POCT技术的应用是检验医学成熟的标志课件.ppt

POCT技术的应用是检验医学成熟的标志 1 2020 3 21 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 2020 3 21 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 2020 3 21 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 4 2020 3 21 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 P 0 001 Conclusions Acutemyocardialinfarctioncanbeexcludedrapidlyintheemergencydepartmentbyuseofpoint of caremeasurementsofmyoglobinandtroponinIduringthefirst90minutesafterpresentation 5 2020 3 21 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 medicalvs intensivecareunit 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 6 2020 3 21 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 LinksCulturalandClinicalEffectivenessofthe QAAMS Point 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 7 2020 3 21 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 8 2020 3 21 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 2020 3 21 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 maintainedarterialbloodgasanalyzerO ShaughnessyP EmancipaterK HsuC BethIsraelMedicalCenter NewYork NY NicholsJH ChristensonRH ClarkeW GronowskiA Hammett StablerCA JacobsE KazmierczakS LewandrowskiK PriceC SacksDB SautterRL Shi