山西省血液中心参加中国国际输血感染预防和控制室间质评的结果分析

目的：分析2013年我实验室参加中国国际输血感染预防和控制（CITIC）室间质评的结果,验证实验室检测输血传染病标志物的能力,提高实验室检测水平。方法将实验室CITIC室间质评的结果与目标结果进行比较,验证检测方法的符合性、灵敏度和特异性。结果2013年实验室参加CITIC室间质评3次,检测CITIC室间质评标本75个,其中第1次室间质评的结果与目标结果不一致的标本有2个,总符合率为98%。结论HBsAg ELISA（生物梅里埃）方法检测标本M乙肝表面抗原结果与目标结果不一致的原因为标本在发放过程中快递出现故障,标本长时间存放于室温导致结果不准确;抗-HCV ELISA（索林）方法检测标本C丙肝抗体结果与目标结果不一致的原因为试剂批间差异造成的假反应性,其他结果均与目标结果符合。2013年我实验室参加CITIC室间质评的结果符合预期。     

地方病防治工作中档案的开发与利用

随着我国地方病防治事业的蓬勃发展,呼和浩特市地方病防治中心的档案工作也逐步走上了规范化、科学化管理的轨道,特别是自档案目标管理活动开展以来,更是将档案管理工作迈上一个新台阶。本文就如何提高档案编研工作,如何深入开发和利用档案信息资源做了一些探讨。     

加强分析前检验质量管理 促进检验与临床良性互动

目的：探讨加强医院分析前检验质量管理的有效手段,建立全程检验质量管理体系,促进检验与临床良性互动,提升医院整体医疗质量。方法：通过分析前检验质量保证知识宣教、建立临床科室分析前检验质量管理工作考评制度、推行检验医师制度和加强信息化建设等手段,加强全院分析前检验质量管理。结果：加强分析前检验质量管理措施,明显减少了分析前因素对检验结果的影响,保证了临床检验结果的准确和可靠性。结论：加强分析前检验质量管理,有效促进了检验与临床良性互动,显著提高了临床检验质量,为医院整体医疗质量做出了重要贡献。     

文献检索课一体化教学与开放实习室教学研究

研究文献检索课一体化教学与开放学习室的教学模式对教学效果的影响,对采用不同授课方法两组学生的考试成绩和各项能力进行分析统计,结果表明新的教学模式能明显提高学生考试成绩和各种能力并有助于提高教师水平。     

Interpretation of diagnostic data: 5. How to do it with simple maths.

The use of simple maths with the likelihood ratio strategy fits in nicely with our clinical views. By making the most out of the entire range of diagnostic test results (i.e., several levels, each with its own likelihood ratio, rather than a single cut-off point and a single ratio) and by permitting us to keep track of the likelihood that a patient has the target disorder at each point along the diagnostic sequence, this strategy allows us to place patients at an extremely high or an extremely low likelihood of disease. Thus, the numbers of patients with ultimately false-positive results (who suffer the slings of labelling and the arrows of needless therapy) and of those with ultimately false-negative results (who therefore miss their chance for diagnosis and, possibly, efficacious therapy) will be dramatically reduced. The following guidelines will be useful in interpreting signs, symptoms and laboratory tests with the likelihood ratio strategy: Seek out, and demand from the clinical or laboratory experts who ought to know, the likelihood ratios for key symptoms and signs, and several levels (rather than just the positive and negative results) of diagnostic test results. Identify, when feasible, the logical sequence of diagnostic tests. Estimate the pretest probability of disease for the patient, and, using either the nomogram or the conversion formulas, apply the likelihood ratio that corresponds to the first diagnostic test result. While remembering that the resulting post-test probability or odds from the first test becomes the pretest probability or odds for the next diagnostic test, repeat the process for all the pertinent symptoms, signs and laboratory studies that pertain to the target disorder. However, these combinations may not be independent, and convergent diagnostic tests, if treated as independent, will combine to overestimate the final post-test probability of disease. You are now far more sophisticated in interpreting diagnostic tests than most of your teachers. In the last part of our series we will show you some rather complex strategies that combine diagnosis and therapy, quantify our as yet nonquantified ideas about use, and require the use of at least a hand calculator.     

OpScan-MIMS

The expansion of a unique system for medical, epidemiological, and laboratory information management is described. The system utilizes an automated, optically scanned data entry mode (OpScan), and a generalized, interactive storage and retrieval software package (MIMS). Aggregate medical, epidemiological, and laboratory information are monitored, with the permission of the locality, via telephone terminals at four sexually transmitted disease clinics. OpScan-MIMS combines an efficient, rapid, and cost-effective method for data entry with a user-friendly computer system that requires no specialized training in computer language.     

Cost containment and labor-intensive tests. The case of the leukocyte differential count

We conducted an analysis of the use of the leukocyte differential count to determine (1) the services ordering the largest numbers of tests, (2) the proportion of differentials that were clinically justifiable and useful, and (3) the potential for real cost savings as opposed to reduction in charges if unjustified differentials could be eliminated. The sources of all laboratory requisitions during three nonconsecutive weeks were determined; criteria for test justifiability were established; an audit of a random sample of medical records was conducted on two services obtaining the most tests; and a time-motion study was undertaken in the hospital hematology laboratory. Forty-seven percent of differentials were obtained on medical and surgical inpatients and only 10% in the medical clinics. Forty-eight percent and 62% of differentials on the medical and surgical services, respectively, were unjustifiable , making up 26% of all differentials done in the hospital laboratory. Test results appear to have affected patient management in less than 3% of patients; no unjustified test altered a patient's diagnosis or therapy. Elimination of only "unjustified" medical and surgical differentials would permit a reduction of 1.8 full-time equivalent positions from the hospital laboratory. The leukocyte differential is over-used, only occasionally useful, and amenable to real cost reduction.     

Advancing Biomedical Image Retrieval: Development and Analysis of a Test Collection

ObjectiveDevelop and analyze results from an image retrieval test collection.MethodsAfter participating research groups obtained and assessed results from their systems in the image retrieval task of Cross-Language Evaluation Forum, we assessed the results for common themes and trends. In addition to overall performance, results were analyzed on the basis of topic categories (those most amenable to visual, textual, or mixed approaches) and run categories (those employing queries entered by automated or manual means as well as those using visual, textual, or mixed indexing and retrieval methods). We also assessed results on the different topics and compared the impact of duplicate relevance judgments.ResultsA total of 13 research groups participated. Analysis was limited to the best run submitted by each group in each run category. The best results were obtained by systems that combined visual and textual methods. There was substantial variation in performance across topics. Systems employing textual methods were more resilient to visually oriented topics than those using visual methods were to textually oriented topics. The primary performance measure of mean average precision (MAP) was not necessarily associated with other measures, including those possibly more pertinent to real users, such as precision at 10 or 30 images.ConclusionsWe developed a test collection amenable to assessing visual and textual methods for image retrieval. Future work must focus on how varying topic and run types affect retrieval performance. Users’ studies also are necessary to determine the best measures for evaluating the efficacy of image retrieval systems.     

我院30例布鲁菌病临床与实验室分析

目的探讨布鲁菌病的流行特征、临床表现及实验室诊断,提高对该病的认识。方法回顾性分析我院2008-2012年收治的布鲁菌病病人的临床资料、实验室数据并复习相关文献。结果 30例临床表现均有发热、多汗、乏力、布鲁杆菌凝集试验阳性,20例静脉血或穿刺液培养阳性,经细菌学鉴定为布鲁杆菌。其他伴随症状和体征有咳嗽、咳痰、头痛、心悸、关节疼痛或肿胀、肝脾肿大、肝肾功能异常等。患者初诊科室除发热门诊外,还有呼吸科、骨科、心内科、神经内科、血液科、肾病科、风湿科等。结论布鲁菌病临床表现多样,首诊于不同科室,非牧区城市医院各临床科室及检验医师均应高度重视布鲁菌病,对不明原因发热者应及早进行血培养和布鲁杆菌凝集试验。     

关于临床检验信息查询系统的开发

介绍了以《临床检验项目分类与代码》和《国际疾病分类代码-10》作为标准代码，以《全国临床检验操作规程》、近年出版的临床检验专著和医学期刊杂志一次文献作为系统信息资料来源，利用Delphi 2005开发工具，以SQL Server2000为数据库平台，开发建立具有多种查询方式的临床检验信息查询系统。     

A Document Clustering and Ranking System for Exploring MEDLINE Citations

ObjectiveA major problem faced in biomedical informatics involves how best to present information retrieval results. When a single query retrieves many results, simply showing them as a long list often provides poor overview. With a goal of presenting users with reduced sets of relevant citations, this study developed an approach that retrieved and organized MEDLINE citations into different topical groups and prioritized important citations in each group.DesignA text mining system framework for automatic document clustering and ranking organized MEDLINE citations following simple PubMed queries. The system grouped the retrieved citations, ranked the citations in each cluster, and generated a set of keywords and MeSH terms to describe the common theme of each cluster.MeasurementsSeveral possible ranking functions were compared, including citation count per year (CCPY), citation count (CC), and journal impact factor (JIF). We evaluated this framework by identifying as “important” those articles selected by the Surgical Oncology Society.ResultsOur results showed that CCPY outperforms CC and JIF, i.e., CCPY better ranked important articles than did the others. Furthermore, our text clustering and knowledge extraction strategy grouped the retrieval results into informative clusters as revealed by the keywords and MeSH terms extracted from the documents in each cluster.ConclusionsThe text mining system studied effectively integrated text clustering, text summarization, and text ranking and organized MEDLINE retrieval results into different topical groups.     

Training appropriate laboratory workers for rural health centres in Papua New Guinea

Many rural health centres in developing countries continue to treat patients without the help of any laboratory tests. The result is often inaccurate diagnosis, wasteful use of multiple drugs, and increasing drug resistance of pathogens. It is unlikely that there will ever be sufficient funds to employ a full-time laboratory worker at each of the many small remote health centres in Papua New Guinea. It is also doubtful whether staff and health extension officers who run such centres have the appropriate knowledge to adequately utilize full-time laboratory personnel. It is feasible, however, to train selected health workers in courses of three to four months' duration to perform a few simple laboratory tests part-time, in addition to their clinical duties. Suitable tests are those where the result does not require skilled interpretation. For most such tests, the result is the diagnosis. After the clinical staff have received the laboratory diagnosis, they are free to decide whether it fits the clinical picture. If so, they can then find the appropriate treatment to prescribe in standard treatment books. The present paper describes the experience in setting up and operating laboratory training for health centre staff in Milne Bay Province, Papua New Guinea. Costs and initial results of the program are discussed.     

Regulation of physicians' office laboratories. The Idaho experience

Timely availability of reliable test results enhances the office practitioner's ability to provide high-quality care that is personally satisfying to patients. Modern technology allows physicians to have such timely information available through test analyses performed in an office laboratory. Studies of physicians' office laboratories in Idaho found the performance, initially, to be unacceptably variable for many hematology, urinalysis, clinical chemistry, and microbiology tests. State regulation, requiring each office laboratory to comply with quality assurance guidelines and to participate in a proficiency testing program, resulted in a marked improvement in the proficiency level of office laboratory testing in Idaho. With the increasing dispersion of clinical laboratory technology, it is essential that standards of practice for the office laboratory be developed that ensure, within reasonable limits, the reliability of test information used in patient care. If widespread acceptance of such standards cannot be developed with a voluntary approach, states should consider regulation of office laboratories within their jurisdiction. Compliance with standards of practice, voluntarily or as a result of regulation, should promote quality performance in the office laboratory and allow the physician to use confidently the timely test information in dealing with diagnostic and management problems in patient care.     

A Simple Method for Calculating the Financial Balance of a Hospital, Based on Proportional Dividing

It is necessary to estimate financial status to determine hospital management policy. The costs and revenues (financial balance) of each hospital division are one good index. However, it is difficult to calculate the financial balance for each division, since clinics and central services are intricately involved with each other. There are no reports on a pragmatic method for calculating the financial balance. We devised a simple method based on proportional dividing. Consequently, one individual was able to complete the calculation for our hospital, which consists of 1300 beds and 23 clinics, without using the central hospital computer system.     

PubMed，ISI-Medline，Google Scholar检索性能对比测评

PubMed,ISI—Medline,Google Scholar是科研人员查找生物医学文献使用较多的检索工具。从检索范围、检索字段、检索方式、检索结果处理、个性化服务等角度对3者进行比较分析,结果表明3者均具有不可替换的优势,同时也存在各自不足,科研人员需根据需求选择相应的检索工具,制定适宜的检索策略。     

Automated pharmaceutical assistance systems

The function of the clinical pharmacokinetic service (CPS) in University Hospital is described. A methodological procedure was developed for routine interpretation of specified drug serum levels. Work lists that identify analytical procedures to be included for clinical pharmacokinetic evaluation are prepared daily. The results of all analyses of serum drug levels are evaluated by a pharmacist who is trained in clinical pharmacokinetics. Patient variables that influence serum levels of drugs are mathematically manipulated by program logic. Projections of expected drug levels as a result of dosing regimens are made and compared to measured laboratory results. Iterative programming that modifies projections on the basis of actual measurements is employed to determine individual drug dosing regimens the provide therapeutic/nontoxic serum levels of drugs. The drug/test interference system, which accesses the CPS data base, provides information concerning the potential physiologic, therapeutic, or toxic effect of drugs on biochemical substances. The system allows display of data concerning each drug before it is administered. Information concerning the date and time of initiation and termination of drug therapy allows for a warning comment to be attached automatically to the appropriate laboratory test result if interference is indicated.     

A rapid one-step method of EIA for detection of circulating antigen of Schistosoma japonicum

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The evolution of a functional real-time laboratory records retrieval and archival system

The vast flood of information resulting from medical record keeping in a clinical laboratory must be cataloged and archived. To deal with this problem we designed an approach employing automated report generation by a laboratory computer, data base management of patient laboratory results, and automated microform generation via computer output microform (COM). This paper documents the steps that led to the system we are currently employing. The system described maintains the availability of current patient laboratory data, creates a microform archive and an on-line index, and serves as the data base for research inquiries. In addition, we have experienced a cost savings over manual procedures and now possess the capability of expansion without the costly addition of personnel.     

Similar cases retrieval from the database of laboratory test results

We proposed a suitable method to search similar cases from the laboratory test results database, whose data are basically numerical and ordinal data. We transformed raw data into ordinal ranks and into new scores lying between 0 and 1, then calculated the Mahalanobis distances as a similarity measure. We used 3000 cases of blood count data. In 100 sample cases, 95% of the most similar 20 cases obtained by our method were included in those by the criterion (Mahalanobis distances calculated from raw data). Next, we applied our method to the data relevant to thyroid diseases. In 96 sample cases, the most similar 10 cases were retrieved from 1655 cases. The diagnoses were consistent with that of the sample cases in 32.4%. When we used Euclidean distance, the result worsened to 27.7%. Our method proved to be suitable in our attempt to identify similar cases in complicated laboratory test data.