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In this article, the factors contributing to a shortage of qualified medical laboratory technologists in the US have been examined, and the Canadian perspective studied. Continued public relations programs, with special programs directed to high school, college and university students would seem to be the appropriate way to prevent similar problems from occurring and escalating in Canada.
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BACKGROUND: Monoclonal gammopathy of undetermined significance is defined by the presence of: low serum and/or urine monoclonal protein level; less than 10% plasma cells in bone marrow; normal serum calcium, creatinine and hemoglobinlevels; and no bone lesions on full skeletal X-ray survey. OBJECTIVES: To study the necessity of bone marrow examination for the diagnosis and clinical course of MGUS. METHODS: We retrospectively screened the medical records of all patients in whom monoclonal protein was found in the serum during 2001-2002 in the medical laboratories of Meir Medical Center. Asymptomatic patients who had serum monoclonal immunoglobulin G < 3.0 g/dl or IgA < 2.0 g/dl or IgM < 1.0 g/dl without anemia, renal failure, hypercalcemia or any bone lesions on skeletal survey were eligible. Full records of patients who were evaluated in the hematology clinic were available (group 1). The remaining patients were followed by their family physicians; thus we had access only to their electronic files including laboratory results and new diagnoses (group 2). Demographic and clinical parameters as well as clinical course werewere evaluated. RESULTS: Both groups (57 and 255 patients, respectively) had similar demographic, laboratory and clinical characteristics. Bone marrow examination was performed in 30 of 57 patients (group 1): 16 were normal, 8 had an excess of normal plasma cells, and 6 had excess of pathologic plasma cells. However, only in two of the latter six could a diagnosis of multiple myeloma be established. All group 1 patients were followed for 22 +/- 11 months and onlytwo developed overt multiple myeloma. During the same period, 6 of 255 patients (group 2) were diagnosed as multiple myeloma and 3 as MGUS in other hospitals. The rest had a stable course with no change in their laboratory values. CONCLUSIONS: Our findings suggest that bone marrow examination should not be performed routinely in patients who fulfill strict clinical and laboratory criteria of MGUS.
Today, there are many problems to be solved in the curricula in the medical school education in Japan. Generally, the typical classical curriculum of the undergraduate studies in medical education is divided into two courses such as the basic and the clinical medicine. Recently, some schools, have adapted an integrated education program through a six school year course of studies including the two-year premedical course and introduced an early exposure system in clinical medicine. Department of Laboratory Medicine (Clinical Pathology) has a central medical laboratory where clinical practice tests, especially specimen tests, are performed by medical laboratory technicians trained in laboratory technology. The central laboratory system was introduced by the GHQ of the Allied Occupation Forces after World War II in Japan. This was first established in 1950 at the National Tokyo First Hospital. Afterwards, this system was adopted in almost all hospitals in Japan. Consequently, clinical testing was transferred from doctors to medical laboratory technicians and this practice brought a decrease in the doctor's level of the current knowledge or techniques of laboratory testing. Therefore, education in Laboratory Medicine in the medical schools, should be refocused to train medical students to be a clinician who understands the test principles, selects suitable tests and interprets the results, reduces the number of test(s) for clinical practice. This clinical training will be for the physical, mental and economic welfare of the patient. The actual changes of the curriculum which have been made with time for Laboratory Medicine at Tokushima University Medical School, are introduced and discussed.
Medical toxicology is a medical subspecialty focusing on the diagnosis, management and prevention of poisoning and other adverse health effects due to medications, occupational and environmental toxins, and biological agents. The medical toxicology laboratories operates an analytical facility for clinical toxicology (intentional or unintentional drug overdose), environmental medicine (occupational and environmental toxicology, workplace drug monitoring), drug of abuse management, therapeutic drug monitoring (TDM) and in some cases forensic toxicology. This article is focus on clinical toxicology, monitoring of drug abused patients and TDM. Still the most popular in medical toxicology is determination of xenobiotics in classic biological materials (blood/plasma, urine) however alternative materials (saliva, hairs) cause increasing attention. Alternative materials has special value in drug of abuse management (evaluation of drug abstinence), when collecting the blood create some problems and urine samples can be adulterated. For screening usually immunology based assays are applied and for some xenobiotics thin-layer chromatography (TLC) method. Conformation and quantitative analysis are carrying on using chromatographic method. In clinical toxicology chemical analysis are performed for diagnostic, therapeutic and some time for legal purposes. If results of toxicological analysis have direct influence on diagnosis or treatment they should be available during 2 hours other determination ought to be performed during 24 or 48 hours. Integral part of toxicological analysis is interpretation of results carried over by well-trained analyst with close co-operation with clinical toxicologist (physician).
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Tip deformities as small as 10 mum on cannulae can cause unnecessary pain to patients. The only way of preventing these deformed cannulae from reaching patients is to test every cannula at the manufacturing stage. Clinical and laboratory tests carried out by the company compare handling and trauma caused by medical cannulae with technical parameters for manufacturing and testing. This article discusses the results of these tests, which the author found verified that the properties of medical cannulae can be evaluated by measuring the penetration load piercing a skin substitute. The discovery of tip deformities with clinical significance led to the development of specially designed equipment that detects the presence of deformities by using the noise made by a deformed cannula penetrating a foil.
The clinical hematology practices utilized at veterinary teaching hospitals and private veterinary diagnostic laboratories were surveyed using a questionnaire. The hematology caseload at private diagnostic laboratories was larger, and comprised predominantly of canine and feline submissions. The Coulter S Plus IV and Serono Baker 9000 were the hematology analyzers used most frequently at veterinary medical laboratories. The Abbott Cell-Dyn 3500, a multispecies analyzer capable of leukocyte differential counting, was utilized more by private laboratories. Commercial hematology control reagents were used at all laboratories; teaching hospital laboratories more often used reagents supplied by the manufacturer of the analyzer. A greater percentage of private diagnostic laboratories participated in the external quality assurance programs offered by Veterinary Laboratory Association and College of American Pathologists. While private diagnostic laboratories retained the EDTA blood specimens longer after initial testing, the teaching hospital laboratories retained blood smears and complete blood count reports longer. The complete blood count reports at veterinary teaching laboratories more often included red blood cell volume distribution width, mean platelet volume, manual hematocrit, plasma protein, and leukocyte differentials as absolute concentrations. The laboratory practices utilized by these veterinary medical laboratories were generally similar, and differences were attributed to divergent emphasis on economic accountability and clinical investigation.