Management Practice of Outsourcing Hospital Tests to Independent Clinical Laboratories / 中国医疗器械杂志

With the development of medical technology and the deepening of medical reform, hospital laboratory test continues to expand. Affected by factors such as technology and cost, the business of outsourcing laboratory test to independent clinical laboratories develops rapidly. However, this cooperation mode has not been carried out for a long time and lacks systematic management experience. Through the analysis of the motivation of hospital delivery, this study expounds the classification, judgment basis and requirements for suppliers of third-party clinical laboratory delivery, as well as the operation practice of laboratory test delivery, so as to provide reference for more standardized and effective testing delivery for hospitals.

Application of delta checks in clinical laboratories / 中华检验医学杂志

The delta checks are one of the patient-based quality control options to identify the errors and the significant changes in patients′ condition. Compared with the traditional internal quality control method, the delta checks have the characteristics of real-time monitoring, with no additional detecting cost, thus the delta checks are widely used in clinical laboratories. In addition, the delta checks are also useful in the auto-verification system to screen out the abnormal results for manual verification. This article reviewed the delta checks′ development history, parameters selection, application values in quality control and auto-verification.

Evaluation of clinical laboratories in diagnosing intestinal parasitic infections

Parasitic infections are an important public health issue due to their high prevalence and widespread incidence. In Brazil there are no data on the performance of clinical laboratories regarding fecal examinations. The purpose of this study was, therefore, to assess the performance of clinical laboratories in Curitiba and its Metropolitan Region, Paraná state, on the diagnosis of intestinal parasitic infections. Samples were sent to laboratories in three semi-permanent preparations on glass slides for microscopy analysis and three samples in diluent solution. The forwarded samples contained ten different parasite species and 22 possible diagnoses. The laboratories were scored very good, good, average or below average according to a predetermined standard. None of the assessed laboratories scored very good regarding the diagnosis of intestinal parasitic infections, 21.1% of laboratories scored good, 15.8% average and 63.2% below average. There were 22% false positives and 24.4% false negative results. The diagnosis of Ascaris lumbricoides eggs was least mistaken. The most common diagnostic failures were in the identification of hookworm larvae, Iodamoeba bütschlli cysts and Fasciola hepatica eggs. The poor performance of laboratories in parasitological diagnosis demonstrated that parasitology laboratories are neglected and professional training is not up to standard

Herramienta de evaluación de equipos biomédicos automatizados para laboratorios clínicos / Automated health technology assessment tool for clinical laboratories / ferramenta de avaliação de tecnologia de saúde automatizada para laboratórios clínicos

Resumen Este artículo presenta una herramienta desarrollada como apoyo para los laboratorios clínicos en el proceso de QJ evaluación y selección de tecnología biomédica, de forma que éste pueda ser automatizado en la fase analítica, facilitando la toma de decisiones basadas en la evidencia. Para el desarrollo de la herramienta se estructuró un método que contó con la entrevista a expertos en gestión de tecnología biomédica de cuatro laboratorios clínicos del Departamento y se estableció una metodología de evaluación de tecnología en salud que facilita la toma de decisiones basadas en la evidencia, mediante un software que permite llevar a cabo el proceso de evaluación de tecnologías biomédicas automatizadas en laboratorios clínicos. Como resultado se obtuvo un proceso estandarizado para evaluar tecnologías biomédicas automatizadas en laboratorios clínicos, realizando inicialmente un análisis de la necesidad real de tecnología que se tiene en la institución y posteriormente realizando los análisis técnico, clínico, económico y de proveedor a cada uno de los posibles equipos médicos automatizados que se pueden incorporar en las actividades del laboratorio y pueden solventar la necesidad de tecnología ya detectada. Para llevar a cabo este proceso de manera sencilla y práctica, se diseñó un software que facilita la toma de decisiones en cuanto a la incorporación de equipos médicos al laboratorio clínico mediante la calificación de cada una de las características, especificaciones, atributos y funciones que brinda cada uno de los equipos que pueden solventar una necesidad especifica de tecnología biomédica. El trabajo concluye con una estandarización y herramienta que presenta la ruta estratégica para adquirir tecnologías que satisfacen completamente las necesidades de un laboratorio clínico de manera que se mejoren y faciliten los procesos de evaluación tecnológica en éstos.

Abstract The purpose of this paper is to describe a tool which will aid clinical laboratories standardize the process of Health Technology Assessment (HTA) and selection of automatic medical equipment at the analytical stage facilitating decision making. The development of this tool was made by interviewing experts from four different clinical laboratories in our department. After this activity was complete we used a software to establish the based on evidence methodology to evaluate healthcare technology. We obtained a standardized process to evaluate automatic biomedical equipment in clinical laboratories by addressing the real technology need and then conducting a technical, clinical, economical and logistical analysis of each and every automatic medical equipment that could be used to solve that need. In order to make HTA process that includes both the evaluation and selection appropriate, the software grade all medical equipment that could be used to solve the identified need by its characteristics, specifications, attributes and functions. This work concludes with an alternative standardized method that could be used not only for the evaluation, selection and acquisition of appropriate automatic medical technology but also that improves and facilitates the evaluation process of these devices in clinical laboratories.

Resumo O objetivo deste trabalho é descrever uma ferramenta que auxiliará os laboratórios clínicos a padronizar o processo de Avaliação de Tecnologias em Saúde (HTA) e a seleção de equipamentos médicos automáticos no estágio analítico, facilitando a tomada de decisão. O desenvolvimento desta ferramenta foi feito entrevistando especialistas de quatro laboratórios clínicos diferentes em nosso departamento. Depois que essa atividade foi concluída, usamos um software para estabelecer a metodologia baseada em evidências para avaliar a tecnologia de assistência médica. Obtivemos um processo padronizado para avaliar equipamentos biomédicos automáticos em laboratórios clínicos, abordando a real necessidade de tecnologia e, em seguida, realizando uma análise técnica, clínica, econômica e logística de cada um dos equipamentos médicos automáticos que poderiam ser usados para solucionar essa necessidade. A fim de tornar o processo de ATS que inclua tanto a avaliação quanto a seleção apropriada, o software classifica todos os equipamentos médicos que poderiam ser usados para solucionar a necessidade identificada por suas características, especificações, atributos e funções. Este trabalho conclui com um método padronizado alternativo que poderia ser usado não só para a avaliação, seleção e aquisição de tecnologia médica automática apropriada, mas também que melhora e facilita o processo de avaliação destes dispositivos em laboratórios clínicos.

Programa de Acreditación de Laboratorios: 22 años contribuyendo a la calidad de los laboratorios de la Argentina / Laboratory Accreditation Program: contributing to laboratory quality in Argentina for over 22 years / Programa Acreditação de Laboratórios: 22 anos contribuindo à qualidade dos laboratórios da Argentina

El Programa de Acreditación de Laboratorios (PAL) se estableció en 1994 con el objeto de mejorar las prestaciones bioquímicas de los Laboratorios Clínicos de la provincia de Buenos Aires. La estructura organizativa es conforme a normas internacionales y los requisitos exigidos para los laboratorios fueron diseñados en un esquema que tuvo en cuenta los avances en los procesos de gestión de los laboratorios y las realidades regionales del país. Con dicha estrategia el programa extendió sus actividades a lo largo y ancho del país. Las auditorías en terreno son desarrolladas por pares evaluadores que cumplen con estrictas normas éticas. Al presente cuenta con más de 1000 laboratorios acreditados ubicados en 18 de las 24 provincias argentinas y su proyección a futuro apunta a hacerse extensivo a la totalidad del territorio nacional.

The laboratories accreditation program (PAL for its name in Spanish) was established in 1994 in order to improve the services of biochemical laboratories of the Province of Buenos Aires. The organisational structure was based on international standards, and the requirements for the laboratories were designed in a scheme that took into account the advances in the management process of the laboratories and the regional realities in Argentina. With this strategy, the Program spread its activities throughout the country. All the audits are conducted in the site, by peer reviewers that follow strict ethical standards. At the present, PAL has more than 1,000 accredited laboratories located in 18 of the 24 Argentine provinces, and its future projection aims at involving the entire national territory.

O Programa de Credenciamento de Laboratórios (PAL, por suas siglas em espanhol) foi criado em 1994 a fim de melhorar os benefícios bioquímicos dos Laboratórios Clínicos da Província de Buenos Aires. A estrutura organizacional está em conformidade com as normas internacionais, e os requisitos exigidos para os laboratórios foram projetados em um esquema que levou em consideração os avanços nos processos de gestão dos laboratórios e as realidades regionais do país. Com esta estratégia, o programa estendeu suas atividades em todo o país. Auditorias no local são realizadas por avaliadores que cumpre os rigorosos padrões éticos. Atualmente, tem mais de 1.000 laboratórios credenciados localizados em 18 das 24 províncias argentinas e sua projeção futura é encaminhada a se estender por todo o território nacional.

Quality Indicators in Laboratory Medicine:A Fundamental Tool for Quality and Patient Safety / 现代检验医学杂志

Quality indicators (QIs)in laboratory medicine can measure how well a clinical laboratory meets the needs and re-quirements of users and the quality of all operational processes.The identification of reliable QIs is a crucial step in enabling users to quantify the quality of laboratory services.Different QIs and terminologies are currently used and,therefore,there is the need to harmonize proposed QIs.A model of quality indicators has been consensually developed by a group of clinical la-boratories according to a project launched by a working group of the International Federation of Clinical Chemistry and La-boratory Medicine.The model includes 57 QIs related to key processes (35 pre-,7 intra-and 15 post-examination phases)and 3 to support processes.The developed a model of quality indicators and the data collected provide evidence of the feasibility of the project to harmonize currently available QIs,but further efforts should be done to involve more clinical laboratories and to collect a more consistent amount of data.

Trato del personal de laboratorios clínicos en la atención a población sexogénerodiversa: Maracay, 2012 / Treatment of the staff of clinical laboratories in the care to sex gender diverse population: Maracay, 2012

La homolesbotransfobia se ha constituido como problema de salud pública, y con sus expresiones de discriminación, maltrato y exclusión por parte del personal de los servicios de salud, impacta negativamente en la posibilidad de acceso a los servicios de atención por parte de la población LGTTB (lesbianas, gays, trasvestis, transexuales y bisexuales), y de hecho, aunque no cuantificado, en su condición de salud y vida. Es realizado un estudio descriptivo de corte transversal, constituyendo la población estudiada por 47 usuarios y usuarias y 09 miembros/as del personal en servicio de un laboratorio clínico de referencia especializado. La información es procesada y analizada con el Programa Epi Info 6.04, obteniéndose resultados no significativos respecto a la presencia de maltrato, discriminación y comportamientos homofóbicos. A pesar de no ser objetivo de la investigación, el contraste de estos resultados con reportes nacionales e internacionales revela la muy baja sensibilidad del método cuantitativo utilizado para la exploración de esta situación. Se recomienda un abordaje alternativo que permita explorar posible información subjetiva y colaborar en la generación de políticas y programas de salud dirigidos a la población LGTTB.

The homolesbotransfobia was established as a problem of public health, and their expressions of discrimination, abuse and exclusion by health services staff, has a negative impact on the possibility of access to services by the population LGTTB (lesbian, gay, shemale, transsexual and bisexual), and in fact, although not quantified, in its condition of health and life. A descriptive study of cross, becoming the studied population 47 users, and 09 members of the personal service staff of a specialized clinical reference laboratory is conducted. The information is processed and analyzed with the Epi Info 6.04 programme, non-significant results regarding the presence of abuse, discrimination and homophobic behavior. Despite not being a target of the investigation, contrast these results with national and international reports reveals very low sensitivity of the quantitative method used for the exploration of this situation. It is recommended an alternative approach that allows explore possible subjective information and assist in the generation of policies and programmes directed at the population LGTTB.

Primera etapa del Programa de Estandarización de Creatinina en la Provincia del Chaco: relevamiento de tecnologías y procedimientos de los laboratorios clínicos / First stage of the Creatinine Standardization Program in the Province of Chaco: clinical laboratories technologies and procedures survey

Introducción: El Ministerio de Salud Pública, la Fundación Renal del Nordeste Argentino, el Colegio Bioquímico, todas instituciones de la Provincia del Chaco, y la Fundación Bioquímica Argentina emprendieron el desarrollo de un Programa de Estandarización de la Creatinina Plasmática (PECrP). El objetivo es presentar los resultados del relevamiento realizado en los laboratorios clínicos (LC). Métodos: Se realizo una encuesta al 100% (n= 39) de los LC que participan en el programa, siendo del sector publico 22 (56%) los cuales fueron seleccionados por complejidad, tasa mensual de determinaciones de Creatinina y cercanía a poblaciones en desventaja y a los 17 (44%) LC privados que aceptaron participar. Resultados: Los resultados fueron: 1) Tecnología: automática 43,7%, semiautomática 38,4%, manual 17,9%; 2) Metodología: en la modalidad punto final 12,9% y cinética 79,2%, no respondieron 3 (7,69%) laboratorios; 3) Calibradores: 46,3% utilizan patrones en matriz sérica, 17.9% patrones acuosos y no se obtuvieron datos del 35.8%; 4) Los sistemas homogéneos se constataron en el 12,9% de LC, mientras que en el 84,6% se utilizaron sistemas heterogéneos; 5) Temperatura: el 41% hacían la reacción a 25 ºC, mientras que el 48,7% a 37 ºC; 6) Controles de calidad Internos (CCI) y Controles de calidad externos (PEEC): solo el 38,4.% utiliza ambos, el15,4% ninguno y el 25,6% utiliza solo una de las dos herramientas (CCI o PEEC), resultando un 41% de los laboratorios participantes con controles parciales o ausentes. Conclusiones: Teniendo en cuenta la heterogeneidad observada en los instrumentos y en las condiciones de la determinación se definieron nuevas líneas de trabajo para continuar con el programa de estandarización.

Introducción: The Ministry of Public Health, La Fundación Renal del Nordeste Argentino (The Renal Foundation of the Argentinean Northeast), El Colegio Bioquímico (The BiochemicalSchool), all the institutions of the Province of Chaco, and La Fundación Bioquímica Argentina (The Argentinean Biochemical Foundation) beganthe development of a Plasmatic Creatinine Standardization Program (PCrSP). The objective is to present the results of the survey conducted in the Clinical Laboratories (CL). Methods: A survey was performed in 100% (n= 39) of the CL participating in the program; 22 (56%) of them belong to the public sector and were selected by complexity, monthly rate of creatinine determinations, and proximity to vulnerable populations, and 17 (44%) of them are private CL that agreed to participate. Results: The results were as follows: 1) Technology: automatic (44.8%), semi-automatic (37.9%), manual (17.2%); 2) Method: 5 (13.9%) used endpoint and 31 (86.1%) used kinetic method; 3 laboratories did not provide a response; 3) Calibrators: 18 (36.7%) used serum matrix, and 7 (17.9%) aqueous patterns, and no data was obtained from 14 (35.9%) labs; 4) Homogeneous systems were verified for 5 (13.2%) labs, and for 33 (86.8%) of them systems were heterogeneous; 5) Temperature: 16 (43.2%) reacted at 25 ºC, and 19 (51.4%) at 37 ºC; 6) Internal Quality Controls (IQC) and External Quality Controls (EQC): 15 (48.3%) performed both, 6 (19.4%) performed neither, 10 (32.3%) performed either of them (IQC or EQC), where 51.7% of the participating laboratories had partial or absent controls. Conclusions: Considering the heterogeneity observed in both the tools and the determination conditions, new operating lines for standardization were defined.

Aspectos éticos em uma disputa de mercado entre laboratórios clínicos e um plano de saúde: relato de caso / Ethical issues in a market dispute between clinical laboratories and a health plan: case report

Como alternativa à assistência em saúde pública, surgem no Brasil os planos privados. Esse segmento sofreu grande intensificação nas décadas de setenta e oitenta, culminando com a entrada das grandes seguradoras no cenário da medicina suplementar. Rapidamente, os prestadores de serviço se associaram a elas, solidificando-as no mercado e desencadeando uma relação de dependência. O presente artigo analisou, em forma de relato de caso, uma disputa mercadológica entre laboratórios clínicos e um plano de saúde, enfatizando os aspectos éticos e morais envolvidos nesse episódio.

In Brazil the private health plans appear as an alternative to the public health assistance. This segment suffered great intensification in the seventies and eighties, culminating in the entry of large insurance company in the scenario of supplementary medicine. Quickly, the service providers associated with these insurance companies, consolidating them in the market and triggering a relationship of dependency. This article analyzed, in the form of a case report, a marketing dispute between clinical laboratories and a health plan, emphasizing the moral and ethical aspects involved in this episode.

Avaliação do controle externo da qualidade nos laboratórios clínicos do Rio de Janeiro de 2006 a 2008 / Evaluation of external quality assessment in clinical laboratories from Rio de Janeiro in the years 2006-2008

INTRODUÇÃO: O Controle Externo da Qualidade (CEQ) é uma ferramenta importante para a garantia da qualidade das análises laboratoriais, auxiliando o laboratório a avaliar a eficiência da fase analítica de seus processos. Um resultado errôneo de uma análise prejudica a conclusão do diagnóstico de uma enfermidade e a indicação correta do tratamento a ser tomado. As inspeções sanitárias em laboratórios clínicos (LCs) no estado do Rio de Janeiro são feitas com base no roteiro de inspeção sanitária publicado pela Portaria SES/CVS 743, de junho de 2006, na RDC 302/2005 e legislação vigente. Os resultados observados quanto ao CEQ, do total de 347 inspeções realizadas pelo Setor de Laboratórios de Análises Clínicas da Secretaria de Saúde e Defesa Civil (LAC-SESDEC) no decorrer dos anos pesquisados, são apresentados a seguir: em 2006, entre as 133 inspeções realizadas em Laboratórios de Análises Clínicas, 44 por cento dos estabelecimentos não possuíam contrato com provedor de ensaios de proficiência (EPs); em 2007, entre as 95 inspeções realizadas em Laboratórios de Análises Clínicas, 38 por cento não possuíam contrato com provedor de EPs; em 2008, entre as 119 inspeções realizadas em Laboratórios de Análises Clínicas, 35 por cento não possuíam contrato com provedor de EPs. Dos 214 laboratórios clínicos inspecionados nos anos de 2007 e 2008, 62 por cento (134 estabelecimentos) possuíam CEQ, entretanto, desses 134 estabelecimentos, 65 por cento não registravam as ações corretivas relacionadas com as não conformidades detectadas em relatório emitido pelo provedor de EPs. MÉTODO: No presente estudo, foi avaliada a distribuição percentual dos resultados das inspeções sanitárias realizadas em LCs no estado do Rio de Janeiro de 2006 a 2008, cadastrados na Secretaria Estadual de Saúde e Defesa Civil (SESDEC), relacionando o número de LCs que não atendem às exigências sanitárias, item: "Controle Externo da Qualidade - CEQ da Portaria 743/2006", e a natureza e a iniciativa desses estabelecimentos: LC intra e extra-hospitalares (hospitais públicos ou privados, próprios ou terceirizados). OBJETIVO: Avaliação percentual do CEQ em LCs no estado do Rio de Janeiro ao longo do período analisado, com relação à natureza desses estabelecimentos.

INTRODUCTION: External Quality Control (EQC) is an important tool for quality assurance, assisting the laboratory in evaluating the efficiency of the analytical phase of its processes. An erroneous result of an analysis hinders the conclusion of diagnosis and the suitable treatment prescription to be followed. Health inspections in Clinical Laboratories (CL) in the State of Rio de Janeiro are made based on a sanitary inspection procedure issued by Directive SES/CVS 743, June 2006, RDC 302/2005 and current Brazilian legislation. EQC results observed from the total of 347 inspections conducted by the Division of Clinical Analysis Laboratories of the Department of Health and Civil Defense (LAC-SESDEC) during the period under review are presented below: 44 percent of 133 inspections performed in Clinical Analysis Laboratories had no contract with a proficiency testing provider in 2006; 38 percent of 95 inspections conducted in Clinical Analysis Laboratories did not have a contract with any proficiency testing provider in 2007; and 35 percent of 119 inspections conducted in Clinical Analysis Laboratories had no contract with any proficiency testing provider in 2008. Sixty-two percent (134 laboratories) of 214 CL inspected in the years 2007 and 2008 had EQC, however, 65 percent of them did not record the corrective actions related to the nonconformities identified in a report issued by the proficiency testing provider. METHOD: In this study, we evaluated the percentage distribution of the results of health inspections conducted in CL in the State of Rio de Janeiro from 2006 to 2008, registered at SESDEC, stating the number of CL that did not meet health requirements (item: "External Quality Control -EQC-Directive 743/2006") and the nature and the sector of these laboratories: intra and extra hospital clinical laboratories (publicly or privately owned hospitals and outsourced hospitals). OBJECTIVE: Statistic evaluation of EQC in CL in the State of Rio de Janeiro during the period under review as to the nature of these laboratories.

Impacto del Programa de Evaluación Externa de la Calidad en Química Clínica en México de 2004 a 2008 / Impact of the Program of External Quality Assessment in Clinical Chemistry in Mexico from 2004 to 2008 / Impacto do Programa de Avaliação Qualidade Externa em Química Clínica no México de 2004 a 2008

Se valoró el impacto del Programa de Evaluación Externa de la Calidad, aplicable a laboratorios clínicos en el área de Química Clínica, en México, con base en resultados obtenidos por los laboratorios durante el ciclo marzo 2008-febrero 2009 y el periodo 2004-2008, mediante un estudio analítico, longitudinal y retrospectivo de los resultados obtenidos por los laboratorios que participaron en el Programa de Evaluación Externa de la Calidad de la Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí. El análisis estadístico se realizó con los programas Microsoft® Office Excel y Epi Info T. El porcentaje de laboratorios clínicos con desempeño aceptable (excelente y bueno) por analito, durante el ciclo de evaluación marzo 2008-febrero 2009, fue del 75% al 82%, que aumentó cuando se utilizaron métodos automatizados y semiautomatizados. Para el periodo 2004-2008, los laboratorios en 2004 tuvieron 3,02 veces mayor riesgo de no calificar con desempeño aceptable (p<0,05) que en 2008. En conclusión, el Programa de Evaluación Externa de la Calidad de la Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, ha tenido un impacto favorable en el desempeño global de los laboratorios clínicos, que permite asegurar su calidad analítica.

The impact of the External Quality Assessment Program, applicable to clinical laboratories in the area of Clinical Chemistry in Mexico, was studied, based on laboratory results during the March 2008-February 2009 cycle and the 2004-2008 period, through analytical, longitudinal, retrospective analyses of the results obtained by the laboratories that participated in the External Quality Assessment Program of the School of Chemical Sciences of Universidad Autónoma de San Luis Potosí. Statistical analysis was performed with Microsoft® Office Excel and Epi Info T programs. The percentage of clínical laboratories with acceptable performance (excellent and good) by analyte during the evaluation cycle in March 2008-February 2009 was 75% to 82%, whích íncreased when automated and semíautomated methods were used. For the 2004-2008 period, the laboratories, in 2004, had 3.02 times greatet risk of not qualifying with acceptable performance (p<0.05) than in 2008. In conclusión, the External Qualíty Assessment of the School of Chemícal Sciences of Universidad Autónoma de San Luis Potosí has had a strong impact on the overall performance of clinical laboratories, whích ensures the latter's qualíty.

¿Cuándo dos exámenes seriados de laboratorio representan un cambio en el estado de salud de un paciente? / When two consecutive laboratory results indicate a change in health status in a patient?

Sources of variation between two serial tests must be considered in interpreting if there was a clinically significant change. The main causes of variation are the biological variation coefficient (CVB) of the test in question, which must be obtained from the literature, and the analytical coefficient of variation (CVA) of the same test, which must be obtained from the internal quality control laboratory data. With both data we can calculate the critical difference or “reference change value” which helps us to decide whether there was a real change in the patient’s health.

Biomonitorización de plaguicidas: ¿una necesidad del país? / Biomonitoring pesticides: a national need?

The word ‘biomarker’ is being used more frequently during the last decade. Currently, a great amount of research is directed to fnd toxicological biomarkers for several different chemical substances, since persons are more exposed now than decades before. For this reason, it is important to perform a biomonitoring of such substances in order to assess the possibility that low quantities could cause health problems. Obtaining toxicological values through biomonitoring is also useful to control the exposure. The markers of poisoning by chemicals available worldwide are numerous, but unfortunately in Chile only a few are being used. It is essential to have more toxicology and environmental laboratories to test the levels of exposure of our population.

El término biomarcador ha tenido un uso explosivo en la última década y el área de la toxicología no ha sido la excepción. En la actualidad se busca obtener el mayor número de biomarcadores toxicológicos de sustancias químicas a las que un ser humano puede estar expuesto. La biomonitorización de los agentes químicos es fundamental para conocer en qué concentraciones estas sustancias pueden ocasionar algún problema de salud en la población y también es útil para regular la exposición a ellos. A nivel mundial, son numerosos los marcadores disponibles de intoxicación por sustancias químicas, pero en Chile son pocos los que se utilizan en forma amplia. Dado lo anterior, es fundamental implementar laboratorios toxicológicos y ambientales capaces de realizar la biomonitorización de plaguicidas en forma exhaustiva y confiable.

Challenge and strategy in the development of full automatization of clinical laboratories in China / 中华检验医学杂志

The pivotal characteristics, the current situation, the challenge being faced with and the potential solution related to the automatized flow line of the clinical laboratory is introduced in order to provide the reference for the healthy development of the full automatization of the clinical laboratories in China.