Education and Recognition of Professional Qualifications in the Field of Medical Biochemistry in Serbia
Medical biochemistry is the usual name for clinical biochemistry or clinical chemistry in Serbia, and medical biochemist is the official name for the clinical chemist (or clinical biochemist). This is the largest sub-discipline of the laboratory medicine in Serbia. It includes all aspects of clinical chemistry, and also laboratory hematology with coagulation, immunology, etc. Medical biochemistry laboratories in Serbia and medical biochemists as a profession are part of Health Care System and their activities are regulated through: the Health Care Law and rules issued by the Chamber of Medical Biochemists of Serbia. The first continuous and organized education for Medical Biochemists (Clinical Chemists) in Serbia dates from 1945, when the Department of Medical Biochemistry was established at the Pharmaceutical Faculty in Belgrade. In 1987 at the same Faculty a five years undergraduate branch was established, educating Medical Biochemists under a special program. Since school-year 2006/2007 the new five year undergraduate (according to Bologna Declaration) and postgraduate program of four-year specialization according to EC4 European Syllabus for Post-Gradate Training in Clinical Chemistry and Laboratory Medicine has been established. The Ministry of Education and Ministry of Public Health accredits the programs. There are four requirements for practicing medical biochemistry in the Health Care System: University Diploma of the Faculty of Pharmacy (Study of Medical Biochemistry), successful completion of the profession exam at the Ministry of Health after completion of one additional year of obligatory practical training in the medical biochemistry laboratories, membership in the Serbian Chamber of Medical Biochemists and licence for skilled work issued by the Serbian Chamber of Medical Biochemists. The process of recognition of a foreign higher education document for field of medical biochemistry is initiated on request by Candidate. The process of recognition of foreign higher education documents is performed by the University. In the process of recognition in Serbia national legislations are applied as well as international legal documents of varying legal importance.
Medical biochemistry is the usual name for clinical biochemistry or clinical chemistry in Serbia, and medical biochemist is the official name for the clinical chemist (or clinical biochemist). This is the largest sub-discipline of the laboratory medicine in Serbia. It includes all aspects of clinical chemistry, and also laboratory hematology with coagulation, immunology, etc. Medical biochemistry laboratories in Serbia and medical biochemists as a profession are part of Health Care System and their activities are regulated through: the Health Care Law and rules issued by the Chamber of Medical Biochemists of Serbia. The first continuous and organized education for Medical Biochemists (Clinical Chemists) in Serbia dates from 1945, when the Department of Medical Biochemistry was established at the Pharmaceutical Faculty in Belgrade. In 1987 at the same Faculty a five years undergraduate study program was established, educating Medical Biochemists under a special program. Since the academic year 2006/2007 the new five year undergraduate (according to Bologna Declaration) and four-year postgraduate program according to EC4 European Syllabus for Postgraduate Training in Clinical Chemistry and Laboratory Medicine has been established. The Ministry of Education and Ministry of Public Health accredited these programs. There are four requirements for practicing medical biochemistry in the Health Care System: University Diploma of the Faculty of Pharmacy (Study of Medical Biochemistry), successful completion of the professional exam at the Ministry of Health after completion of one additional year of obligatory practical training in the medical biochemistry laboratories, membership in the Serbian Chamber of Medical Biochemists and licence for skilled work issued by the Serbian Chamber of Medical Biochemists. In order to present laboratory medical biochemistry practice in Serbia this paper will be focused on the following: Serbian national legislation, healthcare services organization, sub-disciplines of laboratory medicine and medical biochemistry as the most significant, education in medical biochemistry, conditions for professional practice in medical biochemistry, continuous quality improvement, and accreditation. Serbian healthcare is based on fundamental principles of universal health coverage and solidarity between all citizens.
Lipid Profile of Healthy Women During Normal Pregnancy
The four basic lipid indexes (Chol, Trig, HDL-C and LDL-C) increase during pregnancy, following different rates of increase. Among the four analytes triglycerides show the largest increase and HDL-C the smallest. All analyte values are raised during the 40 weeks of pregnancy, except HDL-C which is stabilized during the second trimester. After delivery the values decrease, except LDL-C which remains steady (for some weeks) before starting to fall following the others. In this study the relations between the four lipid indexes and some predisposing factors (age, gestational age, nationality, body mass index, profession, smoking and diabetes during pregnancy) were investigated. The sample consisted of 413 pregnant women, mainly Greeks and Albanians. After regression analysis it was proved that the only common predisposing factor was the gestational age. Triglycerides and total cholesterol are also influenced by the women's age. The lipid indexes showed no important difference between the pregnant women in the first trimester and the non-pregnant women. On the contrary, there was a statistical difference between the pregnant women in the second and third trimester and between them and the women in the first trimester. The percentages of increase between first and second trimester were: Chol: 38%, Trig: 115%, HDL-C: 30%, LDL-C: 33%. The percentages of increase between first and third trimester were: Chol: 65%, Trig: 208%, HDL-C: 26%, LDLC: 64%.
Federica Braga, Ilenia Infusino and Mauro Panteghini
To be accurate and equivalent, laboratory results should be traceable to higher-order references. Furthermore, their quality should fulfill acceptable measurement uncertainty as defined to fit the intended clinical use. With this aim, in vitro diagnostics (IVD) manufacturers should define a calibration hierarchy to assign traceable values to their system calibrators and to fulfill during this process uncertainty limits for calibrators, which should represent a proportion of the uncertainty budget allowed for clinical laboratory results. It is therefore important that, on one hand, the laboratory profession clearly defines the clinically acceptable uncertainty for relevant tests and, on the other hand, endusers may know and verify how manufacturers have implemented the traceability of their calibrators and estimated the corresponding uncertainty. Important tools for IVD traceability surveillance are quality control programmes through the daily verification by clinical laboratories that control materials of analytical systems are in the manufacturer’s declared validation range [Internal Quality Control (IQC) component I] and the organization of Exter nal Quality Assessment Schemes meeting metrological criteria. In a separate way, clinical laboratories should also monitor the reliability of employed commercial systems through the IQC component II, devoted to estimation of the measurement uncertainty due to random effects, which includes analytical system imprecision together with individual laboratory performance in terms of variability.
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4. Gittell JH. High Performance Healthcare – using the power of relationships to achieve quality, efficiency and resilience. New York: McGraw-Hill, 2009.
5. Framework for action on interprofessional education & collaborative practice. Health Professions Network Nursing and Midwifery Office within the Department of Human Resources for health, WHO 2010.
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Mustafa Serteser, Abdurrahman Coskun, Tamer C. Inal and Ibrahim Unsal
Healthcare is a complex profession involving the state-of-art technology and sometimes leading to unintentional harm. Many factors contribute to the occurrence of medical errors. Patient safety is one of the most serious global health issues and defined as the absence of preventable harm to a patient during any process of medical care. The frequency of medical errors is higher than expected. It has been concluded that the majority of medical errors are not because of the individual attitudes but mainly caused by faulty systems or processes leading the staff to make mistakes or fail to prevent them. Patient safety is a shared responsibility comprised of many stakeholders such as society, patients, nurses, educators, administrators, researchers, physicians, government and legislative bodies, professional associations and accrediting agencies. Medical laboratory services are essential to patient care and need to be available to meet the needs of both patients and caregivers. ISO- 15189:2007 Medical Laboratories-Particular requirements for quality and competence, an internationally recognized standard containing requirements necessary for diagnostic laboratories to demonstrate their competence to deliver reliable laboratory services. It applies quality system requirements to the clinical laboratories with a strong focus on responsiveness to the needs of patients and clinicians. Applying the performance improvement strategies focusing on different phases in total testing process will significantly reduce the errors and therefore will improve the patient safety. In this way, laboratory professionals contribute to improvement of safety and outcomes of care by working in interdisciplinary approach manner.
Modern Academic Science is largely based on the formulation of hypotheses that are then confirmed through observations and experiments. There is little scope for curiosity that played an important role in early Science. Results carrying negative implications are not easy to publish, and hypotheses have a tendency to take on the mantra of religious beliefs. Academic Science is facing on many fronts pressures that hardly existed in the past. Financial rewards apart from salary can be very high, in the form of fees for consultants, expert legal witnesses, patent development, and even the establishment of private companies. Commercial funding forms a significant percentage of the Total Research Budgets in Science and Medicine, but this often leads to loss of control over research protocols and freedom to communicate the results. Media attention confers fame and prestige that is assiduously sought out by some individual scientists, often supported by University resources, and Press Conferences prior to or synchronous with actual publication. Scientists have long been employed full-time by Government Departments, but research contracts are being increasingly offered by the latter to academic staff on a part-time basis. These pressures and opportunities, together with the priority given to research by most University Tenure and Promotion Committees, are tending to diminish the appetite of scientists for other important responsibilities such as teaching and administration. In a few decades, University scientists have moved from the »Ivory Tower« to the High Street, and many are serving more than one master. The above scenario may bring increased remuneration and the pursuit of research that would be too expensive without these external sources, but adverse consequences have also occurred. They may lead to the complicity of scientists, through no fault of their own, in the introduction of drugs and supplements that: a) fail to deliver the benefits claimed; b) increase the risk of some unrelated illness; c) possess dangerous side effects not known or reported at the time of introduction. Examples include hormone replacement therapy and antioxidant vitamins (A and E) to protect against Coronary Heart Disease; dietary fibre to prevent colon cancer; and arguably calcium supplements to treat osteoporosis. On occasions, academic scientists have served as fronts for the publication by the manufacturers of falsified reports minimizing the risk of serious drug side-effects to ensure Regulatory Approval, as occurred with Vioxx in the treatment of arthritis, and Seroquel for schizophrenia and bipolar depression. Individual fraud or misconduct is more frequent than suspected, because most incidents are without major impact and are suppressed by Universities and Funding Agencies. Major scandals are rare, but may have serious repercussions for the general public and bring science into disrepute. Recent examples include: the Cold Fusion controversy (Low Energy Nuclear Reaction); the link age by Andrew Wakefield of autism with Rubella vaccination; the infamous creation of stem cells by somatic cell nuclear transfer falsely reported by Hwang Woo-Suk. Fraud by commercial companies is subject to the full force of the law, but Science is treated as a self-regulating profession, and as such the punishments handed out are relatively trivial. In essence, Science prior to 1950, except in North America, proceeded along a highway that segregated the traffic into Commercial, Government and Academic streams, and passed through inspiring landscapes and green pastures. It later came to a crossroads from which the alternative road led to the Marketplace, and on which segregation into the above three streams was not enforced. It has now become the main thoroughfare for Science world-wide, but there are reasons to believe that this has increased the incidence of dangerous driving and traffic accidents in the form of conflicts of interest, unethical behaviour, misconduct and even fraud. It may be too late to return to the crossroads and continue along the original highway, but there could be considerable merit in restoring the original segregation between the three streams of Science and in developing, as well as enforcing, a stricter code of behaviour, for which some elements are proposed.
Michela Seghezzi, Sabrina Buoro, Giulia Previtali, Valentina Moioli, Barbara Manenti, Ramon Simon-Lopez, Cosimo Ottomano and Giuseppe Lippi
11. Furundarena JR, Uranga A, Sainz MR, González C, Uresandi N, Argoitia N, et al. Usefulness of the lymphocyte positional parameters in the Sysmex XN haematology analyser in lymphoproliferative disorders and mononucleosis syndrome. Int J Lab Hematol 2018; 40: 41–8.
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of funding and could benefit from ample economic resources, the current scenario is now overwhelmed by an unprecedented worldwide economic crisis ( 2 ), which has also obligated laboratory managers to increase volume and complexity of testing, contextually preserving quality and cutting down costs. This altered scenario has inevitably forced laboratory managers and laboratory professionals to become familiar with many different instruments borrowed from other professions, such as leadership skills ( 3 ), budgeting activities ( 4 ) and, last but not least, project