广西采供血机构实验室2008年室内质控情况的调查分析

目的了解广西全区采供血机构实验室质量控制效率及实验室整体检测水平的发展趋势。方法对2008年广西全区14个血站及24个单采血浆站血液检测实验室ELISA试验的室内质控数据做回顾性对比分析。结果2008年广西全区采供血机构的实验室ELISA试验的17448次室内质控中共出现失控259次,随机误差占失控次数的14.29%(37/259)、占总质控数的0.21%(37/17448),系统误差占失控次数的85.71%(222/259)、占总质控数的1.27%(222/17448),结论基本了解广西采供血机构实验室室内质控失控出现的特点及原因,有助于及时采取改进措施,不断完善和持续改进实验室质量体系,提高实验室检测水平,保证血液检验质量。     

ELISA实验室内质控失控的回顾性分析

目的 分析2010年1月～2013年6月室内质控失控情况,为实验室质量管理体系持续改进提供依据.方法 根据失控原因分类统计2010年1月～2013年6月室内质控失控次数和失控率,分析失控原因的变化情况.结果 2010年1月～2013年6月室内质控失控率为1.64％.设备管理是导致失控的主要原因,占66.2％,其次是人为差错和试剂物料原因,分别占18.5％和14.5％.结论 实验室质量管理体系运行较为稳定,通过对失控原因的分析,加强不同检测系统间差异比对、继续完善室内质控框架建立是下一步质量管理体系持续改进的方向.     

艾滋病抗体初筛室内质控分析

目的提高HIV抗体检测工作质量,保证HIV抗体初筛实验室检测结果的准确性.方法 用ELISA法检测HIV抗体,对弱阳性质控血清的S/CO值绘制质量控制图.结果 通过HIV抗体检测室内质量控制工作,可以发现检测过程中出现的如水浴箱温度失控,加样不准等一些问题,及时分析和解决.结论 弱阳性外部对照质控品S/CO值可监控HIV抗体初筛实验的重复性和稳定性,对监测实验室结果的准确性和可信度方面起了重要作用.ELISA检测手工操作步骤比较多,操作细节都对实验结果有很大影响,因此需要规范实验操作,并严格按照要求进行.     

如何分析生化室内质控失控原因

目的：探讨生化室内质控失控的引发原因，制定标准化室内质控失控处理文件。方法：统计和分析我科生化室2003年至2007年间室内质控失控原因及处理结果。结果：导致生化室内质控失控原因所占比例分别为：试剂原因52．8%；质控原因13．9％；校准品原因6．9%；人为原因3．3%；仪器原因12．8％；其它原因10．5％。结论：通过统计分析，查找经常引起失控的原因，针对性地制定室内质控方法，并采取相应的措施，实施质量改进，可大大减少室内质控失控，使检测结果更加稳定可靠，并在室内质控失控时能快速查找到失控的真正原因。     

无锡地区实验室2010年室内质控情况回顾性分析

目的了解无锡市中心血站实验室室内质控效率及实验室整体检测水平的发展趋势。方法对2010年无锡市中心血站实验室血液检测ELISA试验的室内质控数据进行回顾性分析。结果 2010年本站实验室ELISA检测项目共有5 793个室内质控结果,其中65次(1.12%)属于"警告",20次(0.35%)属于"失控";失控中随机误差7次(35%),系统误差13次(65%)。随机误差和系统误差分别占质控总数的比例为0.12%和0.22%。结论从总体上说明本站实验室室内质控效率处于室内质控的可接受范围内。     

血站实验室酶联免疫吸附试验室内质控的实施与探讨

目的探讨血站实验室酶联免疫吸附试验（ELISA）实施统计学室内质控的可行性、质控方法、质控规则与控制目标。方法收集2006～2011年乐山市中心血站实验室实施即刻法和Levey-Jennings质控图（L-J法）室内质控的情况,统计分析室内质控结果,评价现行统计学室内质控方法,讨论ELISA室内质控的控制目标。结果即刻法和L-J法简便易行,可为ELISA实验是否在控提供客观依据,有助于提高实验室检测能力;ELISA室内质控的变异系数（CV%）,批间小于20%为控制目标。结论即刻法和L-J法等统计学质控可监控ELISA实验的精密度变化,是一种保证检测结果可靠性的有效技术手段;统计学室内质控并非ELISA质量控制的全部,作用有限,全面质量管理有赖于实验室质量体系的建立、实施、监控和持续改进。     

生化室内质控失控原因分析

目的探讨生化室内质控失控的引发原因,制定标准化室内质控失控处理文件。方法统计和分析生化室2003~2007年间室内质控失控原因及处理结果。结果导致生化室内质控失控原因所占比例分别为:试剂原因52.8%;质控原因13.9%;校准品原因6.9%;人为原因3.3%;仪器原因12.8%;其他原因10.5%。结论通过统计分析,查找经常引起失控的原因,针对性地制定室内质控方法,并采取相应的措施,实施质量改进,可大大减少室内质控失控,使检测结果更加稳定可靠,并在室内质控失控时能快速查找到失控的真正原因。     

HBsAg检测室内质控失控原因及处理

酶联免疫吸附分析（ELISA）法以检测灵敏度高的特点被广泛应用。对ELISA检测方法可产生影响的因素较多,因此,进一步加强免疫检验室内质控是保证检测结果的可靠性和保障献血员血液质量安全性的重要手段。现对本实验室2007年6月间用ELISA法检测献血员血清HBsAg的室内质控结果进行回顾性分析,研究导致失控的原因,并加以纠正。现报告如下。     

乙肝表面抗原室内质控的失控分析评价

目的 通过评价、分析乙肝表面抗原的室内质量控制的失控原因,为改善工作质量提供帮助.方法 回顾统计乙肝表面抗原的室内质量控制的失控记录,汇总其失控的原因.结果 室内质控达不到试剂盒和质控的基本要求的失控发生频率是14/3 224(0.4%),而且,这类失控是比较容易追踪的,与操作者的操作失误相关,而质控品的吸光度/临界值(S/CO)比值在Levy-Jenning质控图上超过-x±3s的失控的原因多种多样,其总体的失控率是167/3 224(5.2%).结论 室内质控的分析是一个积累的过程,在出现失控的时候,坚持对实验的全过程进行一次追踪分析,尽量查找原因,形成一种制度化的工作程序,从而保证工作质量.     

人类免疫缺陷病毒抗体检测的质量控制

目的探讨影响人类免疫缺陷病毒(HIV)抗体检测结果质量的因素,采取质控措施,保证其检测结果的准确性与可靠性。方法将HIV抗体阳性血清稀释至OD/CO值为1.5～2.5,以此作为室内外部对照质控血清,检测中加入该血清,采用酶联免疫吸附测定(ELISA)法测定。结果20次检测OD/CO值的平均值(x)为2.620,标准差(s)为0.846,x±2s为0.928～4.316。结论在20次测定中出现1次失控,6次漂移。通过查核原因及更换检验人员,严格质控措施,使误差减少到允许的最低范围,提高了结果的准确性与可靠性。     

Psychometric Characteristics of the Headache-Specific Locus of Control Scale

Martin and colleagues have described their development of a Headache-Specific Locus of Control scale (HSLC) which contains 11 items for each of its three subscales: internal, health care professional, and chance orientations. In this replication study, we gathered data from patients who came to a Headache Clinic in a medical center (n = 151) and from a comparison sample (n = 192). Factor analysis and alpha coefficients were similar to those reported by Martin. Only small correlations were found between the subscale scores although some of them were statistically significant. This suggests that the HSLC is a psychometrically competent instrument. Additionally, mean scores of its three subscales differentiated the patient population from those whose headaches were less severe and thus did not seek help.     

Fundamentals of feedback control applied to microcomputer instrumentation design

Summary Feedback control is widely used in applications which range from simple control of room temperature to very sophisticated control of space flight. This paper describes some fundamentals of feedback control as they apply specifically to microcomputer based medical devices. A classical controller is described in its analog and digital implementations. Reference is made to methods for adjusting or tuning the controller for specific applications. Successful applications of adaptive or self-tuning control are discussed. Examples of feedback control include systems to control arterial blood pressure by the infusion of sodium nitropruside, systems to control arterial carbon dioxide concentration by mechanical ventilation and systems to control depth of anesthesia by controlled anesthesia delivery.     

A Survey of Persons Who Use Integrated Control Devices

Integrated devices allow users to operate multiple pieces of assistive technology items from a single input device. Through this single input device, users with severe physical limitations are able to operate several other devices such as a wheelchair, telephone, computer, and communication aid. Twenty-four integrated control users completed a telephone survey to ascertain consumer satisfaction with integrated controls. Eighteen were either satisfied or very satisfied with the evaluation for an integrated control, one was neither satisfied nor dissatisfied, two were very dissatisfied, and three did not respond to the question. Twenty were very satisfied or satisfied and four were either dissatisfied or very dissatisfied with the training they received. Twenty-two respondents indicated they were either very satisfied or satisfied with their integrated control device, one was neither satisfied nor dissatisfied, and one was very dissatisfied. In general, respondents were satisfied with their integrated control devices. Specifically, respondents were satisfied with the increase in independence and the ability to control other equipment such as television sets and computers. Simplicity, touch sensitivity, and visual/auditory feedback appeared to play important roles in satisfaction.     

Cell Dyn-1700血液分析仪质控规则选择

目的选择CellDyn1700血液分析仪质控规则。方法根据CellDyn1700血液分析仪所做的室内质控和室间质控确定仪器的不精密度(CV)和不准确度(bias),根据公式:ΔSec=[(Tea-|bias|)/s]-1.65计算出临界系统误差,然后参考王治国等人制作的单规则固定限和多规则质控选择及设计表格,选定合适的质控规则和控制测定值个数(n)。结果CellDyn1700血液分析仪测定血细胞时白细胞(WBC)、红细胞(RBC)、血红蛋白(Hb)、平均红细胞体积(MCV)、平均红细胞血红蛋白浓度(MCHC)选择1-2.5s规则(n=1),平均红细胞血红蛋白含量(MCH)选择1-2s规则(n=1),红细胞压积(HCT)、血小板(PLT)选择Westgard多规则13s/22s/R/4(n=2)。结论试验测定项目不同,测定值个数不同,选择的质控规则也不同。     

三相并网逆变器静止坐标系零稳态误差电流控制分析及在线切换控制研究

电流控制是三相并网逆变器运行的关键问题之一。为了实现快速准确的电流控制,深入分析了三相并网逆变器旋转坐标系PI控制、静止坐标系PR控制和静止坐标系PCI控制三者之间的联系和区别,证明了静止坐标系PR控制和旋转坐标系PI控制两者并不等效,探讨了静止坐标系PR控制和PCI控制在动态性能和稳态性能方面的特点,并提出一种在线平滑切换方案,有效利用两者的优势,最后搭建了基于TMS320F2812 DSP的数字控制实验平台,完成了电网电压平衡/不平衡两种情况下的实验测试,为不同工况下合理选择控制策略提供了重要的理论依据。     

Clinical review: clinical management of atrial fibrillation - rate control versus rhythm control

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the critically ill and is associated with adverse outcomes. Although there are plausible benefits from conversion and maintenance of sinus rhythm (the so-called 'rhythm-control' strategy), recent randomized trials have failed to demonstrate the superiority of this approach over the rate-control strategy. Regardless of approach, continuous therapeutic anticoagulation is crucial for stroke prevention. This review addresses the findings of these studies and their implications for clinical management of patients with atrial fibrillation.     

阳极端效应及其在肢体投照中的应用

本文通过对X线管阴阳极端X线强度差异的测定，探讨了阳极端效应的规律以及在临床投照工作中的应用。10台X线机测定结果示X线管阴阳极两端X线强度分布差异为20～70％。临床实践证明阳极端效应在肢体投照中应用的必要性和可行性，对平衡照片密度有一定价值。作者建议在日常投照工作中，对X线机阳极端效应进行监测；掌握和利用X线这一不可避免的现象而改善照片质量。同时对减少阳极端效应的影响提出了看法。     

Use of statistical process control in the production of blood components

summary .  Introduction of statistical process control in the setting of a small blood centre was tested, both on the regular red blood cell production and specifically to test if a difference was seen in the quality of the platelets produced, when a change was made from a relatively large inexperienced occasional component manufacturing staff to an experienced regular manufacturing staff. Production of blood products is a semi-automated process in which the manual steps may be difficult to control. This study was performed in an ongoing effort to improve the control and optimize the quality of the blood components produced and gives an example of how to meet EU legislative requirements in a small-scale production centre. Data included quality control measurements in 363 units of red blood cells, 79 units of platelets produced by an occasional staff with 11 technologists and 79 units of platelets produced by an experienced staff with four technologists. We applied statistical process control to examine if time series of quality control values were in statistical control. Leucocyte count in red blood cells was out of statistical control. Platelet concentration and volume of the platelets produced by the occasional staff were out of control, which was not the case with the experienced staff. Introduction of control charts to a small blood centre has elucidated the difficulties in controlling the blood production and shown the advantage of using experienced regular component manufacturing staff.     

XS-1000i血液分析仪质量控制规则的选择和分析

目的根据本实验室的实际工作情况,为XS-1000i血液分析仪选择质量控制(下称质控)规则。方法根据XS-1000i血液分析仪所做的室内质控和全球质评确定仪器的不精密度(CV)和不准确度(bias),利用操作过程规范图(OPSpecs)法选择合适的质控规则和控制测定值个数(n)。结果试验测定项目不同,测定值个数不同,选择的质控规则也不同。低值:WBC选择13s/22s/R4s/41s/10x规则(n=3),RBC、MCV选择13s规则(n=2),HGB、PLT选择13s/22s/R4s/41s/10x规则(n=2);中值:HGB选择13s/22s/R4s规则(n=2),WBC、RBC、PLT、MCV选择13s规则(n=2);高值:WBC、PLT、MCV选择13s规则(n=2),RBC、HGB选择13s/22s/R4s规则(n=2)。结论临床实验室可根据实际情况利用操作过程规范图选择质控方案,从而有效控制实验室分析结果的质量。     

质控方案设计工具在室内质量控制中的应用

目的:应用几种质控方案设计工具,根据我室现有检测方法实际性能设计理性的室内质量控制方法。方法:依据美国 CLIA’88能力验证计划的分析质量要求确定临床总允许误差(TEa),以长期室内质量控制的数据估计各方法的不精密度(CV%),以参加卫生部临床检验中心的能力对比检验(PT)成绩估计不准确度(bias%),以此计算临界误差的大小,按照方法的过程能力大小使用质控选择表格进行规则的初期选择,并用功效函数图确认质控方法的性能,确定到达特定水平质量保让时,不同规则及每批测定质控个数需检出的临界误差大小,并建立操作过程规范图。结果:我室总胆红素(TB)、肌酐(CREA)、胆固醇(CHO)的测定在低值水平处方法性能较差,不能很好地检测出误差,需要查找原因进行质量改进,其他项目可根据方法性能选择不同的规则进行控制。结论:通过质控方案设计工具的使用,建立适合本室的方法控制规则,既保证测定结果能够满足临床的质量要求,又达到节约成本的目的,同时通过积极查找并解决不满意方法存在的问题,进行持续质量改进提高我室的过程能力。