循证检验医学思想在检验医学生教育中的培养和应用

由经验医学向循证医学转变是21世纪医学的一场深刻的变革。从循证医学到循证检验医学，是21世纪临床医学的发展趋势。加强对检验医学生的循证医学教育具有深远的意义。循证检验医学教育关注方法学的评估教育、检验与临床的沟通教育和检验结果对健康结局的影响教育，这是检验医学教育工作面临的挑战和艰巨使命。     

脑血管病患者血脂和血流动力学的循证检验

循证检验医学(evidence-based laboratory medicine，EBLM)对于临床具有两方面意义，一是为临床医生提供尽可能好的检验结果以协助做出诊断、预防、治疗决策。二是对不断增加的检验技术进行评估，以确定其所用的技术是否准确、可靠、安全、经济和有效。循证医学的定义也适用于循证检验医学。恰当地运用循证检验医学方法，有可能较好地解决目前医疗市场中检验项目过多所造成的一些问题，尤其是因医疗保险产生的患愿望和外部预算限制之间的紧张关系。     

循证医院与循环检验医学的概念

循证医学 (ｅｖｉｄｅｎｃｅ ｂａｓｅｄｍｅｄｉｃｉｎｅ)是二十一世纪临床医学的发展趋势 ,将循证医学的原则运用到检验医学中 ,将会更好地促进检验医学的发展 ,“循证检验医学 (ｅｖｉｄｅｎｃｅ ｂａｓｅｄｌａｂｏｒａｔｏｒｙｍｅｄｉｃｉｎｅ,ＥＢＬＭ)”的概念就反映了这种趋势。循证检验医学的基本概念一、循证医学的基本概念循证医学 ,简言之 ,就是任何临床的诊治决策 ,必须建立在当前最好的研究证据与临床专业知识和患者的价值相结合的基础上。所谓最好的研究证据 ,就是指迄今已有的 ,包括最新的 ,最接近事实的证据 ,它们是指来…     

循证医学在检验医学中的应用

循证医学（evidence—based medicine，EBM）是以证据为基础的医学，循证医学在检验医学的应用即为循证检验医学（evidence—based laboratory medicine，EBLM）。EBLM就是遵循EBM的核心思想，在应用大量可靠的临床资料和经验的基础上，研究检验项目临床应用的价值，为临床诊断、疗效观察、病情转归提供最有效、最实用、最经济的检验项目及检验组合，并最终获得可靠的检验信息资料，为医疗决策提供循证。     

开设循证检验医学课程在实验诊断学教学中的作用探索

随着检验医学的发展,循证检验医学日渐成为国际关注的热点。为了帮助学生了解和认识循证检验医学,本文探讨了在医学检验系本科教育中开设循证检验医学课程的作用和意义,提出了课程教学目标和教学内容,并积极探索一种研究型、设计型、开放式的教学方式,以更好地促进临床检验医学的发展和检验地位的提高。     

循证检验医学与临床检验医学

循证医学(evidence-based medicine，EBM)是加拿大麦克玛斯特大学的David Sackett教授在长期的临床流行病实践的基础上，于1992年正式提出的概念。目前EBM正强劲地推动全球医学从经验医学模式向循证医学模式转变，它将EBM的原则运用到检验医学中，并正在促进检验医学的发展；“循证检验医学”的概念反映了这种趋势，它是近20年来发展起来的一门新兴学科，属方法学范畴。     

循证医学与检验医学

早在十九世纪就已倡议循证医学（EvidenceBasedMedicineEBM），但直到二十世纪八十至九十年代才渐兴起，开成新的模式，它提倡以医师的专业知识与外界的最佳证据的密切结合，成为当代国际医学界倡导的学科发展的方向之一，已受到广泛的重视和兴趣，以下就循证医学与检验医学的关系谈谈自己的体会。１循证医学所谓循证医学（EBM）就是在病人的诊疗过程中，要求医师谨慎地、清晰地、明智地、带有判断性地运用目前所拥有的最佳证据，对病人进行针对性的临床诊断和治疗，以最佳的预后评价为目标，EBM的具体过程为明确需要分析的临床问题，…     

循证检验医学与实验室质量控制

随着EBM在全世界的传播与普及,循证检验医学悄然兴起,但实质性研究目前还不多。本文从医院临床检验实际出发,探讨用循证医学原理和方法指导实验室质量控制的可行性。     

循证检验医学在现代临床检验工作中的应用

临床检验是以检验医学项目作为检测的基础，针对临床疾病的病情发展、疾病诊断及疗效观察预后判断为主而展开的研究工作。循证检验医学的兴起和发展，丰富了现代医学的内涵，为临床医学诊断提供决策证据，也为临床科研工作的深入研究提供了有效的检验标尺。     

循证检验医学与老年病防治关系的探讨

目的：探讨循证检验医学在老年病防治医学领域的作用和关系及发展前景。方法：检索和收集卫生部卫生统计信息中心资料库及《中国期刊网专题》全文数据库相关文献，引入循证检验医学的概念。结果：检验医学与老年病防治医学密切相关，互相渗透，缺一不可。人口老龄化与疾病谱的变迁，老年慢性病及慢性病与死亡率增加是影响我国人民健康水平主要因素。循证检验医学在这方面的研究必将给老年医学临床诊断带来新的和突破性的发现。结论：老年人是慢性病的主体。循证检验医学以当前最好的证据为基础，向临床医师提供反映老年患者真实情况的证据，探索疾病预防和早期诊治方法。是保障老龄期健康，健康老龄化的重要途径之一。     

新型冠状病毒肺炎疫情下检验医学临床服务管理的探索

2019 年年底以来,一种新型冠状病毒肺炎在我国大范围流行。检验医学作为临床医学的重要学科,应发挥自 己的专业特色,参与抗击新型冠状病毒肺炎的诊疗活动中。通过介绍河南中医药大学人民医院检验医师团队组成、临床 服务内容、方式等方面内容,阐述检验医学在抗击新型冠状病毒肺炎疫情的重要作用。     

危险源分类在临床实验室生物危害防护中的应用

目的:探讨危险源分类理论在临床实验室生物危害防护中的应用价值。方法:在现有生物安全及防护知识的基础上,应用危险源分类理论对临床实验室生物相关危险源进行分类,并采取具有针对性的防护措施,确保实验室的生物安全。结论:运用安全原理中危险源分类理论,有利于帮助临床实验室生物安全的针对性和系统性管理,具有一定的实用价值。     

临床检验总误差与测量不确定度

在检验医学领域,探讨测量不确定度(measurement uncertainty,MU)和总误差(total error,TE)的区别是个值得关注的问题。多年来,国内外的检验医学专家们对MU进行研究并促进其在检验医学领域的发展,同时也使临床实验室开始关注MU的意义和作用。然而,由于TE在临床实验室中的习惯性使用以及TE与MU二者的概念有类似之处且容易导致混淆,因此许多实验室依然无法完全接受MU。该文通过解释TE与MU的概念,并且分析TE模型与MU模型各自的优缺点和作用,帮助临床实验室进一步了解TE和MU,并在实际工作中合理运用。     

脑受体显像临床研究现状与进展

目前受体显像已从长期实验室基础研究进入临床应用研究阶段,脑受体显像更是得到了长足的发展.利用放射性核素进行人脑受体显像,是分子生物学和核医学结合产生的新医学示踪技术的分子医学,即分子核医学将用于脑科学研究的新技术,是分子影像学技术在脑科学研究及应用的一个重要组成部分,具有广阔的应用前景.     

Single and Combined Diagnostic Value of Clinical Features and Laboratory Tests in Acute Appendicitis

Objectives:  The objective was to evaluate the diagnostic accuracy of clinical features and laboratory test results in detecting acute appendicitis.
Methods:  Clinical features and laboratory test results were prospectively recorded in a consecutive series of 1,101 patients presenting with abdominal pain at the emergency department (ED) in six hospitals. Likelihood ratios (LRs) and the areas under the receiver operating characteristic curve (AUC) were calculated for the individual features. Variants of clinical presentation, based on different combinations of clinical features, were investigated and the accuracies of combinations of clinical features were evaluated.
Results:  The discriminative power (AUC) of the individual features in patients with suspected appendicitis ranged from 0.50 to 0.65. For five of the 23 predictor sets, the accuracy for appendicitis was more than 85%. This accuracy was only found in male patients. The relative frequency of these predictor sets ranged from 2% to 13% of patients with suspected appendicitis. A combination of the clinical features migration of pain to the right lower quadrant (RLQ), and direct tenderness in the RLQ, was present in only 28% (120/422) of clinically suspected patients, of whom no more than 85 patients had appendicitis (71%). A "classical" presentation (combination of migration of pain to the RLQ, tenderness in the RLQ, and rigidity) occurred in only 6% (25/422) of patients with suspected appendicitis and yielded an accuracy of 100% in males but only 46% in females.
Conclusions:  The discriminative power (AUC) of individual clinical features and laboratory test results for appendicitis was weak in patients with suspected appendicitis. Combinations of clinical features and laboratory tests with high diagnostic accuracy are relatively infrequent in patients with suspected appendicitis.     

6σ质量标准在临床生化检验室内质量控制中的应用研究

目的应用6σ质量标准分析临床生化检验质量控制数据,评价检验项目质量水平,改进检验质量。方法收集2007年度临床生化检验项目室内质量控制及室间质量评价数据;按照美国临床实验室改进修正法案中允许总误差(TEa)标准,采用公式σ=(TEa-bias)/CV,计算各检验项目的σ值,绘制6σ性能决定图,评价分析性能,并设计质量控制方案。结果 28个临床生化常规检验项目中,检验项目总分析性能σ≥6、5、4和3者,分别占25%、35.7%、57.1%和71.4%,所有检验项目的平均σ=4.77;当σ≥5时,采用1_(3S)(n=2)质量控制规则能满足质量要求。结论 6σ质量标准的应用,有助于提高临床生化检验质量水平,6σ管理是一项有效的质量管理工具。     

Clinical laboratory regulation under the Clinical Laboratory Improvement Amendments of 1988: can it be done?

This report examines logical but not yet widely recognized ramifications of the Clinical Laboratory Improvement Amendments of 1988 (CLIA'88), federal legislation that will require certification of all laboratories examining human specimens. Examination of the CLIA'88 committee reports and committee hearings suggest that more than the conventional approach to laboratory standards will be needed to meet the public's expectations as articulated by our elected representatives. The conventional approach to clinical testing standards seeks to assure quality by regulating the laboratory analytical process. However, little empirical evidence is available to support or refute this model, which has been used during the past 25 years. One alternative paradigm for laboratory standards is an approach that examines the total laboratory testing process, including the selection, ordering, and interpretation of the test as well as the laboratory analysis per se. The history of controversy over laboratory standards--especially personnel standards, the glacial federal regulatory rulemaking process, public expectations of fail-safe technology, among other factors--suggests the implementation of CLIA'88 will be a lengthy and vigorously debated contest. The risk of a test is seldom inherent in the test itself, but rather is a function of the context in which the test is being used to provide information for medical decision making. Our premise is that diagnostic tests must be examined in the context of the laboratory testing situation. We suggest that now is the appropriate time for laboratory professionals, practicing physicians, and the public to abandon conventional thinking regarding clinical laboratory standards. We believe that CLIA'88 reflects a shift in public expectations toward fail-safe laboratory testing and the need for additional government oversight in laboratory test quality. If these new expectations persist, CLIA'88 represents a potential landmark in the course of federal authority and the practice of medicine in the United States.     

Laboratory medicine and sports: between Scylla and Charybdis

Laboratory medicine is complex and contributes to the diagnosis, therapeutic monitoring and follow-up of acquired and inherited human disorders. The regular practice of physical exercise provides important benefits in heath and disease and sports medicine is thereby receiving growing focus from almost each and every clinical discipline, including laboratory medicine. Sport-laboratory medicine is a relatively innovative branch of laboratory science, which can provide valuable contributions to the diagnosis and follow-up of athletic injuries, and which is acquiring a growing clinical significance to support biomechanics and identify novel genomics and "exercisenomics" patterns that can help identify specific athlete's tendency towards certain types of sport traumas and injuries. Laboratory medicine can also provide sport physicians and coaches with valuable clues about personal inclination towards a certain sport, health status, fitness and nutritional deficiencies of professional, elite and recreational athletes in order to enable a better and earlier prediction of sport injuries, overreaching and overtraining. Finally, the wide armamentarium of laboratory tests represents the milestone for identifying cheating athletes in the strenuous fight against doping in sports.     

Laboratory managers' views on attrition and retention of laboratory personnel.

OBJECTIVE: This study was undertaken to provide information on the current shortage of clinical laboratory employees and to identify strategies for retaining laboratory employees. DESIGN: A paper survey was distributed to 800 clinical laboratory managers. SETTING: The survey was sent to laboratory managers at their work sites. PATIENTS OR OTHER PARTICIPANTS: 190 usable surveys were returned for a response rate of 24%. INTERVENTIONS: Surveys were mailed in March 2003. MAIN OUTCOME MEASURES: The number of CLTs and CLSs considered fully staffed at the laboratory managers' institutions, the numbers of CLTs and CLSs who left the institutions in a five-year period, and the reasons employees left were tabulated. The managers' responses to questions on the factors that they considered most important in retaining laboratory employees were tabulated and categorized. RESULTS: In this five-year period (1998-2002), 5% of employees left their jobs annually. Over 60% of laboratory employees who left did so in the first five years of practice. The top five reasons that employees left their jobs were: (1) new laboratory job, (2) moved/family obligations, (3) retirement, (4) left the field entirely, and (5) employee was fired. In the first year of practice, 15% of the employees who left were fired. Between one and five years of practice, 7.3% left because of the hours or shift, 6.7% left to pursue further education for a non-laboratory career, and 6.7% left the field entirely. In the group of employees who left between five and ten years, 13.5% left the field entirely and 5.2% left for sales or clinical trials positions. Over 40% of the employees with more than ten years of experience who left did so because of retirement. CONCLUSION: Most laboratory employees who left did so to take another laboratory position; however, reasons for leaving vary with years of experience. The number of laboratory employees leaving the profession exceeds the number of new graduates entering the profession making the retention of employees essential. Laboratory managers identified salary as the most important retention factor.     

新型冠状病毒实验室检测专家共识

新型冠状病毒肺炎疫情仍在全球肆虐,实验室检测是疫情防控的关键环节.基于目前实验室检测所积累的经验和难点,结合当前最新研究进展,中国医院协会临床微生物实验室专业委员会组织临床微生物学、分子生物学和免疫学检验相关专家共同制定了《新型冠状病毒实验室检测专家共识》.本共识对新型冠状病毒临床常用检测方法,尤其是核酸、抗体及抗原检...