条形码检验信息系统在临床检验工作中的应用

目的 实现检验结果与检验申请自动匹配，将检验结果自动传送至相应部门，真正实现检验工作流程的全自动化。方法使用预条码化标本采集容器留取标本，通过连接检验仪器、收集检验数据，完成申请、检验、报告的自动化数字工作流程。结果提高了工作效率，减少了在接收检验要求、报告结果和保存记录等工作中可能出现的人为误差。结论条形码检验信息系统的应用畅通了检验信息的交流渠道。使医院的管理逐步走向科学化和规范化。     

不合格检验标本与分析前质量相关性及预防对策

目的:从临床采集标本不规范,导致标本不合格的真实例子,分析其产生的原因,探讨其对质量的影响,从中针对问题寻找相应对策,提高检验结果的准确性和可靠性。方法:对近年来检验科接收到的不合标本的个别例子,回顾性分析。从患者准备、标本采集、运送、贮存等分析前各环节进行探讨。结果:不合格检验标本原因较多,而主要原因与临床护理工作相关,其中标本不正确采集是较突出的。并且对检验结果影响较大。结论:针对各种不同隐患和差错采取相应的预防对策。从源头控制标本质量,提高标本合格率,为临床提供准确、及时、可靠的检验结果。     

临床检验分析前的影响因素和质量控制探析

目的探讨临床检验分析前的影响因素及最佳质量控制方法。方法结合笔者所在医院实际研究影响检验标本质量的各种因素并分析采取的对应综合措施。结果通过针对原因的有效控制,避免了影响检验标本质量的多种因素,提高了标本质量。结论细致、全面、周到的综合性对策可以最大程度的减少标本影响,有效控制影响因素,提高检验标本质量。     

加强临床检验分析前实验室的质量保证

目的:探讨加强检验分析前实验室质量保证.方法:从检验师.医师和护士三个方面论证分析前各自的责任.结果:检验师提高素质,敢好宣教,标本查对和沟通;医师明确各检验项目临床意义,结果的分析和判断;护士正确采集标本和运送.结论:重视分析前的各个环节.     

探讨血液标本放置时间对生化检验结果的影响

目的：研究血液标本放置时间对生化检验结果的影响。方法以我院在2010年3月～2014年1月间收治的120例行生化检验的患者为研究对象,检测基准为1、4、8h后,分别实施生化检测,对7项检查结果进行分析,观察其具体的变化情况。结果检查基准为采血1h,血液标本放置时长达到4h后,从检查结果中可以看出,其血糖与谷丙转氨酶同标本放置1h内的检验结果存在显著差异,具有统计学意义（P＜0.05）。标本放置时间达到8h后,其总胆红素、碱性磷酸酶、钾离子、γ谷氨酰转肽酶、血糖与谷丙转氨酶与1h内的生化检测结果均存在显著差异,具有统计学意义（P＜0.05）。结论检测顺序的安排对于检测结果了产生较大影响,若检测项目具备不稳定因素,则测定工作需要在短时间内完成,可避免检测结果出现太大误差。     

护士对常规检验项目认知情况调查分析

目的了解护士对常规检验项目及相关知识的掌握情况。方法采用自拟问卷,对538名护士进行检验报告知识掌握情况的调查。结果护士对检验项目认知的总正确率仅为27．5％。不同护龄、职称、学历护士回答正确率均处于低水平。结论护士应充分认识检验报告对护理工作的重要意义，应加强相关知识的学习,以提高护理质量。     

影响血常规检验分析前质量缺陷的因素及应对措施

目的分析影响血常规检验分析前质量缺陷的相关因素,探讨有效的质量控制措施。方法搜集2014-07—2015-03月间血常规检验的8 268份血液标本,对血液样本所存在的缺陷进行整理、归类、统计、分析。结果 8 268份血液标本中,检验分析前发现217份样本有质量缺陷,送样样本缺陷率为2.6%,影响血常规检验分析前质量缺陷的相关因素中,样本抽取量不合格所占比例最大(33.0%),其次为样本抽取后放置时间对结果影响(24.3%)、采集后温度影响(16.9%)、标本标记不清(10.6%)、标本中的凝块对结果影响(6.9%)、抗凝管不合格(6.0%)、其他因素(2.3%)。结论在血常规检验分析前应严格做好各环节的质量控制工作,针对影响血常规分析前质量缺陷的高危因素采取针对性应对措施,以降低样本缺陷率,保证检验质量。     

检验标本留取规范速查卡的设计与应用

目的 提高送检标本的合格率.方法 护理部在检验科协助下编制检验标本留取规范速查卡,卡片彩色印刷并过塑.结果 应用速查卡后标本采集不合格率显著低于应用前(P＜0.01).结论 速查卡的应用方便护士快速获取检验项目的留取要求,可提高送检标本合格率及护士的工作效率.     

条形码检验信息系统采血流程核对表的设计与应用

采血的及时性、准确性在一定程度上能保证检验值的可靠性.但由于各种因素出现某些失误,如布置试管遗漏、漏采血等,一定程度上影响患者的诊治及工作效率与准确性.我科从2008年12月始,根据条形码检验信息系统采血流程,院信息系统(HIS)结合移动工作站(EDA),应用条形码扫描完成病房采血流程,建立核对表,规范、科学地管理标本采集,未发生漏布管、漏采血等情况.     

临床微生物检验存在的问题及改进措施

从检验人员的专业知识和技术水平、标本质量、检验方案设计和检验室与临床沟通4个方面总结分析了临床微生物检验存在的问题,并提出了改进措施。     

护理实验室开放管理的实践

目的探讨护理实验室开放管理的教学效果.方法将2003级护理本科4个教学班随机分为传统实验室管理模式组(传统组,98人)和开放实验室管理模式组(开放组,104人),分别实施不同的实验室管理方案,课程结束后进行操作技能考核和问卷调查,评价2种实验室管理模式的教学效果.结果开放组学生操作技能综合评分、掌握知识牢固程度、技能操作水平、学习兴趣评分显著高于传统组(均P<0.01).结论护理实验室开放管理在培养学生动手能力、综合运用知识能力及创新能力方面起到非常重要的作用,有助于护理实践教学质量的提高.     

Laboratory contamination affecting orthopedic surgical management

Bacterial contamination of pathology specimens can occur during collection, transport, or laboratory processing. Recognized sources of laboratory contamination include contamination of microscopy slides before use and contamination of reagents. We present 2 cases where contamination of glass beads used in the microbiology department as part of the tissue preparation process for urgent Gram stain led to unnecessary revision surgery. Contamination of the glass beads alone has not been cited elsewhere in the literature, and the authors feel that this needs to be brought to the attention of arthroplasty surgeons and microbiologists.     

Laboratory tests in children undergoing ambulatory surgery: a review of clinical practice and scientific studies

The drive for cost containment in the United States has lead anesthesiologists to re-assess the benefits of routine pre-operative laboratory and radiological testing. The value of routine tests has been questioned not only by insurance companies but also by physicians. Common pre-operative laboratory and radiological tests are reviewed in the following analysis. Specifically, the use of such tests in children scheduled for ambulatory surgery is discussed. Current clinical practice patterns of pediatric anesthesiologists are included so that physicians may make conclusions on the basis of published literature and clinical practice of peers.     

Are Routine Postoperative Laboratory Tests Necessary After Primary Total Hip Arthroplasty?

BackgroundRecently, the practice of ordering routine postoperative laboratory tests in primary total hip arthroplasty (THA) has been challenged. This study aimed to evaluate the utility of routine postoperative laboratory tests after primary elective THA in an Asian population and identify the risk factors associated with abnormal postoperative laboratory test–related intervention.MethodsWe retrospectively reviewed 395 consecutive patients who underwent primary elective THA at a single tertiary academic center. Patient clinical information and laboratory test results were collected for analysis.ResultsA total of 349 (88.4%) patients had abnormal postoperative laboratory test results; most patients had anemia and hypoalbuminemia. Twenty-seven (6.8%) patients received clinical intervention. Of the 307 (77.7%) patients with postoperative anemia, 7 patients received blood transfusion. Factors associated with transfusion were female gender, low body mass index, long operation time, and low preoperative hemoglobin levels. Of the 149 (37.7%) patients with postoperative hypoalbuminemia, 16 received albumin supplementation. Factors associated with albumin supplementation were female gender, long operation time, and low preoperative albumin levels. Although 36 patients had abnormal postoperative creatinine, only 1 patient required specialist consultation. For electrolyte abnormalities, hyponatremia was noted; however, no patient received sodium supplementation. Moreover, 14 patients developed hypokalemia, of which 6 required potassium supplementation; 163 patients had hypocalcemia, of which 2 received calcium supplementation.ConclusionRoutine laboratory tests after primary elective THA are unnecessary for most of the patients in modern clinical practice. However, for those with identified risk factors, postoperative laboratory tests still should be performed.     

Routine Postoperative Laboratory Tests Are Not Necessary After Primary Total Hip Arthroplasty

Background

Postoperative laboratory testing has been used routinely for patients undergoing total hip arthroplasty (THA). However, with modern-day improvements in perioperative care pathways, it is unclear whether this practice remains justified. The purpose of this study was to assess the utility of routine postoperative laboratory tests in primary THA.

非淋菌性尿道炎实验诊断研究进展

非淋菌性尿道炎 (NGU)是常见的性传播疾病之一。沙眼衣原体是NGU最常见的病原体 ,NGU的病原体还包括溶脲脲原体、生殖支原体、阴道毛滴虫等。随着分子生物学、免疫学的发展 ,PCR、连接酶链反应 (LCR)等新技术被广泛用于实验室诊断研究中 ,因而有必要建立NGU快速、准确的实验诊断方法并将其标准化。本文就NGU的概念、病因学、临床表现、实验室诊断及治疗方面的研究进展作一概述     

Routine Laboratory Tests are not Necessary After Primary Total Joint Arthroplasty: A Prospective Study Utilizing a Selective Algorithmic Approach

BackgroundLaboratory tests are obtained following total joint arthroplasty (TJA) despite a lack of supporting evidence. No prior study has prospectively analyzed the effect of discontinuing routine laboratory tests. This study aimed to determine whether discontinuing routine laboratory tests in TJA patients resulted in a difference in 90-day complications.MethodsThis was a prospective protocol change study at a high-volume center. Prior to protocol change, patients underwent routine laboratory tests following primary unilateral TJA (control group). After the change, an algorithmic approach was used to selectively order laboratory tests (protocol group). Patients with bleeding disorders, chronic obstructive pulmonary disease, arrhythmia, coronary artery disease, congestive heart failure, chronic renal failure, dementia, abnormal preoperative sodium, potassium, or hemoglobin <10 g/dL were excluded. In-hospital and 90-day data were collected. Student’s t-test was used to analyze continuous variables and chi-squared test was used for categorical variables. A pre-hoc analysis examining the primary outcome required 607 patients per group to achieve 80% power.ResultsThe protocol group included 937 patients, whereas the control group included 891 patients. The protocol group had fewer females and total hip arthroplasties. There were no differences in age, body mass index, American Society of Anesthesiologists classification, tranexamic acid administration, or estimated blood loss between the protocol and control groups. There were also no differences in transfusions, electrolyte corrections, unplanned consults, length of stay, or transfers. The protocol cohort had more fluid boluses and home discharges. There was no difference in 90-day complications between the 2 groups.ConclusionsThis study utilizing an algorithmic approach to laboratory collection demonstrates that discontinuing routine laboratory tests following TJA is safe and effective. We believe this protocol can be implemented for most patients undergoing primary unilateral TJA.     

提高高等中医院校实验诊断学教学质量的几点思考

实验诊断学是一门临床医学与基础医学的桥梁学科，是现代实验室科学技术与临床医学在更高层次上的结合，是--fq发展迅速、多学科交叉的学科，是诊断学中迅速发展的重要组成部分。实验诊断学是高等中医院校医学生在校学习阶段必修的医学课程。当前在这门课程的教学目的、教材编写、课程设计、授课重点、联系实际、教研室建设、教师培养和教学评估体系建设等方面都还存在着一些值得探讨的问题，处理好这些问题，对提高高等中医院校实验诊断学教学质量，培养高素质的中医人才有重要的实际意义。     

Laboratory diagnosis and practical treatment of patients

The practical treatment of patients requires a reliable diagnosis and prognosis followed by therapy. Laboratory medicine is an essential scientific basis to rational treatment in each of these three phases. The significance, usefulness and extent of laboratory tests are largely dependent upon the disease spectrum. The possibilities and aims of laboratory medicine are: 1. Knowledge of and research into both the pathobiochemical and statistical connections between biochemical data and diseases leading to the selection of diagnostically reliable and relevant parameters. 2. Knowledge of the sensitivity, specificity and predictive values of relevant biochemical parameters and their application to the different clinical problems. 3. Evaluation of reliable analytical methods with details of their accuracy and precision. 4. Critical evaluation of pre-analytical factors. The translation of accurate laboratory data into clinically relevant information must always be coupled with a critical assessment of its diagnostic value, validity and range of error. An uncritical "consumption" of laboratory data is dangerous for both the patient and the clinician as is the suppression of these data when it does not fit the supposed diagnosis. Laboratory medicine is indispensible in proper patient care since it guarantees adequate medical action. The information that it delivers is binding and therefore offers help as well as protection.     

Laboratory tests of renal function

The human kidney provides essential regulatory and excretory functions. Body water content, plasma electrolyte composition and plasma pH are all under the regulatory control of the kidney. In addition, the kidney provides a path of excretion for blood-borne, water-soluble, low-molecular-weight compounds. These include the end-products of protein metabolism, such as urea and creatinine, as well as foreign compounds with similar physicochemical characteristics and their metabolites. Endocrine activity of the human kidney includes the secretion of the hormones erythropoietin and renin and the activation of vitamin D by hydroxylation to its 1,25-dihydroxycholecalciferol form. The renal blood flow is immense, constituting 25% of resting cardiac output. The glomeruli form 170–200 litres of ultrafiltrate per day and the selective reabsorption of water and solutes results in the final formation of approximately 1.5 litres of urine for excretion. Here, commonly used laboratory tests of renal function are discussed, including glomerular filtration rate (GFR), creatinine clearance, serum creatinine concentration estimation of GFR, cystatin C assay, serum urea concentration, urinalysis, free water clearance and endocrine changes in renal disease. It must be noted, however, that these tests require a clinical assessment of the patient to allow meaningful interpretation.