Daria Pašalić
Department of Medical Chemistry, Biochemistry and Clinical Chemistry
Zagreb University School of Medicine
Šalata ul 2.
10 000 Zagreb, Croatia
Phone +385 (1) 4590 205; +385 (1) 4566 940
E-mail: dariapasalic [at] gmail [dot] com

Useful links



Müller M.PS00-1: The challenges for the clinical laboratory in a changing environment Biochemia Medica 2009;19(Suppl 1):S13-S14.
Austrian Society of Quality assurance and Standardisation, Vienna, Austria
Corresponding author:mathias [dot] mueller [at] oequasta [dot] at (mathias [dot] mueller [at] oequasta [dot] at)
During the past 10 or 15 years many changes in our political, social, ecological and economical environment have occurred. This trend can obviously not be stopped and is also seen in the health care environment, where we might be facing dramatic changes and developments in the coming decade.
As for the laboratory, one of the most striking challenges is the overwhelming and still increasing number of tests to be performed, validated and clinically interpreted every day. In many cases these tests must be performed 24hrs per day, 7 days a week. This becomes even more difficult since the cost pressure still remains, leading to cost savings in terms of reduction in personnel. Many times at the expense of eliminating well educated personnel. On the other side, there is a steadily growing demand for shorter turn around times, availability and quality of tests. To cope with these challenges, the lab has to focus on four major fields within the hospital or health care framework.
1.   Analytics: The number of new tests and parameters will further increase. The proof of their clinical utility and application will be an issue and requires clinical evaluations. New systems must involve a flexible and modular architecture to cope with the different requirements in large and smaller specialised labs. Online quality control systems will help to ensure a real-time quality control and should become the standard in each lab.
2.   Workflow and logistics: A clear strategy for the pre-analytical phase of samples inside and outside the lab, starting from sample collection to the measurement must be defined in each lab. Integration of results from remote or satellite labs has to be established. All items related to sample transport and storage, result transmission and communication as well as logistics of reagents and disposables must be organised.
3.   Results and diagnosis: Automated result validation and interpretation will become necessary to effectively run a lab. Rule engines and knowledge base-solutions (expert system) need to be implemented increasingly to support the decision making in the lab. Expert networks with fast communication links using telemedicine and internet connections will be established. Security issues of electronic patient data and data archives need to be considered.
4.  Hospital and health care: The environment in which the lab is embedded will have specific demands such as communication between the lab (LIS) and external partners in integrated patient care networks. Furthermore consolidation of hospital lab services and in sourcing from private health care providers, specialisation, and implementation of tailor made solutions will be essential to fulfil individual requirements.
As for these four areas, there are already good examples on how a lab can cope with these challenges. I will present examples that demonstrate the future lab vision of yesterday has already started to become reality today.
Baton V.PS00-2: The great issues for medicine in next century. Biochemia Medica 2009;19(Suppl 1):S14-S15.
KU-Leuven, Department of Clinical Chemistry, Brugge, Belgium
Corresponding author:victor [dot] blaton [at] skynet [dot] be
The opportunity to present this lecture on invitation by the Croatian Society of Medical Biochemists in celebration of the long career of Prof Elizabeta Topic in Laboratory Medicine caused me to reflect back on my own career in Medical Biochemistry and medicine. I am impressed and astonished by one dominant and recurring theme - how a few good ideas and the power of science can radically transform the way of live.
1965 a very important year for Elizabeta - her choice Pharmacy therapeutic medicine was very primitive by today’s standards. There were no calcium blockers or ACE inhibitors, no statines for cholesterol and no Prozac for depression and no vaccines against hepatitis and influenza. There were no bone marrow transplantation, no liver or heart transplants. Coronary bypass operations did not exist. There were no CAT scans or MRI’s. Alzheimer was a very rare disorder. AIDS was unknown and there were only a couple Xerox machines over the world and finally there were no McDonald’s restaurants. And bring me to the theme that the world in general and the world of medicine have been radically changed by three turns of events. Burgers, chips and genes. Elizabeta was also involved in genes related diseases. Let me explain.
The genius of the founder of the Big Mac was an answer that the people wanted to be served in 60 seconds, creating fast food restaurants and change completely the way of live and introducing the metabolic syndrome. Without microchips there were no car phones, no cash cards and no personal computers. Around the same time 1966 was a turning point in the history of the genes, the genetic code was completely deciphered, in 1972 the recombinant technique was discovered. Our new power to manipulate genes leaded to the knowledge of the complete DNA sequence of the human genome. Great scientific discoveries always lead to applications that benefit the society. As chips led to the birth of the microchip industry genes has led to the creation of the biotechnology industry, which after 25 years has been extremely impressive. The biotechnologists have assumed a style that is reminiscent of an earlier revolution in art called surrealism, they live and think in a world of fantasy and dreams. Let us consider the work of the Belgian artist René Magritte “The castle in the sky” “Clairvoyance”. What will be medicine in 2099 no prediction however “Expect the unexpected”.
Elizabeta worked hardly on continuous education which need further reorientation and fundamental changes. The problem is that we not take enough advantages in our profession of the enormous technological breakthroughs that the basic scientists are giving us, we need more patient oriented research than disease oriented. I would like to place her work as important for the next future.
Kovacs GL.PS00-3: The present and future of endocrine laboratory diagnostics. Biochemia Medica 2009;19(Suppl 1):S15-S16.
Institute of Laboratory Medicine, University of Pecs, Pecs, Hungary
Corresponding author:gabor [dot] l [dot] kovacs [at] aok [dot] pte [dot] hu
When the author began his career in 1972 he found a calorimeter in the endocrine lab put out of use just a few years before. The hormone laboratory has changed dramatically since the last 30 years and even more since. Many of the major principles governing clinical endocrinology taken for granted today were established during the last 50 years. In fact, during this period, twelve individuals received or shared Nobel Prizes for discoveries directly related to endocrinology and hormone assays. From the tremendous amount of information gathered during half a century, the author has selected three topics that had a particular impact on the practice of endocrinology and therefore on hormone measurements. These three topics are the discovery and identification of brain neuropeptides, the mediation of hormonal action through extra- and intracellular receptors, and the evolution of the concept of free hormones. The author does not feel that we have sufficient foresight or wisdom to extrapolate what endocrinology laboratories (if they still exist) will look like in only 20 years from now. Part of what we already use, assay formats and automated analyzers, will probably still be around. We may expect improvements in the recipes to eliminate interferences caused by heterophil antibodies in immunoassays. The problems of cross reactivity for small molecules will eventually be solved by using tandem mass spectrometry technology instead of immunoassays. There is no doubt that the number of definitive methods based on isotope dilution mass spectrometry for biochemical measurements reflects that mass spectrometry is superior to immunoassays for small molecules. Molecular biology has already found its way in the endocrinology field with the identification of mutations responsible for various sub-types of multiple endocrine neoplasia, congenital adrenal hyperplasia, or almost any other genetically determined endocrine disease. The measurement of thyroglobulin messenger RNA by RT-PCR is already used in the follow-up of patients with differentiated cancer of the thyroid. Measurement of genes and mRNAs for different kallikreins has been proposed as prognostic markers for many cancers. Identification of mutations in the traditional estrogen receptor is now indicated for breast cancer. The role of the laboratory specialist in hormone testing has also changed in the last 50 years. For many years, laboratory specialists prepared their own kits. Now, clinical biochemists can make no changes to manufacturers’ protocols without risking legal action. Assay development will be concentrated within research and manufacturers’ laboratories. Our role will be more devoted to explain the limitations of these assays to clinicians submerged by all kinds of information and – most importantly - to consult with them.
Stavljenić-Rukavina A.PS00-4: Laboratory medicine in the future: people are most important. Biochemia Medica 2009;19(Suppl 1):S17.
Croatian Chamber of Medical Biochemists, Zagreb, Croatia
Corresponding author:astavljenic [at] hkmb [dot] hr
Review of the scope of laboratory medicine in the last 2 decades shows a constant development of the profession by expanding diagnostic possibilities as well as technological progress of laboratory infrastructure. However, the healthcare system, especially the public healthcare, includes several key issues in laboratory medicine which have contributed to accuracy of diagnosis and treatment of frequent diseases, patient’s safety, rational healthcare consumption and development of evidence-based medicine. Those issues are recognized through critical evaluation of diagnostic tests application in medicine based on scientific principles, application of new technologies which provide prompt response to physician’s question “what is wrong with my patient and am I treating him/her efficiently”, establishment of quality improvement system and upgrade in education of professionals, patients and public.
Some individuals, recognized experts in laboratory medicine, depending on their working place, give their contribution to development of medical biochemistry profession. Through their work they not only promote medicine to which they serve, but also by striving in their knowledge, they set a new direction and give examples for posterity.
Laboratory medicine of the future is focused on reviewing its efficiency in scope of evidence-based medicine and principles of the best possible patient’s protection from wrong diagnosis and treatment. While the higher level of efficiency requires new technology, shorter TAT, higher rate of responses to clinicians and patients questions, the answer to the question of patients’ safety is much more complex and requires a multidisciplinary approach especially in hospital practice. Patients’ reliability in the diagnosis and treatment is one of the priority projects of the World Health Organization and national strategies of health system reform. It is very important that recognized experts in the field of laboratory diagnostics are capable of assessing scope of their profession and are determined to communicate with all other medical professionals who care about the patients. Through the overview of professor’s Elizabeta Topić contribution in certain professional area and medical biochemistry, biochemistry this lecture will analyze the state of the art of the past and its development in the future.