POCT技术的应用是检验医学成熟的标志ppt演示课件

POCT技术的应用是 检验医学成熟的标志,1,命题提出的理念,一个检验分析系统，当它的检测分析灵敏度、特异性达到极限的时候，要想再提高，就要改造这个系统，甚至要建立新的系统。 新技术的推广应用是我们每一个医学工作者的使命和职责 消除临床医学和检验医学之间的某些误区是现代医学发展的必然,2,检验医学成熟与否的问题,检验医学成熟的标准 检验医学应当是发展、完善和充实医学科学的生力军，自身和其他科学或学科的理论和技术是发展、完善和充实检验医学的动力源泉 检验医学成熟的一面 检验医学的概念，循证检验医学，新理论、新技术等 检验医学不成熟的一面 检验医学概念的纷争，新理论、新技术应用的障碍等 检验医学既成熟又不成熟,3,命题论证,POCT技术的应用是缩短急救检验中TAT的最有效方法之一 论据： Circulation 2001 Sep 25;104(13):1483-8Related Articles, Books, LinkOut Ninety-minute exclusion of acute myocardial infarction by use of quantitative point-of-care testing of myoglobin and troponin i. McCord J, Nowak RM, McCullough PA, Foreback C, Borzak S, Tokarski G, Tomlanovich MC, Jacobsen G, Weaver WD. Clin Chim Acta 2001 Sep 15;311(1):67-72Related Articles, Books, LinkOut Point-of-care testing of cardiac markers: results from an experience in an Emergency Department. Altinier S, Zaninotto M, Mion M, Carraro P, Rocco S, Tosato F, Plebani M.,4,论据,Circulation 2001 Sep 25;104(13):1483-8Related Articles, Books, LinkOut Ninety-minute exclusion of acute myocardial infarction by use of quantitative point-of-care testing of myoglobin and troponin i. McCord J, Nowak RM, McCullough PA, Foreback C, Borzak S, Tokarski G, Tomlanovich MC, Jacobsen G, Weaver WD. Background- Diagnostic strategies with ECG and serum cardiac markers have been used to rule out acute myocardial infarction in 6 to 12 hours. The present study evaluated whether a multimarker strategy that used point-of-care measurement of myoglobin, creatine kinase (CK)-MB, and troponin I could exclude acute myocardial infarction in /=3 hours. Methods and Results- We prospectively enrolled consecutive patients (n=817) in the emergency department who were evaluated for possible acute myocardial infarction. In patients with nondiagnostic ECGs, we measured CK-MB, troponin I, and myoglobin with a point-of-care device at presentation and at 90 minutes, 3 hours, and 9 hours. Standard central laboratory testing of CK-MB was done at the same time intervals, and triage decisions were made by emergency physicians who were unaware of point-of-care results. Sensitivity and negative predictive value were compared for both the multimarker, point-of-care approach and the central laboratory strategy. Sensitivity and negative predictive value for point-of-care combination of myoglobin and troponin I by 90 minutes was 96.9% and 99.6%, respectively. CK-MB measurements and blood sampling at 3 hours did not improve sensitivity or negative predictive value. Median time from sampling to reporting of results was 71.0 minutes for the central laboratory versus 24.0 minutes for the point-of-care device (P0.001). Conclusions- Acute myocardial infarction can be excluded rapidly in the emergency department by use of point-of-care measurements of myoglobin and troponin I during the first 90 minutes after presentation.,5,论据,Clin Chim Acta 2001 Sep 15;311(1):67-72Related Articles, Books, LinkOut Point-of-care testing of cardiac markers: results from an experience in an Emergency Department. Altinier S, Zaninotto M, Mion M, Carraro P, Rocco S, Tosato F, Plebani M. Department of Laboratory Medicine, University-Hospital of Padova, Via Giustiniani, 2, 35128, Padua, Italy Aim: An experimental approach to the use of point-of-care testing for cardiac markers in the Emergency Department (ED) of our Institution has been carried out using two devices (SCS, Dade Behring and Triage Cardiac Panel, Biosite Diagnostics) for the measurement of cardiac markers. Results: (1) From the analytical point of view, a fundamental tool for an efficient management of patients was the agreement between results from point-of-care testing and from the instruments located in STAT lab and/or central laboratory: in about 5% of patients, a lack of comparability of data, resulted in an inappropriate admission of patients (medical vs. intensive care unit). (2) The actual total turnaround time (TAT) in the management of samples sent to STAT lab was estimated to be equal to 82.5 min (50th percentile). (3) In the same organizational setting, the use of a point-of-care device produced a turnaround time equal to 17 min (50th percentile). (4) The reduction in turnaround time resulted in a faster discharge for five patients who had normal ECG findings and cardiac marker values, the Delta time (POCT-STAT lab) ranging from -10 to -70 min. Conclusions: The point-of-care option evaluated also in relation to personnel issues for staff working in the ED, brought some interesting questions about the characteristics of POCT devices (easy to use 100%, safety for operator 91%) and the obtained results (quantitative and correlated to STAT lab, 91%), as well as the need of other options such as the implementation of rapid tube sample delivery.,6,命题论证,POCT技术的应用有利于病人关怀和改善医患关系 论据：Clin Biochem Rev. 2006 Aug;27(3):161-70. Links Cultural and Clinical Effectiveness of the QAAMS Point-of-Care Testing Model for Diabetes Management in Australian Aboriginal Medical Services. Shephard MD. Community Point-of-Care Services, Flinders University Rural Clinical School, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. The national Quality Assurance for Aboriginal Medical Services (QAAMS) Program, in which point-of-care testing (POCT) for haemoglobin A(1c) (HbA(1c) and urine albumin: creatinine ratio (ACR) is performed for diabetes management in 65 Australian Aboriginal medical services, is now embedded in the practice of diabetes care across Indigenous Australia. This paper documents the results of a detailed survey to assess levels of satisfaction with the QAAMS HbA(1c) Program among three key stakeholder groups-doctors, POCT operators and patients with diabetes. Both doctors and patients with diabetes agreed that the immediacy of POCT results contributed positively to patient care, improved the doctor-patient relationship, and made the patient more likely to be both compliant and self-motivated to improve their diabetes control. Both POCT operators and patients with diabetes reported improved satisfaction with their diabetes services after the introduction of POCT. The paper also provides evidence from two participating medical services that POCT has been an effective tool in improving the delivery of pathology services and clinical outcomes for both individuals and groups of patients with diabetes. A statistically significant reduction in HbA(1c) from 9.3% (+/- 2.0) to 8.6% (+/- 2.0) was observed in 74 diabetes patients 12 months after commencing POCT (p = 0.003, paired t-test). An improvement in the percentage of patients achieving glycaemic targets and a reduction in the percentage of patients with poor control was also observed in this group. These data provide evidence that the QAAMS POCT model delivers a culturally and clinically effective service for diabetes management in Aboriginal Australia,7,命题论证,检验医学不受地理、环境等因素的限制、扩大其应用领域，有赖于POCT技术 论据：Am J Clin Pathol. 2006 Oct;126(4):513-20. Links Katrina, the tsunami, and point-of-care testing: optimizing rapid response diagnosis in disasters. Kost GJ, Tran NK, Tuntideelert M, Kulrattanamaneeporn S, Peungposop N. POCT.CTR, Pathology and Laboratory Medicine, School of Medicine, University of California Davis, Davis, CA 95616, USA. We assessed how point-of-care testing (POCT), diagnostic testing at or near the site of patient care, can optimize diagnosis, triage, and patient monitoring during disasters. We surveyed 4 primary care units (PCUs) and 10 hospitals in provinces hit hardest by the tsunami in Thailand and 22 hospitals in Katrina-affected areas. We assessed POCT, critical care testing, critical values notification, demographics, and disaster responses. Limited availability and poor organization severely limited POCT use. The tsunami impacted 48 PCUs plus island and province hospitals, which lacked adequate diagnostic instruments. Sudden overload of critical victims and transportation failures caused excessive mortality. In New Orleans, LA, flooding hindered rescue teams that could have been POCT-equipped. US sea, land, and airborne rescue brought POCT instruments closer to flooded areas. Katrina demonstrated POCT value in disaster responses. We recommend handheld POCT, airborne critical care testing, and disaster-specific mobile medical units in small-world networks worldwide.,8,命题论证,POCT技术的应用是临床医学与检验医学紧密联系的重要桥梁之一 论据： 临床实验室认可标准ISO15189要求，有确实可靠措施保证与临床的紧密联系 具体操作上，可成为非常可行的切入点，实验室参与操作准入、质量监控管理等工作，临床部门进行实际操作，提供结果比对资料等,9,命题论证,POCT技术具备充实、丰富、完善和发展检验医学的特征 论据Acad Emerg Med 2000 Oct;7(10):1168Related Articles, Books, LinkOut An assessment of quality control testing in an emergency department (ED) maintained arterial blood gas analyzer OShaughnessy P, Emancipater K, Hsu C. Beth Israel Medical Center, New York, NY. Nichols JH, Christenson RH, Clarke W, Gronowski A, Hammett-Stabler CA, Jacobs E, Kazmierczak S, Lewandrowski K