News
Report calls for one medical lab services agency across province
Management of Alberta’s $700-million lab services system should be handed over to a new public agency that would be responsible for delivering all medical testing across the province, a new report recommends. In a large scale analysis, the Health Quality Council of Alberta says consolidating medical labs under a central organization provides the best option to address of number of issues stemming from a currently fragmented system (e.g., wait times, decision-making processes, investment stability, support for research).
“There was strong consensus from across the province that the laboratory sector in Alberta is at a key milestone, a tipping point where change is needed,” reads the report which was obtained by Postmedia prior to its public release on Friday. “The status quo was not seen as viable.” Health Quality Council investigators found this fragmentation, combined with the fact Alberta Health Services’ has four different vice-presidents with accountability for lab services, to be a major headache holding the system back.
The plan for an integrated, publicly run lab service model has been the province’s policy since late 2015, when Health Minister Sarah Hoffman blew up an AHS initiative to have all medical testing in Edmonton handled by a single private company. The province has moved forward on its vow by announcing last fall that AHS would take over Dynalife’s operations starting in 2022.
Laboratorians take the stand
Sometimes a laboratory professional’s insights and expertise make all the difference in a legal case. Consider the mother who lost custody of her newborn because a test showed high levels of alcohol in her blood shortly after delivery. Whether a laboratorian goes to court to give factual testimony or to offer an opinion, the rules are the same, experts said. Know the material, answer questions clearly and succinctly, and stay within your area of expertise.
According to Jim Hilbert, who teaches scientists how to testify, the main role of a scientist in court is to educate the judge or jury. "Your job is not to try to make the case," he commented. "Your job is to simply tell the truth." Sticking with the facts sounds simple, but sometimes pressure rises in the courtroom to do otherwise. As an expert witness, laboratorians need to stay calm and composed in court, even when a colleague they respect tries to discredit them, according to Saeed Jortani, PhD, DABCC, director of clinical chemistry and toxicology at University of Louisville Hospital. "You have to have a very tough skin when you do this," he said. "You have to be able to accept criticism. You have to be able to hold your posture, be very patient, and just answer the questions."
Read the article for more advice - you might just need it.
Canadian healthcare providers stop to clean their hands
Every year, 220,000 Canadian patients (approximately one in nine) will develop a hospital-acquired infection during their stay and an estimated 8,000 of those will die. Furthermore, the cost to treat hospital-acquired infection is estimated to be +$100 million annually. Optimal hand hygiene is one of the most effective ways to reduce healthcare associated infections. By implementing simple hand hygiene tasks, such as cleaning your hands at the right time and in the right way, lives can be saved. This message is championed at the highest level of government such as the Honourable Jane Philpott, federal Minister of Health.
Thousands of healthcare professionals across Canada participate in STOP! Clean Your Hands Day, which takes place every year on May 5. "Self-improvement doesn't need to be a burden. Small, incremental changes can lead to big things. Not only can you improve your own practices, you're setting an easy to follow example for everyone around you," said Chris Power, CEO, Canadian Patient Safety Institute.
Clinical Chemistry
New blood test may predict diabetes better
A team of researchers has come up with a new blood test that may better predict gestational diabetes. The study led by researchers at Brigham and Women's Hospital has found that a single measurement of plasma glycated CD59 (GCD59), a novel biomarker for diabetes, at weeks 24-28 of gestation identified, with high sensitivity and specificity, women who failed the glucose challenge test as well as women with gestational diabetes. Plasma levels of GCD59 were also associated with the probability of delivering a large-for-gestational-age newborn.
The team conducted a case-control study of 1,000 pregnant women who were receiving standard prenatal care - 500 women who had a normal glucose challenge test (control subjects) and 500 women who failed the glucose challenge test and required a subsequent oral glucose tolerance test (case patients). Researchers found that, when compared with the control subjects, the median plasma GCD59 value was 8.5-fold higher in the patients who failed the glucose challenge test and 10-fold higher in the subset of these patients who met diagnostic criteria for gestational diabetes in the subsequent oral glucose tolerance test.
Hematology
A novel automated slide-based technology for visualization, counting, and characterization of the formed elements of blood
In a proof of concept article in Archives of Pathology & Laboratory Medicine, researchers describes a potential new approach to the CBC in which a known volume of undiluted anticoagulated whole blood is precisely applied onto a microscope slide as a monolayer. The method uses the standard morphology of an air-dried blood film stained with a Romanowsky stain.
The analysis is accomplished by multispectral digital imaging that allows precise simultaneous counting of all of the formed elements, while their digital images are analyzed for morphology and classification. Compared with the existing combination of a flow cytometer, slide maker, and staining device with a stand-alone cell imager, the device is a single integrated system that eliminates electrochemical and laser components, reduces the number and volumes of reagents and liquid consumables supplies, and features a much smaller footprint in the laboratory. The time to complete a report that requires direct visual assessment of cellular morphology from a glass slide could be greatly reduced. High correlations were obtained between the prototype instrument and a flow-based system as described in the article.
Microbiology
Microbiology, molecular, MALDI-TOF or all of the above?
The newest technologies in microbiology hold the potential to automating the discipline. The key for all labs is to find open, fully automated, modular and flexible diagnostic solutions that fit the unique needs of the lab and its patient population.
Molecular techniques can generate results and positive identifications quickly; so can Matrix-Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) mass spectrometry. However, molecular and MALDI-TOF are still held hostage to the pre-analytical steps and delays. A new generation of pre-analytical systems that require very little interaction and improve error rates and inefficiencies holds the promise of maximizing analytic benefits and creating a new holistic system. Sometimes called “walk-away” specimen pre-analytical processing systems, these new tools include a new generation of automated plate streakers. Some full lab automation systems include algorithms and artificial intelligence that automatically read, interpret, and segregate bacterial cultures.
The ideal marriage between pre-analytic automation and new identification techniques should enable the automatic processing of a sample during many of the steps inherent to microbiological analysis. It should provide highly sophisticated lighting and a camera system to make each plate image clear and accurate—just like using a plate microscope with every plate, so lab staff can reliably make accurate work-up decisions.
Anatomic Pathology
Is honey the new buzzword in histology?
In recent years, there has been interest in using honey as a safe alternative to the gold standard of formalin; it has the ability to prevent both autolysis and putrefaction and to preserve tissue without any harmful effects.
Studies have shown that tissues preserved in low concentrations of honey can be processed and stained in the histology laboratory and produce results that compare favourably with tissues fixed in formaldehyde. This has been shown not only in tissues stained with haematoxylin and eosin and special stains but also in immunostaining, where antigen retrieval methods were not a pre-requirement.
So what is its secret and why aren’t we using it? Honey contains many compounds such as antioxidants, flavanoids, hydrogen peroxide and the sugars glucose and fructose. But because honey is a natural substance, its potency is dependent upon its origin and processing. As a result, its superpowers and acidity are variable, restricted not only by its sugar content but also by the production of hydrogen peroxide that is slowly released by the action of the enzyme glucose oxidase that is present in honey and can inhibit bacterial growth. The presence of phenol (an antiseptic) and the metabolites of nitric oxide have also shown to have a potent biological effect.
Molecular Genetics
CRISPR could transform the way we diagnose disease
The gene editing tool CRISPR could one day mean that we can simply edit away disease, blight and undesirable genetic traits. Now, it's also gaining traction in another realm of medical technology: Diagnosing disease. Researchers from UC Berkeley announced that they have discovered 10 new CRISPR enzymes that can potentially be used to diagnose diseases like Zika or dengue fever quickly and cheaply. The technology isn't ready for prime-time yet, but it could eventually allow clinics to test a sample of someone's blood, saliva or urine for many diseases at once.
The work piggy backs off earlier work by both Berkeley and the Broad Institute. In September, Berkeley researchers reported the discovery of Cas13a and its ability to detected specific sequences of RNA. Last month, the Broad Institute reported that it had used Cas13a to develop a diagnostic tool that could detect Zika and other viruses. At the time, they said that their technique was not only small and portable, but could cost as little as 61 cents ($0.82) per test in the field. Such a tool might detect viral and bacterial diseases, as well as potentially cancer-causing mutations.
The new work essentially expands the tools available in the toolbox, allowing the CRISPR systems to detect more than one thing at once.
Research
Hamilton researchers discover blood test may predict death after surgery
A new study done by researchers has found that a simple blood test can predict and possibly prevent many of the deaths that happen after surgery. Nearly 22,000 patients aged 45 years or older were enrolled in the VISION study by researchers at Hamilton Health Sciences’ Population Health Research Institute (PHRI) and McMaster University. They found that 18% of the patients, who hailed from 23 hospitals in 13 countries, sustained heart damage within 30 days of non-cardiac surgery. The study says that without enhanced monitoring as many as 93% of those complications will go undetected, potentially until it’s too late.
"The effects of surgery anywhere in the body create a perfect milieu for damage to heart tissue, including bleeding, blood clot formation, and long periods of inflammation," said Dr. P.J. Devereaux, director, division of cardiology at McMaster University. In the study, patients had their blood tested after surgery for a protein called high-sensitivity troponin T, which is released into the bloodstream when injury to the heart occurs. Devereaux says that monitoring the levels of troponin after surgery will help identify and avoid heart injuries. The study found that 1.4% of patients died within 30 days following non-cardiac surgery. "One per cent seems like a small number, until you consider that about 200 million surgeries are performed each year around the world," said Devereaux.
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