Strategies for Sustainability of University-Based Medical Laboratory Sciences Programs.

The COVID-19 pandemic has taken a major toll on the economy and funding for public education. For that reason, the pandemic has a worrisome effect on the sustainability of university/college based Medical Laboratory Sciences MLS training programs. Stakeholders of university-based MLS programs include university administrators, students, clinical affiliates and faculty. Each group has specific goals and challenges that affect the sustainability of the program. This report details strategies that can be used to satisfy the goals specific to key stakeholders that lead to sustainability. These strategies apply in pandemic times and in the back-to-normal future.

Development of low-cost cardiac and skeletal muscle laboratory activities to teach physiology concepts and the scientific method.

Anatomy and Physiology courses taught at community colleges tend to focus laboratory hours primarily on anatomy as opposed to physiology. However, research demonstrates that, when instructors utilize active learning approaches (such as in laboratory settings) where students participate in their own learning, students have improved outcomes, such as higher test scores and better retention of material. To provide community college students with opportunities for active learning in physiology, we developed two laboratory exercises to engage students in cardiac and skeletal muscle physiology. We utilized low-cost SpikerBox devices to measure electrical activity during cardiac (electrocardiogram) and skeletal muscle (electromyogram) contraction. Laboratory activities were employed in Anatomy and Physiology courses at two community colleges in southeast Michigan. A 2-h laboratory period was structured with a 20-min slide presentation covering background material on the subject and experiments to examine the effects of environmental variables on nervous system control of cardiac and skeletal muscle contraction. Students were asked to provide hypotheses and proposed mechanisms, complete a results section, and provide conclusions for the experiments based on their results. Our laboratory exercises improved student learning in physiology and knowledge of the scientific method and were well-received by community college students enrolled in Anatomy and Physiology. Our results demonstrate that the use of a SpikerBox for cardiac and skeletal muscle physiology concepts is a low-cost and effective approach to integrate physiology activities into an Anatomy and Physiology course.

Quo Vadis Point-of-Care Diagnostics? Report II of the SWISS SYMPOSIUM in Point-of-Care Diagnostics 2017.

U.S. studies show that the global point-of-care (POC) diagnostics market will reach $40.5 bn by 2022, with a compound annual growth rate (CAGR) of 10%. This is one of the reasons why HES-SO Valais-Wallis and CSEM, acting on behalf of the NTN Swiss Biotech thematic platform in vitro Diagnostics (TP IVD), invited interested parties on October 26, 2017 to the SWISS SYMPOSIUM in Point-of-Care Diagnostics (see CHIMIA No. 12/2017). We now bring the second report on the future prospects of POC diagnostics.

Leveraging the real value of laboratory medicine with the value proposition.

Improving quality and patient safety, containing costs and delivering value-for-money are the key drivers of change in the delivery of healthcare and have stimulated a shift from an activity-based service to a service based on patient-outcomes. The delivery of an outcomes-based healthcare agenda requires that the real value of laboratory medicine to all stakeholders be understood, effectively defined and communicated. The value proposition of any product or service is the link between the provider and the needs of the customer describing the utility of the product or service in terms of benefit to the customer. The framework of a value proposition for laboratory medicine provides the core business case that drives key activities in the evolution and maintenance of high quality healthcare from research through to adoption and quality improvement in an established service. The framework of a value proposition for laboratory medicine is described. The content is endorsed by IFCC and WASPaLM.

[What Has Been Done in Surugadai Nihon University Hospital as a Laboratory Physician--Encounter with FAB Classification and Establishing the Additional Laboratory Management Fee].

I was requested by Nihon University to contribute to the official journal of the Japanese Society of Laboratory Medicine (Rinsho Byori). A special review of the final lecture at Surugadai Nihon University Hospital was requested by the editorial board of the Japanese Society of Laboratory Medicine. I submitted a review under the heading of "I have carried out upon retirement, ..." based on the final lecture at Surugadai Nihon University Hospital. The contents of the lecture were how to widely disseminate the FAB classification of acute leukemia and how to establish an additional laboratory management fee. Finally, I showed how to charge an additional management fee correctly based on a laboratory physician's activities in Surugadai Nihon University Hospital. I summarize the lecture in this article.

[A Perspective on Innovation for Efficient Medical Practice in View of Undergraduate and Postgraduate Education and Training in Laboratory Medicine].

Continuous advances in medical laboratory technology have driven major changes in the practice of laboratory medicine over the past two decades. The importance of the overall quality of a medical laboratory has been ever-increasing in order to improve and ensure the quality and safety of clinical practice by physicians in any type of medical facility. Laboratory physicians and professional staff should challenge themselves more than ever in various ways to cooperate and contribute with practicing physicians for the appropriate utilization of laboratory testing. This will certainly lead to a decrease in inappropriate or unnecessary laboratory testing, resulting in reducing medical costs. In addition, not only postgraduate, but also undergraduate medical education/training systems must be markedly innovated, considering recent rapid progress in electronic information and communication technologies.

Clinical integration of next generation sequencing: coverage and reimbursement challenges.

Public and private payers face complex decisions regarding whether, when, and how to cover and reimburse for next generation sequencing (NGS)-based tests. Yet a predictable reimbursement pathway is critical both for patient access and incentives to provide the market with better clinical evidence. While preliminary data suggests that payers will use similar evidentiary standards as those used to evaluate established molecular diagnostic tests, the volume and complexity of information generated by NGS raises a host of additional considerations for payers that are specific to this technology.

Healthcare reform 101.

The intent of the Affordable Care Act is to ensure that all Americans have access to quality, affordable healthcare while significantly reducing the cost burden for this country. It is estimated that an additional 32 million individuals will be covered. The Congressional Budget Office (CBO) estimates this legislation will reduce the deficit by $143 billion in the first 10 years (2011-2020) with an additional $1.2 trillion in savings during the subsequent decade. comprehend and change. That is why it has taken so long to pass any legislation related to this issue. We are almost 50 years post-introduction of Medicare and Medicaid and while there has been much dialogue and a number of infamous attempts to tackle the issue, the ACA is the first successful attempt to pass legislation. History will tell if Congress and the President "got it right" but the alternative of doing nothing was also unacceptable. One might predict that some of what has been legislated and already implemented will stand and result in positive change (i.e. the focus on preventive health and wellness) while other aspects will require change - some minor and some major. We are already seeing changes and timelines that are being modified and delayed. This is a topic that will require an ongoing assessment and look-back to see what was done correctly and what needs to be changed.

Retention in care and outpatient costs for children receiving antiretroviral therapy in Zambia: a retrospective cohort analysis.

BACKGROUND: There are few published estimates of the cost of pediatric antiretroviral therapy (ART) in Africa. Our objective was to estimate the outpatient cost of providing ART to children remaining in care at six public sector clinics in Zambia during the first three years after ART initiation, stratified by service delivery site and time on treatment. METHODS: Data on resource utilization (drugs, diagnostics, outpatient visits, fixed costs) and treatment outcomes (in care, died, lost to follow up) were extracted from medical records for 1,334 children at six sites who initiated ART at <15 years of age between 2006 and 2011. Fixed and variable unit costs (reported in 2011 USD) were estimated from the provider's perspective using site level data. RESULTS: Median age at ART initiation was 4.0 years; median CD4 percentage was 14%. One year after ART initiation, 73% of patients remained in care, ranging from 60% to 91% depending on site. The average annual outpatient cost per patient remaining in care was $209 (95% CI, $199-$219), ranging from $116 (95% CI, $107-$126) to $516 (95% CI, $499-$533) depending on site. Average annual costs decreased as time on treatment increased. Antiretroviral drugs were the largest component of all outpatient costs (>50%) at four sites. At the two remaining sites, outpatient visits and fixed costs together accounted for >50% of outpatient costs. The distribution of costs is slightly skewed, with median costs 3% to 13% lower than average costs during the first year after ART initiation depending on site. CONCLUSIONS: Outpatient costs for children initiating ART in Zambia are low and comparable to reported outpatient costs for adults. Outpatient costs and retention in care vary widely by site, suggesting opportunities for efficiency gains. Taking advantage of such opportunities will help ensure that targets for pediatric treatment coverage can be met.

[The algorithms of evaluation of economic effectiveness of laboratory technologies].

The article considers several practical situations requiring estimation of economic effectiveness. The protocols of estimation, costs and effectiveness accounting requirements of practical public health are proposed. The necessity of development of correct epidemiological model is demonstrated to estimate profit of innovations of diagnostic stage. The estimation "costs-effectiveness" is made for troponins at diagnostic of cardiac infarction and prostate-specific antigen under screening of prostate cancer.

Changing trends in laboratory testing in the United States: a personal, historical perspective.

This article reflects on my nearly 40 years providing clinical and laboratory genetic services. It reviews the evolution of laboratory and genetic testing from their grant-supported academic research to current complexities. Changes in the economic and academic landscape parallel technological innovations in laboratory testing. My career trajectory parallels the newer trend of genetic testing. I began in academics, working as a student and postdoctoral fellow in academic laboratories that also provided clinical testing services. Next came time in a small molecular laboratory performing diagnosis and testing services. My current position is with a national commercial laboratory company.

Análisis de la demanda de pruebas microbiológicas en el área sanitaria sur de Lugo: influencia del nivel asistencial y del servicio peticionario / Analysis of the demand of microbiological tests in the sanitary south area of Lugo: influence of the health care level and of the petitioner service

Introducción. El objetivo de este trabajo es estudiar la influencia del nivel asistencial y del centro de salud o servicio peticionario en la demanda de pruebas microbiológicas. Material y métodos. Se utilizaron como fuentes de información para este estudio el sistema informático del laboratorio central y la memoria del Hospital Comarcal de Monforte. Resultados. El porcentaje de peticiones realizadas al laboratorio que contenían pruebas microbiológicas fue superior en atención primaria que en atención especializada (31,9 vs 23,8%). Se encontraron diferencias significativas en las tasas de peticiones de pruebas microbiológicas no serológicas entre los distintos centros de salud de atención primaria, las cuales oscilaron entre una tasa máxima del 294‰ y una tasa mínima del 54‰ Las tasas de peticiones de pruebas serológicas fueron similares entre los distintos centros de salud. Sin embargo, hubo diferencias significativas en el porcentaje de cultivos de orina positivos. En la atención especializada hubo diferencias significativas entre los distintos servicios en las tasas de peticiones de pruebas microbiológicas no serológicas y serológicas y la intensidad de uso de las pruebas microbiológicas en pacientes hospitalizados estuvo asociada con el peso medio de los GRD relacionados con las enfermedades infecciosas. Conclusiones. Existen diferencias en el uso de pruebas microbiológicas tanto entre niveles asistenciales como entre los distintos centros de salud de atención primaria o servicios de atención especializada. Las diferencias entre los distintos centros de salud de atención primaria podrían ser debidas a factores no relacionados con necesidades de salud de la población (AU)

Background. The aim of this work is to study the influence of the health care level and of the health centre and petitioner service on the demand for microbiological tests. Material and methods. The computer system of the central laboratory and the annual report of the Regional Hospital of Monforte were used as sources of information for this study. Results. The percentage of requests made to the laboratory that contained microbiological tests was higher in primary than in specialized care (31.9% vs 23.8%). We found significant differences in the rates of requests for non-serological microbiological tests between the different primary care health centres, which ranged between a maximum rate of 294‰ and a minimal rate of 54‰. Rates of serology requests were similar between for the different health centres. Nevertheless, there were significant differences between the health centres in the percentage of positive urine cultures. In specialized care there were significant differences between the different services in the rates of requests of both non-serological and serological microbiological tests and the intensity of use of the microbiological tests in hospitalized patients was associated with the average weight of the DRG (diagnosis related group) related to infectious diseases. Conclusions. There are differences in the use of microbiological tests both between health care levels (primary or specialized care) and between primary care health centres or specialized care services. The differences between primary care health centres might be due to factors unrelated to the needs of health of the population (AU)

It takes a community to resurrect a CLS program.

Florida Gulf Coast University (FGCU) revised and reactivated its former 2+2 NAACLS accredited program in 2006, by instituting an innovative 3+1 approach. With the efforts of the community laboratories, FGCU instituted an innovative structure which made its CLS program more viable by greatly reducing expenses of operation without sacrificing the quality of education.