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MJD PLMED Pathology And Laboratory Medicine Question: What is evidence based practice and how does it relate to laboratory medicine? Give at least 2 specific detailed examples of this in your placement laboratory The following are all recommended reading on this topic from my university. Answer: Evidence based practice is an extensively used decision making process applied in various service provision fields and is supported by strong scientific evidence to improve client outcome very efficiently. In this regard, medical science is a domain where the evidence based practice have been utilised in the field of nursing and medicine to improve health outcomes of patients (1). Evidence based practice primarily relies on coordinated contribution of several aspects that includes expert opinion, scientific evidence and client, patient or caregiver perspectives and priorities. It is person centred practice that takes into consideration the needs, values, interests and choices of individuals receiving care. The essential steps followed are framing the clinical question relevant to the patient, finding relevant scientific evidence, assessing the evidence, making comparison with the real life scenario and finally making the clinical decision. It strongly discourages use of single observations and intuition to make clinical decisions. Incorporation the principles of evidence based practices in the field of laboratory medicine various issues like sufficiency of testing, profit of the laboratory and eventual clinical outcomes of the tests (2). The fitness of laboratory medicine in the care pathway, nature and quality of testing, appropriate testing, utility of testing and the method in which the tests can impact clinical actions, all of these factors can be evaluated by applying evidence based practice in laboratory medicine. Two detailed examples of evidence based practice in our placement laboratory have been provided herein. Collagen Mason’s Trichrome Stain is a differential staining procedure used to differentiate between collagen and smooth muscle tissues in tumours. Moreover, it is used to detect the increase in collagen fibres in case of diseases like cirrhosis. It is one of the most routine staining tests for liver and kidney tissues. As suggested by the name three different stains viz. hematoxylin (purple nuclear stain), mix of xylidin and acid fuscin (red cytoplasmic stain) and aniline blue (light green collagen fibre stain) constitute Mason’s trichrome stain (3). The staining principle depends on the permeability of the tissues to the different stains. The Aniline blue in our laboratory was prepared 9 months ago; hence it is preferable to apply the stain for 10minutes instead of 5minutes. The following pictures show Aniline blue staining for 5 minutes and 10 minutes respectively.                                             Fig: Aniline blue stained for 5 minutes and 10 minutes respectively. The second example cited here is Haematoxylin and Eosin stain, which is used extensively in RMIT pathology lab. Haematoxylin eosin staining is often considered as gold standard as cancer suspected biopsies are often stained with haematoxylin and eosin stains (4). In RMIT pathology lab used reagents are used at times which is why staining the nucleus for 4 minutes instead of 1.5-3 minutes often show better results. When old reagents are being used, the reagents lose some of their intensity and so applying them for longer duration is required. Evidence based practice has been adopted by many fields to improve the quality of the concerned practice. In laboratory medicines evidence based approaches provide logic and well defined processes. However, there are still challenges regarding the application of the principles as traditional behaviours still prevail to this date. It is the responsibility of the laboratories and the clinicians to curb such hurdles and help apply evidence based information in the field of laboratory medicine. References: Rousseau DM, Gunia BC. Evidence-based practice: the psychology of EBP implementation. Annual review of psychology. 2016 Jan 4;67:667-92. DiCenso A, Guyatt G, Ciliska D. Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences; 2014 Mar 18. Rahunen K, Rieppo L, Lehenkari P, Finnilä M, Saarakkala S. Evaluation of quantitativity of histological collagen stains in articular cartilage. Osteoarthritis and cartilage. 2016 Apr 1;24:S307-8. Chan JK. The Wonderful Colors of the Hematoxylin–Eosin Stain in Diagnostic Surgical Pathology. International journal of surgical pathology. 2014 Feb;22(1):12-32.

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