Selection criteria for rehabilitation services

In an era of inadequate resources for all health services, rehabilitation services providers are frequently asked to produce criteria defining the patients they will accept. In principle rationing of services by ability to benefit is fair. In practice there are many difficulties. The evidence to allow selection of patients for rehabilitation does not exist and probably the best criterion of ability to benefit from rehabilitation (not 'likely to have a good outcome') is demonstration of benefit within a rehabilitation programme. Basic considerations of epidemiological statistical facts also show that criteria are likely to select too many inappropriate patients into services or exclude too many appropriate patients from services. The solution is for purchasers and providers to develop mutual trust and, in the UK at least, to ensure that patients who do not need rehabilitation can be discharged quickly into appropriate support services.     

Quality assurance in a large reference laboratory

The success of a quality assurance system is contingent on close adherence to each protocol, from preparation of the patient to issuance of the final result. In the event that the system experiences failures at any point, the quality of laboratory data may be jeopardized. Again, the system requires support not just from management and personnel employed at the technical level, but from the entire organization. It requires a complete commitment to quality and to the provision of a high level of service. Such quality assurance programs have been highly successful in the manufacturing industry. For an example, one need look no further than the domination of certain world markets by Japanese industries. Their commitment to quality and their system-wide quality control efforts have been essential to the success and growth of their organizations. Currently, systems that provide high levels of quality assurance are under scrutiny in an effort to reduce costs. As more effort is placed into monitoring an organization's quality, the expenditure of non-revenue producing dollars increases. A large organization should question these expenditures. However, when evaluating such a program, it should be realized that the costs associated with the pursuit of quality are often offset by savings realized through improved processes. Further, quality is a salable commodity. Its lack may be costly. According to Westgard et al., costs of quality can be grouped into prevention costs, appraisal costs, and failure costs. Prevention costs include those costs incurred through the development of sound analytic procedures and adequate training of technical personnel. Appraisal costs comprise those costs incurred as a result of challenging the analytic procedure as well as the entire system. Failure costs represent the dollars spent when out-of-control assays have to be repeated. An important step in evaluating potential savings produced by a quality control program is assigning a dollar value to the cost of repeating an assay. In general, as the quality of an organization's product increases, the expense of providing the product decreases. Likewise, as productivity increases, the cost of testing decreases. Increased quality and productivity provide a higher percentage of profit. As the profitability of an organization increases, the additional resources required to investigate new methods, themselves a valuable contribution to quality assurance, are provided.(ABSTRACT TRUNCATED AT 400 WORDS)     

临床检验量值溯源与参考系统

医疗卫生工作需要准确可比的检验结果，实现临床检验标准化的有效途径是建立和保证检验结果的计量学溯源性。溯源性通过一系列由不同等级测量程序和校准物实现的比较测量而建立，较低级别程序足够特异和校准物具有互通性是计量学溯源的前提。较高级别的测量程序和校准物称参考系统，参考系统需符合特定计量学要求，为此有关国际组织成立检验医学溯源联合委员会（JCTLM），鉴定现有国际参考测量程序、参考物质和参考实验室。总之，临床检验量值溯源问题已受到广泛重视，发展和应用参考系统将可能成为临床检验领域的重要课题。     

检验医学参考系统研究与应用以及有关问题

检验结果准确可比是医疗卫生工作的基本需要,参考系统是检验医学标准化的基础.近年我国参考系统研究在多项国家或地方科研计划的支持下取得明显进展,建立多种重要常规检验项目参考方法或候选参考方法,用于常规方法校准与评价、基质效应研究和参考物质研制.随着有关研究的不断进展,参考系统将在我国诊断试剂生产、临床实验室检验及外部质量控制等关键环节发挥重要作用.     

临床医学实验室生物参考区间的建立

目的以血清总胆固醇（TC）、高密度脂蛋白胆固醇（HDL—C）2个生化项目为例,探讨适合本实验室建立生物参考区间的方法。方法结合ISO15189：2003（E）《医学实验室——质量和能力的专用要求》条款要求和美国临床实验室标准化委员会（NCCLS）C28-A2文件推荐方法,先引用权威书刊、厂家试剂说明书或转移其他医院实验室的生物参考区间,然后进行实验验证,验证不通过的项目,收集120例健康参考个体自建适用于本实验室的生物参考区间,定期进行临床评审。结果TC现用生物参考区间验证通过,可以继续使用;HDL—C验证不通过,不适用,须自建生物参考区间,自建区间为男性0．82～1．82mmol／L、女性0．89～1．97mmol／L。结论采用本研究方法确立临床医学实验室生物参考区间从多途径保证检验指标的生物参考区间可靠、准确、科学、实用,能确保生物参考区间符合临床要求,值得推广应用。     

Use of laboratory tests in out-of-hours services in Norway

Objective

To investigate the use of laboratory tests and which factors influence the use in Norwegian out-of-hours (OOH) services.

Design

Cross-sectional observational study.

Setting

Out-of-hours services in Norway.

Subjects

All electronic reimbursement claims from doctors at OOH services in Norway in 2007.

Main outcome measures

Number of contacts and laboratory tests in relation to patients’ and doctors’ characteristics.

Results

1 323 281 consultations and home visits were reported. Laboratory tests were used in 31% of the contacts. C-reactive protein (CRP) was the most common test (27% of all contacts), especially in respiratory illness (55%) and infants (44%). Electrocardiogram and rapid strep A test were used in 4% of the contacts. Young doctors, female doctors, and doctors in central areas used laboratory tests more often.

Conclusion

CRP is extensively used in OOH services, especially by young and inexperienced doctors, and in central areas. Further investigations are required to see if this extensive use of CRP is of importance for correct diagnosis and treatment.Key Words: Clinical chemistry tests, CRP, diagnostic tests, emergency medical services, primary health careA few point-of-care laboratory tests are available for diagnostic use in out-of-hours services in Norway.

• A laboratory test was taken in 31% of all consultations/home calls.
• C-reactive protein (CRP) was the dominating test (27% of all contacts), and the rate was especially high in small children.
• Test use was most frequent in out-of-hours services in central areas and by younger doctors.

     

The ins and outs of laboratory information systems. Combining the hospital and reference laboratory

Regulatory and reimbursement pressure on laboratory and hospital organizations have led to diversified or hybrid combinations of hospital inpatient, outpatient, and reference laboratory operations. Laboratory information system (LIS) requirements to integrate these operations become more complex than for either operation alone, because inpatient and reference operations have different and sometime conflicting priorities. Careful attention to LIS requirements is necessary to implement hybrid laboratory operations systems successfully.     

计量溯源性和临床检验参考系统*

摘要：精确诊断和治疗离不开准确可比的实验室检测结果。随着自动化、室间质量评价和实验室认可的发展，检测结果越来越趋向于全球化。无论使用何种分析系统，同一个样本的检测结果应在空间和时间上具有可比性，为临床提供准确可靠的信息。计量溯源能使检测结果溯源到高级别的参考系统，是保证终端实验室检测结果准确可比、实现标准化的重要途径。该文就计量溯源性和参考系统相关内容进行概述，并介绍了2020版ISO 17511的6种校准等级及其与2003版的区别。     

检验医学参考测量系统的研究与应用

检验医学参考测量系统建设是医学实验室检验结果 量值溯源的重要保障,也是实现标准化和结果 互认的重要基础.近半个世纪以来,以参考测量程序、参考物质和参考测量实验室为架构的检验医学参考测量系统已基本形成,并逐渐完善.近10年来,中国医学参考测量实验室的发展进步显著,但在参考测量程序和参考物质的研究上较为滞后."检验医学参考...     

国际临床化学联合会酶学测定参考方法实验室网络的初步建立

目的 总结我国实验室运行国际临床化学联合会(IFCC)酶学测定参考方法情况和参加IFCC参考实验室室间质评(RELA)结果,了解我国酶学参考测量水平.方法 目前国内有8家实验室运行全部或部分IFCC酶学参考方法.各实验室按IFCC参考方法建立测量程序,评价各自程序的精密度与准确性,精密度评价按美国临床和实验室标准协会(CLSI)EP-5进行,准确度评价采用国际有证参考物质.7家实验室参加2006年RELA.结果 各实验室目前能达到的批内变异系数(CV)均在1.5%以内,批间精密度在2%以内.部分实验室进行了有证参考物质分析,测定结果偏倚在给定的不确定度范围内.我国酶学实验室在2006年RELA中具有与除外组相似的室间CV,只是样本A乳酸脱氢酶(LDH)及样本B ALT的室间CV较大,但剔除可能离群值后室问CV与除外组相似.结论 中国酶学实验室经过5年的发展,现在无论从硬件配置还是技术力量上均已接近国外同类实验室,我国临床酶学参考实验室网络已初步建立.     

Maintaining the quality of laboratory services in a cost-containment environment

Cutting costs while maintaining quality requires a very complete understanding of laboratory medicine and laboratory management. The pathologist must take the lead in maximizing the usefulness of laboratory information, while minimizing costs of labor, reagents, send-outs, equipment, maintenance, space, and overhead. Consideration is given to evaluation of alternative laboratory arrangements, streamlining of quality control, and monitoring and optimizing laboratory utilization, in cooperation with the clinician.     

Clinical laboratory reference intervals in pediatrics: The CALIPER initiative

Objective and rationaleReference intervals provided on laboratory reports are essential for appropriate interpretation of test results, and can significantly impact clinical decision-making and the quality of patient care. Careful determination and/or validation of reference intervals by the laboratory for use in the patient population it serves are therefore important to ensure their proper utility. Unfortunately, critical gaps currently exist in accurate and up-to-date pediatric reference intervals for accurate interpretation of laboratory tests performed in children and adolescents. These critical gaps in the available pediatric laboratory reference intervals have the clear potential of contributing to erroneous diagnosis or misdiagnosis of many diseases of childhood and adolescence. Most of the available “normal” ranges for laboratory tests were determined over 2 decades ago on older instruments and technologies, and are no longer relevant considering the current testing technology used by clinical laboratories. It is thus critical and of utmost urgency that a more acceptable and comprehensive database be established.Discussion and conclusionIn the present review, we discuss the considerations and challenges faced when generating and validating reference intervals in accordance to the current guidelines published by the Clinical Laboratory Standards Institute (CLSI). We raise particular attention to the present-day deficiencies in available pediatric reference intervals, and highlight the special issues and unique difficulties that are additionally faced when establishing reference intervals in children. Finally, we highlight a recent Canadian initiative, the CALIPER project, whose mandate is to establish and maintain a database of comprehensive and up-to-date pediatric reference intervals to be eventually made available to all clinical laboratories worldwide.