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1.
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   

2.
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   

3.
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   

4.
Graphics are powerful tools to communicate research results and to gain information from data. However, researchers should be careful when deciding which data to plot and the type of graphic to use, as well as other details. The consequence of bad decisions in these features varies from making research results unclear to distortions of these results, through the creation of “chartjunk” with useless information. This paper is not another tutorial about “good graphics” and “bad graphics”. Instead, it presents guidelines for graphic presentation of research results and some uncommon, but useful examples to communicate basic and complex data types, especially multivariate model results, which are commonly presented only by tables. By the end, there are no answers here, just ideas meant to inspire others on how to create their own graphics.  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.
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7.
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   

8.
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   

9.
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   

10.
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   

11.
The confined flow of red blood cells (RBCs) in microvasculature is essential for oxygen delivery to body tissues and has been extensively investigated in the literature, both in vivo and in vitro. One of the main problems still open in microcirculation is that flow resistance in microcapillaries in vivo is higher than that in vitro. This discrepancy has been attributed to the glycocalyx, a macromolecular layer lining the inner walls of vessels in vivo, but no direct experimental evidence of this hypothesis has been provided so far. Here, we investigate the flow behavior of RBCs in glass microcapillaries coated with a polymer brush (referred to as “hairy” microcapillaries as opposed to “bare” ones with no coating), an experimental model system of the glycocalyx. By high-speed microscopy imaging and image analysis, a velocity reduction of RBCs flowing in hairy microcapillaries as compared to bare ones is indeed found at the same pressure drop. Interestingly, such slowing down is larger than expected from lumen reduction due to the polymer brush and displays an on-off trend with a threshold around 70 nm of polymer brush dry thickness. Above this threshold, the presence of the polymer brush is associated with an increased RBC deformation, and RBC velocity is independent on polymer brush thickness (at the same pressure drop). In conclusion, this work provides direct support to the hypothesis that the glycocalyx is the main factor responsible of the higher flow resistance found in microcapillaries in vivo.  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.
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   

14.
孟小燕 《资源科学》2019,41(6):1111-1119
居民是城市生活垃圾分类回收系统中的关键主体之一,其分类回收参与率的高低直接关系到整个城市垃圾分类工作的成败。为分析居民垃圾分类行为决策机制,本文以苏州市为案例,对其中心城区居民开展实地问卷调查,并运用结构方程统计分析方法,探讨影响居民生活垃圾分类行为的主要因素和作用路径。研究结果表明：居民生活垃圾分类行为主要由4个主观因素和7个外部情境因素共同作用的结果,且外部条件因素的综合影响是个体主观因素的近2倍,其中,“环境设施和服务”潜变量相关因素对居民行为的综合影响最大,公共宣传教育、回收设施便利性、分类设施便利性、参与意愿和环保意识为对居民垃圾生活处理行为影响最显著的前5个因素。为进一步加快推进中国城市生活垃圾分类工作,建议加强城市生活垃圾分类回收配套设施规划建设,广泛开展垃圾分类回收宣传教育,完善相关法律法规并建立有效的激励约束机制。  相似文献   

15.
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   

16.
We present a novel cell culture chip, namely, “inverting microwell array chip,” for cultivation of human induced pluripotent stem cells. The chip comprises a lower hydrogel microwell array and an upper polystyrene culture surface. We demonstrate the formation of uniform cellular aggregates in the microwell array, and after inversion, a culture with controlled aggregate size and geometrical arrangement on the polystyrene surface. Here, we report effects of cell concentrations on a cultivation sequence in the chip.  相似文献   

17.
The paper re-examines the twin concepts of knowledge “tacitness” and “codification”, which both the literature on (broadly defined) industrial districts, and some recent econometric literature on “localized knowledge spillovers” have possibly mis-handled. Even within specialized local small and medium enterprises (SMEs) clusters, knowledge may be highly codified and firm-specific. The case study on Brescia mechanical firms shows that knowledge, rather than flowing freely within the cluster boundaries, circulates within a few smaller “epistemic communities”, each centered around the mechanical engineers of individual machine producers, and spanning to a selected number of suppliers’ and customers’ technicians. Physical distance among members of each community vary a lot, but even local messages may be highly codified.  相似文献   

18.
Recent simulations by Chen and Dorfman [Electrophoresis 35, 405–411 (2014)] suggested that “tilting” the electric field with respect to the lattice vectors of a hexagonal post array would lead to a substantial improvement in electrophoretic DNA separations therein. We constructed such an array where the electric field is applied at an angle equidistant between the two lattice vectors. This tilted array leads to (i) baseline resolution of 20 kbp DNA and λ DNA (48.5 kbp) in a 4 mm channel and (ii) measurable separation resolutions for electric fields up to 50 V/cm, both of which are improvements over untilted post arrays of the same post density. The predicted time required to reach a resolution of unity is approximately 5 min, independent of electric field. The separations are more reproducible at higher fields.  相似文献   

19.
Plagiarism remains at the top in terms of interest to the scientific community. In its many vicious forms, patchwork plagiarism is characterized by numerous unresolved issues and often passes “below the radar” of editors and reviewers. The problem of detecting the complexity of misconduct has been partially resolved by plagiarism detection software. However, interpretation of relevant reports is not always obvious or easy. This article deals with plagiarism in general and patchwork plagiarism in particular, as well as related problems that editors must deal with to maintain the integrity of scientific journals.  相似文献   

20.
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   

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