A aplicação da tecnologia da informação na Saúde tem dado um suporte à prestação do cuidado ao paciente com mais qualidade e propiciado a adesão de processos mais lineares, eficientes e seguros. Apresenta-se, nesta Tese, o desenvolvimento e a avaliação de um módulo, denominado Sistematização da Assistência de Enfermagem (Módulo SAE) que, incorporado ao Sistema de Informação Hospitalar (SIH) do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, seja capaz de automatizar as ações envolvidas no Processo de Enfermagem, identificando os benefícios e as limitações decorrentes da adoção de um sistema informatizado. A metodologia foi desenvolvida em duas etapas, uma para possibilitar o desenvolvimento e a implantação do Módulo SAE, outra para avaliar a contribuição para o enfermeiro e sua aplicabilidade no ponto de cuidado do paciente (PCP). A primeira etapa constou da organização das funcionalidades do Processo de Enfermagem no Módulo SAE. Como resultado, um conjunto de funcionalidades, estruturadas ou em texto livre, foi definido e compreende: coleta dos dados do paciente e exame físico, diagnóstico e evolução de enfermagem, intervenções e prescrição de enfermagem. O uso do Módulo SAE foi realizado em paralelo com a SAE manuscrita durante 6 meses e aprovado por 28 enfermeiros. Após esta fase, 50 outros enfermeiros foram treinados e utilizaram o Módulo SAE no seu trabalho diário, durante 15 meses, finalizando a primeira etapa com 78 enfermeiros treinados. A segunda etapa constou de uma pesquisa com os enfermeiros que responderam dois questionários para avaliar o uso do Módulo SAE, por meio de duas formas diferentes de acesso, uma delas por computador fixo no posto de enfermagem e a outra, um computador móvel desenvolvido no próprio hospital, para levar o sistema ao PCP. Para obter melhores resultados na pesquisa, as características pessoais desses enfermeiros foram analisadas e comparadas. Da homogeneidade dos resultados foram selecionados 42 profissionais aptos para usarem o computador móvel, dos quais, 25 participaram. Mediante os resultados analíticos e estatísticos, concluiu-se que o Módulo SAE incorporado no SIH contribuiu para o enfermeiro obter maior legibilidade e segurança no registro eletrônico, tanto por acesso fixo como por acesso móvel. A comparação entre as formas de acesso para a formulação do diagnóstico e da prescrição de enfermagem demonstrou resultado positivo a despeito das diferenças estatisticamente significantes (teste não paramétrico de Wilcoxon). Além disso, o registro eletrônico permitiu ao enfermeiro dispor de maior tempo para a assistência direta ao paciente (fixo 84% e móvel 60%). Quanto à facilidade do uso do computador móvel no PCP, as respostas positivas (84%) indicaram a diminuição do tempo gasto para a atualização da prescrição de enfermagem. / The application of information technology in health has given support to the patient care with more quality and provides more linear, efficient and safe processes. This thesis presents the development and evaluation of a module called Systematization of Nursing Care (SAE Module) that when incorporated into the Hospital Information System of the Heart Institute of the University of Sao Paulo Medical School is able to automate the actions involved in Nursing Process. The identification of the benefits and limitations resulting from the adoption of an information system are also described. The methodology was developed in two stages: the first involved the development and deployment of the SAE Module, and the second involved the assessment of the nursing computerized system to the nurse and its application at the point of patient care (PCP). The first step included the organization of the nursing process in the SAE Module. As a result, a set of features, structured or free texts were defined and comprised: collection of patient data and physical examination, nursing diagnosis and evolution, nursing interventions and prescription. The use of SAE Module was done in parallel with the SAE handwritten during 6 months and approved by 28 nurses. After this stage, 50 other nurses were trained and used it in their daily work for 15 months, finalizing the first step with 78 trained nurses. The second step involved the evaluation of nurses who replied two forms to evaluate SAE Module usage through two different ways of access, one using a fixed computer in the nursing counter and the other using a mobile computer, developed in the hospital in order to bring the system to the PCP. In order to obtain the best results from the evaluation, personal characteristics of these nurses were reviewed and compared. Fortytwo nurses were selected according to the homogeneity of the results, out of which 25 participated in the evaluation. The analytical and statistical results lead to the conclusion that the SAE Module incorporated into SIH contributed to the nurse to get more readability and security from patient electronic records for both fixed and mobile access. The comparison between the two forms of access to the formulation of nursing diagnosis and prescription has shown positive results despite statiscally significant differences (nonparametric Wilcoxon test). In addition, it was observed that the patient electronic record (fixed 84% and 60%) allowed an increase of the nurse´s time in the direct patient care. Regarding the use of a mobile computer in the PCP, the positive responses (84%) indicated a reduction in the time spent to update the nursing prescription.

<p>Point of care (POC) diagnosis is essential in personalized treatment to obtain effective clinical outcomes when the patient is on site. And Mass spectrometry (MS) system promotes the applications of rapid sampling ionization, which could be a tool for fast disease determination. In this thesis, a miniature MS system was firstly developed for POC tissue analysis. Lipid profile in rat organs were demonstrated. By coupling with online Paternò–Büchi (PB) reaction, fast determination of lipid C=C bond location isomers was realized. The system was applied to quantitatively analyze the change of lipid C=C location isomers between mouse normal and cancerous samples. The intensity ratio of fatty acid 18:1 (D9) and 18:1 (D11) in wild type breast tissue was calculated to be 2.881, while the ratio in tumor breast tissue was 0.667. The direct sampling-based miniature MS system is potential for POC analysis of lipid profiles and lipid biomarkers discovery.</p> <p>Secondly, an integration of paper-capillary spray and MS make it possible to analyze dried blood samples instantly in clinical laboratory and hospital. Quantitation of ratio between deuterate Phenylalanine and deuterate Tyrosine was achieved by using paper spray and paper-capillary spray MS directly, without any pretreatment of blood samples. Furthermore, these methods could generate calibration curves which enable the calculation of Phenylalanine concentration in whole human blood within 60 seconds. This disposable design is a promising application for point-of-care (POC) PKU analysis in newborn screening. </p> <p>At last, an increased in free fatty acids (FFAs) of cereals was observed during storage, and a simple and direct rice quality assessment was performed using nanoESI (Nano-Electrospray Ionization) mass spectrometry method. Six fatty acids including palmitic, oleic, and linoleic acids were compared between different rice species, growth regions and harvest years. 2D and 3D linear discriminant analysis (LDA) methods were deployed and a good sample separation was achieved. This direct sampling method of extracting FAs from rice surface combined with MS is suitable for industrial use in rapid identification for large number of samples.</p>

abstract: Over the past several decades, there has been a growing interest in the use of fluorescent probes in low-cost diagnostic devices for resource-limited environments. This dissertation details the design, development, and deployment of an inexpensive, multiplexed, and quantitative, fluorescence-based lateral flow immunoassay platform, in light of the specific constraints associated with resource-limited settings. This effort grew out of the need to develop a highly sensitive, field-deployable platform to be used as a primary screening and early detection tool for serologic biomarkers for the high-risk human papillomavirus (hrHPV) infection. A hrHPV infection is a precursor for developing high-grade cervical intraepithelial neoplasia (CIN 2/3+). Early detection requires high sensitivity and a low limit-of-detection (LOD). To this end, the developed platform (DxArray) takes advantage of the specificity of immunoassays and the selectivity of fluorescence for early disease detection. The long term goal is to improve the quality of life for several hundred million women globally, at risk of being infected with hrHPV. The developed platform uses fluorescent labels over the gold-standard colorimetric labels in a compact, high-sensitivity lateral flow assay configuration. It is also compatible with POC settings as it substitutes expensive and bulky light sources for LEDs, low-light CMOS cameras, and photomultiplier tubes for photodiodes, in a transillumination architecture, and eliminates the need for expensive focusing/transfer optics. The platform uses high-quality interference filters at less than $1 each, enabling a rugged and robust design suitable for field use. The limit of detection (LOD) of the developed platform is within an order of magnitude of centralized laboratory diagnostic instruments. It enhances the LOD of absorbance or reflectometric and visual readout lateral flow assays by 2 - 3 orders of magnitude. This system could be applied toward any chemical or bioanalytical procedure that requires a high performance at low-cost. The knowledge and techniques developed in this effort is relevant to the community of researchers and industry developers looking to deploy inexpensive, quantitative, and highly sensitive diagnostic devices to resource-limited settings. / Dissertation/Thesis / Doctoral Dissertation Electrical Engineering 2018

<p>The cardiac troponins are the biochemical markers of choice for the diagnosis of acute myocardial infarction (AMI) and risk prediction in patients with acute coronary syndrome (ACS). In this thesis, the role of early serial cardiac troponin I (cTnI) testing was assessed in fairly unselected patient populations admitted because of chest pain and participating in the FAST II-study (n=197) and the FASTER I-study (n=380). Additionally, the importance of cTnI testing in stable post-ACS patients from the FRISC II-study (n=1092) was studied.</p><p>The analyses in chest pain patients demonstrate that cTnI is very useful for early diagnostic and prognostic assessment. cTnI allowed already 2 hours after admission the reliable exclusion of AMI and the identification of low-risk patients when ECG findings and a renal marker such as cystatin C were added as conjuncts. Other biomarkers such as CK-MB, myoglobin, NT-pro BNP or CRP did not provide superior clinical information. However, myoglobin may be valuable in combination with cTnI results for the early prediction of an impending major AMI when used as input variable for an artificial neural network. Such an approach applying cTnI results only may also furthermore improve the early diagnosis of AMI.</p><p>Persistent cTnI elevation > 0.01 μg/L was detectable using a high-sensitive assay in 26% of the stable post-ACS patients from the FRISC II-study. NT-pro BNP levels at 6 months were the most important variable independently associated to persistent cTnI elevation besides male gender, indicating a relationship between adverse left ventricular remodeling processes and cTnI leakage. Patients with persistent cTnI elevation had a considerable risk for both mortality and AMI during 5 year follow-up. </p><p>These analyses thus, confirm the value of cTnI for early assessment of chest pain patients and provide new and unique evidence regarding the role of cTnI for risk prediction in post-ACS populations.</p>

The cardiac troponins are the biochemical markers of choice for the diagnosis of acute myocardial infarction (AMI) and risk prediction in patients with acute coronary syndrome (ACS). In this thesis, the role of early serial cardiac troponin I (cTnI) testing was assessed in fairly unselected patient populations admitted because of chest pain and participating in the FAST II-study (n=197) and the FASTER I-study (n=380). Additionally, the importance of cTnI testing in stable post-ACS patients from the FRISC II-study (n=1092) was studied. The analyses in chest pain patients demonstrate that cTnI is very useful for early diagnostic and prognostic assessment. cTnI allowed already 2 hours after admission the reliable exclusion of AMI and the identification of low-risk patients when ECG findings and a renal marker such as cystatin C were added as conjuncts. Other biomarkers such as CK-MB, myoglobin, NT-pro BNP or CRP did not provide superior clinical information. However, myoglobin may be valuable in combination with cTnI results for the early prediction of an impending major AMI when used as input variable for an artificial neural network. Such an approach applying cTnI results only may also furthermore improve the early diagnosis of AMI. Persistent cTnI elevation &gt; 0.01 μg/L was detectable using a high-sensitive assay in 26% of the stable post-ACS patients from the FRISC II-study. NT-pro BNP levels at 6 months were the most important variable independently associated to persistent cTnI elevation besides male gender, indicating a relationship between adverse left ventricular remodeling processes and cTnI leakage. Patients with persistent cTnI elevation had a considerable risk for both mortality and AMI during 5 year follow-up. These analyses thus, confirm the value of cTnI for early assessment of chest pain patients and provide new and unique evidence regarding the role of cTnI for risk prediction in post-ACS populations.

In der vorliegenden Arbeit wird eine integrierbare Pumpentechnologie für polymerbasierte mikrofluidische Systeme entwickelt. Ausgehend von den Anforderungen für die Durchführung molekulardiagnostischer Nachweise kommen dabei Fertigungsverfahren zum Einsatz, die sich auch für Einweg-Anwendungen eignen. Das genutzte Aktorprinzip für die integrierten Mikropumpen basiert auf der Elektrolyse von Wasser. Zur besseren technologischen Integrierbarkeit wird das Wasser in Form eines Hydrogels appliziert. Der Elektrolyt wird dabei mit einer Polymermembran mit geringer Wasserdampfdurchlässigkeit verschlossen. Die Membran wird in ihrem plastischen Verformbereich genutzt. Zur Dimensionierung der Mikropumpen und des mikrofluidischen Systems werden analytische und numerische Modelle entwickelt, die eine gute Übereinstimmung mit den Messwerten zeigen. Die Funktionsfähigkeit wird anhand zweier vollständig integriert ablaufender Immunoassays demonstriert. Dabei kommt ein polymerbasierter, optischer Biosensor zum Einsatz.

In this dissertation, three different microfluidic devices with bioanalytical applications are presented. From chapter to chapter, the bioanalytical focus will gradually become the development of a point-of-care sensor platform able to yield a reliable and quantitative response in the presence of the desired target. The first device consists of photolithographically-patterned gold on glass bipolar electrodes and PDMS Y-shaped microchannels for the controlled enrichment, separation from a mixture, and delivery of two charged dyes into separate receiving microchannels. The principle for the permanent separation of these dyes is based on the concept of bipolar electrochemistry and depended on the balancing/unbalancing of convective and electromigrating forces caused by the application of a potential bias, as well as the activation/deactivation of the bipolar electrodes. Two different bipolar electrode configurations are described and fluorescence is used to optimize their efficiency, speed, and cleanliness of delivery. The second device is a DNA sensor fabricated on paper by wax printing and folding to form 3D channels. DNA is detected by strand-displacement induced fluorescence of a single-stranded DNA. A multiplexed version of this sensor is also shown where the experiment results in “OR” and “AND” Boolean logic gate operations. In addition, the nonspecific adsorption of the reagents to cellulose is studied, demonstrating that significant reduction of nonspecific adsorption and increased sensitivity can be achieved by pre-treating the substrate with bovine serum albumin and by preparing all analyte solutions with spectator DNA. The third device, also made of paper, has a novel design and uses a versatile electrochemical detection method for the indirect detection of analytes via the direct detection of AgNP labels. A proof-of-concept experiment is shown where streptavidin-coated magnetic microbeads and biotin-coated AgNPs are used to form a composite model analyte. The paper device, called oSlip, and electrochemical method used are easily coupled so the resulting sensor has a simple user-device interface. LODs of 767 fM are achieved while retaining high reproducibility and efficiency. The fourth device is the updated version of the oSlip. In this case, the objective is to show the current progress and limitations in the detection of real analytes using the oSlip device. A sandwich-type immunoassay approach is used to detect human chorionic gonadotrophin (pregnancy hormone) present in human urine. Various optimization steps are performed to obtain the ideal reagent concentrations and incubation time necessary to form the immunocomposite in one step, that is, by mixing all reagents at the same time in the oSlip. Additionally, improvements to the electrochemical detection step are demonstrated. / text

In this work, alternating current (AC) electric fields are used in combination with microfluidics to manipulate micro- and nano-sized particles and to probe the electrical characteristics of microchannels with potential application in portable diagnostics. This work was carried out as contribution to a collaborative research project involving researchers from chemistry, electrical engineering and mechanical engineering at the University of Victoria, in addition to researchers from the BC Cancer Deeley Research Centre. The manipulation of particles or cells within a microchannel flow is central to many microfluidic applications. In the context of diagnostics that utilize antibodies in serum, for example, the removal of cells from the sample is often required. Continuous removal of particles and cells is particularly critical in the case of flow-through nanohole array based sensing, as these serve as fine filters and thus are very susceptible to clogging. In this work, chevron shaped, interdigitated electrodes are used to produce dielectrophoretic forces in combination with hydrodynamic drag to displace particles from their corresponding streamlines to the center of a microchannel. Analytical and finite element modeling are used to provide insight into the focusing mechanism. Dielectrophoresis (DEP) also offers opportunities for particle manipulation in combination with porous media. In this preliminary work, the viability of dielectrophoresis tuned nano-particle transport in a nanohole array is investigated through analytical and numerical modeling. The effects of hydrodynamic drag and Brownian motion are considered in the context of applied voltage, flow rate and particle size. Preliminary flow-through tests are performed experimentally as proof of concept. The final contribution focuses primarily on external infrastructure that enables AC microfluidic diagnostics, with particular relevance to portable device applications and so-called point-of-care devices. Cell phones, and mp3 players are examples of consumer electronics that are easily operated and are ubiquitous in both developed and developing regions. Audio output (play) and input (record) signals are voltage-based and contain frequency and amplitude information. Audio signal based concentration, conductivity, flow rate, and particle detection measurements are demonstrated in a microfluidic platform.

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No. of bitstreams: 1 josemunizpazelijunior.pdf: 868943 bytes, checksum: 7c1afb9837b6e1d73d18f7ea10b1401f (MD5) Previous issue date: 2012-11-29 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A Doença Renal Crônica (DRC) é um problema de saúde pública mundial e o número de pacientes inscritos em programas de terapia de substituição de função renal vem crescendo progressivamente. A morbimortalidade dos pacientes com DRC é impressionante e se deve principalmente a doença cardiovascular. A remoção inadequada de líquidos durante a hemodiálise é um dos principais fatores responsáveis por esta evolução desfavorável. A hipervolemia crônica leva a hipertensão, hipertrofia ventricular esquerda, congestão pulmonar e aumenta as taxas de hospitalização e mortalidade. A hipovolemia, por outro lado, se associa com náuseas, vômitos, diminuição da qualidade de vida, perda da função renal residual, trombose do acesso venoso e redução da adequação da diálise, devido às frequentes interrupções das sessões de diálise. O peso seco, definido como o menor peso atingido pelo paciente no final das sessões, quando a maior parte do excesso de líquido acumulado tenha sido removido, ainda é avaliado clinicamente, mas tem fraca correlação com a verdadeira volemia. Apesar de não podermos contar com método que seja “padrão-ouro”, devido às limitações na acurácia e aplicabilidade, várias exames complementares tem sido estudados e validados para a determinação mais precisa da volemia em pacientes dialíticos, incluindo a avaliação ultrassonográfica da veia cava inferior (VCI). O alto custo dos ecocardiógrafos e a necessidade de um ecocardiografista para operá-los têm impedido a disseminação da ultrassonografia para avaliar a VCI e, consequentemente, a volemia. Nós hipotetizamos que a classificação volêmica baseada na determinação do diâmetro expiratório da VCI indexado pela superfície corpórea (DVCIi) e o índice de colabamento inspiratório da VCI (ICVCI) realizada por médico nefrologista, sem especialização em ultrassonografia, é similar àquela obtida no mesmo exame realizado por médico especialista em ecocardiografia utilizando um ecocardiógrafo padrão (ECO) ou um equipamento de ultrassom convencional (US). Neste estudo transversal, um ecocardiografista experiente e um nefrologista sem especialização formal em ultrassonografia avaliaram consecutivamente o DVCIi e o ICVCI de 52 pacientes, durante as sessões de hemodiálise. No protocolo I, o nefrologista usou o US e o cardiologista usou o ECO; no protocolo II os aparelhos foram invertidos entre os pesquisadores. Em ambos os protocolos, os coeficientes de Pearson e kappa foram utilizados para avaliar a correlação entre as variáveis contínuas e categóricas, respectivamente. A concordância entre os examinadores foi avaliada pelo Bland-Altman. Obtivemos imagens de boa qualidade da VCI em 96% dos pacientes. As avaliações do DVCIi apresentaram forte correlação em ambos os protocolos (r= 0,88 e 0,84, nos protocolos I e II, respectivamente). A correlação entre as classificações volêmicas foi excelente no protocolo I (kappa = 0,82 e 0,93 pelo DVCIi e ICVCI, respectivamente) e substancial no protocolo II (kappa = 0,77 e 0,75 pelo DVCIi e ICVCI, respectivamente). A concordância entre os examinadores pelo gráfico de Bland-Altman das avaliações de DVCIi foi também muito boa em ambos os protocolos. Nefrologistas sem especialização formal em ultrassonografia usando um US podem avaliar a volemia de pacientes dialíticos através da ultrassonografia de VCI. O mesmo equipamento que já equipa as clínicas de diálise e é utilizado para diversas outras finalidades, como biópsia renal guiada, acesso venoso guiado, avaliação do trato urinário, mapeamento vascular e estudo das fístulas e enxertos, pode ser utilizado para determinação do peso seco. Esperamos assim, reduzir custos e melhorar a qualidade do atendimento dos pacientes dialíticos, através da disseminação da avaliação ultrassonográfica da VCI. / Chronic kidney disease has emerged as a public health problem of substantial proportions, and the number of patients who require renal replacement therapy has been growing over the years. The mortality rate of patients with ESRD remains amazing, and a large part of this mortality is due to cardiovascular disease. The inadequate fluid removal during hemodialysis is a major factor responsible for this unfavorable development. The hypervolemia leads to chronic hypertension, left ventricular hypertrophy, pulmonary congestion and increased rates of hospitalization and mortality. The hypovolemia, moreover, is associated with nausea, vomiting, diminished quality of life, loss of residual renal function, access thrombosis and reduction of dialysis adequacy, due to frequent interruptions of dialysis sessions. Clinically estimated dry weight, defined as the lowest post-dialysis weight at which most excess body fluid will have been removed, is widely used but is poorly predictive of volemic status. Despite the lack of gold standards, related to limitations in accuracy and feasibility, fluid volume has been assessed by using various tools, including ultrasonographic evaluation of the inferior vena cava (IVC). We sought to determine whether a nephrologist with limited ultrasound training can accurately assess the IVC in patients undergoing haemodialysis compared with a cardiologist by using a regular ultrasound system (RUS) or a full cardiovascular ultrasound system (CVUS). In a cross-sectional study, an experienced cardiologist and a nephrologist without formal ultrasound training consecutively measured the indexed IVC expiratory diameter (VCDi) and IVC collapsibility index (IVCCI) of 52 patients during haemodialysis sessions. In protocol I, the nephrologist used an RUS and the cardiologist used a CVUS; in protocol II, the machines were interchanged. In both protocols, Pearson and kappa correlation coefficients were used to evaluate the 11 interobserver correlation of continuous and categorical data, respectively. The interexaminer agreement was determined by the Bland–Altman method. High-quality IVC images were obtained in 96% of the patients. The VCDi measurements showed strong correlation in both protocols (r = 0.88 and 0.84 in protocols I and II, respectively). The volaemic classifications were excellent in protocol I (kappa = 0.82 and 0.93 by the VCDi and IVCCI, respectively) and substantial in protocol II (kappa = 0.77 and 0.75 by the VCDi and IVCCI, respectively). The interexaminer agreement on the VCDi measurements was also very good in both protocols. Ultrasound evaluation of the IVC can be performed by nephrologists without formal training using an RUS to assess volaemic status in patients undergoing haemodialysis. The same equipment that is already being used in dialysis clinics for several other purposes, such as guided renal biopsy, guided venous access, evaluation of the urinary tract, vascular mapping and study of fistulas and grafts can be used to determine the dry weight. We hope reduce costs and improve the quality of care for dialysis patients, through the spread of ultrasound evaluation of the IVC.

Abstract Point-of-care testing (POCT) is defined as laboratory tests performed outside the traditional clinical laboratory close to the patient at the time and place where care is received, such as hospitals and healthcare centers. The main reason for the use of POCT is that they provide rapid results and enable prompt interventions, with hopefully improved patient outcomes. All phases of laboratory procedure are included in POCT offering many opportunities for errors, which can influence on patients’ treatment. The measurements are more often performed by nurses than by laboratory professionals. These nurses have different kinds of professional backgrounds, e.g. public health nurses, registered and practical nurses, with minimal or no knowledge of laboratory procedures. The aim of the study was to develop a two-step training and management strategy for nurses to do POCT in hospital and primary healthcare center. In accordance with the strategy, with reasonable investment of laboratory resources, designated contact nurses were first trained in POCT by laboratory professionals, after which the contact nurses trained other nurses in POCT their respective units. Blood glucose, the most common point-of-care (POC) test, was chosen as an example to investigate the influence of training on the quality of the test performed by nurses. The quality of blood glucose measurements was studied by analyzing the control results obtained by nurses and biomedical laboratory scientists (BLSs). The study participants included nurses who were either untrained or trained to do POCT by using the developed interactive two-step training strategy. In conclusion, the nurses trained by using interactive two-step strategy achieved near-similar quality of blood glucose measurements as BLSs. The good quality of glucose measurements, once achieved by training, was also sustained in the long-term. / Tiivistelmä Määritelmän mukaan vieritutkimuksiksi kutsutaan laboratoriotutkimuksia, joita tehdään perinteisen laboratorion ulkopuolella, tarvittaessa lähellä potilasta sairaalassa ja perusterveydenhuollon alueella. Pääasiassa vieritutkimuksia tehdään silloin kun tulos halutaan saada nopeasti ennen hoitopäätöstä tai tulevaa toimenpidettä. Vieritutkimusten tekeminen sisältää kaikki laboratoriotyön vaiheet ja jokaisessa vaiheessa on mahdollisuus tehdä virheitä, jotka voivat vaikuttaa potilaiden hoitoon. Laboratorioammattilaisten sijaan määrityksiä tekevät yhä useammin hoitajat sairaalan eri yksiköissä ja perusterveydenhuollon alueella. Näillä hoitajilla on erilainen ammatillinen peruskoulutus, kuten perushoitajan tai sairaanhoitajan koulutus, ja heillä on vähän tai ei ollenkaan tietoa laboratoriomenetelmistä. Tämän tutkimuksen tarkoituksena oli kehittää hoitajien vieritutkimustoimintaan koulutus- ja hallintomalli, joka toimisi sekä sairaalassa että terveyskeskuksessa. Strategian perusteena oli käyttää suhteellisen vähän laboratorioresursseja ja päästä silti hyvään laadulliseen lopputulokseen. Strategiaksi valittiin kaksiportainen, vuorovaikutteinen koulutusmalli, jossa laboratorioammattilaiset kouluttivat sairaalan ja perusterveydenhuollon yksiköissä ns. yhdyshenkilöt, jotka puolestaan kouluttivat edelleen oman yksikkönsä muut hoitajat tekemään vieritutkimuksia. Veren glukoosimääritys, joka on yleisin vieritutkimus, valittiin esimerkkitutkimukseksi tutkittaessa koulutuksen vaikutusta hoitajien tekemien vieritutkimusten laatuun. Veren glukoosimääritysten laatutasoa tutkittiin analysoimalla hoitajien ja laboratoriohoitajien tekemien kontrollinäytteiden tuloksia. Tutkimukseen osallistui hoitajia, jotka oli koulutettu kehitetyllä vuorovaikutteisella kaksiportaisella koulutusstrategialla vieritutkimusten tekemiseen, sekä hoitajia, jotka eivät olleet saaneet vastaavaa koulutusta. Koulutusmallin avulla hoitajien suorittamien vieritutkimusten laatu parani ja he saavuttivat lähes saman laatutason kuin laboratoriohoitajat. Hyvä, kerran saavutettu glukoosimääritysten laatutaso säilyi myös pitkällä aikajaksolla.