THE MICROSCOOP SPRING-SUMMER EDITION 2017 VOLUME 34 NO. 1 OREGON STATE SOCIETY OF AMERICAN MEDICAL TECHNOLOGISTS

Transcription

1 THE MICROSCOOP SPRING-SUMMER EDITION 2017 VOLUME 34 NO. 1 OREGON STATE SOCIETY OF AMERICAN MEDICAL TECHNOLOGISTS

2 Oregon State Society of American Medical Technologists Officers 2017 Marilyn Albertsen PRESIDENT Hwy 202 Astoria, Oregon Audriene Whitley SECRETARY Salt Lake Creek Rd Dallas, Oregon Edna Anderson TREASURER 1397 Redwood St NW Salem, Oregon Susan M Beard EDITOR 6593 Noel Lane NE Albany, Oregon William Dettwyler LEGISLATIVE CHAIR 5555 Sunnyview Rd NE Salem, Oregon Louise Isbell BOARD MEMBER 198A W Woodside St Grant Pass, Oregon Susan Potter BOARD MEMBER 845 NW Merrie Dr Corvallis, Oregon Sheryl Rounsivill WESTERN DISTRICT COUNCILLOR 2078 S Hayston Fresno, California Kimberly Cheuvront PhD AMT JUDICIARY COUNCILLOR 100 Fair Oaks Dr Affirming, West Virginia PAGE 2

3 PRESIDENT'S MESSAGE The rainy days finally ended. I wondered if the sun will ever be out. We went through almost all our wood for next year. It has been so damp and have the moles been active. It has been an interesting time of the year. TABLE OF CONTENTS ORSSAMT Officers President's message District Councillor's message 4 Legislative Report Editor's message Articles Point of Care Body Language Calendar of Events Be sure to come to the Oregon Spring Seminar. It is only a day and a half. It is held at the Hallmark Inn in Newport, Oregon. Check out our website for more information. Remember if you don't come, we will not know who you are. We need your feedback on topics you wanted to hear. If you know of any speakers you would like to hear let us know. There is no business meeting but we will be having a board meeting. Please me any of your concerns. I would love to help you with that. The NWMLS will be in Lynnwood, Washington in October. There are many national and state awards that you can earn only if you get involved. If you start to attend our meetings and state activities you will earn these awards. So do come and let's us see you there. You could be the next award winner! Marilyn Albertsen - PRESIDENT PAGE 3

4 WESTERN DISTRICT COUNCILLOR MESSAGE Hello Western District state societies. Hope everyone is doing great and staying dry. California has had its share of rain and snow this winter. I do believe we are finally out of the drought. The National BOD and Councillor meeting was held on February in Tucson, Arizona. These meetings are always filled with information. This year the National Meeting will be in Kansas City, Missouri, July 9-13, The format of the program will be the same as last year. All educational programs are at the beginning of the week, leadership on Wednesday and the AMT business meeting at the end of the week. The convention will start on Sunday and ends on Friday. There will be several workshops on Sunday. It is always wonderful to visit different places of the country. Kansas City has much to offer, especially their famous barbecue sauce. I hope many of you can attend. It's a time to learn, do our business and reconnect with our AMT family. Don't miss out on the early bird registration fee. Councillors will be holding two leadership training workshops. What are youdoing with our money? CEU's are your responsibility Driving through AMT site Look for a message on the board at the registration area to find where Click I canto be add located. text Feel free to contact me if you would like to meet with me. My goal is to meet as many of youas possible, to reconnect and also to meet new western state society members. Be sure to track your CCP's with AMTrax, about 10% of members get audited. Don't lose your membership by not tracking. Remember this is your responsibility to get it done. Reminder for your state meetings, youneed to get all your scientific speakers pre-approved through Camille Murray, at least 1-2 weeks prior to the meeting. If you haven't completed or updated your by-laws in the last 3 years please do so, they must go to Kim Cheuvront, Judiciary Chair, for approval prior to posting them on the website. Once approved please send me a copy also. Congratulations to all Western state societies as we are all on board with the Central Banking. Thank you for getting this done so fast Convention will be held in Washington D.C. July If you need to reach me my address is: sherryrou@comcast.net It remains an honor to be your District Councillor as I start my third year. Thank youfor the privilege of working with all of you. Sheryl Rounsivill RMA, RPT,CMAS,AHI Western District Councillor PAGE 4

5 LEGISLATIVE REPORT SPRING-SUMMER 2017 PAGE 5

6 Infectious Disease - PCR vs. POCT This article is permitted by Dr. Omai Garner PhD, D(ABMM) Most sore throat cases for primary care physicians are of viral origin. Group A Streptococcus is the most frequent agent of bacterial pharyngitis 5-10% in adults and up to 30% in pediatrics. Clinical presentation alone does not allow reliable discrimination between viral and bacterial origin. Rapid throat swab testing allows for immediate-onset antibiotic therapy, decrease infectivity, and a probable reduction in complications. Current gold standard is a culture of Group A strep on a blood agar plate. Sensitivity or rapid is between 60-80% compared to culture (false negative persists). Studies demonstrate the Rapid test negative, culture positive patients are actually infected and not just streptococcal carriers. Specificity is 95% or greater (False positive are very rare). IDSA recommends that negative rapid Group A tests are always backed up with culture for children and adolescents. Studies show up to 70% of physicians are not using the rapid test correctly. EDITOR'S MESSAGE This year I have the opportunity to be part of the Legislative Symposium held last March 20-21, 2017 at the Hilton Hotel Alexandria Virginia. What an eye opener for me. There are so many things we can do as part of the Laboratory professionals and members of the American Medical Technologist (AMT). It was a joint effort to help our profession. It was very informative of how everyone within helped with each other to talk to their State Representatives, Senator and other legislative officials to hear our concerns. As a resident and member of Oregon State we are especially honored to be able to meet the Healthcare Legislative assistants of Senator Ron Wyden who is one of the Chairs for the Budget Committee in Capitol Hill. It was a memorable time. How to use a Fire Extinguisher Sweep the nozzle back and forth at the base of the fire until it appears to be out. Pull -the pin at the top extinguisher that keeps the handle from being activated. Squeeze the handle and maintain a distance of eight to ten feet away. Aim the nozzle at the base of the fire. PAGE 6

7 Point-of-Care Testing Parathyroid Hormone Assay Have you read the recent publication about the use of a rapid POC IOPTH? It is interesting how this assay results in a significant decrease in the amount of time, and results to be communicated to the "surgical team." The aim of any Point-of-care testing (POCT) is to reduce turnaround time so this report might be expedited. The concern however is the quality control of such a POCT tool. There is no data on the precision, sensitivity, specificity, interference and reproducibility of the test. This reduced time of intraoperative parathyroid hormone level results reporting, and the surgical time is an important factor in providing the answer to cost-effectiveness. The evidence is on the table for intraoperative rapid immunoassay of parathyroid hormone. This test saves money and improves outcome in surgery for primary hyperthyroidism, according to new draft laboratory practice. The draft guidelines of the National Academy of Clinical Biochemistry recommend that surgeons routinely use intraoperative parathyroid hormone testing for initial surgery and reoperation for primary hyperthyroidism and strongly recommend it s use in minimally invasive and directed procedures. About 90 to 95 percent of cases of primary hyperthyroidism are cured by surgery even without intraoperative parathyroid hormone monitoring. The use of intraoperative PTH testing allows the surgeon to perform laparoscopic-type of surgery with a small incisions or radioisotope-directed surgeries. The rapid PTH test lets surgeons know in almost real time when they have removed all of the abnormally secreting parathyroid tissue, saving the patient from additional time in surgery. This approach seems to be effective because "PTH has a half-life of less than five minutes, so there is a rapid decrease of hormone once the surgeon has excised the abnormal tissue." According to Lori Sokoll, PhD, chair of the NACB focus committee that developed the guidelines. Advances in technology have significantly improved clinical laboratory testing in accuracy, sensitivity and even the size of the equipment footprint. While the multi-test analyzer of central laboratories remains the mainstay for clinical laboratory testing. References: Annual American Association of Clinical Chemistry Meeting July 2004 Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm of Point-of-Care Testing by Lori J. Sokoll, Frank H. Wians, Jr. And Alan T. Remaley PAGE 7

8 A New Paradigm in Infectious Disease Testing: Molecular Point of Care Testing Dr. Omai Garner, PhD, D(ABMM) Dr Garner is the Assistant Clinical Professor of the Department of Pathology and Lab Medicine. He is also the Associate Director of Clinical Microbiology and The Director of Point of Care Testing at UCLA Health System There are three options in performing a test in a Clinical Diagnostic Testing. Reference Laboratory testing- large test menu, economies of scale, low test price and long turn-around-times. Hospital Laboratory testing- expanded test menu, shorter turn-around-times and expert consultation. Point of Care Testing- test menu is limited, unit cost per test is higher, rapid turn-around-times. History of Point of Care Testing In ancient times testing of urine was used for diabetes diagnosis. In 1960s-70s dipstick urinalysis, physician performed microscopy and fecal occult testing was introduced. The handheld glucose meters intended for home use came out in the late 1980s. And in early 1990s handheld glucose meters used in the hospital to monitor patients. Issues arose related to accuracy, operator training, quality control and management of testing data in the medical record. Federal regulations expanded to cover Point of Care testing and physician office point of care came under scrutiny of regulatory organizations. CLIA: Clinical Laboratory Improvements Amendments CLIA is a federal regulation that controls all clinical diagnostic testing. The Center for Medicare and Medicaid Services (CMS) regulates all diagnostic laboratory testing within the US. This bill was first passed in 1967, then expanded in 1988 (CLIA '88) in scandalous cytology "pap mills". The objective of CLIA is to ensure quality of all laboratory testing. In 1988 CLIA defined test complexity system. Waived testing, Non- Waived testing (Moderate to High Complexity). Waived tests are not exactly the same as Point of Care Tests. Some point of care tests are waived, some are moderate complexity. Point-of-care testing is bedside/patient side testing and is an independent discipline whereas waived testing is a regulatory term referring to test complexity. Tests using simple and accurate methodologies that the likelihood of erroneous results is negligible is a waived test. Only 8 analytes were identified as waived analytes in 1992, many more tests have been added to the list. In 1997, Congress revised the CLIA waiver process so that waiver may be granted to any system that the manufacturer applies for waiver in which the tests meet the statutory criteria and the manufacturer provides scientifically valid data verifying that the waiver criteria have been met. PAGE 8

9 Criteria for Test Complexity Knowledge, Training and Experience Reagent and Material Preparation Characteristics of Operational Steps,Calibration, QC, Proficiency Material, Test System Trouble-shooting and Interpretation and Judgment FDA scores 1,2,3 which means 1 as least complex for 7 criteria. Score of 12 or more means a moderate complexity. Moderate to High complexity is considered a Non-waived. This requires federal licensed personnel and a CLIA facility certificate to perform and interpret all testing. Waived Testing Requirements : Quality Control Follow manufacturer instructions Frequency of QC is defined by the manufacturer External controls run as required by manufacturer Verify QC is acceptable before reporting patients results Waived Testing Requirements: Validation and Correlation Initial correlation between waived instruments not required. Correlations between waived instruments and main lab instruments not required Multi-instrument comparison not required Reagents- lot-to-lot reagent validation not required Follow manufacturer instructions for handling and validating. Waived Testing Requirements : Competency and Training During the 1st year that an individual is performing patient testing, competency will be assessed at least semiannually. Competency must at least be reassessed annually Training documents for all users must be kept on-site. In performing POC testing, it is very important to establish a quality assurance program to ensure that good laboratory practices are followed by all staff. There should be a comprehensive manual containing training checklists, standardized procedures, competency assessment guidelines, supply information, regulatory requirements and quality control logs to all sites performing POC testing. All tests performed at POC be approved by a POC committee to ensure that only accurate, easy to use and supportable tests are implemented with methods that can be standardized across all areas. Implement a web-based training program for POC waived tests. Develop a standardized format for documenting patient test results performed by manual methods. These are all suggestions that will benefit your facility and clinics. This article is permitted by Dr. Omai Garner - UCLA SPRING-SUMMER 2017 PAGE 9

10 Body Language Boot Camp Basic Training Jane L. Smith MS MT(ASCP) SI, DLM Technical Manager, Scientific Affairs Recognize importance of Body Language Does your body language match your message? Dress and grooming Body Language Verbal Message Body posture Voice tone and pace Are you sending the wrong message? Eye contact Handshake Body Language Verbal Message...Continuation on page 11 SPRING-SUMMER 2017 PAGE 10

11 Universal Greeting Facts of Handshakes Use for meeting, greeting, parting, offering congratulations, or completing an agreement Cultural Personal Appropriate Business Handshake Stand and extend your right hand straight out in front of your body with your thumb pointing upward Lean in, but be careful not to get too close Keep eye contact Close your fingers around the other hand with your thumb resting to the side Greeting Gently squeeze for 3-4 seconds Body Language is Consist of : 1. Appearance 2. Gestures 3. Touch 4. Posture 5. Walk 6. Facial expressions 7. Vocal cues References : POC NW Meeting April 2017 Business Etiquettes for Handshake by Russell Huebsch Businessballs.com SPRING-SUMMER 2017 PAGE 11

12 CALENDAR OF EVENTS The photos in this newsletter is courtesy of Photos by Orion. Orion is married with two beautiful children, and has shared the pleasure of being behind the camera with his wife Kathryn for over 10 years. Together they run Photos By Orion and love to help their clients preserve precious memories. Orion also enjoys Capturing the nature and beauty of the Pacific Northwest, taking hikes, photographing waterfalls, and flying his drone everywhere he can. Taking his hobby and making a career out of it has been a dream come true for Orion, and he looks forward to many more adventures with his trusty camera by his side. PAGE 12