News
Hospitals putting their labs in one place
Hospitals wrestle with the centralization of services when it comes to clinical labs. Northwell Health is replacing its existing core lab in Lake Success, NY, with two automated facilities, one devoted to biological testing and function as the hospital system’s immediate connection while the other would facilitate chemistry-related testing six miles away.
Northwell’s anticipated testing growth was pegged at between 250% over capacity and will be 400% in the future. It was determined that a fully automated workflow and testing system would be created by several different collaborating manufacturers in response to this need. When it is fully implemented next year, Northwell will be home to an automated clinical testing platform in which two parallel, duplicate lines will run 120 linear feet and together will be able to process up to 20 million tests annually around the clock, utilizing the platform’s various analyzer modules. Read more about the Northwell experience along with their planning and design consideration that influence the construction of a centralized clinical testing or core lab.
Quality
A call to action on direct-to-consumer testing
With a projected value of $350 million by 2020, the DTC testing industry, opinions have emerged on the lawless nature of these tests, not to mention their tendency to generate fear mongering. An opinion article in the Journal of the American Medical Association calls for several actions to rein in direct-to-consumer (DTC) testing before it gets out of control, including more state regulations and state medical board sanctions against providers who work for DTC companies.
"If physicians, healthcare industry stakeholders, and policymakers are serious about reining in healthcare spending and promoting high-value healthcare, then the DTC medical marketplace cannot be ignored because it exploits the same lack of accountability for high-volume, low-value medical testing that provoked the regulatory environment governing physicians and hospitals today," states Kimberly Lovett Rockwell, MD, JD, an associate with Jones Day in Detroit and co-author of the article. Read more of this thought provoking article and determine your views as a stakeholder.
Pre-Analytical
Genetic counselors save costs across the genetic testing spectrum
An estimated 70,000 genetic testing products are currently available, with about 10 reaching the market each day. Increasingly, Genetic Counselors (GCs) are providing test utilization management (UM) services and are reducing health care costs. Members of the National Society of Genetic Counselors Test Utilization Subcommittee shared data collected through their institutional processes related to ordering genetic tests, tracking cost savings, and improving patient outcomes.
At Seattle Children’s Hospital, laboratory GCs reviewed 3441 genetic tests’ send-out orders from the hospital and ambulatory clinics over a 57-month period, resulting in a 32% test modification rate and $972,000 total cost savings. At Laboratory Corporation of America, BRCA1/BRCA2 orders were reviewed. Analysis of the adjusted total number of orders (n = 280) requested by non-genetics providers (71% of requesters) revealed that 152 orders (54%) were modified by a laboratory GC following consultation with the ordering provider. Based on the cost of the original order and the adjusted cost after testing had been modified, savings totalled approximately $148,000.
Point-of-Care
A major shift in laboratories was announced at the AACC, if you read between the lines
POC (Point-of-Care) testing has been cannibalizing laboratory testing for about twenty years now, but the sharply renewed interest of laboratory vendors in POC signals a cataclysmic change in the laboratory space. Abbott seemed to pick up on or define the future when they acquired i-STAT in 2003. Fast forward to today, and it is clear that the rest of the mega vendor crowd appears to be convinced that Abbott had foresight that the rest of the market was lacking in 2003 – lab consolidation will accelerate with the use of POC testing, and moderate-sized laboratories may cease to exist. It is Siemens Healthineers that has signaled the latest shift with the agreement to acquire Epocal from Alere, literally, during the AACC convention. News about the gobbling up of POC products and companies is likely to dominate the laboratory space for months to come.
Couple this POC change with the continued consolidation of laboratories to offsite locations (offsite from the main hospital), and it is clear the laboratory is moving to two very different entities at opposite ends of the laboratory spectrum. Most hospital laboratories in the country will migrate to both ends, and what is now in the middle will be almost totally non-existent.
Leadership
7 summer reads for all your health care needs
This summer, the heat hasn’t been slowing us down. At the Institute for Healthcare Improvements and in the world of health care, improvers have been making great waves. To make it easier for you to keep up, we’ve made a list of seven engaging posts on - seven must-see resources for all your health care improvement needs.
- IHI Framework for Improving Joy in Work
- Moved to Action: Health Center CEOs Pen Letter to Senators
- Patient Safety's Missed Opportunities
- WIHI: The Digital Transformation: How Technology Is Helping (and Hurting) Health Care
- The Global Epidemic of Unneeded Cesarean Sections
- What Is Bias, and What Can Medical Professionals Do to Address It?
- The Right Care, Right Setting, and Right Time of Hospital Flow
Clinical Chemistry
New microfluidic chip boosts the sensitivity of immunoassays by >1000x
An international team of scientists from Technion – Israel Institute of Technology and IBM Research in Zurich have jointly developed a technique which can improve the sensitivity of protein detection in immunoassays by more than 1,000-fold, when compared to a standard immunoassay implementation.
The team’s method is based on a simple piece of hardware – a microfluidic chip containing flow channels the width of a human hair. Moran Bercovici, assistant professor at the faculty of Mechanical Engineering at Technion said, "We use an old focusing technique called isotachophoresis (ITP) in a new way – using a combination of electric fields and specialized chemistry. This enables us to collect proteins into a tiny volume and precisely deliver them to react with detection antibodies patterned on the surface of the microchannel”. “We essentially fool the detector," adds Federico Paratore, a PhD student. "We present to a standard detector a protein concentration that is 10,000-fold higher than in the original sample, and get the detector to respond accordingly." The team’s approach may enable simple devices capable of analyzing small samples, replacing the large and sophisticated laboratory equipment required today.
Transfusion Medicine
Blood agency seeking $855-million in funding to boost plasma supply, document reveals
Canadian Blood Services (CBS) is seeking $855-million over seven years to significantly boost the amount of plasma it collects from unpaid donors to make medications, according to a released confidential document. The national blood authority sent the provincial, territorial and federal governments a business plan in January that advocated for the opening of 40 new plasma-collection centres so that Canada could become less reliant on paid American donors for its supply of immune globulin. The blood authority doled out just over $623-million for the drugs in 2016, up from about $459-million two years earlier.
Right now, CBS only collects enough plasma to fill 17% of Canada’s need for immune globulin but wants to up that to 50%. Lois Shepherd, the director of transfusion medicine at Kingston Health Sciences Centre, said demand for immune globulin is rising in part because of the aging population. According to a seven-page CBS letter sent in March that was obtained by The Globe and Mail, the start-up and operating costs of the plan are expected to rise from $5-million this year to $247-million in 2023-24, after which the agency hopes to offset some of that with savings elsewhere in its plasma budget.
Microbiology
Infection identification gets high-tech boost at Grand River
New high-tech equipment in Grand River Hospital's microbiology lab is speeding up identification of infections to get patients on the best treatment faster. The Kitchener hospital is already making use of a biotyper that cuts identification times of various pathogens by at least a day, and it's readying a new automated system for preparing specimens for analysis.
Faster results mean doctors "can treat more appropriately sooner," said Carol Ellis, senior medical laboratory technologist. It's also a boon for the busy microbiology lab, which tests nearly 165,000 specimens every year. Most organisms isolated from patient specimens take 24 to 48 hours to grow on a culture plate. Before the new machine, an additional 24 hours or more would be needed for identification. "It's the one machine I would never give back," Ellis said.
Related Article: Carol Ellis: The importance of medical lab techs
New antibiotic class found effective against gonorrhea in the laboratory
For the first time, researchers from Imperial College London and the London School of Hygiene & Tropical Medicine have tested the new antibiotic, closthioamide, on gonorrhoea samples in the laboratory. The results were published in the journal Antimicrobial Agents and Chemotherapy.
The researchers tested 149 samples of N. gonorrhoeae from hospital patients with infections in the throat, urethra, cervix and rectum. They found that at very low amounts (≤ 0.125mg/L), closthioamide was effective against 146 of 149 samples taken from patients, and against all of the samples provided by the World Health Organization, which were known to be resistant to other antibiotics.
Although still yet to be tested on animals and humans, the researchers say the antibiotic could be an exciting new step in the fight against the disease. Dr John Heap, lead author, said: "The imminent threat of untreatable antibiotic-resistant infectious diseases, including gonorrhoea, is a global problem, for which we urgently need new antibiotics. This new finding might help us take the lead in the arms race against antimicrobial resistance."
Cytology
BODIPY-based dye for no-wash live-cell staining and imaging
In nonpolar solvents, hydrophobic organic fluorophores often show bright fluorescence, whereas in polar media, they usually suffer from aggregation-caused quenching (ACQ). Published in BioTechniques, including supplementary material, researchers report the development and successful use of a new cell-staining dye based on a BODIPY derivative behavior of a 1,3,5,7-tetramethyl-BODIPY derivative with a sufficiently simple structure and facile synthesis.
The dye displays pronounced solvatochromic behavior that enables bright and uniform cell staining. Compared with previously reported dyes, mono-TMB 2 can be used for instant fluorescence cell visualization, for example, in cell proliferation or motility assays. Mono-TMB 2 showed excellent signal contrast without the need for the preliminary washing off of the unbound dye, which is advantageous in experiments where the washing off procedure is undesirable. Owing to Mono-TMB 2’s reversible coupling to the membrane, the cells were destained and used again for subsequent staining and visualization in the same green channel of a fluorescence microscope.
Thank you!
We appreciate that you have taken the time to read LabBuzz. This is a CSMLS venture to provide relevant medical laboratory news to its members.
We need your help to grow this newsletter! Please pass along the subscription link to any colleague you think would benefit from hearing about med lab news.