RESUMO
BACKGROUND: Thyroid function is one of the most current procedures in the evaluation of endocrine function performed in daily practice; the reference intervals for thyrotropin (TSH) depend on the assay technology and the instruments in each laboratory. The main objective of this study is to determine the thyrotropin reference values in patients considered as euthyroid, living in the Andean region, at 2850 meters above sea level (Quito, Ecuador). METHODS: A cross-sectional, analytical, epidemiological study was conducted using a sample of 595 healthy adult volunteer donors from the Military Hospital Blood Bank in Quito-Ecuador. Serum samples were analyzed for thyrotropin levels using electrochemiluminescence. The reference values were calculated using recommendations from the CLSI C28A3 guide. RESULTS: The mean age of the overall sample was 35.7 (7.2) years, 50.9% (n = 303) were women. TSH recovered in the total sample showed a median of 2.64 mIU/L (2.5th-97.5th percentiles: 0.91-8.35 mIU/L); after removing outliers the reference values for the studied population were 0.87 to 5.21 mIU/L, without differences by sex. CONCLUSIONS: General laboratory practice should improve harmonization of TSH assays. This is a must in daily clinical practice, since it would allow us to share real reference intervals in an established population and may be related to the presence or absence of thyroid pathology.
Assuntos
Glândula Tireoide , Tireotropina , Adulto , Estudos Transversais , Equador , Feminino , Humanos , Masculino , Valores de ReferênciaRESUMO
BACKGROUND: The Six Sigma methodology is focused toward improvement, based on the Total Quality Management. It has been implemented in analytical procedures for clinical laboratories in the form of Sigma Metrics. This method is used in the evaluation of analytical procedures, providing evidence for risk-based management. METHODS: A descriptive study was carried using data from 18 Chilean clinical laboratories. The information of their performance and quality specifications used in their routine work was obtained from UNITY, an internal quality comparison program. RESULTS: A total of 3461 sigma evaluations was gathered, mostly from biyearly controls. The general distribution shows a median of 5.5 with positive asymmetry similar to other publications. The reported quality specifications are based in CLIA for 51.2% of the cases, 30.2% from biological variation, and 10.7% from other programs for the external quality evaluation. Significant differences (P < 0.05) were found between medians against their specification source. CONCLUSIONS: In the studied series, it would be feasible to implement a risk-based quality control system with simple rules and minimal control materials for 55.5% of the evaluated sigmas. 19.6% of the sigmas require improvement mainly in precision. The variety in specifications reveals a lack of harmonization in the specification's selections.
Assuntos
Serviços de Laboratório Clínico , Laboratórios Clínicos , Chile , Humanos , Controle de Qualidade , Gestão da Qualidade TotalRESUMO
Contexto: el personal de enfermería cumple un rol fundamental en el proceso transfusional; el nivel de conocimientos debe ser periódicamente evaluado a fin de garantizar una buena práctica transfusional. Objetivo: evaluar el nivel de conocimientos que posee el personal de enfermería del Hospital Pediátrico Baca Ortiz (HPBO) previo y posterior a la intervención, frente a los procedimientos para solicitud, administración y monitoreo de los componentes sanguíneos. Sujetos y métodos: estudio no-experimental pre y post-evaluatorio en el personal de enfermería del Hospital Pediátrico Baca Ortiz de la ciudad de Quito. Se diseñó y aplicó una encuesta estructurada a los profesionales de enfermería del Hospital Pediátrico Baca Ortiz a través de la cual se evaluaron aspectos técnicos relativos a la práctica transfusional en lo relativo a solicitud, administración y monitoreo de los componentes sanguíneos. Resultados: la intervención se realizó en 176 profesionales, distribuidos en tres grupos de capacitación; se observó un incremento global del 14,27% en el puntaje post-intervención sobre 20 puntos, con una p<0,002, estadísticamente significativa. La pre-intervención demostró un menor porcentaje de respuestas correctas en lo referente a la toma y envío de muestras (45,2%). Al evaluar el impacto de la intervención se observó que en la etapa relativa a "recepción de hemocomponentes en el servicio hospitalario, verificación, condiciones de envío, validación del paciente y administración de la transfusión" paso del 67,7% al 79,06% de respuestas válidas con una diferencia porcentual de 11,3%. El área hospitalaria que mayor impacto tuvo fue consulta externa, desde un 22,2% de respuestas correctas en la etapa de pre-intervención y la de menor impacto fue el área quirúrgica con 14,15%. Conclusión: la pre-intervención evidenció debilidades y puntos de mejora en los conocimientos del personal de enfermería que fueron fortalecidos significativamente por la intervención realizada. La educación continua reviste utilidad y relevancia para mejorar percepciones y prácticas en medicina transfusional (AU)
Context: nurses play a fundamental role in the transfusion process; The level of knowledge should be periodically evaluated in order to guarantee good transfusion practice. Objective: to evaluate the level of knowledge held by the nursing staff of the Baca Ortiz Pediatric Hospital (HPBO) before and after the intervention, as opposed to the procedures for requesting, administering and monitoring the blood components. Subjects and methods: pre and post-evaluation non-experimental study in the nursing staff of the Baca Ortiz Pediatric Hospital in the city of Quito. A structured survey was designed and applied to the nursing professionals of the Baca Ortiz Pediatric Hospital through which technical aspects related to the transfusion practice regarding the application, administration and monitoring of the blood components were evaluated. Results: the intervention was carried out in 176 professionals, divided into three training groups; an overall increase of 14.27% was observed in the post-intervention score over 20 points, with p <0.002, statistically significant. The pre-intervention showed a lower percentage of correct answers regarding the taking and sending of samples (45.2%). When evaluating the impact of the intervention it was observed that in the stage relative to "reception of blood components in the hospital service, verification, delivery conditions, patient validation and administration of the transfusion" step from 67.7% to 79.06% of valid answers with a percentage difference of 11.3%. The hospital area that had the greatest impact was external consultation, from 22.2% of correct responses in the pre-intervention stage and the one with the least impact was the surgical area with 14.15%. Conclusion: the pre-intervention showed weaknesses and points of improvement in the knowledge of the nursing staff that were significantly strengthened by the intervention performed. Continuing education has utility and relevance to improve perceptions and practices in transfusion medicine. (AU)