将循证检验医学运用于临床检验工作具有现实的临床意义

目的　探讨研究“循证检验医学”(evidance basedlaboratorymedicine ,EBLM)对临床检验工作思路的可操作性。方法　从临床检验实际工作出发,运用循证检验医学的原理和方法指导临床检验报告准确、快速地服务于临床,预防医疗事故的发生。结果　更加丰富地体现了临床检验医学实质和存在价值。结论　循证检验医学对促进临床检验实验室的进步和检验医学的发展具有重要作用。     

浅谈循证检验医学发展

随着科学技术和基础医学研究的不断发展,人们不断对循证医学有了更深刻的了解,从而促进检验医学的发展,提出循证检验医学。     

循证医学在实验诊断教学中的应用

作为"21世纪医学新思维"的标志性学科——循证医学,当前倍受医学界高度重视,其重要分支——循证实验诊断学及其在医学教育中的作用逐渐成为国际医学界关注的焦点。该文探讨了将循证医学理念和模式引入医学系本科实验诊断教学中的意义和作用,提出了实验诊断课程教学的内容和目标,并积极探索一种设计型、研究型、开放式的教学方式,以更好地促进实验诊断学的发展和地位的提高。     

关注新要求和新发展的空间

随着科学技术的飞速发展,给医学检验领域提出了新的要求,也提供了新的发展空间,值得我们医学检验工作者特别关注。如： 1 循证医学的发展,给医学检验提出了新的要求！： 循证医学 Evidence－based Medicine（EBM）就是遵循证据的医学。它要求任何临床的诊治决策,必须建立在当前最好的研究证据与临床专业知识和患者的价值相结合的基础上。遵循证据是循证医学的本质所在,而证据则是循证医学的基石。临床研究者和应用者尽可能提供和应用当前最可靠的临床研究证据是循证医学的关键。 1．1 循证医学中的证据：主要指临床人体研究的证据…     

循证医院与循环检验医学的概念

循证医学 (ｅｖｉｄｅｎｃｅ ｂａｓｅｄｍｅｄｉｃｉｎｅ)是二十一世纪临床医学的发展趋势 ,将循证医学的原则运用到检验医学中 ,将会更好地促进检验医学的发展 ,“循证检验医学 (ｅｖｉｄｅｎｃｅ ｂａｓｅｄｌａｂｏｒａｔｏｒｙｍｅｄｉｃｉｎｅ,ＥＢＬＭ)”的概念就反映了这种趋势。循证检验医学的基本概念一、循证医学的基本概念循证医学 ,简言之 ,就是任何临床的诊治决策 ,必须建立在当前最好的研究证据与临床专业知识和患者的价值相结合的基础上。所谓最好的研究证据 ,就是指迄今已有的 ,包括最新的 ,最接近事实的证据 ,它们是指来…     

应用循证检验医学提高临床实验室的价值

循证医学是近年来国内外倡导的新医学模式,在医学领域中迅速兴起,为临床医学注入了新的活力。循证检验医学的发展将改变检验医学的现状,不断地为临床诊疗提供以患者为中心的最佳实验医学技术和实验医学服务。     

循证检验医学思想在检验医学生教育中的培养和应用

由经验医学向循证医学转变是21世纪医学的一场深刻的变革。从循证医学到循证检验医学，是21世纪临床医学的发展趋势。加强对检验医学生的循证医学教育具有深远的意义。循证检验医学教育关注方法学的评估教育、检验与临床的沟通教育和检验结果对健康结局的影响教育，这是检验医学教育工作面临的挑战和艰巨使命。     

循证检验医学的发展概况

循证医学（evidence-based medicine,EBM）是以证据为基础的医学,EBM在检验医学的应用即为循证检验医学（evi-dence-based laboratory medicine,EBLM）,是遵循EBM的核心思想,在应用大量可靠的临床资料和经验的基础上,研究检验项目临床应用的价值,为临床诊断、疗效观察、病情转归提供最有效、最实用、最经济的检验项目及检验组合,并最终获得可靠的检验信息资料,为医疗决策提供循证。1检验医学的发展进入21世纪,随着人类社会的进步,科学技术得到了迅猛发展,我国经济的快速增长使得人们生活水平得到普遍提高,人们的医疗需求、保健意识和法律意识也普遍增强,从而促进了医学的发展。医学检验从形式上而言,由原始的手工操作发展成更多的计算机控制的自动化操作;从内容上而言,以分子生物学技术、免疫标记技术等新技术、新方法的出现为代表,为医学检验赋予了新的内容和新的发展空间。     

检验医学专业学生循证能力的培养

循证检验医学是将循证医学与原则应用到检验医学中的现代检验医学学科理论,它强调应用最好的现代医学检验技术和质量控制体系对检验结果进行严格的质量控制和客观评价,以达到向临床医生提供反映受检者真实客观的机体和病理情况的证据的目的[1].目前,循证医学所采用的方法学和思维方法在世界发达国家的卫生行业已被广发采用,我国检验医学专业学生是否具备这种能力关系到他们的就业和发展.     

循证检验医学

在当今倡导证据指导下的医疗行为及决策的时代 ,分析检验医学存在的问题 ,讨论将循证医学的理念引入检验医学的必要性及可行性 ,探索循证检验医学实践的途径 ,以使检验医学跟上临床医学的最新发展步伐 ,提供以病人为中心的最佳实验医学技术及实验医学服务。     

Evidence-based laboratory medicine as a tool for continuous professional improvement

BACKGROUND: Evidence-based medicine (EBM), defined as "the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of patients," seems a tool (a "new paradigm") able to meet individual clinical experience with robust observations. EBM has been driven by the need to manage information overload by cost control and by public request for the best in diagnostics and treatment. METHODS: The application of EBM in laboratory medicine or evidence-based laboratory medicine (EBLM) is aimed to advance clinical diagnosis by researching and disseminating new knowledge, combining methods from clinical epidemiology, statistics, and social science with the traditional pathophysiological molecular approach. RESULTS: EBLM, by evaluating the role of diagnostic investigations in the clinical decision-making process with emphasis on measurable outcome, can help both in improving the quality of new scientific findings and in translating the results of good-quality research into everyday practice. CONCLUSIONS: Since there is a need to integrate many educational tools to focus the strategy on promoting the implementation of best practices, the STARD proposal for robust diagnostic test primary studies, the presence of systematic reviews of high quality, and the development of valid guidelines based on the best scientific evidence may be useful to promote an a evidence-based culture for appropriateness, efficiency, and effectiveness in laboratory medicine.     

循证检验医学

在当今倡导证据指导下的医疗行为及医疗决策的时代，分析检验医学存在的问题，讨论将循证医学的理念引入检验医学的必要性及可行性，探索循证检验医学实践的途径，以使检验医学跟上临床医学的最新发展步伐，提供以病人为中心的最佳实验医学技术及实验医学服务。     

Clinical Governance and evidence-based laboratory medicine.

BACKGROUND: Clinical Governance is described as "a framework through which the NHS organisations are accountable to continue to improve the quality of the service and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish"; it is aimed to ensure continuous improvement in the overall standard of clinical care, ensuring that clinical decisions are based on the most up-to-date evidence in terms of effectiveness. METHODS: If Clinical Governance is a framework through which NHS organisations are accountable to continuously improve the quality of their services and safeguarding high standards of care, Clinical Effectiveness is a vital part of Clinical Governance. Clinical Effectiveness is a term that refers to measuring and monitoring the quality of care, and comprises various activities, including: Evidence-Based Practice, Research and Development, Clinical Audit, Clinical Guidelines, Integrated Care Pathways, and Total Quality Management. RESULTS: The application of evidence-based medicine (EBM) in laboratory medicine or evidence-based laboratory medicine (EBLM) aims to advance clinical diagnosis by researching and spreading new knowledge, combining methods from clinical epidemiology, statistics and social science with the traditional pathophysiological molecular approach. EBLM, by evaluating the role of diagnostic investigations in the clinical decision-making process, can help in translating the results of good quality research into everyday practice. CONCLUSIONS: If Clinical Governance is a framework through which organisations are accountable to improve the quality of care, health professionals should identify high quality standards, and systematically and rigorously monitor against them the process and outcomes that represent the diagnostic process. Within such a policy framework, practice guidelines are expected to play a major role, providing the basis to access the quality of care and guidance where clinical practice is found not in line with professional standards.     

循证检验医学与实验室质量控制

随着EBM在全世界的传播与普及,循证检验医学悄然兴起,但实质性研究目前还不多。本文从医院临床检验实际出发,探讨用循证医学原理和方法指导实验室质量控制的可行性。     

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。"检验医学参考测量系统的研究与应用"专题刊登的6篇论著分别就临床化学标准化、参考测量程序的建立和不确定度评定、参考物质的研制和基质效应评价、参考测量系统在体外诊断产品(IVD)和室间质量评价中的应用等方面进行介绍,希望可以为进一步推动中国医学参考测量系统的研究和应用提供参考。     

Evidence-based laboratory medicine

Evidence-based medicine (EBM) is a method for solving problems concerning the assessment of laboratory testing in patient care. Practising EBM involves the use of the available evidence to make health care decisions. The best way to practice EBM is the development, validation and implementation of guidelines. Guidelines are considered as the process by which healthcare research and experience are translated into improved patient care. In laboratory diagnostics EBM can be best demonstrated in high-prevalence conditions. Because of the number of patients encountered, high-prevalence conditions have a greater impact on patient morbidity and health care expenditure. In evidence-based laboratory medicine the best evidence comes from systematic reviewing studies of diagnostic tests. The reviewing of diagnostic trials and the development of good practice guidelines on the basis of these studies must be an important task of the scientific associations of clinical chemistry and laboratory medicine.     

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。     

Are laboratory investigations recommended in current medical practice guidelines supported by available evidence?

It has been suggested that evidence-based laboratory medicine (EBLM) could help to improve the pertinence and accuracy of medical guidelines. In order to demonstrate this, we have used an EBLM approach (i.e. a systematic review) to examine three recently published guidelines that gave quite conflicting recommendations regarding the use of laboratory variables in the management of primary non-small cell lung cancer patients. In recommending the routine measurement of serum albumin, and, to a lesser extent, that of serum calcium in the pre-therapeutic prognostic evaluation of the advanced disease, the American Thoracic Society and the European Respiratory Society were probably correct with regard to calcium but perhaps mistaken regarding albumin. Some of the recommendations of the European Group on Tumour Markers regarding the usefulness of routine measurements of tumour markers (carcinoembryonic antigen (CEA), cancer antigen 125 (CA 125), tissue-polypeptide antigen (TPA)) in the pre- and/or post-therapeutic prognostic evaluation can also be criticised. In addition, the latter society as well as the Société de Pneumologie de Langue Fran?aise did not even try to list laboratory variables, others than tumour markers, that would be useful to stratify patients participating in clinical trials (i.e. lactate dehydrogenase (LDH), albumin, calcium, blood cell count, etc.), and the laboratory variables listed by the two former societies were probably not the right ones in this context: in particular LDH and tumour markers (fragments of cytokeratin 19 (Cyfra 21-1), tissue-polypeptide-specific antigen (TPS), neuron-specific enolase (NSE)) were not mentioned. Most, if not all of these discrepancies in the current medical practice guidelines might have been avoided had an EBLM approach been used by the authors.     

Exploring the iceberg of errors in laboratory medicine

The last few decades have seen a significant decrease in the rates of analytical errors in clinical laboratories, and currently available evidence demonstrates that the pre- and post-analytical steps of the total testing process (TTP) are more error-prone than the analytical phase. In particular, most errors are identified in pre-pre-analytic and post-post analytic steps outside the walls of the laboratory, and beyond its control. However, in a patient-centered approach to the delivery of health care services, there is the need to investigate any possible defect in the total testing process that may have a negative impact on the patient. In fact, in the interests of patients, any direct or indirect negative consequence related to a laboratory test must be considered, irrespective of which step is involved and whether the error is caused by a laboratory professional (e.g., calibration or testing error) or by a non-laboratory operator (e.g., inappropriate test request, error in patient identification and/or blood collection). Data on diagnostic errors in primary care and in the emergency department setting demonstrate that inappropriate test requesting and incorrect interpretation account for a large percentage of total errors whatever the discipline involved, be it radiology, pathology or laboratory medicine. Patient misidentification and problems in communicating results, which affect the delivery of all diagnostic services, are widely recognized as the main goals for quality improvement. Therefore, some common problems affect diagnostic errors, although specific faults characterising errors in laboratory medicine should lead to preventive and corrective actions if evidence-based quality indicators are developed, implemented and monitored. The lesson we have learned is that each practice must examine its own total testing process to discover its weaknesses and identify appropriate remedies.