南京市2016年至2020年常规化学室间质评结果分析

目的 分析南京市二级以上实验室常规化学检测结果 ,考核不同实验室间结果 的可比性.方法 收集2016年至2020年全市各参评实验室常规化学室间质评回报结果 ,分析22个回报项目的合格率及变异系数.结果 五年来质评结果 合格率均稳定在93％以上,PT合格率较高的是淀粉酶(平均99.49％)、肌酸激酶(平均99.09％),...     

定量免疫项目室间质评4年结果回顾与分析

目的 通过回顾与分析2010年至2013年参加江苏省免疫定量项目室间质评结果,分析影响定量免疫项目检验质量的因素,进一步提高实验室免疫检验水平.方法 将2010年至2013临床免疫定量项目室间质评结果进行统计,采用能力验证（PT）方法进行评分,同时结合偏倚和SDI等指标进行分析.结果 4年室间质评肿瘤标志物平均PT得分为95分,内分泌项目为99分,3个项目出现过不合格的情况,所有项目平均偏倚的绝对值在4％ ～11％,平均SDI绝对值在0.3～1.1.结论 室间质评工作可对检验结果进行持续性的监测,可促进各临床实验室严控质量管理,从而提高检验工作的质量.     

2013—2021年江苏省免费孕前优生健康检查项目TORCH室间质评结果分析

目的 总结分析2013—2021年江苏省免费孕前优生健康检查项目TORCH室间质评结果,为不断提高实验室服务质量提供参考建议。方法 全省每年开展两次TORCH室间质评活动,每次下发弓形虫（TOX）IgM/IgG、巨细胞病毒（CMV）IgM/IgG、风疹病毒（RV）IgG,IgM抗体和IgG抗体各5支质评品。各实验室按照要求及时检测并回报检测结果、检测方法、仪器和试剂,由江苏省卫生健康发展研究中心对所有回报结果进行统计分析和评价。结果 2013—2021年合计18次TORCH室间质评考核成绩合格率除2013年和2020年个别项目低于90%外,其他年份均大于97%。TORCH检测项目结果符合率在95.23%～99.89%。结果漏检率最高为2013年的4.77%,最低为2021年的0.11%。结论 通过回顾性分析2013—2021年TORCH室间质评结果发现各实验室检测水平在不断提高,可为免费孕前优生健康检测项目提供准确可靠的检测数据。     

超敏CRP室间质评偏倚较大的原因及对策分析

目的 探讨我科室超敏CRP检测系统室间质评偏倚较大的原因及对策。方法 将卫生部临检中心室间质评成绩回报主页中超敏CRP的临检中心数据按方法、试剂、校准物及EQA分组统计后,分别观察5个EQA样品在各组中的中位数,并与我科室检测系统所属组的中位数进行比较,并以重新分组后的中位数为靶值,分别计算我科室EQA网络回报结果和冻存样品复测结果与此靶值的bias%和正确度。结果 EQA网络回报结果与冻存样品复测的结果一致,以试剂和校准物生产厂家进行分组时,两次检测结果与中位数的bias%均＜1/3TEa,正确度验证通过;而以方法和EQA分组方法分组时bias%则明显增高,虽然均＜TEa,但仍有3个及以上样品的bias%＞1/2TEa,正确度验证未通过。结论 超敏CRP室间质评时以仪器进行分组计算靶值的方式可能不适当,建议按试剂厂家进行分组或以参考方法对EQA样品赋值后进行偏倚的评估,以正确指导临床实验室进行质量改进;同时,试剂厂家应加强校准品的溯源性及互通性,且校准品的浓度应包含不同医学决定水平处的浓度。     

全血细胞计数室间质量评价结果分析及西格玛性能验证

目的 回顾性分析2014年至2018年全国全血细胞计数室间质量评价结果及西格玛管理在质量改进中的应用.方法 以实验室参加全国全血细胞计数室间质量评价回报结果为研究对象,将实验室的室内质控在控数据的累计变异系数作为不精密度的估计值,用实验室参加室间质评的测定值与靶值的百分差值的绝对值的平均值作为实验室检测的偏倚估计值,根据卫生行业标准WS/T 406-2012中的相关要求,计算相应项目的西格玛(σ)值,并绘制标准的西格玛性能验证图.结果 从2014年至2018年参加全国全血细胞计数室间质量评价PT得分来看,2014年和2016年成绩较好,PT平均得分均为100％,2015年成绩最差,PT平均得分仅有62.5％.在全血细胞计数的8个项目中,质量评价成绩比较满意的是WBC、RBC、HGB、PLT、MCH等,PT得分均为100％.成绩不稳定的项目是MCV及其关联项目HCT和MCHC,PT得分为0～100％不等.整体来看,2014年至2018年全血细胞计数室间质评项目的变异系数逐渐变小,总体趋势是σ水平逐步提高,σ<3的项目逐步减少,σ≥3的项目比例逐步提高.2014年和2016年的全血细胞计数室间质评PT评分均为100％,但2014年和2016年σ≥3的项目比例分别只有12.5％(2/16)和56.25％(9/16).2015年σ≥3的项目比例为50％(4/8),高于2014年的12.5％(2/16).2017年至2018年PT成绩比2015年有明显提高,但仍有31.25％(5/16)和18.75％(3/16)的项目的σ<3,虽然实验室的精密度(CV值)比2014年明显改善,但项目的PT得分只有93.75％～95.00％.结论 PT成绩满意,σ水平不一定高,要提高检验项目的σ水平,应关注实验室的精密度和准确度,西格玛性能验证比单独的能力验证更能客观评价实验室的检测能力.     

基于全血细胞计数的机器学习算法构建侵袭性乳腺癌预测模型

目的 探讨利用实验室全血细胞计数(complete blood count, CBC)数据和机器学习算法构建侵袭性乳腺癌预测模型,并评价其临床应用价值。方法 回顾性收集2014年1月至2022年6月来自北京市3家医院的15 979条患者数据,将其划分为训练集、验证集和测试集。应用递归特征消除法确定特征变量。使用支持向量机、随机森林、梯度提升树、逻辑回归和K最近邻5种机器学习算法构建模型。采用受试者工作特征曲线下面积(area under the receiver operating characteristic curve, AUC)、灵敏度、特异性和准确度4项指标及其95%置信区间(95%CI)评估模型性能。利用混淆矩阵图验证最佳模型的临床有效性。结果 纳入AGE、EO%、RBC、NEUT#、MCH、MPV、PDW、EO#、RDW-CV和LYMPH#10个特征变量构建模型,随机森林模型性能表现最佳,在测试集中,AUC为0.923(95%CI 0.890～0.955),灵敏度为91.4%(95%CI 0.876～0.901),特异性为83.8%(95%CI 0.832～0.837),准...     

全血细胞减少的巨幼细胞性贫血10例分析

全血细胞减少是多种疾病造成的外周血象改变,可由造血系统或非造血系统疾病引起。2000年3月至2004年10月,我科收治全血细胞减少的巨幼细胞性贫血10例,现总结分析如下:1临床资料1.1一般资料10例患者均系我科住院患者,年龄21-63岁,平均48.3岁。男7例,女3例,病程最长5月,最短12天,     

芳村区1996年～1999年碘盐监测结果分析

目的了解自1996年来芳村区碘加工、销售、食用情况.方法将1996～1999年芳村区卫生防疫站对辖区范围内碘盐监测资料整理分析,依据<全国碘缺乏病防治方案>进行结果判定.结果碘盐加工、零售、居民用户三个环节碘浓度合格率逐年提高,碘盐加工厂按批合格率由1996年的44.4%提高到1999年的91.7%,份样合格率由1996年的75.1%提高到1999年的96.7%.但零售环节、居民用户环节不合格样碘浓度极低,1999年分别为5.2mg/kg和0.5mg/kg.结论加强零售市场管理,规范碘盐流通渠道,提高食用碘盐水平是2000消灭碘缺乏病目标实现的重要保证.     

攀枝花市盐边县2012～2014年碘盐检测结果分析

目的 了解盐边县居民户食用合格碘盐情况,保障消除碘缺乏病工作的开展.方法 每年按照《四川省碘盐监测方案》采样后按GB/T 13025.7-1999直接滴定法进行检测.结果 2012～2014年共监测居民户食用碘盐900份,合格碘盐879份,碘盐覆盖率99.8％、合格碘盐食用率97.7％、碘盐合格率97.9％、非碘盐率0.22％.非碘盐2份(国胜乡1份、箐河乡1份),不合格碘盐19份,均为少碘盐(新九乡1份、箐河乡1份、共和乡3份、渔门镇8份、鱤鱼乡4份、永兴镇2份).结论 我县碘盐质量达标且稳定,但仍存在有非碘盐充销现象.     

陕西省岐山县2007年～2012年新生儿TSH、Phe筛查结果分析

新生儿疾病筛查是早期发现某些先天性或遗传性代谢性疾病的有效方法,作为降低出生缺陷三级预防措施,对减少降低儿童智力低下,提高人口素质具有深远意义。我市从2007年7月开展新生儿疾病筛查,本文旨在对2007～2012年我县新生儿TSH、Phe检测结果进行分析,以了解我县新生儿甲状腺减低（CH）及苯丙酮尿症（PKU）发病情况。     

邵武市2016~2017年布鲁氏杆菌人间感染检测结果分析

目的 掌握邵武市布鲁氏杆菌人间感染的流行趋势,逐步控制人间布鲁氏杆菌病的发病率,促进养殖业持续健康发展。方法 按照《布鲁氏菌病防治手册》,采用虎红平板凝集试验与试管凝集试验相结合的方法对涉及家畜交易、屠宰、养殖、挤乳和畜产品加工等布病高危人群进行血清学检测。结果 2016年~2017年我市共检样品429份,SAT阳性11例,其中10例抗体滴度为1:100,1例抗体滴度为1:400,阳性率为2.56%。网络直报阳性13例。结论 大量牲畜从外地引进未经有效检疫和管理,从业人员对布病的危害认识不足、自我防护的意思淡薄布病流行的主要原因,应加强牲畜流通环节的检疫和管理,做好牛羊等牲畜的集中定点屠宰,开展宣传教育,作业过程中做好个人防护,以控制疫情。     

2014~2016年成都市托幼机构消毒质量监测分析

目的 通过对我市近三年托幼机构消毒质量监测结果分析,探索存在的问题,寻找传染病防控关键环节提供科学依据,预防和控制传染病的发生。方法 依据“四川省幼托机构消毒隔离工作常规”等,于2014~2016年对我市所有托幼机构的室内空气、物体表面、工作人员手卫生等进行连续3年监测。结果 三年监测结果的总合格率为96.14%,各年度合格率处于同一水平,差异无统计学意义（P>0.05）;班级空气合格率和使用中消毒液合格率有所提高,工作人员手卫生合格率略呈下降趋势,差异有统计学意义（P＜0.05）。公立托幼机构的消毒监测合格率逐年提升,私立托幼机构则略有下降,差异有统计学意义（P＜0.05）。结论 我市托幼机构总体消毒合格水平较高,手卫生仍然是今后托幼机构开展消毒培训的重点,尤其加强对私立托幼机构的监测、管理和监督。     

心理测评及生活质量评价中被择答案用词的频数分析

目的:为生活质量评价提供标准化的等间距的被择答案用词.方法:收集了131份量表(心理量表123份、生活质量量表8份),采用SPSS10.0统计软件,分析各答案类型及其用词的频数分布.结果:常用的生活质量、心理量表里的答案中,多数为5级,占31.68%,其次为4级和3级,分别占21.99%和13.35%.答案用词呈多样化.结论:在设计生活质量评价量表的被择答案时,建议采纳5级设计.答案用词宜采用使用频率高,且具有等间距性的规范化用词.     

Assessment of multiparametric MRI in a human glioma model to monitor cytotoxic and anti-angiogenic drug effects

Early imaging or blood biomarkers of tumor response is needed to customize anti-tumor therapy on an individual basis. This study evaluates the sensitivity and relevance of five potential MRI biomarkers. Sixty nude rats were implanted with human glioma cells (U-87 MG) and randomized into three groups: one group received an anti-angiogenic treatment (Sorafenib), a second a cytotoxic drug [1,3-bis(2-chloroethyl)-1-nitrosourea, BCNU (Carmustine)] and a third no treatment. The tumor volume, apparent diffusion coefficient (ADC) of water, blood volume fraction (BVf), microvessel diameter (vessel size index, VSI) and vessel wall integrity (contrast enhancement, CE) were monitored before and during treatment. Sorafenib reduced tumor CE as early as 1 day after treatment onset. By 4 days after treatment onset, tumor BVf was reduced and tumor VSI was increased. By 14 days after treatment onset, ADC was increased and the tumor growth rate was reduced. With BCNU, ADC was increased and the tumor growth rate was reduced 14 days after treatment onset. Thus, the estimated MRI parameters were sensitive to treatment at different times after treatment onset and in a treatment-dependent manner. This study suggests that multiparametric MR monitoring could allow the assessment of new anti-tumor drugs and the optimization of combined therapies.     

Influence of dosing frequency and schedule on the response of chronic asthmatics to the aerosol steroid,budesonide

The influence of various dosing regimens on the response of asthmatic patients to aerosol steroid was investigated. Budesonide, a topically active corticosteroid like beclomethasone dipropionate, was given q.i.d. or b.i.d., in the morning or A.M./P.M., at doses of 400, 800, and 1600 μg/day. Each patient (n = 34) took every treatment combination for 2 wk. The antiasthmatic and systemic effects, measured by changes in peak expiratory flow rate (PEFR), blood eosinophils, and serum cortisol levels increased approximately linearly on log dose budesonide (p < 0.0005). Systemic effects of the drug were nonsignificant at low dosage. At high dosage, morning dosing conserved hypothalamic-pituitary-adrenal function, but at the cost of a marginal reduction in efficacy (Δ PEFR, p =0.12). Halving the dose frequency reduced the antiasthmatic potency of the drug, i.e., PEFR fell by an amount equivalent to approximately eightfold reduction in daily dosage (p = 0.002). This effect was not evident when asthma was in remission but became so with asthma in relapse. Overall, the q.i.d. A.M./P.M. regimen showed the best risk-benefit relationships. The data indicate (I) that reductions in dose frequency made with the hope of improving patient compliance and thus conserving the drug's long-term efficacy are likely to lead to the reverse effect, (2) that the clinician can conserve a better balance of risk vs benefit by titrating dosage in terms of puffs per dose rather than doses per day, and (3) that patients can increase the antiasthmatic efficacy of this aerosol steroid without any increase in drug costs (or apparent risk) by simply increasing dosing frequency. These therapeutic considerations probably apply to some or all of the other topically active steroids currently used to treat asthma.     

Health outcomes and related effects of using social media in chronic disease management: A literature review and analysis of affordances

Whilst the future for social media in chronic disease management appears to be optimistic, there is limited concrete evidence indicating whether and how social media use significantly improves patient outcomes. This review examines the health outcomes and related effects of using social media, while also exploring the unique affordances underpinning these effects. Few studies have investigated social media’s potential in chronic disease, but those we found indicate impact on health status and other effects are positive, with none indicating adverse events. Benefits have been reported for psychosocial management via the ability to foster support and share information; however, there is less evidence of benefits for physical condition management. We found that studies covered a very limited range of social media platforms and that there is an ongoing propensity towards reporting investigations of earlier social platforms, such as online support groups (OSG), discussion forums and message boards. Finally, it is hypothesized that for social media to form a more meaningful part of effective chronic disease management, interventions need to be tailored to the individualized needs of sufferers. The particular affordances of social media that appear salient in this regard from analysis of the literature include: identity, flexibility, structure, narration and adaptation. This review suggests further research of high methodological quality is required to investigate the affordances of social media and how these can best serve chronic disease sufferers. Evidence-based practice (EBP) using social media may then be considered.     

Quality validation of platelets obtained from the Haemonetics and Trima Accel automated blood-collection systems

BackgroundPlatelet transfusion is required to treat haemo-oncology or trauma patients. Platelet apheresis (PA) performed with apheresis equipment has increased rapidly in recent years. Leucocyte-reduced platelet apheresis (LRPA) can reduce the risk of platelet refractoriness and febrile nonhemolytic transfusion reactions (FNHTRs) for transfusion. Accordingly, this study aimed to investigate and compare the platelet metabolic and functional responses between PA performed with Haemonetics and LRPA performed with Trima Accel cell separator.MethodsThe qualities of platelets collected through PA and LRPA were evaluated in terms of visual appearance, morphology, platelet-aggregation changes, metabolic activities, and bacterium-screening test during 5-day storage. Statistical analyses included two-sample t-test and generalised estimating equation(GEE) method.ResultsDuring 5-day storage in LRPA, residual leucocytes were all <1.0×10⁶, and the parameters of platelet function were as follows: platelet aggregated to agonists such as adenosine 5′-diphosphate (ADP) and collagen, and the extent of shape change and pO₂ showed no statistically significant difference between PA and LRPA. The hypotonic shock reaction (HSR) on days 0, 1, and 3 were significantly higher in LRPA than in PA (71.78±6.92 vs. 64.10±7.42; P=0.002; 71.53±8.98 vs. 62.96±9.84; P=0.007; 68.05±7.28 vs. 57.76±6.80; P<0.0001, respectively). Values of mean platelet volume (MPV) were statistically larger in PA than in LRPA on days 0, 1, and 3. On day 5, the swirling score was higher in LRPA than in PA. The mean lactate levels had no statistically significant difference between PA and LRPA. Moreover, no growth was observed through bacterium-screening test conducted on 40 samples.ConclusionComparison of LRPA and PA products collected from the Trima Accel and Haemonetics automated blood-collection systems, respectively, revealed that both products possessed good platelet qualities even though additional processes are needed to reduce leucocytes. Furthermore, investigating the outcomes of other apheresis instruments with focus on the safety of donors, products, and recipients is necessary.     

From expert-derived user needs to user-perceived ease of use and usefulness: A two-phase mixed-methods evaluation framework

Underspecified user needs and frequent lack of a gold standard reference are typical barriers to technology evaluation. To address this problem, this paper presents a two-phase evaluation framework involving usability experts (phase 1) and end-users (phase 2). In phase 1, a cross-system functionality alignment between expert-derived user needs and system functions was performed to inform the choice of “the best available” comparison system to enable a cognitive walkthrough in phase 1 and a comparative effectiveness evaluation in phase 2. During phase 2, five quantitative and qualitative evaluation methods are mixed to assess usability: time-motion analysis, software log, questionnaires – System Usability Scale and the Unified Theory of Acceptance of Use of Technology, think-aloud protocols, and unstructured interviews. Each method contributes data for a unique measure (e.g., time motion analysis contributes task-completion-time; software log contributes action transition frequency). The measures are triangulated to yield complementary insights regarding user-perceived ease-of-use, functionality integration, anxiety during use, and workflow impact. To illustrate its use, we applied this framework in a formative evaluation of a software called Integrated Model for Patient Care and Clinical Trials (IMPACT). We conclude that this mixed-methods evaluation framework enables an integrated assessment of user needs satisfaction and user-perceived usefulness and usability of a novel design. This evaluation framework effectively bridges the gap between co-evolving user needs and technology designs during iterative prototyping and is particularly useful when it is difficult for users to articulate their needs for technology support due to the lack of a baseline.