Evidence based practice and advanced competencies in a MHS-CLS program.

The goals, curriculum, implementation, and immediate impacts of an entry-level Master of Health Science in Clinical Laboratory Science (MHS-CLS) degree are described as compared to the baccalaureate program (BS-CLS) in the same institution. The MHS-CLS program was instituted in fall semester, 2008; the inaugural class graduated in spring semester 2010. To document the need for the MHS-CLS, program statistics, such as the number of students entering the current BS-CLS program with previous baccalaureate degrees, numbers of students graduating with biology and chemistry degrees in the United States, CLS workforce shortages and pending retirement statistics were used. The shortage of CLS practitioners able to perform and publish evidence-based practice research also supported program need. The MHS-CLS curriculum includes advanced courses, advanced competencies incorporated into existing BS-CLS courses, and a capstone research project in evidence based practice.

The roles of the clinical laboratory scientist: educator, consultant, advocate.

Advances in clinical laboratory medicine have created an opportunity for clinical laboratory scientists to assume a new role--the role of educator in the integrated healthcare system. A gap created between critical laboratory test results and medical decisions requires the translation of laboratory results into meaningful clinical guidelines. This article suggests three ways the clinical laboratory scientist can fill this gap.

Effectiveness of Practices to Support Appropriate Laboratory Test Utilization: A Laboratory Medicine Best Practices Systematic Review and Meta-Analysis.

OBJECTIVES: To evaluate the effectiveness of practices used to support appropriate clinical laboratory test utilization. METHODS: This review followed the Centers for Disease Control and Prevention (CDC) Laboratory Medicine Best Practices A6 cycle method. Eligible studies assessed one of the following practices for effect on outcomes relating to over- or underutilization: computerized provider order entry (CPOE), clinical decision support systems/tools (CDSS/CDST), education, feedback, test review, reflex testing, laboratory test utilization (LTU) teams, and any combination of these practices. Eligible outcomes included intermediate, systems outcomes (eg, number of tests ordered/performed and cost of tests), as well as patient-related outcomes (eg, length of hospital stay, readmission rates, morbidity, and mortality). RESULTS: Eighty-three studies met inclusion criteria. Fifty-one of these studies could be meta-analyzed. Strength of evidence ratings for each practice ranged from high to insufficient. CONCLUSION: Practice recommendations are made for CPOE (specifically, modifications to existing CPOE), reflex testing, and combined practices. No recommendation for or against could be made for CDSS/CDST, education, feedback, test review, and LTU. Findings from this review serve to inform guidance for future studies.

Evaluating distance learning in clinical laboratory science.

OBJECTIVE: The purpose of this study was to determine if there were any significant differences in academic performance between distance students and on-campus students in clinical laboratory science. DESIGN: A quantitative causal comparative research design was used. SETTING: The research study was conducted at an academic health sciences university in the eastern United States. PATIENTS OR OTHER PARTICIPANTS: Anecdotal graduate data were collected from students that had graduated from the Clinical Laboratory Science (CLS) program. INTERVENTIONS: The students had either received their CLS education via distance or through the traditional on-campus methods. MAIN OUTCOME MEASURES: Academic performance was the major outcome measured. This was determined by comparing distance students' final grade point average (GPA) scores and certification scores to their on-campus counterparts. RESULTS: The researchers found no significant difference in gender between distance and on-campus students; however, there was a significant difference in age. On average the distance students were older than their on-campus counterparts. There were no significant differences found for mean overall admission GPA, mean math science admission GPA, mean final GPA score, and mean certification score. There were also no differences found in any of the subcategories of the certification exam except for urinalysis. For the urinalysis subcategory the distance students significantly outperformed their on-campus counterparts. Correlation studies showed that there were significant positive correlations between overall admission GPAs, math science admission GPAs, final GPA scores, and certification scores. CONCLUSIONS: The researchers have shown that distance learning CLS graduates are as academically prepared as their on-campus counterparts.

Lipoprotein Biomarkers and Risk of Cardiovascular Disease: A Laboratory Medicine Best Practices (LMBP) Systematic Review.

BACKGROUND: Controversy exists about the incremental utility of nontraditional lipid biomarkers [e.g., apolipoprotein (apo) B, apo A-I, and non-HDL-C] in improving cardiovascular disease (CVD) risk prediction when added to a conventional model of traditional risk factors (e.g., total cholesterol, LDL cholesterol, HDL cholesterol, sex, age, smoking status, and blood pressure). Here we present a systematic review that was conducted to assess the use of nontraditional lipid biomarkers including apo B, apo A-I, apo B/A-I ratio, and non-HDL-C in improving CVD risk prediction after controlling for the traditional risk factors in populations at risk for cardiovascular events. CONTENT: This systematic review used the Laboratory Medicine Best Practices (LMBP™) A-6 methods. A total of 9 relevant studies published before and including July 2015 comprised the evidence base for this review. Results from this systematic review indicated that after the adjustment for standard nonlipid and lipid CVD risk factors, nontraditional apolipoprotein biomarkers apo B (overall effect = relative risk: 1.31; 95% CI, 1.22-1.40; 4 studies) and apo B/apo A-I ratio (overall effect = relative risk: 1.31; 95% CI, 1.11-1.38; 7 studies) resulted in significant improvement in long-term CVD risk assessment. SUMMARY: Available evidence showed that nontraditional lipid biomarkers apo B and apo B/apo I ratio can improve the risk prediction for cardiovascular events after controlling for the traditional risk factors for the populations at risk. However, because of insufficient evidence, no conclusions could be made for the effectiveness of apo A-I and non-HDL-C lipid markers to predict the CVD events, indicating a need for more research in this field.