BGH, Kingston labs merge; Eight jobs lost
Brockville General Hospital (BGH) is integrating its laboratory services with the Kingston Health Sciences Centre (KHSC), a move that will cut eight positions. As part of the ongoing "recovery plan" carried out by provincially appointed BGH supervisor Kevin Empey, the move follows the announcement a month ago that 14 full-time positions throughout the hospital have been deemed unnecessary. "Staff were surprised and disappointed and kind of shocked by the magnitude of it," Empey acknowledged. But a supervisor said some staffers acknowledged that this kind of integration has already happened elsewhere in the region. The move, effective immediately, eliminates one pathologist position, six lab technologists and one clerical position. Medical staff from KHSC and the Southeastern Ontario Academic Medical Association (SEAMO) will provide all laboratory medical services.
"While critical and timely testing required for immediate patient care will remain at BGH’s core lab, the integration with KHSC and SEAMO will leverage KHSC’s state-of-the-art-technology and provide full access to a specialized medical team," hospital officials stated in a media release. BGH will have monitoring in place to ensure that, for instance, transportation to Kingston does not create problems in the service, said Empey.
Improving error reporting in healthcare
The only way to encourage medical errors and near misses being reported is to create a non-punitive culture. A few system-wide frameworks are available to assist healthcare organizations with this task. An example is the Communication and Optimal Resolution tool. While this is a facility-wide framework where diagnostic errors as well as other types of errors can be reported, there are things that can be implemented within your own laboratory.
- Employees should feel safe reporting errors. If there is a perception that they will be punished or receive maltreatment due to the reporting, errors will continue to go unreported.
- Determine the root-cause of the error. It may seem easy to lay blame, but is there an underlying problem(s) that caused the error(s)?
- Utilize a group or committee to determine the best way to ensure that the error doesn’t occur again. Having different points of view is important to develop feasibility. Is there a process control that could be instituted, such as an LIS hard stop?
- Monitor for that error. You do not know if your corrective action worked in preventing the error from occurring again if you are not monitoring specifically for it.
- Document, Document, Document. When processes change within the facility, new errors may occur, or former errors may recur.
Rates of inappropriate laboratory test utilization in Ontario
A team from McMaster University and LifeLabs studied a clearly defined category of excessive laboratory utilization for nine analytes in Ontario where inappropriate diagnostic testing is defined in terms of the time interval between tests (thyroid stimulating hormone, hemoglobin A1c, lipid profile, serum protein electrophoresis, immunofixation, quantitative immunoglobulins, Vitamin D, Vitamin B12, and folate).
The study found that the percentage of inappropriate tests ranged from 6% to 20%. Large proportions of these inappropriate tests were completed > 2 weeks prior to the minimum threshold to reorder defined by practice guidelines and/or were repeated excessively within a year. Between 60% and 85% of the time, the ordering physician of an inappropriate test was the same physician who ordered the previous test. Specialists were more likely than primary care physicians to order repeat tests too soon.
It is recommended that systems for preventing unnecessary repeat testing are investigated by funding agencies and that reducing inappropriate testing be considered as a design element for electronic medical records and related information technology systems.
Point-of-care urine drug test kits used by rehabilitation programs in Canada and US to help drug users detect the presence of fentanyl in their heroin and opiate drugs
In a sort of "guerilla-warfare" street experiment that applies diagnostic technologies to a problem, the manager of a needle-exchange program in the Bronx, New York has been helping heroin and other opioid users discover if a product they are about to ingest is contaminated by handing out test strips designed for testing urine. The addicts participating in these special programs use the POCT urine test strips to test their drugs for the presence of fentanyl to help prevent overdoses and deaths. The idea is to inform drug users of what they have in hand and possibly encourage them to choose not to take the drug, use less, or slow things down. St. Ann’s Corner of Harm Reduction gives out about 15 strips and is sharing data collected with officials.
St. Ann’s isn’t the first to use urine test strips for drug checking. Vancouver Coastal Health (VCH), launched a pilot program for drug-checking in 2016 at its Insite facility, a supervised injection site that opened in 2003. Data from 173 tests performed in July and August found that 86% of drugs tested contained fentanyl, noted a VCH news release. A CBC News, Manitoba, article called the death rate due to fentanyl ingestion a "Canada-wide disaster."
Disruptive technology for the treatment of hemophilia
An international team of hematologists including Guy Young, MD, of Children's Hospital Los Angeles, has found that in patients with hemophilia A with inhibitors, a novel therapy called emicizumab, decreases incidence of bleeding episodes by 87%. "This is the most significant advancement I have seen during my 20 years working in the field of hemophilia," said Young. Results of this multicenter phase III study called HAVEN 1, were published in the New England Journal of Medicine. The study enrolled 109 males over the age of 12 with hemophilia A with inhibitors.
Emicizumab, a novel monoclonal antibody, is given subcutaneously only once per week. According to Alan S. Wayne, MD, director of the Children's Center for Cancer and Blood Diseases, "This is a breakthrough for individuals with hemophilia A who no longer respond to conventional clotting therapies. The standard treatment for patients with hemophilia A and inhibitors has been to use medications called 'by-passing agents'. This new therapy is dramatically more effective at preventing bleeding. Additionally, in comparison to by-passing agents, emicizumab is easier to administer, requires less frequent dosing, and based on this study, appears to have an improved safety profile."
Related Article: Shire, Roche slug it out in billion-dollar haemophilia drug battle
Department of Transfusion Medicine staff save the life of a patient with rare blood disease
A unique delivery, containing thawed blood, arrived by international carrier to treat a 59-year-old patient from Canada with a devastating rare blood disease called severe aplastic anemia. In addition to severe aplastic anemia, the patient also had an extremely rare antibody in her blood that attacked a specific red cell antigen that appears in 99% of people's blood.
The Canadian facility did not have a match for this rare blood type, so she received blood that had the antigen which resulted in a poor response and serious adverse reactions to the transfusions. Due to the complicated situation, she was referred to the NIH Clinical Center. However, NIH did not have suitable blood match for this patient either. Dr. Jamal Carter, a clinical fellow with the Department of Transfusion Medicine, and Marina Bueno, a technical specialist in the Immunohematology Reference Laboratory, contacted outside blood donation organizations for a match. In December 2016, within 24 hours of its departure from a blood donation center in Germany, two units of rare blood arrived for the patient.
Reflecting on the experience, Dr. Willy Flegel, chief of the NIH Laboratory Services Section noted, "This trans-Atlantic collaboration worked out very well... to ensure the patient's care and safety." The patient's clinical status soon improved dramatically, and she has since stopped requiring regular transfusions.
Oral sex spreading unstoppable bacteria
Oral sex is producing dangerous gonorrhoea and a decline in condom use is helping it to spread, the World Health Organization (WHO) has said. The sexually transmitted infection is rapidly developing resistance to antibiotics. WHO analysed data from 77 countries which showed gonorrhoea's resistance to antibiotics was widespread and in three cases had been the infection was completely untreatable. Gonorrhoea can infect the genitals, rectum and throat, but it is the last that is most concerning health officials. Dr Teodora Wi, Medical Officer, Human Reproduction for WHO said, "When you use antibiotics to treat infections like a normal sore throat, this mixes with the Neisseria species in your throat and this results in resistance." Thrusting gonorrhoea bacteria into this environment through oral sex can lead to super-gonorrhoea. Symptoms can include a thick green or yellow discharge from sexual organs, pain when urinating and bleeding between periods. However, of those infected, about one in 10 heterosexual men and more than three-quarters of women, and gay men, have no easily recognisable symptoms. WHO is calling on countries to monitor the spread of resistant gonorrhoea and to invest in new drugs.
Single urine biomarker assay predicts recurrence of bladder cancer
Researchers at the University Hospital of Lyon in France have developed a urine biomarker test that they claim can detect low-grade urothelial bladder cancer (UBC) and predict the likelihood of tumor recurrence earlier and more accurately than the cytology gold standard. The single biomarker assay, developed by Françoise Descotes, Ph.D., Alain Ruffion, M.D., Ph.D., and colleagues detects mutated forms of telomerase reverse transcriptase (TERT) in the urine of UBC patients. The team compared the urine test with cytology in 348 patients. The biomarker assay demonstrated an overall sensitivity of 80.5% and specificity of 89.8% for bladder cancer detection. In contrast, the overall sensitivity of cytology was just 33.6%. Importantly, TERT assay sensitivity wasn’t affected by disease stage or grade, and the urine biomarker test was markedly more sensitive than cytology in detecting early-stage nonmuscle invasive bladder cancer. Although urine cytology is cheap and easy to perform, it isn’t suitable for detecting low-grade lesions. The team hopes that the simple, noninvasive test could help doctors detect and start to treat bladder cancer early, potentially before symptoms appear, and accurately detect disease recurrence.
HPV testing after abnormal cytology hastens detection of cervical precancer
HPV testing after abnormal cytology resulted in earlier detection of high-grade cervical intraepithelial neoplasia lesions, according to results of an observational study. Researchers focused on the histologic 5-year cervical intraepithelial neoplasia (CIN) outcomes after atypical squamous cells of undetermined significance cytology screening between 2008 and 2012 among women aged 21 to 64 years (457,317 women, nine laboratories).
They linked pathology reports for biopsy outcomes and allowed for a minimum follow-up of 1 year. The first cytology results per woman included 20,677 cases (4.5%) of atypical squamous cells of undetermined significance. In the first year of follow-up, women who underwent HPV testing had a shorter time to CIN3+ detection (median, 103 vs. 393 days). Absolute difference in detection decreased from 0.56% in the first year to 0.34% by year 5. "Therefore, most CIN [grade 3 or more severe] lesions were persistent and are eventually detected even without HPV triage," the researchers wrote. HPV testing also improved detection of CIN2+ lesions (3% vs. 1.6%) and CIN grade 1 lesions (11.6% vs. 6.6%). Biopsy rates appeared 55% higher and loop electrosurgical excision procedure rates within 5 years appeared 20% higher among women who underwent HPV testing.
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