加强实验室的检验质量管理

检验质量是实验室的立足之本。围绕实验室质量控制 ,已制定了室内质控和室间质评制度。但随着科技进步、环境及人员的变化 ,检验质量控制已不能局限于实验室内部。现按照仪器 (试剂 )、项目 (标本 )和制度 (人员 )这 3个决定检验质量的关键环节 ,就如何加强实验室质量管理提出一些看法和建议。一、保证合格仪器和试剂进入实验室 ,消除质量隐患(一 )控制检验仪器和试剂的来源 :由于检验仪器和试剂 (特别是进口仪器和试剂 )的极大利润诱惑及医院的采购制度不完善 ,使得一些不完全具备技术条件的公司通过各种手段获得经营检验仪器和试剂的准入…     

微生物检验质量控制影响因素分析

随着卫生检验工作逐步与国际接轨,实验室质量控制已成为实验室竞争生存的必要条件。按照《检验和校准实验室能力的通用要求》和《产品质量检验机构计量认证／审查认可(验收)评审准则(试行)》的要求,实验室必须建立质量控制体系,提供公正、准确、科学的检验数据,为卫生行政部门制定疾病预防与控制策略及采取措施和卫生监督提供科学依据,为社会日益增长的卫生需求提供卫生技术服务。因此,有必要调查分析影响微生物检验质量控制的因素,以提高微生物检验工作的质量。     

2005年-2010年浙江省全血细胞计数室间质量评价结果分析

临床实验室检验结果在临床诊断、治疗、观察病情等过程中具有重要作用。临床检验室间质量评价(external quality as-sessment,EQA)通过多家实验室分析同一样本,在实验室间建立可比性,对实验室的检验质量进行评价与监督,提高了实验室识别检测误差的能力,对保证临床检验的准确性和一致性起了积极的作用,同时为实验室间结果的互认提供依据。2006年的《临床实验室管理办法》明确规定实验室必须参加     

疾控中心微生物实验室质量控制与影响因素探讨

在微生物检验过程中,由于操作过程相对复杂,影响检验结果准确性的因素较多。因此,完善和健全的质量控制管理体系是确保实验室有效运行和检验数据准确性与可靠性的重要保障。本文通过对本地区疾控中心微生物实验室室内质量控制(包括检测人员、环境设施、仪器设备、检验方法、标本处理、材料)和室间质量控制(包括能力验证活动、室间比对)情况的分析和总结,探讨可能影响实验室检测活动相关的各种质控因素,并制订相应的计划。旨在加强微生物实验室建设,提高疾控中心微生物实验室在疾病预防控制和卫生应急事件中的处置能力,为基层微生物实验室建立完善的质量管理体系提供参考。     

生化免疫检验结果自动审核信息化系统构建及其验证研究

目的：设计并构建生化免疫检验结果自动审核信息化系统,促进审核系统的智能化及科学应用,提高检验结果的准确性。方法：参考《医疗质量管理办法》和《医学实验室质量和能力认可准则》(ISO15189),以及美国病理学会(CAP)清单以及《自动审核的应用指南》AUTO-IO等文件,构建适合临床检验工作的生化免疫检验结果自动审核信息化系统,以自动化流水线中间体软件为核心,整合实验室自动化系统(LAS)各功能模块、实验室信息系统(LIS)系列硬件、软件和医院信息系统(HIS),搭建生化免疫检验结果自动审核信息化系统。结果：在临床生化检验工作中应用生化免疫检验结果自动审核信息化系统,可实现对检验科样本的有效审核。应用系统后,检验科样本审核时间缩短,样本审核报告的准确性明显提高,整体提升了临床生化检验的工作效率。结论：生化免疫检验结果自动审核信息化系统的构建与应用明显提高了临床生化检验的工作质量,进一步保证样本审核报告的准确性。     

疾控中心微生物实验室质量控制的影响因素与措施

目的 针对本疾控中心微生物实验室质量控制问题进行深入分析,探讨其发生因素及应对措施。方法 以本疾控中心2015年1月— 2017年1月开展的微生物实验室质量控制工作为研究对象。其中2016年1月— 2017年1月开始执行全面质量控制管理(观察组),2015年1— 12月采用常规质控管理(对照组),分别在2个时间段中随机抽取出146份微生物检验样本,统计质量问题发生率及发生原因。结果 观察组质量问题发生率(4.7%)明显低于对照组(19.8%,P<0.05);观察组实验室质量影响因素(人员、样本、检验操作、环境、仪器等)发生率均低于对照组,差异有统计学意义(P<0.05)。结论 疾控中心微生物实验室质量控制影响因素众多,全面认知影响因素发生原因并积极采取有效控制措施,降低质量问题发生率,提升微生物检验结果准确性目的,是目前相关部门首要解决的任务。     

微生物实验室质量控制的影响因素分析

目的探究微生物实验室质量控制的影响因素及相关对策。方法将2019年1月—2020年1月青岛西海岸新区某二级医疗机构微生物实验室的84份微生物检验样本为对照组,采取常规管理方案;将2020年1月—2021年1月该实验室的84份微生物检验样本为研究组,采取质量控制措施。对比两组微生物检验样本质量问题发生率。结果两组微生物检验样本质量问题发生率,研究组低于对照组,差异有统计学意义(P0.05)。影响医疗机构微生物实验室质量控制的因素包括人员、样本与试剂、环境与设备、实验室管理等,其中对照组以人员和实验室管理为主要影响质量的因素。结论依据相关影响因素开展医疗机构微生物实验室质量控制可降低微生物检验样本质量问题发生率。     

CNCA-12-A01食品微生物学能力验证结果分析

能力验证是利用实验室间比对来确定实验室检测能力的活动,是实验室质量控制的重要方式[1].通过能力验证,对检验人员技能、实验室内部质量控制情况进行检验,能最有效地消除偏差,提高检验人员检测水平,保证检测数据达到检验质量标准[2].2012年10月北京市西城区疾病预防控制中心微生物实验室参加了中国国家认证认可监督管理委员会(CNCA)组织的CNCA-12-A01食品微生物学能力验证计划.     

“6S”管理模式在公共卫生实验室内务活动中应用

近年来,国内一些外资企业在实验室人员、设备、材料、方法、设施环境等质量控制要素的内务管理中引进整理(Seiri)、整顿(Seiton)、清扫(Seiso)、清洁(Seiketsu)、素养(Shitsuke)、安全(Security)等管理模式(简称“6S”),可使实验环境整洁、有序,有效利用实验室空间、降低资源消耗、减少寻找时间、提升设备性能、提高工作效率,预防为主,保证实验室安全,保证检验报告质量[1-2].     

影响理化检验结果的主要因素及改进措施

<正>各级疾病预防控制机构实验室作为向社会出具公信力检验报告的检验检测机构,按照《实验室资质认定评审准则》(2016年1月1日将更新为《检验检测机构资质认定评审准则》)的要求,需要建立一整套完整的质量管理体系,以保证检测结果和服务质量。理化实验室作为疾病预防控制中心实验室的重要组成部分,其日常质量管理和质量控制工作需要持续不断的提高和完善。本研究针对理化检验工作中影响检验结果的主要因素进行分析,提出持续改进措施。     

EDTA-dependent pseudothrombocytopenia in a case of liver cirrhosis

Pseudothrombocytopenia (PTCP) is the consequence of an EDTA-activated platelet agglutination, resulting in a spuriously low platelet count. We report the case of a 54-year-old man with EDTA-dependent PTCP associated with liver cirrhosis. He couldn't undergo endoscopic examination and dental care for two years because of a previous diagnosis of severe thrombocytopenia secondary to liver cirrhosis. Lack of PTCP recognition may lead the physician to misdiagnosis and mismanagement of the patient.     

假性血小板降低对临床患者检测值的影响

目的探讨临床患者检测中EDTA依赖性假性血小板减少现象的存在,以降低临床误诊率。方法采用sysmex-5000血液分析仪分析EDTA-PTCP阳性患者静脉血经EDTA抗凝后不同时间的血小板数量,同时检测同一患者静脉血用枸橼酸钠和肝素抗凝后的血小板数量并用手工计数方法检测该患者血小板数量。结果枸橼酸钠和肝素抗凝法及手工计数法与EDTA抗凝血30min以后上机检测法比较差异有统计学意义（t=13.24、14.36、14.22,P〈0.05）,EDTA抗凝血30min以后上机检测法与EDTA抗凝血10min内上机检测法比较差异有统计学意义（t=13.34,P〈0.05）,枸橼酸钠和肝素抗凝法及手工计数法与EDTA抗凝血10min内上机检测法比较差异均无统计学意义（t=0.06、0.07、0.21,P〉0.05）。结论EDTA—PTPC阳性患者,静脉血经EDTA抗凝30min以后上机检测法与肝素和枸橼酸钠抗凝上机检测法及手工计数法有很大的差别。对于首次检测血小板数值减低的标本均应用手工计数血小板或涂片镜检,以确认是否存在抗凝剂所致血小板聚集现象,以降低假性血小板减少引起的误诊。     

Implementation of the redesigned Community Health Fund in the Dodoma region of Tanzania: A qualitative study of views from rural communities

The need to understand how an intervention is received by the beneficiary community is well recognised and particularly neglected in the micro–health insurance (MHI) domain. This study explored the views and reactions of the beneficiary community of the redesigned Community Health Fund (CHF) implemented in the Dodoma region of Tanzania. We collected data from focus group discussions with 24 groups of villagers (CHF members and nonmembers) and in‐depth interviews with 12 key informants (enrolment officers and health care workers). The transcribed material was analysed thematically. We found that participants highly appreciate the scheme, but to be resolved are the challenges posed by the implementation strategies adopted. The responses of the community were nested within a complex pathway relating to their interaction with the implementation strategies and their ongoing reflections regarding the benefits of the scheme. Community reactions ranged from accepting to rejecting the scheme, demanding the right to receive benefit packages once enrolled, and dropping out of the scheme when it failed to meet their expectations. Reported drivers of the responses included intensity of CHF communication activities, management of enrolment procedures, delivery of benefit packages, critical features of the scheme, and contextual factors (health system and socio‐political context). This study highlights that scheme design and implementation strategies that address people's needs, voices, and values can improve uptake of MHI interventions. The study adds to the knowledge base on implementing MHI initiatives and could promote interests in assessing the response to interventions within the MHI domain and beyond.     

Evaluation of physical activity counseling in primary care using direct observation of the 5As

BACKGROUND

The 5As (ask, advise, assess, assist, arrange) are recommended as a strategy for brief physical activity counseling in primary care. There is no reference standard for measurement, however, and patient participation is not well understood. This study’s objectives were to (1) develop a coding scheme to measure the 5As using audio-recordings of primary care visits and (2) describe the degree to which patients and physicians accomplish the 5As.

METHODS

We developed a coding scheme using previously published definitions of the 5As, direct-observation measures, and evaluation of audio-recorded discussions of physical activity. We applied the coding scheme to 361 audio-recorded visits by patients reporting low levels of physical activity and 28 physicians in northeast Ohio.

RESULTS

The coding scheme achieved good inter-rater agreement for each of the 5As (κ = 0.62–1.0). A total of 135 visits included discussion of physical activity. Although ask tasks occurred in 91% of visits, it infrequently elicited sufficient detail about current activity. Patient readiness to change physical activity (assess) was infrequently directly elicited by the physician (24%), but readiness was commonly expressed by the patient in response to an assessment of current level of physical activity (53%). Ambivalence was infrequently followed by physician assistance (49%).

CONCLUSIONS

Our newly developed measure showed that (1) physicians infrequently assess patient readiness to change, (2) patient expressions of ambivalence are common, and (3) specific mention of recommended guidelines for exercise is nearly absent. Future work should increase clinician skills in exploring ambivalence and readiness to change, as well as improve explicit mention of recommended guidelines for physical activity.     

Supplying emergency contraception via community pharmacies in the UK: reflections on the experiences of users and providers

This paper discusses findings from an evaluation of a scheme to provide free emergency hormonal contraception (EHC) via community pharmacies in the North-West of England. Drawing on interview data with pharmacists taking part in the scheme and focus groups with users, we tentatively suggest that the scheme was largely well received. The benefits of the service, cited by both pharmacists and users, included enhanced access to EHC, at times when it was needed, and at no cost to the user. In particular, users noted a welcome absence of judgmental attitudes when accessing the service. Pharmacists too were positive about the service, not least because they believed that it conferred enhanced professional status. However, both users and pharmacists had a number of major concerns about the schemes, centring on the potential for misuse, changes in contraceptive behaviour and the impact on sexually transmitted infections. We conclude that more research is needed to explore these issues.     

Meta分析发表偏倚的联合诊断研究

摘要:目的 评价基于发表时间顺序的发表偏倚诊断方法与基于效应量及其误差项的传统诊断方法联合诊断发表偏倚的准确度。方法 采用无偏和有偏的Meta分析模拟数据计算各并联联合诊断方案的灵敏度和特异度,评价6种联合诊断方案的诊断准确度。结果 未加权效应量-发表时间顺序回归模型法和Egger回归法并联时灵敏度最高(0.613);样本例数倒数为权重的效应量-发表时间顺序加权回归模型法和Begg秩相关法并联时特异度最高(0.729),且在6种联合诊断方案中其约登指数最大(0.313)。结论 基于不同理论依据构建的发表偏倚诊断方法以并联方式联合应用时可以提高发表偏倚的诊断准确度,6种联合诊断方案中,效应量-发表时间顺序加权回归模型法和Begg秩相关法为最优方案。     

A review of point-of-choice nutrition labelling schemes in the workplace, public eating places and universities

Background: Nutrition labelling schemes at the point-of-choice allow opportunity for behaviour change by modifying the environment. In the workplace they provide a particularly good opportunity to expose employees repeatedly to healthier food choices. The Heartbeat Award scheme (HBA) is an example of such a scheme and was launched in England in 1990 by the Health Education Authority. Method: Twenty point-of-choice labelling schemes are reviewed in the workplace, public eating places and universities. We outline the characteristics of effective programmes, and suggest how the HBA scheme could be developed to maximize its impact. Results: Nutrition labelling schemes may be most effective when they are adapted for the target audience and use simple messages, especially if the messages promote both healthiness and taste. Even though schemes may not have an immediate effect on food choice, they may act together with other factors to enhance customer self-efficacy, thereby increasing the likelihood of positive food choices being made. Conclusion: Most of the studies reviewed demonstrate some positive short-term benefits from schemes. We are unable to conclude that these result in long-term behaviour changes, because of a lack of follow-up studies.     

Physician payment mechanisms,hospital length of stay and risk of readmission: Evidence from a natural experiment

We provide an analysis of the effect of physician payment methods on their hospital patients’ length of stay and risk of readmission. To do so, we exploit a major reform implemented in Quebec (Canada) in 1999. The Quebec Government introduced an optional mixed compensation (MC) scheme for specialist physicians working in hospital. This scheme combines a fixed per diem with a reduced fee for services provided, as an alternative to the traditional fee-for-service system. We develop a model of a physician's decision to choose the MC scheme. We show that a physician who adopts this system will have incentives to increase his time per clinical service provided. We demonstrate that as long as this effect does not improve his patients’ health by more than a critical level, they will stay more days in hospital over the period. At the empirical level, we estimate a model of transition between spells in and out of hospital analog to a difference-in-differences approach. We find that the hospital length of stay of patients treated in departments that opted for the MC system increased on average by 4.2% (0.28 days). However, the risk of readmission to the same department with the same diagnosis does not appear to be overall affected by the reform.     

A comparison of published head and neck stage groupings in laryngeal cancer using data from two countries

The combination of T, N, and M classifications into stage groupings is meant to facilitate a number of activities including: the estimation of prognosis and the comparison of therapeutic interventions among similar groups of cases. We tested the UICC/AJCC fifth edition stage grouping and six other TNM-based groupings proposed for head and neck cancer for their ability to meet these expectations in laryngeal cancer using data from Ontario, Canada, and the area of Southern Norway surrounding Oslo. We defined four criteria to assess each grouping scheme: (1) the subgroups defined by T, N, and M comprising a given group within a grouping scheme have similar survival rates (hazard consistency); (2) the survival rates differ among the groups (hazard discrimination); (3) the prediction of cure is high (outcome prediction); and (4) the distribution of patients among the groups is balanced. We previously identified or derived a measure for each criterion, and the findings were summarized using a scoring system. The range of scores was from 0 (best) to 7 (worst). The data sets were population-based, with 861 cases from Ontario and 642 cases from Southern Norway. Clinical stage assignment was used and the outcome of interest was cause-specific survival. Summary scores across the seven schemes had similar ranges: 0.9 to 5.1 in Ontario and 1.8 to 5.7 in Southern Norway, but the ranking varied. Summing the scores across the two datasets, the TANIS-7 scheme (Head & Neck 1993;15:497-503) ranked first, and was ranked high in both datasets (first and second, respectively). The UICC/AJCC scheme ranked sixth out of seven schemes, and its ranking was fifth and seventh, respectively. UICC/AJCC stage groupings were defined without empirical investigation. When tested, this scheme did not perform best. Our results suggest that the usefulness of the TNM system could be enhanced by optimizing the design of stage groupings through empirical investigation.