The Importance of Manual Urine Microscopy

Research presented today at the National Kidney Foundation spring clinical meeting indicates that manual microscopy surpasses automated analyzers when assessing kidney injury. The abstract is titled “Manual Microscopy: Not a Lost Art” and says, in part: “In this study, we examined if a significant difference exists between the reported ranges of granular and muddy brown casts using manual microscopy as compared to an automated urine analyzer in an acute kidney injury cohort.”

According to one of the abstract’s authors, Dr. Sharda, “What our research has been able to show so far is that the automated system under reported the value of granular casts in our patient cohort of acute kidney injury. The automated system still has utility as a screening test, but manual microscopy should be done in all cases of abnormal kidney function, as accurate quantification of casts could have some prognostic benefit to patients.”

The poster is available online. The authors are currently writing a paper on their research; their contact information is here.

Laboratory Professionals Week Celebrations Around the World

Happy Laboratory Professionals Week! Lab week is celebrated not only in the United States but around the world as well. As in the United States, labs get in on the fun on an individual level as they recognize their employees and the importance of the lab, and larger organizations organize celebrations and community outreach events.

In Cote d’Ivoire, located in West Africa, there is a week’s worth of activities and celebrations planned. The activities include ceremonies recognizing laboratory professionals throughout the country, demonstration sessions, and community outreach to the general public via radio broadcasts, information pamphlets, and text messages, among other activities. The official lab week ceremony will take place on April 22nd in the largest city of Cote d’Ivoire, Abidjan, at INFAS (the Institut National de Formation des Agents de Sante or the National Institute for Training of Health Workers). Speeches will be given by high ranking government officials, including the Minister of Health, as well as representatives of CDC-PEPFAR, and the Association Ivoirienne de Biologie Technique (l’AIBT), the national lab association.

In Tanzania, located in East Africa, the Tanzanian laboratory professionals association, Medical Laboratory Scientists Association of Tanzania (MeLSAT) has organized awareness raising activities and celebrations as well. Throughout the week they will provide community outreach by offering testing and educational information on HIV, diabetes, and high blood pressure. They will also be collecting blood donations for the national blood bank. The lab week closing celebration will be a parade in the town of Sumbawanga to celebrate laboratory professionals and their achievements and to raise awareness among the community.

What are you doing to celebrate in your neck of the woods?

 

Levy

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

Shout it from the Mountaintop

Even after working in the laboratory field for twenty years, I’ve always thought that one of the more interesting things I come across is how few people really know what we are and what we do. Laboratory Professionals Week is not only a chance for us to celebrate ourselves and the outstanding job we do every day, it can also be a prime opportunity to begin changing that worldly lack of knowledge about us. It’s a chance to Get the Word Out!

Here in Dallas we get creative every year for Lab Week. Each section of the Lab creates a poster board depicting what they do in their section. Usually we try to include both the usual, common things, as well as the things that non-laboratorians might not be aware of. Each part of the lab/pathology creates one. So we have not just Chemistry, Hematology, Microbiology/Virology and Blood Bank. We also have poster creations from our Metabolics Lab (inborn errors of metabolism testing), Client Services/Accessioning, Sendouts, Phlebotomy, Histology, Electron Microscopy and Advanced Diagnostics, our molecular diagnostic lab.

As those of us in the laboratory field know, laboratory professionals are really creative. We always end up with at least ten colorful and eye-catching posters depicting the whole range of services provided by the Laboratory/Pathology departments. During Lab Week, those posters are hung in the hallway coming into the Hospital. They are viewed daily for that week by hospital personnel and the public alike. It never ceases to amaze me when I walk past them, how many versions of “I had no idea they did that!” I hear, and how many times I hear it.

In our current healthcare climate, the Laboratory can no longer afford to be a hidden profession. With healthcare dollars becoming increasingly dear, we must make our worth known to other healthcare professionals and to the public. We need to keep ourselves situated as prominent and important players on the healthcare team. Laboratory Professionals Week can provide a wonderful time and place to begin working on those goals.

 

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-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.

Think Globally, Act Locally

National Laboratory Professionals Week is April 20-25, 2014—and this year during the same week is Earth Day, on April 22, 2014. That is an interesting combination of things we should take time to contemplate—what does Earth Day have to do with laboratory medicine? Or vice versa?

Well, a number of things come to mind:

  • As laboratory professionals, we are committed and dedicated to being part of the healthcare team that discovers and cures peoples’ health and promotes well-being.
  • Laboratory professionals are also committed to using supplies efficiently and effectively, saving costs, and using/disposing of hazardous materials safely which parallels a strong commitment to our environment.
  • The health and well-being of the planet is directly proportional to the health and well-being of the inhabitants of the planet.

It seems to me there is a directly proportional relationship here; and a link to our present and future state, as we pursue health for both the people of the world and the planet we all occupy.

Laboratory professionals the world over act locally to take care of the patients who are our neighbors and friends and family in our communities…and we think globally to support the needs and resources and collegial relationships that take care of the patients and neighbors and friends on our planet. What better combination to celebrate, support and call world-wide attention to than National Laboratory Professionals Week and Earth Day? If your laboratory is doing something special that illustrates “thinking globally, acting locally,” please send me a note about your Lab Week Celebration Activities at bsumwalt@pacbell.net . I would love to consolidate and share those ideas!

Wishing everyone in the field and industry of Laboratory Medicine a great Lab Week—both locally, and globally!

 

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

Critical Results: Use Them Wisely

All laboratory professionals know what a critical value is. The original definition was coined by Lundberg in MLO in 1972 as: “A laboratory test result that represents a pathophysiologic state at such variance with normal as to be life-threatening unless something is done promptly and for which some corrective action could be taken”. There are two pieces to this. First of all, it’s a life-threatening value. Secondly, it’s a value that needs to be acted upon immediately and for which some action can be taken.

All laboratories and healthcare systems define their own tests that have critical values, what those critical values are and which tests that are themselves “critical.” A “critical test” must have the results reported every time, no matter the result. “Critical values” are life-threatening values on tests that are routinely not life-threatening. When creating and defining this list, the people involved should keep the definition of a critical value firmly in mind and make an effort not to include analyte concentrations which are not life-threatening. Most hospital lists include sodium, potassium and glucose as a minimum on their list of tests with critical values; many hospitals contain a large number of other tests. For example, creatinine is a test that is oftenoften included, and yet, at what level of creatinine is the patient’s life emergently threatened? It’s sometimes difficult to please all your medical staff with which values should be considered critical and which should not, and  which tests will need to be called back to a care-giver immediately.

One solution has been to create carve-outs – areas of the hospital that don’t require notification about certain “critical” results. For example, dialysis may not need notification every time one of their patients has a “critical” creatinine. Or the ICU may not need to be notified for each separate critical potassium on a patient they are following closely and monitoring often during a single shift. The problem with “carve-outs” is that if you have many of them, you’re setting the technologist up to fail. How can they keep track of what needs to be called and what doesn’t?

It’s important that laboratory professionals define their list of critical values to make this system as streamlined as possible. If your institution has defined too many “critical values,” it may be taking too much time out ofthe laboratory professional’s and the caregiver’s day for making and /or receiving too many unnecessary calls with values.  You may wish to look at that definition again and see if all the tests on your critical list truly meet the definition of “critical.”

 

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-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.

 

Failure is Always an Option

I had some fun this April Fool’s Day and sent some emails out that stated we failed some CAP surveys. I know I’m evil but you have to have some fun sometimes! The reactions were interesting in that everyone deals with failure differently. Show me someone who has never failed and I’ll show you someone who won’t know how to react once they do. It is inevitable. We try to never experience it but we will and it is how you react that sets people apart.

I am proud and speak of my failures regularly because it gives people strength knowing that they are not alone. In my career I have been involved in a total hospital failure and had to work my way back up the ladder. It is through these failures that we learn the most about ourselves and about situations. When I was just out of school I used to think that experience wasn’t that important. I thought, “I’ve learned what I need to know in school, I should be a supervisor NOW!” I am in the second half of the first 10 years of my career and have learned that every situation brings with it experience that becomes knowledge. That knowledge will carry me into the second and third decades of my career. Both the successes and failures will help me as I move forward.

Experience is gained through those situations and it is up to the people involved to either take it with them or forget about it and be vulnerable to repeat them. As leaders we are sometimes under pressure to work or move forward with options that may not be our choices, but we must get our staff to buy in and perform. These directives usually given from a few pay grades above should be followed so that if you do fail you can show that you followed their directives. You do not want to be seen as someone who is resistant to change or someone who will be an obstacle. This will just get you more headaches and possibly affect your advancement in the future. Having said that always state your concerns as well as present ideas that may be a better option. You do not want to be silent when it matters most.

I have always learned more from my failures than I have from my successes. During an interview a CEO once told me, “You want to make your big mistakes early in your career because the higher you get the less forgiving people are of the big ones.” We make our mistakes during a constant search to be the so-called “polished professional.” When we get to the higher pay grades we should be able to see a failure coming a mile away and be able to safely get out of the way. Successes come with great planning and a dump truck full of experiences. Remember, failure is always an option.

 

Herasuta

Matthew Herasuta, MBA, MLS(ASCP)CM is a medical laboratory scientist who works as a generalist and serves as the Blood Bank and General Supervisor for the regional Euclid Hospital in Cleveland, OH.