News
Happy Anniversary LabBuzz!
This week marks our one year anniversary. We hope there's been something to pique your interest in every issue and that you have learned new things throughout this past year.
If you've missed an issue, be sure to catch up in the archive.
Here’s to another year of curating and sharing clinical laboratory related news!
Opportunities to enhance laboratory professionals’ role on the diagnostic team
Diagnostic errors affect 5% of US adults seeking outpatient care each year and contribute to approximately 10% of patient deaths as well as 6% to 17% of hospital adverse events.
The 2015 Institute of Medicine report Improving Diagnosis in Health Care (free download) highlighted that improvement in the diagnostic process requires better collaboration among physicians and laboratory professionals. A study was conducted to understand why physicians do not contact laboratory professionals when facing diagnostic challenges and identify opportunities for laboratory professionals to become more recognized members of the clinical care team.
Responses from 1,768 physicians were collected. When faced with diagnostic challenges, they reported using electronic resources because they find it difficult and time-consuming to contact the laboratory. Only 20% had an effective way to access laboratory professionals, mostly seeking help for logistical but less for clinical issues. Continuing medical education, professional articles and updates from the laboratory were helpful. The study concluded that laboratory professionals have an opportunity to play a greater role in the diagnostic process by becoming active members of the clinical care team, beyond providing results.
Read the strategies provided in the article to increase the laboratory professionals’ role in the diagnostic process.
Medical Laboratory Scientists, Educators speak out against CMS position on nursing degrees
The Centers for Medicare & Medicaid Services (CMS), in a policy memorandum stated the following: "A bachelor’s degree in nursing meets the requirement of having earned a bachelor’s degree in a biological science for high complexity testing personnel. The laboratory may show a Primary Source Verification (PSV) report verifying that a bachelor’s degree in nursing was earned, a diploma with the type of degree earned, or transcripts as evidence of meeting the education personnel requirement."
This update prompted the American Society for Clinical Pathology (ASCP) (covered here), to state: "Based on our review of biological science and nursing degree requirements, biological science degrees require three to four times more academic science than does nursing. Another notable contrast is that biological science degrees are heavily reliant on advanced level coursework in the sciences while nursing degrees are not. We have great respect for the work and invaluable services nurses provide patients. That said, given the significant lack of biological and other science obtained through a typical degree in nursing, we do not agree that the nursing degree is equivalent to a biological sciences degree or that it would adequately prepare someone to perform non-waived laboratory services..."
Industry leaders provide their thoughts on the CMS memorandum in this heated article. Here is one example but read more and conclude your own thoughts.
"This shows the basic flaw in the CLIA regulations, which do not specify clinical training of folks with a biological sciences BS degree. Anyone who thinks they can do all of the troubleshooting and interpretation of laboratory test results just by a BS degree in biology OR nursing, is basically a button-pusher who will repeatedly, and predictably, place patient care in danger." Ann McLane PhD, MLS, American Society for Clinical Laboratory Science, Delaware President.
Pre-Analytical
Phlebotomy tip of the month
Trick or Treat? Blood specimen collection can be tricky! Perform it incorrectly and you can trick physicians into mismanaging their patients when they base medical decisions on inaccurate test results. Read the Centre for Phlebotomy Education’s tip of the month in detail. Here are the quick highlights for you:
Trick: Not drawing timed specimens on time.
Trick: Not assuring the patient has met test requirements (i.e., fasting) prior to the draw.
Trick: Inducing hemoconcentration through prolonged tourniquet application.
Trick: Improperly cleansing the site prior to the draw (i.e., blood cultures and blood alcohol).
Trick: Failure to follow the order of draw.
Trick: Not properly labeling the sample at the patient’s side.
Trick: Delayed transport of samples collected.
Treat: All your patients should receive the proper protocol when drawing and handling their blood samples. Hospitals and other healthcare facilities can be a scary place. The trick to putting patients at ease is to make sure your procedure isn’t masquerading as something it isn’t.
Clinical Chemistry
New testing method allows for more effective diagnosis of genetically-based high cholesterol
A new genetic testing method developed at Western University called LipidSeq can identify a genetic basis for high-cholesterol in almost 70% of a targeted patient population. Using next-generation sequencing (NGS) technology, researchers were able to pinpoint specific areas of a person’s DNA to more effectively diagnose genetic forms of high-cholesterol, which markedly increase risk for heart attack and stroke.
The study, published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, used the LipidSeq method on 313 patients with LDL cholesterol levels above 5.0 mmol/L who had been referred to the lipid clinic at LHSC. From those patients, LipidSeq was able to identify a genetic mutation in 67%. Fifty-four per cent were single gene mutations, and the other 13% were polygenic DNA variants, meaning they were a combination of multiple bad genes inherited together.
The study also showed that the percentage of individuals with an identified genetic component increased as cholesterol levels in the patient increased. LipidSeq has already been licensed for use in the U.S. to help clinicians identify patients with genetically-based high-cholesterol in order to guide drug prescriptions.
A new class of biologic drugs came onto the market in Canada last year, and while more effective for treating high-cholesterol, they are also more expensive. "With this testing method, we can pinpoint who needs these more expensive drugs and those that don’t," said Dr. Rob Hegele, a Distinguished University Professor at Western University’s Schulich School of Medicine & Dentistry and a scientist at Robarts Research Institute.
Transfusion Medicine
Red cells — Aging gracefully in the Blood Bank
One of the major controversies regarding transfusion therapy is whether older blood is harmful, owing to a red-cell "storage lesion". The debate intensified after a retrospective study of patients undergoing cardiac surgery suggested that the use of older red cells was associated with increased mortality. During the past 20 years, investigators have conducted 13 randomized trials involving more than 5,000 patients to evaluate the effect of short-term storage versus long-term storage of blood. None of these trials suggested that fresher blood is superior to older blood.
Nancy Heddle and colleagues recently reported the results of the Informing Fresh versus Old Red Cell Management (INFORM) trial, which showed no significant difference in mortality between patients who received a transfusion of blood that had been stored for a median of 11 days (short-term storage group) and those who received a transfusion of blood that had been stored for a median of 23 days (long-term storage group). The INFORM trial evaluated almost four times the number of patients who were included in the other 13 previous trials combined. Thus, the data from this trial have substantially more weight to assess mortality.
The combined data show that the transfusion of fresher red cells is not advantageous for most hospitalized patients and provides evidence for the current practices of blood banks, which manage a resource that is already constrained. However, the question is still open as to whether the transfusion of red cells during the last week of storage (35 to 42 days) poses more risk than the transfusion of blood stored for shorter intervals.
Microbiology
Bacteria 'alarm clock' may cause repeat infections in patients
"Whenever bacteria such as Salmonella invade the body, around a third of the bugs 'cloak' themselves as a defence mechanism against the body's immune system. They enter a type of stand-by mode possibly to hide from the body's immune system, that means they are not killed by antibiotics," states Dr Sophie Helaine, Department of Medicine at Imperial College London.
Her previous research has shown that Salmonella bacteria switch themselves into stand-by mode by 'poisoning' themselves with a toxin called TacT. Recently, the team found that a bacteria 'alarm clock' wakes dormant salmonella in the body, allowing the bug to trigger a repeat infection.
As published in the journal Molecular Cell, the alarm clock is an enzyme called peptidyl-tRNA hydrolase (Pth) and is shared among different types of bacteria, including Salmonella and E. coli. This finding may explain why some people suffer repeated bouts of infections, such as ear or urinary tract infections, despite taking antibiotics. The team hopes to use these findings to tackle hard-to-treat infections as these persistent bacteria can contribute to antibiotic resistance. "If we can figure out how to control this mechanism, and force the bacteria out of stand-by, we could then treat then with antibiotics to kill them," explained Dr Helaine.
Safety
Canadian Patient Safety Week
This week is Canadian Patient Safety Week. Test your knowledge about safe care with an interactive Patient Safety Online Quiz. Be sure to check it out at www.asklistentalk.ca.
A couple of patient safety facts:
An estimated 30,000 patients die from preventable incidences or medical errors each year.
The Canadian Adverse Event Study (Baker et al 2004) found a 7.5% adverse events incidence rate in acute care hospitals. Surgery was identified as the service most responsible for the care 51.4% of the time in these adverse events.
The Canadian Patient Safety Institute (CPSI) recently launched a new program called SHIFT to Safety. SHIFT to Safety provides the tools and information needed to make patient safety a priority while navigating the healthcare system, whether as a member of the public, a practitioner or leader. Learn more at SHIFTtoSafety.com.
CPSI is a not-for-profit organization that exists to raise awareness and facilitate implementation of ideas and best practices to achieve a transformation in patient safety. CPSI operates collaboratively with health professionals and organizations, regulatory bodies and governments to build and advance a safer healthcare system for Canada. Largely funded by Health Canada, CPSI reflects the desire to close the gap between the healthcare we have and the healthcare we deserve.
Research
WSU portable smartphone laboratory detects cancer
Washington State University researchers have developed a low-cost, portable laboratory on a smartphone that can analyze several samples at once to catch a cancer biomarker, producing lab quality results.
The research team, led by Lei Li, assistant professor in the School of Mechanical and Materials Engineering, recently published the work in the journal Biosensors and Bioelectronics . Although smartphone spectrometers exist, they only monitor or measure a single sample at a time, making them inefficient for real world applications. Li’s multichannel spectrometer can measure up to eight different samples at once using a common test called ELISA, or colorimetric test enzyme-linked immunosorbent assay, that identifies antibodies and color change as disease markers. It can detect human interleukin-6 (IL-6), a known biomarker for lung, prostate, liver, breast and epithelial cancers.
Although Li’s group has only used the smartphone spectrometer with standard lab-controlled samples, their device has been up to 99% accurate. The researchers are now applying their portable spectrometer in real world situations. Li’s design works with an iPhone 5. He is creating an adjustable design that will be compatible with any smartphone.
Thank you!
We appreciate that you have taken the time to read LabBuzz. This is a CSMLS venture to provide relevant medical laboratory news to its members.
We need your help to grow this newsletter! Please pass along the subscription link to any colleague you think would benefit from hearing about med lab news.
If you have any suggestions to improve LabBuzz, we would love to hear from you. In fact, if you have a news or publication link you would like us to consider for a future issue, please send it to labbuzz@csmls.org