Islands
Alele Museum in the Republic of the Marshall
Islands in Majuro, solicit criticism and advice for
improving the medical program’s operation. One
important quality assurance mechanism is the
involvementof volunteer physicians from around the
United States, for this rotation through the program
of new medical eyes and ears keeps the medical
program attuned to neweror better approaches to
diagnosis and management.
In addition to
information obtained by personal interaction during
the missions, ideas for bettering the program are
requested via a questionnaire distributed to all
professional personnel at the end of cach mission.
Finally, the results of these and other mechanisms
of quality assurance are reviewed by the
Brookhaven National Laboratory Clinical Research