Technological Advances & Future Trends in Laboratory Medicine
Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th Edition. (United States) 2016- Chapter 79.
Adeli K, Higgins V, Trajcevski K, Palmert MR. Important considerations for interpreting biochemical tests in children. BMJ. 2018 May 24;361:k1950. doi: 10.1136/bmj.k1950.
Higgins V, Asgari S, Chan MK, Adeli K. Pediatric reference intervals for calculated LDL cholesterol, non-HDL cholesterol, and remnant cholesterol in the healthy CALIPER cohort. Clin Chim Acta. 2018 Nov;486:129-134.
Tahmasebi H, Trajcevski K, Higgins V, Adeli K. Influence of ethnicity on population reference values for biochemical markers. Crit Rev Clin Lab Sci. 2018 Aug;55(5):359-375.
Higgins V, Truong D, White-Al Habeeb NMA, Fung AWS, Hoffman B, Adeli K. Pediatric reference intervals for 1,25-dihydroxyvitamin D using the DiaSorin LIAISON XL assay in the healthy CALIPER cohort. Clin Chem Lab Med. 2018 May 24;56(6):964-972.
Ozarda Y, Higgins V, Adeli K. Verification of reference intervals in routine clinical laboratories: practical challenges and recommendations. Clin Chem Lab Med. 2018 May 5.
Abstract
Laboratory medicine is the branch of medicine that provides objective data to clinicians and other healthcare workers to guide appropriate clinical decision making. Laboratory medicine is integral to many clinical decisions on prevention, diagnosis, treatment, and disease management. It supplies health care professionals with evidence-based data necessary to provide high-quality, safe, effective and appropriate care to patients. The past 50 years have witnessed notable achievements in the field of laboratory medicine and clinical laboratory diagnostics. There have been enormous advances in clinical laboratory technology as well as its clinical applications through the identification of a growing number of laboratory biomarkers of acute and chronic disease. These technological advances have augmented the important role of laboratory medicine in healthcare delivery clearly establishing it as a vital part of the continuum of patient care. There have been many notable achievements in the field of laboratory medicine and clinical laboratory diagnostics. In my lecture, I will elaborate on some of the key achievements that I personally feel have had the greatest impact in the field and have enhanced the value and impact of laboratory medicine in healthcare delivery. These include the increased emphasis on the concept of quality systems and total quality management, technological innovations, point of care testing, informatics/data management, and evidence-based laboratory medicine.
Technological innovations in analytical methodology have also had a major impact on enhancing the efficiency and quality of clinical laboratory service. Improved assay technology combined with the advent of automation have contributed to increased productivity and reduced laboratory error. Automation has particularly had a direct impact in the field of clinical pathology including clinical chemistry, immunology, serology, and hematology. Automated analyzers combined with the use of track technology has allowed the processing of thousands of samples in a single day and significant improvements in laboratory turnaround time in both hospitals and community reference laboratories. In addition to technological advances in routine chemistry and hematology, the introduction of advanced analytical instrumentation such as mass spectrometry (MS) and nuclear magnetic resonance (NMR) into the clinical laboratory has revolutionized complex and specialized areas of laboratory testing particularly in the areas of special chemistry, therapeutic drug monitoring (TDM), toxicology, microbiology and metabolic disease screening.
Another major breakthrough in laboratory medicine has been the miniaturization of assay systems and the advent of point of care testing (POCT) at patient bedside. POCT is a fast growing area and is likely to have an immense impact on the future delivery of laboratory services. A growing number of biochemical, immunochemical, toxicological, hematological, and coagulation markers can be measured at the point of care on small handheld devices. Despite the initial challenges with analytical performance, major advances have been made in improving precision and reproducibility of POCT technology and increased confidence in these devices from both clinical programs and clinical laboratories. Along with the implementation of more precise and accurate point of care devices, a fundamental shift in the provision of POCT has recently occurred with implementation of complete eConnectivity solutions allowing documentation of all POCT results in patient charts and bidirectional communication between various devices and the central laboratory information system
The relatively recent advent of web-based and mobile communication has also created the unique opportunity for effective communication between patients, clinicians, and laboratories to engage in the process using innovative electronic and online modalities. Mobile EMR and web applications are used to provide tools which help physicians provide safe, cost-effective, high-quality care, allowing online access to scientific medical information, key medical reference resources, graphical presentations of disease workflows, and tele-medicine. Indeed, laboratory medicine is a domain which offers a unique opportunity to analyze extremely large, rich and complex data sets of information concerning medical laboratory test results. In recent years, an increasing number of web-based and mobile applications have been developed to improve access to laboratory test information and aid in test result interpretation. They range from simple apps that provide reference lab value information to complex medical diagnostics data management.
Prof. Dr. Kh. Adeli
Postdoctoral Diploma, Clinical Biochemistry, University of Toronto, Canada
Biochemistry, Paediatric Laboratory Medicine Senior Scientist, Molecular Medicine, Research Institute
Board Member, American Association of Clinical ChemistryAACC Academy (NACB)
Member, Scientific Advisory Board, International Centre in Genetic Engineering and Biotechnology, Trieste, Italy.
Chair, International Federation of Clinical Chemistry (IFCC), Communications and Publications Division
Member, Divisional Executive Committee - Clinical Biochemistry, University of Toronto
Member, Senior Executive Committee, Banting and Best Diabetes Centre, University of Toronto
Chair, Postdoctoral Training Program Committee in Clinical Chemistry, Faculty of Medicine, Dept of Lab. Medicine & Pathobiology, Postgraduate MD, University of Toronto Editor-in-Chief, Critical Reviews in Clinical Laboratory Sciences.
Email: khosrow.adeli sickkids.ca
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