Scientific Program

SATURDAY JUNE 20

0800-1700

Pathologists Assistants Program & PA Poster Presentations

0800-1130

Scientific Workshops W2011–W2014

1300-1630

Scientific Workshops W2021–W2024

1700-1900

Symposium: Patient Safety and Quality Assurance: Jurisdictional Quality Plans and Indicators in Interpretative Pathology: Experience in Canada and Abroad

1700-2030

Transition into the Practice of Anatomical Pathology: A Workshop for Residents

 

 

SUNDAY JUNE 21

0800-1200

Pathologists Assistants Program

0800-1130

Scientific Workshops W2111–W2114

0830-1130

Scientific Workshops W2116–W2118

1230-1400

Symposium: Communication & Documentation Pitfalls in Pathology

1300-1600

Scientific Workshops W2126–W2128

1400-1700

Symposium: Guillermo Quinonez Seminar on the Medical Humanities and International and Global Pathology combined Symposium: History of Medicine and Forensic Pathology in the Developing World

1700-1745

CAP-ACP Junior Scientist Award Lecture: The Morphologic and Immunohistochemical Spectrum of Papillary Renal Cell Carcinoma: A Study Including 132 Cases with Pure Type 1 and Type 2 Morphology as well as Tumors with Overlapping Features

1745-1830

CAP-ACP William Boyd Award Lecture: Diabetic Complications: a Journey Beyond Genes

 

 

MONDAY JUNE 22

0800-1030

Symposium: Canadian Society of Cytopathology: Urine Cytology Update: the Paris System of Reporting

0800-1030

Symposium: Hematological Pathology

0800-1030

Symposium: Pediatric and Perinatal Pathology: An Approach to the Diagnosis of Metabolic Diseases in the Perinate for the Pathologists

0900-1200

Symposium: Clinical Biology and Preventative Medicine

1100-1230

Oral Presentations

1300-1600

Symposium: Clinical Biochemistry of Extreme Physiological Conditions

1400-1700

Symposium: Education: Assessment for Learning

1400-1700

Symposium: Forensic Pathology: Ebola and Case Presentations

1700-2000

Poster Presentations

 

 

TUESDAY JUNE 23

0715-0815

Breakfast Roundtables

0800-1130

Symposium: Advanced Diagnostics: New Frontiers in Classification of Malignant Lymphoma

0800-1130

Symposium: Anatomical Pathology: Dermatopathology

0800-1130

Symposium: Neuropathology: Nerve and Muscle Pathology

0830-1200

Symposium: Advances in Point of Care Testing

1400-1700

Dr. Cam Coady Slide Seminar: Osteoblasts in Health and Disease

1700-1800

Recent Trends In Pathology: CAP Guidelines for p16 Immunohistochemistry in CIN2

 

 

WEDNESDAY JUNE 24

0730-0830

Breakfast Roundtables

0930-1230

Symposium: Toxicology

 

Symposium: Patient Safety and Quality Assurance Symposium: Quality Improvement and Innovation Partnership (QIIP)
Saturday June 20, 1700-1900

 

1700-1800

Jurisdictional Quality Plans and Indicators in Interpretative Pathology: Experience in Canada and Abroad

J. Conor O’Keane, Mater Misericordiae University Hospital; Royal College of Physicians of Ireland

 

Objectives:

At the end of this session, participants will be able to:

  • Explain how the programme focused on actionable areas i.e. scoped to be within clinician control.
  • Summarize approaches to lead change in a busy and difficult environment where services are being delivered on an ongoing basis.
  • Discuss options to use collected data effectively within the lab, hospital and country.

The talk provides an overview of the implementation of a Histopathology national quality improvement programme in response to incidents investigated in 2006/2008 indicating a lack of measurable evidence of the quality of services. The programme focuses on raising standards through the application of a systems-based approach to quality improvement. It measures the spectrum of quality in diagnostic services, as opposed to the evaluation of incidents arising in the healthcare environment and uses data to set intelligent targets. This facilitates units departments to routinely review their performance against national aggregates and drive improvement against targets.

Note: It is recognised internationally that 100% elimination of error is not possible. The programmes focus on identifying error and preventing or minimising the harm that may arise from the error. The talk sets out the steps involved in designing, implementing and embedding the programme. The session will be of value to all those working in laboratory medicine, pathology residents, medical scientists, general and anatomic pathologists.

 

1800-1900

Jurisdictional Quality Plans and Indicators in Interpretative Pathology: the Canadian Perspective

Panel Discussion with:

Katherine Chorneyko, Quality Management Program (Ontario)
Laurette Geldenhuys, Quality Programs in Halifax
John Srigley, Quality Initiative in Interpretive Pathology (CPAC)
Tamara Trotter, Alberta Provincial Quality Assurance Program

 

Question to be explored include:

  1. Barriers to implementation.
  2. Approach to Evaluation of evidence for choosing indicators in an interpretive QA program.
  3. What worked/did not work/solutions based on experience to date.

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Transition into the Practice of Anatomical Pathology: A Workshop for Residents
Saturday June 20, 1700-2030

 

Transition into the Practice of Anatomical Pathology: A Workshop for Residents

Bojana Djordjevic, University of Ottawa

David Grynspan, University of Ottawa

Pauline Henry, University of Toronto

 

Objectives:

At the end of this session, participants will be able to:

  • Have a more concrete understanding of the different patterns of practice in anatomical pathology.
  • Gain insight into the task of preparing for and seeking their first position as a staff anatomical pathologist.
  • Learn about the multiple facets of adapting to becoming a staff pathologist including independent diagnostic sign-out, increased participation and responsibility within multidisciplinary teams and finding one’s niche within the pathology department in areas of medical education, research or administration.
  • Become aware of various strategies for obtaining and maintaining a healthy work-life balance.

Finding first employment and transition into practice can be a daunting task for anatomical pathology residents. For many, the pressure is felt well before fellowship or even residency training ends. The central objective of this workshop is to provide an informed, practical and organized guide to this process. We will share the collective experience of three junior staff pathologists who practice in different settings ranging from academic subspecialty to general community. The workshop will consist of lecture, interactive panel discussion and open forum components.

The workshop will run from 1700-1930, followed by a dinner from 1930-2030.

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Symposium: Communication & Documentation Pitfalls in Pathology
Sunday June 21, 1230-1400

 

Communication & Documentation Pitfalls in Pathology

Kathryn G. Reducka, Physician Risk Manager, The Canadian Medical Protective Association

 

Objectives:

At the end of this session, participants will be able to:

  • Identify when a duty of care may exist when consulting or giving a second opinion.
  • Explain the importance of documentation when doing an intradepartmental review.
  • Employ techniques to reduce medico-legal risks and improve patient safety in pathology practice.

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Symposium: Guillermo Quinonez Seminar on the Medical Humanities and International and Global Pathology combined Symposium: History of Medicine and Forensic Pathology in the Developing World
Sunday June 21, 1400-1700

 

Chair: Laurette Geldenhuys, Queen Elizabeth II Health Science Centre; Dalhousie University

 

1400-1445

Part I: As is Our Pathology, So is Our Practice

James R. Wright, Jr., University of Calgary

 

Objectives:

At the end of this session, participants will be able to:

  • Examine the history of a commonly cited quote attributed to Sir William Osler.
  • Explore the role of William Boyd in the preservation of the quote.
  • Describe the true meaning of the quote.

1445-1500 Refreshment Break

 

1500-1600

Part II: Why Did Cytopathology Take So Long to Thrive?

James R. Wright, Jr., University of Calgary

 

Objectives:

At the end of this session, participants will be able to:

  • Examine the history of Cytopathology with an emphasis on Lionel S. Beale’s pioneering work in the 1850s-1860s and that of Leonard S. Dudgeon in 1927.
  • Explain the 60+ year hiatus with little progress between Beale and Dudgeon.
  • Explain the lack of initial impact of George Papanicolaou’s and Aurel A. Babeş’s papers published in 1928 introducing the diagnosis of Cervical Cancer using vaginal smears.
  • Describe why there was another gap with little progress until the publications of Papanicolaou & Trout in the early 1940s and why Cytopathology immediately thrived thereafter.

This presentation will cover two historical topics. The first relates to the history of cytopathology. Lionel S. Beale made some of the earliest contributions to Cytopathology in the 1850-60s, but few advances were made over the next 60+ years. In 1927, Leonard S. Dudgeon published his wet film method for intraoperative diagnosis and a year later George Papanicolaou and Aurel A. Babeş independently discovered that cervical cancer can be diagnosed using vaginal smears. Even after these huge advancements, little progress was made until the early 1940s when exfoliative Cytopathology flourished. None of the standard histories of Cytopathology explain these two gaps. The author will explain these two gaps by putting them into the context of the history of cancer. The second, topic will explore the history of a quote that is cited whenever there is a pathology scandal in Canada. The quote “as is your pathology, so is your practice” is attributed to William Osler.

 

1600-1700

Forensic Medicine and International Law

Christopher Milroy, The University of Ottawa

 

Objectives:

At the end of this session, participants will be able to:

  • Discuss the basic types of International Law.
  • Discuss the history of Forensic Medicine in War Crimes.
  • Discuss the history of Forensic Medicine in Human Rights abuses.
  • Discuss the role of Forensic Medicine in Humanitarian emergencies.
  • Explore the different roles Forensic Medicine plays in Humanitarian Law and Human Rights law.

The presentation examines the role of Forensic Medicine in War Crimes, Human Rights abuses and Humanitarian emergencies from the Second World War to the current times. It examines the types of international law, the use and abuse of Medicine in conflicts with a particular focus on Forensic Pathology.The presentation particularly looks at incidents in the Second World War (Katyn massacre), the war in the Former Yugolslavia, human rights abuses and Regional Human Rights Tribunals. The presentation also touches on the potential conflict between gathering evidence for criminal trials and the need for humanitarian assistance.

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CAP-ACP Junior Scientist Award Lecture: The Morphologic and Immunohistochemical Spectrum of Papillary Renal Cell Carcinoma: A Study Including 132 Cases with Pure Type 1 and Type 2 Morphology as well as Tumors with Overlapping Features
Sunday June 21, 1700-1745

 

Lecturer/Award Recipient: Fadi Brimo, McGill University Health Centre

 

Objective:

At the end of this session, participants will be able to:

  • Describe the issues encountered in subtyping papillary renal cell carcinoma and the way to address them.

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CAP-ACP William Boyd Award Lecture: Diabetic Complications: a Journey Beyond Genes
Sunday June 21, 1745-1830

 

CAP-ACP William Boyd Award Lecture: Diabetic Complications: a Journey Beyond Genes

Lecturer/Award Recipient: Subrata Chakrabarti, London Health Sciences Centre

 

Objectives:

At the end of this session, participants will be able to:

  • Discuss pathogenetic mechanisms leading to chronic diabetic complications.
  • Describe specific epigenetic alterations in chronic diabetic complications.
  • Recognize the roles of non-coding RNAs in chronic diabetic complications.

Chronic diabetic complications are major causes of mortality and morbidity in the western world. Such complications in diabetic patients cause renal failure, vision loss, heart failure etc. Glucose induced cellular damage alters a large number of molecules ultimately causing functional and structural changes in the organs.

 

Multiple intracellular signaling pathways, initiated primarily in the endothelial cells as a result of hyperglycemia, converge on the cell nucleus changing gene transcription and ultimately manifesting as functional and structural damages. Such alterations occur in the absence of DNA mutation through epigenetic mechanisms. These mechanisms include histone acetylation, DNA methylation, ubiquitination, changes in non-coding RNAs such as microRNA (miRNA), long non-coding RNA etc.

Glucose induced aberrant signaling activates transcription factors. However, to initiate gene transcriptions, histone acetyl transferases (HATs) eg.p300, are essential as they open up the chromatin for gene transcription. HAT activities are balanced by histone deacetylases (HDACs). Overall, such alterations result in accelerated aging-like changes in the endothelial cells in diabetes. mRNAs are further subjected to transcriptional repression or degradation through miRNA. Specific miRNAs also regulate production of HATs and HDACs. Furthermore, histone methylation regulates miRNA production. Hence complex webs of epigenetic pathways are involved in the pathogenesis of functional and structural changes in chronic diabetic complications. Such processes lead to increased production of vasoactive factors, increased expression of mesenchymal markers and extracellular matrix proteins and reduced expression of endothelium-specific transcripts, causing phenotypic changes in the endothelial cells, indicative of endothelial to mesenchymal transition.

We have identified these changes, in the endothelial cells and in the tissues of diabetic animals as well as in human diabetes. This presentation will identify new mechanisms and potential novel treatment strategies targeting epigenetic and transcriptional machinery for the prevention and treatment of chronic diabetic complications.

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Canadian Society of Cytopathology: Urine Cytology Update: the Paris System of Reporting
Monday June 22, 0800-1030

 

Urine Cytology Update: The Paris System of Reporting Urinary Tract Cytology

Güliz A. Barkan, Loyola University Medical Center

Fadi Brimo, McGill University Health Centre

 

Objectives:

At the end of this session, participants will be able to:

  • Explain the findings in normal urine cytology, common, and uncommon neoplasms in urinary tract cytology.
  • Summarize the key morphological features observed in all categories of the Paris System of reporting urinary tract cytology.
  • Discuss the diagnostic criteria set forth in the Paris System of reporting urinary tract cytology, and review the clinical implications and outcome of each category.
  • Review the most commonly used ancillary tests, and their utilization in diagnosis of urinary tract cytology.

Urinary tract cytology is notoriously a difficult subject due to the lack of a standardized reporting system and subjectivity of the diagnostic criteria. This presentation is based on the Paris System of reporting urinary tract cytology – an international effort to unify and standardize the reporting terminology of urinary tract cytology. The presentation is designed to address the salient morphological/diagnostic criteria and the reporting terminology. The indications, judicious utilization, and practical integration of ancillary tests (FISH, etc.) will be discussed as well. Importantly the clinical implications of individual diagnostic categories will be covered, with the associated percentages of risk of development of high-grade urothelial carcinoma. The session will be of value to: pathology residents, general and anatomic pathologists as well as cytopathologists.

 

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Symposium: Hematological Pathology
Monday June 22, 0800-1030

 

0800-0915

Diffuse Large B-cell Lymphoma

Leonard Jeffrey Medeirios, The University of Texas MD Anderson Cancer Center

 

Objectives:

At the end of this session, participants will be able to:

  • Diagnose morphologic variants and subtypes of diffuse large B-cell lymphoma recognized in the World Health Organization classification.
  • Recognize clinicopathologic and immunophenotypic findings that have prognostic value in patients with diffuse large B-cell lymphoma.
  • Apply results of conventional cytogenetic analysis and fluorescence in situ hybridization to enhance diagnosis of diffuse large B-cell lymphoma.

Diffuse large B-cell lymphoma is the most common type of lymphoma worldwide. Although many patients respond well to standard chemotherapy, about 40% of patients relapse or are refractory to primary therapy and have a poor prognosis. It has become clear that a “one size fits all” approach to pathologic diagnosis and therapy is insufficient. Diffuse large B-cell lymphoma is a heterogeneous category of lymphoma as currently defined with highly variable clinical, morphologic, and genetic features. These features can be used for risk stratification and also point to potential therapeutic targets that can be exploited in the design of new therapeutic agents and regimens.

This presentation will begin with the relatively “old fashioned” pathologic definition of this disease. The highly variable clinical, immunophenotypic, cytogenetic, and molecular genetic features of diffuse large B-cell lymphoma and their impact on prognosis or treatment planning will discussed. In addition, various subgroups of diffuse large B-cell lymphoma recognized in the current lymphoma classification system also will be reviewed. It now seems reasonable to conclude that the diagnosis of diffuse large B-cell lymphoma, by itself, is important but insufficient for patient care. Statements must be made regarding tumor biology that will either be essential for risk stratification or will highlight potential targets for which currently therapeutic drugs can be used or for which newer agents in development may be used if the patient experiences relapse.

This session will be of value to pathologists, pathologists-in-training, pathology assistants, and others involved in the care of patients with diffuse large B-cell lymphoma.

 

0915-1030

Lymphoma Classification: The Importance of Getting it Right – Clinical Perspective

Ronan Foley, Hamilton Health Sciences, McMaster University

 

Objectives:

At the end of this session, participants will be able to:

  • Know how accurate diagnosis has important consequences on treatment options for patients.
  • Know newer therapeutic approaches in the treatment of T-cell lymphomas based on diagnosis.
  • Know areas of uncertainty, emerging improvements in treatment options for patients with B-cell lymphomas.

As a hematologic oncologist, the clinician’s perspective on pathologic diagnosis of malignant hematologic neoplasms is presented. Emphasis on some of the newer treatment options and pathways as well as areas of uncertainty in treatment algorithms will be discussed.

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Symposium: Pediatric and Perinatal Pathology: An Approach to the Diagnosis of Metabolic Diseases in the Perinate for the Pathologists
Monday June 22, 0800-1030

 

An Approach to the Diagnosis of Metabolic Diseases in the Perinate for the Pathologists

Chantal Bernard, McGill University

Miriam Blumenkrantz, Montreal Children’s Hospital

Michael Geraghty, Childrens Hospital Eastern Ontario, University of Ottawa

Fabienne Parente, McGill University Health Center

 

Objectives:

At the end of this session, participants will be able to:

  • Define the metabolic autopsy in 2015 and recognize its indications.
  • Recognize selected clinical and pathological presentations of metabolic disorders.
  • Develop an interdisciplinary approach for diagnosis.
  • Discuss the optimal biochemistry testing for diagnosis.
  • Discuss guidelines for peri-mortem and post-mortem sampling (metabolic autopsy protocol).
  • Recognize how large scale DNA testing will change future metabolic diagnosis.

A panel of experts representing medical genetics, medical biochemistry and pediatric pathology will present a practical approach to the diagnosis of metabolic diseases in the perinatal-neonatal period, as well as an update on metabolic autopsy. Using clinical vignettes, they will review selected conditions, clinically, biochemically and pathologically, that may indicate an underlying metabolic disease, such as hydrops/hepatosplenomegaly, liver failure/fatty liver, cardiomyopathies and neonatal encephalopathies. The participant will also be informed on practical guidelines on metabolic autopsy- for optimal tissue sampling in the case of suspected metabolic disease: the when, how, by who, how long after demise, how much, what tissues, for what tests.

This symposium is targeted for a wide audience of pathologists and pathology residents.

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Clinical Biology and Preventative Medicine
Monday June 22, 0900-1200

 

Chair: Mathieu Provencal, Hôpital Maisonneuve-Rosemont

 

Symposium Objectives:

At the end of this session, participants will be able to:

  • Discuss recent data about diseases epidemiology.
  • Recognize how good or bad habits could impact quality of life.
  • Identify different strategies and/or new clinical biomarkers set up within the clinical laboratory that can assist both patients and doctors in achieving prevention (e.g. new clinical guidelines for diabetes, cardiology, etc.).

0900-0950

New Concepts in Cardiovascular Disease Prevention

Martin Juneau, Montréal Heart Institute; University of Montreal

 

Objectives:

At the end of this session, participants will be able to:

  • Recognize the minimal amount of exercise necessary for chronic diseases prevention and what is the “dose-response curve” for exercise.
  • Describe the role of high intensity exercise training versus low to moderate continuous exercise.
  • Discuss the benefits of the Mediterranean (or similar) diet and the role of the microbiome with respect to nutrition.

According to the World Health Organization, non-communicable diseases (NCDs) caused 38 million deaths in 2012 and 42% of these or 16 million deaths were premature and avoidable. The costs of treating these diseases are devastating even for the richest states.

Strategies to prevent NCDs must come from all sectors of society and not only from the health sector. These include public policies in agriculture, taxation, transportation, education, urban design, etc. At the individual level, new concepts in exercise and diet will be presented.

 

0950-1020 Refreshment Break

 

1020-1110

Cancer Prevention

Richard Beliveau, Notre-Dame Hospital

 

Objectives:

At the end of this session, participants will be able to:

  • Recognize the causes of cancer, the chronic aspect of its development, and the interaction of heredity and lifestyle factors that define its progress.
  • Discuss the major role lifestyle plays in prevention: use of tobacco, excess weight, exercise, nutrition, exposure to UV rays.
  • Describe the application of concrete intervention strategies, stemming from recent research, to reduce the probabilities of developing cancer and, in the event of cancer, to maximize the chances of survival.

The majority of current deaths due to cancer could be avoided. A horrifying and enigmatic disease, cancer is often seen as a calamity that strikes at random, an adversity against which we are powerless.

Numerous studies have shown that there is a link between the use of tobacco, excess weight, a sedentary lifestyle, exposure to ultraviolet (UV) rays or lack of sleep, and the progression of cancer, and that most current cancer deaths could be avoided with simple lifestyle changes. It is possible to adopt a defensive approach against cancer by applying ten major recommendations which can concretely reduce the probability of developing this disease.

 

1110-1200

If Lifestyle is the Medicine, What’s the Spoon?

David L. Katz, Yale University School of Medicine

 

Objectives:

At the end of this session, participants will be able to:

  • Describe how chronic disease burden is attributable to lifestyle.
  • Discuss which lifestyle practices most influence health outcomes.
  • Recognize the evidence for cultural delivery of lifestyle ‘as’ medicine.

We have known now for a span of decades that the leading causes of premature death and chronic disease in the United States and increasingly around the world are behavioral factors under our potential control. We have as well consistent evidence from diverse sources indicating that amelioration of a short list of such factors, with an emphasis on dietary pattern, physical activity, and tobacco use, can slash rates of chronic disease and premature death alike. But choices people make are governed ultimately by choices people have. In an obesigenic and morbidigenic environment that conspires mightily against healthful living, salutary behavior change is all too often forestalled. Constructive and compassionate guidance from clinicians can help confront this challenge, and the case is made that lifestyle in medicine is of real value. But the case is also made that lifestyle is not fundamentally a clinical issue but a cultural one. For the full promise of lifestyle medicine to be realized, it must be lifestyle as medicine—and spoons full of cultural change will be required to make that medicine go down.

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Oral Presentations
Monday June 22, 1100-1230

 

Objectives:

At the end of this session, participants will be able to:

  • Evaluate and validate different educational tools in residency training for learning and assessment.
  • Identify new findings and techniques in Pathology diagnosis impacting on prognostication and patient care.
  • Identify new biomarkers or molecular signatures as tools for diagnosis and or prognosis.
  • Assess the significance of new findings and observations in the context of current literature.

Session 1: Innovations in Residency Education and Assessment

 

1100-1115

O101 Towards competency by design: establishing a ‘transition to pathology’ rotation for PGY1 residents
Chelsea Maedler1, Livia Florianova1, Pylyp Zolotarov1, Linnea Duke1, Milene Gonzalez-Verdecia1, Richard Fraser1, Jason Karamchandani1, Zu-Hua Gao1, Ramila Amre1, Chantal Bernard1. 1Department of Pathology, McGill University, Montreal Quebec Canada.

 

1115-1130

O102 Learning and networking opportunities at a resident-led multidisciplinary academic day: how social media has helped
Deepti M Ravi1,3, Laura Morrison2,3, Winnie Chan2,3, Alex Chorley2,3, Christine Orr2,3, Teresa Chan2,3. 1Department of Pathology, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5. 2Department of Medicine, McMaster University, Hamilton, ON, 3McMaster Multidisciplinary Academic Day Organizing Committee.

 

1130-1200

O103 Autopsy education in Canada: assessing need for competency-based education through survey of educators
Stephanie L. Reid1,2, Carolyn M. Morris-Larkin1,2, Vernon R. Curran1. 1Memorial University of Newfoundland, St. John’s, NL; 2Discipline of Laboratory Medicine, Eastern Health, St. John’s, NL.

 

1145-1200

O104 An Interactive Computer Based Model for the Standardization of Oral Examinations in Anatomical Pathology
Elena D. Diaconescua, Alex O. Salagean, Hala Faragallaa,b, Andrea Grina,b, Vladimir Iakovleva,b, Adriana Krizovaa,b, George M Yousefa,b. aLaboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada; bDivision of Pathology, St. Michael’s Hospital, Toronto, Ontario.

 

1200-1215

O105 CanMEDS OSCE in Anatomical Pathology residency program
Syed M. Abedia, Jeremy Danielsa, Snezana Popovica. aDepartment of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario.

 

1215-1230

O106 Remediation of pathology residents in difficulty: the University of Toronto experience
Julia Keitha, Nadia Ismiila, Shachar Sadea, Simon Raphaela, Susan Glover Takahashib, Matthew Cesaria. aLaboratory Medicine and Pathobiology, University of Toronto, Toronto, ON; bPostgraduate Medical Education, University of Toronto, Toronto, ON.

 

Session 2: Toward Fulfilling the Promise of Precision Medicine and Theranostics

 

1100-1115

O201 The prognostic value of immune biomarkers in leiomyosarcoma
Samantha Burugua, Matt van de Rijnb and Torsten Nielsena. aDepartment of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC; bDepartment of Pathology, Stanford University Medical Center, Stanford, CA.

 

1115-1130

O202 Cooling colorectal cancer with TRPM8 agonists
Liena Zhao1, Stefan Urbanski1, Rithwik Ramachandran2. 1Department of Pathology, University of Calgary, Alberta, Canada; 2Department of Physiology and Pharmacology, University of Calgary, Alberta, Canada.

 

1130-1145

O203 Reappraisal of immunohistochemistry in the diagnosis of ovarian mucinous neoplasms: the added value of SATB2 and the relevance of biomarker discovery through proteomic database mining
Sarah Stricklanda, Jason Wassermana, Bojana Djordjevica, Ana Giassia, Carlos Parra-Herrana. aDepartment of Pathology, University of Ottawa. Ottawa, Ontario.

 

1145-1200

O204 Novel KI67 IHC assessment in breast cancer with high inter-observer reproducibility
Gilbert Bigrasa, Judith Hughb, Wei-Feng Donga, Richard Berendta, Hua Yangc. aLaboratory Medicine and Pathology Cross Cancer Institute, University of Alberta, Alberta Canada; bLaboratory Medicine and Pathology, University of Alberta, Alberta, Canada; cDepartment of Laboratory Medicine and Pathology, University of Calgary, Alberta, Canada.

 

1200-1215

O205 Expression of thyroid hormone alpha receptor (THRα) isoforms in triple negative breast cancer (TNBC)
Katarzyna J. Jerzaka, Jessica G. Cockburnb, Gregory R. Pondb, Robin Hallettc, John A. Hassellc, Kathleen I. Pritcharda,d, Sukhbinder K. Dhesy-Thindb, Anita Baneb,e. aDepartment of Medicine, University of Toronto, Toronto, ON. bDepartment of Oncology, Juravinski Cancer Centre, Hamilton, ON. cDepartment of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON. dDepartment of Public Health Sciences, University of Toronto, Toronto, ON. eDepartment of Pathology and Molecular Medicine, McMaster University, Hamilton, ON.

 

1215-1230

O206 Estimating recurrence in lobular breast cancer using Magee equations
Nina Chang1, Amelia Parrott1, Angel Arnaout2, Susan J Robertson1. 1Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON; 2Department of General Surgery, University of Ottawa, Ottawa, ON.

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Clinical Biochemistry of Extreme Physiological Conditions
Monday June 22, 1300-1600

 

Chair: Alexandre Benoit, Hôpital de Verdun

 

Symposium Objectives:

At the end of this session, participants will be able to:

  • Discuss what we consider as extreme conditions for biochemical parameters.
  • Discuss different extreme or extraordinary conditions that influence precise biological aspects.
  • Identify what and how biochemical parameters may influence clinical follow-up.
  • Discuss what we consider normal range and critical values influenced by environmental and extreme activities.

1300-1350

Cardiovascular Consequences of Intermittent Hypoxemia in Health and Disease

Marc Poulin, University of Calgary

 

Objectives:

At the end of this session, participants will be able to:

  • Identify the consequences of intermittent hypoxemia in the patient with long standing obstructive sleep apnea.
  • Explain the effects acute exposure to intermittent hypoxia (molecular, physiological) in otherwise healthy young adults.
  • Assess the implications of the above findings to the high altitude workers who travel from sea level to high altitude for work.

This talk will address the question of whether there should be concern over the potential negative consequences – especially for the cardiovascular system – of the intermittent hypoxemia experienced by workers who travel from sea level to high altitude ( > 3,000m) for work (i.e., workers in countries such as Chile, Argentina, and Peru). We will discuss this possibility first by discussing the most thoroughly documented effects of nocturnal intermittent hypoxemia in the patient with long standing obstructive sleep apnea. Then we consider the consequences of intermittent hypoxemia in otherwise healthy young adult humans, and finally conjecture on how these results might apply to the high altitude worker and what to do about it. The intermittent hypoxemia attending severe obstructive sleep apnea has been well documented to produce oxidative stress, sensitization of carotid chemoreceptor output and marked reductions in endothelium-dependent vasodilation, leading to persistent daytime elevations in sympathetic vasomotor outflow and systemic hypertension. In healthy young awake adult humans brief periods of daily hypoxic exposure have not elicited adverse cardiovascular after-effects. On the other hand, recent studies mimicking the intermittent hypoxemia of sleep apnea in healthy subjects for up to two weeks shows persistent (daytime) elevations in muscle sympathetic nerve activity (MSNA), impaired vascular vasodilation and moderate elevations in systemic blood pressure. In summary, given our current questioning of both the benefits (to performance) and the (cardiovascular) risks of prolonged intermittent hypoxemia, it seems important to determine for each worker when the risks might exceed the benefits. We address the problem of cardiovascular consequences of intermittent hypoxemia as experienced clinically in severe obstructive sleep apnea and in healthy adults and the implications of these findings to the high altitude workers who travel from sea level to high altitude for work.

 

1350-1440

Pushing the Heart to the Limit: the Physiologic and Biochemical Consequences of Prolonged and Intense Physical Exercise

Michael White, Montreal Heart Institute

 

Objectives:

At the end of this session, participants will be able to:

  • Review the impact of chronic and intense exercise on physiological responses and on biomarkers in humans.
  • Identify the changes in biochemistry parameters associated with the marathon and ironman challenges.
  • Present the impact of training and conditioning on those responses.

Chronic regular exercise provides significant benefits on cardiovascular, cardio-metabolic, and overall health. In fact the practice of regular moderate aerobic exercise may prolong life by 8 to 10 years and decrease cardiovascular disease and diabetes by about 50%. In addition, chronic exercise may reduce the risk of some cancer by 15%. Moreover chronic exercise decreases the circulating markers of inflammation.

Despite the benefits related to the practice of regular exercise, strenuous and intense exercise such as the marathon or Ironman may cause some structural changes to the myocardium. In fact, some studies have reported elevation in cardiac markers such has BNP, Troponin, IL-6, cardiac edema, as well as global left ventricular dysfunctions following strenuous long distance endurance exercise. In addition, some recent investigations have reported sub-clinical inflammation in athletes engage in high volume endurance exercise training. Finally the life-long risk of atrial fibrillation increases with some sports such has running or cycling.

The effects of intense aerobic training and competitive endurance exercise remain controversial. Intense and prolonged endurance exercise such as the marathon results in high cardiovascular strain whose clinical relevance, especially for middle age and older athletes is unclear and remains a matter of controversy. There is a need for more investigations on the metabolic consequences of intense endurance exercise especially in amateur runners over the age of 35 years.

 

1440-1510 Refreshment Break

 

1510-1600

Clinical Laboratory Support in the International Space Program

Kathleen A. McMonigal, NASA/Johnson Space Center

 

Objectives:

At the end of this session, participants will be able to:

  • Discuss medical support for space flight missions.
  • Name the effects of long-duration space flight on the human body.
  • Discuss international cooperation in the Space Program.

This presentation will provide a brief overview of human physiology in microgravity. The presentation will review medical support for human space missions, with emphasis on clinical laboratory support for space flight. Support for surveillance of astronaut health will be reviewed. The speaker will briefly address research countermeasures and considerations for space flight research. The presentation will include introduction to biomarker detection technologies, including hardware and devices that may be deployed on future space flight missions. This session will be of value to pathologists, pathology residents, clinical chemists, and scientists.

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Symposium: Assessment for Learning
Monday June 22, 1400-1700

 

Chair: Marcio Gomes, University of Ottawa, The Ottawa Hospital

 

1400-1500

Assessment for Learning: The Basis of Competence Based Medical Education

Farhan Bhanji, McGill University, Royal College of Physicians and Surgeons

 

Objectives:

At the end of this session, participants will be able to:

  • Discuss the pivotal role of Assessment-for-learning in Competence Based Medical Education.
  • Contrast assessment-of-learning and assessment-for-learning.
  • Describe the components and tools of an assessment-for-learning program.

1500-1530 Refreshment Break

 

1530-1630

How Would Assessment for Learning Look Like in Pathology?

Marcio Gomes, The Ottawa Hospital, University of Ottawa

Christopher Davidson, Queen’s University

Daniel Fontaine, University of Alberta

 

Objectives:

At the end of this session, participants will be able to:

  • Discuss assessment-for-learning tools that could be applied to pathology and laboratory medicine.
  • Use structured direct observation as an assessment tool in pathology.
  • Describe the elements of effective feedback.

This will be an interactive session to highlight how structured observation can be used in the context of competency-based resident training in Pathology.

 

1630-1700

Forum – Assessment-for-learning (all presenters)

The Royal College of Physicians and Surgeons of Canada (Royal College) developed the CanMEDS framework of competencies. The framework became a mandatory requirement for accreditation. The next steps of implementation will require fully competence-based training programs, also know as Competency-by-design and anatomical pathology will be in the 2016 cohort roll out. This session will discuss the concepts of assessment-for-learning and its pivotal role in Competence Based Medical Education. Both concepts and tools will be explored and a practical approach to the implementation of assessment-for-learning in pathology will be demonstrated.

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Forensic Pathology: Ebola and Case Presentations
Monday June 22, 1400-1700

 

Chair: Jacqueline L. Parai, The Ottawa Hospital

 

1400-1530

We Need to Talk About Ebola

Frances Jamieson, Public Health Ontario and University of Toronto

 

Objectives:

At the end of this session, participants will be able to:

  • Summarize the epidemiology, transmission and natural reservoirs, pathophysiology, and clinical presentation of Ebola Virus Disease.
  • Discuss current recommendations for collection, handling, processing and the diagnostic laboratory testing of specimens from patients with suspect Ebola Virus Disease.
  • Review and describe the role of public health laboratories and the Canadian Public Health Laboratory Network in the response to emerging and re-emerging pathogens.

Since Ebola Virus (EBOV) was first discovered in 1976 in the Democratic Republic of Congo, it has been responsible for several outbreaks. The 2014 outbreak in West Africa is the largest EBOV outbreak in history, and is also the first outbreak in West Africa, and the first epidemic. The risk of EBOV infected individuals entering Canada is low however the potential for infected travellers and health-care workers returning to Canada exists. The public health system must be prepared to respond and be able to rapidly identify and diagnose persons at risk for EBOV disease to prevent transmission and spread. This presentation will review and summarize EBOV and EBOV disease, describe laboratory diagnostic testing and the role of the public health laboratory system in the response to emerging and re-emerging pathogens such as EBOV.

This session will be of value to general and anatomic pathologists and other laboratory physicians and residents, pathology assistants and technical staff.

 

1530-1600 Refreshment Break

 

1600-1620

Case Presentation

Christopher Milroy, University of Ottawa

 

Objectives:

At the end of this session, participants will be able to:

  • Discuss infections and intravenous drug misuse.
  • Discuss the role of microbiology in the autopsy.
  • Discuss the histopathology of necrotizing fasciitis.

This case involves a 54 year old man with a known history of intravenous drug misuse who presented to the Emergency Room with pain from his arthritis. He was known to have osteoarthritis and was on pain medication. He stated that he had been injected by a friend with a pain killing drug because of his level of pain. He was noted to have some developing cellulitis in his right antecubital fossa and was prescribed antiobiotics and a fentanyl patch and was discharged home. Subsequnetly that day he was admitted in extremis to another hospital, had multiple cardiac arrests and could not be resuscitated.

At autopsy he had early decompositional changes more advanced than expected. A fentanyl patch was in-situ. The organs did not show major macroscopic pathology except that the lungs were heavy. A swab of the right antecubital fossa grew Group A Streptococcus and microscopy showed a necrotizing fasciitis with large numbers of Streptococci seen on Gram stains. Toxicology revealed the presence of benzoylecgonine but not cocaine, oxycodone and hydromorphone.

Death was due to necrotizing fasciitis secondary to Group A Streptococcal infection.

This presentation will be of value to pathology residents, general and anatomical pathologists, pathology assistants, microbiologists and toxicologists.

 

1620-1640

Case Presentation

Jacqueline Parai, Eastern Ontario Regional Forensic Pathology Unit

 

Objectives:

At the end of this session, participants will be able to:

  • Discuss the Influenza A/H1N1 2009 pandemic.
  • Recognize the pulmonary pathology findings seen in fatal H1N1 infections.
  • Discuss the risk factors and comorbidities seen in cases of fatal H1N1 infections.

A death due to an H1N1 influenza infection will be presented, this will include the decedent’s clinical history and autopsy findings. The literature describing the 2009 influenza A/H1N1 pandemic will also be discussed.

The session will be of value to pathology assistants who participate in autopsy pathology, pathology residents, general pathologists, anatomic pathologists and forensic pathologists.

 

1640-1700

Case Presentation

Michael S. Pollanen, University of Toronto

 

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Symposium: Advanced Diagnostics: New Frontiers in Classification of Malignant Lymphoma
Tuesday June 23, 0800-1130

 

0800-0900

Diagnostic Work Up of Double Hit Lymphomas – What Pathologists Need to Know

Nathalie Johnson, Jewish General Hospital, McGill University

 

Objectives:

At the end of this session, participants will be able to:

  • Describe a cost effective approach to identify cases that require FISH for MYC and BCL2.
  • Describe the rationale for implementing MYC by immunohistochemistry in your institution.
  • Define the prognostic significance of other markers such as Ki-67 protein and BCL6 protein expression as well as genomic amplifications of MYC.

The survival of patients with aggressive lymphomas that harbor concurrent translocations in MYC and BCL2 (i.e. double hit lymphomas, DHIT) has been extremely poor. Recently, high-dose chemotherapy regimens have been shown to be superior to the standard RCHOP regimen in selected patients. Other oncogenic events can also increase MYC and BCL2 protein expression in cases that don’t have the gene translocations. These so-called MYC+/BCL2 “dual expressers” are also associated with a poor outcome with RCHOP. However, the optimal treatment for these patients is unclear. Given the prognostic significance of concurrent MYC and BCL2 deregulation, either by FISH or IHC, pathologists may be asked to perform additional diagnostic tests in cases of aggressive lymphomas.

 

0900-1000

Cell-of-origin in diffuse large B-cell lymphoma: approaching the clinic

David Scott, BC Cancer Agency

 

Objectives:

At the end of this session, participants will be able to:

  • Describe the cell-of-origin distinction in DLBCL and the underlying biology.
  • Assess the utility of COO as a biomarker in the clinical context.
  • Appraise the performance of established and emerging assays for COO.

Diffuse large B-cell lymphoma (DLBCL), the most common form of lymphoma world-wide, comprises a heterogeneous group of cancers united by common morphology, immunophenotype and aggressive clinical behaviour. Although the majority of patients are cured with modern immunochemotherapy, 30-40% experience disease progression or relapse, with most of these patients dying from lymphoma. In 2000, using gene expression profiling, it was shown that DLBCL contained two major molecular subtypes: activated B-cell-like (ABC) DLBCL and germinal B-cell-like (GCB) DLBCL – the so-called “cell-of-origin” (COO). These two subtypes display different molecular pathogenesis and outcomes to treatment. Most recently, it has been demonstrated that they also have different responses to targeted drugs. Thus COO is both a prognostic and predictive biomarker that is rapidly becoming relevant to clinical practice. This presentation will summarize the COO distinction, the underlying biology, the emerging clinical relevance and both the established and new assays for COO. Finally, it will discuss the use of assays to guide the move from the current “one-size fits all” approach to treatment of DLBCL to treatment tailored to tumour biology. The session will be of value to: pathology residents, PAs, general and anatomic pathologists.

 

1000-1030 Refreshment Break

 

1030-1130

Large B-cell Lymphoma Work Up

Emina Emilia Torlakovic, University of Toronto

 

Objectives:

At the end of this session, participants will be able to:

  • Describe required minimal work up for aggressive DLBCL.
  • Describe new/emerging assays for immunophenotyping.
  • Describe new/emerging assays for RNA analysis in situ.

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Symposium: Anatomical Pathology: Dermatopathology
Tuesday June 23, 0800-1130

 

0800-0845

Small Lesions that Get Under Your Skin

Sébastien Labonté, CHU-L’Hôtel-Dieu de Québec

 

Objectives:

At the end of this session, participants will be able to:

  • Compare different mesenchymal lesions of the skin.
  • Select the appropriate adjuvant tests to order.
  • Formulate a short differential diagnosis.

Several mesenchymal lesions of the skin will be reviewed, using real-life cases. Emphasis will be on recognition of look-alikes and avoidance of diagnostic pitfalls. Rational use of immunohistochemistry and molecular tests will also be discussed. The session will be of value to pathology residents and pathologists.

 

0845-0930

Instructive Cases in Dermatopathology – Lymphoid Tumors

Lyn McDivitt Duncan, Harvard Medical School, Massachusetts General Hospital Dermatopathology Service

 

Objectives:

At the end of this session, participants will be able to:

  • Formulate an appropriate differential diagnosis when faced with a dense cutaneous lymphoid infiltrate.
  • Specify immunohistochemical stains that will help distinguish cutaneous lymphomas of different cell lineages.
  • Identify important benign mimics of aggressive tumors.

This session will focus on instructive cases of cutaneous lymphoid tumors. In most cases of cutaneous lymphoid infiltrates, correlating the clinical findings with the histomorphology and immunophenotype is essential to arriving at the correct diagnosis. Cases that highlight some pitfalls and clues to arriving at the correct diagnosis will be presented. The session will be of value to trainees in pathology and practicing pathologists.

 

0930-1000

Instructive cases in Dermatopathology – Cutaneous Infections

Victor A. Tron, St. Michael’s Hospital

 

Objectives:

At the end of this session, participants will be able to:

  • Understand the diversity of cutaneous infections.
  • Have an approach to diagnosis using traditional and modern approaches.
  • Understand the clinical importance of diagnosing these disorders.

A number of cases will be presented that will centre around the role of infectious agents in skin disease. This will also include clinical images, which will highlight the importance of close collaboration with treating clinicians. This session will be of interest and value to medical students, residents, PAs, Pathologists and other laboratory physicians and scientists.

 

1000-1030 Refreshment Break

 

1030-1130

A New Pragmatic Approach to Difficult Melanocytic Lesions – Illusion or Reality?

Danny Ghazarian, UHN, University of Toronto

 

Objectives:

At the end of this session, participants will be able to:

  • Be exposed to a new approach in difficult melanocytic lesions.
  • Be familiar with the potential pitfalls.
  • Adopt a new practical synoptic reporting system.
  • Participate in the diagnosis of a list of cases shown.
  • Increase the comfort zone and confidence in these cases.

The session will discuss and explain a new model or approach in the diagnoses of the difficult and the confusing melanocytic lesions. This will be easy to follow and to be adopted by the targeted audience. In addition, this model will minimize the potential pitfalls, mistakes or misses in the diagnoses.

 

A synoptic report which was developed by us at UHN, which will be followed during the presentation step by step, will be discussed and be included to further facilitate the understanding of this new approach. Numerous real histopathological cases of different melanocytic lesions will be shown at the end (time permitting). The audience will be actively participating in the diagnoses using the model discussed. We hope, at the end of the session, the five learning objectives listed above will be covered and fulfilled. Targeted audience: Anatomic and General pathologists, dermatopathologists, dermatologists, residents, fellows and other medical professionals who are interested in pigmented lesions.

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Symposium: Neuropathology: Nerve and Muscle Pathology
Tuesday June 23, 0800-1130

 

Chair: Gerard Jansen, University of Ottawa

 

0800-0900

Muscle Pathology for Non-Neuropathologists

Jeffrey T. Joseph, University of Calgary

 

Objectives:

At the end of this session, participants will be able to:

  • Understand some clinical criteria for obtaining a muscle biopsy.
  • Know generally how to process a muscle biopsy.
  • Approach muscle biopsy histology in a systematic manner.
  • Diagnose key categories of muscle disease.
  • Know when further neuropathology consultation should be sought.

This presentation will review major clinical indications for obtaining a muscle biopsy, discuss basic aspects about how to process a muscle biopsy, provide a systematic approach to examine a muscle biopsy glass slide, discuss several major and important categories of muscle disease, and indicate when additional neuropathology expertise should be sought.

Target audience: anatomic pathology residents, pathology assistants and histotechnologists, anatomic pathologists.

 

0900-1000

Quality Assurance Considerations in Muscle Biopsy Pathology

Julia Keith, Sunnybrook Health Sciences Centre, University of Toronto

Raj Saniasy, Sunnybrook Health Sciences Centre

 

Objectives:

At the end of this session, participants will be able to:

  • Explain the rationale for ‘special handling’ of diagnostic muscle biopsies, including the justification for enzymology and electron microscopy.
  • Apply basic QA principles to muscle pathology and state common challenges to quality in muscle pathology that occur during the pre-analytic, analytic and post-analytic stages.
  • To compare our experience troubleshooting artefactual phenomena in muscle biopsies with that of their home institution.

Muscle biopsy interpretation has long been the domain of Neuropathologists. This presentation will discuss issues surrounding muscle biopsy that are of interest to an Anatomical Pathology department including trainees and administrators. Included is a synopsis of and justification for proper handling of muscle biopsies in the laboratory, and a discussion of Quality Assurance issues arising in muscle biopsy practice. The goal is to facilitate a discussion among attendees about troubleshooting common challenges to quality in muscle biopsy pathology.

 

1000-1030 Refreshment Break

 

1030-1130

Skin Biopsy as a Diagnostic Tool in the Investigation of Peripheral Neuropathy

Jean Michaud, University of Ottawa

 

Symposium Objectives:

At the end of this session, participants will be able to:

  • Identify the most important clinical indications for requesting a skin biopsy in the exploration of possible small fiber sensory neuropathy.
  • Have a good knowledge of the innervation of the skin.
  • Explain the complexity and limitation of the technical procedure and histological analysis.
  • Analyze the histological changes in small fiber sensory and autonomic neuropathies.

The presentation will review the place of small fiber sensory neuropathy in the larger field of peripheral neuropathies with a focus on the clinical signs and symptoms supporting clinical indications for a skin biopsy. The innervation of the skin will be reviewed. The special technical protocol along with its limitations and the pathologist role will be outlined. The important histological and immunohistochemical findings will be discussed in part on a case based fashion. Finally, the potential for expanding this technique and for research will be summarized. The session will be of value to: residents, surgical pathologists, dermatopathologists, neuropathologists, pathology assistants and histotechnologists.

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Advances in Point of Care Testing
Tuesday June 23, 0830-1200

 

Chair: Nathalie Lepage, Children’s Hospital of Eastern Ontario

 

Symposium Objectives:

At the end of this session, participants will be able to:

  • Discuss current POCT practices in Canada.
  • Educate colleagues on diversity of POCT in clinical laboratories and Hospitals, and their positive impact on patient care.
  • Recognize and integrate novel biosensor technologies as they become commercially available.
  • Describe POCT methodologies in development and their potential benefit on patient care in the future.

0830-0915

The Trials and Tribulations of Point-of-Care Testing (POCT): A Clinical Biochemist’s Perspective

Julie Shaw, The Ottawa Hospital

 

Objectives:

At the end of this session, participants will be able to:

  • Define POCT.
  • Measure the scope of POCT in Canada.
  • Describe the accreditation requirements for POCT in general terms.
  • Describe the laboratory’s role in POCT.
  • Explain the challenges that face POCT from laboratory and clinical perspectives.
  • Identify strategies to overcome the challenges facing POCT.

This presentation will include data from a recent National survey on POCT in Canada. This survey looked at the scope of POCT in-use, POCT oversight and inquired on POCT challenges facing laboratories across the Country. I will discuss, in detail, the accreditation standards for POCT, with particular attention paid to those set by the Institute for Quality in Healthcare (IQMH). The presentation will discuss challenges with achieving compliance to accreditation standards and will review some of the strategies I’ve used in dealing with these challenges. I will highlight ways in which Information System (IS) and Information Technology (IT) capabilities can be leveraged to tackle challenges facing POCT in terms of operator and result management. The session will be of value to Clinical Biochemists, General Pathologists, Medical Laboratory Technologists, Physicians and Residents.

 

0915-1000

POCT is Invading the Clinical Microbiology Laboratory

Nathan Ledeboer, Medical College of Wisconsin

 

Objectives:

At the end of this session, participants will be able to:

  • Compare Molecular POCT assays for detection of influenza and Group A strep.
  • Discuss patient management benefits from infectious POCT assays in inpatient and outpatient environment.
  • Discuss outcome benefits of detection of agents of sepsis.

Significant advances have been made in POCT testing for infectious diseases. Automation and simplification of molecular assays for detection of influenza and Group A streptococcal pharyngitis have recently been released with similar sensitivity to laboratory based assays. This presentation will evaluate the clinical impact of implementation of these assays. Further this presentation will discuss improvements in outcomes associated with laboratory based POC assays for detection of agents of sepsis. This presentation will be of interest to clinical chemists, clinical microbiologists, pathology residents, medical technologists, and general and clinical pathologists.

 

1000-1030 Refreshment Break

 

1030-1115

Prospects and Challenges of Graphene-based Biosensors and Bioelectronics

Jonathan Claussen, Iowa State University

 

Objectives:

At the end of this session, participants will be able to:

  • Summarize the exceptional physiochemical properties of graphene.
  • Identify the distinct fabrication methods of graphene.
  • Determine which graphene manufacturing protocol is most suitable for a particular biomedical application.
  • Assess the effectiveness of ink jet printed graphene in biosensor applications.

Single-layer graphene is a two-dimensional (2D) material that exhibits highly favorable properties including high electrical and thermal conductivity (electron mobility ≈105 cm2/V & thermal conductivity ≈ 5000 W/mK at room temperature), elasticity (stretchability ≈ 20%) and strength (200 times > steel) as well as low molecular impermeability (near perfect blocking of molecules). Furthermore, the biocompatible nature of graphene is well-suited for cell adhesion/culture while defects/breaks within the carbon-carbon bonds are well-suited for functionalization with biorecognition agents for biosensing. Despite these advantageous material properties, graphene is still not widely used in commercial, biosensor, theranostic or other bio-related devices. The cost and complexity of manufacturing graphene on a large scale and subsequently incorporating the material into devices has impeded wider implementation. This presentation will review current graphene manufacturing protocols, the current state of biological research associated with grapehene, and potential paths forward for scalable graphene fabrication techniques. Current graphene manufacturing protocols including exfoliation, chemical vapor deposition, and epitaxial growth will all be discussed including the transfer of fabricated graphene to more biocompatible surfaces through stamping or ink jet printing. Particular emphasis will be given to ink jet printed graphene biosensors that are currently being developed in our laboratory. This session will be of value to engineers, scientists, and general pathologists.

 

1115-1200

Advances in Point of Care Testing

Aaron Wheeler, University of Toronto

 

Objectives:

At the end of this session, participants will be able to:

  • Describe digital microfluidics (DMF).
  • Reflect on where DMF may fit into POCT.
  • Describe the University of Toronto work using DMF for POCT.

There is great enthusiasm in the microfluidics community for the development of “lab on a chip” systems for portable, point-of-care (POC) analysis. A major challenge in such applications is sample preparation—in particular, bridging the gap from the macro-scale of clinical specimens to the micro-scale of efficient fluidics/detection. The last decade has seen important advances in this area, but most systems today are either (a) very simple, with modest capability to integrate sophisticated sample processing protocols, or (b) require extensive off-chip ancillary equipment to operate (pumps, valves, tubes, interconnects, etc.). In this talk, I will present work towards an alternative scheme for POC analysis that relies on “digital microfluidics” (DMF). In DMF, droplets of sample and reagents are manipulated electrostatically on open devices (with no channels) bearing an array of electrodes covered with a hydrophobic insulator. DMF has the potential to address the challenges described above, allowing for sophisticated, multi-step sample processing on devices that operate with minimal external resources. I will highlight two different applications: on-chip immunoassays for diagnosing infectious diseases (including congenital rubella syndrome) and portable mass spectrometry-based quantitation of drugs of abuse for workplace testing. These examples and others suggest that digital microfluidics may be a useful new tool in the area of POC analysis.

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Dr. Cam Coady Slide Seminar
Tuesday June 23, 1400-1700

 

Osteoblasts in Health and Disease

Andrew E. Rosenberg, University of Miami

 

Objectives:

At the end of this session, participants will be able to:

  • Summarize the functions of bone forming cells in the creation, maintenance, and remodeling of bone tissue.
  • Explain the pathophysiology of osteoporosis and how to mitigate it’s severity discuss the differential diagnosis of bone forming neoplasms.
  • Explain the features that help distinguish benign from malignant cartilage forming neoplasms.
  • Compare the features of the different types of epitheliloid vascular tumors of bone and soft tissue.
  • Summarize the features of the spectrum of notocordal cell tumors.

The lecture will provide a foundation of information regarding the embryology, morphology, molecular biology, and function of bone forming cells in the creation of bone tissue, individual bones, and the skeletal system. The important role of bone forming cells in the endocrinological control of energy metabolism, development of the male phenotype and the maintenance of male fertility will be described. Diseases caused by mutations that effect osteoblasts and their pathological expressions will be illustrated. The mechanisms underlying postmenopausal and aging osteoporosis and the role of pharmaceutical treatment will be described and natural interventions that individuals can institute in their daily lives to limit bone mass loss will be presented. Lastly, the lecture will review in detail the clinicopathologic and radiological features of a variety of benign and malignant osteoblast neoplasms. The slide presentation will include a broad spectrum of non-neoplastic and neoplastic conditions of bone and soft tissue. Entities represented include bone forming tumors, cartilage forming tumors, vascular tumors, notocordal tumors, lymphoid tumors, adipocytic tumors, fibroblastic neoplasms, myxoid neoplasms, pseudosarcomas, and select metabolic diseases.

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Recent Trends In Pathology: CAP Guidelines for p16 Immunohistochemistry in CIN2
Tuesday June 23, 1710-1755

 

Jennifer M. Dmetrichuk, McMaster University

Alice Lytwyn, McMaster University

 

Objectives:

At the end of this session, participants will be able to:

  • Assess the evidence for p16 IHC in CIN 2 lesions.
  • Appraise a systematic review.
  • Evaluate guideline recommendations.

p16 have been advocated for use in CIN 2 biopsies to identify lesions with malignant potential. We present the results of a systematic review of the literature, including a quality review and assessment of applicability of the included studies. We then present our recommendation, based on this review and formulated using the GRADE system, for discussion.

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Toxicology
Wednesday June 24, 0930-1300

 

Chair: Pierre-Olivier Hétu, CHUM

 

Symposium Objectives:

At the end of this session, participants will be able to:

  • Discuss the integration of pharmacology/toxicology laboratory testing in clinical, legal, or other specialized settings.
  • Describe the contemporary methodological approaches used in pharmacology/toxicology laboratories.
  • Discuss how to correctly interpret pharmacology/toxicology lab results in a patient-oriented manner.

0930-1015

Applications of Pharmacogenomics in the Clinic

Marie-Pierre Dubé, Institut de Cardiologie de Montréal

 

Objectives:

At the end of this session, participants will be able to:

  • List some of the pharmacogenomic tests in clinical use.
  • Compare different genetic technologies available for genetic diagnosis.
  • Discuss the available clinical guidelines for genetic tests.
  • Explain how pharmacogenomics can be used in the drug discovery process.

In this session, we will review some of the most popular pharmacogenomic tests used in regular clinical practice in the fields of oncology, cardiology, and infectious diseases. We will discuss the regulatory agencies endorsing pharmacogenetic diagnostic tests and will learn about the peer-reviewed process leading to the publication of clinical practice guidelines for pharmacogenetic tests. Technologies in use and under development for clinical genetic testing will be examined. The discovery trajectories leading to the development and implementation of genetic tests will be presented and supported with examples. Finally, we will discuss the latest developments to watch for and the future directions to expect in this field. The session will be of value to anyone with an interest in pharmacogenomics.

 

1015-1045 Refreshment Break

 

1045-1130

Discussion on the Difficulties in Keeping up to Pace with Newer Drugs and New Cheating Strategies, from the Analytical and Interpretative Point of View

Christine Ayotte, INRS – Institut Armand-Frappier, Montreal

 

Objectives:

At the end of this session, participants will be able to:

  • Discuss the list of substances and methods prohibited in sport.
  • Discuss and compare the analytical strategies involved in testing blood and urine samples.
  • Recognize new products (including designer drugs) are introduced and how they could be detected.

Adopting a fatalistic posture about doping in sports is trendy: athletes caught positive have missed a QI test, the dopers are always one step ahead, and everybody cheats. This presentation will discuss the “evolution” of doping regimens and the analytical strategies adopted in laboratories to adjust to new realities. For years, the majority of drugs taken by athletes were pharmaceutical compounds, diverted from their original therapeutic application. In the past 15 years, the list of doping agents and methods was doped with designer steroids, stimulants, peptides, hormones and copies, all available more or less easily.

 

1130-1215

Hair Testing for Drugs: Advantages, Disadvantages, Analytical Challenges, and Interpretation

Adam Negrusz, United States Drug Testing Laboratories

 

Objectives:

At the end of this session, participants will be able to:

  • Evaluate the usefulness of hair testing for drugs.
  • List advantages and disadvantages of hair testing.
  • Recognize analytical challenges and interpretational difficulties.

The proposed mechanisms of deposition of drugs in hair will be presented. In addition, the usefulness of hair testing for the purpose of drug-free workplace, child custody, in utero exposure to drugs of abuse, investigation of drug-facilitated crimes, and addiction treatment, will be discussed. The presentation will also include analytical issues such as the initial hair preparation, extraction methods, preliminary testing and confirmation. Advantages and disadvantages of hair testing will be defined.

 

1215-1300

Hair Testing for Biomarkers of Alcohol Use: Comparison with Blood and Urine

Adam Negrusz, United States Drug Testing Laboratories

 

Objectives:

At the end of this session, participants will be able to:

  • Name alcohol biomarkers in hair vs. in blood and urine.
  • Recognize the significance of alcohol biomarkers in hair and other specimens.

There are several biomarkers of alcohol use and abuse available to forensic toxicologist. Testing for alcohol biomarkers in hair will be presented in the context, among the others, of in utero exposure to alcohol, and compared with other specimens such as blood, urine or meconium. The session will be of value to forensic and clinical toxicologists, pathologists, medical residents, neonatologists, etc.

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