News
Diagnostic lab set to close after more than 50 years
After 52 years the Medicine Hat Diagnostic Laboratory will close its doors permanently at the end of March.
It began in 1965 as a small independent lab under Dr. Paul Racette. From a staff of four part-time technologists and five support staff it went to employing 75 people with branches in Brooks and Foremost, said Ruth Bruins who started at MHDL in 1971. Dr. Wai Chow, pathologist, became a partner in Medicine Hat Diagnostic Laboratory in 1981 and sole owner in 1995 when Racette retired. Many of the staff have been at MHDL for decades.
A couple years ago Alberta Health Services decided not to renew its contract with MHDL and established its own collection services laboratory on Carry Drive. Operations will commence there part-time from March 6 and full-time from March 20. About half of the MHDL staff have already transitioned to employment with AHS or will be transitioning, said Bruins. The others have found jobs elsewhere and in some cases decided to leave the healthcare field.
MHDL has a track record of consistently receiving the highest levels of accreditation for accuracy and reliability of laboratory testing, said Bruins. Staff have taken great pride in the level of excellence achieved. “Our staff are hugely proud of our profession and what we have accomplished throughout our many years of service to the Medicine Hat Community,” said Bruins.
Preeclampsia blood test shows 'promise'
A blood test to detect a common and potentially deadly pregnancy complication has shown a lot of promise in trials, says a professor from the Royal Women's Hospital in Melbourne.
Preeclampsia is a serious high blood pressure disorder that affects pregnant women, and can kill the mother and baby if not managed effectively. Professor Shaun Brennecke and a team of researchers at the Royal Women's Hospital have developed a blood test that measures proteins released from the placenta during pregnancy. So far, the testing for these biomarkers has been proven effective in predicting preeclampsia, Prof Brennecke said. The test's reliability so far has provided much optimism for a nationwide roll-out, even though this would still be "a long" time away, said Prof Brennecke.
"Currently, if a patient presents with any signs or symptoms suggesting the development of preeclampsia, she is admitted to hospital for monitoring. However, the new blood test reveals if the chances of developing preeclampsia are low or high," Prof Brennecke said. If the chances are low, the mother could go home and remain with her family, with no need to stay in hospital, and can continue her routine antenatal care visits. "Alternatively, if a patient shows a high level of risk, it provides much more precise information regarding when she might need to deliver," Prof Brennecke said.
WHO publishes list of bacteria for which new antibiotics are urgently needed
The World Health Organization (WHO) published its first ever list of antibiotic-resistant "priority pathogens" – a catalogue of 12 families of bacteria that pose the greatest threat to human health.
The list was drawn up in a bid to guide and promote research and development (R&D) of new antibiotics, as part of WHO’s efforts to address growing global resistance to antimicrobial medicines. The list highlights in particular the threat of gram-negative bacteria that are resistant to multiple antibiotics. These bacteria have built-in abilities to find new ways to resist treatment and can pass along genetic material that allows other bacteria to become drug-resistant as well.
The most critical group of all includes multidrug resistant bacteria that pose a particular threat in hospitals, nursing homes, and among patients whose care requires devices such as ventilators and blood catheters. They can cause severe and often deadly infections such as bloodstream infections and pneumonia. These bacteria have become resistant to a large number of antibiotics, including carbapenems and third generation cephalosporins – the best available antibiotics for treating multi-drug resistant bacteria.
The second and third tiers in the list – the high and medium priority categories – contain other increasingly drug-resistant bacteria that cause more common diseases such as gonorrhoea and food poisoning caused by salmonella.
WHO priority pathogens list for R&D of new antibiotics
Priority 1: CRITICAL
- Acinetobacter baumannii, carbapenem-resistant
- Pseudomonas aeruginosa, carbapenem-resistant
- Enterobacteriaceae, carbapenem-resistant, ESBL-producing
Priority 2: HIGH
- Enterococcus faecium, vancomycin-resistant
- Staphylococcus aureus, methicillin-resistant, vancomycin-intermediate and resistant
- Helicobacter pylori, clarithromycin-resistant
- Campylobacter spp., fluoroquinolone-resistant
- Salmonellae, fluoroquinolone-resistant
- Neisseria gonorrhoeae, cephalosporin-resistant, fluoroquinolone-resistant
Priority 3: MEDIUM
- Streptococcus pneumoniae, penicillin-non-susceptible
- Haemophilus influenzae, ampicillin-resistant
- Shigella spp., fluoroquinolone-resistant
Quality
Do No Harm: Diagnostic Errors and the Lab
Historically, the laboratory industry has focused its quality improvement efforts within the boundaries of the laboratory. We have been lab-centric in this respect and have not focused on collaboration with other members of the health care team or patient outcomes.
The laboratory has been very good at detecting and eliminating errors in the analytical phase. Less focus has been placed on identifying and remedying errors outside of the analytical phase, particularly those that occur outside the boundaries of the lab (pre-pre and post-post-analytical).
In order for the laboratory to have a positive impact on diagnostic errors, it is necessary to become part of the interdisciplinary patient-centered care team. Laboratory professionals need to view their services as contributing to patient outcomes, not just generating results.
Research on diagnostic errors and the laboratory’s role has found that failure to order appropriate diagnostic tests, including lab tests, makes up 55% of missed and delayed diagnoses in the ambulatory setting and 58% of errors in emergency departments. We know that healthcare providers don’t understand our tests as well as we do. This statistic underscores the need for Clinical Lab Scientists to interact with and provide education to ordering providers on the proper use of the testing we provide.
One way that clinical laboratory professionals can affect positive change is by collaborating with other healthcare providers to establish evidence-based decision-making guidance for ordering tests. Providing feedback to providers detailing improper test utilization patterns, both over- and under-utilization, is another way that laboratory professionals can help to reduce diagnostic errors. Other ways the laboratory can help reduce diagnostic errors include reflexive testing, consultative services and improved test reporting.
The lab can help to reduce diagnostic errors by focusing on becoming more patient-centered, educating providers on lab testing, providing consultative services, initiating feedback loops that extend beyond the walls of the lab and ensuring that we have an effective non-conformity management system.
Hematology
Evidence-based Quality Control
This article discusses a new approach for automated hematology analyzers’ daily control limits. The discussion covers some common issues around control of analyzers, suggests a new evidence-based approach to daily control limits and concludes with a discussion of the benefits of this approach in the laboratory.
Accustomed to false control rejections and not believing the problem is the analyzer, laboratorians often presume that the problem is the control and just repeat the control again. This practice often leads to multiple repetitions. It is frustrating, and difficult for operators to know when there actually is an analyzer issue.
Hematology controls are multiplex controls: each control level is testing multiple parameters at the same time. Therefore, since one level has 35 parameters, the probability of one parameter exceeding the 12SD limit is up to 80 percent. How, then, is that QC run handled? Typically, the entire run is deleted, and normal data from the other parameters is rejected as well.
To address these issues, we found a new approach to develop daily control limits—an evidence-based approach that retains complete error detection abilities while significantly decreasing the false control rejections that desensitize the lab to control failures.
The evidence-based approach to QC limits addresses many of the issues that have plagued labs for the last 20 years by addressing high false rejections while maintaining 100 percent possible error detection. In most labs, running QC is a cumbersome process involving:
- The potential of outliers that need to be dealt with.
- The hassle of investigating and documenting.
- The fact that if the cause of the outlier is not found, labs frequently suspect that limits are the issue rather than that the analyzer has a problem.
- The fact that, if the issue is limits, labs often consider increasing them to get the QC within range. (Widening the limits may make life easier, but changing the limits can be an arbitrary process that does not address the root cause of the QC failure.)
Be sure to read the entire article to fully understand this complex issue.
Molecular Genetics
Ethicists Say Go Slow On Gene-editing CRISPR, Ponder What It Means To Be Human
The search for cure of congenital and other serious illnesses may be over with the revolutionary gene-editing tool known as CRISPR. Among its uses is to help scientists understand the genetic origin of an illness, which was not possible in the past.
Ethicists have warned, however, of the risks as scientists wield the tool that has the potential not only to cure patient's congenital disease but could also make permanent changes in the human genome that are heritable by a person's offspring.
In a report by the National Academy of Sciences and the National Academy of Medicine published on February 14, the experts sounded the need not to rush on CRISPR. While the report did not completely prohibit the editing of a human genome, it called for sort of bar of standards to allow it only if proven safe.
The recent report penned by some 22 experts from different countries was viewed as a major departure from the previous stand on CRISPR. Some ethicists viewed it as a slippery slope. The latest report had taken a more open position provided that the interventions should meet several criteria which include the following: it should be proven safe, and it should be regulated to be used only to cure rare and serious illnesses.
Ethicists agree that therapeutic uses of the gene-editing tool are acceptable. It has, however, become a slippery slope when CRISPR is used for cosmetic changes. For example, the color of the eyes or desired athletic trait. The technique's potential use to make changes in sperm and eggs or embryo, which will be permanent and heritable by future generations, raises the fear of eugenic-driven human population.
Safety
Study reports multidrug resistant bacteria found in hospital sinks
Many recent reports have found multidrug resistant bacteria living in hospital sink drainpipes, putting them in close proximity to vulnerable patients. But how the bacteria find their way out of the drains, and into patients has been unclear. Now a team from the University of Virginia, Charlottesville, has charted their pathways. The research is published February 24 in Applied and Environmental Microbiology, a journal of the American Society for Microbiology.
"Our study demonstrates that bacterial spread from drainpipes to patients occurs via a staged mode of transmission," said principal investigator Amy Mathers, MD, Associate Professor of Medicine and Pathology, Division of Infectious Diseases and International Health.
Initially, the bacteria colonize the elbows of the drain pipes. The investigators showed that from there, the colonies grow slowly towards the sink strainers--at the rate of roughly one inch per day, said Mathers. Given the distance in typical hospital sinks of elbows below the sink bowls, it frequently takes a week for the colonies to reach the sink strainers. From there, bacteria quickly get splattered around the sink, and even onto the counters surrounding the sinks, where they can be picked up by the patients.
The project grew out of the knowledge that patients are dying from infections with multidrug resistant bacteria that they acquire while hospitalized. In a review Mathers' team conducted with Alice Kizny Gordon, MBBS and colleagues of the University of Oxford, UK, they found more than 32 papers describing the spread of bacteria resistant to carbapenem--an important antibiotic--via sinks, and other reservoirs of water within hospitals. Half of those papers have appeared since 2010.
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