Context. —Fish consumption has been associated with a decreased risk of coronary artery disease. Recent studies have illustrated that the high mercury content in cold-water fish may negate the cardiovascular benefits of fish meals. Fish oils have similar antiatherogenic properties to fish, and similar studies should be performed to determine the level of mercury in fish oils. Objective. —To determine the concentration of mercury in 5 over-the-counter brands of fish oil. Results. —The levels of mercury in the 5 different brands of fish oil ranged from nondetectable (<6 μg/L) to negligible (10–12 μg/L). The mercury content of fish oil was similar to the basal concentration normally found in human blood. Conclusions. —Fish are rich in omega-3 fatty acids, and their consumption is recommended to decrease the risk of coronary artery disease. However, fish such as swordfish and shark are also a source of exposure to the heavy metal toxin, mercury. The fish oil brands examined in this manuscript have negligible amounts of mercury and may provide a safer alternative to fish consumption.

Context .—Managing the quality of point-of-care testing (POCT) is a continuing challenge. Advances in testing technologies and the development of specialized informatics for POCT have greatly improved the ability of hospitals to manage their POCT program. Objectives .—To present the evolving role of technology improvement, informatics, and program management as the key developments to ensure the quality of POCT. Data Sources .—This presentation is based on a review of the literature and on our experiences with POCT at the Massachusetts General Hospital (Boston). Conclusions .—Federal and state regulations, along with accreditation standards developed by the College of American Pathologists and The Joint Commission, have established guidelines for the performance of POCT and have provided a strong incentive to improve the quality of testing. Many instruments for POCT have incorporated advanced design features to prevent analytic and operator errors. This, along with the development of connectivity standards and specialized data management software, has enabled remote review of test data and electronic flow of information to hospital information systems. However, documentation of manually performed, visually read tests remains problematic and some POCT devices do not have adequate safeguards to prevent significant errors. In the past 2 decades the structure of a successful POCT management program has been defined, emphasizing the role of POCT managers working in conjunction with a pathology-based medical director. The critical skill set of POCT managers has also been identified. The POCT manager is now recognized as a true specialist in laboratory medicine.

Context. —The consumption of fish high in omega-3 fatty acids is advocated by the American Heart Association to decrease the risk of coronary artery disease. However, fish contain environmental toxins such as mercury, polychlorinated biphenyls, and organochlorine pesticides, which may negate the beneficial cardiovascular effects of fish meals. Toxin levels vary depending on both the fish source and the specific toxin, and neither farm-raised nor wild fish are toxin free. Fish oil supplements also prevent the progression of coronary artery disease and reduce cardiovascular mortality. However, only sparse data exist on the level of toxins in fish oil. In a previous study we showed that the amount of mercury in 5 over-the-counter brands of fish oil was negligible. Objective. —To determine the concentrations of polychlorinated biphenyls and other organochlorines in 5 over-the-counter preparations of fish oil. Design. —The contents of 5 commercial fish oil brands were sent for organochlorine analysis. Results. —The levels of polychlorinated biphenyls and organochlorines were all below the detectable limit. Conclusions. —Fish oil supplements are more healthful than the consumption of fish high in organochlorines. Fish oils provide the benefits of omega-3 fatty acids without the risk of toxicity. In addition, fish oil supplements have been helpful in a variety of diseases, including bipolar disorder and depression.

Objectives:. Point-of-care laboratory testing (POCT) offers reduced turnaround time and may promote improved operational efficiency. Few studies have b

Context. —Reporting of laboratory critical values has become an issue of national attention because of important regulatory, medicolegal, and clinical concerns. Objective. —To survey aspects of the laboratory critical-value reporting process at a broad range of institutions. Design. —A survey was developed regarding the operational and information-technology aspects of critical value reporting. Results. —More than 730 responses were obtained from a broad distribution of hospitals. In addition, we analyzed more than 700 written responses from survey participants. Conclusions. —The survey results provide insight into the standard of practice and level of compliance with current Joint Commission and College of American Pathologists requirements for critical values, demonstrate considerable heterogeneity, and suggest areas for improvement. A common issue raised during the survey and follow-up teleconference was the incidence of outpatient false-positive critical values. In this report, we also demonstrate that attention to preanalytic transport and processing issues can assist in minimizing this issue.