ASVCP guidelines: quality assurance for point‐of‐care testing in veterinary medicine

Point‐of‐care testing (POCT) refers to any laboratory testing performed outside the conventional reference laboratory and implies close proximity to patients. Instrumental POCT systems consist of small, handheld or benchtop analyzers. These have potential utility in many veterinary settings, including private clinics, academic veterinary medical centers, the community (eg, remote area veterinary medical teams), and for research applications in academia, government, and industry. Concern about the quality of veterinary in‐clinic testing has been expressed in published veterinary literature; however, little guidance focusing on POCT is available. Recognizing this void, the ASVCP formed a subcommittee in 2009 charged with developing quality assurance (QA) guidelines for veterinary POCT. Guidelines were developed through literature review and a consensus process. Major recommendations include (1) taking a formalized approach to POCT within the facility, (2) use of written policies, standard operating procedures, forms, and logs, (3) operator training, including periodic assessment of skills, (4) assessment of instrument analytical performance and use of both statistical quality control and external quality assessment programs, (5) use of properly established or validated reference intervals, (6) and ensuring accurate patient results reporting. Where possible, given instrument analytical performance, use of a validated 1_3s control rule for interpretation of control data is recommended. These guidelines are aimed at veterinarians and veterinary technicians seeking to improve management of POCT in their clinical or research setting, and address QA of small chemistry and hematology instruments. These guidelines are not intended to be all‐inclusive; rather, they provide a minimum standard for maintenance of POCT instruments in the veterinary setting.     

协力构建和谐的医患关系

和谐的医患关系是社会主义和谐社会的重要内容.构建和谐的医患关系,需要政府、医院、医务人员和患方的共同努力.为此,政府应增加卫生经费投入,加快卫生立法步伐;医院应着力医德医风建设,正确处理医疗纠纷;医务人员应树立人文关怀理念,改善医疗服务态度;患方应科学认识就医行为,理性对待医疗事故.     

固相萃取-超高效液相色谱-串联质谱法测定美国进口水果中15种高风险农药及助剂残留

建立了固相萃取-超高效液相色谱-串联质谱 (SPE-UPLC-MS/MS) 测定美国进口水果中15种高风险农药及助剂（乙酰甲胺磷、灭多威、噻虫嗪、噻菌、啶虫脒、西玛津、嘧霉胺、咯菌腈、啶酰菌胺、甲氧虫酰肼、腈菌唑、环酰菌胺、四氟醚唑、增效醚、毒死蜱）残留量的分析方法。样品经破壁机匀浆,乙腈涡旋提取,氨基固相萃取柱净化,岛津Shim-pack XR-ODS色谱柱分离 (75 mm × 2.0 mm,1.6 μm)。采用电喷雾离子源多反应监测模式进行质谱检测,外标法定量。在0.001~0.5 mg/L范围内,15种农药及助剂的质量浓度与对应的峰面积间线性关系良好,R2 ≥ 0.999 5。以梨、葡萄和苹果3种基质为例验证了方法的准确度和精密度。结果表明:在0.005~0.5 mg/kg添加水平下,15种农药及助剂的平均回收率在80%~115%之间,相对标准偏差在5.5%~16%之间,定量限为0.005~0.01 mg/kg。该方法简便、快速、可靠,适用于同时测定水果中上述15种农药及助剂残留。     

高龄老年患者心律失常与心率变异性分析

目的 观察高龄老年住院患者心律失常和心率变异性(HRV).方法 收集心内科住院75岁以上的老年患者121例,其中高血压病22例,冠心病51例,冠心病合并症19例,其他疾病及无器质性疾病患者为对照组(29例),分析其心律失常及HRV时域指标.结果 高危室性早搏仅见于高血压病和冠心病患者.全部窦性心搏RR间期的标准差(SD...     

Subject-based reference values: biological variation, individuality, and reference change values

Subject-based reference values have been largely overlooked in veterinary medicine. These values represent longitudinal data rather than the cross-sectional data represented by standard population-based reference values. As such they provide information about biological and analytical variation. Inherent random variation of analytes around a homeostatic set point is referred to as biological variation; data on biological variation are underutilized in veterinary medicine and have multiple applications that include setting analytical goals, predicting the utility of population-based reference intervals (RIs), assessing the value of partitioning reference values, and evaluating the significance of changes in serial results. To generate these data, relatively few individuals are sampled for a short period of time. Given the difficulty of obtaining specimens from large number of healthy individuals to establish a cross-sectional RI for many veterinary species, especially exotic species, use of subject-based RIs is a practical alternative approach for the veterinary diagnostician. Furthermore, for the majority of biochemical analytes and even many hemostatic variables, population-based reference values are less sensitive than subject-based reference values for detecting pathologic changes in an individual. The focus of this review is the clinical usefulness of subject-based reference values and diagnostic implications for their use. Implementation of the concepts of biological variation, individuality, and reference change value (RCV) may allow large diagnostic laboratories to offer more sensitive reference values to assess health and detect disease.