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.

[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.

[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.

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.

[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.

Evaluating the effects of imputation on the power, coverage, and cost efficiency of genome-wide SNP platforms.

Genotype imputation is potentially a zero-cost method for bridging gaps in coverage and power between genotyping platforms. Here, we quantify these gains in power and coverage by using 1,376 population controls that are from the 1958 British Birth Cohort and were genotyped by the Wellcome Trust Case-Control Consortium with the Illumina HumanHap 550 and Affymetrix SNP Array 5.0 platforms. Approximately 50% of genotypes at single-nucleotide polymorphisms (SNPs) exclusively on the HumanHap 550 can be accurately imputed from direct genotypes on the SNP Array 5.0 or Illumina HumanHap 300. This roughly halves differences in coverage and power between the platforms. When the relative cost of currently available genome-wide SNP platforms is accounted for, and finances are limited but sample size is not, the highest-powered strategy in European populations is to genotype a larger number of individuals with the HumanHap 300 platform and carry out imputation. Platforms consisting of around 1 million SNPs offer poor cost efficiency for SNP association in European populations.

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.

Student molecular laboratory performance outcomes in a baccalaureate CLS program.

UNLABELLED: As new molecular assays are developed in research laboratories and approved by the Food and Drug Administration (FDA) for clinical use, molecular diagnostics becomes an integral discipline of clinical laboratory science. Since 2001, guidelines of the National Accreditation Agency for Clinical Laboratory Science (NAACLS) have required that CLS Educational Programs incorporate molecular diagnostics into the curriculum. SETTING: In fall of 2005, CLS faculty/researchers, affiliated with a baccalaureate program in an academic medical university, incorporated molecular diagnostic lecture content with online virtual laboratories into the Clinical Chemistry course. Then beginning in fall of 2006, manual performance of molecular laboratory exercises was introduced. OBJECTIVE: The aim of this study was to assess whether inclusion of hands-on molecular laboratories improved student outcomes on molecular questions during the final course examination. METHOD: CLS faculty evaluated student learning by written examination of lecture and laboratory content. Researchers performed two-sample t-tests to establish if significant differences existed in molecular questions scores achieved by students exposed to virtual and hands-on exercises. RESULTS: The researchers found a statistically significant difference in examination performance between the students that had a hands-on experience and students with virtual laboratory experience only. Further data analysis suggested that hands-on experiential laboratories had the greatest effect on students who performed in the middle percentiles. CONCLUSION: The researchers proposed that in order to improve examination scores of the weakly performing students other interventions may be necessary such as more lecture or laboratory time. This prompted development of a full time clinical molecular methods course, separate from Clinical Chemistry.

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.

Medical technology adoption, uncertainty, and irreversibilities: is a bird in the hand really worth more than in the bush?

The influence of current medical technology adoption decisions on the use of future potential interventions is often overlooked. Some health interventions, once exercised, restrict future potential interventions for both related and unrelated medical conditions. For example, treatment of a patient with an antibiotic may lead to resistance in that patient that precludes future treatment with the same or related compounds. This irreversibility raises the value of treatment modalities that preserve future treatment options. Surprisingly, partial reversibility with or without learning can either increase or decrease this value, depending on the distribution of patient types within the treated population. Evaluations that ignore these option values miss an important part of the welfare equation that is becoming increasingly important as individuals live longer and the stock of medical treatments increases.

Much cheaper, almost as good: decrementally cost-effective medical innovation.

Under conditions of constrained resources, cost-saving innovations may improve overall outcomes, even when they are slightly less effective than available options, by permitting more efficient reallocation of resources. The authors systematically reviewed all MEDLINE-cited cost-utility analyses written in English from 2002 to 2007 to identify and describe cost- and quality-decreasing medical innovations that might offer favorable "decrementally" cost-effective tradeoffs-defined as saving at least $100 000 per quality-adjusted life-year lost. Of 2128 cost-effectiveness ratios from 887 publications, only 9 comparisons (0.4% of total) described 8 innovations that were deemed to be decrementally cost-effective. Examples included percutaneous coronary intervention (instead of coronary artery bypass graft) for multivessel coronary disease, repetitive transcranial magnetic stimulation (instead of electroconvulsive therapy) for drug-resistant major depression, watchful waiting for inguinal hernias, and hemodialyzer sterilization and reuse. On a per-patient basis, these innovations yielded savings from $122 to almost $12 000 but losses of 0.001 to 0.021 quality-adjusted life-years (approximately 8 hours to 1 week). These findings demonstrate the rarity of decrementally cost-effective innovations in the medical literature.

Financial analysis of technology acquisition using fractionated lasers as a model.

Ablative fractional lasers are among the most advanced and costly devices on the market. Yet, there is a dearth of published literature on the cost and potential return on investment (ROI) of such devices. The objective of this study was to provide a methodological framework for physicians to evaluate ROI. To facilitate this analysis, we conducted a case study on the potential ROI of eight ablative fractional lasers. In the base case analysis, a 5-year lease and a 3-year lease were assumed as the purchase option with a $0 down payment and 3-month payment deferral. In addition to lease payments, service contracts, labor cost, and disposables were included in the total cost estimate. Revenue was estimated as price per procedure multiplied by total number of procedures in a year. Sensitivity analyses were performed to account for variability in model assumptions. Based on the assumptions of the model, all lasers had higher ROI under the 5-year lease agreement compared with that for the 3-year lease agreement. When comparing results between lasers, those with lower operating and purchase cost delivered a higher ROI. Sensitivity analysis indicates the model is most sensitive to purchase method. If physicians opt to purchase the device rather than lease, they can significantly enhance ROI. ROI analysis is an important tool for physicians who are considering making an expensive device acquisition. However, physicians should not rely solely on ROI and must also consider the clinical benefits of a laser.

Components of a comprehensive capital equipment planning program.

As you may have already figured out, there is crossover and gaps between all of these capital equipment components. CE often will, and proactively should, make recommendations based on the CE, clinical, and financial components but rarely has direct knowledge of the strategic element. The clinical, finance, and administrative folks likely have visibility to most of these, but may lack full awareness of at least one component. The key is to engage key stakeholders from all these critical areas and develop a process to pull all this information together in one nice, neat package. Defining the person or persons responsible for taking the lead on this in your organization will depend greatly on the organization's type and size. For a single, standalone community hospital, it will likely be the facility administrator. For an integrated delivery network (IDN), a corporate entity, led by supply chain, finance, or both, may take the lead. Your organization may also employ consultative services or software to help facilitate this function. Regardless of who takes the lead, a weighting or scoring system that assigns certain values in all the outlined component categories, is clearly defined, and is easy to understand for all the contributors will need to be developed. If you are unaware or unclear of what the process is, find out and figure out how you can be a vital contributor to the process. This is one more way you can demonstrate the value you and your department bring to your organization.

Healthcare costs for new technologies.

INTRODUCTION: Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. OBJECTIVE: This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. DISCUSSION: Avoidable healthcare cost drivers are identified and related policy issues are discussed.

Medical technology and cost containment: two applications of operations research.

The government proposes "common sense" regulations to help contain rising health costs due to the increasing use of high-technology procedures, such as computerized tomography scanning. Two illustrations are given showing that such ad hoc regulations may have the effect of increasing costs and are certainly far from the optimum obtained by known methods of operations research.

Assessing technological change in cardiothoracic surgery.

Technological innovation--broadly defined as the development and introduction of new drugs, devices, and procedures--has played a major role in advancing the field of cardiothoracic surgery. It has generated new forms of care for patients and improved treatment options. Innovation, however, comes at a price. Total national health care expenditures now exceed $2 trillion per year in the United States and all current estimates indicate that this number will continue to rise. As we continue to seek the most innovative medical treatments for cardiovascular disease, the spiraling cost of these technologies comes to the forefront. In this article, we address 3 challenges in managing the health and economic impact of new and emerging technologies in cardiothoracic surgery: (1) challenges associated with the dynamics of technological growth itself; (2) challenges associated with methods of analysis; and (3) the ways in which value judgments and political factors shape the translation of evidence into policy. We conclude by discussing changes in the analytical, financial, and institutional realms that can improve evidence-based decision-making in cardiac surgery.

The influence of economic incentives and regulatory factors on the adoption of treatment technologies: a case study of technologies used to treat heart attacks.

The Technological Change in Health Care Research Network collected unique patient-level data on three procedures for treatment of heart attack patients (catheterization, coronary artery bypass grafts and percutaneous transluminal coronary angioplasty) for 17 countries over a 15-year period to examine the impact of economic and institutional factors on technology adoption. Specific institutional factors are shown to be important to the uptake of these technologies. Health-care systems characterized as public contract systems and reimbursement systems have higher adoption rates than public-integrated health-care systems. Central control of funding of investments is negatively associated with adoption rates and the impact is of the same magnitude as the overall health-care system classification. GDP per capita also has a strong role in initial adoption. The impact of income and institutional characteristics on the utilization rates of the three procedures diminishes over time.

Analysing uncertainty around costs of innovative medical technologies: the case of fibrin sealant (QUIXIL) for total knee replacement.

This paper presents a relatively simple cost model comparing the costs of using a commercial fibrin sealant (QUIXIL) in addition to conventional haemostatic treatment vs. conventional treatment alone in total knee replacement (TKR) surgery, and demonstrates and discusses how one- and two-way sensitivity analyses can inform decisions regarding an innovative medical technology, for which there is limited evidence on economic parameters. The model synthesises data from various sources and assesses the proportion of individuals likely to need blood transfusion, the resource use after TKR and transfusion-related adverse events. Whether using fibrin sealant is cost saving strongly depends on the amount used, the achieved reduction in hospital length of stay (LOS) and price of QUIXIL. If a 10-ml dose of fibrin sealant is required to achieve the effects as described in the published trials, its use adds cost, but if 25% or more of patients are treated with a 5-ml dose, its use becomes cost saving for the NHS. The sensitivity analyses provide clear guidance regarding parameters for additional data collection; design of future trials; and product pricing in relation to its effectiveness, and are likely to be preferred over more sophisticated approaches to inform medical device decision-making, particularly at the local level.