Test doctor: Among clinic and laboratory" Bridge formation "

Test doctor: Among clinic and laboratory" Bridge formation "
Test doctor: Among clinic and laboratory" Bridge formation "
Staff reporter's king red Yang is blue in autumn "The formulation of a high-quality test result, there are half the contributions of laboratories, also there are clinical medical personnel's half the contribution; But once go wrong, study carefully its responsibility, lie in examining a doctor more. " At what has been held a few days ago examine the fourth China by doctor conference and examine with at summit forums clinical, China's test cures the grand professor of clump jade of SCTE's president to point out, with the renewal, development of medical science and technology and checker, the working range of test doctor should not be limited to examining samples, but should expand the whole course before, in, after test is analyzed, change the limited experimental data into high-efficient diagnostic messages, more and participating in clinical diagnosis and treating more directly. More than 60% of the experimental error happens as far back as 1997 before analyzing, one Italy examine expert, examine kind and incidence taking place in error, go on and count to emergency call while being famous. The result reveals, nearly 68.2% of the test errors are being examined in earlier stage, and it is 13.3% and 18.5% to come from and examine in middle period and examine the back-end error rate respectively. 2007, this person examine expert, carry on, count while being similar, result reveal, examine previous the intersection of error and incidence up to 61.9% still. "Among 10 years, though medical science and technology is being developed constantly, examine the error incidence and scarcely improve. 60% more than error, in examine begin yet, happening, this prove, examine doctor and clinician, strengthen necessity of communication in another perspective too. " Cong YuLong says. It is introduced, a series of treatment course before the so-called ones that mean from gathering the sample before analysis plan to measure to the laboratory, the intersection of patient and preparation, choice of vacuum tube, sample gather and sample stick to number, the intersection of sample and transport, the intersection of sample and hand over, the intersection of sample and deal with and the intersection of sample and the intersection of person who keep and link. The Israel patient prepares links as the example, the medicine can't ignore to the influence of the test result. Clump jade grand to inject, measure the intersection of urine and influence of albumen, analyze to heavy dose of penicillin to chemistry once, found finally, it was " ++ " to the urine albumen Patient separately inject by penicillin on 2,400,000 units, 3,200,000 units, 4,800,000 unit in 30 minute, all patient urine albumen reveal it is false and negative; And 1 hour later, only measure and reveal some patient " + " ; The last all patient urine albumen measures the result and can return to to medicines in 5 hours " ++" Level. Moreover, caffeine, alcohol, vitamin C, tobacco composition,etc. will make blood plasma such as blood glucose, urine acid, aldosterone examine the index and rise or reduce. Though it is essential to examine the course before analyzing to the last test result, but the clump jade is grand says frankly, the standardizing operation of the above-mentioned links has not obviously caused the attention of the doctor, nurse. There are statistics that reveal, cause the main factor of the error before examining including gathering the sample unstandardly (account for 6%~8%) , gather incorrect time ' Accounts for 2.2%) , sample been inspected by ready samples in time after collecting ' Accounts for 22.2%) , the sample is not up to standard ' Accounts for 2.3%) When. So, Cong YuLong emphasizes, in clinic diagnosis, examining a doctor should instruct or assist the medical personnel to pay close attention to patient's one's own characteristic, including inquiring patient's eating habit, medicine operating position voluntarily etc., at the same time, apply to test, the intersection of patient and the intersection of person who discern and whole course that sample gather for guidance, train, answer questions and consult. Should participate in making and examining the optimization grouping of the project recently, have published an article entitled ' it is used rationally that pulmonary embolism examine the project while diagnosing the course ' in " clinical biochemical annual report ". Among them, the Italian scholar leaves hospital among one year to a general hospital in hospital every year 27000 patients the analysis that the data carry on reveal, amounts to 4385 items to the test project that the pulmonary embolism patient adopts, but the unreasonable test project accounts for 21.7% among them, it is 31.20 euro that per person measures the expenses. Article unreasonable to check, define as " have clinical symptom worsen evidence and continue the intersection of test and event that launch during on the basis of see unusual the intersection of test and project before and in hospital; It is launched that out-of-range, no longer carry on checking the project of the investigation " . Peking University follow Deputy Director of card medical center Zhan SiYan Professor say so high proportion appropriate to find event in an example while making a diagnosis and giving treatment. It is introduced " the the intersection of U.S.A. and medical the intersection of association and periodical " publish one article, add up to, carry on the intersection of system and person who review analyze, point out by 4039 article to issue from 1966 to 1997, in clinic diagnosis, the unreasonable project proportion of test that launches is 4.5% - 95%. In addition, there are statistics that reveal, 8 repetition which examine the project such as high density lipoprotein of Canadian adult, blood sodium are tested and cost every year and is up to 13,900,000 dollars - 35,900,000 dollars. Cong YuLong says whether some doctors or lack and examine knowledge to adopt the drawing in the net type to check to the patient clinically for one's own interests, also already become the general phenomenon in course of clinic diagnosis of our country. If liver function is checked, generally several key indexes can reflect the question, but a lot of doctors often choose " 20 items of biochemistry " . So, this demands to examine a doctor and launch diversified forms of special topics and have an informal discussion to the clinical department's organization to different test instrument, apparatus, project, set up and jointly investigate the mechanism with the clinician, communicate and consult with the clinician more. On one hand, can make the effective, rational, economic test project making with the clinician up, index together according to the methodology research of the experiment project, clinical meaning " Consult the range " , " reporting value of crisis " When; On the other hand, can also through exchange with clinician and communicate, understand clinician to potential requirement that medical science examine. Want, offer valuable the intersection of judgement and the intersection of information and the intersection of Tianjin and some the intersection of hospital and serious disease guard one of ward occur frequently, injure patient come down with dyspnea, heart the next day after admitted to hospital district pained, the clinician checked myocardium enzyme for the patient immediately, revealed the specific index of acute myocardium infarction finally - -Creatine phosphokinase (CK) , creatine phosphokinase isoenzyme (CK-MB) Increase notably, the clinician judges patient's suspected myocardium infarction according to the test result. However, examine a doctor to propose after analyzing patient's symptom and test result in an all-round way, the result of CK-MB will be determined the influencing of the method to cause falsely and positively; And after patient's serious wound, it may cause CK to rise that its muscle is damaged. So, judge whether a wound patient has cardiac muscle that should combine CK-MB and CK ratio to judge to damage again. In addition, will combine changes such as the patient's clinical manifestation, physical sign and electrocardiogram,etc. to judge synthetically, monitor specific index troponin that the cardiac muscle damaged dynamically at the same time, so as not to leak and examine or misdiagnose. Finally, with examining the communicating in time of the doctor, choose the corresponding index through the clinician Monitor, the patient has been made a definite diagnosis of and treated effectively, has got rid of the judgement of myocardium infarction. "This example has well proved that examines the importance that a doctor communicates with the clinician. " Cong YuLong says, in recent years, examining the instrument realizes automation, semi-automation or computer progressively, advanced experimental technique and instrument popularize at home progressively, has not merely improved accuracy and accuracy of the experimental result, have also offered a lot of new indexes for the fact that clinical. But, what patient's materials, condition changing, healing solution from obtaining clinically, the quality evaluation after guaranteeing to analyze, and the work puts forward the suggestion to making a diagnosis and giving treatment clinically; How to introduce the principles of these methods, clinical meaning to the medical personnel, make it can choose to test, analyze the test result and used in diagnosing and treating it is important contents of examining medical science correctly rationally, also a duty of examining the doctor. The modern idea of examining medical science has already broken through and examined the limitation that personnel have been only responsible for sample in the past, the responsibility which the test doctor bore has been already from offering the data simply to offering valuable judgement information to change.


|