News
Dispelling the 70% claim
It is likely that the vast majority of clinical laboratory professionals have heard some version of this claim:
- 70% of all medical decisions are based on laboratory results, and/or
- 70% of a patient’s medical record is made up of laboratory data.
Where did it come from? The earliest published reference is from 1996 by Rodney Forsman at the Mayo Clinic; however, no evidence is published in the paper. In a 2004 interview, Forsman cites unpublished sources including conversations with other doctors in the United States. Whether the initial claim was based on a scientific study is irrelevant because, without published data, we as scientists cannot simply take the claim at face value and then cite it as fact.
Laboratory professionals could and should be a flexible information resource that facilitates selection of the right test. We are uniquely positioned to help clinicians identify the most effective testing protocol and interpret results accurately in a timely fashion. So does the 70% claim really matter? Michael Hiltunen President of MedStar Consulting, argues that it is time to put the 70% claim to bed. Find out why in this article.
Unifor and Medical Laboratories of Windsor agreement ratified
Medical Laboratory Assistants and Medical Laboratory Technicians, represented by Unifor Local 2458, have ratified a tentative agreement with Medical Laboratories of Windsor, bringing a three week strike to an end. "We're pleased to have a deal that recognizes the value of the members work," said Tullio DiPonti, Local 2458 Secretary-Treasurer. "We appreciate the support that we received from the public during this job action. Now that we have a resolution, the members are looking forward to once again delivering high quality service to patients in the Windsor community." The workers voted 81% in favour of a new three year contract that includes wage increases, improved benefits and increased vacation. "I'm very proud of what was achieved by the bargaining committee," said Katha Fortier, Unifor Assistant to the National President. "This agreement is a start to addressing the disparity between the public and private sectors in Ontario's health care system."
Quality
Why hospital doctors should cut back on blood tests
Doctors should reduce the number of repetitive blood tests they perform for hospital patients, researchers report in a literature review. They also provide an evidence-based blueprint to guide hospitals in cutting unnecessary daily blood draws from clinically stable patients.
Citing individual studies where front-line health care workers reduced lab tests between 8% and 19%, the authors state the cost savings have ranged from $600,000 to more than $2 million per year. The most successful efforts to reduce daily lab testing involved educating health care providers about costs, showing providers their ordering habits, and restricting automated repeat ordering of tests. “Reducing unnecessary daily inpatient laboratory testing is only one small improvement, but doing so successfully can help change the culture of health care providers to be more keenly focused on thoughtful ordering and prescribing for their patients,” says Pam Johnson.
Motherisk hair test rejected by judge - 22 years before scandal blew up
The same failings identified in a 2015 independent review of Motherisk in Ontario were laid bare in an American criminal case in 1993. In a pretrial hearing for a murder case in Adams County, Colo., the hair-testing evidence presented by former Motherisk lab manager Julia Klein was blasted by the prosecutor as being so deficient that it gave “legitimate researchers in this area a bad name.” The judge who rejected Motherisk’s evidence compared the lab’s process to one in which the scientist “shot the arrow in the air, let it land, and then went and painted the target around the arrow.”
In early 1993, Allen Thomas Jr., an ex-con in his mid-20s, was charged with raping and stabbing to death a 71-year-old grandmother in her home in a Denver suburb in February 1991. The state had a strong case. But to obtain a death sentence, the jury would have to be convinced, among other things, that there were no mitigating factors clouding Thomas’s state of mind. Read Part 1 and Part 2 of this telling court tale.
Transfusion Medicine
Blood from women who have been pregnant could be fatal to men in transfusions, study finds
Scientists from Sanquin Research found that transfusions from blood donors who have been pregnant were associated with an increased risk of mortality in male recipients, but not female recipients. The study looked at 31,118 patients who had received 59,320 red blood cell transfusions between 2005 and 2015 in major hospitals in the Netherlands. By comparing survival rates of the recipients, they found "a statistically significant increase in all-cause mortality among male recipients of red blood cell transfusions".
In total, 3,969 patients studied died after their transfusions, with the lead cause being transfusion-related acute lung injury. The researchers found that men under the age of 50 were 1.5 times more likely to die within three years, if they received a transfusion from a woman who had been pregnant before donating. Whilst significant, this isn't a huge increase, but nevertheless, it could have implications for transfusions in the future if the same results are replicated elsewhere. The results are published in the Journal of the American Medical Association.
Microbiology
Symptom- and laboratory-based ebola risk scores to differentiate likely ebola infections
The 2014–2016 West Africa Ebola virus epidemic overwhelmed the health systems of the 3 most affected countries. Currently, the most common laboratory test to identify EVD relies on a reverse transcription PCR, which is not a rapid point-of-care (POC) test. Researchers hypothesized that calculated risk scores could support separating triaged patients on the basis of the likelihood of being positive, and therefore, potentially slowing the spread of disease.
In a retrospective cohort study, patient data from the Kerry Town Ebola treatment centre in Sierra Leone was extracted from 252 Ebola-positive and 172 Ebola-negative patients to develop easy-to-use risk scores, based on symptoms and laboratory tests. Headache, diarrhea, difficulty breathing, nausea/vomiting, loss of appetite, and conjunctivitis comprised the symptom-based score. The laboratory-based score also included creatinine, creatine kinase, alanine aminotransferase, and total bilirubin. The risk score correctly identified 92% of Ebola-positive patients as high risk for infection; both scores correctly classified >70% of Ebola-negative patients as low or medium risk.
Molecular Genetics
Will molecular allergy diagnostic tests replace skin prick tests?
Recently debated in the World Allergy Organization Journal, there are several problems associated with skin prick tests. Over the last 30 years, molecular allergy diagnostic tests have been developed, such as the Immuno-Solid phase Allergen Chip (ISAC). Using biochip technology, a specialized instrument can measure the levels of IgE antibodies in a patient’s blood to approximately 112 purified or recombinant allergens simultaneously. Unlike the allergen extracts used in the skin prick test, recombinant allergens have the benefit of being produced under standardized conditions and are free from contamination.
Unfortunately, molecular allergy diagnostic tests are not routinely offered as a primary Type I allergy screening method, due to cost and lack of training. ISAC is usually offered only after the skin prick test and blood testing; therefore, more expenses are incurred by the patient. The extra time associated with interpreting and communicating results may also add to the cost. Despite these issues, read why the authors recommend screening with ISAC first, followed by skin prick testing only if necessary.
Research
Screening for disease or toxins in a drop of blood
The promise of being able to quickly and accurately screen for diseases or chemical contaminants in a tiny drop of blood has long been an elusive goal. But scientist Daojing Wang says his company’s technology is up to the job.
As a researcher at the Department of Energy’s Lawrence Berkeley National Laboratory, Wang and others developed a multinozzle emitter array (MEA), a silicon chip that can dramatically shorten the time it takes to identify proteins, peptides, and other molecular components within small volumes of biological samples. “We can improve the sensitivity and throughput of mass spectrometry for detecting biomarkers in blood or other biological fluids for precision medicine,” said Wang, founder and president of the company. “Our first product, the M3 emitter, is up to 10 times more sensitive than conventional emitters, and with some analytes, even 100 times more sensitive.” This patented technology is now being commercialized by Newomics Inc..
Using chromatography to detect drugs from fingerprints
Paper spray - as a technique to generate a sample for mass spectrometry - was first described in 2010. It is a simple technique where a sample is placed on a piece of chromatography paper or the paper can be wiped on a surface to pick up traces of a sample. The paper is either wetted before the sample is applied or after, and then a high voltage is applied. This creates ions, which can then be used as samples for the mass spectrometer. New research has taken this process and developed a method for detecting cocaine in fingerprints. Limits of detection for cocaine, benzoylecgonine, and methylecgonine were 1, 2, and 31 ng/mL respectively, with relative standard deviations < 33%. No matrix effects were observed. Analysis of 239 fingerprint samples yielded a 99% true-positive rate and a 2.5% false-positive rate, based on the detection of cocaine, benzoylecgonine, or methylecgonine with use of a single fingerprint. This is the first time it has ever been used to detect the presence of drugs in fingerprints.
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