Analysis on optimal cut-off values for prediction of lumbar spinal stenosis using lumbar pedicle thickness / 中国基层医药

Objective:To investigate the optimal cut-off values for the prediction of lumbar spinal stenosis using lumbar pedicle thickness.Methods:The clinical data of 64 patients with lumbar spinal stenosis (patient group) admitted to Binzhou Center Hospital from November 2019 to April 2021 and 48 healthy volunteers (healthy control group) who concurrently received routine physical examination involving lumbar spine MRI examination in the same hospital were retrospectively analyzed. Lumbar pedicle thickness was measured on T 2 weighted images of the L 5 vertebral body in the axial projection. Lumbar pedicle thickness was compared between groups using the independent sample t-test. The relationship between lumbar pedicle thickness and age change was analyzed using a one-way analysis of variance. The efficacy of lumbar pedicle thickness in the diagnosis of lumbar spinal stenosis was evaluated using the receiver operating characteristic (ROC) curve, optimal cut-off values, sensitivity, specificity, and the area under the ROC curve. Results:There was no significant correlation between lumbar pedicle thickness and age change ( P > 0.05). Lumbar pedicle thickness of patients with lumbar spinal stenosis was significantly higher than that of healthy controls [(13.25 ± 1.73) mm vs. (8.54 ± 1.88) mm, t = 13.75, P < 0.05]. ROC curve results showed that the optimal cut-off value was 10.50 mm, with a sensitivity of 95.3% and a specificity of 85.4. The area under the ROC curve was 0.963 (95% CI 0.928-0.998). Conclusion:The increase in lumbar pedicle thickness is related to the increase in the incidence of lumbar spinal stenosis. Lumbar pedicle thickness is an accurate, objective, and clear morphological parameter for the prediction of lumbar spinal stenosis. Application of lumbar pedicle thickness to predict lumbar spinal stenosis is innovative and scientific.

Valor de creatinina, potasio y glicemia como predictores de eventos adversos del síndrome coronario agudo

Introducción: En los últimos años la definición de síndrome coronario agudo, ha englobado las diferentes formas de presentación de la cardiopatía isquémica aguda. A pesar de las posibilidades terapéuticas actuales presenta todavía una morbimortalidad elevada y no se cuenta con herramientas de laboratorio para sospechar de manera precoz las complicaciones. Objetivo: Determinar el valor de los cambios de la concentración de creatinina, potasio y glicemia como predictores de eventos adversos del síndrome coronario agudo. Métodos: Se realizó un estudio analítico de cohorte. La muestra estuvo constituída por 124 pacientes. Se confeccionó un formulario donde se recogieron los datos a partir de las historias clínicas, las variables fueron: grupos de edades, sexo, color de piel, diagnóstico, evento adverso, creatinina, potasio y glicemia. Resultados: Predominó el grupo de edad de más de 60 años, el sexo masculino y color de piel blanco. Los principales eventos adversos fueron arritmias y disfunción ventricular izquierda. La creatinina elevada se asoció a disfunción ventricular izquierda, insuficiencia cardíaca y edema agudo del pulmón, la hiperpotasemia con arritmias potencialmente fatales que degeneraron en paro en asistolia y muerte. La hipopotasemia se asoció con arritmias y la hiperglicemia con la recurrencia del episodio isquémico. Conclusiones: La totalidad de los pacientes con valores normales de creatinina, potasio y glicemia no presentaron complicaciones y se demostró su utilidad como predictores de eventos adversos del síndrome coronario agudo.

Introduction: In recent years, the definition of acute coronary syndrome has encompassed the different forms of presentation of acute ischemic heart disease. Despite the current therapeutic possibilities, it still presents a high morbidity and mortality and there are no laboratory tools to suspect complications early. Objective: To determine the value of the changes in the concentration of creatinine, potassium and glycemia as predictors of adverse events of acute coronary syndrome in patients admitted to Hospital Universitario Manuel Ascunce Domenech in the period from October 2017 to October 2018. Methods: A analytical cohort study. The sample consisted of 124 patients. A form was made where the data were collected from the medical records, the variables were: age groups, sex, skin color, diagnosis, adverse event, creatinine, potassium and glycemia. Results: The age group over 60 years old, male sex and white skin color predominated. The main adverse events were arrhythmias and left ventricular dysfunction. Elevated creatinine was associated with left ventricular dysfunction with heart failure and acute pulmonary edema, hyperkalemia was associated with potentially fatal arrhythmias that degenerated into asystole arrest and death. Hypokalemia was associated with arrhythmias and hyperglycemia with the recurrence of the ischemic episode. Conclusions: All the patients with normal values ​​of creatinine, potassium and glycemia without complications and their usefulness as predictors of adverse events of acute coronary syndrome was demonstrated.

Desarrollo e implementacion de un proyecto de comunicacion efectiva de valores criticos en un laboratorio publico pediatrico / Development and implementation of an effective communication project of critical values in a pediatric public laboratory / Desenvolvimento e implementação de um projeto de comunicação efetiva de valores críticos em um laboratório público pediátrico

Los valores criticos (VC) son resultados de laboratorio que deben comunicarse inmediatamente al profesional responsable, representan una amenaza para la vida del paciente y requieren atencion clinica urgente. La deteccion y comunicacion efectiva de valores criticos (CEVC) impacta directamente en la seguridad del paciente y es responsabilidad del laboratorio. Entes acreditadores y la International Organization of Standardization (ISO- 15189:2012) incluyen los VC entre sus requisitos. En 2017 se desarrollo un proyecto para garantizar la CEVC en el Hospital Garrahan. Se reviso el proceso de CEVC documentado en 2015. Se realizaron encuestas y reuniones dentro del laboratorio que evidenciaron falta de adherencia al mismo. Los VC no se comunicaban de la forma estandarizada y frecuentemente no se registraban. Se evaluaron las causas utilizando el diagrama de Ishikawa, lo que reflejo ausencia de consenso para elaborar el documento inicial. Se realizaron encuestas y reuniones intralaboratorio y con los servicios medicos, para consensuar aspectos relacionados con la CEVC y umbrales para diferentes analitos. Se acordo un nuevo listado de VC y otro de valores de informe inmediato en los que era necesario garantizar la comunicacion efectiva, aunque no requirieran intervencion medica urgente. Se protocolizo la CEVC: informe telefonico al medico tratante registrado en un formulario estandar. Se redacto y difundio un nuevo procedimiento. Se desarrollo un sistema de monitoreo con indicadores de calidad. Promover la mejora continua y desarrollar proyectos interdisciplinarios favorece la atencion centrada en el paciente y su familia. El trabajo mancomunado de diferentes servicios permitio consensuar la lista de VC y un protocolo de comunicacion acorde a las necesidades de esta institucion pediatrica.

The critical values (CV) are laboratory results that should be reported immediately to the responsible professionals, representing a threat to the patient's life and being required for urgent clinical attention. Detection and effective communication of the critical values (ECCV) impacts directly on the patient's College of Americans Pathologists (CAP), Joint Commission on Accreditation of Health Care Organizations (JCAHO), Clinical Laboratory Improvements Amendments (CLIA) e safety and it is the laboratory's responsibility. Accrediting bodies and the International Organization of Standardization (ISO 15189:2012) include CV among their mandatory requisites. In 2017, a project was developed to guarantee the ECCV at the Hospital Garrahan. The ECCV process documented in 2015 was reviewed. Surveys and assemblies were carried out within the laboratory, finding evidence of the lack of compliance with standard procedures. The CV were neither reported according to the expected standardized rules nor registered regularly. The causes were evaluated using the Ishikawa diagram, which reflected the absence of consensus to elaborate the initial document. Surveys and intra-laboratory assemblies were performed alongside with medical Departments staff, in order to come to terms on aspects related to the ECCV as well as thresholds for different analytes. Agreement was reached on a new CV list and another list for immediate reporting, in which it is essential to guarantee effective communication, even though they do not require urgent medical intervention. The ECCV was standardized through a telephone report to the treating physician registered in standard forms. A new operation procedure was edited and shared. A monitoring system with quality indicators was developed. Promoting continuous improvements as well as developing interdisciplinary projects enhance patient and family-centred care. The joint work of different Service Departments made it possible to issue the CV list and a communication protocol according to the needs of this pediatric institution.

Os valores críticos (VC) são resultados laboratoriais que devem ser imediatamente comunicados ao profissional responsável, representam uma ameaça para a vida do paciente e requerem atenção clínica urgente. A detecção e comunicação efetiva de valores críticos (CEVC) é de responsabilidade do laboratório e impacta diretamente na segurança do paciente. Organismos de acreditação e a Organização Internacional de Padronização (ISO-15189: 2012) incluem os VC entre seus requisitos. Em 2017, um projeto foi desenvolvido para garantir a CEVC no Hospital Garrahan. O processo do CEVC documentado em 2015 foi revisado. Pesquisas e reuniões foram realizadas dentro do laboratório, evidenciando a falta de adesão a ele. VC não se comunicavam de maneira padronizada e frequentemente não se registravam. As causas foram avaliadas, usando o diagrama de Ishikawa, refletindo a ausência de consenso para preparar o documento inicial. Pesquisas e reuniões foram realizadas dentro do laboratório e com os serviços médicos, para acordar aspectos relacionados à CEVC e limiares para diferentes analitos. Uma nova listagem de VC foi acordada e outra de valores de relatório imediato nas quais era necessário garantir a comunicação efetiva, mesmo que não exijissem intervenção médica urgente. O CEVC foi registrado: relatório telefônico para o médico responsável pelo tratamento registrado em um formulário padrão. Um novo procedimento foi escrito e divulgado. Um sistema de monitoramento com indicadores de qualidade foi desenvolvido. Promover a melhoria contínua e desenvolver projetos interdisciplinares favorece o cuidado centrado no paciente e sua família. O trabalho conjunto de diferentes serviços permitiu chegar a um consenso sobre a lista de VC e um protocolo de comunicação de acordo com as necessidades dessa instituição pediátrica.

Expert consensus on the development of standardization of emergency medical laboratory capacity in Chinese / 中华检验医学杂志

In order to enhance the communication and cooperation between clinic and medical laboratory, strengthen the emergency medical laboratory and clinical management, promote the development of emergency medical laboratory and clinic, improve the comprehensive emergency treatment ability, and realize the standardized construction of emergency under the hierarchical diagnosis and treatment. The emergency clinical experts and medical laboratory experts formed a teamto discuss how to understand the needs of clinicians, standardize the construction of emergency medical laboratory and improve emergency treatment ability through multiple meetings and questionnaires. The laboratory staffandthe clinicians should communicate effectively. According to the common diseases or critical cases in the emergency, they should work out the types of emergency test items together, select the critical value items, and determine the critical value reporting threshold. The quality management system of emergency medical laboratory should be established, operated effectively and improved continuously, so as to provide accurate and timely report for clinic and improve the ability of medical institutions at all levels to treat critical cases. Emergency physicians and laboratory staff should work together to standardize the construction of emergency medical laboratory, improve the service ability of emergency medical laboratory, and promote the ability of emergency physicians at all levels of medical units to treat critical cases.

Evaluation of the clinicai analysis service provided to an emergency department / Avaliação do serviço de análises clínicas prestado a uma unidade de emergência

ABSTRACT Introduction: Time for releasing test results and critical value communication by the clinical laboratory are considered important determinants of patients' length of stay in the Emergency Department (ED). As well as physician satisfaction, they are used as quality indicators of the Clinical Analysis Service (CAS). Objective: The aim of this study was to evaluate the time to return a test result, the communication of critical values and the level of satisfaction of the ED physicians of a university hospital with the CAS. Material and methods: A physician satisfaction survey was conducted using a questionnaire. The test turnaround time for emergency requests was analyzed by observation of the pre-analytical phase and monitoring the analytical and post-analytical phases through the laboratory information system. In order to evaluate the communication of critical values by the CAS, a document analysis of the process was performed. Results: Physicians' overall satisfaction with the CAS was considered average. Greater satisfaction was observed with reliability of the results and the staff courtesy and lesser with the delivery time of results. The test turnaround time exceeded clinicians' expectations and the average described in the literature. No experience with critical-value communication was perceived. Conclusion: The results show several opportunities for progress in the relationship between ED and CAS. The improvement of laboratory quality indicators also depends on the involvement of ED physicians and nurses and embraces monitoring, planning, education and investment in system computerization.

RESUMEN Introducción: El tiempo de entrega de pruebas y la comunicación de valores críticos por el laboratorio clínico son considerados factores determinantes del tiempo de permanencia del paciente en la Sección de Urgencias (SU). Por lo tanto, así como la satisfacción de los médicos, estos datos también son utilizados como indicadores de calidad del Servicio de Análisis Clínicos (SAC). Objetivo: Evaluar el tiempo de entrega de pruebas, la comunicación de valores críticos y el grado de satisfacción de los médicos de la SU de un hospital universitario con el SAC. Material y método: Se realizó una encuesta de satisfacción de los médicos, utilizando un cuestionario. El tiempo de reporte de resultados en la SU ha sido analizado por medio de observación presencial de la fase preanalítica y monitoreo en el sistema computorizado de las fases analítica y postanalítica del laboratorio. Para evaluar la comunicación de valores críticos por el SAC, un análisis documental del proceso ha sido realizado. Resultados: La satisfacción general con el SAC fue considerada regular por los médicos participantes; hubo mayor satisfacción con la confianza en los resultados y con la atención del personal, y menor con el tiempo de entrega de resultados. Los tiempos de reporte han sido más largos que las expectativas de los médicosy la media descripta en la literatura. No se ha observado una cultura de comunicación de valores críticos. Conclusión: Los resultados han ensenado varias oportunidades deprogreso en la relación entre SUy SAC. La mejoría de los indicadores de calidad de laboratorio evaluados depende también del envolvimiento de los médicos y enfermeros del SU e incluye monitoreo, planeamiento, educación e investimento en informatización del sistema.

RESUMO Introdução: O tempo de liberação de exames e a comunicação de valores críticos pelo laboratório clínico são considerados importantes determinantes do tempo de permanência do paciente no Serviço de Emergência (SE). Portanto, assim como a satisfação dos médicos, esses dados também são utilizados como indicadores de qualidade do Serviço de Análises Clínicas (SACL). Objetivo: Avaliar o tempo de liberação de exames, a comunicação de valores críticos e o nível de satisfação dos médicos do SE de um hospital universitário em relação ao SACL. Material e métodos: Foi realizada uma pesquisa de satisfação dos médicos, utilizando um questionário. O tempo de liberação dos resultados de exames de emergência foi analisado por meio de observação presencial da fase pré-analítica e monitoramento no sistema informatizado das fases analítica e pós-analítica do laboratório. Para avaliar a comunicação de valores críticos pelo SACL, foi realizada análise documental do processo. Resultados: A satisfação geral com o SACL foi considerada regular pelos médicos participantes, com maior satisfação quanto à confiança nos resultados e à cortesia dos servidores e menor quanto ao tempo de entrega de resultados. Os tempos de liberação de resultados dos exames ultrapassaram as expectativas dos médicos e a média descrita na literatura. Não foi observada cultura de comunicação de valores críticos. Conclusão: Os resultados demonstraram várias oportunidades de progresso na relação entre o SE e o SACL. A melhoria dos indicadores da qualidade laboratorial avaliados depende também do envolvimento dos médicos e dos enfermeiros do SE e inclui monitoramento, planejamento, educação e investimento em informatização do sistema.

Evaluation of multidisciplinary collaborative nursing model for people with critical conditions during physical examination / 中华健康管理学杂志

Objective This study explored the effect of the multidisciplinary-team collaborative nursing model in physical examinations of people with critical conditions (based on test results).Methods We selected 962 patients with critical conditions based on test-result values found from February to April 2018 as the general process group treated through the routine nursing model,and we also selected 1009 patients with critical conditions based on test-result values found from May to July 2018 as the multidisciplinary collaborating group using a team nursing model.The multidisciplinary collaborative nursing team members included health management center nurses,outpatient nurses,resident nurses,and ward nurses.We compared visiting rates,hospitalization rates,average visiting times,and overall satisfaction after the patients received notification of their abnormal results.There were 488 male patients (50.7％) and 474 female patients (49.3％) in the general process group,with an average age of 51.9 ± 14.9 years;there were 537 male patients (53.2％) and 472 female patients (46.8％) in the multidisciplinary collaboration group,with an average age of 51.0 ± 13.0.Results For the multidisciplinary collaboration group and the general process group,respectively,the visiting rate was 53.0％ and 44.7％ (x2=13.65);the hospitalization rate was 26.7％ and 20.9％ (x2=4.38);overall satisfaction was 97.9％ and 95.9％ (x2=6.49);and the average visiting time was 4 days and 6 days (Z=5.04).The differences were statistically significant (P＜0.05).By category,the visiting rate for radiology and ultrasound patients among the multidisciplinary collaboration group was significantly higher than in the general process group (64.4％ vs.50.8％ for radiology,45.9％ vs.37.3％ for ultrasound,x2=7.65,7.11,P＜0.05).The hospitalization rate for ultrasound patients in the multidisciplinary collaboration group was significantly higher than in the general process group (12.5％ vs.6.4％,x2=10.17,P＜0.05).The average visiting time of ultrasound,abnormal blood pressure,and laboratory testing patients was significantly lower in the general process group (4 days vs.6 days,4 d vs.7 days,4 days vs.5 days,Z=3.37,1.97,2.62,P＜0.05).The overall satisfaction of radiology patients was significantly higher than in the general process group (98.6％ vs.94.3％,x2=5.39,P＜0.05).Conclusion The multidisciplinary team collaborative nursing model improves the rate of visiting and hospitalization of patients with critical conditions after physical examination,shortening their stays,helping patients get timely diagnoses and treatment,and improving patient satisfaction,making the model worth popularizing and applying more broadly.

Auto recognizing critical values from medical image examination reports by using regular expressions / 实用放射学杂志

Objective To introduce a method of automatically identifying critical values from medical image examination reports and prompt the physician to report it,to prevent the omission of the critical value reporting and improve the medical quality.Methods According to the requirement of critical value reporting system,regular expressions were made for each emergency situation of medical image examination,in order to form a critical value feature library.And an algorithm was designed to find critical value and prompt doctors automatically.Results According to this method,the critical value auto recognize software was developed and had been tested in Nanfang Hospital for 6 months.The software ran well.Conclusion Using regular expressions to define a criteria value feature library and design an algorithm of identifying criteria values,can recognize critical values and prompt physician automatically.

Research progress of platelet function tests in antiplatelet effect on monitoring P2Y12 receptor antagonist / 天津医药

The P2Y12 receptor antagonist is used widely in prevention and treatment of cardiovascular and cerebrovascular disease. Monitoring changes of platelet function after treatment can improve the prognosis of patients. The platelet function test is the important way to evaluate high residual platelet reactivity after antiplatelet treatment, including light transmission aggregometry (LTA), whole blood impedance aggregometry assay (WBIA), vasodilator- stimulated phosphoprotein (VASP), thrombelastogram (TEG), platelet function analyzer- 100 (PFA-100) and VerifyNow system (VerifyNow). It is very different for the reflecting ability with residual reactivity of platelets among these tests after anti-platelet therapy, and also significant difference for assessment effect. Among them, LTA is a classic method for the curative effect evaluation of anti-platelet agents, which is convenient and cheap, but it is susceptible to the operating and environment interference. The clinical application of WBIA is less, and which lacks threshold value for assessment. VASP is sensitive for the changes of platelet function, but the test is complex and expensive. TEG can monitor the inhibition ratio of drugs on anti-platelets, but it needs to verify the safety of treatment. It is not clear for sensitivity and specificity with monitoring anti-platelet agent by PFA-100. VerifyNow is effective and reliable, but the cost is high. The evidence of clinical study shows that LTA, VASP and VerifyNow can reflect the effect of platelet inhibition of P2Y12 receptor antagonists sensitively, and is associated with the risk of major adverse cardiac events (MACE) in patients with cadiovascular diseases.

A survey of nurses′monitoring and management of blood glucose critical values / 现代临床护理

Objective To investigate the cognition of the monitoring and management of blood glucose critical values among clinical nurses. Method Totally 112 clinical nurses from 28 departments of the hospital were involved in the investigation with a self-designed questionnaire. Results The average score on monitoring and management of blood glucose critical values was (79.69 ± 14.12). 53 nurses (47.32%) were at a medium or lower level. There were significant differences in the scores among the nurses of different age, work experience, education level and professional title (P<0.05). Conclusions The clinical nurses have inadequate knowledge about the monitoring and management of blood glucose critical values. The hospital administration should carry out various training methods for nurses to improve their ability in nursing diabetic patients.

Evaluation and Analysis of Medical Testing Critical Value Management / 现代检验医学杂志

Objective To analyze medical critical value management present situation,proposed the corresponding counter-measure.Methods Used a retrospective analysis method to analyse 506 cases of medical critical value report in the Second People’s Hospital of Neijiang City in September of 2014,and did constituent ratio of critical values with software,and differ-ent time frequency,critical values occur in different clinical departments,critical value report etc.Results The highest rate of the critical value of laboratory medicine was platelet (PLT),the project was accounted for a total 16.80%,followed by:white blood cell (WBC)13.24%,serum creatinine (Cr)12.25%.Critical value report was concentrated at 9:00~11:00,ac-counted for about 34%;Tuesday and Thursday urgent value reported more volume,Sunday less.Critical value report number was:severe medical center (ICU)accounted for 24.70% of the total number of emergency,department of internal medicine for 21.15%,Department of hematology for 19.57%.Conclusion The inspection department personnel must seriously im-plement the critical value report system of laboratory medicine,clinical departments to seriously implement the critical value reporting and registration system.Each year,according to the evaluation of medical test critical values,ensure medical quality and safety.

Investigation on critical value management in clinical laboratory / 国际检验医学杂志

Objective To investigate the present situation of critical value management in clinical laboratory,and propose im-provement measures.Methods Retrospectively analyze on the 506 cases of critical value reports in the hospital in September 2013, including the distribution of critical value items,the frequency critical value reports at different time in one day,the amount of criti-cal values reported in different department and so on.Results The most reported critical value item was platelet(PLT),which ac-counted for 16.80%,followed by WBC(13.24%)and serum creatinine(12.25%);Critical value reported mostly between 9:00 and 11:00,which accounted for 34% of one days′s reports;The amount of the critical value reports on Tuesday and Thursday were more than that on Sunday;Critical values reported for the patients of Intensive Medical Center(ICU)accounted for the highest pro-portion(24.70%),followed by those of nephrology department(21.15%)and hematology department(19.57%).Conclusion Criti-cal value reporting system should be strictly executed in clinical laboratory;Critical values should be carefully registrated in clinical deparments;Annual inspection of critical value system is required.

Implementation, validation and review of a critical values list in a cardiac emergency room / Implantação, validação e revisão da lista de valores críticos em um pronto-socorro cardiológico

Introduction: Laboratory critical values (CV) can indicate threatening conditions that require rapid clinical intervention. The aim of this study was to implement, validate and review a critical values list (CVL) at Pronto-Socorro Cardiológico de Pernambuco - Universidade de Pernambuco (PROCAPE-UPE). Method: This study was conducted between 2011 and 2013. To formulate the CVL, laboratory tests performed at PROCAPE were analyzed and compared with those of the Journal of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and the College of American Pathologists (CAP). A draft CVL was validated by physicians; staff training and the standard operating procedure were developed covering the entire clinical analysis laboratory, in order to formalize the procedure of critical result reporting. The CVL was updated every six months. Results: Changes were made in CV intervals for the measurement of total serum calcium, serum sodium, serum potassium, the international normalized ratio (INR) and total leukocyte count. Thyroid-stimulating hormone (TSH) was also included in the CVL. In the pediatric CVL, dosages of serum sodium and INR were included, and a change in the value of serum potassium was made. Thus, periodic reviews of CVL allowed greater adequacy to the needs of the study population and avoided overloading the notification process. Conclusion: Clinical laboratories must be responsible for the implementation, validation and review of their CVL to ensure patients’ health. .

Introdução: Valores críticos (VC) laboratoriais podem ser indicativos de condições de risco de morte que requerem intervenção clínica rápida. O objetivo deste estudo foi implantar, validar e revisar uma lista de valores críticos (LVC) no Pronto-Socorro Cardiológico Universitário de Pernambuco-Universidade de Pernambuco (PROCAPE-UPE). Método: Este trabalho foi realizado no período de 2011 a 2013. Para elaborar a LVC, os testes laboratoriais realizados no PROCAPE foram analisados e comparados com os dos jornais da Federação Internacional de Química Clínica e Medicina Laboratorial (IFCC) e do Colégio Americano de Patologistas (CAP). Após a elaboração da LVC, ela foi validada por médicos; treinamentos e procedimento operacional padrão foram desenvolvidos abrangendo todo o laboratório de análises clínicas, com o intuito de formalizar o procedimento de comunicação de resultados críticos. A LVC foi revisada a cada seis meses. Resultados: Foram realizadas modificações nos intervalos de VC na dosagem de cálcio sérico total, sódio sérico, potássio sérico, no índice internacional normalizado (INR) e na contagem total de leucócitos. Também foi incluído na LVC o hormônio estimulante de tireoide (TSH). Na LVC exclusiva da pediatria, foi incluída a dosagem de sódio sérico e o INR, e uma alteração no valor do potássio sérico foi realizada. Assim, uma avaliação periódica da LVC possibilitou maior adequação às necessidades da população de estudo e evitou sobrecarga no processo de notificação. Conclusão: Faz-se necessário que os laboratórios de análises clínicas sejam responsáveis pela implantação, validação ...

Analysis on distribution regularity of clinical critical value in Xining area / 国际检验医学杂志

Objective To understand the distribution regularity of the clinical critical value in the plateau region by analyzing the clinical critical value distribution situation in order to provide the scientific basis for further perfect the critical value report system. Methods The critical value items reported by our department from July 1,2010 to June 30,2011 were retrospectively analyzed for studying its distribution regularity.Results The incidence rate of critical values report in our hospital was 0.29%,the incidence rate of critical value such as blood potassium,glucose and blood gas pH had no difference in distribution between genders in Xining region(P >0.05),but had significantly difference among different age groups(P <0.05).In addition,the report number of the criti-cal value of the blood potassium,glucose and blood gas pH in the internal medicine was significantly higher than that in the surgical departments(P <0.01).Conclusion The periodic retrospective analysis of critical value report helps to improve the clinical diagno-sis and the reporting system of critical value.

Valores críticos en el laboratorio clínico: de la teoría a la práctica / Critical values in the clinical laboratory: from theory to practice

Resumen: independiente del motivo por el cual el médico solicita una prueba de diagnóstico, al final del proceso, el laboratorio clínico genera un informe escrito que entrega al paciente en los laboratorios clínicos ambulatorios o incorpora a la historia clínica en los laboratorios clínicos hospitalarios. Los valores críticos, también conocidos como valores de alarma, mal denominados valores de pánico, son los resultados de pruebas de diagnóstico que expresan una situación médica que puede poner en riesgo la vida del paciente si no se interviene adecuada y oportunamente, de ahí la importancia de que se informen al médico que ha solicitado la prueba, inmediatamente se identifiquen. La política y manejo de los valores críticos es un requisito obligatorio en los laboratorios clínicos de los países desarrollados y hace parte de procesos de acreditación o de calidad en los países en vía de desarrollo, como sucede en Colombia, desafortunadamente muy pobremente desarrollado en los laboratorios clínicos del país. Una vez que el laboratorio clínico opta por establecer un programa de valores críticos, debe instaurar claramente una política de valores críticos, la lista de exámenes con sus respectivos valores críticos, los mecanismos y las personas responsables de notificar los valores críticos cuando éstos se presentan; además de que deberá implementar mecanismos internos que le permitan evaluar y hacer seguimiento de la política de valores críticos, como un mecanismo de mejoramiento continuo. En este módulo se presentan los elementos indispensables para establecer un programa de valores críticos en el laboratorio clínico, independiente de su nivel de complejidad y ubicación, ya sea ambulatorio u hospitalario. La política de valores críticos, más que una norma o una herramienta de mejoramiento continúo en el laboratorio clínico: es un derecho de los pacientes.

Abstract: Regardless of why the doctor orders a diagnostic test, at the end of the process the clinical laboratory generates a written report that is handed to the patient by the clinical laboratories or is incorporated into the medical records in hospital clinical laboratories. Critical values, misnamed panic values, are results that express a medical situation that may jeopardize the patient’s life if not properly and timely intervened, hence the need to be informed immediately after being detected to the doctor who requested them. Policy and management of critical values is a mandatory requirement in clinical laboratories in developed countries and is part of accreditation and quality processes in developing countries, as in Colombia, unfortunately very poorly developed in clinical laboratories in the country. Once the clinical laboratory chooses to establish a critical values program, it must clearly establish a policy of critical values, the list of tests with their respective critical values, the mechanisms, and those responsible for informing the critical values when they occur; furthermore, it must implement internal mechanisms for assessing and following-up the critical values policy as a mechanism that requires continuous improvement. This module presents the essential elements to establish a critical values program in a clinical laboratory, regardless of its level of complexity and location, either outpatient or inpatient. The politics for critical values, more than a regulation or a tool for continuous improvement in the clinical laboratory: is a right for the patients.

Application evaluation of critical value fists data / 中华检验医学杂志

Objective Analyze the historical data of critical values lists,providing scientific evidence for continuous improvement of critical value systems.Methods Screen out critical value lists data of 2006 from laboratory information system,after pretreatment and transformation of data,calculate the percentage of critical value,and its daily distribution,weekly distribution and department distribution, evaluate the range and turnaround time for critical value.Results The rate of critical value was 1.67%.It was mainly concentrated from 8 to 13 O'clock.Monday and Thursday have more critical value than other days.From the perspective of department,the majority critical value was from hematology department and transplantation department.After the evaluation of distribution diagram of critical value range,the lower critical value limit of blood potassium was adjusted from 3.0 mmol/L to 2.8 mmol/L,the blood platelet and leukocyte counts for parlents with hematology disease were a(Ijusted from 20×109/L,1.5×109/L to 10×1O9/L,1.0×109/L respectively.The laboratory turnaround time for 76.2% critical value was less than 1 hour.Conclusion Review and analyze critical value lists data regularly can improve the work efficiency and quality for the laboratory and clinic department and better meet patients' safety needs.

Innovation Research and Practical Application of Critical Values Monitor in Medical Security Alert System / 医疗卫生装备

Objective The application of modern information technology to manage critical values of clinical examination,in order to improve the management level of patients safety and reduce the medical risk.Methods The critical values reminder in medical security alert system is developed and applied,the core module of the system are warning monitor of equipment record and SMS warning monitor of alerting in testing critical value.Results Through the application of system,the information of testing critical values are obtained duly,comprehensively and accurately,the notification time of clinical testing critical values are abbreviated,the notification scopes are spread and achieved the management of critical value at different levels.Conclusion The application of the system can be perfected the management of critical values,ensured patients safety,improved the medical quality and enhanced the management level of hospital,and then the system has become another example of informationization creating value.