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The Collaboration between IML and Major Medical Institutions - Supplement Service with Esoteric Testing
Hua Li (Guangdong 999 Brain Hospital, China)

The Background

The Guangdong 999 Brain Hospital is a specialized hospital focusing on the diseases of brain and neurological system, is located in Guangzhou City, Guangdong Province of China. The hospital consists of two groups of departments: the clinical department, including Department of Neurology, Neurosurgery, Neurological Rehabilitation, Psychiatry, Cerebral Palsy Treatment and Comprehensive Tumor Treatment Centers; and functional departments such as Department of Clinical Laboratory, Department of Radiology, Pharmacy and Department of Electrophysiology. The hospital has over 700 beds and is a grade III specialized hospital based on the classification system for medical institutes in China. In 2011, the hospital admitted about 16,000 patients and over 100,000 outpatients .The hospital emphasizes on the importance of laboratory testing in clinical practice and has established the clinical laboratory to meet demands from different disciplines within the hospital. The Department of Clinical Laboratory has employed a number of highly qualified staff that actively introduces advance equipments. Currently, up to 97% of the lab-tests can be conducted within the hospital and the other 3% are referred to other hospitals and Independent Medical Laboratories (IML). Generally, the specimens sent out are the following: Genetic tests for inherited diseases, Metabolic disease tests, Immune-Antibody, and special tests of non-neurological system disease. The reasons for sending out such samples are:- (1) the hospital is specialized in the diseases of brain and neurological system, and does not perform many tests on non-neurological disease, such as thalassemia, G6PD, B-BNP, and immune antibody tests; (2) the genetic and metabolic tests require the lab-staff to be trained in Molecular Diagnostics as well as some high-cost equipments, making it difficult nor economical to develop and conduct these tests in the hospital. Considering all these factors, our hospital decided to use the third-party service of a diagnostics laboratory, provided by an IML, i.e. the Guangzhou KingMed Clinical Laboratory, one of the branches in Kingmed Center For Clinical Laboratory.

As a brain neuro-specialized hospital, the majority of diseases involved in neurology include cerebrovascular disease, headache, dizziness, hereditary diseases, intracranial infection, demyelinating disease, and degenerative disease. The dominant diseases handled within neurosurgery are cerebral tumors and cerebral traumas. From a clinical point of view, the lab-tests provided by our hospital laboratories can only meet the basic clinical demands but for a number of diseases, more laboratory support are needed for clinicians to diagnose and plan for treatment. For instance, some of the hereditary diseases could be diagnosed relying on clinical data, while a large number of cases would require certain gene tests to confirm the diagnosis. On the other hand, the gene tests and pedigree analysis of the family members are necessary to ensure healthy pregnancies and for scientific nurture. Some examples are mitochondrial encephalomyopathy, hereditary ataxia, Wilson disease, progressive muscular dystrophy, tuberous sclerosis, motor neuron disease, chorea, Addison-Schilder disease. The Epilepsy Center in our hospital, receives 20,000 outpatients annually. The commonly-occurring hereditary diseases closely related to epilepsy includes: mitochondrial encephalomyopathy, tuberous sclerosis, progressive myoclonic epilepsy, Dravet syndrome, HLA-B*1502 allele abnormality which is related to severe allergies to carbamazepine, autosomal dominant nocturnal frontal lobe epilepsy, glucose transporter deficiency and some ion channelopathy. The diagnosis of these diseases are also depended on tests at the gene level. Additionally gene tests are very useful for the selection of anti-epileptic drugs and the estimation of prognosis. Once diagnosis has been confirmed, some hereditary diseases can be controlled or even clinically cured by simple dietary changes or therapy. Despite the large demand for this type of tests existing over the years, there seems to be no solution for our hospital due to the large sample volume, technological limitation, financial resource, personnel shortages and particularly the tests required often belong to high-tech detection range and require high-cost equipments performed with sophisticated procedures. In more advanced countries, these kinds of tests are likely provided by IML or reference laboratories with some classifying the tests into a specific groups, so-called esoteric tests or detections. Fortunately, Kingmed has established the Department of Esoteric Testing and provided esoteric testing service satisfying clinical demand.

The third-party clinical laboratory or IML is a relatively new industry for the clinicians, laboratorians, and even the medical service system, even though the concept was envisioned just in the last 10 years. Before the availability of the third-party service of lab-testing, we completely relied on the clinical laboratory of the hospital and required the lab to provide all of the diagnostic testing that we needed. In most of the cases the hospital laboratory failed to do so. The gap between the demands of clinical practice and the service limitations of a laboratory obstructs the capabilities of a physician, surgeon even a department or hospital. This demand induces and promotes the attractiveness and development of third-party laboratories. As one of the clients for the third-party service of diagnostic testing, I would like to give a positive remark on the IMLs and its model of service. The benefits of utilizing IML services can be summarized as: (1) elevating my clinical capability; (2) providing an efficient way to bring me new knowledge and concepts to my field as well as in laboratory medicine and (3) it has given me a broader perspective to understand the medical service system both nationally and internationally thereby allowing me to select and use the services available. I certainly believe that the collaboration between the KingMed and our hospital will move to the next level and the IML services will go along with me throughout my entire career.

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