POCT技术的应用是检验医学成熟的标志PPT课件.ppt

POCT技术的应用是检验医学成熟的标志,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,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,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：Circulation2001Sep25;104(13):1483-8RelatedArticles,Books,LinkOutNinety-minuteexclusionofacutemyocardialinfarctionbyuseofquantitativepoint-of-caretestingofmyoglobinandtroponini.McCordJ,NowakRM,McCulloughPA,ForebackC,BorzakS,TokarskiG,TomlanovichMC,JacobsenG,WeaverWD.ClinChimActa2001Sep15;311(1):67-72RelatedArticles,Books,LinkOutPoint-of-caretestingofcardiacmarkers:resultsfromanexperienceinanEmergencyDepartment.AltinierS,ZaninottoM,MionM,CarraroP,RoccoS,TosatoF,PlebaniM.,论据,Circulation2001Sep25;104(13):1483-8RelatedArticles,Books,LinkOutNinety-minuteexclusionofacutemyocardialinfarctionbyuseofquantitativepoint-of-caretestingofmyoglobinandtroponini.McCordJ,NowakRM,McCulloughPA,ForebackC,BorzakS,TokarskiG,TomlanovichMC,JacobsenG,WeaverWD.Background-DiagnosticstrategieswithECGandserumcardiacmarkershavebeenusedtoruleoutacutemyocardialinfarctionin6to12hours.Thepresentstudyevaluatedwhetheramultimarkerstrategythatusedpoint-of-caremeasurementofmyoglobin,creatinekinase(CK)-MB,andtroponinIcouldexcludeacutemyocardialinfarctionin/=3hours.MethodsandResults-Weprospectivelyenrolledconsecutivepatients(n=817)intheemergencydepartmentwhowereevaluatedforpossibleacutemyocardialinfarction.InpatientswithnondiagnosticECGs,wemeasuredCK-MB,troponinI,andmyoglobinwithapoint-of-caredeviceatpresentationandat90minutes,3hours,and9hours.StandardcentrallaboratorytestingofCK-MBwasdoneatthesametimeintervals,andtriagedecisionsweremadebyemergencyphysicianswhowereunawareofpoint-of-careresults.Sensitivityandnegativepredictivevaluewerecomparedforboththemultimarker,point-of-careapproachandthecentrallaboratorystrategy.Sensitivityandnegativepredictivevalueforpoint-of-carecombinationofmyoglobinandtroponinIby90minuteswas96.9%and99.6%,respectively.CK-MBmeasurementsandbloodsamplingat3hoursdidnotimprovesensitivityornegativepredictivevalue.Mediantimefromsamplingtoreportingofresultswas71.0minutesforthecentrallaboratoryversus24.0minutesforthepoint-of-caredevice(P0.001).Conclusions-Acutemyocardialinfarctioncanbeexcludedrapidlyintheemergencydepartmentbyuseofpoint-of-caremeasurementsofmyoglobinandtroponinIduringthefirst90minutesafterpresentation.,论据,ClinChimActa2001Sep15;311(1):67-72RelatedArticles,Books,LinkOutPoint-of-caretestingofcardiacmarkers:resultsfromanexperienceinanEmergencyDepartment.AltinierS,ZaninottoM,MionM,CarraroP,RoccoS,TosatoF,PlebaniM.DepartmentofLaboratoryMedicine,University-HospitalofPadova,ViaGiustiniani,2,35128,Padua,ItalyAim:Anexperimentalapproachtotheuseofpoint-of-caretestingforcardiacmarkersintheEmergencyDepartment(ED)ofourInstitutionhasbeencarriedoutusingtwodevices(SCS,DadeBehringandTriageCardiacPanel,BiositeDiagnostics)forthemeasurementofcardiacmarkers.Results:(1)Fromtheanalyticalpointofview,afundamentaltoolforanefficientmanagementofpatientswastheagreementbetweenresultsfrompoint-of-caretestingandfromtheinstrumentslocatedinSTATlaband/orcentrallaboratory:inabout5%ofpatients,alackofcomparabilityofdata,resultedinaninappropriateadmissionofpatients(ensivecareunit).(2)Theactualtotalturnaroundtime(TAT)inthemanagementofsamplessenttoSTATlabwasestimatedtobeequalto82.5min(50thpercentile).(3)Inthesameorganizationalsetting,theuseofapoint-of-caredeviceproducedaturnaroundtimeequalto17min(50thpercentile).(4)ThereductioninturnaroundtimeresultedinafasterdischargeforfivepatientswhohadnormalECGfindingsandcardiacmarkervalues,theDeltatime(POCT-STATlab)rangingfrom-10to-70min.Conclusions:Thepoint-of-careoptionevaluatedalsoinrelationtopersonnelissuesforstaffworkingintheED,broughtsomeinterestingquestionsaboutthecharacteristicsofPOCTdevices(easytouse100%,safetyforoperator91%)andtheobtainedresults(quantitativeandcorrelatedtoSTATlab,91%),aswellastheneedofotheroptionssuchastheimplementationofrapidtubesampledelivery.,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：ClinBiochemRev.2006Aug;27(3):161-70.LinksCulturalandClinicalEffectivenessoftheQAAMSPoint-of-CareTestingModelforDiabetesManagementinAustralianAboriginalMedicalServices.ShephardMD.CommunityPoint-of-CareServices,FlindersUniversityRuralClinicalSchool,FlindersUniversity,GPOBox2100,Adelaide,SA5001,Australia.ThenationalQualityAssuranceforAboriginalMedicalServices(QAAMS)Program,inwhichpoint-of-caretesting(POCT)forhaemoglobinA(1c)(HbA(1c)andurinealbumin:creatinineratio(ACR)isperformedfordiabetesmanagementin65AustralianAboriginalmedicalservices,isnowembeddedinthepracticeofdiabetescareacrossIndigenousAustralia.ThispaperdocumentstheresultsofadetailedsurveytoassesslevelsofsatisfactionwiththeQAAMSHbA(1c)Programamongthreekeystakeholdergroups-doctors,POCToperatorsandpatientswithdiabetes.BothdoctorsandpatientswithdiabetesagreedthattheimmediacyofPOCTresultscontributedpositivelytopatientcare,improvedthedoctor-patientrelationship,andmadethepatientmorelikelytobebothcompliantandself-motivatedtoimprovetheirdiabetescontrol.BothPOCToperatorsandpatientswithdiabetesreportedimprovedsatisfactionwiththeirdiabetesservicesaftertheintroductionofPOCT.ThepaperalsoprovidesevidencefromtwoparticipatingmedicalservicesthatPOCThasbeenaneffectivetoolinimprovingthedeliveryofpathologyservicesandclinicaloutcomesforbothindividualsandgroupsofpatientswithdiabetes.AstatisticallysignificantreductioninHbA(1c)from9.3%(+/-2.0)to8.6%(+/-2.0)wasobservedin74diabetespatients12monthsaftercommencingPOCT(p=0.003,pairedt-test).Animprovementinthepercentageofpatientsachievingglycaemictargetsandareductioninthepercentageofpatientswithpoorcontrolwasalsoobservedinthisgroup.ThesedataprovideevidencethattheQAAMSPOCTmodeldeliversaculturallyandclinicallyeffectiveservicefordiabetesmanagementinAboriginalAustralia,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：AmJClinPathol.2006Oct;126(4):513-20.LinksKatrina,thetsunami,andpoint-of-caretesting:optimizingrapidresponsediagnosisindisasters.KostGJ,TranNK,TuntideelertM,KulrattanamaneepornS,PeungposopN.POCT.CTR,PathologyandLaboratoryMedicine,SchoolofMedicine,UniversityofCaliforniaDavis,Davis,CA95616,USA.Weassessedhowpoint-of-caretesting(POCT),diagnostictestingatornearthesiteofpatientcare,canoptimizediagnosis,triage,andpatientmonitoringduringdisasters.Wesurveyed4primarycareunits(PCUs)and10hospitalsinprovinceshithardestbythetsunamiinThailandand22hospitalsinKatrina-affectedareas.WeassessedPOCT,criticalcaretesting,criticalvaluesnotification,demographics,anddisasterresponses.LimitedavailabilityandpoororganizationseverelylimitedPOCTuse.Thetsunamiimpacted48PCUsplusislandandprovincehospitals,whichlackedadequatediagnosticinstruments.Suddenoverloadofcriticalvictimsandtransportationfailurescausedexcessivemortality.InNewOrleans,LA,floodinghinderedrescueteamsthatcouldhavebeenPOCT-equipped.USsea,land,andairbornerescuebroughtPOCTinstrumentsclosertofloodedareas.KatrinademonstratedPOCTvalueindisasterresponses.WerecommendhandheldPOCT,airbornecriticalcaretesting,anddisaster-specificmobilemedicalunitsinsmall-worldnetworksworldwide.,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,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AcadEmergMed2000Oct;7(10):1168RelatedArticles,Books,LinkOutAnassessmentofqualitycontroltestinginanemergencydepartment(ED)maintainedarterialbloodgasanalyzerOShaughnessyP,EmancipaterK,HsuC.BethIsraelMedicalCenter,NewYork,NY.NicholsJH,ChristensonRH,ClarkeW,GronowskiA,Hammett-StablerCA,JacobsE,KazmierczakS,LewandrowskiK,Pric