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Allergic bronchopulmonary aspergillosis (ABPA), a severe inflammatory respiratory disease, is caused by a hypersensitivity reaction to the colonization of the airways with Aspergillus fumigatus. It is most often described in patients with asthma or cystic fibrosis. The diagnosis of ABPA is based on a combination of clinical, radiological, and immunological findings that have been included in different diagnostic criteria over the years. In this paper, we review the biomarkers included in these diagnostic criteria and novel research biomarkers that may be used in the diagnosis and treatment follow-up of ABPA in cystic fibrosis. [ABSTRACT FROM AUTHOR]

Clinical chemistry plays an important role in medical practice. Approximately 60% to 70% of medical decisions rely on laboratory test results, justifying the need for physicians to have sufficient knowledge of clinical chemistry. However, recent studies have shown that medical students’ knowledge of clinical chemistry is inadequate, and many are unable to interpret the meaning of laboratory parameter results. This implies that the study of clinical chemistry in the curriculum is currently insufficient. There are several related problems, namely a lack of a formal or structured clinical chemistry curriculum, limited time allocated for these studies, a lack of teaching experts and the failure of stakeholders to acknowledge the importance of clinical chemistry. This review discusses problems in the current clinical chemistry education of medical students and provides solutions. A structured search strategy in PubMed and Google Scholar for publications in English was applied using the search terms “clinical chemistry”, “clinical pathology”, “laboratory” and “laboratory medicine” in combination with one of the following keywords: “education”, “medical student”, “curriculum”, “guideline”, “undergraduate”, “medical school” and “training”. The extracted literature focused on research studies, review articles and meta-analyses. Background information and details about the current status of clinical chemistry/ laboratory medicine education were extracted from review articles, while research articles were used to analyse and evaluate the current conditions in the medical schools regarding clinical chemistry/ laboratory medicine education. [ABSTRACT FROM AUTHOR]

The term "emerging technology" (ET) is used extensively, and there are numerous definitions offered, but to our knowledge, none specifically encompass the field of laboratory medicine. An ET definition that incorporates the overarching IFCC aim of "Advancing excellence in laboratory medicine to support healthcare worldwide" would clarify discussions. We discuss key aspects of the term "emerging technology(ies)" as it applies to laboratory medicine with a view to laying the foundations for a practical definition for the profession and propose the definition of an ET as "An analytical method or device that by virtue of its stage of development, translation into broad routine clinical practice, or geographical adoption and implementation has the potential to add value to clinical diagnostics". [ABSTRACT FROM AUTHOR]

OBJECTIVES: The routine teaching mode of diabetes mellitus (DM) is divided into various sub-majors of medical laboratory, which is not conducive to clinical laboratory physicians quickly mastering relevant knowledge. A novel DM laboratory testing pathway is established to improve teaching efficiency and enhance the effects of talent cultivation in laboratory medicine. METHODS: The guidelines and expert consensuses of DM were gathered from professional websites and databases. The clinical laboratory diagnostic pathway was formulated, and the questionnaire and mutual evaluation were used to evaluate the teaching effectiveness of 8-year undergraduate students enrolled in 2018 and enrolled in 2019, respectively. RESULTS: Clinical laboratory physicians developed and approved the DM clinical laboratory diagnostic pathway, which included the entire process of DM diagnosis and differential diagnosis, drug selection, treatment impact monitoring, prognosis evaluation, etc. The results of the questionnaires showed that, in comparison to the teaching mode used with the students enrolled in 2018 and enrolled in 2019, the percentages of more improvement and significant improvement were significantly increased (P< 0.01) and the percentages of no improvement and slight improvement were significantly decreased (P <0.01). Following the instruction of the DM clinical laboratory diagnostic route, the results were greatly improved, including points emphasized and the accuracy of responding to questions, among other things, according to the teachers' and students' mutual evaluation (P< 0.05). CONCLUSIONS: To enhance the teaching quality in laboratory medicine, it is required to build the disease clinical laboratory diagnostic pathway for a novel teaching method. This may boost teachers' and students' confidence and broaden their knowledge. [ABSTRACT FROM AUTHOR]

Background: Reference intervals (RIs) for patient test results are in standard use across many medical disciplines, allowing physicians to identify measurements indicating potentially pathological states with relative ease. The process of inferring cohort-specific RIs is, however, often ignored because of the high costs and cumbersome efforts associated with it. Sophisticated analysis tools are required to automatically infer relevant and locally specific RIs directly from routine laboratory data. These tools would effectively connect clinical laboratory databases to physicians and provide personalized target ranges for the respective cohort population. Objective: This study aims to describe the BioRef infrastructure, a multicentric governance and IT framework for the estimation and assessment of patient group–specific RIs from routine clinical laboratory data using an innovative decentralized data-sharing approach and a sophisticated, clinically oriented graphical user interface for data analysis. Methods: A common governance agreement and interoperability standards have been established, allowing the harmonization of multidimensional laboratory measurements from multiple clinical databases into a unified "big data" resource. International coding systems, such as the International Classification of Diseases, Tenth Revision (ICD-10); unique identifiers for medical devices from the Global Unique Device Identification Database; type identifiers from the Global Medical Device Nomenclature; and a universal transfer logic, such as the Resource Description Framework (RDF), are used to align the routine laboratory data of each data provider for use within the BioRef framework. With a decentralized data-sharing approach, the BioRef data can be evaluated by end users from each cohort site following a strict "no copy, no move" principle, that is, only data aggregates for the intercohort analysis of target ranges are exchanged. Results: The TI4Health distributed and secure analytics system was used to implement the proposed federated and privacy-preserving approach and comply with the limitations applied to sensitive patient data. Under the BioRef interoperability consensus, clinical partners enable the computation of RIs via the TI4Health graphical user interface for query without exposing the underlying raw data. The interface was developed for use by physicians and clinical laboratory specialists and allows intuitive and interactive data stratification by patient factors (age, sex, and personal medical history) as well as laboratory analysis determinants (device, analyzer, and test kit identifier). This consolidated effort enables the creation of extremely detailed and patient group–specific queries, allowing the generation of individualized, covariate-adjusted RIs on the fly. Conclusions: With the BioRef-TI4Health infrastructure, a framework for clinical physicians and researchers to define precise RIs immediately in a convenient, privacy-preserving, and reproducible manner has been implemented, promoting a vital part of practicing precision medicine while streamlining compliance and avoiding transfers of raw patient data. This new approach can provide a crucial update on RIs and improve patient care for personalized medicine. [ABSTRACT FROM AUTHOR]

Context: Clarification of the association among phenotypes, genetic, and environmental factors with clinical laboratory traits can reveal the cause of diseases and assist in developing methods for the prediction and prevention of diseases. It is difficult to investigate the environmental effect on phenotypes using individual samples because their genetic and environmental factors differ, but we can easily investigate the influence of environmental factors using monozygotic (MZ) twins because they have the same genetic factors. Objective: We aimed to examine the methylation level of CpG sites as an environmental factor affecting adiponectin levels on the basis of the same genetic background using MZ twins and to identify the epigenetic factors related to adiponectin levels and the genetic factors associated with sensitivity to acquired changes in adiponectin. Methods: Using 2 groups built from each twin of 232 MZ twin pairs, we performed a replicated epigenome-wide association study to clarify the epigenetic factors affecting adiponectin levels adjusted by genetic risk score. Moreover, we divided twin pairs into concordant and discordant for adiponectin levels. We conducted a genome-wide association study to identify a genetic background specific for discordance. Results: Methylation levels at 38 CpG sites were reproducibly associated with adjusted adiponectin levels, and some of these CpG sites were in genes related to adiponectin, including CDH13. Some genes related to adiponectin or insulin resistance were found to be genetic factors specific for discordance. Conclusion: We clarified specific epigenetic factors affecting adiponectin levels and genetic factors associated with sensitivity to acquired changes in adiponectin. [ABSTRACT FROM AUTHOR]

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Thyroid function tests (TFTs) are routinely requested by general practitioners (GPs) in the clinical biochemistry laboratory. Hypothyroxinaemia (low fT4) accompanied by TSH within the reference interval (RI) is a discordant pattern which is seen commonly in non-thyroidal illness and also as result of medications. Hypopituitarism is a lot rarer, but a serious condition the laboratory does not want to miss.All thyroid hormone samples from primary care meeting the discordant case definition under investigation [fT4<10 pmol/L and TSH within RI (0.3–4.2 mU/L)] had partial anterior pituitary profiles [PAPP (cortisol, oestradiol/testosterone, prolactin, gonadotrophins)] added as reflex tests and results interpreted by a chemical pathologist. From January to June 2023, we conducted structured interviews with the requesting GPs, and, where indicated, requested repeat samples for full anterior pituitary profile [FAPP (PAPP, growth hormone (GH) and insulin-like growth factor 1 (IGF-1)]. We also reviewed the laboratory records of patients with previously known hypopituitarism to determine their fT4 and TSH values at diagnosis.Over the 6 months 41,487 GP TFTs were requested; 54 (0.13%) fitted the discordant case definition and had PAPP reflexed. 13 FAPPs were requested. We identified 3 cases of hypopituitarism. The number of additional tests required to diagnose 1 case of hypopituitarism was 129. In 74% of reflex-tested cases, there was a plausible explanation for the TFT pattern (medications, known thyroid dysfunction, non-thyroidal illness, pregnancy).This study highlights the importance of medical liaison and early intervention in a biochemistry laboratory in identifying cases of unsuspected hypopituitarism. [ABSTRACT FROM AUTHOR]

Abstract Opportunity is the essence of a career in science or medicine and this continues to be a major source of satisfaction for the many scientists and health care providers worldwide. Having trained as a PhD scientist, the world of clinical medicine seemed to be a galaxy away. I could not have been more wrong in that assumption. Here, I tell the story of my career trajectory so that those new to the sciences understand the potential and the opportunities afforded by a career in clinical laboratory medicine.

Background: Rapid SARS-CoV-2 antigen tests are potentially useful tools for screening carriers with high viral load. This study was aimed to assess the potential association between viral load and positivization time of a manual SARS-CoV-2 commercial antigen test in routine nasopharyngeal specimens. Methods: In a sample of subjects undergoing routine diagnostic testing, SARS-CoV-2 positivity of nasopharyngeal samples was assayed with both molecular (Altona Diagnostics RealStar SARS-CoV-2 RT-PCR Kit) and antigenic (Roche SARS-CoV-2 Rapid Antigen Test) tests. Positivization time of rapid antigen test was correlated and compared with viral load expressed as mean of SARS-CoV2 E/S genes cycle threshold (Ct) values. Results: The study sample consisted of 106 patients (median age 48 years, 55 women) with positive results of rapid SARS-CoV-2 antigen testing. A highly significant Spearman's correlation was found between mean SARSCoV-2 E/S genes Ct values and positivization time of manual antigen test (r= 0.70; p

Laboratory Medicine represents an essential part of healthcare with a fundamental impact on the clinical management and outcome of the patient; it has undergone significant changes over time, switching from specimen- to patientcentered vision. The leitmotif of this evolution has been and is currently the innovation. [ABSTRACT FROM AUTHOR]

Mainstays of current treatment for acute respiratory distress syndrome (ARDS) focus on supportive care and rely on intrinsic organ recovery. Animal models of ARDS are often limited by systemic injury. We hypothesize that superimposing gastric aspiration and ventilator-induced injury will induce a lung-specific injury model of severe ARDS. Adult swine (n = 8) were subject to a 12 h injury development period followed by 24 h of post-injury monitoring. Lung injury was induced with gastric secretions (3 cc/kg body weight/lung, pH 1-2) instilled to bilateral mainstem bronchi under direct bronchoscopic vision. Ventilator settings within the injury period contradicted baseline settings using high tidal volumes and low positive end-expiratory pressure. Baseline settings were restored following the injury period. Arterial oxygenation and lung compliance were monitored. At 12 h, PaO 2 /FiO 2 ratio and static and dynamic compliance were significantly reduced from baseline (P < 0.05). During the postinjury period, animals showed no signs of recovery in PaO 2 /FiO 2 ratio and lung compliance. Lung edema (wet/dry weight ratio) of injured lungs was significantly elevated versus noninjured lungs (8.5 ± 1.7 versus 5.6 ± 0.3, P = 0.009). Expression of proinflammatory cytokines IL-6 and IL-8 were significantly elevated in injured lungs (P < 0.05). Twelve hours of high tidal volume and low positive end-expiratory pressure in conjunction with low-pH gastric content instillation produces significant acute lung injury in swine. This large animal model may be useful for testing severe ARDS treatment strategies. [ABSTRACT FROM AUTHOR]

Steroid analysis in clinical laboratories is dominated by immunoassays (IAs) that have a high sample turnover but are inherently limited in trueness, precision, and sensitivity. Liquid chromatography coupled to mass spectrometry (LC-MS/MS) has proved to be a far more capable tool, delivering better sensitivity, specificity, and the possibility of parallel analysis of multiple steroids and metabolites, providing the endocrinologist with more reliable and comprehensive diagnostic information. An LC-MS/MS assay with gradient elution over less than eight minutes and a one-step sample preparation combining protein precipitation with phospholipid removal of off-line solid-phase extraction was developed and validated. It allowed the quantification of 11-deoxycorticosterone (11-DOC), 11-deoxycortisol (11-DF), 17-OH-progesterone (17P), 21-deoxycortisol (21-DF), androstenedione (ANDRO), aldosterone (ALDO), corticosterone (CC), cortisol (CL), cortisone (CN), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), dihydrotestosterone (DHT), estradiol (E2), progesterone (PROG), and testosterone (TES) in human serum. Interday imprecision was generally better than 15%, trueness was proven by recovery experiments with ISO 17034-certified reference materials, proficiency testing (UK NEQAS), and measuring serum reference standards. In-house comparison against IVD-CE-certified immunoassays (IA) for 17P, ANDRO, CL, DHEAS, E2, PROG, and TES was conducted by assessing leftover routine patient samples and purpose-built patient serum pools. None of the compared routine IAs were meeting the standards of the LC-MS/MS. Insufficient overall comparability was found for ANDRO and 17P (mean bias > +65%). Accuracy limitations at lower concentrations were present in IAs for PROG, E2, and TES. [ABSTRACT FROM AUTHOR]

The Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) Big Data and Artificial Intelligence (BAI) Working Group promoted a survey to frame the knowledge, skills and technological predisposition in clinical laboratories. A questionnaire, focussing on digitization, information technology (IT) infrastructures, data accessibility, and BAI projects underway was sent to 1,351 SIBioC participants. The responses were evaluated using SurveyMonkey software and Google Sheets. The 227 respondents (17%) from all over Italy (47% of 484 labs), mainly biologists, laboratory physicians and managers, mostly from laboratories of public hospitals, revealed lack of hardware, software and corporate Wi-Fi, and dearth of PCs. Only 25% work daily on clouds, while 65%—including Laboratory Directors—cannot acquire health data from sources other than laboratories. Only 50% of those with access can review a clinical patient's health record, while the other access only to laboratory information. The integration of laboratory data with other health data is mostly incomplete, which limits BAI-type analysis. Many are unaware of integration platforms. Over 90% report pulling data from the Laboratory Information System, with varying degrees of autonomy. Very few have already undertaken BAI projects, frequently relying on IT partnerships. The majority consider BAI as crucial in helping professional judgements, indicating a growing interest. The questionnaire received relevant feedback from SIBioC participants. It highlighted the level of expertise and interest in BAI applications. None of the obstacles stands out more than the others, emphasising the need to all-around work: IT infrastructures, data warehouses, BAI analysis software acquisition, data accessibility and training. [ABSTRACT FROM AUTHOR]

During the last few years, clinical laboratories have faced a sea change, from facilities producing a high volume of low-cost test results, toward a more integrated and patient-centered service. Parallel to this paradigm change, the digitalization of healthcare data has made an enormous quantity of patients' data easily accessible, thus opening new scenarios for the utilization of artificial intelligence (AI) tools. Every day, clinical laboratories produce a huge amount of information, of which patients' results are only a part. The laboratory information system (LIS) may include other "relevant" compounding data, such as internal quality control or external quality assessment (EQA) results, as well as, for example, timing of test requests and of blood collection and exams transmission, these data having peculiar characteristics typical of big data, as volume, velocity, variety, and veracity, potentially being used to generate value in patients' care. Despite the increasing interest expressed in AI and big data in laboratory medicine, these topics are approaching the discipline slowly for several reasons, attributable to lack of knowledge and skills but also to poor or absent standardization, harmonization and problematic regulatory and ethical issues. Finally, it is important to bear in mind that the mathematical postulation of algorithms is not sufficient for obtaining useful clinical tools, especially when biological parameters are not evaluated in the appropriate context. It is therefore necessary to enhance cooperation between laboratory and AI experts, and to coordinate and govern processes, thus favoring the development of valuable clinical tools. [ABSTRACT FROM AUTHOR]

This article discusses the issues on the veracity of measurement results in laboratory diagnostics, which are used as a basis in making medical decisions. For a correct diagnosis establishment, especially if the measurement results are close to the reference values of the parameters being determined, the accuracy and/or uncertainties of measurement results should be evaluated. The work considers the practical application of the document ISO/TS 20914:2019 "Medical laboratories ― Practical guidance for the estimation of measurement uncertainty," which uses the methodology of the Guide to the Expression of. Uncertainty in Measurement and outlines a practical approach to estimating uncertainties based on information available in a laboratory. This article presents an example of estimating measurement uncertainties performed in a medical laboratory. Particular attention was paid to the assessment of the measurement precision, i.e., type A uncertainty. The data available in the laboratory were analyzed, and the compliance of the obtained measurement results with current requirements was assessed. The implementation of ISO/TS 20914:2019 in activities of medical laboratories enables to evaluate the uncertainties of measurements conducted in the laboratory and the factors that make maximum contribution to measurement uncertainties. [ABSTRACT FROM AUTHOR]

Appropriateness in Laboratory Medicine has been the object of various types of interventions. From published experiences, it is now clear that to effectively manage the laboratory test demand it is recommended to activate evidence-based preventative strategies stopping inappropriate requests before they can reach the laboratory. To guarantee appropriate laboratory test utilization, healthcare institutions should implement and optimize a computerized provider order entry (CPOE), exploiting the potential of electronic requesting as "enabling factor" for reinforcing appropriateness and sustaining its effects over time. In our academic institution, over the last 15 years, our medical laboratory has enforced various interventions to improve test appropriateness, all directly or indirectly based on CPOE use. The following types of intervention were implemented: (1) applying specific recommendations supported by monitoring by CPOE as well as a continuous consultation with clinicians (tumour markers); (2) removing outdated tests and avoiding redundant duplications (cardiac markers, pancreatic enzymes); (3) order restraints to selected wards and gating policy (procalcitonin, B-type natriuretic peptide, homocysteine); (4) reflex testing (bilirubin fractions, free prostate-specific antigen, aminotransferases, magnesium in hypocalcemia); and (5) minimum retesting interval (D-Dimer, vitamin B12, C-reactive protein, γ-glutamyltranspeptidase). In this paper, we reviewed these interventions and summarized their outcomes primarily related to the changes in total test volumes and cost savings, without neglecting patient safety. Our experience confirmed that laboratory professionals have an irreplaceable role as "stewards" in designing, implementing, evaluating, and maintaining interventions focused to improving test appropriateness. [ABSTRACT FROM AUTHOR]

Objectives: The paucity of data regarding the availability and extent of diagnostic medical services across sub-Saharan Africa hinders appropriate allocation of resources to improve health care in these regions. We assessed anatomic pathology (AP) and clinical pathology (CP) services in Nigeria, one of the most populous and fastest-growing countries in the world., Methods: Two individual surveys (AP focused and CP focused) were developed by subject matter experts and administered to individuals involved in pathology and laboratory medicine diagnostic services at hospitals and laboratories across Nigeria between June and August 2022 using the American Society for Clinical Pathology email listserv., Results: A total of 75 responses (29 AP and 46 CP) were received from 48 unique laboratories. Twenty-four sites provided AP services and 35 provided CP services. Eleven respondents performed both AP and CP services. Among AP services, basic surgical and cytopathology capabilities were available at most sites; however, the availability of automated technologies (eg, automated sample processing and staining) was more variable. Advanced diagnostic techniques, (eg, immunohistochemistry, human papillomavirus testing, molecular diagnostics) were rarely performed. The most frequently available CP services included hematology, microbiology, and chemistry. Microbiology services appeared to be among the most robust laboratory medicine services, particularly parasitology and bacteriology testing. Similar to AP services, more advanced diagnostic assays, such as flow cytometry, cytogenetics, and molecular testing, were largely unavailable., Conclusions: These findings augment earlier studies and identify gaps that should be prioritized from a policy perspective to improve medical services and the overall health care infrastructure in Nigeria., (© American Society for Clinical Pathology, 2024.)

Laboratory medicine provides pivotal medical information through analyses of body fluids and tissues, and thus, it is essential for diagnosis of diseases as well as monitoring of disease progression. Despite its universal importance, the field is currently suffering from the limited workforce and analytical capabilities due to the increasing pressure from expanding global population and unexpected rise of noncommunicable diseases. The emerging technologies of microfluidic automation and artificial intelligence (AI) has led to the development of advanced diagnostic platforms, positioning themselves as adaptable solutions to enable highly efficient and accessible laboratory medicine. In this review, we will provide a comprehensive review of microfluidic automation, focusing on the microstructure design and automation principles, along with its intended functionalities for diagnostic purposes. Subsequently, we exemplify the integration of AI with microfluidics and illustrating how their combination benefits for the applications and what the challenges are in this rapidly evolving field. Finally, the review offers a balanced perspective on the microfluidics and AI, discussing their promising role in advancing laboratory medicine., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Race and ethnicity are population descriptors that clinicians and researchers often use to classify humans. The utility of these groupings in research and clinical contexts warrants scrutiny, since these groupings fail to adequately capture genetic diversity and instead, are proxies for the complex interplay of genetic, social, and structural determinants of health. Here, the authors review the concepts of race, ethnicity, and genetics. They also describe laboratory medicine examples where race and ethnicity are used that warrant scrutiny and revision, and areas where greater emphasis on including racialized minorities is necessary to improve health disparities., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Laboratory-based immunology evaluation is essential to the diagnostic work-up of patients with complex immune disorders, and is as essential, if not more so, depending on the context, than genetic testing, as it enables identification of aberrant pathways amenable to therapeutic intervention, and clarifies variants of uncertain significance. There have been considerable advances in techniques and instrumentation in the clinical laboratory, in the past two decades, though there are still "miles to go". One of the goals of the clinical laboratory is to ensure advanced diagnostic testing is widely accessible to physicians and thus patients, through reference laboratories, particularly in the context of academic medical centers. This ensures a greater likelihood of translating research discoveries into the diagnostic laboratory, based on patient care needs, rather than a sole emphasis on commercial utility. However, these advances are under threat from burdensome regulatory oversight that can compromise, at best, and curtail, at worst, the ability to rapidly diagnose rare immune disorders and ensure delivery of precision medicine. This review discusses the clinical utility of diagnostic immunology tools, beyond cellular immunophenotyping of lymphocyte subsets, which can be used in conjunction with clinical and other laboratory data for diagnosis as well as monitoring of therapeutic response in patients with genetic immunological diseases., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

The use of social media platforms in pathology and medical laboratory science has increased in recent years, revolutionizing the way professionals in these fields interact, disseminate information, and collaborate. To gain an understanding of the current landscape regarding social media use in pathology and medical laboratory science, a novel systematic review was conducted. A search of PubMed, Medline, Embase, and Scopus was performed to identify articles evaluating social media use within pathology and medical laboratory science. Articles published in English within the previous 10 years were searched on December 22, 2022. Inclusion criteria were articles containing information regarding social media utility in pathology or laboratory medicine and related articles that mentioned specific hashtags for pathology. The review process involved analyzing the social media platforms referenced, hashtags mentioned, and the presence of international authors as key endpoints of interest. 802 publications were identified; 54 studies met inclusion criteria. Subspecialties represented were considered, but none were found to be statistically significant. X/Twitter (n = 42) was the most discussed social media platform. The top hashtags discussed were #pathJC (5.1%), #dermpathJC (4.2%), #USCAP2016 (3.4%), and #PathBoards (3.4%). Analysis of these articles provides insights into current trends, including the social media platforms referenced, hashtags used, and involvement of international authors. This review will contribute to a deeper understanding of the role and impact of social media in these fields, highlighting opportunities and challenges for future research and practice in pathology and lab medicine., Competing Interests: CPS is an ambassador for Knowledge In Knowledge Out but he does not receive financial compensation for this position. SH is the founder and has ownership equity in Odyssey HealthCare Solutions, Inc. KMM is a founder of PathElective.com but he does not receive financial compensation for this website. The remaining authors have no conflicts of interest., (© 2024 The Author(s).)

Background: Healthcare 4.0. refers to the integration of advanced technologies, such as artificial intelligence (AI) and big data analysis, into the healthcare sector. Recognizing the impact of Healthcare 4.0 technologies in laboratory medicine (LM), we seek to assess the overall awareness and implementation of Healthcare 4.0 among members of the Korean Society for Laboratory Medicine (KSLM)., Methods: A web-based survey was conducted using an anonymous questionnaire. The survey comprised 36 questions covering demographic information (seven questions), big data (10 questions), and AI (19 questions)., Results: In total, 182 (17.9%) of 1,017 KSLM members participated in the survey. Thirty-two percent of respondents considered AI to be the most important technology in LM in the era of Healthcare 4.0, closely followed by 31% who favored big data. Approximately 80% of respondents were familiar with big data but had not conducted research using it, and 71% were willing to participate in future big data research conducted by the KSLM. Respondents viewed AI as the most valuable tool in molecular genetics within various divisions. More than half of the respondents were open to the notion of using AI as assistance rather than a complete replacement for their roles., Conclusions: This survey highlighted KSLM members' awareness of the potential applications and implications of big data and AI. We emphasize the complexity of AI integration in healthcare, citing technical and ethical challenges leading to diverse opinions on its impact on employment and training. This highlights the need for a holistic approach to adopting new technologies.

Importance: Guidelines recommend avoiding unnecessary laboratory tests to minimise risks of anaemia in hospitalised patients as well as reduce costs, but there are costs to skipping routine labs including missing acute kidney injury., Objective: Quantify the costs and benefits of routine labs in dollar costs as well as mortality., Evidence Review: This is a retrospective analysis of 48 204 admissions at University of Kentucky Hospitals and simulates different strategies for skipping labs., Findings: In a simplified estimate of pure dollar costs, the costs of daily labs appear to outweigh the costs of missing acute kidney injury., Conclusions and Relevance: In both dollar costs and the number of patients with mortality effects, the benefits of randomly skipping labs appear to significantly outweigh the costs, but the costs are not insignificant., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and objectives: Laboratory medicine is equally challenged by economic and new technological pressures. Clinical laboratories have undergone major change due to advancement of technology, which has improved the decision making of clinicians but introduced the risk of errors. This study aimed to evaluate the errors that occurred in the pre-analytical phase of laboratory testing. Methods: This was a prospective observational study that was done in the Clinical Biochemistry Laboratory of a tertiary care center from June 2016 to May 2017. The path of the sample was analyzed from sample collection to transport. Frequency of deficiencies in the request forms and different types of pre-analytical errors were recorded. Results: During the study period, the frequency of pre-analytical errors was about 3.1%. Sample hemolysis was the predominant error in sample collected from both indoor and outdoor patients. Conclusion: Proper management of pre-analytical errors requires continuous evaluation of source of errors, taking corrective measures, and significant interdepartmental cooperation.

The article discusses the ongoing impact of the COVID-19 pandemic caused by the SARS-CoV-2 virus. While the virus is no longer as destructive as it was at the beginning of the pandemic, it has become endemic and continues to harm vulnerable populations. The article presents several studies on COVID-19 detection, prognostication, and long-term effects. These studies explore methods for detecting the virus, predicting patient outcomes, and understanding the persistence of symptoms after recovery. The article emphasizes the importance of scientific research in filling knowledge gaps and preparing for future pandemics. [Extracted from the article]

This study aims to compare the influences of traditional lectures (TL) with a flipped classroom (FC). Two consecutive classes of students from a laboratory medicine speciality learned medical molecular biology through the flipped or nonflipped (TL) approach with online microlectures. We inspected examination scores, learning experiences and perceptions of the FC model and peer collaboration in the course by means of mixed-methods. The average examination score for the 2016 FC students was higher than that for the 2017 traditional students. The course evaluations submitted by the students showed positive learning experiences and perceptions of the FC model. The flipped approach also increased peer collaboration. This research reveals the positive influences of FC with online microlectures on learning. It is proposed that future research evaluates the influences of FC on the other courses in laboratory medicine higher education. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients and clinicians often rely on the outcome of laboratory tests, but can we really trust these test results? Good quality management is key for laboratories to guarantee reliable test results. This review focusses on external quality assessment (EQA) schemes which are a tool for laboratories to examine and improve the quality of their testing routines. In this review, an overview of the role and importance of EQA schemes for clinical laboratories is given, and different types of EQA schemes and EQA providers available on the market are discussed, as well as recent developments in the EQA landscape. External quality assessment (EQA) schemes are a tool for clinical laboratories to evaluate and manage the quality of laboratory practice with the support of an independent party (i.e., an EQA provider). Depending on the context, there are different types of EQA schemes available, as well as various EQA providers, each with its own field of expertise. In this review, an overview of the general requirements for EQA schemes and EQA providers based on international guidelines is provided. The clinical and scientific value of these kinds of schemes for clinical laboratories, clinicians and patients are highlighted, in addition to the support EQA can provide to other types of laboratories, e.g., laboratories affiliated to biotech companies. Finally, recent developments and challenges in laboratory medicine and quality management, for example, the introduction of artificial intelligence in the laboratory and the shift to a more individual-approach instead of a laboratory-focused approach, are discussed. EQA schemes should represent current laboratory practice as much as possible, which poses the need for EQA providers to introduce latest laboratory innovations in their schemes and to apply up-to-date guidelines. By incorporating these state-of-the-art techniques, EQA aims to contribute to continuous learning. [ABSTRACT FROM AUTHOR]

Diagnostic devices, methodological approaches, and traditional constructs of clinical pathology practice, cultivated throughout centuries, have transformed radically in the wake of explosive technological growth and other, e.g., environmental, catalysts of change. Ushered into the fray of modern laboratory medicine are digital imaging devices and machine-learning (ML) software fashioned to mitigate challenges, e.g., practitioner shortage while preparing clinicians for emerging interconnectivity of environments and diagnostic information in the era of big data. As computer vision shapes new constructs for the modern world and intertwines with clinical medicine, cultivating clarity of our new terrain through examining the trajectory and current scope of computational pathology and its pertinence to clinical practice is vital. Through review of numerous studies, we find developmental efforts for ML migrating from research to standardized clinical frameworks while overcoming obstacles that have formerly curtailed adoption of these tools, e.g., generalizability, data availability, and user-friendly accessibility. Groundbreaking validatory efforts have facilitated the clinical deployment of ML tools demonstrating the capacity to effectively aid in distinguishing tumor subtype and grade, classify early vs. advanced cancer stages, and assist in quality control and primary diagnosis applications. Case studies have demonstrated the benefits of streamlined, digitized workflows for practitioners alleviated by decreased burdens. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic shifted pathology education in medical schools worldwide towards online delivery. To achieve this goal, various innovative platforms were used by pathology educators and medical students, facilitating both synchronous and asynchronous learning. The aim of this study was to review the published evidence regarding remote pathology teaching at the medical school level during this period, present our own experience, and provide some perspectives regarding the best mode of pathology teaching post-pandemic. Among its advantages, virtual pathology education was considered among students and educators as convenient, flexible, and engaging, while learning outcomes were met and students' academic performance was in general satisfactory. However, several challenges were faced. For instance, suboptimal internet connection compromised the flow of classes and was even associated with a lower academic performance. The lack of hands-on laboratory activities, such as operating the light microscope and tissue grossing, and the reduced student interactions among themselves and their instructors, were also pointed out as significant drawbacks of remote pathology education. Whereas online education has multiple advantages, experiencing the physical university environment, in-person interactions and teamwork, exposure to the "hidden curriculum", and hands-on activities are vital for medical school education and future student development. In conclusion, the implementation of a blended approach in pathology education—where online and face-to-face sessions are jointly used to promote students' engagement, interaction with their instructors and peers, and learning—could be the most optimal approach to pathology teaching in medical schools post-pandemic. [ABSTRACT FROM AUTHOR]

Microbial antibiotic resistance remains a serious public health problem worldwide. Conventional culture-based techniques are time-taking procedures; therefore, there is need for new approaches for detecting bacterial resistance. The aim of this study was to assess antibiotic resistance of Escherichia coli by analyzing biochemical parameters with machine learning systems without using antibiogram.

Clinical practice guidelines (CPGs) are recommendations based on a systematic review of scientific evidence that are intended to help healthcare professionals and patients make the best clinical decisions. CPGs must be evidence-based and are designed by multidisciplinary teams. The purpose of this study is to assess the topics related to the clinical laboratory addressed in CPGs and evaluate the involvement of laboratory professionals in the CPG development process.

• The next frontier of the clinical laboratory is the system biology approach. • Metabolomics represents the result of the interplay between the host and exposome. • ISO 23118:2021 contains specifications for standardizing the preanalytical phase. • A standard reference material is available to improve harmonization in metabolomics. [ABSTRACT FROM AUTHOR]

For thirty years Pathologists Overseas (PO) has worked in low- and middle-income countries (LMICs) to provide affordable, sustainable, and high-quality pathology and laboratory medicine (PALM) services through strategic partnerships and the efforts of our large volunteer network. We address low quality diagnostic services by targeting the 3 pillars of PALM quality: human resources, systems, and quality and accreditation. To improve human resource capacity, PO and our partnering organizations provide virtual continuing education to pathologists and laboratory professionals in these countries. To improve systems, we provide laboratory information system installation and implementation support. Lastly, to improve quality and help laboratories progress toward accreditation, we support an external quality assurance program for laboratories in LMICs. As a relatively small organization, PO demonstrates that a network of dedicated volunteers, in partnership with corporations and professional organizations, can initiate sustainable change in the quality of PALM services in LMICs by focusing efforts on the core components of laboratory quality.

Since commercial SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) antigen rapid detection tests (Ag-RDTs) display broad diagnostic efficiency, this study aimed to evaluate the clinical performance of Fluorecare SARS-CoV-2 Spike Protein Test Kit in a real-life scenario.