Loading Viruses

Occasionally some of our terminology in healthcare has its own set of nuances. We combine words or word-parts to give them more precise and clear meaning, and often they create a unique definition. Take for example, words like symptomology; chemotherapy; biotechnology; or the now-ever-popular term genetic engineering. Then take for example some well-used medical terms that have become mainstream—like the term for a gazillion little strands of RNA, all of which we lump together and call “viral.” Viral loads in laboratory terms indicate diagnostic criteria for the remission or advancement of disease, such as the case in Hepatitis or HIV/AIDS. But it also now means a serious problem with your computer, or the latest cat-video gone rampant on the internet. In my case, it just recently indicated a personalized upper respiratory infection from Central Asia!

Travel has its ups and downs, and at the end of two weeks of wonderful training and interaction with our colleagues in Kyrgyzstan, I succumbed to a “load of virus”—and faced the drudgery of coping with it while cramped into the aisle seat of airplanes, passing time wandering during layovers in foreign terminals, hopping into passport lines and customs checks. With nearly 36 hours of travel ahead of me, I plowed through it all in the fog of decongestants and analgesics and tried desperately not to sneeze or cough—which only made it worse. I’m certainly not the first, nor the last person on the planet to catch a cold, but I was certainly among the most miserable!

Now that the worst is behind me and my diagnosis is just a “horse” and not a “zebra,” I’d be interested in your opinion…is catching a cold considered “a viral load” or just merely “loading a virus?” Just maybe we have a new and even more descriptive term for uploading seasonal cold and flu! Let me know what you think at bsumwalt@pacbell.net and who knows, maybe our new twisted term will actually “go viral.”

 

???????????????????????????????

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

Mobile Technology and Health Care

I just stumbled upon this BBC article about a TED talk from about a year ago that discusses an app called Ucheck that can be used to test urine samples for a variety of elements, including glucose, proteins and nitrites.  Instead of having to go to a lab to get these urine tests, an individual can use this app—the purchase of which includes the dipsticks and supplies needed to utilize the app—to run initial urinalysis screening tests.

I imagine the Ucheck folks have thought about and researched the pros and cons and possible issues with a system like this.  Process issues, user error, contamination (although supposedly one of the elements in the test helps to gauge contamination), among others come to my mind immediately. My biggest question, however, is what does the Ucheck app-user do next after they receive their results? How does the patient proceed if they do need additional medical attention?

The internet can make mini doctors of all of us—there is enough information to make many self-diagnoses, but not necessarily accurate ones.  My doctor recently told me they have stopped giving patients full reports from various tests because they found the patients would go home and Google everything on the report and come back to them scared and with inaccurate information.  She said this Google-ing gives everyone access to enough information to be dangerous.  Would this app give people just enough information to be dangerous?

The TED talk mentions that the app is being put to the test in a laboratory in India—if effective that certainly could be very useful in terms of providing mobile health care, particularly in remote regions of the world.  Use of the app in a controlled medical setting where there are trained laboratory and medical personnel available to interpret results is a different story than an individual using it at home.

The TED talk and related articles I found were from 2013 so I did some sleuthing to see if I could find more recent information.  I found an article noting that the FDA sent the Ucheck developers a note that the app needs to meet FDA guidelines in order to be in use.  I didn’t find follow-up information on what happened after the FDA note, but I haven’t been able to find the app through my iPhone’s app store. Perhaps it’s been put on hold?

Regardless of whether this particular app moves forward, however, medical advances using mobile technology such as these are certainly on the horizon.  Which makes for an interesting conversation.  Mobile technology could be revolutionary in some parts of the developing world where access to medical resources is scarce.  But do they provide what is needed?  Are they being used in a setting where if a diagnosis is made there are resources to treat that diagnosis?

What do you think?  Are these positive developments?  Could they be helpful and harmful?  How will regulation work?

Levy

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

Live from Kyrgyzstan

Greetings from Bishkek, Kyrgyzstan! And Happy St. Patrick’s Day to those of you with Irish heritage and those who just think they’re a bit’o’Irish on this day! I have been in Bishkek, Kyrgyzstan the past week, joining colleagues to work with the Kyrgyzstan laboratories on preanalytical processes and phlebotomy techniques that are so important in patient safety and specimen integrity. Over the two weeks we are here, we are working with more than sixty people and have a very full agenda. I’m scrambling to refresh my Russian/Kyrgyz greetings and phrases, but oddly enough it’s coming back. I doubt I’ll ever master the Cyrillic alphabet, but the accents are growing more familiar.

We began last week with full-on challenges: agenda changes, delayed supplies and the ‘usual’ need to be flexible and unflappable. Our shipped supplies and materials were delayed in customs for two days, so we were “working without a net.” Our team works well together and we have been well received by our Kyrgyz colleagues so that diminishes difficulties. They are a lively and vocal group, giving us lots of opportunity for dialogue which is always a pleasure. We are finding that their knowledge is strong but their experience and skills with the standard equipment used to collect blood is lacking. Some of them have never seen or used devices we take for granted—evacuated disposable tubes and safe, sterile needles are often not available in rural parts of the country—and some of the statistics shared with us by their national infection control director are staggering. Some of the examples shared: uncapped, reused glass tubes for transport of serum to reference lab testing sites; rubber-stoppered pipettes reused after rinsing in water or alcohol; requisitions rolled up and used as “tube stuffers” that served as caps to specimen bottles; confusion on the difference between serum and plasma; single digit numbers written in wax pencil as the second (an in some cases, first) patient identifier. All are challenges they are facing in rural collection sites for lack of resources and training. Fortunately the groups we are working with are in position to change that, and it is energizing to see how much they really want safety and progress for their healthcare workers and patients. As always, I learn much more than I teach…and this week has been no exception. In between training weeks, we spent Saturday with a high level group facilitating and mentoring a country-wide process improvement project, and helping to identify and outline next steps. Working side by side with our CDC partners was an opportunity to learn and hopefully to contribute to the discussions and strategies ahead. This is where change will happen, and it’s exciting to see it up close and personal.

Next time I hope to share some customer service experiences with you, as we gather stories and experiences from our Kyrgyzstani colleagues about how they address and resolve issues at the point of service to patients. If you’d like me to ask our colleagues any questions while I’m here, email me at bsumwalt@pacbell.net . It’s a different world, but in so many ways it’s the same issues we face in our laboratories back home.

 

???????????????????????????????

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

Service Snippets

I’ve gotten some great responses regarding my recent blogs on Customer Service, and want to share some of these with you. Good ideas always generate more good ideas, and I think you will find these fun ideas very interesting. As we know, patients can usually only judge our quality and testing performance by what they see and what they experience at the drawing station…so, with permission to share, here are two excellent ones:

Children are often the most difficult to draw, and take more time and technique than adults. One laboratory draw station, part of a large metropolitan children’s hospital, has a system that works to help keep children occupied and parent’s angst levels lower during the busiest times. When patients show up for a phlebotomy and the wait is greater than 15 minutes, they are given a “restaurant beeper” and a coupon for the coffee/juice cart outside on the patio, and then are paged when the phlebotomist is ready for them.

A 25 bed rural hospital in West Virginia surprises a lot of people when they go out to the parking lot, and do a “vehicle draw” for patients that have difficulty making it into the hospital, for older patients who struggle with wheelchairs etc., or if someone is just too ill to come into the building. The staff is truly committed to serving their patients and proud that something so small can make such a difference. 

Perhaps these two fine examples (as well as the one from our colleagues in Africa) will generate some ideas about how your operations might make little changes that accommodate patients, and provide the best service you can offer—which we know directly translates to showing patients the quality we are proud of as laboratory professionals. Explore it with your teams, get some ideas going, and make it work for you.

I will be leaving soon for another global experience with colleagues from another part of our world and we will be working on the pre-analytical processes (including the importance of customer service) for our external AND internal customers. I’ll be writing my next blog “live from Kyrgyzstan!”

In the meantime, I’d be interested to know what you’d like me to ask our colleagues while I’m there. You can email me at bsumwalt@pacbell.net  and perhaps we’ll get a little international dialogue on the topic…and as always, I look forward to hearing your comments and ideas for building better laboratories and processes around the world, and at home in our own communities!

???????????????????????????????

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

Customer Service—A Global Perspective

Last time we talked about how customer service changes the perspective of our patients/customers, and how they judge the quality of our laboratories by their snapshot visit to the drawing station. Over the years, I’ve seen some good, some bad, and some very ugly customer service practices…one I discovered even in my own laboratory one day, just by having my blood drawn in the outpatient phlebotomy draw station!

There are lots of “best practices” around the world, and it is interesting for me to hear from colleagues or observe practices that I think are worth knowing, and worth sharing. One comes to mind in a favorite place in Africa. The rural clinic was always very busy, people everywhere lined up on benches waiting to be seen or for pharmacy or for a lab/radiology procedure. It looked like every busy primary clinic everywhere, except for the lovely colorful headdresses on the women and the different kinds of “baby carriers.” When you looked closely, many people did not have shoes, and also had their lunch nearby in a tin carrier because they were prepared to spend the day. When you looked even more closely, sometimes you see smiles and congenial conversation…but more often you can see eyes showing pain or illness, tears, fear, compassion and concern on the faces of those there to receive care, and those there for support.

In this particular busy clinic, the laboratory drawing room was down a narrow hall off to one side, and had steel bars on the door with a buzzer for entry. A necessity, but not very inviting. My African colleagues were concerned that patients would be intimidated by the negative appearance, as many of them travelled miles to get there with children or family and often didn’t even speak the dialect of the district. So they decided to do what they called “walk around draws.” Two phlebotomists took turns, one in the “caged drawing room” and one with a lab tray “roaming the waiting room.” The “roamer” would ask if the patient wished to have their blood drawn in the room down the hall, or if they would prefer a “bed side draw” right there where they were waiting. It provided opportunity to smile at the children, reassure a grandmother, speak to a caregiver if the patient was very ill, and greet people around the patient while also (bonus!) talking out loud about lab procedures—VERY important in that culture. The patient felt surrounded by the clinic community, which was parallel to being in the healer’s hut in their village while everyone gathered around to hear and see the care being given. It worked for them, and even improved their drawing room wait times.

As we explore how we can make patients more at ease, more knowledgeable, and provide improved access to our lab services, we tend to think in terms of how it will improve the lab processes. I learned a valuable lesson from my Africa colleagues: we should also think of how to improve the “patient experience” in safe and culturally appropriate ways. There are many stories and observations on how we do things wrong, but this is an enlightened one about how our global colleagues are doing it right!

As I mentioned in my last blog, the next time YOU have to have your blood drawn, take a close look around and notice what your patients and customers see. I guarantee you will always be surprised by something, and will leave the drawing room with at least one idea of how your lab can do it better.   And, if you have a great example of improving the patient experience in the laboratory, let me know at bsumwalt@pacbell.net I’m always in the market for new ideas to share.

 

???????????????????????????????

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

Thinking Outside (or Rather, Inside) the Box

“The weather outside is frightful…” The west is facing unprecedented drought, the east is having debilitating storms, and the Midwest a “polar challenge” that keeps everyone on frost-bite watch. In times like these when we can’t reconcile with Mother Nature, I tend to reflect on the challenges of specimen and supply chain transport. Consider the challenges that we face with those issues when weather isn’t cooperative? Plane flights cancelled = delayed specimens to referral labs = delayed results and diagnoses. Interstate shut-downs = trucks sitting still = reagents too hot or too cold for too long. Blizzard or sand-storm conditions = couriers unable to travel = delayed pick-up/delivery = compromised specimen integrity.

Now translate that to our international colleagues, and you can see the difficulties they face on a daily basis. Long distances in the heat of the deserts, or snows of the tundras. Difficulties with transport, with trucks breaking down or planes unable to fly. Concerns with reliable transport via public buses, taxis, independent drivers/pilots who are not specifically trained in laboratory supply and specimen transport. The quality of the reagent and the integrity of the specimen = the precision of the result. It’s that simple…but it isn’t simple at all, is it?

So while we are dealing with the present weather conditions and issues, be reminded that our global laboratory colleagues deal with these issues in all kinds of weather and climate challenges every day, and have the same concerns. It’s a challenge Mother Nature provides for us, and one we must have contingency plans for in order to provide the best service to our patients.

If you are having weather challenges at the moment, I will hold good thoughts. Stay warm, or hydrated, or whatever the conditions require—and when our weather has passed, try to hold good thoughts for your colleagues around the globe who face it year around! If you want to know how they cope, let me know at bsumwalt@pacbell.net and I’ll share some recommendations I have learned from many of them over the past few years!

???????????????????????????????

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

US Global AIDS Coordinator and the Laboratory

In early November, Eric Goosby, the U.S. Global AIDS Coordinator charged with leading the implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR) announced that he is stepping down from his position  to take a professorship at the University of California, San Francisco, where he will focus on the implementation of health programs in developing countries.

The Global AIDS Coordinator is appointed by the President and confirmed by the Senate and reports directly to the Secretary of State. According to PEPFAR website, the Coordinator:

  • Leads the U.S. Government’s international HIV/AIDS efforts;
  • Ensures program and policy coordination among the relevant USG agencies and departments and nongovernmental organizations, avoiding duplication of effort;
  • Pursues coordination with other countries and international organizations;
  • Resolves policy, program, and funding disputes among the relevant USG agencies and departments;
  • Directly approves all activities of the United States relating to combating HIV/AIDS in 15 focus countries; and
  • Promotes program accountability and monitor progress toward meeting the Emergency Plan’s goals.

Given the influence this position has in the implementation of USG international HIV/AIDS efforts, the search to replace Dr. Goosby is of great importance. This person is in the position to guide the direction of PEPFAR implementation and thus may place emphasis on particular initiatives and programs. This Wall Street Journal article mentions four names that are on the short list for Dr. Goosby’s successor.

Certainly there are many important qualifications and characteristics that are needed to be effective in this position. However, as part of the laboratory community, it is my hope that one of those qualifications will be a high level understanding and knowledge of the lab.  With an understanding of the importance of the lab in terms of diagnostics and care and treatment I hope that this person will then guide the implementation of crucial laboratory strengthening programs. From the creation of region specific reference ranges, to better regulated supply chain management, to streamlined equipment and reagent procurement, to the training of personnel, there is much that can be improved in labs at the forefront of the fight against HIV/AIDS. With improved diagnostics, particularly at point of care sites, the care and treatment of HIV/AIDS can be improved, which will not only save and improve lives but will also save money and resources.

Thus, my plea to whomever is appointed, know the lab (or surround yourself with those who do) and make laboratory improvements a cornerstone to the continued work of PEPFAR and USG HIV/AIDS efforts.

 

Levy

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