{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:57:25Z","timestamp":1793318245768,"version":"4.5.0"},"reference-count":40,"publisher":"Walter de Gruyter GmbH","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_cclm-2021-0421_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We aimed to share a new laboratory model based on laboratory knowledge, meaningful use of information technology, and partnership with clinicians, to lead the appropriate use of laboratory testing and clinical decision making in the diagnosis of as-yet-undiagnosed disease. More specifically, we evaluate the role of eight different opportunistic interventions to diagnose certain asymptomatic disorders, by means of the automatic registration of appropriate laboratory testing according to different scenarios.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2021-0421_abs_002\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This is a retrospective longitudinal study to evaluate the impact of laboratory interventions on the diagnosis of different diseases and on patient care, including data from January 2012 to September 2020.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2021-0421_abs_003\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, the above strategies have so far identified 2063 patients with clinically relevant as-yet-undiagnosed disorders who would have otherwise remained occult, such\u00a0as for instance, primary hyperparathyroidism, diabetes, and hypomagnesemia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2021-0421_abs_004\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We are facing a new laboratory model, a leading laboratory rather than a passive traditional laboratory, not just to intervene in clinical decision-making, but to make the clinical decision, through the identification of patients with occult disease.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/cclm-2021-0421","type":"journal-article","created":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T03:00:10Z","timestamp":1621479610000},"page":"1634-1641","source":"Crossref","is-referenced-by-count":20,"title":["The clinical laboratory: a decision maker hub"],"prefix":"10.1515","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3420-5509","authenticated-orcid":false,"given":"Mar\u00eda","family":"Salinas","sequence":"first","affiliation":[{"name":"Clinical Laboratory, Hospital Universitario de San Juan , San Juan , Alicante , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maite","family":"L\u00f3pez-Garrig\u00f3s","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, Hospital Universitario de San Juan , San Juan , Alicante , Spain"},{"name":"Department of Biochemistry and Molecular Biology , Universidad Miguel Hern\u00e1ndez , Elche , Spain"},{"name":"CIBER en Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP) , Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Flores","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, Hospital Universitario de San Juan , San Juan , Alicante , Spain"},{"name":"Department of Clinical Medicine , Universidad Miguel Hernandez , Elche , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ester","family":"Mart\u00edn","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, Hospital Universitario de San Juan , San Juan , Alicante , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Leiva-Salinas","sequence":"additional","affiliation":[{"name":"Department of Radiology , University of Missouri , Columbia , MO , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2021,5,20]]},"reference":[{"key":"2023033111233267302_j_cclm-2021-0421_ref_001","doi-asserted-by":"crossref","unstructured":"Lundberg, GD. 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Critical (panic) value notification: an established laboratory practice policy (parameter). JAMA J Am Med Assoc 1990;263:709. https:\/\/doi.org\/10.1001\/jama.263.5.709.","DOI":"10.1001\/jama.1990.03440050103044"},{"key":"2023033111233267302_j_cclm-2021-0421_ref_005","doi-asserted-by":"crossref","unstructured":"Salinas, M, Flores, E, Lugo, J, Guti\u00e9rrez, M, Uris, J. Retrospective study of critical values: agreement and improvement. Lab Med 2008;39:413\u20137. https:\/\/doi.org\/10.1309\/rn0mxjd6bth6mje1.","DOI":"10.1309\/RN0MXJD6BTH6MJE1"},{"key":"2023033111233267302_j_cclm-2021-0421_ref_006","doi-asserted-by":"crossref","unstructured":"Plebani, M, Laposata, M, Lundberg, GD. The brain-to-brain loop concept for laboratory testing 40 years after its introduction. 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A study of the differences in the request of glycated hemoglobin in primary care in Spain: a global, significant, and potentially dangerous under-request. Clin Biochem 2014;47:1104\u20137. https:\/\/doi.org\/10.1016\/j.clinbiochem.2014.04.020.","DOI":"10.1016\/j.clinbiochem.2014.04.020"},{"key":"2023033111233267302_j_cclm-2021-0421_ref_036","doi-asserted-by":"crossref","unstructured":"Salinas, M, L\u00f3pez-Garrig\u00f3s, M, Flores, E, Leiva-Salinas, C, Valero, VP, Gasc\u00f3n, F, et al.. Glycated hemoglobin: a powerful tool not used enough in primary care. J Clin Lab Anal 2017;32:e22310. https:\/\/doi.org\/10.1002\/jcla.22310.","DOI":"10.1002\/jcla.22310"},{"key":"2023033111233267302_j_cclm-2021-0421_ref_037","doi-asserted-by":"crossref","unstructured":"Salinas, M, L\u00f3pez-Garrig\u00f3s, M, Flores, E, Uris, J, Leiva-Salinas, C, P\u00e9rez-Mart\u00ednez, A, et al.. Potential over request in anemia laboratory tests in primary care in Spain. Hematology 2015;20:368\u201373. https:\/\/doi.org\/10.1179\/1607845414y.0000000210.","DOI":"10.1179\/1607845414Y.0000000210"},{"key":"2023033111233267302_j_cclm-2021-0421_ref_039","doi-asserted-by":"crossref","unstructured":"Oosterhuis, WP, Venne WPV van de, Deursen, CT van, Stoffers, HEJH, Acker, BA van, Bossuyt, PMM. Reflective testing \u2013 a randomized controlled trial in primary care patients. Ann Clin Biochem 2020;58:78\u201385.","DOI":"10.1177\/0004563220968373"},{"key":"2023033111233267302_j_cclm-2021-0421_ref_040","doi-asserted-by":"crossref","unstructured":"Salinas, M, L\u00f3pez-Garrig\u00f3s, M, Flores, E, Blasco, A, Leiva-Salinas, C. Successful implementations of automated minimum re-test intervals to overcome Ferritin over-requesting in a Spanish hospital laboratory. Clin Chem Lab Med 2020;58:e287\u20139. 10.1515\/cclm-2020-0668. 32598304.","DOI":"10.1515\/cclm-2020-0668"},{"key":"2023033111233267302_j_cclm-2021-0421_ref_041","doi-asserted-by":"crossref","unstructured":"Salinas, M, Flores, E, Lopez-Garrigos, M, Leiva-Salinas, M, Asencio, A, Lugo, J, et al.. Computer-assited interventions in the clinical laboratory process improve the diagnosis and treatment of severe vitamin B12 deficiency. 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