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Cadamuro J. Disruption vs. evolution in laboratory medicine. Current challenges and possible strategies, making laboratories and the laboratory specialist profession fit for the future. Clin Chem Lab Med 2023; 61:558-566. [PMID: 36038391 DOI: 10.1515/cclm-2022-0620] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/01/2022] [Indexed: 01/06/2023]
Abstract
Since beginning of medical diagnostics, laboratory specialists have done an amazing job, continuously improving quality, spectrum and speed of laboratory tests, currently contributing to the majority of medical decision making. These improvements are mostly of an incremental evolutionary fashion, meaning improvements of current processes. Sometimes these evolutionary innovations are of a radical fashion, such as the invention of automated analyzers replacing manual testing or the implementation of mass spectrometry, leading to one big performance leap instead of several small ones. In few cases innovations may be of disruptive nature. In laboratory medicine this would be applicable to digitalization of medicine or the decoding of the human genetic material. Currently, laboratory medicine is again facing disruptive innovations or technologies, which need to be adapted to as soon as possible. One of the major disruptive technologies is the increasing availability and medical use of artificial intelligence. It is necessary to rethink the position of the laboratory specialist within healthcare settings and the added value he or she can provide to patient care. The future of the laboratory specialist profession is bright, as it the only medical profession comprising such vast experience in patient diagnostics. However, laboratory specialists need to develop strategies to provide this expertise, by adopting to the quickly evolving technologies and demands. This opinion paper summarizes some of the disruptive technologies as well as strategies to secure and/or improve the quality of diagnostic patient care and the laboratory specialist profession.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
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Carobene A, Cabitza F, Bernardini S, Gopalan R, Lennerz JK, Weir C, Cadamuro J. Where is laboratory medicine headed in the next decade? Partnership model for efficient integration and adoption of artificial intelligence into medical laboratories. Clin Chem Lab Med 2023; 61:535-543. [PMID: 36327445 DOI: 10.1515/cclm-2022-1030] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The field of artificial intelligence (AI) has grown in the past 10 years. Despite the crucial role of laboratory diagnostics in clinical decision-making, we found that the majority of AI studies focus on surgery, radiology, and oncology, and there is little attention given to AI integration into laboratory medicine. METHODS We dedicated a session at the 3rd annual European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) strategic conference in 2022 to the topic of AI in the laboratory of the future. The speakers collaborated on generating a concise summary of the content that is presented in this paper. RESULTS The five key messages are (1) Laboratory specialists and technicians will continue to improve the analytical portfolio, diagnostic quality and laboratory turnaround times; (2) The modularized nature of laboratory processes is amenable to AI solutions; (3) Laboratory sub-specialization continues and from test selection to interpretation, tasks increase in complexity; (4) Expertise in AI implementation and partnerships with industry will emerge as a professional competency and require novel educational strategies for broad implementation; and (5) regulatory frameworks and guidances have to be adopted to new computational paradigms. CONCLUSIONS In summary, the speakers opine that the ability to convert the value-proposition of AI in the laboratory will rely heavily on hands-on expertise and well designed quality improvement initiative from within laboratory for improved patient care.
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Affiliation(s)
- Anna Carobene
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Cabitza
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy.,DISCo, Università Degli Studi di Milano-Bicocca, Milan, Italy
| | - Sergio Bernardini
- Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy.,Department of Experimental Medicine, University of Tor Vergata, Rome, Italy
| | - Raj Gopalan
- Siemens Healthcare Diagnostics, Siemens Healthineers, Malvern, PA, USA
| | - Jochen K Lennerz
- Department of Pathology, Center for Integrated Diagnostics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
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Cadamuro J, Simundic AM. The preanalytical phase – from an instrument-centred to a patient-centred laboratory medicine. Clin Chem Lab Med 2022; 61:732-740. [PMID: 36330758 DOI: 10.1515/cclm-2022-1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Abstract
In order to guarantee patient safety, medical laboratories around the world strive to provide highest quality in the shortest amount of time. A major leap in quality improvement was achieved by aiming to avoid preanalytical errors within the total testing process. Although these errors were first described in the 1970s, it took additional years/decades for large-scale efforts, aiming to improve preanalytical quality by standardisation and/or harmonisation. Initially these initiatives were mostly on the local or national level. Aiming to fill this void, in 2011 the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group “Preanalytical Phase” (WG-PRE) was founded. In the 11 years of its existence this group was able to provide several recommendations on various preanalytical topics. One major achievement of the WG-PRE was the development of an European consensus guideline on venous blood collection. In recent years the definition of the preanalytical phase has been extended, including laboratory test selection, thereby opening a huge field for improvement, by implementing strategies to overcome misuse of laboratory testing, ideally with the support of artificial intelligence models. In this narrative review, we discuss important aspects and milestones in the endeavour of preanalytical process improvement, which would not have been possible without the support of the Clinical Chemistry and Laboratory Medicine (CCLM) journal, which was one of the first scientific journals recognising the importance of the preanalytical phase and its impact on laboratory testing quality and ultimately patient safety.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine , Paracelsus Medical University Salzburg , Salzburg , Austria
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics , University Hospital “Sveti Duh”, University of Zagreb, Faculty of Pharmacy and Biochemistry , Zagreb , Croatia
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Mrazek C, Haschke-Becher E, Felder TK, Keppel MH, Oberkofler H, Cadamuro J. Laboratory Demand Management Strategies-An Overview. Diagnostics (Basel) 2021; 11:1141. [PMID: 34201549 PMCID: PMC8305334 DOI: 10.3390/diagnostics11071141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 01/07/2023] Open
Abstract
Inappropriate laboratory test selection in the form of overutilization as well as underutilization frequently occurs despite available guidelines. There is broad approval among laboratory specialists as well as clinicians that demand management strategies are useful tools to avoid this issue. Most of these tools are based on automated algorithms or other types of machine learning. This review summarizes the available demand management strategies that may be adopted to local settings. We believe that artificial intelligence may help to further improve these available tools.
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Affiliation(s)
- Cornelia Mrazek
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria; (E.H.-B.); (T.K.F.); (M.H.K.); (H.O.); (J.C.)
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Cadamuro J, Hillarp A, Unger A, von Meyer A, Bauçà JM, Plekhanova O, Linko-Parvinen A, Watine J, Leichtle A, Buchta C, Haschke-Becher E, Eisl C, Winzer J, Kristoffersen AH. Presentation and formatting of laboratory results: a narrative review on behalf of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group "postanalytical phase" (WG-POST). Crit Rev Clin Lab Sci 2021; 58:329-353. [PMID: 33538219 DOI: 10.1080/10408363.2020.1867051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In laboratory medicine, much effort has been put into analytical quality in the past decades, making this medical profession one of the most standardized with the lowest rates of error. However, even the best analytical quality cannot compensate for errors or low quality in the pre or postanalytical phase of the total testing process. Guidelines for data reporting focus solely on defined data elements, which have to be provided alongside the analytical test results. No guidelines on how to format laboratory reports exist. The habit of reporting as much diagnostic data as possible, including supplemental information, may lead to an information overload. Considering the multiple tasks physicians have to do simultaneously, unfiltered data presentation may contribute to patient risk, as important information may be overlooked, or juxtaposition errors may occur. As laboratories should aim to answer clinical questions, rather than providing sole analytical results, optimizing formatting options may help improve the effectiveness and efficiency of medical decision-making. In this narrative review, we focus on the underappreciated topic of laboratory result reporting. We present published literature, focusing on the impact of laboratory result report formatting on medical decisions as well as approaches, potential benefits, and limitations for alternative report formats. We discuss influencing variables such as, for example, the type of patient (e.g. acute versus chronic), the medical specialty of the recipient of the report, the display of reference intervals, the medium or platform on which the laboratory report is presented (printed paper, within electronic health record systems, on handheld devices, etc.), the context in which the report is viewed in, and difficulties in formatting single versus cumulative reports. Evidence on this topic, especially experimental studies, is scarce. When considering the medical impact, it is of utmost importance that laboratories focus not only on the analytical aspects but on the total testing process. The achievement of high analytical quality may be of minor value if essential results get lost in overload or scattering of information by using a non-formatted tabular design. More experimental studies to define guidelines and to standardize effective and efficient reporting are most definitely needed.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Hillarp
- Department of Clinical Chemistry, Halland Hospital, Halmstad, Sweden
| | | | - Alexander von Meyer
- Institute for Laboratory Medicine and Medical Microbiology, Medizet, München-Klinik, Munich, Germany
| | - Josep Miquel Bauçà
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain
| | - Olga Plekhanova
- Laboratory Diagnostics Center, State Clinical Hospital No. 67 named after L.A. Vorokhobov Moscow Healthcare Department, Moscow, Russia
| | - Anna Linko-Parvinen
- Laboratory of Haematology, Tykslab, Laboratory Division, Turku University Hospital, Turku, Finland
| | - Joseph Watine
- Laboratoire de Biologie Médicale, Hôpital de Villefranche-de-Rouergue, France
| | - Alexander Leichtle
- University Institute of Clinical Chemistry, Inselspital - Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christoph Buchta
- Austrian Association for Quality Assurance and Standardization of Medical and Diagnostic Tests (ÖQUASTA), Vienna, Austria
| | | | - Christoph Eisl
- School of Business & Management, University of Applied Sciences Upper Austria, Steyr, Austria
| | - Johannes Winzer
- School of Business & Management, University of Applied Sciences Upper Austria, Steyr, Austria
| | - Ann Helen Kristoffersen
- Department of Medical Biochemistry and Pharmacology, Laboratory Clinic, Haukeland University Hospital and Noklus, Haraldsplass Deaconess Hospital, Bergen, Norway
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Mrazek C, Lippi G, Keppel MH, Felder TK, Oberkofler H, Haschke-Becher E, Cadamuro J. Errors within the total laboratory testing process, from test selection to medical decision-making - A review of causes, consequences, surveillance and solutions. Biochem Med (Zagreb) 2021; 30:020502. [PMID: 32550813 PMCID: PMC7271754 DOI: 10.11613/bm.2020.020502] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022] Open
Abstract
Laboratory analyses are crucial for diagnosis, follow-up and treatment decisions. Since mistakes in every step of the total testing process may potentially affect patient safety, a broad knowledge and systematic assessment of laboratory errors is essential for future improvement. In this review, we aim to discuss the types and frequencies of potential errors in the total testing process, quality management options, as well as tentative solutions for improvement. Unlike most currently available reviews on this topic, we also include errors in test-selection, reporting and interpretation/action of test results. We believe that laboratory specialists will need to refocus on many process steps belonging to the extra-analytical phases, intensifying collaborations with clinicians and supporting test selection and interpretation. This would hopefully lead to substantial improvements in these activities, but may also bring more value to the role of laboratory specialists within the health care setting.
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Affiliation(s)
- Cornelia Mrazek
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
| | - Martin H Keppel
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Thomas K Felder
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hannes Oberkofler
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
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Mrazek C, Simundic AM, Salinas M, von Meyer A, Cornes M, Bauçà JM, Nybo M, Lippi G, Haschke-Becher E, Keppel MH, Oberkofler H, Felder TK, Cadamuro J. Inappropriate use of laboratory tests: How availability triggers demand - Examples across Europe. Clin Chim Acta 2020; 505:100-107. [PMID: 32084382 DOI: 10.1016/j.cca.2020.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The appropriate use of laboratory diagnostics is increasingly at stake. The aim of this study was to depict some paradigmatic examples of under- and overutilization, as well as possible solutions across Europe. METHODS We collected six examples from five European countries where a rise or decline of orders for specific laboratory parameters was observed after organizational changes but without evidence of changes in patient collective characteristics as source of this variation. RESULTS The collected examples were the following: 1-Germany) Switch from a Brain-Natriuretic-Peptide assay to NT-pro Brain-Natriuretic-Peptide assay, resulting in a 374% increase in these analytics; 2-Spain) Implementation of a gatekeeping strategy in tumor marker diagnostics, resulting in a 15-61% reduction of these diagnostics; 3-Croatia) Stepwise elimination of creatine-kinase-MB assay from the laboratory portfolio; 4-UK) Removal of γ-glutamyl transferase from a "liver function" profile, resulting in 82% reduction of orders; 5-Austria) Implementation of a new device for rapid Influenza-RNA detection, resulting in a 450% increase of Influenza testing; 6-Spain) Insourcing of 1,25-(OH)2-Vitamin D measurements, leading to a 378% increase of these analyses. CONCLUSION The six paradigmatic examples described in this manuscript show that availability of laboratory resources may considerably catalyze the demand, thus underscoring that inappropriate use of laboratory resources may be commonplace in routine laboratories all across Europe and most probably beyond. They also demonstrate that the application of simple strategies may assist in overcoming this issue. We believe that laboratory specialists need to refocus on the extra-analytical parts of the testing process and engage more in interdisciplinary patient-care.
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Affiliation(s)
- Cornelia Mrazek
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia; Faculty of Pharmacy and Biochemistry, University of Zagreb, Croatia
| | - Maria Salinas
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Alexander von Meyer
- Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Michael Cornes
- Biochemistry Department, Worcester Acute Hospitals NHS Trust, Worcester, UK
| | - Josep Miquel Bauçà
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain
| | - Mads Nybo
- Dept. of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | | | - Martin H Keppel
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Hannes Oberkofler
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Thomas K Felder
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria.
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Cadamuro J, Ibarz M, Cornes M, Nybo M, Haschke-Becher E, von Meyer A, Lippi G, Simundic AM. Managing inappropriate utilization of laboratory resources. ACTA ACUST UNITED AC 2019; 6:5-13. [PMID: 30096052 DOI: 10.1515/dx-2018-0029] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/27/2018] [Indexed: 12/29/2022]
Abstract
Background The inappropriate use of laboratory resources, due to excessive number of tests not really necessary for patient care or by failure to order the appropriate diagnostic test, may lead to wrong, missed or delayed diagnosis, thus potentially jeopardizing patient safety. It is estimated that 5-95% of tests are currently used inappropriately, depending on the appropriateness criteria, thus significantly contributing to the potential of generating medical errors, the third leading cause of death in the US. Content In this review, we discuss the reasons as well as the medical and financial consequences of inappropriate utilization of laboratory tests. We then provide demand management (DM) tools as a means for overcoming this issue and also discuss their benefits, challenges, limitations and requirements for successful implementation. Summary and outlook When based on current evidence, adapted to local conditions and developed in close collaboration with clinicians, DM is a reasonable strategy for progressing toward better management of over- and underuse of laboratory resources.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Müllner Hauptstr. 48, 5020 Salzburg, Austria, Phone: +43-57255-57263, Fax: +43-57255-23199
| | - Mercedes Ibarz
- Laboratory Medicine Department, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Michael Cornes
- Clinical Chemistry Department, Worcester Acute Hospitals NHS Trust, Worcester, UK
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | | | - Alexander von Meyer
- Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia
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Cadamuro J, Gaksch M, Wiedemann H, Lippi G, von Meyer A, Pertersmann A, Auer S, Mrazek C, Kipman U, Felder TK, Oberkofler H, Haschke-Becher E. Are laboratory tests always needed? Frequency and causes of laboratory overuse in a hospital setting. Clin Biochem 2018; 54:85-91. [PMID: 29409798 DOI: 10.1016/j.clinbiochem.2018.01.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/20/2018] [Accepted: 01/30/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Inappropriate utilization of laboratory resources is an increasing concern especially in high-throughput facilities. Until now, no reliable information has been published addressing to which extent laboratory results are actually used for clinical decision-making. Therefore, we aimed to close this gap using a novel retrospective approach including a survey of clinicians and nurses. METHODS We retrospectively evaluated the number of re-orders for potassium (K), lactate dehydrogenase (LD), aspartate-aminotransferase (AST), activated partial thromboplastin-time (APTT) and prothrombin-time/INR (PT/INR), after the initial order had to be cancelled due to preanalytical non-conformities. We analyzed subgroups regarding time to re-order, ward and sample priority (urgent vs. routine). Subsequently, we surveyed clinicians and nurses, asking for their estimate of the amount of failed re-orders as well as for possible reasons. RESULTS From initially cancelled tests, only ~20% of K, LD, AST and ~30% of APTT and PT/INR tests were re-ordered within 24 h. 70% of the investigated clinical chemistry and 60% of coagulation tests were re-ordered one week after cancellation or not at all. Survey participants quite accurately estimated these numbers. Routine laboratory panels, short stay of out-patients, obsolete test results and avoiding additional phlebotomies were the main reasons for not re-ordering cancelled tests. CONCLUSIONS Overall, 60-70% of test results in the investigated assays ordered in a high throughput laboratory are potentially inappropriate or of doubtful clinically importance. Although clinicians and nurses are aware of this situation, it is the duty of laboratory specialists to overcome overutilization in close collaboration with all involved healthcare workers.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria.
| | - Martin Gaksch
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Helmut Wiedemann
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Alexander von Meyer
- Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG, Klinikum St. Marien, Amberg, Weiden, Germany
| | - Astrid Pertersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University of Greifswald, Greifswald, Germany
| | - Simon Auer
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Cornelia Mrazek
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Thomas K Felder
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hannes Oberkofler
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
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Premawardhana LD. Thyroid testing in acutely ill patients may be an expensive distraction. Biochem Med (Zagreb) 2017; 27:300-307. [PMID: 28694722 PMCID: PMC5493170 DOI: 10.11613/bm.2017.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/15/2017] [Indexed: 02/01/2023] Open
Abstract
In health, an efficient negative feedback mechanism maintains serum thyroid hormone concentrations within an exquisitely controlled narrow range. Therefore any change that occurs to thyroid hormones in intrinsic thyroid disease is concordant and easy to interpret. Optimal functioning of the many tissues they influence is thereby facilitated.
The situation in acute illnesses is different. Mechanisms that operate in these circumstances influence the hypothalamic-pituitary-thyroid axis and its components producing thyroid test results, which are discordant, do not fit recognizable patterns and are difficult to interpret. The yield of abnormalities is also low (about 7%). As many studies indicate, thyroid tests are expensive and consume large amounts of the hospital budget and resources of hospital laboratories. Other studies have shown that when abnormalities are detected, clinicians do not intervene or follow up these subjects. Therefore the clinical utility of thyroid testing in acutely ill patients is debatable. Interventions to change requestor behaviour with regard to thyroid testing in acutely ill subjects and the success of some audit and educational interventions are worthy of note.
Thyroid testing in acutely ill patients is often an expensive distraction and is of limited clinical value. Targeted thyroid testing should be offered in this group only to those with: (a) symptoms or signs of thyroid disease e.g. goiter or orbitopathy; (b) risk factors for thyroid disease, previous or family history of thyroid disease;
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Affiliation(s)
- Lakdasa D Premawardhana
- Section of Endocrinology, YYF Hospital, Caerphilly, UK
- Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff, UK
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Cadamuro J, Skocic M, Meisl B, Raggam RB, Felder TK, Prüller F, Reinstadler K, Wiedemann H, Mrazek C. A diagnostic algorithm for the detection of inhibitors against coagulation Factor V. Clin Chem Lab Med 2017; 54:e203-6. [PMID: 26677891 DOI: 10.1515/cclm-2015-1005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/16/2015] [Indexed: 11/15/2022]
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Lippi G, Baird GS, Banfi G, Bölenius K, Cadamuro J, Church S, Cornes MP, Dacey A, Guillon A, Hoffmann G, Nybo M, Premawardhana LD, Salinas M, Sandberg S, Slingerland R, Stankovic A, Sverresdotter SM, Vermeersch P, Simundic AM. Improving quality in the preanalytical phase through innovation, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE). ACTA ACUST UNITED AC 2017; 55:489-500. [DOI: 10.1515/cclm-2017-0107] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
It is now undeniable that laboratory testing is vital for the diagnosis, prognostication and therapeutic monitoring of human disease. Despite the many advances made for achieving a high degree of quality and safety in the analytical part of diagnostic testing, many hurdles in the total testing process remain, especially in the preanalytical phase ranging from test ordering to obtaining and managing the biological specimens. The Working Group for the Preanalytical Phase (WG-PRE) of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has planned many activities aimed at mitigating the vulnerability of the preanalytical phase, including the organization of three European meetings in the past 7 years. Hence, this collective article follows the previous three opinion papers that were published by the EFLM WGPRE on the same topic, and brings together the summaries of the presentations that will be given at the 4th EFLM-BD meeting “Improving quality in the preanalytical phase through innovation” in Amsterdam, 24–25 March, 2017.
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