临床微生物实验室信息系统本科实习带教的探索

实验室信息系统（laboratory information system,LIS）的广泛使用,极大地提高了检验科的服务和管理质量,在给检验工作带来极大方便的同时,也对实习带教提出了新要求。文章针对临床微生物LIS系统特点,结合ISO15189认可中实验室信息系统的要求,适应微生物检验技术的发展需求,从检验科实习岗前培训到进入微生物组系统培训等方面探索推动临床微生物实验室信息系统实习教学工作,不断完善并规范临床微生物医学检验技术专业实习教学体系。     

检验标本闭环管理系统的设计与实现

我院检验科为国内唯一通过ISO15189、GB19489、美国CAP 三项认证的实验室。根据实验室质量管理要求,通过设置关键业务点,优化临床标本管理流程,利用条形码和移动PDA等先进计算机网络技术,开发设计临床检验标本管理系统。该系统加强了实验室环节质量控制,实现了标本全程闭环管理,责任全程可追溯,提高了临床检验标本管理水平,使标本管理流程更加标准化、规范化。     

ISO15189 质量管理体系作为医学检验专业实习教学内容的探索

【】ISO15189质量管理体系是国际医学实验室最新质量管理的理念和质量改进方法的标准。医学检验专业学生学习和实践该体系,对于毕业后能够快速成为既懂专业又懂管理的临床实验室应用型人才具有重要意义。 本研究将ISO 15189质量管理体系作为检验专业实习教学的一个重要内容,按照质量体系的管理要素和技术要素进行教学设计。学生参与到实验室质量管理的各个实践环节中,通过编写体系文件,参加质量活动,并对质量体系中的重点和难点技能进行实践,既培养了学生ISO 15189标准的基本理念,也熟悉了实验室认可体系的基本模式和过程,毕业后很快成为了本单位实验室质量管理的骨干力量。     

中职卫生学校实验室仪器设备信息管理系统模块的建立探讨

目的探讨建立中职卫生学校实验室设备管理系统的可行性。方法在学校实验室信息管理系统平台上,基于ISO15189认证标准和模块化设计,采用三层架构建立B/S模式学校实验室设备管理系统。结果建立了设备和设备文件,使用说明,人员授权,维护,质量控制报告,校准记录,故障管理和不良事件报告的一系列记录和管理路径。结论该系统的建立实现了学校实验仪器设备全过程管理的实时记录,保存,监控和查询功能。     

ISO系列文件在医学检验实验室的应用

介绍了ISO/IEC导则25在临床实验室应用的体会,分析了ISO 9000系列、ISO 17025和ISO/FDIS 15189之间的关系,提出了我国医学检验实验室在保证临床检验质量方面应选择的方法和标准.     

“盲目跟风”和“事不关己”都不可取专家呼吁正确理解ISO15189认证内涵

在日前召开的第四届中国检验医师大会暨检验与临床高峰论坛上,有关专家指出,《医学实验室质量和能力的专用要求》（ISO15189）作为医学实验室学科建设的标准和医学检验的国家标准,通过认证可可有效促进医学实验室进步与发展。但切忌盲目追求ISO15189认证,或者认为不参加认证此标准就有已无关,这两种倾向都是对ISO15189认证内涵的背离。     

ISO15189在多医疗区实验室管理的应用

ISO15189即《医学实验室——质量和能力的专用要求》,是国际标准化组织临床实验室起草的,用于指导医学实验室建立自己的检测质量及技术管理体系并指导其运作的标准。实验室的管理具有多样性、复杂性、管理难度大等特点,多医疗区实验室的管理则更加考验管理者的能力。本文参照国内外医学实验室广泛认可的ISO15189质量管理体系对多医疗区实验室的统一管理模式进行探讨,以期建立适合多医疗区实验室的质量管理体系。     

实验结果回报时间分析

目的:分析血常规五分类标本、生化标本、免疫标本的实验结果回报时间(TAT),探讨影响TAT延长的可能因素。方法:通过实验室信息系统(LIS)分析血常规五分类标本、生化标本、免疫标本的TAT,计算从采集到审核各阶段的时间与ISO15189实验室实验TAT目标值对比,分析各阶段的影响因素。结果:快速急诊标本TAT不符合ISO15189实验室TAT目标值,门诊标本、住院标本均符合ISO15189实验室TAT目标值。影响实验结果 TAT延长的主要因素为快速急诊标本未及时处理、标本量处于高峰期、检测项目或者过程过于复杂繁琐、仪器故障与保养、维护影响标本检测、运送人员和其他人员素质不够,与临床沟通不够等。结论:门诊和住院的标本符合ISO15189实验室TAT目标值,满足了临床和病人的需要。对未符合ISO15189实验室管理采取急诊标本进行优先处理,保证检验质量和临床需求。     

临床血液学与体液学实验室申请医学实验室认可的方法研究

自2003年《医学实验室‐质量和管理要求》（ISO15189：2003）发布以来,经中国合格评定国家认可委员会（CNAS ）于2008年修订为最新版《医学实验室质量和能力认可准则》（ISO15189：2007）（以下简称《认可准则》）［1］。国内已有100多家医学实验室、医学检测中心等通过了医学实验室认可,全面提升了管理质量和水平［2］。本实验室于2013年年初通过评审,现就临床血液学与体液学检验领域认可的经验与体会报道如下。     

分析前的质量保证在临床检验中的重要意义

分析前阶段又称检验前过程(pre-examination process).按ISO 15189:2003(E)<医学实验室-质量和能力的专用要求>的定义:分析前阶段按时间顺序,该阶段始于来自临床医师的申请包括检验要求,患者准备,原始样本采集,运送到实验室并在实验室内部的传递,直到检验分析过程开始时结束.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.