Study by Center for Disease Dynamics finds dramatic rise in global antibiotic consumption

Study by Center for Disease Dynamics finds dramatic rise in global antibiotic consumption

A dramatic increase in global consumption of antibiotics has led public health experts to call for innovative new ways to rein in excessive use of the drugs, following a study by the Centre for Disease Dynamics, Economics and Policy, in Washington DC.

The study found a 65% rise in worldwide consumption of antibiotics from 2000 to 2015, despite efforts to encourage more prudent use of the drugs. The unrestrained use of antibiotics is the main cause of the increasing appearance of drug-resistant infections, which now kill more than half a million people worldwide. A report in 2014 predicted that the spread of drug resistance could claim millions of lives per year by 2050.

Eili Klein, an author of the study, which was published in Proceedings of the National Academy of Science, criticised the global response to the global antibiotic resistance crisis as “slow and inadequate” and called for a “radical thinking” of antibiotic consumption.

At Randox, our pioneering R&D teams have developed a revolutionary swab test for respiratory infections which will help to reduce the unnecessary prescription of antibiotics. Earlier this year, Public Health England reported that 59% of people who visited their GP with a sore throat were prescribed antibiotics, in spite of only 13% actually needing them.

The new Randox swab test indicates the cause of the infection and whether a patient needs antibiotics or not, by rapidly detecting and identifying the cause of 21 respiratory infections in just 5 hours

The test assists the clinician in prescribing the appropriate antibiotic.

John Lamont, Lead Scientist at Randox Laboratories, said;

“Current diagnostic testing for respiratory infections takes at least 36 hours to confirm the nature of an infection, and they cannot name and categorise infections as bacterial or viral in the way our new respiratory test can.”

This test, if widely adopted, could allow medical practitioners to make the correct treatment choice on the same day as examination and before patients have already begun a precautionary course of inefficient antibiotics. It would also have additional efficiency savings for the NHS, by eliminating the need for lengthy microbiology lab tests and unnecessarily prescribing drugs which are not needed.

This new rapid and accurate test will give clinicians confidence in their diagnosis of respiratory infections and will allow for quicker treatment if necessary, which benefits patient outcomes. By reducing the prescription of unnecessary antibiotics, we can limit their use only for when they are truly needed.

The test is also available as a Randox Health Cough, Cold & Flu offering, and can be carried out by booking an appointment with Randox Health at our clinics in Crumlin, Holywood or London, or by arranging the mobile clinic to visit you at your home or place of work.

Book an appointment with one of our clinics, or arrange the mobile clinic, by phoning 0800 2545 130 or by clicking here.

For further information about the Randox Respiratory Infection Array please contact the Randox PR team by email: randoxpr@randox.com or phone 028 9442 2413

 

 

 


GPs are told to stop prescribing antibiotics for sore throats

Today, the National Institute for Health and Care Excellence has published guidelines that state doctors should not prescribe precious antibiotics for most people with sore throats and should instead recommend drugs like paracetamol.

The guidelines from NICE and Public Health England, which aim to limit the use of antibiotics, said doctors should only be prescribing the medicines for more severe cases that are most likely to have been caused by a bacterial infection.

This is despite recent research that suggests antibiotics are prescribed in 60% of sore throat cases, for which doctors are unable to tell if the infection is viral or bacterial.

The National Institute for Health and Care Excellence said most sore throats were caused by viral infections, which cannot be treated by antibiotics.

At Randox, our pioneering R&D teams have developed a revolutionary swab test for respiratory infections which indicates the cause of the infection and whether a patient needs antibiotics or not. This helps to limit the number of patients who are prescribed antibiotics unnecessarily.

The Randox test, which can rapidly detect and identify the cause of 21 respiratory infections in just 5 hours, assists the clinician in prescribing the appropriate antibiotic.

John Lamont, Lead Scientist at Randox Laboratories, said;

“Current diagnostic testing for respiratory infections takes at least 36 hours to confirm the nature of an infection, and they cannot name and categorise infections as bacterial or viral in the way our new respiratory test can.”

This test, if widely adopted, could allow medical practitioners to make the correct treatment choice on the same day as examination and before patients have already begun a precautionary course of inefficient antibiotics.  It would also have additional efficiency savings for the NHS, by eliminating the need for lengthy microbiology lab tests and unnecessarily prescribing drugs which are not needed.

This new rapid and accurate test will give clinicians confidence in their diagnosis of respiratory infections and will allow for quicker treatment if necessary, which benefits patient outcomes.

The test is also available as a Randox Health Cough, Cold & Flu offering, and can be carried out by booking an appointment with Randox Health at our clinics in Crumlin, Holywood or London, or by arranging the mobile clinic to visit you at your home or place of work.

Find out more about the Cough, Cold & Flu Respiratory test here.

Book an appointment with one of our clinics, or arrange the mobile clinic, by phoning 0800 2545 130 or by clicking here.

For further information please contact the Randox PR team by email: randoxpr@randox.com or phone 028 9442 2413

 


Randox showcases most advanced dairy screening test on market at World Dairy Summit

Improving global dairy standards is the focus for Randox Food Diagnostics, which is demonstrating its latest advancement – the ‘InfiniPlex for Milk’ – at the 2017 World Dairy Summit. Over 1000 international delegates are expected to attend the event being held in Belfast’s Waterfront Hall between 30th October to 3rd November.

With maintaining consumer confidence in the safety and integrity of dairy products featuring as one of the key topics at this year’s summit, the Northern Ireland-based company is keen to showcase how it can help producers get an edge in the market through ensuring food safety.

At the International Dairy Foundation’s annual conference event Randox Food will be showcasing the InfiniPlex, an innovative system which tests for 130 restricted drugs from one sample, such as antibiotics, non-steroidial anti-inflammatory and anti-parasitic drug residues.  This is the most comprehensive array on the market and achieves 98% compliance with EU regulations.

The Infiniplex also identifies a number of drug compounds which are not on the EU’s regulated list but which are unsuitable for human consumption. Using this multiplex system ensures that any Randox-tested dairy product will be the safest on the shelf.

Dr FitzGerald, Founder and Managing Director of Randox Laboratories, commented;

“It is our aim to ensure that dairy producers have access to the latest and most comprehensive milk safety screening technologies. The Infiniplex for Milk is the world’s first screening technology that ensures dairy processors are compliant with regulations. By meeting its complex needs, InfiniPlex is changing the face of the global dairy industry.”

David Ferguson, Global Business Manager for Randox Food Diagnostics, added;

“Standard industry practice means the primary residues for which screening is carried out is usually limited to two certain varieties of antibiotics. The InfiniPlex for Milk provides a unique insight into the specific combination of drug compounds detected in a single sample offering drug discrimination that allows the user to see what commercially available drug was administered at animal level. Using our multiplex testing offers the global milk industry the most comprehensive product for the analysis of veterinary drug residues in food, protecting the food industry and the consumer.”

The International Dairy Federation World Dairy Summit takes place in the Waterfront Hall. Randox Food Diagnostics can be found at Booth 5.

For further information about Randox Food Diagnostics milk testing, please visit: http://www.randoxfood.com/Matrices/Milk

For any further questions please contact Randox PR by phoning 028 9445 1016 or emailing RandoxPR@randox.com


Randox responds to antibiotic resistance warning from NI Chief Medical Officer Dr. Michael McBride

Today, Northern Ireland’s Chief Medical Officer Dr. Michael McBride has stated that antibiotic resistance is now the greatest risk to human health and medicines worldwide. Dr. McBride said; “Currently 700,000 people die worldwide each year from drug resistant infections and this figure is forecasted to reach 10 million deaths by 2050, if the problem is ignored.”

It is rather alarming therefore that 70% of GPs admit that they prescribe antibiotics when they are unsure if they are treating a viral or bacterial infection. By prescribing antibiotics for viral infections, which can’t be combatted with antibiotics, patients are being exposed to antibiotics which are of no benefit.

John Lamont, Lead Scientist at Randox Laboratories, said that “Current diagnostic testing for respiratory infections takes at least 36 hours to confirm the nature of an infection, and they cannot name and categorise infections as bacterial or viral is the way our new respiratory test can.”

At Randox, our pioneering R&D teams have developed a revolutionary swab test for respiratory infections which indicates the cause of the infection and whether a patient needs antibiotics or not. This helps to limit the amount of patients who are prescribed antibiotics, reducing antibiotic resistance.

The Randox test, which can rapidly detect and identify the cause of 21 respiratory infections in just 5 hours, can also subsequently determine the appropriate antibiotic drug treatment for patients.

This test, if adopted by GP surgeries, could allow medical practitioners to make the correct treatment choice on the same day as examination and before patients have already begun a precautionary course of inefficient antibiotics.  It would also have additional efficiency savings for the NHS, by eliminating the need for lengthy microbiology lab tests and unnecessarily prescribing drugs which are not needed.  This new rapid and accurate test will give the GP confidence in their diagnosis of respiratory infections and will allow for quicker treatment if necessary, which benefits patient outcomes.

The test is also available as a Randox Health Cough, Cold & Flu offering, and can be carried out by booking an appointment with Randox Health at our clinics in Crumlin, Holywood or London, or by arranging the mobile clinic to visit you at your home or place of work.

So what action can we take to limit the looming antibiotic resistance crisis?

  1. Ask your GP if tests will be performed to make sure you even need antibiotics and that the correct antibiotic is prescribed.
  2. Take the antibiotics as prescribed. Make sure you complete the prescribed course, even when you start feeling better. This makes sure that all bacteria from your current infection are eradicated, leaving none behind that could potentially develop resistance to your antibiotic.
  3. Only take antibiotics prescribed for you; do not share or use leftover antibiotics. Taking the wrong medication will delay correct treatment and allow bacteria to multiply, and potentially develop a resistance to the antibiotic you are using incorrectly.

Find out more about the Cough, Cold & Flu Respiratory test here.

Book an appointment with one of our clinics, or arrange the mobile clinic, by phoning 0800 2545 130 or by clicking here.

For further information please contact the Randox PR team by email: randoxpr@randox.com or phone 028 9442 2413


Randox Food Diagnostics harnessing science of antibiotic screening to ensure safer honey

Global leader in food screening technology, Randox Food Diagnostics have developed a range of pioneering honey quality tests which are being adopted by apiculturists across the world to ensure the safety and quality of their produce.

The array of tests, developed by the Antrim-based firm, are being showcased this week at the world’s largest apiculture meeting, the Apimondia International Conference, being held in Istanbul, Turkey from September 29th to October 4th.

The company hopes to highlight to consumers and producers about the importance of food safety, and in particular the dangers of antibacterial residue in food. Scientists have warned that antibiotics used in food production, are passing through the food chain to consumers and therefore contributing to the rise in infections caused by antibiotic-resistant bacteria.

Randox Founder and Managing Director, Dr Peter FitzGerald, commented;

“As a company committed to supporting the fight against antibiotic resistance we must continue to drive awareness amongst producers and consumers alike.

 “We are working closely with industry to promote a responsible approach to antibiotic use in food production and we hope that by working with some of the biggest names in the apiculture market, other honey producers will see the benefits of being able to offer their customers complete consumer confidence in a high quality, and importantly, safe product.”

 At Apimondia 2017 Randox Food Diagnostics will showcase a range of major technological advancements including the firm’s Antimicrobial Array 1 Ultra, Antimicrobial Array II Plus and Antimicrobial Array V. Thanks to Randox’s patented Biochip Array Technology, these testing panels can simultaneously screen for multiple antibiotics that are sprayed on beehives to ensure the safety of the colony, from only one sample of the produce.

Randox Food’s Antimicrobial Arrays join the company’s already extensive menu of honey screening tests, including its test for Hydroxymethylfurfural (HMF), a test for an organic compound produced by dehydration of sugars, which can be indicative of overheating, poor storage conditions or aged honey.  The test was recently validated by leading South American honey producer Geomiel, which credited Randox Food for delivering an immediate improvement in the quality of its honey products.

David Ferguson, Global Business Manager for Randox Food Diagnostics, commented;

 “We welcome the fact that so many of the world’s leading producers, including Geomiel, have embraced our vision of continuously improving testing standards.

“We have invested a lot in simplifying the process of conducting multiple tests, and consolidating this onto one unique biochip is a cost-effective way for the honey industry to maintain and improve standards. Apimondia 2017 attendees will be offered a complete testing bundle – including our popular analysers, the Randox Evidence Investigator and RX misano, to enable them to test for antibiotics and assess quality in one easy-to-manage system.

“Another unique feature of what we offer here at Randox Food Diagnostics is our ever-expanding test menu. The RX misano for example has a customisable test menu which allows clients to upload new parameters using USB, ensuring access to the most up-to-date tests on the market.

“We will be inviting Apimondia guests to learn more about the upcoming launch of our new pesticide tests, which will provide multiple results for the world’s most prevalent pesticides, such as Amitraz, Acetamiprid, Carbofuran, Carbaryl, and Paraquar. We remain committed to supporting food producers by providing them with the newest and highest quality tests.”

For further information about Randox Food Diagnostics honey testing, please visit: http://www.randoxfood.com/Matrices/Honey

For any further questions please contact Randox PR by phoning 028 9445 1016 or emailing RandoxPR@randox.com


Randox Food Diagnostics test committed to fighting antibiotic resistance is awarded AOAC Performance Tested Certification

After several years of dedicated R&D, Randox Food Diagnostics are pleased to announce that the industry’s leading body, the AOAC, has granted its Performance TestedSM certification to the company’s Antimicrobial Array I Ultra Kit (License Number 051705).

AOAC standards are used globally to facilitate public health and safety and promote trade, and the rigorous three year certification process was completed in conjunction with the US Food and Drug Administration Center for Veterinary Medicine validation protocol. In addition to internal validation studies and reporting to the AOAC Research Institute, an external independent expert laboratory was required to evaluate the methodology.

Achieving the AOAC Performance TestedSM certification sends a strong statement to the industry about RFD’s commitment to support food producers by providing the highest quality diagnostic tests.

The widespread use of antibacterial agents in veterinary practice, as bacteriostatic agents as well as to promote growth, has increased the concern about the levels of contamination of food products that can be consumed by the public. To protect both the consumer and the industry, regulatory authorities have specified maximum residue limits.

The Antimicrobial Array I Ultra Kit tests for 13 antibacterial agents: for consumer protection, the presence of these compounds in the food supply is highly regulated or banned. This Biochip based kit uses a multi-analytical approach, and therefore maximises detection capability which will improve food safety.

Head of Randox Food Diagnostics, David Ferguson, said:

“This is a major achievement for our team and we are delighted to receive this certification from AOAC. One of our central goals is to be a catalyst for improving food safety, which is why we invested so much into tackling the widely-reported dangers of antibacterial residue in food.

“There’s a growing awareness among consumers and producers about the critical issue of food safety. The Antimicrobial Array I Ultra Kit will meet the increasing demand for highly accurate diagnostic tests.”

The test kit is exclusively available on Randox’s proprietary Biochip Array Technology.

For more information please contact enquiries@randoxfood.com

 

About AOAC-RI

The AOAC Research Institute (AOAC-RI) was incorporated in 1991 as a wholly owned subsidiary of AOAC INTERNATIONAL. The AOAC-RI serves as an independent, third-party, nongovernment administrator of AOAC conformity assessment programs including the AOAC Performance Tested MethodsSM (PTM) and Official Methods of AnalysisSM (OMA) programs for alternative and sole source methods.

For more information, visit www.aoac.org.


Children at increased risk of drug-resistant infections after taking antibiotics

Children who are prescribed antibiotics are 12 times more at risk of acquiring drug-resistant infections in the weeks afterwards, according to a leading public health figure.

Public Health England medical director Paul Cosford told the Science and Technology Committee this week that the risk is greater for younger people than it is for adults.

“We’ve got good evidence that if you or I have a course of antibiotics now, within three months our risk is three times to get a resistant infection of some sort because we’ve had the antibiotics affecting all the organisms in our bodies. If you’re a child you’re 12 times more likely to get a resistant infection in the three months after a course of antibiotics.”

Whilst acknowledging that the drugs do a have part to play, Cosford stressed this had to be done correctly – and compared antibiotics to “using a pesticide in a rich woodland.” At the same time as tackling the harmful infection the drugs will destroy useful bacteria in the gut.

The information was taken from two major reviews on the routine-use of antibiotics in primary care, and he said the results underline the importance of continued efforts to decrease prescription rates.

“There is a growing body of evidence that taking antibiotics makes it more likely that your next infection will be a resistant one, so prudent use of these life-saving medicines is essential.”

One review looked at children who had urinary tract infections and found that they were more than 13 times more likely to have contracted drug-resistant strains if they had been given antibiotics in the previous six months.

The 2014 Longitude Prize survey of antibiotics in primary care revealed that 90% of British GPs felt pressure from patients to give out the drugs, and almost half had done so knowing it would not treat the patient’s condition.

Mark Woolhouse, Professor of Infectious Disease Epidemiology at Edinburgh University told The Guardian that the consequences of antibiotic resistance required a global plan, just as with climate change. However he added that, “In terms of the threat to my own health, and that of my children, and my family’s health, I am much more concerned about antimicrobial resistance than I am about climate change.”

Randox is supporting the battle against antibiotic resistance. Our wide range of related products includes our Respiratory Multiplex Array which tests 22 common virus and bacteria pathogens can detect whether an antibiotic should be prescribed.

John Lamont, Chief Scientist at Randox Laboratories, whose team developed the molecular test, commented;

“Current diagnostic testing for respiratory infections takes at least 36 hours to confirm the nature of an infection, and they cannot name and categorise infections as bacterial or viral in the way that our respiratory test can. C-reactive protein tests, for example, that are currently in use can only indicate whether a bacterial infection is likely. We need more than just guess work to combat the antibiotic resistance pandemic.”

For more information, please visit http://dev.randox.com/respiratory-multiplex-array/ or contact RandoxPR@randoxcom


World Antibiotic Awareness Week at Randox

The global crisis of antimicrobial resistance is never far from the headlines. As part of World Amicrobial Awareness Week, we’ve been discussing the dangers and importantly the work being done to combat this growing threat.

There’s a very simple reason why we must all do what we can to tackle AMR. This year it’s thought 700,000 people died from drug resistant illnesses such as bacterial infections, malaria, HIV/Aids or tuberculosis. Experts warn that by 2050, this figure will rise to 10million.

Randox’s aim is to revolutionise global healthcare and we are committed to combating the threat of antibiotic resistance. We have a number of tests on the market that can help the fight against AMR, strengthen consumer confidence and ensure quality and safety for a number of different industries. So to round off this week, we spoke to two of our experts at Randox: Business Development Manager, Dr Mary Jo Kurth, and Molecular Diagnostics Manager, Dr Martin Crockard.

70% GP’s have been reported to prescribe antibiotics when they don’t know whether the infection is caused by the virus or bacteria.

At the frontline of the battle to curb AMR are the GPs but they’re not able to access the latest technology which can help them. Dr Mary Jo Kurth said, “In the current GP setting, diagnostic testing to determine whether a respiratory infection is bacterial or viral is unavailable, and therefore doctors often have to guess – or feel pressurised into prescribing antibiotics because patients demand it. However antibiotics only work to treat bacterial infections and are useless in treating infections that are caused by viruses.

 “The consequences are severe. Medical procedures like organ transplantation and cancer chemotherapy need antibiotics to prevent and treat the bacterial infections that can be caused by the treatment. Without effective antibiotics, even routine operations could become high risk procedures if serious infections can’t be treated. The hard won victories against infectious diseases of the last fifty years will be jeopardized.”

Our Biosciences division have developed a test that can rapidly detect and identify the cause of 22 respiratory infections, in both the upper and lower respiratory tract, and therefore subsequently determine if an antibiotic is required as well as then identify the most effective antibiotic to take. Additionally our Confidante kit – the world’s first over-the-counter home sexual health test – can detect ten of the most common STIs with one patient sample and deliver accurate and reliable results securely and discreetly within one week. This takes the guesswork out of antibiotic prescription and could go a long way in fighting the antibiotic resistance crisis.

Dr Martin Crockard said, “Identifying the specific cause of illnesses provides opportunities to tailor treatment, reducing antibiotic misuse. Not all infections respond to antibiotics, however a multiplex approach which identifies bacterial, viral or fungal pathogens encourages improved clinical decision-making, refining treatment, leading to enhanced patient care.

The molecular group here at Randox are developing a range of multiplex infection detection arrays to identify specific infection agents, allowing more appropriate use of antibiotics to improve patient care and reduce the onset of antibiotic resistance.”

In addition to tackling AMR via medical settings, there is work that can be done to deal with it in our food. Randox Food Diagnostics offer a comprehensive range of diagnostic solutions to allow for the detection and quantification of antibiotic residues within animal and food products. With validation across a range of matrices Randox Food allows producers to ensure their products are free from antibiotic residues.

As consumer awareness develops so does the need for antibiotic screening within agriculture and food production. Guaranteeing an antibiotic-free product strengthens consumer confidence and ensures food integrity on a global scale. Randox Food offers the Evidence Investigator matched with biochip array technology to provide the end user with fast, reliable results to ensure antibiotic free produce.

The UK Government recently commissioned a two year review into the crisis. Led by Lord Jim O’Neill, the final report outlined a new system of ‘market entry rewards’ worth $1.6 billion to the successful developer of a new antibiotic, which meets a prospectively-defined criteria of ‘unmet need’. Developers of alternative therapies aimed at tackling areas where there is unmet need due to rising AMR would also be eligible for these rewards. Such rewards would be paid after a successful product comes to market.

Chief Medical Officer, Dame Sally Davies said, “Antimicrobial resistance poses a catastrophic threat. If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics. That’s why governments and organisations across the world, including the World Health Organization and G8, need to take this seriously.

“This is not just about government action. We need to encourage more innovation in the development of antibiotics – over the past two decades there has been a discovery void around antibiotics, meaning diseases have evolved faster than the drugs to treat them.”

AMR will not go away on its own. It requires complex and comprehensive action across many sectors.

If you are interested in finding out more information, please visit randox.com


The UK Government is being urged to ban excessive use of antibiotics in farming

To coincide with the start of World Antibiotic Awareness Week the UK Government is being urged to ban excessive use of antibiotics in farming by a group of leading doctors, according to The Daily Telegraph.

Made up of 12 royal medical colleges, the British Medical Association and the Faculty of Public Health, the group say that the UK should “use the opportunity afforded by Brexit to lead the world in banning” preventative prescription of medicines on animals.

A decision made by the European Parliament earlier this year to ban mass agricultural medication has not yet been ratified by member states or the European Commission.

A Department of Environment, Food and Rural Affairs’ spokesman told the newspaper that dealing with AMR is a “top priority” though the paper notes it ‘stopped short of promising a ban.’

In 2015 McDonalds set itself a two year deadline to stop its US restaurants buying chicken raised with human antibiotics. It led to one of the US’s leading meat producers – Tyson Foods – promising to end the practice by September 2017 – which is, as The Guardian stated, “one of the most aggressive timelines yet set by an American poultry company.” The company’s CEO Donnie Smith told the newspaper: “We have found as we have reduced the level of antibiotics we use, whether it’s human use or vet-only, our cost has actually gone down. A lot of the ways we’ve been able to accomplish this is by working with our farmers on better husbandry practices. If this millennial mum wants a no-antibiotic ever..nugget we better supply that.”

Farmers Weekly reported this month on a Danish Crown initiative launched in 2015 whereby pig farmers attach an antibiotics-free tag to piglets at the neonatal stage. It’s removed at any point if antibiotic treatment is deemed necessary. It claims that although early farm trials suggest a production fall of up to 2.5 piglet per sow per year, the “premium covers additional costs if 35% or more piglets carry the tag to the slaughterhouse.”

Pig farmer Stine Mikkelsen carried out a major review of hygiene and health on her farm to reduce antimicrobial use to boost revenue by £11.25 per pig. She says that although production is down and labour costs did increase, it “feels good” to farm in this way. She told the newspaper, “I am very motivated to do something about it – it’s a hard route to take but I have a good feeling about this system.”

Randox Food Diagnostics is working with global leaders in the food industry to tackle antibiotic resistance and safeguard their use for both human and veterinary treatment.

Using a dedicated research and development team, Randox have the ability to respond rapidly to emerging new drugs of abuse and regulations in relation to food and animal safety, with sixty-five new residue drug targets are currently in development to keep up with the ever changing market of food safety. Randox Food Diagnostics are ensuring that all residue screening laboratories requirements are met by providing reliable food safety screening on a global scale.

On top of the food safety product range Randox Food also offer a range of analysers, reagents and test kits for use throughout the winemaking process to ensure quality is maintained in every bottle.

This product range includes the RX misano semi-automated wine analyser and the RX Monaco fully automated wine analyser.

For more information on what we do, please visit: www.randoxfood.com

 

 

The RX misano is currently unavailable to purchase in Germany


Clinical Laboratory Survey