The posters below were presented at LABCON2019.
Wine coloured samples? Development of laboratory guidelines for hydroxocobalamin interference in patients pulled from housefires.
Determining the precarious employment status of medical laboratory assistants in Canada
Exploring the impact of cannabis legalization on Canadian laboratories
Internationally educated medical laboratory technologists (IEMLTS): An exploration of methods for bridging gaps for employment to meet MLT shortages in Saskatchewan
Inductively coupled plasma mass spectrometry (ICP-MS) methods portability assessment across instrument platforms
Patient centric approach for run acceptance criteria in large targeted metabolomics panels
Creation of Choosing Wisely recommendations for medical laboratory professionals
An application of The Knowles’ Adult Learning Theory to develop an advanced practice course for cytotechnologists
Is there an SOP for this? Using simulation to assess the implementation of a laboratory information system in medical laboratory science education
Wine colored samples? Development of laboratory reporting guidelines for hydroxocobalamin (OHCob) interference in patients pulled from house fires
OHCob is used for the treatment of cyanide poisoning secondary to smoke inhalation from house fires. OHCob discolors bodily fluids red, potentially interfering with measurements on spectrophotometric-based assays. The objective was to investigate the impact of OHCob interference on chemistry, coagulation, and urinalysis analytes.
Normal and abnormal discard plasma/urine samples were spiked with a high dose (1.5 mg/mL) of OHCob or equivalent diluent volume (control). Samples (n = 5) were run on >40 assays using Beckman Coulter DxC600/Access2/DxH800, STA-Compact STAGO and Siemens Clinitek Atlas analyzers. Dose-response treatments were performed on a subset of assays if interference was >10%. Daily samples obtained from a patient administered OHCob in the emergency department (ED) were analyzed for changes to color and chemistry measurements.
Spiking studies revealed positive bias (range 26-1298%) to total bilirubin, lactate, magnesium, uric acid, creatinine-enzymatic, prothrombin time, partial prothrombin time, d-dimer and hemoglobin. There was negative interference (range 12-63%) to alanine aminotransferase, aspartate aminotransferase, creatinine-Jaffe and creatine kinase. Urinalysis dipsticks were falsely increased (grades up to 3+) on glucose, ketones, blood, nitrates and leukocytes. Subsequent dose-response treatments showed statistically significant (p<0.05) increase/decrease in values. Interference in samples from a patient administered a single dose of OHCob was not detected by hemolysis index (HI), but showed gradual recovery on select chemistry analytes as OHCob was cleared from the body and red colouration faded over time.
Among the assays tested, 16 analytes had varying degrees of interference. These findings will aid in developing reporting procedure to prevent unreliable results from being misinterpreted in the ED. The lack of HI flagging further underscores importance of communication with ED to identify these samples.
Exploring Precarious Careers for Medical Laboratory Assistants in Canada
The purpose of this study is to better understand the current career environment regarding precarious positions as well as any emotional or health-related impacts on overall employee well-being for Medical Laboratory Assistants (MLAs) working in laboratories across Canada.
A review of current available literature showed that there is no current peer-reviewed data regarding the unstable or insecure career status of MLAs in Canada. In reviewing other health care professions, recent limited studies have shown an increased tendency for temporary or casual hiring practices with potential corresponding negative effects on health and workplace safety. This study will use a mixed-method design as follows:
Online National Survey - To represent the approximate 1811 currently active CSMLS MLA members, using a 95% confidence interval and 5% margin of error, the study will aim to recruit 318 MLA participants (survey). Additional non-CSMLS MLAs will also be recruited (N value cannot be determined for this population). The survey recruitment is in progress and will recruit as many MLAs as possible.
Focus Groups The focus groups will target CSMLS MLA members (only) to obtain a descriptive understanding of the membership’s perspective. The focus groups will recruit up to 24 participants (up to 8 per focus group).
As the study is currently underway, the most current information garnered from the study will be presented at the time of poster presentation.
Conclusions will be provided once data is analyzed from the project which is currently in progress.
Exploring the Impact of Cannabis Legalization on the Canadian Laboratory
The legalization of recreational cannabis has the potential to greatly impact work conducted within Canadian laboratories. Whether it be elevated test volume due to an increase in drug tests, updating policies regarding substance use at work, or learning the new procedures for handling specimens involved in drug testing, cannabis legalization has the potential to cause great change. By investigating the first hand experiences of those working in the laboratory since cannabis was legalized on October 17, 2018, we can gain a better understanding of the specific impact of cannabis legalization on the Canadian laboratory.
Focus groups featuring those CSMLS members currently working in a MLA or MLT position will be conducted; as well as interviews featuring those CSMLS members in an MLA or MLT managerial position. The sessions will consist of guiding questions to provoke conversation among participants regarding first-hand experiences; qualitative data will be collected and later analyzed for trends.
The focus groups and interviews have not yet been conducted, however we do anticipate conducting them in the next few weeks.
Exploring the impact of cannabis legalization on the Canadian laboratory will examine the changes experienced by MLP’s working in the laboratory since cannabis became legal. The objective is to create a better understanding of the short term changes in order to better prepare for the long term changes.
Internationally Educated Medical Laboratory Technologists (IEMLTS): An exploration of methods for bridging gaps for employment to meet MLT shortages in Saskatchewan.
To understand IEMLTs’ and employers’ experiences, educational and service gaps to determine additional programs or supports required for IEMLTs to obtain employment in Saskatchewan.
Research was approved by the Saskatchewan Polytechnic Research Ethics Board. Data were collected from May through July, 2018. Interviews were conducted with CSMLS and SSMLT representatives to identify the number of IEMLTs at various stages of licensing. Online questionnaires were administered to IEMLTS and employers and/or supervisors of IEMLTs to collect data about the knowledge gaps and experiences of IEMLTs adapting to professional life in Canada.
IEMLTs have varied professional and educational experiences which may add value for Canadian employers willing to hire IEMLTs. However, IEMLTS face barriers including lengthy certification processes, cultural differences, poor English-language proficiency, plus challenges understanding and integrating into the Canadian healthcare system.
Participants most commonly reported workplace practicum, Canadian culture and Canadian healthcare system education, CSMLS certification information, communication skills, job search, resume writing, plus interview skills would be beneficial to secure Canadian MLT employment.
Building infrastructure that supports IEMLTs in successfully integrating into medical laboratory services is imperative to the meaningful involvement of these skilled immigrants. Saskatchewan Polytechnic has the potential to resolve identified challenges through a bridging program which would contribute to IEMLTs’ efficient integration into the Canadian workforce.
Inductively Coupled Plasma Mass Spectrometry (ICP-MS) Method Portability Assessment Across Instrument Platforms
Our objective was to determine the portability of our hair element method from a Perkin Elmer ELAN DRC II ICP-MS (ELAN) to an Agilent 8900 Triple Quadrupole ICP-MS (Agilent) in order to reduce the amount of interferences seen in elemental analysis results from the ELAN, while also improving the accuracy of the method.
Portability of the method across the two instrument platforms was assessed by determining linearity, stability, precision, accuracy, limit of detection (LOD), limit of quantitation (LOQ) and optimal gas modes on the Agilent 8900. These results were then compared to the values obtained by the PerkinElmer ELAN. 249 split patient hair samples and 4 different controls were also run between both instruments and these values were assessed for precision and accuracy.
The precision and accuracy results of the split patient samples were used to determine the optimal gas mode and mass shift for each of the elements analyzed. The assessment of precision and accuracy of the split patient samples also determined that some elements were not statistically comparable between the two ICP-MS analyzers. This method portability study was comparing a single quadrupole analyzer to a superior triple quadrupole analyzer which removes many more interferences – so many of the result values from the Agilent ICP-MS were lower than those produced by the ELAN. In addition, when analyzing LOD and LOQ results were lower when analyzed on the Agilent due to differences between a triple quadrupole found on the Agilent and the DRC found on the ELAN.
In conclusion, the method was found to be portable between the two instrument platforms. Interferences seen in results produced using the Perkin Elmer ELAN DRC II ICP-MS for hair elemental analysis were significantly reduced when moved to a triple quadrupole analyzer such as the Agilent 8900 Triple Quadrupole ICP-MS.
Patient Centric Approach for Run Acceptance Criteria in Large Metabolomics Panels for LC-MS/MS and GC-MS/MS
Using multivariate statistics as a quick decision tool to determine batch intra- and inter-day performance.
The proposed method is inspired from the untargeted metabolomics approach and applied for a quantitative targeted metabolomics panel of 40+ steroids in urine. The method consists of preparing a pooled sample of all the patients destined to be analyzed. This pool is run throughout the batch in between every 10 patients.
Principal component analysis, as well as a measure of statistical dispersion of the pooled sample in relation to the test patients (D-ratio) is used for analytics.
Using principal component analysis for the above samples as well as other QC samples we were able to establish a quick and accurate way to review large analyte panels for run acceptance.
This graphical approach allows for a quick assessment of the method reproducibility, instrument reproducibility and variance of patient results. From this data we can derive a D-ratio (variance of QC relative to the variance of the samples). As established in previously published work a D-ratio below 5% deems our results acceptable. Compounds that don’t meet this specification are reviewed in more detail and appear to be at the limit of quantitation of our method.
This approach provides a quick and useful tool for determining run acceptance in Large Metabolomics Panels for LC-MS/MS and GC-MS/MS.
Is there an SOP for this? Using simulation to assess the implementation of a laboratory information system in medical laboratory science education.
We created and implemented several simulation scenarios incorporating various functions of a Laboratory Information System (LIS) at the University of Alberta Medical Laboratory Science (MLS) program. First-year student performance was evaluated to understand effectiveness and limitations of the use of simulation to practice and apply LIS and other transferable skills.
The MLS-LIS Simulation Rubric, based on LIS standard operating procedures (SOPs) and general CSMLS competencies, was used to record specific skills, behaviours, and overall simulation performance. LIS-specific tasks involved data entry, manual results entry, test cancelling and inquiry functions. Behaviours evaluated were general SOP use, communication, safety, professionalism and critical-thinking. The Simulation Thinking Category (STC) rubric was used to categorize students’ cognitive approach to the scenario. Student perspectives on process and effectiveness were gathered using a post-simulation survey.
25 students participated. The majority of students were categorized in preoperational thinking category on the STC rubric (60%). They relied heavily on SOPs, may have missed important steps, and required a long period of time to complete tasks. In the survey, 96% of the students felt that they practised technical skills relevant to the clinical setting; 72% were able to use appropriate SOPs; and 84% demonstrated effective communication skills.
Using simulation early in an MLS program is an effective way for students to practise LIS and transferable skills prior to completing clinical rotations.
An Application of The Knowles’ Adult learning Theory to Develop an Advanced Practice Course for Cytotechnologists
In order to meet the rapidly changing professional demands in the field of Diagnostic Cytology, and with the revision of the CSMLS Competency Profile, there is a need to develop an advanced practice course to support an expanded role of cytotechnologists with additional competencies to complement their knowledge and skills, and fill curriculum gaps.
The advanced practice cytology course with an andragogical approach is premised on the six assumptions of Malcolm Knowles’ for adult learners. The methods and resources utilized in the making of this course have utilized a learner-centered approach that is, facilitating the adult learners to develop new set of knowledge and skills.
Upon doing a learner analysis of cytotechnologists, The Adult Learning Theory seems to be a good fit for the advanced practice cytology course design.
With a multi-faceted approach, the implications of this course on adult learners, process, context and facilitators were viewed. It was found to have a consistent and collaborative approach for the learners to have highly successful experiences as they pursue and complete the course. Their motivation, engagement and guided self-direction would further enable them to integrate different dimensions of learning in their professional lives and careers.
In alignment with the revision of the Diagnostic Cytology Competency Profile by the CSMLS, major program redesign at The Michener Institute, and the inclusion of the new competencies in the curriculum by the CMLTO, there is a need to bring the existing cytotechnologists up to speed and support them to expand their knowledge, skills and experiences.
The course is also aimed to support internationally trained technologists and some of the fresh graduates who are interested to specialize in a certain area of the medical laboratory science.
Indigenous Land Acknowledgement : We respectfully acknowledge the CSMLS office, located in Hamilton, Ontario, is situated upon the traditional territories of the Haudenosaunee Confederacy, the Mississauga Nation, Anishinaabe Peoples, and the Neutral Peoples. This land is covered by the Dish With One Spoon wampum, which is a treaty between the Haudenosaunee and Anishinaabe to share and care for the resources around the Great Lakes. We further acknowledge that this land is covered by the Between the Lakes Treaty No. 3, 1792, between the Crown and the Mississaugas of the Credit First Nation.
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