generalist – Page 30

Are We Creating Wisdom After Y2K?

We all remember the panic and drama over the centennial turn of the century? Well, here we are in the middle of the second month of the fifteenth year of this “new millennium.” Who could imagine we’d be this far into the future this fast?

As the world turns, we balance on the precipice of our “seasoned and experienced” laboratory professionals reinventing, repurposing, redefining their careers, or just moving on to enjoy life after laboratory service—and leaving the bench at a rate that looks like a diabetic insulin spike. We are also experiencing a surge of new laboratory interest, (thanks, CSI!) and it’s refreshing to see students eager to learn and practice in our labs and specialty departments. But there is a “gap” in the middle, a desert of years when schools closed, students went into nursing or pharmacy or radiology instead of laboratory science, and we didn’t “feel” it because we were in the prime years of our careers. This “gap” is very soon going to appear on the horizon and it’s looking a bit like the Olduvai Gorge…deep and wide with not too many ways to cross unscathed.

It is with urgency that those of us still active in the field begin to engage, mentor, sponsor and grow new laboratory professionals around the world. Seek out that student you don’t know yet, take that youngest tech to lunch, make friends with a student/young tech from another country, take a turn at teaching and training (yep, without the stipend or salary bonus—just do it because someone did it for you a long time ago, and I’m guessing they weren’t compensated either…) I’d like to challenge everyone to leave some knowledge behind as you take the next step on life’s path. There are so many ways to do it, find a way to give a little bit back, help complete the circle.

Just remember…the next generation of medical technologists and laboratory scientists are going to be performing tests and releasing results for us one of these days. Wouldn’t it be great if they were as good as I want them to be when they’re doing my CBC and chemistries, and cross matching that unit I hope I don’t need during surgery? I’ll be crossing my fingers, and counting on the fact that YOU were one of their mentors!

Here’s to the next 15 years in our Y2K world! Cheers!

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

CAP Inspections and the Resident

Hello, fellow blog readers! It’s about 4 weeks since we communicated last. Since my first half of the year was loaded with lighter CP rotations to allow me to complete interviews for two successive fellowships, this half of the year is surgpath heavy and so that’s why I took a short hiatus from posting.

Well, I have a 4 week reprieve before I have another surgpath rotation and I am on what we refer to as our “comprehensive CP” rotation. Basically, it’s a combination chemistry-microbiology rotation. Since both of those rotations don’t always have enough work to require a resident to remain at the hospital for the usual 8-5 schedule, we cover both rotations simultaneously. We also have 11 comp CP rotations throughout the 4 years at my new program which is quite a lot but after the initial 2 months of “wet lab” rotating through all the stations in the chemistry and microbiology labs, we have the flexibility to tailor our comp CP rotation. And so, right now, I write as I sit in a hotel in Baltimore about to meet for our third preparation meeting before my attending and I go inspect a new molecular genetic pathology laboratory for the College of American Pathologists tomorrow. Since this is this lab’s first inspection, unlike the usual CAP inspection, this one is announced – they know we are coming and can prepare for our visit. The two of us will complete the entire inspection; my program counts this as rotation duties even though I am off-campus.

This is the second CAP inspection that I’ve been asked to assist with since I transferred to my program as a PGY-3. I think it’s great that my program gives our residents this opportunity since as attendings (whether we are AP or CP), we will also have to either assist in or enforce adherence to CAP or other accreditation standards and supervise preparations for lab inspections every other year and self-inspections on the alternate off-years. At my program, residents assist in both the preparations for CAP and off-year inspections. I’ve said it before, but residency is the transition from passive learning to active learning where we should participate in the daily responsibilities that our attendings oversee and that we will have in the future.

So, this inspection will be much more work than when I inspected the chemistry and special chemistry sections with my last team. Since there are only two of us, we are responsible for splitting the duties for the lab director, general, common, and molecular pathology accreditation checklists. CAP suggests a “ROAD” approach: read (through their binders of policies, SOP’s, etc), observe (a sample from receipt in the lab and though processing and interpretation of results), ask (open ended questions), and discover.

Well, I guess it’s time for me to go inspect but before I leave, I’d like to encourage all trainees (residents and fellows) to apply to serve as a junior member on one of the CAP’s committees or councils. You need to be a junior member but membership is free as a resident. Each committee or council (that oversees multiple committees in a topic area) usually has one junior member on it, very rarely, two. I’m currently serving my second year as the junior member on the Council on Education and I can say it has been a very rewarding experience where I have met many role models who definitely take an interest in what I have to say about the trainee opinion and who also think of me when opportunities arise that they think might be good for me. You can access both the instructions to apply (which includes a list of the committees/councils with junior member positions opening up in 2016) and the junior member application here – you will need a letter of recommendation from your program director and email in your app before the deadline of March 31^st. Good luck guys! If you have any questions, feel free to email me.

-Betty Chung, DO, MPH, MA is a third year resident physician at Rutgers – Robert Wood Johnson University Hospital in New Brunswick, NJ.

Microfluidics + Consumer Electronics = The Future of Point of Care Testing?

In a paper published yesterday in Science Translational Medicine, researchers tested a low-cost smartphone attachment (a “dongle”) that detects the presence of HIV and syphilis antibodies using ELIZA technology. While the research took place in Rwanda and highlights the usefulness of such technology in low-resource settings, the implications are potentially far-reaching in terms of point-of-care and direct-to-consumer testing.

What do you think? Do you think using smartphone attachments could replace full laboratories in the not-so-distant future?

–Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

Something for Nothing

I’m probably going to be a little bit on a soap box with this post, but this is something that is bothering me. It’s about the society we live in and how it’s becoming more and more of a “something for nothing” society. We expect to get things without having to pay for them. In fact we’re so used to it that we even get angry when someone asks for payment. Let me give you some examples:

How many times have you gone to Wikipedia to look for an answer to a question? Or any other site on the Internet for that matter? And how many times have you donated any funds at all to the upkeep and maintenance of that site? Guess what. It costs money to maintain a website.

How many times have you downloaded a song off the Internet without paying for it in any way? People spend money to record songs and money to make movies. Where does the money come from to allow them to continue doing those things if nobody pays for the ones already made?

The reason this is bothering me is in relation to our professional associations. Even here, people want to receive benefits without paying for a membership – something for nothing. Our professional associations are worth supporting. They offer us educational opportunities, networking opportunities and a host of other benefits. All of these things cost our associations money to produce and provide. And even big associations cannot afford to continue eating the costs without eventually being financially unable to continue. You might be surprised to know how much of any given board meeting for your association is spent discussing staying financially viable.

Nobody, including your professional associations, can stay in business if they cannot make enough of a profit margin to survive, basically if they give away too much for free. I think it’s time for us to stop expecting everything to be handed to us without needing to give anything in return. So go for it. Donate to Wikipedia, buy your CDs, blue-rays and downloads, and join your professional societies. You will not regret it.

-Patti Jones PhD, DABCC, FACB, is the Clinical Director of the Chemistry and Metabolic Disease Laboratories at Children’s Medical Center in Dallas, TX and a Professor of Pathology at University of Texas Southwestern Medical Center in Dallas.

CLSI Publishes New Guide for Laboratory-Developed Tests

From the press release:

“The Clinical and Laboratory Standards Institute (CLSI) has published Quality System Regulation for Laboratory-Developed Tests: A Practical Guide for the Laboratory.This guide converts the requirement complexities of US Food and Drug Administration (FDA) regulations into plain language, offering intuitive assistance on how to conform to the Quality System Regulation (QSReg), 21 CFR 820, when creating laboratory-developed tests (LDTs). This CLSI practical guide can help laboratorians learn how to address the new demands, beyond the Clinical Laboratory Improvement Amendments (CLIA) regulations, within their unique laboratory settings.

“LDTs are in vitro diagnostic devices that are intended for clinical use and are designed, manufactured, and used within a single laboratory. This practical guide is intended to clarify how to implement the QSReg that may be required for some classifications of LDTs. On October 3, 2014, the FDA issued draft guidance for regulating LDTs that includes notification or registration of LDTs with the FDA, reporting adverse events, and other requirements. This document only addresses the QSReg that is currently applicable to manufacturers and is expected to become applicable for some classifications of LDTs when the final guidance is published.”

To purchase this guide for your laboratory, visit the CLSI website.

How to Say “No”

Saying “no” to things is a learned skill that takes continuous practice, and a good amount of balance. The balance is because when you’re starting out in your career, I firmly believe that it’s important for you to agree to requests and to take on new tasks. It gets you out there, introduces you to new people and new skill sets, and teaches you so much you might not learn just performing your regular job. But then we get into a habit of saying ‘yes”, and we all know how hard habits are to break. We think things like, “if I don’t do it, no one will” or “if I do it, it will be done correctly.” Or more than just those things, we all like to please people, especially our friends and colleagues. So when a friend asks you to take on another research project or review a paper or look over some data or run a test or cover their call, we all readily agree to taking on just one more task.

As with every other aspect of life though, there is such a thing as too much of a good thing. Saying “no” occasionally is good for your overall health and sanity. It’s entirely possible to reach a stage where you’re so over-whelmed that you cannot do a good job at any of the tasks you have undertaken. Thus learning the art of saying “no” is also important, and is something I myself am just still struggling to learn.

Here are some points to remember that may help you when you need to say “no:”

Don’t give an immediate response, especially if you have any concerns about having time for this new task. Tell the person you will get back to them after some thought, and tell them when you will reply to them.
Give yourself time to consider whether the new task can be accommodated in your current workload, or whether you will have to short something else to accommodate it.
Be firm once you’ve decided. Don’t use phrases like “I don’t think I can.” Say “I cannot. ” And be persistent because you may have to turn down this opportunity more than once.
Always remember, you are turning down a request, not a person. It is especially hard when the request comes from a friend, but sometimes it is necessary.
Accepting a task that you don’t have time for is not doing any favors for yourself or the person asking. If the requestor has to then become a nagger to get you to complete their task, they will not thank you for it.

In conclusion, it’s important to maintain a balance at work without overloading yourself with too many tasks to allow you to accomplish any of them well. Learning to say no to requests is an important part of keeping that balance.

Clinical Laboratory Science Education

At a young age, children have an idea of what they want to be when they grow up. From lawyers, to doctors, to scientists, children believe they can do it all. However, clinical laboratory science is not for everyone. In fact, Courtney Lower, who graduated from the University of Illinois-Springfield in 2014 with a Bachelor of Science degree in CLS, would attest to that. She believes that for someone to succeed in this field, one “must have patience, a high level of problem solving skills, and a compassion for helping others.” Possessing all of those skills is necessary when providing laboratory information and services that are required for the diagnosis and treatment of disease.

A clinical laboratory scientist not only performs laboratory tests, but he or she must also be able to explain the significance of these tests to physicians and other health professionals. A CLS must also be able to evaluate new methods and determine the effectiveness of new laboratory tests. This intense problem solving, along with her love for science, was what attracted Lower to the degree in the first place – which has in turn opened up the door to several possibilities.

Receiving a CLS degree has the potential to set one up for a multitude of exciting careers. A graduate can work in laboratories in several different settings: hospital, clinic, reference, government, or commercial. Within those laboratories, one could work in areas such as microbiology, chemistry, blood bank, hematology, and virology. Opportunities also exist in stem cell laboratories and veterinary clinics. Graduates can also use the degree to propel themselves into graduate or medical school.

Typically, CLS students take several science courses—typically chemistry and biology—before starting their degree-specific coursework. Most students take a similar route of three years of undergraduate schooling followed by a year in a laboratory setting to finish out their degree. Students enjoy this short schooling because it means that they can get into laboratories sooner. In particular, Lower remarked that, “My favorite program was rotations. It prepared me for transitioning from the classroom to the laboratory and I was able to gain more hands-on knowledge.”

Receiving a clinical laboratory degree has never been better when it comes to the job search. Graduates are basically guaranteed a job, partly because the degree is so versatile and partly because of abundant vacancies in the field. Hopefully this will be a degree that inspires young students let their love for science grow and partake in this field, allowing them to truly be able to do it all. Children can grow up knowing that they can serve a wide variety of employment opportunities and that their dreams can grow right along with them.

-Shannon Little is from Stillwater, Minnesota and is currently a journalism student at the University of Missouri. She is the fundraising chairman for Autism Speaks U. and is active in her sorority. In her free time, she enjoys watching U of M football.

Test Turnover

What’s your lab’s procedure for getting rid of an obsolete test, or bringing in a new one? Any change to the test menu has some level of difficulty associated with it, however my opinion is that replacing a test with a new method that gives different results is the easiest to accomplish, followed by introducing a completely new test, and lastly removing an obsolete test. In that last case I’m specifically talking about removal of a test that is no longer the best way to diagnose a disease or monitor treatment.

In any of these cases, does your lab use the “rip the band aid off” method? For example, do you send a succinct notification that as of the first of the month this test will no longer be available in your lab, or this test will have results 33% higher than the doctors have been previously seeing? Or do you use a more gentle method, such as offering to run the old and new method together for 2-6 months to let the doctors get used to the new values? Or in the case of removing a test, do offer to try to find them an alternative lab which is still running the old test? Or do you simply leave the old test in place and hope it eventually dies a natural death from lack of use? Unfortunately, some tests never seem to die – like CKMB and bleeding time.

A lot of the difficulty, both in getting rid of old tests and in bringing in completely new ones, can probably be laid on the doorstep of human nature. Just like other humans, doctors like what they’re used to and don’t like changing their routine. Even when overwhelming evidence suggested that a new test is better (troponin), they want to use what they have always used to diagnose and treat their patients (CKMB). When the evidence for a test’s utility is not so clear cut, it’s even more difficult to introduce a new test. Examples of this include Cystatin C and fructosamine. Cystatin C is becoming more widely used and will no doubt survive as a test, but fructosamine? Part of the issue with fructosamine may have been the silly name they gave it. Fructosamine? Really? If they had called it glycated proteins/albumin it may have fared better. Fructosamine sounds too much like a fruit drink.

Maintaining a test menu that is appropriate for your population and that doesn’t include unnecessary or obsolete tests is an interesting balancing act. It definitely requires having a good rapport with your clinicians and getting their input along the way.

Season of Greetings

It’s amazing the year is nearly over, the halls are decked, candles lit, celebrations scheduled. Friends and families gather, eat too much, hug and kiss, pass around gifts and graciousness…and microbes.

Laboratory professionals know all too well that “Seasons Greetings” are just the thing for passing along your favorite virus or enteric pathogen. This year, we are especially conscious of the contagious nature in the world of unseen assailants. Global health has faced the disastrous affects of improper hand washing and challenging sanitation conditions; and not just with the Ebola crisis, but in refugee camps and among those facing the strife of war.

Laboratories don’t close for holiday celebrations…and laboratory professionals don’t always get the days and times off that would make them happy around the holidays. But this year I challenge us with two things:

Remember to offer “Seasons Greetings” with best practices and don’t take any of your laboratory favorites along to the parties and gatherings!
If you’re working that extra shift, or one that is encroaching on your family and personal time—remind yourself that there are so many in the world who would rejoice in the opportunity to be working, to be healthy enough to be working and free of disease, strife and conflict, and could watch their children and families smile, eat too much, hug and kiss and pass along “Seasons Greetings”.

My best to you for this holiday season, whatever ways you celebrate, and ‘tis the season to remember our colleagues globally and do something to make the world a little better place locally! Happy Holidays!

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

The Future Cost of Antimicrobial Resistance

Over on Superbug, Maryn McKenna (are you following her yet? No? If you’re into infectious disease, you should) discusses a recent report on the global ramifications of antimicrobial resistance. In it, the authors project by 2050, 10 million deaths a year will be attributed to infections caused by six resistant organisms. (Those are: Klebsiella pneumoniae, E. coli, MRSA; HIV, TB and malaria.) These deaths will cause an estimated loss of 100 trillion dollars of lost gross national product.

So what can laboratory professionals and pathologists do to help stop these predictions from coming true? For starters:

Advocate for and implement antibiotic stewardship programs.
Educate the public about proper antibiotic use.
Practice good laboratory safety practices.

What else can labs, microbiologists, and pathologists do to stem the tide of antibiotic resistance?

–Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.