LABORATORY BUSINESS — methodical, technical, organizational support and practical performance of laboratory researches: a) biological liquids of the person for the purpose of prevention, diagnosis of diseases and control of results of treatment; b) objects of the environment for definition of extent of their pollution by biological, chemical agents, and also influence of physical factors. L. — the sphere of the prof. of activity of employees of laboratories to lay down. - the prof. and a dignity. - epid, institutions. Form of the organization L. in to lay down. - institutions the lab is professional. the clinicodiagnostic service, i.e. system of clinical diagnostic laboratories to lay down. - professional, the institutions of various profile and power combined by the uniform scientific and methodical management and the general task — the most rational and effective use of scientific concepts and practical recommendations laboratory diagnosis (see) for optimization of diagnostic and medical processes. Form of the organization L. in sanitation and hygiene is system a dignity. - a gigabyte. and bacterial, the SES laboratories of various level combined by the general tasks — protection of the surrounding environment, providing optimum a dignity. - a gigabyte. working conditions, training, life, food of the person, the prevention of acute diseases (see. Bacteriological laboratory , Virologic laboratory , Radiological laboratories , Sanitary and hygienic laboratory ).
Big role in development and implementation of the principles of the organization a lab. services at the first stages of development of the Soviet health care were played by P. P. Averyanov, A. A. Bogomolets, O. I. Bronstein, E. A. Kost, E. G. Mineeva, E. D. Ravich-Birger, V. N. Toparskaya, R. L. Ulanovskaya, T. N. Feldman, T. V. Hitrovo-Goreva, etc. 60 — the 70th were marked by transition to higher stage L., to the answering further development of specialized medical aid and enlargement to lay down. - professional, institutions. In these conditions began to create the joint laboratories in large to lay down. - professional, institutions and the centralized laboratories capable to provide with the most difficult types of analyses a number of city institutions or the district. The resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» (1977) provided strengthening of works on centralization a lab. services, the organizations in the republican, regional and regional centers of the centralized clinical diagnostic laboratories, concentration in them the main researches for healthcare institutions and equipment by their modern devices, devices and reactants.
For the benefit of improvement of the organization of work and upgrading of work enlargement and centralization of SES laboratories is carried out: a) association in the uniform centralized laboratory on the basis of regional SES with inclusion in its structure of personnel of laboratories city and regional (in the city) SES; b) merging of laboratories of city and regional SES on the basis of one of them; c) integration of laboratories of city SES due to merge of laboratories of the rural districts to it adjacent to the city; d) creation of interdistrict laboratories on the basis of large SES of rural districts.
Diagnostic lab. researches are made: a) clinical diagnostic laboratories of BC, policlinics, clinics; b) the centralized laboratories providing biochemical hormonal, immunol., tsitol, and other researches group to lay down. - professional, institutions (see. Laboratory, clinicodiagnostic ); c) the SES laboratories which are carrying out a part mikrobiol, and parazitol, researches of diagnostic character. The network of clinical diagnostic laboratories of the country contains St. 36 thousand divisions in structure to lay down. - the prof. of institutions with personnel apprx. 140 thousand people who is carrying out within a year St. 1 billion analyses, and St. 5 thousand laboratories as a part of SES. Growth of clinicodiagnostic researches in the USSR for 1970 — 1976 is presented in table 1.
Also the tendency to increase in number a gigabyte is observed. and bacterial, researches in SES. In 1974 in comparison with 1970 the number of these analyses grew by 13%.
The structure of main types of researches in clinical diagnostic laboratories for 1970 — 1975 is presented in table 2.
Nomenclature of main types lab. analyses the lab represents the maximum range. tests which can be realized at this stage of development a lab. diagnoses. Technical, economic and medical factors dictate restriction of its limits. The doctor is interested not in increase in number a lab. indicators, and in increase in their informational content and diagnostic value. Requirements of laboratories for quantity and quality laboratory engineering (see), chemical reactants and biol, drugs, growing according to expansion of range a lab. tests and to complication of their analytical basis, it is necessary to proportion to opportunities of economy. M3 of the USSR are approved lists of an obligatory minimum a lab. tests for 47 types of institutions according to their profile, power, the importance in a health system. The unity of researches in laboratories of hospitals and policlinics is provided that allows to realize more in necessary volume preclinical a lab. inspection of the patients who are subject to hospitalization and that to reduce the diagnostic period of stay of the patient on a bed. Obligatory minimum various lab. researches in basic groups to lay down. - professional, institutions it is presented according to the specified list in tab. 3. Apparently from the table, the largest range of laboratory tests is presented in laboratories of the republican, regional and regional hospitals which are the organizational and methodical and advisory centers for all clinical diagnostic laboratories in this territory and also in the centralized clinical diagnostic laboratories that allows to provide performance of the maximum range of researches.
Use of carefully selected unified techniques is provided, uniform for all to lay down. - professional, institutions of the country that will allow to provide a uniform accuracy rate of researches and to compare results of the analyses made to the same patient in different institutions.
The methods applied in the clinical and diagnostic purposes shall have high analytical reliability and diagnostic value, convenience of use at inspection of people, wide technical availability and profitability. According to these requirements at selection of the unified techniques criteria of analytical, clinical, diagnostic, technical and economic suitability are applied. By 1977 in the USSR 168 methods on 121 indicators which according to the methodical indications M3 of the USSR are applied in all clinical diagnostic laboratories of the country were unified. At the same time are developed and accustom to well equipped — so-called reference laboratories reference methods of a research which are selected by the only criterion — their high analytical reliability. They serve as a standard for assessment of the unified methods and quality of researches in ordinary laboratories.
Along with quality of a method reliability of results of researches depends also on accidental and systematic errors of intra laboratory character. For identification and elimination of these errors in a lab. to service quality control of researches is exercised. Hardware of laboratories is defined by the approximate list approved by M3 of the USSR for different types of laboratories depending on their appointment and power.
Supply with the equipment and its repair are carried out by Soyuzmedtekhniki institutions, supply with reactants — through local Boards of Pharmacy and directly through supplying and Soyuzreaktiv trade organizations of Min-va of chemical industry of the USSR. The m3 of the USSR regulates an obligatory assortment minimum of chemical reactants for a lab. researches in healthcare institutions.
The basis of personnel of laboratories is made by workers with vocational medical education: doctor-laboratory assistants, the paramedic-laboratory assistants, medical laboratory assistants (see. Laboratory assistant ). Training of doctor-laboratory assistants is carried out in workplaces in large laboratories by primary specialization and at departments clinical a lab. diagnoses institutes of improvement of doctors (see) and f-tov improvements and specializations of doctors of medical in-t, professional development — at the specified departments. The highest form of training of doctor-laboratory assistants is the wedge, an internship (see. Internship clinical ). Training of medical technologists is carried out on a lab. departments of medical schools; professional development — in workplaces in laboratories and in schools for professional development of workers with secondary medical education. Doctor-laboratory assistants, the paramedic-laboratory assistants and medical laboratory assistants periodically undergo certification. To doctor-laboratory assistants it is appropriated the second, first and highest qualification categories, to medical technologists and medical laboratory assistants — the first qualification category. The biologists who ended high fur boots, chemists, pharmacists as medical laboratory assistants — druggists with secondary education are allowed to work in laboratories as laboratory assistants with the higher education. They can improve skills together with medics. Performance of researches, development of new methods, control of work of laboratory assistants with secondary education, communication with clinical physicians, organizational and methodical work, in a duty of laboratory assistants with secondary education — implementation of analyses, preparatory work, execution of documentation belongs to functions of doctor-laboratory assistants.
The organization of work in laboratories in many respects depends on their type and power. In large laboratories division of labor, creation of crews by types of researches, work with big series of runs, use of means of mechanization and automation is possible. In all laboratories rational forms of the organization of jobs, registration documentation, coding of the studied tests, rapid tests etc. are used.
Along with the intra laboratory organization of work the increasing value the organization of relationship of laboratories about a wedge, departments gets, use of technical means of communication, streamlining of purposes of analyses on the basis of coordinated a lab. tests, differential and diagnostic programs, holding clinical laboratory conferences, etc.
Lab. the analysis is made, as a rule, according to the appointment of the doctor (on duty or treating) issued on the form of the established form. The result of a research would be sent to department or policlinics, appointed a research for the patient, on the form of the approved M3 of the USSR of a sample or, in some cases, established in this establishment, signed by the worker who made the analysis or the manager. laboratory (by transfer the surname of the employee responsible for correctness of information transfer by teletype is specified). For ensuring correctness of interpretation of results of a research on the form standards of the studied parameters (according to the indication of body of health care in departments of BC, policlinics instead there can be instructions with the indication of standards) are specified. Results of researches shall be expressed in units corresponding to the International System of Units and GOST «Units of Physical Quantities» (see. Units ). Order of their use and other units in a lab. to practice is established by methodical recommendations M3 of the USSR.
With increase in volume a lab. information and integration of laboratories there is rational a use of the COMPUTER for management of laboratories and bonds about a wedge, divisions.
Growth lab. researches puts a problem of preparation of the corresponding shots as average, and the top management, and also accurate planning of development of L. in medical institutions of the country.
Methodical management of laboratories is performed of the chief (non-staff) specialists on a lab. to the case M3 of the USSR, min. - in health care of federal and autonomous republics, managements and public health departments, the All-Union scientific and methodical and control center for laboratory business by both the organizational and methodical and control centers on places. The main direction of their activity is defined by the comprehensive program of standardization and quality management a lab. researches. Plays an important role in improvement of activity of laboratories All-Union scientific about-in doctor-laboratory assistants, created in 1952. The congresses held by it, plenums of board, a meeting of local departments promote implementation of achievements of medical science, uniform methodical installations, the best practices of laboratories.
Publication of All-Union science foundation of doctor-laboratory assistants is the Laboratory Business magazine issued since 1955. In it theoretical and practical questions a wedge, laboratory diagnosis — methods a lab are taken up. researches and results of their use in diagnosis, problems of scientific and technical progress in L., questions of the organization lab. services, scientific organization of work and best practices of work of laboratories. Besides, some questions L. are covered also in other medical magazines.
Table 1. GROWTH of CLINICODIAGNOSTIC RESEARCHES In the USSR for 1970 — 1976.
Table 2. STRUCTURE of MAIN TYPES of RESEARCHES IN CLINICAL DIAGNOSTIC LABORATORIES of the USSR for 1970-1975 *
Table 3. The OBLIGATORY MINIMUM of VARIOUS LABORATORY RESEARCHES IN BASIC GROUPS of TREATMENT AND PREVENTION FACILITIES ON the LIST of 197 5 g (in number of tests)
Bibliography: Kost E.A., etc. All-Union science foundation of doctor-laboratory assistants, in book: Nauch. the medical islands of the USSR, under the editorship of M. V. Volkov, page 389, M., 1972; K. I. Splinter and d river. Organization of sanitary and epidemiologic service, M., 1977, bibliogr.; Materials about a state and perspectives of development of laboratory clinicodiagnostic service in the country, M., 1977; Menshikov V. V., etc. Indicators and tendencies of development of clinical laboratory diagnosis at the present stage, Laborat, business, No. 9, page 515, 1977; Brooms to ying A. I. To history of laboratory matter in domestic medicine, in the same place, No. 12, page 753, 1974; Ravi of the h is B and r of e p E. D. K of history of the organization of laboratory matter in the USSR, in the same place, No. 9, page 520, 1977; Sh and t to both N I. V. and Menshikov V. V. Laboratory diagnostic service in system of the Soviet health care, in the same place, No. 10, page 579, 1977.
V. V. Menshikov.