{"presentation":{"slides":[{"elements":[{"x":5.446623093681917,"y":6.479481641468682,"width":88.23529411764706,"height":23.758099352051836,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Random Blinded Rechecking (RBRC<\/strong>)<\/span> <\/span>is the process of re-reading a statistically valid sample of routine slides from a TB diagnostic centre based on lot quality assurance strategy (LQAS) in a blinded manner to assess the laboratory performance.<\/span><\/p>\n"},"subContentId":"f22f56bb-8328-4e87-9f1d-f993d5e42c3b","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":7.625272331154684,"y":32.39740820734341,"width":23.965141612200437,"height":51.83585313174946,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-641a598c820d1.png","mime":"image\/png","copyright":{"license":"U"},"width":421,"height":513,"originalImage":{"path":"images\/file-641a596b1a9a9.png#tmp","mime":"image\/png","height":1080,"width":1920}},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"2860dee6-f57a-4c19-aac6-865d2777fbba","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":61.00217864923747,"y":32.39740820734341,"width":25.05446623093682,"height":49.676025917926566,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-641a59d5da3bf.png","mime":"image\/png","copyright":{"license":"U"},"width":517,"height":559,"originalImage":{"path":"images\/file-641a59b7a2a37.png#tmp","mime":"image\/png","height":1080,"width":1920}},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"9b9a7b6b-89e2-4ce5-99f5-2f265473ee15","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":2.178649237472767,"y":84.23326133909288,"width":35.947712418300654,"height":12.958963282937365,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Figure 1: Annexure B for Blinded Rechecking of TB diagnostic centre Slides (RNTCP Laboratory Network Guidelines<\/a>)<\/span><\/p>\n"},"subContentId":"ad2e7218-3eee-4485-8fb9-82daf88a8192","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":57.734204793028326,"y":84.23326133909288,"width":35.947712418300654,"height":15.11879049676026,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Figure 2: Worksheet for Blinded Rechecking of TB diagnostic centre Slides as per Annexure C (RNTCP Laboratory Network Guidelines<\/a>)<\/span><\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"809b6675-869e-4a57-b070-f40319dd44c1"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":6.5359477124183005,"y":10.799136069114471,"width":88.23529411764706,"height":82.07343412526998,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

RBRC Process<\/strong><\/span><\/span><\/p>\n\n

\n\t
The district TB officer (DTO) sends information to all senior TB lab supervisors (STLS) of the district on the number of slides to be collected every month from each TB diagnostic Centre<\/span><\/li>\n\t
The STLS then selects the required number of slides from the TB Laboratory Register and marks the RBRC selected slides in the laboratory register with a circle<\/span><\/li>\n\t
The laboratory technician (LT) fills out Annexure B (Figure 1) for the selected slides<\/span><\/li>\n\t
LT seals the filled Annexure B in an envelope and marks the slide box with the Serial No. of slides, name of the TB diagnostic centre and TB unit (TU), month and year<\/span><\/li>\n\t
The STLS hands over sealed envelopes and the slide box to the DTO<\/span><\/li>\n<\/ul>\n"},"subContentId":"0a94abdc-249a-489a-919b-064069a4a40c","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":6.5359477124183005,"y":8.639308855291576,"width":87.14596949891067,"height":84.23326133909288,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
The DTO with the help of the statistical assistant (SA) removes all the identifying attributes of the selected slides (including the test results). This process is called Blinding<\/strong><\/span>.<\/strong><\/span><\/span><\/li>\n\t
Blinded re-examination of selected slides is done by the STLS of another TB Unit (TU) within the respective district. The STLS (controllers) must have demonstrated proficiency with the Ziehl-Neelsen (ZN) staining and reading method (as seen by panel testing done by Intermediate Reference Laboratory (IRL)).<\/span><\/li>\n\t
Smears may be evaluated for specimen quality (sputum versus saliva), appropriate size and thickness, and quality of staining (as per Annexure C, Figure 2).<\/span><\/li>\n\t
Problems detected by the controller are noted on the form, as this information may be very useful to supervisors responsible for providing feedback to the peripheral technicians, assessing possible reasons for high false positive or false negative results, and implementing plans for retraining and corrective action. <\/span><\/li>\n<\/ul>\n"},"subContentId":"49873e07-eb86-4f27-b29a-9fa5e55b6809","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":8.639308855291576,"width":91.50326797385621,"height":53.99568034557235,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
<\/p>\n\n
\n\t
The DTO with the help of the statistical assistant compares the results provided by the STLS against the original results provided by the LT. This process is called Unblinding.<\/strong><\/span><\/span><\/li>\n\t
The discrepant slides are sent for umpire (second controller) reading.<\/span><\/li>\n\t
All discrepant slides are re-stained and re-examined by the second controller, as there is likelihood of fading of carbol fuchsin. This rechecking of discordant slides by a second controller also acts to evaluate the performance of the first controllers.<\/span><\/li>\n<\/ul>\n"},"subContentId":"41709bfa-c919-4e9b-a22f-263a8661579d","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.446623093681917,"y":6.479481641468682,"width":88.23529411764706,"height":88.55291576673866,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Feedback after RBRC<\/strong><\/span><\/span><\/p>\n\n
\n\t
Regular and timely feedback to the TB diagnostic centre is essential to improve performance<\/span><\/li>\n\t
Feedback and remedial actions are provided at the end of each sampling period i.e., completion of rechecking of the annual sample<\/span><\/li>\n\t
Also, feedback is given on a monthly basis to the respective TB Diagnostic Centre using the form in Annexure D (Figure 3) during the monthly on-site evaluation visit by the STLS responsible for the respective TB Diagnostic Centre<\/span><\/li>\n\t
Feedback includes the return of slides with discordant results to be re-read by the original LT of the respective TB Diagnostic Centre<\/span><\/li>\n\t
Potential sources of errors are investigated during the on-site evaluation visit<\/span><\/li>\n\t
Appropriate corrective actions and\/or remedial training are provided within one month<\/span><\/li>\n<\/ul>\n"},"subContentId":"e77756c0-9c65-427a-a26c-18598a30e064","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":27.233115468409586,"y":17.3110151187905,"width":30.501089324618736,"height":65.2267818574514,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-641a5b53e309c.png","mime":"image\/png","copyright":{"license":"U"},"width":533,"height":542,"originalImage":{"path":"images\/file-641a5b3c1e10c.png#tmp","mime":"image\/png","height":1080,"width":1920}},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"3ce77d84-ded1-456e-ba99-5e6c56c34a80","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":6.5359477124183005,"y":84.23326133909288,"width":70.04357298474946,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Figure 3: Quality Assurance Report on Sputum Microscopy as per Annexure D (RNTCP Laboratory Network Guidelines<\/a>)<\/span><\/p>\n"},"subContentId":"b6e2576f-deaa-40d7-b605-886e4d1f36a3","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}}],"keywordListEnabled":true,"globalBackgroundSelector":{},"keywordListAlwaysShow":false,"keywordListAutoHide":false,"keywordListOpacity":90},"override":{"activeSurface":false,"hideSummarySlide":false,"summarySlideSolutionButton":true,"summarySlideRetryButton":true,"enablePrintButton":true,"social":{"showFacebookShare":false,"facebookShare":{"url":"@currentpageurl","quote":"I scored @score out of @maxScore on a task at @currentpageurl."},"showTwitterShare":false,"twitterShare":{"statement":"I scored @score out of @maxScore on a task at @currentpageurl.","url":"@currentpageurl","hashtags":"h5p, course"},"showGoogleShare":false,"googleShareUrl":"@currentpageurl"}},"l10n":{"slide":"Slide","score":"Score","yourScore":"Your Score","maxScore":"Max Score","total":"Total","totalScore":"Total Score","showSolutions":"Show solutions","retry":"Retry","exportAnswers":"Export text","hideKeywords":"Hide sidebar navigation menu","showKeywords":"Show sidebar navigation menu","fullscreen":"Fullscreen","exitFullscreen":"Exit fullscreen","prevSlide":"Previous slide","nextSlide":"Next slide","currentSlide":"Current slide","lastSlide":"Last slide","solutionModeTitle":"Exit solution mode","solutionModeText":"Solution Mode","summaryMultipleTaskText":"Multiple tasks","scoreMessage":"You achieved:","shareFacebook":"Share on Facebook","shareTwitter":"Share on Twitter","shareGoogle":"Share on Google+","summary":"Summary","solutionsButtonTitle":"Show comments","printTitle":"Print","printIngress":"How would you like to print this presentation?","printAllSlides":"Print all slides","printCurrentSlide":"Print current slide","noTitle":"No title","accessibilitySlideNavigationExplanation":"Use left and right arrow to change slide in that direction whenever canvas is selected.","accessibilityCanvasLabel":"Presentation canvas. Use left and right arrow to move between slides.","accessibilityProgressBarLabel":"Choose slide to display","containsNotCompleted":"@slideName contains not completed interaction","containsCompleted":"@slideName contains completed interaction","slideCount":"Slide @index of @total","containsOnlyCorrect":"@slideName only has correct answers","containsIncorrectAnswers":"@slideName has incorrect answers","shareResult":"Share Result","accessibilityTotalScore":"You got @score of @maxScore points in total","accessibilityEnteredFullscreen":"Entered fullscreen","accessibilityExitedFullscreen":"Exited fullscreen","confirmDialogHeader":"Submit your answers","confirmDialogText":"This will submit your results, do you want to continue?","confirmDialogConfirmText":"Submit and see results","slideshowNavigationLabel":"Slideshow navigation"}}

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MO-TC: Quality Assurance of TB Detection Centres

Quality assurance of Stains and Internal Quality Control

Random Blinded ReChecking [RBRC] Concept

RBRC Process

RBRC Process at DTC

Random Blinded ReChecking [RBRC] Interpreting Feedback