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Evidence-based principles and practices in pathology: selected problem areas.

Mark R Wick1, T David Bourne, James W Patterson

  • 1Department of Pathology, University of Virginia Health System, Charlottesville, Virginia 22908-0214, USA. mrw9c@virginia.edu

Seminars in Diagnostic Pathology
|April 28, 2006
PubMed
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Evidence-based medicine (EBM) principles are often overlooked in laboratory medicine, impacting areas from pathology to clinical testing. This review highlights common non-EBM practices and their origins in hospital laboratories.

Area of Science:

  • Laboratory Medicine
  • Pathology
  • Evidence-Based Medicine

Background:

  • Many laboratory medicine practices deviate from evidence-based medicine (EBM) principles.
  • These deviations occur in both anatomic and clinical pathology.
  • Practices may be influenced by inadequate education, habit, or empirical reliance by clinicians and pathologists.

Purpose of the Study:

  • To identify and discuss exemplary problem areas in hospital laboratories where EBM principles are not applied.
  • To analyze the reasons behind the perpetuation of non-EBM practices.

Main Methods:

  • This is an overview and discussion of existing concepts and techniques.
  • Exemplary problem areas in laboratory medicine were selected for analysis.

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Main Results:

  • Non-EBM practices are prevalent in areas such as metastatic malignancies, oncological therapy, surgical margin analysis, general laboratory testing, coagulation defect evaluation, blood product administration, and hepatic iron-overload syndromes.
  • Departures from EBM stem from both external (clinical consumers) and internal (pathologist) factors.

Conclusions:

  • There is a significant need to integrate EBM principles more rigorously across various domains of laboratory medicine.
  • Addressing these non-EBM practices requires improved education and a critical re-evaluation of established procedures.