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Development of Laboratory Medicine in Europe

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  • 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 (?)
  • 4. 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
  • 8. 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
  • 9. 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
  • 11. Trend to miniaturization in laboratory medicine Floor standing bench top portable handhold microchip nanochip
  • 12. 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
  • 13.  
  • 14. 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.  
  • 16. blood glucose (mg / dl) reference intervals (textbooks) decision limits (WHO) type 2 DM IGT VP 0 70 – 115 126 110 VP 2h 200 140 VB 0 60 – 100 110 100 VB a,0 135 118 VB 2h 180 120 VB a,2h 194 150 CP 0 126 110 CP 2h 220 140 CB 0 70 – 100 110 100 CB 2h 200 140 CB a,0 135 118 CB a,2h 237 150
  • 17. 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
  • 18. 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
  • 19. 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
  • 20. 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)
  • 22. 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.

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