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.

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.

Biopsychosocial Patterning of Multimorbidity and Its Consequences

2018 ◽  
pp. 220-236
Author(s):  
Elliot Friedman ◽  
Beth LeBreton ◽  
Lindsay Fuzzell ◽  
Elizabeth Wehrpsann
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Outcomes ◽  
The United States ◽  
Chronic Medical Conditions ◽  
Quality Of Life Research ◽  
Increased Risk ◽  
Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

Compassion

2021 ◽  
pp. 121-137
Author(s):  
Sandro Galea
Keyword(s):  
United States ◽  
The United States ◽  
Poor Health ◽  
Health Conditions ◽  
Common Humanity ◽  
True Nature ◽  
The Public ◽  
Disadvantaged Groups

This chapter evaluates the central role of compassion in preventing the contagion next time. During COVID-19, compassion revealed just how many people in the United States are deeply vulnerable to poor health. This vulnerability was often a product of underlying health conditions. There are many health challenges in the United States which annually generate a level of mortality comparable to that of COVID-19, challenges like obesity and addiction. However, America have not addressed these challenges with anywhere near the level of urgency they brought to bear in addressing COVID-19. A key reason why is, arguably, because these challenges are not infectious, making it possible for the public at large to escape the visceral feeling of vulnerability to a disease which transmits through the air and can strike anybody. Instead, they see these challenges somehow as niche issues, the niche being the lives of the marginalized and disadvantaged groups. This outlook allows them to evade the feeling of common humanity which gives rise to compassion. Compassion, then, depends on the understanding of the true nature of health and of the shared vulnerability to disease.

scholarly journals Virulence of Marburg Virus Angola Compared to Mt. Elgon (Musoke) in Macaques: A Pooled Survival Analysis

Viruses ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 658 ◽  
Author(s):  
Paul Blair ◽  
Maryam Keshtkar-Jahromi ◽  
Kevin Psoter ◽  
Ronald Reisler ◽  
Travis Warren ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Clinical Laboratory ◽  
Cynomolgus Macaque ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Marburg Virus ◽  
Time To Death ◽  
Risk Of Death ◽  
Published Evidence ◽  
Increased Risk

Angola variant (MARV/Ang) has replaced Mt. Elgon variant Musoke isolate (MARV/MtE-Mus) as the consensus standard variant for Marburg virus research and is regarded as causing a more aggressive phenotype of disease in animal models; however, there is a dearth of published evidence supporting the higher virulence of MARV/Ang. In this retrospective study, we used data pooled from eight separate studies in nonhuman primates experimentally exposed with either 1000 pfu intramuscular (IM) MARV/Ang or MARV/MtE-Mus between 2012 and 2017 at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID). Multivariable Cox proportional hazards regression was used to evaluate the association of variant type with time to death, the development of anorexia, rash, viremia, and 10 select clinical laboratory values. A total of 47 cynomolgus monkeys were included, of which 18 were exposed to MARV/Ang in three separate studies and 29 to MARV/MtE-Mus in five studies. Following universally fatal Marburg virus exposure, compared to MARV/MtE-Mus, MARV/Ang was associated with an increased risk of death (HR = 22.10; 95% CI: 7.08, 68.93), rash (HR = 5.87; 95% CI: 2.76, 12.51) and loss of appetite (HR = 35.10; 95% CI: 7.60, 162.18). Our data demonstrate an increased virulence of MARV/Ang compared to MARV/MtE-Mus variant in the 1000 pfu IM cynomolgus macaque model.

The rise of electronic nicotine delivery systems and the emergence of electronic-cigarette-driven disease

2020 ◽  
Vol 319 (4) ◽  
pp. L585-L595 ◽  
Author(s):  
Kielan Darcy McAlinden ◽  
Mathew Suji Eapen ◽  
Wenying Lu ◽  
Pawan Sharma ◽  
Sukhwinder Singh Sohal
Keyword(s):  
United States ◽  
Cigarette Smoking ◽  
Electronic Cigarettes ◽  
Scientific Evidence ◽  
The United States ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Cellular Processes ◽  
Increased Risk

In 2019, the United States experienced the emergence of the vaping-associated lung injury (VALI) epidemic. Vaping is now known to result in the development and progression of severe lung disease in the young and healthy. Lack of regulation on electronic cigarettes in the United States has resulted in over 2,000 patients and 68 deaths. We examine the clinical representation of VALI and the delve into the scientific evidence of how deadly exposure to electronic cigarettes can be. E-cigarette vapor is shown to affect numerous cellular processes, cellular metabolism, and cause DNA damage (which has implications for cancer). E-cigarette use is associated with a higher risk of developing crippling lung conditions such as chronic obstructive pulmonary disease (COPD), which would develop several years from now, increasing the already existent smoking-related burden. The role of vaping and virus susceptibility is yet to be determined; however, vaping can increase the virulence and inflammatory potential of several lung pathogens and is also linked to an increased risk of pneumonia. As it has emerged for cigarette smoking, great caution should also be given to vaping in relation to SARS-CoV-2 infection and the COVID-19 pandemic. Sadly, e-cigarettes are continually promoted and perceived as a safer alternative to cigarette smoking. E-cigarettes and their modifiable nature are harmful, as the lungs are not designed for the chronic inhalation of e-cigarette vapor. It is of interest that e-cigarettes have been shown to be of no help with smoking cessation. A true danger lies in vaping, which, if ignored, will lead to disastrous future costs.

scholarly journals Challenges of Laboratory Medicine: European Answers

2011 ◽  
Vol 30 (4) ◽  
pp. 273-278 ◽  
Author(s):  
Irena Korita ◽  
Victor Blaton
Keyword(s):  
Strategic Alliances ◽  
Business Models ◽  
Clinical Laboratory ◽  
Clinical Chemistry ◽  
Laboratory Medicine ◽  
Biomedical Sciences ◽  
Clinical Laboratories ◽  
Laboratory Services ◽  
Enhance Efficiency

Challenges of Laboratory Medicine: European Answers Medical laboratories play a vital role in modern healthcare, and qualified specialists in Clinical Chemistry and Laboratory Medicine are essential for the provision of high-quality preanalytical, analytical and consultative services. Laboratory medicine has undergone major transformations during the last decade. Ongoing technological developments have considerably improved the productivity of clinical laboratories. Information on laboratory services is globally available, and clinical laboratories worldwide face international competition and there is a huge pressure to reduce costs. To be prepared for the future, clinical laboratories should enhance efficiency and reduce the cost increases by forming alliances and networks, consolidating, integrating or outsourcing, and more importantly create additional value by providing knowledge services related to in vitro diagnostics. Therefore, business models that increase efficiency such as horizontal and vertical integration are proposed, based on collaborative networks for the delivery of clinical laboratory services. Laboratories should cooperate, consolidate and form strategic alliances to enhance efficiency and reduce costs. There is a growing conflict between the science and the art of clinical practice and on the role of the biomedical sciences in medical practice. We have a dehumanizing effect on medical care. Disease is defined at the level of sick molecules and cells and curative medicine is being replaced by the preventive care of the disease. Undoubtedly all those questions will raise considerable problems and challenges for the medical educators.

Role of laboratory medicine in collaborative healthcare

2018 ◽  
Vol 0 (0) ◽  
Author(s):  
Ian D. Watson ◽  
Patricia Wilkie ◽  
Amir Hannan ◽  
Graham H. Beastall
Keyword(s):  
Clinical Laboratory ◽  
Point Of Care ◽  
Healthcare Delivery ◽  
Continuing Professional Development ◽  
Laboratory Medicine ◽  
Sources Of Information ◽  
Patient Centered ◽  
Laboratory Service ◽  
Laboratory Services ◽  
Centered Care

Abstract Healthcare delivery and responsibility is changing. Patient-centered care is gaining international acceptance with the patient taking greater responsibility for his/her health and sharing decision making for the diagnosis and management of illness. Laboratory medicine must embrace this change and work in a tripartite collaboration with patients and with the clinicians who use clinical laboratory services. Improved communication is the key to participation, including the provision of educational information and support. Knowledge management should be targeted to each stakeholder group. As part of collaborative healthcare clinical laboratory service provision needs to be more flexible and available, with implications for managers who oversee the structure and governance of the service. Increased use of managed point of care testing will be essential. The curriculum content of laboratory medicine training programs will require trainees to undertake practice-based learning that facilitates interaction with patients, clinicians and managers. Continuing professional development for specialists in laboratory medicine should also embrace new sources of information and opportunities for collaborative healthcare.

Gout prevalence in the Hmong: a prime example of health disparity and the role of community-based genetic research

2021 ◽  
Author(s):  
Youssef M Roman ◽  
Kajua Lor ◽  
Txia Xiong ◽  
Kathleen Culhane-Pera ◽  
Robert J Straka
Keyword(s):  
Health Disparity ◽  
Genetic Research ◽  
The United States ◽  
Health Conditions ◽  
Community Based ◽  
Traditional Medicines ◽  
Increased Risk ◽  
Genomic Studies ◽  
History Of

Individuals of distinct Asian backgrounds are commonly aggregated as Asian, which could mask the differences in the etiology and prevalence of health conditions in the different Asian subgroups. The Hmong are a growing Asian subgroup in the United States with a higher prevalence of gout and gout-related comorbidities than non-Hmong. Genetic explorations in the Hmong suggest a higher prevalence of genetic polymorphisms associated with an increased risk of hyperuricemia and gout. History of immigration, acculturation, lifestyle factors, including dietary and social behavioral patterns, and the use of traditional medicines in the Hmong community may also increase the risk of developing gout and lead to poor gout management outcomes. Engaging minorities such as the Hmong population in biomedical research is a needed step to reduce the burden of health disparities within their respective communities, increase diversity in genomic studies, and accelerate the adoption of precision medicine to clinical practice.

Implications of the Opioid Crisis for the American Disability Community

2020 ◽  
Vol 34 (4) ◽  
pp. 265-274
Author(s):  
Mykal J. Leslie ◽  
Kathleen Sheppard-Jones ◽  
Malachy L. Bishop
Keyword(s):  
United States ◽  
Rehabilitation Counseling ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Research Education ◽  
Opioid Crisis ◽  
Increased Risk ◽  
The Relationship

PurposeThe profession of rehabilitation counseling has long been responsive to emerging disabilities. To date, however, the profession's attention and response to the ongoing opioid crisis in the United States has been incommensurate with the scope and detriment of opioids and opioid use disorder (OUD) on Americans with disabilities. The opioid crisis, including the overuse, abuse, and overdose rates associated with prescription and illegal opioids, affects people of all ages and backgrounds. However, people with disabilities are at increased risk for developing OUDs, and they experience greater barriers to OUD treatment than people without disabilities.MethodThis article describes the origins and development of this crisis, the relationship between disability and increased risk for OUD, and the barriers to treatment that exist. We then evaluate the role of rehabilitation counseling, including the need for further action in advocacy, research, education, and policy.Results and ConclusionsThroughout this article, we encourage a more urgent and concerted response than seems to be the case presently.

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