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1.
In the August 2020 issue of Clinical Chemistry and Laboratory Medicine, Giuseppe Lippi and Mario Plebani proposed a definition of laboratory medicine, which ends with this sentence: “The results of these measurements are translated into actionable information for improving the care and/or maintaining the wellness of both a single individual and an entire population”. Nevertheless, the selfishness of individuals may, sometimes, jeopardize the interest of whole populations. The virtue of justice being within the reach of the entire human community more than of single individuals, the final sentence in the definition proposed by Giuseppe Lippi and Mario Plebani, should therefore, in our view, be rewritten, less selfishly, for example like this: “For a given investment, these measurements are preferably made when they bring as much beneficence, and non-maleficence, as possible to the whole population”.  相似文献   

2.
The adjectives “generic”, “subgeneric”, “specific”, and “individual” are proposed to be added to the term “quantity”, depending on the case, in order to diminish the ambiguity of this term and to classify the different types of quantities.  相似文献   

3.
IntroductionAn appropriate management of anaemia laboratory tests is crucial for a correct diagnosis and treatment. A non-sequential “shotgun” approach (where every anaemia related test is ordered) causes workload and cost increases and could be potentially harmful. We have implemented a Decision Support System through our laboratory information system (LIMS) based on reflexive algorithms and automatic generation of interpretative reports specifically in diagnosis of anaemia for primary care patients.Materials and methodsWhen a request contained an “Anaemia Suspicion Study” profile, more than twenty automatic reflexive rules were activated in our LIMS based upon laboratory results. These rules normally involved the addition of reflexive tests. A final report was automatically generated for each interpretation which was always reviewed for their validity by two staff pathologists. We measured the impact of this system in the ordering of most common anaemia related tests and if a proper treatment was established based on the interpretive report.ResultsFrom all the studies performed, only 12% were positive being “iron deficiency” and “anaemia of chronic disease” the most frequent causes, 62% and 17%, respectively. Proper treatment was established in 88% of these anaemic patients. Total iron, transferrin, ferritin, folate and vitamin B12 demand decreased substantially after implementation representing a cost reduction of 40% only for these five tests.ConclusionsOur system has easily improved patient outcomes, advising on individual clinical cases. We have also noticeably reduced the number of over-requested tests and laboratory costs.  相似文献   

4.
At the down of the third millennium, it is rather misleading to consider the “whole population” as a conceptual entity, whereby the population is actually composed by single individuals, who differ broadly in terms of age, sex, ethnic origin, occupation, health, wellbeing, lifestyle and risk factors. While reaffirming strongly that laboratory medicine shall aim to provide data that could be translated into actionable information on “BOTH” an individual and universal level, we confute and refuse the naive and too simplistic approach that the common beneficence shall always be prioritized over the individual good, since the common good is just the sum of many individual beneficences.  相似文献   

5.

Background

Failure to follow-up laboratory test results has been described as one of the major processes contributing to unsafe patient care. Currently, most of the laboratories do not know with certainty not only their rate of missed (or unreviewed) requests but the economical cost and impact that this issue implies. The aim of our study was to measure that rate and calculate the resulting costs.

Material and methods

In January 2015, we checked in our Laboratory Information Management System (LIMS) for every emergency request from 1st July 2011 to 30th June 2014, if they had been reviewed by any allowed user or not. 319,064 requests were ordered during that period of time. Results were expressed as “ordered requests”, “missed requests” and its percentage. Additionally, total cost of missed requests was calculated in euros (€). “Non-productive days” were theorised (as the days producing requests that were not reviewed) based on these results.

Results

7924 requests (2.5%) were never reviewed by clinicians. This represented a total cost of 203,039 € and 27 “non-productive” days in three years. Significant differences between inpatients, outpatients and emergency department as well as different emergencies units were found after application of statistical analysis.

Conclusions

In terms of resources, never reviewed or missed requests appear to be a not negligible problem for the clinical laboratory management. Electronic result delivery, with electronic endorsement to indicate follow-up of requests along with better systems of electronic requesting should be investigated as a way of improving patient outcomes and save unnecessary expenses.Key words: quality indicators, health care, extra-analytical phase, total quality management, clinical laboratory information systems  相似文献   

6.
IntroductionEpithelial cells (ECs) are structures regularly observed during urine microscopy analysis. The correct identification of EC subtypes can be useful since renal tubular epithelial cells (RTECs) are clinically relevant. We investigate the urinary ECs report and the judgement of its clinical importance by Brazilian laboratories.Materials and methodsA survey with four questions was made available to participants of the Urinalysis External Quality Assessment Program (EQAP) from Controllab. Laboratories composed 3 groups: (1) differentiating ECs subtypes: “squamous”, “transitional” and “RTECs”; (2) differentiating ECs subtypes: “squamous” or “non-squamous” cells; (3) without ECs subtype identification. Participants did not necessarily answer to all questions and the answers were evaluated both within the same laboratory’s category and within different categories of laboratories.ResultsA total of 1336 (94%) laboratories answered the survey; Group 1, 119/140 (85%) reported that ECs differentiation is important to the physician and 62% want to be evaluated by EQAP, while in Group 3, 455/1110 (41%) reported it is useful to them, however only 25% want be evaluated by EQAP. Group 2 laboratories 37/51 (73%) reported that the information is important, but only 13/52 (25%) are interested in an EQAP with differentiation of the 3 ECs subtypes.ConclusionMost of the laboratories do not differentiate ECs in the three subtypes, despite the clinical importance of RTECs. Education of laboratory staff about the clinical significance of urinary particles should be considered a key priority.  相似文献   

7.
The research examines the notion that the principles underlying the procedure used by doctors to diagnose a patient's disease are useful in the design of “intelligent” IR systems because the task of the doctor is conceptually similar to the computer (or human) intermediary's task in “intelligent information retrieval”: to draw out, through interaction with the IR system, the user's query/information need. The research is reported in two parts. In Part II, an information retrieval tool is described which is based on “intelligent information retrieval” assumptions about the information user. In Part I, presented here, the theoretical framework for the tool is set out. This framework is borrowed from the diagnostic procedure currently used in medicine, called “differential diagnosis”. Because of the severe consequences that attend misdiagnosis, the operating principle in differential diagnosis is (1) to expand the uncertainty in the diagnosis situation so that all possible hypotheses and evidence are considered, then (2) to contract the uncertainty in a step by step fashion (from an examination of the patient's symptoms, through the patient's history and a physical (signs), to laboratory tests). The IR theories of Taylor, Kuhlthau and Belkin are used to demonstrate that these medical diagnosis procedures are already present in IR and that it is a viable model with which to design “intelligent” IR tools and systems.  相似文献   

8.
The geometry of crossing structure formed by two-layer microchannels determines the axial and transverse movements of contact interface between two liquid streams, which gives us a new method for promoting the micromixers. Hence, we designed four different three-dimensional micromixers by selecting two different crossing structures as basic units (one unit is a crossing structure called “X” and the other is a reversed crossing structure called “rX”). In order to find out how the crossing-structure sequence affects the mixing performance within three-dimensional micromixers, we organized these four mixers in different ways, i.e., the first combination is X-rX-X-rX-…, the second is X-rX-rX-X-…, the third is X-X-rX-X-…, and the last one is X-X-X-X…. Consequently, quite distinct mixing phenomena are engendered. Furthermore, experiments were also conducted using the first and the last models to verify the simulation results. We infer that the last mixer is more likely to trigger chaos and convection by rotating the contact surface than the first one that merely swings the surface even when the flow rates and viscosities of the two liquid streams are increased.  相似文献   

9.
IntroductionThe interest in quality management tools/methodologies is gradually increasing to ensure quality and accurate results in line with international standards in clinical laboratories. Six Sigma stands apart from other methodologies with its total quality management system approach. However, the lack of standardization in tolerance limits restricts the advantages for the process. Our study aimed both to evaluate the applicability of analytical quality goals with Roche Cobas c 702 analyser and to determine achievable goals specific to the analyser used.Materials and methodsThe study examined under two main headings as Sigmalaboratory and Sigmaanalyser. Sigmalaboratory was calculated using internal and external quality control data by using Roche Cobas c 702 analyser for 21 routine biochemistry parameters and, Sigmaanalyser calculation was based on the manufacturer data presented in the package inserts of the reagents used in our laboratory during the study. Sigma values were calculated with the six sigma formula.ResultsConsidering the total number of targets achieved, Sigmaanalyser performed best by meeting all CLIA goals, while Sigmalaboratory showed the lowest performance relative to biological variation (BV) desirable goals.ConclusionsThe balance between the applicability and analytical assurance of “goal-setting models” should be well established. Even if the package insert data provided by the manufacturer were used in our study, it was observed that almost a quarter of the evaluated analytes failed to achieve even “acceptable” level performance according to BV-based goals. Therefore, “state-of-the-art” goals for the Six Sigma methodology are considered to be more reasonable, achievable, and compatible with today’s technologies.  相似文献   

10.
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11.
In the 70ies of the last century, ther term “preanalytical phase” was introduced in the literature. This term describes all actions and aspects of the “brain to brain circle” of the medical laboratory diagnostic procedure happening before the analytical phase. The author describes his personal experiences in the early seventies and the following history of increasing awareness of this phase as the main cause of “laboratory errors”. This includes the definitions of influence and interference factors as well as the first publications in book, internet, CD-Rom and recent App form over the past 40 years. In addition, a short summary of previous developments as prerequesits of laboratory diagnostic actions is described from the middle age matula for urine collection to the blood collection tubes, anticoagulants and centrifuges. The short review gives a personal view on the possible causes of missing awareness of preanalytical causes of error and future aspects of new techniques in regulation of requests to introduction of quality assurance programs for preanalytical factors.  相似文献   

12.
In this paper, we present a low cost and equipment-free blood filtration device capable of producing plasma from blood samples with mL-scale capacity and demonstrate its clinical application for hepatitis B diagnosis. We report the results of in-field testing of the device with 0.8–1 ml of undiluted, anticoagulated human whole blood samples from patients at the National Hospital for Tropical Diseases in Hanoi, Vietnam. Blood cell counts demonstrate that the device is capable of filtering out 99.9% of red and 96.9% of white blood cells, and the plasma collected from the device contains lower red blood cell counts than plasma obtained from a centrifuge. Biochemistry and immunology testing establish the suitability of the device as a sample preparation unit for testing alanine transaminase (ALT), aspartate transaminase (AST), urea, hepatitis B “e” antigen (HBeAg), hepatitis B “e” antibody (HBe Ab), and hepatitis B surface antibody (HBs Ab). The device provides a simple and practical front-end sample processing method for point-of-care microfluidic diagnostics, enabling sufficient volumes for multiplexed downstream tests.  相似文献   

13.
The article treats the problem of “rationality” in learning processes in research policies. The underlying hypothesis is that there are contemporary efforts in research policy-making, which, against views in organisational sociology like “bounded rationality” or “garbage-can”, endeavour to “rationalise” the process of decision-making in research policies. This hypothesis is worked out by taking one example, the setting-up of the “National Centres of Competence in Research” (NCCR) in Switzerland and analyse the processes that have contributed to the acceptance of this funding measure. Our finding is that Switzerland has introduced some “rationalising devices” but that these devices are still insufficiently institutionalised and can be further elaborated. In addition, it is made clear that goal-oriented problem-solving and interests are closely intertwined and cannot be dissociated from another. This may have distorting effects on the rationality of the learning process. It is, nevertheless, a necessary condition in order to learn at all.  相似文献   

14.
Researchers in indexing and retrieval systems have been advocating the inclusion of more contextual information to improve results. The proliferation of full-text databases and advances in computer storage capacity have made it possible to carry out text analysis by means of linguistic and extra-linguistic knowledge. Since the mid 80s, research has tended to pay more attention to context, giving discourse analysis a more central role. The research presented in this paper aims to check whether discourse variables have an impact on modern information retrieval and classification algorithms. In order to evaluate this hypothesis, a functional framework for information analysis in an automated environment has been proposed, where the n-grams (filtering) and the k-means and Chen’s classification algorithms have been tested against sub-collections of documents based on the following discourse variables: “Genre”, “Register”, “Domain terminology”, and “Document structure”. The results obtained with the algorithms for the different sub-collections were compared to the MeSH information structure. These demonstrate that n-grams does not appear to have a clear dependence on discourse variables, though the k-means classification algorithm does, but only on domain terminology and document structure, and finally Chen’s algorithm has a clear dependence on all of the discourse variables. This information could be used to design better classification algorithms, where discourse variables should be taken into account. Other minor conclusions drawn from these results are also presented.  相似文献   

15.
李天润  陈爽 《资源科学》2022,44(3):494-507
社会经济发展过程中一个国家（地区）森林面积由减少转为增加的“森林转型“内在驱动机制,是资源环境研究关注的热点。以4期卢旺达土地覆盖数据为主要信息源,分析1990—2015年该地区森林变化的趋势和时空特征。结合社会经济数据,借助森林转型的路径分析法,探究卢旺达森林面积变化的影响因素及其所遵循的转型路径。在此基础上,利用PLUS模型对卢旺达2030年的森林空间动态分布进行模拟预测,对如何继续保持良好转型态势提出相关建议。结果表明：①卢旺达森林面积在2010年开始出现净增长,由2010年的197383.2 hm2增加到2015年的213087.8 hm2,年增加率0.8%;②国家公园和保护区是森林增长主要地区,且主要来源于稀树草原和耕地,分别占森林净增加总面积的87.8%和8.8%;③转型的内在驱动机制主要是国家政策引导下发生的“国家森林政策路径”和“森林稀缺路径”,全球化路径体现在植树技术与资金支持;④对卢旺达2030年森林模拟预测显示,森林转型仍将继续,预计到2030年森林面积将净增加34065.2 hm2。为进一步提高研究区森林覆盖率,卢旺达政府部门应改善森林恢复的薄弱环节,加快农业集约化推广;通过为农村社区创造场外就业机会,引导经济和就业发生转型,从而推动基于“经济发展路径”与“农村集约化路径”的森林增加。  相似文献   

16.
We present numerical simulations of DNA-chip hybridization, both in the “static” and “dynamical” cases. In the static case, transport of free targets is limited by molecular diffusion; in the dynamical case, an efficient mixing is achieved by chaotic advection, with a periodic protocol using pumps in a rectangular chamber. This protocol has been shown to achieve rapid and homogeneous mixing. We suppose in our model that all free targets are identical; the chip has different spots on which the probes are fixed, also all identical, and complementary to the targets. The reaction model is an infinite sink potential of width dh, i.e., a target is captured as soon as it comes close enough to a probe, at a distance lower than dh. Our results prove that mixing with chaotic advection enables much more rapid hybridization than the static case. We show and explain why the potential width dh does not play an important role in the final results, and we discuss the role of molecular diffusion. We also recover realistic reaction rates in the static case.  相似文献   

17.
In this special topic of Biomicrofluidics, the importance of microfluidics in the field of drug delivery is highlighted. Different aspects from cell-drug carrier interactions, delivery vehicle assembly to novel drug delivery devices are considered. The contributing reviews and original articles illustrate the synergistic outcomes between these two areas of research with the aim to have a positive impact on biomedical applications.Microfluidics is certainly one of the huge success stories when it comes to anticipated impact and fulfilled promises in academic research environments. Microfluidic approaches are game changers in many disciplines in natural science, including (bio)medical science. In the latter case, the fields of biosensing/diagnostics, tissue engineering, and drug discovery/delivery have benefited from concepts which allow for the fast throughput manipulation of fluids at the submillimeter length scale.A key aim in microfluidic-assisted drug discovery is the development of strategies which will facilitate the identification of potential “hits”—new drugs with the anticipated therapeutic benefit. In this context, “organ(disease)-on-chips” are considered as highly sophisticated in vitro models with lower cost and less ethical issues compared to extensive testing in animals. This technology is still very young with countless research challenges to be addressed and eventually overcome, but the few current reports are promising, and include “gut-on-chip,” “cancer-on-chip,” or “blood vessel-on-chip.” Additionally, intravenously injected drug delivery vehicles are exposed to the blood stream and the induced mechanical forces which are likely to affect their interaction with cells and tissue. Therefore, understanding the diffusion phenomena of biomolecules in microfluidic devices as reviewed by Yesil-Celiktas and coworkers in the current special content is crucial.1 What is more, the contribution by Hosta-Rigau and colleagues provides a comprehensive overview over the interaction of drug carriers and cells in microfluidic-based systems which deliver a simple, but yet more realistic model of the dynamic in vivo situation.2 Further, to illustrate the relevance of shear stress when assessing the potential of nanocarriers for drug delivery applications, we assembled novel block copolymers consisting of poly(cholesteryl acrylate) as the hydrophobic core and poly(N-isopropylacrylamide) as the hydrophilic extensions together with lipids into vesicles using the evaporation-rehydration method.3 Following on, we biologically evaluated the assemblies with applied shear stress using macrophages. In a related report by the Chakraborty group, a biocompatible acoustic microfluidic system was outlined including the effect of microbubbles with the applied acoustic field on biological cells.4From a different perspective, droplet microfluidics has become a popular method to assemble a huge diversity of particles of different size, shape, and morphology equipped with options for active or passive drug release. Microfluidics provides unique opportunities and flexibility to fabricate decent amounts of mono-disperse drug carriers using monomers, polymers, lipids, or inorganic precursor materials as building blocks. The assembly of size-tunable polymer/lipid particles by Sun et al.,5 and the fabrication of poly (lactic-co-glycolic acid) nanoparticles incorporated within poly (ethylene glycol) (PEG) microgels by the Chen group,6 provide interesting examples in this context. Further, artefacts associated with this technique have to be addressed and understood to avoid inaccurate and misleading data as reported by Litten et al.7 Microfluidic techniques can also be employed for cell encapsulation. Fan et al. demonstrated the trapping of human colon cancer cells in hydrogel particles with preserved viability and response to inflammatory stimuli.8Novel drug delivery devices which consider microfluidic concepts and set-ups are an interesting addition to traditional approaches. Implantable drug delivery systems provide an alternative to ensure constant drug level in blood without relying on the compliance of the patient while circumventing challenges involved in oral drug delivery coming from drug instability or limited absorbance among others. Yi and coworkers propose a reservoir approach in combination with a heat responsive valve towards the long term delivery of solid drugs.9 What is more, nebulizers, as alternative to inhalers for pulmonary drug delivery, suffer from miniaturization and drug degradation issues. Cortez-Jugo et al. report on a novel portable acoustomicrofluidic device, which successfully nebulized monoclonal antibodies into a fine aerosol mist including the first positive biological evaluation.10Further, combining microfluidics with sensing concepts as illustrated by Knoll and coworker11 is of importance, since the design of drug delivery vehicles strongly relies on the fundamental understanding of the interaction between biomolecules, cells, and tissue.Taken together, these articles give an overview over the use of microfluidics in the area of drug delivery, which goes beyond the assembly of drug carries, but also provides a platform for their biological evaluation or the design of entirely new drug delivery devices. I hope that this collection of articles will stimulate new ideas and future collaborations between engineers/chemists/physicist and biologists towards the common goal to provide solutions for biomedical challenges. Finally, I would like to thank Professor Leslie Yeo for the invitation to be the guest editor for this special topic, and Christine Urso and other editorial and production staffs of Biomicrofluidics for making it a reality.  相似文献   

18.
The random walk of spherical living cells on a silicon dioxide glassy substrate was studied experimentally and numerically. This random walk trajectory exhibited erratic dancing, which seemingly obeyed anomalous diffusion (i.e., Lévy-like walk) rather than normal diffusion. Moreover, the angular distribution (−π to π) of the cells'' trajectory followed a “U-shaped pattern” in comparison to the uniform distribution seen in the movements of negatively charged polystyrene microspheres. These effects could be attributable to the homeostasis-driven structural resilient character of cells and physical interactions derived from temporarily retained nonspecific binding due to weak forces between the cells and substrates. Our results provide new insights into the stochastic behavior of mesoscopic biological particles with respect to structural properties and physical interactions.  相似文献   

19.
Whilst laboratory-on-chip cell separation systems using dielectrophoresis are increasingly reported in the literature, many systems are afflicted by factors which impede “real world” performance, chief among these being cell loss (in dead spaces, attached to glass and tubing surfaces, or sedimentation from flow), and designs with large channel height-to-width ratios (large channel widths, small channel heights) that make the systems difficult to interface with other microfluidic systems. In this paper, we present a scalable structure based on 3D wells with approximately unity height-to-width ratios (based on tubes with electrodes on the sides), which is capable of enriching yeast cell populations whilst ensuring that up to 94.3% of cells processed through the device can be collected in tubes beyond the output.  相似文献   

20.
FACTS is an APL-based interactive on-line system used for retrieval of budget and accounting data. The system provides selective retrieval and manipulation of financial data for management in a development laboratory. The terms “teilnehmer” and “teilhaber” are defined and it is argued that use of a teilnehmer system, such as APL, can considerably reduce the programming and monitary investment for information science systems applications. A brief discussion of APL's text editing facilities is also included to introduce this relatively unknown language to information scientists.  相似文献   

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