전력산업 기능별 분리에 따른 요금결정 원칙 검토 및 …...전력산업 기능별 분리에 따른 요금결정 원칙 검토 및 새로운 요금산정기준 마련
임상병리검사의 활용 원칙
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Transcript of 임상병리검사의 활용 원칙
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Albumin . 6.33% 3430 albumin 27g/L . TPN 51% 33.6% . 15000 1 U$ 225 .
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, WBC : 4,000 - 10,000/cmmABGA : PO2 : 75 mmHg O2 saturation : 92% pH : 7.35 - 7.45
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2 Hb 10g/dL : reticulocytes countElectrophoresis immunoelectrophosisLeukemia : immunological marker study, molecular testsAHGT : unexpected antibody
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1. 2. 3. 4. 5. 6. ,
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Laboratory TestsScreening testConfirmatory testProfile/battery testHealth screening testStat testPOCT(point of care testing)
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Profile Tests (SNUH)Routine CBCCoagulation panelThrombosis panel-A,BPlatelet aggregation Routine urinalysisRoutine stool exam.Admission panel
Liver panelLipid panel-A, -BLipoprotein profileElectrolyte panelType & screeningBody fluid-routine testBody fluid-chemistry
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Health Screening TestsHb, Hct, WBCAST, ALT, GGT, HBsAgSerum/Urine glucose CholesterolVDRL, HIV(?)
Stool occult bloodCreatinine, BUNCervical cytologyProstate specific AgGastroscopyColonoscopy
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(CBC). ( BT, PT, APTT)(ABO, Rh) (admission battery) (Na, K, Cl) (HBsAg, anti-HBs)AIDS(Anti-HIV)
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: 2 , : 3 / : ,
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(PT) (APTT)
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Specimen & Storage(I)EDTA tube SST tubeMicro-samplingNo hemolysisSafety : HIV etc.
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Specimen & Storage(II)Blood gas : heparinized syringe, ice cubeCoagulation test : citrate tube, ? 1 : 9 24 hrs urine : 7:00 am(-) 7:00 am(+)Pleural/Joint fluid cell count(EDTA)Sputum for M. tuberculosis : conseq. 3 daysSerum separation within 2 hrs
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(1998) : 706 : 192 ( Big 5 ) POL() : 1,500 : 3.3% : 2.7% : 5.7% : 500 : 30,000 : 1,200 : 10%
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Univ. Hospital (64)Hospital (500)Commercial Lab (5)Local Commercial Lab (120)(low esoteric assay)Clinics (18,000) with or without POL(low esoteric assay)Integrated Laboratory System in Koreaesoteric assaysesoteric assaysesoteric assaysesoteric assay
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Automation, Laboratory Information systemSystematization (Total Laboratory Automation), Molecular biology
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Automation of CBC KEQAS in Hematology, 83 -98
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CLIS - Hitachi 747-100Up to 2400 tests/hr800 samples/day
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Microbiol Laboratory Evolution(II)
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Microbiology Laboratory Evolution(I)
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Total Laboratory Automation(TLA)
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iSTATNa,K,Cl,Ca++, pH,pCO2,pO2O2-sat, Total CO2, HCO3 -BUN, Glucose, Hct, Hb,
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HBSAg Methods and Principles
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Molecular Diagnosis in SNUH
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New Technologies/AreasMolecular diagnosticsChromosome analysisFlow cytometryImage data managementPOCT ( point of care testing)Pharmacogenomics
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Quality of Laboratory Tests
AccuracySensitivitySpeedMedical outputsPrecisionSpecificityEconomy
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CVs of WBC,Hb,Platelet according to cell counters KEQAS in Hematology,1998
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72/F, CMMoL
Count BlastsSeg LymphMonoEoBasoLUCManual count246222901A5.119.049.10.126.7B62.722.88.70.10.45.3
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Error SourcesPre-analytical error : diet, alchol, exercise, drug, sampling posture/time/site, lipemia hemolysis, ictericAnalytical error : method, reagent, instrument, RT, human source, Post-analytical error : reporting error, human source
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Pre-analytical Errors - casesIdentification error: transfusion reactionSampling from an extremity with IV fluid line/indwelling IV catheter : glucose 1000mg/dL
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?Hb : 4% Plt : 7KCa : 4Protein : 9 Alb : 9%Cholest : 9 TG : 10Alk.Ph : 9 ALT : 7
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Hb. 2.4 Hb. 9.5 ?
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: control chart, delta check, total (continuous) QA----- : proficiency survey
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Laboratory AccreditationDeveloped by KSCPFor an accreditation of commercial laboratoriesOn-off of laboratory tests A right to claim reimbursement of interpretative/QA summary report
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Not verified results Verified results Interpretative report Cumulative report Summary report ( )
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(Panic Value, Critical Value)Hb(adult) : < 6.0 , 20 < Hb(newborn) : < 9.5 , 22 < Platelet : < 30.000 , 1,000,000 < PT : 30 < pH : < 7.20 , 7.60 < PCO2 : < 20 mmHg, 65 < PO2 : < 40 mmHg,
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, , ?University Hospitalnamepatient medical records
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Basic StructureDB server(NCR 3600, Oracle 7.1)Web server(Axil 311, Oracle 7.1)Web browsersCommon Gate Pathway
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Web-based information sharing : hematology consult[Utilization of electronic hematology images and documents]
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Interpretation of ResultsReference value : +/- 2SD, 2.5 - 97.5percentilePositive predictive value (%) = TP/TP+FP x 100Decision level : Ca++ > 10.2 mg/dL for primary hypoparathyroidism < 7.0 mg/dL for tetany
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Pitfalls of Reference ValuesPatients A and B had the same degree of test increase, but the new value for patient B remains within the reference range
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Cholesterolfrom 200mg/dL to 220mg/dL
Day to day analytical variation : 5 %Biological intra-individual variation : 4.6 %Total intra-individual variation : 18.8% CVi2 = CV2a + CV2bio
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: 150,000 - 430,000100,000/cmm : , 50,000/cmm :
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Positive predictive value(PPV) ------------------------- Prevalence PPV------------------------- 1% 16.1 % 2% 27.9 % 5% 50.0 % 10% 67.9 % 25% 86.4 % 50% 95.0 %-------------------------
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? : : , , Mini : DNA chip, Microsensor (Coulter-mini, Hitachi-mini ----) (utilization management)
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POCT ? , , , ., , , , , , , , , , , , ,
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Dry ChemistryGlucose, TG, CreatinineCholesterol, TG, CK, Hb, AST, ALT, GGT, UreaUric acid, ALP, Bilirubin
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Point-of-Care Testing , , BUN, Bilirubin, Blood gases, Na, K, Cl, Hb, Hct, Activated clotting time, PT/APTT, HCG, Microscopy,