R701: Postmortem Biochemistry – Vitreous Humor and Blood Analysis FULL

R702: Order Sets...Gold or Fools' Gold? FULL

R703: Discordant Results Between Serum Free Light Chain Assays (sFLC) and Immunofixation Electrophoresis (IFE): Any Consolation? FULL

R704: Medical Error and Disclosure: Myth or Reality? FULL

R705: Implementation of FIT (Fecal Immunochemical Test) in the Clinical Laboratory FULL

R706: Point of Care Testing on the Edge: Challenges in Pediatrics and Obstetrics FULL

R707: Interpretation of Biochemical Tests in the Elderly FULL

R708: Pitfalls in Primary Aldosteronism Screening: Diagnosis and Tumor Localization FULL

R801: Pseudohyperkalemia: a New Twist on an Old Phenomenon FULL

R802: Lessons learned from Removing Tests from Routine Laboratory Service FULL

R803: Automation of Hemolysis, Icterus and Lipemia Reporting in the Clinical Laboratory FULL

R804: The interoperable Electronic Health Record (iEHR) in Canada: Current Status and the Need for Clinical Laboratory Professionals to Become Involved FULL

R805: High Sensitivity Troponin – A New Test FULL

R806: Alpha 1 Antitrypsin Deficiency-Which Tests Do I Order? FULL

R807: Introduction to Metabolomics Technology and Applications FULL

R808: You and Your Head: The Art of Leading while Being Led FULL

Vitreous humor specimens are an essential specimen for postmortem alcohol and biochemical investigations. Many forensic and clinical laboratories routinely analyse glucose, acetone, β-hydroxybutyrate and ethyl alchol in vitreous humor specimens. A normal vitreous humor glucose concentration excludes the possibility of hypoglycemia prior to death but does not indicate the extent of hyperglycemia prior to death. Elevated vitreous humor glucose concentrations in postmortem cases are helpful in assessing if diabetic ketoacidosis occurred prior to death along with HbA1c analysis in postmortem blood. Elevated β-hydroxybutyrate (and acetone) along with elevated glucose values in vitreous humour indicate diabetic ketoacidosis. In alcoholic ketoacidosis, one may not find elevated ethyl alcohol in biological fluids. β-hydroxybutyrate and acetone are often elevated in alcoholic ketoacidosis but the vitreous humor glucose concentration is generally much lower than in diabetic ketoacidosis. Vitreous humor ethyl alcohol analysis is especially informative when postmortem blood alcohol is of limited value due to putrefaction and/or possible contamination due to trauma, etc. Biochemical analysis of ketone bodies such as acetone and β-hydroxybutyrate, glucose and ethyl alcohol provide valuable information in the determination of the manner of death, especially when there is no anatomical cause of death and toxicology investigations are negative.

Objectives:

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

• Understand the value of ketone analysis in assessing diabetes mellitus and alcoholic ketoacidosis related fatalities;
• Appreciate the limitations of glucose analysis in VH and role for blood HbA1c;
• Evaluate the essential role of vitreous humor biochemical analysis in death investigations when there is no obvious anatomical cause of death.

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Many hospitals are developing tools to produce order sets for patient management. Most of these order sets include a diagnostic component that may impact the laboratory. Setting a good working relationships in the process of the drive towards computerized physician order entry will be important in protecting the laboratory budget in the future.

The roundtable will allow participants the opportunity to explore the concept of order sets, get exposure to the limited evidence for order sets and understand why hospitals and physicians use order sets. The possible impact of order sets on laboratory practice will be discussed. The presentation will give participants the basic tools to help them work with the hospitals in the introduction and implementation of order sets.

Objectives:

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

• Define order set;
• Become familiar with the evidence base for order sets in clinical practice;
• Develop an understanding of how order sets can impact laboratory utilization.

Click here: Dr. Andrew C. Don-Wauchope biography

Dr. Andrew Craig Don-Wauchope
Dr Don-Wauchope has a clinical practice in lipidology and cardiovascular risk reduction and is involved with the core laboratory and special chemistry laboratory at the McMaster University Medical Centre. He is an educator for both undergraduate and postgraduate medical education and has an interest in curriculum design and implementation. His research interests are varied and range from basic science through to clinical laboratory test utilization. Recently he has been involved in with the order sets committee at Hamilton Health Sciences and the planning of the laboratory tests included in order sets. The Hamilton Regional Laboratory Medicine Program has removed a number of tests from routine practice as part of a utilization initiative over the past year.
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Monoclonal gammopathies are characterized by the presence of monoclonal immunoglobulins or fragments (so-called M-component or MC), traditionally detected by serum and/or urine Immunofixation Electrophoresis (IFE). MC can also be detected by measuring serum polyclonal free light chain concentrations (sFLC): an abnormal ratio of the free kappa to free lambda light chain concentrations (rFLC) suggests its presence. However, not all abnormal rFLC are associated with positive IFEs. A normal rFLC with a positive IFE almost invariably indicate a good prognosis. The meaning of an abnormal rFLC but negative IFE is, however, not that straight forward. An understanding of both the analytical and clinical performance as well as the limitations of the two techniques is essential in providing proper laboratory guidance to physicians on test utilization and interpretation.

The objectives of this round table are to (1) review the analytical performance and limitations of both IFE and sFLC, (2) describe situations under which results of the two techniques are expected to differ and their clinical implications, in light of findings from an in-house clinical audit and recent studies reported in the literature, and (3) discuss how sFLC results should be interpreted and commented on laboratory reports.

Objectives:

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

• Improve their understanding of the techniques (and their limitations) used for detecting monoclonal gammopathies;
• Describe situations and implications under which results of FLC and IFE differ;
• Provide proper guidance on interpretation included in laboratory reports to clinicians.

Click here: Dr. P.C. Chan biography

P. C. Chan, Ph.D., DABCC, FCACB
P. C. Chan obtained his MSc in Clinical Biochemistry from University of Western Australia, PhD in Medical Science from the University of Calgary, and post-doctoral Diploma in Clinical Chemistry and Laboratory Medicine from the University of Toronto.
He is certified as a Fellow in Clinical Chemistry with the Canadian Academy of Clinical Biochemistry, as well as a Diplomate in both Clinical Chemistry and Molecular Diagnostics with the American Board of Clinical Chemistry.
As a practicing Clinical Biochemist, PC is professionally active and has served in various capacities in the Clinical Chemistry community: Head of Publication, CSCC (current), President-Elect of CCABP (current), Chair and Chair-Elect of AACC Upstate New York Section, Councilor of OSCC, OLA and CAP Assessor, and Member of Advisory Committee of local MLS programs and QMP-LS Endocrinology/Immunology Committee. He lectures regularly at the University of Toronto and Michener Institute, and is appointed as Assistant Professor and Clinical Adjunct Professor at the two institutions respectively. His research interests span from genetic predisposition to diseases to investigation of monoclonal gammopathies and POC testing.
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The patient safety agenda, propelled by the Institute of Medicine report in 1999, is emerging as an organizational priority of current health care systems. Errors are inherent in all human processes and therefore will continue to occur despite the profession’s best efforts. The failure in appropriately disclosing an error causes distress to the patients who may have suffered harm during care. We will review and compare the main concepts in medical error and disclosure and discuss various medical error disclosure initiatives across the globe. The Canadian provincial initiatives, though similar in content, remain isolated because of their non-mandatory nature and absence of federal or provincial laws on disclosure. Error disclosure policy requires integration of various aspects including bioethics, physician-patient communication, quality of care, and team-based care delivery. The complexities of medical error disclosure to patients present ideal opportunities for medical educators to probe how learners are balancing the ethical complexities involved in error disclosure with other related fields. We believe that disclosure of a critical event and its integration into a ‘no-fault’ model should be an integral part of the institutional accreditation process.

Objectives:

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

• Have a quality perspective on medical error and disclosure;
• Provide explanations for common barriers for the medical error disclosure process;
• Have a global view of medical error disclosure policies in Canada and around the globe.

Click here: Dr. Jay Kalra biography

Dr. Jay Kalra
Dr. Jay Kalra, an educator, researcher and quality health care advocate, is a Professor of Pathology at the University of Saskatchewan and has served as Head of the Department of Pathology and Head of the Department of Laboratory Medicine, Saskatoon District Health. Dr. Kalra has served as the President of the Canadian Association of Medical Biochemists, the Intersociety Council of Laboratory Medicine of Canada, the Canadian Chairs of Pathology and Laboratory Medicine, the Canadian Association of Pathologists and as the Director of Saskatchewan Stroke Research Centre.
Jay is a pioneer in establishing guidelines for thyroid-function testing, quality assurance programs and laboratory utilization in health care. Dr Kalra is advancing the agenda, nationally and internationally, related to quality care and patient safety including risk management, ethical issues, disclosure of medical/clinical error issues and related policies and practices.
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The Canadian Association of Gastroenterology published a position statement of screening patients for colorectal cancer in December 2010. The recommendations included annual fecal occult blood testing, preferably by FIT (Fecal Immunochemical Test). The advantages of FIT include increased sensitivity, specificity, and easier collection procedure, as well as the requirement for only 1 specimen and no dietary restrictions.

This roundtable deals with the implementation of an automated FIT method in a BC community lab in September 2010 in and the practical matters of validation, reporting of results, requirement for and determination of a borderline interval, and correlation with the traditional guaiac-based slide testing for fecal occult blood. Reagent costs and the introduction and marketing of this test to physicians and patients as a patient-pay basis will also be imparted and debated. This session is geared for participants who want to learn more about FIT, for those intending to implement FIT in their laboratory, and for those already familiar with FIT and who want to discuss their experience.

Objectives:

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

• Understand the differences in sensitivity and specificity between the guiaic and immunochemical methods for occult blood testing;
• Validate a automated FIT method;
• Implement FIT in the laboratory.

Click here: Dr. Cheryl Tomalty biography

Dr. Cheryl Tomalty
Dr. Cheryl Tomalty graduated with a PhD in Biochemistry from the University of Ottawa and a post-doctoral Diploma in Clinical Biochemistry from the University of Toronto. She began her career as a Clinical Chemist at the North York General Hospital in 1981. She received her certification in Clinical Biochemistry from the Canadian Academy of Clinical Biochemists (CACB) in 1982.
Dr. Tomalty joined Dynacare Medical Labs (now Gamma-Dynacare) in Ottawa in 1985 as a Clinical Chemist, and was later appointed as Technical Director of Chemistry and Hematology. She served on the Professional Advisory Committee of the Medical Technologist program of Algonquin College Ottawa for several years. In 1994, she became the Laboratory Coordinator of the Montreal General Hospital responsible for administration of all the clinical laboratories, and she went on to lead the laboratory integration team of the three hospitals of the McGill University Health Centre. She then returned to Ottawa in 2000 as a Clinical Chemist with Abbott Point of Care, manufacturer of the i-STAT System, located in Ottawa.
Dr. Tomalty is a Founding fellow in the CABC and she was President of the Ontario Society of Clinical Chemists from 2005-2007. Dr. Tomalty joined LifeLabs based at their Burnaby Reference Laboratory in November 2007. She was appointed to the Department of Pathology and Laboratory Medicine at the University of British Columbia as a Clinical Instructor in December 2008. She and her husband Francis are delighted with their move to Vancouver. They have 2 sons and a daughter who are all back east.
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Pediatric and obstetric populations have unique clinical requirements for point of care testing. The spectrum of clinical conditions and guidelines for investigation, a minimal intervention approach, sample volume and quality considerations, and context-specific turn around time requirements may favour implementation of point of care testing in ways that differ from a general adult hospital environment. Conditions such as hypertensive pregnancy, preterm labour, fetal distress, newborn jaundice and neonatal hypoglycemia, and settings such as neonatal and pediatric intensive care, pediatric emergency department, and specialty outpatient clinics have challenged and shaped the Point of Care Testing Program at Children’s & Women’s Health Centre of British Columbia. Participants are invited to reflect and share insights about indications for point of care testing, practicalities of method evaluation, selection of operators and quality assurance in the pediatric/obstetric environment.

Objectives:

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

• Identify five clinical conditions in pediatrics and obstetrics that may need special point of care testing initiatives;
• Outline approaches to evaluating point of care testing methods involving blood, urine or transcutaneous measurements in pediatric/obstetric populations;
• Evaluate their personal experience with pediatric/obstetric point of care testing with a view to determining future directions.

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Several studies have sought to define reference intervals for older persons. However, there is a limitation in this approach as it is difficult to use reference intervals in this heterogeneous group of people in comparison to the younger adults. This is because of increased use of medications, particularly for chronic diseases, acute disease, muted symptoms, and age-related physiological and biochemical changes. There is a gradual decay of homeostatic mechanisms which increase the susceptibility of older persons to disease and decrease their ability to recover from them. Differentiation between age-related changes and disease-related biochemical changes is difficult and not well understood. Modest changes in a younger person may not identify an abnormality which requires attention, but in an older person slight changes are associated with increased morbidity and mortality if no corrective action is taken. Overall, studies have shown many biochemical tests are not significantly different from the typical adult reference interval. Of those which are different it is usually a wider reference interval rather than a shift of the reference interval to a lower or higher concentration. The older person is unlikely to be cared by a physician who specializes in geriatrics which increases the risk of missing or delaying a diagnosis and providing appropriate disease management. The patterns of disease presentation in the older group can be quite different but the laboratory can assist the non-specialist by providing test interpretation focused on this age group.

Objectives:

At the conclusion of this session, participants will:

• Gain an understanding of the difference in the interpretation of biochemical tests between normal aging and disease;
• Be able to highlight key biochemical tests which require different interpretation in the elderly compared to younger adults;
• Recognize the value of geriatric biochemist.

Click here: Dr. Cynthia Balion biography

Dr. Cynthia Balion
Dr. Cynthia Balion is an Associate Professor in the Department of Pathology and Molecular Medicine at the McMaster University and Clinical Biochemist for the Hamilton Regional Laboratory Medicine Program. Her research interests are in the discovery and evaluation of biomarkers for Alzheimer’s disease and aging, systematic reviews of diagnostic tests, and new approaches to enhancing laboratory test reporting. She is also the Director of the Biorepository and Bioanalysis Centre (BBC) for the Canadian Longitudinal Study on Aging (CLSA).
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Primary aldosteronism (PA) screening, diagnosis, and subtype classification should, in principle, be fairly straight forward. Unfortunately, from the perspective of the clinical laboratorian, this is not the case. Bias problems between antibody-based assays for aldosterone and plasma renin activity make adoption of published aldosterone to renin ratio cutoffs very difficult. The advent of manual and automated mass assays for renin has added another confounding variable. In addition, antihypertensive medications, especially in combination, can have a marked physiological effect and generally decrease the sensitivity of the screening and diagnostic process.

Once a diagnosis of PA is established, most patients go on to have adrenal venous sampling performed. Collection of these samples presents the radiologist a number of technical challenges in large part because of the anatomy of the right adrenal vein. From the laboratory perspective, there are important analytical issues that must be considered—specifically around dilution effects. Further, the laboratorian can perform a great service to the radiologist, internist, and especially the patient, if they release an interpretation as part of their laboratory report. This is simply a case of learning by experience: the laboratorian may see 40-60 AVS cases per annum whereas the internist may only see one or two.

We will share our experience of how to interpret AVS samples, the value of ACTH stimulation and some of the interpretive pitfalls that exist.

Objectives:

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

• Understand how methodological bias can affect the aldosterone to renin ratio and its appropriate interpretation;
• Identify the effect of antihypertensive medications and patient preparation on aldosterone and renin in the screening and diagnostic phases;
• Appropriately handle, analyze, and interpret adrenal vein sampling aldosterone and cortisol results.

Click here: Dr. Daniel Holmes biography

Dr. Daniel Holmes
Daniel Holmes did his undergraduate degree in Chemical Physics from the University of Toronto. He went to medical school at the University of British Columbia (UBC) where he also did his residency in Medical Biochemistry. He is a Clinical Assistant Professor of Pathology and Laboratory Medicine at UBC and Division Head of Clinical Chemistry at St. Paul's Hospital in Vancouver. Interests include laboratory medicine statistics, clinical endocrinology with special focus on secondary hypertension, clinical lipidology and clinical mass spectrometry. On vacations Dan likes to canoe with his wife Kathy who works as a teacher at Pacific Academy School in Surrey, BC and Childrens' Ministry Director at Bethany Baptist Church in Richmond, BC. They have three children aged four, seven, and nine years.
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Severe hyperkalemia is a potentially life-threatening condition which needs immediate medical intervention. Pseudohyperkalemia can also be misleading and result in wrong interpretation and inappropriate patient management. Immediate recognition and appropriate interpretation of pseudohyperkalemia would, on the other hand, prevent misdiagnosis and unnecessary intervention. Pseudohyperkalemia occurs due to excessive leakage of potassium from cells, during or after blood is drawn. Pseudohyperkalemia is usually induced by hemolysis due to mechanical stress during venipuncture and transportation, excessive tourniquet time or fist clenching during phlebotomy. Pseudohyperkalemia has been increasingly seen in many hematological disorders such as leukocytosis and thrombocytosis. Reverse pseudohyperkalemia has recently been reported in leukemic patients in whom the plasma potassium levels are greater than the serum potassium levels due to heparin-induced cell membrane damage.

In laboratory setting, the following measures should be taken to investigate and prevent pseudohyperkalemia: 1. rule out specimen hemolysis by visual inspection; 2. minimize excessive trauma to the sample to avoid hemolysis; 3. prompt centrifugation and assay should be performed; 4. if high potassium was seen in serum samples, repeat measurement of potassium for both plasma and serum specimens should be performed to compare the disparate results; 5. the presence of pseudohyperkalemia should be considered in any patient with marked leukocytosis or thrombocytosis; 6. in the presence of pseudohyperkalemia in heparinized plasma, whole blood specimen collected in balanced heparin syringe should be recommend and determined on the blood gas analyzer in the setting of leukocytosis.

Objectives:

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

• Recognize the common causes of pseudohyperkalemia;
• Understand the causes of uncommon fictitious and reverse pseudohyperkelemia;
• Interpret, investigate, and prevent pseudohyperkalemia.

Click here: Dr. Qing-He Meng biography

Qing-He Meng PhD, MD, DABCC, FCACB, FACB
Qing-He Meng received his medical education and had practiced as a physician for 8 years in China. He obtained his PhD in Clinical Chemistry from the University of Helsinki, Finland, in 1999. Following postdoctoral training in Clinical Chemistry at McMaster University, he assumed the position of Clinical Chemist/Assistant Professor at Royal University Hospital, University of Saskatchewan, Canada in 2003. He then moved to the Hospital for Sick Children, the University of Toronto and took the position as a Clinical Chemist and Assistant Professor in 2006. Currently he is Associate Director of Clinical Chemistry at Royal University Hospital and Clinical Professor at the University of Saskatchewan, Canada. Qing is a Diplomate of the American Board of Clinical Chemistry (ABCC) and Fellows of NACB (FACB) and the Canadian Academy of Clinical Biochemistry (FCACB). In addition to laboratory service, he is also actively involved in research and teaching at various levels. His research interests focus on lipids, diabetes, atherosclerosis, and cardiac markers. He has received substantial funds and has published over 40 papers in refereed journals. He serves as a reviewer for several journals and AACC annual meeting abstract committee. He is on the editorial board of Clinica Chimica Acta. He is also a Lab inspector for the CAP and the Chair of the Credentials Committee of the Canadian Academy of Clinical Biochemistry. Currently he is the president of North American Chinese Clinical Chemists Association.
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There is ongoing pressure to introduce new tests in laboratory medicine. However, very little or no attention is given to removing outdated tests or tests with little or no clinical utility. In some instances laboratories negotiate replacement of one test by a newer test. More often both the new and the old test run in parallel. Some tests provide little or no clinically useful information but have traditionally been used and are thus difficult to remove from practice. The round table will be based on the experience of removing tests from service over the past year. Background will be provided as to why tests were chosen for removal, describe the process of removal and the lessons that we have learned through this process. This will facilitate removing tests in a more smooth manner in the future.

Objectives:

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

• Identify clinical reasons for removing tests from routine service;
• To explain the process of removing a test from routine service;
• To identify potential problems associated with removing a test from routine service.

Click here: Dr. Andrew C. Don-Wauchope biography

Dr. Andrew Craig Don-Wauchope
Dr Don-Wauchope has a clinical practice in lipidology and cardiovascular risk reduction and is involved with the core laboratory and special chemistry laboratory at the McMaster University Medical Centre. He is an educator for both undergraduate and postgraduate medical education and has an interest in curriculum design and implementation. His research interests are varied and range from basic science through to clinical laboratory test utilization. Recently he has been involved in with the order sets committee at Hamilton Health Sciences and the planning of the laboratory tests included in order sets. The Hamilton Regional Laboratory Medicine Program has removed a number of tests from routine practice as part of a utilization initiative over the past year.
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Reporting of the presence of common interferences hemolysis (H), lipemia (L) and iceterus (I) to physicians is crucial for the accurate interpretation of laboratory results. Both the reporting of the interference as well as an interpretation of how the test result is affected is mandated by regulatory organizations (eg. QMPLS in Ontario). Numerous chemistry analyzers on the market now offer applications to detect the degree of hemolysis, lipemia and icterus in clinical samples in an automated fashion. Additionally, both instrument vendors’ technical bulletins and independently published literature is available to correlate the numerical values reported from the instrument to the degree of interference for each chemistry or immunoassay test. Implementing a fully automated reporting solution for HIL remains a challenge for many clinical laboratories.

This session will review key considerations for designing a fully automated reporting system for HIL:

1. What and what not to automate?
2. How to report results with interference and when not to report results?
3. Which tests/sample types should qualify for HIL reporting and which should not?
4. How to integrate manual benches with automated benches to harmonize reporting across the whole laboratory?
5. How to handle single departments/physicians who would like “custom” reports?

Objectives:

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

• Describe approaches for standardizing the reporting process for common interferents: hemolysis (H), icterus(I) and lipemia (L);
• Understand both the benefits and limitations of automated HIL detection and reporting;
• Be aware of LIS considerations involved in automating HIL reporting.

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Canada, like other countries of the developed world, has recognized the importance of the iEHR as a means of improving health care for its citizens and potentially producing economies in the health care system. This recognition is strongly supported by senior levels of government and the Canadian and Provincial Medical Associations.

The agency responsible for coordination of activities related to the iEHR is Canada Health Infoway (Infoway), which has been working since 2001 with various partners to create the pieces required to form the iEHR system. Infoway is a child of the Federal, Provincial and Territorial governments, with funding to date exceeding one billion dollars.

The “i” of iEHR stands for “interoperable”, and in the current context that implies seamless communication between the components of the system, as implemented in different parts of the country. This will demand adherence to standards, and many of Infoway’s projects are related to the adoption of existing standards or the development of new standards. For the clinical laboratories, Infoway has agreed that the standard for units will be the System International (SI), supplemented in some areas with SNOMED-CT.

The current status of the iEHR will be discussed, but because each province and territory jealously guards its own health care system, and because there is no uniform way to assess the true degree of implementation of iEHRs, jurisdictional comparison is difficult.

Laboratory professionals can become involved through participation in Infoway Canada’s Standards Collaborative Working Group 5 and by ensuring that their laboratories adopt SC standards.

Objectives:

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

• Understand the role of Infoway Canada in facilitating the development of an interoperable electronic health record (iEHR);
• Appreciate the current status of the iEHR in Canada;
• Recognize the essential role of the laboratory professional in the successful implementation of the iEHR.

Click here: Dr. J. Gilbert Hill biography

J. Gilbert Hill MD PhD
Received B.Sc. (Engineering Chemistry, 1951) degree from Queen's University, Kingston Ontario, M.D. degree (1956) from McGill University, Montreal, Quebec and Ph.D. (Biochemistry, 1963) from Queen's University. Founding Fellow of the Canadian Academy of Clinical Biochemistry. After 30 years service at the Hospital For Sick Children in Toronto, retired in 1995 as Biochemist-in-Chief. Currently Consultant in Information Technology and member of the Honorary Medical Staff at the Hospital For Sick Children, and Professor Emeritus, Department of Laboratory Medicine and Pathobiology at the University of Toronto.
Professional activities include:
Ontario Society of Clinical Chemists: President 1970-71; Lifetime Achievement Award 2005
Canadian Society of Clinical Chemists: President 1976-77; Ames Award 1982
International Federation of Clinical Chemists: Treasurer 1979-81; Secretary 1982-84
Intersociety Council of Laboratory Medicine of Canada: President 1984-86
Ontario Medical Association: Honorary Life Memberhip 1995
From 1975 to 1997 served on various committees of the Laboratory Proficiency Testing Program of Ontario (LPTP, now called QMP-LS), including fifteen years as Chairman of the Clinical Chemistry committee.
For the past twenty years, actively involved through membership in key committees in the development and implementation of standards for the electronic transmission of clinical laboratory information: 1985 to 1997, Titular or Associate member of the joint Commission on Nomenclature, Properties and Units of the International Federation of Clinical Chemistry (IFCC) and the International Union of Pure and Applied Chemistry (IUPAC), and since 1995 member of the Laboratory committee of the Logical Observation Identifier Names and Codes (LOINC) project at the Regenstrief Institute for Medical Research at Indiana University/Purdue University (IUPUI) in Indianapolis. Actively involved with the Ontario Laboratory Information System (OLIS) project from 1990 to 2005; Consultant with the electronic Child Health Network (eCHN) project since its commencement in 1997 at the Hospital For Sick Children, member of the pan Canadian Standards Group (pCSG laboratory) of Infoway Canada since 2005, and member of the Standards Collaborative Strategic Committee (SCSC) of Infoway Canada since 2007.
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The clinical application of high sensitivity cardiac troponin assays is emerging in various clinical settings outside of the acute coronary syndrome setting. Despite recent high profile publications there is much confusion in the clinical community regarding what exactly constitutes a high sensitivity assay and what is the best way to interpret elevations. This round table will begin to discuss these important areas.

Objectives:

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

• Communicate to clinical colleagues what metrics are used to classify a troponin assay as a high sensitivity assay;
• Appreciate the utility of these high sensitivity assays outside of the acute coronary syndrome setting;
• Realize the importance of clinical chemists in the interpretation of these assays.

Click here: Dr. Pete Kavsak biography

Dr. Pete Kavsak
Pete Kavsak is a clinical biochemist within the Hamilton Regional Laboratory Medicine Program and an Assistant Professor in the Department of Pathology and Molecular Medicine at McMaster University. Current interests include understanding the role of cardiac troponin in and outside of the acute coronary syndrome setting.
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Alpha 1 antitrypsin deficiency (AATD) is a well known and common disorder, particularly in patients of European descent. The disorder may manifest as a multisystem disorder affecting primarily the pulmonary and hepatic systems as well as others. Clinical expressivity is highly variable with several environmental and genetic modifiers of the clinical phenotype now recognized. Treatment options include optimization of modifiable risk factors, including correction of deficient plasma AAT levels. As many cases are clinically unrecognized, an efficient but simple investigation protocol is required. Each diagnostic test, by itself, is fallable and thus an algorithm incorporating the complementary test result information is required. Most tests now require minimal sample requirements and thus can be used readily on both neonates and adults.
During this roundtable, we will discuss all of these aspects of AATD and finally compare and contrast approaches to investigation of AATD. Participants are invited to submit questions / proposals for investigation in advance of the meeting.

Objectives:

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

• Understand the clinical phenotypes along with modifiers of the disease expressivity;
• Understand the tests available for the investigation of A1AT Deficiency (AATD) along with their pitfalls;
• Suggest an optimal algorithm for the investigation of AATD.

Click here: Dr. Andre Mattman biography

Dr. Andre Mattman
Andre Mattman is a medical biochemist with a joint appointment in the dept of pathology and laboratory medicine at St Paul's Hospital and the department of internal medicine at Vancouver General Hospital where he is a consultant in the Adult Metabolic Disease Clinic. His current laboratory medicine interests focuses on testing for alpha 1 antitrypsin deficiency as well as previous interests related to prenatal screening and heavy metal testing. His clinical intersts are in mitochondrial disease, lysosomal storage disorders and other adult onset inborn errors of metabolism.
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This roundtable has been designed to provide an introduction to metabolomics technology and applications for life science and clinical researchers wishing to investigate or become involved in nuclear magnetic resonance (NMR) spectroscopy or mass spectrometry (MS) – based metabolomics studies. Roundtable participants will be introduced to the field of metabolomics and the principles of NMR and MS technologies including the strengths and limitations of each technique, sample preparation requirements, and spectral acquisition and processing. Mathematical and statistical methods for extracting relevant information from complex data will be touched upon. Depending on participant interest, select case studies (biomarker discovery, disease mechanism, drug toxicity, or nutrition) will be presented to reveal practical applications of metabolomics and creative ways to report data. Questions, thoughts, and personal experiences are encouraged to be shared with the group. Clinical biochemists can improve health through metabolomics research. The goal is to determine how we can overcome challenges to advance the field to its full potential.

Objectives:

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

• Define metabolomics and describe the general work flow of a metabolomics project;
• Discuss the principle, strengths, and limitations of nuclear magnetic resonance (NMR) spectroscopy and mass spectrometry for analysis of metabolites in biological specimens;
• Identify metabolomics applications in the field of clinical biochemistry.

Click here: Dr. Kareena Schnabl biography

Dr. Kareena Schnabl
Kareena Schnabl received her undergraduate education in Pharmacology at the University of Alberta and a Master’s degree in Pharmaceutical Sciences, with certification in Higher Education Teaching, at the University of Manitoba. She returned to the University of Alberta to complete a PhD in Experimental Medicine with the Departments of Medicine (Division of Gastroenterology) and Agricultural, Food and Nutritional Sciences. To develop her growing interest in Clinical Chemistry, Kareena completed postgraduate clinical chemistry training at the University of Toronto and achieved certification with the Canadian Academy of Clinical Biochemistry. Her research experience is in the area of glycolipid biochemistry, multiplex immunoassays, pediatric inflammatory bowel disease, point of care testing, and vitamin D. She began her chemistry career as a metabolomics consultant with Chenomx Inc., a small biotechnology company in Edmonton. Kareena is excited to have settled home in Alberta and has recently joined the medical consultant team at DynaLIFEDx, as a Clinical Chemist. She is looking forward to developing her personal interests in medical education, diagnostic immunology, drug safety, molecular diagnostics, and nutritional biochemistry with the medical community.
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Using anecdotes from a thirty year career spanning a Pediatric and Medical Biochemistry residency to serving as Pathology and Laboratory Medicine Department Head, I will illustrate how to enjoy a stimulating and rewarding career in Laboratory Medicine through good times and bad.

As a section or division head, you are sandwiched between the Scylla of being responsible to your Department Head, and the Charybdis of managing the staff who are responsible to you.

We will consider some of the characteristics needed to successfully navigate this tricky strait without being consumed by the many-headed monster of budget cuts, consultants and restructuring, or being sucked into the whirlpool of never-ending demands on your time.

Throughout I will emphasize the importance of emerging at the end of your career journey with your curiosity, sense of humour, sense of self and your integrity intact.

Objectives:

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

• Differentiate between management and leadership;
• Understand how to work positively with both your staff and department head;
• Identify key steps to achieve your goals.

Click here: Dr. Gillian Lockitch biography

Dr. Gillian Lockitch
With dual specialties in Paediatrics and Medical Biochemistry, Gillian Lockitch served as Genes, Elements and Metabolism (GEM) Program Head and later Department Head of Pathology & Laboratory Medicine at British Columbia's Children’s and Women’s Hospital. At various times she also served as Chair of the BC Society of Clinical Chemists and the Pediatric Chemistry division of the American Association for Clinical Chemistry, and as President of the Canadian Association of Medical Biochemists, and the International Association for Pediatric Laboratory Medicine. Now retired from medical practice she is a Professor Emerita at the University of British Columbia and also enjoying a second career in lifestyle/entertainment journalism as writer/publisher of www.reviewfromthehouse.com.
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