The challenge of preventing overdiagnosis

Death itself comes to be regarded as a failure of medicine and doctors, rather than the inevitable culmination of every life.

Over the past several decades, the economic interests of the pharmaceutical and medical technology industries have both pressured and tempted medicine to overextend itself. The traditional moral commitment of the medical profession to relieve suffering and to care for the dying has been gradually displaced by a futile and misguided attempt to solve humanity’s most profound existential problems through biotechnical means. Doctors now apply more and more powerful treatments towards the end of life and try to prevent diseases by seeking out and correcting more and more risk factors. All this has led to an epidemic of overdiagnosis and overtreatment affecting us all, but perhaps particularly harming the old.

Doctors and other health professionals are gradually beginning to understand that they may now find themselves in the unfortunate position of doing harm while trying to do good; academic researchers are working to investigate the extent and effects of overdiagnosis, and how it might be mitigated; and journalists and policy-makers seem finally to be beginning to take the issue seriously by promoting greater public debate.

Read more:
The challenge of preventing overdiagnosis

Source: CMAJ Blogs

International Congress on Quality in Laboratory Medicine 2017

Welcome to International Congress on Quality in Laboratory Medicine!
9-10 February 2017 Helsinki

International Congress on Quality in Laboratory Medicine is an annual congress for clinical laboratory and quality management professionals organised by Labquality Ltd. Congress draws annually approximately 1,000 visitors to Helsinki.

The 2017 Congress themes are: Evidence-Based Laboratory Medicine (EBLM) and Impact of Total Quality Management (TQM)

Read more:
www.labqualitydays.com


Source: Youtube via Labquality

Clinical Laboratory Safety

CLSI provides several standards to medical laboratories to keep laboratory safe.

CLSI clinical laboratory safety standards:

• Prepare your laboratory with one of our leading clinical laboratory safety standards
• Protect your staff from occupationally acquired infections
• Ensure your laboratory properly handles waste.
• Enhance emergency preparedness in your facility

Read more and get your own copy:
Laboratory Safety 

Source: CLSI

ISO15189 - The Four Components of a Quality Management System

Medical laboratories are a critical part of the healthcare system. A patient’s diagnosis and treatment are often based on test results, and an incorrect test result could lead to a misdiagnosis — which could have potentially fatal consequences. This is why accurate test results are critical — each and every time a test is conducted. In order to improve the accuracy of results, medical labs around the world have begun adopting ISO 15189: Medical laboratories—particular requirements for quality and competence. The standard requires medical labs to implement a quality management system. This requires them to document all their processes and procedures to ensure lab technologists always understand and follow the correct method when conducting a test.

This white paper provides an overview of the four main components of a quality management system:

1. Management Responsibility
2. Resource Management
3. Service Realization
4. Measurement, Analysis & Improvement

Download free white paper here (registration needed):
ISO 15189 Medical Laboratories: Understanding the Four Components of a Quality Management System

Source: Dark Daily

Hospital command center

The people who manage patient flow at hospitals might like a crystal ball that shows them when their resources are about to be overwhelmed. Hospitals are trying out what might be the next best thing. They're wiring command centers with monitors that display predictive analytics fueled by every conceivable data source that gives a glimpse of a patient's movement through the facility.

Taking a cue from other industries that assemble command centers to manage complex logistics, GE Healthcare equipped Johns Hopkins with the company's first Wall of Analytics, which features 22 information screens that can pull data from 14 sources, including the electronic health record, admission software and OR scheduling applications. GE is working with a handful of other hospitals to deploy the technology.

Although the command center at Johns Hopkins has been up and running for less than a year, the hospital has seen a 30% reduction in ER patients who have to wait for an inpatient bed and a roughly 70% reduction in patients who must be held in the OR because there's no recovery or inpatient bed for them, according to Jim Scheulen, Johns Hopkins Hospital's chief administrative officer for emergency medicine and capacity management.

Read more:
Hospital command centers help manage flow

Source: Modern Healthcare Modern Healthcare business news

Laboratory’s role in healthcare quality

Healthcare providers depend on accurate and precise lab results in order to do their jobs well and give patients the best possible care. Often, laboratory results are the decision point in a patient’s treatment. With so much on the line, it’s no surprise that laboratories everywhere are committed to constant improvement.

USA is having Healthcare Quality Week in October. This week is designated to celebrate and acknowledge the work of healthcare quality professionals perform all year round. Quality professionals address many issues in the healthcare workplace including risk management, patient safety, and quality improvement.

Let’s have a closer look at some of the ways that laboratories contribute to patient safety and healthcare quality every day:

• Quality control
• External quality assessment (Proficiency testing)
• Specially trained personnel
• Top level documentation
• Internal audits

Read more:
The Laboratory’s Central Role in Healthcare Quality

Source: LabTestingMatters
Image: Lego

A lot of blood, for no reason?

Curbing genetic testing for clot-prone patients is just one example of how to improve spending of health care dollars through better ordering of tests. A half billion dollars, at least, gets spent each year on blood tests to see which hospital patients have a genetic quirk that makes their blood more likely to form dangerous clots.

Writing in the Journal of Hospital Medicine , they review what’s known about testing for the trait called inherited thrombophilia, and call for a drastic cut in the test’s use by doctors across America.

After all, they write, hospitalized people who have already had such dangerous clots, called venous thromboembolisms or VTEs, don’t need a positive genetic test to justify taking medication and making other changes to prevent future ones.

And there’s no evidence that medication to prevent clots will help hospital patients who haven’t yet had a VTE. Testing their DNA for inherited thrombophilia won’t change that.

In other words, the authors say, ordering inherited thromboembolism testing on inpatients is something doctors do for little or no reason. And according to the team’s analysis of data pulled from medical records, they do it hundreds of thousands of times a year in Medicare patients alone.

Can we call this predictive, preventive and personalised laboratory medicine?

Read more:
A lot of blood, for no reason? U-M team concludes that common, costly clot test has few benefits | University of Michigan Health System

 Source: University of Michigan Health System

What motivates a scientist?

I put down the pipettes and start the timer. The samples are tucked in the heating block and the enzymes (manufactured in some bland warehouse in Germany) have thirty minutes to do their magic. The gloves come off and I mentally browse through tasks to fill this mini-gap. Should I read a paper? Perhaps add a few lines to that manuscript that insists on not writing itself. Thirty minutes is too short to be productive at any of these tasks so I sit in the empty lab, wondering. The timer moonwalking steadily to the inevitable beep.

“Why do I do this?” – I wonder.

Read more:
What motivates a scientist?

Source: researcherblogski

Would you like to work in Italy as a biomedical laboratory scientist?

IFBLS' member ANTeL have published a procedure for all Biomedical Laboratory Technologists and Scientist who want to work in Italy as Biomedical Laboratory Technologists being recognized by the Italian Health System.

There are two options and procedures:

• Course A: if you prefer to obtain the Italian bachelor in
  Biomedical Laboratory Technologies (Laurea in Tecniche di Labroatorio
  Biomedico) which allow to the profession;
  

• Course B: if you prefer to request to the Health Ministry to recognize your original diploma obtained in your country.

Open procedure guide here (pdf)


Read more from IFBLS web site:
PROCEDURE FOR THE ACCESS TO THE PROFESSION IN ITALY

Source: IFBLS

Free Guide to Scientific Writing

Clinical Chemistry has published online Guide to Scientific Writing, a series of educational articles on how to design and write scientific research papers for publication. These articles will help authors, educators, researchers, training program directors, and other professionals write more clearly and effectively, thereby improving their chances for success. We encourage educators and training program directors to use them as a teaching aid, and provide a link to them on their own Web sites.

Aarticles are easy to read and humorous at times, yet are full of useful information and examples to illustrate important points. Because the articles will benefit anyone interested in scientific writing, those are available not only to subscribers, but to all scientists. Translations into Chinese and Spanish are available as well.

Read more:
Guide to Scientific Writing

 Source: AACC

What is the Pre-analytical Phase?

Labquality Days - Nordic Congress on Quality in Laboratory Medicine

Tim Lang, Dr, FRCPath, Consultant Clinical Scientist Clinical Biochemistry Department, University Hospital of North Durham, UK

Test ordering and collection of samples are important tasks in the pre-analytical phase of the laboratory diagnosis pathway. Over recent years the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for Preanalytical Phase (WG-PRE) has strived to make quality improvements and harmonize the many aspects of this phase. At the same time laboratories are under pressure to deliver a high quality service to meet the needs of their patients against ever expanding workloads,  increase costs, reduced revenue and inappropriate testing. They are challenged to identify this waste in their processes and remove unnecessary steps in their patients’ journeys.

Read more and find the full presentation here:
Demand management in the preanalytical phase - Labquality

Source: Labquality Days
Image credits: Tim Lang & Plebani

Video: The best moments of Labquality Days

Labquality has published a trending video of Nordic Congress on Quality in Laboratory Medicine. Enjoy feelings and memories from Labquality Days 2016

Read more:
Labquality Days Video

Source: Labquality

Lab tech faked result in drug case in USA

A lab technician for the State Police allegedly faked results in a drug case, and has drawn into question 7,827 criminal cases on which he worked, according to state officials.

Basically, he was observed writing 'test results' for suspected marijuana that was never tested.

Judge: We may need to let prisoners out over lab tech's faked results

Kamalkant Shah worked as a laboratory technician for the State Police laboratory in Little Falls. Shah was removed from lab work on Dec. 10 as soon as the problem was discovered. Shah has not been charged with any crime, and is believed to have retired.

Read more:
Lab tech allegedly faked result in drug case; 7,827 criminal cases now in question

Source: NJ.com

MARBLE E-learning program - Master in Biomedical Laboratory Sciences

The EMJMD-MARBLE represents a step-change in the provision of Master Degree programmes in BLS in Europe and will be a unique educational offering in this domain globally. Students enrolling on this programme will have a unique educational experience of a truly international nature. In their first year they will spend time in each of the four partner countries as well as engaging in continuous E-learning provided by the all partners as a whole. In the second year students will focus on more specialist topics, namely by having a specialist clinical practice and by carrying out a specialised research project leading to a Master’s thesis. This will be carried out in a European country of their choice or in collaboration with one of the Associated Partners (AP) who represent potential employers in key sectors such as industry, research centres, the health sector, academia and professional agencies. The expertise, skills, competence and connections that the students obtain during this programme will help to equip them to meet the current and future needs of the labour market (e.g. as . Graduates of this programme will be competent to take on roles as diagnostic partners in healthcare.

The primary aim of the EMJMD-MARBLE is to educate and train biomedical laboratory scientists (BLs) to the highest national and international standards and equip them to meet the current and emerging professional requirements of this key diagnostic sector as researchers, advocates, leaders and diagnostic partners. A secondary aim is to increase the European dimension of BLS and help to consolidate a unified identity for the profession, thereby harmonizing and supporting specialist practice across the European area. Taken together these aims will facilitate the increase in students’ specialist knowledge, promote mobility of graduates and provide high quality post-graduate Biomedical Laboratory Scientists (BLs) for the European and international markets.

Read more:
Marble-home - JMD Marble

Source: MARBLE

Important work behind the scenes

The hidden profession that saves lives

Medical Laboratory Science (also called Clinical Laboratory Science or Biomedical Laboratory Science) is one of the most under-recognized health professions.

We are proud of our work and we shall show it to the world.

Image credits: Lisa Edwards

Born to be a laboratory scientist

Medical Laboratory Scientists (MLS) and Medical Laboratory Technicians (MLT) — also known as Clinical Laboratory Scientists (CLS) — perform laboratory tests on patient samples to provide information needed to diagnose or monitor treatment. Examples of common laboratory tests include tests to detect anemia, diagnose diabetes and strep throat, and provide a transfusion to an accident victim.

Doctors rely on laboratory test results to make informed patient diagnoses. Patient history along with physical signs and symptoms are vital, but most diagnoses need confirmation that only laboratory tests can provide. The laboratory professionals also contribute to wellness testing, guiding treatment, and monitoring patient progress.

Read more:
The hidden profession that saves lives

How many RBC transfusions have been ordered based on an erroneous fingerstick hemoglobin result?

Clinical Laboratory professionals know that point of care test results performed on a fingerstick sample of blood are often less accurate and precise than results performed on a central laboratory analyzer using a venous sample. Improvements in point of care technology have greatly improved the analytical performance of point of care devices. A recent study published in the American Journal of Clinical Pathology convincingly demonstrated that much of the variability in point of care testing occurs during the preanalytical phase of collecting a fingerstick sample of blood.

Compared to tests on venous blood, the coefficient of variation for successive drops of fingerstick blood exceeded venous blood by 3.4 times for hemoglobin, 5.7 times for WBC count, 3.0 times for lymphocyte count, 7.7 times for granulocyte count, and 4.0 times for platelet count. In some individuals, hemoglobin concentration differed by more than two g/dL between two successive drops of blood.

Read more:
Questionable Accuracy of Point of Care Tests Performed on Fingerstick Blood Samples 

Source: ClinLab Navigator

New Technologies in QC

Quality control plays a key role in helping laboratories ensure the quality of patient results and minimize patient risk. While many think of QC as being a static area within the field of clinical laboratory sciences, it is, in fact, dynamic with advances in QC strategy continually evolving. New technologies in QC are presented at local and national conferences around the globe, but only a fraction in the lab community is fortunate enough to attend these meetings.

A good estimate for target mean for a new lot can be achieved by designing a crossover study with 10 results and back calculating the standard deviation (SD) from a previous lot. The targets should be re-evaluated after accumulating more than 60 data points at each level. For a new lot with no historical data, establishing initial SD requires more than 60 data points. It is also suggested that there should be a quarterly review.

New Z-squared QC rules (Z2) and repeat Z-squared are also shown to be more powerful than traditional ­multi-rules.

Read more:
New Technologies in QC

Source: advance

How to ensure the quality of preanalytical phase and point-of-care testing

These are the themes of Nordic Congress on Quality in Laboratory Medicine 2016. The congress will be held on 11-12 February, 2016 in Helsinki, Finland
www.labqualitydays.com

Preanalytics

Preanalytics is currently the most interesting topic in laboratory medicine all over Europe. Should there be failures in some preanalytical steps, the consequent analysis result can be worthless. The Preanalytics session will focus on the management of the preanalytical phase and how to handle patient preparation & guidance, highlighting the importance of sampling and logistic issues. The speakers from Europe and Canada will touch the key preanalytical factors in different disciplines including biochemistry, haematology, microbiology and pathology.

Point-of-Care testing (POCT)

Utilising POCT is growing rapidly in many countries. When executed with high quality and based on medical needs, POCT gives immediate benefits for the patient and generally speeds up the treatment process. Join the POCT session to share the latest Nordic developments and be inspired by the best practices in Switzerland and Australia. The program also highlights external quality assessment, data management and current standards used in POCT accreditation.

Program Thursday 11th February, 2016

Demand management in the preanalytical phase
Tim Lang, Dr, FRCPath, Consultant Clinical Scientist
Clinical Biochemistry Department, University Hospital of North Durham, UK

How to guide and prepare the patient and the importance of sampling
Mads Nybo, M.D., Ph.D., Chief Physician
Department of Clinical Biochemistry and Pharmacology, University hospital of Odense, Denmark

The ways in which we measure and grade preanalytic and postanalytic performance in microbiology by Performance Testing
Michael Noble, M.D., FRCPC
The University of British Columbia in Vancouver BC, Canada

Preanalytics in coagulation lab: why struggle for better results?
Valdas Banys, Ph.D.
Faculty of Medicine, University of Vilnius, Lithuania

The “preanalytical question” in anatomical pathology – implications and challenges for personalized medicine in a digital world
Pedro Soares de Oliveira, M.D.
Department of Pathology, Hospital da Luz, Lisbon, Portugal

Logistics and preanalytical factors in specimen transportation – how it’s done locally, nationally and on an international scale
Tommi Vaskivuo, M.D., Ph.D., Adjunct Professor, Chief Medical Officer
synlab, Finland

Program Friday 12th February, 2016

POCT for glucose measurements in different matrix – reference systems can provide solutions for improved analytical quality
Gerhard Schumann, Professor, Dr
Hannover Faculty of Medicine, Institute of Clinical Chemistry, Hannover, Germany

POCT in Switzerland
Roman Fried, Ph.D., MBA
Institute of Clinical Chemistry, University hospital of Zürich, Switzerland 

Challenges in POCT for coagulation
Piet Meijer, Ph.D.
The ECAT Foundation, Voorschoten, The Netherlands

POCT accreditation based on ISO standards 15189 and 22870 in Germany
Ralf Bauerndistel, Dr., Lead Assessor
German Accreditation Body (DAkkS), Germany

Medical device connectivity
Michael Aistrup Nielsen, Global Product Manager, DM & CS
HemoCue, Denmark

EQA of POCT methods: how to interpret results?
Anne Stavelin, Ph.D.
NOKLUS, Bergen, Norway

POCT – the Australian experience
Tony Badrick, Ph.D. Chief Executive
RCPAQAP, Australia

Welcome to Helsinki

Throughout its 450-year history, maritime Helsinki has swung between the currents of Eastern and Western influences. The lifestyle in the second most northern capital city in the world is full of contrasts and fascinating habit cultures. Influences from both the East and West are visible in the city’s architecture, culinary culture, events, traditions and many other elements that are unique to the way of life in Helsinki.

Nordic Congress on Quality in Laboratory Medicine

Useful links

>> Labquality Days 2016
>> Scientific program
>> Download program (pdf)
>> Registration


See you in Helsinki!

Nordic Congress on Quality in Laboratory Medicine 2016

Labquality Days 11-12 February, 2016, Helsinki, Finland

Labquality Days is one of the largest annual congresses in Scandinavia focused on quality and laboratory medicine. The congress is held at Messukeskus, Expo and Convention Centre in Helsinki. The congress inspires laboratory medicine and quality management professionals, researchers, and healthcare experts. The 2016 congress themes are Point-of-Care Testing (POCT) and Preanalytics.

Read more: www.labqualitydays.com

Preliminary Scientific Program

Thursday 11th February, 2016

 

Preanalytics

 

Demand management in
the preanalytical phase
Tim Lang, Dr, FRCPath, Consultant Clinical Scientist,
Clinical Biochemistry Department,
University Hospital of North Durham, UK

How to guide and prepare the patient
and the importance of sampling
Mads Nybo, M.D. Ph.D., Chief Physician,
Department of Clinical Biochemistry and Pharmacology,
University hospital of Odense, Denmark

The ways in which we measure and grade
preanalytic and postanalytic performance in
microbiology by Performance Testing
Michael Noble, M.D. FRCPC,
The University of British Columbia in Vancouver BC, Canada

Pre-analytics in coagulation lab:
why struggle for better results?
Valdas Banys, Ph.D.
Faculty of Medicine, University of Vilnius, Lithuania

The “pre-analytical question” in anatomical
pathology – implications and challenges for
personalized medicine in a digital world
Pedro Soares de Oliveira, M.D.
Department of Pathology, Hospital da Luz, Lisbon, Portugal

Logistics and preanalytical factors in specimen
transportation – how it’s done locally, nationally
and on an international scale
Synlab/speaker to be announced

Preliminary Scientific Program

Friday 12th February, 2016

 

POCT

 

POCT for glucose measurements in different
matrix – reference systems can provide solutions
for improved analytical quality
Gerhard Schumann, Professor, Dr
Hannover Faculty of Medicine, Institute of Clinical Chemistry,
Hannover, Germany

POCT in Switzerland
Roman Fried, M.D.
Institute of Clinical Chemistry,
University hospital of Zürich, Switzerland
Challenges in POCT for coagulation
Piet Meijer, Ph.D.
The ECAT Foundation, Voorschoten, The Netherlands

POCT accreditation based on ISO standards
15189 and 22870
Speaker to be announced
Point-of-Care data management & connectivity
Staffan Ahlandsberg, Global Business Director DM & CS
Hemocue, Sweden

EQA of POCT methods: how to interpret results?
Anne Stavelin, Ph.D.
NOKLUS, Bergen, Norway

POCT – the Australian experience
Tony Badrick, Ph.D.
Chief Executive, RCPAQAP, Australia