Adiponectin- Hormone responsible for putting out small fires.
The body is constantly under attack from the abuse of living. Internally there are all these injuries occurring at the molecular level, causing damage that spreads like wildfire until it is out of control. Metabolic syndrome is an example of this. What is it? This is a term used to describe a group of conditions that put patients at higher risk of developing type two diabetes and/or heart disease. Patients having three or more of the following are considered to have Metabolic Syndrome:
- High fasting glucose (greater than 5.6 mmol/L)
- High Blood Pressure (130/85 of higher)
- High Triglyceride (> 1.7 mmol/L)
- Decreased HDL (<1.0 in men, <1.3 in women) (A trick to remember which cholesterol is which is that HDL is the Healthy one, LDL is the Lousy one )
- Abdominal obesity or too much fat around the waist (>102 cm (40 inches) for men, >88 cm (35 inches) for women)
There is some debate on what causes Metabolic Syndrome. Is it due to increased insulin resistance, genetics, old age or life style? Wouldn’t it be nice if there was a diligent fulltime fighter in the human body that went around putting out the little brush fires these conditions caused before they became five alarm threats to our health?
Researchers have discovered a hormone that does this and it is from an unlikely source.
After studying the cells found in adipose (fatty) tissue called adipocytes, it was discovered that forty percent of the expressed genes were unknown or novel genes, even the gene that was most abundant and specific for an adipocyte. Further research identified a protein produced by adipocytes termed adiponectin.
Logic would determine that the more adipose tissue you have the more adipocytes present would result in increased levels of adiponectin, correct?
Wrong. To everyone’s surprise the higher the body mass index (BMI) the lower the adiponectin levels. Healthy patients with low levels of body fat had higher levels of adiponectin. Patients with Metabolic Syndrome and diabetes also had low levels of adiponectin.
So what does adiponectin exactly do?
It can help prevent atherosclerosis in blood vessels. Atherosclerosis is damage to cell walls caused by accumulation of fatty materials, such as LDL cholesterol and white blood cells called monocytes. Adiponectin has been found to prevent this kind of cell wall damage by having inhibitory affect against molecules that cause LDL and monocytes from sticking to vessel walls. This protein once secreted by adipocytes enters into the blood stream and looking for damaged cells lining vessel walls to repair, putting out small fires before they burn out of control.
The bad news is that measurement of adiponectin is not routinely done in the medical lab... yet. But when it does, it will help determine which patients will be at risk of developing Metabolic Syndrome. A good article to read about this can be found at :
http://atvb.ahajournals.org/cgi/reprint/24/1/29
Thank you for taking the time to read my posting. I look forward to your thoughts and comments.
Regards,
Mark Hawkins
Sunday, December 20, 2009
Wednesday, December 2, 2009
Tight Glycemic Control
One of the complications of critically ill patients is developing hyperglycemia, high glucose levels, even when they are not diabetic. Controlling the glucose level presents an added challenge to the care of these patients since it has been postulated that high glucose levels can lead to more complications such as septicemia, neuropathy and death. The conventional therapeutic approach has been to monitor the patients glucose and to treat when the plasma glucose level is greater than 11.9 mmol/L (215mg/dL) by insulin infusion and then try to maintain it between 10.0 to 11.0 mmol/L (180-200 mg/dL). Although this does work, the question has been would trying to have tighter glycemic control improve patient outcomes?
In 2001, the New England Journal of Medicine published a study by Dr. Greet Van den Berghe that tried to answer that question. In her study (which can be found at:
http://content.nejm.org/cgi/content/short/345/19/1359) 1548 ICU patients receiving mechanical ventilation were given intense insulin therapy, put insulin infusion to maintain their glucose levels between 4.4-6.0 mmol/L (80-110 mg/dl). Glucose was measured using whole blood with an ABL700 at 1 to 4 hour intervals.
The results were impressive. Bloodstream infections were reduced by 46%, acute renal failure by 41%, RBC transfusions by 50% and critical illness polyneuropathy by 44%. Most impressive of all was the mortality rate being halved from 8.0% to 4.6%.
With such positive patient outcomes, many hospitals have started using tight glycemic control and have reported similar impressive results. Logic would conclude that tight glycemic works.
However in March 2009 the NEJM released a the results of the NICE-SUGAR (Normoglycemic in Intensive Care-Survival Using Glucose Algorithm Regulation) study that evaluated hospitals using tight glycemic control on critically ill patients.
It was a huge multinational study that examined the outcomes of 6000 patients. In this study (http://content.nejm.org/cgi/content/short/360/13/1283?ssource=mfv), the opposite was found, that tight glycemic control did not decrease mortality, but increased it.
So where does that leave the critically ill patient? The day after the NICE-SUGAR study was released, a joint statement was released by the American Diabetes Association and the American Association of Clinical Endocrinologists stating that tight glycemic control should not be abandoned, but be up to the clinician on whether or not the patient would benefit from it. This statement can be found at:
http://newswise.com/articles/joint-statement-on-the-nice-sugar-study-on-intensive-versus-conventional-glucose-control-in-critically-ill-patients?ret=/articles/list&category=latest&page=1&search[billing_institution_id]=0&search[date_range]=&search[institution_name
Dr. Van den Berghe’s groundbreaking study has shown that keeping glucose levels tightly controlled can improve patient outcomes while the NICE-SUGAR study illustrates that before a hosptital jumps on the tight glycemic control bandwagon it has to have the infrastructure in place. The cornerstone to this is accurate and precise measurement of blood glucose levels. In order for this to happen, the lab will have to be involved. Why?
On the surface it looks like the lab has no role in tight glycemic control since it is done by nurses. All that is required is for a single drop of blood placed on a test strip that is then stuck in the small bedside monitor and wait for the result to be displayed. It doesn’t get any simpler than that.
The same could be said about driving a car. There have been news stories of children as young as five taking their parents car for a spin down the freeway. That doesn’t mean the driving age should be dropped to six. The same could be said for any health care professional performing bedside glucose monitoring. Before anyone can operate them, they have to be trained on not only how to use them, but the institution’s standard operating procedures as well. This is where the lab can be a vital resource, providing training and making sure that the instruments used are properly working.
If anyone involved in the NICE-SUGAR is reading this posting, would it be possible if you could answer this simple question regarding the operators. Was there any external proficiency testing done?
What is external proficiency testing? It is standard in all labs, where an outside agency sends specimens that the lab has to analyze and send the result in. The labs performance is then evaluated depending on how accurate the results were. If the lab consistently produces good results, it passes. However if the lab is inconsistent in its performance, its accreditation can be taken away.
External proficiency testing is not cheap. But neither is quality.
Another reason the lab can be involved is if the doctor wants to check other analytes, such as electrolytes and ketone bodies. Patients who are dehydrated and are on certain medications can have spurious results on the bedside glucose monitors, and may require a different analyzer to measure their glucose level.
Some labs actually do the bedside glucose testing with very good consistent results. An example of this is the program run by Brenda Franks at Nebraska Methodist Hospital in Omaha where phlebotomists do the bedside glucose testing. An article on their success can be found at:
http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=cap_today%2F0909%2F0909f_POC_leader_spreads.html&_state=maximized&_pageLabel=cntvwr
Bottom line, tight glycemic controls works, but it’s not perfect. The lab should be used as an excellent resource if the organization wants to pursue this for their critically sick patients.
In 2001, the New England Journal of Medicine published a study by Dr. Greet Van den Berghe that tried to answer that question. In her study (which can be found at:
http://content.nejm.org/cgi/content/short/345/19/1359) 1548 ICU patients receiving mechanical ventilation were given intense insulin therapy, put insulin infusion to maintain their glucose levels between 4.4-6.0 mmol/L (80-110 mg/dl). Glucose was measured using whole blood with an ABL700 at 1 to 4 hour intervals.
The results were impressive. Bloodstream infections were reduced by 46%, acute renal failure by 41%, RBC transfusions by 50% and critical illness polyneuropathy by 44%. Most impressive of all was the mortality rate being halved from 8.0% to 4.6%.
With such positive patient outcomes, many hospitals have started using tight glycemic control and have reported similar impressive results. Logic would conclude that tight glycemic works.
However in March 2009 the NEJM released a the results of the NICE-SUGAR (Normoglycemic in Intensive Care-Survival Using Glucose Algorithm Regulation) study that evaluated hospitals using tight glycemic control on critically ill patients.
It was a huge multinational study that examined the outcomes of 6000 patients. In this study (http://content.nejm.org/cgi/content/short/360/13/1283?ssource=mfv), the opposite was found, that tight glycemic control did not decrease mortality, but increased it.
So where does that leave the critically ill patient? The day after the NICE-SUGAR study was released, a joint statement was released by the American Diabetes Association and the American Association of Clinical Endocrinologists stating that tight glycemic control should not be abandoned, but be up to the clinician on whether or not the patient would benefit from it. This statement can be found at:
http://newswise.com/articles/joint-statement-on-the-nice-sugar-study-on-intensive-versus-conventional-glucose-control-in-critically-ill-patients?ret=/articles/list&category=latest&page=1&search[billing_institution_id]=0&search[date_range]=&search[institution_name
Dr. Van den Berghe’s groundbreaking study has shown that keeping glucose levels tightly controlled can improve patient outcomes while the NICE-SUGAR study illustrates that before a hosptital jumps on the tight glycemic control bandwagon it has to have the infrastructure in place. The cornerstone to this is accurate and precise measurement of blood glucose levels. In order for this to happen, the lab will have to be involved. Why?
On the surface it looks like the lab has no role in tight glycemic control since it is done by nurses. All that is required is for a single drop of blood placed on a test strip that is then stuck in the small bedside monitor and wait for the result to be displayed. It doesn’t get any simpler than that.
The same could be said about driving a car. There have been news stories of children as young as five taking their parents car for a spin down the freeway. That doesn’t mean the driving age should be dropped to six. The same could be said for any health care professional performing bedside glucose monitoring. Before anyone can operate them, they have to be trained on not only how to use them, but the institution’s standard operating procedures as well. This is where the lab can be a vital resource, providing training and making sure that the instruments used are properly working.
If anyone involved in the NICE-SUGAR is reading this posting, would it be possible if you could answer this simple question regarding the operators. Was there any external proficiency testing done?
What is external proficiency testing? It is standard in all labs, where an outside agency sends specimens that the lab has to analyze and send the result in. The labs performance is then evaluated depending on how accurate the results were. If the lab consistently produces good results, it passes. However if the lab is inconsistent in its performance, its accreditation can be taken away.
External proficiency testing is not cheap. But neither is quality.
Another reason the lab can be involved is if the doctor wants to check other analytes, such as electrolytes and ketone bodies. Patients who are dehydrated and are on certain medications can have spurious results on the bedside glucose monitors, and may require a different analyzer to measure their glucose level.
Some labs actually do the bedside glucose testing with very good consistent results. An example of this is the program run by Brenda Franks at Nebraska Methodist Hospital in Omaha where phlebotomists do the bedside glucose testing. An article on their success can be found at:
http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=cap_today%2F0909%2F0909f_POC_leader_spreads.html&_state=maximized&_pageLabel=cntvwr
Bottom line, tight glycemic controls works, but it’s not perfect. The lab should be used as an excellent resource if the organization wants to pursue this for their critically sick patients.
Monday, November 2, 2009
The future of the INR
Traditional anticoagulants such as warfarin and heparin prevent clot formation by interfering with the ability of proteins in the blood called clotting factors to function. Dabigatran is a new class of anticoagulants called thrombin inhibitors that work by interfering with the stage of clot formation, preventing the protein thrombin from converting fibrinogen to fibrin. So how will this affect the medical laboratory?
The warfarin industry is a billion dollar industry and part of the cost is constantly monitoring its therapeutic affect on the patient. The test used to monitor warfarin therapy is called the the INR (short for International Ratio). A low INR means that the dose is to low, there is an increased risk of clots forming. A high INR means there is a risk of uncontrolled bleeding. Both situations require time and resources to bring the INR back into a therapeutic range.
Since Dabigatran does not require any blood tests to monitor it, the INR could become obsolete, and with it the entire lab infrastructure that goes into doing this test.
This is not the first time an established anticoagulant therapy was replaced by a better replacement. For years a drug called heparin was used to treat blood clots. Like warfarin, it needed to be constantly monitored by a lab test called the APTT and had to be administered intravenously in a hospital setting. Then ten years ago Lovenox (also known as low molecular heparin), was released. It had the benefits of being injectable, not requiring constant
But if dagibatrin replaces warfarin as a treatment for the prevention of blood clots, the patient no longer needs to have any monitoring done, and the lab loses a client. Can you blame the patient though? No more having to go to the lab to be poked and prodded, over time veins become scarred resulting in it become harder and more painful to get blood specimens for the INR test. Dagibatrin has none of the dietary restrictions that warfarin has.
It stands as a testament to warfarin’s contribution as a cost effective way of improving people’s lives that it has taken over 50 years before a suitable replacement might be found.
How can labs face the challenges dabigatrin present?
Even if dagibatran replaces warfarin, it will not make it or the INR test obsolete. Like all drugs, dagibatran cannot be taken by everyone. Heartburn was the major non-bleeding related side effect, so severe that it had to be discontinued.
The long term affects of taking dagibatran have not been studied as well. How will the human body be affected by taking this drug for six months, 1 year 1 decade? Possible, dagibatran will have some minor side effects that will require some lab testing. An example of this would be how lipitor now requires liver function testing to be done.
Another side effect was there being a very small but statistically significant increase in the risk of heart attack for some patients. Why is still being investigated, but it could require some sort of lab test to screen patients that are in this risk group, possible a future gene test designed for this.
Even if the patient has none of the above problems, as with any anticoagulant therapy there is a chance of uncontrolled bleeding. It will be up to the lab to determine if the bleeding is due to dagibatran. This will be done by using either of two tests, thrombin time (TT) or ecarin clotting time (ECT). Medical labs will need to add these two tests to physicians if dagibatran use increases.
It is quite possible that warfarin may become obsolete, and this will have a huge impact on Medical Laboratories.
But it is only by understanding what these changes are and preparing for them that labs will be able to survive and even thrive.
Thank you for taking the time to read my posting. I look forward to your thoughts and comments.
Regards,
Mark Hawkins
The warfarin industry is a billion dollar industry and part of the cost is constantly monitoring its therapeutic affect on the patient. The test used to monitor warfarin therapy is called the the INR (short for International Ratio). A low INR means that the dose is to low, there is an increased risk of clots forming. A high INR means there is a risk of uncontrolled bleeding. Both situations require time and resources to bring the INR back into a therapeutic range.
Since Dabigatran does not require any blood tests to monitor it, the INR could become obsolete, and with it the entire lab infrastructure that goes into doing this test.
This is not the first time an established anticoagulant therapy was replaced by a better replacement. For years a drug called heparin was used to treat blood clots. Like warfarin, it needed to be constantly monitored by a lab test called the APTT and had to be administered intravenously in a hospital setting. Then ten years ago Lovenox (also known as low molecular heparin), was released. It had the benefits of being injectable, not requiring constant
But if dagibatrin replaces warfarin as a treatment for the prevention of blood clots, the patient no longer needs to have any monitoring done, and the lab loses a client. Can you blame the patient though? No more having to go to the lab to be poked and prodded, over time veins become scarred resulting in it become harder and more painful to get blood specimens for the INR test. Dagibatrin has none of the dietary restrictions that warfarin has.
It stands as a testament to warfarin’s contribution as a cost effective way of improving people’s lives that it has taken over 50 years before a suitable replacement might be found.
How can labs face the challenges dabigatrin present?
Even if dagibatran replaces warfarin, it will not make it or the INR test obsolete. Like all drugs, dagibatran cannot be taken by everyone. Heartburn was the major non-bleeding related side effect, so severe that it had to be discontinued.
The long term affects of taking dagibatran have not been studied as well. How will the human body be affected by taking this drug for six months, 1 year 1 decade? Possible, dagibatran will have some minor side effects that will require some lab testing. An example of this would be how lipitor now requires liver function testing to be done.
Another side effect was there being a very small but statistically significant increase in the risk of heart attack for some patients. Why is still being investigated, but it could require some sort of lab test to screen patients that are in this risk group, possible a future gene test designed for this.
Even if the patient has none of the above problems, as with any anticoagulant therapy there is a chance of uncontrolled bleeding. It will be up to the lab to determine if the bleeding is due to dagibatran. This will be done by using either of two tests, thrombin time (TT) or ecarin clotting time (ECT). Medical labs will need to add these two tests to physicians if dagibatran use increases.
It is quite possible that warfarin may become obsolete, and this will have a huge impact on Medical Laboratories.
But it is only by understanding what these changes are and preparing for them that labs will be able to survive and even thrive.
Thank you for taking the time to read my posting. I look forward to your thoughts and comments.
Regards,
Mark Hawkins
Monday, September 21, 2009
A new paradigm in coagulation testing
A new paradigm in coagulation testing
The bottom line is that I am both worried and excited about the change in coagulation testing I see on the horizon. I’m not sure if my colleagues are aware of it or not, but it is there. Do I sound ominous? Well for laboratory medicine there is a significant change coming, a new paradigm in coagulation testing and since it will affect my job, I am taking notice of it. But at the same time as a healthcare provider I am excited and happy about the positive changes it will make for patients.
What is this change I see coming? Simply put, the demise of the warfarin industry. The value of this industry is in the billions, and some of those funds go to the lab. If the warfarin industry becomes obsolete, so does a source of income for labs.
First of all, a brief history lesson about warfarin. At the beginning of the 1900’s, farmers in the Midwest were noticing that their cattle were starting to die after eating in certain fields. Autopsies revealed they had all died of massive internal bleeding. The culprit was discovered to be the sweet clover they had eaten. Research isolated the compound that caused the bleeding, and it was named Coumadin. Coumadin’s action was found to decrease the blood’s clotting ability. It did this by interfering with Vitamin K’s ability to produce clotting proteins in the liver. Without being able to clot, eventually the smallest bump or scrape will lead to a massive bleed and eventually death. That is what made Coumadin such an effective poison, so effective that it was first marketed as a rat poison.
Now the major cause of death in the industrialized world is either heart attacks, strokes or both. What happens is that blood is clotting too much. A clot forms in the artery of either the brain or heart, blocking blood circulation. So if the clotting can be prevented, the blood flow is unaffected and death and sickness are prevented. Since Coumadin prevents blood from clotting, it can be used as a medication to prevent heart attacks and strokes. It seemed to work and was renamed Warfarin. These types of medication are known as anticoagulants (anti-against, coagulants-clotting).
Unfortunately, just because it was renamed Warfarin and used as a medicine didn’t mean that it wasn’t still poisonous. Warfarin levels had to be monitored by a lab test called the INR. If the INR was at an acceptable level then the medication didn’t have to be adjusted. Unfortunately, sometimes the INR would become unstable and the patient would have to have multiple blood tests to find the right dosage to bring the INR back to a therapeutic level. Remember, this stuff was originally rat poison, and if the INR was too high, the patient could bleed to death. Sometimes the patient will require a blood transfusion to replace the clotting factors they are missing.
Of course, this is all a major source of work (and revenue) for the lab. It is not convenient for the patients who have to have their blood constantly tested, or the physician to try and get the right dosage without killing their patient.
It has long been the Holy Grail of pharmacological research to find an anticoagulant that did not require blood testing to monitor it, nor have the nasty side effects of warfarin.
That Holy Grail has been found, and it is called Dabigatran. Next week’s entry will deal with its impact on the medical lab industry.
The bottom line is that I am both worried and excited about the change in coagulation testing I see on the horizon. I’m not sure if my colleagues are aware of it or not, but it is there. Do I sound ominous? Well for laboratory medicine there is a significant change coming, a new paradigm in coagulation testing and since it will affect my job, I am taking notice of it. But at the same time as a healthcare provider I am excited and happy about the positive changes it will make for patients.
What is this change I see coming? Simply put, the demise of the warfarin industry. The value of this industry is in the billions, and some of those funds go to the lab. If the warfarin industry becomes obsolete, so does a source of income for labs.
First of all, a brief history lesson about warfarin. At the beginning of the 1900’s, farmers in the Midwest were noticing that their cattle were starting to die after eating in certain fields. Autopsies revealed they had all died of massive internal bleeding. The culprit was discovered to be the sweet clover they had eaten. Research isolated the compound that caused the bleeding, and it was named Coumadin. Coumadin’s action was found to decrease the blood’s clotting ability. It did this by interfering with Vitamin K’s ability to produce clotting proteins in the liver. Without being able to clot, eventually the smallest bump or scrape will lead to a massive bleed and eventually death. That is what made Coumadin such an effective poison, so effective that it was first marketed as a rat poison.
Now the major cause of death in the industrialized world is either heart attacks, strokes or both. What happens is that blood is clotting too much. A clot forms in the artery of either the brain or heart, blocking blood circulation. So if the clotting can be prevented, the blood flow is unaffected and death and sickness are prevented. Since Coumadin prevents blood from clotting, it can be used as a medication to prevent heart attacks and strokes. It seemed to work and was renamed Warfarin. These types of medication are known as anticoagulants (anti-against, coagulants-clotting).
Unfortunately, just because it was renamed Warfarin and used as a medicine didn’t mean that it wasn’t still poisonous. Warfarin levels had to be monitored by a lab test called the INR. If the INR was at an acceptable level then the medication didn’t have to be adjusted. Unfortunately, sometimes the INR would become unstable and the patient would have to have multiple blood tests to find the right dosage to bring the INR back to a therapeutic level. Remember, this stuff was originally rat poison, and if the INR was too high, the patient could bleed to death. Sometimes the patient will require a blood transfusion to replace the clotting factors they are missing.
Of course, this is all a major source of work (and revenue) for the lab. It is not convenient for the patients who have to have their blood constantly tested, or the physician to try and get the right dosage without killing their patient.
It has long been the Holy Grail of pharmacological research to find an anticoagulant that did not require blood testing to monitor it, nor have the nasty side effects of warfarin.
That Holy Grail has been found, and it is called Dabigatran. Next week’s entry will deal with its impact on the medical lab industry.
Friday, August 28, 2009
Posting #4- Never Assume
The material posted on this blog (The Labvocate) is for information purposes only, and can not be used for the purpose of diagnosing and/or the treatment of individual medical conditions
The material posted on this blog (The Labvocate) are the opinions of the author, and do not reflect those of the Northern Health Authority.
Early on in life I was taught the following lesson about making assumptions. Why should you never assume? The lesson went like this. The teacher wrote the word out:
ASSUME
Then put slashes in the following spots:
ASS/U/ME
The final part of the lesson then was written out.
Assumptions have to be made in day to day living of course, and it would be unrealistic (and not mention neurotic) if a person challenged every one they faced each day. After all, no news probable means good news, correct?
Not necessarily.
One question patients ask after the lab has taken their specimen is when will the doctor get the result? That is such a simple question. However it is also a loaded question. Sometimes what they are really asking is “when do you think the Doctor will contact me to discuss the results of the test?”
The answer may be never.
According to a recent study released by the Archives of Internal Medicine revealed that sometimes a medical practice either doesn’t inform a patient of an abnormal lab result, or does not keep a formal record of the result being discussed with the patient. How often does this occur? The study gives the statistic 1 out of every 14 abnormal test results (approximately 7%) not being given or discussed with patients.
It was an interesting article filled with statistics. One thing the authors mentioned was that this study was done on doctors who were willing for researchers to go through their records. Of the 98 practices approached, only 19 agreed to participate. I applaud the 19 that did, but at the same time I can appreciate why the other 79 did not. Whatever reasons they have for not participating has to be respected, and left at that.
What was interesting was that the study found that there was no difference between practices that manually wrote notes in the patient’s charts and those that used an Electronic Medical Record (EMR). No matter what system was used the study recommended Doctors perform the following five steps regarding test results:
1) All test results are routed to the responsible physician.
2) The physician signs off on all results.
3) The practice informs patients of all results, normal and abnormal, at least in general terms.
4) The practice documents that the patient has been informed.
5) Patients are told to call after a certain time interval if they have not been notified of their results.
But what about the patient, what can they do to make sure that they are informed of an abnormal lab result?
Here are five suggestions to make sure you are notified of an abnormal lab result.
1) Find out what tests the doctor has ordered and record them.
2) Find out from the lab what test are done on site, are referred out and how long before the doctor gets the results.
3) Schedule your next appointment around the time your doctor is expecting the test results
4) Two to three days before your appointment, contact the doctor’s office to make sure all the lab results are in. If they are not, have the office get them. Reschedule your appointment if necessary.
5) Discuss the results with your doctor. Ask them this simple question, ‘were there any abnormal results?’
Hopefully, an abnormal result will not be missed. But as mentioned at the beginning of this posting, do not assume that any system is a 100% foolproof. Due diligence, especially when it comes to your health, is the final safeguard.
Thank you for taking the time to read my posting. I look forward to your thoughts and comments..
Regards,
Mark Hawkins
The material posted on this blog (The Labvocate) is for information purposes only, and can not be used for the purpose of diagnosing and/or the treatment of individual medical conditions
The material posted on this blog (The Labvocate) are the opinions of the author, and do not reflect those of the Northern Health Authority.
Early on in life I was taught the following lesson about making assumptions. Why should you never assume? The lesson went like this. The teacher wrote the word out:
ASSUME
Then put slashes in the following spots:
ASS/U/ME
The final part of the lesson then was written out.
Assumptions have to be made in day to day living of course, and it would be unrealistic (and not mention neurotic) if a person challenged every one they faced each day. After all, no news probable means good news, correct?
Not necessarily.
One question patients ask after the lab has taken their specimen is when will the doctor get the result? That is such a simple question. However it is also a loaded question. Sometimes what they are really asking is “when do you think the Doctor will contact me to discuss the results of the test?”
The answer may be never.
According to a recent study released by the Archives of Internal Medicine revealed that sometimes a medical practice either doesn’t inform a patient of an abnormal lab result, or does not keep a formal record of the result being discussed with the patient. How often does this occur? The study gives the statistic 1 out of every 14 abnormal test results (approximately 7%) not being given or discussed with patients.
It was an interesting article filled with statistics. One thing the authors mentioned was that this study was done on doctors who were willing for researchers to go through their records. Of the 98 practices approached, only 19 agreed to participate. I applaud the 19 that did, but at the same time I can appreciate why the other 79 did not. Whatever reasons they have for not participating has to be respected, and left at that.
What was interesting was that the study found that there was no difference between practices that manually wrote notes in the patient’s charts and those that used an Electronic Medical Record (EMR). No matter what system was used the study recommended Doctors perform the following five steps regarding test results:
1) All test results are routed to the responsible physician.
2) The physician signs off on all results.
3) The practice informs patients of all results, normal and abnormal, at least in general terms.
4) The practice documents that the patient has been informed.
5) Patients are told to call after a certain time interval if they have not been notified of their results.
But what about the patient, what can they do to make sure that they are informed of an abnormal lab result?
Here are five suggestions to make sure you are notified of an abnormal lab result.
1) Find out what tests the doctor has ordered and record them.
2) Find out from the lab what test are done on site, are referred out and how long before the doctor gets the results.
3) Schedule your next appointment around the time your doctor is expecting the test results
4) Two to three days before your appointment, contact the doctor’s office to make sure all the lab results are in. If they are not, have the office get them. Reschedule your appointment if necessary.
5) Discuss the results with your doctor. Ask them this simple question, ‘were there any abnormal results?’
Hopefully, an abnormal result will not be missed. But as mentioned at the beginning of this posting, do not assume that any system is a 100% foolproof. Due diligence, especially when it comes to your health, is the final safeguard.
Thank you for taking the time to read my posting. I look forward to your thoughts and comments..
Regards,
Mark Hawkins
Sunday, August 16, 2009
Mrs. Clinton and GM
I am not an economist, nor a politician. I’m just a medical lab technologist who likes working in Canada. A childhood spent in hospitals due to uncontrolled asthma is probable one of the reasons why I’m in healthcare, and why I’m glad I have access to universal coverage.
I’m also a big fan of the U.S. I’ve had the opportunity of visiting my southern neighbor four times and I can hardly wait for the next visit. There are lots to do, the people are great and it is the only place in the world that knows how to make sourdough bread.
Lately though there has been some Canada bashing lately in the U.S. media about the shortcomings of our healthcare. So as a Canadian who works in this industry here are a few observations I have about the situation.
First of all, to any American readers in the words of one of your Presidents, Lyndon B. Johnson, “I’m not going to piss on your rug.” The American system is what it is. Apparently some people think it’s the best system in the world, while there are others who think it is in need of desperate repair.
I agree. The U.S. needs universal healthcare. If you need a reason no go further than to the collapse of GM.
What does the bankruptcy of one of the largest American companies in history has to do with healthcare reform? Economic reasons that’s why.
On Feb. 11, 2005 (over four years ago), G. Richard Wagoner Jr., the CEO of GM told the Economic Club of Chicago that “failing to address the health care crisis would be the worst kind of procrastination.” Mr. Wagoner also said that “GM is the canary in the coal mine for Medicare and everyone else. There are many, many more companies out there in trouble because of healthcare costs than just the auto, steel and airline industries.”
In 2005, the healthcare of 1.1 million people was covered by GM. That would be like going to the city of Dallas, Texas and saying all your healthcare bills are taken care of. How much did it cost? 5.2 billion dollars. If GM healthcare was a country, it’s GDP would be the world’s 140th biggest, knocking out Laos. It was expected to go up by 400 million that year, 7.6%. As a result of these factors, GM had to recoup costs by adding $1500 to the price of each vehicle it sold.
The Indian Carmaker Tata, will be able to produce a car (the Nano) for $2000, just $500 more than what had to be added to the sticker price of a car on the lot in 2005.
How can the U.S. hope to compete globally with this huge burden? What did Mr. Wagoner call GM, the ‘canary in the coal mine?’ Well one can see that the little bird is fighting for its life.
So I have to wonder what Mrs. Clinton is thinking about these days. Who knows if things would have been better if she had been successful in the nineties with her plans for healthcare reform? Would GM be offering a $1900 car in India in this parallel universe?
Unfortunately politics caused healthcare reform to collapse, and it looks like Mr. Obama is falling in the same traps. The only piece of advice I can give him is to paraphrase one of Abraham Lincoln’s more famous lines. When it comes to healthcare reform, ‘you can please some of the people all of the time, you can please all of the people some of the time, but you will never be able to please all the people all the time.’
Thank you for taking the time to read my posting. I look forward to your thoughts and comments.
Regards,
Mark Hawkins
I’m also a big fan of the U.S. I’ve had the opportunity of visiting my southern neighbor four times and I can hardly wait for the next visit. There are lots to do, the people are great and it is the only place in the world that knows how to make sourdough bread.
Lately though there has been some Canada bashing lately in the U.S. media about the shortcomings of our healthcare. So as a Canadian who works in this industry here are a few observations I have about the situation.
First of all, to any American readers in the words of one of your Presidents, Lyndon B. Johnson, “I’m not going to piss on your rug.” The American system is what it is. Apparently some people think it’s the best system in the world, while there are others who think it is in need of desperate repair.
I agree. The U.S. needs universal healthcare. If you need a reason no go further than to the collapse of GM.
What does the bankruptcy of one of the largest American companies in history has to do with healthcare reform? Economic reasons that’s why.
On Feb. 11, 2005 (over four years ago), G. Richard Wagoner Jr., the CEO of GM told the Economic Club of Chicago that “failing to address the health care crisis would be the worst kind of procrastination.” Mr. Wagoner also said that “GM is the canary in the coal mine for Medicare and everyone else. There are many, many more companies out there in trouble because of healthcare costs than just the auto, steel and airline industries.”
In 2005, the healthcare of 1.1 million people was covered by GM. That would be like going to the city of Dallas, Texas and saying all your healthcare bills are taken care of. How much did it cost? 5.2 billion dollars. If GM healthcare was a country, it’s GDP would be the world’s 140th biggest, knocking out Laos. It was expected to go up by 400 million that year, 7.6%. As a result of these factors, GM had to recoup costs by adding $1500 to the price of each vehicle it sold.
The Indian Carmaker Tata, will be able to produce a car (the Nano) for $2000, just $500 more than what had to be added to the sticker price of a car on the lot in 2005.
How can the U.S. hope to compete globally with this huge burden? What did Mr. Wagoner call GM, the ‘canary in the coal mine?’ Well one can see that the little bird is fighting for its life.
So I have to wonder what Mrs. Clinton is thinking about these days. Who knows if things would have been better if she had been successful in the nineties with her plans for healthcare reform? Would GM be offering a $1900 car in India in this parallel universe?
Unfortunately politics caused healthcare reform to collapse, and it looks like Mr. Obama is falling in the same traps. The only piece of advice I can give him is to paraphrase one of Abraham Lincoln’s more famous lines. When it comes to healthcare reform, ‘you can please some of the people all of the time, you can please all of the people some of the time, but you will never be able to please all the people all the time.’
Thank you for taking the time to read my posting. I look forward to your thoughts and comments.
Regards,
Mark Hawkins
Monday, August 3, 2009
What exactly is Medical Laboratory Technology
What exactly is Medical Laboratory Technology? It’s a branch of Pathology, the medical specialty that studies disease. There are five major disciplines, Clinical Chemistry, Hematology, Medical Microbiology, Histology and Transfusion Medicine. So how do these relate to you, the patient?
Disclaimer: The following is only an example and is entirely fictional. Information given cannot be used to take the place of a licensed medical doctor’s care.
Why was that disclaimer written? As soon as the term ‘sore throat’ is used, the reader will instantly swallow to make sure that their throat is fine. Everyone has had this complaint at least once, and it is common reason to see your doctor.
What does the doctor do? Looks down the patient’s throat, and usually sticks a swab down there to give the patient’s gagging reflex a workout. Where does the swab go? To the lab, to the Microbiology department where the lab tech will analyze it to determine if:
1) There is an infection present
2) What is causing it
So after the swab is analyzed the lab it is determined that the sore throat is not caused by an infection. What’s next? The physician notices a lump in the throat and decides that a biopsy or tissue sample of it needs to be taken. After surgery, the specimen is sent to the lab to the Histology department.
Histology is the study of tissues. The lab techs in this department process the tissue specimen and cut into slices thinner than human hair, put them on glass slides, and then stain them for the pathologist to examine microscopically. After looking at the slides, the diagnosis comes back as cancer of the throat.
Once again I have to emphasize this is only a fictionalized example. The care of a sore throat is best done by a licensed healthcare professional.
Of course the best treatment is surgery to remove the tumor, and since there is a chance of bleeding, the surgeon will need to have some units of blood on hand. The lab techs in Transfusion Medicine will be responsible to make sure there are safe blood products available for this scenario.
So after surgery, the tumor has been removed and the next course of treatment is chemotherapy. Hematology, the study of blood cells, will be used to make sure that the body’s immune system can tolerate this treatment, while Clinical Chemistry will ensure your organs will be able to handle it as well.
Once again, I cannot stress it enough, if you have a sore throat, please see your doctor about it. Please do not tell him that the Labvocate told you it is cancer.
So to review, the five disciplines of Medical Laboratory Technology are:
1) Hematology
2) Clinical Chemistry
3) Transfusion Medicine
4) Microbiology
5) Histology
I have worked in all of them, and each one has its advantages and disadvantages. But no matter what department, I always remember what was drilled into our heads by our instructors:
“Treat each specimen as if it’s from someone important to you.”
Thank you for taking the time to read my posting. I look forward to your thoughts and comments..
Regards,
Mark Hawkins
Disclaimer: The following is only an example and is entirely fictional. Information given cannot be used to take the place of a licensed medical doctor’s care.
Why was that disclaimer written? As soon as the term ‘sore throat’ is used, the reader will instantly swallow to make sure that their throat is fine. Everyone has had this complaint at least once, and it is common reason to see your doctor.
What does the doctor do? Looks down the patient’s throat, and usually sticks a swab down there to give the patient’s gagging reflex a workout. Where does the swab go? To the lab, to the Microbiology department where the lab tech will analyze it to determine if:
1) There is an infection present
2) What is causing it
So after the swab is analyzed the lab it is determined that the sore throat is not caused by an infection. What’s next? The physician notices a lump in the throat and decides that a biopsy or tissue sample of it needs to be taken. After surgery, the specimen is sent to the lab to the Histology department.
Histology is the study of tissues. The lab techs in this department process the tissue specimen and cut into slices thinner than human hair, put them on glass slides, and then stain them for the pathologist to examine microscopically. After looking at the slides, the diagnosis comes back as cancer of the throat.
Once again I have to emphasize this is only a fictionalized example. The care of a sore throat is best done by a licensed healthcare professional.
Of course the best treatment is surgery to remove the tumor, and since there is a chance of bleeding, the surgeon will need to have some units of blood on hand. The lab techs in Transfusion Medicine will be responsible to make sure there are safe blood products available for this scenario.
So after surgery, the tumor has been removed and the next course of treatment is chemotherapy. Hematology, the study of blood cells, will be used to make sure that the body’s immune system can tolerate this treatment, while Clinical Chemistry will ensure your organs will be able to handle it as well.
Once again, I cannot stress it enough, if you have a sore throat, please see your doctor about it. Please do not tell him that the Labvocate told you it is cancer.
So to review, the five disciplines of Medical Laboratory Technology are:
1) Hematology
2) Clinical Chemistry
3) Transfusion Medicine
4) Microbiology
5) Histology
I have worked in all of them, and each one has its advantages and disadvantages. But no matter what department, I always remember what was drilled into our heads by our instructors:
“Treat each specimen as if it’s from someone important to you.”
Thank you for taking the time to read my posting. I look forward to your thoughts and comments..
Regards,
Mark Hawkins
Wednesday, July 29, 2009
Greetings from the Labvocate
Mission Statement-To inform the public about Medical Laboratory Issues, and how they affect healthcare.
Thank you for taking the time to read my blog.
Medical Laboratory Technology. What exactly is it, and why does it matter to you? For that matter, why am I putting the energy into this endeavor, instead of showing off pictures of my garden’s progress?
Recent developments have happened that have convinced me that a blog dedicated to this topic needed to be done (these developments will be discussed in future postings). So this is my blog, the Labvocate.
I will try to be informative, objective, and fair. A balance between education and editorial will be reached. I’m open to comments and suggestions for postings. Civilized discussion and comments will be most welcome.
One thing will not be done by this blog. Providing individual diagnostic services.
Diagnosing your medical problems is the job of a licensed medical doctor. Here’s disclaimer #1:
The material posted on this blog (The Labvocate) is for information purposes only, and can not be used for the purpose of diagnosing and/or the treatment of individual medical conditions.
For example there could be a posting about blood thinners (i.e. warfarin). Discussion about the technical aspects of monitoring this class of medication, or trends in therapy would be encouraged. But if a reader were to ask what their INR should be, there could be no to that answer that question. Period, end of conversation, nest topic please. If you’re not getting the answer from your physician is it because the question hasn’t been asked?
Attacking other medical professions is not going to be part of this blog’s philosophy either. We’re all in the trenches together, sometimes outside forces try to distract us from what’s important, the patient.
That’s doesn’t mean everything is smooth sailing. There’s a lot of things my colleagues in the other professions do that are quite frankly annoying and petty..from my perspective. So future possible postings could be asking these professions why do you that, is there a genuine reason or do you folks do that just to specifically annoy the lab?
One last thing that needs to be cleared up and it’s an important one. For the last twenty years, I have had the pleasure of working for the Northern Health Authority (NHA), and it’s one I would like to continue. So here’s disclaimer #2:
The material posted on this blog (The Labvocate) are the opinions of the author, and do not reflect those of the Northern Health Authority.
Hopefully the administration of NHA will be available for future dialogue and/or guest hosting.
So thank you for taking the time to read my first posting. I look forward to your thoughts and comments.
Regards,
Mark Hawkins.
Thank you for taking the time to read my blog.
Medical Laboratory Technology. What exactly is it, and why does it matter to you? For that matter, why am I putting the energy into this endeavor, instead of showing off pictures of my garden’s progress?
Recent developments have happened that have convinced me that a blog dedicated to this topic needed to be done (these developments will be discussed in future postings). So this is my blog, the Labvocate.
I will try to be informative, objective, and fair. A balance between education and editorial will be reached. I’m open to comments and suggestions for postings. Civilized discussion and comments will be most welcome.
One thing will not be done by this blog. Providing individual diagnostic services.
Diagnosing your medical problems is the job of a licensed medical doctor. Here’s disclaimer #1:
The material posted on this blog (The Labvocate) is for information purposes only, and can not be used for the purpose of diagnosing and/or the treatment of individual medical conditions.
For example there could be a posting about blood thinners (i.e. warfarin). Discussion about the technical aspects of monitoring this class of medication, or trends in therapy would be encouraged. But if a reader were to ask what their INR should be, there could be no to that answer that question. Period, end of conversation, nest topic please. If you’re not getting the answer from your physician is it because the question hasn’t been asked?
Attacking other medical professions is not going to be part of this blog’s philosophy either. We’re all in the trenches together, sometimes outside forces try to distract us from what’s important, the patient.
That’s doesn’t mean everything is smooth sailing. There’s a lot of things my colleagues in the other professions do that are quite frankly annoying and petty..from my perspective. So future possible postings could be asking these professions why do you that, is there a genuine reason or do you folks do that just to specifically annoy the lab?
One last thing that needs to be cleared up and it’s an important one. For the last twenty years, I have had the pleasure of working for the Northern Health Authority (NHA), and it’s one I would like to continue. So here’s disclaimer #2:
The material posted on this blog (The Labvocate) are the opinions of the author, and do not reflect those of the Northern Health Authority.
Hopefully the administration of NHA will be available for future dialogue and/or guest hosting.
So thank you for taking the time to read my first posting. I look forward to your thoughts and comments.
Regards,
Mark Hawkins.
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