The establishment and prompt reporting of critical values to patient care providers is one of the crucial requirements of clinical laboratories. Each laboratory is expected to individually establish the thresholds of critical values and periodically update the lists. In this study, we attempted to investigate the status of critical value reporting (CVR) systems in Korean clinical laboratories and develop adequate guidelines based on comparative reviews examining expert consensus. In responses from 11 clinical laboratories, the number of test items with a critical value threshold was 9.4 on average (standard deviation=5.0). Some of the test items, especially ammonia, lactate, and carboxyhemoglobin, lacked critical value thresholds despite having been recommended by expert opinions and guidelines. The upper limit of critical value thresholds showed variability, with glucose showing the largest difference among laboratories (range, 450–700 mg/ dL; coefficient of variation=14.7%). When evaluating the appropriateness of establishing critical value for a particular test, it is generally recommended to consider the “actionability” factors, which consist of effectiveness in decreasing mortality, availability of immediate response systems, and inclusion of the decision-making process in the institution’s critical pathway of standard patient care. As for the optimal value of individual thresholds, laboratory managers should review three quantitative markers: the ratio of CVR cases in total reported results, the ratio of confirmed CVR and responses by clinicians in total CVR cases, and the turnaround time of the tests assigned with critical value thresholds.

Background: BRCA testing is necessary for establishing a management strategy for ovarian cancer. Several BRCA testing strategies, including germline and somatic testing, are implemented in clinical practice in Korea. We aimed to comparatively evaluate their cost-effectiveness from patients’ perspective. Methods: We developed a decision model comprising five BRCA testing strategies implemented in Korea: (1) germline testing first, followed by somatic tumor testing for patients without a germline variant; (2) somatic testing first, followed by germline testing for patients with a variant detected by somatic testing; (3) both germline and somatic testing; (4) germline testing alone; and (5) somatic testing alone, with no testing as the comparator. One-way sensitivity analysis was conducted to test the uncertainty of key parameters. Results: Assuming a willingness-to-pay of $20,000 per progression-free life-year gain (PF-LYG), all five strategies were considered cost-effective. Strategy 4 was the most cost-effective option, with an incremental cost-effectiveness ratio (ICER) of $2,547.7 per PF-LYG, followed by strategy 1, with an ICER of $3,978.4 per PF-LYG. Even when the parameter values were varied within the possible range, the ICERs of all strategies did not exceed the willingness-to-pay threshold. Conclusions Considering the importance of knowing a patient’s BRCA gene status, germline testing first, followed by somatic testing, may be a reasonable option.

Fabrication of dentures using CAD/CAM system has the advantage of reducing the number of patient visits and reducing errors during laboratory work. After the extraction of maxillary residual teeth, this patient changed to a completely edentulous state and the stability and retention of the existing mandibular complete denture were insufficient due to the absorption of the mandibular residual ridge, so the restoration of the mandibular implant retained overdenture and maxillary complete denture were planned.By digitizing the concept of BPS (Biofunctional prosthetic system) that uses the patient’s functional movement in closed mouth technique, the vertical dimension was taken by Gnathometer CAD and digital facebow transfer was performed using UTS CAD. In this case, fabrication of maxillary complete denture and mandibular implant-retained overdenture using monolithic disc and CAD/ CAM system demonstrated favorable denture retention, stability, and support and the patient is satisfied with improved functions and esthetic of dentures.