Application and evaluation of ultrasound critical value in ruptured tubal pregnancy / 中华超声影像学杂志

Objective:To evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Methods:The clinical and ultrasound data of 70 patients with ruptured tubal pregnancy diagnosed by surgery in Peking Union Medical College Hospital from August 2017 to May 2021 were retrospectively analyzed to evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Results:Among the 70 patients, 68 patients underwent gynecological ultrasonography and two patients did not. Sixty-three cases (92.6%, 63/68) were accurately diagnosed as adnexal ectopic pregnancy mass, abdominal and pelvic effusion/blood clot, and 5 adnexal ectopic pregnancy masses (7.4%, 5/68) were missed.Among the 5 missed cases, 4 cases (80%, 4/5) were heterotopic pregnancy (2 cases of IVF-ET 2 embryos, 1 case of patient taking ovulation induction drugs, 1 case of gravida with twin family history) and 1 case (20%, 1/5) of single tubal pregnancy. Critical values were reported in the all 63 cases of ruptured tubal pregnancy diagnosed by preoperative ultrasound.Conclusions:Ultrasound could accurately diagnose tubal pregnancy and assess its rupture, and timely report the critical value, effectively guarantee the medical safety. The particularity and complexity of ultrasound diagnosis in early pregnancy with assisted reproductive technique deserve more attention.

HIV screening and confirmation results of voluntary blood donors in Wuhu area / 中国输血杂志

【Objective】 To analyze the HIV infection among voluntary blood donors in Wuhu area, so as to provide effective data for improving blood donation recruitment strategies and clinical safe blood use. 【Methods】 All reactive samples from HIV screening among voluntary blood donors in Wuhu from January 2017 to September 2020 were selected and sent to Wuhu CDC for confirmation test.The receiver operating characteristic (ROC) curve was used to compare the accuracy of enzyme-immune reagents. The optimal critical value of ELISA was used to analyze the setting of serological gray area. The preliminary screening S/CO values of confirmed positive, negative and indeterminate samples were compared, and the significance of differences were analyzed by SPSS 22.0 software. 【Results】 75 cases of initially HIV reactive samples were submitted for testing: 17 cases were confirmed positive, 17 indeterminate and 41 negative.The area under curve (AUC) of the 4th generation anti-HIV ELISA reagent was greater than that of the 3rd generation reagent, and the 4th generation reagent was better than the 3rd generation reagent in accuracy. All the 17 confirmed positive samples had high S/CO reactivity with duplicate reagents, and the initial screening S/CO value was significantly higher than that of confirmed negative and indeterminate samples (P0.05). 【Conclusion】 Voluntary blood donors in Wuhu is a middle-endemic population for HIV infection. The setting of grey areas for serological testing is of little significance. Blood safety should be further guaranteed through standardized pre-donation interventions, sensitive nucleic acid detection technologies and shared regional data platforms.

A Study of Analysis of Critical Values at Emergency Biochemistry Laboratory in a Tertiary Care Hospital in India.

One of the important functions of a clinical biochemistry laboratory is clear, accurate, and rapid communication of a critical value to clinicians1. Critical value reporting is one of the requirements for laboratory accreditation. This study aimed to analyse the critical values data at a tertiary care hospital in New Delhi, India in the emergency laboratory setting and compare it with the available data from previous studies.METHODSThis is a retrospective study of emergency biochemistry samples done over a period of two months from July 2019 to September 2019. The critical values data of several biochemical parameters generated from the testing of samples on Beckman Coulter Olympus AU 480 during three months period were analysed. Statistical analysis was conducted using Microsoft Excel 2016 program.RESULTS183056 tests were analysed, and 11875 critical alerts were generated the incidence of which varied from 0.8% for glucose (children) to 10.6% for serum potassium in children. Frequency of critical values for serum potassium is highest followed by serum sodium. Also, critical values for serum potassium in paediatric patients is higher than in adults. It can be stated that there is a need to study of frequency of critical values in emergency as well as routine laboratories to identify the parameters with maximum critical values and also recognize the underlying causes for the same and take suitable measures.CONCLUSIONSThe frequency of critical value for serum potassium, is highest followed by serum sodium, in case of samples received from adult patients. Also, frequency of critical values for serum potassium in paediatric patients is even higher than adults. These values show that these critical biochemical values can be detrimental to these patients and timely notification to the clinician is very important so that necessary actions could be taken to correct them. Further studies of critical values in emergency labs is required to observe trends and identify the underlying causes and suggest suitable remedial measures if any.

Analysis of Reported Critical Values and Their Associated Clinical Conditions in a Clinical Chemistry Laboratory of a Tertiary Health Institution in Nigeria

Studies involving critical values in recent time have mainly dwelt on compliance to timely reporting as well as the volumes of the individual reported critical analytes. There is paucity of data however, especially in this environment, on the relationships that exist between reported critical biochemical analytes and the presenting clinical conditions of the patients as at the time of the laboratory investigation. This study therefore sought to investigate such relationships.This study is a retrospective study of data obtained in the year 2018 from the critical value register of the Department of Chemical Pathology, Babcock University Teaching Hospital Ilisan-Remo, Ogun state, Nigeria. Data obtained was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0. Level of statistical significance was set at p < 0.05. Relationship between variables was determined using Chi-square Test.Original ResearchArticleIn the year under review, a total of 270 critical values from various biochemical analytes were obtained; out of which 34.0% waspotassium, representing the highest occurrence. Calcium had the highest proportion of its tests from the year having critical outcomes (2.2%) compared to other biochemical parameters. Kidney disease was the most frequently reported clinical condition (25.1%) with critical values of biochemical analytes. This study also showed a strong statistical association (p = 0.000) between diabetic ketoacidosis and critical levels of hyperkalemia, critical outcomes of hypocalcaemia and infection/sepsis as well as critical level of azotemia and pregnancy related complications.This study has shown potassium as the most reported critical biochemical analyte which occurred mostly as cases of critical hyperkalemia. This was associated with a high burden of kidney diseases among the study population. The study has also drawn attention to the need for immediate and constant check of blood calcium and urea levels in patients that have sepsis and pregnancy related complications respectively.

Application of PDCA circulation method in critical value management in ultrasound department / 中华医学超声杂志（电子版）

Objective To analyze the current situation of the quality of critical value management in ultrasound department,and to explore the application and effect of PDCA cycle method in critical value management.Methods The quality status of emergency data during the period from January 2015 to January 2019 after the PDCA cycle was adopted was analyzed.The PDCA cycle method was applied to improve the overall quality.The reporting rate,awareness rate,qualified rate of writing,and timely rate of clinical treatment were compared before and after the PDCA cycle was adopted to evaluate the effect of PDCA cycle method.Results From January 2015 to January 2019,the reporting rate was 96.4％,98.0％,94.5％,and 96.7％,the awareness rate of critical value was 63.2％,78.6％,84.8％,and 92.2％,the qualified rate of writing was 70.4％,77.2％,85.3％,and 94.0％,and the timely rate of clinical treatment was 50.9％,71.7％,81.1％,and 85.5％,respectively.The awareness rate,the qualified rate of writing,and the timely rate of clinical treatment were significantly improved (x2=12.464,38.184,52.926,all P ＜ 0.05).Conclusion PDCA cycle method can improve the quality of emergency management in ultrasound department.

Critical Value Report: Survey and Literature Review

BACKGROUND: Communication with clinicians in the pre- and post-analytical period to report correct and adequate laboratory test results is crucial. Specifically, the notification of critical values that identify a treatable life-threatening condition should be effectively implemented. Although critical value reporting consists of a series of inter-dependent decisions and processes, standard critical value practices in clinical laboratories have not been agreed upon yet. METHODS: We analyzed the critical value reporting protocols currently used in Korea and performed a systematic review of published literature to provide best practices to improve the quality of critical value reports. RESULTS: Commonly included critical value reports (number of healthcare facilities) are such as followings: hemoglobin (59/59), platelet (52/59), white blood cell (51/59), activated partial thromboplastin time (45/59), glucose (56/59), potassium (55/59), sodium (50/59) total calcium (42/59), creatinine (42/59), and gram stain result when blood culture is positive (24/59). CONCLUSIONS: Substantial variations in the critical value report protocols exist among the participating clinical laboratories. Further effort should be invested to standardize the protocol.

Investigations on the determination methods of alert thresholds for critical values in clinical laboratories / 临床检验杂志

Objective To retrospectively analyze the literature of alert thresholds for the critical values of clinical biochemistry and hematology tests in adults,and collect the evidence source of these alert thresholds.Methods The literatures during 2006 and 2016 were retrieved,and the evidence sources were evaluated and ranked using the 1999 Stockholm hierarchy for analytical performance specifications in laboratory medicine.Results Thirty most frequently reported laboratory tests with alert thresholds were presented with evidence rankings.Four determination methods of alert thresholds were reported in 92 articles with alert thresholds for critical values.Among them,70％ of alert thresholds were set by individual institutions,18％ by the surveys of clinical laboratories or clinicians,2％ by the recommendation of professional institutions,and 10％ by the evaluation of clinical findings.The sources of these alert thresholds were ranked into level 4,level 3,level 2 and leve 1,respectively.In addition,the alert thresholds of 7 clinical laboratory tests were presented as critical δ values.Conclusion The alert thresholds are set mainly by individual institutions in current clinical laboratoties,followed by the surveys of clinical laboratories or clinicians.Moreover,the general level of evidence source is lower.

Design and implementation of critical value SMS reporting system / 医疗卫生装备

Objective To design a critical value SMS reporting system which covers the existing hospital inspection and laboratory system,and to supplement the existing critical value reporting methods.Methods The system was designed with Delphi programming language and SQL Server database.The critical value data view with unified format was established in the databases of all the systems,the import program stored the data in the database of the SMS reporting system in time,and the SMS sending program controlled the SMS transceiver by calling DLL function to transmit SMS after detecting un-sent critical value message periodically.Results The system realized SMS reporting of the critical values to the medical staffs,and decreased their workload.Conclusion The system enhances the efficiency and quality of the medical technician while providing data reference for critical value management,and thus is worthy promoting practically.

Analysis on critical value situation in hematology laboratory of a hospital during 2 0 1 5 / 国际检验医学杂志

Objective To analyze the critical value items of hematology laboratory during 2015 in order to further perfect the critical values reporting system.Methods The critical value items of hematology laboratory during 2015 were collected from the Laboratory Information System (LIS)of this hospital and perform the statistical analysis on the occurrence rate of critical value,de-partment distribution and specimen source.Results The critical value items included 8 items of RBC,WBC,PLT,etc.There were 9 235 cases of critical value report in 2015 with the incidence rate of 1.74%.PLT had the largest proportion of critical values cases (30.62%),followed by PT (22.27%);PT had the highest rate of critical value(7.27%),followed by PLT(2.67%).The depart-ment of the highest occurrence rate in critical value was the hematology department,followed by the oncology department.Conclu-sion Some problems are exist reporting system,certain problems exist in setting the hematological critical item and threshold value setting .Various laboratories should formulate the critical value limit suitable for the hospital by positively consulting with clinic un-der the basis the setting of critical value items and critical limits.Laboratories should actively consult with clinicians to formulate the critical value limit that is suitable for the hospitals on the basis of reference literatures at home and abroad.

Critical Values of Neonatal Coagulation in Clinical Practice and the Investigation of Normal Reference Range / 现代检验医学杂志

s:Objective To investigate the critical value of neonatal coagulation and the normal reference range in clinical prac-tice,and make Value of the formulation of clinical treatment programs and prevention of neonatal blood coagulation disor-ders.Methods Collected neonatal specimens of 350 cases from January to June 2016 in the General Hospital Ningxia Medi-cal University,after birth with in 6h,the parameters of plasma coagulation:activated partial thromboplastin time (APTT), prothrombin time (PT)clotting time (TT)and fibrinogen (FIB).Made statistics and analysis of all critical information to improve the value of the cases after contact with the telephone registration of neonatology,and critical investigation occurred gestational age children value,birth weight,and critical analysis of the proportion of the value of the proj ect,the distribution of the disease,clinical response and so on.Results Compared with adults and children,four indexes of coagulation levels of newborn were significantly different (t=1.66~2.66,P0.05).The range of personal critical value of the newborn infant was intended to develop:PT(≤8 s and≥30 s),APTT (≤20 s and ≥90 s)and FIB(≤0.6 g/L and ≥10 g/L).Revised “response rate”,clinicians have increased attention com-pared with the previous increase,reducing the false critical value report incidence.Conclusion The indicators of neonatal co-agulation were different from the adults and children.For the establishment of neonatal blood coagulation parameters refer-ence range,on a regular basis to summary on the clinical data of blood coagulation critical value,and contribute to the devel-opment of suitable critical value standard,and improve the clinical comprehensive diagnosis and treatment level.

Analysis of laboratory critical value reporting in the department of spine surgery and management strategies / 中国实用护理杂志

Objective To investigate the common critical value (CV) of patients hospitalized in the department of spine surgery and to determine the corresponding management. Methods Medical records of patients between 2013 January and 2014 December were retrospectively reviewed. 47 cases with CV were noted. The following characteristics of CV were recorded and analyzed, including time-point at occurrence, type, reason and management. Results Most of the CVs (43/47, 91.5%) were detected between 8 am to 12 am, and between 17 pm and 21 pm. Overall, there were 24 cases of abnormal blood electrolyte (51.1%), 13 cases of abnormal routine blood test (27.7%), 5 cases of abnormal blood coagulation test (10.6%), and 1 case of abnormal TnT (2.1%). The remaining 4 cases including 2 cases detected in the night (1 case of abnormal blood gas test and 1 case of abnormal TnT) and 2 cases detected in the afternoon (1 case of positive blood bacteria culture and 1 case of low blood glucose level). Conclusions The most common CVs were summarized in the clinical practice. The findings have important clinical implications concerning the management of these CVs. In addition, preventive modality of daily nursing and standardization of medical management should be applied so as to ensure the safety of patients and rapid recovery.

Application of failure mode and effect analysis in the management of critical value of blood ;specimens / 中国实用护理杂志

Objective To explore the effect of failure mode and effect analysis (FMEA) method in strengthening the management of critical value of blood specimens in hospital. Methods According to the procedures of FMEA, critical values management team were established, drew flow chart of generating test specimens and crisis value, explored the potential failure mode and failure cause, analyzed the severity, possibility and critical value, and formulate and implement countermeasures according to the research outcome. Results The crisis value of the failure mode fell from 1 320 to 151 after the implementation of FMEA, and rate of decline was 88.56%; number of unqualified blood samples decreased from 510 cases to 78 cases, and the difference is statistically significant (χ2=407.27, P<0.05);critical value processing defects decreased from 85 cases (a total of 236 cases) to 3 cases (a total of 229 cases), and the difference was statistically significant (χ2=91.26, P<0.05). Conclusions FMEA method is helpful to improve the accuracy and precision of critical value management of clinical blood samples, so as to ensure the safety of patients in hospitals.

Analysis of clinical application of critical value electric reporting system / 国际检验医学杂志

Objective To investigate the clinical application value of the critical value electric reporting system .Methods The critical value data from Aug .1 ,2015 to Jan .31 ,2016 were inquired through the electronic hospital information system (eHIS) .The incidence rate of critical values ,items distribution and department distribution were analyzed .Results A total of 3 405 items of crit‐ical value were reported .The occurrence rate of critical values was 0 .45% .The top 5 of critical values numbers were chlorine (25 .76% ) ,myocardial‐specific isoenzyme of creatine kinase (19 .97% ) ,serum sodium (9 .43% ) ,platelet count (9 .05% ) and partial pressure of carbon dioxide (6 .40% ) .The top 5 departments of critical values reported number were the cardiology department (18 .94% ) ,followed by neurological intensive care unit (12 .04% ) ,intensive care unit (9 .52% ) ,second wards of neurosurgery (5 .11% ) and neurovascular wards (5 .02% ) .The median time of critical value report was reduced by 33 .33% and the quartile range time weas reduced by 40 .00% .Conclusion The application of critical value electric reporting system reduces the elapsed time of critical value report ,increases the promptness and accuracy of critical value report ,and has an important significance to guarantee the medical quality .

Application analysis of critical value reporting system in a obstetrics and gynecology hospital / 国际检验医学杂志

Objective To analyze the clinical application value of the critical value reporting system.Methods The data record-ings of the critical values reported by the clinical laboratory department from Nov.2013 to May.2014 were inquired through the clinical laboratory information management system(LIS).The incidence rate of the critical values,receipt time of the critical values, items and department distribution were analyzed.Results A total of 1856 items of critical value were reported.The occurrence rate of the critical values was 0.31%.The top 5 of critical value numbers according to the item distribution were white blood cells (46.28%),total bilirubin (16.92%),D-dimer (9.81%),hemoglobin(8.51%)and platelets (8.03%).According to the depart-ments distribution,the top 3 departments with maximal reported critical values were the neonatal department (37.12%),followed by the department of gynecological oncology(23.33%)and the obstetrical department (21.17%).Conclusion The critical value reporting system plays an important role in the obstetrics and gynecology hospital.It should be evaluated and analyzed regularly.

Research on the added value of CT values mean the critical value of sensitivity analysis in the clinical diagnosis of giant cell tumor of bone / 中国医学装备

Objective:To investigate the CT value added value of the mean of critical value in the diagnosis of giant cell tumor clinical sensitivity.Methods: Aretrospective analysis, selected from March 2013 to November 2014, the clinical data of 120 patients with bone tumors treated, they can be divided into two groups at random, control group and the observer, 60 cases in each group, observer for patients with giant cell tumor of bone, the control for the patients with giant cell tumor of bone. Each patient chose three ROI, the added value of the mean values of enhanced CT and CT values mean as observed values, under the experience of observation analysis of patients with giant cell tumor of the added value of CT values mean critical value and its sensitivity in the clinical diagnosis of giant cell tumor of bone.Results: The observation group of patients after CT enhanced scan display area average CT value of HU(108±39)HU was significantly higher than the control group(82±78)HU CT value(t=3.348, P<0.05), statistically significant difference; Through the ROC curve analysis, found that when the added value of CT values mean acuity 96.5 as critical, sensitivity and specificity of diagnosis of giant cell tumors of bone are 90.9% and 90.9% respectively; When the CT value added value of the mean acuity 41.5 HU as the critical point, the sensitivity and specificity of diagnosis of giant cell tumor bone were 98.9%, 48.1% respectively.Conclusion: The bone giant cell average CT value added value of diagnosis of critical value of 96.5HU 41.5HU, and high sensitivity, but the specificity is low, the added value of CT values help determine the existence of the giant cell tumors of bone.

Evaluation of clinical application of platelet critical value and adjustment of the cut-off value / 国际检验医学杂志

Objective To investigate clinical application of critical value of platelet count and its threshold adjustment . Methods Theincidence rate and regularities of distribution of critical value of platelet count were retrospectively analyzed in pa‐tients ,whose platelet count was ≤50 × 109/L from Jan .2012 to Dec .2013 .And the suitable critical values of platelet count for dif‐ferent clinic units were set through clinical coordination .Results The platelet count were detected in 193 776 samples ,and detection results of 1 602 samples reached the critical value of platelet count (detection rate was 0 .83% ) .The critical value of platelet for he‐matology unit was adjusted to ≤10 × 109/L ,for surgical unit was adjusted to ≤50 × 109/L ,and for other units the critical value was still ≤20 × 109/L .Meanwhile ,cases were regarded as reaching the critical value when detection results of platelet count were differ by 50% in short time .Conclusion The adjustment of critical value of platelet count for different units could improve efficiency of clinic and laboratory ,and enhance safety of patients .

Construction of the Reporting System for Test Critical Values / 医学信息学杂志

The paper analyzes deficiencies in traditional manual screening of critical values , telephone notifications and manual record-ing of critical value reports , as well as problems existing in current critical value reporting systems in China .It designs a stable , timely and accurate reporting system for test critical values and mainly introduces the system design , system function and application features .

Process and Quality Improvement of Critical ValueNotification of Emergency Specimens in General Laboratory / 现代检验医学杂志

Objective To estimate the critical value notification of emergency specimens in general laboratory whether a-chieved the desired goals,and to apply quality improvement measures to achieve quality improvement purposes.Methods Critical values of emergency specimens in general laboratory were monitored and collected in 2014.Statistical analysis was done for non-notification rates and sources of the critical values,and quality improvement began in July,2014 by training, continuing education and amonthly bulletin of notification data of critical values.Results Total number of Critical values of emergency specimens in general laboratory in 2014 was 2 648 and 1 950 of them had been reported by telephone.Total notifi-cation rate was 61.4% in the first 6 months,and was 81.4% from July to December.At last,Critical value notification rates increased to 97.72% in December.Conclusion Strengthening the management of critical value notification can help impro-ving the quality of laboratory service,as well as enhancing stuff responsibility and awareness of service for clinic.

The value of combined use of laboratory indicators for diagnosis of early renal functional damage / 中国中西医结合急救杂志

Objective To explore the value of combined use of laboratory indicators for diagnosis of early renal functional damage. Methods Eighty-six patients with various kidney diseases were enrolled in the Second Affiliated Hospital of Guangzhou Medical University. On admission,the serum Cystatin C(Cys C),creatinine(Cr), Urea,etc were determined. The value of using combined laboratory indicators in the diagnosis of renal functional damage was obtained through the analysis of the receiver operating characteristic curve(ROC curve);multiple variable indicators were grouped to establish multiple logistic regression models to be compared and evaluated. Results In the early and late renal injury groups(group B of 32 cases and group C of 12 cases),the serum levels of Cys C,Cr, and Urea were significantly higher than those in the normal renal function control group(group A of 42 cases),the elevation in level in group C being the most significant〔Cys C(mg/L):3.47±0.75 vs. 1.59±1.29,Cr(μmol/L):669±466 vs. 214±173,Urea(mmol/L):21.22±13.10 vs. 11.04±8.24,PCys C+Urea>Cys C>Cr+Urea(0.920=0.920>0.911>0.908>0.809). In this sequence,the AUC made by Cys C+Cr+Urea and Cys C+Cr were equal,both 0.920, whose sensitivity was 75.0%,specificity 100.0%,positive predictive value 100.0%,negative predictive value 80.0%and diagnostic accuracy rate 87.5%. So,Cys C + Cr combination could be used to substitute Cys C + Cr + Urea, and the former clinical diagnostic effect was the best,much higher than that by using AUC whose curve was made by Cys C alone. Conclusion The value of using only one laboratory indicator for diagnosis of patients with early renal functional damage is not high,while applying Cys C+Cr combination can improve the diagnostic effect greatly,and its sensitivity and specificity are higher.

Optimizing of ELISA assay for HBV serum markers / 国际检验医学杂志

Objective To analyze and approach the optimizing of ELISA assay for HBV serum markers.Methods To compare the critical value rate of flushing with distilled water,flushing with cleaning tap water and flushing without anything.Results The HBsAg critical value rates of flushing with distilled water,flushing with cleaning tap water and flushing without anything were 0.52%,2.60% and 5.56%.The HBsAb critical value rates of flushing with distilled water,flushing with cleaning tap water and flushing without anything were 5.52%,8.02% and 14.86%.The HBeAg critical value rate of flushing with distilled water,flush-ing with cleaning tap water and flushing without anything were 2.82%,2.92%and 3.55%.Conclusion Flushing with distilled wa-ter or flushing with cleaning tap water can reduce the high critical value rate because of enzyme or developer pollution.Flushing with distilled water exhibits more efficacy than flushing with cleaning tap water.