[What Has Been Done in Surugadai Nihon University Hospital as a Laboratory Physician--Encounter with FAB Classification and Establishing the Additional Laboratory Management Fee]

I was requested by Nihon University to contribute to the official journal of the Japanese Society of Laboratory Medicine (Rinsho Byori). A special review of the final lecture at Surugadai Nihon University Hospital was requested by the editorial board of the Japanese Society of Laboratory Medicine. I submitted a review under the heading of "I have carried out upon retirement, ..." based on the final lecture at Surugadai Nihon University Hospital. The contents of the lecture were how to widely disseminate the FAB classification of acute leukemia and how to establish an additional laboratory management fee. Finally, I showed how to charge an additional management fee correctly based on a laboratory physician's activities in Surugadai Nihon University Hospital. I summarize the lecture in this article.

[Laboratory and Team-Based Medicine--From the Standpoint of JSLM]

The Japanese Society of Laboratory Medicine (JSLM) organized a working group to promote team-based medicine 2 years ago. The Japan Society for Clinical Laboratory Automation (JSCLA) formed a committee for team-based medicine and it was active for five years from 2006 to 2011. The author, an officer of the JSCLA, presents previous activities and policies for the future. The three main activities were as follows: Firstly, a seminar with a lecture and practice was held at meetings of the JSCLA. Secondly, Internet services were set up to introduce action programs and promote team-based medicine. Thirdly, the guidebook was edited, written from the point of view of laboratory medicine. The committee worked hard and produced favorable results. It is difficult with the present circumstances to organize a committee for team-based medicine in the JSCLA again. We expect cooperation in seminars and meetings.

[From JSLH (The Japanese Society for Laboratory Hematology): An Active Team Approach to Medicine as Laboratory Technologists, through Showing Bone Marrow and Peripheral Blood Samples Directly to Patients with Hematological Malignancy]

The clinical path for the treatment of acute myeloid leukemia (AML) patients has been in practice in our hospital since 2003. In the clinical path, laboratory technologists take on the role of explaining the microscopic findings in bone marrow and peripheral blood samples to patients (with or without their families) using the view-sharing microscope in our laboratory. From July 2003 to October 2014, 56 patients were enrolled in the AML clinical path and given an explanation of their bone marrow and peripheral blood samples. The patients' median age was 62, and the median time spent for explanation was 40 minutes. We conducted a questionnaire feedback survey involving those who enrolled, and the results showed significant improvement in the recognition of the disease pathophysiology, treatment efficacy, and the importance of precautions against infectious diseases. Based on the feedback, we have made marked efforts to provide patients with an improved environment during the explanatory session. This includes installing a special display for the patients, drawing a schematic illustration that shows how the blood cells differentiate, and putting them into operation in a hematology ward to promote patient privacy and precautions against infectious diseases. Hematological laboratory technologists have played an important role in patient care in our hospital. To perform their role as effectively as possible, hematological laboratory technologists participate in the conferences of the Department of Hematology and Oncology regularly, in which medical staff members can discuss the conditions and clinical courses of patients. We aim to contribute to patient satisfaction by sophisticating specialized knowledge as hematological laboratory technologists and cooperate with other medical staff members.

[Japanese Association of Clinical Laborato Physicians--What We Are Doing Now and How We Should Develop in the Future as Competent Members of Team Medicine]

No clinical laboratory would admit they do not practice team medicine, at least conceptually. However, true team medicine is more than an aspiration--it is an intentional care structure built, led, and delivered by a diverse, multidisciplinary team of physicians, medical technologists, nurses, pharmacists, and dozens of other professionals. We clinical laboratory physicians are able to fulfill an important role as competent members of the team medicine. Because we can look at the results of clinical examinations of patients earlier than anyone else, we can interpret the patient's condition by analyzing that results, and provide useful information to facilitate team medicine. I have conducted a questionnaire survey on team medicine targeting clinical laboratory physicians to clarify the tasks we are performing. In this paper, I describe what clinical laboratory physicians are currently doing, and how should we develop in the future.

[From laboratory to practice: counseling with clinicians]

The provision of medical laboratory services is a key element in diagnostic and treatment. The care of analytical quality remains in focus of attention. The interest to pre-analytical quality increased. However, alongside with it quality of post-analytical stage and such its significant element as support of timely and effective application of laboratory results in interest of patient has great importance. The purpose of study was to consider approaches to development of this aspect of medical laboratory practice and to demonstrate the modes which proved their effectiveness.

[The organization of scientific innovative laboratory complex of modern technologies]

The article discusses the actual issues of scientific innovative activity during the realization of principles of private-public partnership. The experience of development of model of scientific innovative complex is presented The possibilities to implement research achievements and their application in the area of cell technologies, technologies of regenerative medicine, biochip technologies are demonstrated. The opportunities to provide high level of diagnostic and treatment in practical health care increase of accessibility and quality of medical care and population health promotion are discussed.

[The directions and experiences of integration of clinical laboratory diagnostic and branch medicine]

The article considers the actual issues of teaching laboratory medicine to students of medical faculty and to physicians getting trained in different programs of postgraduate education. The major models of interaction between clinical physicians and specialists of laboratory diagnostic are considered. The proposed model of teaching of laboratory medicine is developed in collaboration with clinical chairs and is based on the principle of "clinical laboratory council of physicians". The analysis of clinical cases of specific patients and clinical analytical critiques are in the basement of the given system. The algorithm of considering one of situation tasks used in teaching is presented as example.

[The metrological support of medical laboratory activity]

The article discusses the methodological approaches in implementing of regulations of the Federal law FZ-102 "On the support of unity of measurements in the area of laboratory medicine "from the positions of GOSTK ISO 9001-2008 "The systems of quality management. Requirements" and GOST K ISO 15189-2009 "medical laboratories. The particular requirements to quality and competence". The application of GOSTK ISO 18113.1-5 "The medicine items for diagnostic in vitro. Information provided by manufacturer (marking)" neatly assigns the responsibility for support of metrological correctness of laboratory measurements.

[Activities for laboratory medicine support after the Great East Japan Earthquake by the Japanese Society of Laboratory Medicine]

The Great East Japan Earthquake caused a tragic tsunami and resulted in serious damage to north region of Japan on March 11, 2011. The Japanese Society of Laboratory Medicine, JSLM launched an ad hoc Committee to support Laboratory Medicine affairs in the affected area. We expected that laboratory testing demands would increase during the weeks following the disaster. We decided to support the use of Point-of-Care Testing. Many POCT devices use battery-powered analyzers. This is definite advantage for their use in areas with limited access to power and water supplies. We contacted many companies about the possibility of providing POCT devices, IVD reagents and/or any laboratory supplies including disposable materials. Finally, forty companies agreed to support this project and we received list of reagents materials for more than one hundred IVD tests. We entered this information on our web site and continued to update it as additional support was received. Once a request of support was received, communication were made to confirm the amount of material, the method of shipping/receipt and if any specific training that would be required for its use at the testing site. Also, we dispatched volunteer Medical Technologists for eight weeks to assist in the laboratory work. Some of the crucial points in recruiting volunteer laboratory professions are expenses and accommodations. We prepared not only accommodations but also transportation methods and covered all expenses including insurance and meals. Our relief activities have shown that Laboratory Medicine and Medical Technologists are useful in disaster-affected area.

[The major directions of population support with high-tech medical care]

The article deals with issues of organization of the activities and strategy of development of new federal high-tech technology medical centers. The emphasis is made on the issues of centers functioning in present conditions. The substantiation of directions of enhancement of medical support of population with high-tech medical care is discussed.

The technology acceptance model: its past and its future in health care

Increasing interest in end users' reactions to health information technology (IT) has elevated the importance of theories that predict and explain health IT acceptance and use. This paper reviews the application of one such theory, the Technology Acceptance Model (TAM), to health care. We reviewed 16 data sets analyzed in over 20 studies of clinicians using health IT for patient care. Studies differed greatly in samples and settings, health ITs studied, research models, relationships tested, and construct operationalization. Certain TAM relationships were consistently found to be significant, whereas others were inconsistent. Several key relationships were infrequently assessed. Findings show that TAM predicts a substantial portion of the use or acceptance of health IT, but that the theory may benefit from several additions and modifications. Aside from improved study quality, standardization, and theoretically motivated additions to the model, an important future direction for TAM is to adapt the model specifically to the health care context, using beliefs elicitation methods.

Management of a point-of-care testing program

The approach to managing a point-of-care testing (POCT) program has evolved over recent years. Although many of the essential features of early POCT management programs remain intact, contemporary challenges including expansion of the test menu, changing regulatory requirements, and the development of more sophisticated data management connectivity require ongoing adaptation of POCT management programs. Despite improvements in test quality and regulatory compliance, significant challenges for the management of POCT will continue for the foreseeable future.

CLS to higher education administrator: the right navigational skills

OBJECTIVES

To identify the experiences, training, and opportunities that directed and influenced the career paths of women clinical laboratory scientists that transitioned to higher education administrators.

METHODS

A multi-site case study design was selected for this qualitative research involving a purposive sample of eight research participants. Data collection was guided by ten open-ended questions in seven face-to-face and one telephone semi-formal interviews.

SETTINGS AND PARTICIPANTS

The purposive sample included women clinical laboratory scientists who held a current higher education administrative position at the dean's level, including associate and assistant dean positions, in a university setting. The participants were located in eight higher education institutions in Nebraska, Illinois, Ohio, Tennessee, Missouri, and Texas.

OUTCOMES MEASURES

MAIN Leadership skills/characteristics, professional development opportunities, mentoring experiences, opportunities for advancement.

RESULTS

Possessing a doctoral degree, demonstrating competence and strong leadership skills, having a good role model and/or mentor, displaying the ability to see the big picture, and possessing exemplary communication skills were identified by this group of women as necessary requirements for obtaining and maintaining a position as a higher education administrator.

CONCLUSION

The participants in this study confirmed that by possessing a terminal degree and a defined skill set, they were able to obtain a higher education administrator position.

Integration of the CLS doctorate into the healthcare organization

OBJECTIVE

A review of how the doctorally prepared CLS fits into the healthcare organization.

DESIGN

Literature review.

BACKGROUND

Numerous national studies have called for a reshaping of the health care delivery system and the need to improve patient outcomes. Because of unprecedented advances in laboratory related technology as well as the need for economic retrenchment strategies in health care, with its significant influence on patient care, the laboratory has become the subject of intensive study. It has been concluded that the traditional organizational structure of the laboratory information process and the required personnel skills both need rethinking. In order to foster change in the laboratory, an advanced degreed CLS laboratory professional is needed, one already equipped with a broad scientific base developed via a baccalaureate/masters level of education.

CONCLUSION

With the addition of advanced technical expertise, basic medical skills, data interpretation skills and patient interaction abilities, and medical research experience, this laboratory professional can enhance the effective and efficient use of laboratory information and ultimately improve patient care. The clinical doctorates in CLS are educationally and experientially prepared to recommend support and enhance appropriate testing. They translate and transform complex laboratory data into an understandable product necessary for clinicians to be able to assess the validity of current and new assays to ensure better patient care. In addition, they assist in reducing questionable test usage, thereby reducing costs for both the patient and the laboratory.

Exploring professional-related outcome differences between phlebotomy technicians, medical laboratory technicians, and medical technologists

As part of a large scale practice analysis on Phlebotomy Technicians (PBTs), Medical Laboratory Technicians (MLTs), and Medical Technologists (MTs), additional data on four "home made measures" of professional-related outcomes, i.e., professional development, quality assurance monitoring, employer reimbursement, and types of continuing education, were also collected. In order to maximize data use from the overall sample of 3,097 respondents (constituting only 18% of the population surveyed), pairwise deletion of data was utilized. No a priori differences between PBTs, MLTs and MTs on these outcomes were hypothesized, and none were found for professional development and employer reimbursement. The finding that PBTs were lower than MLTs and MTs on quality assurance monitoring was interpreted as being job expected. Despite the study limitations, professional development for not just laboratory professionals but all allied health professionals remains an important recruitment and retention issue, as demand for all health services is expected to increase.

A content analysis of analyst research: health care through the eyes of analysts

PURPOSE

This article contributes to the understanding of how health care companies may communicate the business models by studying financial analysts' analyst reports. The study examines the differences between the information conveyed in recurrent and fundamental analyst reports as well as whether the characteristics of the analysts and their environment affect their business model analyses.

METHODOLOGY

A medium-sized health care company in the medical-technology sector, internationally renowned for its state-of-the-art business reporting, was chosen as the basis for the study. An analysis of 111 fundamental and recurrent analyst reports on this company by each investment bank actively following it was conducted using a content analysis methodology.

FINDINGS

The study reveals that the recurrent analyses are concerned with evaluating the information disclosed by the health care company itself and not so much with digging up new information. It also indicates that while maintenance work might be focused on evaluating specific details, fundamental research is more concerned with extending the understanding of the general picture, i.e., the sustainability and performance of the overall business model. The amount of financial information disclosed in either type of report is not correlated to the other disclosures in the reports. In comparison to business reporting practices, the fundamental analyst reports put considerably less weight on social and sustainability, intellectual capital and corporate governance information, and they disclose much less comparable non-financial information.

RESEARCH IMPLICATIONS/LIMITATIONS

The suggestion made is that looking at the types of information financial analysts consider important and convey to their "customers," the investors and fund managers, constitutes a valuable indication to health care companies regarding the needs of the financial market users of their reports and other communications. There are some limitations to the possibility of applying statistical tests to the data-set as well as methodological limitations in relation to the exclusion of tables and graphs.

The rural rotation in a medical technology program: a ten-year retrospective study

OBJECTIVE

This study evaluated the effectiveness of a rural rotation as a tool to recruit medical technology program graduates to medically underserved areas.

DESIGN

A paper survey was distributed to all 1994 - 2003 graduates of the West Virginia University Medical Technology Program.

SETTING

The survey was mailed to the graduates' homes.

PATIENTS OR OTHER PARTICIPANTS

Ninety-four of the two hundred six surveys were returned for a response rate of 45.6%.

INTERVENTIONS

Surveys were mailed in January 2004.

MAIN OUTCOME MEASURES

Responses to questions regarding choice of site for rural rotation, whether or not a job was offered at the rural site, and whether the graduate subsequently worked at a rural site were tabulated. Responses to questions concerning whether the rotation helped the respondent to appreciate the needs of rural health facilities and whether the rotation resulted in a greater interest in working in a rural area were tabulated. Responses were also tabulated for questions about the value of the rural rotation to the respondent's education and whether the rural rotation was recommended for future students.

RESULTS

Of respondents, 70.2% chose their rural rotation sites due to proximity to their homes and 38.3% were offered jobs at their rural rotation sites. 50% of all respondents subsequently worked at a rural site. Of respondents, 73.4% indicated strong agreement that the rotation helped them appreciate the needs of the rural facility, and 37.2% indicated agreement with becoming more interested in working at a rural site. Of respondents, 65% indicated that the rural rotation was beneficial and that they would recommend it to future students.

CONCLUSION

Results of the survey suggest that a prior rural affinity is a factor associated with selection of rural sites for medical technology program graduates. The survey results also suggest that a rural rotation during medical technology education is beneficial to individuals, including those who elect not to go to rural sites after graduation.

ABBREVIATIONS

Health professions shortage areas (HPSAs) nurse practitioners (NP) medically underserved areas (MUAs) West Virginia Rural Health Education Partnerships (WVRHEP).

Technology, governance and patient safety: systems issues in technology and patient safety

Technology and equipment are often identified as contributors to adverse medical events, however technology is seldom the focal point of investigation as a source of medical error or adverse event. It is often seen as both a means of reducing error (e.g., automated drug dispensing machines) or as a major contributing factor to adverse events (e.g., through cognitive overload). Here we review literature about the governance of technology in health settings, which is addressed in relation to patient safety. We outline the challenges of addressing technology governance issues in the health sector, provide an overview of governance processes, and suggest that technology related adverse events have been largely conceptualized as device and user problems rather than system or socio-technical problems, which is reflected in governance processes associated with medical devices. A recognition of the situatedness of medical practices implies that new forms of governance may be required that place greater emphasis on socio-technical and systems issues.

Nursing in a technological environment: Nursing care in the operating room

Operating room nurses continue to draw criticism regarding the appropriateness of a nursing presence in the operating room. The technological focus of the theatre and the ways in which nurses in the theatre have shaped and reshaped their practice in response to technological change have caused people within and outside the nursing profession to question whether operating room nursing is a technological rather than nursing undertaking. This paper reports findings from an ethnographic study that was conducted in an Australian operating department. The study examined the contribution of nurses to the work of the operating room through intensive observation and ethnographic interviews. This paper uses selected findings from the study to explore the ways in which nurses in theatre interpret their role in terms of caring in a technological environment.

A brief note on further investigating correlates of work exhaustion for medical technologists

Using a sample of 184 medical technologists (MTs) over a three-year period, this study found support for the hypothesis that downsizing leads to higher job loss insecurity and task load perceptions, which both lead to increased work exhaustion. As such this study extends previous research on MT work exhaustion by Blau, Tatum and Ward-Cook. Study limitations and future research issues are briefly discussed.

The Swiss success story

Medical technology is one of the most important growth sectors in Switzerland. Current conditions are good, but hunting down profits is hard for some.

The personality traits of medical technologists: implications for recruitment and retention

Clinical laboratory science is in the midst of a perfect storm. The turbulent nature of the employment market along with diagnostic pathology's mission to develop new, powerful diagnostic tools imply a future that will be both challenging and rewarding. Yet, success in the future will require immediate attention to current issues of recruitment, retention and expansion of the medical technologist's role. An analysis of the personality traits of medical technologists may provide insight into work preferences as they relate to job satisfaction and willingness to accept the changes in the profession. In this study, we will attempt to gain this insight through examination of a personality profile of a group of medical technologists.

Utilization management strategies: where to start?

The purpose of a utilization or test management program is to identify for the clinician the most frequently ordered and useful laboratory tests relevant to the diagnosis, prognosis, treatment, and management of the patient. As such, a test management program must be carefully constructed to provide appropriate and effective utilization of laboratory services by incorporating and promoting the highest quality and best practice standards for patient care.1 At the same time, a test management program must not hinder the clinician's ability to properly care for the patient by ordering the right test at the right time for the right reason. Too often, utilization strategies solely focus on cost reduction without regard for clinical impact.

Knowing the nurse practitioner: dominant discourses shaping our horizons

The purpose of this paper is to examine the various discourses, particularly the dominant instrumental and economic discourses that have brought the phenomena of the nurse practitioner (NP) into being. It is proposed that NPs have been constituted as an object of nature and therefore understood metaphorically as a tool or instrument within the health care system to be used efficiently and effectively. Heidegger's philosophical analysis of the question concerning technology is used to argue that our current ways of knowing the NP through these discourses, with their emphasis on calculative logic, have resulted from our modern view of the essence of technology. It is also argued that there is now a need to shape our horizons concerning the NP in new and different ways. There is a need to engage in dialogical forms of research in order to evoke the richness and depth of what it means to be an NP, that is, to reveal the other modes of expression by which we define ourselves, understand others and nursing.

Germany: financing innovation is the future challenge

Changes are required to encourage innovation in the industry. Some ways forward are described.

Achieving appropriate design and widespread use of health care technologies in the developing world

OBJECTIVES

To identify and describe constraints facing the development and dissemination of technologies appropriate for public health care challenges and solutions in the developing world.

METHODS

Review of lessons learned in development and introduction of numerous health technologies as experienced by a non-profit organization working on technologies for 25 years.

RESULTS

Many obstacles prevent appropriate technologies from reaching widespread use and acceptance. These include low profit margins in developing world markets, regulatory constraints, and the need for systems changes. Strong public/private-sector partnerships and realistic approaches to working in these environments make a difference.

CONCLUSIONS

There is a growing awareness of the need for new technologies and experience with strategies that can make them happen. Some technologies with documented value for maternal care in developing world settings appear to be stuck short of widespread acceptance and use. Understanding the factors impeding their progress can enable the public sector and its collaborators to organize and facilitate their progress more effectively.

Switzerland's medical technology potential

Favoured for its central European location and sophisticated scientific environment, Switzerland's medical device industry is thriving.