Laboratory medicine

1
Laboratory medicine
Multidisciplinary branch of medicine providing
the health care system with laboratory
results....(R.Dybkaer) Medical laboratory ISO
15189, 3.8 laboratory for the biological,
microbiological, immunological, chemical,
immunohaematological, biophysical, cytological,
pathological, or other examination of materials
derived from the human body....
2
Future trends and challenges

• Financial limitations forces concentration of
  resources
• Overlapping techniques also require laboratories
  
• "without walls"
• 3. Genomics, transcriptomics, proteonomics,
  metabolomics
• 4. Professional expertise
• Improvement of quality of service and of
  consultation
• in the sense of TDM
• POCT engagement of central laboratories
• Justification of laboratory medicine as a
  discipline

3
Competence centre for LM
1.Step integration of clinical microbiology in
the central laboratory Institute for
Laboratory Medicine 2.Step Private limited
liability company (community 49 , private group
51 ) 3.Step Concentration of several
disciplines in one building (laboratory
medicine, blood bank, hygiene, human genetics,
etc.) 4.Step Further consolidation towards one
organisational unit (?)
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Benefits of concentration

• broaden financial resources
• eliminate dual financial system
• focussing competence (more specialists)
• providing more efficient regional patient care

5
Future trends and challenges

• Financial limitations forces concentration of
  resources
• Overlapping techniques also require
• laboratories "without walls"
• 3. Genomics, transcriptomics, proteonomics,
  metabolomics
• 4. Professional expertise
• Improvement of quality of service and of
  consultation
• in the sense of TDM
• POCT engagement of central laboratories
• Justification of laboratory medicine as a
  discipline

6
Future trends and challenges

• Financial limitations forces concentration of
  resources
• Overlapping techniques also require laboratories
  
• " without walls"
• Genomics, transcriptomics, proteonomics,
• metabolomics
• 4. Professional expertise
• Improvement of quality of service and of
  consultation
• in the sense of TDM
• POCT engagement of central laboratories
• Justification of laboratory medicine as a
  discipline

7
Future trends and challenges

• Genomics, transcriptomics, proteonomics,
• metabolomics
• - traditional genetic diseases (CAH)
• - gene expression in oncology (cancer diagnosis)
• - tailored pharmacotherapy (TDM)
• - infectious diseases

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breast cancer
7 10 herediterally determined 80 due to
BRCA 1 and 2 80 of BRCA 1 carriers develop
breast cancer Up to the age of 70
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Future trends and challenges

• Genomics, transcriptomics, proteonomics,
• Metabolomics
• - traditional genetic diseases (CAH)
• - gene expression in oncology (cancer diagnosis)
• - tailored pharmacotherapy (TDM)
• - infectious diseases

10
Future trends and challenges

• Genomics, transcriptomics, proteonomics,
• Metabolomics
• - traditional genetic diseases (CAH)
• - gene expression in oncology (cancer diagnosis)
• - tailored pharmacotherapy (TDM)
• - infectious diseases

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Trend to miniaturization in laboratory medicine
Floor standing bench top portable handhold
microchip nanochip
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Future trends and challenges

• Financial limitations forces concentration of
  resources
• Overlapping techniques also require laboratories
  
• "without walls"
• 3. Genomics, transcriptomics, proteonomics,
  metabolomics
• 4. Professional expertise
• Improvement of quality of service and of
  consultation
• in the sense of TDM
• POCT engagement of central laboratories
• Justification of laboratory medicine as a
  discipline

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(No Transcript)
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Future trends and challenges

• Financial limitations forces concentration of
  resources
• Overlapping techniques also require laboratories
  
• "without walls"
• 3. Genomics, transcriptomics, proteonomics,
  metabolomics
• 4. Professional expertise
• Improvement of quality of service and
• of consultation in the sense of TDM
• POCT engagement of central laboratories
• Justification of laboratory medicine as a
  discipline

15
(No Transcript)
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blood glucose (mg / dl) reference intervals
(textbooks) decision limits (WHO) type 2
DM IGT VP0 70 115 126 110 VP2h 200 140 V
B0 60 100 110 100 VBa,0 135 118 VB2h
180 120 VBa,2h 194 150 CP0 126 110
CP2h 220 140 CB0 70 100 110 100 CB2h
200 140 CBa,0 135 118 CBa,2h 237
150
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Future trends and challenges

• Financial limitations forces concentration of
  resources
• Overlapping techniques also require laboratories
  
• "without walls"
• 3. Genomics, transcriptomics, proteonomics,
  metabolomics
• 4. Professional expertise
• Improvement of quality of service and of
  consultation
• in the sense of TDM
• POCT engagement of central laboratories
• Justification of laboratory medicine as a
  discipline

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Strategies of central laboratories for engagement
in POCT

• The top management should decide on the
  responsibilities
• Installation of a POCT commission chaired by the
• laboratory director(selection and justification
  of POCT
• instruments, quality assurance program,
• comparability of results with laboratory
  results)
• Nomination of a POCT coordinator
• 4. On-line network between laboratory and POCT
  stations

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Indications for POCT glucose

• at least 5 tests per week
• insulin therapy
• suspicion for hypoglycemia
• training of patients
• not for diagnosing type 2 DM or glucose
  intolerance

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Future trends and challenges

• Financial limitations forces concentration of
  resources
• Overlapping techniques also require laboratories
  
• "without walls"
• 3. Genomics, transcriptomics, proteonomics,
  metabolomics
• 4. Professional expertise
• Improvement of quality of service and of
  consultation
• in the sense of TDM
• POCT engagement of central laboratories
• Justification of laboratory medicine as
• a discipline

21
Evaluation of method comparisons

• 1.Step
• definition of the analytical comparability
• (conventual concept)
• 2.Step
• determination of the diagnostic relevance
• (future concept)

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Summary

• Vision same quality and comparable results in
  Europe by
• means of harmonisation of methods, of reference
  intervals,
• development of decision limits and the same
• accreditation system. ELM tries to support these
  goals.
• all disciplines must come under one roof or on
  one platform
• in so-called competence centres which should be
  organized
• on a regional basis servicing a population of
  0.5 to 1.0
• million people. If the region is spread,
  especially in
• rural areas, satellite laboratories may be
  required.
• Several competence centres can co-operate for
• special expertise.