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PubMedDate not supplied

Computerized health information networks: house calls of the future?

The Cleveland Free-Net is the nation's first free open-access computer system providing health information to the public. An online survey was developed for the family medicine clinic housed within the Free-Net to study the characteristics of the users of the system and the reason they selected the Free-Net as a source of health information. Three areas were addressed: 1) user demographics; 2) content analysis of questions; and 3) reasons Free-Net was used instead of the person's own health care provider. An analysis of the initial system done in 1985 revealed that early users of the system were known to be predominantly white male professionals, generally in the 25-35 age range. In comparison to that profile, more of the users in this study were women, but the majority of users continued to be white male professionals. Questions asked can be classified in six categories: diagnosis, symptoms, treatment, medications, laboratory tests, and prevention. The main categories of medical concerns were cardiovascular, gastrointestinal, obstetrical, and gynecologic problems. Users tended to use the Free-Net for health information rather than their physician because the traditional means was not always appropriate for the life-style of this population.

Adult↗
PubMed2003

[Our practical training program in laboratory medicine for medical students--Yamagata University].

At the Department of Laboratory Medicine at Yamagata University, our medical students are trained to have practical knowledge and the ability to plan laboratory examinations for the clinical diagnosis of patients. For 4th-year medical students, 31 clinical lectures are scheduled on a variety of subjects concerning laboratory findings. The 2-week practical training of 5th-year students includes an educational curriculum that allows them to master the various aspects of laboratory examinations, such as collecting blood samples, determining flow-volume curves, and conducting abdominal echograms. Finally, 6th-year medical students undergo a 5-week training period during which they learn the essentials of laboratory examinations. We are proud of our present clinical curriculum for medical students. However, within a couple of years, the clinical educational program for medical students will be changed for the purpose of better preparing medical doctors in Japan. The advisory organ of the Japanese Ministry of Health, Labor, and Welfare has recommended the induction of a newly developed model core curriculum that will be nationally standardized and will focus on problem-based learning for medical students. Therefore, the present educational system, even in the field of laboratory medicine, will have to be changed.

Clinical Laboratory Techniques↗
PubMed2005

Change of pathology request forms can reduce unwanted requests and tests.

BACKGROUND: Developments in clinical and laboratory medical practice have resulted in a large increase in laboratory workload, with considerable financial implications. It has been shown that the design of laboratory request cards can influence patterns of test ordering and possibly reduce inappropriate requests. AIMS/METHODS: To redesign pathology request cards with a view to reducing inappropriate test requesting. RESULTS: A redesign of the request cards used by general practitioners in the Bradford area led to a significant reduction in the ordering of specific investigations. CONCLUSIONS: The redesigning of pathology request cards can have a beneficial effect on test requesting.

Blood Chemical Analysis↗
PubMed1980

Appropriate laboratory utilization and medical usefulness.

When the hospital laboratory system is designed to meet clinical needs efficiently, more appropriate use of laboratory services is achieved. In this article, the author describes a system whereby test profiles are constructed to match the clinical problems, treatments, and test ordering patterns of clinicians.

Clinical Laboratory Techniques↗
PubMedDate not supplied

Successful community-based laboratory services program for long-term care facilities, Part 2.

Hagerstown Medical Laboratory, Inc., located in Hagerstown, Maryland, has an outreach program that currently provides laboratory services to 52 long-term care facilities. Part 1 of this series, published in the May/June 2001 issue of Clinical Leadership & Management Review, discussed general organization, staffing, and safety issues for their Nursing Home Program. Part 2 relates their experience with contracts, fees, and reimbursement.

Aged↗
PubMed2002

The management of clinical laboratories in Europe: a FESCC survey. Forum of the European Societies of Clinical Chemistry and Laboratory Medicine.

The professional duties of the specialists in clinical chemistry differ from country to country in Europe. One of the main goals of the Strategic Plan of the Forum of the European Societies of Clinical Chemistry and Laboratory Medicine (FESCC; IFCC-Europe) is to promote a high scientific and professional standard in the field of clinical chemistry and laboratory medicine in Europe. This can be stimulated by the knowledge of the local conditions in each country and by striving towards a strong and harmonised position in all the European countries. In order to enhance the knowledge of the managerial situation of the specialists in clinical chemistry in Europe, FESCC launched a survey in September 2000. This survey provides information about the position of the specialists in clinical chemistry in the various disciplines in the medical laboratories and in hospitals, and about the advisory tasks and the managerial education during the post-graduate training in clinical chemistry. Of the 35 FESCC member countries 33 have participated in the survey (94%). The results show a rather heterogeneous situation in Europe caused by the local historical developments, the differences in academic background and the relative numbers of private and physicians' office laboratories. Large differences exist between the European countries in the disciplines of laboratory medicine that are headed by a specialist in clinical chemistry. In the different countries the clinical chemistry laboratories are headed by specialists in clinical chemistry in between 20% and 100% of the laboratories. The haematology, immunology, microbiology, therapeutic drug monitoring, molecular biology and haemostasis laboratories and departments of blood banking are headed by specialists in clinical chemistry in between 0% and 100% of the laboratories. The responsibilities for the various managerial tasks of the specialists in clinical chemistry show no uniformity in Europe. In the majority of the countries the general management, the purchase of equipment and reagents and the education of technicians are in >90% the responsibility of the specialists in clinical chemistry. In most countries the majority of the specialists in clinical chemistry are members of the medical staff of the hospitals and have a position equivalent to the position of specialists in other medical disciplines. In some countries, however, it only holds true for the specialists with a medical background. In 79% of the countries the law regulates the profession of the specialists in clinical chemistry and in 60% of the countries the law regulates their position in the medical staff of the hospital. The advisory tasks to physicians, general practitioners and other users of laboratory tests are practised by >90% of the laboratories in 64% of the countries. Information is given directly to the patients by >90% of the laboratories in 30% of the countries. Only in a few countries laboratories give information to the public. The post-graduate training in clinical chemistry includes a managerial training in 58% of the countries, the study of information technology in 61% of the countries and an economy and/or a business administration study in 15% of the countries. In 27% of the countries no managerial education forms part of the post-graduate study in clinical chemistry. Harmonisation of the managerial aspects of the profession is one of the challenges for the European specialists in clinical chemistry. A European syllabus for post-graduate training could be helpful.

Chemistry, Clinical↗
PubMed1980

A model career ladder approach to medical technology education.

The medical technology program at the University of Vermont was modified in 1972 to create a 2 + 2 integrated curriculum with specialty options progressing that associate degree to baccalaureate degree. This design allows the fundamentals acquired in the associate degree curriculum of the medical laboratory technician (MLT) to serve as a practical and theoretical foundation that can be expanded upon in the baccalaureate degree curriculum of the medical technologist (MT). Options in the baccalaureate degree curriculum are generalist, specialist in clinical chemistry, in hematology, and in clinical microbiology. The design of this program provides a response to the changing role of the clinical laboratory practitioner.

Curriculum↗
PubMed1988

Medical relevance of laboratory tests. A clinical perspective.

To address the role of proficiency testing in the medical usefulness of laboratory tests, nine steps involved in the generation and application of a laboratory test result are identified and discussed: test ordering, patient preparation, specimen, sample, analysis, result, reporting, recognition, and action. Clinical uses of test results are enumerated. Good clinical skills are necessary for optimal test efficiency. Clinicians should improve their selection of tests, pay attention to proper patient preparation, and refine the process of interpretation of test results using disease-based reference ranges and more formal analysis of predictive value. By better definition of the clinical uses of laboratory tests, appropriate attention can be directed to steps in the laboratory domain such as medically relevant goals for accuracy and precision. With clearer understanding of the testing process, proficiency testing for monitoring laboratory performance can be more fully utilized. Audit models should be developed that include assessment of the outcome of the laboratory testing process.

Clinical Competence↗
PubMed2003

Use of a major medical center clinical laboratory as a reference laboratory for a developing country: ordering patterns help set laboratory priorities.

BACKGROUND: The test menus for developed and developing countries may differ, depending on many factors, including the expected volume of testing, disease frequency and therapies available, clinical impact of the test, technical skill and equipment needed, cost, the patient population served, and whether alternative testing sites are available, and some of them may not be exactly known. We assessed test priorities in a developing country by making a broad range of tests available and then assessing which tests were actually used by the physicians in the country for the care of their patients. METHODS: The Barnes-Jewish Hospital laboratory and Washington University Medical Center provided patients in the developing country of Eritrea access to the same tests as patients in St. Louis for all analytes that are stable at 4 degrees C, the lowest temperature that could be used for shipping. RESULTS: The use of the St. Louis laboratories increased steadily from 1998 to 2001. More than one-half of the physicians in Eritrea used the reference laboratories, with requests for thyroid function and female fertility representing 48-71% of the test requests over the 4 years evaluated. The high degree of utilization for these test batteries was not predicted. Testing for thyroid function, female fertility, and lipid panels are now performed, or soon will be performed, in Eritrea based on the experience of the reference laboratory system. The reference laboratory system is continuing so that the test priorities of the country can be evaluated on an ongoing basis and specialized tests can be made available at a low cost. CONCLUSION: The experiences of a reference laboratory for a developing country can help to identify unanticipated priorities for medical testing within the country.

Clinical Laboratory Techniques↗
PubMed1982

Standards for laboratory accreditation.

After years of review by all of the CAP resource and other committees and councils, the Commission on Laboratory Accreditation developed a revised Standards for Accreditation of Medical Laboratories (Last revision, 1974). They were approved by the House of Delegates and, in the February issue of Pathologist '82, comments were solicited from the entire membership. Presented in the following pages are the final Standards for Laboratory Accreditation, which the Board of Governors adopted as CAP policy at its Sept. 2-4 meeting in Traverse City, Mich.

Accreditation↗
PubMed1980

Patients in the dark about pathologist functions.

Pathologists are little known to the public. In a day when each dollar for health care is so closely scrutinized, such a lack of understanding may lead to lack of support for our profession. Early this year, outpatients at the Milwaukee County Medical Complex in Wisconsin answered questions concerning laboratory tests, medical laboratories, and pathologists. The results revealed a severe lack of knowledge about pathologist functions, and, according to the authors, illustrates well the need for patient and public education about medical laboratory services. The results of the survey presented here were used in creating an educational videofilm, prepared within the Department of Pathology of the Medical College of Wisconsin, which was shown during the recent National Medical Laboratory Week in the same outpatient laboratory where the polling occurred.

Awareness↗
PubMed1986

How to make laboratory information more informative.

I review psychological literature relevant to the design of medical laboratory data reports and computer display systems, illustrate how to improve such systems, and discuss needs for further research.

Computers↗
PubMed2005

The late Greco-Roman and Byzantine contribution towards the evolution of laboratory examinations of bodily excrement. Part 2: sputum, vomit, blood, sweat, autopsies.

Although the establishment of medical laboratory institutions was a continuous process that matured only after the 16th century, several attempts had already been made to attain a diagnosis by investigating bodily excrement. In the first part of our work, published in a previous issue of this journal, we presented data on urine, sperm, menses and stools. In this paper we present data on sputum, vomit, blood, sweat, and autopsies, thus completing the list of human materials used for laboratory examinations. All the data used are extracted from codices of Late Antiquity and Byzantium and translated by us. We did not study medical texts from the other great ancestors of Western medicine, namely Arabic and Jewish writings. From the texts cited, it is apparent that the lack of technological means was no obstacle for the doctor to create an "examinational" mind, i.e., to try to correlate the macroscopic findings in the excrement with the pathophysiological mechanism that induced them, solely with the use of the senses. This not only applies to the examination of urine, as is commonly assumed, but also to many other excrements of the upper and lower orifices of the body, as well as the human body as a whole.

Autopsy↗
PubMed2003

Should informed consent be required for laboratory testing for drugs of abuse in medical settings?

Laboratory testing for drugs of abuse is often conducted in medical settings, with little consideration of the technical limitations and the potential for legal and social harm to the patient. We consider several technical problems associated with such testing, including the lack of chain-of-custody procedures, the possibility of false-positive results with screening immunoassays, and the infrequency of confirmatory testing. Important ethical issues arise because of the sensitive nature of drug test results, the ramifications of false-positive results, the limitations of confidentiality protection, and the practice of testing without the patient's knowledge. Taken together, these technical and ethical concerns suggest that drug testing policies in medical settings should specify which conditions require explicit informed consent, as well as create procedures for protecting this sensitive information.

Confidentiality↗
PubMed1999

The impact on accuracy and cost of ligase chain reaction testing by pooling urine specimens for the diagnosis of Chlamydia trachomatis infections.

BACKGROUND AND OBJECTIVES: Nucleic acid amplification testing is the most accurate approach to diagnosing Chlamydia trachomatis infections. Our objective was to compare the accuracy and cost savings of pooling urines as opposed to individual testing. STUDY DESIGN: Strategies of pooling urine specimens into groups of four (4x pool) or eight (8x pool) followed by testing the positive pools individually were compared to individual specimen testing to determine if significant cost savingS could be realized without compromising the sensitivity and specificity of the LCx C. trachomatis Assay (Abbott Laboratories, Abbott Park, Chicago, IL) performed in a busy private medical laboratory. RESULTS: A total of 1,220 patient urine samples, 1,187 male (97%) and 33 female (3%), were tested using the normal LCx specimen to cutoff ratio (S/CO) of 1.0 and a decreased S/CO value of 0.2. Individual testing identified 98.2% (109/111) of positive urines. The 4x pooling maneuver identified 92.8% (103/111) of positive patients with the regular cutoff and 96.4% (107/111) when the cutoff was decreased. These values were 95.9% (47/49) and 97.9% (48/49), respectively, when eight urines were pooled. Both pooling and individual testing strategies identified all the negative samples accurately. Cost savings of pooling were calculated to be 44.5% for pools of four and 37.5% for pools of eight, applying the lowered cutoff. CONCLUSIONS: Pooling urine specimens for testing with the C. trachomatis LCx system is a simple, accurate, and cost-saving approach that can significantly reduce the cost of amplified nucleic acid testing with minimal sacrifice of testing accuracy.

Adolescent↗
PubMed1992

A critical study into the fecal analysis routine in practice in Jordan.

The fecal analysis routine adopted by 21 diagnostic medical laboratories in Jordan was surveyed by the means of a questionnaire filled in by the senior year medical technology students who spent 16 weeks in these laboratories as trainees. The recommended routine fecal analysis was not completed satisfactorily by any of the laboratories surveyed. The wet mount microscopic examination was the sole technical test done for the examination of parasite and ova by the majority of the laboratories, 90% (19 of 21). None of the surveyed laboratories adopted the routine use of a concentration technique. One hundred and eight known positive stool specimens were examined by four qualified medical technologists. The wet mount technique revealed positivity in 53% of specimens only, while the formol-ether sedimentation technique yielded 98-100% positivity. This indicates the value of the formol-ether sedimentation technique over the practiced wet mount technique in the routine fecal analysis.

Clinical Protocols↗