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The Top 25 Laboratory Tests by Volume and Revenue in Five Different Countries

Horton S, Fleming KA, Kuti M, Looi LM, Pai SA, Sayed S, et al.

Am J Clin Pathol, 2019 04 02;151(5):446-451.
PMID: 30535132 DOI: 10.1093/ajcp/aqy165

OBJECTIVES: To compare the most common diagnostic/laboratory tests across five different referral hospitals by volume and revenue.
METHODS: The authors obtained data on volumes and reimbursement rates for the most common 25 tests at the five hospitals with which they are affiliated and organized them to be as comparable as possible. Simple descriptive statistics were used to make cross-country comparisons.
RESULTS: There are strong similarities across all five hospitals in the top five tests by both volume and revenue. However, the top five by volume differ from the top five by revenue. Reimbursement rates also follow common patterns, being lowest for the most common biochemical test; intermediate for the most common hematology and microbiology tests, respectively; and highest for the most common pathology test.
CONCLUSIONS: Most of the most common tests also appear in the new Essential Diagnostics List. This may inform plans for universal health coverage.
Access to pathology and laboratory medicine services: a crucial gap

Wilson ML, Fleming KA, Kuti MA, Looi LM, Lago N, Ru K

Lancet, 2018 05 12;391(10133):1927-1938.
PMID: 29550029 DOI: 10.1016/S0140-6736(18)30458-6

As global efforts accelerate to implement the Sustainable Development Goals and, in particular, universal health coverage, access to high-quality and timely pathology and laboratory medicine (PALM) services will be needed to support health-care systems that are tasked with achieving these goals. This access will be most challenging to achieve in low-income and middle-income countries (LMICs), which have a disproportionately large share of the global burden of disease but a disproportionately low share of global health-care resources, particularly PALM services. In this first in a Series of three papers on PALM in LMICs, we describe the crucial and central roles of PALM services in the accurate diagnosis and detection of disease, informing prognosis and guiding treatment, contributing to disease screening, public health surveillance and disease registries, and supporting medical-legal systems. We also describe how, even though data are sparse, these services are of both insufficient scope and inadequate quality to play their key role in health-care systems in LMICs. Lastly, we identify four key barriers to the provision of optimal PALM services in resource-limited settings: insufficient human resources or workforce capacity, inadequate education and training, inadequate infrastructure, and insufficient quality, standards, and accreditation.
Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions

Sayed S, Cherniak W, Lawler M, Tan SY, El Sadr W, Wolf N, et al.

Lancet, 2018 05 12;391(10133):1939-1952.
PMID: 29550027 DOI: 10.1016/S0140-6736(18)30459-8

Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan.
Apes in the Anthropocene: flexibility and survival

Hockings KJ, McLennan MR, Carvalho S, Ancrenaz M, Bobe R, Byrne RW, et al.

Trends Ecol Evol, 2015 Apr;30(4):215-22.
PMID: 25766059 DOI: 10.1016/j.tree.2015.02.002

We are in a new epoch, the Anthropocene, and research into our closest living relatives, the great apes, must keep pace with the rate that our species is driving change. While a goal of many studies is to understand how great apes behave in natural contexts, the impact of human activities must increasingly be taken into account. This is both a challenge and an opportunity, which can importantly inform research in three diverse fields: cognition, human evolution, and conservation. No long-term great ape research site is wholly unaffected by human influence, but research at those that are especially affected by human activity is particularly important for ensuring that our great ape kin survive the Anthropocene.
Fulltext The Lancet Commission on diagnostics: transforming access to diagnostics

Fleming KA, Horton S, Wilson ML, Atun R, DeStigter K, Flanigan J, et al.

Lancet, 2021 Nov 27;398(10315):1997-2050.
PMID: 34626542 DOI: 10.1016/S0140-6736(21)00673-5