MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C87D62.2A8C8BA0" Tento dokument je webová stránka tvořená jedním souborem, rovněž nazývaná soubor webového archivu. Zobrazí-li se tato zpráva, znamená to, že prohlížeč nebo editor nepodporuje soubory webových archivů. Stáhněte si prohlížeč, který podporuje webový archiv, například aplikaci Windows® Internet Explorer®. ------=_NextPart_01C87D62.2A8C8BA0 Content-Location: file:///C:/B13459F0/slp.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Preanalytická fáze laboratorního vyšetření

Obsah této prezentace pravděpodobně nebude prohlížeč schopen správně zobrazit.

Chcete-li i přesto pokračovat, klepněte sem.

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Klepnutím= lze upravit styl předlohy nadpisů.
Klepnutím lze upravit styly př= ;edlohy textu.
Druhá úroveň
Třetí úroveň = ;
Čtvrtá úroveň= 3;
Pátá úroveň
‹#›
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Aplikace pravidel SLP v klinické biochemii=
  Martin Beránek
  ÚKBD = FN HK
&#= 13;
   přednáška =
 Bioanalytika
   
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Tři fáze laboratorního vyšetření
Preanalytická fáze=
Analytická fáze
Postanalytická fáze
Všechny fáze ovlivňují nejistotu laboratorních výsledků<= /b>
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text/html; charset="us-ascii" Preanalytická fáze laboratorního vyšetření
Čím preanalytická fáze ovlivňuje výsledek:
•Pacient =
•Typ a odběr biologického•Transport vzorku
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•Příprava analytického•Uchováván&ia= cute; vzorků po analýze
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Tok nových informací o preanalytických vlivech
  Výrobce
  Klinická   
 laboratoř
     Lékař
  Odběrová  
     sestra
Student   
bioanalytiky
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Pacient – zdroj variability
=
•Pohlaví (♂: ↑= GGT, CK, UREA, Fe, 17-OH steroidy<= /span>)
•Etnikum&n= bsp; černoši: ↑ TP, IgG o 40%, CK, LD,
•        = ;            &n= bsp;            = ;          ↓ CHOl, TAG, Hb, leu<= span style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-hansi-font-fami= ly: Arial;font-size:75%;color:#FFFFCC;mso-color-index:0;display:none'> =
•        = ;          asiaté: ↑ AMYL, N. Zéland - <= span style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-bidi-font-famil= y: Arial;mso-hansi-font-family:Arial;font-size:75%;color:#FFFFCC;mso-color-in= dex: 0'>↑ KM=
•Věk (děti: ↑= ALP, ACP, P, ↓ KREA, TAG, UREA) <= /span>
•Biologické cykly (hormony, KREA, Fe)
•Gravidita (↑= hCG, α<= span style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-hansi-font-fami= ly: Arial;font-size:75%;color:#FFFFCC;mso-color-index:0'>1FP, CHOL, ↓ Hb, KREA, UREA) <= /span>
•Současné choro= by (jaterní choroby vs IM)
•Biologický polo= 9;as analytu (Alb vs pre-alb= )
•<= /span>
Faktory neovlivnitelné preanalyticky
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Pacient
faktory=         = ;             preanalyticky 
•Fyzická aktivita (hemokonc. - ↑ Alb, ↑ CK, AST, LD, MYO, ↓ pH, ↑ laktát, centralizace oběhu – ↑ KREA, UREA, ↓ TAG, GLU, MK, ↑ ketony, ↔ hormony)
<= span style=3D'font-family:Arial;font-size:156%;color:#CCFF33'>•Psychický stres (↑ nadledv. hormony, GLU, NEMK)
<= span style=3D'font-family:Arial;font-size:156%;color:#CCFF33'>•Strava (↔ GLU, TAG, NEMK, URE= A, KM, P, pH moči)
•Tekutiny (hemokonc., avitaminosy, alkohol –= ↑ AST, ALT, GGT, ↓ GLU, ↑ KM)
<= span style=3D'font-family:Arial;font-size:156%;color:#CCFF33'>•Kouření (↑ <= span style=3D'font-family:Arial;font-size:156%;color:#CCFF33'>•Léky (↔ metabolismus, interference, parent. výživa)
<= span style=3D'font-family:Arial;font-size:156%;color:#CCFF33'>•Operační výkon (léky, ↑ CK, AST, LD, Myo, hormony)
<= span style=3D'font-family:Arial;font-size:133%;color:#FFFFCC;mso-color-index:0; visibility:hidden'>•
ovlivnitelné
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Základní informace pro <= span style=3D'position:absolute;top:15.75%;left:8.42%;width:83.14%;height:9.5%'= >pacienta před odběrem=   
<= span style=3D'font-family:Arial;font-size:133%;color:#FFFFCC;mso-color-index:0'= >•<= /span>odběr mezi 6= -8 hodinou ranní
<= span style=3D'font-family:Arial;font-size:133%;color:#FFFFCC;mso-color-index:0'= >•<= /span>24-48H bez intenzivní fyzické aktivity
•<= /span>den před odběrem vynechat léky, které nejsou <= span style=3D'position:absolute;top:32.57%;left:3.62%;width:84.05%;height:9.5%'= >nezbytné &= #13;
<= span style=3D'font-family:Arial;font-size:133%;color:#FFFFCC;mso-color-index:0'= >•<= /span>10-12H před odběrem lačnit, ale doplňovat tekutiny !
<= span style=3D'font-family:Arial;font-size:133%;color:#FFFFCC;mso-color-index:0'= >•<= /span>ráno bez větší fyzické aktivity (běh, kolo) <= /span>
<= span style=3D'font-family:Arial;font-size:133%;color:#FFFFCC;mso-color-index:0'= >•<= /span>před odběrem nepít alkohol ani kávu <= /div>
<= span style=3D'font-family:Arial;font-size:133%;color:#FFFFCC;mso-color-index:0'= >•<= /span>15 min před odběrem v klidu sedět
<= span style=3D'font-family:Arial;font-size:133%;color:#FFFFCC;mso-color-index:0'= >•<= /span>u speciál= ních testů dodržovat předepsanou přípravu
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Typy biologického materiá= lu v KBch
<= span style=3D'font-family:Arial;font-size:88%;color:#FFFFCC;mso-color-index:0'>= •<= /span>Krev (venózní, kapilární, arteriální)
<= span style=3D'font-family:Arial;font-size:88%;color:#FFFFCC;mso-color-index:0'>= •<= /span>Plasma
<= span style=3D'font-family:Arial;font-size:88%;color:#FFFFCC;mso-color-index:0'>= •<= /span>Sérum
<= span style=3D'font-family:Arial;font-size:88%;color:#FFFFCC;mso-color-index:0'>= •<= /span>Moč <= /span>
<= span style=3D'font-family:Arial;font-size:88%;color:#FFFFCC;mso-color-index:0'>= •<= /span>Stolice
<= span style=3D'font-family:Arial;font-size:88%;color:#FFFFCC;mso-color-index:0'>= •<= /span>Pot
<= span style=3D'font-family:Arial;font-size:88%;color:#FFFFCC;mso-color-index:0'>= •<= /span>Tekutiny: synoviální, likvor, amniová, pleurální,
•        = ;            perikardiální, z břišní dutiny <= /span>
•Vzorek pevné tkáně (kostní dřeň, nádor, biopsie, …)
<= span style=3D'font-size:88%;color:#FFFFCC;mso-color-index:0;visibility:hidden'>= •<= /span>
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Odběr biologického materiálu
•<= /span>Identifikace<= /span> zkumavky =3D identi= fikace žádanky
•<= /span>Primárn&ia= cute; odběrové soupravy eliminují lidskou chybu a = kontaminaci při manipulaci se vzorkem
•<= /span>Čas srážení (30 min) pro přípravu séra !
•<= /span>Odběrov&yacu= te; plast(PP, PE) – kaolin ↓•<= /span>Plast – propustný pro plyny !!
     (=3D>↑ pO2↓ pCO2
•Inertní gel (silikon, PE) ̵= 1; rozhraní sérum-krvinky
        = ;            &n= bsp; 
•
•
gel
sérum
  
         °C, stabilita 2-3 dny
ρ =3D 1,04 g/ml
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Vybrané analyty v plasmě a séru
•Vyšší hodnoty v plasmě:
•    = TP (o 4%), LD (o 2,7%= ), vápník (0,9%), chloridy (0,2%)
•<= /span>
•Vyšší hodnoty v séru:
•    draslík (o 8,4= %), fosfáty (7%), GLU (5,1%), CK (2,1%), uhličitany (1,8%), ALP (1,6%), Alb (1,3%), AST (0,9%), UREA (0,6%), KM (0,2%), sodík (0,1%)
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Antikoagula= ncia
= •princip:  vazba Ca2+ 2+) z krve, aktivace <= /span>antitrombinu III (heparin)
•
•<= /span>heparinát<= /u> lithný= , amonný, draselný, sodný (!)
•<= /span>Na2EDTA; K23EDTA
•<= /span>citrát sodný, draselný, amonný, ACD
<= span style=3D'font-family:Arial;font-size:156%;color:#FFFFCC;mso-color-index:0'= >•oxalát draselný, amonný (+ NaF u GLU v plasmě) =
•
<= span style=3D'font-family:Arial;font-size:156%;color:#FFFFCC;mso-color-index:0'= >•<= /span>pro vyšetření z plné krveISE elektrody, POCT<= /span>) =
<= span style=3D'font-family:Arial;font-size:156%;color:#FFFFCC;mso-color-index:0'= >•vyšetřen&i= acute; v plasmě (fibrinogen, statimová vyšetř.)
•<= /span>vyšetřen&i= acute; krvinek (hematologie)
<= span style=3D'font-family:Arial;font-size:156%;color:#FFFFCC;mso-color-index:0'= >•promytí krvin= ek (HbA1c), separace leukocytů
•<= /span>analýza DNA
•
T
Y
P
Y=
P
R
O
Č
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Transport biologického vzorku
<= span style=3D'font-family:Arial;font-size:178%;color:#FFFFCC;mso-color-index:0'= >•<= /span>uzavřené standardní odběrové nádobky
•<= /span>transport při <= /span>20-37 ºC=  a ve tmě =
<= span style=3D'font-family:Arial;font-size:178%;color:#FFFFCC;mso-color-index:0'= >•<= /span>↑ teplota >ºC): denaturace enzymů, ↓ GLU
•<= /span>↓ teplota (< 0 ºC): hemolýza, = ↑ K+
<= span style=3D'font-family:Arial;font-size:178%;color:#FFFFCC;mso-color-index:0'= >•<= /span>stanovení amoniaku – transport při 0 ºC
•<= /span>světlo: = ↓ bilirubinu
•
       !! = stanovení hodnot analytů v případě srážlivé krve nejpozději do 1H po odběru    
        = ;          (↑ K+, ↓= Cl-, ↓= ; GLU)
> 2H: raději transport séra než plné krve!!!
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Hemolýza = =3D erytrolýza
Δ= pH
      Interference <= /b>
při měření bilirubinu
      Interference <= /b>
fotometrická (hem)
Cévní lumen<= /b>
 ery : plasma
  LD   &nb= sp; 160 : 1
 AST      40 : 1= 3;
    K+       23 : 1 = ;
 Mg2+     2,5 : 1
   Cl-      1,5 : 1&#= 13;
  Na+        = ;    1 : 19
Ca<= span style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-hansi-font-fami= ly: Arial;font-size:59%;color:#FF0066;position:relative;top:-.45em;mso-text-ra= ise: 30%'>2+         1 : 128
Na+/K+ ATPasa
Na+
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Uchovávání (skladování) = vzorků krve
<= span style=3D'font-family:Arial;font-size:178%;color:#FFFFCC;mso-color-index:0'= >•<= /span>20-40 ºplná krev<= /u>:
   glykolýza v Ery → ↓ ATP →↓ membránové Na,K-ATPázy
   → hyperkalémie, hyponatrémie
    Leu  <= /span>↓ O2  ↑ CO2        = ;  Ery  ↓ pH  ↑ laktátu
<= span style=3D'font-size:44%;color:#FFFFCC;mso-color-index:0;visibility:hidden'>= •<= /span>
>krev pro většinu BCh analytů v chladnici
=3D> kapilárn&iac= ute; krev pro ABR: na ledu a měřit do 1H
>NaF: ↓ glykolýzy na 24H: pro glykémii a laktát
><= 1H: oddělení plasmy (séra) od krvinek, 4°C
------=_NextPart_01C87D62.2A8C8BA0 Content-Location: file:///C:/B13459F0/slp_soubory/slide0039.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Preanalytická fáze laboratorního vyšetření
Změny pH při skladování=
↑ laktát=
↓ pCO2
↓ iCa2+
↓ iMg2+
↓Cl-
∆ vazebnosti: léků, MK, BIL,&= #8230;
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 Uchovávání vzorků sér a plasmy
      4 = º
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 Příprava analytického vzorku
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Analytické znaky metod<= /span>
•Diagnostická citlivost a specifičnost
•Analytická citlivost <= /span>
•Mez detekce a mez stanovitelnosti
•Analytická specifičnost =
•Výtěžnost
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Analytické znaky metody jsou testovány v rámci validačního procesu
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R0lGODlhCwALAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAK AAoAhAAAAAAA/xgY/ygo/52d/5OT/6en/9TU/8zM/9fX/87O/8PD/+/v//T0/+vr//Dw/////wEC AwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwUtIAAwB4E0opgMQSso osO27gMcdL5ARk4XN19rJ/MJbIAV7ZUalU5NEQQwTYUAADs= ------=_NextPart_01C87D62.2A8C8BA0 Content-Location: file:///C:/B13459F0/slp_soubory/slide0085.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Preanalytická fáze laboratorního vyšetření
Referenční materiál
•<= /span>  Nativní poolované sérum zamrazené na –70 st.C
•<= /span>
•<= /span>  Lyofilizované nativní poolované sérum s kryoprotekcí
•<= /span>
•<= /span>  Lyofilizované nativní poolované sérum&#= 13;
•<= /span>
•<= /span>  Lyofilizované bovinní sérum 
        = ;          
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Stabilita referenčních materiálů !
Návaznost laboratorní= ;ch metod ! =
Komutabilita referenční= ;ch materiálů
(co nejvíce nativní charakter) ! =
Neinfekčnost<= b> !
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Kontrola kvality
(práce v laboratoři)
•Vnit"= 5;ní kontrola kvality (VKK, IQC)
•    Informuje o stabilit&= #283; analytického systému
•    Základem dlouhodobé hodnocení CVa (%)
•
•Externí kontrola kvality (EHK, EQA)
= 226;   Informuje o porovnatelnosti laboratoře, tedy o systematické chybě =
•   Základem hodnocen&ia= cute; bias (a výpočet z skore)
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 Vnitřní kontrola kvali= ty<= b>
/VKK, IQC/
= nZajišťuje stabilitu všech fází laboratorního měření a <= span style=3D'font-size:156%;text-shadow:auto'>spolehlivost výsledku = ;
<= span style=3D'font-size:156%;text-shadow:auto'>n2 materiály nejlépe 2x denně na začátku směny
<= span style=3D'font-size:156%;text-shadow:auto'>nReferenční meze analytů
<= span style=3D'font-size:156%;text-shadow:auto'>nPoužívat stejnou předem otestovanou šarži po 6-12M
    Testován&iacut= e; v sérii 20 měření (průměr, bias, CV= a, ±3s)
<= span style=3D'font-size:156%;text-shadow:auto'>n1x měsíčně průměr a SEM
<= span style=3D'font-size:156%;text-shadow:auto'>nPrůběžně diagram Levey-Jenningsův=
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Westgardova kontrolní pravi= dla VKK        13s= , 22s, R3s, 10x
+3s
+2s
+1s
X
-1s
-2s
-3s
Série (měsíční průměry měření= )
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 Externí kontrola kvality<= b>
/EHK, EQA/
nZajišťuje porovnatelnost laboratoří: metodickou a výsledkovou
nZjišťuje systematickou chybu měření porovnáním s referenčním vzorkem&= #13;
<= span style=3D'font-size:156%;text-shadow:auto'>nSlouží k vyjádření nejistoty analytické části měření =
nNelze ji použít k hodnocení vlivu preanalytické fáze
<= span style=3D'font-size:156%;text-shadow:auto'>nMezinárodní a národní společnosti
<= span style=3D'font-size:156%;text-shadow:auto'>n1-2x ročně
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Klinické laboratoře ČR
 <= b>Organizátor EHK
* Hodnocen&i= acute; účastníka
   Hodnocení kontrolního cyklu
   (mezilaboratorní, pe= er group,
    k referenčn&iacu= te; metodě)
* Identifika= ce chyb
* Hodnocen&i= acute; časových trendů
* Doklad o účasti
* Certifikát úspěšnosti
Matematick&ea= cute; zpracování výsledků =
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file:///C:/B13459F0/slp_soubory/slide0175.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Preanalytická fáze laboratorního vyšetření
Jak se hodnotí úspěšnost laboratoře?
=
  <= span style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-hansi-font-fami= ly: Arial;font-size:200%;text-shadow:auto;color:#FFCC99'>- dle odchylky od cílov&eacut= e; hodnoty
<= span style=3D'font-family:Arial;font-size:75%;color:yellow;mso-color-index:3'><= span style=3D'mso-special-format:bullet;position:absolute;left:-4.44%'>•<= /span>Cílová hodnota RM získaná změřením analytu
•        = ;      referenční metod= ou (např. glukosa= )
•<= /span>
<= span style=3D'mso-special-format:bullet;position:absolute;left:-4.15%'>•<= /span>Cílová hodnota RM získaná v několika expertních
•      laboratořích metodou = doporučenou IFCC (enzymy)
•
<= span style=3D'font-family:Arial;font-size:75%;color:#CCFFCC'>•Cílová hodnota z&i= acute;skaná jako průměr účastníků EHK
•        = ;      (nelze hodnotit správnost metody !!!) (hormony)&#= 13;
= •<= /span>
<= span style=3D'font-family:Arial;font-size:75%;color:#CCFFCC'>•Cílová hodnota z&i= acute;skaná jako průměr účastníků EHK 
•        = ;            &n= bsp;    používajících tutéž analytickou metodu
•        = ;       (hormony metodou RIA firmy Amersham)
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Hodnocení úspěšnosti v EHK=
R= 26;Cílov&aac= ute; hodnota (TV) ±= ; 2 SD
= 226;(interval spolehlivosti 95%)= 3;
•=
= 226;Tolerančn&i= acute; rozpětí TEmax<= /b> (HL – DL)
•
•
•
DL          Cíl= ová hodnota        = ;  H= L
Umax
Umax
UTV
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Ce= lková chyba laboratoře
•    Odchylka od TV =3D celková chyba laboratoře
•        = ;    (pro měření v daný čas a za daný= ;ch
•        = ;            &n= bsp;          podmínek)
•Nejistota metod= y Uc (anal. fáze)
•=3D matematický odhad rozsahu výsledku využívající všechny zdroje nejist= ot této fáze vyšetření;
•Nejist= ota všech fází by měla být součástí výsledku
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        = ;         Validita (platnost, spolehlivost)
        = ;      “Celková analytická chyba“ (TE, total error)
         Rozdíl výsledku měření od hodnoty veličiny v RM.
         Kvantifikace systematick&e= acute;  ch= yby (bias) a náhodné        = ; 
      chyby analýzy (CVa) měření (st= atist. spolehlivost 95%)
        = ;         
        = ;          TE =3D 2*CVa + |b= |
        = ;         
        = ;          TE =3D 2*Ö(CV= a= 2=  + <= /span>|b| 2= )
  
     
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Příklad hodnocení Uc= (%)
<= span style=3D'font-size:178%;text-shadow:auto'>nOdhaduje nejistoty rutinního měření glukosy v séru dle výsledků V= KK a EHK
=
<= span style=3D'mso-spacerun:yes'>    1. Reprodukovatelnost při VKK= :         CVa =3D 1,2%
<= span style=3D'mso-spacerun:yes'>   
<= span style=3D'mso-spacerun:yes'>    2. Pravdivost (správnost, = bias) při EHK:  b =3D 3,0% = ;
        = ;   CVb =3D |b| / Ö3 =3D 1,7%     (3… n-dní měření)
<= span style=3D'mso-spacerun:yes'>    3. Nejistota hodnoty glukosy v RM= : UTV =3D 0,5%
   
    4= .  Uc =3D 2x Ö (CVa2 + CVb= 2 + UTV2) =3D 4,3%&#= 13;
    
------=_NextPart_01C87D62.2A8C8BA0 Content-Location: file:///C:/B13459F0/slp_soubory/slide0180_image074.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhygACAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAADK AAIAgAAAAP///wIijI+py+0Po5y02vsACLvz74XgKJbkaaboqrbs68bwLIdAAQA7 ------=_NextPart_01C87D62.2A8C8BA0 Content-Location: file:///C:/B13459F0/slp_soubory/slide0181.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Preanalytická fáze laboratorního vyšetření
Hodnocení Uc dle <= b>z-skóre<= b> v rámci EHK
   Předpoklady výpočtu:
   - návaznost na referenční metodu:      b<= span style=3D'font-family:Symbol;font-size:156%;text-shadow:auto;mso-char-type:= symbol'>®0
   - je známa dlouhodobá  SD  metody v dané laboratoři
   - laboratoř je účastníkem EHK (a dána cílová hodn= ota TV)
        = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;       
        = ;            &n= bsp;            = ;     naměřená hodnota - TV
        = ;            z skóre =3D  -------------------------------
        = ;            &n= bsp;            = ;            &n= bsp;   SD metody
Z-skóre = >3  =3D  hrubá chyb= a
Z-skóre = £ 1 =3D metoda naprosto v pořádku
n= ejobjektivnější ukazatel dlouhodobé kvality výsledků labor. metody =
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Trendy v rozvoji EHK
Návaznost (dokumentace IVD-MD)
Nejistota (Uc v dokumentaci)
Nativní materiály bez vlivu matrice
      (individuální dárce či pool) <= /div>
Nadnárodní globální charakter
         (nákladnost RM)
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Základem standardní laboratorní práce je především:
<= span style=3D'font-size:88%'>1.Provádět kontrolu kvality (IQC EQA)= 3;
2.
2.Pečlivě číst příbalové informace výrobce
3.
3.Vést záznamy o technickém sta= vu přístrojů
4.
4.Vést pečlivou laboratorní dokum= entaci
5.
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Analytické cíle
•Rozvoj technologie – přesnější analýzy
•   (↓ CV)
•Nové techniky a komutabilnější materiály – vyšší návaznost (↓ bias)
•Nové statistické metody a výpočetní technika
•Snižován&iacu= te; nejistoty v pre- a post-analyt. fázi
•Snižování nejistoty vs. cena vyšetření
•        = ;     … existují smysluplné hranice ?
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Analytické cíle – odvození složek nejistot = z biologických rozptylů analytů
CVi =3D intraindividuální biologický rozptyl  
        = ;  vypočítaný tzv. chronobiologickými studiemi
  
CVg =3D interindividuální (skupinový) rozptyl
=
  CV= c =3D celkový biologick&yacut= e; rozptyl =3D CVi  +  CVg
=
        = ;  CVa £ 0,5 * CVi        = ;   |b| £ 0,25 * CVc 
=
=
------=_NextPart_01C87D62.2A8C8BA0 Content-Location: file:///C:/B13459F0/slp_soubory/slide0194_image076.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhcgEnAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAABx ASYAggAAAM3/zcz/zMv/y8j/yAECAwECAwECAwP/GLLc/jDKSau9OOsagP9gKI7jZp5oqq4nwL5w LM9kbdtzru+8Ayidm3BILBqPyKQyBFwSF86odEqtFqEuq3bL7Q4FXhA4TC6bleDmec1ue9RehntO 78rH9bw+ig/394CBQmkCQYKHiB9wdn+JjntYjY+TdJJblpSZZ4SGmp5mi1xyn6Rkd6WofmaYqa1L nK6xUqGXrLK3N5G4u0i2VL68wR6wwsUjtFqjxsvDUMDMss980NTE1MXIVljXxbrcxtJO4d+f1uS4 2VXK57en7LzjaO/wP4Xzt+m/8feI3vyx+3r9i1av00BS+aasO1jOGcNWAY9EfFjHHMVMCaVsu6jJ yx/Hjqs+lisoEqM9PxtLJnKnctLEKy0pWYwZKCOflzQZDcvpCOcXnitJAq15Mk7KoRUdIg3kc9BS pkKf1rEprqnUV2OsXpVXRutWgVS/agmL5qjYrkrPtvFKgq1ap2TfRonby63ctlkdgtmbha/fvoD/ Cg5MeLDhwogPK07MeLHjvmZrPZ7cuDLly5YzY95cGIqCHqBDi95gUPLo06hTQxkAgLXr1rBfy45N e7bt2rhv687Ne7fv3sB/C+ddZrjx4MiPK0/OfLlz5AkAADs= ------=_NextPart_01C87D62.2A8C8BA0 Content-Location: file:///C:/B13459F0/slp_soubory/slide0197.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Preanalytická fáze laboratorního vyšetření
IVD MD – In Vitro Diagnostic Medical Devices
Evropská direktiva 98/79EC=
•EU od 1.1.2001 zákonná povinnost výrobců = IVD výrobků pos= kytovat informace zákazníkům k zajištění jakos= ti měření a návaznosti (značka CE):
•Výrobce
•Výrobek – rizika, šarže, exspirace, obsah, účel, podmínky    =
•Hodnoty kalibrátorů a kontrol s nejistotami <= /span>
•Návod k použití (složení, stabilita, aditiva, SOP, výpočty, 
•        = ;          kalibrace, VKK, prostředí, EHK, návaznost, Uc RM
•Referenční intervaly, citace
•Datum vydání dokumentace
•Plná platnost pro nové i vyráběné výrobky od ledna 2006<= /div>
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•Určuje zodpovědnost a povinnosti = výrobců IVD
•<= /span>Není potřeba posudek NRL
•Změna vedení dokumentace v národ. jazycích
•Zpřís= tupnění dat o výrobě a změnách orgánům státu a zákazníkovi
•Součást dokumentace laboratoře
•
•<= /span>
Co přinesla Direktiva 98/79 ?
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Provozní dokumentace o řízení kvality<= /div>
        = ;    
        = ;            &n= bsp; Laboratorn&ia= cute; příručka kvality
        = ;      Výsled= ky VKK a EHK 
         Technická dokumentace
      Standardní operační postupy
  Validačn= í a verifikační protokoly
<= span style=3D'font-family:Arial;font-size:178%;text-shadow:auto;visibility:hidd= en'>n
<= span style=3D'font-family:Arial;font-size:178%;color:#FFCCFF;text-shadow:auto; visibility:hidden'>n
<= span style=3D'font-size:178%;text-shadow:auto;visibility:hidden'>n
?
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   Valida&#= 269;ní dokumentace
•Validace =3D ověření a potvrzení pravdivosti
•Verifikace =3D ověření trvání závěrů validace
•pro splnění požadavků  ke klinicko-laboratorní použití <= /div>
•
•V a l= i d o v a t:
•  = 3;
•  CO?        metodu, vzorkování, přístroj, soupravu, SW
•  KOHO?   klinické laboratoře, výrobce soupr= av, …  <= /div>
•  ČÍM?=        zkoušení (testování) a hodnocení dostupných  věd.
•        = ;          a technických informací, výsledků EHK a VKK 
•  KDO?     sama laboratoř, klinik, RL, ČSKB, auditor
•
•  PODLE ČEHO?     ČSN ISO 8402
• <= /span>
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Metodické položky v provozní dokumentaci= (v = SOP)<= span style=3D'mso-spacerun:yes'> 
= n<= span style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-hansi-font-fami= ly: Arial;font-size:156%;text-shadow:auto;color:#FFCCFF'>Preanalytick&eacut= e; procesy
<= span style=3D'font-family:Arial;font-size:156%;color:#FFCCFF;text-shadow:auto'>= n<= span style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-hansi-font-fami= ly: Arial;font-size:156%;text-shadow:auto;color:#FFCCFF'>Analytické procesy – VKK, realizace n&aacut= e;vaznosti, účast v EHK, validační  a verifikační dokumentace <= /div>
n
= = n<= span style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-hansi-font-fami= ly: Arial;font-size:156%;text-shadow:auto;color:#FFCCFF'>Postanalytick&eacu= te; procesy – výsledkové protokoly, funkce LIS, interpretace a konsultace, způsoby komunikace= s „klienty“.
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Technická dokumentace
•Instalační protokoly k přístrojům
•Návod k obsluze
•Záruční a pozáruční servis
•Preventivní údržba (technik, operátor)
•<= /span>Přístrojové karty (inventární č., amortizace, provozní hodiny)
•Protokol o zaškolení obsluhy
•Protokol kalibrace a kontroly pipet
•Revize elektro, vzducho, vody, plynu, PC...
•Hygienická opatření, preventivní prohlídky
•Biologický a chemický odpad
•<= /span>
•<= /span>
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Akreditace zkušebních a kalibračních laboratoří =
núřední uznání odborné úrovně (způsobilosti) provádět= <= span style=3D'font-size:156%;text-shadow:auto'>zkoušky nebo kalibrační měření
<= span style=3D'font-size:156%;text-shadow:auto'>nAudit, auditor (úředně pověřená osoba)
<= span style=3D'font-size:156%;text-shadow:auto'>nČasová omezenost platnosti =
= nKritéria pro akreditaci dána <= span style=3D'font-size:156%;text-shadow:auto'>mezinárodními n= ormami <= u>pro systém řízení kvality v laboratoři
=   ČSN-ISOIEC 17025 (1999) – obecné požadavky na <= /span><= span style=3D'font-size:156%;text-shadow:auto'>způsobilost chemické laboratoře
  ISO DIS 15189 (2001) – norma pro akreditci <= span style=3D'font-size:156%;text-shadow:auto'>klinických zkušebních laboratoří
  Návaznost na ISO 9000 a ISO 9001 – řízen&iacut= e; kvality v= ýroby a služeb
<= span style=3D'font-size:156%;text-shadow:auto;visibility:hidden'>n
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3Das1479tn 3D"MODULAR
= Koncentrace celkového cholesterolu v krvi:   5,0 mmol/l
Modular (Roc= he)
= Chyba měření (analytická chyba):        = ;       ±= ; 0,2 mmol/l
= Odběr, transport, uložení (preanalytická): ± 0,1 mmol/l
= Noční odběr (biologický vliv):        = ;            &n= bsp; ±= ; 0,1 mmol/l
= Dávkování léčiva (interference):        = ;          ±= ; 0,2 mmol/l
5,0
4,0
6,0
= A/D převod, zaokrouhlení výsledku:<= span style=3D'mso-spacerun:yes'>        = ;    ±= ; 0,1 mmol/l
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3Das1479tn 3D"MODULAR
= Koncentrace celkového cholesterolu v krvi:   5,0 mmol/l
Modular (Roc= he)
5,0
4,0
6,0
= 3;
        = ;            &n= bsp;  Nejistota výsledku měření (Uc)
        = ;            &n= bsp;      ±= ; 0,7 mmol/l
Interval pravděpodobného výskytu skutečné hodnoty s uvážením všech zdrojů chyb
 
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Analytická chyba
Preanalytická chyba
Biologický vliv
Interference
Lze ovlivnit
&pl= usmn;
√
√
Zdroj nejistoty výsledku měření
Standardizace        podmínek = ;
vyšetření
= A/D převod, zaokrouhlení výsledku:<= span style=3D'mso-spacerun:yes'>        = ;    ±= ; 0,1 mmol/l
3D"PE02364_"
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vytištěné těsně před začátkem první hodiny přednášky=
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g_bgSound ) { idx=3Dg_bgSound.indexOf(","); pptSound.src=3Dg_bgSound.substr( 0, idx ); pptSound.loop=3D -(parseInt(g_bgSound.substr(idx+1))); } SlideObj.filters.revealtrans.Apply() } SlideObj.style.visibility=3D"visible" if( fTrans ) SlideObj.filters.revealtrans.Play() } function MakeNotesVis() { if( !IsNts() ) return false SlideObj.style.display=3D"none" nObj =3D document.all.item("NotesObj") parent.SetHasNts(0) if( nObj ) { nObj.style.display=3D"" parent.SetHasNts(1) } return 1 } function ChkAutoAdv() { if(SldHasTrans()) SlideObj.onfilterchange=3DAutoAdv else AutoAdv() } function AutoAdv() { if(!IsWin("PPTSld") || !gUseSldTimings )return var sld=3DGetCurSld() if( (sld.mAdvDelay>0) && !parent.IsFramesMode() ) setTimeout("parent.GoToNextSld()",sld.mAdvDelay) } function GetObj(id) { if(g_supportsPPTHTML) return document.all(id); else return document.getElementById(id); } function SldHasTrans() { return SlideObj.style.filter !=3D ""; } function GetSldId() { return sId=3Dlocation.href.substring(location.href.la= stIndexOf('/')+1) } function HideMenu() { if( frames["PPTSld"] && PPTSld.document.all.item("ctx= tmenu") && PPTSld.ctxtmenu.style.display!=3D"none" ) { PPTSld.ctxtmenu.styl= e.display=3D'none'; return true } return false } function IsWin( name ) { return window.name =3D=3D name } function IsNts() { return IsWin("PPTNts") } function IsSldOrNts() { return( IsWin("PPTSld")||IsWin("PPTNts") ) } function SupportsPPTAnimation() { return( navigator.platform =3D=3D "Win32"= && navigator.appVersion.indexOf("Windows")>0 ) } function SupportsPPTHTML() { var appVer=3Dnavigator.appVersion, msie=3DappVer.indexOf("MSIE "), ver=3D0 if( msie >=3D 0 ) ver=3DparseFloat( appVer.substring( msie+5, appVer.indexOf(";",msie) ) ) else ver=3DparseInt(appVer) return( ver >=3D 4 && msie >=3D 0 ) } function _RSW() { if( !g_supportsPPTHTML || IsNts() || ( !g_scaleInFrame && (!IsWin("PPTSld") || !parent.IsFullScrMode()) ) ) return var padding=3D0; if( IsWin("PPTSld") && parent.IsFramesMode() ) padding=3D6 cltWidth=3Ddocument.body.clientWidth-padding cltHeight=3Ddocument.body.clientHeight-padding factor=3D(1.0*cltWidth)/g_origW if( cltHeight < g_origH*factor ) factor=3D(1.0*cltHeight)/g_origH newSize =3D g_origSz * factor if( newSize < 1 ) newSize=3D1 s=3DSlideObj.style s.fontSize=3DnewSize+"px" s.posWidth=3Dg_origW*factor s.posHeight=3Dg_origH*factor s.posLeft=3D(cltWidth-s.posWidth+padding)/2 s.posTop=3D(cltHeight-s.posHeight+padding)/2 if( g_scaleHyperlinks ) ScaleHyperlinks( factor ) } function _InitAnimations() { animRuntimeInstalled =3D ''+document.body.localTime !=3D 'undefined'; isFullScreen =3D (window.name =3D=3D "PPTSld") && !parent.IsFramesMode(); g_animUseRuntime =3D g_showAnimation && animRuntimeInstalled && !(isFullSc= reen && parent.IsSldVisited()); if( g_animUseRuntime ) { collSeq =3D document.all.tags("seq"); if( collSeq !=3D null ) { for(ii=3D0;ii numSlds ) gSldJumpIdx =3D numSlds; if ( gSldJumpIdx >=3D 0 ) { if ( gSldJumpIdx =3D=3D 0 ) gSldJumpIdx =3D 1; var jumpTo =3D parseInt(gSldJumpIdx); gSldJump =3D 0; gSldJumpIdx =3D ""; win.GoToSld( parent.GetSldList().mList[jumpTo-1].mSldHref ) } } } function _KDH() { if( event.keyCode =3D=3D 8 ) { event.returnValue =3D 0; parent.GoToPrevSld(); } } var g_HLinkArray =3D new Array(); function IMapAreaObj( areaObj, coords ) { this.areaObj =3D areaObj; this.coords =3D coords; } function InitHLinkArray() { var appVer =3D navigator.appVersion; var msie =3D appVer.indexOf ( "MSIE " ) var ver =3D 0; if ( msie >=3D 0 ) ver =3D parseInt ( appVer.substring( msie+5 ) ); linkNum =3D 0; for (i=3D0; i 4 ) ) g_HLinkArray[linkNum++] =3D new IMapAreaObj( areaObj, ParseCoords( ar= eaObj.coords ) ); } } function ScaleHyperlinks( factor ) { for( ii=3D0; ii< g_HLinkArray.length; ii++) { coordsStr=3D""; imaObj =3D g_HLinkArray[ii]; for ( jj=3D0; jj < imaObj.coords.length-1; jj++ ) coordsStr +=3D (imaObj.coords[jj]*factor) + ","; coordsStr +=3D (imaObj.coords[jj]*factor); imaObj.areaObj.coords =3D coordsStr; } } function ParseCoords( coordsStr ) { var numArray =3D new Array(); var i =3D curPos =3D commaPos =3D 0; while ( ( commaPos =3D coordsStr.indexOf(",", curPos) ) !=3D -1 ) { numArray[i++] =3D parseInt( coordsStr.substr( curPos, commaPos ) ); curPos =3D commaPos + 1; } numArray[i] =3D parseInt( coordsStr.substr( curPos ) ); return numArray; } function DocumentOnClick() { if( IsNts() || parent.HideMenu() ) return; if( ( g_allowAdvOnClick && (window.name=3D=3D"PPTSld") && !parent.IsFrames= Mode() ) || (event && event.keyCode=3D=3D32) ) { if( g_animUseRuntime && g_animMainSequence && g_animMainSequence.cangonex= t ) return; parent.GoToNextSld(); } } var g_supportsPPTHTML =3D SupportsPPTHTML(), g_scaleInFrame =3D 1, gId=3D""= , g_bgSound=3D"", g_scaleHyperlinks =3D false, g_allowAdvOnClick =3D 1, g_showInBrowser = =3D 0, gLoopCont =3D 0, gUseSldTimings =3D 1; var g_showAnimation =3D g_supportsPPTHTML && SupportsPPTAnimation() && ( (w= indow.name=3D=3D"PPTSld" && !parent.IsFramesMode()) || g_showInBrowser );va= r g_animManager =3D null; var g_animUseRuntime =3D false; var g_animItemsToHide, g_animInteractiveItems, g_animSlideTime; var g_animMainSequence =3D null; var ENDSHOW_MESG=3D"Konec prezentace, klepnutím ukončíte= předvádění.", SCREEN_MODE=3D"Frames", gIsEndShow= =3D0, NUM_VIS_SLDS=3D49, SCRIPT_HREF=3D"script.js", FULLSCR_HREF=3D"fullscr= een.htm"; var gCurSld =3D gPrevSld =3D 1, g_offset =3D 0, gNtsOpen =3D gHasNts =3D gO= tlTxtExp =3D 0, gHasNarration =3D 0, gOtlOpen =3D true window.gPPTHTML=3DSupportsPPTHTML() var gMainDoc=3Dnew Array(new hrefList("slide0001.htm",1,-1,1),new hrefList(= "slide0022.htm",1,-1,1),new hrefList("slide0002.htm",1,-1,1),new hrefList("= slide0019.htm",1,-1,1),new hrefList("slide0004.htm",1,-1,1),new hrefList("s= lide0005.htm",1,-1,1),new hrefList("slide0021.htm",1,-1,1),new hrefList("sl= ide0041.htm",1,-1,1),new hrefList("slide0010.htm",1,-1,1),new hrefList("sli= de0038.htm",1,-1,1),new hrefList("slide0011.htm",1,-1,1),new hrefList("slid= e0013.htm",1,-1,1),new hrefList("slide0018.htm",1,-1,1),new hrefList("slide= 0014.htm",1,-1,1),new hrefList("slide0039.htm",1,-1,1),new hrefList("slide0= 015.htm",1,-1,1),new hrefList("slide0017.htm",1,-1,1),new hrefList("slide01= 35.htm",1,-1,1),new hrefList("slide0191.htm",1,-1,1),new hrefList("slide008= 1.htm",1,-1,1),new hrefList("slide0083.htm",1,-1,1),new hrefList("slide0085= .htm",1,-1,1),new hrefList("slide0163.htm",1,-1,1),new hrefList("slide0167.= htm",1,-1,1),new hrefList("slide0170.htm",1,-1,1),new hrefList("slide0172.h= tm",1,-1,1),new hrefList("slide0225.htm",1,-1,1),new hrefList("slide0174.ht= m",1,-1,1),new hrefList("slide0175.htm",1,-1,1),new hrefList("slide0177.htm= ",1,-1,1),new hrefList("slide0179.htm",1,-1,1),new hrefList("slide0178.htm"= ,1,-1,1),new hrefList("slide0180.htm",1,-1,1),new hrefList("slide0181.htm",= 1,-1,1),new hrefList("slide0186.htm",1,-1,1),new hrefList("slide0165.htm",1= ,-1,1),new hrefList("slide0192.htm",1,-1,1),new hrefList("slide0194.htm",1,= -1,1),new hrefList("slide0197.htm",1,-1,1),new hrefList("slide0198.htm",1,-= 1,1),new hrefList("slide0213.htm",1,-1,1),new hrefList("slide0200.htm",1,-1= ,1),new hrefList("slide0205.htm",1,-1,1),new hrefList("slide0207.htm",1,-1,= 1),new hrefList("slide0214.htm",1,-1,1),new hrefList("slide0216.htm",1,-1,1= ),new hrefList("slide0217.htm",1,-1,1),new hrefList("slide0035.htm",1,-1,1)= ,new hrefList("slide0226.htm",1,-1,1)); function FullScrInit() { g_allowAdvOnClick =3D GetCurSld().mAdvOnClk document.body.style.backgroundColor=3D"black" document.oncontextmenu=3Dparent._CM; document.onkeydown =3D _KDH; document.ondragstart=3DCancel document.onselectstart=3DCancel self.focus() } function Redirect( frmId ) { var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId() if(idx>=3D0) str=3Dstr.substr(1); if( window.name !=3D frmId && ( sId !=3D str) ) { obj =3D GetObj("Main-File") window.location.href=3Dobj.href+"#"+sId return 1 } return 0 } var MHTMLPrefix =3D CalculateMHTMLPrefix(); function CalculateMHTMLPrefix() { if ( document.location.protocol =3D=3D 'mhtml:') { href=3Dnew String(document.location.href) Start=3Dhref.indexOf('!')+1 End=3Dhref.lastIndexOf('/')+1 if (End < Start) return href.substring(0, Start) else return href.substring(0, End) } return ''; } function GetTags(base,tag) { if(g_supportsPPTHTML) return base.all.tags(tag); else return base.getElementsByTagName(tag); } function UpdNtsPane(){ if(frames["PPTNts"]) PPTNts.location.replace( MHTMLP= refix+GetHrefObj( gCurSld ).mNtsHref ) } function UpdNavPane( sldIndex ){ if(gNavLoaded) PPTNav.UpdNav() } function UpdOtNavPane(){ if(gOtlNavLoaded) PPTOtlNav.UpdOtlNav() } function UpdOtlPane(){ if(gOtlLoaded) PPTOtl.UpdOtl() } function SetHasNts( fVal ) { if( gHasNts !=3D fVal ) { gHasNts=3DfVal UpdNavPane() } } function ToggleOtlText() { gOtlTxtExp=3D!gOtlTxtExp UpdOtlPane() } function ClearMedia() { if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0; } function FullScreen() { if ( PPTSld.g_animUseRuntime ) PPTSld.document.body.pause(); ClearMedia(); var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else return gCurSld } function GetNumSlds() { if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; PPTSld.location.replace(MHTMLPrefix+obj.mSldHref) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 PPTSld.location.replace(MHTMLPrefix+href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('


' + ENDSHOW_MESG + '

') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); function ImgBtn( oId,bId,w,action ) { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } function TxtBtn( oId,oeId,action,chkState ) { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() { b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() { b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState var sNext=3D"Další",sPrev=3D"Předchozí",sEnd=3D"Kon= ec prezentace",sFont=3D"Arial",sArrow=3D"Šipka",sFreeform=3D"Voln&yacu= te; tvar",sRect=3D"Obdélník",sOval=3D"Ovál" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() } function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();= PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() } function M_True() { return true } function M_End() { window.close( self ) } function CreateMenuItem( node,text,action,eval ) { var e=3DCreateItem( node ) e.type=3D"menuitem" e.Action=3Daction e.IsActive=3Deval e.innerHTML=3Dtext if( !e.IsActive() ) e.style.color=3D"threedshadow" e.onclick=3DPerform e.onmouseover=3DHighlight e.onmouseout=3DDeselect s=3De.style; s.fontFamily=3DsFont s.fontSize=3D"9pt" s.paddingLeft=3D2 } function CreateSeparator( node ) { var sObj=3DCreateItem( node ) SetCMBorder(sObj,"menu","menu") var s=3DsObj.style s.borderTopColor=3D"threedshadow" s.borderBottomColor=3D"threedhighlight" s.height=3D1 s.fontSize=3D"0px" } function CreateItem( node ) { var elem=3DPPTSld.document.createElement("DIV") node.insertBefore( elem ) return elem } function SetCMBorder( o,ltClr,rbClr ) { var s=3Do.style s.backgroundColor=3D"menu" s.borderStyle=3D"solid" s.borderWidth=3D1 s.borderColor=3DltClr+" "+rbClr+" "+rbClr+" "+ltClr } ------=_NextPart_01C87D62.2A8C8BA0 Content-Location: file:///C:/B13459F0/slp_soubory/fullscreen.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; 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charset="us-ascii" Preanalytická fáze laboratorního vyšetření ------=_NextPart_01C87D62.2A8C8BA0 Content-Location: file:///C:/B13459F0/slp_soubory/outline.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"
 Po= známky
Prezentac= e
Osnova
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