Página 1 dos resultados de 979 itens digitais encontrados em 0.025 segundos

A aplicação da técnica de referenciação (benchmarking) em serviços de medicina laboratorial; Benchmarking applicability in laboratory medicine services

Galoro, César Alex de Oliveira
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 15/09/2008 PT
Relevância na Pesquisa
55.74%
A prática da Medicina Laboratorial vem mudando em conseqüência do desenvolvimento tecnológico e regulamentações dos Sistemas de Saúde levando à implantação de Sistemas de Qualidade e monitoramento de indicadores. A aplicabilidade e os potenciais benefícios do Benchmarking como instrumento de análise da qualidade foram testados em um grupo de oito laboratórios hospitalares através do recebimento, análise e devolução aos participantes de Relatórios de Acompanhamento relativos a indicadores diversos dos anos de 2005 e 2006. O método 6 foi utilizado, quando aplicável, para avaliar a qualidade dos processos. Foram colhidos dados de indicadores de produção, produtividade, absenteísmo segurança no trabalho, recoletas e tempo para liberação de laudos. O Benchmarking é uma ferramenta útil e aplicável para a gestão de qualidade nos laboratórios clínicos, principalmente quando associado a instrumento independente de avaliação de qualidade de processos, porém é necessária a definição de mecanismos que garantam a confiabilidade dos dados primários utilizados nos programas; Laboratory Medicine practice is changing as a result of technological development and regulations pressures, letting to the implementation of quality systems and monitoring indicators. This study tested Benchmarking applicability and benefits as a tool for quality analysis in brazilian laboratory medicine services. The study was performed with eight hospital laboratories through the receipt...

Leprosy: a review of laboratory and therapeutic aspects - Part 2

Lastória, Joel Carlos; Abreu, Marilda Aparecida Milanez Morgado De
Fonte: Sociedade Brasileira de Dermatologia Publicador: Sociedade Brasileira de Dermatologia
Tipo: Artigo de Revista Científica Formato: 389-401
ENG
Relevância na Pesquisa
45.78%
Leprosy is a chronic infectious condition caused by Mycobacterium leprae(M. leprae). It is endemic in many regions of the world and a public health problem in Brazil. Additionally, it presents a wide spectrum of clinical manifestations, which are dependent on the interaction between M. leprae and host, and are related to the degree of immunity to the bacillus. The diagnosis of this disease is a clinical one. However, in some situations laboratory exams are necessary to confirm the diagnosis of leprosy or classify its clinical form. This article aims to update dermatologists on leprosy, through a review of complementary laboratory techniques that can be employed for the diagnosis of leprosy, including Mitsuda intradermal reaction, skin smear microscopy, histopathology, serology, immunohistochemistry, polymerase chain reaction, imaging tests, electromyography, and blood tests. It also aims to explain standard multidrug therapy regimens, the treatment of reactions and resistant cases, immunotherapy with bacillus Calmette-Guérin (BCG) vaccine and chemoprophylaxis.

Leprosy: a review of laboratory and therapeutic aspects - Part 2

Lastória,Joel Carlos; Abreu,Marilda Aparecida Milanez Morgado de
Fonte: Sociedade Brasileira de Dermatologia Publicador: Sociedade Brasileira de Dermatologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2014 EN
Relevância na Pesquisa
45.78%
Leprosy is a chronic infectious condition caused by Mycobacterium leprae(M. leprae). It is endemic in many regions of the world and a public health problem in Brazil. Additionally, it presents a wide spectrum of clinical manifestations, which are dependent on the interaction between M. leprae and host, and are related to the degree of immunity to the bacillus. The diagnosis of this disease is a clinical one. However, in some situations laboratory exams are necessary to confirm the diagnosis of leprosy or classify its clinical form. This article aims to update dermatologists on leprosy, through a review of complementary laboratory techniques that can be employed for the diagnosis of leprosy, including Mitsuda intradermal reaction, skin smear microscopy, histopathology, serology, immunohistochemistry, polymerase chain reaction, imaging tests, electromyography, and blood tests. It also aims to explain standard multidrug therapy regimens, the treatment of reactions and resistant cases, immunotherapy with bacillus Calmette-Guérin (BCG) vaccine and chemoprophylaxis.

Rational use of blood calcium determinations

Ferreira-Junior,Mario; Lichtenstein,Arnaldo; Sales,Maria Mirtes; Taniguchi,Leandro Utino; Aguiar,Francisco José Bueno de; Fonseca,Luiz Augusto Marcondes; Sumita,Nairo Massakazu; Duarte,Alberto José da Silva
Fonte: Associação Paulista de Medicina - APM Publicador: Associação Paulista de Medicina - APM
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2014 EN
Relevância na Pesquisa
55.82%
CONTEXT AND OBJECTIVE: This study was motivated by the recent excessive increase in requests for blood calcium determinations and laboratory tests in general, in the Hospital das Clínicas complex of Faculdade de Medicina, Universidade de São Paulo (HCFMUSP). Its aim was to suggest rules for the determination of total and ionized calcium in our intensive care units, emergency department, wards and outpatient services, thus contributing towards improving the quality of medical care and achieving more appropriate use of human and financial resources. DESIGN AND SETTING: Critical analysis on clinical and laboratory data and the pertinent scientific literature, conducted by the study group for rational clinical laboratory use, which is part of the Central Laboratory Division, HCFMUSP. METHODS: The study group reviewed scientific publications, statistics and clinical and laboratory data concerning requests for total and ionized calcium determinations in the settings of intensive care units, emergency department, wards and outpatient services. RESULTS: From this critical analysis, clinical decision flow diagrams aimed at providing guidance for ordering these tests were constructed. CONCLUSIONS: Use of the proposed flow diagrams may help to limit the numbers of inappropriate requests for ionized and total calcium determinations...

Dengue: profile of hematological and biochemical dynamics

Azin,Francisca Raimunda F. Guerreiro; Gonçalves,Romelia Pinheiro; Pitombeira,Maria Helena da Silva; Lima,Danielle Malta; Castelo Branco,Ivo
Fonte: Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular Publicador: Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2012 EN
Relevância na Pesquisa
45.78%
AIM: The objective of this study was to correlate laboratory tests during the evolution of dengue fever, comparing frequencies between the different clinical forms in order to use test results to predict the severity of the disease. METHODS: This is an observational, descriptive and retrospective study of 154 patients with clinical and serological diagnoses of dengue fever who, in the period from January to May 2008, were admitted in a tertiary state hospital in the city of Fortaleza that is a referral center for infectious diseases. The patients were allocated to two groups according to age: under 15 years old (n = 66) and 15 years or older (n = 88). The tests analyzed were blood count, platelet count, and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations. RESULTS: Thrombocytopenia and elevated transaminases were observed in patients with classic dengue fever. The main laboratory abnormalities found in dengue hemorrhagic fever were thrombocytopenia, hemoconcentration and elevated transaminases, similar to severe dengue with the exception of hemoconcentration. Most laboratory abnormalities started on the 3rd day but were more evident on the 5th day with restoration of values by the 11th day; this was more prominent in under 15-year-olds and with the more severe clinical forms. CONCLUSIONS: These results are relevant in assessing the disease because they can be used as markers for more severe forms and can help by enabling the adaptation of the therapeutic conduct to the needs of individual patients.

Sperm retrieval techniques for assisted reproduction

Esteves,Sandro C.; Miyaoka,Ricardo; Agarwal,Ashok
Fonte: Sociedade Brasileira de Urologia Publicador: Sociedade Brasileira de Urologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2011 EN
Relevância na Pesquisa
45.8%
Different surgical methods such as PESA, MESA, TESA, TESE and micro-TESE have been developed to retrieve spermatozoa from either the epididymis or the testis according to the type of azoospermia, i.e., obstructive or non-obstructive. Laboratory techniques are used to remove contaminants, cellular debris, and red blood cells following collection of the epididymal fluid or testicular tissue. Surgically-retrieved spermatozoa may be used for intracytoplasmic sperm injection (ICSI) and/or cryopreservation. In this article, we review the surgical procedures for retrieving spermatozoa from both the epididymis and the testicle and provide technical details of the commonly used methods. A critical analysis of the advantages and limitations of the current surgical methods to retrieve sperm from males with obstructive and non-obstructive azoospermia is presented along with an overview of the laboratory techniques routinely used to process surgically-retrieved sperm. Lastly, we summarize the results from the current literature of sperm retrieval, as well as the clinical outcome of ICSI in the clinical scenario of obstructive and non-obstructive azoospermia.

Relevance of nucleic acid amplification techniques for diagnosis of respiratory tract infections in the clinical laboratory.

Ieven, M; Goossens, H
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1997 EN
Relevância na Pesquisa
45.89%
Clinical laboratories are increasingly receiving requests to perform nucleic acid amplification tests for the detection of a wide variety of infectious agents. In this paper, the efficiency of nucleic acid amplification techniques for the diagnosis of respiratory tract infections is reviewed. In general, these techniques should be applied only for the detection of microorganisms for which available diagnostic techniques are markedly insensitive or nonexistent or when turnaround times for existing tests (e.g., viral culture) are much longer than those expected with amplification. This is the case for rhinoviruses, coronaviruses, and hantaviruses causing a pulmonary syndrome, Bordetella pertussis, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Coxiella burnetii. For Legionella spp. and fungi, contamination originating from the environment is a limiting factor in interpretation of results, as is the difficulty in differentiating colonization and infection. Detection of these agents in urine or blood by amplification techniques remains to be evaluated. In the clinical setting, there is no need for molecular diagnostic tests for the diagnosis of Pneumocystis carinii. At present, amplification methods for Mycobacterium tuberculosis cannot replace the classical diagnostic techniques...

Recovery of Anaerobic Microorganisms from Clinical Specimens in Prereduced Media Versus Recovery by Routine Clinical Laboratory Methods 1

McMinn, M. Talmage; Crawford, James J.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /02/1970 EN
Relevância na Pesquisa
55.74%
Prereduced anaerobically sterilized culture media, used with rigid adherence to the cultivation techniques described by Moore and his associates, were capable of recovering more than twice the number of anaerobic bacteria from clinical specimens than could be recovered by the conventional use of fluid thioglycolate medium and of blood-agar plates incubated anaerobically with hydrogen generation packets. No loss of clinical isolates was encountered with the more sensitive methods; however many of the isolates recovered only in prereduced media would not grow when placed into thioglycolate medium. A representative anaerobic isolate placed into aerobic transport broth was unable to survive beyond 30 min. Methods employing prereduced media were not difficult to master and were feasible for clinical laboratory use. Evidence implicating the gingival crevice flora as an important possible source of anaerobic bacteria that become involved in systemic infections was considered.

New approaches to poliovirus diagnosis using laboratory techniques: memorandum from a WHO meeting.

Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica
Publicado em //1992 EN
Relevância na Pesquisa
45.79%
Laboratory diagnosis of poliomyelitis is an important part of the WHO initiative for global eradication of poliomyelitis. During the last year, new methods have been developed for the detection of poliovirus in clinical specimens, for intratypic differentiation, for the analysis of poliovirus neurovirulence, and for the detection of poliovirus antibodies. Progress in laboratory techniques for detection of poliovirus antibodies and for characterization of poliovirus isolates has suggested several new approaches to poliovirus diagnosis using laboratory techniques.

Quantities and units for electrophoresis in the clinical laboratory

Férard, G.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
Publicado em //1992 EN
Relevância na Pesquisa
45.77%
Electrophoretic techniques have been developed and refined over decades, and are now widely used in clinical laboratories. For example, electrophoresis is routinely used to separate many different components, including proteins, lipoproteins, and isoenzymes. More recently, the applications of molecular biology in diagnosis have increased the use of electrophoresis to separate DNA components in the clinical laboratory. Various kinds of quantities are used for the description of separation procedures. It is the purpose of this document to provide manufacturers and users of electrophoretic techniques with a list of relevant quantities and units consistent with the International System of Units (SI) and standards of the International Organization for Standardization (ISO).

Laboratory Test Interpretation by Pattern Analysis Using a Microcomputer

Salwen, Martin; Wallach, Jacques
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 04/11/1981 EN
Relevância na Pesquisa
45.78%
Interpretive analysis of laboratory tests has been programed in BASIC on a Commodore 8032 microcomputer using pattern recognition techniques. A diagnostic matrix for the polycythemia differential using laboratory and clinical data will be demonstrated. An algorithm classifying the five diagnostic groups and the strategies indicated at each level of the differential is incorporated into the program. The system is designed for interactive clinical use and evaluates screening, incomplete or comprehensive data sets.

Resampling Approach for Determination of the Method for Reference Interval Calculation in Clinical Laboratory Practice▿

Pavlov, Igor Y.; Wilson, Andrew R.; Delgado, Julio C.
Fonte: American Society for Microbiology (ASM) Publicador: American Society for Microbiology (ASM)
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
55.74%
Reference intervals (RI) play a key role in clinical interpretation of laboratory test results. Numerous articles are devoted to analyzing and discussing various methods of RI determination. The two most widely used approaches are the parametric method, which assumes data normality, and a nonparametric, rank-based procedure. The decision about which method to use is usually made arbitrarily. The goal of this study was to demonstrate that using a resampling approach for the comparison of RI determination techniques could help researchers select the right procedure. Three methods of RI calculation—parametric, transformed parametric, and quantile-based bootstrapping—were applied to multiple random samples drawn from 81 values of complement factor B observations and from a computer-simulated normally distributed population. It was shown that differences in RI between legitimate methods could be up to 20% and even more. The transformed parametric method was found to be the best method for the calculation of RI of non-normally distributed factor B estimations, producing an unbiased RI and the lowest confidence limits and interquartile ranges. For a simulated Gaussian population, parametric calculations, as expected, were the best; quantile-based bootstrapping produced biased results at low sample sizes...

Vitamin b12 and folate tests: The ongoing need to determine appropriate use and public funding

Willis, C.; Metz, M.; Hiller, J.; Elshaug, A.
Fonte: Australasian Med Publ Co Ltd Publicador: Australasian Med Publ Co Ltd
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
55.72%
Criteria have been developed for assessing the safety, effectiveness and cost-effectiveness of new and emerging health interventions, but additional challenges exist in identifying opportunities for reducing the use of existing health technologies or procedures that are potentially overused, (cost-)ineffective or unsafe.1 Criteria have been proposed to flag technologies that might warrant further investigation under quality improvement programs.1 These criteria are: new evidence becomes available; there is geographical variation in use; variation in care between providers is present; the technology has evolved and differs markedly from the original; there exists a temporal trend in the volume of use; public interest or controversy is present; consultation with health care workers and funders raises concerns; new technology has displaced old technology; there is evidence of leakage (use beyond the restriction or indication); the technology or intervention is a “legacy item” that has never been assessed for cost-effectiveness; use is not in accordance with clinical guidelines; or the technology is nominated by clinical groups. After such a nomination was made by members of the clinical laboratory community regarding vitamin B12 and folate tests...

Contribuição para o estudo do custo unitário das análises laboratoriais e sua comparação com a tabela de procedimentos da Associação Médica Brasileira - AMB 92, em um laboratório de pequeno porte; Contribution to the study of unitary cost of clinical analysis in comparison to the table of procedures of the Brazilian Medicai Association BMA 92, in a small size laboratory

Freitas, Gisele Palo Corrêa de
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 06/10/2005 PT
Relevância na Pesquisa
55.86%
O Laboratório de Análises Clínicas (LAC) vem buscando, no decorrer dos anos, alternativas quanto à sua capacidade em gerar receita. A busca por melhores resultados incrementou a parceria com as organizações chamadas de "convênios médicos" ou "medicina de grupo" que, em geral, remuneram as análises laboratoriais com base em tabelas de procedimentos criadas pela Associação Médica Brasileira AMB. Destas, a mais utilizada é a Tabela AMB 92, devido a utilizar valores de Coeficiente de Honorários (CH), que convertidos em reais, são mais interessantes para os LAC. Este estudo teve como base o método recomendado pelo "National Committee for Clinical Laboratory Standards" - NCCLS, que normatiza a apuração do custo baseado na atividade desempenhada durante a sua realização. O objetivo deste trabalho foi estabelecer o custo das análises laboratoriais e verificar se, em comparação à tabela AMB 92, a opção pelos contratos com os "convênios médicos" realmente gera lucro a um laboratório de pequeno porte. Para tanto foram selecionadas as análises mais solicitadas no mês de agosto de 2004 em um laboratório de pequeno porte, que presta atendimento a pacientes conveniados a planos de saúde e particulares. O ressarcimento aos laboratórios prestadores de serviço é efetuado com base no valor do CH...

Aspectos clínicos e moleculares da hiperplasia adrenal macronodular independente de ACTH em sua forma familial; Clinical and molecular aspects of familial ACTH-independent macronodular adrenal hyperplasia

Alencar, Guilherme Asmar
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 14/10/2013 PT
Relevância na Pesquisa
45.87%
INTRODUÇÃO: A hiperplasia adrenal macronodular independente de ACTH (AIMAH) é uma doença rara, caracterizada pela presença de macronódulos funcionantes nas adrenais e por uma produção aumentada, autônoma e sustentada de cortisol. Constitui uma causa incomum de síndrome de Cushing (SC). A forma esporádica da doença parece ser a mais frequente, no entanto, se desconhece a real prevalência de sua forma familial. Apesar de ser uma entidade clínica conhecida há quase 50 anos, o processo fisiopatológico que culminaria com a AIMAH, as alterações genéticas predisponentes e aspectos clínicos, laboratoriais e radiológicos relevantes da doença ainda não foram elucidados de forma clara. O diagnóstico recente de uma grande família portadora da doença viabilizou a realização do presente trabalho. OBJETIVOS: 1) Caracterizar a evolução da AIMAH em sua forma familial, correlacionando as manifestações clínicas, os dados laboratoriais e os achados radiológicos; 2) investigar a possível associação entre a AIMAH e a ocorrência de meningiomas intracranianos; 3) avaliar a atividade metabólica das adrenais hiperplasiadas na AIMAH; 4) definir o padrão de herança genética da doença na família estudada; e 5) mapear regiões cromossômicas e loci potencialmente relacionados à etiologia genética da AIMAH familial. MÉTODOS: 96 membros da família estudada foram inicialmente submetidos a uma avaliação clínica e laboratorial pormenorizada. Em seguida...

Immunological consequences of using three different clinical/laboratory techniques of emulsifying peptide-based vaccines in incomplete Freund's adjuvant

Koh, Yi T; Higgins, Sean A; Weber, Jeffrey S; Kast, W Martin
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em 23/10/2006 EN
Relevância na Pesquisa
45.86%
Incomplete Freund's adjuvant (IFA) serves as a carrier for water-in-oil emulsion (W/O) vaccines. The stability of such emulsions greatly affects vaccine safety and efficacy since continued presence of antigen depots at lymphoid organs releasing low-level antigens is known to stimulate a potent immune response and high-level systemic release of antigens can lead to tolerance. W/O emulsions for the purpose of clinical and laboratory peptide-based vaccinations have been prepared using the techniques of syringe extrusion, vortex or high-speed homogenization. There is no consensus in the field over which technique would be best to use and no immunological data are available that compare the three techniques. In this study, we compared the immune responses induced by a peptide-based vaccine prepared using vortex, syringe-extrusion and homogenization. The vaccination led to tumor rejection by mice vaccinated with the peptide-based vaccine prepared using all three techniques. The immunological data from the in vivo cytotoxicity assay showed a trend for lower responses and a higher variability and greater range in the immune responses induced by a vaccine that was emulsified by the vortex or homogenizer techniques as compared to the syringe-extrusion technique. There were statistically significant lower numbers of IFNγ-secreting cells induced when the mice were vaccinated with a peptide-based vaccine emulsion prepared using the vortex compared to the syringe-extrusion technique. At a suboptimal vaccine dose...

Epidemiological and clinical characteristics of cutaneous leishmaniasis and their relationship with the laboratory data, south of Brazil

Curti,Maura Cristiani de Moura; Silveira,Thaís Gomes Verzignassi; Arraes,Sandra Mara Alessi Aristides; Bertolini,Dennis Armando; Zanzarini,Paulo Donizeti; Venazzi,Eneide Aparecida Sabaini; Fernandes,Andrea Cláudia Silva; Teixeira,Jorge Juarez Vieira; Lo
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2011 EN
Relevância na Pesquisa
55.8%
OBJECTIVE: To evaluate clinical, epidemiological and laboratorial aspects for the understanding of the disease characteristics and its relationship with diagnostic tests. METHODS: A retrospective, descriptive and analytical study involving 2,660 American cutaneous leishmaniasis (ACL) suspected patients from southern Brazil was undertaken between April 1986 and December 2005. Data on population characteristics and laboratory tests were obtained. Diagnostic laboratory tests used were direct search for Leishmania spp. (DS), Montenegro skin test (MST) and indirect immunofluorescent assay (IFA). RESULTS: 62.3% of patients were positive for at least one laboratory test. DS test was positive in 65.1%; MST in 92.3% and IFA in 70.0%. Although Cohen's Kappa test did not reveal any agreement with laboratory diagnosis for ACL, the association between MST and IFA tests increased positiveness to 98.9%; MST and DS to 97.2%; and IFA and DS to 85%. IFA and MST positiveness were higher among patients with < 2-month lesion-evolution time. Most ACL patients were male (72.6%) in the age range of 15-49 years, featuring lesions during two months or less (53.9%) and a cutaneous form of the disease (88.0%). CONCLUSION: Findings suggest that for the adequate identification of ACL cases a combination of laboratory tests that involves the association of MST with at least another test should be used.

Nueva serie sobre Laboratorio Clínico en la Revista Médica de Chile

Guzmán D,Ana María; Quiroga G,Teresa
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2009 ES
Relevância na Pesquisa
55.82%
The Chilean Autonomous Commission for Medical Specialties Certification recognized Clinical Laboratory as a specialty in 1994. This decision was based on the great development of the specialty that incorporated new methodologies and developed automatic computerized methods. The main objective of the Clinical Laboratory specialist is to work as a consultant to define the laboratory diagnostic strategies that have the best cost effectiveness ratio. He must also select and assess diagnostic methods, supervise their implementations and assure the quality of the results generated. He must also be an efñcient laboratory director and administrator.

Valores de alerta en el laboratorio clínico y su aporte al cuidado y seguridad del paciente

Guzmán D,Ana María; Lagos L,Marcela
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2009 ES
Relevância na Pesquisa
45.77%
Critical values are those laboratory values that are so abnormal that may threaten the life of a patient unless immediate corrective or therapeutic actions are undertaken. Among laboratory procedures, this definition has been incorporated to standards that watch over patients' safety. Health institutions should incorpórate this practice and monitor its effectiveness.

Field and laboratory preparedness: challenges to rolling out new multidrug-resistant tuberculosis diagnostics

Griffin,Anne M. J.; Caviedes,Luz; Gilman,Robert; Coronel,Jorge; Delgado,Freddy; Quispe,MaryLuz; Moore,avid A. J.
Fonte: Organización Panamericana de la Salud Publicador: Organización Panamericana de la Salud
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2009 EN
Relevância na Pesquisa
55.72%
OBJECTIVES: In a pilot implementation project of the microscopic-observation drug-susceptibility methodology, we conducted a process evaluation to identify health system and logistic challenges that need to be addressed in order to harness the benefits of rolling out promising new diagnostic tools for multidrug-resistant tuberculosis (MDRTB). METHODS: Regional data relating to health system practices and performance related to the MDRTB diagnostic algorithm were collected at health center, local, and regional laboratories. RESULTS: Parallel implementation of a new test and an existing method creates demands on funds, personnel, sample transport, and information systems in addition to new test startup costs. Obviating the need for primary culture at intermediate laboratories through direct drug susceptibility testing (DST) at the regional reference laboratory significantly reduces delay. Field application of well-defined national guidelines for DST is patchy. If fidelity to national guidelines were perfect, DST requests would increase more than 50-fold, with important implications for laboratory capacity. CONCLUSIONS: Implementing a new MDRTB diagnostic presents challenges to the laboratory environment, the existing DST process, and the application of national guidelines in peripheral clinics. Assessing each element can maximize efficient use of a new tool. Specifically...