News
As Seasoned Lab Professionals Retire, Certified Staff Needed to Supply Future Workforce
With baby boomers retiring in droves, the medical laboratory profession needs to intensify efforts to recruit the next generation of professionals, according to the newly-released American Society for Clinical Pathology (ASCP) 2016-2017 Vacancy Survey. A focus on qualifications and certification status is crucial to addressing the needs of the laboratory workforce of the future, according to the Vacancy Survey, which was published in the March 2018 issue of the journal, AJCP.
Retirement rates of laboratory professionals (for those retiring in the next five years) are at their highest across the majority of departments since 2012. Moreover, the rate of supervisory retirements is higher compared with staff, especially in the anatomic pathology, chemistry, toxicology, cytogenetics, cytology, flow cytometry, hematology, coagulation, immunology, microbiology, phlebotomy, point-of-care, send-outs, and specimen departments. Data suggest that these fields will soon be experiencing a drain in personnel who have been working for a long period of time and have a vast amount of experience.
Overall, 24 percent of survey respondents said their primary concern is finding qualified laboratory professionals to staff the labs. They also indicated that the number of applicants is extremely low compared with the number of personnel retiring. To fill the vacancies, some laboratories are hiring non-certified staff, a trend that Carlo Ledesma, SH(ASCP)CM, MT(ASCP), has observed in his region in Oklahoma City, Okla.
His team conducted a study to see if there was a difference in quality between certified and noncertified lab professionals. “We wanted to get data from our immediate area. There were increased errors in nontraditional hires (who lack certification) compared to traditional hires. They take longer to train, which means allocating more financial resources. They failed to recognize critical results because they don’t know the clinical difference in a test.”
Kaiser Health News Labels Routine Clinical Laboratory Testing and Other Screening of Elderly Patients an 'Epidemic' in US
Health screenings, particularly those for chronic diseases, such as cancer, can save lives by detecting diseases in their early stages. However, as consumers become more engaged with the quality of their care, one trend is for healthcare policymakers to point out that many medical procedures and care protocols may not bring benefit—and may, instead, bring harm.
No less an authority than Kaiser Health News (KHN) is also questioning what it calls an “epidemic” of testing in geriatric patients. Since medical laboratory tests are part of many screening programs, a rethinking of what tests are necessary in older patients would likely impact clinical laboratories and pathology groups going forward.
“In patients well into their 80s, with other chronic conditions, it’s highly unlikely that they will receive any benefit from screening, and [it is] more likely that the harms will outweigh the benefits,” Cary Gross, MD, Professor of Medicine and Director of the National Clinician Scholars Program at the Yale School of Medicine, told KHN as part of an investigative series called “Treatment Overkill.”
That opinion is supported by a 2014 study published in the Journal of the American Medical Association (JAMA) Internal Medicine. The researchers concluded, “A substantial proportion of the US population with limited life expectancy received prostate, breast, cervical, and colorectal cancer screening that is unlikely to provide net benefit. These results raise concerns about over screening in these individuals, which not only increases healthcare expenditure but can lead to patient harm.”
CNC is showing off its MLT program for National Medical Laboratory Week
The College of New Caledonia (CNC) is showing off its MLT program as part of National Medical Laboratory Week.
The program works closely with Northern Health to give students tools they need to succeed in industry.
“We’re fulfilling a need in BC for employment; we have a really high retirement rate in the lab-tech field right now.” said Michelle Lui, MLT Instructor
Lui says because of the high retirement rate, their students will be able to stay in the north for this line of work.
Microbiology
U.K. case of ‘super-gonorrhea’ a global concern: microbiologist
A U.K.’s man recent diagnosis of “super-gonorrhea” is a reminder that the infection may become untreatable by any antibiotic in the future.
This is because of antimicrobial resistance.
Gone are the days when a shot of penicillin was guaranteed to cure an infection, Dr. Vanessa Allen, chief of medical microbiology at Public Health Ontario told Global News. “If you have a resistant bacteria that spreads, the concern is that it’ll become a common problem worldwide.”
Public Health Ontario data shows that the last resort drug to treat gonorrhea, cephalosporins, has presented an increase in resistance within the province.
Over the last few decades, five antibiotic classes were found to be no longer effective in treating gonorrhea, including penicillin documented in 1976, tetracyclines in 1985 and quinolones in 1994.
Despite the effort put into developing new drugs, Dr. Allen says, they probably won’t work for a very long time since drugs being developed are just advanced versions of medications that are already on the market.
“The consequence of running out of drugs to treat infections is seeing patients being hospitalized for illnesses that were once cured with medication,” she adds. That’s something that doctors haven’t seen in 70 years.
Fingerstick Point-of-Care Test Allows for Single-Visit HCV Diagnoses
The Xpert® Hepatitis C Virus (HCV) Viral Load (VL) Fingerstick point-of-care test can detect active infection accurately from 100 µL of capillary whole blood in 1 hour, allowing for single-visit HCV diagnoses, according to an observational cohort study published in The Journal of Infectious Diseases.
Researchers in Australia evaluated the sensitivity and specificity of a redesigned prototype Xpert HCV VL fingerstick assay for HCV RNA detection (fingerstick) and the Xpert HCV VL assay (plasma) compared with the Abbott RealTime HCV VL assay by venous puncture in 223 participants enrolled at drug treatment clinics and homeless services.
The researchers found that the sensitivity and specificity of the Xpert HCV VL assay (plasma) for HCV RNA quantification in samples collected by venipuncture were 100%. Likewise, the sensitivity and specificity of the Xpert HCV VL fingerstick assay for HCV RNA quantification in samples collected by fingerstick were also 100%.
Therefore, the fingerstick assay provides a substantial advantage over the plasma assay by avoiding the need for plasma separation and enables testing and diagnosis in 1 hour compared with 2 hours.
Molecular Genetics
Doctors don’t feel qualified to interpret genomic tests, concludes Cambridge’s PHG Foundation
Genomic testing is a key weapon in the armoury of precision medicine, helping doctors to find the right treatment for an individual patient by analysing DNA information.
The UK government has committed to taking genomic medicine beyond specialists and embedding it into mainstream clinical care. But a new report from a Cambridge health policy think tank, the PHG Foundation has concluded that the vast majority of hospital doctors do not consider themselves qualified or competent to interpret the results of genomic tests.
The report outlines the work needed to ensure that doctors are armed with the knowledge to utilise the tests available. Dr Hilary Burton, lead author of the report ‘Genomics in mainstream clinical pathways’, said: "Our aim with this report is to highlight the changes essential to widening access to genomic medicine."
"Genomic medicine is a very new developmental area for clinicians in mainstream practice. Those making referrals for genomic testing will need training in ordering the right tests and understanding the report of results, particularly the way in which it may support clinical decision-making. Even after training, doctors are likely to need ongoing support from the genetics service."
The report identifies two critical barriers that are preventing the widespread, effective and safe application of genomic medicine. The first is choosing which patients will benefit and making the right referral for testing. The second barrier is understanding the result well enough to make the best clinical decision.
Research
Monitor detects dangerously low white blood cell levels in chemotherapy patients
MIT researchers have now developed a portable device that could be used to monitor patients' white blood cell levels at home, without taking blood samples.
Such a device could prevent thousands of infections every year among chemotherapy patients, the researchers say. Their tabletop prototype records video of blood cells flowing through capillaries just below the surface of the skin at the base of the fingernail. A computer algorithm can analyze the images to determine if white blood cell levels are below the threshold that doctors consider dangerous.
"Our vision is that patients will have this portable device that they can take home, and they can monitor daily how they are reacting to the treatment. If they go below the threshold, then preventive treatment can be deployed," says Carlos Castro-Gonzalez, a postdoc in MIT's Research Laboratory of Electronics (RLE) and the leader of the research team.
In a paper appearing in Scientific Reports, the researchers showed that the device could accurately determine whether white blood cell levels were too low, in a study of 11 patients undergoing chemotherapy.
The technology the researchers used to tackle this problem consists of a wide-field microscope that emits blue light, which penetrates about 50 to 150 microns below the skin and is reflected back to a video camera. The researchers decided to image the skin at the base of the nail, known as the nailfold, because the capillaries there are located very close to the surface of the skin. These capillaries are so narrow that white blood cells must squeeze through one at a time, making them easier to see.
The technology does not provide a precise count of white blood cells, but reveals whether patients are above or below the threshold considered dangerous—defined as 500 neutrophils (the most common type of white blood cell) per microliter of blood.
Ethics
Co-inventor: CRISPR gene editing could have 'profound positive effect,' but ethics concerns remain
Jennifer Doudna, who co-invented a gene editing technology that could transform how numerous genetic conditions are treated, says the process not only raises many hopes, but also brings concerns about "designer babies."
That technology, called CRISPR Cas9, has been used successfully to meticulously change specific genetic traits in multiple species, including monkeys, mice and certain plants.
Doudna and other scientists have said CRISPR Cas9 can revolutionize the fight against genetic disease in humans. But she has also warned that its wide-ranging capacity to alter genes will inevitably lead to various ethical dilemmas about a range of issues — including the eventual prospect of "CRISPR babies," or so-called designer humans pre-selected to have certain traits even before they are born.
What are these ethical dilemmas that could potentially be presented when we get to that point?
Doudna: There really are three areas that I think about.
One is the human embryo editing. We could call it germline editing. It basically just means making changes that are heritable in DNA in humans, that can be inherited by future generations. And just to be clear, that's distinct from the idea of using gene editing in an adult, or a patient, in cells that are not part of the germline (in which affected genes are) not eggs or sperm, so the changes to DNA would not be passed to future generations. And I think most people feel that that kind of (non-germline) application is really not ethically fraught. It's something that would affect one person and it needs to be treated as one would treat any other kind of therapeutic for safety and effectiveness, but doesn't affect future generations.
(The second ethics question) is applying the CRISPR Cas9 technology in agriculture. And that raises the whole question of how do we define genetically modified organisms, or GMOS. That (has) led to a really fascinating ongoing debate/discussion in many countries about how we define GMOs and (when) CRISPR Cas9 (is) used in plants, does that lead to plants that we would consider ... GMO.
I think the third area of (ethical) application is something called gene drive. And that simply means using this technology in a way that drives a genetic trait very quickly through a population, for example a population of insects like mosquitoes that would lead to, for example, either preventing mosquitoes from being able to transmit disease or even prevent mosquitoes from being able to reproduce. Again there are pros and cons. This could have an incredibly positive impact on human health if we could prevent mosquito-borne diseases from being spread, like Dengue virus, Zika, etc. But it also raises the possibility of unintended environmental consequences and how do we control something like that once it's unleashed.
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