全血细胞计数移动均值法质量控制规则应用的探讨

目的 通过12S(警告限),13S规则和X-B质控方法联合应用于全血细胞计数检测室内质量控制,来寻求临床实验室全血细胞计数不同参数室内质控的质控方法的适用者.方法 迈瑞全自动血液分析仪BC-5500上所做的原装高、中、低三个水平质控品的质控数据,用12S (警告限),13S规则和仪器自带的X-B功能同时对红细胞平均体积(MCV)、红细胞平均血红蛋白量(MCH)和平均红细胞血红蛋白浓度(MCHC)进行质控分析.结果 X-B质控图上全部质控结果在控,而L-J规则进行判断的质控图上随着时间的延长部分参数MCV、血细胞比容(HCT)、MCHC开始出现假性失控.结论 全血细胞计数质控品部分参数MCV、HCT、MCHC稳定性受限于开瓶时间的限制,临床实验室全血细胞计数室内质控不适宜用L-J质控规则进行判断,而更适合用X-B进行判断.     

Internal quality control system for non-stationary, non-ergodic analytical processes based upon exponentially weighted estimation of process means and process standard deviation.

The analytical processes in clinical laboratories should be considered to be non-stationary, non-ergodic and probably non-stochastic processes. Both the process mean and the process standard deviation vary. The variation can be different at different levels of concentration. This behavior is shown in five examples of different analytical systems: alkaline phosphatase on the Hitachi 911 analyzer (Roche), vitamin B12 on the Access analyzer (Beckman), prothrombin time and activated partial thromboplastin time on the STA Compact analyzer (Roche) and PO2 on the ABL 520 analyzer (Radiometer). A model is proposed to assess the status of a process. An exponentially weighted moving average and standard deviation was used to estimate process mean and standard deviation. Process means were estimated overall and for each control level. The process standard deviation was estimated in terms of within-run standard deviation. Limits were defined in accordance with state of the art- or biological variance-derived cut-offs. The examples given are real, not simulated, data. Individual control sample results were normalized to a target value and target standard deviation. The normalized values were used in the exponentially weighted algorithm. The weighting factor was based on a process time constant, which was estimated from the period between two calibration or maintenance procedures. The proposed system was compared with Westgard rules. The Westgard rules perform well, despite the underlying presumption of ergodicity. This is mainly caused by the introduction of the starting rule of 12s, which proves essential to prevent a large number of rule violations. The probability of reporting a test result with an analytical error that exceeds the total allowable error was calculated for the proposed system as well as for the Westgard rules. The proposed method performed better. The proposed algorithm was implemented in a computer program running on computers to which the analyzers were linked on-line. Each result was evaluated on-line, and a limit violation was immediately reported. The system has performed satisfactorily in our laboratory for ten analyzers for over 1 year.     

Intermethod variation in serum carcinoembryonic antigen (CEA) measurement. fresh serum pools and control materials compared.

This study was undertaken to evaluate the feasibility of using commercial control materials in a regional external quality assessment scheme (EQAS) for serum carcinoembryonic antigen (CEA) measurement. We have assessed the commutability of 12 commercial control materials using five automated immunochemical systems. We compared the intermethod behavior of the materials with that of 12-14 patient serum pools. In a total of 48 comparisons (12 materials x 4 pairs of analytical systems), seven instances of non-commutability were apparent, as shown by normalized residuals falling outside the +/-3 interval. The use of non-commutable materials generates two negative effects. In EQAS, the interlaboratory variation recorded is not representative of the variation expected in the assay of patient sera; in interlaboratory harmonization programs, recalibration with non-commutable materials increases, instead of decreasing, the interlaboratory variation. Both these effects were shown to occur in CEA measurement with the tested materials and systems. The materials planned to be used in our EQAS turned out to be commutable: this gave us the guarantee of measuring realistic interlaboratory variation values, although the check for commutability should be extended to all the analytical systems used by the participants in the scheme.     

质控小组应用持续质量改进模式在病区管理中的作用

目的 探讨病区质控小组应用持续质量改进(CQI)模式在病房管理中发挥的作用.方法 病区成立质控小组应用CQI模式对护理进行质量控制与未实施前的质量控制方法进行护理质量及患者满意度的比较.结果 采用CQI模式后病区护理质量及患者满意度明显提高(P＜0.01).结论 通过病区成立质控小组并采用CQI模式对护理进行质量控制能让病区护理质量稳步提高.     

In vitro susceptibility testing and quality control parameters for sarafloxacin (A-56620): a fluoroquinolone used for treatment and control of colibacillosis in poultry

Sarafloxacin (formerly A-56620) is a fluoroquinolone recently introduced into veterinary practice for the therapy of colibacillosis and other indicated infections. Sarafloxacin was noted to be very active and comparable to ciprofloxacin and enrofloxacin for inhibiting 823 strains from a wide variety of species at ≤1 or ≤2 μg/mL. In vitro susceptibility tests for sarafloxacin using National Committee for Clinical Laboratory Standards (NCCLS) methods were also studied and interpretive criteria for Escherichia coli–associated colibacillosis isolates were proposed: susceptible at ≤0.06 μg/mL (≥25 mm) and resistant at ≥0.25 μg/mL (≤21 mm). Sarafloxacin agar dilution MIC results were approximately one log₂ dilution higher than broth microdilution endpoints. The interpretive criteria demonstrated a low error rate of 5.9%, with a very major rate of only 0.5% (correlation coefficient between methods = 0.94). Quality control trials in six laboratories established MIC and zone diameter (5-μg disk) limits for the NCCLS recommended strains: for the broth microdilution test, E. coli ATCC 25922 = 0.008 to 0.03 μg/mL, Pseudomonas aeruginosa ATCC 27853 = 0.12 to 1 μg/mL, Enterococcus faecalis ATCC 29212 = 0.5 to 2 μg/mL, and Staphylococcus aureus ATCC 29213 = 0.06 to 0.25 μg/mL; and for the disk diffusion test, E. coli ATCC 25922 = 30 to 36 mm, S. aureus ATCC 25923 = 25 to 30 mm, and P. aeruginosa ATCC 27853 = 23 to 29 mm. These criteria for in vitro tests with sarafloxacin should enable the longitudinal monitoring of its activity against the indicated pathogens and allow detection of emerging resistant populations that may necessitate altered dosing regimens.     

Anti-streptococcal activity of SB-265805 (LB20304), a novel fluoronaphthyridone, compared with five other compounds, including quality control guidelines

SB-265805 (formerly LB20304) is a novel C-7 pyrrolidine-substituted naphthyridone that has a broad spectrum of activity, especially against Gram-positive cocci. SB-265805 activity was compared with ciprofloxacin, grepafloxacin, moxifloxacin, sparfloxacin, and penicillin against 599 Streptococcus spp. isolated recently from more than 30 medical centers in North and South America. These included 70 isolates with decreased susceptibility to recently released fluoroquinolones (levofloxacin MIC, > or = 4 micrograms/mL). All strains were tested by reference microdilution methods in lysed horse blood-supplemented Mueller-Hinton broth. Sixteen percent of 148 beta-haemolytic streptococci (strains of gr. B and C) were not susceptible to penicillin, whereas 38% and 42% of viridans group streptococci and Streptococcus pneumoniae were resistant to penicillin, respectively. SB-265805 potency against 301 pneumococci (MIC90, 0.06 microgram/mL) was fourfold more active than moxifloxacin and was > or = eightfold more potent than other quinolones. Against beta-haemolytic streptococci, SB-265805 and moxifloxacin were the most active (MIC90, 0.06 and 0.25 microgram/mL, respectively), whereas sparfloxacin, grepafloxacin, and ciprofloxacin (MIC90, 0.5-1 microgram/mL) were less potent. SB-265805 MICs versus viridans group streptococci (MIC90, 0.12 microgram/mL) were fourfold lower than sparfloxacin or grepafloxacin, and twofold more active than moxifloxacin. A nine-laboratory quality control (QC) protocol conforming to NCCLS M23-T3 guidelines demonstrated a modal SB-265805 MIC of 0.016 microgram/mL for S. pneumoniae ATCC 49619 (proposed QC range, 0.008 to 0.03 microgram/mL). The SB-265805 disk (5-microgram) QC range was 28-34 mm (97.3% of qualifying results). In general, SB-265805 in vitro activity against Streptococcus species was superior to sparfloxacin, grepafloxacin, and moxifloxacin and markedly greater than ciprofloxacin. This degree of antimicrobial potency warrants further investigation of this newer drug for its potential human clinical application against streptococcal infections.     

人性化护理对慢性肾衰竭行血液透析患者生活质量的影响

目的:探讨人性化护理应用于行血液透析的慢性肾衰竭患者的临床效果。方法:将92例行血液透析的慢性肾衰竭患者随机分为实验组(n=47)和对照组(n=45)。对照组给予常规护理,实验组给予人性化护理。结果:实验组生活质量评分显著优于对照组(P0.01)。结论:对行血液透析的慢性肾衰竭患者采取人性化护理,可以显著提高患者舒适度,改善患者生活质量,值得在临床上应用和推广。     

品管圈在提高护士PDA使用率中的应用

目的探讨品管圈在提高护士PDA使用率的应用效果。方法成立品管圈活动小组,运用品质管理手段管理护士PDA(Personal Digital Assistant,即个人数码助理)的使用。结果实施品管圈活动后,护士PDA执行率由活动前的63.6%提高到活动后的85.5%,差异具有统计学意义(P0.05)。结论正确运用品管圈可明显提高护士PDA使用率,提高圈员综合能力。     

品管圈对降低全血采集不足量发生率的效果观察

目的探讨品管圈在降低全血采集不足量发生率中的应用效果。方法运用品管圈活动的管理方法,分析影响全血采集不足量的主要因素,制定对策并组织实施。比较改善前后全血采集不足量发生率,评价本品管圈有形成果和无形成果。结果改善后全血采集不足量发生率由原来的1.50%降到0.67%,下降幅度达0.83%。改善前后比较,献血反应和采血不畅2项指标有差异(P<0.05)。活动后的达标率为108%,达到了预期目标。圈员解决问题能力、团队凝聚力都有一定程度提高。结论本次品管圈活动降低全血采集不足量发生率,减少血液报废,保证了血液质量,提高血液采集成功率,值得推广。     

右美托咪啶混合舒芬太尼用于腹腔镜下胆囊切除术后自控静脉镇痛的效果

目的评价右美托咪啶混合舒芬太尼用于腹腔镜下胆囊切除术后自控静脉阵痛(PCIA)的效果。方法选择全凭静脉气管插管全身麻醉下进行LC手术患者90例,年龄35~55岁,ASA 1~2级,采用随机数字表法,将患者随机分为3组(n=30):1组于患者苏醒拔管后给予安慰剂(生理盐水)治疗;2组于患者苏醒拔管后采用舒芬太尼进行PCIA[背景输注量0.015μg/(mL.h),PCA量0.023μg/kg,锁定时间15 min];3组于患者苏醒拔管后采用舒芬太尼混合右美托咪啶进行PCIA[右美托咪啶背景输注量0.045μg/(kg.h),PCA量0.07μg/kg,锁定时间15 min舒芬太尼用量用法不变]于术后4、8、16、24 h记录PRINCE-HENRY疼痛评分和RAMSAY镇静评分,于24 h进行患者满意度评价,记录不良反应的发生情况。结果于1组比较2,3组镇痛后效果非常明显;于2组比较3组术后4、8、24 h的PRINCE-HENRY评分和舒芬太尼用量降低,患者满意度升高(P<0.05)其余指标间比较差异无统计学意义。结论右美托咪啶混合舒芬太尼用于腹腔镜下胆囊切除术后自控静脉阵痛的效果优于单独应用舒芬太尼。     

In vitro activity of dirithromycin (LY 237216) compared with activities of other macrolide antibiotics.

Dirithromycin inhibited Streptococcus pyogenes, Streptococcus pneumoniae, and other hemolytic streptococci at concentrations of less than or equal to 0.03 to 0.12 micrograms/ml, with 90% inhibition at 0.12 micrograms/ml, which is comparable to results using erythromycin. Group A streptococci, listeriae, and enterococci resistant to erythromycin were resistant to dirithromycin. Erythromycin-susceptible staphylococci were inhibited by 0.5 micrograms/ml, but for erythromycin-resistant isolates MICs were greater than or equal to 8 micrograms/ml. For Haemophilus influenzae, MICs were greater than or equal to 8 micrograms/ml, two- to fourfold greater than for erythromycin. The activity of dirithromycin against staphylococci and streptococci was not decreased by the addition of human serum.