Clinica chimica acta; international journal of clinical chemistry
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The mission of the Federation of European Societies of Clinical Chemistry is to support and promote clinical chemistry and laboratory medicine in Europe, to aid communication between the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and National Scientific Societies, to develop education and quality in the discipline, and to encourage young scientists to take an active role in these activities. One recent initiative of the Federation was a survey on accreditation of medical laboratories and training in laboratory medicine in Europe. Among European countries, three promote accreditation according to EN 45001, several countries apply systems based on professional and nationally defined standards (e.g. ⋯ Data on vocational training demonstrate that this is based on a postgraduate education with duration ranging from 6 months to 11 years; in most countries the average length of university education is 5 years and that of postgraduate training is 4 years. A great difference, moreover, exists regarding the polyvalent versus monovalent training. Taken together, these data indicate that a great effort should be made by the Federation for promoting harmonization and coordination in Europe.
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Anion gap (AG) is a calculated value commonly used in clinical practice. It approximates the difference between the concentration of unmeasured anions (UA) and unmeasured cations (UC) in serum. At present, the reference range of anion gap has been lowered from 8-16 to 3-11 mmol/l because of the changes in technique for measuring electrolyte. ⋯ If one finds high incidence of increased anion gap (>24 mmol/l) or decreased anion gap (<2 mmol/l), one should check the quality control of electrolyte and whether the patients were hypoalbuminemia or hyperglobulinemia. An anion gap exceeding 24 mmol/l will suggest the presence of metabolic acidosis. It is very rare to find anion gap with the negative sign.
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Comparative Study
Analytical performance of a portable critical care blood gas analyzer.
The portable blood gas analyzer OPTI Critical Care Analyzer was evaluated in comparison to routine laboratory assays using heparinized blood samples of adults and newborns. Within-run imprecision studies were performed with native blood using tonometry to adjust blood gas concentrations. ⋯ The coefficients of variation for the within-run imprecision were below 1.1% for sodium and hemoglobin, and below 2.6% for all other parameters, except for pCO(2) with coefficients of variation up to 3.6% at low calibration gas concentrations. Due to this analytical performance and its portability, the OPTI system is well suited for low to medium test frequencies and immediate use in emergency rooms, intensive care or surgery units.
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Point-of-care testing (POCT) has economic and medical benefits in the areas of immediate medical management, resource utilization and time management. Starting with bedside glucose, the Mount Sinai Medical Center has, over the past 11 years, implemented 23 POC tests, spanning complexity from blood gas/electrolyte testing to occult blood, in compliance with all regulatory and accreditation requirements. QC data are reviewed on a daily and weekly basis and all patient results are in the electronic medical record. ⋯ In 1999, over 1300 individuals performed over 440,000 POC tests within the institution. A formalized continuous quality improvement (CQI) program for the POCT program was developed in the fall of 1999. All testing sites are reviewed on a monthly basis for various quality indicators that cover QC performance, maintenance performance, proficiency testing, patient identification, and alert value confirmations.
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In response to clinical demand some point-of-care analysers now provide blood lactate measurements, but recently concern has been expressed about the value and interpretation of these measurements. We undertook this study to evaluate blood lactate measurements in patients with acute renal failure undergoing haemofiltration (HF) with lactate replacement fluid. At baseline, 27 patients had base deficits of >5 mmol/l and 14 (52%) had blood lactates of >3.5 mmol/l. ⋯ Of the remaining 12 patients with improved base deficit (+2 to +20), 10 (83%) survived. Lactate tolerance was compromised in patients with co-incidental liver disease, those on inotropic support, and in patients with initial blood lactate measurements of >10 mmol/l and large base deficits. The data suggest that blood lactate and simultaneous acid-base response measurements during HF help to assign correct buffer replacement and should be performed on all patients.