Defining laboratory medicine, or squaring the circle?

In the August 2020 issue of Clinical Chemistry and Laboratory Medicine, Giuseppe Lippi and Mario Plebani proposed a definition of laboratory medicine, which ends with this sentence: "The results of these measurements are translated into actionable information for improving the care and/or maintaining the wellness of both a single individual and an entire population". Nevertheless, the selfishness of individuals may, sometimes, jeopardize the interest of whole populations. The virtue of justice being within the reach of the entire human community more than of single individuals, the final sentence in the definition proposed by Giuseppe Lippi and Mario Plebani, should therefore, in our view, be rewritten, less selfishly, for example like this: "For a given investment, these measurements are preferably made when they bring as much beneficence, and non-maleficence, as possible to the whole population".

Value-based healthcare: the role of laboratory medicine.

The global increase of health demands pushes administrators and policy makers to provide good quality health care at sustainable costs. Many approaches have been developed, among which value-based health care (VBHC) is one of the most promising: value is given by outcomes achieved per dollar spent. Best value is given by shared benefits between all the stakeholders involved in the process: patients, providers, suppliers, payers and citizens. However, VBHC implementation is a current challenge for hospitals and healthcare providers, that may find it difficult to adapt their organization into a patient-centered clinical pathway based on both classical outcomes and innovative patient-evaluation. If any contribution to improve cost-effectiveness over the full cycle of care is welcome, laboratory medicine is achieving increasing importance, by generating useful knowledge to reduce costs and improve patient care, provided by a biunivocal relationship with clinicians. On the one hand, pathologists have to emphasize the importance of laboratory data to improve diagnostic and prognostic traditional thinking. On the other hand, the same data are useful only when supported by strong evidence. Introducing laboratory medicine professionals to VBHC would be useful to achieve better skills on data outline, comparable methodologies, quality control, cost assessment, multidisciplinary coordination and patient-specific procedures.

El Laboratorio Clínico en Atención Sanitaria, ¿proceso clave o de apoyo? / The clinical laboratory in the health care system: a key or a support process?

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Infección por los virus de la hepatitis C y de la inmunodeficiencia humana y coinfección por ambos en el área de salud de León durante el período 1993-2004 / HCV and HIV infection, and coinfection in the León health area in the period 1993-2004

Fundamento: Ante la escasez de registros poblacionales, elestudio de las serologías positivas detectadas en los servicios delaboratorio puede ser una aceptable aproximación para conocerlas tendencias de determinadas infecciones. El objetivo de estetrabajo es conocer la evolución de las infecciones por los virus dela inmunodeficiencia humana (VIH) y de la hepatitis C (VHC) asícomo de la coinfección (COIN) durante el período 1993-2004.Métodos: Se utilizó la base de datos de serologías positivasdel Servicio de Laboratorio del Hospital de León. La informaciónse estudió en función de la fuente origen de las muestras. Para elcálculo de las tasas se utilizó el padrón municipal de personasmayores de 14 años. Para la población reclusa el número de internadosel último día de cada año. Se analizó el periodo comprendidoentre 1993 y 2004. Se utilizaron las pruebas de Chi-cuadradoy de Chi-cuadrado para tendencias.Resultados: El número de serologías positivas para VHC,VIH y COIN fueron respectivamente 467, 112 y 78 en 1993; 217,24 y 15 para 2002 y 294, 42 y 21 en 2004. De acuerdo con lasmuestras procedentes del hospital, banco de sangre y ambulatorios,la tasa promedio anual por 100.000 habitantes para los períodos1993-95 y 2001-04 en hombres variaron de 153,3 a 69,5 paraVHC; de 26,2 a 10,0 para VIH y de 21,7 a 3,8 para COIN. En elcaso de las mujeres de 56,6 a 37,7 para VHC, de 9,2 a 2,3 paraVIH y de 6,3 a 0,4 para COIN. En todos los casos las tendenciasfueron significativamente descendentes (p<0,05). La razón deserologías positivas de las muestras provenientes de prisión bajóentre 1993-2004 del 34,5% al 7,2% para VHC; del 11,7% al 1,1%para VIH y del 9,5% al 1,0% para COIN. De los sujetos infectadospor VHC lo estaban también por VIH el 11,5% y el 65,6% yde los infectados por VIH lo estaban por VHC.Conclusiones: Se ha observado un descenso en el número ytasas de serologías positivas a lo largo del periodo de estudio(AU)

Background: As few population studies exist, the study ofpositive serological tests detected in laboratory services may bean acceptable approximation for the assessment of HIV andHepatitis C infection and coinfection by both.Methods: A study was made of the database of positiveserologies of the Laboratory Service of León General Hospital.Data were treated in accordance with the origin of the samples. Tocalculate rates, the municipal census of persons over 14 was used.For the prison population, the number of inmates on the last dayof each year was considered. The period analysed was 1993-2004.The Chi-square test and Chi-square test for tendencies were used.Results: The number of positive serologies for HCV, HIVand coinfection were 467, 112 and 78 in 1993; 217, 24 and 15 in2002, and 294, 42 and 21 in 2004. According to the samples fromthe hospital, blood bank and health centres, the average annualrate per 100,000 inhabitants for the three-year periods 1993-95and 2001-04 in men varied from 153.3 to 69.5 for HCV, from 26.2to 10,0 for HIV and from 21.7 to 3.8 for coinfection. The figuresfor women were 56.6-37.7 for HCV, 9.2-2.3 for HIV and 6.3-0.4for coinfection. In all cases, there was a significant downwardtrend (P<0.05). The positive serologies from the prison for theperiod 1993-2004 varied between 34.5% and 7.2% for HCV,11.7%-1.1% for HIV and 9.55 and 1.0% for coinfection. Of thoseinfected by HCV, 11.5% were HIV positive, and of those infectedby HIV, 65.5% were also positive for HCV.Conclusions:A drop was observed in the number and rates ofpositive serological tests over the period studied(AU)

[Molecular pharmacogenetics in hospital laboratories in France: current data and future prospects]. / La pharmacogénétique moléculaire hospitalière en France: données actuelles et perspectives.

Molecular pharmacogenetic units have recently been established in several hospital laboratories in France. The clinical impact of these units is still limited and numerous problems of organizational, ethical, legal, technical, social and economical nature remain to be resolved. However, an increasing number of these units, a rise in their activities and an enlargement of their scope of application are foreseeable in the future. Ultimately, these units would significantly contribute to limit the public health problem caused by interindividual variabilities in drug effects. In view of these prospects, it seems essential that such hospital activity should be quickly recognised by the authorities and the various health sectors in France. It is also essential that the problems that arise from such pharmacogenetic activities should be considered by the authorities and would profit from the organization of a national network and from financial guarantees.

Ethics: a code for the laboratory.

The subject of ethics has become relevant once again since the 2004 expose of fraudulent laboratory practices involving HIV and hepatitis testing at the Maryland General Hospital. After congressional hearings into accrediting organizations entrusted to assure healthcare standards and patient safety, which had inspected Maryland General, vital changes were made--and laboratories are now subject to unannounced inspections. Here, we present a quondam cover story (June 1995) with a companion article (March 1998) that prove the subject of ethics never goes out of fashion.