[AT THE CROSSROADS: THE ROLE OF LABORATORY MEDICINE IN THE PATIENT CARE PROCESS].

INTRODUCTION: In recent decades, the laboratory medicine profession has undergone significant changes due to both technological developments and economic constraints. Technological innovations support automation, provide faster and more accurate equipment, and allow increased efficiency through the use of commercial test kits. These changes, combined with budgetary constraints, have led to mergers and centralization of medical laboratories to optimize work and cut costs. While this centralization may be a business necessity, it leads to a disconnection between the laboratory and the clinical context. In addition, laboratory tests are treated as a commodity, which places emphasis on price only, rather than quality. In this article, we review the developments and changes that medical laboratories and the laboratory medicine profession have undergone in recent decades. We focus on technological and structural challenges affecting the functioning of medical laboratories and the relations between laboratory workers and medical teams. We then introduce vocational education changes required for the laboratory medicine profession. We propose defining the role of medical laboratory directors in terms of their basic training as medical doctors or doctors of science. We suggest that laboratory employees should become a reliable source of information regarding selection of appropriate test methods, processing data and presenting the results to the medical staff. Laboratory workers must deepen their clinical knowledge and become an integral part of the patient care process, along with medical and nursing staff. Special training programs for medical laboratory workers and directors must be developed in order to match the complex activities currently being conducted in laboratories.

[MEASURING ADHERENCE TO SELF-CARE GUIDELINES FOR PATIENTS WITH TYPE 2 DIABETES WITH DIABETIC ULCERS ADMITTED to THE ORTHOPEDIC REHABILITATION DEPARTMENT AT TEL HASHOMER HOSPITAL DURING 2012-2013].

INTRODUCTION: Diabetic foot is a devastating complication of diabetes and represents the major cause of lower limb amputations in the western world in the 21st century. The World Health Organization predicts a dramatic increase in the number of diabetes patients over the next decade and by the year 2025, their number is expected to increase to 300 million. AIMS: Examine whether training leads to improving performance in the built-in self-care guidelines in patients with type 2 diabetes who were hospitalized with diabetic ulcers in the Orthopedic Rehabilitation Ward in Tel Hashomer between the years 2012-2013. METHODS: The study included 68 type 2 diabetic patients with diabetic ulcer aged 30-80 years, regardless of gender, who were hospitalized following a worsening ulcer. The research tools included demographic, medical and self-care diligence questionnaires and HbA1c measurements in a sugar balance report. RESULTS: Results show significant change in eating habits, number of patient measurements performed during the week and treatment of the diabetic foot between the treatment group and the control group. In addition, support has been found to positively affect self-care response. The only variable where no benefit changes could be observed was the medicines consumption variable. DISCUSSION: Prescriptive guidance, routinely performed, results in improvement in self-care among diabetic patients. Mentoring is enabling people to understand the importance of carrying out instructions received.

Effect measure modification and confounding of severe head injury mortality by age and multiple organ injury severity.

PURPOSE: The study aim is to assess confounding and effect measure modification of the relationship between head injury severity (measured using the Glasgow Coma Scale [GCS]) and mortality by age and multiple organ injury (measured using the Injury Severity Score [ISS]). Head injury-related mortality is affected by head injury severity, as well as age and multiple organ injury. However, little is known about the effect modification of these relationships. METHODS: Stratifications and multiple logistic regression analyses examined the association of mortality with GCS score less than 9, controlled for ISS of 16 and higher or age of 55 years and older. Receiver operating curve (ROC) analyses were used to explore the relationship of GCS cutoff values and prediction of death by the ISS and age categories mentioned. RESULTS: Both age and ISS modified head injury mortality in a similar direction: there was a negative interaction between age and ISS and more severe head injury. Lower GCS values (indicating more severe head injury) related more strongly to mortality in younger persons. Lower GCS values related more strongly to mortality when extracranial injuries were less severe. These data indicate effect modification. Data indicate negative confounding of the association between GCS and mortality by age and positive confounding by ISS. Multivariate analyses indicate that only younger age modifies the effect of more severe head injury with statistical significance when both age and multiple organ injury are considered. ROC analyses conducted with stratified and logistic regression analyses indicate that GCS is a better predictor of death in those with younger age. CONCLUSIONS: The relationship of head injury severity and mortality is modified and confounded by age and ISS. GCS is a better predictor of death in younger patients.