实验室信息系统对检测后标本的管理

目的实验室信息系统（laboratory information system，LIS）利用样本条码标识建立实验室自动化系统检测后标本的管理流程。方法自动化流水线的标本检测完成后，设计LIS，根据样本条码校验项目完成属性，记录存放位置，检索需复查样本的存放状态，核定样本销毁时限等，实现信息化监控的样本后管理流程。结果建立了实验室自动化系统中标本在线和离线的规范高效管理，实现了检测标本管理流程的各节点监控，可有效预防样本后处理流程中的失误。结论应用该LIS建立了有效的标本管理流程并规范了实验室管理。     

Direct microscopic examination of clinical specimens for the laboratory diagnosis of fungal infections

The question of which stain or procedure to use for the detection of fungal elements is one that can be resolved by personal preference and user experience. All procedures require technologists to remember that specimens may contain any number of bacterial, fungal, or other etiologic agents. To “think microbiology” when looking at any type of direct examination will lead to better detection rates.

Advances continue to be made in the area of rapid and direct detection of fungi in clinical specimens. Molecular techniques such as DNA probes, in situ hybridization, and the polymerase chain reaction are currently being evaluated in several reference laboratories. These techniques are shown to have high degrees of sensitivity and specificity. However, they are very specialized and cumbersome test that require several hours to complete, and will not be readily available to the average mycology laboratory in the near future.

Currently, laboratories must rely on the astute powers of observation and inquisitive minds of those performing the work. Calcofluor white appears to enhance the detection of fungal elements due to its staining properties. Laboratories will find that investing in a fluorescent microscope and approproate filters will yield better patient care.     

Genetic, clinical, and laboratory markers for DOCK8 immunodeficiency syndrome

DOCK8 immunodeficiency syndrome (DIDS) is a combined immunodeficiency characterized by recurrent viral infections, severe atopy, and early onset malignancy. Genetic studies revealed large, unique deletions in patients from different families and ethnic backgrounds. Clinical markers of DIDS include atopic dermatitis, allergies, cutaneous viral infections, recurrent respiratory tract infections, and malignancy. Immune assessments showed T cell lymphopenia, hyper-IgE, hypo-IgM, and eosinophilia. The impaired lymphocyte functions in DIDS patients appear central for disease pathogenesis.     

An examination of the usefulness of repeat testing practices in a large hospital clinical chemistry laboratory

A long-standing practice in clinical laboratories has been to automatically repeat laboratory tests when values trigger automated "repeat rules" in the laboratory information system such as a critical test result. We examined 25,553 repeated laboratory values for 30 common chemistry tests from December 1, 2010, to February 28, 2011, to determine whether this practice is necessary and whether it may be possible to reduce repeat testing to improve efficiency and turnaround time for reporting critical values. An "error" was defined to occur when the difference between the initial and verified values exceeded the College of American Pathologists/Clinical Laboratory Improvement Amendments allowable error limit. The initial values from 2.6% of all repeated tests (668) were errors. Of these 668 errors, only 102 occurred for values within the analytic measurement range. Median delays in reporting critical values owing to repeated testing ranged from 5 (blood gases) to 17 (glucose) minutes.     

Genetic susceptibility testing for hereditary breast and ovarian cancer--approach from a commercial clinical laboratory

Genetic testing for hereditary cancers and other common diseases are still considered as the research testing, not for the clinical testing in Japan. One of the major reason of this situation is related to the guidelines regarding the human genetic testing issued successively in the spring of 2001, one by joint work of the eight learned societies and the other by the Japan clinical laboratories association. Both of these guidelines warn the condition of the clinical application of genetic testing after research stage must have the evidence data for clinical utility. We describe the situation of the genetic testing in the U.S. focusing the social background of increasing breast cancer cases and the contribution of Myriad Genetic Laboratories, Inc. for the genetic testing industry. We also describe the Japanese situation of the genetic testing and problems to be solved before spreading widely.     

Good laboratory management and clinical laboratory physician

Medical expenses have been increasing annually, and reducing expenses while maintaining effective medical care is desirable. In the late 1990s, Japanese government introduced policies expected to improve the medical security system. In the clinical laboratory field, some revisions such as packaging of certain tests(blanket test), separation between performance and interpretation fees for laboratory test, proper use of tumor markers, and additional fees for sample management. Japanese government also wants the clinical laboratory to return accurate laboratory test result to patients and physicians. Laboratory physicians have to make a great effort to manage clinical laboratories according to the guideline for GIOs of laboratory physicians from the Japanese Society of Clinical Pathology. The laboratory physician is the key person for good laboratory management.     

Inflammatory reaction and laboratory tests: hematologic examination

The leukocyte count, the differential leukocyte count and the erythrocyte sedimentation rate (ESR) are the more commonly used tests for diagnosing or managing an inflammatory process. Measurements of acute-phase proteins has an advantage over that of the leukocyte count and ESR. Especially microscopic examination of peripheral blood smear can be time consuming, but the simple and inexpensive technique is still clinically useful when a high grade bacteremia is likely to be present. Although the results are examiner dependent, it should be reliable in the proper clinical setting. In the guidelines for the selection of laboratory tests for monitoring the acute phase response, published in 1988, the International Committee for Standardization in hematology (ICSH) considered the biohazzard of ESR. Therefore the ESR should not routinely be performed on blood samples from patients who show a positive test for hepatitis virus or human immunodeficiency virus. The subcommittee for laboratory tests in daily care situations in Japan Society of Clinical Pathology published the "Essential Laboratory Tests" in 1989. We conclude that the differential leukocyte counts and the ESR should be used to follow the activity and response to treatment of certain inflammatory disorders when other objective indicators are not available.     

地中海贫血产前筛查的循证检验

目的评价红细胞平均体积(MCV)、红细胞脆性试验和血红蛋白(Hb)电泳在地中海贫血产前筛查中的应用价值,为临床寻找一个较理想的地贫产前筛查的检验方法。方法选择2年间在我院进行系统产前检查的孕妇2060例资料,对已被基因诊断证实的210例地中海贫血孕妇的筛查实验结果进行回顾性分析。结果MCV、红细胞脆性及Hb电泳单项检测在地中海贫血产前筛查的灵敏度和特异度分别为:97.6%、89.5%、90.0%及76.0%、89.3%、97.3%;MCV与Hb电泳、红细胞脆性与Hb电泳两项平行联合检测的灵敏度及特异度分别为:100.0%、99.0%及86.7%、89.3%,系列联合检测的灵敏度及特异度分别为:89.0?.1%及99.7%、100.0%。MCV、红细胞脆性及Hb电泳三项平行联合检测的灵敏度及特异度分别为:100.0%、79.7%;三项系列联合检测的灵敏度及特异度分别为:86.7%、100.0%。经u检验,平行联合检测的灵敏度与各单项检测灵敏度之间、系列联合检测的特异度与各单项检测特异度之间差异有统计学意义(P<0.05)。结论MCV、红细胞脆性及Hb电泳三项联合检测是地中海贫血产前筛查的最理想的试验方法。     

International trends in clinical laboratory testing

During the 20th century, at least until the 1980s, clinical laboratory practice had been rapidly expanded, mainly because of a significant advancement in medicine as a whole and also in laboratory technology. However, recent economic changes in health care environment worldwide have been influencing greatly future trends in clinical laboratory practice. In 1983, the DRG/PPS was introduced in the Medicare hospital care in the United States, and it will be introduced also in out-patient care after the January of 2000. This payment system has been expanded to the HMO, and a drastic change has occurred in clinical laboratory practice, particularly since 1988 when the CLIA'88 was implemented. In Japan, the DRG/PPS is now in the process of preparing for the future introduction into the National Health Insurance System. The clinical laboratory must pursue both quality management and adequate utilization of laboratory tests. In near future, the ISO standards in clinical laboratory testing will prompt to the implementation of quality management in the clinical laboratory. Evidence-based laboratory medicine or systematic review in diagnostic testing will be introduced in order to improve the utilization of clinical laboratory tests.     

Teaching laboratory medicine. The clinical laboratory experience

A medical student's introduction to the clinical laboratory often sets the tone for the relationship that will exist between him or her and the laboratory throughout medical practice. As part of the sophomore pathology and laboratory medicine course at the University of South Alabama, Mobile, groups of seven or eight medical students spend one hour in each of ten different areas of the clinical laboratory. This experience acquaints the students with laboratory personnel, organization, and procedure, and emphasizes the importance of communication between clinicians and the laboratory staff. Consequently, our students have greater awareness of the capabilities and limitations of laboratory testing. This has, in turn, resulted in more efficient use of laboratory resources by clinicians and fewer complaints about laboratory service. The relatively small size of the classes in our institution enables us to schedule these sessions effectively. However, schools with larger classes could use a similar system since many of these schools have access to laboratories at more than one hospital.     

Placental examination in a clinical setting

Placental examination has been proved to be of clinical value in cases selected because of gestational complications, unusual disorders of mother or infant, perinatal death, problems in perinatal diagnosis, and multiple pregnancy. Ten percent to 15% of births meet these criteria for selection. Causes of perinatal death, such as placental abruption, cord accidents, placental infarction, infection, and hematologic disorders, have been demonstrated. Clinically occult abnormalities, including chronic infections, maternal vascular disease, neoplasms, and storage diseases, have been recognized. Amniotic lesions and single umbilical artery have directed attention to fetal malformations. Monozygosity has been documented by monochorionic placentation. As a diagnostic source, the placenta has contributed to clinical care, understanding of disabilities among surviving children, and insight of forensic value. Limitations of placental studies stem from their qualitative nature and from gaps in current knowledge of gestational pathophysiology.