临床实验室检验差错的测量研究

实验室对患者安全有重大的影响,因为所有诊断的80~90%是基于实验室检验作出的。据报道,实验室差错发生率为所有试验结果的0.012-0.6%。患者安全是一个管理问题,其可通过实施积极的系统来识别及监控质量故障得到提高。这可通过包括事件报告随后的根本原因分析的反应方法得到促进。这可导致识别及纠正该系统中方针及程序的不足之处。另一种方法是前瞻性方法,如失效模式和效应分析(或故障模式和影响分析)。本文的重点是整个检验过程,预测主要不良事件以及先发制人防止它们的发生。它可用于高风险过程的前瞻性的风险分析以减少实验室及其他患者医疗领域内出差错的可能性。     

临床检验前阶段室间质量评价方案的设计

在检验医学领域中,有很多研究已描述检验全过程不同阶段出现的最频繁的差错,且这些差错的很大部分都出现在检验前阶段。检验中阶段的误差登记然后反馈给参加者的方案已经由室间质评（External Quality Assessment,EQA）组织在大多数国家进行了数十年。但是迄今为止,只有很少的组织专注于检验前阶段,而且大多数的EQA组织并不提供检验前EQA方案（External Quality Assessment Schemes,EQAS）。执行和标准化检验前EQAS是比较困难的,认可机构也并没有对实验室参加这类方案提出要求。然而,一些正在进行的检验前阶段EQA计划是存在的,使用的方法可以分为三种类型：收集实验室检验前程序的信息、发放真实样品来收集可能影响测量程序的干扰因素、或者登记真实的实验室差错并将这些内容关联到质量指标。这三个类型有不同的侧重点和不同的实施挑战,这三者的结合可能是检出和监视出现在检验前阶段的广泛差错所必须的。     

探讨临床免疫检验的质量控制方法与效果

目的:对临床免疫检验的质量控制方法及效果进行分析探讨。方法:选取自2011年8月至2013年8月期间实施免疫学检验的资料作为研究对象,对其进行收集整理,从临床标本、试剂及仪器等可能导致免疫检验结果出现误差的因素入手,探讨出控制临床免疫检验质量的有效方法。结果:通过分析可知,标本质量、仪器设备、人员素质以及实验室的温度、湿度等都是影响临床免疫检验质量的主要因素(P0.05)。结论:在临床上,影响免疫检验质量的因素有很多,因此对实验室操作人员提出了更高的要求,使其必须严格按照操作规程执行,注意检验中存在的细节,从而有效的确保检验质量。     

临床检验生化分析的前质量保证探析

目的:分析影响临床检验生化分析前质量的相关因素,总结保证生化检验前质量的相关对策。方法:选取2012年4月~2014年4月在我院进行生化检验的病历资料,对其生化检验分析过程中发生的差错进行回顾性分析,总结影响生化检验分析前质量的相关因素。结果:出现生化检验差错的148例病例中,64.19%发生在分析前,23.65%发生在分析中,112.16%发生在分析后。在影响分析前质量的各项因素中,采样不规范所占比例最高,其次为样本送检不及时,另外患者准备不当、样本处理欠妥也是影响检验分析前质量的主要因素。结论:生化检验分析的前质量会受到多种因素影响,生化检验科应加强前质量管理、控制,以确保检验结果的准确,从而为临床诊断、治疗提供可靠依据。     

临床检验后阶段质量指标及其质量规范

目的 探讨我国当前检验后阶段的质量指标及其质量规范,为临床实验室建立QI体系提供参考。 方法 采用卫生部临床检验中心和北京科临易检信息技术有限公司共同设计开发的网络平台,向参加中心2015年全国临床检验专业质量指标调查的所有实验室发放调查表按照不同专业和不同医院等级进行分组,采用Kolmogorov-Smirnov检验判断数据正态性,Kruskal-Wallis检验和Mann-Whitney检验分别进行多组和两组间的比较。结果 分别有5 229家、4 643家和4 421家实验室上报了检验报告不正确率、危急值通报率和危急值通报及时率的相关数据。各指标均有超过95%的实验室、σ水平≥3 σ和≥6 σ的实验室则分别占47.87%、91.17%、85.95%。各指标在不同专业之间存在显著差异;除危急值通报率以外,其余2项指标在不同等级医院之间也存在显著差异。结论 我国临床实验室检验后阶段3项QI的差错率相对较低,多数实验室危急值通报率和危急值通报及时率达到了100%。临床实验室应基于此调查,进一步监测3项指标,同时正确有效地识别检验后阶段的薄弱环节,建立更多合适的QI并基于当前技术水平确定相应的质量规范。     

浅谈食品安全与微生物检验

随着人们生活水平的提升,使得人们对自身的生活水平质量的重视程度也在不断地提升,食品质量安全的问题作为影响其生活质量的重要因素,已倍受社会和人们关注。微生物对食品所造成的污染,已成为世界各国重要的问题之一,因此,对食品进行微生物检验是确保食品质量安全的主要手段。     

6σ 质量管理方法在临床化学检测性能评价中的应用

目的:应用六西格玛(6σ)质量管理方法分析临床生化检验项目质量控制数据,评价其分析性能,设计生化检验项目的质量控制方法并指导其质量改进。方法:收集2010年度临床生化检验项目室内质量控制及室间质量评价的数据,按照美国临床实验室改进修正法案允许总误差(TEa)标准,采用公式值=[TEa%-偏倚(bias%)]/变异系数(CV%),计算检验项目的σ值,绘制标准化6σ性能决定图,评价检验项目分析性能,设计质量控制方案,计算检验项目的质量目标指(QGI),查找导致性能不佳的主要原因,提出优先改进方法。结果:临床生化检验项目中,常规生化和干式生化的检验项目达到6西格玛水平分别占66.6%和58.4%,达到5～6西格玛水平分别占4.8%和8.3%,达到4～5西格玛水平分别占4.8%和8.3%,4.达到3～4西格玛水平分别占4.8%和16.7%,在3西格玛水平以下分别占19%和8.3%,全部检验项目的平均σ值分别为9.33和6.95。在12个6σ值<6的检验项目中有50%要优先改进精密度,25%需要优先改进准确度,其余则两者都要改进。结论:6σ质量管理方法可以有效地应用于临床化学检测性能评价,设计个性化的质量控制方案可更有效地控制质量,有助于不断提高临床实验室生化检验项目质量水平。     

临床免疫检验质量控制相关措施探析

目的对应用综合质量控制管理模式对接受免疫检验的患者实施管理的临床效果进行研究。方法选择在我院就诊的接受免疫检验的住院患者84例,随机分为对照组和研究组,平均每组42例。采用常规免疫检验管理模式对对照组实施管理;采用综合质量控制管理模式对研究组实施管理。结果研究组患者经免疫检验后病情诊断的准确率明显高于对照组,组间差异显著(P0.05);病情误诊和漏诊例数明显少于对照组,组间差异显著(P0.05)。结论应用综合质量控制管理模式对接受免疫检验的患者实施管理的临床效果非常明显。     

提升妇幼保健医院临床检验质量控制的策略

本文主要结合妇幼保健医院规模小、投入少、医技及管理能力较弱的特点就如何提高其临床检验质量控制水平作了一些探讨。     

提高医学实验室标本分析前质量控制方法的探讨

目的:探讨提高医学实验室标本分析前质量控制的方法。方法:根据《医学实验室质量和能力专用要求》(ISO15189)的分析前质量管理内涵并结合我院实验室实际情况,对流程再造前、后发生的总标本差错数进行对比分析。结果:通过完善实验室信息管理系统(LIS)的功能、实验室内部流程改造、对临床护士的培训等方面工作,流程再造前后有显著性差异(P<0.05)。结论:合理的分析前质量控制方法可提高医学实验室检测质量。     

Characteristics of the membranes of the pellicle of the ciliatePseudomicrothorax dubius

Summary The membranes of the pellicle of the ciliatePseudomicrothorax dubius are investigated using thin section electron microscopy and freeze-fracture replicas. The plasma membrane is covered by a surface coat and is connected to the outer alveolar membrane by short, sometimes branched, bridges. The inner alveolar membrane is coated on both sides. The epiplasm lies in intimate contact with the cytoplasmic surface of this membrane, and there is a corresponding deposit on the other surface. This deposit is regularly striated.The epiplasmic layer and the alveoli are interrupted at sites of cytotic activity,e.g., the attachment sites of trichocysts, the cytoproct, and the parasomal sacs. The striated deposit ends where the epiplasm ends, indicating a direct relationship between these two epimembranous layers.There is a deposit along the sides of the first part of the tip of the trichocysts, and in this region the trichocyst membrane is free of intramembranous particles.The membrane of the parasomal sacs has a coat on both surfaces. That on the extraplasmic surface is similar to the surface coat of the plasma membrane. The origin of the cytoplasmic coat is unknown. The cytotic activity of these sacs is indicated by their highly irregular profiles.     

The early development of the tail and the transformation of the shape of the nucleus of the spermatid of the domestic fowl,Gallus gallus

Summary The differentiation of the spermatid, especially in reference to the formation of the flagellum, and transformation of the shape of the nucleus was investigated in the domestic fowl.In the early stage of the spermatid, a prominent Golgi apparatus appears around the centrioles. The Golgi vesicles then surround the axial-filament complex which develops from the distal centriole. These vesicles fuse to form continuous membrane at the earliest stage of flagellar formation, and in the succeeding stage Golgi lamellae are attached to the plasma membrane of the developing flagellum. From these observations, it is assumed that Golgi apparatus may be a source of the membrane system of the flagellum.The microtubules distributed around the nucleus form the circular manchette. The anterior region of the nucleus with the manchette is cylindrical in shape and the posterior region without it remains irregular in shape. When the circular manchette has been completed, the whole nucleus acquires a slender cylindrical shape. The circular manchette then changes into the longitudinal manchette. The nuclei of spermatids without a longitudinal manchette are abnormal in shape. In view of these observations it is assumed that the nuclear shaping of the spermatid may be accomplished by circular manchette and the maintenance of shape of the elongated nucleus by longitudinal manchette.The authors wish to thank Mr. Takayuki Mori for his helpful suggestions and technical advices     

Characterization of the composition of the aqueous humor and the vitreous body of the eye of the frog Rana temporaria L

This study aimed to analyze the aqueous humor (AH) and the vitreous body (VB) of the eye of the adult frog Rana temporaria L. as a representative species of amphibians, which lead a semi-terrestrial life. The presence of collagen, albumin, uric acid and electron donors was shown in both media; however, there are slight differences in their concentrations. To determine collagen, a spectral-fluorescent probe, cyanine dye, was used. The presence of collagen in AH of the frog was found at the first time. The total content of electron donors (ascorbic and uric acids, tryptophan, and tyrosine) in VB and HA was roughly estimated at ~ 1.5 × 10^− 4 mol/L. Both VB and AH absorb light in similar UV regions. The total protein and albumin contents in AH were found to be somewhat higher than those in VB. The uric acid content was at an equally low level in both intraocular media. It is supposed that the similarity of VB and AH compositions shown in this work is due to some exchange between VB and AH contents in the course of accommodation. The role of intraocular fluids in physiological functions of the eye and in protecting the retina against UV light is discussed.     

Observations on the permeability of the choriocapillaris of the eye

Summary The choriocapillaris is a fenestrated capillary bed located posterior to the retinal pigment epithelium. It serves as the main source of supply to the photoreceptors, retinal pigment epithelium, and other cells of the outer retina. The permeability of these capillaries to intravenously injected ferritin (MW — approx. 480,000; mol. diam. 11 nm) was examined in the mouse, rabbit, and guinea pig, each of which is characterized by a different type of retinal vascularization. In all three species, the bulk of the ferritin remained in the capillary lumina, where it appeared to be blocked at the level of the diaphragmed fenestrae. Some ferritin was present in endothelial cell vacuoles. The results confirm previous work on the rat choriocapillaris and indicate that the barrier function of the choriocapillary endothelium is present even among species in which the retinal circulation differs significantly.Supported by NIH grant EY03418