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A special collection issue from The Journal of Applied Laboratory Medicine brings to light the value of laboratory medicine in the SARS-CoV-2 pandemic, in the opioids epidemic, and in molecular diagnostics. The future of lab medicine will depend more on value basics than testing volume, according to journal Editor-in-Chief Robert H. Christenson, PhD. “The articles in this special collection help underscore that point,” he told CLN Stat.
“Who hasn’t heard about the importance of lab testing in the COVID-19 era? Other specialties and stakeholders—even the lay public—are recognizing its importance,” added Christenson. At this critical juncture, the hope is laboratorians will seek out the JALM special collection to find examples of the value proposition in laboratory medicine.
The impact of the COVID-19 pandemic worldwide makes the focus on value a timely one, wrote Christenson, JALM editorial board member David G. Grenache, PhD, and Michael Oellerich, MD, Hon MD, FAACC, FAMM, FFPath (RCPI), FRCPath, in a preamble to the issue. Grenache also serves as AACC president. Several articles in the collection address detecting acute SARS-CoV-2 infections and the role of anti–SARS-CoV-2 serology testing in evaluating immune response, which can determine disease prevalence and exposure to the virus or infection.
“The value of real-time reverse transcription PCR [polymerase chain reaction] testing for detection of SARS-CoV-2 viral infection has been profound, and media reports have noted that the supply of testing reagents is frequently outstripped by the immense need for reverse transcription PCR testing,” noted the preamble authors, who edited the special collection. Its value to global public health is unquestionable.
Two studies by Grenache and colleagues at TriCore Reference Laboratories that highlight the nontraditional role of clinical labs in chronic disease care management underscore the importance of evidence-based laboratory medicine. This work, along with a paper by Oellerich and others that used 15 key steps to identify the value proposition of using donor-derived cell-free DNA (dd-cfDNA) in organ transplantation, “were both really innovative, and help to illustrate and document the value of lab testing,” said Christenson, a co-author of the latter.
Oellerich and colleagues leveraged data analytics and big data to combine tests that had never been combined before. “It’s now possible to gain synergism, so that tests work together and provide information that is greater than the simple sum of their contributions. In this way, we can provide a lot more information than what the tests could do on their own,” said Christenson. Other articles on molecular diagnostics include technology and value propositions for the use of liquid biopsy to detect circulating tumor cells and the use of molecular pathology biomarkers in oncology.
An article by Iain Macpherson and others that describes intelligent liver function testing strategies for recognizing hepatic conditions is a must-read, said Christenson. “This paper is about working smarter to improve patient outcomes in liver disease.” Investigators took liver function tests and used data analytics by way of an algorithm to detect more than 2,000 abnormal diagnoses in Scotland that might otherwise have been missed. This identifies more cases, bringing patients in for earlier treatment that can lead to better health outcomes, said Christenson.
Authors of this paper received the prestigious UNIVANTS of Healthcare Excellence award. “This competitive award goes through a peer-review process and is a forum for recognizing teams that collaborate across disciplines, transform healthcare delivery, and demonstrate improved patient outcomes,” according to Christenson, Grenache, and Oellerich.
The special issue also addresses the role of laboratory medicine in the opioids epidemic. One report on how to deliver more insightful interpretive data with urine drug panel and toxicology testing in wake of changing clinical needs is particularly worth exploring. “These articles are important to this public health crisis,” noted the authors.