The role of the physician in laboratory medicine: a European perspective

2012 ◽  
Vol 66 (5) ◽  
pp. 432-437 ◽  
Author(s):  
Siraj A Misbah ◽  
Vana Kokkinou ◽  
Katie Jeffery ◽  
Wytze Oosterhuis ◽  
Brian Shine ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Laboratory Medicine ◽  
Vital Role ◽  
Added Value ◽  
Medical Laboratory ◽  
Diagnostic Laboratory ◽  
Laboratory Services ◽  
Science Laboratories ◽  
Laboratory Technology

Advances in medical laboratory technology have driven major changes in the practice of laboratory medicine over the past two decades by the development of automated, cross-disciplinary single platform analysers. This has led to the blurring of boundaries between traditional disciplines and the emergence of core automated or blood science laboratories. This paper was commissioned by the Union of European Medical Specialists to examine the changing role of laboratory-based physicians in the light of these advances by focusing on the added value of expert interpretation of test results and resultant improvements in clinical outcomes. The paper also considers the broad range of responsibilities of laboratory-based physicians and the difficulties in precisely measuring how this translates into improved clinical outcomes. Given its provenance, the paper concentrates predominantly on the role of laboratory-based physicians while acknowledging the essential and vital role of scientists in running diagnostic laboratory services.

Quality and future of clinical laboratories: the Vico’s whole cyclical theory of the recurring cycles

2018 ◽  
Vol 56 (6) ◽  
pp. 901-908 ◽  
Author(s):  
Mario Plebani
Keyword(s):  
Clinical Laboratory ◽  
The United States ◽  
Laboratory Medicine ◽  
True Nature ◽  
Laboratory Services ◽  
Increased Risk ◽  
Analytical Work ◽  
Laboratory Technology ◽  
Test Request

AbstractIn the last few decades, laboratory medicine has undergone monumental changes, and laboratory technology, which has made enormous advances, now has new clinical applications thanks to the identification of a growing number of biomarkers and risk factors conducive to the promotion of predictive and preventive interventions that have enhanced the role of laboratory medicine in health care delivering. However, the paradigm shift in the past 50 years has led to a gap between laboratory and clinic, with an increased risk of inappropriateness in test request and interpretation, as well as the consolidation of analytical work in focused factories and megastructurers oriented only toward achieving greater volumes, decreasing cost per test and generating a vision of laboratory services as simple commodities. A careful historical revision of the changing models for delivering laboratory services in the United States leads to the prediction that there are several reasons for counteracting the vision of clinical laboratory as a commodity, and restoring the true nature of laboratory services as an integral part of the diagnosis and therapy process. The present study, which reports on internal and external drivers for change, proposes an integrated vision of quality in laboratory medicine.

Laboratory medicine in the new healthcare environment

2016 ◽  
Vol 54 (4) ◽  
Author(s):  
Simona Ferraro ◽  
Federica Braga ◽  
Mauro Panteghini
Keyword(s):  
Healthcare Delivery ◽  
Laboratory Medicine ◽  
Added Value ◽  
Optimal Care ◽  
Clinical Leadership ◽  
Healthcare Environment ◽  
Medical Discipline ◽  
Laboratory Results ◽  
Medical Disciplines

AbstractThe 21st century challenge is to redesign healthcare systems to be safe, efficient, effective, timely, equitable and patient-centred. Although laboratory medicine is integral to many of these objectives involving prevention, diagnosis, treatment, and managing disease of patients, it suffers from poor visibility as a medical discipline and as a profession and fewer rewards for educational efforts when compared to other medical disciplines. Laboratory scientists are often perceived as managing machinery and equipment, but conversely they need to take a position of shared clinical leadership, showing the role of laboratory tests to guarantee optimal care for patients. This is however challenging because of some reluctance by laboratory professionals to involve themselves in test structuring and requesting and in the inspection of work as it arrives because it is assumed that all requests are clinically necessary; there is a poor communication and integration between clinical wards and laboratory; and, importantly, there is the need for an excellent cultural and scientific background of laboratory professionals for implementing outcome research and to act as knowledge managers and skilled clinical consultants. By combining the unique talent of performing quality laboratory assays with knowledge of the pathophysiologic rationale behind the tests, laboratory professionals have the expertise to advise their clinical colleagues in regard to the appropriate test selection and interpretation of laboratory results, thereby creating opportunities to define the added value and the pivotal role of laboratory medicine on healthcare delivery.

scholarly journals The Study of The Type Laboratory Examination in Health Service Facilities With Integration Determination of Local Content Courses DIII-Health Analys

2019 ◽  
Vol 1 (2) ◽  
pp. 77-80
Author(s):  
Kuntjoro Adi Purjanto ◽  
S.Y Didik Widiyanto ◽  
Teguh Budiharjo
Keyword(s):  
Core Curriculum ◽  
Clinical Chemistry ◽  
Medical Laboratory ◽  
Main Task ◽  
Chemical Test ◽  
Face To Face ◽  
Local Content ◽  
Laboratory Services ◽  
Immunological Examination ◽  
Laboratory Technology

Introduction: Health Laboratory Services is an integral part of healthcare services to the public. The main task of health analyst conducts healthcare laboratory services. In order to produce health analyst personnel who meet the needs of graduates or stake holders, the education will apply the curriculum for the learning process. Diploma in Education 3 students must take at least 108 credits (semester credit unit). Meanwhile, the education core Curriculum 3 medical laboratory technology defined by 82 credits. In order to fulfill the credits set need to be arranged local content to meet the shortage of credits from the core curriculum that is suitable for learning access. Purpose: Obtain the amount of data on the number of laboratory tests and local subjects. Method: Secondary Data from the recording and reporting of each laboratory for 3 months. Results: A total of 48.04% clinical chemical test types. A total of 18.87% hematological examination. A total of 1.88% of parasitological and microbiological examination. A total of 19.54% of immunological examination. The curriculum that is used by the Poltekkes Department of Health analyst Semarang 108 SKS with 82 SKS core curriculum and 26 SKS local payload. The subject or number of face-to-face is based on the data proportion of three large groups of tests, namely clinical chemistry (48.04%). Immunological examination (19.54%) and hematological examination (18.87%). Conclusion: The most proportion of tests on fasyankes are clinical chemistry (48.04%). Courses "Knowledge of materials practice" could be added to the curriculum of the D3 of the Poltekkes health analyst Program in Semarang. Suggestion: Need to calculate the credits and proportion of face to face or depth to the local content course "knowledge of practice materials" and placement in the semester.

scholarly journals Diagnostics 4.0: the medical laboratory in digital health

2018 ◽  
Vol 0 (0) ◽  
Author(s):  
Michael Neumaier
Keyword(s):  
Health Care ◽  
Clinical Decision Making ◽  
Digital Health ◽  
Preventive Health Care ◽  
Clinical Decision ◽  
Laboratory Medicine ◽  
Cloud Services ◽  
Added Value ◽  
Medical Laboratory ◽  
The Way

AbstractDuring recent years, the digital revolution has changed the face of societies including industrial production, economies and peoples’ social lives. From these changes we may extrapolate the developments that digitization of health care will bring to medicine in general and laboratory medicine in particular. Disruptive technologies will fundamentally change the way laboratory tests are going to be ordered, carried out and interpreted in the future, and test results from various sources need to be curated to be of added value for the patient’s condition. Wearables and implantables will quantify the concentrations for an unknown number of laboratory parameters, and the data will be stored in cloud services at the fingertips of the patient as the sovereign of his/her health care data. A 24/7 online availability of health services will strengthen predictive medicine and may enable a vastly improved preventive health care that is supported by deep-learning algorithms for clinical decision-making not only on behalf of the physician, but also the empowered patient (e.g. health bots). This will likely shift the current role of Laboratory Medicine as a central provider of diagnostic information from a “hidden champion” towards a higher visibility redefining the patient-physician-laboratory relationship. For example, accessing digital health data will allow Laboratory Medicine to more efficiently contribute to the medical dialog than is often the case today. From this perspective, this will require major readjustments in the way we execute our profession, and it will also need new concepts of education and continuous professional development.

scholarly journals Emergency Biochemistry Services—Are They Abused?

1982 ◽  
Vol 19 (5) ◽  
pp. 325-328 ◽  
Author(s):  
A D Stuart Smith ◽  
Alan Shenkin ◽  
Frances J Dryburgh ◽  
H Gemmel Morgan
Keyword(s):  
Emergency Service ◽  
Medical Laboratory ◽  
Royal Infirmary ◽  
Concomitant Increase ◽  
Out Of Hours ◽  
Medical Practitioners ◽  
Laboratory Services ◽  
Industrial Dispute ◽  
Clinical Biochemist

An out-of-hours emergency biochemistry service, which allows access by all medical practitioners of varying experience within a hospital, can lead to overuse or even abuse of limited and costly facilities. When the workload increases, problems of staffing a voluntary (but paid) working rota may emerge. An industrial dispute involving medical laboratory scientific officers (MLSOs) caused the role of the emergency service to be examined and alternative regulating mechanisms to be tested. Experience at Glasgow Royal Infirmary between 1974 and 1981 has been reviewed. From 1977 to 1979, when clinicians (usually junior) arranged analyses directly with the MLSOs, test numbers increased by about 26% per annum. This was not associated with any concomitant increase in the range of analyses offered. During a five-week period in 1980, consultant clinicians had to contact a consultant clinical biochemist to arrange all emergency analyses, and test numbers were reduced to 13% of the previous levels. Subsequently, all requests for emergency analyses were made by clinicians to laboratory medical staff, and test numbers fell to approximately 60% of 1979 levels. This requesting system is now firmly established. Continued vigilance is required to maintain the reduced level of requesting, but too great a limitation on emergency requests may cause less efficient patient management. Senior clinical staff should be encouraged to take greater responsibility for the use of emergency laboratory services.

scholarly journals Medical laboratory technology in the Republic of South Africa : beyond 2000

1994 ◽  
Author(s):  
◽  
Carolyn Margaret Winchester
Keyword(s):  
South Africa ◽  
Medical Technology ◽  
Clinical Pathology ◽  
Medical Laboratory ◽  
Medical Technologist ◽  
Medical Technologists ◽  
The Republic ◽  
Laboratory Technology ◽  
Year 2000

The arena with the for medical technologists result that educational is continually changing directive must change accordingly. A number of big issues have changed the role of the medical technologist. Cognisance of the identified issues is essential if the profession is to survive the year 2000. The future directions of medical technology ar~ analysed in this disseration in order to identify the knowledge and skills that the professional medical technologist will require for the 21st century. The factors which have up to now introduced dramatic changes in clinical pathology laboratories will also present certain opoortunities for laboratory professionals but taking cognisance of the necessity for change and professional ability. This study was thus conducted to explore the educational requirements necessary for the professional future of medical Africa. laboratory technologists in the Republic of South !'.C.,' . A t~eoretical sub-structure lays the foundation for the study. The literature review in Chapter 2 outlines medical technology eduction both in the Republic of South Africa and in certain other countries. The necessity for change in the education of medical laboratory technologists is addressed here. Chapter 3 examines the factors (gleaned from the literature) which are producing a need for such dramatic change for the century ahead. It also examines the role of the technikons and the roles of the technikons with regard to the training of medical technologists and the influence of academic drift. The methodology in Chapter 4 explains the structuring and administration of a questionnaire used to capture data from registered medical laboratory technologists in the Republic of South Africa. The processed data results are discussed in Chapter 5. Tables are presented at the conclusion of certain groups of major issues. Chapter 6 concludes with the findings

scholarly journals Lab Wisely in Canada: Enhancing and highlighting the role of all clinical laboratory professionals in reducing harm and waste

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S117-S117
Author(s):  
A VanSpronsen ◽  
C Nielsen ◽  
B Djukic ◽  
V Villatoro
Keyword(s):  
Laboratory Testing ◽  
Clinical Laboratory ◽  
Significant Proportion ◽  
Choosing Wisely ◽  
Medical Laboratory ◽  
Medical Overuse ◽  
Specimen Collection ◽  
Laboratory Services ◽  
Inappropriate Utilization

Abstract Introduction/Objective Stewardship initiatives are a key strategy for addressing inappropriate utilization of clinical laboratory resources. These approaches require engagement of multiple types of stakeholders. Some professional groups are historically underrepresented, such as those who perform specimen collection, testing, and quality processes. A specific campaign is needed to engage these groups and highlight their expertise. Methods/Case Report We surveyed Medical Laboratory Technologists and Medical Laboratory Assistants to understand the barriers they face to participating in laboratory stewardship initiatives. These survey findings helped shape tools and resources that we created for new campaign called Lab Wisely. We also identified that one-third of existing Choosing Wisely Canada recommendations relate to laboratory testing. We categorized and tagged each recommendation to create a publicly-available searchable database which was placed on the campaign website (LabWisely.ca). Results (if a Case Study enter NA) NA Conclusion Laboratory testing is featured in a significant proportion of all Choosing Wisely Canada recommendations, supporting the idea that the clinical laboratory should be heavily involved in reducing medical overuse in healthcare. In our survey, we found that laboratory professionals face time and workload constraints, but feel a professional responsibility for ensuring appropriate resource use by all users. There was also a lack of ‘know- how’ around tangible ways to become involved. The Lab Wisely website has become a one-stop-shop for highlighting the role of technical and scientific professionals in laboratory stewardship and providing concrete tools that can be used to develop capacity in these groups. Every level of staff can and should be involved in improving the utilization of clinical laboratory services.

System-related and cognitive errors in laboratory medicine

Diagnosis ◽  
2018 ◽  
Vol 5 (4) ◽  
pp. 191-196 ◽  
Author(s):  
Mario Plebani
Keyword(s):  
Improve Patient Safety ◽  
Quality Care ◽  
Diagnostic Errors ◽  
Educational Interventions ◽  
Laboratory Medicine ◽  
Cognitive Errors ◽  
Organizational Issues ◽  
Laboratory Services ◽  
Remediation Strategies

Abstract Current efforts focusing on better defining the prevalence of diagnostic errors, their causes and remediation strategies should address the role of laboratory testing and its contribution to high-quality care as well as a possible source of diagnostic errors. Data collected in the last few years highlight the vulnerability of extra-analytical phases of the testing cycle and the need for programs aiming to improve all steps of the process. Further studies have clarified the nature of laboratory-related errors, namely the evidence that both system-related and cognitive factors account for most errors in laboratory medicine. Technology developments are effective in decreasing the rates of system-related errors but organizational issues play a fundamental role in assuring a real improvement in quality and safety in laboratory processes. Educational interventions as well as technology-based interventions have been proposed to reduce the risk of cognitive errors. However, to reduce diagnostic errors and improve patient safety, clinical laboratories have to embark on a paradigmatic shift restoring the nature of laboratory services as an integral part of the diagnostic and therapy process.

scholarly journals Comparison of regression for blood ALP levels using methods of the Japan Society of Clinical Chemistry and the International Federation of Clinical Chemistry and Laboratory Medicine in bovine, canine, feline, and human testing

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253396
Author(s):  
Akihisa Hata ◽  
Noboru Fujitani ◽  
Masahiro Takeshita ◽  
Chie Tanaka ◽  
Noriko Matsuda ◽  
...  
Keyword(s):  
Veterinary Medicine ◽  
Clinical Laboratory ◽  
Clinical Chemistry ◽  
Animal Health ◽  
Laboratory Medicine ◽  
International Federation ◽  
Medical Laboratory ◽  
Japan Society ◽  
Medical Laboratories ◽  
Laboratory Technology

Livestock and companion animal health have a direct impact on human health. Research on clinical laboratory technology for veterinary medicine is as important as that on human laboratory technology. Reagents and analysis equipment for human medical laboratory tests are often used in veterinary medicine. Medical laboratories in Japan utilize the Japan Society of Clinical Chemistry (JSCC) method for blood alkaline phosphatase (ALP) analysis. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) method is used worldwide for ALP catalytic concentration measurement. When the IFCC method is used, human blood ALP activity is approximately one-third of the JSCC method’s activity. The JSCC method for ALP measurement was switched to the IFCC method in medical laboratories in Japan in April 2020 for global standardization purpose. It is uncertain whether conventional JSCC method reagents will continue to be supplied. In veterinary medicine, the relationship between the JSCC and IFCC methods in terms of ALP measurement is almost unclear. This study investigated the regression between JSCC and IFCC methods measuring ALP in bovine, canine, feline, and human. The regression formulas for bovine, canine, feline, and human ALP values using the conventional JSCC (x) and IFCC (y) methods are y = 0.379x + 0.124, y = 0.289x + 8.291, y = 0.358x + 0.432, and y = 0.337x + 2.959, respectively. These results suggested that the IFCC method measurement could be estimated by approximately one-third of the JSCC method measurement in animal species such as bovine, canine, and feline. By applying the conversion factors proposed in this study, a very good correlation could be obtained between the two methods for each animal.

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