News
Mounting shortage of medical lab techs hurts most in rural Alberta, expert says
Medical laboratory technologists are raising the alarm about a shortage in their profession in Alberta and across the country. The Canadian Society for Medical Laboratory Science (CSMLS) met with MPs and government officials in Ottawa on April 4th to talk about the issue. The group is calling on the federal government to fund research that could help post-secondary institutions find ways to get students trained and working in the field more quickly.
Sonja Chamberlin, an associate dean at SAIT and a member of the society, says Canada's aging population is creating an increased demand for lab tests, including blood and DNA tests, cancer screening, and other increasingly sophisticated medical tests. "In the rural and remote areas in Alberta we're already seeing difficulties in filling positions," she said. Post-secondary institutions are unable to increase capacity because there is a lack of clinical placements for students in Calgary and Edmonton.
CSMLS president Mary Costantino said in a release that the meeting in Ottawa was a good opportunity to talk about the mounting problem. "While the greatest current impact is in our rural and remote communities, the consequences of not addressing the underlining causes could create measurable delays in medical testing," she said.
Technologies on IBM’s 5-in-5 List could impact pathology and clinical laboratories
Clinical laboratory testing and diagnostics are one of the five technologies included in IBM’s 2017 list of the technologies it predicts will have the greatest impact on society during the next five years. Of equal interest is that several of the other technologies included in IBM’s list have the potential to be used in medical laboratories and anatomic pathology groups. The list is called “5-in-5” and has been released annually for the past 10 years by the tech giant.
These are the five influencers for 2016 listed on the IBM Research press release. Click on each to read more detail.
Swiss Post drone to fly laboratory samples for Ticino hospitals
In mid-March 2017, Swiss Post, the Ticino EOC hospital group and drone manufacturer Matternet launched a joint innovation project: they plan to use modern delivery drones to transport laboratory samples autonomously between two EOC hospitals in Lugano – the Ospedale Italiano and the Ospedale. The samples are currently transported by road. The use of drones will make transport faster and more efficient in order to further enhance the provision of care to patients.
Swiss Post is one of the first companies in the world to test autonomous drone logistics for a commercial application. As soon as the drone meets all of the strict requirements regarding safety, practicality and reliability, the regular use of drones between the two hospitals will become an everyday occurrence. This is expected to be achieved by 2018. From then on, trained hospital staff will be able to load the drone independently with a safety box (in which the lab samples are packaged) and launch the drone with a smartphone application. The drone will then fly autonomously along the predefined route to its destination, where the box will be received by another member of staff.
1 in 10 pregnant women with Zika in U.S. had babies with birth defects
About 1 in 10 pregnant women with confirmed Zika infections in the U.S. last year gave birth to a baby or had a fetus with Zika-related defects, the Centers for Disease Control and Prevention announced Tuesday. The report gives the most complete picture so far of the harm Zika has caused in the U.S., mostly after pregnant women travelled to other nations and territories. "Zika continues to present a terrible threat to pregnant women and infants, and we need to improve awareness among pregnant women and their providers," said Jeffrey Duchin, a spokesperson for the Infectious Diseases Society of America.
- About 1,300 pregnant women in 44 states showed evidence of possible Zika infection. Approximately 1,000 of these women completed or lost those pregnancies by the end of the year, and more than 50 had a baby or fetus with birth defects.
- About 250 women had Zika infections confirmed by blood tests, and 24 of them, about 10%, had affected babies. The birth defect rate was even higher, 15%, in those with infections confirmed in the first trimester of pregnancy.
Quality
Unnecessary care in Canada
The Canadian Institute for Health Information (CIHI) and Choosing Wisely Canada (CWC) are working together to report on patients receiving unnecessary tests and procedures every year in Canada. CIHI is leading a multi-group measurement collaborative to develop methodologies for measuring the rates of selected tests and procedures, which will help ensure that all of CWC's physician recommendations are supported by evidence. By supporting this campaign with comparable, pan-Canadian data on the rates of potentially unnecessary tests and procedures, CIHI and its collaborators are helping to engage patients and their caregivers so that they can make informed choices about their care.
Looking at eightselected CWC recommendations, the Unnecessary Care in Canada report finds that up to 30% of patients had tests, treatments and procedures that were potentially unnecessary.
Read the full report for more details on these lab impacting recommendations:
- Don’t transfuse red blood cells for arbitrary hemoglobin or hematocrit thresholds in the absence of symptoms
- Don’t perform preoperative testing before low-risk surgeries
Point-of-care or clinical lab INR for anticoagulation monitoring: Which to believe?
Why are the INR results so different, and which result should be used to guide warfarin dosing recommendations?
A 68-year-old female with a history of hypertension, diabetes mellitus, stroke, and atrial fibrillation presents for routine follow-up at your hospital’s anticoagulation clinic. The clinical pharmacist checks her international normalized ratio (INR) with a point-of-care (POC) device to monitor her anticoagulant therapy (warfarin). The POC INR result is elevated to 4.0, which is above the recommended INR goal range of 2.0–3.0 based on her clinical indication of atrial fibrillation. The pharmacist enters the POC INR result into the patient’s electronic medical record and discovers she had an INR obtained earlier that same day, along with a basic metabolic panel and complete blood count ordered by her primary care physician. The clinical lab (CL) INR result was 2.9, and obtained just 90 minutes earlier. All other test results were normal.
The patient says she hasn’t started any new medications or had recent warfarin dose changes, nor has she experienced bleeding symptoms or changed her diet. INR measurements from the past 6 months have all been within range. Given the conflicting INR information, the pharmacist is uncertain whether the patient should continue her current warfarin dosing schedule or have an adjustment.
Read the full article to understand some of the benefits and limitations associated with POC INR testing as well as the discordance between POC and CL INR assays, as well as suggested strategies for managing discordant INR values.
Hematology
How stress controls hemoglobin levels in blood
Published in Cell Research, researchers at the Hebrew University of Jerusalem report the discovery of an entirely new mechanism through which globin genes are expressed. Discovery of this hitherto unknown property of the hemoglobin genes shows that stress is absolutely needed to allow for the production of hemoglobin.
"Surprisingly, we have revealed an entirely new mechanism through which hemoglobin gene expression is regulated by stress. An intracellular signal, essential for coping with stress, is absolutely necessary to allow for hemoglobin production. That stress signal is activated by the hemoglobin gene itself. Although we have long known that this signal strongly inhibits protein synthesis in general, during hemoglobin gene expression it first plays its indispensable, positive role before being turned off promptly to allow for massive hemoglobin formation needed for breathing," said Prof. Raymond Kaempfer, the Dr. Philip M. Marcus Professor of Molecular Biology and Cancer Research at the Hebrew University of Jerusalem.
Once activated, PKR will place a phosphate (a process known as phosphorylation) onto a key initiation factor needed for the synthesis of all proteins, called eIF2-alpha. That in turn leads to inactivation of eIF2-alpha, resulting in a block in protein synthesis. This process is essential for coping with stress. The realization that stress is not only important but also essential may have important implications for how we understand hemoglobin expression.
Anatomic Pathology
Announcing first-ever American Association of Anatomists Virtual Microscopy Database
The American Association of Anatomists (AAA) launches their first-ever Virtual Microscopy Database (VMD) available to educators and researchers worldwide. It was created as a centralized repository where a community of anatomy and histology scholars and researchers can share a large selection of virtual tissue slides for enhancing education, research, and scholarship.
"More and more schools forego the expensive purchase and maintenance of microscopes and glass histology slides that can break and instead use virtual microscopy with computers to teach students the microscopic structure and function of cells, tissues, and organs. As no single slide collection is complete and flawless, pooling image collections from many different schools and making them available to all histology educators and researchers in form of the VMD electronic database is a perfect solution," concluded Dr. Michael Hortsch.
The VMD is a free resource and will continue to accept digital tissue slide submissions from interested donors.
Molecular Genetics
Congenital cytomegalovirus — The next newborn screening frontier?
Cytomegalovirus (CMV) is the most common infectious cause of congenital sensorineural hearing loss, which leads to speech and language delay. The virus also causes microcephaly, developmental disability, and vision abnormalities. Yet, the prospect of CMV newborn screening remains controversial.
Despite studies deeming it cost-effective and research linking antiviral treatment to better outcomes, some hearing loss experts say that current targeted screening programs miss many asymptomatic infants, while no studies show antiviral drugs improve longer-term hearing outcomes in either symptomatic or non-symptomatic babies.
Another factor that had been holding back the concept of CMV newborn screening was that inexpensive, rapid screening tests did not exist. But now the Centers for Disease Control and Prevention recommends polymerase chain reaction (PCR) testing of saliva as the standard diagnostic test for congenital CMV, providing a high-throughput method of detecting the virus. The somewhat muddled picture of CMV screening and treatment benefits appears to be clarifying as promising study data come out.
Read the full in-depth article on the latest research, understanding the outstanding issues and what federal screening recommendations are supported.
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