Opposition grows as Quebec pushes for centralized medical labs
Medical professionals across Quebec are sounding the alarm about the provincial government’s plan to centralize all medical laboratories. Hospital personnel and union leaders have been summoned to meetings in medical establishments throughout Quebec about the government’s controversial Optilab project.
Optilab is part of a provincial reorganization of laboratory services, intended to save tens of millions of dollars a year. The government has set up 11 high-volume processing centres across the province, including at the McGill University Health Centre and the Centre hospitalier de l’Université de Montréal.
“We are worried and we are waiting,” Carolle Dubé, president of the APTS union which represents some 5,000 lab technologists, said in an interview. “We do not think the problems we are concerned about have been resolved.” Once Optilab is fully functional, Dubé said it will require the transportation of about 70 per cent of all test samples to centralized hubs and that is a risky business — especially since there were about 61.2 million lab tests carried out in Montreal in 2014-15, and 191 million throughout Quebec, according to the health department.
Increased transportation of samples boosts the likelihood of error or lost or ruined samples, said Doris Levasseur Bourbeau, president of the Ordre professionnel des technologistes médicaux du Québec. “These are critical, life and death samples,” Bourbeau said in an interview. “If the sample is lost, there could be serious consequences.”
A press aide to Health Minister Gaétan Barrette said the system is designed to provide the best, most efficient services. It is being implemented gradually, said Julie White, and there should be no short-term job losses, although positions may be reduced through attrition. No hospital labs will close.
Alberta Health Services to buy out Dynalife, transfer services back to province
Alberta Health Services (AHS) plans to buy out the private laboratory testing company Dynalife and transfer the services back to the province, effectively ending private lab services in the province.
AHS is expected to hire all Dynalife staff, including unionized lab workers and non-unionized managers. Dynalife employs about 1,200 people and provides lab testing services for Edmonton and northern Alberta.
AHS and Dynalife are expected to have a transition plan in place by Oct. 1, 2018 and a system for working out any disagreements.
Last month, Alberta Health Services announced it would extend Dynalife's laboratory services contract for another five years, a decision Hoffman said would allow an AHS administrative team to explore options for an "integrated system provincewide."
Dynalife runs northern Alberta's primary testing facility and 27 community sample collections sites in Edmonton and surrounding area, along with five collection sites and four health centre locations in northern and central Alberta.
Alberta Health Services to extend Dynalife lab services contract for five years
Health minister cancels $3B lab contract with Sonic Healthcare
CDC whistleblower claims agency has been using wrong Zika test
At the centre of the debate at the Centers for Disease Control and Prevention (CDC) is one of the leading experts on Zika virus, Robert Lanciotti chief of the lab responsible for developing tests to diagnose viral diseases. Lanciotti was demoted in May after he raised concerns inside and outside the agency about the CDC’s decision in the spring to recommend a new test for Zika. That test was substantially less effective than another established test, he said, and misses nearly 40% of Zika infections. He also said the agency withheld information about testing differences from state and local public health laboratories. The scientist was reinstated to chief in July after he filed a whistleblower retaliation claim.
The questions raised by Lanciotti prompted an internal investigation by the CDC who acknowledged in their report that testing for Zika is difficult and needs to be improved. The agency said it made improvements that will boost the new test’s sensitivity. The internal investigation also found that the CDC acted reasonably when it withheld the conflicting test data from state public health labs. Releasing it could have created “considerable confusion during an ongoing emergency response,” the investigators said. In a statement late Tuesday, the CDC said it had conducted a thorough independent investigation and determined the allegations were not substantiated by the evidence. The agency said it remains committed to providing its public health partners with the best available science and tools to combat the epidemic.
Body surface area: a predictor of response to red blood cell transfusion
A current focus of transfusion medicine is a judicious strategy in transfusion of blood products. Unfortunately, the ability to predict hemoglobin (Hgb) response to transfusion has been limited. Published in the Journal of Blood Medicine, the study examined red blood cell transfusion response variability and the ability to predict which patients will have an Hgb rise higher or lower than that predicted by the long-standing convention of “one and three”.
Data for 167 consecutive patient encounters were reviewed retrospectively. DeltaHgb was defined as posttransfusion Hgb minus pre-transfusion Hgb per red blood cell unit. Patients were classified as “high responders” (DeltaHgb >1 g/dL) or as “low responders” (DeltaHgb ≤1 g/dL).
Results identified that age, sex, body weight, estimated blood volume, and body surface area were significantly associated with response category (P<0.05). On validation, the model H=6.5–(3.3 × body surface area), with the cutoff probability of 0.5, was found to correctly classify patients into high and low responders in 69% of cases (sensitivity 84.6%, specificity 43.8%). This model may equip clinicians to make more appropriate transfusion decisions and serve as a springboard for further research in transfusion medicine.
Novel test may rapidly differentiate between viral, bacterial infections
Researchers at Imperial College London identified two genes that became activated when children became ill from an infection linked to bacteria rather than a virus. This has led to a diagnostic test that may distinguish between infection types, according to recently published findings.
To evaluate whether febrile children with a virus can be differentiated from those affected by a bacterial infection, researchers conducted a cross-sectional study that included 370 febrile children in London, Spain, the Netherlands and the United States. Patients in the 4-year study were sorted into a discovery (n = 240) and a validation (n = 130) group after they underwent microbial investigation for definite bacterial, viral or indeterminate infection. The research team then examined genes that had switched places on the patients’ white blood cells. RNA micro arrays data showed that 2-transcript host RNA signature genes, IFI44L and FAM89A, became switched on in bacterial infections and could predicted bacterial infections with 100% accuracy with 2-transcript RNA signature in the validation group. Among those with definite viral infection, the genes showed a specificity of 96.4%for viral infection.
“The challenge is now to transform our findings into a diagnostic test that can be used in hospital emergency departments or general practice surgeries, to identify those children who need antibiotics” said Dr. Michael Levin, FRCPCH, professor in the department of medicine at Imperial College London.
In a world first, a scientist has begun editing the genes of healthy human embryos
A scientist in Sweden has begun editing the genes of healthy human embryos for the first time in known history, according to an exclusive report published by NPR.
Fredrik Lanner of the Karolinska Institute thawed five embryos that had been donated for research. A colleague injected the embryos with the genome editing tool CRISPR/Cas-9. Lanner's plan is to use the tool to study early embryonic development, the process by which embryonic cells first begin to divide as an embryo grows during its first days. This technology could allow us to eliminate deadly genetic diseases from people before they are born but could also in theory be used to engineer desired traits into children.
In the states which don't regulate embryo research in the US, the experiments that Lanner is doing would be legal, since there are no plans to implant edited embryos into people. That sort of procedure — one that could result in an actual birth — would need to be approved by the FDA, and the current budget bill does not allow for this.
While Lanner is the first to do this research in healthy human embryos, other researchers have similar plans in the UK. Researchers in China have also already published data on their efforts to edit non-viable human embryos.
Parliament must act quickly to end genetic discrimination
Genetic screening enables countless patients to identify gene markers associated with serious illnesses and take effective steps to preserve their health. The Canadian Cancer Society, for example, notes that women with the BRCA marker who undergo genetic testing and take preventive measures can reduce their risk of contracting breast cancer by nearly 90%. Also, members of some First Nations in northern B.C. are 20 times more likely than the national average to be afflicted by Long QT Syndrome — a terrible, genetically inherited heart disease. Genetic testing can support identification, treatment and outcomes for this disease. However, genetic testing can be the first step in being denied insurance coverage or employment opportunities.
Canada is the only G-7 country without protections to prevent genetic discrimination, including measures to stop employers or insurance providers from demanding individuals take genetic tests or disclose results. This week, the House of Commons commenced debate on Bill S-201, An Act to Prohibit and Prevent Genetic Discrimination — which safeguards the privacy of genetic test results and prohibits employers or insurers from requiring their disclosure.
In this opinion piece, understand Bill S-201 from the perspective of someone with a genetically inherited disorder. Lorne Marin has Usher Syndrome, which begins as night and peripheral vision loss and gradually leads to blindness, deafness and deteriorated balance.
DNA-based vaccine guards against Zika in monkey study
An experimental DNA-based vaccine protected monkeys from infection with the birth defects-causing Zika virus, and it has proceeded to human safety trials."When a vaccine is effective in a lower primate species, it is a good signal that it will be effective in humans," said Dr. Amesh Adalja, a senior associate at the UPMC Center for Health Security.
"The NIH vaccine candidates have cleared an important hurdle, and we are awaiting results from phase 1 human studies." Published in the journal Science, researchers provided a single Zika vaccine dose to six rhesus monkeys and two shots to 18 monkeys. This potential vaccine contains a piece of DNA created synthetically in the laboratory from the Zika virus. When introduced into the body, the DNA causes small virus-like particles to be secreted from cells. These particles are not full-fledged Zika, but are similar enough to the virus that the immune system might produce an antibody response that will also protect against Zika.
Researchers found that none of the monkeys who received a single dose were protected from Zika infection, but the vaccine did appear to create an antibody response. The two-dose vaccine series protected 17 out of the 18 monkeys against exposure to Zika and provided researchers with an idea of how much antibody response is needed to protect against infection.
Related Article: Zika testing: Quest Diagnostics to offer MAC-ELISA and molecular assays
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