Clinical Chemistry I 0202304 PDF

Clinical Chemistry I 0202304 Instructor: Mohammad QABAJAH E-mail: [email protected] Week_01 Introduction - EBM 2 Objectives - Explain the reasons for performing a laboratory test - Describe the field of laboratory medicine - Describe the sub-disciplines, in...

Clinical Chemistry I 0202304 Instructor: Mohammad QABAJAH E-mail: [email protected] Week_01 Introduction - EBM 2 Objectives - Explain the reasons for performing a laboratory test - Describe the field of laboratory medicine - Describe the sub-disciplines, information handling, and ethical issues - State the importance of maintaining confidentiality in the laboratory - Justify for practicing an evidence-based laboratory medicine “ Introduction to Clinical Laboratory Medicine What is Laboratory Medicine The discipline involved in the selection, provision, and interpretation of diagnostic tests This discipline includes: - Research - Administration - Teaching activities - Clinical services Testing in Laboratory Testing in laboratory may be directed at: - Confirming a clinical suspicion - Excluding a diagnosis - Assisting in selection, optimization and monitoring treatment - Providing a prognosis - Screening for disease in absence of symptoms - Monitoring the severity of a physiological disturbance Clinical Chemistry and Laboratory Medicine - Boundaries between and among the parts of the clinical lab has become more blurred with the increasing use of molecular testing Diagnosis - IFCC: Currently called “International Federation of Clinical Chemistry and Laboratory Medicine” Laboratory Medicine - Today’s clinical laboratory is a complex arena o ering an expansive menu of tests which continues to grow - Hundreds of millions of laboratory tests are performed every year - >70% of the objective data in a patient’s medical record comes from the clinical laboratory - The specific types of clinical laboratories in health care institutions varies greatly from one place to another. Clinical Laboratory Fields - Chemistry/Immunoassay - Hematology and Coagulation - Blood Bank/Apheresis - Endocrinology - Immunoserology - Microbiology (including Bacteriology, Virology, Parasitology, etc.) - Urinalysis, Fluid Analysis and Medical Microscopy - Molecular Pathology - Cytogenetics - Tissue Typing/HLA - Toxicology Reference Lab - Some laboratories perform the lab tests at reference labs; are often called “send out labs” - Clinical reference laboratories provide testing services for patients and healthcare providers - The labs performed are generally specialized tests that are infrequently ordered or that require specialized equipment  Laboratory Testing Process Overview PreAnalytic Analytic PostAnalytic Provider Order View Result Right Test at Interpret Right Time on Act Right Patient Phlebotomy/Nursing Collect Sample From Right Patient at Right Time in Right Tube Transport Sample to Lab Laboratory Verify & Test Report Specimen Resutls  Laboratory Department Sending (5%) Post-Analytical Phase: Pre-Analytical Phase: Laboratory Outside the Lab (15%) (20%) Analytical Phase: Pre-Analytical Phase: Laboratory Laboratory (25%) (35%) “ Evidence Based Medicine-EBM Medicine at Past - Doctor experience - Weak experiments - Drugs companies - Animal studies BUT… A practice based exclusively on science and math is e ective only if your patients are robots or clones! Individual human di erences and personal preferences!  Knowledge & Experience Past knowledge and practice might be outdated or inadequate Graduate Medical School Practiced Physician Examples Solution?? Evidence Based Medicine - A new approach to clinical care and research - It is the physician’s duty to find the best and most current information and apply it judiciously for the benefit of the patient. Basis of Medical Practice (Check all that apply) I. Training, clinical experience and consultation with other professionals II. Convincing evidence (non-experimental) from articles, case reports, product literature, etc. III. Preferences of the patient IV. Active Search of Randomized Controlled Trials, Systematic Reviews, Meta-Analysis Reports You are Practicing Evidence Based Medicine The Purpose of Evidence Based Medicine To learn how to: - Distinguish evidence from propaganda (advertisement) - Probability from certainty - Data from assertions - Rational belief from superstitions - Science from folklore - Theory from dogma (P. D. Hurd, Sci Am 1999;281:87-92) Evidence Based Medicine It is a change in the way physicians practice medicine, teach and learn, and handle research. - Clinical Practice: Based on the best current evidence - Patient Care: Compassionate, patient-oriented - Learning & Teaching/Research: Problem solving Three Major Components of EBM PATIENT Question or Problem The Basic Steps of EBM – 5A’s The Clinical Question The FIRST step The HARDEST step The MOST IMPORTANT step! Asking Good Questions is A Skill to be Learned. It will make the case easier for you... and also for others Hmmm… Is he about to Exactly how much give me a BONUS? time did you spend on that project? Or is he about to FIRE me? EBM, A Good Question Must be: - Specific: Identify the problem, clarify the clinical issue - Answerable: Through the literature - Contain multiple aspects: Patient, options, comparisons, etc EBM QUESTION: Includes Multiple Factors P: PATIENT - Type of patient or population E: EXPOSURE - Environmental, personal, biological I: INTERVENTION - Clinical intervention C: COMPARISON - Compare alternative treatment O: OUTCOME - Clinical outcome of interest PEICO The Basic Steps of EBM – 5A’s See YOU Next Lecture