山西省15项临床检验质量指标调查结果与分析

目的 调查分析山西省临床检验15项质量指标现状。方法 利用网络平台,向辖区内598家医疗机构临床实验室发放调查表。对规定时间内回报的数据,利用Microsoft Excel 2003、SPSS13.0进行统计学分析处理。结果 194家实验室回报结果。13项以率统计的指标再用西格玛（Sigma,σ）度量评价,有10项总体σ满足最低可接受水平（3σ）,其余3项总体σ水平均<1。不同等级医院实验室和不同专业之间部分项目有显著差异。不同专业常规检验前周转时间约为30 min,急诊检验为10 min。不同专业常规检验中周转时间在 30~180 min,急诊在 20~60 min。结论 通过本次调查研究了解到检验中的质量控制工作相对薄弱。实验室应加强信息系统建设,保证可靠的数据采集和常态化的监控工作。     

Quality procedures in non-gynaecological cytology laboratories in England and Wales

All non-gynaecological cytology laboratories in England and Wales (n = 212) were surveyed by telephone. The aim was to investigate what concepts of quality applied in this context and to establish what tools and techniques of quality improvement were used. The overall response was 146 (69%). The respondents mainly comprised NHS Trusts and University Departments. The study showed that there was a diverse approach to quality. All types of quality assurance and customer focus procedure questioned were undertaken but to a varied extent; three laboratories (2%) used a complete range and three (2%) used no procedure at all. Accreditation was associated with staffing adequacy and use of surveys, but not quality assurance (QA) or user focus. Laboratories with a high priority for quality performed more QA and reported a higher staffing adequacy. Critical incident analysis was dependent on workload. Computerization did not affect quality procedures and involvement in the Breast Screening Programme did not result in different quality measures. The time since last update was independent of all factors and external quality assurance (EQA) was not widely available. The study suggested that an integrated approach to quality had not been adopted in English and Welsh cytology laboratories and that there may be a need for a more strategic approach with greater availability of EQA, guidelines on quality tools, closer linkage of accreditation and quality procedures and the production of minimum and ideal standards. The ideal standard could be the complete range of procedures, and the minimum standard could comprise those processes in most frequent use, i.e. critical incident analysis, correlation methods, action on information, analysis of what is done with diagnostic information, a complaints procedure and customer surveys.     

Partial Rescreening of All Negative Smears: an Improved Method of Quality Assurance In Laboratories Undertaking Cervical Screening

Partial rescreening was carried out on 9633 cervical smears reported as negative by standard screening. Each slide was ‘step-screened’ at normal speed for 30 s. Thirteen false negative smears were detected by this method. No false negatives were revealed by conventionally rescreening 10% of the same study group. the sensitivity of the method was assessed by ‘step-screening’ 100 known positive smears. of this group 92 were detected. the results indicate that partial rescreening is a sensitive method of quality assurance and should replace conventional 10% proportional rescreening, which is ineffective.     

Rapid rescreening of cervical smears: an improved method of quality control

Rapid rescreening of approximately 30% of all negative and inadequate consecutive smears was carried out over a 26-month period. Smears (n = 24012) were rescreened using a × 6.3 objective only. Two minutes were allowed for each slide. Thirty-nine smears were found to have been incorrectly diagnosed as negative, a rate of 0.16%. This can be compared with the previous 26 months during which the traditional 1 in 10 random rescreening of unsatisfactory and negative smears had been carried out at a routine pace and with an objective of × 10. A total of 6866 smears were rescreened. Eleven were found to have been incorrectly diagnosed as negative, a rate of 0.16%. Rapid rescreening is as sensitive as 1 in 10 rescreening, and allows a greater proportion of smears to be rescreened. We propose rapid rescreening should replace the traditional 1 in 10 rescreening methods.     

品管圈在提升研究型医院品质中的运用与实践探索

为探索医院转型发展的策略和路径,第三军医大学新桥医院积极开展医院品质建设,通过“建组织、树理念、引方法、培团队、推活动、管过程、享成果”七步流程,建立了研究型医院品质管理新模式。并以“品管圈”为牵引,使员工不仅要增强发现问题的意识,学会运用科学的管理工具解决问题,更要具备研究型的理念思路去创新管理的方法和手段,以实现“以患者为中心,以员工为导向,持续质量改进”的全面质量管理目标。     

Establishment of laboratory quality control indicators for NAT on blood donors' samples

In order to establish and screen nucleic acid test (NAT) quality control indicators for blood donor samples, C_T value of each test item were detected by NAT, internal and external quality controls, the number of unsuccessful mixed samples, the split positive rate, the rate of detection efficiency, and the equipment failure rate were collected. The "instant method" is used to establish the Levey-Jennings quality control chart, the mixed test positive rate, the rate of unqualified sample. Possion distribution is used to establish the quality control chart, and it is easily to operate and monitor NAT effectively. The results displayed that quality control charts were established, including unqualified sample Possion distribution quality control chart, the rate of equipment failure quality control chart, the failure rate of reagent batch and inefficient quality control chart, test result positive of Possion distribution quality control chart, quality control charts of NAT positive Possion distribution probability, the rate of split positive quality control charts, quality control charts of unsuccessful mixed samples, quality control chart of reagents effective rate, internal quality control chart, correctness, and NAT qualitative quality control chart. The study established quality control indicators throughout the whole NAT process, which were able to effectively improve NAT quality control and the efficacy of laboratory management.     

基于控制图的医院服务质量持续改进

目的 应用统计过程控制理论分析指导医院服务质量持续改进。方法 联合使用多个控制图方法对医院服务质量评价指标的变化趋势进行监控,及时发现过程中的异常波动,制定针对性措施实施过程改进。结果 找出了影响医院服务质量数据波动的主要原因,制定改进措施,取得了良好的管理效果。结论 控制图可以准确全面反映医院服务质量的总体情况和过程控制情况,根据数据异常分布状态找到潜在的影响服务质量的原因并进行持续改进,是有效的过程管理工具。     

医院病历质控体系构建的创新思路与实践

分析了当前各医院病历质控体系中存在的主要问题,提出病历质控体系设计应当遵循随机化、公开化和责任化3个原则。从6个方面介绍了医院构建基于两级随机盲态设计的病历质量控制体系的创新思路与具体实践。在体系中围绕“能够负责、敢于负责、必须负责”3个方面建立了科学严谨的责任落实保证机制,确保了新的体系高质量的常态化运作。用公平、公正、公开以及具有刚性和辅以适当奖惩措施的质控结果,有效促进了病历质量和医疗服务质量的持续提升。     

Pre-emptive Quality Control of a Misfolded Membrane Protein by Ribosome-Driven Effects

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40S subunit dissociation and proteasome-dependent RNA degradation in nonfunctional 25S rRNA decay

Eukaryotic cells have quality control systems that eliminate nonfunctional rRNAs with deleterious mutations (nonfunctional rRNA decay, NRD). We have previously reported that 25S NRD requires an E3 ubiquitin ligase complex, which is involved in ribosomal ubiquitination. However, the degradation process of nonfunctional ribosomes has remained unknown. Here, using genetic screening, we identified two ubiquitin-binding complexes, the Cdc48-Npl4-Ufd1 complex (Cdc48 complex) and the proteasome, as the factors involved in 25S NRD. We show that the nonfunctional 60S subunit is dissociated from the 40S subunit in a Cdc48 complex-dependent manner, before it is attacked by the proteasome. When we examined the nonfunctional 60S subunits that accumulated under proteasome-depleted conditions, the majority of mutant 25S rRNAs retained their full length at a single-nucleotide resolution. This indicates that the proteasome is an essential factor triggering rRNA degradation. We further showed that ribosomal ubiquitination can be stimulated solely by the suppression of the proteasome, suggesting that ubiquitin-proteasome-dependent RNA degradation occurs in broader situations, including in general rRNA turnover.     

Changes in Biological Characteristics of Trichogramma pretiosum (Hym.: Trichogrammatidae) Reared on Eggs of Anagasta kuehniella (Lep.: Pyralidae) for 23 Generations

Possible changes in biological characteristics of Trichogramma pretiosum (Riley) (Hymenoptera: Trichogrammatidae) were monitored during 23 generations reared on eggs of Anagasta kuehniella (Zeller) (Lepidoptera: Pyralidae), to determine quality control parameters in rearing procedures of this parasitoid. Parasitism rates (percent of eggs parasitized) of T. pretiosum varied from 10 to 76%, with lower values for the first four generations. From the 17th generation, the variability in the parasitism rate was lower. Viability (percent adult emergence rate) of T. pretiosum in eggs of A. kuehniella varied from 22 to 100%, again with lower values in earlier generations. Adult longevity of T. pretiosum varied from 5.3 to 15.9 days, and showed a reduced longevity with increasing number of generations. Sex ratio of the offspring of this parasitoid was not affected by the timing of parasitism on eggs of A. kuehniella.     

生物制品检定动态管理系统的开发和应用

掌握生物制品的检定动态是质量管理的重要内容,由于检定周期随着制品种类、批数及检定条件的变化而变化,以往靠手工方式查阅繁杂的检定记录,难以随时快速、全面了解当时的检定状况。检定动态管理软件的开发可应用计算机自动跟踪显示检定进度和检定状态,及时反映制品质量和检定条件变化,明显提高了生产和质量管理部门的工作效率。     

Quality of the Entomopathogenic NematodeSteinernema carpocapsaeProduced on Different Media

The characteristics of morphometric (body length and width), biochemical (fatty acid content), motility, and penetration rate of infective juveniles ofSteinernema carpocapsaeBeijing strain reared on four different culture media [e.g., plant protein medium (I), animal protein medium (II), plant and animal protein medium (III), andin vivoculture (IV) were systematically compared in this research. The results showed that the average lengths of infective juveniles were 497.4 ± 0.09, 514.3 ± 0.08, 525.7 ± 0.09, and 556.6 ± 0.09 μm, the average widths were 24.9 ± 0.006, 25.6 ± 0.005, 26.1 ± 0.006, and 27.9 ± 0.004 μm, and the average dry weights per million infective juveniles were 49.2 ± 2.2, 58.6 ± 2.4, 59.6 ± 1.8, and 80.7 ± 1.7 mg cultured by media I, II, III, and IV, respectively. The highest relative content of fatty acid of infective juveniles was obtained from medium IV at 15.4 ± 1.2 × 10⁵μV/s, and the lowest one was 6.76 ± 0.3 × 10⁵μV/s from medium I and 11.8 ± 0.2 × 10⁵and 13.7 ± 0.3 × 10⁵μV/s from media II and III, respectively. The numbers of nematodes that moved a vertical distance of 5 cm in sand column within 48 h were 24 ± 3.6, 75 ± 11.6, 69 ± 9.7, and 92 ± 13.2 and the penetration rates into theGallerialarva within 24 h were 2.8 ± 0.45, 6.0 ± 1.14, 6.4 ± 0.74, and 6.0 ± 0.7% from media I to IV, respectively. The results indicated that the quality of entomopathogenic nematode was influenced by the cultural medium component. The animal protein, especially from insects which were presented in media II, III, and IV, has a strong positive effect on nematode quality.     

城市生态观测:质量控制对象、体系和规范编制

城市生态系统长期观测是开展城市生态安全评价和制定人居环境健康管理政策的基础。为了确保城市生态观测数据的准确性和科学性,通过辨识城市生态观测质量控制的概念,基于"人机料法环"理论构建了城市生态观测质量控制体系,结合城市生态观测质量控制相关规范的编制与实施现状,探讨了城市生态观测质量控制规范的编制技术。结果表明：（1）城市生态观测质量控制是面向城市生态观测内容（要素、空间格局、功能、服务）,为保证生态观测全过程质量要求、提高生态观测结果的准确性而实施的质量控制活动和措施。（2）城市生态观测质量控制体系可从对象和过程这两个维度进行界定：对象维度方面,包括"人"-人员、"机"-仪器设备、"料"-数据、"法"-文件和"环"-观测过程5个方面;过程维度方面,涵盖城市生态观测全过程,包括城市生态观测前期准备工作、观测过程中以及观测后的数据录入、审核与评价等环节的质量控制措施。（3）我国已发布的生态观测相关技术标准中,发布的时间越晚,质量控制内容越完整,目前生态观测相关标准共102则,仅38则明确提出了质量控制具体要求。（4）《城市生态观测质量控制规范》编制需包含质量体系和质量控制措施两项技术内容,主要包括前引、正文和附录三个章节,对生态观测全过程质量保证和质量控制技术进行规定。     

Restricted access: spatial sequestration of damaged proteins during stress and aging

The accumulation of damaged and aggregated proteins is a hallmark of aging and increased proteotoxic stress. To limit the toxicity of damaged and aggregated proteins and to ensure that the damage is not inherited by succeeding cell generations, a system of spatial quality control operates to sequester damaged/aggregated proteins into inclusions at specific protective sites. Such spatial sequestration and asymmetric segregation of damaged proteins have emerged as key processes required for cellular rejuvenation. In this review, we summarize findings on the nature of the different quality control sites identified in yeast, on genetic determinants required for spatial quality control, and on how aggregates are recognized depending on the stress generating them. We also briefly compare the yeast system to spatial quality control in other organisms. The data accumulated demonstrate that spatial quality control involves factors beyond the canonical quality control factors, such as chaperones and proteases, and opens up new venues in approaching how proteotoxicity might be mitigated, or delayed, upon aging.     

Parametric and non-parametric prediction intervals based phase II control charts for repeated bioassay data

Quality control for repeated bioassay runs can be performed by phase II control charts, well-known from industrial quality control. The value of interest is the potency, of which a single value per run is available. Parametric and non-parametric prediction intervals are described to estimate quality control intervals for future re-test runs. Violations against the normal distribution occur in real data frequently, particularly outliers. The non-parametric prediction intervals are limited to not too small sample sizes in both the historical and future sampling phases. Therefore, robust prediction intervals based on winsorization are proposed. R-functions for all prediction intervals are provided.     

In VitroRearing ofTrichogramma minutumRiley (Hymenoptera: Trichogrammatidae) for Ten Generations, with Quality Assessment Comparisons ofin Vitroandin VivoReared Adults

Trichogramma minutumRiley were reared for 10 generations on an artificial diet containing a yeast extract, FreeAmine III, nonfat dry milk, chicken egg yolk, chicken embryo extract, andManduca sexta(L.) egg liquid. Quality control parameters, including adult longevity, sex ratio, pupation rate, percentage of pupae to emerge as adults, adult female body length, number ofHelicoverpa zea(Boddie) eggs parasitized by a female, and percentage of deformed females were assessed and compared to insects rearedin vivoon irradiatedH. zeaeggs. The development time was longer forin vitroreared insects, but there were more deformed females in thein vitroculture. The sex ratio, however, was generally not significantly different between thein vitroandin vivocultures. Thein vitroreared females generally were larger, lived longer, and parasitized moreH. zeaeggs. Emergence of adults was in excess of 75% in all but the firstin vitrogeneration and was generally not significantly different from adult emergence in thein vivoculture. These findings will be of value in the development of a practical system forin vitromass rearing ofTrichogrammafor use in biological control.     

线粒体质量控制:运动促进健康与预防疾病的靶向

作为真核细胞中提供能量并与疾病发生相关的重要细胞器,线粒体对于运动表现出高超的可塑性响应。运动可以促进新生线粒体的生物合成、融合与分裂动态平衡及失去功能的线粒体的自噬清除,从而维持整个线粒体网络的功能,保证细胞的能量供给。本文综述了运动应激对这些过程的调控,从线粒体质量控制角度为运动促进健康及预防疾病的机理提供了合理解释。