Analysis on the Development Dilemma and Opportunity of Independent Clinical Laboratory Based on PEST-SWOT

Objective To study the current status of independent clinical laboratory(ICL)in China to offer some suggestions for further development of the industry because independent clinical testing is gradually occupying an important position in the medical market with the change of medical service mode.Methods The PEST-SWOT matrix model was constructed to sort out the strength and weakness,opportunities and threats of ICL and medical institutions.Results and Conclusion ICLs should enhance their social recognition by improving testing technology and industry operating standards.At the same time,it is also necessary to enhance their position in the clinical diagnosis industry and promote diversified competition in the field of clinical diagnosis so as to better help the development of national grading diagnosis and precision medicine.From the perspectives of SO,ST,WO,and WT,the development strategies of ICL are proposed,including personalized clinical diagnosis services and the construction of a database,and the family doctor system with community+ICL services.The remote diagnostic services should be implemented to help national graded diagnosis and treatment,and different operation schemes should be made to conform to market development.Besides,the access standards for ICL must be strictly required.Then,differentiated operations of enterprises should be valued for establishing industry brands and social awareness.Lastly,enterprises must focus on talents construction and management.

Phenobarbital Use as Adjunct to Benzodiazepines in the Treatment of Severe Alcohol Withdrawal Syndrome

Severe AWS （alcohol withdrawal syndrome） and AWD （alcohol withdrawal associated delirium） are common indications for intensive care unit admissions. Approximately 25% of patients with severe alcohol withdrawal require prolonged critical care hospital courses, often complicated by respiratory failure, need for mechanical ventilation due to administration of sedative continuous infusions and development of nosocomial infections. Although benzodiazepines are the mainstay of therapy for alcohol withdrawal, some patients exhibit benzodiazepine-refractory alcohol withdrawal. The use of phenobarbital as adjunct to benzodiazepines has been shown in studies to be effective in enhancing therapeutic responsiveness to benzodiazepines and reducing the need for mechanical ventilation. The objective of this study is to evaluate whether severe alcohol withdrawal treatment based on combining symptom-triggered benzodiazepine therapy with adjunctive phenobarbital will result in decreased mechanical ventilation rates, decreased use of continuous sedative infusions, decreased time to withdrawal symptom resolution and decreased length of stay in the intensive care unit. Chart reviews were utilized to determine total amount of benzodiazepine and phenobarbital use, need for mechanical ventilation, requirement of continuous lorazepam, dexmedetomidine or propofol infusions, average intensive care unit length of stay and incidence of adverse effects.