News
Hidden camera reveals security breach at Hull Hospital lab
A hidden camera investigation by Radio-Canada has revealed lax security at the hematology and biochemistry lab of the Hull Hospital, despite a 2017 warning from Quebec's professional order of medical technologists calling for the institution to restrict access.
Quebec's health ministry said the security situation for the lab "does not appear to meet standards."
At 7 a.m. on March 8, a Radio-Canada reporter entered the Gatineau, Que., hospital with a hidden camera and was able to easily go inside the hematology and biochemistry lab. The reporter moved around without any employee in the lab confronting him. Medical samples were within reach, but the reporter did not touch them.
After being told about the situation by Radio-Canada, the Outaouais regional health authority (le Centre intégré de santé et de services sociaux de l'Outaouais, or CISSSO) said the lab was not monitored or locked between 6:30 a.m. and 8 a.m. CISSSO said the lab is not locked during its office hours and the receptionist is responsible for monitoring access during the workday, starting at 8 a.m.
Medical labs must always be absolutely secured, according to Doris Levasseur Bourbeau, president of l'Ordre professionnel des technologistes médicaux du Québec (OPTMQ) or, in English, the Professional Order of Medical Technologists of Quebec. "Access to the lab must be exclusively limited to authorized personnel," Bourbeau said in French.
Visitors passing through the lab could distract employees, increasing the risk for error, she said. "People in the lab are working with samples that are very precious, very important," she said. "We're talking about blood samples, cerebrospinal fluid, where you cannot have people disturbed by comings and goings."
Levasseur Bourbeau said the Hull Hospital needs to control access to samples to avoid cross-contamination and the potential of exposure to infection.
Sackville Memorial Hospital Foundation launches Accuracy is the Best Result Good Chemistry Campaign
The Sackville Memorial Hospital (SMH) Foundation has launched its Accuracy is the Best Result Good Chemistry Campaign 2018, with an ambitious $100,000 fundraising goal. Strong community support is needed once again to ensure laboratory professionals have the best technology to provide the most accurate results for patients.
This year, the Foundation will purchase a sophisticated chemistry analyzer for the lab at the SMH. This technology will provide quick and accurate results, allowing physicians to make the correct diagnosis and administer prompt treatment to patients. The new unit will replace an aging unit that is reaching the end of its lifespan. The lab touches virtually every aspect of patient care. The lab, which performs over 61,000 tests per year, is arguably the hospital’s most vital service. Diagnostic tests are often the least expensive component of the health care pathway, yet they influence more than 70 per cent of all health care decisions. The dedicated team of medical laboratory professionals at SMH process over 250 specimens per day from admitted patients, the emergency department, Extra Mural Program, long-term care facilities and various clinics throughout the Tantramar area.
Hematology
Accurate Blood Counting Without User Training
Dengling Xie and co-authors in the Multimodal Biomedical Imaging and Therapy Lab at the University of Science and Technology of China (USTC) have developed a simple, inexpensive CBC instrument capable of being operated by completely untrained users.
Rather than using flow cytometry, the USTC method utilizes fluorescence and bright field imaging performed on a low-cost microscope. The images are then automatically computer-analyzed to determine cell counts, returning RBC, WBC, and platelet counts, along with a 3-part WBC differential.
"Our original system required preparing the sample in a few steps, with lots of pipetting. You had to practice it a few times to really get the hang of it." Solving this challenge required re-engineering the reagent system to allow all of the chemicals to be pre-prepared, eliminating the need for pipetting and reducing the sample preparation to a single dilution step. With a simplified preparation method in hand, the control of the microscope was also automated to the "push-button" level.
Performance of the system was assessed on 120 blood samples measured by expert as well as untrained users, in both laboratory and field settings. For each blood sample, the results of the low-cost method were compared with the clinical gold standard using the error targets laid out by the US Center for Medicare and Medicaid Services (CMS) Clinical Laboratory Improvement Amendments (CLIA) guidelines for the complete blood counts. CLIA guidelines set the maximum allowable error for laboratory tests, with the requirement that >95% of measurements must fall within these error targets.
The results of the USTC field trial demonstrated that the new, low-cost, easy-to-use method were not only statistically equivalent with the clinical gold standard, but that this performance was independent of user training. According to study co-author Zachary Smith, "This means that users who have never even seen our instrument before can walk up, read a short protocol, and get accurate results in just a few minutes." For those living in remote rural environments, the ability to have a CBC performed at a local clinic, or even at their own home, could save a costly or time-consuming trip to the hospital and increase their access to care.
Transfusion Medicine
Red blood cell, plasma transfusions decline nationwide
Use of red blood cell and plasma transfusions declined across the United States from 2011 through 2014, according to study results.
Ruchika Goel, MD, MPH, and colleagues analyzed data from the National Inpatient Sample from 1993 to 2014. They used weighted estimates of more than 30 million discharges each year from 1,100 hospitals in 47 states across the US.
The proportion of patients who underwent red blood cell transfusions during hospitalization increased steadily from 1993 to 2011, when it peaked at 6.8%. The rate declined to 5.7% in 2014 (adjusted risk ratio = 0.83; 95% CI, 0.78-0.88).
The decrease in red blood cell transfusions over time appeared larger among elective admissions than nonelective admissions (P for interaction < .001).
Researchers reported statistically significant reductions in red blood cell transfusions regardless of patient sex, race/ethnicity, risk severity and payer type. However, results showed no significant reduction in red blood cell transfusions among children.
The percentage of patients who underwent plasma transfusions during hospitalization also declined from 1% in 2011 to 0.87% in 2014 (adjusted risk ratio = 0.87; 95% CI, 0.8-0.95).
Results showed no decrease in platelet transfusions nationwide.
DesiCorp of Louisville wants to expand the shelf life of blood
What does human blood have in common with a tank of sea monkeys? Well, not much unless you're working with DesiCorp — then the connection between the two is everything.
The company has been researching the sea creatures to figure out how they can first dehydrate red blood cells and then rehydrate them for later use in blood transfusions. The company's goal is to extend the shelf life of human blood, which can only be used for 42 days after it is harvested in the U.S. (35 days in Europe), and can only be stored in high-tech refrigerators.
But the shelf life of dried blood could be years instead of days, Michael Menze, the company's director and president said. Additionally, it wouldn't need to be stored at a specific temperature. All you'd need to bring the blood back to life for a transfusion would be sterile water.
Menze, and others trying to solve the problem of blood-storage time, have been studying the sea monkeys for years because of their ability to be dehydrated and then come back to life when water is added — sometimes years after the original dehydration.
They found that the sea monkeys and other creatures like them have a common denominator called trehalose. Menze explains it as two glucose molecules attached in a very specific way. They found that when trehalose is dehydrated, it takes on a glass-like state until it is rehydrated. The glass state stops chemical reactions for molecules encased within it, essentially freezing everything inside. Then when water is added, the glass state of the trehalose is broken and the creature comes back to life, almost as if it has been frozen in time.
But for decades, nobody could figure out how to get the trehalose into red blood cells to make them capable of the dehydration and rehydration process in the same way that sea monkeys exhibit. Jonathan Kopechek was researching the use of "sonoporation" technology in cancer treatments. Sonoporation uses sound waves to open up the pores of cells and make them penetrable. Sonoporation allows the researchers to put the trehalose in the red blood cells, which allows them to dry them and bring them back to life. They're still working on perfecting the process — right now the most successful round has only brought back 50 percent of the red blood cells.
Menze said that they will start working on drying rat blood for animal testing very soon. They think they can start clinical trials with animals in the next five months.
Anatomic Pathology
Artificial intelligence can diagnose prostate cancer as well as a pathologist
Chinese researchers have developed an artificial intelligence system which can diagnose cancerous prostate samples as accurately as any pathologist, holding out the possibility of streamlining and eliminating variation in the process of cancer diagnosis.
The system may also help overcome shortages of trained pathologists and in the longer term lead to automated or partially-automated prostate diagnosis.
Confirmation of a prostate cancer diagnosis normally requires a biopsy sample to be examined by a pathologist. Now the Chinese AI system has shown similar levels of accuracy to pathologists and can also accurately classify the level of malignancy of the cancer, eliminating the variability which can creep into human diagnoses. “This is not going to replace a human pathologist,” said Hongqian Guo, who led the research. “We still need an experienced pathologist to take responsibility for the final diagnosis. What it will do is help pathologists make better, faster diagnoses, as well as eliminating the day-to-day variation in judgement which can creep into human evaluations.”
Guo’s group took 918 prostate samples from 283 patients and ran these through the AI system, with the software gradually learning and improving diagnosis. The pathology images were subdivided into 40,000 smaller samples of which 30,000 were used to train the software while the remaining 10,000 were used to test accuracy.
The results showed an accurate diagnosis in 99.38 per cent of cases, using a human pathologist as a gold standard. Guo said that means the AI system is as accurate as a pathologist.
The system was programmed to learn and gradually improve how it interpreted the samples. “Our results show that the diagnoses the AI system reported were at a level comparable to that of a pathologist. Furthermore, the system could accurately classify the malignancy level of prostate cancer,” said Guo.
Molecular Genetics
Home genetic tests should be interpreted by experts: Geneticists recommend seeking clinical test validation after initial study finds up to 40 percent of at-home genetic tests to be inaccurate
Results from at-home genetic tests are not always accurate. A new study in the journal Genetics in Medicine now shows that up to 40 percent of direct-to-consumer (DTC) genetic tests provide incorrect readings in the raw data.
Stephany Leigh Tandy-Connor, study leader at Ambry Genetics Corp in the US, expressed concern about the fact that most DTC test results are interpreted by medical providers with limited genetic training due to a shortage of genetic counsellors and other highly trained genetic professionals available for public consultation.
Unlike clinical genetic tests carried out in a laboratory, DTC tests are not diagnostic and only offer risk information for a limited set of conditions. While the FDA currently prohibits most DTC companies from offering diagnostic genetic tests, some do give customers their raw genotyping data upon request. This can then be taken to third-party companies to interpret for a fee. The raw data provided to the customer is often accompanied by a disclaimer that it is neither validated for accuracy nor intended for medical use.
Tandy-Connor and her colleagues set out to assess how accurate DTC tests were in highlighting the presence of specific genetic variants. They analyzed the raw data of 49 patients that were referred to Ambry Genetics Corp for confirmatory testing, after sharing their DTC raw data results with their medical providers.
The researchers found that two out of every five (40 percent) variants noted in the DTC raw data were incorrectly reported and could not be verified by further diagnostic lab tests. In eight instances, the variants that were present were misunderstood by third-party interpretation services.
"Such a high rate of a false positives in this particular study was unexpected," says Tandy-Connor, who believes that some of the discrepancies in the results can be explained by technical differences between the various testing methods used. "While DTC results may lead to healthy changes in lifestyle or diet, these could also result in unwarranted emotions, including anxiety when someone obtains unexpected information, inaccurate information, or disappointment when receiving a lack of comprehensive diagnostic analysis."
Research
Cellphone-based tech could cut lab visits for blood tests
Researchers have developed a cellphone-based blood test technology that can provide immediate results in the comfort of one's home or a doctor's clinic, thereby cutting visits to the laboratory.
In a paper published in the journal Biosensors and Bioelectronics, the researchers detailed a mobile version of the "Enzyme Linked Immunosorbent Assay" (ELISA), the gold standard technique used to detect the presence of an antibody or antigen.
Instead of sending patients to a laboratory, the new cellphone-based technology - Mobile Enzyme Linked Immunosorbent Assay (MELISA) -- allows for the very same test to be conducted in the doctor's office, clinic or even in a remote area.
The device consists of a water bath heater that incubates samples at a target temperature and analyses them via images taken by mobile phone. The device uses colour analysis to determine the RGB (red, green, blue) colour components of each sample.
The portable MELISA weighs less than half a kilogram, and the researchers believe that it has the potential to help older patients suffering chronic conditions and those across the world.
Ethics
Biologist used patient's bug-ridden poo sample to get time off work - Wales Online
A scientist who didn’t want to work day shifts swapped his own feces with a patient who had salmonella to prove to his bosses he had food poisoning.
Bernard Watkins worked as a biomedical scientist in the microbiology department at Cwm Taf University Health Board. After he was handed day shifts, instead of his preferred night shifts, he went into a freezer at work and took a patient sample which had tested positive for salmonella before using a computer at work to check a patient’s confidential details and make sure they had the disease. But days later he confessed all to one of his bosses – admitting he had "spiked" his sample.
He left a fecal sample in the office on the same date. Two days later, on October 12, he called his employers to say he wouldn’t be working for the rest of the week as he remained unwell. The same day the fecal sample tested positive for salmonella.
One of his bosses, Kelly Ward, the manager for Microbiology, phoned Mr Watkins and asked him to submit another fecal sample signed by his GP. On October 13, Mr Watkins explained to Mrs Ward he had been to his GP and provided the sample. That sample tested negative for salmonella.
Just two days later, as Mr Watkins was finishing a night shift which ended at 8am, he called Mrs Ward and asked to meet her when she got into work. He told her he "deliberately contaminated" a sample of a patient who had salmonella with his own feces by adding in his own fecal matter, saying his employer would have "found out anyway".
All of the allegations against Mr Watkins were found proven by a Health and Care Professions Council (HCPC) conduct and competence panel. They found his actions amounted to misconduct and his fitness to practice was impaired.
In coming to their decision regarding the sanction, panel chair Claire Cheetham said: "Because of the aggravating factors outlined and because of the gravity and calculated nature of the dishonesty against the registrant's employer, the panel has concluded that the only available sanction that it can impose in this case is a striking off order."
Mr Watkins' name will now be struck off from the register and he will be unable to carry on working as a scientist.
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